MINISTRY OF HEALTH
MINISTRY OF HEALTH
PERFORMANCE BASED FINANCING UNIT
QUARTERLY QUALITY ASSESSMENT GRID FOR HEALTH CENTERS
RWANDA 2008
CONTENTS
INTRODUCTION TO QUARTERLY QUALITY ASSESSMENT 3
1 Contractual approach 3
1.1 Definition 3
1.2 Purpose 3
1.3 Basic principles 3
2 Health Center Assessment 3
2.1 Assessment tools 3
2.1.1 Monthly statement 3
2.1.2 Quarterly health center quality assessment grid 3
2.2 Evaluator profile 4
2.2.1 Instructions and profile for selecting the evaluator of the monthly statement 4
2.2.2 Instructions and profile for selecting the evaluator of the quarterly quality assessment grid 4
3 Quarterly quality assessment (grid) 5
3.1 Organization of the quarterly quality assessment 5
3.1.1 Assessment Schedule 5
3.1.2 Assessment Roll-out 5
3.2 Documentation 5
3.3 Use of the quarterly quality assessment grid 6
3.4 Sampling indicators 8
3.4.1 Document analysis 8
3.4.2 Direct observation 8
3.5 Allocation of points 8
QUARTERLY HEALTH CENTER QUALITY ASSESSMENT GRID 9
GENERAL INFORMATION 9
QUARTERLY SUMMARY OF QUALITY ASSESSMENT OF HEALTH CENTER ACTIVITIES 13
QUARTERLY SUMMARY OF OBSERVATIONS AND RECOMMENDATIONS CONCERNING HEALTH CENTER SERVICES 14
1. GENERAL ORGANIZATION (26) 15
2. HYGIENE AND SANITATION (14) 18
3. PRIMARY HEALTH CARE (PHC) AND HOSPITALIZATION (85) 21
4. MATERNITY (65) 24
5. PRENATAL CONSULTATION (63) 26
6. FAMILY PLANNING (57) 30
7. VACCINATION (35) 32
8. GROWTH MONITORING (26) 35
9. HIV PREVENTION (45) 38
10. TUBERCULOSIS (14) 41
11. LABORATORY (15) 43
12. PHARMACY MANAGEMENT (30) 45
13. FINANCIAL MANAGEMENT (25) 48
INTRODUCTION TO QUARTERLY QUALITY ASSESSMENT
1. Contractual approach
1. Definition
The contractual approach is a performance-based financial strategy aimed at enhancing the quantity and quality of preventive and curative public health care, in compliance with set standards, through “health care purchasing” guaranteed by a contract between the funding party (buyer) and the service provider (seller).
2. Purpose
To improve the health care provided to the population at health care facilities.
3. Basic principles
The funds derived from the remuneration of health care services are used to strengthen the capacities of health facilities – their operation, staff training, performance-based rewards, and the financing of all other strategies aimed at improving the quality and quantity of health care.
2. Health Center Assessment
1. Assessment tools
1. Monthly statement
The monthly statement of activities to be subsidized at health centers is a quantitative assessment of 14 indicators chosen from among the PMA (basic packet of health services) indicators. This quantity is validated against specific criteria and based on a review of documentation (data collected from charts and registers).
2. Quarterly health center quality assessment grid
The quarterly health center quality assessment grid is a tool that makes it possible to rate technical quality on the basis of direct observation and a document review of 13 PMA activities including HIV. The evaluation is done on a quarterly basis, with a monthly statement, and the quality score is established at the end of the quarter being assessed.
The quality score obtained from the quarterly assessment grid is applied to the validated quantitative results in the monthly statements.
2. Evaluator profile
To ensure that the data and results of the monthly statements and quarterly quality assessments are reliable, an evaluator profile and criteria have been established. The steering committee’s validation of the data in the monthly statements and the quarterly quality grid must take into account compliance with these indicators and profiles.
1. Instructions and profile for selecting the evaluator of the monthly statement
▪ The steering committee, chaired by the Director of the Family Health Unit, is responsible for selecting evaluators (as established in the steering committee’s terms of reference.
▪ Evaluators may be selected from among the members of the steering committee, of the unit responsible for health, promoting the family, and protecting the rights of the child, or from among members of the hospital staff.
▪ Evaluators must be selected in accordance with the following profile and be approved by the steering committee:
➢ Minimum level: A1 or A2;
➢ At least one year’s experience in the health field;
➢ Training or mentoring in the use of the monthly statement.
2. Instructions and profile for selecting the evaluator of the quarterly quality assessment grid
▪ The Director of the hospital is responsible for selecting evaluators from among hospital supervisors. The steering committee approves the evaluators.
▪ The team must be permanent and clearly identified.
▪ Evaluators must meet the following profile:
➢ Minimum level: A1 or A2 in the health field
➢ At least 2 years’ experience in the health field
➢ Versatile (capable of assessing a number of PMA activities)
➢ Training or mentoring in the supervision and use of the quarterly quality grid.
3. Quarterly quality assessment (grid)
1. Organization of the quarterly quality assessment
1. Assessment Schedule
The assessment is conducted on a quarterly basis, with monthly vouchers. Each of the 13 activities is assessed once a quarter.
2. Assessment Roll-out
• Assessments are unannounced, without any prior notification of the health center team..
• The evaluator’s visit is planned on the day when the assessment is to take place..
• The evaluator works with the person responsible for the activity (for the case observation segment) or with the head of the service, or a replacement (for the document segment).
• Following the assessment, the data are approved with the names and signatures of the head of service (or a replacement), the relevant official (or a replacement), and the evaluator.
• Following the assessment, the team of evaluators takes the time to discuss with the official and the available staff members the positive points of the assessment and the areas to be improved. After this discussion, the evaluation team, together with the official and the staff members present, shall make recommendations, including those requiring technical supervision.
• A copy of the assessment results is given to the health center and to the hospital for analysis, compilation, and classification;
• After all 13 activities have been assessed, the whole team of evaluators prepares a summary of the quarterly assessment of the health center and presents it to the person responsible for monitoring and evaluation in the health center..
• The original copy of the complete assessment of the health center is submitted to the focal point of the steering committee (responsible for district health and hygiene).
2. Documentation
The health center is responsible for making available and accessible all current regulatory documents from the Ministry of Health, such as norms, standards, flow charts, protocols, and directives. This documentation is to be available at all times to the staff of the health center and to the evaluation team during its visits.
3. Use of the quarterly quality assessment grid
The quarterly assessment, with monthly vouchers, has five parts:
General information
▪ Identification of the health center
▪ Information on assessments
▪ Information on quarterly activities
o Quarterly summary of quality assessment of health center activities
This page of the assessment is presented in the form of a table with 7 columns.
▪ 1st column: Activity number
▪ 2nd column: Activities to be assessed
▪ 3rd column: Points possible (total number of points for each activity assessed)
▪ 4th column: Points awarded to each activity (total points obtained for each activity)
▪ 5th column: Gap (= points available less points awarded)
▪ 6th column: Percentage (points awarded/points available x 100)
▪ 7th column: Remarks (explanations of the gap)
o Quarterly summary of observations and recommendations concerning health center services
This page contains four lines:
▪ 1st line: Recommendations from the previous quarter that have not been implemented and explanation
▪ 2nd line: Strong and weak points identified during the current quarterly evaluation
▪ 3rd line: Recommendations concerning weak points
▪ 4th line: Recommended technical supervision
For the assessment to be valid, this summary page must be signed by the person responsible for monitoring and evaluation in the district hospital or a replacement.
o Checklist for assessment of activities
The checklist for assessing activities is presented in the form of a table with six columns.
