TY - JOUR
T1 - Quality of facility-based family planning services for adolescents in Malawi
T2 - findings from a national census of health facilities
AU - Jayachandran, Vinitha
AU - Chapotera, Gertrude
AU - Stones, William
N1 - This research was developed at a DHS Program workshop funded by USAID Malawi.
PY - 2016/6/1
Y1 - 2016/6/1
N2 - Background: The main objective of this study was to describe the quality, in terms of provision and experience of care, of facility-based family
planning services for adolescents compared to older clients in Malawi.
Methods: Secondary data analysis was performed on data obtained from the Service Provision Assessment survey 2013-14, a census of all formal
health facilities in the country. For the present study the inclusion criterion was that the client’s age was recorded in the data set, which
gave a weighted total of 1388 observations of consultations, reflecting provision of care, and client exit interviews, reflecting experience
of care.
Results: The youngest clients (age group 13 to 19 years) had twice the odds of reporting a better experience of care compared to clients aged
26 and older (odds ratio [OR] 2.03, 95% confidence interval [CI] 1.15 to 3.54, P = 0.013). The standard of observed provision was low,
typically with half or more of the mandated elements of care omitted. Compared with clients aged over 25, provision of care was slightly
better for adolescents, with a coefficient of 4.56 on a percentage scale (95% CI 0.90 to 8.23, P = 0.015) and a coefficient of 2.33 for
those aged 20-25 (95% CI 0.21 to 4.44, P = 0.032). Clients seen in facilities under nongovernmental management had better provision
of care compared to government facilities, with a coefficient of 12.35 (95% CI 6.70 to 18.01, P < 0.001); care was worse for clients seen
in clinics compared to hospitals (coefficient −6.88, 95% CI −11.41 to −2.35, P = 0.003) and also for clients seen by health surveillance
assistants compared to those seen by a clinician (coefficient −9.41, 95% CI −15.53 to −3.29, P = 0.003).
Conclusions : Quality of care for adolescents attending facility-based family planning services was slightly better than for older clients, but this is
overshadowed by the finding of a low standard of care overall. Health system strengthening, especially at the clinic level, is a policy and
programming priority that will contribute to adolescent reproductive health in Malawi.
AB - Background: The main objective of this study was to describe the quality, in terms of provision and experience of care, of facility-based family
planning services for adolescents compared to older clients in Malawi.
Methods: Secondary data analysis was performed on data obtained from the Service Provision Assessment survey 2013-14, a census of all formal
health facilities in the country. For the present study the inclusion criterion was that the client’s age was recorded in the data set, which
gave a weighted total of 1388 observations of consultations, reflecting provision of care, and client exit interviews, reflecting experience
of care.
Results: The youngest clients (age group 13 to 19 years) had twice the odds of reporting a better experience of care compared to clients aged
26 and older (odds ratio [OR] 2.03, 95% confidence interval [CI] 1.15 to 3.54, P = 0.013). The standard of observed provision was low,
typically with half or more of the mandated elements of care omitted. Compared with clients aged over 25, provision of care was slightly
better for adolescents, with a coefficient of 4.56 on a percentage scale (95% CI 0.90 to 8.23, P = 0.015) and a coefficient of 2.33 for
those aged 20-25 (95% CI 0.21 to 4.44, P = 0.032). Clients seen in facilities under nongovernmental management had better provision
of care compared to government facilities, with a coefficient of 12.35 (95% CI 6.70 to 18.01, P < 0.001); care was worse for clients seen
in clinics compared to hospitals (coefficient −6.88, 95% CI −11.41 to −2.35, P = 0.003) and also for clients seen by health surveillance
assistants compared to those seen by a clinician (coefficient −9.41, 95% CI −15.53 to −3.29, P = 0.003).
Conclusions : Quality of care for adolescents attending facility-based family planning services was slightly better than for older clients, but this is
overshadowed by the finding of a low standard of care overall. Health system strengthening, especially at the clinic level, is a policy and
programming priority that will contribute to adolescent reproductive health in Malawi.
KW - adolescent health
KW - contraception
KW - contraception behaviour
KW - family planning services
KW - quality of health care
KW - service provision assessment
KW - Malawi
U2 - 10.4314/mmj.v28i2.4
DO - 10.4314/mmj.v28i2.4
M3 - Article
SN - 1995-7262
VL - 28
SP - 48
EP - 52
JO - Malawi Medical Journal : the Journal of Medical Association of Malawi
JF - Malawi Medical Journal : the Journal of Medical Association of Malawi
IS - 2
ER -