title: Improving access to services and interactions with clients in Guatemala: the value of distance learning.
abstract: OBJECTIVE
  To develop and test a distance-learning programme to improve the quality and efficiency of family planning services in Guatemala.
  
  
  METHODS
  The setting was rural family planning services in Guatemala. The study design was quasi-experimental with one intervention and one control group and with pre- and post-intervention measures. Two staff members from each of 20 randomly selected health districts were trained as leaders of the training programme. In turn, the 40 trainers trained a total of 240 service providers, under the supervision of four health area facilitators. The results were compared with 20 randomly selected control health districts. The intervention was a distance-learning programme including 40 in-class hours followed by 120 inservice practice hours spread over a 4-month period. Distinctively, the programme used a cascade approach to training, intensive supervision, and close monitoring and evaluation. Patient flow analysis was used to determine number of contacts, waiting times, and the interaction time between service providers and clients. Consultation observations were used to assess the quality and completeness of reproductive health information and services received by clients.
  
  
  RESULTS
  The intervention showed a positive impact on reducing the number of contacts before the consultation and client waiting times. More complete services and better quality services were provided at intervention clinics. Some, but not all, of the study objectives were attained. The long-term impact of the intervention is as yet unknown.
  
  
  CONCLUSIONS
  Distance-learning programmes are an effective methodology for training health professionals in rural areas.
authors.affiliation: Escuela de Graduados de Administración Pública y Políticas Públicas, Tecnológico de Monterrey, Mexico DF, Mexico. carlos.brambila@itesm.mx
authors.forename: Carlos
authors.initials: C
authors.lastname: Brambila
authors.forename: Felipe
authors.initials: F
authors.lastname: Lopez
authors.forename: Julio
authors.initials: J
authors.lastname: Garcia-Colindres
authors.forename: Marco Vinicio
authors.initials: MV
authors.lastname: Donis
mesh_terms: D003150:Community Health Workers; D020375:Education, Distance / Q000458:organization & administration*; D005193:Family Planning Services / Q000458:organization & administration*; D006166:Guatemala; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D011203:Poverty; D015397:Program Evaluation; D011641:Public Relations; D012424:Rural Population