Jhpiego/Lesotho, Maseru, Lesotho
Jhpiego/Lesotho, Maseru, Lesotho.
Glob Health Sci Pract. 2016 Jul 13;4 Suppl 1(Suppl 1):S87-96. doi: 10.9745/GHSP-D-15-00231. Print 2016 Jul.
The World Health Organization and the Joint United Nations Programme on HIV/AIDS recommend early infant male circumcision (EIMC) as a component of male circumcision programs in countries with high HIV prevalence and low circumcision rates. Lesotho began incorporating EIMC into routine maternal, newborn, and child health (MNCH) services in 2013 with funding from the United States Agency for International Development and United Nations Children's Fund. This presented unique challenges: Lesotho had no previous experience with EIMC and cultural traditions link removal of the foreskin to rites of passage. This process evaluation provides an overview of EIMC implementation.
The Lesotho Ministry of Health and Jhpiego conducted a baseline assessment before service implementation. Baseline information from an initial assessment was used to develop and implement an EIMC program that had a pilot and a scale-up phase. Key program activities such as staff training, quality assurance, and demand creation were included at the program design phase. Facilitating factors and challenges were identified from a review of information collected during the baseline assessment as well as the pilot.
Between September 2013 and March 2015, 592 infants were circumcised at 9 sites: 165 (28%) between 1 day and 6 days after birth; 196 (33%) between 7 and 30 days, and 231 (39%) between 31 and 60 days. Facilitating factors included strong support from the Ministry of Health, collaboration with stakeholders, and donor funding. Providers were enthusiastic about the opportunity to offer new services and receive training. Challenges included gaining consent from family members other than mothers, and parents' concern about pain and complications. The EIMC program also had to manage providers' expectations of compensation because overtime was paid to providers who took part in adult circumcision programming but not for EIMC. Limited human resources, including authorization only for doctors to perform EIMC, impeded provision of services.
Despite communication, compensation, and task-shifting challenges, integrating EIMC services with MNCH services could be a sustainable model for EIMC service delivery in Lesotho.
世界卫生组织和联合国艾滋病规划署建议在艾滋病毒流行率高和割礼率低的国家将早期婴儿男性割礼（EIMC）作为男性割礼计划的一个组成部分。莱索托于 2013 年开始将 EIMC 纳入常规母婴、新生儿和儿童保健（MNCH）服务，资金来自美国国际开发署和联合国儿童基金会。这带来了独特的挑战：莱索托以前没有进行 EIMC 的经验，而且文化传统将去除包皮与成年仪式联系在一起。本过程评估提供了 EIMC 实施的概述。
莱索托卫生部和 Jhpiego 在服务实施前进行了基线评估。初始评估的基线信息用于开发和实施一个试点和扩大阶段的 EIMC 计划。在方案设计阶段纳入了工作人员培训、质量保证和需求创造等关键方案活动。从基线评估和试点期间收集的信息审查中确定了促进因素和挑战。
2013 年 9 月至 2015 年 3 月，在 9 个地点为 592 名婴儿进行了割礼：165 名（28%）在出生后 1 至 6 天；196 名（33%）在 7 至 30 天；231 名（39%）在 31 至 60 天。促进因素包括卫生部的大力支持、与利益攸关方的合作以及捐助资金。提供者对提供新服务和接受培训的机会感到兴奋。挑战包括获得除母亲以外的家庭成员的同意，以及父母对疼痛和并发症的担忧。EIMC 计划还必须管理提供者对补偿的期望，因为加班费用支付给参与成人割礼方案的提供者，但不支付给 EIMC 提供者。人力资源有限，包括仅授权医生进行 EIMC，阻碍了服务的提供。
尽管存在沟通、补偿和任务转移方面的挑战，但将 EIMC 服务与 MNCH 服务相结合，可能成为莱索托 EIMC 服务提供的可持续模式。
