In Namibia, I-TECH has been involved in supporting the Ministry of Health and Social Services (MOHSS) to scale up medical male circumcision (MC), which has been shown to lower the risk of HIV infection among men by 60%. To support health care workers to safely and effectively perform the procedure, I-TECH has assisted the MOHSS to produce a new MC training video. Recently, two members of the I-TECH Namibia team who participated in the production of the videos, Eva-Liisa Kafidi and Justin Nyatondo, kindly agreed to share a little more about the videos and the MC program.
Male circumcision is an approach to HIV prevention that I-TECH is involved with in several countries. Can you tell readers a little more about the history of the program in Namibia?
Certainly. In March 2007, the World Health Organization and UNAIDS issued policy and program recommendations on male circumcision for the prevention of HIV infection. These emphasized that safe MC services should be scaled up as a priority intervention in settings with heterosexual epidemics characterized by high HIV prevalence and low levels of MC. Namibia is one of the 14 southern and eastern African countries identified as priority areas for this recommendation.
In response, the Government of the Republic of Namibia, through the MOHSS, widened the scope of its HIV prevention package to include the provision of safe, affordable, and accessible MC services. To provide some background: According to a 2008 assessment, Namibia had a low MC prevalence rate of 21%, which requires a rapid scale up of MC services to achieve at least 80% coverage by 2025 to attain the desired public health impact.
What role has I-TECH played?
I-TECH has been involved with the male circumcision program from 2009, when Namibia started rolling out MC services to health facilities. Of course, the rollout requires adequate training for providers, and I-TECH has been involved with this important step. After an initial pilot training by Jhpiego, I-TECH Namibia, in collaboration with the MOHSS, adapted that curriculum for doctors and nurses, making it particularly tailored to the Namibian context.
In addition, I-TECH supported the MOHSS to develop and pilot MC curriculums for community counselors and an MC curriculum for managers. The three curricula are now used in the training of physicians and nurses, community counselors, and facility managers. In addition, I-TECH supported the MOHSS to conduct a training of trainers course for potential MC trainers.
I-TECH provides technical guidance to support the implementation of safe and effective male circumcision services through regular visits to MC sites, and by certifying that providers are able to perform key procedures. I-TECH trainers also carry out regular onsite mentoring visits for providers who have demonstrated some proficiency with the procedure, and has designed the standardized tools used to assess MC providers.
Can you talk a little bit about the new MC training video?
Yes! The MOHSS has set a goal of circumcising 450,000 men by 2015. To increase the number of MC providers and meet this goal, I-TECH supports MOHSS to conduct a two-week training course, Male Circumcision under Local Anesthesia, on a regular basis. The participants, who are nurses and doctors, are equipped with the knowledge, skills, and competence required to implement the program. The course encompasses two components: didactic [classroom based] sessions during the first week, followed by practical sessions with real patients at the National Referral Hospital (Windhoek Central Hospital) during week two. In addition, community counselors are trained to provide specific counseling on male circumcision before the procedure. To date, nine trainings have been conducted and more than 9,000 men have been circumcised.
Safety is an important element of the training. Key skills and safety procedures to minimize the risk of complications, such as infection, are therefore emphasized throughout. To further support this goal, the MC curriculum also includes a series of videos. These four videos cover the following topics:
- Surgical hand scrubbing
- How to put on sterile surgical gloves (correctly!)
- Instrument processing (decontamination and cleaning)
- Instruments and supplies required for adult male circumcision
The videos are shown to participants in the classroom, after which they are asked to demonstrate the same skills in simulated sessions and during practice when managing actual patients (under supervision) in week two.
MOHSS drafted the video scripts based on its on-the-ground experience, with close collaboration and technical assistance from I-TECH. Namibia is also the leading implentor of partial task-shifting in MC service delivery, and therefore trains nurses to conduct the procedure under the supervision of doctors. Reflecting this major policy shift in Namibia, the actors in the videos are all nurses from the MOHSS.
Thank you! Is there anything more you’d like to add?
I-TECH is delighted to be involved in this prevention program. The videos will allow us to maintain a consistent message on infection prevention to circumcision providers in Namibia!
Learn more about I-TECH’s work in Namibia.