Department of Global Health Systems and Development, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2200-TB46, New Orleans, Louisiana, USA.
BMC Health Serv Res. 2011 Aug 24;11:203. doi: 10.1186/1472-6963-11-203.
Public and private family planning providers face different incentive structures, which may affect overall quality and ultimately the acceptability of family planning for their intended clients. This analysis seeks to quantify differences in the quality of family planning (FP) services at public and private providers in three representative sub-Saharan African countries (Tanzania, Kenya and Ghana), to assess how these quality differentials impact upon FP clients' satisfaction, and to suggest how quality improvements can improve contraceptive continuation rates.
Indices of technical, structural and process measures of quality are constructed from Service Provision Assessments (SPAs) conducted in Tanzania (2006), Kenya (2004) and Ghana (2002) using direct observation of facility attributes and client-provider interactions. Marginal effects from multivariate regressions controlling for client characteristics and the multi-stage cluster sample design assess the relative importance of different measures of structural and process quality at public and private facilities on client satisfaction.
Private health facilities appear to be of higher (interpersonal) process quality than public facilities but not necessarily higher technical quality in the three countries, though these differentials are considerably larger at lower level facilities (clinics, health centers, dispensaries) than at hospitals. Family planning client satisfaction, however, appears considerably higher at private facilities - both hospitals and clinics - most likely attributable to both process and structural factors such as shorter waiting times and fewer stockouts of methods and supplies.
Because the public sector represents the major source of family planning services in developing countries, governments and Ministries of Health should continue to implement and to encourage incentives, perhaps performance-based, to improve quality at public sector health facilities, as well as to strengthen regulatory and monitoring structures to ensure quality at both public and private facilities. In the meantime, private providers appear to be fulfilling an important gap in the provision of FP services in these countries.
公共和私人计划生育服务提供者面临不同的激励结构，这可能会影响整体质量，并最终影响其目标客户对计划生育的接受程度。本分析旨在量化撒哈拉以南非洲三个代表性国家（坦桑尼亚、肯尼亚和加纳）的公共和私人提供者的计划生育服务质量差异，评估这些质量差异如何影响计划生育客户的满意度，并提出如何改善质量以提高避孕续用率。
使用直接观察设施属性和客户-提供者互动，从坦桑尼亚（2006 年）、肯尼亚（2004 年）和加纳（2002 年）进行的服务提供评估（SPA）中构建技术、结构和过程质量指标。通过控制客户特征和多阶段聚类样本设计的多元回归分析评估公共和私人设施结构和过程质量不同措施对客户满意度的相对重要性。
在这三个国家，私营卫生设施的人际（过程）质量似乎高于公共设施，但在技术质量方面不一定更高，尽管在较低级别的设施（诊所、卫生中心、诊所）中，这些差异要大得多。然而，计划生育客户满意度在私人设施（医院和诊所）中似乎要高得多，这很可能归因于过程和结构因素，例如等待时间更短，以及方法和用品的库存更少。
由于公共部门代表发展中国家计划生育服务的主要来源，政府和卫生部应继续实施并鼓励激励措施，也许是基于绩效的激励措施，以改善公共部门卫生设施的质量，并加强监管和监测结构，以确保公共和私人设施的质量。与此同时，私人提供者似乎在填补这些国家计划生育服务提供方面的一个重要空白。
