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Using health facility assessment data to strategically roll-out male circumcision in Nyanza province, Kenya: a mixed method approach
Presented by Amy Herman-Roloff (United States).
A. Herman-Roloff1, E. Llewellyn2, R. Bailey1, K. Agot3
1University of Illinois at Chicago, Epidemiology, Chicago, United States, 2Nyanza Reproductive Health Society, Kisumu, Kenya, 3Impact Research and Development Organization, Kisumu, Kenya
Background: The Male Circumcision Consortium is supporting the Government of Kenya (GoK) to scale-up male circumcision (MC) services for HIV prevention in Nyanza Province, Kenya. The Nyanza Reproductive Health Society (NRHS), as a member of MCC, is engaged in increasing the capacity of health facilities to provide MCs in two districts.
Methods: NRHS conducted an assessment of all health facilities in the two districts. The assessment focused on evaluating the minimum criteria for MC service provision as outlined by the GoK. The assessment was conducted during February-October, 2008 using a questionnaire and a GPS device. The minimum criteria were analyzed descriptively and spatially using SAS and ArcGIS.
Results: 81 health facilities were assessed. Results showed that no facility was adequately prepared to provide MC services. Most (85%) possessed 2-4 of the seven minimum criteria to provide MC services. Many facilities were able to meet select criteria: 67% had an autoclave and 70% provided HIV counseling and testing. Barriers to providing MC services were: 21% of facilities did not have space for a minor theater; 12% staffed an adequate number of clinicians; and 10% reported having an adequate STI drug supply. All facilities required capacity building. ArcGIS pattern analysis tools (e.g., Nearest Neighbor and Hotspot) were used to prioritize where to build capacity considering both facility location and the amount and type of capacity building needed.
Conclusions: A mixed method approach to analyzing assessment data proved helpful in visually displaying and analyzing the assessment data. At the national level, these results supported the position to lobby for nurses to perform MCs. Locally, NRHS responded to the observed gaps in capacity and geographic coverage of MC services by implementing several service delivery models.
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