by: Kelly Curran;1 Emmanuel Njeuhmeli;2 Andrew Mirelman;3 Kim Dickson;4 Tigistu Adamu;1 Peter Cherutich;5 Thembisile Khumalo Mavuso;6

Jennifer Albertini;7 Laura Fitzgerald;8 Naomi Bock;9 Jason Reed;9 and David Stanton2

1Jhpiego/Baltimore; 2USAID/Washington, D.C.; 3Johns Hopkins Bloomberg School of Public Health; 4WHO/Geneva; 5National AIDS and STI Control Programme, Kenya; 6Ministry of Health, Swaziland; 7USAID/Swaziland; 8Jhpiego/Swaziland and 9CDC/Atlanta

Innovative and Efficient Approaches for Meeting the Human Resource Needs of the Male Circumcision Scale up in Southern and Eastern Africa

Background

• Male circumcision (MC) reduces female to male HIV transmission by approximately 60%

• 80% coverage within five years would avert over 3 million new HIV infections in 14 African countries by 2025, but would require over 20 million MCs

• The shortage of health professionals poses a critical challenge to the MC scale-up

20,373,693 Adult Men, Ages 15−49 to be Circumcised across All 14 Countries

Methods: Review of Existing HR Situation and MC Program Responses

• Absolute shortage of health care workers– WHO estimates sub-

Saharan Africa has 25% of the world’s disease burden but only three percent of the world’s health workforce

• Underutilization of existing health care workers• Unemployed and recently

retired healthcare workers

Findings: Optimizing ScarceHuman Resources

Findings: Kenya Task Shifting and Campaign Approaches

A policy change (task shifting) empowered nurses to conduct MC surgery

Number of MCs performed increased while maintaining safety

268,000 MCs in first 2.5 years of programme, including 36,000 and 50,000 during two Rapid Results Initiatives (RRI)

Findings: Quantification of Nursing Workforce in Swaziland

Category Number Comments

Unemployed but registered with the Swazi Nursing Council

110 Breakdown: Zimbabwean: 57 (51.8%); Swazi: 32 (29.1%); Zambian: 4 (3.64%); Congolese: 4 (3.64%); Uganda: 1 (0.9%); Ghana: 1 (0.9%); Nigeria: 1 (0.9%); Unknown: 10 (9.1%) 

Recently retired (within five years)

12 These nurses all indicated their interest in returning to work to support MC services

Newly graduating professional nurses

8 Eight graduating nurses indicated their interest in working on MC full-time

Swazi nurses working in the UK

5 These nurses all indicated their interest in returning to Swaziland to work to support the accelerated VMMC program

Newly graduating nursing assistants

17 These nursing assistants can staff recovery rooms or serve as bedside nurses (not anesthesia/suture nurses)

On-leave from public sector employment

Average of 107 per month

Most of these nurses are on vacation, not medical or maternity leave

Total 259  

Conclusions and Recommendations

It is possible to increase the productivity and expand the size of the MC workforce through – Surgical efficiency approaches– Efforts to match supply with demand– Task shifting – Task sharing – Redeployment of existing staff during campaign

periods – Engaging “on leave” staff – Targeted recruitment of new graduates, recently

retired, unemployed and expatriate volunteer healthcare workers