scispace - formally typeset
Search or ask a question
Journal ArticleDOI

Measuring client satisfaction and the quality of family planning services: A comparative analysis of public and private health facilities in Tanzania, Kenya and Ghana

24 Aug 2011-BMC Health Services Research (BioMed Central)-Vol. 11, Iss: 1, pp 203-203
TL;DR: Because the public sector represents the major source of family planning services in developing countries, governments and Ministries of Health should continue to implement and to encourage incentives to improve quality at public sector health facilities, as well as to strengthen regulatory and monitoring structures to ensure quality at both public and private facilities.
Abstract: Background: Public and private family planning providers face different incentive structures, which may affect overall quality and ultimately the acceptability of family planning for their intended clients This analysis seeks to quantify differences in the quality of family planning (FP) services at public and private providers in three representative subSaharan African countries (Tanzania, Kenya and Ghana), to assess how these quality differentials impact upon FP clients’ satisfaction, and to suggest how quality improvements can improve contraceptive continuation rates Methods: Indices of technical, structural and process measures of quality are constructed from Service Provision Assessments (SPAs) conducted in Tanzania (2006), Kenya (2004) and Ghana (2002) using direct observation of facility attributes and client-provider interactions Marginal effects from multivariate regressions controlling for client characteristics and the multi-stage cluster sample design assess the relative importance of different measures of structural and process quality at public and private facilities on client satisfaction Results: Private health facilities appear to be of higher (interpersonal) process quality than public facilities but not necessarily higher technical quality in the three countries, though these differentials are considerably larger at lower level facilities (clinics, health centers, dispensaries) than at hospitals Family planning client satisfaction, however, appears considerably higher at private facilities - both hospitals and clinics - most likely attributable to both process and structural factors such as shorter waiting times and fewer stockouts of methods and supplies Conclusions: Because the public sector represents the major source of family planning services in developing countries, governments and Ministries of Health should continue to implement and to encourage incentives, perhaps performance-based, to improve quality at public sector health facilities, as well as to strengthen regulatory and monitoring structures to ensure quality at both public and private facilities In the meantime, private providers appear to be fulfilling an important gap in the provision of FP services in these countries

Content maybe subject to copyright    Report

Citations
More filters
Journal ArticleDOI
TL;DR: The Marie Stopes International (MSI) offers implants as one of many family planning options in 15 sub-Saharan African countries, from 80,041 implants in 2008 to 754,329 implants in 2012, a 9-fold increase amounted to more than 1.7 million implants delivered cumulatively over the 5-year period as mentioned in this paper.
Abstract: Contraceptive implants offer promising opportunities for addressing the high and growing unmet need for modern contraceptives in sub-Saharan Africa. Marie Stopes International (MSI) offers implants as one of many family planning options. Between 2008 and 2012, MSI scaled up voluntary access to implants in 15 sub-Saharan African countries, from 80,041 implants in 2008 to 754,329 implants in 2012. This 9-fold increase amounted to more than 1.7 million implants delivered cumulatively over the 5-year period. High levels of client satisfaction were attained alongside service provision scale up by using existing MSI service delivery channels—mobile outreach, social franchising, and clinics—to implement strategies that broadened access for underserved clients and maintained service quality. Use of adaptive and context-specific service delivery models and attention to key operational components, including sufficient numbers of trained providers, strong supply chains, diverse financing mechanisms, and implant removal services, underpinned our service delivery efforts. Accounting for 70% of the implants delivered by MSI in 2012, mobile outreach services through dedicated MSI provider teams played a central role in scale-up efforts, fueled in part by the provision of free or heavily subsidized services. Social franchising also demonstrated promise for future program growth, along with MSI clinics. Continued high growth in implant provision between 2011 and 2012 in all sub-Saharan African countries indicates the region's capacity for further service delivery expansion. Meeting the expected rising demand for implants and ensuring long-term sustainable access to the method, as part of a comprehensive method mix, will require continued use of appropriate service delivery models, effective operations, and ongoing collaboration between the private, public, and nongovernmental sectors. MSI's experience can be instructive for future efforts to ensure contraceptive access and choice in sub-Saharan Africa, especially as the global health community works to achieve its Family Planning 2020 (FP2020) commitments to expand family planning access to 120 million new users.

