Percent of facilities meeting minimum standards with regard to essential supplies and equipment to support provision of LAPMs

 

Percent of facilities meeting minimum standards of quality by specific long-acting or permanent method (LAPM) with regard to equipment, medications and supplies, and trained staff. For the following four LAPMs, minimum quality standards include:

Vasectomy
  • At least one trained provider
  • All 4 IP elements* (see below)
  • Lidocaine
  • NSV instruments** (see below)
Female Sterilization
  • At least one trained provider
  • All 4 IP elements* (see below)
  • Lidocaine
  • ML/LA instruments*** (see below)
Hormonal Implant
Insertion (Norplant®, Jadelle®, Sino-Implant II)
  • At least one trained provider
  • All 4 IP elements* (see below)
  • Cup, Iodine
  • Trocar

Insertion (Implanon®)

  • Cup, Iodine
  • Implanon® Applicator

 Removal (All types)

  • Scalpel Handle, #3, graduated in cm
  • Forceps, Mosquito, Straight, 5"
Intrauterine Device (IUD)
Insertion
  • At least one trained provider
  • All 4 IP elements* (see below)
  • Cup, Iodine
  • Sound, Uterine, Sims, 12.5"
Removal
  • IUD String Retriever

 

 

*Infection prevention (IP) elements (bucket with lid, bucket for high level disinfectant, chlorine powder, puncture resistant container)

**No-scalpel vasectomy (NSV) instruments (NSV dissecting forceps, NSV ringed forceps, 4 mm)

***Minilaparotomy (ML) and laparoscopy (LA) instruments (elevator, uterine, Ramathibodi hook, tubal, Ramathibodi)

EngenderHealth’s RESPOND Project has a full list of medical instruments and expendable medical supplies needed to provide LA/PM.

This indicator is calculated as:

(Number of facilities meeting minimum standard of quality to offer LAPM services / Total number of surveyed facilities eligible to offer LAPM services) x 100

Data should be collected for each LAPM method and broken down by facility type.


 

Responses to a facility survey question asking whether or not a facility has all the necessary infrastructure and resources to provide that service and/or a facility assessment based on observation of supplies cabinet; inventory of functional status of equipment and location in relation to the LAPM service delivery area; inventory or medications and supplies; inventory of all staff providing LAPM services and their designations; and information on qualification and continued training related to LAPM services, for staff providing the service on the day of the visit. Data should be collected separately by method. Evaluators may disaggregate data by type of facility, geographic area, or sector (e.g., government, private for profit, private non-profit).

At each facility, the following should be assessed:

  • All essential equipment for LAPM services present, functioning, and located in the service delivery area or in reasonable proximity for utilization;
  • All essential medications and supplies for LAPM services present; and
  • At least one staff member assigned to the facility who has either pre-service or in-service training that qualifies them to provide LAPM services following standard protocols.

If targeting and/or linking to inequity, classify service delivery points by location (poor/not poor) and disaggregate by location.


Facility survey/Facility assessment


 

This indicator provides information on a facility’s ability to offer a specific LAPM service with a minimum standard of quality. It can be used to identify gaps between planned service standards and actual resources on-site, which are required to provide the LAPM service to the given standard. These gaps will most often reflect problems with the support systems, such as the commodities and logistics systems, staff allocation, or staff training.

One important aspect of this indicator is that it assesses the LAPM resource availability at the delivery site. Evaluators interpret as "not available" any essential items absent from the service delivery area (e.g., forceps sitting in another service delivery area, or supplies locked in a storage closet). This approach more realistically assesses a facility's capability for meeting LAPM service standards.


It should be noted that the list of equipment for each method is the minimum list needed to provide services of acceptable quality. Also, this indicator does not measure the actual delivery of the LAPM service. Similarly, it does not measure whether service providers followed the right procedures and made the right decisions regarding the course of action for specific clients.


health system strengthening (HSS), long-acting/permanent methods (LAPM), family planning, quality
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