Churches Health Association of Zambia

HEALTH FACILITY QUARTERLY QUALITY ASSESSMENT TOOL

GENERAL INFORMATION • HEALTH CENTER IDENTIFICATION

Health facility : Ward:

District:

Province:

Phone No:

Fax:

PO Box:

Status: Public Partner :

Missionary

Private

Catchment Population:

Number of beds:

Name of Team Leader:

Phone No:

PO Box:

E-mail:

• INFORMATION ON THE ASSESSMENTS Name of the DHMT (Evaluator of the quarter) : Activity or assessed services

Date of previous assessment of that service

Date of current assessment

Name of the evaluator

Evaluators function or service in the hospital

Starting hour of the assessment

Ending hour of the assessment

Churches Health Association of Zambia _ Quarterly Technical Quality Assessment Tool

SYNTHESIS OF QUARTERLY QUALITY ACTIVITIES ASSESSMENT IN HEALTH FACILITY QUALITY EVALUATION OF HEALTH CENTRE:____________________________ DISTRICT:__________________________ ________QUARTER 20_____ N ASSESSED ACTIVITIES Available Attributed Difference % Points Points

1

Curative Consultation

35

2

Antenatal Care (ANC)

50

3

Family Planning (FP)

57

4

Expanded Program of Immunization (EPI)

28

5

Delivery Room

65

6

HIV Services

16

7

Supply Management

21

8

General Management

20

9

Health Management Information System (HMIS)

18

10 Community Participation

9

11 TB Screening

25

12 Admission Ward

15

TOTAL

359

1 CHAZ PBF project, 2011.

Observations

Churches Health Association of Zambia _ Quarterly Technical Quality Assessment Tool

QUARTERLY SYNTHESIS OF THE OBSERVATIONS AND RECOMMENDATIONS ON THE SERVICE OF HEALTH CENTERE

District: ______________________________ Health Center: ______________________________ Date:_______________________ 1. List recommendations not addressed from the previous quarter and provide justifications

2. Identified strong Points during this quarter

3. Identified weak points to improve during this quarter

4. Recommendations regarding the weak points to improve

5. Technical supervisions recommended

_______________________________________ ___________________ Responsible: Name &Signature

Date

2 CHAZ PBF project, 2011.

Churches Health Association of Zambia _ Quarterly Technical Quality Assessment Tool

QUALITY CRITERIA ASSESSMENT TOOLS

1 CURATIVE CARE (35) No

CHECK LIST ITEMS

1. Equipment available in the treatment room and in working condition: 1) Thermometer 2) Blood pressure machine 3) Stethoscope 4) Otoscope set 5) Unused non-sterile gloves 6) Adult scale 7) Waste disposal bin 8) Examination table 9) Running water from tap or bucket with Tap filled with water. for washing hands with soap 2. Privacy: Individual treatment room with curtains or painted windows, room divider (if shared room), doors that close 3. Documentation for consultation available to provider: 1) Integrated Treatment guidelines (ITG), 2) Tally sheets

CRITERIA

POSSIBLE MAXIMUM SCORE

Treatment room equipped with 9 functional materials = 9 One material missing or nonfunctional = 5 More than one material missing or non-functional =0

9

Assured privacy = 3

3

Privacy non assured = 0 2 documents present in consultation room =3 1 or 2 documents missing = 0 4. Treatment of 5 consecutive Each correct cases of children under age entry and exit 5 according to IMCI points according protocol who are in the to flowchart or facility at time of visit protocol =4 Case without following IMCI protocol =0

3

20

POSSIBLE MAXIMUM SCORE= 35

3 CHAZ PBF project, 2011.

OBTAINED JUSTIFICATION OF SCORE SCORE

OBTAINED SCORE=

Churches Health Association of Zambia _ Quarterly Technical Quality Assessment Tool

