Quick investigation of quality
In contrast to the service provision assessment (SPA), which spans multiple areas of reproductive health, the Quick Investigation of Quality (QIQ) refers to the set of three related data collection instruments designed to monitor 25 indicators of quality of care in clinic-based family planning programs. The QIQ was developed and tested to allow programs to monitor quality of care in family planning programs, and can be used to do so on a regular basis (e.g., every one to two years) if desired.
These key indicators, which are relevant to client behavior and outcomes and are by no means comprensive, serve as “markers” for a wide range of behaviors or conditions; facilities that perform well on these should perform well on the larger set. For a complete description of the QIQ, see “Quick Investigation of Quality (QIQ): A User’s Guide for Monitoring Quality of Care in Family Planning” (MEASURE Evaluation, 2016). In Module 1, Table 1 on pp. 5-6 lists the 25 indicators and pp. 6-11 define the indicators. Subsequent Modules include:
- Module 2: Guidelines for Sampling
- Module 3: Facility Audit Tool
- Module 4: Observation Tool
- Module 5: Client Exit Interview Tool
- Module 6: Data Analysis and Presentation of Results
The ratings or assessments of an external evaluator (in the case of the facility audit, observation guide, and mystery client) and self-report on the client exit interview
Evaluators can measure each indicator by one (or more) of three methods of data collection, which are the same as for the SPA:
- The facility audit, with selected questions to the program manager, measures the readiness of a facility to deliver quality services.
- Observing client-provider interactions and selected clinical procedures allows evaluators to directly assess the actual level of quality given.
- The exit interview with clients departing from the facility (and previously observed) provides feedback from clients on their perceptions of the quality received.
The basic premise is that improved quality of care leads to service utilization, contraceptive adoption, and contraceptive continuation. The items included in the QIQ were drawn largely from the Situation Analysis (Miller et al., 1997) and were later reformulated to be consistent with the SPA (i.e., most of the items contained in the QIQ are included in the SPA instrument for family planning).
These QIQ indicators measure five of the six elements of the Bruce/ Jain framework: choice of methods, information given to clients, technical competence, interpersonal relations, and follow-up and continuity mechanisms. Although specific to family planning, this low-cost, practical methodology has been adapted to related reproductive health topics in several instances (Sullivan and Bertrand, 2000).
Ideally, one would like to develop a summary score for the full set of indicators. Although it will continue to be valuable to report the strengths and weaknesses of specific facilities or a network of facilities, a summary score will facilitate comparisons among facilities in a network or in a given facility over time.
Bessinger, R. and J.T. Bertrand. 2001. “Monitoring Quality of Care in Family Planning Programs: A Comparison of Observation and Client Exit Interviews.” International Family Planning Perspectives. 27(2):63-70.
Miller, R., A. Fisher, K. Miller, L. Ndhlovu, B. Ndugga Maggna, I. Askew, and D. Sanogo. 1997. The Situation Analysis Approach to Assessing Family Planning and Reproductive Health Services: A Handbook. New York, NY: The Population Council.
Sullivan, T.M. and J.T. Bertrand (eds). 2000. Monitoring Quality of Care in Family Planning by the Quick
Investigation of Quality (QIQ): Country Reports. MEASURE Evaluation Project Technical Report Series 5.
University of North Carolina, Chapel Hill, NC: Carolina Population Center.
Sullivan, T.M., J. Rice, and J.T. Bertrand, 2001. “Empirically Testing the Bruce/Jain Framework: Are Six Elements Enough?” Presented at Population Association of America Meeting, March 29-31, 2001, Washington, DC.