Influence of the Service Delivery Environment on Family Planning Outcomes in Nigeria
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Author(s): Gage AJ, Zomahoun D
Using linked data from the 2009 Community Participation for Action in the Social Sectors project health facility and household surveys, this paper examined the association of the family planning service delivery environment with contraceptive outcomes among males and females in five states of Nigeria. Multilevel logit models were used to assess the association with contraceptive outcomes of method choice, health worker training, equipment availability, quality of provider-client interaction, use of quality assurance methods, and perceived needs in local family planning health facilities. The findings showed a strong positive association of the availability of an increased range of contraceptive methods and the use of quality assurance systems by family planning health facilities in the local government area (LGA) with odds of knowing three or more modern methods of contraception. The breadth of health worker training to provide family planning services had a positive association while a perceived need for staff by family planning providers in the LGA had a negative association with the odds of both lifetime use and current use of a modern method. The quality of family planning provider-client interaction in the LGA was positively associated with current use of a modern method. In LGAs with higher quality family planning provider-client interaction, the odds of ever using and the odds of currently using a modern method were significantly higher for women than for men. To increase knowledge of modern contraception, programs should target LGAs that provide a limited range of contraceptive methods and that use few quality assurance mechanisms. Efforts to increase modern contraceptive use should reach LGAs with staff shortages, low quality of provider-client interaction, and a limited scope of in-service training on the delivery of family planning and reproductive health services.
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