Monitoring Quality of Care in Family Planning Programs: a Comparison of Observation and Client Exit Interviews

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Author(s): Bessinger R E, Bertrand J T

Year: 2000

As part of an ongoing initiative to identify efficient, reliable methods of monitoring quality of care in family planning programs, the Quick Investigation of Quality (QIQ) was developed and field-tested in multiple countries in 1998-99. The current analysis examines the comparability of results between observations and exit interviews on selected indicators using data from three countries (Ecuador, Uganda, and Zimbabwe). These two instruments differ somewhat in the type of information collected, yet there is considerable overlap. For example, observation is better at measuring accuracy of information during counseling and technical competence of the provider, whereas exit interviews provide the client's perspective on the services received. However, the two converge when clients report on the providers' actions during counseling and clinical examination. The researchers compared frequencies on selected indicators available from both instruments and calculated Kappa coefficients for agreement after linking data from observation and exit interviews for the same client. Although levels would vary across countries for a given indicator, within a country results were consistent between instruments. Agreement was good to excellent on many of the indicators. These data provide evidence that the QIQ is a reliable means of monitoring QC in family planning programs. Moreover, a number of the QC indicators can be obtained from either data collection method, raising the question of whether full implementation of both instruments is always needed. Although some programs may opt for one instrument over the other due to resource constraints, the combination provides a fuller assessment of QC.