|
Guidance on Policy Development and Programme Implementation
A growing number of tools are available for policy makers and programme implementers and those involved in designing and executing programmes that offer male circumcision as an HIV risk-reduction strategy for heterosexual men. Some of the key tools are described here and are available online.
This page will be regularly updated. If you are seeking something that does not appear to be listed here, please email us.
Guidance to assist country programming and policy development
The data from randomised controlled trials suggest that male circumcision has the potential to dramatically reduce men's risk of acquiring HIV from their female partners. Policies and regulations guidance tools are important for providing guidance to design and set up effective programmes. At the same time, it is critical to understand that a new dedicated policy on male circumcision is often not required or necessary, as long as the basic elements of an enabling environment are in place to allow the scale-up of accessible voluntary male circumcision services.
WHO/UNAIDS' New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications (2007, PDF, 1.1 MB) provides guidance to policy makers and programme managers on what issues need to be considered and addressed when planning for programme scale-up. In March 2007, WHO/UNAIDS convened an international consultation including policy makers, programme managers, researchers, and AIDS and women's health advocates to examine the results of the three male circumcision clinical trials and other evidence and to determine the policy and programme implications. The participatory process ensured that the 11 conclusions and recommendations that were made covered critical issues such as partial protection, human rights, culture, communication, discrimination, gender, risk compensation, health systems constraints, and further research that needs to be done. You may also read a summary version (2009, PPT, 89 KB) or full version (2009, PPT, 110 KB) of presentation material on New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications.
Safe, Voluntary, Informed Male Circumcision and Comprehensive HIV Prevention Programming: Guidance for Decision-makers on Human Rights, Ethical and Legal Considerations (2008, PDF, 1.20 MB) provides guidance on the human rights, legal and ethical issues that decision makers may need to consider when they are deciding whether or not to initiate or expand male circumcision services in the context of comprehensive HIV programming.
Strategic and operational planning
Developing a national strategy for scale-up, with a clear operational plan, is important because it serves as a means to coordinate efforts, work efficiently, and mobilize the necessary resources. A national strategy helps guide implementation and facilitates communication with stakeholders at various levels.
Operational Guidance for Scaling up Male Circumcision Services for HIV Prevention (2008, PDF, 837 KB) provides practical guidance to help operationalise the scale-up of male circumcision services efficiently and effectively. It also explains why communication at high levels is necessary to support advocacy efforts and to provide decision-makers and the general population with accurate information about male circumcision.
Situation analysis
Each country must assess the need for and current status of male circumcision services, identify gaps, and proceed accordingly.
Male Circumcision Situation Analysis Toolkit (2009, PDF, 1.22 MB) provides a framework and tools that can be used to carry out a situation analysis, prior to making decisions about how to increase rates of safe male circumcision.
Costing
The cost of service at the point of delivery can be a barrier to men seeking safe male circumcision services. In view of the potential public health benefit of expanding male circumcision services in countries with generalized HIV epidemics, such countries should consider providing male circumcision services at no cost or at the lowest cost possible to the client, as for other essential health services.
Substantial financial resources will be needed to rapidly and safely expand male circumcision services for HIV prevention. Such expansion will require efficient use of existing resources and the commitment of additional resources by countries and donors.
The Male Circumcision Decision-Makers' Program Planning Tool enables the user to calculate the cost of male circumcision services by delivery mode based on clinical guidelines and locally derived information about staff time and salaries, supplies, equipment, and shared facility and staff costs. It also helps users calculate the net cost per HIV infection averted as a function of the number of male circumcisions performed for each service delivery and coverage timeframe option. These uses of the tool are illustrated in a series of briefs summarising the potential cost and impact of scaling up male circumcision services in 14 African countries.
Quality assurance
Quality assurance is the assessment or measurement of the quality of care or services rendered and the implementation of any necessary changes to either maintain or improve the quality of care. Standards define quality for a health care system or service, set the quality level, and provide the basis for measuring quality. The standards are systems-based, meaning that they are designed to encompass all elements of service delivery that affect the quality and outcomes of services such as male circumcision.
The WHO-recommended minimum package for male circumcision services consists of HIV testing and counselling, active exclusion of symptomatic STIs and syndromic treatment where required, provision and promotion of male and female condoms, counselling on risk reduction and safer sex, and male circumcision surgical procedures performed as described in the WHO/Jhpiego Manual for Male Circumcision under Local Anaesthesia (2009, PDF, 2.87 MB).
Male Circumcision Quality Assurance: A Guide to Enhancing the Safety and Quality of Services (2008, PDF, 2.12 MB) outlines the roles and responsibilities of national and district programme managers for implementing safe quality male circumcision services and provides guidance for the planning of a national quality assurance programme.
The Male Circumcision Services Quality Assessment Toolkit (2009, PDF, 989 KB) helps facility managers and providers assess their own performance. It can be used by national and district managers to conduct external assessments of facilities. The Toolkit includes a Scoring Tool (Excel, 45 KB), into which users can enter assessment findings and monitor progress towards meeting the standards.
Logistics and supplies
While standard male circumcision surgical procedures do not require more than other basic minor outpatient surgical procedures, countries considering scaling up male circumcision services generally suffer from inadequate budgets and difficult choices when it comes to prioritising expenditures, with weak systems of procurement, distribution, and stock management. Ensuring that adequate commodities are available — for all aspects of the services — is a critical element of providing quality male circumcision services. Furthermore, some countries may adopt approaches which require specialized equipment or devices which will need to be procured and distributed accordingly. Click here for more information about WHO's health services management initiative, Managers taking Action based on Knowledge and Effective use of resources to achieve Results (MAKER).
Country implementation updates
Some countries in sub-Saharan Africa can be considered priority countries for support for male circumcision programme scale-up because of their low prevalence of male circumcision and high prevalence of HIV. These include Botswana, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe. The pace and the stage of male circumcision scale-up varies by country. A report on the Progress in Male Circumcision Scale-up: Country Implementation and Research Update (2010, PDF, 1.23 MB) shows how these countries have made progress to scale up services. Click here for regular updates on country progress on male circumcision programme implementation as they become available.
Communication
Male Circumcision & HIV Prevention in Eastern and Southern Africa. Communications Guidance (2008, PDF, 2.1 MB) provides a communications framework to support male circumcision programming in eastern and southern Africa and offers guidance for male circumcision advocacy. It outlines key communication approaches, highlights key messages for advocacy, and proposes eight steps for effective communication.
Monitoring and evaluation
A Guide to Indicators for Male Circumcision Programmes in the Formal Health Care System (2010, PDF, 1.53 MB) examines objectives common to all male circumcision programmes and presents indicators that programmes can use to monitor and evaluate progress toward achieving those objectives. Adaptable to different country situations, the guide includes indicators for the creation of demand for, and supply of, male circumcision services, as well as the maximisation of safer sex behaviour. Users are assumed to have prior knowledge of monitoring and evaluation and to know, for example, how to measure male circumcision status, but the guide provides extensive references to help users develop their understanding of such issues.
|
