Vmmc)(Vmmc) in in Z Zambiaambia ((20162016--2020)2020)

REPUBLIC OF ZAMBIA MINISTRY OF HEALTH

NATIONAL OPERATIONAL PLAN FOR THE SCALE-UP NATIONAL OPERATIONAL PLAN FOR THE SCALE-UP OF VOLUNTARY MEDICAL MALE CIRCUMCISION OF VOLUNTARY MEDICAL MALE CIRCUMCISION (VMMC)(VMMC) IN IN Z ZAMBIAAMBIA ((20162016--2020)2020)

June Ministry2016 of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN June Ministry2016 of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN (2016-2020) (2016-2020)

Contents

Tables ii ContentsFigures ...... iii FOREWORD ...... iv Tables ii ACKNOWLEDGEMENTS ...... v Figures ...... iii LIST OF CONTRIBUTORS ...... vi FOREWORD ...... iv ACRONYMS ...... viii ACKNOWLEDGEMENTS ...... v A. EXECUTIVE SUMMARY ...... 1 LIST OF CONTRIBUTORS ...... vi B. INTRODUCTION ...... 3 ACRONYMS ...... viii C. SITUATION ANALYSIS ...... 4 A. EXECUTIVE SUMMARY ...... 1 D. STRATEGY AND OPERATIONAL PLAN BY PILLAR (2016-2020) ...... 7 B. INTRODUCTION ...... 3 PILLAR 1: LEADERSHIP AND ADVOCACY ...... 7 C. SITUATION ANALYSIS ...... 4 PILLAR 2: GOVERNANCE AND CORDINATION ...... 13 D. STRATEGY AND OPERATIONAL PLAN BY PILLAR (2016-2020) ...... 7 PILLAR 3: SERVICE DELIVERY ...... 20 PILLAR 1: LEADERSHIP AND ADVOCACY ...... 7 PILLAR 4: COMMUNICATION AND DEMAND GENERATION ...... 36 PILLAR 2: GOVERNANCE AND CORDINATION ...... 13 PILLAR 5: MONITORING AND EVALUATION ...... 44 PILLAR 3: SERVICE DELIVERY ...... 20 PILLAR 6: IMPLEMENTATION SCIENCE ...... 54 PILLAR 4: COMMUNICATION AND DEMAND GENERATION ...... 36 PILLAR 7: RESOURCE MOBILIZATION ...... 59 PILLAR 5: MONITORING AND EVALUATION ...... 44 PILLAR 8: SUSTAINABILITY AND EARLY INFANT MALE CIRCUMCISION (EIMC) .... 62 PILLAR 6: IMPLEMENTATION SCIENCE ...... 54 E. VMMC NATIONAL WORKPLAN (2016-2020) ...... 65 PILLAR 7: RESOURCE MOBILIZATION ...... 59 Appendix 1: ANNUAL VMMC TARGETS BY DISTRICT ...... 80 PILLAR 8: SUSTAINABILITY AND EARLY INFANT MALE CIRCUMCISION (EIMC) .... 62 Appendix 2: VMMC EQUIPMENT SET AND CONSUMABLE KIT CONTENTS ...... 86 E. VMMC NATIONAL WORKPLAN (2016-2020) ...... 65 Appendix 3: EIMC EQUIPMENT SET AND CONSUMABLE KIT CONTENTS ...... 88 Appendix 1: ANNUAL VMMC TARGETS BY DISTRICT ...... 80

Appendix 2: VMMC EQUIPMENT SET AND CONSUMABLE KIT CONTENTS ...... 86

Appendix 3: EIMC EQUIPMENT SET AND CONSUMABLE KIT CONTENTS ...... 88

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN i (2016-2020)

Tables

Table 1 : VMMC Objectives by Pillar ...... 6 TableTables 2 : VMMC Service Delivery Models ...... 22 TaTableble 31 :Provincial: VMMC Objectives target by yearby Pillar...... 25 6 Table 24 : VMMCDetailed Service M&E recommendations Delivery Models ...... by stakeholder and...... level of care ...... 5022 Table 35: :ProvincialImplementation target scienceby year ...... prioritization ...... 5525 Table 4 : Detailed M&E recommendations by stakeholder and level of care ...... 50 Table 5: Implementation science prioritization ...... 55

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN ii (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN ii (2016-2020)

Figures

Figure 1: Annual VMMCs required for 90% target by 2020 ...... 2 FigureFigures 2 : National Organogram for Advocacy ...... 11 FigureFigure 31: :Annual National VMMCs Level Governance required for & 90% Coordination target by 2020 structure ...... for VMMC in...... Zambia ...... 15 2 Figure 24: : ProvincialNational Organogram Level Governance for Advocacy & Coordination ...... structure ...... for VMMC in Zambia...... 1711 FigurFiguree 35 : DistrictNational Level Level Governaces Governance & & Coordination Coordination Structures structure for VMMC in Zambia ...... 1915 Figure 4:6 :Provincial 2015 VMMC Level Outputs Governance by service & Coordination delivery model structure ...... for VMMC ...... in Zambia ...... 1723 Figure 57 : District Progress Level against Governaces old targets, & settingCoordination new targets Structures (2016 -for2020) VMMC ...... in Zambia ...... 1924 Figure 68: : Provincial2015 VMMC Targets Outputs Chart by (2016 service-2020) delivery ...... model ...... 2325 Figure 79: : Deco Progressntamination against oldProcess targets, for settingDisposable new targetsVMMC (2016 Kits -...... 2020) ...... 2429 Figure 8:10: Provincial VMMC Health Targets Care Chart Waste (2016 Streams-2020) ...... 3025 Figure 9:11 Deco : Flowntamination Chart for new Process Supply for ChainDisposable Management VMMC SystemKits ...... 3429 Figure 10:12 :VMMC Seven Segments Health Care of VMMC Waste Streams Clients ...... in Zambia (VMMC...... Market Research)...... 3830 Figure 1113 : FlowDemand Chart Generation for new Supply Reccommendations Chain Management for each System Client ...... Segment ...... 3439 Figure 1214 : SevenAge proportions Segments ofof VMMCtotal VMMCs Clients ...... in Zambia (VMMC...... Market Research)...... 3842 Figure 1315 : DemandM&E challenges Generation and Reccommendationssolutions...... for each...... Client Segment ...... 3947 Figure 1416 : AgeM&E proportions Transition ofStage total I (CurrentVMMCs ...... Situation) ...... 4251 Figure 1517 : M&E challengesTransition andStage solutions II (Intermediate)...... 5247 Figure 1618 : MM&E&E Transition Stage IIII (Current (Fully transitioned, Situation) ...... well functioning)...... 5351 Figure 1719 : M&EResource Transition mobilization Stage –II Projected (Intermediate) Funding ...... gap chart ...... 5260 Figure 18 : M&E Transition Stage III (Fully transitioned, well functioning) ...... 53 Figure 19 : Resource mobilization – Projected Funding gap chart ...... 60

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN iii (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN iii (2016-2020)

FOREWORD

The Ministry of Health (MoH), in 2020, which represents 90% coverage of collaborationFOREWORD with cooperating partners, has males between the ages of 10 – 49 with a developed this operational plan to assist in focus on those between 15 – 29 years. This theThe efficient Ministry and effectiveof Health implementation (MoH), ofin is2020 in, whichline with represents the UN 90%AIDS coverage 90-90 -90of thecollaboration Voluntary with Medical cooperating Male Circumcisionpartners, has strategymales between to combatthe age s ofthe 10 –HIV/AIDS 49 with a developed(VMMC) program this operational in Zambia. plan This to programassist in pandemic.focus on those between 15 – 29 years. This thewas efficientinitiated and in effective 2007 implementationand subsequently of is in line with the UNAIDS 90-90-90 thescale Voluntaryd up in order Medical to reduce Male theCircumcision incidence strategyThe MoH to encourages combat allthe stakeholder HIV/AIDSs to (VMMC)and prevalence program of in HZambia.IV in Zambia.This program The continuepandemic. to strengthen their commitment to wasMinistry initiated hopes into continue2007 and with subsequently this effort the implementation of Zambia’s national scaleby capitalizingd up in order on lessons to reduce learnt the in incidence the past VMMCThe MoH program encourages over the all next stakeholder five yearss toas andyears prevalenceof implementation of HIV inand Zambia. leveraging The continuepart of tothe strengthen greater theireffort commitment to address to Ministryrenewed energyhopes toand continue support fromwith thispartners. effort theZambia’s implementation HIV and AIDS of Zambia’sepidemic. national byThe capitalizing goal for this on phase lessons of implementationlearnt in the past is VMMC program over the next five years as yearsto circumcise of implementation 1,985,083 million and leveragingmales by part of the greater effort to address renewed energy and support from partners. Zambia’s HIV and AIDS epidemic. The goal for this phase of implementation is to circumcise 1,985,083 million males by

Honorable Dr. Joseph Kasonde Minister of Health

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN iv (2016-2020)

ACKNOWLEDGEMENTS

The Ministry of Health wishes to recognize The program further recognizes and thanks AandCKNOWLEDGEMENTS appreciate the Voluntary Medical Male the Bill and Melinda Gates Foundation for Circumcision (VMMC) program within the their financial contribution towards the TheDirectorate Ministry of of Disease Health Surveillance, wishes to recognize Control Thedevelopment program furtherand dissemination recognizes and of thanks this and appreciateResearch, allthe theVoluntary VMMC Medical stakeholders Male thenational Bill anddocument. Melinda Gates Foundation for Circumcisionnamely all implemen (VMMC)ting program partne rs,within Clinton the the ir financial contribution towards the DirectorateHealth Access of DiseaseInitiative Surveillance, (CHAI) andControl the developmentThe implementation and dissemination of the ofVMMC this andProvincial Research Medical, all the VMMCOffices stakeholdersfor their nationaloperational document. plan will contribute to saving namelycontribution all implemen towards tingthe partnedevelopmentrs, Clinton of the lives of men in Zambia and in turn save Healththe VMMC Access operational Initiative plan. (CHAI) and the Thethe livesimplementation of all members of of thethe ZambianVMMC Provincial Medical Offices for their operationalcommunity. plan will contribute to saving contribution towards the development of the lives of men in Zambia and in turn save the VMMC operational plan. the lives of all members of the Zambian community.

Dr. Peter Mwaba

Permanent Secretary Ministry of Health Dr. Peter Mwaba Permanent Secretary Ministry of Health

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN v (2016-2020)

LIST OF CONTRIBUTORS

The MoH would like to acknowledge the following for facilitating the process of development of LISTthis operational OF plan .CONTRIBUTORS

TheMinistry MoH of would Health like (MOH) to acknowledge the following for facilitating the process of development of thisDr. Elizabethoperational Chizema plan. Director Disease Surveillance Control and Research Dr. Bushimbwa Tambatamba Deputy Director Epidemiology and Disease Control MinistryDr. James of Exnobert Health Zulu(MOH) National VMMC Coordinator Dr. ElizabethAlbert Kaonga Chizema DirectoTB/HIVr DiseaseOfficer –Surveillance Global Fund Control PMU and Research Dr. BushimbwaDaniel Makawa Tambatamba DeputyMedical DirectorSuperintendent Epidemiology - Chipata and Central Disease Hospital Control Dr. James Exnobert Zulu National VMMC Coordinator Dr.Ministry Albert of Kaonga Defense/ Defence ForceTB/HIV Medical Officer Services– Global (DFMS) Fund PMU Dr.Major Daniel Samson Makawa Tembo MedicalPrevention Super Managerintendent - Chipata Central Hospital Major Kabengele Mapona HIV Prevention Manager Ministry of Defense/Defence Force Medical Services (DFMS) CentreMajor Samson for Disease Tembo Control (CDC) Prevention Manager Dr.Major Omega Kabengele Chituwo Ma pona HIVPublic Prevention Health Spe Managercialist

Centre for InfectiousDisease Control Disease (CDC) Research in Zambia (CIDRZ) Dr.Mr. OmegaLane-Lee Chituwo Lyabola ProjectPublic HealthManager Spe cialist Dr. Stephen Besa VMMC Technical Advisor CentreMs. Christine for Infectious Matoba Disease ResearchAssistant in Zambia Project (CIDRZ) Coordinator Mr. Lane-Lee Lyabola Project Manager Dr.Churches Stephen Association Besa of Zambia (CHAZ)VMMC Technical Advisor Mr.Ms. PeterChristine Banda Matoba AssistantProgram ManagerProject Coordinator Mr. Josphat Bwembya Program Manager Churches Association of Zambia (CHAZ) Mr.Clinton Peter Health Banda Access Initiative (CHAI)Program Manager Ms.Mr. JosphatHilda Shakwelele Bwembya DeputyProgram Country Manager Director Mr. Tichakunda Mangono Program Manager ClintonMr. Trevor Health Mwamba Access Initiative (CHAI)Program Manager Ms. HildaElina MwaleShakwelele DeputyProgram Country Officer Director Mr.Ms. TichakundaJessicah Z. Shawa Mangono Program ManagerAnalyst Mr. Trevor Mwamba Program Manager Ms.FHI360/ZCPTIIB Elina Mwale Program Officer Dr.Ms. PatrickJessicah Katamoyo Z. Shawa AssociateProgram Analyst Director Technical Services Mr. Gabriel Kibombwe Senior Technical Officer FHI360/ZCPTIIB Dr. Patrick Katamoyo Associate Director Technical Services MinistryMr. Gabriel of Health, Kibombwe Zambia | VMMC NATIONALSenior Technical OPERATIONAL Officer PLAN vi (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN vi (2016-2020)

JPHIEGO Dr. Joseph Nikisi Technical Director JPHIEGODr. Jackson Okuku Technical Advisor – MC and HIV/AIDS Dr.Mr. JosephNashiol Nikisi Nyirongo SeniorTechnical Technical Director Officer Dr. Jackson Okuku Technical Advisor – MC and HIV/AIDS Mr.SCMS Nashiol - JSI Nyirongo Senior Technical Officer Mr. Chimuka Hampango Senior Public Health Logistics Advisor SCMS - JSI Mr.Society Chimuka for Family Hampango Health (SFH) Senior Public Health Logistics Advisor Dr. Albert Machinda Project Director Mr.Society Alick for Samona Family Health (SFH) Program Manager Dr. AlbertFred Chita Machindangala ProjectDirector Director Communications Mr. Alick Samona Program Manager Dr.UNAIDS Fred Chita ngala Director Communications Ms. Narmada Acharya Strategic Intervention Advisor UNAIDS USAIDMs. Nar madaDiscover Acharya Health Strategic Intervention Advisor Mr. Joshua Kashitala VMMC Advisor USAID Discover Health WorldMr. Joshua Health Kashitala Organization (WHO) VMMC Advisor Dr. Lastone Chitembo Program Officer

World Health Organization (WHO) DZAMBARTr. Lastone Chitembo Program Officer Mr. Ephraim Sakala PopART Study Intervention Manager for VMMC and TB ZAMBART Mr. Ephraim Sakala PopART Study Intervention Manager for VMMC and TB

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN vii (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN vii (2016-2020)

ACRONYMS

AE Adverse Events ACRONYMSANC Antenatal Care AEBCC AdverseBehaviour Events Change Communication ANCCBO AntenatalCommunity Care Based Organizations BCCCCDS BehaviourClinical Care Change and Diagnostic Communication Services CBOCDC CommunityCentre for Disease Based OrganizationsControl CCDSCDE ClinicalClassified Care Daily and Employee Diagnostic Services CDCCIDRZ Centre for InfectiousDisease Control Disease Research in Zambia CDECHAZ ClassiChurchesfied HealthDaily Employee Association of Zambia CIDRZCHAI CentreClinton for Health Infectious Access Disease Initiative Research in Zambia CHAZCSO ChurchesCivil Society Health Organization Association of Zambia CHAIDTC ClintonDistrict HealthTechnical Access Committees Initiative CSODHIO CivilDistrict Society Health Organization Information Officer DTCDHIS District TechnicalHealth Information Committees System DHIODJ DistrictDisc Jockey Health Information Officer DHISDMO District HealthMedical Information Officer System DJDSA DiscDaily Jockey Subsistence Allowance DMODSCR DistrictDisease MedicalSurveillance, Officer Control and Research DSADQA DailyData QualitySubsistence Audit Allowance DSCEDCR DiseaseEpidemiology Surveillance, and Disease Control Control and Research DQAEDQA DataExterna Qualityl Data Audit Quality Audits EDCeLMIS EpidemiologyElectronic Logistics and Disease Management Control Systems EDQAEMLIP ExternaEssentiall DataMedicines Quality Logistics Audits Improvement Program eLMISF&Q ElectronicForecasting Logistics and Quantification Management Systems EMLIPFP EssentialFamily Planning Medicines Logistics Improvement Program F&QGNC ForecastingGeneral Nursing and Quantification Counsel FPHCW FamilyHealth PlanningCare Worker GNCHIA GeneralHealth Informa Nursingtion Counsel Aggregation HCWHTC HealthHIV Testing Care Worker and Counselling HIAHPCZ Health InformaProfessionstion Council Aggregation of Zambia HTCHMIS HIVHealth Testing Management and Counselling Information System HPCZIEC HealthInformation Professions Education Council and ofCommunication Zambia HMISIP HealthImplementing Management Partners Information System IECIPC InformationInter-personal Education Communication and Communication IPIDQA ImplementingInternal Data Quality Partners Audits IPCIS InterImplementation-personal Communication Science IDQALMU InternaLogisticsl Data Management Quality Audits Unit ISMCDMCH ImplementationMinistry of Community Science Development Mother and Child Health MinistryLMU of Health,Logistics Zambia Management | VMMC UnitNATIONAL OPERATIONAL PLAN viii MCDMCH Ministry of Community(2016 Development-2020) Mother and Child Health Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN viii (2016-2020)

MCH Mother and Child Health MNCH Maternal, New-born and Child Health MCHMOCTA MotherMinistry and of Chiefs Child Healthand Traditio nal Affairs MNCHMOE Maternal,Ministry of New Education-born and Child Health MOCTAMOF Ministry of ChiefsFinance and Traditional Affairs MOEMoH Ministry of EducationHealth MOFM&E MinistryMonitoring of Financeand Evaluation MoHMSL MinistryMedical Storesof Health Limited M&EMTEF MonitoringMid-Term Expenditure and Evaluation Framework MSLNAC MedicalNational Stores AIDS LimitedCouncil MTEFNASF MidNational-Term AIDS Expenditure Strategic Framework Framework NACNGO NationalNon-Governmental AIDS Council Organization NASFNHC NationalNeighbourhood AIDS Strategic Health Committees Framework NGNHSPO NonNational-Governmental Health Strategic Organization Plan NHCPANC NeighbourhoodPost Antenatal Care Health Committees NHSPPEPFAR NationalPresident's Health Emergency Strategic Plan Plan for AIDS Relief PANCPHE PostPublic Antenatal Health Education Care PEPFARPMO President'sProvincial Medical Emergency Officer Plan for AIDS Relief PHEPPP PublicPublic -HealthPrivate EducationPartnership PMOPRS ProvincialPartner Reporting Medical SystemOfficer PPPQAQI PubQualitylic-Private Assurance Partnership and Quality Improvement PRSRM PartnerResource Reporting Mobilization System QAQIRMMS QualityReport forAssurance Essential and Medicines Quality Improvementand Medical Supplies RMRDQA ResourceRoutine Data Mobilization Quality Audit RMMSSBCC ReportSocial Behavioural for Essential Change Medicines Comm andunication Medical Supplies RDQASCMS RoutineSupply Chain Data ManagementQuality Audit System SBCCSMAG SocialSafe Motherhood Behavioural Action Change Groups Comm unication SCMSSRH SupplySexual andChain Reproductive Management Health System SMAGSSZ SafeSurgical Motherhood Society of Action Zambia Groups SRHSFH SexualSociety and for ReproductiveFamily Health Health SSZTaT SurgicalTurnaround Society Time of Zambia SFHTMC SocietyTraditional for FamilyMale Circumcision Health TaTTOR TurnaroundTerms Of Reference Time TMCToT TraditionalTrainer of Trainers Male Circumcision TORTSS TermsTechnical Of SupportReference Services ToTTWG TrainerTechnical of WorkingTrainers Group TSSU5 TechnicalUnder 5 Support Services TWGUSAID TechnicalUnited States Working Agency Group for International Development U5UTH UnderUniversity 5 Teaching Hospital USAIDUNAIDS United StatesNations Agency Programme for International on HIV/AIDS Development UTH University Teaching Hospital Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN UNAIDS United Nations Programme on HIV/AIDS ix (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN ix (2016-2020)

VCT Voluntary Counselling and Testing VMMC Voluntary Medical Male Circumcision

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN x (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN x (2016-2020)

A. EXECUTIVE SUMMARY A. EXECUTIVE SUMMARY In 2005 and 2006, three randomized clinical 80% among HIV-negative adult men aged 1 2 3 trials in Kenya , South Africa , and Uganda 15-49 years by 2015. This implied ambitious showedIn 2005 andthat 2006, Voluntary three randomized Medical clinicalMale 80%numerical among targets HIV of-negative 1,864,396 adult VMMCs men aged for Circumcisiontrials in Kenya (VMMC)1, South Africa can reduce2, and Ugandafemale-3 152012-49- 2015.years by 2015. This implied ambitious showedto-male sexualthat Voluntarytransmission Medical of HIV Male by numerical targets of 1,864,396 VMMCs for Circumcisionroughly 60%. In(VMMC) 2007, WHO can reduce and UNAIDS female- Although2012-2015. the program scaled up toissued-male jointsexual recommendations transmission of to HIVinclude by significantly in the first half of the roughlyVMMC 60%.as part In 2007, of comprehensiveWHO and UNAIDS HIV operationalAlthough planthe period,program it decelerated scaled in theup issuedprevention joint recommendationsand treatment toprograms include secondsignificantly half duein tothe significant first half capacity of andthe 6 VMMCespecially as inpart settings of comprehensive with high HIV fundingoperational challenges plan period, that it deceleratedled to a in30% the preventionprevalence andand low VMMCtreatment prevalen programsce. seconddecrease half in outputs due to fromsignificant 2014 tocapacity 2015. Asand a especially in settings with high HIV fundingresult, Zambiachallenges managed that ledto tocircumcise a 30%6 Asprevalence one of and the low fourteen VMMC ( 14prevalen) sub-ce.Saharan decrease1,005,424 in menoutputs out from of 20141,864,396 to 2015. du Asring a African countries selected for VMMC, result,2012-2015, Zambia thus achievingmanaged a nationalto circumcise VMMC ZambiaAs one beganof the providing fourteen VMMC (14) sub services-Saharan as 1,005,424coverage ofmen 54% out, which of 1,864,396is 26 percentage during Africana method countriesof HIV prevention selected infor 2007 VMMC,. Two points2012-2015, shy thusof theachieving 80% atarget. national This VMMC new Zambiayears later, began in providing2009, the VMMC national services VMMC as coverageoperational of plan54% for, which 2016 -is2020 26 (Thepercentage Plan) aprogram method was of HIVformally prevention launched in and2007 VMMC. Two pointswill build shy onof thethe existing80% target. momentum This new to yearswas incorporat later, in ed2009, in allthe key national national VMMC health operationalreach a new plan ambitious for 2016 -2020target (The of Plan)90% 4 programpolicy and was strategy formally documents launched and, elevating VMMC willcoverage build of on 10 -49the year existing olds, withmomentum a focus onto wasthe interventionincorporated toin aall core key nationalcomponent health of reachthe core a agenew groups ambitious of 15 -29target i.e. 1,985,083of 90% Zambia’spolicy and national strategy HIV documents prevention4, elevatingstrategy. coverageVMMCs byof 2020.10-49 year olds, with a focus on theTo guideintervention the significa to a ntcore program component scale -upof the core age groups of 15-29 i.e. 1,985,083 5 Zambia’srequired, nationalthe first HIV operational prevention plan strategy. for VMMCs by 2020. ToVMMC guide was the develope significad ntfor program the period scale 2012-up- 2015required, aiming the to first reach operational VMMC coverage plan5 forof VMMC was develope d for the period 2012- 1 Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV 2015preventi aimingon in young to men reach in Kisumu, VMMC Kenya: coverage a randomized of controlled trial. Lancet 2007;(369):643-656 2 1 Auvert B, Taljaard D, Lagarde E, et al. 2005 Randomized, controlled Bailey RC, intervention Moses S, Parker trial CB,of male et al. circumcision Male circumcision for reduction for HIV ofpreventi HIV infectionon in young risk: menThe ANRSin Kisumu, 1265 triaKenya:l. PLoS a randomizedMed 2005; controlled trial. Lancet 2007;(369):643-656 22(11): e298. doi:10.1371/journal.pmed.0020298 3 GrayAuvert RH, B, Kigozi Taljaard G, SerwaddaD, Lagarde D, E,et etal. al.Male 2005 circumcision Randomized, for HIVcontrolled prevention intervention in men trialin Rakai, of male Uganda: circumcision a randomised for reduction trial. Lancetof HIV 2007;infection (369): risk: 657 The-666 ANRS 1265 trial. PLoS Med 2005; 42(11): e298. doi:10.1371/journal.pmed.0020298 3 National Male Circumcision Strategy and Implementation Plan for Gray 2010 RH,-2020 Kigozi, National G, Serwadda AIDS Strategic D, et al. Framework Male circumcision 2011-2015, for . HIVCountry prevention Operational in men Plan in for Rakai, the Scale Uganda:-Up ofa VMMCrandomised in Zambia, trial Lancet 2007; (369): 657-666 42012-2015 5 NationalCountry MaleOperational Circumcision Plan Strategyfor the an Scaled Implementation-Up of Voluntary Plan 6 CHAI service delivery efficiency and effectiveness analysis, Medicalfor 2010 Male-2020 Circumcision, National AIDS in Zambia, Strategic 2012 Framework-2015 2011-2015, 2015 Country Operational Plan for the Scale-Up of VMMC in Zambia, Ministry2012-2015 of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 5 Country Operational Plan for the Scale-Up of Voluntary 6 CHAI service delivery efficiency and effectiveness 1analysis, Medical Male Circumcision in Zambia, 2012-2015 (2016-2020) 2015 Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 1 (2016-2020)

Figure 1: Annual VMMCs required for 90% target by 2020

500000 Figure 1: Annual VMMCs required for 90% target by 2020 430,945 450000 419,097 500000 392,829 400000 382,412 359,800 450000 430,945 350000 419,097 392,829 400000 382,412 300000 359,800 350000 250000 300000 200000 250000 150000 200000 100000 150000 50000 100000 0 50000 2016 2017 2018 2019 2020

0 These annual targets2016 represent 2017a significant 2018highlighted 2019in this plan. Centralizing2020 the

increase over current annual VMMC supply chain system will allow the program Thesevolumes, annual and targetsthus will represent require a significant tohighlight bettered incoordinate this plan. andCentralizing standardize the increase overin fundingcurrent andannual a VMMCsimilar supplycommodity chain systemprocurement will allow in thea programmulti- vaugmentationolumes, and thusin service will require delivery a significant capacity. toimplementer better coordinateenvironment andwhile standardizeleveraging increaseThis is especiallyin funding important and agiven similar the commoditythe Partner Reportingprocurement System in to strengthena multi- augmentationdecreasing international in service VMMCdelivery capacity.resource implementerthe HMIS data environment system will enablewhile leveragincomplete,g Thisenvelope is especiallyand local importanteconomic givenchallenges the theaccurate Partner and Reporting timely Systemdata tocapture strengthen for decreasingwhich affect international both global andVMMC local resourcefunding. themonitoring HMIS data and systemevaluation will (M&E)enable complete,purposes. envelopeSustained andleadership local economicand advocacy, challenges a accurateImplementation and timelyScience datawill capturecontinue forto whichstronger affect sub- nationalboth global level and management local funding. and monitoringinform the andprogram evaluation on the (M&E) most purposes.effective Sustainedcoordination leadership structure andand targeted advocacy, demand a Implementationand efficient activities. Science A detailedwill continue transition to strongergeneration sub will-national bring thelevel program management closer and to informand sustainability the program plan on will the be most developed effective by coordinationthe client while structure maintain and ingtargeted the requireddemand andend effiof cient2017 activities. to guide A detailedthe program transition in generationmomentum will and bring oversigh the tprogram at national closer level. to inteand gratingsustainability several plan aspects will be developedof VMMC by theCentralization client while and maintain integrationing the arerequired also towardsend of sustainability.2017 to guide the program in momentum and oversight at national level. integrating several aspects of VMMC Centralization and integration are also towards sustainability.

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 2 (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 2 (2016-2020)

B. INTRODUCTION SinceB. the releaseINTRODUCTION of global guidance in 2007, success of this plan is hinged on the recommending countries with generalized program’s ability to mobilize sufficient SinceHIV epidemicthe release and of low global rates guidance of circumcision in 2007, successresources of to thiscover plan the USis $85hinged million on gapthe recommendingto adopt VMMC countries as an withHIV generalizedprevention program’sover the next ability 5 years. to This mobilize will fund sufficient targeted interventionHIV epidemic, Zambiaand low rateshas ofscaled circumcision up its resourcesdemand generationto cover the and US increase$85 million service gap toVMMC adopt program VMMC significantly as an HIV. During prevention 2012- overdelivery the nextcapacity 5 years. to Thismatch will thisfund demandtargeted intervention2015 scale-up,, Zambia the program has scaledreached up more its demandscale-up. generationMonitoring and andincrease evaluation, service VMMCthan 54% program of its clients,significantly about. During 26% shy 2012 of- deliveryImplementation capacity Scienceto match will this serv demande to 2015the national scale-up, target the of program 80%. However, reached duemore to scaleidentify-up. programmaticMonitoring gapsand andevaluation, suggest thanthe time 54%-limit of itson clients,VMMC aboutas well 26 as% an shy ever of- Implementationcorresponding solutions Science to willaddress serv ethem. to thechanging national demographic target of 80% and. However, epidemiologic due to identifyAn augmented programmatic VMMC managementgaps and teamsuggest at thelandscape time-limit, VMMC on VMMC targets as arewell aas dynamic. an ever- correspondingnational and solutionssubnational to addresslevel them.will changingThus, the demographicZambia VMMC and program epidemiologic revised Ancoordinate augmented the VMMC program management and use team the at landscapethe targets, VMMCfor this Operationaltargets are aPlan dynamic. to be nationalappropriate and channels subnational for leadership level andwill Thus,aligned the with Zambia new VMMC global programguidance revised and coordinateadvocacy both the to setprogram policy andand to usemaintain the thetargets; targets specifically for this Operational UNAIDS Plan90 -90to -90be appropriateprogram visibility channels and forpriority leadership within and acampaignligned with that wasnew launched global inguidance 2015. and advocacyoutside the both MoH. to set L ongpolicy-term and sustainability to maintain targets; specifically UNAIDS 90-90-90 isprogram also a visibilitymajor consideration and priority forwithin which and a campaignWith this that plan,was launchedZambia in 2015.intends to separateoutside thetransition MoH. planLong will-term be required.sustainability circumcise 1,985,083 HIV negative males is also a major consideration for which a Withbetween this the agesplan, of 10Zambia-49, by theintends year 2020, to separateBased ontransition a robust plan willsituation be required. analysis circumcisewith a focus 1,985,083 on those HIVbetw eennegative 15-29 malesyears. presented to, and ratified by, the VMMC betweenThis way, the theages countryof 10-49, willby the reach year 2020,90% Basednational onTWG, a thisrobust plan providessituation theanalysis major withcoverage a focus rates on amongst those betw theeen most 15 -29effective years. presentedstrategies throughto, and whichratified it bywill, theachieve VMMC the Thisage groupsway, thefor country the mostwill reachimmediate, 90% objectivesnational TWG, by pillar this planand ultimatelyprovides the its majorreach coveragesignificant rates impact amongst in terms the ofmost number effective of thestrategies stated throughtargets. whichA detailed it will work achieve plan the is ageHIV infectionsgroups for averted. the Thesemost newimmediate, targets objectivesalso included by atpillar the endand ofultimately this document its reach to significantwere determined impact using in terms the Decision of number Makers of theguide stated the planningtargets. Aa nddetailed execution work of plan these is HIVPolicy infections Planning Toolaverted. v.2.1 These (DMPPT new 2.1)targets. alsostrategies included at bothat the national end of thisand document subnational to were determined using the Decision Makers guidelevel. Thethe planninglaunch of a ndthis execution plan will of inform these InPolicy order Planning to reach Tool this v.2.1 target, (DMPPT the Zambia2.1). strategiessubsequent at bothsubnational national launchesand subnational where VMMC program will implement the level.districts The and launch provinces of this will plan develop will inform their strategiesIn order tooutlined reach thisin this target, plan the through Zambia a subsequentown work planssubnational aligned tolaunches this document where VMMCcollaboration program of MoH will andimplement partners. Thethe districtsand the andattached provinces national will developwork plan.their strategies outlined in this plan through a own work plans aligned to this document collaboration of MoH and partners. The and the attached national work plan.

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 3 (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 3 (2016-2020)

C. SITUATION ANALYSIS

DespiteC. political SITUATION shifts that led to changes in ANALYSISquality assurance and proper planning and VMMC leadership and advocacy structures identification of priorities. in 2012, the program has now successfully Despitetransitioned political back shifts to MOH that led as toits changes umbrella in qualityThe program assurance currently and proper employs planning a mix and of VMMCministry. leadershipThis transition and advocacy also affected structures the identificationmethods such of aspriorities. mass-media, mid-media, ineffectiv 2012,eness the programof VMMC has nowgovernance successfully and community radio, neighbourhood health transitionedcoordination. back While to MOHthe asnational its umbrella and Thecommittees program (NHC)currently andemploys inter a- personalmix of subnationalministry. This coordination transition also structures affected theare methodscommunication such as(IPC) mass to-media, generate mid demand.-media, currentlyeffectiveness well -oforganized VMMC and governance closely linked, and communityRecent market radio, research neighbourhood approaches healthhave justcoordination. like leadershipWhile the andnational advocacy, and committeesstratified clients (NHC) based and on intertheir- personalunique governancesubnational andcoordination coordination structures was alsoare communicationcharacteristics and(IPC) path to generateto adoption demand. of impactedcurrently wellby organizational-organized and change closelys thatlinked, led VMMC.Recent marketThis plan research encourages approaches the use have of tojust changes like in leadershipMoH departmental and structureadvocacy,s thesestratified results clients to target based clients on i.e.their to informunique governancein 2012. Thu ands VMMCcoordination was underwas alsothe VMMCcharacteristics demand and generation path to and ad successfullyoption of impactedmanagement by organizationalof the Ministry change of Communitys that led VMMC.appeal to This each plan client encourages segment. the Increased use of toDevelopment, changes in MoHMother departmental and Child structure Healths thesecollaboration results toand target joint clients-funding i.e. are to needinformed in(MCDMCH) 2012. Thu fors VMMCthe durationwas under of the VMMCto close demand this gapgeneration on targeted and successfully demand managementprevious operational of the Ministry plan. The of programCommunity has appealgeneration, to each clientdissemination segment. Increasedof Development,now successfully Mother transitioned and backChild toHealth MoH collaborationcommunications and jointstrategy-funding and are needothered (MCDMCH)and there is a needfor tothe re engageduration key ofVMMC the toactivities. close this gap on targeted demand previouschampions operational, add technical plan. The programcapacity hasat generation, dissemination of nownational successfully level and transitionedfocus on funding back tocapacity MoH Forcommunications Monitoring & strategyEvaluation, and there other are and implementationthere is a need toat resubnationalengage key level. VMMC currentlyactivities. several sub-optimal processes at champions , add technical capacity at facility and district health office level that nationalFor service level and delivery,focus on fundingZambia capacity has Forresult Monitoring in discrepancies & Evaluation, between there HMIS are andcircumcised implementation close to at1.2 subnational million males level. since currently(DHIS2) severaland Pa subrtner-optimal Reporting processes System at 2007, but the exit of some partners and facility(PRS). andAn distriinitialct datahealth quality office auditlevel thatand Forfunding service uncertainties delivery, led to 30%Zambia decline has in resulttraining inexercise discrepancies reduced databetween discrepancies HMIS circumcised2015 outputs. close The to 1.2program million ismales generally since (DHIS2)from 37% andto 7% Pa inrtner one year.Reporting The programSystem 2007efficient, but given the theexit configurationof some partner of services and (PRS).is committed An initial to reducing data quality and maintainingaudit and fundingdelivery anduncertainties VMMC provider led to 30% compensation decline in trainingdiscrepancies exercise below reduced 5% datain discrepanciesthe medium 2015modalities. outputs. However, The programambitious istarge generallyts call fromterm. 37%Long to 7%term, in oneall year.stakeho Thelders program have efficientfor increase givend capacity, the configuration HR and efficiency of service; a iscommitted committed to makto reducinging the HMIS and maintaining system the deliverywell-integrated and VMMC service provider delivery compensation platform; a maindiscrepancies M&E system below for 5% VMMC in the by mediumthe end centralizedmodalities. However,supply ambitiouschain; standardized targets call ofterm. 2017. Long term, all stakeholders have for increased capacity, HR and efficiency; a committed to making the HMIS system the well-integrated service delivery platform; a main M&E system for VMMC by the end Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN centralized supply chain; standardized of 2017. 4 (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 4 (2016-2020)

Implementation Science is important for $51 million projected funding; the program continuous improvement of the program. It will need to raise enough funding to cover Implementationwill inform program Science efficiency, is important cost, andfor the$51 USmillion $85 million projected gap fundi ng; the program continuousimpact. Currently, improvement the of theprogram program. has It will need to raise enough funding to cover willconducted inform researchprogram onefficiency, Shang Ringcost, and theFinally, US $85although million EIMC gap has already been impact.PrePex withCurrently, the hope ofthe introducing program device has- introduced to Zambia, there is currently a conductedbased circumcision research in 2017.on Shang Ring and Finally,gap in althoughresource EIMCmobilization has already as well been as PrePex with the hope of introducing device- introducedservice delivery to Zambia, capacity there for is it.currently This isa basedAs mentioned circumcision before, in 2017. the Zambia VMMC gapbecause in resourceEIMC has mobilization less immediate as wellimpact as program has thus far utilized its funding servicerelative deliveryto adult capacityand adolescent for it. ThisVMMC is resourcesAs mentioned quite before, efficiently. the Zambia However, VMMC the becausehence donors’EIMC hasreluctance less immediate to fund impact it. newprogram targets has to thus 2020 far will utilized require itsa renewedfunding relativeConsequently, to adult this andcalls adolescentfor integration VMMC of resourcescommitment quite from efficiently. the both theHowever, MoH, andthe henceEIMC intodonors’ existing reluctance maternal to andfund child it. newfunding targets and toimplementing 2020 will r equirepartners a renewedin order Consequently,health services andthis acalls robust, for evidenceintegration-based of commitmentto mobilize the from resources the both required the MoH, to meet and EIMCtransition into and existingsustaina bilitymaternal plan forand VMMC child fundingtargets. Theand implementingtotal funding partnersrequired infor order the inhealth services and a robust, evidencegeneral.-based tonext mobilize five years the is resourcesUS $136 millionrequired. Withto meet US transition and sustainability plan for VMMC targets. The total funding required for the in general. next five years is US $136 million . With US

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 5 (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 5 (2016-2020)

Zambia’s VMMC Program Goal

Zambia’s“To contribute VMMC to Program the reduction Goal of HIV incidence by scaling up VMMC to reach 90% of HIV negative men between the ages of 10-49, with a focus on those between “To15-29 contribute years, by to2020.” the reduction of HIV incidence by scaling up VMMC to reach 90% of HIV negative men between the ages of 10-49, with a focus on those between VMMC15-29 years, Objec bytives 2020.” by Pillar

