Counseling, Training, and Performance and Quality Improvement


Counseling is “a special type of client-provider interaction. It is a two-way communication between a health care worker and a client, for the purpose of confirming or facilitating a decision by the client, or helping the client address problems or concerns” (EngenderHealth, 2003. p. 26).[i] Good counseling depends on providing accurate and appropriate information, developing good interpersonal skills, maintaining confidentiality and privacy, tailoring the interaction to the client’s needs, and providing enough information while avoiding overload. Counseling can take place at both the facility and community levels during ANC, PNC, and PAC, and ad hoc. Home visits by CHWs are particularly good opportunities to provide counseling and education and check on the health of a woman.

Key Resources for Counseling:


Quality MNC services require competent, well-prepared staff and volunteers who can safely provide information and services. Training needs to be interactive where participants are engaged in activities such as role plays, small group work, learning games, and opportunities to demonstrate what they have learned in field. Training curricula are included as key resources throughout this TRM.

Key Resource for Training: ACNM, 2010. Home-Based Life Saving Skills

Performance and Quality Improvement

The wide range of initiatives aimed at improving quality in health care build on models and tools first used in industry. One of the most widely used approaches promoted by the Institute for Health Care Improvement[i] is based on Langley’s Model for Improvement[ii] (Figure 2), which asks three questions: (1) What are we trying to accomplish? (2) How will we know that a change is an improvement? and (3) What changes can we make that will result in improvement? A good quality improvement intervention has these qualities:

  • Meets community, client, and provider expectations and needs, as well as internationally accepted technical standards
  • Focuses on systems and processes
  • Uses data to analyze the service delivery process (e.g., Health Facilities Assessment)
  • Encourages a team approach to ongoing problem solving and quality improvement

Where appropriate, programs also can train staff to regularly monitor the quality of obstetric care and ensure that essential systems are operational. Criterion-based audits can be used to reinforce established protocols and maintain health workers’ knowledge and skills for managing obstetric complications. 

Figure 2. Langley's Model for Improvement


Key Quality Improvement Resources:



[i] Institute for Healthcare Improvement. 2014.

[ii] Langley, G.L., et al. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd Edition). San Francisco: Jossey-Bass Publishers, 2009.

[i] EngenderHealth, 2003. Comprehensive Counseling for RH: A Participants’ Handbook.