QUARTERLY SYNTHESIS OF THE OBSERVATIONS AND RECOMMENDATIONS ON CURATIVE CARE

District: ______________________________ Health Center: ______________________________ Date:_______________________ 1. List recommendations not addressed from the previous quarter and provide justifications

2. Identified strong Points during this assessment

3. Identified weak points to improve during this assessment

4. Recommendations regarding the identified weak points

5. Technical supervisions recommended

_______________________ Name &Signature of evaluator

__________

___________________________ ______ _________

Date

in charge Name, Signature&Stamp

4 CHAZ PBF project, 2011.

Date

Churches Health Association of Zambia _ Quarterly Technical Quality Assessment Tool

Assessment Areas

2 ANTENATAL CARE (ANC) (50) No

CHECK LIST ITEMS

1. ANC visit, first such client (5 cases): Questioning on (using appropriate language): 1) Gynecological and Obstetrical history (Gravid/Para/Abortions) including tetanus vaccination status 2) Convulsions 3) Medical and Surgical history : i) Diabetes, ii) Heart disease, iii) Hypertension, iv) Kidney disease, v)TB, and vi) asthma, 4) HIV testing (with guidance if appropriate) 2. ANC visit: Questioning (5 cases): Complaints about current pregnancy

CRITERIA

Case fulfilling all criteria = 2

Case with even one unmet criterion = 0

If not done = 0 One examination of a case with all relevant elements = 1 One examination of a case with even one relevant element missing = 0

4. ANC visit: (5 cases)

One examination of a case with all relevant elements = 2

CHAZ PBF project, 2011.

10

Questioning done = 1

3. ANC visit: (5 cases) Physical examination: 1) Weight 2) Blood pressure 3) Breast examination and 4) Check for edema

Obstetric examination: 1) Height of uterus 2) Presentation (from 36 weeks) 3) Fetal heartbeat (from 20 weeks) (2 clients)

POSSIBLE MAXIMUM SCORE

One examination of a case with even one relevant element missing = 0, 5

5

5

10

OBTAINED JUSTIFICATION OF SCORE SCORE

Churches Health Association of Zambia _ Quarterly Technical Quality Assessment Tool

No

CHECK LIST ITEMS

5. ANC visit: (5 cases) Administration of tetanus vaccine according to guidelines: 1) Correct intervals 2) Correct storage of vaccine 6. ANC visit: ( 5 cases) Correct prescription of: 1) Iron for women who are HIV-negative or whose HIV status is unknown 2) Folic acid 3) Mebendazole (from second trimester) 4) Fansidar (from 4th month) 7. ANC visit: Management of cases with complications: ( 5 cases) 1) Complications identified 2) Appropriate decision taken according to flowchart 3) Information communicated to patient.

CRITERIA

POSSIBLE MAXIMUM SCORE

One case of administering a vaccine fulfilling all criteria = 1

5

One case with one unmet criterion = 0

One case with prescriptions given correctly = 1 One case with even one incorrect prescription = 0

5

Case fulfilling all criteria=2

First case with even one unmet criterion = 0.

10

POSSIBLE MAXIMUM SCORE= 50

6 CHAZ PBF project, 2011.

OBTAINED SCORE

OBTAINED SCORE=

JUSTIFICATION OF SCORE

Churches Health Association of Zambia _ Quarterly Technical Quality Assessment Tool

QUARTERLY SYNTHESIS OF THE OBSERVATIONS AND RECOMMENDATIONS ON ANTENATAL CARE

District: ______________________________ Health Center: ______________________________ Date:_______________________ 1. List recommendations not addressed from the previous quarter and provide justifications

2. Identified strong Points during this assessment

3. Identified weak points to improve during this assessment

4. Recommendations regarding the identified weak points

5. Technical supervisions recommended

_______________________ Name&Signature of evaluator

__________

___________________________ ______ _________

Date

HC’s in charge Name, Signature&Stamp

7 CHAZ PBF project, 2011.

Date

Churches Health Association of Zambia _ Quarterly Technical Quality Assessment Tool

