Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.
Voluntary Medical Male Circumcision (VMMC) Programme, Right to Care, Johannesburg, Gauteng, South Africa.
PLoS One. 2021 Aug 5;16(8):e0254850. doi: 10.1371/journal.pone.0254850. eCollection 2021.
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 focused on the changes in quality of service after implementation of continuous quality improvement (CQI) action plans. This study aimed to evaluate the impact of coaching, provision of standard operating procedures (SOPS) and guidelines, mentoring and on-site in-service training in improving quality of VMMC services across four Right to Care (RTC) supported provinces in South Africa.
This was a pre- and post-interventional study on RTC supported VMMC sites from July 2018 to October 2019. All RTC-supported sites that were assessed at baseline and post-intervention were included in the study. Data for baseline CQI assessment and re-assessments was collected using a standardized National Department of Health (NDoH) CQI assessment tool for VMMC services from routine RTC facility level VMMC programme data. Quality improvement support was provided through a combination of coaching, provision of standard operating procedures and guidelines, mentoring and on-site in-service training on quality improvement planning and implementation. The main outcome measure was quality of service. A paired sample t-test was used to compare the difference in mean quality of service scores before and after CQI implementation by quality standard.
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 12% for infection prevention (95%CI: 7-17; p<0.001) and 8% for male circumcision surgical procedure, (95%CI: 3-13; p<0.01). Similarly, individual counselling, and HIV testing increased by 14%, (95%CI: 7-20; p<0.001), group counselling, registration and communication by 8%, (95%CI: 3-14; p<0.001), and 35% for monitoring and evaluation, (95%CI: 28-42; p<0.001). In addition, there were significant increases for management systems of 29%, (95%CI: 22-35; p<0.001), leadership and planning 23%, (95%CI: 13-34; p<0.001%) and supplies, equipment, environment and emergency 5%, (95%CI: 1-9; p<0.01). The overall quality of service performance across provinces increased by 18% (95%CI: 14-21; p<0.001).
The overall quality of service performance across provinces was significantly improved after implementation of CQI support intervention program. Regular visits and intensive CQI support are required for sites that will be performing below quality standards.
最近在非洲撒哈拉以南国家的研究表明，自愿男性包皮环切术（VMMC）服务的质量存在差距和挑战。对于实施持续质量改进（CQI）行动计划后服务质量的变化，关注较少。本研究旨在评估在南非四个“关爱权利”（RTC）支持的省份实施辅导、提供标准操作程序（SOP）和指南、指导以及现场在职培训对 VMMC 服务质量的影响。
这是一项关于 2018 年 7 月至 2019 年 10 月接受 RTC 支持的 VMMC 场所的干预前和干预后研究。所有在基线和干预后评估的 RTC 支持场所均纳入研究。使用国家卫生部（NDoH）的标准化 VMMC 服务 CQI 评估工具，从常规 RTC 设施级 VMMC 方案数据中收集了基线 CQI 评估和重新评估的数据。通过辅导、提供标准操作程序和指南、指导和现场在职培训，提供了质量改进支持，以进行质量改进规划和实施。主要观察指标是服务质量。采用配对样本 t 检验比较 CQI 实施前后按质量标准计算的服务质量评分的差异。
共有 40 个卫生设施在基线和 CQI 支持访问后进行了评估。结果显示，在接受 CQI 支持干预后，感染预防的整体服务质量变化显著增加 12%（95%CI：7-17；p<0.001），包皮环切术外科手术增加 8%（95%CI：3-13；p<0.01）。同样，个体咨询和 HIV 检测增加了 14%（95%CI：7-20；p<0.001），小组咨询、登记和沟通增加了 8%（95%CI：3-14；p<0.001），监测和评估增加了 35%（95%CI：28-42；p<0.001）。此外，管理系统增加了 29%（95%CI：22-35；p<0.001），领导和规划增加了 23%（95%CI：13-34；p<0.001%），供应、设备、环境和应急增加了 5%（95%CI：1-9；p<0.01）。各省的整体服务质量表现提高了 18%（95%CI：14-21；p<0.001）。
在实施 CQI 支持干预计划后，各省的整体服务质量表现显著提高。对于低于质量标准的场所，需要定期访问和密集的 CQI 支持。
