Please use this identifier to cite or link to this item:
Scopus Web of Science® Altmetric
Type: Journal article
Title: Client and facility level determinants of quality of care in family planning services in Ethiopia: multilevel modelling
Author: Tessema, G.
Mahmood, M.
Gomersall, J.
Assefa, Y.
Zemedu, T.
Kifle, M.
Laurence, C.
Citation: PLoS One, 2017; 12(6):e0179167-1-e0179167-20
Publisher: PloS
Issue Date: 2017
ISSN: 1932-6203
Editor: Khan, H.T.A.
Statement of
Gizachew Assefa Tessema, Mohammad Afzal Mahmood, Judith Streak Gomersall, Yibeltal Assefa, Theodros Getachew Zemedu, Mengistu Kifle, Caroline O. Laurence
Abstract: Over the last two decades, while contraceptive use has improved in Ethiopia, the contraceptive prevalence rate remains low. In addition to socio-demographic and cultural factors, the quality of care in Family Planning (FP) services is an important determining factor of FP utilization. However, little research exists on the determinants of quality of care in FP services in Ethiopia. This study aims to identify the client and facility level determinants of quality of care in FP services in Ethiopia.This study was based on the first Ethiopian Services Provision Assessment Plus (ESPA+) survey conducted in 2014. A total of 1247 clients nested in 374 health facilities were included in the analysis. Multilevel mixed-effects logistic regression modelling was conducted. The outcome variable, client satisfaction, was created using polychoric principal component analysis using eleven facets that reflect client satisfaction.The results showed that both client-level and facility-level factors were associated with quality of care in FP services in Ethiopia. At the client-level; provision of information on potential side effects of contraceptive method (AOR = 5.22, 95% CI: 2.13-12.80), and number of history and physical assessments (AOR = 1.19, 95% CI: 1.03-1.34) were positively associated with client satisfaction, whereas waiting times of 30 minutes to two hours (AOR = 0.11, 95% CI: 0.03-0.33) was negatively associated with client satisfaction. At the facility-level; urban location (AOR = 4.61, 95% CI: 1.04-20.58), and availability of FP guidelines/protocols for providers (AOR = 4.90, 95% CI: 1.19-20.19) had positive significant effect on client satisfaction.Quality improvement programs in FP services in Ethiopia should focus on shortening waiting times and provision of information about the potential side effects of contraceptive methods. It is also important to improve health providers' skills in thorough client history taking and physical assessment. Further distribution and implementation of best practice guidelines for providers working in the FP services must be a priority.
Keywords: Humans
Family Planning Services
Quality of Health Care
Rights: © 2017 Tessema et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
DOI: 10.1371/journal.pone.0179167
Published version:
Appears in Collections:Aurora harvest 8
Public Health publications

Files in This Item:
File Description SizeFormat 
hdl_106164.pdfPublished Version1.86 MBAdobe PDFView/Open

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.