Background: To control the HIV epidemic among 15-49 year olds, the Mozambique Ministry of Health (MOH) aims to offer voluntary medical male circumcision (VMMC) to 2 million men by 2018. Despite availability of VMMC services in Manica and Tete provinces since 2012, a high site level provision of VMMC to males had not been achieved. In 2015, efforts were made to act on external quality assessment (EQA) recommendations to increase availability and quality of VMMC services.
Description: VMMC sites received MOH and partners'' support in using site specific action plans to address the gaps identified. Redistribution of staff (providers, counsellors and mobilizers) within sites and recruitment of additional staff was done to match the defined site-staffing needs based on bed capacity. All staff members were retrained on client-provider interaction, focusing on barriers to service uptake, VMMC follow-up rates and wound care. USAID''s VMMC Site Capacity and Productivity Assessment Tool was used to analyse data from 2015 to 2017. The number of males receiving VMMC rose from 21,824 to 100,636. The proportion of 15 to 29 years old males receiving VMMC increased from 45% to 58%. Achievement of targets increased from 34% to 105%. Despite the rise in volumes of clients served, adverse event rates were stable at below 2%.
Lessons learned: Several interventions accounted for the considerable increase in uptake and production of the VMMC services: i) Optimising staff availability at each site to match site capacity, ii) Redistribution and retraining of all VMMC staff on communication with clients, at all stages of the VMMC services, from early mobilization to post-surgery follow-up; iii) Intense supervision, data monitoring and data-based decision making to fine-tune the activities, iv) Opening services on Saturday to extend services for those clients not able to reach services during the week and; v) a spirit of collaboration and cooperation among all players in using analysed data to improve on gaps identified.
Conclusions/Next steps: High site productivity which was observed as increased uptake of services among 10-29 years olds is critical for achieving efficiency within VMMC programs. Lessons from the Manica and Tete VMMC program can assist other programs to improve site performance.

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