Providers' compliance with the balanced counseling strategy in Guatemala

The balanced counseling strategy developed in Peru improved family planning care and clients' knowledge of their contraceptive method choice, but few providers adopted it. To expand its use, an algorithm was introduced and training, job aids, and reinforcement were supplied to Ministry of Health providers, most of whom were paraprofessionals, from two areas (40 clinics) in Guatemala. Mystery clients made pretest and post-test visits to these clinics and to providers from a nonequivalent control group (40 clinics). The results showed that the strategy was used in 85 percent of the controlled consultations at the experimental clinics. Use of the strategy improved quality of care regardless of the provider's performance at baseline and regardless of ethnic or regional differences. Counseling session length increased by nine minutes, but real-client load did not change. Guatemalan clients can be expected to benefit from the strategy. The increased session length has not yet caused problems, but it may pose policy dilemmas in the future.