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 Retailer General 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 5RDTs 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. 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.

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

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

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

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

13. Can you train informal providers to deliver RDTs? which type of provider is best?

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 proposes blood test at other facility Provider doesn’t propose blood test

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 proposes blood test at other facility Provider doesn’t propose blood test 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 proposes blood test at other facility Provider doesn’t propose blood test % 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 proposes blood test at other facility Provider doesn’t propose blood test 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.