Presentation Outline

2. Presentation Outline Partnership and Collaboration with HoTL Build up activities and response – December Season Report on initiation intervention Recommendation Conclusion

3. Partnership and Collaboration with HoTL • Traditional Initiation has been the focus and priority of the EC Provincial government and other circumcision stakeholder • Like other key sectors, ECDoH acknowledges that traditional initiation is the competency of the HoTL. • The ECDoH’s involvement and role is to support the circumcision practice by working with and through the established task team led by HoTL. • The ECHoTL, DoH, DoE and SAPS are spearheading the implementation of the Initiation Monitoring and Intervention Strategy to ensure safe passage of initiates from boyhood to manhood

4. Multi-Sectoral Initiation Monitoring Team • Overall Response Team (MECs) and key leadership in various sectors – led by Nkosi Ngangomhlaba Matanzima • Technical Coordinating Multi-Sector Team – Provincial Member – HoTL, NDoH, PDoH, NGO, SD, SAPS, CODEFSA • Multi-Sectoral Monitoring Team – Dedicated Team from HoTL, Social Development, SAPS, DoH, DoE, NGOs. • Traditional Leaders led Local Initiation Forums and Monitoring Teams

5. PREPARATION FOR SUMMER SEASON 2013 • Pre - initiation build up activities towards the Summer Initiation Season: • Provincial initiation Workshop for key strategic departments( LGTA/ HOTL, DOH, DOE, SAPS, NPA, SOCDEV and CODEFSA) • Traditional Councils consultation outreach by HoTL Executive Team and ImbumbaYamakhosikaziAkomkhulu • Schools, churches, community Imbizos and community radio campaigns promoting safe initiation practices

6. PREPARATION FOR SUMMER SEASON 2013 • Trainings of Traditional Surgeons and Nurses. • Monitoring Teams were workshoped in order to standardize operation procedure and equipment needed during monitoring of initiation schools. • Summer Initiation Launch event - Palmerton Methodist Church, Lusikisiki - 24 November 2013 • Provincial Technical Monitoring Teams were deployed to districts to monitor readiness for the season

7. PREPARATION FOR SUMMER SEASON 2013 • Additional surgical supplies were provided to all monitoring teams • Provision of clinical personnel to all monitoring teams in the entire province • Medical doctors were also deployed in the OR Tambo Municipal District • Preparations also looked into readiness of health facilities to admit and manage initiation complications • Rescue Centre established in Palmerton facilitated by CODEFSA and supported by (Male Nurses) from Provincial Department of Health

8. HEALTH FACILITY READINESS • 5hospitals identified as main referral hospitals in OR Tambo and Alfred Nzo: • St Patrick hospital for Alfred Nzo district • St Elizabeth hospital for Qaukeni Sub-district supported by Holy Cross and Bambisana Hospitals • St Barnabas hospital for Nyandeni Sub-district supported by Canzibe and Silimela Hospitals • St Lucy’s hospital for Mhlontlo supported by MalizoMpehle and Nessie Night Hospitals • Mthatha General for KSD Sub-district supported by NMAH. • Throughout the province Districts were encouraged to be ready for admissions

11. NGO Support during the Season CODEFSA: • Additional 2 vehicles • Provision of lunch packs • Protective clothing • Establishment of rescue • center and provision of • food for initiates • Funding of workshop for • women

14. SUMMERY OF CIRCUMCISION STATS – Dec 2013

15. Distribution of initiation death

16. Jun/Dec 2013 Initiation deaths Comparison

17. Indicated Causes of Initiates’ Deaths

18. Deaths from Illegal and Legal Schools

19. Summer Season Review Consultation • A summer season review consultation workshop held with on 14 January with all Montoring Teams and stakeholders involved in on 14 January to: • Critically review the 2013 December/January Initiation season • Prepare a comprehensive report that will encompass recommendations on what program of action should be considered going forward

20. Reported Challenges • Not every district or local areas has established active Initiation Forums. • Traditional Circumcision Schools not easily accessible to monitoring teams as are built on mountainous areas. • Initiation schools not reachable on time – lots of boys could not be reach. • Centralisation of initiation schools not yet effected. Schools are still spread out throughout the province, often not easily idetified • Sepsis is being noticed as a common occurrence in most complicated initiation schools • Partial circumcision still occur especially in Nyandeni and Mhlontlo area. • Initiates flee when they see monitoring teams, in fear of discrimination amongst themselves. Some refused to be taken to hospitals.

21. Reported Challenges Cont… • Establishment of Illegal schools is still a challenge especially in OR Tambo and Alfred Nzo Districts. • Parents reported to be against medical interventions/treating of initiates with antiseptic ointment and bandages when DMOs find a condition that requires. • Discrimination of initiates by peers and communities, who were assisted or sort medical help. • Circumcision of underage boys in the Pondoland area • No legislation guiding initiation in the province • Lack of commitment from municipalities and other government departments. • High rate of substance abuse by initiates

22. Recommendations • Expedite the process of developing a National and Provincial Initiation Legislation • Institutionalization of management initiation practice – permanent structure and staffing • Standardization of Initiation Monitoring Teams and Local Forums with clear Terms of Reference • Development and implementation of a broader and integrated 5 year strategic plan and year long programme of actions • Adequate budget allocation for the initiation program

23. Recommendations Cont….. • Centralization of initiation schools with sensitivity to various sub-cultures. • Enhance active involvement of Traditional Leadership at local level • Improvement of technical training for traditional nurses and surgeons • Vigorous police intervention, intelligence and NPA to secure convictions. • Building community and parent ownership of the practice. Parents to take responsibility for their children • Active involvement and contribution by local municipalities. • Psychosocial support for victims of penile injuries and peers of deceased initiates (Social Development)

24. Plan for the next season • Broad and integrated 5 year strategic plan and year long programme of actions are being crafted. Focus is on: • Review of the current legislative framework, • Centralisation of initiation school with designated areas - in rural and urban • Establishment of active local initiation forums and training there of. Terms of Reference to be clearly defined • Training of Traditional Surgeons and nurses. Establishment of database. • Vigorous school outreach educational programs, working with the DoE. • Community mobilization, engagement and education through community dialogs, Imbizo, radio slots and Youth consultation programs. • Registration of boys for initiation through local Traditional Council, working with DoE. • Workshop for women to re-inforce their role –Led by NgamakhosikaziAkomkhulu • Establishment of a Nerve Centre – Coordination of monitoring activities, especially during seasons • Establishment Rescue centres. Hotspot areas to be prioritised

25. List of needed Resources • Resources mobilization and coordination. • Dedicated budget is needed through the HoTL • Human Resources - Dedicated teams from various departments to form part of the teams especially during seasons • Doctors/Male nurses – screening and monitoring during the season. DoH to provide • Food packs • Stipend for forum members (volunteers) – working with monitoring team • Transport. • Communication tools – Walkie-talkies, cellphone airtime • Medical supplies - Dressing kit/packs per car – DoH to provide • Accommodation for monitoring team – • Protective clothing – Rain suites, work suits, boots

26. Thank you