EVALUATION 
OF THE 
MAXIMIZING ACCESS AND QUALITY (MAQ) INITIATIVE 
Carol D. Brancich 
Robert Blomberg 
Pinar Senlet 
November 2002 
Submitted by: 
LTG Associates, Inc. 
TvT Global Health and Development StrategiesTM
a division of Social & Scientific Systems, Inc.
Submitted to: 
The United States Agency for International Development 
Under USAID Contract No. HRN–C–00–00–00007–00 
This document is available online (POPTECH Publication Number 2002–087–013) at 
www.poptechproject.com, on the MAQ Initiative web site, www.maqweb.org, as well as through 
the Development Experience Clearinghouse (www.dec.org). Additional information about this 
and other POPTECH publications may be obtained from 
The Population Technical Assistance Project 
1101 Vermont Avenue, NW, Suite 900 
Washington, DC 20005 
Telephone: (202) 898-9040 
Fax: (202) 898-9057 
admin@poptechproject.com 
Evaluation of the Maximizing Access and Quality (MAQ) Initiative was made possible through support 
provided by the United States Agency for International Development (USAID) under the terms of Contract 
Number HRN–C–00–00–00007–00, POPTECH Assignment Number 2002–087. The opinions expressed 
herein are those of the authors and do not necessarily reflect the views of USAID. 
ACKNOWLEDGMENTS 
The team would like to express its gratitude to the staff of the MAQ Initiative, to the staff 
of POPTECH, and to survey questionnaire respondents and those individuals who 
participated in the interviews. The evaluation benefited greatly from the time and effort 
contributed by these individuals. 
ACRONYMS 
CA Cooperating agency 
CPI Client–provider interaction 
FHI Family Health International 
FP Family planning 
GH/PRH Bureau for Global Health, Office of Population and Reproductive Health 
HIV/AIDS Human immunodeficiency virus/acquired immune deficiency syndrome 
HPN Health, population, and nutrition 
IBP Implementing Best Practices (WHO) 
IPPF International Planned Parenthood Federation 
JHU/CCP Johns Hopkins University Center for Communication Programs 
JSI John Snow, Inc. 
LAC Latin America and the Caribbean 
MAQ Maximizing Access and Quality 
NGO Nongovernmental organization 
PAC Postabortion care 
PLP Population Leadership Program 
PVO Private voluntary organization 
QIQ Quick Investigation of Quality 
RH Reproductive health 
SDI Service Delivery Improvement 
STD Sexually transmitted disease 
STI Sexually transmitted infection 
UNFPA United Nations Population Fund 
USAID United States Agency for International Development 
WHO World Health Organization
CONTENTS 
Page 
Executive Summary.........................................................................................................i
I. Introduction...............................................................................................................1 
 Background.................................................................................................................1 
 Methodology...............................................................................................................2 
II. Findings, Conclusions, and Recommendations......................................................4 
 Online Survey .............................................................................................................4 
 Structure, Functions, and Relationships......................................................................6 
 Identification and Dissemination of Best Practices and Knowledge Sharing...........11 
 Utilization of MAQ Documents and Tools and Implementation of Best Practices..15 
 Costs..........................................................................................................................20 
APPENDICES 
A. Scope of Work 
B. Distribution List for Survey Questionnaire 
C. Persons Interviewed 
D. Online Survey 
E. Survey Results 
F. Illustrative Restructuring Model 
G. Documents Reviewed 
i 
EXECUTIVE SUMMARY 
This report represents the evaluation of the United States Agency for International 
Development (USAID), Bureau for Global Health, Office of Population and 
Reproductive Health (GH/PRH) Maximizing Access and Quality (MAQ) Initiative. 
Since its inception in 1994, the MAQ Initiative has been located in the Research Division 
and recently has been moved into the Service Delivery Improvement (SDI) Division. 
The Initiative deals with evidence-based best practices aimed at removing access barriers 
and improving quality family planning (FP) and reproductive health (RH) services. The 
move into SDI is intended to focus the future evolution of the MAQ Initiative more on 
actual field implementation than it has been in the past. 
The purpose and objectives of this evaluation as noted in the scope of work are to 
! contribute to the overall development of a new strategy for SDI and also 
clarify the role of MAQ in the newly organized Office of Population and 
Reproductive Health, 
! focus on the larger impact that the MAQ Initiative has had over the past few 
years as well as make recommendations for its future focus and directions, 
! determine how MAQ should best evolve to meet field program needs, and 
! look at the degree to which USAID and its partners are sharing MAQ 
information and if that knowledge sharing continues to grow. 
The evaluation examines the achievements and challenges within the MAQ Initiative’s 
! structure, organization, and functions; 
! relationships with other initiatives, USAID cooperating agencies (CAs) and 
consortia, the World Health Organization (WHO), USAID Missions, and host 
national partners; 
! identification and dissemination of best practices, inclusive of its major 
dissemination activity, the MAQ Exchange, and its recent participation in 
WHO’s Implementing Best Practices (IBP) activities; 
! costs; and 
! implementation relationships and processes.
The evaluation team reviewed the web-based MAQ information as well as that presented 
on several linked CA web sites. A web-based survey questionnaire was generated using 
the areas noted in the paragraph above. This survey was made available electronically to 
82 persons on a list provided by the senior medical advisor and initiative staff. 
Qualitative assessments of achievements and challenges were obtained using the same 
USAID/Washington–provided list, which the evaluation team used to contact individuals 
ii 
for in-person or telephone interviews. Due to telephone communication difficulties, the 
evaluation team accepted one person’s response to several questions sent by e-mail. The 
total number of persons interviewed was 57. 
The following section summarizes the evaluation’s key findings and conclusions and the 
principal recommendations for the future. 
OVERARCHING CONCLUSIONS AND RECOMMENDATIONS 
The MAQ Initiative is extremely valuable for advancing the USAID/Washington agenda 
for improvement in FP and RH program quality and access. The MAQ Initiative has 
resulted in significantly increased collaborative work within the CA community. The 
evaluation team recommends the continuation of the MAQ Initiative with some 
modifications. The modifications should address structure, functions, and relationships; 
processes for the identification of best practices, dissemination, and implementation of 
best practices; and budgeting and accounting issues. Following are the evaluation team’s 
conclusions and recommendations. 
RESULTS OF ONLINE SURVEY 
Conclusions 
! Results of the online survey are supportive of the MAQ Initiative. 
! Online survey findings corroborate findings from interviews. 
! The MAQ Initiative receives greater levels of support and appreciation from 
CA staffs than it does from USAID staff. 
! CAs have been more successful at internal dissemination of MAQ Initiative 
information than has USAID. 
! The level of reported involvement in the Initiative does not influence 
respondent ratings of the Initiative. 
Recommendation 
! The reasons for the differences in the scores given by CA staffs versus 
USAID staff should be explored. 
STRUCTURE, ORGANIZATION, AND RELATIONSHIPS 
Conclusions 
! The MAQ Initiative is extremely valuable for advancing the 
USAID/Washington agenda for improvement in FP and RH program quality 
and access. There is unanimous support among the interviewees for 
continuing the MAQ Initiative. 
iii 
! The Initiative has benefited from well-recognized, high profile leadership. 
! There is an inconsistent understanding among CA participants, 
USAID/Washington, and Mission staffs of MAQ Initiative and Exchange 
purposes, principles, and outcomes. 
! The decision-making process of the MAQ Initiative is from the management 
level and is supply driven. 
! Other than MAQ Initiative’s staff, GH/PRH divisions’ staffs are not 
consistently involved in Initiative activities. 
! WHO’s name and logo have provided greater influence and acceptance of 
their joint efforts. 
! Many interviewees do not understand the distinctions among best practice 
organizations (i.e., Advance Africa, CATALYST, and between IBP and MAQ 
Exchange). 
! As the number of IBP activities increases, there is a question of the level of 
WHO staffing and funding. 
Recommendations 
! The MAQ Initiative needs a clearly stated framework. 
! The MAQ Initiative should be restructured to ensure that all other divisions’ 
staffs are apprised and selectively involved in the Initiative and its activities. 
! An exploration should be undertaken to determine how the Initiative might 
serve the interests of the various technical foci of the Bureau for Global 
Health. 
! High profile, technical leadership should continue. 
! The Initiative’s structure should be reconfigured to ensure shared ownership 
(see appendix F for an illustrative option). 
! USAID/Washington and CA staffs should promote the products and resources 
of the MAQ Initiative when dealing with USAID Missions and in-country 
partners. 
! A process should be developed for obtaining input from field sources (USAID 
and in-country partners) for identifying priority quality and access best 
practice needs. 
! USAID/Washington should clarify and communicate the distinctions among 
Advance Africa, CATALYST, and the MAQ Initiative. Similarly, 
iv 
clarification and communication regarding MAQ Exchange and IBP are 
needed. 
IDENTIFICATION AND DISSEMINATION OF BEST PRACTICES 
Conclusions 
! The MAQ Initiative resulted in significant increases in information sharing 
and collaborative work among the CAs. 
! The MAQ Initiative has been successful in disseminating information about 
best practices in access and quality to CAs, especially at the domestic 
(headquarters) level where CA staffs have been active participants in MAQ 
work. 
! There is a lack of criteria for determining a best practice. 
! Contraceptive technology and client–provider interaction (CPI) best practices 
have been the practices most widely disseminated. 
! Nonmedical best practices have not achieved the level of consensus that 
clinical best practices have. 
! The lack of priority setting for the implementation of best practices makes it 
difficult to be clear about the most important messages delivered to programs. 
! The MAQ Exchanges have been increasingly successful as a dissemination 
vehicle. 
! MAQ Exchanges contribute to learning and local capacity building among 
less developed countries. 
! The MAQ web site is not as well utilized by overseas users and non-English 
speakers as it is by U.S.–based users. 
Recommendations 
! The MAQ Initiative needs to determine the level of evidence required to 
qualify a nonmedical practice as a best practice. 
! The Initiative should place more emphasis on identification and dissemination 
of nonmedical best practices. 
! More reciprocal sharing and learning among less developed countries needs to 
be promoted as a component of MAQ capacity building. Countries involved 
in Exchanges would benefit from follow-up networking. 
v 
! The MAQ web site format should be made more attention holding and easier 
to use than it is, and the web site should be promoted more systematically than 
it is. 
UTILIZATION OF MATERIALS AND IMPLEMENTATION 
Conclusions 
! MAQ materials and tools are being used effectively in field programs, when 
adequately disseminated. Inadequate utilization seems to be a result of 
ineffective/nonsystematic dissemination and/or promotion of their utilization. 
! MAQ clinical tools, contraceptive updates, and counseling aids are more 
widely used than other materials. 
! Utilization of MAQ materials may have been underestimated due to the lack 
of brand recognition for MAQ in field programs. 
! The MAQ Initiative has placed more emphasis on implementation and 
application of best practices over recent years. 
! The successful Central America and Nigeria MAQ Exchanges have common 
elements and lessons learned that could be used in future implementation 
strategies. 
! USAID Missions’ involvement and support of MAQ activities are 
prerequisites for successful implementation. 
! In order for MAQ concepts to be utilized and implemented in country 
programs, they need to be incorporated into CAs’ routine work. 
! The MAQ Initiative and Exchange have not provided guidance regarding 
processes and context issues for the application of MAQ concepts and 
principles. 
Recommendations 
! USAID/Washington, the Missions, and the CA community should continue to 
promote the utilization of MAQ documents and tools in field programs, with 
increased emphasis on nonclinical materials. 
! Lessons learned from the Central America and Nigeria Exchanges should be 
used in designing and implementing future MAQ Exchanges and IBP 
meetings. 
! The two differing funding models for action plan implementation used in the 
MAQ Exchanges in Nigeria (bilateral) and Central America 
(USAID/Washington Latin America and the Caribbean Bureau and in-country 
vi 
funds) should be followed up and evaluated to determine whether they 
produced successful outcomes. 
! Incorporating accountability language for MAQ concepts and principles 
implementation into CA cooperative agreements and contracts would ensure 
implementation in the future. 
! USAID/Washington and the CAs should continue to strengthen their 
discussions with USAID Missions to ensure active involvement and support 
of the Missions for the implementation of best practices. 
! USAID/Washington, in concert with the Missions, needs to provide additional 
guidance on process and context issues for implementation. 
COSTS 
Conclusions 
! The exact cost of the MAQ Initiative is difficult to calculate due to the 
inconsistency in CA budget and accounting processes. 
! Reported estimated expenditures do not support the assertion that total MAQ–
related expenditures greatly exceed allocations. 
Recommendations 
! USAID/Washington and the CAs should annually plan together for budget 
allocations to match MAQ activities. 
! CAs should create a budget category for MAQ and MAQ–related activities 
that combines core and MAQ core funds. 
1 
I. INTRODUCTION 
The purpose and objectives of this evaluation as noted in the scope of work (see appendix 
A) are to 
! contribute to the overall development of a new strategy for the Service 
Delivery Improvement (SDI) Division and also clarify the role of the 
Maximizing Access and Quality (MAQ) Initiative in the newly organized 
Office of Population and Reproductive Health (GH/PRH), 
! focus on the larger impact that the MAQ Initiative has had over the past few 
years as well as make recommendations for its future focus and directions, 
! determine how the MAQ Initiative should best evolve to meet field program 
needs, and 
! look at the degree to which the United States Agency for International 
Development (USAID) and its partners are sharing MAQ information and if 
that knowledge sharing continues to grow. 
BACKGROUND 
The genesis of the MAQ Initiative is rooted in both quality and access issues. It began in 
the early 1990s when the need for removing access barriers and improving quality 
services was recognized as a major issue for USAID programs. Highlighting access and 
quality of service delivery elevated these issues to a priority level within the Office of 
Population and stimulated identification and documentation of evidence-based best 
practices throughout the office and its cooperating agency (CA) structure. As one 
interviewee stated, “The MAQ Initiative put quality on the global reproductive health 
care agenda.” 
A medical barriers initiative was formed to meet this need with reducing medical/clinical 
barriers as the first priority. In May of 1994, building upon this initiative, the MAQ 
Initiative was established. Soon other dynamics within service delivery systems, seen as 
nonmedical barriers, came to the forefront (e.g., client–provider interaction [CPI], 
supervision, and communication). 
The purpose of the MAQ Initiative as stated on the MAQ web site is to bring together 
staff from USAID/Washington and the Missions, CAs, and their community and program 
managers to identify and implement practical, cost-effective, focused, and actionable 
interventions aimed at improving access to and quality of family planning (FP) and 
selected reproductive health (RH) services. The overall rationale is that there is a large 
unmet demand for voluntary contraceptive services. Removing barriers, promoting 
access, and improving quality by focusing on specific practical improvements can serve 
the needs of clients and thereby markedly improve programs. The Initiative aims to distill 
and disseminate lessons learned from the broader CA experience as well as to identify 
critical areas that have not yet been addressed. 
2 
The MAQ Exchange is described on the MAQ web site as having been developed as a 
dissemination vehicle for MAQ best practices and principles. It is a means of engaging 
USAID Missions, their country counterparts, USAID/Washington, and CAs in a 
discussion aimed at developing or improving programs that reflect MAQ principles and 
practices. The process equips the Missions and their partners for implementing a set of 
realistic activities for which priority has been established and applying MAQ best 
practices. 
The MAQ Exchange was revised in 1999 through extensive and intensive input from 
many CAs. In the curriculum, the Key MAQ Concepts module serves as an overview to 
