The Use of Self-Assessment in Improving the Quality of Family Planning Clinic Operations: The Experience with Cope in Africa
Table 1
Table 1. Problems Identified by Clinic Staff at First COPE Exercises, and Outcome at Follow-up Visits, 11 Sites in Ghana, Kenya, Nigeria, and Uganda
| Problem | Total no. of sites where problem identified | Solved | Attempted | Unsolved | Impossible* | Solution/ comments |
| 1. Shortage of staff | 7 | 4 | - | 3 | 3 | Solved, where possible, by reassignment or transfer of staff. |
| 2. Shortage of trained family planning staff | 7 | 7 | - | - | - | Solved mostly by on-the-job training. |
| 3. No forum for discussion of family planning/ voluntary surgical contraception issues | 8 | 6 | - | 2 | - | 3 sites formed active voluntary surgical contraception committees. |
| 4. No signs directing clients to family planning clinic | 8 | 6 | 1 | 1 | - | Signs erected in 6 sites; 1 site made signs but did not yet have them in place. |
| 5. Inadequate or broken equipment | 7 | 3 | 1 | 3 | 2 | Where solved, COPE gave extra jolt to solve long-standing problem. |
| 6. Long waiting times | 6 | 5 | - | 1 | - | Variety of interventions (see text on CFA results). |
| 7. Lack of information, education, and communication (IEC) and of IEC materials | 6 | 3 | 2 | 1 | - | Group education sessions started, materials acquired by various means. |
| 8. No privacy for counseling | 5 | 2 | - | 3 | 2 | Creative solutions found. |
| 9. Family planning supplies unavailable or inadequate | 5 | 4 | - | 1 | 1 | Alternative, unofficial channels developed in 3 sites. |
| 10. Incomplete records | 5 | 4 | 1 | - | - | 1 staff member was made responsible for this. |
| 11. Record retrieval problem | 5 | 4 | 1 | - | - | Solution helped to shorten locating times and therefore waiting. |
| 12. High cost of sterilization for clients | 3 | - | 1 | 2 | 2 | Solution attempted by reducing required lab tests or number of visits. |
| 13. No hospital staff orientation in family planning | 3 | 2 | 1 | - | - | Orientation on family planning/ sterilization helped to address negative staff attitudes. |
| 14. Inadequate counseling | 3 | 3 | - | - | - | On-the-job orientation/ retraining. |
| 15. Preoperative and postoperative written instructions not available | 3 | 1 | - | 2 | - | Not available in printed form at time of follow-up visit. |
| 16. Inadequate building | 3 | - | - | 3 | 3 | Scattered family planning units; no space for individual counseling. |
| 17. Restrictive age or parity policies | 2 | 1 | 1 | - | - | Individual service provider problem. |
| 18. Public transport inadequate | 2 | - | 1 | 1 | 2 | One site attempted to get new routing. |
| 19. No outreach | 2 | - | 1 | 1 | - | Site attempted to link with community-based distribution program. |
| 20. Clients not seen in turn | 2 | 1 | - | 1 | - | Numbers system started. |
| 21. No follow-up of sterilization surgery defaulters | 2 | - | 1 | 1 | - | Abandoned; proved very difficult. |
| 22. Staff wages insufficient | 2 | - | - | 2 | 2 | Countrywide problems. |
| 23. Mandatory blood donations by client or relative for sterilization | 1 | - | - | 1 | 1 | Ingrained hospital policy. |
| 24. No ongoing family planning assessment | 1 | 1 | - | - | - | Monthly reports used as feedback. |
| 25. No transport for surgical complications | 1 | 1 | - | - | - | Ambulance provided. |
| 26. Postoperative medicines not available | 1 | 1 | - | - | - | Small dispensary set up in surgical unit. |
| 27. No recording of vital signs during procedure | 1 | - | - | 1 | 1 | Impossible because of lack of staff. |
| 28. Number of sterilizations down | 1 | - | - | 1 | 1 | Transfers of staff. Ambulance provided. |
| 29. Sterilization clients delayed | 1 | - | 1 | - | - | As a result of COPE, doctors usually arrive on time. |
| 30. Postnatal clients discharged before sterilization | 1 | 1 | - | - | - | Medical staff more flexible after COPE. |
| 31. Clients came for sterilization on wrong day | 1 | 1 | - | - | - | Better communication. |
| 32. Untidiness in counseling rooms | 1 | 1 | - | - | - | Rooms straightened. |
| 33. Telephone inaccessible | 1 | 1 | - | - | - | Telephone moved. |
| 34. Mold in ceiling of operating room | 1 | - | - | 1 | 1 | Part of general hospital problem. |
| 35. No tea for clients | 1 | 1 | - | - | - | Tea cart provided. |
| TOTAL | 109 | 64 | 13 | 32 | 21 |
| Total number of problems identified: | 109 |
| Total number within staff's power to solve: | 88 |
| Number solved: | 64 |
| Number solved and attempted: | 77 |
| Percentage of all problems solved: | 58.7% |
| Percentage of solvable problems solved: | 72.7% |
| Percentage of solvable problems solved or attempted: | 87.5% |