Reviewer ’s report  
 
Title:  Impact of the Urban Reproductive Health Initiative on family planning uptake at facilities 
in Kenya, Nigeria, and Senegal  
 
Version: 0 Date: 16 Aug 2017 
 
Reviewer:  Karen  Hardee  
 
Reviewer’s report:  
 
The URHI is a significant family planning initiative and the finding that program effort (dose) 
made a difference to outcomes across three countries that participated in it is important.  With 
that said, this paper leaves me wanting more explanation about implementation of URHI and 
also guidance on how to interpret the findings.  There must be more to say than do a bunch of 
things and the number of new users will go up.  Also, it would be important to say why control 
sites were not included in the MLE desig n.   
 
Page 1: The authors cite Bruce 1990 for what is needed to increase contraceptive use.  Bruce is 
about quality of care and was written 27 years ago.  I was surprised not to see any reference to 
rights in the paper - FP2020 talks about women's and girl s' rights to family planning and work on 
rights -based approaches to family planning have progressed since 2012.  Quality and access are 
part of rights but are not synonymous with rights.  I realize it has come out since this paper was 
written but the autho rs might want to check out Anrudh Jain's update of the Bruce Framework ( 
http://www.popcouncil.org/uploads/pdfs/2017RH_QoCRightsBasedFP.pdf).  It would be good to 
say that while there increasing attention to rights -based family planning, URHI was designed to 
improve access to quality family planning services.  The discussion (page 9) also says that 
improving access and quality - linked with demand is what is needed in FP2020 countries.  What 
about other components of rights -based family planning?   
 
On page  2 there needs to be a better transition between the introductory material on the evidence 
for access and quality of care and the URHI project.  What about saying that the purpose of the 
paper is to use evidence on access and quality from three countries t hat participated in the URHI 
and then describe the initiative.   
 
The authors seem to use access and availability interchangeably - please clarify.  
 
Page 5:  The authors note that the interventions in the three countries varied - but just seeing the 
list o f the components for each country on page 5 seems like apples and oranges and does not 
give the reader any sense of what the components entailed - and if they can be compared across 
the countries.  Could the authors give any additional information about th e components and the 
comparability across countries.   
 
For example, training of providers - was the content similar across the countries?  How does 
whole site training differ from "any interviewed provider received training from URHI at any 
time."  The co mponents of contraceptive supply management also differed - in Kenya it was 
redistribution of methods between facilities, in Nigeria it was no stock -outs in the last month 
(which is an outcome rather than an intervention) and in Senegal it was the push mod el - can 
those be compared?  With these differences across countries, it is not clear how to interpret the 
findings across countries.  Was it the combination of components that made the difference?  Was 
URHI better implemented in certain countries?  The st arting point for family planning 
programming was different in the three countries - Kenya is far ahead of Nigeria and Senegal - 
how did that affect the results, if at all?   
 
Page 6:  the loss of observations was high - around 40 percent in each country.  D id the authors 
do any analysis of the facilities that were lost compared to those included in the analysis?   
 
Page 6:  The sentence: "We used a matched sample of facilities for which data were available for 
independent and dependent variables for both tim e periods" is not clear.  Does that just mean that 
facilities for which data were available for both baseline and endline were included?   
 
Page 6:  I don't understand the use of the term "Participation in non -URHI program 
components…"  Why non -URHI?   
 
Are the methods appropriate and well described?  
If not, please specify what is required  in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please  explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
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