Adopting a client-centered approach often requires a shift in attitudes. Even while trying to deliver good-quality services, most service providers and other staff members have assumed that they, as health care experts, know what is best for clients. An orientation to the client recognizes that clients' concerns and preferences also are valid and important.

A client orientation also provides a new perspective on program management. The wants and needs of program staff members, too, must be met if they are to be motivated and to provide good care consistently. Thus front-line providers and their supervisors can be considered, in management terminology, "internal clients."

In client-centered health care, clients are considered first and foremost at every point in the planning, implementation, and evaluation of service delivery (99). Clients are the experts on their own personal circumstances and wants (262, 372). Program staff gather information from clients to design and offer appropriate services (344). Client preferences guide every aspect of service delivery, from clinic hours to counseling techniques to contraceptive decision-making (19, 113,151).

At the same time, client-centered health care continues to value providers' expertise. Providers possess the specialized knowledge and skills to help clients make informed choices, to ensure clients' safety, and to maintain the technical quality of care. For example, clients should choose their own contraceptive method, based on their childbearing plans, personal situation, and individual preferences—but only after a provider has informed them about the range of methods available, discussed the pros and cons of the client's preferred method, and screened them according to medical eligibility criteria (189).