Mystery client survey on malaria rapid
diagnostic tests
Measuring service quality of private outlets
Study Objective

To determine
–
–
the proportion of providers that correctly describe and
demonstrate 5 key steps in for conducting and interpreting a
rapid diagnostic test for malaria.
whether provider quality differed by intervention arm and
provider type.
The study was conducted 3-5 months after PSI gave RDT
training to the target providers
Outlet types
Medical Drug Retailer
Itinerant Drug Vendor
General retail store
Medical Drug
Retailers
9%
Itinerant Drug
Vendors
28%
General Retail
Stores
63%
Intervention Description
Arm 1: RDT resupply at ~$0.18/RDT, upon receipt of used
RDTs
Arm 2: RDT resupply at ~$0.18/RDT, upon receipt of used
RDTs
 Plus: Financial incentive of free RDT test for every 5
RDTs purchased
Arm 3: RDT resupply at ~$0.18/RDT, upon receipt of used
RDTs
 Plus: Bi-weekly support visits to outlets (one-on-one
discussions, BCC/IEC materials, visits to recent patients,
etc.)
Overall findings
 65% of providers proposed an RDT without
prompting.
 Of the providers who performed the mRDT,
–
–
–
–
95% used an antiseptic
94% read the results correctly
85% showed the client results
84% gave a correct treatment
 40% performed all five steps.
WHICH INTERVENTION IS BEST?
MC reports fever that s/he suspected of malaria in past
week
(n=171)
Provider proposes
blood test (RDT) at
his/her own facility
(n=96) (56.1%)
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Provider doesn’t
propose blood test
(n=57) (33.3%)
Arm 1
Arm 2
Arm 3
Arm
Provider proposes
blood test at other
facility
(n=14) (8.2%)
MC reports fever that s/he suspected of malaria in past
week
(n=171)
Provider proposes
blood test (RDT) at
his/her own facility
(n=96) (56.1%)
N=19 ,11.4%
additional tests
performed
after request
Provider doesn’t
propose blood test
(n=57) (33.3%)
MC asks for Blood Test
(n=74) (43.3%)
Provider proposes
blood test at other
facility
(n=14) (8.2%)
MC reports fever that s/he suspected of malaria in past
week
(n=171)
Provider proposes
blood test (RDT) at
his/her own facility
(n=96) (56.1%)
Provider proposes
blood test at other
facility
(n=14) (8.2%)
Provider doesn’t
propose blood test
(n=57) (33.3%)
100.0%
N=19 ,11.4%
additional tests
performed
after request
80.0%
Arm 1
Arm 2
Arm 3
60.0%
40.0%
20.0%
0.0%
Arm
MC reports fever that s/he suspected of malaria in past
week
(n=171)
Provider proposes
blood test (RDT) at
his/her own facility
(n=96) (56.1%)
N=19 ,11.4%
additional tests
performed
after request
Provider doesn’t
propose blood test
(n=57) (33.3%)
MC asks for Blood Test
(n=74) (43.3%)
Provider proposes
blood test at other
facility
(n=14) (8.2%)
Arm 3: Most likely to treat “not malaria” correctly
% of Providers Treating Properly and Reading Result Correctly
90.0%
80.0%
70.0%
60.0%
50.0%
Arm 1
Arm 2
Arm 3
40.0%
30.0%
20.0%
10.0%
0.0%
Arm
Can you train informal providers to deliver RDTs?
WHICH TYPE OF PROVIDER IS BEST?
MC reports fever that s/he suspected of malaria in past
week
(n=171)
Provider proposes
blood test (RDT) at
his/her own facility
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Provider doesn’t
propose blood test
General Retail
Stores
Itinerant Drug
Vendors
Medical Drug
Retailers
Type
Provider proposes
blood test at other
facility
MC reports fever that s/he suspected of malaria in past
week
(n=171)
Provider proposes
blood test (RDT) at
his/her own facility
Provider doesn’t
propose blood test
MC asks for Blood Test
Provider proposes
blood test at other
facility
MC reports fever that s/he suspected of malaria in past
week
(n=171)
Provider proposes
blood test (RDT) at
his/her own facility
Provider proposes
blood test at other
facility
Provider doesn’t
propose blood test
80.0%
% of Providers
Performing
Tests
75.0%
70.0%
65.0%
60.0%
55.0%
Type
General Retail
Stores
Itinerant Drug
Vendors
Medical Drug
Retailers
MC reports fever that s/he suspected of malaria in past
week
(n=171)
Provider proposes
blood test (RDT) at
his/her own facility
Provider doesn’t
propose blood test
MC asks for Blood Test
Provider proposes
blood test at other
facility
Itinerant Drug Vendors: Most likely to treat “not
malaria” correctly
% of Providers Treating Properly and Reading Result Correctly
80.0%
70.0%
60.0%
General Retail Store
50.0%
40.0%
Itinerant Drug Vendor
30.0%
Medical Drug
Representative
20.0%
10.0%
0.0%
Type
Summary
 The quality of providers with regards to performing and
interpreting the mRDT was quite high, despite general lack of
formal health training among informal private providers.
 Providers who received intervention Arm 3 (mRDT subsidies
and counseling, education and training) performed the best in
regards to correctly treating after using mRDTs.
 Among the provider types Itinerant Drug Vendors received the
highest percentages in all 5 key steps except for the use of
antiseptic.
 For almost all 5 key steps General Retail Stores performed
better than pharmacies. General Retail Stores are much more
numerous than pharmacies in villages.