Sahara Country Updates


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Sahara Country Updates

  1. 1. 5th SAHARA Conference Dr Sibongile Dludlu UNAIDS RST/ESA Male circumcision Country Updates Johannesburg, South Africa 01 December 2009
  2. 2. Outline • Review key elements for country MC Programming • Give an analysis of country implementation • Outline some challenges and constraints • Consider facilitating factors
  3. 3. Global 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
  4. 4. UN Support Actions UN 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
  5. 5. UN 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
  6. 6. UN Tools and Guidelines to Support Implementation 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
  7. 7. 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)
  8. 8. Operational Guidance Key elements for operationalizing MC services 1. Leadership and 6. Quality assurance and partnership improvement 2. Situation analysis 7. Human resource development 3. Advocacy 8. Commodity security 4. Enabling policy and 9. Social change regulatory environment communication 5. Strategy and 10. Monitoring and operational plan evaluation
  9. 9. Two years later…… How far have countries moved …???
  10. 10. Situation 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
  11. 11. Policy Notable 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
  12. 12. Strategy • 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
  13. 13. Progress 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
  14. 14. Progress on Male Circumcision Tanzania, Malawi Situation analysis, pilot Kenya: national guidance & service sites strategy, situation analysis, guidelines, training, Quality Rwanda advocacy Assurance guide, expanded service campaign, situation delivery, communication & advocacy assessment under development, M&E, research underway, services in military Uganda Situation analysis, policy Lesotho: advocacy, development, Comms draft situation analysis, policy development, draft Zambia: Situation analysis, strategy & comms trainings, strategy & Implementation plan, service Namibia: delivery Champions visit, Botswana: Situation analysis, advocacy, DMPPT,draft DMPPT, strategy, training, M&E, policy, strategy, training communications and QA and QA planned, communications plan Swaziland Situation analysis, policy, strategy & Implementation plan, leg/regulatory assessment, trainings, QA, M&E draft, comms draft
  15. 15. Snapshot of country progress Policy Service Leadership I II Situation & Trainin Training Quality delivery analy Reg g I II Assu M & E Botswana Kenya Lesotho Malawi Mozambique Namibia Rwanda South Africa Swaziland Tanzania Uganda Zambia Zimbabwe
  16. 16. Service Delivery How many circumcisions have been done?
  17. 17. 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%
  18. 18. Challenges and Constraints • 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
  19. 19. Challenges and Constraints • 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
  20. 20. Facilitating 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
  21. 21. Facilitating 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
  22. 22. 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