QUALITY METRICS
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FAMILY PLANNING ABORTION SERVICES MATERNAL HEALTH
Quality is measured in multiple ways around the globe, but common, standardized metrics are still missing.
For this reason, Metrics for Management has set out to build tools that measure quality in the Family Planning, Abortion Service & Maternal Health areas.
METRIC: FAMILY PLANNING QUALITY
In light of the FP2020 global initiative and the inclusion of family planning in both the millennium and sustainable development goals,family planning services in low- and middle-income countries are receiving increasing attention. While health programs seek to provide quality services to users, maintaining that quality often requires a significant investment of time, personnel, and resources. This conflict both highlights the current lack of a common measure of family planning quality and creates a prime opportunity to establish one.Measuring quality will help programs know to what extent their investments are yielding results, and how it can inform prioritization of future efforts.Therefore, Metrics for Management,is working to develop a common measure of clinical family planning quality.
To support the use of a three-question index to measure the quality of family planning counseling.
In the fall of 2015, Metrics for Management convened 19 experts across a variety of disciplines – family planning service providers, global policy leaders, academics, researchers, and donor agencies – to define what the necessary steps are to develop a standardized measure of family planning quality.
Metrics for Management, with collaboration from Marie Stopes International and Population Services International, is leading research to identify quality measures most highly correlated with important family planning outcomes such as discontinuation. The next phase of the research will include the development and testing of an easy-to-use quality measurement tool.
Check out the book on Quality Measurement in Family Planning: Past, Present, Future that resulted from the Bellagio Conference on Quality in Family Planning, held in October 2015. Read about the BellagioCenter Conference on Quality in Family Planning, held in October 2015. Read the briefing paper on quality.
If you would like to learn more about our family planning quality research activities, please contact our Director of Research and Technical Assistance.
METRIC: ABORTION CARE QUALITY TOOL
Millions of women worldwide need access to safe, high-quality abortion care. Recent estimates indicate that more than 56 million abortions are performed per year, with nearly 88% occurring in developing countries. Despite progress in the provision of safe abortion, significant disparities remain in access to and quality of abortion services around the world. Currently, no consistent, valid, and reliable method exists to measure quality in abortion care, learn from the results, and/or use that information to improve quality of care.
There is a critical need for a common suite of measures to evaluate the quality of abortion care in low- and middle-income countries. These measures must also go beyond the safety of the immediate procedure to assess client’s actual needs and values for their abortion care. Standardized measurement of abortion care quality, that includes client perspectives, contributes to improved health outcomes.
The ACQTool is a short set of indicators developed by an international panel of experts, through extensive research and usability testing, to provide an accurate assessment of the quality of abortion service an individual has received during and after their abortion experience. The tool is designed for both in-facility and out-of-facility use, such as pharmacies or hotlines.
Develop a set of standardized, actionable, simple, timely, and valid metrics to measure and improve the quality of abortion service provision using a human rights and client-centered lens.
The 4-year Abortion Service Quality Initiative developed, tested, and validated a simple, effective metric to assess the quality of abortion service provision. The work of this initiative has defined the evidence-based, standardized indicators that make up the ACQTool.
Read the “Advancing measurement of abortion quality” meeting report.
Read the "A practical global standard for measuring abortion care quality to learn more about how the metric was developed" brief.
Read the “Abortion metrics matter” brief.
Read the “Measuring abortion services” brief.
Read the Introducing the ACQTool brief.
Read the ACQTool Indicator Dashboard brief.
Read the Abortion Service Quality Initiative to learn more about how the metric was developed.
Read our article Understanding the Abortion Experiences of Young People to Inform Quality Care in Argentina, Bangladesh, Ethiopia and Nigeria.
Read our article Definitions, measurement and indicator selection for quality of care in abortion.
Read our article Quality of care and abortion: beyond safety.
Read our article Toward a standard measure of abortion service quality-a stakeholder first approach.
Read our article “I just have to hope that this abortion should go well”: perceptions, fears, and experiences of abortion clients in nigeria.
Read our article Perspectives on high‑quality interpersonal care among people obtaining abortions in argentina
METRIC: MATERNAL HEALTH QUALITY
High quality maternal health care delivery is critical to the health and survival of pregnant women and newborns, yet there is limited agreement on the definition of quality in maternal healthcare or how to measure it. We see significant variations of quality of maternal health care across facilities. Better data and better methods to measure quality are needed in order to develop and implement effective solutions.
The World Health Organization has identified nearly 400 indicators to measure the quality of maternal health services. Metrics for Management seeks to reduce that number to create an easy-to-use metric that is applicable in LMIC settings.
