ORIGINAL RESEARCH ARTICLE Clinicians’ perspective of a training programme in syndromic management of sexually transmitted infections in Northern Tanzania David Martin MD MPhil 1 , Elise Klouman MD PhD 2 , Melkiory Masatu MD PhD 1 and Knut-Inge Klepp PhD MPH 2 1 Centre for Educational Development in Health Arusha, Tanzania; 2 Faculty of Medicine, University of Oslo, Box 1046 Blindern, N-0316 Oslo, Norway Summary: This process evaluation study was designed to investigate clinicians’ perception of a training programme on syndromic management of sexually transmitted infections (STIs) and their experiences in applying the skills learnt during the course. Out of 136 eligible course participants from Arusha and Kilimanjaro regions, Tanzania, 47 were invited to take part in the study and 40 agreed to participate (85%). The research instruments consisted of a structured interview including open- and close-ended questions, a self-administered ques- tionnaire, and an observation checklist. While the clinicians reported to be satisfied with the course itself, the results revealed insufficient practical training. The clinicians reported problems with condom promotion and partner notification, and frequent shortage of equipment and drugs in the clinics was observed. Future courses on syndromic management of STI should focus on skills training related to health education and counselling, and have a stronger emphasis on practical, clinical work. There is need to address barriers to condom promotion and partner referral. Keywords: STI, private health sector, syndromic management, training, process evaluation Introduction The World Health Organization (WHO) recom- mends syndromic treatment of sexually trans- mitted infections (STI) in developing countries at the primary health care level. 1,2 According to this concept, treatment is not based on aetiologic diagnosis, but relies on elements from the medical history such as symptoms and sexual behaviour, as well as clinical signs, all defined in a fixed algorithmic model. This approach has been demon- strated to be effective in reducing the HIV incidence in rural East Africa. 3 There are only few studies reporting how this approach is perceived and practised by clinicians in East Africa, but available data clearly demonstrate that improved training and supervision in syndromic manage- ment is called for. 4–6 In 1995 the Tanzania AIDS Project, in liaison with the National AIDS Control Programme under the Ministry of Health, introduced a training pro- gramme on syndromic management of sexually transmitted disease (STD) to clinicians from pri- vately owned health facilities. Conducting such courses is a major undertaking in a resource-poor country like Tanzania both in terms of direct cost, and in terms of time and commitment on the part of the participating private health-care clinicians. Thus, process evaluation in order to determine the usefulness, strengths, and weaknesses of the train- ing from the trainee’s perspective is important. This study investigated the clinicians’ perception of the training programme and their experiences in applying the skills learnt during the course. Methods Training programme From July 1995 to January 1997, 10 courses, each lasting two weeks, were held at the Centre for Educational Development in Health, Arusha. The training consisted of classroom sessions and a three-days practical training in hospital out-patient clinics. The classroom sessions used participatory teaching methods, e.g. lectures, small-groups learn- ing, role play, demonstration, case study, and video show. Various teaching aids were used, including posters, anatomical models, condoms and condom use demonstration models, WHO case manage- ment modules, STI treatment guidelines, patient International Journal of STD & AIDS 2005; 16: 697–701 697 Correspondence to: Knut-Inge Klepp Email: k.i.klepp@medisin.uio.no