Appendix 3.1 PBF Quality of Care Checklists_primary and secondary health facilities.pdf

Appendix 3.1 PBF Quality of Care Checklist

Appendix 3.1.1 Quality Assessment questionnaire primary-level health facilities

1. General health facility information

Name of PHC 2 HF with main contract: …………… Population in catchment area: …….

Name of OIC: …………….. Tel: ……………………. Date evaluation: …………..

Names of evaluators / qualification /:

1. …………………………….…………………………

2. …………………………….…………………………

3. …………………………….…………………………

4. …………………………….…………………………

Organisation evaluators / telephone

County of: ………… District of: …………

Ownership HF: public / faith based / private for non-profit / private for profit

Number of non-qualified personnel: …… Check payroll and incentive list with signatures and stamp

Nbr of GoL payroll staff in HF: …….. Nbr of incentive staff with contract HF: ….

- Nbr of qualified staff1 available in HF: ….. (A)

- Target for Nbr of qualified staff = Population in catchment area

/ 1000 = …. (B)

- Qualified staff available / target qual. staff = A / B = … %

Check payroll and incentive list with signatures and stamp

- Nbr short admission or IPC beds in HF: …. (A)

- Target for Nbr of short admission /IPC beds =

Population in catchment area / 1000 = …. (B).

- Beds available / target beds = A / B = …. %

The main contract holders are the PHC Clinics Level 2 covering a population of 3,500 to 12,000. PHC Clinics level 1 cover remote areas in rural catchment areas or are private clinics in urban areas.

This must be clarified in the business plan. The PHC 1 and 2 clinics develop one BP to provide the full Essential Package of Health

Services. They may be linked through a sub-contract (private clinics) or the PHC 1 Clinic staff are part of the PHC 2 Clinic but live near PHC 1.

Are there sub-contracts between PHC 2 and PHC 1 or linked health facilities? Yes / No

Names of subcontractors or linked PHC 1 Clinics

Outreach, health promotion and referral services will be provided for the communities from the nearest PHC 1 or 2 Clinics with the support of Community Health Assistants (CHA). Curative care is only done by qualified staff, not CHAs.

Number of CHVs in catchment area working with qualified staff such as CHSS: …….

CHAs receive incentives through community outreach indicators (HH visit following protocol, recovering drop out cases, identifying new cases)

2. Previous score and critical recommendations

Quality Score of previous quarter: … %

Three main critical recommendations of the previous quality review: Implemented

A. ………………………………………………………………………………………………

…………………………………………………………………………………. Yes / No

1 Qualified staff is anybody with at least two years of specialized training either medical or non-medical

If no, why? ...……………………………………………………………………………….

B. ………………………………………………………………………………………………

…………………………………………………………………………………. Yes / No

If no, why? ...……………………………………………………………………………….

C. ………………………………………………………………………………………………

…………………………………………………………………………………. Yes / No

If no, why? ...……………………………………………………………………………….

3. Components of the quality review questionnaire

Components Available score

Number of indicators

Achieved score

Achieved %

1. General Indicators 16 10 …. … %

2. Human resource management 13 7 …. … %

3. Quarterly business plan 10 7 …. … %

4. Finances and Indices management tool 10 4 …. … %

5. Infection prevention and control 29 12 …. … %

6. OPD department / emergency room 30 24 …. … %

7. Malaria 16 8 …. … %

8. Non-communicable diseases 10 6 …. … %

9. Mental Health 10 5 …. … %

10. Community PBF and equity 20 11 …. … %

11. Nutrition 17 10 …. … %

12. Tuberculosis services 17 11 …. … %

13. HIV – AIDS services 14 7 …. … %

14. Immunization – school program 22 15 …. … %

15. Family Planning 18 12 …. … %

16. Maternity -delivery care, ANC, PNC 38 29 …. … %

17. Room short admissions or in-patient ward 12 7 …. … %

18. Minor surgery 8 6 …. … %

19. Laboratory services 13 9 …. … %

20. Essential drugs management 12 8 …. … %

21. Tracer essential drugs 17 34 …. … %

TOTAL 352 242 …. … %

4. General indicators

GENERAL INDICATORS

Protocol

Respected

NOT

Respected

1. Health map of the primary-level HF catchment area

- Map is available and attached on the wall (at least A3 format size)

- Map displayed in the HF showing secondary HFs, villages/suburbs, major roads, natural obstacles, special places and distances to outreach posts for EPI, FP, ANC

- Map shows population attached to the outreach posts

1 0

2. Important reports available

- Business plans, financial ledgers, indices management tool, HMIS monthly report, quantity invoices report

- Official letters

- Documents are in binders, well displayed on shelves and accessible by the officer in charge, director, deputy director, administrator within 5 minutes

3 0

3. Health Facility Development Committee meetings conducted

- Held at least once per quarter or more often when required (check minutes)

- Minutes should contain signed participant list

- Minutes describe in how far recommendations of previous meeting were achieved

- Minutes contain at least two realistic recommendations, indicates who is responsible and with deadlines

1 0

4. Monthly technical quality improvement meeting conducted

- Check the minutes of last month’s technical quality improvement meeting,

- Minutes have a date and time of beginning and end and an agenda,

- Attendance list of participants signed

- If there were deaths => mortality review conducted

- If there were grievances => recommendations were developed

- Minutes describe in how far recommendations of previous meeting were achieved

- Minutes contain at least two realistic recommendations, indicates who is responsible and with deadlines

2 0

5. Grievance management system in place

- Locked suggestion/complaint box exists in health facility

- Suggestions are kept in grievances file

- Discussion take place on grievances on staff-staff, client-staff interaction issues

1 0

6. Referral Ledger from PHC to hospital and referral forms available and used

- Check existence of referral Ledger and referral forms

- Evaluator checks last 3 referral forms

- Evaluator determines in how far patients arrived at next level of care

1 0

7. Referral system with transport services organized from community to PHC and from

PHC to hospital

- Health facility has referral protocol from the community to the HF and from the HF to higher level hospital

- Transport system for referral organized by either: 1. Hammock; 2. Canoe; 3.

