XIX International AIDS Conference

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MOPDE0102 - Poster Discussion Session


Determinants of VMMC provider burnout in four sub-Saharan countries

Presented by Dino Rech (South Africa).

J. Bertrand1, D. Rech2, E. Njeuhmeli3, D. Castor3, S. Frade2, M. Loolpapit4, M. Machaku5, W. Mavhu6, L. Perry1


1Tulane SPHTM, Global Health Systems and Development, New Orleans, United States, 2CHAPS, Johannesburg, South Africa, 3USAID, Washington, United States, 4FHI360/Kenya, Nairobi, Kenya, 5Jhpiego/Tanzania, Dar es Salaam, United Republic of Tanzania, 6ZAPP, Harare, Zimbabwe

Background: The Systematic Monitoring of the Male Circumcision Scale-up (SYMMACS) is designed to track voluntary male circumcision (VMMC) service delivery in Kenya, South Africa, Tanzania, and Zimbabwe. The study measured adoption of six elements to increase efficiency in the delivery of clinical VMMC services, including:
  • Surgical method (e.g., forceps-guided)
  • Task shifting (allowing non-physicians to perform VMMC)
  • Task-sharing (allowing non-physicians to conduct aspects of VMMC)
  • Rotation among multiple bays in the operating theater
  • Bundling of supplies and tools
  • Use of electrocautery instead of ligating sutures

Methods: Data collection took place at 14-30 VMMC sites per country (73 sites total) from April-December 2011. It included observation of the clinical facilities, observation of VMMC procedures, interviews with VMMC providers and the in-charge officer, and compilation of service statistics. A total of 357 providers reported on their attitudes towards their jobs and on the pervasiveness of burnout in the field of VMMC.
Results: The results are useful for monitoring service delivery in each country and conducting cross country comparisons. The data shows varied levels of burnout and job satisfaction among providers across countries (see tables 1 and 2).

Among all providersKenya (n=85)South Africa (n=105)Tanzania (n=93)Zimbabwe (n=74)
% reporting to have noticed any provider fatigue/burnout among colleagues when they perform MC full-time as a primary work activity    
Yes, frequently8.214.30.09.5
Yes, occasionally80.026.78.624.3
Yes, but very rarely7.115.216.132.4
No, not at all4.741.074.229.7
Don´t know0.02.91.14.1
[Table 1. Occurrence of VMMC provider reported burn]



% of providers who report to strongly agree or agree with the following statements on job satisfaction :Kenya (n=85)South Africa (n=105)Tanzania (n=93)Zimbabwe (n=74)
? Performing (or assisting in performing) male circumcision is a personally fulfilling job.87.182.8100.081.1
? I personally have begun to experience work fatigue or burnout from performing (or assisting in performing) male circumcision repeatedly.70.636.253.827.0
[Table 2. VMMC provider personal job satisfaction a]

The various survey instruments allow for an analysis of which program, site and provider level factors may contribute to increased burnout. This paper presents results on: type of site (mobile/ static/ outreach), site volume, provider cadre, education and additional training, time in field, full/part-time status, and variety of tasks performed. For example, preliminary analyses from Zimbabwe indicated that physicians experience higher levels of burnout than their nurse colleagues.
Conclusions: The review of these practices across the four countries will shed light on alternative methods of staffing and service delivery that contribute to lower levels of burnout among VMMC providers. The results could inform policies and program planning for VMMC as well as other clinical HIV services.

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