Table 2 Preferred service delivery options for a male circumcision program for HIV prevention
Traditional penile-cutting communities | |||
|---|---|---|---|
Location | Service provider | ||
Health facility | Traditional house | Health worker | Traditional cutter |
To increase safety and precision of cut | To preserve culture. | Health worker could be involved in traditional ceremony as a guest at traditional house | If provided with skills and resources from the government |
Initial procedure completed at health facility but all follow up and medication completed in traditional ways | To strengthen the community | Health worker to complete in health facility | To increase ease of access for some communities |
Completed at health facility but followed up with customary celebrations | For the community to have more control of program. | Â | Â |
For poor families who can’t afford customary celebrations. | Because it defined customary practice |  |  |
| Â | Completed only at traditional house to respect custom | Â | Â |
| Â | For wealthy families to promote social standing | Â | Â |
Financing | Target population | ||
Free | Payment | Â | |
Should be free if completed by government | For traditional purposes only | > 10 years as per traditional custom | |
Should be free if completed by government | In kind or in gratitude, a part of cultural celebration | School age | |
Communities that do not engage in traditional penile cutting | |||
Location | Service provider | ||
Health facility | Community location | Health worker | Peer/non-health worker |
At health facility to increase safety of procedure | Complete in secret community location | Health worker to increase safety | Use of local cutter due to loss of potential income if Health worker only involved |
At health facility but it would need to be discrete | For ease of access | Health worker from outside community to increase secrecy and safety | Accredited local cutter to alleviate human resource burden on health system |
Not at major hospital as it is too public | Going to health facility can be expensive and time consuming | Male health worker as it would save embarrassment for patient and female health worker | Â |
Community outreach program to aid post level and if possible village level to assist in mitigating access issues for rural people | Â | Â | Â |
Financing | Target population | ||
Free | Payment | < 5 years | >10 years |
Because the government was promoting it | To increase accountability for action | Because many children are exposed to sex early | Around time of sexual debut |
A cost would be a barrier to service uptake | In kind or in gratitude | Other countries circumcise babies | Older because boys they would be stronger physically and mentally to handle pain and procedure |
Young men would not have access to cash due to poor employment options | Â | Â | Older so that children would have a choice |
| Â | Â | Â | If too high then this may impact on uptake |