Motorbike; 4. Rented vehicle; 5. Hospital ambulance 6. National ambulance

- HF has a system to refer vulnerable patients free-of-charge

- Referral protocol clarifies patient’s contribution for transport services

3 0

8. Availability of radio or mobile for communication with PHC 1 Clinics and outreach posts in catchment area and with next-level referral hospital

- Marked HF details and number displayed

- Radio or mobile phone (property HF) with batteries and/or credit (minimum $ 20)

1 0

9. Kitchen services for short admission or in-patients available and clean

- Walls in sheets or bricks, roof well covered with sheets or tiles

- With trash bin for waste disposal

- Running water at distance less than 5m, or water container of at least 50 L

1 0

10. Mortuary available

- A room or small building

- Away from direct observation and out of sight of other patients

2 0

TOTAL Score - 16 points maximum … / 16 XXXXX

Observations about component

5. Human resource management

HUMAN RESOURCES MANAGEMENT

Protocol

Respected

NOT

Respected

1. Health centre human resources list available

- List contains name, academic degree, position, gender, age.

- List presents qualified and non-qualified staff; clinical staff and non-clinical staff

- List presents civil servants and contract staff remunerated by HF

1 0

2. HF identified in business plan shortages or excesses in qualified staff

- Standard for qualified staff is 1 / 1000 population in the catchment area

- If shortage or excess the business plan contains actions such as recruiting incentive staff, requesting more staff from MOH, transferring excess staff

2 0

3. Duty roster – work schedule available

- Schedule completed and posted on wall

- Both for clinical and non -clinical staff

1 0

4. Health facility has staff attendance system

- Paper or electronic ledger in place

- Ledger contains information about arrival time and departure time

- Ledger contains information about additional hours worked or hours not worked

- Additional hours or hours lost are signed off by supervisor

2 0

5. Orientation meetings for staff

- There is a quiet, confidential room or place for orientation / evaluation talks 1 0

- Orientation takes place by OIC or unit head, who explains HF mission, goals, performance standards and the HF business plan and indices management tool

- Records of orientation talks available in employee file and accessible to verifiers

6. Performance evaluation management

Verifier randomly selects the files of 2 employees from HR list and checks:

- Availability of staff records and job descriptions

- Job description must include: Scope of work, specific line of duty, reporting requirement, qualification and competencies

- HF conducts performance evaluations either by supervisor or HR committee

- Evaluations must be scored quarterly, signed and filed after feedback session

- Personal staff file contains quarterly individual performance evaluation for indices management tool

3 0

7. Capacity building plan

- HF capacity training plan exists

- Plan contains topics for learning sessions

- Topics for learning sessions are based on the recommendations of the last quarterlyquality assessments CHT, NVA report and internal last quarter individual performance reviews

- In case the HF has an agreement with the nearby hospital or CHT to train staff they have a training plan with training manual, PowerPoints, and exam questions.

3 0

TOTAL Points - 13 points maximum … / 13 XXXXX

COMMENTS on the COMPONENT

6. Quarterly business plan

QUARTERLY BUSINESS PLAN (BP)

Respected

NOT

Respected

1. Health Facility Quarterly Business Plan is available and accessible

- Supervisor checks the contract between the CHT (= principal) and the health facility (= agent)

- The current quarter business plan is approved and signed by both parties

1 0

2. Analysis of achievements of the business plans is done monthly

This can be done during the technical quality improvement meeting that also reviews the indices management tool

1 0

3. Strategies to reach remote communities

- The business plan contains strategies to reach remote communities in the catchment area such as through sub-contracts with secondary health services providers, involvement of

CHSS and CHAs or other outreach strategies

1 0

4. HF management aims to implement all activities of the Essential Package

- The business plan shows the intend to introduce the activities related to all essential package output indicators including safe delivery care, curative care, household visits by

2 0 qualified staff, follow up on dropouts, nutrition, financial and human resource management, quality improvement bonuses (QIBs)

5. Business Plan contains convincing strategy to implement FP

- Included in household visit protocol

- Supply of inputs is assured also including alternatives in case of stock outs at CMS

1 0

6. Business plan responds to critical recommendations

- The business plan refers to the critical recommendations of CHTquality assessments and the NVA verification visits (maximum 4).

- The BP identified convincing actions that respond to the critical recommendations

2 0

7. Business Plan is developed with key stakeholders

- OIC, all HF staff, HC development committee members (if functional)

- Representative (s) of secondary health services providers (if applicable)

- The minutes of the meetings for the drafting of business plans with attendance list

2 0

TOTAL Points - 10 points maximum … / 10 XXXXX

7. Finances and Indices management tool

FINANCES, INCOMES, RUNNING COSTS PERFORMANCE BONUS

Protocol

Respected

NOT

Respected

1. Financial ledgers and cash book available and well kept – budget committee

- Financial ledgers with receipts and expenses with date, without omissions

- Cash book and bank statement available

- Theoretical balance cashbook corresponds to liquidity at time of verification

- Availability of financial report paper-based & electronic; reporting log stating the frequency.

- Budget review committee meets monthly to validate report and indices management tool to calculate staff bonuses

3 0

2. Cash HF earnings exceed USD 7.00 / person / year

- Calculate monthly salaries paid by government and salaries of contract workers including for community activities paid by health facility

- Add monthly cost-sharing earnings, insurance- and company contract payments

- Add monthly income generating activities and cash donations

- Add monthly or quarterly PBF subsidies, QIBs and other direct financial support

- Multiply the total monthly earnings by 12, divide the sum by the target population

- Review in how far it reaches at least $ 7.00 / person / year

2 0

3. Basic salaries + performance bonuses do not exceed 60% of total HF income

- Supervisor calculates the sum of the 1. Fixed salaries paid by GoL payroll staff, 2. Fixed salaries paid by HF to incentive staff, 3. Performance bonuses paid to staff

- Supervisor divides the above sum by the total HF expenses (should be below 60%)

4. All staff members know how monthly performance bonuses are calculated 3 0

Criteria for the calculation of performance bonus established in the HF:

(a) Responsibility.

