Iringa, Tanzania—In Tanzania’s efforts to prevent the spread of HIV, Illuminata Sanga is breaking ground and stereotypes. She is among the 200 nurses who are performing voluntary medical male circumcisions (VMMCs) proficiently and safely in an area of Tanzania that has been hit especially hard by the HIV/AIDS epidemic.
Sanga, 36, received her training in VMMC as part of a Jhpiego-supported program funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development (USAID) global flagship Maternal and Child Health Integrated Program (MCHIP).
VMMC has become an important component of an HIV prevention strategy that includes condoms, limiting sexual partners and abstinence. Iringa, in the southern highlands of Tanzania, is a region with three times the national average of people living with HIV. Clinical trials have proved that VMMC reduces female-to-male HIV transmission by approximately 60 percent.
More and more nurses are taking an active role in these VMMC campaigns because they are the health care providers most often on the frontlines in communities throughout Africa. As part of this strategy, nurses do it all—educate, counsel and test, and, as the World Health Organization (WHO) recommends, perform VMMC procedures.
“Over 60 percent of the providers in Iringa are nurses, taking the lead in all steps of the VMMC procedure. This is a strong example of task shifting, a key component of efficiency principles recommended by WHO in scaling up VMMC services in the target countries,” said Dr. Augustino Hellar, VMMC Program Advisor at Jhpiego’s offices in Tanzania.
Sanga came well-prepared for her new assignment.
As a senior operating room nurse at Iringa Regional Hospital, Sanga makes sure that the operating room environment is safe, equipment functions properly and all procedures are conducted under conditions that maximize patient safety. She checks that the surgical instruments are at the ready, and anticipates the surgeon’s every move to help ensure a smooth operation.
Sanga’s attention to detail and organizational skills helped make her proficient in minor surgery. Since Sanga began participating in the VMMC program in 2009, she estimates that she has performed 4,000 procedures for adolescents and men. In the past two and a half years, more than 100,000 clients have received services in Iringa and Njombe regions.
“Nurse Sanga has been a champion of the program in the region. Being one of the first providers to be trained in the VMMC program, she has proven to be a remarkable manager, a very proficient provider, a trainer and also a mentor for newly trained providers,” said Dr. Hellar.
Last year, Sanga was the site manager of Ikonda Health Centre, a VMMC site in Makete district that performed more than 750 circumcisions in less than two weeks—helping to avert up to 170 future HIV infections. “There are times my team performed over a hundred circumcisions a day,” said Sanga, who is married and has two children.
Using the same tactics she uses in the operating theater, Sanga made sure her team “was well-organized, everyone knew their responsibilities and, at the end of the working day and the beginning of the next day, we would sit down to evaluate as well as plan next activities together.”
“I had a remote site so I made sure we were never short of equipment and supplies. Each day we set targets and everyone would work so hard to meet goals,” says Sanga.
Sanga says that she is very motivated by the way the people of Iringa have received the program. Thanks to strong community mobilization and radio advertisements, many residents understand the importance of VMMC in reducing HIV infection.
“I believe I am making a significant contribution,” said Sanga.