Jhpiego Male Circumcision Programs Jabbin Mulwanda Kelly Curran Technical Leadership Office 19 May...
-
Upload
colby-paddock -
Category
Documents
-
view
215 -
download
0
Transcript of Jhpiego Male Circumcision Programs Jabbin Mulwanda Kelly Curran Technical Leadership Office 19 May...
Jhpiego Male Circumcision Programs
Jabbin MulwandaKelly CurranTechnical Leadership Office
19 May 2009
2
About Jhpiego
An affiliate of Johns Hopkins University
35 years working to strengthen the performance of healthcare workers and health systems around the world
Focused on transforming research into practice
Nearly 600 staff working in 55 countries
3
Where We Work—May 2009
4
Jhpiego’s Role in MC
MC policy and guidelines development Service delivery
Orienting managers and providers Procurement of key supplies and equipment (including infection
prevention supplies) Refurbishment of some sites Assistance with client record keeping and data collection
Training MC service providers and counselors Quality assurance and performance improvement Assist in limited Operations Research
5
Jhpiego’s History in MC
2002: Co-sponsored international consensus meeting on MC for HIV Prevention with USAID and PSI
2003-2005: Implemented pilot MC/male RH project in Lusaka, Zambia in collaboration with PSI/AIDSMark USAID Population Funds
6
Zambia MC/MRH Learning Resource Package and Client Education Materials
7
Jhpiego’s History in MC
December 2005: Assisted WHO in developing international reference manual titled Male Circumcision Under Local Anaesthesia
2006-2007: Development of Training Materials to support reference manual content
8
Collaboration with WHO and UNAIDS
Adult MC course covers five competencies: Group Education Individual Counseling Pre-surgical Assessment MC Procedure Post-operative Care and Counseling
June 2007: Field Test in Lusaka, Zambia March, June 2008: Additional regional MC courses January 2008: Regional MC Training of Trainers
9
Additional Collaboration with WHO and UNAIDS
Male Circumcision Situation Analysis Toolkit
Male Circumcision Quality Assurance Standards
Male Circumcision Operational Guidance
All tools available at www.malecircumcision.org
10
Collaboration with WHO and UNAIDS, cont.
Participation in international/regional meetings: Documenting Newborn MC Practices in Nigeria Operations Research MC Communications MC MOVE
Conducted MC technical update for the College of Surgeons of East, Central and Southern Africa (COSECSA)
11
Next Steps
Develop newborn/pediatric MC courseware based on content in reference manual
Field-test newborn MC course
12
Zambia: Collaboration with PSI
Integrate MC services into stand-alone VCT centers (New Start) Repurpose counseling rooms into procedure rooms Advise on procurement of supplies/equipment Development of emergency plan Training of providers Supportive supervision for providers
13
Male Circumcision Partnership
PSI-led consortium working to scale up MC in Swaziland and Zambia; focus on engaging NGO, FBO and private sectors in MC
Partners include Jhpiego, Marie Stopes International and the Population Council
Funded by the Bill and Melinda Gates Foundation Working in close collaboration with PEPFAR-funded MC
programs in Swaziland and Zambia
14
PEPFAR-Funded MC Programs
Jhpiego is currently implementing PEPFAR-funded activities or programs in the following countries; Botswana Ethiopia Lesotho Mozambique South Africa Tanzania Zambia
15
PEPFAR-Funded MC Programs, cont.
Botswana Requires Assessment of the Botswana Public Health Care
System’s Ability to Expand and Strengthen Male Circumcision Services (Facility Readiness Assessment)
Ethiopia Federal MOH has made MC a component of national prevention
strategy; focus on low MC prevalence regions Build capacity of Surgical Society of Ethiopia to provide MC
training and TA First MC training in November 2008 uncovered unmet need for
MC in Addis Ababa
16
PEPFAR-Funded MC Programs, cont.
Lesotho Supported MOH with MC Scale-up (adult and newborn) Reviewed national MC strategy documents Six pilot sites identified Facility readiness assessments planned for June, 2009
Mozambique Translation of key MC tools into Portuguese Assessment of Surgical Capacity completed Strengthening Surgical Services, Including MC, pilot
planned at four sites
17
PEPFAR-Funded MC Programs, cont.
South Africa Recruiting for the position of Biomedical Prevention
Advisor, to be seconded to National Department of Health
Providing support to NDOH and SANAC to develop national MC policy
Tanzania Adapted MC training materials to Tanzanian context MC pilot planned for high HIV/low MC prevalence
regions
18
PEPFAR-Funded MC Programs, cont.
Zambia Adapt MC training materials Develop Male Reproductive
Health Kit (with partners) Establish MC training
centers at all provincial hospitals plus national military hospital
Procurement of supplies and equipment for public sector sites
Conduct MC training nationwide
Distributing MC Supplies and Equipment in Ndola
19
Future PEPFAR-Funded MC Programs
Namibia First adult MC training planned for July, 2009
Rwanda Support to Rwanda Defense Force MC program
Swaziland National MC scale-up in collaboration with MC Partnership; pilot
test MC MOVE model
Jhpiego is planning PEPFAR-funded MC programs or activities in the following countries:
20
Challenges
Insufficient political commitment at the top. Tacit support is not enough; leadership is required to take MC to scale Improved political commitment and leadership would
help address many related challenges
Is the prospect of massive MC scale up too overwhelming? Is it time to move from “this is why you should scale
up MC” to “this is how you can scale up MC?”
21
Challenges, cont.
Poor condition of public sector surgical services in most countries in the region Dilapidated infrastructure Insufficient number
instruments Erratic supply of
consumables Inconsistent electricity to
power lamps, autoclaves Running water a challenge
Pipes but no wash basin,
Kitwe, Zambia
22
Challenges, cont.
Providers and managers often view MC as “extra work” rather than an integral component of the national HIV program
Certain countries are not embracing task-shifting
Lack of dedicated MC service in public and FBO facilities However, providers in dedicated MC services reporting
burn-out/boredom providing MC all day, every day
23
Lessons Learned to Date
Political commitment at all levels is critical Participants with basic surgical skills can be
trained to competency in 2 weeks Training more that one provider per site is critical Most sites need additional MC supplies and
equipment Invest in developing high performing/high volume
sites for training VCT counselors can play a key role in MC
services as counselors/educators