The interface between the traditional leadership and the District Health Management Offices in the delivery of health services in Mopani, Vhembe and Sekhukhune Districts in Limpopo Province

Master Thesis


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University of Cape Town

The African Communities, especially those that are living in the rural tribal areas have been undergoing traditional male circumcision for many decades. The traditional male circumcision is a passage from boyhood to manhood. In the process of this transition, there have been incidents of botched circumcisions which resulted in the deaths of initiates, dehydration, penile mutilation and in worse situations even penile amputation. These adverse events have been attributed to problems such as ill-trained traditional surgeons, the use of unsterile surgical equipment, harsh winter conditions, underlying diseases that were not diagnosed prior to circumcision, among others. In response, the government introduced the male medical circumcision as an alternative to traditional male circumcision with the aim to curb the problems associated with the latter. This was at the same time that the World Health Organisation adopted male medical circumcision as one of the strategies for the prevention of the spread of HIV and AIDS. These two decisions assisted to accelerate the need to introduce the male medical circumcision by working with relevant stakeholders. The purpose of the paper is to look at how the male medical circumcision was introduced with a special focus on the three districts in Limpopo province. The paper looks at the impact of the interface between the traditional leaders and the district health management offices during the introduction of the male medical circumcision. The former is regarded as the custodian of the traditional male circumcision while the latter takes the lead in the introduction of the male medical circumcision. A qualitative research method was used to undertake this study. The relevant literature was reviewed and used to understand the extent of the practice of male circumcision in both traditional and medical settings. The key role players in Vhembe, Mopani and Sekhukhune districts in Limpopo province, and from other sectors were interviewed for the purpose is learning more about the male medical circumcision. The major findings of the study are that the traditional leaders expected to be consulted during the introduction of the male medical circumcision because they saw it as encroaching on the traditional male circumcision which they see as their domain. This is because for the traditional leaders, male circumcision is more than just the cutting of the foreskin but it is a traditional, spiritual and necessary ritual that ensures proper transition from boyhood to manhood. They also needed to be consulted because for them traditional circumcision is a sacred practice that women and those who have not undergone it are not allowed to participate in. On the other hand, the department of health was convinced that male medical circumcision is one of the key strategies to prevent the spread of HIV and AIDS and as such needed to be introduced. The introduction of male medical circumcision was also aimed to reduce the number of botched circumcisions through strict practice of aseptic techniques. In the final analysis, it became clear that there is an increased intake of the male medical circumcision where there is cooperation between the traditional leaders and the district health management offices. This is more evident in the areas where traditional leaders have influence. This happened over time as the two parties gained each other’s trust and confidence.