| Abstract |
The “Performance Monitoring and Accountability 2020” (PMA2020) project in Ethiopia is implemented in a nationally representative sample of 200 enumeration areas throughout Ethiopia. The project is designed to generate data on a variety of reproductive, maternal, and newborn health (RMNH) indicators that can inform national and regional governments. For the second round of data collection in Ethiopia (referred to as PMA2014/Ethiopia), the project employed 30 supervisors and 5 regional coordinators to collect data on service delivery point,s and each supervisor and regional coordinators was expected to interview three to four health service delivery points (SDPs).
The survey was conducted in the 11 regions of Ethiopia: Amhara, Oromiya, SNNPR, Tigray, Addis Ababa city, Afar, Gambella, Benishangul-Gumuz, Somali, Harari, and Dire Dawa. Due to resource constraints, estimates are generated for only the first five regions (Amhara, Oromiya, SNNPR, Tigray, Addis Ababa city), with the other six regions combined into one grouping. PMA2014/Ethiopia-R2, the second round of data collection in Ethiopia, used a multi-stage cluster design with urban/rural regions as strata. Data collection was conducted between January and March 2014.
PMA2020 uses standardized questionnaires for SDPs to gather data that is comparable across program countries and consistent with existing national surveys. A service delivery questionnaire was used to collect data from the PMA2014/Ethiopia-R2 survey related to service delivery points (SDP). All PMA2020 questionnaires are administered using Open Data Kit (ODK) software installed on mobile phones (smartphones) using the Android operating system. The PMA2014/Ethiopia questionnaires appeared in three local languages (Amharic, Afan Oromo, and Tigrigna), in addition to English.
The sample of 200 enumeration areas generated a sample of 398 service delivery points in the PMA2014/Ethiopia survey. The results from the survey showed that more than one in two (54.8%) facilities were health centers/clinics, one in five (21.6%) were health posts, 17.0% were hospitals and the remaining 6.7% were pharmacies/ drug shops/other. Nearly three in four (88.4%) facilities belong to the public sector and 49.1% were located in rural areas. One-fourth (24.9%) were in SNNPR, 13.9% in Tigray, 23.4% in Amhara, and 15.7% in Oromiya regions. The number of beds was used to measure facility size, with 84.8% being small (50 beds or fewer) and 5.9% have more than 100 beds.
Among the 398 facilities surveyed, 86.4% reported offering family planning counseling and methods to unmarried adolescents. Four-fifths of the 389 facilities surveyed provide injectables, pills, or condoms (94.6%, 87.4%, and 93.196). About three-quarters (71.1%) provide implants and over half (57.3%) EC. IUD services are available from 49.6% of facilities, and more frequently at hospitals, and health centers, or health clinics. Private retail outlets are more likely to offer condoms, emergency contraception, pills, and injectables than other methods.
Among the 368 facilities offering injectables and 276 facilities offering implants, 17.6%, and 18.8% respectively reported being out of stock in the 12 months preceding the survey. The highest stockout rate was reported for pills at 30.3%. Health centers and health posts were more likely to report stock-Outs, with the highest stockout rates in health posts-32.5% for injectables, 45.7% for implants, and 40.3% for pills. On average 378 health facilities offered family planning services 5.6 days per week. Pharmacies reported an average of 6.5 days and health posts the lowest, at 5.0 days. Urban facilities offer family planning services 5.7 days per week, compared to 5.5 days for rural providers.
The largest number of visits in one complete month was for male condoms (69,102), followed by injectables (27,221), pills (4,587), and implants (5,219). The number of monthly new clients was highest for male condoms (44,165), injectables (7,919), and implants (2,347). Hospitals and health centers accounted for most of the servicing of new clients, particularly for injectable delivery, condoms, IUDs, and implants. Total visits were generally higher in urban than rural facilities and are smaller compared to larger facilities. Overall, 16.8% of facilities reported charging fees to clients for family planning services. Facilities in urban areas (27.8%) were more likely to charge fees than rural facilities (6.8%).
Among the 398 facilities, more than 90% reported integrating contraceptive information and services into all three related sexual and reproductive health services. Integration was 100% for HIV and close to 100% for postabortion services. Nine out of ten facilities reported integrating family planning into postnatal services. None of the private providers offered integrated services. |
| Description |
Performance Monitoring for Accountability 2014/Ethiopia-R2 Service Delivery Point (SDP) dataset produced by 398 SDPs was targeted to be representative at the national level and in 5 of 11 regions (Amhara, Oromiya, SNNPR, Tigray, Addis Ababa city). Data collection was conducted between October and December 2014.
The SDP dataset includes measures of contraceptive availability, stock-outs, numbers of clients served, outreach through mobile services and community health workers, and integration of family planning with other health services such as HIV, maternal health, and post-abortion care. The SDP dataset also includes measures of service quality, such as availability of supplies for both insertion and removal of intrauterine devices (IUDs) and implants, storage conditions for contraceptive commodities, and availability of adequate hand-washing stations for providers. The SDP dataset includes variables that identify the enumeration areas that each SDP serves. These enumeration areas are the same EAs as in the household dataset, which allows for linking at the community level between households and the health service environment.
PMA2020 uses standardized questionnaires for SDPs to gather data that is comparable across program countries and consistent with existing national surveys. Service delivery point questioners were used to collect data from the PMA2014/Ethiopia-R2 related to service delivery points. All PMA2020 questionnaires are administered using Open Data Kit (ODK) software installed on mobile phones (smartphones) using the Android operating system. The field supervisors themselves administered the service delivery points (SDP) questionnaire at an additional three lowest levels of care from tertiary to primary SDPs (typically, the health post, intermediate health center, and district or referral hospital) assigned to each selected EA are interviewed. All interviews with service delivery point respondents are conducted face‐to‐face. Generally, Performance Monitoring and Accountability 2020 (PMA2020) was created to provide rapid and frequent estimates of modern contraceptive use in FP2020 priority countries. |