91 citations

Journal ArticleDOI
19 Feb 2015-PLOS ONE
TL;DR: Examining the determinants of antenatal care (ANC) quality in Ghana focuses on the role of place of residence and SES (education and wealth), with urban residence and higher SES positively associated with higher ANC quality but the urban effect is completely explained by sociodemographic factors.
Abstract: Author(s): Afulani, Patience A | Abstract: BACKGROUND:Approximately 800 women die of pregnancy-related complications every day. Over half of these deaths occur in sub-Saharan Africa (SSA). Most maternal deaths can be prevented with high quality maternal health services. It is well established that use of maternal health services vary by place of residence and socioeconomic status (SES), but few studies have examined the determinants of quality of maternal health services in SSA. The purpose of this study is to examine the determinants of antenatal care (ANC) quality in Ghana-focusing on the role of place of residence and SES (education and wealth). The analysis also examines the interactions of these variables and the mediating role of ANC timing, frequency, facility type, and provider type. METHODS:The data are from the Ghana Maternal Health Survey (N = 4,868). Analytic techniques include multilevel linear regression with mediation and moderation analysis. RESULTS:Urban residence and higher SES are positively associated with higher ANC quality, but the urban effect is completely explained by sociodemographic factors. Specifically, about half of the urban effect is explained by education and wealth alone, with other variables accounting for the remainder. The effects of education are conditional on wealth and are strongest for poor women. Starting ANC visits early and attending the recommended four visits as well as receiving ANC from a higher level facility and from a skilled provider are associated with higher quality ANC. These factors partially explain the SES differentials. IMPLICATIONS:Ghanaian women experience significant disparities in quality of ANC, with poor illiterate women receiving the worst care. Targeted efforts to increase quality of ANC may significantly reduce maternal health disparities in Ghana and SSA. A particularly crucial step is to improve ANC quality in the lower level health facilities, where the most vulnerable women are more likely to seek ANC.

78 citations


Cites background or result from "Measuring client satisfaction and t..."

  • ...The positive association between SES and quality of ANC are consistent with findings from other studies on quality of primary health care services and family planning [41,42,53] as well as those from qualitative studies on quality of delivery services [54–56]....

    [...]

  • ...But other studies suggest quality of care is higher in private facilities, though this is more for interpersonal than technical quality [42,57,60,61]....

    [...]

  • ...The narrower social power gap between high SES women and health personnel may also allow higher status women to assert their preferences to obtain high quality care [12,13,41,42,53,57]....

    [...]

  • ...Higher-tiered facilities like hospitals may also provide better quality ANC than lower-tiered ones like health centers, because of better infrastructure and personnel; and private health facilities may provide better quality care than public health facilities, although this is more likely for interpersonal than technical quality [41,42]....

    [...]

Journal ArticleDOI
TL;DR: Efforts to assist with method selection and to improve the content of contraceptive counseling and treatment of clients by providers have the potential to increase contraceptive use in urban Kenya.
Abstract: CONTEXT: Family planning is highly beneficial to womens overall health particularly in developing countries. Yet in much of Sub-Saharan Africa contraceptive prevalence remains low and unmet need for family planning remains high. It is hypothesized that the poor quality of family planning service provision in many low-income settings is a barrier to contraceptive use but this hypothesis has not been rigorously tested. METHODS: Survey data from 3990 women were used to investigate whether family planning service quality was associated with current modern contraceptive use in five cities in Kenya in 2010. In addition audits of selected facilities and service provider interviews were conducted in 260 facilities and exit interviews were conducted with family planning clients at 126 high-volume clinics. Individual- and facility-level data were linked according to the source of the womans current method or other health service. Binomial regression was used to estimate adjusted prevalence ratios and robust standard errors were used to account for clustering of observations within facilities. RESULTS: Sixty-five percent of women reported currently using a modern contraceptive method. Providers solicitation of clients method preferences assistance with method selection provision of information on side effects and good treatment of clients were positively associated with current modern contraceptive use (prevalence ratios 1.1 each); associations were often stronger among younger and less educated women. CONCLUSION: Efforts to assist with method selection and to improve the content of contraceptive counseling and treatment of clients by providers have the potential to increase contraceptive use in urban Kenya.

