Promoting approaches that enable integration and sustainability of VMMC: early learnings in Zimbabwe

BACKGROUND: The first decade of Voluntary Medical Male Circumcision (VMMC) implementation was a partner-driven approach where sexually active males were prioritized to enable reduction in HIV incidence. VMMC program in Zimbabwe is transitioning to government-led "sustainability" phase aiming to move toward routine VMMC to maintain long-term impact of circumcision on HIV incidence. With funding from the Bill and Melinda Gates Foundation, PSI through Population Solutions for Health (PSH) implemented a user-centred design approach to support the Ministry of Health and Child Care (MoHCC) and its partners to develop, test and lead processes required for districts to shift from a catch-up model towards a more sustainable, integrated model. Sustainability implementation had to be rigorous, measurable, district led, user centred and district specific.
DESCRIPTION: The collaborative user-centred design workshops enabled district specific planning using insights gathered from health system players and key program users and influencers including parents, boys, community leadership and educators to build a relevant transition plan as in a 5-step process shown below.


LESSONS LEARNED: The approach fostered buy-in to the phased approach for transitioning to more integrated and sustainable models of implementation, and subsequent ownership to the developed plans.The workplans followed a standard format but allowed for flexibility to address the district-specific operating environment as quoted below:
'If I'm asked to mention one thing, I enjoyed in the past four days, it's the four days. It was reflecting what we are seeing and hearing. We were producing our own. This is my workplan, not prescribed.'- Kingford Chivende, District Nursing Officer, Zvimba District
CONCLUSIONS: A toolkit was developed providing step-by-step guide for health systems and programs intending to implement user-informed processes to guide the development of sub-national implementation models. PSI and PSH supported MoHCC to extend toolkit use through developing sustainability models in PEPFAR and USAID funded districts approaching saturation.

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