Male Circumcision Quality Assurance Guidance Expert Review Meeting

WHO Meeting Report Male Circumcision Quality Assurance Guidance Expert Review Meeting 12-13 November 2007 Montreux, Switzerland WHO meeting report Montreux Nov 2007 Table of Contents Table of Contents .2 Executive Summary Background Day Session 1.1 Overview of Quality Assurance 1.2 Overview of the Draft Male Circumcision Quality Assurance Guide 1.3 Country Experiences with Quality Improvement Programmes and Standards Setting .8 1.3.1 Standards-based Management and Recognition: An Innovative Approach to Improving Performance and Quality of Health Services in Limited Resource Settings 1.3.2 National Adolescent Friendly Clinic Initiative (NAFCI), South Africa .9 1.3.3 A Standards-driven National Initiative to Improve the Quality and Expand the Coverage of Health Service Provision to Adolescents in United Republic of Tanzania 10 1.4 Process to Develop HIV Care Standards 10 Session 11 2.1 Overview of Male Circumcision Standards .11 2.2 Group Discussions and General Comments: 12 Male Circumcision Standards 12 Day 13 Session 13 3.1 Provider Certification Experiences: JHPIEGO 13 3.2 Discussion on Male Circumcision Provider Certification 13 Session 14 4.1 Overview of Accreditation 14 4.2 Male Circumcision Accreditation Discussion .14 4.3 Summary of Recommendations and Next Steps .14 Appendix 1: Agenda 17 Appendix 2: List of Participants 19 WHO meeting report Montreux Nov 2007 Acknowledgement This meeting was convened by the World Health Organization Departments of HIV and Reproductive Health and Research The financial support of the Bill and Melinda Gates Foundation as part of the Second UN Work Plan on Male Circumcision and HIV is gratefully acknowledged Executive Summary A World Health Organization (WHO) Male Circumcision (MC) Quality Assurance Guidance Expert Review Meeting was held in Montreux, Switzerland on the 12th and 13th of November 2007 Approximately 30 experts representing the governments, programme implementers, private sector, surgeons, and international organizations from the USA, Africa, and Europe attended the consultative meeting The majority of the experts were from the fields of HIV and AIDS prevention and quality of health care The goal of the expert consultative meeting was to review the draft international guidance on quality assurance of male circumcision services, guidance on standards and certification of providers The objectives of the meeting are to: Review and discuss the draft Male Circumcision Quality Assurance Guide; Agree on standards for male circumcision services; The expected outcomes were: Draft guidance document reviewed and notes for revision detailed; and Consensus on standards for male circumcision services obtained The background to the meeting was that on March 28 2007 WHO and UNAIDS released policy and programmatic recommendations that male circumcision should be recognized as an efficient intervention for HIV prevention and that promoting male circumcision should be recognized as an additional, important strategy for the prevention of heterosexually-acquired HIV infection in men It is anticipated that demand for male circumcision will increase and action is therefore required to improve current male circumcision practices and ensure that safe services are available to the men and boys that require them If safe male circumcision services are to be scaled up, then it is imperative that appropriate systems are put in place to regulate the delivery of the services It is important to define, among other things, who can provide the services, and the minimum standards required in the health facilities providing services Key Recommendations: Presentations and discussions were held over the two days and recommendations were made for the revision of the draft guidance There was general agreement that the document should be revised to focus and give more attention to quality improvement and quality assurance of services and less on accreditation The section on providers should also focus more on WHO meeting report Montreux Nov 2007 assessing and improving provider competencies rather than on certification Other key recommendations made included the following: General  Strengthen the section on quality assurance and ensure consistency with other WHO HIV quality assurance guidelines or documents  Outline other methodologies to measure quality other than accreditation and introduce a table that compares the methodologies giving the advantages and disadvantages of each of the methods  Introduce a new section outlining national and district level guidance, which will include information on: - Community involvement - Communication - Human resources and staffing - Costing of services Standards  The standards were accepted with suggestions for some rewording and revision to suit the developed criteria Certification of Providers  Recommend the training of non-physician providers and outline the key competencies that need to be met to be a skilled male circumcision provider  Focus of this section to be on assessing and improving competencies rather than certification  Re-order the providers section to include the following key components in the certification: competency