QUALITY OF FAMILY PLANNING SERVICE IN GUJI ZONE OROMIA REGIONAL STATE

A thesis proposal submitted to the school of Graduate Studies of Jimma University in partial fulfillment
of the requirements for the degree of a Master of Public Health degree in Health service Management

6/4/2013
By Yirdachew Semu
Advisors: Dr. Elias Ali Yesuf (MD, MPH) –Department of Health Services Management, Jimma University
Contents
Abstract.......................................................................................................................................................2
1. Introduction & statement of the problem...............................................................................................3
2.Literature Review.....................................................................................................................................6
2.1 DEFINING ‘QUALITY’..........................................................................................................................6
2.2 The Definition and Objective of a High Quality Program...................................................................7
2.3 Elements of Family Planning program success..................................................................................7
1.Contraceptive Security.....................................................................................................................7
2.Client Centered Care.........................................................................................................................8
3.Easy Access.......................................................................................................................................8
4.Affordable service.............................................................................................................................8
5.Effective communication..................................................................................................................8
6.Trained Staff.....................................................................................................................................9
2.4 Benefits of Good Quality....................................................................................................................9
2.5 Quality of care as a factor that can inhibit the use of Family Planning services................................9
2.6 Analytical frame wok of the study...................................................................................................10
3. Objectives:.............................................................................................................................................13
3.1 General objective.............................................................................................................................13
3.2 Specific objectives:..........................................................................................................................13
4. Subject and methods:-...........................................................................................................................14
4.1 Study design....................................................................................................................................14
4.2 Study area........................................................................................................................................14
4.3 Source population...........................................................................................................................14
4.4 Study units.......................................................................................................................................14
4.5 Inclusion & exclusion criteria...........................................................................................................15
4.6 Sample size determinations.............................................................................................................15
4.7 Sampling procedure.........................................................................................................................15
4.8 Data collection instruments to be used are.....................................................................................15
4.9 Questionnaire development and data collection.............................................................................15
5. The study variables................................................................................................................................16
 5.1 Dependant variable.........................................................................................................................16
5. 2 Independent variables....................................................................................................................16
6 .Data management and analysis.............................................................................................................16
7 Data quality assurance..........................................................................................................................17
8.Operational definitions...........................................................................................................................17
9. Communication of the result.................................................................................................................17
10. Ethical clearance..................................................................................................................................17
11.work plan..............................................................................................................................................18
Budget Breakdown....................................................................................................................................19
Appendix...................................................................................................................................................24

Abstract
IntroductionBackground:

Quality is an essential element of any service if it is to attract and retain clients. Good quality
care in family planning (FP) services helps individuals and couples meet their reproductive
health needs safely and effectively. Studies of contraceptive discontinuation rates have indicated
that - with the exception of the desire to become pregnant - the principal reason for
discontinuation is dissatisfaction with the quality of services. Please add a statement here on why
this study is needed? Or the gap that had prompted this study.

OBJECTIVE

To assess the quality of family planning services in Guji zone, Oromia Regional state.

Methods & Materials

STUDY DESIGN: Descriptive cross-sectional study will be employed in .

SETTINGS: Governmentpublic Health health institution providing family planning services in

Guji Zone.

STUDY SAMPLE:
The study will be conducted in selected health facilities based on their pervious daily client flow.
422 women visiting these clinics for family planning services will be interviewed face-to-face
and client-provider interactions will also observed.

MEASUREMENTS:

Client exit interviews, observations of service delivery andFurthermore, clinic inventories were
will be used as survey tools to assess the quality in preparedness of the clinics, the service
delivery process and client satisfaction, as outcomes of the service. A set of indicators were
identified for this purpose

Total Budget: ????

Expected outcome:

Keywords: please list 3-5 key words here.

1. Introduction & statement of the problem
Quality is an essential element of any service if it is to attract and retain clients. Good quality
care in family planning (FP) services helps individuals and couples meet their reproductive
health needs safely and effectively [1,2]. Poorly delivered FP services can lead to incorrect, or
discontinued contraceptive use and cause unwanted pregnancies, infections, injuries and even
death [3]. It is the right of the clients to be treated with privacy and dignity, receive information
and the chosen contraceptive methods safely [4].
Family planning plays an essential role in improving maternal health, which is one of the eight
Millennium Development Goals (MDGs) world leaders have pledged to achieve by 2015. Family
planning is a low-cost yet effective way to lower maternal mortality by reducing the number of
high-risk births. Pregnancies that are too early, too close, too many, or too late pose adverse
health consequences for the mother, child, and family (5).

Rapid population growth has become the major threat facing the world today. .The population of
less developed regions of the world including Africa, most of Asia, and Latin America is
growing four times faster than the more developed Regions such as Europe, North America, and
Australia. By the year 2025, world population may reach a whopping 8.5 billion (6). Unplanned
population growth could have an effect on the environment and on people’s quality of life.
Ethiopia is one of the most populous countries in Africa. It stands after Nigeria and Egypt.
According to the 2007 census, the projected estimate for the year 2005 was 86.5-million with
annual growth rate of 2.6 (7). The Ethiopian population growth is increasing alarmingly from
year to year and it reached to 86,591,919 in 2005 E.C. (DHS 2011 ). High population growth
rates put pressure on the already meager resources and pose a serious challenge to developing
nations (8).
The Ethiopian population policy, which was adopted early 1993, has the objectives of reducing
the total fertility rate; reducing morbidity and mortality, as well as raising the contraceptive
prevalence rate to a national average of 44% by the year 2015 (9). However, the Ethiopian
population is growing at 2.6% per annum and the unmet need for family planning is high, about
25.3% (2011 EDHS). In Ethiopia, the probability of an adult woman dying from a maternal
cause during her reproductive lifespan is about one in 40 (5). When a woman dies in pregnancy
or childbirth, this affects not only the well-being of the family but also the social and economic
development of the community and nation. Further, the surviving newborns often suffer from
poor health and are at a greater risk of dying before reaching age five. Waiting at least two years
from the previous birth to attempt another pregnancy reduces the risk of illness and death for
mothers, as well as newborns, infants, and children. In addition to the health benefits, spacing
births allows parents to devote more time to each child in the early years, easing pressures on the
family’s finances and giving parents more time for income-generating activities (10).

The 2011 Demographic and Health Survey reported that while the current use of family
planning methods (contraceptive prevalence rate) among 15-49 years women was estimated to be
20%, 37% have used a method of family planning at some time, indicating a high
discontinuation (2011 EDHS). However, to be successful, family planning programs must be
sensitive to the community being served and set in a manner that meets the user's needs (11);
which can be addressed by improving their quality of care because the basis for action in family
planning, as stated in the program of action of the International Conference on Population and
Development, is to enable couples and individuals to decide freely and responsibly the number
and spacing of their children, to have the information and means to do so, to insure informed
choices and to make available a full range of safe and effective methods (12).