MAQ principles and practices. The MAQ Synergy Framework is also found in this 
module. Later in 1999, the World Health Organization (WHO) requested input from 
MAQ Initiative partners to help design a dissemination activity that has evolved into 
Implementing Best Practices (IBP) meetings. The MAQ Exchange format and content 
areas inform the construct of IBP. (See the Relationships section for additional discussion 
of WHO partnership and IBP.) 
METHODOLOGY 
Data and information upon which the MAQ Initiative evaluation is based came from two 
sources: individual and group interviews conducted either in person or by telephone by 
members of the evaluation team, and a brief web-based survey. 
The scope of work did not call for international travel; therefore, no field observations 
could be made. The findings in this report are based on second party reports of 
conditions. Additionally, it was not possible to complete interviews with a few field staff 
because of telecommunication problems, thereby limiting field-level implementation 
information. 
An e-mail was sent from the senior medical advisor’s office to a list of 82 key 
informants, asking them to complete the web-based survey and to notify the team of their 
availability for an interview. The list was provided by Initiative staff (see appendix B). 
This is not a random sample but rather a sample of individuals specifically selected for 
their familiarity with and knowledge of the MAQ Initiative. Recipients of the e-mail 
were informed that not all of them would be contacted for an interview because of time 
constraints, but all were encouraged to complete the survey on the web. The e-mail 
included the web address of the survey questionnaire as well as a password for accessing 
it. Three weeks into the evaluation, a reminder e-mail was sent to the same list, asking 
recipients to complete the survey if they had not already done so. 
Interviews 
For the interviews, an interview guide was developed, based on the scope of work, which 
covered the issues the evaluation team was asked to address. Because not all respondents 
were knowledgeable about all areas covered in the scope of work, the interview guide 
served more as an aid to make sure that appropriate questions were asked. Interviews 
typically lasted about 1 hour, although several were shorter when respondents were 
relatively new to or had limited experience with the Initiative. In most instances, all three 
members of the evaluation team participated in each interview. 
3 
Between October 3 and October 29, 2002, the team completed 57 interviews. These 
included 8 respondents from USAID/Washington, 5 from USAID Missions, 35 from CA 
headquarters staff, and 4 from CA field staff. Two of the respondents were from partner 
nongovernmental organizations/private voluntary organizations (NGOs/PVOs) and three 
were from WHO. The names of individuals proposed for interviews were derived from 
the survey questionnaire list and were provided to the team by the MAQ Initiative staff. 
The MAQ staff set priorities for these names and interviews were scheduled by the 
POPTECH assignment manager. A list of persons interviewed (respondents) can be 
found in appendix E. 
Web-Based Survey 
The web-based survey was created using SurveyMonkey.com, a web-based survey 
subscription service that permits subscribers to create their own questionnaires. The 
survey consisted of 11 items based on questions in the scope of work plus one item that 
asked for the respondent’s affiliation type (USAID/Washington, USAID Mission, CA 
Headquarters, CA Field, or Other). (See appendix D for a copy of the online survey.) 
The survey was completed by 63 people (77 percent), whose affiliations were as follows: 
USAID/Washington 8 (12.7 percent of all respondents) 
USAID/Mission 8 (12.7 percent) 
CA Headquarters 40 (63.5 percent) 
CA Field 3 (4.8 percent) 
Other 4 (6.3 percent) (2 from WHO, 1 NGO, and 1 
 member of the Francophone subcommittee) 
SurveyMonkey automatically tabulates responses as respondents submit them and 
provides graphic readout of results. Data from the survey can be exported from the web 
site to other applications for additional analysis if desired. Findings from the online 
survey are presented in the Findings, Conclusions, and Recommendations section of this 
report. 
4 
II. FINDINGS, CONCLUSIONS, AND RECOMMENDATIONS 
ONLINE SURVEY
Findings 
Sixty-three people completed the anonymous online survey, responding to 11 questions 
plus one item regarding respondent affiliation. (Distribution of the respondents by 
affiliation can be found in the Methodology section of this report.) This is not a random 
sample but rather a sample of individuals specifically selected for their familiarity with 
and knowledge of the MAQ Initiative. While no claims are made about the 
representativeness of this sample, the trends are still considered instructive. 
Unfortunately, only three CA field staff completed the online survey; as a consequence, 
caution must be used to not overinterpret their responses. The most obvious finding is 
that CA respondents rate all items more positively than did USAID respondents. 
(Summary tables of survey results make up appendix E). 
Item 1
The Initiative receives relatively consistent scores for its success in the identification and 
documentation of best practices. 
Item 2
Across all respondent groups, contraceptive technology and client–provider interaction 
(CPI) were the two technical areas in which the MAQ Initiative was seen as most 
successful. Each of these was checked by 83 percent of all respondents. Management 
and supervision scored a distant third, having been checked by only 48 percent of all 
respondents. However, there were differences between USAID and CAs staff in their 
selection of most successful areas.
Among all CA staffs, the percentage of respondents that checked contraceptive 
technology and CPI was 92 percent and 90 percent, respectively, whereas among all 
USAID respondents, CPI was checked by only 62 percent, and contraceptive technology 
was checked by only 56 percent. 
Item 3
When asked to what extent the MAQ Initiative facilitates information sharing between 
USAID and the CAs and among the CAs themselves, CA and USAID/Washington 
respondents gave the Initiative higher scores than did USAID Mission–based 
respondents. 
Item 4
CA staff reported greater dissemination of information about the MAQ Initiative within 
their organizations than did either USAID/Washington or Mission staff. This speaks to 
5 
the need for greater internal communication about the Initiative within the USAID 
structure. 
Item 5
When asked to what extent the MAQ Initiative had contributed to the dissemination of 
best practices to the field, CA staffs were more likely to rate this outcome more positively 
than were USAID staff, especially those in the Missions. 
Item 6 
CA respondents rated Initiative functioning under its current organization and structure 
more favorably than USAID staff did. 
Item 7
The MAQ web site has been visited more often by CA staffs in the field and by ‘Other’ 
respondents (three out of four of whom are overseas) than by domestically based CA 
staffs. The web site has very low utilization by USAID/Washington and Mission staffs; 
only 38 percent of all USAID staff reported ever having visited MAQWeb.org. By 
contrast, 90 percent of CA respondents reported having visited the web site at least once. 
Item 8
Interestingly, both CA field staffs and USAID Mission staffs rated the Initiative higher on 
the extent to which it has contributed to the incorporation and implementation of best 
practices in field programs than did each group’s domestic counterparts. 
Item 9
CA respondents rated the Initiative higher regarding how worthwhile it is relative to cost 
and effort than did USAID staff, but the differences in rating were relatively small 
between the two groups. CA field staffs rated this item the highest. 
Item 10
When asked if the MAQ Initiative should continue, 68 percent of all respondents replied 
“yes, with some modifications.” Another 26 percent said “yes, with significant 
modifications.” Only 3 percent said “yes, with no modifications,” and only 2 percent 
(one respondent) said it should not continue. CA staffs and USAID staff were somewhat 
divergent in their replies. More than 70 percent of CA staffs replied “yes, with some 
modifications,” whereas only 50 percent of USAID staff checked this option. Thirty￾eight percent of USAID staff favored significant modifications, whereas only 28 percent 
of CA staffs chose that response option. 
Item 11
CA staffs reported greater levels of involvement with the MAQ Initiative than did 
USAID staff. Interestingly, increased involvement did not influence scores given on the 
6 
questionnaire. Respondents who rated their involvement 1 (not at all), 2, or 3 had 
average scores on the other survey items that were very similar to those who rated their 
involvement 4 or 5 (very involved). 
Conclusions 
! Results of the online survey are supportive of the MAQ Initiative. 
! Online survey findings corroborate findings from interviews. 
! The MAQ Initiative receives greater levels of support and appreciation from 
CA staffs than it does from USAID staff. 
! CAs have been more successful at internal dissemination of MAQ Initiative 
information than has USAID. 
! The level of reported involvement in the Initiative does not influence 
respondent ratings of the Initiative. 
Recommendation 
! The reasons for the differences in the scores given by the CA staff versus 
USAID staff should be explored. 
STRUCTURE, FUNCTIONS, AND RELATIONSHIPS 
Findings: Structure and Functions 
Since its inception eight years ago, the MAQ Initiative was housed in the Office of 
Population and Reproductive Health’s Research, Technology and Utilization Division 
(formerly the Office of Population, Research Division); it has just been placed under the 
SDI Division. The MAQ Initiative has been led by the senior medical advisor. A 
Population Leadership Program (PLP) fellow, who serves as the MAQ technical advisor 
(50 percent), and a program assistant (50 percent) currently staff it. Combined staff 
functions for the two positions fall under two basic categories: MAQ program 
management and research, and best practices dissemination and implementation support 
to the field, including the MAQ Exchanges and IBP. 
Leadership of the MAQ Initiative, namely the senior medical advisor, was unanimously 
praised by interviewees. Interviewees applied such terms as MAQ champion, visionary 
leader, highly placed advocate, and evidence-based directed. MAQ Initiative 
participants’ interaction with the senior medical advisor provides them with quality 
technical and visionary leadership. This leadership is recognized as such among 
partnering agencies as well (e.g., WHO, International Planned Parenthood Federation 
[IPPF], and United Nations Population Fund [UNFPA]) and produces high-level profiling 
for USAID’s quality and access efforts. 
The Initiative created and maintains a well-received, well-attended, and highly regarded 
forum for USAID, CAs, interested NGOs, PVOs, and consulting groups and individuals. 
7 
It is widely and enthusiastically described as a unique if not singular USAID mechanism 
for collegial collaboration, cross-fertilization, and information sharing. Further, the 
MAQ Initiative brings together a network of CAs focused on specific quality and access 
issues. Unanimous support was given by interviewees regarding the CA participation, 
collaboration, and information sharing present in the MAQ Initiative format. 
Currently, five subcommittees are actively working on identified theme/topic needs with 
a sixth subcommittee focused on a linguistic/geographic region’s unique needs (i.e., 
Francophone countries). Two subcommittees are dormant. The active subcommittees are 
Community-Driven Quality; Policy, Advocacy, Communication, and Education; Client–
Provider Interaction; Management and Supervision; Organization of Work; and the 
Francophone subcommittee. Long-standing subcommittees that are now dormant are 
Technical Guidance/Competence and Monitoring and Evaluation. 
Each group has at least two co-chairs. U.S.–based subcommittee co-chairs representing 
their respective groups previously met as the MAQ Initiative Steering Committee, with 
meetings open to other interested parties. More recently, the concept of a steering 
committee has been dropped and an open meeting format adopted. This group convenes 
twice yearly. Subcommittee co-chairs have provided strong leadership and continuity 
and have stimulated productivity within their groups. While the tenure of subcommittee 
co-chairs provides for continuity of leadership, attention to fostering new leadership and 
shared ownership through chair rotation is not evident. 
Each subcommittee meets whenever and wherever it deems necessary and with input 
from the senior medical advisor and Initiative staff, establishes its outputs, outcomes, and 
products. The team was not able to find a clear process for identifying priority topics for 
subcommittees’ agendas. Previously, a USAID staff representative shared co-chair status 
on selected subcommittees; however, this is not the case at present. Subcommittee co￾chairs report to the open meeting on such issues as their group’s progress, emerging 
issues, products, and dissemination statistics. While co-chairs mostly have had long 
tenures, subcommittee general membership tends to ebb and flow. The Francophone 
subcommittee functions within Francophone Africa. The Francophone subcommittee 
maintains a secretariat in Dakar, Senegal, working in concert with USAID/Washington 
staff. This information and the results from the survey questionnaire (item 10) indicate 
that the MAQ Initiative structure is in need of modification. An illustrative restructuring 
model developed by the team is found in appendix F. 
A number of interviewed respondents stated that they were unclear about the MAQ 
Initiative and Exchange purpose and vision even though such statements are present on 
MAQ information brochures, the web site, and handouts. The lack of awareness of web￾posted purpose and vision statements indicates that the Initiative’s communication and 
promotion activities are in need of modification. 
Interviewees also pointed out that there is no framework for the MAQ Initiative. The 
Synergy of Interventions, also known as the Lotus diagram, even though considered by 
some as a framework, is rather a visual summary of essential components found within a 
quality service environment. The diagram is found on the MAQ web site and in the 
Exchange Key Concepts module. 
8 
Another commonly expressed concern was that the focus of MAQ activities was more 
supply driven (input and decision-making at the USAID/Washington and CA level) than 
demand driven, which would require that more attention be paid to the needs and 
priorities identified by field-based CA representatives, Missions, and their partner 
organizations. This approach to decision-making and priority setting was noted by many 
interviewees as being a style of management that weakens rather than strengthens 
Mission buy-in motivation and does not encourage broad-based field support of the 
Initiative’s best practices. 
Findings: Relationships 
The MAQ Exchange was developed as a vehicle for establishing dialogue with USAID 
in-country program implementers. Exchange activities are coordinated through the 
Initiative. Initiative USAID/Washington staff takes the lead in coordinating Exchange 
activities in concert with the host Mission(s) and selected CA participants. 
USAID/Washington communicates with USAID Missions describing, the MAQ 
Exchange as a means of engaging Missions, country counterparts, USAID/Washington, 
and CAs in a discussion aimed at improving programs using MAQ principles and 
practices. 
Costs are minimal for the Missions; however, frequently the MAQ Exchange is not 
recognized nor accepted as a valuable opportunity by Missions. Often Missions are either 
not involved in or not well informed of the larger MAQ Initiative. In these instances, CA 
representatives, both field and U.S.–based, are often placed in the position of describing 
and explaining the MAQ Initiative, the MAQ Exchange, and MAQ concepts and 
principles. They are extensions of the championing efforts found within the 
USAID/Washington leadership and U.S.–based CA community. The team found 
evidence that these field champions are rotating out of their positions and the 
championing effort at the field level is diminishing. 
CA collaboration has produced the MAQ Exchange content modules, their translation, 
and materials production. USAID/Washington and CAs make large investments of time 
and staff efforts in conducting MAQ Exchanges. This has led to some CAs expressing 
frustration at the level of effort required to participate in MAQ Exchange activities. 
Expansion of the MAQ Initiative into partnership with WHO regarding the IBP activities 
has caused some CAs to experience intensified frustration since even higher levels of 
effort are required for participation in these activities. 
A large number of interviewed respondents expressed confusion regarding the differences 
between IBP and the MAQ Exchange. There was also confusion among those 
interviewed as to whether the MAQ Exchanges have been supplanted by the IBP 
meetings, or whether it would be a good or a bad idea to have the MAQ Exchange 
disappear altogether. For example, a number of interviewed respondents expressed 
concern that the IBP is devoid of USAID Mission participation or sponsorship, thereby 
diminishing the prospects of bilateral support for action plans developed. Others, 
unfamiliar with the limited staffing and financial resources available at WHO for this 
work, believe that the MAQ Exchange activity might be turned over to WHO to 
coordinate and implement. Few recognize the mutuality of the IBP with WHO providing 
leadership, sponsorship, and support for some participants (via WHO regional offices) 
9 
and USAID/Washington and CAs providing technical and financial resources and 
support. 
When WHO and USAID/Washington collaborated to create the IBP activity, it produced 
