1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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.

10. 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

11. 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

12. 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

13. Thank You