Launch of the Voluntary Medical Male Circumcision (VMMC) Continuous Quality Improvement and External Quality Assessment Toolkit
This webinar, moderated by Dr. Emmanuel Njeuhmeli of the USAID Office of HIV/AIDS, provided an introduction to the new online Voluntary Medical Male Circumcision (VMMC) Continuous Quality Improvement (CQI) and External Quality Assessment (EQA) Toolkit and discussed how the toolkit can support improvement in VMMC program performance. The webinar featured two speakers and a panel discussion.
Dr. Zebedee Mwandi of Jhpiego shared AIDSFree’s experience with acting on quality challenges identified through both external and internal quality assessments to improve site performance, quality, and productivity in the USAID-supported VMMC program in Manica and Tete provinces of Mozambique. He explained how the USAID-supported VMMC program in Mozambique has greatly improved quality and performance, under the leadership of the Ministry of Health of Mozambique and with support from AIDSFree, HC3, ASSIST, and GSCM-PSM.
Between October 2016 and March 2017, AIDSFree and HC3, together with the MOH, embarked on a quality improvement plan addressing the gaps observed at the program level and at the individual site level. Monthly, weekly and daily site-level targets were set, disaggregated by age and used to monitor progress and ensure that each staff member at each site knew what targets were expected in each site and what elements needed to be observed or checked or done to maintain high quality of services. AIDSFree also developed site-level staffing and training plans and recruited new staff in areas where site productivity analysis showed understaffing. Site-level teams and supervisors set aside one day a week for staff to discuss and address quality issues.
Showing data from 2015-2017, Dr. Mwandi demonstrated how the AIDSFree-supported sites increased their site capacity and productivity and at the same time, increased performance, both against circumcision targets and quality standards. He also highlighted the effective partnership that AIDSFree developed with the HC3 Project, which was responsible for improving in-service communication and counseling and demand generation in the same sites. The key support that HC3 provided to the USAID-supported VMMC sites included training staff at the VMMC sites on key messages and how to effectively use behavior change communication materials; updating materials and developing new job aids and ensuring consistency with the latest PEPFAR guidance. In the area of demand creation, HC3 put in place a very fine-tuned strategy that was adapted to the specific situation of each site, especially with respect to age group targets. AIDSFree shared the site-specific action plans were shared with HC3 so that its mobilizers could focus efforts on where to reach 15-29 year olds and address age-specific barriers to VMMC uptake. “The lesson we have learnt in Mozambique is that the strong program improvements in the USAID-funded VMMC program have been the result of close collaboration between IPs with a common goal. Each IP has unique strengths and when there is collaboration, the results are impressive. It’s not an easy process to cultivate this culture of collaboration, you need to build trust among staff, so that they cooperate and see themselves as one team. Competition and blaming one another can very easily stall progress. But with good will and recognition that we are all working toward a common goal, excellent results are achievable.”
Following Dr. Mwandi’s presentation, Ms. Lani Marquez of the USAID ASSIST Project introduced the webinar audience to the newly launched resource to help all countries improve quality and safety of VMMC services: the VMMC Continuous Quality Improvement (CQI) and External Quality Assessment (EQA) Toolkit. She gave a brief walk-through of the eight sections of the toolkit to point out what kind of resources and guidance it provides, including 1) an introduction to addressing quality issues in VMMC programming, 2) the essential stages in CQI roll-out, 3) EQA methodology and tools, 4) how to address critical patient safety and other programming issues, 5) country-specific tools, 6) tested change ideas for common problems encountered in meeting VMMC quality standards, 7) case studies, articles, and reports, and 8) multimedia products related to VMMC CQI and EQA.
After the two presentations, a panel of USAID ASSIST staff from South Africa, Uganda, Malawi, and Tanzania shared their experience and advice engaging MOH, IPs, and facility-level CQI teams in using the VMMC quality tools found in the toolkit: Dr. Donna Jacobs, HIV Lead and Regional Director for Southern Africa for the USAID ASSIST Project; Ms. Tiwonge Moyo, Chief of Party for ASSIST in Malawi; Dr. Anna Lawino, a QI Advisor for USAID ASSIST in Uganda, and Dr. Joseph Kundy, a QI Advisor for USAID ASSIST in Tanzania.
Dr. Njeuhmeli closed the webinar with reflections on the past five years of USAID support for applying CQI and EQA methods to VMMC programming, citing two key lessons. First, the critical moment to build in CQI is in program design. “In the VMMC program, we thought about CQI later in the process and as a result, have been running to catch up. Going forward, CQI processes need to be built into VMMC program and planning from the start,” said Dr. Njeuhmeli. The second lesson is that EQAs, while a good way to call attention to quality gaps, are not a sustainable strategy for improving quality in VMMC programs because they don’t provide a strong engine for site-level improvement and follow-up.
He also highlighted the key accomplishments from USAID investments in VMMC quality assurance and quality improvement tools and capacity building through the USAID ASSIST Project: With core and field support funding, VMMC CQI was introduced in eight countries: Uganda, South Africa, Malawi, Tanzania, Namibia, Mozambique, Lesotho, and Swaziland. In Uganda and South Africa, the scale of CQI activities has been extensive. In Malawi, VMMC CQI is also now benefitting VMMC sites supported directly by the Ministry of Health with World Bank funding, in addition to PEPFAR-supported sites. Through this support, site-level improvement teams have achieved significant improvements in key measures of VMMC service quality related to core quality standards as well as increasing client follow-up, reducing moderate and severe adverse events, increasing linkage of HIV-positive VMMC clients to care and treatment, and increasing linkage of STI-infected VMMC clients to treatment and follow-up to ensure they return for VMMC once the STI has cleared.
USAID has supported development and standardization of VMMC CQI and M&E tools as well as incorporation of VMMC quality data within Ministry of Health reporting systems, and this new online toolkit is a great resource for countries to use going forward as they address quality issues. Another key achievement was to integrate site efficiency and productivity analysis into routine EQAs. The example of Mozambique presented in the webinar demonstrated clearly how implementing partners can use this information to refocus resources to achieve substantial productivity and efficiency gains.
View the webinar recording: