Comprehensive quality systems encompass quality improvement/assurance (QI/QA) and external quality assessment (EQA) as well as continuous quality improvement (CQI) mechanisms. [See WHO Male Circumcision Quality Assurance: A Guide to Enhancing the Safety and Quality of Services, PEPFAR External Quality Assessment (EQA) Tools, and USAID ASSIST Project VMMC CQI and EQA Toolkit]. The development of a well-coordinated, comprehensive quality assurance and continuous quality improvement strategy is critical to the success of any health program scale-up plan (Massoud 2001). It is also important that this strategy is integrated into all aspects of the VMMC program right from the start of VMMC services. QA is a cross-cutting activity, linking other VMMC pillars, including leadership, management, infection control, waste management, and the VMMC minimum package of services. [See WHO Male Circumcision Quality Assurance: A Guide to Enhancing the Safety and Quality of Services]. Without a targeted strategy focusing on provision of high-quality VMMC services, patient safety and robust infection control practices, investments in VMMC service provision, and scale-up may not yield the anticipated results [See WHO Male Circumcision Quality Assurance: A Guide to Enhancing the Safety and Quality of Services]. Furthermore, the VMMC program may continue to be vulnerable to several unanticipated consequences, such as poor patient outcomes, high morbidity and mortality rates, and fear/stigma of the VMMC program, thereby potentially negating investments in demand-creation activities. [See PEPFAR Quality Strategy]. It is therefore important to ensure QA and CQI activities are prioritized during scale-up of VMMC programs and concerted efforts are made toward promoting integration, capacity development, routine quality monitoring, and implementation with a goal of sustainability [See USAID ASSIST Project VMMC CQI Toolkit].