Clients’ perceptions of the quality of post-abortion care in eight health facilities in Dakar, Senegal

  • Journal of Biosocial Science, Year 2021

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Study Justification:
– The utilization of post-abortion care (PAC) among women in need remains low, especially in settings with high rates of unsafe abortion and maternal mortality.
– There is a need for interventions to address the unmet need for PAC, but more information is required on how women value different aspects of PAC.
– This study aims to provide evidence on women’s perceptions of the quality of PAC in Dakar, Senegal, to inform interventions and improve utilization.
Study Highlights:
– Exit interviews with 729 PAC clients in 2018 at eight health facilities in Dakar, Senegal were conducted.
– Information on patient characteristics, services received, and women’s perceptions of the quality of care were collected.
– Domains reflecting aspects of PAC relevant to client satisfaction were assessed, including accessibility, facility environment, information and counseling, family planning, provider technical competence and readiness, and client-staff interaction.
– Factors associated with higher satisfaction with PAC were identified, including physical comfort during the procedure, counseling on treatment procedure, privacy, availability of supplies and medicines, facility admission process, facility cleanliness, waiting time, clarity of counseling, and access to different contraceptive methods.
– The mean rating for overall quality of care was 3.7, with the lowest rating for quality of information and counseling (mean=2.4) and the highest rating for client-staff interaction (mean=3.8).
Recommendations for Lay Reader and Policy Maker:
– Interventions should focus on improving physical comfort during procedures, providing clear and comprehensive counseling on treatment procedures, ensuring privacy, and ensuring the availability of necessary supplies and medicines.
– Attention should be given to improving the facility admission process, cleanliness, and waiting time.
– Efforts should be made to enhance the clarity of counseling and provide access to a variety of contraceptive methods.
– Addressing these factors may lead to improved utilization of PAC in Dakar, Senegal.
Key Role Players Needed to Address Recommendations:
– Health facility administrators and managers
– Health care providers
– Policy makers and government officials
– Women’s health advocacy groups
– Community leaders and influencers
Cost Items to Include in Planning the Recommendations:
– Training programs for health care providers on patient-centered care and counseling skills
– Procurement of necessary supplies and medicines
– Facility renovations or improvements to enhance privacy and cleanliness
– Development and dissemination of educational materials on PAC and contraceptive methods
– Community outreach and awareness campaigns
– Monitoring and evaluation activities to assess the impact of interventions
Please note that the cost items provided are general examples and may vary based on the specific context and resources available in Dakar, Senegal.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on exit interviews with 729 PAC clients in 2018 at eight health facilities in Dakar, Senegal. The study used ordinal logistic regression models to identify factors associated with women’s rating of overall quality of care. The paper provides mean ratings for overall quality of care and domain-specific ratings. However, the abstract does not mention the sampling method or response rate, which could affect the generalizability of the findings. To improve the evidence, future studies could include a more representative sample and provide more details on the methodology, such as the sampling strategy and response rate.

Post-abortion care (PAC) integrates elements that are vital for women’s survival after abortion complications and their ability to meet their subsequent fertility intentions. Currently, the utilization of PAC among women in need remains too low, particularly in settings where unsafe abortion is an appreciable cause of maternal mortality. Interventions have aimed at addressing unmet need; however, these still require information on the extent to which women value different aspects of PAC. This paper presents such evidence from Dakar, Senegal. Exit interviews with 729 PAC clients in 2018 at eight health facilities obtained information on patient characteristics, content of services received and women’s perceptions of the quality of care, both overall and according to subject-specific domains. These domains reflect aspects of PAC that are relevant to clients’ satisfaction: accessibility, facility environment, information and counselling, family planning, provider technical competence and readiness and client-staff interaction. Ordinal logistic regression models were estimated to identify factors that were associated with women’s rating of overall quality of care (on a scale of 1 to 5, 1 being lowest). Predictors that were significantly associated with the outcome were used in a multivariate ordinal logistic regression model that estimated the probability of positive differences in the outcome associated with women’s classification of each predictor. Women reported a mean rating of 3.7 for overall quality of care. The lowest domain-specific rating was for quality of information and counselling (mean=2.4) and the highest was for client-staff interaction (mean=3.8). Factors associated with clients’ higher odds of being more satisfied with PAC were: physical comfort during the procedure, recall of counselling on treatment procedure, privacy, perceived availability of supplies and medicines, facility admission process, facility cleanliness, waiting time, clarity of counselling and access to different contraceptive methods. Interventions that target these factors may improve the utilization of PAC in Dakar, Senegal.

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Based on the research findings presented in the publication “Clients’ perceptions of the quality of post-abortion care in eight health facilities in Dakar, Senegal,” the following innovations can be developed to improve access to maternal health:

1. Strengthening Information and Counselling Services: Develop comprehensive training programs for healthcare providers to effectively communicate with patients and provide accurate information about post-abortion care procedures, treatment options, and contraceptive methods. Implement standardized counseling protocols to ensure consistent and high-quality information is provided to patients.

