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Terefe B, Mekonnen BA, Tamir TT, Assimamaw NT, Limenih MA. Evaluation of Quality of Prevention of Mother to Child Transmission of HIV Service Provision and Its Determinants: The Case of Health Facility Readiness and Mothers' Perspectives. J Multidiscip Healthc 2024; 17:93-110. [PMID: 38205128 PMCID: PMC10778913 DOI: 10.2147/jmdh.s446035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
Background Prevention of Mother-To-Child Transmission of HIV (PMTCT) is a comprehensive intervention aimed at reducing vertical transmission. More than 90% of pediatric AIDS cases are caused by MTCT. However, the quality of care has lagged in terms of service integration, client satisfaction, and facility readiness, although improvements have been observed. Evidence on the quality of PMTCT services is required by clinicians, and policymakers. Therefore, this study aimed to evaluate the effectiveness of PMTCT services provided by public health facilities in Northwest Ethiopia. Methods This cross-sectional study was conducted at nine public health facilities in Gondar city between June 1 and July 17, 2022. A total of 334 mothers were participated. The Structure-Process-Outcome components were used to evaluate service quality. About 135 counseling sessions were observed. The SPSS 26 software was used for statistical analyses. To identify mothers' satisfaction with the service, P-values < 0.25, and < 0.05 were considered in the binary and multiple logistic regression analyses to identify significant variables, respectively. Results The overall performance of the health facilities was 74.09% (72.19-76.01 CI 95%). In 88.89% of cases, the output quality was higher and rated as good. However, the quality of the input and process services was 60.40% and 72.97%, respectively. Women's satisfaction was 67.09%. Women aged 15-24 years (AOR= 0.31; 95% CI:0.06, 0.79), formally educated (AOR=0.59; 95% CI:0.35, 0.67), > one hour of arrival (AOR=0.71; 95% CI:0.55, 0.93), > 30 minutes waiting time (AOR=0.23; 95% CI:0.11, 0.37), sufficient time for counseling (AOR=2.83; 95% CI:1.72, 3.97), and opening hours (AOR=4.27; 95% CI:2.09, 6.67) were factors associated with satisfaction in women. Conclusion The quality of PMTCT service provision and mothers' satisfaction were low. Reducing waiting time, punctuality of service providers, adequate counselling, and availability of basic resources can boost mothers' satisfaction.
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Affiliation(s)
- Bewuketu Terefe
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Birhanu Abie Mekonnen
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Tarik Tamir
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nega Tezera Assimamaw
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Miteku Andualem Limenih
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Rahman M, Islam MJ, Adam IF, Duc NHC, Sarkar P, Haque MN, Mostofa MG. Assessing the readiness of health facilities to provide family planning services in low-resource settings: Insights from nationally representative service provision assessment surveys in 10 Countries. PLoS One 2023; 18:e0290094. [PMID: 37972005 PMCID: PMC10653533 DOI: 10.1371/journal.pone.0290094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 08/01/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Many low-income countries continue to have high fertility levels and unmet need for family planning (FP) despite progress in increasing access to modern contraceptive methods and in reducing the total fertility rate (TFR). Health facilities in sub-Saharan Africa (SSA) and South Asia (SA) are thought to be unable to adequately deal with the burden of high unmet FP demands due to their weaker health systems. As a result, determining the readiness of health facilities that offer FP services is critical for identifying weaknesses and opportunities for continued development of FP health systems in those regions. Service Provision Assessment (SPA) tools-which break down health systems into measurable, trackable components-are one useful way to assess service readiness and the ability of health institutions to deliver FP services. METHODS Using data from nationally representative SPA surveys, we conducted a study that aimed to: (1) evaluate healthcare facilities' readiness to provide FP services; and (2) identify the factors that affect FP service readiness. Using a cross-sectional survey design, we used data from SPA surveys conducted in 10 low-resource SA and SSA countries: Afghanistan, Bangladesh, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania, and the Democratic Republic of the Congo (DRC). We analyzed data from public and private health facilities in Afghanistan (84), Bangladesh (1,303), Kenya (567), Malawi (810), Namibia (357), Nepal (899), Rwanda (382), Senegal (334), Tanzania (933), and the DRC (1,061) for a total of 6,730 facilities. We used 17 items/indicators recommended by the Service Availability and Readiness Assessment to measure a health facility's readiness to provide FP services across four domains. RESULTS Only 3.6% to 34.1% of the health facilities were reporting at least 75% (12-13 of 17) of the relevant items for FP service provision. Most of the health facilities in the countries under investigation suffered from lack of readiness, meaning that they did not fulfill at least 75% of the standards (12-13 items of 17 items on the availability of trained staff and guidelines, equipment, and commodities components). The factors associated with higher readiness scores varied among the 10 countries analyzed. Regression models showed that increases in the number of FP healthcare providers available at a health facility and infection control measures for FP exams were factors linked to increased readiness scores in all 10 countries. The low readiness of health facilities to provide FP services in the countries studied showed that the health systems in these low-resource settings faced significant problems with providing FP services. Differences in country-specific variability in the characteristics linked with better preparedness ratings could be attributed to data collected across different years in different nations or to country-specific healthcare financing policies. CONCLUSIONS To increase a health facility's readiness to offer FP services, country-specific factors must be addressed, in addition to common factors found in all 10 countries. Further research is required to determine the causes of country-level differences in FP tracer item availability to develop targeted and effective country-specific strategies to improve the quality of FP services in the SA and SSA regions and address unmet need for FP.
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Affiliation(s)
- Mosiur Rahman
- Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi, Bangladesh
| | - Md. Jahirul Islam
- Griffith Criminology Institute, Griffith University, Mount Gravatt, Queensland, Australia
| | | | | | - Prosannajid Sarkar
- Dr. Wazed Research and Training Institute, Begum Rokeya University, Rangpur, Bangladesh
| | - Md. Nuruzzaman Haque
- Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi, Bangladesh
| | - Md. Golam Mostofa
- Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi, Bangladesh
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Saptarini I, Suparmi, Dhewantara PW, Kristina, Suryatma A, Sumiarsih M, Hendarwan H. The Availability and Readiness of Primary Health Care Facilities to Provide HIV Testing and Counseling Services in Indonesia. Asia Pac J Public Health 2023; 35:546-548. [PMID: 37846043 DOI: 10.1177/10105395231206450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Affiliation(s)
- Ika Saptarini
- Research Center for Pre-clinical and Clinical Medicine, National Research and Innovation Agency, Jakarta, Indonesia
| | - Suparmi
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Jakarta, Indonesia
| | - Pandji Wibawa Dhewantara
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Jakarta, Indonesia
| | - Kristina
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Jakarta, Indonesia
| | - Anton Suryatma
- Research Center for Pre-clinical and Clinical Medicine, National Research and Innovation Agency, Jakarta, Indonesia
| | - Mimi Sumiarsih
- Center for Health Resilience and Resource Policy, Health Development Policy Agency, Ministry of Health of the Republic of Indonesia, Jakarta, Indonesia
| | - Harimat Hendarwan
- Research Center for Pre-clinical and Clinical Medicine, National Research and Innovation Agency, Jakarta, Indonesia
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Ikwara EA, Nakero L, Anyolitho MK, Isabirye R, Namutebi S, Mwesiga G, Puleh SS. Determinants of primary healthcare providers' readiness for integration of ART services at departmental levels: A case study of Lira City and District, Uganda. PLoS One 2023; 18:e0292545. [PMID: 37796961 PMCID: PMC10553216 DOI: 10.1371/journal.pone.0292545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 09/23/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Decreasing or flattening funding for vertical HIV services means that new and innovative ways of providing care are necessary. This study aimed to assess the determinants of readiness for integration of Antiretroviral Therapy (ART) services at the departmental level among primary health care providers (PHCP) at selected health facilities in Lira District. METHODS A cross-sectional survey employing mixed methods approaches was conducted between January and February 2022 among 340 primary healthcare practitioners (PHCP) at selected health facilities in Lira district. An interviewer-administered questionnaire was used to collect quantitative data. Quantitative data was analyzed using Stata version 15. and presented as proportions, means, percentages, frequencies, and odds ratios. Logistic regression was used to determine associations of the factors with readiness for ART integration at a 95% level of significance. Thematic analysis was used to analyze qualitative data. RESULTS The majority 75.2% (95% CI; 0.703-0.795) of the respondents reported being ready for the integration of ART services. PHCPs who were aware of the integration of services and those who had worked in the same facility for at least 6 years had higher odds of readiness for integration of ART, compared with their counterparts [aOR = 7.36; 95% CI = 3.857-14.028, p-value <0.001] for knowledge and duration at the current facility [aOR = 2.92; 95% CI = 1.293-6.599, p-value < 0.05] respectively. From the qualitative data, the dominant view was that integration is a good thing that should be implemented immediately. However, several challenges were noted, key among which include limited staffing and drug supplies at the facilities, coupled with limited space. CONCLUSIONS The study reveals a high level of readiness for the integration of ART services at departmental levels among Primary Healthcare Providers. Notably, PHCPs knowledgeable about integration and those who spent at least six years at the current health facility of work, were strong determinants for the integration of ART services in resource limited settings. In light of these findings, we recommend that policymakers prioritize the implementation of training programs aimed at upskilling healthcare workers. Furthermore, we advocate that a cluster randomized controlled trial be conducted, to evaluate the long-term effects of this integration on overall health outcomes.
