1. MC MOVE Models for optimizing the volume and efficiency of MC services By Dr Dino Rech

2. MC MOVE Evolution of efficiency principles in surgery and MC Efficiency principles used in MC Progress to date – New sites and programs –Research –Ongoing evolution. Efficiency challenges – Balancing demand and supply/ seasonality –Counselling and communications –Part time MC providers vs specialised teams

3. Evolution of efficiency principles in surgery and MC…e.g. Aravind Eye Hospital India Orange Farm South Africa

4. Evolution of efficiency principles in surgery and MC MOVE WHO pilot initiative: Aims to maximise Surgical results and minimising time and resources needed to perform high volumes of surgery. Facilitates cost effective solutions to MC scale up in high volume/demand settings

5. Task-Shifting - Training / certification of entire MC procedure to lower health cadres, e.g., clinical officers, nurses. Efficiency Principles used in MC Task-Sharing Assign steps to lower cadres: - Surgical area clean & prep - Anaesthetic block - Final foreskin stitches - Wound dressing Sharing supported by: - 4 beds per operator - 6 lower cadres per operator - Theatre layout for staff flow - Alcohol gel hand sanitizing - Gown change only if blood Surgical Efficiency Techniques Task- Shifting Task-Sharing Techniques - Forceps-guided - Cautery (monopolar) for haemostasis - Fewer stitches (8-12) for foreskin apposition - Collective wrap of surgical items - Pre-assembled surgical kits - Theatre layout for faster patient turnover

6. The Fourth Efficiency Principle Adequate Client flow and demand for services -Communications -Mobilization -Counselling and testing services

7. Surgical layout

8. 1 2 3 4

9. Efficiency focused MC Kits

10. Surgical Methods Surgical methods compared Time savings to surgeon/procedure Forceps-guided/dorsal slit2:25 Forceps-guided/sleeve resection7:40 Dorsal slit/sleeve resection5:15 * Times depicted are based on time-motion observations at Orange Farm, South Africa

11. Results Indicator Pre ‐ MOVE MOVE (Sleeve) MOVE (Forceps Guided) Doctor Operating Time 25 ‐ 50 min.10 ‐ 20 min5 ‐ 10 min Cubicle Turnover Time 60 min 30 ‐ 40 min25 ‐ 30 min # of Clients 1 ‐ 2 an hour3 ‐ 5 an hour5 ‐ 8 an hour * Note Graph with initial impact and results from Tanzania.

12. Progress to date Efficiency focused( use of MOVE) implementation –South Africa –Swaziland –Zimbabwe –Tanzania –Botswana –Zambia –Kenya Research Efficiency or MOVE Evaluation

13. Aggregate Numbers – Four Pilot Sites. Tanzania 13 MOVE Begins

14. Challenges to implementing efficient high volume services –Balancing demand and supply / managing seasonality of demand –Counselling and communications: How to keep up? –Part time MC providers VS specialised teams: Pros and Cons

15. New Super Efficient MC Device in SA???