COPE® for Child Health: A Process and Tools for Improving the Quality of Child Health Services
Purpose:
To help health care staff to assess and improve the quality of child health services.
Description:
COPE for Child Health is a process and a set of simple and practical tools designed to assess and improve quality of child health services. The process encourages self-assessment and joint problem solving by service staff and supervisors.
The manual contains the following chapters to guide users through the COPE process. Services covered in the manual include antenatal care, postpartum and neonatal care, sick young infant visit (age1 week to 2 months), sick young child visit (age 2 months to 5 years), growth monitoring, infection prevention, immunization and well childcare.
Chapter 1 provides an overview of how quality may be understood
Chapter 2 describes how to initiate the first COPE exercise. (The first COPE exercise is often done with the assistance of an external facilitator, or with a supervisor within the system who has been trained in facilitating COPE. The facilitator works with supervisors and staff to assess the services they provide. Staffs also interview clients. Based upon the problems identified, they develop an action plan containing problems and causes, suggested solutions, persons responsible for taking action, and the timeframe for solving the problems.)
Chapters 3-8 provide instructions for organizing the first COPE meeting and using the self-assessment tools. These tools include:
Chapter 9 offers suggestions for continuing COPE and describes how using COPE can improve a site over time.
Intended users:
The manual is designed to be used jointly by all levels of clinic or hospital staff and their supervisors and managers who provide child health services.
Developed by:
EngenderHealth (formerly AVSC International), who developed the COPE methodology for family planning services with partners in Kenya beginning in 1989. The adaptation of COPE for Child Health Services began in 1997, in collaboration with UNICEF in Kenya, and technical input from WHO, BASICS, the SARA Project and financial support from the Africa Bureau of USAID and USAID-REDSO/ESA. The implementation of the tools was done in collaboration with UNICEF and the Ministries of Health of Kenya and Guinea.
Application:
The manual was applied in Kenya and Guinea in the institutional settings (rural and peri-urban health centers). A study shows that the application of this tool has had marked improvement in service quality, providers’ attitudes and behavior, and client satisfaction at the intervention sites as compared to the control sites. Providers in the intervention sites were observed performing more thorough assessments of children, maintaining better privacy and demonstrating greater respect for clients during counseling, and were more likely to discuss family planning, child growth, general health and nutrition. Clients at intervention sites were significantly more likely to report having received information on a range of health topics, and were more likely to report being “very satisfied” overall with their visit, and that services ‘were better than before.”
Advantages:
COPE is a simple to use, easy to understand, and cost-effective tool for managers who aim to involve staff and create ownership in the quality improvement process. The COPE process encourages a customer mindset among staff who begins to assess and improve the services they provide on a continuous basis. COPE promotes teamwork and cost-consciousness, and provides steps in how to institutionalize a process of continuous improvement.
Limitations:
The manual does not suggest priorities in addressing the shortcomings identified. The process is focused on making the best use of the individual facility’s resources, but cannot resolve problems that require system-wide change or vast resources. It also requires a great deal of time and strong commitment from the staff and on the part of the institutions and site managers to improve the quality of the health facilities because quality improvement is an ongoing process.
Facilitative Supervision
Managers and supervisors play a critical role in involving and motivating staff to create ownership and commitment to quality improvement. In addition to relying on the COPE process and tools, EngenderHealth has developed a handbook for managers to assist them in implementing quality improvement at their sites. Aiming to improve quality, facilitative supervision focuses on meeting the needs of health care staff, thus enable them to provide quality services to clients.
The Facilitative Supervision Handbook is available from EngenderHealth.
Recommendations for users:
Recommended for use in facilities or programs where managers and staff are committed to improving the quality of child health services. Also, it is recommended to combine Integrated Management of Childhood Illness (IMCI) training and supervision support with the introduction of COPE for Child Health to enable improvements in these practices.
Reports and Publications:
Bradley, J., S. Igras, A. Shire, M. Diallo, E. Matwale, F. Fofana, A. Camara, F. Sawe and J. Becker. “COPE for Child Health in Kenya and Guinea: An Analysis of Service Quality.” EngenderHealth, New York. August 2002. A report of the results from the two-year evaluation EngenderHealth. Compass. “Improving Provider Performance: Results from Guinea and Kenya.” 2002, No. 1.