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Affiliation(s)
- Emmanuel Asher Ikwara
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Lira University, Lira City, Uganda
| | - Lakeri Nakero
- Department of Community Health, Faculty of Public Health, Lira University, Lira City, Uganda
| | | | - Rogers Isabirye
- Department of Midwifery, Faculty of Nursing and Midwifery, Lira University, Lira City, Uganda
| | - Syliviah Namutebi
- Department of Midwifery, Faculty of Nursing and Midwifery, Lira University, Lira City, Uganda
| | - Godfrey Mwesiga
- Department of Psychiatry, Faculty of Medicine, Lira University, Lira City, Uganda
| | - Sean Steven Puleh
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Lira University, Lira City, Uganda
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Puleh SS, Ikwara EA, Namutebi S, Nakero L, Mwesiga G, Isabirye R, Acen J, Anyolitho MK. Knowledge and perceptions of primary healthcare providers towards integration of antiretroviral therapy (ART) services at departmental levels at selected health facilities Lira district, Uganda. BMC Health Serv Res 2023; 23:394. [PMID: 37095491 PMCID: PMC10123554 DOI: 10.1186/s12913-023-09388-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 04/11/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Investigations conducted among healthcare providers to assess their knowledge and perceptions towards the integration of anti-retroviral therapy (ART) related services in Sub-Saharan Africa are limited. This study explored the knowledge and perceptions of primary healthcare providers towards the integration of ART management services at departmental levels in health facilities in Lira district. METHODS We conducted a descriptive cross-sectional survey that employed qualitative methods of data collection in four selected health facilities in Lira district between January and February 2022. The study involved in-depth interviews with key informants and focus group discussions. The study population consisted exclusively of primary healthcare providers; however, those who were not full-time employees of the participating health facilities were excluded. We used thematic content analysis. RESULTS A significant proportion of staff (especially those who are not directly involved in ART) still lack full knowledge of ART services integration. There was generally a positive perception, with some suggesting ART integration can minimize stigma and discrimination. The potential barriers to integration included limited knowledge and skills for providing comprehensive ART services, insufficient staffing and space, funding gaps, and inadequate drug supplies, coupled with increased workload due to enlarged clientele. CONCLUSION Whereas healthcare workers are generally knowledgeable about ART integration, but their knowledge was limited to partial integration. The participants had a basic understanding of ART services being provided by different health facilities. Furthermore, participants viewed integration as critical, but it should be implemented in conjunction with ART management training. Given that respondents reported a lack of infrastructure, increased workload, and understaffing, additional investments in staff recruitment, motivation through training and incentives, and other means are needed if ART integration is to be implemented.
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Affiliation(s)
- Sean Steven Puleh
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Lira University, Lira City, Uganda.
| | - Emmanuel Asher Ikwara
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Lira University, Lira City, Uganda
| | - Syliviah Namutebi
- Department of Community Health, Faculty of Public Health, Lira University, Lira City, Uganda
| | - Lakeri Nakero
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Lira University, Lira City, Uganda
| | - Godfrey Mwesiga
- Department of Psychiatry, Faculty of Medicine, Lira University, Lira City, Uganda
| | - Rogers Isabirye
- Department of Nursing and Midwifery, Faculty of Health Sciences, Lira University, Lira University, Lira City, Uganda
| | - Joy Acen
- Department of Nursing and Midwifery, Faculty of Health Sciences, Lira University, Lira University, Lira City, Uganda
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Thapa DK, Acharya K, Karki A, Cleary M. Health facility readiness to provide antenatal care (ANC) and non-communicable disease (NCD) services in Nepal and Bangladesh: Analysis of facility-based surveys. PLoS One 2023; 18:e0281357. [PMID: 36913361 PMCID: PMC10010536 DOI: 10.1371/journal.pone.0281357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/20/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Antenatal care (ANC) visits provide an important opportunity for diagnostic, preventive, and curative services for non-communicable diseases (NCDs) during pregnancy. There is an identified need for an integrated, system-wide approach to provide both ANC and NCD services to improve maternal and child health outcomes in the short and long term. OBJECTIVE This study assessed the readiness of health facilities to provide ANC and NCD services in Nepal and Bangladesh, identified as low-and middle-income countries. METHOD The study used data from national health facility surveys in Nepal (n = 1565) and Bangladesh (n = 512) assessing recent service provision under the Demographic and Health Survey programs. Using the WHO's service availability and readiness assessment framework, the service readiness index was calculated across four domains: staff and guidelines, equipment, diagnostic, and medicines and commodities. Availability and readiness are presented as frequency and percentages, while factors associated with readiness were examined using binary logistic regression. RESULTS Of the facilities, 71% in Nepal, and 34% in Bangladesh reported offering both ANC and NCD services. The proportion of facilities which showed readiness for providing ANC and NCD services was 24% in Nepal and 16% in Bangladesh. Gaps in readiness were observed in the availability of trained staff, guidelines, basic equipment, diagnostics, and medicines. Facilities managed by the private sector or a Non-Governmental Organization, located in an urban area, with management systems to support the delivery of quality services were positively associated with readiness to provide both ANC and NCD services. CONCLUSION There is a need to strengthen the health workforce by ensuring skilled personnel, having policy, guidelines and standards, and that diagnostics, medicines, and commodities are available/provided in health facilities. Management and administrative systems are also required, including supervision and staff training, to enable health services to provide integrated care at an acceptable level of quality.
