Using Balancing Weights to Compare Performance across Facilities Providing Family Planning Services in Kenya

Lucas Godoy Garraza, University of Massachusetts Amherst
Carolina Cardona, Johns Hopkins University
Peter Gichangi, International Center for Reproductive Health, Kenya
Mary Thiongo, International Centre for Reproductive Health, Kenya
Philip A. Anglewicz, Johns Hopkins University
Leontine Alkema, University of Massachusetts Amherst

The relationship between the quality of family planning (FP) delivery in facilities and outcomes such as service satisfaction or contraceptive discontinuation is of key interest to the FP field. However, assessment of these relationships is methodologically challenging due to differences in populations served across facilities. We use novel data on facilities and clients from the Performance Monitoring for Action (PMA) project and a new methodological approach to examine relationships of interest in Kenya. We use a design-based direct standardization method to balance the distribution of populations served across facilities while controlling for the additional variability induced by the balancing weights. We find significant evidence of variation in FP outcomes across groups of facilities that cannot be accounted for by differences in client characteristics. E.g., the type of facility (e.g., dispensary), their size, the proportion of staff present, and whether the facility was public were associated with more positive service satisfaction.