8-10 june 2010 arusha, tanzania by ayanda nqeketo national mc coordinator ministry of health,...

Male Circumcision Country Update, Swaziland

8-10 June 2010 Arusha, Tanzania By AYANDA NQEKETONational MC Coordinator

Ministry of Health, Swaziland

Swaziland’s Current Plan for Scale Up of MC Services

National MC policy was approved in August 2009 Current plan is to circumcise 111,000 adult men

(80% of the adult male population aged 15-24) over 5 years Increasing the capacity of public and private MC

service providers Utilize fixed and mobile sites

Scale up has been slow Since 2007—only xx adult MCs and xx neonatal MCs

have been performed At the current rate it will take longer than 5 years to

reach our targets


Evolution of the Accelerated Saturation Initiative (ASI)

MOH engaged the USG and other key stakeholders in dialogue around accelerating the scale up of MC

In Feb 2010, the ASI proposal was presented the Cabinet

The Cabinet passed a resolution and requested assistance from the USG to implement

In March the GKOS requested the Task Force to prepare a detailed implementation plan


Details of an Accelerated Plan to Scale Up MC Services

• Partner with USG for funding and technical expertise


Phase 1 Preparation and piloting 3-6 months

Phase 2 Regional implementation of ‘full scale’ ASI

1-2 months

Phase 3 Full scale 7 months

Key Issues Requiring Further Dialogue

Three key challenges will affect the success of the ASI: 1. Existence of trained human resources- Limited 2. Adequacy of the facilities- Limited3. Acceptance of the MC campaign

With a mainly rural population, MC services will likely need to be taken to the people rather than relying solely on the people traveling to fixed MC service-delivery sites


Projections The target population will be 161,291 males aged

15-49 years old Reasons for expanding the target group include;

the prevalence of intergenerational sex, age of first sexual debut, and HIV incidence


Total Males Aged 15-49 236,594

Estimated circumcised (8% prevalence) 18,928

Estimated uncircumcised (92%) 217,666

Estimated HIV-infected (25.9% prevalence) 61,278

Estimated HIV-negative (74.1%) 175,316

Total needing circumcision (not circumcised and HIV neg)

161,291

4 regions of Swaziland

Hhohho

Shiselweni

Manzini Lubombo


Hospitals and Health Centers by Tinkhundla


Hhohho

Shiselweni

Manzini Lubombo

Matsanjeni

Mhlambanyatsi

Motjane

Matsanjeni1

Sithobela

Ndzingeni

Mayiwane

Khubuta

Gege

Mbabane East

Mthongwaneni

Zombodze

Mafutseni

Shiselweni

Sigwe

Mukhiweni

Mangcongco

Lubuli

Timpisini

Ngudzeni

Nkwene

Hlane

Sandleni

eKukhayeniSiteki

Nkaba

Hhukwini

Ntondozi

Ludzeludze

Nhlambeni

Lomahasha

Hosea

Ntfonjeni

Manzini South

Mhlume

Mtsambama

Manzini North

Mahlangatja

Lobamba

Mbangweni

Mpolonjeni

Maseyisini

Maphalaleni

Mahlanya

Mhlangatane

Mandlangempisi

Ngwempisi

Pigg's Peak

Dvokodweni

Mbabane West

Kwaluseni

LaMghabi

Siphofaneni

Lavumisa

Mbabane

Piggs Peak

Mbabane East

SitekiGood Shepherd

Sihobela

Mkhuzweni

Matsanjeni

Nhanagano

Hlathikhulu

Mankayane

R.F.M. Hospital

Mhlambanyatsi

Dvokolwako

Preparations

MC Task Force formed an ASI sub-committee and four workgroups Mapping and policy Logistics Human resources MC service delivery including M&E


Magnitude of the Effort… Illustrative Scenario

Main office / warehouse 3 regional offices / warehouses 27 clinical teams and support staff

> 500 staff and volunteers 4 fixed sites - operational all year

10 clinical teams Total MCs 52,300

13 mobile sites – operational 3 – 10 months 7 clinical teams Total MCs 32,000

507 outreach events – operational for one week 10 clinical teams Total MCs 44,700


Phase 1 – Pilot Testing

Procurement and supply chain management

Recruitment and deployment of volunteers Adequacy of staffing plans Implementing more efficient clinical

methods ASI workgroup performs a methodical

review of each pilot Lessons learned incorporated in

subsequent pilots


Thanks to…..

Ministry of Health National Male Circumcision Taskforce USD /PEPFAR USAID Health Policy Initiative (HPI) WHO / UNAIDS MC partners in Swaziland Communities in Swaziland


8-10 june 2010 arusha, tanzania by ayanda nqeketo national mc coordinator ministry of health,...

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