Family Planning Supply Environment in Kinshasa, DRC: Survey Findings and Their Value in Advancing Family Planning Programming

Patrick Kayembe; Saleh Babazadeh; Nelly Dikamba; Pierre Akilimali; Julie Hernandez; Arsene Binanga; Jane T Bertrand

doi:10.9745/GHSP-D-15-00298

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FIGURE 1.
Spatial Distribution of Health Facilities Providing Contraception, Kinshasa, Democratic Republic of the Congo, 2013
Abbreviation: CYP, couple‐years of protection.
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FIGURE 2.
Number of Facilities per Health Zone Offering at Least One Method of Contraception per 100,000 Population, Kinshasa, Democratic Republic of the Congo, 2013
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FIGURE 3.
Availability of Specific Contraceptive Methods at Surveyed Facilities, Kinshasa, Democratic Republic of the Congo, 2012 and 2013
Abbreviations: EC, emergency contraception; IUD, intrauterine device.
CycleBeads, female sterilization, and EC were not included in the 2012 survey.
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FIGURE 4.
Availability of Specific Contraceptive Methods by Source of External Support, Kinshasa, Democratic Republic of the Congo, 2013
Abbreviations: EC, emergency contraception; FP, family planning; IUD, intrauterine device; PEPFAR, US President's Emergency Plan for AIDS Relief.

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TABLE 1 Methodological Approaches to the 3 Facility-Based Surveys in Kinshasa, DRC

	2012	2013	2014
Dates of data collection	Jan–Mar 2012	Oct 2013–Jan 2014	Aug–Sep 2014
Approach to sampling of sites	Attempted to identify universe of family planning sites	Attempted to identify universe of family planning sites	Random sample of 58 enumeration areas; up to 6 SDPs per enumeration area
Type of facilities included	Health facilities (hospital, health center, health post, clinic) and commercial pharmacies	Health facilities (hospital, health center, health post, clinic); no pharmacies	Up to one each per enumeration area:• hospital• health center• health post• clinic• pharmacy• kiosk
Mechanism for data collection	Pencil and paper	Smartphone	Smartphone
Length of questionnaire	Short	Short	Detailed
Used 3-star “readiness” rating	Yes	Yes	No
Geocoding of SDPs	Yes	Yes	Yes

Abbreviations: DRC, Democratic Republic of the Congo; SDP, service delivery point.

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TABLE 2 Number and Types of SDPs That Reported Offering Contraception in Kinshasa, DRC, 2012, 2013, and 2014 Facility-Based Surveys^a

	2012			2013		2014
SDP Type	No.	% of all health facilities^b	% of all SDPs^b	No.	% of all health facilities^b	No.	% of all health facilities^b	% of all SDPs^b
Health facilities (excluding pharmacies)
Hospital	23	12.5	1.5	72	18.2	17	21.5	10.6
Clinic	8	4.3	0.5	20	5.1	6	7.5	3.8
Health center	151	82.1	9.8	302	76.5	55	68.8	34.4
Heath post	2	1.1	0.1	1	0.3	1	1.3	0.6
Subtotal	184	100.0	12.0	395	100.0	80	100.0	50.0
Pharmacies	1345	–	87.6	–	–	80	–	50.0
Total SDPs	1535	–	100.0	–	–	160	–	100.0

Abbreviations: DRC, Democratic Republic of the Congo; SDP, service delivery point.
↵a The 2014 survey took a sample of SDPs, whereas the 2012 and 2013 surveys attempted to identify the universe of health facilities providing family planning. The 2013 survey did not include pharmacies.
↵b That reported offering contraception.

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TABLE 3 Three-Month (January–March 2013) CYP by Method, Kinshasa, Democratic Republic of the Congo

Method	Total CYP	% of Total CYP
Jadelle	6346	48.8
IUD	3100	23.8
CycleBeads	1397	10.7
3-month injectable	1011	7.8
Female sterilization	650	5.0
Implanon	158	1.2
Male condom	152	1.2
Male sterilization	90	0.7
Pill	64	0.5
1-month injectable	21	0.2
Female condom	17	0.1
Emergency contraception	2	0.0
Diaphragm	0	0.0
Total	13,008	100.0

Abbreviations: CYP, couple-years of protection; IUD, intrauterine device.