VMMCPILLAR Objec tives by PillarOBJECTIVE Pillar 1: Leadership & To increase and sustain program visibility and priority at both national Advocacy and subnational level and garner multi-sectoral support from key OBJECTIVE PILLAR stakeholders Pillar 2:1: LeadershipGovernance & TToo increasebuild sufficient and sustain technical program and visibility strategic and capacity priority to atcoordinate both national and &Advocacy Coordination manageand subnational a growing level VMMC and programgarner multiwith -strongsectoral linkage supports between from keythe stakeholdersnational and subnational levels Pillar 3:2: GovernanceService ToTo offerbuild asufficient comprehensive technical VMMC and strategic package capacity of service to coordinatein an efficie andnt, Delivery& Coordination effectivemanage a andgrowing increasingly VMMC programintegrated with manner strong linkagewhile sensuring between the highestnational quality and subnational of services levels Pillar 4:3: Service To offerincrease a comprehensive demand and meetVMMC the package targets offor service VMMC in inan theefficie mostnt, CommunicationDelivery & effective (core)and increasinglyage groups integratedthrough a targeted,manner whilemarket ensuring/client-based the Demand Generation approachhighest quality of services Pillar 5:4: Monitoring & To reduceincrease data demand discrepancies and meet between the targets HMIS for and VMMC PRS from in the 37% most to EvaluationCommunication & beloweffective 5% (core) and developage groups HMIS/DHIS2 through a targeted,system intomarket a self/client-sufficient,-based Demand Generation reliableapproach sources of VMMC M&E data by the end of 2017 Pillar 6:5: Monitoring & To conductreduce data operations discrepancies research between studies HMISto fill the and most PRS critical from VMMC37% to ImplementEvaluation ation informationbelow 5% and gaps develop and provide HMIS/DHIS2 implementable system recommendationsinto a self-sufficient, for Science VMMCreliable sourcespolicy and of VMMCpractice M&E data by the end of 2017 PILLARPillar 6: 7: Resource To conductmobilize operations sufficient financialresearch studiesresources to fillto coverthe most the critical programmatic VMMC MobilizationImplementation fundinginformation gap whilegaps andalso provideensuring implementableefficient and effective recommendations use of existing for Science resourcesVMMC policy and practice PillarPILLAR 8: Sustainability 7: Resource To mobilizedevelop sufficientand implement financial a resourcesrobust plan to cover for theVMMC programmatic program &Mobilization EIMC transitionfunding gap and while integration also ensuring in the sustainabilityefficient and andeffective maintenance use of existing phase, onceresources scale -up targets have been met Pillar 8: Sustainability To develop and implement a robust plan for VMMC program & EIMC transitionTable and1 : VMMC integration Objective in thes by sustainability Pillar and maintenance phase, once scale-up targets have been met

Table 1 : VMMC Objectives by Pillar

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 6 (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 6 (2016-2020)

D. STRATEGY AND OPERATIONAL PLAN BY PILLAR (2016-2020) D. STRATEGY AND OPERATIONAL PLAN BY PILLAR (2016-2020)

PILLAR 1: LEADERSHIP AND ADVOCACY

PILLAR 1: LEADERSHIP AND ADVOCACY Objective

To increase and sustain program visibility and priority at both national and subnational Objectivelevel and garner multi-sectoral support from key stakeholders

To increase and sustain program visibility and priority at both national and subnational Strategies level and garner multi-sectoral support from key stakeholders

I. Increase program visibility and priority within the health portfolio and at all levels of Strategies the health care system II. Re-engage the key actors in VMMC advocacy for the new Operational Plan (2016- I. Increase program visibility and priority within the health portfolio and at all levels of the2020) health including care system Parliament, Traditional and Religious leaders III. Prepare the program’s advocacy and leadership for any potential changes as a result II. Re-engage the key actors in VMMC advocacy for the new Operational Plan (2016- 2020)of organizational including Parliament, and political Traditional shifts and Religious leaders IV. Strategically disseminate critical information to key stakeholders within the program, III. Prepare the program’s advocacy and leadership for any potential changes as a result ofincluding organizational regular campaignsand political and shifts launch of this Operational Plan

IV. Strategically disseminate critical information to key stakeholders within the program, including regular campaigns and launch of this Operational Plan During 2012-2015, the Zambia VMMC Director of Disease Surveillance, Control

program successfully created supporting and Research (DSCR) and Deputy Director Duringstructures 2012 and-2015, conducted the Zambia activities VMMC for (EpidemiologyDirector of Disease and Disease Surveillance Control),, Control who programsustained leadershipsuccessfully and created advocacy supporting of the alland operateResearch under(DSC Rthe) and authority Deputy Directorof the structuresprogram, ledand by theconducted Ministry ofactivities Health, withfor (EpidemiologyPermanent Secretary, and Disease and the Control), Minister who of sustainedthe participation leadership of governmentand advocacy and of civilthe allHealth. operate Outside under of thethe MoH,authority prioritization of the program,society stakeholders. led by the Ministry The VMMC of Health, program with Permanentof VMMC inSecretary, Parliament and and the the Minister activity of theenjoyed participation high visibility of government and engagement and civil theHealth. inter Outside-ministerial of thecommi MoH,ttee prioritization on HIV of societywithin thestakeholders. MoH at nationalThe VMMC level programthrough theof VMMC NAC havein Parliament elevated andthe theprogram. activity Atof enjtheoyed placement high visibilityof the VMMCand engagement National subthe -international-ministerial (Province) commi level,ttee leadership on HIV and of withinCoordinator the MoH as the at national levelfocal throughperson. theadvocacy NAC haveis ledelevated by thethe program.Provincial At theThe coordinatorplacement ofis underthe theVMMC supervision National of subCoordinators-national (Province) and/or focal level, personsleadership under and CoordinatorMinistry of Health, as the Zam nationalbia | VMMCfocal person NATIONAL. advocacyOPERATIONAL is led PLAN by the Provincial7 The coordinator is under the supervision(2016 of-2020) Coordinators and/or focal persons under Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 7 (2016-2020)

the direction of the Provincial Medical I. Increase program visibility and Officer (PMO) while local (district and priority within the health portfolio facility) leadership and advocacy falls under and at all levels of the health care the direction of the Provincial Medical I. Increase program visibility and theOfficer facility (PMO) in-charge while and localfocal (districtpersons withand systempriority within the health portfolio factheility) supervision leadership of and the advocacy District fall Medicals under and at all levels of the health care theofficer facility (DMO). in-charge At and thisfocal personslocal levelwith, Advocacysystem efforts for VMMC will identify community groups with influential social the supervision of the District Medical and engage individuals at the national, standing such as traditional/religious officer (DMO). At this local level, Advocacyprovincial, effortsdistrict, for and VMMC community will identify levels. leaders, VMMC Champions and community groups with influential social andThese engage efforts willindividuals include stakeholdersat the national, from neighbourhood health committees are also a standing such as traditional/religious provincial,the highest levelsdistrict, of andnational community government levels. to critical component of the advocacy strategy leaders, VMMC Champions and Thesetraditional, efforts community will include and stakeholders religious leaders. from and should be continually engaged. neighbourhood health committees are also a theWhile highest each levelsstakeholder of national group government will play toa critical component of the advocacy strategy traditional,different role, community the advocacy and religious and outreach leaders. However, there were three major challenges and should be continually engaged. Whileefforts eachof all stakeholderwill be important group forwill national play a that slowed down the leadership and differentVMMC scale role,-up the. advocacy and outreach advocacy component during the period of However, there were three major challenges efforts of all will be important for national the previous operational plan (2012-2015). that slowed down the leadership and VMMCTo improve scale-up .and strengthen political These were: (i) the switch in ministries advocacy component during the period of leadership, Programme Coordinators have which moved VMMC from MoH to the previous operational plan (2012-2015). Tbeeno improveidentified atand national, strengthen provincial political and MCDMCH in 2012; (ii) the attrition and These were: (i) the switch in ministries leadership,district levels Programme with focal Coordinatorspersons at facility have changes in the role of VMMC national which moved VMMC from MoH to beenlevel. identified The MoH at national,will be responsibleprovincial andfor coordinator (the program has seen a total of MCDMCH in 2012; (ii) the attrition and districtleading levelsand drivingwith focal the persons VMMC at agendafacility five coordinators to date) and (iii) the delay changes in the role of VMMC national forwardlevel. Thethroug MoHh thesewill be cadres responsible and thefor in replacing the VMMC coordinator which coordinator (the program has seen a total of strategiesleading and outlined driving in this the plan VMMC. agenda led to a 6-month leadership gap in the first five coordinators to date) and (iii) the delay forward through these cadres and the half of 2015. In order to address these three National level in replacing the VMMC coordinator which strategies outlined in this plan. issues while building on the existing led to a 6-month leadership gap in the first At the national level, VMMC champions structures and the previous plan’s success in half of 2015. In order to address these three willNational be identified level from within the broader leadershipissues while and buildingadvocacy, on thisthe planexisting will community,At the national including level, political,VMMC championstraditional structuresincrease current and the visibilityprevious plan’sand priority success ofin willand bereligious identified leaders, from andwithin other the broaderpopular leadershipVMMC, re -aengagend advocacy, key actors, this takeplan prewill- community,(male and female) including community political, figures traditional such increaseemptive measurescurrent visibility to sustain and the priority program of as musicians, fashion models, sports through political and organizational changes and religious leaders, and other popular VMMC, re-engage key actors, take pre- personalities and radio disc jockeys (DJs). and strategically disseminate important (male and female) community figures such emptive measures to sustain the program asThese musicians, VMMC championsfashion willmodels, commit sports to a throughinformation. political and organizational changes personalitiesminimum numberand radio of disc national jockeys media(DJs). and strategically disseminate important Theseappearances, VMMC as champions well as a minimum will commit number to a information. 7 minimumof community number appearances of national each mediayear .

appearances, as well as a minimum number 7 of7 community appearances each year . The National Male Circumcision communication strategy 2012 includes detailed strategies on messaging and key themes on

Ministry of Health, Zambia | VMMC NATIONAL 7OPERATIONAL PLAN The National Male Circumcision communication strategy8 2012 (2016-2020) includes detailed strategies on messaging and key themes on Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 8 (2016-2020)

Furthermore, to ensure that VMMC has the VMMC with both males and females. cross-cutting support necessary for wide- Information on VMMC will flow through Fuscalerthermore, roll-out, tocollaboration ensure that VMMCwill be hassought the VnormalMMC MoHwith channelsboth males for andhealth females.-related crossbetween-cutting the MoHsupport and necessaryother line ministries,for wide- Informationinformation onmaterials, VMMC willand flow will through be scaleas well roll as- out,across collaboration branches of willthe MoHbe sought (e.g., normaldisseminated MoH by channels PMOs throughfor health DMOs-related to betweenMaternal theand MoH Child and Health other line(MCH)). ministries, The theinfo rmationfacility level.materials, Each district and willwill appoint be asVMMC well as agenda across shouldbranches be of highlighted the MoH (e.g.,and andisseminated individual by PMOsto coordinate through DMOsVMMC to Maternalprioritized and by theChild existing Health inter (MCH)).-ministerial The thecommunication facility level. efforts; Each districtthis individual will appoint will VMMCcommittee agenda on HIV should of thebe highlightedNational AIDS and anadvocate individual for theto acceptancecoordinate ofVMMC the prioritizedCouncil (NAC), by the whichexisting will inter serve-ministerial as a communicationcomprehensive efforts;VMMC this service individual am ongwill committeeplatform for on advocacy. HIV of the National AIDS advocatechiefs, local for headmen,the acceptance key community of the Council (NAC), which will serve as a comprehensiveopinion leaders, andVMMC key communityservice am basedong organizations (CBOs), including women’s Provincialplatform for and advocacy. District levels chiefs, local headmen, key community opiniongroups. Thisleaders, person and willkey becommunity responsible based for The Provincial and District Medical Officers organizationsidentifying, engaging (CBOs), and including coordinating women’s the Provincialwill provide and leadership District levelsfor the VMMC groups.efforts of This community person will groups. be responsible At the district for level, advocacy will be largely grassroots; Theprogram Provincial at the andprovincial District and Medical district Officers levels identifying, engaging and coordinating the much of the information to be disseminated wirespectively.ll provide Advocacyleadership activitiesfor the willVMMC feed efforts of community groups. At the district will also flow through the existing health programinto those at that the occurprovincial or already and district exist at levels both level, advocacy will be largely grassroots; committees. Emphasis will be placed on respectively.levels. Provincial Advocacy Medical activities Officers will(PMOs) feed much of the information to be disseminated generating community-owned leadership in intowill thosedistribute that occur information or already existto at bothkey will also flow through the existing health driving a gender-sensitive VMMC agenda. levels.constituencies Provincial and Medical ensure thatOfficers VMMC (PMOs) a key committees. Emphasis will be placed on willcomponent distribute of the overallinformation health programto key in generating community-owned leadership in In addition to playing a leadership and consttheir ituenciesdistricts. andThis ensure entails that emphasizing VMMC a keythe driving a gender-sensitive VMMC agenda. advocacy role within the country, Zambia’s componentintegration ofwith the overallother healthhealth program services in VMMC decision-makers will also advocate theirincluding districts. those This that entails reach emphasizing women (e.g.the In addition to playing a leadership and for VMMC scale-up at the global level, by integrationMCH, Cervical with Cancer other Screening). health services advocacy role within the country, Zambia’s disseminating evidence based publications at including those that reach women (e.g. VMMC decision-makers will also advocate key conferences. MCH,This plan Cervical will alsCancero be officiallyScreening). launched in for VMMC scale-up at the global level, by each of Zambia’s provinces; guidance for disseminating evidence based publications at launch dates and program content will be key conferences. This plan will also be officially launched in II. Re-engage the key actors in VMMC provided at the national level. VMMC each of Zambia’s provinces; guidance for advocacy for the new Operational advocates will participate in provincial launch dates and program content will be Plan (2016-2020) including II. Re-engage the key actors in VMMC providedplanning meetingsat the nationalas well aslevel. the VMMClaunch. Parliament,advocacy for Traditional the new Operational and advocatesSensitization will workshops participate wit h inkey provincial ReligiousPlan (2016 leaders-2020) including planningopinion leaders meetings will asbe held.well Taswo the provincial launch. Parliament, Traditional and Sensitizationand two district workshops health wit hpromoters key provincial will To complementReligious leaders structures within the MoH, opinionundergo leaderstraining will on be communicating held. Two provincial about the VMMC program will also re-engage key and two district health promoters will advocates such as the President’s office as VMMC. These will also be included in the upcoming VMMC To complement structures within the MoH, undergo training on communicating about Communication strategy that will replace it. the VMMC program will also re-engage key Ministry of Health, Zam bia | VMMC NATIONAL advocatesOPERATIONAL such as PLANthe President’s office as VMMC. These will also be included in the upcoming VMMC 9 Communication strategy that will replace it. (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 9 (2016-2020)

and when appropriate (through the MoH advocacy requires the participation of the Permanent Secretary and Minister’s offices). legislature. Non-profits, NGOs, traditional, andCabinet when (other appropriate line ministries(through thesuch MoH as advocacylocal government requires andthe religiousparticipation leaders of willthe PermanentMinistry of SecretaryChiefs and and Traditional Minister’s offices).Healers lbeegislature. equipped Non with-profits, targeted NGOs, information traditional, for CabinetAssociation (other (MOCTA), line ministries Ministry such ofas theirlocal governmentfollowers, and religiousconstituents leaders andwill MinistryEducation of (MOE) Chiefs andand MinistryTraditional of FinanceHealers congregants.be equipped with targeted information for Association(MOF) will be(MOCTA), engaged for Ministrycollaborative of their followers, constituents and Educationadvocacy on(MOE) demand and Ministrygeneration of, Financeservice congregants.The momentum with traditional leaders and delivery(MOF) andwill funding,be engaged respectively. for collaborative It will be chiefs on advocacy and demand generation criticaladvocacy that on representativesdemand generation from, servicethese hasThe momentumdampened withsince traditional2012. The leaders VMMC and deliveryministries and are funding, present respectively. at all high It willprofile be Communicationschiefs on advocacy TWG and willdemand engage generation and plan criticalVMMC thatevents, representatives including campaigns. from theseThe jointhas dampenedadvocacy sinceevents 2012 with. The MOCTAVMMC ministriesParliamentary are Committeepresent at onall Health high willprofile be Communications(Ministry of Chiefs TWG and willTradit engageional and Affairs) plan VMMCapprised events,of all important including VMMCcampaigns. activities, The jointto get advocacybuy-in andevents political with goodwill MOCTA to Parliamentaryespecially where Committee policy on changesHealth will and be (Ministryrevitalize thisof Chiefs relationship and Tradit. ional Affairs) apprised of all important VMMC activities, to get buy-in and political goodwill to especially where policy changes and revitalize this relationship.

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 10 (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 10 (2016-2020)

Figure 2 : National Organogram for Advocacy

Figure 2 : National Organogram for Advocacy Highest level of advocacy President

Highest level of advocacy President

Active involvement of MOH and other line Cabinet ministries (MOF, MOE, MOCTA); Participation in campaign launches. Active involvement of MOH and other line Cabinet ministries (MOF, MOE, MOCTA); Participation in campaign launches. Parliamentary Advocacy for policy change through parliament Committee on where necessary Health Parliamentary Advocacy for policy change through parliament Committee on where necessary Health

NGOs and MPs & Traditional Religious CSOs leaders Councillors Leaders

NGOs and MPs & Traditional Religious CSOs leaders Local and International ReachCouncillors out to constituents Reach outLeaders to constituents Reach out to followers advocacy

Local and International ReachFurthermore, out to constituents attrition Reachof outthe to followersVMMC III. Prepare the program’sReach advocacy out to constituents and advocacy National Coordinator post during the 3 leadership for any potential changes years of the Operational Plan (2012-2015) as a result of organizational and Furthermore, attrition of the VMMC III. Prepare the program’s advocacy and presented challenges to advocacy in the political shifts National Coordinator post during the 3 leadership for any potential changes yearsform ofof nascentthe Operational relationships Plan and (2012 inevitable-2015)

as a result of organizational and presentedloss of challengesinstitutional to knowledge.advocacy in Thethe In 2012, unforeseen organizational changes political shifts formprogram of nascentalso had relationships to operate and without inevitable a resulted in the VMMC program falling lossnational of coordinatorinstitutional for knowledge.the first half The of under MCDMCH, a new line ministry that In 2012, unforeseen organizational changes program2015 which also further had slowedto operate down without advocacy a was created then. This had a significant resulted in the VMMC program falling nationalefforts and coordinator program scalefor -theup. However,first half byof impact on the leadership and advocacy, under MCDMCH, a new line ministry that 2015the end which of 2015,further VMMC slowed and down other advocacy health particularly at national level where it was created then. This had a significant effortsprograms and transitionedprogram scale from-up. However,MCDMCH by necessitated the re-engagement of leadership impact on the leadership and advocacy, theback end to oMoH,f 2015, aVMMC welcome and moveother healthwhich on VMMC priorities and the sudden particularly at national level where it programsrevamped transitionedfamiliar relationshipsfrom MCDMCH and changes in reporting structures slowed necessitated the re-engagement of leadership backorganizational to MoH, systems a welcome for continued move MOHwhich down some administrative processes. on VMMC priorities and the sudden revampedand partner collaborationfamiliar relationships on VMMC. and changes in reporting structures slowed Ministry of Health, Zambia | VMMC NATIONAL organizationalOPERATIONAL systems PLAN for continued 11MOH down some administrative processes(2016-.2020) and partner collaboration on VMMC. Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 11 (2016-2020)

plan will enable the widest coverage of the Political and organizational changes have a message and access to the document by as huge impact on leadership and advocacy, planmany will key enable audienc thees widest and coveragestakeholders of theas Politicalthus the andprogram organizational should changestake any have steps a messagepossible. andThis accessis crucial to forthe nationaldocument, regional by as hrequireduge impact to prepareon leadership for eventualities and advocacy, and manyand international key audienc advocacy.es and stakeholders as thusunforeseen the program disruptions should that maytake comeany stepswith possible. This is crucial for national, regional required2016 general to prepareelections for and eventualities other political and andThe internationalofficial launch advocacy. of national VMMC unforeseenevents. This disruptions includes thatstrengthening may come withthe guidance documents will be planned and 2016TWG general(and electionsimplementing and other politicalpartner Theattended official by keylaunch stakeholders of national and high VMMC-level events.participation) This asincludes an independent strengthening body thatthe guidanceopinion leaders. documents A VMMC will beadvocacy planned toolkit and TWGwill be able(and to sustainimplementing its activity partnerdespite attendedcontaining by keyinformational stakeholders materials,and high- levelto participation)political and MoHas an organizationalindependent body changes that. opinionsupport leaders.the dissemination A VMMC advocacy of targeted, toolkit willThe beprogram able to shouldsustain alsoits activitybe ready despite to containingaudience-appropriate informational VMMC materials,messages willto politicalconduct refresherand MoH activity organizational and re-engage changes all. supporbe developedt the disseminationand distributed. of Materialstargeted, Thethe governingprogram bodiesshould thatalso are be relevant ready forto audiencetailored specifically-appropriate for VMMC female audiencesmessages will conductadvocacy refresher after these activity changes and occur. re-engage all be includeddeveloped in theand advocacy distributed. toolkit Materials in order the governing bodies that are relevant for tailoredto address specifically the role forwomen femal playe audiences in demand will generation (i.e., in infant, adolescent and IV.advocacy Strategically after these disseminate changes occur. critical be included in the advocacy toolkit in order toadult address VMMC the decision role women-making), play and in demandbecause information to key stakeholders it is vital that women themselves accurately within the program, including regular generation (i.e., in infant, adolescent and IV. Strategically disseminate critical adultunderstand VMMC the decision benefits-making), of VMMC and becauseand its campaignsinformation and to key launch stakeholders of this partial effectiveness for men. National-level Operational Plan it is vital that women themselves accurately within the program, including regular uadvocacynderstand meetings the benefits designed of VMMC to inform and and its

campaigns and launch of this partialsensitize effectiveness key opinion for leaders men. Nationalwill be -levelheld The development and dissemination of this Operational Plan advocacyincluding membersmeetings designedof parliament, to inform members and new Operational Plan (2016-2020) is also a sensitizeof underlying key opinionministries, leaders traditional will beleaders, held major tool for leadership and advocacy since The development and dissemination of this includingwomen’s membersgroups, ofrelig parliament,ious leaders, members and the strategies in this document are designed new Operational Plan (2016-2020) is also a ofbusiness underlying leaders. ministries, Advocacy traditional efforts directedleaders, to outlive any one partner, organization or major tool for leadership and advocacy since women’sat national groups,media, includingreligious headsleaders, of newsand employee. Thus, a national launch of this the strategies in this document are designed businessmedia agencies, leaders. will Advocacy be prioritized. efforts directed to outlive any one partner, organization or at national media, including heads of news employee. Thus, a national launch of this media agencies, will be prioritized.

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 12 (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 12 (2016-2020)

PILLAR 2: GOVERNANCE AND CORDINATION

PILLARObjective 2: GOVERNANCE AND CORDINATION To build sufficient technical and strategic capacity to coordinate and manage a growing ObjectiveVMMC program with strong linkages between the national and subnational levels

To build sufficient technical and strategic capacity to coordinate and manage a growing Strategies VMMC program with strong linkages between the national and subnational levels

I. Increase technical capacity at national level and improve the TWG to enable quick Strategies decision-making and resolution of existing and future VMMC policy discrepancies II. Support the provincial level through secondment, joint-planning and direct budget I. Increase technical capacity at national level and improve the TWG to enable quick decisionsupport -formaking VMMC and activities resolution depending of existing on and the futureprovincial VMMC needs policy discrepancies III. Revamp the District Technical Committees to enable routine program management II. Support the provincial level through secondment, joint-planning and direct budget supportand partner for VMMCcollaboration activities at this depending level on the provincial needs

III. Revamp the District Technical Committees to enable routine program management and partner collaboration at this level national coordinator for the first half of Governance and coordination is necessary 2015 had adverse consequences for

for planning, monitoring of progress and governancenational coordinator and coordination. for the However,first half thisof Governanceexecution of andprogrammatic coordination decisions is necessary that deci2015sion had was reversedadverse atconsequences the end of 2015,for forensure planning, efficient monito andring effective of progress resources and andgovernance the VMMC and coordination. program However,is now fully this executionutilization ofto programmaticmeet the national decisions targets. that transitioneddecision was backreversed to MoH.at the endIn orderof 2015, to ensureGovernance efficient and coordinationand effective at resourcesnational, functionand the well,VMMC this programnew governance is now fullyand utilizationprovincial andto meetdistrict the level national is not targets. only coordinationtransitioned backstructure to MoH. needs In sufficientorder to Governanceinstrumental andin achieving coordination the targetsat national,, but capacityfunction andwell, technical this newskill atgovernance all the levels and of provincialso in alensuring and district accountability. level is notLike onlythe care,coordination and it must structure be integrated needs into sufficient existing instrumentalprevious plan, in implementationachieving the targetsof VMMC, but governmentcapacity and technicalstructures skill withat all theinput levels and of alsowill continuein ensuring to be accountability. closely aligned Likewith the supportcare, and fromit must implementing be integrated andinto fundingexisting previousexisting MoH plan, structures implementation so as to of encourage VMMC partnersgovernment through structures effective with decision input-making and willan integratedcontinue toapproach be closely to aligned public with health. the bodiessupport such from as theimplementing TWG. The TWGand funding in turn existingThis will MoH boost structures ownership so as toand encourage ensure requirespartners clearthrough Terms effective of Reference decision so-making as to programan integrated continuity approach beyond to publicimplementing health. bebodies responsive such as the andTWG. readyThe TWG to inmake turn partnerThis will support. boost ownership and ensure programmaticrequires clear Termsand strategic of Reference decisions so asand to program continuity beyond implementing recommendations.be responsive and ready to make Thepartner sudden support. transition of VMMC to programmatic and strategic decisions and MCDMCH in 2012 and the absence of a recommendations. The sudden transition of VMMC to Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 13 MCDMCH in 2012 and the absence(2016 of -a2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 13 (2016-2020)

I. Increase technical capacity at demand generation (VMMC national level and improve the TWG Communications Strategy, Market- to enable quick decision-making and monitoring etc.); and program I. Increase technical capacity at demand generation (VMMC resolutionnational level of existing and improve and future the TWG Communicationsadministrative dutiesStrategy. The, NationalMarket- toVMMC enable policy quick discrepancies decision-making and monitoringCoordinator willetc.); provide and technical program and resolution of existing and future administrativetactical leadership duties to the. nationalThe teamNational and Strengthening national level capacity VMMC policy discrepancies Coordithe TWG,nator whilewill servingprovide as technicalthe program and The priority at the national level will be to tacticalfocal personleadership linking to the thenational national team and subnational levels. The Director (DSCR) strengthenStrengthening coordination, national levelreorganiz capacitye service the TWG, while serving as the program and Deputy Director (Epidemiology and Thedelivery, priority and atimprove the national the managementlevel will be ofto focal person linking the national and subnationalDisease Control level) s.will The co ntinueDirector to (provideDSCR) strengthenthe national coordination, program inreorganiz line withe service this andpolitical Deputy, strategic Director and(Epidemiology administrative and odelivery,perational and plan. improve the management of Diseaseleadership. Control Any ) matterswill co ntinuerequiring to providepolicy the national program in line with this politicalchanges, andstrategic official communicationand administrative will go Atoperational the national plan. level, the core technical team leadership.through the PermanentAny matters Secretary requiring, and allpolicy the will consist of the National VMMC Coordinator, a Monitoring and Evaluation changesway up to and the official Minister communication if required. will go At the national level, the core technical team (M&E) Officer and a VMMC Program through the Permanent Secretary, and all the will consist of the National VMMC Major activities for the national team will Coordinator,Officer. This teama Monitoring will report and to theEvaluation Deputy way up to the Minister if required. include supporting provincial teams in (M&E)Director Officer(Epidemiology and a VMMC and ProgramDisease Majorimplementing activities this for theoperational nationa l planteam andwill OfficerControl). Thiswho teamin turn will reports report to to the the Director Deputy includealigning partnersupporting support provincial to new teams national in DirectorDisease Surveillance(Epidemiology, Control andand ResearchDisease implementingVMMC strategy this and targets.operational The MoHplan teamand Control)(DS-CR). who The in M&Eturn reports Officer to willthe Directorprovide aligningwill collect partner and support analyze to financialnew national and Diseasesupport Surveillanceto all provinces, Control andand Researchwill be responsible for supporting data collection, VMMCprogram strategy performance and targets. data The to MoH monitor team (DS-CR). The M&E Officer will provide progress towards targets, identify analysis and management while the Program will collect and analyze financial and support to all provinces and will be implementation challenges and reprogram responsibleOfficer will befor responsiblesupporting fordata coordination collection, program performance data to monitor activitiesprogress tot owardsaddress targets,these challenges.identify analysisof specific and management implementation while the Programactivities implementationCoordination at challengesnational level and willreprogram set the Officerspanning will both be serviceresponsible delivery for coordination(human and activitiespace at whichto addressdistricts andthese provinces challenges. will ofinfrastructural specific capacity,implementation training schedulesactivities Coordinationimplement at nationalVMMC level willactivities. set the spaandnning any other both adservice-hoc supplydelivery concerns (human etc. and); pace at which districts and provinces will infrastructural capacity, training schedules implement VMMC activities. and any other ad-hoc supply concerns etc.);

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 14 (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 14 (2016-2020)

Figure 3 : National Level Governance & Coordination structure for VMMC in Zambia

Figure 3 : National Level Governance & Coordination structure for VMMC in Zambia Hon. Minister of Health

Hon. Minister of Health

Permanent Secretary

Director Director Director Planning & Director HR Director TSS DSCR CCDS DevelopmentDirector Director Director Planning & Director HR Director TSS DSCR CCDS Development Deputy Director Epidemiology and Disease Control Deputy Director Epidemiology and Disease Control

National National VMMC Coordinator VMMC NationalTWG National VMMC Coordinator VMMC TWG

Funding and Demand & Implementing NAC Service Delivery M&E Officer FundingPartners and DemandOfficer & Implementing NAC Service Delivery M&E Officer Partners Officer

Streamlining the (Technical Working the national VMMC Technical Working

Group) TWG mandate and activities Group (TWG). Streamlining the (Technical Working the national VMMC Technical Working

Group) TWG mandate and activities Group (TWG). The VMMC National Coordinator will Partner organizations will engage in VMMC assume day-to-day administrative functions programming through the national TWG, The VMMC National Coordinator will Partner organizations will engage in VMMC related to VMMC programming in Zambia, which will be called and chaired by the assume day-to-day administrative functions programming through the national TWG, executing decisions on behalf of the MoH. Department of Disease Surveillance, related to VMMC programming in Zambia, which will be called and chaired by the All major decisions regarding VMMC will Research and Control. The national TWG executing decisions on behalf of the MoH. Department of Disease Surveillance, be made by the MoH in consultation with will comprise of four sub-committees: (i) All major decisions regarding VMMC will Research and Control. The national TWG be made by the MoH in consultation with will comprise of four sub-committees: (i) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 15 (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 15 (2016-2020)

Funding & Resource Mobilization; (ii) M&E meeting of each year will discuss progress and Research (iii) Service Delivery, Quality towards program objectives set in the FundingAssurance & Resource& MobilTraization;ining; (ii) M&Eand meetingprevious ofyear, each set/confirm year will discuss annual progresstargets, and(iv)Communication Research (iii) Service and Delivery, Demand Quality towardsnew objectives program and objectives develop seta nationalin the AssuranceGeneration. These& subcommitteesTraining; andwill pworkplanrevious year,(aligned set/confirm to the Operational annual targets, Plan (ivdeliberate)Communication on technical andaspects, Demandprovide new2016 -2020)objectives to guideand developthe program. a national Any Generguidanceation. and Thesemake recommendationssubcommittees willon workplanrevisions to(aligned TWG structureto the Operational and ToRs mustPlan deliberatethe scale -upon oftechnical VMMC aspects, services, provide thus 2016be finalized-2020) into monthlyguide theTWG program. meetings Anyand guidanceinforming andthe mainmake TWG’s recommendations decision-making on revisionsapproved toby TWG Sen iorstructure MoH andleadership. ToRs must As theprocess. scale -up of VMMC services, thus beTWG finalized Chair, in themonthly MOH TWG makes meetings the finaland inform ing the main TWG’s decision-making approveddecisions andby Senensuresior MoHclear documentationleadership. As process.All major VMMC decisions will be made by TWGand prompt Chair, communicationthe MOH makes of resolutions the final the MoH in consultation with the national decisionsto all stakeholders and ensures andclear senior documentation ministry AllVMMC major Technical VMMC decisionsWorking willGroup be made(TWG). by andofficials prompt at both communication national and of sub resolutions-national theThe MoHMoH inshall consultation be the chair with for the the national TWG, tolevel all as appropriate.stakeholders and senior ministry VMMCwhile (Clinton Technical Health Working Access Group Initiative(TWG). officials at both national and sub-national The(CHAI) MoH willshall bebe thethe chair secretariat. for the TWG,The levelFinally, as appropriate.to allow smooth scale-up of VMMC whilemembership (Clinton for theHealth TWG Access will comprise Initiative all services, the program must revise national (CHAI)key VMMC will partners be andthe stakeholders.secretariat. The policiesFinally, toand allow directives smooth scaleto -upaddress of VMMC the membership for the TWG will comprise all services,following thediscrepancies: program must revise national keyAlthough VMMC the partners TWG andmembership stakeholders. was very policies(i) Lackand of directivestransparency to and/oraddress formal the active during 2012-2015, it needs to be followingdocumentation discrepancies: for allocation of augmented in terms of the organizational sites/districts Although the TWG membership was very (i) Lack of transparency and/or formal diversity while streamlining the actual active during 2012-2015, it needs to be (ii) documentationThe difference infor the ageallocation of cons entof representatives in attendance from these augmented in terms of the organizational sites/districtsfor HIV testing (16+) and that for organizations. In addition to existing TWG VMMC procedure (18+). diversity while streamlining the actual (ii) The difference in the age of consent members, the TWG will also include representatives in attendance from these forEventually, HIV testing these (16+) two and thatpolicies for Surgical Society of Zambia (SSZ), other organizations. In addition to existing TWG VMMCshould be harmonizedprocedure (18+). private sector medical/health organizations, members, the TWG will also include (iii) Eventually,Out-dated HIV/AIDSthese two workplacepolicies MoH cadres with VMMC institutional Surgical Society of Zambia (SSZ), other shouldpolicies be whichharmonized do not include memory (e.g. previous coordinators), Health private sector medical/health organizations, (iii) OutVMMC-dated HIV/AIDS workplace Professions Council of Zambia (HPCZ), MoH cadres with VMMC institutional policies which do not include and MSL to lead the logistics and supply memory (e.g. previous coordinators), Health VMMC Professionschain discussion. Council of Zambia (HPCZ), and MSL to lead the logistics and supply Effective January 2016, the TWG will chain discussion. develop a fixed monthly schedule for TWG Effectivemeetings atJanuary the beginning 2016, ofthe each TW year,G andwill developany ad-hoc a fixed meetings monthly will schedule be announced for TWG at meetingsleast 2 weeks at the in beginning advance. of The each first year, TWG and any ad-hoc meetings will be announced at Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN least 2 weeks in advance. The first TWG 16 (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 16 (2016-2020)

II. Support the provincial level through S/he will coordinate the planning and secondment, joint-planning and implementation scale-up at the province, direct budget support for VMMC providing technical supervision to districts II. Support the provincial level through S/he will coordinate the planning and activitiessecondment, depending joint-planning on the and implementationwithin their respectivescale-up atprovinces the province, and directprovincial budg needset support for VMMC providingcarrying out technical other duties supervision as outlined to districts in the activities depending on the withinterms oftheir refer ence.respective Implementing provinces partners and Provincial level provincial needs carryingwill align out targets other to dutiesthe MoH as outlined provincial in andthe At the provincial level, the PMO oversees tedistrictrms of targets refer ence.within Implementingthis plan and willpartners liaise with the PMO through regular provincial theProvincial program level while the provincial VMMC will align targets to the MoH provincial and stakeholder meeting/forum and will be Atcoordinator the provincial provides level, hands the- onPMO coordination oversees district targets within this plan and will liaise withaccountable the PMO to throughthe PMO regular for anyprovincial issues theand programserves as whilethe link the between provincial the nationalVMMC stakeholderneeding meeting/forum andresolutio will ben. coordinatorand the district provides coordination hands-on coordination structures. accountable to the PMO for any issues and serves as the link between the national needing resolution. and the district coordination structures. Figure 4: Provincial Level Governance & Coordination structure for VMMC in Zambia

Figure 4: Provincial Level Governance & Coordination structure for VMMC in Zambia Provincial Medical Officer Provincial Medical National VMMC Officer Coordinator National VMMC Clinical Care Specialist Coordinator

Clinical Care Specialist

Provincial VMMC Coordinator/ Focal person Provincial VMMC Coordinator/ Focal person

District focal District focal person person District focal District focal person person

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 17 (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 17 (2016-2020)

The situation analysis8 revealed that, as structure has been working well but there is planned for in the previous Operational an urgent need to revamp the District ThePlan, situationall provinces analysis have8 revealed a focal that,person as structureTechnical has Committees been working to wellensure but thatthere allis plannedtaking on for the in rolethe opreviousf provincial Operational VMMC partnersan urgent are needaligned to torevamp MoH districtthe District level Coordinator.Plan, all provinces However, have the aamount focal ofperson time targetsTechnical in liaisonCommittees with the to DMOensure as thatwell allas dedicatedtaking on theto VMMCrole of provincialdepends onVMMC the partnersensure dataare alignedreview toand MoH monitoring district level of provincialCoordinator. However,needs. While,the amount Northern, of time targetsprogress in liaisonat this with levelthe .DMO All aspartners well as Muchinga,dedicated Luapulato VMMC and Easterndepends Provinceson the ensureimplementing data reviewVMMC and activities monitoring will beof provincialhave full timeneeds. dedicated While, Provincial Northern, MC progressaccountable at to thisthe DMOlevel . andAll will partnersactively Muchinga,Coordinators, Luapula Central, and Lusaka, Eastern Southern Provinces and implementingparticipate in VMMCthe districtactivities technicalwill be haveWester fulln havetime delegateddedicated ProvincialProvincial MC accountablecommittee meeting.to the DMO The districtand will technical actively Coordinators,Coordinators withCentral, dual Lusaka, roles within Southern HIV. and In pcommitteearticipate willin reportthe to thedistrict DMO technicalfor final WesterCopperbeltn have and delegatedNorth-Western Provincial provinces, MC committeedecisions on meeting. implementation The district and thetechnical DMO Coordinatorsthe Clinical Care with dualSpecialists roles withindouble HIV. up Inas committeewill be accountable will report to to the the province DMO for for final all CopperbeltProvincial MCand Coordinators.North-Western In provinces,terms of decisionsVMMC activitieson implementation implemented and thein DMOtheir thehuman Clinical resources, Care Specialiststhis model double will largelyup as willdistrict. be accountable to the province for all Provincialremain the MCsame. Coordinators. With respect In to termsfunding, of VMMC activities implemented in their humanmore resources resources, should this bemodel dedicated will largelyto the district. remainsubnational the same.level according With respect to the to budgetedfunding, moreactivities. resources Thus, provincialshould be supportdedicated will to be the a subnationalmix of secondment, level according joint to-planning the budgeted and activities.direct budget Thus, support provincial for VMMCsupport willactivities be a mixdepending of secondment, on the provincial joint needs.-planning and direct budget support for VMMC activities III.depending Revamp on thethe Districtprovincial Technical needs. Committees to enable routine III. programRevamp managementthe District Technical and partner Committeescollaboration to at enable this level routine program management and partner District level collaboration at this level At district level, the coordination is done by delegatedDistrict level VMMC Coordinators who work Atwith district implem level,entin theg partnerscoordination and isfacility done inby- delegatedcharges under VMMC the leadershipCoordinators of thewho DMO. work withAt facility, implem theentin ign -chargespartners coordinateand facility thein- chargesactivities under of the the VMMCleadership providers. of the DMO. This At facility, the in-charges coordinate the

8activities Situation Analysisof the of Zambia’sVMMC Voluntary providers. Medical ThisMale Circumcision, presented and ratified at a Special TWG th Workshop in Lusaka, April 13 2016 Ministry8 Situation ofAnalysis Health, of Zambia’s Zambia Voluntary | VMMC Medical NATIONAL Male OPERATIONAL PLAN Circumcision, presented and ratified at a Special TWG 18 Workshop in Lusaka, April 13th 2016 (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 18 (2016-2020)

Figure 5 : District Level Governaces & Coordination Structures for VMMC in Zambia

Provincial Figure 5 : District Level Governaces Medical& Coordination Officer Structures for VMMC in Zambia

Provincial DistrictMedical Medical Officer Officer (DMO) District Technical District Medical

Committee Officer (DMO) District District VMMC Technical Coordinator Committee District VMMC Coordinator

Facility in Facility in Facility in charge charge charge

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 19 (2016-2020)

PILLAR 3: SERVICE DELIVERY

ObjectivePILLAR 3: SERVICE DELIVERY To offer a comprehensive VMMC package of service in an efficient, effective and Objectiveincreasingly integrated manner while ensuring the highest quality of services

To offer a comprehensive VMMC package of service in an efficient, effective and Strategies increasingly integrated manner while ensuring the highest quality of services

I. Expand existing capacity to provide comprehensive VMMC services by introducing Strategiespre -service training, eliminating missed opportunities for service delivery and efficiently deploying innovative methods such as devices for service delivery I. Expand existing capacity to provide comprehensive VMMC services by introducing II. preEnsure-service adequate training, infrastructural eliminating missed resources opportunities (equipment for and service waste delivery management) and efficiently while deployingmaintaining innovative the quality met ofhods VMMC such during as devices scale for-up service by standardizing delivery QAQI guidelines, materials and activities II. Ensure adequate infrastructural resources (equipment and waste management) while III. maintainingFacilitate the the integration quality of of VMMC VMMC during services scale with-up other by standardizing health programs QAQI at all guidelines, levels of materialscare and andcentralize activities VMMC commodity management into the existing Supply Chain System III. Facilitate the integration of VMMC services with other health programs at all levels of IV. careConduct and centralizeannual planning, VMMC commoditygeographic managementprioritization intoand theofficially existing documentSupply Chain the Systemallocation of geographies and/or facilities to partners

IV. Conduct annual planning, geographic prioritization and officially document the

allocation of geographies and/or facilities to partners The VMMC Focal Person will be assigned Zambia VMMC service delivery by the DMO at each District Health Office Service delivery in Zambia is conducted at toThe oversee VMMC all Focal scheduling Person andwill logisticsbe assigned for allZambia levels VMMCof care serviceand in deliveryvarious types of byservice the DMOdelivery. at each Public District health Health facilities Office offering the standard VMMC package will Servicefacilities. delivery Both staticin Zambia and outreachis conducted service at to oversee all scheduling and logistics for be categorized into four service levels (Level alldelivery levels continue of care toand contribute in various significantly types of service delivery. Public health facilities A, Level B, Level C, and Level D) according facilities.to VMMC Both scale static-up. andService outreach delivery service is offering the standard VMMC package will to the facility type, availability of human deliveryprimarily continue coordinated to contribute at the district significantly level. be categorized into four service levels (Level resources, and the amount of support toStrong VM MCcoordination scale-up. ofS ervicehuman delivery resources is A, Level B, Level C, and Level D) according needed. See Table 2 : VMMC Service primarilyand supplies coordinated at this atlevel the is district critical level. to to the facility type, availability of human Delivery Models. Strongensuring coordination a complete ofand human comprehensive resources resources, and the amount of support serviceand supplies VMMC at packagethis level that is meetscritical theto needed. See Table 2 : VMMC Service Where mobile units are used to provide establishedensuring a completeguidelines, andeven comprehensive in remote Delivery Models. VMMC services in locations that have servicesettings. VMMC package that meets the Where mobile units are used to provide establishedMinistry of Health,guidelin Zames, biaeven | VMMC in remote NATIONAL OPERATIONAL PLAN VMMC services in locations that 20have settings. (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 20 (2016-2020)

limited health care facilities and in catchment areas that have little or no limitedexisting infrastructurehealth care the facilities following andmust bein catchmenttaken into account:areas that have little or no existing The infrastructure size and density the following of the catchment must be taken populationinto account: and prevalence of HIV and male circumcision in the catchment  The size and density of the catchment populationarea and prevalence of HIV and  malePotential circumcision physical spacein the that catchment can be areadedicated (temporarily or permanently) to VMMC services  Potential physical space that can be  dedicatedExisting infrastructure (temporarily and equipment, or permanently)availability of toskilled VMMC human services resources  ExistingLevel of infrastructure support of andmanager equipment,s and availabilityservice providers of skilled human resources  LevelAccessibility of support of sites/facilities of manager tos andthe servicetarget population providers  AccessibilityService linkage of andsites/facilities referral between to the targetVMMC population and other services such as care and treatment, post-operative  Service linkage and referral between VMMCcare, and and support/AE other services management such as caremay include:and treatment, post-operative care,o HIVand caresupport/AE and treatment management sites for may include:those who test HIV-positive Clinics able to perform post- o HIV care and treatment sites for operativethose who care test HIV-positive Regional, tertiary hospitals—AE o Clinics able to perform post- managementoperative care

o Regional, tertiary hospitals—AE For immediatemanagement impact, VMMC services will concentrate on the ages 15-29. However, Forthis immediatedoes not impactpreclude, VMMC the provision services willof concentrateservices to other on theage groupsages 15 if-29. they However, come in thisfor circumcision.does not preclude Each district the willprovision develop of a serviceslocalized to workplan other age and groups budget if they that come aligns in forwith circumcision. this national Eachoperational district plan will , developoutlining a localizeddetailed steps workplan for implementation and budget .that aligns with this national operational plan, outlining detailed steps for implementation.

