QUALITY OF SRH CARE This is a sample Knowledge Asset primarily intended to assist UNFPA staff and partners in the following: (1) to share knowledge and experiences on how to address quality of care issues in policy dialogues and UNFPA programming; (2) to provide examples of what has been done in quality of care by different UNFPA colleagues and partners; and (3) to network with other UNFPA colleagues and practitioners with similar interests. This knowledge asset has been developed by a UNFPA Knowledge Network for Quality of RH Care and is guided by the principles of the ICPD Programme of Action and its Five-Year Review. Many of the network members have been engaged in the UNFPA interregional Quality of Care project, "Stronger Voices for Reproductive Health". UNFPA also partners with ILO-STEP, UNICEF, and WHO on this project. If you would like to find out more about the asset or network, please send an email to: QoCknowledge@unfpa.org This is a sample knowledge asset on how to incorporate quality of care issues in your country programme. UNFPA staff and programme partners Knowledge for Saving Women's Lives Please enter keyword Quality of Sexual and Reproductive Health (SRH) Care Defining Quality of Care Learn about the key concepts for Quality of Care programming What is meant by "quality of care"? Quality of Sexual and Reproductive Health (SRH) Care refers to the provision of SRH services, technologies, and information that are safe, effective, affordable, and responsive to users’ needs and reproductive rights. A primary goal of providing quality services is to enable users to make informed decisions that contribute to and enhance their reproductive health so they can lead healthier, more productive lives. Strengthening the “supply” of and “demand” for services is a way for governments to follow up on their commitments to ICPD, especially the goal of universal access to reproductive health services by 2015. What is UNFPA's approach to quality of care? Far from being a luxury, quality of care is about meeting the ICPD and ICPD+5 goals of ensuring not only that reproductive health services are universally accessible by 2015, but that they are of adequate quality to meet the reproductive health needs of individuals and couples. Better quality means a more effective health system to deal not only with RH but also other areas of health. UNFPA has been very active in supporting governments and their partners in improving the quality of reproductive health care in their countries. UNFPA's approach to quality of care is two-pronged by strengthening both the "demand" and "supply" of services. UNFPA provides support to strengthen the "supply" of services through: Ensuring a secure supply and choice of quality contraceptives and other reproductive health commodities to meet every person’s reproductive health needs “at the right time and the right place” Purchasing essential equipment and supporting infrastructure improvements at health facilities Providing technical support to RH programme planners on how to improve their service delivery and logistics systems Training health care providers in technical, interpersonal, and counseling skills UNFPA works to increase users’ “demand” for quality services through: Creating awareness among communities about the importance of reproductive health and their right to quality reproductive health services Supporting women’s empowerment and organizing mobilization campaigns to highlight the responsibilities of the health system to promote informed choice Building the capacity of organized community groups to participate in public forums or local health councils to advocate for quality of care in the health facilities they use UNFPA strengthens partnerships and builds alliances to promote quality of care through: Engagement in policy dialogues about reproductive health and quality services Working with governments, donors, civil society, and multilateral organizations to influence decision-making and resource allocations Bringing together users, health care providers, and local officials at the decentralized level to dialogue and carry out actions to make services work for people What are the basic elements of quality of care that I should know? Good quality of care requires: Geographical, socio-cultural, and financial access for users Offering choice among a range of methods and services to users Providing counseling and information that addresses users' wants, needs, and rights Technically competent service delivery Respectful interpersonal relations between providers and users Follow-up of users and/or mechanisms that encourage continuity Links to other appropriate services Grounding all activities in the context of ensuring reproductive rights Involving communities in having a say in how RH care is delivered Addressing quality of care therefore can encompass many dimensions : Meeting minimal standards of excellence Technical aspects (i.e., technical training, safety, proper apsesis, clinical protocols) Non-technical aspects (i.e., clients' waiting times, staff's attitudes, providers' responsiveness to clients' needs/wants, communication skills) Programmatic and administrative elements (i.e., policies, infrastructure, access, supervision, management, logistics) Public health aspects (i.e., offering the greatest health benefit with the least health risks to the greatest number of people with available