Using the Disca Tool

The Quality of Care for Sexually Transmitted Diseases in 

Region E Eastern Cape 

Using the DISCA Tool. 

1

Written by: Grace Mufamadi and Bongiwe Shongwe. 

Produced by the National STI Initiative: 

The National STI Initiative developed as a response to the recommendation from the National 

HIV/AIDS Review in 1997, which documented high rates of Sexually Transmitted Infections in 

South Africa and their crucial importance in the spread of HIV. 

It is a collaboration of the Initiative for Sub-district Support (ISDS), Reproductive Health Research 

Unit (RHRU) and the Department of Health and the Kaiser Family Foundation funds it. Its aim is to 

strengthen district level capacity to implement effective STD control programme. 

Acknowledgements 

Many thanks to all who contributed, in various ways; like arranging the meetings, making transport 

available, and collecting data at the clinics, particularly Mr. S. Yose (Acting Regional Director) the 

communicable diseases coordinators 

Mrs G. Makwabasa, Mrs S. Vengeni, Mrs Mdolo, 

Mrs O.Ntshangase, Mrs Nomso Arosi MSH regional co-ordinator and the clinics that participated in 

the implementation of the DISCA. 

A special thank you to Dave McCoy and Anne Moys for their valuable input into the document. 

Your commitment, wisdom and effort have made it possible for a report of this nature to be 

available. 

TABLE OF CONTENTS 

INTRODUCING THE DISCA TOOL IN REGION E ................................................................4 

PROFILE OF REGION E……………………………………………………………………… ...5 

2

FINDINGS AND INTERPRETATION ......................................................................................6 

Findings in the Mount Frere Health District.............................................................................6 

Findings in the Maluti Health District ......................................................................................8 

Findings in Flagstaff Health District ......................................................................................10 

Findings in Umzimkhulu Health District................................................................................12 

TABLES AND GRAPHS COMPARING THE FOUR DISTRICTS .........................................15 

GENERAL COMMENTS.........................................................................................................21 

CONCLUSION ........................................................................................................................24 

RECOMMENDATIONS ..........................................................................................................25 

3

INTRODUCTION 

Sexually transmitted infections (STIs) are a major health problem in South Africa. They not only 

present a huge disease burden on society but also facilitate the spread of HIV. The care and 

management of patients with STIs has been identified as a key area to enhance HIV prevention 

efforts in our country. 

To assess the quality of care of sexually transmitted diseases a tool known as DISCA (District 

STD Quality of Care Assessment) was developed after consultation with nurses, public health 

professionals, and health services managers. 

The tool is a short questionnaire that looks at the key input, process and output indicators related 

to STD care. This tool has been approved by the Department of Health (DoH) and is contained in 

Appendix 1. 

INTRODUCING THE DISCA TOOL IN REGION E 

The tool was introduced in this region of the Eastern Cape in June 2000. A meeting was held 

with the regional DoH where it was presented and the intentions of implementing it within the 

region were outlined. 

In the meeting, the tool was accepted and there was strong agreement that it should be 

implemented in all the districts in the region. However, that was subject to the districts buying 

into the idea of DISCA. A second meeting was then held where the districts were invited and the 

proposal (to introduce the tool in the districts) was outlined to them. Each district had a 

representative; either a District Manager, a district Communicable Disease Manager, a Health 

Information officer, Clinic Supervisor or a Programme Manager. 

Although there was agreement with the district representatives that the tool would be 

implemented in their districts, problems emerged when it was time to implement the DISCA: 

• Resistance to the tool since it was perceived to be a duplication of the provincial HIV/ 

AIDS, STD and TB (HAST) tool. 

• District representatives could not meet with their district colleagues due to time 

constraints. 

• The tool was seen as extra work, since the districts were already overloaded with 

meetings, workshops, etc. 

• People looked at the tool as a research project for people to gain information, write their 

dissertations and are never heard of again. 

• There was a feeling that there was not going to be enough manpower to implement 

DISCA. 

These issues raised were important. Much time was invested in addressing them. 

The ISDS nurse training facilitator spent time building rapport with the staff, mainly 

telephonically, giving continuous support and communicating the advantages of the tool. 

