needed to ensure that providers apply new skills on the job.

Methods: In December 1997 and January 1998, 201 providers working at 170 clinics in Indonesia

attended a training course on client-centered counseling. They were divided into three subgroups

for follow-up. One group (controls) received no reinforcement, one conducted weekly selfassessments

and the third attended peer-review meetings in addition to conducting selfassessments.

Data were collected before training, immediately afterward and after four months

of reinforcement to measure changes in provider and client behavior.

Results: In the month after training, counseling sessions were about twice as long as before,

and providers offered twice as much information and counseling on medical and family planning

issues. The frequency of providers’ facilitative communication (which fosters rapport and client

participation) doubled from 15 to 30 instances per session, and the number of clients’ questions

increased from 1.6 to 3.3. After reinforcement, providers’ facilitative communication, clients’ active

communication and clients’ ratings of self-expression and satisfaction increased in the selfassessment

group, but did not change significantly in the control group. Both providers’ facilitative

communication and clients’ active communication improved further in the peer-review group,

but this intervention did not affect clients’ perspectives on the counseling experience.

Conclusions: Self-assessment and peer review help maintain providers’ performance after

training and prompt continuous quality improvement.