A facility-based study of women' satisfaction and perceived quality of reproductive and maternal health services in the Kenya output-based approach voucher program.

BACKGROUND: This is a facility-based study designed to assess perceived quality of care and satisfaction of reproductive health services under the output-based approach (OBA) services in Kenya from clients' perspective. METHOD: An exit interview was conducted on 254 clients in public health facilities, non-governmental organizations, faith-based organizations and private facilities in Kitui, Kilifi, Kiambu, and Kisumu counties as well as in the Korogocho and Viwandani slums in Nairobi, Kenya using a 23-item scale questionnaire on quality of reproductive health services. Descriptive analysis, exploratory factor analysis, reliability test, and subgroup analysis using linear regression were performed. RESULTS: Clients generally had a positive view on staff conduct and healthcare delivery but were neutral on hospital physical facilities, resources, and access to healthcare services. There was a high overall level of satisfaction among the clients with quick service, good handling of complications, and clean hospital stated as some of the reasons that enhanced satisfaction. The County of residence was shown to impact the perception of quality greatly with other social demographic characteristics showing low impact. CONCLUSION: Majority of the women perceived the quality of OBA services to be high and were happy with the way healthcare providers were handling birth related complications. The conduct and practice of healthcare workers is an important determinant of client's perception of quality of reproductive and maternal health services. Findings can be used by health care managers as a guide to evaluate different areas of healthcare delivery and to improve resources and physical facilities that are crucial in elevating clients' level of satisfaction.

Accessibility of long-term family planning methods: a comparison study between Output Based Approach (OBA) clients verses non-OBA clients in the voucher supported facilities in Kenya.

BACKGROUND: The study seeks to evaluate the difference in access of long-term family planning (LTFP) methods among the output based approach (OBA) and non-OBA clients within the OBA facility. METHODS: The study utilises a quasi experimental design. A two tailed unpaired t-test with unequal variance is used to test for the significance variation in the mean access. The difference in difference (DiD) estimates of program effect on long term family planning methods is done to estimate the causal effect by exploiting the group level difference on two or more dimensions. The study also uses a linear regression model to evaluate the predictors of choice of long-term family planning methods. Data was analysed using SPSS version 17. RESULTS: All the methods (Bilateral tubal ligation-BTL, Vasectomy, intrauterine contraceptive device -IUCD, Implants, and Total or combined long-term family planning methods -LTFP) showed a statistical significant difference in the mean utilization between OBA versus non-OBA clients. The difference in difference estimates reveal that the difference in access between OBA and non OBA clients can significantly be attributed to the implementation of the OBA program for intrauterine contraceptive device (p = 0.002), Implants (p = 0.004), and total or combined long-term family planning methods (p = 0.001). The county of residence is a significant determinant of access to all long-term family planning methods except vasectomy and the year of registration is a significant determinant of access especially for implants and total or combined long-term family planning methods. The management level and facility type does not play a role in determining the type of long-term family planning method preferred; however, non-governmental organisations (NGOs) as management level influences the choice of all methods (Bilateral tubal ligation, intrauterine contraceptive device, Implants, and combined methods) except vasectomy. The adjusted R2 value, representing the percentage of the variance explained by various models, is larger than 18% for implants and total or combined long-term family planning. CONCLUSION: The study showed that the voucher services in Kenya has been effective in providing long-term family planning services and improving access of care provided to women of reproductive age. Therefore, voucher scheme can be used as a tool for bridging the gap of unmet needs of family planning in Kenya and could potentially be more effective if rolled out to other counties.