Vasectomy as a proxy: extrapolating health system lessons to male circumcision as an HIV prevention strategy in Papua New Guinea
<p>Abstract</p> <p>Background</p> <p>Male circumcision (MC) has been shown to reduce the risk of HIV acquisition among heterosexual men, with WHO recommending MC as an essential component of comprehensive HIV prevention programs in high prevalence settings since 2007. W...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2012-09-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://www.biomedcentral.com/1472-6963/12/299 |
| _version_ | 1828435670954147840 |
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| author | Tynan Anna Vallely Andrew Kelly Angela Law Greg Millan John Siba Peter Kaldor John Hill Peter S |
| author_facet | Tynan Anna Vallely Andrew Kelly Angela Law Greg Millan John Siba Peter Kaldor John Hill Peter S |
| author_sort | Tynan Anna |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>Male circumcision (MC) has been shown to reduce the risk of HIV acquisition among heterosexual men, with WHO recommending MC as an essential component of comprehensive HIV prevention programs in high prevalence settings since 2007. While Papua New Guinea (PNG) has a current prevalence of only 1%, the high rates of sexually transmissible diseases and the extensive, but unregulated, practice of penile cutting in PNG have led the National Department of Health (NDoH) to consider introducing a MC program. Given public interest in circumcision even without active promotion by the NDoH, examining the potential health systems implications for MC without raising unrealistic expectations presents a number of methodological issues. In this study we examined health systems lessons learned from a national no-scalpel vasectomy (NSV) program, and their implications for a future MC program in PNG.</p> <p>Methods</p> <p>Fourteen in-depth interviews were conducted with frontline health workers and key government officials involved in NSV programs in PNG over a 3-week period in February and March 2011. Documentary, organizational and policy analysis of HIV and vasectomy services was conducted and triangulated with the interviews. All interviews were digitally recorded and later transcribed. Application of the WHO six building blocks of a health system was applied and further thematic analysis was conducted on the data with assistance from the analysis software MAXQDA.</p> <p>Results</p> <p>Obstacles in funding pathways, inconsistent support by government departments, difficulties with staff retention and erratic delivery of training programs have resulted in mixed success of the national NSV program.</p> <p>Conclusions</p> <p>In an already vulnerable health system significant investment in training, resources and negotiation of clinical space will be required for an effective MC program. Focused leadership and open communication between provincial and national government, NGOs and community is necessary to assist in service sustainability. Ensuring clear policy and guidance across the entire sexual and reproductive health sector will provide opportunities to strengthen key areas of the health system.</p> |
| first_indexed | 2024-12-10T19:12:17Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-10T19:12:17Z |
| publishDate | 2012-09-01 |
| publisher | BMC |
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| series | BMC Health Services Research |
| spelling | doaj.art-7cee19d1605b491dbe609333287344822022-12-22T01:36:42ZengBMCBMC Health Services Research1472-69632012-09-0112129910.1186/1472-6963-12-299Vasectomy as a proxy: extrapolating health system lessons to male circumcision as an HIV prevention strategy in Papua New GuineaTynan AnnaVallely AndrewKelly AngelaLaw GregMillan JohnSiba PeterKaldor JohnHill Peter S<p>Abstract</p> <p>Background</p> <p>Male circumcision (MC) has been shown to reduce the risk of HIV acquisition among heterosexual men, with WHO recommending MC as an essential component of comprehensive HIV prevention programs in high prevalence settings since 2007. While Papua New Guinea (PNG) has a current prevalence of only 1%, the high rates of sexually transmissible diseases and the extensive, but unregulated, practice of penile cutting in PNG have led the National Department of Health (NDoH) to consider introducing a MC program. Given public interest in circumcision even without active promotion by the NDoH, examining the potential health systems implications for MC without raising unrealistic expectations presents a number of methodological issues. In this study we examined health systems lessons learned from a national no-scalpel vasectomy (NSV) program, and their implications for a future MC program in PNG.</p> <p>Methods</p> <p>Fourteen in-depth interviews were conducted with frontline health workers and key government officials involved in NSV programs in PNG over a 3-week period in February and March 2011. Documentary, organizational and policy analysis of HIV and vasectomy services was conducted and triangulated with the interviews. All interviews were digitally recorded and later transcribed. Application of the WHO six building blocks of a health system was applied and further thematic analysis was conducted on the data with assistance from the analysis software MAXQDA.</p> <p>Results</p> <p>Obstacles in funding pathways, inconsistent support by government departments, difficulties with staff retention and erratic delivery of training programs have resulted in mixed success of the national NSV program.</p> <p>Conclusions</p> <p>In an already vulnerable health system significant investment in training, resources and negotiation of clinical space will be required for an effective MC program. Focused leadership and open communication between provincial and national government, NGOs and community is necessary to assist in service sustainability. Ensuring clear policy and guidance across the entire sexual and reproductive health sector will provide opportunities to strengthen key areas of the health system.</p>http://www.biomedcentral.com/1472-6963/12/299Male circumcisionHIV/AIDSPapua New GuineaHealth system strengtheningNo-scalpel vasectomy |
| spellingShingle | Tynan Anna Vallely Andrew Kelly Angela Law Greg Millan John Siba Peter Kaldor John Hill Peter S Vasectomy as a proxy: extrapolating health system lessons to male circumcision as an HIV prevention strategy in Papua New Guinea BMC Health Services Research Male circumcision HIV/AIDS Papua New Guinea Health system strengthening No-scalpel vasectomy |
| title | Vasectomy as a proxy: extrapolating health system lessons to male circumcision as an HIV prevention strategy in Papua New Guinea |
| title_full | Vasectomy as a proxy: extrapolating health system lessons to male circumcision as an HIV prevention strategy in Papua New Guinea |
| title_fullStr | Vasectomy as a proxy: extrapolating health system lessons to male circumcision as an HIV prevention strategy in Papua New Guinea |
| title_full_unstemmed | Vasectomy as a proxy: extrapolating health system lessons to male circumcision as an HIV prevention strategy in Papua New Guinea |
| title_short | Vasectomy as a proxy: extrapolating health system lessons to male circumcision as an HIV prevention strategy in Papua New Guinea |
| title_sort | vasectomy as a proxy extrapolating health system lessons to male circumcision as an hiv prevention strategy in papua new guinea |
| topic | Male circumcision HIV/AIDS Papua New Guinea Health system strengthening No-scalpel vasectomy |
| url | http://www.biomedcentral.com/1472-6963/12/299 |
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