A report on technical assistance in developing human relations skills for health center staff in Panama.

The authors purpose was to identify problems in family planning services delivery influenced by poor attitudes and procedures of clinic personnel to work with health ministry personnel in designing a short term training program and to test and evaluate it and to prepare a checklist for clinic personnel involved in family planning services. Meetings were held with relevant people in the AID mission and the Ministry of Health; relevant literature was reviewed; staff and patients at 4 health centers were observed and interviewed; and observations and solutions were reviewed with Ministry Personnel. Pilot training courses for health center directors and other health center staff were developed and tested (1 trial of each of the 2 courses) and the trials were evaluated in conjunction with Ministry personnel involved. Future steps were discussed with Ministry training personnel the head of Maternal and Child Health in the Ministry the AID Population Officer and the directors of the health regions where pilot courses were offered. At the health center level it was found that the treatment of patients and relations between clinic personnel were problem areas. Early arrival and long waiting times were noted as well as lack of privacy for patients. Lack of attendance by obstetrician-gynecologists (or tardiness on their part) were observed as well as paternalistic attitude and abrupt treatment and impatience on the part of staff and unwillingness to provide counseling. Personnel were frustrated by crowded conditions and difficulties with patients and open criticism of their colleagues and lack of positive feedback feelings of inequitable pay and workload and unclear role definition were also noted although it was felt that workshops could move toward addressing these problems. In the Ministry confusion over who should be responsible for developing and conducting human relations training is being looked into by an interdisciplinary Ministry commission. The authors make recommendations in 3 areas: structures for human relations training; training content; and selection of personnel to carry out training. In sum it is recommended that a structure be set up to organize and supervise training from the national level down to each health center and that training be guided primarily by experiences and not rely on the presentation of didactic material. The desirable characteristics of individual trainers are also indicated. (Authors modified)