Coordinating Mobile and Outreach VMMC Services in Kenya

Dr. Walter ObieroClinical Manager

Nyanza Reproductive Health Society

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

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.

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

General SRH session

Mobile clinic set up

Individual MC counseling / VCTGroup MC education

Surgery ongoing Surgery ongoing

Mobile Services

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