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Marie Stopes India 2012 Client Exit Interview Report
Outreach Camps through MSI Clinical Outreach Teams (COT, Rajasthan) and MSI supported Government camps in Nagaur, Rajasthan
and Uttar Pradesh 28th December 2012
Percent of clients who are…
All Clients Govt Nagaur MSI COT Govt UP
Living Under
$1.25/day
Under Age
25
Adopters
Evidence to Action! Key recommendations from the data:
1. Inception of Youth Task Force. 2. Emphasis on method mix. 3. Innovative BCC and marketing strategies
to reach the unreached.
Exceed national FP sector by more than 10% points
Within 10% points (+/-) of national FP sector
Miss national FP sector by more than 10 % points
Comparison data not available
Facts at a glance:
•Youth:
--0% of clients under age 20
•Travel:
--Clients travelled 30 minutes on average to reach Govt Nagaur camps and MSI COT sites, and 40 minutes to reach Govt UP sites
•Follow-up:
--75% of clients report receiving follow-up instructions!
•Marketing:
-- 2.5% of clients report radio use and 25% report television use
--27% of clients reported using a mobile phone
Family Planning Behaviour:
--17% of total clients switched from a short-term family planning method to a long-term method
--24% of Govt Nagaur clients switched
--14% of MSI COT clients switched
--34% of Govt UP clients switched
41.4% 35.9% 39.2% 50.8%
13.2% 18% 13.5% 4.9%
80.3% 76.2% 83.4% 63.9%
13%
Under age 25
41%
Living under $1.25/day
Looking at National data comparisons for % living under $1.25/day (Graph 1), Overall 41% of the
clients availing services were living under $1.25/day. This is within 10% points of National FP data of
32.7%.
Graph 1: National data comparison for % living under $1.25/day
Similarly, 13% of all the clients were under age 25 population (Graph 2). This is again within 10%
points of National FP data of 10% clients at all the three camp types were within +10% points of
National FP sector (10%).
Graph 2: National data comparison for % under 25 years
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80%
Percentage of Adopters
National data for comparison of adopters is not available. However, 80% of all the clients were
adopters (Graph 3).
Graph 3: % of Adopters
Background
Whilst our MIS data gives us some basic information about the clients we serve, the information we
collect does not give a detailed client profile and their satisfaction level with our services. During a
series of exit interviews we collected various socio-demographic data, details of what services our
clients were receiving that day, our clients’ satisfaction with different aspects of our services, and
information on media and mobile phone usage. MS India is specifically interested in understanding its
client profile including the age of clients and economic background. This would help the operations
team to develop strategies to reach the unreached eligible couples with unmet need. This is more
important now that MSI is focussing on generating CYPs that count i.e. High Impact CYP. Similarly
the level of satisfaction of clients with our services provide considerable feedback to the Clinical
Outreach Teams (COT) to improve their service delivery and provide counselling, privacy and follow-
up instructions in case the need be.
Section 1: Client Profile
FINDING 1: Females make up the majority of MS India clients with 98% of family planning clients
being females. Considering the age group of the clients, the weighted average was 13% clients in 20-
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24 years age group followed by majority (62%) in 25-29 years and 24% who were 30+. There were no
clients covered in the age group of 15-19 years. Looking at the trend from last year’s exit survey
findings, there are variations in the age group of clients. Though, this year as well there were no
clients in the age group of 15-19, however, the percentage of clients in the age group 20-24 years
went down from 28% in MSI COT in 2011 to around 14% this year. Almost 87 per cent of the clients in
COT camps were in the age group of 25+ as against 73% in 2011. There are significant variations in
the type of camps, as clients in UP are older than in Rajasthan. More than 60% of the clients in Govt
Nagaur camps and MSI COT camps were in the age group of 25-29 years as against 30% in Govt UP
Camps. In Govt UP Camps, majority of the clients (66%) fall in the 30+ age group. Similarly, only 5%
were in the age group of 20-24 years in these camps.
Almost 63% of the total clients (65% in Govt Nagaur, 63% in COT and 68% in Govt UP) had none/non
formal education. More than 40% of the clients were unemployed in both Govt Nagaur and COT
camps as against 80% in UP camps. Conversely, almost 47% were involved in agricultural activities
in both Govt Nagaur and COT camps whereas only 8% were doing any agricultural activities. This
difference could be due to difference in work pattern of females. In Rajasthan, women are involved in
agricultural activities as against the two MS India focus districts where females are generally involved
in only household chores. Interestingly, around 98% of all the clients already had two or more living
children before they decided to use family planning method from MSI. More than 90% of all the clients
in Rajasthan and 65% clients in UP already had either one or two living boys. This highlights the
preference for a male child before they decide to stop or space their pregnancy.
96% of MSI outreach service clients are Hindu in both the States followed by 4% Muslims. Looking at
caste composition, on an average, 48% of clients availing these services are from other backward
classes (OBCs), followed by 22% schedule tribes (STs) and 19% schedule caste (SCs). Indian caste
system is a system of social stratification and social restriction in which communities are grouped
under the four well known categories: Brahmins (priests), Kshatriyas (kings, warriors, law enforcers,
administrators), Vaishyas (traders, bankers), and Shudras (Artisans, labourers, agriculturists, cattle
raisers, craftsmen). The Government of India has officially documented castes and sub-castes. As per
Census 2011, Scheduled Castes, Scheduled Tribes and Other Backward Classes constitute 16%, 7%
and 32% of the total Indian population) respectively. National Family Health Surveys have highlighted
that these people are often the most underserved and in need of health services. The survey data
highlights that the MSI services reach a disproportionally high percentage of people from these casts,
proving that MSI is reaching the underserved population of the two States.
