ISQUA16-1862A MOBILE DATA-DRIVEN SAFETY AND QUALITY SYSTEM FOR VOLUNTARY MEDICAL MALE CIRCUMCISION (VMMC) IN MOZAMBIQUE

Abstract

Objectives: To implement a mobile registry and monitoring system for safety, quality, and management of the PEPFAR-funded VMMC Program in Mozambique. Method(s): In 2009, the Mozambican Ministry of Health (MOH) started a VMMC program to circumcise 2 million men by 2018 as part of its HIV prevention strategy. Since then, Jhpiego, with support of CDC/PEPFAR, has collaborated with the MOH for the provision of nearly 450,000 circumcisions by December 2015. Demand for VMMC in Mozambique is markedly seasonal and varies among provinces and even districts and localities. Therefore, a significant part of the services is provided by mobile units and temporary sites. Managing and expanding such a large-scale program with attention to safety and quality presents many challenges, particularly if traditional management tools are used. To address this situation, Jhpiego developed a mobile, tablet-based, data-driven safety and quality system for VMMC consisting of four modules: - Daily data on clients served in aggregate and by provider - An electronic client record including procedures and complications - Assessments of compliance with established standards of care - Confirmation of > minimal stock of critical medical supplies The system was developed starting in 2012 using Mobile Data Studio and Mobile Data Anywhere software for data capture and uploading and Excel for exporting data. The first two modules have been completed, the third one is being tested, and the fourth is being deigned. Daily reports on clients and providers' production as well as the electronic client record started the same year 2012. Paper-based client records prior to 2012 were retrospectively entered in the system. Data is entered daily at the site level and sent electronically to a central database. Where there is no connectivity the system stores data locally and synchronizes with the central database when connectivity is available. Data received centrally is shared daily via email, including summary data, tables, and graphs, with national and provincial Jhpiego VMMC program managers. Result(s): Data analyzed daily by site include: number of clients by age, HIV status, and other demographic characteristics and number of procedures performed by individual providers by cadre. Electronic patient records are stored in the central database. Severe complications are reported immediately with inclusion of pictures that help to assess the case for potential referrals. Based on the information provided VMMC managers make prompt decisions on the most efficient location of mobile units, temporary sites, and providers, on better targeting of demand-generation activities, and on strengthening safety and quality by analyzing complication trends. The successful operation of this mobile safety and quality system has helped the Jhpiego/Mozambique VVMC program to annually increase its production keeping a very low rate of complications. Procedures increased from 77,652 in 2012, to 99,942 in 2013, 106,052 in 2014, and 133,677 in 2015. The complication rate has been 0.3% of which only 1/10 were severe. Conclusion(s): A real-time mobile system with integrated data on patients and providers production by facility helped to consistently expand the VMMC activities in Mozambique with a low rate of complications. Its success was facilitated not only by the timely flow of relevant information but also by its dissemination among key managers, and its use for daily decision-making. The system is simple in its design and operation. The addition of the two new modules being tested and designed will enhance even more the capabilities of the system and its usefulness.