According to United Agency for International Development , prevention of unintended

pregnancy and HIV transmission can be achieved through dual protection. One of the most
effective ways to prevent unintended pregnancy and Human immunodeficiency virus (HIV)
infection is for mutually monogamous, uninfected partners to practice effective contraception.
Other dual protection methods are: the practice of abstinence and or delay of sexual debut,
correct and consistent condom use, and the use of an effective family planning method along
with correct and consistent condom use (dual protection method). Unprotected sex may lead to
sexually transmitted infections (STIs), HIV infection and unintended pregnancies. During
Voluntary Counselling and Testing (VCT), the risks of pregnancy should also be discussed
during pretest counselling. Referral to family planning services and provision of non-clinical
methods should be available for clients who want a family planning method ( 13 ). Studies of
contraceptive discontinuation rates have indicated that - with the exception of the desire to
become pregnant - the principal reason for discontinuation is dissatisfaction with the quality of
services [14). Thus an assessment of the quality of family planning services will make possible
the identification of problems that exist in the care of clients, enhance the attraction of clients for
family planning and ensure the continued use of the services.

The fact that Ethiopia is a large country with difficult terrain in many areas, low utilization of
family planning is especially high among the nomadic pastoralist community (15).

Assessment of the quality of service delivery in health facilities is receiving growing recognition
as a strategy for monitoring and evaluation of primary health care program in developing
countries (including family planning). Recently, the idea of quality improvement has been used
in managing health services, including those offered by Family planning Program (16). Studies
regarding status of quality of care in family planning services in our country are not carried out
sufficiently; however, such studies in other developing countries showed the presence of low
quality of care in such services being provided at service delivery points which contributed to
lessened service utilization. The study conducted in Jimma zone indicated that 10.9% and 8.1%
of those who reported problem clients expressed dissatisfaction with waiting time and solutions
given by the provider respectively (17). The other study conducted in Northeast Ethiopia
indicated that 66.3% responded there was no adequate privacy in service provision sessions and
18% said that it was difficult to understand the service provider (18 ). Why this study is needed
despite theexistence of the studies from Jimma and Northwest Ethiopia. Are you going to use a
better design or method? Please, here write a passage about these issues.
The objective of this study, therefore, is to assess the existing level of quality of care in family
planning services in Guji zone and formulate recommendations for improvement, which in effect
increases service utilization and coverage.

2.Literature Review
2.1 DEFINING ‘QUALITY’
The US Agency for Healthcare Research and Quality defines quality health care as "doing the
right thing, at the right time, in the right way, for the right person—and having the best possible
results (19). Historically, quality has been defined at a clinical level, and involves offering
technically competent, effective, safe care that contributes to the client’s well-being. But quality
of care is a multidimensional issue that may be defined and measured differently, according to
stakeholders’ priorities.
  Clients, whose perception of quality may be influenced by social and cultural concerns,
place significant emphasis on the human aspects of care.
 Providers usually stress the need for technical competency, as well as infrastructure and
logistical support from their institution
 Program managers may focus on support systems, such as logistics and recordkeeping;
and
 Policymakers and donors are concerned with cost, efficiency, and outcomes for health
investment as a whole (20).
Available literature on medical and health care research includes various formulations for
defining and capturing the essence of ‘quality’. Among the earliest and most prominent are
Donabedian’s explorations of a definition and of the process involved in the provision of quality
care’. His pioneering work helped to systematize thinking on the multi-layered aspects of
‘quality’ in health services.
The concept of quality, as defined by Donabedian, is a ‘property’ or characteristic of medical
care. This characteristic can range from one end of the spectrum to the other (e.g. low to high
quality care) and can manifest itself through various elements or “attributes”. The first category
of attributes includes the technical aspects of care and the human context in which it is provided.
The second category of attributes, according to Donabedian, goes beyond the technical
interpersonal frame and includes accessibility and continuity. Another significant contribution to
understanding the definition of quality, particularly in terms of family planning services, comes
from Bruce''. Her broad definition includes the ways in which individual users are treated by the
system. Bruce has identified a framework which encompasses six fundamental elements crucial
to the quality of family planning services if clients' demands and expectations are to be fully met.
These elements include technical competence, provider-client information flow, choice of
methods, interpersonal relations, follow-up and continuity mechanisms, and the appropriate
constellation of services. This model, developed by Bruce, has spurred interest in the different
elements of quality in reproductive health-care services (19).

2.2 The Definition and Objective of a High Quality Program

According to Studies on family planning , high quality and low quality programes contrast as
much in content as in goals. The only standard for quality that can be articulated with confidence
is a process standard that gives answers to the following question: What is a program seeking to
do for its clients? A program of high quality is client oriented and aims to help individuals
achieve their reproductive intentions and goals. Although its focus is not on demographic targets,
a high quality program would still have an impact on fertility reduction. Such a program,
however, will not implement fertility reduction policies that may come in direct conflict with its
client’s welfare. Nevertheless, improvement in the quality of care will reduce fertility by
increasing contraceptive use (21).

2.3 Elements of Family Planning program success

Roux identified the following six elements of family planning success and these will be
discussed as the basics that will improve quality of family planning services:

1.Contraceptive Security
To succeed, a family planning program needs an uninterrupted supply of a variety of
contraceptive methods that clients can choose from and use their preferred method without
interruption. Successful programs provide contraceptive security ensuring that people are able to
choose, obtain, and use high quality contraceptives whenever they want them. Offering full range
of contraceptive options is also important. Contraceptive security requires planning and
commitment on several commodities, equipment and other supplies should be always available.

2.Client Centered Care

When clients receive services that are tailored to their needs, they are more likely to find a
suitable method, continue to use it and return to a provider when they need help or another
method. Client centered care means that clients′ needs guide the planning and implementation of
family planning services. It also means that services meet medical standards, which require
provider’s commitments and expertise.

3.Easy Access
When clients can easily obtain services, they are better able to use family planning and to obtain
help when they want it. In the broadest sense, a population has good access to services when
service delivery points are conveniently available to everyone, and everyone knows where to
find these services, everyone feels welcomed, services are free of unnecessary administrative and
medical barriers, and people can choose from a range of contraceptives. Offering services
through multi channels, such as clinics, community based distribution, private practices, mobile
or temporary facilities, and retail outlets, helps to increase access .
4.Affordable service
As the number of contraceptive users increases worldwide, growth is fastest among those least
able to pay for services. The decrease in donor funding for many programs challenges these
programs to keep services affordable for everyone while ensuring that people are able to choose,
obtain, and use high quality contraceptives whenever they want them. Targeting free or
subsidized family planning services affordable for all clients should be considered.

5.Effective communication
The highest quality, most accessible health care services are pointless if people do not know
about them or want them. Effective behavior change communication activities raise awareness
about family planning, motivate individuals to seek services, and help them to successfully use
their contraceptive method of choice.

6.Trained Staff
Good quality services require a strong human resource system, a supportive working
environment, and motivated providers who are well trained in clinical procedures. Providers
should also have up to date knowledge of contraceptive technology and good interpersonal
communication skills (22).

