How does quality of care relate to a right-based approach to family planning programs?

Quality of care has long been a pillar of health care in general and family planning programs in particular. However, the theme has been getting less attention in recent years and its meaning has gotten blurred, confusing the discourse and what it is donors and governments should invest in and monitor. The rationale for increasing and sustaining a focus on quality of care in Family Planning (FP) programs is twofold. It is a desired end in itself, both practically and ethically, as well as a means to other desired outcomes, such as greater continuation rates among satisfied users and more efficient supply systems. But different organizations define the term differently. The concept of quality has gotten conflated with the concept of rights-based. While there is overlap, the concepts are not synonymous. A lack of agreement on definitions and distinguishing characteristics of these two terms leads to insufficient attention to some important program elements. Both concepts are important and call for greater clarity to guide program design, quality assurance and improvement, and appropriate indicators for consistent monitoring and evaluation.

This paper compares definitions of quality and contrasts them with the essentials of a rights-based approach. It aims to create common understanding of what these terms mean, where they overlap and how they differ. The comparative review revealed that quality of care is essentially a supply-side construct that relates to the conditions and actions programs should ensure for their clients during service delivery. It is rooted in evidence-based medical science and focuses on the safety and effectiveness of services. Its orientation is primarily around the health system and service provider competencies and behaviors towards those they serve.

In contrast, a rights-based approach centers on the dignity, needs, and autonomy of individual clients and potential clients. It is about empowering and engaging people to exercise self-determination for their health and fertility, and eliminating policy and program barriers and practices, including all forms of discrimination, which would block anyone from enjoying their rights. While it includes quality of care, a rights-based approach is more an ethical model than a medical one. It is a broader programmatic construct than quality of care, reflecting all components of healthcare systems and programs, including the policy and cultural context in which they operate and both supply and demand. And unlike quality of care, a rights-based approach applies both to those served and those not served. It is characterized by participation, individual agency, and equity – with special attention to marginalized and vulnerable groups—and it stresses program accountability.