This indicator reflects the success of that training, com­bined with efforts to ensure adequate supplies of drugs and other necessary materials to care provision points. It tracks changes in the provision of adequate care to patients seeking care for STIs.

Choosing which STI service delivery points to survey is important. Traditionally, this indicator has applied primarily to public sector STI clinics, because most of the early training in syndromic management was of pub­lic sector employees. However, people with STIs often seek treatment in other sectors œ either at private sector clinics, from pharmacies or from traditional healers. Some countries have begun to include these sectors in training programs for syndromic management, and evaluations using this indicator have successfully been carried out in these sectors. Service delivery points sur­veyed should include representative service providers from any sector that has received training in syndromic management of STIs.

This indicator, measured through observation but in­cluding provider interviews in the process of data col­lection for validation purposes, has been widely used and proven feasible. There has been discussion of the extent to which the direct observation and provider in­terview methodologies bias data. It is thought that ser­vice providers perform better under observation than they normally would, or over-report “correct” diagno­sis and treatment, falsely diminishing the gap between knowledge and practice. However, client exit interviews and mystery patient methodologies, as well as proving feasible, have demonstrated that the biases are smaller than was assumed. The gap between knowledge and practice in the area of treatment often shaped results because service providers do not follow “correct” pro­tocols simply because they know drugs are unavailable or unaffordable. We thus recommend that evaluators present this indicator with indicators of drug availabil­ity.