Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
BMC Health Serv Res. 2019 Aug 9;19(1):559. doi: 10.1186/s12913-019-4388-3.
To date, there is little information on the sustainability of family planning (FP) service quality after completion of a donor-funded program. This paper examines the sustainability of the Nigerian Urban Reproductive Health Initiative (NURHI) program on quality of FP services in two cities: Ilorin, where the program ended in March 2015 and Kaduna where the program continued.
Data come from three time periods: 2011, before program implementation; 2014, near Phase 1 completion; and 2017, two-years post Phase 1. In 2011, we undertook a facility audit and provider surveys in all public sector facilities in each city as well as all private facilities mentioned as the source for FP or maternal, newborn, and child health services in a 2010 women's household survey. In 2014 and 2017, we returned to the same facilities to undertake the facility audit and provider surveys. Quality is measured from principal component analyses of 30 items from the facility audit and provider surveys. Service use outcomes are measured as the ratio of FP clients (total and new) to the number of reproductive health staff members. Multivariate random effect models are estimated to examine changes in the outcomes over time, between NURHI and non-NURHI facilities and by city.
We demonstrate that NURHI facilities had better quality and higher service use than non-NURHI facilities. Further, while quality of services was higher in Ilorin in 2011, by 2014 and three years later (2017), the quality was better in Kaduna where the program continued. In addition, while no difference was found in service utilization between Ilorin and Kaduna in 2014, by 2017, Kaduna had significantly more new FP users than Ilorin.
In Ilorin, quality of services did not continue its strong upward trend after the program ended. Programs need to consider long-term strategies that support continuation of program components post program implementation. This may include ensuring continued training of providers and addressing equipment and commodity stock-outs through system changes rather than specific facility-level changes. The findings from this study can be used to inform future programs seeking to improve quality of FP services in a sustainable manner.
迄今为止，关于在捐助者资助的项目完成后，计划生育（FP）服务质量的可持续性，我们知之甚少。本文考察了尼日利亚城市生殖健康倡议（NURHI）项目在两个城市的 FP 服务质量的可持续性：伊洛林，该项目于 2015 年 3 月结束；卡杜纳，该项目仍在继续。
数据来自三个时期：2011 年，项目实施前；2014 年，接近第一阶段完成；以及 2017 年，第一阶段结束后两年。2011 年，我们对每个城市的所有公立机构以及在 2010 年妇女家庭调查中提到的所有 FP 或母婴和儿童保健服务来源的所有私立机构进行了机构审计和服务提供者调查。2014 年和 2017 年，我们回到相同的机构进行机构审计和服务提供者调查。质量是通过对机构审计和服务提供者调查中的 30 个项目进行主成分分析来衡量的。服务使用结果是通过 FP 客户（总数和新客户）与生殖健康工作人员数量的比例来衡量的。采用多变量随机效应模型来检验随着时间的推移，NURHI 机构和非 NURHI 机构以及两个城市之间结果的变化。
我们表明，NURHI 机构的服务质量优于非 NURHI 机构，服务利用率更高。此外，虽然 2011 年伊洛林的服务质量较高，但到 2014 年和三年后（2017 年），在项目继续的卡杜纳，服务质量更好。此外，虽然 2014 年伊洛林和卡杜纳之间的服务利用率没有差异，但到 2017 年，卡杜纳的新 FP 用户明显多于伊洛林。
在伊洛林，项目结束后，服务质量没有继续保持强劲的上升趋势。项目需要考虑长期战略，以支持项目实施后项目组件的持续。这可能包括确保继续对提供者进行培训，并通过系统变革而不是特定机构层面的变革来解决设备和商品库存不足的问题。本研究的结果可用于为未来以可持续方式提高 FP 服务质量的项目提供信息。
