The six centres will operate thanks to a seven million rand grant by PEPFAR, the US President’s Emergency Plan for AIDS Relief. Provided under the Society for Family Health banner, the service will be contracted out to community and non-governmental organisations that have an interest in the expansion of medical male circumcision in the form of a franchise model. Scott Billy is the Director of the Society for Family Health, in South Africa.
‘We will be looking for partner NGOs who would be interested in receiving a grant to provide medical circumcision services. This network of sites will be operated under a non-profit franchise model. It will be standardised services, standardised training and, then, support in terms of financial support, but also, technical support, marketing and education support and, then, quality assurance support. We’ll have our centralised quality assurance team which will make sure that all of the sites are providing services that match government guidelines’.
‘This model, which is a non-profit franchising model is an adaptation of commercial franchising. For example, when you go to Nando’s, each Nando’s is individually owned and operated, but the services are the same everywhere, the quality is the same, and, then, from the centre they provide quality assurance and they dictate the standards of quality. For our franchise partners, we will give them a grant which will allow them to hire the appropriate people. So, they’ll have to hire doctors and nurses, then, we’ll provide the training’, says Scott Billy, Director of the Society for Family Health, in South Africa.
Although the KwaZulu-Natal, Mpumalanga and Gauteng provinces have been identified as the host centres for the new medical male circumcision clinics, Billy says the actual venues where the centres will be located have not yet been decided upon.
‘We’re currently working with the provincial departments of health to identify where they’d like us to work. We need to make sure that what we’re doing is co-ordinated with government’s plans’, he says.
He adds that the choice of expanding the service in the three provinces was a strategic one from a public health point of view as well as from a point of getting value for money invested.
‘In general, if you want to maximise the number of infections you prevent, you should focus your medical male circumcision resources on those provinces that have the highest HIV prevalence and the lowest prevalence of male circumcision. By focusing your circumcision resources on those provinces, you can really prevent the greatest number of new infections and, hopefully, eventually bring down the prevalence rates and the incidence rates’, says Billy.
Initial forecasts show that the six centres have a modest target for their first year of operation, which will grow incrementally thereafter.
‘In year one, we expect to circumcise 57 000 men. By year two all the sites will be set up and we’ve set ourselves a target of 134 000 circumcisions for the year. This is based on the number of teams we have and we’re assuming each team can do approximately 40 circumcisions a day’.
Billy says the expansion is riding on the growth of the demand for medical male circumcision in recent years, particularly in KwaZulu-Natal where King Goodwill Zwelithini personally intervened to promote the intervention.
‘We know there’s a great demand for circumcision in KZN. It’s largely because of the King and what he’s done. The effect is enormous. What the King did a couple of years ago is quite amazing. By making medical male circumcision a part of traditional Zulu culture, he’s given young men a reason to get circumcised. When you go to our site and you talk to the guys who are there and you ask them why they are there, most of them say they are there because they ‘want to be a man’, even though they understand the partial prevention benefits of circumcision. And this makes our job a lot easier. Then, of course, part of the service we provide is counselling. So, we talk to them about partial protection’¦ what it means to undergo a procedure which protects you only 60%. But we’re not so sure about demand in Gauteng and Mpumalanga, but we’re hopeful that the demand for medical male circumcision will be as strong in those provinces as it is in KZN’, he says.
Research has shown that heterosexual men who are medically circumcised have a 60% less risk of contracting HIV. Medical male circumcision is effective when used in conjunction with condoms and other safe sex behaviour. The procedure is also recommended for good penile hygiene.