PEPFAR has supported the application of CQI to VMMC programs since 2013, beginning with a pilot activity in Uganda with 30 sites supported by 10 different implementing partners. An improvement team was formed in each site and supported with monthly coaching visits by the USAID ASSIST Project and the implementing partner. When these 30 sites started improvement work in March and April 2013, their baseline assessments showed various quality gaps and areas where performance was below 50 percent compliance. A color-coded dashboard was used to summarize results for each area, where red showed performance was below 50 percent; yellow showed performance at 51-80 percent; and green showed performance above 80 percent.
Through consistent work on finding ways to improve in each of the seven areas, after 18 months, all 30 sites had consistently demonstrated performance in green (good) or yellow (needs some improvement) across all standards; none of the ASSIST-supported sites still had a standard classified as red (poor).
CQI is supporting VMMC sites to address a whole range of critical issues. Sites in Uganda have dramatically increased the proportion of HIV-positives identified in VMMC who are linked to care and treatment as well as mitigation of tetanus risk through integrating tetanus toxoid immunization in VMMC services. In South Africa, sites have applied CQI to improve coordination with local health authorities, data quality, client follow-up, and the management of adverse events. CQI-supported sites in Malawi have made steady gains in increasing 48-hour post-operative review. In both South Africa and Namibia, CQI is being applied with private VMMC providers in addition to public sites operated by the Department of Health and PEPFAR implementing partners. In Tanzania, in addition to applications to adult VMMC services, CQI is helping to integrate early infant male circumcision into Reproductive and Child Health clinics.