This paper presents a method for evaluating and monitoring the quality of care of family planning services. The method was implemented in Haiti by International Planned Parenthood Federation Western Hemisphere Region (IPPF/WHR), the managerial agency for the Private Sector Family Planning Project (PSFPP), which is sponsored by the USAID Mission. The process consists of direct observations of family planning services and clinic conditions by trained Haitian housewives playing the role of 'mystery clients', who visit clinics on a random basis without prior notice. Observations conducted by mystery clients during one year, from April 1990 to April 1991, are presented and illustrate the use of the method. In addition, measurements for rating the acceptability of the services were developed, providing a quantitative assessment of the services based on mystery clients' terms. Statistical results demonstrate that simulated clients ranked some criteria of acceptability higher than others. These criteria are: the interaction provider/client, information adequacy, and competence of the promoter. Likewise, simulated clients' direct observations of the services permitted the identification of deficiencies regarding the quality of care such as the paternalistic attitudes of the medical staff; the lack of competence of promoters; and the lack of informed choice. Based on its reliability since its implementation in 1990 the method has proven to be a useful tool in programme design and monitoring.
PIP: The author presents a method implemented in Haiti by the International Planned Parenthood Federation for evaluating and monitoring the quality of care of family planning services. Trained Haitian housewives visit clinics as mystery clients on a random basis without prior notice to directly observe family planning services and clinic conditions. Observations conducted by these clients from April 1990 to April 1991 are presented. Measurements are also developed for rating the acceptability of the services, providing a quantitative assessment of services based upon mystery clients' terms. Judgement criteria include the provider/client interaction, information adequacy, and competence of the promoter. Statistical results show simulated clients to rank some criteria of acceptability higher than others. Moreover, simulated clients' direct observations of services permitted the identification of deficiencies regarding the quality of care such as the paternalistic attitudes of the medical staff, the lack of competence of promoters, and the lack of informed choice. This method is proving to be a useful tool in designing and monitoring programs.