Quality of sexually transmitted disease services in Jamaica: evaluation of a clinic-based approach. Collaborative Working Group on Indicators of STD Case Management

As part of a larger strategy to develop global indicators of HIV (human immunodeficiency virus) infection prevention programmes, a clinic-based method for the assessment of sexually transmitted disease (STD) service quality was developed and field tested by trained observers who visited a random sample of public-sector clinics in Jamaica in October 1991. The assessment included an inventory of equiptment and drugs, interview with clinic staff, and observations of 27 health workers in 15 clinics as they provided services to 115 patients presented for STD care. This observation-based method provided Jamaican programme managers with descriptive data on STD case management in public clinics within a one-month study period at an approximate local cost of US$ 5000. Based on weighted estimates, 91 percent of public-sector STD patients in Jamaica were seen in clinics whose staff had received some training in STD case management during the preceding 12 months. The correct treatment rate was estimated to be 82 percent for those diagnosed with gonorrhoea, and 70 percent for those diagnosed with syphilis. Based on 98 observed encounters for first-time-for-episode patients, counselling included sex partner referral (57 percent), partner reduction (48 percent), and condom use (59 percent). Although 61 percent of STD patients were seen in clinics with condoms in stock on the day of the assessment, only 23 percent were offered condoms during their visit. The clinic-based assessment method can be adapted to the programme management and reporting needs of the countries at all stages of STD service development, and can provide data needed to improve programme operations and meet international reporting standards (AU)

The role of applied research in donor-supported public health programmes in developing countries - abstract

The basic goal of scientific inquiry, whether in individual patient care or in health practice, is to replace intuitive thinking or ad hoc decision-making with methodological tools for appropriate decision-making. Two objectives of the USAID-supported African Child Survival Initiative - Combatting Childhood Communicable Disease (ACSI-CCCD) have been to provide data necessary for programmatic needs and to develop indigenous research capability among African counterparts and institutions. The twelve-year experience of applied research in ACSI-CCCD was reviewed through project documents, research reports and proposals, and focus groups, individual interviews and on-site visits with African investigators and programme managers. Research undertaken with CCCD support was compared to the typology of Feachem et al which classifies the priorities for developing country research in hiearchical fashion. Particular attention was paid to evaluating programme or policy impact or research findings, benefits to local institutions or individual researchers, and perceived value of the research proces or results to local, national or regional health objectives. Over 250 research activities in 18 countries received CCCD support from the project's inception. Significant accomplishments were achieved in strengthening research capacity as well as advancing programmatic objectives, despite the conflicting nature of these goals. Identified strengths of the CCCD research component were its close links to local programmes and programme managers, responsiveness to local priorities, availability of local review and funding mechanisms, policy relevance, and flexibility in the face of changing circumstances. Skills transfer and availability of technical assistance were also highlighted. Weaknesses identified included inadequate monitoring and supervision of research activities (particularly in remote or widespread geographical locations), absence of a clear agenda or priorities for indigenous research, sometimes conflicting objectives of donors and local programme managers, and relatively small achievements in institutional strengthening. Long-term benefits in donor-sponsored applied research will require acknowledging a clear distinction between "promoting research" and "developing researchers". Both short-term training, such as workshops and mentoring relationships, and formal postgraduate training are necessary to establish an acceptable and sustainable research infrastructure for health services in developing countries (AU)