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GSM RESEARCH

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GSM strongly believes in making evidence-based decisions, strategies and plans. Research provides this evidence and important insights, including consumer perception, brand awareness, and sales information, that helps steer GSM's activities and programmes.

Research, Monitoring & Evaluation

The research department at GSM is involved during the design of any project or programme with donors and provides robust inputs to the programme team on proposal development, research requirements, and realistic timelines related to studies that can explore and assess impact. The research department also takes a lead in dissemination of findings from all research projects, both at national as well as international forums.

Monitoring and evaluation is an integral part of GSM. Through M&E, the programme results at all levels (input, output, outcome and impact) are measured to provide the basis for accountability and informed decision-making at both programme and policy levels. The GSM M&E mechanism contains donor agreed indicators and the targets to be achieved to demonstrate performance. In addition, indicators for efficiency and performance are also reviewed. Data is collected, processed and transformed into strategic information (SI), for informed decision-making at all levels.

The studies conducted by Research department are as follows

1. MAP Study

Objective: Assess the geographical coverage and quality of coverage of GSM products and services (GSM providers) in project rural and urban areas of Pakistan. Estimate measures of penetration of GSM services within rural and urban areas.

GSM conducts MAP survey on biannual basis on measuring the quality, penetration, volume and share of its social marketing and social franchise systems. The purpose of the Measuring Access and Performance (MAP) Survey is to provide evidence for social marketing & franchise decision-making in the areas of product and service delivery systems. The MAP study aims to improve the performance of social marketing & franchise programs in terms of health impact, behavior change, cost-effectiveness, equity, and efficiency. The study identifies areas of poor coverage or access, and, internally, will be used in strategic, project, and marketing planning. At present every district /Tehsil in Pakistan is divided into Union Councils (UC); the smallest administrative unit. The geographical areas for this study are UCs. The UC are used as the primary unit of analysis for this study and stratified by rural and urban areas. A total 152 UCs were selected for this survey, clean sweep methodology used for this MAP survey, All health care facilities, and traditional (TO) and non-traditional outlets (NTO) such as small grocery stores that sell or provide family planning services and products are being audited in each UC.

Study Approach: The study utilized a quantitative, survey-based methodology, in which all health care facilities, traditional, and non-traditional outlets were audited in each administrative unit. Product coverage estimates were calculated using the Non-LQAS technique.

Phase I: Before the selection of 152 Union Councils, a complete listing of Union councils is collected and collated. Listings for certain areas are gathered from the population Census Organization and other related government sources.

GPS coordinates: Another important part of the MAP survey is GPS (Global positioning system), all traditional and non-traditional outlets and health facilities GPS coordinates are collected in all 152 selected UCs.

2. Tracking Results Continously (TRAC)

Objective:

  • Assessment of client perceptions regarding IUD and communication messages
  • Assessing percentage of MWRAs who believe that IUD is a safe and effective contraceptive method
  • Assessing percentage of MWRAs who know that side effects after IUD insertion will disappear within 3-6 months

We collect quantitative data about our social marketing programs by conducting TRaC studies. TRaC is a multi-round survey-based research approach that we use to gather information from a representative sample of our target populations. The data collected from TRaC studies allow us to understand characteristics of the groups we work with such as sociodemographics, health behaviors, knowledge about health products, and much more. This information is very useful to understand how to best design our social marketing programs as well as to assess if they are effective

3. Price Sensitivity Study

Objective:

  • The current prices at which clients are paying for family planning products (condoms, OC, pills, Injectable, IUDs,) & services
  • To establish the range of acceptable prices (to consumers) for all family planning products to be purchased
  • To establish the optimal price for all family planning products

4. Client Exit Survey

Greenstar conducts a semi-annual client exit survey for its social franchise network in to assess whether clients are satisfied with Greenstar Services offered and whether quality of care is up to a minimum standard.

Objective:

The overall aim of the exit interview survey is to identify whether GSM services are meeting the needs of clients who attend the Greenstar facilities and to identify areas to improve clients satisfaction of their experience. The objectives of the client satisfaction exit interview are:

  • To assess clients satisfaction of their experiences at Greenstar facilities, including their perception of quality of services provided; and
  • To assess the client profile by collecting more socio-demographic information about our clients such as the level of education, marital and employment status, Greenstar can better understand the type of client seeking different services and who is accessing the services and to assess whether GSM is reaching underserved populations.

5. Manual Vacuum Aspiration Study

Objective:

  • Understand the providers attitudes and experiences of these services and challenges in promoting and providing these services
  • Understand client's attitude and experience of these services along with the barriers to client uptake of post MVA FP adoption
  • Determine support further needed from Greenstar to promote Post MVA FP adoption more broadly, improving provider's productivity and service delivery
  • Inform the redesign of promotional materials, the design of mid-media campaigns and provider motivational activities, the revision of training and refresher materials, and the development of medical representatives' provider behavior change messages and tools.

6. Postpartum Intrauterine device Study

Objective:

  • Understand the provider challenges in promoting and providing these services and barriers to client uptake
  • Determine support further needed from Greenstar to promote PPIUD more broadly, improving provider productivity and service delivery
  • Inform the redesign of promotional materials, the design of mid-media campaigns and provider motivational activities, the revision of training and refresher materials, and the development of medical representatives' provider behavior change messages and tools.

7. Assessing the business model of IPC workers at Greenstar Social Marketing

The objective of the study is to evaluate the IPC business model in the light of other outreach programs.

Method: An exploratory qualitative and a quantitative study was conducted An overview of the literature about outreach workers’ practices and effectiveness in creating behavioral change among the women of reproductive age was also assessed that helped in developing the guideline. Data from MIS was used to assess the impact that IPC made to a providers productivity is terms of IUD insertions and sales.

