Monitoring Quality of Care in Family Planning Programs: A Comparison of Observations and Client Exit Interviews

Abstract

Monitoring quality of care in family planning programs is important but the complexity and subjectivity of the topic create many challenges. The Quick Investigation of Quality (QIQ) was developed to monitor quality of care by using observations of client-provider interactions exit interviews with clients and facility audits. The QIQ was field-tested in multiple countries in 1998-99. Using linked data for 583 clients in Ecuador 539 in Uganda and 736 in Zimbabwe this analysis examines the comparability of results from observations and exit interviews. For a given indicator levels of agreement between data from observations and interviews varied across countries but within a country results were consistent between instruments. For the three countries combined agreement was good to excellent (kappas 0.47-0.98) on 13 of 14 indicators examined; observations and exit interviews yielded consistent responses in 63-99% of cases. Agreement was highest on the indicators that measured interpersonal relations. Inconsistencies reflected primarily that clients received information outside of the observed client-provider interaction. Observations and client exit interviews provide very similar results for many indicators. However while some programs may opt for one instrument over the other because of resource constraints the combination provides a fuller assessment of quality of care. (authors)