Uganda’s safe male circumcision policy: examining citizen’s participation, barriers and strategies for uptake; a case study: Rukungiri municipality

Abstract

The study focused on Uganda’s circumcision policy which was launched in 2010.The study had four objectives namely; to examine the existing interventions, citizen participation, barriers and strategies for uptake of SMC in Rukungiri Municipality. Since 1986, circumcision has been linked with low HIV prevalence through its efficacy of lowering HIV transmission from females to men with a relative risk reduction of 51-60% which was hailed as evidence by World Health Organization (WHO) as a crucial HIV intervention in countries where there is high HIV prevalence and low circumcision prevalence. Its acceptability in Sub Saharan Countries ranged from 29-87%. Additionally, safe male circumcision fulfils the Sustainable Development Goal (SDG, 2016-2030) numbers three – Ensuring health lives and promotes well-being for all at all ages. The study followed a descriptive case study design and used mixed methods approach where quantitative questionnaires and interviews were conducted in data collection. Data was analyzed using Microsoft excel computer program and Statistical packages for social sciences (SPSS). The study was guided by Social Cognitive Theory (SCT) of Bandura, 2005; which suggests that ‘behaviors, environmental influences, and beliefs are highly interactive and dependent’ (Kalichman 1998: 42). The framework identifies three main sources of influence on people’s attitudes, perceptions and intentions to act and their ability to carry out their intentions. SCT is centered on the idea that self-efficacy, self-motivation and knowledge, as well as having the required skills to implement a behavior change will lead to action, in this case going for the procedure. The major findings were; creating awareness through IEC campaigns, Health services infrastructure already available and accessible, trained (qualified) personnel are available in most health facilities, public- private partnership, Strong support from political leadership and Facilitation of Staff. . However, this is a challenge in the Ministry of Health where 72% of the Health facilities do not have constant supply and 70% of the Essential medicines and supplies are not provided for in the budget, yet the demand for other interventions including SMC are on increase. The SMC policy was top down where the technocrats formulated the policy and the citizens were used at the implementation level. The barriers of SMC from the study were; excessive pain, bleeding, long queues , too old for circumcision, loss of sexual pleasure, long healing and abstinence period, fear of losing the job, adverse events post circumcision, death and mandatory HIV Counseling and testing (HCT). The community was used as a means towards circumcision policy implementation as the policy was top down, the health officials were used as technocrats in national and regional meetings and they defended their supervisors at the central government level as participation in policy making process was counterfeit. It’s true that the citizens were empowered to get involved in the circumcision policy making process using IEC campaigns about the benefits of safe male circumcision to increase the demand and uptake. The study therefore recommended that: Comprehensive sensitization of the public using information, Education and Communication (IEC) on the proper benefits of SMC, increased funding to procure equipment and supplies including emergency and resuscitation equipment xii with observation facilities to carryout SMC interventions, refresher training, conducting the circumcision at school and in holidays, engagement of community leaders, providing the SMC hotline, Post-operative follow-up services, TT vaccination, provision of free transport, training of community mobilizers, supervision of male circumcision services in public and private health facilities, compliance with infection control and establishing referral system in case of adverse events post circumcision and follow up care, integrating neonatal circumcision into the health system, dialogue meetings and citizen participation for ownership and sustainability of the program.