Existence of national/subnational or organizational policies or strategic plans that promote equitable and affordable access to high-quality family planning and reproductive health services and information
“Policies and plans” include broad reproductive health (RH) and population policies, guidelines and laws. They also include programmatic and organizational documents whose objective is to regulate the kinds of services to be delivered, to whom, and under what conditions.
Most developing countries now have some national RH policies or laws in place (although few have a stand-alone family planning (FP) or RH policy). Experience has shown, however, that macro-level policies, laws, councils, and programs do not guarantee FP/RH service availability and quality. Therefore, it is strongly recommended that any policy review include operational policies such as rules, codes, regulations, guidelines, etc.
“Promote access” refers to mechanisms that encourage provision of RH services, and increase the number of service delivery points offering services and/or types of services and methods available. “Promote quality” refers to mechanisms that encourage quality FP/RH services such as technical competence of providers and responsiveness to client needs. When evaluators measure both access and quality, they should construct separate indicators for each to maintain uni-dimensionality of each.
The policy documents should be easily available to the public with details on the publishing ministry/agency and an explanation of how the policy promotes access to quality FP and RH information and services. Supporting documentation should include the policy/plan/guideline itself, where or by whom it was issued or published, and an explanation of how the policy/plan/ guideline promotes access to or quality of FP/RH services. For example: Is support given to a full range of FP/RH dimensions, or for only a single program element? Are all populations– women, men, youth– covered? Is accountability discussed?
At times, evaluators may wish to measure progress towards supportive policies. In this case, they can construct separate indicators for each stage of development (e.g., in draft, submitted for approval, approved), or can devise an ordinal rating scale to track progress from draft to final approval.
If targeting and/or linking to inequity, evaluators will also want to see evidence that the policies focus resources or other attention on poor and/or other underserved areas or groups.
Actual policy/plan/guideline document with evidence of approval (or submission for approval). They appear in constitutional provisions; legislation; implementing rules and regulations; executive orders; ministerial level decrees, and other measures of a regulatory nature (including related regulations and enforcement mechanisms); official goals and plan programs; statements and other formally documented government directives; standards; guidelines; and decrees.
A content analysis of the documents should include level (e.g., national, provincial), topic area addressed (e.g., access, quality, FP, HIV/AIDS), and, where applicable, crosscutting issues (e.g., gender, human rights, youth).
The purpose of this indicator is to ensure that FP/RH policies exist that measure the degree of explicit support for access to and/or quality of FP/RH services on the part of government and other bodies, including service delivery institutions.
policy, access, quality
A gender perspective on plans and policies examines their content and their implementation strategies.
- Are the contents and language of the plans in line with major international agreements, such as ICPD, that focus on sexual and reproductive rights, not on demographic targets?
- Is the language gender sensitive (e.g., using “women” and “men” rather than “couple,” which is gender insensitive; couples may or may not have common FP/RH goals or the barriers a “couple” faces may depend on whether the male member or the female member of the couple is seeking care)?
- Do the implementation strategies explicitly account for gender-specific ways for women and men to access the care they need?
- Do the strategies exclude all elements of coercion or any such elements that act to disempower individual men or women (e.g., policies that give husbands control over the RH of women)?
Does the policy/strategy address the society’s gender norms that may be harmful or inequitable (e.g., allowing life-saving blood transfusions for women suffering from post-partum hemorrhage without requiring the husband or woman’s father’s consent; allowing women the autonomy to obtain an FP method)?
Quality of Care in Sexual and Reproductive Health Services