resources, such as having the ability to produce an impact on maternal morbidity and mortality, on STI rates, on HIV iincidents) Reproductive rights (i.e., the right of all couples and individuals to decide freely andresponsibly the number, spacing, and timing of their children and to have the information and means to do so). Policy Learn how to integrate Quality of Care in national policy dialogues and strategy development. What are the main elements of Quality of SRH Care that should be included in national policies? The Framework for the Rights of Clients and Needs of Staff below (adapted from IPPF and EngenderHealth) provides a useful starting point on the main elements of Quality of SRH Care that should be included in national policies: THE RIGHTS OF THE CLIENTS: Information; Access to services; Informed choice; Safe services; Privacy and Confidentiality; Dignity, Comfort and expression of opinion; Continuity of care THE NEEDS OF STAFF: Facilitative supervision and good management; Information, training and development; Supplies, equipment and infrastructure --- Besides the above-mentioned framework, components of quality of care should be based on the comprehensive reproductive health strategy adopted and priorities set down by the government of the respective country. The following components may be included: **Clearly defined SRH programme priorities and standards of service at each level of service delivery in respect to the following components: family planning, safe motherhood, neonatal care, RTI/STI/HIV/AIDS prevention, adolescent reproductive health, infertility, and post-abortion care. **A comprehensive framework for addressing reproductive rights, women's empowerment, male involvement, community participation, and gender violence. **A plan that integrates RH with primary care services **A strategic plan by the Ministry of Health or an interagency body on the organizational and management structure, implementation strategies, financing mechanisms, and resource allocations for the national SRH policy. In all entry points possible, it is critical that UNFPA presents the case for Quality of SRH Care as a concrete strategy for ensuring universal access to SRH by 2015. This is a way for governments to follow through on their responsibility of ensuring reproductive rights as agreed in ICPD. How can UNFPA incorporate quality of SRH care aspects into national development frameworks such as SWAPS and PRSPs? How can UNFPA influence and ensure that Quality SRH care is a substantive aspect of the CCA/UNDAF? 1) UNFPA should seek access to the discussion forum where decisions are being made related to CCA and SWAPS, and in particular, look for opportunities to chair some of the working groups set up in the context of SWAPS/PRSPs, especially those related to health. 2) As part of a strategic approach, the UN (including UNFPA) should try to ensure that the CCA is an integral part of the situational analysis for SWAPS and PRSP. However, if there already exists a similar nationally led situational analysis, the UN should adopt it to the extent possible. Such was the case in Tanzania, where the UN system agreed to fully support and participate in the analytical phase of the Tanzanian Assistance Strategy (TAS), rather than pursuing a parallel UN led process. This also provided opportunities for the UN to influence the process. 3) As part of the CCA, the terms of reference (TOR's) should specifically reflect the need for a thorough analysis of the current reproductive health status, including maternal and adolescent health and underlying factors that influence RH status, one of which will be poor quality of SRH services. At this point UNFPA would have to be part of the policy dialogue and to argue for such inclusion by presenting clearly the linkage between poor RH status and developmental objectives such as poverty reduction. 4) As part of ensuring sustainable development and national security, development frameworks should feature the rights based approach as one of the guiding principles for support and here a clear comparative advantage of the UN. Thus the situational analysis will aim at reflecting on the infringement of basic human rights and the related implications to development. In this context, Reproductive Rights will be addressed and particularly on the extent to which its infringement contributes to poor RH outcomes and promotes gender inequality. This arguments needs to be well articulated by UNFPA. 5) Using data, UNFPA needs to provide evidence at the policy level on how improved Quality of SRH Care will address sectoral objectives including the promotion of gender equity. This could be presented through best practices or any other innovative approach from within or other countries with similar developmental challenges, or by supporting a process that will generate this information. This is a convincing approach that will ensure that improved quality of SRH care is being prioritized at the national level. What could be UNFPA's role in advocating for Quality SRH Care with the government? 1) UNFPA needs to provide the evidence that improved Quality of SRH Care will contribute to sectoral objectives. 2) UNFPA needs to identify partners especially the civil society who are experienced in promoting quality RH services, and build their capacity to lobby for inclusion of quality SRH care as part of the agenda at various entry points. 