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COPE® Self-Assessment Process

"Client-Oriented, Provider-Efficient"

COPE®, which stands for "client-oriented, provider-efficient" services, is a process that helps health care staff continuously improve the quality and efficiency of services provided at their facility and make services more responsive to clients'needs. EngenderHealth's various COPE handbooks, toolbooks, and supplementary materials are described below, as well as other useful quality improvement resources. For more information, read our COPE overview.

COPE® Handbook: A Process for Improving Quality in Health Services, Revised Edition
This revised version of COPE®: Client-Oriented, Provider-Efficient Services, described below, incorporates lessons learned over the years in conducting the COPE self-assessment process for improving services and provides more detailed explanation about the process. Using a revised format, this handbook includes generic instructions and tips for conducting a COPE exercise in any health service; the instruments, or "tools," used in specific health services are provided in the toolbooks described below.
(2003) English SM-29; (2006) French SM-29F.
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COPE® for Reproductive Health Services: A Toolbook to Accompany the COPE® Handbook
A supplement to COPE® Handbook: A Process for Improving Quality in Health Services, Revised Edition. Provides updated versions of the self-assessment guides, the client interview guide, and other materials for a range of reproductive health services, including antenatal care, labor and delivery, postpartum and newborn care, postabortion care, family planning, reproductive tract infections (including sexually transmitted infections), HIV and AIDS, gynecological services, men's reproductive health services, sexuality, infertility, and prevention of harmful practices.
(2003) English SM-30 (free); (2006) French SM-30F (free).
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COPE® for Male Circumcision Services: A Toolbook to Accompany the COPE® Handbook
To ensure success in the provision of adult male circumcision (MC) services, health care workers must be extremely sensitive to clients’ rights and needs for informed decision making, confidentiality, privacy, and nonjudgmental counseling. Furthermore, they must have the proper training, support, and supplies to provide services safely, in ways that make their clients feel comfortable. They must also be able to make appropriate referrals for prevention, treatment, care, and support, as necessary. This toolbook, a supplement to the COPE® Handbook (see above), provides updated versions of the self-assessment guides, the client interview guide, and other materials for address the relevant range of topics for providing an integrated package of quality MC services, including HIV counseling and testing, promotion of safe sexual practices, condom demonstration and promotion, and screening for and treatment of sexually transmitted infections. The COPE tools for MC offer a structured approach for assessing the unique considerations inherent in the delivery of MC services, regardless of whether services are provided through a health facility or through mobile outreach teams.
(2011) English.
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COPE® for HIV Care and Treatment Services: A Toolbook to Accompany the COPE® Handbook
This toolbook, a supplement to the COPE® Handbook (see above), provides updated versions of the self-assessment guides, the client interview guide, and other materials for identifying and solving on-site problems that compromise the quality of services designed for HIV care and treatment. The tools address such issues as information, education, informed consent, confidentiality, disclosure of HIV status, clinical management of HIV, antiretroviral treatment, palliative care, counseling on drug adherence, positive prevention, monitoring drug toxicity and viral load, HIV-TB coinfection, referrals to home and community-based care, integration of SRH and HIV services, and community action to reduce stigma and discrimination and increase support for HIV prevention and care services.
(2008) English.
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COPE® for HIV Counseling and Testing Services: A Toolbook to Accompany the COPE® Handbook
This toolbook, a supplement to the COPE® Handbook (see above), provides updated versions of the self-assessment guides, the client interview guide, and other materials for identifying and solving on-site problems that compromise the quality of services designed for HIV counseling and testing. The tools address such issues as information, education, informed consent, disclosure of HIV status, counseling on HIV prevention and care, condom promotion, HIV counseling and testing approaches, laboratory diagnostics, referrals to care and treatment services both at the health facility and in the community, integration of SRH and HIV services, and community action to reduce stigma and discrimination and increase support for HIV prevention and care services.
(2008) English.
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COPE® for Cervical Cancer Prevention Services: A Toolbook to Accompany the COPE® Handbook
A supplement to COPE® Handbook: A Process for Improving Quality in Health Services, Revised Edition. Provides updated versions of the self-assessment guides, the client interview guide, and other materials for identifying and solving on-site problems that compromise the quality of cervical cancer prevention services. Among the cervical cancer-specific issues addressed in the tools are screening tests and examinations, laboratory services, treatment of precancerous lesions, appropriate follow-up and management of clients, referral and feedback between different service components, and equipment and supplies.
(2004) English SM-33. Free / Spanish SM-33S. Free.
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COPE® for Comprehensive Abortion Care: A Toolbook to Accompany the COPE® Handbook
A supplement to COPE® Handbook: A Process for Improving Quality in Health Services, Revised Edition, this toolbook contains COPE tools that have been adapted to address the provision of quality comprehensive abortion care. Comprehensive abortion care builds on global strategy to reduce death and suffering from the complications of unsafe and spontaneous abortion by promoting the five elements of postabortion care: community and provider partnerships for prevention, resource mobilization, and assurance that services meet community needs; counseling to identify and respond to women’s needs and concerns; treatment of incomplete and unsafe abortion and its complications; provision of family planning services, to help women prevent an unwanted pregnancy or practice birth spacing; and reproductive and other health services, preferably provided on-site or via referrals to other facilities.
