scholarly journals Development of integration indexes to determine the extent of family planning and child immunization services integration in health facilities in urban areas of Nigeria

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Kate L. Sheahan ◽  
Jennifer Orgill-Meyer ◽  
Ilene S. Speizer ◽  
Siân Curtis ◽  
John Paul ◽  
...  
Keyword(s):  
Family Planning ◽  
Service Delivery ◽  
Urban Areas ◽  
Health Facilities ◽  
Index Score ◽  
Child Immunization ◽  
Integrated Service Delivery ◽  
Immunization Services ◽  
The Impact ◽  
Integrated Service

Abstract Background Integrating family planning into child immunization services may address unmet need for contraception by offering family planning information and services to postpartum women during routine child immunization visits. However, policies and programs promoting integration are often based on insubstantial or conflicting evidence about its effects on service delivery and health outcomes. While integration models vary, many studies measure integration as binary (a facility is integrated or not) rather than a multidimensional and varying continuum. It is thus challenging to ascertain the determinants and effects of integrated service delivery. This study creates Facility and Provider Integration Indexes, which measure capacity to support integrated family planning and child immunization services and applies them to analyze the extent of integration across 400 health facilities. Methods This study utilizes cross-sectional health facility (N = 400; 58% hospitals, 42% primary healthcare centers) and healthcare provider (N = 1479) survey data that were collected in six urban areas of Nigeria for the impact evaluation of the Nigerian Urban Reproductive Health Initiative. Principal Component Analysis was used to develop Provider and Facility Integration Indexes that estimate the extent of integration in these health facilities. The Provider Integration Index measures provider skills and practices that support integrated service delivery while the Facility Integration Index measures facility norms that support integrated service delivery. Index scores range from zero (low) to ten (high). Results Mean Provider Integration Index score is 5.42 (SD 3.10), and mean Facility Integration Index score is 6.22 (SD 2.72). Twenty-three percent of facilities were classified as having low Provider Integration scores, 32% as medium, and 45% as high. Fourteen percent of facilities were classified as having low Facility Integration scores, 38% as medium, and 48% as high. Conclusion Many facilities in our sample have achieved high levels of integration, while many others have not. Results suggest that using more nuanced measures of integration may (a) more accurately reflect true variation in integration within and across health facilities, (b) enable more precise measurement of the determinants or effects of integration, and (c) provide more tailored, actionable information about how best to improve integration. Overall, results reinforce the importance of utilizing more nuanced measures of facility-level integration.

scholarly journals Development of Integration Indexes to Determine the Extent of Family Planning and Child Immunization Services Integration in Health Facilities in Urban Areas of Nigeria

2020 ◽  
Author(s):  
Kate Sheahan ◽  
Jennifer Orgill-Meyer ◽  
Ilene Speizer ◽  
Sian Curtis ◽  
John Paul ◽  
...  
Keyword(s):  
Family Planning ◽  
Service Delivery ◽  
Urban Areas ◽  
Health Facilities ◽  
Index Score ◽  
Child Immunization ◽  
Integrated Service Delivery ◽  
Immunization Services ◽  
The Impact ◽  
Integrated Service

Abstract Background: Integrating family planning into child immunization services may address unmet need for contraception by offering family planning information and services to postpartum women during routine child immunization visits. However, policies and programs promoting integration are often based on insubstantial or conflicting evidence about its effects on service delivery and health outcomes. Since most studies measure integration as binary (a facility is integrated or not) rather than a multidimensional and varying continuum, it is difficult to understand the determinants and effects of integration. This study creates Facility and Provider Integration Indexes, which measure capacity to support integrated family planning and child immunization services, and applies them to analyze the extent of integration across 400 health facilities. Methods: This study utilizes cross-sectional health facility (N= 400; 49% hospitals, 51% primary healthcare centers) and healthcare provider (N= 1,479) survey data that were collected in six urban areas of Nigeria for the impact evaluation of the Nigerian Urban Reproductive Health Initiative. Principal Components Analysis was used to develop Provider and Facility Integration Indexes that estimate the extent of integration in these health facilities. The Provider Integration Index measures provider skills and practices that support integrated service delivery while the Facility Integration Index measures facility norms that support integrated service delivery. Index scores range from zero (low) to ten (high). Results: Mean Provider Integration Index score is 5.42 (SD 3.10), and mean Facility Integration Index score is 6.22 (SD 2.72). Twenty-three percent of facilities were classified as having low Provider Integration scores, 32% as medium, and 45% as high. Fourteen percent of facilities were classified as having low Facility Integration scores, 38% as medium, and 48% as high. Conclusion: Many facilities in our sample have achieved high levels of integration, while many others have not. Results suggest that measuring integration as a binary variable does not (a) reflect the true variation in integration within and across health facilities, (b) enable nuanced measurement of the determinants or effects of integration, or (c) provide tailored, actionable information about how best to improve integration. Overall, results reinforce the importance of utilizing more nuanced measures of facility-level integration.

