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Enhancing Quality for Clients: The Balanced Counseling
Strategy
Program Brief no. 3, July 2003
Part 3: Lessons Learned and References
The studies in Peru and Guatemala suggest the following findings on improving client choice, and hence quality of care, by implementing the balanced counseling strategy with accompanying job aids:
- The balanced counseling strategy improves the quality of family
planning counseling—when providers use the job aids.
- Nonprofessional or paraprofessional providers are capable of using
algorithms such as the balanced counseling strategy when they receive
sufficient training.
- Though use of the balanced counseling strategy increases the quality
of counseling information provided, there is still room for improvement.
Average scores on quality indicators, as recorded by simulated clients,
reached only half the maximum in Peru and two-thirds of the maximum
in Guatemala. Increasing the availability of method pamphlets, improving
supervision to enhance use of the method cards and pamphlets, and strengthening
the algorithm and job aids could help improve the quality of care provided.
- Intensity of training affects compliance. The Peruvian providers
were first exposed to the strategy in a two-day workshop, then received
a one-day training workshop on the use of the balanced counseling strategy
and the job aids. In contrast, the Guatemalan providers participated
in a one-day workshop followed by four reinforcing revisits. Researchers
believe that close and continual supervision provided in both the Guatemala
interventions contributed to the high level of compliance and resulting
quality improvements made at the experimental clinics.
- Institutional leadership reinforces compliance. Though Peruvian MOH authorities expressed their commitment to the innovation, field observations suggested that institutional involvement was not apparent after the experiment began. In Guatemala, by contrast, the MPSAS and health area directors accompanied the intervention team during the revisits to the trained providers. This probably increased providers’ perception of higher-level support and involvement.
Conclusions
Studies conducted to date on the balanced counseling strategy show that when used with the job aids, this model can improve both the quality of the provider’s counseling and the client’s ability to make an informed decision about the most appropriate contraceptive method for her needs. The model is adaptable and has been replicated with improved results. Further research in Peru and Guatemala, already underway, will determine ways of refining and improving the strategy.
Acknowledgments
The assistance of the following reviewers is appreciated: Susan Adamchak, Family Health International/FRONTIERS; Lauren Bocanegra, Sarah Harbison, and Shawn Malarcher, USAID Bureau for Global Programs, Office of Population; Jim Foreit, John Townsend, and Ricardo Vernon, Population Council/FRONTIERS. Editors: Stephanie Joyce and Laura Raney.
This publication was made possible through support provided by USAID under the terms of Cooperative Agreement No. HRN-A-00-98-00012. The opinions expressed herein do not necessarily reflect the views of USAID.
Suggested citation: León et al. 2003. “Enhancing Quality for Clients: The Balanced Counseling Strategy,” FRONTIERS Program Brief No. 3. Washington, D.C.: Population Council.
© 2003 by the Population Council, Inc. All rights reserved.
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References
Bruce, Judith. 1990. “Fundamental Elements of Quality of Care: A Simple Framework,” Studies in Family Planning 21(2): 61-91.
León, Federico R. 1999. "Providers' compliance with quality of care norms," FRONTIERS Final Report. Washington, DC: Population Council. (PDF, 2.5 MB)
León, Federico R. et al. 2001. “Counseling Sessions Length and Amount of Relevant Information Exchanged in Peruvian Clinics,” International Family Planning Perspectives 27(1): 28-33 & 46.
León, Federico R. 2002. “Introducing the Job Aids-Assisted Balanced Counseling Strategy: A Test in Peru MOH Clinics,” paper presented at the annual meeting of the American Public Health Association, November.
León, Federico R. and Alex Ríos. 2003. “Balanced Counseling Strategy Reversed Negative Trend at the IGSS,” FRONTIERS Peru PCI-QoC Project Bulletin No. 24, May 15. Lima: Population Council.
León, Federico R., Carlos Brambila, Marisela de la Cruz, John H. Bratt, Julio García Colindres, Benedicto Vásquez, and Carlos Morales. 2003a. "Testing balanced counseling to improve provider–client interaction in Guatemala's MOH clinics," FRONTIERS Final Report. Washington, DC: Population Council. (PDF, 1.3 MB)
León, Federico R., Santiago Roca, Alex Ríos, Adriana Zumarán, and Ana Rosa Feijoo. 2003b. "One-year client impacts of quality of care improvements achieved in Peru," FRONTIERS Final Report. Washington, DC: Population Council. (PDF, 931 KB)
Peru Ministry of Health. 1999. Manual de Consejería de Planificación Familiar (Manual of Family Counseling). Lima: Ministerio de Salud, Dirección General de Salud de las Personas.
Hard copies available free of charge from frontiers@popcouncil.org; also available in PDF (520 KB)
For more information contact:
Frontiers in Reproductive Health (FRONTIERS)
Population Council
4301 Connecticut Ave. N.W., Suite 280
Washington, DC 20008 USA
Telephone: +1 202 237 9400
Facsimile: +1 202 237 8410
E-mail:
frontiers@popcouncil.org
