The quality of care in family planning: a case study of Chogoria, Eastern Kenya

Abstract

This paper compares the quality of family planning services in the catchment areas of Chogoria and Maua hospitals, both in the Meru district of Kenya. The quality issues compared are personnel, types of methods, information, recruiting and counselling of clients, knowledge and source of modern contraceptives, desired family size, use of contraceptives, and satisfaction of providers and clients. A comparative approach is adopted to study the aspects of family planning that have made Chogoria relatively more successful than Maua and the rest of Kenya. The data used in this analysis is qualitative and was collected through personal observation, interviews, and group discussions with health care providers. The results show that while the family planning programmes of Chogoria and Maua are comparable in many respects, there are also important differences. For example, Chogoria family planning personnel were more knowledgeable about contraceptives and were more satisfied with the training provided by Chogoria hospital than were their counterparts in Maua. The relationship between the senior and the junior staff was more cordial in Chogoria. The content of the information about contraceptives provided to women attending clinics was similar in both hospitals. But the teachers in Chogoria were more knowledgeable and confident than those in Maua. In Chogoria, the decision to use family planning is jointly taken by the husband and the wife, and if a client fails to turn up for an appointment a follow-up is scheduled. In Maua, the decision to use family planning is taken unilaterally by the wife and defaulters are not followed up. The study showed that 78 percent and 33 percent of the participants were using modern family planning methods in Chogoria and Maua respectively. Three conclusions are drawn from the study. First, that the satisfaction of family planning providers and their clients contributes positively towards more knowledge and use of modern contraceptives. Second, that women feel more secure and comfortable with the methods they use if their husbands are involved in deciding whether or not to adopt them. Finally, follow-up services for those who fail to attend appointments helps to strengthen rapport between providers and clients and provides an opportunity to learn of the circumstances that lead to discontinuing the use of contraceptives.