3 FAMILY PLANNING (FP) ( 57) No

CHECK LIST ITEMS

1. Direct Observation of the Room and Supplies: Contraceptive methods: 1. Pills 2. Injectable contraceptives 3. Implant 4. Condoms A) Availability of contraceptive with theoretical stock corresponding to physical stock; and B) Minimum stock levels maintained 2. Analysis of 10 randomly chosen FP clients from the past three months: Justification of methods recommended, used, and prescribed compared to methods indicated on the basis of questioning, history, and physical examination (In the registers) 3. (If not on clinic day), Analysis of 10 randomly chosen FP clients from the past three months: number of entries completely filled in all fields

CRITERIA

POSSIBLE MAXIMUM SCORE

One contraceptive method fulfilling both criteria A and B = 3 A contraceptive method with even one unmet criterion = 0

12

Correct justification = 3 Unjustified = 0

30

Yes = 1.5 No = 0

15

POSSIBLE MAXIMUM SCORE= 57

8 CHAZ PBF project, 2011.

OBTAINED SCORE

OBTAINED SCORE=

JUSTIFICATION OF SCORE

Churches Health Association of Zambia _ Quarterly Technical Quality Assessment Tool

QUARTERLY SYNTHESIS OF THE OBSERVATIONS AND RECOMMENDATIONS ON FAMILY PLANNING (FP)

District: ______________________________ Health Center: ______________________________ Date:_______________________ 1. List recommendations not addressed from the previous quarter and provide justifications

2. Identified strong Points during this assessment

3. Identified weak points to improve during this assessment

4. Recommendations regarding the identified weak points

5. Technical supervisions recommended

_______________________ Name & Signature of evaluator

__________ Date

___________________________ ______ _________ HC’s in charge Name, Signature & Stamp

9 CHAZ PBF project, 2011.

Date

Churches Health Association of Zambia _ Quarterly Technical Quality Assessment Tool

4 EXPANDED PROGRAM FOR IMMUNIZATION (EPI) (28) No

CHECK LIST ITEMS

CRITERIA

1.

EPI: Available and functional equipment and supplies: 1) Refrigerator 2) Vaccine carriers 3) Vaccine cold box 4) Spare parts (wicks and glass containers for paraffin refrigerator) 5) Parrafin reserve (5 liters minimum) and/or generator 6) Thermometer, salter scales Availability of vaccines and diluents: BCG Polio Pentavalent Tetanus Measles Diluting agent 1) Physical presence of unexpired, labeled antigens 2) No interruption of supply during past three months

Each equipment and supplies available and functional = 1 Even one piece of equipment or supply missing or nonfunctional = 0 Availability of all antigens and diluents fulfilling both criteria =2

2.

3.

4.

Storage of vaccines: 1) Vaccines carefully arranged in refrigerator sections (frozen and non-frozen vaccines) 2) No products other than vaccines and accumulators stored in refrigerator Available consumables and printed forms: 1) Syringes 2) Dilution syringes (2 and 5 ml) 3) Receptacles 4) Absorbent cotton 5) Under five cards 6) Tally sheets 7) Registers of vaccinations

POSSIBLE MAXIMUM SCORE

2 Expiry or disruption of supply of one antigen or diluting agent = 0 Storage fulfilling both criteria = 2 Storage with even one unmet criterion = 0 Availability of all items= 7 Even one item missing = 0

10 CHAZ PBF project, 2011.

6

2

7

OBTAINED JUSTIFICATION OF SCORE SCORE

Churches Health Association of Zambia _ Quarterly Technical Quality Assessment Tool

4 EXPANDED PROGRAM FOR IMMUNIZATION (EPI) (28) No

CHECK LIST ITEMS

CRITERIA

5a.

