Measuring family planning quality and its link with contraceptive use in public facilities in Burkina Faso, Ethiopia, Kenya and Uganda

Abstract

The individual impacts of several components of family planning service quality on contraceptive use have been studied, but the influence of a composite measure synthesizing these components has not been often investigated. We (1) develop a composite score for family planning service quality based on health facility data from Burkina Faso, Ethiopia, Kenya and Uganda and (2) examine the influence of structural quality on contraceptive practice in these four countries. We used nationally representative cross-sectional survey data of health facilities and women of reproductive age. First, we constructed quality scores for facilities using principal component analysis to integrate 18 variables. Second, we linked women to their closest facility using geo-coordinates. Third, we estimated multivariable logistic regression models to calculate women’s odds ratios for modern contraceptive use adjusting for facilities’ quality and other factors. In Burkina Faso, Ethiopia and Uganda, the odds of using a modern method of contraception was greater if the nearest facility provided high- or medium-quality services compared with low quality in the univariable model. After controlling for possible confounders, the adjusted odds ratios were significant for high quality (aOR: 3.12, P value: 0.005) and medium quality (aOR: 2.57, P value: 0.009) in Ethiopia and in the hypothesized direction but not statistically significant in Uganda or Burkina Faso, and in the opposite direction in Kenya. A process quality measure—having been visited by a community health worker—was statistically significantly associated with modern contraceptive use in three of the four countries (Burkina Faso aOR: 2.18, P value: 0.000; Ethiopia aOR: 1.78, P value: 0.000; Uganda aOR: 1.96, P value: 0.012). These results suggest that service quality in public facilities may be less relevant to contraceptive use in environments where the universe and reach of providers changes actively. Programs promoting contraception therefore need to consider quality within facility types and their service environments.

Quality of Family Planning Counseling in Ethiopia: Trends and determinants of information received by female modern contraceptive users, evidence from national survey data, (2014- 2018)

“…The quality of structural components of family planning services in public facilities (i.e. number of methods available, distance to facility) has been identified as an important factor in the adoption of modern contraception use in Ethiopia [15,18]. Nevertheless, studies have suggested that the quality and coverage of family planning counseling remains low in Ethiopia.…”

Determinants of change in long-acting or permanent contraceptives use in Ethiopia; A multivariate decomposition analysis of data from the Ethiopian demographic and health survey

“…About 3% change in LAPMs use was due to the change in LAPMs use behavior among women who were visited by health workers. Studies in Ethiopia indicated that discussion about family planning with health workers was associated with increased LAPMs uptake [35,40]. The reason for this might be that when health workers visit home, they are more likely to provide detailed information about LAPMs.…”

Influence of Quality Counseling on Performance of Family Planning Programs in Kuresoi North Sub-County, Nakuru County, Kenya

“…The health care providers in a family planning perspective include nurses, clinical officers, HIV counsellors, and community health volunteers. The more the health care providers have been involved with counselling on family planning, the more the quality of counselling is affected [5]. The research disclosed a reduction in the quality of counselling in Burkina Faso, Ethiopia, Kenya and Uganda due to involvement of informal practitioners like community health workers.…”

“…These countries were Ethiopia, Burkina Faso, Uganda and Kenya. The research was done by Fruhauf, Zimmerman, Kibira, Makumbi, Gichang, Shiferaw, Seme, Guiella, and Tsu [5] on calculating contraceptive excellence as well as its connection with contraceptive usage in municipal health care facilities in the four countries. In addition, the study indicated that quality of services and contraceptive use were compromised by an upsurge in informal providers offering contraceptive amenities.…”