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. 2025 May 15;22(1):82.
doi: 10.1186/s12978-025-02026-w.

Readiness of health facilities to deliver family planning services and associated factors in urban east-central Uganda

Jacquellyn Nambi Ssanyu  1   2 , Rornald Muhumuza Kananura  3   4 , Leif Eriksson  5 , Peter Waiswa  3   6   7 , Mats Målqvist  5 , Joan Nakayaga Kalyango  8
Affiliations

Readiness of health facilities to deliver family planning services and associated factors in urban east-central Uganda

Jacquellyn Nambi Ssanyu et al. Reprod Health. .

Abstract

Background: Health facility readiness is essential for realizing voluntary, rights-based family planning. However, many countries, including rapidly urbanizing Uganda, face challenges in ensuring their health facilities are sufficiently equipped to meet the growing demand for these services. This study assessed readiness and associated factors across public, private-not-for-profit (PNFP), and private-for-profit (PFP) health facilities in urban east-central Uganda to guide strategies for improving service delivery.

Methods: The study used secondary data from a cross-sectional study done in Jinja City and Iganga Municipality, including a health facility assessment and health worker survey. Readiness was measured using the Service Availability and Readiness Assessment methodology, and health worker knowledge and biases were assessed through the Situation Analysis approach. Sample weights adjusted for facility and health worker representation, and linear regression examined associations between readiness scores and various factors.

Results: Among 152 health facilities, 94.2% offered family planning services, with an average readiness score of 46.7% (standard deviation ± 17.0). Short-acting methods had high availability (99.0%), while long-acting reversible contraceptives (34.2%) and permanent options (8.9%) were less available, compounded by prevalent stock-outs. Additionally, staff refresher training was inadequate, particularly in PFP facilities (50.4%), and health worker knowledge, confidence and willingness to provide some methods, particularly long-acting options and natural family planning counselling, were low. Notably, out of 261 health workers, 97.7% imposed at least one restriction to service access based on either age, parity, marital status, or spousal consent, more pronounced in PNFP facilities. Readiness was significantly associated with facility level (health centre level II facilities: β = -9.42, p = 0.036; drug shops: β = -11.00, p = 0.022), external supervision (β = 9.04, p = 0.009), holding administrative meetings (β = 9.72, p = 0.017), and imposing marital status (β = -9.42, p = 0.017) and spousal consent access barriers (β = 6.24, p = 0.023).

Conclusions: This study found sub-optimal facility readiness, highlighting the need to strengthen governance of services across both public and private sectors, implement comprehensive training for health workers in both sectors, and align policies to ensure equitable access to a full range of services for all clients.

Keywords: Access barriers; Family Planning; Health facility readiness; Uganda; Urban.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical approval for the study was granted by the Makerere University School of Public Health Research and Ethics Committee (REC) (Reference Number: SPH-2023–384) and the Uganda National Council for Science and Technology (UNCST) (Reference Number: HS3222ES). The Urban Thrive Project, whose data was utilized for this study, also received approval from the Makerere University School of Public Health REC (Reference Number: SPH-2021–146) and UNCST (Reference Number: HS1826ES). In addition, administrative clearance was obtained from the leadership of Jinja City and Iganga Municipality. All health facilities provided authorization to be included in the study while the health workers interviewed provided written informed consent prior to their participation. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Family planning services provided at each level and the distribution of health facilities across levels
Fig. 2
Fig. 2
Proportion of health workers knowledgeable enough to counsel and provide various methods (N = 261)
Fig. 3
Fig. 3
Proportions of facilities with different methods available and no stock-outs in the past three months (N = 145)
Fig. 4
Fig. 4
Weighted proportions of providers who reported recommending different family planning methods (N = 261)
Fig. 5
Fig. 5
Readiness across public, PNFP and PFP facilities in Jinja City and Iganga Municipality
See this image and copyright information in PMC

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References

    1. Prata N. The need for family planning. Popul Environ. 2007;28(4):212–22.
    1. United Nations Population Fund. Family planning is a human right 2018. Available from: https://www.unfpa.org/press/family-planning-human-right.
    1. Jain AK, Hardee K. Revising the FP quality of care framework in the context of rights-based family planning. Stud Fam Plann. 2018;49(2):171–9. - PubMed
    1. Bruce J. Fundamental elements of the quality of care: a simple framework. Stud Fam Plann. 1990;21(2):61–91. - PubMed
    1. RamaRao S, Mohanam R. The quality of family planning programs: concepts, measurements, interventions, and effects. Stud Fam Plann. 2003;34(4):227–48. - PubMed

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