Table 1 Illustrative examples of negotiation of access to slum sites

Kenya

The process for obtaining access to the two slum sites in Nairobi, Kenya firstly required engagement with the Nairobi City County Health Management team (HMT) to inform them of the planned research. A research protocol and ethical clearance letter from the nationally accredited Ethical Review Board was submitted. Following review, a research authorization letter was issued by the research committee copied to the relevant sub-county authorities. Pre-requisite authorization for the project was also obtained from the National Commission for Science, Technology and Innovation (NACOSTI). Subsequent meetings were held with the respective sub-county HMTs who made a recommendation to work with community health assistants who were conversant with different health service providers in the area. In addition, the local research team engaged with the local government chiefs based within the slum sites who arranged for meetings with Community Advisory Committees. The Community Advisory Committees comprising community leaders and representatives were briefed on the project objectives and given opportunity to air concerns regarding upcoming project activities. Access to the slum sites was granted during these meetings with CACs. Finally, an inception meeting was held in Nairobi to bring together county government officials, representatives from community advisory teams as well as NGO representatives in each slum site in order to explain the research project in more detail and how they can be involved as the research progresses.

Nigeria

Obtaining access to the three slum sites located in Ibadan and Lagos firstly required permission from the Governments of Oyo and Lagos States and to inform the chairpersons of the three relevant Local Government Areas (LGAs; the third-tier administrative unit). Once this permission was granted and advocacy visits had been made to the LGA chairpersons, researchers met with the local traditional leaders’ council of each of the communities. The site in Lagos had one traditional chief, while one in Ibadan had a committee of several local chiefs, with one selected by them as spokesperson. The remaining site in Ibadan has two local chiefs, one for the indigenous Yoruba community and another for the sizeable migrant Hausa ethnic group resident there. The study was explained to each traditional chief-in-council and their cooperation for the data collection exercises to be carried out in the communities was sought. Researchers also met with health practitioners operating within the study slum sites, which included traditional healers, patent medicine vendors, clinic matrons and proprietors of health facilities to ensure they were aware of the study, willing to provide information and welcomed researcher involvement. Lastly, in order to gain access to information about health facilities in the areas of study, permission was obtained from the State Ministry of Health and the Medical Officer of Health in each of the LGAs.