External quality assessment (EQA) of VMMC programs involves site visits by US Government personnel, often accompanied by Ministry of Health and implementing partner staff, to review and observe how individual VMMC sites perform against pre-determined criteria, using standardized tools. EQA is an example of external quality assurance. The standards assessed include WHO, UNAIDS, PEPFAR, and national guidelines. The EQA process strongly complements WHO’s VMMC Quality Assurance Toolkit and service delivery sites’ self-assessments.
PEPFAR-sponsored VMMC EQAs generally are led by US Government staff and involve Ministry of Health staff and often implementing partner personnel who are external to the sites being assessed. PEPFAR recommends an annual EQA for each of the VMMC priority countries during which a number of VMMC sites are visited.
The objectives of a VMMC EQA are to:
- Ensure that PEPFAR VMMC for HIV prevention programs are conducted according to national guidelines, as well as WHO/UNAIDS and PEPFAR standards
- Provide feedback to site staff, MOH, and PEPFAR regarding the quality of VMMC service delivery
- Provide recommendations to improve service safety and quality
- Provide a basis for continuous quality improvement (CQI) and other interventions (when applicable)
The added value of EQA for VMMC programming is that external eyes are often better able to identify gaps than are those closely associated with the program. Host country governments are able to appreciate weaknesses and address them. Sites that have participated in EQA and that attend to recommendations often find they are able to improve quality and safety of services as well as increase demand for VMMC services and improve the efficiency of site operations. Finally, EQA provides an opportunity for dialogue among all stakeholders about areas that need improvement and establishes the basis and justification for CQI activities to address gaps found.