ABSTRACT
Background: Traditional circumcision is common among the amaXhosa in Umlamli; Eastern Cape. Circumcision is associated with high morbidity and mortality. The need to reduce complications was identified as a priority by the local community. The aim was to design; implement and evaluate a project to improve the safety of traditional circumcision.Method: A safe circumcision team was established and comprised health workers; community leaders and traditional surgeons. Outcome mapping involved three stages: intentional design; outcome; and performance monitoring and evaluation. The eight boundary partners were the initiates; parents; community leaders; traditional surgeons; the District Health Services; the provincial Department of Health; the emergency services and the police. Outcomes; progress markers and strategies were designed for each boundary partner. The team kept an outcome and strategy journal and evaluated hospital admissions; genital amputations and mortality.Results: Ninety-two initiates were circumcised; with two admissions for minor complications; compared to 10 admissions; two amputations and two deaths previously. More than 70 of the outcome measures were achieved in all boundary partners; except emergency services and the Department of Health. The key aspects were: the use of outcome mapping; the participatory process; a lower age limit; closure of illegal schools; consolidation of accredited schools; training workshops for traditional surgeons; private treatment room for initiates; assistance with medical materials; pre-circumcision examination; certificates of fitness.Conclusion: This study has shown the value of community-orientated primary care initiatives to address local health problems. Key lessons were identified and the project could easily be replicated in communities facing similar challenges