Client satisfaction with family planning services in the area of high unmet need: Evidence from Tanzania Service Provision Assessment Survey, 2014-2015

Abstract

Background: Client satisfaction has been found to be an important factor for the uptake and continuation of family planning services. This study aimed to examine the current status of and factors associated with client's satisfaction with family planning services in Tanzania, which has a high unmet need for family planning. Methods: The study used data from the Tanzania Service Provision Assessment survey of 2014-2015. A facility was classified as having high service readiness for FP if it scored at least 67.7% on a composite score based on three domains (staff training and guidelines, basic diagnostic equipment, and basic medicines), following criteria developed by the World Health Organization. The exit interview questionnaire was used to collect information from women about their level of satisfaction, whether "very satisfied," "more or less satisfied," or not satisfied with the services received. The response was dichotomized into "Yes" if the woman reported being very satisfied with services received otherwise coded as "No". Unadjusted and adjusted logistic regression models were used to assess the association between the client satisfaction and covariate variables; service readiness, facility type, managing authority, location, management meetings, supervision, provider's sex, and working experience, clients' age and education. All analyses were weighted to correct for non-response, disproportionate and complex sampling by using the "SVY" command in Stata 14. Results: Out of the 1188 facilities included in the survey, 427 (35.9%) provided family planning services. A total of 1746 women participated in observations and exit interviews. Few (22%) facilities had a high readiness to provide family planning services. While most facilities had the recommended equipment available, only 42% stocked contraceptives (e.g. oral pills, injectable contraceptives and/or condoms). Further, trained staff and clinical guidelines were present in only 30% of services. Nevertheless, the majority (91%) of clients reported that they were satisfied with services. In the multivariate analysis, a high service readiness score [AOR = 2.5, 95% CI; 1.1-6.0], receiving services from private facilities [AOR = 2.3, 95% CI; 1.1-5.0], and being in the age group 20 to 29 years [AOR = 0.3, 95% CI; 0.1-0.7] were all significantly associated with clients' satisfaction with family planning services. Conclusion: There is a high level of client satisfaction with family planning services in Tanzania. Maintaining and exceeding this level will require improvements in the provision of staff training and the availability of contraceptives in existing services.