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Reproductive Health

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Assessment and improvement of family planning supervision in Zimbabwe
To assess the quality of supervision at the district level, data were collected from various sources: structured observations of supervisors, audiotaping of supervisor-provider interactions, recording of all supervisory activities, and interviews with supervisors and supervisees. A team composed of current and past supervisors, along with researchers, determined the supervisory practices that would be measured. Relying on supervision standards developed by Zimbabwean stakeholders, the study found zero percent of supervisors performed "high," 56% performed "medium," and 44 percent performed "low." Supervisors devoted less than 5 percent of their time to patient care issues. The supervisors' main strengths were in giving feedback on technical standards, discussing and analyzing data, and developing rapport with the providers. They were most deficient in making suggestions, seeking client input, problem solving with the providers, and building on previous (and future) supervisory visits. The supervisors' weakest areas were continuity of supervisory visits, being proactive, and engaging in joint problem solving with front-line providers. Building on this formative study, QAP designed an intervention to enhance supervisory skills and improve patient care using supervisor led, on-job training of providers, and included a detailed course curriculum. The course was implemented in Zimbabwe's Mashonaland East Province, and the curriculum revised and published.

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The Quality of Supervisor-Provider Interactions in Zimbabwe

Improving family planning counseling with self-assessment and peer review in Indonesia
The quality of client-provider communication during a counseling session was measured by the number of facilitative communications and number of informative communications by the provider during the session. Three interventions were tested: a one week training for the providers in inter-personal communication, a low cost self-assessment protocol, and weekly peer review meetings. The self-assessment and peer review aimed primarily at reinforcing facilitative communication. A sample of 203 family planning counselors was randomly assigned to one of three groups. Group 1 received the training only; group 2 received the training and implemented the self-assessment for 16 weeks following the training; and group 3 received the training and implemented both the self-assessment and peer review for 16 weeks. Approximately two counseling sessions per counselor were audio-taped and analyzed at three different times: just before the training, just after the training, and 16 weeks after the training. The average number of facilitative and informative communications increased by 2-3 times between the first two measurements for all three groups, indicating that the training had a strong short-term impact. However, after 16 weeks, the training-only group lost about half of its gain in both facilitative and informative communication, while the other two groups maintained their gain in facilitative communication although they lost about half the gain in informative communication. These results suggest that self-assessment and peer review interventions are effective strategies for reinforcing training in facilitative communication.

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Improving Provider-Client Communication: Reinforcing IPC/C Training in Indonesia with Self-Assessment and Peer Review

Client communication behaviors with healthcare providers
This study used the data obtained in the Indonesia counseling, self-assessment, and peer review study to analyze what causes clients to participate actively during family planning counseling. Culturally acceptable ways for Indonesian clients to participate in consultations include asking questions, requesting clarification, stating opinions, and expressing concerns. Based on a multi-variate analysis of 1,200 counseling sessions, factors significantly associated with client active communication were, in order of importance: providers' information giving, providers' facilitative communication, providers expressing negative emotion, client educational level, and province. The study's findings reinforce the importance of achieving good provider counseling performance.

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Client Communication Behaviors with Healthcare Providers in Indonesia

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The Quality Assurance Project (QAP) is funded by the U.S. Agency for International Development (USAID) under Contract Number GPH-C-00-02-00004-00.