Comparison of the "Self - assessment" monitoring tool with "Routine supervisions" in maternal care services of urban health centers in Semnan, Iran

Quality assessment based on client oriented approach is one of the most effective methods in improving efficacy of services. The "Self-assessment" consists of four monitoring tools including "service assessment, client flow analysis, client exit interview and plan of action"; and can be performed by staff group forming in Service Delivery Points (SDPs). The main objective of the present study was to compare "Self-assessment" with "Routine supervision". Material &

Eight urban SDPs have been allocated (by stratified random allocation) to the "Self-assessment" and "Routine supervision" groups, which had three and five SDPs, respectively. The following variables have been determined for comparison of two methods after one round of the Self-assessment: 1) monitoring performance by finding problems in SDP 2) job satisfaction of staff 3) staff attitudes towards their job 4) staff practice. Difference of pre and post intervention data of two groups have been compared by Man Whitney and t-test.

Most frequent problems which have been picked up by the Self-assessment were deficiencies in materials and instruments, problems in physical structure of SDPs and educational materials. In the other hand problems that raised by "Routine supervision" were usual administrational issue, deficiencies in materials and instruments, and finally roughly suggestions regarding service delivery, e.g. low quality of care. The Self-assessment had more in-depth approach in evaluation of technical aspects of services and client rights than routine supervision. In addition, although this was a short term evaluation, Self-assessment showed regarding staff attitudes towards relations with their colleagues (P=0.05) and their overall satisfaction (P=0.04). It seems that these effects were contributed by team forming in SDPs.

The Self-assessment affects staff participation, their attitudes towards client rights, innovation for problem solving and finally results in quality improvement. The important point is coordination and supportive role of central levels with this activity; otherwise its impact would be diminished after afew rounds.