Lauren VanEnk, MPH, Program Officer, Institute for Reproductive Health discusses the results of a recent study evaluating the quality and outcomes of faith-based family planning programs in Uganda.

1. Assessing family planning service quality
across faith-based facilities in Uganda

2. WHAT FACTORS AFFECT QUALITY COUNSELLING?
Provider Bias Stock outs Policy

3. Uganda Protestant
Medical Bureau (UPMB)
Uganda Catholic
Medical Bureau (UCMB)
• Belong to a network of private not-for-
profit service delivery institutions in
Uganda
• Provide ~35% of health services and
70% of health training institutions

4. Exit
interview
(Mar-Apr)
3m follow
up (Jun-Jul)
6m follow
up (Sept-
Oct)
Methodology
Client Follow-up Interviews
N=310
UCMB=196, UPMB=114
Research Objectives
1. Describe the experience of clients receiving family planning services from
UCMB and UPMB facilities from a quality of care perspective.
2. Describe the behavior of new family planning users who receive counseling
at UCMB or UPMB facilities.
3. Understand couple perceptions, attitudes, and behaviors related to family
planning.
RESEARCH DESIGN

5. CLIENT KNEW THE SITE WAS AFFILIATED WITH THE
[CATHOLIC/PROTESTANT] CHURCH
n=310
88%
12%
Yes
No

6. RELIGIOUS AFFILIATION OF CLIENTS
Catholic n=196
Protestant n=114
57%
24%
8% 10%
1% 1%
29%
48%
7%
4%
11%
0%
Catholic Church of Uganda
(Anglican)
Pentecostal Muslim Seventh Day
Adventist
Other
Catholic Protestant

7. WHY CLIENTS CHOSE THIS FACILITY
n=310
30%
36%
50%
15%
67%
42%
13%
18%
Closest facility
Provides the best care
Offers services needed
Received care here in the past
Protestant Catholic

8. CLIENT PERCEPTIONS:
INTERPERSONAL SKILLS
Catholic Protestant
Provider treated client respectfully
100% 100%
Others could not overhear what was said during
counseling 95% 71%
Provider listened attentively
100% 100%
Client felt comfortable asking questions during the
counseling session 100% 98%
Client believes information shared will be kept secret
92% 60%

9. CLIENT PERCEPTIONS:
HEALTH & PERSONAL HISTORY
Catholic Protestant
Provider asked whether or not client would like children in
the future 58% 80%
Provider asked about partner’s attitude toward using a
family planning method 65% 21%
Provider asked what client already knew about family
planning methods 74% 81%
Provider asked what concerned the client about using a
family planning method 57% 78%
Provider acknowledged and responded to client’s concerns
99% 89%

10. CLIENT PERCEPTIONS:
METHOD INFORMATION & FOLLOW UP
Catholic Protestant
Provider explained how to use selected method correctly
100% 99%
Provider described possible side effects or problems with
using the family planning method 86% 91%
Provider asked client to repeat important instructions
98% 75%
Provider explained that this method does not provide
protection from HIV or STIs 82% 87%
Client felt they received the information needed to make a
good choice about which method to use 96% 96%
Provider told client she could switch to another method if not
satisfied 81% 95%

11. INFORMED CHOICE:
DID PROVIDERS DISCUSS ALL METHODS WITH THE CLIENT?
100%
92%
89%
52% 51%
58%
55% 54%
45%
40%
33%
95%
37%
75%
86%
75%
97%
73%
84%
91%
46% 46%
SDM TwoDay
Method
LAM COC pill POP pill Injectables IUD Implants Condom Female
sterilization
Male
sterilization
Catholic ProtestantCatholic n=196
Protestant n=114

12. PROVIDERS WHO TALKED ABOUT IMPLANTS
71%
11%
64%
88%
80%
85%
Catholic Site 1 Catholic Site 2 Catholic Site 3 Protestant Site 1 Protestant Site 2 Protestant Site 3

13. FAMILY PLANNING METHOD DECISION
MAKING: METHOD PREFERENCES
48%
38%
16%
39%
52%
10%
No specific method in mind Specific method in mind:
Received
Specific method in mind:
Did not receive
Catholic ProtestantCatholic n=196
Protestant n=114

14. FAMILY PLANNING METHOD DECISION MAKING:
REASONS FOR SELECTING AN ALTERNATIVE
n=43
*Respondents could select more than one option
47%
44%
9%
19%
3%
0%
82%
0%
36%
0%
0%
9%
Changed mind after listening to provider
Did not meet screening criteria
Found out about new methods during counseling session
Provider recommended another method
Method never available at health center
Preferred method that can be used without partner's
knowledge
Protestant Catholic

15. SATISFACTION WITH COUNSELING
Catholic n=196
Protestant n=114
33%
54%
57%
41%
9%
3%
1%
3%
1%
0%
Catholic
Protestant
Very satisfied Satisfied Neither satisfied nor dissatisfied Dissatisfied Very dissatisfied

16. CONCLUSION
• Site selection: Clients were aware of religious
affiliation and services offered by sites
• Counselling skills: Providers performed well with
interpersonal skills and FP information, improvement
needed in assessing clients’ history and fertility
intentions
• Informed choice: Protestant providers
outperformed Catholic providers, though all could
use improvement
• 1 Catholic site underperforming compared to others
• Method access: Most clients received their method
of choice or had no preference
• Top reasons for not receiving method of choice included:
changed mind after listening to the provider and not
meeting the screening criteria for the method
• Satisfaction: Most clients were satisfied with their
counseling experience