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 21 (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 21 (2016-2020)

Level A Level B Level C Level D Type • District or general hospital • Zonal health centre • Health centre equivalent • Health post equivalent equivalent equivalent Scope of • fully responsible for all seven • fully responsible for all • partially relies on external assistance • Entirely relies on external Level A Level B Level C Level Level A D Level BLevel A Level C Level B LevelLevel C D Level D Service core VMMC responsibilities9 seven core VMMC from Level A or B facilities assistance from Level A, B or C Type • District or general hospital • Zonal health centre • Health centre equivalent Type • • provideDistrictHealth postadditionalor equivalentgeneral support Typehospital to • Zonalresponsibilities• Districthealth 9 or generalcentre •hospital mayHealth not• centre beZonal able equivalent to takehealth on all sevencentre core • • HealthfacilitiesHealth centre post to equivalent offer dedicated • Health post equivalent equivalent equivalent surroundingequivalent lower-level clinics equivalentequivalent VMMC responsibilitiesequivalent 9 initially VMMC services on specific days. Scope of • fully responsible for all seven • fully responsible for all • partially relies on externalScope assistance of • • fullythrougEntirely responsibleh outreach relies foron all Scope sevenexternal • of fully• responsiblefully responsible for forall all• sevenButpartially should• reliesfully at least onresponsible handleexternal local assistancefor demand all • • partiallyEntirely relies relies on externalon external assistance • Entirely relies on external 9 9 Service core VMMC responsibilities seven core VMMC from Level A or B facilitiesService • servecoreassistance VMMC as clinical from responsibilities Leveltraining ServiceA, Bhubs9 or C seven corecore VMMC responsibilitiesVMMC generationfrom Level seven A or B facilitiescore VMMC fromassistance Level Afrom or B Level facilities A, B or C assistance from Level A, B or C 9 9 • provide additional support to responsibilities • may not be able to take on all seven core • provideforfacilities the district additionalto offer support dedicated to responsibilities• provide 9 additional support• mayto not beresponsibilities able to take on all seven core • mayfacilities not be ableto tooffer take ondedicated all seven core facilities to offer dedicated 9 9 9 surrounding lower-level clinics VMMC responsibilities Frequencyinitially of • ProvidessurroundingVMMC servicesdedicated lower on-level specific VMMC clinics days. • Providessurrounding dedicated lowerVMMC-level • clinicsVMMCVaries according responsibilities to needs initially of catchment • VMMC“miniVMMC- responsibilitiescampaign servicess” on conductedspecific initially days. a VMMC services on specific days. through outreach through outreach • But should at least handleService local demand servicesthrough outreachseveral days of the services between 1-12 days • Butpopulation should at(weekly, least handle monthly, local quarterlydemand • Butfew should times at perleast yearhandle or localduring demand • serve as clinical training hubs generation • weekserve as clinical training hubs per• monthserve as clinical training hubsgenerationor bi -annually) generationspecial occasions. for the district for the district for the district • Last for several consecutive days Frequency of • Provides dedicated VMMC • Provides dedicated VMMC • Varies according to needsFrequency of catchment of • • Provides“mini-campaign dedicateds” conducted FrequencyVMMC a • of Provides• Provides dedicated dedicated VMMC •VMMC Varies •according Provides to dedicatedneeds of catchmentVMMC • • Varies“miniand willaccording-campaign offer dedicatedtos” needsconducted ofservices catchment a • “mini-campaigns” conducted a Service services several days of the services between 1-12 days population (weekly, monthly,Service quarterly servicesfew times several per yeardays Serviceorof duringthe servicesservices between several 1-12 daysdays of populationthe services (weekly, between monthly, 1- 12quarterly days populationfewto large times numbers (weekly, per year ofmonthly, clientsor during atquarterly a few times per year or during week per month or bi-annually) weekspecial occasions. per monthweek or bi-annually)per month orspecialtime bi-annually) occasions. special occasions. Resources • • 2Last-3 table for several operating consecutive team with days • Ideally using 1-3 table • Sufficient for minimum package of • InsufficientLast for several human consecutive resources days • Last for several consecutive days anand in -willhouse offer medical dedicated officer services operating teams services (outreach) and willinfrastructure offer dedicated f services and will offer dedicated services to large numbers of clients at a • Involve any available health care • Requiresto large numbersmedical tentsof clients and other at a to large numbers of clients at a time providers from the facility during temporarytime structures time Resources • 2-3 table operating team with • Ideally using 1-3 table • Sufficient for minimumResources package of • • 2Insufficient-3 table operating human team Resourcesresources with • Ideally• 2-3using table 1 operating-3 table team• withSufficientVMMC • outreach Ideallyfor minimum serviceusing days 1package- 3 table of • • SufficientInsufficient for humanminimum resources package of • Insufficient human resources an in-house medical officer operating teams services (outreach) Other • serveanand in - houseinfrastructureas a referral medical hub fofficer for any • alsooperating servean in teamsas-house a referral medical hub officer • Mayservices use (outreach) operatingmedical teamstents or other • servicesN/Aand infrastructure (outreach) f and infrastructure f • Involve any available health care • adverseRequires medicalevents tentsrequiring and other for any adverse events • temporaryInvolve anystructures available to increase health capacity care • • InvolveRequires any medical available tents andhealth other care • Requires medical tents and other providers from the facility during specializedtemporary attentionstructures requiring specialized whereproviders infrastructure from the is lackingfacility during providerstemporary from structures the facility during temporary structures VMMC outreach service days attention VMMC outreach service days VMMC outreach service days Other • serve as a referral hub for any • also serve as a referral hub • May use medical tentsOther or other • • serveN/A as a referral hub Otherfor any • also• serveserve as asa referrala referral hub hub •for Mayany •use alsomedical serve astents a referral or hubother • • MayN/A use medical tents or other • N/A adverse events requiring for any adverse events temporary structures to increase capacity adverse events requiring for anyTableadverse adverse 2 : VMMCevents events Service requiring Deltemporaryivery Models forstructures any toadverse increase eventscapacity temporary structures to increase capacity specialized attention requiring specialized where infrastructure is lacking specialized attention requiringspecialized specialized attention where infrastructurerequiring is lackingspecialized where infrastructure is lacking attention attention attention

Table 2 : VMMC Service Delivery Models 9 The seven core VMMC responsibilities are as follows: 1) community-level demTableand 2generation, : VMMC 2) Service clinical service Delivery provision, Models 3) infection Table 2prevention, : VMMC 4) Service behavioural Del counselling,ivery Models 5) quality assurance, 6) data management, and 7) supply-chain management. Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 22 9 9 The seven core VMMC responsibilities are as follows: 1) community-level demand generation, 2) clinical service provision, 3) infection prevention,9 The seven 4) core behavioural VMMC responsibilitiescounselling, 5) arequality as follows:assurance,(2016 The 1) seven community-6)2020) data core -VMMClevel dem responsibilitiesand generation, are 2)as clinicalfollows: service 1) community provision,-level 3) infectiondemand prevention,generation, 4)2) behaviouralclinical service counselling, provision, 5)3) qualityinfection assurance, prevention, 6) data4) behavioural counselling, 5) quality assurance, 6) data management, and 7) supply-chain management. management, and 7) supply-chain management. management, and 7) supply-chain management. Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 22 Ministry of Health, Zambia | VMMC NATIONALMinistry of Health, OPERATIONAL Zambia | VMMC PLAN NATIONAL 22OPERATIONAL PLAN 22 (2016-2020) (2016-2020) (2016-2020)

Opportunities for Efficiency by service delivery model Opportunities for Efficiency by service delivery model In terms of composition, 56% of Zambia’s government resources. Compensation is 2015In terms MCs of10 werecomposition, from static 56% service of Zambia’s models alsogovernment based on performanceresources. Compensation (400 Kwacha peris while2015 MCs44%10 waswere from from outreach static service (30% models urban teamalso based11 per on10 performanceMCs) thus decreasing (400 Kwacha the cost per outreachwhile 44% and was 14%from ruraloutreach outreach). (30% urban See teamper VMMC11 per 10 would MCs) entail thus decreasingreducing or the halting cost Figureoutreach 6 : and2015 14%VMMC rural Outputs outreach). by service See theper compensation,VMMC would whichentail reducingis already or very halting low Figuredelivery 6 model : 2015 below VMMC. Outputs by service bythe regional compensation, standards which. is already very low d elivery model below. by regional standards. Similarly, urban outreach is already quite Figure 6 : 2015 VMMC Outputs by service efficientSimilarly, at urban facility outreach-level because is already teams quiteonly dFigureelivery 6model : 2015 VMMC Outputs by service efficient at facility-level because teams only delivery model go out when clients are booked, matching go out when clients are booked, matching 100% supply to demand. Additionally, travel costs 100% Outreach - aresupply minimized to demand by .only Additionally, doing short travel distance, costs Outreachrural, - oneare -minimizedday outreach by only and doing pegging short distance,provider 90% 28,907 rural, one-day outreach and pegging provider 90% 28,907 compensations to their performance (based 80% oncompensat numberions of MCsto their as opposedperformance to number (based 80% Outreach - ofon days).number of MCs as opposed to number 70% Outreachurban, - of days). 70% 58,724urban, Thus, only the rural outreach model 58,724 60% presentsThus, o somenly theopportunity rural outreach for facility model-level 60% efficiency,presents some but itopportunity represents onlyfor facility14% of-level the 50% program.efficiency, Alternatively, but it represents the onlyprogram 14% shouldof the 50% conprogram.sider lookingAlternatively, at above the-facility program level should costs 40% andcon siderin orderlooking to at increaseabove-facility efficiency level costsand 40% reduceand in ordercost to increaseper efficiencyVMMC. and 30% Static, reduce cost per VMMC. 30% 110,814Static, 20% 110,814 20% 10% 10% 0% 0% 2015 MCs 2015 MCs Static site service delivery presents limited opportunitiesStatic site service for delivery driving presents facility limited-level efficienciesopportunities since for service driving delivery facility is already-level efficientefficiencies due since to anservice increasingly delivery integratedis already approachefficient duewhich to an takesincreasingly advantage integrated of economiesapproach whichof scale takesafforded advantage by existing of economies of scale afforded by existing

10 Data source was disaggregated VMMC numbers from 11 A team is considered to consist of: 1 Surgeon provider, 1 implementing10 partners. It is close to, but does not exactly Assistant,11 1 counselor and 1 CDE (Hygiene Assistant –for Data source was disaggregated VMMC numbers from A team is considered to consist of: 1 Surgeon provider, 1 implementingmatch the national partners VMMC. It totals. is clo se to, but does not exactly Assistant,instrument 1processing). counselor and 1 CDE (Hygiene Assistant –for matchMinistry the national of Health, VMMC totals. Zambia | VMMC NATIONAL instrumentOPERATIONAL processing). PLAN 23 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 23 (2016-2020)

Progress to date and 2016-2020 National and Provincial and District Targets

Progress to date and 2016-2020 National and Provincial and District Targets Figure 7 : Progress against old targets, setting new targets (2016-2020)

1,000 Figure 7 : Progress against old targets, setting new869 targets (2016-2020) 900 MCs

1,000 800 869 Target 900 MCs

Thousands 700 800 Target 600 527 Thousands 700 431 500 419 393 600 527 360 382 400 271 431 500 419 393 300 199 360 382 400 168 200 271 300 199 294 314 100 168168 174 222 200 - 294 314 100 168 174 222 -

12 In 2007, the WHO and UNAIDS announced recommendations for countries with high HIV prevalence and low VMMC coverage to incorporate VMMC in their HIV program response. 12 SinceIn 2007, then, the Zambia WHO andhas UNAIDScircumcised announced 1,173,860 males.recommendations During 2007 for-2011 countries conducted with higha total HIV of prevalence168,436 which and included low VMMC pilot andcoverage mini -scaleto incorporate up of services. VMMC The in most their significant HIV program scale- upresponse. to date Sinceoccurred then, during Zambia the previoushas circumcised operational 1,173,860 plan period males. (2012During-2015). 2007 However,-2011 conducted despite successfula total of 168,436scale-up whichuntil 2014, included there pilot was and a 30% mini decrease-scale up inof totalservices. outputs The inmost 2015. significant This was scale caused-up toby date the occurredexit of some during partners the previous in 2014 operational as well as planreduced period funding (2012 which-2015). disrupted However, service despite delivery successful for scalemajor-up implementing until 2014, therepartners was in a the30% second decrease half inof total2014 outputsand early in 2015. 2015. This was caused by the exit of some partners in 2014 as well as reduced funding which disrupted service delivery for major implementing partners in the second half of 2014 and early 2015.

12 http://www.who.int/mediacentre/news/releases/2007/pr10/en/ Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 12 24 http://www.who.int/mediacentre/news/releases/2007/pr1(20160/en/-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 24 (2016-2020)

Figure 8: Provincial Targets Chart (2016-2020)

Figure 8: Provincial Targets Chart (2016-2020) 450,000 450,000 400,000

400,000350,000 350,000 402,374 402,374

300,000

402,374 402,374

300,000

250,000

200,000250,000

286,028 286,028

200,000

252,707 252,707

286,028 286,028

150,000

226,194 226,194

252,707 252,707

150,000

100,000 226,194 226,194 186,770 186,770

167,872 167,872

100,000 152,833 152,833 186,770 186,770

50,000 145,488

109,682 109,682 55,134 55,134 167,872 167,872

152,833 152,833

50,000 145,488

109,682 109,682 - 55,134

Steady scale-up targets by province by year Steady scale-up targets by province by year

Province 2016 2017 2018 2019 2020 TOTAL CentralProvince 39,4312016 40,5462017 201836,960 201933,852 35,9802020 TOTAL 186,770 CopperbeltCentral 30,71639,431 31,58440,546 28,79136,960 26,37033,852 28,02735,980 145,488186,770 EasternCopperbelt 6030,716,387 62,09431,584 56,60228,791 51,84326,370 55,10128,027 286,028145,488 LuapulaEastern 32,26760,387 33,17962,094 30,24456,602 27,70151,843 29,44255,101 152,833286,028 LusakaLuapula 84,95032,267 87,35233,179 79,62630,244 72,93127,701 77,51529,442 402,374152,833 MuchingaLusaka 35,44284,950 36,44487,352 33,22079,626 30,42772,931 32,33977,515 167,872402,374 NorthernMuchinga 47,75535,442 49,10536,444 44,76233,220 40,99830,427 43,57532,339 226,194167,872 NorthNorthern-Western 11,64047,755 11,96949,105 10,91144,762 40,998 9,993 10,62143,575 226,194 55,134 SouthernNorth-Western 53,35211,640 54,86011,969 50,00810,911 45,804 9,993 48,68210,621 252,707 55,134 WesternSouthern 23,15653,352 23,81154,860 21,70550,008 19,88045,804 21,12948,682 109,682252,707 TOTALWestern 419,097 23,156 430,945 23,811 392,829 21,705 359,800 19,880 382,412 21,129 1,985,083 109,682 TOTAL 419,097 430,945 392,829 359,800 382,412 1,985,083 Table 3 :Provincial target by year Table 3 :Provincial target by year

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 25 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 25 (2016-2020)

I. Expand existing capacity to provide provider and oriented HCW attend to one comprehensive VMMC services by table together. Classified employees are used introducing pre-service training, to assist with non-patient contact related eliminating missed opportunities for tasks such as autoclaving the surgical service delivery and efficiently instruments and preparing the room. deploying innovative methods such Increasing the number of beds available to as devices for service delivery the team, using electro cautery and introducing devices are some of the ways to For this Operational Plan (2016-2020), augment the program’s service delivery Zambia aims to circumcise 1,985,083 males capacity. The VMMC team structure between10-49 years old, representing 90% comprises 4 cadres, two providers, one lead coverage for the core age groups of 15-29 and the other supporting, one Hygiene by 2020. Scaling up and optimizing service Assistant and one Counsellor. delivery implies increasing the service delivery capacity and avoiding missed Human Resources are the biggest challenge opportunities for service delivery. While the for VMMC as there are often shortages, former can be partially achieved by especially at lower level facilities (Level C, improving efficiency of service delivery, for D). Unfortunately, there is currently no Zambia mobilizing resources required to visibility on service delivery and training at reach these target is more important. The national level. This will be one of the roles latter requires an unprecedented level of of the new cadre on the national team, the planning and collaboration among VMMC Program Officer. This lack of implementing partners within the TWG in program details on the personnel and order to capture all service delivery capacity situation is exacerbated by the fact opportunities. that the training methods and packages are not standardized since different partners Human resource requirements have different follow slightly different specifications. Furthermore, retention of Although Zambia does not require a specifications. Furthermore, retention of providers is generally poor due to career surgeon to perform VMMC, there is still providers is generally poor due to career mobility, general inactivity, disinterest and concern about the strain that scale-up of mobility, general inactivity, disinterest and the MoH staff rotation that occurs every VMMC could have on the health system. the MoH staff rotation that occurs every two years, leaving some providers in areas With a goal of almost 419,097 in 2016, with no VMMC capacity. reaching these targets will only be possible if human resources are sufficient and human resources are sufficient and Training requirements optimally deployed. VMMC provider training will remain a key Two or more tables are recommended for component of the pre-service Clinical optimizing HR efficiency using the dorsal Officers and Medical Licentiate curricula as slit surgical method of VMMC. With three it is a sustainable and more efficient strategy VMMC tables at one site, one HCW can be for building VMMC provider competency in assigned to physically examine clients on the long term. The incorporation of the pre- other tables while the trained VMMC service VMMC in teaching curricular should Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 26 (2016-2020)

be extended to the nursing schools and this example, if a partner cannot provide service will be achieved through use of an at designated facilities due to funding delays, addendum for VMMC surgical components they must immediately notify the MoH of the clinical components of the curricula. through the TWG in order to identify other In the interim, in-service training of existing partners who can temporarily deliver HCWs will be used to meet other training service. In addition, a simple campaign demands and new developments in the monitoring tool has been developed; it will program e.g. devices. Where feasible, be used to monitor the outputs during decentralized training of trainers at campaign season to make sure that high- provincial and/or district levels and volume sites maintain their productive provision of mentorship training packages status by identifying uncharacteristic drops to service delivery points is required. in output. This tool will be deployed and used in every province, and will be the Due to the human resource challenges of responsibility of the VMMC provincial attrition, inactivity and the need to meet an coordinator. increasing number of procedures in the catch-up phase, many areas do not have As for the district, given that district targets enough providers to meet the demand. The vary significantly, careful planning will be number of additional VMMC service used to ensure that resources made available providers to be trained will be based on the to each district correspond to the district’s existing service delivery models and district level of demand. During dissemination and level calculations of need. The program will roll-out of this operational plan, each district need to train Counsellors, hygiene assistants, will develop its own costed implementation and mobilizers with emphasizing areas with plan tailored to its demographic poor coverage rates to improve equity of characteristics. service.

Matching Supply and Demand and Devices eliminating missed opportunities Devise-based VMMC has been shown to Matching demand generated to service result in incremental demand and also delivery is a priority. For outreach, this is provide opportunities for additional optimized when staff utilization is efficiencies. Zambia is currently looking at maximized i.e. if teams are only deployed both PrePex and Shang Ring as options for once the level of demand at outreach posts device-based VMMC. Active and Passive has reached a predetermined number. It is surveillance will be conducted for each also wise to continue to minimize long device by the end of 2016. Swift distance outreach to avoid high DSA and introduction and roll-out of devices will travel allowances. begin in 2017. This will also require communication strategies tailored to educate It is also important to capitalize on all clients on, and generate demand for the opportunities for service delivery, and device(s). eliminate missed opportunities. For Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 27 (2016-2020)

Waste management II. Ensure adequate infrastructural Waste management II. Ensureresources adequa whilete maintaining infrastructural the Voluntary Medical Male Circumcision resourcesquality of VMMCwhile maintaining during scale the-up by (VMMC)Voluntary is anMedical activity Malethat generates Circumcision health standardizingquality of VMMC QAQI during guidelines, scale-up by care(VMMC) waste, is whichan activity is composed that generates of both health non- standardizingmaterials and activitiesQAQI guidelines, carehazardous waste, andwhich hazardous is composed elements. of both If non not- materials and activities managedhazardous correctly and hazardous health careelements. waste carriesIf not Equipment management manageda risk of infectioncorrectly andhealth / or care injury waste for carrieshealth Equipment management carea risk professionals of infection andand patients./ or injury for health The Zambia VMMC program adopted, and care professionals and patients. predominantlyThe Zambia VMMC uses programre-useable adopted surgical, and To avoid negative impacts on public health predominantlyinstruments. As usesresult ,re -alluseable implementing surgical andTo avoidthe negativeenvironment, impacts it onis publicessential health to partnersinstruments need. As toresult adhere, all implementingto national and the environment, it is essential to standardspartners needof itonstrument adhere management.to national develop safe and reliable methods for the handlingdevelop safeand andtreatment reliable of methods health care for riskthe Therefore,standards theof responsibilityinstrument formanagement. instrument wastehandling (HCRW) and treatment including of Disposable health care Non risk- decontaminationTherefore, the responsibility should be for assigned instrument to Sharpwaste (HCRW)Metal Instruments including. DisposableService providers Non- qualifieddecontamination individuals should who havebe demonstratedassigned to mustSharp Metalhave Instrumentsclear Standard. Service Operatingproviders competencequalified individuals this area who. Decontamina have demonstratedtion is must have clear Standard Operating competenceachieved by thispre area-soaking. Decontamina and manuallytion is Procedures on the segregation, handling, storage,Procedures transpo on rt,the treatment segregation, and disposal handling, of cleaningachieved bydisposable pre-soaking non -andsharp manuallymetal Nonstorage,-sharp transpo Metalrt, treatmentInstruments and asdisposal well ofas cleaninginstruments disposable in a sodiumnon- sharphypochlorite metal Non-sharp Metal Instruments as well as solutioninstruments to disinfectin a sodiumthe items hypochlorite, rendering other types of HCRW to cater for each step ofother the typescycle 13of HCRW to cater for each step themsolution safe to fordisinfect handling the or items disposal., rendering After . of the cycle13. decontamination,them safe for handling the instruments or disposal. must After be thoroughdecontamination,ly rinsed the instrumentsand dried mustbefore be thoroughundergoingly sterilizationrinsed and or transport.dried before undergoing sterilization or transport. For sites that do not have an autoclave, reusableFor sites instrument that do notsets havewill need an toautoclave, be sent toreusable an external instrument facility, sets usuallywill need a districtto be sent or higherto an -externallevel hospital, facility, with usually an autoclave. a district This or processhigher-level will hospital,also typically with anrequire autoclave. additional This suppliesprocess willand also personnel typically to require manage additional storage andsupplies logistics and for personnel the newly to sterile manage equipment. storage and logistics for the newly sterile equipment. Facilities and districts with limited autoclavingFacilities andcapacity districts will be withsupplied limited with additionalautoclaving instrument capacity willsets inbe order supplied to ensure with thatadditional this does instrument not create sets a in barrier order to facilityensure that this does not create a barrier to facility service delivery or meeting the demand for 13 VserviceMMC deliveryduring outreach or meeting activities. the demand for Ackerson S. and Pahl, N. 2013, Voluntary Medical Male VMMC during outreach activities. Circumcision13 Ackerson GuidanceS. and Pahl, Document; N. 2013, Submitted Voluntary to theMedical US Agency Male for International Development by the Supply Chain Circumcision Guidance Document; Submitted to the US Agency forManagement International System Development(SCMS) by the Supply Chain Management System (SCMS) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 28 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 28 (2016-2020)

Figure 9: Decontamination Process for Disposable VMMC Kits14

The effective management of HCRW is considered a basic element of waste minimization, identification and proper segregation of the waste. Segregation is the responsibility of the generator of the waste at the point of generation. Segregation is the process of separating Thedifferent effective types managementof waste at theof pointHCR Wof generationis considered and a keepingbasic element them isolated of waste from minimization, each other. Toidentification improve segregation and proper efficiency, segregation the correctof the usewaste. of containers,Segregation proper is the placement responsibility and labelling of the ofgenerator container of the swaste mustat the pointbe of generation.carefully Segregationdetermined is the processand of separatingfollowed. different types of waste at the point of generation and keeping them isolated from each other. To improve segregation efficiency, the correct use of containers, proper placement and labelling of containers must be carefully determined and followed.

14 Source: Ministry of Health, Zambia Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 29 (2016-2020) 14 Source: Ministry of Health, Zambia Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 29 (2016-2020)

Figure 10: VMMC Health Care Waste15 Streams

Disposal of biomedical waste must be performed according to existing guidelines. In the event that a facility does not have a functioning incinerator, waste will be brought to the nearest health facilityDisposal wher of biomedicale an incinerator waste ismust available. be performed Disposal according of other tomaterials existing suchguidelines. as used In gauzethe event will followthat a facility the same does procedure. not have Duringa functioning QAQI, incinerator, the VMMC waste teams will must be broughtensure that to the sites nearest selected health for implementationfacility where an of incinerator device-based is available.VMMC are Disposal ready to of dispose other ofmaterials the resulting such aswaste used as gauze per waste will followmanagement the same procedure. During QAQI, the VMMC teams must ensure that sites selectedguidelines. for implementation of device-based VMMC are ready to dispose of the resulting waste as per waste management guidelines.

15 Source: PEPFAR, SCMS VMMC Waste Management Guidelines, as adopted by MoH Zambia Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 15 30 Source: PEPFAR, SCMS VMMC Waste Management Guidelines,(2016-2020) as adopted by MoH Zambia Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 30 (2016-2020)

framework17 at each level of service delivery. Quality assurance Usingframework the17 at Performanceeach level of serviceImprovement delivery. Quality assurance QA is a totality of actions that will provide ApproachUsing the (PIA) Performance in each serviceImprovement delivery confidenceQA is a totality that ofa actionsproduct that or willservice provide will pointApproach will (PIA) strengthen in each AEservice reporting. delivery satisfyconfidence given that requirementsa product or forservice quality will Apointdopting will the strengthenPIA framework AE willreporting. require (Nationalsatisfy given Guideline requirements 2012). forThe quality key jointAdopting collaboration the PIA framework of all will VMMCrequire principles(National include:Guideline orientation2012). The towards key stakeholders,joint collaboration as well as otherof expertsall VMMCoutside mprincipleseeting theinclude: needs andorientation expectation towards of thestakeholders, TWG (e.g. as Health well as Profession other experts Council outside of client’smeeting andthe community, needs and fo cusexpectation on systems of Zambiathe TWG (HPCZ)). (e.g. Health The Profession program Councilwill work of andclient’s process, and community,use of data fotocus analyze on systemsservice Zambiawith the (HPCZ)).QA/QI unitThe atprogram MoH towill develop work anddelivery process, processes use of dataand to analyzeencourage services a corewith VMMCthe QA/QI quality unit indicators at MoH to to be develop added collaborativedelivery processes team approachand encourage to problems a coreto the VMMC present quality comprehensive indicators to benational added collaborativesolving and team approachquality improvement.to problem qualityto the indicators.present comprehensive This approach national for solvingImproving theand documentati qualityon improvement.and reporting qualityQA/QI willindicators. leverage Thison existing approach processes for ofImproving AEs in the VMMCdocumentati programon and will reporting require setQA/QI up will forleverage Qual onity existing improvement processes adoptingof AEs in the VMMCperformance program improvement will require committee/teamsset up for , dataQual reviewity improvementmeetings and approachadopting throughthe performance use of M&E improvementdata. committee/teamssupportive supervision., data review Concurrently,meetings and approach through use of M&E data. supposupportivertive supervisionsupervision. will notConcurrently, be confined In March 2015, a report was produced tosuppo thertive national supervision level supervisors will not be, but confined it will followingIn March a2015, WHO a reportconsultative was producedmeeting toalso the be nationaldecentralized level tosupervisors the subnational, but it level will providingfollowing a guidanceWHO consultativeon tetanus meeting risk throughalso be decentralized a series of toTraining the subnational of Trainers level mitigationproviding approacguidancehes andon surveillancetetanus riskfor (ToT)through sessions. a series Inof particular,Training ofsupportive Trainers VMMCmitigation country approac hesprograms. and surveillance Zambia hasfor supervision(ToT) sessions. visits shouldIn particular, be decentraliz supportiveed to adoptedVMMC thecountry ‘clean programs.care’ approach Zambia at facility has thesupervision province. v isits should be decentralized to andadopted individual the ‘clean level care’, comprising approach atrigorous facility the province. surgicaland individual skin levelpreparation, comprising forrigorous all circumcisions,surgical skin includingpreparation device formethods, all andcircumcisions, good personal including wound caredevice educa methods,tion, as itsand tetanus good personalrisk mitigation wound strategy care educa16. tion, as its tetanus risk mitigation strategy16.

As the VMMC program scales up, Asenhancing the safeVMMC and qualityprogram VMMC scale servicess up, throughenhancing standardization safe and quality and VMMC monitoring services of Qualitythrough sAssurance/Qualitytandardization and monitoringImprovement of (QA/QI)Quality Assurance/Qualitycharacteristics will becomeImprovement even more(QA/QI) importan characteristicst. There is needwill becometo strengthen even adoptionmore importan of t. Thethere is nationalneed to strengthenQuality improvemadoption entof theguidelines national conceptualQuality improvement guidelines conceptual

16 17 Zambia Country Operational Plan (COP) 2016 Strategic (See page 17 & 18: The first edition of 2012 Guideline on Direction16 Summary, PEPFAR April 14, 2016 Quality17 improvement for Health Care Workers in Zambia) Zambia Country Operational Plan (COP) 2016 Strategic (See page 17 & 18: The first edition of 2012 Guideline on DirectionMinistry Summary, of Health, PEPFAR ZambiaApril 14, 2016 | VMMC NATIONAL QualityOPERATIONAL improvement for Health PLAN Care Workers in Zambia)31 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 31 (2016-2020)

III. Facilitate the integration of VMMC services with other health programs at all levels III. Facilitateof care and the centralize integration VMMC of VMMC commodity services management with other healthinto the programs existing atSupply all levels Chainof care System and centralize VMMC commodity management into the existing Supply Chain System Integration of VMMC service delivery Integration of VMMC service delivery Zambia’s VMMC program is now mature and increasingly moving towards routine, integrated serviceZambia’s delivery VMMC to programtake full iadvantages now matu ofre the and economies increasingly of scalemoving that towards result from routine, using integrated existing servicegovernment delivery structures to take andfull advantageresources toof providethe economies time-limited of scale VMMC that result services. from In using order existing to do governmentfurther accelerate structures integration and resources, this Plan toproposes provide to time adopt-limited the following VMMC strategiesservices. : In order to do further accelerate integration, this Plan proposes to adopt the following strategies: 1. Integration of VMMC services with other health programs at the health facility (FH, 1. MCH,Integration ANC, of and VMMC SRH), services strengthening with other referral/follow health programs-up systemsat the health and investingfacility (FH, in MCH,infrastruc ANC,ture andand refurbishmentSRH), strengthening of facilities referral/follow to accommodate-up systems VMMC and services investing in thein longinfrastruc termture and refurbishment of facilities to accommodate VMMC services in the long term 2. Prioritization of areas based on HR and capacity gaps 2.3. PrioritizationStreamlining of areaoperationss based toon focusHR and on capacitythe most gaps productive sites with threshold for 3. StreamliningMCs per year or of per operations month or to per focus day on the most productive sites with threshold for 4. RoutinizationMCs per year or of per service month delivery or per da byy increasing focus on static site productivity and 4. conductingRoutinization outreach of service on guaranteed delivery highby increasing-demand daysfocus or onduring static ‘mini site- campaigns’productivity and conducting outreach on guaranteed high-demand days or during ‘mini-campaigns’ 5. Phasing/Site-graduation – implementing partners continually facilitating sites from 5. partnePhasing/Siter-dependence-graduation to become – implementing independent, partners fully-MoH continually VMMC facilitating sites. Partners sites assistfrom facilitiespartner-dependence within each districtto become to take independent, ownership offully the-MoH seven VMMC core VMMC sites.- specificPartners service assist facilitiesdelivery withinresponsibilities: each district 1) tocommunity take ownership-level ofdemand the seven generation, core VMMC 2) -clinicalspecific service provisideliveryon, responsibilities: 3) infection prevention, 1) community 4) behavioural-level demand counselling generation,, 5) quality 2) clinical assurance, service 6) dataprovisi management,on, 3) infection and 7)prevention, supply-chain 4) management.behavioural counselling , 5) quality assurance, 6) data management, and 7) supply-chain management. 6. Direct budget, Results-focused funding – identify and fund high-volume 6. Directsites/districts budget, that needResults minimal-focused booster funding funding – toidentify activate theirand teamfund andhigh resources-volume forsites/districts VMMC that need minimal booster funding to activate their team and resources for VMMC 7. VMMC compensation/incentive structure must be standardized, officially 7. documentedVMMC compensation/ and publishedincentive in the shortstructure-term. Thismust will beavoid standardized, differential paymentsofficially documentedwhich can impact and thepublished program in negatively.the short -Interm. the longThis termwill oveavoidr the differential next five years)payments will bewhich gradually can impact reduced the and program restructured negatively. over In time. the Restructuringlong term ove compensationr the next five willyears) follow will principlesbe gradually of reducedresults- basedand restructured models aimed over at time. system Restructuring strengthening compensation rather than willindividual follow compensationprinciples of results -based models aimed at system strengthening rather than individual compensation

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 32 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 32 (2016-2020)

Integration of procurement of VMMC Quantification into central Supply Chain Management into central Supply Chain Management The MoH and partners will collaborate to System System quantify national need at annual forecasting meetings which will include supply and The MoH and implementing partners will meetings which will include supply and procurement planning. The forecasts will be collaborate to centralize VMMC procurement planning. The forecasts will be reviewed during periodic review meetings. procurement into the existing Supply Chain reviewed during periodic review meetings. National pipeline monitoring and System. Currently, procurement is partner- National pipeline monitoring and management will be the responsibility of the driven and not centralized. This leads to low management will be the responsibility of the MoH. The MoH will take leadership in the visibility and accountability for MoH. The MoH will take leadership in the Forecasting and Quantification (F&Q) for commodities, reliance of the national Forecasting and Quantification (F&Q) for the national need of the program. Program quantification exercise on inaccurate service the national need of the program. Program managers, procurement specialists, data for procurement, and existence of managers, procurement specialists, monitoring and evaluation (M&E) officers, parallel/vertical supply systems run by IPs, monitoring and evaluation (M&E) officers, relevant information specialists, warehouse resulting in reduced country ownership of relevant information specialists, warehouse managers, service providers, donor agencies, the process. managers, service providers, donor agencies, implementing partners, and technical

experts will be involved in quantification. Centralization of the currently fragmented The F&Q will be based on logistics, service VMMC supply pipeline and standardization statistics, and morbidity/demographic of supply chain management guidelines will forecasts with the results feeding into the avoid the frequent shortages and national procurement plan. commodities supply interruptions at facility Procurement level. Joint national forecasting, level. Joint national forecasting, The program will allow for procurement of quantification, and real-time eLMIS will quantification, and real-time eLMIS will commodities through the government and allow 4-week turnarounds to deliver 4 allow 4-week turnarounds to deliver 4 different cooperating partners based on the months of stock. This will cater for seasonal months of stock. This will cater for seasonal national need determined by the F&Q demand and avoid long turnaround time demand and avoid long turnaround time process. Procurement coordination and (TAT). The following are key attributes of (TAT). The following are key attributes of national pipeline monitoring will be led by Zambia’s planned VMMC supply chain Zambia’s planned VMMC supply chain the MoH and supported by partners to management system: management system: ensure the correct products are available in- Product Selection country and are ready for distribution when needed. A standard product list will be developed which will be adhered to across the country Distribution for the VMMC programme. This will be Distribution driven by factors that will take into As the program transitions to the consideration quality, effectiveness, safety sustainability phase, it is expected that and cost effectiveness. This will be reviewed MOH will take-up the role of coordinating every other year to cater for changes within the supply chain and commodity security the programme. issues with implementing partners and Medical Stores Limited (MSL). MSL, which

manages the central warehouse and delivery

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 33 (2016-2020)

systems for medicines, laboratory and other facilities orders. In the interim, the general supplies that are distributed through implementing partners (IPs) may procure the government health system, will take up buffer stock/commodities which can be the role for VMMC commodities in like used to ‘top-up’ facilities to meet the gap manner up to the last mile based on the unfulfilled by MSL

The model is shown in the diagram18 below.

