Mystery Client (MC) exercise Assessing the quality of client-provider interaction and provider behavior displayed before customers USAID-DFID NGO Health Service Delivery Project

Specific objectives of MC exercise Understand the level of quality of care at the clinic Staff behavior displayed to the customers Make the clinics client friendly Share observations with NGOs and provision for corrections Learn by own experience and internalize understanding USAID-DFID NGO Health Service Delivery Project

Selection of clinics and prepare visit schedule Steps followed for conducting MC’s in clinics Selection of clinics and prepare visit schedule Selection of Mystery Clients Orientation to Mystery Clients Mystery Client visits in clinic followed by checklist Inform NGO-HQ and Clinic Manager Debriefing and discussions Cancellation of documents issued by clinics (money receipt, prescription) and Documentation & reporting USAID-DFID NGO Health Service Delivery Project

USAID-DFID NGO Health Service Delivery Project Major criteria for selection of clinics Covering all the network NGOs Considered both urban and rural Visited old and new and expanded clinics Considered all types of clinic (vital, ultra-B & C) Combination of NGOs having big number of clinics vs. less number Efforts made to cover clinics as much as possible within short time USAID-DFID NGO Health Service Delivery Project

2nd phase Mystery Client Visit findings over visiting 100 clinics Data collection period: March’16 to August’16 USAID-DFID NGO Health Service Delivery Project

USAID-DFID NGO Health Service Delivery Project Mystery client visit Name and # of clinics covering 23 NGOs Name of NGO # of clinic Swanirvar 16 PSTC 11 CWFD 6 JTS Tilottoma 5 PSF 3 BAMANEH Kanchan samity 4 SSKS SHIMANTIK SUPPS 2 PKS CRC BANDHAN USAID-DFID NGO Health Service Delivery Project

USAID-DFID NGO Health Service Delivery Project Mystery client visit contd: Name and # of clinics covering all 23 NGOs Name of NGO # of clinic UPGMS 2 IMAGE PSKS NISHKRITI SOPIERT 5 FDSR PROSHANTI SUS SMC 6 USAID-DFID NGO Health Service Delivery Project

Type and Location of the clinics visited by MC USAID-DFID NGO Health Service Delivery Project

Checklists contain the following features Each of 4 checklists has 20 indicators with three broad areas - such as clinic environment, counseling and service provider (paramedic and medical officer/ physician) with a scoring scale from 1 to 3 and having three grades such as unsatisfactory, satisfactory and good. USAID-DFID NGO Health Service Delivery Project

Type of checklists # of checklist used Types and number of checklists used = Total 100 Type of checklists # of checklist used ANC 38 FP 33 LCC 21 CH 08 USAID-DFID NGO Health Service Delivery Project

USAID-DFID NGO Health Service Delivery Project Data processing and analysis The numerical data of each category of checklists entered in to SPSS data format and processed for analysis Three indicators of each category of checklists are individually analyzed as these are different from one another Each aspect (e.g. Clinic cleanliness) was categorizes into three point scale (Likert Scale): 1=Unsatisfactory, 2=Satisfactory and 3=Good USAID-DFID NGO Health Service Delivery Project

USAID-DFID NGO Health Service Delivery Project Key findings USAID-DFID NGO Health Service Delivery Project

USAID-DFID NGO Health Service Delivery Project Key findings USAID-DFID NGO Health Service Delivery Project

USAID-DFID NGO Health Service Delivery Project Key findings USAID-DFID NGO Health Service Delivery Project

USAID-DFID NGO Health Service Delivery Project Key findings USAID-DFID NGO Health Service Delivery Project

USAID-DFID NGO Health Service Delivery Project Key findings USAID-DFID NGO Health Service Delivery Project

USAID-DFID NGO Health Service Delivery Project Key findings USAID-DFID NGO Health Service Delivery Project

USAID-DFID NGO Health Service Delivery Project Key findings USAID-DFID NGO Health Service Delivery Project

USAID-DFID NGO Health Service Delivery Project Key findings USAID-DFID NGO Health Service Delivery Project

USAID-DFID NGO Health Service Delivery Project Key findings USAID-DFID NGO Health Service Delivery Project

USAID-DFID NGO Health Service Delivery Project Key findings USAID-DFID NGO Health Service Delivery Project

USAID-DFID NGO Health Service Delivery Project Key findings USAID-DFID NGO Health Service Delivery Project

USAID-DFID NGO Health Service Delivery Project Key findings USAID-DFID NGO Health Service Delivery Project

USAID-DFID NGO Health Service Delivery Project Key findings USAID-DFID NGO Health Service Delivery Project

USAID-DFID NGO Health Service Delivery Project Key findings USAID-DFID NGO Health Service Delivery Project

USAID-DFID NGO Health Service Delivery Project Key findings USAID-DFID NGO Health Service Delivery Project

USAID-DFID NGO Health Service Delivery Project Key findings USAID-DFID NGO Health Service Delivery Project

USAID-DFID NGO Health Service Delivery Project Key findings USAID-DFID NGO Health Service Delivery Project

USAID-DFID NGO Health Service Delivery Project Other key findings An average 11 staff attended the debriefing meeting in the clinics Average waiting time 36 minutes including services Clinic staff are receiving this MC visit and follow up debriefing session in a positive way as part of self criticism/overcome the gaps In some cases money receipts were not issued though MC gives money as service charge but later issued In most cases missed opportunity remain untouched as this issue is considered as less effective to spend time Feedback mechanism often do not consider as a tool to support the clients concern/problems USAID-DFID NGO Health Service Delivery Project

USAID-DFID NGO Health Service Delivery Project Recommendations Clinic Managers need to emphasize their day to day supervisory role and routine monitoring of client-providers interactions NGO-HQ to make comprehensive visit to clinics, mentor/guide to maintain customer caring attitude Admin. Assistant’s may be utilized to support other staff to display caring attitude to the customers BCC materials need to place in customers waiting room and make it available for customer’s take away USAID-DFID NGO Health Service Delivery Project

USAID-DFID NGO Health Service Delivery Project Recommendations On certain interval CM should conduct client exit interview to assess the clinic service delivery procedure, system and quality Mystery Clients exercise should be undertaken by the NGOs as part of regular monitoring system Provision for rewarding/appreciation of good staff to increase the ownership and job satisfaction Team building exercise is much needed to increase harmony among the clinic staff USAID-DFID NGO Health Service Delivery Project