New Perspectives on Quality of Care : No

focus of a family planning and reproductive health program. But can programs afford it? There is no simple answer. The multiple dimensions of quality of care make it more difficult to identify and measure affordable improvements in service delivery. Calculating program costs is challenging, and different methods of determining costs can lead to widely varying estimates (Janowitz and Bratt 1992). The critical elements of a quality service may vary from program to program— and from one perspective to another. Determining how much quality costs is a challenge, but it is both possible and important for programs’ sustainability. There are few studies that quantify the cost and cost effectiveness of providing high-quality reproductive health care. This brief focuses on various aspects of costs and examines information about the cost of improving quality (as opposed to the cost of quality of care in general), then outlines some ways to improve quality while containing costs. Quality, access, and cost are interrelated program elements, and a change in one element affects the others. Given their finite resources, programs may face difficult choices as they attempt to find the appropriate balance. Ideally, decisions about quality should be the result of a dialogue among key stakeholders: policymakers, providers, and clients. Each program has to decide what standard of quality is appropriate to apply considering its situation, its resources, and the needs and perceptions of the population it is meant to serve. This policy brief, part of the New Perspectives on Quality of Care series, uses the framework developed by the U.S. Agency for International Development’s Maximizing Access and Quality (MAQ) initiative. Why Invest in Quality? Quality has many dimensions. From an ethical standpoint, program managers need to satisfy clients’ rights to obtain competent, compassionate, high-quality care. Perceptions of quality can be subjective. Clients tend to value the appearance of the service setting, privacy, respectful treatment, and convenience, while providers emphasize facility environment, program infrastructure, and workload (Bruce 1990; Jain 1989; Khan et al. 1999; see also the other briefs in this series). Quality services have many benefits. Improvements in quality can save money for both programs and clients, and quality services may attract more clients while reinforcing programs’ efficiency and sustainability. Moreover, providing appropriate levels of quality can prevent the longer-term—often hidden—costs associated with poor care. For example, a client who receives inadequate counseling may not use contraceptives correctly and may experience an Improving the Quality of Reproductive Health Care: How Much Does It Cost? P o p u l a t i o n C o u n c i l a n d P o p u l a t i o n R e f e r e n c e B u r e a u