title: Voluntary medical male circumcision: strategies for meeting the human resource needs of scale-up in southern and eastern Africa.
abstract: Voluntary medical male circumcision (VMMC) reduces female-to-male HIV transmission by approximately 60%; modeling suggests that scaling up VMMC to 80% of men 15- to 49-years-old within five years would avert over 3.3 million new HIV infections in 14 high priority countries/regions in southern and eastern Africa by 2025 and would require 20.33 million circumcisions. However, the shortage of health professionals in these countries must be addressed to reach these proposed coverage levels. To identify human resource approaches that are being used to improve VMMC volume and efficiency, we looked at previous literature and conducted a program review. We identified surgical efficiencies, non-surgical efficiencies, task shifting, task sharing, temporary redeployment of public sector staff during VMMC campaign periods, expansion of the health workforce through recruitment of unemployed, recently retired, newly graduating, or on-leave health care workers, and the use of volunteer medical staff from other countries as approaches that address human resource constraints. Case studies from Kenya, Tanzania, and Swaziland illustrate several innovative responses to human resource challenges. Although the shortage of skilled personnel remains a major challenge to the rapid scale-up of VMMC in the 14 African priority countries/regions, health programs throughout the region may be able to replicate or adapt these approaches to scale up VMMC for public health impact.
authors.affiliation: Jhpiego, Baltimore, Maryland, USA. kcurran@jhpiego.net
authors.forename: Kelly
authors.initials: K
authors.lastname: Curran
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Njeuhmeli
authors.forename: Andrew
authors.initials: A
authors.lastname: Mirelman
authors.forename: Kim
authors.initials: K
authors.lastname: Dickson
authors.forename: Tigistu
authors.initials: T
authors.lastname: Adamu
authors.forename: Peter
authors.initials: P
authors.lastname: Cherutich
authors.forename: Hally
authors.initials: H
authors.lastname: Mahler
authors.forename: Bennett
authors.initials: B
authors.lastname: Fimbo
authors.forename: Thembisile Khumalo
authors.initials: TK
authors.lastname: Mavuso
authors.forename: Jennifer
authors.initials: J
authors.lastname: Albertini
authors.forename: Laura
authors.initials: L
authors.lastname: Fitzgerald
authors.forename: Naomi
authors.initials: N
authors.lastname: Bock
authors.forename: Jason
authors.initials: J
authors.lastname: Reed
authors.forename: Delivette
authors.initials: D
authors.lastname: Castor
authors.forename: David
authors.initials: D
authors.lastname: Stanton
mesh_terms: D000293:Adolescent; D000328:Adult; D000351:Africa, Eastern / Q000453:epidemiology; D000353:Africa, Southern / Q000453:epidemiology; D002944:Circumcision, Male / Q000191:economics* / Q000379:methods; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D010348:Patient Care Team / Q000458:organization & administration; D011634:Public Health; D000078329:Workforce; D055815:Young Adult