Assessing Client Profile Evaluating Client Satisfaction Through Exit Interviews MSIGlobal

Assessing Client Profile & Evaluating client satisfaction through Exit Interviews:

Guidelines

Guidelines for implementing the MSI Client Satisfaction Exit Interview Questionnaire Survey

for Marie Stopes International Partners

Marie Stopes International1 Conway Street – Fitzroy Square

Guidelines for conducting client satisfaction exit interviews

London W1T 6LP - United Kingdomhttp://www.mariestopes.org.uk

Contents

1. Introduction.................................................................................................................................................. 32. Aims and objectives....................................................................................................................................... 33. Ethical Issues................................................................................................................................................. 34. Planning....................................................................................................................................................... 34.1 Budget..........................................................................................................................................................................44.2 Deciding when to conduct the interviews..................................................................................................................44.3 Deciding who conducts the interviews.......................................................................................................................45. Methodology................................................................................................................................................ 45.1 Deciding the sample size.............................................................................................................................................45.2 Deciding which facilities to survey..............................................................................................................................45.3 Deciding when to sample clients................................................................................................................................56. The Questionnaire Tool.................................................................................................................................. 66.1 Adapting the tool.........................................................................................................................................................66.2 Notes regarding categories and definitions:..............................................................................................................77. Fieldwork...................................................................................................................................................... 87.1 Conducting the interviews..........................................................................................................................................87.2 Recognising and reporting survey limitations............................................................................................................88. Data management......................................................................................................................................... 89. Analysis plan and dummy tables..................................................................................................................... 910. Report writing............................................................................................................................................. 911. Support with exit interviews.........................................................................................................................9Appendix 1: Sample letter for assessing need for ethical approval........................................................................10Appendix 2: Work Plan........................................................................................................................................ iAppendix 3: Budget........................................................................................................................................... 2Appendix 4: Sample Client Notification Poster.....................................................................................................3Appendix 5: Provider Introduction Guide.............................................................................................................4Appendix 6: Sample client information sheet.......................................................................................................5Appendix 7: Sample client consent forms............................................................................................................6Appendix 8: Cored Indicators and Dummy Tables.................................................................................................7

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http://www.mariestopes.org.uk/


1. IntroductionClient satisfaction evaluations are an opportunity to involve clients in the process of your programme evaluation by consulting them about their experiences with your services. Whilst measuring client satisfaction does not measure outcomes, it can provide valuable feedback on process measures of your programme, such as cost, the helpfulness of support staff, treatment received and the physical setting of services.

Measuring socio-economic status (SES) or position (SEP) is important in understanding determinants of health. One other purpose of the exit interview surveys is to obtain a profile of the clients attending Marie Stopes International (MSI) to ascertain whether MSI is reaching poorer and more marginalised populations, and to understand other demographic characteristics of target populations.

2. Aims and objectivesThe overall aims of the exit interview survey is to identify whether MSI services are meeting the needs of clients who attend the MSI facilities (including centres, outreach facilities and social franchisees) and to identify areas to improve clients’ satisfaction of their MSI experience. Furthermore, this information is required for monitoring of SCALE and other large donor funded programmes. The objectives of the client satisfaction exit interview are:

to assess clients’ satisfaction of their experiences at MSI facilities, including their perception of quality of services provided; and

to assess the client profile. By collecting more socio-demographic information about our clients such as the level of education, marital and employment status, MSI can understand better the type of client is seeking different services and who is accessing the services to be able to see if there are client types (e.g. poorer people) that MSI could try to target as well as assessing the extent MSI are reaching underserved populations.

3. Ethical IssuesWhether ethical review is required for this type of evaluation will vary from country to country. All facilities that plan to conduct the exit interviews are advised to contact the appropriate Ethics Committee at the Ministry of Health to obtain approval to conduct this research. It is important to check whether this is required as MSI may in the future wish to publish the results of the exit interviews to share the findings with a wider audience than just MSI at country level. A sample letter is provided in appendix 1.

All potential respondents must be asked permission to be interviewed, and participation must be voluntary. Sample information sheets and consent forms are provided in appendix 2 and 3. This means that no one should be coerced to participate. Questionnaire forms must remain completely anonymous and confidential, and should not be linked to client records. Some ethics committees may waive the requirement of a signed consent form as the risk to the participants is minimal and if they can be reassured that the survey will be anonymous, unlinked and confidential, and that the data will be stored securely.

