Volunteer Program to Support MC Scale Up in Swaziland Presented by: AYANDA NQEKETO National MC Coordinator Swaziland, Ministry of Health Volunteer Program to Support MC Scale Up in Swaziland Ministry of Health, Swaziland

Volunteer Program Background Swaziland has a severe shortage of skilled human resources for health Just over 100 registered doctors are currently in practice Swaziland does not have a medical school Currently only doctors are permitted to perform MC Accelerated Saturation Initiative (ASI) target is 161, 291 adult MCs; Swaziland cannot meet the need with existing staff Solution – augment existing staff with qualified expatriate volunteer doctors and nurses Ministry of Health, Swaziland

MC Volunteer Program Description Developed a strategy for selection, registration, placement, and post-placement assessment of international volunteer doctors and nurses Volunteers are provided with airfare, visas, accommodation, local transportation, malpractice insurance coverage, a mobile phone, and a standard daily stipend Ministry of Health, Swaziland

MC Volunteer Program Partnerships Swaziland MOH and MC Task Force USG/PEPFAR Swaziland USG/PEPFAR USA Jhpiego WHO UNAIDS PSI The American Urological Association (AUA) International Volunteers in Urology (IVUmed) Ethiopia Surgical Society Nyanza Reproductive Health Society and Kenya MOH And growing… Ministry of Health, Swaziland

AUA and IVUMed Volunteers Edward “Chip” Collins (second from left) with RFM hospital staff

Ira Sharlip and Winnie Adams in front of Litsemba Letfu Men’s clinic.

MC Volunteer Program Volunteer Pilot Mission: 21 April to 30 April 3 urologists from the AUA plus 1 urology resident from IVUmed Placed at Litsemba Letfu Men’s Clinic, FLAS Manzini, Raleigh Fitkin Memorial (RFM) Hospital Collaboration with “Back to School” MC Initiative 253 MCs performed Ministry of Health, Swaziland

MC Volunteer Program, cont. Volunteer Mission 2: 25 May to 11 June 3 surgeons from the Surgical Society of Ethiopia (SSE) 6 nurses from NRHS in Kenya Placed at 3 mission or public sector hospitals: RFM, Mankayane Hospital, and Pigg’s Peak Hospital 285 MCs conducted as of 7 June

MC Volunteer Program Successes, continued…. Assessed capacity of public, NGO and mission hospitals and clinics to host volunteers. Selected sites based on their existing readiness to scale-up MC for HIV Prevention services PSI developed demand generation plans specific to each site “Locum” nurses recruited and contracted to support volunteers Oriented all volunteers Procured additional MC supplies Registered with Medical and Nursing Council Included all volunteers on malpractice insurance policy Ministry of Health, Swaziland

MC Volunteer Program, Challenges and Lessons Learned MC volunteer doctors need sufficient nursing support and counselors Demand creation is essential; it has been challenging to generate demand in public sector since MC program started in NGO sector Manage client and provider expectations in shifting from sleeve to forceps guided method Existing policies prevented volunteer nurses from being fully utilized (no task shifting) Operational systems must also be piloted place prior to full-scale implementation Ministry of Health, Swaziland

MC Volunteer Program, Way Forward Build new partnerships to source international volunteer nurses and doctors Streamline the registration processes Maximize the use of Swazi-national staff including unemployed expatriate nurses Prior to deployment, assess skills of volunteers and provide remediation if necessary (to date all MC volunteers have been hand-picked but this is not scalable) Ministry of Health, Swaziland

Thanks to… Ministry of Health National MC Task Force USG/PEPFAR Jhpiego WHO/UNAIDS MC partners in Swaziland Communities in Swaziland For their technical, programmatic and financial support Ministry of Health, Swaziland

Thank You Ministry of Health, Swaziland