Measuring family planning service delivery. An assessment of selected indicators across implementing partners.

Family planning (FP) service delivery is a key component of the global health program of the U.S. Agency for International Development (USAID). There is a long tradition of measuring FP service delivery activities and outcomes through indicators that are internationally standardized and program-specific. Although essential for understanding the content quantity and quality of services being provided with U.S. government assistance the monitoring and evaluation (M&E) of FP service delivery faces many challenges. USAID technical advisors asked MEASURE Evaluation to assess a set of 16 indicators and five indicator areas that may be used to measure service delivery among USAID’s implementing partners (IPs). The indicators and indicator areas selected by USAID represented the types of indicators that IPs collect but were not representative of the entirety of USAID service delivery measurement. Rather they posed potential challenges in harmonization collection and reporting. Information and feedback on the use of the selected indicators were collected from eight service delivery IPs and seven technical resources (a combination of projects and published tools). The information was assessed for common trends and reported challenges. Indicator guidance for FP service delivery projects was then developed and applied to the selected indicators. This assessment provides a summary and analysis of IP feedback and indicator-specific recommendations. A main finding was that many of the service delivery indicators selected by USAID for review were not collected by IPs. USAID partners primarily collect project-specific output-level indicators specific to the scope of their work. This finding indicated that understanding of the application of indicator criteria in the service delivery context is problematic resulting in some misunderstanding of the measurement needs and capacities of service delivery projects by USAID technical advisors. Another finding was that there were differences in indicator language and definitions: six out of the 16 indicators in the assessment had variations in indicator language definitions or how the indicator was operationalized by the various IPs who used them. Finally it was found that the indicator areas that were being proposed (such as couples’ communication client/provider communication and provider attitudes) need development to ensure that valid and reliable measures are available for use. This report offers recommendations and guidance for each of the selected indicators and indicator areas based on whether a project will be using the information for monitoring/process evaluation only or will also be conducting an outcome/impact evaluation. This report provides specific criteria to guide USAID and IPs in the selection of FP service delivery indicators. These are standard indicator criteria with an additional focus on practicality and cost efficiency for service delivery IPs. This report includes recommendations for each indicator as to whether it should be collected by service delivery IPs the language should be harmonized an alternate indicator should be used or assessment needs to be completed. This assessment can be used to inform USAID service delivery measurement among IPs. It should enable the harmonization of data collected by IPs and reported to USAID. It should also aid in the prioritization and selection of indicators for service delivery projects.