The 1994 International Conference on Population and Development (ICPD) set forth the challenge of ensuring, not just that reproductive health services are universally available, but also that they are of adequate quality.
Far from being a luxury, improving quality of care can be a cost-effective means of achieving the ultimate goal of better reproductive and sexual health. If clients are not treated with respect, and if they do not get a high-level of care, they may not use the available services. Or they may have poor outcomes.
Improving quality of care is part of health reform processes that are under way in many countries. But often insufficient attention is given to the specific ways in which quality of care applies to reproductive and sexual health services.
UNFPA has been active for years in all of these areas, largely through providing technicalsupport, equipment and training for health care providers.
Since 1994, services in many countries have been reoriented to improve their quality and better meet clients’ needs and wishes—through a wider choice of contraceptive methods, better follow-up, evidence-based guidelines and protocols (see below) and improved training of staff to provide information and counselling (with an emphasis on sensitivity, privacy, confidentiality and informed choice). Improving services for poor populations is another global priority.
Since ICPD + 5, attention has also focused on consumers as agents of change, as a complement to the support to providers. The idea is to encourage consumers to organize and push for higher quality health services and more participation of women in their management. Efforts to improve quality focus on improving the service environment to meet clients’ needs by involving all levels of staff in identifying problems and suggesting solutions.
Evidence-based guidelines to improve sexual and reproductive health care are being adapted to local contexts, disseminated and put into practice through the WHO/UNFPA Strategic Partnership Programme. Guidelines introduced through the programme address clinical issues related to family planning, maternal and newborn health, and management of sexually transmitted infections.
These guides developed through rounds of consultations with health professionals, consolidate consensus-driven, evidence-based interventions into easy-to-use protocols that can greatly simplify decision-making and improve clinical practice. Through the strategic partnership between UNFPA and WHO, a series of workshops introducing the guidelines have been conducted in six regions involving ministries of health and other partners in some 60 countries.
Based on a careful analysis of the situation and consultation with stakeholders, the guidelines may be translated and adapted so that they will be more appropriate and useful in different national contexts. The process includes careful monitoring and evaluation before the guidelines are widely disseminated and put into practice.
The components of quality reproductive health care are well established. Clients need a choice of contraceptive methods, accurate and complete information, technically competent care, good interaction with providers, continuity of care, and a constellation of related services.
Studies from around the world suggest that clients also want: