Improving provider-client communication: reinforcing IPC/C training in Indonesia with self-assessment and peer review
To improve the quality of reproductive health care in Indonesia, refresher training in interpersonal communication and counseling (IPC/C) has been offered to clinic-based family planning service providers who attend to family planning clients. This study tested the effectiveness and feasibility of two low-cost alternatives to supervision self-assessment and peer review that may reinforce providers' skills after training. The performance of three groups of providers from East Java and Lampung Provinces who attended an IPC/C training were compared. Providers in self-assessment only group conducted self-assessment exercises for 16 weeks after the training. Providers in the peer review with self-assessment group attended peer review meetings as well as conducted self-assessment exercises over the 16-week period. The control group received no reinforcement after training. Reinforcement activities improved provider-client interaction, although self-assessment and peer review did not have a similar positive impact on information giving. Both types of reinforcements proved feasible for low-resource settings. Cost analysis shows that money spent on training alone, without reinforcement, had minimal impact on provider performance. Adding peer review to self-assessment proved cost-effective despite its relative higher cost. The impact of the reinforcement strategies on providers, as well as on client behaviors is discussed. This study points to simple, affordable strategies to maximize the impact of costly training courses.