AEGiS-13IAC: Improving supervision of STD services in Namibia Evaluation of a supervision tool for syndromic STD management.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Improving supervision of STD services in Namibia Evaluation of a supervision tool for syndromic STD management.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. ThOrC767)

Mwilima S;;; S. Mwilima, NACOP-Ministry of Health & Social Services, P.O. Box 22331-Bachbrecht, Windhoek, Namibia, Tel.: +264-61-2032198, Fax: +264-61-224155, E-mail: nacp@iafica.com.na

OBJECTIVE: To evaluate a supervision tool for Syndromic Management of STD, designed by the National AIDS Co-ordination Programme of the Ministry of Health and Social Services.

METHOD: A supervisory tool, consisting of a 2-page checklist was designed by NACOP. This tool was used during joint supervisory visits, carried out with local supervisory staff in clinics from all 13 health regions in Namibia. The tool addressed issues regarding the 1) accessibility to the facility, 2) availability of space and equipment for examination, 3) staff training, 4) availability of STD drugs, educational materials and condoms, 5) correct syndrome identification and treatment. Local supervisors randomly selected 40 clinics with a total of 150 staff members to evaluate the supervision tool.

RESULTS: Each of the 40 selected clinics was accessible during regular working hours and 30 of these (75%) were also accessible thereafter. All 40 clinics had essential equipment for examination. Despite sufficient availability of STD drugs at central level, 62.5% of the clinics had at least one out of the 7 STD drugs out of stock. Of the 150 health staff 120 (80%) were interviewed. Only 58 (48%) of these workers had received formal training in syndromic STD management. Trained health workers performed better (90% of STD cases correctly managed) than untrained staff (3% correctly managed). In only 15 of the 40 clinics, the nurse in charge supervised her colleagues regarding STD management. Follow-up by regional supervisors was poor in most regions. Only in one region, regular supervision was carried out. In this region, more than 90% of STD cases were correctly managed.

CONCLUSION: Syndromic STD management is substantially better by trained than untrained staff. Inadequate supervision contributes to drug shortages and inconsistent STD management by trained staff. The supervisory tool assisted local supervisors in monitoring case management and addressing shortcomings.

Keywords: AEGIS, Evaluation Studies, Condoms, Namibia, Ambulatory Care Facilities, Case Management, Interviews, Health Education, Greece, Education, organization & administration
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ThOrC767