Zimbabwe Country Presentation

1. Zimbabwe Country Presentation Update on Male Circumcision Programme Presented By: Sinokuthemba Xaba National MC Focal Person/AIDS & TB Unit MOHCW 8-10 June 2010

2. Background • Total Population : 12 million • HIV prevalence 13.7% • MC prevalence –self reported 10.3% ZDHS 2006 • MC adopted 2007 through a consultative process • Country situational analysis carried out in 2008 • Male circumcision Steering committee established with 3 TWGs

3. MC Policy Policy launched in December 2009 • Goal: Framework for safe, acceptable accessible, voluntary and sustainable MC services + human rights (consent & minors) • Objective: To reduce the incidence of HIV infection • MC - a public health intervention provided at the lowest cost possible • MC -provided in a manner that does not undermine existing interventions • MC - provided in approved health facilities • Collaborative activities with traditionally circumcising communities • Communication issues

4. Programme Implementation Status • Phased implementation approach • MC pilot program started in 2009 • 5 sites pilot sites: • National training site • Stand alone vs. Integrated • Public / Private Partnership • Uniformed Services • Evaluation of pilot phase completed information used in strategy development • Development of MC strategy nearing completion • DMPPT completed, validation in progress

5. Coordination and Management • MC coordinated from the AIDS and TB Unit of the Ministry of Health and Child Welfare • MC Steering Committee • Three technical working groups • NAC involved in the overall coordination of the national response to HIV and AIDS • Preliminary coordination work with TMC in progress and very positive • Close Collaboration with NGOs, CBOs, traditional leaders

6. 5 MC sites operational Trained 104 doctors, nurses, other HCWs through national training program Circumcised 6070 males between 5/09 and 4/2010 Site assessments for roll out initiated Communication and advocacy material developed Radio campaigns and community mobilisation Achievements (1)

7. Achievements(2) • “MOVE” Implementation • Use of the forceps guided surgical technique, • Pre-assembled instrument and commodity kits • Diathermy for hemostasis • Open plan operating room with several cubicles • Allocation of more than one staff and surgical bay per surgeon

8. Partnerships • Funding partners • PSI, PEPFAR, UNFPA, WHO, UKAID, Gates through WHO • Implementing partners • MOHCW,NAC,ZNFPC, PSI, Local NGOs, CBOs

9. Challenges • Funding for MC roll out and demand creation • Human resources constraints • Motivation of health care providers • Reaching the “high hanging fruits” in terms of demand creation

10. Lessons Learned • Stakeholder consultations are critical for success of MC programme • Phased approach to guide scale up • Strong communication and advocacy strategy for demand creation is core • Recognition of comparative advantages of different partners • Successfully implemented components of the MOVE model • Uptake of HTC among MC clients has been high (over 98%) • Recruitment for MC through existing T&C services in the pilot phase • High uptake of follow up services ( 99% at day 2, 94% at day 7 and 74% at day 42)

11. Recommendations • Task shifting should be considered in the provision of MC services, especially the potential role of nurses in the surgical component of the MC program. • To the extent possible, MC services should be carefully linked with other HIV programs, an example of such integration include supply chain management • Mixture of service delivery approaches ( stand-alone, co-located and outreach) are important for scale up • The private sector should be mobilised in MC roll out as an important and strategy stakeholder

12. Need for assistance • Additional financial support for MC roll-out and impact evaluation

13. Acknowledgements Dr Owen Mugurungi Dr Karin Hatzold. Gertrude Ncube Dr Sarah Banda