Table 3. Summary of the statistically significant factors affecting quality of care in family planning services in Africa.
| First Author, year of publication and reference number | Factors for QoC in FP services | Authors conclusions | |||
|---|---|---|---|---|---|
| Socio-demographic and other factors* | Structural Factors* | Process Factors* | Controlled variables during multivariate analysis | ||
| Abdel-Tewab 2002[47] | Client’s age less than 35 (AOR=0.3), physicians age less than 35 (AOR=0.2) | Client-centred communication (AOR= 2.8), high positive talk by physician (AOR= 2.0), FP methods chosen by the client (AOR=3.3) | Physician’s duration of stay in the project, Physician’s attendance on the training course focusing on counselling and interpersonal communication, types of FP used, Physicians to clients talk ratio. | Client-centred communication was associated with a three-fold increase in the likelihood of client satisfaction. In addition, solidarity statements by the physician (positive talk) was also important for client satisfaction. | |
| Agha 2009[41] | Private facility (AOR=3.1), Hospital (AOR=0.4), Region: Central province (AOR=8.9), coast (AOR= 0.2), client’s age 25-34(AOR=0.4), 34+ (AOR=0.07), client’s primary education (AOR=0.07), secondary education (AOR=0.008) | Index of services availability (AOR=1.7), number of staff per facility (AOR=1.002), providers with 7+ years of experience (AOR=3.9), providers received family planning training in last 3 years (AOR= 3.6), providers believed supervisor support would help improve (AOR= 4.6), provider believed incentives would help improve services (AOR=3.1), Provider believed there was opportunity for promotion (AOR= 3.1), clients paid for family planning (AOR=0.4) | Confidentiality assured (AOR= 1.8), high reproductive history and physical examination score (AOR=1.2), longer waiting time (AOR=0.98), | • Catchment population, • Time taken to reach facility |
Client satisfaction is much higher at private facilities. Technical quality of care provided is similar in public and private facilities. |
| Hutchinson 2011[50] | • Ghana • NGO facilities (β1=0.3034) (H), (β2=0.7329) (C), • Client education: primary (β2= 0.5967), secondary (β2=0.8252) (H) • Kenya • NGO facilities (β1 =0.6930) (C), • Urban facility (β1= -0.8163) (C) • Tanzania • NGO facilities (β1=1.1462), (β2=2.4378) (C) |
• Ghana • Supervisory visit in last 6 months (β2=-1.1562) (H) • Number of days FP offered (β2= 0.4559) (H) • Quality stock inventory (β2=0.4317) (H) • Kenya • Facility inventory (β1=0.1243) (C), trained provider present 24 hours (β2=0.7691) (C), supervisory visit in last 6 months (β1= -0.3453) (H), (β2 = -1.4670) (C), total FP offered (β1= -0.0839) (H), FP client record maintained (β1= -0.3421) (H), (β2= 1.1700) (C) number of trained provider (β1= -0.1385) (H) • Tanzania • Facility inventory (β2= 0.1091), (β1=0.0628) (H), protocol on FP followed (β1= 0.1376) |
• Ghana
• Number of reproductive health related questions asked and physical exam done (β1= 0.0308) (C), • Client told about side effect (β1= 0.5430) (C)(β1= 0.3884), • Injection method prescribed (β1=0.3884) (C), long waiting time (β2= -0.0048), (β1=-0.0021) (H) (β2= -0.009), (β1= -0.0037) (C) • Kenya • Number of reproductive health related questions and physical exam (β1= 0.0431) (H), (β2= 0.1418) (C) • confidentiality assured (β1= 0.4389) (β2=0.3512) (H), long waiting time (β2= -0.008), (β1=-0.004) (H), (β2= -0.011) (C) • Tanzania • Injection method prescribed (β2=0.5246), • Long waiting time (β2= -0.007) (β1=-0.0030) (H) (β1=0.0237) (C) |
In the three countries, the catchment population, structural factors such as number of staff, system for quality assurance, number of FP trained and process factors such as visual and auditory privacy, client concerns noted were controlled | Private health facilities appear to be of higher (interpersonal) process quality than public facilities Client satisfaction appears considerably higher at private facilities |
