Manual for Male Circumcision under Local Anaesthesia

Male circumcision under local anaesthesia
Version 3.1 (Dec09)
The quality of male circumcision services can be defined through the
development and communication of standards. Quality can then be
measured by determining whether the standards are being met.
Various methods can be used to measure quality, e.g. selfassessment,
peer assessment and external assessment. Quality
improvement methodology can be used to continuously improve the
quality of male circumcision care and services.
WHO has developed a comprehensive guide to quality assurance 1 for
male circumcision programmes. The guide defines ten service
standards that each programme should meet (Box) and includes the
essential competences for male circumcision service provision. In
addition it outlines the process of quality assessment and includes
guidance for facility managers and staff. The guide is supplemented
by a toolkit 2 to assist managers and staff assess the quality of
services.
Recommended male circumcision service standards
1. An effective management system is established to oversee the
provision of male circumcision services.
2. A minimum package of male circumcision services is provided.
3. The facility has the necessary medicines, supplies, equipment
and environment for providing safe male circumcision services of
good quality.
4. Providers are qualified and competent.
5. Clients are provided with information and education on HIV
prevention and male circumcision.
6. Assessments are performed to determine the condition of clients.
7. Male circumcision surgical care is delivered according to
evidence-based guidelines.
8. Infection prevention and control measures are practised.
9. Continuity of care is provided.
10. A system for monitoring and evaluation is established.
SUPERVISION
Traditional approaches to supervision emphasize inspecting facilities
and checking individual performance. They focus on finding fault or
errors, and sanctioning those responsible, or thought to be
responsible. This type of supervision often causes negative feelings
and rarely results in an improved service.
In contrast, supervision for performance and quality improvement
focuses on:
1
2
World Health Organization. Male circumcision quality assurance: a guide to enhancing the safety and
quality of services. Geneva, World Health Organization, 2008 (available at www.malecircumcision.org)
World Health Organization. Male circumcision services quality assessment toolkit. Geneva, World
Health Organization, 2009 (available at www.malecircumcision.org)
Record keeping, monitoring, evaluation and supervision Chapter 9-5