Socio-demographic characteristics of respondents
A total of 576 clients of family planning users were successfully interviewed immediately after receiving care in eight (8) public health facilities and gave a response rate of 99%.
As shown in Table 1, 378 (65.6%) were repeat clients, while 198 (34.4%) were new clients. The majority of participants, 253 (43.9%) were between 20–24 years old with a mean age of 25 years (SD + 4.5). (Table 1)
Table 1
; Socio-demographic characteristics of respondents
Variables | | No. | % |
Respondents age group | 15–19 20–24 25 and more | 96 253 227 | 16.7 43.9 39.4 |
Types of Clients | Repeat New | 378 198 | 65.6% 34.4% |
Religion | Orthodox Muslim Protestant Catholic | 208 236 84 48 | 36.1 41.0 14.6 8.3 |
Ethnicity | Oromo Somali Amhara | 341 208 27 | 59.2 36.1 4.7 |
Place of Residence | Urban Rural | 392 184 | 68.1 31.9 |
Educational status | Not read and write Primary school Secondary school & above | 222 203 151 | 38.1 36.0 25.9 |
Occupation | Housewife Employee Merchant Daily labourer | 270 116 96 94 | 46.9 20.1 16.7 12.4 |
Marital status | Not married (single) Married & live together Widowed &divorced | 24 512 40 | 4.2 88.9 6.9 |
Have you ever discussed about F/P with your husband/partner? | Yes No | 512 64 | 88.9 11.1 |
Availability And Functionality Of Logistic Supplies For Family Planning Services
Eight family planning service delivery points (health facilities) were audited for the availability and functionality of family planning services logistics, and supplies that were crucial to function effectively and could affect the quality of care provided.
Satisfactory Facility Environment
Among eight health facilities, only five had a clean water supply, and 50% had toilets with poor sanitation. In three of the health facilities, there was a shortage of staff assigned to work in family planning services and in all health facilities, there was a shortage of trained providers. All health facilities' official working days and hours were from Monday to Friday from 8:30 am to 5:30 pm except for lunch time (12:30 am-8:00 pm).
All health facilities have an examination couch and clients seating and offer visual privacy but not auditory privacy during a pelvic examination, IUCD insertion or during consultation time. Based on the findings, the facility environment in our study area was satisfactory.
Availability Of Minimum Equipment To Offer Fp Services
The result showed blood pressure measurement apparatus, weight scale, and stethoscope were available in all health facilities, but stethoscopes were shared with other departments in 3 (37.5%) of health facilities. Uterine sound, tenaculum, speculum, and scissors were unavailable in 2 (25%) facilities. All health facilities had essential disposable items like needles, syringes and gloves. All health facilities had laboratory units, but 2 (25.0%) of health facilities had not been performing pregnancy tests because of the absence of kits for pregnancy tests. Hence, all health facilities fulfilled the minimum equipment to offer family planning services.
Availability Of Fp Contraceptive Supplies
The assessment result indicated that combined pills, progestin-only pills, Depo Provera, Implanon and condoms were available in all setups. However, IUCD was only available in three health facilities. The procedure for tubal legation and vasectomy was carried out in two hospitals.
As shown in Fig. 1; Client exit interviews showed the majority, 209 (36.3%) of clients were using/received Implanon, 196 (34.0%) of clients were using injectable (Depo-Provera), 130 (22.6%) of clients were using pills, 29 (5.0%) using a condom and only 12 (2.1%) using IUCD (Fig. 1).
All of the health facilities had recording systems for received and dispensed FP commodities and adequate storage facilities. Stores were protected from sun, rain, wet, and rats in all health facilities. Based on the above information, the minimum standard of contraceptive supply is achieved.
Availability Of Reproductive Health Guidelines And Fp Iec Materials
Only 4 (50%) health facilities had a copy of Ethiopian Minister of Health (EMOH) guideline of family planning and reproductive health services and achieved the requirement.
As Fig. 2 shows, all health facilities had at least one information education and communication (IEC) material but not three at a time. Regarding IEC materials during consultations, 35 (21.9%) were used flip charts, 28 (17.5%) were displayed samples of contraceptives, brochures were used by 8 (5.0%) of clients and posters were used by 50 (31.3%) of clients. A combination of two or more IEC materials was used for 39 (24.4%) clients (Fig. 2).
