presented by dr. dino rech
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Implications of the fast-evolving scale-up of adult Voluntary Medical Male Circumcision for quality of services in South Africa D Rech , S Frade , A Spyrelis , L Perry, M Farrell, R Fertziger , D Castor, E Njeuhmeli , C Toledo, JT Bertrand. Presented by Dr. Dino Rech. - PowerPoint PPT PresentationTRANSCRIPT
Implications of the fast-evolving scale-up of adult Voluntary Medical
Male Circumcision for quality of services in South Africa
D Rech, S Frade, A Spyrelis, L Perry, M Farrell, R Fertziger, D Castor, E Njeuhmeli, C Toledo, JT Bertrand
Presented by Dr. Dino Rech
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SYMMACS South Africa• SYstematic Monitoring of the voluntary Medical Male Circumcision Scale-up in Eastern and
Southern Africa
• Objective: Assess implementation of VMMC under actual field conditions in four countries, including South Africa. Monitor adoption of WHO six elements of efficiency. Assess quality and safety during scale-up.
• Methods: Data were collected using three instruments during clinicians 2-day visits to sites:
Abbreviated version of the WHO Quality Assessment of facilities (WHO, 2009)
Observation and timing of VMMC procedures
Interviews with providers and site managers
• Sample:
Any site operational in 2011: N = 15 Sample from more than 80 operational sites in 2012: n = 40
Same 15 sites sampled in 2011 and 2012 (repeat sites); 25 new sites in 2012, with a
total of 40 sites (expanded sites)
*Significant differences refer to p values < 0.05
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Results: Table 1. Quality assessment of VMMC sites
Item observed:
2011: n=15 sites2012a: n=15 sites (same site)
2012b: n=40 sites (expanded sites)
Satisfactory %2011 2012a 2012b
Existence of functioning information system (manual/computerized) *
60.0 100 97.5
Monitoring system in place for adverse events ^ 60.0 26.7 22.5
Report of supervisory visits in past 6 months ^ 60.0 40.0 17.5
External monitoring of adverse events in past 6 months ^ 40.0 6.7 2.5
Clinical personnel conduct a basic preoperative assessment * 51.2 20.3 12.3
Demonstrate ‘safety first approach’ to ensure no part of the penis besides the foreskin is in danger of being injured
97.5 97.3 97.2
Mean QA score across all parameters ^ 1.68 1.51 1.36
* Difference is statistically significant in both comparisons^ Difference is statistically significant in expanded sites only
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Results• Challenges Drop in ‘readiness to provide services’ in expanded (not repeat sites) ie.
supplies, equipment, systems etc.– Likely due to the rapid scale-up and the large number of new sites
Drop in ‘quality of surgical services’ in expanded and repeat sites ie. pre- & post-operative procedures
– Likely due to ‘dilution’ of skilled staff across new sites & employment of new and inexperienced staff
• Successes Actual surgical technique scored the highest Almost universal adoption of 3 efficiency elements
• Recommendations1. Independent team to monitor program quality and reporting of AE’s 2. Improve supply chain systems