The use of targets to direct public health programmes, particularly in global initiatives, has become widely accepted and commonplace. This paper is an ethical analysis of the utilisation of targets in global public health using our fieldwork on and experiences with voluntary medical male circumcision (VMMC) initiatives in Kenya. Among the many countries involved in VMMC for HIV prevention, Kenya is considered a success story, its programmes having medically circumcised nearly 2 million men since 2007. We describe ethically problematic practices in Kenyan VMMC programmes revealed by our fieldwork, how the problems are related to the pursuit of targets and discuss possible approaches to their management. Although the establishment and pursuit of targets in public health can have many benefits, assessments of target-driven programmes tend to focus on quantifiable outcomes rather than the processes by which the outcomes are obtained. However, in order to speak more robustly about programmatic ‘success’, and to maintain community trust, it is vital to ethically evaluate how a public health initiative is actually implemented in the pursuit of its targets.
- HIV infection and AIDS
- public health ethics
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
Contributors SR, AG, DH and WKL conceived, conducted and analysed data of the qualitative study on male circumcision referred to in this article. SR wrote the first draft of this article. All authors provided input into manuscript development, that is, initial drafts, critical revisions and approval of the final version.
Funding Research reported in this publication was supported by funding from the National Institute of Mental Health and the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under Award Number R01MH102125 (WKL, PI) and from the Center for AIDS Research, University of North Carolina at Chapel Hill (P30 AI050410). SR’s work was supported by a visiting residency at the Brocher Foundation.
Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or any other funding body.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Ethics of pursuing targets in public health: the case of voluntary medical male circumcision for HIV prevention programs in Kenya.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are available.
Read the full text or download the PDF:
Other content recommended for you
- Uptake of voluntary medical male circumcision among men with sexually transmitted infections in Lilongwe, Malawi: a protocol for a pre-interventional and post-interventional study
- Estimating the impact of the US President's Emergency Plan for AIDS Relief on HIV treatment and prevention programmes in Africa
- Sexually transmitted infections (STI) and antenatal care (ANC) clinics in Malawi: effective platforms for improving engagement of men at high HIV risk with voluntary medical male circumcision services
- Social complexities of informed consent and assent among young males undergoing voluntary medical male circumcision in Eswatini
- Geospatial assessment of the voluntary medical male circumcision programme in Tanzania, 2011–2016
- Relative efficiency of demand creation strategies to increase voluntary medical male circumcision uptake: a study conducted as part of a randomised controlled trial in Zimbabwe
- Innovative demand creation strategies to increase voluntary medical male circumcision uptake: a pragmatic randomised controlled trial in Zimbabwe
- Linkage of voluntary medical male circumcision clients to adolescent sexual and reproductive health (ASRH) services through Smart-LyncAges project in Zimbabwe: a cohort study
- Does peer education go beyond giving reproductive health information? Cohort study in Bulawayo and Mount Darwin, Zimbabwe
- Progress in voluntary medical male circumcision for HIV prevention supported by the US President’s Emergency Plan for AIDS Relief through 2017: longitudinal and recent cross-sectional programme data