Number of institutions delivering minimum package of male circumcision services
The number of facilities providing the minimum package of male circumcision services. This includes:
- HIV testing and counseling
- Active exclusion of symptomatic STIs; syndromic treatment where required
- Provision and promotion of male and female condoms
- Counseling on risk reduction and safer sex
- Male circumcision surgical procedures performed as described in the Manual for male circumcision under local anaesthesia (WHO, 2008).
This package should be available at all facilities providing male circumcision services. These services could be offered at different locations in the same facility. However, systems and processes should be set up to facilitate easy client flow and referral from one point to another. More comprehensive packages can be offered, depending on the facility and the prevailing problems in the community. Only facilities meeting the minimum package of male circumcision services should be counted for this indicator.
Range of male circumcision services offered
Health facility survey. Data should be disaggregated by type and location of health-care facility and age of clients (neonates or men).
Another data source is WHO’s Male Circumcision Services Quality Assessment Toolkit (2009), which provides a tool for assessing the quality of male circumcision services under Section 2.
This indicator of access and quality assesses progress towards maximization of supply of male circumcision services available to the intended population and delivered to a minimum standard.
Disaggregation by type and location of facility allows an assessment of the range and numbers of facilities that deliver male circumcision services, and government or nongovernmental activity. If compared with total numbers of facilities the indicator may inform the allocation of resources, e.g. if only a small proportion of government district hospitals are performing male circumcision services, resources may have to be allocated to them. In addition, if mapping of each facility is done, geographical coverage may be assessed. Disaggregation by age of client allows an assessment of possible demand for or supply of services, by age of client.
A similar indicator, “Number of locations providing male circumcision surgery as part of the minimum package of male circumcision for HIV prevention services within the reporting period”, has been added under a new Prevention sub-area on male circumcision in the PEPFAR Next Generation Indicators Reference Guide (2009).
Although this indicator provides information on the existence of a minimum package of male circumcision services offered, the fact that a facility meets the indicator criteria does not mean that the actual delivery of services is of high quality. For example, although staff may report following appropriate surgical procedures for male circumcision, this indicator does not entail actually observing the procedure.
access, health system strengthening (HSS), quality, male circumcision, HIV/AIDS
WHO & UNAIDS. A guide to indicators for male circumcision programmes in the formal health care system. 2009. http://www.who.int/hiv/pub/malecircumcision/hiv_mc_me.pdf
WHO. Male circumcision quality assurance: a guide to enhancing the safety and quality of services. 2008. http://www.who.int/hiv/pub/malecircumcision/qa_guide/en/
PEPFAR, 2009, The President’s Emergency Plan for AIDS Relief: Next Generation Indicators Reference Guide, Washington, DC: USAID/PEPFAR. https://www.k4health.org/toolkits/igwg-gender/president%E2%80%99s-emergency-plan-aids-relief-next-generation-indicators-reference
WHO, 2009, Male Circumcision Services Quality Assessment Toolkit. http://www.who.int/hiv/pub/malecircumcision/qa_toolkit/en/