Dr. Farhat Rehana Malik Peshawar Medical College Quality Family Planning services provision in Private Clinics of Khyber Pukhtunkhwa Dr. Farhat Rehana Malik Peshawar Medical College

Introduction Pakistan is sixth most populous country, facing challenges to attain socio-economic development. PDHS 2012-13 indicates poor indicators (IMR, MMR & CPR) In Pakistan 25 % of married women have an unmet need for family planning. Private sector is providing 40% of the family planning services in Pakistan. Quality is an essential element of any service if it is to attract and retain clients.

Introduction Perception of good quality services is directly related to higher contraceptive use (1- 3) Franchised private clinics are offer better quality services (4) A significant positive relationship exists between quality of family planning services and contraceptives usage (5 & 6) Rationale; Project based programs achieve output only, with compromising the yielding resources. 1- Bangladesh, tanzania studies 2- A study conducted at Ethiopia and Pakistan family planning health facilities concluded that 3- Bangladesh, Tanzania and Peru studies reported a significant positive relationship between quality of family planning services and use of contraceptives Structural parameters are the easiest to provide and evaluate but often neglected.

Objective Primary; To assess the structural parameters of quality in private family planning clinics of Khyber Pukhtunkhwa, from January-2010 to December- 2014. Secondary; 1- To assess physical infrastructure items at private clinics of KPK. 2- To assess procedure room items in private clinics of KPK. 3- To assess components of infection prevention at private clinics of KPK.

Methodology A descriptive study January, 2010- December, 2014 All KPK based 474 private clinics of an NGO 46 urban cities of 13 districts of KPK A standardized checklist including modules for physical infrastructure, procedure room & infection prevention. Informed consent was taken from all studied clinics. Institutional Review Board Committee approval

Methodology (Continued) During the five year time period, every clinic was visited twice / year. A standardized checklist including components of physical infrastructure, procedure room & infection prevention were assessed. Clinics scoring; 90 % and above were A-grade clinics, between 70-89 % were B-grade clinics, between 50-69 % termed as C- grade clinics and less than 50 % scores were D-grade clinics which needed special attention.

Results Number of clinics

Results (Continued)

Results (Continued) Bar charts to be included

Summary Strengths; Weak Areas; IEC Material Reference Manual Councilor's Kit Privacy Cleanliness Procedure Room items Chlorine Solution Weak Areas; Unknown strength of chlorine solution Brush for cleaning instruments Utility Gloves Anti- septic solution Record Keeping Boards & Logos Waste basket with plastic bag inside

Conclusion Quality family planning services at private clinics of KPK, were compromised by weaker components i. e boards, logos, privacy, record keeping & sterilization and cleaning of instruments) as identified by the research. Explain it rpoper

Recommendations Dissemination of these findings, to motivate other providers to carry quality services at their clinics. Dire need to replicate these system in Government Family Planning Centers, in order to increase contraceptive users. Special focus on the weaker components, as identified through the study to have impact of family planning services in the country. Targget weak areas,

References 1. Bruce J. Fundamental elements of the quality of care: a simple framework. Stud Fam Plann 1990; 21:61-91. 2. Tumlinson K, Speizer IS, Curtis SL, Brian W. Pence. Validity of standard measures of family planning service quality: findings from the simulated client method. Stud Fam Plann 2014; 45:443–70. 3. Arends-Kuenning M, Kessy FL. The impact of demand factors, quality of care and access to facilities on contraceptive use in Tanzania. J Biosoc Sci 2007; 39:1-26. 4. Shah NM, Wang W, Bishai DM. Comparing private sector family planning services to government and NGO services in Ethiopia and Pakistan: how do social franchises compare across quality, equity and cost? Health Policy Plan 2011; 2:63-71. 5. Mensch, B, Arends-Kuening M, Jain A. The impact of quality of family planning services on contraceptive use in Peru. Stud Fam Plann 1996; 27:59-75. 6. Koenig, M, Hossain, M, Whittaker M. The influence of quality of care upon contraceptive use in rural Bangladesh. Stud Fam Plann 1997; 28:278-89.

Acknowledgements Green Star clinics owners and their co operation for allowing me to assess their setups. The officials of Green Star organization, who rendered valuable support.