69 citations

Journal ArticleDOI
03 Nov 2016-PLOS ONE
TL;DR: The evidence suggests that lowering access barriers and avoiding unnecessary pre-requisites for taking contraceptive methods are important to improve the quality of care in family planning services.
Abstract: Background Improving use of family planning services is key to improving maternal health in Africa, and provision of quality of care in family planning services is critical to support higher levels of contraceptive uptake. The objective of this systematic review was to synthesize the available evidence on factors determining the quality of care in family planning services in Africa. Methods Quantitative and qualitative studies undertaken in Africa, published in English, in grey and commercial literature, between 1990 and 2015 were considered. Methodological quality of included studies was assessed using standardized tools. Findings from the quantitative studies were summarized using narrative and tables. Client satisfaction was used to assess the quality of care in family planning services in the quantitative component of the review. Meta-aggregation was used to synthesize the qualitative study findings. Results From 4334 records, 11 studies (eight quantitative, three qualitative) met the review eligibility criteria. The review found that quality of care was influenced by client, provider and facility factors, and structural and process aspects of the facilities. Client’s waiting time, provider competency, provision/prescription of injectable methods, maintaining privacy and confidentiality were the most commonly identified process factors. The quality of stock inventory was the most commonly identified structural factor. The quality of care was also positively associated with privately-owned facilities. The qualitative synthesis revealed additional factors including access related factors such as ‘pre-requisites to be fulfilled by the clients and cost of services, provider workload, and providers’ behaviour. Conclusion There is limited evidence on factors determining quality of care in family planning services in Africa that shows quality of care is influenced by multiple factors. The evidence suggests that lowering access barriers and avoiding unnecessary pre-requisites for taking contraceptive methods are important to improve the quality of care in family planning services. Strategies to improve provider behavior and competency are important. Moreover, strategies that minimize client waiting time and ensure client confidentiality should be implemented to ensure quality of care in family planning services. However, no strong evidence based conclusions and recommendations may be drawn from the evidence. Future studies are needed to identify the most important factors associated with quality of care in family planning services in a wider range of African countries.

63 citations

Journal ArticleDOI
TL;DR: The focus of HIV testing should shift from married women (routinely tested during antenatal care visits) to unmarried women and women with multiple sexual partners and men should be encouraged to test for HIV periodically.
Abstract: To identify predictors of HIV testing and condom use in Mozambique. Nationally representative survey data collected in Mozambique in 2009 was analyzed. Logistic regression analysis was used for two outcomes: HIV testing and condom use. Women at a higher risk of HIV were less likely to be tested for HIV than women at a lower risk: compared to married women, HIV testing was lower among never married women (OR = 0.37, CI: 0.25-0.54); compared to women with one lifetime partner, HIV testing was lower among women with four or more lifetime partners (OR = 0.62, CI: 0.47-0.83). Large wealth differentials were observed: compared to the poorest women, HIV testing was higher among the wealthiest women (OR = 3.03, CI: 1.96-4.68). Perceived quality of health services was an important predictor of HIV testing: HIV testing was higher among women who rated health services as being of very good quality (OR = 2.12, CI: 1.49-3.00). Type of sexual partner was the strongest predictor of condom use: condom use was higher among men who reported last sex with a girlfriend (OR = 9.75, CI: 6.81-13.97) or a casual partner (OR = 11.05, CI: 7.21-16.94). Being tested for HIV during the last two years was the only programmatic variable that predicted condom use. Interestingly, being tested for HIV more than two years ago was not associated with condom use. Frequent mass media exposure was neither associated with HIV testing nor with condom use. The focus of HIV testing should shift from married women (routinely tested during antenatal care visits) to unmarried women and women with multiple sexual partners. Financial barriers to HIV testing appear to be substantial. Since HIV testing is done without a fee being charged, these barriers are presumably related to the cost of transportation to static health facilities. Mechanisms should be developed to cover the cost of transportation to health facilities. Substantially increasing community-based counseling is one way of reducing the cost of transportation. Men should be encouraged to test for HIV periodically.

55 citations


Cites background from "Measuring client satisfaction and t..."

  • ...Aspects of quality that are observed by clients such as waiting time, provider courtesy, availability of medicines often drive clients’ perceptions of quality and satisfaction with services [15-17]....

