The Aurum Institute (Aurum) is a proudly South African, internationally recognised, non-profit organisation whose main focus over the past 17 years has been TB and HIV research and health systems strengthening. In an effort to contribute to South Africa’s ambitious target to circumcise 4.3 million males between the ages of 15-49 years old by December 2016, Aurum has been offering Voluntary Medical Male Circumcision services at a large state-of-the-art clinic (Winnie Mandela Male Health Clinic) since September 2011.
About The Clinic
The clinic is located in Tembisa, a middle to low income “township” consisting of a mix of formal and informal housing in Ekurhuleni. Ekurhuleni is one of five districts in Gauteng Province. The estimated population of Ekurhuleni is 2,865,611 (DHIS 2010 Mid-Year Population Estimates); which constitutes 5,6% of the national population and makes up 27% of the population in Gauteng (9 245 085). Seventy-seven percent (77.8%) of the Ekurhuleni population are uninsured and rely on the public health services. Males constitute 51% of the total population. The age group under 5 years constitutes 9% whereas the youth (age group 15 to 34 years) constitute 37% of the total population.
The clinic was constructed from refurbished pre-fabricated containers which were used in a large HIV Prophylaxis Randomized Clinical Trial conducted by Aurum. Clients go through a series of services offered at the clinic: HIV counselling and Testing (if status unknown), risk-reduction counselling, VMMC counselling (which includes gender-based counselling and education), pre-operative medical assessments, and preparation for the surgery. An eight-man “buddy system” is incorporated to provide peer support throughout the process. The clinic is almost completely automated; with an on-line appointment system and data management system which allows for effective follow-up and tracking of patients.
The CDC/PEPFAR Grant
The clinic is funded through a CDC Cooperative Agreement which is in year 4 of a five-year grant. The funds are directed through a “Human Resources for Health” mechanism. The VMMC component of this grant supports the above-outlined VMMC package of services in two Provinces (Gauteng and the North West (NW) Provinces). Unlike Winnie Mandela Clinic the same VMMC package of services is offered in two slightly different models in the North West Province – a roving team model and a mobile clinic model. This was in direct response to the completely different needs of the two provinces: whereas Gauteng is largely urban, with densely populated areas which can be serviced from a central clinic; large parts of the NW are rural, sparsely populated, of difficult geographic terrain and inhabitants are of relatively poorer socio-economic status. Therefore, in the North-West, there is a greater need to “take services to the people”.
In addition to the Direct Service Delivery (DSD) outlined above, a significant component of Aurum’s VMMC mandate is Health Systems Strengthening, DOH capacity building and ensuring sustainability of the programme beyond PEPFAR-funded support. To this end facility start-up support (which comprises site assessment, recommendations and “hand-holding” during start-up, Continuous Quality Improvement (CQI), DOH staff training and mentoring, Data Management support are integral components of the support Aurum offers.