3) Mobilize resources for ensuring support for quality of SRH services. 4) In consultation with key partners, generate a country specific analytical framework that underscores systemic, socio-cultural and external factors that contribute to the poor quality of SRH care and propose strategies for addressing this. The proposed strategies could be then costed for more precise advocacy. For the case of Tanzania, UNFPA advocated in the National Quality of Health Care Framework the inclusion of a right-based approach as means of improving quality. 5) UNFPA needs to advocate at Government level through different National forums and civil societies activists on promoting RH rights and gender equality as means of improving RH outcomes. Is there a national SRH policy/strategy that addresses Quality of Care? The answer to this question can be different for individual countries. In the context of Nepal, there is a National Reproductive Health Strategy (HMG/MOH, 1998). It was developed with UNFPA support for the 4th Country Programme. It is a comprehensive document reflecting the government’s commitment to integrated RH package, strengthening programme management, advocacy and IEC strategies. The strategy does not address QOC SRH specifically. However, there exists a QOC unit in the FHD/DoHS/MoH, which addresses National standard for QoC in FP. As stated in National RH strategy document, “Reproductive Health is not a new concept, but it is only a new approach”. Hence it seeks to strengthen the existing Safe Motherhood and neonatal health, Family Planning, HIV/AIDS, STD, Infertility and Nutritional Programs from a holistic life cycle approach. At the same time “gender perspective and empowerment of women will be built into all relevant program areas”(HMG/N19988: 4) Additionally, the document set RH targets to be achieved by 2001 as well as program Package on RH services with a range of choices to be delivered at different levels of family/decision makers, community sub-health posts, health posts and primary health care centers and district hospitals (HMG/N, 1998:8) This RH strategy also fits within the context of the 1991 National Health Policy as well as the 1997-2017 Second Long Term Health Plan. Against the above background, the following strategies have been adopted for the effective and efficient provision of quality of RH services: *Implement the “Integrated Health Package” at hospital, PHC Center, Health Post and Sub Health Posts as well as through Primary Health Care Outreach, TBAs ,FCHVs/MothersGroups and other community family level activities based on standard clinical protocols and operational guidelines; *Enhance functional integration of RH activities carried out by different divisions; *Emphasize advocacy for the concept of RH including the creation of an enabling environment for inter and intra–sectoral collaboration; *Review and develop IEC materials to support all levels of intervention including rumour-countering messages; *Ensure effective management systems by strengthening and revitalizing existing committees at various levels; *Develop a national RH research strategy, which outlines research priorities and work plans based on information requirements of policy makers, planners, mangers and service providers; *Construct/upgrade appropriate service delivery and training facilities at the National, Regional, District and Health Post level; *Institutional strengthening through structured Planning, Monitoring/Supervision and Performance Review; *Develop an appropriate RH programme for adolescents; *Support for national experts/consultants; and Promote inter-sectoral and multi-sectoral coordination. What is an example in which UNFPA incorporated Demand aspects of Quality of Care in policy and strategy development? In Nepal, the Stronger Voices for Reproductive Health Project (led by UNFPA in partnership with ILO-STEP, UNICEF, and WHO) has recently spearheaded the development of a National Quality of Care Strategy for Reproductive Health in response to a request by the Ministry of Health. Please see the <a href="../resources/KS Policy_Nepal QoC Strategy Process.doc"> attached</a> for the brief context, the steps taken, lessons learned from the process, and who you can network with for further information. Analysis Learn how to conduct needs assessments for Quality of Care programming What tools should I use to determine users' perspectives on quality of care? The following are suggested tools / methods that can be used to determine users' perspectives on quality of care: Client exit interview Client perspectives can be determined by conducting an interview with them as they leave the service delivery point to assess how they feel about the services they received. The interview can be an informal conversation, or a more formal questionnaire such as an client satisfaction survey. Focus Group Discussions Focus groups are a qualitative research technique used to gain in-depth, but not representative, understanding of attitudes, beliefs and perceptions of a specific group of people. Focus groups on a planned topic led by a facilitator may be used to assess client expectations and/or level of satisfaction, or attitudes toward RH issues. They are an especially effective method for generating discussion among participants and between them and the facilitator about sensitive issues (i.e. quality of care, reproductive