8. Client satisfaction with the service

Client satisfaction following VCT has been looked at in several studies. It is, nevertheless, difficult to develop objective measures of client satisfaction. In most studies levels of client satisfaction are reported as being high. This may be in part because clients do not want to upset their health providers, or feel that criticizing a service would jeopardize their future care. The following studies all used client exit interviews, either immediately following a counselling session or as part of a longer-term, follow-up study:

· A study from Myanmar (Kyweet al., 1996²³⁷ and Thu, 1997²³⁸) looked at the acceptability of VCT services. Data were collected on the content of counselling sessions and on client satisfaction of counselling. Of those people attending for VCT 90% were “satisfied with the counselling services they received”.

· In Zambia, of 377 people who had attended a VCT centre, 94% had discussed safer sex with their counsellors and 89% said that they had found the discussion helpful in making decisions. The majority said that they had found counselling a useful experience and that it had helped them cope with their status. They also said that the links to support services were important (Kayawe et al., 1998²³⁹).

· The “New Start” project in Zimbabwe has assessed client satisfaction using exit interviews and found that 80% were satisfied with the service (PSI, 1999²⁴⁰).

· In the multi-centre trial a sample of 81 clients were interviewed at 6 months following testing (Sangiwa, 2000²⁴¹). Most were satisfied with the service and appreciated being made welcome, respected by the counsellors and provided with a level of continuity (seeing the same counsellor at pre- and post-test counselling). The service’s confidentiality and the fact that the counsellors told them the truth was also said to be important. Those who tested seropositive mentioned as significant the value of ongoing supportive counselling for coping with living with HIV and staying healthy.

· In Budapest, Hungary, in an evaluation of an anonymous VCT centre, 94% of the 2000 respondents were satisfied with the services (Csepe et al., 1998²⁴²).

· In Abidjan, Cd’Ivoire interviews of counsellors revealed that 99% of clients appreciated VCT services (Doumatey et al., 2000²⁴³).

In a study carried out by the Kenya Association of Professional Counsellors 100 counselling sessions were reviewed through client exit interviews, counsellor self-assessment questionnaires and supervisor evaluation of audio taped sessions. The ratings by the three groups broadly concurred and, in general, the sessions were deemed to be of high quality. Counsellors tended to under-rate their effectiveness, whereas clients and the supervisor ratings were very closely matched. This suggests that quality assurance in counselling could be conducted cheaply and effectively using client exit interviews (Rachier et al., 2000²⁴⁴).