Client Exit Interview (Demonstration Project in UP)

(To be administered 7 days after receiving Female Sterilization service)

Name of Respondent: Name of Husband: .. Village: Bijnor Lanmark: TPC: 1 Rohta ASHA Name: Educational level of Client: Religion: Caste: 2. Ailum Kotwali Dehat Block: District: 1 Meerut 2 Muzaffarnagar 3

Mobile No. TPC ID: ASHA Code:

No. of children: Son-------- Daughter---------------- Total---------------Sr. No. 1 Questions Were you comfortable when ASHA met you at your door step to discuss about FP method / abortion? Did she mention the range of FP methods/Abortion services available at or through your nearest Sky Health Centre? Did she mention you about the possible side effects of the FP method/abortion you are choosing? Did she inform you what to do in case of any complication after the FP method accepted / abortion done? Overall how would you rate the services provided by ASHA to meet your FP needs? Codes Skip to

1 Yes 2 No 3 Unsure/ cant tell 1 Yes 2 No 3. Cant remember 1 Yes 2 No 3. Cant remember 1 Yes 2 No 3. Cant remember 1. Very satisfied 2. Somewhat satisfied 3. Neither satisfied nor dissatisfied 4. Somewhat dissatisfied 5. Very dissatisfied Did you have a female sterilization 1. Yes procedure done, which gives permanent 2. No
1

10

11

12

13

14 15 16

protection against pregnancy? In which location did you have the 1. At a WHP Franchisee sterilization procedure? Clinic 2.At a government facility (PHC or CHC) 3.Other (Specify): ___________________ Were you referred for sterilization by your 1. Yes SkyHealth Telemedicine Centre Provider 2. No (Name)? 3. Unsure From the time you submitted your name for 1. Less than 1 week sterilization, how long did it take for the 2. 1-3 weeks service to be performed? 3. 4-6 weeks 4. Longer than 6 weeks Prior to the procedure, were you counseled 1. Yes by the SkyHealth Telemedicine Centre 2. No provider that the sterilization procedure is a 3. Cant remember permanent method of pregnancy prevention, and should only be undertaken by women who are finished having the number of children they want? Did the SkyHealth Telemedicine Centre 1. Yes provider counsel you on all your family 2. No planning options before you decided to have 3. Cant remember sterilization? Did the SkyHealth Telemedicine Centre 1. Yes provider treat you with respect and give you 2. No enough time and freedom to decide on 3. Cant remember which family planning option is best for you, before you decided to have sterilization? On the day of the surgery, did the 1. Yes clinic/hospital first have you do a urine 2. No pregnancy test to ensure that you were not 3. Cant remember pregnant? Did you feel that the facility was clean? 1. Yes Go to Q 16 2. No Which aspects of the facility were NOT clean? Which of the following were you given just 1. You were given an before the surgery? injection in the abdomen (MULTIPLE RESPONSES POSSIBLE) with a freezing medicine 2. You were put to sleep with a medicine through an IV

17 18

19

20

21

22

23

3. You were given sleeping medicine through a face mask 4. Other (Specify) ___________________ 5. Cant remember Overall, did you experience much pain or 1. Yes discomfort? 2. No Did you feel like you were treated 1. Yes respectfully by the surgeon and the nursing 2. No staff? Were all of your queries and concerns 1. Yes handled to your satisfaction during your 2. No stay, including during surgery? Is there anything else you would like to share with us about your experience or how you were treated? There are some complications that can 1. No, I have had no happen after a surgical procedure like problems during or after sterilization. Have you experienced any the sterilization complications during or after the 2. Trouble waking up sterilization? after the surgery DO NOT PROMPT. CLIENT TO 3. Fever MENTION ANSWER 4.Redness/swelling/disc SPONTANEOUSLY. (MULTIPLE harge at the incision site RESPONSES POSSIBLE) 5. Persistent pain 6.Other (Specify)____________ How long after the surgery did it take for 1. Less than 3 days you to be able to do all you household work 2. 3-7 days and other duties (ex. child care) as usual? 3. More than a week 4.Other (Specify)____________ 5. I still dont feel back to my normal self How much did you pay for the procedure 1.Nothing Everything and all other costs related to your hospital was free stay? 2.Just charges for medicines (Less than Rs. 500) 3.Charged for the procedure and medicines (Over Rs. 2000) 4.I was paid Rs. 600 cash
3

5.Other (Specify)____________ 6. Cant remember 24 Did the SkyHealth Telemedicine Centre 1. Yes give you the Toll-Free Number that you can 2. No call for help in case you have any 3. Cant remember complications or concerns following the surgery? 25 Have you called the Toll-Free Number for 1. Yes assistance after the surgery? 2. No 26 Over what concern(s) did you call the TollFree Number? 27 Were you satisfied with the advice or 1. Very satisfied assistance that you received after calling the 2. Somewhat satisfied Toll-Free Number? 3. Neither satisfied nor dissatisfied 4. Somewhat dissatisfied 5. Very dissatisfied 28 Was your concern resolved within 24 hours 1. Yes of calling the Toll-Free Number? 2. No 3. Cant remember 29 Overall, how would you rate your 1. Very satisfied experience? 2. Somewhat satisfied 3. Neither satisfied nor dissatisfied 4. Somewhat dissatisfied 5. Very dissatisfied 30 Do you feel comfortable to return to the 1. Yes SkyHealth telemedicine centre provider for 2. No any future health care needs? 3. Unsure 31 Would you recommend sterilization to a 1. Yes family member or friend as a satisfactory 2. No family planning method for those who have 3. Unsure finished having the number of children they want? Thank and Terminate