assessment, competency-based training, tasks and providers, certification process and level of health care provider  Involve the in-country certifying bodies in decision making to train nonphysician service providers  Include operationalization of certification (certification process) with illustrative approaches added in the manual  Create a competency table to ensure coverage of all activities (basic training on minimum package for all and competencies of managers) and re-order to the following headings: counselling, assessment, surgery, record keeping, quality assurance and safety Accreditation  Introduce a section on quality assessment that focuses on different evaluations of quality  Cut down the section on accreditation and refer to WHO and other accreditation documents available  Encourage national governments to use standardization or accreditation bodies within their countries The next key steps agreed upon were the following:  Revise the Quality Assurance Guidance and send a revised draft to participants by end December 2007 WHO meeting report Montreux Nov 2007    Pilot the Quality Assurance document in or countries by early 2008 Swaziland, Zambia and Kenya agreed to be pilot countries Convene a regional meeting on the Quality Assurance document by nd quarter of 2008 Develop a male circumcision services quality assessment tool WHO meeting report Montreux Nov 2007 Background Three randomized controlled trials in Orange Farm, South Africa; Rakai, Uganda; and Kisumu, Kenya 1,2,3 have demonstrated that circumcised men have about 60% reduced risk of HIV infection from heterosexual intercourse On the 28th of March 2007 WHO and UNAIDS released policy and programmatic recommendations that male circumcision should be recognized as an efficacious intervention for HIV prevention and promoting male circumcision should be recognized as an additional, important strategy for the prevention of heterosexually acquired HIV infection in men It is anticipated that demand for male circumcision will increase Consequently, action is required to improve current male circumcision practices to ensure safe quality services are available to men and boys that require these services It is imperative then that appropriate systems are put in place to regulate the delivery of services It is important to outline among other things, which health care workers can provide the services, what are their competencies, and what are the minimum standards that are needed in health facilities that provide the services The male circumcision Quality Assurance Guide under review was being developed to assist policy makers and programme managers to set up and provide safe quality male circumcision services The initial draft of the Guide focused on standards, accreditation and certification of service providers Transparent and controlled certification procedures help to establish and demonstrate that the facility is committed to providing safe and effective care and quality services An expert review was convened in Montreux, Switzerland on the 12th and 13th November 2007 to review the draft Male Circumcision Quality Assurance Guidance Approximately 30 experts attended the meeting including representatives from the governments of Kenya, Uganda, Namibia, Swaziland Lesotho; the Centres for Disease Control, USA; International Council of Nurses; JHPIEGO; Family Health International (FHI); Joint Commission International (JCI); UNICEF; and WHO Background documents available at the meeting included: a WHO/UNAIDS background paper on Male Circumcision: global determinants of prevalence, safety and acceptability, a UNAIDS document on safe male circumcision and comprehensive HIV prevention programming: Guidance for decision makers on human rights, ethical and legal considerations, a draft report on EngenderHealth’s experience entitled “Implementing facility-based family planning & other reproductive health services; lessons applicable to introduction of male circumcision for HIV prevention” and UNAIDS Best Auvert B, Taljaard D, Lagarde E, et al Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial PLoS Med 2005;2(11):e298 Bailey C, Moses S, Parker CB, et al Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomized controlled trial Lancet 2007;369: 643-56 Gray H, Kigozi G, Serwadda D, et al Male circumcision for HIV prevention in young men in Rakai, Uganda: a randomized trial Lancet 2007;369:657-66 WHO meeting report Montreux Nov 2007 Practice publication on collaboration with Traditional Healers for HIV Prevention and Care in sub-Saharan Africa: suggestions for Programme Managers and Field Workers The meeting opening highlighted the goal, objectives and expected outcomes Goal The goal of the expert consultative meeting was to review the draft international guidance guidelines on standards and certification of male circumcision services The framework includes sections on the development of an accreditation programme, certification of providers and standards The objectives of the WHO Expert review meeting were:    To review and discuss the draft male circumcision quality assurance guidance document; To agree on standards for male circumcision services; and To agree on standards for male circumcision providers