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Coordinating Mobile and Outreach VMMC Services in Kenya
Dr. Walter ObieroClinical Manager
Nyanza Reproductive Health Society
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MobilizationInitial Contact
Repeated ContactsTransport
Group Counselin
g20-45 min(optional)
IndividualCounselin
g/consentin
g5-20 min
HIV CT (PITC)
20-60 min
Pre-Surgery3-5 min
Surgery15-45 min
Follow-up5-30 min
Post Surgery3-5 min
Total Time: 76 – 215 minutes
Surgery : 8% - 45% of total time
Registration 5 min
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IntroductionFacility assessments done across priority districts.
<10% able to provide services due to resource constraints.
Currently 90% of all MCs done through mobile and outreach approaches.
Achieving an optimal balance between service delivery capacity and client flow requires coordination of mobilization, fleet management, supply chain management, task-shifting, team mobility.
Mobilization considerations: seasonality in client flow; client geographical distribution variation; difficulty of client booking systems; difficulty in mobilizing older clients; remuneration of mobilizers; involvement of women; dedicated clinic MC days.
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Considerations in Outreach/Mobile Settings
Availability and pre-operative preparation of clients have largest impact on number of procedures, not intra-operative time
Infrastructure limitations: counselling, theatre, recovery, storage, power and incineration.
HTC approaches: VCT versus PITC (increase in uptake of testing from 37% to 93.6%)
Client post-op follow-up visits poor (Return rate 30% June 2010)
Handling emergencies after routine working hours challenging.
Infection prevention in mobile and outreach settings including operating theatre, waste disposal, water supply
Data handling
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General SRH session
Mobile clinic set up
Individual MC counseling / VCTGroup MC education
Surgery ongoing Surgery ongoing
Mobile Services
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AcknowledgementsMinistry of Public Health and Sanitation,
KenyaMinistry of Medical Services, KenyaNational AIDS &STI Control Programme,
KenyaNational Male Circumcision Taskforce, KenyaNyanza Male Circumcision Taskforce, KenyaCentres for Disease Control and PreventionFamily Health InternationalImpact Research & Development
Organization, Kenya