Another approach, used by programs in Bolivia, Egypt, Ghana, India, Indonesia, and Kenya, is to improve the public image of service providers along with their skills. By promoting the fact that providers are concerned and competent, a communication campaign can raise public expectations about the quality of care (302). Any communication directed to clients should be linked to training and other efforts that improve the actual quality of care. If the image of a program is better than reality, clients will be disappointed and dissatisfied.

Family planning providers rely on co-workers to furnish and maintain equipment, to make sure that supplies are available, to file records, to provide training and supervision, to refer clients to them and accept referrals from them, and to accomplish many other tasks (92, 113, 344). When co-workers do not meet these needs, providers find it harder to offer good services.

Rather than blaming staff members for a program's shortcomings, supervisors should review and reorganize support systems to facilitate their work (344). For example, managers at Masaka Hospital in Uganda improved primary health care services by supplying providers with uniforms, work schedules, regular supervision, salary supplements raised from client fees, and a reliable flow of supplies (278). Previously, many outpatients waited all day without being treated, in large part because of poorly motivated, poorly supervised, and underpaid providers. The new system eliminated long delays, and both patients and staff expressed greater satisfaction. The utilization of outpatient services had increased by 47% after six months.

For staff members, job satisfaction and performance often depend on expectations. When staff members expect everyone to work together for better quality, they can prompt co-workers to improve (344). For example, a quality improvement team at a Costa Rican health clinic initially raised staff expectations by improving the flow of medical records. As momentum grew, everyone became involved. For example, laboratory workers began helping in the reception area during busy morning hours (119).