(b) Additional hours (over time) or hours lost.

(c) Quarterly individual performance evaluations.

(d) Non-private sector practice

(e) Quality evaluation (of the department)

The HF must use at least 3 criteria

- Find out from 2 people chosen randomly in how far they understand the indices management tool and how their bonuses have been calculated

COMMENTS on the FINANCIAL COMPONENT

8. Infection prevention and control

INFECTION PREVENTION AND CONTROL

Protocol

Respected

NOT

Respected

1. Functioning hand washing with running water available in OPD consultation room, short admission or in-patients ward, maternity, office (COVID)

- Handwashing station has running water, soap, paper towels, alcohol dispenser

4 0

2. Use of personal protective equipment (PPE) – COVID and other infections

- There is a space just outside the isolation space/room designated for putting on and taking off PPE

- Facility has a three-month supply of PPE according to MOH IPC supplies guidelines, which has PPE suits, disposable aprons, face shields, hood, body bags, heavy duty gloves

(rubber), sprayers (backpack or hand), rain boots.

4 0

3. Health centre fence available and well-maintained

- Preferably cement wall. If grass or wire fence no entrances, not accessible for dogs, goats, chickens

- Health centre has one gate, which can be locked

2 0

4. Courtyard cleanliness

- No waste or dangerous objects in courtyard: needles – gloves – used swabs.

- Bin with a lid and accessible to clients - not full

- Grass cut – garden well maintained – no animal excrement

2 0

5. Presence of sufficient toilets / latrines in good condition

- At least 1 toilet / latrine with lids for 4 beds – 2 for outpatient department and 1 for staff

- 24 / 24 light available at toilets

- Running water and hand washing basin or water basin with at least 20L of water

- Evacuation of the wastewater in a sanitation pit or sewer

- Floor without cracks

- Doors can be closed and locked, no flies

- Toilet / latrine with walls made with bricks, roof covered with sheets or tiles

- Recently cleaned without visible faecal matter

6. Presence of showers in sufficient numbers and in good condition

- At least 1 shower per 4 beds; 1 shower for staff

- Shower with running water

- Evacuation of the wastewater in a sanitation pit or sewer

2 0

7. Incinerator and placenta pit in place or alternative for waste disposal system

- Functional incinerator in use or when not used at moment of visit well cleaned

- Placenta pit with lid

- Well-built fence around incinerator, door locked by key at moment of inspection

5 0

8. Waste pit for non-contaminated objects

- Hole of min 3 metres depth, fenced, without infected or non-decomposable objects 1 0

9. Staff sterilises instruments according to standards

- Sterilizer (or autoclave) in good condition and functional.

- Sterilisation protocol is displayed.

- Supervisor checks in how far the protocol is respected

4 0

10. Hygienic conditions assured in wound dressing and injection room

- Bins infected objects with lid – security box for needles well positioned and used 1 0

11. Waste handlers and health workers are vaccinated.

- Vaccinated for hepatitis B

- Facility has record of the staff, who are vaccinated and confirm if the staff found is among the vaccinated

12. Contaminated / stained instruments and linen are washed and disinfected

- Soaked with soap and water before being sent to the sterilization room

- In delivery room, minor surgery room, dressing room

- Linen from patients in holding areas are disinfected with 0.5% chlorine solution after discharge or when soiled.

- Chlorine solution 0.5% is properly prepared, labelled (indicate the concentration, date of preparation and expiration) and used.

1 0

TOTAL Points - 29 points maximum … / 29 XXXXX

9. OPD department / emergency room

OPD CONSULTATION DEPARTMENT / EMERGENCY ROOM

Protocol

Respected

NOT

Respected

1. Waiting area for OPD and emergency room in good conditions and clean

- With sufficient benches and / or chairs – for social distancing

- Pamphlet that visitors must wear masks, wash hands (COVID)

- No standing patients or lying on the floor

- Waiting area is protected against sun and rain

2. Cost recovery rates (if applicable) displayed in waiting area, visible for public

- Fees rates clearly visible for patients before consultation 1 0

3. Patients use waiting coupons to attend OPD – EPI - MCH

- Patients receive numbered waiting coupons according to order of arrival with the exception of emergencies/urgent cases

1 0

4. Outpatient consultation room and emergency room in good condition and clean

- Walls in concrete, paved and painted,

- Floor paved with cement or tiles without cracks,

- Ceiling in good condition,

- Glass in windows (not broken) with curtains, and functional doors with lock

1 0

5. Consultation room and waiting space well separated ensuring privacy

- Room with closed door – curtains on windows – no through way 1 0

6. Service availability for emergencies 7 / 7 and 24 / 24

- The evaluator checks entries in Ledger for the last 2 Sundays 2 0

7. Consultation room and emergencies ward with lights 24 / 24, 7 / 7

- Electricity available from grid, solar light or generator

- Back-up mechanism in place

2 0

8. All OPD consultations and emergencies are conducted by qualified staff

- Identification of consulting staff on the particular day from patients that consulted on the evaluation day

1 0

9. Staff is uniformed

- Medical officer: clinical coat, long sleeves, clean

- Nurse: wear scrubs, or nursing uniform short sleeves, clean, buttoned with name tag, covered shoes (no slippers), nail trimming, no varnish, no dangling jewellery

- Midwives: Navy Blue and white (dress, skirts or trouser suit)

1 0

10. Correct monthly numbering in the OPD patient’s registry and emergency room

- Correct numbering (monthly numbering must exist)

- Registry concluded at the end of the month

- Total number old and new consultations of the month

- If consultation of child => immunization status is checked

1 0

11. Correct Management of Acute Respiratory Infections

- Flow diagram available in OPD (IMNCI)

- Diagram applied – check 2 cases

2 0

12. Correct management of Diarrhoea

- Flow diagram available in OPD (IMNCI)

