Male Circumcision:

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Male Circumcision:




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Presentations text content in Male Circumcision:

Slide1

Male Circumcision: Policy & Programming

Commodities & Supply Chain

Management

Slide2

Knowledge Check

Answer the following questions to see how much you know about this topic.

Each male circumcision (MC) surgery will require an MC kit. Each MC kit will contain:A consumables packAn instrument seta and bEach male circumcision (MC) site will need all of the following EXCEPT:An MC kit for each MC surgeryInfection prevention and waste disposal suppliesMC equipmentEquipment and supplies for general anesthesiaAn MC emergency medical toolkit

A strong supply chain management system is needed to ensure that the appropriate commodities and equipment are consistently available to male circumcision programs

.

True

False

Pre-sorting and organizing male circumcision (MC)

commodities:

Will make it easier for an MC facility to order and manage inventory

Will

help ensure that each MC facility has all essential MC commodities available on-site

a

and b

Is

a waste of

time

Each clinic that uses

reusable

surgical instruments will need its own autoclave.

True

False

Slide3

A Challenge: Managing the Commodities and Supplies Required to Circumcise Millions of Men

The scale-up of male circumcision (MC) for HIV prevention across eastern and southern Africa will require well-organized and streamlined systems that can provide the commodities and supplies needed to circumcise millions of men.

This session focuses on efficiencies for commodities and supply chain management in MC programs.

Slide4

A Challenge: Managing the Commodities and Supplies Required to Circumcise Millions of Men (continued)

Did You Know?

A meeting of MC implementing partners was held in May 2009 to discuss issues related to supply chain management and to produce a comprehensive list of MC commodities.

Highlights of this meeting are available in the

PEPFAR MC Partners’ Meeting: Commodities and Improved Coordination of Male Circumcision for HIV Prevention

report.

Source

: PEPFAR MC Technical Working Group 2009

Slide5

What's Needed for Each MC Surgery?

Photo of an MC kit (unopened)

Each MC surgery will require an

MC kit. Each MC kit will contain:A consumables pack, the essential MC consumables packaged in a multipurpose, recyclable plastic tray. These consumables (e.g., gauze, needles, scalpel blade, and gloves) are used in an MC operation and then discarded.An instrument set (surgical instruments used in an MC operation (may be disposable or reusable and will vary by surgical procedure)Sources: WHO 2010; PEPFAR Male Circumcision Technical Working Group 2009

Highlights:

MC

Kits

To improve efficiency, all the consumables and instruments needed to perform a single MC surgery should be organized and packed together (pre-bundled) into an MC kit.

Slide6

What's Needed at Each MC ServiceDelivery Site?

Each MC site (whether it uses disposable or reusable surgical instruments) will need the following:An MC kit for each MC surgery, as described on the previous slide (includes consumables and instruments, bundled as Module 1)Infection prevention supplies (bundled as Module 2)Waste disposal supplies (bundled as Module 3)MC equipment (bundled as Module 4, may include optional diathermy [electrocautery] equipment)MC emergency medical toolkit (bundled as Module 5)Source: PEPFAR Male Circumcision Technical Working Group 2009

See

lists of bundled MC items

.

Slide7

What's Needed at Each MC Service Delivery Site? (continued)

Infection prevention for MC in Zambia

Highlights

MC

Commodities for Service Delivery Sites

Pre-sorting and organizing the MC commodities needed to provide MC services will make it easier for an MC facility to order and manage inventory, and will help ensure that each MC facility has all essential MC commodities available on-site.

Slide8

MC Kits: Contents and Options

You Decide . .

.

Can you identify the MC surgical items pictured on the left?

To

see the answers, go to the next slide.

Slide9

MC Kits: Contents and Options (continued)

a. O-drape; b. Aprons; c. Plastic pick-up forceps; d. Artery forceps/clamp; e. Gloves in the MC kit; f. Artery forceps, straight and curved; g. MC kit (opened); h. Vaseline gauze; i. Needle holder and stitch scissors, 2-in-1; j. MC kit (unopened); k. Gauze; l. Syringes, needles, tape, sterility indicator, and alcohol swabs; m. Pick-up forceps, sutures, and surgical blade and handle

Slide10

MC Kits: Contents and Options (continued)

Selection of MC instruments will vary depending upon the surgical technique to be used (forceps-guided, sleeve resection, dorsal slit). However, all sites should have a standard set of MC equipment, an emergency toolkit as well as all the commodities required to prevent infection and to provide diathermy (electrocautery) – if diathermy is being used.

To run an efficient MC site, a country program will need to choose one of

three kit options

. See

a description of each of these kit options.

Source

: PEPFAR Male Circumcision Technical Working Group 2009

Slide11

Disposable Versus Reusable Surgical Instruments

If

disposable

surgical instruments are used, systems will need to be in place to ensure that disposable items are used only once and that they can be disposed of safely. For example,

clearly labeled

, puncture- and tamper-proof sharps containers will need to be provided.

If

reusable

surgical instruments and equipment are used, systems will need to be in place to provide immediate decontamination, cleaning, and sterilization.