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Affiliation(s)
- Deependra K. Thapa
- Nepal Public Health Research and Development Center, Kathmandu, Nepal
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, Australia
- * E-mail:
| | | | - Anjalina Karki
- Nepal Public Health Research and Development Center, Kathmandu, Nepal
| | - Michelle Cleary
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, Australia
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Abstract
BACKGROUND The unmet need for safe and effective contraception still remains high. In 2017, about 25% of women of childbearing age who wanted to avoid pregnancy in the developing world were not using a modern contraceptive method. The biggest proportion (21%) of these women live in Sub-Saharan Africa. Little attention has been paid to the health systems factors impacting the integration of family planning into HIV services. This systematic review intends to document health systems factors constraining or facilitating the integration of family planning into HIV services. METHODS A search of electronic databases such as PubMed and Google Scholar was conducted using keywords. We considered peer-reviewed articles which were published in English between 1st January 2010 and 31st December 2020. The peer-reviewed articles which were considered focussed on identifying barriers and facilitators at the levels of the health system which influence the success or failure of integrated family planning and HIV programs, availability of integrated family planning services in HIV care, the evidence on the feasibility, effectiveness and cost-effectiveness of integrating family planning and HIV services and investigating the outcomes of programs aimed at strengthening family planning integration in HIV counselling, testing and care. Twenty-seven articles that identify factors affecting integration of family planning into HIV services met the inclusion criteria and were thematically analysed. RESULTS Health systems factors constraining integration of family planning and HIV services were human resource turnover and shortages, lack of policy guidance on integrated care, poor oversight, unclear service delivery guidelines, inadequate infrastructure and insufficient monitoring systems. Facilitators to the successful integration of family planning into HIV services were identified as training in family planning for service providers, the creation of a supportive policy environment to accommodate service integration, supportive supervision and a positive attitude by service providers towards service integration. CONCLUSION Increase in the health workforce to support integrated service delivery, skills enhancement for service providers and improvement in family planning commodity stock levels play a key role in facilitating the integration of family planning into HIV services.
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Affiliation(s)
- Luka Nkhoma
- School of Public Health, University of Zambia, Lusaka, Zambia
| | | | - Joseph Mumba Zulu
- Institute of Distance Education, University of Zambia, Lusaka, Zambia
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Khan MN, Akter S, Islam MM. Availability and readiness of healthcare facilities and their effects on long-acting modern contraceptive use in Bangladesh: analysis of linked data. BMC Health Serv Res 2022; 22:1180. [PMID: 36131314 PMCID: PMC9490900 DOI: 10.1186/s12913-022-08565-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 09/13/2022] [Indexed: 11/23/2022] Open
Abstract
Aim Increasing access to long-acting modern contraceptives (LMAC) is one of the key factors in preventing unintended pregnancy and protecting women’s health rights. However, the availability and accessibility of health facilities and their impacts on LAMC utilisation (implant, intrauterine devices, sterilisation) in low- and middle-income countries is an understudied topic. This study aimed to examine the association between the availability and readiness of health facilities and the use of LAMC in Bangladesh. Methods In this survey study, we linked the 2017/18 Bangladesh Demographic and Health Survey data with the 2017 Bangladesh Health Facility Survey data using the administrative-boundary linkage method. Mixed-effect multilevel logistic regressions were conducted. The sample comprised 10,938 married women of 15–49 years age range who were fertile but did not desire a child within 2 years of the date of survey. The outcome variable was the current use of LAMC (yes, no), and the explanatory variables were health facility-, individual-, household- and community-level factors. Results Nearly 34% of participants used LAMCs with significant variations across areas in Bangladesh. The average scores of the health facility management and health facility infrastructure were 0.79 and 0.83, respectively. Of the facilities where LAMCs were available, 69% of them were functional and ready to provide LAMCs to the respondents. The increase in scores for the management (adjusted odds ratio (aOR), 1.59; 95% CI, 1.21–2.42) and infrastructure (aOR, 1.44; 95% CI, 1.01–1.69) of health facilities was positively associated with the overall uptake of LAMC. For per unit increase in the availability and readiness scores to provide LAMC at the nearest health facilities, the aORs for women to report using LAMC were 2.16 (95% CI, 1.18–3.21) and 1.74 (95% CI, 1.15–3.20), respectively. A nearly 27% decline in the likelihood of LAMC uptake was observed for every kilometre increase in the average regional-level distance between women’s homes and the nearest health facilities. Conclusion The proximity of health facilities and their improved management, infrastructure, and readiness to provide LAMCs to women significantly increase their uptake. Policies and programs should prioritise improving health facility readiness to increase LAMC uptake.
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Affiliation(s)
- Md Nuruzzaman Khan
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, 2222, Bangladesh.
| | - Shahinoor Akter
- Gender and Women's Health, Centre for Health Equity School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - M Mofizul Islam
- Department of Public Health, La Trobe University, Melbourne, 3086, Australia
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Readiness of Mozambique Health Facilities to Address Undernutrition and Diarrhea in Children under Five: Indicators from 2018 and 2021 Survey Data. Healthcare (Basel) 2022; 10:healthcare10071200. [PMID: 35885727 PMCID: PMC9319856 DOI: 10.3390/healthcare10071200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/26/2022] Open
Abstract
The World Health Organization’s systems framework shows that service delivery is key to addressing pressing health needs. Inadequate healthcare and the lack of healthcare services are factors associated with undernutrition and diarrhea in children under five, two health conditions with high morbi-mortality rates in Mozambique. The aim of the analysis was to determine the readiness score of nutrition and diarrhea services for children under five and the influence of malaria and HIV (Human Immunodeficiency Virus) service readiness on the readiness of these two services. A total of 1644 public health facilities in Mozambique were included from the 2018 Service Availability and Readiness Assessment. Additionally, a cross-sectional study was conducted to determine the availability and readiness scores of nutrition services in 2021 in five referral health facilities. The availability of nutrition and diarrhea services for children is low in Mozambique, with both scoring below 75%. Major unavailability was observed for human resources, guidelines, and training dimensions. Diarrhea (median (IQ): 72.2% (66.7 to 83.3)) and nutrition service readiness (median (IQ): 57.1% (52.4 to 57.1)) scores were significantly different (p < 0.001), while it is desirable for both services to be comprehensively ready. Nutrition services are positively associated with diarrhea service readiness and both services are associated with malaria and HIV service readiness (p < 0.05). None of the health facilities had all tracer items available and none of the facilities were considered ready (100%). There is a persisting need to invest comprehensively in readiness dimensions, within and across child health services.
