Despite efforts to use facility surveys to measure the quality of family planning programs, routine, reliable measurement and monitoring of national-level quality has not been possible.
A new composite index to measure national-level quality, the National Quality Composite Index (NQCI), is proposed and used to compare program quality in 30 developing countries. Index scores represent the unweighted average of scores from indicators of three different dimensions of quality—structure, process and outcome. The structural indicator, the Method Availability Index, used data from the 2014 Family Planning Effort survey, while the process indicator (the Method Information Index) and outcome indicator (the Method Success Index) used data from the most recent Demographic Health Surveys conducted in the included countries. Correlations between these and other indicators were examined.
The unweighted average NQCI score for the 30 countries was 60; scores ranged from 50 in Pakistan to 72 in Cambodia. The average scores for the three NQCI components were 52 for Method Availability (range, 40–73), 41 for Method Information (range, 13–71) and 86 for Method Success (range, 70–99). Scores for these components were not correlated with each other, suggesting that they measure distinct dimensions of program quality. Overall NQCI scores were correlated with existing measures of national-level quality, but not with total fertility rate and modern contraceptive prevalence rate.
The NQCI and its three components use data routinely collected through national surveys, and can be used to measure and monitor national-level quality of family planning programs.
Anrudh K. Jain, currently an independent researcher, was distinguished scholar, Population Council, New York, at the time this research was conducted.
This study was conducted as part of the Measuring and Monitoring Quality of Care project funded by a grant to the Population Council from The David and Lucile Packard Foundation. The author gratefully acknowledges the contribution of Bill Winfrey in providing tables used to create the Success Index, and the useful comments he received on an earlier draft of this article from many colleagues, including Saumya RamaRao and John Townsend.