4. PlanningGood planning prior implementation of the exit interviews is essential to ensure there is appropriate budget and resources to produce timely, quality data that is useful for programmes as well as the partnership. A sample work plan is attached in appendix 2 that should be completed by the M&E Manager and shared with all team members involved in the survey. It is also important at the planning stage that all centre and outreach managers, as well as franchisee providers are informed of the survey and that their facility may be randomly selected to take part in the survey. The Research and Metrics Team (RMT) will support programmes in setting up the survey and data analysis.

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4.1 BudgetThe exit interview survey can be implemented internally or contracted out, and should not incur too much cost. Depending on the country and size of programme the exit interview survey will require a budget of between US$5,000 – 10,000. Programmes are advised to start budgeting for annual Exit interview survey as a part of their M&E activities either through MSI discretional Fund proposals or other sources of funding. A template of a budget for this type of survey is attached in Appendix 3.

4.2 Deciding when to conduct the interviewsThe timing of interviews can influence your results: the season, month and even the day of the week may affect the type of clients that attend facilities. No study can avoid bias, but it is important to recognise how the study might be affected by such issues and to address some of the major influences.

In order to address seasonal biases, it is advised that exit interview surveys are conducted twice a year, about 6 months apart. Careful consideration to the timing of the survey should take into any general factors that affect clients’ ability to attend the facility (such as holiday seasons, harvest periods, rainy season, other public events, etc.). Surveys should be conducted on days that represent as close to the ‘usual’ day as possible. Ideally, samples will be taken from clients attending the clinic from every day in one week.

4.3 Deciding who conducts the interviewsIn some settings, it may be feasible and appropriate for clients to complete self-administered exit interview questionnaires, for example when a population has universal literacy. However, in many of the MSI settings, this might exclude clients who cannot read or write, and this would be an important bias in the data obtained.

For this reason, it is advised that exit interviews to measure client satisfaction are conducted by an interviewer, preferably someone who is not directly connected to the service. Interviewees may include volunteers (consider college students) or former clients themselves trained to take on this role. In some settings, it may be more appropriate to have clients interviewed by someone of the same sex and of a similar age group to encourage more truthful responses by making respondents feel as comfortable as possible about being asked questions about their clinic visit. As an alternative if it is not possible to have non-MSI employees conducting the interview, consider having staff from other facilities conduct the interviews, maybe swapping staff for the duration of the survey so two reciprocal facilities conduct the survey at the same time. If the interviews have to be conducted by a facility member, it is best not to have the principal clinicians conduct the interview.

5. MethodologyThe following methodology is recommended to ensure the exit surveys have minimal standard procedures for deciding sample size, selecting clients to interview as well as the general set up of the survey. However, as all programmes differ in their design of implementation (e.g the way they do outreach activities), as well as differences in client flow for particular services, some parts of this suggested methodology may need adapting to ensure the survey is representative of your client population. Your Regional research manager will help you decide what will work best to suit your programme needs.

5.1 Deciding the sample sizeThe sample size needs to be big enough to detect important effects of outcome, but not so large that precious resources (e.g. time and staff) are wasted. The sample size needs to be adequate to capture the general profile of clients and satisfaction levels in each country, as well as for different service delivery mechanisms, namely: fixed clinics, outreach and social franchising. The minimum sample size is 300 clients, whereby 100 clients will be sampled form fixed clinics, 100 from a sample of outreach sites and another 100 from franchisee providers. The analysis will present data for each of these different clients, and not as an aggregate of all clients from the 3 service delivery mechanisms.

5.2 Deciding which facilities to surveyThe sampling framework proposed to identify which clinics to conduct the surveys is purposive to address the diversity of types and numbers of facilities in countries of different sizes, budgetary and other resource constraints. It

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is important that the facilities included in the study are randomly selected. This means that each fixed centre or outreach team has an equal chance of being selected for the survey.

Table showing how to select total number of facilities to sample for exit surveysType of facility Number of facility

in countryTotal number of facilities to sample

Fixed < 10 Minimum of 2 (if >1 in country)10 - 39 Minimum of 340 - 99 Minimum of 4≥ 100 Minimum of 5

Outreach < 10 Minimum of 2 (if >1 in country)10 - 39 Minimum of 340 - 99 Minimum of 4≥ 100 Minimum of 5

Franchisee < 10 ALL10 - 39 Minimum of 2040 - 99 Minimum of 20≥ 100 Minimum of 40

Nb. These are minimum numbers and the greater number of facilities included in the sample the more representative this will be of the programmes service delivery.

