Increasing Male Circumcision (MC) Service Delivery through Demand Creation and Mentorship for Kitwe Central Hospital, a Tertiary Hospital in Zambia Maureen Chilila, RN, RM, MSc Jabbin Mulwanda, MD Nashiol Nyirongo CO Martha Ndhlovu, RN, RM, Mcur Hilda Shasulwe, RN, RM Joseph Nikisi, MD, MPH

Background Zambia  Population: 13,046,508 (CSO 2010)  HIV prevalence: 14.3% adults (2007 DHS)  Male circumcision prevalence: 12.7% of men  Highest MC prevalence in Northwestern Province (71%) and Western (40%)  MOH estimates $47 per MC  7 MCs in Zambia avert one new HIV infection = $329 per infection averted 2

Kitwe District Profile  Kitwe District is in the Copperbelt Province and has a total population of 516,386, with a population density of 655 persons per square kilometer.  HIV prevalence: 17  District MC: 78,966  Average annual MC target: 19,741  Average monthly MC target: 1,645 3

Issues  Kitwe Central Hospital is located in Kitwe District.  It is surrounded by 29 health centers.  It is among the three tertiary hospitals in Zambia.  The site was selected and set up to provide MC (equipment, training, supplies, M&E tools).  Investment did not give us the expected numbers – clients did not come to access MC. services. 4

Description: Demand Generation for MC  Attached Jhpiego staff as an overseer  Collaboration with other partners:  Several meetings were held  Community mobilizers were trained 5

Description: Demand Generation Channels  Local radio programs/ announcements  Posters  Fliers  Vehicle-mounted loudspeaker announcements in catchment areas  Meetings with Neighborhood Health Committees  Use of community health workers/mobilizers  Talks in schools/colleges 6

Matching Demand Creation Efforts with Service Delivery  Minimal refurbishments  Orientation of managers and supervisors  Training of providers and counselors  Provision of surgical equipment and supplies  Follow-up of providers and supportive supervision to enhance transfer of learning  Paying staff working outside official hours  Efficiencies – fewer providers per operating 7

Mentorship for Skilled Manpower-Efficiency  Providers were mentored before and during the campaign to enhance transfer of learning and increase efficiency.  Checklist and other mentorship tools were used.  During mentorship, peer learning was encouraged. 8

Number of Males Circumcised as Part of the Minimum Package of MC for HIV Prevention Services (February 2009 to August 2011) Routine MC Provision Main MC Campaign 9

Lessons Learned  The presence of a mentor at the facility proved to be a motivator.  Creating sustainable synergies for demand creation has maintained a steady flow of clients.  Obtaining management support at the facility level promotes ownership and hence sustains the service. 10

Next Steps  Provide mentorship and demand creation support to the Ministry of Health facilities 11

Thank you 12