Quick Investigation of Quality: A User's Guide for Monitoring Quality of Care in Family Planning (2nd Edition)

This resource offers materials needed to design and implement a practical, low-cost methodology for monitoring quality of care (QoC) in clinic-based family planning (FP) programmes in developing countries. QoC in FP and reproductive health (RH) programmes can be understood to incorporate 6 elements: choice of methods, information given to clients, technical competence, interpersonal relations, follow-up and continuity mechanisms, and the appropriate constellation of services. The importance of quality of care in FP/RH services was reinforced at the 1994 International Conference on Population and Development, where the focus of FP efforts shifted to a more comprehensive approach that calls for client-oriented, quality FP services that empower a woman to make an informed choice in an environment of dignity and respect. The FP2020 initiative (2014) placed further emphasis on the rights of women and girls to make informed decisions about their reproductive health.

Developed by MEASURE Evaluation, Quick Investigation of Quality (QIQ) refers to a set of 3 related data collection instruments designed to monitor 25 indicators of quality of care in clinic-based family planning programmes. First, the facility audit is used to determine the readiness of each facility to serve the client. Information is collected about types of services provided, types and amounts of supplies in stock, the condition of the facility, and the types of records kept. For instance, noting that information, education, and communication (IEC) materials can be valuable aids to communication, and their presence enhances the quality of services, the evaluator is asked to look for posters on the walls or doors of the facility and ask the staff in charge of FP services if they have flipcharts, brochures, or pamphlets. Second, in the observation, a person with clinical training follows the client and evaluates the performance of the provider during counseling and clinical sessions. Third, the client exit interview collects information about the client's experience at a given health facility. To arrive at the list of QoC indicators, members of the cooperating agency (CA) community with a particular interest in QoC and/or programme evaluation were surveyed to identify those indicators of quality they felt most directly affected quality outcomes in terms of client behaviour. For example, one indicator is: Provider demonstrates good counseling skills. "Specific behaviours that improve communication and/or make the client feel comfortable include:

• Asking open-ended questions
• Encouraging clients to ask questions
• Treating clients with respect
• Seeing clients in private
• Discussing a return visit
• Asking clients about concerns with the method chosen
• Using a client record, and
• Assuring the client's confidentiality.

...Provider skill in this area is particularly important because a client may be more likely to continue contraceptive use if s/he feels comfortable with his/her interactions with clinic staff." Along these lines, Indicator 15 is: "Client participates actively in discussion and selection of method (is "empowered") - Ideally, clients should feel comfortable to ask the provider questions and to participate in the discussion surrounding the visit. A client may be considered empowered if s/he initiates some of the topics of discussion and if s/he actively seeks information from the provider."

"Full assessments of service quality should include all 25 indicators and three data collection methods, however, users are invited to pull out, revise, and in other ways adapt the tools as needed to fit their particular monitoring needs. We also remind users that the tools can be modified for use with other areas of health as well."

The volume offers an overview of the QIQ (objectives, a short list of indicators, and methodological and ethical issues), guidelines for sampling and training of field personnel, instruments and guidelines for data collection, and summary results from the short list of indicators (tabular and graphic forms). This second edition (the first was published in 2001) contains all the original elements, though a few technical changes were required. For example, to reflect the fact that FP services are working to include men as clients, the guidance and tools are now gender-inclusive.

MEASURE Evaluation, which is funded by the United States Agency for International Development (USAID), is working in collaboration with members of the Monitoring and Evaluation Subcommittee of the Maximizing Access and Quality (MAQ) initiative assumed the lead role in developing and testing this method in 5 countries: Ecuador, Morocco, Turkey, Uganda, and Zimbabwe.