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.

What's NEW

Planning activities are underway in the six pilot countries -- India, Kyrgyzstan, Mauritania, Nepal, Peru and Tanzania.

Launched in 2001, with funding from the United Nations Foundation (UNF), Stronger Voices builds on the respective strengths and experiences of four UN partners: UNFPA, ILO-STEP, WHO and UNICEF.

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