1. Zambia MC Up-Date Arusha, Tanzania 8 th – 10 th June 2010

2. 2 Background Initial drive by donor community since 2007 Ministry of Health assumed leadership June 2009 after High Level MC Advocacy Meeting facilitated by WHO 2009 focus on establishing coordination and implementation mechanisms (office at MOH, TWG + sub-committees) and development of inception operational plan 2010 Current drive focused on consolidating provincial and district level coordination/leadership (6/9 provinces done)

3. 3 Leadership/Partnership  MoH leads MC programme –Directorate of Public Health & Research HIV unit  National MC Coordinator  National TWG (multi sectoral) –Sub-committees Service Delivery; Communication; QA & M&E and Research –Last meeting 13 May 2010

4. 4 Leadership/Partnership  Strong partnerships –Implementation partnership (WHO, MoH, JHIPIEGO, SFH, CIDRZ, ZPCT, MSI, etc) based on comparative advantages  Decentralised MC Leadership by provincial MOH structures - all provincial health teams officially oriented and local initiatives are emerging, e.g. local NGOs space for MC

5. 5 Leadership/Partnership  MC TWG TOR –Provide advice, information sharing and technical guidance –Review and facilitate review of new evidence on MC for HIV –Support MoH review, develop and disseminate guidelines and clinical protocols –Provide technical support to the “2010 – 2020 Strategy and Implementation Plan” –Review and adapt IEC and communications materials, training manuals and protocols for training and practice of MC providers –Ensure that MC quality assurance standards are adhered to –Ensure that MC practitioners and facilities are accredited with the Medical Council of Zambia

6. 6 TWG Membership NAME OF SUB-COMMITTEE M&E /RESEARCHQA/TRAININGSERVICE DELIVERYCOMMUNICATION 1.MoH (Pub Health/Research 2.MoH (M&E) 3.NAC 4.USAID 5.WHO 6.Jhpiego 7.NGOCC 8.PCI 9.CDC 10.UNAIDS 11.UNFPA 12.Min of Youth Sport and CD 1.MoH (Clinical Care/Diag) 2.MoH (HR/Admin) 3.Medical Council of Zambia 4.GNC 5.UTH 6.Surgical Society 7.Jhpiego 8.UNICEF 9.USAID 10.SFH 11.MSI 12.ZPCT 1.MoH (Tech Support) 2. MoH (Planning/Policy) 3. CIDRZ 4. MC Partnership 5. JSI/SCMS 6. CHAMP 7.SFH 8.UNFPA 9.WHO 10.NAC 11.CHAZ 12.General Practitioners 13.MSI 14.FHI/ZPCT 15.Jhpiego 16.Islamic Center 1.MoH 2.MOE 3.Min of Youth Sport CD 4.ZMA 5.HCP/CCP 6.MSI 7.ZCCP 8.SFH 9.Youth Vision Zambia 10.Pediatric Association 11.MWAZ 12.NZP+ 13.NAC 14.WHO 15.SAFAIDS 16.Likumbi L M 17.ZINGO

7. 7 Situation Analysis  Situation Analysis conducted based on toolkit. –Desk review –Key informant interviews –Stakeholder meetings –Focus Group Discussions –Service availability mapping –Stakeholder feedback not yet done  Additional tool used – SFH site assessment tool was adapted for facility assessment

8. 8 Policy and Programming  Policy environment to facilitate role-out is a combination of HIV prevention and sexual/reproductive health –MC recognized as a component of comprehensive HIV prevention services under existing policy –MC recognized in context of Public Health Act (1935) as a component of male reproductive health services under Reproductive Health policy of 2008  No new policy drafted – “2010 – 2020 Strategy and Implementation Plan”  Free services – public and NGO  Programme costed partly, but DMPPT complete – pending review

9. 9 Highlights of National Strategy  A 10 year National MC Strategy and Implementation Plan developed by MoH with all partners.  Goal:- High quality, safe MC services available and accessible to all ♂ 13 – 39yrs on voluntary basis, achieving 50% by 2020  Provides guidance on; –Target population HIV –ve ♂ 13-39; and neonates –Target figure 2.5 million –Providers: docs, licentiates, clinical officers, nurses

