| Like the clients, the providers believed that their clinics were chosen partly because of their competitive fees. |
1. Cost incurred for family planning services was identified as barriers for family planning services |
Providers identified a range of factors related to the availability of resources
including clients’, low income levels, and inability to pay high fees; inadequate supplies; and high staff workload. |
| Perceptions of clients’ ability to pay for services influenced the type of care providers offered. Sometimes providers would not bother to make referrals for contraceptive methods or medical treatment if they believed that financial support was lacking. |
| Lack of supplies was the most commonly cited barrier to quality family planning services. The few providers who reported that they had enough contraceptive supplies still said they lacked disinfectant, gloves, family planning cards and educational materials. Some stock-outs of contraceptives and other supplies were reported to last 3–6 months and led to discontinuation. |
2. Lack of family planning supplies (equipment’s, contraceptive methods, and other materials) were perceived as barriers for family planning services provision |
| Providers and managers agreed that many family planning clinics did not stock implants and intrauterine devices because they lacked trained providers who could insert them. Furthermore, lack of training resulted in some providers imposing menstruation barriers–meaning a client must be menstruating before starting a contraceptive method–because they were concerned about inadvertently giving a method to a pregnant woman. Managers agreed this practice occurred and admitted this could result in unintended pregnancies. |
| Almost all providers felt that the quality of care they could offer was compromised because they were overloaded with work, and managers confirmed some clinics were understaffed. |
3. Workload of providers was identified as factor quality of care in family planning services |
| …..the providers were critical of some of their inconsiderate actions at the clinics…. |
1. Provider behaviour while interacting with clients was identified as a factor for quality of care |
Behavior of providers towards clients, for example being disrespectful of client’s time, and privacy and confidentiality of clients for example the need to hide from husbands and parents were identified as factors affecting the quality of care. The range of services offered by providers to clients was also identified as factor influencing the quality of care. |
| Providers reported that many women secretly used contraceptive methods. A woman who hides use and experiences a side effect is at risk of stopping the method rather than switching to a method that might be detected by her husband, they said. Informed choice loses much of its meaning when the primary use criterion is a method that cannot be detected. |
2. Privacy and confidentiality for client from other clients and parents were factor for quality of care |
| Medical examination were identified by both clients and providers as an important component of family planning service provision which affects choice, continuation and satisfaction with services. |
3. Providers perceived range of services such as conducting medical examination as an important element in the provision of family planning services |