scholarly journals Development of Integration Indexes to Determine the Extent of Family Planning and Child Immunization Services Integration in Health Facilities in Urban Areas of Nigeria

2020 ◽  
Author(s):  
Kate L. Sheahan ◽  
Jennifer Orgill-Meyer ◽  
Ilene Speizer ◽  
Sian Curtis ◽  
John Paul ◽  
...  
Keyword(s):  
Family Planning ◽  
Service Delivery ◽  
Urban Areas ◽  
Health Facilities ◽  
Index Score ◽  
Child Immunization ◽  
Integrated Service Delivery ◽  
Immunization Services ◽  
The Impact ◽  
Integrated Service

Abstract Background: Integrating family planning into child immunization services may address unmet need for contraception by offering family planning information and services to postpartum women during routine child immunization visits. However, policies and programs promoting integration are often based on insubstantial or conflicting evidence about its effects on service delivery and health outcomes. While integration models vary, many studies measure integration as binary (a facility is integrated or not) rather than a multidimensional and varying continuum. It is thus challenging to ascertain the determinants and effects of integrated service delivery. This study creates Facility and Provider Integration Indexes, which measure capacity to support integrated family planning and child immunization services and applies them to analyze the extent of integration across 400 health facilities. Methods: This study utilizes cross-sectional health facility (N= 400; 58% hospitals, 42% primary healthcare centers) and healthcare provider (N= 1,479) survey data that were collected in six urban areas of Nigeria for the impact evaluation of the Nigerian Urban Reproductive Health Initiative. Principal Components Analysis was used to develop Provider and Facility Integration Indexes that estimate the extent of integration in these health facilities. The Provider Integration Index measures provider skills and practices that support integrated service delivery while the Facility Integration Index measures facility norms that support integrated service delivery. Index scores range from zero (low) to ten (high). Results: Mean Provider Integration Index score is 5.42 (SD 3.10), and mean Facility Integration Index score is 6.22 (SD 2.72). Twenty-three percent of facilities were classified as having low Provider Integration scores, 32% as medium, and 45% as high. Fourteen percent of facilities were classified as having low Facility Integration scores, 38% as medium, and 48% as high. Conclusion: Many facilities in our sample have achieved high levels of integration, while many others have not. Results suggest that measuring integration as a binary variable does not (a) reflect the true variation in integration within and across health facilities, (b) enable nuanced measurement of the determinants or effects of integration, or (c) provide tailored, actionable information about how best to improve integration. Overall, results reinforce the importance of utilizing more nuanced measures of facility-level integration.

scholarly journals Development of Integration Indexes to Determine the Extent of Family Planning and Child Immunization Services Integration in Health Facilities in Urban Areas of Nigeria

2021 ◽  
Author(s):  
Kate L. Sheahan ◽  
Jennifer Orgill-Meyer ◽  
Ilene Speizer ◽  
Siân Curtis ◽  
John Paul ◽  
...  
Keyword(s):  
Family Planning ◽  
Service Delivery ◽  
Urban Areas ◽  
Health Facilities ◽  
Index Score ◽  
Child Immunization ◽  
Integrated Service Delivery ◽  
Immunization Services ◽  
The Impact ◽  
Integrated Service

Abstract Background Integrating family planning into child immunization services may address unmet need for contraception by offering family planning information and services to postpartum women during routine child immunization visits. However, policies and programs promoting integration are often based on insubstantial or conflicting evidence about its effects on service delivery and health outcomes. While integration models vary, many studies measure integration as binary (a facility is integrated or not) rather than a multidimensional and varying continuum. It is thus challenging to ascertain the determinants and effects of integrated service delivery. This study creates Facility and Provider Integration Indexes, which measure capacity to support integrated family planning and child immunization services and applies them to analyze the extent of integration across 400 health facilities. Methods This study utilizes cross-sectional health facility (N= 400; 58% hospitals, 42% primary healthcare centers) and healthcare provider (N= 1,479) survey data that were collected in six urban areas of Nigeria for the impact evaluation of the Nigerian Urban Reproductive Health Initiative. Principal Component Analysis was used to develop Provider and Facility Integration Indexes that estimate the extent of integration in these health facilities. The Provider Integration Index measures provider skills and practices that support integrated service delivery while the Facility Integration Index measures facility norms that support integrated service delivery. Index scores range from zero (low) to ten (high). Results Mean Provider Integration Index score is 5.42 (SD 3.10), and mean Facility Integration Index score is 6.22 (SD 2.72). Twenty-three percent of facilities were classified as having low Provider Integration scores, 32% as medium, and 45% as high. Fourteen percent of facilities were classified as having low Facility Integration scores, 38% as medium, and 48% as high. Conclusion Many facilities in our sample have achieved high levels of integration, while many others have not. Results suggest that using more nuanced measures of integration may (a) more accurately reflect true variation in integration within and across health facilities, (b) enable more precise measurement of the determinants or effects of integration, and (c) provide more tailored, actionable information about how best to improve integration. Overall, results reinforce the importance of utilizing more nuanced measures of facility-level integration.

