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This tool objective is to aid ministries of health, key partners and stakeholders, to carry out an evaluation of care provided at out-patient health care facility level in a systematic and participatory way, to identify areas that need to be improved and to develop relevant action plans. The tool, which was developed as a complement to the maternal and neonatal hospital care assessment tool, is primarily designed for country-wide comprehensive assessments of the quality of maternal and neonatal care, but it can also be used in a single facility for internal audit purposes. The assessment process itself, the assessment findings and the relevant action plan should be seen as a component of a quality improvement strategy. The tool is a generic framework that needs to be adapted to the epidemiology and, even more important, to the health system structure and capacity at country level.