1. 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

2. 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

3. 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

4. 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

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

6. 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

7. 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

8. 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

9. 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

10. 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

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

12. Thank you 12