Selecting fixed centres and outreach sites:

To randomly select which facilities to survey two team members need to be involved in writing the names of each facility on a piece of paper and placing the names in a bowl. One person holds the bowl, and the other picks out the required number of facility names whilst ‘blindfolded’. This should be done separately for each type of facility (fixed and).

Selecting franchisee providers:

As the flow of clients for social franchisee is usually less than for MSI fixed centres and outreach (i.e average 3-5 clients a week for FP/SA), then the selection of providers will increase to minimise the length of time waiting at a clinic for clients to exit. It is advised that the first three FP/SA clients are selected from a franchisee up to two days, and then at the end of the second day the survey moves onto the next franchisee provided even if only one client was interviewed.

Social Franchising programmes may also want to consider including all types of clients in the survey, such as include non-FP / SA clients as well as FP/SA clients. By doing this you can understand more about the type of clients of these providers and if they are potential clients for FP services. Also, one important measure evaluating the SF programme is to assess overall quality of these services and franchisees therefore you may choose to include all types of clients to understand their feedback. You may want to discuss this with your regional research manager to decide what would work best for your programme, but also what is feasible in terms of time and cost.

5.3 Deciding when to sample clientsIt is suggested that clients are interviewed as they leave their final consultation or when they leave the clinic. However, this is biased by the fact that clients with positive views immediately following treatment may change their minds if the effects of treatment are negative, or vice versa.

Only clients attending for FP/SA services should be included in the sampling framework for your evaluation purposes. Great care must be taken to achieve a representative sample of clients. It is suggested that the sampling is spread over each day of the week, so that roughly equal numbers of clients are interviewed each day.

Below is a simple formula to help you calculate the number of clients to invite to interview each day, depending upon the sample size required from your facility, including an allowance for a percentage of clients who decline to participate:

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Estimated number of clients to invite to respond per day =

[ ( n / 100)* (% expected refusal rate)] * n . number of days the facility operates per week

Next, you need to spread the interviews out through the day so that all respondents are not interviewed in the morning. This is because those who come in the morning earlier may be different to the clients who come later (for example, they may live further away, or be the clients with more children who take longer to prepare before they can leave the house in time to get to the clinic). So, to decide how many clients to allow to pass before a client is invited to participate:

Invite every xth client to respond, where x =

estimated number of clients to invite to respond per day estimated number of client visits per week.

This formula is available in an excel spread sheet to assist in your country specific calculation that can be obtained from the RMT.

6. The Questionnaire ToolThe questionnaire has been designed to assess client profile and evaluate client satisfaction. The types of questions to ask and how to ask them have been thoroughly researched to be applied to most countries and include commonly used indicators for these type of surveys. The Questionnaire has been divided into four sections:

1. Interview & Site information2. Service Utilisation3. Client Profile4. Client Satisfaction & Feedback on Quality

The tool is a “global” tool that the RMT have developed to help programmes collect key data to inform management decision upon. The tool will also enable comparable analysis results across the partnership as well as fulfil specific programmatic decision making

6.1 Adapting the toolProgrammes should review the tool and decide what questions are relevant to the programme (type of FP services provided, what type of demographic information etc) and what are culturally appropriate to ask). Before fieldwork it is important that the final questionnaire is pre-tested among approximately 20 clients to test if the translation and possible answer categories are suitable for this population. These 20 clients should be representative of your usual client population.

Questions can be omitted but it is important that the order of question numbers for the specific questions are not changed, nor the answer categories. We need this to remain consistent for the data entry programme and for cross country comparison.

If answer categories are not relevant, for example for question 203: What services did you use today? And the programme does not provide foam tablets, diaphragm or ligation / vasectomy, simply cut these out of the questionnaire but do not change the numbers for the remaining service options. As demonstrated below:

201.

Which services did you use today? (mark all that apply) (local translation here)

1 Contraceptive pills, non-emergency2 Emergency contraceptive pills3 Male condoms4 Female condoms5 Foam tablets6 Diaphragm7 Injection8 Intra-uterine system or device

9 Implant 10 Ligation or vasectomy11 MSP12 MSMP13 Removal of implant or device14 FP counselling with no FP provision15 Other, State: ……………………………………..

