Covering the Last Kilometer: Using GIS to Scale-Up Voluntary Medical Male Circumcision Services in Iringa and Njombe Regions, Tanzania

Abstract

Background: Based on the established protective effect of voluntary medical male circumcision (VMMC) in reducing female-to-male HIV transmission, Tanzania's Ministry of Health and Social Welfare (MOHSW) embarked on the scale-up of VMMC services in 2009. The Maternal and Child Health Integrated Project (MCHIP) supported the MOHSW to roll out VMMC services in Iringa and Njombe, 2 regions of Tanzania with among the highest HIV and lowest circumcision prevalence. With ambitious targets of reaching 264,990 males aged 10-34 years with VMMC in 5 years, efficient and innovative program approaches were necessary.

Program description: Outreach campaigns, in which mobile teams set up temporary services in facilities or non-facility settings, are used to reach lesser-served areas with VMMC. In 2012, MCHIP began using geographic information systems (GIS) to strategically plan the location of outreach campaigns. MCHIP gathered geocoded data on variables such as roads, road conditions, catchment population, staffing, and infrastructure for every health facility in Iringa and Njombe. These data were uploaded to a central database and overlaid with various demographic and service delivery data in order to identify the VMMC needs of the 2 regions.

Findings: MCHIP used the interactive digital maps as decision-making tools to extend mobile VMMC outreach to "the last kilometer." As of September 2014, the MOHSW with MCHIP support provided VMMC to 267,917 men, 259,144 of whom were men were aged 10-34 years, an achievement of 98% of the target of eligible males in Iringa and Njombe. The project reached substantially more men through rural dispensaries and non-health care facilities each successive year after GIS was introduced in 2012, jumping from 48% of VMMCs performed in rural areas in fiscal year 2011 to 88% in fiscal year 2012 and to 93% by the end of the project in 2014.

Conclusion: GIS was an effective tool for making strategic decisions about where to prioritize VMMC service delivery, particularly for mobile and outreach services. Donors may want to consider funding mapping initiatives that support numerous interventions across implementing partners to spread initial start-up costs.

FIGURE 1

Voluntary Medical Male Circumcision Focus Regions in Tanzania Map image adapted from Sémhur/Wikimedia Commons/CC-BY-SA-3.0.

FIGURE 2

Maps Used to Plan 2012 Voluntary Medical Male Circumcision Outreach Campaign, Iringa and Njombe Regions, Tanzania

FIGURE 3

Map of Total Population Layered With Number of Voluntary Medical Male Circumcisions Performed, by Ward, Iringa and Njombe Regions, Tanzania, April 2012 Abbreviation: MC, male circumcision.

FIGURE 4

Map of Male Population Ages 10–49 Layered With Number of Voluntary Medical Male Circumcisions (VMMCs) Performed, by Ward, Iringa and Njombe Regions, Tanzania, August 2013

FIGURE 5

Interactive Map Displaying Information on Manda Health Centre Site, Njombe Region, Tanzania

FIGURE 6

Interactive Map Displaying Satellite Imagery of Facility Layout

FIGURE 7

Interactive Map of Facilities Performing 0–1,000 Voluntary Medical Male Circumcisions (VMMCs)^a and Quality of Roads ^a Shown as yellow (no VMMCs) and pink (<1,000 VMMCs) circles.

FIGURE 8

Percentage of VMMCs Performed in Urban Versus Rural Health Facilities and Total Number of Health Facilities Reached, by Fiscal Year, Iringa and Njombe Regions, Tanzania, 2010–2014