Percent primary health care facilities providing comprehensive approaches for symptomatic STIs
The number and percent of primary health care facilities providing comprehensive case management (or syndromic management) for symptomatic STI infections (WHO, 2003). For resources using this or similar indicators, see WHO (2007) and WHO/UNFPA (2008).
This indicator is calculated as:
(Number of primary health care facilities providing comprehensive care for symptomatic STIs / Total number of primary health care facilities in a country or given area) x 100
WHO (2003; 2007) lists the following components for comprehensive case management of STI-infected persons:
- Correct diagnosis by syndrome or laboratory diagnosis
- Provision of effective treatment
- Reduction in or prevention of further risk-taking behavior through age-appropriate education and counseling
- Promotion and provision of condom, with clear messages for correct and consistent use
- Notification and treatment of sexually transmitted infections in sexual partners, where applicable
- Referral for existing complications or sequelae whenever needed
Syndromic management can be used for clients presenting with consistently recognized signs and symptoms and treatment based on flowcharts used at the primary health clinic level (WHO, 2007). For additional background on and recommendations for case and syndromic management of STIs, see WHO (2003); WHO (2007); CDC (2010).
Surveys or reviews of client records from primary health care sites provided by supervisors or evaluators on types of comprehensive STI care services provided. It is recommended that data are collected using a census-based approach (i.e., from all primary care sites in the target area). For validation purposes, the data collector may choose to conduct brief follow-up interviews with a subset of clients. Where the data are available, the indicator can be disaggregated by province and district, urban/rural location, type of facility (public, private, community-based), and client characteristics (sex, age group, most-at-risk populations).
Client records, surveys, and interviews from primary care sites, staff, and clients.
This indicator measures the coverage and components of care provided by primary health facilities delivering recommended STI diagnostic testing, treatment, and related services. These facilities can serve as points of entry for persons in need of STI, HIV/AIDS, and other reproductive health care services and trends in STI care delivery can inform planning, commodities and logistics for diagnostic testing, medications, condoms and other preventive supplies, as well as, staffing needs and training. STIs other than HIV are responsible for a large global burden of morbidity and mortality, both directly through their impact on general health and quality of life, reproductive health and child health and through their role in facilitating the transmission of HIV. Improved comprehensive case management of STIs is one of the interventions proven to be a feasible and cost-effective approach to reduce the incidence of HIV in the general population (WHO, 2007). The U.N. Declaration of Commitment on HIV/AIDS specifies control of STIs as a primary HIV prevention strategy (UNGASS, 2001). Treatment and reduction of STIs are related to achieving Millennium Development goals # 6 to combat HIV/AIDS, #5 to improve maternal health and #4 to reduce infant mortality.
While the indicator measures coverage of comprehensive STI care, it does not evaluate the quality and outcomes of the care. Lack of accuracy and quality control in record keeping at primary care sites can impact the validity of this indicator. While focusing on primary care facilities provides useful information on a main point of entry to health care, in many settings, people with STIs seek medications directly from pharmacies and the informal private sector, often without diagnosis, follow-up care, or preventive counseling and supplies. In order to promote utilization of primary care facilities, especially by most-at-risk subpopulations, public and private primary care providers need to take into account the health seeking behaviors and preferences of the different subpopulations. Particular attention should be given to gender equity, adolescents, low-income and marginalized groups, in addition to ease of access, scheduling, and privacy (WHO, 2007).
access, quality, sexually transmitted infection (STI), integration
Women’s access to and utilization of primary care STI treatment services may be limited by cultural gender norms that affect women’s mobility, exposure to media and STI treatment information, women’s resources for health care services, as well as, the possible stigma associated with STI treatment. STI services that require partner notification may be putting women’s safety and livelihoods at risk. The UNAIDS (2010) agenda for women, girls, and gender equality calls for national AIDS authorities and ministries of health to incorporate gender equality into policies STIs and HIV for the achievement of universal access to prevention, treatment, care and support for women.
CDC, 2010, Sexually Transmitted Diseases Treatment Guidelines, 2010, MMWR, https://www.cdc.gov/mmwr/pdf/rr/rr5912.pdf
Dec. 17, 2010/Vol. 59/No. RR-12, Atlanta, GA: CDC.
UNGASS, 2001, Declaration of Commitment on HIV/AIDS,
UNAIDS, 2010, Agenda for Accelerated Country Action for Women, Girls, Gender Equality and HIV, Geneva, UNAIDS. http://www.unfpa.org/webdav/site/global/shared/documents/publications/2010/agenda_for_accelerated_country_action_en.pdf
WHO, 2003, Guidelines for the Management of Sexually Transmitted Infections, Geneva: WHO.
WHO, 2007, Global Strategy For The Prevention And Control Of Sexually Transmitted Infections: 2006–2015, Geneva: WHO. http://whqlibdoc.who.int/publications/2007/9789241563475_eng.pdf
WHO/UNFPA, 2008, National-level monitoring of the achievement of universal access to reproductive health: conceptual and practical considerations and related indicators, Geneva: WHO. http://whqlibdoc.who.int/publications/2008/9789241596831_eng.pdf