- Diagram applied – check 2 cases

2 0

13. The proportion of patients treated with antibiotics < 50%

- Check in the Ledger the last 30 cases, and analyse the diagnosis and calculate the rate – no more than 14 over 30 cases

This indicator aims to avoid over-prescription of antibiotics and resistance

2 0

14. Under-5 nutritional status reviewed

- All children under-5 years that come for any consultation 1 0

15. Weighing equipment

- Baby scale available and functional - check scale with object of known weight

- Scale to measure height

- Scale for persons – well-calibrated to zero

16. Development of progress graphs

- Coverage with regard to expected targets OPD – targeted free health care

- Displayed on the wall

1 0

17. Stethoscope & BP machine available and functional

- Check blood pressure and ask somebody to verify functionality 1 0

18. Thermometer (thermophiles) available and functional

- Inspect the thermometer 1 0

19. Otoscope available with kits

- Inspect: available charged batteries with strong light 1 0

20. Examination bed available

- Made from durable material and with non-permeable mattress 1 0

21. Wheelchair available 1 0

22. Supplies for IV cannula opening (cannula, plaster/tape, alcohol swab, cotton) 1 0

23. Glucometer with Strips Available 1 0

24. Availability of a tongue depressor 1 0

TOTAL Points - 30 points maximum … / 30 XXXXX

10. Malaria

Malaria Protocol

Respected

NOT

Respected

1. Malaria management protocols directly available

- National protocol of uncomplicated and complicated malaria and their management posted on the wall or available on the OPD desk

- Supervisor checks the availability for detailed manuals on general malaria case management and malaria case management in pregnancies

2 0

2. OPD clinician on duty has been trained in malaria case management

- Supervisor checks to see in how far OPD clinicians on duty received the five-days post basic malaria case management training

- Clinicians can be civil servants or contract workers

2 0

3. Clinician knows how to classify malaria cases. Supervisor interviews OPD clinician on duty

- Uncomplicated malaria cases

=> Clinician knows at least two symptoms of malaria

=> Fever (cold stage, hot phase, sweating phase), loss of appetite, headache, vomiting, nausea, body aches, general malaise

=> mRDT or microscopy test positive of malaria parasite

- Complicated Malaria

=> patient is diagnosed with malaria with at least one sign of complication:

Cerebral malaria, with abnormal behavior, impairment of consciousness, seizures, coma, or other neurologic abnormalities.

=> Severe anemia

=> Hemoglobinuria (hemoglobin in the urine)

=> mRDT or Microscopy test positive of malaria parasite

4. Clinician knows to manage malaria according to standard treatment guidelines.

Supervisor interviews OPD clinician on duty

- Uncomplicated malaria

=> artemisinin-based combination therapy (ACT) based on age group

- Complicated malaria

=> Immediate treatment: Give artesunate intravenously. If artesunate is not available give intramuscular artemether or intravenous quinine. If intravenous administration is not possible, artesunate or quinine may be given intramuscularly into the anterior thigh.

=> Emergency referral when immediate treatment does not mitigate symptoms

2 0

5. Clinician knows to prevent malaria according to standard treatment guidelines.

Supervisor interviews OPD clinician on duty

- Pregnant women received sulfadoxine-pyrimethamine as preventive intermittent treatment at least 3 doses (IPTp3) during pregnancy

- Pregnant women are provided long-lasting insecticidal nets (LINN) at first ANC visits and at facility delivery

2 0

6. Availability of malaria diagnostic inputs:

Security Stock = Monthly Average Consumption (MAC) / 2

- RDT test kit and blood smear

2 0

7. Availability of malaria preventive inputs:

Security Stock = Monthly Average Consumption (MAC) / 2

- Sulfadoxine-pyrimethamine

- Long-lasting insecticidal nets

8. Availability of malaria therapeutic inputs:

Security Stock = Monthly Average Consumption (MAC) / 2

- Artemisinin-based combination therapy (ACT) oral

- Artesunate IM/IV injection,

- Arthemeter IM Injection

- Quinine IV 300mg/600mg

2 0

TOTAL Point – 16 points maximum … / 16 XXXXX

OBSERVATIONS COMPONENT

11. Non-Communicable Diseases

NCDs Protocol

Respected

NOT

Respected

1. NCD Ledger

- Well filled in (recording appropriate services for all ages)

- Counselling of clients and caregivers

- Ensure client is informed about follow-up date (as recorded in ledger)

1 0

2. Availability of NCDs reports

- NCDs report are available at health facility (monthly service delivery report) 1 0

3. Availability of functional screening materials for NCDs Clinic and stored properly

- Blood pressure machine (BP Cuff) both for children and adults

- Weighting Scale(s)

- Glucose Meter(s)/ strips

- Referral forms

- Patient’s card

- Box file for record keeping

- NCDs treatment protocol/guideline(s)

2 0

4. Availability of NCDs essential supplies

- Insulin Type1(Insulin zinc suspension, lente insulin 40IUfor adults; Children 10IU to 50IU) mixtard 30/70, NPH 70% long acting Regular 30%

- Insulin Type2 (Metformin PO 500mg to 1g,)

- Gestational Diabetes

- Dextrose 50%, Urine bags, Glucometers, Test strips, Insulin syringes,

- Presence of stock taking control cards

- Evaluator checks the physical stock available match with the stock book

2 0

5. Storage of NCDs commodities

- Insulin stored at proper temperature (2-8oC)

- Other NCDs medical supplies (Lancet, swab, Normal Saline 0.45 half 0.9 full, Chemistry analyzer, Reagent and drugs stored at appropriate temperature

2 0

6. Adherence to patient charts and treatment protocols

- All patients chart conforms to the treatment protocol (diabetes – hypertension)

- Health education of the patient (causes, signs and symptoms, prevention and effects, diets, lifestyles, follow-up, interpersonal relationship

2 0

TOTAL Point – 10 points maximum 10 XXXXX

12. Mental health

Mental Health Protocol

Respected

NOT

Respected

1. Clinician has a specialized person trained in mental health (MH)

- Supervisor checks availability of MH trained clinician – civil servant or contract

