Indicators for Measurement and Improvement of the Quality of Family Planning Programs: The Philipines, 1997-1998

The Philippine government has adopted a policy called the Responsible Parenthood and Reproductive Health Act (RPRH) in support of modern family planning (FP) and improved RH. This includes the goal of ensuring 6 million women access to modern contraception. Implementation has stalled because of court appeals.

Over ten years prior to the passage of the RPRH Act, researchers in the Philippines conducted studies to assess the quality of FP services and care received. The study of quality in FP employs a framework that includes its determinants and effects, and incorporates fundamental elements that reflect clients’ experience of services. Included among these fundamental elements is the concept of choice; namely, a client’s ability to receive options for methods of family planning.

In response to the need of program managers to understand the quality of services at the field level, the Situation Analysis (SA) approach was developed. The SA is a field-level assessment of quality of services, meaning the readiness of FP/RH programs to deliver services of good quality, and the quality of care, meaning the healthcare experience received by clients. SA provides managers information on those aspects over which they have control and about which they can make programmatic changes in order to ensure good quality of care. Good care cannot be given or received when the enabling conditions do not exist. However, readiness alone is no guarantee that good care will be provided; readiness to provide an IUD is irrelevant if an IUD is not the right choice for a prospective client. The conceptual model used in this study in the Philippines reflects the framework described above, placing the focus on multiple stages of care. Policy makers must set the appropriate context for program orientation and service delivery, facilities must be ready to provide RECOMMENDATIONS Philippine Policy • The Administration intends to provide 6 million women, emphasizing those living below the poverty line, access to contraception. The evidence in our study suggests that quality of care is equally as important as increased access to and coverage of contraceptive services. • Family planning networks should increase attention to quality of care monitoring to ensure a greater quality of care received by the client. • Evidence suggests that contraceptive prevalence does not automatically meet reproductive health goals, an emphasis on improved quality of care could lead to stronger outcomes to support modern reproductive health priorities. • The link between quality of service and quality of care needs to be further examined. Our evidence suggests a knowledge gap between the two in terms of readiness and delivery of contraception. 2 Table 1: SDP Readiness to provide various FP methods, n = 70, Feb-March 1997 Figure 1: Percent of Facilities Ready to Provide Indicator for All Contraceptive Methods, Mar and Aug 1997 0 10 20 30 40 50 60 70 80 90 100 Full Readiness Equipment Available Method Available At Least One Trained Provider Mar 1997 (n = 70) Aug 1997 (n = 76) Item of Readiness Condom (%) Pill (%) IUD (%) Injectable (%) All Methods (%) At least one trained provider 86 87 79 74 59 Method in Supply 99 99 99 96 93 Equipment Available N/A N/A 47 81 41 All of the Above 3 Items 84 86 40 66 26 services of good quality, and providers must have all resources required to serve their clients. At the end of this causal chain, facility users should receive good quality care. However, relatively little is known about how and why readiness affects client-provider interactions.