The Use of Self-Assessment in Improving the Quality of Family Planning Clinic Operations: The Experience with Cope in Africa
Table 1


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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%

* "Impossible" problems are those unsolved problems that were beyond the power of clinic staff to solve without outside help or funds.