Number and percent of private sector outlets that provide a specific family planning service meeting national and/or international quality standards
The number or percent of private sector (PS) outlets or service delivery points that provide a specific family planning (FP) service that meets national and/or international quality standards in a country or designated area, during a specified time period.
The private sector is defined as all the providers, suppliers, and ancillary and support services that lie outside the public sector. These include commercial or for-profit entities, franchises, multinational corporations, non-profit organizations, community groups, informal vendors, and private providers, such as doctors, pharmacies, and hospital staff (Armand et al., 2007).
Quality standards should be based on international guidelines, although these may be adapted on a national basis. FP services should be available to men as well as women and to adolescents (with referral as required), and can include providing clients with essential information during counseling, eliciting client history, conducting physical examination and monitoring, and providing FP method, follow-up and treatment according to standard protocols (WHO/UNFPA, 2008; Abt, 2005). The basic package of FP methods available should include modern methods (e.g., hormonal contraceptives, IUDs), condoms, and counseling and/or referrals on fertility awareness methods, postpartum FP, and the lactational amenorrhea method, in addition to referrals for methods requiring higher levels of care, such as implants and sterilization.
This indicator is calculated as:
(Number of PS outlets that provide a specific FP service meeting national and/or international quality standards / Total number of PS outlets in designated area during the past year or specified time period) x100.
This is one of the core indicators for Improved quality of care in private sector facilities in the expanded Strengthening Health Outcomes though the Private Sector (SHOPS) Project (Abt, 2009). The indicator can also be calculated as a subset for PS provision of FP from the Quality of Care indicator in this database – Percent of facilities where clients receive the service that meets the expected standards. For more details on this and related indicators, see Abt (2009) Abt (2011); Abt (2005); and Reproductive Health Supplies Coalition (2009).
Data can be used from PS facility and outlet records, health information systems (HIS), direct observation, exit interviews, and specialized surveys, such as Health Facility Assessments (HFA) and the Service Provision Assessment Survey (SPA). For an overview of various HFA instruments, see MEASURE Evaluation/USAID/WHO (2008), and for SPA, see MEASURE DHS (2011). The data can be disaggregated by the type of PS facility or program (commercial for-profit, non-profit organization, franchise, community groups, etc.), by the specific types of FP methods and services available, and by other relevant factors such as districts, urban/rural location, and target populations.
Facility records; HIS; specialized surveys, such as HFA and SPA; direct observation; exit interviews
This indicator measures access to quality FP products and services in the PS and the extent to which PS providers adhere to recommended standards for delivery of these services. The PS can help increase clients’ access to services and products by a number of means from having convenient hours and locations, maintaining supplies when public sector providers experience stock outs, using generic products to reduce prices, to utilizing alternative approaches, such as mobile units to reach underserved areas. Given the importance of the private sector in providing FP services, effective approaches for monitoring and evaluation of the quality of care are essential. This indicator can be used for policy and planning purposes to track strengthening and scale-up of effective PS services, in addition to identifying gaps and problems in PS service delivery. Strengthening PS involvement in providing quality FP services is considered essential to achieving the Millennium Development Goals to #4 reduce child mortality and #5 improve maternal health.
While this indicator measures whether provision of FP services follow accepted standards, it does not evaluate the accuracy with which providers evaluate clients’ needs and the appropriateness of subsequent actions. Obtaining a full inventory of and information on all PS FP providers can be problematic in settings where PS providers are not required to register with or report to government agencies, such as the ministry of health. Given the detailed information needed to accurately measure this indicator, it may be advisable to assess it for smaller districts or sample areas, rather than for larger regions. Data from third-party observations of client-provider interactions are subjective, and time delays between when the clients actually received services and follow-up interviews can lead to recall bias.
family planning, quality, private sector
Abt Associates, 2005, Performance Monitoring Indicators for the Private Sector Program (PSP), with Explanatory Notes. Bethesda, MD: Abt Associates, Inc. https://www.shopsplusproject.org/sites/default/files/resources/1081_file_PSP_Perfomance_Monitoring_Indicators_April_1_2005.pdf
Abt Associates, 2009, Strengthening Health Outcomes through the Private Sector (SHOPS) Project: Performance Monitoring Plan (PMP), Year 1. Bethesda: MD: ABT Asociates, Inc.
Abt Associates, 2011, Updated SHOPS Performance Monitoring Plan (PMP), Bethesda: MD: ABT Asociates, Inc.
Armand F., O’Hanlon B., McEuen M., Kolyada L., and Levin L. March 2007. Private Sector Contribution to Family Planning and Contraceptive Security in the Europe and Eurasia Region. Bethesda, MD: Private Sector Partnerships-One project, Abt Associates Inc.
MEASURE DHS. 2011, Service Provision Assessments (SPA) Survey Overview, DHS Website http://www.measuredhs.com/What-We-Do/Survey-Types/SPA.cfm
MEASURE Evaluation/USAID/WHO, 2008, Profiles of Health Facility Assessment Methods: Report of the International Health Facility Assessment Network (IHFAN), Chapel Hill, NC: MEASURE Evaluation. https://www.measureevaluation.org/resources/publications/tr-06-36
Reproductive Health Supplies Coalition, 2009, Reproductive Health Supplies Coalition: Monitoring and Evaluation Framework (2007-2015), Brussels: RHSC.
WHO/UNFPA, 2008, National-level monitoring of the achievement of universal access to reproductive health: conceptual and practical considerations and related indicators, Geneva: WHO. http://whqlibdoc.who.int/publications/2008/9789241596831_eng.pdf