Table 3 Observation notes, District Plan-Do-Review meeting, June 2012

A set of over 20 indicators were reviewed systematically. Taking one indicator at a time the district performance since the start of the financial year was assessed against its target. If it was not meeting the target, then time was spend reviewing the performance against the pervious year’s performance for the quarter, and looking at trends over time. In additional any subdistrict that was not meeting the district performance average was asked to explain their situation and how they were addressing the problem.

In reviewing the couple year protection rate, the district manager pointed out that the district was generally not doing well. He highlighted the performance of (Subdistrict A) which had dropped below the baseline. He said that this indicator was driven by many component parts and that one priority component was contraception services to women under 18, and that this needed to be a particular focus going forward. The manager of Subdistrict A reported that she had done an analysis of this component but that this was now out of date and that she would repeat it. She said that this indicator was proving to be one of the most challenging. She said that her subdistrict strategy was one of service integration however, while this was successful in identifying new clients, they are not retaining these new clients in care. On monitoring performance of facilities over time they found that the statistics of some of the better performing facilities had dropped. She reported that further enquiry led them to find that staff didn’t really believe in strategy and weren’t committed to its implementation.

The district manager seemed satisfied with this report, and then invited the manager of Subdistrict B to explain her subdistrict’s poor performance in the couple year protection rate.