Measuring client satisfaction and the quality of family planning services: a comparative analysis of public and private health facilities in Tanzania, Kenya and Ghana.

Paul L Hutchinson,Sohail Agha,Mai Do

doi:10.1186/1472-6963-11-203

Paul L Hutchinson, Sohail Agha + Show 1 more

Open Access

https://doi.org/10.1186/1472-6963-11-203

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Abstract

BackgroundPublic and private family planning providers face different incentive structures, which may affect overall quality and ultimately the acceptability of family planning for their intended clients. This analysis seeks to quantify differences in the quality of family planning (FP) services at public and private providers in three representative sub-Saharan African countries (Tanzania, Kenya and Ghana), to assess how these quality differentials impact upon FP clients' satisfaction, and to suggest how quality improvements can improve contraceptive continuation rates.MethodsIndices of technical, structural and process measures of quality are constructed from Service Provision Assessments (SPAs) conducted in Tanzania (2006), Kenya (2004) and Ghana (2002) using direct observation of facility attributes and client-provider interactions. Marginal effects from multivariate regressions controlling for client characteristics and the multi-stage cluster sample design assess the relative importance of different measures of structural and process quality at public and private facilities on client satisfaction.ResultsPrivate health facilities appear to be of higher (interpersonal) process quality than public facilities but not necessarily higher technical quality in the three countries, though these differentials are considerably larger at lower level facilities (clinics, health centers, dispensaries) than at hospitals. Family planning client satisfaction, however, appears considerably higher at private facilities - both hospitals and clinics - most likely attributable to both process and structural factors such as shorter waiting times and fewer stockouts of methods and supplies.ConclusionsBecause the public sector represents the major source of family planning services in developing countries, governments and Ministries of Health should continue to implement and to encourage incentives, perhaps performance-based, to improve quality at public sector health facilities, as well as to strengthen regulatory and monitoring structures to ensure quality at both public and private facilities. In the meantime, private providers appear to be fulfilling an important gap in the provision of FP services in these countries.

Highlights

Public and private family planning providers face different incentive structures, which may affect overall quality and the acceptability of family planning for their intended clients
Correlates of client satisfaction - multivariate regression analysis We examined the correlates of client satisfaction among clients of private and public sector facilities in each of the Signific
This study has focused on measuring the extent of quality differentials between public and private family planning (FP) providers in three countries and relating client satisfaction to both clients’ perceptions and experts’ assessments of the quality of FP services

Summary

Introduction

Public and private family planning providers face different incentive structures, which may affect overall quality and the acceptability of family planning for their intended clients. Studies of contraceptive discontinuation rates, for example, have indicated that - with the exception of the desire to become pregnant - the principal reason for discontinuation is dissatisfaction with the quality of services [10] Both the public and private sectors supply substantial portions of family planning methods in developing countries, but face different incentives to provide services of high quality and to ensure client satisfaction [11,12]. Motivated to maximize the demand for their services while minimizing their costs, private for-profit facilities generally face greater incentives to be efficient and clientfriendly providers of health care Even so, they have been shown to be of varying quality, often due to the inability of government regulatory bodies to adequately monitor and enforce standards [19,20,21,22]. Non-governmental facilities, often notfor-profit and affiliated with religious, faith-based organizations, have been touted as being likelier to provide higher quality services because of their social mission, but evidence to support this has been mixed [13,18]

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