One of the first quality improvement processes used by USAID to help reproductive health service providers in clinics and hospitals improve the quality of their services and make better use of resources was COPE, which stands for "client-oriented, provider-efficient" services. COPE was developed in 1988 by AVSC International (now EngenderHealth). It is a process that helps health care staff continuously improve the quality and efficiency of services provided at their facility and make services more responsive to clients' needs.

COPE provides staff with practical, easy-to-use tools to identify problems and develop solutions using local resources, and it encourages all levels of staff and supervisors to work together as a team and to involve clients in assessing services. Through COPE, staff develop a customer focus, learning to define quality in concrete terms by putting themselves in their clients' shoes. The process also enables staff to explore the strengths of their work site.

The COPE approach uses an experienced COPE facilitator to work with the participating facility’s staff to carry out COPE. A trained facilitator at the site level is a requirement of the approach to help lead and support COPE exercises. Ideally, an external COPE facilitator works with the site facilitator during the first COPE exercise at the site.

COPE uses the same quality management principles as many other improvement approaches: focusing on meeting and exceeding clients’ expectations and needs and identifying problems in the way things are done (the process) rather than on assigning blame to individual providers. COPE uses a self-assessment process to help site managers and staff identify barriers to quality and ways those barriers can be overcome. COPE self-assessment guides are organized around the rights of the client and the needs of the provider to ensure quality services. Other tools used in COPE include client interviews, client flow analysis, and action planning. The COPE process facilitates reflection and action on ways in which all staff in a facility can improve efficiency and orient services toward meeting client needs with available resources.

EngenderHealth has published and makes available on its web site a series of COPE manuals covering the basic approach and tools to facilitate its application to specific types of health services, including reproductive health, HIV care and treatment, HIV counseling and testing, cervical cancer prevention, prevention of mother-to-child transmission of HIV, maternal health, and child health. The basic COPE approach is described in COPE® Handbook: A Process for Improving Quality in Health Services (revised edition, 2003). EngenderHealth has also adapted the COPE approach for application at the community level through a participatory process and set of tools designed to help health care workers build partnerships with community members in order to improve local health services.

• COPE® Self-Assessment Process
• COPE® for Child Health in Kenya and Guinea: An Analysis of Service Quality