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Cultural differences related to feedback on services differ from setting to setting. Methods for eliciting client feedback must take into account local cultural norms: tools and methods suggested here can be adapted to tailor them to each individual setting. Please check with your Regional Research Manager, RMT if you wish to make any changes or additional questions to ensure that you are obtaining data that will still be comparable across sites, Also note that additions may require re-submission for ethical approval and should also be discussed with the RMT.

6.2 Notes regarding categories and definitions:Definitions for Level of Education for Section 2, Q.306

Level of education is an objective measure and used to assess social patterning of health and health service use as well as been shown to be associated with health more than any other SEP indicator, Many surveys ask about literacy, but asking about education is considered by experts to be adequate: literacy is sometimes used as a marker of ‘quality’ of education, in addition to amount received. But is far from essential, and it’s not very widely used in health research.

The categories in the questionnaire are based on definitions widely used such as:

1. Formal education is that provided in the system of schools, colleges, universities and other formal educational institutions recognised by the Ministry of Education.

2. Non-formal education includes any organised educational activities that do not correspond to the above definition of formal education. This includes adult literacy programmes, basic education for out-of-school children, life-skills, work skills. If a religious school is not recognised by the Ministry of Education, then it is a non-formal school.

3. Vocational or technical training of education: mainly designed to lead participants to acquire the practical skills, know-how and understanding necessary for employment in a particular occupation or trade or class of occupations or trades.

Definition for Occupations

The definitions listed in the questionnaire tool are standard occupation categories. You may like to select categories of occupation that are officially used in your country or in other national surveys that are more useful or consistent with your programme’s monitoring needs.

For example, in a recent KAP survey in Sierra Leone KAP survey (2009) the following occupation categories were used:

Agricultural Worker / Housework in your own home / Housekeeper (for relative or employer)/ Middle professional (e.g forces, nurse) / Professional/Managerial/Technical / Student (in school or home awaiting results) / Trading/Vending for relative or employer / Trading/Vending for oneself / Apprentice (Seamstress, Hairdresser, etc)

Definitions for national level of poverty / average annual household income

Several methods exist to measure SEP, including the measurement of income or consumption expenditure based on the assumption that material living standards largely determine well-being. Although it has been argued that monetary measures fail to capture the diverse aspects of well-being, particularly in low-income settings where income is largely seasonal, as well as involving lengthy questionnaires that require skilled interviewers and subject to biases due to respondent recall and reluctance to divulge information about expenditure, the exit survey aims to capture a measure of poverty using an estimate of annual household income that will in turn be used in conjunction with other SEP indicators as explained above.

It is suggested countries find out their national median household income and in the survey it is asked if their household income is below this, equal or above this level. To ensure we capture the poorest of the poor, it may be advised to set the bar lower and use a median income value for which 25% (instead of 50%) of the population falls below.

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7. Fieldwork

7.1 Conducting the interviewsIn order to facilitate enrolling clients to the survey, notices can be placed in the waiting area informing clients that a survey will be conducted to assess satisfaction with their experience at the facility, and that some or all clients will be asked to provide feedback on their experiences in order to help improve the services. See appendix 4 for a sample notice that can be adapted visually and linguistically as appropriate for each setting. Receptionists or health educators can also inform clients upon registration that they may be asked to help with the anonymous survey, but that it is not compulsory and will not affect their treatment of service today.

Clients who access franchisee providers will need to be approached for the survey in a different way, as franchisees are independent practitioners and it is important that the intrusion of the survey is kept at a minimum so not to affect their business or the relationship with the MSI programme. It is advised that the franchise provider ask their clients about the survey (see provider introduction guide appendix 5) and then introduce those clients who are FP/SA clients and who agree to participate, to the interviewer waiting outside.

Clients should be approached in a friendly manner by the interviewer who should explain who they are, what their connection is to the clinic and why they have approached The ‘Client Information Sheet’ (see appendix 1) should be read out to the client, and a copy provided if requested. For each person asked, the consent form should be completed. A room or sheltered, private area will need to be identified, where clients can give feel at east to answer questions without anyone overhearing.

7.2 Recognising and reporting survey limitationsNo study can avoid bias, but it is important to recognise how the study might be affected by such issues and to address some of the major influences. The timing and frequency of surveys should be clearly indicated in reports and any associated biases or limitations should be discussed.

