Publications Summary

Document Type
Further Analysis
Publication Topic(s)
Family Planning, Maternal Mortality
Nepal SPA, 2021
Recommended Citation
Assaf, Shireen, Swadesh Gurung, and Hamdy Moussa. 2023. Levels and Quality of Provider Counseling in Nepal Health Facilities during Antenatal Care, Family Planning, and Sick Child Care Visits. DHS Further Analysis Reports No. 143. Rockville, Maryland, USA: ICF
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Publication Date
June 2023
Publication ID

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This report examines the levels and quality of counseling provided in the health facilities of Nepal. Providers during antenatal care, family planning, or sick child care consultations were observed for providing specific counseling to their clients. The clients were then asked in the exit interview if they received this counseling. The agreement between observation and the client’s report is an indicator of the quality of the counseling that was provided. In general, there were low levels of counseling provided and lower levels of agreement that the counseling had occurred. With antenatal care, the lowest levels of counseling were related to the side effects of iron pills, breastfeeding, and use of family planning after delivery. For family planning, the lowest level of counseling was a method’s protection from sexually transmitted infections, while for sick child care the lowest level was the weight and growth of the child. For other counseling items that were observed at higher levels, the agreement that the counseling had occurred was lower, which might indicate that the counseling provided was not effective. The observed counseling and agreement on counseling with the client’s report differed by client, provider, and facility characteristics. For example, counseling on danger signs was more likely to be given to clients who have higher education or who had more than one visit. Nurses and midwives were found to provide more counseling and have higher agreement on counseling than other provider types. Providers’ training, when significant, was found to also increase the observation of counseling and the agreement on counseling provision. The importance of counseling was related to the client’s knowledge of danger signs, ways to prepare for delivery, and a method’s protection from sexually transmitted infections. In general, counseling and the agreement that the counseling had occurred increased the likelihood of having knowledge compared to the clients who did not receive the counseling. These findings highlight areas of intervention that can improve the levels and quality of counseling. These include training specific providers in client-centered counseling and ensuring that effective, high-quality counseling is provided to all clients at each visit.


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