Sahara Country Updates

22
5 th SAHARA Conference Dr Sibongile Dludlu UNAIDS RST/ESA Male circumcision Country Updates Johannesburg, South Africa 01 December 2009

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Transcript of Sahara Country Updates

Page 1: Sahara Country Updates

5th SAHARA Conference

Dr Sibongile DludluUNAIDS RST/ESA

Male circumcision Country Updates

Johannesburg, South Africa01 December 2009

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Outline

• Review key elements for country MC

Programming

• Give an analysis of country implementation

• Outline some challenges and constraints

• Consider facilitating factors

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Global RecommendationsGlobal Recommendations• Countries with high prevalence (>15%), generalized

heterosexual HIV epidemics and low rates of MC should consider urgently scaling up access to MC services

• 13 countries identified: Botswana, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe

• Consider ethics, communication, culture, health systems, funding, gender, comprehensive prevention strategies

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UN Support ActionsUN Support ActionsUN Agencies have a joint work plan:

The goal of the UN partners joint work plan on male circumcision is to assist countries to make evidence-based policy and programme decisions to improve the availability, accessibility and safety of male circumcision and reproductive health services as an integral component of comprehensive HIV prevention strategies

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UN Support ActionsUN Support Actions

The objectives are to:

1. Set global norms and standards

2. Provide technical support to countries

3. Conduct high level advocacy and develop global communication strategies and messages

4. Coordinate the setting of global research priorities, and develop systems for monitoring and evaluation of male circumcision services

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The UN partners are working

together to develop resources to

support programme scale up:

• Information/Advocacy documents

• Guidance documents

• Tools

• Reports

• The Male Circumcision Clearing House

UN Tools and Guidelines to Support UN Tools and Guidelines to Support ImplementationImplementation

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Developed by the World Health Organization (WHO), the

Joint United Nations Programme on HIV/AIDS

(UNAIDS), the AIDS Vaccine Advocacy Coalition(AVAC), and

Family Health International (FHI)

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Operational Guidance Operational Guidance

1. Leadership and partnership

2. Situation analysis

3. Advocacy

4. Enabling policy and regulatory environment

5. Strategy and operational plan

6. Quality assurance and improvement

7. Human resource development

8. Commodity security

9. Social change communication

10. Monitoring and evaluation

Key elements for operationalizing MC services

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Two years later……How far have countries moved How far have countries moved How far have countries moved How far have countries moved How far have countries moved How far have countries moved How far have countries moved How far have countries moved ……………………????????????????????????

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Situation AnalysisSituation Analysis• A situation analysis is to determine attitudes, beliefs,

practices and socio cultural aspects of MC, policy and regulatory framework, health system readiness

• Some countries have done comprehensive SA –Botswana, Lesotho, Namibia, Uganda, Zambia, Zimbabwe

• Others rapid assessment - Swaziland (Key informants, Facility readiness), Rwanda (facility readiness)

• Some still in progress – Malawi, Tanzania

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PolicyPolicyNotable differences in approach:

• Botswana no separate policy but strategy with policy elements

• Kenya policy guidelines

• Lesotho, Namibia, Swaziland, Uganda and Zimbabwe, dedicated policies (drafts completed)

• Zambia – Information note to Cabinet – not policy

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StrategyStrategy• Country strategies developed that include:

– Objectives, target population, numbers of men to be reached, costs, service delivery strategies, resource mobilization, monitoring and evaluation

• Decision Makers' Programme Planning Tool to determine cost, impact, pace of scale up

• Most countries have 'catch-up' strategies to reach adult men – Botswana, Kenya, Swaziland, Zimbabwe, Zambia

• But longer term neonatal circumcision also being considered in Botswana, Swaziland, Zambia

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Progress in other Key ElementsProgress in other Key Elements• Quality Assurance being implemented in Kenya, and Swaziland using WHO Guide and Toolkit

• Regional and country trainings in almost all countries

• Communication strategies under development in Kenya, Namibia, Swaziland – UN Toolkit under development

• M&E Indicators gradually being introduced into HMIS – Botswana, Kenya

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Progress on Male Circumcision

Zambia: Situation analysis, trainings, strategy & Implementation plan, service delivery

Botswana: Situation analysis, DMPPT, strategy, training, M&E, communications and QA

SwazilandSituation analysis, policy, strategy & Implementation plan, leg/regulatory assessment, trainings, QA, M&E draft, comms draft

Kenya: national guidance & strategy, situation analysis, guidelines, training, Quality Assurance guide, expanded service delivery, communication & advocacy under development, M&E, research

Rwanda advocacy campaign, situation assessment underway, services in military Uganda

Situation analysis, policy development, Comms draft

Namibia:Champions visit, advocacy, DMPPT,draftpolicy, strategy, training and QA planned, communications plan

Lesotho: advocacy, situation analysis, policy development, draft strategy & comms

Tanzania, MalawiSituation analysis, pilot service sites

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Snapshot of country progress

Zimbabwe

Zambia

Uganda

Tanzania

Swaziland

South Africa

Rwanda

Namibia

Mozambique

Malawi

Lesotho

Kenya

Botswana

Service delivery M & E

Quality Assu

Training II

Training I

Policy &

RegSituation

analyLeadership I II

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Service Delivery Service Delivery

How many circumcisions have been done?

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Service Delivery Service Delivery

• Kenya - Cumulatively 40,000 MC’s done by October 2009

• Zimbabwe - 4 sites, 1818 men circumcised as of June 2009

• UTH Zambia – 2500 in 6-month

Adverse event rates remain low <3%

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Challenges and Challenges and ConstraintsConstraints

• Human resource constraints- For country programming at national level, staff already

overloaded

- For service delivery – lack of personnel, staff mobility

• Political support – it has been a process to get political buy-in in some countries, also delays due to elections, set backs with change of government

• Funding – countries not clear on what funds are available and how to access

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Challenges and Challenges and ConstraintsConstraints

• Traditional providers – almost all countries have them but no clear guidance on how to involve them

• Communication – partial protection, issues of risk compensation, how to develop strategies and tools

• HIV positive men – how service delivery sites will handle without stigma and discrimination

• Implications for women – how to involve women in service delivery, monitor and evaluate for adverse societal effects

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Facilitating FactorsFacilitating Factors• Level of political commitment now in almost all countries

• Country Champions

• Leadership and coordination- Of the UN, with WHO leading joint UN team- UN coordination with other partners- MoH leadership and collaboration with NACs- National multi-stakeholder MC Task Forces and focal persons

- Countries with well coordinated TF making more rapid progress

- Replication at provincial level

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Facilitating FactorsFacilitating Factors• Engagement of key stakeholders in countries with

extensive consultations – with traditional providers, women, young people

• Availability of tools and guidelines and increasing technical support

• Funding support - PEPFAR, Gates, GFATM

• Subtle country peer pressure through experiences sharing

• Innovative models to improve the efficiency of services

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Acknowledgements

•Country Male Circumcision Task Forces

•UN Male Circumcision Working Group, Geneva

•UN Inter Agency Working Group (IATT)

•Implementing partners supporting MC roll out in countries