2.4 Benefits of Good Quality

Quality of care, a client-centered approach to providing high-quality health care as a basic
human right, has emerged as a critical element of family planning and reproductive health
programs. It has been promoted by local stakeholders, such as women’s health and primary
health care organizations, and affirmed at international conferences, such as the 1994
International Conference on Population and Development.
Several impact studies have shown that improving the quality of reproductive health services
increases contraceptive use. Studies in Bangladesh, Senegal, and Tanzania showed that women’s
contraceptive use was higher in areas where clients felt that they were receiving good care than it
was in areas with lower quality health facilities (17).
Providing high-quality care also makes sense for service providers, since improving basic
standards of care attracts more clients, reducing per capita costs of services and ensuring
sustainability. For example, the Bangladesh Women’s Health Coalition attracts clients by
providing a mix of services, so that clients can use a visit for more than one purpose, and by
having well-trained paramedical personnel, rather than physicians, perform pelvic exams, IUD
insertions, and menstrual regulation services. The high volume of clients has enabled the
program to distribute its fixed costs over a larger number of clients, allowing the coalition to
serve more people at a lower cost (23).

2.5 Quality of care as a factor that can inhibit the use of Family Planning
services
The quality of family planning services has a strong impact on contraceptive use (Koc, 2000).
Choice is the first and fundamental element in providing quality family planning. Making family
planning available at various types of outlets also promotes choice. Until the 1990s the emphasis
was on the quantity of services provided rather than the quality (DeGraaf, 1991). DeGraaf (1991)
argues that evidence from field programs demonstrates that the quality of services provided can
have an important impact on contraceptive use. Quality in family planning programs means
extending the choice of contraceptive methods, providing adequate information, increasing the
technical competence of providers, improving interpersonal relations between providers and
clients, and incorporating adequate client support and follow- up. Much of the failure to use
existing services is attributable to lack of quality. A study in Indonesia found that 12 months
after receiving contraceptive services, 85 per cent of women who had not received their first
choice of method had stopped using contraception (Fathonah, 1996). In addition, a Bangladesh
study found that lack of counseling about usual side effects and their significance was the main
reason why women discontinued using injectables (DeGraaf, 1991).
Studies regarding status of quality of F/P service in Ethiopia are not carried out sufficiently.
However studies in Jimma , showed that, 69(10.9%) and 14(8.1%) of those who reported
problems expressed dissatisfaction with waiting time and solution given by providers
respectively. Method unavailability was the reason in most services delivery points for providing
methods different from client choice. In this study again provider’s special training and time of
training have shown significant difference on quality of indicators. Several constraints in the
service provision of family planning were also identified (17).
2.6 Analytical frame wok of the study
In this study, the J. Bruce (1990) framework was used, which is the central paradigm for quality
in international family planning Program. The Bruce framework has at least four main
advantages over other efforts to evaluate the quality of family planning care.
 First, in contrast to other quality of medical care frameworks (e.g., Donabedian and
others), Bruce’s framework is tailored specifically to family planning.
 Second, the Bruce framework provides a comprehensive framework for evaluating the
interpersonal dimension of quality of care and for developing appropriate indicators, a
perspective that has been lacking in most other quality frameworks.
 Third, the Bruce framework focuses attention on the actual process of service provision,
as opposed to a primary focus upon service structure (e.g., staffing, equipment) or service
outputs (e.g., number of contraceptive users, unintended pregnancy).
 Finally, the Bruce quality framework takes as a central focus the perspectives and direct
experiences of clients themselves with the service process.
The Bruce framework consists of six main elements:-
1. Choice of methods: number of contraceptive methods offered on a reliable basis;
methods offered to serve needs of major subgroups (age, gender, breast-feeding women);
satisfactory choices for couples wishing to space/limit births; no unnecessary restrictions
upon methods.
According to a study conducted by Bessinger & Bertrand as cited in Becker and others,
providers should ask new clients about their fertility intentions and assist them to select
the most appropriate family planning method. Observers noted whether the provider and
client discussed her desire for more children or the timing of next birth, staff conducting
exit interviews asked each woman if the provider asked her whether she would like to
have more children. In each country, results from observations and exit interviews were
comparable (53% and 63% in Ecuador, for example). In Ecuador and Uganda, the
proportion of women who stated during exit interviews that they received their preferred
method (84% and 81%, respectively) was slightly higher than the proportion recorded
during observations (80% and 76%, respectively). In studies asking clients directly about
the method of choice available to them, few clients reported being unable to obtain their
method of choice from the provider. Nevertheless, one-third of a nationally
 representative sample of black women reported that a family planning provider had
strongly encouraged them to adopt a specific birth control method when they had wanted
to use another one( 24).

Information to clients: information provided to clients during service interactions which allows clients
to choose and use contraception with competence and satisfaction. This includes information about
method contraindications, method advantages and disadvantages, how to use selected method, potential
side effects, and continuing care from service providers.

Studies asking clients about specific information provided during the visit generally have found
high proportions reporting discussions about specific topics, such as the effectiveness of different
contraceptives and how to use particular methods. However, studies that have asked the clients to
rate the quality of the information provision overall have tended to find less positive results.
Fourteen percent of women in Washington felt that their family planning provider had not given
them sufficient explanations at their most recent visit, among women seen at hospitals, the
proportion reporting incomplete explanation was 25% (24).

2. Technical competence: providers’ clinical techniques; observance of protocols; and

asepsis in clinical conditions
3. Interpersonal relations: the degree of empathy; trust/ rapport, confidentiality/ privacy;
and sensitivity by provider to the client’s needs.
Across studies, women have generally reported respectful and friendly treatment by
providers. However, few studies have distinguished clinicians and other staff members’
interaction with clients. Another aspect of client-staff interactions that has been studied is
privacy, some studies have identified problems with privacy, especially while clients are
waiting to be seen for their appointment (24).
4. Mechanisms for encouraging continuity and follow up: encouraging continuity of use
through well-informed users/formal program mechanisms. Mechanisms could include
both mass media and client-based follow-up mechanisms (return appointments, home
visits to clients)
 5. Appropriate constellation of services: the extent to which family planning services are
situated to be convenient and acceptable to clients. This includes their accessibility
(distance, timing, cost) and the degree of integration with other services (vertical,
integrated with maternal and child health services, comprehensive reproductive health
services) .

IMPACT ON
CLIENTS
PROGRAM QUALITY OF CARE
READINESS RECEIVED BY
CLIENTS
AREA

 Access  Choice of methods

Components

 Infrastructure  Information exchange  Client

 Contraceptive  Interpersonal relations satisfaction
availability  Provider competency  Method
 IEC materials  Mechanisms to continuation
 Equipment encourage continuity/ follow-up
 Staff care

Figure 1. Model used in identifying the assessment of quality in the FP services.

3. Objectives:
3.1 General objective
 To assess the quality of family planning services in Guji zone, Oromia Regional
state.

