SHOPS Plus supports the Nepal CRS Company, a social marketing organization, to ensure the quality of health services delivered through the Sangini network of family planning service providers. The network comprises nearly 4,000 private pharmacies that provide modern family planning methods. They are the only private sector providers of injectable contraceptives in the country. CRS trains Sangini providers to give high-quality counseling and a variety of modern methods to meet women’s needs. To monitor family planning service quality, CRS quality assurance officers conduct regular support visits to Sangini pharmacies to observe the quality of family planning service provision and work with the providers to improve their performance.
Using data to determine private provider efficacy
In 2018, SHOPS Plus conducted a study to monitor the quality of contraceptive information and services provided at Sangini pharmacies. The team used a mystery client approach in which individuals trained to act like typical clients visited Sangini providers who had received support visits from CRS within the past two years. The mystery clients requested one of two family planning services: 1) the provider’s recommendation for a contraceptive method or 2) oral contraceptives. SHOPS Plus compared mystery client results against findings gathered during the support visits to identify discrepancies between the knowledge providers demonstrated during a visit and how well they implemented this knowledge in practice.
The findings indicated significant “know-do” gaps among providers, especially around appropriate counseling. Despite scoring well on during the support visits, providers did not follow the protocols when serving clients. For instance, less than 50% of providers used screening checklists or ensured patient confidentiality. Typically, providers did not mention all the methods available to the mystery clients and, when they discussed injectables and oral contraceptives, they often failed to talk about their side effects.
A Sangini provider in Nepal prepares to dispense injectable contraception to a client. Photo credit: Jessica Scranton
Translating research into action
Using research findings, SHOPS Plus supported CRS to develop a detailed action plan addressing barriers to quality among Sangini providers. CRS has completed some of these activities to minimize “know-do” gaps, including improving provider training on counseling skills by streamlining the curriculum to minimize time spent on lectures and increase time spent practicing skills. CRS changed the way technical support visit are scored to ensure comprehensive and accurate evaluation of provider skills.
Innovating to improve quality
CRS will develop an incentive structure to increase provider compliance with quality standards and respond to poor performance. Incentives for high-quality performance will include updated CRS Sangini branding and performance awards.
The organization is committed to ensuring that patients are aware of services available at Sangini providers. To that end, CRS is designing a mass media campaign to promote public awareness of patient rights regarding family planning services. In addition, CRS will revamp the information, education, and communication materials displayed at Sangini outlets to make them more visible and easy to read for both providers and customers.
The mystery client study and subsequent action plan illustrate the importance of consistently assessing provider performance to determine areas of improvement and using those findings to inform quality improvement and assurance strategies. SHOPS Plus will continue to support CRS as it implements its action plan as part of the project’s broader strategy of building its capacity to generate and use data for evidence-based decision making.