Figure 11 : Flow Chart for new Supply Chain Management System

MASCSMSL EMLIP Packing MSL Shipping LMU

District

REMMS

MSL Health Voucher Hub Centre Voucher

Voucher

Impleme Voucher nting Hospital Partners

18 18 Source: VMMC Logistics System Design, GRZ

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 34 (2016-2020)

Reporting and Ordering of VMMC or deliver to the district which will then CoReportingmmodities and Ordering of VMMC ordeliver deliver to theto facilitiesthe district where which an MSLwill thenhub Commodities deliverdoes not to exist. the facilities where an MSL hub All VMMC service delivery points will does not exist. reportAll VMMC for and service order commoditiesdelivery points through will reportone national for and supplyorder commoditieschain with throughMedical Storesone national Limited supply (MSL). chain Thewith MedicalVMMC IV. Conduct annual planning, commoditiesStores Limited will be(MSL). managed The through VMMC the IV. geographicConduct annual prioritization planning, and Essentialcommodities Medicines will be Logistics managed Improvement through the geographicofficially document prioritization the allocation and of ProgrammeEssential Medicines (EMLIP) Logistics, the national Improvement logistics geographiesofficially document and/or the facilities allocation to of managementProgramme (EMLIP) system for, the essential national medicines logistics geographiespartners and/or facilities to managementand medical supplies. system for essential medicines partners Annual Planning and prioritization at and medical supplies. nationalAnnual P levellanning and prioritization at national level The VMMC in-country supply chain will The Zambia VMMC landscape is a multi- Theutilize VMMC an electronic in-country logistics supply management chain will Theimplementing Zambia VMMCpartner landscape environment, is a multi and- informationutilize an electronic system logistics(eLMIS) managementwhich will thusimplementing requires partnerofficial documentationenvironment, andof enhanceinformation the systemvisibility, (eLMIS) accountability which andwill geographicalthus requires focus official and facilitydocumentation allocation byof accuracyenhance ofthe logistics visibility, data accountabilityin the programme. and partner.geographical This focusfacility and map facility will be allocation updated byat Logisticsaccuracy ofdata logistics will be data collected in the and programme. available leaspartner.t once This a facilityyear to map inform will beprogress updated and at inLogistics a national data repositorywill be collected for the and MoH available and capacityleast once discussions. a year to inform progress and partnersin a national to use repository for procurement for the MoHand other and capacity discussions. logisticspartners decisionto use fors. procurement and other District-level planning logistics decisions. District-level planning This Plan proposes that detailed work plans

The PMO will play a supervisory role for andThis Planbudgets proposes at district that detailed level workshould plans be VMMCThe PMO commodity will play alogistics supervisory mana rolegement for, developedand budgets with at districtthis documentlevel should as bea VMMCaddressing commodity essential logisticsmedicines mana logisticsgement, guideline.developed Thewith districtthis coordinatingdocument asteam a addressreportinging and essential distribution medicines issues. The logistics health willguideline. determi Thene the district combination coordinating of service team facilityreporting will and complete distribution and sendissues. a ReportThe health for levelswill determi mostne appropriatethe combination for generatingof service Essentialfacility will Medicines complete and sendMedical a Report Supplies for demandlevels most and appropriatedelivering VMMCfor generating in each (REMMS)Essential Medicinesto the district and whichMedical the Supplies district districtdemand andand deliveringassess the VMMC availability in eachof (REMMS)will enter tointo the the district eLMIS which and t hese districtnd an resourcesdistrict and (both assess facilities the and availability staff) in their of electronicwill enter copyinto tothe Medical eLMIS Storesand seLimitednd an arearesources to carry (both out facilities dedicated and VMMC staff) inclinics. their (MSL)electronic logistics copy managementto Medical Storesunit (LMU) Limited on Usingarea to district carry -outlevel dedicated VMMC targetsVMMC over clinics. the a(MSL) monthly logistics basis. management MSL will packunit (LMU)orders onin fiveUsing years district from-level 2016 VM-2020,MC targets MoH overstaff thein sealeda monthly packages basis. for MSL each will facility pack andorders either in eachfive yearsdistrict from will 2016make-2020, decisions MoH regarding staff in deliversealed packagescommodities for eachdirectly facility to theand healtheither serviceeach district delivery will and make demand decisions creation. regarding facilitiesdeliver commodities in districts serviced directly by to an theMSL health hub, service delivery and demand creation. facilities in districts serviced by an MSL hub,

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 35 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 35 (2016-2020)

PILLAR 4: COMMUNICATION AND DEMAND GENERATION PILLAR 4: COMMUNICATION AND DEMAND GENERATION

Objective ToObjective increase demand and meet the targets for VMMC in the most effective (core) age groupsTo increase through demand a targeted, and meet market/client the targets -forbased VMMC approach. in the most effective (core) age groups through a targeted, market/client-based approach.

Strategies StrategiesI. Provide a national demand generation roadmap by finalizing and launching the I. ProvideNational a VMMCnational Advocacydemand generation and Communications roadmap by finalizingStrategy and(2016 launching-2020), andthe Nationaloutlining howVMMC to take Advocacy advantage and of Communicationsreferral networks andStrategy client (2016follow-2020),-up and II. outliningGenerate howhigher to takedemand advantage by implementing of referral networks novel, andmarke clientt-based follow and-up client- II. Generatecentric methodshigher demandof demand by implementing generation novel,through marke hight-based-yield and targeted client- ccentricommunication methods channels of demand generation through high-yield targeted III. Integratecommunication market channels research findings and plan for capacity to carefully monitor III. Integratedemand across market market research segments findings and plan for capacity to carefully monitor IV. Improvedemand across program market effectiveness segments by focusing the majority of demand generation IV. activitiesImprove onprogram the core effectiveness age groups by(15 focusing-29) the majority of demand generation V. Supplementactivities on thefunding core agefor groupsdemand (15 generation-29) activities through joint-funding of V. Supplementspecific activities funding for demand generation activities through joint-funding of specific activities A well-coordinated, targeted demand The VMMC program currently employs a generationA well-coordinated, strategy that targetedaccounts demandfor the mixThe VMMCof methods program to currentlygenerate employs demand a generationdistinct informational strategy that needs accounts and behavioural for the includingmix of methodsMass to Mediagenerate (Primarilydemand distinctchange informationaltriggers of males needs and and females behavioural is an Communityincluding Radio),Mass NeighbMediaourhood (Primarily Health indispensablechange triggers tool of malesfor Zambia’sand females national is an CommunityCommittees Radio),(NHCs) Neighb, ourhoodInter-Personal Health VMMCindispensable scale- uptool plan. for TheZambia’s strategy national should CommitteesCommunication (IPC)(NHCs) and, othersInter. -Personal appealVMMC to scale both-up the plan. primary The strategyand secondary should Communication (IPC) and others. targetappeal audiencesto both theand primaryconvince and them secondary to seek targetVMMC audiences services; and otherwise, convince investments them to seek in I. Provide national demand generation VMMC infrastructureservices; otherwise, and human investments resources in I. roadmapProvide national by finalizing demand and generation launching toVM dateMC willinfrastructure have less impactand human than resourcesintended. roadmapthe National by finalizing VMMC Advocacy and launching and Thusto date willcommunication have less impact and than intended.demand theCommunications National VMMC Strategy Advocacy (2016 and- geThusneration communication is a key priority and for bothdemand the 2020)Communications Strategy (2016- 2020) shortgeneration and long is aterm. key priority for both the The National VMMC Advocacy and short and long term. CommunicationThe National StrategyVMMC hasAdvocacy already beenand developedCommunication and awaitsStrategy finalization has already after been the developed and awaits finalization after the Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 36 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 36 (2016-2020)

launch of this Operational Plan. This comprehensive approaches which will documentlaunch of willthis offer Operational specific guidelines Plan. This for include;comprehensive targeted approaches advocacy, whichmass-media, will documentconducting willSocial offer specBehaviouralific guidelines Change for midinclude;-media targeted and IPC advocacy, strategies mass that-media, have Communicationconducting Social (SBCC) Behavioural activities Changein all beenmid-media articulated and IPCin thestrategies National that VMMC have placesCommunication and circumstances (SBCC) andactivities especially in allto Advocacybeen articulated and Communicationsin the National StrategyVMMC particularplaces and types/segments circumstances ofand clients. especially to 2016Advocacy-2020 and Communications Strategy particular types/segments of clients. 2016-2020 The Advocacy and Communication Strategy Market-segmentation Approach Market-segmentation Approach wasThe Advocacythoroughly and Communicationreviewed by Strategy the The VMMC Communications sub- communiwas thoroughlycations subcommitteereviewed byof the Thecommittee VMMC already Communicatio drafted a nsNational sub- VMMCcommuni cationsTWG tosubcommittee address inequality of thein VMMCcommittee Advocacy already anddrafted Communications a National relationshipsVMMC TWG and towomen’s address distinct inequality needs. inIt StrategyVMMC (2016Advocacy-2020) whichand Communications incorporates the alsorelationships outlines andand women’sspecifies distinctthe appropriate needs. It Strategyclient-centric, (2016 -market2020) which segmented incorporates approach. the alsochannels outlines of and communication.specifies the appropriate SBCC Thisclient new-centric, approach market targets segmented segments approach. of the messageschannels containedof communication. therein must SBCC be population,This new approach tailoring targetsthe message segments and of using the medicallymessages accurate,contained evidencetherein- based,must anbed approppopulation,riate, tailoringpreferably the message andhigh -usingyield considermedically the accurate, cultural sensitivitiesevidence-based, of the localand appropcommunicationriate, channelspreferably to engagehigh- yieldthe population.consider the culturalFinally, sensitivities it will ofmeet the localthe clientcommunication as follows: channels to engage the informationpopulation. needsFinally, for itall willtarget meetaudiences the client as follows: aboutinformation the benefits, needs importancefor all target and audiences limits of . Segmentation and Targeting: about the benefits, importance and limits of VMMC; condom use and VCT. The . SegmentationIdentify and andsegment Targeting: target VMmessagingMC; condomfor target usesegments and willVCT be. basedThe audiencesIdentify and tailorsegment key VMMCtarget onmessaging IPSOS for findings target segmentson VMMC will bedemand based messagesaudiences toand address tailor barrierskey VMMC and on IPSOS findings on VMMC demand creation. increasemessages VMMC to address uptake barriers and creation. . Tailored,increase VMMC informative uptake Messaging: The strategy will be launched in the third . shouldTailored, be informative medically Messagin accurate,g: The strategy will be launched in the third quarter of 2016 just after the Operational shouldevidence -based,be medically and consider accurate, the quarter of 2016 just after the Operational Plan, but before August campaign. evidencecultural -sensitivitiesbased, and ofconsider the localthe Plan, but before August campaign. population.cultural sensitivities It should alsoof themeet local the

informationpopulation. Itneeds should for also allmeet target the II. Generate higher demand by information needs for all target II. implementingGenerate higher novel, demand market by -based audiences; specifying the benefits, audiences; specifying the benefits, implementingand client-centric novel, methods market of-based importance and limits of VMMC importance and limits of VMMC anddemand client generation-centric methods through of hig h- and integrating condom use and and integrating condom use and demandyield targeted generation communication through hig h- VCT in the SBCC materials. VCT in the SBCC materials. yieldchannels targeted communication Messaging and target segmentation willMessaging use theand IPSOStarget segmentationfindings on channels VMMCwill use demand the IPSOS generation. findings on Communication and demand generation . VMMC demand generation. increaseCommunication the uptake and of VMMCdemand servicesgeneration and Proper Communication Channels: . : continuouslyincrease the uptakeinfluence of VMMCpositive servicesbehavioural and Properoutline Communicationspecific channels Channelsthat are outline specific channels that are changecontinuously, contributing influence to positive the reduction behavioural of appropriate for communication. appropriate for communication. newchange HIV, contributing incidence. toThe the SBCC reduction will useof new HIV incidence. The SBCC will use Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 37 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 37 (2016-2020)

Seven segment types of VMMC clients Seven segment types of VMMC clients In line with the IPSOS findings in 2015, this strategy will target the audiences as segmented below:In line with the IPSOS findings in 2015, this strategy will target the audiences as segmented below: Figure 12 : Seven Segments of VMMC Clients in Zambia (VMMC Market Research) Figure 12 : Seven Segments of VMMC Clients in Zambia (VMMC Market Research) 7 segments of men were identified in Zambia 7 segments of men were identified in Zambia

Traditional Believers Socially- Traditional Supported Socially- Believers Believers Supported 13% 14% Believers 13% 14% Indifferent Resistants 17% Self-reliant Indifferent 19% Believers Resistants 17% Self-reliant 19% Believers

11% Knowledgeable 11% 12% Hesitants Knowledgeable Scared 14% 12% Rejecters Hesitants Scared 14% Rejecters Friends-Driven Hesitants Friends-Driven Base: all men, n=2000 Hesitants 9 Base: all men, n=2000 9

While efforts will be made to drive volumes in every segment, more focus will be given to the While‘Friends effort-Drivens wilHesitantsl be made’, ‘Scared to drive Rejecters volumes’ and in ‘Indifferentevery segment, Resistants more’ to focus give willthe be right given king to theof ‘Friendsinformation-Driven that Hesitants would’ , turn‘Scared them Rejecters into VMMC’ and ‘ Indifferentbelievers andResistants ultimately’ to givechoose the toright undergo king theof procedureinformation. that would turn them into VMMC believers and ultimately choose to undergo the procedure.

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 38 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 38 (2016-2020)

Recommendations by client segment Recommendations by client segment Figure 13 : Demand Generation Reccommendations for each Client Segment Figure 13 : Demand Generation Reccommendations for each Client Segment

Recommendations Overview Recommendations Overview

Segment Key Messages Mass Media IPCs Advocates Devices Segment Key Messages Mass Media IPCs Advocates Devices Full and personalized VMMC becoming norm, how to VMMC becoming social norm – Provide community Fullbenefits and ;personalized sense of VMMCmanage becoming healing time, norm, clarify how painto PrePex as an Friends-driven VMMCbe part becomingof norm; more social emotional norm – Providenetwork community of advocate benefitsaccomplishment;; sense of manageduring procedure, healing time, address clarify pain PrePexadditional as an FriendsHesitants-driven bebenefits; part ofdetailed norm; moreinfo onemotional networksupport – ofVMMC advocate as accomplishment;address uncertainty duringuncertainty procedure, about serviceaddress quality additionaloption Hesitants benefits;proceduredetailed & healinginfo process. on supportsocial norm– VMMC as addresson risks uncertainty uncertaintyand availability; aboutreasons service for quality pride option procedure & healing process. social norm on risks Addressand availability;uncertaintyreasons on healing for pride Socially- Address uncertainty on healing PrePex as an Addressand pain;uncertainty identify non on-circumcised healing supportedSocially- Addressprocess anduncertainty pain during on healing healing Not a target Engage as advocates PrePexadditional as an andfriends pain; to identifygo together non -forcircumcised the supportedBelievers processand procedure and pain during healing Not a target Engage as advocates additionaloption friendsVMMC to go together for the Believers and procedure Address uncertainty on healing option Address their questions about VMMC PrePex as an Self-reliant Addressand pain;uncertainty identify non on-circumcised healing Addresspain during their procedure questions and about Not a target Engage as advocates PrePexadditional as an SelfBelievers-reliant andfriends pain; to identifygo together non -forcircumcised the painhealing during process procedure and Not a target Engage as advocates additionaloption friendsVMMC to go together for the Believers healing process option Safety of procedure and low risk CommunicateVMMC safety – credible Use advocates to PrePex as a Scared Safetyof complications; of procedure Pain and low risk Communicateinfo about low safetyrisk of – credible Useallay advocates fears, share to Not a target PrePexnon-surgical as a RejectersScared ofmanagement complications;during Pain healing; infocomplications, about low riskexpert of service; pain allayexperience, fears, share Not a target nonoption-surgical Rejecters managementEmphasize protectionduring healing; benefits complications,is real, but certainly expert manageable service; pain experience,accompany them option Emphasize protection benefits is real, but certainly manageable accompany them Assurance in protection benefits, Address uncertainty in safety; low added benefit of VMMC with risk of negative consequences Use advocates to Not Knowledgeable Assurance in protection benefits, Address uncertainty in safety; low addedcondom benefit use; Safety of VMMC of procedurewith Not a target risk(esp. of for negative sexual life);consequencesaddress Useallay advocates fears, share to Notparticularly KnowledgeableHesitants condomand low riskuse; of Safety complications; of procedure Not a target (esp.questions for sexual about life); pain;address expert allayexperience fears, share particularlyapplicable Hesitants andPain low management risk of complications; questionsservice; involve about partners pain; expert experience applicable Pain management service; involve partners Full info on benefits & risks + Need a lot of Full benefits, process, Communicate full info on benefits Fullgeneral info HIV/ on benefits STIs protection & risks + info; Needadvocates a lot around,of PrePex as an Indifferent Fullpain benefits, exists – howprocess, to Communicateand risks; acceptance full info of on VMMC benefits by generalclarify safety HIV/ STIsof procedure; protection info; advocatescommunicating around, pride PrePexadditional as an IndifferentRejecters painmanage exists it; –sensehow ofto andwider risks; community acceptance and of advocacy VMMC by clarifyaddress safety myths of believed; procedure; where communicatingin VMMC and allay pride additionaloption manageaccomplishment it; sense of widerfrom leaders; community dispel and myths advocacy Rejecters addressto get info; myths service believed; where infears VMMC and allay option accomplishment from leaders; dispel myths to get info; service fears No need in additional motivation, Traditional Information on benefits and but will benefit from short No need in Not a target No need in additional motivation, No need in advocates TraditionalBelievers Informationrisks; where onto getbenefits info; serviceand butcommunication will benefit from on benefits short and Nodevices need in Not a target risks; info about service/ clinics No need in advocates **Believers Identify in clinicsrisks; and where emphasize to get info; the needservice to use condoms after VMMC communication on benefits and devices ** Identify in clinics and emphasize the need to use condoms after VMMC risks; info about service/ clinics

Campaign Planning and Modalities campaigns, sustained service delivery Campaign Planning and Modalities etc.)campaigns, sustained service delivery The VMMC program has continued to etc.) . Special focus shall be placed on The VMMC program has continued to . benefit from successful campaign launches resuscitatingSpecial focus shallthe be placedDecember on sincebenefit 2012. from Despite successful novel campaign methods, launches VMMC resuscitating the December since 2012. Despite novel methods, VMMC campaign through early planning, campaigns will still remain a pivotal earlycampaign execution through earlyand planning,special campaigns will still remain a pivotal early execution and special platform for demand generation. Pre- messaging arranged,platform timelyfor demand and innovative generation. campaign Pre- messaging arranged, timely and innovative campaign . Anticipation of demand and supply modalities will enhance the effectiveness of . Anticipation of demand and supply modalities will enhance the effectiveness of disruptions: the program will pre- targeted demand generation, taking disruptions: the program will pre- targeted demand generation, taking empt any campaign disturbances advantage of referral networks both during empt any campaign disturbances advantage of referral networks both during resulting from political or other and outside campaigns. So, campaigns will resulting from political or other and outside campaigns. So, campaigns will competing/disrupting activity emphasize the following areas: competing/disrupting activity emphasize the following areas: through mini-campaigns and . Campaign Planning shall begin 3 through mini-campaigns and . Campaign Planning shall begin 3 reorganizing the timing of demand weeks before each campaign to generationreorganizing the timing of demand allowweeks forbefore timely each launchescampaign andto generation employallow fornew timelyideas forlaunches campaign ands employ new ideas for campaigns timing/frequency (e.g. mini- timing/frequency (e.g. mini- Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 39 (2016-2020) 39 (2016-2020)

. Referral networks: pay attention to . Development and distribution of . Referral networks: pay attention to . Development and distribution of the effectiveness of referral IEC, BCC and promotional networks and follow up materials on VMMC; such as booklets, flipcharts, posters, fliers, Coordinating Demand generation Coordinating Demand generation brochures and T-shirts etc. . Utilization of social media channels, At national level, a new cadre with dual . Utilization of social media channels, such as Facebook, Twitter, demand generation and service delivery such as Facebook, Twitter, Whatsapp and Instagram, to provide roles (VMMC Program Officer) will lead the Whatsapp and Instagram, to provide accurate information on VMMC coordination of all national-level activities, accurate information on VMMC services including campaigns and TWGs. They will services work closely together with the VMMC Provincial Level Demand generation provincial coordinator on all demand Provincial Level Demand generation The provincial health office will liaise with generation issues. At the facility, the VMMC The provincial health office will liaise with the subnational VMMC technical working focal point person at district level will be the subnational VMMC technical working group to coordinate and supervise all appointed to coordinate activities such as group to coordinate and supervise all demand generation activities which will training, and monitoring of IPC agents in demand generation activities which will include: VMMC facilities. include: . Identifying local VMMC champions . Identifying local VMMC champions to promote the service at both the National Level Demand Generation to promote the service at both the provincial and district levels At National-level, VMMC media coverage provincial and district levels . Developing and implementing will continue addressing key behavioural . Developing and implementing gender inclusive campaigns; determinants to increase overall demand for gender inclusive campaigns; . Utilizing community radio stations VMMC through the following key activities; . Utilizing community radio stations as a platform for dissemination of as a platform for dissemination of . Press conferences and media briefs VMMC messages through: Pre- . Press conferences and media briefs VMMC messages through: Pre- recorded and live VMMC client sensitizing media personnel on the recorded and live VMMC client testimonials, interviews and radio objective of the national VMMC testimonials, interviews and radio drama; live phone-in programs led program; drama; live phone-in programs led . Radio and TV spots addressing key by local DJs to discuss VMMC and . Radio and TV spots addressing key by local DJs to discuss VMMC and provide a forum for the panel to determinants of VMMC uptake; provide a forum for the panel to interact and provide correct . Phone-in shows, talk shows and interact and provide correct information to the community. interviews to create a platform for information to the community.

informed national dialogue on District Level Demand Generation VMMC District Level Demand Generation At District level, the VMMC focal point . Featuring VMMC champions and At District level, the VMMC focal point person, in collaboration with community- ambassadors such as traditional and person, in collaboration with community- level advocates, traditional leaders, identifies civic leaders level advocates, traditional leaders, identifies activities that will influence a positive SBCC. . Press releases, news and features activities that will influence a positive SBCC. These activities will include; articles on VMMC These activities will include; . presentations, to the target audience . Use of the existing 990 Health Talk . presentations, to the target audience in places such as learning line for VMMC in places such as learning

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 40 (2016-2020)

institutions, churches and work channels (mass-media and campaigns). At places local level, Facility in-charges will ensure . Community level informative and that the IPC agents and the NHC have up- interactive activities such as drama, to-date materials and tools. Regular Mobile Video Unit, public address supervision will inspire adherence to systems and soccer tournaments. standard program guidelines and quality IPC During these activities, VMMC session procedures. District coordinators champions and satisfied clients will are also required to conduct regular field be given the platform to share their supervision to identify the gaps and inform experiences. bi-annual refresher trainings for demand generation.

III. Integrate market research findings and plan for capacity to carefully Sustainability of demand generation monitor of demand across market A successful, sustainable demand generation segments structure for VMMC requires the following; . Market Research to Monitor Demand . A high level of political will and organic community ownership Once novel demand generation methods . Integration of VMMC demand have been implemented, it is also important have been implemented, it is also important generation with other interventions to continuously monitor the demographics to continuously monitor the demographics at implementation level and shifting demand generation dynamics. and shifting demand generation dynamics. . Continuous and timely training for The respective VMMC focal persons shall The respective VMMC focal persons shall Health Promoters and IPC staff be responsible administering and analysing be responsible administering and analysing . Up-to-date guidelines/ protocol the tracking tools to monitor the market the tracking tools to monitor the market . Stakeholder networking and research work and measure the changes in research work and measure the changes in collaboration the country’s demand generation profile . Systems strengthening based on client segments that were . 19 . Advocacy for resource mobilization identified and modelled by Ipsos19. These activities will also require full partner collaboration. Initial findings have already been adopted into the upcoming Advocacy and Communication Strategy (2016-2010), and a pilot study to help the Ministry and stakeholders determine how to integrate and implement segmentation in the most useful way.

At national level, this includes revising the main messages and communication

19 19 Implementing the segmented approach to VMMC demand generation, Next Steps 2016 Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 41 (2016-2020)

Figure 14 : Age proportions of total VMMCs Figure 14 : Age proportions of total VMMCs 120.0% 120.0%

100.0% 100.0% 50+ 80.0% 50+ 80.0% 15-49 61.7% 59.5% 55.8% 58.5% 55.8% 58.5% 15-49 60.0% 61.7% 59.5% 10-14 60.0% 10-14 <1 40.0% <1 40.0%

20.0% 36.3% 38.7% 42.3% 41.1% 20.0% 36.3% 38.7% 42.3% 41.1%

0.0% 0.0% 2012 2013 2014 2015 2012 2013 2014 2015

barrier to increasing this proportion of core IV. Improve program effectiveness by VMMCsbarrier to. increasing this proportion of core IV. focusing Improve theprogram majority effectiveness of demand by VMMCs. focusinggeneration the activities majority on of thedemand core age - The non-core group (10-14) has been generationgroups (15- 29activities years) on the core age- trendingThe non -coreupwards group since (10 -14)2012. has Goingbeen groups (15-29 years) forward,trending theupwards plan is sinceto reverse 2012. this Goingeffect whereforward, feasible the plan. Zambia is to reversehas a thisuniversal effect Age-targeting and Effectiveness where feasible. Zambia has a universal Age-targeting and Effectiveness access policy when it comes to health so In Zambia, modelling data in 2013 showed nonaccess-core policy age- groupswhen itwill comes not be to tuned health away. so thatIn Zambia, targeting modelling specific dataage ingroup 2013s showed(15-29) VMMCnon-core donorsage-groups support will notmeasures be tuned to away. dis- thatincreases targeting the program specific effectiveness age groups in(15 term-29)s VMMCincentiv izedonors MCs insupport this non measures-core age togroup, dis- increasesof the number the program of HIV effectiveness Infections inAverted terms butincentiv it willize be MCs challenging in this non to reverse-core age the group, trend (HIA)of the andnumber the immediacy of HIV Infections of this impact. Averted In sincebut it willabout be halfchallenging of the tonon reverse-core theMCs trend are (HIA)2015, onlyand 58.5%the immediacy of VMMCs of this fell impact.within the In sincefrom aboutnearly half saturatedof the non -and/ocore MCsr high are 2015,proxy 20only core 58.5% age- groupof VM MCsof 15 fell-49 within, showing the adolescentfrom nearly TMC saturatedprovinces whereand/o ther trendhigh annuallyproxy20 coredecreasing age-group trend of. This15- 49was, showing in part isadolescent going TMCin theprovinces opposite where direction.the trend dueannually to high decreasing MC coverage trend. (‘nearThis -wassaturation’) in part is going in the opposite direction. duerates to and high a MChigh coverage frequency (‘near of- saturation’)adolescent traditionalrates and aMC high (‘adolescent frequency TMC’) of adolescent in some hightraditional-volume MC provinces (‘adolescent which TMC’) present in someed a high-volume provinces which presented a

20 Zambia’s HMIS does not yet track 15 - 29 age -group so 15-49 was20 chosen as a proxy. Zambia’s HMIS does not yet track 15-29 age-group so 15-49 wasMinistry chosen asof a proxy.Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 42 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 42 (2016-2020)

The operational plan revision process has Despite successful campaigns every year, the redefinedThe operational target agepla-groupsn revision and processstrategies has to departureDespite successful and scaling campaigns down of every some year, prime the emphasizeredefined target core age--groupsgroups and(15- strategies29) and de to- demanddeparture generation and scaling partners down hasof someleft a visibleprime emphasize corenon -agecore-groups age groups(15-29) and(10- 14).de- gapdemand in generationdemand generation partners has funding left a visible and Onceemphasize allocated non -tocore the age district groups level, (10 these-14). activity.gap in Thus,demand partner generation collaboration funding through and targetsOnce allocatedwill organicallyto the district result level, inthese a theactivity. VMMC Thus, Communicationspartner collaboration TWG through will geographicallytargets will prioritizedorganically age resultstrategy inbased a becomethe VMMC increasingly Communications important toTWG fund andwill ongeographically current MC prioritized coverage/saturation age strategy basedrates. sustainbecome demandincreasingly generation important for to scalefund andup. Finally,on current on- goingMC coverage/saturationanalysis on effectiveness, rates. Implementingsustain demand partnersgeneration will for contributescale up. includingFinally, on synth-goingesis analysis and disseminationon effectiveness, of collectivelyImplementing to partnersa national will level contribute demand bestincluding-practices synth throughesis and the dissemination TWG will beof collectivelygeneration pool,to a organizednational levelfor demandspecific requiredbest-practices to measurethrough theprogress TWG towardswill be universallygeneration pool,beneficial organized activities for suchspecific as effectivenessrequired to measure progress towards campaignuniversally launchbeneficiales, activitiesdissemination such ofas effectiveness Advocacycampaign andlaunch Communicationses, dissemination policy of (2016Advocacy-2020), and marketingCommunications tools policyand V. Supplement funding for demand (2016segmentation-2020), researchmarketing etc. tools and V. generationSupplement through funding joint for -demandfunding of segmentation research etc. specificgeneration activities through joint-funding of specific activities

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 43 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 43 (2016-2020)

PILLAR 5: MONITORING AND EVALUATION PILLAR 5: MONITORING AND EVALUATION

Objective ToObjective reduce data discrepancies between HMIS and PRS from 37% to below 5% and developTo reduce HMIS/DHIS2 data discrepancies system between into HMIS a self -andsufficient, PRS fromreliable 37% sources to below of VMMC5% and M&Edevelop dataHMIS/DHIS2 by the end of 2017system into a self-sufficient, reliable sources of VMMC

M&E data by the end of 2017 Strategies

StrategiesI. Improve data capture, quality and accuracy at subnational level through I. consistentImprove datamonitoring capture, of qualityprogress and and accuracyevaluation at of subnational data to identify level and through solve programmaticconsistent monitoring challenges of progress and evaluation of data to identify and solve II. Harmonizeprogrammatic HMIS challenges and PRS tools and processes to reduce the data discrepancies III.II. TransitionHarmonize fully HMIS from and PRS PRS (Partner tools and Reporting processes System) to reduce to HMIS the data for discrepancies M&E III. Transition fully from PRS (Partner Reporting System) to HMIS for M&E

The M&E framework for VMMC plays the of VMMC - proportion of male Therole M&Eof reporting framework on key for achievementsVMMC plays andthe circumcisionsof VMMC conducted- proportion using devices of male evaluatingrole of reporting the effectiveness on key achievements of the VMMC and circumcisions conducted using devices programevaluating as the part effectiveness of Zambia’s of overallthe VMMC HIV preventionprogram as strategy.part of Zambia’sStandardized overall VMMC HIV I. Improve data capture, quality and dataprevention collection strategy. and Standardizedreporting tools VMMC (MC I. Improveaccuracy dataat subnational capture, quality level through and clientdata collectionIntake Form, and Register, reporting Adverse tools Ev(MCent consistentaccuracy at M&E subnational activities level to gaugethrough clientForm, IntakeReview Form, Form, Register, etc.) Adverse will inform Event consistentprogress and M&E evaluation activities of todata gauge to nationalForm, Reviewlevel summary Form, indicatorsetc.) will compiled inform progressidentify and and solve evaluation programmatic of data to bynational the newlevel VMMCsummary M&Eindicators Officer compiled once challengesidentify and solve programmatic hired.by the Thenewse VMMCbroad M&Enational Officer summary once challenges Monitoring hired. These broad national summary indicators will be tracked through HMIS: i) Monitoring cindicatorsoverage of will VM beMC tracked - number through of males HMIS: who i) Monitoring will done by the government chaveoverage been of VMcircumciseMC - numberd; ii) HIV of males status who - throughMonitoring HMIS will donewith bythe the supportgovernment of havenumber been of circumcisedcircumcised; males ii) HIVwho arestatus HIV - cooperatingthrough HMIS partners. with The the VMMC support national of positive,number ofHIV circumcised negative andmales unknown who are status; HIV technicalcooperating working partners. group’s The VMMC M&E national sub- iii)positive, adverse HIV Events negative (AE) and -unknown proportion status; of committee,technical workingled by group’sthe VMMC M&E M&Esub- moderateiii) adverse AEEvents and (AE)severe - proportionAE among of Officer,committee, shall led report by onthe VMMVMMCC p rogressM&E circumcisedmoderate AE males;and severeiv) followAE -amongup - Officer,based on shall routine report service on VMMdata collectedC progress at circumcisedproportion of males;circumcised iv) malesfollow with-up at- thebased facility on rleveloutine an serviced processed data throughcollected the at proportionleast one post of circumcisioncircumcised visitmales v) withmethod at HMIS.the facility The level following and processed specific tasksthrough will thebe least one post circumcision visit v) method HMIS. The following specific tasks will be Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 44 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 44 (2016-2020)

prioritized within the monitoring aspect of M&E.prioritized within the monitoring aspect of . Quarterly district level M&E. . performanceQuarterly reviewsdistrict: Each districtlevel . Incorporation of revised M&E healthperformance office reviewswill hold: Each quarterly district . toolsIncorporation and indicators of revised in HMISM&E: statushealth reviewoffice ofwill VM holdMC quarterlyprogram Thetools natiandonal indicators M&E framework,in HMIS: implementationstatus review of VMwhereMC programMC indicators,The national and updatedM&E toolsframework, will be providers,implementation Health Centrewhere in -chargesMC incorporatedindicators, and in updated the revised tools national will be providers,and district Health coordinators Centre willin-charges attend HMISincorporated summary. in the revised national toand review district their coordinators performance. will attend . StrengthenHMIS summary. the use of newly . Quarterlyto review their performance.provincial level . Strengthendeveloped M&Ethe toolsuse (registers,of newly . performanceQuarterly provincialreviews : Eachlevel clientdeveloped intake M&E forms tools and (registers, HIA 2): provincialperformance health reviewsoffice :will Eachhold usedclient in intake all facilities forms byand MoH HIA and2): quarterlyprovincial statushealth review office ofwill VM holdMC partners.used in all facilities by MoH and programquarterly implementationstatus review of where VMMC all . partners.Disseminati on of the M&E coordinatorsprogram implementation will attend towhere review all . Disseminatiframework andon revisedof the tools M&E: the theicoordinatorsr performance. will attend to review newframework national and M&E revised framework tools: willthe . Quarterlytheir performance. national VMMC benew disseminated national M&E and frameworkstaff trained will on . programQuarterly performance national review:VM MCThe revisedbe disseminated tools and staff trained on MoHprogram in performancecollaboration review: with Thethe . Conductingrevised tools data audit visits to VMMoHMC in TWGcollaboration will review with datathe . healthConducting facilities data : auditconduct visits bito- quarterlyVMMC TWGto target will follow review-up withdata annuallyhealth datafacilities audits: at conductnational levelbi- quarterlyprovinces to throughouttarget follow the-up withyear andannually begin data monthly audits dataat national audit visitslevel accordingly.provinces throughout the year atand district begin level,monthly focusing data onau ditfacilities visits . Annualaccordingly. national VMMC program reportingat district level,inconsistently focusing on facilities or . performanceAnnual national review VMMC: MoprogramH in irregularlyreporting to improveinconsistently data quality.or performancecollaboration withreview all :partners MoH willin Duringirregularly the to dataimprove audits, data VMMCquality. facilitatecollaboration a national with meetingall partners at end will of DistrictDuring thefocal datapoint audits, persons VMMC and thefacilitate year a nationalto review meeting atprogram end of DHIOsDistrict shouldfocal pointinterrogate persons the dataand performancethe year to andreview share program best onDHIOs a monthly should basis. interrogate the data practices.performance All andprovincial share healthbest on a monthly basis. officespractices. will Allbe representedprovincial andhealth all scientificoffices will as be well represented as operational and all Evaluation researchscientific findingsas well will asbe discussed.operational Evaluation Evaluation is critical to inform advocacy, research findings will be discussed. policyEvaluation development, is critical tostrategic inform advocacy,planning, II. Harmonize HMIS and PRS tools and programmaticpolicy development, and donorstrategic reporting. planning, It II. processesHarmonize to HMIS reduce and the PRSdata tools and providesprogrammatic insight and into donor what reporting.activities areIt processesdiscrepancies to reduce the data workingprovides andinsight what, into if whatany, activitieschanges are discrepancies requiredworking andfor what,VMMC if interventions.any, changes areTo In 2014 VMMC data discrepancies surfaced requiredinstitute forroutine VM MCreview interventions. of strategic To duringIn 2014 a VMMCcomparative data datadiscrepancies audit21 conducted surfaced information,institute routine the following review meetings of st willrategic be during a comparative data audit21 conducted heldinformation, each year: the following meetings will be 21 held each year: Zambia VMMC M&E Audit Report, September 2015 21 Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL Zambia VMMC M&E Audit PLAN Report, September 2015 45 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 45 (2016-2020)

in April 2015. The audit showed a deviation ofin Aprilup to 2015.37% Thebetween audit Health showed Ma a nagementdeviation &of upInformation to 37% between System Health (HMIS) Ma nagementand the Partner& Information Reporting System System (HMIS) (PRS), withand the formerPartner showingReporting higher System numbers. (PRS), Whilewith the M&Eformer progressshowing andhigher contribution numbers. Whilemade theby theM&E PRS progress to date and is noteworthy,contribution themade MoH by andthe PRSall VMMC to date partners is noteworthy, are committed the MoH to workand all towardsVMMC partnersstrengthening are committed the HMIS to systemwork towardsas the sole strengthening official source thefor VMMCHMIS datasystem by as end the ofsole 2017. official In source order forto VMMCachieve datathis, bythe endVMMC of 2017. program In order will toimplement achieve thethis, following the VMMC summary program recommendations will implement to addressthe following the following summary M&E recommendations challenges. to address the following M&E challenges.

