دورية أكاديمية
أعرض في EDS

Balancing competing priorities: Quantity versus quality within a routine, voluntary medical male circumcision program operating at scale in Zimbabwe.

التفاصيل البيبلوغرافية
العنوان: Balancing competing priorities: Quantity versus quality within a routine, voluntary medical male circumcision program operating at scale in Zimbabwe.
المؤلفون: Feldacker C; International Training and Education Center for Health (I-TECH), Seattle, WA, United States of America.; Department of Global Health, University of Washington, Seattle, WA, United States of America., Murenje V; International Training and Education Center for Health (I-TECH), Harare, Zimbabwe., Makunike-Chikwinya B; International Training and Education Center for Health (I-TECH), Harare, Zimbabwe., Hove J; Zimbabwe Association of Church-related Hospitals (ZACH), Harare, Zimbabwe., Munyaradzi T; Zimbabwe Community Health Intervention Project (ZICHIRE), Harare, Zimbabwe., Marongwe P; International Training and Education Center for Health (I-TECH), Harare, Zimbabwe., Balachandra S; United States Centers for Disease Control and Prevention, Division of Global HIV & TB, Harare, Zimbabwe., Mandisarisa J; United States Centers for Disease Control and Prevention, Division of Global HIV & TB, Harare, Zimbabwe., Holec M; International Training and Education Center for Health (I-TECH), Seattle, WA, United States of America., Xaba S; Ministry of Health and Child Care, Harare, Zimbabwe., Sidile-Chitimbire V; Zimbabwe Association of Church-related Hospitals (ZACH), Harare, Zimbabwe., Tshimanga M; Zimbabwe Community Health Intervention Project (ZICHIRE), Harare, Zimbabwe., Barnhart S; International Training and Education Center for Health (I-TECH), Seattle, WA, United States of America.; Department of Global Health, University of Washington, Seattle, WA, United States of America.; Department of Medicine, University of Washington, Seattle, WA, United States of America.
المصدر: PloS one [PLoS One] 2020 Oct 13; Vol. 15 (10), pp. e0240425. Date of Electronic Publication: 2020 Oct 13 (Print Publication: 2020).
نوع المنشور: Journal Article; Multicenter Study; Research Support, U.S. Gov't, P.H.S.
اللغة: English
بيانات الدورية: Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE
أسماء مطبوعة: Original Publication: San Francisco, CA : Public Library of Science
مواضيع طبية MeSH: Circumcision, Male/*standards , Circumcision, Male/*statistics & numerical data , HIV Infections/*prevention & control , Health Personnel/*psychology, Adolescent ; Child ; Child Health ; Circumcision, Male/economics ; Government Programs/economics ; Humans ; Interviews as Topic ; Male ; Patient Acceptance of Health Care ; Qualitative Research ; Quality Assurance, Health Care ; Voluntary Programs/economics ; Zimbabwe
مستخلص: Background: Since 2013, the ZAZIC consortium supported the Zimbabwe Ministry of Health and Child Care (MOHCC) to implement a high quality, integrated voluntary medical male circumcision (VMMC) program in 13 districts. With the aim of significantly lowering global HIV rates, prevention programs like VMMC make every effort to achieve ambitious targets at an increasingly reduced cost. This has the potential to threaten VMMC program quality. Two measures of program quality are follow-up and adverse event (AE) rates. To inform further VMMC program improvement, ZAZIC conducted a quality assurance (QA) activity to assess if pressure to do more with less influenced program quality.
Methods: Key informant interviews (KIIs) were conducted at 9 sites with 7 site-based VMMC program officers and 9 ZAZIC roving team members. Confidentiality was ensured to encourage candid conversation on adherence to VMMC standards, methods to increase productivity, challenges to target achievement, and suggestions for program modification. Interviews were recorded, transcribed and analyzed using Atlas.ti 6.
Results: VMMC teams work long hours in diverse community settings to reach ambitious targets. Rotating, large teams of trained VMMC providers ensures meeting demand. Service providers prioritize VMMC safety procedures and implement additional QA measures to prevent AEs among all clients, especially minors. However, KIs noted three areas where pressure for increased numbers of clients diminished adherence to VMMC safety standards. For pre- and post-operative counselling, MC teams may combine individual and group sessions to reach more people, potentially reducing client understanding of critical wound care instructions. Second, key infection control practices may be compromised (handwashing, scrubbing techniques, and preoperative client preparation) to speed MC procedures. Lastly, pressure for client numbers may reduce prioritization of patient follow-up, while client-perceived stigma may reduce care-seeking. Although AEs appear well managed, delays in AE identification and lack of consistent AE reporting compromise program quality.
Conclusion: In pursuit of ambitious targets, healthcare workers may compromise quality of MC services. Although risk to patients may appear minimal, careful consideration of the realities and risks of ambitious target setting by donors, ministries, and implementing partners could help to ensure that client safety and program quality is consistently prioritized over productivity.
Competing Interests: The authors have declared that no competing interests exist.
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معلومات مُعتمدة: United States PEPFAR PEPFAR; U2G GH000972 United States GH CGH CDC HHS
تواريخ الأحداث: Date Created: 20201013 Date Completed: 20201204 Latest Revision: 20201214
رمز التحديث: 20231215
مُعرف محوري في PubMed: PMC7553309
DOI: 10.1371/journal.pone.0240425
PMID: 33048977
قاعدة البيانات: MEDLINE
الوصف
تدمد:1932-6203
DOI:10.1371/journal.pone.0240425