Validity of Standard Measures of Family Planning Service Quality; Findings from the Simulated Client Method

Katherine Tumlinson, University of North Carolina at Chapel Hill
Ilene S. Speizer, University of North Carolina at Chapel Hill
Sian Curtis, University of North Carolina at Chapel Hill
Brian Pence, Population Council

Despite widespread endorsement within the field of international family planning regarding the importance of quality of care as a reproductive right, the field has yet to develop validated data collection instruments to accurately assess family planning service quality. This validation study, conducted among 19 higher volume public and private facilities in Kisumu, Kenya, used the simulated client method to test the validity of three standard data collection instruments included in large-scale surveys: provider interviews, client interviews, and third party observation of client-provider interactions. Results found low specificity and low positive predictive values in each of the three instruments for a number of quality indicators, across all aspects of quality generally studied, suggesting that quality of care may be overestimated by traditional methods. Revised approaches to measuring family planning service quality may be needed to ensure accurate assessment of programs and to better inform quality improvement interventions.