Tools and Guidelines
Guidelines and other practical tools are vital to assist programme managers and other stakeholders who plan to create or scale up voluntary medical male circumcision services.
Manual for Early Infant Male Circumcision under Local Anaesthesia
Almost five years ago WHO convened an expert group to develop Early Infant Male Circumcision (EIMC) under Local Anesthesia manual. Following the publication of the manual, field experience on the introduction of EIMC from early adopter countries provided key insight to how providers can effectively be trained. As a result of collaborative work between PEPFAR and its implementers, UN agencies (WHO and UNICEF) authored this comprehensive competency based training package, Facilitators Guide(2014, PDF, 475 KB) and Learners Workbook(2014, PDF, 474 KB), to accompany the EIMC manual (download the manual below).
The training package has information for country training programs to not only transfer EIMC related knowledge and skills using competency based approach but also share tips on planning for an effective EIMC training. In addition, the training package lends itself for a blended (self-paced and group based) training design as well as a prolonged post training mentorship until providers reach desired level of competency.
Guidance on Engaging Volunteers to Support the Scale-up of Male Circumcision Services (2010, PDF, 249 KB). This document provides an overview of a global initiative to engage volunteer surgical teams in order to support the building of local capacity and improving access to male circumcision for HIV prevention in areas where human resources are limited. It is designed to serve as a reference for policy makers, programme managers, professional associations, and volunteers who wish to participate in the programme.
Considerations for Implementing Models for Optimizing the Volume and Efficiency of Male Circumcision Services for HIV Prevention (2010, PDF, 548 KB). This document provides guidance to help programmes improve the efficiency of clinical and surgical activities so that they can strengthen their capacity to meet demand for male circumcision services. It addresses clinical techniques, staffing, facility space, client scheduling and flow, commodities management, cost efficiencies, and quality assurance. The options presented are appropriate for a variety of settings, including public facilities, private facilities, outreach locations, and mobile services.
The Operational Guidance for Scaling up Male Circumcision Services for HIV Prevention (2008, PDF, 837 KB) document provides practical guidance to help operationalise the scale-up of male circumcision services efficiently and effectively. The guide outlines and explains the key elements required for programme set-up: leadership and partnership, situation analysis, advocacy, enabling the policy and regulatory environment, strategic and operational planning, quality assurance, human resource development, service delivery approaches, communication, monitoring, evaluation and operations research. The introduction and/or scale-up of new services is not an entirely linear progression, and while there is a logical sequence for the key elements in the guide, programme scale-up is not a completely stepwise approach. Countries must consider how best to sequence the key programme elements. The guide is relevant to the scaling up of programmes in both the public and private sectors.
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). This document 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.
UNAIDS Legal and Regulatory Self-Assessment Tool for Male Circumcision in Sub-Saharan Africa (2008, PDF, 240 KB). This self-assessment tool provides practical guidance on legal, regulatory, and policy considerations associated with implementation and scale-up of male circumcision services for HIV transmission prevention in sub-Saharan Africa. The results of the assessment process will be useful for health programme planners and others who are considering the introduction or expansion of male circumcision services in the context of comprehensive HIV prevention programmes. The tool can be used together with the document listed directly above.
Each country must assess their current status, identify gaps, and proceed accordingly. Situation analysis is an essential first element allowing one to determine the current status and map the way forward. The Male Circumcision Situation Analysis Toolkit (PDF, 1.21 MB) provides a framework and tools that can be used to carry out a situation analysis, prior to making decisions on how to plan and implement efforts to increase rates of safe male circumcision.
Cost and financing materials
The Male Circumcision Decision-makers’ Programme Planning Tool was developed by the Futures Institute in collaboration with UNAIDS and WHO. The tool calculates the cost of male circumcision services by delivery mode based on clinical guidelines and locally-derived inputs on staff time and salaries, supplies, equipment, and shared facility and staff costs. It estimates the impact of the epidemic using a transmission model that calculates new infections by age and sex as a function of the current force of infection, coverage levels, and speed of scale-up. The tool incorporates sensitivity analysis for key inputs, including the impact of male circumcision on women. The male circumcision decision-makers’ programme planning tool also allows choice of intended target population by age (newborn, adolescent, adult) and risk (e.g., sexually transmitted disease clinic attendees, seronegative men in discordant partnerships); service delivery mode (hospital, clinic, campaign); provider (surgeon, family physician, clinical officer); adverse events; ancillary services (HIV testing and counselling; gender sensitivity programmes); potential risk compensation (increased number of sexual partners, decreased condom use); scale-up rate; and coverage goals. The tool estimates HIV incidence, HIV prevalence, AIDS deaths, overall costs, and net cost per HIV infection averted as a function of the number of male circumcisions performed for each service delivery and coverage timeframe option.
Programme monitoring and evaluation
Monitoring and evaluation can provide ongoing information on programmes, usually based on a framework of specific indicators to measure programme performance, outcomes, and impacts over time.
Logistics, supply, and waste management
Voluntary Medical Male Circumcision (VMMC) Health Care Waste Management (HCWM) Toolkit (2013, PDF, 1.18 MB). This toolkit was developed to assist program implementers with the waste management challenges associated with VMMC programs; it contains guidance on the development of a waste management system to support VMMC programs, standard operating procedures on waste disposal and training tools for waste handlers and transporters. Based on South African National Standards, International Best Practice and the SCMS Health Care Waste Management Model, this comprehensive set of tools provides guidance on building HCWM operational infrastructure, improves staff capacity and aids stakeholders in managing the waste generated by VMMC campaigns.
Uganda National Guidelines: Managing Healthcare Waste Generated from Safe Male Circumcision Procedures (PDF, 1.5 MB). National guidelines have been developed to guide health service providers in managing waste generated from safe male circumcision at both static and outreach service delivery points in Uganda. This document describes safe, reliable methods for handling and treating such waste to avoid serious public health consequences and substantial environmental impact.
Community engagement materials supporting service implementation
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