Process followed by hospitals in carrying out medical male circumcision: WC Department of Health briefing

Health (WCPP)

12 May 2021
Chairperson: W Philander (DA)
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Meeting Summary

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The Western Cape Health Department briefed the Standing Committee on voluntary medical male circumcision. It was explained that Medical Male Circumcision (MMC) had been established as an HIV prevention intervention as the chances of acquiring HIV infection were lowered by 60% through the procedure. This service was said to be offered in a variety of settings such fixed facilities, mobiles and dedicated MMC sites, with majority of these sites found within the primary health care facilities. The launch of the service was on World Aids Day in 2020 and since then, bookings were done via telephone, SMS or WhatsApp which made the service cost-effective. The Department indicated that there had been few cases reported, since the commencement of the program but these had been based on the materials used and not on any problems experienced by those who had undergone the surgery.

Members inquired on the role of partners involved in the provision of the service and how they were  monitored, to better understand those with the responsibility of the procedure room and surgery. The basis of the service being provided to communities was further investigated as Members wanted to understand if it catered to cultural purposes and how communities at large were able to benefit and also have the necessary information.

The Committee resolved that the Department should send a detailed breakdown of MMC services conducted in the regions and districts of the province in the past two years. Further, the Department should furnish the Committee with the marketing strategy for the MMC service, and the list of NPOs it is partnering with. Lastly, the Department should develop a communication campaign on the medical benefits of MMC in order to get attention from the public at large

 

Meeting report

Briefing by the Western Cape Department of Health: Voluntary Medical Male Circumcision

Dr Saadiq Kariem, COO: Western Cape Department of Health, informed the Committee that MMC started as an HIV prevention intervention and mentioned that it could reduce the chances of acquiring HIV infection by 60%. Additional benefits include the reduced chances of Human Papilloma Virus (HPV) amongst women and a set platform for mens health service as it would be part of men’s health package. He stated that it was offered in a variety of settings like fixed facilities, mobiles, and dedicated MMC sites. The majority of these sites are within the primary health care facilities and can also be accessed through non-profit organisation (NPO) partners, and traditional circumcisors.

He said that the launch of the Metro Men’s Health Centre was on World Aids Day in 2020 and bookings are done via telephone, SMS or WhatsApp which makes the service cost-effective in terms of staff utilisation for an elective procedure. Clients are screened for COVID-19 on arrival, and the service is offered to all clients who come to the site and walk-ins, where possible, are also accepted. An interested client is taken to the prep-room for wellness screening in areas like weight, urine testing, blood pressure, horizontal gene transfer (HGT), rapid plasma reagin (RPR), if sexually transmitted infections (STI) symptoms are present and prostate screening for those over 40 years of age. The medical officer assesses the client, obtains consent and a physical examination is done. Then the MMC will be done in the procedure room, or the client is referred or deferred. The client goes to the recovery room for 30 minutes or longer, depending on the clinical decision where he is observed. A post-operation counselling is done, and follow-up dates and pain medications are provided. Thereafter, the client gets a sick certificate for three days.

When it comes to a follow-up, he mentioned that the client is required to return after 48 hours and on day seven post-surgery. This follow-up can be at the men’s clinic or the nearest primary health care facility and adverse events on post-operation are managed by the medical officer.

Discussion

Ms A Bans (ANC) wanted to know what the role of the NPOs is in the provision of the MMC and how they are monitored. She wanted to understand who was taking responsibility for the procedure room and surgery.

Dr Kariem said the Department was expanding the service by making use of its partners, the NPOs, who conduct the surgery/circumcision. The procedure is done by medical doctors that are trained to do the work and these NPO’s cover some rural areas. He added that funding was received from the United States Signal Intelligence Directive (USSID).

Ms L Botha (DA) asked on patient feedback or clients who have gone through the procedure. She wanted to know if there are any severe impacts following the procedure and enquired on what was happening in rural areas regarding MMC.

Dr Kariem said the feedback was positive and there had been no noted severe effects which is why the Department was encouraging people to return after 48 hours and on the 7th day after the surgery.

Ms R Windvogel (ANC) enquired if the service was offered only in hospitals because there are rural areas with no hospitals.

Dr Kariem said the procedure can be done in any sterile procedure room and that was the reason why the NPOs were involved as well.

Mr P Marais (FF+) wanted to understand what brought the demand for the MMC service and if it is for a particular culture.

Dr Kariem explained that the rationale behind this was for HIV prevention. He said that there were a number of men who come for the service because of health reasons, while others come because it is a cultural thing that is needed in their communities.

The Chairperson asked if there were any plans to have this service or Men’s Health Centre in rural areas.

Dr Kariem explained that NPOs assist in rural areas and the service was being offered in primary health care facilities. He added that there are centers or hospitals in rural areas where people are referred to for the operation and additional information can be obtained from the Men’s Metro Health Centre.

