Structural quality of health facilities to provide family planning services in Ethiopia: Evidence from the 2021-22 Ethiopia Service Provision Assessment survey.

The structural quality of family planning services reflects the capacity of health facilities to deliver effective care through adequate infrastructure, supplies, commodities, and trained personnel. While some evidence exists, recent national-level estimates of structural quality in Ethiopia remain limited. This study addresses this gap by assessing the overall structural quality of family planning services and the factors influencing it. Using data from the 2021-22 Ethiopia Service Provision Assessment survey, we assessed the structural quality across four domains: availability of trained staff, family planning guidelines, contraceptives, and equipment and supplies, aggregated into a composite score ranging from 0 to 100%. A survey-weighted multiple linear regression model was applied to assess associations between structural quality and facility characteristics, management factors, and regional variation. Among 1,102 health facilities, the estimated overall structural quality score for family planning services was 42.4% (95% CI: 41.2% to 43.6%). The availability of family planning guidelines, trained staff, equipment and supplies, and contraceptives was 55.9%, 24.1%, 45.6%, and 44.1%, respectively. Structural quality was 18.4% lower in private clinics (95% CI: -25.1% to -11.7%) and 17.0% lower in health posts (95% CI: -24.3% to -9.6%) compared to hospitals. Compared to metropolitan regions, the score was 12.4% lower in Gambela (95% CI: -20.3% to -4.6%) and 13.5% higher in Benishangul Gumuz (95% CI: 4.2% to 22.7%). Facilities that received external supervision in the past six months had 4.9% (95% CI: 0.1% to 9.7%) higher structural quality than those without supervision. Overall, the structural quality of facilities providing family planning services in Ethiopia remains suboptimal, with notable variations by facility type, region, and supervision status. Strengthening facility readiness, especially in underperforming settings, and ensuring regular supervision are essential to improving the capacity of facilities to deliver effective family planning services and advance progress toward Family Planning 2030 commitments.