| Tafese 2013[55] | Educational status (β2=0.09) | Perceived sufficiency of consultation** (β2=0.24), perceived facilitated services***(β=0.17), | Marital status, preferences of additional children, discussion with husband/partner, occupational status, religion, age, and waiting time | • There was lack of critical resources for the provision of quality family planning services. • Client satisfaction was affected by recipient of adequate information about the chosen family planning method, and educational status |
|
| Wang 2014[22] | • Kenya
• Government managed facilities (β1=-0.28) (C) • Senegal • Government managed facilities (β1= -0.68) (H) |
• Namibia
• Supervisory visit to facility within the past 6months (β1=0.27) (C) Number of days FP services provided (β1= -0.041) (C) • Number of FP visual aids (β1= -0.06) (C) • Senegal • Supervisory visit to facility within the past 6months (0.83) (H) • Number of days FP services provided (β1= -0.14) (C) |
• Kenya • Process composite score (β1=0.09) • Injectable provided/prescribed (β1=0.47) • Waiting time (β1=-0.01) (H) (β1=-0.00) (C) • Namibia • Waiting time (β1= -0.01) (H) (β1=-0.021) (C) |
Clients age, Educational status | • The client satisfaction score was higher at clinics and other types of facilities than hospitals/health centres in Senegal. • Process attributes seem to be more predictive of client satisfaction than structural attributes. Long waiting time was association with lower levels of client satisfaction. More client satisfaction was observed in the private sector than in the public sector. |
| Assaf 2015[49] | Client’s education: no education (AOR= 2.1), primary and post primary (AOR=2.0), provider’s years of education: 6-12 years (AOR=2.9), 13-16years (AOR=3.4) facility region: Dakar (AOR=4.8), Thies (AOR=2.5), central (AOR=11.5), South (AOR=13.9) | Client left with FP methods (AOR=3.7), No counselling on methods side effects (AOR=2.6), counselling on when to return (AOR=2.0), No waiting time (AOR=5.4) | Client age, payment for services, client status, types of contraceptive method used, provider’s job description, provider salary, counselled on how to use the method, health facility type, general structure equipment composite index | The effectiveness of the different forms of counselling was not seen in the outcomes of client overall satisfaction. | |
| Argago 2015[48] | Repeated client (AOR=3.04), history of side effect (AOR=0.121), history of unintended pregnancy (AOR=2.8) | Less than 30min to reach the services (AOR= 5.5), convenient opening hour (AOR=4.73), perceived health facility unclean (AOR= 0.192) | Clients who were advised on how to use the method (AOR=3.43) privacy ensured (AOR= 5.08) | Parity, still birth, number of living children, respect and courtesy, giving written information, told about the methods side effects | The frequency of FP visit, waiting time, cleanness of health facilities, history of side effect, history of unintended pregnancy, and information on how to use methods, privacy during examination and procedure and convenience of opening hour were the predictors of client satisfaction. |
| Nasr 2016[54][50] | Waiting place$, cleanliness of examination room$, quality of FP methods$, availability of methods$ Cost$ | privacy during examination$ waiting time$, | Confounders not controlled | The number of received training program affects quality of family planning counselling of nurse’s practice, providers of the services and the provided services affect the client satisfaction. | |
AOR- Adjusted Odds Ratio β1- Regression coefficient for linear regression analysis β2 = regression coefficient for logistic regression analysis FP-Family Planning H- Hospital (analysis done for hospitals/health centres) C- Clinic/other facilities (analysis done for client/other facilities)
* the factors included only significant factors adjusted for confounders.
** Information given about the method and the time spent for consultation
*** clinic site is easy to get and short waiting time
$ p- value for chi-square less than 0.05