Spatial Mapping Results in a Successful Large-Scale Voluntary Medical Male Circumcision (VMMC) Campaign: Using GIS Data for

Decision-Making Positively Impacts the VMMC Scale-Up in Iringa and Njombe Regions of Tanzania
by: Elizabeth Edouard1, Hally Mahler2, Abdallah Maganga1, Saidi Mkungume1, Augustino Hellar2, Victor Mponzi1 and Sifuni Koshuma3 affiliate: 1Jhpiego, an affiliate of Johns Hopkins University/Tanzania; 2Maternal and Child Health Integrated Program (MCHIP)/Jhpiego, an affiliate of Johns Hopkins University/Tanzania; 3Ministry of Health and Social Welfare (MOHSW)

Background
n In 2010, the MOHSW set a target of 264,990 VMMCs to be conducted in Iringa and Njombe regions of Tanzania. n The USAID flagship Maternal and Child Health Integrated Program (MCHIP) has assisted the MOHSW to provide VMMC services in fixed and outreach sites. As of April 2012, more than 140,000 adolescents and men had been served, with funding from the Presidents Emergency Plan for AIDS Relief (PEPFAR). n Reaching the remote rural communities of Iringa and Njombe through outreach services is necessary to achieve the MOHSW targets. n In April 2012, the program had already worked in 30+ outreach sites. (There are more than 400 health facilities in the two regions.) n In prior years, campaign sites were determined based on recommendations by district officials and site assessments. n As the 2012 winter campaign approached, the team decided to conduct an analysis of VMMC program data, in the context of population and health facility demographics, using geographic information systems (GIS) to optimize site selection. Male Cicumcision Percentage of men, age 1549, who are circircumcised
Kagera 4.8% Mwanza 64% Mara 88% Simiyu 30%

Methods
n Population data at the ward level from the Tanzania 2002 Census, projected for 2012, were overlaid with coordinates of the majority of health facilities in Iringa and Njombe, inclusive of facility-level VMMC data disaggregated by age. n Using Quantum GIS (QGIS), these data were spatially analyzed to identify areas of both regions where there was a high concentration of potential clients for VMMC. n Data were put into SHAPE files and entered into QGIS. n SHAPE files are attribute tables containing data (e.g., population, sq km of catchment areas, ward boundaries) that are represented on a visual file, like a map. n SHAPE files can be layered on top of each other to tell a story with the data. VMMC Sites and Villages (Ludewa, Njombe and Mufindi), April 2012

2012 Winter Campaign

n The layered maps helped the team to select 24 outreach sites for the campaignmost of which had a catchment population of 5,000 or more males aged 1049. n As a result of this enhanced targeting, the program was able to serve 25,816 males in rural communities in six weeks, as compared to 14,476 in the same time frame in the previous year. VMMC Sites and Other Health Sites in Iringa and Njombe Regions, April 2012

Legend All VMMC Sites by MC Done 0800 8011,600 1,6012,400 2,4013,200 3,2014,000
4,0016,500 Health Facilities (Mapped by Measure) Total Population by Ward 010,000 10,00115,000 15,00120,000 20,00125,000 25,001100,000

Arusha 3.2% Kilimanjaro 97% Manyara 1.5%

Shinyanga 32% Kigoma 77% Tabora 56%

Conclusions and Recommendations

Pemba >99% Unguja >99% DSM 99%
Legend All VMMC Sites by MC Done 0800 8011,600 1,6012,400 2,4013,200 3,2014,000 4,0016,500 Villages (Mapped by WHO in 2003) Total Population by Ward 010,000 10,00115,000 15,00120,000 20,00125,000 25,001100,000

Tanga 99%

Singida 88%

Katavi 44%

Dodoma 95% Morogoro 88%

Rukwa 28%

Mbeya 38% Njombe 49%

Iringa 60%

Pwani 99%

Lindi 99%

2011/12 Tanzania HIV/AIDS and Malaria Indicator Survey

Ruvuma 78%

Results
n The analysis helped identify many potential VMMC service delivery sitesparticularly in large rural villages and clusters of villages with sizable populations. n Age-disaggregated maps also illustrated that many older men remained to be circumcised in areas already highly served.

Mtwara >99%

n In scaling up VMMC, spatial analysis offers an innovative method to identify pockets of underserved communities. n Since the 2012 winter campaign, spatial analysis has also been used to help better target VMMC demand creation activities, and drive changes in approaches to service delivery in communities where large groups of older men remain to be served. n Currently, the program is adding more layers, including information on infrastructure such as road access, electricity and water, in order to make planning and implementation of outreach activities more effective. n As VMMC programs approach scale, tools such as GIS mapping will become more important to program managers. Njombe Region: MC Facilities and Wards Proportion

Legend All Facilities Main Roads Secondary Roads VMMC Facilities 01,000 1,0002,000 2,0003,000 3,0004,000 4,0005,000 Proportion of VMMC Done

This poster was funded by PEPFAR through the United States Agency for International Developments (USAIDs) Maternal and Child Health Integrated Program (MCHIP), under Cooperative Agreement #GHS-A-00-08-00002-000. The opinions herein are those of the authors and do not necessarily reflect the views of USAID.

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