- Clinician received at least the six-months post-basic mental health training

- The mhGAP (Mental Health Gap Action Program) manual is available in hospital and used by clinician

2. mhGAP trained clinician knows how to determine MH conditions

- Full mental and physical health assessment should be done according to (mhGAP) protocol for mhGAP clinicians and mhGAP or Diagnostic and Statistical Manual (DSM5) for

Mental Health Clinics

- Depression (also post-partum): Supervisor asks for key symptoms:

=> sad mood, loss of interest in pleasurable activities, decreased energy

=> uses Patient Health Questionnaires (PHQ-9) to screen for depression disorders

- Anxiety patients: Supervisor asks for key symptoms:

=> Uses GAD-7) screening tool

- Psychosis (e.g.: post-partum) Supervisor asks to identify key symptoms

=> talking by themselves, seeing things that are not real, having false beliefs)

- Epilepsy - Supervisor asks to identify key symptoms

=> continue convulsion without any underlining medical cause

2 0

3. Clinicians know to manage MH conditions according to mhGAP protocol

- Depression and anxiety => take vital signs, counsel, prescribe with amitriptyline

25mg/50mg, and refer if necessary

- Psychosis => take vital signs, counsel, prescribe chlorpromazine 50mg/100mg and

Haloperidol 5mg/10mg and refer if necessary

- Epilepsy => take vital signs, counsel, prescribe carbamazepine 100mg/200mg, Phenobarbital 50mg/100mg and refer if necessary)

2 0

4. MH expert knows how to identify and treat common epileptic patients before or during perinatal care

Supervisor asks MH expert about how to identify and treat epileptic patients

- Assess for history of birth trauma and childhood illness

- Assess for any form accident and trauma to the brain

- During seizure, ease the person to the floor.

- Turn the person gently onto one side. This will help the person breath

- Clear area around the person of anything hard or sharp. This can prevent injury

- Put something soft and flat, like a folded jacket, under his or her head to prevent further injury to the brain

- Manage all patients according to the three (3) treatment plans: only counselling, only medication, or counselling plus medication

- Assessed all patients for drug side effects and managed

2 0

5. mhGAP clinician can make follow-up on mental health clients

- Supervisor asks if clinician can follow-up on mental health patients (patient’s condition, compliance in taking their medications, side effects of medications, family support)

1 0

TOTAL Point – 10 points maximum 10 XXXXX

13. Community PBF and equity

COMMUNITY PBF - EQUITY

Protocol

Respected

NOT

Respected

1. Home Visits According to Protocol conducted

- At least 30 home visits were done during the last month

- Evaluator checks 3 HH visit protocols for completeness

- A qualified staff has joined the community volunteer such as a CHA

3 0

2. Protocol for selecting the very poor and vulnerable is available

- Including for the permanently very poor, the circumstantial cases such as accidents or during disasters

3 0

3. List of vulnerable in the catchment area of the HF is available

- Accessible within 5 minutes

- At least 2% of the households in the catchment area are identified as poor

2 0

4. Effect of home visits on FP

- At least 3 new cases in the past month for FP arrived at HF after home visit 1 0

5. Effect of home visit on toilets / latrines

- List of houses of the catchment area of the HF showing available toilets / latrines with convincing improvement strategies

2 0

6. HF organizes “active screening” of malnutrition through home visits.

Supervisor checks:

- HF organizes general home visits, which includes active screening for malnutrition among children 0-59 months and pregnant and lactating mothers

- HF staff and community health volunteers (CHVs) during home visits have MUAC tapes, (including a spare one), a tally sheet, referral slips, counselling instructions, pencils, pencil sharpeners, eraser, waterproof bag.

- Home visit staff refers children with MAM or SAM to STP-, OPT services of HC

1 0

7. HF organizes follow-up visits to families with children MAM or SAM, who

- Did not attend the OTP/SFP after community diagnosis with MAM or SAM

- Defaulted from the treatment schedule at HF

- Were discharged or defaulted from In Patient Facility (IPF) and did not enrol in OTP/SFP program HF

- Have failed to respond to treatment

- There is in Ledger at least 1 child per month recovered after home visit

* Staff should not reprimand defaulters. Poor staff attitude to caretakers is most common reason

8. Home visit staff knows how to use the nutrition screening tally sheet.

Supervisor asks home visit staff how they use tally sheets. Answer must include:

- Community’s name, date of visit, name of staff, who did home visit

- Nr of children screened, Nr of children with oedema

- Nr of children with MUAC < 11,5 cm (= red band = SAM).

- Nb of children with MUAC 11,5 – 12,5 cm (= yellow band = MAM).

- Nb of children with MUAC > 12,5 cm (= green band = normal).

- Nr of children referred, Nr of children, who refused referral.

9. Effects community PBF on the follow-up of TB 1 0

- Protocol on the follow-up of dropouts available

- At least one case of TB

10. Effect of Community PBF on the follow-up of EPI dropouts

- Protocol on the follow-up of dropouts available - defaulter tracking forms

- Evidence that the follow-up program is running

1 0

11. Preventable Disease Surveillance conducted

- Presence of trained surveillance focal person at this facility

- Passive surveillance conducted by the facility

Poliomyelitis, meningitis, cholera, shigellosis, Lassa fever, measles, rabies, viral haemorrhagic fever, neonatal tetanus, yellow fever, COVID 19, maternal deaths, neonatal deaths and unexplained cluster of deaths or health events were the priority diseases and events to be reported weekly in Liberia under IDSR.

If yes, verify treatment and weekly Integrated Disease Surveillance and Response (IDSR) ledgers, case-based forms.

