MALE CIRCUMCISION VOLUNTEER PROGRAMME: Feasibility Assessment In Namibia MALE CIRCUMCISION VOLUNTEER PROGRAMME: Feasibility Assessment In Namibia Dr. Justin K. Nyatondo I-TECH Namibia Contributing Authors: Epafras Anyolo, MOHSS George Obita, WHO Dino Rech, WHO Alexis Ntumba, IntraHealth

Presentation outline Objectives of the assessment Rationale for using volunteers Methodology Key findings Recommendations Progress to date

Objectives of the Assessment To assess selected sites for readiness to receive volunteers To provide technical support to the male circumcision (MC) Task Force to develop a plan to introduce the volunteer programme in Namibia. To provide recommendations on areas that need strengthening

Rationale for use of volunteers Despite significant steps in scaling up MC services in Namibia human resource constraints remain a major barrier  Lack of personnel  Trained MC providers overloaded with other duties  Current legal framework only allows doctors to perform MC Use of volunteers has been used with success in other programmes in Namibia  Eye Camps (cataract surgery)  Operation Smile (cleft palate)

Assessment team Team led by two WHO consultants accompanied by representatives from:  Ministry of Health and Social Services  Development partners: o I-TECH Namibia o IntraHealth o USAID o CDC Five hospitals visited: Windhoek Central, Oshakati, Onandjokwe, Rundu, and Nyangana

Methodology Methods used included  Interviews - management and staff using a standardised checklist  Observation - infrastructure, lay-out, equipments, and supplies  Document review Key Areas considered:  Facility space  Staffing  Equipment and supplies  Current and future demand  Volunteer hosting logistics  Facility willingness to receive volunteers

Findings Facility space:  All facilities have dedicated surgical space for MC that can be made available full time Staffing:  Doctors performing MC are available at all sites  Three sites have a team comprising of at least a doctor, nurse and counsellor trained on MC for HIV prevention  Very little time is dedicated to MC due to competing work demands hence low numbers of MCs done to date  Staff at Rundu and Nyangana hospitals not trained on MC for HIV prevention

Findings (2) Equipment and supplies:  Generally equipment and supplies are available, including medicines and consumables  A limited number of MC specific surgical kits  Current levels of MC kits capacity limited to a maximum of 5-10 cases a day

Findings (3) Current and future demand  Windhoek and Oshakati hospitals had waiting lists ~60 – 100 clients despite no active demand creation o Average waiting time up to 6 months  Average number of MCs done per week ranged from 0 – 5 across the five facilities  Indication from hospitals and partners is that potential demand could be high with mobilization

Findings (4) Volunteer hosting logistics:  All hospitals are easily accessible and have good nearby hotels/lodges  No logistics planning has been done yet.  Country experience in hosting eye camp volunteers is reassuring  Focal persons available at most sites Facility willingness to receive volunteers:  All hospital teams expressed willingness and enthusiasm to receive volunteers Demand Creation:  Ensure adequate demand prior to volunteers’ arrival

Recommendations Facility space:  Do lay out planning for waiting room and counselling space Staffing:  Ensure availability of adequate trained support staff throughout the volunteer mission Equipment and supplies:  Increase the number of MC kits to a minimum of 20 per hospital  Strongly recommend the introduction and training on diathermy  Consider use of MC disposable kits

Formal invitation letter to WHO inviting volunteers to Namibia drafted Ideal period for initial volunteer mission provisionally set for Aug - Sept 2010 MoHSS and partners building capacity at sites through  MC dedicated staff recruited (Dr & nurses)  Training  Procuring instruments and consumables  Making necessary infrastructural adjustments at facilities Good in country partner support available to address gaps Progress…..