Building Consensus and Communication

- Building the foundation for improving care at points of first encounter requires intensive effort at the policy and program management levels.

Engaging the commitment and resources of public health officials and STD managers and providers demands significant technical assistance and consensus building. AIDSCAP's experience in Haiti, where such efforts led to national consensus on STD guidelines and improvements in service delivery, shows that the time and resources necessary to orient and train policymakers, managers and providers are well worth the investment. An initial assessment is necessary to determine a baseline level of care that is provided. This will be the data used to determine improvement.

- Biologic studies of STD prevalence and antibiotic susceptibility in a country are essential to building consensus on national STD treatment guidelines.

The local data that these studies generate can help convince STD program managers and health care providers to adopt the syndromic approach to STD management. AIDSCAP found that once managers and providers understood the magnitude of the STD problem in their country and the ineffectiveness of many of the current treatment practices, they were more likely to appreciate the benefits of a simple, standardized approach that increases access to effective treatment.

- Training alone is not enough to implement syndromic management into an existing health care system.

Supervision, updates, refresher courses and a commitment to change management practices are essential to integrate syndromic management into existing health care systems. Syndromic guidelines can be distributed and implemented in a standardized way on a large — even national — scale through clinical flowcharts. Moreover, flowcharts facilitate and improve training of health care workers in STD management.