Assessing the sustainability of the Nigerian urban reproductive health initiative facility-level programming: longitudinal analysis of service quality
Abstract Background To date, there is little information on the sustainability of family planning (FP) service quality after completion of a donor-funded program. This paper examines the sustainability of the Nigerian Urban Reproductive Health Initiative (NURHI) program on quality of FP services in...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-08-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12913-019-4388-3 |
| _version_ | 1819081057511669760 |
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| author | Ilene S. Speizer Lisa M. Calhoun Courtney McGuire Peter M. Lance Caroline Heller David K. Guilkey |
| author_facet | Ilene S. Speizer Lisa M. Calhoun Courtney McGuire Peter M. Lance Caroline Heller David K. Guilkey |
| author_sort | Ilene S. Speizer |
| collection | DOAJ |
| description | Abstract Background To date, there is little information on the sustainability of family planning (FP) service quality after completion of a donor-funded program. This paper examines the sustainability of the Nigerian Urban Reproductive Health Initiative (NURHI) program on quality of FP services in two cities: Ilorin, where the program ended in March 2015 and Kaduna where the program continued. Methods Data come from three time periods: 2011, before program implementation; 2014, near Phase 1 completion; and 2017, two-years post Phase 1. In 2011, we undertook a facility audit and provider surveys in all public sector facilities in each city as well as all private facilities mentioned as the source for FP or maternal, newborn, and child health services in a 2010 women’s household survey. In 2014 and 2017, we returned to the same facilities to undertake the facility audit and provider surveys. Quality is measured from principal component analyses of 30 items from the facility audit and provider surveys. Service use outcomes are measured as the ratio of FP clients (total and new) to the number of reproductive health staff members. Multivariate random effect models are estimated to examine changes in the outcomes over time, between NURHI and non-NURHI facilities and by city. Results We demonstrate that NURHI facilities had better quality and higher service use than non-NURHI facilities. Further, while quality of services was higher in Ilorin in 2011, by 2014 and three years later (2017), the quality was better in Kaduna where the program continued. In addition, while no difference was found in service utilization between Ilorin and Kaduna in 2014, by 2017, Kaduna had significantly more new FP users than Ilorin. Conclusions In Ilorin, quality of services did not continue its strong upward trend after the program ended. Programs need to consider long-term strategies that support continuation of program components post program implementation. This may include ensuring continued training of providers and addressing equipment and commodity stock-outs through system changes rather than specific facility-level changes. The findings from this study can be used to inform future programs seeking to improve quality of FP services in a sustainable manner. |
| first_indexed | 2024-12-21T19:54:43Z |
| format | Article |
| id | doaj.art-37c5a10d2e124df095980a148bb32455 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-21T19:54:43Z |
| publishDate | 2019-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-37c5a10d2e124df095980a148bb324552022-12-21T18:52:08ZengBMCBMC Health Services Research1472-69632019-08-0119111110.1186/s12913-019-4388-3Assessing the sustainability of the Nigerian urban reproductive health initiative facility-level programming: longitudinal analysis of service qualityIlene S. Speizer0Lisa M. Calhoun1Courtney McGuire2Peter M. Lance3Caroline Heller4David K. Guilkey5Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public HealthCarolina Population Center, University of North Carolina at Chapel HillCarolina Population Center, University of North Carolina at Chapel HillCarolina Population Center, University of North Carolina at Chapel HillCarolina Population Center, University of North Carolina at Chapel HillDepartment of Economics, University of North Carolina at Chapel HillAbstract Background To date, there is little information on the sustainability of family planning (FP) service quality after completion of a donor-funded program. This paper examines the sustainability of the Nigerian Urban Reproductive Health Initiative (NURHI) program on quality of FP services in two cities: Ilorin, where the program ended in March 2015 and Kaduna where the program continued. Methods Data come from three time periods: 2011, before program implementation; 2014, near Phase 1 completion; and 2017, two-years post Phase 1. In 2011, we undertook a facility audit and provider surveys in all public sector facilities in each city as well as all private facilities mentioned as the source for FP or maternal, newborn, and child health services in a 2010 women’s household survey. In 2014 and 2017, we returned to the same facilities to undertake the facility audit and provider surveys. Quality is measured from principal component analyses of 30 items from the facility audit and provider surveys. Service use outcomes are measured as the ratio of FP clients (total and new) to the number of reproductive health staff members. Multivariate random effect models are estimated to examine changes in the outcomes over time, between NURHI and non-NURHI facilities and by city. Results We demonstrate that NURHI facilities had better quality and higher service use than non-NURHI facilities. Further, while quality of services was higher in Ilorin in 2011, by 2014 and three years later (2017), the quality was better in Kaduna where the program continued. In addition, while no difference was found in service utilization between Ilorin and Kaduna in 2014, by 2017, Kaduna had significantly more new FP users than Ilorin. Conclusions In Ilorin, quality of services did not continue its strong upward trend after the program ended. Programs need to consider long-term strategies that support continuation of program components post program implementation. This may include ensuring continued training of providers and addressing equipment and commodity stock-outs through system changes rather than specific facility-level changes. The findings from this study can be used to inform future programs seeking to improve quality of FP services in a sustainable manner.http://link.springer.com/article/10.1186/s12913-019-4388-3SustainabilityNigeriaFamily planningUrbanQuality |
| spellingShingle | Ilene S. Speizer Lisa M. Calhoun Courtney McGuire Peter M. Lance Caroline Heller David K. Guilkey Assessing the sustainability of the Nigerian urban reproductive health initiative facility-level programming: longitudinal analysis of service quality BMC Health Services Research Sustainability Nigeria Family planning Urban Quality |
| title | Assessing the sustainability of the Nigerian urban reproductive health initiative facility-level programming: longitudinal analysis of service quality |
| title_full | Assessing the sustainability of the Nigerian urban reproductive health initiative facility-level programming: longitudinal analysis of service quality |
| title_fullStr | Assessing the sustainability of the Nigerian urban reproductive health initiative facility-level programming: longitudinal analysis of service quality |
| title_full_unstemmed | Assessing the sustainability of the Nigerian urban reproductive health initiative facility-level programming: longitudinal analysis of service quality |
| title_short | Assessing the sustainability of the Nigerian urban reproductive health initiative facility-level programming: longitudinal analysis of service quality |
| title_sort | assessing the sustainability of the nigerian urban reproductive health initiative facility level programming longitudinal analysis of service quality |
| topic | Sustainability Nigeria Family planning Urban Quality |
| url | http://link.springer.com/article/10.1186/s12913-019-4388-3 |
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