Impact of improved client-provider interaction on women's achievement of fertility goals in Egypt

Abstract

Contraceptive prevalence is relatively high in Egypt with 56 percent of currently married women use a method according to the Egypt 2000 Demographic and Health Survey (El Zanaty and Way 2001). However, the family planning program is concerned about discontinuation rates showing that three in every 10 users stop using a method within the first 12 months of adoption. Evidence also suggests that the quality of care in Ministry of Health and Population (MOHP) clinics has improved and in many respects is quite good, yet some elements remain inadequate. A two-phase operations research study was launched in Egypt in early 2000 with the goal of demonstrating how improving the quality of client-provider interaction (CPI) could be achieved in large health care systems, specifically in relation to family planning. The study was designed to explore how CPI improvements could enhance family planning knowledge, method continuation rates, client satisfaction, and achievement of fertility goals. This study forms part of a global initiative conducted in comparable fashion in two other countries, Peru (León et al. 2003) and Uganda (Okullo et al. 2003). Research Questions The CPI study in Egypt has been designed to answer the following research questions: 1. Can measurable improvements be made in client-provider interaction by introducing practical systems-oriented, provider-oriented, and client-oriented interventions? 2. If client-provider interactions are improved, will there be measurable improvements in: (a) women's knowledge about available contraceptive choices; (b) women's satisfaction with contraception; (c) continued use of any method; (d) women's ability to obtain their preferred method (unless there is clear contraindication); (e) correct use of the chosen method; (f) prompt switching to another method; (g) women's ability to achieve their fertility goals or reproductive intentions (to delay a first birth, to space or to limit pregnancies); (h) increased numbers of new and continuing clients attending the clinic; and (i) a more diverse method mix in family planning clinics? 3. What is the impact of the intervention package on the job satisfaction of providers? 4. What are the costs of the various components of the intervention (training, technical assistance, additional monitoring, and client visits)? 5. Do the costs of carrying out family planning visits increase, and if so, by how much? Research questions (1), (3), (4) and (5) were investigated in Phase I of the study (SPAAC 2002). Research question (2) was examined through Phase II of the study (the present study) in which a cohort of new family planning acceptors was enrolled and followed-up for a period of 13 months after the index visit. Client outcomes were measured at seven and 13 months through home interviews.

A systematic review of the effectiveness of counselling strategies for modern contraceptive methods: what works and what doesn’t?

“…Studies of paper-based decision aids for face-to-face counselling found increased method selection and satisfaction with services after training on WHO Decision-Making Tool in Iran,33 and increased LARC uptake with shared decision-making brochures in the USA 34. However, Balanced Counselling Strategy training – using method-specific counselling cards35 – had no effect on contraceptive use, continuation or clinic satisfaction in Peru36 or Egypt 25…”

“… 34 However, Balanced Counselling Strategy training – using method-specific counselling cards 35 – had no effect on contraceptive use, continuation or clinic satisfaction in Peru 36 or Egypt. 25 …”

What Works in Family Planning Interventions: A Systematic Review

“…One article of lower quality focused on increased method options (Khan et al 2004 - introducing emergency contraceptive pills into the method mix); another of lower quality focused on client provider interactions (Nawar et al 2004). Nine reported on various quality improvement approaches (high quality: Bashour et al 2008, Bolam et al 1998, Xiaoming et al 2000; medium quality: Khan et al 2008, Kunene et al 2004, Sherwood-Fabre et al 2002, Sanogo et a.…”

“…Eleven studies of efforts to improve quality of care met the inclusion criteria for this review. One study of lower quality focused on increasing method options by introducing emergency contraceptive pills into the method mix (Khan, Hossain, and Rahman 2004); another of lower quality focused on client-provider interactions (Nawar et al 2004). Nine reported on various qualityimprovement approaches (high quality: Bolam et al 1998;Sun et al 2000;Bashour et al 2008;medium quality: Sherwood-Fabre, Goldberg, and Bodrova 2002;Sanogo et al 2003;Kunene et al 2004;Khan et al 2008;low quality: Speizer et al 2004;Varkey et al 2004).…”

Situational analysis of the private sector in the delivery of family planning services in Egypt: Current status and potential for increased involvement

“…Results of EDHS 2014 suggest that the quality of counseling offered by private doctors is reasonable, as 63% of private physicians told clients about family planning methods other than the one they received and 52% told them about side effects. However, there are anecdotal reports of private physicians advising women complaining of IUD side effects to take out the IUD and 'get some rest' before using another method (Nawar et al, 2004). Moreover, the quality of counseling offered by pharmacists is questionable, as EDHS 2014 has shown that 46.9 percent of pharmacy users were told about various FP methods, while 28.1 percent were told about method side effects.…”