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SEX OF THE CLIENT No Question Check the box for the client’s sex 11 Answer Pass Std Male Female CLIENT COMFORT AND WAITING TIME No Question 12 Is it difficult for you to come to this clinic during consultation hours Did you have any difficulty coming to the clinic today For example, did you have to find someone to take care of your children or request permission at 13 work (ONLY MARK YES IF THE DIFFICULTY IS DIRECTLY RELATED TO GENDER ISSUES.) Did you wait more than half an hour to be attended 14 15 Did any educational activity take place in the waiting room while you waited Answer Yes No Yes No Pass Std V.11 IV.1 Yes No II.17 Yes No VII.4 CLIENT-PROVIDER INTERACTION AND TREATMENT No 16 17 18 19 20 Question In general, during your visit today did you feel that any person in this clinic did not treat you well Would you rather be seen by a man or a woman Who saw you during your visit/counseling session: a man or a woman FILL OUT LATER: Was the client seen by a provider of the sex they prefer (BASED ON QUESTIONS 17 AND 18) Did you feel comfortable speaking with the provider today Answer Yes No Pass Std V.9 Man Woman Either Man Woman Yes N o Yes N o 20 V.10 V.6 2 Quality and Gender Accreditation Reference Guides Appendix IV.1 Clinic Client Exit Interviews CLINIC CONDITIONS No 21 22 23 Question Did different areas in the health clinic seem uncomfortable to you, such as hallways, consulting rooms, bathrooms Did any areas in the health clinic seem dirty to you Answer Yes No Yes No FILL OUT LATER: Did the client find the areas in the health clinic uncomfortable or dirty (BASED ON QUESTIONS 21 AND 22) Yes No Pass Std 24 V.2 CONTENTS OF THE CONSULTATION OR COUNSELING SESSION No Question In your visit today, did the provider talk to you about: How to prevent STIs 24 Answer Yes No How to prevent HIV infection Yes No How to prevent cervical or uterine cancer Yes No How to prevent breast cancer Yes No How to prevent an unwanted pregnancy Yes No Yes No 30 FILL OUT LATER: Did the
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