Slide12

Disposable Versus Reusable Surgical Instruments (continued)

Sterilizing reusable surgical instruments requires one or more autoclaves. Buying power may possibly be leveraged through mass purchasing of autoclaves and other instruments. A district or country may establish and maintain a centralized sterilization unit capable of handling the sterilization needs of an entire area. (WHO 2010)

Did You Know?

Disposable

surgical instruments are more applicable in mobile settings.

Slide13

Supply Chain Management System

The effectiveness of MC programs will depend on a

strong supply chain management system that can ensure that the appropriate commodities and equipment are consistently available.

Did You Know?

The Partnership for Supply Chain Management (PFSCM),

with funding from PEPFAR, is working to provide technical and financial assistance to countries (e.g., Swaziland and Zimbabwe) to build or improve their supply chain system for MC commodities.

You can find more detailed information about commodities and supply chain management in the Global Health eLearning course

on

Logistics for Health Commodities

.

Slide14

Supply Chain Management System (continued)

The following

key components of supply chain management

will need to be in place:

Forecasting

: continuous anticipation of future MC supply needs

Procurement

: an efficient system for obtaining MC commodities bundled into sterilized sets/packs/kits

Distribution

: getting MC supplies where they are needed, on time, to multiple locations and settings

Storage

: ensuring the quality and safety of MC commodities, and their packaging, while making them available for distribution

Stock in hand

: keeping track of the quantities of usable MC commodities that are currently available at the MC service delivery site (excluding items that are expired or no longer usable)

Waste disposal management

: ensuring that protocols for safe handling and disposal of waste are established and practiced at the MC service delivery site, with special attention given to handling and disposal of biohazardous and infectious wastes (e.g., MC commodities soiled with blood)

Slide15

Lessons Learned

Countries' decision making regarding selection of surgical technique, reusability of surgical instruments, use of diathermy (electrocautery), service delivery setting, and targeted number of men to be circumcised all impact the choice of commodities and the cost-efficiency of programs.

Bundling commodities into "kits" containing the instruments and supplies for a single surgery may ease procurement, distribution, inventory tracking, and clinical use.

Central procurement will take advantage of economies of scale to decrease the price of commodities.

Distribution relies upon host country governments' commitments to facilitating importation of necessary commodities.

No single organization, country, or donor can singly achieve the scope and scale of activities to realize maximum efficiency – consensus and collaboration are required.

Source

: Njeuhmeli et al. 2010b

Slide16

Knowledge Recap

Answer the following questions to see how much you know about this session.

Each male circumcision (MC) surgery will require an MC kit. Each MC kit will contain:A consumables packAn instrument seta and bEach male circumcision (MC) site will need all of the following EXCEPT:An MC kit for each MC surgeryInfection prevention and waste disposal suppliesMC equipmentEquipment and supplies for general anesthesiaAn MC emergency medical toolkit

A strong supply chain management system is needed to ensure that the appropriate commodities and equipment are consistently available to male circumcision programs

.

True

False

Bundling male circumcision commodities into _______ containing the instruments and supplies for a single surgery may ease procurement, distribution, inventory tracking, and clinical

use.

"Pods"

"

Tubes"

"

Kits"

"Backpacks“

Slide17

Knowledge Recap (continued)

Answer the following questions to see how much you know about this session.

Pre-sorting and organizing male circumcision (MC) commodities:Will make it easier for an MC facility to order and manage inventoryWill help ensure that each MC facility has all essential MC commodities available on-sitea and bIs a waste of timeNo single organization, country, or donor can singly achieve the scope and scale of male circumcision activities to realize maximum efficiency.TrueFalse

Each clinic that uses reusable surgical instruments will need its own autoclave.

True

False

Slide18

Commodities & Supply Chain ManagementKnowledge Recap Answer Key

Please note that the questions and answers match those in the Knowledge Recap. The number and order of questions in the Knowledge Check may differ.

Each male circumcision (MC) surgery will require an MC kit. Each MC kit will contain: c. a and bEach male circumcision (MC) site will need all of the following EXCEPT: d. Equipment and supplies for general anesthesia Adult/adolescent medical male circumcision, as described in this course, is performed under LOCAL anesthesia.

A strong supply chain management system is needed to ensure that the appropriate commodities and equipment are consistently available to male circumcision programs.

True

Bundling male circumcision commodities into _______ containing the instruments and supplies for a single surgery may ease procurement, distribution, inventory tracking, and clinical use.

c.

"Kits"

Slide19

Commodities & Supply Chain ManagementKnowledge Recap Answer Key (continued)

Please note that the questions and answers match those in the Knowledge Recap. The number and order of questions in the Knowledge Check may differ.

Pre-sorting and organizing male circumcision (MC) commodities: c. a and bNo single organization, country, or donor can singly achieve the scope and scale of male circumcision activities to realize maximum efficiency. a. True: Consensus and collaboration are required.

Each clinic that uses reusable surgical instruments will need its own autoclave.

b.

False: Although sterilizing reusable surgical instruments requires one or more autoclaves, a district or country may establish and maintain a centralized sterilization unit capable of handling the sterilization needs of an entire area.


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