Cold chain: 1) Maximum and Minimum temperatures of refrigerator between +2*C and +8*C, 2) Unbroken cold chain during previous three months. If available Direct observation of four consecutive children in the vaccination program: Growth monitoring chart checked to determine whether vaccination is due If available Registration completed: (5 cases ) 1) On individual chart 2) On growth chart 3) In register 4) On tally form

Chain fulfilling both criteria = 4

5b.

5c.

POSSIBLE MAXIMUM SCORE

Even one day of interruption=0

4

Checked for each case = 4

4

If not checked = 0

One case with registration fulfilling all criteria = 0.6 One case with even one unmet criterion = 0

3

POSSIBLE MAXIMUM SCORE= 28

11 CHAZ PBF project, 2011.

OBTAINED JUSTIFICATION OF SCORE SCORE

OBTAINED SCORE=

Churches Health Association of Zambia _ Quarterly Technical Quality Assessment Tool

QUARTERLY SYNTHESIS OF THE OBSERVATIONS AND RECOMMENDATIONS ON EXPANDITURE PROGRAM FOR IMMUNIZATION

District: ______________________________ Health Center: ______________________________ Date:_______________________ 1. List recommendations not addressed from the previous quarter and provide justifications

2. Identified strong Points during this assessment

3. Identified weak points to improve during this assessment

4. Recommendations regarding the identified weak points

5. Technical supervisions recommended

_______________________ Name&Signature of evaluator

__________ Date

___________________________ ______ _________ HC’s in charge Name, Signature & Stamp

12 CHAZ PBF project, 2011.

Date

Churches Health Association of Zambia _ Quarterly Technical Quality Assessment Tool

5 DELIVERY ROOM (65) No

CHECK LIST ITEMS

1. Privacy: Curtains or painted windows, room divider (if shared room), doors that close, running water (tap or bucket with tap), 3 buckets for Infection prevention, labeled 2. Available and functional equipment and supplies: 1) Adjustable, clean delivery table 2) at least 3 sterilized instrument boxes (with needle holder, two Kocher clamps, toothed forceps, two pairs of scissors) 3) Neonatal suction devise 4)Foetal scope 5) Suture thread, 6) light source 7) infant weighing scale 8) Sterilizing drum 9) Ophthalmic ointment 10) Gauze drum 11) Plastic apron 12) local anesthesia (at least 20ml in reserve) 13) unused and non-torn surgical gloves 14 umbilical cord clamp 3. Analysis of 10 randomly selected partograms: 1) Partogram filled out according to the rules 2) Decision made/documented if alert line is passed within one hour 3) Delivery by qualified staff (at least a nurse, midwife, Clinical Officer, doctor)

CRITERIA

POSSIBLE MAXIMUM SCORE

Assured privacy = 11 11 If privacy not assured= 0

One material available and functional = 1 If even one material (1) to (5) is unavailable or nonfunctional = 0

14

One partogram fulfilling 3 criteria =4 One partogram with even one unmet criterion = 0

40

POSSIBLE MAXIMUM SCORE = 65

13 CHAZ PBF project, 2011.

OBTAINED SCORE

OBTAINED SCORE=

JUSTIFICATION OF SCORE

Churches Health Association of Zambia _ Quarterly Technical Quality Assessment Tool

QUARTERLY SYNTHESIS OF THE OBSERVATIONS AND RECOMMENDATIONS ON DELIVERY ROOM

District: ______________________________ Health Center: ______________________________ Date:_______________________ 1. List recommendations not addressed from the previous quarter and provide justifications

2. Identified strong Points during this assessment

3. Identified weak points to improve during this assessment

4. Recommendations regarding the identified weak points

5. Technical supervisions recommended

_______________________ Name&Signature of evaluator

__________ Date

___________________________ ______ _________ HC’s in charge Name, Signature&Stamp

14 CHAZ PBF project, 2011.

Date

Churches Health Association of Zambia _ Quarterly Technical Quality Assessment Tool

