Improving the quality of VMMC services using continuous quality improvement at Mangochi, Mzimba North and Nkhotakota District Hospitals in Malawi
With support from United States Agency for International Development (USAID), multi-sectoral quality improvement (QI) teams at Mangochi, Mzimba North and Nkhotakota district hospitals providing voluntary medical male circumcision (VMMC) services were trained to apply QI methods to improve the quality of VMMC services. In December 2016, baseline assessments in the three hospitals, using the Ministry of Health VMMC continuous quality improvement (CQI) assessment tool adopted from the WHO standards on male circumcision, found the following total mean scores: 26% for Mangochi; 49% for Nkhotakota; and 42% for Mzimba North. These low-quality scores were associated with a number of quality gaps, including in the areas of management systems, monitoring and evaluation, infection prevention services, and client follow-up. The QI teams conducted root cause analyses associated with these low scores and tested possible solutions. While Mangochi and Mzimba North district hospitals were able to improve their already good rates of client follow-up at 48 hours post-operation, Nkhotakota District Hospital made substantial gains, increasing the proportion of clients that came back for the 7 day post-operation follow-up from 0% in October/December 2016 to 100% in September 2017. After six months, the three district hospital QI teams were assessed again using the same tool, and their total mean scores had improved to 77%, 57%, and 60%, respectively.