الفهرس 
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Abstract
Objectives. The aim of this study was to measure the extent of structural and process quality differentials in FP services in PHC centers and units in Damanhour, El-Beheira, and to determine how these differentials affect FP clients’ satisfaction with those services. The study also aimed to prioritize SDPs as perceived by FP clients and service providers.
Methods. A descriptive cross sectional survey was adopted. Three FP clinics were selected randomly out of those linked to MCHCs, FHUs, and UHCs (One clinic from each) in Damanhour city, El Beheira governorate. The target population included all clients attending the selected FP clinics during a 3-month period from October to December 2011 (N=220), as well as all service providers (18 physicians and nurses). Data collection methods and tools included the following:
- Facility Inventory questionnaire (Appendix I)
- Health provider interview questionnaire (Appendix II)
- Observational checklists for technical procedures (Appendix III)
- Clients’ Exit Interview questionnaire (Appendix IV)
- Informed consent form (Appendix V)
Results. The main study findings were presented as follows:
Section I: Background characteristics of FP clients
IA. Sociodemographic profile
- A total of two hundred and twenty female clients were interviewed at the three selected FP clinics, in Damanhour city, El Beheira governorate.
- The clients’ age ranged from 19 to 49 years with a median age of 31 years.
- The majority of the clients were from semi-urban (52.7%) and rural areas (39.1%), and only (8.2%) were urban residents.
- About half of them (49.5 %) completed their secondary and university education. High school and university education were more likely to be encountered among those attending Desounes FHU (64.3%). In contrary, the highest percentage of those attending Al helal MCHC (54.4%) were illiterates or just read and write.
- Most of the women (89.1%) were house wives.
- Less than half of the clients’ husbands (45.9%) had secondary school and university certificates. Three fifths (60.0%) of husbands of those attending Desounes FHU were more likely to be highly educated. A considerable proportion of husbands of those attending Al helal MCHC 44.4% were illiterates or just read and write.
IB. Fertility pattern
- Number of clients’ children varied from 0-7, with a median of 2 children.
- The last son’s age ranged from one to 240 months (20 years), with a median of 36 months.
IC. Reproductive attitudes
- More than half of FP clients had no intention to get pregnant (56.8%).
ID. Contraceptive practices
- Nearly two thirds of FP clients attending the three clinics were in a return visit (62.7%).
- The majority (97.5%) were current contraceptive users. The most commonly used methods were the injectables (58.1%), followed by oral contraceptives (32.6%). Only a minority used IUDs (7.4%). The use of male condoms was reported by only 1.9% of clients.
- About one quarter of the FP clients (25.5%) preferred not to pay for the services. All those attending Al helal MCHC and Abo-elreesh UHC could afford paying 5-10 pounds to get better services or treatment.
- Nearly two-thirds of contraceptive users (63.4%) had no side effects resulting from the use of different contraceptive methods. Side effects were more likely to be reported by attendees of Desounes FHU (52.9%).
Section II: Quality measures of FP services
IIA. Differences in structural attributes of quality between the three studied FP clinics
Infrastructure and availability of services
- There were no major differences in infrastructure and equipment at the three clinics.
- Services were available at all facilities. All FP clinics provided services for six days per week, and a trained provider was more likely to be always present. The average waiting time at all facilities was less than an hour, and the average time taken to reach all facilities was shorter than 30 minutes. The number of FP methods offered was higher at Al-helal MCHC (6 methods) compared to the other two clinics (5 methods in each).
Management
- All facilities had a formal system to review management issues, and had contraceptive stocks.
Counseling
- Al-helal MCHC and Abo-elreesh UHC had a larger number of protocols (guidelines) on FP counseling, and a larger number of visual aids as compared to Desounes FHU.
- Al-helal MCHC and Abo-elreesh UHC had a private room for FP counseling, that was not present in Desounes FHU.
- All of the three clinics had a good system for keeping client records.
- All the providers received FP in-service training during the preceding 3 years.
Provider motivation
- All providers at the three FP clinics believed that incentives (salary, holidays, and promotion) would help improve the quality of services. They also believed that reducing their workload and additional training would help improve quality of care.
IIB. Differences in process attributes of