10. 10 Highlights of National Strategy Successful Task-Shifting: Enrolled Nurse Assisted By Registered Nurse. Livingstone Gen Hosp

11. 11 Highlights of National Strategy –Minimum package of services – Informed consent, MC counseling, HIV/STI CT & Rx, Safe MC, Post MC care, Condom use –MC as point of entry to Comprehensive HIV prevention, sexual & reproductive health (FP, mat health, gender, sexuality) –Multi-sectoral collaboration –Communication and advocacy –Monitoring and evaluation/operational research

12. 12 Highlights of National Strategy  Traditional MC: objective is to collaborate whilst allowing for cultural norms (life skills, coming of age education, etc)  Issues to confirm with TMC –Infection Prevention –Assess surgical techniques and outcome of surgery –Access to other services like HIV CT/education, STI education/prevention/Rx, care in event of complications

13. 13 Highlights of National Strategy  M&E Framework –Draft completed (to allow immediate scale up interim parallel system to HMIS for subsequent integration – integrated system being developed) –Disseminated to all provinces; in use for reporting –Indicators yet to be included in national HMIS –Data collection on number of procedures on-going –Technical up-dates for MC included in MTEF cycle –Risk Compensation Behavioral Study to open in next 4 weeks

14. 14 Summary Progress To-Date  WHO/UNAIDS Tools that have been adapted – MC under LA Manual – MC under LA training package includes official MoH certification guidelines – Guidance on Ethical/legal issues ; consent procedure adapted – DMPPT ; data collection and analysis completed – MC M&E tool kit ; Indicators adapted

15. 15 Service Delivery  Current No. Active Sites 56  Cumulative MC’s done 29,082  Service Delivery Approaches –Integrated services in all 9 provincial hospitals and some HC’s –Out-Reach services in existing facilities around the country – Account for >60% of all MC’s conducted –Weekend campaigns held at Copper Belt University and traditionally circumcising communities

16. 16 Service Delivery MC’s Performed

17. 17 Service Delivery Active MC Sites

18. 18 Advocacy  Key Organization/Groups advocating for MC –SFH – Demand Stimulation –AIDS Free – Community Education/Advocacy –Youth Vision – Community Education/Advocacy –Gardner Premier Communications – Community Education/Demand stimulation/Advocacy –Mwazanato – Community Education/Demand  No organization with declared opposition; Traditional groups (Western, Northern, Luapula, Southern provinces), Some Christians

19. 19 Advocacy  Advocacy target groups –Youths –Traditional leaders –Health professionals –Faith based organizations –Women groups –General population

20. 20 Advocacy Meeting Held Name of MeetingTarget audienceContent of discussion Advocacy stake-holder meeting Key stake-holders in MCConsensus and development of a Cabinet memo on MC Advocacy stake-holder meeting Key stake-holders in MCDevelopment of the National MC Strategy and Implementation plan 2010 – 2020 National MC launch by Hon Minister of Health General Zambian Population An advocacy activity to announce the country’s position on MC as part of HIV prevention strategies National MC Situation Analysis data collection field work Key stake-holders, and community leaders; women groups, youths, religious leaders, health professionals Discussion of the evidence and obtaining perceptions of the stake-holders of the need for nation-wide implementation and related health seeking behavior and attitudes of communities Collaboration meeting with traditional circumcisers in N/Western Traditional leadersCollaboration with traditional circumcisers Orientation of Provincial Med Offices to Strategy Provincial, district and hospital management staff/HW’s National government priorities for the MC program at all levels

21. 21 MC Branding  National MC Brand Logo developed and adopted by MOH  National Campaign planned for 3 rd Qtr 2010 –Media including TV series

22. 22 Key Challenges  Human resource shortages  Poor infrastructure  Low resource base from GRZ  Ethnicity barriers

23. 23 Next Steps  Consolidate Prov/Dist leadership in MC –Include Prov/Dist/Hosp supervisors in training –Provide TA to Prov/Dist MTEF planning for MC  Focus shift; from new sites to optimizing out-put of current sites –Optimize HR deployment (both GRZ & NGO) –MOVE  National Campaign planned for August 2010; Target >30,000  Launch MOH training package & step up training  Prioritize Quality