Appropriate Constellation Of Services
By exit interview, the distance of clients’ homes from the service delivery was estimated by the clients themselves and 311 (54.0%) of clients were reported that they traveled less than 30 minutes, 201 (34.9%) of clients were traveled 30–60 minutes and 64 (11.1%) of clients were traveled more 60 minutes. Regarding the opening hours of health facilities, 452 (78.5%) of the clients agreed that the opening hour was convenient for them, and 124 (21.5%) of clients disagreed with opening hours.
As Table 2 shows, the median waiting time was 25 minutes and SD +/- 20 minutes, ranging from 5 minutes to 45 minutes. The waiting time of clients at the service delivery points before getting services, 503 (87.3%) of clients were reported that the waiting time was short, and 73 (12.7%) of clients were informed that the waiting time was long (Table 2).
Table 2
Client’s accessibility to health facility and F/P information
Variable | | No. | % |
Source of F/P service information for first time | Husband Neighbors Health professional | 211 150 215 | 36.6 26.0 37.3 |
Distance of client’s home from health facilities. | Less than 30 minutes 30–60 minutes More than 60 minutes | 311 201 64 | 54.0 34.9 11.1 |
Health facility opening hours convenient? | Yes No | 452 124 | 78.5 21.5 |
Feeling of clients about waiting time | It was short Long time | 503 73 | 87.3 12.7 |
Getting desired information & service | Yes No | 534 42 | 92.7 7.3 |
Will you come back for next appointment? | Yes No | 534 42 | 92.7 7.3 |
Provider Competency For Provision Of Family Planning Services
As shown in Table 3, Four hundred seventy (81.6%) of the respondents reported that the provider explained how the method works. Almost all, 530 (92.0%) of the respondents reported that the provider demonstrated how to use the method, 455 (79.0%) of providers described possible side effects, 464 (80.6%) of providers explained what to do for side effects, 496 (86.1%) of providers told to their clients about the possibility of changing method and 473 (82.1%) of them mentioned when and where to go for supply or follow-up (Table 3).
Table 3
Information given to clients by service provider
Information told about the preferred method (n = 576) | Yes (%) | No (%) |
Demonstrate how to use method | 530 (92.0%) | 46 (8%) |
Explained how the method works | 470 (81.6%) | 106 (18.4%) |
Described about possible side effects | 505 (87.7%) | 71 (12.3%) |
Explained what to do for side effects | 464 (80.6%) | 112 (19.4%) |
Told about possibility of changing method | 496 (86.1%) | 80 (13.9%) |
Mentioned when and where to go for supply or follow-up. | 473 (82.1%) | 103 (17.9%) |
Client-provider Interaction From Client Perspective
As shown in Table 4; 430 (74.6%) of clients reported that consultation time with the provider was about right (appropriate), 146 (25.4%) of clients were informed that the consultation time was short, and 52 (9.0%) of the clients were did not want to respond. Moreover, 527 (91.5%) of the clients reported that the provider was easily understandable, and 36 (6.3%) of the clients said that the provider was challenging to understand (Table 4).
Table 4
View of clients on the process of obtaining service
Variable | | No. | % |
Consultation time with service provider | About right Short | 430 146 | 74.6 25.4 |
Provider was easy to understand | Easily understandable Difficult to understand | 540 36 | 93.7 6.3 |
Why you preferred this health facility | I can choose provider Provide quality services Integrate service provided Near to my home | 355 115 69 37 | 61.6 20.0 12.0 6.4 |
Will you come back for next appointment | Yes No | 511 65 | 88.7 11.3 |
Client Satisfaction With Family Planning Services Provided
As Table 5 shows, Among all F/P users interviewed, 517 (89.8%) were satisfied with F/P counseling given by service providers, while 59 (10.2%) of them were not satisfied. The majority of the respondents were satisfied with the ease of getting F/P unit (89%). Overall satisfaction of clients with family planning services was indicated that, 455 (79.0%) of the clients were satisfied with the service they received, and 69 (12.0%) of the clients were not satisfied (Table 5).
