TITLE:
A Comparative Evaluation of the Voluntary Medical Male Circumcision Program for Seke and Goromonzi Districts, Mashonaland East Province, Zimbabwe, 2017
AUTHORS:
Hamufare Mugauri, Owen Mugurungi, Gerald Shambira, Tsitsi Juru, Notion Tafara Gombe, Mufuta Tshimanga
KEYWORDS:
Male Circumcision, Adverse Events, Comparative, Program Evaluation
JOURNAL NAME:
Open Journal of Preventive Medicine,
Vol.7 No.7,
July
25,
2017
ABSTRACT:
Background: In 2009, Zimbabwe incorporated Voluntary Medical Male Circumcision
(VMMC) to a consortium of measures to eliminate HIV transmission
by 2030. Seke and Goromonzi districts simultaneously commenced implementing
VMMC. These districts have comparable population, geography,
and support yet scored varied performances. Cumulatively, (2009-2016) Seke
achieved 83% while Goromonzi achieved 15% of set circumcision targets. We
compared the performance of the VMMC program in the 2 districts. Methodology:
A process evaluation was conducted modelled on a logical framework.
Interviewer-administered questionnaires and checklists were used to
collect data. Epi info7 was used to generate frequencies and proportions. Results:
Three health facilities in Seke and four in Goromonzi were implementing
VMMC. Material resources were maintained at three months buffer stock
and human resources equitably distributed between the two districts. Additional
support (three nurses), from the national army, was received by Seke,
and management provided vehicle support for program activities. Goromonzi
conducted half of the targeted mobilisations (6/12) and Seke 12/12. Similar
amounts of financial support were simultaneously disbursed. Seke circumcised
99.5% (4716) and Goromonzi 48.5% (2372) of annual targets. Adverse
reactions were 0.04% (2) for Seke and 2.3% (55) for Goromonzi for same period
with no review meetings conducted. Seke participants attributed performance
to effective demand creation (22; 100%), effective coordination (20;
90.9%) and management support (21; 95.5%). Goromonzi participants cited delayed payments (20; 90.9%), lack of active leadership involvement in planning
and execution (14; 63.6%) and weak mobilisations (11; 50%) to have
worked against the program. Conclusion: Effective demand creation and coordination,
manpower boost and leadership support enhanced VMMC program
performance for Seke and was therefore recommended for Goromonzi.
Resource availability did not translate to performance in Goromonzi where
lack of active leadership involvement in planning and execution, weak mobilisations
resulted in poor results. Robust demand creation strategies were
suggested for both districts.