Case Study: Rollout of Voluntary Medical Male Circumcision Communication in Kenya

From the Communication for Change (C-Change) Project, this case study on voluntary medical male circumcision (VMMC) emerges from an experience through which C-Change provided support to the Kenya Voluntary Medical Male Circumcision (VMMC) programme from 2009 to 2011. C-Change supported the rollout of the Government of Kenya’s VVMMC programme in Nyanza Province and other provinces as part of a comprehensive HIV-prevention strategy. The project worked under the leadership of National Male Circumcision (MC) Taskforce and the Ministry of Public Health and Sanitation (MoPHS).

C-Change provided technical assistance in social and behaviour change communication (SBCC) and worked closely and collaboratively with the MoPHS, the National MC Task Force, the Nyanza Provincial MC Task Force, and a range of partners to operationalise and implement Kenya’s National MC Communication Strategy. The project also worked with the MC Technical Working Group of the US President’s Emergency Plan for AIDS Relief (PEPFAR) and task force leaders to establish VMMC communication sub-committees of national and regional technical working groups, coordinate VMMC communication activities, and develop evidence-based VMMC communication materials.

The case study highlights lessons learned in the process that included:

1. Formative research for materials development
2. Concept testing
3. Pretesting
4. Stakeholder review and more pretesting

The review and testing resulted in the VMMC materials being translated into local languages: Luo, Kiswahili, Teso, and Turkana.

Among the lessons learned are the following:

• Ownership of the rollout by the MoPHS and communities was key. However, partners were requested not to use their branding, so that all materials were used more extensively by all partners.
• The task forces served as champions for VMMC, increasing rollout synergy.
• The MoPHS and the National MC Task Force partnered with the media and political leaders to neutralize opposition to VMMC.
• "The detailed implementation guide for Nyanza compensated for a lack of detail in the VMMC Communication Strategy. The guide’s systematic approach, based on a socio-ecological model, guided the rollout of culturally appropriate and effective communication approaches and materials. The guide helped to build consensus and streamline demand creation."
• Stakeholder opinions differed from audience feedback on material development. "To encourage stakeholders to pay more attention to audience preferences and opinions, C-Change shared results of audience consultations and helped stakeholders to recognize the importance of concept testing and pretesting."
• There was a need for a rapid "use" assessment relating to the distribution and use of the materials.
• More research on women is needed: "their roles in decisions on VMMC uptake and their perceptions of their risk and vulnerability. Additional research is also needed to evaluate counselling for circumcision candidates on the healing time and post-surgical abstinence, along with research on the extent to which circumcised men embark on more risky sexual behaviour because of perceptions that circumcision protects against HIV infection."
• More information is needed in the toolkit for neonatal male circumcision, strategies for low literacy groups and men who have sex with men as special populations, as well as more materials for health care workers.