When do you know if a new family planning service is really available? : Challenges in tracking availability of a new service and new users during scale up from pilot to national level

Monitoring challenges exist when new services are integrated into, and expanded throughout, a health care delivery system. The Standard Days Method (SDM) is being scaled-up to national level into family planning (FP) programs in several countries. This multi-year process requires careful monitoring, yet when new services are in the process of scale-up, it is difficult to track new users and service availability since the service is not yet fully integrated into monthly service statistics and other reports. In Rwanda, government HMIS do not yet directly report new SDM users nor does the government track service expansion. To monitor scale-up, parallel efforts are needed. Using secondary data is a good option yet care must be taken to understand the data in order to interpret actual status of scale-up.

A facility assessment conducted by a partner organization indicated that 75% of facilities providing FP offered the SDM, a surprising finding since this was not reflected in new user data. Further data analysis, however, indicated that the product associated with SDM was available in only 12% of facilities, suggesting that method stock-out was a problem. These findings led to advocacy to address supply chain issues. A facility assessment conducted two years later revealed that the supply system was now functioning better (commodity available in 86%; stock-out in previous three months reported in only 8% of facilities).

The case study highlights issues in monitoring new service expansion, including understanding varying definitions of ‘availability' and making intelligent use of secondary data to inform scale-up strategies.