FIG 1 - HEALTH PROVIDERS TRAINED ON CONFIDENTIALITY INCREASING FAMILY PLANNING UPTAKE: LEARNING FROM A FAILED SOMALI HEALTH CARE WORKER CONFIDENTIALITY TRAINING Nasir Hassan, Innovations Manager, PSI BACKGROUND FIG 1 - HEALTH PROVIDERS TRAINED ON CONFIDENTIALITY Management Midwifes Nurses 1st Iteration 3 5 2nd Iteration 2 12 14 Total = 41 health providers Somali Utilization rates of modern contraception are some of the lowest in the world. With a growing population and weak health systems, the existing population has an acute need to increase utilization of modern contraception. Through PSI Somali Advocates for Health and Nutrition (SAHAN) demand creation program, Somali women participated in this program described the health care worker professionalism as a significant barrier for women in accessing family planning information or services. An intervention was designed and tested to address the finding that a key barrier to uptake of modern family planning methods is that women do not trust healthcare workers to respect their privacy. The extent to which this intervention failed reveals the strength of the bias against this behavior change and all the more reason to continue exploring ways to change provider behavior. We intend to continue to test new ways to achieve the desired behavior change, such as integrating into the training compelling stories of patients negatively impacted by privacy violations, or more visible monitoring of provider behavior. This experience shows that mystery clients are an effective monitoring tool to test if training results in health care provider behavior change. However, we learned a lot from this process. Some programs are scaled up based on pre- and post- training knowledge change, which is clearly insufficient in some cases for behavior change. Had our measurements of success been limited to such an approach we would have assumed this intervention was a success. The health providers were told in advance they might be monitored with mystery clients, but still failed this test. We were able to fail fast, a central concept for our programme approach. Another learning was that the health providers are part of the health behavior change challenges, as they are members of the community and have the same perceptions of FP as the general community. In this Somali context, the communal values are a competing factor affecting the uptake of healthy behavior and utilization of modern contraceptives. As this experience revealed, in contexts where family planning is sensitive it is important to use mystery clients or other methods to monitor actual behavior change, and not just assume training alone will change behavior. CONCLUSION METHODS A two-hour training took place in Hargeisa with 13 health care workers at one public health facility and a plaque was placed in the consultation room demonstrating the health facility’s completion of the training and commitment to its standards. Following a mystery client assessment, a second two-day training for 23 health care workers was implemented in Hargeisa, as an iteration to the first test to see if a longer training would be more successful. To assess changes from the training, two “mystery clients” were sent in within the week to the facility. ANC attendees were also asked about the plaque. RESULTS Most healthcare workers viewed the first training as a refresher training reminiscent of previous ethics trainings. After the training, 15 women attending ANC services indicated appreciation for the plaque signifying the completion of the training. While the training appeared to meet its objectives, in practice the health care workers did not maintain patient confidentiality, as was revealed through the mystery client exercise. The first mystery client consultation was brief, with no eye contact made by the providers; there was a lack of privacy with other providers in the room able to listen to the exchange. Misinformation about long-acting reversible modern contraception methods (LARCS) was given. The mystery client rated the overall experience a 2 out of 10. During the consultation with the second mystery client the nurses discussed the previous patient at an audible level and again the nurse gave misinformation about LARCs. PSIhealthylives population-services-international nahassan@psi.org @PSIimpact