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Authors: James Nkale, Susan Wandera, Florence Anobe, Stephen Oboth, James
Kayizzi
Health systems strengthening; an effective approach to scaling up
voluntary medical male circumcision in six districts in central Uganda
Background
• In Uganda, where HIV prevalence is
7.3%
• Voluntary medical male circumcision
(VMMC) is a proven biomedical
intervention with up to 60% efficacy
• Circumcision coverage about 26%.
• A five year target of providing medical
circumcision to four million men
(2010-2015).
The VMMC package
The issue
Health systems capacity to handle the task is a main constraint •Infrastructure, HR, supplies, HMIS).
Project scope
• A five year project for Scaling up HIV/AIDS Prevention (SCHAP) in six districts in the central region of Uganda;
• Wakiso, Luwero, Nakasongola, Nakaseke, Mityana, and Mubende.
• Health system strengthening model used to respond to the challenge
Scope, population
Region DistrictUncircumcise
d 15+
Uncircumcised
HIV– 15+
Central Wakiso 267436 243367
Central Mubende 110926 100942
Central Mityana 57572 52391
Central Luwero 76738 69832
Central Nakaseke 35,150 32,023
CentralNakasongo
la28712 26,127
Total/Male
Population
576534 524682
Health facility levelsLevel of facility
Characteristics Gaps
HC II Target population: 20,000Geo. Coverage: ParishMaternity, OPDSkilled staff: 10
• Infrastructure• Human resource• Skills• Demand creation
HC III Target population: 50,000Geo coverage: Sub countyMat., OPD, Ward, LabSkilled staff: 16
• Infrastructure• Human resource• Skills• Demand creation
HC IV Target Pop. : 100,000Geo. Service: CountyMat., OPD, Wards, theater, Lab
• VMMC Skills• Demand creation
Process
Collaborative approach of implementation
•MOH/ District health teams (DHO, DHE, DNO, HIV focal person)
•Community systems (womens groups, VHT, developmental groups etc.)
•Other health stake holders (CBOs, FBOs, other NGOs with complementary roles.
Infrastructure• Minor refurbishments (paint, window
replacement, plambing)
• Partitioning/ temporary shelters
• Equipment (surgical bed, trolleys)
Human resource
• Identified and oriented six district focal persons
• Hands on training for 169 health workers in surgical skills (Surgery, assisting and counseling)
• Trained 499 peer educators, 366 VHTs
• Oriented 18 health information/ records officers
• Supported district to fill up HR gaps
A hands on training session
Service delivery • Provided supplies and facilitation
• Static clinics held at HC IV and III.
• Outreaches held at health center II
• Camps organised by combined teams at under served populations
• Schedules developed by facility incharge.
• Support supervision done with DHT
Key outcomes• Collaborative service delivery/
supervision• Phased reduction of sites
demonstrate sustainable service delivery
• Improved M&E, capture into HMIS • New innovations for mobilisation and
waste management • A total of 227721 circumcisions
done
VMMC outputs
DistrictUncircumcised
Men 15+
Circumcised in 4years
by Project
Wakiso 243367 105625
Mubende 100942 43811
Mityana 52391 22739
Luwero 69832 30308
Nakaseke 32,023 13898
Nakasongola 26,12711340
Total 524682 227721
Challenges• Competing priorities
• Staff transfers
• Need intense supervision to ensure quality
• Availability of utilities (water and electricity)
• Referral mechanisms
Lessons learned
• The approach increased coverage
• Enhances multiple partner involvement
• Enables sustainability
• Involvement of DHT supports supervision
• Men are able to support their families to
utilize other health services.
THANK YOU