a conference similar to the MAQ Exchange model under the aegis of WHO. No one 
doubts the far-reaching effects of WHO sponsorship of joint ventures with USAID, yet 
many interviewees do not clearly understand why there are two separate activities so 
similar in format and content. 
Joint production—WHO, USAID, UNFPA, and IPPF—of consensus-based documents, 
such as Eligibility Criteria and Essentials of Contraception, reflect the value of such a 
partnership relationship, which all interviewees applauded. The global recognition factor 
of WHO and UNFPA endorsements is invaluable to the increased acceptability of 
concepts and content, particularly at higher levels of government health care structures. 
The team believes that IBP differs from the MAQ Exchange in a number of fundamental 
ways. The IBP is a regional meeting with teams of varying sizes coming from a number 
of countries. For example, the Cairo IBP had teams from 11 countries, and the teams 
ranged in size from 1 person to more than 30 people. The WHO regional offices are 
responsible for extending invitations to attend the IBP; the bulk of the invitations are for 
governmental agencies. The countries from which teams may come are also of vastly 
different size with vastly different sized programs and resources. Moreover, the countries 
may not have a common primary language, consequently relying on English as a 
common language. 
In contrast, with the exception of the recent Central America Exchange, MAQ Exchanges 
have been conducted in a single country where team members are likely to speak a 
common primary language and have familiarity with the FP/RH program needs and 
priorities in their country. This homogeneity increases the utility of the MAQ Exchange 
as well as the value and practical applicability of developed action plans. Additionally, 
since USAID Missions sponsor the MAQ Exchange, there is greater likelihood of 
funding for action plans developed during the Exchange. 
Distinctions and interrelationships between the MAQ Initiative and the recently formed 
consortia funded by USAID/Washington (Advance Africa and CATALYST) are also not 
clearly apparent since all three entities deal with best practices. Language regarding 
assisting others in the application of best practices is found in both consortia purpose 
statements; Advance Africa focuses on Africa whereas CATALYST focuses on the other 
regions and countries of the USAID portfolio. Both organizations have web sites where 
descriptions of their objectives, mandates, and program approaches can be found. 
Conclusions 
! The MAQ Initiative is extremely valuable for advancing the 
USAID/Washington agenda for improvement in FP and RH program quality 
and access. There is unanimous support among the interviewees for 
continuing the MAQ Initiative. 
! The Initiative has benefited from well-recognized, high profile leadership. 
10 
! There is an inconsistent understanding among CA participants, 
USAID/Washington, and Mission staffs of MAQ Initiative and Exchange 
purposes, principles, and outcomes. 
! The decision-making process of the Initiative is from the management level 
and is supply driven. 
! Other than MAQ Initiative’s staff, GH/PRH divisions’ staffs are not 
consistently involved in Initiative activities. 
! WHO’s name and logo have provided greater influence and acceptance of 
their joint efforts. 
! Many interviewees do not understand the distinctions among best practice 
organizations (i.e., Advance Africa, CATALYST, and between IBP and MAQ 
Exchange). 
! As the number of IBP activities increases, there is a question of the level of 
WHO staffing and funding. 
Recommendations 
! The MAQ Initiative needs a clearly stated framework. 
! The MAQ Initiative should be restructured to ensure that all other divisions’ 
staffs are apprised and selectively involved in the Initiative and its activities. 
! An exploration should be undertaken to determine how the Initiative might 
serve the interests of the various technical foci of the Bureau for Global 
Health. 
! High profile, technical leadership should continue. 
! The Initiative’s structure should be reconfigured to ensure shared ownership 
(see appendix F for an illustrative option). 
! USAID/Washington and CA staffs should promote the products and resources 
of the MAQ Initiative when dealing with USAID Missions and in-country 
partners. 
! A process should be developed for obtaining input from field sources (USAID 
and in-country partners) for identifying priority quality and access best 
practice needs. 
! USAID/Washington should clarify and communicate the distinctions among 
Advance Africa, CATALYST, and the MAQ Initiative. Similarly, 
clarification and communication regarding MAQ Exchange and IBP are 
needed. 
11 
IDENTIFICATION AND DISSEMINATION OF 
BEST PRACTICES AND KNOWLEDGE SHARING 
Findings 
The MAQ Initiative has been increasingly successful in the dissemination of MAQ 
principles and identified best practices through both formal and informal channels. It is 
widely recognized that one of MAQ’s functions is that it serve as a clearinghouse. 
Formal dissemination has occurred through printed materials (e.g., Essentials of 
Contraceptive Practice, MAQ Papers), through meetings (e.g., MAQ mini-universities, 
MAQ Exchanges, IBP conferences), and through the MAQ web site (MAQweb.org). 
Informal dissemination has occurred through MAQ subcommittees, the MAQ steering 
committee, and through collaborative work that has occurred among CAs by virtue of 
their work on MAQ activities, such as topical modules prepared for use in MAQ 
Exchanges. 
A distinction is made between the dissemination of best practices and their 
implementation in the field. Dissemination refers to making USAID and CA staffs and 
host country partners aware of and knowledgeable about the Initiative and evidence￾based best practices. Implementation refers to the application of those best practices in 
service delivery settings. 
There was unanimous agreement among interviewed respondents that the most successful 
efforts at dissemination of best practices have occurred in the areas of contraceptive 
technology and CPI. These are topic areas in which the Initiative has been active the 
longest. The Initiative partnered with WHO in establishing family planning medical 
eligibility criteria, Essentials of Contraceptive Technology, and Care Guidelines, with 
subsequent consensus for their content obtained from UNFPA and IPPF. This 
relationship resulted in publications that display all partners’ logos, adding greater 
influence and acceptance to the documents’ contents. There is solid support for the 
finding that it is easier to obtain consensus on clinical best practices and medical service 
standards than it is to obtain similar consensus on operational (e.g., management and 
supervision) best practicesMAQ Initiative areas that are not yet recognized as highly 
successful, in part because of their newness and organization of work. 
As the MAQ Initiative has expanded to address new content beyond contraceptive 
technology and CPI, there has been a proliferation of identified best practices that may or 
may not in fact be best practices. This is so because there are no established criteria for 
qualifying practices for inclusion in a list of MAQ best practices. As several respondents 
noted, there are no rigorous standards regarding the level of evidence and documentation 
required to qualify as a best practice. To paraphrase one respondent, best practices are 
mixed with promising practices and lessons learned, and not all may be best practices. 
Moreover, the proliferation of practices identified as best has not been accompanied by 
any establishment of priority for application. Sometimes the proliferation of identified 
best practices is due to what several respondents referred to as unimportant differences in 
CA terminology for their best practices. This may introduce confusion at the field level, 
especially among partner organizations, where they find seemingly mixed, rather than 
12 
consistent, messages. However, another expressed viewpoint was that a proliferation of 
best practices is not bad as it increases the likelihood that one or another idea will trigger 
creative responses in the target audience, thereby leading to improvements in quality and 
access. 
The plethora of information generated through the MAQ Initiative presents difficulties 
for information management at USAID, CAs, and related organizations. Although 
several of the MAQ dissemination efforts have specifically targeted Mission health, 
population, and nutrition (HPN) officers, awareness and understanding of the MAQ 
Initiative purpose and its value among this group appear to remain quite low. 
Several of the CAs have developed or are developing formal internal structures and 
processes to manage the flow of MAQ–related information throughout their 
organizations. Among the implemented practices are the assigning of staff members to 
cover all MAQ subcommittees, scheduled internal meetings on MAQ activities and 
subcommittees, electronic bulletin boards, and e-mailed updates. Efforts at MAQ–related 
information dissemination have met more success at the CA headquarters level than at 
the field level. 
MAQ Exchanges 
Perhaps the most significant MAQ Initiative dissemination efforts have been the MAQ 
Exchanges. A MAQ Exchange allows USAID Missions to bring information on a range 
of evidence–based best practices in FP/RH service delivery to teams of policymakers and 
providers in a given country. The Exchange format includes the presentation of content 
(modules) as well as through highly interactive discussions with and among participants; 
during these discussions, participants share their own programmatic experiences. The 
Exchange, which varies in length from 3 to 5 days, includes workshops during which 
participant teams create implemental action plans. Content selected for presentation at an 
Exchange is tailored to the needs of the participants, based on preparatory assessments 
conducted in-country. The Exchange acts as a catalyst and information resource to assist 
country programs to improve access to and quality of reproductive health care. 
MAQ Exchanges typically have about 35 participants from NGOs and governmental 
organizations that provide FP/RH services. High-level policymakers may also 
participate, as do representatives from selected in-country partner organizations. 
Invitations to the MAQ Exchange come from the USAID Mission. 
Since 1999, six MAQ Exchanges have occurred at either the country or, in the case of 
Central America, subregional level (held in Honduras). Country-level Exchanges have 
taken place in Romania, Tanzania, Ghana, Guatemala, and Nigeria. Each Exchange has 
incorporated the lessons learned from prior Exchanges, resulting in continuous 
improvements and effectiveness. The Exchanges have changed over time and now have 
the option to include RH modules developed by CA participants to highlight the best 
practices within related emerging issues (e.g., postabortion care [PAC], HIV/AIDS, 
sexually transmitted diseases [STDs], and dual protection). The most recent 
Exchangesin Central America and Nigeria, undertaken in 2002appear at this early 
stage to have had the best impact and outcomes yet. (See Implementation of Best 
13 
Practices section for further details.) Countries involved in Exchanges would benefit 
from follow-up networking. 
CA Collaboration and Information Sharing 
Interviewees from CAs praised most highly and valued most the collaboration that the 
MAQ Initiative had engendered in their working relationships, a finding corroborated by 
the web-based survey. There was near unanimous agreement among interviewees that the 
MAQ Initiative has facilitated CA collaboration and information sharing in ways that 
would not have occurred in its absence. An example from the field is that the 
Francophone subcommittee CAs would not be working collaboratively without the 
presence of the MAQ Initiative. 
CA respondents report having benefited from MAQ Initiative collaboration that has 
resulted in the introduction of new thinking to their organizations through the sharing that 
has taken place, especially through subcommittee work and the open forums, but also 
from work on specific products. Many acknowledge the integration of MAQ content into 
their work plans and organizational culture as a result of this collaboration. 
Respondents cited many examples of this collaboration, including the solicitation of input 
on papers, checklists, Exchange modules, collaborative field testing of products, work on 
presentations at the Exchanges, and at the annual mini-university held in Washington, 
D.C. They also reported an increased collegiality derived from these collaborative efforts 
that has led to informal communication and Exchanges across CAs that would not have 
developed otherwise. 
MAQ Web Site 
The MAQ web site, electronic home of MAQ concepts, publications, and Exchange 
modules, with links to related sites, receives many visits per day. The web site contains 
full descriptions of the MAQ Initiative, its purpose, structure, subcommittees, 
publications, reports, proceedings, and its accomplishments and expected outcomes. 
Additional information on the MAQ Exchange and its purpose and contents, the MAQ 
Synergy Framework, MAQ tools, and the MAQ Pak is also available on the web site. 
Recent statistics indicate that in a 1–week period ending October 1, 2002, the site had an 
average of 842 visits per day (slightly higher than the 793 average daily visits from 
January 1 to October 1, 2002) for a total of 5,900 visits that week; these visitors requested 
an average of 349 pages per day (slightly higher than the daily average of 293 from 
January 1 to October 1, 2002). Visitors downloaded an average of 101 megabytes of data 
each day that week, compared with an average daily data download of only 76.6 
megabytes for the 9–month period ending October 1, 2002. Use has been fairly 
consistent throughout the year, with May having slightly more page requests than any 
other month. Approximately 20 percent of visits are from outside the United States. 
Interviewees offered a number of observations about the web site, most of them 
favorable, but a number of them pointing out opportunities for improvement, including 
the following: 
14 
! The site is not as easy to use as it could be; it could be made easier to navigate 
and locate content. 
! Many of the files are graphic intensive (especially MAQ Exchange modules) 
and these are very time consuming to download, especially via modem. This 
is even more problematic for residents of countries where connections to the 
web are unstable with frequent disconnections. 
! The site is not updated or refreshed frequently with new content. 
! The site is not as attractive and exciting for viewers as it could be; “it lacks 
pizzazz.” 
! The site is in English, limiting its use by non/limited-English speakers. 
Conclusions 
! The MAQ Initiative resulted in significant increases in information sharing 
and collaborative work among the CAs. 
! The MAQ Initiative has been successful in disseminating information about 
best practices in access and quality to CAs, especially at the domestic 
(headquarters) level where CA staffs have been active participants in MAQ 
work. 
! Criteria for determining a best practice are lacking. 
! Contraceptive technology and CPI best practices have been the practices most 
widely disseminated. 
! Nonmedical best practices have not achieved the level of consensus that 
clinical best practices have. 
! The lack of priority setting for the implementation of best practices makes it 
difficult to be clear about the most important messages delivered to programs. 
! The MAQ Exchanges have been increasingly successful as a dissemination 
vehicle. 
! MAQ Exchanges contribute to learning and local capacity building among 
less developed countries. 
! The MAQ web site is not as well utilized by overseas users and non-English 
speakers as it is by U.S.–based users. 
Recommendations 
! The MAQ Initiative needs to determine the level of evidence required to 
qualify a nonmedical practice as a best practice. 
15 
! The Initiative should place more emphasis on identification and dissemination 
of nonmedical best practices. 
! More reciprocal sharing and learning among less developed countries needs to 
be promoted as a component of MAQ capacity building. Countries involved 
in Exchanges would benefit from follow-up networking. 
! The MAQ web site format should be made more attention holding and easier 
to use than it is, and the web site should be promoted more systematically than 
it is. 
UTILIZATION OF MAQ DOCUMENTS AND TOOLS 
AND IMPLEMENTATION OF BEST PRACTICES 
Findings: Utilization of MAQ Documents and Tools 
There was ample evidence that many of the MAQ Initiative materials and tools are being 
extensively used in field programs. Essentials of Contraceptive Technology and the Do 
you know your family planning choices? wall chart were frequently cited as valuable 
materials that are being utilized in the field. Essentials of Contraceptive Technology has 
been translated into six languages and is being used globally as a resource and reference 
for updating family planning standards and practice, job aids, and training curricula. 
Other materials and tools, such as the Medical Eligibility Criteria, MAQ Checklist, and 
MAQ Exchange modules also are used widely. 
Other tools and materials were developed by the individual CAs but were adopted as part 
of the MAQ tool kit and extensively utilized in the field to further MAQ concepts and 
principles. Family Planning/Reproductive Health Service Delivery Guidelines, COPE 
(Client-Oriented, Provider-Efficient services), GATHER (Greet, Ask, Tell, Help, Explain, 
and Return),1
 and Pregnancy Checklist tools are such examples. The Guidelines have 
been used to develop and adapt practice guidelines in over 30 countries and are 
incorporated into the curricula of training centers and donor-assisted projects. A 
noteworthy study conducted in Kenya to evaluate the effectiveness of the guidelines 
provided clear-cut evidence that “family planning service guidelines, when properly 
disseminated improved practices.”2
 