2. Improving Facility Environment: Implement measures to create a clean, comfortable, and private environment within health facilities. This can include regular cleaning and maintenance, ensuring privacy during consultations and procedures, and providing comfortable waiting areas for patients.

3. Enhancing Provider Competence and Readiness: Invest in ongoing training and professional development programs for healthcare providers to improve their technical competence and readiness in delivering post-abortion care services.

4. Reducing Waiting Time and Improving Facility Admission Process: Implement strategies to reduce waiting times, streamline admission procedures, and improve overall efficiency in health facilities to enhance the patient experience.

5. Expanding Access to Contraceptive Methods: Ensure a wide range of contraceptive options are readily available and accessible within health facilities. Train healthcare providers in contraceptive counseling and provision, and ensure a consistent supply of contraceptives.

By implementing these innovations, health facilities in Dakar, Senegal, can enhance the quality of post-abortion care and improve access to maternal health services.
AI Innovations Description
Based on the research findings presented in the publication “Clients’ perceptions of the quality of post-abortion care in eight health facilities in Dakar, Senegal,” the following recommendation can be developed into an innovation to improve access to maternal health:

1. Strengthening Information and Counselling Services: Given that the lowest domain-specific rating reported by women was for the quality of information and counselling, it is crucial to enhance these services. This can be achieved by training healthcare providers to effectively communicate with patients, ensuring that they receive comprehensive and accurate information about post-abortion care procedures, treatment options, and contraceptive methods. Additionally, implementing standardized counseling protocols can help improve the quality and consistency of information provided to patients.

2. Improving Facility Environment: Women’s perceptions of the facility environment play a significant role in their overall satisfaction with post-abortion care. Therefore, efforts should be made to create a clean, comfortable, and private environment within health facilities. This can include regular cleaning and maintenance of facilities, ensuring adequate privacy during consultations and procedures, and providing comfortable waiting areas for patients.

3. Enhancing Provider Competence and Readiness: Women’s satisfaction with post-abortion care was positively associated with their perception of provider technical competence and readiness. To improve access to maternal health, it is essential to invest in ongoing training and professional development programs for healthcare providers. This can help ensure that they possess the necessary skills, knowledge, and confidence to deliver high-quality care to women seeking post-abortion services.

4. Reducing Waiting Time and Improving Facility Admission Process: Women’s satisfaction was influenced by factors such as waiting time and the facility admission process. Implementing strategies to reduce waiting times, streamline admission procedures, and improve overall efficiency can contribute to a more positive patient experience and increase the utilization of post-abortion care services.

5. Expanding Access to Contraceptive Methods: Access to different contraceptive methods was positively associated with women’s satisfaction. To improve access to maternal health, it is important to ensure that a wide range of contraceptive options is readily available and accessible within health facilities. This can involve training healthcare providers in contraceptive counseling and provision, as well as ensuring a consistent supply of contraceptives.

By implementing these recommendations, health facilities in Dakar, Senegal, can enhance the quality of post-abortion care and ultimately improve access to maternal health services.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Sample Selection: Select a representative sample of women who have recently sought post-abortion care in health facilities in Dakar, Senegal. Ensure that the sample includes a diverse range of demographic characteristics, such as age, education level, and socioeconomic status.

2. Baseline Assessment: Conduct baseline assessments to gather information on the women’s perceptions of the quality of post-abortion care, including their satisfaction with information and counseling services, facility environment, provider competence and readiness, waiting time, and access to contraceptive methods. This can be done through structured interviews or surveys.

3. Intervention Implementation: Implement the recommended interventions in selected health facilities. This may involve training healthcare providers in effective communication and counseling techniques, improving facility cleanliness and privacy, enhancing provider competence through training programs, implementing strategies to reduce waiting times, and ensuring a consistent supply of contraceptive methods.

4. Post-Intervention Assessment: After a suitable period of time, conduct a follow-up assessment to evaluate the impact of the interventions on women’s perceptions of the quality of post-abortion care. Use the same assessment tools and methods as the baseline assessment to ensure comparability.

5. Data Analysis: Analyze the data collected from the baseline and post-intervention assessments using appropriate statistical methods. Compare the women’s perceptions of the quality of post-abortion care before and after the interventions to determine if there have been any significant improvements.

6. Evaluation of Impact: Assess the impact of the interventions by examining changes in women’s satisfaction with information and counseling services, facility environment, provider competence and readiness, waiting time, and access to contraceptive methods. Calculate effect sizes and statistical significance to determine the magnitude and significance of the improvements.

7. Recommendations and Implementation: Based on the findings of the evaluation, develop recommendations for scaling up the interventions to other health facilities in Dakar, Senegal. Provide guidance on the implementation of the interventions and monitor their effectiveness over time.

By following this methodology, it would be possible to simulate the impact of the main recommendations on improving access to maternal health in Dakar, Senegal. The findings can inform policy and practice decisions to enhance the quality of post-abortion care and ultimately improve maternal health outcomes.


Statistics:
Citations: 1
Identifiers:
DOI: 10.1017/S0021932021000365
ISSN: 00219320
Research Areas:
Community Interventions, Health System and Policy, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health
Study Countries:
Senegal
Participants Gender:
Female
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