4

In addition, the ISDS nurse training facilitator accompanied clinic supervisors and 

programme coordinators in their visits to several clinics. 

PROFILE OF REGION E 

Region E of the Eastern Cape comprises of four districts i.e. Mount Frere, Flagstaff, 

Umzimkhulu and Maluti. Mount Frere’s population is estimated at 290 000. Flagstaff has an 

estimated population of 490 000; Maluti’s is estimated at 290 000 while Umzimkhulu’s is at 

150000. The health clinics in all these districts are highly under sourced and lack basic services. 

(ISDS Mt Frere Technical report: November 1997) 

Data Collection 

A total of 106 DISCA questionnaires were handed out and 70 were returned. The table below 

outlines the breakdown of the questionnaires given out and those returned: 

District Population Total Number of 

Clinics. 

Number of Clinics 

Assessed. 

Maluti 290 000 22 18 (81%) 

Umzimkulu 150 000 24 18 (75%) 

Flagstaff 490 000 41 17 (41%) 

Mt. Frere 290 000 19 17 (89%) 

A team of people was responsible for conducting the assessments. They included community 

matrons, clinic supervisors, hospital tutors, communicable disease managers, district research 

teams, and nurse trainers. Initially, there was agreement that clinic supervisors should be the 

ones conducting the interviews, as the aim of the tool is to support supervision. However there 

was a feeling that nurses were not going to feel comfortable talking to supervisors. It also 

emerged that some supervisors were not going to be available due to time constraints. 

Each clinic was to be notified of the DISCA exercise by the communicable disease managers or 

supervisors before time. However, some clinics could not be contacted and only knew of the 

exercise when the DISCA was actually implemented. 

Conducting interviews 

One Sister per clinic was interviewed. In the absence of a clinic sister, a nursing assistant or 

enrolled nursing assistant was interviewed. Only one person in the team conducted the actual 

interviews, while others checked the drug stores and the clinic register. This only happened if 

there was more than one person doing the interview. If there was only one interviewer, he/she 

did all the checks as well. 

5

Findings in the Mount Frere Health District 

Accessibility and Utilization 

This looked at accessibility in terms of time, availability of consultation rooms, privacy of those 

consultation rooms and whether all the consultation rooms treated STIs. 

• All the clinics were open between 8-4 with the exception of one clinic that did not give a 

response to the question. 

• Half of these clinics were not accessible after hours. 

• The number of consultation rooms in the 16 clinics was 23. Each clinic ranged from 1-5 

with an average of 1,4 

• All the available rooms were used for STI consultation. Of the 15 clinics that responded 

to the question regarding privacy, 13 said that they treated their STI patients in privacy. 

• The number of adult patients seen was 16,130 per month with a range of 625-2985 and an 

average of 949 patients per clinic per month. 

• Only 13 clinics indicated the number of STI patients. The STI patients range from 6-382 

with an average of 54.2 

• The total number of STI clients was 704, which is 4.4% of the adult patients. This is a 

very small proportion, which could be attributed to the following reasons: 

• Data collection was not accurate or 

• People do not go to clinics when they have STIs 

• Clinicians do not detect STIs in clients coming for other reasons. 

Examination facilities 

• All the clinics had examination couches. However, only 11 clinics had examination 

lights. This was worrying since for proper examination of female genitalia there must be 

adequate lighting. 

• Only 9 (52%) clinics had sterilized specula. This was quite worrying and may be an 

indication that women are not properly examined. The methods employed for sterilizing 

specula are boiling and disinfecting. 

• All the clinics had examination gloves 

Provision of safe and effective treatment 

• Sixteen clinics responded to this question and all of them had STI guidelines. Fifteen 

responded that they had these guidelines in the consultation rooms 

• All the clinics had individual education material 

• Only 7(41%) clinics had the education material in Xhosa. This is very worrying because 

it means that there are people who do not benefit from such material since they cannot 

understand it. 

• 16 (94,1%) clinics had dildos available. 

• Only one clinic had syphilis testing done on site. 

