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Analysis of Health Facility Based Barriers And Facilitators To Use Of Sexual And Reproductive Health Care Services Among Most At Risk Populations (MARPS): Evidence From A Mystery Client Survey In Nigeria
Ezire O, Okekearu I, Adeniyi F and Faweya O
Background: Access to sexual and reproductive health care services for most at risk population (MARPs) is a very important step in stemming the spread of HIV; as HCT and early diagnosis and treatment of STIs can contribute to reduction of the spread of HIV. Within Nigeria and most Sub Saharan African countries, MARPs are highly stigmatized both in the general society and in health care centres. It is important health care facility based facilitators and barriers to MARPs’ access to use of sexual and reproductive health care services by MARPs are identified to guide project design and implementation as well as policy formulation.
Methods: Mystery client survey was conducted in thirty three (33) healthcare facilities in Nigeria. For the purpose of the survey, the mystery clients (MARPs) sought only STI consultation and HIV counselling and testing services. Twelve (12) mystery clients visited each facility seeking either STI or HCT service in the facility. Ethical approval was obtained from the Nigeria Institute of Medical Research (NIMR). SPSS version 20 was used for the Bi-variate and multivariate logistic regression analysis.
Results: While positive attitude of health care workers was found to be a facilitator of access to health care services, this study shows that perceived quality of services is a very significant variable in MARPs’ use of a health care facility. We also found that MARPs were more willing to refer their community members to facilities that have educational materials promoting non-stigmatizing attitude towards PLWHAs and MARPs. Amazingly, privacy of services provided was not significant.
Conclusion: It is recommended that standard of health care practices should be enforced. Training and re training of health care workers on provision of MARP friendly services should be formalized and scaled up. Investment in educational materials (posters) in health facility settings should be promoted.