COPE® and Community COPE®

Tools for Engaging Communities in Defining and Addressing Quality of Care

What is COPE?

COPE is both a PROCESS and a set of tools designed to support continuous assessment and improvement of health services.

1. Gather and analyze

information

2. Develop & prioritize action

plans

4. Evaluate

3. Implement action plans/ interventions

The COPE Process

What is the focus of COPE?

The COPE methodology focuses on:

Clients’ Rights: • Information• Access• Informed choice• Safe Services• Privacy & confidentiality• Dignity, comfort, & expression

of opinion• Continuity of care

Staff Needs: • Facilitative supervision &

management• Information, training, &

development• Supplies, equipment, &

infrastructure

What are the Goals of COPE and Community COPE?

Facility COPE involves the facility staff and managers* in the process of: – Defining quality– Identifying gaps– Developing and

implementing solutions

Community COPE involves members of the community in the process of– Defining quality and community

needs– Identifying gaps between the

community’s definition of quality and actual performance

– Working with facility staff/managers to implement solutions that meet community needs and preferences

COPE and Community COPE are complementary processes for defining quality, prioritizing problems, and identifying solutions.

* 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?

6. Implement action plan

5. Develop action plan and select COPE Committee

3. Identify & prioritize problems

4. Identify root causes of priority problems

2. Self-assessment

1. Orient site staff & managers

7. Review progress

What Process is Used to Introduce Community COPE?

7. Form a Quality Improvement Committee

6. Prioritize & develop action plan

5. C-COPE assessment activities

(interviews, discussions, site walk-through, participatory mapping)

2. Meet w/ local leaders/groups

1. Orient site staff & managers

9. Monitor & review progress

3. Identify participants/ groups for C-COPE

4. Select & plan C-COPE activities

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.