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Building consensus to improve care for sexually transmitted infections: engaging with the private sector in Botswana, Namibia and Zambia

Date: Tuesday 30 October 13.30–15.00
Source: Forum 11
Authors: Oluseyi Oyedele, Senior Researcher, South African Development Community (SADC) STI Initiative, Initiative for Sub-District Support (ISDS), Health Systems Trust, South Africa
with AG Elgoni, SN Iipinge, C Mulenga, M Rahman, F Hussein and N Chabikuli


The public health significance of providing early and appropriate treatment for sexually-transmitted infections (STI) has been underscored by the evidence that many STIs are co-factors in the sexual transmission of HIV. Controlling STIs is therefore a priority strategy for the ongoing control of the HIV epidemic. Providing first-time clients with high quality STI treatment needs to be an issue involving both the public and private health-care sector.

A programme of appropriate participatory action research was carried out in Botswana, Zambia and Namibia: 1) to assess quality of STI care in the private health- care sector; 2) to develop a public-private partnership framework for STI care; 3) to engage relevant stakeholders for improved STI services.

A rapid situation analysis approach was taken including: 1) a review of literature; 2) structured in-depth interviews with stakeholders; 3) assessment of a purposeful sample of private general practitioners (GPs); 4) client exit interviews; and 5) focus group discussions.

Findings showed that the private sector is considered important in the provision of STI services in the three countries and by all stakeholders. STI patients prefer to utilize the private sector for STI care despite the provision of free STI services in the public sector. Confidentiality in the private clinic setting, the perception that being treated by a doctor was better, extended working hours and fast services were some of the reasons given. Assessment of the quality of STI care by private GPs showed a generally poor compliance with national guidelines. There was little evidence of public-private partnership activities for STIs. STI data are not collected from the private sector making the information unavailable for use in planning and coordinating national responses.

Consensus-building workshops were held in each country during which findings from the studies were presented and issues of partnerships between the sectors were discussed. Consensus was reached on the need for the public and private sectors to work more closely together for improved STI services. STI working groups were established with representatives from both sectors. A public-private partnership framework document has been developed based on lessons learned and plans are underway to implement it in the countries.