• Only 12 of the 17 clinics had Partner Notification cards available and of the 12, only 4 

had these cards in a local language. 

6

• It is worrying to note that not all STI patients get tested for syphilis; in fact there seems to 

be no STI patients tested for syphilis at all. This could also be an indication that the 

interviewers did not understand the question. 

Treatment of STI clients 

This section indicated the number of STI clients seen, the common infections and whether the 

infections seen were treated correctly, according to the STI protocol. It also looked at whether 

blood is tested for latent Syphilis. 

• This section was generally poorly completed. Some clinics did not fill it in at all while 

some filled it in incompletely. 

• A large number 108 (15,3%) of clients presented with vaginal discharge. There were no 

cases that presented with mixed syndromes, an indication that correct examination is not 

being done (e.g. speculum examination on women) or that there was incorrect diagnosis. 

• The percentage of clients correctly treated was only 26%, a very low figure indeed. This 

may be indicative of a number of reasons such as: 

• Drugs shortage, resulting in staff giving what is available and 

hoping for the best. 

• Lack of knowledge on what to prescribe 

• Staff did not use or did not know how to use protocols in their 

consultation rooms 

• Staff did not record the treatment that they have given. 

Antenatal Screening and STD Treatment 

This section looked at the number of pregnant clients screened for syphilis and assessed the 

referral of patients 

• 14 clinics conducted syphilis tests on all pregnant women and all the clinics examined 

and treated pregnant clients for STIs other than syphilis. 

• Six clinics referred women with genital warts. 

7

STI drugs and treatment 

• This section looked at the availability of drugs. This was another section of DISCA that 

was poorly filled in. Quite a number of clinics did not fill in this part. 

Drug 

Out of stock at the time of DISCA 

assessment 

Out of stock in the month prior to 

Disca assessment 

Ciprofloxacin 5.8% 11.7% 

Metronidazole 17.6% 11.7% 

Erythromycin 70.5% 47% 

Doxycyline 5.8% 23.5% 

Benzathine 5.8% 5.8% 

• There was a serious shortage of drugs in the clinics. Transport problems were cited as the 

reason for this shortage. 

Staff training 

This section evaluated the number of staff that has gone for training in both STI Management 

and AIDS Counseling. It also looked at the number of staff working in a facility. 

• The total number of Professional Nurses was 41, average was 2.4. 

• Of the total number, 83% had been on formal training in STI Management and only 31% 

had received training in HIV Counseling. There is a great need for staff to attend courses 

in AIDS Counseling. 

Findings in Maluti Health District 

Accessibility 

• All the clinics, except one were open between 8-4pm. 

• Only 4 (22%) clinics did not open after hours. 

• The number of consultation rooms in all the 18 clinics was 25. Each clinic ranged from 

0-2 with an average of 1.4. 

• Seventeen clinics used all rooms for STI consultation and all the seventeen treated STI 

patients in private. 

• Seventeen clinics responded. The total number of adult patients was 11315 with a ranged 

of 252-1455 and an average of 629. 

• The total number of STI clients was 209, which is 1.8% of the adult patients. The STI 

patients ranged from 1-48 with an average of 12.3. 

8


This looked at the availability of equipment, which has a great impact on the quality of 

examinations done and eventually the correct diagnosis. 

• Sixteen (89%) clinics had examination couches. The other two clinics without couches 

were Mobile Clinics. These could be using stretchers to examine clients. 

• Fifteen clinics had examination lights. 

• Only 8 (44%) clinics had sterilized specula. This is a very low percentage and quite 

worrying. Together with the low percentage of examination couches, this could mean that 

STI patients were not examined – clinicians only listened to the symptoms as described 

by the patient and then prescribed. There are only two clinics where speculum 

examinations are done on all women. The implication is that clients would be 

inadequately treated since other infections would not be picked up. 

• The methods employed for sterilizing specula were boiling and using a disinfectant 

solution 


Provision of safe treatment 

• All the clinics had STI guidelines, and 17 of them had these guidelines in the consultation 

rooms 

• Only 11 (61.1%) clinics had individual education material. This is a very worrying 

percentage since it indicated a missed opportunity in educating clients about STIs. 

