Focused Demand Creation For VMMC Services Among Males And Young Men Aged 15 Years And Above In Kisekka, Bukulula and Kimaanya-Kabonera Sub-Counties of Masaka District

Period: 1st-15th June 2023.

 Venue: Sseke Secondary School, Integrated Secondary School, St. Mary’s Secondary School, Ddegeya, St. Charles Lwanga Secondary School, MOD Public Health Foundation

 Dates:  08th June, 2023 and 15th June 2023.

 Targeted Places:

Secondary Schools, bars, churches, rural communities, trading centers, and Carpentry and Repair garages.

Objectives

a)      To provide Safe Medical Circumcision (SMC) in locations nearer to the programme participants.

b)      To mobilize project beneficiaries (Young and adult men 15 years and above) to attend VMMC community outreaches through which they are mentored to become champion change agents who can facilitate demand creation and awareness for Sexual and reproductive health services in Kisekka and Bukulula Sub-Counties, Masaka District.

c)      To provide quality VMMC Surgeries to mobilized project beneficiaries (Young and adult men 15 years and above in Kisekka and Bukulula Sub-Counties, Masaka District.

d)      To Enhance behavior, change and communication among men and their female partners through community engagement and health promotion activities and distribution of SBCC Materials.

e)      To sensitize beneficiaries about improving environment, waste management by using available and appropriate resources in their surroundings to enhance wellbeing.

f) Leverage opportunities for people to access to sexual health services that meet their individual needs.

g) Roll out services that are relatable, local, relevant, approachable, confidential, non-judgemental, and accessible to eligible consumers, while respecting all human protected characteristics.

h) Facilitate programme participants to have control of their own sexual health with service products meeting their needs.

Participants or stakeholders make up:

The participants who enhanced targeted mobilisation for VMMC outreaches/Camps included:

Stakeholder population-based community structures (SPCS) such as: 12 School Management Committees (Headteacher, School Nurse, and Schools Prefect), 2 Religious leaders, 4 youth groups, 1 traditional and healthcare structures (6 VHTs), 3 VMMC mobilisers, 5 Chairperson L.C1, 3 Rakai Health Sciences Program (RSHP) team, MOD Staff (VMMC Surgeons and their assistants, 1 Project Officer, 1 Programme Accountant, 2 Technical Leads).

Expectations:

 

1.      SOPs: Develop and follow a checklist and Standard Operating Procedures (SOPS) to enhance the quality-of-Service Provision for VMMC services to targeted programme participants. These Include:

a)      VMMC Mobilisation Checklist

b)      VMMC Outreach/Camp Preparation checklist

c)      SOP for VMMC Surgical Procedure at the Outreach/Camp

d)      SOP for VMMC Follow-Up

e)      SOP for Waste Management

f)       SOP for handling of Surgical Instruments/kits

g)      Management of finances; payments, accountabilities at the outreach/Camp checklist.

2.      Preparation for VMMC: We expected the MOD mobilisers to work with programme participants to identify and arrange suitable venues, create time to attend VMMC’s SMC outreach sessions and consequently those identified as eligible to consent for VMMC Surgery either directly or through their parents and care givers for young men between 15-17 years.

3.      Compensation: Mobilised programme participants expected to receive VMMC incentives such as transport refund of amount between UGX 5000-10,000 or being delivered nearer to their homes after SMC surgery as a motivation and compensation for the waiting time and recovery from surgery. This expectation was very common among non-boarding students. In addition, they expected to receive adequate post-surgery care information for the pain, wound care, bandage removal, bathing, ablution, including visits other than phone calls for a physical check up to confirm whether they would be healing normally.

4.      Assurances: Reassurance by the mobilisers, counsellors and surgical team that the MOD team would follow up programme participants in case of adverse events until the concerned body part (penis) goes back to normal shape.

5.      The risk management plan: For young men mobilised from schools especially those boarding section, the management committee expected the MOD team to follow up circumcised students until recovery to avoid missing any classes as well as not allowing any reason for conflict with parents, benefactors and caregivers.

6.      Local language IEC: The MOD teams was expected to translate IEC material into local contexts, to display materials that promote provision of integrated VMMC services and to challenge participants to use word of mouth to motivate peers to get interested in accessing health services.

7.      We were also expected to properly manage waste and clean up venues allocated for provision of integrated VMMC services. The ultimate plan is to be able to enhance demand creation and awareness, extend a unique experience in form of quality and integrated service that contributes to a quality health continuum and the same time preserve the hygiene of the surrounding environment.

       Achievements and Lessons learned:

1)      When we returned for follow up visits a number of programme participants who were in Advanced classes had removed the bandages as well as using boxer pants and not following the post-surgery guidelines. This means that during the health education sessions post-surgery care talks should emphasize the need for keeping the bandage on for at-least for the first forty-eight (48) hours after surgery and using the tight pant to immobilize the shaft, to avoid swelling and risk of bleeding.

2)      Targeted mobilisation for integrated health services delivery particularly VMMC services to men requires skills in partnership management and using mobilisers who have created credibility in communities with all Stakeholder population-based community structures.

3)      Ability to translate high level medical information into everyday living local messages is an important element of community engagement for health promotion.

4)      Regular Technical Support Supervision (TSS), on spot visits of field activities including physical data verification with programme participants maintains quality of service delivery and value for money of medical services being provided in the communities.

5)      Physical follow up of circumcised adult and young men especially on day two for bandage removal creates trust and improved service experience among programme participant.

6)      Contribute to the critical number of spaces where programme participants could access SMC.

7)      We provided opportunities for young people to access Sexual and Reproductive Health Services at St. Charles, Lwanga Kasasa Secondary School in Bukulula Sub-County; Sseke Secondary School; Integrated Secondary School; St. Mary’s Secondary School in Kimaanya-Kabonera Sub-County.

8)      Improved knowledge and awareness about VMMC services in all targeted communities.

9)      St. Charles Lwanga and Sseke Life Skills' Clubs were formed to enhance heathy living outcomes in their communities. 

10)  Providing time for all SMC teams to talk through the processes (briefing and debrief), allocate responsibilities and roles creates room for bonding and coordinated activities which reduces flow time.

Way forward:

1.      In collaboration with Rakai Health Sciences Programme (RHSP), organize refresher training or mentorship programme for MOD staff (Surgeons and their assistants) in VMMC surgeries to address existing knowledge gaps in the procedure.

2.      With Support from PEPFAR small grants, enhance community engagement, health promotion through Sports activities for behavior change and communication among programme participants during the quarter if July-September 2023.

Concluding remarks and Recommendations:

This service created opportunities which in turn enhanced the demand for Sexual Reproductive Health (SRH) service continuum in form of Safe Medical Male Circumcision (SMC). This leveraged programme participants' engagement in health seeking and life enhancing practices; gaining access to a full board SMC package including pre and post care continuum; attendant health education through which programme participants interacted with qualified health promotion and education providers; and contributed to the critical number of eligible young and adult males demanding and taking up SMC. We were able to create a Life Planning Club as part of MOD Public Health Foundation's mission to prevent diseases; prolong life; and promote health. We hope that through this interaction, we shall form and sustain Life Planning Clubs in both School and Out-of-School Based Systems and Structures. Leveraging mechanisms linking larger networks enhances communities' engagement in activities leading to better life outcomes. This is a risk mitigation product and it contributes to critical action ensuring a prevention continuum in these spaces and cascading to the end to HIV goal. Sexual and Reproductive health is a fundamental part of growth and development of humans. Reaching out to communities with health promoting approaches for all and eligible age-groups ensures services meet needs along the human life course.