The expected outcomes included:    Draft document reviewed and notes for revision detailed; Consensus on standards for male circumcision services obtained; and Consensus on standards for male circumcision providers obtained WHO meeting report Montreux Nov 2007 Day Session 1.1 Overview of Quality Assurance Joanne Ashton (JCI) The overall concept of quality assurance was presented Three elements of quality assurance were outlined for the group: defining, measuring and improving quality The concept outline highlighted that quality is defined by the standards Compliance to the standards can then be measured, and quality improvement methods used to make improvements where standards are not met Quality improvement activities need to be undertaken once a gap between real and expected performance is identified A definition of quality assurance was provided: "a set of activities that are carried out to set standards and to monitor and improve performance so that the care provided is as effective and as safe as possible" Different approaches of measuring quality were mentioned including: peer assessment; self-assessment; supervisor; certification and accreditation She also touched upon the basic framework on organizing for quality assurance and concluded that quality assurance is not a vertical program working independently within an organization but should be integrated with other programmes 1.2 Overview of the Draft Male Circumcision Quality Assurance Guide Julie Samuelson (WHO) An overview of the draft guidance was presented She reviewed the key sections of the draft guidance manual which included:  Aims, objectives and quality assurance guiding principles  Ten proposed male circumcision standards that had been developed based on the minimum service package for male circumcision, programme experience and a literature review  Guidance on certification of male circumcision practitioners  Guidance on accreditation of a male circumcision programme She also shared some comments received from the experts who were unable to attend the meeting for consideration Ms Samuelson pointed out that each section should be reviewed and considered to its appropriateness in the document under review 1.3 Country Experiences with Quality Improvement Programmes and Standards Setting 1.3.1 Standards-based Management and Recognition: An Innovative Approach to Improving Performance and Quality of Health Services in Limited Resource Settings Edgar Necochea (JHPIEGO) WHO meeting report Montreux Nov 2007 Dr Necochea highlighted key challenges for quality improvement in many low resource settings He mentioned that JHPIEGO has worked in many varied low resource countries, e.g Brazil, Malawi and Afghanistan and has been focusing on finding solutions to problems rather than problem analysis Four steps in standards-based management and recognition were described including 1) setting standards, 2) implementing standards, 3) measuring progress and 4) rewarding achievements The need for developing standards that not only tells providers what to but how to it was emphasized A tool is used to measure the standards, which list the performance standard along with the verification criteria; a "yes" and "no" format is used Performance factors that were identified included capability (knowledge, skills and information), opportunity (resources, tools and capacity) and motivation (inner drive and incentives) An important change management strategy is to start with the easiest task and move on to more difficult ones A multidimensional supervision and support system is an important aspect of the approach A variety of ways to monitor and support change included continuous self and peer assessments, internal and external assessments, supportive supervision as well as client involvement and community participation Experience has shown that repetition is an effective method of transfer of information, this redundancy ensures compliance Recognition has been found to be an effective incentive, such as feedback, social and material recognition 1.3.2 National Adolescent Friendly Clinic Initiative (NAFCI), South Africa Kim Dickson (WHO) The National Adolescent Friendly Clinic Initiative is a youth friendly service programme that was implemented in South Africa in response to the HIV crisis The goal of the programme was to bring a positive behaviour change among young South Africans to reduce teenage pregnancy, sexually transmitted infections and HIV/AIDS The key aim was to improve the quality of adolescent health care services at the primary care level Standards were developed based on various barriers to health care services as identified by youth, e.g unfriendly providers, lack of privacy and confidentiality; also taking into consideration the systems for which the services were provided, e.g the environment, staff competency, availability of equipment and supplies, and management Quality principles of defining, measuring and improving quality were a foundation of the NAFCI programme The accreditation process involved a clinic self appraisal followed by an improvement process An external assessment was conducted when the clinic felt that they had met the standards Recognition was provided for achievement at different