Quality of reproductive health services at private for-profit institutions in Addis Ababa

Abstract

Abstract
Background: Private for-profit health institutions are expanding, and making considerable
contributions to improve health care for significant number of population. Their crucial share in
reproductive health (RH) services in this area is growing rapidly. Assessing the quality of service
being provided by the private sector particularly in the area of RH provision has paramount
importance.
Objective: To assess the quality of RH services at private for-profit health institutions in Addis
Ababa and to provide programmatic recommendations.
Methods: A descriptive cross-sectional study was conducted to assess the quality of service using a
structured questionnaire through client exit interview, service provider interview, observation of
client-provider interaction, provider’s technical competence and using a checklist for inventory of
equipment and supplies of health institutions. The study was conducted from April to December
2006.
Result: Ten private for profit health institutions were included in this study. A total of 411
clients who came to receive RH services including family planning (FP), antenatal care(ANC),
delivery services, postnatal care(PNC), post abortion care(PAC) and sexually transmitted
infection (STI) management were studied. Among others fourty six service providers were
interviewed and 76 observations of client-provider interactions were made. Overall 91.2% exit
interview respondents reported satisfaction with services they received. In multivariate analysis,
satisfaction of clients was lower for those women who reported waiting for a long time without
getting the service (OR=0.07, 95% CI: 0.03, 0.16), those who were not treated politely
(OR=0.04, 95% CI: 0.01, 0.11), those who did not get satisfactory response for their questions
(OR=0.02, 95% CI: 0.01, 0.08),and those with short consultation time (OR=0.13, CI: 0.05,
0.31). All of the study institutions had basic equipment and supplies for the services. Majority of
the providers received basic training in RH services. Inadequate supervision, less use of IEC
materials, and missed opportunity for VCT services was identified as a problem.
Conclusion: Improving the use of IEC materials, refresher training and supportive supervision
for the service providers by responsible authorities are recommended. It is suggested that creating a
mechanism to reduce long waiting time can improve client satisfaction.
Keywords: Private for profit health sector, quality reproductive health services, Supportive supervision
1Ethiopian Society of Obstetricians and Gynecologists, 2Department of Community Health, Addis Ababa University