MEASUREMENT THAT MATTERS: UNDERSTANDING QUALITY OF CARE FROM CLIENTS’ PERSPECTIVES

High quality of care in contraceptive provision is associated with greater contraceptive uptake, higher continuation of use, and improved client satisfaction. Various frameworks and indicators to measure quality of care have been developed, used, and updated over several decades. Across these frameworks, four key domains relating to care received are: respectful care, method selection, effective use, and continuity of contraceptive use and care. The Evidence Project has developed a package of validated, evidence-based tools and training materials to support governments and implementing partners in measuring and monitoring quality of care. Measuring quality of care from clients' perspectives will help programs celebrate successes, target areas for improvement, and ultimately improve uptake and continuation of voluntary contraceptive use. The Evidence Project validated two measures of quality of care using data from a longitudinal study of reversible contraceptive users in India. Clients were interviewed about the quality of care they received, and the quality of care measures' ability to predict contraceptive continuation three months later was assessed. The quality of care was measured using 22 items, which was reduced to a 10-item proxy measure through exploratory factor analysis. While the full 22-item measure more comprehensively captures clients' experiences, a 10-item version adequately measures quality of care and also predicts contraceptive continuation, making it ideal for routine data collection and monitoring of programs. The Evidence Project is currently working to confirm the same measures in an additional study in Burkina Faso, in order to routinely monitor quality of care for family planning services in the public sector and through performance-based financing programs. A second way to measure quality of care from clients' perspectives is the MIIplus. The Method Information Index (MII), a three-item measure, has been used to assess quality of care based on the information a client receives about a selected contraceptive method. As part of the study in India, the value of adding a fourth item, which asks whether the client was told about the possibility of switching to another method if the one she selected was not suitable, was explored. The addition of the fourth item, forming the MIIplus, was found to be a better predictor of contraceptive continuation than the MII alone. This short measure can be used to track progress in quality of care at national and subnational levels. Monitoring client perspectives of quality of care allows programs to incorporate crucial feedback as they strengthen their service provision. The Evidence Project has developed a package of materials that includes client exit interview tools in English and other languages, a data collection manual, and a sample training agenda and presentation(s). These resources can be used in multiple ways, including for special studies, routine monitoring, and abbreviated ways to monitor quality of care. The measures provide tools for rigorous measurement of quality of care received, allowing programs and governments to identify areas of success and areas for improvement and to work toward the betterment of quality of care in their programs.