APPENDIX FOptional Session
Facilitative Supervision for Quality Improvement Curriculum
Compliance with the following:
(1) No quotas or targets
(2) No incentives, bribes, gratuities, or financial rewards for clients or program staff
(3) No denial of rights or benefits for not accepting FP services
(4) Provision of comprehensive information on health benefits and risks of the chosen method, plus inadvisable conditions and adverse side effects
(5) Full disclosure for experimental contraceptive methods and procedures
Quota or target = a predetermined number of births, FP acceptors, or acceptors of a certain method that a service provider or referral agent is required to achieve
Provider payments violate the amendment only when
payment is based on a quota or target, set as a
Clients must receive comprehensible information about risks, benefits, side effects, and contraindications of their chosen method.
USAID regulations on human subjects (22 CFR 225) provide necessary guidance.
Vulnerabilities vs. Violations
Put Tiahrt into perspective within informed
choice and quality of care:
(1) Community health workers have annual workload projections for FP clients, based on community needs assessments.
(2) Outreach workers are scolded, their salary is withheld, or they may be transferred to other sites if they do not achieve their workload projections.
(3) Using a performance-based disbursement (PBD) mechanism, USAID establishes “benchmarks” for sterilization or contraceptive acceptance that are linked to release of funds.
(4) Sterilization clients receive money, food, and/or clothing after completing the sterilization procedure.
(5) Government employees get a pay increase if they provide documentation of a client’s sterilization after the birth of a second child.
(6) Providers receive a per-case payment for sterilization clients.
(7) The best “performing” health centers in a program receive supplies and/or equipment as rewards, based on health indicators, including FP acceptance.