Population Council Research that makes a difference

The Balanced Counseling Strategy Plus:
A Toolkit for Family Planning Service Providers
Working in High HIV/STI Prevalence Settings

Recently updated, the Balanced Counseling Strategy Plus: A Toolkit for Family Planning Service Providers Working in High HIV/STI Prevalence Settings (BCS+) is an interactive, client-friendly approach for improving counseling on family planning and prevention, detection, and treatment of sexually transmitted infections (STIs) including HIV.

The BCS+ was adapted from the Balanced Counseling Strategy, an evidence-based and well-researched tool for improving counseling on contraceptive methods. The BCS+ toolkit, developed and tested in Kenya and South Africa, provides the information and materials needed for health care facility providers to provide complete and high-quality family planning counseling to clients who live in areas with high rates of HIV and STIs.

This second edition toolkit includes the following:

1. BCS+ Trainer’s Guide (PDF): Supervisors and others can use this to train health care facility directors and service providers on how to use the BCS+ for counseling family planning clients.
   
   
2. BCS+ User’s Guide (PDF): This guide focuses on how to implement the Balanced Counseling Strategy Plus. It can be distributed during training or used on its own with the BCS+ job aids.
   
   
3. BCS+ job aids comprising:
   
   • BCS+ algorithm (PDFs: A3 or A4) that summarizes the 19 steps needed to implement the BCS+ during a family planning counseling session. These steps are organized into four stages: pre-choice, method choice, post-choice, and STI/HIV counseling.
     
   • BCS+ counseling cards (PDF) that the provider uses during a counseling session. There are 26 counseling cards, the first of which contains six questions that the service provider asks to rule out the possibility a client is pregnant. Each of the next 16 cards contains information about a different family planning method. The next 3 cards provide advice on pregnancy and the postpartum period. The last 6 cards provide essential information for counseling on preventing, detecting, and treating STIs and HIV.
     
   • BCS+ method brochures (PDF) on each of the 16 methods represented by the counseling cards. The brochures provide counseling to clients on the method they have chosen and then are given to clients for later reference. This means clients do not have to rely on their recollection of what was discussed with the provider.

   • WHO Medical Eligibility Criteria Wheel (offsite link) guides providers through medical conditions and medications that may be contraindications to use of particular contraceptive methods.
     
     

The BCS+ tools are generic and can be revised according to national and/or regional guidelines and different contexts. In fact, many organizations have used the BCS+ toolkit, in both original and modified formats, in their local service-delivery programs. For example, a family planning technical advisor to the Government of Southern Sudan reported successful training and patient counseling using the BCS+ in its family planning program:

The cards were very handy, making my counseling sessions very easy, and the feedback from the participants was great! Now, all 44 pilot primary health facilities in the ten states of South Sudan have copies for their day-to-day use. We have planned for periodic technical support to address challenges they may face, and implementing partners have agreed that the cards will be used during the rollout phase next year.

A video describing use of the BCS+ toolkit in South Africa also is available.

To obtain Microsoft Word versions of BCS+ files to modify or revise according to your local setting, please contact publications@popcouncil.org.