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Hakim S, Chowdhury MAB, Ahmed NU, Uddin MJ. The availability of essential medicines for diabetes at health facilities in Bangladesh: evidence from 2014 and 2017 national surveys. BMC Health Serv Res 2022; 22:377. [PMID: 35317808 PMCID: PMC8941751 DOI: 10.1186/s12913-022-07738-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 03/01/2022] [Indexed: 11/12/2022] Open
Abstract
Background Bangladesh ranks among the world’s top ten countries in the number of diabetic patients. The prevention of this disease requires treating patients with essential medicines, and the first crucial step in the uptake of these medicines is availability. We aimed to assess the availability of essential medicines for diabetes (EM-Diabetes) and to explore health facility characteristics associated with the availability of those medicines. Methods We performed the analysis using nationally representative data from the two waves of the cross-sectional Bangladesh Health Facility Survey (BHFS) in 2014 and 2017. Data are available for 1548 and 1524 health facilities in the 2014 and 2017 BHFS. Study samples of this study were 217 facilities (73 from 2014 and 144 from 2017) that offer diabetes diagnosis and treatment services. The outcome variable ‘EM-Diabetes availability’ was calculated as a counting score of the tracer medicines: metformin, glibenclamide, injectable insulin, and injectable glucose solution. A multivariable Poisson regression model was used to identify the health facility characteristics (such as, managing authority, location, external supervision, regular quality assurance activities, national guidelines for diagnosis and management of diabetes, etc.) associated with EM-Diabetes availability. Results Since 2014, there have been minimal increases in Bangladeshi health facilities that provide diabetes screening and treatment services (from 4.7% to 9.4%). Among facilities offering diabetes services, 64.5% (BHFS 2014) and 55.7% (BHFS 2017) facilities had no EM-Diabetes on-site at all. Between 2014 and 2017, the availability of metformin increased (from 27.5% to 40.1%), but there was a decrease in the availability of glibenclamide (from 16.5% to 9.1%), injectable insulin (from 20.4% to 11.4%), and injectable glucose solution (from 20.4% to 19.2%). Furthermore, publicly owned facilities [relative risk (RR) = 0.44, 95% confidence interval (CI): 0.25–0.78 for 2014 and RR= 0.54, 95% CI: 0.41–0.71 for 2017] and facilities in rural settings [RR= 0.26, 95% CI: 0.12–0.55 for 2014 and RR= 0.60, 95% CI: 0.44–0.81 for 2017] were significantly associated with decreased availability of EM-Diabetes in both survey years. Moreover, routine user fees [RR=3.70, 95% CI: 1.86–7.38] and regular quality assurance activities [RR= 1.62, 95% CI: 1.12–2.34] were also significantly associated with increased EM-Diabetes availability in 2017 only. Conclusions Overall, the health facilities in Bangladesh had insufficient essential medicines for treating diabetes. In general, the availability of EM-Diabetes declined from 2014 to 2017, except for metformin. Policymakers should consider a wide range of policy implications, focusing on the management of public facilities, rural facilities, routine user fees, and quality assurance activities to improve the availability of EM-Diabetes at health facilities in Bangladesh.
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Affiliation(s)
- Shariful Hakim
- Department of Statistics, Shahjalal University of Science & Technology, Sylhet, 3114, Bangladesh.,Chander Hat Degree College, Nilphamari, Bangladesh
| | | | - Nasar U Ahmed
- Department of Epidemiology, Florida International University, Miami, FL, USA
| | - Md Jamal Uddin
- Department of Statistics, Shahjalal University of Science & Technology, Sylhet, 3114, Bangladesh.
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Acharya K, Subedi D, Acharya P. Health facility readiness to provide integrated Family Planning, Maternal and Child Health (FPMCH) services in Nepal: Evidence from the comprehensive health facility survey. PLoS One 2022; 17:e0264417. [PMID: 35213614 PMCID: PMC8880709 DOI: 10.1371/journal.pone.0264417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 02/10/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction This study aimed to build the emergent body of evidence of family planning and maternal and child health (FPMCH) service integration benefits that can be useful in reaching the target of sustainable development goals (SDGs). Methods We utilized data from the 2015 Nepal Health Facility Survey and used the World Health Organization service readiness manual for defining the service readiness indicator score of all services related to FPMCH integration. Composite readiness index for all services including family planning, antenatal care service, delivery and newborn service readiness index, and curative child care service readiness index was considered for the integration of all services (i.e. readiness for FPMCH). Multivariable linear regression models were fitted to examine the association between covariates and readiness score to provide integrated services. Results The mean readiness score of integrated services in health facilities in Nepal was 52.1%. The services in private hospitals and peripheral health facilities had significantly lower readiness scores of integrated services compared to government hospitals. Compared to Province 3(Province 3 holds the national capital), Province 2 had significantly lower and Province 7 had significantly higher readiness scores. There is a marginally significantly higher readiness score of integrated services in the facilities where management meetings are held compared to where management meetings are never conducted. Interestingly, health facilities where external supervision occurred in the last 4 months had better service readiness of integrated services compared with those facilities with no external supervision. Similarly, the facilities that performed the routine quality assurance activities and facilities having a system for collecting opinion and being reviewed had a higher integrated services readiness score than their counterparts. Conclusion This study found a scope of improvement in management practices in the health sector of Nepal especially for supportive supervision, quality assurance (QA) activities, monthly management meetings, and a system of collecting and reviewing opinions from the clients. Strengthening management practices especially, promoting supportive supervision and adhering to QA protocols may improve HF readiness to implement integrated FPMCH in Nepal. Being low readiness, there is an urgent need for policy reform to improve the integrated service readiness, particularly in Province 2.
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Affiliation(s)
- Kiran Acharya
- New ERA, Rudramati Marga, Kalopul, Kathmandu, Nepal
- * E-mail:
| | - Dipak Subedi
- Ministry of Health and Population, Kathmandu, Nepal
| | - Pawan Acharya
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
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Sonenthal PD, Nyirenda M, Kasomekera N, Marsh RH, Wroe EB, Scott KW, Bukhman A, Connolly E, Minyaliwa T, Katete M, Banda-Katha G, Mukherjee JS, Rouhani SA. The Malawi emergency and critical care survey: A cross-sectional national facility assessment. EClinicalMedicine 2022; 44:101245. [PMID: 35072017 PMCID: PMC8762065 DOI: 10.1016/j.eclinm.2021.101245] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/16/2021] [Accepted: 12/08/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Data on emergency and critical care (ECC) capacity in low-income countries (LICs) are needed to improve outcomes and make progress towards realizing the goal of Universal Health Coverage. METHODS We developed a novel research instrument to assess public sector ECC capacity and service readiness in LICs. From January 20th to February 18th, 2020 we administered the instrument at all four central hospitals and a simple random sample of nine of 24 district hospitals in Malawi, a landlocked and predominantly rural LIC of 19·1 million people in Southern Africa. The instrument contained questions on the availability of key resources across three domains and was administered to hospital administrators and clinicians from outpatient departments, emergency departments, and inpatient units. Results were used to generate an ECC Readiness Score, with a possible range of 0 to 1, for each facility. FINDINGS A total of 114 staff members across 13 hospitals completed interviews for this study. Three (33%) district hospitals and all four central hospitals had ECC Readiness Scores above 0·5 (p-value 0·070). Absent equipment was identified as the most common barrier to ECC Readiness. Central hospitals had higher median ECC Readiness Scores with less variability 0·82 (interquartile range: 0·80-0·89) than district hospitals (0·33, 0·23 to 0·50, p-value 0·021). INTERPRETATION This is the first study to employ a systematic approach to assessing ECC capacity and service readiness at both district and central hospitals in Malawi and provides a framework for measuring ECC capacity in other LICs. Prior ECC assessments potentially overestimated equipment availability and our methodology may provide a more accurate approach. There is an urgent need for investments in ECC services, particularly at district hospitals which are more accessible to Malawi's predominantly rural population. These findings highlight the need for long-term investments in health systems strengthening and underscore the importance of understanding capacity in LIC settings to inform these efforts. FUNDING Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Department of Emergency Medicine, Brigham and Women's Hospital.
