Abstract
BACKGROUND: Promoting client-centered care (CCC) has been a long-standing goal for sexual and reproductive health (SRH) programs. MSI Reproductive Choices (MSI), a global SRH service delivery organization, set out to fully operationalize CCC delivery utilizing a new strategic framework and measurement approach. DEVELOPMENT OF THE APPROACH: The framework was developed by a global technical group at MSI, based on a literature review, country pilots in Nepal and Zambia, and practical experience in service delivery and quality improvement. It is based on a socioecological model, recognizing that SRH client experience is determined by the behavior of the provider, the managerial support given to providers, and the broader organizational culture. The accompanying composite CCC metric assesses performance across these 3 levels annually using program monitoring tools. A digital results dashboard links to a suite of guidance and tools to support CCC improvement. LESSONS LEARNED: SRH programs in 28 countries have been monitoring their progress on CCC since 2021, and a majority have made improvements in their CCC performance since then. Using the annual CCC results, global support staff and country managers have selected interventions based on local needs, including CCC training, client feedback systems, and client experience checklists. Implementation of a global staff engagement survey has been instrumental in CCC measurement, complementing preexisting client exit interview and quality audit processes. A global CCC monitoring process allows sharing of successes and positive practice, and staff have supported and championed CCC. CONCLUSION: Recognizing the critical influences of provider support and engagement as well as broader organizational culture has been pivotal in scaled operationalization of CCC within SRH programs. The simple framework and accompanying metric can be adapted to fit available tools and data systems in other institutions to support attainment of the highest standards of quality care and respect for client rights.