Mielke, E., Bradley, J and J. Becker. “Improving Maternal and Child Health Services through COPE” QA Brief, Winter 2001, Vol. 9, No. 2. Provides a review of experience and tools for COPE for Maternal Health Services and COPE for Child Health Services.
In addition, there are several articles and publications about the COPE process and tools, and its applications to Family Planning and Child Health Services. In all of these applications, the COPE process remains the same:
AVSC International. Working Paper number 1, COPE: A Self-Assessment Technique for Family Planning Services (April 1991). Describes the self-assessment process and earliest experiences in Kenya and Nigeria.
AVSC International. Working Paper number 2, The Use of Self-Assessment in Improving the Quality of Family Planning Clinic Operations: The Experience with COPE in Africa (December 1992). Describes follow up evaluation of COPE in 11 African Clinics.
Beattie, K, Dr. A.J. Faisel, M. Ahmed and Dr. B.A. Pati. “Introducing COPE in Asia: A Quality Management Tool for FP Services in Bangladesh” Innovations Vol.1: 16-29, 1994.
Bradley, J., J. Bruce, S. Diaz, C. Huezo, K. Mworia. “Using COPE to Improve Quality of Care: The Experience of the Family Planning Association of Kenya” Quality/ Calidad/Qualité No. 9, Population Council, 1998. Describes the introduction and rollout of COPE in FPAK clinics, results of the process, and lessons learned.
Lynam, P, L. McNeil Rabinovitz and M. Shobowale. “Using Self-assessment to Improve the Quality of Family Planning Clinic Services” Studies in Family Planning (1993) Vol 24, 4: 252-260.
Lynam, P., T. Smith and J. Dwyer. “Client Flow Analysis: A Practical Management Technique for Outpatient Clinic Settings” International Journal for Quality in Health Care (1994) Vol. 6, No. 2: 179-186.
Mielke, E., K. Beattie. “COPE: A Process and Tools for Healthcare” QA Brief, Spring 2001, Vol.9, No. 1. Provides a brief overview of COPE process, purpose, results and new adaptations of the materials.
Availability:
English
Contact:
Erin Mielke
Quality Improvement Program Manager
EngenderHealth
440 Ninth Avenue
New York, NY 10001
To help health care staff to assess and improve the quality of child health services.
Description:
COPE for Child Health is a process and a set of simple and practical tools designed to assess and improve quality of child health services. The process encourages self-assessment and joint problem solving by service staff and supervisors.
The manual contains the following chapters to guide users through the COPE process. Services covered in the manual include antenatal care, postpartum and neonatal care, sick young infant visit (age1 week to 2 months), sick young child visit (age 2 months to 5 years), growth monitoring, infection prevention, immunization and well childcare.
Chapter 1 provides an overview of how quality may be understood
Chapter 2 describes how to initiate the first COPE exercise. (The first COPE exercise is often done with the assistance of an external facilitator, or with a supervisor within the system who has been trained in facilitating COPE. The facilitator works with supervisors and staff to assess the services they provide. Staffs also interview clients. Based upon the problems identified, they develop an action plan containing problems and causes, suggested solutions, persons responsible for taking action, and the timeframe for solving the problems.)
Chapters 3-8 provide instructions for organizing the first COPE meeting and using the self-assessment tools. These tools include:
- Self-Assessment Guides. 10 self-assessment forms. 7 forms on getting information about client rights, and 3 forms on staff needs.
- 1 form for Client Interviews
- 1 form/ template for Client Flow Analysis
- 1 checklist for the Integrated Management of Childhood Illness (IMCI) Record Review
- 1 template for action plan.
Chapter 9 offers suggestions for continuing COPE and describes how using COPE can improve a site over time.
Intended users:
The manual is designed to be used jointly by all levels of clinic or hospital staff and their supervisors and managers who provide child health services.
Developed by:
EngenderHealth (formerly AVSC International), who developed the COPE methodology for family planning services with partners in Kenya beginning in 1989. The adaptation of COPE for Child Health Services began in 1997, in collaboration with UNICEF in Kenya, and technical input from WHO, BASICS, the SARA Project and financial support from the Africa Bureau of USAID and USAID-REDSO/ESA. The implementation of the tools was done in collaboration with UNICEF and the Ministries of Health of Kenya and Guinea.
