1. Mystery client survey on malaria rapid diagnostic tests Measuring service quality of private outlets

2. 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

3. Outlet types Medical Drug RetailerGeneral retail store Itinerant Drug Vendor

5. 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.)

6.  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. Overall findings

7. WHICH INTERVENTION IS BEST?

8. 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 doesn’t propose blood test (n=57) (33.3%) Provider proposes blood test at other facility (n=14) (8.2%)

9. 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 doesn’t propose blood test (n=57) (33.3%) Provider proposes blood test at other facility (n=14) (8.2%) MC asks for Blood Test (n=74) (43.3%) N=19,11.4% additional tests performed after request

10. 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 doesn’t propose blood test (n=57) (33.3%) Provider proposes blood test at other facility (n=14) (8.2%) N=19,11.4% additional tests performed after request

11. 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 doesn’t propose blood test (n=57) (33.3%) Provider proposes blood test at other facility (n=14) (8.2%) MC asks for Blood Test (n=74) (43.3%) N=19,11.4% additional tests performed after request

12. Arm 3: Most likely to treat “not malaria” correctly

13. WHICH TYPE OF PROVIDER IS BEST? Can you train informal providers to deliver RDTs?

14. 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 Provider proposes blood test at other facility

15. 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 Provider proposes blood test at other facility MC asks for Blood Test

16. 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 Provider proposes blood test at other facility % of Providers Performing Tests

17. 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 Provider proposes blood test at other facility MC asks for Blood Test

18. Itinerant Drug Vendors: Most likely to treat “not malaria” correctly

19. 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.