Exposed: Mystery of Kenya’s ‘ghost circumcisions’

A youth undergoes cut during a Voluntary Male Circumcision (VMC) at Masogo dispensary in Muhoroni constituency. [Denish Ochieng/Standard]

Tens of thousands of ‘ghost circumcisions’ may have been reported in Kenya since 2008; costing donors a tidy amount of money.

A new evaluation report financed by the US Government, shows the much praised Voluntary Medical Male Circumcision (VMMC) in Kenya may have been built on falsified data.

The report published on December 18 shows data from the four core counties of Kisumu, Siaya, Homa Bay and Migori to have been highly inflated.

The report says there was suspected intentional inflation of data reporting by some implementing partners although the team did not locate the smoking gun.

“We did not get evidence confirming that VMMC data in Kenya were intentionally exaggerated,” the CDC-Nairobi office told the Saturday Standard in an email last week.

Justin Williams of CDC said they are however conducting a follow-up study to measure actual VMMC coverage in Kenya.

The evaluators in the current study had been presented with 320,000 records of circumcised males in the four counties for the period 2008-2016.

But after evaluation, the data in all the counties was found highly inflated. In Homa Bay County, data for 2016 showed coverage rates of up to 180 per cent.

“In Kisumu, Migori and Siaya, modeled estimates for 2016 were well over 100 per cent for all age groups,” says the report.

Yet despite the excessive coverage, the projects continued reporting high circumcision demand hence a requirement for more funding.

Worried over the puffed up data the study team, comprising USAID, US Centres for Disease Control and Prevention - Nairobi, Family Health International (FHI360) and the National AIDS and STIs Control Programme set to rationalise the data. They applied a four-point strategy which involved removing double reporting and recording migrants only in their home counties.

Others included shifting from UN population estimates to data from the Kenya National Bureau of Statistics as the most appropriate.

Finally the team removed cases of traditional circumcisions from the VMMC programme registers.

“Even after addressing these issues, overestimation of 2016 male circumcision coverage estimates persisted, especially in Homa Bay.” For Homa Bay, the report tells of some “systematic source of the discrepancy.”

While the authors say they did not get evidence of deliberate over-reporting, some county management teams it says had noted discrepancies.

The discrepancies were between the numbers recorded in the project site registers and those provided by medical facilities.

Kenya, the report says is the first country in which the team encountered these data issues and advised stricter data safeguards to be put in place.

“Valid client contact information - including residence - should be included in programme records, as lack of these details makes spot quality checks difficult.”

Kenya launched VMMC in 2008 as a critical component in HIV prevention. This was after studies demonstrated that circumcising sexually active men reduces their risk of acquiring HIV from their female partners during sex.

Initially, Kenya targeted atleast 860,000 men by July 2013 or 80 per cent national coverage. The country managed to reach 800,000 men (71 per cent) in a programme that is almost exclusively funded by the US.

In the four years between 2012 and 2015 Kenya received about Sh6 billion for VMMC from the US. The second phase 2015-2019 was estimated to require Sh4.9 billion.

A report published in November shows a VMMC exercise on 116 street boys in Eldoret town last year to have cost Sh1.3 million ($12,526) for a 30-day period.

The second phase of the VMMC, which ends next year targets children between 0 to 60 days old, and adolescents aged 10 to 14. But with the current findings on data falsification the reported success may be in doubt. Williams said the ongoing Kenya Population-based HIV Impact Assessment (KENPHIA) will shine more light on VMMC coverage.

KENPHIA, launched in June is visiting 20,000 households nationally and is expected to rationalise previously controversial HIV data.

In March for example, data presented at a conference in Boston, US by CDC-Nairobi showed HIV prevalence rates in Nyanza to have been highly exaggerated.