4 0

Points TOTAL – 20 points maximum … / 20 XXXXX

14. Nutrition

Nutrition Protocol

Respected

NOT

Respected

1. HF or sub-contracted PHC 1 in catchment area has nutrition services with staff trained in Integrated Management of Acute Malnutrition (IMAM)

- HF has Supplementary Feeding Program (SFP) for Moderate Acute Malnutrition (MAM) and Outpatient Therapeutic Facility Program (OTP) for Severe Acute Malnutrition (SAM) without complications

- SAM cases with complications are referred to Inpatient Facility (IPF) services in nearby hospital or dedicated nutrition centre with inpatient care

- Nurse or Midwife in charge of nutrition is trained in Community Integrated Management of

Child Illnesses, measurement techniques, admission- and discharge criteria for MAM treatment and SAM treatment (without complications) and defaulter tracing.

3 0

2. HF conducts “passive screening” for malnutrition

Supervisor checks:

- All children (and women with malnourished child) attending the health centres are checked with MUAC and screened for oedema

1 0

3. Availability in HF of anthropometric materials in functional condition at points where under-5s receive nutrition services

- Screening tally sheets

- Salter Scale calibrated to zero, weighing tub available, clean in good condition

- Height board position in the HF with weight for height table

- Nutrition registration book

- Z-score chart laminated and readable with the standard deviations (SD)

- Mid Upper Arm Circumference tapes

- Charts for outpatient therapeutic program (OTP) for SAM

- Chart for inpatient facility (IPF) for severe acute malnutrition (SAM)

4. Adult scale available and functional - BMI calculation

- Inspect in comparison with the known weight of supervisor, after weighing the needle of the scale should come to zero

- Body Mass Index (BMI) for adults is calculated

5. Nutritional HF staff knows to read and interpret Z-score, weight for height, weight for length, MUAC, bilateral oedema

Supervisor checks with MW or nurse:

- Staff evaluates correctly Moderate Acute Malnutrition =>W/H - W/L ≥ -3 Z score and < -

2 Z score OR MUAC ≥ 11.5 cm and < 12.5 cm - absence bilateral oedema.

- Staff checks MAM in pregnant or lactating women => MUAC < 21 cm

- Staff evaluates correctly Severe Acute Malnutrition => with weight for height <-3 Z-score

OR MUAC < 11.5 and/or presence of bilateral oedema

- Staff distinguishes when patients require outpatient therapeutic program (OTP) for SAM

=> Good appetite, no oedema and no other complications

- Staff distinguishes when patients require in patient facility care (IPF) for SAM

=>presence of bilateral oedema or fails appetite test or severe other complications

2 0

6. HF successfully obtains dry rations for MAM Supplementary Feeding Program

- Receives inputs from MOH, NGOs, UNICEF. OR

- HF buys dry rations locally and obtains PBF reimbursements for each child receiving supplementary feeding

- Supervisor checks in nutrition Ledger that MAM children obtained SFP rations

- Supervisor checks that HF has at least one month of dry ration supply for SFP

2 0

7. Staff knows how to prepare and distribute MAM premix dry rations for

Supplementary Feeding Program (SFP). Supervisor checks:

- Daily ration => Corn Soya blend 250 gr; vegetable oil 30 gr; sugar 20 gr

- 14-day ration => Corn Soya blend 3.500 gr; vegetable oil 420 gr; sugar 280 gr

- 14-day ration of 4.2 kg is given in clean family container

- Caretakers prepare at home 1 volume of premix with 3 volumes of clean water

2 0

8. Staff knows how to administer medicines for MAM and SAM

- 6-11 months => Vit A 100.000 IU, 12-59 months => Vit A 200,000 IU

- 12-23 months => Albendazole 200mg or Mebendazole 250 mg; > 23 months =>

Albendazole 400 mg or Mebendazole 500 mg

- Iron/folic acid, < 10 kg => 1 tab per 14 days; > 10 kg => 2 tabs per 14 days

1 0

9. Staff correctly surveils MAM and SAM children during repeat visits

- Checks MUAC and weight child, knows target MUAC and target weight for discharge and when to refer for IPF

- Treatment failure defined as no weight gain after 5 weeks; any weight loss after 3 weeks, weight loss at any time of more than 5%, failure to reach discharge weight after 3 months.

- Treatment failure may be caused by incorrect application of SFP, RUTF, RUSF, home / social circumstances, underlying diseases

10. Staff knows to manage SAM patients according to nutrition protocol 2 0

Supervisor checks:

- SAM OTP management => Ready to Use Supplementary Food (RUSF) Anti-malaria drug, Amoxicillin 125mg to 1000mg, Measles vaccine from 9 months child

TOTAL Point – 17 points maximum … / 17 XXXXX

15. Tuberculosis

Tuberculosis Protocol

Respected

NOT

Respected

1. Health facility has Trained Clinician Providing TB services

- Supervisor checks if facility has qualified staff to diagnose and treat TB patients

- Clinician in TB unit must be trained in basic level TB training of 5 days

- Clinician in TB unit must be trained in the TB refreshing training of 3 days

1 0

2. Availability of TB Diagnostic and Treatment Guidelines

- Supervisor checks whether HF has TB diagnostic algorithm. This is a stepwise approach for the investigation of a presumed TB patient and how to interpret the result of the laboratory examination.

- Facility has TB treatment algorithm

1 0

3. Does the health facility have the appropriate Ledgers?

- Presumptive Ledger

- Treatment Ledger

- Laboratory Ledger

- Treatment Cards

- Referral Ledger, which may include drug resistance TB diagnosis

1 0

4. Facility has a functional microscope for sputum smear detection of TB

- Supervisor checks for the availability of functional microscope for sputum smears

- Microscope has the following: functional objectives, immersion oil, mirror or electricity, slides, slides cover, GIEMSA

2 0

5. Clinician knows how to collect sputum to transport to GeneXpert site

Supervisor asks TB staff to explain and should mention at least 5 of the 6 points

- The sample volume should be 2 to 3 ml.

- Patient must rinse his/her mouth to remove any food

- Patient should take deep breath three times and cough hard, put the sputum in the cup

(labelled with a unique identifier)

- Sample(s) should be transported un in triple layers according to the GeneXpert site in a cool box.

- If sample(s) cannot be transported the same day, it should be kept in a refrigerator

- Collect sputum far away from other people preferable in a dedicated area where people can feel safe and not looked upon when producing sputum.

