Health care workers hold the power to improve the quality of services they offer. This concept is key in AVSC's quality improvement efforts around the world. The stories below tell how health care workers, on their own and with the support of their institutions, have made services safer, more customer-oriented, and more efficient.

These examples grew out of experiences with COPE, AVSC's low-cost process for improving quality at service sites. COPE gets supervisors and staff from all levels at a site involved in identifying barriers to quality services and helps them to solve problems that they can address with their own resources.

Making Things Work

A hospital in Tanzania waited for months for higher-level supervisors to provide funds for repairing or replacing broken equipment. The hospital decided to stop waiting. It decided to use available funds to send a hospital technician for training in maintenance and repair.

Now, blood pressure equipment, autoclaves, bedsprings, and water pipes are fixed promptly, and clients and staff benefit as a result. Staff at the hospital describe COPE as fostering "a state of believing in ourselves."

Finding Creative Solutions

Through COPE, clinic and hospital staff find solutions to common problems, such as the need for supplies, often by identifying alternative resources.

At another site in Tanzania, many of the beds were in such disrepair that clients were placing their mattresses on the floor for comfort. As part of a COPE exercise, one supervisor asked the staff what they could do to solve the problem themselves. The staff noted that the wire mesh protecting the windows could also be used to reinforce the bed frames. Since the mesh was inexpensive and easy to find in the community, staff were able to make the repairs and solve the problem.

Everyone Plays a Role

All staff have a role to play in improving quality. In Kenya, a lack of running water forced clinic staff to go to a cistern to draw water--a burdensome task in the midst of their other responsibilities.

At a COPE meeting to resolve the problem, staff talked about how costly it would be to replace the water system. But the expense was beyond the budget. How else could they raise funds?

Finally, the gardener, who had been listening intently, told the group that the problem was a broken pipe. Fix the pipe, he pointed out, and water would be restored. The repair was made at minimal cost, and the problem was solved.

The striking thing about these efforts is their simplicity. Not only are health care staff uniquely qualified to identify obstacles to quality, but they often know the cause of the problem; they can suggest and often implement the best solution.

Bit by bit, the changes add up. Eventually, they can lead to major improvements in the quality of reproductive health services for men and women around the world.

Naadu Blankson-Seck is an editor/writer and Phyllis Butta is quality services advisor for AVSC.

Illustration: Joan Hilty