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QUEST: Quality Upheld, Every Service, Every Time

QUEST is designed to strengthen the capacity of advocates to assess and monitor the quality of sexual and reproductive health policies and programs to make the case for the prioritization of quality and rights.

PAI’s Quality Upheld, Every Service, Every Time (QUEST) project analyzes national contexts and global trends relating to quality and rights. While interest in expanding access to sexual and reproductive health is on the rise, policymakers often do not place adequate emphasis on the quality of care delivered and the rights of everyone — including women and girls — receiving that care. QUEST is designed to examine the role of the health system, governance, gender inequity and pervasive social norms, among other factors that restrict rights and the provision of quality sexual and reproductive health information, services and supplies.

Findings in five countries demonstrate challenges and opportunities for accessing and delivering quality sexual and reproductive health care that fulfills rights.


Democratic Republic of the Congo, Ethiopia, India, Myanmar, Pakistan

As duty-bearers, governments have a responsibility to respect, protect and fulfill the sexual and reproductive health and rights of their citizens — including the provision of high-quality services and care. Quality of care is a multifaceted approach that adheres to high standards. These standards include, but are not limited to:

  • Access to and choice of contraceptive methods;
  • Clear and medically accurate information, including the risks and benefits of a range of methods;
  • Availability of equipped providers who are technically and culturally competent; and
  • A client-provider interaction that respects informed choice, privacy and confidentiality, as well as client preferences and needs.

PAI works with partners to analyze the gaps, opportunities and challenges of providing high-quality, rights-based sexual and reproductive health care at the national and subnational levels. Unlike many of the other examinations of quality at the client and provider levels, QUEST takes a unique approach by examining barriers and opportunities to improved quality and rights at the health systems, policy and governance levels. While rarely integrated into considerations of quality at the client-provider level, issues in macro-level systems can have a profound effect on an individual’s ability to exercise their rights and receive high-quality sexual and reproductive health care.

There’s a taboo around sexuality of young people. They are seen to be asexual until they are married. And there are not enough resources to respond to their health needs.
Francoise Mukuku, director of youth advocacy, Si Jeunesse Savait (SJS)

Common themes emerging from PAI partner QUEST findings

  • Delivery of quality health services is dependent on a functional and coordinated government at the national and subnational levels.
  • The absence of an open, constructive relationship between government and civil society inhibits the ability of the health system to deliver quality services that meet community needs. It also impedes the government and health system from being held accountable for ensuring reproductive health and rights.
  • The gap between written policies and implementation and the lack of harmonization among legal and policy systems hinder the provision of high-quality services. Existing policies and laws governing health services and rights are difficult to reverse or override with new frameworks.
  • Commodity stockouts, inadequately trained health care staff and unethical practices negatively impact the quality of care and rights.
  • The best efforts of legal, regulatory and policy frameworks to address quality and rights are easily overridden by values and social norms.
  • Youth and unmarried women are disproportionately affected by social and cultural taboos around sex and reproductive health.

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