Glob Health Sci Pract. 2015 Dec 17;3(4):630-45. doi: 10.9745/GHSP-D-15-00298. Print 2015 Dec.
Kayembe P1, Babazadeh S2, Dikamba N1, Akilimali P1, Hernandez J2, Binanga A3, Bertrand JT2.
- 1University of Kinshasa, School of Public Health, Kinshasa, Democratic Republic of Congo.
- 2Tulane School of Public Health and Tropical Medicine, Department of Global Health Management and Policy, New Orleans, LA, USA.
- 3Tulane International LLC, Kinshasa, Democratic Republic of Congo.
Modern contraceptive prevalence was 14.1% in 2007 in Kinshasa, the capital city of the Democratic Republic of the Congo (DRC). Yet virtually nothing was known about the family planning supply environment.
Three surveys of health facilities were conducted in 2012, 2013, and 2014 to determine the number, spatial distribution, and attributes of sites providing family planning services. The 2012 and 2013 surveys aimed to identify the universe of family planning facilities while obtaining a limited set of data on “readiness” to provide family planning services (defined as having at least 3 modern methods, at least 1 person training infamily planning in the last 3 years, and an information system to track distribution of products to clients) and output (measured by couple-years of protection, or CYP). In contrast, the 2014 survey, conducted under the umbrella of the Performance Monitoring and Accountability 2020 (PMA2020) project, was based on 2-stage cluster sampling. This article provides detailed analysis of the 2012 and 2013 surveys, including bivariate and multivariate analysis of correlates of readiness to provide services and of output.
We identified 184 health facilities that reported providing at least 1 contraceptive method in 2012 and 395 facilities in 2013. The percentage of sites defined as “ready” to provide services increased from 44.1% in 2012 to 63.3% in 2013. For the 3-month period between January and March 2013, facilities distributed between 0 and 879.2 CYP (mean, 39.7). Nearly half (49%) of the CYP was attributable to implants, followed by IUDs (24%), CycleBeads (11%), and injectables (8%). In 2013, facilities supported by PEPFAR (n = 121) were more likely than other facilities to be rated as ready to provide services (P<.0001); however, PEPFAR-supported sites generated less CYP on average than sites supported by familyplanning implementing agencies (P<.0001). Multivariate analysis showed 3 variables were associated with CYP: type of health facility, length of time in operation, and number of contraceptive methods available. Clinics generated higher (3-month) CYP than hospitals and health centers by 65.3 and 61.5 units, respectively (P<.01). The mean CYP for facilities in operation for 4-6 years was 26.9 units higher (P<.05), and 50.2 units higher for those operating 7+ years (P<.01), than the reference group of facilities in operation for 1 year or less. For each additional method available at a facility, CYP increased by almost 8 units (P<.01).
Findings from these surveys suggest that lack of physical access is not the defining reason for low contraceptive use in Kinshasa, although it is highly likely that other service-related factors contribute to low service utilization. The results contributed to increasing the momentum for family planning in the DRC in many ways, including mobilizing partners to increase contraceptive access and increasing donor investment infamily planning in the DRC.
© Kayembe et al.