3.2 Specific objectives:

 To determine the proportion of assess knowledge & skills of family planning providers
with adequate knowledge and skills on contraceptive methods.
 To assess client provider interaction in the HFS of Guji Zone.
 To assess acceptability of family planning services by clients.
 To measure the percentage of clients satisfied withassess client satisfaction onthe
provided services.
  To assess the availability, adequacy of logistics & supplies for family planning service.

4. Subject and methods:-

4.1 Study design: -Both qualitative and quantitative cross-sectional study.

During this survey, data will be collected using structured questionnaire form September 2013 to
October 2013. As supplement to questionnaire, an in-depth interview and observation will be
also conducted.

4.2 Study area and period: - Guji zone is one of the 18 zones of Oromia region. It is
located at southern parts of the region. It is bounded by Bale Zone in the East, Borena Zone in
the South-East; Somali Region in the South and SNNPR in the North-West. The Zone has an
area of 35,454 sq.kms; while its population density stands at 43 persons per sq. km(Please cite a
source here). Based on the 2007 Population and Housing Census (Pleae cite a Reference here),
the zonal population in 2005 E.C. is estimated to be 1,628,796 with 1:1 sex ratio. The Zone has
13 woredas and two town administrations with 322 rural and 35 urban kebeles.
The Zone currently has a total of 355 health institutions, out of which 2 are hospitals, 52 health
centres and the remaining 302 health posts. Medical staff engaged in the provision of health care
services in government owned health facilities include: 10 physicians, 72 health officers, 394
nurses of all categories, 23 environmental health workers and 683 rural based health extension
workers (Cite a source here) .With all these health institutions there is Family Planning service
and the contraceptive prevalence rate is 28 % . This study will be undertaken form September
2013 to October 2013.
4.3 Source population: - All female reproductive Age group (15-49) in Guji Zone

4.4 Study units: - All female Family Planning users and service providers who will be
available during data collection time.

4.5 Inclusion & exclusion criteria:-All females who are Family Planning users at the time
of data collection are included in the study, but all male contraceptive users at the time of data
collection are excluded from the study.

4.6 Sample size determinations

The required sample size will be determined by using single population proportion formula
considering the following assumptions:-Prevalence of 50% (considering the availability of
personnel and contraceptive methods), level of significant, 5%, and margin of error = 5%, and
10% non-response rate. Then the formula for calculating the sample size will be.

n = (zα/2 )2 P (1-P) . =384 +10% non-response rate = 422

d2

4.7 Sampling procedure: - Since it was very difficult to cover all Family planning sites
within the time and resources available for the study, only “Major Family planning sites”, will be
selected based on daily flow of clients, & involved in the study based on convenience.

4.8 Data collection instruments and methodsto be used are:-Standardized

structured questionnaire for face-to-face exit-interview, structured check lists for non-
participatory direct observation of client-provider interaction, cCheck lists for document and
record review, and guide for in-depth interview for service providers, & zonal coordinator

4.9 Questionnaire development and data collection:-

The format for questionnaire will consists of likert style and ranking format. Liker type approach
involves providing people with a statement and asking them to indicate how strongly they agree
or disagree (having a scale of range 1 strongly disagree to 3 strongly agree).In ranking format, a
lists of alternatives will be given and they are asked to rank their preference. The questionnaire
will be pre-tested in Family guidance Association clinic and in any other Health center in Addis
Ababa which is similar to the study group to ensure that the questionnaire is clear for the
respondents. The questionnaire will be checked for its clarity, understandability, completeness,
reliability, consistency, sensitivity, time and pattern of response. Then correction will be made
accordingly.

Eight enumerators will be selected and recruited for data collection. Two coordinators will be
recruited and they will strictly follow to ensure the completeness of questionnaire and to give
farther clarification. Three days training will be given which is based on the manual that will be
developed, and later discussion will be made.

Qualitative study:-The study will be supplemented by an in-depth interview and observation of

provider–client interaction. An in–depth interview will be conducted with all service providers.
Structured checklists will be used to assess the provider client interaction and for inventory of
logistics. Service providers also will be asked about their training, knowledge on the practice of
service delivery. During record review of family planning monitoring charts, reporting, the
presence and functionality of the different logistics will be investigated. Inspection will be done
to assess the availability, functionality, and adequacy of equipments and supplies

5. The study variables:-

5.1 Dependant variable: - F/P users satisfaction.

5. 2 Independent variables are:-Method choice (enough methods), Provider competence

(skills and experience), information about methods, positive feeling of providers, and socio-
demographic variables

6 .Data management and analysis: -

The completed questionnaire will be checked for completeness and consistency by the
principal investigator. Code will be given to the completed questionnaire. The coded
questionnaire will be categorized by health institution (health service delivery points). The
 principal investigator with an experienced data clerk will enter the data using EPI info version
6.0 and SPSS 10.0 statistical packages. Data clean up will be performed to check for, accuracy,
consistencies, & values. Any error will then be identified and corrected. Central tendency &
dispersion will be used, analyzed and described in the form of frequency tables & depicted
graphically. Internal comparison will be made. Chi-square test and/ or ANOVA will used to
determine the level of significance.

7 Data quality assurance: - data collectors will be instructed to check the completeness of
the response. The principal investigator and filled supervisor will recheck completeness of the
questionnaire immediately after interview at field level and during submission.

8.Operational dDefinitions of terms:-

1- Quality:- in health care and Family Planning service, this means offering a range of
service that are safe ,effective and that satisfy clients needs and want.
2- Logistics: - Family Planning equipments, supplies and physical set-ups like storage
facilities for use by service delivery points.
3- Choice of methods: - The freedom given to clients to choose a method according to their
Family planning intention, preference, & health status.
4- Information Given to clients:- The information imparted during service contact that
enables to choose, and employ contraceptive methods effectively
5- Waiting Time: The time gap between the client’s arrival at the SDP and the time the
client received F/P services.
9. Communication of the result:

The result of the study will be communicated to the organization or institution or individuals
who have direct or indirect input to the project. All attempts will be made to present the results
of the study on local and/or international Journals.

