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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

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

9. 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

10. 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

11. 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

29. 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

30. 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

31. 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