Quality of care in family planning services in Senegal and their outcomes

Abstract

BackgroundHigh quality of care in family planning (FP) services has been found to be associated with increased and continued use of contraceptive methods. The interpersonal skills and technical competence of the provider is one of the main components of quality of care. To study the process component of quality of care, the distribution of the FP counseling topics was examined by client, provider and facility characteristics. To assess the outcomes of quality of care, client satisfaction and their knowledge of their method’s protection from STIs were used. This study examined the factors associated with these outcomes with a focus on provider counseling and training.MethodsData from the 2012–2013 Senegal Service Provision Assessment survey was used for the analysis. The survey included a representative sample of the health facilities in Senegal and collects data by observing the clients’ FP visits and conducting exit interviews. The main outcomes of interest were provider’s counseling in FP, client’s satisfaction with FP services and client’s knowledge of their method’s protection from STIs. Several covariates were used in the analysis which represent client, provider and facility characteristics.ResultsThe level of counseling was inadequate-- very low proportions of providers that performed different types of counseling. Counseling was more likely to be provided to new than returning clients. Approximately 84% of the clients were very satisfied with services but only 58% had correct knowledge of their method’s protection from STIs. Clients were significantly less likely to be very satisfied when their providers counseled on side effects and when to return, and counseling provided on method’s protection from STIs did not significantly improve knowledge in this area. Clients seen by a provider with FP training had almost twice the odds of having correct knowledge about their method’s protection from STIs compared with clients seen by a provider with no recent training.ConclusionsThe percentage of providers offering FP counseling to their clients was relatively low and was ineffective on the client-focused outcomes. Interventions may be required for more effective counseling methods that are client-centered as well as providing more FP training to providers.

Women’s contraceptive discontinuation and switching behavior in urban Senegal, 2010–2015

“…We found that women who were users of traditional methods were significantly more likely to be switchers to modern methods; traditional method use may be a gateway to more effective method use and therefore these women should be supported in this process. A recent analysis of data collected at health facilities in Senegal found that the general level of counseling for FP was inadequate: only 18% of providers counseled their clients on three items examined by the survey (how to correctly use the method, possible side effects, and when to make a return visit) [ 18 ]. Yet earlier research in Senegal found that women who received good quality care at the time of method initiation were 1.3 times more likely to be using a method after 16 months than were women who did not receive higher quality counseling [ 19 ].…”

Effective coverage of primary care services in eight high-mortality countries

“…Relatively little research exists on effective coverage of family planning and sick-child care. While past research has documented poor quality of clinical care from sources such as SPA surveys, 35–37 to our knowledge, this study is the first to calculate effective coverage of these services using observed measures of clinical quality. Other effective coverage studies have used input measures such as facility type or readiness based on infrastructure and supplies.…”

Examining trends in family planning among harder-to-reach women in Senegal 1992–2014

“…Health providers have a role to play in dispelling myths about FP, as well as in helping women find a better-suited method if side effects occur (including nausea, headaches, and menstrual irregularity associated with hormonal methods)44. However, two Service Provision Assessment analyses have found that the quality of FP counselling in Senegal is generally poor, with few providers counselling on side effects and follow-up services in particular4546.…”