MALE CIRCUMCISION VOLUNTEER PROGRAMME Feasibility Assessment In Namibia

MALE CIRCUMCISION VOLUNTEER PROGRAMME: Feasibility Assessment In Namibia Dr. Justin K. Nyatondo I-TECH Namibia Contributing Authors: Epafras Anyolo, MOHSS George Obita, WHO Dino Rech, WHO Alexis Ntumba, Intra. Health

Presentation outline • • • Objectives of the assessment Rationale for using volunteers Methodology Key findings Recommendations Progress to date

Objectives of the Assessment • • • To assess selected sites for readiness to receive volunteers To provide technical support to the male circumcision (MC) Task Force to develop a plan to introduce the volunteer programme in Namibia. To provide recommendations on areas that need strengthening

Rationale for use of volunteers • • Despite significant steps in scaling up MC services in Namibia human resource constraints remain a major barrier § Lack of personnel § Trained MC providers overloaded with other duties § Current legal framework only allows doctors to perform MC Use of volunteers has been used with success in other programmes in Namibia § Eye Camps (cataract surgery) § Operation Smile (cleft palate)

Assessment team • Team led by two WHO consultants accompanied by representatives from: § Ministry of Health and Social Services § Development partners: I-TECH Namibia o Intra. Health o USAID o CDC o • Five hospitals visited: Windhoek Central, Oshakati, Onandjokwe, Rundu, and Nyangana

Methodology • Methods used included • Key Areas considered: § Interviews - management and staff using a standardised checklist § Observation - infrastructure, lay-out, equipments, and supplies § Document review § § § Facility space Staffing Equipment and supplies Current and future demand Volunteer hosting logistics Facility willingness to receive volunteers

Findings • Facility space: § All facilities have dedicated surgical space for MC that can be made available full time • Staffing: § Doctors performing MC are available at all sites § Three sites have a team comprising of at least a doctor, nurse and counsellor trained on MC for HIV prevention § Very little time is dedicated to MC due to competing work demands hence low numbers of MCs done to date § Staff at Rundu and Nyangana hospitals not trained on MC for HIV prevention

Findings (2) • Equipment and supplies: § Generally equipment and supplies are available, including medicines and consumables § A limited number of MC specific surgical kits § Current levels of MC kits capacity limited to a maximum of 5 -10 cases a day

Findings (3) • Current and future demand § Windhoek and Oshakati hospitals had waiting lists ~60 – 100 clients despite no active demand creation o Average waiting time up to 6 months § Average number of MCs done per week ranged from 0 – 5 across the five facilities § Indication from hospitals and partners is that potential demand could be high with mobilization

Findings (4) • Volunteer hosting logistics: § All hospitals are easily accessible and have good nearby hotels/lodges § No logistics planning has been done yet. § Country experience in hosting eye camp volunteers is reassuring § Focal persons available at most sites • Facility willingness to receive volunteers: § All hospital teams expressed willingness and enthusiasm to receive volunteers • Demand Creation: § Ensure adequate demand prior to volunteers’ arrival

Recommendations • Facility space: § Do lay out planning for waiting room and counselling space • Staffing: § Ensure availability of adequate trained support staff throughout the volunteer mission • Equipment and supplies: § Increase the number of MC kits to a minimum of 20 per hospital § Strongly recommend the introduction and training on diathermy § Consider use of MC disposable kits

Progress…. . • • • Formal invitation letter to WHO inviting volunteers to Namibia drafted Ideal period for initial volunteer mission provisionally set for Aug - Sept 2010 Mo. HSS and partners building capacity at sites through § § • MC dedicated staff recruited (Dr & nurses) Training Procuring instruments and consumables Making necessary infrastructural adjustments at facilities Good in country partner support available to address gaps