rights, reproductive health) and issues difficult to address through other quantitative methods such as surveys. Mystery Client Technique This technique involves training individuals to visit family planning clinics as “clients” to observe services provided from the client’s perspective. Suggestion boxes Suggestion boxes allow clients to voice their opinions on services in an anonymous manner, and on a continual basis. However, drawbacks relate to whether users are not accustomed to being asked for feedback, or whether they are able to write. How do I explore reproductive rights from both the users' and providers' perspectives? Reproductive rights can be explored both in the community (with users and non-users) and at the service delivery level. Conducting focus groups is an effective way to generate discussions on these issues with community members, women's groups and leaders. At the service delivery level, reproductive rights can be explored by interviews with providers and clients and through consultation observations and the clinic flow/operation in general. It is critical to assess whether providers take into consideration the broader context of women's lives, and recognize how gender inequalities and barriers affect information, choices, and access to services. Programme Planning Learn how to plan a Quality of Care programme based on needs assessments Who are the main stakeholders to involve in planning and implementing a Quality of Care project? Possible stakeholders to include: Government, usually Ministry of Health and the relevant ministries overseeing women's affairs, children, or social affairs Beneficiaries from the community (e.g., women, men, young people, local leaders, religious leaders, etc.) Health care providers and programme planners Multilateral and bilateral partners NGOs and groups from civil society (e.g., women's groups, advocacy groups, micro-credit groups, youth groups, faith-based organizations, etc.) Private sector representatives if relevant What QoC strategies that focus on the demand side should I consider in planning a project? Demand-oriented strategies need to go beyond traditional service delivery approaches and cut across different disciplines such as gender, reproductive rights, RH services, and women's empowerment. Different strategies have been tried, including the following: **Gender-based strategies for Quality of Care that include explicit gender-specific components and activities in operational plans, such as in-service training for clinic staff on RH/rights/gender; engaging men in participatory workshops to support SRH programmes; and capacity building such as women's empowerment projects (livelihoods)that link with services. Use of gender-specific indicators in operational plans, such as IPPF's Manual to Evaluate Quality of Care from a Gender Perspective, is also useful [see tools for manual reference]. **Strategies that involve community mobilization for reproductive health and build bridges between communities and providers are part and parcel for creating users' demand for Quality. The Puentes project in Peru demonstrated that participatory workshops for providers and communities can be conducted to reach common understanding of Quality of Care and that lead to increased service utilization. **Strategies that involve building women's capacity so women can become powerful agents in changing the status quo and their relationship with health services. Building women's economic power and leadership capacity through savings/credit clubs helps increase their control over their lives and their sense of agency. Women's groups can play an important role in creating safe spaces for women to discuss SRH concerns and the role of services. **Strategies that focus on rights awareness and building expectations of good quality could encourage users to insist on good quality from the health system. Participatory approaches, mass media communications strategies and community events can help create an environment where communities should expect good quality SRH services as their right. How do I select sites for my project? For the Stronger Voices for RH project in Peru, every effort was made to ensure the different project sites were representative of the country's geographic diversity: the coast, mountain, and jungle regions. One site per region was selected in consultation with the Ministry of Health, the UN Partners, and other key stakeholders such as NGOs. Criteria for finalizing the sites were: current experiences in community mobilization, the presence and motivation of young people to participate in the project, and the presence of other development initiatives on which to build and network. Other criteria could be for epidemiological reasons, such as poor RH outcomes. How do I develop a logframe for a QoC project that focuses on "demand"? By analyzing the project concept and from needs assessment findings at the community level, interventions to be undertaken are identified by stakeholders. For the Stronger Voices for RH project in Tanzania, this is done through consultative stakeholders workshop and meetings. Following that, indicators are developed in relation to the expected outputs. The UNFPA Tanzania team and MOH partners then reviewed the proposed outputs, indicators and activities. Since this is a community based (demand-oriented) project, indicators that are realistically