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

2021 ◽  
Author(s):  
Kate Sheahan ◽  
Ilene Speizer ◽  
Jennifer Orgill-Meyer ◽  
Sian Curtis ◽  
Morris Weinberger ◽  
...  
Keyword(s):  
Family Planning ◽  
Urban Areas ◽  
Unmet Need ◽  
Principal Component ◽  
Public Facility ◽  
Postpartum Contraception ◽  
Child Immunization ◽  
Immunization Services ◽  
Facility Level ◽  
The Impact

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 effects of integration has been inconsistent, and more evidence is required to determine whether and how to invest in integration. This study applies continuous facility-level family planning and child immunization integration index scores to: (1) determine whether integration changes over time, (2) assess the impact of the Nigerian Urban Reproductive Health Initiative (NURHI) on integration, and (3) identify facility-level characteristics associated with integration across facilities in urban areas of Nigeria. Methods: Longitudinal data from health facilities in six urban areas of Nigeria are available from 400 facilities at baseline (2011) and 385 facilities at endline (2014). Difference-in-differences models estimate the impact of NURHI on Provider and Facility Integration Index scores and determine associations between facility-level characteristics and integration. 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) 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. NURHI did not have a significant effect on integration index scores. Results identify facility-level characteristics associated with integration: location, family planning client load, years of provider experience, provider training, and public facility ownership. 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.

Determinants of Family Planning and Child Immunization Services Integration in Urban Areas of Nigeria: A Longitudinal Analysis

2020 ◽  
Author(s):  
Kate Sheahan ◽  
Ilene Speizer ◽  
Jennifer Orgill-Meyer ◽  
Sian Curtis ◽  
Morris Weinberger ◽  
...  
Keyword(s):  
Family Planning ◽  
Urban Areas ◽  
Contraceptive Use ◽  
Unmet Need ◽  
Modern Contraceptive ◽  
Child Immunization ◽  
Period 2 ◽  
Immunization Services ◽  
Facility Level ◽  
The Impact

Abstract Background: Unmet need for contraception is high in the postpartum period. Research has identified the role that integration of family planning into child immunization services can have in addressing this need. However, evidence about the effects of family planning and immunization integration has been inconsistent and more evidence is required to determine whether and how to invest in integration. This study applies continuous facility-level family planning and child immunization integration index scores to: (1) determine whether facility-level integration changes over time, (2) assess the impact of the Nigerian Urban Reproductive Health Initiative (NURHI) - a program that aimed to increase modern contraceptive use - on integration, and (3) identify determinants of integration across facilities in urban areas of Nigeria. Methods: Longitudinal data from health facilities in six urban areas of Nigeria are available from 400 facilities at baseline and 385 facilities at endline. Difference-in-differences models are used to assess the impact of NURHI on Provider Integration and Facility Integration Index scores, and to identify facility-level determinants of integration. The two outcome measures, Provider and Facility Integration Index scores, measure attributes that support integrated service delivery. The independent variables are (1) time period (2) whether the facility received the NURHI intervention, and (3) facility-level characteristics. Results: Our results show that the Provider Integration Index scores increased significantly only among non-intervention facilities while Facility Integration Index scores did not increase significantly in either group. We find that NURHI did not have a significant effect on integration index scores. Results also pinpoint facility characteristics that influence integration, including public ownership and the proportion of providers who have received family planning training. 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.

scholarly journals Innovation in Evaluating the Impact of Integrated Service-Delivery: The Integra Indexes of HIV and Reproductive Health Integration

PLoS ONE ◽  
2016 ◽  
Vol 11 (1) ◽  
pp. e0146694 ◽  
Author(s):  
Susannah H. Mayhew ◽  
George B. Ploubidis ◽  
Andy Sloggett ◽  
Kathryn Church ◽  
Carol D. Obure ◽  
...  
Keyword(s):  
Reproductive Health ◽  
Service Delivery ◽  
Integrated Service Delivery ◽  
The Impact ◽  
Integrated Service

scholarly journals Facility-level characteristics associated with family planning and child immunization services integration in urban areas of Nigeria: a longitudinal analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kate L. Sheahan ◽  
Ilene S. Speizer ◽  
Jennifer Orgill-Meyer ◽  
Siân Curtis ◽  
Morris Weinberger ◽  
...  
Keyword(s):  
Family Planning ◽  
Urban Areas ◽  
Unmet Need ◽  
Principal Component ◽  
Public Facility ◽  
Postpartum Contraception ◽  
Child Immunization ◽  
Period 2 ◽  
Immunization Services ◽  
Facility Level

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.

Sign in / Sign up

Export Citation Format

Share Document