A New Composite Index to Measure National-Level Quality of Family Planning Programs

Area of Science:

• Public Health
• Reproductive Health
• Health Services Research

Background:

• Measuring national-level quality of family planning programs has been challenging.
• Existing methods using facility surveys lack routine reliability for monitoring.
• There is a need for a standardized, national-level quality assessment tool.

Purpose of the Study:

• To propose and validate a new composite index for measuring national-level family planning program quality.
• To compare program quality across 30 developing countries using the proposed index.
• To assess the distinct dimensions of quality captured by the index components.

Main Methods:

• Developed the National Quality Composite Index (NQCI) as an unweighted average of three quality dimensions: structure, process, and outcome.
• Utilized data from the 2014 Family Planning Effort survey for the structural indicator (Method Availability Index).
• Employed recent Demographic Health Surveys for process (Method Information Index) and outcome (Method Success Index) indicators.

Main Results:

• The average NQCI score across 30 countries was 60, with scores ranging from 50 (Pakistan) to 72 (Cambodia).
• Component scores varied significantly: Method Availability (average 52), Method Information (average 41), and Method Success (average 86).
• Component scores were not correlated, indicating they measure distinct quality dimensions; NQCI correlated with existing quality measures but not fertility or contraceptive prevalence rates.

Conclusions:

• The National Quality Composite Index (NQCI) and its components can effectively measure and monitor national-level family planning program quality.
• The index utilizes routinely collected data from national surveys, enhancing feasibility and reliability.
• The NQCI provides a valuable tool for understanding and improving family planning services globally.