CONTENTS
Chapters
- The Toll of STDs
- Reducing the Toll of STDs
- Managing STDs
- Diagnostic and Treatment Tips
- Getting Services to the People
- Getting People to Services
- Promoting Prevention—Condoms and Monogamy
HIGHLIGHTS
Population Reports is published by the Population Information Program, Center for Communication Programs, The
Johns Hopkins School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland
21202-4012, USA
Volume XXI, Number 1
June, 1993 |
The Structure of STD Services
The structure of an STD services program must serve the main
function of providing accessible clinical services. Programs have
been structured in several different ways:
- An integrated structure, in which staff of primary
health clinics, outpatient departments of district and
provincial hospitals, family planning programs, and
antenatal clinics are trained to provide STD services
(as in Viet Nam, Zimbabwe, and other countries) (9,
162, 228);
- A vertical structure, in which providers specializing
in STD management are stationed in primary care clinics
and in STD clinics in district and provincial hospitals
(as in Senegal and Sri Lanka) (226, 228).
- A structure combining integrated and vertical services
(as in India, the Philippines, Thailand, and Zambia).
In Zambia, for example, STD services are offered in
primary health clinics and in STD clinics in district
hospitals (114). Like national ministries, the health
departments of large cities may also set up a combined
structure. The city of Harare, Zimbabwe, for example,
offers services in primary health clinics and
stand-alone STD clinics (162).
Program planners need to weigh the advantages and disadvantages of integrating
STD services or setting up separate STD clinics. Some people prefer to go
to integrated clinics because the reason for their visit is not obvious,
as it would be at an STD clinic. Also, when family planning and antenatal
care providers are trained in STD management, they may be able to screen
clients for STDs when the clients are seeking care for other reasons (see
Chapter 6.2, Screening).
Thus they can identify women who have asymptomatic STDs (228). Integrated
services may lack funding, however, and staff may be overworked or have
no STD training.
In theory, in single-purpose STD clinics highly trained
providers offer comprehensive STD services. In reality, however,
like multipurpose clinics, many STD clinics lack equipment and
drugs, and staff may be overworked and have little time for each
patient. In addition, women are reluctant to attend such clinics
because they treat mostly men. Also, staff in some STD clinics
treat women rudely (228).
Whatever structure is chosen, programs need to set standards
of STD management by issuing national guidelines and by training
and supervising providers, to evaluate diagnostic tests and drug
treatment, to conduct surveillance of the prevalence of STDs, and
to work with policy-makers (325). These functions can be
performed by one or more "centers of excellence," universities,
or research institutes (226). The AIDS Task Force of the European
Communities offers training courses on the planning and
management of STD programs in developing countries (337). |