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Presentation Outline

• Partnership and Collaboration with HoTL • Build up activities and response – December

Season• Report on initiation intervention• Recommendation• Conclusion

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Partnership and Collaboration with HoTL

• Traditional Initiation has been the focus and priority of the EC Provincial government and other circumcision stakeholder

• Like other key sectors, ECDoH acknowledges that traditional initiation is the competency of the HoTL.

• The ECDoH’s involvement and role is to support the circumcision practice by working with and through the established task team led by HoTL.

• The ECHoTL, DoH, DoE and SAPS are spearheading the implementation of the Initiation Monitoring and Intervention Strategy to ensure safe passage of initiates from boyhood to manhood

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Multi-Sectoral Initiation Monitoring Team • Overall Response Team (MECs) and key leadership in

various sectors – led by Nkosi Ngangomhlaba Matanzima• Technical Coordinating Multi-Sector Team – Provincial

Member – HoTL, NDoH, PDoH, NGO, SD, SAPS, CODEFSA• Multi-Sectoral Monitoring Team – Dedicated Team from

HoTL, Social Development, SAPS, DoH, DoE, NGOs.• Traditional Leaders led Local Initiation Forums and

Monitoring Teams

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PREPARATION FOR SUMMER SEASON 2013

•Pre - initiation build up activities towards the Summer Initiation Season:

• Provincial initiation Workshop for key strategic departments( LGTA/ HOTL, DOH, DOE, SAPS, NPA, SOCDEV and CODEFSA)

• Traditional Councils consultation outreach by HoTL Executive Team and Imbumba Yamakhosikazi Akomkhulu

• Schools, churches, community Imbizos and community radio campaigns promoting safe initiation practices

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PREPARATION FOR SUMMER SEASON 2013

• Trainings of Traditional Surgeons and Nurses.• Monitoring Teams were workshoped in order to

standardize operation procedure and equipment needed during monitoring of initiation schools.

• Summer Initiation Launch event - Palmerton Methodist Church, Lusikisiki - 24 November 2013

• Provincial Technical Monitoring Teams were deployed to districts to monitor readiness for the season

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PREPARATION FOR SUMMER SEASON 2013

• Additional surgical supplies were provided to all monitoring teams

• Provision of clinical personnel to all monitoring teams in the entire province

• Medical doctors were also deployed in the OR Tambo Municipal District

• Preparations also looked into readiness of health facilities to admit and manage initiation complications

• Rescue Centre established in Palmerton facilitated by CODEFSA and supported by (Male Nurses) from Provincial Department of Health

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HEALTH FACILITY READINESS

• 5 hospitals identified as main referral hospitals in OR Tambo and Alfred Nzo:– St Patrick hospital for Alfred Nzo district– St Elizabeth hospital for Qaukeni Sub-district supported by Holy Cross

and Bambisana Hospitals – St Barnabas hospital for Nyandeni Sub-district supported by Canzibe

and Silimela Hospitals– St Lucy’s hospital for Mhlontlo supported by Malizo Mpehle and Nessie

Night Hospitals– Mthatha General for KSD Sub-district supported by NMAH.

• Throughout the province Districts were encouraged to be ready for admissions

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ITEMS/SERVICES QUANTITY DURATION COST IMPLICATION

Hired vehicles 20 vehicles8 vehicles

60 days: 15/12 – 13/0118 Days: 06/12 – 23/12

R1,386,120 + R145,680

DoH Vehicles 10 vehicles

Accommodation Services For Provincial And District Staff Including HOTL Stakeholder Workshop In Mthatha Garden Court School Campaigns for Safe Circumcision 6-8/11/2013 In OR Tambo & Alfred NzoHOTL & Imbumba Yamakhosikazi Akomkhulu (IYA)Monitoring & Intervention Programme Of Initiates

75 People

10 People

9 People 32 People

21-22/10/2013

6-8/11/2013

11-26/11/2013 24/11/2013-20/12/2013

Total Of R1 127 840

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ITEMS/SERVICES DURATION COST IMPLICATION

Build-up activities:•Trainings (RTC)•Community Mbizos•School visit campaigns•Launch event

28/08/2013

to

13/11/2013

(Accurate figures still being compiled)

NGO Support during the NGO Support during the SeasonSeasonCODEFSA:

•Additional 2 vehicles •Provision of lunch packs •Protective clothing•Establishment of rescue •center and provision of •food for initiates•Funding of workshop for• women

