From patient to client.
OBJECTIVE
To gain insight in the knowledge, attitude and practices of users and providers of reproductive health services in rural areas of Kyrgyzstan and Tajikistan before and after interventions.


METHODS
KAP (Knowledge, Attitude, Practices) studies under 500 respondents.


RESULTS
Training that addressed the determinants of behavioural change contributed to the motivation under health care providers to improve performances. The simultaneously implemented education program for users of health services enhanced the preparedness for birth of pregnant women and their family members. Both interventions had positive effects on health outcomes.


CONCLUSIONS
Behavioural change, from hierarchic and directive into client-centred and supportive, can be realized in Central Asia by enhancing the decision-making capacities of providers. A client-centred attitude of health care providers is the key condition for sustainable improvement of service delivery. Improving client-provider communication is a cost-effective way to enhance the quality of care in low resource settings, such as in Central Asia.


CONCLUSIONS
The providers can be best trained in a practical setting, when trainees are enabled to practice with real patients, under guidance of a highly skilled professional. Psychological components such as addressing emotions and exploring the values and beliefs of providers should be incorporated in separate training modules.
Netherland School Public and Occupational Health, Amsterdam, The Netherlands. o.dehaan@nspoh.nl
Olga
O
de Haan
D001291:Attitude of Health Personnel; D003142:Communication; D003376:Counseling; D005193:Family Planning Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education*; D006801:Humans; D007707:Kyrgyzstan; D018802:Patient-Centered Care; D009629:Person-Centered Psychotherapy; D010817:Physician-Patient Relations; D010865:Pilot Projects; D011247:Pregnancy; D015397:Program Evaluation; D019035:Rural Health Services / Q000458:organization & administration; D012424:Rural Population; D011795:Surveys and Questionnaires; D013620:Tajikistan