Issues in integration of STD programs into health-care systems.

This third chapter of "Control of Sexually Transmitted Diseases (STDs): A Handbook for the Design and Management of Programs" presents a strategy for integrating STD prevention and care activities into health care systems especially at the district level. It focuses on the circumstances needed for integration of STD programs into health care systems and when it is necessary to add specialized approaches also. Current STD programs have not been successful in increasing access and improving cost-effectiveness the reasons for which revolve around the lack of a rational STD package low priority by authorities uncoordinated STD service delivery specialized STD treatment facilities STD case management in primary health care (PHC) (horizontal approach) and private sector providers. Public health STD specialists must address the deficiencies of the current delivery system and develop strategies that surpass the weaknesses of past efforts. Proposed is a six-step approach to change attitudes about STDs and to reduce the STD incidence and complications from STDs. The first three steps are an intervention package that revolves around developing a training module to teach PHC staff how to use the syndromic STD approach chart. The last three steps aim to ensure that when people recognize symptoms they will seek health care immediately while having the confidence that the health facilitys staff have been able to build. The proposed integrated approach focuses on a decentralized operational structure at the district level but with a central unit responsible for research technical guidance and materials. The chapter includes lessons learned from case studies: Strengthening prevention and management of STD/AIDS Kenya; The District STD Intervention Program in Mwanza Region Tanzania; and Improving STD Case Management in the Jamaican Private Sector.