1. ICFP panel: Quality Metrics for Family Planning – the “Secret Sauce”?
Benchmarking FP quality: A standardized measure of facility-level family planning readiness
Ben Bellows
ICFP panel: Quality Metrics for Family Planning – the “Secret Sauce”?
26 January 2016

2. Background
Metrics Working Group (MWG) helps social franchises to report performance beyond utilization numbers
Health impact (DALYs)
Cost-effectiveness
Additionality (formerly “health market expansion” and “new users”)
Sustainability (TBD)
Equity (DHS wealth quintiles)
Quality

3. Differing priorities, differing attributes
Program Managers:
Easy to collect (fast, inexpensive)
Easy to interpret by managers and field staff
Agency Headquarters:
Standardized
Comparable across countries
Easy to explain
Other Stakeholders:
Comparable to global or national standards
Rigorous
Objective: To create an index of quality that differentiates high and low performing facilities while remaining meaningful in the national context of FP quality.

4. Assessing quality of care: Donabedian framework
Structure
Process
Outcome
Facility characteristics
- Services available
- General infrastructure
- Availability of supplies, drugs, equipment, guidelines
- Basic and comprehensive care
Staff characteristics
- Skill mix
- Training
Clinical care
- Knowledge and skills
- Examinations performed
- Services provided
- Explanations given
Interpersonal relations
- Waiting time
Privacy, & confidentiality,
Staff friendliness,
Communication
Dignity
Health status
- Functional status
- Symptom relief
User evaluation
- Satisfaction
- Awareness
Quality of family planning services assessed using Donabedian’s multi dimensional framework: structure; process and outcome

5. 35 structure/ readiness questions

6. Methods Test internal consistency of 35 questions (Cronbach’s alpha)
Use principal components analysis (PCA) to generate distribution of scores from national SPA facilities
Use PCA factor weights from national SPA facilities to generate distribution of scores from local Bungoma facilities
Compare scores between local Bungoma and national SPA facilities

7. Kenya SPA 2010 facility scoring on FP readiness (n=576)
SPA quintile
Nat’l referral hospital
Prov. referral hospital
Dist hosp.
Sub-dist. Hosp.
Other hosp.
Health center
Clinic
Disp.
Maternity
Stand alone VCT
Total Q1 1 24 18 31 40 6
122 Q2 8 11 5 14 12 55 4
110 Q3 13 20 15 21
114 Q4 19 25 Q5 35 10
116 2 7 71 63 85 91 76
133 44
576
0-24%
25-49%
50-74%
75-100%

8. Bungoma public facilities scoring on FP readiness (n=43)
SPA quintile
Nat’l referral hospital
Prov. referral hospital
Dist hosp.
Sub-dist. Hosp.
Other hosp.
Health center
Clinic
Disp.
Maternity
Stand alone VCT
Total Q1 1 Q2 Q3 5 17 22 Q4 11 Q5 2 30 43
0-24%
25-49%
50-74%
75-100%

9. Limitations
Lack of “must have” quality indicators. This strategy is orthogonal to normative questions of content.
E.g. Are affirmative answers to all 35 questions required to be considered a functional “FP-ready” facility?
The index is limited by what’s available in SPA survey
Further reflection warranted on time difference between national SPA survey (2010) and Bungoma facility assessment (2014)

10. Going forward
Repeat this approach with other facility surveys & SPA datasets
Development of quality process index

11. Thank you
Comments, feedback to
Ben Bellows