Contraceptive prevalence is relatively high in Egypt with 56 percent of currently married women use a method according to the Egypt 2000 Demographic and Health Survey (El Zanaty and Way 2001). However, the family planning program is concerned about discontinuation rates showing that three in every 10 users stop using a method within the first 12 months of adoption. Evidence also suggests that the quality of care in Ministry of Health and Population (MOHP) clinics has improved and in many respects is quite good, yet some elements remain inadequate. A two-phase operations research study was launched in Egypt in early 2000 with the goal of demonstrating how improving the quality of client-provider interaction (CPI) could be achieved in large health care systems, specifically in relation to family planning. The study was designed to explore how CPI improvements could enhance family planning knowledge, method continuation rates, client satisfaction, and achievement of fertility goals. This study forms part of a global initiative conducted in comparable fashion in two other countries, Peru (León et al. 2003) and Uganda (Okullo et al. 2003). Research Questions The CPI study in Egypt has been designed to answer the following research questions: 1. Can measurable improvements be made in client-provider interaction by introducing practical systems-oriented, provider-oriented, and client-oriented interventions? 2. If client-provider interactions are improved, will there be measurable improvements in: (a) women's knowledge about available contraceptive choices; (b) women's satisfaction with contraception; (c) continued use of any method; (d) women's ability to obtain their preferred method (unless there is clear contraindication); (e) correct use of the chosen method; (f) prompt switching to another method; (g) women's ability to achieve their fertility goals or reproductive intentions (to delay a first birth, to space or to limit pregnancies); (h) increased numbers of new and continuing clients attending the clinic; and (i) a more diverse method mix in family planning clinics? 3. What is the impact of the intervention package on the job satisfaction of providers? 4. What are the costs of the various components of the intervention (training, technical assistance, additional monitoring, and client visits)? 5. Do the costs of carrying out family planning visits increase, and if so, by how much? Research questions (1), (3), (4) and (5) were investigated in Phase I of the study (SPAAC 2002). Research question (2) was examined through Phase II of the study (the present study) in which a cohort of new family planning acceptors was enrolled and followed-up for a period of 13 months after the index visit. Client outcomes were measured at seven and 13 months through home interviews.

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of the POLICY Project throughout the study are deeply appreciated. We would especially like to acknowledge Dr. Jim Foreit for his assistance in suggesting appropriate statistical tests. Last but not least, this study would not have been possible without the patience and candidness of the CSI clients who participated in the study.

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The goals of the two year training program at the Cairo Demographic Center (CDC) were to increase the number of researchers using operations research (OR), and to help institutionalize the ability of the Center to offer training in operations research in reproductive health. This report (1) evaluates the effectiveness of the program in accomplishing its goals and (2) provides feedback for OR curriculum development. The project trained researchers with program and policy-making responsibilities. It provided participants with the experience of designing an operations research project and built participants' skills in communicating research results to managers. A total of 41 participants from 16 different countries attended the 1999 and 2000 courses. Participant evaluations showed that, overall, the course met its objectives. The first year's program received high marks from participants, and these increased somewhat in the second year. Participant evaluations were used to modify the training. After the completion of the second year course, CDC incorporated operations research training in its regular diploma curricula. The Center plans to offer short term training programs for UNFPA-and WHO-sponsored students from the Middle East and sub-Saharan Africa. Basic funding for the OR curriculum has been assumed by CDC. The first course without FRONTIERS financial input was taught in 2001. The impact of the OR training on 1999 course graduates was assessed through questionnaires administered immediately after the training and one year after the training. The training that the students received in OR has mainly been incorporated into their own teaching activities, but a substantial number of students have also designed and worked on OR projects, and submitted OR proposals to donors for funding. A major problem in increasing course graduate involvement in OR is that many do not work in institutions or settings (Census Bureaus, Police Crime Statistics Units) that are conducive to operations research activities.