MC MOVE
Models for optimizing the volume and efficiency of MC
services
By Dr Dino Rech
MC MOVE
• Evolution of efficiency principles in surgery
and MC
• Efficiency principles used in MC
• Progress to date
– New sites and programs
– Research
– Ongoing evolution.
• Efficiency challenges
– Balancing demand and supply/ seasonality
– Counselling and communications
– Part time MC providers vs specialised teams
Evolution of efficiency principles
in surgery and MC…e.g.
Aravind Eye Hospital India
Orange Farm South
Africa
Evolution of efficiency principles in
surgery and MC
MOVE
WHO pilot initiative:
Aims to maximise Surgical results and minimising
time and resources needed to perform high
volumes of surgery.
Facilitates cost effective solutions to MC scale up
in high volume/demand settings
Efficiency Principles used in MC
Techniques
Surgical Efficiency
Techniques
- Forceps-guided
- Cautery (monopolar) for haemostasis
- Fewer stitches (8-12) for foreskin
apposition
- Collective wrap of surgical items
- Pre-assembled surgical kits
-Theatre layout for faster patient turnover
-DEVICES/ SHANG
RING ??
Task-Sharing
Assign steps to lower cadres:
- Surgical area clean & prep
- Anaesthetic block
- Final foreskin stitches
- Wound dressing
Sharing supported by:
- 4 beds per operator
- 6 lower cadres per operator
- Theatre layout for staff flow
- Alcohol gel hand sanitizing
- Gown change only if blood
Task-Shifting
Task-Sharing
TaskShifting
- Training /
certification of entire
MC procedure to
lower health cadres,
e.g., clinical officers,
nurses.
The Fourth Efficiency Principle
Adequate Client flow
and demand for
services
-Communications
-Mobilization
-Counselling and
testing services
Surgical layout
Efficiency focused MC Kits &
Electrocautery
Surgical Methods
Surgical methods
compared
Time savings to
surgeon/procedure
Forceps-guided/dorsal slit
2:25
Forceps-guided/sleeve resection
7:40
Dorsal slit/sleeve resection
5:15
* Times depicted are based on time-motion observations at Orange Farm, South
Africa
Results
Pre‐MOVE
MOVE
(Sleeve)
MOVE
(Forceps
Guided)
Doctor
Operating
Time
25‐50 min.
10‐20 min
5‐10 min
Cubicle
Turnover
Time
60 min
30‐40 min
25‐30 min
3‐5 an hour
5‐8 an hour
Indicator
# of Clients
1‐2 an hour
* Note Graph with initial impact and results from Tanzania.
Progress to date
• Efficiency focused( use of MOVE)
implementation (PSI MOVE Implementation)
–
–
–
–
–
–
–
South Africa PSI
Swaziland PSI
Zimbabwe PSI
Tanzania
Botswana
Zambia PSI
Kenya
• Research:
MOVE Evaluation or Systematic
Monitoring & Evaluation of Male Circumcision Scale
up
Aggregate Numbers – Four Pilot
Sites. Tanzania
MOVE Begins
13
Challenges to implementing
efficient high volume services
– Balancing demand and supply / managing
seasonality of demand
– Counselling and communications: How to
keep up?
– Part time MC providers VS specialised
teams: Pros and Cons
Thank You!