Models to increase Volumes and Efficiency in Zimbabwe’s Male Circumcision program

K. Hatzold1, C. Samkange2, E. Fusire3, G.S. Dendere4, K. Kaseke1, D. Rech5, R. Dhlamini1,

G. Ncube6, O. Mugurungi6

Institutes: 1Population Services International Zimbabwe, Harare, Zimbabwe, 2University of

Zimbabwe College of Health Sciences, 3Zimbabwe Republic Police, Medical Department 4Air

Force of Zimbabwe, Medical Department, 5Population Services International, 6Ministry of

Health and Child Welfare Zimbabwe

Background• Adult HIV prevalence 13.7%• MC prevalence 10.3% • 750,000 HIV infections could be

averted if 80% of males are

circumcised• Goal to circumcise 80% of 15-29 year old males by

2015 (1.3 million) • Policy only allows doctors to conduct MCs • Completed 12 months pilot phase to test models of

service delivery, 6500 males circumcised over 12 months

• High latent demand for MC

MOVE Components • Forceps guided method

• Cost-effective, Safe, High outputs

• Diathermy for hemostasis

• Team of 2 doctors & 3 nurses serving 4 clients at one time

• Open plan operating room with several cubicles – Client flow– Quick movement between cubicles– Communication among team

• Disposable MC kits, hand scrub between clients

MC Client Flow

Client 1 Client 3

Client 2 Client 4

Surgical Team

Doctor 1

Doctor 2

N

N

N

A

A

A

A

S

S

S

S

Client 5

Results

Surgical Steps Time pre MOVE Time post MOVE

Pre-op assessment, scrubbing (Nurse) 5 min 5 min

Anaesthesia (Doctor) 2 min 2 min

Operating Time (Doctor) 25-30 min 7-10 min

Dressing and Cleaning (Nurse) 2 min 2 min

Cubicle Turnover Time 60 min 25-30 min

# of Clients per team 1-2 per hour 8-10 per hour

Next Steps • Multi-country operational research to

evaluate MC MOVE.

• Efficiency models used for expansion of MC services.

• Policy change towards task shifting of surgical components of MC to nurses.

page 7

Acknowledgments Partners • MOHCW Zimbabwe

– O. Mugurungi, G. Ncube

• C. Samkange, University of Zimbabwe• D. Rech, PSI

Donors:– USAID – UKAID

Implementers: • PSI MC team

– E. Fusire, G.S. Dendere, K. Kaseke, R.Dhlamini