Important note: Information in this article was accurate in 2009. The state of the art may have changed since the publication date.
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New Vision (Kampala) - September 13, 2009
Milly Nattimba
A total of 90 trainers were passed out early this year. the centre conducted a trainers' training in medical male circumcision.
The centre is set to train more trainers for eastern, central and southern Africa in preparation for the rolling out of mass medical male circumcision, which is a big achievement for the centre; tucked away in rural Kalisizo, 160km from Kampala.
According to Prof. David Serwadda, a founding principal investigator of the programme, the accreditation is based on the quality and vast experience of the programme, including state-of-the-art surgical theatres and laboratories as well as the availability of volunteers for circumcision.
"This, therefore, places a huge responsibility on the centre to maintain the high standards of teaching, coordinating logistics and maintaining theatre as well as laboratory standards," he says.
The training targets doctors, nurses, theatre assistants, counsellors and different personnel involved in carrying out circumcision.
"We train teams, not individuals. We select a minimum of three health workers from each health facility that we consider for the training, on the understanding that they will utilise the skills and knowledge received.
That is why we take on those already involved in surgery," says Dr. Jabbin Mulwanda, the regional male circumcision technical advisor at Jhpiego, an International organisation that provides technical support for the training.
A number of obstacles in the health sector in sub-Saharan Africa have constrained effective service delivery. Public health facilities are burdened with workload, underfunding, absenteeism of staff and long waiting hours, leading to loss of public confidence in health facilities.
What does the ministry say?
The director general of health services at the health ministry, Dr. Sam Zaramba, says for successful implementation of mass circumcision, it is crucial that the public's confidence in the healthcare system is restored.
"There are issues like remuneration and under-provision of supplies to health centres. The ministry is putting pressure on the Government to improve health workers' conditions, especially those in clinical service. a memo on remuneration has already been submitted," he says.
Benefits of male circumcision
Medical male circumcision is an investment, but the returns are reportedly worth every shilling. "In the long-term, if implemented successfully, and fewer people are getting infected, the chances of avoiding future costs on AIDS treatment are high.
There is urgent need to increase the number of trained health personnel, including clinical officers and comprehensive nurses to promote task shifting," Serwadda explains.
Train more Staff
The principal of the College of Health Sciences, Prof. Nelson Sewankambo, says it is necessary to train people like nurses for mass implementation of medical male circumcision in order to off-load responsibility to other people.
However, to do this, the ministry of health should come out with a clear policy on task shifting and define the tasks to be downloaded to others", he said.
Sewankambo says although retraining people who have already passed through medical school is not cost-effective, it is crucial in the mass implementation of medical male circumcision for HIV prevention.
Zaramba, says his ministry is expecting a $100m loan from the World Bank to improve infrastructure and procure medical equipment which will include equipment for male circumcision.
The ministry has also submitted an application for the Global Fund, where male circumcision has been included as a key component of prevention that requires funding.
The governments of Netherlands and Japan have provided funding for surgical equipment, diagnostic radiological equipment and infrastructure development.
With the excitement that male circumcision has generated among Ugandans, Zaramba cautions against people perceiving it as a magic bullet.
The protection provided by circumcision is only partial, so people must be educated on safe sexual practices, including abstinence, faithfulness, correct and consistent use of condoms.
Medical male circumcision is a promising intervention that provides a considerable degree of protection and we need to support its effective implementation," Zaramba says.
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