The impact of counseling and the quality of services provided by both skilled and unskilled health care workers within government facilities in Zou/Collines, Benin was assessed both prior to and following the intervention trial. At both points, baseline/endline data was collected on the quality of counseling, health workers' knowledge of maternal care, in addition to facility-based newborn care practices. At this time, a pictorial set of counseling cards was also introduced, which were to be used to improve upon current service delivery. Fourteen public health maternities were included in the study, of which seven were randomly assigned to interventions and the other seven to control groups. Methods of evaluation consisted of direct observation and exit interviews with pregnant women and new mothers, in addition to extensive surveying of both skilled and unskilled workers.

Results indicated that the baseline quality of skilled provider counseling was inadequate; however, it improved substantially, as a result of training, increased supervision, and the implementation of job aids. This was directly correlated with improved maternal care knowledge in areas such as birth preparedness, maternal and newborn danger signs, newborn care, and healthy home practices. The study confirmed that lay providers were also capable of achieving comparably high performance levels using job aids. In conclusion, task delegation and job aids both significantly improve the quality of counseling provided by health care workers, in addition to increasing patient understanding of maternal and newborn care.