Healthcare workers’ perspectives on access to sexual and reproductive health services in the public, private and private not-for-profit sectors: insights from Kenya, Tanzania, Uganda and Zambia

Abstract

Background Access to sexual and reproductive health services remains a challenge for many in Kenya, Tanzania, Uganda and Zambia. Health service delivery in the four countries is decentralised and provided by the public, private and private not-for-profit sectors. When accessing sexual and reproductive health services, clients encounter numerous challenges, which might differ per sector. Healthcare workers have first-hand insight into what impediments to access exist at their health facility. The aim of this study was to identify differences and commonalities in barriers to access to sexual and reproductive health services across the public, private and private not-for-profit sectors. Methods A cross-sectional survey was conducted among healthcare workers working in health facilities offering sexual and reproductive health services in Kenya (n = 212), Tanzania (n = 371), Uganda (n = 145) and Zambia (n = 243). Data were collected in July 2019. Descriptive statistics were used to describe the data, while binary logistic regression analyses were used to test for significant differences in access barriers and recommendations between sectors. Results According to healthcare workers, the most common barrier to accessing sexual and reproductive health services was poor patient knowledge (37.1%). Following, issues with supply of commodities (42.5%) and frequent stockouts (36.0%) were most often raised in the public sector; in the other sectors these were also raised as an issue. Patient costs were a more significant barrier in the private (33.3%) and private not-for-profit sectors (21.1%) compared to the public sector (4.6%), and religious beliefs were a significant barrier in the private not-for-profit sector compared to the public sector (odds ratio = 2.46, 95% confidence interval = 1.69–3.56). In all sectors delays in the delivery of supplies (37.4-63.9%) was given as main stockout cause. Healthcare workers further believed that it was common that clients were reluctant to access sexual and reproductive health services, due to fear of stigmatisation, their lack of knowledge, myths/superstitions, religious beliefs, and fear of side effects. Healthcare workers recommended client education to tackle this. Conclusions Demand and supply side barriers were manifold across the public, private and private not-for-profit sectors, with some sector-specific, but mostly cross-cutting barriers. To improve access to sexual and reproductive health services, a multi-pronged approach is needed, targeting client knowledge, the weak supply chain system, high costs in the private and private not-for-profit sectors, and religious beliefs.

The impact of an innovative community-based peer-led intervention on uptake and coverage of sexual and reproductive health services among adolescents and young people 15–24 years old: results from the Yathu Yathu cluster randomised trial

“…This potentially impacted uptake of these services. Stock-outs at public health facilities have been reported to negatively impact uptake of SRH services by healthcare workers including in Zambia [ 30 ]. Clearly, a robust procurement system is essential to avoid stock outs.…”

Using the Nominal Group Technique to Inform Approaches for Enhancing Men’s Utilization of Sexual and Reproductive Health Services

“…Moreover, the unfriendly behaviour of healthcare providers, coupled with their often stigmatizing responses, are persistently reported to deter men from visiting health facilities. Consequently, men wait until their health conditions have severely deteriorated before presenting themselves at health facilities [ 20 , 26 , 30 , 51 , 52 , 53 , 54 ].…”

Quality of health service in the local government authorities in Tanzania: a perspective of the healthcare seekers from Dodoma City and Bahi District councils

“…The use of the SERVQUAL model to assess the quality of health services is significant in that health services in Tanzania were reported to face several challenges [21,29,30,35]. However, the researchers concluded the perception and experience of the health workers [27][28][29][30]. The quality assessment for the World Health Organisation emphasized the need for the view of healthcare seekers when assessing the service delivery for sustainability [37].…”

“…Similarly, healthcare seekers' determinants of quality are essential to enable providers to segment healthcare services based on the specific needs of each group in the community. The literature on assessing service quality from consumers' perspectives is scant in Tanzania; most of the available literature focuses on quality drawing from the experience of health workers [28][29][30][31]. Thus, this article partly addressed the gap by explaining the influence of the socio-demographic dimensions on the perceived quality of healthcare service from the experience of the healthcare seekers in the councils of Dodoma City and Bahi District in Tanzania.…”