Scaling up male circumcision for HIV prevention in Tanzania

HIV and AIDS remain the most important public health problems in Tanzania. Promoting effective interventions that prevent new infection and control the epidemic is a priority. Male circumcision is effective in preventing HIV in men. However, there have been some challenges in scaling up circumcision services in Tanzania.

To provide national leadership, coordination, resource mobilisation and advocacy, the Tanzanian Ministry of Health, with support from World Health Organization (WHO), formed two bodies (the Taskforce Committee and Technical Working Group) to oversee the scaling up of circumcision services in the country. These bodies were formed through a series of consultative and inclusive processes involving multiple partners. Members of the oversight bodies were selected on the basis of experience in policy formulation, implementation and advocacy issues, and technical competence in circumcision issues.

The introduction and scaling up of circumcision services requires
actions from several key stakeholder groups

The two oversight bodies took the following steps and decisions:

• establishing national leadership to scale up circumcision services
• designating a focal person at the Ministry of Health to coordinate day-to-day work 
• drafting circumcision guidelines for health practitioners and using these to train service providers 
• preparing sites for the roll out of circumcision services in Kagera, Iringa and Mbeya Regions 
• applying to the Global Fund for HIV, Tuberculosis and Malaria for funding to roll out male circumcision services nationwide.

Tanzania’s National Institute for Medical Research (NIMR) reviews, synthesises, and presents evidence to ensure that decisions are based on strong evidence. NIMR conducted two sub-studies to assess the acceptability and feasibility of carrying out safe circumcision services in health facilities and to explore the role of traditional circumcision service providers in the national strategy. Findings from these studies show:

• There is high level of acceptability in both traditional and non-traditional circumcising populations.
• Traditional circumcisers play a key decision-making role in traditional circumcising populations and should have a role to play in the national strategy.
• Health systems need strengthening for the effective delivery of circumcision services.

The presentation of NIMR’s findings before the two oversight bodies has led to the development of an enabling policy, plan of action and implementation strategy. However several challenges remain, such as the integration of traditional and clinical-based male circumcision, and inherent limitations within the public health system.

The introduction and scaling up of circumcision services requires actions from several key stakeholder groups. The technical working group ensured the active participation of policymakers, donors, advocacy groups, researchers and implementing partners. It was this partnership that was crucial in setting into motion the drive to roll out circumcision services in Tanzania.

Wambura Mwita
National Institute for Medical Research, PO Box 1462, Mwanza, Tanzania
T +255 28 2500399
wmwita@yahoo.com

The National Institute for Medical Research is a partner in the Programme for Research and Capacity Building in Sexual and Reproductive Health and HIV in Developing Countries