By Andrea Sprockett, Kim Longfield, and Dominic Montagu
Family planning is a rich field that has evolved dramatically over the last 40 years, driven by attention to client-centered care, client rights and engagement, and data for evidence-based program management. Reaching the ambitious targets set by the Sustainable Development Goals and the Family Planning 2020 initiative requires a focus on service quality for a number of reasons, including ensuring choice, reducing discontinuation, and improving access to high quality care.
Yet family planning quality measurement is not easy, consistent, or accurate.
In October 2015, we assembled a group of implementers, researchers, and policy makers at the Rockefeller Center in Bellagio, Italy. Our aim was to simplify the measurement of family planning service quality and make it easier to collect data critical for decision-making. In advance of the meeting, each participant prepared a background paper to advance the discussion on how to measure family planning quality. Here’s a snapshot of what we learned:
Global interest in family planning is high. Understanding family planning quality has gained renewed attention thanks to international initiatives. In addition to the Sustainable Development Goals and the Family Planning 2020 initiatives, their predecessor, the Millennium Development Goals (2000-2015) recognized that reaching maternal health goals depended on increasing the use of family planning. These initiatives galvanized the community to work together to expand access to family planning methods, increase new adopters, and ensure new adopters continue to use their chosen methods.
There is agreement about how to frame family planning quality, but not about how to measure it. Nearly every background paper referenced Donabedian’s structure-process-quality framework or the 6-part Bruce framework to assess quality of family planning care. Quality is a multifaceted construct, and remains a challenge to measure. There are several methods, but data collected at the health facility or program level are often inconsistent or incomplete as a result of the varied approaches applied in different situations. Both adoption and continuation of family planning require quality service delivery that can be assessed against agreed-upon metrics.
We need to hold ourselves accountable to a standardized, routine measure of family planning quality. Most quality assurance initiatives are created for and by individual programs, forcing each new implementer to relearn the same lessons of measuring family planning quality. None of the quality measures created at global, regional, or national levels have been standardized or adopted into common use in service delivery programs. As a result, quality does not improve, family planning users continue to discontinue their choice of methods, and global family planning goals cannot be met.
We need to take action. As a result of the Bellagio meeting, the expert group concluded that we need a standardized and routinely applied measure of family planning quality. The Bellagio group agreed that an effective measure must be:
- Easy and inexpensive to use
- Facilitate comparison against national standards, and
- Be valued by stakeholders.
Together we are undertaking a study in Uganda and Pakistan to simplify the measurement of family planning quality, and to scale up consistent use and reporting across service delivery programs.
Over the last year, we have worked to bring the Bellagio background papers together into a summary of measurement issues for clinic-based family planning.
We invite you to journey with us in our endeavor to simplify measurement and provide actionable data for your programs. If you would like to learn more about this effort, please contact Dr. Nirali Chakraborty, Metrics for Management’s Director of Research & Technical Assistance.