• Only 1(5,6%) clinic had the education material in a local language. Again, they are 

missing out on clients who may not understand English. 

• Only two clinics had syphilis testing done on site. 

• Those not done on site, time for the results to come back ranged from the same day to 3 

days. 

• Only 4 (23.2%) clinics had dildos available for education. Those that did not have them 

stated that clinicians demonstrated the use of condoms using their fingers or they just tell 

clients how condoms were used without any demonstration. It is crucial that people know 

how to use condoms properly and they might not understand this if there is no proper 

demonstration, and for this, a dildo is essential. 

• No STI patients were tested for syphilis at all. 


• A number of clinics did not fill in this part of the questionnaires. This could be due to the 

fact that they did not understand what they had to do. This shows a need to train people 

on the DISCA tool and its significance before it is used. 

• There were not many clients (only 1) that presented with more than one STI. Clinicians 

could be missing other syndromes because they do not do proper examination. This is not 

surprising judging by the fact that not all women have speculum examination done on 

them. 

• The percentage of clients correctly treated was only 8.9%. The same reasons as in Mount 

Frere apply here 

9


• Only 2 (22%) clinics reported doing syphilis testing on all pregnant women attending 

ANC for the first time. 

• Sixteen (89%) examined and treated women for STI other than syphilis 

• Most clinics (29%)referred clients who did not respond to treatment. One clinic referred 

all pregnant women with STIs. Two clinics did not refer women with STIs but treated 

them. 


This section looks at the availability of drugs 

Drug 


assessment 



Ciprofloxacin 11.1% 50% 


Erythromycin 55.5% 27.7% 

Doxycyline 16.6% 33.3% 

Benzathine 0% 22.2% 

• Many clinics did not fill in this section. A very worrying factor because one can then not 

get a clear/true picture of the drug situation in the district. Nevertheless, there does seem 

to be a problem with drug supply in most clinics. 


• The total number of Professional Nurses is 35, average 2 per clinic. 

• Of the total number, (48%) have been on formal training in STI Management and only 

14% have received training in HIV Counseling. There is a big need for staff to be trained 

on STI Management and HIV Counseling 

Findings in Flagstaff Health District 

Only 41% of the DISCA questionnaires were returned. A total of 41 were given out and only 17 

came back. Again, a lot of the sections on the questionnaires were also not filled in completely. It 

is possible that there was not enough time to conduct the interviews or the importance of the 

DISCA tool was not properly communicated. 

Accessibility 

• All the clinics in this region were opened at all times between 8-4pm 

• Three clinics did not respond to this question. Twenty three (59%) of the clinics did not 

open after hours 

• The total number of consultation rooms was 35, the range 1-4 and the average 2.1 

• Seventy (70%) of the clinics used all rooms for STI consultation and in 94% of these 

consultation rooms; STI patients were treated in private. 

10

• Sixteen clinics responded. The total number of adult patients is 10043 with a range of 30- 

3234 and average of 591 per clinic. 


patients range from 8-395 with an average of 48.2. Sixteen clinics responded to this 

question. 


• Ninety-four (94%) of the clinics had examination couches. 

• Only 59% of the clinics had examination lights. 

• Only 35.3% of the clinics had sterilized specula. 

• Thirty-five (35%) of the clinics did not respond to this question. The method used for 

sterilizing specula was dipping them in a disinfectant solution. 

• Ninety-four (94%) of the clinics had examination gloves 


• All the clinics had STI guidelines, but only 70% of them had guidelines in all the 

consultation rooms. 

• Only 82% of the clinics had individual education material. Three clinics did not respond 

to this question. 

• Only 29% of the clinics had the education material in a local language. 

• Three clinics had syphilis testing done on site. 

• The time taken for the results to come back from the laboratory ranging from four days to 

two weeks. 

• 70% of the clinics have had male condoms running out in the past month, an alarming 

figure indeed. This is a worrying development in the wake of HIV/AIDS 

• All the clinics showed their clients how to use condoms, although only 53% had dildos 

available. Most used posters and verbal education, to teach their clients about condom 

use. 