Table 1: Background characteristics of core service clients, by delivery channel
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SERVICE DELIVERY CHANNEL
Socio-demographic
characteristics
Weighted Average
N = 198
Govt Nagaur
N = 101
Outreach
N = 253
Govt UP
N= 122
Sex
Male 2% 3% 2% 0%
Female 98% 97% 98% 100%
Age
15-19 0% 0% 0% 0%
20-24 13.2% 18% 13.5% 4.9%
25-29 62.4% 64% 66.9% 29.5%
30+ 24.4% 18% 19.5% 65.6%
Relationship Status
Single/never
married
0% 0% 0% 0%
Married 100% 100% 100% 100%
Living together 0% 0% 0% 0%
Widowed/
Separated/divorced
0% 0% 0% 0%
Education level
none / non-formal
Some primary
63.1%
13.1%
65.3%
10.9%
62.5%
13.8%
68%
7.4%
completed primary 16.7% 13.9% 17.4% 14.8%
Some secondary
completed secondary / vocational or technical training
5.1%
1.0%
9.9%
0%
4.7%
1.2%
5.7%
1.6%
some tertiary or higher
1% 0% 0.4% 2.5%
Poverty
Less than $1.25 per day
(using the PPI)
41.4% 35.9% 39.2% 50.8%
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Below national poverty
line
23.8% 20.1% 22.4% 31.4%
Occupation
Unemployed 47% 47.5% 42.7% 78.7%
Agriculture 42.9% 46.5% 47% 8.2%
Unskilled manual 6.6% 4% 6.7% 5.7%
Skilled manual 1.5% 0% 2% 0%
Sales and
services
1% 2% 1.2% 1.6%
Clerical 0.5% 0% 0% 5.7%
Professional / technical
/ managerial
0.5% 0% 0.4% 0%
Student 0% 0% 0% 0%
Median time to reach
MSI provider
30 30 40
Service Utilisation
FINDING 2:
Around 96% of the female clients opted for female sterilization in Rajasthan irrespective of the service
provider. On the other hand, the method mix was different in Uttar Pradesh, where almost a similar
percentage opted for both female sterilization (52%) and IUD (48%). There was no client for male
sterilization in UP. In UP the reason for high percentage of IUD users can be attributed to less number
of surgeons at the facility level to perform sterilizations whereas govt staff nurse, ANM is more widely
available and trained in inserting IUD even at the sub centre level. There were variations among
clients who reported receiving FP counselling based on camp type. Around 64% of MSI COT camp
clients reported receiving counselling, followed by 52% of Govt Nagaur clients and 39% of Govt UP
clients. There have been variations in FP counselling from last year since in 2011, counselling was
more prominent at village level rather than at facility level. However, from 2012, on-site FP
counselling has been given a priority.
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96%
3% 1%
52%
96%
2% 2%
64%
51.6%
0%
48.4% 38.5%
Female Sterilization Male Sterilization IUD FP Counselling
Service Utilization
Govt Nagaur MSI COT Govt UP
Figure 1: Service utilisation of exit interview clients, according to type of service provider
Reaching the underserved
In order to assess if we are reaching the poorest segments of the population we compared the % of
family planning clients who live on less than $1.25 per day to the % of the national population living on
less than $1.25 a day (using World Bank data).
We also used educational status as a proxy for socio-economic status. We compared the % of our
family planning clients with less than a primary level of education to the % of all modern method users
in the country (using DHS data) with less than a primary level of education.
The young are often an underserved and high priority group for family planning. We compared the
percentage of our family planning clients that are under 25 years old with the percentage of all
modern method users in the country (using DHS data) that are under 25 years old.
Table 2: poverty and education level and age of MSI clients compared to national population
Poverty Indicator:
Weighted
Average
N = 198
Govt Nagaur
N = 101
MSI COT
N = 253
Govt UP
N= 122
National Data
Comparisons
% that live on less
than $1.25 a day
35.9% 39.2% 50.8% 32.7%
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% that have no
education or some
primary education
76.3% 76.2% 76.3% 75.4% 55%
% that are under 25
years old
13.2% 18% 13.5% 4.9% 10%
FINDING 3: Findings revealed that MS India program is at par with the National data of 33% that live
on less than $1.25 a day in Rajasthan. However, the country program is targeting more clients in this
category in UP. Looking at different types of camps, the program is covering 51% of poor clients in
govt UP camps as compared to 36% and 39% in govt Nagaur and MSI COT respectively. However,
this percentage has declined from 62% to 39% in MSI COT camp clients. Further running a
significance test (t-test) at 90% confidence interval reveals that there is statistically significant
difference between Govt Nagaur and Govt UP as well as MSI COT and Govt UP clients coverage.
Looking at the % of clients who have BPL card, overall 32% clients have BPL card. Around 19%
clients in Govt Nagaur, 36% in MSI COT and 14% in Govt UP camps have BPL card.
Similarly, looking at the percentage of clients that have no education or some primary education, the
project is successfully serving the uneducated population (76% as against 55% of national population).
This percentage has gone up by 8 percentage points from last year. Likewise, the program’s reach to
young people under 25 years of age is also comparable to the national population (13% compared to
10% of national population). However, this percentage has come down by 10 percentage points since
last year.
Family planning adopters and switchers
FINDING 4:
Looking at the weighted average, almost 80% of the clients that visited the camps were not using any
family planning method in the previous 3 months; 5% were continuers of MSI services and 15% used
a method from another provider. Looking at different camp types Govt Nagaur had 76% adopters,
MSI COT had 83% and Govt UP witnessed 64% adopters. A t-test revealed statistically significant
difference in adopters between MSI COT and Govt UP camp clients. Again, 1%, 4% and 14% of the
clients visiting these camps respectively were MSI continuers of service i.e. they were using a modern
method in the previous 3 months from MSI. Likewise, 23% of Govt Nagaur clients, 13% of COT
clients and 22% of Govt UP clients reported using a modern method in the previous 3 months but
from another provider. Looking at the clients who moved from short term method to LAPM, overall
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17% have switched their FP method with a camp wise breakup of 24% of Govt Nagaur clients, 14%
COT clients and 34% Govt UP clients. Again statistical significant difference was observed between
percentage of switchers in MSI COT and Govt UP camp clients.
