Between April 1992 and March 1993, the USAID-sponsored Evaluation Project\'s Service Delivery Working Group (SDWG) met to develop family planning (FP) program performance and impact indicators for use in evaluating FP programs. After extensive review of the work of an earlier subcommittee, the SDWG devised a core list of indicators categorized according to the 6 elements of the Bruce Framework on Quality of Care: 1) choice of method, 2) informing and counseling clients, 3) technical competence, 4) interpersonal relations, 5) mechanisms to ensure continuity, and 6) appropriateness/acceptability of services. The SDWG also identified outcome measures and proposed data collection methods for each indicator. The list of quality indicators was initially intended for use in clinic-based services, but it has been adapted for use in community-based distribution and social marketing programs. The indicators are being subjected to international field tests with the list adapted to the needs of ongoing projects. International experience in the application of these indicators will be reviewed at an Evaluation Project meeting in late 1994. At this time, an attempt will be made to reduce the list to the most essential service quality indicators. The Evaluation Project would like to learn about any field applications of the indicators and to share the indicators list with interested individuals. The contact person for this Project is Dr. Jane Bertrand, Tulane University, School of Public Health and Tropical Medicine, 1501 Canal Street, New Orleans, Louisiana 70112; fax: 504-584-3653.

Uniform national guidelines on the delivery of family planning methods and services improve client care, assuming these guidelines are based on current scientific information. Compliance with these guidelines yields safe and efficient delivery of family planning services. Service providers need information, training, supplies, and guidelines to deliver quality services. Guidelines contribute to consistency among family planning programs in different settings. Even though clinics may not provide the same services, the guidelines allow them to provide the same standards of care. Specifically, eligibility criteria, contraindications, and follow-up schedules are the same regardless of the service delivery point. Various international health organizations (such as World Health Organization, USAID, Program for International Training in Health, International Planned Parenthood Federation, and Association for Voluntary Surgical Contraception) have developed guidelines for family planning service delivery. Governments can use these documents to develop national family planning guidelines and policies. They should adapt the guidelines to local needs and consider program resources. After development of the national guidelines, training, workshops, and dissemination of written materials should be provided for policymakers, physicians, nurses, and other health providers. Countries that have either developed or are working to draft their own national guidelines are Cameroon, Ghana, Mexico, and Nepal.

It is important to supervise health workers in order to maintain and improve their performance and the overall quality of care. In Tanzania, district health management teams are responsible for supervising health centers. Staff in the centers should then supervise dispensaries which are then tasked with supervising village health posts. The Ministry of Health recommends at least two supervision visits per unit per year. In 1987, the Ministry of Health issued the National Guidelines for Supervision (NGS) of health centers and dispensaries to be used by the supervisors of the peripherals health workers. The authors reviewed NGS records in Mpwapwa and Kondoa districts for 1989-92 in their analysis of the supervision process and the appropriateness of the tools for supervision in Tanzania. Neither district has achieved the standard of two visits per year. The supervisory teams varied and the mean active time in the units was four hours. Moreover, the role of the community representatives in supervision is unclear and inconsistent. Those in charge of the health centers and dispensaries are satisfied with the quality of supervision from the district team, but they do not routinely supervise their satellite health units as required by the national guidelines. Study findings demonstrate the merit of periodically reviewing NGS records in the interest of formulating recommendations for improving the supervision process.