Community COPE®: Building Partnership with the Community to Improve Health Services
Community COPE is intended to assist supervisors and staff at service delivery sites to gather information from the community about the services the facility provides. The process identifies site strengths and weakness and also involves community members in addressing the weaknesses identified. Community COPE provides strategies to encourage the community to participate in and take ownership of quality-improvement efforts both at the site and community levels. Community COPE is an extension of COPE, which stands for Client-Oriented, Provider-Efficient services.
The Community COPE manual provides a step-by-step explanation of the participatory process including meeting with local leaders, identifying community groups to work with, preparing and conducting participatory activities, developing and prioritizing the action plan, reviewing membership of the site’s quality improvement committee, and implementing the action plan.
The appendices include specific tools to carry out each step. These include values clarification exercises for providers, a guide for discussions with local leaders, facilitation tips, individual interviews for current/ former/ and potential clients of health services, group discussion guides by topic, a site walk-through checklist, and guides for participatory mapping by topic.
The tool is intended for use at the local level. However, as a number of useful techniques are described, it could be adapted for use at a regional or central level where client input on health services is desired.
Community COPE is developed by EngenderHealth. The process and tools were first developed and piloted in Kenya in 1998 and were field-tested in Tanzania, Senegal, Dominican Republic, and Mongolia. The handbook was published in 2002
In Kenya, several district and mission hospitals and a health center applied the tool. In Tanzania and the Dominican Republic, rural and urban NGO clinics used the tool. In Senegal, six sites in two districts applied the tool, and in Mongolia, a provincial MOH hospital used the tool. Reports from all these sites that have used the tool indicate a wide range of solutions to local service problems. Community support (labor, financial, and in-kind) for local facilities increased, and communication between local communities and their health care providers improved.
Community COPE is a user-friendly tool that contains a number of examples to guide the users through the process. It provides not only a systematic process to obtain community input into service provision and quality management, but also a process to encourage community ownership of solutions.
Specific advantages of using Community COPE include:
- Site staff learn why some community members do not seek services, do not gain access to services, or stop using services.
- Provides another way to learn clients’ views about the services
- Helps the site provide more relevant, accessible services
- Builds trust between clients and site staff
- Makes services more sustainable
- Promotes empowerment, increased awareness and behavior change in the community.
- Ensures ongoing, two-way communication between the site and the community
- Makes work more interesting and satisfying for health care workers.
As with any quality improvement effort, this process takes time and commitment.
Recommendations for users:
When selecting the types of groups to work with in the community, it is essential to have the health facility’s goals in mind in terms of reaching groups of different gender, age range, neighborhood, language group, etc. Particularly when addressing sensitive health issues, it is important to focus activities with specific subgroups rather than large mixed groups of people. In addition, allowing the community members and clinic staff to define their own roles and commitment levels is critical to ensuring sustainability and reasonable expectations for all involved.
Dohlie, MB, E. Mielke, T. Bwire, D. Adriance, F. Mumba "COPE, a Model for Building Community Partnerships That Improve Care in East Africa" Journal for Healthcare Quality, Vol 22, No.5. September/October 2000.
PRIME II/EngenderHealth (Program Profile July 2002) “Consumer Driven Quality in ADOPLAFAM’S Centro Diagnóstico, Santo Domingo, Dominican Republic”
EngenderHealth (Program Profile July 2002) “Community COPE in Senegal: Strengthening Partnerships Between Providers and Community Members”
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Quality Improvement Program Manager
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