Another important indicator reflecting the extent to which we are reaching the underserved is whether
we are providing family planning to people that were not already using it. The findings reveal that
almost 87% of the total clients have never ever used any family planning method before coming to
MSI services. It is important to reach people that were not already using modern family planning, in
order to expand contraceptive prevalence and grow the family planning market. Reaching these types
of clients will have a greater impact than serving clients that were already using family planning
anyway.
Table 3: family planning adopters and continuers
Weighted Average
N1 = 198
Govt Nagaur
N = 101
MSI COT
N = 253
Govt UP
N= 122
% of family planning
adopters1
80.3 % 76.2% 83.4% 63.9%
% of family planning
continuers2
4.5% 1% 4% 13.9%
% of family planning
clients that did use a
modern method in the
previous 3 months that
was provided to them by
another provider
15.2% 22.8% 12.6% 22.1%
1 Family planning adopters are those clients that did not use a modern family planning method in the 3 months
prior to receiving the MSI service
2 Family planning continuers are clients that did use a modern method in the previous 3 months that was
provided to them by MSI (Continuers)
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Table 4: short term method to long-term method switchers
Weighted Average
N = 198
Govt Nagaur
N = 101
MSI COT
N = 253
Govt UP
N= 122
% of family planning
clients that switched from
a short term method of
family planning to a long
term method
17.2% 23.8% 13.8% 34.4%
Data triangulation using MIS Data
MS India program has taken the three sub-groups under Outreach camps as separate camps namely
Govt Nagaur, MSI COT and Govt UP. Comparing the service use of these three types of camps vis-à-
vis annual MIS data and Exit Interview data, quite interesting findings emerged. Female sterilization
remained the preferred choice as well during the exit survey period. However, further looking at the
preferences within MIS and exit survey data revealed that clients had a higher preference for female
sterilization during the period of exit survey (Nov-Dec) as compared to the year (96%vs81% in MSI
COT and 52%vs37% in Govt UP). Conversely, preference for IUD had gone down during the exit
survey period as against the rest of the year (2%vs17% in MSI COT and 48%vs63% in Govt UP). The
reason could be the ‘seasonality’ associated with sterilization. It is a common belief among the
community that surgeries should be done on the onset of winters for easy healing and early recovery.
Diwali (Indian festival) is marked as the beginning of winters and therefore sterilization cases rise post
Diwali. The EI survey was done post Diwali. IUD is preferred during the ‘off season’. However, this
trend was not witnessed in Govt Nagaur camps.
MIS and Exit Interview Data of Govt UP Camps
Govt UP Camps
MIS data on number of SERVICES
MIS data on number of
CLIENTS EXIT INTERVIEW
SAMPLE SIZE
MIS data on percentage of clients
EXIT INTERVIEW
data on percentage
of clients
Female sterilisation
1304 1304 63 37.2 51.6
Male sterilisation
3 3 0 0.08 0
Intra-uterine system or device 2195 2195 59 62.7 48.3
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TOTAL NUMBER OF CLIENTS 3502 3502 122 100 100
MIS and Exit Interview Data of MSI COT Camps
MSI COT
MIS data on number of SERVICES
MIS data on number of
CLIENTS EXIT INTERVIEW
SAMPLE SIZE
MIS data on percentage of
clients
EXIT INTERVIEW
data on percentage of
clients
Female sterilisation 8228 8228 243 81.7 96.04
Male sterilisation
140 140 5 1.4 1.9
Intra-uterine system or device 1694 1694 5 16.8 1.9
TOTAL NUMBER OF CLIENTS 10062 10062 253 100 100
MIS and Exit Interview Data of Govt Nagaur Camps
Govt Nagaur
MIS data on number of SERVICES
MIS data on number of
CLIENTS EXIT INTERVIEW
SAMPLE SIZE
MIS data on percentage of
clients
EXIT INTERVIEW
data on percentage of
clients
Female sterilisation 4032 4032 97 98.4 96.03
Male sterilisation 34 34 3 0.83 2.9
Intra-uterine system or device 28 28 1 0.68 0.99
TOTAL NUMBER OF CLIENTS 4094 4094 101 100 100
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Section 2: Client Satisfaction and Quality of Care
FINDING 6:
Four indicators were used to assess overall satisfaction rates. Namely:
1. % of respondents who would recommend the MSI facility to a friend
2. % of respondents who would return to the facility to use another service in future
3. % of respondents who were satisfied or very satisfied with their overall experience with the
MSI service provider
4. % of respondents whose experiences met or exceeded expectations
Additional questions probed into the clients’ views of all aspects of service delivery in terms of:
opening hours, cleanliness, waiting time, friendliness and respect at reception, friendliness and
respect from the health care provider, time with the health care provider, quality of advice and
information, and procedure.