Exit interviews do not capture those who have not returned to the facility because of an unsatisfactory experience. It is also important to recognise that the evidence of positive client satisfaction does not provide sufficient information to confirm the effectiveness or accessibility of services, for example, clients with no base for comparison may be satisfied with a service that is ineffective as determined by more objective evaluations, and those who cannot access services will not be included in the sample of respondents. Conducting interviews as the client exits the facility ensures a higher response rate but does not provide adequate time for the client to assess the efficacy of outcomes of the treatment.

8. Data management Issuing study numbers for respondents might be most easily done by numbering the individual forms before the survey is conducted. This way, confusion and duplication of study numbers is avoided when more than one interviewer is involved. This also allows for inclusion of refusals to be counted and it will make the process of enrolling respondents quicker. Respondents’ study numbers should start with four digits that represent the month and year of the survey (for example, a survey conducted in April 2009 would start ‘0409’), and then by consecutive numbers starting from 001.

A data entry and an analysis programme with a manual that is available separately. These programmes will enable comparisons across sites and countries. For this reason, if questionnaires are amended, you must keep the question numbers for the specific questions the same because the responses (or variables) will be coded based upon these question numbers.

Data should be independently double entered at country level: this means that two different people should enter the data once each. Using the Epi Info programme, all differences in data entry can be identified and corrected. Guidelines on data entry will be issued along with the data entry programme by your Regional Research Manager.

Care must be taken to store the original forms in a locked cabinet and a locked room. Answer sheets should be kept separately from the consent forms with signature on them if ethics committees require signed consent. Forms can be destroyed once the data has been cleaned on electronic files and the data has been analysed.

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9. Analysis plan and dummy tablesTo ensure the data is presented in a simple way that is useful for programme managers to base decisions upon concerning: client profile, client satisfaction and client feedback on quality it is suggested the dummy tables listed in appendix 8 be completed. These tables include the core indicators that are required to address the following statements that underpin the purpose of the exit survey:

1. We are reaching poor and/or under-served segments of the population.2. Our beneficiaries are satisfied with our overall service delivery.3. Clients perceive our service delivery to be of high quality

Note, that the data will be disaggregated by the different clients who receive services from static clinics, outreach and social franchising and not as aggregate for the whole programme.

10. Report writingA template for a short report will be provided by RMT. The report will include sections explaining the Background to the programme, objectives of the survey, detailed methods section explaining sampling, selection criteria and any limitations with the study, key findings presented in dummy tables and descriptive analysis, conclusions and recommendations for further action described for each service delivery level (e.g clinic, outreach, social franchising) as well as the country programme.

11. Support with exit interviewsSupport with planning, implementation and analysis of the data will be provided by the Regional Research Manager of the Research & Metrics Team in London. For support, clarification and other queries about exit interviews, please contact Louise Bury at the following email address: [email protected]

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mailto:[email protected]


Appendix 1: Sample letter for assessing need for ethical approval

Your NameName of Facility / Country OfficeMarie Stopes InternationalPO Box 123CityCountry

Date, 2009Dr. XxxxChairEthics CommitteeMinistry of HealthPO Box 123CityCountry

Dear Dr. Xxx,

Marie Stopes International, MSI: Assessing client satisfaction & perception of quality with services through exit interviews

At Marie Stopes International, we are keen to provide our clients with high quality care and a positive experience at our clinics. In order to evaluate the experience of our clients and to incorporate their opinions into the evaluation of our work, we plan to conduct biannual exit interviews. These exit interviews will ask clients about their perception of quality and satisfaction. I would like to clarify whether formal ethical approval from your committee is required before we initiate the first survey: more details are provided below to inform your decision.

The cross-sectional survey will take place once or twice a year (depending on the size of each facility) and will comprise a component of our routine monitoring and evaluation procedures. Clients who have received services from an MSI provider will be systematically sampled and asked if they would like to participate in the survey. The sample sizes will be estimated to ensure adequate power and precision to enable statistical assessments of significance. The survey will be unlinked and anonymous, and participants will be asked for verbal consent, which will be recorded. The data will remain anonymous and confidential and will be entered on to a password encrypted electronic data base that only MSI staff will have access to. This data may be pooled across sites and countries and published if the findings are of relevance.

Data requested from clients is not sensitive and we do not propose to examine client records for these surveys. Please find attached a copy of the proposed survey manual including the questionnaire tool to be conducted in the following MSI facilities: we hope that this helps you to decide whether or not we need to apply for formal ethical approval to conduct these, or whether this formality can be waived as this will become a component of routine clinic monitoring and evaluation procedures.

