背景:在自愿医疗男性包皮环切术(VMMC)计划中,社区参与一直是促进VMMC接受的核心,尤其是在非割礼社区。WeusedthecaseofthedevelopmentofcommunityengagementplansforsenabilityofVMMCinZambiatoillustratediversityofstakers,他们的力量,角色,以及社区参与的策略。方法:采用文献综述法收集数据,与社区利益相关者进行深入访谈(n=35)和焦点小组讨论(n=35),卫生工作者,健康中心委员会,辅导员,教师,社区志愿者和父母/照顾者。采用专题分析法对数据进行分析。分析以权力和利益模型为指导。结果:在可能参与赞比亚VMMC响应的可持续性阶段的社区利益相关者的权力/影响力和兴趣评级方面,农村和城市地区之间存在差异。例如,在城市环境中,邻里卫生委员会(NHCs),卫生工作者,俱乐部的领导人,社区卫生工作者(CHW),收音机,电视和社交媒体平台排名最高。从这个列表中,社交媒体和电视平台在农村地区的排名不高。一些利益攸关方比其他利益攸关方拥有更多的权力来源。权力的形式或来源包括技术专长,地方当局,财政资源,集体行动(通过学校采取行动,教堂,媒体平台,其他社区空间),和关系权力。主要作用和战略包括加强和扩大地方协调系统,加强社区参与,促进社区主导的监测和评估,通过使用当地认可的通信空间和渠道,促进VMMC的所有权,并改善VMMC活动中的本地问责流程。结论:通过与最相关的利益相关者协商,并考虑到社区在方案制定中的需求,VMMC计划可能能够利用社区结构和系统来降低VMMC的长期需求生成成本,并提高男性包皮环切术的可接受性和频率.
Background: Within the Voluntary Medical Male Circumcision (VMMC) programme, community engagement has been central in facilitating the acceptance of VMMC, especially in non-circumcising communities. We used the case of the development of community engagement plans for sustainability of VMMC in Zambia to illustrate diversity of stakeholders, their power, roles, and strategies in community engagement. Methods: Data were collected using document review, in-depth interviews (n=35) and focus group discussions (n=35) with community stakeholders, health workers, health centre committees, counsellors, teachers, community volunteers and parents/caregivers. Data were analysed using thematic analysis. The analysis was guided by the power and interest model. Results: Differences were noted between the rural and urban sites in terms of power/influence and interest rating of community stakeholders who could be involved in the sustainability phase of the VMMC response in Zambia. For example, in the urban setting, neighbourhood health committees (NHCs), health workers, leaders of clubs, community health workers (CHWs), radio, television and social media platforms were ranked highest. From this list, social media and television platforms were not highly ranked in rural areas. Some stakeholders had more sources of power than others. Forms or sources of power included technical expertise, local authority, financial resources, collective action (action through schools, churches, media platforms, other community spaces), and relational power. Key roles and strategies included strengthening and broadening local coordination systems, enhancing community involvement, promoting community-led monitoring and evaluation, through the use of locally recognised communication spaces and channels, facilitating ownership of VMMC, and improving local accountability processes in VMMC activities. Conclusions: By consulting with the most relevant stakeholders, and considering community needs in programme development, the VMMC programme may be able to leverage the community structures and systems to reduce long term demand generation costs for VMMC and increase the acceptability and frequency of male circumcision.