Following a successful execution of Community Score Card Monitoring at six model health public facilities by Action Group for Heath, Human Rights and HIV/AIDS (AGHA –Uganda) in 3 districts, STI management and treatment was identified to be one critical area that needed immediate redress. This became one of the action items because many of the health centers evaluated experienced frequent drug stock outs and poor understanding and implementation of STI treatment guidelines by healthcare workers.
The above was confirmed by lead stakeholders during a policy dialogue organized by AGHA Uganda on the same subject. According to Dr. Peter Kyambadde, a representative of the MoH at the national level policy meeting, explained that STIs shaped formal healthcare in Uganda and the STI program is as old as the introduction of western medicine to the country. However, Dr. Joshua Musinguzi explained, with the appearance of HIV as a key public health problem, other STIs were put on the back-burner and funding was either reduced or forgotten altogether. This is problematic because STIs continue to be of great public importance in Uganda and consistently rank among the 5 leading causes of adult OPD consultation. Adding to this dialogue was Mr. Isaac Ddumba who is the HIV Focal Person in Mukono also explained that 20% of OPD attendance was as a result of STI concerns.
Several factors were cited as posing a challenge to STI management. For example, during the above policy dialogue it was realized that the current policy guideline was outdated (2010 version) and not reviewed to include new emerging concerns such as STI drug shortages at different facility levels. Thus, MOH needed a quick action to fix the gap therein.
STI combination drugs as per the syndromic treatment remain cumbersome to the patients since it involves several types of anti-biotics to treat symptoms other than specific STD.
Absence of STI surveillance system that could aid management of the disease further presents a gap that calls for redress if any meaningful gains are to be registered in the STI control.
Emergence of drug resistance especially the type of anti-biotics being provided to the different facilities based on their levels. Most STI infections are usually asymptomatic or mild in presentation leaving the patient under-dozed. From the experience of health service providers (Health workers) from Kisenyi and Kawaala Health Centers IVs in Kampala, Kojja and Mukono HC IV in Mukono and Kira and Kajjansi HC IVs in Wakiso district, the facilities are overwhelmed by the number of patients who turn up for STI screening and treatment and that they largely employ the syndromic approach in STI treatment. According to Sr. Teddy Nalwogga of Kisenyi HC IV, the biggest challenge was the inadequate supply of drugs stating that, “The number of patients accessing STI screening and treatment services remain high in the face of limited drugs supply, worse still we still handle case management based on symptoms present”
Such was the voice of several health workers interacted with during the community score card exercise at the different facilities.
Other issues raised by the health workers from the different facilities included challenges with laboratory services. Culture and sensitivity tests were not supported by adequate reagents and other medical supplies yet it would be the most suitable approach for effective treatment. This was largely attributed to medicines and supplies not provided at these public health facilities.
According to Dr. Stephen of Kojja HC IV in Mukono, history taking poses the first challenge stating that “Clients do not tell the right problem at history taking point by the health worker ether due to limited awareness or fear of facing the reality of the disease”. Most clients report secondary signs.
Patients find it rather costly to purchase recommended drugs ending up with basic treatment that hardly address the real challenge.
Privacy is usually compromised at history taking up to treatment stage due to poor infrastructure at the facilities causing some patients to shy away. According to Rebecca a nurse at Kira HC IV the limited space in the clinic violates the privacy of the patient and often it takes time and commitment from the healthcare worker for the individual to open up to them, thereby increasing wait times for others accessing the clinic. The capacity of the Kira Health Center is also not high enough to carry out screening for cancer of the colon and there is lack of funds to reach out to the key populations of the area. Similarly, drugs are not available for key conditions such as anal warts.
Patients usually fail to turn up with their partners for treatment often leading to re-infection especially among the key populations.