1. Leadership and Planning

Challenge Actions CQI Teams Took to Address the Challenge
Insufficient knowledge of, involvement in, and support for quality assurance and quality improvement
  • Arrange for QA/QI/CQI sensitization training for facility managers
  • Brief facility management and board on CQI and its “return on investment”, i.e. improved patient outcomes and staff fulfilment
Inadequate involvement of facility leadership in day-to-day operations and quality of services
  • Engage facility management from the outset of CQI activities, including the CQI baseline assessment and reassessments
  • Share assessment findings with leadership and inspire buy-in through involving them in action planning to address gaps/needs
  • Ensure continuous communication with facility leadership regarding CQI integrationConduct regular meetings between VMMC stakeholders and management
  • Conduct regular meetings between VMMC stakeholders and management
Lack of ownership and accountability
  • Create a culture for CQI by linking it to the facility’s mission and strategic objectives
  • Include VMMC CQI as standing agenda item for clinic committee/hospital board meetings
Lack of mechanisms to plan and prioritize tasks
  • Support the development of operational plans, and budgets where applicable, for service delivery, staffing, commodities, quality improvement, community involvement and M&E
  • Document plans and adopt tools for prioritizing tasks and monitoring impact
Insufficient knowledge of catchment population and profile
  • Obtain demographics for the catchment area
  • Analyze data and set targets
  • Develop monitoring plan to track progress
Lack of support for female involvement in VMMC
  • Training on how females are relevant for VMMC as sexual partners, mothers, sisters, and caregivers


The document provides recommendations from the USAID ASSIST Project in South Africa for addressing challenges that are commonly experienced in VMMC programs.