Evidence that policy barriers to equitable and affordable FP services and information have been identified and/or removed
Evidence that policy barriers to access family planning (FP) services and information have been identified and/or removed. This indicator is related to the indicator, Existence of national or subnational policies or guidelines that promote access to FP services and information. Whereas the previous indicator includes the broad rubric of policies, laws, and program documents, this indicator focuses on modifying or removing existing policies which create obstacles to FP services and information.
This is especially pertinent to legal and regulatory reform. Policies can intentionally or unintentionally create barriers to access, in turn affecting service providers, potential clients, and ultimately families and communities. They may affect both the public and private sectors (such as restrictions on particular contraceptive methods or eligibility requirements for services) or may affect primarily the private sector. Kenney (1993) distinguishes five categories of regulatory barriers:
- Regulations that constrain contraceptive options;
- Tax and import policies;
- Advertising and promotion regulations;
- Other regulations affecting the commercial sector; and
- Regulations affecting non-profit organizations.
Added to these are restrictions on access to training and exclusions from policy formulation meetings and other arenas in which policies are made. Cross et al. (2001) identifies additional categories of operational policy barriers, including organizational structures, regulations regarding personnel, vital statistics and health information, and procurement.
Old and updated policy documents, showing evidence of restrictions in the old policy that do not appear in the new policy.
This indicator can be quantified in several ways. As a baseline measure, it may be expressed as the number and type of policy barriers that significantly hinder FP service delivery. To measure change over time in a country application, the evaluator should count and qualify the policy barriers identified at baseline, which were subsequently removed. Evaluators can measure change through naming and counting those identified policy barriers that do not appear in the new policy. Evaluators should link clearly the barriers identified at baseline, the policy interventions carried out, and the barriers identified at follow-up.
Because policy barriers by their nature tend to be very specific, evaluators can readily assess whether the new policy removes them. For example, if the barrier removed is import duties on contraceptives, evaluators can interview commercial distributors to determine if they no longer pay duties.
Policy, document, legal and regulatory reviews – Policy documents with evidence of government approval, or submissions for approval. Key informant interviews.
The purpose of this indicator is to measure the extent to which national governments expand participation in developing policy and in providing FP services; facilitate increased access to FP services for all sectors of the population; and address potential policy roadblocks to effective and efficient delivery of FP services and information. Removing client eligibility requirements– such as marital status, minimum age, or parity for receiving FP methods — empowers women and youth to demand the services and products they want. Private sector participation in policy development may ensure that FP programs address the needs of all different groups in a population. The private sector can also be an important provider of services, especially in countries where government programs are either overburdened by demand or are unable to reach certain population groups.
Although a policy barrier may have legally been removed, the change may not be effectively practiced. For example, if a barrier constraining contraceptive options is eliminated– such as requiring parental consent to provide services to unmarried youth under age 18 — in addition to conducting a legal and regulatory review, evaluators should also interview providers to assess their awareness of the barrier removal as well as interview youth to assess their ability to obtain services.
Also, because changing laws or policies is typically a lengthy process, evaluators may not have evidence of actual modifications or removal of policy barriers within a project time frame of five years, for example. Therefore, evaluators may wish to break the indicator into two parts, such that “Evidence that policy barriers to access to FP services and information have been identified”, is a separate indicator in order to capture the process of change.
access, family planning, policy
Kenney, G.M. 1993. “Assessing Legal and Regulatory Reform in Family Planning.” OPTIONS for Population Policy. Policy Paper Series No. 1. Washington, DC.: The Futures Group International.
Cross, H., K. Hardee and N. Jewell. 2001. “Reforming Operational Policies: A Pathway to Improving Reproductive Health Programs.” POLICY Project. Policy Occasional Papers No. 7. Washington, DC.: The Futures Group International.