Application:
The manual was applied in Kenya and Guinea in the institutional settings (rural and peri-urban health centers). A study shows that the application of this tool has had marked improvement in service quality, providers’ attitudes and behavior, and client satisfaction at the intervention sites as compared to the control sites. Providers in the intervention sites were observed performing more thorough assessments of children, maintaining better privacy and demonstrating greater respect for clients during counseling, and were more likely to discuss family planning, child growth, general health and nutrition. Clients at intervention sites were significantly more likely to report having received information on a range of health topics, and were more likely to report being “very satisfied” overall with their visit, and that services ‘were better than before.”
Advantages:
COPE is a simple to use, easy to understand, and cost-effective tool for managers who aim to involve staff and create ownership in the quality improvement process. The COPE process encourages a customer mindset among staff who begins to assess and improve the services they provide on a continuous basis. COPE promotes teamwork and cost-consciousness, and provides steps in how to institutionalize a process of continuous improvement.
Limitations:
The manual does not suggest priorities in addressing the shortcomings identified. The process is focused on making the best use of the individual facility’s resources, but cannot resolve problems that require system-wide change or vast resources. It also requires a great deal of time and strong commitment from the staff and on the part of the institutions and site managers to improve the quality of the health facilities because quality improvement is an ongoing process.
Facilitative Supervision
Managers and supervisors play a critical role in involving and motivating staff to create ownership and commitment to quality improvement. In addition to relying on the COPE process and tools, EngenderHealth has developed a handbook for managers to assist them in implementing quality improvement at their sites. Aiming to improve quality, facilitative supervision focuses on meeting the needs of health care staff, thus enable them to provide quality services to clients.
The Facilitative Supervision Handbook is available from EngenderHealth.
Recommendations for users:
Recommended for use in facilities or programs where managers and staff are committed to improving the quality of child health services. Also, it is recommended to combine Integrated Management of Childhood Illness (IMCI) training and supervision support with the introduction of COPE for Child Health to enable improvements in these practices.
Reports and Publications:
Bradley, J., S. Igras, A. Shire, M. Diallo, E. Matwale, F. Fofana, A. Camara, F. Sawe and J. Becker. “COPE for Child Health in Kenya and Guinea: An Analysis of Service Quality.” EngenderHealth, New York. August 2002. A report of the results from the two-year evaluation EngenderHealth. Compass. “Improving Provider Performance: Results from Guinea and Kenya.” 2002, No. 1.
Mielke, E., Bradley, J and J. Becker. “Improving Maternal and Child Health Services through COPE” QA Brief, Winter 2001, Vol. 9, No. 2. Provides a review of experience and tools for COPE for Maternal Health Services and COPE for Child Health Services.
In addition, there are several articles and publications about the COPE process and tools, and its applications to Family Planning and Child Health Services. In all of these applications, the COPE process remains the same:
AVSC International. Working Paper number 1, COPE: A Self-Assessment Technique for Family Planning Services (April 1991). Describes the self-assessment process and earliest experiences in Kenya and Nigeria.
AVSC International. Working Paper number 2, The Use of Self-Assessment in Improving the Quality of Family Planning Clinic Operations: The Experience with COPE in Africa (December 1992). Describes follow up evaluation of COPE in 11 African Clinics.
Beattie, K, Dr. A.J. Faisel, M. Ahmed and Dr. B.A. Pati. “Introducing COPE in Asia: A Quality Management Tool for FP Services in Bangladesh” Innovations Vol.1: 16-29, 1994.
Bradley, J., J. Bruce, S. Diaz, C. Huezo, K. Mworia. “Using COPE to Improve Quality of Care: The Experience of the Family Planning Association of Kenya” Quality/ Calidad/Qualité No. 9, Population Council, 1998. Describes the introduction and rollout of COPE in FPAK clinics, results of the process, and lessons learned.
Lynam, P, L. McNeil Rabinovitz and M. Shobowale. “Using Self-assessment to Improve the Quality of Family Planning Clinic Services” Studies in Family Planning (1993) Vol 24, 4: 252-260.
Lynam, P., T. Smith and J. Dwyer. “Client Flow Analysis: A Practical Management Technique for Outpatient Clinic Settings” International Journal for Quality in Health Care (1994) Vol. 6, No. 2: 179-186.
Mielke, E., K. Beattie. “COPE: A Process and Tools for Healthcare” QA Brief, Spring 2001, Vol.9, No. 1. Provides a brief overview of COPE process, purpose, results and new adaptations of the materials.
Availability:
English
Contact:
Erin Mielke
Quality Improvement Program Manager
EngenderHealth
440 Ninth Avenue
New York, NY 10001