The effectiveness of Community Health Units (CHU) in delivering child immunization services is a critical component of public health in urban informal settlements. In Nairobi County, CHU are tasked with ensuring that all children receive necessary immunizations. However, the effectiveness of these units is influenced by several factors, including the Accountability System and Human Resource Management practices. Despite the implementation of CHU, a significant proportion of children in these informal settlements remain unimmunized. Previous studies have not sufficiently explored how the clarity of accountability systems and adherence to human resource practices impact the effectiveness of CHU in delivering child immunization services. This gap necessitates an in-depth examination to enhance the performance of CHU in such vulnerable populations. We aimed to examine the influence of the accountability system and Human Resource Management practices on the effectiveness of CHU in delivering child immunization services in urban informal settlements in Nairobi County, Kenya. The study adopted a cross-sectional descriptive design, utilizing an interpretivist research philosophy to explore the depth of the relationship between the independent variables (Accountability System and Human Resource Management) and the dependent variable (effectiveness of CHU delivery of child immunization services). A sample of 354 Community Health Workers was selected from 449 fully functional CHU in the informal settlements using stratified simple random sampling. Data was collected via a structured questionnaire and analyzed using descriptive statistics and binary logistic regression to determine the relationship between variables using SPSS version 26. The findings revealed that a clear accountability system significantly increased the effectiveness of CHU in delivering child immunization services, with an odds ratio of 0.140. Similarly, adherence to standard human resource practices significantly improved CHU performance, with an odds ratio of 0.207. The logistic regression model indicated that 43.1% of the variance in CHU effectiveness could be explained by the independent variables. The results underscored the importance of clear communication channels, community involvement in monitoring and evaluation, and consistent support supervision as vital elements in enhancing CHU performance. We conclude that strengthening accountability systems and adhering to standard human resource practices are essential for improving the delivery of child immunization services by CHU in
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