Manual for Male Circumcision under Local Anaesthesia

Male circumcision under local anaesthesia
Version 3.1 (Dec09)
minutes before being cleaned and sterilized 50% of the time (a
gap of 50%).
• 36% of clients undergoing male circumcision (and/or their
parents) were counselled about HIV (a gap of 74%).
• Find the causes of performance gaps. A performance gap
means that what is occurring does not meet the performance
standards that have been set. If this is found to be the case, the
manager needs to explore with staff why the gap is occurring.
Sometimes the reasons for poor performance are not immediately
obvious, and it may take some time to find the real cause. For
example, if 74% of clients undergoing male circumcision are not
being counselled about HIV infection, analysis of the gap may
reveal the following possible causes:
• shortage of staff (especially counsellors and nurses);
• a high client load;
• no space in the clinic for counselling clients;
• a shortage of test kits for HIV;
• staff not aware of facility policy; or
• no one in the facility has been trained in counselling and
testing.
• Select and implement interventions to improve performance.
Once the causes of the performance gap have been determined,
the manager and staff will need to identify, put in order of priority,
plan and implement interventions to improve performance. These
interventions can be directed at improving the knowledge and
skills of staff, or the environment and support systems. Many
different types of interventions can improve worker performance.
To make the best use of resources, it is important to select the
most appropriate ones.
• Monitor and evaluate performance. Once an intervention has
been implemented, it is important to determine whether it has had
the desired result. In other words, did the intervention lead to
improved performance Did the team come closer to meeting
established standards If not, the team will need to look again at
what is hindering performance, to make sure that the interventions
were targeted at the real cause of the performance gap. If
performance has improved, it is important to continue monitoring
to make sure that the level of performance is maintained.
Record keeping, monitoring, evaluation and supervision Chapter 9-8