Assessment of Family Planning Counseling Skills in Public versus Private Sector GATHER Approach

Aim of The Study: To support the National Family Planning Program in Egypt through improving its counseling component. Specific objectives: (1) Assessment of performance of family planning counseling (FPC) skills using the GATHER steps. (2) Evaluating the utilization of health education materials in FPC (3) Exploring the use of questioning techniques to ensure clients understanding. (4) Collecting the providers recommendations for improving the quality of FPC. Subjects And Methods: A stratified multistage random sample including four governorates was selected: Cairo, Dakahlia, Ismailia and Minia governorate. In each governorate 2-3 districts were randomly selected: 8 sites within the selected districts were randomly selected. For each site all facilities ofMOHP providing family planning services, three private OBGY clinics and three pharmacies were included. Quantitatively a self-administered questionnaire covered background characteristics of providers, self-assessment for steps of counseling GATHER, supportive communication skills and health education. A total of 67 items were used, the upper score limit for which was 201. The questionnaire was pilot tested and modified. A total of 846 physicians and 438 auxiliary workers (AWs) in MOHP, 192 private OBGYs and 170 pharmacists completed the questionnaire. Appropriate statistical tests were applied. Results: Medical providers in Dakahlia had the highest mean total score while the least score was recorded in Ismailia. The mean total score for FPC tasks provided by A Ws was much lower than that of medical providers in all governorates. The mean total score for FPC skills was significantly higher among physicians in MOHP followed by private OBGYs and was least amongst pharmacists. Using health education materials was significantly higher among MOHP physicians. Linear regression analysis showed that working in MOHP and the greater the number of attended training courses positively influenced the mean total score for counseling (Adjusted R square =0.4 and P=0.000). One third of medical providers failed to formulate a correct open-ended question. Conclusion: Self-assessment of performance of FPC demonstrated a wide variation between the studied governorates. Ismailia governorate should be targeted for intensive training courses. Pharmacists needed special FPC training. Health information discussed during counseling was insufficient and health education materials were underutilized. These gaps should be considered in designing a FPC training program to improve performance of service providers.