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  • Title: Indicators for measuring the quality of family planning services in Nigeria.
    Author: Askew I, Mensch B, Adewuyi A.
    Journal: Stud Fam Plann; 1994; 25(5):268-83. PubMed ID: 7871552.
    Abstract:
    This article presents the Situation Analysis approach as a means of collecting data that can be used to assess the quality of care provided by family planning service-delivery points (SDPs), and describes the quality of services offered in Nigeria. Elements of the quality of services provided at 181 clinical service-delivery points in six states of Nigeria are described. The substantive results from the study suggest that although most of the 181 service points sampled are functional, the quality of care being provided could be improved. Illustrative scores for these indicators and elements of the Bruce-Jain framework are given. By comparison with contraceptive prevalence surveys, the Situation Analysis approach is still in its early stages. Some methodological issues are raised here and future directions for strengthening the validity and applicability of the approach are discussed. Baseline data for a situation analysis of family planning programs in Nigeria was collected from 181 clinical service delivery points (SDPs) in six of Nigeria's 30 states. The variety of instruments described by Fisher et al. were used and modified for the Nigerian context in a workshop setting in 1992. Data was collected during March and April 1992. The sample represented over 10% of SDPs nationally and the public SDPs were stratified by type and represented almost 50% of the family planning SDPs within the 6 states. A modified version of the Bruce-Jain framework was used in the analysis: interpersonal relations, choice of method, provider-client information exchange, technical competence, and mechanisms to assure continuity of care. There were eight interpersonal indicators. Findings showed that 97% of clients received a friendly greeting, but only 33% were probed about whether clients had questions. There was visual and auditory privacy for only 71% of SDPs. Over 75% had at least curtained off areas for examinations. 13% had no private areas at all. 39% reported no waiting time, and 39% reporting a waiting time of under 30 minutes. Busy SDPs had the shortest waits. New clients had a mean duration of 33 minutes for interaction with staff. Resupply or check-ups averaged 19 minutes. Public SDPs had shorter visit times. Less busy SDPs had longer visits. The number of methods available averaged 4.5 per SDP but varied by state. 3.5 methods/client were the mean number of methods mentioned to the 121 new clients. 28% learned about only one method. 55% of the 128 new clients had a method choice before counseling was initiated. About 22% of those not voluntarily reporting a preference were asked a preference. Equal amounts of information on each method were not provided. Limited information was provided on how to use, side effects, effectiveness, and contraindications. Few IEC aids were used, and those were primarily contraceptive samples (86% of cases). Groups health talks were a common method of imparting contraceptive information.
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