    [...]

References
More filters
Journal ArticleDOI
23 Sep 1988-JAMA
TL;DR: Assessing quality depends on whether one assesses only the performance of practitioners or also the contributions of patients and of the health care system, on how broadly health and responsibility for health are defined, and on whether the maximally effective or optimally effective care is sought.
Abstract: Before assessment can begin we must decide how quality is to be defined and that depends on whether one assesses only the performance of practitioners or also the contributions of patients and of the health care system; on how broadly health and responsibility for health are defined; on whether the maximally effective or optimally effective care is sought; and on whether individual or social preferences define the optimum. We also need detailed information about the causal linkages among the structural attributes of the settings in which care occurs, the processes of care, and the outcomes of care. Specifying the components or outcomes of care to be sampled, formulating the appropriate criteria and standards, and obtaining the necessary information are the steps that follow. Though we know much about assessing quality, much remains to be known. (JAMA1988;260:1743-1748)

5,353 citations

01 Jun 1993
TL;DR: This report examines the controversial questions surrounding health care and health policy and advocates a threefold approach to health policy for governments in developing countries and in the formerly socialist countries, based in large part on innovative research.
Abstract: This is the sixteenth in the annual series and examines the interplay between human health, health policy and economic development. Because good health increases the economic productivity of individuals and the economic growth rate of countries, investing in health is one means of accelerating development. More important, good health is a goal in itself. During the past forty years life expectancy in the developing world has risen and child mortality has decreased, sometimes dramatically. But progress is only one side of the picture. The toll from childhood and tropical diseases remains high even as new problems - including AIDS and the diseases of aging populations - appear on the scene. And all countries are struggling with the problems of controlling health expenditures and making health care accessible to the broad population. This report examines the controversial questions surrounding health care and health policy. Its findings are based in large part on innovative research, including estimation of the global burden of disease and the cost-effectiveness of interventions. These assessments can help in setting priorities for health spending. The report advocates a threefold approach to health policy for governments in developing countries and in the formerly socialist countries. First, to foster an economic environment that will enable households to improve their own health. Policies for economic growth that ensure income gains for the poor are essential. So, too, is expanded investment in schooling, particulary for girls. Second, redirect government spending away from specialized care and toward such low-cost and highly effective activities such as immunization, programs to combat micronutrient deficiencies, and control and treatment of infectious diseases. By adopting the packages of public health measures and essential clinical care dsecribed in the report, developing countries could reduce their burden of disease by 25 percent. Third, encourage greater diversity and competition in the provision of health services by decentralizing government services, promoting competitive procurement practices, fostering greater involvement by nongovernmental and other private organizations, and regulating insurance markets. These reforms could translate into longer, healthier, and more productive lives for people around the world, and especially for the more than 1 billion poor. As in previous editions, this report includes the World Development Indicators, which give comprehensive, current data on social and economic development in more than 200 countries and territories.

2,402 citations

Journal ArticleDOI
TL;DR: A framework for assessing quality from the client's perspective is offered, consisting of six parts (choice of methods, information given to clients, technical competence, interpersonal relations, follow-up and continuity mechanisms, and the appropriate constellation of services).
Abstract: This article argues for attention to a neglected dimension of family planning services--their quality. A framework for assessing quality from the client's perspective is offered, consisting of six parts (choice of methods, information given to clients, technical competence, interpersonal relations, follow-up and continuity mechanisms, and the appropriate constellation of services). The literature is reviewed regarding evidence that improvements in these various dimensions of care result in gains at the individual level; an even scarcer body of literature is reviewed for evidence of gains at the level of program efficiency and impact. A concluding section discusses how to make practical use of the framework and distinguishes three vantage points from which to view quality: the structure of the program, the service-giving process itself, and the outcome of care, particularly with respect to individual knowledge, behavior, and satisfaction with services.

883 citations


"Measuring client satisfaction and t..." refers background in this paper

  • ...Operational definitions of quality of care and client satisfaction Over the years, researchers have developed numerous systems and indicators for measuring the quality of family planning services [6,8,9,33,34]....

    [...]

  • ...One principal determinant of uptake and continued utilization of family planning services is overall client satisfaction with those services [8,9]....

    [...]

  • ...This is consistent with previous research [8,21]....

    [...]