levels Clinics achieving 30 - 59% of the standards received a bronze star, those achieving 60-90% received a silver star and clinics that met 90% or greater received a gold star Various tools were developed to support the clinics to implement the standards, including a clinic guide to NAFCI accreditation, a resource directory of available technical assistance within the provinces, a values clarification manual and a reproductive health clinical practice handbook NAFCI also worked in close WHO meeting report Montreux Nov 2007 collaboration with district health management teams including the national and clinic levels Lessons learned from the NAFCI experience included the importance of the willingness to embrace change at all levels of health care service management; strong leadership at all levels, full staff involvement and buy in to the process, and involving youth and the community in all aspects of service improvement Additional success factors included development of clinic quality improvement teams; use of an external facilitator to support the implementation of the programme and finding innovative means to address lack of resources 1.3.3 A Standards-driven National Initiative to Improve the Quality and Expand the Coverage of Health Service Provision to Adolescents in United Republic of Tanzania Venkatraman Chandra-Mouli (WHO) The objective of this national initiative was to improve the quality and expand the coverage of an evidence-based package of health interventions in order to achieve clearly defined health outcomes in Tanzania The Ministry of Health had five objectives within the National Adolescent Health and Development Strategy 2004 - 2008 that aimed at improving the quality and expand the coverage by building on experiences gained within the country and establish the policy based on the national standards The first step when developing the national standards on adolescent friendly reproductive health services was to organize a working group, with a wide consultation of stakeholders, to draft the national standards A draft set of standards was developed, revised, finalized and approved Input and process indicators were developed for obtaining information and advice relevant to adolescent needs, circumstances and stage of development A handout and facilitator’s guide were developed to build a positive attitude and clinical / interpersonal competencies A lesson learned was that all levels of key stakeholders could either help or hinder the initiative, and thus, it is important to involve them In concluding remarks, Dr Chandra-Mouli indicated that the following questions need to be addressed during the expert review meeting: Why standards? Should they be internal or external? Who owns and who will translate standards into action? 1.4 Process to Develop HIV Care Standards Paul vanOstenberg (JCI) Dr van Ostenberg cautioned that standards will always be imperfect, thus it is best to reach consensus at a particular point in time, so that standards can be used and then, reviewed and revised regularly The basic guiding principles should always be acceptable, knowledgeable and evidence-based The standards developed should not re-state or duplicate what is in other documents and should state the target audience He pointed out that standardization is an on-going process He raised questions such as, how can one show an external evaluator that you have met standards? How you package the standards - is it in accreditation or other related programmes? WHO meeting report Montreux Nov 2007 10 Discussions suggested that it would be better to work with the existing standardization systems in the countries to improve the quality of services Session 2.1 Overview of Male Circumcision Standards Joanne Ashton (JCI) & Kim Dickson (WHO) In the Quality Assurance Guidance review meeting, Ms Ashton introduced the characteristics of good standards as being: Valid - Based on scientific evidence or other acceptable experience, expert consensus at a minimum  Reliable - Leads to the same result each time it is applied by anyone who uses it  Clear - Understood in the same way be everyone; not subject to misinterpretation  Realistic - Can be achieved with existing resources, suited to the setting  Measurable - Can be quantified or counted These criteria were suggested as a basis for reviewing the proposed male circumcision service standards  She also presented that standards can be written in a variety of formats e.g.; service or facility standards, protocols, procedures, algorithms, product specifications or clinical practice guidelines Standards need to be written down and communicated for health care workers to use them She highlighted the importance of an effective management system for overseeing the provision of male circumcision by mentioning the following key areas: supportive supervision; policies and procedures for service provision; policies to support client rights; complying with applicable laws and regulations and provision of services in an ethical manner The Proposed Male Circumcision Service Standards Ms Ashton presented the proposed male circumcision service standards (box 1) and suggestions for areas to be covered by the criteria Box Proposed Male Circumcision