A Comparative Evaluation of the Voluntary Medical Male Circumcision Program for Seke and Goromonzi Districts, Mashonaland East Province, Zimbabwe, 2017

摘要

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.