MC MOVEModels for optimizing the volume and efficiency of MC

services

By Dr Dino Rech

MC MOVE• Evolution of efficiency principles in surgery and

MC• Efficiency principles used in MC• Progress to date

– New sites and programs– Research– Ongoing evolution.

• Efficiency challenges– Balancing demand and supply/ seasonality– Counselling and communications– Part time MC providers vs specialised teams

Evolution of efficiency principles in surgery and MC…e.g.

Aravind Eye Hospital India

Orange Farm South Africa

Evolution of efficiency principles in surgery and MC

MOVEWHO pilot initiative:

Aims to maximise Surgical results and minimising time and resources needed to perform high

volumes of surgery.

Facilitates cost effective solutions to MC scale up in high volume/demand settings

Task-Shifting

- Training / certification of entire MC procedure to lower health cadres, e.g., clinical officers, nurses.

Efficiency Principles used in MC

Task-Sharing

Assign steps to lower cadres:- Surgical area clean & prep- Anaesthetic block- Final foreskin stitches- Wound dressing

Sharing supported by:- 4 beds per operator- 6 lower cadres per operator- Theatre layout for staff flow- Alcohol gel hand sanitizing- Gown change only if blood

Surgical Efficiency Techniques

Task-Shifting Task-Sharing

Techniques

- Forceps-guided- Cautery (monopolar) for haemostasis - Fewer stitches (8-12) for foreskin apposition- Collective wrap of surgical items- Pre-assembled surgical kits- Theatre layout for faster patient turnover

The Fourth Efficiency Principle

Adequate Client flow and demand for services

-Communications

-Mobilization

-Counselling and testing services

Surgical layout

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2

3

4

Efficiency focused MC Kits

Surgical Methods

Surgical methods compared

Time savings to surgeon/procedure

Forceps-guided/dorsal slit 2:25

Forceps-guided/sleeve resection 7:40

Dorsal slit/sleeve resection 5:15

* Times depicted are based on time-motion observations at Orange Farm, South Africa

Results

Indicator Pre‐MOVEMOVE

(Sleeve)

MOVE (Forceps Guided)

Doctor Operating Time

25‐50 min. 10‐20 min 5‐10 min

Cubicle Turnover Time

60 min 30‐40 min 25‐30 min

# of Clients 1‐2 an hour 3‐5 an hour 5‐8 an hour

* Note Graph with initial impact and results from Tanzania.

Progress to date

• Efficiency focused( use of MOVE) implementation – South Africa – Swaziland– Zimbabwe– Tanzania– Botswana– Zambia– Kenya

• Research Efficiency or MOVE Evaluation

Aggregate Numbers – Four Pilot Sites. Tanzania

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MOVE Begins

Challenges to implementing efficient high volume services

– Balancing demand and supply / managing seasonality of demand

– Counselling and communications: How to keep up?

– Part time MC providers VS specialised teams: Pros and Cons

New Super Efficient MC Device in SA???