Assessing Quality Of Family Planning Service Provision...

Assessing Quality Of Family Planning Service Provision Among Private Patent Medicine Vendors

In Nigeria

C. Ujuju, A. Gofwan, R. Fakolade, S. Adebayo, A. NwalaThe Society for Family Health, Nigeria

The Society for Family Health

Background

• More than half (58%) of users of contraceptives in Nigeria obtain their contraceptives from the private medical sectors (NDHS, 2003).

• 71% of oral contraceptive pill users get their supply from Patent Medicine Stores (PMS) or Private Patent Medicine Vendors (PPMVS) (NPC Nigeria & ORC Macro, 2004).

• Majority of PPMVs do not have a medical background and are allowed to dispense only oral contraceptives according to National Standards of Practice.


Intervention• To enhance skills in dispensing practices, PPMVs

were trained through a USAID funded project.• The aim of the training was to improve the availability

of and access to Family Planning (FP) products and services.

• The training encouraged PPMVs to:-Counsel clients on FP-Dispense oral pills -Refer new clients who require family planning services to a health facility in line with the national Standards of Practice.

page 3The Society for Family Health

Intervention

• Over 10,000 PPMVs were trained across the country.

• Training was followed by improved volume of sales of oral contraceptives.

• Society for Family Health evaluated the quality of services provided by the trained PPMVs using a Mystery Client Survey.


Methodology• Mystery Client Survey is a study in which a pre-

recruited person visits an outlet anonymously, posing as a regular client, to assess the quality of customer services based on pre-determined criteria.

• This approach presents a woman of reproductive age who visits a PPMV with the intention of obtaining a contraceptive method.

• The mystery client fills a survey form detailing the services obtained during the visit to the outlet.

• The study was conducted in 4 states in Nigeria: Lagos, Plateau, Enugu and Kano.


Methodology

• Data were managed and analyzed with Statistical Package for Social Sciences (SPSS) version 11.5.

• Frequency tables were generated from the data. • A qualitative study using in-depth interviews (IDIs)

was also used to obtain information. • Two IDIs were conducted in each state; 8 in all.• Notes based analysis was conducted.


Findings

• 410 PPMVs were sampled from the list of PPMVs trained.

• 94% of the outlets visited were in the urban and semi- urban areas while only 6% were in rural areas.

• 84% of the PPMVs had pills in stock on the day of the survey.


Findings

• Most of the PPMV service personnel understand the importance of referral.

• However, only 45% of PPMVs referred new clients who require FP products to a health facility.


Findings

• The qualitative study revealed that demand by clients who refuse to visit health facilities necessitates the provision of oral pills to first time users.

• Reasons why clients prefer obtaining FP methods from PPMVs was attributed to:- Absence of formalities and less time spent with the PPMVs

before being attended to. - Nearness of the outlets to their homes. - Perception of clients that they will pay more at a health

facility.


Findings• Findings also revealed the information

provided to clients during counseling sessions.-39% of the mystery clients were informed about other FP methods during the counseling session with the PPMVs.

-17% of them were advised on how to take the pills.

-22% of clients were told what to do when they missed a pill.

-14% were informed about side effects of oral contraceptives.


Findings

• 51% of PPMVs referred ‘clients’ who presented with a complication to a higher level of care.

• The other 49% preferred to treat on site.


Lessons Learnt

• Training of the PPMVs enhanced the distribution channel for oral contraceptives.

• Improving the capacity of PPMVs through trainings ensured appropriate and qualitative RH service delivery by the PPMVs.

• Scaling up PPMVs training would improve the quality of contraceptive supply as they are an important source of Family Planning Services in Nigeria.


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