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Maximazing Access and Quality Website

James F. Phillips/The Population Council

Table of Contents

• Summary
• Credits

1. Promoting Dialogue
2. Supporting the Client’s Role
• Box: Client-Centered Counseling
3. Improving Providers’ Performance
• Table: Activities to Improve CPI
• Box: Supervisors Can Improve CPI
4. Best Practices in Training
5. Evaluating the Quality of CPI
• Box: Evaluating Training Programs
6. Moving Beyond Family Planning
7. Bibliography

• INFO Project
• Order
• Online Reports
• Upcoming Reports
• POPLINE

This issue was prepared in collaboration with the Maximizing Access and Quality (MAQ) Initiative of the United States Agency for International Development's Office of Population and Reproductive Health. The MAQ Initiative supports research and evidence-based interventions to promote access and quality of reproductive health and family planning services.

Published by the Information & Knowledge for Optimal Health (INFO) Project, Center for Communication Programs, The Johns Hopkins University Bloomberg School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA.

Improving Client-Provider Interaction

In family planning programs, good face-to-face interaction between the client and providers is key to meeting clients’ needs and program goals. Programs can best improve client-provider interaction (CPI) when they move beyond just training providers and strengthen CPI continuously in multiple ways.

Good face-to-face communication between clients and providers forms a cornerstone of good-quality services, and family planning programs have worked hard to improve it. Most providers are trained professionals and caring community members who want to communicate well with clients. Why then do clients sometimes receive inadequate information or suffer poor treatment? Relying on training alone and focusing exclusively on providers, while neglecting the client’s role in consultations, have held back efforts to strengthen CPI. What more can programs do?

Good CPI respects the client’s right and ability to make informed choices. With support and encouragement, family planning clients can actively participate in their own care and make well-informed choices. Specifically, programs can:

• Balance the client’s and provider’s roles in decision-making by teaching providers to respect clients’ ability to choose for themselves and engage clients in decision-making.
• Explore clients’ thinking about health decisions by asking about their personal, social, and economic concerns during consultations and in monitoring and evaluation.
• Address clients’ concerns about side effects by counseling them on what to expect before they start a method, and responding to their concerns if side effects develop.
• Encourage clients to play an active role in consultations by developing mass media campaigns, print materials, and client education that legitimate clients’ rights and encourage them to ask questions of providers.

Training can strengthen providers’ knowledge and interpersonal skills. Programs also must address the many other factors that affect providers’ ability to interact with clients. Programs can:

• Define clear expectations for good CPI by disseminating and reinforcing policies, guidelines, job descriptions, and protocols that promote good communication practices.
• Give providers feedback on their performance by focusing supervision on CPI and by encouraging coworkers, clients, and the community to help.
• Make CPI training more effective by refining curricula, adopting proven training methods, and supporting trainees’ efforts to apply new skills on the job.
• Provide the space, supplies, and time that providers need to counsel clients effectively.
• Motivate providers by recognizing and rewarding superior performance.
• Match workers with jobs to ensure that providers have the knowledge, attitudes, and skills essential for good CPI.

Systematic evaluation produces the objective information that managers need to improve CPI. To evaluate CPI effectively, programs must choose meaningful indicators and data sources. Involving policy-makers, managers, and service providers in the evaluation process helps ensure that recommendations respond to real needs, are feasible, and will be acted upon.

As family planning programs become more integrated with other health care, CPI faces new possibilities and challenges, particularly in addressing HIV/AIDS. Providers increasingly are responsible for multiple reproductive health services. Family planning clients often have other reproductive health concerns that can be addressed during clinic visits. Providers who communicate effectively with clients can learn about their interrelated sexual and reproductive health concerns and can help them become more aware of risky behavior and empower them to make healthy choices.