Nirali M Chakraborty

• Ph.D.
• Chief Executive Officer at Metrics for Management

Background Despite progress in assuring provision of safe abortion, substantial disparities remain in quality of abortion care around the world. However, no consistent, valid, reliable method exists to routinely measure quality in abortion care across facility and out-of-facility settings, impeding learning and improvement. To address this need, th...

Objective We used the newly developed Abortion Care Quality Tool (ACQTool) to compare client-reported quality of medication abortion care by source (facility-managed vs pharmacy-sourced self-managed abortion (SMA)) in Bangladesh. Methods We leveraged exit and 30-day follow-up surveys collected to develop and validate the ACQTool collected at nongo...

Objective This qualitative study aimed to identify person-centred domains that would contribute to the definition and measurement of abortion quality of care based on the perceptions, experiences and priorities of people seeking abortion. Methods We conducted interviews with people seeking abortion aged 15–41 who obtained care in Argentina, Bangla...

Measurement of the quality of abortion services is essential to service improvement. Currently, its measurement is not standardized, and some of the tools which exist are very long, and may deter use. To address this issue, this study describes a process used to create a new, more concise measure of abortion care quality, which was done with the en...

Purpose: Poor privacy and confidentiality practices and provider bias are believed to compromise adolescent and young adult sexual and reproductive health service quality. The results of focus group discussions with global youth leaders and sexual and reproductive health implementing organizations indicated that poor privacy and confidentiality pr...

Background Studies in the literature have found mixed results on the effect of microcredit on health outcomes. Of the five previous experimental studies that included microcredit and a health intervention, three reported no significant changes in health status or behaviors. The purpose of this study was to test for marginal and interactive effects...

Universal Health Coverage in Low- and Middle-Income Countries is increasingly expanding through incorporation of private clinics, pharmacies, and hospitals into an overall health system funded in whole or part through government-managed health insurance. This underscores the importance of policies on health provision which apply across the whole de...

Background Improving facility-based quality for maternal and neonatal care is the key to reducing morbidity and mortality rates in low- and middle-income countries. Recent guidance from WHO and others has produced a large number of indicators to choose from to track quality. Objective To explore how to translate complex global maternal and neonata...

Background: The quality of contraceptive counseling that women receive from their provider can influence their future contraceptive continuation. We examined (1) whether the quality of contraceptive service provision could be measured in a consistent way by using existing tools from 2 large-scale social franchises, and (2) whether facility quality...

Background Studies in the literature have found mixed results on the effect of microcredit on health outcomes. Of the five previous experimental studies that included microcredit and a health intervention, three reported no significant changes in health status or behaviors. Methods This study consisted of a 4-celled experimental design in 128 villa...

Introduction: Several measures to assess family planning service quality (FPQ) exist, yet there is limited evidence on their association with contraceptive discontinuation. Using data from the Measurement, Learning & Evaluation (MLE) Project, this study investigates the association between FPQ and discontinuation-while-in-need without switching in...

Little consensus exists about how to measure quality of care in abortion. Our purpose is to (a) provide common language for healthcare quality definitions, frameworks and measurement; (b) synthesize literature about quality measurement in abortion; and (c) present criteria for quality metric development. Quality includes effectiveness, patient cent...

Objective To develop a shortened, valid and reliable scale applicable across multiple settings for routine monitoring of person‐centered maternity care (PCMC). Methods Exploratory analysis was used to generate parsimonious versions of a 30‐item PCMC scale in four datasets from cross‐sectional surveys conducted between August 2016 and October 2017,...

Introduction: Several measures to assess family planning service quality (FPQ) exist, yet there is limited evidence on their association with contraceptive discontinuation. Using data from the Measurement, Learning & Evaluation (MLE) Project, this study investigates the association between FPQ and discontinuation-while-in-need in five cities in Ken...

Quality of family planning counseling is likely associated with whether or not women continue to use the same contraceptive method over time. The Method Information Index (MII) is a widely available measure of contraceptive counseling quality but little is known about its association with rates of method continuation. The index ranges from 0 to 3 b...

The Method Information Index (MII) is calculated from contraceptive users’ responses to questions regarding counseling content—whether they were informed about methods other than the one they received, told about method‐specific side effects, and advised what to do if they experienced side effects. The MII is increasingly reported in national surve...

Understanding differences in the wealth status of patients can inform planning decisions aimed at providing affordable access to high quality care to all. This study assesses differences in the wealth status of clients of family planning and child health services by health sector. It also describes reason for facility choice, cost of services, and...

Background: A key component of universal health coverage is the ability to access quality healthcare without financial hardship. Poorer individuals are less likely to receive care than wealthier individuals, leading to important differences in health outcomes, and a needed focus on equity. To improve access to healthcare while minimizing financial...

In Kenya the public sector provides 59.9% of all contraception, the remaining 40% delivered by commodity outlets, NGOs, faith-based organizations, social franchised providers, and for-profit clinics. Across many countries, population based surveys have shown that there is a socio-economic differential in sources of family planning, with women in hi...

Objectives: The aim of the study was to assess continuation rates and satisfaction among post-partum intrauterine device (PPIUD) accepters. Methods: This prospective observational study comprised 591 Zambian women who underwent PPIUD insertion at sites of the Society for Family Health, Lusaka, Zambia. The women were contacted 6-12 months after P...