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Affiliation(s)
- Paul D. Sonenthal
- Brigham and Women's Hospital, Division of Pulmonary and Critical Care Medicine, 75 Francis St, Boston, MA 02115, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Partners In Health, 800 Boylston St Suite 300, Boston, MA 02199, USA
- Corresponding author at: Brigham and Women's Hospital, Division of Pulmonary and Critical Care Medicine, 75 Francis St, Boston, MA 02115, USA.
| | - Mulinda Nyirenda
- Queen Elizabeth Central Hospital, Adult Emergency and Trauma Centre, P.O. Box 95, Blantyre, Malawi
- University of Malawi College of Medicine, Private Bag 360 Blantyre 3, Chichiri, Malawi
| | - Noel Kasomekera
- Ministry of Health, P.O. Box 30377, Lilongwe 3, Malawi
- Abwenzi Pa Za Umoyo/Partners In Health, PO Box 56, Neno, Malawi
| | - Regan H. Marsh
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Partners In Health, 800 Boylston St Suite 300, Boston, MA 02199, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Emily B. Wroe
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Abwenzi Pa Za Umoyo/Partners In Health, PO Box 56, Neno, Malawi
- Brigham and Women's Hospital, Division of Global Health Equity, 75 Francis St, Boston, MA 02115, USA
| | - Kirstin W. Scott
- University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA
| | - Alice Bukhman
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Emilia Connolly
- Abwenzi Pa Za Umoyo/Partners In Health, PO Box 56, Neno, Malawi
- Division of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, USA
- Division of Hospital Medicine, Cincinnati Children's Hospital, 3333 Burnet Ave, Cincinnati, OH 45229, USA
| | | | - Martha Katete
- Abwenzi Pa Za Umoyo/Partners In Health, PO Box 56, Neno, Malawi
| | - Grace Banda-Katha
- Queen Elizabeth Central Hospital, Adult Emergency and Trauma Centre, P.O. Box 95, Blantyre, Malawi
| | - Joia S. Mukherjee
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Partners In Health, 800 Boylston St Suite 300, Boston, MA 02199, USA
| | - Shada A. Rouhani
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Partners In Health, 800 Boylston St Suite 300, Boston, MA 02199, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA
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Usman F, Tsiga-Ahmed FI, Abdulsalam M, Farouk ZL, Jibir BW, Aliyu MH. Facility and care provider emergency preparedness for neonatal resuscitation in Kano, Nigeria. PLoS One 2022; 17:e0262446. [PMID: 34995340 PMCID: PMC8741031 DOI: 10.1371/journal.pone.0262446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 12/24/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction
The knowledge, attitude, and practice of emergency neonatal resuscitation are critical requirements in any facility that offers obstetric and neonatal services. This study aims to conduct a needs assessment survey and obtain individual and facility-level data on expertise and readiness for neonatal resuscitation. We hypothesize that neonatal emergency preparedness among healthcare providers in Kano, Nigeria is associated with the level of knowledge, attitudinal disposition, practice and equipment availability at the facility level.
Methods
A semi-structured, self-administered questionnaire was administered to a cross-section of health providers directly involved with neonatal care (n = 112) and attending a neonatal resuscitation workshop in Kano state. Information regarding knowledge, attitude, practice and facility preparedness for neonatal resuscitation was obtained. Bloom’s cut-off score and a validated basic emergency obstetric and neonatal care assessment tool were adopted to categorize outcomes. Multivariable logistic regression was employed to determine independent predictors of knowledge and practice.
Results
Almost half (48% and 42% respectively) of the respondents reported average level of self-assessed knowledge and comfort during resuscitation. Only 7% (95% CI:3.2–13.7) and 5% (95% CI:2.0–11.4) of health providers demonstrated good knowledge and practice scores respectively, with an overall facility preparedness of 46%. Respondents’ profession as a physician compared to nurses and midwives predicted good knowledge (aOR = 0.08, 95% CI: 0.01–0.69; p = 0.01), but not practice.
Conclusion
Healthcare provider’s knowledge and practice including facility preparedness for emergency neonatal resuscitation were suboptimal, despite the respondents’ relatively high self-assessed attitudinal perception. Physicians demonstrated higher knowledge compared to other health professionals. The low level of respondents’ awareness, practice, and facility readiness suggest the current weak state of secondary health systems in Kano.
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Affiliation(s)
- Fatima Usman
- Department of Pediatrics, Bayero University, Kano & Aminu Kano Teaching Hospital, Kano, Nigeria
- * E-mail:
| | - Fatimah I. Tsiga-Ahmed
- Department of Community Medicine, Bayero University, Kano & Aminu Kano Teaching Hospital, Kano Nigeria
| | - Mohammed Abdulsalam
- Department of Pediatrics, Bayero University, Kano & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Zubaida L. Farouk
- Department of Pediatrics, Bayero University, Kano & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Binta W. Jibir
- Department of Pediatrics, Hasiya Bayero Pediatrics Hospital, Kano, Nigeria
| | - Muktar H. Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Centre, Nashville, Tennessee, United States of America
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Olakunde BO, Adeyinka DA, OlaOlorun FM, Oladele TT, Yahaya H, Ndukwe CD. Integration of family planning services into HIV services in Nigeria: Evidence from the Performance Monitoring and Accountability 2020 survey in seven states. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2021; 20:181-188. [PMID: 34264164 DOI: 10.2989/16085906.2021.1925312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Despite global calls for stronger linkages between family planning and HIV, a growing body of evidence in sub-Saharan Africa suggests that the integration of family planning and HIV service delivery is suboptimal in some countries. In this study, we assess the integration and quality of family planning services in health facilities that provide HIV-related services in Nigeria. This study analysed secondary data from the Performance Monitoring and Accountability 2020 cross-sectional survey conducted between May and July 2016 in seven states in Nigeria. Our study sample was restricted to 290 health facilities providing HIV services. We performed descriptive statistics and binary logistic regression analyses. Ninety-five per cent of the health facilities reported offering family planning counselling, provision of family planning methods, and/or referral for family planning methods to clients accessing HIV services. About 84% of these health facilities with integrated family planning and HIV services reported that they discussed the preferred method, dual methods, instructions and side effects of the chosen method, and the reproductive intentions with clients during an HIV consultation. None of the health facilities' characteristics was significantly associated with the integration of family planning services into HIV services. Private health facilities (aOR 0.3, 95% CI 0.07-0.92), urban health facilities (aOR 3.8, 95% CI 1.64-8.76), and provision of postnatal care (aOR 3.9, 95% CI 1.10-13.74) were statistically associated with the quality of family planning services provided to clients accessing HIV services. Family planning services were integrated into HIV services in a majority of the health facilities in our study. However, our findings indicate the need for improvement in the quality of family planning services provided to clients accessing HIV services.
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Affiliation(s)
- Babayemi O Olakunde
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria.,Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Daniel A Adeyinka
- Department of Public Health, National AIDS and STI Control Programme, Federal Ministry of Health, Abuja, Nigeria.,Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
| | - Funmilola M OlaOlorun
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Tolulope T Oladele
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria
| | - Hidayat Yahaya
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria
| | - Chinwendu D Ndukwe
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria
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Bintabara D, Lilungulu A, Jumanne S, Nassoro MM, Mpondo BC. Does facility readiness promote high-quality of provider-initiated HIV testing and counseling to pregnant women? A national survey for improving policy of prevention of mother-to-child transmission of HIV in Tanzania. AIDS Res Ther 2021; 18:38. [PMID: 34217319 PMCID: PMC8254244 DOI: 10.1186/s12981-021-00362-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Provider-initiated HIV testing and counseling (PITC) is a recommended approach to screen for HIV to all pregnant women during antenatal care (ANC) visits, and all with HIV positive results have to be enrolled into prevention of mother-to-child transmission of HIV (PMTCT) program. However, little is known about the relationship between facility readiness and the uptake of PITC to pregnant women attending ANC in Tanzania. Therefore, this study assessed whether the facility readiness promotes the uptake of PITC to the pregnant women attending ANC for the purpose of improving the PMTCT interventions in Tanzania. Methods This study analyzed data for health facilities obtained from the 2014–2015 Tanzania service provision assessment survey. The Primary outcome measure was a composite variable (with score of 0–5) in which its higher scores indicates provision of high-quality of PITC. Also, facilities scored higher in the PMTCT service readiness index were considered to have high readiness to provide PMTCT services. In Poisson regression analyses, a series of models were fitted to assess whether there is an association between provision of high-quality of PITC and facility readiness. In all statistical analysis, a P < 0.05 was considered significant. Results Out of 1853 included first-visit ANC consultations, only about one-third of pregnant women received all five components required for PITC. The mean percentage of PMTCT readiness score was moderate 63.96 [61.32–66.59]%. In adjusted model, we found that facility with high readiness to provide PMTCT services was significantly associated with the provision of high-quality of PITC (model 2: [β = 0.075, P = 0.00]). Conclusion In order to increase high-quality of PITC services, efforts should be made to improve the PMTCT facility readiness by increasing availability of trained staffs, diagnostic tools, and ARTs among health facilities in Tanzania. Supplementary Information The online version contains supplementary material available at 10.1186/s12981-021-00362-y.