• 88% of the clinics had Partner Notification cards in adult consultation rooms. 

• Only 1 clinic takes RPR blood from all STI clients. The follow up question (which 

patients have blood taken for RPR) did not receive any response from the clinics except 

for one clinic, which gave syphilis as the answer. This clearly indicates that the question 

was not understood. 


• This section of the questionnaire received a very poor response. This could be because 

the questions were not clearly understood, or that the respondents did not know what was 

expected here. This again shows a need for more training on the tool. 

• A significant number of clients presented with genital ulcers. Only one presented with 

multiple STIs. 

• The percentage of clients correctly treated was only 18.9%. 


• Only 64% of the clinics reported doing syphilis testing on all pregnant women attending 

ANC for the first time. Two clinics did not respond to this question. 

11

• 70.5% examined and treated women for STI other than syphilis 

• Only two clinics did not refer pregnant STI clients for treatment. Three clinics referred 

first trimester cases and two referred women with genital warts. 



Drug 


assessment 



Ciprofloxacin 0% 59% 

Metronidazole 18% 35% 

Erythromycin 82% 64% 

Doxycyline 53% 59% 

Benzathine 0% 6% 

• Drugs shortage, especially erythromycin and Doxycyline is a serious issue in this district. 

Reasons cited for this shortage were bad roads, which made it impossible for transport 

delivering drugs to reach the clinics. Insufficient supply was also another reasons. 


• The total number of Professional Nurses was 35, an average 2 per clinic. 

• Of the total number, 37% had been on formal training in STI Management and only 5.7% 

had received training in HIV Counseling. There is a big need for staff to be trained on 

STI Management and HIV Counseling 

Findings in Umzimkhulu Health District 

Of the 24 questionnaires that were given out, 18 were returned. The following findings are based 

on the 18 questionnaires that were returned. 

Accessibility 

• All the clinics are open at all times between 8-4pm 

• Sixty one (61%) of the clinics do not open after hours. Of all the districts in region E, this 

is the district with the highest number of clinics not opening after hours. 

• The total number of consultation rooms was 30. The range was 0-7 and the average 1.7 

• Eighty three (83%) of the clinics use all rooms for STI consultation and in 77% of the 

consultation rooms STI patients are treated in private 

• The total number of adult patients was 20914 with a range of 369-2684 and the average 

of 1161 


patients range from 11-156 with an average of 42.4 Seventeen clinics responded. 


• Only 88.9% clinics had examination couches. 

12

• Only 44.4% clinics had examination lights. This is a very worrying factor because it then 

has a negative effect on the way women are diagnosed. 

• Only 66% clinics had sterilized specula. 

• The method used for sterilizing specula is boiling. Five clinics did not respond to this 

question. This could indicate that the question was not understood. This again, proves a 

great need for training in the DISCA tool or they don’t have or use specula. 



• 94% of the clinics had STI guidelines, and all of them had these guidelines in all the 

consultation rooms 

• Only 66% of the clinics had individual education material. 

• Only 39% of the clinics had the education material in a local language. Again, they are 

missing out on clients who may not understand English. 

• Only four clinics had syphilis testing done on site. 

• The time taken for the results to come back from the laboratory ranging from one hour to 

a month. 

• 44% of the clinics have had male condoms running out in the past month. This is a 

worrying development in the wake of HIV/AIDS 

• 44% of the clinics had Partner Notification cards in adult consultation rooms. This was a 

very low percentage. With STIs, it is quite important that partners get treated as well to 

avoid re-infection. It would be interesting to find out if clients are told to bring their 

partners to the clinic as well. 

• Only 4 clinics take RPR blood from all STI clients and those that do not do this, take 

blood only for the following cases: 

• Relapses 

• Genital sores 

• Suspected syphilis 

• Clients that are not responding to treatment 


• 67 (8,75%) of all the STI patients treated was vaginal discharge. 

• Only 2 clients presented with multiple STIs 

• The percentage of clients correctly treated was only 16%. The same reasons as in Mount 

Frere apply here 


• Only 56% of the clinics reported doing syphilis testing on all pregnant women attending 

ANC for the first time. 