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YEAR HOSPITAL ADMISSIONS

AMPUTATIONS

INITIATEDEATHS

LEGALINITIATES

ILLEGALINITIATES

ARREST

2006 JUNE 288 5 26 3470 285 0

2006 DEC 512 7 32 11243 708 0

2007 JUNE 329 41 24 12563 1460 0

2007 DEC 311 11 8 33005 1327 0

2008 MAR 18 0 5 241 152 2

2008 JUNE 352 11 24 14741 1694 49

2008 DEC 267 0 5 40290 553 23

2009 JUNE 461 47 55 17538 2470 29

2009 DEC 252 2 36 39581 896 9

2010 JUNE 389 22 41 18450 1429 12

2010 DEC 269 1 21 53128 1352 7

2011 JUNE 313 10 26 13886 2808 35

2011 DEC 338 10 36 41903 937 24

2012 JUNE 358 17 49 15259 730 8

2012 DEC 219 6 25 22654 367 13

2013 JUNE 359 24 40 12169 2314 19

2013 DEC 297 7 43 31626 602 21TOTAL 5332 221 496 381411 20149 251

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SUMMERY OF CIRCUMCISION STATS – Dec 2013

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Distribution of initiation death

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Jun/Dec 2013 Initiation deaths Comparison

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Indicated Causes of Initiates’ Deaths

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Deaths from Illegal and Legal Schools

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Summer Season Review Consultation A summer season review consultation workshop

held with on 14 January with all Montoring Teams and stakeholders involved in on 14 January to: Critically review the 2013 December/January Initiation

season Prepare a comprehensive report that will encompass

recommendations on what program of action should be considered going forward

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Reported Challenges Not every district or local areas has established active Initiation Forums. Traditional Circumcision Schools not easily accessible to monitoring teams

as are built on mountainous areas. Initiation schools not reachable on time – lots of boys could not be reach. Centralisation of initiation schools not yet effected. Schools are still spread

out throughout the province, often not easily idetified Sepsis is being noticed as a common occurrence in most complicated

initiation schools Partial circumcision still occur especially in Nyandeni and Mhlontlo area. Initiates flee when they see monitoring teams, in fear of discrimination

amongst themselves. Some refused to be taken to hospitals.

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Reported Challenges Cont… Establishment of Illegal schools is still a challenge especially in OR Tambo

and Alfred Nzo Districts. Parents reported to be against medical interventions/treating of initiates

with antiseptic ointment and bandages when DMOs find a condition that requires.

Discrimination of initiates by peers and communities, who were assisted or sort medical help.

Circumcision of underage boys in the Pondoland area No legislation guiding initiation in the province Lack of commitment from municipalities and other government

departments. High rate of substance abuse by initiates

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Recommendations• Expedite the process of developing a National and

Provincial Initiation Legislation• Institutionalization of management initiation practice –

permanent structure and staffing • Standardization of Initiation Monitoring Teams and Local

Forums with clear Terms of Reference• Development and implementation of a broader and

integrated 5 year strategic plan and year long programme of actions

• Adequate budget allocation for the initiation program

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Recommendations Cont …..• Centralization of initiation schools with sensitivity to various sub-

cultures.• Enhance active involvement of Traditional Leadership at local level• Improvement of technical training for traditional nurses and surgeons• Vigorous police intervention, intelligence and NPA to secure

convictions.• Building community and parent ownership of the practice. Parents to

take responsibility for their children• Active involvement and contribution by local municipalities. • Psychosocial support for victims of penile injuries and peers of

deceased initiates (Social Development)

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Plan for the next season Broad and integrated 5 year strategic plan and year long programme of actions are being

crafted. Focus is on:• Review of the current legislative framework, • Centralisation of initiation school with designated areas - in rural and urban • Establishment of active local initiation forums and training there of. Terms of Reference to

be clearly defined • Training of Traditional Surgeons and nurses. Establishment of database.• Vigorous school outreach educational programs, working with the DoE.• Community mobilization, engagement and education through community dialogs, Imbizo,

radio slots and Youth consultation programs. • Registration of boys for initiation through local Traditional Council, working with DoE. • Workshop for women to re-inforce their role –Led by Ngamakhosikazi Akomkhulu• Establishment of a Nerve Centre – Coordination of monitoring activities, especially during

seasons• Establishment Rescue centres. Hotspot areas to be prioritised

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List of needed Resources Resources mobilization and coordination.

Dedicated budget is needed through the HoTL Human Resources - Dedicated teams from various departments to form part

of the teams especially during seasons Doctors/Male nurses – screening and monitoring during the season. DoH to

provide Food packs Stipend for forum members (volunteers) – working with monitoring team Transport. Communication tools – Walkie-talkies, cellphone airtime Medical supplies - Dressing kit/packs per car – DoH to provide Accommodation for monitoring team – Protective clothing – Rain suites, work suits, boots

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Thank you

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