Does quality matter? An analysis of two-family planning delivery models on quality of care and client satisfaction of services provided in the private sector in Kajiado County, Kenya

Milka Choge, Timothy Abuya, Kenneth Ngure, Elizabeth Echoka


There is evidence that good quality family planning (FP) services increases utilization. This was a facility-based mixed-method to compare the quality of care in the social franchised and non-franchised private health facilities in Kajiado County, Kenya. Quantitative data were collected from 586 FP clients’ exit interviews and a facility inventory in 32 health facilities. Additionally, qualitative interviews were conducted with FP users and providers. The outcome variable was client satisfaction. Logistic regression findings show that clients in a social franchise were 2.2 times more satisfied than a non-franchise facility(p=0.03). Social franchises had higher numbers of trained providers on FP (p=0.019) and low contraceptive stock-outs. The satisfied clients had shorter waiting time (p=0.002) and clients with high school education were less likely to be satisfied (Adjusted Odds Ratio = 0.44, p=0.001). Improving contraceptives availability, health provider training and reducing clients’ waiting time will increase client satisfaction and thus increase FP use. (Afr J Reprod Health 2021; 25[5]: 49-60).

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Ahmed S, Li Q, Liu L and Tsui AO. Maternal deaths

averted by contraceptive use: an analysis of 172 countries. Lancet Lond Engl. 2012;380(9837):111-125. doi:10.1016/S0140-6736(12)60478-4

WHO. Family planning/contraception methods. Accessed

July 28, 2021.

Family Planning 2020. Projected trends in contraceptive

use, Kenya. Published June 27, 2018. Accessed March 19, 2021.

Statistics of Kenya National Bureau of Statistics (KNBS).

Kenya Demographic and Health Survey 2014. Calverton, Maryland: Macro International Inc. Published online December 1, 2015. Accessed March 19, 2021.

Tessema GA, Streak Gomersall J, Mahmood MA and

Laurence CO. Factors determining quality of care in family planning services in Africa: a systematic review of mixed evidence. PLoS One. 2016;11(11):e0165627.

Fruhauf T, Zimmerman L, Kibira SPS, Makumbi F,

Gichangi P, Shiferaw S, Seme A, Guiella G and Tsui A. Measuring family planning quality and its link with contraceptive use in public facilities in Burkina Faso, Ethiopia, Kenya and Uganda. Health Policy Plan. 2018 Sep 1;33(7):828-839. doi: 10.1093/heapol/czy058. PMID: 30010860; PMCID: PMC6097453.

Zapata LB, Tregear SJ, Curtis KM, Tiller M, Pazol K,

Mautone-Smith N and Gavin LE. Impact of Contraceptive Counseling in Clinical Settings: A Systematic Review. Am J Prev Med. 2015 Aug;49(2 Suppl 1):S31-45. doi: 10.1016/j.amepre.2015.03.023. PMID: 26190845; PMCID: PMC4608447.

Ministry of Health Kenya. National Family Planning

Costed Implementation Plan 2017-2020. 2017.:84.

Madhavan S, and Bishai D. Private Sector Engagement in

Sexual and Reproductive Health and Maternal and Neonatal Health: A Review of the Evidence. Johns Hopkins University.2010.

MoH. Kenya Master Health Facility List: Find all the

health facilities in Kenya. Accessed July 28, 2020.

Argago TG, Hajito KW and Kitila SB. Clients satisfaction

with family planning services and associated factors among family planning users in Hossana Town Public Health Facilities, South Ethiopia: Facility-based cross-sectional study. Int J Nurs Midwifery. 2015;7(5):74-83. doi:10.5897/IJNM2015. 0163

Kenya Population and Housing Census Volume I:

Population by County and Sub-County. Kenya National Bureau of Statistics. Accessed March 20, 2021.

Ministry of Health Kenya. Kenya Health Information

System- aggregate. Accessed July 28, 2020.

Diggle P. Analysis of Longitudinal Data. Second

Paperback Edition. Oxford University Press; 2013.

Donabedian A. The Quality of Care: How Can It Be

Assessed? JAMA. 1988;260(12):1743-1748. doi:10.1001/jama.1988.03410120089033

Fundamental elements of the quality of care: A simple

framework | Population Council. Accessed October 14, 2020.

Kenya service provision assessment survey. Accessed

July 28, 2020.

ATLAS.ti: The Qualitative Data Analysis and Research

Software. ATLAS.ti. Accessed August 10, 2021.

Hancock NL, Vwalika B, Sitali ES, Mbwili-Muleya C, Chi

BH and Stuart GS. Evaluation of service quality in family planning clinics in Lusaka, Zambia. Contraception. 2015;92(4):345-349. doi:10.1016/j.contraception.2015.06.025

Wang W, Do M, Hembling J and Ametepi P. Assessing

the quality of care in family planning, antenatal, and sick child services at health facilities in Kenya, Namibia, and Senegal. Published online September 1, 2014. Accessed March 19, 2021.

Sieverding M, Briegleb C and Montagu D. User

experiences with clinical social franchising: qualitative insights from providers and clients in Ghana and Kenya. BMC Health Serv Res. 2015;15(1):49. doi:10.1186/s12913-015-0709-3

Nijmeijer KJ, Fabbricotti IN and Huijsman R. Is

franchising in health care valuable? A systematic review. Health Policy Plan. 2014;29(2):164-176. doi:10.1093/heapol/czt001

Hasselback L, Dicko M, Viadro C, Ndour S, Ndao O and

Wesson J. Understanding and addressing contraceptive stock-outs to increase family planning access and uptake in Senegal. BMC Health Serv Res. 2017;17(1):373. doi:10.1186/s12913-017-2316-y

Assaf S, Wang W and Mallick L. Quality of care in family

planning services in Senegal and their outcomes. BMC Health Serv Res. 2017;17(1):346. doi:10.1186/s12913-017-2287-z

Hutchinson PL, Do M and Agha S. Measuring client

satisfaction and the quality of family planning services: A comparative analysis of public and private health facilities in Tanzania, Kenya and Ghana. BMC Health Serv Res. 2011;11(1):203. doi:10.1186/1472-6963-11-203

Bintabara D, Ntwenya J, Maro II, Kibusi S, Gunda DW

and Mpondo BCT. Client satisfaction with family planning services in the area of high unmet need: evidence from Tanzania Service Provision Assessment Survey, 2014-2015. Reprod Health. 2018;15(1):127. doi:10.1186/s12978-018-0566-8

Wambua JM, Mbayaki R, Munyao PM, Kabue

MM, Mulindi R, Change PM, Ikamati R, Jahonga R, Ambalu R, Marang W and Mudany M. Client satisfaction determinants in four Kenyan slums. International Journal of Health Care Quality Assurance, 2015,Vol. 28 No. 7, pp. 667-677.

Wogu D, Lolaso T and Meskele M. Client Satisfaction

with Family Planning Services and Associated Factors in Tembaro District, Southern Ethiopia. Open Access J Contracept. 2020;11:69-76. doi:10.2147/OAJC.S258831.


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