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 46 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 46 (2016-2020)

Summary M&E Recommendations Summary M&E Recommendations Figure 15 : M&E challenges and solutions Figure 15 : M&E challenges and solutions

M&E Challenges M&E Recommendations M&Ei. ChallengesMissing/mis categorised data in M&Ei. RecommeAll MC sitesndations must submit their i. HMISMissing/mis due tocategoris non-availabilityed data in i. Allown MC numbers sites must on HIA submit forms their HMISof source due documents to non-availability at ownand/or numbers partners on must HIA leave forms ofoutreach source service documents delivery at points and/orcopies of partners source must documents leave at ii. outreachAggregated service numbers delivery reported points copiesfacilities of source documents at ii. Aggregatedunder PRS do numbers not have reported ii. facilitiesUnbundling of age bands, site undergranular PRS enough do not info have on age ii. Unbundlingtype and MC of reviews age bands, and site granularbands , site enough type andinfo MC on age typemethod and in MC data reviews reporting and tools bandsreviews , siteand type method and MC methodfor impact in dataassessment reporting tools iii. reviewsPoor data and-capturing method and iii. forComprehensive impact assessment guidelines and iii. Poorhandling data practices-capturing and and non - iii. Comprehensivecadence, clarification guidelines and and handlingadherence practices to recommended and non- cadence,designation clarification of responsibilities and adherenceguidelines oftento recommended occur at designationfor data management of responsibilities guidelinesservice delivery often pointsoccur at iv. forStandardization data management of tools into iv. serviceLack of delivery ownership points of data iv. Standardizationsingle tool and increased of tools intodata iv. Lackmanagement of ownership at sub -ofnational data singleinterrogation tool and at increased subnational data managementlevel at sub-national interrogationlevel to reconcile at subnational discrepancies v. levelWeak linkages exist between levelfaster to reconcile discrepancies v. WeakM&E linkagesand program exist between v. fasterM&E activities (DQA and data M&Eimplementation and program v. M&Einterrogation) activities incorporated (DQA and data into implementation interroutinerogation) implementation incorporated and into routinecampaign implementation planning and campaign planning

Table 4, below, is an expanded list of these recommendations categorized and customized by individualTable 4, below stakeholders/actors., is an expanded This list highlightsof these recommendations the level of responsibility categorized and and the customizeddifferent roles by thatindividual each typestakeholders/actors. of stakeholder willThis play highlights in revising the levelthe HMIS of responsibility M&E system and and the harmonizingdifferent roles it withthat eachthe typePRS; of thisstakeholder process willwill play require in revising a massive the HMIS collaborative, M&E system consultative and harmonizing approach. it with the PRS; this process will require a massive collaborative, consultative approach.

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 47 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 47 (2016-2020)

Detailed M&E Recommendations (Activities by stakeholder and level of care) Detailed M&E Recommendations (Activities by stakeholder and level of care)

Level of Health Care Findings Recommended Activities ServiceLevel of Delivery Health CarePoint (HealthFindings facility/hospital) Recommended Activities Service DeliveryHuman Point (HealthLack offacility/hospital) clear ownership of Delegate duty for MC register to specific HumanResources/Other Lackspecific of data clear capture ownership activities of Delegatecadre/officer duty for MC register to specific Resources/OtherSupport specific(MC register) data capture activities cadre/officer Support (MCWeak register) linkage between M&E Data review meetings , data comparison and Weakand program linkage data between M&E Datainterrogation review meetingsat all levels , data comparison and and program data interrogation at all levels Tools/Systems Different client intake forms Standardized client intake form Tools/Systems DifferentLack of data client capture intake tools forms StandardizedRequest for clientdata intakecapture form tools well in Lack of data capture tools Requestadvance fromfor datathe capturecentral leveltools (District/well in advanceProvinces) from the central level (District/ Inadequate indicators for Provinces)Introduce new indicators to HIA form Inadequateprogram indicators for Introduce new indicators to HIA form Processes program Processes Missing forms, data Record client intake per case MissingIncomplete forms, register data Record clientin register intake daily per case IncompleteLate, incomplete, register missing RecordFill and insubmit register HIA daily form monthly Late,facility dataincomplete, missing Fill and submit HIA form monthly facility data District Health Office District HumanHealth Office Lack of comparative data 1. Support the enhancement of data analysis HumanResources/Other Lackanalysis of at districtcomparative level data 1.and Support interrogation the enhancement at district of datalevel analysison a Resources/OtherSupport analysis at district level andmonthly interrogation basis to atinform district accurate level ondata a Support monthlycapture. basis to inform accurate data capture.2. Increase technical capabilities of the 2.DHIO Increase to conduct technical comparative capabilities analysis of theof DHIOPRS (partner to conduct summaries) comparative and HIA2 analysis forms of PRSbefore (partner entry into summaries) DHIS2 and HIA2 forms before entry into DHIS2 Irregular district data review 1. Build capacity for data interrogation and Irregularcausing a districtmismatch data betwee reviewn 1.verification Build capacity by -DHIOs for data and interrogation VMMC District and causingpartner anda mismatch district data betwee n verificationCoordinators by to - captureDHIOs accurateand VMMC data District partner and district data Coordinators2. Hold data review to capture meetings accurate frequently data 2. Hold data review meetings frequently

Tools/Systems Tools/Systems Lack of data capturing tools at District coordinators and Information Lackfacility of level data capturing tools at Districtofficers tocoordinators ensure that facilitiesand Information have data facility level officerscapturing to tools ensure at all thattimes facilities have data Underreporting in DHIS due capturing1. Communicate tools at withall times district coordinators to Underreportingto lack of source indocuments DHIS due at 1.ensure Communicate all numb erswith reported district coordinatorsat facility level to tooutreach lack of sites source documents at ensureare reported all numb to theers reporteddistrict aton facilitya monthly level outreach sites arebasis reported to the district on a monthly basis2. Delegated, DHIS trained hospital staff to 2.verify Delegated, and report DHIS MC traineddata monthly hospital staff to verify and report MC data monthly Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 48 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 48 (2016-2020)

Processes Lack of data verification by 1. District Medical Officers to send a memo Processes Lacksenior ofmanagement data verification at district by 1.informing District MedicaVMMCl Officersparent facilitiesto send ato memo send seniorlevel management at district informingmonthly summary VMMC reportsparent facilitiesof VMMC to senddata level monthlyfrom respective summary outreach reports and of static VMMC sites. data from2. DHIOs respective to outreachexpect receipt and static of sites.summary 2.reports DHIOs from to parent expect facilities receipt and of followsummary up reportswhen summary from parent report facilities is not received. and follow up when3. District summary Medical report Officers is not to received. verify and sign 3.VMMC District summary Medical dataOfficers from to parent verify andfacilities sign VMMCand partner summary reports. data from parent facilities and partner reports.

Provincial Health Office ProvincialHuman Health Office Lack of data comparative 1. Support monthly data comparative HumanResources/Other Lackanalysis of at provincialdata comparative level 1.analyses Support at provincial mont levelhly data comparative Resources/OtherSupport analysis at provincial level analyses2. Increase at provincial technical level capabilities of the Support 2.DHIO Increase to conduct technical comparative capabilities analysis of theof DHIOPRS (partner to conduct summaries) comparative and HIA2 analysis forms of PRSbefore (partner entry into summaries) DHIS2 and HIA2 forms before entry into DHIS2

Tools/Systems Lack of VMMC data review Support Provincial Health Information Tools/Systems Lackand interrog of VMMCation atdata provincial review SupportOfficers andProvincial Provincial Health Coordinators Information to andlevel interrog ation at provincial Officersconduct dataand review Provincial meetings Coordinators for VMMC to level conduct data review meetings for VMMC

Processes Lack of data quality audits at Enhance data quality through quarterly Processes Lackprovincial of data level quality audits at Enhanceprovincial auditsdata duringquality campaign through monitoring quarterly provincial level provincial audits during campaign monitoring VMMC National Coordinating Office VMMC HumanNational CoordinatingLack of Office dedicated staff to Hire a new M&E officer to interrogate HumanResources/Other Lackinterrogate of dedicateddata frequently staff to HireVMMC a datanew atM&E national officer level toon interrogatea monthly Resources/OtherSupport interrogate data frequently VMMCbasis data at national level on a monthly Support Lack of regular check-up and basisDelegate M&E officer to respond to requests Lacksupply of ofregular MC checkclient- upintake and Delegatefor data tools M&E officer to respond to requests supplyforms andof registersMC client intake for data tools Tools/Systems formsExcel andbased registers partner data Revise partner template into more granular Tools/Systems Excelaggregation based tool partnercontains widedata Reviseage bands partner template into more granular aggregationage bandwidth tool contains wide age bands ageLack bandwidth of program impact Revise MC register, HIA tool, HMIS to Lackanalysis of program impact Revisegranular MCage bandsregister, HIA tool, HMIS to analysisNumerous client intake forms granularStandardise age bandsthe client intake form as Numerous client intake forms Standardisegovernment documentthe client forintake VMMC form client as governmentcapture data document for VMMC client Processes HMIS data comparison with captureMonthly data interrogation of national VMMC Processes HMISPRS undertaken data comparison once sincewith Monthlydata interrogation of national VMMC PRSinception undertaken of VMMC once sincedata data inceptionelements in ofHMIS VMMC data elements in HMIS Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 49 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 49 (2016-2020)

Lack of RDQA tool Incorporate RDQA with supportive Processes Lack ofof RDQA data verificationtool by Incorporate1.supervision District Medica at nationalRDQAl Officers and withprovincial to sendsupportive alevel memo Implementing Partners senior management at district supervisioninforming VMMC at national parent and provincialfacilities tolevel send ImplementingHuman Partners Lacklevel of resources for data Participationmonthly summary in DQAs, reports IQAs of VMMCand EQAs data HumanResources/Other Lackquality of auditsresources and for M&Edata Participationperiodicallyfrom respective and in outreach beforeDQAs, a campaignandIQAs static and periodsites. EQAs Resources/OtherSupport qualitycapacity buildingaudits and M&E periodically2. DHIOs andto beforeexpect areceipt campaign of periodsummary SuTools/Systemspport capacityExcel based building data aggregation Revisereports partnerfrom parent template facilities into andmore follow granular up Tools/Systems Exceltool basedcontains data aggregationlarge age Reviseagewhen bands summary partner reporttemplate is notinto received. more granular toolbandwidth contains large age age3. District bands Medical Officers to verify and sign bandwidthMiscategoris ation of MC ProvideVMMC summarygranular datadata throughfrom parent PRS, facilitiesby site and partner reports. Misoutputscategoris (by siteation type, oflevel MCand Providetype (outreach granular anddata throughstatic), levelPRS, by(clinic, site outputsgeography) (by site type, level and typehospital) (outreach and relevantand static), geographical level (clinic, area geography) hospital)(district) and relevant geographical area Provincial Health Office (district) ProcessesHuman DataLack notof datashared comparativeat service Data1. isSupport to be leftmont at hlyrespective data comparativefacility, e.g. ProcessesResources/Other Datadeliveranalysis notpoints at provincialshared at level service Datacopiesanalyses is of atto client provincialbe leftintake at level formsrespective facility, e.g. Support deliverLack of points follow up on data copiesFollow2. Increase of upclient ontechnical intake data forms capabilitiescapture at offacility the Lackcapture of at followfacility up on data FollowespeciallyDHIO toup MC conduct onregister data comparative capture analysisat facility of capture at facility especiallyPRS (partner MC registersummaries) and HIA2 forms Table 4 : Detailed M&E recommendations bybefore stakeholder entry into and DHIS2 level of care Table 4 : Detailed M&E recommendations by stakeholder and level of care

Tools/Systems Lack of VMMC data review Support Provincial Health Information and interrogation at provincial Officers and Provincial Coordinators to level conduct data review meetings for VMMC

Processes Lack of data quality audits at Enhance data quality through quarterly provincial level provincial audits during campaign monitoring

VMMC National Coordinating Office Human Lack of dedicated staff to Hire a new M&E officer to interrogate Resources/Other interrogate data frequently VMMC data at national level on a monthly Support basis Lack of regular check-up and Delegate M&E officer to respond to requests supply of MC client intake for data tools forms and registers Tools/Systems Excel based partner data Revise partner template into more granular aggregation tool contains wide age bands age bandwidth Lack of program impact Revise MC register, HIA tool, HMIS to analysis granular age bands Numerous client intake forms Standardise the client intake form as government document for VMMC client capture data Processes HMIS data comparison with Monthly interrogation of national VMMC PRS undertaken once since data inception of VMMC data elements in HMIS Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 4950 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 50 (2016-2020)

III. Transition fully from PRS (Partner Reporting System) to HMIS for M&E III. Transition fully from PRS (Partner Reporting System) to HMIS for M&E Stage I:Processes Current SystemLack has of37% data data verification discrepancy by 1. District Medical Officers to send a memo Stage I: Current Systemsenior has 37%management data discrepancy at district informing VMMC parent facilities to send The previous section outlinedlevel detailed solutions to addressmonthly currently summary known reports gaps ofand VMMC provided data a basisThe previous for elevating section the outlined HMIS system detailed to solutionsbe the sole to official addressfrom VMMC currently respective data kn outreach source.own gaps and andstatic provided sites. a 2. DHIOs to expect receipt of summary basis for elevating the HMIS system to be the sole officialreports VMMC from data parent source. facilities and follow up The flow diagrams in this section illustrate the 3 stageswhen of summary transition report and is notthe received. characteristics definingThe flow each diagrams system in at thiseach sectionstage of illustrate transition. the Figure 3 stages 3.16 District, belowof transition Medical shows the Officersand currently the to characteristicsverify suboptimal and sign structuredefining eachfor VMMC system M&E.at each stage of transition. Figure VMMC16, below summary shows datathe currentlyfrom parent suboptimal facilities and partner reports. structure for VMMC M&E. Figure 16 : M&E Transition Stage I (Current Situation) Figure 16 : M&E Transition Stage I (Current Situation) Provincial Health Office Human Lack of data comparative 1. Support monthly data comparative Resources/Other analysis at provincial level analyses at provincial level Support 2. Increase technical capabilities of the DHIO to conduct comparative analysis of PRS (partner summaries) and HIA2 forms before entry into DHIS2

Tools/Systems Lack of VMMC data review Support Provincial Health Information and interrogation at provincial Officers and Provincial Coordinators to level conduct data review meetings for VMMC

Processes Lack of data quality audits at Enhance data quality through quarterly provincial level provincial audits during campaign monitoring

supply of MC client intake for data tools forms and registers Tools/Systems Excel based partner data Revise partner template into more granular aggregation tool contains wide age bands age bandwidth Lack of program impact Revise MC register, HIA tool, HMIS to analysis granular age bands Numerous client intake forms Standardise the client intake form as government document for VMMC client capture data Processes HMIS data comparison with Monthly interrogation of national VMMC PRS undertaken once since data inception of VMMC data elements in HMIS Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 4951 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 51 (2016-2020)

Figure 17 : M&E Transition Stage II (Intermediate) Processes Lack of data verification by 1. District Medical Officers to send a memo Figure 17 senior: M&E management Transition Stage at district II (Intermediate) informing VMMC parent facilities to send level monthly summary reports of VMMC data from respective outreach and static sites. 2. DHIOs to expect receipt of summary reports from parent facilities and follow up when summary report is not received. 3. District Medical Officers to verify and sign VMMC summary data from parent facilities and partner reports.

Provincial Health Office Human Lack of data comparative 1. Support monthly data comparative Resources/Other analysis at provincial level analyses at provincial level Support 2. Increase technical capabilities of the DHIO to conduct comparative analysis of PRS (partner summaries) and HIA2 forms before entry into DHIS2

Tools/Systems Lack of VMMC data review Support Provincial Health Information and interrogation at provincial Officers and Provincial Coordinators to level conduct data review meetings for VMMC Stage II: Complementary System aims for <5% disc repancy, 2016

These twoProcesses systems shouldLack oflive data side quality-by-side audits, as atshown Enhance in Figuredata quality17, while through the HMISquarterly is Stage II: Complementaryprovincial System level aims for <5% discprovincirepancy,al audits 2016 during campaign monitoring strengthened through increased data interrogation/comparison as well as best practice sharing Theseacross thetwo twosystems platforms. should Thelive nationside-byal -sideM&E, asTWG shown subcommittee in Figure 17shall, while be responsible the HMIS for is VMMC National Coordinating Office strengthenedreviewing these through findings increased and drawing data interrogation/comparisonup a feasible plan of action as im wellplemented as best duringpractice 2016 sharing and across theHuman two platforms.Lack Theof nationdedicatedal M&Estaff TWGto Hire subcommittee a new M&E shall officer be responsible to interrogate for 2017. Resources/Other interrogate data frequently VMMC data at national level on a monthly reviewingSupport these findings and drawing up a feasible planbasis of action implemented during 2016 and 2017. Lack of regular check-up and Delegate M&E officer to respond to requests supply of MC client intake for data tools forms and registers Tools/Systems Excel based partner data Revise partner template into more granular aggregation tool contains wide age bands age bandwidth Lack of program impact Revise MC register, HIA tool, HMIS to analysis granular age bands Numerous client intake forms Standardise the client intake form as government document for VMMC client capture data Processes HMIS data comparison with Monthly interrogation of national VMMC PRS undertaken once since data inception of VMMC data elements in HMIS Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 52 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 49 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 52 (2016-2020)

Figure 18 : M&E Transition Stage III (Fully transitioned, well functioning) Processes Lack of data verification by 1. District Medical Officers to send a memo Figure 18 : M&E Transitionsenior Stagemanagement III (Fully at transitioned, district informing well function VMMCing) parent facilities to send level monthly summary reports of VMMC data from respective outreach and static sites. 2. DHIOs to expect receipt of summary reports from parent facilities and follow up when summary report is not received. 3. District Medical Officers to verify and sign VMMC summary data from parent facilities and partner reports.

Tools/Systems Lack of VMMC data review Support Provincial Health Information and interrogation at provincial Officers and Provincial Coordinators to level conduct data review meetings for VMMC

Processes Lack of data quality audits at Enhance data quality through quarterly provincial level provincial audits during campaign monitoring Stage III: Sustainable HMIS system for VMMC ~0% discrepancy, 2017+ VMMC National Coordinating Office This third and final stage (Figure 18) will only be possible through the provision of complete Stage III:Human Sustainable HMISLack of system dedicated for VMMCstaff to ~0% Hire discrepancy, a new M&E 2017+ officer to interrogate and accurateResources/Other source datainterrogate collection data tools/forms, frequently clarificationVMMC anddata emphasisat national of level M&E on guidelinesa monthly Thisto improve thirdSupport and data final collection stage ( Figurepractices, 18) better will onlycategorization be possiblebasis and through disaggregat the provisionion of indicators of complete and andmore accurate effective, source integrated dataLack collection data of regularinterrogation tools/forms, check-up at and clarificationsubnational Delegate and M&Elevels. emphasis officer This to crossof respond M&E-cutting toguidelines requests effort requiresto improve the data buy collection-in andsupply practices,concerted of MC better effortclient categorization intakefrom allfor data governmentand tools disaggregat andion non of -indicatorsgovernmental and forms and registers morestakeholders effective, in the integrated VMMC spacedata .interrogation By December at 2017, subnational the HMI Slevels. should This be incross final- cuttingstage 3 whereeffort Tools/Systems Excel based partner data Revise partner template into more granular misalignmentsrequires the buyin the-in dataandaggregation flowconcerted structures tool containseffort between fromwide the allage PRS bandsgovernment and HMIS andno longer non- governmentalexist and the HMISstakeholders is a fully in theindependent VMMCage spacebandwidth and effective. By December source 2017,of VMMC the HMI M&ES should data. be in final stage 3 where misalignments in the dataLack flow ofstructures program between impact the Revise PRS andMC HMIS register, no HIAlonger tool, exist HMIS and theto HMIS is a fully independentanalysis and effective source of VMMCgranular M&E age bandsdata. Numerous client intake forms Standardise the client intake form as government document for VMMC client capture data Processes HMIS data comparison with Monthly interrogation of national VMMC PRS undertaken once since data inception of VMMC data elements in HMIS Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 53 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 49 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 53 (2016-2020)

Processes Lack of data verification by 1. District Medical Officers to send a memo senior management at district informing VMMC parent facilities to send level monthly summary reports of VMMC data from respective outreach and static sites. PILLAR 6: IMPLEMENTATION2. DHIOs SCIENCE to expect receipt of summary PILLAR 6: IMPLEMENTATIONreports from SCIENCE parent facilities and follow up when summary report is not received. Objective 3. District Medical Officers to verify and sign VMMC summary data from parent facilities ToObjective conduct operations research studies toand fill partner the most reports. critical VMMC information gapsTo conduct and provide operations implementable research recommendationsstudies to fill the for most VMMC critical policy VMMC and practice information gaps and provide implementable recommendations for VMMC policy and practice

Provincial Health Office Strategies Human Lack of data comparative 1. Support monthly data comparative StrategiesI. Resources/Other Facilitate stakeholderanalysis at provincial participation level in IS analysesactivities at provincialand develop level and maintain a I. SupportliveFacilita databasete stakeholder of implementation participation science in IS projects/studies 2.activities Increase and technical develop capabilities and maintain of athe II. Ensurelive database wide ofdissemination implementation of study science findings projects/studiesDHIO and to facilitate conduct the comparative adoption ofanalysis these of PRS (partner summaries) and HIA2 forms II. findingsEnsure wide to improve dissemination program of implementation study findingsbefore and entry facilitate into DHIS2 the adoption of these findings to improve program implementation

Implementation science (IS) is the study of outcomes. Implementing partners and the methodsImplementationTools/Systems to promote science Lackthe(IS) isintegrationof the VMMC study dataof reviewMoHoutcomes. Support will workImplementingProvincial together Health topartners set Informationa researchand the researchmethods tofindings promote and andthe interrogevidenceintegrationation intoatof provincial agendaMoH Officers will that work bestand fitProvincialtogethers the program. toCoordinators set a research to level conduct data review meetings for VMMC healthcareresearch policyfindings or practice.and evidence This improves into agenda that best fits the program. executionhealthcare policyof programsor practice. byThis translating improves I. Facilitate stakeholder participation researchexecutionProcesses findings of programs and evidenceLack byof intodatatranslating practicequality audits at Enhance data quality through quarterly atresearch scale. Itfindings will also and inf ormevidenceprovincial MoH into and level practicepartner I. provinciinFacilitate IS activitiesal audits stakeholder during and developcampaign participation andmonitoring in IS activities and develop and atorganizations scale. It will about also inf bestorm practices MoH and in partnerservice maintain a live database of delivery,VMMCorganizations National resource about Coordinating bestutilization, practices Office indemand service implementationmaintain a live database science of generdelivery,ation,Human resource behavioural utilization,Lack changeof dedicateddemand and staff to Hireimplementationprojects/studies a new M&E scienceofficer to interrogate generutilizationation,Resources/Other of technologicalbehavioural interrogate solutions.change data IS frequently andhas VMMCprojects/studies data at national level on a monthly Support Researchbasis prioritization utilization of technological solutions. IS has four component areas thatLack canof regularbe utilized check -up andResearch Delegate prioritization M&E officer to respond to requests foureither component individually areas and/or thatsupply jointly can of be toMC utilizedinform client intakeFor for the data Zambian tools program to efficiently use eitherthe VM individuallyMC program: and/or forms jointly and registersto inform limitedFor the resourcesZambian programand to improve to efficiently outcome use thei. VM MCTools/SystemsUtilization program: of Excelmonitoring based partnerand dataeffectiveness,limited Revise resources partner research templateand topriorities improveinto more which outcome granular can aggregation tool contains wide age bands i. evaluationUtilization dataof monitoring and effectiveness, research priorities which can age bandwidth contribute significantly to the success of the ii. Operationsevaluation data research Lack of program impactprogramcontribute Revise MC mustsignificantly register, be identified. toHIA the tool,success The HMIS ofocusf theto iii.ii. ImpactOperations evaluation researchanalysis shouldprogramgranular be must ageon bands areasbe identified.representing The potential focus iv.iii. ImpactCost-effectiveness evaluationNumerous estimation client intake forms bottleshouldStandardise necks be on or theareasbarriers client representing to reachingintake potentialformnational as iv. Cost-effectiveness estimation targetsbottlegovernment necksfor orproviding documentbarriers to safefor reaching andVMMC effectivenational client capture data targets for providing safe and effective The useProcesses of these methodologicalHMIS data tools comparison will withVM MonthlyMC services. interrogation This ofincludes national optimalVMMC provideThe use aof rigorous these methodological evidencePRS baseundertaken totools inform wonceill sincemethodsVM dataMC services.for improving This programincludes efficiencyoptimal nationalprovide apolicies rigorous and evidence proceduresinception base in toof order informVMMC to dataandmethods quality, for improvingeffective demandprogram generationefficiency improvenational policiesVMMC aprogramnd procedureselements performance inin HMISorder and to models,and quality, models effective of services demand integration generation that improve VMMC program performance and models, models of services integration that Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 4954 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 54 (2016-2020)

reinforce VMMC outcomes, supply chain a prioritization of needs based on the management tools and methods for Zambian program context. Also, Table 5 reducingreinforceProcesses VMcostsMC outcomes,and Lackprogram ofsupply data impactverificationchain byindicatesa 1.prioritization District whether Medica ofthel Officers needssource tobasedof sendinformation ona memo the senior management at district informing VMMC parent facilities to send management tools and methods for Zambian program context. Also, Table 5 assessments. Table 5 provideslevel a general regardingmonthly best summary practi cesreports is mostly of VMMC likely to data be reducingoverview ofcosts priority and areas, program specific examplesimpact foundindicatesfrom in respective whetherstudies and outreachthe practicessource and ofstatic in information the sites. region assessments.of research and Table evaluation 5 provides topics, aas generalwell as orregarding 2.within DHIOs Zambia.best topracti expect ces isreceipt mostly of likely summary to be overview of priority areas, specific examples foundreports in studiesfrom parent and practicesfacilities andin the follow region up when summary report is not received. of research and evaluation topics, as well as or within Zambia. Table 5: Implementation science prioritization 3. District Medical Officers to verify and sign VMMC summary data from parent facilities and partner reports. TableArea 5: ImplementationExample science topicsprioritization Prioritization Information Source AreaSurgical Efficiency ExampleVMMC Surgical topics methods, VMMC devices, PrioritizationHigh InformationRegional, Zambia Provincial Health Officetask shifting, task sharing, provider retention Source Human Lack of data comparative 1. Support monthly data comparative SurgicalDemand Efficiency creation VMMCCommunity Surgical based, meth IPCods, models,VMMC devices,referral High Regional,Zambia, Regional Zambia Resources/Other analysis at provincial level analyses at provincial level Support tasksystems, shifting, reaching task sharing,out to women provider retention2. Increase technical capabilities of the DemandQuality creation CommunityAdverse events, based, client IPC satisfaction, models, referral DHIOclient toHigh conduct comparativeZambia, analysis Regional of systems,follow-up, reaching CT rates, out tocounselling women services,PRS (partner summaries) and HIA2 forms Quality clientAdverse and events, female clientpartner satisfaction, understanding beforeclient of entryHigh into DHIS2 Zambia, Regional VMMC’sfollow-up, effects CT rates, counselling services, Service integration clientVMMC and linkages female withpartner RH, understanding FP and HIV of High Regional, Zambia, & Sustainability VMMC’sservices, effectsSustainable models for VMMC Lack of VMMC data review Support Provincial Health Information Service Tools/Systemsintegration VMMCroutinization linkages and withintegration RH, FP into and MoHHIV High Regional, Zambia, and interrogation at provincial Officers and Provincial Coordinators to structures & Sustainability services,level Sustainable models for VMMCconduct data review meetings for VMMC routinization and integration into MoH Commodities and structuresHuman resources, VMMC kits, VMMC High Zambia, Regional supplies Processes devicesLack of data quality audits at Enhance data quality through quarterly Commodities and Human provincial resources, level VMMC kits, VMMCprovinci alHigh audits during campaignZambia, monitoring Regional suppliesImpact devicesHIV incidence, health systems, economic Moderate Regional, Zambia VMMC National Coordinating productivity, Office behavioural Impact Human HIVLack incidence, of dedicated health systems,staff to economic Hire a newModerate M&E officerRegional, to interrogate Zambia Resources/Otherproductivity, interrogate behavioural data frequently VMMC data at national level on a monthly Support basis to the longer timeline generally required for Obtaining informationLack for evidenceof regular- check-up and Delegate M&E officer to respond to requests supply of MC client intakecomplex for data study tools designs, including protocol based decision makingforms and registers development,to the longer timelineethical generally review, required study for Obtaining information for evidence- Tools/Systems Excel based partner dataimplecomplex Revisementation, partnerstudy designs,analysistemplate includingandinto disseminationmore protocolgranular MoHbased decisionwill collaborate making aggregationwith implementing tool contains wide age bands ofdevelopment, key findings. Thereforeethical otherreview, approaches study partners to frame researchage bandwidth and evaluation implementation, analysis and dissemination prioritiesMoH will and collaborate ensure the Lackwith incorporation implementingof program of impactfor Revise collecting MC evidence,register, HIA as welltool, as HMISIS tools to of key findings. Therefore other approaches evidencepartners tointo frame program research analysispractice. and evaluationResearch shouldgranular be age utilized bands in conjunction with for collecting evidence, as well as IS tools projectspriorities and and impact ensure evaluations theNumerous incorporation that client require intake of forms evidenceStandardise generated the clientfrom intakemore formcomplex as shouldgovernment be utilized document in conjunctionfor VMMC clientwith levidenceonger time into lines program and more practice. rigorous Research study research and evaluation projects. evidencecapture datagenerated from more complex designsprojects Processes willand beimpact unlikely evaluations HMISto inform data that programcomparison require with Monthly interrogation of national VMMC research and evaluation projects. scalelonger-up time in the lines immediate and morePRS-term. rigorousundertaken This isstudy dueonce since data designs will be unlikely inceptionto inform ofprogram VMMC data elements in HMIS Ministryscale-up ofin Health,the immediate Zambi-aterm. | VMMC This NATIONALis due OPERATIONAL PLAN 55 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 49 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 55 (2016-2020)

Operations research . Increasing demand for VMMC services using referrals to Below isProcesses a selection of Lackoperations of data research verification by 1. District Medical Officers to send a memo Operations research . VMIncreasingMC: Given demand the broad for VMstrategyMC topics that have particularsenior relevance management and at district informing VMMC parent facilities to send forservices VMMC usingdemand referralsgeneration, ISto importanceBelow is a selectionfor the of leveloperationsZambia researchVMCC monthly summary reports of VMMC data from willVMrespective MCbe : outreachusedGiven tothe and understand broadstatic sites. strategy the program.topics that Thehave topics particular reflect relevance the current and 2. DHIOsrelativefor VM to MC impactexpect demand ofreceipt communicationgeneration, of summary IS needsimportance of the forprogram: the toZambia reach nationalVMCC reports from parent facilities and follow up strategieswill be used(e.g., tomedia understand campaigns the targets,program. increase The efficiencytopics reflect and safetythe currentand to when summary report is not received. comparedrelative impact toof communicationinterpersonal assureneeds ofthe thelong program:-term effectiveness to reach nationalof the 3. District Medical Officers to verify and sign VMMCcommunication),strategies summary (e.g., data fromtomedia ensure parent campaigns resources facilities targets, increase efficiency and safety and to VMCC intervention. The following list is and partnerarecompared usedreports. mostto effectively.interpersonal IS indicative,assure the butlong by- termno means effectiveness exhaustive. of the researchcommunication), will also tobe ensureused to resources increase VMCC. intervention. The following list is VMMC Devices: According to the theare useused and most efficiency effectively. of family IS indicative,Provincial Healthbut by noOffice means exhaustive. studies that were conducted in planning,research will reproductive also be used health to increase and . HumanZambiaVMMC onDevices: the acceptability,Lack According of data safety,to thecomparative 1. Support monthly data comparative Resources/Other analysis at provincial level analysesHIVthe at useprovincialpr eventionand levelefficiency and oftreatment family studies that were conductedTM in Supportefficacy, of the Shang Ring and 2. Increaseservicesplanning, technical asreproductive a referral capabilities forhealth VMof MCandthe ZambiaTM on the acceptability, safety, Prepex devices, both devices DHIOservices.HIV to conductpr eventionAssessments comparative and of analysistreatmenteffective of efficacy, of the Shang RingTM and PRS (partner summaries) and HIA2 forms showed strong indication that the referralservices andas clienta referral follow for-up, VMas wellMC PrepexVMMCTM devi dceevices, can potentiallyboth devices bring before entry into DHIS2 services.as potential Assessments client incentives of effective will be showed strong indication that the about improvements in service referralevaluated. and client follow-up, as well VMefficiency,MC devi increasedce can potentiallysafety, decrease bring . Riskas potential compensation client incentives: willRisk be about improvements in service Tools/Systemscost, and encourage Lack greater of VMMC demand data review Supportcompensationevaluated. Provincial is Healthcharacterized Information as the forefficiency, VMMC increased services.and interrogsafety, Considering ationdecrease at provincial Officers and Provincial Coordinators to level conduct. increaseRisk data review in compensationsexu meetingsal risk behaviourfor VMMC: Risk due thatcost, andmost encourage of the greaterdevices demand have compensationto a belief that is VMCCcharacterized significantly as the for VMMC services. Considering received WHO pre -qualification, the increasereduces inor sexueliminatesal risk behaviourone’s risk due of that most of the devices have Processesprogram will endeavourLack of datato scale quality up audits at Enhanceacquiringto a databelief qualitythatHIV. VMCC throughWell significantly -designedquarterly received WHO preprovincial-qualification, level the provincial audits during campaign monitoring the use of devices in routine VMMC reducesprospective or eliminatesevaluations one’s are expected risk of program will endeavour to scale up service provision, alongside the acquiringto be key sourcesHIV. of informationWell-designed to the use of devices in routine VMMC VMMC currentNational surgical Coordinating methods. Office The scale assureprospective that riskevaluations compensation are expected does Humanservice provision,Lack alongsideof dedicated the staff to Hire a new M&E officer to interrogate up process will be preceded by notto be offset key sourcesthe benefits of information of VMMC onto Resources/Otheractivecurrent surveillancesurgical interrogatemethods. phase Thedatain selectfrequentlyscale VMMC data at national level on a monthly Support basis assureHIV thatin riskZambia. compensation Further, does publicup process sector will facilities,be preceded to bybe Lack of regular check-up and Delegatenotinterventions M&Eoffset officer the thatbenefits to maximizerespond of VM to positiverequestsMC on active surveillance phase in select followed by full scalesupply up. of MC client intake for databehaviourHIV tools in changeZambia. shouldFurther, be . public sector formsfacilities, and registersto be Methods for improving efficiency interventionsassessed and thatwill bemaximize integrated positive into Tools/Systemsfollowed by full scaleExcel up. based partner data Revise partner template into more granular of services: Priorities have to be behaviourthe VMCC programchange to maximizeshould thebe . Methods for improvingaggregation efficiency tool contains wide age bands determined and ageset bandwidth regarding best beneficialassessed and impact will onbe the integrated epidemic. into practicesof services: for surgeryPriorities and have services to beto Lack of program impact Revise. Sustainabilitythe MC VMCC register, program : HIAGiven totool, maximizethe HMISdeclining theto determined and set regarding best promote efficiencyanalysis and lower per- granularglobalbeneficial age bandsV MMCimpact resouon therce epidemic. envelope MCpractices costs. for ThesurgeryNumerous Zambia and services clientcountry intake to forms Standardise the client intake form as . andSustainability the inevitable: Given reductionthe declining in programpromote efficiencywill determine and lower perand- government document for VMMC client captureimplementingglobal data VMMC partner resou rceparticipation envelope MCimplement costs. itsThe own Zambia approach country for Processes HMIS data comparison with Monthlyinand VMMC interrogationthe inevitablein the of long nationalreduction run, VMMC what in program will determine and high-volume, highPRS- qualityundertaken service once since data modelsimplementing of transition partner and participation integration provision.implement its owninception approach of VMMC for data in VMMC in the long run, what high-volume, highelements-quality in HMISservice Ministry of Health, Zambia | VMMC NATIONAL OPERATIONALmodels of transitionPLAN and integration provision. 56 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 49 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 56 (2016-2020)

are most sustainable for the MoH to . Adverse events – tracking AEs by continue VMMC services with facility type, provider, and client limitedareProcesses most partner sustainable support?Lack for of thedata MoH verification to by 1.. DistrictAdversecharacteristics; Medica eventsl Officers – tracking to send AEsa memo by senior management at district informing VMMC parent facilities to send continue VMMC services with level monthly. Behaviouralfacility summary type, data reportsprovider, – assess of VMMC riskand factorsclient data Synthesizinglimited partnerexisti ngsupport? research and from ofcharacteristics;respective VMMC outreach clients andand staticrelationship sites. to evaluation: IS research and evaluation on 2.. DHIOsVCTBehavioural uptake;to expect data –receipt assess of risk summary factors VMSynthesizingMC programs existi tong dateresearch has beenand reports. of fromVMMC parent clients facilities and relationshipand follow upto when Servicesummary uptake report istracking not received. – adjus ting IS research and evaluation on conductedevaluation: regionally and within Zambia. 3. DistrictVCTcommunication Medical uptake; Officers models to verify andgiven sign ApplicableVMMC programs and practical to recommendationsdate has been VMMC. Servicedemand summary uptakeseasonality; data trackingfrom and parent – adjus facilitiesting fromconducted such regionallystudies will and bewithin systematically Zambia. and. partnerImpactcommunication reports. of VMCC onmodels health systemsgiven analysedApplicable, synthesized,and practical disseminated,recommendations and –demand assessing seasonality; impact andof VMCC on utilfromized such in program studies decision will be making. systematically . provisionImpact of ofVMCC other onservices. health systems analysedProvincial, Healthsynthesized, Office disseminated, and Human Lack of data comparative 1. –Support assessing mont impacthly data of VMCCcomparative on Examplesutilized Resources/Otherin programof program decision issuesanalysis making. for at which provincial data level Routineanalysesprovision data at provincial analysis/reviews of other level services. : Program can be synthesizedSupport and applied include: Information 2. Increase and technical data that capabilities may be availableof the DHIO to conduct comparative analysis of Examples. VM ofMC program Devices issues – forevaluation which data of willRoutine be dataused analysis/reviewsto answer some: Programrelevant can be synthesized and applied include: PRS (partner summaries) and HIA2 forms device safety from field studies and questionsInformationbefore entry related and into data toDHIS2 VMMC. that may Examples be available of . VMregionalMC studies;Devices – evaluation of routinewill be data used reviews to answerare some relevant . deviceEffective safety counselling from field and studies informed and questions . Community related to-based VMMC. interviews Examples ofto consentregional studies;procedures – evaluations of routine assessdata reviews acceptability are of VMMC Tools/Systems Lack of VMMC data review Support Provincial Health Information . bestEffective practices; counselling and informed . Community-based interviews to and interrogation at provincial Officersdevices and (mysteryProvincial clientCoordinators surveys to& . Improvingconsent procedures VCTlevel testing– evaluations rates of– conductsatisfiedassess data review clientacceptability meetings surveys) for of VMMC VM MC bestimpact practices; evaluations of specific . Trendsdevices (mysteryin the acceptabilityclient surveys and & . Improvinginterventions VCT to improvetesting ratesuptake; – demandsatisfied clientfor VMsurveys)MC among sub- andimpactProcesses evaluationsLack ofof data specificquality audits at Enhance. Trendspopulations; data in quality the acceptabilitythrough quarterly and provincial level provincial audits during campaign monitoring . Marketinterventions-based to segmentationimprove uptake; of demand for VMMC among sub-

clientsand to inform demand generation Processpo evaluationpulations; and documentation VMMC National Coordinating Office . continuouslyMarket-based segmentation of of practices: The successes and failures of Human Lack of dedicated staff to Hire a new M&E officer to interrogate clients to inform demand generation Resources/Other interrogate data frequently programProcessVMMC implementation evaluationdata at national and willlevel documentation be on systemically a monthly CollatingcontinuouslySupport and analysing M&E data: gathered,of basispractices: analysed The successesand used and to failures produce of M&E data is collated Lackfrom ofpublic regular health check -up andrecommendationsprogram Delegate implementation M&E officer tofor will respond be systemicallymid to requests-course Collatingfacilities and and partner analysing organizationssupply M&Eof toMC inform data:client intakecorrectionsgathered, for data toolsanalysed and program and usedadaptations. to produce Key M&E data is collated formsfrom andpublic registers health recommendations for mid-course the VMTools/SystemsMC program Excel (see basedpillar partner 5: dataquantit Reviseative partner process template indicators into more willgranular be Monitoringfacilities and & partner Evaluation). organizationsaggregation to tool inform contains wideincorporatedcorrections age bands and in programthe M&E adaptations. system Keyand Thisthe allowsVMMC the programprogramage to bandwidth(see track pillar progress 5: utilizedquantitative to summarize process programindicators development will be towardsMonitoring targets & Evaluation). and improveLack theof efficiencyprogram impactandincorporated Revise progress. MC Emphasisinregister, the HIAM&Eshould tool, besystem placedHMIS and onto analysis granular age bands andThis quality allows of the services. program Examples to track of progress specific processutilized tonarratives summarize that program focus on development prioritized Numerous client intake forms Standardise the client intake form as towards targets and improve the efficiency and progress. Emphasis should be placed on topics where M&E systems can inform researchgovernment areas document and topicsfor VMMC (Table client 5: programs:and quality of services. Examples of specific processimplementationcapture narratives data science that focusprioritization). on prioritized topics whereProcesses M&E systemsHMIS datacan comparisoninform with research Monthly areasinterrogation and topicsof national (Table VMMC 5: programs: PRS undertaken once sinceimplementation data science prioritization). inception of VMMC data elements in HMIS Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 57 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 49 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 57 (2016-2020)

