US AID - DFID NGO Health Service Delivery Project

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

3. 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-DFIDNGO Health Service Delivery Project

4. 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-DFIDNGO Health Service Delivery Project

5. 2nd phase Mystery Client Visit findings over visiting 100 clinics Data collection period: March’16 to August’16 USAID-DFIDNGO Health Service Delivery Project

6. Mysteryclient visit Name and # of clinics covering 23 NGOs USAID-DFIDNGO Health Service Delivery Project

7. Mystery client visit contd: Name and # of clinics covering all 23 NGOs USAID-DFIDNGO Health Service Delivery Project

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

10. Types and number of checklists used = Total 100 USAID-DFIDNGO Health Service Delivery Project

11. 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-DFIDNGO Health Service Delivery Project

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29. 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-DFIDNGO Health Service Delivery Project

30. 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-DFIDNGO Health Service Delivery Project

31. 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-DFIDNGO Health Service Delivery Project