MSI Competency Assessment Checklist: Counselling

Clinical Staff Name: ______________________ Designation: ______________________

General Counselling Pre-Procedure Yes/No/NA Notes

1. * Maintains privacy and confidentiality

2. Greets and employs a client-centred style of communication when

speaking to clients

3. Uses language the client is comfortable with

4. * Follows a structured counselling approach like REDI (Rapport,

Explore, Decide and Implement) or according to local protocols

5. * Asks client about the service(s) they are seeking and if they have
something specific in mind

6. * Provides comprehensive and correct information on service

options that fits with client's reproductive health needs and
lifestyle preferences

7. * Explains dual protection to clients

8. Uses flipchart or other job aids appropriately to explain service

options

9. * Supports clients to make own decisions after weighing up all

information including advantages, disadvantages and
consequences of each option

10. * Explains how the chosen service would be provided; its side
effects; and possible complications which may require referral
to higher level facility in rare cases

11. Checks that client fully understands the chosen option by asking
them to repeat key points

12. * Checks that client’s decision for chosen service is voluntary

13. * Takes informed consent appropriately with consideration for

vulnerable groups such as young people; illiterate; clients with
history of sexual abuse or violence, long term physical, mental,
intellectual or sensory impairments and mental health illness
14. * Documents written informed consent appropriately as per MSI/
local protocols

MSI Competency Assessment Checklist: Counselling v4.0 Page 1 of 4

15. Indicates how and where to access the chosen service.
If appropriate, discusses scheduling; and interim or partner
contraception

Method-Specific Counselling Yes/No/NA Notes

TUBAL LIGATION

16. * Emphasises that although tubal ligation is a permanent method

there is a very small chance of failure

17. If postpartum, discusses with the client if their decision would

change if the baby were to die or suffer from health problems

VASECTOMY

18. * Emphasises that although vasectomy is a permanent method

there is a very small chance of failure

19. * Explains that the method will become effective only after 3
months so an additional contraceptive method will be required
during this time

IUD/IUS

20. * Emphasises that IUD/IUS are long acting reversible

contraceptives that are very effective

21. Explains that the client can switch method if unhappy with the
method

IMPLANTS

22. * Emphasises that implants are long acting reversible

contraceptives that are very effective

23. Explains that the client can switch method if unhappy with the
method

PROGESTIN-ONLY INJECTABLE

24. Emphasises that progestin-only injectable is a reversible

contraceptive with a very small chance of failure if the injection
is repeated at the right time

25. Explains that after stopping the injection there may be a delay
in return to fertility of up to one year

ORAL CONTRACEPTIVE PILL

MSI Competency Assessment Checklist: Counselling v4.0 Page 2 of 4

26. * Emphasises that oral contraceptive pills are short acting
contraceptives with a small chance of failure if the pill is taken
correctly

27. Explains hormonal side effects and risks associated with taking
oestrogen

CONDOM

28. Emphasises that a new condom needs to be used correctly for

every sexual encounter for maximum effectiveness

29. Emphasises that condoms are the only contraceptive method that
can protect against both pregnancy and sexually transmitted
infections and HIV

EMERGENCY CONTRACEPTION

30. * Explains that emergency contraception (EC pill and copper

IUD) helps to prevent pregnancy when taken up to 5 days after
unprotected sex but the sooner they are taken, the more
effective they will be

31. Explains that emergency contraceptive pills (ECPs) will not

protect from pregnancy from any episodes of unprotected sex
that occur after they take the ECPs

SAC/ PAC

32. * Emphasises key characteristics of SAC/PAC option chosen

33. * Explores PAFP needs and explains options

General Counselling: Post-Procedure Yes/No/NA Notes

34. * Provides post procedure instructions orally and in writing if

possible for the following:
• Follow-up care
• Follow-up visits where required or as per local protocols
• To return or call any time for advice or medical attention
• Warning signs and what to do in such cases
• Contact number (preferably 24/7) for any emergency related to
the service

35. Discusses arrangement for discharge (e.g. person accompanying

client to home)

MSI Competency Assessment Checklist: Counselling v4.0 Page 3 of 4

 Result of Competency Assessment
* Attach Competency Assessment Checklist if clinical staff is assessed as level 2

Service Assessed: Counselling Tick as

appropriate

Level 1
• Individual completed all steps correctly.
• Competent to provide this service independently subject to regular re-assessment.

Level 2 *
• Individual missed one or more of the steps.
• Cannot provide this service independently. Must offer this service only under direct
supervision of a competent clinical staff till endorsed as fully competent by the
competent clinical staff.

Other observations:

Specify actions to be taken to achieve/maintain competency:

Clinical Staff Name: Clinical Staff Signature:

Competency Assessor Name: Competency Assessor Signature:

Date of Assessment: Location:

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