title: Covering the Last Kilometer: Using GIS to Scale-Up Voluntary Medical Male Circumcision Services in Iringa and Njombe Regions, Tanzania.
abstract: BACKGROUND
  Based on the established protective effect of voluntary medical male circumcision (VMMC) in reducing female-to-male HIV transmission, Tanzania's Ministry of Health and Social Welfare (MOHSW) embarked on the scale-up of VMMC services in 2009. The Maternal and Child Health Integrated Project (MCHIP) supported the MOHSW to roll out VMMC services in Iringa and Njombe, 2 regions of Tanzania with among the highest HIV and lowest circumcision prevalence. With ambitious targets of reaching 264,990 males aged 10-34 years with VMMC in 5 years, efficient and innovative program approaches were necessary.
  
  
  METHODS
  Outreach campaigns, in which mobile teams set up temporary services in facilities or non-facility settings, are used to reach lesser-served areas with VMMC. In 2012, MCHIP began using geographic information systems (GIS) to strategically plan the location of outreach campaigns. MCHIP gathered geocoded data on variables such as roads, road conditions, catchment population, staffing, and infrastructure for every health facility in Iringa and Njombe. These data were uploaded to a central database and overlaid with various demographic and service delivery data in order to identify the VMMC needs of the 2 regions.
  
  
  RESULTS
  MCHIP used the interactive digital maps as decision-making tools to extend mobile VMMC outreach to "the last kilometer." As of September 2014, the MOHSW with MCHIP support provided VMMC to 267,917 men, 259,144 of whom were men were aged 10-34 years, an achievement of 98% of the target of eligible males in Iringa and Njombe. The project reached substantially more men through rural dispensaries and non-health care facilities each successive year after GIS was introduced in 2012, jumping from 48% of VMMCs performed in rural areas in fiscal year 2011 to 88% in fiscal year 2012 and to 93% by the end of the project in 2014.
  
  
  CONCLUSIONS
  GIS was an effective tool for making strategic decisions about where to prioritize VMMC service delivery, particularly for mobile and outreach services. Donors may want to consider funding mapping initiatives that support numerous interventions across implementing partners to spread initial start-up costs.
authors.affiliation: Jhpiego, Dar Es Salaam, Tanzania.
authors.forename: Hally
authors.initials: H
authors.lastname: Mahler
authors.affiliation: Jhpiego, Baltimore, MD, USA sarah.searle@jhpiego.org.
authors.forename: Sarah
authors.initials: S
authors.lastname: Searle
authors.affiliation: Jhpiego, Baltimore, MD, USA.
authors.forename: Marya
authors.initials: M
authors.lastname: Plotkin
authors.affiliation: Jhpiego, Dar Es Salaam, Tanzania.
authors.forename: Yusuph
authors.initials: Y
authors.lastname: Kulindwa
authors.affiliation: United States Agency for International Development (USAID), Dar Es Salaam, Tanzania.
authors.forename: Seth
authors.initials: S
authors.lastname: Greenberg
authors.affiliation: United States Agency for International Development (USAID), Dar Es Salaam, Tanzania.
authors.forename: Erick
authors.initials: E
authors.lastname: Mlanga
authors.affiliation: USAID, Washington, DC, USA.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Njeuhmeli
authors.affiliation: Tanzania Ministry of Health and Social Welfare, Dar Es Salaam, Tanzania.
authors.forename: Gissenje
authors.initials: G
authors.lastname: Lija
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002944:Circumcision, Male / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000379:methods*; D040362:Geographic Information Systems; D015658:HIV Infections / Q000517:prevention & control*; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D015397:Program Evaluation / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data; D013636:Tanzania; D055815:Young Adult