Ssanyu Jacquellyn Nambi, Kananura Rornald Muhumuza, Eriksson Leif, Waiswa Peter, Målqvist Mats, Kalyango Joan Nakayaga
Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala, Uganda.
Department of Women's and Children's Health, Centre for Health and Sustainability, Uppsala University, Uppsala, Sweden.
Reprod Health. 2025 May 15;22(1):82. doi: 10.1186/s12978-025-02026-w.
Health facility readiness is essential for realizing voluntary, rights-based family planning. However, many countries, including rapidly urbanizing Uganda, face challenges in ensuring their health facilities are sufficiently equipped to meet the growing demand for these services. This study assessed readiness and associated factors across public, private-not-for-profit (PNFP), and private-for-profit (PFP) health facilities in urban east-central Uganda to guide strategies for improving service delivery.
The study used secondary data from a cross-sectional study done in Jinja City and Iganga Municipality, including a health facility assessment and health worker survey. Readiness was measured using the Service Availability and Readiness Assessment methodology, and health worker knowledge and biases were assessed through the Situation Analysis approach. Sample weights adjusted for facility and health worker representation, and linear regression examined associations between readiness scores and various factors.
Among 152 health facilities, 94.2% offered family planning services, with an average readiness score of 46.7% (standard deviation ± 17.0). Short-acting methods had high availability (99.0%), while long-acting reversible contraceptives (34.2%) and permanent options (8.9%) were less available, compounded by prevalent stock-outs. Additionally, staff refresher training was inadequate, particularly in PFP facilities (50.4%), and health worker knowledge, confidence and willingness to provide some methods, particularly long-acting options and natural family planning counselling, were low. Notably, out of 261 health workers, 97.7% imposed at least one restriction to service access based on either age, parity, marital status, or spousal consent, more pronounced in PNFP facilities. Readiness was significantly associated with facility level (health centre level II facilities: β = -9.42, p = 0.036; drug shops: β = -11.00, p = 0.022), external supervision (β = 9.04, p = 0.009), holding administrative meetings (β = 9.72, p = 0.017), and imposing marital status (β = -9.42, p = 0.017) and spousal consent access barriers (β = 6.24, p = 0.023).
This study found sub-optimal facility readiness, highlighting the need to strengthen governance of services across both public and private sectors, implement comprehensive training for health workers in both sectors, and align policies to ensure equitable access to a full range of services for all clients.
卫生机构的准备情况对于实现基于权利的自愿计划生育至关重要。然而，包括快速城市化的乌干达在内的许多国家，在确保其卫生机构具备足够的设备以满足对这些服务日益增长的需求方面面临挑战。本研究评估了乌干达中东部城市的公共、非营利性私立（PNFP）和营利性私立（PFP）卫生机构的准备情况及相关因素，以指导改善服务提供的策略。
该研究使用了在金贾市和伊甘加市进行的一项横断面研究的二手数据，包括卫生机构评估和卫生工作者调查。使用服务可用性和准备情况评估方法来衡量准备情况，并通过情况分析方法评估卫生工作者的知识和偏见。对样本权重进行调整以反映机构和卫生工作者的代表性，并通过线性回归研究准备情况得分与各种因素之间的关联。
在152家卫生机构中，94.2%提供计划生育服务，平均准备情况得分为46.7%（标准差±17.0）。短效方法的可用性很高（99.0%），而长效可逆避孕方法（34.2%）和永久性避孕方法（8.9%）的可用性较低，且普遍存在缺货情况。此外，工作人员进修培训不足，特别是在营利性私立机构（50.4%），并且卫生工作者在提供某些方法，特别是长效方法和自然计划生育咨询方面的知识、信心和意愿较低。值得注意的是，在261名卫生工作者中，97.7%至少基于年龄、产次、婚姻状况或配偶同意对服务获取施加了一项限制，在非营利性私立机构中更为明显。准备情况与机构级别（二级卫生中心机构：β = -9.42，p = 0.036；药店：β = -11.00，p = 0.022）、外部监督（β = 9.04，p = 0.009）、召开行政会议（β = 9.72，p = 0.017）以及施加婚姻状况（β = -9.42，p = 0.017）和配偶同意获取障碍（β = 6.24，p = 0.023）显著相关。
本研究发现机构准备情况未达最佳水平，凸显了加强公共和私营部门服务治理、对两个部门的卫生工作者进行全面培训以及调整政策以确保所有客户公平获得全方位服务的必要性。
