ASSESSMENT OF QUALITY OF CONTRACEPTIVE COUNSELLING SERVICES IN PUBLIC HEALTH FACILITIES OF ZAMFARA STATE

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Author

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Department of Medicine

ABSTRACT
Contraceptive counselling for rightful decision making in family planning methods selection is one important reproductive right of a woman. The study aimed to assess quality of contraceptive counselling services in public health facilities of Zamfara state. The study identified the number of formally/certified FP trained service providers, assessed quality of contraceptive counselling, identified number of client?s offered, pattern of contraceptive method mix in the last six month preceding the study and client?s satisfaction with service provision. A concurrent mixed method study design (qualitative and quantitative) method was employed for the study. Seven (7) public health care facilitiesout of the 22 available hospitals were selected for the study through multi-stagesampling technique from which 48 clients were interviewed. The tools for data collectionwere an observation guide and an interview checklist adopted from Kim (1995) used to elicit responses of the respondents via overt non-participant observations during counselling sessions, client exit interviews and clients` satisfaction with the service provision. Service delivery registers of the selected facilities were scrutinized for availability of contraceptive method mix in the last six months prior to survey. The number of formally trained FP providers in the selected facilities was obtained from the state MCH coordinator and corroborated at the facilities from the respective head of the FP clinics. Data from Client Exit Interview (CEI) was transcribed in Hausa and translated into English by a translation expert which was subsequently analysed manually using thematic content methodology. The reports from the observations of the counselling sessions were coded and also analyzed manually. The data on contraceptive method mix was analyzed using excel spread sheet 2010 and presented in a table and simple percentages. Pearson correlation coefficient was used to test relationship between variables at p-value of 0.05. Findings revealed that most of the respondents are within the reproductive age 20-39 years with range between 4-6 parity haven the highest % of 39.5. Majority had secondary education and all were married (100%). The quality of client-provider interaction was found to be poor as evaluated by the researcher and reported by the respondents. Trained service providers were in short supply with 50%. Nearly 4,000 clients were offered various contraceptive method mix in which the injectable was the commonest method accounting for one quarter of these clients followed closely by the implant with 34.7%, despite poor client-provider interaction, clients were still satisfied with some aspect of counselling such as greeting, provision of free contraceptive and information they received from their service providers. Correlation was seen between various subset of the client satisfaction and socio-demographic characteristics; occupation and parity were found to be correlated with counselling session (p=0.012) and (0.050) respectively. The findings suggest the need for increase awareness and enlightment on FP counselling to women through mass media, mass employment by the government to address shortages and the need for FP providers to be specifically trained on contraceptive counselling techniques to improve the quality of FP counselling services in public health facilities in Zamfara state. Key: ServiceQuality, Contraceptive Counselling, Method Mix, Service Providers.