6 No

HIV SERVICES (16) CHECK LIST ITEMS

1. VCT/PMTCT: Equipment and supplies. 1) Equipment and supplies meet MOH standards (i) One desk (ii) Three chairs (iii) bookshelf (iv) Singleuse receptacle (v) Materials for taking blood samples (tubes, needles, gloves, adaptor, tourniquet, tube holder, stopper) (vi) Lab forms, (vii) Running water 2) IEC/BCC supplies available on the table (i) Box of condoms (at least 10 condoms) (ii) Model of a penis, (iii) HIV/AIDS booklets/leaflets pertaining to VCT and PMTCT

CRITERIA

POSSIBLE MAXIMUM SCORE

Criteria 1) and 2) fulfilled = 16

One criterion unmet = 0

16

POSSIBLE MAXIMUM SCORE = 16

15 CHAZ PBF project, 2011.

OBTAINED JUSTIFICATION OF SCORE SCORE

OBTAINED SCORE =

Churches Health Association of Zambia _ Quarterly Technical Quality Assessment Tool

QUARTERLY SYNTHESIS OF THE OBSERVATIONS AND RECOMMENDATIONS ON HIV

District: ______________________________ Health Center: ______________________________ Date:_______________________ 1. List recommendations not addressed from the previous quarter and provide justifications

2. Identified strong Points during this assessment

3. Identified weak points to improve during this assessment

4. Recommendations regarding the identified weak points

5. Technical supervisions recommended

_______________________ Name&Signature of evaluator

__________ Date

___________________________ ______ _________ HC’s in charge Name, Signature&Stamp

16 CHAZ PBF project, 2011.

Date

Churches Health Association of Zambia _ Quarterly Technical Quality Assessment Tool

7 SUPPLY MANAGEMENT (21) No

1.

2.

3.

4.

5.

6.

CHECK LIST ITEMS

CRITERIA

Pharmacy premises in accordance with regulations: 1) Refrigerator 2) Ventilated premises 3) 20ml Medicine cup 4) Lockable Drug Cabinet

Premises fulfilling all criteria = 2 Even one unmet criterion = 0

2

Cleanliness of pharmacy (no dust on shelves and products, no cobwebs)

Cleanliness assured = 2 Cleanliness not assured= 0

2

Stocking fulfilling all criteria =5 Even one unmet criterion = 0

5

One tool fulfilling both criteria = 2 One tool with even one unmet criterion = 0

6

All tracer drugs and consumables available = 4 Disruption of even one drug or consumable = 0

4

Procedure fulfilling both criteria = 2 Even one unmet criterion = 0

2

Stocking in accordance with regulations: 1) Products arranged on shelves, not on floor 2) Logically arranged products (alphabetical 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 Management of tools:  Stock control card  Order forms  Order book 1)Presence of these tools in pharmacy stock, 2) Filled in regularly according the norms Availability of tracer drugs and consumables: 1) all molecules and consumables available 2) No interruption of supply since last assessment. [antibioticspenicillin injectable, antimalarial, anticonvulsants, ferrous sulphate, folic acid, ORS, oxytocin, normal saline, ringers, 5% dextrose fluids] Correct procedure observed for destruction of outdated products : 1) Inventory register or card for outdated products 2) Presence of DHMT member signature in register or on the

17 CHAZ PBF project, 2011.

POSSIBLE OBTAINED JUSTIFICATION MAXIMUM SCORE OF SCORE SCORE

Churches Health Association of Zambia _ Quarterly Technical Quality Assessment Tool

card of having collected the expired drugs POSSIBLE OBTAINED MAXIMUM SCORE= SCORE=21

QUARTERLY SYNTHESIS OF THE OBSERVATIONS AND RECOMMENDATIONS ON SUPPLY MANAGEMENT

District: ______________________________ Health Center: ______________________________ Date:_______________________ 1. List recommendations not addressed from the previous quarter and provide justifications

