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Community Contribution

Health Workers at the Forefront of Improving Medical Male Circumcision

Kate Fatta, John Byabagambi

The USAID Applying Science to Strengthen and Improve Systems project (ASSIST) was asked to run a pilot program with 30 health facilities and implementing partners (IPs) to improve the quality of safe male circumcision (SMC) in Uganda after an external assessment found major gaps in quality of service provision. Our main objective was to set up a site-level system that was health worker-led to continuously identify gaps in SMC service delivery and develop local solutions to address these gaps. Each IP identified three health units to serve as learning sites from which best practices would be spread to the rest of the SMC sites. Four representatives from each site were invited to attend a 3-day training. Improvement teams were formed that would spearhead the process of addressing the gaps. Representatives from each of the sites were invited to attend peer-to-peer learning sessions, during which each team was given an opportunity to share their work. Good and poor performing teams would be identified and asked to share what had enabled them to perform well or what challenges they were facing, in an effort to provide additional support. Site exchange visits were also organized in which participants from either a poor-performing site visited a good-performing site or vice versa. After a year and a half of implementation, we organized a harvest meeting in which we systematically put together changes that had yielded positive results at most of the sites. The approach has spread from 30 sites to now 165 sites in Uganda and has also been introduced by ASSIST in other countries.


This case study was submitted as part of USAID's CLA Case Competition, held in August 2015. Taken together, this collection of submissions illustrates the diversity of ways collaborating, learning, and adapting approaches are being operationalized in the field. Stringent judging criteria was used to determine official CLA Case Competition winners, so not all submissions should be considered an official USAID endorsement of best practice. To view all entries, visit the CLA Case Competition page.

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