I-TECH assists the Ministry of Health and Social Services with the expansion and provision of voluntary medical male circumcision (VMMC) as an HIV prevention option. This support started in 2008 with the development of national guidelines and training materials, followed by national trainings of health care workers. In 2015, this support expanded to include direct service delivery in the Oshana and Zambezi regions, as well as Karas region from 2017 onward. Since 2016, I-TECH has also supported demand creation with a network of community-based mobilizers and recruiters using a human-centered design approach to actively engage communities and stakeholders to increase the number of men voluntarily electing medical circumcision. The program has performed over 36,000 VMMCs in Namibia.
I-TECH has trained physicians, nurses, and community counselors to ensure that adequate skills and experience are in place to deliver safe, high-quality male circumcision services.
Scott Barnhart
Scott Barnhart, MD, MPH, has an extensivebackground as Professor of Global Health and former Director of Global Health Programs for I-TECH at the University of Washington. He has had responsibility for leading nine country offices, projects in 14 countries, and more than 500 staff. This experience and training has included extensive clinical work, research and program management in pulmonary and environmental and occupational medicine, and more than eight years as Medical Director of a safety net/Level 1 Trauma Center hospital.
Ensuring health systems can quickly detect and respond to emerging health threats is a critical challenge in both domestic and global health. Dr. Barnhart’s major implementation projects include scale-up of voluntary medical male circumcision (VMMC) in Zimbabwe and Malawi, OpenMRS, and laboratory information systems. Dr. Barnhart deploys his expertise in multiple African countries and Haiti to strengthen health systems and health care.
A goal of Dr. Barnhart’s work is to promote country-led, country owned sustainable development. Consistent with the principles of the Paris Declaration, the goal is to transition the bulk of development work and the associated leadership, ownership, technical direction and control of funding into the countries where development occurs. This approach ensures that the entire continuum of skills necessary for development (technical expertise, administration (human resources, operations, and management and accountability for funds) is transitioned to local partners. A key indicator is to have 75% or more of a grant’s funding expended in-country on local programs and local citizens and to support the local economies in these highly resourced constrained countries. Dr. Barnhart has worked closely to advance this model through projects in Haiti with a goal to shift the majority of a project to a local organization and in Zimbabwe where the VMMC program is largely run through local partners.
The EMR iSanté enables research on population health in Haiti, including the implementation of Option B+. This work was presented at the International AIDS Society Conference in 2015 ... Read More
Since 2013, the ZAZIC Consortium has been implementing Voluntary Medical Male Circumcision (VMMC) as part of a combination HIV prevention package approved by the Ministry of Health and Child Care (MoHCC) in Zimbabwe. Unlike other VMMC programs in the region, the ZAZIC model uses an integrated approach, blending local clinic ... Read More
I-TECH assists the Ministry of Health and Social Services with the expansion and provision of voluntary medical male circumcision (VMMC) as an HIV prevention option. This support started in 2008 with the development of national guidelines and training materials, followed by national trainings of health care workers. In 2015, this ... Read More
It is critical that health care providers receive the necessary training to empower them to improve patient outcomes CHARESS supports both pre-service and in-service training efforts in Haiti. In particular, CHARESS is a key partner of MSPP in maintaining its national clinical guidelines. ... Read More
The Dogg performs to a crowd in Katima Mulilo, Namibia. The Dogg plans to set an example by getting circumcised next month.
Namibian newspaper New Erareported today that hip hop artist The Dogg (real name Martin Morocky) has agreed to be circumcised next month by Dr. Bernard Haufiku, Namibia’s Minister of Health and Social Services, as part of the country’s voluntary medical male circumcision (VMMC) program. The procedure is to take place on Minister Haufiku’s birthday, Sept. 19.
The International Training and Education Center for Health (I-TECH), with PEPFAR funding, has supported the VMMC efforts of the Ministry of Health and Social Services (MOHSS) in the Oshana and Zambezi regions on many fronts. Between 2010 and 2014, I-TECH supported health care worker training in the provision of VMMC nationwide and has supported the delivery of VMMC procedures since November 2014. Since the start of this year, I-TECH has also been engaged in critical efforts to create demand for the procedure.
Marocky, who lost both of his parents to HIV/AIDS, was previously involved in the MOHSS’s “Break the Chain” campaign to reduce concurrent sexual partnerships in Namibia. He’s been a VMMC ambassador since May 2016, serving as the face behind a nationwide concert and social media campaign urging 15- to 49-year-old men to “get the smart cut.”
The Dogg shares the message of HIV prevention with a school in Katima Mulilo.
So far, Marocky has held nine concerts in the Erongo, Oshana, and Zambezi regions, as well as delivered encouragement to young men through radio talk shows and TV advertisements. He has also spoken one-on-one to young men about the preventive benefits of VMMC — namely, that the procedure can reduce the risk of HIV infection by more than 60%.
