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Summary Report on the COPE Approach to Safe Abortion Services in Nepal

The COPE (client-oriented, provider-efficient) approach originated as a quality improvement process for family planning services and was developed by Engender Health, which has been developing and refining the COPE technique and tools since 1988.

COPE is a client-centered approach to performance assessment that helps healthcare staff to improve the quality of services provided by their facility and makes services more responsive to the clients’ needs. Since COPE involves self-assessment, it promotes a sense of ownership among staff. When all levels of staff assess their own services, rather than undergoing an external evaluation, they feel personally responsible for correcting any identified issues with regard to quality or effectiveness. COPE also enables staff to explore opportunities to develop and implement action plans to improve services and fosters a sense of accountability and commitment to carry out these action plans. It also promotes teamwork and cooperation among all levels of staff. COPE utilizes self-assessment checklists and other tools to address the provision of quality comprehensive abortion care. By using the tools together, supervisors and staff become accustomed to working as a team.

Studies have indicated that COPE has been successfully implemented in several countries around the world.1 Since 2013, Ipas Nepal has been implementing this approach in its intervention health facilities across 15 districts, but the effectiveness of COPE in the Nepalese context is yet to be evaluated. The overall purpose of this study was to assess service availability, service site readiness, providers’ support, logistic supply, monitoring and Health Facility Operation Management Committee (HFOMC) support among COPE implemented and non-implemented health facilities. The results of this study will inform any future scaling-up of the approach in Ipas intervention districts and beyond.

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