USE CASES

Reproductive Health Unit (RHU) of a ministry of health (MoH) wanted to understand the quality of abortion services being provided in hospitals and health centers, and to understand whether the ACQTool would be a good way to assess quality more broadly. They decided to implement the ACQ facility tools in the hospitals and health centers in one of the country’s subregions, in conjunction with the regional health minister. The site checklist was administered in each facility and up to four providers responsible for reproductive health care were interviewed at each site. Finally, MoH staff sought to interview 30 abortion and post-abortion care clients per site.

The RHU was drawn to the ACQTool for its research-based underpinning and relatively short length. They used the tool via the KoBoToolbox electronic data collection application and found the data analysis tool provided on our website to be simple to use and edit. Importantly, the ACQTool helped MoH officials to identify areas of need across hospitals and health centers that they will now seek out resources to address more efficiently.

An international health services non-governmental organization (NGO) that trains service providers in both health facilities and pharmacies in providing medical abortion services believes that the services provided in pharmacies are just as good, if not better, than those provided in facilities. They chose to use the Abortion Care Quality (ACQ) tools to compare the quality of services between the two facility types. The NGO considered it an important strength of the ACQToolkit that it had been validated and isapplicable across both facility and pharmacy settings. The NGO staff also appreciated that not only will the ACQTools provide scores for each indicator value but will also indicate whether indicator scores meet predefined quality thresholds. In this case, NGO evaluators ensured that the sample size used would allow for the ability to detect significant differences between the two facility types, if facilities were meeting indicator quality thresholds at a 50% rate. The total sample required was then allocated across facilities and pharmacies supported by the NGO. Once collected, the data will be shared during future training sessions; used for advocacy purposes; and disseminated as either gray or peer-reviewed publications.

A local non-governmental organization (NGO) supports a hotline in its home Latin American country that provides medically accurate information to people seeking abortion information, including where to obtain medication and what to expect during the abortion process. Representatives from an NGO in a neighboring country visited the hotline during a learning trip and are cautiously optimistic about supporting the development of a similar hotline in their country. However, some stakeholders have concerns. The hotline suggests that they can use the Abortion Care Quality (ACQ) metrics to demonstrate that well trained hotline counselors provide high quality abortion care. It also suggests that the metrics could be used in the context of a new hotline, to understand where training and additional support is required over time. The hotline selected the ACQ evaluation toolkit because it knows that all of its indicators have been previously validated as being strongly correlated with important client health and service quality outcomes. Working with an external research partner, the hotline seeks consent from 100 clients over a one-month period, to participate in a short follow-up interview. Each of the hotline’s counselors also completed a survey using the hotline provider survey tool. To reduce bias, hotline employees were all surveyed on the same day, and attempts were made to reduce communication between employees during the time of the survey. The data showed some differences between counselors, with more experienced counselors scoring higher. Overall, the hotline met the quality threshold for 75% of the quality indicators measured via the client exit interview. These results are indicative of very high-quality provision.

An international donor organization that provides funding and support to organizations in low and middle-income countries to expand access to safe, high-quality abortion care is in the process of developing a new five-year evaluation plan. The organization has traditionally relied on process-oriented measures, such as the number of services provided or the number of advocacy phone calls made, to assess how effective funds have been in increasing access to safe abortion care. However, the organization wishes to place additional emphasis on service quality over the coming five years. They decide to integrate the ACQToolkit into their evaluation framework.

The donor was drawn to the ACQToolkit for a number of reasons. Most important, the donor appreciated that the toolkit was developed through a rigorous research process that identified indicators that were either statistically associated with desirable client outcomes or as being important to the research group expert review panel’s conceptual understanding of abortion service quality. Further, the donor was impressed that the ACQToolkit had been validated for use in many different service settings. This gave the organization confidence that the ACQ could yield valid findings across the many different abortion service site types that it supports, including clinics, pharmacies, and medicine vendor networks. Finally, the donor appreciated that ACQToolkit questionnaires could be easily deployed using KoboToolbox, an electronic data collection platform, thereby making data collection and basic analyses simple to conduct.

The donor decided to request that its beneficiary organizations that provide abortion and post abortion care services to more than 1,000 clients per year collect service quality data using the ACQToolkit annually. While the electronic data collection method creates dashboard results that can be readily viewed in Excel, the donor also plans to use the available Stata code to conduct its own additional analyses of the collected data. After data collection and initial analyses, the donor plans to aggregate annual site-level indicator data to the global level in order to evaluate their organization’s yearly progress in helping to expand access to high-quality abortion care to all people.

A regional abortion care organization with the goal of improving the quality and availability of abortion care services in a number of Latin American countries recently finalized a cooperative agreement with several clinic and telemedicine service networks. The agreement will allow the collection of clinics and telemedicine services spread across four Latin American countries to receive additional funding and technical support from their regional partner and will improve coordination between partners as they work to harmonize standards of care and protocols. The overall goal of the agreement is to improve care quality provided to clients seeking guidance and resources for self-managed medication abortion across these various care platforms.

The international organization and its local partner organizations plan to evaluate ongoing quality improvements in each project using the ACQTool. The organizations’ managers are familiar with how the ACQTool’s indicators were first developed and validated in health facilities, pharmacies, and hotlines, and are confident that many of the tool’s domains and indicators are also relevant to their own site settings. In each country, the local partner organization will evaluate services using the ACQTool six months after project initiation and then 18 months after. Evaluating the projects’ care quality at two time points not only allows project managers to evaluate whether their services are achieving the ACQTool’s quality thresholds but, just as important, whether they are seeing improvements in care over time.