Table 5
Satisfaction of clients on F/P services
Attitude questions or statements | Agree (%) | Disagree (%) |
Provider greeting is good and in a friendly way. | 523 (90.8%) | 55 (9.2%) |
Provider performs the procedure with cleanliness and sanitation. | 513 (89.1%) | 63 (10.9%) |
Provider has good knowledge and skill to perform the procedure. | 466 (80.9%) | 110 (19.1%) |
Sufficient family planning methods are available. | 458 (78.7%) | 118 (20.5%) |
Information given about the method is sufficient/adequate | 560 (97.2%) | 16 (2.8%) |
Waiting time is fair and adequate. | 503 (87.3%) | 73 (12.7%) |
Privacy was maintained. | 536 (93.0%), | 40 (7.0%) |
Waiting place is adequate with latrine and water supply. | 445 (77.3%) | 131 (22.7%) |
Consultation time with provider is appropriate time. | 378 (65.6%) | 198 (34.4%) |
During consultation, the provider is easy to understand | 527 (91.5%) | 49 (8.5%) |
Quality f/p services can be better provided by doctor | 378 (65.6%) | 198 (34.4%) |
Quality f/p services can be better provided by female nurse | 513 (89.1%) | 63 (10.9%) |
Quality f/p services can be better provided by male nurse | 312 (54.2%) | 164 (45.8%) |
Quality f/p services can be better provided by HEW | 201 (34.9) | 375 (65.1%) |
Do you agree that you have received quality f/p services from this health facility and satisfied? | 455 (79.0%) | 121 (21.0%) |
Factors associated with client satisfaction with family planning services.
In bivariate logistic regression analysis, client’s residence, educational status, facility opening hours, short waiting time, maintained privacy, having family planning discussion with husbands, sufficient consultation time, demonstration of how to use the methods, and proper explanation of side effects was significantly associated with client satisfaction.
In multivariate logistic regression analysis again, client education, the convenience of facility opening hours, maintained privacy, demonstrated of how to use the method, and having family planning discussions with husbands were significant associations with client satisfaction.
Clients with primary education were 2.11 times more likely satisfied with family planning services provided them than those with secondary education and above (AOR = 2.11 95%CI (1.11–4.24). Clients who agreed that the facility opening hour was convenient for them were 3.13 times more likely satisfied than those who disagreed with the facility opening hour (AOR = 3.13 and 95% CI (2.12–5.75).
Family planning users whose privacy was maintained during examination and procedure were four times more likely satisfied than those whose privacy was not maintained (AOR = 4.1 and 95% CI (2.50–8.12). Clients who demonstrated how to use the method were 1.98 times more likely to be satisfied than those who were not demonstrated (AOR = 1.98 and 95% CI (1.01–5.20).
Clients who had family planning discussions with husbands were five times more likely satisfied than those who had no family planning discussion (AOR = 5.05, 95% CI: 3.33–7.64) (Table 6).
Table 6
; Factors associated with client satisfaction with F/P services
Variables | Satisfaction Yes No | COR (95%CI) | COR (95%CI) |
Respondent’s age 15–24 years >=25 years | 150 199 77 150 | 1.00 0.178(0.12–0.27) | 1.00 0.390 (0.19–2.541) |
Marital status of respondents Single Married*1 | 10 14 364 188 | 1.00 1.591(1.77–3.17) | 1.00 2.156(0.674–6.89) |
Have discussion with husband on F/P No Yes | 18 46 267 245 | 1.00 4.429(3.15–5.28) | 1.00 5.05 (3.33–7.64) ** |
Having children No Yes | 18 22 266 270 | 1.00 0.91(0.23–3.55) | 1.00 2.71(0.99–6.01) |
Breast-feeding No Yes | 106 160 120 150 | 1.00 1.13 (2.12–5.75) | 1.00 1.98 (0.62–4.35) |
Educational status Secondary school and above Primary education and less | 71 80 223 202 | 1.00 1.20 (1.32–6.15) | 1.00 2.11 (1.11–4.24) ** |
Convenient opening hours of facility No Yes | 64 60 196 256 | 1.00 2.61(1.13–4.55) | 1.00 3.13 (2.12–5.75) ** |
Privacy maintained No Yes | 11 29 300 236 | 1.00 2.1(1.92–4.32) | 1.00 4.10 (2.50–8.12) ** |
Demonstrated how to use the method No Yes | 11 35 325 205 | 1.00 1.50 (1.11–3.23) | 1.00 1.98 (1.21–5.20) ** |