1. MOVE Model MC Service Delivery in Swaziland

2. Litsemba Letfu
First picture: Litsemba Letfu in May 2009 – one big empty space.
2nd and 3rd pictures what it looks like now
Designed to use efficiency models to increase the volume of clients seen.

3. Layout – client flow.
Describe what happens in each room.
Emphasize unidirectional client flow. Emphasize 8-bed theater (2 private rooms – barely used)

4. Litsemba Letfu Branding.
Explain why men’s clinic. Designed to be an entry point for health services for men

5. Models for Optimizing Volume & Efficiency
Task Sharing
Assigning steps to lower cadres of staff
Supported by:
-Surgical layout
High nurse/doctor ratio
High bed/doctor ratio
Alcohol hand gel between procedures
Task Shifting
-shifting service
provision to lower
cadres of staff
Technique
Cautery for hemostasis
pre-packaged kits
Theater layout
Explain MOVE model.
Emphasize: doctors must provide surgical procedure, no clinical officer cadre
Sleeve method
Explain which components are used by LL and which aren’t.
Emphasize that you don’t need a big fancy clinic to use varoius MOVE principles.

6. Stats to date June 2009 – May 2010: 5052 MCs at clinic
Number of MCs per month
June 2009 – May 2010: 5052 MCs at clinic
2065 MCs on outreach
Clinic HIV Testing rate: 81%
Follow-up rate:
88% (2-day)
53% (7-day)
AE rate: 1.7%
Part of high numbers in april/may attributed to back-to school promotion held during school holidays.
Clinic was seeing between people a day.

7. Mobile Outreach Sept 09-May10: 2065 MCs on outreach
Apply MOVE model to mobile outreach
MOVE model also applied to mobile outreach settings.
Identify clinics with space and send clinical teams regularly to perform MCs.

8. Demand Creation
High volume sites are only as good as the number of clients seen
Demand creation activities essential
Currently 95% of demand creation in Swaziland is interpersonal
Transport primary barrier

9. Future Directions Expand mobile outreach
Programmatic support for public sector
Strategies to prevent counseling bottleneck
Expand demand creation efforts