title: Improving the quality of child health services: participatory action by providers.
abstract: OBJECTIVE
  To test a quality improvement approach called COPE (Client-Oriented, Provider-Efficient services), for use in strengthening health systems and supporting Integrated Management of Child Health (IMCI) efforts.
  
  
  METHODS
  Pre- and post-intervention observations of client/provider interactions, facility audits, staff and client surveys, and focus groups to evaluate differences between eight COPE intervention and eight matched non-intervention facilities after a 15-month intervention in 2001.
  
  
  METHODS
  Primary care clinics in Guinea and Kenya.
  
  
  METHODS
  Health care providers and child caregivers.
  
  
  METHODS
  Over 15 months, the intervention supported four COPE exercises at each intervention site, supported supervisor training in quality management, and organized minimal training in topics selected by site staff as areas where training was needed.
  
  
  METHODS
  Differences in staff's and child caregiver's knowledge, attitudes, and practices; differences in the quality of services provided.
  
  
  RESULTS
  On almost every quality indicator (over 65 indicators), whether reported by staff, observed by evaluators, or reported by clients, the intervention sites performed statistically significantly better than control sites.
  
  
  METHODS
  sites were cleaner and more pleasant, with more respect and information for clients, and more privacy. Staff had better personal communication skills, better diagnostic skills, and prescribing practices and gave better home care instructions to carers. Clients in intervention sites were more informed and more satisfied, and their children had better immunization coverage than those in control sites.
  
  
  CONCLUSIONS
  COPE is a simple process, yet our study confirms that it can have a very dramatic effect on the quality of services. This study demonstrated how all areas of quality can be addressed by empowering health care providers to take action by using COPE. We suggest that COPE can complement Integrated Management of Childhood Illness (IMCI) training and can help to achieve better health for children.
authors.affiliation: EngenderHealth, 440 Ninth Avenue, New York, NY 10001, USA. jbradley@engenderhealth.org
authors.forename: Janet
authors.initials: J
authors.lastname: Bradley
authors.forename: Susan
authors.initials: S
authors.lastname: Igras
mesh_terms: D002648:Child; D002662:Child Health Services / Q000592:standards*; D016701:Guinea; D007722:Health Knowledge, Attitudes, Practice; D006302:Health Services Research; D006801:Humans; D007630:Kenya; D009936:Organizational Innovation; D018802:Patient-Centered Care; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care