Managing and Using Information

Tools and Techniques

Specific Quality Assessment For Family Planning Services

For quarterly visits

I. Database: (For the comparison of different clinics)

1) Total population of target community:	a)____________________
2) Number of women aged 15-44 [usually 20% of a)]:	b)____________________
3) Number of different women, aged 15-44, who received family planning services at the clinic in the past 3 months	c)____________________
3.1) % of coverage = {4x(c)/(b)}:	d)____________________
4) Number of births in community in the past 3 months:	e)____________________
4.1) community birth rate = {4x(e)}/(a)}:	f)____________________
5) Number of family planning return visits in past 3 months:	g)____________________
6) Number of first visits for family planning in past 3 months:	h)____________________
6.1) ratio of return visits/first visits = (g)x(h):	i)____________________
7) Family planning methods provided by the clinic:

Injectable contraceptives

Number of visits for each method in the past 3 months:
Oral contraceptives	_______________
Injectable contraceptives	_______________
Sterilization	_______________
Condoms	_______________
IUDs	_______________
Contraceptive implants	_______________
Other	_______________
TOTAL
(A tally sheet to compare different clinics would follow)

II. Rapid Site Assessment

		Yes	Barely	No
1)	Is there an adequate and private exam area for pelvic exams (tables, curtains, etc.)?
		All	Some	None
2)	Are contraceptive supplies available?
Oral Contraceptive Pills IUDs Condoms Injectables Foaming Tablets Sterilization Contraceptive Implant
		All	3-4 items	0-2 items
3)	Are examination supples available?
Working speculum Clean sheets Stethoscope and blood pressure cuff Lamp or light with working batteries Spatulas, slides, and fixative for pap smears
			Yes	No
	Is there documentation on an individual client basis for family planning activities carried out at the clinic (charts, cards, etc.)?
If there is documentation of individual client records, then do a review of ten randomly chosen family planning clients seen in the past 6 months:
			number of clients out of 10
4)	Does the history note the gravida/parity		___/10
5)	Is any of the "Past History" completed?		___/10
6)	Is the blood pressure recorded?		___/10
7)	Is there documentation of any health education or counseling regarding birth spacing?		___/10
8)	Was there a pap smear done in the year prior to the birth spacing visit or since then?		___/10
9)	Is tetanus immunization status indicated; if documentation is not adequate, has immunization been done?		___/10
10)	Is there a follow-up visit in less than 6 months for all women put on OCPs, injectables, or IUDs?		___/10
	Number of women out of 10 put on these methods		___/10

III. Organizational Assessment

1)	List personnel at the clinic who are doing/will do family planning activities (attach additional pages as necessary): Name:_________________________ Position:______________________________________ Past Training:___________________ F.P. Training________________________ None_____
		Yes	No
2)	Is there a book of protocols for family planing?
		Used	Unused
	Does it look ...
		Yes	No
3)	Has there been a documented family planning supervisory visit to the clinic in the past three months?
	If yes, explain who visited and for how long:
		Yes	No
4)	Are family planning activities integrated with other clinic activities?
Review random sample of women aged 15-44 (choose five charts or names at random from log book) seen in the past two weeks for problems other than family planning and see if there is documentation that family planning was discussed with them: _____/5 women
		Yes	No
5)	Is there a referral system for family planning problems?
	Referral card seen
	Filled referral card seen
	Returned filled referral card seen
	Date on last card

6)	Is there a system to follow up on clients who don't return?
	Explain:
7)	Is there some program for the community promotion of family planning?
	Explain:
8)	Is there a system to facilitate return visits (for example, to pick up OCPs or get the routine injection)?
	Explain: