Chapter 4: VMMC Communication at the Site Level and Demand Creation

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Chapter Goals

To ensure that site-level staff are able to:

  • Provide key audiences in the community with accurate and complete information about VMMC to build demand and enable eligible men to make an informed choice.
  • Communicate essential information on voluntary medical male circumcision (VMMC) and HIV prevention clearly and comprehensively at appropriate stages of the client’s visit.
  • Identify and correct any myths and misconceptions about VMMC, and address any fears/concerns about the procedure.
  • Instruct the client on and ensure comprehension of postoperative measures to ensure safety and proper healing.
  • Provide communication and counseling tailored to the client (based on his age, life phase, and other needs).
  • Provide each client with high-quality services that result in customer satisfaction and peer referrals.
  • Provide general information on successful demand creation strategies and considerations.

What Users Need to Know

Communication at Site Level

VMMC services offer a unique opportunity to engage adolescent and adult males in high-quality HIV prevention communication and services; and to share key messages with males who otherwise might not interact with the health system. Consistent communication and counseling throughout these VMMC services is critical for capitalizing on this opportunity. This reference guide helps to ensure that in-service communication and counseling content is comprehensive and standardized across PEPFAR’s (U.S. President’s Emergency Plan for AIDS Relief ) VMMC country programs [See Best Practices Guide: VMMC In-Service Communication].

Given the large number of topics that need to be covered at each phase of the VMMC service (group education preoperative, individual counseling, immediate postoperative, follow-up visit), checklists are available as a tool for ensuring consistency and accuracy of communication and services [See Checklist on VMMC Counseling]. For those VMMC sites where a device is offered as a circumcision method, device-based VMMC warrants tailored in-service communication to ensure that clients are aware of the unique attributes of the device-based procedure— device placement, wearing of the device, device removal, and recovering from device-based circumcision and wound healing by secondary intention. A device-specific counseling checklist is also available [See Checklist on Counseling for VMMC with Device]. Circumcision with a device method where the foreskin is left in situ and removed several days after application (elastic collar clamp) should be undertaken only if the client is adequately protected against tetanus by immunization with tetanus-toxoid-containing vaccine (TTCV) [See Tetanus and Voluntary Medical Male Circumcision: Risk According to Circumcision Method and Risk Mitigation, Report of the WHO Technical Advisory Group, 12 August 2016.] Finally, counselors should be aware of myths about VMMC and be ready to address them. A list of frequently asked questions is also available [See VMMC Frequently Asked Questions (FAQs)].

Demand Creation

Demand creation can be defined as strategic interventions that reinforce motivating factors and help the target audiences overcome key barriers, with the aim of increasing service uptake. Community engagement, mass media, and advocacy are critical components of VMMC demand creation; they require close coordination with services.

Demand creation is part of a broader package of communication interventions. It’s important to ensure consistency of information disseminated across the VMMC continuum [See Phases and Steps for VMMC Demand Creation].

Successful demand creation follows communication best practices and includes the following elements:

  • A clearly defined communication and demand creation strategy, informed by research, that outlines key barriers and motivators, primary and secondary audiences, channels, and key messages. In most countries, the communication plan will include a strategic mix of channels and approaches, such as community engagement, mass media, infection prevention and control materials, and advocacy with leadership and influential agents, among other approaches. [See Communication Strategy for Voluntary Medical Male Circumcision in Kenya; Communication Materials Adaptation Guide; A Guide to Working with the Media to Promote VMMC in Kenya; VMMC Video Discussion Guide; and VMMC Demand Creation Toolkit.]
  • Outreach scaled to align with the availability of services.
  • Communication through multiple channels that engages the target population and key influential people, including partners, parents or guardians, employers, and other individuals and groups that can influence the VMMC decision. Such channels include community radio, social media, interpersonal peer communication, and TV shows with a panel of VMMC experts.
  • Tailored messages and communication channels that resonate with younger and older men, both in and outside of relationships (segmenting audience and influencers for more effective demand creation).
  • Engagement of women by providing tailored information about VMMC’s benefits for women and their key role as mothers and partners.
  • Clearly written, attractive brochures and leaflets printed in the local language, targeted to specific audiences, such as parents and partners.
  • Materials that clearly direct potential clients to local VMMC service sites.
  • Recruitment of satisfied clients to encourage their peers to undergo VMMC (a tool that can add to community sensitization and mobilization). Male friends and peers can be strong advocates.
  • Monitoring community mobilization to ensure the quality and consistency of messages, and to follow up with potential clients who do not present for services.
  • Communication campaigns that can be adjusted, as needed, to match the volume of services that can be provided; similarly, services that can be scaled up to keep pace with the demand created by advocacy, sensitization, and mobilization.
  • Consistent reporting, collection, and analysis of data to inform demand creation.

The following activities can be used to monitor communication:

  • Track the communication activities to assess how well plans are being implemented. This may include materials produced and disseminated, media intensity index, and reporting of community mobilizer action plans, among others. This information can be triangulated with service uptake to see where demand creation activities are on target or need modification.
  • Use referral slips to further strengthen monitoring of demand creation efforts and closer linkages to specific activities [See Sample VMMC Referral and Follow-Up Card].
  • At the site level, collect data at client intake to determine where the client heard about VMMC and what motivated him to come for services. Analyze these data on a regular basis to inform demand creation activities and resource allocation [See Sample VMMC Client Intake Registration Form].

Tools, Instruments, and Guidance Documents

  1. Best Practices Guide: VMMC In-Service Communication
  2. Checklist on VMMC Counseling
  3. Checklist on Counseling for VMMC with Device
  4. VMMC Frequently Asked Questions (FAQs)
  5. Communication Strategy for Voluntary Medical Male Circumcision in Kenya
  6. Communication Materials Adaptation Guide
  7. A Guide to Working with the Media to Promote VMMC in Kenya
  8. VMMC Video Discussion Guide
  9. VMMC Demand Creation Toolkit
  10. Sample VMMC Client Intake Registration Form
  11. Sample VMMC Referral and Follow Up Card
  12. Phases and Steps for VMMC Demand Creation

To read more about the frequently referenced information, additional information, and to read related case studies download the chapter PDF.

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