Facility Survey on Safe Abortion in Six Clinics of Global Comprehensive Abortion Care (GCACP) Project (Completed 2009)

The study carried out for the Family Planning Association of Nepal (FPAN), has made an attempt to help FPAN meet quality of care standards through a facility survey on Safe Abortion in six clinics of Global comprehensive abortion care (GCACP) project districts.The GCACP districts were namely Ilam, Sarlahi, Palpa, Banke, Kailali and Kanchanpur.

The methodology of the study included review of relevant literature, some secondary data analysis and primary data collection using observation/interactive checklist on quality of care (QOC) and exit interviews with clients. In order to reinforce and verify the findings the existing HMIS-11 abortion register data were also analysed.

This current study follows the quality of care framework for family planning developed by Judith Bruce. Since the framework has great salience for abortion and postabortion care providers, it has been adapted by Ipas, the Population Council, the WHO and others specifically for abortion-related care- both postabortion care and induced abortion services.

All six SDPs have facilities for registration, waiting, counselling and physical examination. Records are maintained confidentially at the service delivery points (SDPs). Waiting areas have seating arrangement (tables & chairs), they are sheltered, well ventilated, have drinking water and clean toilets. Counselling and consultation/examination room ensure privacy. Inter personal communication between provider and client was found good in five SDPs.

Service provider’s competency with respect to the procedure, medication, and interaction with clients was found good. Most providers maintain client records but the follow up of clients after the procedure was not up to the standards.

SDPs have suitable facilities for infection prevention services such as “a separate room for processing instruments/equipment”, “clean water”, “a separate room/area for examining clients”, “a washing facility with immediate access to the procedure room”, “a hot air oven, autoclave, or boiler” and “covered containers for storing equipment”.

Surgical abortion procedure (EVA/MVA) was measured by inquiring whether the SDP has suitable facilities, supplies and equipment to perform EVA/MVAs; staffs follow IPPF QOC-infection prevention guidelines /protocols; service providers (doctors, nurses) are competent and confident to provide MVA and management of post EVA/ MVA clients (post recovery). Except Kanchanpur SDP, other five SDPs were found having adequate lighting in EVA/MVA room. However, all six SDPs were found having ventilation and necessary equipment in EVA/MVA room.

Quality of abortion related services was generally satisfactory to most women including post abortion counselling and EC and ten of 20 clients also accepted EC but in Banke and Palpa none accepted it. Few women suggested that a female doctor and more information would make clinics attractive to women.