Zambia MC Up-Date

1. Zambia MC Up-Date Arusha, Tanzania 8th – 10th June 2010

2. Background • Initial drive by donor community since 2007 • Ministry of Health assumed leadership June 2009 after High Level MC Advocacy Meeting facilitated by WHO • 2009 focus on establishing coordination and implementation mechanisms (office at MOH, TWG + sub-committees) and development of inception operational plan 2010 • Current drive focused on consolidating provincial and district level coordination/leadership (6/9 provinces done)

3. Leadership/Partnership • MoH leads MC programme • Directorate of Public Health & Research • HIV unit • National MC Coordinator • National TWG (multi sectoral) • Sub-committees • Service Delivery; Communication; QA & M&E and Research • Last meeting 13 May 2010

4. Leadership/Partnership • Strong partnerships • Implementation partnership (WHO, MoH, JHIPIEGO, SFH, CIDRZ, ZPCT, MSI, etc) based on comparative advantages • Decentralised MC Leadership by provincial MOH structures - all provincial health teams officially oriented and local initiatives are emerging, e.g. local NGOs space for MC

5. Leadership/Partnership • MC TWG TOR • Provide advice, information sharing and technical guidance • Review and facilitate review of new evidence on MC for HIV • Support MoH review, develop and disseminate guidelines and clinical protocols • Provide technical support to the “2010 – 2020 Strategy and Implementation Plan” • Review and adapt IEC and communications materials, training manuals and protocols for training and practice of MC providers • Ensure that MC quality assurance standards are adhered to • Ensure that MC practitioners and facilities are accredited with the Medical Council of Zambia

6. TWG Membership

7. Situation Analysis • Situation Analysis conducted based on toolkit. • Desk review • Key informant interviews • Stakeholder meetings • Focus Group Discussions • Service availability mapping • Stakeholder feedback not yet done • Additional tool used – SFH site assessment tool was adapted for facility assessment

8. Policy and Programming • Policy environment to facilitate role-out is a combination of HIV prevention and sexual/reproductive health • MC recognized as a component of comprehensive HIV prevention services under existing policy • MC recognized in context of Public Health Act (1935) as a component of male reproductive health services under Reproductive Health policy of 2008 • No new policy drafted – “2010 – 2020 Strategy and Implementation Plan” • Free services – public and NGO • Programmecosted partly, but DMPPT complete – pending review

9. Highlights of National Strategy • A 10 year National MC Strategy and Implementation Plan developed by MoH with all partners. • Goal:- High quality, safe MC services available and accessible to all ♂ 13 – 39yrs on voluntary basis, achieving 50% by 2020 • Provides guidance on; • Target population HIV –ve ♂ 13-39; and neonates • Target figure 2.5 million • Providers: docs, licentiates, clinical officers, nurses

10. Highlights of National Strategy Successful Task-Shifting: Enrolled Nurse Assisted By Registered Nurse. Livingstone Gen Hosp

11. Highlights of National Strategy • Minimum package of services – Informed consent, MC counseling, HIV/STI CT & Rx, Safe MC, Post MC care, Condom use • MC as point of entry to Comprehensive HIV prevention, sexual & reproductive health (FP, mat health, gender, sexuality) • Multi-sectoral collaboration • Communication and advocacy • Monitoring and evaluation/operational research

12. Highlights of National Strategy • Traditional MC: objective is to collaborate whilst allowing for cultural norms (life skills, coming of age education, etc) • Issues to confirm with TMC • Infection Prevention • Assess surgical techniques and outcome of surgery • Access to other services like HIV CT/education, STI education/prevention/Rx, care in event of complications

13. Highlights of National Strategy • M&E Framework • Draft completed (to allow immediate scale up interim parallel system to HMIS for subsequent integration – integrated system being developed) • Disseminated to all provinces; in use for reporting • Indicators yet to be included in national HMIS • Data collection on number of procedures on-going • Technical up-dates for MC included in MTEF cycle • Risk Compensation Behavioral Study to open in next 4 weeks

14. Summary Progress To-Date • WHO/UNAIDS Tools that have been adapted • MC under LA Manual • MC under LA training package includes official MoH certification guidelines • Guidance on Ethical/legal issues; consent procedure adapted • DMPPT; data collection and analysis completed • MC M&E tool kit; Indicators adapted

15. Service Delivery • Current No. Active Sites 56 • Cumulative MC’s done 29,082 • Service Delivery Approaches • Integrated services in all 9 provincial hospitals and some HC’s • Out-Reach services in existing facilities around the country – Account for >60% of all MC’s conducted • Weekend campaigns held at Copper Belt University and traditionally circumcising communities

16. Service Delivery MC’s Performed

17. Service Delivery Active MC Sites

18. Advocacy • Key Organization/Groups advocating for MC • SFH – Demand Stimulation • AIDS Free – Community Education/Advocacy • Youth Vision – Community Education/Advocacy • Gardner Premier Communications – Community Education/Demand stimulation/Advocacy • Mwazanato – Community Education/Demand • No organization with declared opposition; Traditional groups (Western, Northern, Luapula, Southern provinces), Some Christians

19. Advocacy • Advocacy target groups • Youths • Traditional leaders • Health professionals • Faith based organizations • Women groups • General population

20. Advocacy Meeting Held

21. MC Branding • National MC Brand Logo developed and adopted by MOH • National Campaign planned for 3rd Qtr 2010 • Media including TV series

22. Key Challenges • Human resource shortages • Poor infrastructure • Low resource base from GRZ • Ethnicity barriers

23. Next Steps • Consolidate Prov/Dist leadership in MC • Include Prov/Dist/Hosp supervisors in training • Provide TA to Prov/Dist MTEF planning for MC • Focus shift; from new sites to optimizing out-put of current sites • Optimize HR deployment (both GRZ & NGO) • MOVE • National Campaign planned for August 2010; Target >30,000 • Launch MOH training package & step up training • Prioritize Quality