MAQ materials on contraceptive technology, clinical tools, and counseling materials 
have higher utilization in the field programs compared with management/ 
supervision/monitoring tools and publications. For example, there is little evidence that 
the MAQ Papers developed on management and CPI have penetrated to the field and are 
being used by country programs. A possible explanation is that these types of materials 
were more recently developed and have not been adequately disseminated. It is also 
possible that the use of management and CPI materials were not as rigorously promoted 
in the field as the clinical materials. 
 
1
 COPE was developed by EngenderHealth; GATHER was developed by the Johns Hopkins University 
Center for Communication Programs. 
2 The Effectiveness of National Dissemination of Updated Reproductive Health/Family Planning 
Guidelines in Kenya, Family Health International, August 2001. 
16 
Quick Investigation of Quality (QIQ) is a practical methodology developed under the 
MAQ Initiative for measuring quality in clinic-based FP/RH programs. The tool was 
piloted in five countries and the results were documented. The study concluded that QIQ 
is a practical methodology that can be adapted to local interests and needs. The team was 
not able to find evidence that this tool was incorporated into many country programs 
except for Turkey and partially in Uganda. Again, this may be the result of inadequate 
dissemination and/or lack of supportive policies for application. 
One factor that makes it difficult to assess the extent of MAQ materials use in the field is 
the lack of brand recognition. Many respondents from USAID Missions were aware of 
the tools and materials mentioned above, but did not recognize them as products of the 
MAQ Initiative. In essence, this is a good indication that the MAQ materials have been 
incorporated into field programs and that brand recognition is not necessary. However, 
the lack of awareness that these materials are MAQ Initiative outcomes can lead to an 
underestimation of the extent of their utilization and the overall impact the Initiative has 
had. 
Findings: Implementation of Best Practices 
Although the purpose of the MAQ Initiative is the implementation of practical, focused 
interventions aimed at improving access to and quality of reproductive health services, 
the Initiative did not accelerate its focus on implementation until the late 1990s. During 
the early years of the Initiative, efforts were concentrated on identifying and 
disseminating best practices and the development of materials and tools. Even before 
placing a systematic emphasis on implementation, the evaluation team was told that the 
MAQ Initiative had had an impact on organizational cultures and agendas of USAID, 
CAs, and host country partners by advancing the quality of services, access to services, 
and broad collaboration. 
A success story regarding implementation of MAQ best practices comes from Romania. 
Three MAQ Exchange activities were conducted in Romania in 1999, through which 
action plans but not follow-up plans were developed. The USAID Mission bought into 
the MAQ Initiative and followed up vigorously to ensure the application of MAQ best 
practices in shaping the country’s reproductive health program. In Romania, the push 
and guidance for the implementation of MAQ principles was from the USAID Mission, 
since the Mission was intimately involved in the MAQ Exchange activities held there. 
The Romanian Mission employs the MAQ Checklist as its guidelines for developing 
quality FP/RH services throughout the country. It also uses the Synergy of Interventions 
as a guide to developing and/or modifying the other components of the Romanian FP/RH 
health delivery system. Romania also solicited and received support from UNFPA for 
the translation and publication of Essentials of Contraceptive Technology. Additionally, 
the Exchanges conducted served as a catalyst in changing the country’s policy that only 
obstetricians/gynecologists could provide family planning services. General practitioners 
are also now allowed to do so. More recently, MAQ Exchanges have taken a more 
systematic approach to application by incorporating action plans and follow-up and 
evaluation mechanisms to encourage implementation. The Central America subregional 
17 
MAQ Exchange, which was conducted in Honduras in 2002, and more recently the 
Nigerian MAQ Exchange, share several similar elements for successful implementation: 
! Both Exchanges conducted country-specific needs assessments prior to 
activity design. 
! Country team members were identified through joint committees to ensure 
appropriate composition. Teams included both decision-makers and service 
delivery technical resource persons. 
! Exchanges used local facilitators to endorse local capacity building. The 
Central America Exchange was also valuable in fostering learning and cross￾fertilization among the regional countries. 
! USAID Missions were actively involved and supportive in both Exchanges. 
! The action plans developed through both Exchanges were realistic and fit into 
the existing country program activities. 
! Support was available for participating countries to implement action plans 
developed through the Exchanges. In the case of the Central America 
subregional Exchange, the Latin America and the Caribbean (LAC) Bureau, 
through a designated CA, provided $15,000 of seed money for each country’s 
action plan for one year. In Nigeria, technical support from the new bilateral 
project, the VISION project, has facilitated implementation of action plans. 
! Follow-up plans were laid out to monitor the implementation of action plans. 
For each country, a responsible party was designated to coordinate and follow 
up on work plan activities. 
Seed money, which was provided for the Central America Exchange countries, was an 
accountability factor for the country teams and increased their focus on implementing 
their plans. Using seed money to gain additional resources also increased the likelihood 
of implementation. Given the limited funding and one-year timeframe, action plans from 
the Central America Exchange were developed to complement and fit into overall 
country programs or projects. 
Following the Exchange, Guatemala changed its intrauterine device practice due to 
shared regional learning. In El Salvador, contraceptive technology update information is 
being incorporated into medical and nursing training as a result of the MAQ Exchange. 
The team was also told that there is considerable progress in implementing action plans in 
one of the three targeted states in Nigeria. It should be noted that the exchange of ideas 
during the MAQ Exchanges might stimulate activities that result in the application of an 
idea that is not an exact replication. This spin-off effect is difficult to identify and 
measure. 
The IBP meeting held in Cairo early in 2002 used a design similar to the MAQ 
Exchanges. Country teams developed work plans and a mentor, mostly from CAs, was 
designated for each country. However, many of the elements outlined above were not 
18 
explicitly present in the Cairo meeting. There was less involvement from the USAID 
Missions and funding was uncertain. 
While the above examples provide strong potential for application of best practices in the 
future, it is too early to predict their success. All three eventsthe Central America and 
Nigeria exchanges and Cairo IBPtook place very recently. However, the team had 
anecdotal evidence from Nigeria, Guatemala, and El Salvador that action plan 
implementation is underway. 
A critical question that remains unresolved is the level of responsibility that the MAQ 
Initiative has over the implementation of practical, cost-effective, and actionable 
interventions. Key informants involved in MAQ have differing opinions on the role of 
MAQ regarding implementation. Many believe that the Initiative’s role is to provide 
opportunities for experts to collaborate and pool their knowledge and experience to 
identify and promote best practices and to make them accessible to a wider audience. 
Once the knowledge is disseminated, the CA community, USAID, and partner 
organizations will internalize and use them. Others think that implementation and 
application of the identified tools and concepts are within the mandate of the MAQ 
Initiative and that MAQ has the responsibility to follow up on and ensure 
implementation. 
The answer probably lies somewhere in between these two different views. 
USAID/Washington leads the MAQ Initiative but does not have full responsibility for 
implementing field programs. USAID/Washington’s key role is to advance and 
disseminate evidence-based technical knowledge. While USAID/Washington has some 
responsibility for application, it does not have full control over it. Implementation 
responsibility rests with the USAID field Missions and active involvement of the 
Missions is a key prerequisite for MAQ’s future success. Past experience indicates that 
Mission involvement and support of MAQ activities, regardless of the mechanism, has 
greatly increased application of MAQ concepts at the country level. 
The CAs are the implementers of USAID–funded programs in the field and the actual 
work of the MAQ Initiative is part of many CAs. The evaluation team observed that 
some CAs were better able than others to integrate MAQ philosophy and activities into 
their ongoing jobs. When integration is high, there is also a high level of contribution to 
and implementation of MAQ concepts. 
In order for MAQ concepts to be utilized and applied in country programs, they need to 
be incorporated into the CAs’ routine work. Recently awarded CATALYST and 
Advance Africa consortia both have clearly stated mandates to apply best practices. In 
order to promote implementation of best practices by CAs, future cooperative agreements 
should include language mandating that they do so. 
USAID/Washington has been primarily focusing on the content of the MAQ Initiative 
and Exchanges up to now with less focus on the process and context of implementation. 
A number of interviewees noted that the MAQ Initiative and Exchange have not provided 
guidance regarding process and context issues. Diffusion of the content of MAQ 
information has been thought to be sufficient to ensure application. However, the 
assumption that knowledge and skills are adequate for tailoring the proper processes into 
19 
different contexts may be incorrect. Implementation requires a strong focus on all three 
application factors: content, process, and context. 
Conclusions 
! MAQ materials and tools are being used effectively in field programs, when 
adequately disseminated. Inadequate utilization seems to be a result of 
ineffective/nonsystematic dissemination and/or promotion of their utilization. 
! MAQ clinical tools, contraceptive updates, and counseling aids are more 
widely used than other materials. 
! Utilization of MAQ materials may have been underestimated due to the lack 
of brand recognition for MAQ in field programs. 
! The MAQ Initiative has placed more emphasis on implementation and 
application of best practices over recent years. 
! The successful Central America and Nigeria MAQ Exchanges have common 
elements and lessons learned that could be used in future implementation 
strategies. 
! USAID Missions’ involvement and support of MAQ activities are 
prerequisites for successful implementation. 
! In order for MAQ concepts to be utilized and implemented in country 
programs, they need to be incorporated into CAs’ routine work. 
! The MAQ Initiative and Exchange have not provided guidance regarding 
processes and context issues for the application of MAQ concepts and 
principles. 
! IBP follows a similar design to MAQ Exchanges but is less structured. 
Recommendations 
! USAID/Washington, the Missions, and the CA community should continue to 
promote the utilization of MAQ documents and tools in field programs, with 
increased emphasis on nonclinical materials. 
! Lessons learned from the Central America and Nigeria Exchanges should be 
used in designing and implementing future MAQ Exchanges and IBP 
meetings. 
! The two differing funding models for action plan implementation used in the 
MAQ Exchanges in Nigeria (bilateral) and Central America 
(USAID/Washington LAC Bureau and in-country funds) should be followed 
up and evaluated to determine whether they produced successful outcomes. 
20 
! Incorporating accountability language for MAQ concepts and principles 
implementation into CA cooperative agreements and contracts would ensure 
implementation in the future. 
! USAID/Washington and the CAs should continue to strengthen their 
discussions with USAID Missions to ensure active involvement and support 
of the Missions for the implementation of best practices. 
! USAID/Washington, in concert with the Missions, needs to provide additional 
guidance on process and context issues for implementation. 
COSTS 
GH/PRH allocates core funds earmarked for the MAQ Initiative. CAs participating in the 
Initiative receive these core funds at the beginning of the fiscal year. MAQ–earmarked 
core funds have been allocated to 20 agencies or projects over the last five years. MAQ 
funds have declined by almost 80 percent since 1998. The mechanism for the allocation 
of funds for the MAQ Initiative is similar to other projects and initiatives. CAs develop 
annual plans for MAQ activities that they propose to undertake accompanied by a budget. 
MAQ Initiative staff reviews proposed work plans and allocates funding to undertake 
selected activities. 
Some of the CA representatives interviewed reported that current allocations of MAQ 
core funds were inadequate to cover the full costs of MAQ and MAQ–related activities. 
They further stated that the initiation of IBP activities affected CA budgets because most 
CAs used MAQ core funding for both MAQ and IBP activities. Therefore, the CAs 
reported internally that they allocated other core funds for IBP and MAQ activities. 
Some CA interviewees reported that in order to cover the costs of both MAQ and IBP 
activities, they expend at least twice as much as the MAQ–earmarked funds they 
received. 
Some interviewees reported that their CAs have created a separate budget category for 
MAQ–related activities and have combined earmarked MAQ and other core funds under 
this category. Others reported that they did not create a separate budget category for 
MAQ–related activities and charged MAQ–related costs to other budget categories. 
Because of inconsistent budgetary practices, it was not possible for the team to calculate 
the total costs of the MAQ Initiative. 
Seven CAs with the largest MAQ allocations were asked to provide the approximate 
level of their total expenditures for MAQ–related activities over the last three years. The 
estimated expenditures reported by some CAs do not support the assertion that total 
MAQ–related expenditures greatly exceed allocations during this time period. The total 
expenditures exceed MAQ–earmarked allocations by 50 percent. 
The team noted a perception among the USAID/Washington staff that MAQ is a costly 
initiative. This perception is not widely shared among the CA community. Even though 
many CAs had expressed disappointment that they have to spend more resources for 
MAQ than they receive from earmarked monies, they still believe that the overall costs 
for the Initiative are not high. In particular, those CAs that are closely involved in MAQ 
