Back to Search
Start Over
Quality of Voluntary Medical Male Circumcision Services during Scale-Up: A Comparative Process Evaluation in Kenya, South Africa, Tanzania and Zimbabwe
- Source :
- PLoS ONE, PLoS ONE, Vol 9, Iss 5, p e79524 (2014)
- Publication Year :
- 2014
- Publisher :
- Public Library of Science (PLoS), 2014.
-
Abstract
- Background The rapid expansion of voluntary medical male circumcision (VMMC) has raised concerns whether health systems can deliver and sustain VMMC according to minimum quality criteria. Methods and Findings A comparative process evaluation was used to examine data from SYMMACS, the Systematic Monitoring of the Voluntary Medical Male Circumcision Scale-Up, among health facilities providing VMMC across two years of program scale-up. Site-level assessments examined the availability of guidelines, supplies and equipment, infection control, and continuity of care services. Direct observation of VMMC surgeries were used to assess care quality. Two sample tests of proportions and t-tests were used to examine differences in the percent of facilities meeting requisite preparedness standards and the mean number of directly-observed surgical tasks performed correctly. Results showed that safe, high quality VMMC can be implemented and sustained at-scale, although substantial variability was observed over time. In some settings, facility preparedness and VMMC service quality improved as the number of VMMC facilities increased. Yet, lapses in high performance and expansion of considerably deficient services were also observed. Surgical tasks had the highest quality scores, with lower performance levels in infection control, pre-operative examinations, and post-operative patient monitoring and counseling. The range of scale-up models used across countries additionally underscored the complexity of delivering high quality VMMC. Conclusions Greater efforts are needed to integrate VMMC scale-up and quality improvement processes in sub-Saharan African settings. Monitoring of service quality, not just adverse events reporting, will be essential in realizing the full health impact of VMMC for HIV prevention.
- Subjects :
- Male
Program evaluation
Quality management
Non-Clinical Medicine
Epidemiology
lcsh:Medicine
Global Health
Tanzania
South Africa
Medicine
Infection control
lcsh:Science
Health Systems Strengthening
media_common
Multidisciplinary
biology
HIV epidemiology
Preparedness
Infectious diseases
Health Services Research
Public Health
Medical emergency
Behavioral and Social Aspects of Health
Research Article
Zimbabwe
medicine.medical_specialty
media_common.quotation_subject
HIV prevention
Developing country
Viral diseases
Nursing
Humans
Quality (business)
Health Care Quality
Quality of Health Care
Health Care Policy
business.industry
Public health
lcsh:R
HIV
medicine.disease
biology.organism_classification
Kenya
Circumcision, Male
General Surgery
lcsh:Q
Surgery
business
Subjects
Details
- ISSN :
- 19326203
- Volume :
- 9
- Database :
- OpenAIRE
- Journal :
- PLoS ONE
- Accession number :
- edsair.doi.dedup.....2f4be97a858a995da4f02820a2461dca