▪ 1st column: Activity number
▪ 2nd column: Checklist Items
The items on the checklist make it possible to assess the quality of execution of the activity. These items are evaluated by analyzing documents and by direct observation.
▪ 3rd column: Scoring instructions
The scoring instructions explain how to evaluate and score each item.
▪ 4th column: Maximum possible score
▪ 5th column: Score obtained
The score obtained is the result of the evaluation of the checklist item on the basis of the scoring instructions.
▪ 6th column: Scoring justification
The scoring justification explains the reasons for the difference between the maximum possible score and the score obtained.
o Summary of observations and recommendations concerning the activity
A summary page containing four lines follows the assessment of each activity .
▪ 1st line: Recommendations from preceding quarter that were not implemented and an explanation
▪ 2nd line: Strong and weak points identified during the assessment of this activity
▪ 3rd line: Recommendations concerning weak points
▪ 4th line: Recommended technical supervision
For this quarterly assessment to be validated, all summary pages must be signed by the evaluator, the person (or replacement) responsible for the activity, and the relevant official (or replacement).
4. Sampling indicators
The choice of cases to be studied is made using a probability-based methodology.
1. Document analysis
o Number of cases to be selected
The number of charts to be selected, or the sample, is established at 10 cases out of the total number. For activities where there are fewer than 10 cases, the evaluator will examine all cases.
o Choice of cases
The random sampling method is used to select the number of cases to be analyzed. Systematic random sampling consists of calculating the sample interval (k) by dividing the total number of cases (N) by the number of cases to be selected (10) and rounding to the nearest whole number.
To determine the first chart to be selected from the register, the evaluator randomly selects a number between 1 and (k), which then becomes the first file. The evaluator then adds (k) to select the following file, and so on.
Where a case number is missing, the evaluator will replace it by the following case.
For example:
➢ Health center with 50 family planning (FP) consultations found in the records.
➢ Number of cases to be selected from the records = 10 cases, to which the quality control standards will be applied.
➢ Sample interval (k) = 50/10 = 5.
➢ The evaluator randomly selects a number between 1 and 5 (e.g., 5). The proposed number represents the first file.
➢ After file 5, every fifth file is selected until 10 files have been selected (e.g. the second file is 10, the third is 15, etc.).
2. Direct observation
The number of cases to be observed for each activity is indicated in the grid. If the number of cases required is not found at the time of the assessment visit, the activity will have to be studied during the next visit to assess the remaining cases needed to complete the sample of 10.
5. Allocation of points
The total number of points (500) for the 13 activities to be assessed was allocated by using a ranking procedure based on national prioritization criteria and known problems in the field that might be resolved by performance-based financing (PBF). The elements of each activity were scored by taking into account their relative comparative importance. .
QUARTERLY HEALTH CENTER QUALITY ASSESSMENT GRID
GENERAL INFORMATION
▪ IDENTIFICATION OF HEALTH CENTER
|Name of health center: |
|Sector: |District : |Province : |
|Telephone: |Fax : |P.O. Box: |
|Status: Public □ Accredited □ Private:□ Partner: |
|Population served: |Number of beds: | |
|Name of official: |Telephone: |
|P.O. Box: |Email: |
▪ INFORMATION REGARDING ASSESSMENTS
|Name of evaluating hospital for the quarter: |
|Activities or services to be assessed|Date of previous|Date of current |First and last name of evaluator |Function of evaluator or hospital |Time assessment began |Time assessment ended |
| |assessment |assessment | |service | | |
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▪ TRAINING DURING QUARTER
|Category |Total number |Training topics during relevant quarter |Trainers |Number of staff trained |
|Social worker | | | | |
|Assistant | | | | |
|Lab assistant | | | | |
|Data administrator | | | | |
|Nurse A0 | | | | |
|Nurse A1 | | | | |
|Nurse A2 | | | | |
|Nurse A3 | | | | |
|Lab technician A1 | | | | |
|Lab technician A2 | | | | |
|Lab technician A3 | | | | |
|Physician | | | | |
|Nutritionist A1 | | | | |
|Nutritionist A2 | | | | |
|Pharmacy manager | | | | |
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QUARTERLY SUMMARY OF QUALITY ASSESSMENT OF HEALTH CENTER ACTIVITIES
|QUALITY ASSESSMENT of health center ____________________________ District ___________________________________________________ |
|________________QUARTER 200___ |
|No. |ACTIVITY ASSESSED |Points possible |Points awarded |Gap |% |Remarks |
|1 |General |26 | | | |
| |organization | | | | |
QUARTERLY SUMMARY OF OBSERVATIONS AND RECOMMENDATIONS REGARDING HEALTH CENTER SERVICES
|District ___________________________ Health center _______________________________ Date _______________________ |
|Recommendations from preceding quarterly assessment not implemented, and explanation |
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|Strong and weak points identified during current quarterly assessment |
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|Recommendations concerning weak points |
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|Recommended technical supervision |
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____________________________________________________ ___________________
Signature of monitoring and evaluation official Date
|1. GENERAL ORGANIZATION (26) |
|No. |CHECKLIST ITEMS |SCORING INDICATORS |MAXIMUM POSSIBLE SCORE |SCORE OBTAINED |SCORING JUSTIFICATION |
|1. |Available minutes of the three previous monthly meetings of the |Minutes fulfilling all |3 | | |
| |health center board of directors. Minutes should contain: 1) |criteria = 1 | | | |
| |date, time of opening and closing of meeting 2) program or | | | | |
| |agenda 3) signed list of persons present 4) account of meeting |Minutes with even one | | | |
| |a) adoption of minutes of previous meeting; b) statement of |criterion unmet = 0 | | | |
| |recommendations or actions of previous meeting; c) topics | | | | |
| |discussed, including the following: i) description of topic; ii)| | | | |
| |decisions or recommendations; iii) execution timetable; iv) | | | | |
| |person responsible; v) observation 5) signatures of chairman | | | | |
| |and secretary. | | | | |
|2. |Available minutes of past three monthly meetings on analysis of |Minutes fulfilling all |3 | | |
| |community data with social workers. Minutes should contain the |criteria = 1 | | | |
| |elements listed under item 1 of the checklist. | | | | |
| | |Minutes with even one | | | |
| | |criterion unmet = 0 | | | |
|3. |Monthly analysis report of Health Information System (HIS) data |Analysis report of data on 6 |3 | | |
| |on priority problems (Vaccination, PHC, FP, maternity, malaria, |priority problems containing | | | |
| |HIV and other priority diseases in the region) containing: 1) |all elements = 1 | | | |
