Family Planning Service Quality And Client Satisfaction-Performance Analysis In Central And Western Rural Regions Of China

【Background】During last three decades,China has achieved tremendous success in birth control.However,quality of family planning service had not been paid enough attention to.After the 1994 International Conference on Population and Development(ICPD),which advocated quality of service and qualified reproductive health care,China has made a decisive change to an integrated population policy to suite the social development better.Provision Quality of Care in family planning service initiated by National Population and Family Planning Commission of China requires normalized management system based on advanced science and technology.Compared with eastern China, central and western China is less developed.How to carry out family planning program with Quality of Care in central and western rural regions has become a crucial challenge in current China.【Objectives】To describe clients' satisfaction and the actual quality of family planning service in central and western rural regions.To explore the impact factors associated with clients' satisfaction and with quality of family planning service and find out measures that could bridge the gap between current performance and good quality of care.【Methods】This is a cross-sectional study.The Strategic Approach framework developed by WHO/RHR and the Performance Improvement framework developed by Human Performance Technology were used.Quantitative and qualitative methods were adopted in the fieldwork.Each of the study sites includes one county and one township in Chongqing Municipality,Ningxia Hui Nationality Autonomous Region and Henan province.Twenty percent counties of each province and townships of a whole county were randomly selected and their family planning courses at county level or township level were investigated by mail questionnaire.At one county and one township in each of the study provinces,the service facilities,procedures and quality control systems were observed on the spot.Family planning administrative staff,service providers and some clients exited from service were interviewed by research staff.Some married women at reproductive age at study sites were investigated with a structured questionnaire.【Results】1.Clients' satisfaction and influence factors:Three hundred and eighty married women were interviewed with structured questionnaire.The mean age was 31.89.About 70%of them were graduated from middle school,81.1%lived in rural area and 64.2%were farmers.The observed proportion of women satisfied with family planning service was 69.2%Among the 30.8%of dissatisfaction,67.5%were dissatisfied with contraceptive method,16.2%were dissatisfied with the provision of service and 16.2%were dissatisfied with both of them.About 67%of the women wanted consulting service of family planning and self-health care,66%of them demanded treatment of Gyn-diseases and side effects of contraceptive methods,and 17%of them demanded contraceptive methods with high effectiveness and low side effects.Higher clients' satisfaction was associated with province of Ningxia or in Henan, nonagricultural occupation,accordance between contraceptive using and the women's own will,and higher quality of care.Moreover,higher accordance was associated with Ningxia or Henan,IUD user,independent contraceptive selection.Ningxia,shorter waiting time,and shorter distance between clients' habitation and the clinics were associated with higher evaluation of quality. Family planning propaganda contributed to client's acquaintance with quality of care,but the content of the propaganda with poor contraceptive knowledge could not worked as expected.2.Quality of care and associated determinants:A total of 32 county family planning clinics and 32 township family planning clinics were investigated by mail questionnaire.Three family planning clinics at county and three at township level were observed on the spot.Forty-one clients,eleven administrators and six service providers were interviewed by the research team.Eighteen service providers took the exams to test their relevant medical knowledge. It was showed that networks for family planning service were basically set up in the study sites and all study clinics were licensed by family planning administration.Inserting or removal IUDs or implant,surgery abortion and medical abortion were in the service categories at over 90%county level study sites.Inserting and removal IUDs were the main kinds of service items at township level sites.Most of the clinics provided the contraceptive methods within the national category,but 30%still provided those removed from the national category,such as medical copper ring 165,etc.It was commonly observed that laboratory examinations were insufficient in most clinics except type-B ultrasonic examination,vaginal discharging test and blood routine examination.None of the clinics could provide the whole set of obligatory examinations.The number of skilled service providers was insufficient in the study sites. Percentage of service providers in the clinics at county level was 74.6%and town level was 48.7%,which was less than the national requirements.Lack of certificated clinic providers,especially nurses or laboratory technicians was commonly existed.Type B-ultrasound machine was generally equipped;some other such as electrocardiogram or X-ray machine was not equipped in most of the study sites.Benzalkonium bromide,a kind of proved bad efficacy sterilant,was still in use at the study sites.Some administrators did not know what element supplies should be prepared for quality of care.It was one thing that lack of service capacity influenced the actual performance, shortage of funds were quite another.The compensation for free family planning service was less than the real cost.The monitoring of service quality was inappropriate and the management system was not effectively operated. On the other hand,the national guidelines were not practical enough to guide the practice well.【Conclusions and Suggestions】1.The contraceptive and reproductive health knowledge is rather limited in family planning propaganda.Such knowledge should be increased.It should be helpful to conduct a variety of forms of propaganda,so as to enhance clients' contraceptive knowledge and capability of using contraceptive methods, and further,to increase their satisfaction on family planning service.2.The effectiveness,safety and convenience are the most important concerns of contraceptive adoption.We suggest that the method mix in rural family planning clinics should include those from the state's contraceptive method category,which recommended by National Population and Family Planning Commission.3.The lack of service providers and their poor capability of service provision impacted the quality of care.Further training of service providers and a well-designed promotion mechanism are needed in family planning sector.4.The compensation for free family planning service could not cover the real cost.This is one of the main causes that the lab test was not routinely conducted in study sites.It is needed to review what should be provided in family planning service and how much it costs.Increasing financial support to cover the real cost of free family planning service is the key element to improve quality of family planning care.5.The infrastructure is obsolete and the diagnosis equipment is not enough. It affected the quality of care as well.Improvement of infrastructure and provision of diagnosis equipment to meet the basic requirement are needed in rural area of the study sites.6.The monitoring of service quality is inappropriate and the management system is not effectively operated in study site.It is needed to establish and improve the monitoring as well as management.7.The performance guideline for family planning service is not very practical. An updating guideline is needed,which gives detailed information on service environmental requirement,procedure,operation procedure,etc.