Gvt Takes Over Circumcision Program

[dropcap]T[/dropcap][dropcap]HE[/dropcap] Ministry of Health and Child Care (MoHCC) together with the Population Services International (PSI) have come up with a Voluntary Medical Male Circumcision (VMMC) sustainability transition implementation plan (STIP) that will see government taking over implementation and programing of the project in both scale up and maintenance districts by the year 2021.

By Michael Gwarisa

Under the new framework, VMMC programing and implementation will move from a vertical heavily partner and donor supported programme to a more locally-owned and managed intervention. The decision comes at the back of a successful VMMC journey which has seen not less than 1.3 million men being circumcised since commencement of the program in 2009 as well as an attainment of a national; VMMC coverage of 43 percent among males aged 10-29.

Speaking at the of   VMMC Transition Implementation plan event, National Coordinator of the National VMMC program in the MoHCC, Dr Sinokuthemba Xaba said Zimbabwe was on track to achieving the VMMC target and government has capacity to run with the VMMC program but called on more efforts to be channelled towards financial resources mobilisation.

“VMMC is one of the high impact HIV prevention initiatives that we have in Zimbabwe. The overwhelming and clear evidence of its impact in reducing chances of contracting HIV by 60% made us to jump on board and adopt this initiative as we knew the HIV burden that was on our country’s shoulders.

“Although significant progress has been made in reducing the incidence and prevalence rates in our country, much more concerted efforts are required. Ladies and gentlemen, an estimated 1.3 million people in Zimbabwe are living with HIV. HIV prevalence among adults aged 15 – 49 years has declined by more than half in the last two decades, from 32% in 1997 to 13% in 2017,” said Dr Xaba.

The MoHCC and PSI have been partners in the implementation of circumcision programs in Zimbabwe since 2009. This new Strategy will span from this year, 2019 to 2021. A few years ago we the first official VMMC Strategy was launched Accelerated Strategic Costed Operational Plan (ASCOP), which ended in December 2018.

In Zimbabwe, overall new HIV infections have been declining, and currently stand at 0.47% among adults aged 15 – 64 years. However, despite the decline in our HIV prevalence and incidence rates, there still remains the need for us to seriously continue to innovate as we seek to address this challenge in our nation.

Dr Xaba added that the VMMC programme in Zimbabwe has been widely recognized as one of the most successful VMMC programmes from the fourteen priority countries implementing VMMC at public health scale.

In an interview on the side-lines of  event, PSI Deputy Country Director, Ngonidzashe Madidi said even though they are now handing over the program to the ministry of health, they will be in the picture to give technical support to all the provinces and districts.

“Our role as PSI was to inform the ministry on the models that they can use to scale up, we have been a partner through scale up and we have been funded by The Bill and Melinda Gates foundation, funded also by UK Aid and funded and funded by USAID for the USG funds.

“Our role as well is in supporting implantation itself in direct sites that we have been implementation the program in urban centres and training sector nurses to implement on behalf of the ministry. We also support demand generation, so we partner with the ministry of education across all levels and also with the community structures that the ministry has in communities,” said Madidi.

PSI also played a critical role in the crafting of the old strategy ASCOM as a technical thought leader in the space to inform the priorities that were put in the strategy. They also informed critically in the new strategy the areas of focus that the ministry need to carry going forward.

“We are continuing as a technical partner to all the provinces and districts as they transition from a fairly vertical and heavily donor funded program, to a something they own and drive and our role is to do the hand holding piece saying we have been doing this since 2009 it now your turn but we will not let you run alone, we will hold you and handover our capacity and the things that we have been doing over the year so that the ministry and can fully won it and do all the work.

“Our hope is the if the ministry own all the work, we become a lighter touch technical assistance team, we will become less visible in the frontlines and more in the backroom where we come in as advisors as when we are needed by government,” added Madidi.

As at January 2019,  a total of 1,4 million men so far and a majority of these being in the 10 – 15 year age group have been circumcised.

According to the Minsitry of health, the previous strategy contributed to the rapid scale up of the programme, and this new Strategy that we are unveiling today will set the pace for the new focus in the program which is geared on transitioning this initiative to sustainability. Sustainability in our HIV programmes is of critical importance as we need to make sure continued quality service provision, even in the light of dwindling donor funding.

The Ministry of Health has carried out pilot projects to see how different components and elements of sustainability will operate. A lot of consultations at various levels have been done and we have listened to the people, including the clients and potential clients themselves and what they said is what is contained in this document we are disseminating today. We are also looking forward to sharing our experiences, lessons and mistakes with other countries as we pioneer this progressive journey towards themselves.”

Some of the identified critical characteristics of sustainability that the new plan will be working on will include: integrated VMMC programming; effective government led supply chain management, coordination, service delivery and demand generation functions; capacitating the lower level staff and training more staff; strengthen partnerships with traditional, religious and community leaders among other important components.





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