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

Quality of RTI/STI Case Management Services in India: Perspectives and Challengesbehaviour and to stress the importance of early treatment from qualified/trained serviceproviders. At the community level, the syndromic approach in men with urethral dischargeand genital ulcers seems to work well in detecting STIs, although its use needs to bevalidated in India. It is also quite possible that men will be more likely to bring in theirpartners for treatment and vice versa, and this may lead to identification of asymptomaticwomen. Public sector facilities providing STI services are predominantly MCH/FP basedand are targeted mainly at women and thus may be unavailable to men. A study inBangladesh (Hawks et al., 1999) has demonstrated the feasibility of establishing STI clinicsfor men, within the existing STI/MCH and family planning system. The activity wouldincorporate not only STIs but provide comprehensive sexual health services for men.Addressing STIs in men will have financial implications in the form of training the existingcadre of male health workers, establishing links with pharmacists and the private sector,and referring patients for medical evaluation and counselling.CostsWorldwide, the cost of adding STI services to the existing list of services offered is a concern tofamily planning programmes. Establishment of any new service involves additional costs,whether provided in combination with other services or not. Costs will vary according to thetreatment regimen offered, services delivered by health workers or physicians, possible casedetection opportunities, diagnostic options, screening services, partner management strategies,IEC, and types of targeted interventions. Additional costs are to be considered in cases wherepregnant women need to be screened for syphilis.PartnershipsIn India, the private sector provides 82 percent of out-patient days of care (National Council ofApplied Economic Research, 2000). Programmes should strive to establish linkages withnetworks of private practitioners for improving the quality of services offered through conductof orientation/training programmes. Focus should be on the use of protocols, counselling, andco-treatment. Similarly, social franchising, which will entail running clinics to achieveobjectives of providing quality care and enhance equity in access, needs to be give a fair trialunder the social marketing programme.Epidemiological ChallengesEvidence from the studies conducted across the country during the last decade deserves seriousattention. There is a continued preponderance of genital ulcer disease (syphilis, chancroid,herpes, and granuloma inguinale) in the country’s STI profile, accounting for close to 75 percentof all STIs. Also, bacterial and treponemal STIs continue to dominate the reported STI profileacross the country as they did during the 1980s. The rise in the incidence of viral STIs, again awidespread phenomenon, is also a matter of concern. Emergence of viral STIs (e.g., HSV1 and 2,HBV, and HPV) are posing new challenges for adopting appropriate screening techniques andtreatment options in low-resource settings. There are reports indicating a high degree ofassociation between HSV-2 and HIV infection with respect to prevalence, stage of HIV infectionand viral shedding of HIV, and HSV-2 among high-risk behaviour groups. The increasing trendin the number of young people reporting to different clinics with STIs is another matter of165