Service Standards WHO meeting report Montreux Nov 2007 11 Proposed Male Circumcision Service Standards Standard An effective management system oversees the provision of male circumcision services Standard A minimum package of male circumcision services is provided Standard Practitioners are qualified and competent Standard Assessments are performed to determine client needs Standard Clients are provided information and education for HIV prevention and male circumcision Standard Drugs, supplies and equipment necessary for providing essential male circumcision services are available Standard Male circumcision surgical care is delivered according to evidence-based guidelines Standard Infection prevention and control measures are practiced Standard Continuity of care is provided Standard 10 A system for monitoring and evaluation is established 2.2 Group Discussions and General Comments: Male Circumcision Standards Meeting participants formed three groups which each included a mix of programme managers, surgeons, and quality experts to review and make recommendations regarding the proposed standards Nine of the standards were reviewed on day (3 per group) Standard (related to provider competency) was set aside for discussion on day two A plenary session was held to discuss the proposed changes and come to agreement on the standards The key issues and points discussed were the following:  Communities should be provided with a clear message that male circumcision is an additional HIV prevention strategy  Training of other health care providers on male circumcision competencies should be encouraged rather than focusing on surgeons and doctors only (Two examples were provided, e.g Zambia trains nurses while Kenya trains medical assistants’ in performing male circumcision)  A proper reporting system is required for sustainability of the programme  Cost implications to clients need to be considered in the low resource countries A suggestion was made that male circumcision programmes should be integrated with other HIV prevention services; and that governments should provide either free services or at a minimum subsidized affordable price Governments should also have a separate WHO meeting report Montreux Nov 2007 12  budget and mobilize resources from other donors locally and internationally A suggestion was made for the change of the document title to "Guide for Safe, Quality Male Circumcision Services"  It was suggested that the Guide should be written with as little jargon as possible, avoiding the use of acronyms The ten standards were accepted with minor revisions to the wording Each of the three groups developed criteria for their allocated standards reviewed Day Session 3.1 Provider Certification Experiences: JHPIEGO Peter Johnson (JHPIEGO) Dr Johnson presented the goal of certification as ensuring health care providers are capable of offering safe and effective services He presented that capability requires development and maintenance of competence (what one needs to be able to meet the standards) He indicated that there are three types of competency measurements that included: knowledge measured by using objective tests; skills measured using checklists and attitude measured using role play or simulation Monitoring should be across the continuum of care from training to performance support The certification principles were highlighted JHPIEGO has learnt that they must: have an externally driven process; consist of validated measures; be monitored by a neutral party; be transparent to all stakeholders and have a provision for certification of new providers versus experienced ones He finalized his presentation by highlighting certification considerations including working within the scope of practice towards achieving competency He pointed out individual capability as compared to a team Certification should not be cadre dependent; although sometimes task shifting of providers can result in political tension 3.2 Discussion on Male Circumcision Provider Certification Kim Dickson (WHO) Dr Dickson reviewed the section of the Guide regarding male circumcision provider certification She requested that the small group discussions regarding provider competencies focus on standard and the organization and contents of the table of competencies The participants then went back to their allocated groups to review standard on provider competency and the section on provider certification Following the small group work, a discussion was held regarding certification of service providers Each of the groups gave their feedback on standard WHO meeting report Montreux Nov 2007 13 and on the section reviewed Key issues and recommendations included the following:  Recommend the training of non physician providers and outline the key competencies that need to be met to be a skilled male circumcision provider  Focus of this section to be on assessing and improving competencies rather than certification  Re-order the providers section to include the following key components in the certification: competency assessment, competency-based training, tasks and providers, certification process and level of health care provider  The need to involve in-country certifying bodies in taking