The opinion of clients and providers towards introduction of user fee for clinic-based family planning services in Kenya

Abstract

A descriptive study of client and provider opinions towards the introduction of family planning user fees was conducted from 27th April to 27th May 1994, in six MOH hospitals which are indicator hospitals for the Health Care Financing Programme in Kenya. The hospitals were the Provincial General Hospitals in Mombasa, Nyeri, New Nyanza, and the District Hospitals in Homa Bay, Kajiado and Meru. During the study five hundred and eighty (580) MCH/FP clients and twenty (20) FP providers were interviewed using a pretested questionnaire. Their general characteristics, MCH/FP service utilization/provision and opinions on introduction of FP user fees were examined. Client/household characteristics and travel factors were also examined in relation to opinions on FP user fees. The mean age of the clients interviewed was 25.8 years (SO 5.58), the majority (86.4%) being married and having a mean parity of 2.46 living children (SO 1.67). Of the providers interviewed the mean family planning provision period was 6.58 years (SO 5.06). The majority of the clients (69.0%) listed proximity and familiarity of the Ministry of Health facilities as first reason for choosing to come to these facilities.- Only 8% of the clients said they choose it because it did not charge or was of low cost as compared to other facilities providing MCH/FP services. On overall quality rating 86.0% of the clients rated the MCH/FP services as good to excellent, with 66.0% indicating that no improvement in the present service delivery was needed. Of the clients interviewed 48.0% were of the opinion that women would be willing to pay user fees, 74.0% were in a position to pay and 71.0% husbands/partners were willing to assist to pay. Only 6% of the clients said they would not be in a position to pay, with the others indicating that willingness and ability to pay will depend on how much will be charged for the FP services. On the issue of whether to exempt some women from the user fee 62.0% were not for the idea while 29.0% thought that some clients should be exempted (those not financially able). It was noted that older clients, those with many children, more educated and had previously or were currently using family planning services were more positive to the idea of FP user fees introduction. The providers had similar positive opinion with 55.6% saying women would be willing to pay but 90% said that some women should be exempted from paying the FP user fees. Both the clients and providers were also asked what they thought was a reasonable charge for the FP services. The mean and median charge responses mentioned were noted to be lower as compared to the fees at other charging facilities in ~he nearby areas. It was also a general observation that clients were willing to pay