In order to understand if and how well the poor are being served at health facilities, social franchises and other service providers have begun to systematically assess the wealth of their clients. Understanding whether or not the relatively poor are seeking health services at a particular type of facility is only moderately helpful without associa...

Background In Kenya, as in many low-income countries, the private sector is an important component of health service delivery and of providing access to preventive and curative health services. The Tunza Social Franchise Network, operated by Population Services Kenya, is Kenya’s largest network of private providers, comprising 329 clinics. Franchis...

This interactive workshop covers the development of the EquityTool, a free, easy-to-use, mobile-based application that assesses the wealth of program beneficiaries in low- and middle-income countries. The workshop illustrates the difference between wealth quintiles and other measures of economic equity, and walks participants through the process fo...

Background: Social franchising programs in low- and middle-income countries have tried using the standard wealth index, based on the Demographic and Health Survey (DHS) questionnaire, in client exit interviews to assess clients’ relative wealth compared with the national wealth distribution to ensure equity in service delivery. The large number of...

Background: The private sector makes up a significant portion of healthcare in low- and middle-income countries (LMICs). One strategy for improving healthcare standards for the poor is social franchising, which applies the contracting and managerial systems of commercial franchising to social aims. In 2011, the Social Franchising Metrics Working Gr...

In many low- and middle-income countries, a majority of people seek health care from the private sector. However, fragmentation, poor economies of scale, inadequate financing, political opposition, a bias toward curative services, and weak regulatory and quality control systems pose serious challenges for the private sector. Social franchising addr...

Background Nepal has high unmet need for family planning and low use of intrauterine devices (IUDs). While clients¿ attitudes toward the IUD are known in a variety of contexts, little is known about providers¿ knowledge and perceptions of the IUD in developing countries. Nepal¿s liberal IUD service provision policies allow the opportunity to explor...

Public policies can influence many different types of interfaces. Popular topics within HCI that are subject to rules and regulations include accessibility, voting, and healthcare. However, as the HCI community has gotten more involved with the development of gaming systems, it is also important to examine how games are influenced by policies aimed...

This guide provides practical, step-by-step advice for M&E staff, data analysts, and program implementers on the calculation of nationally representative wealth quintiles from programmatic data, a key step in monitoring equity in health and development programs. The guide provides a worked example taken from a recent household survey, plus detailed...

Background The majority of social marketing programs are intended to reach the poor. It is therefore essential that social marketing organizations monitor the health equity of their programs and improve targeting when the poor are not being reached. Current measurement approaches are often insufficient for decision making because they fail to show...

Motivating improved health provider behaviors related to quality, productivity, customer satisfaction and equity is central to the success of health service delivery through PSI’s 24 social franchise networks globally. In order to do this PSI applies the same marketing rigor to influencing providers as an important target audience as would be appli...

Women's empowerment is a dynamic process that has been quantified, measured and described in a variety of ways. We measure empowerment in a sample of 3500 rural women in 128 villages of Bangladesh with five indicators. A conceptual framework is presented, together with descriptive data on the indicators. Linear regressions to examine effects of cov...

Policy makers in developing countries need to assess how public health programmes function across both public and private sectors. We propose an evaluation framework to assist in simultaneously tracking performance on efficiency, quality and access by the poor in family planning services. We apply this framework to field data from family planning p...

Background: In cash strapped bureaucracies, an effective method to assess health programs using available data is important. As policy makers in developing countries look to extend, improve and assess their family planning and reproductive health services, we propose a novel tool and framework to assist them. Methods: Facility and exit interview...

BACKGROUND There is a growing interest in the role of private health providers in low- and middle-income countries (LMICs). Informal private providers (IPPs) provide a significant portion of health care in many LMICs, but they have not received training in allopathic medicine. Interventions have been developed to take advantage of their potential t...

There has been an increasing availability and accessibility of modern health services in rural Bangladesh over the past decades. However, previous studies on the socioeconomic differentials in the utilization of these services were based on a limited number of factors, focusing either on preventive or on curative modern health services. These studi...

Background: Microcredit loans, providing collateral free loans to the poor worldwide, are often hailed as a tool to improve health. Although the relationship between wealth and health is well established, the role of microcredit in this framework has not been well studied. Purpose: To compare household consumption patterns of new microcredit clie...

A rticle 25 of The Univer-sal Declaration of Human Rights proclaims that ev-eryone has a right to medical care necessary for health and well be-ing [1]. As members of the United Nations, states have a normative responsibility to ensure access to necessary healthcare for their citi-zens. Nevertheless, private provi-sion of healthcare is omnipresent...

Objectives: Frameworks for assessing service quality in reproductive health/family planning (RH/FP) have traditionally only used the client's perspective, and quantitative analyses of service quality in reproductive health clinics are limited and rarely combine multiple sources of information. We derived a quality index using survey data from facil...

The key social goals in health service provision are quality and accessibility to the poor. Social franchises are one mechanism to achieve both goals, but little is known about their performance. The objective of this paper is to compare the cost per each percentage point increase in the proportion of poor clients for social franchises as compared...