I look forward to hearing from you in due course.

Yours Sincerely,

Dr Xxx

Position.

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Appendix 2: Work Plan

Activity

Month Month Month

1 – 7 8 - 14 15 - 21 22 - 28 29 - 30 01- 04 05 - 11 12 - 18 19 - 25 26 - 31 01 – 08 09 - 15 16 - 22 23 - 29 30

Review budget allocation

Prepare work plan

Review questionnaire / translate

Seek ethics approval (if necessary)

Create sampling frame (total number of fixed centre, outreach and SF providers)Identify / recruit interviewers

Plan and execute training for fieldwork

Conduct fieldwork: survey

Data entry and cleaning

Data analysis and dissemination

Write Research Report

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Appendix 3: Budget

This budget template is based on the survey being implemented in-house. If your programme requires external support to conduct the survey a different budget will be needed. Please ask you Regional Research Manager for support to identify and contract the work with a research agency.

No Categories Rate Amount (US$)

1 Training of interviewers (1-2 days) Documents, stationery, snacks

2 Fieldwork costs Lodging (hotel cost) Per diem for research team Car rent (2 trips) Local travel for researchers

3 Data entry and cleaning (optional) Data cleaning Fees for data entry ($1per questionnaires)

4 Administrative costs Cell phone for researchers Printing questionnaires Stationery (notepad, pencil etc) Admin cost (Office, computers, phone) Printing final report Total Estimated Budget

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Appendix 4: Sample Client Notification Poster

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Notice of client satisfaction survey

As valued clients, Marie Stopes International is continuously striving to improve our services so that you have positive experiences with quality

care.This week we are conducting a survey and will be asking some or all clients for YOUR feedback on

the services provided here.The interviewers may ask you for 15 minutes of

your time as you leave the clinic to help take part in the survey. Your help with this is important

because your thoughts and impressions are highly valued and will help us to see how we can

continue to improve the quality of our care to make YOUR experiences here better.

If you take part, we guarantee that we will not write your name anywhere, and your answers will

not be linked with your medical records: the survey is completely confidential and anonymous.

Your help will be appreciated, but whether you take part in the survey or not is completely up to you and will not in any way affect your care and

treatment at this facility.Thank you for your time!


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Appendix 5: Provider Introduction Guide

For franchisee providers to use when introducing clients to participate in the client satisfaction exit interview survey

BlueStar Health Network: client satisfaction exit interviews

Provider Introduction Guide

The BlueStar Health Network would like to ask some of the clients who use these facilities some questions about their visit today to help improve the quality of its services. As a provider of the BlueStar Network I would like to tell you about this short survey and ask if you would like to participate.

The questions will ask about the type of service you came here for and your views regarding the services and the staff members. The interviewer will also ask you some questions about you age, marital status, education level and your ability to read. The information given by all the people who help us to see if the BlueStar network is meeting the needs of our valued clients and to improve our services.

The questions will take about 15 minutes to complete. All information that you provide will remain strictly private and confidential and your name will not be written on any of the survey questionnaire, and the information will not be linked with your private medical records at this or any other clinic.

Whether you decide to take part in this survey or not is entirely voluntary – this means that you do not have to answer these questions. Whether you take part or not will not affect any future care that you receive at this facility or any other BlueStar service provider. Additionally, you may decline to answer some of the questions if they make you feel uncomfortable.

If you agree to participate I am required to ask for your signed consent (see additional form), and then there will be an interviewer waiting for to talk to you quickly as you leave the facility.

Thank you for your time.

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Appendix 6: Sample client information sheet

Marie Stopes International: client satisfaction exit interviews

Client Information Sheet

We are asking for your help to improve our services by answering some questions about your visit to the MSI facility today. The questions will ask about the type of service you came here for and your views regarding the services and the staff members. We will also ask you some questions about you age, marital status, education level and your ability to read. We will use the information given by all the people who help us to see if we are meeting the needs of our valued clients and to improve our services.

The questions will take about 15 minutes to complete. All information that you provide us will remain strictly private and confidential and we will not write your name on any of the survey questionnaires and will not be linked with your private medical records at this or any other clinic. We will not discuss your individual answers with the staff members.

Whether you decide to take part in this survey or not is entirely voluntary – this means that you do not have to answer these questions. Whether you take part or not will not affect any future care that you receive at the facility. Additionally, you may decline to answer some of the questions if they make you feel uncomfortable.

Thank you for your time.

