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Measuring Success of a Continuing-Client Strategy |
 
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| March 2007 Issue No. 11 |
The INFO Project • Johns Hopkins Bloomberg School of Public Health • Center for Communication Programs • 111 Market Place, Suite 310 • Baltimore, Maryland 21202, USA • 410-659-6300 • 410-659-6266 (fax) • www.infoforhealth.org • infoproject@jhuccp.org | |
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How can program managers know whether a continuing-client strategy is succeeding in reaching its objectives? How can they decide what parts of the program's operations need to improve, or when to change direction to better meet client needs, if necessary? Establishing a monitoring and evaluation system provides a powerful tool for program managers to determine program strengths and weaknesses (see What is Monitoring and Evaluation?).
The approach described in "Developing a Continuing-Client Strategy," the issue of Population Reports that this supplement accompanies, points to several key program components that, when delivered effectively, can ensure that clients are able to continue using family planning as long as they want to—not only when they first visit a family planning facility but also as their reproductive intentions and health needs change (15).
Establishing a system for monitoring and evaluation at the start of the continuing-client strategy is essential for measuring how well it is succeeding. The system should include indicators that measure key components of the strategy (see Program Indicators for a Continuing-Client Strategy). Managers can collect and analyze information about these indicators and use them to identify problems in service delivery, assess trends in client care, and adjust the program's approach to ensure that they are reaching strategic goals.
The key components of a continuing-client strategy can be grouped into two major categories:
- Program readiness (including availability of contraceptives and other supplies, staff training and attitudes, and job aids and training materials);
- Quality of care (including choice of methods, client-provider interaction, technical competence, and mechanisms for follow-up) (14).
Monitoring these indicators is important because they have a direct effect on a continuing client’s reproductive health outcomes—including client satisfaction with care and continued use of family planning to avoid unintended pregnancy (11, 14).
Program readiness. Program readiness indicators measure activities that prepare facilities to meet client demand and to provide good-quality services (14). For example, programs can set up a record-keeping system to capture information related to contraceptive continuation—including each client's stated reproductive intentions, contraceptive side effects or other problems with a method, method switching, method discontinuation, and date of next follow-up visit (17). Managers can analyze information collected through a program-wide or facility-level record-keeping system and use it to identify and monitor potential contraceptive continuation issues related to service delivery.
Quality of care. Indicators of quality of care assess providers' medical and counseling skills and the appropriateness and acceptability of clinical services. Clients who are treated with respect, given sound medical care, and are offered options for continued care are more likely to be satisfied with services, to continue contraceptive use, and to avoid unintended pregnancies (11, 14). For example, tracking client flow through the clinic can help managers and providers minimize clinic waiting times and thus encourage contraceptive continuation. Long waiting times often discourage clients from returning to a clinic for follow-up care (12, 15).
Reproductive health outcomes. To best assess the effect of a continuing-client strategy, managers should measure indicators not only of program readiness and quality of care but also programmatic impact on reproductive health outcomes, such as the percentage of pregnancies that are unintended. Helping clients avoid unintended pregnancies is a key objective of a continuing-client strategy. Meeting the family planning needs of continuing clients by helping them sustain contraceptive use can reduce their exposure to unintended pregnancy (3, 10, 11).
Programs will not be able to assess all the outcomes, however, often for reasons such as limited resources and technical expertise. For example, measuring the all-method contraceptive continuation rate at the program level can be expensive and time consuming because it requires follow-up with new acceptors (1). Thus for programs, measuring indicators of program readiness and quality of care that have a recognized association with reproductive health outcomes is often a more feasible way to assess the effect of the program's continuing-client strategy (11, 14).
How To Use This Report
This tool offers program managers a quick reference to measure how well a continuing-client strategy is succeeding. It includes 24 key indicators organized into three areas: program readiness, quality of care, and reproductive health outcomes. By measuring these indicators, managers can track changes in program performance and fine-tune operations as needed to achieve the objectives of a continuing-client strategy. This tool is a companion to the "Developing a Continuing-Client Strategy" Population Reports issue.
