Quality improvement-making reproductive health services safer and
more responsive to clients-is a primary focus of AVSC's work around
the world.
Why Does Quality Matter?
The most important reason to improve quality of care is that clients
are entitled to the best possible services.
Additionally, a clinic's survival depends on the quality of its
services: If a clinic does not respond to their needs, clients will
not use its services. Studies show that client satisfaction and
effective use of contraception increase with improvement in service,
such as reduced waiting times, better training for providers, and
increased client and community health education.
AVSC's quality improvement approach includes three major components:
- Facilitative supervision, which emphasizes two-way communication
and joint problem solving
- Whole-site training, a decentralized, practical approach
to training
- COPE, a low-cost self-assessment tool that helps staff
identify problems and implement solutions
Widespread Use of COPE
COPE-which empowers staff and enables them to identify and solve
problems on their own-has proven to be one of AVSC's most powerful
quality-improvement tools. For example, a study of COPE in four
African countries found that sites resolved 59% of all problems
identified and solved 73% of them without outside help.
COPE examines areas of special concern to clients-access to services,
informed choice, safety, privacy, confidentiality, and continuity
of care-as well as critical areas for staff, such as supervision,
management, training, supplies, and equipment.
Over the years, COPE's popularity has continued to grow. The AVSC
book COPE: Client-Oriented, Provider-Efficient Services has
been translated into 14 languages, and COPE has been used in a wide
range of countries, including Bangladesh, Brazil, Indonesia, Kenya,
and Tanzania.
Workshop participants from India and Singapore
learn about COPE exercises at a clinic in Sonargaon, Bangladesh.
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Examples: COPE in Tanzania and Bangladesh
Tanzanian clinics that routinely use COPE have seen many improvements
in equipment maintenance, infection prevention practices, local funding
for reproductive health services, and clinic efficiency. One assessment
of 66 Tanzanian service sites for an average of 14 months found a
measurable improvement in overall service quality.
In Bangladesh, COPE has been widely used in dozens of clinics
and maternal and child welfare centers. A 1997 evaluation found
significant improvements in quality: The efficiency and cleanliness
of clinics had improved, more than 70% of problems identified had
been resolved using local resources, and clinics were providing
more types of contraceptive methods.
Partnering to Improve Quality
In Bangladesh, AVSC is part of two coalitions-the Quality Improvement
Partnership and the Service Delivery Partnership-working to improve
the quality of services in several hundred participating clinics.
In addition to developing standards of care for family planning
and other services, the QIP has organized quality-assurance visits
to clinics and trained more than 200 managers in more facilitative
supervisory approaches.
All of AVSC's quality-improvement work has one goal: to make reproductive
health services safer, more efficient, and more responsive to the
women and men who want to protect their own health and the health
of others.