21 
and that have experienced programmatic benefits believe that it is a cost-effective 
initiative and that it merits the cost and effort. 
Conclusions 
! The exact cost of the MAQ Initiative is difficult to calculate due to the 
inconsistency in CA budget and accounting processes. 
! Reported estimated expenditures do not support the assertion that total MAQ–
related expenditures greatly exceed allocations. 
Recommendations 
! USAID/Washington and the CAs should annually plan together for budget 
allocations to match MAQ activities. 
! CAs should create a budget category for MAQ and MAQ–related activities 
that combines core and MAQ core funds. 
APPENDICES 
A. Scope of Work 
B. Distribution List for Survey Questionnaire 
C. Persons Interviewed 
D. Online Survey 
E. Survey Results 
F. Illustrative Restructuring Model 
G. Documents Reviewed 
APPENDIX A 
SCOPE OF WORK 
(from USAID) 
1 
SCOPE OF WORK 
MAQ INITIATIVE EVALUATION 
BACKGROUND 
Maximizing Access and Quality (MAQ) is a USAID/Washington Office of Population 
Special Initiative. The purpose of the MAQ Initiative is to bring together staff from 
USAID/Washington, USAID Missions, the cooperating agency (CA) community and 
program managers to identify and implement practical, cost-effective, focused and 
actionable interventions aimed at improving both the access to and quality of family 
planning and selected reproductive health services. The MAQ Initiative was established 
in May of 1994, building upon the Medical Barriers Initiative. The overall rationale is 
that there is a large unmet demand for voluntary contraceptive services. Removing 
barriers, promoting access and improving quality by focusing on specific practical 
improvements can serve the needs of clients and thereby markedly improve programs. 
Although many CAs are already addressing MAQ–related objectives in their program 
activities, the MAQ Initiative provides opportunities for experts to collaborate and pool 
their knowledge and field experience to identify and promote state-of-the-art tools and 
concepts, thereby making them accessible to a wider audience. The MAQ Initiative 
highlights those areas of greatest actionability or accomplishment that might serve as 
models in other countries or regions. In essence, MAQ aims to distill and disseminate 
lessons learned from the broader CA experience as well as identify critical areas that have 
not yet been addressed. 
STRUCTURE 
The MAQ Working Group is decentralized and draws significantly on leadership in the 
CA community. Currently six subcommittees have been formed, five of which focus on 
a different technical aspect of quality and access: Client-Provider Interaction (CPI); 
Policy, Advocacy, Communication and Education (PACE); Management and 
Supervision; Community–Driven Quality (CDQ); and Organization of Work (OOW). An 
additional subcommittee, the Francophone Regional Subcommittee, has a regional focus 
and a technical agenda that varies over time. Each subcommittee is chaired by two or 
three co-chairs from CAs. The co-chairs plan, carryout and report on activities in 
coordination and consultation with USAID. 
Since mid-1999, USAID has worked through the MAQ Initiative with WHO and other 
partner agencies to develop a practical and structured approach to capturing and applying 
best practices to family planning/reproductive health programs. The IBP (IBP) 
Consortium works at the international, regional and country level and demonstrates a 
model of international cooperation among major organizations. The main objectives of 
the IBP Consortium are to minimize duplication of effort, maximize the use of donor 
resources, efficiently use technical materials and tools developed by partners, promote 
change from within the system and encourage continuous improvement through 
mentorship and supportive follow-up. To date, the Consortium's practical work has 
primarily been focused on regional and inter-country meetings. 
2 
ASSESSMENT GUIDELINES 
The MAQ Initiative has recently been moved into the Service Delivery Improvement 
(SDI) Division from the Research Division, where it had been located for eight years. 
This move into SDI reflects the continued evolution of MAQ to become part of the 
"mainstream" and focus more on actual field implementation. 
EVALUATION PURPOSE AND OBJECTIVES 
! The outcome of this assessment will contribute to the overall development of a 
new strategy for SDI and also clarify the role of MAQ in the newly reorganized 
Office of Population and Reproductive Health. 
! It will be an overall assessment of MAQ and will focus on the larger impact that 
the MAQ Initiative has had over the past few years as well as make 
recommendations for its future focus and direction. 
! The assessment will determine how MAQ should best evolve to meet field 
program needs. 
! The assessment will look at the degree to which USAID and its partners are 
sharing MAQ information and if that knowledge sharing continues to grow. 
Specifically, the objectives of the evaluation are to answer and assess the following areas: 
Cross–fertilization and information sharing
To what extent has the MAQ Initiative played a key role in facilitating the exchange 
of best practices among USAID and its partners? Without the MAQ process, to 
what extent would sharing and cross-fertilization of best practices in quality and 
access have occurred? Would it have been to the same extent or been as 
efficient/effective? 
! To what extent does participation in MAQ facilitate collaboration between CAs and 
cross-fertilization of best practices? To what extent have CAs adopted the collective 
best practices?
! To what extent do CA point persons transfer the information that they gain through 
their involvement in MAQ subcommittees and meetings to their colleagues within 
their own organizations? To what extent has this influenced their organizations' 
program work?
Best Practices Utilization and Dissemination 
To what extent has MAQ "captured" best practices in specific technical areas? 
! Are the best practices that have been captured of high technical quality? Technical 
areas to look at: Client–Provider Interaction, Supervision, Leadership, Contraceptive 
Technology Update, Performance Improvement, Community Defined Quality, etc. 
(please see MAQ Exchange modules for full range of technical focus areas). Also 
can look at MAQ innovation and research. 
3 
! To what extent has the MAQ subcommittee structure contributed to the identification 
and documentation of technical best practices? 
! To what extent has the "IBP" Consortium and its activities contributed to the capture 
of best practices? 
Dissemination 
To what extent has MAQ contributed to dissemination and incorporation of best 
practices in CA and field programs? 
! To what extent have MAQ concepts and technical guidance made their way into field 
programs?
! To what extent have the MAQ Exchanges/IBP conferences influenced application of 
best practices to improve access and quality of RH services in field programs?
MAQ Material Utilization and Cost Effectiveness
To what extent are key MAQ documents and tools being utilized? 
! Possible documents to look at: Essentials of Contraceptive Technology books and 
wallcharts; Medical Eligibility Criteria; MAQ Exchange Modules; MAQ web site; 
pregnancy checklist; etc. 
! Is the MAQ Initiative worthwhile relative to the cost? What is the real cost of MAQ? 
How is money allocated? (Please note these totals reflect only the MAQ Special 
Initiative funding over the past five years. This does NOT reflect the total Office of 
Population core funds or field support funds spent on access and quality activities.) 
 MAQ Budget 1998–2002 
1998: $5.900 million 
 1999: $3.030 million 
 2000: $1.775 million 
 2001: $1.200 million 
 2002: $1.260 million 
Next steps
Future 
! Should MAQ continue as a special initiative? How much have MAQ's objectives 
been incorporated into the mainstream work of the CAs? 
! How should MAQ evolve? What should the relationship of MAQ be to other 
ongoing best practices efforts (e.g. FHI's "Research to Practice" Initiative, Advance 
Africa's Best Practices Compendium, etc.)? 
! How much has MAQ been mainstreamed? Do the principles of MAQ continue to 
need special emphasis/attention? 
4 
METHODOLOGY AND SCHEDULING 
The evaluation team will consist of three consultants: a generalist, a technical expert, and 
a program expert. The team will determine and develop the methodology for the 
assessment before the assessment begins. They will determine the best way to collect the 
information from the key informants and will determine how/when/where the data 
collection will take place. There is possible travel to the offices in DC, New York, and 
North Carolina in order to carry out the evaluation. It has been determined that out-of￾country travel is not necessary for this assessment. Interviews will be conducted with 53 
MAQ key informants (see below). 
The evaluation will start October 1, 2002. Tentative dates are as follows: data collection 
will be conducted from Oct.1–Oct. 23. Oct.23–Oct 30: documentation. Finally, Oct. 31–
Nov.6 for the presentation of the report. The final report will be completed by Nov.15, 
2002. This report will be an internal document and will not be a fully edited POPTECH 
report. 
APPENDIX B 
DISTRIBUTION LIST FOR SURVEY QUESTIONNAIRE 
DISTRIBUTION LIST FOR SURVEY QUESTIONNAIRE 
U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT 
Washington 
Margaret Neuse 
Jim Shelton 
Michele Moloney-Kitts 
Jeff Spieler 
Estelle Quain 
Dana Vogel 
Jim Griffin 
Maureen Norton 
Marguerita Farrell 
Sarah Harbison 
Mihira Karra 
Kellie Stewart 
Missions 
Alonzo Wind 
David Losk 
Melinda Wilson 
Samresh Sengupta 
Brenda Doe 
Barbara Winkler Hughes 
Maricarmen Estrada 
Michael Mushi 
Felix Awantang 
Lucrecia Castillo 
Laura Slobey 
Bunmi Dosumu 
Susan Monaghan
COOPERATING AGENCIES, PROJECTS, AND PVOS 
Advance Africa 
Susan Palmore 
EngenderHealth 
Lynn Bakamjian 
Roy Jacobstein 
Carmela Cordero 
Jan Kumar 
Jean Ahlborg 
Ade Adetunji 
Family Health International (FHI) 
Roberto Rivera 
Judith Collins 
Tita Oronoz 
Robert Rice 
John Stanback 
JHPIEGO 
Rick Sullivan 
Ronald Magarick 
Jennifer Macias 
Chris Davis 
Pamela Lynam 
Abigail Kyei 
JHU/Population Communication Services (PCS) Project 
Jane Bertrand 
Phyllis Piotrow 
Michele Heerey 
Robert Ainslie 
Ma Umba Mabiala 
JHU/Population Information Program 
Ward Rinehart 
Management Sciences for Health (MSH) 
Doug Huber 
Sallie Craig Huber 
Wayne Stinson 
Allison Ellis 
Pathfinder International 
Kathy Solter 
Population Leadership Program (PLP) 
Sharon Rudy 
PRIME 
Bill Jansen 
Pape Gaye 
Marc Luoma 
Jim MacMahon 
Yvonne Sidhom 
Boniface Sebikali 
Milton Cordero 
Population Council 
John Townsend 
Emma Ottolenghi 
Juan Diaz 
Quality Assurance Project 
Diana Silimperi 
Thada Bornstein 
Jorge Hermida 
Save the Children 
Lisa Howard-Grabmann 
Debbie Fagan 
Mary Beth Powers 
World Health Organization (WHO) 
Maggie Usher 
Bert Petersen 
Sarah Johnson 
OTHER 
Elaine Murphy 
Ayman Moshen 
Joanna Nerquaye-Tetteh 
Lucas Mbofung 
Justine Tantchou 
Nagbandja Kampatibe 
Kadidiatou Maikibi 
APPENDIX C 
PERSONS INTERVIEWED 
PERSONS INTERVIEWED 
U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT 
Washington 
Margaret Neuse, Director, Office of Population and Reproductive Health 
Jim Shelton, Senior Medical Advisor 
Michele Moloney-Kitts, Chief, SDI Division 
Dana Vogel, Health and Population Officer, SDI 
Jim Griffin, Senior Technical Advisor, SDI 
Maureen Norton, Senior Technical Advisor, SDI 
Sarah Harbison, Senior Technical Advisor, Research Division 
Mihira Karra, Senior Technical Advisor 
Kellie Stewart, MAQ Coordinator 
Missions 
Alonzo Wind, Health Development Officer, USAID/Nicaragua 
Barbara Winkler Hughes, Deputy Director for Population and Health, USAID/Zambia 
Maricarmen Estrada, Reproductive Health Specialist, USAID/El Salvador 
Lucrecia Castillo, Project Officer for HIV/AIDS, USAID/Guatemala 
Susan Monaghan, Senior Health Advisor, USAID/Romania 
COOPERATING AGENCIES, PROJECTS, AND PVOS 
Advance Africa 
Susan Palmore, Director of Strategic Dissemination 
EngenderHealth 
Lynn Bakamjian, Director of Programs 
Roy Jacobstein, Medical Director 
Carmela Cordero, Deputy Medical Director 
Jan Kumar, Senior Manager for Informed Choice 
Jean Ahlborg, Regional Medical Advisor, Thailand 
Ade Adetunji, Director of VISION Project, Nigeria 
Family Health International (FHI) 
Roberto Rivera, Director of Office for International Research Ethics 
Judith Collins, Senior Associate for Communication and Training 
Tita Oronoz, Senior Communication and Training Officer 
Robert Rice, Director of Training 
John Stanback, Senior Associate for Health Services and Research 
JHPIEGO 
Rick Sullivan, Director of Learning and Performance Support 
Ronald H. Magarick, Director of Training in Reproductive Health 
Jennifer Macias, Team Leader for Africa Region 
Chris Davis, MAQ Advisor 
Pamela Lynam, Regional Technical Director, Kenya 
JHU/Population Communication Services (PCS) 
Jane Bertrand, Director 
Phyllis Piotrow, Former Director 
Michele Heerey, Senior Program Officer for Quality and Performance 
Robert Ainslie, Senior Program Officer, Latin America Division 
Ma Umba Mabiala, Senior Program Officer, Africa Division 
JHU/Population Information Program 
Ward Rinehart, Director 
Management Sciences for Health (MSH) 
Doug Huber, Principal Medical Officer for Reproductive Health 
Sallie Craig Huber, Senior Fellow 
Wayne Stinson, Senior Program Associate 
Allison Ellis, Co-Director of Programs Unit 
Pathfinder International 
Kathy Solter, Director of Technical Services 
Population Leadership Program (PLP) 
Sharon Rudy, Director 
PRIME 
Bill Jansen, Director 
Pape Gaye, Regional Director for West, Central, and North Africa 
Yvonne Sidhom, Director of Reproductive Health and Special Initiatives 
Boniface Sebikali, Area Program Manager for West and Central Africa 
Population Council 
John Townsend, Director of FRONTIERS Reproductive Health Program 
Emma Ottolenghi, Senior Consulting Associate 
Quality Assurance Project 
Diana Silimperi, Deputy Project Director 
Thada Bornstein, Deputy Training Director 
Save the Children 
Lisa Howard-Grabmann, Associate Director for Community and Institutional Capacity 
Debbie Fagan, Community-Defined Quality Advisor 
World Health Organization 
Maggie Usher, Scientific Advisor for Reproductive Health and Research 
Bert Petersen, Coordinator for Family Planning 
Sarah Johnson, PLP Fellow 
OTHER 
Elaine Murphy, Professor of Global Health at Georgetown University (formerly of 
PATH) 
APPENDIX D 
ONLINE SURVEY 
Exit this survey >>
 MAQ Initiative Evaluation Survey
 1. Introduction
This questionnaire is part of an assessment that will 
contribute to the overall development of a new strategy for 
USAID/SDID and also clarify the role of MAQ Initiative in the 
newly reorganized Office of Population and Reproductive 
Health.
 1. In your opinion, to what extent has the MAQ Initiative been 
successful in identification and documentation of best practices?
Not at all 
successful 1 2 3 4 5 Highly 
successful
 2. In your opinion, in which technical areas has MAQ been most 
successful in capturing best practices? Check all that apply.
Client-provider interaction
Management and supervision
Leadership
Contraceptive technology
Community-defined quality
Policy, advocacy, communication and education (PACE)
Monitoring and evaluation
None
Other (please specify)
 
