Creating Demand for Male Circumcision
Jhpiego has been working in Malawi
since 1999. Its work has focused on a number of health interventions including
the provision Voluntary Medical Male Circumcision (VMMC).. PacharoMunthali
in this article follows up the Voluntary Medical Male Circumcision (VMMC) work
that Jhpiego has been carrying out in Zomba. In the article he explores the
successes registered so far. He strives to find out gaps that as a nation we
need to address.
It’s morning. Precisely, it is
three minutes after 9 hours. Since arriving at the health centre, apart from
meeting the medical personnel and being briefed on the procedure that is
followed, he uttered nothing. For ten minutes it seemed as if he would say nothing.
He is Village Headman Mzazira
II has been waiting outside Chipini Health Centre. It is a symbolic wait, at
least he knows. It’s not just his wait. Once he gets circumcised he believes
his subjects will follow suit. He is at Chipini Health Centre for his screening
and Voluntary Medical Male Circumcision (VMMC) procedure.
Chipini Health Centre is a
Chingale -based health facility in Zomba district. The district with 2014
population estimates hovering above 600,000; the district has high HIV prevalence
rate.
HIV prevalence is around 15. That’s
alarming. The District Medical Officer, Dr Vanessa Kandole early this year was
quoted by Malawi News agency, describing the situation as “pathetic.”
"As a key component of
prevention of HIV, Voluntary Male Medical Circumcision (VMMC) is important in
Zomba as one way of reducing the prevalence rate which currently is on the
higher side," Kandole had explained in the media.
Kandole has stated that VMMC
campaigns have been conducted since 2013 in Zomba. As a result at least 18
thousand males have gotten the smart cut. According to the Joint United Nations
Programme on HIV/AIDS (UNAIDS); an estimated 5.8 million males had undergone
VMMC by the end of 2013 in 14 priority countries in East and southern Africa.
The effort towards attain such cuts
has been collaborative. Being led by Ministry of Health, Jhpiego has been one
of the players. The presence of Jhpiego in areas around Chipini Health Centre
has been one instance.
Today at Chipini Health Centre, male
community members are waiting anxiously. In numbers, so far there is presence
of eleven individuals – men and of course adolescent boys. All these mortals
want to be subjected to the meticulous procedures of male circumcision.
Voluntarily medically sound of course. All this is being done for a good reason
– HIV prevention.
When his turn comes, he will
undergo counseling. After counseling he will go through the screening process.
It is after screening that he will submit himself to the actual VMMC procedure.
It’s a process.
“You see this is symbolic. I
am a village headman, and I want to lead by example,” Village headman Mzazira 2
says as goes inside the clinic.
“I want my people to
appreciate, and soberly understand that this is life,” he grins.
Chipini is just one area in which
Jhpiego is carrying out its intervention. Jhpiego has been in Malawi since
1999. From 2010 to 2011 Jhpiego, under MCHIP, facilitated the development of
national standard operating procedures for voluntary medical male circumcision
(VMMC). During that period Jhpiego implemented Malawi’s first pilot
initiative on VMMC for HIV prevention in Mulanje, resulting in provision of
male circumcision services to 4,348 men.
In 2012, Jhpiego received
additional funding through Maternal and child health integrated program to
provide VMMC services to more than 8,000 males in Thyolo District. As Jhpiego
expands its work the foot prints that it has marked are indelible. Since 2011
to date 115647 males have undergone voluntary medical
male circumcision.
Jhpiego has a number of
advocacy approaches. One of them is through the use of chiefs. After conducting
advocacy meetings with chiefs in the target districts, the Ministry of Health
requested MCHIP to offer VMMC services in vulnerable and hard to reach health
centres only to ensure the procedure is recognized as a medical intervention
and is not confused with traditional rites of initiation.
“Our work especially on promotional
activities have focused mainly on inter and intrapersonal communication at the
local level. The approach has yielded enormous success,” says Samson Jali,
Community Mobilisation Assistant.
Jhpiego is working in a number of
districts. The VMMC project called Sankhani has spread from Chikwawa, Zomba to
Thyolo.
Why choosing these districts?
“Ministry of Health and USAID after
World Health Organization (WHO) recommendation identified some districts which
were a priority due to high HIV prevalence. The three are among the priority
districts,” says Lionel Chipeta, Communications and Demand Creation Manager.
As Chipeta shows the figures of the
number of clients that have received smart cut, he reveals that they foster
demand creation through interpersonal communication.
“Mostly we are using Interpersonal
communication which triggers honest discussions with individuals and groups. We
also have events like pool tournament, bawo tournament, football bonanzas which
are simply crowd pullers and then we engage them into discussions using
Community Mobilizers,” he adds.
Two main obstacles are apparent so
far. In the three districts where implementation work is
being carried out, Chipeta says, they “still haven’t registered a lot more of
the older population.” Those that are above 15 haven’t been forth comingas
expected.
“At national level, Malawi has done
about 7% of the modelled targeted number while countries like Tanzania have
reached about 90% of their target, Botswana is at 41% while Zambia is around
53%. As a nation, we is still very low in reaching our expected target to halt
more HIV cases as desired.”Adds Chipeta.
“We still have people failing to
comprehend and understand the science behind VMMC,” he adds.
So far, as they look forward to next
year, Chipeta believes progress has been admirable. They only need to
strengthen the approaches to reach out to more young adults, especially those
between ages of 15-29. This group is at high risk as it is very sexually
active.
Jhpiego’s approach has embraced the
enormous involvement of community leaders such chiefs.
“Chiefs are custodians of culture
and they are in authority in the districts we are currently working. It is
credible to involve them so that this intervention is not seen as an alien
intervention. At all levels people have to understand the science behind VMMC
and how it works,” Chipeta concludes.
VMMC is a Ministry of health
intervention. For its success, the Ministry is working with a number of partners.
Jhpiego is one of them. Jhpiego is implementing partner with funding from Presidents
Emergency Plan for AIDS Relief (PEPFAR) and United States Agency for
International Development (USAID).