Changes in Service Availability, Readiness, Process of Care, and Client Satisfaction with Family Planning Services: A Comparison between the 2015 and 2021 Nepal Health Facility Surveys (FA147) - Analysis Brief [AB41]

A comparative analysis of the 2015 and 2021 Nepal Health Facility Surveys (NHFS) was conducted to assess seven broad domains of FP services: service availability, infection prevention and control, family planning commodity management, management meetings and quality assurance monitoring, basic equipment and items for family planning service delivery/service readiness, provider's adherence to provision of family planning service standards of quality care, and clients' opinions of the family planning service. The data in this analysis were drawn from the two nationally representative NHFS of 2015 and 2021. A simple additive index was used that produced scores by adding binary variables. The scores for numerous indicators were compared to determine any notable differences. The analysis shows that almost all health facilities in both 2015 and 2021 offered at least one modern method of FP, with little difference between the two surveys. However, the proportion of facilities that offer 7 modern methods increased from 28% in 2015 to 37% in 2021. Infection prevention and control capacity in health facilities that offer at least one modern method of family planning increased from 42% in 2015 to 63% in 2021. Trends in commodity management are mixed, with an increase in stockouts of contraceptive pills (16% in 2015 to 23% in 2021) and an improvement in commodities received within 2 weeks of order (71% in 2015 to 81% in 2021). The analysis shows that conducting routine meetings improved from 38% in 2015 to 51% in 2021. The overall index of availability of basic equipment and tools for FP service delivery shows an improvement from 2015 (54%) to 2021 (61%). However, important tools are still lacking. The analysis shows that adherence to most domains of quality FP service delivery improved between 2015 (27%) and 2021 (36%). Clients' exit interview data reveal that complaints about common problems declined between 2015 (12%) and 2021 (7%), indicating an improvement in client satisfaction. The results from this study point to several implications for improving FP healthcare delivery. While method choice in the facilities improved from 2015 to 2021, it is still limited and there is room to improve coverage. Similarly, while there was improvement in measures of infection prevention and control, there are still large proportions of facilities without essential infection prevention and control equipment/items. There were few improvements observed in the area of FP commodity management, especially with the issue of stockouts. There is an immediate need to provide facilities with lacking equipment.