A novel qualitative assessment tool tracking progress towards sustainability of Zimbabwe's voluntary medical male circumcision program


BACKGROUND: Since 2009, Zimbabwe has implemented voluntary medical male circumcision (VMMC) as a high-impact, one-time HIV prevention intervention. While the initial goal of the program was to scale VMMC services, stakeholders recognized that scale up and sustainability must be simultaneously pursued in response to differences in sub-national performance. This led to the development of the Sustainability Transition Implementation Plan in 2019 which outlined sustainability goals for the VMMC programme. The VMMC Transition Assessment Dashboard (VTAD) assessments were developed to track progress towards country-defined sustainability goals and to identify health system barriers and enablers to transitioning to sustainability.
METHODS: The VTAD assessment is designed to collect data on key processes in the VMMC program while tracking progress towards the development of program characteristics necessary for sustainability by programmatic pillar[1]. Data is collected through a consultative process guided by the Ministry of Health and Child Care that prioritizes understanding the qualitative structure and implementation of VMMC activities. Findings from the assessment are incorporated into the district, provincial, and national program planning.

[1] Leadership, management, and coordination(LMC); Service delivery(SD); Programme Quality(Q); Demand Generation(DG); Strategic Information(SI) and Financing

RESULTS: Progress towards sustainable LMC1 was driven by increased programme coordination, clearly defined roles and responsibilities, and district level program ownership. Lack of integrated VMMC plans and sub-optimal engagement of stakeholders were identified as barriers to sustainable LMC1. Modified service delivery models to support program continuity during the COVID-19 pandemic contributed to a more sustainable SD1. However, vertical and siloed VMMC programming at service delivery points impeded the integrated HIV prevention programming necessary for sustainability. Under the Q1 pillar, integrated and standardised quality assurance activities managed by the district personnel and timely detection and management of VMMC adverse events accelerated sustainability progress. SI and DG1 remained relatively stagnant after adoption of new HMIS tools and updated global guidance on the priority age group requiring new strategies to engage older VMMC clients.
CONCLUSIONS: The VTAD facilitates structured discourse about VMMC sustainability for all stakeholders while promoting greater district-level program ownership, data-driven planning, and identification and monitoring of barriers to and enablers of program sustainability.

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