ABSTRACT
Although evidence suggests that the quality of care in Ministry of Health and Population [MOHP] clinics has improved and in many aspects is quite good yet other aspects including client-provider interaction is still deficient. The aim of the present study was to: provide base -line data on a wide range of indicators relating to quality of family planning services. It would also measure indicators of clients' perceptions of interaction with clinical staff, knowledge about family planning methods and satisfaction with provided services. The study is a cross-sectional facility based survey conducted in two governorates of Lower Egypt namely Menoufia and Sharkia. These represent two of the lowest governorates with the highest discontinuation rates and the lowest contraceptive prevalence rates. Two districts were randomly chosen from each of the selected governorates. Six family planning clinics were chosen to represent the different types of MOHP family planning facilities in each district, yielding a total of 24 clinics in both governorates. Field work was conducted during a four week period from October to November, 2000. All new and returning family planning clients who visited the study clinics during the recruitment period were eligible for the exit interview. Of these clients, the first 30 clients who visited the study clinics during the recruitment period were selected, with priority of selection given to new clients. A total of 726 clients completed the exit interview [434 new and 292 returning family planning clients]. In addition, a total of 240 family planning consultations were observed in this study with an average of 10 consultations per clinic. Study findings found the overall information exchange in all clinics to be inadequate, specifically information items considered essential for the determination of the clients' needs. Discussion of STDs and assessment of clients' risk of contracting an STD was also deficient where the total mean score for information exchange was found to be 5. Data generated from observations sessions showed that the mean number of methods discussed during encounters was 2.4. Data from the client exit interviews showed that 77% of new clients reported that they were given enough information about all methods and 71% were told about method use. Being informed of the possibility of switching to other methods was reported by only 60% of clients. The majority of clients received what they came for, with the exception of monopills [not available] and condoms. An index with a maximum value of 12 for counselors and 9 for physicians' interactions was computed. The mean score of counselors' and physicians' interactions was 4.9 and 4.0.The majority of clients were able to answer correctly the questions regarding pills [89%], injections [87%], and IUD [88%]. However, this was not the case for NORPLANT[R] [34%] or STD safety [5%]. The mean score of correct answers for specific methods was low. Overall, satisfaction was found to be acceptable with few exceptions. Of the core satisfaction areas on the questionnaire, the issue that was most frequently mentioned as causing dissatisfactions to the clients was the waiting time. Finally the study concluded that: The issue of CPI should be stressed upon as a mean of FP service quality improvement. Providers should be encouraged to sustain the good quality interpersonal relationship perceived by the clients. Provider attitudes towards information exchange in relation to STDs/A IDS should be investigated and addressed. Clients should be encouraged to take a proactive role in the delivered services. As well, family planning method shortages and biases for/against specific methods should be overcome in all MOHP clinics in order to ensure a meaningful choice for clients and to enable clients to achieve their fertility goals