Family planning integration in Ethiopia’s primary health care system: a qualitative study on opportunities, challenges and best practices

Abstract

Background

Family planning (FP) service integration into primary health care (PHC) is an effective approach to realize reproductive autonomy, increase the use of contraceptives, and improve maternal and child health outcomes. The Ethiopian government promotes integration of FP services into primary health care (PHC). However, there is paucity of evidence on the status of FP service integration. The aim of this study is to explore the state of FP integration into PHC services and identify facilitators and barriers to integration.

Methods

A qualitative study nested with a larger national study was conducted from July to October 2022. A total of 60 interviews were conducted with FP stakeholders including, government organizations, non-governmental organizations, donors, service providers, and clients. Interviews were audio recorded, transcribed, and coded using OpenCode 4.03. The coded data were analyzed using framework analysis approach, using the Primary Health Care Performance Initiative (PHCPI) framework. Direct quotes and results from the coding and categorization were used to develop the report.

Results

Family planning is largely provided in designated units by dedicated staff within PHC facilities. The provision of integrated FP service within each service unit is in its early stage. Successful examples of integration include integration of FP with postnatal care, abortion care, and youth-friendly service centers. Facilitators of integration include commitment of the government and partners, the presence of policies and guidelines, and positive attitude of service providers and clients. However, integration of FP also faces challenges that are largely related to challenges of the FP program even before integration. These include resource shortage, health workers shortage, health workers’ capacity/skill gaps, misconceptions about FP, religious and socio-cultural norms, and lack of awareness.

Conclusions

Integration of FP with PHC services in the Ethiopian public health facilities is viable. Pre-existing challenges of the FP program continued to be barriers to integration. Expanding the experiences of good practices in the integration of FP with post abortion care, post-natal care, and youth-friendly service centers to other components of PHC warrants attention. Addressing both supply- and demand-side challenges of the FP program is needed to facilitate the integration of FP with other PHC services.

Plain language summary

This study aimed to explore the status of integrating family planning (FP) services into primary health care (PHC) in Ethiopia and identify the facilitators and barriers to integration. The study included 60 interviews with stakeholders, including government and non-government organizations, service providers, and clients. We found that while dedicated FP staff provide services in designated units within PHC facilities, the provision of integrated FP services within other PHC units is in its early stage. Integration with post-abortion care, post-natal care, and youth-friendly service centers showed exemplary results that need to be used as good practices. The study identified challenges including resource shortage, health worker shortage, misconceptions about FP, religious and socio-cultural norms, and lack of awareness. The positive attitude of service providers and the commitment of the government and partners were identified as facilitators of integration. The study recommends expanding the successful practices of FP integration to other components of PHC and addressing supply- and demand-side challenges to facilitate the integration of FP services with PHC.