Examples of process evaluation objectives platforms for the prioritization of include: implementation science topics and for Examples. ProcessesNarratives of process of program evaluationLack ofevolution; dataobjectives verification byprovidiplatforms 1. Districtng updates Medicafor thel Officerson prioritizationassessments to send a memo andof senior management at district informing VMMC parent facilities to send include:. Documentation levelof program failures evaluations.implementationmonthly summary Inscience reportsaddition, topics of VMMC biand-annual datafor . Narrativesand reasons of programtarget objectives evolution; were implementationprovidifromng respective updates outreach scienceon andassessments staticdissemination sites. and . missed;Documentation of program failures meetingsevaluations.2. DHIOs should toIn beexpect heldaddition, receiptto inform of biprogramsummary-annual . and reasons target objectives were developmentimplementationreports from during parentscience facilitiesthe critical disseminationand followscale- upup Delineate program performance when summary report is not received. scoresmissed; to quantify success; and phases.meetings3. District The should Medicalbi- annualbe heldOfficers meetingto informto verify should program and signbe . DocumentationDelineate program of performanceprogram developmentcoordinatedVMMC summary by during the MoH,data the from and critical parentbe focused scalefacilities- onup investmentsscores to quantify and costs. success; and phases.evidenceand partner The to improve reports.bi-annual program meeting practice should andbe

. Documentation of program coordinatedoutcomes with by representationthe MoH, and frombe focused national, on

investments and costs. provincialevidence to and improve district program level officials.practice andTo Provincial Health Office II. Ensure wide dissemination of study Human Lack of data comparativeensureoutcomes 1. evidenceSupport with representation becomesmonthly practice,data from comparative the national, MoH findingsResources/Other and facilitate analysis the atadoption provincial level isprovincial analysescommitted atand provincial to districtusing level itlevel to informofficials. policy To II. ofEnsure theseSupport widefindings dissemination to improve of program study ensureand2. toIncrease evidencefacilitate technical becomesstandardizati capabilitiespractice,on of the practicesof MoH the implementationfindings and facilitate the adoption andis DHIOcommitted while to conduct tomonitoring using comparative it to progressinform analysis policy onof PRS (partner summaries) and HIA2 forms of these findings to improve program programand to facilitatematic changes. standardizati Donorson andof practicespartners Dissemination and utilization of IS before entry into DHIS2 implementation andare expectedwhile tomonitoring play a significant progress role onin evidence programproviding matic resources changes. and Donors support and for partners IS in Dissemination and utilization of IS keyare expectedpriority toareas play aby significant supporting role ISin evidenceFor IS to be effective, evidence needs to be Tools/Systems Lack of VMMC data reviewdisseminationproviding Support resourcesProvincial meetings, and Health supportcooperating Information for ISwith in disseminated to ministry,and interrogpartnersation andat provincial Officers and Provincial Coordinators to stakeholdersFor IS to be effective,and utilized evlevelidence for needs program to be thekeyconduct MoHpriority datain reviewcollectingareas meetingsby informationsupporting for VMMC andIS decisiondisseminated making. to Theministry, VM M C partnersTWG, as welland disseminationaligning their operations meetings, to cooperating national policy. with asstakeholders the M&E suband-committee utilized of forthe TWGprogram are the MoH in collecting information and decisionProcesses making. The VMLackMC of TWG, data qualityas well audits ataligning Enhance their data operations quality to throughnational policy.quarterly provincial level provincial audits during campaign monitoring as the M&E sub-committee of the TWG are

VMMC National Coordinating Office Human Lack of dedicated staff to Hire a new M&E officer to interrogate Resources/Other interrogate data frequently VMMC data at national level on a monthly Support basis Lack of regular check-up and Delegate M&E officer to respond to requests supply of MC client intake for data tools forms and registers Tools/Systems Excel based partner data Revise partner template into more granular aggregation tool contains wide age bands age bandwidth Lack of program impact Revise MC register, HIA tool, HMIS to analysis granular age bands Numerous client intake forms Standardise the client intake form as government document for VMMC client capture data Processes HMIS data comparison with Monthly interrogation of national VMMC PRS undertaken once since data inception of VMMC data elements in HMIS Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 58 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 49 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 58 (2016-2020)

Processes Lack of data verification by 1. District Medical Officers to send a memo senior management at district informing VMMC parent facilities to send level monthly summary reports of VMMC data from respective outreach and static sites. PILLAR 7: RESOURCE MOBILIZATION2. DHIOs to expect receipt of summary PILLAR 7: RESOURCE MOBILIZATIONreports from parent facilities and follow up when summary report is not received. Objective 3. District Medical Officers to verify and sign VMMC summary data from parent facilities ToObjective mobilize sufficient financial resources andto cover partner the reports.programmatic funding gap while alsoTo mobilize ensuring sufficientefficient and financial effective resources use of existing to cover resources the programmatic funding gap while also ensuring efficient and effective use of existing resources

Provincial Health Office Strategies Human Lack of data comparative 1. Support monthly data comparative StrategiesI. Resources/Other Mobilize sufficientanalysis at resourcesprovincial levelfor continuedanalyses scale at- upprovincial through level a new, intensive I. SupportTMobilize WG sub sufficient-committee resources (Resource for continuedMobilization)2. Increasescale -upwhile technicalthrough maintaining acapabilities new, intensiveefficient of the DHIO to conduct comparative analysis of utilizationTWG sub of-committee existing funding (Resource Mobilization) while maintaining efficient PRS (partner summaries) and HIA2 forms II. Maintainutilization andof existing document funding an accurate understandingbefore entry into of DHIS2 the VMMC resource II. environmentMaintain and and document programmatic an accurate funding understanding gaps at all times of the VMMC resource environment and programmatic funding gaps at all times

Tools/Systems Lack of VMMC data review Support Provincial Health Information The goal of this operationaland interrog planation is atto provincial due Officers to continued and Provincial integration Coordinators of service to achieveThe goal 90% of thiscoverage operationallevel of VMMC plan is forto delivery,dueconduct to continued dataoutput/performance review integrationmeetings for VMMCof servicebased uncircumcised,achieve 90% coverageHIV-negative of VMMCmen within for compensationdelivery, output/performance at reasonable cost, as wellbased as theuncircumcised, core age- grHIVoup -negativeby 2020. menWhile within the matchingcompensation of demandat reasonable and cost,supply as wellduring as Processes Lack of data quality audits at Enhance data quality through quarterly servicethe core delivery age-gr modelsoup by provincial and2020. scale Whilelevel-up plans the outreach,matchingprovinci minimizingalof audits demand during long andcampaign distance supply monitoring outreach during service delivery models and scale-up plans outreach, minimizing long distance outreach outlined in this document are expected to and adopting reusable commodities. Despite improveoutlinedVMMC National thein thisefficiency documentCoordinating of resources are Office expected directed to andthis adoptingrelatively reusaefficientble commodities. resource utilization, Despite towardsimproveHuman theVMMC, efficiency significant ofLack resources of dedicatedadditional directed staff toZambiathis Hire relatively a needsnew efficient M&Ean officerresourceintensive to utilization,interrogateresource resourcestowardsResources/Other willVMMC, be required significantinterrogate to meet additionalthedata stated frequently mobilizationZambiaVMMC needsdata drive at national anfor thisintensive level new on Operational a resourcemonthly targets.resources Support will be required to meet the stated Planmobilizationbasis (2016 -2020) drive in for order this tonew meet Operational the new Lack of regular check-up and Delegate M&E officer to respond to requests targets. targetsPlan (2016 which-2020) are ambitiousin order to and meet will the require new supply of MC client intake for data tools forms and registers atargets strong which focus are on ambitious raising more and willfunding require to I. Mobilize sufficient resources for Tools/Systems Excel based partner datareacha strongRevise these focuspartner targets. on template raising intomore more funding granular to I. Mobilize sufficient resources for continued scale-upaggregation through a tool new, contains wide reach age thesebands targets. continued scale-up through a new, intensive TWG subage-committee bandwidth Some of the current hindrances to resource intensive TWG subLack-committee of program impact Revise MC register, HIA tool, HMIS to (Resource Mobilization) while mobilizationSome of the andcurrent utilization hindrances are: to resource (Resourcemaintaining Mobilization) efficientanalysis utilization while of granular age bands Numerous client intake forms mobilizationStandardise• Intermittent and the utilization clientfunding are:intake disruptions form as maintainingexisting funding efficient utilization of government• andIntermittent disbursement document funding delaysfor VMMC disruptions client existing funding capture data • Lackand disbursement of private delays sector health Over theProcesses years, ZambiaHMIS has datamanaged comparison to with Monthly interrogation of national VMMC • insuranceLack of toprivate fund VMMC sector, limitinghealth maintainOver the relativelyyears, Zambia efficientPRS has undertakenoperations managed oncetoin since data inception of VMMC data insurancethe flexibility to fundof VMMC VMMC funding, limiting maintain relatively efficient operations in terms of VMMC costs sinceelements 2012. in HMISThis was the flexibility of VMMC funding terms of VMMC costs since 2012. This was Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 4959 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 59 (2016-2020)

• While the government provides 2020 the VMMC program will require a critical infrastructural resources for total of US $136 million over the next 5 Lack of data verification by 1. District Medical Officers to send a memo • ProcessestheWhile program, the governmentonly a relatively provides small years.2020 theCurrently, VMMC theprogram projected will requirefunding a senior management at district informing VMMC parent facilities to send amountcritical infrastructurof monetarylevelal resources funding foris availabletotalmonthly of USis summaryUS $136 $5 1million millionreports over ofwh VMMC ichthe leaves next data 5a available.the program, Th onlye programa relatively wouldsmall fundingyears.from Currently,respectivegap of US outreach $85the million.p androjected static sites.funding benefitamount greatlyof monetary from increased funding MoH is available 2. DHIOs is US to $5expect1 million receipt wh ichof summaryleaves a reports from parent facilities and follow up budgetavailable. allocations The program would fundingThe resources gap of USrequired $85 million. to implement the when summary report is not received. • benefitThe greatlycompensati from increasedon MoHand operational 3. District planMedical were Officers estimated to verify based and on sign an budgetreimbursement allocations model is not analysisTheVMMC resources of summary the required previous data fromto implement year’sparent averagefacilities the • Theeternally sustainablecompensati on and operationalfundingand partner per planVMMC, reports. were aestimateds proxy for based the actuaon anl

reimbursement model is not analysiscost. of the previous year’s average

eternally sustainable funding per VMMC, as proxy for the actual Provincial Health Office Required resources cost. Human Lack of data comparative 1. Support monthly data comparative In orderResources/Other to reach 90% analysisVMMC at withinprovincial the level analyses at provincial level RequiredSupport resources 2. Increase technical capabilities of the core-age group, a target of 1,985,083 by DHIO to conduct comparative analysis of In order to reach 90% VMMC within the PRS (partner summaries) and HIA2 forms Figurecore-age 19 : group,Resource a mobilizationtarget of –1,985,083 Projected Fundingby gap chartbefore entry into DHIS2

Figure 1935 : Resource mobilization – Projected Funding gap chart

3530Tools/Systems Lack of VMMC data review Support Provincial Health Information Millions 8.4 and interrogation at provincial Officers and Provincial Coordinators to level conduct data review meetings for VMMC 3025 Millions 16.0 8.4 2520Processes Lack of data quality14.5 audits at Enhance data quality throughfunding gapquarterly provincial16.0 level provincial audits during campaign monitoring 2015 14.5 funding gap funding VMMC National Coordinating Office 23.5 23.5 23.7 available 1510Human Lack of dedicated staff to Hire a new M&E officer to interrogate funding Resources/Other interrogate15.2 data frequently VMMC data at national level on a monthly Support 23.5 12.5 basis23.5 23.7 available 10 5 Lack of regular check-up and Delegate M&E officer to respond to requests 15.2 supply of MC client12.5 intake for data tools 50 forms and registers 0.0 0.0 Tools/Systems2016 Excel2017 based partner2018 data Revise2019 partner2020 template into more granular aggregation tool contains wide age bands 0 0.0 0.0 age bandwidth Government resources2016 2017 2018 Of 2019the total costs,2020 it is expected that the Lack of program impact Revise MC register, HIA tool, HMIS to analysis governmentgranular age willbands also contribute to the In addition to supplying the infrastructure Government resources Numerous client intake forms programOfStandardise the total monetarily. costs,the clientit is expectedintake formthat theas and human resources, the government is governmentgovernment willdocument also contributefor VMMC to clientthe Incommitted addition to supplymobilizinging the the infrastructure resources programcapture monetarily. data HMIS data comparison with Monthly interrogation of national VMMC necessaryand humanProcesses to resources,m ake the theprogram government a success is andcommitted to achieve to positivemobilizing publicPRS theundertakenhealth resources impact. once since data inception of VMMC data necessary to make the elementsprogram in a HMIS success Ministryand to achieve of Health, positive Zambi publica | VMMChealth impact. NATIONAL OPERATIONAL PLAN 60 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 49 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 60 (2016-2020)

Funding gap and resource mobilization 3 years of the Operational plan. They will TWG Subcommittee identify, target and engage all potential FundingProcesses gap and resourceLack mobilizationof data verification bysou3 years1.rces District of fundingthe Medica Operational lfor Officers the VMMC plan.to send They program a memo will senior management at district informing VMMC parent facilities to send TWGGiven Subcommitteea total cost of U S $136 million over withidentify, the targetgoal ofand raising engage the allfull potentialamount the next five years, an leveladditional monthly summary reports of VMMC data US $85 requiredsoufromrces respectiveof to funding fund outreach thefor programthe and VMMC static until sites.program 2020. Given a total cost of US $136 million over million in funding will be required to fund Theywith2. DHIOsthewill goal writeto of expect raisingand receipt submitthe fullof summaryVMMCamount the next five years, an additional US $85 the operational plan. Major contributions applicationsrequiredreports tofrom fundfor parent fundingthe facilitiesprogram and and untilinvestment follow 2020. up millionfor funding in funding so far will have be requiredcome from to fund the when summary report is not received. cases.They will write and submit VMMC Unitedthe operational States plan.Government, Major contributions through 3. District Medical Officers to verify and sign applicationsVMMC summary for funding data from and parent investment facilities for funding so far have come from the PEPFAR and Global Fund. The finalization cases.and partner reports. Unitedof this operationalStates Government, plan will facilitatethrough a II. Maintain and document an accurate PEPFARdialogue andbetween Global the Fund. government The finaliza tionand understanding of the VMMC Provincialpartnersof this operational whichHealth Officewill planmobilize will facilitateadditional a II. Maintainresource environment and document and an accurate resourcesdialogueHuman betweento close thecurrent Lackgovernment offunding data andcomparative 1.understandingprogrammatic Support mont fundingof hlythe VMdata gapsMC comparative at all Resources/Other analysis at provincial level analyses at provincial level futurepartners gaps.Support which will mobilize additional 2.resourcetimes Increase environment technical capabilities and of the resources to close current funding and DHIOprogrammatic to conduct funding comparative gaps analysisat all of Thefuture TWG gaps. will form a subcommittee to EveryPRStimes year,(partner the summaries)RM TWG andwill HIA2conduct forms an conduct intensive resource mobilization before entry into DHIS2 annual resource assessment to continually The TWG will form a subcommittee to from the government, existing donors and assessEvery andyear, prioritize the RM theTWG program’s will conduct resource an evenconduct through intensive public resource-private mobilizationpartnerships needsannual through resource regular assessment resource/funding to continually gap (PPP)from theandTools/Systems government,other non -traditional existingLack of donors.donorsVMMC Theanddata reviewanalysisassess Support and based prioritizeProvincial on t hethe Healthremainingprogram’s Information programresource evenRM TWG through will bepublic active-private andfor interrogat leastpartnerships ationthe firstat provincial targetsneeds Officers through and needsand regular Provincialby geography. resource/funding Coordinators gapto level conduct data review meetings for VMMC (PPP) and other non-traditional donors. The analysis based on the remaining program

RM TWG will be active for at least the first targets and needs by geography. Processes Lack of data quality audits at Enhance data quality through quarterly provincial level provincial audits during campaign monitoring

VMMC National Coordinating Office Human Lack of dedicated staff to Hire a new M&E officer to interrogate Resources/Other interrogate data frequently VMMC data at national level on a monthly Support basis Lack of regular check-up and Delegate M&E officer to respond to requests supply of MC client intake for data tools forms and registers Tools/Systems Excel based partner data Revise partner template into more granular aggregation tool contains wide age bands age bandwidth Lack of program impact Revise MC register, HIA tool, HMIS to analysis granular age bands Numerous client intake forms Standardise the client intake form as government document for VMMC client capture data Processes HMIS data comparison with Monthly interrogation of national VMMC PRS undertaken once since data inception of VMMC data elements in HMIS Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 61 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 49 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 61 (2016-2020)

Processes Lack of data verification by 1. District Medical Officers to send a memo senior management at district informing VMMC parent facilities to send level monthly summary reports of VMMC data

from respective outreach and static sites. PILLAR 8: SUSTAINABILITY AND2. EARLYDHIOs to INFANT expect receipt MALE of summary PILLAR 8: SUSTAINABILITY ANDreports EARLY from INFANTparent facilities MALE and follow up CIRCUMCISION (EIMC)when summary report is not received. CIRCUMCISION (EIMC)3. District Medical Officers to verify and sign VMMC summary data from parent facilities Objective and partner reports. ToObjective develop and implement a robust plan for program transition and integration of VMMCTo develop services and inimpl theement sustainability a robust and plan maintenance for program phase, transition once scale and-up targetsintegration are met of Provincial Health Office VMMC services in the sustainability and maintenance phase, once scale-up targets are met Human Lack of data comparative 1. Support monthly data comparative

Strategies Resources/Other analysis at provincial level analyses at provincial level Support 2. Increase technical capabilities of the StrategiesI. Develop a comprehensive, evidence-basedDHIO transition to conduct and comparative sustainability analysis plan of I. Developcovering alla pillarscomprehensive, of program evidence -basedPRS (partnertransition summaries) and sustainability and HIA2 planforms II. coveringMaintain allexisting pillars ofservices program for Early Infantbefore Male entry Circumcision into DHIS2 (EIMC) while II. Maintainmobilizing existing resources services and evidence for Early for Infant program Male implementation Circumcision in(EIMC) sustainability while

mobilizingphase resources and evidence for program implementation in sustainability

phase Tools/Systems Lack of VMMC data review Support Provincial Health Information

and interrogation at provincial Officers and Provincial Coordinators to I. Develop a comprehensive,level evidence- II. conductMaintain data existing review meetings services for for VMMC Early I. Developbased transition a comprehensive, and sustainability evidence - II. MaintainInfant Male existing Circumcision services (EIMC)for Early

based transition and sustainability Infant Male Circumcision (EIMC) planProcesses covering all pillarsLack of programdata quality audits at Enhancewhile mobilizing data quality resources through and quarterly plan covering all pillarsprovincial of program level provinciwhileevidence almobilizing audits for program during resources campaign andmonitoring As sustainability nears, the program will implementationevidence for program in a sustainability VMMCneedAs sustaina to Nationalunderstandbility Coordinatingnears, how tothe move programOffice towards will a implementationphase in a sustainability sustainableneed to Humanunderstand phase howofLack to VMMC.move of dedicatedtowards Inter a- staff to Hirephase a new M&E officer to interrogate ministerialsustainableResources/Other andphase interdepartmental ofinterrogate VMMC. datameetings Interfrequently- ZambiaVMMC introduceddata at national Early level Infanton a monthly male willministerial becomeSupport and crucial interdepartmental in building meetingsa broad circumcisionZambiabasis introduced (EIMC) withEarly the Infant launch maleof a Lack of regular check-up and Delegate M&E officer to respond to requests stakeholderwill become base crucial for discussionsinsupply building of on MC athe broad bestclient intakePubliccircumcision for data Health tools (EIMC) Evaluation with the(PHE) launch in ofthe a waystakeholder to transition base for roles discussions formsand responsibilities and on registers the best beginningPublic Health of 2008.Evaluation This evaluation(PHE) in wasthe forway VMMCto Tools/Systemstransition as well roles as implement Exceland responsibilitiesbased integrated partner dataundertakenbeginning Revise partner ofby Centre2008. template forThis Infectiousinto evaluation more Digranular seasewas servicefor VMMC delivery as well likeas implement aggregationall other integrated tool health contains wideResearchundertaken age bands byin CentreZambia for Infectious(CIDRZ Di) seaseand age bandwidth interventions.service delivery Ultimately, like allan evidenceother -healthbased ResearchUniversity ofin ZambiaZambia Medical (CIDRZ School,) withand Lack of program impact Revise MC register, HIA tool, HMIS to evaluationinterventions. will Ultimately, be requiredanalysis an evidenceto develop-based a allUniversity granularprocedures ageof Zambiabands conducted Medical at the School, University with sustainabilityevaluation will andbe requiredtransitionNumerous to plan.develop client intakeThe a forms Teachingall Standardiseprocedures Hospital theconducted (UTH)client at intakein the Lusaka, Universityform andas countrysustainability will likelyand adopt transition a phased plan. approach The twoTeachinggovernment local clinicsHospital document (Matero (UTH) Reffor in and VMMCLusaka, Kanyama) clientand. tocountry VMMC will sustainability likely adopt wherea phased regions approach with Thetwocapture localstudy clinicsdata concluded (Matero in RefMarch and Kanyama)2011 with. Processes HMIS data comparison with Monthly interrogation of national VMMC highto VMMC MC rates sustainability become PRSwherethe testingundertaken regions ground with once since600The data Neonatesstudy concluded (0-28 days) in circumcised.March 2011 with forhigh sustainability MC rates become until it inception thecan testing be rolledof ground VMMC out data 600 Neonates (0-28 days) circumcised. nationally.for sustainability until itelements can be inrolled HMIS out nationally. Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 4962 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 62 (2016-2020)

Following the conclusion of this evaluation, consumables pack. However, the process is USG funding was provided to CIDRZ different form adult VMMC since it requires throughFollowingProcesses CDC the conclusionto spearheadLack of thethisof scaledataevaluation, -verificationup of byaconsumables device1. District called Medicapack. a Mogen l However,Officers clamp to the sendto processcomplete a memo is senior management at district informing VMMC parent facilities to send USG funding was provided to CIDRZ different form adult VMMC since it requires EIMC. In Zambia, EIMClevel focuses on infants themonthly procedure. summary A detailed reports listof VMMCof surgical data through0-60 days. CDC M oreto spearheadthan 10,420 the infantsscale-up had of instruments,a devicefrom respective called aconsumables outreachMogen clamp and static andto completesites. other EIMC.been circumcised In Zambia ,by EIMC Septemb focuseser 2014 on infants prior suppliesthe2. procedure.DHIOs required to A expect fordetailed EIMC receipt list is ofincludedof summarysurgical in 0to-60 CIRDZ days. transitioningMore than 10EIMC,420 toinfants GRZ had on Appendixinstruments,reports from sectionconsumablesparent . facilitiesSupply andand follow chainother up when summary report is not received. beenst circumcised by September 2014 prior supplies required for EIMC is included in 1 October 2014. The implementation to management,3. District Medical including Officers to verifyforecasting, and sign dateto CIRDZ has demonstrated transitioning EIMCthe feasibility to GRZ22 onof procurement,AppendixVMMC summary distributiosection data. fromn, Supplyand parent storage facilitieschain will EIMC1st October in Zambia, 2014. Theyet theimplementation scale-up of theto bemanagement, andcoordinated partner reports. includingthrough Governmentforecasting, dateprogram has hasdemonstrated been slower the than feasibility anticipated.22 of structures.procurement, distribution, and storage will

AsEIMC the in countryZambia, embarksyet the scaleon -upincreasing of the be coordinated through Government Provincial Health Office program has been slower than anticipated. structures.Advocacy & demand generation uptake Humanof EIMC there Lackis need of to dataincrease comparative 1. Support monthly data comparative As the country embarks on increasing awarenessResources/Other among parents analysis and at provincialguardians level Whileanalyses there at provincialwill be levela range of national uptake Supportof EIMC there is need to increase Advocacy2. Increase & demand technical generation capabilities of the about the existence and benefits of EIMC. demand generation efforts similar to that of awareness among parents and guardians DHIO to conduct comparative analysis of adultWhile VMthereMC, will some be area rangespecific of to national EIMC Governanceabout the existence & coordination and benefits of EIMC. PRS (partner summaries) and HIA2 forms sincedemandbefore it generationwillentry occur into DHIS2 effortsat the similarcommunity to that a ndof adult VMMC, some are specific to EIMC GovernanceLeadership and & coordination for EIMC will facility level while integrating with MNCH be done by Government. All trainings will since(ANC, it PANC,will occur U5, at FP). the EIMCcommunity program and beLeadership coordinated and coordination through gover for EIMCnment -willled implementationfacility level while demonstrates integrating with that MNCH the Tools/Systems Lack of VMMC data review Support Provincial Health Information beTWG. done Integratingby Government. EIMCand All interrog intotrainings ationexisting willat provincial immediate(ANC, Officers PANC, postnataland U5,Provincial periodFP). EIMCCoordinators is too program late to beMaternal, coordinated New -bornthrough leveland goverchildnment health-led introduceimplementationconduct datathe reviewsubject demonstrates meetings to mothers/parents. for VMMCthat the services,TWG. Integratingwith enhanced EIMC intogovernment existing Parentsimmediate need postnatal sufficient period time isto toodiscuss late theto lMaternal,eadership Newwill -bornbe a andpre -requisitechild health for issueintroduce among the themselvessubject to mothers/parents.and with their services,Processes with enhancedLack of governmentdata quality audits atParents Enhance need data sufficient quality time through to discuss quarterly the sustainability. By 2015 EIMCprovincial services level were familiesprovinci beforeal audits they during are campaignready to monitoringauthorize offeredleadership in 23will site sbe; in Wa estern,pre-requisite Copperbelt, for consent.issue among While themselves the MNCH and platform with theirwill

Easternsustainability. and ByLusaka 2015 EIMCprovinces. services Trained were continuefamilies beforeto strive they to areinvolve ready male to authorizepartners, VMMC National Coordinating Office offered in 23 sites; in Western, Copperbelt, consent. While the MNCH platform will providersHuman include Lackdoctors, of dedicatedmedical staff toMOH Hire willa newexpand M&E its officerreach toto allinterrogate men by licentiates,Eastern Resources/Otherand n ursesLusaka (general provinces.interrogate nurses dataTrained frequentlyand enhancingcontinueVMMC to data strive communityat nationalto involve level male onengagement, apartners, monthly midwives),providersSupport andinclude clinical doctors, officers. medicalOther expanding,MOHbasis will expandand strengthening its reach to male all -mento-male by trainedlicentiates, staff ninclude:urses counsellors(generalLack of nursesregular, mobilizers checkand -up andenhancingcommunity Delegate M&E basedcommunity officer interventions to respond engagement, thatto requests reach midwives), and clinicalsupply officers. of MC Other client intakeexpanding, for data tools and strengthening male-to-male hygiene assistants (CE). forms and registers men where they work, live, and socialize trained Tools/Systemsstaff include: counsellorsExcel based, mobilizers partner datacommunity Revise partner based template interventions into more that granular reach hygieneService assistantsdelivery (CE). aggregation tool contains widemen age where bands they work, live, and socialize age bandwidth Transition and sustainability EIMC will be implemented in all 10 Service delivery Lack of program impact Revise MC register, HIA tool, HMIS to provinces during the strategicanalysis plan period at TransitionPoliticalgranular will age and andbands sustainability government leadership is allEIMC levels will of becare implemente whichNumerous haved in aclient trainedall intake10 forms criticalStandardise as we scalethe upclient EIMC intake services form in theas provider.provinces duringEIMC theis strategicperformed plan periodusing ata countryPoliticalgovernment involvementwill anddocument government of PMOsfor VMMC,leadership DMOs client and is surgicalall levels instrument of care whichkit and have a singlea trained-use thecriticalcapture community as datawe scale is upkey EIMC in initial services stages in theof Processes HMIS data comparison with Monthly interrogation of national VMMC provider. EIMC is performed using a country involvement of PMOs, DMOs and PRS undertaken once sincescale data up. Lessons learnt are that community 22surgical To date, thereinstrument are no robust costkit studiesand ona the single cost of -EIMCuse engagementthe community through is key in itsinitial established stages of in Zambian settings. inception of VMMC data elements in HMIS scale up. Lessons learnt are that community Ministry22 of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN To date, there are no robust cost studies on the cost of EIMC engagement through its established63 inMinistry Zambian settings. of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 49 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 63 (2016-2020)

structures before service delivery is initiated HIV prevention strategies and is a must. Before EIMC can scale up, the integrated into other national frame followingstructures activitiesbefore service should delivery be unde isrtaken initiated in worksHIV includingprevention MNCH strategies strategies and ais realistic,a must. sustainableBefore EIMC manner: can scale up, the  Demandintegrated intoGener otheration: national Increase frame following Training activities – shoulda pool be ofunde trainerrtaken ofin worksownership including of EIMCMNCH servicesstrategies by a realistic,trainers sustainable in each manner: province and trained  Demandengaging publicGener facilityation: providersIncrease as  providersTraining – EIMCa pool counsellors of trainer andof ownershippart of a comprehensiveof EIMC services MNCH by mobilizerstrainers in eachup to province the level andof ZONEtrained engagingdemand publicgeneration facility packa providersge, and as (orproviders wherever EIMC there counsellors is a trained and partsensitizing of a comprehensiveinfluential community MNCH providermobilizers isup found)to the leveland of mobilize ZONE demandleaders like generation traditional, packa religiousge, and training(or wherever and IEC there materials is a trained civicsensitizing leaders influential community  providerSupply Chain is Management:found) and Strengthen mobilize leaders like traditional, religious and trainingthe existing and nationalIEC materials Central Medical civic leaders Monitoring &  SupplyStores Chainsupply Management: chain management Strengthen Evaluation/Implementation science systemthe existing to nationalmeet Centralthe increased Medical Monitoring & requirementsStores supply of chain EIMC management scale up EAdditionalvaluation/Implementation indicators will need scienceto be added (appendixsystem to 3) meet the increased to M&E registers for EIMC in advance of  Resourcerequirements mobilization: of EIMC EIMC hasscale to upbe nationalAdditional indicatorsroll-out willof need0 -to60 be addeddays. incorporated(appendix 3) into comprehensive to M&E registers for EIMC in advance of  Resource mobilization: EIMC has to be national roll-out of 0-60 days. incorporated into comprehensive

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 64 (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 64 (2016-2020)

E. VMMC NATIONAL WORKPLAN (2016-2020) PILLAR 2016 Q2 2016 Q3 2016 Q4 2017 Q1 2016 Q1 2017Q2 2017Q3 2017Q4 E. VMMC NATIONAL WORKPLAN (2016-2020) E. VMMC NATIONAL WORKPLAN (2016-2020)

PILLAR PILLAR

2016 Q2 2016 Q3 2016 Q4

2017 Q1 2016 Q1

2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q1

2017Q2 2017Q3 2017Q4

2017Q2 2017Q3 2017Q4 KEY STRATEGY DETAIL ACTIVITIES 2018 2019 2020 PILLAR #1: LEADERSHIP & ADVOCACY - To increase and sustain program visibility and priority at both national and

subnational level and garner multi-sectoral support from key stakeholders KEY STRATEGY DETAIL ACTIVITIES I. Increase program 2018 2019 OfficialKEY2020 STRATEGY launch of national VMMCDETAIL guidance ACTIVITIES 2018 2019 2020 PILLAR #1: LEADERSHIP & ADVOCACY - To increase and sustain program visibilityvisibility and and priority at both national documents and will be plannedPILLAR and attended #1: by LEADERSHIP key & ADVOCACY - To increase and sustain program visibility and priority at both national and subnational level and garner multi-sectoral support frompriority key stakeholders within the stakeholders and high-level opinion leaders subnational x level and garner multi -sectoral support from key stakeholders I. Increase program Official launch of national VMMC guidance health portfolio and I.Develop Increase advocacy program toolkit containing informationalOfficial launch of national VMMC guidance materials, frameworks, and other tools for demand visibility and documents will be planned and attended by key at all levels of the visibility and visibility and documents will be planned and attended by key stakeholders and high-level opinion leaders priority generation ( targeted at specific audiences) stakeholders and high-xlevel opinion leaders x priority within the x health care system priority within the health portfolio and Develop advocacy toolkit containing informational healthDisseminate portfolio (ongoing) and advocacy toolkit, Develop advocacy toolkitx containingx x informationalx x x x x x materials, frameworks, and other tools for demand materials, frameworks, and other tools for demand at all levels of the visibility and informationalat all levels materials,of the frameworksvisibility and generation ( targeted at specific audiences) x priority generation ( targeted at specific audiences) x health care system priority Highlighthealth care VMMC system and share priority areas at x x x Disseminate (ongoing) advocacy toolkit, x x x x x x x x Annualx Planning Launch (MTEF) Disseminate (ongoing)x advocacy toolkit, x x x x x x x x x x informational materials, frameworks II. Re-engage the National-level advocacy meetings designed toinformational materials, frameworks x x x Highlight VMMC and share priority areas at 1 key actors in x x informx and sensitize key opinion leaders will Highlightbe VMMC and share priority areas at x x x Annual Planning Launch (MTEF) x VMMC xadvocacy held including members of parliament (engageAnnual new Planning Launch (MTEF) x x II. Re-engage the National-level advocacy meetings designed to for the new x x parliamentII.x Re-engage health portfolio)the National-level advocacy meetings designedx to x x x 1 key actors in inform and sensitize key opinion leaders will be Operational Plan 1 Nationalkey actors-level advocacy in meetings (in partnershipinform and sensitize key opinionx leaders will be x x x x VMMC advocacy held including members of parliament (engage new Re-engage the withVMMC NAC) advocacy designed to inform and sensitize heldkey including members of parliament (engage new (2016-2020) key actors opinion leaders will be held including membersparliament of health portfolio) for the new parliament health portfolio) x for the new x including underlying ministries (MoE, MoF, Min of GenderNational -level advocacy meetings (in partnership Operational Plan National-level advocacy meetings (in partnership x x x x Operationalx Plan x x x x x with NAC) designed to inform and sensitize key Parliament, and Women Affairs etc.) Re-engage the with NAC) designed to inform and sensitize key Re-engage the (2016-2020) (2016-2020) key actors opinion leaders will be held including members of Traditional and National-level advocacy meetingskey actors designed toopinion leaders will be held includingx members of x x x x including underlying ministries (MoE, MoF, Min of Gender Religious leaders informincluding and sensitize key opinion leaders will underlyingbe ministries (MoE, MoF, Min of Gender Parliament, and Women Affairs etc.) held Parliament,with MOCTA and traditional leaders and Women Affairs etc.) Traditional and National-level advocacy meetings designed to x x x x xTraditional and National-level advocacy meetings designed to x x x x x Religious leaders inform and sensitize key opinion leaders will be Religious leaders inform and sensitize key opinion leaders will be held with MOCTA and traditional leaders Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN held with65 MOCTA and traditional leaders (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 65 Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 65 (2016-2020) (2016-2020)

PILLAR 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q1 2017Q2 2017Q3 2017Q4

PILLAR 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q1 KEY STRATEGY2017Q2 2017Q3 2017Q4 DETAILE. VMMCACTIVITIES NATIONAL WORKPLAN (20162018 -20192020) 2020 National-level advocacy meetings designed to x x x x x x x x x

PILLAR inform and sensitize key opinion leaders will be 2016 Q2 2016 Q3 2016 Q4 2017 Q1 2016 Q1

2017Q2 2017Q3 2017Q4

held with women’s groups, religious leaders, and

KEY STRATEGY DETAIL ACTIVITIES 2018 2019 business2020 leaders at national and subnational level

National-level advocacy meetings designed to x x x x x x x x Identifyx key VMMC spoke persons and champions x x x x

inform and sensitize key opinion leaders will be like musicians, footballers, parliamentarians, held with women’s groups, religious leaders, and religiousKEY STRATEGY leaders and traditional DETAIL leaders (input ACTIVITIES 2018 2019 2020 business leaders at national and subnational level through TWG) PILLAR #1: LEADERSHIP & ADVOCACY x - To increase and sustain program visibility and priority at both national and Identify key VMMC spoke persons and champions x x x Increasex VMMC visibility at national events and xsubnational x x levelx andx garnerx multix -sectoralx x supportx fromx key stakeholders like musicians, footballers, parliamentarians, I.traditional Increase ceremonies. program Official launch of national VMMC guidance religious leaders and traditional leaders (input Ongoingvisibility enga gementand with district level traditionaldocuments x will bex plannedx andx attendedx xby keyx x x x x leaders through TWG) x priority within the stakeholders and high-level opinion leaders x

Increase VMMC visibility at national events and x x x x III.x Preparex xthe x x x healthSemix -annual portfolio review and of the VMMC program Developby the advocacy toolkit containing informational x x x traditional ceremonies. materials, frameworks, and other tools for demand program’s TWGat all taking levels into of theaccount allvisibility potential and changes x x x x Ongoing engagement with district level traditional generation ( targeted at specific audiences) x x x x x advocacyx x andx x xPrepare forx healthx care system priority leaders leadership for any potential Disseminate (ongoing) advocacy toolkit, x x x x x x x x x III. Prepare the Semi-annual review of the VMMC program by the potential changes x changesx x informational materials, frameworks program’s TWG taking into account all potential changes x x as a resultx of x political shifts Highlight VMMC and share priority areas at x x x advocacy and Prepare for organizational and Annual Planning Launch (MTEF) x x leadership for any potential political shifts MidII. -Reterm-engage review of the the Operational plan National-level advocacy meetings designed to x x x x potential changes changes IV. Strategically 1 Nationalkey actors and provincial in launch of strategic inform and sensitize key opinion leaders will be political shifts as a result of disseminate critical documentsVMMC advocacy like the Operational Plan held including membersx of parliament (engage new parliament health portfolio) x organizational and information to key Strategically Nationalfor the and newprovinci al launch of strategic political shifts Mid-term review of the Operational plan disseminatex documentsOperational Communication Plan strategy. National-level advocacy x meetings (in partnership x x x x x stakeholders within with NAC) designed to inform and sensitize key National and provincial launch of strategic critical Re-engage the x x x x x x x x IV. Strategically the program, information National(2016 VMMC-2020) campaign launcheskey actors and miniopinion leaders will be held including members of documents like the Operational Plan x disseminate critical including regular provincialincluding campaign launches targeted to specificunderlying ministries (MoE, MoF, Min of Gender Strategically National and provincial launch of strategic information to key campaigns and provincesParliament, and Womenx Affairs etc.) disseminate documents Communication strategy. x stakeholders within Traditional and National-level advocacy meetings designed to critical Ministryx x of Health,x Zambix ax | VMMCx NATIONALx x OPERATIONAL PLAN x x x x x the program, information National VMMC campaign launches and mini Religious leaders inform and66 sensitize key opinion leaders will be including regular provincial campaign launches targeted to specific (2016-2020) held with MOCTA and traditional leaders campaigns and provinces x Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 66 Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 65 (2016-2020) (2016-2020)

