2. Management Systems

Challenge Actions CQI Teams Took to Address the Challenge
Missing policy documents
  • Identify the missing documents using the assessment checklist and share the list with the facility in-charge to cross-check their availability in other parts of the health unit
  • Obtained missing documents and keep them in a secure, but easily accessible place for the team
  • Request the missing documents from the District Health Office or implementing partner
  • Held a Continuous Medical Education (CME) session to discuss important policy documents
  • Oriented staff on the relevant VMMC documents
No written VMMC plan in place
  • Develop activities in line with the district priorities and SMC targets for the year
  • Budget for the various activities and include the responsible person per activity
  • Share the plan with all key stakeholders to have a common plan
No written staff roles and responsibilities
  • Hold a team meeting to discuss and understand everyone’s roles and responsibilities
  • Write these roles down and display them
Few staff trained in VMMC procedures
  • Approach the supporting IP to train staff in VMMC
  • Identify training needs and jointly develop a training plan with the IP
  • Skilled, trained staff work and supervise untrained staff on the job
No client flow chart
  • Hold a team meeting to discuss how clients should move from one process to another
  • Draw the client flow and display it in an area where it is visible to both clients and staff
Poor documentation of linkage to other services
  • Get a notebook to register the clients who attend VMMC education or add a column in the existing register to indicate clients referred for other services
  • Started recording clients linked to other services (STI treatment, HIV chronic care) in a referral register
  • Place phone calls to sites/stations that are receiving referred clients for other services to ensure complete documentation
No quality improvement team
  • Request the district health office and IP to train staff in QI if they are not already trained
  • Select members to form the QI team ensuring that all sections of the VMMC services (like registration, infection prevention, surgical procedure, records management) are represented
  • Identify a QI team leader
  • Develop a schedule for QI team meetings
No written minutes of QI team meetings
  • Appoint a meeting coordinator and set dates for each meeting
  • Remind team members about the meeting a day prior to the meeting to ensure they attend
  • Rotate responsibilities for taking written minutes of each meeting
  • Post QI team meeting minutes in a visible place in the VMMC unit
No system for client feedback
  • Use VMMC champions to obtain client feedback
  • Created a client feedback corner at the health unit where feedback is received
  • Identify key areas on which feedback is desired and develop a questionnaire to administer to the clients
No system for investigating moderate or severe adverse events
  • Conduct CME on adverse events grading and management
  • QI team reviews and investigates adverse events
  • Obtain the grading scale (where possible laminate) and display it in the procedure and examination rooms
Poor client follow-up
  • Ask clients to come back for removal of dressing and review
  • Give clients a clear message on the importance of follow-up
  • Use a checklist to ensure that all staff are giving the same message to clients
  • Discus the importance of client follow-up during counselling and testing for HIV and group education sessions and postoperative education
  • Assign a staff member the task of attending to clients who return for follow-up and indicate this on the duty roster
No supply management in place
  • Select members who should take control of the stock cards by updating them and making timely orders of medicines and supplies
  • Selected team members support the store keeper who is able to get stock cards and also manage them
  • Where the supply management system is electronic, VMMC commodities should be included in the system
VMMC supplies not included in orders to the National Medical Stores
  • Develop a list of required items and estimate amounts required- in-charge of the drug store should be involved in the process
  • Add these items to the health unit’s order to National Medical Stores so that they are delivered through the system