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: 21 Aug 2017 
 
Reviewer:  Kelsey  Holt 
 
Reviewer’s report:  
 
Review of "Impact of the Urban Reproductive Health Initiative on family planning uptake at 
facilities in Kenya, Nigeria, and Senegal"  
 
Thank you for providing me with the opportunity to review this submission. In this article, the 
authors present the results of a pre - post- evalua tion using facility audits and individual provider 
interviews to assess the impact of supply side interventions to improve family planning service 
quality in Nigeria, Kenya, and Senegal. The findings have great relevance for the FP2020 
initiative, given th at the outcome variables are directly related to the initiative's goals of 
increasing use of contraception.  
 
With minor revisions, I recommend the manuscript for publication.  
 
Feedback:  
 
1. It is critical that the authors engage with the component of FP202 0 related to rights -based 
service delivery and acknowledge in the Intro and Discussion that any supply side 
interventions should adhere to principles of voluntary, rights -based family planning 
service provision, and that comprehensive assessment of impact of supply side 
interventions should include client -centered, rights -focused measures. For example, I 
encourage authors to note in the Discussion that assessment of impact should also take 
into account not just contraceptive use but also include examination  of client -centered 
and rights -based measures such as client assessment of experience with family planning 
care. For reference, see recent work by the FP2020 initiative related to quality of care in 
the context of rights based family planning.  
 
2. The justi fication for fixed effects regression rather than mixed effects is not clear - please 
elaborate on what variables were included in the model and how that relates to the point 
authors make about facility improvements being targeted at underserved areas  
 
3. P-values for Tables 3 and 4 should be provided so that readers can gauge the degree of 
statistical significance  
 
4. More detail on how the findings from Table 3 were translated into the creation of dose 
scores should be provided, including a description of weighting or justification for no 
differential weighting of elements if appropriate.  
 
5. Limitations section should make clear that this approach to measuring impact of the 
intervention does not include a control group and limits causal inference capabilit ies (not 
only because of selection bias, which is mentioned, but also confounding by unmeasured 
covariates that may be associated with both contraceptive uptake and service 
improvements in a given area)  
 
6. Discussion of promise of the initiative based on t hese findings should include 
acknowledgement that the implementation of each component does not always equate 
with good implementation - e.g., provider training might have influenced uptake but do 
we really know that this is because training led to higher quality care? What if it was 
through a different mechanism such an inadvertent training effect leading providers to 
inappropriately encourage method use to the detriment of voluntarism?  
 
Thank you again for the opportunity to review this submission; I look  forward to seeing a revised 
version of the manuscript.  
 
Are the methods appropriate and well described?  
If not, please specify what is required  in your comments to the authors.  
 
No 
 
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 am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation  that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, e ither now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relatin g to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the  above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
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