• 89% examined and treated women for STI other than syphilis 

• Only two clinics did not refer pregnant STI clients for treatment. Most clinics (47%) 

referred clients with genital warts. 

13



Drug 


assessment 



Ciprofloxacin 11.1% 22.2% 


Erythromycin 44% 22.2% 

Doxycyline 50% 39% 

Benzathine 16.6% 22% 

• 44% of the clinics responded that although they did get drugs, the supply was usually 

insufficient, which was why they found themselves running out of drugs. 


• The total number of professional Nurses was 34, with the average of 2 per clinic 

• Of the total number, 41% had been on formal training in STI Management and only 26% 

had received training in HIV Counseling. There is a big need for staff to be trained on 

STI Management and HIV Counseling 

14

TABLES AND GRAPHS COMPARING THE FOUR DISTRICTS 

ACCESSIBILITY 

MT FRERE MALUTI UMZIMKULU FLAGSTAFF 

Clinics that open between 8-4pm 94.1% 94.4% 100% 100% 

Clinics that offer after hour’s service. 47% 77.8% 39.9% 23.5% 

No of consultation rooms. 23 25 30 35 

Clinics that have all consult. rooms treating 94.1% 94.4% 83.3% 70.6% 

STI. 

Clinics that offer private consultation in their 76.5% 94.4% 77.8% 94.1% 

consultation rooms. 

Total number of adults patients. 16130 11315 20914 10043 

Total No. of STI clients last month 704 209 754 819 

Percentage of STI clients to total adults 4.40% 1.80% 3.60% 8.10% 

SAFE EXAMINATION: 


Clinics with examination couches. 100% 88.9% 88.9% 94.1% 

Clinics with examination lights. 64.7% 83.3% 44.4% 58.8% 

Clinics with available specula 52.9% 44.4% 66.7% 35.3% 

Method of sterilizing speculum. nr = 12 

boiling = 2 

solution = 3 

nr = Not Responded 

nr = 1 

boiling = 7 

n/a = 2 

not used = 1 

solution = 7 

nr = 5 

autoclaving = 2 

boiling = 11 

Clinics with examination gloves. 100% 100% 100% 94.1% 

nr = 8 

autoclaving = 1 

boiling = 2 

solution = 6 

15

No. of women who have speculum exam done on them 

70.00% 

60.00% 

50.00% 

40.00% 

30.00% 

20.00% 

a few 

all 

most 

none 

10.00% 

0.00% 

Mt frere Maluti Umzimkhulu Flagstaff 

TREATMENT OF STI CLIENTS MT FREREMALUTI UMZIMKULU FLAGSTAFF 

Total Number of STIs seen 704 209 754 819 

No. of treated clients recorded 

No. of Urethral discharge 25 20 25 10 

No. of Vaginal discharge 108 29 67 13 

No. of PID 7 9 38 5 

No. of Genital Ulcers 5 4 28 12 

No. of Genital Warts 0 1 0 1 

Mixed infections: 

No. of Vaginal discharge with Genital 

Ulcers. 

No. of Urethral discharge with Genital 

Ulcers 

Others: 

1 

1 

2 1 

No. of Balantis 1 

No. of Inguinal Absces 2 1 

No. of Burning of micturition. 2 5 

No. of Scrotal Swelling 1 1 1 

No. of Pubic lice 1 

Percentage clients correctly treated. 26.50% 8.90% 16.10% 18.90% 

Prescription correct Yes = 45 

No = 99 

Nr = 26 

Was RPR or UDRL test requested yes = 1 

no = 143 

Yes = 16 

No = 15 

Nr = 149 

yes = 0 

no = 4 

Yes = 29 

No = 88 

Nr = 63 

yes =17 

no = 92 

Yes = 32 

No = 0 

Nr = 138 

yes = 2 

no = 41 

16

Flagstaaf's STI clients treatment 

Mt frere's STI clients treatment 

18.90% 

26.50% 

Correct 

Incorrect 

Correct 

Incorrect 

81.10% 

73.50% 

Umzimkhulu's STI clients treatment 

Maluti's STI clients treatment 

83.90% 

16.10% 

Correct 

Incorrect 

91.10% 

8.90% 

Correct 

Incorrect 

17

PROVISION OF SAFE TREATMENT. 


