A multilevel analysis on the predictors of client satisfaction with family planning services in Ethiopia: evidence from the Ethiopian service provision assessment (ESPA) 2021/22.

Abstract

Background: Ethiopia has experienced growth in the utilization of family planning services. However, there are reports of relatively low client satisfaction across the country.

Objective: The objective of this study was to assess client and facility level predictors of satisfaction with family planning services in Ethiopia.

Method: A multi-level mixed effects logistic regression analysis was conducted on a national survey obtained from the service provision assessment 2021-22. A total of 2071 clients (level one) and 529 facilities (level two) were included.

Results: Overall, 56% of clients were highly satisfied with the family planning service they received. Findings from the random effects of the multilevel analysis show there is a significant difference in client satisfaction between facilities, with an intra-class correlation of 0.56 in the null model. At the client-level, age above 30, auditory privacy, and discussion on side effects are significantly associated with higher client satisfaction. At the facility level, having a waiting area, facilities with a quality unit and/or committee, a DHIS2 reporting system, operating for more than 20 days a month, privately owned facilities and availability of family planning guidelines are associated with higher odds of being satisfied. On the other hand, at the client level, having a primary or higher education, increasing wait time and clients asking their providers questions are associated with lower odds of being satisfied. At the facility level, having a fixed user fee significantly reduces the odds of client satisfaction.

Conclusions: Human resource and professional development training and health system strengthening is recommended.