Basics of Community-Based FP Workshop February 26 to March 3, 2007 Demeter Namuyobo, FPAU Paige Bowen, MIHV

1. Basics of Community-Based FP Workshop February 26 to March 3, 2007 Demeter Namuyobo, FPAU Paige Bowen, MIHV

2. Session Objectives At the end of this session, participants will be able to: Describe the different service quality elements and suggest program interventions for improving FP service quality Describe the basic features of external quality improvement, PDQ, COPE and how to use each

3. What is Quality Improvement? Set of activities carried out to set standards and to monitor and improve performance so care is as effective and safe as possible. Quality Assurance Project Monograph

4. Client Rights Information Access to services Informed choice Safety of services Privacy and confidentiality Dignity, comfort, expression of opinion Continuity of care Source: Engender Health

5. Elements of Quality Choice of FP methods � variety and reliable supply Information given to clients Technical competence Interpersonal relations Infrastructure / Equipment Appropriate constellation of services Mechanisms to encourage continuity Effectiveness Efficiency Source: Judith Bruce, MAQ, ADRA, QAP

6. 4 Principles Meets patient and community expectations and needs Focuses on systems and processes Uses data to analyze service delivery processes Encourages team approach to problem solving and quality improvement. Quality Assurance Project Monograph

7. Role of Managers in Supporting QI Establishing a culture of excellence Quality improvement as a priority Team approach Embracing change / innovations

9. Steps for Quality Improvement: QI Step #1

18. Quick Investigation of Quality (QIQ) Facility audit Observation of client-provider interaction Client exit interview

19. Service Provision Assessments (SPA) Community Questionnaire Facility Inventory Questionnaire Health Worker Questionnaire New FP Client Consultation Protocol (Observation) FP Client Exit Interview Questionnaire May add: STI Client Consultation Protocol STI Client Exit interview Questionnaire

20. Service Provision Assessments (SPA) Sick-Child Consultation Protocol Sick-Child Visit Exit Interview Questionnaire Antenatal Care Consultation Protocol Antenatal Care Client Exit Interview Questionnaire

21. COPE: Facility-Based approach to QI Self-evaluation approach Involvement of all staff in performance review Cyclical approach Assessment � Problem prioritization � Action � Evaluation Set of tools for self review

23. PDQ: Partnership Approach to QI Partnership Defined Quality � partnership between providers and community (both users and non-users) working together to identify and address priority problems. Recognition that quality may be defined from different perspectives (client / provider) Recognition that providers and clients can work together as allies to address problems � overcomes blame  Process for identifying problems separately, bringing providers and community members together, and establishing QI teams of providers and community members to address problems and continue to identify new ones in cyclical review.

24. The PDQ Process Steps

31. Information Sources for Assessing Access and Quality� �Eyeball� Service Delivery Site Visits Situation Analysis Personal Observation Interviews with providers, clients, managers and policy makers Client follow-up studies Client Oriented Provider Efficient (COPE) surveys Patient flow analysis Mystery client surveys Operations Research

32. Information Sources for Assessing Access and Quality� Previous evaluations and assessments Other specific studies revealing client perspective (data on clients� perception of the level of quality of care) DHS Service statistics (number of users, users by method, return visits, referrals, etc�) Service delivery guidelines Infection Prevention Guidelines and Protocols clearly posted, supplies and equipment available, and staff trained on use

33. Useful Reference Documents in areas of Access and Quality WHO Medical Eligibility Criteria (MEC) for Contraceptive Use WHO Decision Making Tool Essentials of Contraceptive Technology Pocket Guide for FP Service Providers, JHPIEGO Handbook of Indicators for FP Programs (EVALUATION Project) Compendium of FP/RH Indicators (MEASURE EVALUATION) USAID Technical Reference Materials (FP, etc�) FHI Checklists www.communitybasedfp.org Jim Shelton�s Contraceptive Pearls, jshelton@usaid.gov