Quality of Family Planning Services and Client Satisfaction in the Public and NGO Sectors in Kenya

Objective: To compare the quality of family planning services delivered at public and NGO facilities in Kenya, a country in which the private sector's role in contraceptive service delivery has increased. To determine the relationship between structure and process attributes of quality and client satisfaction.

Methods: Data from the 2004 Kenya Service Provision Assessment (SPA) are analyzed. The Kenya SPA is a representative sample of health facilities in the public and non-government (NGO) sectors and comprises data obtained from a facility inventory, service provider interviews, observations of client-provider interactions and exit interviews. Quality of care indicators are compared between the public and NGO sectors along three dimensions: structure, process and outcome.

Results: NGO facilities were superior to public sector facilities in terms of physical infrastructure and the availability of services. Public sector facilities performed better in terms of management and structural features of counseling. The provision of interpersonal and technical quality of care was better at NGOs, even though technical quality of care was poor at both NGO and public sector facilities. Client satisfaction was higher at NGO facilities.

Conclusions: There is an urgent need to improve quality of family planning service delivery in Kenya. Studies are needed to better understand the determinants of client satisfaction. A more developed understanding of client expectations of care from different types of facilities may be a first step in helping providers supply services in a way that is responsive to client demand but does not compromise on the quality of care provided.