Table 6: Overall satisfaction by service delivery channel
Weighted
Average
N = 198
Govt Nagaur
N = 101
MSI COT
N = 253
Govt UP
N= 122
Would recommend the MSI
facility to a friend
99.5% 96% 100% 100%
Would return for another
service in future
78.7% 85.1% 75.9% 93.4%
Satisfied or very satisfied with
their overall experience at an
MSI facility
66% 56.4% 64% 89.3%
The experiences met or
exceeded expectations
99.5% 98% 99.2% 100%
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Almost all the clients irrespective of the channel, expressed that they would recommend the MSI
facilities to a friend. Also, 79% of the clients would like to return to the facility for another service in the
future. Almost 66% of them were satisfied or very satisfied with their overall experience at the facility
with significant differences visible between Rajasthan clients (56-64%) and UP clients (89%). The %
of clients satisfied at MSI COT camps is almost similar as compared to last year (65%). However,
client satisfaction at the Govt Nagaur camps which are the MSI supported govt camps is
comparatively low. The reason could be government staff who is involved in conducting procedures
and not MSI staff. Likewise, almost all the clients highlighted that the experiences either met or
exceeded their expectations. It was interesting to see that all the clients who were either satisfied or
very satisfied with their experience would recommend MSI facility to their friends. This percentage has
gone up from 67% in 2011.
Quality of Care: Follow-up instructions
FINDING 7: Although the exit interview showed a drastic improvement in providing clear follow-up
instructions to clients yet there is further scope of improvement in this aspect. Further analysis shows
that more than 70% of Rajasthan clients (both Govt Nagaur and MSI COT) as against 95% of Govt
UP clients received clear instructions. Compared to the last year’s survey findings, the rate of follow-
up instructions has improved almost twofold from 37% to 70% for MSI COT clients.
Section 3: Marketing
Sources of information on MSI services
FINDING 8: The most common source of information continues to be the Community based
distributor/village health worker with more than 90% of the total clients reporting hearing about MSI
services from them. It was almost 95% in 2011. Interestingly, MSI Outreach i.e. demand generation
before the camp was an important source of information for the clients receiving services in UP govt
camps (71%). This was followed by a recommendation from someone who has already used the
service (5-9%); media (5-8%) and government provider (5%). Similar findings were reported during
the last year’s exit survey where community based distributor/village health worker were both the
most common as well as most influential source of information for MSI services.
The reason for such high rate is that these are the government workers who are incentivised to bring
the clients.
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95%
10%
5%
4.8%
5%
95.5%
6.4%
5.7%
7.7%
5.1%
90.5%
71.4%
4.8%
4.8%
9.5%
0% 20% 40% 60% 80% 100% 120%
CBDW
MSIO
Govt
Media
Friend
Sources of Information about MSI service
Govt UP
MSI COT
Govt Nagaur
89%
3% 2%
1% 4% 1%
Govt Nagaur
CBDW
MSIO
Govt
Media
Friend
Others
Figure 2: Common sources of information about MSI service reported by clients
Almost 98% of outreach clients were aware of the MSI provider as a result of some form of marketing
or BCC material. There were not much variations based on service delivery channel. Around 75% of
family planning outreach clients were adopters AND were aware of the MSI provider as a result of
marketing or BCC. Further break down by camps highlights 72% and 81% of the clients in Govt
Nagaur and MSI COT were adopters and aware of MSI as against 63% clients in Govt UP camps.
Figure 3a: (Govt Nagaur) Sources of information that most influenced the client to use the MSI service
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93%
2% 4% 1%
MSI COT
CBDW
MSIO
Govt
Friend
Figure 3b: (MSI COT) Sources of information that most influenced the client to use the MSI service
Figure 3c: (Govt
UP) Sources
of
information that most influenced the client to use the MSI service
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60%
38%
2%
Govt UP
CBDW
MSIO
Govt
CBDW continue to dominate as the source of information as was seen in the last exit survey findings.
Looking at the source of information that most influenced the clients to use MSI services, state
specific variations were quite evident. Although almost 90% clients in Rajasthan (both Govt Nagaur
and MSI COT) were influenced by Community based distributor/village health workers/ANM/AWW,
only 60% of UP clients considered them to be influential source. In UP govt camps, almost 40%
clients reported getting influenced by MSI outreach workers. The most common reason for this could
be attributed to the fact that in Rajasthan, MSI outreach workers and government field level
functionaries support each other in creating demand for FP services and are considered as ‘one’ by
the community. However, UP being a comparatively new MSI program, and FP not being a priority of
government field staff, both the field workers are often seen separately and therefore the community
can easily distinguish one from the other.
Communication channels
FINDING 9: According to the exit interview data the most common type of media used by clients was
TV, reported by almost a quarter of the clients. However, almost half of the clients (48%) do not use
any media. Only around 30% of our clients own a mobile phone, increased from 16% last year. This
indicates that SMS and other mobile phone based innovations may not work with our clients. The
extent to which clients used other means of communication is explored below.
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Table 7: Media types used in the past two weeks
Weighted Average Govt Nagaur MSI COT Govt UP
N = 198 N = 101 N = 253 N = 122
Newspaper 5.1% 4% 4.3% 7.4%
TV 24.7% 23.8% 25.7% 17.2%
Radio 2.5% 1% 2.4% 5.7%
Magazine 0.5% 1% 0.8% 1.6%
Internet 0% 0% 0% 0%
Any other media 0.5% 0% 0.4% 1.6%
Does not use media
48% 34.7% 48.2% 55.7%
Declines to answer 0% 0% 0% 0%
Client motivation to attend MSI services
Clients were asked about their main motivation for visiting MSI that day, Each client was asked to
choose one factor that was the most influential in their decision to attend the MSI service on that day.
FINDING 10: The majority of clients irrespective of type of camps attended MSI services because of
proximity of the facility. Though more than 70% of the clients both in govt Nagaur and MSI COT
reported proximity as the main reason, around 43% reported the same in govt UP camps. In UP,
clients could get an IUD even at the Sub centre level which is generally close to their village. This
might be the reason that proximity was not a selling point for UP clients. This was followed by good
reputation of the service provider where 20% of clients in govt Nagaur, 13% in MSI COT and around
30% in govt UP reported this factor. (see figures 4a-c). Around 10% and 16% of the clients in MSI
COT and govt UP respectively also mentioned that they knew the provider/staff. Low cost was also an
important indicator to avail MSI services for clients in govt UP camps (10%). This year’s findings also
show a similar trend as last year.
