One-year client impacts of quality of care improvements achieved in Peru.

A study with 24 health directorates of the Peru MOH as units of experimentation and analysis that was conducted in 2000-2001 showed that two-day provider training plus one-day re-training on the job aids-assisted Balanced Counseling Strategy resulted in significant enhancement of the quality of care an increase of four minutes in session length and improved client knowledge of the method chosen when this was an IUD or hormonal method. This study presents results of a one-year follow-up. New-event family planning clients were recruited as they exited counseling sessions at treated and control clinics. The clients had chosen a contraceptive method and stated intentions to use contraception for at least one year. A questionnaire that included the calendar module of DHS was applied twice in home interviews to tap six and 12-month outcomes. Twelve-month data from 215 clients were analyzed in depth. Knowledge of the method chosen when this was the IUD or a hormonal method was greater in the treated cohort (p < .05 one-tailed df = 18) at the end of the follow-up period. Mean monthly (k = 12) family planning use rates over health-directorates (n = 12) were obtained for each cohort. The latter months showed less use of needed contraception (p < .01 df = 1111) and the treated cohort greater use (.81) than the control cohort (.78 p < .01 df = 111) when contemporaneous perceptions of need were considered. Cumulative continuation rates from life tables did not differ significantly between cohorts according to the Wilcoxon (Gehan) statistic. Proportions of method shifting were similar in both cohorts. Attainment of contemporaneous reproductive goal was significantly greater in the treated cohort (.96) than the control cohort (.95 p < .01 df = 111). The intervention caused consistent yet small improvements in client outcomes. Correlational findings suggested that better impacts can be achieved in provincial primary health facilities than in larger settings like clinics or hospitals in capital cities. The results are important because: 1) other studies have failed to show significant impacts of controlled quality-of-care improvements on the use of contraception; and 2) the Balanced Counseling Strategy was not implemented to its full extent. Greater impacts can be expected when the Strategy’s potential is fully realized. (excerpt)