8. Assessment of In-Service Outreach Workers in Social Franchising Network of Greenstar

Objective: The purpose of the study is to assess the impact of In-Service Outreach Workers in the uptake of Family Planning methods as well as to explore the strengths and weaknesses of the ISOW’s model.

Method: Based on the objective, mixed methodology was adopted to acquire the information needed. An exploratory qualitative study was conducted with ISOWs and management across three regions: Karachi, Islamabad, and Peshawar. A total of 9 in-depth interviews were taken from ISOWs along with the providers they are attached with. Moreover, 3 clients per provider were also interviewed to get a holistic view of the program’s mechanism. Apart from this, Sales and Performance Reports were analyzed to assess whether the counselling efforts were translated into increased uptake of FP method.

Monitoring Activities

The M&E component of Greenstar's RME department conducts several activities with the objective of assessment and improvement of client care and to uphold professional standards; to identify areas of risk within services and to create a culture of quality improvement in the clinical setting and at program level. M&E exists with representation in all nine regions to analyze the gap of quality of services on periodic basis and inform stakeholders for timely improvement.

Following is the list of activities which M&E performs on quarterly basis:

  1. Clinical Audit of Network – Facility Assessment and Provider Skill Assessment
  2. Monitoring of Quality Assurance team
  3. Training Assessment
  4. Monitoring of IPC activities
  5. Stock Monitoring
  6. Retrospective Verification of Voluntary Surgical Contraception
  7. Help line mystery Caller Survey

M&E Activities in regions are executed by 9 Regional Clinical Auditors who spend most of their time in the field conducting network visits, training assessments and monitoring of quality assurance supervisory visits. They also conduct monitoring of IPC and other initiatives.

1. Clinical Audit of Network – Facility Assessment and Provider Skill Assessment:

A total of 19 Providers is selected for each region every quarter through LQA sampling. Review of provider’s file is done at regional offices where provider files are kept. Provider’s educational documents, license to practice, training certificates from Greenstar, Recruitment forms, MoU, SBMR scores, QTV and previous clinical audit reports are reviewed. This is followed by onsite visit for Facility audit and skill assessment of all providers in the sample.

2. Monitoring of Quality Assurance team:

Work Plans of Quality Assurance Managers are shared by Network team at head office level. Each month the regional clinical auditors select two Quality Assurance Managers randomly. Selected Quality Assurance Manager’s activities are monitored at all providers she visits during monitoring day. At least one SBMR is observed per staff. Quarterly monitoring report is sent to Head Office. During the past quarter Network plans were regularly shared at head office level and work plan adherence during monitoring days was ensured by network team.

3. Training Assessment:

Building the technical competencies of the GS network provider is a mandate of GSM, which is done by imparting trainings and conducting on-site technical assistance visits. Training, as an important activity of health services department, enables providers to ensure provision of long acting reversible and irreversible methods and post abortion care by developing their technical knowledge and skill. Training assessment by M&E ensures that these trainings are done according to GS standards. At least one training session is observed each month by Regional Clinical Auditors. Class room Training plans is shared regularly and response on M&E reports is given timely by head of training.

4. Monitoring of IPC Activities:

Regional Clinical Auditors monitor various behavior change communication aspects with their effectiveness in developing desired outcome i.e., contraception uptake. The aim of monitoring IPC activities is to ensure uniformity in message being communicated to the targeted community, including MWRAs, their associates and GS providers. The scope of monitoring includes;

  1. Observation of community educators’ interaction with MWRA during household visits
  2. Observation of community educators’ interaction with a group during neighborhood meeting
  3. Collection of feedback from GS provider about the usefulness of the IPC work
  4. Collection of feedback and information from MWRA to verify the collected data

Lot Quality Assurance Sampling (LQAS) technique was used to remove sampling bias. The monthly or quarterly work plans of all community educators of the specific region were received at region and forwarded to head office for drawing the sample of 19. For every region, sample size of total 76 is desirable to achieve, with 19 sample each for all four monitoring activities of IPC. The four monitoring checklists together will be used to assess community educator’s performance in terms of job delivery, quality assurance and data verification.

5. Stock Monitoring survey:

The objective of stock monitoring is to observe availability and assess quality standards of GS products at the outlets associated with GS franchise networks, FMCGs and Pharmacies on quarterly basis.

Methodology:The survey is an on-going process and is performed quarterly. A structured questionnaire was used to obtain information against product availability and quality indicators. The data was collected by the sales team for FMCGs & pharmacies and clinical auditors for GS providers, The LQAS sampling methodology was utilized, a small random sample of 19 outlets was selected from three lots per region. The three lots from each region were stratified into: FMCG outlets, pharmacies and service providers.

To extract a random sample of 19 outlets from each lot, lists of newly activated and existing retail outlets, pharmacies and service providers were retrieved from MIS for each quarter.The findings represent three key indicators: availability of the products (currently available), storage conditions (visibility of the product and sunlight exposure) and the expiry of the product (product does not expire in the next 3 months).

6. Client Validation:

Client verification for voluntary surgical contraception is conducted at designated clinics of Greenstar social marketing where the services are offered free of cost. Every month health services collects data of VSC clients for financial reimbursement to providers and clients (wage loss/transport). Retrospective VSC client verification is being conducted by M&E department from July 2015 onwards.

7. Help line mystery Caller Survey:

Helpline monitoring was done by two different methods including

  • Mystery calls - 19 mystery calls in a quarter were made by Regional Clinical Auditors
  • Listening to call recordings - Randomly 19 recorded calls in a quarter were listened

Standards of quality such as: appropriate reply to a caller, sufficient time given to a caller, knowledge about topic, relevance of content, use of appropriate language, verbal gestures, listening skills, knowledge about GSM providers, and services and products were assessed during both activities.