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TABLE 4 Correlates of Readiness (Based on the 3-Star Rating) and of Output (Based on CYP) in the 2013 Survey, Kinshasa, DRC: Results of Bivariate Regression Analysis

		Readiness: Percentage Rated 3-Star		Output: Mean CYP (3-Month Period)
	No.	%	P Value^a	Mean	P Value^b
Total	395	63.3		39.7
Managing authority			.37		.34
Private	120	61.7		26.4
Faith-based	100	68.0		48.5
Government	97	57.7		38.7
NGO	75	68.0		51.3
Other	3	33.3		22.6
Type of health facility			.03		.02
Health center	303	59.7		35.5
Clinic	20	85.0		97.3
Hospital	72	72.2		41.5
No. of years in operation			.25		.001
0–1	100	56.0		7.3
2–3	121	68.9		34.9
4–6	83	61.9		47.8
7 or more	89	65.2		62.8
No. of days/week in operation			.05		.03
0–3	121	54.5		24.6
4–6	205	66.8		51.5
7	69	68.1		31.3

Abbreviations: CYP, couple-years of protection; DRC, Democratic Republic of the Congo.
↵a P value calculated using chi‐square test.
↵b P value calculated using ANOVA test.

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TABLE 5 Attributes and Performance of Facilities Providing Family Planning Services by Source of External Support, Kinshasa, Democratic Republic of the Congo, 2013

		Source of External Support
	Total (N = 395)	FP Implementing Organization (n = 187)	PEPFAR (n = 121)	None (n = 87)	P Value
No. of years in operation, mean	4.7	5.6	3.0	4.9	.05
No. of days per week of FP service delivery, mean	4.8	4.9	4.7	4.7	.15
Type of facilities, %
Hospital	72	31	20	21	.05
Health center	302	148	90	65
Clinic	20	8	11	1
Achievement of elements in 3-star readiness index, %
3+ methods	72.9	78.6	92.6	33.3	<.001
Staff trained in FP	88.9	93.6	94.2	71.3	<.001
Basic information system	82.3	90.4	87.6	57.5	<.001
All 3 elements	63.3	71.7	77.7	25.3	<.001
CYP, Jan–Mar 2013, mean	39.7	61.3	23.7	15.8	<.001
Zero CYP (no methods distributed), %	33.4	20.9	43.0	47.1	<.001

Abbreviations: CYP, couple-years of protection; FP, family planning; PEPFAR, US President’s Emergency Plan for AIDS Relief.

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TABLE 6 Multivariate Regression Analysis of Factors Associated With 3-Month CYP

	Mean CYP (SE)
Managing authority
Government	1 [Reference]
NGO	19.65 (1.34)
Faith-based	12.34 (0.93)
Private	5.36 (0.40)
Other	9.55 (0.18)
Facility type
Clinic	1 [Reference]
Hospital	-65.26 (2.79)**
Health center	-61.50 (2.86)**
Source of external support
No support	1 [Reference]
FP implementing agency	13.23 (0.99)
PEPFAR	-18.91 (1.28)
No. of years in operation
0–1	1 [Reference]
2–3	13.72 (1.10)
4–6	26.87 (1.97)^*
≥7	50.19 (3.43)**
No. of days per week in operation
1–3	1 [Reference]
4–6	19.16 (1.79)
7	3.49 (0.25)
Number of methods available	7.75 (3.06)**
Number of trained staff	3.45 (1.28)
Information system (yes/no)	8.06 (0.58)

Abbreviations: CYP, couple-years of protection; FP, family planning; PEPFAR, US President’s Emergency Plan for AIDS Relief; SE, standard error.
↵* P<.05, ** P<.01, *** P<.001