Family Planning Program Effort Index

This indicator is a score measuring the strength of the national family planning (FP) program of a given country on four dimensions (policies, services, evaluation, and method access). The score has a potential range of 0-300 points, based on 1-10 points for each of 30 items.


Responses to a detailed questionnaire from selected key informants (representatives of the ministry of health, IPPF affiliate or other NGO; international consultants familiar with that country; and other informed individuals).


A questionnaire designed explicitly for this purpose, completed by an average of 10-15 individuals per country. The items have remained constant over the multiple rounds of data collection.


The purpose of the Family Planning Program Effort Index is to assess the strength of FP programs worldwide and to measure changes over time. It attempts to measure the effort (input) that goes into the FP program, not the results achieved. These data have been collected in seven different cycles from 1972 to 2009, spanning nearly four decades. The questionnaire relates to 30 measures of effort. Researchers convert the responses to these questions to individual scores (ranging from 1-10) for each of the 30 items, using an established set of rules.

The Family Planning Program Effort Index serves several important purposes:

  1. It allows for cross-national comparisons of FP programs at different points over several years;
  2. It traces the evolution of the FP program in a given country over time; and
  3. It measures FP program input, independent of outcomes (such as contraceptive prevalence or fertility).

As such, it has been used to analyze the relative importance of FP program effort versus social and economic factors in the decline of fertility rates worldwide (Lapham and Mauldin, 1984; Mauldin and Ross, 1991; Ross and Mauldin, 1996; Ross and Stover, 2001).

This index is useful primarily to researchers, donor agency representatives, and those interested in understanding FP programs in the international context. Although it indicates areas of strength and weakness for a national program, it has not been the tool of preference for program managers at the country level in identifying ways to improve programs. Indeed, in contrast to other widely used measures and tools (CYP, contraceptive prevalence, DHS and RHS surveys, situation analysis) which are widely known to family planning program managers throughout the developing
world, the Family Planning Program Effort Index is used primarily for research purposes.

Nonetheless, the Index represents a valuable source of information to the international reproductive health community. It is the only source of data that purports to measure inputs using a standard set of questions across countries and over time. The results for the Family Planning Program Effort Index have generally coincided with qualitative assessments of "how good a family planning program is" in a given country. For example, the scores indicate that in 1972 a quarter of the world's population lived in countries with very weak or no FP programs. As of 1999, no country in the world fell in this category. 

Most of the indicators in this database are included to encourage evaluators and researchers to collect the necessary data to use them. By contrast, the data collection for the Family Planning Program Effort Index is conducted by a small team of researchers based in the United States, using a standardized instrument across countries.

The index is useful to the international reproductive health community because it offers data of this nature for secondary use, not as a type of information routinely collected by program managers for the purpose of program improvement.


A major criticisms that has been leveled against this index is that the responses of the key informants are biased by their knowledge of key outcomes (contraceptive use and fertility decline). That is, if contraceptive prevalence is high, the respondents unconsciously give high scores to the availability of methods, assuming that the two go hand in hand. In short, although the index claims to measure inputs, the responses may be biased by a knowledge of outcomes.


index, training, management, commodity, health system strengthening (HSS), access, family planning, communication, policy, long-acting/permanent methods (LAPM)
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