Clinics with guidelines in all consultation rooms. 88.2% 94.4%) 94.4% 70.5% 

Clinics with individual patient education material. 100% 61.1% 66.7% 82.3% 

Clinics with education material in local language. 41.2% 5.6% 38.8%) 29.4% 

Clinics that do syphilis tests on site. 5.9% 11.1% 22.2% 17.6% 

Turn around time for Syphilis. Within an hour = 1 3 days = 1 

same day = 1 

1 hour = 2 

1 week = 1 

1 week = 1 

2 weeks = 1 

4 days = 1 

1 month = 1 

Clinics with male condoms running out. 0% 11.1% 44.4% 70.6% 

Clinics that show STI clients how to use a condom. 100% 77.8% 100% 100% 

Clinics with dildos available. 94.1% 23.2% 88.9% 52.9% 

Clinics with Partner Notification cards in adult cons. 70.6% 83.3% 44.4% 88.2% 

Rooms. 

Clinics with Partner Notification cards in a local 23.5% 0% 55.5% 64.7% 

language 

Number of Partner Notification cards issued last month. 237 124 175 221 

How many partners came for treatment last month. 143 45 175 132 

Clinics that take RPR blood from al STI clients. Not done Not done 4 clinics 1 clinic 

If not for which pts. Was blood taken for RPR? None None relapses = 1 

genital sores = 1 

suspected syphilis = 

1 

not responding to 

treatment = 1 

syphilis = 1 

18

PERCENTAGE OF SPECIFIC STIs 

16.00% 

14.00% 

12.00% 

15.34% 

13.80% 

10.00% 

8.00% 

6.00% 

4.00% 

2.00% 

0.00% 

3.50% 

0.71% 0.99% 

9.09% 

3.82% 

8.75% 

5.04% 

3.71% 

3.18% 

1.90% 

1.22% 

1.57% 1.46% 

0.49% 

0.61% 0.12% 

Mt FRERE MALUTI UMZIMKHULU FLAGSTAAF 

UD 3.50% 9.09% 3.18% 1.22% 

VD 15.34% 13.80% 8.75% 1.57% 

GU 0.71% 1.90% 3.71% 1.46% 

PID 0.99% 3.82% 5.04% 0.61% 

GW 0.49% 0.12% 

district 

UD 

VD 

GU 

PID 

GW 

19

STAFF TRAINING. 

MT MALUTI UMZIMKULU FLAGSTAFF 

FRERE 

No. of Professional nurses working at 41 35 34 35 

this clinic. 

Those have been on formal training in 82.9% 48.5% 41.1% 37.1% 

STI. 

Those on formal training in HIV 31.7% 14.2% 26.4% 5.7% 

counseling. 

No. of doctors, Clinicians working today. 32 33 42 44 

Clinics with STI supervisor. 100% 83.3% 11.1% 52.9% 

20

GENERAL COMMENTS 

COMMENTS MT FRERE 

Problems affecting daily delivery of quality STI. Recommendations to improve the situation. Action Plan 

Shortage of drugs Improve drug supply Staff training on prescription writing (drug dosage and duration) 

Staff shortage More staff Develop partner notification slips in local language 

Contacts not coming back Supervisors to visit regularly Improve client examination 

No privacy in consultation rooms More transport Ensure staff follow guidelines (STD) 

Clinic supervisors not visiting Improve community awareness on STD Develop posters in local language 

Shortage of equipment Nurse training on STD and AIDS counseling Send staff for courses 

Unused specula, although available (need for training) 

Work on roads 

Less attendance because of STD stigma 

No hospital feedback after referring 

COMMENTS Flagstaff 


Delayed drug supply Health promotion to be undertaken Transport for blood to hospitals 

Contacts not reporting Staff training Staff training 

Lack of transport to send blood specimens to hospitals Superintendent motivated to improve drug supply 

Negative attitude towards condoms Community awareness 

Difficult for clients to trace partners More IEC material on preventative measures 

