Roll out of mobile clinic for early infant male circumcision in rural communities

SafeCirc, in collaboration with Fountain Medical Services, Give Right Foundation and Friends of Adaklu (FOA), is set to establish a mobile clinic to serve rural communities and improve access to Early Infant Male Circumcision (EIMC).

The initiative follows concerns over the persistent practice of late male circumcision in parts of the Adaklu district, identified during an EIMC training programme organised by FOA in collaboration with internationally renowned physician, Dr David Tomlinson, a Clinical Assistant Professor in the Department of Family Medicine at Brown University in the United States.

The decision was informed by a one-week outreach exercise that involved health workers trained in EIMC from the Volta and Oti Regions. As part of efforts to address late circumcision, 10 infants were circumcised in the Golokope community in Adaklu District, with an additional 10 scheduled to undergo the procedure. The exercise was carried out by Emmanuel Kwame Yiboe, a Senior Midwifery Officer at the Ho Municipal Health Directorate, and was funded by Dr David Tomlinson.

To ensure sustainability, Friends of Adaklu’s Programme and Policy Advisor, Robert Tornu, disclosed that the initiative would provide internship opportunities for students from across the globe in early male circumcision combined with community advocacy activities. The programme will also focus on community engagement and sensitisation on the health benefits of early infant male circumcision for newborns between 0 to 60 days.

As part of broader stakeholder engagement, Friends of Adaklu collaborated with Mimi Health Centre and Fountain Medical Service to train midwives and other health professionals on the use of the AccuCirc circumcision device. The initiative aligns with guidelines from the World Health Organisation, which notes that male circumcision is easier to perform and associated with less pain and fewer complications when carried out within the first two months of life.

Mr Emmanuel Yiboe explained that circumcising infants between 7 and 60 days significantly reduces risks such as excessive bleeding and promotes faster healing, making it the safest period for the procedure. He added that circumcision later in life may increase health risks for sexual partners due to the build-up of bacteria under the foreskin, particularly where hygiene is poor. He further cautioned that unsafe procedures involving injury to the tip of the penis can result in deformities and long-term psychological distress, stressing that the AccuCirc device is designed to minimise such risks.

Adamu Abdullah, a representative of the Fulani community in Adaklu highlighted social and cultural challenges affecting access to safe health services, including early infant male circumcision, in Sulleykope and surrounding communities. He explained that some residents are uncomfortable allowing unfamiliar health workers to circumcise their children, while others are reluctant to take their infants to health facilities altogether. In addition, many women are unable to visit hospitals without the permission of their husbands, further limiting access to professional care.

According to him, fears that hospital-based circumcision could injure a child’s penis have led some families to rely on local circumcision practitioners, known as “Wazam”, with others travelling as far as Ziope for the service. Despite these concerns, he acknowledged that nurses at Mimi Health Centre are generally welcoming and responsive, sometimes allowing families to receive care and pay later.

Mr Nyanudela also noted his personal role in supporting access to care by transporting nurses on motorbikes to attend to pregnant women and covering costs when families are unable to pay. He raised concerns about difficulties faced by some Fulani residents in obtaining National Health Insurance cards, calling on government to intervene to make access easier.

The training programme aimed to strengthen the capacity of health workers by assessing their readiness to deliver EIMC services, while also examining community perceptions and cost considerations. It provided a platform to engage local health officials on global medical evidence supporting early infant male circumcision as a safer and more effective public health intervention.

Health workers were introduced to the benefits of the AccuCirc device, including improved accuracy through proper alignment of the foreskin, reduced risk of serious injury, and lower chances of repeat procedures. Each single-use device includes a protective shield for the infant and is designed to prevent the mixing of parts, significantly enhancing safety.

Participants also discussed social and cultural misconceptions that contribute to delayed circumcision. Midwife Logodzo Mary of the Awoma CHPS Compound in the Jasikan Bodada sub-district noted that some parents believe circumcising boys at an older age improves sexual performance. She explained that this belief often leads families to present children for circumcision after two years, increasing the likelihood of complications and reducing preventive health benefits.

The training included hands-on demonstrations of safer circumcision methods suitable for infants within the first 60 days of life. Mrs Mary said the session had strengthened her ability to educate mothers and encourage early uptake of circumcision services. Participants were additionally trained to counsel caregivers on wound care and follow-up, underscoring the importance of proper aftercare to prevent infection and ensure positive health outcomes.