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11 / 24

-Quality of counseling

Good                                                                     Bad

3/ Supervisory checklists for

Family planning

A/Service delivery

-Availability of contraceptives

Yes                                                                        No

If No, why?

-Types available (please notify)

-If other types are not available, please comment

-How contraceptives delivery takes place

Inside centre                            outside centre

If outside centre, please explain

B/Use of contraceptives by beneficiaries

-Age of user

-Number of children

-Age of last child

-Age difference between children (if the number is above two)

-Contraceptives use

Yes                                                                        No

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