CHAPTER 10. Comprehensive Quality Assurance and Continuous Quality Improvement

CHAPTER GOALS

To ensure site staff are able to:

  • Provide comprehensive, high-quality VMMC services at all sites, in line with national, WHO (World Health Organization) and PEPFAR (U.S. President’s Emergency Plan for AIDS Relief ) standards through quality assurance and continuous quality improvement activities.
  • Prioritize patient safety, maximize site-level efficiencies, and build capacity for implementation of quality methodology.

WHAT USERS NEED TO KNOW

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].

CASE STUDIES

TOOLS, INSTRUMENTS & GUIDANCE DOCUMENTS

  1. WHO Male Circumcision Quality Assurance: A Guide to Enhancing the Safety and Quality of Services
  2. PEPFAR External Quality Assessment (EQA) Tools
  3. WHO Manual for Male Circumcision Under Local Anaesthesia, 1st edition
  4. PEPFAR Quality Strategy
  5. USAID ASSIST Project VMMC CQI and EQA Toolkit
  6. EQA Country Report Template
  7. EQA Site Report Template
  8. Uganda VMMC CQI Guide

To see charts, graphs, and read additional information, download the chapter PDF.