 3. To what extent has MAQ facilitated information sharing between 
USAID and the CAs and among the CAs themselves?
Not at all 1 2 3 4 5 Greatly
 4. How well have the MAQ best practices been disseminated within 
your organization?
Not at all well 
1 2 3 4 5 Very well
 5. To what extent has MAQ contributed to the dissemination of best 
practices to the field?
Not at all 1 2 3 4 5 Greatly
 6. How well do you think the MAQ Initiative functions under its 
current organization and structure?
Not at all well 
1 2 3 4 5 Very well
 7. How often have you used the MAQ Initiative website?
Never 1 2 3 4 5 Very often
 8. To what extent has the MAQ Initiative contributed to the 
incorporation and implementation of best practices in field programs?
Not at all 1 2 3 4 5 Greatly
 9. Do you think the gains from the MAQ Initiative have been 
worthwhile relative to the cost and effort?
Not at all 1 2 3 4 5 Greatly
 10. Should MAQ continue as a special 
initiative?
No
Yes, with some modification
Yes, with significant modifications
Yes, with no modifications
No answer
 11. How involved have you been with the MAQ 
Initiative?
Not at all 1 2 3 4 5 Very 
involved 
 12. What is your affiliation?
USAID/W
USAID Mission
CA Headquarters
CA Field
Other (please specify)
 
