1
Presentation Outline
•
•
•
•
•
Partnership and Collaboration with HoTL
Build up activities and response – December Season
Report on initiation intervention
Recommendation
Conclusion
2
Partnership and Collaboration with HoTL
• Traditional Initiation has been the focus and priority of the EC Provincial
government and other circumcision stakeholder
• Like other key sectors, ECDoH acknowledges that traditional initiation is
the competency of the HoTL.
• The ECDoH’s involvement and role is to support the circumcision practice
by working with and through the established task team led by HoTL.
• The ECHoTL, DoH, DoE and SAPS are spearheading the implementation of
the Initiation Monitoring and Intervention Strategy to ensure safe passage
of initiates from boyhood to manhood
3
Multi-Sectoral Initiation Monitoring Team
• Overall Response Team (MECs) and key leadership in various
sectors – led by Nkosi Ngangomhlaba Matanzima
• Technical Coordinating Multi-Sector Team – Provincial Member –
HoTL, NDoH, PDoH, NGO, SD, SAPS, CODEFSA
• Multi-Sectoral Monitoring Team – Dedicated Team from HoTL,
Social Development, SAPS, DoH, DoE, NGOs.
• Traditional Leaders led Local Initiation Forums and Monitoring
Teams
4
PREPARATION FOR SUMMER SEASON 2013
•
Pre - initiation build up activities towards the Summer Initiation Season:
• Provincial initiation Workshop for key strategic departments( LGTA/
HOTL, DOH, DOE, SAPS, NPA, SOCDEV and CODEFSA)
• Traditional Councils consultation outreach by HoTL Executive Team
and Imbumba Yamakhosikazi Akomkhulu
• Schools, churches, community Imbizos and community radio
campaigns promoting safe initiation practices
5
PREPARATION FOR SUMMER SEASON 2013
• Trainings of Traditional Surgeons and Nurses.
• Monitoring Teams were workshoped in order to
standardize operation procedure and equipment needed
during monitoring of initiation schools.
• Summer Initiation Launch event - Palmerton Methodist
Church, Lusikisiki - 24 November 2013
• Provincial Technical Monitoring Teams were deployed
to districts to monitor readiness for the season
6
PREPARATION FOR SUMMER SEASON 2013
• Additional surgical supplies were provided to all monitoring teams
• Provision of clinical personnel to all monitoring teams in the entire
province
• Medical doctors were also deployed in the OR Tambo Municipal
District
• Preparations also looked into readiness of health facilities to admit
and manage initiation complications
• Rescue Centre established in Palmerton facilitated by CODEFSA
and supported by (Male Nurses) from Provincial Department of
Health
7
HEALTH FACILITY READINESS
•
5 hospitals identified as main referral hospitals in OR Tambo and Alfred
Nzo:
– St Patrick hospital for Alfred Nzo district
– St Elizabeth hospital for Qaukeni Sub-district supported by Holy Cross and
Bambisana Hospitals
– St Barnabas hospital for Nyandeni Sub-district supported by Canzibe and
Silimela Hospitals
– St Lucy’s hospital for Mhlontlo supported by Malizo Mpehle and Nessie Night
Hospitals
– Mthatha General for KSD Sub-district supported by NMAH.
•
Throughout the province Districts were encouraged to be ready for
admissions
8
ITEMS/SERVICES
QUANTITY
DURATION
COST
IMPLICATION
Hired vehicles
20 vehicles
8 vehicles
60 days: 15/12 –
13/01
18 Days: 06/12 – 23/12
R1,386,120 + R145,680
DoH Vehicles
10 vehicles
Accommodation Services For Provincial And
District Staff Including HOTL

Stakeholder Workshop In Mthatha
Garden Court

School Campaigns for Safe
Circumcision 6-8/11/2013 In OR Tambo
& Alfred Nzo

HOTL & Imbumba Yamakhosikazi
Akomkhulu (IYA)

