Mystery Client Survey among Private Providers in the Sangini Social Franchising Network

Abstract

Background: This study was carried out for the USAID-funded Ghar Ghar Maa Swasthya (GGMS) project, which has an objective of ensuring the quality of family planning service delivery through the network of medical shops. A key project indicator is the percentage of franchise outlets that meet minimum quality assurance standards for FP/MCH product and provision of care. The results from this survey aim to provide a value for this indicator and additional information on quality of services in Sangini outlets. The primary objective of this study was to measure the quality of services delivery from Sangini providers in the 49 priority districts across the dimensions of pre-counseling, client assessment (screening), Sangini standard procedure, infection prevention, physical facilities, presence of behavioral change communication (BCC) materials, and product availability. Methods: The target group for this study was Nepal CRS Company (CRS) trained Sangini providers/outlets in the Sangini network in the 49 GGMS districts. The study used a mystery client approach in order to ascertain information on the quality of service delivery. The unit of analysis was the Sangini outlet. The sampling approach for this study was Lot Quality Assurance Sampling (LQAS) method and sampling was done using simple random sampling. The sample size of this study was 114 outlets: 19 outlets per five development regions and 19 outlets in the Kathmandu metropolitan area. The study was conducted from January to February 2012, following the training. Collated data were entered into a standardized data entry mask developed in EPI Info for data checking and cleaning. Following this, data were transferred into Excel for analysis. Results: The overall level of quality indicator was estimated as 50.1%, slightly lower than the target of 54%. Among the 86 components, the level of quality was highest in the western development region, where 61 of the 86 indicators met the quality standard. Across the hard-to-reach districts, 23 of the 86 components met the minimum quality standard, 24 were somewhat below minimum, and 39 were significantly below minimum. Conclusions: CRS senior management should review the list of components and prioritize areas that are most important to improve. CRS field staff can play an important role in making sure that supplies, sales support, and BCC materials are adequate at outlets. Future efforts should focus on enhancing providers’ interpersonal communication skills, and a follow up study should be conducted in the same regions in the coming year. Keywords: mystery client survey; private providers; quality; Sangini.