Situation Analysis

A comparative analysis was conduced of four Situation Analysis studies carried out in West Africa between 1992 and 1995. The studies, all conducted by the Population Council, include Burkina Faso (1995), Senegal (1994), Cote d’Ivoire (1992), and Ghana (1993). The data were compared with respect to functional capacity, quality of care, eligibility barriers, and performance of the family planning programs.

A Situation Analysis study involves the systematic collection of data at the level of the service delivery point (SDP) among a representative sample or census of SDPs. The methodology was developed in 1989, during Phase I of the Population Council's Africa Operations/Technical Assistance Project. The two overall objectives of a Situation Analysis Study are 1) to describe the functioning and quality of FP services, and 2) to analyze the relationship between sub-system functioning and the quality of services. The four standard instruments of a Situation Analysis are: inventory of facilities and equipment, observation of the interaction between provider and client, FP client interview, and provider interview.

The following summarizes some of the major findings of the comparative analysis:

Functional Capacity of SDPs

• The availability of methods varies greatly both within and across countries: the majority of SDPs in all countries have combined pills and condoms (except in BF where only 50% of SDPs have condoms), many have progesterone pills, some have IUDs (very low in BF) and very few provide CCV. The SDPs provide on average 3-5 contraceptive methods.
• Most SDPs have experienced stock-outs in the 3-6 months prior to the study.
• The availability of basic infrastructure and equipment varies tremendously across the countries.
• On average providers (doctors and midwives) have received practical training in 2 to 5 contraceptive methods.
• In Burkina Faso, Senegal, and Cote d’Ivoire between 12 and 30% of providers where trained in IEC techniques. In Ghana between 40% (NGO, other) and 60% (public) received training in IEC.
• Between 20% (Burkina) and 70% (Cote d’Ivoire) received a supervision visit in the six months prior to the study.

Quality of Services Provided

Counseling

• Few new clients received a counseling session related to the method that they chose: Burkina 20% and Senegal 60%.
• Clients that did receive a counseling session were rarely told about side effects, treatment of, and other information related to method chosen (or other methods).
• Providers generally did present several methods to the new clients, but not in detail.
• In Burkina Faso and Cote d’Ivoire about 65% of clients were asked about their reproductive intentions.
• Few clients were asked about their previous experience with family planning.

Technical competence

• Providers conducted general consultation procedures (asked about: medical history, weight, last menstrual period, blood pressure, breast-feeding) with between 20-60% of new clients across the four countries.
• Between 10-60% of clients were asked about STD symptoms (vaginal bleeding, pelvic pain, discharge): Burkina 10%, Senegal 55%, Ghana 20%.
• Between 60% (Burkina) and 90% (CI) provided the appropriate methods to breast-feeding women (progesterone only pill or other method depending on age of child).

Mechanisms for encouraging continuity

• Most clients across the four countries were given an appointment for a follow-up visit.

Clinic Performance

• The distribution of clients across the SDPs in all the countries is very skewed. A few SDPs provide services to the majority of the clients. In Burkina Faso for example, 2% of the SDPs serve 50% of the clients. These sites are most often in urban areas.

Eligibility Barriers

The following presents the results of an analysis of provider responses to questions on whether they applied five specific criteria in providing family planning methods: minimum age, maximum age, minimum number of children, marital status, and spousal consent.

• Age and parity barriers were the most commonly reported barriers by providers.
• Barriers are highest for the most commonly accepted and available methods in each of these countries, such as the combined oral contraceptive.
• Ghanaian staff were most likely to report imposing a barrier for any type of method (93%). Burkina Faso staff were the least likely (79%).

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