In Haiti, "Mystery Clients" Evaluate Quality of Care

Abstract

Mystery clients posing as family planning patients evaluated the services of private family planning clinics in Port-au-Prince Haiti. This strategy was initiated in 1990 funded by the United States Agency for International Development and administered by the International Planned Parenthood Federation (IPPF). The mystery clients were 3 women and 1 man who had been trained in physiology contraceptive side effects and contraindications. The clinic directors had been notified about the mystery clients who made 5-6 visits/month. Clinics were visited by clients about 4 times in a 6-month period and reports to the clinics will include the observations of at least 3 mystery clients. If the clinic suggested that they choose a method the client accepted one (except for Depo-Provera which is implanted on the spot) or made an appointment to receive Norplant or sterilization. The coordinator recorded the informants comments on a debriefing questionnaire that contained 40 quality-of-care indicators. IPPF presented a review of the mystery clients findings from May 1990 to April 1991 to 14 involved clinics. The clients made 23 visits to 4 hospitals 27 visits to 5 clinics and 22 visits to 5 health posts offering family planning services. The informants rated the services as not acceptable on 7% of the clinic visits and 13% of the health post visits. A rating of not very acceptable was given on 33% of the clinics visits 32% of health post visits and 57% of hospital visits. They gave a rating of acceptable on 41% of visits to clinics and health posts and on 44% of visits to hospitals. A very acceptable rating was only given on 18% of the visits to clinics and on 14% of the visits to health posts. The mystery client strategy has expanded: they now visit 8 institutions that operate about 30 clinics and informants assess the messages of counselors about AIDS. In 1990-91 minisurveys a contraceptive prevalence rate of 16% was found in the mystery clients area.