1. by: Kelly Curran; 1 Emmanuel Njeuhmeli; 2 Andrew Mirelman; 3 Kim Dickson; 4 Tigistu Adamu; 1 Peter Cherutich; 5 Thembisile Khumalo Mavuso; 6 Jennifer Albertini; 7 Laura Fitzgerald; 8 Naomi Bock; 9 Jason Reed; 9 and David Stanton 2 1 Jhpiego/Baltimore; 2 USAID/Washington, D.C.; 3 Johns Hopkins Bloomberg School of Public Health; 4 WHO/Geneva; 5 National AIDS and STI Control Programme, Kenya; 6 Ministry of Health, Swaziland; 7 USAID/Swaziland; 8 Jhpiego/Swaziland and 9 CDC/Atlanta Innovative and Efficient Approaches for Meeting the Human Resource Needs of the Male Circumcision Scale up in Southern and Eastern Africa

2. Background Male circumcision (MC) reduces female to male HIV transmission by approximately 60% 80% coverage within five years would avert over 3 million new HIV infections in 14 African countries by 2025, but would require over 20 million MCs The shortage of health professionals poses a critical challenge to the MC scale-up 20,373,693 Adult Men, Ages 15−49 to be Circumcised across All 14 Countries

3. Methods: Review of Existing HR Situation and MC Program Responses Absolute shortage of health care workers – WHO estimates sub- Saharan Africa has 25% of the world’s disease burden but only three percent of the world’s health workforce Underutilization of existing health care workers Unemployed and recently retired healthcare workers

4. Findings: Optimizing Scarce Human Resources

5. Findings: Kenya Task Shifting and Campaign Approaches  A policy change (task shifting) empowered nurses to conduct MC surgery  Number of MCs performed increased while maintaining safety  268,000 MCs in first 2.5 years of programme, including 36,000 and 50,000 during two Rapid Results Initiatives (RRI)

6. Findings: Quantification of Nursing Workforce in Swaziland CategoryNumberComments Unemployed but registered with the Swazi Nursing Council 110Breakdown: Zimbabwean: 57 (51.8%); Swazi: 32 (29.1%); Zambian: 4 (3.64%); Congolese: 4 (3.64%); Uganda: 1 (0.9%); Ghana: 1 (0.9%); Nigeria: 1 (0.9%); Unknown: 10 (9.1%) Recently retired (within five years) 12These nurses all indicated their interest in returning to work to support MC services Newly graduating professional nurses 8Eight graduating nurses indicated their interest in working on MC full-time Swazi nurses working in the UK 5These nurses all indicated their interest in returning to Swaziland to work to support the accelerated VMMC program Newly graduating nursing assistants 17These nursing assistants can staff recovery rooms or serve as bedside nurses (not anesthesia/suture nurses) On-leave from public sector employment Average of 107 per month Most of these nurses are on vacation, not medical or maternity leave Total259

7. Conclusions and Recommendations It is possible to increase the productivity and expand the size of the MC workforce through – Surgical efficiency approaches – Efforts to match supply with demand – Task shifting – Task sharing – Redeployment of existing staff during campaign periods – Engaging “on leave” staff – Targeted recruitment of new graduates, recently retired, unemployed and expatriate volunteer healthcare workers