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Quality of RTI/STI Case Management Services in India: Perspectives and Challengesconcern. Also there are considerable geographic variations in the distribution patterns ofcommon STIs in the country.A surveillance system for STIs needs to be established for an effective control programme with afocus on case reporting, prevalence assessment, assessment of STI syndromic etiologies,monitoring of anti-microbial resistance, and so forth. Such information would be useful foridentifying population sub-groups with high prevalence and monitoring such trends. Suchinformation would also be useful to establish cut-off prevalence levels for classical STDs forconsideration of presumptive treatments.Technological ChallengesConsidering the poor performance of algorithms, especially for vaginal discharge syndrome, it iscrucial that existing guidelines be re-examined. Low-cost simple diagnostic options (e.g., wetmount, KOH test, pH test, and Gram stain) will considerably improve the sensitivity andspecificity of algorithms. Guidelines should also insist on complete clinical examination toarrive at a diagnosis using algorithms. Rapid diagnostic options should be incorporated in theprogramme as and when such tests are feasible to be conducted in the peripheral settings. Thepossibility of self-sampling by the clients (using tampons, etc.) could be considered.Management ChallengesMonitoring and evaluation are key to the long-term success of any health programme, but theseare particularly critical for assessing the potential value of new approaches, such as integration.Currently, the Community Needs Assessment Approach does not take into account the need toplan services for expected STI patients in the community. Sub-centre action plans and monthlyreporting forms do not have information items on estimated cases based on the currentprevalence levels. Similarly, there is no information on RTI/STI cases either screened or referredby the health worker. Data on monitoring indicators reflecting the quality of services should beincluded in the management information system (MIS). Different sets of reporting formats areintroduced in the FHAC. Similarly, there is an attempt to build surveillance system for STIs bythe State AIDS Control Societies through etiological diagnosis, although such facilities might notbe available at many such reporting units. There is an urgent need to review the existing recordsand reporting formats and eliminating dual recording burdens.Quality of CareQuality elements that need attention include provision of privacy during counselling andexamination of clients, technical competence of service providers (i.e., conducting a speculumexamination, collection of specimens for lab tests, preparation of smear and interpretation ofresults, and counselling skills). Other quality elements that do not get much attention includemechanisms for partner management, follow-up care, referrals, and advice on condom useduring the course of treatment. Counselling for risk reduction will also constitute an importantcomponent of care. Availability of lab equipment in adequate numbers, test kits and reagents,drugs, and medicines should also receive attention. The programme should also focus onestablishing integrated logistics systems involving supplies under RCH and the NACP.166
Quality of RTI/STI Case Management Services in India: Perspectives and ChallengesConclusionsOne of the major recommendations of the ICPD was to “make available universal access to a fullrange of high quality reproductive health services, including family planning and sexual health”through primary health care systems. The situation in many developing countries, includingIndia, has been that neither STIs nor RTIs are systematically managed in the peripheral healthcare settings. In addition, special clinics, such as STI clinics, are not very effective in reachingout to those who need these services. Strengthening STI case management within the gamut ofRCH programmes is a laudable goal. Integration will mean that RCH communicationprogrammes should encourage seeking early treatment; service delivery personnel will have tobe trained in case detection and providing prompt treatment using management protocols; andnecessary equipment and supplies must be ensured.ReferencesAPAC-VHS. 1998. STD: Health Care Facility Survey in Tamil Nadu-A Report.Fleming, D.T. and J.M. Wasserleit. 1999. “From Epidemiological Synergy to Public Health Policyand Practice: The Contribution Other STDs to Sexual Transmission of HIV Infection.” SexualityTransmitted Infections 75: 3-17.Garg, S. 2000. An Epidemiological and Sociological Study of Symptomatic and AsymptomaticReproductive Tract Infections and Sexually Transmitted Infections among Women in an UrbanSlum. Task Force Project under Special Programme of Research, Development and Training.Government of India. 2000. National Population Policy 2000.Goyal, R.S., Raina Neena, and Saulina Arnold. 2001. Management of RTIs: Interplay of SocialEnvironment. Jaipur: IIHMR.Grosskurtu, H., F. Mosha, J. Todd, et al. 1995. “Impact of Improved Treatment of STDs on HIVInfection in Rural Tanzania.” The Lancet 346: 530-36.Hawks, S., L. Morison, S. Foster, K. Gausia, J. Chakraborty, R. Weeling. 1999. “Reproductive TractInfections in Women in Low Income, Low Prevalence Situations: Assessment of SyndromicManagement in Matlab, Bangladesh.” The Lancet 354: 1776-81.Hook, E.W. 1992. “Herpes Simplex Virus Infection as a Risk Factor for HIV Infection inHetrosexuals.” Journal of Infectious Diseases 164: 251-255.IndiaCLEN. 2000. Family Health Awareness Campaign, 2000: Coverage Evaluation.International Institute for Population Studies (IIPS). 2000. NFHS-2. Key Findings. Mumbai.Kaitharag, K., et al. 1995. “STD Services in Madras: Could Their Role in STD Prevention BeStrengthened?” Indian Journal of Public Health 39: 93-99.167
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Health Policy IssuesandHealth Progr
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ContentsContentsPrefaceList of Part
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I would also like to thank our tech
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List of ParticipantsIndu Kumar Pand
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List of ParticipantsMohmed ShaukatD
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List of ParticipantsR K PurohitAddi
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GlossaryGlossaryAbbreviationsAIIMSA
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GlossaryLHVLILMISMAPMCMCHMDRTBMDTM&
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GlossaryTHRTRCTRIPsTTTUUDCUIPUPUTVC
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Inaugural Sessionwould be the first
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Inaugural SessionOnly 18% of the pr
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Inaugural SessionMadhukar Gupta, Ch
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Inaugural Sessionrotational basis f
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Inaugural Sessiontell you more abou
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Public Health Issues, Priorities, a
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National Health Programmes: An Over
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Use of Epidemiological Surveillance
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Designing a Surveillance SystemFurt
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Designing a Surveillance Systemsurv
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National Health Programme in Uttara
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IEC Strategies for Health in IndiaS
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IEC Strategies for Health in Indial
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IEC Strategies for Health in IndiaA
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Session 3Private and Public SectorP
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Cost Recovery Measures in Governmen
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Cost Recovery Measures in Governmen
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Streamlining the Drug Procurement a
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Sanitation and Public Health Issues
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Ayurveda and Unani Department and t
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Specific Health Policy and Programm
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