Increasingly, family planning programs are making quality of care a top priority. Programs and providers are finding more and better ways to satisfy clients' needs and raise the quality of services while using resources more efficiently.

Improving quality offers many benefits. Contraceptive use is safer and more effective. Information and services are more accessible. Clients make informed decisions and are more satisfied. Providers find their work more rewarding. The public has a more positive view of health care and its providers.

Applying the lessons of the quality movement in industry and medicine, programs have created approaches that suit reproductive health care in developing countries. While still in the early stages, these efforts suggest some important principles:

Clients come first. Client-centered care provides what clients everywhere want—respect, understanding, fairness, accurate information, competence, convenience, and results. The best care helps clients achieve their own reproductive goals.

Quality design, quality control, quality improvement—the three sides of the "quality triangle" are equally important:

• Quality design sets objectives, allocates resources, and establishes guidelines to ensure effectiveness and safety, maximize access, and increase clients' satisfaction.
• Quality control monitors program activities and staff performance to ensure that they meet quality objectives.
• Quality improvement seeks to keep raising the level of care—no matter what its current level—often by forming staff teams to solve problems.

Strengthen systems and processes. Thinking of an organization as a network of interdependent systems and processes can help improve quality. Flawed systems and processes often prevent staff members from doing their best. Rather than blaming staff for poor quality, managers can redesign systems to support their efforts. Of course, good quality requires competent staff, adequate supplies, and appropriate facilities. Even without added resources, however, programs can redesign processes, update guidelines, and improve communication with clients. By using resources more efficiently, some quality improvements also save money.

Everyone contributes. Good quality happens when every staff member at every level believes that quality is important and takes responsibility for it. Managers can promote teamwork and communication between units, empower staff to innovate, and reward good-quality work. Front-line providers and supervisors, given the opportunity, can improve processes and increase efficiency. Whether quality improvement efforts start at the top or at the grass roots, ultimately they work best when the entire oganization, including support and management functions, is involved.

Every program can improve quality. No matter what its scale, budget, or cultural setting, every program can take steps toward better quality. Improvements often can be simple and inexpensive, such as hanging a curtain to give clients privacy. Many problems can be solved with existing resources, such as using on-the-job training to improve infection prevention.

Offering good quality of care has always been a goal of family planning programs. Now, worldwide attention to quality is producing new help for programs. An international consortium of experts and agencies including WHO, USAID, and USAID-supported organizations has developed essential consensus on service delivery issues. This guidance helps national programs write science-based guidelines that promote quality and access. Also, technical assistance agencies offer a variety of systematic, on-the-ground approaches to quality improvement tailored to reproductive health care in developing countries.