Background: Scaling-up voluntary medical male circumcision (VMMC) becomes trickier as coverage increases and the number of eligible men decreases. IntraHealth International, with CDC funding, used geographic information system (GIS) mapping with information from community experts to identify geographical areas in Tanzania with large numbers of uncircumcised men for targeted service delivery.
Description: We collected 2016 ward-level male population projection data in the four IntraHealth-supported regions and shape files with geo-referenced points (e.g., ward boundaries, road networks, forests/vegetation, water bodies) from the National Bureau of Statistics. The geo-coordinates of health facilities were extracted from the national health facility registry and DATIM GIS interface and used to geo-reference facility locations. We subtracted 2011-2016 service delivery data on circumcised men from the PROMIS database to establish estimations of uncircumcised men in the respective wards of the four regions. Geo-coded data and shape files were overlaid into GIS software (ArcGIS Pro Esri 2017) and analyzed to create maps of facility locations, coverage and areas with high concentration of uncircumcised men where demand creation and VMMC scale-up were prioritized.
Lessons learned:
· Maps showed over 61% of uncircumcised men were located in 40% of the wards within the four regions.
· Community experts provided additional socio-economic factors needed for consideration in planning VMMC outreach campaigns such as accessibility, availability of water/electricity for sterilization of instruments, and availability of lodging for service providers.
· The number of men circumcised annually increased three-fold from 67,414 in 2016 to 225,093 in 2017; over 92% were aged 10-29 (PEPFAR priority age group), which was three times higher than previous years.
· The project achieved these results with a $7.1 million budget, an average of US$31.12 per client, significantly lower than the national estimate and previous years at US$50 and US$39.36, respectively.
Conclusions/Next steps: Coupled with qualitative socio-economic information from community experts, interactive GIS mapping ensures efficiency in planning and monitoring for high-impact large-scale interventions at a minimum cost. Project designs should consider using interactive GIS maps to make strategic decisions for targeted high-impact interventions.



[Distribution of uncircumcised men in IntraHealth-supported regions in Tanzania]