The Client is Always Right: “Secret Client” Improves the Situation in the Field of Medicine

The “Secret Client” methodology was used for decades in the field of goods and services, however, no one carried out such a study from the point of view of analyzing medical services.

The Eurasian Coalition on Male Health (ECOM) presents here a “Manual on the “Secret Client” Methodology for Assessing the Quality of Services Related to HIV Treatment and Prevention among MSM and Trans People”.  It was developed through a project of the Zaporizhya Regional Charitable Foundation “Gender Z”, implemented in the framework of its small grants competition, and through the project “Coordinated, strategic, and decisive approach: association of MSM and trans networks” carried out by ECOM with support from M-Pact.

Quality and affordable services, independent of any stigma and discrimination, are a necessary component for a successful fight against the HIV epidemic, especially among key populations.

There are many different ways to measure the quality of services, from evaluating policies and procedures to direct supervision of the provision of individual services. The “Secret Client” methodology also has a place among these different methods.

The manual describes the methodology for assessing medical services, which can be used, not only within organizations working with men who have sex with men and trans people, but also within organizations working with other key populations.

 “The relevance of the study “Quality services without labels” was due, first of all, to the predicted stigmatized attitudes of medical workers towards representatives of the LGBT community, and second of all, to the limited level of knowledge of medical workers about HIV prevention consultations given the specific sexual behavior of this group, – stated Elena Veligodskaya, head of the “Aids Center” in Zaporizhya (Ukraine). – Due to the lack of proper training, health workers are poorly informed about how to provide quality services, and about the specificities of HIV counseling for LGBT people. Another problem that was discovered during the research was the quality of HIV testing services, including rapid testing”.

The study revealed that medical personnel providing HIV-related services are not trained and do not have the knowledge necessary for working with MSM.

The first study was carried out in 2017.  The data results helped to assess the attitude of medical workers towards MSM, and to analyze trends and provide recommendations on improving the situation. Following this, it was decided to carry out a follow-up assessment in 2018. Based on a comparison of the 2017 and 2018 data, one can see the dynamics of the improvement in the situation of the work of medical personnel with MSM. Positive changes were also observed with regards to the equipping of medical institutions: informational posters and materials about HIV testing were available in accessible language.

“In its work, ECOM supports innovative projects in the region.  This project is useful for community organizations working with MSM and trans people, as well as with people using drugs, sex workers, and other groups vulnerable to HIV”, – stated Yuri Yoursky, ECOM’s Human Rights and Legal Issues Officer. “This project showed how it is possible to achieve great results with limited resources, and how it is practically possible to change the situation in the medical field at the local level, as well as at the national level when carrying out similar programs in a broader format”.