10. Ethical clearance:-Letter of ethical clearance will obtained from Jimma University.
Letter for cooperation from each level is expected, informed consent will be obtained, and
confidentiality will be maintained.
 11.work plan
S. Activities

Jan,2014
N
o
May

Aug

Nov
Mar

Dec
Apr
Feb

Sep

Oct
Jun

Jul

1 Development of proposal

2 Proposal confirmation by
advisors

3 Proposal defense

4 Finalizing proposal after ethical

clearance

5 Data collection

6 Data Entry & analysis

7 Report writing

8 1st draft submission to advisers

9 2nd draft submission to advisers

10 Thesis submission to advisers for
mock defense

11 Mock defense

12 Final thesis submission to the

departments (both 3 hard &
electronic copies through e-mail)

13 Sendingthesesto examiners(both
internal & external)

14 Final defense

15 Submission of final thesis with

approval of internal examiner &
advisers
 Budget Breakdown
s/no Budget category Unit cost Multiplying factor Total
cost

1 Personnel cost Daily wage (including Number of staff days

per diem)
(number of staff × number of working days

P.I allowance 150 1 principal investigator× 10days 1500.00

Supervisors ‘per diem 150 2 supervisors × 10 days 3000.00

Data collectors 150 12data collectors× 10 days 18000.00

Sub total Personnel TOTAL 22,500.0

0

2 Supplies Cost per item Number

Questionnaire dupli. 3birr/questionnaire 2340 7023.00

Clip board 20 15 300.00

Flip chart paper 2 50 100.00

Pen 3.00 30 90.00

Pencil 1.00 30 30.00

Eraser 1 birr 30 30.00

Sharper 1 birr 30 30.00

Marker 10 10 100.00

Transparency(pack) 150 1 150.00

Printing paper(pack) 90 6 540.00

Photocopying cost .5 2340 1170.00

Printing and binding 20 12 240.00

 Subtotal Supplies TOTAL 9803.00

3 Training Cost per item Number of days

Hall rents 500 2 days 1000.00

Tea/coffee 10birrperhead 5 days 600.00

/day(10X10 = 100)

Subtotal Training TOTAL 1600.00

4 Grand Total (total 1+2+3+4) 33,903.0

0
Reference

1. Bruce J. Implementing the user perspective. Studies in Family Planning 1980; 11: 29-33.
2. Jain AK. Fertility reduction and the quality of family planning services. Studies in Family
Planning 1989; 20: 1-16.
3. Adrienne J, Kols MA, Jill ES. Family planning programmes: improving quality. Population
Reports, (Population Information Program, John Hopkins University, School of Public
Health, Maryland), 1998; 26: 1-10.
4. Heuzo C, Malhotra U. Choice and use continuation of methods of contraception.
International Planned Parenthood Federation, London, 1993; 45-46
5. World Health Organization. 2010. Trends in Maternal Mortality 1990–2008.
http://whqlibdoc.who.int/publications/2010/9789241500265_eng.pdf.
6. Population today, 1992, 20 (10).
7. CSA. Population and housing census of Ethiopia. Results at the country level, statistical
report office population and housing census commission central statistical community, AA,
Ethiopia, 2007
8. John Hopkins University. Saving women’s lives. Population reports, 1994, 25 (1): 3-4.
9. Ministry of Health. Guidelines of Family planning services in Ethiopia 1996.
10. Population Reference Bureau. 2009. Family Planning Saves Lives 4th edition.
http://www.prb.org/pdf09/familyplanningsaveslives.pdf.
11. Family Health International Working papers: Maternal Mortality and Morbidity in Sub-
Saharan Africa 1995; No. WP 95-03:28-29.
12. World Health Organization. Improving access to quality care in Family planning: medical
eligibility criteria for contraceptive use. WHO/FRH/FPP/96.9: 1-2.
13. Family Planning/ HIV integration: technical guidance for USAID-supported field
programmes. United Agency for International Development, Washington.
14. Blanc AK, Curtis SL, Croft TN: Monitoring contraceptive continuation: links to fertility
outcomes and quality of care. Stud Family Planning 2002, 33(2):127-140.
15. Three Successful Sub-Saharan Africa Family Planning Programs: Lessons for Meeting the
MDGs
16. WHO, program for the control of diarrheal disease. Health facility case management Survey
guide lines Geneva, WHO, 1990.
17. Eskindir Loha, Makonnen Asefa, Chali Jira, Fasil Tessema ,Assessment of quality of care in
family planning services in Jimma Zone, Southwest Ethiopia

18. Mesganaw Fantahun Quality of family planning services in northwest Ethiopia

19. Agency for Healthcare Research and Quality, US Department of Health and Human Services.
Your guide to choosing quality healthcare: a quick look at quality. Available at:
www.ahrq.gov/consumer/qnt/qntqlook.htm. Accessed April 26,2007
20. Population Council and Population Reference Bureau New Perspectives on Quality of Care: No.1
21. Koenig et al. 1997; Mroz et al. 1999; Speizer and Bollen 2000
22. Kay et al. 1991, as cited in Kols and Sherman 1998
23. Women’s and Children’s Health Policy Center Department of Population and Family Health
Sciences Johns Hopkins University School of Public Health , Approaches and Indicators for
Measuring Quality in Region VIII Family Planning Programming December 2000.
24. Bessinger, R. E. & Betrand, J. T. (2001). International Family Perspectives Monitoring
Quality of Care in Family Planning Programs: A Comparison of Observations and Client
Exit Interviews, Vol.27, no.2 p.1-13. June 2001.

Appendix
English questionnaire for exit interview
Jimma University
 Medical Faculty
Department of Health service management
Please, here include a passage explaining the aim and method of the study to
the clients and asking for verbal or written consent to participate in the study.
Questionnaire on quality of family planning service to be filled by data collectors
Region______________ Zone_____________ Woreda______________
Cod number of the health institution______________
Code number of the client ------------ Client arrived at service delivery points-------- Time client
received service------- Waiting time-------------------
Interviewer: -
Name_____________________ Cod number_________________

Part I: Socio – Background characteristics

No Questionnaire Coding category Skip
to
10 How old are you? 1. Age in years ------ 88. Don't Know
1
10 Your residence 1. Rural 2. Town
2
10 What is your current marital 1.Single 2.Married & live together
3 status? 3.Married but not live together
4. Divorced. 5. Widowed
10 If married /have regular partner, 1.Yes
4 have you discussed family 2.No
planning with your husband?
10 Do you have children? 1.Yes 2.No Q111
5
10 If yes, how many living children 1.One 2.Two 3.Three & above
6 do you have?
10 What is the age of your youngest 1. ------Year/Month------- 88. Don't know
7 child?
10 Would you like to have more 1.yes 2.No
8 children 3.Depend on God 4.Depend on husband
10 If yes, when would you like the 1.Immedeatly 2.Up to one year
9 next child 3. Up to two years 4. Up to three years
5. After three years
11 Are you currently breastfeeding? 1.Yes 2.No
0
11 What is your educational level? 1.Illitrate 2. Write & read only
1 3. Primary school(1-8)
4.Secondaryschool completed
5.Tweleve +1& above
11 What is your religion 1.Orthodox Christian 2.Catholic
2 3.Protestant 4.Muslim
5.Other (Specify)-------
Religiosity based on worship 1. Daily church/ mosque goer
places attendance 2. Two-six times Weekly…
3. Weekly
4. Every 2 weeks
5. Monthly
6. During holidays
7. Not going at all
11 What is your ethnicity? 1.Amhara 2.Oromo 3.Tigre
3 4.Agew 5.Guragie
 6.Other (specify)----
11 What is your occupation? 1.Government employee
4 2.Private employee 3.Merchant
4.Un employed 5.House wife
6.Student 7.Daily laborer
8.Prostitute 9.Other (specify)------
11 What is your monthly income? ---------------Eth.birr
5
Family size including dependents
and relatives, in number.

