Exit Client Survey – Clients’ satisfaction among women of reproductive age (18-49 years) receiving family planning services in Nepal, 2019

In Nepal, family planning is one of the most successful public health programs, with a well-known impact on women’s health and the lowering of maternal mortality. Maternal mortality is a major public health concern around the world. The International Conference on Population and Development in Cairo in 1994 made a significant contribution by recognizing that the fulfillment of sexual and reproductive rights is a human rights problem. CPR is 39 percent, according to the Department of Health’s annual report for 2077/78. The aim of this study was to assess the satisfaction and associated factors among women receiving FP services.

A cross sectional study design with two different sampling techniques was used. From public HFs, two lists of health posts each for province 2 and province 5 was developed from which 30 health posts were randomly selected in each province. In the second stage, no of OK clinics for each province were chosen in proportion to the total no of clinics. OK clinics were then randomly selected in each province. The study population was women of reproductive age 18 to 49 years, who had received family planning services on the day of data collection. The sampling unit was 59 private OK clinics from six provinces (Province 1, 2, 3, Gandaki, 5 and Sudurpaschim) and 60 public HFs of province 2 and 5. A total of 504 private OK clinic clients and 240 public facility clients were included in the study.

31% of the total clients from private OK clinics, and 32.9% of the clients from public health facilities reported high satisfaction in all three satisfaction determinants: services met expectation, likely to return and likely to recommend the facility. In both public and private OK clinics, Muslim and Dalit ethnicity were underrepresented in seeking FP services. Among a total of 240 public facility clients, only 13.7% of them had ever met or participated in the group/individual discussion about family planning methods held by OK Network Service Provider in the past 3 months compared to 71.6% (n=504) from the total private OK clinic clients. From the regression results, we found that Madhesi women were less likely to be satisfied (AOR: 0.41, 95%CI: 0.20-0.86) with the services compared to Dalit clients. Clients who reported that reputation of provider and referral from OK didis as reason for using the particular facility were two times more likely (AOR 2.72, 95%CI: 1.54-7.48) to be highly satisfied with the services compared to those who did not answer “reputation of provider” as the reason for using the particular facility.

Overall satisfaction was recorded among Nepalese women who used FP services in this study. BCC initiatives in other public HFs’ catchment areas would primarily assist FP clients who use public facilities. Behavior Change Communication strategies, which include mobilizing OK didis, should expand overall coverage of WRA, particularly Muslim and Dalit WRA, in order to improve their knowledge and boost their use of FP and abortion services. Addressing these bottlenecks may improve client satisfaction and, as a result, increase access to and use of financial planning services.