Sincerely,

Xxxx Xxxx

Country Director / Facility Manager

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Appendix 7: Sample client consent formsSample when signed consent is not required:


Client Consent Form (verbal)Complete for every client approached:

I certify that I have read the Client Information Sheet and have explained this survey to the participant, and that s/he understands the nature and the purpose of the study and consent to the participation in the study. S/he has been given opportunity to ask questions which have been answered satisfactorily.

Please tick one box: The client declines to be interviewed

The client agrees to be interviewed

Name of interviewer: __________________________ Position: ____________________

Signature: __________________________ Date: ____________________

Sample when signed consent is required:


Client Consent Form (signed)I certify that:

I have read (or been read) and kept a copy of the information sheet concerning the above study, and I understand what is required of me if I take part.

My questions concerning this study have been answered by the study investigators.

I understand that at any time I may withdraw from this study, or decline to answer a question without giving any reason and without affecting my normal care and management at this facility in any way.

I agree to take part in this study by answering some questions in an interview.

Signature/mark of client:________________________ Date: ____________________

Name of interviewer: ________________________ Position: ____________________

Signature of interviewer:________________________ Date: ____________________

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Appendix 8: Cored Indicators and Dummy Tables

STATEMENT 1: We are reaching poor and/or under-served segments of the population.

Core Indicators to Track (corresponding survey question number is noted in parenthesis)

1. Percent distribution of clients according to key background characteristics, including residency, education levels, occupation and husband occupation

2. % of respondents whose annual household income falls below the national average (Q308)

3. Median reported transit time to the MSI service provider (in hours) (Q202)4. % of respondents who are first-time clients of the MSI service provider (Q201)5. % of respondents who are new family planning acceptors (Q310)

Dummy Tables

o TABLE 1: Socio-demographic profileo TABLE 2: Vulnerability table o TABLE 3: Type of service received according to important sources of differentialso FIGURE 1: Percent distribution of MSI outreach clients’ household incomes

compared to the national average

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Table 1. Background Characteristics of MSI Exit Interview Clients, According to Type of Service Provider and Sex

BACKGROUND CHARACTERISTICS TYPE OF SERVICE DELIVERY POINT & SEX OF THE CLIENTStatic Clinic Social Franchisee Outreach

Male Female Total1 Male Female Total Male Female TotalMedian age

Age Group (5-year categories) <15 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50+

Religion Animist Buddhist Catholic Non-Catholic Christian Hindu Muslim Other Residence Urban Peri-urban Rural

Relationship Status2

Single/never married Married, monogamous union Married, polygamous union Common-law/cohabiting Separated/divorced Widowed

Annual income level Below national average Equal to national average Above national average

Occupation3 Unemployed Agriculture Unskilled manual Skilled manual Sales and services Clerical Professional / technical / managerial

Occupation of Husband /partner Unemployed Agriculture Unskilled manual

1 The country can decide whether there is a substantial enough number of persons who fall under the ‘Other’ category that warrants creating an additional column in the table.2 Some of the following categories can likely be collapsed depending on the local context.3 Occupation categories for female respondent and husband / partner can be identified at the local level

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Skilled manual Sales and services Clerical Professional / technical / managerial

Total Number of Living Children 0 1 2 or more

Total Number of Respondents

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Table 2. Reaching the Underserved and Reducing Unmet Need

TYPE OF SERVICE DELIVERY PROVIDER & SEX OF THE CLIENTStatic Clinic Social Franchisee Outreach

Male Female Total Male Female Total Male Female Total

Median reported transit time to the MSI service provider (in hours)

Percentage of respondents whose annual household income falls below the national average4

Percentage of respondents who are first-time clients of the MSI service provider

Percentage of respondents who are new family planning acceptors

Percentage of respondents who are young people (15-24 years)

Percentage of respondents who are have received no formal / some primary education


Figure 1. Percent distribution of MSI outreach clients’ household incomes compared to the national average

4 To ensure we capture the poorest of the poor, this measure will based on the median annual household income level for respective countries as indicated by the national level of povery.

