The strategic approach to improving the quality of care of reproductive health services is a methodologythat countries can use to identify and prioritize their needs for reproductive health policies and programme developments; test appropriate interventions to address priority needs, and then scale up these tested interventions to a regional or national level. The strategic approach is based on a systems framework.

The strategic approach helps us to examine the relationship between people (including their respective reproductive health needs, user perspectives and gender), the service delivery system (including policies, programmes, issues of access, availability, equity and quality of care) and the characteristics of available technologies. It gives us a choice to understand the interactions between these components as well as how they are influenced by the broader social, cultural, political and health resource contexts. It is based on the idea that appropriate decisions concerning policies and programme development should be based on the understanding of these relationships.

The strategic approach operates through three stages:

Stage I - Strategic Assessment
Stage II - Testing Interventions
Stage III - Scaling up and Expansion

Stage I strategic assessments examine users’ needs and perspectives, the available technologies and services and the capacity of the service-delivery system, so as to determine appropriate strategies for improving the quality of care.

It is a participatory strategicassessment designed to assess countries in making decisions about how best to improve the quality of care so as to better the needs of clients within the existing resource constraints. At this stage, it is probably important for us to ask the strategic question: Is there any need to improve the provision of choices that are
available, be it the contraceptive or the methods of abortion? It also allows us to question, like: Is there a need to introduce a new method or reject a method that exists and what actions can be taken to improve choices and quality of care?

Stage II involves action research to design and test optimal models for introducing technologies or services based on recommendations that come out of the strategic assessment. It not only tests the clinical, medical or technical efficacy or efficiency but also deals with a larger context of applying the intervention at the community or the system’s level.

Stage III uses research results and lessons learned in stage II for policy and programme development and its implementation on a broader scale. It also involves the scaling-up of activities and successful interventions.

The strategic approach is a participatory process, calling for a multi-disciplinary perspective and the involvement of stakeholders including policy-makers, programme managers, service-providers, researchers, women’s health advocates, users of services, influential leaders of women, youth and community groups.

Multiple perspectives generate broad-based support and consensus. A country-led team, emphasizing country ownership of the process and the resulting recommendations, implements it. The decision-making is transparent and open. Besides, the participants feel responsible and have the ownership of the process and results. It is more important for us to understand this, as we deliberate upon the methods of medical abortion and its introduction in the health system.

The strategic approach initially was introduced for contraceptive choices but now has been adapted to address several reproductive health issues including STIs/RTIs, HIV/AIDS, maternal and newborn health, adolescent reproductive health, abortion and postabortion care, cervical cancer down-staging and comprehensive reproductive health services.

The advantages of a participatory process are several. Multiple perspectives on an issue generate a broad-based support and consensus. Wide-specturm of viewpoints helps make decision making transparent and open. There is a genuine involvement of stakeholders. So that the barriers to access and definitions of appropriate services can be determined and situations identified. Opinons of community, residents and frontline health workers contribute to understanding barriers for effective service-delivery and defining proper solutions that reflect local priorities and realities. The approach is going to be very useful for medical abortion programme introduction accross the country.