Update on Male Circumcision Programme Presented By: Sinokuthemba Xaba National MC Focal Person/AIDS & TB Unit MOHCW 8-10 June 2010 Zimbabwe Country Presentation

Background Total Population : 12 million HIV prevalence 13.7% MC prevalence –self reported 10.3% ZDHS 2006 MC adopted 2007 through a consultative process Country situational analysis carried out in 2008 Male circumcision Steering committee established with 3 TWGs

Policy launched in December 2009 Goal: Framework for safe, acceptable accessible, voluntary and sustainable MC services + human rights (consent & minors) Objective: To reduce the incidence of HIV infection MC - a public health intervention provided at the lowest cost possible MC -provided in a manner that does not undermine existing interventions MC - provided in approved health facilities Collaborative activities with traditionally circumcising communities Communication issues MC Policy

Programme Implementation Status Phased implementation approach MC pilot program started in sites pilot sites:  National training site  Stand alone vs. Integrated  Public / Private Partnership  Uniformed Services Evaluation of pilot phase completed information used in strategy development Development of MC strategy nearing completion DMPPT completed, validation in progress

Coordination and Management MC coordinated from the AIDS and TB Unit of the Ministry of Health and Child Welfare MC Steering Committee Three technical working groups NAC involved in the overall coordination of the national response to HIV and AIDS Preliminary coordination work with TMC in progress and very positive Close Collaboration with NGOs, CBOs, traditional leaders

Achievements (1)  5 MC sites operational  Trained 104 doctors, nurses, other HCWs through national training program  Circumcised 6070 males between 5/09 and 4/2010  Site assessments for roll out initiated  Communication and advocacy material developed  Radio campaigns and community mobilisation

Achievements(2) “MOVE” Implementation Use of the forceps guided surgical technique, Pre-assembled instrument and commodity kits Diathermy for hemostasis Open plan operating room with several cubicles Allocation of more than one staff and surgical bay per surgeon

Partnerships Funding partners  PSI, PEPFAR, UNFPA, WHO, UKAID, Gates through WHO Implementing partners  MOHCW,NAC,ZNFPC, PSI, Local NGOs, CBOs

Challenges  Funding for MC roll out and demand creation  Human resources constraints  Motivation of health care providers  Reaching the “high hanging fruits” in terms of demand creation

Lessons Learned Stakeholder consultations are critical for success of MC programme Phased approach to guide scale up Strong communication and advocacy strategy for demand creation is core Recognition of comparative advantages of different partners Successfully implemented components of the MOVE model Uptake of HTC among MC clients has been high (over 98%) Recruitment for MC through existing T&C services in the pilot phase High uptake of follow up services ( 99% at day 2, 94% at day 7 and 74% at day 42)

Recommendations Task shifting should be considered in the provision of MC services, especially the potential role of nurses in the surgical component of the MC program. To the extent possible, MC services should be carefully linked with other HIV programs, an example of such integration include supply chain management Mixture of service delivery approaches ( stand-alone, co- located and outreach) are important for scale up The private sector should be mobilised in MC roll out as an important and strategy stakeholder

Need for assistance Additional financial support for MC roll-out and impact evaluation

Acknowledgements Dr Owen Mugurungi Dr Karin Hatzold. Gertrude Ncube Dr Sarah Banda