2. Identified strong Points during this assessment

3. Identified weak points to improve during this assessment

4. Recommendations regarding the identified weak points

5. Technical supervisions recommended

_______________________ Name & Signature of evaluator

__________ Date

___________________________ ______ _________ HC’s in charge Name, Signature & Stamp

18 CHAZ PBF project, 2011.

Date

Churches Health Association of Zambia _ Quarterly Technical Quality Assessment Tool

8 GENERAL MANAGEMENT (20) No

CHECK LIST ITEMS

1. Available minutes of the three previous monthly meetings of the health center management committee. Minutes should contain: 1) Date, time of opening and closing of meeting 2)Agenda items 3) Signed list of persons present 4) Description of the meeting a) Adoption of minutes of previous meeting; b) Review of 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 of the meetings 2. Inventory of equipment and supplies: Updated monthly asset register

3. Reception: 1) Covered waiting rooms complete with chairs or benches; 2) Staff member conducting triage according to seriousness of problem and 3) Waiting room with number/ticket to the clients 4. Cleanliness of rooms, halls, and grounds: 1) Presence of trash receptacles (in waiting room and corridor) 2)No loose trash;3) Receptacles for syringes present in treatment rooms 4)Within and surrounding health center entirely cleared of weeds and stagnant water drained

CRITERIA

POSSIBLE MAXIMUM SCORE

Minutes fulfilling all criteria = 3 Minutes with even one criterion unmet = 0

All inventories present and up-to-date = 1 Missing or obsolete inventory = 0

1

One element present = 1 (max. 3 elements)

3

Each cleanliness criterion fulfilled = 0.75

3

19 CHAZ PBF project, 2011.

3

OBTAINED SCORE

JUSTIFICATION OF SCORE

Churches Health Association of Zambia _ Quarterly Technical Quality Assessment Tool

8 GENERAL MANAGEMENT (20) No

CHECK LIST ITEMS

5.

6.

7.

8.

9.

10.

11.

No organic waste, syringes, or dangerous products in halls, rooms, or any other location on the grounds of the health center that are easily accessible to the public Functioning incinerator or disposal pit: Operated and used according to the rules (triage and destruction, etc.) Placenta pit with slab and cover

CRITERIA

POSSIBLE OBTAINED MAXIMUM SCORE SCORE

Yes = 1 Presence of organic waste or used syringes, needles or used bandages = -5 point penalty

Functioning incinerator or disposal pit used in accordance with regulations = 2 If not available =0 Available water Availability of water source source = 1 (running water or well, Water source not pump, or water tower/tank available = 0 Water dispensers available Available water in consultation rooms, in dispensers = 1 delivery room and near Not available = 0 latrines Presence of latrines and All latrines fulfill showers 1) Usable; 2)No criteria = 1 organic matter within or All showers fulfill outside; 3)Door that criteria = 1 closes from the inside; Even one latrine 4)Covered pit (for latrines) with unmet criterion=0/1 Even one shower with unmet criterion=0/1 Pressure sterilizer or Available and functional autoclave available sterilization materials: and functional = 1 Pressure sterilizer or Not available or non autoclave functional=0 Clean, neat uniforms worn Uniforms worn by by all full-time or part-time all staff = 2 staff. Staff includes CDE Even one without and CHWs employed by uniform=0 the HC.

1

2

1

1

2

1

2

POSSIBLE OBTAINED MAXIMUM SCORE= SCORE=20 20 CHAZ PBF project, 2011.

