Task sharing

Additional providers are needed to scale up male circumcision services; thus, decision-makers need to consider the role of non-physician providers to meet this need. The successful use of non-physician providers to perform more complex clinical and surgical procedures (e.g., nurses and clinical officers) has been well-documented in various countries.1,2,3

Experience has also shown that appropriately trained non-physician providers can safely conduct procedures such as Caesarean sections,
mini-laparotomy under local anaesthesia for female sterilisation, no-scalpel vasectomy, repair of simple obstetric fistula, manual vacuum aspiration, and a variety of other surgical procedures.4 Specifically, it has been successfully demonstrated that well trained staff (including clinical officers) can be used to perform male circumcision.5 In Kenya, clinical officers who routinely conducted consultations and selected surgical procedures were trained in the techniques of adult male circumcision.6 Therefore, in order to scale up the availability of male circumcision services, it is recommended that countries identify non-physician providers who can be trained to perform this procedure and provide comprehensive services.


  1. Mullan F, Frehywot S. Non-physician clinicians in 47 sub-Saharan African countriesLancet 2007; 370(9605):2158-2163.

  2. Hanvoravongchai P. Scaling up health workforces in response to critical shortagesLancet 2007;370(9605):2080-2081. 

  3. Krieger JN, Bailey RC, Opeya J, et al. Adult male circumcision: results of a standardized procedure in Kisumu District, KenyaBJU Int 2005;96(7):1109-1113.

  4. EngenderHealth. Implementing facility-based family planning & other reproductive health services: Lessons applicable to introduction of male circumcision for HIV prevention. New York: EngenderHealth, 2006.

  5. Bowa K, Lukobo M. Male circumcision: lessons learnt from a service site.  (Dec 5-6, 2006), Presented at Strategies and Approaches for Male Circumcision Programmng 5-6 December 2006. Geneva, Switzerland: World Health Organization, 2007.

  6. Bailey C, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomized controlled trialLancet 2007; 369:643-656.