Part II C1ient interview on service satisfaction (For both new & repeat)
 No Ques202tionnaire Coding category Skip to
201 Who told you for the first time about the 1. Husband 2. Neighbors
family planning service of this clinic? 3. Health professional 4. Other (specify)_____
202 How long did it take to you to arrive at 1.Less than 1/2 hr 2.1/2 to 1 hr
this clinic? 3.1 to 2 hrs 4.More than 2 hrs
88. Don't know
203 Are the opening hours for this clinic 1.Yes
convenient for you? 2. No 88. Don't know the opening Hours
204 How long did you wait between the time 1. No wait 2. Less than 1/2 hr
you first arrived to the clinic and gets 3. Half to one hour 4. 1 hour and above
family planning service? 88. Don't know
205 How do you feel about your waiting 1.No waiting 2.Short
time? 3.Long 4.Too long
88. Don't know
206 Do you feel that today you received the 1.Yes 2.No
information & service that you wanted? 3.Some but not adequate information and
service
4. I have received the service but not the
information.
5. I have received the information but not the
service.
6.Other (specify)---------------
207 If not why 1.provider do not want to tell me
2.the service I want was not available
3.time was too short & I did not get time
4. Other (specify). -----------
208 Did you feel that your consultation with 1.About right 2.Too short
the clinical staff was … 3. Too long 88. Don't know
209 During consultation, was the provider 1.Easy to understand 2.Difficult to understand
easy to understand? 3.Don't understand
210 Did you ask any question about family 1.Yes Q212
planning 2.No-----------------------
211 If yes, did the answer satisfy you? 1.Yes 2.No 3.Partically
212 Was there enough privacy during 1.Yes 2.No
consultation?
213 Do you know any other clinic where you 1.Yes
can get family planning service? 88. don’t know
214 If yes, is this clinic the closest site to 1. Yes 2.No 88. Don't know
your home?
215 Do you believe the service provider who 1.Yes 2.No
attended you today could be trusted with
secret?
216 Will you come back for next 1.Yes 2.No
appointment?
217 Would you recommend the services 1.Yes 2.No
provider you saw today to a friend?
Part II section I: - Question for new family planning users
No Ques202tionnaire Coding category Skip to
218 Why do you come to this clinic? 1. To start birth control 2. To get counseling
3. To get both service
219 Did you decide to use contraceptive 1.Yes 2.No------------ Q221
method at this visit?
220 If yes which method did you accept 1.Pills 2.IUCD
today? 3.Condom 4.Female sterilization
5.Diaphragn 6.Injectable
7.Spermicide 8.Nor plant
9. Other (specify)------------
221 If no, why did you not start to use 1.Change my mind
contraceptive method today 2.Came for information only
3.Pregnancey suspected
4.Contraindication for method wanted
5.Method wanted not available
88. Don't know
222 During the consultation for the method
you accept to use, did the health personnel
explain about the following
222. Clearly explains how the method works? 1.Yes 2.No
1
222. Demonstrate how to use it? 1.Yes 2.No
2
222. Describe possible side effects 1.Yes 2.No
3
222. Explain what to do if you experience any 1.Yes 2.No
4 problems before the next visit?
222. Explains the possibility of changing 1.Yes 2.No
5 method if you are not happy with it?
222. Where to go for supply or follow up 1.Yes 2.No
6 visit?
223 In addition to the method you 1.Yes 2.No______ Q225
received, were you told about any
other methods?
224 If yes, which method?
224. Pills 1.Yes 2.No
1
224. Injectable 1.Yes 2.No
2
224. Spermicidal 1.Yes 2.No
3
224. Diaphragm 1.Yes 2.No
4
224. IUCD 1.Yes 2.No
5
224. Condom 1.Yes 2.No
6
224. Female sterilization 1.Yes 2.No
7
 224. Nor plant 1.Yes 2.No
8
224. Other (specify)----------------------- 1.Yes 2.No
9
225 Will you come for next appointment? 1.Yes 2.No

Part II section II: - for re supply or follow-up clients

No Questionnaire Coding category Skip
to
226 Which method are you using? 1.Pills 2.Injectable
3.Spermicides 4.Diaphragm
5.IUCD 6.Condom
7. Nor plant 8. Other (specify)-----------
227 Which method do you know other than the
method you are using
227. Pills 1.Yes 2.No
1
227. Injectable 1.Yes 2.No
2
227. Spermicidal 1.Yes 2.No
3
227. Diaphragm 1.Yes 2.No
4
227. IUCD 1.Yes 2.No
5
227. Condom 1.Yes 2.No
6
227. Female sterilization 1.Yes 2.No
7
227. Nor plant 1.Yes 2.No
8
227. If other specify ___________ 1.Yes 2.No
9
228 Last time you have obtained family planning 1.Yes------------------------- Q230
method, did you get it from this clinic 2.No
229 If no, where did you get it 1.Other Governmental health institution
2.Private clinic 3.Community based
distribution
4.Pharmacy 5.Other
230 Did you pay for the service and for 1.Yes 2.No
contraceptive?
231 If yes how much for one visit? 1.Price for contraceptive per cycle ----
2.Price for service -------
232 If a friend of yours wanted family planning 1.Come to this clinic 2.Go to somewhere
service, would you encourage her to come to this else
clinic or go elsewhere? 88. Don’t know
233 If you encourage her to go somewhere else,
 why?
233. Long waiting time here 1.Yes 2.No
1
233. Far away 1.Yes 2.No
2
233. Poor quality service 1.Yes 2.No
3
233. Poor/inadequate consultation here 1.Yes 2.No
4
233. Only few F/P methods are available here 1.Yes 2.No
5
233. Other (specify)---------------------- 1.Yes 2.No
6
234 Which service did you like from this clinic?
234. 1.Get service with in short period 1.Yes 2.No
1
234. 2.Provider gives good 1.Yes 2.No
2
234. 3.Counselling was clear & satisfactory 1.Yes 2.No
3
234. 4.Received the method chosen 1.Yes 2.No
4
234. 5. Other (specify)-------------------------- 1.Yes 2.No
5
235 Will you come for next appointment? 1.Yes 2.No
Part II section III: - Knowledge questions for different contraceptive methods for both new
and repeat clients

