This Quality Assurance Project aimed to design and test a feasible, valid and useful tool for measuring and acting upon client satisfaction data at the district level in Niger, West Africa. The research involves focus groups with a representative sample of clients in order to define the quality dimensions associated with the structured data collection tools. This project proposes to expand the knowledge base of the health services literature by providing more details as to the relevant dimensions of client satisfaction in the developing world. Several determinants are thought to be connected with client satisfaction and these include sociodemographic factors, physical and psychological status and attitudes and expectations concerning medical care. Findings indicate that communities are assertive receivers of health care as they judge the worth of medical service provided through the Ministry of Health clinics. However, poor attitudes of staff and unavailability of drugs at the clinic dispensary were predictors of client dissatisfaction, and distance from the health center seemed to be a clear confounder in analyzing satisfaction across clients. Meanwhile, there were differences between facilities, as 65% of clients across the facilities that were studied stated that they were satisfied.