The quality of family planning services at the Philippine General Hospital Reproductive Health Care Center: an assessment based on the quality of care framework

Quality of care has received much attention in family planning (FP) beginning in the early period of this decade. While a number of studies in the quality of FP services using the Situation Analysis (SA) approach had been done in other developing countries, country initiatives had been more recent. This study sought to find out the quality of FP services in one public, clinic-based service delivery point utilizing the SA approach and adapting the Bruce quality of care framework. The objectives were to describe the characteristics of program management and structure (subsystem availability and functioning), and the nature of service provision (focusing on the elements of choice of method, information given, interpersonal relations, and mechanisms of continuity/follow-up) and relate these to client satisfaction. A mix of qualitative and quantitative methods were utilized in data gathering. Instruments developed by the Population Council for a basic SA study were used as revised, after pretesting in the same SDP. All FP service providers and new FP clients composed the study group. Data were obtained through observations of client-provider interactions, structured interviews with providers and clients, and actual examination of facilities, equipment and records/reports. Analysis was done through a scoring system for indicators of quality and a contextual analysis. The study was undertaken in a period of one month with almost daily visits to the SDP from the time it opened until closing time. The findings revealed that the SDP is offering some level of quality services in spite of problems in some subsystems and in some elements of quality. Among the subsystems, SDP facilities and resources had the highest score of 86 percent, followed by the chart audit (84 percent), and provider dimension (76 percent). The score for quality of services as perceived by clients (67.5 percent) was higher than the score obtained as observed by the researcher (54 percent), reflecting some amount of courtesy blas. Likewise, overall client satisfaction with services received had a score of 90 percent. Problem areas in service provision were the quality of information given regarding FP method accepted and client waiting time. Based on the findings, facilities/resources, provider dimension, and quality of interaction contributed directly to client satisfaction. Furthermore, the centrality of client-provider interactions as a determinant of the outcome was inferred from the results