Create a measure of maternal health quality that combines strong evidence with real-life utility to improve patient health outcomes.
Metrics for Management is reviewing existing indicators of maternal health in a process to reduce the total number of indicators. This reduction process will help us understand which indicators have the largest impact on maternal morbidity and mortality. We will then assess the real-life utility of these indicators as we work to develop a metric that is useful to facility management.
METRIC: PERSON CENTERED MATERNITY CARE
The concept of Person Centered Maternity Care (PCMC) focuses on the patient experience as an integral part of high quality maternity care. Studies have shown a strong relationship between the patient experience and technical quality, as well as in improving the demand for maternity care services (antenatal, delivery and postpartum care). It affirms that maternity care should be free of abuse, and then extends the concept to also emphasize the patient’s experience with regard to communication, respect, dignity, and emotional support.
There is a growing emphasis on the patient experienceas a key component of quality maternity care, yet there are limited ways to measure or assess this experience. With a growing number of global initiatives focused on continuing to reduce preventable maternal and neonatal deaths, there is a need for a standard, validated measure of patient experience that is both culturally relevant and broadly applicable. Such a measure would complement and be implemented in conjunction with assessments of technical quality of maternity care. In response to this need, Metrics for Management is developinga simple-to-use scale of person-centered maternity care that is valid in multiple developing country contexts.
Create a scale for Person Centered Maternity Care that is easy to use and valid in multiple low- and middle-income country contexts.
Using data collected by researchers at the University of California, San Francisco (UCSF), and expert opinion on the most important components of person centered maternity care, Metrics for Management shortened a previously published 30-item PCMC scale. UCSF researchers developed the original scale in Kenya, and applied it in Ghana and India. We simplified the scale using expert opinion alongside robust mathematical techniques to identify those scale items that are most important to capturing person-centeredness in maternity care. Next steps include additional validation of our short scale in other countries, and with diverse patient populations.
Download the 13-item scale.
Read our article in the International Journal of Gynecology and Obstetrics that uses data from three countries to devleop the scale.
Read the “Person-Centered Maternity Care” brief.
METRIC: METHOD INFORMATION INDEX
The quality of family planning counseling is important to support women to use, and continue using, contraception, when desired. Providing women with a choice of contraceptive methods and with high-quality counseling are critical elements of rights-based family planning.
Therefore, providers, managers and donors of family planning services need to understand if a client is receiving appropriate and complete counseling during her visit.
To support the use of a three-question index to measure the quality of family planning counseling.
The Method Information Index (MII) is a widely available measure of contraceptive counseling quality but little was known about its association with rates of method continuation. Using data from a prospective cohort study in Pakistan and Uganda, Metrics for Management and partners investigated the relationship between the 3-question MII and method continuation. We found that higher scores on the MII were associated with continued use of family planning, the first study of its kind to validate the MII.
Read our study in Global Health Science and Practice examining the relationship between the MII and method continuation, our article measuring contraceptive counseling quality, and our analysis of the MII in Studies in Family Planning.
Download the MII guide.
Read the “Method Information Index” brief.
METRIC: Measuring Youth Sexual and Reproductive Health (MY SRH)
Despite global commitments, meeting the sexual and reproductive health (SRH) needs of young individuals still falls short. Our research with youth leaders reveals two primary challenges: inadequate privacy and confidentiality practices at service points and provider bias. Accessible and user-centered measurement approaches are crucial to advancing youth-friendly SRH quality and coverage; however, there is no measure that allows for rapid assessment of the combined concepts of privacy, confidentiality, and provider bias.
Therefore, Metrics for Management is working to develop a simple and easy method to measure youth SRH service quality and friendliness.
Create a robust, evidence-based measurement tool for health program managers to easily and effectively assess the quality and friendliness of youth SRH services.
Metrics for Management undertook a series of focus groups with youth leaders from Africa, Asia, and Europe. Participants from these focus groups suggested that poor point-of-service privacy and confidentiality practices and provider bias were significant impediments to receiving high-quality SRH services. We validated the global applicability of their observations through a review that found:
- poor privacy and confidentiality practices in SRH services are frequently linked to poor perceptions of service quality by young people.
- provider bias is a key barrier to accessing SRH services and a sign to young people of poor service quality.
We are now convening an advisory group of young clinicians, youth SRH leaders, and youth-oriented health and human rights experts to develop the partnerships necessary to further define the measurement problem and to inform the research approach we will use in developing a new user-centered, youth-focused measure of adolescent and young adult SRH service quality.
