Innovating: Looking at VMMC linkages for sexual and reproductive and other health needs Presenter: Dr Mugurungi Director AIDS and TB Programmes MOHCC, Zimbabwe IAS Durban 18 July 2016

Country context HIV remains a major public health challenge in Zimbabwe (47% disease burden) Prevalence 15% among adults (ZDHS 2010) VMMC is mostly provided as a vertical intervention to enable catch-up Adolescent boys constitute a major proportion of VMMC acceptors (up to 48%) Outside VMMC program, young boys have very little contact with the health system Globally most new infections occur in young people and there is need to step up prevention efforts targeting young people

Core elements of VMMC and ASRH packages VMMC package Male circumcision, including follow-up wound care/hygiene HIV testing and Services Promotion of safer sex practices & risk reduction counseling Social Behaviour Change Communication Condom promotion & distribution Screening and treatment of STIs ASRH Package Health Education talks, distribution of IEC materials Condom promotion & distribution Contraception, STI and HIV prevention, diagnosis & treatment, menstrual hygiene) Edutainment services (film, drama and sport), life skills education, recreation, library services Referral services There is overlap between ASRH and VMMC programs’ packages which makes the case for integration and linkages

Zimbabwe ASRH/VMMC linkages project Aimed at enhancing the linkages between the ASRH & VMMC programs in order to transition to longer term VMMC strategies/services Partners involved – MoHCC, ZNFPC, City of Bulawayo, WHO & UNICEF (U-Report) Project will provide guidance on how to link efficiently and effectively the 2 programs Started in 2014 and in two phases First phase: preparatory ground work to enable understanding of the two programs & selection of project sites Second phase: Project implementation focusing on demonstrating linkages and learning lessons for larger scale implementation

First Phase Consultants selected to work on 3 areas for the project baseline between Apr & Dec 2014 Mapping of the Current Configuration of ASRH and VMMC services in the project sites Development of Messages in support of the programme Development of Service Delivery Protocol and Menu of Options Project sites selected Mt Darwin district- Rural Bulawayo City- Urban

First Phase Key findings & recommendations There appeared to be a skills gap among service providers for ASRH & there was need to strengthen their capacity Young people were not being reached effectively through the community model & there was need to strengthen this Mapping of the Current Configuration of ASRH and VMMC services in the project sites There was messaging already going on for VMMC & ASRH programs & this was to be used as a starting point Social networks e.g. Whatsapp & Facebook are popular among young people and these can be used Messaging should target themes such as risk perception & influence of peers Development of Messages in support of the programme 3 options to be considered depending on local context Minimum package: Provision of basic information on ASRH & VMMC. All facilities should be able to provide this package. Basic package: Minimum package plus STI screening and treatment, HTS, linkages to prevention ,treatment and care & clinical services for VMMC and ASRH Expanded package: In addition to the minimum and basic packages, the expanded package includes social and behavioral change interventions Development of Service Delivery Protocol and Menu of Options

Second Phase Started in Dec 2015 (1 year duration) Developed work plan & budget in consultation with project site teams Recruitment of a dedicated officer to oversee implementation Youth Centre “seed fund” to be used on the discretion of YC committees for activities that will create demand for both services

Implementation progress to date Advocacy & sensitization meetings Health policy makers, Clinical & non clinical staff, Community leaders & parents, young people Developed IEC materials IEC & referral slips development workshop with all stakeholders participating Adopted use of social media- WhatsApp & Facebook Developed training materials Adapted from pre-existing VMMC & ASRH manuals Routine M&E Using M&E materials currently used in both programs Capacity building Training for health facility & community based HCW, peer educators

Incorporating U-Report Platform supported by UNICEF Used in the project for: communication of VMMC & ASRH information & upcoming campaigns/ outreach dates conducting periodic polls to ascertain knowledge and attitudes of young people towards VMMC and ASRH monitoring and evaluation of the project through regular sending out of poll questions to adolescents.

U-report initial poll results Questions to assess current utilization of youth centres Up to 17% of males feel that they have no reason to visit a youth centre Up to 40% of males do not know where the youth centre is located. Both ASRH & VMMC programs can leverage on the strengths or popularity of each other to boost uptake and utilization There is a significant proportion of young people that feel that they have no reason to seek ASRH services at the youth centres and even bigger proportion is not aware of where the services are located. We should looks at ways to increase the uptake of ASRH and VMMC services leveraging on the respective strengths of each other

Successes & Challenges Buy-in from all stakeholders in both pilot districts Increased visibility of Youth Centres & VMMC clinics VMMC outreach activities started at youth centers in Bulawayo Project has created a platform for discussion around VMMC & ASRH & has provided an opportunity for demand creation for both programs Challenges The first phase of the ASRH/VMMC project has taken considerably a longer time than initially anticipated Competing service provider priorities as a result of a system with many vertical programs

Lessons learnt Community involvement at all stages of the project is key Recruitment of a dedicated officer improved coordination There is need to address the issue of competing priorities at all levels of the health system Myths & misconceptions about VMMC are still persistent in both project sites & demand creation activities need to target these

Thank You