Using COPE To Improve Quality of Care: The Experience of the Family Planning Association of Kenya.

COPE (Client-Oriented, Provider-Efficient) methodology, a self-assessment tool that has been used in 35 countries around the world, was used to improve the quality of care in family planning clinics in Kenya. COPE involves a process that legitimately invests power with providers and clinic-level staff. It gives providers more control over their environment, more scope to take initiative, and more authority over logistics such as supplies and key aspects of finances. The COPE technique consists of four main components: self-assessment, client interviews, client flow analysis, and the plan of action. As a result of using COPE, staff and client needs are being met; better training is being provided; teamwork is encouraged; clients are viewed as customers with rights; and the COPE process is being carried up the organizational ladder to improve management throughout the system. Lessons learned in implementing the process include the following: (1) quality improvement cannot be legislated; (2) to achieve real change, management also must be willing to change; (3) staff at all levels are capable of assuming increased levels of responsibility and contributing to the process of change; (4) viewing clients as "customers" and understanding that they have rights serves to reframe the client-provider relationship; (5) improving the quality of services does not have to mean increased costs; and (6) by involving other organizations in the change process, the quality of services can be affected more broadly. (KC)