| An
Innovative Approach
to Quality of Care Traditionally,
much of the work to improve health services has focused
on the “supply side” of the dynamic relationship
between health care providers and users. Such work has
included provision of supplies and equipment, training,
and the application of facility-based analysis to improve
management. Since the ICPD, many efforts have focused
on the development of client-centered services, including:
- developing
information, education and communication materials,
- improved
counseling
- soliciting
users’ perspectives to improve the delivery of
services.
Over
the past decade, UNFPA has tailored its country programmes
to take account of the experiences fostered by working
with community representatives to better manage health
services. The Bamako Initiative led by UNICEF is perhaps
the best known among these efforts. The continuation
of this work is critical to the success of the Stronger
Voices for Reproductive Health initiative. Recognizing
the importance of the “demand side,” the Stronger
Voices initiative is directed primarily at increasing
the capacity of individuals and groups – especially
women - to demand and obtain quality care. The approach,
characterized as “informed demand”, is two-pronged:
- Raise
awareness of reproductive health needs and rights
among individuals and women’s groups.
- Mobilize
and strengthen the capacity of women’s groups
to exercise their reproductive rights.
Community-based
women’s groups are in a stronger position to negotiate
with local leaders and health care providers for better
reproductive health care, more suitable to their specific
needs and concerns. Through collective strength these
groups are able to actively negotiate with health providers
on standards of quality as well as fees for services.
Bringing
Together Providers and Users Collaboration
– or partnership -- between providers and users
is represented in the diagram above by the intersection
of the circles representing supply and demand. All three
areas – supply, demand and interaction of the two
-- are being taken into consideration by the “Stronger
Voices” initiative. Its specific focus is on strengthening
ways that improve the quality of reproductive health
care. This is accomplished through creating and mobilizing
informed demand among user groups for improved quality,
and strengthening the supply of services to be responsive
to users’ needs and rights. Moreover, bringing
together providers and users in the quality improving
process creates shared ownership, commitment, and sustainability. With
health reform and decentralization underway in many
countries, more innovative and participatory approaches
are needed to ensure that reproductive health issues
receive adequate attention during periods of transition. While
the approach outlined here is applicable to health services
as a whole, this particular initiative focuses on reproductive
and sexual health care, an area that has often received
insufficient attention.
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