“I’ve encouraged ‘the smart cut’ through my music and appearances,” said Marocky. “But I’m now looking forward to protecting myself and setting a personal example for young Namibian men.”
The musician will join the more than 11,200 men in Oshana who have undergone a VMMC since 2009. More than 80% of the 12,250-plus procedures performed with I-TECH support since January 2015 are in the high-priority 15- to 29-year-old age group.
Currently, only about a quarter of Namibian men are circumcised. Overcoming cultural hurdles and mobilizing men to get the procedure has become a high priority for the MOHSS.
“Training clinicians in the procedure is only half the battle,” said I-TECH Namibia Country Director Norbert Forster. “Getting the word out to young men about the benefits of VMMC is crucial to ensuring the success of this intervention. The Dogg’s campaign has gone a long way toward changing minds and attitudes.”
The MOHSS and I-TECH are jointly engaging in a number of additional demand generation activities, which mainly focus on school-aged boys and young working men. One such activity, a bicycle lottery, is highlighted below.
Community Members Win Bicycle Lottery After Volunteering for VMMC
The MOHSS, with the support of I-TECH, has awarded the first two winners of new bicycles in a lottery held at Katima Mulilo State Hospital in the Zambezi Region.
The lottery was implemented to encourage more men to come in for VMMC; Zambezi remains the region most affected by HIV/AIDS in Namibia.
The first winner is an NDF soldier. His winning ticket was drawn out of the first group of men who were circumcised between March 1 and April 30, 2016, in the Zambezi region. The second winner, drawn from the May to July cohort, was a 16-year-old attending Mavuluma Senior Secondary School, a remote school in eastern Zambezi region.
During June of this year, the MOHSS Zambezi region team managed to mobilize and circumcise a total of 773 men as part of its I-TECH-supported VMMC program. The vast majority of recipients were between 15 and 29 years of age.
This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under U91HA06801, the International AIDS Education and Training Center (IAETC). The content of this post is the author’s and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
The theme of this year’s conference is “Mobilizing Research for Global Health,” and featured speakers include Olusoji Adeyi, Director, Health, Nutrition and Population, World Bank; Paul Farmer, Co-Founder, Partners in Health; and Stephen Morrison, Vice President, Center for Strategic and International Studies.
Staff members from the International Training and Education Center for Health (I-TECH) will attend to present research on several topics:
Malawi
Quality improvement practices decrease adverse event rates in a surgical male circumcision program in Malawi Kohler PK, Chilongozi DA, Namate D, Barr BA, Msungama W, Phiri O, Tenthani L, Chalulu K, Perdue T, Barnhart S, Krieger JN
Improving nursing and midwifery clinical education by developing local faculty mentoring capacity in Malawi Holman J, Muyaso M, Msiska G, Namate D, Wasili R
Haiti
An assessment of data quality in Haiti’s multi-site electronic medical record system Puttkammer N, Baseman JG, Devine EB, Hyppolite N, France G, Honoré JG, Matheson AI, Zeliadt S, Yuhas K, Sherr K, Cadet JR, G. Zamor, Barnhart S
Kenya
Evolution of the KenyaEMR training program: Towards efficiency and quality in scale-up Atelu C, Antilla J, Muthee V, Puttkammer N
About CUGH
Founded by leading North American university global health programs, CUGH aims to:
Define the field and discipline of global health;
Standardize required curricula and competencies for global health;
Define criteria and conditions for student and faculty field placements in host institutions;
Provide coordination of projects and initiatives among and between resource-rich universities and less-developed nations and their institutions.
CUGH is dedicated to creating balance in resources and in the exchange of students and faculty between institutions in rich and poor countries, recognizing the importance of equal partnership between the academic institutions in developing nations and their resource-rich counterparts in the planning, implementation, management and impact evaluation of joint projects.
Community Mobilizer Adyasi Bamusi (left) receives advice on bicycle care from Lilongwe District Environmental Health Officer Mavuto Thomas.
A group of eight Voluntary Medical Male Circumcision (VMMC) Community Mobilizers can breathe a sigh of relief after receiving bicycles to ease mobility in their clusters. The beneficiaries were selected based on the remote areas and long distances they cover.
Desiree Mhango, I-TECH Malawi’s Deputy Country Director, presented the bicycles. During the ceremony, Lilongwe District Environmental Health Officer Mavuto Thomas, thanked I-TECH for the donation of the 10 bicycles, saying they will be a huge help to mobilizers as they disseminate information on the importance of male circumcision.
Mr. Thomas further advised the eight beneficiaries to take good care of the bicycles in order to sustain their usefulness well into the future.
One of the beneficiaries, Adyasi Bamusi, said the bicycles will not only solve mobility problems in rural communities, but also will be used to ferry clients to circumcision centers.