the decision to train non-physician providers was mentioned  Male circumcision should be incorporated in pre-service training programmes, physicians and mid-level providers  The use of country experiences was suggested as a means of describing how to operationalise male circumcision services Competency-based training was pointed out as an important element  The groups felt that the competency table should be re-categorized into sections: counselling, assessment, surgery, record keeping, quality assurance and safety It was summed up that there should be surety that competencies within the minimum package are covered and everyone within the team receives training on all aspects of the minimum package Competency-based training was also recommended to be included in the Guide under provider certification Session 4.1 Overview of Accreditation Joanne Ashton (JCI) A definition was provided that accreditation is “a programme in which trained external peer reviewers evaluate a health care organization's compliance with pre-established performance standards” Accreditation addresses the health facility rather than individual practitioner’s capability and performance Examples of accreditation programmes were presented: Baby-friendly Hospitals by UNICEF, NAFCI in South Africa and PROQUALI in Brazil Although accreditation has proven to be a successful approach to measuring quality, issues associated with implementing and maintaining accreditation programmes were pointed out such as the need for financial resources, establishing an accreditation body, conducting an external assessment, and whether accreditation should it be compulsory or voluntary 4.2 Male Circumcision Accreditation Discussion A discussion was held regarding accreditation as a quality approach The general recommendation was that the document be revised to reflect that accreditation was just one method of quality assessment and other methodologies needed to be included WHO meeting report Montreux Nov 2007 14 4.3 Summary of Recommendations and Next Steps Dr Dickson reviewed the recommendations as set forth by the group and summarized them as follows: Key Recommendations: General  There was general agreement that the document should be revised to focus and give more attention to quality improvement and quality assurance of services and less on accreditation  Strengthen the section on quality assurance and ensure consistency with other WHO HIV quality assurance guidelines or documents  Outline other methodologies to measure quality other than accreditation and introduce a table that compares the methodologies giving the advantages and disadvantages of each of the methods  Introduce a new section outlining national and district level guidance, which will include information on: - Community involvement - Communication - Human resources and staffing - Costing of services Standards  The standards were accepted with suggestions for some rewording and revision to suit the developed criteria Certification of Providers  Recommend the training of non physician providers and outline the key competencies that need to be met to be a skilled male circumcision provider  Focus of this section to be on assessing and improving competencies rather than certification  Re-order the providers section to include the following key components in the certification: competency assessment, competency-based training, tasks and providers, certification process and level of health care provider  Involve the in-country certifying bodies in decision making to train nonphysician service providers  Include operationalization of certification (certification process) with illustrative approaches added in the manual  Create a competency table to ensure coverage of all activities (basic training on minimum package for all and competencies of managers) and re-order to the following headings: counselling, assessment, surgery, record keeping, quality assurance and safety Accreditation  Introduce a section on quality assessment that focuses on different evaluations of quality WHO meeting report Montreux Nov 2007 15   Cut down the section on accreditation and refer to WHO and other accreditation documents available Encourage national governments to use standardization or accreditation bodies within their countries Next Steps: Dr Farley outlined the next key steps:  Revise the Quality Assurance Guidance and send a revised draft to participants by end December 2007  Pilot the Quality Assurance document in or countries by early 2008 Swaziland, Zambia and Kenya agreed to be pilot countries  Convene a regional meeting on Quality Assurance document by nd quarter of 2008  Develop a male circumcision services quality assessment tool WHO meeting report Montreux Nov 2007 16 Appendix 1: Agenda WORLD HEALTH ORGANIZATION Male Circumcision Quality Assurance Guidance Expert Review Meeting 12 - 13 November 2007 Golf Hotel, Montreux, SWITZERLAND Agenda Day 1: 12 November 0830 - 0900 0900 - 0915 0915 - 0925 Presenter/Facilitator Registration Welcome and Introductions Introductory Remarks Objectives, desired outcomes of the meeting, review of agenda Session Quality Assurance 0925 - 1000 Overview of Quality Assurance (20 mins) Tim Farley(WHO) Kim Dickson (WHO) Joanne