APPENDIX E 
SURVEY RESULTS 
Response Percent Response Total 
1 0 0 
2 4.8 3 
3 25.8 16 
4 45.2 28 
5 24.2 15 
 
Total Respondents 62 
(skipped this question) 1 
Question 1
In your opinion, to what extent has the MAQ Initiative been 
successful in identification and documentation of best practices?
0
3
16
28
15
0 5 10 15 20 25 30
Not at all successful 1
2
3
4
Highly successful 5
Number of Respondents (n=62)
 Response Percent Response Total 
Client-Provider Interaction 83.3 50 
Management and Supervision 48.3 29 
Leadership 13.3 8 
Contraceptive Technology 83.3 50 
Community-Defined quality 23.3 14 
Policy, Advocacy, Communication, and Education (PACE) 30 18 
Monitoring and Evaluation 28.3 17 
None 0 0 
Other (please specify) 21.7 13 
 
 Total Respondents 60 
 (skipped this question) 3 
Question 2
In your opinion, in which technical areas has MAQ been most successful 
in capturing best practices? Check all that apply.
50
29
8
50
14
18
17
0
13
0 10 20 30 40 50 60
Client-Provider Interaction
Management and Supervision
Leadership
Contraceptive Technology
Community-Defined Quality
Policy, Advocacy, Communication, and Education (PACE)
Monitoring and Evaluation
None
Other (please specify)
Number of Respondents (n=60)
Question 3
To what extent has MAQ facilitated information sharing between 
USAID and the CAs and among the CAs themselves?
0
2
6
27
28
0 5 10 15 20 25 30
Not at all 1
2
3
4
Greatly 5
Number of Respondents (n=63)
Response Percent Response Total 
1 0 0 
2 3.2 2 
3 9.5 6 
4 42.9 27 
5 44.4 28 
 
