Press Release

For Immediate Release December 31, 1998

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Hopkins Report: Clients Come First Assures Quality in Reproductive Health Care

Systematic attention to improving quality and putting clients first are winning strategies for developing-country reproductive health programs, according to a new report from the Johns Hopkins School of Public Health. Every program can do something to improve quality, no matter what its resources or its current level of quality, says the report.

"Programs and providers are finding more and better ways to satisfy clients' needs and raise the quality of services while using resources more efficiently," according to Adrienne J. Kols, M.A., and Jill E. Sherman, M.P.H., authors of the Population Reports issue, published by the Johns Hopkins Population Information Program.

Adopting the clients' perspective is key to better quality, according to the authors. This means respecting clients' wishes, responding to their concerns, and assuring clients' right to make informed choices. Studies around the world find that virtually all family planning clients want respect, understanding, complete and accurate information, technical competence, convenient services, fairness, and, of course, results.

Designing programs to meet clients' needs and adopting quality assurance methods borrowed from modern management practice benefits both clients and providers. For family planning clients, the advantages are more choices of contraceptive methods, clearer understanding of their choices, more effective and safer care, and more responsive service providers. For programs, the benefits include more satisfied clients, a better public reputation, greater efficiency, and wider coverage of the population.

At the same time, maintaining and improving technical quality of care is crucial, the report states. Under the auspices of the US Agency for International Development (USAID) and the World Health Organization (WHO), experts have essentially reached international consensus on contraceptive eligibility criteria and important aspects of family planning service delivery. This international expert guidance helps family planning programs draft or update service delivery guidelines that help to ensure safe and effective care and avoid medically unnecessary procedures.

The Hopkins report counters the assumption that better quality has to cost more. Many programs are finding that greater efficiency solves quality problems and also frees resources to serve more clients. For example, a Costa Rican clinic ended the shortage of gynecological experts by training general practitioners and nurses to handle routine prenatal and family planning visits. In Uganda one hospital drew 47% more outpatients after staff members on a quality improvement team improved patient flow, worker motivation, supervision, and availability of supplies.

Egypt's Gold Star program is one of the largest family planning quality-assurance efforts in a developing country. Over 1,000 public clinics have been upgraded and their staffs, retrained. Each quarter of the year, inspectors rate each clinic on 101 quality indicators. Clinics that meet all 101 criteria for two quarters in a row can display a gold star as an emblem of quality. At the same time, the Egypt program's mass-media messages encourage the public to seek out good quality and insist on it where they see the gold star. "Behind every door are friends and kin to serve you and care for the needs of your family," says one campaign slogan. More and more clinics are winning gold stars; trends suggest that by the end of 1998 as many as half of all 3,800 Ministry of Health and Population clinics will have earned Gold Star status.

The Hopkins report details how quality assurance approaches, adapted from modern management approaches such as Total Quality Management (TQM) and Continuous Quality Improvement (CQI), are helping family planning and other primary health care programs systematically assure quality. These approaches work best when staff at all levels and throughout an organization are involved and when clients' views are taken into account.

These quality assurance approaches focus on systems and processes. "Rather than blaming the staff for poor quality," write the researchers, "managers can redesign processes so staff members can do their best."

Population Reports is an international review journal of important issues in population, family planning, and related health matters. It is published four times a year in four languages by the Population Information Program at the Johns Hopkins Center for Communication Programs for more than 170,000 family planning and other health professionals worldwide, with support from the US Agency for International Development (USAID). USAID administers the US foreign assistance program, providing economic and humanitarian assistance in more than 80 countries worldwide.

For more information contact: Stephen Goldstein at Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA. Tel: 410 659-6300; Fax: 410 659-6266; E-mail PopRepts@jhuccp.org. A full-text version of Improving Quality can be found at JHU/CCP's web site: http://www.jhuccp.org/.

Disclaimer: The information provided on this web site is not official U.S. Government information and does not represent the views or positions of the U.S. Agency for International Development or the U.S. Government.