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Bintabara D, Shayo FK. Disparities in availability of services and prediction of the readiness of primary healthcare to manage diabetes in Tanzania. Prim Care Diabetes 2021; 15:365-371. [PMID: 33262058 DOI: 10.1016/j.pcd.2020.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The burdens of Non-communicable Diseases have overstretched health systems in developing countries. The study explores disparities in the availability of services and predicts the readiness of primary healthcare facilities to manage diabetes in Tanzania. METHODS The study analyzed data from the 2014-2015 Tanzania Service Provision Assessment Survey. A total of 1142 primary healthcare facilities were included in this analysis. The Negative binomial regression models were fitted to predict each of selected independent variable that is associated with the readiness of primary healthcare to manage diabetes. RESULTS The overall availability of services was significantly different across the type of facility and managing authority. In an adjusted model, the following were the predictors for a significant increase in readiness to manage diabetes: health center [β = 0.470], private facilities [β = 0.252], the performance of management meetings [β = 0.446], having source of fund other than government [β = 0.193,], and presence of medical doctors [β = 0.677]. CONCLUSION The robust primary care systems to manage diabetes could be achieved by improving the readiness of primary healthcare facilities through optimizing the availability of diagnostic tools, basic medicines, medical doctors, and early release of a government fund to publicly-owned facilities.
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Affiliation(s)
| | - Festo K Shayo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.
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Yusuf SS, Acharya K, Ahmed R, Ahmed A. Understanding general health service readiness and its correlates in the health facilities of Bangladesh: evidence from the Bangladesh Health Facility Survey 2017. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01522-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Acharya K, Thapa R, Bhattarai N, Bam K, Shrestha B. Availability and readiness to provide sexually transmitted infections and HIV testing and counselling services in Nepal: evidence from comprehensive health facility survey. BMJ Open 2020; 10:e040918. [PMID: 33323441 PMCID: PMC7745329 DOI: 10.1136/bmjopen-2020-040918] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE We assessed the availability and readiness of health facilities to provide sexually transmitted infections (STI) and HIV testing and counselling (HTC) services in Nepal. DESIGN This was a cross-sectional study. SETTING We used data from the most recent nationally representative Nepal Health Facility Survey (NHFS) 2015. A total of 963 health facilities were surveyed with 97% response rate. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome of this study was to assess the availability and readiness of health facilities to provide STI and HTC services using the WHO Service Availability and Readiness Assessment (SARA) manual. RESULTS Nearly three-fourths (73.8%) and less than one-tenth (5.9%) of health facilities reported providing STI and HTC services, respectively. The mean readiness score of STI and HTC services was 26.2% and 68.9%, respectively. The readiness scores varied significantly according to the managing authority (private vs public) for both STI and HTC services. Interestingly, health facilities with external supervision had better service readiness scores for STI services that were almost four points higher than compared with those facilities with no external supervision. Regarding HTC services, service readiness was lower at private hospitals (32.9 points lower) compared to government hospitals. Unlike STI services, the readiness of facilities to provide HTC services was higher (4.8 point higher) at facilities which performed quality assurance. CONCLUSION The facility readiness for HTC service is higher than that for STI services. There are persistent gaps in staff, guidelines and medicine and commodities across both services. Government of Nepal should focus on ensuring constant supervision and quality assurance, as these were among the determining factors for facility readiness.
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Affiliation(s)
| | - Rajshree Thapa
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Navaraj Bhattarai
- Nepal Public Health Research and Development Center, Kathmandu, Nepal
| | - Kiran Bam
- Public Health Professional, Kathmandu, Nepal
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Bintabara D, Ngajilo D. Readiness of health facilities for the outpatient management of non-communicable diseases in a low-resource setting: an example from a facility-based cross-sectional survey in Tanzania. BMJ Open 2020; 10:e040908. [PMID: 33177143 PMCID: PMC7661355 DOI: 10.1136/bmjopen-2020-040908] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/30/2020] [Accepted: 09/23/2020] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE This study assessed the readiness of health facilities to provide outpatient management of non-communicable diseases using a nationally representative sample of health facilities from Tanzania as an example of a low-resource country. DESIGN Facility-based cross-sectional survey. SETTING This study analysed data collected from public and private-owned dispensaries/clinics, health centres and hospitals during the 2014-2015 Tanzania Service Provision Assessment survey. PRIMARY OUTCOME MEASURES Three outcome variables are included in this study, namely readiness of facilities to provide outpatient management for diabetes, hypertension and chronic respiratory diseases. These were composite variables measured based on availability of indicators identified in the WHO-Service Availability and Readiness Assessment manual. These indicators were grouped into three domains, viz staff training and guidelines, basic diagnostic equipment and basic medicines. Readiness was measured by assessing the presence of required indicators in each of these domains. RESULTS Out of 1188 health facilities assessed, 52.1%, 64.8% and 60.9% reported providing services related to diabetes, hypertension and chronic respiratory diseases, respectively. A few facilities reported having treatment guidelines (33.2%) or staff trained to provide non-communicable disease services (10.4%). The availability of basic diagnostic equipment and medicines for these diseases was significantly lower in public lower level facilities than in their private counterparts (p<0.05). Facilities located in urban settings as well as higher level (health centre and hospitals) and publicly owned facilities were significantly associated with increased service readiness index for providing outpatient management of non-communicable diseases. CONCLUSION A fair distribution of resources through the 'push' system of refresher training, treatment guidelines, medicines and diagnostic equipment from higher authorities or other agencies may be one way of strengthening the readiness of lower level and public facilities to cope with the increasing burden of non-communicable diseases in low-resource countries such as Tanzania.
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Affiliation(s)
- Deogratius Bintabara
- Department of Community Medicine, School of Medicine, The University of Dodoma, Dodoma, Tanzania
| | - Dorothy Ngajilo
- Ministry of Health, Community Development, Gender Elderly and Children, Dodoma, Tanzania
- Occupational Medicine Division/Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Mayhew SH, Warren CE, Ndwiga C, Narasimhan M, Wilcher R, Mutemwa R, Abuya T, Colombini M. Health systems software factors and their effect on the integration of sexual and reproductive health and HIV services. Lancet HIV 2020; 7:e711-e720. [PMID: 33010243 DOI: 10.1016/s2352-3018(20)30201-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/14/2020] [Accepted: 05/22/2020] [Indexed: 11/19/2022]
Abstract
Despite a large and growing body of literature on sexual and reproductive health (SRH) and HIV integration, the drivers of integration of SRH and HIV services, from a health systems perspective, are not well understood. These drivers include complex so-called hardware (structural and resource) and software (values and norms, and human relations and interactions) factors. Two groups of software factors emerge as essential enablers of effective integration of SRH and HIV services that often interact with systems hardware: (1) leadership, management, and governance processes and (2) provider motivation, agency, and relationships. Evidence suggests the potential for software elements that are essential enablers to overcome some of the obstacles posed by the non-integration of health system hardware elements (eg, financing, guidelines, and commodity supplies). These enabling factors include flexible decision making, inclusive management, and support in motivating frontline staff who can work with agency as a team. Improved software, even within constrained hardware (especially in low-income and middle-income countries), can directly contribute to improved SRH and HIV service delivery.