| |Graph or table of data 2) Comments on implementation of | | | | |
| |activities as compared with targets. |Report with even one element | | | |
| | |missing = 0 | | | |
|4. |Available minutes of the three previous monthly meetings of the |Minutes fulfilling all |3 | | |
| |quality improvement team. Minutes should fulfill the criteria |criteria = 1 | | | |
| |listed under checklist item 1. | | | | |
| | |Minutes with even one | | | |
| | |criterion unmet = 0 | | | |
|5. |Available minutes of the three previous monthly staff meetings. |Minutes fulfilling all |3 | | |
| |Minutes should fulfill the criteria listed under checklist item |criteria = 1 | | | |
| |1. | | | | |
| | |Minutes with even one | | | |
| | |criterion unmet = 0 | | | |
|6. |Data concordance between 3 randomly selected HIS indicators and |Concordance of all three |2 | | |
| |activities records |indicators = 2 | | | |
| | |Even one non-concordant | | | |
| | |indicator = 0 | | | |
|7. |HIS report transmitted during the period (by the 5th working day|Acknowledgment of receipt of a|3 | | |
| |of following month) |report during the period = 1 | | | |
|8. |Inventory of equipment and supplies for each service, updated |All inventories present and |1 | | |
| |monthly |up-to-date = 1 | | | |
| | |Missing or obsolete inventory | | | |
| | |= 0 | | | |
|9. |Services available with staff on duty 24/7, including holidays |Posted duty list and schedule |2 | | |
| | |= 2 | | | |
|10. |Reception: 1) Covered waiting rooms complete with chairs or |One element present = 1 (max.|3 | | |
| |benches; 2) A system of waiting room numbers and guidance in |3 elements) | | | |
| |place 3) Staff member conducting triage according to seriousness| | | | |
| |of problem and waiting room number | | | | |
| |MAXIMUM POSSIBLE SCORE = 26 |SCORE | |
| | |OBTAINED = | |
SUMMARY OF OBSERVATIONS AND RECOMMENDATIONS REGARDING THE GENERAL ORGANIZATION OF THE HEALTH FACILITIES
|District ___________________________ Health center _______________________________ Date _______________________ |
|Recommendations from preceding quarterly assessment not implemented and an explanation |
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|Strong and weak points identified during current quarterly assessment |
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|Recommendations concerning problems identified |
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|Recommended technical supervision |
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______________________________ _________ ______________________________ _______ _________________________________ __________
Signature of evaluator Date Signature of head of service Date Signature of official Date
|2. HYGIENE AND SANITATION (14) |
|No, |CHECKLIST ITEMS |SCORING INDICATORS |MAXIMUM POSSIBLE SCORE |SCORE OBTAINED |SCORING JUSTIFICATION |
|DIRECT OBSERVATION |
|1. |Presence of cleaning products: Supply record cards indicating |Supply record cards correspond|1 | | |
| |amounts in and out correspond to physical supplies (soap, |to physical supplies = 1 | | | |
| |bleach, chloramine, chlorexidine, and at least one detergent) | | | | |
|2 |Reserve of disinfectants, solution formulas posted, and supplies|Product present, formula |1 | | |
| |used (if any) soaked in disinfectants in treatment rooms, |posted, and supplies used (if | | | |
| |maternity wards, and laboratories |any) soaked in disinfectant | | | |
| | |solutions = 1 | | | |
|3 |All beds having mattresses covered with impermeable plastic |Number of mattresses covered |1 | | |
| |intact |with plastic corresponding to | | | |
| | |number of beds = 1 | | | |
|4 |Cleanliness of rooms, halls, and grounds: 1) presence of trash |Each cleanliness criterion |2 | | |
| |receptacles (in waiting room and corridor) 2) no loose trash;3) |fulfilled = 0.5 | | | |
| |receptacles for syringes present in treatment rooms 4) grounds | | | | |
| |surrounding health center entirely cleared of brush and stagnant| | | | |
| |water drained | | | | |
|5 |No organic waste, syringes, or dangerous products in halls, |Yes = 1 |1 | | |
| |rooms, or any other location on the grounds of the health |Presence of organic waste or | | | |
| |center that are easily accessible to the public |used syringes, needles or used| | | |
| | |bandages = 5-point penalty | | | |
|6 |Functioning incinerator: operated and used according to the |Functioning incinerator used |1 | | |
| |rules (triage and destruction, etc.) |in accordance with regulations| | | |
| | |= 1 | | | |
|7 |Placenta pit with slab and cover |Yes = 1 |1 | | |
|8 |Availability of water source (running water or well, pump, or |Available water source = 1 |1 | | |
| |water tower/tank | | | | |
|9 |Water dispensers available in consultation and hospital rooms, |Available water dispensers = |1 | | |
| |in laboratory, and near latrines |1 | | | |
|10 |Presence of latrines and showers 1) usable; |All latrines fulfill criteria |2 | | |
| |2) no organic matter within or outside; 3) door that closes |= 1 | | | |
| |from the inside; 4) covered pit (for latrines) |All showers fulfill criteria =| | | |
| | |1 | | | |
|11 |Available and functional sterilization materials: cocotte, |At least one material |1 | | |
| |autoclave, or heat sterilizer |available and functional = 1 | | | |
|12 |Clean, neat uniforms worn by all staff |Uniforms worn by all staff = 1|1 | | |
| |MAXIMUM POSSIBLE SCORE = 14 |SCORE | |
| | |OBTAINED = | |
SUMMARY OF OBSERVATIONS AND RECOMMENDATIONS REGARDING HYGIENE AND SANITATION IN THE HEALTH CENTER
|District ___________________________ Health center_______________________________ Date _______________________ |
|Recommendations from preceding quarterly assessment not implemented and an explanation |
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|Strong and weak points identified during current quarterly assessment |
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|Recommendations concerning problems identified |
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|Recommended technical supervision |
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______________________________ _________ ______________________________ _______ _________________________________ __________
Signature of evaluator Date Signature of head of service Date Signature of official Date
|3. PRIMARY HEALTH CARE (PHC) AND HOSPITALIZATION (85) |
|No. |CHECKLIST ITEMS |SCORING INDICATORS |MAXIMUM POSSIBLE SCORE |SCORE OBTAINED |SCORING JUSTIFICATION |
|DIRECT OBSERVATION OF ONE RANDOMLY SELECTED TREATMENT ROOM |
|1 |Functional examination materials available in the treatment |Treatment room equipped with 8 |8 | | |
| |room: 1) thermometer 2) blood pressure monitor 3) stethoscope |functional materials = 8 | | | |
| |4) otoscope 5) gloves 6) scale 7) tongue depressor 8) |One material missing or | | | |
| |examination table |non-functional = 4 | | | |
| | |More than one material missing | | | |
| | |or non-functional = 0 | | | |
|2 |Privacy: Individual treatment room with curtains or painted |Assured privacy = 4 |4 | | |
| |windows, room divider (if shared room), doors that close | | | | |
|3 |Documentation for consultation available to provider: 1) |5 documents present in room = 8|8 | | |
| |Nursing flowchart; 2) MST flowchart 3) PNLIP fever flowchart 4)|1 document missing = 0 | | | |
