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Lauren-VanEnk-Session-2B-CCIH-2017

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Lauren VanEnk, MPH, Program Officer, Institute for Reproductive Health discusses the results of a recent study evaluating the quality and outcomes of faith-based family planning programs in Uganda.

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Lauren-VanEnk-Session-2B-CCIH-2017

  1. 1. Assessing family planning service quality across faith-based facilities in Uganda
  2. 2. WHAT FACTORS AFFECT QUALITY COUNSELLING? Provider Bias Stock outs Policy
  3. 3. Uganda Protestant Medical Bureau (UPMB) Uganda Catholic Medical Bureau (UCMB) • Belong to a network of private not-for- profit service delivery institutions in Uganda • Provide ~35% of health services and 70% of health training institutions
  4. 4. Exit interview (Mar-Apr) 3m follow up (Jun-Jul) 6m follow up (Sept- Oct) Methodology Client Follow-up Interviews N=310 UCMB=196, UPMB=114 Research Objectives 1. Describe the experience of clients receiving family planning services from UCMB and UPMB facilities from a quality of care perspective. 2. Describe the behavior of new family planning users who receive counseling at UCMB or UPMB facilities. 3. Understand couple perceptions, attitudes, and behaviors related to family planning. RESEARCH DESIGN
  5. 5. CLIENT KNEW THE SITE WAS AFFILIATED WITH THE [CATHOLIC/PROTESTANT] CHURCH n=310 88% 12% Yes No
  6. 6. RELIGIOUS AFFILIATION OF CLIENTS Catholic n=196 Protestant n=114 57% 24% 8% 10% 1% 1% 29% 48% 7% 4% 11% 0% Catholic Church of Uganda (Anglican) Pentecostal Muslim Seventh Day Adventist Other Catholic Protestant
  7. 7. WHY CLIENTS CHOSE THIS FACILITY n=310 30% 36% 50% 15% 67% 42% 13% 18% Closest facility Provides the best care Offers services needed Received care here in the past Protestant Catholic
  8. 8. CLIENT PERCEPTIONS: INTERPERSONAL SKILLS Catholic Protestant Provider treated client respectfully 100% 100% Others could not overhear what was said during counseling 95% 71% Provider listened attentively 100% 100% Client felt comfortable asking questions during the counseling session 100% 98% Client believes information shared will be kept secret 92% 60%
  9. 9. CLIENT PERCEPTIONS: HEALTH & PERSONAL HISTORY Catholic Protestant Provider asked whether or not client would like children in the future 58% 80% Provider asked about partner’s attitude toward using a family planning method 65% 21% Provider asked what client already knew about family planning methods 74% 81% Provider asked what concerned the client about using a family planning method 57% 78% Provider acknowledged and responded to client’s concerns 99% 89%
  10. 10. CLIENT PERCEPTIONS: METHOD INFORMATION & FOLLOW UP Catholic Protestant Provider explained how to use selected method correctly 100% 99% Provider described possible side effects or problems with using the family planning method 86% 91% Provider asked client to repeat important instructions 98% 75% Provider explained that this method does not provide protection from HIV or STIs 82% 87% Client felt they received the information needed to make a good choice about which method to use 96% 96% Provider told client she could switch to another method if not satisfied 81% 95%
  11. 11. INFORMED CHOICE: DID PROVIDERS DISCUSS ALL METHODS WITH THE CLIENT? 100% 92% 89% 52% 51% 58% 55% 54% 45% 40% 33% 95% 37% 75% 86% 75% 97% 73% 84% 91% 46% 46% SDM TwoDay Method LAM COC pill POP pill Injectables IUD Implants Condom Female sterilization Male sterilization Catholic ProtestantCatholic n=196 Protestant n=114
  12. 12. PROVIDERS WHO TALKED ABOUT IMPLANTS 71% 11% 64% 88% 80% 85% Catholic Site 1 Catholic Site 2 Catholic Site 3 Protestant Site 1 Protestant Site 2 Protestant Site 3
  13. 13. FAMILY PLANNING METHOD DECISION MAKING: METHOD PREFERENCES 48% 38% 16% 39% 52% 10% No specific method in mind Specific method in mind: Received Specific method in mind: Did not receive Catholic ProtestantCatholic n=196 Protestant n=114
  14. 14. FAMILY PLANNING METHOD DECISION MAKING: REASONS FOR SELECTING AN ALTERNATIVE n=43 *Respondents could select more than one option 47% 44% 9% 19% 3% 0% 82% 0% 36% 0% 0% 9% Changed mind after listening to provider Did not meet screening criteria Found out about new methods during counseling session Provider recommended another method Method never available at health center Preferred method that can be used without partner's knowledge Protestant Catholic
  15. 15. SATISFACTION WITH COUNSELING Catholic n=196 Protestant n=114 33% 54% 57% 41% 9% 3% 1% 3% 1% 0% Catholic Protestant Very satisfied Satisfied Neither satisfied nor dissatisfied Dissatisfied Very dissatisfied
  16. 16. CONCLUSION • Site selection: Clients were aware of religious affiliation and services offered by sites • Counselling skills: Providers performed well with interpersonal skills and FP information, improvement needed in assessing clients’ history and fertility intentions • Informed choice: Protestant providers outperformed Catholic providers, though all could use improvement • 1 Catholic site underperforming compared to others • Method access: Most clients received their method of choice or had no preference • Top reasons for not receiving method of choice included: changed mind after listening to the provider and not meeting the screening criteria for the method • Satisfaction: Most clients were satisfied with their counseling experience

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