authors: james nkale, susan wandera, florence anobe, stephen oboth, james kayizzi health systems...
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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
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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).
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The VMMC package
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The issue
Health systems capacity to handle the task is a main constraint •Infrastructure, HR, supplies, HMIS).
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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
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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
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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
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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.
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Infrastructure• Minor refurbishments (paint, window
replacement, plambing)
• Partitioning/ temporary shelters
• Equipment (surgical bed, trolleys)
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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
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A hands on training session
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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
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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
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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
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Challenges• Competing priorities
• Staff transfers
• Need intense supervision to ensure quality
• Availability of utilities (water and electricity)
• Referral mechanisms
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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.
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THANK YOU