This paper derails the 10 WHO standards of VMMC and how each of them is met

1. 1
CME
Topic : QA SENSITIZATION FOR MANAGERS AND SERVICE PROVIDERS
Presenter : Vincent Aloo

2. An Overview of
1. Terminologies in Quality
2. How Quality Assessment is done
3. 10 WHO Standards of VMMC: How we
achieve Quality through our day to day activities

4. Terminologies
• Quality
• Quality Assurance
• Quality Control
• QI
• Benchmarking

5. Quality Dimension/Criteria Data/types for identifying, prioritizing, and measuring change in HIV-related QI
projects
Safety:
Avoiding or reducing
• Adverse events and incidents (side effects and toxicity)
to acceptable limits of actual or • Sentinel events (HIV drug resistance/ early warning Indicators)
potential harm from health care • Internal bench marking
management or the environment • Benchmarking against other services or departments
in which healthcare is delivered • Morbidity and mortality meetings or reports
• Accreditation reports
Accessibility:
Obtaining
• Service utilization
healthcare that is timely, geographically
reasonable, and
•
•
Client feedback (e.g. client focus groups, exit surveys)
Waiting times
provided in a setting where skills and
resources are appropriate to medical
need.
• Missed appointments rates
Effectiveness:
Care, intervention
• Clinical indicators, medical file reviews
or action achieves desired • Benchmarking against other services and departments
outcome. • Morbidity and mortality meetings or reports
Efficiency:
Achieving desired
• Service utilization data
results with the most cost-effective • Finance and expenditure data
use of resources • Audits of equipment and resource usage
• Client feedback
• Waiting times
Acceptability or patient- • Service utilization data
centeredness:
Service is • Client feedback
respectful and client orientated; • Accreditation reports
respect for dignity, confidentiality,
participation in choices, promptness,
quality of amenities, access to social
support networks and choice of provider
• Adverse events (side effects and toxicity)
Equity:
Delivering health
• Clinical indicators, medical file reviews
care which does not vary in • Audits against international standards or evidence- based guidelines
quality because of personal • Service utilization data
characteristics such as gender, race, • Service mapping

6. How is quality assessment done?

7. 1. Observation: assess attitudes, knowledge and skills in
clinical practice, including client-provider interaction, client
management and surgical practice.
2. Formal and informal interviews: One-on-one interviews
with managers, staff and clients.
3. Focus group discussions: to understand attitudes,
beliefs and perceptions
4. Inventory
5. Review of documents:

8. THE 10 WHO STANDARDS

9. Standard Team Participation What is Assessed Result?
Effective management
system to oversee
provision of VMMC
services
 Health rights
policies are
available & known
 Staff roles and
responsibilities
 Services provided in
an organized and
efficient manner
 barriers to
accessing care are
identified and
minimized
 systems for
continuous
Ensure all protocols and
checklists are available and
strictly adhered to
Promote integration of
VMMC/EIMC services in the
facility and smooth MC
services
Ensures team work,
discipline and operation
schedules are maintained
within the team and across
facilities
Adhere to the weekly
facilities coverage schedule
Comply with the VMMC
team rotational schedule
Health rights and
policies
SOPs, Guidelines
Protocols
JDs file
Weekly rotation
workplan
Client flow
Barriers to services
Supervision book

10. Standard Team Participation What is Assessed Result?
Minimum package
of MC
services is provided
 HTS services
 Syndromic mgt
of STIs
 RR & safer sex
counseling
 Male and female
condoms
 Minimum
package of
services
integrated and
linkages made
 Others?
Provide quality and safe
male circumcision services
to clients
Provide STI screening and
treatment
Screen and manage STIs
Provide RR counseling
Consenting to clients
Provide HTS services to
clients
Refer, link and track all
VMMC clients who test HIV
positive
Adhere to national guideline on
HTS and VMMC counseling
Dorsal slit SOP/Pack
SOPs & Job Aids
Observed practice
Competency
Assessment
Syndromic STI chart
& drugs
HTS/Linkage register
Male & female
condoms/
distribution log

11. Standard Team Participation What is Assessed Result?
Medicines, supplies,
equipment and
environment for
providing safe
VMMC services of
good quality
Essential medicines
Supplies and
equipment
Emergency
equipment, supplies
and medications
Infection prevention
supplies
Environment-
adequate for
Efficiently manage
consumables and drugs
stock cards and equipment
inventory
Stock Mgt Book
Inventory
Completeness of
emergency box
No. of dorsal slit
packs
IPC supplies

