Improving STI counseling services of non-formal providers through academic detailing by medical representatives
Presented by Haribondhu Sarma (Bangladesh).
H. Sarma1, S. Khan2, E. Oliveras3
1ICDDR,B, Health System and Infectious Diseases Division, Dhaka, Bangladesh, 2Save the Children USA, Bangladesh Country Office, HIV/AIDS Program, Dhaka, Bangladesh, 3Pathfinder International, Watertown, United States
Background: As in many developing countries, health provision by non-formal providers (NFP) in Bangladesh is increasing. While training can improve their practices, traditional training approaches may not be a feasible approach to reaching the vast number of NFP. Thus, private pharmaceutical companies were approached by a public sector program to test the effectiveness of using their medical representatives to disseminate information to NFP.
Methods: An intervention was developed that included training medical representatives to disseminate guidelines on STI counseling to NFP throughout Bangladesh. To test the feasibility and impact of this approach, we conducted 67 mystery client visits to compare the counseling provided by NFP in intervention areas where medical representatives disseminated the guidelines and counseling provided in areas where the intervention was not implemented.
Results: Mystery clients in the intervention area were more likely to be treated in a friendly manner (83%) than those in the control area (45%). Over 58% of mystery clients in the intervention area received at least one message included in the guidelines on which the medical representatives were trained. No mystery clients in the control area were told to use condoms while the STI lasts compared to 44% in the intervention area. Likewise, more than twice as many clients in the intervention area were advised not to visit sex workers.
Conclusions: MRs are a feasible mechanism for disseminating information to NFPs in Bangladesh. Private-sector companies provide a potential avenue for reaching the vast number of NFPs with basic information that they can share with their clients. The immediate improvements seen in this study suggest the strong potential of academic detailing as a training tool for non-formal providers.
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