PILLAR 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q1 2017Q2 2017Q3 2017Q4

PILLAR

2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q1 2017Q2 2017Q3 2017Q4 E. VMMC NATIONAL WORKPLAN (2016-2020) KEY STRATEGY DETAIL ACTIVITIES 2018 2019 2020

launch of this PILLAR 2016 Q2 2016 Q3 2016 Q4 2017 Q1 2016 Q1

2017Q2 2017Q3 2017Q4

Operational Plan KEY STRATEGY DETAIL ACTIVITIES 2018 2019 2020 PILLAR #2: GOVERNANCE & COORDINATION - To build sufficient technical and strategic capacity to coordinate launch of this

and manage a growing VMMC program with strong linkages between the national and subnational levels

Operational Plan Lobby for the position of M&E officers at national I. Increase KEY STRATEGY DETAIL x ACTIVITIESx 2018 2019 2020 PILLAR #2: GOVERNANCE & COORDINATION - To build sufficient technicaltechnical and capacity strategic capacity to coordinatelevel Lobby for the position of socialPILLAR #1: LEADERSHIP x& ADVOCACYx x - To increase and sustain program visibility and priority at both national and and manage a growing VMMC program with strong linkages between theat nationalnational level and subnational levels subnational level and garner multi-sectoral support from key stakeholders I. Increase Lobby for the position of M&E officers at national x x and improve the mobilisation/service delivery officers at national I.level Increase program Official laun ch of national VMMC guidance technical capacity level TWG to enable Interviewvisibility and hireand staff (once approved) documents will be planned andx attendedx by key at national level Lobby for the position of social x x x quick decision- Increase stakeholders and high- level opinion leaders x mobilisation/service delivery officers at national priority within the and improve the making and technical On-board and train staff Develop advocacy toolkit containingx x informational level health portfolio and TWG to enable resolution of capacity at materials, frameworks, and other tools for demand national level Finalizeat all levels TWG ofschedule the andvisibility Ratify To andRs x x x x x Interview and hire staff (once approved) x existingx and future generation ( targeted at specific audiences) x quick decision- Increase streamline Reachhealth out care and system re-engage new TWGpriority members x x x x making and technical On-board and train staff x VMMCx policy TWG fix policy (Surgical Society of Zambia, HPCZ, private sectorDisseminate (ongoing) advocacy toolkit, x x x x x x x x x resolution of capacity at discrepancies discrepancies representatives etc.) informational materials, x frameworks national level Finalize TWG schedule and Ratify ToRs x x x x x 2 Highlight VMMC and share priority areas at existing and future streamline Reach out and re-engage new TWG members x x x Engagex NAC, Ministry of Legal Affairs on age of x x x x x x x VMMC policy TWG fix policy (Surgical Society of Zambia, HPCZ, private sector consent harmonization Annual Planning Launch (MTEF) x x discrepancies discrepancies representatives etc.) x UpdateII. Re -andengage disseminate the site mapping National-level advocacy meetingsx designed to x x x x x x x inform and sensitize key opinion leaders will be 2 Engage NAC, Ministry of Legal Affairs on age of x x x x 1 Engagekey NACactors on in updating and disseminating consent harmonization HIV/AIDSVMMC advocacy workplace policy held including members x of parliament (engage new parliament health portfolio) x Update and disseminate site mapping x x Leveragex thex Review/Amendx for the new ToRs on the issues of chair, vice MoH chair chair,Operational and secretariat Plan National-level advocacyx meetings (in partnership x x x x x Engage NAC on updating and disseminating with NAC) designed to inform and sensitize key position for (2016-2020) Re-engage the HIV/AIDS workplace policy x quick TWG key actors opinion leaders will be held including members of Leverage the Review/Amend ToRs on the issues of chair, vice decision- including underlying ministries (MoE, MoF, Min of Gender MoH chair chair, and secretariat x making Annual Parliament, ToR review as needed and Women Affairs etc.) position for Traditional and quick TWG National-level advocacy meetings designed to x x x x x decision- Ministry of Health, Zambia | VMMC NATIONALReligious OPERATIONAL leaders PLAN inform and sensitize key opinion leaders will be making Annual ToR review as needed held with67 MOCTA and traditional leaders (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 67 Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 65 (2016-2020) (2016-2020)

PILLAR 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q1 2017Q2 2017Q3 2017Q4

PILLAR

2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q1 2017Q2 2017Q3 2017Q4 E. VMMC NATIONAL WORKPLAN (2016-2020) KEY STRATEGY DETAIL ACTIVITIES 2018 2019 2020 II. Support the Review annual plans for provincial needs (capacity x x x x x PILLAR and budget) 2016 Q2 2016 Q3 2016 Q4 2017 Q1 2016 Q1

provincial level 2017Q2 2017Q3 2017Q4

x x x x x KEY STRATEGY DETAIL ACTIVITIES through 2018Provincial 2019 2020

II. Support the Review annual plans for provincial needs (capacity x secondment,x joint- secondment,x x x

joint-planning provincial level and budget) planning and direct budget support for and direct KEY STRATEGY DETAIL ACTIVITIES 2018 2019 2020 through x x x x x Provincial VMMC activities budget secondment, joint- PILLAR #1: LEADERSHIP & ADVOCACY - To increase and sustain program visibility and priority at both national and secondment, depending on the subnational level and garner multi-sectoral support from key stakeholders planning and direct joint-planning Include these activities during MTEF (provincial provincial needs work plans and budgets) Official laun ch of national VMMC guidance budget support for and direct I. Increase program Communicate message to PMO and DMO todocuments will be planned and attended by key VMMC activities budget III. Revamp the visibility and x District Technical reactivatepriority withinDTC the stakeholders and high-level opinion leaders x depending on the Include these activities during MTEF (provincial Committees to health portfolio and Develop advocacy toolkitx containing informational x x x provincial needs work plans and budgets) materials, frameworks, and other tools for demand enable routine Revamp the at all levels of the visibility and III. Revamp the Communicate message to PMO and DMO to x District generation ( targeted at specific audiences) x program health care system priority District Technical reactivate DTC Technical Disseminate (ongoing) advocacy toolkit, x x x x x x x x x management and Committees to x Committeesx x x informational materials, frameworks partner enable routine Revamp the Highlight VMMC and share priority areas at District collaboration at this x x x program DMO to develop activities and schedule for dataAnnual Planning Launch (MTEF) x x Technical level review for the DTC and include in budget x management and II. Re-engage the National-level advocacy meetings designed to x x x Committees PILLAR #3: SERVICE DELIVERY OF VMMC - To offer a comprehensive VMMC package of service in an efficient, partner key actors in inform and sensitize key opinion leaders will be 1 effective and increasingly integrated manner while ensuring the highest quality of services collaboration at this DMO to develop activities and schedule for data held including members of parliament (engage new Comprehensive VMMC advocacy level review for the DTC and include in budget I. Expand existingx for the new parliament health portfolio) x capacity to provide VMMC, National-level advocacy meetings (in partnership PILLAR #3: SERVICE DELIVERY OF VMMC - To offer a comprehensive VMMC package of servicetraining, in an efficient,ConductOperational provider Plan trainings as required to meet x x x x x with NAC) designed to inform and sensitize key effective and increasingly integrated manner while ensuring the comprehensivehighest quality of servicesequipment and VMMC(2016 client-2020) demand Re-engage the 3 key actors opinion leaders will be held including members of I. Expand existing Comprehensive VMMC services by waste including management underlying ministriesx (MoE, xMoF, Min ofx Gender x x x x capacity to provide VMMC, Parliament, training, Conduct provider trainings as required to meet and Women Affairs etc.) comprehensive equipment and VMMC client demand Traditional and National-level advocacy meetings designed to x x x x x 3 VMMC services by waste Ministry of Health, Zambia | VMMC NATIONALReligious OPERATIONAL leaders PLAN inform and sensitize key opinion leaders will be 68 management x x x x x (2016x -2020)x held with MOCTA and traditional leaders Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 68 Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 65 (2016-2020) (2016-2020)

PILLAR 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q1 2017Q2 2017Q3 2017Q4

PILLAR 2016 Q2 2016 Q3 2016 Q4 2016 Q1 KEY2017 Q1 STRATEGY DETAIL ACTIVITIES 2018 2019 2020 2017Q2 2017Q3 2017Q4 E. VMMC NATIONAL WORKPLAN (2016-2020) introducing pre- Provide quality, efficient VMMC service offering a comprehensive package of services x x x x x x x x x x x service training, PILLAR 2016 Q2 2016 Q3 2016 Q4 2017 Q1 2016 Q1

2017Q2 2017Q3 2017Q4

Ensure proper management of equipment at the

eliminating missed

KEY STRATEGY DETAIL ACTIVITIES opportunities for 2018 2019 facility2020 level x x x x x x x x x x x introducing pre- Provide quality, efficient VMMC service offering a service delivery and Determine any waste management needs and

ensure waste management guidelines are service training, comprehensive package of services x x x x x efficientlyx x x x x x Ensure proper management of equipment at the implementedKEY STRATEGY DETAIL x x ACTIVITIESx x x x x x x x x 2018 2019 2020 eliminating missed deploying Monitor Roll-out simple monitoring tool to all high-volume facility level x x x x x x x x xcampaigns x x PILLAR #1: LEADERSHIP & ADVOCACY - To increase and sustain program visibility and priority at both national and opportunities for innovative methods sites x service delivery and Determine any waste management needs and such as devices for subnational level and garner multi-sectoral support from key stakeholders ensure waste management guidelines are I.Discuss Increase campaign program preparation in pre and postOfficial launx ch of nationalx VMMCx x guidance x x x x x efficiently service delivery campaign meeting implemented x x x x x x x x x x x visibility and documents will be planned and attended by key deploying Monitor Roll-out simple monitoring tool to all high-volume Conduct joint campaign monitoring, along withstakeholders x and high-xlevel opinionx x leaders x x x x x x innovative methods campaigns QAQIpriority or withinsupervisory the visit sites x health portfolio and Develop advocacy toolkit containing informational such as devices for Develop and distribute job aides, pocket bookletsmaterials, frameworks, and other tools for demand Discuss campaign preparation in pre and post x x x x x x x x atx all levels of the visibility and service delivery campaign meeting and tools for AE classification generation ( targetedx at specific audiences) x health care system priority Conduct joint campaign monitoring, along with Coordinate IPs share information available to other partnersDisseminate at x (ongoing)x x advocacy x toolkit,x x x x x xx x x x x x x x x x x x x x x x partnersx x x QAQI or supervisory visit national level (move out, move in) informational materials, frameworks through TWG x x x x x x x x x x x Develop and distribute job aides, pocket booklets to temporarily Highlight VMMC and share priority areas at x x x and tools for AE classification x take over Annual Planning Launch (MTEF) x x Coordinate IPs share information available to other partners at x x x x x x x x servicex deliveryx ConsultII.x Re- districtsengage (DMO) the to allocate/reallocateNational sites -level advocacy meetings designed to x x x partners national level (move out, move in) 1 Finalizekey theactors curriculum in for CO for VMMC inform and sensitizex key opinion leaders will be through TWG x x x x x x x x x x x held including members of parliament (engage new to temporarily Chainama/UNZAVMMC advocacy introduces and implements the x x x x x x x x x take over Pre-service curriculumfor the (first new graduates in 2019) parliament health portfolio) x service delivery Consult districts (DMO) to allocate/reallocate sites training and in- EngageOperational partners Plan who can sponsor top-up trainingNational -level advocacy meetings (in partnership x x x x x x x x service training with NAC) designed to inform and sensitize key Finalize the curriculum for CO for VMMC for Cos Re-engage the x x x (2016-2020) key actors opinion leaders will be held including members of Chainama/UNZA introduces and implements the x x x x x x x x Ensurex including full practicing Clinical officers, follow up on the first intake underlying ministries (MoE,x xMoF, Min of Gender Pre-service curriculum (first graduates in 2019) Parliament, and Women Affairs etc.) training and in- Engage partners who can sponsor top-up training x x xTraditional and National-level advocacy meetings designed to service training for Cos Ministry of Health, Zambi a | VMMC NATIONAL OPERATIONAL PLAN x x x x x x x Religious leaders inform and69 sensitize key opinion leaders will be Ensure full practicing Clinical officers, follow up (2016-2020) held with MOCTA and traditional leaders on the first intake x x Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 69 Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 65 (2016-2020) (2016-2020)

PILLAR 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q1 2017Q2 2017Q3 2017Q4

PILLAR

2016 Q2 2016 Q3 2016 Q4 2017 Q1 2016 Q1 KEY STRATEGY2017Q2 2017Q3 2017Q4 DETAILE. VMMCACTIVITIES NATIONAL WORKPLAN (20162018 -20192020) 2020

Contract and agree on school curriculum x x

PILLAR 2016 Q2 2016 Q3 2016 Q4 2017 Q1 2016 Q1

Roll-out of training curriculum to other schools - 2017Q2 2017Q3 2017Q4

KEY STRATEGY DETAIL ACTIVITIES 2018 2019 private2020 schools x x x x x Engage and advocate with the general nursing

Contract and agree on school curriculum x x

counsel for inclusion of VMMC in nurse Roll-out of training curriculum to other schools - curriculumKEY STRATEGY DETAIL ACTIVITIESx x x x x x x x x 2018 2019 2020 private schools x x x x x Training (including TOT) and procurement for x x x Engage and advocate with the general nursing PILLAR #1: LEADERSHIP & ADVOCACY - To increase and sustain program visibility and priority at both national and active surveillance subnational level and garner multi -sectoral support from key stakeholders counsel for inclusion of VMMC in nurse x x curriculum x x x x x x x x I.Active xIncrease surveillance program for PrePex and Shang RingOfficial laun ch of national VMMC guidance documents will be planned and attended by key Training (including TOT) and procurement for x x x Activevisibility surveillance and report review x x Innovative stakeholders and high-level opinion leaders x active surveillance methods, priority within the x x x Passive Surveillance Develop advocacy toolkit containing informational devices health portfolio and Active surveillance for PrePex and Shang Ring x x Passive surveillance report review and decisionmaterials, on frameworks, and other tools for demand x at all levels of the visibility and Active surveillance report review x x device of choice/methods priority generation ( targeted at specific audiences) x Innovative health care system x x x x methods, Passive Surveillance x x x Training for scale-up Disseminate (ongoing) advocacy toolkit, x x x x x x x x x informational materials, frameworks devices Passive surveillance report review and decision on x Roll-out and scale-up of devices x x x x Highlight VMMC and share priority areas at device of choice/methods II. Ensure Finalize draft document for QAQI x x x x x x x x Annual Planning Launch (MTEF) x x Training for scale-up adequate Print and disseminate x infrastructural II. Re-engage the National-level advocacy meetings designed to x x x Roll-out and scale-up of devices x x x x inform and sensitize keyx opinionx leadersx xwill bex x x x x resources while 1 Ministrykey actorswith IPS in with roll-out II. Ensure Finalize draft document for QAQI held including members of parliament (engage new x maintaining the Standardize VMMC advocacy x x x x x x x x x x x adequate parliament health portfolio) x Print and disseminate x quality of VMMC QAQI for the new infrastructural National-level advocacy meetings (in partnership x x x x x x x duringx scalex -upx byx x x Operationalx Plan resources while Ministry with IPS with roll-out Re-engage the with NAC) designed to inform and sensitize key standardizing (2016-2020) key actors opinion leaders will be held including members of maintaining the Standardize x x x x x x x x x x x QAQI guidelines, including underlying ministries (MoE, MoF, Min of Gender quality of VMMC QAQI materials and ConductParliament, QAQI along with supervision visit and Women Affairs etc.) during scale-up by Traditional and National-level advocacy meetings designed to x x x x x standardizing Ministry of Health, Zambia | VMMC NATIONALReligious OPERATIONAL leaders PLAN inform and sensitize key opinion leaders will be QAQI guidelines, held with70 MOCTA and traditional leaders materials and Conduct QAQI along with supervision visit (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 70 Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 65 (2016-2020) (2016-2020)

PILLAR 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q1 2017Q2 2017Q3 2017Q4

PILLAR 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q1 KEY STRATEGY2017Q2 2017Q3 2017Q4 DETAILE. VMMCACTIVITIES NATIONAL WORKPLAN (20162018 -20192020) 2020

activities

PILLAR 2016 Q2 2016 Q3 2016 Q4 2017 Q1 2016 Q1

2017Q2 2017Q3 2017Q4

III. Facilitate the

Finalize guidance materials for QAQI X

KEY STRATEGY DETAIL ACTIVITIES integration of 2018 2019 Training2020 of provincial ToT (provinces to choose x X activities VMMC services Decentralize cadre)

with other health supportive Provincial cadres will train facilities staff on QAQI III. Facilitate the Finalize guidance materials for QAQI X pro grams at all supervision standardsKEY STRATEGY and requirements DETAIL ACTIVITIES X 2018 2019 2020 integration of and/or QAQI Training of provincial ToT (provinces to choose x X levels of care and Conduct Quarterly QAQI PILLARand Supportive #1: LEADERSHIP & ADVOCACYx x - Tox increase x andx sustainx programx x visibility and priority at both national and VMMC services Decentralize cadre) centralize VMMC supervision (together with partners where subnational level and garner multi-sectoral support from key stakeholders with other health supportive Provincial cadres will train facilities staff on QAQI commodity I.necessary) Increase program Official laun ch of national VMMC guidance programs at all supervision standards and requirements X Final revision and harmonizing standard kits, and/or QAQI management into visibility and documents will bex planned and attended xby key x x x levels of care and Conduct Quarterly QAQI and Supportive x x x x x x x packagesx and consumables (including PrePex)stakeholders and high- level opinion leaders the existing Supply priority within the x centralize VMMC supervision (together with partners where Integrate/centr Develop advocacy toolkit containing informational Chain System alize Supply healthQuantification portfolio process and and timelines x x x x x commodity necessary) materials, frameworks, and other tools for demand Chain Formallyat all levels inform of MSL the of commitmenvisibility andt x x x x x management into Final revision and harmonizing standard kits, x x x x x priority generation ( targeted at specific audiences) x packages and consumables (including PrePex) health care system the existing Supply Procurement Disseminatex (ongoing)x x advocacyx toolkit,x x x x x xx x x x x x x x x x Integrate/centr Chain System alize Supply Quantification process and timelines x x x x Integratedx outreach program's (mobile ART, informational materials,x frameworksx x x x x x x x Chain Formally inform MSL of commitment x x x x cervicalx cancer screening) Highlight VMMC and share priority areas at x x x Integration of Implement men's clinic concept at appropriate x x x x x x x x x Procurement x x x x x x x x x servicesx x Annual Planning Launch (MTEF) x x facilities National-level advocacy meetings designed to Integrated outreach program's (mobile ART, II. Re-engage the x x x x x x x x x x x STI,x Family Planning inform and sensitize keyx opinionx leadersx xwill bex x x x x cervical cancer screening) 1 key actors in held including members of parliament (engage new Integration of Implement men's clinic concept at appropriate x x IV. xConduct x annualx x x x HMIS/PRSVMMCx advocacy Data colle ction, mapping and analysis x x x x x x services parliament health portfolio) x facilities planning, Planning and Disseminationfor the new of results to stakeholders x x x x x x geographic geographic Operational Plan National-level advocacy meetings (in partnership x x x x x STI, Family Planning x x x x x x x x Annualx planning and performance review with NAC) designedx to inform and sensitize key x x x prioritization and prioritization (2016-2020) Re-engage the x IV. Conduct annual HMIS/PRS Data collection, mapping and analysis x x x x x x key actors opinion leaders will be held including members of officially document Pre andincluding post-campaign review meetings x x x x x x x x x x x planning, Planning and underlying ministries (MoE, MoF, Min of Gender Dissemination of results to stakeholders x x the allocation of x Axlloca tionx of x Parliament, x x x x x geographic geographic MoH national to send memo and guidance forand Women Affairs etc.) Annual planning and performance review x x x xTraditional and prioritization and prioritization x National-level advocacy meetings designed to x x x x x Religious leaders officially document Pre and post-campaign review meetings x x Ministryx x of xHealth, x Zambix ax | VMMCx NATIONALx x OPERATIONAL PLAN inform and sensitize key opinion leaders will be held with71 MOCTA and traditional leaders the allocation of Allocation of MoH national to send memo and guidance for x x x (2016x -2020)x Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 71 Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 65 (2016-2020) (2016-2020)

PILLAR 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q1 2017Q2 2017Q3 2017Q4

PILLAR

2016 Q2 2016 Q3 2016 Q4 2017 Q1 2016 Q1 2017Q2 2017Q3 2017Q4 E. VMMC NATIONAL WORKPLAN (2016-2020) KEY STRATEGY DETAIL ACTIVITIES 2018 2019 2020 geographies and/or geographies allocation and/orPILLAR 2016 Q2 2016 Q3 2016 Q4 2017 Q1 2016 Q1

facilities to partners 2017Q2 2017Q3 2017Q4

facilities Updating the existing site mapping at all levels x x x x x KEY STRATEGY DETAIL ACTIVITIES 2018 2019 2020 PILLAR #4: COMMUNICATION & DEMAND GENERATION - To increase demand and meet the targets for VMMC geographies and/or geographies allocation in the most effective (core) age groups through a targeted, market/client-based approach.

facilities to partners and/or Review and revise the expired communication facilities Updating the existing site mapping at all levels x I. Provide x a x x KEYx STRATEGY DETAIL ACTIVITIES 2018 2019 2020 national demand strategy based research findings (IPSOS, PILLAR #4: COMMUNICATION & DEMAND GENERATION - To increase demand and meet the targets for VMMC PILLAR #1: LEADERSHIP & ADVOCACY - To increase and sustain program visibility and priority at both national and generation Implementation research) (May 16) x in the most effective (core) age groups through a targeted, market/client-based approach. subnational level and garner multi-sectoral support from key stakeholders roadmap by Incorporate innovative methods from research x I. Provide a Review and revise the expired communication I. Increase program Official launch of national VMMC guidance finalizing and Present revised strategy to main TWG (May 16) national demand strategy based research findings (IPSOS, visibility and documents will bex planned and attended by key launching the generation Implementation research) (May 16) x Incorporatepriority within input thefrom main TWG and finalisestakeholders the and high-level opinion leaders x National VMMC document (June 16) roadmap by Incorporate innovative methods from research x L aunch the health portfolio and Develop advocacyx toolkit containing informational Advocacy and National Presentation for validation with stakeholders materials, frameworks, and other tools for demand finalizing and Present revised strategy to main TWG (May 16) x at all levels of the visibility and Communications VMMC (Communication experts and VMMCpriority generation ( targeted at specific audiences) x launching the Incorporate input from main TWG and finalise the health care system Strategy (2016- Advocacy and implementers) (June 16) Disseminate (ongoing)x advocacy toolkit, x x x x x x x x x National VMMC document (June 16) x Communicatio Launch the 2020), and outlining Incorporate comments from validation, finaliseinformational materials, frameworks Advocacy and National Presentation for validation with stakeholders ns Strategy (June 16) x Communications VMMC (Communication experts and VMMC 4 how to take (2016-2020) Highlight VMMC and share priority areas at x x x Proof reading, design and print (July 16) Annual Planning Launch (MTEF) Strategy (2016- Advocacy and implementers) (June 16) x advantage of x x x Communicatio National-level advocacy meetings designed to 2020), and outlining Incorporate comments from validation, finalise referral networks LaunchII. Re -theengage National the VMMC Advocacy and x x x ns Strategy (June 16) x and client follow - 1 Communications key actors in Strategy (July 16) inform and sensitize keyx opinion leaders will be 4 how to take (2016-2020) held including members of parliament (engage new Proof reading, design and print (July 16) up DisseminationVMMC advocacy at provincial level advantage of x parliament health portfolio) x x x referral networks Launch the National VMMC Advocacy and start forreviewing the new the 2016-2020 National Operational Plan National-level advocacy meetings (in partnership x x x x x and client follow- Communications Strategy (July 16) x communication and advocacyRe- engagestrategy the with NAC) designed to inform and sensitize key x (2016-2020) up Dissemination at provincial level x x Gu idelines for Review existing demand creationkey actorsreferral formsopinion leaders will be held includingx members of including underlying ministries (MoE, MoF, Min of Gender start reviewing the 2016-2020 National utilizing referral Developing a standard operating procedure for networks Parliament, and Women Affairs etc.) communication and advocacy strategy referrals x xTraditional and National-level advocacy meetings designed to x x x x x Guidelines for Review existing demand creation referral forms Ministry x of Health, Zambi a | VMMC NATIONAL Religious OPERATIONAL leaders PLAN inform and sensitize key opinion leaders will be utilizing referral 72 Developing a standard operating procedure for (2016-2020) held with MOCTA and traditional leaders networks referrals x Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 72 Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 65 (2016-2020) (2016-2020)

PILLAR 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q1 2017Q2 2017Q3 2017Q4

PILLAR 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q1 KEY STRATEGY2017Q2 2017Q3 2017Q4 DETAILE. VMMCACTIVITIES NATIONAL WORKPLAN (20162018 -20192020) 2020

Develop booking forms/referral cards x

PILLAR 2016 Q2 2016 Q3 2016 Q4

2017 Q1 Share both SOP and booking forms/referral cards 2016 Q1 x x 2017Q2 2017Q3 2017Q4

KEY STRATEGY DETAIL ACTIVITIES II. Generate higher 2018 2019 Review2020 existing and develop novel demand x demand by creation tools and materials x Develop booking forms/referral cards x

implementing Pre-test novel demand creation tools and materials x x Share both SOP and booking forms/referral cards x novel,x market - N ovel methods KEY STRATEGY DETAIL ACTIVITIES 2018 2019 2020 of demand incorporate input from pre-test and finalize x x II. Generate higher Review existing and develop novel demand x based and client- PILLAR #1: LEADERSHIP & ADVOCACY - To increase and sustain program visibility and priority at both national and generation Produce the novel demand creation tool x x demand by creation tools and materials centricx methods of subnational level and garnerx multi-sectoral support from key stakeholders implementing Pre-test novel demand creation tools and materials x demandx generation I.Dissemination Increase program at provincial level Official laun ch of national VMMC x guidance x Novel methods novel, market- Implement use of novel demand creation toolsdocuments will be planned and attended by key of demand incorporate input from pre-test and finalize x throxugh high - yield visibility and x x x x x x x based and client- stakeholders and high-level opinion leaders x generation Produce the novel demand creation tool x x targetedx Developpriority a within campaign the calendar mentioning x centric methods of communications health portfolio and Develop advocacy toolkit containing informational Dissemination at provincial level x x frequency and timing materials, frameworks, and other tools for demand demand generation channels Reviewat all levels existing of events the launchvisibility checklist and from priority generation ( targetedx at specific audiences) x through high-yield Implement use of novel demand creation tools x x x x Innovative/Flex x partnerhealthx care system Disseminate (ongoing) advocacy toolkit, targeted x xible campaign x x x x x x x x x Develop a campaign calendar mentioning Develop event launch checklist informational materials,x frameworks communications frequency and timing Highlight VMMC and xshare priority areas at channels Review existing events launch checklist from Share the checklist with main TWG for approval x x x x Annual Planning Launch (MTEF) x x Innovative/Fle partner Incorporate comments from main TWG x xible campaign II. Re-engage the National-level advocacy meetings designed to x x x Develop event launch checklist x III. Integrate Identify all available structures and processesinform and sensitize keyx opinionx leaders will be market research 1 key actors in Share the checklist with main TWG for approval x I ntegrate and ReviewVMMC market advocacy research findings and incorporateheld including members of parliament (engage new findings and plan parliament health portfolio) x Incorporate comments from main TWG x monitor market into foridentified the new structures and process x x for capacity to National-level advocacy meetings (in partnership research DevelopOperational tools necess Planary to measure effectiveness x x x x x III. Integrate Identify all available structures and processes x x carefully monitor findings with NAC) designed to inform and sensitize key of demand(2016- generation2020) channelsRe-engage the x market research Review market research findings and incorporate demand across key actors opinion leaders will be held including members of findings and plan Integrate and Pre-testincluding the tools with technocrats x monitor market into identified structures and process x x underlying ministries (MoE, MoF, Min of Gender for capacity to Parliament, and Women Affairs etc.) research Develop tools necessary to measure effectiveness carefully monitor findings Traditional and National-level advocacy meetings designed to x x x x x of demand generation channels Ministry of xHealth, Zambi a | VMMC NATIONAL OPERATIONAL PLAN demand across Religious leaders inform and73 sensitize key opinion leaders will be Pre-test the tools with technocrats x (2016 -2020) held with MOCTA and traditional leaders

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 73 Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 65 (2016-2020) (2016-2020)

PILLAR 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q1 2017Q2 2017Q3 2017Q4

PILLAR 2016 Q2 2016 Q3 2016 Q4 2017 Q1 2016 Q1 KEY STRATEGY DETAIL ACTIVITIES 2018 2019 2020 2017Q2 2017Q3 2017Q4 E. VMMC NATIONAL WORKPLAN (2016-2020) market segments Implement use of tool with marketing component x x x x x

PILLAR Develop a standard training tool/module for IPC 2016 Q2 2016 Q3 2016 Q4 2017 Q1 2016 Q1

2017Q2 2017Q3 2017Q4

gents x x KEY STRATEGY DETAIL ACTIVITIES 2018 2019 Orient2020 communication groups in the use of market segments developed tools x x x x x Implement use of tool with marketing component x x x x x

IV. Improve Develop a standard training tool/module for IPC IdentifyKEY STRATEGY innovative communication DETAIL channels x x ACTIVITIES 2018 2019 2020 gents x x program Develop messages, tools and materials focussing on Ensure a focus PILLAR #1: LEADERSHIP & ADVOCACY - To increase and sustain program visibility and priority at both national and Orient communication groups in the use of effectiveness by 15-29 age group x x x x x x x x x on the core, 15- subnational level and garner multi-sectoral support from key stakeholders developed tools focusing x thex x 29x year agex - I.Pre Increase-testing of program messages Official laun ch of nationalx VMMC guidance IV. Improve Identify innovative communication channels majority of demand group for all x x Makevisibility changes and and finalise documents will be plannedx and attended by key program Develop messages, tools and materials focussing on generation demand Ensure a focus generation priority within the stakeholders and high-level opinion leaders x effectiveness by 15-29 age group x x activitiesx x onx the x x x x on the core, 15- activities health portfolio and Develop advocacy toolkit containing informational focusing the 29 year agecore age-group (15- materials, frameworks, and other tools for demand Pre-testing of messages x at all levels of the visibility and majority of demand group for all 29 years) Share for implementation at national level generation ( targeted atx specific audiences) x Make changes and finalise x health care system priority generation demand V. Supplement VI. Facilitate Disseminate (ongoing) advocacy toolkit, generation Prepare a national demand creation budget X x x x x x x x x x activities on the funding for MOH/Partner informational materials, frameworks activities collaboration, Share budget with MOH/other partners X core age-group (15- demand generation joint-funding of Highlight VMMC and share priority areas at x x x 29 years) Share for implementation at national level x activities through specific Annual Planning Launch (MTEF) x x V. Supplement VI. Facilitate Prepare a national demand creation budget jointX -funding of demand II. Re-engage the National-level advocacy meetings designed to x x x funding for MOH/Partner specific demand generation key actors in inform and sensitize key opinion leaders will be collaboration, Share budget with MOH/other partners X activities and1 demand generation generation VMMC advocacy held including members of parliament (engage new joint-funding of re-engage parliament health portfolio) x activities through specific traditional for the new National-level advocacy meetings (in partnership joint-funding of demand leaders ReOperational-engage traditional Plan leaders where applicable x x x x x x x x x x x with NAC) designed to inform and sensitize key specific demand generation PILLAR #5: MONITORING(2016-2020) & EVALUATIONRe-engage the - To develop HMIS and DHIS2 into self-sufficient, reliable sources of activities and key actors opinion leaders will be held including members of generation re-engage including VMMC M&Eunderlying data byministries the end (MoE, of 2017 MoF, Min of Gender traditional Parliament, and Women Affairs etc.) leaders Re-engage traditional leaders where applicable x x x x x xTraditional and Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN National-level advocacy meetings designed to x x x x x PILLAR #5: MONITORING & EVALUATION - To develop HMIS and DHIS2 into self-sufficient, reliable sourcesReligious of leaders inform and74 sensitize key opinion leaders will be VMMC M&E data by the end of 2017 (2016-2020) held with MOCTA and traditional leaders

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 74 Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 65 (2016-2020) (2016-2020)

PILLAR 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q1 2017Q2 2017Q3 2017Q4

PILLAR

2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q1 KEY STRATEGY2017Q2 2017Q3 2017Q4 DETAILE. VMMCACTIVITIES NATIONAL WORKPLAN (20162018 -20192020) 2020

I. Improve data Conduct training of staff (DHIO’s, MC PILLAR coordinators, facility information officers) on 2016 Q2 2016 Q3 2016 Q4 2017 Q1 2016 Q1

capture, quality and 2017Q2 2017Q3 2017Q4

comparative data analysis x x KEY STRATEGY DETAIL ACTIVITIES accuracy at 2018 2019 2020 subnational level Hold data review meetings and comparative data I. Improve data Conduct training of staff (DHIO’s, MC Improve data analysis at all levels and incorporate RDQA activity

through consistent capture, quality and coordinators, facility information officers) on capture, quality with supportive supervision x x x x x x x x x M&E activities to KEY STRATEGY DETAIL ACTIVITIES 2018 2019 2020 accuracy at comparative data analysis x x and accuracy at Develop comprehensive guidelines and cadence, gauge progress and subnational subnational level Hold data review meetings and comparative data clarification and designationPILLAR of responsibilities #1: LEADERSHIP for & ADVOCACY - To increase and sustain program visibility and priority at both national and Improve data analysis at all levels and incorporate RDQA activity evaluation of data level through consistent data management, including how and when copies subnational level and garner multi-sectoral support from key stakeholders capture, quality with supportive supervision x x to identifyx x to xsolve x x x I.of xIncrease source documents program must remain at the facilityOfficial launch of national VMMC guidance M&E activities to and accuracy at Develop comprehensive guidelines and cadence, programmatic level documents will be planned and attended by key gauge progress and subnational visibility and x x clarification and designation of responsibilities for challenges stakeholders and high-level opinion leaders x evaluation of data level Incorporatepriority within RDQA the with supportive supervision x x x x x x x data management, including how and when copies health portfolio and Develop advocacy toolkit containing informational to identify to solve of source documents must remain at the facility II. Harmonize Disseminate M&E Audit Findings memo to allmaterials, frameworks, and other tools for demand stakeholdersat all levels of the visibility and x x programmatic level x x HMIS and PRS priority generation ( targeted at specific audiences) x Revise M&E Revisehealth HMIS care M&Esystem Tools to include more granular challenges Incorporate RDQA with supportive supervision x 5 x tools andx processes x x x x Disseminate (ongoing) advocacy toolkit, x x x x x x x x x to reduce the data indicators, and age-groups, outreach v. static, surgical v. device etc. x x II. Harmonize Disseminate M&E Audit Findings memo to all tools informational materials, frameworks discrepancies Standardization of client intake forms x x HMIS and PRS stakeholders x x Highlight VMMC and share priority areas at x x x Print and distribute M&E data tools 5 tools and processes Revise M&E Revise HMIS M&E Tools to include more granular Annual Planningx x Launch x (MTEF) x x to reduce the data indicators, and age-groups, outreach v. static, surgical v. device etc. x x ReviseII. Re partner-engage reporting the tools to include granularNational -level advocacy meetings designed to x x x tools age bands inform and sensitize key opinion leaders will be discrepancies Standardization of client intake forms x x Revise partne1 r key actors in x x reporting tools AdoptVMMC and advocacy use new PRS tools within partnerheld including members of parliament (engage new Print and distribute M&E data tools x x x reportingfor the systems new parliament health portfolio)x x x Revise partner reporting tools to include granular III. Transition fully Conduct annual national comparative data analysisNational -level advocacy meetings (in partnership x x x x x age bands Operational Plan Revise partner x x from PRS (Partner (PRS vs. HMIS) Re-engage the with NAC) designed to inform andx sensitize key x reporting tools Adopt and use new PRS tools within partner Full M&E (2016-2020) Reporting System) Encourage all implementing partners,key actors facilities opinion to leaders will be held including members of reporting systems x x Transition including underlying ministries (MoE, MoF, Min of Gender to HMIS for M&E submit accurate and complete data in a timely III. Transition fully Conduct annual national comparative data analysis mannerParliament, and Women Affairs etc.) x x x from PRS (Partner (PRS vs. HMIS) x x Traditional and National-level advocacy meetings designed to x x x x x Full M&E Encourage all implementing partners, facilities to Reporting System) Transition Ministry of Health, Zambia | VMMC NATIONALReligious OPERATIONAL leaders PLAN inform and sensitize key opinion leaders will be to HMIS for M&E submit accurate and complete data in a timely held with75 MOCTA and traditional leaders manner x x x (2016 -2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 75 Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 65 (2016-2020) (2016-2020)

PILLAR 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q1 2017Q2 2017Q3 2017Q4

PILLAR 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q1 KEY STRATEGY2017Q2 2017Q3 2017Q4 DETAILE. VMMCACTIVITIES NATIONAL WORKPLAN (20162018 -20192020) 2020 Consolidate all data into HMIS and national data

PILLAR collection tools and discontinue PRS as a source 2016 Q2 2016 Q3 2016 Q4 2017 Q1 2016 Q1

2017Q2 2017Q3 2017Q4

for national data x x x KEY STRATEGY DETAIL ACTIVITIES 2018PILLAR 2019 #6:2020 IMPLEMENTATION SCIENCE - To conduct operations research to fill the most critical VMMC Consolidate all data into HMIS and national data information gaps and continually use available data to improve all aspects of the program

collection tools and discontinue PRS as a source I. Facilitate Develop database of research and studies (historical for national data stakeholder x x x andKEY ongoing) STRATEGY describing the DETAILobjectives, timelines ACTIVITIES 2018 2019 2020 PILLAR #6: IMPLEMENTATION SCIENCE - To conduct operations researchparticipation to fill in the IS most critical VMMC and participants PILLAR #1: LEADERSHIP x& ADVOCACY - To increase and sustain program visibility and priority at both national and information gaps and continually use available data to improve allactivities aspects andof the programDatabase of Regularly collect new information on ongoing subnational level and garner multi-sectoral support from key stakeholders I. Facilitate Develop database of research and studies (historical develop and implementation I.studies Increase and update program the database Official laun ch ofx nationalx VMMCx x guidance x x x x x x science documents will be planned and attended by key stakeholder and ongoing) describing the objectives, timelines maintain a live visibility and and participants x projects /studie stakeholders and high-level opinion leaders x participation in IS database of s priority within the Database of Regularly collect new information on ongoing healthFacilitate portfolio stakeholders and participation and supportDevelop of advocacy toolkit containing informational activities and implementation materials, frameworks, and other tools for demand implementation studies and update the database x x x x x x x x x theatx dataall levels collection of the and researchvisibility process and develop and science generation ( targeted at specific audiences) x science health care system priority maintain a live projects/studie projects/studies Disseminate (ongoing)x x advocacy x toolkit,x x x x x xx x x x x x x x x x database of s Facilitate stakeholders participation and support of II. Ensure wide Disseminate all study and research findings locallyinformational - materials, frameworks implementation 6 TWG and subcommittee meetings (national and the data collection and research process dissemination of Highlight VMMC and share priority areas at x x x Dissemination subnational) x x x x x x x x x x science study findings and of study Annual Planning Launch (MTEF) x x Disseminate study and research findings projects/studies x x x xfacilitate x thex x x findings,x x National-level advocacy meetings designed to internationallyII. Re-engage - international the conferences and x x x II. Ensure wide Disseminate all study and research findings locally - adoption of these 1 key actors in inform and sensitize key opinion leaders will be 6 TWG and subcommittee meetings (national and meetings, where appropriate held including membersx x of parliamentx x (engagex xnew x x x x dissemination of Dissemination findings to improve VMMC advocacy subnational) x x x x x x x x x Incorporatex study findings and recommendationsparliament health portfolio) x study findings and of study program Adoption to for the new Disseminate study and research findings into national policy and strategy documents National-levelx advocacyx x meetingsx (inx partnershipx x x x x x facilitate the findings, implementation improve Operational Plan x x x x x internationally - international conferences and Develop clear plan for implementation of findinwithgs NAC) designed to inform and sensitize key adoption of these program (2016-2020) Re-engage the meetings, where appropriate x x x x x x x implementationx x andx recommendations (what,key where, actors how, whoopinion and leaders will be held including members of findings to improve including Incorporate study findings and recommendations when?) underlyingx ministries x (MoE,x xMoF, xMin ofx Genderx x x x x program Adoption to into national policy and strategy documents x x x x x x x x x x x Parliament, and Women Affairs etc.) implementation improve Traditional and National-level advocacy meetings designed to program Develop clear plan for implementation of findings Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN x x x x x implementation and recommendations (what, where, how, who and Religious leaders inform and76 sensitize key opinion leaders will be when?) x x x x x x x x x (2016x -2020)x held with MOCTA and traditional leaders