6. Facility has a robust transportation system for biological samples specimens of persons presumed to have TB for submission to diagnostic Laboratory

- Supervisor checks if clinician pre-counselled patients before testing for TB

- Is there an available copy of the Sputum transport log?

1 0

7. TB trained clinician knows how to diagnose TB cases according to protocol

Supervisor asks clinician on TB duty following questions

- Clinician knows at least 4 key symptoms of pulmonary TB: coughing two weeks, shortness of breath, chest pain, haemoptysis, weight loss, night sweating, loss of appetite, fatigue.

- Clinician knows at least 4 key symptoms of extra-pulmonary TB. In addition to general symptoms above patients may also have the following symptoms: Swollen lymph nodes (TB lymphadenopathy), Headache (TB meningitis); Severe backache, sometimes with difficulties in walking (TB of spine); Swollen joints (TB arthritis); Abdominal pain and distension (TB peritonitis); Intermittent diarrhoea, sometimes with blood (TB of the bowel); and recurrent urinary infections, which are sterile on ordinary culture and unresponsive to antibiotics (renal TB).

2 0

8. Facility provide HIV testing and counselling for TB patients

- Evidence of documentation of TB patients tested for HIV 1 0

9. The health facility has diagnostic equipment

Security Stock = Monthly Average Consumption (MAC) / 2

- Bench aids for Ziehl Neelsen or Led FM platforms

2 0

10. The health facility has anti-TB drugs

Security Stock = Monthly Average Consumption (MAC) / 2

- Isoniazid (INH or H)

- Rifampicin (R)

- Ethambutol (E)

- Pyrazinamide (P)

2 0

11. Facility works with Community Health Volunteers and / or DOTS providers to support TB patients

- Community Treatment Card

- Evidence of community referral

2 0

TOTAL Points - 17 points maximum … / 17 XXXX

16. HIV – AIDS

HIV/AIDS CONTROL

Protocol

Respected

NOT

Respected

1. Counselling room in good condition

- Walls of durable material with plastering and painting

- Ceiling in good condition

- Windows with glasses and curtains and functional doors

- Desk with three chairs, shelf

- Confidentiality assured

2. Counselling room hygienic with blood collection equipment available

- Counselling Ledger available, used and up to date

- Equipment: blood sample bottles and needles (at least 20), blood sample bottle holder, tourniquet

- Bins for stained materials with lid

- Safety box (needles) well placed and used

2 0

3. Presence of a trained person

- Capable to provide client-initiated HIV testing and counselling (CITC) and Provider-Initiated HIV Testing & Counselling (PITC)

2 0

4. Minimal/security stock of reagents

- At least 50 tests of determine and at least 5 confirmation tests

- Match between physical and theoretical stock

2 0

5. HIV testing and treatment guidelines, Ledgers and referral forms

- Standard operating procedures for testing and treatment protocol available in counselling room

- HIV testing algorithm must be displayed on the wall

- ART services treatment Ledgers available and filled properly

- Referral forms available (at least 10)

- Check at least 2 referral forms are in how far they are filled in correctly and filed

2 0

6. Patient Charts

- At least 50 empty patient charts are available

- Filled out patients’ charts are filed properly

- Randomly select 5 charts and check if they are filled correctly

2 0

7. Antiretroviral drugs

- Availability first-line regimen adults Tenofovir, Lamivudine, and Dolutegravir (TLD)

- Adequate stock (at least 50 cans)

2 0

TOTAL Points - 14 points maximum … / 14 XXXXX

17. Immunization services – school programme

IMMUNIZATION

Protocol

Respected

NOT

Respected

1. Human Resource availability

Evaluator interviews vaccinator(s) of health facility

- Does (s)he has the correct basic academic level (high school) and followed specific training sessions (in practice training)

2. EPI data tools availability

Evaluator inspects the availability of the data collection tools

- Human Papilloma Virus (HPV) card (girls from 9 years old, 2 doses with 6 months interval)

- EPI child health passport card with road to growth card (remains with caretaker)

- Tetanus Diphtheria (TD) card => for women of childbearing age (= pregnant (4.6%) and non-pregnant (18%).

- EPI monitoring charts on wall of HF to monitor progress per vaccine

- Laminated Standard Operation Procedures (SOPs) for vaccine and cold chain management to be put on the wall

- IEC materials (flyers, posters, banners) for routine immunization on display

- EPI outreach ledgers, tally book depending on strategy (outreach, mobile, fixed)

- Vaccine stock accountability ledgers and other supplies

1 0

3. EPI data tools well filled in

Evaluator inspects the Ledger and verifies whether the vaccinator/person responsible has completed the Ledgers correctly.

- Return date indicated

- The Human Papilloma Virus (HPV) card is filled in correctly

- Women of childbearing age Tetanus Diphtheria card filled in correctly

- EPI monitoring charts correctly completed and posted on the wall

- Vaccines and other supplies stock accountability - ledgers completed correctly

2 0

4. Vaccinator is able to explain vaccines programme

- Vaccination hygiene practices

- Injection safety (not recapping needle, one mixing syringe to a vial, proper use of safety box, non-expired & contaminated syringes being practiced

- At least 3 critical messages given to each caretaker before leaving the session: Vaccines given, diseases vaccinated against, potential side effects and how to manage.

3 0

5. Quarterly EPI plan available

Evaluator, checks for evidence

- Makes use of catchment area map in general office – or has a copy in EPI room

- Immunization schedule / plan shows fixed & outreach immunization sessions for the past 3 months posted on the wall, which also indicates in how far sessions were implemented

- A defaulter tracking system in place

1 0

6. Staff know about Adverse Events Following Immunization (AEFI) monitoring

- AEFI cases reported through active case search in the last 6 months through PBF defaulter tracing indicators

- Health facility has proper documentation of AEFI activities and reported cases?