| |National guidelines for management of malaria in Rwanda 5) TB | | | | |
| |Guide | | | | |
|ANALYSIS OF TREATMENT OF 10 CASES BY DIRECT OBSERVATION |
|4 |Treatment of 5 cases of children over age 5 according to |Correct entry and exit points |20 | | |
| |flowchart or protocol |according to flowchart or | | | |
| | |protocol =4 | | | |
|5 |Treatment of 5 cases of children under age 5 according to |Correct entry and exit points |25 | | |
| |flowchart or protocol |according to flowchart or | | | |
| | |protocol =5 | | | |
|ANALYSIS OF TREATMENT OF HOSPITALIZED CASES DURING PAST THREE MONTHS |
|6 |Proper treatment of 10 hospitalized cases (analysis of randomly|One case with all criteria |20 | | |
| |selected hospitalization records): 1) identification of patient|fulfilled = 2 | | | |
| |2) complaints or symptoms on admission 3) clinical examination | | | | |
| |guided by admission flowchart 4) laboratory tests 5) diagnosis|One case with even one | | | |
| |6) proper treatment according to flowchart or protocol 7) |criterion unmet = 0 | | | |
| |monitoring of vital signs 8) absence of danger signs 9) length| | | | |
| |of stay three days or less | | | | |
| | | |MAXIMUM POSSIBLE SCORE = |SCORE | |
| | | |85 |OBTAINED = | |
SUMMARY OF OBSERVATIONS AND RECOMMENDATIONS REGARDING THE PRIMARY AND CURATIVE CARE CONSULTATION SERVICE AND HOSPITALIZATION IN THE HEALTH CENTER
|District ___________________________ Health center_______________________________ Date _______________________ |
|Recommendations from preceding quarterly assessment not implemented and an explanation |
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|Strong and weak points identified during current quarterly assessment |
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|Recommendations concerning problems identified |
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|Recommended technical supervision |
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______________________________ _________ ______________________________ _______ _____________________________ __________
Signature of evaluator Date Signature of head of service Date Signature of official Date
|4. MATERNITY (65) |
|No. |CHECKLIST ITEMS |SCORING INDICATORS |MAXIMUM POSSIBLE SCORE |SCORE OBTAINED |SCORING JUSTIFICATION |
|1 |Privacy: Curtains or painted windows, room divider (if shared|Assured privacy = 7 |7 | | |
| |room), doors that close | | | | |
|2 |Available and functional equipment and supplies: 1) |One material available and |18 | | |
| |adjustable, clean delivery table 2) at least 3 sterilized |functional = 1 | | | |
| |instrument boxes (with needle holder, two Kocher clamps, | | | | |
| |serrated forceps, two prs. scissors) 3) neonatal aspirator 4)|If even one material (1) to (5) is | | | |
| |obstetrical stethoscope 5) suture thread, 6) light source |unavailable or non-functional = 0 | | | |
| |7) infant scale 8) sterilizing drum 9) ophthalmic ointment | | | | |
| |10) gauze drum 11) plastic apron 12) local anesthesia (at | | | | |
| |least 50ml in reserve) 13) infant ventilator 14) theater | | | | |
| |boots 15) mask 16) goggles 17) intact surgical gloves 18) | | | | |
| |umbilical cord clamp | | | | |
|ANALYSIS OF PARTOGRAMS FOR THE PREVIOUS THREE MONTHS |
|3 |Analysis of 10 randomly selected partograms: 1) Partogram |One partogram fulfilling 3 criteria |40 | | |
| |filled out according to the rules 2) Decision made if alert |= 4 | | | |
| |line is passed within one hour 3) Delivery by qualified staff| | | | |
| |(at least a nurse A2) |One partogram with even one unmet | | | |
| | |criterion = 0 | | | |
| | | |MAXIMUM POSSIBLE SCORE = 65|SCORE | |
| | | | |OBTAINED = | |
SUMMARY OF OBSERVATIONS AND RECOMMENDATIONS REGARDING THE MATERNITY SERVICE IN THE HEALTH CENTER
|District ___________________________ Health center_______________________________ Date _______________________ |
|Recommendations from preceding quarterly assessment not implemented and an explanation |
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|Strong and weak points identified during current quarterly assessment |
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|Recommendations concerning problems identified |
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|Recommended technical supervision |
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______________________________ _________ ______________________________ _______ _________________________________ __________
Signature of evaluator Date Signature of head of service Date Signature of official Date
|5. PRENATAL CONSULTATION (63) |
|No. |CHECKLIST ITEMS |SCORING INDICATORS |MAXIMUM POSSIBLE SCORE |SCORE OBTAINED |SCORING JUSTIFICATION |
|DIRECT OBSERVATION OF PRENATAL CONSULTATION ROOM AND EQUIPMENT |
|1 |Privacy: Individual consultation room with curtains or painted |Assured privacy = 2 |2 | | |
| |windows, room divider (if shared room), doors that close | | | | |
|2 |Available and functional equipment and supplies: 1) consultation|All materials available and functional =|3 | | |
| |table 2) blood pressure monitor 3) stethoscope 4) tape measure |3 | | | |
| |5) scale with height gauge 6) fetoscope 7) intact impermeable |One material lacking or non-functional = | | | |
| |gloves |0 | | | |
|DIRECT OBSERVATION OF PRENATAL CONSULTATION SESSION |
|3 |Group IEC/CCC: 1) group discussion prior to prenatal |IEC/CCC fulfilling all criteria = 3 |3 | | |
| |consultation 2) existence of up-to-date IEC report notebook |Even one criterion unmet = 0 | | | |
| |with: a) topic b) number of participants c) activity leader d) | | | | |
| |date and e) signature | | | | |
|4 |Consultation done by qualified staff (qualification: at least a |Yes = 2.5 |2.5 | | |
| |nurse A2) |No = 0 | | | |
|OBSERVATION OF 5 NEW REGISTRANTS (1ST VISIT) |
|5 |Questioning: 1) gynecological and obstetrical history |One case fulfilling all criteria = 1 |5 | | |
| |(gravida/para/abortus) including tetanus vaccine 2) convulsions |One case with even one unmet criterion = | | | |
| |3) medical and surgical history: a) diabetes b) heart disease c)|0 | | | |
| |hypertension d) kidney disease e)TB f) asthma 4) HIV testing | | | | |
| |(with guidance if appropriate) | | | | |
|6 |Physical examination 1) weight 2) height 3) blood pressure 4) |One examination with 5 elements = 1 |5 | | |
| |breast examination and 5) check for edema |One examination with even one missing | | | |
| | |element = 0 | | | |
|7 |Obstetric examination: 1) height of uterus 2) presentation (from|One examination of a case fulfilling the |5 | | |
| |36 weeks) 3) fetal heartbeat (from 20 weeks) 4) vaginal touch |criteria = 4 | | | |
| | |One examination of a case with even one | | | |
| | |unmet criterion = 0 | | | |
|8 |Supplementary examinations: Systematic check for: 1) urinary |One case with all supplementary |5 | | |
| |albumin 2) syphilis 3) hemoglobin |examinations = 1 | | | |
| | |One case with even one missing | | | |
| | |examination = 0 | | | |
|9 |Administration of tetanus vaccine according to guidelines: 1) |One case of administration of vaccine |2.5 | | |
| |correct intervals 2) unexpired vaccine 3) storage at vaccination|fulfilling all criteria = 0.5 | | | |
| |site in compliance with regulations 4) means of administering |One case with an unmet criteria = 0 | | | |