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76%
1%
20%
3%
Govt Nagaur
Nearby
Low Cost
Good Reputation
Knows provider/staff
72%
4%
13%
10%
1%
MSI COT
Nearby
Low Cost
Good Reputation
Knows provider/staff
Services/medicines available
Figure 4a – (Govt Nagaur) Percent distribution of most important reason behind choosing the MSI
service provider
Figure 4b – (MSI COT)
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43%
10%
30%
16%
1%
Govt UP
Nearby
Low Cost
Good Reputation
Knows provider/staff
Referred by someone
Figure 4c – (Govt UP)
Section 4: Putting Evidence to Action
Making recommendations for programme improvements using Exit
Interview data
Key piece of evidence #1: Findings highlight that the program needs to target the young population
since currently we are targeting only 13% of the under 25 year old population and no adolescents
under 20 years of age. The young population would have high unmet need for spacing or delaying the
first pregnancy.3
Action item #1: Inception of Youth Task Force. MS India understands the importance of and is
committed to providing safe and accessible sexual and reproductive health services to the youth. MS
India has already nominated one staff member as the focal person to interact with MSI London in
developing and designing youth centred activities.
3 Center for Reproductive Law & Policy. International Family Planning and Reproductive Health Programs:
When Will the U.S. Government Fulfill Its Commitment. New York: The Center, 2001.
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Who is responsible for this area: The point person nominated would be working in close support and
coordination with the field teams including District Coordinators, Block Coordinators and IPCs.
Current status of this action item: One point person has been nominated to take this initiative further
Key piece of evidence #2: Currently, female sterilization is the only preferred choice as compared to
male sterilization, IUD and other spacing methods. This is quite evident from the exit survey findings.
Also, counselling needs further strengthening at all the three types of camps as has been highlighted
in the findings.
Action item #2: Emphasis on method mix and counselling to understand the choices clients have.
Studies have shown that limited method choice is a problem in rural areas and is one of the causes of
increased unsafe abortion rate4. It is imperative that the field staff be sensitized and informed about
the need to promote method mix during their one to one meetings and group meetings.
Who is responsible for this area: Field teams would be responsible after they have been provided
necessary counselling and skill development trainings
Current status of this action item: Counselling trainings for the IPCs have been planned in the first
quarter of the year.
Key piece of evidence #3: Even though the clients reported that they would recommend the facility to
a friend, currently less than 10% of the clients consider ‘someone who has used the service’ as a
source of information.
Action item #3: Peer Approach to identify potential clients and innovative BCC and marketing
strategies to reach the unreached. Since majority of the clients have no or some primary education,
and do not use media, the program needs to utilize other IEC activities like mobile video vans, flip
books, interactive games, etc to communicate the benefit of family planning and informing them about
the nearest such facilities. Additionally, the program must also utilize the existing
4 WHO Fact sheet N°351 July 2012
Exit Interview Report 2012 Marie Stopes International
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grassroot/community groups to engage in family planning discussions. This will be a captive audience
to discuss the family planning needs of the community and informing the group about MSI services.
Who is responsible for this area: Field staff and communication officers.
Current status of this action item: Communication officer would be briefed on the findings through
dissemination workshop and IEC activities would be designed depending upon the target group in the
1st quarter of 2013.
Next Steps
In our pursuit to benchmark as an evidence-based organisation, MS India utilizes Exit Interviews as
an important source to understand their clients better and make their association with us a pleasant
experience. The findings from this survey help us understand what clients value about our services
and how they wish to see us improve. RME team at MS India will take the lead to disseminate exit
survey findings at various levels to feed the findings into the program.
1. Presentation and Circulation of report with key findings and recommendations to the SMT
members for necessary action – The Exit Survey findings will be shared with the Senior
Management Team during the SMT meeting. The SMT would include Program Director;
Operations Directors; State Program Managers; Clinical Services Manager, NBD Manager
and Finance Manager. This would be a good platform for necessary discussion and way
forward to design actionable points.
2. Trainings and Capacity building programs would be designed:
a) Counseling trainings would be organized for the Inter-personal communicators to further
develop their counseling skills and better utilization of IEC material.
b) Capacity building of the field staff and medical staff to ensure the clients has a satisfied
experience with MSI services. This would include maintaining privacy, reducing waiting
time, cleanliness, friendliness of the staff, quality of advice and follow-up instructions.
3. Circulation of reports to external stakeholders – An exit survey brief would be shared with the
NBD Manager to be used as a hand-out for circulation to our existing and prospective partners.
4. Dissemination workshops with district teams including field staff – It is essential to share the
findings of any survey with the teams involved at the field level. Dissemination workshops
would be conducted at the zone level (Jaipur and Udaipur zone) and both the disctricts of UP
Exit Interview Report 2012 Marie Stopes International
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with the District Coordinators, Clinical Outreach Team members, Block Coordinators and Inter-
personal Communicators. These workshops would provide necessary platform to share survey
findings and draw out strategies suggested by field implementers to improve upon their
existing work.
