Implementation of the essential services package through standardized service delivery protocols

Abstract

Objective: Evaluate the range and quality of services delivered from the urban primary-care clinics through the adaptation and implementation of appropriate and practical service delivery protocols.Methodology: The study was on a quasi-experimental design. Based on the national priorities, epidemiological data, implementation feasibility, and client preferences, eight components of essential services were identified. The existing national and international guidelines and protocols were reviewed and adapted. Providers from three clinics of an NGO and three government dispensaries (GOD) were trained on the newly-adapted protocols. These clinics were monitored by a physician regularly. For comparison, the activities of the clinic staff at the two non-intervention NGO sites and two non-intervention government sites were also monitored. A mid-term evaluation, conducted after a year of implementation, was based on the data from the pre-and post-training knowledpe tests, structured observations of provider-client interactions, JiiUysis of tfw clinic records, and interviews with providers and with clients. Results: The results of the evaluation indicated that the intervention markedly improved the diagnostic and treatment practices of the service providers. There were marked improvements in the prescription patterns, with a reduced misuse of antibiotics for the management of diarrhoea, acute respiratory infection (ARI), and reproductive tract infection along the lines suggested by the protocols. After the introduction of the protocols, inappropriate use of metronidazole was reduced from 86% to 31% in diarrhoea cases, and inappropriate use of antihistamine was reduced from 77% to 18% in ARI cases. These changes were not observed or were less pronounced in the comparison clinics. However, the providers stated that the protocols were easy to follow, but had increased the waiting time at the clinics. Conclusion: The practice of following standard protocols improves the quality of services. However, the comments of the providers need to be analyzed further. Complementary subsystem interventions (quality of the physical facility, logistics, information and management support system) are needed to implement the protocols fully