Jhpiego Male Circumcision Programs

Jabbin MulwandaKelly CurranTechnical Leadership Office

19 May 2009

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About Jhpiego

An affiliate of Johns Hopkins University

35 years working to strengthen the performance of healthcare workers and health systems around the world

Focused on transforming research into practice

Nearly 600 staff working in 55 countries

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Where We Work—May 2009

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Jhpiego’s Role in MC

MC policy and guidelines development Service delivery

Orienting managers and providers Procurement of key supplies and equipment (including infection

prevention supplies) Refurbishment of some sites Assistance with client record keeping and data collection

Training MC service providers and counselors Quality assurance and performance improvement Assist in limited Operations Research

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Jhpiego’s History in MC

2002: Co-sponsored international consensus meeting on MC for HIV Prevention with USAID and PSI

2003-2005: Implemented pilot MC/male RH project in Lusaka, Zambia in collaboration with PSI/AIDSMark USAID Population Funds

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Zambia MC/MRH Learning Resource Package and Client Education Materials

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Jhpiego’s History in MC

December 2005: Assisted WHO in developing international reference manual titled Male Circumcision Under Local Anaesthesia

2006-2007: Development of Training Materials to support reference manual content

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Collaboration with WHO and UNAIDS

Adult MC course covers five competencies: Group Education Individual Counseling Pre-surgical Assessment MC Procedure Post-operative Care and Counseling

June 2007: Field Test in Lusaka, Zambia March, June 2008: Additional regional MC courses January 2008: Regional MC Training of Trainers

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Additional Collaboration with WHO and UNAIDS

Male Circumcision Situation Analysis Toolkit

Male Circumcision Quality Assurance Standards

Male Circumcision Operational Guidance

All tools available at www.malecircumcision.org

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Collaboration with WHO and UNAIDS, cont.

Participation in international/regional meetings: Documenting Newborn MC Practices in Nigeria Operations Research MC Communications MC MOVE

Conducted MC technical update for the College of Surgeons of East, Central and Southern Africa (COSECSA)

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Next Steps

Develop newborn/pediatric MC courseware based on content in reference manual

Field-test newborn MC course

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Zambia: Collaboration with PSI

Integrate MC services into stand-alone VCT centers (New Start) Repurpose counseling rooms into procedure rooms Advise on procurement of supplies/equipment Development of emergency plan Training of providers Supportive supervision for providers

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Male Circumcision Partnership

PSI-led consortium working to scale up MC in Swaziland and Zambia; focus on engaging NGO, FBO and private sectors in MC

Partners include Jhpiego, Marie Stopes International and the Population Council

Funded by the Bill and Melinda Gates Foundation Working in close collaboration with PEPFAR-funded MC

programs in Swaziland and Zambia

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PEPFAR-Funded MC Programs

Jhpiego is currently implementing PEPFAR-funded activities or programs in the following countries; Botswana Ethiopia Lesotho Mozambique South Africa Tanzania Zambia

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PEPFAR-Funded MC Programs, cont.

Botswana Requires Assessment of the Botswana Public Health Care

System’s Ability to Expand and Strengthen Male Circumcision Services (Facility Readiness Assessment)

Ethiopia Federal MOH has made MC a component of national prevention

strategy; focus on low MC prevalence regions Build capacity of Surgical Society of Ethiopia to provide MC

training and TA First MC training in November 2008 uncovered unmet need for

MC in Addis Ababa

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PEPFAR-Funded MC Programs, cont.

Lesotho Supported MOH with MC Scale-up (adult and newborn) Reviewed national MC strategy documents Six pilot sites identified Facility readiness assessments planned for June, 2009

Mozambique Translation of key MC tools into Portuguese Assessment of Surgical Capacity completed Strengthening Surgical Services, Including MC, pilot

planned at four sites

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PEPFAR-Funded MC Programs, cont.

South Africa Recruiting for the position of Biomedical Prevention

Advisor, to be seconded to National Department of Health

Providing support to NDOH and SANAC to develop national MC policy

Tanzania Adapted MC training materials to Tanzanian context MC pilot planned for high HIV/low MC prevalence

regions

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PEPFAR-Funded MC Programs, cont.

Zambia Adapt MC training materials Develop Male Reproductive

Health Kit (with partners) Establish MC training

centers at all provincial hospitals plus national military hospital

Procurement of supplies and equipment for public sector sites

Conduct MC training nationwide

Distributing MC Supplies and Equipment in Ndola

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Future PEPFAR-Funded MC Programs

Namibia First adult MC training planned for July, 2009

Rwanda Support to Rwanda Defense Force MC program

Swaziland National MC scale-up in collaboration with MC Partnership; pilot

test MC MOVE model

Jhpiego is planning PEPFAR-funded MC programs or activities in the following countries:

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Challenges

Insufficient political commitment at the top. Tacit support is not enough; leadership is required to take MC to scale Improved political commitment and leadership would

help address many related challenges

Is the prospect of massive MC scale up too overwhelming? Is it time to move from “this is why you should scale

up MC” to “this is how you can scale up MC?”

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Challenges, cont.

Poor condition of public sector surgical services in most countries in the region Dilapidated infrastructure Insufficient number

instruments Erratic supply of

consumables Inconsistent electricity to

power lamps, autoclaves Running water a challenge

Pipes but no wash basin,

Kitwe, Zambia

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Challenges, cont.

Providers and managers often view MC as “extra work” rather than an integral component of the national HIV program

Certain countries are not embracing task-shifting

Lack of dedicated MC service in public and FBO facilities However, providers in dedicated MC services reporting

burn-out/boredom providing MC all day, every day

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Lessons Learned to Date

Political commitment at all levels is critical Participants with basic surgical skills can be

trained to competency in 2 weeks Training more that one provider per site is critical Most sites need additional MC supplies and

equipment Invest in developing high performing/high volume

sites for training VCT counselors can play a key role in MC

services as counselors/educators