| |vaccine corresponds to instructions on vial and injection site | | | | |
| |is in compliance with regulations | | | | |
|10 |Correct prescription of: 1) iron for women who are HIV-negative |One case with all prescriptions given |5 | | |
| |or whose HIV status is unknown 2) folic acid 3) mebendazole |correctly =1 | | | |
| |(from second trimester) 4) SP DOT (from 4th month) 5) |One case with even one incorrect | | | |
| |insecticide-treated mosquito nets |prescription = 0 | | | |
|11 |Risk-based management: 1) risk factors identified 2) appropriate|Management of one case fulfilling all |5 | | |
| |decision taken according to PNC chart 3) information |criteria = 1 | | | |
| |communicated to patient |Management of a case with even one unmet | | | |
| | |criterion = 0 | | | |
| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |
|OBSERVATION OF 5 CASES BEGINNING WITH SECOND VISIT |
|12 |Questioning: Complaints about current pregnancy |Questioning done = 0.5 |2.5 | | |
|13 |Physical examination: 1) weight 2) blood pressure 3) breast |One examination with 4 elements = 0.5 |2.5 | | |
| |examination and 4) check for edema |One examination with even one element | | | |
| | |missing = 0 | | | |
|14 |Obstetric examination: 1) height of uterus 2) presentation (from|One examination of a case with all |2.5 | | |
| |36 weeks) 3) fetal heartbeat (from 20 weeks) 4) vaginal touch |relevant elements = 0.5 | | | |
| | |One examination of a case with even one | | | |
| | |relevant element missing = 0 | | | |
|15 |Supplementary examinations: Systematic check for: 1) urinary |One case with all supplementary |2.5 | | |
| |albumin 2) syphilis 3) hemoglobin |examinations = 0.5 | | | |
| | |One case with even one missing | | | |
| | |examination = 0 | | | |
|16 |Administration of tetanus vaccine according to guidelines: 1) |One case of administering a vaccine |2.5 | | |
| |correct intervals 2) unexpired vaccine 3) conservation according|fulfilling all criteria = 0.5 | | | |
| |to local rules 4) means of administering vaccine corresponds to|One case with one unmet criterion = 0 | | | |
| |instructions on vial and injection site is in compliance with | | | | |
| |regulations | | | | |
|17 |Correct prescription of: 1) iron for women who are HIV-negative |One case with prescriptions given |2.5 | | |
| |or whose HIV status is unknown 2) folic acid 3) mebendazole |correctly = 0.5 | | | |
| |(from second trimester) 4) SP DOT (from 4th month) 5) |One case with even one incorrect | | | |
| |insecticide-treated mosquito nets |prescription = 0 | | | |
|18 |Management of cases with complications: 1) complications |Management of one case fulfilling all |5 | | |
| |identified 2) appropriate decision taken according to flowchart|criteria = 1 | | | |
| |3) information communicated to patient |Management of a case with even one unmet | | | |
| | |criterion = 0 | | | |
| |MAXIMUM POSSIBLE SCORE |SCORE | |
| |= 63 |OBTAINED = | |
SUMMARY OF OBSERVATIONS AND RECOMMENDATIONS REGARDING THE PRENATAL CONSULTATION SERVICE IN THE HEALTH CENTER
|District ___________________________ Health center_______________________________ Date _______________________ |
|Recommendations from preceding quarterly assessment not implemented, and explanation |
| |
| |
| |
| |
|Strong and weak points identified during current quarterly assessment |
| |
| |
| |
| |
| |
|Recommendations concerning problems identified |
| |
| |
| |
| |
| |
|Recommended technical supervision |
| |
| |
| |
| |
| |
______________________________ _________ ______________________________ _______ _________________________________ __________
Signature of evaluator Date Signature of head of service Date Signature of official Date
|6. FAMILY PLANNING (57) |
|No. |CHECKLIST ITEMS |SCORING INDICATORS |MAXIMUM POSSIBLE SCORE |SCORE OBTAINED |SCORING JUSTIFICATION |
|DIRECT OBSERVATION OF THE ROOM AND SUPPLIES |
|1 |Contraceptive methods: |One contraceptive method |12 | | |
| |Pills |fulfilling both criteria = 2 | | | |
| |Injectable contraceptives | | | | |
| |Implant |A contraceptive method with | | | |
| |IUD with uterine forceps and hysterometer |even one unmet criterion = 0 | | | |
| |Condoms | | | | |
| |Collar | | | | |
| |1) Availability of contraceptive with theoretical stock | | | | |
| |corresponding to physical stock 2) alert and security thresholds | | | | |
| |determined and respected. | | | | |
|ANALYSIS OF 10 FAMILY PLANNING CASES FROM THE PREVIOUS THREE MONTHS |
|2 |Justification of methods recommended, used, and prescribed compared|Correct justification = 3 |30 | | |
| |to methods indicated on the basis of questioning, history, and |Unjustified = 0 | | | |
| |physical examination | | | | |
|3 |Verification and monitoring: scheduled appointment |Yes = 1.5 |15 | | |
| | |No = 0 | | | |
| |MAXIMUM POSSIBLE SCORE = 57|SCORE | |
| | |OBTAINED = | |
SUMMARY OF OBSERVATIONS AND RECOMMENDATIONS REGARDING THE FAMILY PLANNING SERVICE IN THE HEALTH CENTER
|District ___________________________ Health center_______________________________ Date _______________________ |
|Recommendations from preceding quarterly assessment not implemented, and explanation |
| |
| |
| |
| |
|Strong and weak points identified during current quarterly assessment |
| |
| |
| |
| |
| |
|Recommendations concerning problems identified |
| |
| |
| |
| |
| |
|Recommended technical supervision |
| |
| |
| |
| |
| |
______________________________ _________ ______________________________ _______ _________________________________ __________
Signature of evaluator Date Signature of head of service Date Signature of official Date
|7. VACCINATION (35) |
|No. |CHECKLIST ITEMS |SCORING INDICATORS |MAXIMUM POSSIBLE SCORE |SCORE OBTAINED |SCORING JUSTIFICATION |
|OBSERVATION OF ROOM AND SUPPLIES |
|1 |Available and functional equipment and supplies: 1) refrigerator 2) |All equipment and supplies available and |2 | | |
| |cold accumulators 3) insulated foam cooler 4) spare parts (wicks and |functional = 2 | | | |
| |glass containers for petrol refrigerator) 5) petrol reserve (5 liters |Even one piece of equipment or supply | | | |
| |minimum) and/or generator 6) thermometer |missing or non-functional = 0 | | | |
|2 |Availability of vaccines and diluents: |Availability of all antigens and diluents |2 | | |
| |BCG |fulfilling both criteria = 2 | | | |
| |Polio |Expiry or disruption of supply of one | | | |
| |Rabies |antigen or dilutant = 0 | | | |
| |Pentavalent | | | | |
| |Tetanus | | | | |
| |1) Physical presence of unexpired, labeled antigens 2) No interruption | | | | |
| |of supply during past three months | | | | |
|3 |Storage of vaccines: 1) Vaccines carefully arranged in refrigerator |Storage fulfilling both criteria = 2.5 |2.5 | | |
| |sections (frozen and non-frozen vaccines) 2) No products other than |Storage with even one unmet criterion = 0 | | | |
| |vaccines and accumulators stored in refrigerator | | | | |
|4 |Available consumables and printed forms: 1) self-blocking syringes 2) |Availability of all items= 2 |2 | | |
| |dilution syringes (2 and 5 ml) |Even one item missing = 0 | | | |
| |3) receptacles 4) absorbent cotton 5) vaccination charts 6) control | | | | |
| |sheets 7) record of vaccinations | | | | |
|5 |Cold chain: 1) Max. and min. temperatures of refrigerator between +2*C |Chain fulfilling both criteria = 3 |3 | | |
| |and +8*C) 2) Unbroken cold chain during previous three months. | | | | |
