The Strengthening People-centered Accessibility, Respect, and Quality (SPARQ) project worked with women and health facilities in Kenya and India on person-centered care in maternity, family planning and abortion services. The four-and-a-half-year project finished at the end of 2019. The project was created to measure the care women received, design interventions to solve problems women identified, and learn whether those interventions could be applied and work on a broad scale. SPARQ began with the researchers determining components of person-centered care, such as dignity and respect, autonomy, privacy and confidentiality, and stigma and discrimination. They interviewed women who’d received services to learn what the women felt was important about these domains. They then designed scales for each health service (maternity care, family planning care and abortion care) with survey questions to measure the degree of person-centered care women received. After evaluating how women were treated, the researchers and staff at partner organizations designed interventions to improve women’s experiences. These interventions differed by topic (childbirth, family planning or abortion) and by country. Specifically, SPARQ implemented the following:
-Quality improvement cycles in India (for delivery) and Kenya (for family planning and delivery). Findings: While QI interventions improved person-centered care (PCC) in India, it actually led to a decrease in PCC in Kenya.
-Training of community health workers providing family planning in India. Findings: Training had no impact on PCC; higher quality PCC was associated with higher uptake and continuation of family planning.
-Training peer-counselors to provide support to women receiving abortions in Kenya. Findings: Decreased stigma related to abortion experiences
-Training pharmacists providing medication abortion in India. Findings: increased pharmacists knowledge, but did not change their behaviors (PCC, stigma) towards clients seeking medication abortion.
In summary, improve person-centered care is challenging as it is hard to change ingrained behaviors, and system/facility level factors that promote poor PCC need to be addressed too.