Quality of Care in Family Planning Services: Differences Between Formal and Informal Settlements of Kira Municipality, Uganda

Abstract

Background: Quality of care (QoC) of family planning (FP) affects contraceptive use, and it varies across types of urban settlement. This study assesses the difference in service delivery point (SDP) structural and process factors between formal and informal urban settlements, and the opinion of the client on the QoC in informal settlements. This is useful in creating an evidence base to advocate for better quality services for the most vulnerable in society.Methods: This was a cross-sectional survey that included SDPs of Kira municipality in Wakiso district, Uganda. Data were collected from all the service points in Kira municipality with the caretakers consented. In addition, using multi-stage sampling, 626 women of reproductive age (15–49 years) who lived in the informal settlements of Kira municipality were interviewed. Data were collected using structured questionnaires, descriptive analysis was carried out in Stata version 14.0, and Chi-square and t-tests were used to compare the informal with the formal settlements.Results: Formal settlements generally had more higher-level SDPs compared to informal settlements (value of p < 0.001). SDPs in the formal settlements provided more FP methods and had more community health workers (CHW) to support their work. Also, SDPs in the formal settlements were more likely to have long-term FP methods available and more likely to have trained personnel to insert and remove implants and IUDs compared to those in informal settlements. Additionally, more SDPs in the formal settlements provided counseling for permanent, long-term, and short-term FP methods. Of the 626 interviewed women, most of the women (68.6%) reported that they would not return to the previous FP provider or refer a friend to the same provider (72.7%).Conclusions: There is a lower quality FP services in the informal settlements with a commensurable effect on the client satisfaction with the services. Therefore, improving the quality of FP services in informal settlements should be a top priority. Improved quality of services could act as a motivation to increase the uptake of modern contraceptives in such settings.

Determinants of quality contraceptive counselling information among young women in Sierra Leone: insights from the 2019 Sierra Leone demographic health survey

“…On the other hand, studies from Jordan have reported lower odds of adequate counselling among government facilities [ 10 ]. However, some studies from Uganda, Ethiopia and Kenya, report findings similar to ours [ 28 , 39 , 42 ]. The predominant source of modern contraceptive methods in Sierra Leone is the public sector providing over 80% of all clients while the private medical sector covers only 18% of users [ 18 ].…”

“…In Sierra Leone, proportion of younger women receiving good quality FP counselling services is higher compared to findings from countries in Sub-Saharan Africa such as Kenya (56.7%), Uganda (34.9%) and Senegal (18%) [ 8 , 29 , 39 ]. Furthermore, studies from other regions in countries such as Nepal and Spain indicated that the quality of FP counselling services were low and unsatisfactory based on the patient expectations and experience thus demanding for more information about the different methods [ 40 , 41 ].…”

“…Access to health facilities has been shown to be a significant factor in the quality of family planning counseling as demonstrated by the high odds of adequate counseling among women who had no big problems with distance to nearby health facility, those had visited a health facility and been visited by a field health worker within 12 months. All these factors increase the contact hours between the young women and health workers’, which allows enough to give information and answer questions related to FP [ 39 ]. It also improves the provider patient relationship, leading to trust and continued use of the selected method of contraception.…”

Access to quality contraceptive counselling among adolescent girls and young women in sub-Saharan Africa

“…In concordance with the findings from previous studies [ 30 , 34 , 35 ], we found that most adolescent girls and young women in SSA do not receive quality contraceptive counselling. Perhaps, the ineffective implementation of sexual and reproductive health policy strategies [ 36 ] as well as the attitude toward contraceptive counselling [ 37 , 38 ] might have contributed to the limited access to quality contraceptive counselling among adolescent girls and young women in SSA.…”

Improving the quality of family planning services in the Philippines: Barriers and opportunities

“…Other studies have identified a range of factors that can promote or inhibit QC for family planning. 6,7,[10][11][12][13][14][15][16][17] However, these prior studies sometimes focused only on clients' or providers' perspectives or used survey methods that assume the factors are known well enough to be limited to closed-ended survey questions. Most of these other studies were also conducted in other countries.…”