Ashton (JCI) Discussion 1000 - 1035 Overview of the Draft WHO Male Circumcision Quality Assurance Guide and summary of reviewers feedback Julie Samuelson (WHO) Discussion 1035 - 1055 Tea Break 1055 - 1230 Country experiences with quality improvement programmes and standards setting  PROQUALI - Brazil  NAFCI -South Africa  Youth friendly service standards  HIV standards Edgar Necochea (JHPIEGO) Kim Dickson (WHO) Venkatraman Chandra-Mouli (WHO) Paul van Ostenberg (JCI) Discussion Session Male Circumcision Service Standards 1230 - 1310 Overview of male circumcision standards Joanne Ashton (JCI) Kim Dickson (WHO) Discussion 1310 - 1420 Lunch 1420 - 1430 Introduction to Group work 1430 - 1630 Group Work: Review of male circumcision standards 1630 - 1700 Tea Break 17:00 - 1830 Group feedback Discussion and agreement on standards 1830 Close for the day WHO meeting report Montreux Nov 2007 17 WORLD HEALTH ORGANIZATION Male Circumcision Quality Assurance Guidance Expert Review Meeting 12 - 13 November 2007 Golf Hotel, Montreux, SWITZERLAND AGENDA Day 13 November 0830 - 0835 Session 0835 - 0900 Review of Day and plan for Day Certification of Providers Provider certification experiences  JHPIEGO Presenter/Facilitator Kim Dickson (WHO) Peter Johnson (JHPIEGO) 0900 - 1025 Discussion of male circumcision provider certification 1025 - 1030 Introduction to group work 1030 - 1100 1100 - 1210 Tea Break Group Work: Male circumcision provider certification 1210 - 1300 Group Feedback 1300 - 1410 Session 1410-1445 Discussion and agreement on provider certification Lunch Accreditation Overview of Accreditation Joanne Ashton (JCI) 1445 - 1520 Discussion Summary of recommendations Kim Dickson (WHO) 1520 - 1530 1530 Next steps and closure Close of the meeting WHO meeting report Montreux Nov 2007 Kim Dickson (WHO) Tim Farley (WHO) 18 Appendix 2: List of Participants WHO Expert Review of Male Circumcision Quality Assurance Guidance 12-13 November 2007 Golf Hotel, Montreux, Switzerland Melanie C Bacon NIAID/DAIDS/BSP/Epidemiology Branch National Institutes of Health USA David Benton International Council of Nurses (ICN) Switzerland Naomi Bock High Risk Sexual Transmission Team HIV Prevention Branch, Global AIDS Program Centers for Disease Control and Prevention (CDC) USA Peter Cherutich National HIV/AIDS and STD Control Programme (NASCOP) Ministry of Health Kenya Adam Groeneveld Urologist, Mbabane Government Hospital Swaziland Tim Hargreave Consultant Murrayfield Hospital Scotland Peter Johnson Director for Global Learning Johns Hopkins University - JHPIEGO USA Didier M Kangudie Programmes Coordinator IntraHealth International Namibia WHO meeting report Montreux Nov 2007 19 Harrison Kiambati Ministry of Health Kenya Samuel Magagula Deputy director of Health Services Ministry of Health Swaziland Palesa Mohaleroe Surgeon M&H Mediclinic Lesotho Jeckoniah O Ndinya-Achola Department of Medical Microbiology College of Health Sciences University of Nairobi Kenya Edgar Necochea Director for Human and Organizational Performance Johns Hopkins University - JHPIEGO USA Paul van Ostenberg Executive Director Standards Development and Interpretation Joint Commission International (JCI) USA Stephen Watya Senior Consultant Surgeon (Urology) Mulago Hospital Department of Surgery Uganda Kwaku Yeboah Director, Prevention and Mitigation Family Health International (FHI) USA UN Agencies David Alnwick Regional Adviser, HIV/AIDS UNICEF Eastern and Southern Africa Regional Office (ESARO) Kenya V Chandra-Mouli Coordinator, Adolescent Health and Development (ADH) World Health Organization Switzerland WHO meeting report Montreux Nov 2007 20 Meena Cherian (unable to attend) Medical Officer Clinical Procedures (CPR) Essential Health Technologies (EHT) World Health Organization Switzerland Francis Hyera WHO Consultant South Africa Kirsty McHarry IMAI Team for Health Systems Strengthening Department of HIV World Health Organization Kenji Tamura AIDS Medicines and Diagnostics Services SSH HIV Department, World Health Organization, Switzerland Meeting Secretariat Joanne Ashton Consultant Joint Commission International USA Kim Eva Dickson Medical Officer Prevention in the Health Sector (PHS) Department of HIV World Health Organization Switzerland Tim Farley Controlling Sexually Transmitted and Reproductive Tract Infections (STI) Department of Reproductive Health and Research (RHR) World Health Organization Switzerland Julie Samuelson Controlling Sexually Transmitted and Reproductive Tract Infections (STI) Department of Reproductive Health and Research (RHR) World Health Organization Switzerland WHO meeting report Montreux Nov 2007 21 ... Work Plan on Male Circumcision and HIV is gratefully acknowledged Executive Summary A World Health Organization (WHO) Male Circumcision (MC) Quality Assurance Guidance Expert Review Meeting was... and quality services An expert review was convened in Montreux, Switzerland on the 12th and 13th November 2007 to review the draft Male Circumcision Quality Assurance Guidance Approximately 30 experts...    To review and discuss the draft male circumcision quality assurance guidance document; To agree on standards for male circumcision services; and To agree on standards for male circumcision