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 76 Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 65 (2016-2020) (2016-2020)

PILLAR 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q1 2017Q2 2017Q3 2017Q4

PILLAR 2016 Q2 2016 Q3 2016 Q4 2017 Q1 2016 Q1 KEY STRATEGY2017Q2 2017Q3 2017Q4 DETAILE. VMMCACTIVITIES NATIONAL WORKPLAN (20162018 -20192020) 2020 PILLAR #7: RESOURCE MOBILIZATION - To mobilize sufficient financial resources to cover the programmatic

PILLAR funding gap while also ensuring efficient and effective use of existing resources

2016 Q2 2016 Q3 2016 Q4 2017 Q1 2016 Q1 2017Q2 2017Q3 2017Q4

I. Mobilize Efficient Ensure that VMMC is prioritized in the MTEF, KEY STRATEGY DETAIL ACTIVITIES 2018 2019 2020 sufficient resources resource NHSP and NASF 2016 -2021 x PILLAR #7: RESOURCE MOBILIZATION - To mobilize sufficient financial resources to cover theutilization programmatic

Develop sustainable national plan for eliminating

for continued scale-

funding gap while also ensuring efficient and effective use of existing resourcesthrough service up through a new, delivery VMMC compensation/reimbursement x Efficient Ensure that VMMC is prioritized in the MTEF, KEY STRATEGY DETAIL ACTIVITIES 2018 2019 2020 I. Mobilize integration resource intensive TWG PILLAR #1: LEADERSHIP & ADVOCACY - To increase and sustain program visibility and priority at both national and sufficient resources NHSP and NASF 2016 -2021 x and/or utilization sub-committee Develop sustainable national plan for eliminating routinization, subnational level and garner multi-sectoral support from key stakeholders for continued scale- through service PMO/DMO and facility levels should develop (Resource performance- I. Increase program Official launch of national VMMC guidance up through a new, delivery VMMC compensation/reimbursement x ministry approved VMMC schedule Mobilization) while based funding documents will be planned and attended by key integration visibility and intensive TWG and reusable stakeholders and high-level opinion leaders and/or maintaining priority within the x sub-committee commodities x routinization, efficient utilization health portfolio and Develop advocacy toolkit containing informational (Resource PMO/DMO and facility levels should develop TWG members to develop ToRs and schedulematerials, for frameworks,x and other tools for demand performance- ministry approved VMMC schedule of existing funding at all levels of the visibility and Mobilization) while based funding RM subcommittee generation ( targeted at specific audiences) x New sub- health care system priority maintaining and reusable committee for TWG to meet and identify subcommittee membersDisseminate (ongoing) x advocacy toolkit, x x x x x x x x x 7 efficient utilization commodities x resource RM subcommittee develop an investment caseinformational to materials, frameworks TWG members to develop ToRs and schedule for x of existing funding x mobilization be used for lobbying for resources, based on HighlightOps VMMC and share priority areas at RM subcommittee x x x New sub- plan Annual Planning Launch (MTEF)x x x committee for TWG to meet and identify subcommittee members x GovII. Reernment-engage and partnersthe to negotiate with National-level advocacyx meetingsx designedx x to x x x x 7 resource RM subcommittee develop an investment case to x 1 insurancekey actors association in to Include VMMC in inform and sensitize key opinion leaders will be mobilization be used for lobbying for resources, based on Ops standard/minimum health insurance packageheld including members of parliament (engage new Mobilize VMMC advocacy plan x parliament health portfolio) resources from Stakeholdersfor the newto decide on standard price across x x x x x x Government and partners to negotiate with x x x x x private sector different types of service delivery points National-level advocacy meetings (in partnership x x x x x insurance association to Include VMMC in Operational Plan (PPP) Re-engage the with NAC) designed tox informx andx sensitize x keyx standard/minimum health insurance package Engage (2016 health-2020) insurance (Insurancekey actors Association opinion of leaders will be held including members of Mobilize Zambia)including on a cost -sharing format for VMMC Stakeholders to decide on standard price across x x x x x underlying ministries (MoE, MoF, Min of Gender resources from whichParliament, is partially reimbursed (commodities and private sector different types of service delivery points and Women Affairs etc.) Traditional and (PPP) x x x x x National-level advocacy meetings designed to x x x x x Engage health insurance (Insurance Association of Ministry of Health, Zambia | VMMC NATIONALReligious OPERATIONAL leaders PLAN inform and77 sensitize key opinion leaders will be Zambia) on a cost-sharing format for VMMC (2016-2020) held with MOCTA and traditional leaders which is partially reimbursed (commodities and Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 77 Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 65 (2016-2020) (2016-2020)

PILLAR 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q1 2017Q2 2017Q3 2017Q4

PILLAR 2016 Q2 2016 Q3 2016 Q4 2017 Q1 2016 Q1 KEY STRATEGY2017Q2 2017Q3 2017Q4 DETAILE. VMMCACTIVITIES NATIONAL WORKPLAN (20162018 -20192020) 2020 consumables offered etc.)

PILLAR

2016 Q2 2016 Q3 2016 Q4 2017 Q1 2016 Q1 2017Q2 2017Q3 2017Q4

KEY STRATEGY DETAIL ACTIVITIES 2018 2019 2020 x x x x x consumables offered etc.) Engage private clinics for service delivery x x x x

II. Maintain and Conduct bi annual gap analysis x x x x x x document an KEY STRATEGY DETAIL ACTIVITIES 2018 2019 2020 accurate PILLAR #1: LEADERSHIP & ADVOCACY - To increase and sustain program visibility and priority at both national and Engage private clinics for service delivery x x x x x x xR esourcex x understanding of assessment to subnational level and garner multi-sectoral support from key stakeholders II. Maintain and Conduct bi annual gap analysis x xthe VMMC x xcontinually x I. xIncrease program Official launch of national VMMC guidance document an resource assess and visibility and documents will be planned and attended by key accurate environment and prioritize priority within the stakeholders and high-level opinion leaders x Resource resource needs understanding of assessment to programmatic health portfolio and Develop advocacy toolkit containing informational materials, frameworks, and other tools for demand the VMMC continually funding gaps at all at all levels of the visibility and generation ( targeted at specific audiences) x resource assess and times health care system priority prioritize Disseminate (ongoing) advocacy toolkit, x x x x x x x x x environment and PILLAR #8: SUSTAINABILITY & EIMC - To develop and implement a robust plan for VMMC program transition and resource needs informational materials, frameworks programmatic integration in the sustainability and maintenance phase, once scale-up targets have been met Highlight VMMC and share priority areas at funding gaps at all I. Develop a Ensure that EIMC is prioritized in the MTEF, x x x x x x x x x x x x x times NHSP and NASF 2016 -2021 Annual Planning Launch (MTEF) x x comprehensive, National-level advocacy meetings designed to PILLAR #8: SUSTAINABILITY & EIMC - To develop and implement a robust plan for VMMC programDevelop transition a EIMCII. and Re Site -engage assessment the and mapping Level 1,2,3 x x x evidence-based inform and sensitize key opinion leaders will be x comprehensive1 facilitieskey actors in integration in the sustainability and maintenance phase, once scaletransition-up targets and have been met held including members of parliament (engage new Ensure that EIMC is prioritized in the MTEF, transition and ReviewVMMC and advocacy update current SOPs, training manual I. Develop a x x x sustainabilityx x x plan x sustainabilityx x x parliament health portfolio) x x NHSP and NASF 2016 -2021 and guidelinesfor the new x comprehensive, 8 covering all pillars plan National-level advocacy meetings (in partnership x x x x x evidence-based Develop a EIMC Site assessment and mapping Level 1,2,3 x ConductOperational Evaluation Plan and develop sustainability and x x x comprehensive of program Re-engage the with NAC) designed to inform and sensitize key transition and facilities transition (2016 plan,-2020) including EIMCkey actors opinion leaders will be held including members of transition and Review and update current SOPs, training manual including sustainability plan sustainability II. Maintain x TWG to decide on the cadre to conduct VMMCunderlying ministriesx (MoE,x MoF, Min of Gender and guidelines EIMC Training 8 covering all pillars plan x (midwifeParliament, or nurse?) and Women Affairs etc.) Conduct Evaluation and develop sustainability and x x x Traditional and National-level advocacy meetings designed to of program Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN x x x x x transition plan, including EIMC Religious leaders inform and78 sensitize key opinion leaders will be TWG to decide on the cadre to conduct VMMC (2016-2020) held with MOCTA and traditional leaders II. Maintain EIMC Training x x (midwife or nurse?) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 78 Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 65 (2016-2020) (2016-2020)

PILLAR 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q1 2017Q2 2017Q3 2017Q4

PILLAR

2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q1 2017Q2 2017Q3 2017Q4 E. VMMC NATIONAL WORKPLAN (2016-2020) KEY STRATEGY DETAIL ACTIVITIES 2018 2019 2020 existing services for Advocate for EIMC to be included in the pre x x x x x x x x PILLAR service curriculum through GNC (General Nursing 2016 Q2 2016 Q3 2016 Q4

2017 Q1 2016 Q1

Early Infant Male 2017Q2 2017Q3 2017Q4

Council) KEY STRATEGY DETAIL ACTIVITIES Circumcision 2018 2019 2020 Conduct Provincial ToT country wide for EIMC x x x x x x x x existing services for Advocate for EIMC to be included in the pre x (EIMC)x x whilex x x x x

skills

service curriculum through GNC (General Nursing mobilizing Early Infant Male Train mobilizers( national or subnational level, Council) resources and KEY STRATEGY DETAIL ACTIVITIESx x x x x x x x 2018 2019 2020 Circumcision ministry or partner-led) Conduct Provincial ToT country wide for EIMC x xevidence x forx x x x x PILLAR #1: LEADERSHIP & ADVOCACY - To increase and sustain program visibility and priority at both national and (EIMC) while EIMC Supply EIMC logistics to be included in the national SCMS x mobilizing skills program Chain subnational level and garner multi-sectoral support from key stakeholders Official launch of nationalx VMMCx x guidance x x x x x x resources and Train mobilizers( national or subnational level, x implementationx x x inx Managementx x (a I. xIncrease program ministry or partner-led) a sustainability ppendix 3) Ongoingvisibility procurement and of EIMC commoditiesdocuments will be planned and attended by key evidence for stakeholders and high-level opinion leaders EIMC Supply EIMC logistics to be included in the national SCMS x phase Governmentpriority within advocacy the to partners to prioritize x x program Chain EIMC Develop advocacy toolkit containing informational implementation in x x x x x x x x healthx portfolio and Management(a EIMC Provincial and district annual plans to includematerials, frameworks, and other tools for demand Ongoing procurement of EIMC commodities at all levels of the visibility and x x x x x x x x x x x a sustainability ppendix 3) Resource generation ( targeted at specific audiences) x EIMChealth care system priority phase Government advocacy to partners to prioritize x mobilization Disseminate (ongoing) advocacy toolkit, x x x x x x x x x EIMC National Level Budget to include EIMC funding x x x x strategies informational materials, frameworks Provincial and district annual plans to include x x x x x x x x x EIMC x x x x x x x x x x Engagex MNCH and its partners for joint planningHighlight VMMC and share priority areas at Resource EIMC x x x and funding with the aim to integrate Annual Planning Launch (MTEF) x x mobilization x x Meetingsx with all community stakeholders, NHC, strategies National Level Budget to include EIMC funding x II. Re-engage the National-level advocacyx meetingsx designedx x to x x x x x x x x x x x x x x x x SMAGx inform and sensitize key opinion leaders will be Engage MNCH and its partners for joint planning EIMC Demand1 key actors in and funding with the aim to integrate EngageVMMC and advocacy sensitize woul d-be parents and spousesheld including membersx of parliamentx x (engagex xnew x x x x creation (communication through midwives, ANC etc.)parliament health portfolio) Meetings with all community stakeholders, NHC, x x x x x x x x x for the new x SMAG ProduceOperational IEC materials Plan National-level advocacy x meetingsx (inx partnershipx x x x x x x x x x x Re-engage the with NAC) designed to inform and sensitize key EIMC Demand Engage and sensitize would-be parents and spouses x x x x x x x x x (2016-2020) key actors opinion leaders will be held including members of creation (communication through midwives, ANC etc.) including underlying ministries (MoE, MoF, Min of Gender Produce IEC materials x x x x x x x x x Parliament, and Women Affairs etc.) Traditional and National-level advocacy meetings designed to x x x x x Ministry of Health, Zambia | VMMC NATIONALReligious OPERATIONAL leaders PLAN inform and79 sensitize key opinion leaders will be (2016-2020) held with MOCTA and traditional leaders Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 79 Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 65 (2016-2020) (2016-2020)

Appendix 1: ANNUAL VMMC TARGETS BY DISTRICT Appendix 1: ANNUAL VMMC TARGETS BY DISTRICT Province District 2016 2017 2018 2019 2020 TOTAL CentralProvince District 2016 2017 2018 2019 2020 TOTAL Central 39,431 40,546 36,960 33,852 35,980 186,770 Kapiri-Mposhi 39,431 40,546 36,960 33,852 35,980 186,770 Kapiri-Mposhi 6,823 7,016 6,395 5,858 6,226 32,318 Chibombo 6,823 7,016 6,395 5,858 6,226 32,318 Chibombo 5,885 6,052 5,516 5,052 5,370 27,875 Mumbwa 5,885 6,052 5,516 5,052 5,370 27,875 Mumbwa 4,999 5,140 4,685 4,291 4,561 23,677 Kabwe 4,999 5,140 4,685 4,291 4,561 23,677 Kabwe 4,991 5,132 4,678 4,285 4,554 23,642 Mkushi 4,991 5,132 4,678 4,285 4,554 23,642 Mkushi 3,926 4,037 3,680 3,370 3,582 18,596 Serenje 3,926 4,037 3,680 3,370 3,582 18,596 Serenje 3,287 3,380 3,081 2,822 3,000 15,571 Chisamba 3,287 3,380 3,081 2,822 3,000 15,571 Chisamba 2,902 2,984 2,720 2,491 2,648 13,743 Chitambo 2,902 2,984 2,720 2,491 2,648 13,743 Chitambo 2,865 2,946 2,685 2,460 2,614 13,570 Itezhi-tezhi 2,865 2,946 2,685 2,460 2,614 13,570 Itezhi-tezhi 2,325 2,391 2,179 1,996 2,122 11,014 Luano 2,325 2,391 2,179 1,996 2,122 11,014 Luano 932 959 874 800 851 4,417 Ngabwe 932 959 874 800 851 4,417 Ngabwe 496 510 465 426 452 2,348 Copperbelt 496 510 465 426 452 2,348 Copperbelt 30,716 31,584 28,791 26,370 28,027 145,488 Kitwe 30,716 31,584 28,791 26,370 28,027 145,488 Kitwe 8,020 8,247 7,517 6,885 7,318 37,987 Ndola 8,020 8,247 7,517 6,885 7,318 37,987 Ndola 6,549 6,734 6,139 5,623 5,976 31,021 Chingola 6,549 6,734 6,139 5,623 5,976 31,021 Chingola 3,264 3,356 3,060 2,802 2,978 15,461 Mufulira 3,264 3,356 3,060 2,802 2,978 15,461 Mufulira 2,523 2,595 2,365 2,166 2,302 11,951 Luanshya 2,523 2,595 2,365 2,166 2,302 11,951 Luanshya 2,306 2,371 2,161 1,980 2,104 10,921 Mpongwe 2,306 2,371 2,161 1,980 2,104 10,921 Mpongwe 1,747 1,797 1,638 1,500 1,594 8,276 Masaiti 1,747 1,797 1,638 1,500 1,594 8,276 Masaiti 1,693 1,741 1,587 1,454 1,545 8,020 Kalulushi 1,693 1,741 1,587 1,454 1,545 8,020 Kalulushi 1,664 1,711 1,560 1,429 1,518 7,882 Chililabombwe 1,664 1,711 1,560 1,429 1,518 7,882 Chililabombwe 1,590 1,634 1,490 1,365 1,450 7,529 Lufwanyama 1,590 1,634 1,490 1,365 1,450 7,529 Lufwanyama 1,359 1,398 1,274 1,167 1,240 6,438 Note: Minor discrepancies in1,359 totals are due1,398 to rounding1,274 of targets 1,167at the district level.1,240 6,438 Note: Minor discrepancies in totals are due to rounding of targets at the district level.

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 80 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 80 (2016-2020)

Province District 2016 2017 2018 2019 2020 TOTAL

ProvinceEastern District 201660,387 201762,094 201856,602 201951,843 202055,101 TOTAL286,028

Chipata 15,387 15,822 14,423 13,210 14,040 72,882 Eastern 60,387 62,094 56,602 51,843 55,101 286,028 Lundazi 12,566 12,921 11,778 10,788 11,466 59,519 Chipata 15,387 15,822 14,423 13,210 14,040 72,882 Petauke 9,408 9,674 8,818 8,077 8,584 44,561 Lundazi 12,566 12,921 11,778 10,788 11,466 59,519 Katete 6,542 6,727 6,132 5,617 5,970 30,989 Petauke 9,408 9,674 8,818 8,077 8,584 44,561 Sinda 5,848 6,014 5,482 5,021 5,337 27,702 Katete 6,542 6,727 6,132 5,617 5,970 30,989 Nyimba 3,337 3,432 3,128 2,865 3,045 15,807 Sinda 5,848 6,014 5,482 5,021 5,337 27,702 Chadiza 3,312 3,406 3,105 2,844 3,022 15,688 Nyimba 3,337 3,432 3,128 2,865 3,045 15,807 Mambwe 2,995 3,080 2,808 2,572 2,733 14,188 Chadiza 3,312 3,406 3,105 2,844 3,022 15,688 Vubwi 990 1,018 928 850 904 4,691 Mambwe 2,995 3,080 2,808 2,572 2,733 14,188 Luapula 32,267 33,179 30,244 27,701 29,442 152,833 Vubwi 990 1,018 928 850 904 4,691 Mansa 6,347 6,527 5,949 5,449 5,792 30,064 Luapula 32,267 33,179 30,244 27,701 29,442 152,833 Samfya 5,739 5,901 5,379 4,927 5,237 27,184 Mansa 6,347 6,527 5,949 5,449 5,792 30,064 Nchelenge 5,134 5,280 4,813 4,408 4,685 24,320 Samfya 5,739 5,901 5,379 4,927 5,237 27,184 Chiengi 3,884 3,994 3,640 3,334 3,544 18,396 Nchelenge 5,134 5,280 4,813 4,408 4,685 24,320 Kawambwa 2,966 3,050 2,780 2,546 2,706 14,047 Chiengi 3,884 3,994 3,640 3,334 3,544 18,396 Mwense 2,640 2,714 2,474 2,266 2,409 12,503 Kawambwa 2,966 3,050 2,780 2,546 2,706 14,047 Milenge 1,553 1,597 1,455 1,333 1,417 7,354 Mwense 2,640 2,714 2,474 2,266 2,409 12,503 Mwansabombwe 1,457 1,498 1,366 1,251 1,330 6,902 Milenge 1,553 1,597 1,455 1,333 1,417 7,354 Chipili 1,101 1,132 1,032 945 1,005 5,216 Mwansabombwe 1,457 1,498 1,366 1,251 1,330 6,902 Chembe 944 970 885 810 861 4,470 Chipili 1,101 1,132 1,032 945 1,005 5,216 Lunga 502 516 470 431 458 2,377 Chembe 944 970 885 810 861 4,470

Lunga 502 516 470 431 458 2,377

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 81 (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 81 (2016-2020)

Province District 2016 2017 2018 2019 2020 TOTAL

ProvinceLusaka Dis trict 201684,950 201787,352 201879,626 201972,931 202077,515 TOTAL402,374

Lusaka 65,708 67,566 61,590 56,411 59,957 311,232 Lusaka 84,950 87,352 79,626 72,931 77,515 402,374

Chongwe 5,041 5,183 4,725 4,328 4,600 23,877 Lusaka 65,708 67,566 61,590 56,411 59,957 311,232

Kafue 4,381 4,505 4,107 3,761 3,998 20,752 Chongwe 5,041 5,183 4,725 4,328 4,600 23,877

Chilanga 3,842 3,951 3,601 3,299 3,506 18,199 Kafue 4,381 4,505 4,107 3,761 3,998 20,752

Rufunsa 1,783 1,833 1,671 1,530 1,627 8,443 Chilanga 3,842 3,951 3,601 3,299 3,506 18,199

Chirundu 1,705 1,753 1,598 1,463 1,555 8,074 Rufunsa 1,783 1,833 1,671 1,530 1,627 8,443

Shibuyunji 1,660 1,707 1,556 1,425 1,515 7,863 Chirundu 1,705 1,753 1,598 1,463 1,555 8,074

Luangwa 831 854 779 713 758 3,934 Shibuyunji 1,660 1,707 1,556 1,425 1,515 7,863

Muchinga 35,442 36,444 33,220 30,427 32,339 167,872 Luangwa 831 854 779 713 758 3,934 Mpika 9,893 10,173 9,273 8,493 9,027 46,859 Muchinga 35,442 36,444 33,220 30,427 32,339 167,872

Nakonde 6,197 6,372 5,808 5,320 5,654 29,352 Mpika 9,893 10,173 9,273 8,493 9,027 46,859

Chama 5,177 5,323 4,852 4,444 4,724 24,520 Nakonde 6,197 6,372 5,808 5,320 5,654 29,352

Mafinga 3,786 3,893 3,549 3,251 3,455 17,934 Chama 5,177 5,323 4,852 4,444 4,724 24,520

Chinsali 3,637 3,740 3,409 3,123 3,319 17,228 Mafinga 3,786 3,893 3,549 3,251 3,455 17,934

Isoka 3,577 3,678 3,353 3,071 3,264 16,943 Chinsali 3,637 3,740 3,409 3,123 3,319 17,228

Shiwangandu 3,174 3,264 2,975 2,725 2,896 15,035 Isoka 3,577 3,678 3,353 3,071 3,264 16,943

Shiwangandu 3,174 3,264 2,975 2,725 2,896 15,035

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 82 (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 82 (2016-2020)

Province District 2016 2017 2018 2019 2020 TOTAL

ProvinceNorthern District 201647,755 201749,105 201844,762 201940,998 202043,575 TOTAL226,194

Kasama 9,566 9,837 8,967 8,213 8,729 45,312 Northern 47,755 49,105 44,762 40,998 43,575 226,194 Mbala 8,714 8,960 8,167 7,481 7,951 41,272 Kasama 9,566 9,837 8,967 8,213 8,729 45,312 Mungwi 6,580 6,766 6,168 5,649 6,004 31,166 Mbala 8,714 8,960 8,167 7,481 7,951 41,272 Luwingu 5,690 5,851 5,334 4,885 5,192 26,952 Mungwi 6,580 6,766 6,168 5,649 6,004 31,166 Kaputa 5,285 5,435 4,954 4,537 4,823 25,034 Luwingu 5,690 5,851 5,334 4,885 5,192 26,952 Mporokoso 4,378 4,502 4,104 3,759 3,995 20,737 Kaputa 5,285 5,435 4,954 4,537 4,823 25,034 Mpulungu 4,182 4,300 3,920 3,590 3,816 19,809 Mporokoso 4,378 4,502 4,104 3,759 3,995 20,737 Chilubi 3 ,359 3,454 3,149 2,884 3,065 15,911 Mpulungu 4,182 4,300 3,920 3,590 3,816 19,809 Nsama23 ------Chilubi 3 ,359 3,454 3,149 2,884 3,065 15,911 North Western 11,640 11,969 10,911 9,993 10,621 55,134 23 Nsama ------Solwezi 5,806 5,971 5,442 4,985 5,298 27,502 North Western 11,640 11,969 10,911 9,993 10,621 55,134 Mwinilunga 1,467 1,508 1,375 1,259 1,339 6,948 Solwezi 5,806 5,971 5,442 4,985 5,298 27,502 Kabompo 1,118 1,149 1,048 960 1,020 5,294 Mwinilunga 1,467 1,508 1,375 1,259 1,339 6,948 Zambezi 928 955 870 797 847 4,397 Kabompo 1,118 1,149 1,048 960 1,020 5,294 Kasempa 866 890 811 743 790 4,101 Zambezi 928 955 870 797 847 4,397 Mufumbwe 715 735 670 614 652 3,385 Kasempa 866 890 811 743 790 4,101 Chavuma 389 400 364 334 355 1,841 Mufumbwe 715 735 670 614 652 3,385 Ikelenge 352 362 330 302 321 1,665 Chavuma 389 400 364 334 355 1,841 Manyinga24 ------Ikelenge 352 362 330 302 321 1,665

Manyinga24 ------

23 Nsama district population numbers are included in Kaputa district. 24 Manyinga district population numbers are included in Kabompo district.

Ministry23 Nsama district of Health,population Zambinumbers aare | included VMMC in Kaputa NATIONAL district. OPERATIONAL PLAN 24 83 Manyinga district population numbers are included in(2016 Kabompo-2020) district. Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 83 (2016-2020)

Province District 2016 2017 2018 2019 2020 TOTAL

Southern 53,352 54,860 50,008 45,804 48,682 252,707 Province District 2016 2017 2018 2019 2020 TOTAL Kalomo 7,638 7,853 7,159 6,557 6,969 36,176 Southern 53,352 54,860 50,008 45,804 48,682 252,707 Monze 6,471 6,654 6,066 5,556 5,905 30,651 Kalomo 7,638 7,853 7,159 6,557 6,969 36,176 Choma 6,382 6,562 5,982 5,479 5,823 30,228 Monze 6,471 6,654 6,066 5,556 5,905 30,651 Mazabuka 5,44 1 5,595 5,100 4,671 4,965 25,772 Choma 6,382 6,562 5,982 5,479 5,823 30,228 Livingstone 4,523 4,651 4,240 3,883 4,127 21,424 Mazabuka 5,44 1 5,595 5,100 4,671 4,965 25,772 Kazungula 4,143 4,260 3,883 3,557 3,780 19,623 Livingstone 4,523 4,651 4,240 3,883 4,127 21,424 Namwala 3,991 4,104 3,741 3,427 3,642 18,905 Kazungula 4,143 4,260 3,883 3,557 3,780 19,623 Sinazongwe 3,980 4,093 3,731 3,417 3,632 18,853 Namwala 3,991 4,104 3,741 3,427 3,642 18,905 Zimba 2,558 2,630 2,397 2,196 2,334 12,114 Sinazongwe 3,980 4,093 3,731 3,417 3,632 18,853 Gwembe 2,343 2,409 2,196 2,012 2,138 11,099 Zimba 2,558 2,630 2,397 2,196 2,334 12,114 Pemba 2,153 2,213 2,018 1,848 1,964 10,196 Gwembe 2,343 2,409 2,196 2,012 2,138 11,099 Chikankata 1,950 2,005 1,828 1,674 1,780 9,238 Pemba 2,153 2,213 2,018 1,848 1,964 10,196 Siavonga 1,780 1,830 1,668 1,528 1,624 8,430 Chikankata 1,950 2,005 1,828 1,674 1,780 9,238 Western 23,156 23,811 21,705 19,880 21,129 109,682 Siavonga 1,780 1,830 1,668 1,528 1,624 8,430 Mongu 3,143 3,232 2,946 2,698 2,868 14,886 Western 23,156 23,811 21,705 19,880 21,129 109,682 Kaoma 3,011 3,096 2,822 2,585 2,748 14,263 Mongu 3,143 3,232 2,946 2,698 2,868 14,886 Kalabo 2,154 2,215 2,019 1,849 1,966 10,203 Kaoma 3,011 3,096 2,822 2,585 2,748 14,263 Senanga 1,851 1,904 1,735 1,589 1,689 8,769 Kalabo 2,154 2,215 2,019 1,849 1,966 10,203 Lukulu 1,600 1,646 1,500 1,374 1,460 7,581 Senanga 1,851 1,904 1,735 1,589 1,689 8,769 Nalolo 1,406 1,446 1,318 1,207 1,283 6,660 Lukulu 1,600 1,646 1,500 1,374 1,460 7,581 Shangombo 1,389 1,429 1,302 1,193 1,268 6,580 Nalolo 1,406 1,446 1,318 1,207 1,283 6,660 Sioma 1,374 1,413 1,288 1,180 1,254 6,508 Shangombo 1,389 1,429 1,302 1,193 1,268 6,580 Sesheke 1,067 1,098 1,001 916 974 5,056 Sioma 1,374 1,413 1,288 1,180 1,254 6,508 Luampa 1,045 1,074 979 897 953 4,948 Sesheke 1,067 1,098 1,001 916 974 5,056 Sikongo 998 1,026 936 857 911 4,728 Luampa 1,045 1,074 979 897 953 4,948 Limulunga 979 1,007 918 840 893 4,637 Sikongo 998 1,026 936 857 911 4,728 Nkeyema 962 989 901 825 877 4,554 Limulunga 979 1,007 918 840 893 4,637 Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN Nkeyema 962 989 901 825 877 844,554 (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 84 (2016-2020)

Province District 2016 2017 2018 2019 2020 TOTAL

Mulobezi 901 927 845 774 822 4,269 Province District 2016 2017 2018 2019 2020 TOTAL

Mitete 701 721 657 602 639 3,319 Mulobezi 901 927 845 774 822 4,269

Mwandi 574 591 538 493 524 2,721 Mitete 701 721 657 602 639 3,319

Mwandi 574 591 538 493 524 2,721

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 85 (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 85 (2016-2020)

Appendix 2: VMMC EQUIPMENT SET AND CONSUMABLE KIT Appendix 2: VMMC EQUIPMENTCONTENTS SET AND CONSUMABLE KIT CONTENTS Surgical instruments set content for dorsal slit

ProductSurgical instruments set contentDescription for dorsal slit # ProductAutoclave storage box DescriptionEstimated dimensions approximately: 5"W x 10"L x 2"H #1 AutoclaveDissection storage dissecting box Estimated13-15 cm dimensions approximately: 5"W x 10"L x 2"H 1 Dissectionscissors dissecting 13-15 cm 1 scissorsCombination needle- 13-15 cm, working surface approximately 20mm 1 Combinationholder/suture scissorsneedle - 13-15 cm, working surface approximately 20mm 1 holder/sutureNeedle-holder/ scissors driver Needle-holder (12-14 cm, working surface 20mm) 1 NeedleSuture scissors-holder/ driver NeedleSuture scissor-holder (12(12--1514 cm)cm, working surface 20mm) 1 SutureToothed scissors tissue forceps SutureTotal length scissor 13 (12 cm,-15 working cm) surface 15 mm serrated 1 ToothedMosquito tissue forcepsclamp Total length 1312 -cm,14 cm working surface 15 mm serrated 14 Mosquitostraight clamp Total length 12-14 cm 4 straightMosquito clamp curve Total length 12-14 cm, working surface 20-30 mm 1 MosquitoHaemostatic clamp clamps curve Total length 1213-1415 cm, working surface 2040 -mm30 mm 12 HaemostaticSource: clampsSCMS Total lengthMC 13-15 cm,core working surfacelist, 40 mm October 20112 Source:(http://scms.pfscm.org/scms/docs/papers/MC_Handout_13_OCT_2011.pdf SCMS MC core list, October) 2011 Consumables(http://scms.pfscm.org/scms/docs/papers/MC_Handout_13_OCT_2011.pdf kit contents )

ProductConsumables kit contents Description # ProductMultipurpose container DescriptionStable plastic recycle tray to conduct procedure, minimum 700 #1 Multipurposetray container Stablemicron plastic virgin recycle plastic, tray with to conduct3 compartments procedure, (Compart minimumment 700 1 = 1 tray micron13X26, virgincompartment plastic, with2 =3 compartments5X8, compartment (Compart 3 ment= 5X5,1 = 13X26,compartment compartment 4 = 2 = 5X8, compartment 3 = 5X5, 5X13compartment and the 4total = size of the Tray is 26X18). O-drape 5X13Disposable and the 100 total cm sizeX 75 of cm the (one Tray side is 26X18). absorbable and one side 1 O-drape DisposableImpermeable 100. The cm twoX 75 different cm (one sidesside absorbable are fused togetherand one sideand not 1 Impermeablelint applied.) . The two different sides are fused together and not Scalpel blade w/handle lintDisposable, applied.) retractable and lockable; blade type 23; total length 1 Scalpel blade w/handle Disposable,11cm retractable and lockable; blade type 23; total length 1 Gauze, plain 11cmGauze swabs 100X100mm (12ply) 20 Gauze, plainpetroleum jelly GauzeParanet swabs gauze 100X100mm 10cmX10cm (12ply)(1 ply) 201 Gauze,impregnated petroleum jelly Paranet gauze 10cmX10cm (1 ply) 1 impregnatedSyringe Syringe 10 ml 1 SyringeInjection needles SyringeOne each 10 of ml 21g and 23g, 1.5 inch 12 InjectionSuture, 3/0 needles OnePolyglycolic each of acid21g suture,and 23g, 75 1.5 cm, inch on reverse cutting needle 26 mm 2 Suture,Braided/absorbable 3/0 Polyglycolic acid suture, 75 cm, on reverse cutting needle 26 mm 2 Braided/absorbablesurgical gloves Sterile, one each of size 8 and 71/2 2 surgicalApron, disposable gloves Sterile,Plastic, onetrash each bag ofquality size 8 and 71/2 2 Apron,Ministry disposable of Health, ZambiPlastic,a | VMMC trash NATIONAL bag quality OPERATIONAL PLAN 86 2 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 86 (2016-2020)

Alcohol swabs 1 1/4" x 2 1/2", isopropyl alcohol 70% 2 AlcoholSurgical swabspaper tape 1Micropore 1/4" x 2 1/2",12 mm, isopropyl 1-3 meter alcohol in Length 70% 21 SurgicalSterile prep paper gloves tape MicroporeExamination 12 glove mm, 1large-3 meter in Length 1 SterileSource: prep glovesSCMS ExaminationMC glove largecore list, October 20111 Source:(http://scms.pfscm.org/scms/docs/papers/MC_Handout SCMS MC core _13_OCT_2011.pdflist, October) 2011 (http://scms.pfscm.org/scms/docs/papers/MC_Handout_13_OCT_2011.pdf) Other items needed for VMMC Other items needed for VMMC Product Description # ProductLidocaine HCl 1%, injection DescriptionSingle 20 ml vial #1 LidocaineGloves, size HCl 8 1%, injection SingleSterile 20surgical, ml vial latex, powdered, size 8, 50 pairs 1 Gloves, size 87 Sterile surgical, latex, powdered, size 8,7.5, 50 50 pairs pairs 1 Gloves,Suture size 7 Sterile75cm, surgical,absorbable, latex, coated, powdered, braided size undyed, 7.5, 50 pairs3/0, 26mm, 1 Suture 75cm,3/8 circle absorbable, reverse cutting coated, needle, braided 12 undyed,pcs 3/0, 26mm, 1 Compression bandage sterile 3/8Box circleof 50, reverse 4.5 meters cutting long needle, x 5 cm 12 pcs 1 Compressiongauze bandage sterile Box of 50, 4.5 meters long x 5 cm 1 gauzeGauze pads Sterile, 4 x 4 in 12-ply, 100 pcs 1 Gauze pads Sterile, 4 x 4 in 12-ply, 100 pcs 1

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 87 Ministry of Health, Zambia | VMMC (2016NATIONAL-2020) OPERATIONAL PLAN 87 (2016-2020)

Appendix 3: EIMC EQUIPMENT SET AND CONSUMABLE KIT Appendix 3: EIMC EQUIPMENTCONTENTS SET AND CONSUMABLE KIT

EIMC Surgical Instrument Set Contents CONTENTS

EIMCProduct Surgical Instrument Set Contents Description # ProductAutoclave storage box DescriptionEstimated dimensions approximately: 5"W x 10"L #1 Autoclave storage box Estimatedx 2"H dimensions approximately: 5"W x 10"L 1 Mogen Clamp xMultple 2"H use EIMC device 1 MogenStraight Clamp artery forceps MultpleSmall size use EIMC device 12 StraightCurved artery artery forceps forceps Small size 2

CurvedProbe artery forceps Small size 21

ProbeScissors 1

ScissorsSurgical blade holder 1

SurgicalRectangular blade Tray holder 1

RectangularGallipot Tray 12 Source:Gallipot CIDRZ 2 EIMCSource: Consumables CIDRZ Kit Contents

EIMCProduct Consumables Kit Contents Description # ProductO-Drape DescriptionDisposable 40cm x40cm #1

OScalpel-Drape Blade Disposable 40cm x40cm 1 ScalpelGauze, PlainBlade Gauze Swabs 100X100mm (12ply) 15 Gauze, Plain Petroleum Jelly GauzeParaffin Swabs Gauze 100X100mm 10cmX10cm (12ply) (1 ply) 51 Impregnated Gauze, Petroleum Jelly Paraffin Gauze 10cmX10cm (1 ply) 1 Syringe Syringe 1 ml (Insulin syringe) or Syringe 2 ml 1 Impregnated SyringeInjection Needles SyringeOne each 1 mlof 21g,(Insulin 23g, syringe) 27g or Syringe 2 ml 12 InjectionSurgical Gloves Needles OneSterile, each one of eac 21g,h of 23g, size 27g 8 and 71/2 2 SurgicalGlucose tabletGloves Sterile,Single wrapped one each tablet, of size 1g 8 and 71/2 21 Source:Glucose CIDRZ tablet Single wrapped tablet, 1g 1 OtherSource: Items CIDRZ Needed for EIMC

OtherProduct Items Needed for EIMC Description # ProductLignocaine 1% (no epinephrine), DescriptionSingle 20 ml vial #1 injection Lignocaine 1% (no epinephrine), Single 20 ml vial 1 Povodine iodine 50ml bottle 1 injection PovodineSuture iodine 50mlVicril bottlerapid 4.0 1 SutureDisposable baby nappy VicrilSize dependent rapid 4.0 on size of baby, size 1 or 2 1 DiLifebuoysposable soap baby nappy Size25g dependentbar for patient on size to carry of baby, size 1 or 2 1 LifebuoyVaseline soap 25g2g Single bar for-use patient plastic/foil to carry packet for patient to carry 1 Vaseline 2g Single-use plastic/foil packet for patient to carry 1

Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 88 (2016-2020) Ministry of Health, Zambia | VMMC NATIONAL OPERATIONAL PLAN 88 (2016-2020)