The Impact of Continuous Quality Improvement on Voluntary Medical Male Circumcision Services Offered in a Public Health Facility in Gauteng Province, South Africa
The City of Johannesburg has a high burden of HIV and is a priority VMMC scale-up district for the US President’s Emergency Plan for AIDS Relief (PEPFAR). Zola Community Health Center (CHC) has been offering PEPFAR-funded VMMC services since November 2010 and began receiving technical assistance from the USAID ASSIST Project in 2014, to establish a quality improvement (QI) team, as well as periodic continuous quality improvement (CQI) assessments and on-site coaching to apply CQI methodology to identify quality gaps and design, implement, and monitor interventions to address them. In August 2014, ASSIST conducted a CQI baseline assessment to gauge Zola CHC’s compliance with Department of Health (DoH) and World Health Organization (WHO) VMMC quality standards and to identify strengths and areas requiring improvement in VMMC service provision. The baseline assessment revealed challenges relating mainly to leadership and planning, VMMC surgical procedure, and infection prevention and control. At baseline, the average score across service quality standards was 67%. Since the establishment of a QI team and the adoption of CQI, adverse events were still observed at Zola CHC, but robust adverse events management and client follow-up systems have been put into place, which have ensured improved documentation, communication with clients, and better management of complications and emergencies. By the fourth reassessment conducted in February 2017, the average score across service quality standards had improved from 67% to 96%.