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Attributes of a good- quality measure

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Dominic Montagu-sept14

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Attributes of a good- quality measure

  1. 1. Attributes of a ‘Good’ Quality Measure Dominic Montagu
  2. 2. Quality of services does not equal quality of care received 91 81 34 31 24 0 20 40 60 80 100 Offering 4+ methods Stocked 4+ methods Mentioned 3+ methods How to use Side effects %ofwomenvisitingforspacing (Haberland et al. 1998) (Botswana, BF, Kenya, Senegal, Zambia)
  3. 3. Overview • FP2020 • FP MWG (Bellagio Group) • What is an Indicator? • Attributes of a Measure
  4. 4. FP2020 http://www.familyplanning2020.org/ • Global Initiative started at 2012 London Summit • 69 Focus Countries • 120 Million additional FP users • PME Working Group • Tracks 18 ’Core Indicators’ • Specialized analysis
  5. 5. FP2020 18 CORE INDICATORS 1. Additional users of modern methods (#) 2. Contraceptive prevalence rate, modern methods (%) 3. Unmet need, modern methods (%) 4. Demand satisfied, modern methods (%) 5. Unintended pregnancies (#) 6. Unintended pregnancies averted (#) 7. Unsafe abortions averted (#) 8. Maternal deaths averted (#) 9. Contraceptive method mix (%) 10. Facilities stocked out (%) 11. Service delivery points with methods available (%) 12. Annual FP expenditures ($) 13. Couple-years of protection (CYPs) 14. Method Information Index (%) 15. Women provided with FP information (%) 16. Women making FP decisions (%) 17. Adolescent birth rate (#) Based on FPET Impact Model Based on survey and routine data 18. Discontinuation
  6. 6. FP MWG (Bellagio Group) Research Update • Objective: – To assess the relationship between quality and contraceptive method discontinuation among clients of FP programs in Pakistan and Uganda • Outcomes: – Facility quality at baseline, including MII – Discontinuation at 3, 6 and 12 months
  7. 7. Indicator Alignment • Structure & process indicators • Common across organizations Organization B Facility Quality Measures Organization C Facility Quality Measures Organization A Facility Quality Measures
  8. 8. Indicator Alignment • PSI and MSI (IPPF to join later) • Alignment to national FP programs Organization B Facility Quality Measures Organization C Facility Quality Measures Organization A Facility Quality Measures
  9. 9. Indicator Alignment • Existing Indicators  Test Indicators against outcomes Organization B Facility Quality Measures Organization C Facility Quality Measures Organization A Facility Quality Measures
  10. 10. Indicators • Facility quality • 6 hypothesized structure & process domains: – Readiness for choice, readiness for management support, client centered readiness, interpersonal skills, information provision, technical competence • Method Information Index (MII) – Client recall of process quality • Discontinuation • 3, 6, 12 month • For reasons other than change in pregnancy intention
  11. 11. What is an Indicator? • An indicator provides a sign or a signal that something exists or is true. It is used to show the presence or state of a situation or condition. Specific Measurable Attainable Relevant Timely • SMART
  12. 12. + EXERCISE • Start with Initial criteria on wall. • Group brainstorming to add/refine • Everyone votes with 3 sticky stars • Most important components of quality initial measure criteria: • Easy to collect and interpret • Low cost • Comparable to National context • Comparable across Countries • Validated • In (wide) use • Inter-rater reliability
  13. 13. Two last points Cost vs. Quality The chimeric ‘gold standard’ for quality measurement
  14. 14. “We’ll know it when we see it!”
  15. 15. END
  16. 16. Better information exchange improved RH outcomes in the Philippines: longitudinal study 52.8 28.4 15.7 54.9 26.5 10.8 62.9 21.5 7.8 0 10 20 30 40 50 60 70 Continuation Unintended pregancies Unwanted births Low Medium High (p=.006) (p=.001)(ns) (Jain et al. 2012)
  17. 17. Change in Method Information Index between two DHS surveys about five years apart for 25 countries 0 10 20 30 40 50 60 70 80 90 100 0 10 20 30 40 50 60 70 80 90 100 MethodInformationIndexinlaterperiod Method Information Index in earlier period Rwanda Cambodia Benin Egypt Tanzania Decreased Increased
  18. 18. Change in weighted regional average of Method Information Index during five years 44 29 34 48 34 39 0 20 40 60 80 100 SSA Other Total MethodInformationIndex Region Earlier Period Later Period
  19. 19. Lowest, median, and highest values of Method Information Index at the latest survey by region and type of method currently used 0 20 40 60 80 100 Pill IUD Injectable Sterilization Implant Sub-Saharan Africa (n=16) Lowest Median Highest Pill IUD Injectable Sterilization Implant Other (n=9) Pill IUD Injectable Sterilization Implant Total (n=25)
  20. 20. Lowest, median, and highest values of Method Information Index at the latest survey by region and household wealth quintile 0 20 40 60 80 100 Poorest Poorer Middle Richer Richest SSA (n=16) Poorest Poorer Middle Richer RichestOther (n=9) Poorest Poorer Middle Richer Richest Total (n=25)
  21. 21. Lowest, median, and highest values of Method Information Index at the latest survey by region and women's education 0 20 40 60 80 100 Noeducation Primary Secondary Higher SSA (n=16) Noeducation Primary Secondary Higher Other (n=9) Noeducation Primary Secondary Higher Total (n=25)
  22. 22. Change in values of Method Information Index between two DHS surveys about five years apart by method currently used in Rwanda, and Tanzania 0 10 20 30 40 50 60 70 80 90 100 0 10 20 30 40 50 60 70 80 90 100 MethodInformationIndexin2010-11 Method Information Index in 2005 RWANDA 0 10 20 30 40 50 60 70 80 90 100 0 10 20 30 40 50 60 70 80 90 100 MethodInformationIndexin2009-10 Method Information Index in 2004 TANZANIA

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