I. For pills
No Ques202tionnaire Coding category Skip to
236 When do you start using pills? 1- With in the 1st to 5th day of
menstruation period
2- Any time
88. Don't know
237 How often could You take a pill? 1- One tablet every day
2- Any time
3- During sexual intercourse
88- Don't know
238 Have you told the importance of pills? 1- Yes 2- No
239 What are the minor problems, if any, you
may experience with taking the pills?
239. No problem 1- Yes 2- No
1
239. Mild headache 1- Yes 2- No
2
239. Small weight gain 1- Yes 2- No
3
239. Nausea 1- Yes 2- No
4
239. Spotting /bleeding 1- Yes 2- No
5
239. Other (specify) ----------------------------------- 1- Yes 2- No
6
239. Don’t know
7
240 Apart from the regular return or resupply
visit, for what problem, if any, would you
come back to the clinic?
240. Chest pain and shortage of breath 1- Yes 2- No
1
240. Severe headache 1- Yes 2- No
2
240. Sever leg pain 1- Yes 2- No
3
240. Vision problem 1- Yes 2- No
4
240. Other/specify/------------------------------------- 1- Yes 2- No
5
241 Did the provider tell you when to come back for 1- Yes 2- No
another visit?
242 Will you continue to use pill? 1- Yes 2- No
 II. for IUCD
No Ques202tionnaire Coding category Skip to
243 If intra uterine contraceptive device is 1. Touching the thread regularity
inserted, can you tell me how you check it is 2. It cannot slip out once it is inserted
in place? 3. Other (specify)-----
88. Don't know
244 When do you come back for first checkup? 1- No need to come back
2- Less than a month
3- After one month
4- After one year
88- Don't know
245 Have you told the importance of this method 1-Yes 2- No
246 What are the minor problems, if any, you
may experience with having an
intrauterine contraceptive device?
246.1 No problems 1-Yes 2- No
246.2 Spotting b/n Menstrual periods 1-Yes 2- No
246.3 Increased discharge 1-Yes 2- No
246.4 Infection 1-Yes 2- No
246.5 Other /Specify/-------------------------------- 1-Yes 2- No
246.7 Don’t know
Apart from the regular check - up visit for
247 what problems, will you return to the
clinic?
247.1 No problem 1-Yes 2- No
247.2 Heavy 1-Yes 2- No
247.3 Expulsion or cannot feel threads 1-Yes 2- No
247.4 Abdominal pain or sever cramps 1-Yes 2- No
247.5 Pain during intercourse 1-Yes 2- No
247.6 Fever, chills 1-Yes 2- No
247.7 Other (Specify)-------------------------------- 1-Yes 2- No
247.8 Don't know
248 Do you know how long can intrauterine 1- Number of Years-----------
device serve once it has been inserted? 88. Don't know
249 Will you continue this method? 1-Yes 2- No
III. For inject able acceptors

No Ques202tionnaire Coding category Skip to

250 Do you know which type of injection you had 1- Yes 2- No
had?
251 How often should you get an injection? 1) Every month
2) Every 2 or Every 3 months
3) Every year 88). Don't now
252 Have you told about the importance of this 1- Yes 2- No
method
253 Apart from the regular return visits, for
what problem, if any, would you come
back to the clinic?
253.1 No problem 1- Yes 2- No
253.2 Severe Headache 1- Yes 2- No
253.3 Heavy bleeding 1- Yes 2- No
253.4 Other/specify/----------------------------------- 1- Yes 2- No
253.5 Don’t know-
254 Did the provider tell you when to come back 1- Yes 2- No
for another visit?
255 Will you continue this method? 1- Yes 2- No

IV. For Norplant users

 No Ques202tionnaire Coding category Skip t
256 How often can you change Norplant ? 1- Every 5 years 2- Every 2 years
3- Every 3 years 4- Every 3 months
88- Don’t know
257 Do you told the importance of Norplant 1- Yes 2- No
258 Apart from the regular visit, for what problems, if
any, should you come back to the clinic
258.1 No problem 1- Yes 2- No
258.2 Sever headache 1- Yes 2- No
258.3 Heavy vaginal bleeding 1- Yes 2- No
258.4 Unexpected weight gain 1- Yes 2- No
258.5 Other/Specify/---------------------------------- 1- Yes 2- No
258.6 Don’t know
259 Did the service provider tell You when to come back? 1- Yes 2- No
260 Will you continue this method? 1- Yes 2- No

IV. for Tubal legation Users

No Ques202tionnaire Coding category Skip to

261 Have you been told the importance of tubal legation 1- Yes 2- No
262 For how long tubal legation serve 1.3 month
2. 1 year
3. Through time
4.other (specify)___________

Part II Section IV. Miscellaneous scale on client satisfaction

No Ques202tionnaire 1 2 3
Disagree Neutral Agree
263 Provider greeting is good and in a friendly why
264 Provider perform the procedure with cleanliness and
sanitation
 265 Provider has good knowledge and skill to perform the
procedure
266 Sufficient methods are available
267 Information given about the method is sufficient
268 Waiting time is adequate
269 Privacy was maintained
270 Waiting place is adequate with latrine and water
supply.

Part II Section V: - Preference of source that quality family planning can be

obtained better.
271. Please place in rank order (from most to least) you would believe you can receive better
service/especially on technical skill/.
Doctor_________
Nurse who is female________
Nurse who is male___________
Community based distributors________
Other specifies._____________

Sample Checklists for observation

 Code number of the client______________

 Date of Visit_________________
 Observation begun__________ end _________.
 Total time required_________
 Name of observer________________ Signature_____________
Checked by supervisor/investigator________________ Signature____________

Part I section I. Observation checklist for new family planning clients

No Questionnaire Coding category Skip
to
300 Does Provider greet client? 1- Yes 2- No
301 Does client know about modern family 1- Yes 2- No
planning?
302 Does client has preference for a particular 1- Yes 2- No
Method?
303 During consultation, did the provider talk
about any of the following?
303.1 Pills 1- Yes 2- No
303.2 Condom 1- Yes 2- No
303.3 IUCD 1- Yes 2- No
303.4 Spermicidal 1- Yes 2- No
303.5 Female sterilization 1- Yes 2- No
303.6 Vasectomy 1- Yes 2- No
303.7 Natural method 1- Yes 2- No
303.8 Diaphragm 1- Yes 2- No
303.9 Nor plant 1- Yes 2- No
303.1 Other/specify ----------------- 1- Yes 2- No
0
304 Did the provider promote or overemphasize 1- Yes 2- No
one method in particular
305 If yes, which method 1. Pills 2. Inject able
3. Condom 4. IUCD
5. Spermicidal 6. Sterilization
7. Natural method 8. Diaphragm
9. Nor plant 10. Other/specify--------
306 IEC materials used during consultation:-
306.1 Flip chart 1- Yes 2- No
306.2 Brochure/pamphlets 1- Yes 2- No
306.3 Sample of contraceptive 1- Yes 2- No
306.4 Posters 1- Yes 2- No
306.5 Anatomical model 1- Yes 2- No
306.6 Other (Specify)-------------- 1- Yes 2- No

Section II. Medical history and physical examination

No Questionnaire Coding category Skip
to
307 During consultation, did the provider ask
the client on the following?
307.1 About contraceptive method history 1-Yes 2- No
307.2 About date of LMP 1-Yes 2- No
307.3 Unusual vaginal discharge/bleeding 1-Yes 2- No
307.4 Pelvic pain 1-Yes 2- No
 307.5 Take weight 1-Yes 2- No
307.6 Take blood pressure 1-Yes 2- No
307.7 Sexual Transmitted disease Problems 1-Yes 2- No
/symptoms
307.8 Perform Physical examination 1-Yes 2- No
307.9 Did laboratory test 1-Yes 2- No
308 During pelvic Examination:
308.1 Client informed? 1-Yes 2- No
308.2 Provider wash hands 1-Yes 2- No
308.3 Sterile procedure used? 1-Yes 2- No
308.4 Client informed about out come? 1-Yes 2- No

