Health Policy Issues and Health Programmes in ... - Amazon S3

Quality of RTI/STI Case Management Services in India: Perspectives and Challengesservices that include case management of STIs, thereby promoting infection-free sex. Thecoincident recognition that STIs enhance HIV transmission, coupled with growing awareness ofthe magnitude of the HIV epidemic, led to a rapid expansion of STI control programmesthroughout the developing world. Within both HIV/AIDS control and conventional familyplanning/MCH programmes, there were rapid and widespread efforts to add STI casemanagement services (WHO, 1999).Present Status of STI Management in IndiaIn India, a vertical national health programme known as the National Venereal Diseases (VD)Control Programme was launched in 1956 to reduce the prevalence of classical VDs in highlyendemic districts of the country. The programme strategy was based on establishing VD clinicsto provide services to those who seek treatment at identified facilities. In medical care settings,treatment services are available through departments of dermatology and venereology inmedical colleges and also in district hospitals. District STI clinics are now established with theNational AIDS Control Organization (NACO) support in most districts in the country. Also, thereis a vast network of private providers belonging to different systems of medicine, includingunqualified practitioners, faith medicine healers, herbalists, and chemists and druggists, whocater to a large proportion of patients suffering from these diseases. As per findings from theNFHS-2, only one-third of women who reported any RTI and sought treatment accessed thepublic health care delivery system (IIPS, 2000).160Family health awareness campaigns (FHAC) have been organized since 1999, as a programmaticresponse to encourage case management of STIs by raising awareness of causation,transmission, and prevention of these diseases and also by offering opportunities for treatmenton scheduled days during the campaign period. Almost all medical officers in the primaryhealth centres (PHCs) have undergone training in syndromic management of STIs using NACOguidelines. Drugs and medicines are also being made available during these camps. However, arecent evaluation of the FHAC (IndiaCLEN, 2000) indicates that among the target population, 73percent in rural areas and 82 percent in urban slums were unaware of the existence of any suchprogramme. Undoubtedly, such campaigns have helped in raising awareness among serviceproviders regarding common STIs, but access and availability of quality treatment services on aregular basis remain major concerns. In UNFPA-supported Integrated Population andDevelopment projects in six states of the country, services for prevention and management ofcommon RTIs are being made available in selected districts within primary health care settings(UNFPA, 2000).Treatment-Seeking BehaviourThere are several treatment-seeking behaviour studies which indicate that patients sufferingfrom STIs access private providers, from both the qualified and unqualified sectors. Whilethere is a culture of silence among women with respect to seeking treatment, men tend toseek services from private sources including chemists. Invariably there is a delay of three tofour months in seeking treatment, as either these conditions are not taken seriously or womenfeel shy or fear stigmatization. Women do know and try common home remedies. Theperceived poor quality of services offered by the public system also acts as a barrier in seeking