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

Quality of RTI/STI Case Management Services in India: Perspectives and ChallengesRecent years have witnessed a rapid expansion of health care infrastructure in the country. Towhat extent are these services integrated in the ongoing RCH programme at the peripherallevel? The public sector remains a major source for preventive and promotive reproductivehealth care interventions in the country, especially in rural areas. Despite the magnitude of theRTI/STI/HIV problem, family planning service providers are not uniformly aware of itsimplications in their role as service providers. Screening for RTIs among contraceptive acceptorsis an important quality element that needs to be stressed. National guidelines for contraceptivedelivery very clearly articulate the need for such screening and appropriate measures formanagement of such cases. Similarly, many services in the RCH package (i.e., prenatal care,adolescent health services, and services for males) provide opportunities for integration. Manystudies have revealed the frustration of women, because different services are not combinedand coordinated. Programmes are yet to deliver a well-integrated reproductive health servicecatering to the diversified reproductive health care needs of the clients. These services areaccessible to women, genital examination is acceptable, there is a tradition of counselling, anduse of condoms and spermicides is familiar. Standards of access and quality for STI casemanagement warrant review. What standards of effective diagnosis are appropriate andaffordable? Under what disease conditions is a non-specific, widespread approach advisable,versus a more effective approach that targets only specific groups? In the following paragraphs,an attempt has been made to highlight different challenges in strengthening STI casemanagement services.Operationalizing Quality RTI/STI Case Management ServicesProgrammatic ChallengesService ProvisionSince family welfare programmes currently exist, management of STIs should be seen as an addonactivity. The reach and quality of existing services will determine the nature and pace ofintegration. Such integrated services should look for new target groups (i.e., women who aresexually active but are neither pregnant nor potential contraceptive clients). Integration shouldtake place both in outreach and clinic settings in terms of screening, diagnosis, referral, andtreatment of common RTI/STIs. The following matrix depicts service provision at differentlevels in the health care delivery system.According to community-based studies and reports of women seeking assistance from layworkers/MCH&FP clinics, a common presenting complaint is vaginal discharge with/withoutvulval irritation commonly caused by candidiasis, BV, or concurrently with other STIs, such astrichomoniasis, gonorrhoea, and chlamydia. For low-risk women, who will return forreassessment if symptoms persist, non-specialists should be able to provide empiricaltreatment for candidiasis alone. A presumptive diagnosis of BV can be made inexpensively bytesting the pH of vaginal secretion (the procedure involves using pH and a positive amine test(using potassium hydroxide for detection of characteristic amine odour). An accurate clinicaland sexual history using a score-driven approach that ought to be evaluated may be taken toidentify all cases to an appropriate facility. Health supervisors at the PHC level may be trained toperform wet mounts for diagnosing candidiasis and trichomoniasis.163