Section III. Complete the following questions for the indicated methods & the likes

No Questionnaire Coding category Skip

to
309 If Intra uterine Contraceptive Device (IUCD)
was inserted: -
309.1 Uterus sound used? 1-Yes 2- No
309.2 Speculum used? 1-Yes 2- No
309.3 Sterile procedure performed used? 1-Yes 2- No
309.4 Emotional support given for Client? 1-Yes 2- No
310 If inject able was given to the client, did
the provider do the following?
 310.1 Injection site disinfected? 1-Yes 2- No
310.2 New/Sterile needle and syringe used? 1-Yes 2- No
310.3 DEPO vial shaken before drawing in to 1-Yes 2- No
syringe?
310.4 Injection site massage? 1-Yes 2- No
310.5 Clint sent to injection room? 1-Yes 2- No
311 For the method selected did the provider
told about any of the following?
311.1 How to use method 1-Yes 2- No
311.2 Advantage 1-Yes 2- No
311.3 Disadvantage 1-Yes 2- No
311.4 Side effects 1-Yes 2- No
311.5 Possibility of switching 1-Yes 2- No
311.6 What to do if problem arises about method 1-Yes 2- No
311.7 Where to go for re supply 1-Yes 2- No
311.8 Communicated about the method 1-Yes 2- No
312 Was the client told when to return for 1-Yes 2- No
resupply
313 If yes, did the provider give to the client 1-Yes 2- No
some form of written reminder?
314 Were any other health issues discussed at 1- Abortion 2- STD
any time during the consultation 3- Immunization 4- Other /Specify

Sample checklists for in-depth interview

Cod of the service provider__________________________
Sex ___ Age _____ marital status_______________
Educational status______________________
1. How long have you been working her? ___________
2. For how many years have you been providing family planning service ____
3. What kind of training have you ever attended? /on Job training/
4. Do you think that the training you have received in F/P is adequate to perform your duties?
5. What kind of training do you think that is important to improve service delivery in F/P
/practical, theoretical/
6. Are you able to perform the following procedures?
6.1. Injection of Depo-Provera, Norstrate.
Can you tell me about importance, side effect, and contra indications, pre requisition measures?
6.2.Norplant: - How to insert, pre requisition measures, side effects, contraindications,
importance, advantage and disadvantage.
6.3. UCD: - How to insert, importance, side-effect, contra-indication, pre requisition measures,
follow up of clients
6.4. Vasectomy or tubal legation: - How to do the procedure, its important, pr requisition
measures, who should decide.
6.4. Pills: - How many (in kinds) pills do you know, Importance, side effects, contra-indication,
for whom each of them are applicable, pre-requisition measure for each of them
7. What is the importance of availability of different contraceptive methods?
8. If a client would like a method that is not available at your clinic, what would you say to her?
9. In professional opinion, what do you consider to be the necessary procedures and tastes before
you can offer the method?
a). Pills b). Injections c) IUCD d) Norplant e) Tubal legation f.) Vasectomy. g) Diaphragm
10. Which method of F/P would you recommend for most people who would like to delay or
space their next birth?
11. Which methods of F/P would you recommend for most people who would like to have no
more children?
12. Which method never you recommend.
13. If client comes to you for F/P service and she is breast-feeding, what advice do you tell her?
14. In addition to using contraceptive methods do you think that some women in this community
use abortion to regulate their fertility? If so, how & where they perform it?
Method specific knowledge questions
A. Pills:
15. When should a client with regular menus start taking pills?
16. If a client forgets to take pill for one or two days, what she should do?
17. What are some minor problems, if any, a client may experience with taking the pills
B- IUCD: -
18. When IUCD can be inserted?
19. How the client check if the IUCD is in place
20. What are the minor problems for IUCD?
21. When should an IUCD client come back for the 1st cheek-up after the insertion?
22. For how long IUCD is effective?
C- Inject able
23. When should a client start an inject able contraceptive?.
24. When should a client return for the next injection?
25. What are the minor problems, if any client may experience.
26. Apart from the regular return visit, for what major problems, if any, should an inject able
client come back to the clinic?
D- SUGGESTIONS FOR IMPROVING FAMILY PLANNING SERVICES
 27. In your opinion which methods of family planning should be given priority and should be
improved?
28. In your opinion, do you believe that there are adequate teaching aids for family planning
clients coming to your institutions?
28.1 Is there a method to follow up defaulters among family planning clients?
28.2 If yes, which method of follow up are you using?
28.3 If a family planning client has a problem, which is beyond the capacity of the institution or
if the method the client desired is not available in the institution, is there a method of referring
her to a better health institution?
28.4 If yes, was feedback sent to you?

checklists for inventory

1. What is the official opening time for this Service delivery point?
2. How soon after the official opening time were services provided?
3. Are family planning services being provided on the day of the visit?
4. Is there a sign announcing that family planning services are available?
5. Indicate the number of staff who provide family planning service at this service delivery point
on the day of the visit, within each designation (eg, nurse, Dr----)
6. Which family planning IEC materials are available? List all that are available
7. Was “a health talks” held today? What was the topic? Who was educating (qualification)?
8. Is there a separate room or area for physical examination?
9. How was the condition of the examination room?
10. Is adequate light and water available in the examination room?

EQUIPMENT AND COMMODITIES INVENTORY

How many types of equipments are available in the service delivery point and/or in the
stockroom for family planning services (mention the available equipments)

S.NO Type of equipments Not available Functional Not Functional

11 Sterilizer
12 Blood pressure apparatus
13 Weight Scale
14 Flash light
15 Uterine sound
16 Speculum
17 Scissors
18 Teneculum
19 Antiseptic solutions
20 Disposable gloves
21 Examination table
22 Thermometer
23 Needle and syringe
24 Mini lap kits
25 Sterile gloves
26 Pregnancy test
27 Disposable needles and
syringes
28 Autoclave
29 Different contraceptive
methods
30 Minor surgery equipments
31 Other
(specify)______________

32. Is there a record system for keeping track of family planning commodities received and
dispensed?
33. Are family planning commodities stored according to their expiration date?
34. Are storage facilities for contraceptives adequate? (“Adequate” means no exposure to rain
and sun, protected from rats and pests. And not subjected to extreme heat)
RECORD KEEPING AND REPORTING
35. Is there a client record card for recording multiple visits or new card issued for each visit?
36. In what condition is the record-card system?
37. Is there a daily family planning activity register /logbook?
38. Are monthly statistic reports about family planning activity sent to a supervisor or higher
unit? IF YES, when was the last report sent? Is feedback received on reports?
39. When was the last time a supervisor come here in relation to family planning?