JUSTIFICATION OF SCORE

Churches Health Association of Zambia _ Quarterly Technical Quality Assessment Tool

QUARTERLY SYNTHESIS OF THE OBSERVATIONS AND RECOMMENDATIONS ON GENERAL MANAGEMENT

District: ______________________________ Health Center: ______________________________ Date:_______________________ 1. List recommendations not addressed from the previous quarter and provide justifications

2. Identified strong Points during this assessment

3. Identified weak points to improve during this assessment

4. Recommendations regarding the identified weak points

5. Technical supervisions recommended

_______________________ Name & Signature of evaluator

__________ Date

___________________________ ______ _________ HC’s in charge Name, Signature & Stamp

21 CHAZ PBF project, 2011.

Date

Churches Health Association of Zambia _ Quarterly Technical Quality Assessment Tool

9 HEALTH MANAGEMENT INFORMATION SYSTEM (HMIS) (18) No

CHECK LIST ITEMS

1. Standard HMIS Registers available and columns filled correctly, legibly and completely: 1) Curative Care; 2) FP; 3)ANC; 4) EPI; 5) VCT/PMTCT 6, Environmental Health Register 2. HMIS report transmitted (by the 7th working day of following month)

CRITERIA

POSSIBLE MAXIMUM SCORE

Columns as in the HMIS handbook, completely and legibly filled for each standard register. All register well filled = 10 [Definition not well filled: (i) Columns not according to set format, (ii)Missing information over the past period (glancing through) and (iii) Systematic illegible information] If even 1 register not well-filled = 0 Acknowledgment of receipt of a monthly HMIS report during the period with Signed copy of HMIS by DHMT = 1 Report not transmitted or with delay=0

OBTAINED SCORE

10

3

3. Monthly analysis report of Health Information System

(HMIS) data on priority problems [Public health flags] (Vaccination, FP, maternity, malaria, HIV and other priority diseases in the District) containing: 1) Monthly cumulative Graph or table of data 2) Comments on those tables and Graph 4. Data concordance between 3 randomly selected HIS indicators and activity records

Each Monthly Analysis report of data on 6 priority problems containing all elements= 1

3

Report with even one element missing = 0

Concordance of all three indicators = 2 Even one non-concordant indicator = 0

2

POSSIBLE OBTAINED MAXIMUM SCORE= SCORE= 18 22 CHAZ PBF project, 2011.

JUSTIFICATION OF SCORE

Churches Health Association of Zambia _ Quarterly Technical Quality Assessment Tool

QUARTERLY SYNTHESIS OF THE OBSERVATIONS AND RECOMMENDATIONS ON HEALTH MANAGEMENT INFORMATION SYSTEM

District: ______________________________ Health Center: ______________________________ Date:_______________________ 1. Non applied recommendations of previous quarter and justifications

2. Identified strong Points during this assessment

3. Identified weak points to improve during this assessment

4. Recommendations regarding the identified weak points

5. Technical supervisions recommended

_______________________ Name & Signature of evaluator

__________ Date

___________________________ ______ _________ HC’s in charge Name, Signature & Stamp

23 CHAZ PBF project, 2011.

Date

Churches Health Association of Zambia _ Quarterly Technical Quality Assessment Tool

10 COMMUNITY PARTICIPATION (9) No

CHECK LIST ITEMS

1. Available minutes of past three monthly meetings on of neighborhood health committees: Minutes should contain: 1)Date, time of opening and closing of meeting 2)Agenda items 3)Signed list of persons present 4) Description of the meeting a) Adoption of minutes of previous meeting; b)Review of 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.

CRITERIA

POSSIBLE MAXIMUM SCORE

Minutes fulfilling all criteria =3 9

Minutes with even one criterion unmet =0

POSSIBLE MAXIMUM SCORE=9

24 CHAZ PBF project, 2011.

OBTAINED SCORE

OBTAINED SCORE=

JUSTIFICATION OF SCORE

Churches Health Association of Zambia _ Quarterly Technical Quality Assessment Tool

QUARTERLY SYNTHESIS OF THE OBSERVATIONS AND RECOMMENDATIONS ON COMMUNITY PARTICIPATION

District: ______________________________ Health Center: ______________________________ Date:_______________________ 1. List recommendations not addressed from the previous quarter and provide justifications

