Voluntary Medical Male Circumcision Program Scale-up

Dr. Albert Kaonga VMMC National Coordinator

Zambia

Back ground

• In 2007 Recommendation by WHO/UNAIDS following

evidence that male circumcision reduces female to male transmission of HIV by 60%

• In 2009 Programme officially launched • There was need for strong strategic direction • Plan was to achieve 80% VMMC coverage among

uncircumcised, HIV-negative men between the ages of 15 and 49 years by 2015.

• Expected to avert 340,000 new HIV infections by 2020

The Country Operational Plan for the scale-up of Voluntary Medical Male Circumcision in Zambia , 2012-2015 Includes annual targets at the district

level Provides detail on how to plan

VMMC service for different facility types

Provides guidance on maximizing efficiency of service delivery

Launch of Country Operational plan

A roadmap for scaling-up VMMC!

Programme Pillars

Pillar 1: Leadership & advocacy Pillar 2: Governance & coordination Pillar 3: Service delivery of VMMC Pillar 4: Communication & demand generation Pillar 5: Monitoring & evaluation Pillar 6: Implementation science Pillar 7: Resource mobilization Pillar 8: Early infant male circumcision (EIMC)

5/16/2014

1. Audience profiles – Who are they and where do we find them?

2. Key Messages – What are they and how can we be consistent?

3. Demand Generation Channels – What are the possible channels for demand creation and which ones are most appropriate for different audiences and communities?

Pillar 4 – Communication & demand generation The National Communication Strategy provides a roadmap for creating VMMC demand by answering the following questions:

Chief Mazimawe, Chairperson House of Chiefs

Pillar 1 – Leadership and advocacy

National VMMC Advert in English

Local Language recording in Eastern Province

Pillar 1 discusses the importance of identifying people who can act as MC champions at both national and local level

Pillar 2 – Governance and Coordination Governance structure of VMMC in Zambia: National level

Monitoring and Evaluation

Coordinator

Director of Mother and Child Health

National MC TWG

Partners

Other Gov’t Stakeholders

Private Sector

NAC

National MC Coordinator

Deputy Director -EDC

Categorization facilities into one of four levels (A-D) based on availability of resources required for MC

Zambian model for optimizing the volume and efficiency of VMMC services

Pillar 3 – Service Delivery

Level A Level B Level C Level D

Facilities able to provide dedicated VMMC service days without supplementary staff or equipment

Facilities requiring outreach staff and mobile equipment

to provide dedicated VMMC service days

Accessible service locations

VMMC commodity efficiency Procedural

efficiency Task-shifting

Efficient client flow Mobile services Efficient activity scheduling

Efficient mix of models

Dedicated service days

VMMC Annual Programme Performance: 2007-2013

304 2.454 16.923

63.604 84.604

173.992

294.466

0

50.000

100.000

150.000

200.000

250.000

300.000

350.000

2007 2008 2009 2010 2011 2012 2013

Tota

l Mal

e Ci

rcum

cisi

ons

Year

From January to December 2013 a total of

294,466 VMMCs were performed

Note: 2013 CHAZ data only for Quarters two, three and four.

The program has scaled up exponentially: 46.3% (294,466) of total VMMCs were performed in the year 2013 alone

304 2.758 19.681

83.285 167.889

341.881

636.347

0

100.000

200.000

300.000

400.000

500.000

600.000

700.000

2007 2008 2009 2010 2011 2012 2013

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rcum

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ons

Cumulative Total MC’s: 2007-2013

5/16/2014

VMMC Annual Programme Performance: 2007-2013

In 2013, 59.4% of MCs were within the target age range

1.5%

38.7%

59.5%

0.3% 0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

0-11 mnths 1-14 yrs 15-49 yrs 50+ yrs

Figure 3: Distribution of 2013 MCs by age

5/16/2014

Target age range

Pillar 8 – Early infant male circumcision

While EIMC will be rolled out in all 10 provinces before 2020, scale-up efforts between 2012 and 2013 will focus on Lusaka, Eastern and Copperbelt Provinces.

To date, the program has expanded to 4 provinces and has completed over 8000 EIMCs (Lusaka, Eastern, Copperbelt, Southern).

The Operational Plan sets the target of reaching 80% of newborn boys with EIMC annually by 2020.

This is the focus of the VMMC program during the “Sustainability phase”

0

2000

4000

6000

8000

10000

2009 2011 2012 2013 2014

Cum

ulat

ive

VMM

Cs

Year

VMMCs 0-11 so far

Figure

Pillar 5 – Monitoring and evaluation

• The MoH has now developed national M&E tools for VMMC (registers, client intake forms) and identified key indicators which will be incorporated into national HMIS (HIA2): – Number of clients circumcised by age – HIV status of clients circumcised – Frequency of moderate and severe adverse events

• This process of rolling out these tools is underway and is being

led by the MoH M&E Unit

Lessons Learned & Way Forward • Having a government-led Country Operational Plan

and technical working group improved coordination and implementation

• Having 3 dedicated months for intensified demand generation and service delivery has significantly contributed to programme scale-up

• Uptake of VMMC has been highest in the 10-29 age group

• Coordination at sub-national levels still a challenge in some areas

• Myths and misconceptions about VMMC • Inefficient utilization of resources due to partner

overlap in some areas

Lessons Learned & Way Forward • Aligning supply with demand in terms of human

resource and supplies can be a challenge • Need to improve supply chain management

commodities • Need to refocus demand generation on geographic

areas and age groups with highest potential for quick and high impact with possible revision of our targets

• Need for integration of VMMC services with other SRH services (e.g. cervical cancer screening)

• Improve coordination at all levels & reduce on unnecessary overlap

• Improve on commodity supply management • VMMC devices?