Special Analysis: National Composite Index on Family Planning (NCIFP)
This special analysis is excerpted from the FP2020 Commitment to Action: Measurement Annex 2015.
The NCIFP is a new tool developed to support FP2020’s efforts to improve the enabling environment for family planning. It measures the existence of policies and guidelines, as well as the extent to which family planning program implementation includes measurable dimensions of quality service provision.
The FP2020 Performance Monitoring & Evidence (PME) and Rights & Empowerment (RE) Working Groups provided oversight and technical guidance for the development of the NCIFP. Avenir Health’s Track20 Project led the development process and analysis of the results.
The NCIFP builds on the long-standing National Family Planning Effort Index (FPE), and, in 2014-2015, the two questionnaires were fielded jointly in 90 countries by Avenir Health and Palladium Group.46
For each country, between 10 and 15 highly informed respondents were selected to answer the two questionnaires. To obtain a variety of perspectives, respondents were drawn from the staff of government family planning programs, local NGOs, local academic or research institutions, and international agencies working locally. Scores for each country reflect the average of the responses across the respondents. The NCIFP consists of 35 items organized under five dimensions: strategy, data, quality, equity, and accountability. 18 items require yes or no answers, 12 use a scale of 1 to 10, and the remaining 5 are composite scores based on averages from a battery of individual questions.
RESULTS
Across the 86 countries for which data was available at the time of this analysis,47 the total unweighted score on the NCIFP was 53.7. Weighting based on the number of women of reproductive age (WRA) living in each country makes some slight difference to the total scores (see figure below). Overall, the “strategy” dimension scored the highest, and, “accountability” scored the lowest. Regional differences, by dimension, are shown in the figure below. To clarify regional patterns we show Asia first as a whole, and again without India and China. Sub-Saharan Africa is divided by Anglophone and Francophone (SSAF-A and SSAF-F). Eastern European and Central Asian (EECA) countries are kept separate.
A surprise was that the Sub-Saharan African countries scored the highest overall, and in several dimensions, as shown in the two rightmost “Total” bars. This pattern is most pronounced in the data and quality dimensions when considering weighted results. Further analysis of regional patterns can be found in the full NCIFP report.48 Looking to the 50 FP2020 focus countries included in the NCIFP analysis, considerable variations on country scores can be seen, ranging from Rwanda (88.6) to Mauritania (25.1). Although not presented here, further analysis by dimension and individual score can help explain what is driving these different scores.
A CLOSER LOOK AT EQUITY
The equity dimension of the NCIFP is of particular interest because it is a domain that existing measures do not adequately address. While the NCIFP is not the full answer to the challenge of measuring equity, it provides a new tool for understanding the perception of equity in countries.
In order to understand what the equity dimension may signify, a comparison has been made to another measure of equity in relation to family planning: the ratio of modern contraceptive use (mCPR) among the poorest and richest women in a country. A ratio of 1 means use is the same; a ratio less than 1 means the mCPR among the poorest is lower than among the richest; and, a ratio greater than 1 means mCPR among the poorest is greater than among the richest.49
The figure below shows a positive relationship between the two equity measures, shown separately for the two regional groups. The line for the SSA countries falls below that for the non-SSA countries because the use ratios are generally lower there.
There is substantial variation within both regions, and some SSA countries do better on the ratio of use than some Non-SSA countries. But the pattern is clear, that in general a higher score on the equity dimension is accompanied by a smaller gap between the poorest and richest wealth quintile in contraceptive use. That is true for both the SSA coun-tries and the non-SSA countries. Where the NCIFP equity score is high, the mCPR ratio between the poorest and wealthiest quintiles is also more equitable.
CONCLUSION
The NCIFP represents a new and innovative measurement tool for examining the enabling environment in which family planning programs are implemented. It is the first comprehensive measurement tool addressing the important topics of equity and accountability. While there is room for further improvement and refinement of the NCIFP, these initial results give us important insights. Like the FPE, the NCIFP is a valuable source of information for the global family planning community, and it should help to inform qualitative assessments of family planning programs. It can also be a useful tool for stimulating and facilitating stakeholder discussions about the factors that contribute to a strong family planning program, as well as perceptions of quality and equity.
Download the full FP2020 Commitment to Action: Measurement Annex 2015
46. Data collection for both the FPE and NCIFP was jointly funded by Bill and Melinda Gates Foundation, through Avenir Health, and USAID, through Health Policy Project, implemented by Palladium. The analysis of the NCIFP was conducted by Avenir Health with funding from the Bill and Melinda Gates Foundation.
47. Countries for which data was not yet available: Cambodia, Dominican Republic, Lebanon, and Russia.
48. www.familyplanning2020.org/measurement-hub.
49. Data were taken from the most recent DHS survey in each country. A total of 52 countries with available mCPR rates (married women) by quintile were included in this analysis, based on data ranging from 1996 to 2014.
