Number of policy changes that have been implemented to enhance the policy environment for private sector family planning service expansion
The number of national or regional policy changes (such as creation of incentives and identification and removal of barriers) implemented to improve conditions for expansion of private sector (PS) involvement in delivery of family planning (FP) products and services during the past year (or specified time period).
Common policy incentives to increase PS services can include exemptions from contraceptive import tariffs, the issuance of vouchers for specific FP services (e.g., IUD insertions and sterilization), and tax credits for employers who underwrite costs for workers’ health services. Policy-related barriers can include undue licensing requirements and client eligibility criteria (e.g., marital status or minimum age), planning meetings restricted to the public sector, advertising and promotion regulations, and import policies. In order to measure change over time, only barriers that were identified prior to policy and project interventions should be counted (Abt, 2005).
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).
This indicator is calculated as:
Total number of documented changes in policy designed to expand PS provision of FP services that have been implemented in a country or designated area during the past year (or specified time period).
This indicator is a composite for FP of two indicators for Promoting an environment supportive of the private health sector in the updated Strengthening Health Outcomes though the Private Sector (SHOPS) Project Performance Monitoring Plan (Abt, 2011). The SHOPS project recommends measuring policy incentives and barriers separately. For further details on this and related indicators from the SHOPS project, see Abt (2011); Abt (2009); Abt (2005); and Reproductive Health Supplies Coalition (2009).
Reviews of policy documents and project records, recorded agreements among the ministry of health (MOH), donor agencies, and public and private sector providers, in addition to reviews of legal and regulatory documents and agreements related to provision of FP services. The reviews should include evidence that the policy changes have been implemented, such as approved legislation, evidence of operational voucher or tax credit systems, budgets and expenditure reports, MOH communications on incentives and new policies, follow-up project reports on PS agreements and activities. The policy changes can be disaggregated by whether they are targeted at providing incentives or at removing barriers to PS involvement
Policy documents; project records; written agreements; legal or regulatory reviews
This indicator measures government commitment to developing a policy environment favorable to PS involvement in providing FP services. Supportive policies for involving the PS can increase access to and sustainability of FP services, often for underserved populations, in addition to relieving some of the constraints challenging the public sector (e.g., overburdened staff and weak distribution channels). 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. Laws, regulations, and policies impact the feasibility and costs of doing business and directly affect the provision of FP services in the private sector (Armand et al., 2007). The public sector is faced with the challenge of how to balance regulations, policies, and quality control, while simultaneously fostering conditions that encourage private sector provision of FP services and products. This indicator can provide baseline information and track trends in government policy support for PS involvement in FP services, which constitutes a vital partnership for achieving the Millennium Development Goals to #4 reduce child mortality and #5 improve maternal health, as well as contributing to #8 a global partnership for development.
The enumeration of this indicator, particularly evidence that policies have been implemented, may require extensive reviews of government and public/private records, reports, and agreements. Also, even when a policy change has been officially implemented, how the policy is interpreted or operationalized may vary considerably. For instance, when a policy-related barrier, such as instituting a minimum age for the provision of an FP method, is legally removed, there may still be significant provider bias (and/or lack of awareness of the new policy) and therefore no actual change in practice.
Because policy change is a long-term process, realistically, the change may not happen within a 5-year project, for example. Evaluators are encouraged to use benchmarks or process indicators that track progress toward this outcome indicator.
access, policy, 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.
Reproductive Health Supplies Coalition, 2009, Reproductive Health Supplies Coalition: Monitoring and Evaluation Framework (2007-2015), Brussels: RHSC.