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Facility-Level Characteristics Associated with Family Planning and Child Immunization Services Integration in Urban Areas of Nigeria: A Longitudinal Analysis

Citation

Sheahan, Kate L.; Speizer, Ilene S.; Orgill-Meyer, Jennifer; Curtis, Sian L.; Weinberger, Morris; Paul, John E.; & Bennett, Antonia V. (2021). Facility-Level Characteristics Associated with Family Planning and Child Immunization Services Integration in Urban Areas of Nigeria: A Longitudinal Analysis. BMC Public Health, 21(1), 1379. PMCID: PMC8274034

Abstract

BACKGROUND: Unmet need for postpartum contraception is high. Integration of family planning with routine child immunization services may help to satisfy unmet need. However, evidence about the determinants and effects of integration has been inconsistent, and more evidence is required to ascertain whether and how to invest in integration. In this study, facility-level family planning and immunization integration index scores are used to: (1) determine whether integration changes over time and (2) identify whether facility-level characteristics, including exposure to the Nigerian Urban Reproductive Health Initiative (NURHI), are associated with integration across facilities in six urban areas of Nigeria.
METHODS: This study utilizes health facility data collected at baseline (n = 400) and endline (n = 385) for the NURHI impact evaluation. Difference-in-differences models estimate the associations between facility-level characteristics, including exposure to NURHI, and Provider and Facility Integration Index scores. The two outcome measures, Provider and Facility Integration Index scores, reflect attributes that support integrated service delivery. These indexes, which range from 0 (low) to 10 (high), were constructed using principal component analysis. Scores were calculated for each facility. Independent variables are (1) time period, (2) whether the facility received the NURHI intervention, and (3) additional facility-level characteristics.
RESULTS: Within intervention facilities, mean Provider Integration Index scores were 6.46 at baseline and 6.79 at endline; mean Facility Integration Index scores were 7.16 (baseline) and 7.36 (endline). Within non-intervention facilities, mean Provider Integration Index scores were 5.01 at baseline and 6.25 at endline; mean Facility Integration Index scores were 5.83 (baseline) and 6.12 (endline). Provider Integration Index scores increased significantly (p = 0.00) among non-intervention facilities. Facility Integration Index scores did not increase significantly in either group. Results identify facility-level characteristics associated with higher levels of integration, including smaller family planning client load, family planning training among providers, and public facility ownership. Exposure to NURHI was not associated with integration index scores.
CONCLUSION: Programs aiming to increase integration of family planning and immunization services should monitor and provide targeted support for the implementation of a well-defined integration strategy that considers the influence of facility characteristics and concurrent initiatives.

URL

http://dx.doi.org/10.1186/s12889-021-11436-x

Reference Type

Journal Article

Year Published

2021

Journal Title

BMC Public Health

Author(s)

Sheahan, Kate L.
Speizer, Ilene S.
Orgill-Meyer, Jennifer
Curtis, Sian L.
Weinberger, Morris
Paul, John E.
Bennett, Antonia V.

Article Type

Regular

PMCID

PMC8274034

Data Set/Study

Nigerian Urban Reproductive Health Initiative (NURHI) Sustainability Study

Continent/Country

Nigeria

Sex/Gender

Ciswomen

ORCiD

Speizer - 0000-0001-6204-1316
Curtis - 0000-0001-5225-860X