1. Expanding Service Delivery in Swaziland Dr S.V. Magagula – Deputy Director of Health Services - MCTF Chairperson

2. Background HIV prevalence – 26% in reproductive age group 42% ANC sentinel surveillance 2008 MC prevalence – SDHS 2006/7 revealed 8% MC Currently approximately 10% of target for 5 year operational plan Key Players – Government, NGOs, FBOs, Development partners (UN, USG/PEPFAR, Bill & Melinda Gates Foundation), volunteer agencies A NATION AT WAR WITH HIV&AIDS

3. Drivers of the epidemic Inadequate depth of knowledge Multiple concurrent sexual partners Low rates of male circumcision Low condom use/inconsistent use High mobility of the population Abuse of gender power relations by men Sexually transmitted diseases Poverty Substance abuse Loss of morals (Christian or cultural)

4. A NATION AT WAR WITH HIV&AIDS NSF 2009/13- Result Based Framework Impact level Result – National Strategic Framework (NSF) The rate of new infections per year has reduced from 3% to below 2.3% by year 2014 Priority interventions a)Social and behavior change communication programs b) Reduction of MCPS c)Increased and deepened knowledge of HIV and AIDS d)Scaling up Prevention of mother to child treatment e)Male circumcision f)Targeting populations at risk i.e. migrant populations sex workers male and female youth

5. Experiences in previous 2-3yrs Operational Guidance – Development of the national MC policy; strategy/operational plan; MC protocols, BCC strategy aligned to the National SBCC strategy- posted to the MC Website Establishment of TWGs – Male Circumcision Task Force - clinical, communication, QA, research and M&E subcommittees Facilities- expanded from 1 to 6 in the last 9 months: Hospitals – RFM, Mankayane, Pigg's Peak, Good Shepherd Hospital; NGOs – FLAS, PSI-Litsemba Letfu A NATION AT WAR WITH HIV&AIDS

6. 2-3 years experience Training of health care workers/providers - Drs, nurses Volunteer programme inception Cabinet approved the proposed ASI in the last February 2010 Dedicated national MC coordinator August 2009 Communication – MC weekly articles in the local newspapers, national radio programme initiated, IEC materials developed, community dialogues (8 communities per region); Inter-personal communication at community level to recruit for mobile outreach. A NATION AT WAR WITH HIV&AIDS

7. Key experiences QA – all facilities targeted for MC service delivery assessed & improvement target for each facility was set Over April-May (3 week school holiday over 2,000 MCs were conducted by 3 facilities Commodities security through partners A NATION AT WAR WITH HIV&AIDS

8. Key accomplishments Implementation – Government, Mission (FBOs), NGOs & volunteer support Establishment of Men’s Clinic (Litsemba Letfu) and 2 nd FLAS outlet in Manzini Strengthened Partnerships Service delivery/numbers of MCs from 2008 to date – 10,000 which is about 10% on planned coverage (110,000 target 2009-2013) A NATION AT WAR WITH HIV&AIDS

9. Facilitating & Constraining Factors Facilitating factors: Partnerships & commitment Funding Absence of traditional MC Constraining factors: Lack of clear M&E plan Slow national roll-out A NATION AT WAR WITH HIV&AIDS

10. Lessons learnt Strategic alliances are key in accomplishment of goal All is possible with resources (human, financial, material) Political commitment is crucial to expand the roll-out - Parliament A NATION AT WAR WITH HIV&AIDS

11. Key next steps 2010-11 Scale-up using Accelerated Saturation Initiative Embracing the MOVE model Infrastructural improvement of facilities to deliver MC Expanded MC Research activities A NATION AT WAR WITH HIV&AIDS

12. Support needed to scale up Accelerated Saturation Initiative to reach scale according to operational plan Human resource Exploring task sharing as necessary M & E in process of developing and strengthening the system A NATION AT WAR WITH HIV&AIDS

13. Thank You! A NATION AT WAR WITH HIV&AIDS