I-TECH’s VMMC program, administered in partnership with the Lilongwe District Health Office, is funded by the Health Resources and Services Administration (HRSA) in collaboration with the U.S. Centers for Disease Control and Prevention’s Division of Global HIV and AIDS (CDC-DGHA), under the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).
The donation is part of a pilot study examining the impact of bicycles on the effectiveness of community mobilizers in rural areas.
To the brass beats of the Prince Edward School Jazz Band, on Feb. 6, a crowd of approximately 150 government officials, health professionals, and members of the press celebrated the launch of three programs in Zimbabwe, two of which are implemented by I-TECH Zimbabwe and partners. These vital programs aim to build local capacity and provide comprehensive services to prevent and combat HIV/AIDS in the country.
Speaking at the festivities were David Bruce Wharton, U.S. Ambassador to the Republic of Zimbabwe; Dr. Owen Mugurungi, director of the AIDS and TB Unit at the Ministry of Health and Child Care (MOHCC); Dr. King Holmes, Chair of the Department of Global Health at the University of Washington; Dr. Ann Downer, Executive Director of the International Training and Education Center for Health (I-TECH); and Dr. Batsirai Makunike-Chikwinya, Country Director of I-TECH Zimbabwe.
“Preventing the spread of HIV/AIDS is important to all of us, as is providing the best level of care to those living with this disease,” said Amb. Wharton. “Today we celebrate the launch of programs that will help us reach these goals together – programs that were designed together, by dedicated teams of collaborating partners from Zimbabwe and from the United States.”
In this spirit of collaboration, the programs, totaling $65 million over five years, support the Zimbabwe MOHCC with grant funding by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), technical support from the Centers for Disease Control and Prevention, and implementation by local and U.S.-based partners. These partners include I-TECH; Zimbabwe Association of Church-Related Hospitals; Zimbabwe Community Health Intervention Research Project; Compre Health Services; The Newlands Clinic and Newlands Clinic Training Centre; Pangaea Global AIDS Foundation, Zimbabwe; and the University of Zimbabwe-University of California, San Francisco Collaborative Research Programme.
The Training and Mentoring Program seeks to develop and deliver in-service training on antiretroviral therapy, including the medical management of HIV/AIDS, women’s reproductive health, tuberculosis (TB), and TB/HIV co-infection to 8,000 health care workers across the country over five years. A mentorship component will also provide health care workers with access to ongoing learning and feedback on clinical issues. Health workers will receive refresher trainings via distance learning technologies, and the effectiveness of the program will be measured through a training database.
Also celebrated – and accompanied by a ribbon-cutting and presentation of 17 new vehicles – was the launch of the Voluntary Medical Male Circumcision Program. The program, building on work that started last spring, seeks to deliver services to 412,000 men in Zimbabwe between the ages of 15 and 49 years over the next five years. Medical male circumcision has proved very effective in preventing the spread of HIV. Randomized controlled trials in Uganda, Kenya, and South Africa have shown that this intervention reduces the risk of female-to-male sexual transmission of HIV by approximately 60%.
“Together, these two programs will improve the effectiveness and quality of prevention, treatment, and care services for those affected by HIV/AIDS – and create better health systems for all Zimbabweans,” said Dr. Holmes.
Right Reverend Bishop Emmanuel Fanuel Magangani of the Anglican Diocese of Northern Malawi is the first prominent church leader to announce that he was recently circumcised as part of the country’s efforts to promote Voluntary Medical Male Circumcision (VMMC).
Lilongwe District’s Nkhoma Hospital has started offering Voluntary Medical Male Circumcision (VMMC) services.
VMMC services began with great enthusiasm: 37 procedures were performed in less than two weeks, according to Dr. Roderick Banda, Medical Officer at Nkhoma Hospital.
“We are encouraged by this overwhelming response,” Banda said.
The project has taken a novel approach to recruiting participants by staging a two-week awareness campaign that incorporates comedy, music, and film. The group has engaged the services of popular local comedians Chindime and Samalani and the Health Education Band of the Ministry of Health. VMMC promotional film documentaries will also be shown.
Local leaders are also getting in on the act. Encouraging his subjects following a VMMC promotional documentary, Group Village Headman (GVH) Chimwaye underscored the need to seriously consider VMMC, a one-time intervention scientifically proven to reduce the transmission of HIV by 60 percent.
“Now we have no reason to complain about long distance to town (VMMC Center in old town in Lilongwe),” he said. “VMMC services are within our own vicinity.”
The initiative is in partnership with Lilongwe District Office and Health Education Unit of the Ministry of Health (HEU), and the International Technology and Education Centers for Health (I-TECH) Malawi as part of a PEPFAR subgrant. It is intended to encourage more eligible men to access locally available VMMC services.
The project has taken a novel approach to recruiting participants by staging a two-week awareness campaign that incorporates comedy, music, and film. The group has engaged the services of popular local comedians Chindime and Samalani and the Health Education Band of the Ministry of Health. VMMC promotional film documentaries will also be shown.