Table 2 HCW perspectives on access to SRH barriers and recommendations for improvement, per sector
Overall N (%) | Public N (%) | Private N (%) | OR (95% CI)a | PNFP N (%) | OR (95% CI)a | |
|---|---|---|---|---|---|---|
Key challenges to accessing SRHC | ||||||
Patient lack of knowledge on SRH | 354 (37.1) | 203 (38.8) | 91 (37.0) | 0.99 (0.69–1.42) | 60 (32.4) | 0.75 (0.52–1.09) |
Issues with supply to HF | 320 (33.5) | 222 (42.5) | 56 (22.8) | 0.40*** (0.27–0.59) | 42 (22.7) | 0.44*** (0.29–0.65) |
Frequent stockouts at HF | 282 (29.6) | 188 (36.0) | 49 (19.9) | 0.47*** (0.31–0.72) | 45 (24.3) | 0.57** (0.38–0.85) |
Religious/cultural beliefs | 272 (28.5) | 142 (27.2) | 47 (19.1) | 0.75 (0.50–1.15) | 83 (44.9) | 2.46*** (1.69–3.56) |
Stigma | 207 (21.7) | 113 (21.6) | 56 (22.8) | 0.97 (0.63–1.48) | 38 (20.5) | 0.75 (0.49–1.16) |
Staff shortages | 182 (19.1) | 144 (27.5) | 18 (7.3) | 0.26*** (0.15–0.46) | 20 (10.8) | 0.34*** (0.21–0.57) |
Staff training on SRH services | 148 (15.5) | 101 (19.3) | 24 (9.8) | 0.49** (0.28–0.83) | 23 (12.4) | 0.61 (0.37–1.01) |
Patient costs | 145 (15.2) | 24 (4.6) | 82 (33.3) | 6.83*** (3.98–11.70) | 39 (21.1) | 4.58*** (2.61–8.03) |
No demand | 102 (10.7) | 40 (7.7) | 45 (18.3) | 1.30 (0.74–2.28) | 17 (9.2) | 1.02 (0.55–1.91) |
Frequent stockouts at central level | 102 (10.7) | 71 (13.6) | 23 (9.4) | 0.70 (0.39–1.25) | 8 (4.3) | 0.35** (0.16–0.75) |
SRHC stockout causes | ||||||
Delay in supply delivery | 471 (54.1) | 320 (63.9) | 83 (37.4) | 0.36 (0.24–0.54)*** | 68 (46.0) | 0.52** (0.34–0.77) |
What is ordered is not what HF received | 295 (33.9) | 226 (45.1) | 37 (16.7) | 0.31 (0.20–0.49)*** | 32 (21.6) | 0.35*** (0.22–0.54) |
Problems with stock at medical stores | 264 (30.3) | 170 (33.9) | 61 (27.5) | 0.94 (0.62–1.41) | 33 (22.3) | 0.61* (0.39–0.95) |
Demand higher than availability | 185 (21.2) | 120 (24.0) | 37 (16.7) | 0.49** (0.31–0.81) | 28 (18.9) | 0.76 (0.47–1.23) |
Affordability for HF | 138 (15.8) | 33 (6.6) | 67 (30.2) | 5.59*** (3.27–9.53) | 38 (25.7) | 4.82*** (2.79–8.34) |
Poor stock management at HF | 128 (14.7) | 63 (12.6) | 34 (15.3) | 1.37 (0.81–2.32) | 31 (21.0) | 1.84* (1.11–3.04) |
Lack of storage space at HF | 80 (9.2) | 58 (11.6) | 14 (6.3) | 0.54 (0.28–1.08) | 8 (5.4) | 0.48 (0.21–1.07) |
Problems with medicine transport to HF | 71 (8.2) | 51 (10.2) | 10 (4.5) | 0.49 (0.22–1.08) | 10 (6.8) | 0.67 (0.32–1.39) |
Recommendations for improvement – supply side | ||||||
Improve supply chain | 523 (55.6) | 346 (66.4) | 104 (43.2) | 0.40*** (0.27–0.57) | 73 (41.0) | 0.38*** (0.27–0.56) |
Timely supply of SRHC | 430 (45.7) | 274 (52.6) | 84 (34.9) | 0.48*** (0.33–0.70) | 72 (40.5) | 0.61** (0.42–0.87) |
