These findings are used in joint health service-civil committees or meetings to discuss the measures needed to enhance health service performance in these areas.

In Pakistan, for example, accountability or vigilance committees have been set up in some districts to ensure health service accountability on publicly defined quality criteria (Cornwall et al., 2000).

In Zambia surveys of perceived quality have been used to link user charges to health service performance as perceived by communities.

In these processes, civil society acts as an important intermediary between individual clients and their grievances. It can mediate, too, between the collective and institutional frameworks that are used to raise and resolve these issues. Given the usefulness of such community surveys, it may be useful to carry these out regularly as periodic sentinel site surveys on community preferences and views on quality of care.