Information & Counseling

Balanced Counseling Strategy Plus (BCS+), a counseling strategy tested and refined in several countries, differs from traditional family planning counseling approaches. Rather than relying on the memory of the health care provider, an algorithm takes into account a client’s wishes about when she would like to become pregnant, which helps determine the contraceptive method best suited for the client according her preferences and needs. Rather than providing excessive information about all available methods, the provider then counsels the client on her chosen method. In addition, BCS+:

• Improves effectiveness and efficiency of the family planning consultation
• Simplifies decision making for the client
• Reduces the amount of information that a provider needs to remember
• Is more responsive to the client’s needs and reproductive intentions
• Allows the provider to spend more time listening to clients’ needs, reproductive intentions and contraceptive preferences

In Kenya, the Tupange project used presentation slides on how to apply BCS+ in family planning consultations and counseling cards on BCS+ to train their providers on quality provision of family planning services.

Referral

If providers cannot provide the contraceptive method the client desires, they should have a clear understanding of to whom they should refer the client, how to make the referral, and how to follow-up.

• Lower-level provider to a higher-level provider within the same facility; for example, a midwife to a physician because only physicians are allowed to insert or remove contraceptive implants
• One facility to another facility; for example, a health post to a hospital for insertion of an intrauterine device (IUD)
• One clinic to another clinic within the same facility; for example, a woman coming to get her child immunized is referred to the family planning clinic

In Nigeria, the NURHI project developed a referral manual that describes exactly how referral procedures should happen at every facility, whether public or private, and at all levels of the health care system (from primary health institutions to tertiary medical centers).

Infection Prevention

Infection prevention is a collective effort made by providers and clients to prevent or minimize risks of transmitting infections. Infection prevention practices are used when caring for all clients, regardless of diagnosis. Universal precautions and key family planning infection prevention practices in the clinic include:

• Washing hands (avoid using a communal towel)
• Wearing gloves
• Decontaminating equipment and devices
• Using new auto-disable syringes and needles for injections
• Using and disposing of needles and sharps properly
• Wearing protective items correctly (for example, using a separate pair of gloves for each client)
• Performing pelvic exams only when necessary
• Promptly cleaning up blood and other bodily fluids, wiping surfaces with chlorine solution
• Using safe disposal systems for waste
• Washing linens

Contraceptive Method Provision

Skilled family planning service providers should be competent to provide the range of contraceptive methods authorized for their  respective cadre, level in the service delivery system and/or type of service delivery point . Regardless of position, all authorized service providers should be competent in the following:

• Screening and/or physical assessments to determine if a client is eligible for a specific contraceptive method
• Providing the contraceptive method along with instructions for correct and consistent use, management of any potential side effects and any necessary follow-up
• Using the ‘tell back’ method to check the client’s understanding of correct and consistent use; management of any side effects; and any follow-up necessary for the client to continue using the method (for example, resupply of oral contraceptives, provision of contraceptive injections) or to discontinue the method if desired (such as removal of implants)

There are globally accepted screening checklists for women who want to use the pill, injectables, IUDs or implants.

Family Planning: A Global Handbook for Providers offers the latest guidance on providing contraceptive methods.

Client Follow-up

Skilled family planning providers should develop a plan for follow-up with the client.

The follow-up visit allows the provider to check in with the client after the initial consultation and give advice on any difficulties the client might be experiencing with her chosen method. The client can also ask questions about any side effects she may be experiencing.

Clients can come back to the facility for the follow-up, but you can consider other ways to follow-up with clients to reduce the burden:

• Phone calls
• Text messages
• Using community health workers that are linked with the facility to follow-up with women in their homes

Recordkeeping & Reporting

In addition to clinical and counseling skills, skilled providers should also have basic administrative skills including:

• Recording information about new clients
• Updating and recording information about returning clients
• Assisting with inventory control for contraceptive supplies
• Conducting supportive supervision for lower-level providers, including community health workers