Prevent stockouts of SRHC at HF | 326 (34.7) | 192 (36.9) | 80 (33.2) | 1.04 (0.71–1.50) | 54 (30.3) | 0.75 (0.51–1.10) |
Ensure sufficient stock available at HF | 275 (28.7) | 180 (34.2) | 56 (22.6) | 0.65* (0.44–0.97) | 39 (21.2) | 0.57** (0.38–0.85) |
Supply SRHC that were ordered | 247 (26.3) | 179 (34.4) | 46 (19.1) | 0.56** (0.37–0.86) | 22 (12.4) | 0.28*** (0.17–0.46) |
(Continued) staff training | 216 (23.0) | 140 (26.9) | 42 (17.4) | 0.63* (0.41–0.97) | 34 (19.1) | 0.66 (0.43–1.03) |
Increase staff | 203 (21.6) | 143 (27.5) | 30 (12.5) | 0.51** (0.32–0.82) | 30 (16.9) | 0.57* (0.36–0.90) |
Increase budget for SRHC | 176 (18.7) | 112 (21.5) | 33 (13.7) | 0.50** (0.30–0.81) | 31 (17.4) | 0.76 (0.48–1.20) |
Provide greater choice of SRHC | 147 (15.6) | 71 (13.6) | 49 (20.3) | 1.60* (1.00-2.55) | 27 (15.2) | 1.05 (0.63–1.73) |
Recommendations for improvement – demand side | ||||||
Client and community education | 778 (81.1) | 437 (82.9) | 194 (78.2) | 0.77 (0.50–1.20) | 147 (79.9) | 0.89 (0.57–1.39) |
Increase male partner involvement | 357 (37.2) | 222 (42.1) | 82 (33.1) | 0.82 (0.57–1.18) | 53 (28.8) | 0.57** (0.39–0.83) |
Offer/improve SRH outreach services | 280 (29.2) | 164 (31.1) | 62 (25.0) | 0.77 (0.52–1.14) | 54 (29.4) | 0.86 (0.58–1.26) |
Increase choice of contraceptives | 222 (23.2) | 129 (24.5) | 59 (23.8) | 0.76 (0.50–1.16) | 34 (18.5) | 0.76 (0.49–1.18) |
Professionalise HCW-patient relationship | 173 (18.0) | 102 (19.4) | 49 (19.8) | 0.88 (0.56–1.36) | 22 (12.0) | 0.43** (0.26–0.73) |
Reduce costs for clients | 202 (21.0) | 38 (7.2) | 113 (45.2) | 7.60*** (4.79–12.04) | 51 (27.7) | 4.10*** (2.53–6.63) |
HF at times unable to provide client with SRHC and services | ||||||
Yes | 359 (37.0) | 155 (29.2) | 123 (49.0) | 1.57* (1.09–2.26) | 81 (42.9) | 1.47* (1.02–2.12) |
Reasons why unable to provide client with SRHC and services | ||||||
SRHC was stocked out | 131 (37.3) | 84 (56.4) | 35 (28.2) | 0.30*** (0.16–0.56) | 12 (15.4) | 0.11*** (0.07–0.28) |
HF does not offer FP services | 65 (18.6) | 13 (8.8) | 24 (19.5) | 1.88 (0.82–4.30) | 28 (35.9) | 6.38*** (2.97–13.72) |
Client unable to pay for service | 60 (17.2) | 4 (2.7) | 44 (35.8) | 15.13*** (4.85–47.18) | 12 (15.4) | 6.88** (2.08–22.70) |
Client was too young | 58 (16.6) | 19 (12.8) | 26 (21.1) | 1.72 (0.78–3.83) | 13 (16.7) | 1.15 (0.51–2.60) |
Service not culturally or religiously acceptable | 56 (16.1) | 13 (8.7) | 5 (4.1) | 0.42 (0.13–1.37) | 38 (49.4) | 12.65*** (5.75–27.81) |
Service would not benefit client | 25 (7.2) | 11 (7.4) | 9 (7.3) | 1.26 (0.42–3.81) | 5 (6.4) | 0.60 (0.19–1.90) |
Lack of HCW knowledge | 23 (6.6) | 16 (10.7) | 5 (4.0) | 0.53 (0.16–1.74) | 2 (2.6) | 0.22* (0.05–0.99) |
Client was unmarried | 17 (4.9) | 6 (4.1) | 4 (3.3) | 0.59 (0.13–2.64) | 7 (9.0) | 1.63 (0.49–5.45) |