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Table 3. Type of service received according to important sources of differentials (presented as 3 separate tables for each service delivery channel – Static clinic, Social franchisee, outreach)

AGE GROUPHOUSEHOLD INCOME

RELATIVE TO NATIONAL AVERAGE

RELATIONSHIP STATUS

<15 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Below Equal to AboveSingle/ never

married

Married/ common-

law

Divorced/ widowed/ separated

Percentage of respondents who received:

Contraceptive pills, non-emergency

Emergency contraceptive pills

Male condoms

Female condoms

Foam tablets

Diaphragm

Injection

Intra-uterine system/device

Implant

Ligation or vasectomy

MSP

MSMP

Removal of implant or device

Family planning counselling only


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STATEMENT 2: Our beneficiaries are satisfied with our overall service delivery.

Recommended Core Indicators to Track(corresponding survey question number is noted in parenthesis)

1. % of respondents who were recommended by a satisfied client (Q205)2. % of respondents who were satisfied or very satisfied with their overall experience with

the MSI service provider (Q418)3. % of respondents who would recommend the MSI facility to a friend (Q420)

Table 4. Type of service received according to important sources of differentials (presented as 3 separate tables for each service delivery channel – Static clinic, Social franchisee, outreach)

MEASURES OF CLIENT SATISFACTION% of clients who were

recommended by a satisfied client

% of clients who were satisfied or very

satisfied with their overall experience at

an MSI facility

% of respondents who would recommend the MSI facility to a friend

Total Number of

Respondents

Type of service delivery provider Static Clinic Social Franchisee Outreach

Type of client New to MSI Existing MSI client

Age Group (5-year categories) <15 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50+

Relationship Status Single/never married Married, monogamous union Married, polygamous union Common-law/cohabiting Separated/divorced Widowed

Household income relative to national averageBelowEqual toabove

STATEMENT 3: Client feedback on quality of service delivery

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Recommended Core Indicators to Track (corresponding survey question number is noted in parenthesis)

1. Percent distribution of most important reason behind choosing the MSI service provider (Q206)

2. % of respondents who are satisfied or very satisfied with the opening hours of the MSI facility (Q401)

3. % of respondents who are satisfied or very satisfied with the cleanliness of the MSI facility (Q402)

4. % of respondents who are satisfied or very satisfied with the length of waiting time at the MSI facility (Q403)

5. % of respondents who are satisfied or very satisfied with the friendliness and respect received from staff upon arrival at the MSI facility (Q404)

6. % of respondents who are satisfied or very satisfied with the friendliness and respect received from the MSI health care provider (Q405)

7. % of respondents who are satisfied or very satisfied with the level of privacy of consultation & treatment received from MSI health care provider (Q406)

8. %of respondents who are satisfied or very satisfied with the length of time they had with the MSI health care provider (Q407)

9. % of respondents who are satisfied or very satisfied with quality for advice and information given by a MSI health care provider (Q408)

10. % of respondents who are satisfied or very satisfied with cost of service received by the MSI facility (Q409)

11. % of respondents who are satisfied or very satisfied with the procedure or treatment received by the MSI health care provider (Q410)

12. % of respondents who are satisfied or very satisfied with the overall experience at the MSI facility (Q411)

Figure 2. Percent distribution of most important reason behind choosing the MSI service provider

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Table 5. Client feedback on quality of service delivery(presented as 3 separate tables for each service delivery channel – Static clinic, Social franchisee, outreach)

COMPONENTS OF QUALITY %satisfied or very satisfied

% dissatisfied or very dissatisfied

Mean level of dissatisfaction

Selected actions for improvement5

Opening hours of the facility

Cleanliness of the facility

Length of your waiting time

Friendliness & respect received from the staff upon your arrival

Friendliness & respect you received from the health care provider

Level of privacy with the health care provider

Length of time spent with health care provider

Quality of the advice and information

Cost of overall service

Procedure or treatment

Overall experience at the facility

5 Suggested format for table for programmatic decision making, to identify areas for improvement based on dissatisfaction levels, whereby threshold for dissatisfaction is decided by the programme.

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Table 5. Client feedback on quality of service deliveryAlternative table

COMPONENTS OF QUALITY TYPE OF SERVICE DELIVERY POINT & SEX OF THE CLIENTStatic Clinic Social Franchisee Outreach

Male Female Total Male Female Total Male Female TotalOpening hours of the facility

Cleanliness of the facility

Length of your waiting time

Friendliness & respect received from the staff upon your arrival

Friendliness & respect you received from the health care provider

Level of privacy with the health care provider

Length of time spent with health care provider

Quality of the advice and information

Cost of overall service

Procedure or treatment

Overall experience at the facility

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Assessing Client Profile Evaluating Client Satisfaction Through Exit Interviews MSIGlobal

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