• Summary
• Credits

1. Understanding the Concept
2. Evidence-Based Practices
3. Adaptability
4. Links with Other Services
5. Minimizing Paperwork
6. Physical Factors
7. Service Hours and Scheduling
8. Client Flow
9. Division of Labor and Job Design
10. Social Factors
11. Implementing the Concept
12. Bibliography

• INFO Project
• Order
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• POPLINE

This issue was prepared in collaboration with the Maximizing Access and Quality (MAQ) Initiative of the United States Agency for International Development's Office of Population and Reproductive Health. The MAQ Initiative supports research and evidence-based interventions to promote access and quality of reproductive health and family planning services.

Published by the INFO Project, Center for Communication Programs, The Johns Hopkins University Bloomberg School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA.

Health care organizations today face many challenges—among them the HIV/AIDS epidemic, rapid social change, shortages of staff and funding, and change within health care service delivery itself, such as decentralization. Moreover, organizations and health care providers and managers must adopt a range of approaches customized to the different needs and changing situations of different clients. Regularly consulting with clients, community leaders, policy-makers, and other key program stakeholders can help programs focus on meeting the greatest current needs.

Modify approaches as needed. Organizations need to prepare themselves for the many changes unfolding in health care to better address their clients’ range of needs. To do so, they must be willing and ready to change the way they deliver services. For instance, maternity clinics in many countries must now consider how to deal with mother-to-child transmission of HIV. Also, family planning providers must alter counseling to include discussion of dual protection.

The need to make services available to people in more remote areas poses its own difficulties. Yet with foresight and adaptability programs can organize work to make services accessible and convenient. In Acarape, Brazil, for instance, the health center changed service hours to accommodate clients coming from rural areas. Staff from the center also worked with the mayor to change transportation schedules to better meet rural clients’ needs (64).

Plan for common fluctuations in health care delivery. Every health care organization faces variation in client demand, stocks of supplies, staff availability, and other factors that affect service delivery. In fact, such changes in conditions are often the norm. Managers and providers need to expect these common events and establish procedures to deal with them. For instance, family planning programs can create back-up plans to deal with crises in service delivery, such as stock-outs in contraceptive supplies. Clinics can borrow supplies from another service delivery point or place emergency orders with a local pharmacy. In Moldova two district health centers swapped supplies to avoid wasting contraceptives whose labeled expiration date was approaching (52). Even when programs have strong supply chains, mechanisms for coping with stock-outs can assure continuity.

Organizations also must cope with both temporary and permanent loss of staff members. In such situations workloads can be reorganized and specific tasks reassigned to other personnel to deliver uninterrupted care. One way to ensure that other health personnel can fill in when a primary service provider is unavailable is to train teams, rather than individuals—part of an approach known as whole-site training (14). The people trained can then become responsible for sharing their knowledge and skills and for training others. Also, developing plans for hiring back-up personnel quickly can ease shortages.

Seek help in making changes. Organizations should ask clients and other key program constituents—that is, stakeholders—for their opinions and suggestions about how to make changes (61). A variety of stakeholders can help, including board members, community leaders, partner organizations, policy-makers, and donors.

Clients and other stakeholders can generate ideas and build consensus about changes, increasing acceptance and reducing resistance (72). Stakeholders are more likely to be committed to new program activities if they are consulted in the beginning and involved throughout the planning process. By providing advice and expressing their interests, stakeholders can claim ownership of and investment in improved services.

Clients and other stakeholders can provide feedback, both individually and from the community, through such techniques as exit interviews, follow-up interviews, focus-group discussions, suggestion boxes, and community meetings (55, 96, 122) (see box right). Community participation empowers community members to solve problems and ensures that clients’ needs determine improvements (29, 65).

Disclaimer: The information provided on this web site is not official U.S. Government information and does not represent the views or positions of the U.S. Agency for International Development or the U.S. Government.