From good intentions to action: The process of development and operationalization of a national policy on scaling up male circumcision as a part of an HIV prevention strategy

Male circumcision (MC) has gained prominence as a strategy in the arsenal of HIV prevention programs in high HIV prevalence and relatively low MC prevalence settings in Africa, where MC policy development has accelerated, albeit not without controversy and scale-up challenges. The presentation describes the preliminary data collection process, tools, and methodologies used to inform the national MC policy development and reviews qualitative and quantitative instruments used at service provider, facility, and policy maker levels. It describes a recommended consultative process with policy-makers and the wide range of institutions with a stake in the process.

Data collection, costing and modeling work inform discussions among policy-makers regarding potential target groups (adults, youth, children, neonates or combinations thereof) and often reveal previously underestimated cultural and traditional fault lines; lack of awareness among target populations about the benefits and risks of MC; resistance among some providers or cultural groups; lack of demand for MC in the public healthcare setting and lack of capacity in the same settings to ensure rapid scale-up; and outdated or inconsistently applied standard operating procedures. The analysis highlights new policy questions, including informed consent for MC for neonates; the role of traditional circumcisers; lack of quality control, monitoring of complication rates, accreditation for private providers; insurance coverage or subsidies for an elective surgery, and more. Armed with evidence and cost data, stakeholders can formulate policy, plan to address bottlenecks to scale-up, and take ownership of the process.