Condoms running out of stock Supply of equipment 

Insufficient equipment 

Bad roads 

21

COMMENTS Maluti 


Shortage of drugs Need for staff training on STI, HIV counseling and screening Consult with dispensary for drug supply 

Lack of equipment (specula, dildos etc) Increased staffing Involvement of supervisors on clinic problems 

Contacts not coming for treatment Regular drug supply Improved clinic structure (building) 

Blood not taken to the lab (transport problems) Supply of equipment Staff training to improve service delivery 

Lack of privacy in the consultation room Regular supervision and discussion of problems Transport provision 

Staff shortage Appropriate building for privacy Have STD awareness day 

Scope limits performance (*clinics run by staff nurses) Staff to follow guidelines 

No training on STD Health education on male patients 

No blood testing facilities Contact tracing 

No visiting doctor and refereed clients do not comply 

*gender issues* 

No policy for blood collection 

*no problems* 

COMMENTS Umzimkhulu 


Shortage of drugs Staff training on STD management Effective transportation of specimen 

Staff shortage Treat after hours as well Training on speculum examination 

Contacts not coming back Community awareness Training on HIV/AIDS counseling 

Inadequate equipment (dildos, specula and lights) More drugs available Drug recording to be improved 

Shortage of transport (affecting blood transportation) Supply of equipment Develop slips in local language 

Nurses not trained on STD management Home visits to follow up on clients Develop IEC material in local language 

Partner notification cards not available Clinic supervisor to be more involved in the running of the clinic Supply condocan 

Lack of privacy Keep blood register to ensure follow up 

Inadequate use of guidelines Plan to transport drugs more effectively 

No policy for blood taking IEC in local language 

IEC material not in local language Sister in charge to educate other nurses on syndromic management 

23

All the districts recommended the following: 

♦ Training STIs and HIV counseling. 

♦ Improving drug supply. 

♦ Supply of equipment. 

♦ Regular supervisory support. 

♦ Contact tracing. 

♦ Community awareness. 

It is encouraging to note that clinic workers recognize the fact that the communities are to be 

made aware of STIs in particular. 

CONCLUSION 

This DISCA analysis highlighted some of the significant problem areas in terms of: 

♦ Drugs – drugs are the main component of STI care without drugs even if other things are in 

place there will be no ways in which the quality of care and the fight against STIs and 

HIV/AIDS will succeed. 

♦ Transport – looking at the distance of the clinics to the central stores for medication, if 

medications are there but they are unable to reach the facility then the quality of care for 

STIs might as well be forgotten or else an alternative method of drug delivery must be in 

place. 

♦ Staff – more staff is needed, adequate time to spend in ensuring a comprehensive health 

history, thorough examination and health education. Particularly with the headcount 

indicated by the data 

♦ Training – It is imperative. Both on the tool itself, the STIs and HIV. 

♦ Clients/Contacts – There is still much that needs to be done regarding clients consulting and 

contacts responding. 

♦ Privacy – this needs attention, for the clinics to have a good turn out of clients at least 

physical privacy should be ensured by using screens in cases where the consultation rooms 

are wide open, whilst waiting for reconstruction of clinics. 

♦ Speculum and lights – for the successful treatment of STIs this equipment is desperately 

needed of course with the training for use. 

♦ IEC – there is a need of pamphlets written in the local language. 

24

RECOMMENDATIONS 

1. Supply of drugs due to high prevalence of PIDs, which indicates that clients are not properly 

treated, are treated inadequately because drugs are not available. 

2. Supply of vaginal speculum for a high prevalence of vaginal discharges, which often come as 

mixed infections. 

3. Training on STIs needed due to low percentage of the correct prescription i.e. 26,5%. 

Training on recording since records are legal documents and often evaluations of any kind 

use records therefore it needs to be appropriate also for the district health information. 

Training is needed on the DISCA tool itself since it has shown that respondents did not know 

what was required of them. Training of staff nurses on the same issues if used in clinics to 

diagnose. 

4. Home based care training is highly recommended especially at Umzimkulu which has a high 

percentage of Genital Ulcers meaning more HIV/AIDS 

25

Using the Disca Tool

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