By late April 2014, only four months into the year, the Voluntary
Medical Male Circumcision (VMMC) program in the Iringa and
Njombe regions of Tanzania had already performed 80,000
medical male circumcisions, nearly four times the number done by
April of previous years. What makes this number of circumcisions so
remarkable is that the program had not even hit its “high season”
yet—the colder months of June and July, which clients traditionally
consider the preferable time to be circumcised in Tanzania.
Due to client beliefs, the agricultural calendar, and other factors, seasonality
has posed a perennial challenge to those responsible for generating
demand for VMMC services in Tanzania—as it has in South Africa,
Zambia, and many other priority countries where VMMC is being scaled
up. In the early years of Tanzania’s VMMC program, 75 to 80 percent of
circumcisions were performed in the high-demand “winter” months.
But can seasonality be overcome?
This case study examines the VMMC program launched in 2009 in Iringa
and Njombe. Managers of this program believe that seasonality, once
considered a key barrier to meeting ambitious targets and running
efficient, productive programs, no longer limits the success of VMMC
programs. The program was implemented by the Tanzanian Ministry of
Health and Social Welfare (MOHSW) with technical and financial assistance
from the Maternal and Child Health Integrated Program (MCHIP),
led by Jhpiego, with support from the U.S. President’s Emergency Plan
for AIDS Relief (PEPFAR) through the U.S. Agency for International Development
(USAID).