2. Identified strong Points during this assessment

3. Identified weak points to improve during this assessment

4. Recommendations regarding the identified weak points

5. Technical supervisions recommended

_______________________ Name & Signature of evaluator

__________ Date

___________________________ ______ _________ HC’s in charge Name, Signature & Stamp

25 CHAZ PBF project, 2011.

Date

Churches Health Association of Zambia _ Quarterly Technical Quality Assessment Tool

11 SCREENING FOR TUBERCULOSIS (25) No

CHECK LIST ITEMS

1. Availability of equipment for screening TB patients: 1)Microscope 2)Glass slides 3)Sputum containers 2. Supplies: 1)Reagents (staining material) 2) Availability of well filled out TB registers a) suspect register b) Laboratory register c) treatment register 3) filled out lab forms 4) TB cards available 3. Screening: 1) patient

screened for HIV 2)Sputum results documented in TB register 3) Treatment initiated and have been available 4)evidence of repeat of sputum examination after two months

CRITERIA

POSSIBLE OBTAINED JUSTIFICATION MAXIMUM SCORE OF SCORE SCORE

If all equipment is available and in functional form = 6 If even one equipment is missing or dysfunctional = 0 If the reagents are available and all the registers are available and properly filled out = 6

6

6 If even one is missing = 4 If more than one is missing =0 Examination filling all the criteria = 13 If even one criteria unmet = 8

13

If more than one criteria is unmet = 0

POSSIBLE OBTAINED MAXIMUM SCORE= SCORE= 25

26 CHAZ PBF project, 2011.

Churches Health Association of Zambia _ Quarterly Technical Quality Assessment Tool

QUARTERLY SYNTHESIS OF THE OBSERVATIONS AND RECOMMENDATIONS ON TB SCREENING

District: ______________________________ Health Center: ______________________________ Date:_______________________ 1. List recommendations not addressed from the previous quarter and provide justifications

2. Identified strong Points during this assessment

3. Identified weak points to improve during this assessment

4. Recommendations regarding the identified weak points

5. Technical supervisions recommended

_______________________ Name & Signature of evaluator

__________ Date

___________________________ ______ _________ HC’s in charge Name, Signature & Stamp

27 CHAZ PBF project, 2011.

Date

Churches Health Association of Zambia _ Quarterly Technical Quality Assessment Tool

12 HEALTH FACILITY ADMISSION (15) No

CHECK LIST ITEMS

1 Admission Ward: 1) Mattresses covered in PVC

CRITERIA

POSSIBLE OBTAINED JUSTIFICATION MAXIMUM SCORE OF SCORE SCORE

Cases filling all criteria = 15 Cases with at least one unmet criteria = 10

2) Clean bed sheets 3) at least one bed sheet and blanket per bed 4) Availability of spread ITN, 5) Curtains on the widows

15 6) Good ventilation, 7) availability of bath room 8) availability of screens for patient privacy 9) Updated and filled out in-patient cards 10) availability of correctly filled out in-patient register

POSSIBLE OBTAINED MAXIMUM SCORE= SCORE= 15

28 CHAZ PBF project, 2011.

Churches Health Association of Zambia _ Quarterly Technical Quality Assessment Tool

QUARTERLY SYNTHESIS OF THE OBSERVATIONS AND RECOMMENDATIONS ON FACILITY ADMISSION

District: ______________________________ Health Center: ______________________________ Date:_______________________ 1. List recommendations not addressed from the previous quarter and provide justifications

2. Identified strong Points during this assessment

3. Identified weak points to improve during this assessment

4. Recommendations regarding the identified weak points

5. Technical supervisions recommended

_______________________ Name & Signature of evaluator

__________ Date

___________________________ ______ _________ HC’s in charge Name, Signature & Stamp

29 CHAZ PBF project, 2011.

Date