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Affiliation(s)
- Susannah H Mayhew
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | | | | | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Rose Wilcher
- Knowledge Management and Structural Interventions, HIV Unit, FHI 360, Durham, NC, USA
| | - Richard Mutemwa
- School of Medicine and Health Sciences, University of Lusaka, Lusaka, Zambia
| | | | - Manuela Colombini
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Mukamuyango J, Ingabire R, Parker R, Nyombayire J, Abaasa A, Asiki G, Easter SR, Wall KM, Nyirazinyoye L, Tichacek A, Kaslow N, Price MA, Allen S, Karita E. Uptake of long acting reversible contraception following integrated couples HIV and fertility goal-based family planning counselling in Catholic and non-Catholic, urban and rural government health centers in Kigali, Rwanda. Reprod Health 2020; 17:126. [PMID: 32807177 PMCID: PMC7433361 DOI: 10.1186/s12978-020-00981-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND When integrated with couples' voluntary HIV counselling and testing (CVCT), family planning including long acting reversible contraceptives (LARC) addresses prongs one and two of prevention of mother-to-child transmission (PMTCT). METHODS In this observational study, we enrolled equal numbers of HIV concordant and discordant couples in four rural and four urban clinics, with two Catholic and two non-Catholic clinics in each area. Eligible couples were fertile, not already using a LARC method, and wished to limit or delay fertility for at least 2 years. We provided CVCT and fertility goal-based family planning counselling with the offer of LARC and conducted multivariate analysis of clinic, couple, and individual predictors of LARC uptake. RESULTS Of 1290 couples enrolled, 960 (74%) selected LARC: Jadelle 5-year implant (37%), Implanon 3-year implant (26%), or copper intrauterine device (IUD) (11%). Uptake was higher in non-Catholic clinics (85% vs. 63% in Catholic clinics, p < 0.0001), in urban clinics (82% vs. 67% in rural clinics, p < 0.0001), and in HIV concordant couples (79% vs. 70% of discordant couples, p = .0005). Religion of the couple was unrelated to clinic religious affiliation, and uptake was highest among Catholics (80%) and lowest among Protestants (70%) who were predominantly Pentecostal. In multivariable analysis, urban location and non-Catholic clinic affiliation, Catholic religion of woman or couple, younger age of men, lower educational level of both partners, non-use of condoms or injectable contraception at enrollment, prior discussion of LARC by the couple, and women not having concerns about negative side effects of implant were associated with LARC uptake. CONCLUSIONS Fertility goal-based LARC recommendations combined with couples' HIV counselling and testing resulted in a high uptake of LARC methods, even among discordant couples using condoms for HIV prevention, in Catholic clinics, and in rural populations. This model successfully integrates prevention of HIV and unplanned pregnancy.
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Affiliation(s)
| | - Rosine Ingabire
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali, Rwanda
| | - Rachel Parker
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Julien Nyombayire
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali, Rwanda
| | - Andrew Abaasa
- London School of Hygiene & Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
- Medical Research Council, Uganda Vaccine Research Institute & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Gershim Asiki
- Medical Research Council, Uganda Vaccine Research Institute & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Sarah Rae Easter
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristin M Wall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Nadine Kaslow
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, GA, USA
| | - Matt A Price
- International AIDS Vaccine Initiative, New York, NY, USA
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
| | - Etienne Karita
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali, Rwanda
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22
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Eastment MC, Wanje G, Richardson BA, Nassir F, Mwaringa E, Barnabas RV, Sherr K, Mandaliya K, Jaoko W, McClelland RS. Performance of family planning clinics in conducting recommended HIV counseling and testing in Mombasa County, Kenya: a cross-sectional study. BMC Health Serv Res 2019; 19:665. [PMID: 31521157 PMCID: PMC6744633 DOI: 10.1186/s12913-019-4519-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/09/2019] [Indexed: 11/28/2022] Open
Abstract
Background A high proportion of African women utilize family planning (FP) services. Accordingly, incorporating HIV testing into FP services may strategically target the first WHO 90–90-90 goal of 90% of people living with HIV knowing their status. Methods The objective of this analysis was to determine the proportion of new FP clients counseled and tested for HIV, as well as correlates of HIV testing, in a random sample of 58 FP clinics in Mombasa County, Kenya. Structured interviews of FP clinic managers collected data on characteristics of FP clinics and staff. Study staff performed a 3-month review of FP registers, summarizing new client HIV testing and counseling (HTC). Because overall rates of HTC were quite low, a binary variable was created comparing clinics performing any HIV counseling and/or testing to clinics performing none. Generalized linear models were used to calculate prevalence ratios (PR) and identify correlates of HTC. Factors associated with any HTC with a p-value < 0.10 in univariate analysis were included in a multivariate analysis. Results Of the 58 FP clinics, 26 (45%) performed any counseling for HIV testing, and 23 (40%) performed any HIV testing. Counseling for HIV testing was conducted for 815/4389 (19%) new clients, and HIV testing was performed for 420/4389 (10%). Clinics without trained HIV testing providers uniformly did not conduct HIV counseling and/or testing (0/12 [0%]), while 27/46 (59%) of clinics with ≥1 provider performed some HTC (p < 0.001). In the subset of 46 clinics with ≥1 trained HIV testing provider, correlates of performing HTC included being a public versus non-public clinic (PR 1.70 95%CI 1.01–2.88), and having an HIV comprehensive care center (CCC) onsite (PR 2.05, 95%CI 1.04–4.06). Conclusion Trained HIV testing providers are crucial for FP clinics to perform any HTC. Approaches are needed to increase routine HTC in FP clinics including staffing changes and/or linkages with other testing services (in standalone VCT services or lab facilities) in order to improve the implementation of existing national guidelines. A future cluster randomized trial is planned to test an implementation strategy, the Systems Analysis and Improvement Approach (SAIA) to increase HTC in FP clinics.
