Barriers to high-quality primary reproductive health services in an urban area of Iran: views of public health providers

Abstract

Objective: to explore public primary reproductive health providers' views on their own roles and tasks in their present organisation, and the perceived barriers to providing high-quality services. Design: a qualitative approach using semi-structured, audio-taped focus group discussions (FGDs). The discussions were held in Farsi or Turkish, transcribed verbatim, translated in to English and analysed using content analysis. Setting: family health units of public health facilities, Tabriz, Iran. Participants: two FGDs with 12 midwives and two FGDs with eight other family health providers working at the facilities. Findings: the providers identified the most satisfying part of their duties as working with clients. Adominant theme in all FGDs was the providers' frustration about a number of factors, most of which were beyond their control. The identified system and organisational barriers were grouped in to five categories: multiplicity of tasks and in compatibility with the providers' own basic training; suboptimal supervision and management; too little time for clients; lack of privacy and appropriate materials for education and counselling; and in adequate opportunities for continuing education. Key conclusions: this study highlighted the providers' satisfaction in working with clients, and their dissatisfaction with not being used to the best of their capabilities due to a number of systemic and organisational barriers. Implications for practice: based on these findings, multifaceted interventions seem to be necessary to improve staff productivity and service quality. The interventions should include needs-based pre-service education, supportive supervision and management, provision of educational materials, simplifying record management, and appointing more staff in socio-economically deprived areas. Research is needed to identify the best way to integrate the services, as well as basic and continuing educational needs of staff. (C) 2008 Elsevier Ltd. All rights reserved.