Ms Bans remarked that her concern was whether the responsibility for the procedure lies with the Department or NPOs, especially in rural areas, as she witnessed a procedure that took an hour which to her was unusual.

Dr Kariem explained that the Department has contracts with many NPOs that take responsibility, which then ensures the involved NPOs have adequate staff to do and monitor the procedure.

Mr Marais remarked that he was not happy with the notion that circumcision prevents HIV because that has not been advertised and only a portion of the population have knowledge of this information. He said that in some cultures people cut their faces, something which can cause an infection, and asked if the Department was catering for a certain culture only.

Ms Juanita Arendse, Chief Director: Emergency and Clinical Services Support, Western Cape Department of Health, explained that the MMC was active in the international platform. She mentioned that the presented pie chart represented prevention in general and every slice of prevention addressed a particular concern or angle. She added that the MMC service was provided because it was evidence based and that the decision was not on a cultural practice. The statistical data also stated that clients came from many geographical areas.

Ms Windvogel wanted to find out if there had been an awareness campaign in the last two years and asked if there were detailed programs on MMC, including numbers of people who have undergone the procedure.

Ms Arendse indicated that marketing efforts have been done such as media campaigns, in collaboration with Non-Governmental Organisations (NGOs) and this includes radio advertisements.

Mr M Xego (EFF) commented that there was a proper awareness that was done in prison at Kannaland, but it was not for the broader community and added that the feedback was positive. He wanted to know how people were going to be made aware about the MMC service because it is a health matter and not only a cultural issue. He asked on those who were responsible for botched circumcisions.

Ms Arendse said that what happened in prisons, happened in communities as well. The Department established fixed sites as some people miss the mobile sites, hence walk-ins have been allowed. She added that everything was done in a manner that is COVID-19 compliant.

Ms Bans wanted to establish how the Department was monitoring the entire process and keeping the NPOs accountable to ensure that standard procedures were adhered to.

Dr Kariem made it clear that the Department had written contracts with the NPOs that serve as a monitoring tool.

Ms Arendse added that these contracts stated the qualifications and training of those who conduct MMC services. She mentioned that there had been cases where the Department intervened in at Grabouw and very few cases of botched MMCs had been reported and had been attended to. She explained that these cases were mainly on the material used and not the procedure and that there were mechanisms in place to ensure everything was done according to the book. She said statistics on MMC programs and number of clients would be forwarded to the Committee.

Resolutions

The Committee resolved that the Department should send a detailed breakdown of MMC services conducted in the regions and districts of the province in the past two years. Further, the Department should furnish the Committee with the marketing strategy for the MMC service, and the list of NPOs it is partnering with. Lastly, the Department should develop a communication campaign on the medical benefits of MMC in order to get attention from the public at large.

Establishment of Western Cape TB Caucus

The Chairperson informed the Committee that the TB Caucus of SA Secretariat wanted to engage with the Western Cape for the establishment of the Western Cape TB Caucus. Unfortunately, the Committee could not decide on the matter and it needed to agree whether it wants to establish a provincial caucus.

Ms Windvogel supported the idea for the establishment of the provincial TB caucus even though it is not known what the responsibilities of the members would be.

The Chairperson indicated that the responsibilities were sent to the Committee and the procedural officer would forward all the details to Members. If the Committee agreed on this, the decision would be sent to the Speaker.

Mr Marais commented that it was important to give attention to TB which really affects the impoverished who stay in unhealthy situations or conditions. He expressed support for the idea and mentioned that TB was an endemic in the Western Cape.

The Committee then resolved to write to the Speaker to engage on the process.

Appointment of WCPP Members to Hospital Board

Ms Nomonde Jamce, Committee Procedural Officer, reminded the Committee that the subject was discussed in previous meetings. The response from the Minister was that the Committee should compile a list of Members who were interested to serve on the Boards of the different hospitals. The list would then be sent to the Minister for approval and each Member was expected to state the hospital of preference. She said that Members who wanted to serve on these Boards have to approach the Committee first, and not write to the Minister directly. She added that the matter also had to be reported in the minutes of the Committee and the list of those interested would be sent for approval.

Mr Marais wanted to establish from which allowance Members’ travelling costs were to be paid from and asked if this was something the Committee wanted to serve on.

The Chairperson said she was going to write to the Speaker to give the Committee an outline of how this was to be done.

Ms Bans indicated her availability because there was no other MPL in her constituency.

Ms Botha asked if the notification had been sent to other Committees besides the Health Committee.

Ms Jamce replied that the notification had only been sent to the Health Committee for discussion first. Members were to advise if this is to be shared with all the MPLs.

The Chairperson pointed out that information had already been shared with all Members of Parliament so that the Committee knows which Members are interested, including the hospitals they prefer.

Meeting minutes were adopted.

The meeting was adjourned.

 

 

 

 

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