Assessing the sustainability of the Nigerian urban reproductive health initiative facility-level programming: longitudinal analysis of service quality

Ilene S Speizer,Peter M Lance,Lisa M Calhoun,Courtney Mcguire,David K Guilkey,Caroline Heller

doi:10.1186/s12913-019-4388-3

Ilene S Speizer, Peter M Lance + Show 4 more

Open Access

https://doi.org/10.1186/s12913-019-4388-3

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Abstract

BackgroundTo date, there is little information on the sustainability of family planning (FP) service quality after completion of a donor-funded program. This paper examines the sustainability of the Nigerian Urban Reproductive Health Initiative (NURHI) program on quality of FP services in two cities: Ilorin, where the program ended in March 2015 and Kaduna where the program continued.MethodsData come from three time periods: 2011, before program implementation; 2014, near Phase 1 completion; and 2017, two-years post Phase 1. In 2011, we undertook a facility audit and provider surveys in all public sector facilities in each city as well as all private facilities mentioned as the source for FP or maternal, newborn, and child health services in a 2010 women’s household survey. In 2014 and 2017, we returned to the same facilities to undertake the facility audit and provider surveys. Quality is measured from principal component analyses of 30 items from the facility audit and provider surveys. Service use outcomes are measured as the ratio of FP clients (total and new) to the number of reproductive health staff members. Multivariate random effect models are estimated to examine changes in the outcomes over time, between NURHI and non-NURHI facilities and by city.ResultsWe demonstrate that NURHI facilities had better quality and higher service use than non-NURHI facilities. Further, while quality of services was higher in Ilorin in 2011, by 2014 and three years later (2017), the quality was better in Kaduna where the program continued. In addition, while no difference was found in service utilization between Ilorin and Kaduna in 2014, by 2017, Kaduna had significantly more new FP users than Ilorin.ConclusionsIn Ilorin, quality of services did not continue its strong upward trend after the program ended. Programs need to consider long-term strategies that support continuation of program components post program implementation. This may include ensuring continued training of providers and addressing equipment and commodity stock-outs through system changes rather than specific facility-level changes. The findings from this study can be used to inform future programs seeking to improve quality of FP services in a sustainable manner.

Highlights

To date, there is little information on the sustainability of family planning (FP) service quality after completion of a donor-funded program
For the analyses presented below, those facilities identified as “Nigerian Urban Reproductive Health Initiative (NURHI) supported” in 2014 remain in this classification in 2017 for examination of long-term sustainability, even though the NURHI program was no longer working in Ilorin in 2017
Our results demonstrate that NURHI facilities tended to have better quality and higher service use than non

Summary

Introduction

There is little information on the sustainability of family planning (FP) service quality after completion of a donor-funded program. One recent exception by Winston and colleagues [8] examines if program components that sought to increase the quality of services led to increases in service use. To do this the authors use longitudinal facility data from urban areas in Kenya, Nigeria and Senegal. The authors demonstrate that facilities with bigger improvements in service quality had increased service use in the follow-up period [8]. No studies were found that examine whether strategies to improve family planning quality of care sustain following the conclusion of program implementation

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