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5.4 ADHERENCE TO STANDARDS FOR QUALITY SERVICE PROVISION
To assess whether family planning providers adhere to service standards, NHFS staff observed
family planning client-provider interactions using checklists based on commonly accepted guidelines for
screening, counseling, and conducting procedures for family planning clients. The observers collected
information to answer the following questions:
Did providers talk about topics essential to determining the appropriateness of the methods
discussed, and, where necessary, did they conduct the physical examination needed to screen
clients for method eligibility?
Did the conditions and procedures followed for provision of specific methods meet national
standard criteria for quality service provision?
The NHFS observers noted what information the provider shared with a client and whether an
examination, where appropriate, was conducted prior to dispensing a method. They did not assess whether
the information given was correct or whether the findings of the examination were appropriately interpreted.
Overall, a total of 768 family planning consultations were observed during the NHFS. Less than
one-fifth of the female family planning clients observed were making their first family planning-related visit.
Tables 5.8.1 through 5.9.2 provide details on first-visit consultations. Tables 5.10.1 and 5.10.2 provide
similar information for all female family planning clients.
5.4.1 Counseling and Client Assessment at First Family Planning Visits
During a family planning visit, especially during a client’s first visit, providers are expected to elicit
information about clients’ personal and health history to help them make an informed choice about
contraceptive use and the methods they might adopt. Therefore, during observations of first family planning
visits, NHFS staff noted what information providers obtained about clients’ reproductive and medical history
and what examinations were conducted. The observers also recorded information relating to the counseling
that occurred during the visit.
Tables 5.8.1 and 5.8.2 present information for first-visit clients on whether providers discussed
specific elements of the client’s reproductive and medical history and conducted the two relevant
examinations (blood pressure and weight), by background characteristics. With regard to the elements of the
client’s reproductive history, just over half of providers asked about the client’s age (54 percent), history of
pregnancy (56 percent), current pregnancy status (53 percent), and the regularity of her menstrual cycle (51
percent). Surprisingly, providers generally did not discuss the woman’s childbearing desires (17 percent) or
breastfeeding status (if she had ever been pregnant) (10 percent), both of which may be important in deciding
on an appropriate contraceptive method. Overall, providers asked about all six items of the client’s
reproductive history in only 2 percent of consultations, all of which took place in health posts.
With regard to the client’s medical history, the most commonly discussed item was chronic illness
(19 percent). Providers only rarely asked whether the woman had any symptoms of sexually transmitted
infections (STIs) (4 percent) or smoked (3 percent).
Just under two-thirds of providers took the client’s blood pressure, and 57 percent weighed the
client. Only a minority of providers (30 percent) asked if the client had concerns or questions about methods
the client had ever used.
Family Planning Services • 105