Manual to Evaluate Quality of Care from a Gender Perspective



To apply a broader gender perspective in assessing the quality of sexual and reproductive health services in a variety of clinical settings.

Intended Users:

Private or public sector sexual and reproductive health organizations, and non-governmental organizations (NGOs) providing reproductive health services.


The Manual to Evaluate Quality of Care from a Gender Perspective is an evaluation and quality improvement tool that describes how to conduct an assessment of quality of care from a gender perspective. The evaluation methodology was originally designed for clinics providing reproductive health counseling and clinical services for female clients. However, it can also be adapted for services targeting male clients. The methodology is guided by six tools described below:

  1. Observation of Physical Aspects of the Clinic (A simple and quick assessment of the physical space and its utilization)
  2. Observation of Client Reception (An examination of what happens from the moment a client enters a clinic until she begins a consultation with a service provider)
  3. Observation of Consultation and Counseling (An examination of client-provider interactions with respect to both traditional quality factors and gender-specific issues)
  4. Client Exit Interview (An assessment of clients’ perceptions of the information and services provided)
  5. Service Provider Interview (An examination of staff attitudes and perceptions regarding their role and that of the institution within a sexual and reproductive health context)
  6. Document Review (An assessment of institutional policies and practice regarding gender, as well as the degree to which the organization’s educational materials are gender-neutral)

Each tool contains data collection and tabulation forms. It has surveys and questionnaires with detailed guidelines on how to and who should conduct the observation and how long an observation might take to be completed. The tools can be applied in any order in its entirety or can be applied in parts depending on the issues the institution wishes to address, the time, and the availability of personnel permit.

Developed by:

International Planned Parenthood Federation/ Western Hemisphere (IPPF/WHR) on January 2000.


The tool has been field-tested by three IPPF affiliates in late 1996 and early 1997 in Colombia, Dominican Republic, and Peru, and subsequently used by IPPF affiliates in additional countries in Latin America and with NGO and public sector programs in Bolivia. A version of the Manual has become part of the Bolivian Ministry of Health’s Technical Publication Series. It has also been translated and adapted for use in China.


The methodology represents the first time that the concepts of gender have been operationalized in a way that allows sexual and reproductive health organizations to assess their programs for gender-sensitivity and quality simultaneously. The methodologies are straightforward and simple, and can be done with local expertise in most countries. The methodology can be used at any time during the life of a program or can be used as a baseline study prior to the initiation of gender-related activities. In all of the applications of the tool to date, the local research teams have carried out the study with no external international technical assistance.


The methodology looks largely at the supply side of the quality issues. It does not focus as much on the demand for gender-sensitive, quality services. In addition, it is designed for women sexual and reproductive health clients, and it does not currently address the gender-specific need of men.

Recommendation for Users:

The methodology should be used in an environment where there is an interest in changing at the higher management levels because the standards of quality from a gender perspective implicit in the manual are very high. In most cases, organizations might find that they have significant issues to address if they were to have the highest levels of quality from a gender perspective. In addition, the methodology is designed primarily for sexual and reproductive health service providers even though the methodology can be adapted for other types of organizations. Institutions are encouraged to adapt the tools to meet their local needs, but they should maintain a certain level of standardization of the methodology and modify the tools only if their usefulness to the institution is enhanced by the process.

Reports and Publications:



The manual is available in English and Spanish.


Judith F. Helzner or Victoria Ward, Ph.D.
International Planned Parenthood Federation/ Western Hemisphere
Region, Inc (IPPF/WHR)
120 Wall Street, 9th Floor
New York, NY 10005-3902
Phone: (212) 214-0214
E-mail: or