National Composite Index on Family Planning (NCIFP)

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1 1 Avenir Health Year Avg. Total M M M National Composite Index on Family Planning (NCIFP)

2 Outline Developing the NCIFP Final results for 2014 Country example Next steps Q&A

3 Developing the NCIFP

4 History of the NCIFP FP2020 developed set of Core Indicators Some areas not well covered by existing data sources Recommended to develop new composite index to cover strategy, data use, quality, equity and accountability. a comprehensive measurement tool to monitor the enabling environment in a manner that takes into account not merely the existence of policies and guidelines but also the extent to which family planning program implementation includes measurable dimensions of quality service provision.

5 Process Initial questionnaire 69 individual questions Fielded to 90 countries, with FPE Initial total scores calculated Revisions made (next slide) Final NCIFP agreed Results calculated for 86 countries* FP2020 s Performance Monitoring & Evidence (PME) and Rights & Empowerment (RE) Working Groups provided oversight and technical guidance throughout process *Cambodia, Dominican Republic, Lebanon, and Russia were excluded from the NCIFP because their data was received after completion of the analysis- only 86 countries included.

6 Revising the NCIFP (1) Strong correlation between questions Very high levels of correlation indicate potential redundancy Asking mostly yes/no questions Score = % of respondents who said yes. In some cases, clear yes/no answer (e.g. does the policy exist), but, in many cases not clear-cut response. Asking about multiple concepts in one question For example: Are there structures in place to address quality of public sector FP services, particularly trainings for providers on rights of clients to full, free, and informed choice (voluntarism, non-discrimination policies, third-party authorization, etc.)? Too many questions Each question has minimal influence on overall score, and, makes it difficult to replicate.

7 Revising the NCIFP (2) What we did: Removed questions with high correlation to other questions Removed questions that did not capture the intended topic Replaced yes/no questions with similar questions from FPE asked on a 1-10 scale Collapsed questions into single individual score Where we ended up: 35 individual scores across 5 domains (strategy, data, quality, equity, accountability) Includes 18 questions from original NCIFP, and 3 composite scores based on NCIFP questions (related to sub-groups) Includes 12 individual questions from FPE, and 2 composite scores from FPE (ready access to LAPMs, and ready access to STMs)

8 Questions by domain: Strategy (6) Does the National Family Planning Action plan include defined objectives over a 5 to 10 year period, including quantitative targets? Does the National Family Planning Action plan include objectives to reach the poorest and most vulnerable groups with quality FP information and services Does the National Family Planning Action plan include projection of the resources (material, human and financial) required to implement the strategy, as well as sets forth a plan to secure the resources? Does the National Family Planning Action plan include a mechanism and funding to support meaningful participation of diverse stakeholders? High level of seniority of the director of the national family planning program and whether director reports to a high level of government (*FPE) Extent to which import laws and legal regulations facilitate the importation of contraceptive supplies or extent to which contraceptives are manufactured locally (*FPE) 8

9 Questions by domain: Data (7) Does the government collect data to monitor special sub-groups? Average of: youth, unmarried women, unmarried youth, postpartum women, wealth status, post-abortion clients, HIV status Does the government collect data from the private sector on commodities? Is there a system of quality control for service statistics? Are data used to\ ensure that the poorest and most vulnerable women and girls have access to quality FP services? Extent to which systems for client recordkeeping, clinic reporting and feedback of results are adequate (*FPE) Extent to which program statistics, national surveys, and small studies are used by specialized staff to report on program operations and measure progress (*FPE) Extent to which program managers use research and evaluation findings to improve the program in ways suggested by findings (*FPE) 9

10 Questions by domain: Quality (12) Are FP SOP in line with WHO and used for determining areas of need for quality improvement? Are there guidelines on task sharing of family planning services? Are indicators for quality of care collected and used for public sector family planning services? Are indicators for quality of care collected and used for private sector family planning services? Are there structures in place to address quality, including participatory monitoring or community/facility quality improvement activities? Does government collect information related to informed choice and provider bias? Extent to which training programs, for each category of staff in the family planning program, are adequate to provide personnel with information and skills necessary to carry out their jobs effectively Extent to which the logistics and transport systems are sufficient to keep stocks of contraceptive supplies and related equipment available at all service points, at all times and at all levels (central, provincial, local) (*FPE) Extent to which the system of supervision at all levels is adequate (regular monitoring visits with corrective or supportive action) (*FPE) Extent to which clients adopting sterilization are routinely informed that it is permanent? (*FPE) Extent to which the entire population has ready and easy access to IUD removal (*FPE) Extent to which the entire population has ready and easy access to implant removal (*FPE) 10

11 Questions by domain: Equity (5) Are there policies in place to prevent discrimination towards special sub-groups? To what extent do service providers discriminate against special sub-groups? Extent to which areas of country not easily serviced by clinics or other service points are covered by CBD programs for distribution of contraceptives (especially rural areas) (*FPE) Extent to which the entire population has ready access to LAPMs Extent to which the entire population has ready access to STMs 11

12 Questions by domain: Accountability (5) Are there mechanisms in place at the national, subnational, and facility level to monitor whether or not access to voluntary, non-discriminatory FP information and services is being achieved? Does the government have mechanisms in place for reporting instances of denial of services on non-medical grounds (age, marital status, ability to pay), or coercion (including inappropriate use of incentives to clients or providers)? Are violations reviewed on a regular basis? Are there mechanisms in place at the facility level to solicit and use feedback from clients? Is there a system in place that encourages dialogue and communication between users and service providers/health officials about service availability, accessibility, acceptability and quality? 12

13 2014 results

14 Global results NCIFP Global: weighted and unweighted* Strategy Data Quality Equity Accountability Total Unweighted Weighted *weighted by women of reproductive age (WRA)

15 Regional results NCIFP by Region and Dimension (weighted) Strategy Data Quality Equity Accountability Total SSAF-F SSAF-A Asia Asia_ex India and China LAC MENA EECA Large regional differences, Sub-Saharan Africa scores highest.

