Private parts - treatment for STIs in Uganda's private sector
Damian Walker, Herbert Muyinda, Susan Foster, Jane
2002-09-26
Effective treatment of curable sexually transmitted infections (STIs) is one of the few strategies available to reduce the spread of HIV in sub-Saharan Africa. Many people with STIs seek treatment from private practitioners. Why are patients turning to the private sector for help? Do they receive adequate care?
A study at the Medical Research Council Programme on AIDS in Uganda involving researchers from the London School of Health and Tropical Medicine suggests that private practitioners can help improve the management of STIs in rural areas.
But it also identifies unmet training needs in appropriate STI treatment, counselling and health education.
Researchers interviewed private practitioners from eighteen a rural area of south-western Uganda, to examine their attitudes and knowledge about managing patients with STIs. Practitioners in six of the parishes received training in the syndromic management of STIs and the supply of drugs. This approach is particularly appropriate in countries such as Uganda, where STI prevalence is high and resources are scarce.
Both practitioners and patients feel that the private sector provides more convenient and confidential care and offers longer opening hours than public health facilities. However treatment is expensive. Drug resistance is also a risk as partial courses of antibiotics are often prescribed.
Other findings include:
*Practitioners estimate that they see an average of 41 patients each week of whom five have STIs.
*Those who attend courses on the syndromic management of STIs are far more likely to prescribe appropriate drugs (82 percent compared with 27 percent of those who have not been trained).
*Almost all of the private practitioners would welcome regular written information on ‘best practice’ in patient management, particularly for STIs. They are also willing to attend meetings on these issues.
*Practitioners are usually adequately equipped. Condoms are available in 82 percent of the clinics but condom demonstrators are only found in 38 percent. Most practitioners say that people know how to use condoms so there is no need to instruct them.
*Although the trained group of practitioners are more likely to mention key health education messages, the level of counselling is low throughout.
*The average cost of private treatment ranges from US$2.3 - 3.8 whereas user charges in public health services are US$0.2 - 0.4.
*The private sector plays a significant role in the management of people with STIs. Interventions aimed at reducing the incidence of HIV infection by controlling treatable STIs must include private practitioners to be successful.
Policy-makers should consider:
*ensuring practitioners receive sufficient training in counselling and health education
*packaging antibiotics in courses of treatment rather than single tablets to discourage inadequate treatments and prevent an increase in drug resistance
*introducing drug policies to encourage the rational use of drugs and to reduce mark-ups applied to pharmaceuticals. (Source: The quality of care by private practitioners for sexually transmitted diseases in Uganda’, Health Policy and Planning 16 (1): 35-40, by D. Walker et al., 2001)
Effective treatment of curable sexually transmitted infections (STIs) is one of the few strategies available to reduce the spread of HIV in sub-Saharan Africa. Many people with STIs seek treatment from private practitioners. Why are patients turning to the private sector for help? Do they receive adequate care?
A study at the Medical Research Council Programme on AIDS in Uganda involving researchers from the London School of Health and Tropical Medicine suggests that private practitioners can help improve the management of STIs in rural areas. But it also identifies unmet training needs in appropriate STI treatment, counselling and health education.
Researchers interviewed private practitioners from eighteen parishes in Masaka, a rural area of south-western Uganda, to examine their attitudes and knowledge about managing patients with STIs. Practitioners in six of the parishes received training in the syndromic management of STIs and the supply of drugs. This approach is particularly appropriate in countries such as Uganda, where STI prevalence is high and resources are scarce.
Both practitioners and patients feel that the private sector provides more convenient and confidential care and offers longer opening hours than public health facilities. However treatment is expensive. Drug resistance is also a risk as partial courses of antibiotics are often prescribed.
Other findings include:
*Practitioners estimate that they see an average of 41 patients each week of whom five have STIs.
*Those who attend courses on the syndromic management of STIs are far more likely to prescribe appropriate drugs (82 percent compared with 27 percent of those who have not been trained).
*Almost all of the private practitioners would welcome regular written information on ‘best practice’ in patient management, particularly for STIs. They are also willing to attend meetings on these issues.
*Practitioners are usually adequately equipped. Condoms are available in 82 percent of the clinics but condom demonstrators are only found in 38 percent. Most practitioners say that people know how to use condoms so there is no need to instruct them.
*Although the trained group of practitioners are more likely to mention key health education messages, the level of counselling is low throughout.
*The average cost of private treatment ranges from US$2.3 - 3.8 whereas user charges in public health services are US$0.2 - 0.4.
*The private sector plays a significant role in the management of people with STIs. Interventions aimed at reducing the incidence of HIV infection by controlling treatable STIs must include private practitioners to be successful.
Policy-makers should consider:
*ensuring practitioners receive sufficient training in counselling and health education
*packaging antibiotics in courses of treatment rather than single tablets to discourage inadequate treatments and prevent an increase in drug
resistance
*introducing drug policies to encourage the rational use of drugs and to reduce mark-ups applied to pharmaceuticals.
(Source: The quality of care by private practitioners for sexually transmitted diseases in Uganda’, Health Policy and Planning 16 (1): 35-40, by D.Walker et al., 2001)
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