COPE® and Community COPE®

Tools for Engaging Communities in

Defining and Addressing Quality of Care
What is COPE?

The COPE Process

COPE is both a
PROCESS and a set of
tools designed to
support continuous 4. Evaluate
1. Gather and
analyze
assessment and information

improvement of health
services.

3. Implement 2. Develop &

action plans/ prioritize action
interventions plans
What is the focus of COPE?

The COPE methodology focuses on:

Clients’ Rights: Staff Needs:

• Information • Facilitative supervision &
• Access management
• Informed choice • Information, training, &
development
• Safe Services
• Supplies, equipment, &
• Privacy & confidentiality infrastructure
• Dignity, comfort, & expression
of opinion
• Continuity of care
What are the Goals of COPE and Community COPE?

COPE and Community COPE are complementary processes for

defining quality, prioritizing problems, and identifying solutions.

Facility COPE involves the Community COPE involves members

facility staff and managers* in of the community in the process of
the process of: – Defining quality and community
– Defining quality needs
– Identifying gaps – Identifying gaps between the
– Developing and community’s definition of quality and
implementing solutions actual performance
– Working with facility staff/managers
to implement solutions that meet
community needs and preferences

* Managers can include community members serving on a facility’s management committee

Why Conduct Facility COPE?

• COPE involves the staff themselves in evaluating the

quality of the services they provide, from the perspective
of both clients’ rights and staff needs.
• Creates “ownership” of service delivery problems among
those best positioned to resolve them.
• Focuses attention on root causes of identified problems.
• Encourages staff to identify simple, low-cost, sustainable
solutions they can implement themselves, without outside
help.
How Can COPE Help Engage Communities in Health?

In settings where community representatives serve on a health

facility’s management committee or board, involving committee
members in the facility COPE process can help:

• Develop and strengthen analytical and problem-solving

skills among community members serving on the committee
• Increase knowledge about health issues and clients’ rights
among influential community leaders/resource persons
• Increase awareness about health providers’ commitment to
quality service delivery
• Sensitize community members about challenges and gaps
facing health facility staff
• Facilitate the mobilization of community support and
resources to address identified gaps
Why Conduct Community COPE?

Community COPE complements facility COPE. At sites where

COPE is being used, involving community-based groups in
Community COPE can help:

• Explore community preferences and priorities more deeply

than can be achieved through client exit interviews in COPE.
• Build partnerships between facility staff and community
members to improve local health services.
• Make health services more responsive to community needs
and priorities.
• Increase community “ownership” of health facilities and
services.
• Foster community-based advocates for a health facility, its
staff, and the services provided.
What are the COPE tools?
Facility COPE tools include:
• 11 self assessment guides
focused on each of the clients’
rights and staff needs
• Client interview guides that
explore quality of care issues
from clients’ perspectives
• Client flow analysis to assess
clients’ waiting time and
consultation time
• Record reviews to review
services provided to clients
• Action plan format
Community COPE tools include:
• Values clarification exercises to
help facility staff appreciate value of
involving community in exploring
quality of care
• Guide for discussions with local
leaders
• Participatory tools for exploring
community perspectives
– Individual interview guide
– Group discussion guide
– Site walk-through guide,
– Participatory mapping
• Action plan format
What Process is Used to Introduce Facility COPE?

1. Orient site staff &

managers

2. Self-assessment 3. Identify & prioritize 4. Identify root causes of

problems priority problems

7. Review progress 5. Develop action plan and

select COPE Committee

6. Implement action
plan
What Process is Used to Introduce Community COPE?

1. Orient site staff & 2. Meet w/ local 3. Identify participants/

managers leaders/groups groups for C-COPE

5. C-COPE 4. Select & plan C-

assessment activities COPE activities
(interviews, discussions, site walk-
through, participatory mapping)

6. Prioritize &
develop action plan

9. Monitor & review 7. Form a Quality

progress Improvement Committee

8. Implement action
plan
EngenderHealth Experience Using Community COPE

• Kenya (Mission Hospital). Interviews, group discussions, and community

meetings identified key concerns/priorities:
– Access (waiting time, distance)
– Client-provider interaction (unfriendly staff)
– Safety (inadequate cleanliness, rats in mortuary)
– Privacy (crowded/co-ed wards, insufficient screens)
• Solutions identified and implemented through Community COPE
– Shorten waiting time
– Increase specialized services
– Outreach services
– Improve staff attentiveness and friendliness
– Clarify charges
– Address blood shortage
– Improve cleanliness
– Clean and renovate mortuary
– Screens and curtains for privacy
EH Experience Using Community COPE (2)

• Senegal - 6 Health Centers. Health facility staff worked with community leaders
and groups, using interviews, group discussion, mapping, and community
meetings to explore perspectives of clients and non-clients.
• Problems identified:
– Access (waiting time, distance)
– Client-provider interaction (unfriendly staff)
– Safety (inadequate cleanliness)
– Privacy & confidentiality (crowded/co-ed wards, inadequate screens)
– Comfort
– Lack of supplies
• Solutions implemented
– Rearranged clinics’ set-ups
– Improved staff attentiveness and friendliness
– Improved cleanliness
– Installed screens and curtains for privacy
– Identified accessible locations for new health posts through mapping
Outcomes of Community COPE

• Improved information sharing and understanding between health staff and

communities
– Staff learned expectations of community
- Staff recognized need to maintain privacy on wards, even when hospital
is crowded
– Community learned about charges for services
• Increased motivation and commitment to do more to improve quality
– Process of soliciting community perspectives and participation
reinforced facility COPE self-assessment process
– “We now own the hospital” - community member
• Increased awareness and appreciation of knowledge and skills gaps
– Health staff learned that community members wanted more information
on family planning
• Improved coordination and organization of services
– Services within the facility better organized
– Outreach services better coordinated with other community events and
outreach services
Lessons Learned through Community COPE

• The “community” is not a uniform group. Comprised of diverse

groups with different needs
• Participatory community assessment activities (interviews, group
discussions, meetings, mapping) revealed more information than
client interviews in COPE exercises ─ but methodologies have
strengths and challenges.
• Community involvement is more than soliciting the community
perspectives on the services. Including community members in
the action planning process is key.