Manual for Male Circumcision under Local Anaesthesia

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Male circumcision under local anaesthesia Version 3.1 (Dec09) Chapter 9 MANAGING A CIRCUMCISION SERVICE Summary • The manager of a clinic circumcision service has a number of roles. These include ensuring quality of services, making sure that good quality records are kept, monitoring and evaluating the programme, and carrying out supportive supervision. • To meet these responsibilities, the clinic manager must set the desired levels of performance for the services provided, assess current levels of performance, work with other clinic staff to analyse the causes of inadequate performance and find solutions for identified problems. RECORD-KEEPING, MONITORING AND EVALUATION The clinic manager should ensure that the health care providers maintain adequate records on all clients. Records should include information on the identity of the client, the type of service provided, and any special circumstances associated with it. Sample record forms to assist this task are given in Appendices 9.1 (stock card), 9.2 (stock-taking card for consumables), 9.3 (adverse event form) and 9.4 (register). A more detailed account of indicators and monitoring and evaluation of male circumcision programmes is given in the WHO/UNAIDS publication A guide to indicators for male circumcision programmes in the formal health care system, which can be downloaded from the Clearinghouse on Male Circumcision for HIV prevention (www.malecircumcision.org). Indicators Health care facility managers need detailed information to allow them to make decisions about how best to use scarce resources. They might want to know the answers to questions such as: • Are we reaching our target audience • Can we provide the necessary services (for example, do we have the appropriate equipment, staff and medications) • Are our services of high quality (for example, do they meet national and international standards) • Do our services meet the needs of our clients • Are we referring clients who need it For each question, managers should develop one or more indicators to monitor the services or the impact of changes. For example, to assess the quality of the circumcision service provided, an appropriate Record keeping, monitoring, evaluation and supervision Chapter 9-1
Male circumcision under local anaesthesia Version 3.1 (Dec09) indicator might be the percentage of male circumcision clients who are re-admitted or referred for management of an adverse event. Answering these questions depends on careful record-keeping by staff who understand the purpose of the records. What is monitoring Monitoring is the routine assessment (e.g. daily, monthly, quarterly) of information or indicators related to ongoing activities. Monitoring helps to: • track progress towards the programme targets or performance standards; and • identify aspects of the programme that are working according to plan and those that are in need of adjustment. What is evaluation Evaluation is the measurement of how much things have changed as a result of the interventions implemented. There are, of course, many factors that can cause things to change. A formal evaluation tries to demonstrate how much a specific intervention contributed to an observed change. Why evaluate male circumcision programmes The purpose of evaluating a male circumcision programme is to: • assess progress made at particular points in time; • assess progress towards objectives; • provide feedback on whether targets are being met; • identify reasons for successes and failures; and • provide a basis for future planning. What is a monitoring system Collecting information to track indicators requires the collaboration of dedicated and knowledgeable staff. Obtaining and reporting the required information represent an extra burden of work, and may even be impossible unless an effective monitoring system is in place. This implies: • All those involved know what information is needed and by whom. • The tools needed to collect the information are available. • All those involved know how and when to report the information. • One person is responsible for making sure the system is working, i.e. that indicators are up to date, that records are being properly kept, and that data are reported to appropriate partners. Record keeping, monitoring, evaluation and supervision Chapter 9-2
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Manual for Male Circumcision under Local Anaesthesia

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