The perspectives of underserved groups need to be reflected in the design, implementation and monitoring of programmes. Geography, language and cultural barriers all limit indigenous people's access to health services. At public health facilities service providers sometimes fail to respond to indigenous women's complaints. Language differences may limit indigenous clients' understanding of the examination process. Some NGOs have reported cases of medical experimentation without informed consent, and use of unapproved or inappropriate drugs.
Close attention is paid to service quality and follow-up.
Partnership with civil society. This is true both in public enterprises serving those too poor to afford private services and in programmes with substantial private sector involvement. Partnerships between government programmes and NGOs have been developed in many countries, recognizing the comparative advantages of the different actors. Non-governmental organizations have helped test new methods of service delivery, including outreach to the poor and to adolescents, and collaborated in training government service providers and in advocacy for national programme expansion. Guidelines and standards of conduct for health systems need to incorporate a reproductive rights perspective.