Frequency and impact of long wait times for family planning in public-sector healthcare facilities in Western Kenya

ABSTRACT

Background

Long wait times for family planning services are a barrier to high quality care and client satisfaction. Existing literature examining family planning wait times has methodological limitations, as most studies use data collected during exit interviews, which are subject to recall, courtesy, and selection bias.

Objective

We sought to employ a mixed methods approach to capture the prevalence, length, causes, and impacts of wait times for family planning services in Western Kenya.

Methods

We used mystery clients, focus groups, key informant interviews, and journey mapping workshops to measure and describe family planning wait times. Fifteen mystery clients visited 60 public-sector facilities to quantitatively capture wait times. We conducted eight focus group discussions with 55 current or former family planning clients and 19 key informant interviews to understand facility-level barriers to family planning and feasible solutions. Finally, we visualized the process of seeking and providing family planning with journey mapping workshops with nine clients and 12 providers.

Results

Mystery clients waited, on average, 74 minutes to be seen for family planning services. In focus group discussions and key informant interviews, three themes emerged: the nature of wait times, the impact of wait times, and how to address wait times. Clients characterized long wait times as a barrier to achieving their reproductive desires. Key informants perceived provider shortages to cause long wait times, which reduced quality of family planning services. Both providers and family planning clients suggested increasing staffing or offering specialization to decrease wait times and increase quality of care.

Conclusion

Our mixed methods approach revealed that wait times for family planning services were common, could be extensive, and were viewed as a barrier to high quality of care by clients, providers, and key informants. Across the board, participants felt that addressing workforce shortages would enhance service delivery and thus promote reproductive autonomy among women in Kenya.

KEYWORDS:

• Queues
• sub-Saharan Africa
• contraception
• women’s health
• access to care

Responsible Editor

Stig Wall

Responsible Editor

Stig Wall

Acknowledgements

We acknowledge our study team and participants for their hard work in making this research possible.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

CRW contributed to the design of the qualitative components and led the framing, writing, and organization of the paper. LEB led the qualitative analysis and provided significant direction and writing of the manuscript. BWB contributed to revisions of the manuscript. DMW led all data collection and contributed to the initial manuscript and subsequent revisions. DO contributed to the initial manuscript and subsequent revisions and provided important policy context. KT designed the parent study, oversaw all data collection, and conducted the quantitative analysis. All authors read and approved the final manuscript.

Ethics and consent

Ethical approval for the study protocol was provided by both the University of North Carolina at Chapel Hill and the Kenya Medical Research Institute. All participants in qualitative study components provided verbal and written consent to participate; written consent was provided by all facility managers for facilities included in the mystery client component.

Paper context

Long wait times pose a barrier to high quality family planning care and client satisfaction, yet existing literature has methodological limitations. We employed a mixed-methods approach to describe prevalence, length, causes, and impacts of family planning wait times. We found that family planning clients and providers perceive long wait times to be pervasive and impede quality of care. Addressing workforce shortages could decrease wait times and promote reproductive autonomy among women in Western Kenya.

Additional information

Funding

Support for this research was provided in part by a career development grant (R00 HD086270) to Katherine Tumlinson and an infrastructure grant for population research (P2C HD047879) to the Carolina Population Center at the University of North Carolina at Chapel Hill. Brooke Bullington received support from an institutional training grant (T32HD52468). The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health (NIH) awarded all of these grants. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the NIH/NICHD. While writing this manuscript, Laura Britton was supported by NIH/NINR T32NR007969 (PI: Bakken).