5. Printed material in the form of posters would be displayed at all the district offices for reference.
Appendix 1: Methodology
Exit Interview dates and locations
Client Exit Survey was carried out for 2 weeks from 26 Nov to 10 December 2012 in two states of
India i.e. Rajasthan and Uttar Pradesh. In Rajasthan 10 operational districts i.e. Jaipur 1 & 2, Ajmer,
Alwar, Sikar, Udaipur, Chittorgarh, Rajsamand, Banswara and Nagaur and in Uttar Pradesh two
districts Bareilly & Badaun were included in the survey. Broadly this survey was carried out at two
types of outreach camps i.e. MSI Supported Government (MSI SG) Camps and MSI Clinical Outreach
Team (COT) Camps. Being a new operational state, COT camps have not been introduced in Uttar
Pradesh yet, so in this state the survey was conducted at MSI supported government camp sites only.
In Rajasthan only MSI COT camps have been covered except one district Nagaur where both type of
camps were incorporated in the survey.
Sampling
Three different samples were taken, one in UP and two different ones in Rajasthan, where MS India is
providing service delivery. In UP and Nagaur in Rajasthan, MS India provides demand generation and
administrative support only whereas in 10 districts of Rajasthan, Clinical Outreach Teams provide
complete service delivery. The camps are therefore mentioned as Govt Nagaur, MSI COT and Govt
UP throughout the report.
Sampling Design:
Rajasthan: Site details are given in the table below:
SITE DETAILS AND SAMPLE COVERED IN RAJASTHAN
Exit Interview Report 2012 Marie Stopes International
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S.No Date Day Site Block District
Sample Covered
1 26-11-2012 Monday Phc Mokampura Banswara
6
2 26-11-2012 Monday Gudhabhagwandas Nagaur Nagaur
8
3 27-11-2012 Tuseday Chc Badarel Talwara Banswara
11
4 27-11-2012 Tuesday RAJPURBADA RAJGARH ALWAR
7
5 27-11-2012 Tuesday Paota Govindarh Jaipur-I
6
6 27-11-2012 Tuesday phc bobas Dudu Jaipur-II
2
7 27-11-2012 Tuesday Thanwla Riya Nagaur
10
8 27-11-2012 Tuesday Borwad Makrana Nagaur
4
9 28-11-2012 Wednesday Ladnun Ladnun Nagaur
6
10 28-11-2012 Wednesday PHC-PARA KEKRI Ajmer
5
11 28-11-2012 Wednesday BHIWADI TIJARA ALWAR
13
12 28-11-2012 Wednesday Khandela CHC Khandela Sikar
2
13 28-11-2012 Wednesday ItawaBhopji Govindarh Jaipur-I
5
14 28-11-2012 Wednesday Chc phagi Phagi Jaipur-II
8
15 28-11-2012 Wednesday CHC SARADA SARADA Udaipur
6
16 28-11-2012 Wednesday Ren Merta Nagaur
3
17 28-11-2012 Wednesday Kuchaman city Kuchaman Nagaur
5
18 29-11-2012 Thursday PHC-TOTGARH JAWAJA Ajmer
2
19 29-11-2012 Tursday Kaanwat Phc Khandela Sikar
6
20 29-11-2012 Tursday Aandhi J.Ramgarh Jaipur-I
9
21 29-11-2012 Thursday Padukalan Riya Nagaur
8
22 29-11-2012 Thursday Kuchera Nagaur Nagaur
5
23 30-11-2012 Wednesday Chc Ganoda Ghatol Banswara 3
24 30-11-2012
Friday PHC-RAMGARH MASUDA Ajmer 3
Exit Interview Report 2012 Marie Stopes International
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25 30-11-2012
Friday CHC Rawatbhata Rawatbhata Chittor 6
26 30/11/2012
FRIDAY CHC DELWARA KHAMNOR Rajsamand 2
27 30/11/2012
Friday CHC JHADOL JHADOL Udaipur 3
28 30-11-2012
Friday MANDHAN SAHAJAHAPUR ALWAR 9
29 30-11-2012
Friday Ajeetgarh CHC Sri Madhpur Sikar 4
30 30-11-2012
Friday Jahota Amber Jaipur-I 6
31 30-11-2012
Friday Parbatsar Parbatsar Nagaur 11
32 02-12-2012 Sunday Koikasim CHC Harsoli Alwar 7
33 03-12-2012 Monday Tizara CHC Bhiwadi Alwar 4
34 04-12-2012 Tuesday Bhim Bhim Rajsamand 2
35 04-12-2012 Tuesday Jhadol Jhadol Udaipur 8
36 05-12-2012 Wednesday Sarada Sarada Udaipur 8
37 05-12-2012 Wednesday Phagi Phagi Jaipur 12
38
07-12-2012
Friday Jayal Jayal Nagaur 8
39
07-12-2012
Friday Riya Riya Nagaur 6
40
07-12-2012
Friday Choti Sarwan Banswara 18
41
07-12-2012
Friday Phalasiya Udaipur 3
42
07-12-2012
Friday Rawatbhata Chittorgarh 10
43
07-12-2012
Friday Bagawas virat nager Jaipur-I 5
44
08-12-2012
Saturday Manana Makrana Nagaur 2
45
08-12-2012
Saturday Timeda Bada Kushalagarh Banswara 7
46
08-12-2012
Saturday Gatweri Jamwaram garh Jaipur-I 5
47
08-12-2012
Saturday Kotda Girwa Udaipur 7
48
08-12-2012
Saturday Mandaphiya Bhadesar Chittorgarh 4
49
09-12-2012
Sunday Tarnau Jayal Nagaur 5
50
09-12-2012
Sunday Phc madawri Phagi Jaipur-II 5
Exit Interview Report 2012 Marie Stopes International
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51
10-12-2012
Monday Didwana Didwana Nagaur 7
52
10-12-2012
Monday Medtacity Medta Nagaur 7
53
10-12-2012
Monday Makrana Makrana Nagaur 7
54
10-12-2012
Monday Deh Jayal Nagaur 17
55
10-12-2012
Monday Pragpura virat nager Jaipur-I 6
Rajasthan, MSI Clinical Outreach Team Camps: Cluster sampling was used for selection of
outreach sites as the total number of facilities were more (>30) and it was not feasible to visit all the
facilities. To get a representative sample of sites from all the districts 30 sites were considered
sufficient to survey, as recommended in the globally standardised MSI Exit Interview (EI) Protocol.
