| Participants identified proximity to facility and cost as important considerations for choosing a source, the mode of travel and time to source were never mentioned directly as reasons for choosing a facility. |
1. Proximity of services influenced access |
Accessibility of services was important to clients.
Proximity to clients’ residing areas, costs incurred to get the services, convenience of opening hours, availability of clients’ preferred contraceptive methods, pre-requisites for getting contraceptives were identified by clients as factors that influence service accessibility. |
| Proximity was stated as a reason for choice of service delivery points in two ways. Sometimes the respondents gave it as the sole reason for choice or in a combination with other reasons. |
| From the combination of reasons for which choice is made, it is clear that proximity is a facilitating factor but not sufficient to sustain use at a health facility. |
| Participants identified proximity to facility and cost as important considerations for choosing a source, the mode of travel and time to source were never mentioned directly as reasons for choosing a facility. |
2. Cost of services influenced clients choice of facilities/ access |
| Among the private clinics, the clients were also able to rank facilities according to the cost of services. |
| Though clients complain about cost, they recognize the higher quality of services at Non-Governmental health facilities. |
| Women reported that private facilities offered long and convenient service hours that accommodated women’s busy schedules. One woman explained that public facilities often closed before they attended to everyone. |
3. Clients tend to prefer facilities having convenient opening hours |
| Some women said that they had wasted time waiting at the public facilities for free services, only to find that their preferred method was not available. One woman began to obtain her contraception at a private facility when she found that public facilities did not stock all methods consistently |
4. Availability of preferred method (method mix) |
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…discontinued from Makuyu Health Centre when she found she was not given the injectable, the method that she had wanted. The secondary reason is that the providers asked her to return to the clinic when she was on menses - to make sure that she was not pregnant. |
5. Administrative issues in terms of putting pre-requisites for taking contraceptive influences access for family planning services |
| Another woman explained that she chose a private facility because she wanted to bypass obstructive processes that she foresaw at the public facility. She had planned to obtain the contraceptive implant at a public facility during her six-week postpartum visit. However, when she received her period four weeks after delivery, she opted for a private facility. |
| Women explained that workers at private facilities always provided whichever method was requested. One woman complained that nurses at the public facility prevented her from switching to the injectable contraceptive, so she went to a private facility where they administered her desired method. |
1. Responsiveness: Respect for client’s needs and freedom to choose was identified as a factor client’s access to family planning services |
The way care was provided in family planning services was central to clients’ notions of quality care. Clients identified six qualities of the way care was provided as influencing quality: 1) responsiveness of providers to clients’ self-perceived needs and freedom to choose the contraceptive method; 2) length of waiting time; 3) behavior of providers towards clients; 4) provision of information and support during consultation; 5) privacy and confidentiality; and 6) range of services. |
| When you walk to a private clinic, you will tell them that you need an injection and when you walk there asking for an injection that is what you will be given. |
| … the high degree of dissatisfaction with methods and lack of provider responsiveness to the clients' problems and needs. |
| While public facilities were able to provide a broad overview of side effects, they were not able to provide individualized attention. Due to crowded facilities in public healthcare settings, some women were not given the opportunity to address problems with their current method. One woman described her disappointment about not receiving adequate counseling from a public facility when she returned with irregular vaginal bleeding |
| Woman in the individual interviews said they preferred public facilities when they needed more decision-making support or guidance for initial selection of a contraceptive method. |
| ….what irritates clients is when they think the providers are idling while they wait…. |
2. Waiting time to receive family planning services related with quality of care |
| The private sector clinics have a better image with respect to waiting time. |
| ….they would like family planning services to be provided within an hour of their arrival so that they could get back to their homes quickly before their absence is noticed. |
| Even though family planning services were free at the public hospitals, one woman explained that she was willing to pay for contraception at private facilities to avoid waiting in long lines: |
| In the public institutions complaints are mostly related to provider behavior while those from the private clinics tend to be related to structural constraints of facilities. |
3. Provider behaviour while talking to the client identified as a barrier for quality of care |
| Respectful treatment was an added benefit of private facilities. Women believed that private facilities treated their customers with care and attention compared to public facilities where participants experienced verbal harassment, inattention, and rudeness. Respectful behaviour included answering questions kindly and allowing sufficient time for each client. One woman described how rude behaviour at public facilities drove clients to private clinics |
| …Though the providers in public institutions are talked of negatively, it should also be pointed out that there are some of them well commended by clients. |
| ….Sometimes the client is just told to use a certain method and she accepts. |
4. Information provision and support in reaching a decision was identified as an important aspect in the delivery of family planning services |
| Because of concern for side effects, almost every woman described an ideal family planning visit as one with ample counseling about side effects and support from the provider to choose a method that minimized side effects |
| Focus groups participants noted that the private facilities prioritized profit over providing safe medical treatment. While some women mentioned that private providers at non-governmental organization (NGOs) answered questions fully, most women said that most private facilities did not provide counseling or decision support when administering a method. |
| While public facilities were able to provide a broad overview of side effects, they were not able to provide individualized attention. Due to crowded facilities in public healthcare settings, some women were not given the opportunity to address problems with their current method. One woman described her disappointment about not receiving adequate counseling from a public facility when she returned with irregular vaginal bleeding |
| Woman in the individual interviews said they preferred public facilities when they needed more decision-making support or guidance for initial selection of a contraceptive method. |
| Privacy and confidentiality also came up when the topic of client home visits was raised. |
5. Maintaining the privacy and confidentiality of clients during family planning provision was valued by clients. |
| Women said they used private facilities when they required more confidentiality. One woman related a story of a friend who chose to receive family planning at a private facility to hide her use from her husband. |
| Medical examinations were identified by both clients and providers as an important component of family planning service provision which affects choice, continuation and satisfaction with services. |
6. Range of services including eligibility screening, blood tests, and physical assessment was valued by clients |
| While public facilities were able to provide a broad overview of side effects, they were not able to provide individualized attention. Due to crowded facilities in public healthcare settings, some women were not given the opportunity to address problems with their current method. One woman described her disappointment about not receiving adequate counseling from a public facility when she returned with irregular vaginal bleeding. |
| An important factor for the recipient of services was the age and maturity of the providers. |
1. Clients perceived to receive family planning services from older and matured provider |
Provider characteristics were identified by clients as factors influencing quality of care. These were provider competency and age. |
| Those who did not mind about the sex of the provider were more concerned about the knowledge and skill of the provider |
2. Provider competency in terms of adequate knowledge and skill was valued by clients. |
| In individual interviews, women elaborated on their perceptions of the deficiencies in private facilities, which included questionable medications, poor eligibility screening, poorly qualified staff, and poor quality counseling. |
| Other women were concerned about the competency of private facility providers. This woman explained her concerns about private providers and her preference for well-qualified public providers |
| While it was expected that private facilities would provide a consistent stock of contraceptive supplies, women worried that these facilities administered fraudulent and expired medications to unaware clients. A few women stated that private facilities were more likely to stock expired contraceptives because their inventory exceeded their client flow. This woman attributed two incidences of failed contraception to fraudulent medication provided at private facilities |