achievable and measurable were selected to be included in the <a href="../resources/Tanzania Sample Planning Logframe.doc"> log frame</a>. Funding Learn how to mobilize resources to support your Quality of Care programme efforts Are there any regional UNFPA and other international programmes covering Quality of SRH Care? At least half of UNFPA's activities are under RH and advocacy, as well as WHO, UNICEF and other donor agencies' RH interventions could be considered as aiming at QOC improvement. Depending on the region, several international organizations and their programmes cover QOC (Breton Wood Institutions, USAID, DFID, Swiss CB, and etc. in Kyrgyzstan). On a global scale, UNFPA, in partnership with ILO-STEP, UNICEF, and WHO, is leading an interregional initiative, "Stronger Voices for Reproductive Health", to support partnerships to improve QoC especially from the demand side. This interregional initiative has involved Kyrgyzstan,India, Mauritania, Nepal, Peru, and Tanzania. Funding for this project was provided by theUnited Nations Foundation (UNF) based in Washington, D.C., under their Women andPopulation Framework. How do I find out about which donors support Quality of RH Care activities in the country? Attending donor group meetings in the Ministry of Foreign Affairs, Ministry in Charge (of concerned divisions), and Programme Planning Division is a good way to find out about donors' programming and funding priorities. In-country donors' webpages are another source, including interviews with international agencies and government officials in charge. For the Stronger Voices for RH project in Kyrgyzstan, we organized a workshop in September 2003 to bring together the different donors and organizations working in the field of social mobilization and health to share experiences and consider joint activities. Subsequently, after different follow-up meetings with the international agencies and localfoundations, we were able to leverage additional funds (including parallel funds fromUNICEF and from the Social Welfare Fund of the Kyrgyz first lady) for the project. What are possible points for collaboration in Quality of Care that UNFPA should emphasize with other donors at global, regional, and country levels? Mutual points to emphasize with donors to leverage resources and strengthen alliances for Quality of RH Care include: **Enhanced partnerships **Mutual synergies to avoid duplication/overlap **Cummulative effect of funds for all involved **Broader and more systematic impact **Commonly determined strategies and policies **Mutual satisfaction for both donors and recipients/beneficiaries **Improved partnerships at all levels **Collaboration to repair/address global misconceptions on RH/FP Contact UNFPA's Resource Mobilization Branch, UN and non-UN agencies on the field to complement suggestions above. How to ensure that funding for quality of care is incorporated into the government's national health programmes? Through advocacy efforts presenting evaluation/assessment reports, better practices from other countries. Participation in the health reform-related meetings to raise the importance of QoC, and close collaboration with the World Bank, WHO, and other major players involved in health reform or support MoH are also necessary. Preparing a joint action plan among donors for QoC efforts is another strategy. Programme Implementation Learn how to ensure successful implementation for your Quality of Care programme How do I operationalize a demand-oriented model on Quality of Care? What are the main steps to implement one at the community level? The Stronger Voices for RH project in Tanzania (led by UNFPA in partnership with ILO-STEP, is an example on how to operationalize a demand model for Quality of Care. This implementation plan is based on an extensive needs assessment and a planning process where consensus has been reached with the government about testing a demand model, which is a relatively new approach to Quality of Care. The approach is well supported by a wide group of stakeholders[1] in Tanzania in light of current health decentralization efforts emphasizing local capacity building and community participation. The following are the key steps being implemented at the project sites (community level): **Sensitize the beneficiaries about the project, including its conceptual approach and the main activities being considered. In Tanzania, this step builds on ongoing participatory planning efforts that involved relevant stakeholders (at both national, district, and community levels) in the project’s needs assessments, consultations, and workshops. This consultative process highlighted the need to work with not only women, but also men (partners) and young people. **Consider the use of participatory learning action (PLA)methods for working at the community level. Such methods are particularly appropriate to ensuring locally defined actions and solutions to addressing community concerns (see examples below). In the context of the Tanzania Stronger Voices project, PLA activities are conducted with organized community groups to address RH, rights, gender and quality of care issues. **Identify key implementing partners to facilitate the PLA activities with the communities. In Tanzania, we carried out a systematic assessment of the potential implementing partners’ capacity for the project. With technical assistance provided