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Background: Funding from the President´s Emergency Plan for AIDS Relief (PEPFAR) has been supporting implementation of Voluntary medical male circumcision (VMMC) programs in 14 priority countries, since 2010. In order to ensure VMMC quality, External Quality Assessments (EQAs) were conducted at selected sites within these countries, by interagency (CDC and USAID) PEFAR teams. In 2014, additional PEPFAR reporting requirements (SIMS) necessitated identification of a more efficient system of data collection to facilitate the VMMC EQA process. The USAID ASSIST project was funded to develop a VMMC EQA mobile application, as well as to support USG EQA teams in 4 countries. This paper describes these experiences.
Description: From Sep2015-Jan2016 four EQA/SIMS visits were conducted, in Swaziland, Lesotho, Zimbabwe and Tanzania. USG EQA teams comprising staff from OHA, in-country USAID missions, USAID ASSIST, HC3-JHU and MOH conducted a total of 24 site-level EQA/SIMS visits. In all countries there were 2-3 EQA teams. Each team comprised between 5-8 members, and visited 4-7 sites over a five day period. At each site, a joint EQA / SIMS tool derived from WHO/UNAIDS normative standards and PEPFAR SIMS guidance was used. The EQA team performed document and chart reviews; observations of facilities, VMMC procedures, equipment and clients; and discussions with key personnel at the site. Site-level data was collected and the team also observed in-person communication, group and individual counseling, VMMC procedures and follow up review. Briefing meetings were held with MOH and in-country USAID missions prior to and following EQA/SIMS visits. Detailed site-level and country-level EQA and SIMS reports were provided to USAID 2-3 weeks following the EQA/SIMS visits. All four countries responded enthusiastically to the joint EQA/SIMS visits.
Lessons learned: Conducting joint EQA/SIMS visits has allowed for greater program efficiencies and reductions in costs, as one site visit may be utilized to fulfill two purposes. It has also allowed for creativity, innovation and improvement in the overall EQA design and process, through engagement of various stakeholders, including USAID ASSIST.
Conclusions/Next steps: The success of joint VMMC EQA/SIMS visits can be attributed to the engagement of various stakeholders working towards a common goal.

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