Health Facility Characteristics Associated with Health System Responsiveness in Nairobi County Healthcare Services

Background: Health system responsiveness (HSR) reflects how well health services meet clients’ legitimate non-clinical expectations, including dignity, communication, autonomy, confidentiality, and prompt attention. In Nairobi County, persistent structural and operational constraints within public healthcare facilities continue to influence patients’ experience, yet empirical evidence linking facility-level characteristics to HSR remains limited. This study examined facility-level factors associated with client-perceived HSR in public healthcare facilities in Nairobi County. Methods: A repeated cross-sectional analytical study was conducted among 1,508 antenatal care clients aged 18 years and above across eight public healthcare facilities in Nairobi County. Client-perceived responsiveness was measured using the World Health Organization HSR questionnaire covering seven domains on a five-point Likert scale. Facility-level data were collected using structured assessment checklists administered to key informants. Mean responsiveness scores were classified as responsive (≥4.0) or not responsive (<4.0). Descriptive statistics were computed, and Fisher’s Exact Test was used to assess associations between facility characteristics and responsiveness status due to the small number of facilities and low expected cell counts. Results: Substantial facility-level inadequacies were identified, including inadequate equipment (87.5%), insufficient supplies (100%), understaffing (100%), high workload (87.5%), and high client volume (87.5%). Client-perceived responsiveness was significantly associated with staffing levels (p = 0.011), equipment availability (p = 0.017), workload (p = 0.017), and client volume (p = 0.017). The presence of policies and guidelines was not significantly associated with responsiveness (p = 0.345). Facilities experiencing greater operational pressure were more likely to be perceived as not responsive. Conclusion: Facility readiness is a critical determinant of health system responsiveness in public healthcare facilities. Structural and operational constraints, particularly staffing shortages, inadequate equipment, and excessive workload, undermine client experience despite the presence of formal policies. Strengthening facility capacity and managing service pressure are essential for improving responsiveness and advancing people-centred care in resource-constrained urban health systems.