Sample size of the respondents was kept at 160 (which was the minimum sample size recommended
in the EI Protocol) to keep it more balanced against practical considerations like budget, cost and time.
Rajasthan, MSI Supported Government Camps: A census of all sites was used to calculate the
sample for MSI supported government camps with minimum total sample of 106 respondents since
the sites were less than 30.
Uttar Pradesh, MSI Supported Government Camps: List of sites given below:
SITE DETAILS AND SAMPLE COVERED IN UTTAR PRADESH
Dates Camp District Blocks Venue
Sample Covered
1 26.11.2012 FP Camp
Badaun Wazirganj PHC Saidpur 6
2 26.11.2012 FP Camp
Barelly Damkhoda CHC Baheri 2
3 26.11.2012 FP Camp
Barelly Bhojipura PHC Bhojipura 4
4 26.11.2012 FP Camp
Barelly Majhgawan PHC Majhgawan
5
5 26/11/1900 IUCD Badaun Ujhani PHC Kacchala 3
6 27.11.2012 FP Camp
Barelly Kuandanda CHC Kuandanda 3
7 27.11.2012 FP Camp
Barelly Meerganj CHC Meerganj 9
8 27.11.2012 IUCD Barelly Bhamora CHC Bhamora 1
9 27.11.2012 Barelly Bithrichainpur SC Rithora 5
10 27/11/2012 FP Badaun Asafpur PHC Asafpur 12
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Camp
11 27/11/2012 IUCD Badaun Usawan PHC Katara 11
12 29/11/2012 FP Camp
Bareilly Bithari Chainpur
PHC Bithari Chainpur
3
13 29/11/2012 FP Camp
Bareilly Dalelnagar PHC Nawabganj 4
14 29/11/2012 FP Camp
Bareilly Nawabganj PHC Nawabganj 4
15 29/11/2012 IUCD Camp
Bareilly Dumkhoda CHC Baheri 1
16 29/11/2012 IUCD Camp
Badaun Samrer PHC Samrer 5
17
30.11.2012
FP Camp
Bareilly Fatehganj W
PHC Fatehganj W 5
18 30.11.2012
FP Camp
Bareilly Bhamora
CHC Bhamora 3
19 30/11/2012
FP Camp
Badaun Mianoo PHC Mianoo
13
20 30/11/2012
FP Camp
Badaun Usawan PHC Mianoo
21
30/11/2012
IUCD Camp
Badaun Mianoo PHC Mianoo
22 30/11/2012
FP Camp
Badaun Bisauli CHC Bisauli 6
23
30/11/2012
FP Camp
Badaun
Binawer
District hospital, Badaun
4
24
30/11/2012
FP Camp
Badaun
QuaderChauk
District hospital, Badaun
25
30/11/2012
IUD Camp
Bareilly
Bhidri_Chainpur PHC Bhidri_Chainpur 3
26
01.12.2012 IUCD Camp Badaun Dataganj
Sub centre Deharpur 2
27
01.12.2012 IUCD Camp Bareilly Bhamora PHC Bhamora 1
28
01.12.2012 IUCD Camp Bareilly Bhojipura PHC Bhojipura 4
29
01.12.2012 IUCD Camp Bareilly Nawabganj CHC Nawabganj 3
A census of all sites was used to calculate the sample for MSI supported government camps in UP
with minimum total sample of 106 respondents since the sites were less than 30.
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Sample Selection:
In order to select sites according to the type of camps, three below mentioned lists of camps and
dates were prepared:
(1) List for MSI SG camps of Nagaur district of Rajasthan mentioned as Govt Nagaur
(2) List for MSI COT camps (Rajasthan only) mentioned as MSI COT
(3) List for MSI supported government camps UP mentioned as Govt UP
These was based on total number of sites and dates of camps allotted by district health authorities
specifically for the months of November and December in which data collection took place. For UP
Govt camps and Rajasthan Govt camps, a census of all sites visited during the data collection period
was taken. Rajasthan COT camps, sites were selected randomly from this list using MSI’s
standardized exit interview sample selector tool.
Minimum stratified sample sizes for all samples were calculated with the following formula:
n=Z2 pq / d2
where
n = number of respondents required using simple random sample
Z=1.96 corresponding to a confidence level of 95%
p = expected coverage for key indicator
q = 1-p
d = required level of accuracy, i.e. maximum size of confidence intervals
The recommended standard minimum sample size provided figures with 95% confidence intervals of
not more than + / - 10%, using the following parameters:
p = 50% (for most conservative sample size estimate)
q = 1-p
d = 10%
This gives the following minimum sample size:
N = (1.962 x 0.5 x 0.5)/0.12 = 96
This was increased by 10% (to 106) to account for non-response.
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The sample size was then inflated when using the cluster sampling approach. The inflation factor was
the design effect, def, of using a cluster sample. This was estimated from previous exit interview
surveys.
nc = n *def
The minimum sample size when using cluster sampling was:
nc = 96 * 1.5 = 144
This was increased by 10% (to 160) to account for non-response.
(See Table 1). A proportional number of clients were interviewed at each site. Every 3rd client in
UP, every 4th client in Rajasthan COT camps and every 5th client in Nagur Govt camps was
interviewed to ensure clients were selected throughout the day.
