By Manivasagan Naicker (JPS Africa, M&E Advisor)

Introduction

JPS Africa (JPSA) responded to the Department of Health (DOH), custodian of the MMC programme and the Department of Cooperative Governance and Traditional Affairs (COGTA), custodian of the Cultural Male Initiation (CMI) programme to support Mpumalanga Province (MP) during the biggest CMI season post the COVID-19 lock down period.  The initial situation was unsatisfying for JPSA due to lack of coordination between multiple stakeholders including DOH, COGTA, the traditional sector, clinicians, and communities.

The potential risk exposure of the initial situation are the reasons why JPSA has started this quest – the real reasons behind developing the data management flow chart and additional standard operating procedures (SOP) and tools to enhance the accurate capturing of data, verification, reporting and submission of the CMI project data.

The rapid execution corresponded to the rollout of the project. During the implementation and execution of the 2022 CMI season, JPSA faced a number of challenges that we managed to overcome. This response by JPSA exceeded the time, effort, cost, and stress associated with executing a short term, fast paced, multisectoral, multi stakeholder project and still complied with applicable legislation, Medical Male Circumcision (MMC) national guidelines to ensure compliance.  

Background

In the province of Mpumalanga, nestled amidst the breathtaking landscapes of South Africa, a remarkable success story unfolded – one that combined the ancient tradition of CMI with best practices in documentation and filing of records. JPSA recognised the importance of preserving the cultural male initiation practice, while also ensuring the well-being, safety of the young initiates, and the compilation of required records aligned to the Protection of Personal Information Act (POPIA) no. 4 of 2013 and Promotion of Access to Information Act (PAIA) no. 2 of 2000. We believed that the process needed to evolve with the changing times, placing a strong emphasis on recording and reporting (R&R) – a crucial component often neglected in such traditional practices.

In 2022, in collaboration with the MPDOH, JPSA aimed to ensure  the successful implementation and verification of MMC-CMI records across several districts, considering the challenges posed by  the post-COVID-19 restrictions and the anticipation of a larger number of male initiates during the said season. JPSA adopted a hybrid  model, involving nine Implementing Partners (IPs) under our watch  to coordinate and support the Medical Male Circumcision (MMC) in  the CMI settings. JPSA provided MMC services in three districts, viz., Gert Sibande, Nkangala and Ehlanzeni. The organisation understood  that without an effective documentation and filing system, there was  a risk of overlooking critical aspects of the initiation process and accountability.

JPS Africa and its IPs performed an overwhelming 56026 MMC in the CMI settings in 2022. Accurate R&R and coordinated documentation was made possible using the SOP’s and electronic registers. Zero deaths were notified.

Objectives

The objectives of this activity were to:

• Develop an electronic tool for capturing MMC-CMI data specific to each IP, facility, and initiate register number.
• Create a systematic and organised filing system for the initiates’ files and supporting documents in the CMI settings.
• Streamline JPSA processes for the provincial verification process and enhance accountability.

Actions Taken

To address the need for effective filing and retrieval of records in the MMC-CMI process, a unique and innovative electronic tool was developed using MS Excel. This e-tool captured data related to MMC such as, initiates demographics, assigned facility linked to CMI sites, service provider, date of MMC, follow-up visits, and any adverse events. By linking this tool to individual IPs and initiates register number, the system allowed for easy analysis of performance and facilitated swift retrieval of records during the provincial verification process.

The development and implementation of SOPs for MMC-CMI, including the standardisation of filing methods, further improved the efficiency and accuracy of the record-keeping process. These measures addressed the challenges posed by the seasonality and extra ordinary volumes of MMC-CMI and the need for careful documentation to preserve documentary evidence as an effective audit trail required by the Department of Health and the Department of National Treasury.

Despite initial challenges in coordinating activities and training multiple newly appointed IP networks, the coordination of R&R was eventually successfully executed. The system provided visibility into the performance of IP networks and facilitated the smooth delivery and acceptance of records by individual reporting facilities (DHIS nodes). Several levels of internal verifications ensured data accuracy, resulting in a quick turnaround time during the provincial verification process.

Outcomes and Achievements

The implementation of the standardised filing system and electronic tool led to significant outcomes and achievements:

• Developed MMC SOPs and standardised filing methods (Figure 1), ensuring consistency and adherence to established protocols.
• Streamlined provincial verifications with a quick turnaround time, aided by the accurate and well-organised supporting documents.
• Smooth delivery and acceptance of records by individual reporting facilities, enhancing transparency and accountability.

Lessons Learned

Throughout the implementation of the SOPs and R&R tools, valuable lessons were learned. The insight gained highlighted the importance of adapting and improving processes to meet the specific needs of each MMC-CMI season. By integrating a comprehensive electronic tool and establishing standard operating procedures, the activity successfully addressed challenges pertaining to data coordination, access, and verification.

Conclusion

The coordination of R&R for the Mpumalanga MMC-CMI season has been a resounding success. Thanks to the efficient filing system, monitoring and evaluating the progress of MMC-CMI activities became effective and more efficient. The positive impact on the provincial verification process, the acceptance of records by reporting facilities, and the enhanced accountability and transparency have positioned this activity as an exemplary model for similar initiatives. The success story from Mpumalanga serves as an inspiring model for other implementing partners seeking to address their challenges in recording and reporting as well preserving documentation. The success and learning from this initiative are not only celebrated at JPSA but have the potential to inspire similar practices locally in other provinces and implementing partners.

Gratitude is expressed to the JPSA staff and interns, IPs, and the Mpumalanga DOH for their unwavering support in making this activity successful. The lessons learned from this endeavour will continue to shape and improve future MMC-CMI initiatives, allowing for the preservation of cultural traditions while ensuring the highest level of care and compliance with established health protocols.

“It is indeed much appreciated. I was appraised about that as well and really wish to take up the good lessons learned and pass onto other organisation’s as good learning practices”. Heskins Maluka, MPDOH MMC Programme Director.

Figure 1: JPSA standardised filing and storage system.