enhanced by encouraging service providers who collect the data to develop a vested interest in their use. It was suggested that more effort should be spent on attaining and maintaining political will for family planning, which would help to create an environment conducive to making the necessary data collection changes. Finally, the importance of computer technology was stressed. Although in many developing countries computer viruses and the lack of availability of hardware and software create problems, it was suggested that as the use of computers increases, these problems will taper off, thereby enabling the flow of detailed data for analysis and evaluation.

CLIENT AND PROVIDER INTERACTIONS

Barbara Mensch discussed three methodologies used for assessing the quality of provider-client interactions--each of which has shortcomings. The first methodology, consisting of an independent observer who records the provider-client interaction, has several problems: (1) An observer is intrusive and probably changes the behavior of both the client and the provider; (2) different observers may not make the same assessment even if they witness the same interaction--threatening data reliability; and (3) structured data collection instruments are often inadequate for recording the more nuanced dimensions of caregiving. A second methodology consists of debriefing simulated clients (some of whom are true clients and some field researchers) who participate directly in the interaction with the provider. Problems with this methodology include the inability of some simulated clients,



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INFORMATION SYSTEMS AND MEASUREMENT FOR ASSESSING PROGRAM EFFECTS: IMPLICATIONS FOR FAMILY PLANNING PROGRAMS IN DEVELOPING COUNTRIES: SUMMARY OF AN EXPERT MEETING enhanced by encouraging service providers who collect the data to develop a vested interest in their use. It was suggested that more effort should be spent on attaining and maintaining political will for family planning, which would help to create an environment conducive to making the necessary data collection changes. Finally, the importance of computer technology was stressed. Although in many developing countries computer viruses and the lack of availability of hardware and software create problems, it was suggested that as the use of computers increases, these problems will taper off, thereby enabling the flow of detailed data for analysis and evaluation. CLIENT AND PROVIDER INTERACTIONS Barbara Mensch discussed three methodologies used for assessing the quality of provider-client interactions--each of which has shortcomings. The first methodology, consisting of an independent observer who records the provider-client interaction, has several problems: (1) An observer is intrusive and probably changes the behavior of both the client and the provider; (2) different observers may not make the same assessment even if they witness the same interaction--threatening data reliability; and (3) structured data collection instruments are often inadequate for recording the more nuanced dimensions of caregiving. A second methodology consists of debriefing simulated clients (some of whom are true clients and some field researchers) who participate directly in the interaction with the provider. Problems with this methodology include the inability of some simulated clients,

OCR for page 10
INFORMATION SYSTEMS AND MEASUREMENT FOR ASSESSING PROGRAM EFFECTS: IMPLICATIONS FOR FAMILY PLANNING PROGRAMS IN DEVELOPING COUNTRIES: SUMMARY OF AN EXPERT MEETING particularly those who are true clients, to assess the quality of the information they are given. There may also be an ethical problem because study teams do not obtain informed consent from service providers prior to the client-provider interaction, due to the need to maintain the appearance of unmonitored interaction. As with the observation technique, variability in interpretation also remains a problem. The third technique consists of interviewing clients and providers soon after their interaction to assess its quality. This method is often biased due to an unwillingness of clients to be critical of the services provided. Clients, particularly first-time users of contraception, may also not be able to evaluate the quality of the information. Because the provider-client transaction is the final objective of family planning program management, Mensch stressed the importance of taking into consideration the larger context in which the providers work. John Newman discussed the projected use of information from both clients and potential clients to ascertain why primary health care centers continue to be underused following investments upgrading the facilities. He noted that either the improvement in facilities was not perceived or that the physical improvement of the facilities was not a constraint to use of the clinics in the first place. A study currently being undertaken at the World Bank involves the collection of qualitative as well as quantitative data. The potential clients are being asked about such things as their knowledge of services, availability of medicines, costs, and expectations of waiting times and the facilities are visited to investigate the actual situation. The perceptions of clinics and factual information from the clinics will then be compared and a quantitative survey developed. It is hoped that the data collected from these types of exercises will enable health departments to make changes that will