In many countries a Memorandum of Understanding is the appropriate title
for this letter.
To: [Key client manager or team leader]
From: [PI facilitator]
Subject: Summary of Initial Performance Improvement Understanding and
Purpose: The purpose of this memo is to summarize our collective agreements
about the two key performance issues identified by you and your colleagues,
and to describe what we jointly decided would be useful next steps to further
assess the situation. This assessment data and analysis can then be used to
help us fully understand the performance issues and their impact so that we
can target interventions that will be most likely to improve performance at
the primary FP/RH provider level. These steps will help move your region toward
the overall country objective of providing quality and sustainable comprehensive
reproductive health services in all clinics and at the community level by 2005.
Process: At your invitation, for the last several weeks we have conducted
general discussions about possible solutions related to two issues: the apparent
decline of client return rates to clinics in your region, and preliminary evidence
that Norplant® acceptance is still very low in spite of efforts to increase
Last week at your request, we met individually with you, several other staff
from [the organization] and key stakeholders involved with RH at the primary
care level in the region. These individual meetings were followed by last Fridays
group meeting with you and your team from [the organization] and with [stakeholders
in attendance]. At that meeting, we summarized what we had learned in the various
meetings held during the week, and then had substantive discussions about desired
results, performance gaps and next steps we might take to begin to understand
how best to address the problems.
Resultsagreements and next steps: During our Friday meeting, we
established consensus on the following points:
- There is a problem with client return rates and Norplant® acceptance.
These problems may be related to the quality of client-provider interaction.
We agreed that, ideally, return rates would rise by 25 percent per quarter
and that acceptance of Norplant®, especially among young people aged 1622,
would be in the range of 20 percent by the end of the year.
- Even with current data limitations, we recognize that performance problems
extend beyond issues that can be addressed by training alone. Meeting participants
expressed different opinions about the causes of performance problems. Many
of these opinions were based largely on anecdotal evidence.
- In order to understand these problems more fully, we need more concrete
data, especially from a field perspective. This data will guide us in choosing
the most effective interventions to help move clinics toward desired client
return rates and broader acceptance of Norplant® as a contraceptive option
We agreed on the following steps to conduct an assessment:
- A team of three people will collect and analyze the data during this phase
of the initiative (or PI approach). We will provide two team members, and
you agreed that [individual] from [client organization] would join the team
to contribute and to learn the particular tools associated with our methodology.
[Individual from client organization] will not conduct interviews or focus
groups because people might feel intimidated by headquarters staff collecting
data. We estimate it will take two weeks of this staff members time,
one week in August and one week in September.
- The assessment team will develop a list of PNA questions, many of which
were raised in our Friday meeting, for your review and approval by August
- During the period of September 1527, the performance assessment team
will collect data using the following methods and sources:
The team will analyze the data from September 27October 3. During
Fridays meeting, we set October 4 as the target date to report results.
We also tentatively agreed that the same group of participants would be able
to attend the results-sharing meeting. Generally, this kind of assessment
produces the following results:
- We will interview a representative sample of 1215 managers and staff
at the regional level.
- We will interview a representative sample of supervisors and primary care
providers at 5 clinics.
- We will conduct focus groups with clinic clients in at least 5 different
sites. We will work with you to finalize the schedule by August 20. You
agreed that [client organization] would introduce us and share our schedule
with those who will be interviewed during the data collection process. You
suggested that you should accompany us to several clinics to ensure that
the introductions are as effective as possible.
- At your request, we will review your strategic plan, your client use statistics
from the last three months and the evaluation report done by [NGO] six months
We agreed that we would collaborate as closely as possible, and that we
would conduct periodic consultation meetings with you and the Performance
Needs Assessment team to check progress at key points in the project.
You agreed that [client organization] would provide logistical support for
the assessment team, including office space while in the regional capital,
travel to and from clinics, etc.
[The donor] agreed to provide funding for necessary technical assistance
costs incurred during the performance needs assessment phase.
- A summary of findings, including descriptions of the desired improved
or new performance, the gaps between desired and actual performance, and
the causes of the performance gaps or problems.
- Based on this summary of findings, a description of recommended interventions
to close performance gaps. Performance gaps may be prioritized, causes may
be described, and interventions may be explored. The report may describe
a range of interventions, outlining the strengths and weaknesses of each,
and estimating which would be the most effective. Each intervention should
be linked closely to a specific cause to clarify how each will eliminate
a performance problem.
Please let me know whether this project agreement letter is accurate from your
perspective. If you have any questions, corrections or suggestions, we would
be most happy to make the necessary changes. Once you have approved the memo,
we will send it to the attendees of last Fridays meeting.