| | |Even one day of interrruption= 0 | | | |
|6 |Management of vaccine supply: 1) theoretical supply of vaccines |Management fulfilling both criteria = 3 |3 | | |
| |corresponds to physical supply 2) alert and security thresholds |Even one unmet criterion = 0 | | | |
| |determined and respected. | | | | |
| | | | | | |
|DIRECT OBSERVATION OF IEC MEETING |
|7 |Group IEC/CCC: 1) group discussion prior to vaccination 2) existence of |IEC/CCC fulfilling all criteria = 1 |1 | | |
| |up-to-date IEC report book with: topic, number of participants, activity|Even one unmet criterion = 0 | | | |
| |leader, date, and signature 3) available and appropriate teaching | | | | |
| |materials | | | | |
|8 |System for identifying children expected for meeting |Existence of system = 2 |2 | | |
| | |Non-existence of system = 0 | | | |
|9 |System for recovering drop-outs(e.g. schedule of due dates, register |Existence of system = 3 |3 | | |
| |with column for recording appointments, classified individual charts) |Non-existence of system = 0 | | | |
|DIRECT OBSERVATION OF 5 CHILDREN IN THE VACCINATION PROGRAM |
|10 |Growth monitoring chart checked to determine if vaccination is due |Checked for one case = 0.5 |2.5 | | |
|11 |Systematic check for BCG scar |Checked in one case = 0.5 |2.5 | | |
|12 |Preparation of vaccines: 1) vaccine vial monitor (VVM) in good condition|One case fulfilling all criteria = 2 |2 | | |
| |2) correct dilution technique 3) use of self-blocking syringe 4) |One case with even one unmet criterion = | | | |
| |correct dosage |0 | | | |
|13 |Injection: 1) Cleansing of injection site with cotton 2) Correct |One case fulfilling both criteria = 0.5 |2.5 | | |
| |injection methods and sites |One case with even one unmet criterion = | | | |
| | |0 | | | |
|14 |Side effects systematically noted |Yes for one case = 0.5 |2.5 | | |
| | |No for one case = 0 | | | |
|15 |Registration completed: 1) on individual chart 2) on growth chart 3) in|One case with registration fulfilling all|2.5 | | |
| |register 4) on tracking form |criteria = 0.5 | | | |
| | |One case with even one unmet criterion =| | | |
| | |0 | | | |
| |MAXIMUM POSSIBLE SCORE = |SCORE | |
| |35 |OBTAINED = | |
SUMMARY OF OBSERVATIONS AND RECOMMENDATIONS REGARDING THE VACCINATION SERVICE IN THE HEALTH CENTER
|District ___________________________ Health center_______________________________ Date _______________________ |
|Recommendations from preceding quarterly assessment not implemented, and explanation |
| |
| |
| |
| |
|Strong and weak points identified during current quarterly assessment |
| |
| |
| |
| |
| |
|Recommendations concerning problems identified |
| |
| |
| |
| |
| |
|Recommended technical supervision |
| |
| |
| |
| |
| |
______________________________ _________ ______________________________ _______ _________________________________ __________
Signature of evaluator Date Signature of head of service Date Signature of official Date
|8.GROWTH MONITORING (26) |
|No. |CHECKLIST ITEMS |SCORING INDICATORS |MAXIMUM POSSIBLE SCORE |SCORE OBTAINED |SCORING JUSTIFICATION |
|DIRECT OBSERVATION OF ROOM AND SUPPLIES |
|1 |Available and functional equipment and supplies: 1) scale 2) |All equipment available and |2 | | |
| |height gauge (or age/height/weight chart) |functional = 2 | | | |
| |3) growth-monitoring charts 4) master chart % weight/height 5) |Even one piece of equipment or| | | |
| |growth monitoring register |supply missing or | | | |
| | |non-functional = 0 | | | |
|2 |Group IEC/CCC: 1) group discussion prior to consultation 2) |IEC/CCC fulfilling all |2 | | |
| |existence of up-to-date discussion guidebook |criteria = 2 | | | |
| | |Even one unmet criterion = 0 | | | |
|DIRECT OBSERVATION OF CONSULTATION (10 CASES) |
|3 |Questioning: child’s history (personal, family, socioeconomic |Complete research for one case|2 | | |
| |situation, status of vaccinations) |= 0.2 | | | |
| | |Even one element missing for | | | |
| | |one case = 0 | | | |
|4 |Weighing of child correct to one decimal point (e.g. 5.8 kg) |Yes = 0.2 |2 | | |
| | |No = 0 | | | |
|5 |Measuring child’s height, correct for age to one decimal point |Yes = 0.2 |2 | | |
| |(e.g. 52.6 cm) |No = 0 | | | |
|6 |Interpretation of median weight/age |Yes = 0.3 |3 | | |
| | |No = 0 | | | |
|7 |Systematic check for signs of micronutrient deficiency: |Complete research for one case|3 | | |
| |Pale palms |= 0.3 | | | |
| |Vitamin A deficiency (eyes) |Even one element missing for | | | |
| |Edemas. |one case = 0 | | | |
|8 |Individual counseling for each child |Yes for one case = 0,3 |3 | | |
| | |No for one case = 0 | | | |
|9 |Administration of vitamin A, mebendazole, iron according to |Yes for one case = 0,2 |2 | | |
| |guidelines |No for one case = 0 | | | |
|10 |Appropriate decision taken for child with problems according to |Yes for one case = 0,3 |3 | | |
| |growth chart |No for one case = 0 | | | |
|11 |Appointment made for each child |Yes for one case = 0,2 |2 | | |
| | |No for one case = 0 | | | |
| |MAXIMUM POSSIBLE SCORE = 26 |SCORE | |
| | |OBTAINED = | |
SUMMARY OF OBSERVATIONS AND RECOMMENDATIONS ON THE GROWTH MONITORING SERVICE IN THE HEALTH CENTER
|District ___________________________ Health center_______________________________ Date _______________________ |
|Recommendations from preceding quarterly assessment not implementedand an explanation |
| |
| |
| |
| |
|Strong and weak points identified during current quarterly assessment |
| |
| |
| |
| |
| |
|Recommendations concerning problems identified |
| |
| |
| |
| |
| |
|Recommended technical supervision |
| |
| |
| |
| |
| |
______________________________ _________ ______________________________ _______ _________________________________ __________
Signature of evaluator Date Signature of head of service Date Signature of official Date
|9. HIV PREVENTION (45) |
|No. |CHECKLIST ITEMS |SCORING INDICATORS |MAXIMUM POSSIBLE SCORE |SCORE OBTAINED |SCORING JUSTIFICATION |
| | | |12 | | |
| |Data-gathering tools. 1) Existence of correctly and completely maintained |Criteria 1) et 2) | | | |
| |records; |fulfilled= 12 | | | |
| |(i) Record of volunteer counseling and testing (VCT) | | | | |
| |(ii) Record of PMTCT counseling in pre-natal consultation (PNC) |One unmet criterion = | | | |
| |(iii) Record of enrolment in VCT |0 | | | |
| |(iv) Record of PNC | | | | |
|1 |(v) Record of PMTCT deliveries | | | | |
| |(vi) Record of pre-ARV and ARV (except in non-ARV cases) | | | | |
| |(vii) Record of prophylaxis | | | | |
| |(viii) Record of VCT lab | | | | |
| |(ix) Record of PMTCT lab | | | | |
| |(x) Record of CD4 | | | | |
| |(xi) Record of tuberculosis | | | | |
| |(xii) Record of children exposed | | | | |
| |(xiii) Record of UNFPA (with TRAC or registration code) | | | | |
| |(xiv) Record of monitoring of PMTCT women | | | | |
| |2) Existence of standards-based classification: | | | | |
| |Records kept in services concerned (VCT, PMTCT, laboratory, maternity, family| | | | |
| |planning, ARV, and infant care) | | | | |
| | | |7 | | |
| |Organization of HIV services. 1) Description of duties available and posted; |Criteria 1) and 2) | | | |
| |(i) heads of following services posted: VCT, PMTCT, laboratory, family |fulfilled = 7 | | | |
| |planning, infant care, and, where applicable, ARV (ii) assigned duties | | | | |
