Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
BMC Health Serv Res. 2021 Oct 11;21(1):1075. doi: 10.1186/s12913-021-07066-z.
Niger demonstrates high fertility and low contraceptive use that are typical in much of the West and Central African region. The government of Niger has committed to increasing modern contraceptive use as part of its health strategy. Designing and testing strategies to improve quality of care and satisfaction of family planning clients is important for addressing low contraceptive use in contexts like Niger.
This study uses recently collected client exit interview data from 2720 clients surveyed in the Dosso region of Niger to examine whether implementation of segmentation-based counseling leads to improved quality of services and client satisfaction. We compare three scenarios: a) facilities where segmentation counseling was implemented since 2017; b) facilities where segmentation counseling began in late 2019; and c) facilities without segmentation counseling. Bivariate and multivariate analyses are undertaken to determine if there are differences in quality of services and client satisfaction between the facility groups and between clients that were segmented and those who were not segmented in the first two scenarios.
Results demonstrate that clients in facilities with segmentation generally received better quality services than clients in facilities without segmentation. Clients in facilities implementing segmentation longer reported higher quality services than the recent segmentation facilities. Clients who were segmented compared to those who were not segmented also reported better quality services. New clients reported higher quality services than returning clients and among new clients, those who were segmented also reported higher quality services. No differences were found in client satisfaction between facility scenarios or between segmented and non-segmented clients.
These findings demonstrate that segmentation or another targeted counseling strategy could be useful to the government of Niger to improve the quality of services offered. As part of the scale up process, the government needs to consider strategies that ensure that all new clients are segmented and design an approach that is sustainable and does not risk failing should there be stock-out of segmentation sheets or loss of counseling cards. This type of targeted counseling could improve the quality of services offered and ideally lead to increased contraceptive use in Niger.
尼日尔的生育率高，避孕药具使用率低，这在西非和中非地区很常见。尼日尔政府已承诺增加现代避孕药具的使用，这是其卫生战略的一部分。在像尼日尔这样的背景下，设计和测试提高计划生育服务质量和客户满意度的策略对于解决避孕药具使用率低的问题非常重要。
本研究使用最近从尼日尔多索地区 2720 名接受调查的客户的客户退出访谈数据，考察基于细分的咨询的实施是否会导致服务质量的提高和客户满意度。我们比较了三种情况：a）自 2017 年以来实施细分咨询的机构；b）2019 年末开始实施细分咨询的机构；c）没有细分咨询的机构。进行了双变量和多变量分析，以确定在服务质量和客户满意度方面，设施组之间以及前两种情况下被细分和未被细分的客户之间是否存在差异。
结果表明，在有细分的机构中，客户通常会获得更好的服务质量，而在没有细分的机构中则不然。在实施细分时间更长的机构中，客户报告的服务质量更高，而最近实施细分的机构则不然。与未细分的客户相比，被细分的客户报告的服务质量更好。与返回的客户相比，新客户报告的服务质量更高，而在新客户中，被细分的客户报告的服务质量更高。在设施方案或细分和非细分客户之间，客户满意度没有差异。
这些发现表明，细分或其他有针对性的咨询策略可能对尼日尔政府提高所提供服务的质量很有用。作为扩大规模的过程的一部分，政府需要考虑确保所有新客户都被细分的策略，并设计一种可持续的方法，并且在细分表或咨询卡丢失的情况下不会失败的方法。这种有针对性的咨询可以提高所提供服务的质量，并有望在尼日尔提高避孕药具的使用。