1 0

7. Cold chain system in good condition

- Solar fridge=> battery in good condition

- Electric fridge => available back up system in case of power cut

1 0

8. Cold Chain Assured

- Availability of activated fridge tag 2

- Evaluator checks the functionality of the fridge tag 2

- Thermometer fridge tag 2 present in the refrigerator compartment

- Temperature is between 2 and 8 degrees Celsius measured from fridge tag 2

- Temperature chart form filled in twice a day – including the visit day

5 0

- Vaccine vial monitor (VVM) remains in stage 1 and 2

- No food or drinks in the fridge

9. No stock-outs of vaccines, other related supplies and equipment

- BCG, measles, polio, pneumonia, ROTARIX, pentavalent, yellow fever, HPV, TD, TCV, IPV

- Diluents, AD syringes, mixing needles, droppers, vaccination cards, HF& OR ledgers, temperature form, stock ledgers and monitoring chat

- Ice packs, at least 2 vaccines carrier, 1 cold box, fridge tag 2 and solar fridge

- Evaluator checks physical stock in fridge that matches with the theoretical stock

2 0

10. Vaccines and ice packs are correctly stored in fridge

- Freezing compartment: Cold accumulators (ice packs) - at least (8)

- Not frozen compartment: vaccines and diluent only with fridge tag 2

1 0

11. Syringes available

- Auto Disable– at least 30, For dilution – at least 3 0 0

12. Waste is collected in bins.

- Waste is collected in bins with bag

- Availability of safety box (container)

1 0

13. Good waiting conditions immunization services

- With sufficient benches and / or chairs, protected against the sun and rain 1 0

14. Availability of a Salter scale (baby scale) in good condition

- Scale calibrated to zero + Pants available, clean and in good condition 1 0

15. School Visitation Programme

- Number of schools in catchment area is known

- During the last 6 months all planned school visitation sessions conducted

1 0

TOTAL Points - 22 points maximum … / 22 XXXXXX

18. Family planning

FAMILY PLANNING

Protocol

Respected

NOT

Respected

1. FP consultations are conducted by qualified staff

- Staff is at least nurse or midwife with 2 years specialized training

- Staff conducting FP services are trained in administering FP commodities

2 0

2. Staff conducting FP knows how to administer FP services

Supervisors ask staff on FP duty. They should answer at least the following:

- Knows the various methods of FP methods => pill, injectable, IUD, implant, emergency care contraception, tubal ligation).

- Administers each method appropriately (oral pill daily, Depo injection for 3 months, implant for 5 years, IUD inserted and can be removed when patient desire)

- Explain side effects of each method to patient and encourages client to return to HF in case of complications

- Clients should be allowed to choose the method they prefer

3. Consultation room in good condition and clean with confidentiality assured

- Walls in concrete, paved and painted,

- Floor paved with cement or tiles without cracks,

- Ceiling in good condition,

- Glasses windows (not broken) with curtains,

- Room with closed door– curtains on the windows – no through way

2 0

4. Wall poster or box image with family planning methods for demonstration 1 0

5. FP Ledger available and filled in

- Up to date and in all sections filled 2 0

6. FP individual forms available and correctly filled in

- Randomly select 5 clients in the registry and check their individual forms

- It’s mandatory to have the following indicators: blood pressure, hepatomegaly, varicose veins, weight

2 0

7. Availability of counselling tool

- WHO Medical Eligibility Criteria Wheel available and used

- Supervisor checks in how far FP nurse understands the use of the tool

2 0

8. HIV testing and counselling

- Clients offered testing in case there are suspicions, and for marriage counselling 1 0

9. Safety stock for oral and injectable contraceptive supplies

For each 10,000 inhabitants

- 147 doses of DEPO or stock ≥ MMC

- 36 boxes of 3 blisters/cycles of pills

1 0

10. IUD with insertion kit available

- Staff trained to insert/remove them

- At least 10 IUDs with an insertion kit available

1 0

11. Implants method available

- Staff trained to insert/remove them

- At least 10 implants available

1 0

12. Condoms available (male)

- At least 288 condoms are available, not expired 1 0

TOTAL Points - 18 points maximum … / 18 XXXXX

19. Maternity – delivery care, ANC, PNC

MATERNITY – delivery care, ANC, PNC

Respected

NOT

Respected

1. Availability of trained OB staff

- Staff conducting deliveries, ANC and PNC have at least 2 years of medical training

- Staff followed specific training in delivery care ANC, PNC

1 0

2. All deliveries are conducted by trained OB staff

- Identification of trained staff from names and signatures in registry 1 0

3. Staff knows how to conduct safe and normal virginal delivery independently

Supervisor asks staff the following to staff

- First stage of labour => Asks patient to empty bladder, checks patient’s dilatation, contraction, foetus heart tone, foetus presentation

- Second stage of labour => delivery of the baby, administration of Oxytocin to mother)

- Third stage of labour => delivery of placenta within 5 to 15mins, observe for any virginal tear or cut

- Fourth stage of labour => clean and weight baby, encourage mother to breastfeed baby, monitor mother and child conditions

2 0

4. The rates for payment of obstetric care cost fares are displayed

- Rates visible to clients prior to the consultation 1 0

5. Sufficient water with soap in the delivery ward

- Running water, with soap- or alcohol dispenser and paper towel dispenser 1 0

6. Delivering ward with light 24/ 24

- Electricity, solar light or rechargeable battery lamp/generator 2 0

7. Waste collected properly in the delivery ward

- Bin with trash bag and lid

- Security box for needles + solution for decontaminating

1 0

8. Delivery ward in good condition

- Walls with durable materials and oil painted or tiles

- Paving in cement without fissures, ceiling in good condition (clean, should not ooze)

- Windows with opaque windows, window glasses intact and functional doors

- At least 2 beds with not torn mattresses, leather covered, spaced at least 1 meter

- Curtain placed between delivery bed and door

1 0

9. Availability of the partogramme / partograph

- At least 10 empty forms 1 0

10. Partogramme / partograph completed correctly

- The evaluator randomly pulls 5 deliveries files and checks their partogramme

- Identification of the woman - date and time of admission…