PIP: In the initial stages of Quality Assurance (QA) programs, the most difficult task has been the selection of appropriate and well-defined quality problems. To avoid such problems, some programs have applied a Systems Model, which relates the different service components, followed by a Systems Analysis, which enabled the team to identify and diagnose key problems. This approach required direct observations of service delivery, interviews with health staff, exit interviews with patients, record reviews, and inventories of supplies and equipment. On the other hand, other country programs, which utilized brainstorming and service statistics, have addressed problems inadequately. In the implementation of quality assessments at the start of the program, several advantages were noted: problem recognition by health providers; helps focus QA efforts on clinical and management issues related to high risk, high volume, or problem-prone areas; and serves as a baseline from which to measure improvements. Despite these advantages, identification of poor service quality, exaggeration of results, expensive assessment cost, and resistance and fear of results could also occur. To offset these negative aspects, QA Project has involved key local staff in decisions concerning the design, development and carrying out of the assessment.