Table A1: Sample description
Govt Nagaur MSI COT Govt UP
Total number of Sites in country
44 99 22
Total number of sites in sample
14 28 19
Total number of respondents in sample
101 253 122
Questionnaire:
The Exit Interview tool consisted of six sections covering Interview & site information, service use,
marketing, demographics, client satisfaction & feedback on quality and Poverty Index. Few additions
were made in the demographic and marketing section. Specific question on religion, caste, Below
Poverty Line (BPL) card (BPL families are issued a card which allow them to avail schemes launched
by the Government) and number of living boys were added under the demographic section. Additional
option of ‘Camp Announcement’ was added under questions M3 and M4; and option of ‘any
community meeting’ and ‘health specific community meeting’ was added under M5 question in
marketing section. Further, the tool was back translated in Hindi language to make it simple and
understandable for both the investigators and the clients.
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The tool was pre tested with 30 non-sample respondents, who visited the camps before the actual
survey started and were representative of the total population. The clients were able to comprehend
the content of the questionnaire and no comments or remarks were made to improve or change the
tool.
Data quality
Steps taken to ensure that the data collected was of high quality include:
Use of the standard MSI tools
Using double data entry
Data cleaning techniques like missing data, syntax editing based on MS India requirement
One day training for interviewers to familiarize them with the questions and conducting the
survey.
Exposure visit followed by real setting mock sessions with the investigators to give them a
proper understanding of probing and skipping pattern.
Supervisory monitoring visits were conducted by M&E officers in both states every alternate
day and daily progress reports.
Limitations
There were a few limitations of the study:
1. The sample included clients who have received the services during the data collection period.
The probability of selection for clients who availed services during other months was zero.
2. There were a few camp cancellations by the government due to competing priorities. Sample
selector was re-run for those districts to get new sites.
3. Post procedure (especially in case of female sterilization), some respondents were not willing
to respond either due to physical weakness or their attendants were in a hurry to take them
back home after the procedure. This might have an impact on the quality of responses from
the clients.
4. The timing when the follow-up instructions are provided to the clients also has an impact on
the responses. For example, in some camps follow-up instructions are provided when the
clients are waiting for their procedure while in others it is provided when they are leaving the
facility after the procedure.
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5. Investigators faced challenge in obtaining responses from a few respondents who came from
very remote villages and did not understand Hindi properly. Investigators sought support from
the clients’ attendants to seek responses from those clients.
6. Likert scale for satisfaction measurement is not a very effective tool to assess the clients’
satisfaction from the services. Clients’ interpretation of ‘very poor’ or ‘very good’ is subjective
and may differ between respondents.
Appendix 2: Service Statistics
Table A2: family planning methods used in the past 3 months, among family planning clients that
used a family planning method in the last 3 months
Govt Nagaur
N = 24
MSI COT
N = 51
Govt UP
N = 45
Female sterilisation 0% 2% 0%
Male sterilisation 0% 0% 0%
Intra-uterine system or device
0% 11.8% 4.4%
Injectable contraception
0% 0% 0%
Implants 0% 0% 0%
Contraceptive pills 33.3% 31.4% 51.1%
Male condoms 66.7% 35.3% 42.2%
Female condoms 0% 0% 0%
Lactational Amenorrhea Method
0% 0% 0%
Other modern method (diaphragm, foam tablets, spermicidal jelly, vaginal ring, contraceptive patches)
0% 0% 0%
Traditional or folk 0% 17.6% 0%
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methods (withdrawal,
rhythm, abstinence)
Emergency
contraception
0% 0% 2.2%
Among the family planning clients who used a family planning method in the last 3 months, 12% and
4% of them in both MSI COT and govt UP respectively used IUD. However, contraceptive pills and
male condoms were the most commonly used methods among all. Around 30% clients in Rajasthan
and 50% in UP have used contraceptive pills. Conversely, almost 67%, 35% and 42% clients in Govt
Nagaur, MSI COT and Govt UP respectively used male condoms during the last 3 months. Traditional
or folk methods were only reported by 18% clients in MSI COT camps.
Table A3: source of family planning method received in previous 3 months
Govt Nagaur MSI COT Govt UP
This facility 3.1% 20.3% 39.7%
Other MSI provider 0% 0% 0%
Other provider 90.6% 77% 57.4%
Don’t know 6.2% 2.7% 2.9%
As per table A3, majority of the clients who were using a family planning method received it from
some other provider. Around 40% of the clients in govt UP camps and 20% in MSI COT camps
reported using any method previously from the present facility itself. This highlights that clients do re-
visit our services either to get re-fill of their supplies or to change their choices or preferences.
Around 33% of family planning clients (30% in govt Nagaur, 37% in COT and 26% in govt UP)
reported that they would not have used family planning if the MSI provider they were served by had
not been there (Table A4).
Table A4: Use Family Planning if the MSI Provider did not exist
Govt Nagaur
N= 101
MSI COT
N= 253
Govt UP
N= 122
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Will not use FP if this facility did not exist
29.7 37.2 26.2
Clients would have had to travel a median time of 67 min in Nagaur, 60 min in MSI COT and 90 min in
govt UP to reach another provider. As per Table A5, one major problem clients reported that they
would face if the MSI provider did not exist was that they would have to travel further (43% in Govt
Nagaur, 31% in MSI COT and 37% in Govt UP).
Table A5: problems that clients report they would face if the MSI provider did not exist
Govt Nagaur
N= 101
MSI COT
N= 253
Govt UP
N= 122
No problem, I would have gone elsewhere
46.5% 38.3% 48.4%
Further to travel 42.6% 31.2% 36.9%
More expensive 3% 3.6% 3.3%
I could not get the method I like
1% 4.7% 4.9%
I could not get any method
4% 13.4% 3.3%
Other problem 3% 7.5% 2.5%
Don’t know 0% 1.2% 0.8%