India's experiences with sterilization indicate that quality of care is an essential feature of appropriate, voluntary family planning services. Good quality of care reduces the problems associated with services and increases client's acceptability and continuation rates. The Center for Excellence in India has established a model that emphasis matching the right method with each client's circumstances. The model first developed standards, which were based on international guidelines and expertise, and then developed and implemented a training program for providers; finally, a quality assurance system was established in order to promote compliance with standards. At present, there is not 100% agreement among international guidelines on standards for sterilization or other methods. In 1992, Family Health International (FHI) published a comparison on 8 major sets of service, delivery, guidelines, and were used around the world; FHI world wide variations in guidelines. A USAID study group is currently reviewing scientific evidence on oral contraceptives, injectables, Norplant, and IUDS. There is difficulty in reaching international consensus and even greater difficulty in changing approaches and policies of specific countries. It is much easier to institute quality of care issues at the beginning of program development or when methods are first introduced. In India, the Centers of Excellence program developed its own national standards on sterilization, and the resulting document is specifically suited to India. The standards emphasize the client's choice and human issues such as counseling and communication. Sterilization reversal, which is not always successful, will be provided, even though sterilization will be promoted as a permanent procedure. 4 regional centers have been set up through medical colleges in Delhi, Calcutta, Bombay and Madras. 12 additional state level centers will be established in the future. Good training was considered an essential part of the India project; recanalization skills were acquired in the US. Training orients practitioners to new standards and basic requirements for good aseptic conditions, proper techniques in surgery, and good communications with the client. The no scalpel technique for male sterilization is being learned; initial findings are that people come specifically because of the availability of this technique. The reward system has changed to emphasize continuing service quality and not quotas.