Access is everything

No amount of education or goodwill will have any great impact if there is no infrastructure in place to deliver results. “This has been particularly true for the people of uThungulu and uMkhanyakude in north-eastern KwaZulu-Natal (KZN), listed among the most deprived districts in South Africa. Poverty is rife in these rural areas, and along with high unemployment rates, low education levels and scant access to piped water and electricity, these communities have no Community Health Centres and no Regional Hospital Services,” says Rachael Rawlinson of CareWorks.

Now, thanks to PEPFAR funding, CareWorks, along with other PEPFAR partners, has been able to take Medical Male Circumcision (MMC) services to these remote areas, going where few other health services go. “The impact has been profound, with KZN now boasting the highest MMC rates in South Africa,” says Rawlinson.

Powerful PEPFAR partnerships

According to Rawlinson, CareWorks enjoys a good relationship with the Department of Health (DoH) and Southern African Clothing & Textile Workers' Union (SACTWU) Worker Health Program as their cutting partners, especially in the uThungulu district where it is traditionally difficult to be accepted. “This has enabled us to turn areas that have historically never performed into currently best performing areas. The contrast is especially marked in deep rural areas like Nkandla and Mthonjaneni, where circumcisions had at best been performed quarterly and are now conducted almost every week.”

During the MMC Programme’s Third Quarter Review meeting, St. Mary’s at Mthonjaneni took the first position in performance, while Nkandla took second position. SACTWU, along with CareWorks as their demand creation partner, has been recognized for their outstanding performance in this region for reaching their MMC targets.

Reaching young people

In KZN, CareWorks is working largely with schools, through the Department of Education. “While we also mobilize workers, few are able to secure the necessary leave and so they rarely attend the circumcision camps,” says Rawlinson.

She adds that CareWorks built relationships with local schools by educating the principals and teachers about circumcision and its importance. CareWorks then mobilized eligible boys and arranged circumcision camps during school days, in collaboration with SACTWU and DoH, thereby reinforcing the culture of learning and teaching around MMC. “This has been a huge success, with some schools even making sites available for circumcision and enabling us to bring the service closer to the communities,” says Rawlinson.

According to Rawlinson, parents are also increasingly cooperative and willing to see that their boys are circumcised, clearly understanding the importance of circumcision. Cases of adverse events have dropped drastically thanks to the education given to boys and communities. “We have found that schools are excellent channels for conveying messages to the surrounding communities in rural areas, because if you distribute fliers at schools they quickly reach the community.”

Universal access

The recent successes in these areas relies heavily on well trained, passionate field mobilizers, able to gain access and acceptance in just about any community. CareWorks’ MMC demand creation model of building a team of such people ensures that the MMC message is understood and accepted.

“We mobilize within the communities creating demand for services and work with service delivery partners to circumcise in schools, community halls, churches, hospitals and clinics. We ensure that every facility is well publicized, so that everyone is able to access MMC services,” concludes Rawlinson.