1. Building Trust With Standardized Quality Metrics in Family Planning Dr. Rehana Ahmed ICFP, Bali, Indonesia 26 January 2016

2. What are we doing ? Towards Standardized Quality Metrics Experts Meeting : Oct 2015 Develop a holistic image of quality. Agree on criteria for quality metrics. Select viable indicators for FP quality and a plan for piloting.

3. What is needed ? Balance: Structural Inputs with Process Quality An implicit assumption of primary drivers of low-quality care  scarcity of qualified health providers and a lack of infrastructure, equipment & access Missing from this debate is systematic evidence on the quality of care that patients actually receive when they enter a clinic. - Jishnu Das et al, 2012

4. What is the balance needed? A focus on process quality ‘The greatest problems are related to “customer handling”. ‘Lack of informed choice is a recurring problem..’ ‘A common issue is less time devoted to client and listening, e.g., ‘assessing clients capacity to understand, retain, and use information ‘ Social Franchise Program Managers Interviews 2015 (Hewlett funded research project UCSF)

5. Impact of poor process quality… an example

6. How did she get to discontinuation …

7. Readiness Choice Tracer commodities Tracer Equipment Service Provider Process Interpersonal Skills Information Provided Technical Competence Outcome Method Information Index 12 month post service

8. Essential Attributes of a Standardized Quality Measure Easy to collect & analyze Actionable & cheap Credible & benchmarkable

9. Support development of metrics Pilot quality metrics across 4 franchisors (MSI, PSI, IPPF, DKT) Universal adoption in private and public sector as basis for purchasing services A challenge for franchisors..

10. Summary A Critical Contribution to Universal Health Coverage A set of standardized transparent Quality Metrics (across readiness, process & outcome )..will build trust and confidence and..be a factor in the purchase of essential services for UHC. Thank you

11. Questions Karl Hoffman : How central is patient satisfaction to quality ? Is it feasible to scale? Judy Gold: Will the metrics information be easily accessible? Elly Brown: In Options we use the HSS approach, where quality goes side by side with accountability--where does accountability fit into this metric? Xx : Do we know if we can hold public sector to franchise tested private sector standards? Stefan : What is the happy ending, e.g. big goal, for this FP quality work? Kathryn Church : Can the FP structural index be made even shorter? Xx: How will the data produced with this metric be used by the average person? How will it be presented? Is the aim to have the standardized score become national? Will the compendium be a tool to disseminate?