Macro-Level Health Financing Trends and Household Financial Catastrophe in Nigeria: A Multi-Method Analysis of Institutional Reforms, 2000-2023
Abstract:
Safety monitoring in family planning (FP) and post-abortion care (PAC) services in low- and middle-income countries (LMICs) relies on safety flags and incident rates, yet these indicators are rarely interpreted together. This creates a risk that incident rate differences between service delivery channels may be misread as quality deficits when they reflect differences in service scope and case complexity. This study examined safety flags, incident rates, and quality assessment performance in an integrated framework across centre-based facilities and outreach teams in a Sierra Leone FP/PAC programme. A longitudinal observational analysis used 108 Quality Technical Assessment (QTA) records from 23 paired service delivery points across 14 districts (2019–2022). Safety flags and safety domain scores were compared between remote and in-person assessment modalities using chi-square and Mann-Whitney U tests. Clinical and product incident rates per 1,000 couple-years of protection (CYP) were compared between channels. Domain-specific QTA scores were compared across eight quality domains. Safety flags did not differ significantly between modalities (p = .740). Centre-based facilities showed significantly higher incident rates than outreach services (U = 0.00, Z = −2.309, p = .021, r = −0.82). Despite this, no significant channel differences were observed in composite QTA final scores (p = .448) or in any of the eight quality domains. The divergence between higher incident rates at centres and equivalent quality scores indicates the difference reflects structural differences in service scope and case complexity rather than quality deficits. These findings support integrated safety frameworks in reproductive health programme monitoring.References:
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