The Southern African Development Community Project on Sexually Transmitted Infections in High Transmission Areas
1. Enhancement of Syndromic Management of STIs in the Selected Cross Border/High Transmission Sites: Botswana, Lesotho, Namibia and Swaziland
Africa south of the Sahara is the region most affected by the HIV/AIDS pandemic, with more than thirty million people living with HIV and AIDS in the region. It is estimated that there are approximately 10 million young people aged 15-24 years and almost 3 million children under 15 years of age living with HIV. Southern African countries including Botswana, Lesotho, Namibia and Swaziland are among the worst affected. HIV prevalence for adults aged 15-49 years in these countries are estimated as follows; Namibia 22.5%, Lesotho 31%, Swaziland 33.4 % and Botswana 38.8%. Sexually transmitted infections (STIs) are a key co-factor in the transmission and acquisition of HIV. Hence STIs are a priority which public health programs have to address effectively. Despite this, and the general knowledge that the level of the STI infection is staggeringly high in southern Africa, there is no accurate data. STI control programs are poorly managed and lack of surveillance systems in most countries in the region.
The STI component of the SADC-DFID CBS/HTS project aims to strengthen the syndromic management of sexually transmitted infections in the selected cross border and high transmission areas (CBS/HTA) in the selected countries through a health systems development approach.
With the Syndromic approach, STIs are classified by syndrome. Each syndrome is made up of a combination of symptoms and clinical signs identified upon examination of the patient. The four main syndromes are:
- Urethral discharge: men
- Lower abdominal pain: women
- Vaginal discharge: women
- Genital ulcer: men or women
This project will assist the SADC region in identifying and developing a regional response to STI control and management. Lessons learned through the work in CB/HTA sites will be used to inform the regional policy response, whilst components of the policy response will be piloted in the CB/HTA sites.
Project Objectives are:
- Improving planning and delivery of client friendly STI services that recognise migration related risk factors in the identified CBS/HTA sites.
- Facilitating the development of a SADC regional response to STI control through harmonisation of STI treatment guidelines and development of minimum standards of care.
- Development of a standardised regional STI training program.
- Development of comprehensive STI surveillance systems that recognize mobile population issues.
- Strengthening systems for drug procurement, stock management and delivery.
- Developing health systems research capacity in the selected countries.
- Synchronise policies on STIs management across the SADC countries.
The project implementation is done in partnership with a local institution (usually NGO: research/development institution) and activities are guided by local Project Steering Committees (PSCs) in each country. The PSC comprise key local stakeholders including health providers, managers, community governance structures and private sector.
A problem-solving approach is practised within the project sites. Problems related to providing high STI care are identified by the local stakeholders and national health service managers. Solutions to these problems are found in a participatory manner through discussion, meetings, joint planning and monitoring and evaluation of new strategies/ activities geared to improving the quality of care.
Output at site Level:
- Better planning and coordination of activities
- Improved monitoring and evaluation for STI quality of care
- Improved tracking of human resources development for STI management
- Improved skills and knowledge for STI management among clinicians
- Improved utilisation of data at clinic and district/regional levels
Output at national Level
- Improved capacity for effective planning and program management
- Improved access to reliable data from lower levels of the health system
- Improved utilisation of data for planning and management at national level
- New or improved surveillance for STI
- Tools for better planning for human resource development for STI management services
- National level publications of STI services, quality of care, surveillance and research
- Cascading of new management systems and processes to other districts/regions beyond the project sites
Output at SADC Regional Level
- Better collaboration with regional partners and between countries on STIs services in relation to cross border and migrant issues
- Sharing of Knowledge and experiences (planned activities)
- Regional policy synchronisation - (planned)
2. STI management and control in Botswana, Namibia and Zambia: Engaging with the private sector
The role of private sector in STI treatment and control
The private health care sector plays an important role in the provision of care for STIs in southern Africa. Over 51% of STI patients seek care from this sector because of greater levels of privacy and a belief that the quality of care is better. However, findings indicate that that a large number of STI cases are treated inappropriately and ineffectively in this sector. Given that STIs facilitate the sexual transmission of HIV, addressing the quality of STI care in the private sector is critical in the fight against STIs and HIV/AIDS.
What is the purpose of this project ?
This project, funded by the IDRC and conducted by the Health Systems Trust will run for one year and aims to investigate the performance and accountability of the private health care sector with respect to the public sector in Botswana, Namibia and Zambia. A participatory research approach will be taken in partnership with researchers in each country. The research will be designed so that it portrays the current situation regarding the delivery and quality of STI services in the private sector as well as the public-private interactions in these three countries.
The project objectives are to:
- assess the quality of private general practitioners' provision of STI services;
- describe the policy and regulatory framework of the private health care sector;
- determine the design and nature of existing public-private partnership for STIs;
- develop a public-private partnerships framework that can facilitate an integrated national and regional approach to STI management and control.
Project activities include :
- reviewing any available country policy documents, published and unpublished literature specific to the three countries which deals with STI management and surveillance in the private sector and existing public private partnerships;
- conducting in-depth Interviews with policy-makers, health service managers and other relevant stakeholders such as Independent practitioners associations (IPAs) and medical councils, at national and provincial levels.
- conducting in-depth interviews which explore GPs' perception of factors that influence the way they manage STIs and their interest in PPPs;
- holding group discussions with community members who utilise private GP services in selected sites;
- conducting exit interviews of STI patients who use private clinics;
- mapping and analysis of stakeholders to determine interest, influence and capacity for public private partnership.
How will lessons be learned?
- One workshop will be organised in each country for interested stakeholders and relevant parties. The workshop will be used to present the initial findings of the situation analysis; to improve on the information collected and to begin a process of dialogue about the way forward.
- Publications emanating from the project will be widely disseminated.
The project will be conducted in a participatory manner. Local researchers will be recruited in each country and fieldwork will be done via the country research partners. Discussion, debate and the sharing of lessons/experiences within and between the selected countries will be encouraged by engaging stakeholders in discussions on how to improve the regulation and quality of the private health care sector. Discussions will also explore strategies to raise the profile of STI control in the private sector through targeted campaigns aimed at government officials, private practitioners, consumer groups and donor programmes.
Project Outcomes will include:
- the availability of baseline data compiled on delivery and quality of STI services provided by private general practitioners;
- the availability of baseline data compiled on public-private interactions with regards to STI services;
- the strengthening of south-south collaboration between NGOs working in the field of health systems development and in country research capacity and networks;
- an improved regulation and quality of service provided by the private health care sector in southern Africa,
- a framework will be available to address STI services in the private sector as well as public-private partnership models;
- More programmes of research and policy work can be developed which are aimed at improving the regulation, accountability, effectiveness and appropriateness of private sector health care and public-private interactions. For example this could include conducting further action research to measure and improve the quality of private sector care; developing a monitoring and surveillance system for STIs in the private sector; or policy interventions aimed at changing health care financing arrangements.
For further information contact:
The project manager: Dr Abdul G Elgoni
Senior researcher: Dr Oluseyi Oyedele
Health Systems Trust
49 Jorrison Street, Braamfontein, 2017
Tel +27 11 404 2415
Fax +27 11 403 2447
Email: Elgoni@hst.org.za or firstname.lastname@example.org