Objective
To
quantify the impact of service provider characteristics on young people’s
choice of family planning (FP) service provider in rural Malawi in order to
identify strategies for increasing access and uptake of FP among youth.
Methods and Findings
A discrete choice experiment was developed to
assess the relative impact of service characteristics on preferences for FP
service providers among young people (aged 15–24). Four alternative providers
were included (government facility, private facility, outreach and community
based distribution of FP) and described by six attributes (the distance between
participants’ home and the service delivery point, frequency of service
delivery, waiting time at the facility, service providers’ attitude,
availability of FP commodities and price). A random parameters logit model was
used to estimate preferences for service providers and the likely uptake of
services following the expansion of outreach and community based distribution
(CBDA) services. In the choice experiment young people were twice as likely to
choose a friendly provider (government service odds ratio [OR] = 2.45,
p<0.01; private service OR = 1.99, p<0.01; CBDA OR = 1.88, p<0.01) and
more than two to three times more likely to choose a provider with an adequate
supply of FP commodities (government service OR = 2.48, p<0.01; private service
OR = 2.33, p<0.01; CBDA = 3.85, p<0.01). Uptake of community based
services was greater than facility based services across a variety of simulated
service scenarios indicating that such services may be an effective means of
expanding access for youth in rural areas and an important tool for increasing
service uptake among youth.
Conclusions
Ensuring that services are acceptable to young people may
require additional training for service providers in order to ensure that all
providers are friendly and non-judgemental when dealing with younger clients
and to ensure that supplies are consistently available.
Below: Sample Choice Task of Family Planning Service Provider
By:
Christine Michaels-Igbokwe, Fern Terris-Prestholt, Mylene
Lagarde
London School of Hygiene and
Tropical Medicine, Faculty of Public Health and Policy, Department of Global
Health and Development, London, United Kingdom
Mylene Lagarde, John Cairns
London School of Hygiene and
Tropical Medicine, Faculty of Public Health and Policy, Department of Health
Services Research and Policy, London, United Kingdom
Effie Chipeta
University of Malawi, College of
Medicine, Blantyre, Malawi
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