Factors Influencing SMC Scale-Up

Each day some 45 health centres are reporting the number of medical male circumcisions performed at that centre in the previous day. It’s clear even from a very quick skim of these numbers that there is still a long way to go in scaling up the SMC Programme.

These numbers alone of course will not tell us if a particular centre is able to increase its daily output, there is no reported measure of centre utilisation.

The opportunity to increase output and utilisation will depend upon three key factors. The first is the availability of trained staff and whether these can be dedicated to performing SMCs or if they will do these together with their normal duties. Second will be the space available within the centre for each of the different parts related to SMC; these include initial counselling, testing for HIV, screening for STIs, performing the circumcision, recovery and discharge. Efficiency of the centre will then depend upon ensuring an adequate flow of clients, which will depend upon successful community engagement and mobilisation. Some of the usual barriers may of course apply to SMC, as to other health services and health seeking behaviour. Whilst the service is being offered free of charge, the men attending will still need to take some time off work and travel to that centre. Loss of income and cost of transport may become real barriers to attendance.

Those tasked with considering how to scale-up will need to carefully consider each of the above as part of programme planning.

About Kevin Duffy

Interim Management and Consulting - Global Healthcare Development. Kevin has over ten years of senior management experience in the delivery of healthcare services in Africa and South Asia. His current focus is on the strategic development of policy, guidance, and tools to help healthcare organisations achieve sustainable impact – balancing the need to become financially sustainable, with the mission of ensuring equitable access to affordable healthcare services.
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