Programs and providers are seeking to offer better care to more people. Increasingly, family planning programs are looking for ways to serve growing numbers of continuing clients and to serve them better, since the quality of services often affects whether people keep using family planning (168). At the same time, programs are looking for ways to appeal to potential new clients, who often are more skeptical and more concerned with the quality of care than clients in the past (154). The quality of care may be the deciding factor for people who want to avoid pregnancy but who feel uncertain about contraception (168).

Further impetus has come from the women's health and primary health care movements, which have championed the rights of clients and rejected earlier approaches to family planning services that set numerical goals (134, 161). The Program of Action of the 1994 International Conference on Population and Development (ICPD) in Cairo called for more attention to the quality of care. It urged a client-centered approach to the delivery of family planning and other reproductive health services (371).

In addition, management theories and methods of quality assurance developed in industry to focus on serving customers better are being applied to health care. Today, health and family planning programs around the world combine conventional approaches to quality control in medicine, such as licensing, standard setting, and accreditation, with the industrial philosophies of Continuous Quality Improvement (CQI) and Total Quality Management (TQM) (50, 294) (see Chapter 2.2, Understanding CQI and TQM).

The quality movement in family planning is young, and its methods are still under development. Even basic definitions have not yet been standardized. The quality movement is broad, diverse, and changing.

There is already sufficient knowledge and experience, however, for providers and managers at every level to improve service quality. Furthermore, it is clear that quality improvements do not have to cost a lot of money. No matter what the level of program resources, quality can always be improved (337). In fact, improving the quality of services is usually cost-effective (see Chapter 1.3, Good Quality Can Cost Less).