1. Voluntary Medical Male Circumcision: Strategies for Meeting the Human Resource Needs of Scale-Up in Southern and Eastern Africa by: Kelly Curran; 1 Emmanuel Njeuhmeli; 2 Andrew Mirelman; 3 Kim Dickson; 4 Tigistu Adamu; 1 Peter Cherutich; 5 Hally Mahler 6 ; Bennet Fimbo; 7 Thembisile Khumalo Mavuso; 8 Jennifer Albertini; 2 Laura Fitzgerald; 9 Naomi Bock; 10 Jason Reed; 10 Delivette Castor 2 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 Jhpiego/Tanzania; 7 Ministry of Health/Tanzania; 8 Ministry of Health, Swaziland; 9 Jhpiego/Swaziland and 10 CDC/Atlanta

2. 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 3% of the world’s health workforce Underutilization of existing health care workers: Unemployed and recently retired health care workers VMMC programs had already developed strategies to address these challenges 20,373,693 Adult Men, Ages 15−49, to Be Circumcised across All 14 Countries

3. Findings: Surgical Efficiencies Optimize Scarce Human Resources 8-10 clients per day Modified Surgical Approach (MOVE) Conventional Surgical Approach 40-60 clients per day

4. Findings: Kenya Task Shifting 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 program, including 36,000 and 50,000 during two Rapid Results Initiatives (RRI)

5. Findings: Quantification of the 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%); Ugandan: 1 (0.9%); Ghanaian: 1 (0.9%); Nigerian: 1 (0.9%); Unknown: 10 (9.1%) Recently retired (within 5 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

6. 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 health care workers

7. Thank You For further information, please visit: PLoS Medicine VMMC Collection: www.ploscollections.org/VMMC2011 Voluntary Medical Male Circumcision: Strategies for Meeting the Human Resource Needs of Scale-Up in Southern and Eastern Africa: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pme d.1001129 http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pme d.1001129