Changes in the quality of voluntary medical male circumcision services in selected districts of the Mpumalanga, Eastern Cape, Free State and North West Provinces of South Africa

BACKGROUND: Recent studies in the Sub-Saharan countries in Africa have indicated gaps and challenges for voluntary medical male circumcision (VMMC) quality of service. Less has been focused on the changes in quality of service after implementation of continuous quality improvement (CQI) action plans. This study aimed to determine changes in the quality of services between baseline and follow-up re-assessments after CQI support intervention at VMMC sites in the North West, Mpumalanga, Eastern Cape and the Free State provinces in South Africa.
METHODS: This was a pre-post design intervention study based on data collected from the National Department of Health sites supported by Right to Care (RTC) on VMMC services in South Africa, from July 2018 to October 2019. Data for baseline CQI assessment and re-assessments was collected using a standardized National Department of Health (NDoH) CQI assessment tool for VMMC services. Quality improvement support was provided through provision of standard operating procedures and guidelines, mentoring and on-site in-service trainings on quality improvement planning and implementation. A paired sample t-test was used to compare the quality of service mean scores before and after CQI implementation by quality standard.
RESULTS: A total of 40 health facilities were assessed at both baseline and after CQI support visits. Results showed significant increases for the overall changes in quality of service after CQI support intervention of 11.89% for infection prevention (95%CI: 6.60-17.15; p<0.001) and 8.28% for male circumcision surgical procedure, (95%CI: 3.25-13.30; p<0.01). Similarly, individual counselling, and HIV testing increased by 13.56%, (95%CI: 6.94-20.19; p<0.001), group counselling, registration and communication by 8.5%, (z=3.529; p<0.001), and 35.08% for monitoring and evaluation, (95%CI: 28.03-42.12; p<0.001). In addition, there were significant increases for management systems of 28.65%, (95%CI: 22.30-35.00; p<0.001), leadership and planning 23%, (95%CI: 12.85-33.88; p<0.001%) and supplies, equipment, environment and emergency 5.10%, (95%CI: 1.09-9.11; p<0.01). The overall quality of service performance across provinces increased by 17.79% (95%CI: 14.24-21.34; p<0.001).
CONCLUSIONS: The overall quality of service performance across provinces was significantly improved after implementation of CQI support intervention program. However, more support was required for male circumcision surgical procedure and infection prevention in Mpumalanga and the Free State respectively.