Monitoring & Intervention Programme
Of Initiates
Total Of R1 127 840

75 People

21-22/10/2013

10 People

6-8/11/2013

9 People

11-26/11/2013

32 People

24/11/201320/12/2013
9
ITEMS/SERVICES
Build-up activities:
• Trainings (RTC)
• Community Mbizos
• School visit campaigns
• Launch event
DURATION
COST IMPLICATION
28/08/2013
to
(Accurate figures still being
compiled)
13/11/2013
10
NGO Support during the Season
CODEFSA:
• Additional 2 vehicles
• Provision of lunch packs
• Protective clothing
• Establishment of rescue
• center and provision of
• food for initiates
• Funding of workshop for
• women
11
YEAR
2006 JUNE
2006 DEC
2007 JUNE
2007 DEC
2008 MAR
2008 JUNE
2008 DEC
2009 JUNE
2009 DEC
2010 JUNE
2010 DEC
2011 JUNE
2011 DEC
2012 JUNE
2012 DEC
2013 JUNE
2013 DEC
TOTAL
HOSPITAL
ADMISSIONS
AMPUTATI
ONS
INITIATE
DEATHS
LEGAL
INITIATES
ILLEGAL
INITIATES
ARREST
288
512
329
311
18
352
267
461
252
389
269
313
338
5
7
41
11
0
11
0
47
2
22
1
10
10
26
32
24
8
5
24
5
55
36
41
21
26
36
3470
11243
12563
33005
241
14741
40290
17538
39581
18450
53128
13886
41903
285
708
1460
1327
152
1694
553
2470
896
1429
1352
2808
937
0
0
0
0
2
49
23
29
9
12
7
35
24
358
17
49
15259
730
8
219
6
25
22654
367
13
359
297
5332
24
7
221
40
43
496
12169
31626
381411
2314
19
21
251
602
20149
12
13
SUMMERY OF CIRCUMCISION STATS – Dec 2013
14
Distribution of initiation death
15
Jun/Dec 2013 Initiation deaths Comparison
16
Indicated Causes of Initiates’ Deaths
17
Deaths from Illegal and Legal Schools
18
Summer Season Review Consultation

A summer season review consultation workshop held
with on 14 January with all Montoring Teams and
stakeholders involved in on 14 January to:


Critically review the 2013 December/January Initiation season
Prepare a comprehensive report that will encompass
recommendations on what program of action should be
considered going forward
19
Reported Challenges







Not every district or local areas has established active Initiation Forums.
Traditional Circumcision Schools not easily accessible to monitoring
teams as are built on mountainous areas.
Initiation schools not reachable on time – lots of boys could not be reach.
Centralisation of initiation schools not yet effected. Schools are still
spread out throughout the province, often not easily idetified
Sepsis is being noticed as a common occurrence in most complicated
initiation schools
Partial circumcision still occur especially in Nyandeni and Mhlontlo area.
Initiates flee when they see monitoring teams, in fear of discrimination
amongst themselves. Some refused to be taken to hospitals.
20
Reported Challenges Cont…







Establishment of Illegal schools is still a challenge especially in OR Tambo and
Alfred Nzo Districts.
Parents reported to be against medical interventions/treating of initiates with
antiseptic ointment and bandages when DMOs find a condition that requires.
Discrimination of initiates by peers and communities, who were assisted or sort
medical help.
Circumcision of underage boys in the Pondoland area
No legislation guiding initiation in the province
Lack of commitment from municipalities and other government departments.
High rate of substance abuse by initiates
21
Recommendations
• Expedite the process of developing a National and Provincial
Initiation Legislation
• Institutionalization of management initiation practice – permanent
structure and staffing
• Standardization of Initiation Monitoring Teams and Local Forums
with clear Terms of Reference
• Development and implementation of a broader and integrated 5
year strategic plan and year long programme of actions
• Adequate budget allocation for the initiation program
22
Recommendations Cont …..
•
•
•
•
•
•
•
Centralization of initiation schools with sensitivity to various sub-cultures.
Enhance active involvement of Traditional Leadership at local level
Improvement of technical training for traditional nurses and surgeons
Vigorous police intervention, intelligence and NPA to secure convictions.
Building community and parent ownership of the practice. Parents to take
responsibility for their children
Active involvement and contribution by local municipalities.
Psychosocial support for victims of penile injuries and peers of deceased
initiates (Social Development)
23
Plan for the next season

Broad and integrated 5 year strategic plan and year long programme of actions are being
crafted. Focus is on:
•
Review of the current legislative framework,
•
Centralisation of initiation school with designated areas - in rural and urban
•
Establishment of active local initiation forums and training there of. Terms of Reference to be
clearly defined
•
Training of Traditional Surgeons and nurses. Establishment of database.
•
Vigorous school outreach educational programs, working with the DoE.
•
Community mobilization, engagement and education through community dialogs, Imbizo,
radio slots and Youth consultation programs.
•
Registration of boys for initiation through local Traditional Council, working with DoE.
•
Workshop for women to re-inforce their role –Led by Ngamakhosikazi Akomkhulu
•
Establishment of a Nerve Centre – Coordination of monitoring activities, especially during
seasons
•
Establishment Rescue centres. Hotspot areas to be prioritised
24
List of needed Resources

Resources mobilization and coordination.










Dedicated budget is needed through the HoTL
Human Resources - Dedicated teams from various departments to form part of
the teams especially during seasons
Doctors/Male nurses – screening and monitoring during the season. DoH to
provide
Food packs
Stipend for forum members (volunteers) – working with monitoring team
Transport.
Communication tools – Walkie-talkies, cellphone airtime
Medical supplies - Dressing kit/packs per car – DoH to provide
Accommodation for monitoring team –
Protective clothing – Rain suites, work suits, boots
25
Thank you
26