by Kerry Cullinan, Health-e, 07-10-2002
Next time you get a sexually transmitted infection (STI), it may be worth your while to go to your local clinic rather than slinking off to see a private doctor.
Researchers have found that the much-maligned government clinics are better at treating STIs than the average general practitioner (GP).
GPs see over 50% of STI cases as people prefer the privacy and the anonymity, says Professor Helen Schneider of Wits University’s Centre for Health Policy. But the technical quality of care is relatively poor compared to public health, which has been practicing syndromic management for a number of years and has quite good STI management.
The problem, Schneider told the annual Reproductive Health Priorities conference, is that doctors tend to offer a package for R120 which covers a consultation and drugs. In order to profit, many doctors tend to cut back on the drugs, perhaps offering just one antibiotic. But in public health people would get two or three different drugs to wipe out a number of different syndromes or categories of infections.
Research in Carletonville found that only 23% of STIs treated in the private sector were treated effectively in comparison to 38% in the public health sector, while a national health department survey found that 64% of rural GPs provided inappropriate STI treatment.
In recognition of this problem, both Gauteng and the Western Cape have been trying to work with private doctors to improve STI treatment.
Dr Bhavna Patel of the department of health in the Western Cape told the conference that her department had been training two private doctors per health district in areas where STI statistics were high and providing them with free drugs.
We have now decided to roll out this programme to 50 doctors, and have provincial cabinet approval for this, said Patel. She said government was aware that the system could be abused, so had introduced strict controls including performance-based contracts for the doctors involved.
Schneider said that although her work with Ekhuruleni (East Rand) doctors had been time-consuming and often difficult, we have no option but to engage them, and need to try a range of things to see what works.
The national Department of Health’s Dr Eva Gosa said a national study of public health clinics’ STI management was underway in a bid to improve the service, particularly as clinics tended to run out of drugs.
STIs are a serious problem in South Africa, and a person with an STI particularly one which causes skin lesions is more at risk of getting infected with HIV as it is easier for the virus to pass into the body.
A University of Cape Town study, also reported on at the conference, found that half of the 400 women screened in a study in Gugulethu and 43% of 400 women in Ga-Rankuwa had bacterial vaginosis