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