Jennings, L., Bertrand, J., Rech, D., et al. PLOS ONE (May 2014), 9(4): e79524, doi: 10.1371/journal.pone.0079524.
This study examined data from the Systematic Monitoring of the Voluntary Medical Male Circumcision Scale-Up (SYMMACS) study to determine whether voluntary medical male circumcision (VMMC) can be delivered and sustained at scale according to quality standards. The study assessed the proportion of facilities that met measures for preparedness, and the number of surgical tasks conducted correctly. Data were collected in 2011 and 2012, when VMMC was expanding rapidly in the four countries studied: Kenya, South Africa, Tanzania, and Zimbabwe. Site assessments determined preparedness to deliver quality care, and direct observation of VMMC surgeries established service quality. The results showed that overall, safe, high-quality VMMC could be delivered and sustained at scale. However, the quality of services varied considerably. The preparedness and quality of some services improved as the number of VMMC sites expanded. In other settings, services were expanded even when they were not meeting readiness and quality standards. Overall, surgery scored highest, while other areas, including infection control, pre-operative examinations, and post-operative monitoring and counseling, scored lower. The authors recommended that quality improvement processes be integrated into VMMC scale-up, and underscored that programs should invest in ongoing monitoring of service quality.