How to Ensure Counseling is NOT a Mini-Lecture_Sascha Lamstein_5.6.14


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  • Note that the deliverable was a "Standardized package of assessment methods and questionnaire
    to assess HIV/nutrition services at health facility and community level". We did NOT include the community level in our toolkit so far.
  • How to Ensure Counseling is NOT a Mini-Lecture_Sascha Lamstein_5.6.14

    1. 1. Reinforcing the Quality of Counseling at the Health Facility Level Sascha Lamstein, PhD Nutrition Programs M&E Advisor SPRING Project
    2. 2. Outline • Background • Process • Content • Questions / next steps 2
    3. 3. Background of the Reinforcement Visits • Nutrition services and supervision of those services at the facility level are limited • SPRING works to expand and strengthen the integration of nutrition assessment, counseling and support (NACS) into existing health programs in selected countries • In Haiti, SPRING was asked to strengthen NACS, including infant and young child feed counseling, in targeted tertiary care facilities (currently 12) through training and quality improvement processes 3
    4. 4. Background: Why undertake a “reinforcement visit”? • Increasing knowledge and awareness of good nutrition practices rarely leads to sustained behavior change • The importance of how interventions are implemented on effectiveness is gaining increased attention – Management – Training … is not enough – Supervision and/or coaching… is essential – Incentives 4
    5. 5. Background: Objectives of the Reinforcement Visits • Assess quality of care and client satisfaction with NACS services • Provide healthcare providers with direction and support in applying guidelines to their day-to-day work • Increase healthcare providers’ knowledge and skills • Improve the quality of NACS services 5
    6. 6. Process of the Reinforcement Visit • SPRING staff play the role of “facilitator” or “coach”, not a “supervisor” • Collaboratively measure: – what providers reported doing – what can be observed of facility infrastructure and provide practices – what clients reported was done during their visits • Present results in auto-generated graphs (dashboard plus presentation) • Meet with facility staff to compare desired and actual performance, identify the root causes of gaps/problems, and develop action plans 6
    7. 7. Content: Reinforcement Visit Tool Development • Conducted an inventory of existing tools for content related to facility-level nutrition services • Reviewed existing standard operating procedures for NACS as well as general counseling guidance (UNICEF IYCF counseling package, ENA framework, GATHER, etc.) • Solicited feedback from Haiti and Uganda regarding challenging questions and useful data • Solicited input from health systems strengthening experts 7
    8. 8. Content: Reinforcement Visit Tool Development • Reviewed and revised operational definitions of NACS at the health facility level using globally- recognized indicators whenever appropriate • Developed tools to… – interview facility staff and clients – observe client-provider interactions – review records 8
    9. 9. Content: Nutrition counseling indicators measured through RVs • Counseling indicators, measured primarily through observation, include: – % of clients who received counseling conducted with key counseling techniques (communicating, listening, encouraging, etc.) – % of clients who received counseling on appropriate nutrition topic (varies by client type) – % of clients supported in developing/reviewing a nutrition care plan – % of clients asked to commit to at least one action item 9
    10. 10. Example: Haiti observations 10
    11. 11. Example: Haiti observations 11
    12. 12. Example: Haiti observations 12
    13. 13. Questions and next steps • What is realistic to expect with regard to nutrition counseling at the secondary and tertiary care level? • What are the key elements (“must haves”) for effective nutrition counseling at the secondary and tertiary care level? • Which elements of counseling are particularly challenging in this setting? • What can be done to ensure that this process is sustained and scaled (built into existing MOH systems)? 13