Improving Family Planning Client-Provider Communication and Counselling Quality through the Balanced Counselling Strategy in Indonesia

Summary:

This presentation describes the design and implementation of the Balanced Counseling Strategy (BCS) to improve the quality of Family Planning (FP) counseling in Indonesia. It was adapted from the Population Council's BCS activity. It is an interactive and client-friendly strategy for improving counseling within family planning consultations. The BCS helps provide a client focused counseling and method choice, provide information upfront on the effectiveness of the methods including the side effect and the client is able to visually see the methods. Monitoring and evaluation was conducted to understand its implementation. Monitoring was conducted in 122 health facilities in four districts to see the client's method adoption after receiving BCS counseling. In the evaluation study, three waves of data collection were carried out including observation of 600 counseling sessions, interviews with providers, and client's exit interview in the intervention and control areas. Preliminary analysis of the monitoring results of seven months (January дус July 2019) shows that more than 60% of clients received counseling with the BCS method and of those who received BCS counseling, more than 80% adopted the FP method. Preliminary results from the evaluation study found that BCS trained providers were more likely to conduct a structured counseling, actively engage clients, and ask more questions, and use the counseling support tools. This presentation will discuss the benefit and challenges of using BCS approach to improve client-provider communication for FP counseling.

Background/Objectives:

FP counseling in Indonesia is an ongoing challenge. Counseling sessions are relatively unstructured, not interactive, resulting in limited choice of methods for clients. Recent data shows women are not getting complete information on their method choice. The 2017 Indonesia DHS indicated that less than 30% of women reported their health provider told them about the side effects of methods and how to deal with them. The MyChoice project partnered with the Indonesian Ministry of Health and the national FP program (BKKBN) to adapt the Balanced Counseling Strategy (BCS) approach for FP counseling.

Description of Intervention and/or Methods/Design:

BCS was initially introduced in 44 public health facilities focused on postpartum family planning in August 2016. The proportion of women accepting a postpartum FP method before discharge increased from 10% to 35%. Due to the success of the intervention, and data showing non-optimal counseling for FP, BCS was expanded for all FP counseling at the primary health facility. The BCS tools developed included a tablet application to guide providers through the BCS algorithm, questions and methods. The app includes brochures, information, and videos for each method. Providers from 122 facilities in 4 MyChoice districts were trained in BCS and how to use the tablet application. Evaluation included three waves of data collection with intervention and controls areas, as well as monthly monitoring of BCS implementation at the facility level.

Results/Lessons Learned:

Preliminary monitoring analysis from January - July 2019 shows that more than 60% of clients received counseling with the BCS method and of those, more than 80% adopted a FP method. Of the clients who adopted the FP method, around half chose injection, and LARC adoption was 33% - 48% per month. It was reported that the use of the Tablet BCS helped providers follow the counseling steps, made the counseling session more efficient, and client more determined in making informed decisions. The evaluation study shows that the BCS trained providers offer more extensive information about the contraceptive methods, including the effectiveness, their use, and side effects, and asking the clients to select a method suited their reproductive needs. BKKBN and MoH immediately scaled up the initiative and in total, 1701 health providers from 455 public health centers in 24 provinces were trained in BCS and equipped with tools.

Discussion/Implications for the Field:

Clients need to be equipped with sufficient knowledge about method choice to make informed choices about the right methods for them. The BCS method improves the quality of provider's counseling and allows the client to take ownership of the decision. Through following the steps of BCS, the quality of counseling has increased the knowledge of women in their decisions for method adoption. BCS increases provider compliance in counseling and client satisfaction in obtaining services, increasing the satisfaction of women with their methods. This will have impact on discontinuation rates of FP methods, decreasing the chance of unplanned pregnancies.

Abstract submitted by:

Yunita Wahyuningrum - Johns Hopkins Center for Communication Programs (JHU CCP) Indonesia
Douglas Storey - JHU CCP
Eddy Hasmi - JHU CCP Indonesia