(2009) English SM-55 (free)
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COPE® for Services to Prevent Mother-to-Child Transmission of HIV: A Toolbook to Accompany the COPE® Handbook
A supplement to COPE® Handbook: A Process for Improving Quality in Health Services, Revised Edition. Provides updated versions of the self-assessment guides, the client interview guide, and other materials for identifying and solving on-site problems that compromise the quality of services designed to prevent mother-to-child transmission of HIV. The tools address such issues as information, education, and counseling on HIV prevention and care, condom promotion, voluntary counseling and testing, family planning services, prevention of transmission using antiretroviral regimens, safe labor and delivery practices, counseling and support for safer infant-feeding practices, and community action to reduce stigma and discrimination and increase support for HIV prevention and care services.
(2003) English SM-034.
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COPE® for Maternal Health Services: A Process and Tools for Improving the Quality of Maternal Health Services
A supplement to COPE® Handbook: A Process for Improving Quality in HealthServices, Revised Edition. Includes all of the instruments needed to conducta COPE exercise, plus tips for facilitating self-assessment activities. Provides tools for addressing antenatal care, routine labor and delivery care, emergency obstetric care (including postabortion care), and postpartum care (immediate and follow-up).
(2001) English MCH-02. $6.50.
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COPE® for Child Health: A Process and Tools for Improving the Quality of Child Health Services (PDF, 2.1MB)
Adapts the process described above in COPE® Handbook: A Process for Improving Quality in HealthServices, Revised Edition, for use in child health services. Includes all of the instruments needed to conduct a COPE exercise, plus tips for facilitating self-assessment activities.
(1999) English MCH-01. $6.50.
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Community COPE® (PDF, 460KB)
A participatory process and set of tools designed to help health care workers build partnerships with community members in order to improve local health services. An extension of COPE® Handbook:A Process for Improving Quality in Health Services, Revised Edition, the handbook provides techniques for eliciting community members' views of and recommendations for service improvement. An EngenderHealth work in progress.
(2002) English SM-23. $6.50.
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COPE® for Child Health in Kenya and Guinea: An Analysis of Service Quality (PDF, 807KB)
Reports on the results of a quasi-experimental study evaluating the introduction and use of the COPE quality improvement process at 16 health facilities offering child health services in Kenya and Guinea. The study demonstrated that the use of COPEresulted in significant improvements in service quality, including improved provider performance, greater client satisfaction with the care received, and increased client knowledge about ways to protect and preserve their children's health.
(2002) English MCH-05. Free.
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Quality Improvement for Emergency Obstetric Care: Leadership Manual and Toolbook
The purpose of this newly revised manual and accompanying toolbook is to assist health care providers working in emergency obstetric care (EmOC) settings to improve the quality of services within their facility. The manual describes a continuous, four-step quality improvement process that is based on participatory principles of staff involvement and ownership and that focuses on clients' rights and needs. The accompanying toolbook contains the information-gathering instruments used as part of the QI process, along with instructions for their use. The revised manual and toolbook are updated versions of the 2001 working drafts Emergency Obstetric Care: Leadership Manual for Improving the Quality of Services and Emergency Obstetric Care: Toolbook for Improving the Quality of Services. Major revisions to the manual include more information about the intended audience, some alternative methods for facilitating the QI process, and an enhanced definition of the "EmOC team." Revisions to the toolbook include simplified questions in the EmOC Assessment and expanded instructions for each tool. Produced by EngenderHealth and the Averting Maternal Death and Disability (AMDD) Program at the Mailman School of Public Health, Columbia University.
(2003) English. Leadership manual: MCH-04M. Free. / Toolbook: MCH-04T. Free. Download this publication:
Leadership Manual: in English (PDF, 525KB), French (PDF, 550KB), and Spanish (PDF, 1MB)
Toolbook: in English (PDF, 1MB), French (PDF, 441KB), and Spanish (PDF, 780KB)

Improving Provider Performance: Results from Guinea and Kenya (PDF, 107 KB)
Compass, 2002, No. 1. Intended broadly for the professional community involved in international public health and development, Compass is a periodic publication featuring snapshots of the results of EngenderHealth's work in the areas of family planning, prevention of HIV and other sexually transmitted infections, and maternal care. This issue reports on how health care providers improved their performance, and their clients were more satisfied with the care they received, when staff at health clinics in Guinea and Kenya were empowered to take initiative through COPE®, EngenderHealth's quality improvement intervention.
(2002) English
AA-COMP02-1. Free.
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Cost Analysis Tool: Simplifying Cost Analysis for Managers and Staff of Health Care Services
A tool health care staff can use to measure the direct costs of providing specific health services. Includes a description of the process, as well as a simple manual and computer worksheets to measure the costs of staff time and supplies used in the provision of a particular service. Results can be used to improve the efficiency of service delivery and to adjust user fees for services. Also includes a diskette for use with Excel.
(2000) English SM-24. $6.
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