The Zimbabwe Association of Church related Hospitals (ZACH) implements the Voluntary Medical Male Circumcision (VMMC) program in seven districts in Zimbabwe, as a sub awardee of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) grant awarded to ZimTTECH. ZACH is part of the ZAZIC consortium, which consists of 3 partners, ZimTTECH, ZiChiRe and ZACH, with ZACH and ZiChiRe being the implementing partners while ZimTTECH provides oversight and technical support to the program.

21 VMMC static sites are operational in the 7 districts supported by ZACH, (Gokwe South, Hurungwe, Lupane, Marondera, Mberengwa, Mbire and Zaka). ZACH implements the program using an integrated model, where the Ministry of Health and Child Care (MOHCC) staff are the primary implementers and are supported by seconded partner staff offering technical assistance as well as direct service delivery in the supported districts.

Each static site has a program vehicle and VMMC partner staff (a nurse and a driver) seconded to support the MOHCC site staff in implementing the program. All the static sites have been capacitated to offer quality VMMC services both at the static site as well as on an outreach basis. Capacitation of all facilities in each district to offer VMMC services independently is ongoing.

VMMC Supported Districts

VMMC Supported Districts

Program Achievements Last 5 Years

The goal of the VMMC program in Zimbabwe is to circumcise 1,4 million men aged 15 years and above and maintain an 80% country coverage to achieve epidemic control. ZACH managed to achieve its annual targets in three of the last 5-year implementation period, and only fell short of meeting the annual target due to effects the COVID-19 pandemic in FY 2019 and FY 2020. Two supported districts, Lupane and Mbire, have already reached 80% circumcision coverage.

Demand Creation Strategies

ZACH has utilised innovative mobilisation strategies, targeting older boys and young men, especially those in higher school grades, out of school youths and self-employed men in small scale mines, the agricultural sector, and rural communities. A considerable investment has been made in supporting a variety of mobilisation strategies which include:

• Recruitment, training, and incentivising community mobilisers
• ‘Bring-a-Buddy’ initiative at workplaces
• Program awareness roadshows
• Musical and soccer galas
• Door to door campaigns
• Community dialogues
• School textbook & soccer jersey support initiative
• Moonlighting

Device Circumcisions (Shang Ring)

All ZACH supported districts offer quality and safe VMMC services using the WHO approved and MOHCC recommended dorsal slit surgical method. The MOHCC approved use of the Shang Ring device method to replace the Prepex® device method in 2021, and two ZACH supported districts (Marondera and Mberengwa) started offering device MCs in May 2021. Uptake of the Shang ring device method has proved to be very popular, especially among the employed youths, as they can continue with their duties without need for time off. The roll out of the device MC method to all supported districts is ongoing.

 Shang Ring Device

Two-Way Texting (2WT)

The VMMC program quality standards require all clients to be followed up at least once after the  MC procedure. 99% of clients are reviewed on day 2 and day 7 post operatively. As a measure to reduce physical contact between staff and clients during the COVID 19 era, ZACH introduced the Two-Way-Texting (2WT) method of reviewing clients in March 2021. This method of client review is offered to eligible clients who have mobile phones and are willing to be reviewed via phone messages. The 2WT method of review has adopted by the MOHCC and roll-out to all districts is ongoing. Low phone ownership among younger clients and erratic phone network in some rural sites is a challenge.

Collaboration with Traditionally Circumcising Tribes (Varemba Camps)

ZACH, in collaboration with the National AIDS Council (NAC), and with support from the MOHCC, the District Administrator’s offices, has successfully collaborated with the Varemba traditionally circumcising tribe and held periodic medical circumcision camps in Mberengwa, Gokwe South and Mbire districts. Previously, The Varemba tribe have been conducting their traditional initiation and circumcision camps privately, without medically trained staff and with inadequate quality and safety standards as recommended by WHO and MOHCC. Through this collaboration, more than 3,000 young Varemba men have been circumcised by trained doctors and nurses in the camps, while they underwent their initiation rituals since 2017. The success of these joint camps has been documented as one of the best practices for the program.

VMMC Program Sustainability

The Zimbabwe VMMC program is transitioning into sustainability, and two ZACH supported districts (Lupane and Mbire) have already reached 80% circumcision coverage. ZACH is supporting the transition to sustainability through the following activities:

• Migrating from disposable surgical kits to re-usable instruments. Zaka, Lupane and Gokwe South districts have been capacitated in autoclaving and are now using re-usable VMMC kits.
• Transitioning from Cost Reimbursement funding system to the Results Based Funding system (RBF). Lupane has moved to RBF, and other supported districts are being migrated to RBF in line with MOHCC policy and timelines.
• Virtual VMMC trainings and Pre-service training support. ZACH has a complement of certified National and provincial trainers who are active in the roll-out of virtual VMMC trainings and mentorship.
• Mobiliser support and retention. ZACH supports the training and retention of community mobiliser through continuous identification, recruitment, Training and incentivizing mobilisers, especially Village Health Workers (VHWs) and Environmental Health Technicians (EHTs) and community based VMMC champions.