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Men and women seeking treatment for STIs

Export Indicator

Percent of men and women reporting symptoms of STIs in the last 12 months who sought care at a service provider with personnel trained in STI care, of all respondents in a population-based or targeted survey aged 15-49
What it measures

STI programmes seek not only to improve the quality of services but to increase the proportion of people recognising their infection and seeking those services. This indicator tracks changes in care seeking behaviour among men and women who believe they may be STI infected, following initiatives to promote health seeking behaviour.

Rationale
Numerator

Number of men or women who say the sought care from a service provider classified by national standards as providing trained care, (e.g., health worker in a clinic, hospital or pharmacist)

Denominator

Total number of men or women who reported symptoms suggestive of STIs

Calculation
Method of measurement

The construction of the indicator will depend on the country’s STI programme strategy. It will include in the numerator men and women who sought care from service providers considered “appropriate” by that strategy because care was provided by people trained to national standards in STI care. In most countries this will be limited to formal health facilities, including STI clinics. In a few countries it will include pharmacies and traditional healers. Respondents in a population-based survey (or, in concentrated epidemics, a sub-population survey of men or women belonging to groups with typically high-risk sexual behaviour such as sex workers or migrant workers) are asked whether they noticed a genital discharge or ulcer in the last 12 months. If yes, they are asked whether they sought treatment, what sort of treatment they sought, and what was the first thing they did for advice or treatment. Respondents are prompted for sources of care including health centres, pharmacies, traditional healers and friends or relatives. If any one of the sources of care they visited is staffed by people trained to national standards in STI service provision, the respondent enters the numerator. The indicator is the number of men or women who say they sought care from a service provider classified by national standards as providing trained care, (e.g., health worker in a clinic, hospital or pharmacist), divided by the total number of men or women who reported symptoms suggestive of STIs. The indicator should be reported separately for men and women. For programme purposes, it should also be disaggregated by type of service provider.

Measurement frequency
Disaggregation

Education: N/A

Gender: Male, Female

Geographic location: N/A

Pregnancy status: N/A

Sector: N/A

Target: N/A

Time period: N/A

Type of orphan: N/A

Vulnerability status: N/A

Explanation of the numerator
Explanation of the denominator
Strengths and weaknesses

The indicator gives an idea of the reach of approved STI service provision. The interpretation of this indicator is confused by two different aspects of programming. First, IEC campaigns may work to increase recognition of STIs and their symptoms and to increase treatment seeking. Second, they work to lower high-risk sexual behaviour and thus reduce new cases of STIs. If the indicator shows a rise in the percentage of men or women with selfreported STIs seeking treatment, it may mean that the prevalence of STIs has risen between surveys, but that the proportion of infected people seeking treatment is unchanged. On the other hand, it may mean that there has been no change in infection rates, but that more infected men and women recognise and report that they are infected, and seek treatment. A greater challenge to interpretation is posed by poor coverage of training in STI management. For example, if the national programme has made an effort to train pharmacists in the syndromic management of STIs but has succeeded so far in training only 20 percent of all pharmacists, should pharmacists qualify in this  indicator as a trained service provider or not? It is suggested that a category of service provider should not be included unless over 50 percent of providers in that category have been trained in STI service provision. The utility of this indicator depends on the existence of an active campaign to increase health-seeking behaviour, and more particularly a campaign that promotes the use of specific categories of service providers. While the relevant survey questions prompt for all types of service providers seen, (and the indicator is constructed using multiple responses), respondents are also questioned about their first source of care. This information should help programme managers in targeting future IEC and training efforts.

Further information