|2 |posted on walls of services |One criterion unmet = | | | |
| |2) Weekly schedule of HIV activities available, posted, and accessible to the|0 | | | |
| |public (i) On outside door of VCT services (ii) On outside door of PMTCT | | | | |
| |services (iii) On central bulletin board of health center | | | | |
| | | |8 | | |
| |VCT: Equipment and supplies. 1) Equipment and supplies meet MOH standards |Criteria 1) and 2) | | | |
| |(i) one desk (ii) three chairs (iii) bookshelf (iv) single-use receptacle |fulfilled = 8 | | | |
|3 |(v) materials for taking blood samples (tubes, needles, gloves, adaptor, | | | | |
| |tourniquet, tube holder, stopper) (vi) lab forms |One criterion unmet = | | | |
| |2) IEC/BCC supplies available on the table |0 | | | |
| |(i) Box of condoms (at least 10 condoms) (ii) model of a penis, (iii) | | | | |
| |HIV/AIDS booklets/leaflets pertaining to VCT | | | | |
| | | |8 | | |
| |PMTCT: Equipment and supplies. 1) Equipment and supplies meet MOH standards |Criteria 1) and 2) | | | |
| |(i) one desk (ii) three chairs (iii) bookshelf (iv) single-use receptacle |fulfilled = 8 | | | |
| |(v) materials for taking blood samples (tubes, needles, gloves, adaptor, | | | | |
|4 |tourniquet, tube holder, stopper) (vi) lab forms |One criterion unmet = | | | |
| |2) IEC/BCC materials available on the table |0 | | | |
| |(i) Box of condoms (at least 10 condoms), (ii) model of a penis (iii) | | | | |
| |HIV/AIDS booklets/leaflets pertaining to PMTCT | | | | |
| | | |10 | | |
| |Laboratory. 1) Temperature of “HIV” refrigerator checked twice a day2) |All criteria fulfilled| | | |
| |Temperature of refrigerator kept between +2C and +8C 3) No interruption of |= 10 | | | |
| |cold chain during three previous months 4) Temperature sheet posted on | | | | |
|5 |refrigerator 5) Storage of capillus and RPR in refrigerator 6) Separation of|One criterion unmet = | | | |
| |samples of HIV+ and HIV– stored in the refrigerator, 7) No unauthorized |0 | | | |
| |items in refrigerator, and 8) Results of quality control available and >98% | | | | |
| |consistent with previous quarter | | | | |
| |MAXIMUM POSSIBLE SCORE = 45 |SCORE | |
| | |OBTAINED = | |
SUMMARY OF OBSERVATIONS AND RECOMMENDATIONS REGARDING THE HIV PREVENTION SERVICE IN THE HEALTH CENTER
|District ___________________________ Health center_______________________________ Date _______________________ |
|Recommendations from preceding quarterly assessment not implemented and an explanation |
| |
| |
| |
| |
|Priority problems identified during current quarterly assessment (strong and weak points) |
| |
| |
| |
| |
| |
|Recommendations concerning problems identified |
| |
| |
| |
| |
| |
|Recommended technical supervision |
| |
| |
| |
| |
| |
______________________________ _________ ______________________________ _______ _________________________________ __________
Signature of evaluator Date Signature of head of service Date Signature of official Date
|10. TUBERCULOSIS (14) |
|No. |CHECKLIST ITEMS |SCORING INDICATORS |MAXIMUM POSSIBLE SCORE |SCORE OBTAINED |SCORING JUSTIFICATION |
|DIRECT OBSERVATION OF SUPPLIES, PRINTED MATERIALS, AND PRODUCTS |
|1 |Management of antituberculosis supplies |Management fulfilling both |2 | | |
| |INH |criteria = 2 | | | |
| |RHZE |Even one unmet criterion = | | | |
| |RH |0 | | | |
| |RHE | | | | |
| |1) presence of all antituberculosis drugs 2) theoretical supply | | | | |
| |corresponds to physical supply | | | | |
|2 |Availability of printed materials: 1) Register of tuberculosis cases 2) |Presence of all printed |1 | | |
| |treatment chart 3) laboratory record 4) transfer chart 5) cross-reference|materials = 1 | | | |
| |chart 6) lab form 7) requisition record for antituberculosis drugs 8) |Absence of even one printed| | | |
| |requisition record for laboratory supplies and reagents. 9) requisition |material = 0 | | | |
| |record for printed materials. | | | | |
|ANALYSIS OF 2 RANDOMLY SELECTED CASES FROM CHARTS AND REGISTER |
|3 |Proper treatment according to PNILT guidelines: 1) at least 2 sputum |One case fulfilling all |10 | | |
| |tests are positive and recorded on treatment chart for new PTB+ cases |criteria = 5 | | | |
| |(laboratory results attached to chart) 2) treatment in accordance with |One case with even one | | | |
| |PNILT protocols (initial phase, continuation, relapse) 3) sputum |unmet criterion = 0 | | | |
| |monitoring if required, in accordance with PNILT instructions 4) HIV test| | | | |
| |completed (or referred) | | | | |
|4 |Existence of patient recovery system in case of irregularity determined |System exists = 1 |1 | | |
| |by PNILT (within 6 days) | | | | |
| |MAXIMUM POSSIBLE SCORE = 14 |SCORE | |
| | |OBTAINED = | |
SUMMARY OF OBSERVATIONS AND RECOMMENDATIONS REGARDING THE TUBERCULOSIS SERVICE IN THE HEALTH CENTER
|District ___________________________ Health center_______________________________ Date _______________________ |
|Recommendations from preceding quarterly assessment not implemented and an explanation |
| |
| |
| |
| |
|Strong and weak points identified during current quarterly assessment |
| |
| |
| |
| |
| |
|Recommendations concerning problems identified |
| |
| |
| |
| |
| |
|Recommended technical supervision |
| |
| |
| |
| |
| |
______________________________ _________ ______________________________ _______ _________________________________ __________
Signature of evaluator Date Signature of head of service Date Signature of official Date
|11. LABORATORY (15) |
|No. |CHECKLIST ITEMS |SCORING INDICATORS |MAXIMUM POSSIBLE SCORE |SCORE OBTAINED |SCORING JUSTIFICATION |
|DIRECT OBSERVATION OF ROOM AND SUPPLIES |
|1 |Available and functional equipment and supplies: 1) Microscope 2) |One piece of equipment or |6,5 | | |
| |centrifuge 3) hemoglobinometer 4) new razor blades 5) cover slips 6) |one supply available and | | | |
| |light source 7) time switch 8) sputum cups 9) stool vials 10) |functional = 0.5 | | | |
| |inoculation loop 11) alcohol lamp 12) diamond-point scriber 13) | | | | |
| |laboratory bench | | | | |
|2 |Presence of unexpired reagents and test strips: 1) Giemsa 2) Kinyoun A |Each product present = 0.5 |2.5 | | |
| |and B (TB control) 3) test strips for albumin and sugar 4) pregnancy test| | | | |
| |5) immersion oil | | | | |
|3 |Sputum bottles, stool vials eliminated in sealable and sealed waste |Waste eliminated in |1 | | |
| |receptacle |receptacle = 1 | | | |
|4 |Presence of environmentally sound wastewater disposal system |Presence of appropriate |1 | | |
| | |system =1 | | | |
|5 |Results of last quarterly quality control (for the previous three |Control result higher than |4 | | |
| |months) of tests for: 1) thick blood smear 2) sputum (for TB control |95% for blood smear or | | | |
| |centers) higher than 95% |sputum tests = 2 | | | |
| | | | | | |
| | |Control results lower than | | | |
| | |95% or missing for blood | | | |
| | |smear or sputum tests = 0 | | | |
| |MAXIMUM POSSIBLE SCORE = 15|SCORE | |
| | |OBTAINED = | |
SUMMARY OF OBSERVATIONS AND RECOMMENDATIONS REGARDING THE LABORATORY SERVICE IN THE HEALTH CENTER
|District ___________________________ Health center_______________________________ Date _______________________ |
|Recommendations from preceding quarterly assessment not implemented and an explanation |
| |
| |
| |
| |
|Strong and weak points identified during current quarterly assessment |