12. Standard Team Participation What is Assessed Result?
Providers are
qualified and
competent
Qualifications and
competences of
staff for their
assigned tasks
Periodic assessment
of staff
competencies
Ongoing in-service
education and
training
Participation and skills
development of facility
healthcare workers
Ensure participation in
CMEs and documentation of
the same
Providing surgical skills
mentorship
Participate in CMEs
Academic
certificate/license
VMMC certificate
EIMC certificate
ShangRing
Prepex
Also; BLS, ACLS,
EPALS
HND, BSc/N…
CME roster
CME minutes
Competency
assessments
List of trained

13. Standard Team Participation What is Assessed Result?
Information and
education on HIV
prevention and
VMMC
Information is
provided to clients
on VMMC, STIs and
HIV prevention
Appropriate
reinforcing IEC
materials
Informed consenting
Educate clients on the
benefits, risks and
procedure of male
circumcision
Ensure proper consenting
Job Aids
Assorted IEC
materials
Properly filled
consent forms

14. Standard Team Participation What is Assessed Result?
Assessment of
clients condition
for surgery
 Initial client
history is taken
 Initial physical
examinations
are performed
Screen patients and ensure
that they are fit for surgery
Screen clients to ensure they
are fit for surgery
Documented client
file
Documented vital
signs
*Documented
VMMC Safe surgery
Checklist

18. Standard Team Participation What is Assessed Result?
MC surgical care
delivered
according to
guidelines
 Dorsal slit/EIMC by
guidelines
 SOPs for
assessment and
management of
AEs
 Immediate
postoperative care
by guideline
Ensure patient safety is
guaranteed before surgery,
during surgery and
immediately after surgery
Document and manage
circumcision related
adverse events accordingly
and promptly notifies the
in-charge and program
officer
Assist surgeon to
circumcise clients
Manage & report adverse
events and according to
the national guidelines
Dorsal slit SOP
Observed practice
on Dorsal slit
SOP for classifying
AEs during and
post circumcision
Immediate post
op SOP/care per
guideline

19. Standard Team Participation What is Assessed Result?
Infection prevention
and control
 IPC
policies/procedures
 IPC measures
practised according
to policy and
procedures
 Individuals are
designated to be
accountable for IPC
activities
-Maintain high hygiene
standards
-Cleaning, packing and
sterilization of
instruments
-Disinfects and cleans the
theatre, linens and
instruments after every
surgery
-Adherence to IPC
guidelines
-Timely servicing of
autoclaves
-Instruments and linen
maintenance
-Autoclave machines
maintenance
IPC SOPs
Adherence to IPC
policies
Procedure for diluting
JIK/DISINFECTANTS
Instrument and linen
processing
Documentation of
autoclaving log
Autoclave service
reports

20. Standard Team Participation What is Assessed Result?
Continuity of
care
 Effective
referral system
 client/family
given discharge
instructions
 A well-
established
mechanism for
follow-up of
clients
Review all circumcised
clients conduct active follow
ups
Monitor health process of
the clients and ensure that
the national standards are
strictly adhered to by the
team
Ensure patient safety is
guaranteed before, during
and after surgery
Review clients and
conducts active follow ups
Referral protocol
Client follow ups
Active follow up SOP/
book
Post op instructions
System of performing
and documenting
follow ups

21. Standard Team Participation What is Assessed Result?
A system for
monitoring and
evaluation
 Data collected
on the services
provided
 Evaluation data
used for the
planning and
improvement of
service delivery
 System for
prompt
reporting and
review of
adverse events
 Data collection
is thorough and
Ensure timely and proper
documentation of client
files and registers
Keep information about
clients in strict confidence
Promptly fill registers, files
and reporting documents
Keep information about
clients in strict confidence
Participate in regular data
auditing and
documentation of best
practices
Promptly fill the registers
and reporting documents
Support VMMC data quality
audit
Maintain confidentiality and
Completeness,
accuracy & legibility
of files/ registers
SI: Data driven
decision making
QA/AE review
meetings
DQA
Monthly data
reviews/feedbacks
Storage of registers &
files
AE documentation/
follow ups

22. Serenyo wou!!
Ejok noi!!!
Asante sana!