COPEÂ® FOR MALE CIRCUMCISION SERVICES - EngenderHealth

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COPE for Male Circumcision Services been applied to many different health services, from family planning to maternal and child health services, to infection prevention practices, and to HIV prevention, care, and treatment services for all staff in a health care setting. ■ COPE helps facility managers work more effectively. Although service managers may initially find introducing COPE and QI to be time-consuming, once staff become involved in solving day-to-day problems on their own, managers generally find that they have more time to focus on major problems. ■ COPE helps reduce costs associated with poor quality. If something is not done correctly the first time, it must be fixed, often repeatedly. Moreover, the consequences may be serious, in terms of both cost and the health of individuals and the community. COPE helps reduce the cost of poor quality by assisting staff to identify and solve problems, focusing on processes and systems to prevent problems from occurring in the future. Implementing COPE A brief overview of the COPE process, including a description of each of these tools, is presented below. For a detailed explanation of the COPE process and of the use of each tool, please refer to the COPE Handbook, the reference and “how-to” manual that accompanies this toolbook. Getting Started Before conducting COPE, facilitators should read through the COPE Handbook in its entirety and become familiar with the process and the tools. The initial COPE exercise takes place over a period of two to three days. Follow-up exercises should be conducted every three to six months thereafter and take two or three days to complete, depending on whether the facility opts to perform a Client-Flow Analysis. (For an overview of the COPE process, see Figure 3, p. 8.) When conducting COPE for MC services, it is important to remember that, like other areas related to HIV and AIDS (keep in mind that many men will seek circumcision for prevention of HIV infection), MC services need to address potential stigmatization that often occurs in HIV services. The Facilitator When health care management decides to introduce COPE at a facility or in some other service setting for the first time, they should seek help from an experienced COPE facilitator. This is usually an external facilitator (from the Ministry of Health, a nongovernmental organization, or a technical assistance agency) who has been trained in COPE and has experience with implementing it. During the initial exercise and the first follow-up exercise, a staff member from the site receives on-the-job training to become a site facilitator. With the assistance of the external facilitator (if needed), the site facilitator will be responsible for organizing all subsequent COPE exercises at the site, together with the QI committee. The committee plays a key role in making QI an ongoing responsibility and the focus of the daily work of staff at all levels. If there is already a QI committee, the ongoing monitoring of COPE activities should be added to its responsibilities. 6 <strong>EngenderHealth</strong>
The Participants COPE for Male Circumcision Services Improving quality is the responsibility of all staff at a facility or in any other service setting; therefore, it is important that a broad range of staff participate in the COPE exercise. This includes manager(s), administrator(s), supervisor(s), service providers, nurses, medical assistants, counselors, health educators, laboratory staff, administration staff, receptionists, guards, cleaning staff, supplies staff, and other support staff, as well as staff from wards or departments that typically refer clients to the service setting. When a staff member is the sole representative from his or her department, it should be made clear that he or she is responsible for sharing information about quality with colleagues and for taking the lead in implementing quality changes together with co-workers. Preparing for a COPE Exercise Through site visits or correspondence, the external facilitator should use the time leading up to the initial COPE exercise to do the following: ■ Build consensus with key managers, QI committee members, and other key staff about the importance of QI and about their support of and commitment to the QI process ■ Discuss with the key staff the site’s strengths ■ Orient site managers and QI committee members to COPE and to their role in the COPE process ■ Gather information about the site ■ Instruct management on selecting staff participants and a potential site facilitator for follow-up COPE exercises ■ Schedule the COPE exercise and discuss all logistics ■ Inform and invite participants ■ Prepare materials for the exercise For follow-up COPE exercises, the external or site facilitator should schedule the exercise, prepare the materials, and help the administration select staff participants. The Introductory Meeting Each COPE exercise begins at an Introductory Meeting, during which the COPE facilitator explains the QI process, defines quality services, and explains the COPE process and tools to all participants. The facilitator and the participants then form teams to work with each of the COPE tools. The Four COPE Tools The COPE tools—practical and easy-to-use data collection and analysis forms—are designed to be flexible, so that each site can adapt them to meet its particular needs. The tools, described in detail below, include Self-Assessment Guides, a Client Interview Guide, forms needed to conduct a Client-Flow Analysis, and a form for the Action Plan. ■ Self-Assessment Guides. The 10 COPE Self-Assessment Guides are organized on the framework of clients’ rights and staff needs. Each guide consists of a series of yes-no questions related to the quality of MC services in the context of one of the clients’ rights or staff needs identified as critical to high-quality care (see Figure 1, p. 8). “No” answers <strong>EngenderHealth</strong> 7
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