16 Timor-Leste Papua New Guinea Myanmar Afghanistan Pakistan Indonesia Bangladesh Nepal India Philippines China Vietnam Sri Lanka Malaysia Mongolia Thailand Guatemala Panama Paraguay Costa Rica Ecuador Peru Trinidad & Tobago Mexico El Salvador Bolivia Honduras Haiti Nicaragua Jamaica Libya Turkey Yemen Iraq Algeria Egypt Iran Jordan Oman Morocco Tunisia South Sudan Lesotho Eritrea Nigeria The Gambia Cameroon Zambia Namibia Liberia Tanzania Kenya Ethiopia Malawi Uganda Zimbabwe South Africa Swaziland Mauritius Ghana Mauritania DRC Congo Chad Madagascar Cote d'ivoire Burundi Guinea Bissau Mozambique Niger Mali Benin Togo Senegal Rwanda Romania Azerbaijan Armenia Moldova Ukraine Kazakhstan Georgia Uzbekistan Kyrgyzstan Tajikistan Turkmenistan Country variation Asia LAC MENA SSA-A SSA-F EECA Large variation across countries within each region

17 Regional results by individual score Despite regional differences, general pattern across scores fairly consistent (e.g. same highs and lows). Similar pattern seen when look country by country.

18 Regional variation explored Largest gap: Quality dimension: Are there structures in place to address quality, including participatory monitoring or community/facility quality improvement activities? LAC scored the lowest at 25.1, compared to SSA-F, the highest at 73.9; creating a 48.8 point gap between the highest and lowest scores. Smallest gap: Quality dimension: Extent to which training programs, for each category of staff in the family planning program, are adequate to provide personnel with information and skills necessary to carry out their jobs effectively". LAC scored lowest at 49.7, compared to MENA, the highest at 61.9, a 12.2 gap between highest and lowest scores. 18

19 Country variation explored Ratio of average deviation across countries/mean: Average variation around the mean adjusted since less variation around a low mean. Highlights questions with lowest and highest variation across countries driving factors in differences in scores. 5 questions with highest variation relative to the mean: 1. Data: Does the government collect data from the private sector on commodities? 2. Quality: Are indicators for quality of care collected and used for private sector family planning services? 3. Quality: Does government collect information related to informed choice and provider bias? 4. Accountability: Does the government have mechanisms in place for reporting instances of denial of services on non-medical grounds (age, marital status, ability to pay), or coercion (including inappropriate use of incentives to clients or providers)? 5. Accountability: Are violations reviewed on a regular basis? 19

20 How does NCIFP track with mcpr? Positive (but weak) relationship between NCIFP and mcpr (latest survey). SSA shows similar slope, but, lower line suggesting similar relationship, but, with lower mcpr achievement. 20

21 Ratio of lowest to highest quintile mcpr How does NCIFP track with equity? Equity Score (NCIFP) v ratio of mcpr in lowest and highest quintiles y = x R² = Similar pattern to mcpr with non-ssa sitting above SSA y = x R² = Higher score on NCIFP equity dimension associated with more even mcpr between highest and lowest quintiles NCIFP Equity Score SSA Non-SSA Linear (SSA) Linear (SSA) Linear (Non-SSA) 21

22 Country example

23 Using the NCIFP in country: Nigeria example (1) Compare country to region, or, other similar countries Benchmark performance, highlight areas for further investigation Comparison of Nigeria and regional average (weighted) Starting point for discussions with policy makers and other Nigeria SSAF-A_weighted 23

24 Using the NCIFP in country: Nigeria example (2) Extent to which program managers use research and evaluation findings to improve the program in ways suggested by findings Extent to which program statistics, national surveys, and small studies are used by specialized staff to report on program Extent to which systems for client recordkeeping, clinic reporting and feedback of results are adequate Are data used to\ ensure that the poorest and most vulnerable women and girls have access to quality FP services? Is there a system of quality control for service statistics? Does the government collect data from the private sector on commodities? Does the government collect data to monitor special sub-groups?* SSAF_A (weighted) Nigeria 24

25 Next steps

26 Next steps with 2014 results Developing a country discussion guide For example: your country scored 50 on Does the National Family Planning Action plan include defined objectives over a 5 to 10 year period, including quantitative targets? meaning half of those interviewed said yes, and half said no. Does your plan have these objectives? If yes dissemination issue, to ensure stakeholders are aware If no discuss action steps to develop objectives Developing an interactive data tool allows for comparisons between countries and regions Further dissemination of NCIFP results use for advocacy at country and global level Continue to develop other measures to capture these dimensionstriangulate with NCIFP to get full picture 26

27 Conclusions Innovative new measurement, building on success of FPE Covers important under-measured concepts- such as quality, equity, accountability Further refinements can be made for future rounds- e.g. using a 1-10 scale instead of yes/no for questions with no clear single answer Overtime, will develop a time series and be able to understand how changes in NCIFP related to changes in contraceptive use 27

28 Finding out more Download the full report: ces/allresources/track20_materials Or lications.php More materials coming soon. 28

29 Thank You 29

30 30

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