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Affiliation(s)
| | - George Wanje
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Barbra A Richardson
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Biostatistics, University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, WA, USA
| | - Faiza Nassir
- Department of Obstetrics and Gynecology, Coast General Hospital, Mombasa, Kenya
| | | | - Ruanne V Barnabas
- Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Epidemiology, Seattle, WA, USA
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Walter Jaoko
- University of Nairobi, Medical Microbiology, Nairobi, Kenya
| | - R Scott McClelland
- Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Epidemiology, Seattle, WA, USA
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23
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Bintabara D, Nakamura K, Ntwenya J, Seino K, Mpondo BCT. Adherence to standards of first-visit antenatal care among providers: A stratified analysis of Tanzanian facility-based survey for improving quality of antenatal care. PLoS One 2019; 14:e0216520. [PMID: 31083696 PMCID: PMC6513091 DOI: 10.1371/journal.pone.0216520] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/23/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Despite the benefits of early antenatal care visits for early prevention, detection, and treatment of potential complications in pregnancy, a high level of provider adherence to first-visit antenatal care standards is needed. However, little information is available regarding provider adherence to antenatal care in Tanzania. This study was performed to assess provider adherence to first-visit antenatal care standards and to apply stratified analysis to identify associated factors in Tanzania. METHODS Data from the 2014-2015 Tanzania Service Provision Assessment Survey were used in this study. Provider adherence to first-visit antenatal care standards was measured using 10 domains: client history; aspects of prior pregnancies; danger signs of the current pregnancy; physical examination; routine tests; HIV testing and counseling; maintaining a healthy pregnancy; iron/folate supplements; tetanus toxoid vaccination, and preparation for delivery. A composite score was then created in which the highest quantile (corresponding to ≥60.5%) considered to provider adhering to first-visit antenatal care standards. Initially, a series of unadjusted logistic regression analyses according to the type of facility and managing authority were performed separately at each level (i.e., facility, provider, and client). Thereafter, all variables with P < 0.2 were fitted into the respective stratified multivariable logistic regression analysis using a 5% significance level. RESULTS A total of 1756 first-visit antenatal care consultations performed by 822 providers in 648 health facilities were analyzed. The overall median [Interquartile range, IQR] adherence to first-visit antenatal care was relatively low at 47.1% [35.7%-60.5%]. After adjusting for selected variables from each level in specific strata, at dispensary; female providers [AOR = 5.5; 95% CI, 1.8-16.4], at health centre; performance of quality assurance [AOR = 2.2; 95% CI, 1.3-3.9], at hospital; availability of routine tests [AOR = 2.5; 95% CI, 1.3-4.8] and basic medicine [AOR = 2.8; 95% CI, 1.4-5.7], at public facilities; availability of medicine [AOR = 1.8; 95% CI, 1.1-3.2] and receiving refresher training [AOR = 1.8; 95% CI, 1.1-3.1], and at private facility; receiving external fund from government [AOR = 3.0; 95% CI, 1.1-8.4] were significantly associated with better adherence to first-visit antenatal care standards. CONCLUSIONS The study highlighted the important factors, including the provision of refresher training, regular distribution of basic medicines, and diagnostics equipment which may influence provider adherence to first-visit ANC standards.
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Affiliation(s)
- Deogratius Bintabara
- Department of Global Health Entrepreneurship, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
- Department of Public Health, College of Health Sciences, The University of Dodoma, Dodoma, Tanzania
| | - Keiko Nakamura
- Department of Global Health Entrepreneurship, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
- * E-mail:
| | - Julius Ntwenya
- Department of Public Health, College of Health Sciences, The University of Dodoma, Dodoma, Tanzania
| | - Kaoruko Seino
- Department of Global Health Entrepreneurship, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan United States of America
| | - Bonaventura C. T. Mpondo
- Department of Internal Medicine, College of Health Sciences, The University of Dodoma, Dodoma, Tanzania
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24
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Bintabara D, Ernest A, Mpondo B. Health facility service availability and readiness to provide basic emergency obstetric and newborn care in a low-resource setting: evidence from a Tanzania National Survey. BMJ Open 2019; 9:e020608. [PMID: 30782861 PMCID: PMC6398731 DOI: 10.1136/bmjopen-2017-020608] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study used a nationally representative sample from Tanzania as an example of low-resource setting with a high burden of maternal and newborn deaths, to assess the availability and readiness of health facilities to provide basic emergency obstetric and newborn care (BEmONC) and its associated factors. DESIGN Health facility-based cross-sectional survey. SETTING We analysed data for obstetric and newborn care services obtained from the 2014-2015 Tanzania Service Provision Assessment survey, using WHO-Service Availability and Readiness Assessment tool. PRIMARY AND SECONDARY OUTCOME MEASURES Availability of seven signal functions was measured based on the provision of 'parental administration of antibiotic', 'parental administration of oxytocic', 'parental administration of anticonvulsants', 'assisted vaginal delivery', 'manual removal of placenta', 'manual removal of retained products of conception' and 'neonatal resuscitation'. Readiness was a composite variable measured based on the availability of supportive items categorised into three domains: staff training, diagnostic equipment and basic medicines. RESULTS Out of 1188 facilities, 905 (76.2%) were reported to provide obstetric and newborn care services and therefore were included in the analysis of the current study. Overall availability of seven signal functions and average readiness score were consistently higher among hospitals than health centres and dispensaries (p<0.001). Furthermore, the type of facility, performing quality assurance, regular reviewing of maternal and newborn deaths, reviewing clients' opinion and number of delivery beds per facility were significantly associated with readiness to provide BEmONC. CONCLUSION The study findings show disparities in the availability and readiness to provide BEmONC among health facilities in Tanzania. The Tanzanian Ministry of Health should emphasise quality assurance efforts and systematic maternal and newborn death audits. Health leadership should fairly distribute clinical guidelines, essential medicines, equipment and refresher trainings to improve availability and quality BEmONC.
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Affiliation(s)
- Deogratius Bintabara
- Department of Public Health, College of Health Sciences, The University of Dodoma, Dodoma, United Republic of Tanzania
| | - Alex Ernest
- Department of Obstetrics and Gynecology, College of Health Sciences, The University of Dodoma, Dodoma, United Republic of Tanzania
| | - Bonaventura Mpondo
- Department of Internal Medicine, College of Health Sciences, The University of Dodoma, Dodoma, United Republic of Tanzania
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25
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Client satisfaction with family planning services in the area of high unmet need: evidence from Tanzania Service Provision Assessment Survey, 2014-2015. Reprod Health 2018; 15:127. [PMID: 30012151 PMCID: PMC6048714 DOI: 10.1186/s12978-018-0566-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 06/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Client satisfaction has been found to be an important factor for the uptake and continuation of family planning services. This study aimed to examine the current status of and factors associated with client's satisfaction with family planning services in Tanzania, which has a high unmet need for family planning. METHODS The study used data from the Tanzania Service Provision Assessment survey of 2014-2015. A facility was classified as having high service readiness for FP if it scored at least 67.7% on a composite score based on three domains (staff training and guidelines, basic diagnostic equipment, and basic medicines), following criteria developed by the World Health Organization. The exit interview questionnaire was used to collect information from women about their level of satisfaction, whether "very satisfied," "more or less satisfied," or not satisfied with the services received. The response was dichotomized into "Yes" if the woman reported being very satisfied with services received otherwise coded as "No". Unadjusted and adjusted logistic regression models were used to assess the association between the client satisfaction and covariate variables; service readiness, facility type, managing authority, location, management meetings, supervision, provider's sex, and working experience, clients' age and education. All analyses were weighted to correct for non-response, disproportionate and complex sampling by using the "SVY" command in Stata 14. RESULTS Out of the 1188 facilities included in the survey, 427 (35.9%) provided family planning services. A total of 1746 women participated in observations and exit interviews. Few (22%) facilities had a high readiness to provide family planning services. While most facilities had the recommended equipment available, only 42% stocked contraceptives (e.g. oral pills, injectable contraceptives and/or condoms). Further, trained staff and clinical guidelines were present in only 30% of services. Nevertheless, the majority (91%) of clients reported that they were satisfied with services. In the multivariate analysis, a high service readiness score [AOR = 2.5, 95% CI; 1.1-6.0], receiving services from private facilities [AOR = 2.3, 95% CI; 1.1-5.0], and being in the age group 20 to 29 years [AOR = 0.3, 95% CI; 0.1-0.7] were all significantly associated with clients' satisfaction with family planning services. CONCLUSION There is a high level of client satisfaction with family planning services in Tanzania. Maintaining and exceeding this level will require improvements in the provision of staff training and the availability of contraceptives in existing services.
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