by the Women’s Health Project in South Africa, the assessment looked at the potential partners’ skills in RH rights, community mobilization, use of PLA methods, staffing and other resource requirements, and partnership experiences working with different government sectors. **Collaborate with the implementing partners on the PLA module with the communities and strengthen mechanisms to promote joint interaction between the community and health system. Built into the PLA curriculum are joint meetings[2] that serve as a mechanism at the community level in order to build communication and promote interaction between the three main stakeholder groups on the above issues. **Work out a joint plan of action by the stakeholder groups (community groups and providers) on the necessary steps to improve quality of RH care at the facilities serving the community. The joint action plan will be linked to the existing format of ward plans, which are usually submitted to the district level for support. **Develop a routine monitoring plan whereby the community groups and providers can monitor progress made on the joint action plan and communicate on areas that require strengthening. **Implement follow-activities so as to enable eachstakeholder group to carry out the joint action plan. The goal is capacity building to continue joint work to achieve quality of RH care. **Promote and publicize the initiative and increase awareness for quality of care improvements through this rights-basedapproach. [1] In Tanzania, this included the Ministry of Health, the President’s Office, NGOs, community level beneficiaries, and the UN coalition partners. [2]Utilizing routine district council meetings for such joint meetings will be a strategy to further integrate the project approach within existing community structures/community life. District council meetings could also serve as a forum for monitoring the joint plan of action by community groups, providers, and local district officials. What might be the potential challenges and main barriers I should expect in implementing a Quality of Care project? How can I avoid them if possible? Some potential challenges can include: How to facilitate acceptance among the beneficiaries of ideas proposed by a third party? How to facilitate agreement among different stakeholders? How to mix various activities? How to adapt processes to different realities (maintaining flexibility)? How to adjust time constraints in order to complete the intervention? How to get resources in case of a unexpected necessity? Main Barriers: Not knowing the project's scope may cause a lack of acceptance by the people. Resistance towards change. How can I avoid them if possible? Have a permanent information system Establish statements on project objectives, strategies, expected results, and benefits Recommendations: For successful implementation, three principles are needed: flexibility, empowerment of people so they can recognize the value of the intervention, and community participation. There must be fluid communication among all the actors. "Do not come with a recipe to implement; reach consensus among all actors involved." Gathering the target population needs through the "Autodiagnosis" method (a participatory approach) has proven to be anexcellent method to approach people's needs and give them the skills to handle SRHissues. The person coordinating activities must have leadership skills. Monitoring & Evaluation Learn steps to systematically monitor and evaluate your Quality of Care programme for impact What are guidelines/good standards for monitoring? Good monitoring requires a focus on results and follow-up. It should answer, "What is progressing well?", and "what is not progressing?". Reports should document findings, recommendations undertaken, and any necessary follow-up action. Good monitoring requires: **Good design which shows the relationships between outcomes, outputs, and activities. Regular site visits to verify progress. **Stakeholder meetings can also be organized to assess progress toward achieving the project goals. **Regular analysis of reports. **Participatory monitoring mechanisms to ensure commitment, ownership, follow-up and feedback on performance. How to elaborate a monitoring framework? The planning of monitoring and evaluation activities should occur at the initial phase of program planning. Planning for monitoring and evaluation should occur simultaneously, since evaluation is an important monitoring tool, and monitoring is an important input to evaluation. The monitoring plan should answer the following questions: WHY: the purpose of the evaluations, including who will use the evaluation findings and how; WHAT: the main concerns and questions to be addressed; the nature of the outcome/and or activities and outputs contributing to the outcome; the necessary information to assess the outcome; the elements are most important to monitor; indicators of progress or success HOW: the data sources and collection methods to be used in the evaluations WHO: will undertake the evaluation: what expertise is necessary? Which evaluations should project stakeholders undertake (an internal evaluation)? Which evaluations should be conducted with the assistance of external consultants? What should be the extent of stakeholder involvement? WHEN: the frequency and timing of each evaluation so that their results in each case or in