| |
| |
| |
| |
| |
|Recommendations concerning problems identified |
| |
| |
| |
| |
| |
|Recommended technical supervision |
| |
| |
| |
| |
| |
______________________________ _________ ______________________________ _______ _________________________________ __________
Signature of evaluator Date Signature of head of service Date Signature of official Date
|12. PHARMACY MANAGEMENT (30) |
|No. |CHECKLIST ITEMS |SCORING INDICATORS |MAXIMUM POSSIBLE SCORE |SCORE OBTAINED |SCORING JUSTIFICATION |
|1 |Pharmacy premises in accordance with regulations: |Premises fulfilling all criteria = 2|2 | | |
| |1) shelves 2) ventilated premises 3) protection against direct |Even one unmet criterion = 0 | | | |
| |sunlight 4) protection against theft. | | | | |
|2 |Cleanliness of pharmacy (no dust on shelves and products, no cobwebs)|Cleanliness assured = 2 |2 | | |
|3 |Stocking in accordance with regulations: 1) products arranged on |Stocking fulfilling all criteria = 5|5 | | |
| |shelves, not on floor 2) logically arranged products (alphabetical |Even one unmet criterion = 0 | | | |
| |order or by type of therapy) 3) on basis of expiry date 4) with signs| | | | |
| |on shelves according to International Common Denomination (generic | | | | |
| |names) 5) agreement between theoretical and physical stock | | | | |
|4 |Management of tools: |One tool fulfilling both criteria = |4 | | |
| |Inventory card |0.5 | | | |
| |Order forms |One tool with even one unmet | | | |
| |Weekly record of Coartem |criterion = 0 | | | |
| |Monthly record of Coartem | | | | |
| |Record of entries of drugs | | | | |
| |Delivery forms | | | | |
| |Internal requisition register | | | | |
| |Monthly inventory of drugs | | | | |
| |1) Presence of tool 2) Filled out according to regulations | | | | |
|5 |Availability of tracer drugs and consumables: 1) all molecules and |All tracer drugs and consumables |6 | | |
| |consumables available 2) No interruption of supply since last |available = 6 | | | |
| |assessment. |Disruption of even one drug or | | | |
| | |consumable = 0 | | | |
|6 | Correct procedure observed for destruction of outdated products : 1)|Procedure fulfilling both criteria =|2 | | |
| |inventory card for outdated products |2 | | | |
| |2) acknowledgment of outdated drugs and reagents received by the |Even one unmet criterion = 0 | | | |
| |hospital. | | | | |
|OBSERVATION OF DISTRIBUTION IN 5 CASES |
|7 |Available equipment and supplies: 1) water filter 2) spatulas 3) |One case with all supplies |3 | | |
| |spoons 4) beaker 5) cutting tool 6) packaging. |available = 0.1 | | | |
|8 |Use of tools: |One tool fulfilling both criteria |3 | | |
| |Daily drug use register (RUMER) |= 0.2 | | | |
| |Daily tracking register |One tool with even one unmet | | | |
| |Internal requisition book |criterion = 0 | | | |
| |1) Presence of tool 2) Filling prescriptions in accordance with | | | | |
| |regulations | | | | |
|9 | Hygiene standards respected when handling drugs: 1) use of |One case with all standards met = |3 | | |
| |spatulas and spoons 2) packaging of drugs |0.6 | | | |
| | |One case with even one unmet | | | |
| | |standard = 0 | | | |
|10 |Instructions on how to take medicines (dose, length of time, |One case with instruction given |3 | | |
| |schedule) correctly and systematically repeated at time of |correctly | | | |
| |distribution |= 0.6 | | | |
| | |One case with incorrect or | | | |
| | |neglected instruction | | | |
| | |= 0 | | | |
| |MAXIMUM POSSIBLE SCORE = |SCORE | |
| |30 |OBTAINED = | |
SUMMARY OF OBSERVATIONS AND RECOMMENDATIONS ON MANAGEMENT OF PHARMACY IN HEALTH CENTER
|District ___________________________ Health center_______________________________ Date _______________________ |
|Recommendations from preceding quarterly assessment not implemented, and explanation |
| |
| |
| |
| |
|Strong and weak points identified during current quarterly assessment |
| |
| |
| |
| |
| |
|Recommendations concerning problems identified |
| |
| |
| |
| |
| |
|Recommended technical supervision |
| |
| |
| |
| |
| |
______________________________ _________ ______________________________ _______ _________________________________ __________
Signature of evaluator Date Signature of head of service Date Signature of official Date
|13. FINANCIAL MANAGEMENT (25) |
|No. |CHECKLIST ITEMS |SCORING INDICATORS |MAXIMUM POSSIBLE SCORE |SCORE OBTAINED |SCORING JUSTIFICATION |
|1 |Fees for services, drugs, and consumables: 1) posted 2) legible 3) at |All criteria fulfilled = 2 |2 | | |
| |reception desk and at cashier 4) complied with |Even one criterion unmet = 0 | | | |
|2 |Billing records: 1) available 2) correctly and completely filled out |All criteria fulfilled = 3 |3 | | |
| |3) without erasures or alterations |Even one criterion unmet = 0 | | | |
|3 |Cash receipts journal: 1) available 2) correctly and completely filled|All criteria fulfilled = 3 |3 | | |
| |out (agrees with billing records) 3) up-to-date 4) no erasures or |Even one criterion unmet = 0 | | | |
| |alterations | | | | |
|4 |Expenditures register: 1) available 2) correctly filled out (in |All criteria fulfilled = 3 |3 | | |
| |agreement with documented evidence of expenditures) 3) up-to-date 4) |Even one criterion unmet = 0 | | | |
| |no erasures or alterations | | | | |
|5 |Documented evidence of expenditures (10 randomly selected documents): |One document fulfilling all criteria =|3 | | |
| |1) certified correct 2) correctly classified by account and date |0. 3 | | | |
| | |One document with even one criterion | | | |
| | |unmet = 0 | | | |
|6 |Bank ledger: 1) available 2) correctly and completely filled out 3) |All criteria fulfilled = 3 |3 | | |
| |up-to-date 4) no erasures or alterations |Even one criterion unmet = 0 | | | |
|7 |Expense voucher: 1) correctly and completely filled out according to |All criteria fulfilled = 2 |2 | | |
| |expenditures record 2) with signatures |Even one criterion unmet = 0 | | | |
|8 |Treasury situation: 1) Agreement between theoretical situation (bank |Treasury fulfilling both criteria = 5 |5 | | |
| |ledger) and actual situation (bank book or statements, or cashbox) 2) |Even one criterion unmet = 0 | | | |
| |Agreement between monthly HIS treasury report and journal of receipts | | | | |
| |and expenditures | | | | |
|9 |Quarterly budget forecast: 1) drawn from annual budget 2) signed by |One budget forecast fulfilling both |1 | | |
| |chairman of Health Committee |criteria = 1 | | | |
| | |Even one criterion unmet = 0 | | | |
| |MAXIMUM POSSIBLE SCORE = |SCORE | |
| |25 |OBTAINED = | |
SUMMARY OF OBSERVATIONS AND RECOMMENDATIONS ON FINANCIAL MANAGEMENT OF HEALTH CENTER
|District ___________________________ Health center_______________________________ Date _______________________ |
|Recommendations from preceding quarterly assessment not implemented, and explanation |
| |
| |
| |
| |
|Strong and weak points identified during current quarterly assessment |
| |
| |
| |
| |
| |
|Recommendations concerning problems identified |
| |
| |
| |
| |
| |
|Recommended technical supervision |
| |
| |
| |
| |
| |
______________________________ _________ ______________________________ _______ _________________________________ __________
Signature of evaluator Date Signature of head of service Date Signature of official Date
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