 Total Respondents 63 
 (skipped this question) 0 
 Response Percent Response Total 
1 1.6 1 
2 12.7 8 
3 38.1 24 
4 33.3 21 
5 14.3 9 
 
 Total Respondents 63 
 (skipped this question) 0 
Question 4 
How well have the MAQ best practices been 
disseminated within your organization?
1
8
24
21
9
0 5 10 15 20 25 30
Not at all well 1
2
3
4
Very well 5
Number of Respondents (n=63)
 Response Percent Response Total 
1 1.6 1 
2 14.5 9 
3 38.7 24 
4 32.3 20 
5 12.9 8 
 
 Total Respondents 62 
 (skipped this question) 1 
Question 5
To what extent has MAQ contributed to the 
dissemination of best practices to the field?
1
9
24
20
8
0 5 10 15 20 25 30
Not at all 1
2
3
4
Greatly 5
Number of Respondents (n=62)
 Response Percent Response Total 
1 0 0 
2 16.4 10 
3 29.5 18 
4 44.3 27 
5 9.8 6 
 
Total Respondents 61 
 (skipped this question) 2 
Question 6
How well do you think the MAQ Initiative functions 
under its current organization and structure?
0
10
18
27
6
0 5 10 15 20 25 30
Not at all well 1
2
3
4
Very well 5
Number of Respondents (n=61)
 Response Percent Response Total 
1 22.6 14 
2 25.8 16 
3 30.6 19 
4 16.1 10 
5 4.8 3 
 
 Total Respondents 62 
 (skipped this question) 1 
Question 7
How often have you used the MAQ Initiative web site?
14
16
19
10
3
0 2 4 6 8 10 12 14 16 18 20
Never 1
2
3
4
Very often 5
Number of Respondents (n=62)
 Response Percent Response Total 
1 1.6 1 
2 26.2 16 
3 26.2 16 
4 39.3 24 
5 6.6 4 
 
 Total Respondents 61 
 (skipped this question) 1 
Question 8
To what extent has the MAQ Initiative contributed to the incorporation 
and implementation of best practices in field programs?
1
16
16
24
4
0 5 10 15 20 25 30
Not at all 1
2
3
4
Greatly 5
Number of Respondents (n=61)
 Response Percent Response Total 
1 0 0 
2 17.2 10 
3 20.7 12 
4 39.7 23 
5 22.4 13 
 
 Total Respondents 58 
 (skipped this question) 5 
Question 9
Do you think the gains from the MAQ Initiative 
have been worthwhile relative to the cost and effort?
0
10
12
23
13
0 5 10 15 20 25
Not at all 1
2
3
4
Greatly 5
Number of Respondents (n=58)
 Response Percent Response Total 
1 1.6 1 
2 67.7 42 
3 25.8 16 
4 3.2 2 
5 1.6 1 
 
 Total Respondents 62 
 (skipped this question) 1 
Question 10
Should MAQ continue as a special initiative?
1
42
16
2
1
0 5 10 15 20 25 30 35 40 45
No
Yes, with some modification
Yes, with significant
modifications
Yes, with no modifications
No answer
Number of Respondents (n=62)
 Response Percent Response Total 
1 1.6 1 
2 15.9 10 
3 28.6 18 
4 31.7 20 
5 22.2 14 
 
 Total Respondents 63 
 (skipped this question) 0 
Question 11
How involved have you been with the MAQ Initiative?
1
10
18
20
14
0 5 10 15 20 25
Not at all 1
2
3
4
Very involved 5
Number of Respondents (n=63)
 Response 
Percent 
Response Total 
USAID/Washington 12.7 8 
USAID Mission 12.7 8 
CA Headquarters 63.5 40 
CA Field 4.8 3 
Other (please specify) 6.3 4 
 
 Total 
Respondents 
63 
 (skipped this 
question) 
0 
Question 12
What is your affiliation?
8
8
40
3
4
0 5 10 15 20 25 30 35 40 45
USAID/Washington
USAID Mission
CA Headquarters
CA Field
Other (please specify)
Number of Respondents (n=63)
APPENDIX F 
ILLUSTRATIVE RESTRUCTURING MODEL 
ILLUSTRATIVE RESTRUCTURING MODEL 
Title: Shared VisionAll the Right People Included 
This model attempts to bring representatives from each of the stakeholder groups together 
throughout the process of identification of work to be performed, execution of that work, 
and implementation and advocacy for it, once it is completed. The model attempts to 
apply MAQ principles to the MAQ Initiative itself. The anticipated benefit of this 
structure is that both USAID/GH/PRH divisions and participating CAs will have shared 
ownership, shared commitment, and shared agreement regarding what the MAQ Initiative 
is attempting to achieve. 
MAQ STEERING COMMITTEE/ADVISORY COMMITTEE 
Membership 
Representatives named by participating CAs, USAID/Washington divisional and 
technical representatives assigned 
Meeting Frequency 
Semiannually or quarterly 
Requirements 
! Highly committed to MAQ mission 
! Able to attend meetings regularly 
! Members act as liaison from committee to home organization 
! Members responsible for disseminating MAQ information within home 
organization 
! Members act as advocates for MAQ 
! CA representatives responsible for bringing forward field input on issues and 
identifying field needs/demands 
Committee Charge 
! Solicit field input through direct field communications 
! Identify and set priorities for work to be performed based upon emerging 
issues and field input 
! Request work from subcommittees/work groups or create new groups 
! Interface with other USAID and WHO/USAID initiatives, consortia, and 
projects through committee representatives 
Size 
Sufficient to act decisively and in a timely manner 
MAQ SUBCOMMITTEES/WORK GROUPS 
Membership 
! Co-chairs include a USAID/Washington representative; co-chairs have 
staggered terms 
! According to technical expertise and/or interest; steering committee 
representatives, CA representatives, and USAID/Washington as ex-officio 
representatives 
Meeting Frequency
As needed 
Requirements 
Committed to regular attendance, completing work assignments, and acting as MAQ 
Initiative advocate within their organizations and in the field 
Subcommittee 
Responsibilities 
! Propose a response to the charge given by the steering committee (e.g., 
describe product[s] to be created) 
! Agree on steps to complete work 
! Review proposed product(s) and steps with steering committee 
! Provide progress reports and final outcomes or product(s) to steering 
committee 
! Assist steering committee in identifying and establishing priorities for 
emerging issues for MAQ focus 
Illustrative 
Work Groups 
! Content focus (e.g., management and supervision, community-driven quality) 
! Geographic focus (e.g., Francophone region, Central America Region) 
! Product focus (e.g., supervision guide, exchange module, job aids, 
management processes) 
! Process focus (e.g., exchange action plan evaluation for seed money use, best 
practice implementation strategies) 
APPENDIX G 
DOCUMENTS REVIEWED 
DOCUMENTS REVIEWED 
Conference on MAQ: Implementing Policies, Norms and Protocols in Reproductive 
Health Services. Conference highlights, Dakar, Senegal, 1–4 March, 1999.
Essentials of Contraceptive Technology. Baltimore: Johns Hopkins Population 
Information Program, 1997. 
Family Health International. Checklist to Rule Out Pregnancy. (Undated) 
__________. The Effectiveness of National Dissemination of Updated Reproductive 
Health/Family Planning Guidelines in Kenya. Chapel Hill, August 2001. 
Gaye, P. et al. Trip Report Nigeria: March 11–23, 2002. INTRAH/PRIME, 2002. 
Improving Access to Quality Care in Family Planning: Medical Eligibility Criteria for 
Contraceptive Use. Geneva: World Health Organization, 2000. 
Jennings, Victoria et al. Analyzing the Organizational Context for Positive Client–
Provider Interaction: A Leadership Challenge for Reproductive Health. MAQ Paper 
Vol. 1, No. 1, Boston, MA: Management Sciences for Health, 2000. 
MAQ: From Guidelines…to Action. Proceedings of the MAQ Conference, Washington, 
D.C., May 12–13, 1998. 
MEASURE Evaluation. Monitoring Quality of Care in Family Planning by the Quick 
Investigation of Quality (QIQ): Country Reports. MEASURE Evaluation Technical 
Report Series No. 5, Carolina Population Center, University of North Carolina at Chapel 
Hill, July 2000. 
Murphy, Elaine and Cynthia Steele. Key Principles in Client–Provider Interaction. MAQ 
Paper Vol. 1, No. 2, Boston, MA: Management Sciences for Health, 2000. 
Oliver, J. et al. Trip Report Honduras: April 17–27, 2002. Quality Assurance Project, 
2002. 
Senlet, P. Best Practices in Monitoring and Evaluation: Lessons from the USAID Turkey 
Population Program. Special Report, MEASURE Evaluation, Carolina Population 
Center, 2002. 
Shelton, J., S. Davis, and J. Mathis. Checklist for Family Planning Service Delivery with 
Selected Linkages to Reproductive Health. Washington, D.C. (No date) 
Stinson, W., L. Bakamjian, S.C. Huber, and D. Silimperi. Managing Programs to 
Maximize Access and Quality: Lessons Learned from the Field. MAQ Paper Vol. 1, No. 
3, Boston, MA: Management Sciences for Health, 2000. 
USAID. MAQ Initiative Committee Meeting Minutes. 1997–2002. 
__________. MAQ Subcommittee Statement of Purpose and Goals. (Undated) 
 POPULATION TECHNICAL ASSISTANCE PROJECT
 1101 Vermont Ave., NW Suite 900 Washington, DC 20005 Phone: (202) 898-9040 Fax: (202) 898-9057 www.poptechproject.com