combination can be used to make important programme related decisions RESOURCES: the budget required to implement the monitoring plan. What would need to be done to plan for baseline activities as part of the evaluation component of a Quality of SRH Care project? Conducting a baseline is a critical stage for a project's evaluation process, as it provides benchmark data to help establish whether changes in the different domains of interest might be attributed to the project after is is completed. In order words, a baseline, as part of evaluation, is helpful to show whether a project "worked". Hence, the following steps for planning baseline activities should occur at the planning stage before project implementation: **Define project goal, objectives and indicators (process and outcome) in a detailed log frame. **Undertake participatory planning of the baseline activities with relevant stakeholders (Government - central and local councils, NGOs, Community groups, UN partners) to define target groups, sampling design, study design and tools to be used. **Identify and obtain technical advice from competent Research institutes in-country and if possible, internationally. **Analyze the context (social-cultural, political, administrative, economic) in which the baseline activities will be undertaken. Good Practices & Tools Learn about what has worked in other Quality of Care programmes What tools are available for Quality of RH Care programming? A number of tools and manuals exist for developing all aspects of programme development for Quality of Care--from analysis and planning to monitoring/evaluation. Please see the <a href="../resources/QoCTools_lastdraft.doc"> attached reference</a> for examples of possible tools and how to obtain them. What is an example of a good practice that raised women's awareness about reproductive health, rights, and the importance of RH services in their lives? In Peru, one of the project countries involved in the UNFPA-led "Stronger Voices for RH" project, the USAID-supported Reprosalud project has demonstrated the power of participatory processes and community mobilization that has led to increased knowledge about RH, rights, and the importance of health services. This rights-based project used “autodiagnosticos” that consisted of games and group exercises designed to help women analyze their lives, identify their priority RH needs, and reflect on how services can meettheir needs. Consequently, with increased knowledge and sense of agency, thewomen mobilized at the community level to advocate for their RH/rights and improvedquality of care from health care providers. Please see the <a href="../resources/ReproSalud case study.doc"> attached </a>for a brief description of this project and how it can be adapted for your project needs. Title of resources Please enter resource description here http://www.un.org Fundamental Elements of Quality of Care: A Simple Framework Bruce, J. (1990). “Fundamental Elements of Quality of Care: A Simple Framework.” Studies in Family Planning 23 (6): 61-91. Quality of Care in Family Planning: Clients’ Rights and Providers’ Needs Huezo, C. and Diaz, S. (1993). “Quality of Care in Family Planning: Clients’ Rights and Providers’ Needs, Advances in Contraception (9) 129-139. The Importance of Quality in Family Practice Dominguez, J. (2000). “The Importance of Quality in Family Practice.” ArchMedFam 3(1): 19-26. The WHO Strategic Approach to Improving Quality of Care of Reproductive Health Services http://www.who.int/reproductive-health/strategic_approach/index.htm Making Decisions about Contraceptive Introduction: A Guide for Conducting Assessments to Broaden Contraceptive Choice and Improve Quality of Care. World Health Organization (2002). “Making Decisions about Contraceptive Introduction: A Guide for Conducting Assessments to Broaden Contraceptive Choice and Improve Quality of Care.” http://www.who.int/reproductive-health/publications/rhr_02_11_contraceptive_introduction/c i-guide.pdf If Many Push Together, It Can Be Done: Reproductive Health and Women’s Savings and Credit in Nepal. Arens, T., Caudill, D., Gautam, S., Haberland, N. and Nakarmi, G. 2002. “If Many Push Together, It Can Be Done: Reproductive Health and Women’s Savings and Credit in Nepal.” Responding to Cairo: Case Studies of Changing Practice in Reproductive Health and Family Planning. Ed. Nicole Haberland and Diana Measham. New York: Population Council. 395-414. Monitoring and Evaluation for Results: A Handbook United Nations Development Programme (n.d.). "Monitoring and Evaluation for Results: A Handbook." The Programme Manager's Monitoring and Evaluation Toolkit United Nations Population Fund Office of Oversight and Evaluation. 2000. “The Programme Manager's Monitoring and Evaluation Toolkit.” December 2000. ReproSalud: Feminism Meets USAID in Peru. Rogow, D. and S. Wood. “ReproSalud: Feminism Meets USAID in Peru.” In Responding to Cairo: Case studies of changing practice in reproductive health and family planning. Eds. N. Haberland and D. Measham. New York: Population Council, 2002 QoC Tools ../resources/QoCTools_lastdraft.doc Nepal QoC National Strategy Process ../resources/KS Policy_Nepal QoC Strategy Process.doc Tanzania Sample Logframe ../resources/Tanzania Sample Planning Logframe.doc ReproSalud Case Study ../resources/ReproSalud case study.doc Stepping Stones http://www.steppingstonesfeedback.org