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Background: South Africa (SA) is home to 6.4 million people living with HIV, with an estimated HIV prevalence of 18.9% amongst 15‐49 year old adults. The National Department of Health (NDOH), in partnership with PEPFAR, rolled out Voluntary Medical Male Circumcision (VMMC) services as a key HIV prevention strategy. With programmatic expansion, quality issues were noted. In June 2014, the USAID ASSIST project was funded to implement Continuous Quality Improvement at 134 PEPFAR-supported sites to improve the quality and safety of VMMC services.
Description: Baseline CQI assessments in 134 facilities, across 9 provinces demonstrated quality gaps in compliance with 8 key VMMC Quality standards (Leadership and planning, management systems, monitoring and evaluation, registration, group education and counselling, individual counselling and HIV testing, infrastructure, equipment and supplies, surgical procedure and infection prevention and control). Based on performance, sites were classified for intense (monthly), light (quarterly) or collaborative (annual) support by the ASSIST team. During CQI support visits, facility-level CQI teams were established, quality gaps identified, analyzed and improvement interventions tested, adapted and scaled up to address these gaps. Implementing partners (IPs) played an important role in implementation. Additionally, Four CQI trainings were conducted, attended by 6 provinces. Basic CQI concepts, methodology and tools were discussed and applied during group work. Three CQI learning sessions were conducted, where provinces, DOH facilities, IPs and private providers shared lessons on best practices as well as what did not work. During learning sessions, individuals and groups were given the opportunity to learn from colleagues. Quarterly site re-assessments were conducted.
Lessons learned: Lessons learned: Within a 12-month period, provision of CQI by ASSIST staff led to improved overall compliance with all 8 VMMC Quality standards. This resulted in improved quality of VMMC services and better collaboration between DOH and VMMC implementing partners.
Conclusions/Next steps: Implementation of CQI has yielded tangible results in VMMC service delivery in South Africa.

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