Abstract
BackgroundThe integration of family planning (FP) and HIV-related services is common in sub-Saharan Africa. Little research has examined how FP quality of care differs between integrated and non-integrated facilities. Using nationally representative data from Malawi and Tanzania, we examined how HIV integration was associated with FP quality of care.MethodsData were drawn from Service Provision Assessments (SPAs) from Malawi (2013–2014) and Tanzania (2014–2015). The analytic sample was restricted to lower-level facilities in Malawi (n = 305) and Tanzania (n = 750) that offered FP services. We matched SPA measures to FP quality of care indicators in the Quick Investigation of Quality (QIQ). We conducted bivariate and multivariate analyses of 22 QIQ indicators to examine how integration status was related to individual QIQ indicators and overall FP quality of care at the facility- and client-level.ResultsThe prevalence of HIV integration in Malawi (39%) and Tanzania (38%) was similar. Integration of HIV services was significantly associated (p < 0.05) with QIQ indicators in Malawi (n = 3) and Tanzania (n = 4). Except for one negative association in Tanzania, all other associations were positive. At the facility-level, HIV integration was associated with increased odds of being at or above the median in FP quality of care in Malawi (adjusted odd ratio (OR) = 2.24; 95% confidence interval (CI) = 1.32, 3.79) and Tanzania (adjusted OR = 2.10; 95% CI = 1.37, 3.22). At the client-level, HIV integration was not associated with FP quality of care in either country.ConclusionBased on samples in Malawi and Tanzania, HIV integration appears to be beneficially associated with FP quality of care. Using a spectrum of FP quality of care indicators, we found little evidence to support concerns that HIV integration may strain facilities and providers, and adversely impact quality outcomes. Rather, it appears to strengthen FP service delivery by increasing the likelihood of stocked FP commodities and achievement of other facility-level quality indicators, potentially through HIV-related supply chains. Further research is needed to assess FP quality of care outcomes across the various platforms of FP integration found in sub-Saharan Africa.
Highlights
The integration of family planning (FP) and HIV-related services is common in sub-Saharan Africa
Distribution of facilities by country Malawi Of 305 facilities included in the weighted Malawi Service Provision Assessment (SPA) analytic sample, 39% met the criteria for HIV services integration by offering FP services and at least one of the two HIV care and support services
We found that integration status was positively associated with facility-level FP quality of care measures in both countries, as well as a subset of facility- and client-level Quick Investigation of Quality (QIQ) indicators in Malawi (n = 3) and Tanzania (n = 4)
Summary
The integration of family planning (FP) and HIV-related services is common in sub-Saharan Africa. Integration of family planning (FP) and HIV-related services is a long-term trend in the health systems of sub-Saharan Africa [1]. The literature on FP and HIV service integration effects on facility-, provider-, and client-level outcomes is largely positive though inconclusive. The maintenance of FP quality of care is essential for positive client health outcomes and adherence to a reproductive rights-based approach to FP. The multidimensional nature of FP quality of care posited by the Bruce/Jain Framework necessitates measurement at the facility level (e.g. availability of FP methods), provider level (e.g. adherence to infection control guidelines), and client level (e.g. communication about client-preferred FP method) to sufficiently capture FP quality of care
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