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Assessing Facility Readiness of Family Planning Services in Ghana

Assessing Facility Readiness of Family Planning Services in Ghana. Stephanie Hess, Kerry Bruce, Rafa Flores, Monique Hennink MCH EPI Conference Atlanta, GA December 14, 2007. Ghana. Population: 22.4 million Total fertility rate: 4.4.

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Assessing Facility Readiness of Family Planning Services in Ghana

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  1. Assessing Facility Readiness of Family Planning Services in Ghana Stephanie Hess, Kerry Bruce, Rafa Flores, Monique Hennink MCH EPI Conference Atlanta, GA December 14, 2007

  2. Ghana Population: 22.4 million Total fertility rate: 4.4 • Upward trend in use of FP methods • 12.9% (1988) to 25.3% (2003) CIA World Factbook

  3. Background • High-quality family planning (FP) services require facilities to have suitable infrastructure, an adequate supply of contraceptive methods, and the necessary equipment and staff to provide counseling. • Lack of updated staffing guidelines for the health sector.

  4. Purpose of Study • To assess the readiness of health facilities in Ghana to provide short-term FP methods (i.e. oral contraceptives, male condoms and injectables). • Facility readiness was assessed with four indicators: • Staffing • Infrastructure • Family planning supplies • Equipment

  5. Data 1. Facility Baseline Assessment (FBA) 2. Reproductive and Child Health Equipment Assessment (RCHEA) • Government Hospitals n=27 • Mission/Private Hospitals n=4 • Government Health Centers n=100 • Mission/Private Health Centers n=5 Total n=136 facilities

  6. Framework Equipment Examples: visual aids on FP methods, protocols, blood pressure gauge Infrastructure Examples: water, electricity, functioning toilets, privacy for counseling FP clients Facility Readiness to Provide FP Services FP Supplies Staff Availability & stock-outs of male condom, injectables, oral contraceptives Presence of a midwife Staff: Patient ratio for midwives and community health nurses

  7. Criteria for Assessment • Staff • At least one midwife in the facility • Infrastructure (3 of 6 amenities) • Electricity • On-site water • Protected waiting area • Functioning toilet • Clean facility • Visual/auditory privacy for counseling

  8. Criteria for Assessment • Supplies -Adequate number of at least one of the following methods*: combined pill, progesterone-only pill, 2-3 month supply injectable, 1 month supply injectable, male condom • Equipment -National Reproductive Health Service protocol OR Essentials of Contraceptive Technology book (Hatcher 2007) -At least one visual aid for FP -Sharps container for infection prevention -Basic FP examination equipment (3 of 4 items) * Calculated based on CDC guidelines

  9. Results Overview 29% of facilities (n=39) met the minimum requirements for all indicators to provide short-term methods of family planning.

  10. Results Overview Most of the 136 facilities have the necessary infrastructure and staff to provide short-term FP services

  11. Results: Staffing Facilities who reported having at least one midwife present

  12. Results: Infrastructure Facilities with minimum infrastructure (3 of 6 basic amenities)

  13. Results: Supplies Facilities that had an adequate supply of at least one short-term FP method

  14. Results: Equipment Facilities who met the minimum requirements for equipment

  15. Limitations • As this was an analysis of secondary data, data were not collected in order to answer the research questions. • Benchmarks were chosen to assess facility readiness without a strong base of support from existing literature. • Each of the indicators are given equal weight, but they may not all equally important in determining facility readiness for FP. • The quality of the FP service provision could not be assessed using this dataset since FP observation and client exit interviews measuring satisfaction with services were not conducted.

  16. Discussion • Areas in most need of attention are: • Supplies (Govt hosp, M/P HC) • Equipment (M/P Hosp, Govt HC, M/P HC) • Provides evidence for importance of staffing guidelines

  17. Conclusion & Recommendations • Facilities not meeting criteria should be targeted in future interventions to improve the quality of family planning service delivery in Ghana. • Ensuring that health centers have the necessary supplies will increase facility readiness and possible use of a short term method.

  18. Thank You! Kerry Bruce and Richard Killian, Quality Health Partners Monique Hennink and Rafa Flores, Rollins School of Public Health, Emory University O.C. Hubert Charitable Fund For further information, please contact hess.st@gmail.com. More information on related projects can be obtained at www.ghanaqhp.org.

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