WASH policy landscape: exploring context, process, content, and actors in childcare centres in Nairobi’s informal settlements

Abstract Introduction Adequate water, sanitation, and hygiene (WASH) services are fundamental to health and development. However, many underserved areas such as informal settlements lack these services, creating significant infrastructural and public health challenges. Inadequate WASH infrastructure in Nairobi’s informal settlements reveal significant gaps in childcare centre guidelines. Integrating robust guidelines and quality WASH services into childcare centres optimize operations and directly improves children’s wellbeing. This study explores the policy environment governing WASH service delivery in these settings. We analysed the policy landscape’s content, context, actors, and processes. Methods This study employed a dual-methodological approach within Nairobi’s informal settlements. First, we systematically reviewed 25 policy documents to analyse the content, context, actors, and processes governing WASH guidelines, utilizing Walt and Gilson’s Policy Triangle Framework. Second, we conducted 32 in-depth interviews (IDIs) and 8 key informant interviews (KIIs) with policymakers, parents, and childcare providers. These interviews used the same framework to identify policy gaps and practical implementation barriers. Results Results revealed a systemic fragmentation within the WASH policy landscape. While water (88%) and sanitation (80%) guidelines appeared frequently, hygiene guidelines were significantly less represented (68%). Overlapping mandates among the Ministries of Health, Education, and Water and Sanitation hindered effective implementation of policy guidelines. Gaps in the policy process and fragmented inter-sectoral coordination weakened the overall governance of WASH services and practices. This lack of institutional synergy ultimately resulted in suboptimal and precarious WASH outcomes within informal settlements. Conclusions Current WASH policy frameworks are misaligned with the realities of informal urban settlements. Existing documents have inadequate strategies for these environments and for children under five. This contextual disconnect, coupled with the barriers of persistent poverty, means that service delivery often remains stalled or unsustainable. Bridging the gap between policy and practice requires moving beyond the policy content to the “how” of the policy process. Relevant actors in the sector should move towards a governance model that prioritizes a cohesive, politically supported, and monitored architecture for tangible community impact.