{"name": "DEMO_Primary_ISS_Form", "type": "survey", "title": "FEDERAL MINISTRY OF HEALTH, \nIntegrated Supportive Supervision (ISS) tool for PHCs, \nODK (DEMO Version 2018)", "id_string": "Primary_ISS_Form_ODK", "sms_keyword": "Primary_ISS_Form_ODK", "default_language": "English", "version": "2019010801", "choices": {"one_point": [{"label": "Yes", "name": "1"}, {"label": "No", "name": "0"}], "two_points": [{"label": "Yes", "name": "2"}, {"label": "No", "name": "0"}], "three_points": [{"label": "Yes", "name": "3"}, {"label": "No", "name": "0"}], "four_points": [{"label": "Yes", "name": "4"}, {"label": "No", "name": "0"}], "five_points": [{"label": "No", "name": "0"}, {"label": "Yes", "name": "5"}], "ten_points": [{"label": "No", "name": "0"}, {"label": "Yes", "name": "10"}], "RI_vaccines": [{"label": "Delivered", "name": "delivered"}, {"label": "Collected", "name": "collected"}], "child_vaccine": [{"label": "Parents", "name": "parents"}, {"label": "Caregiver", "name": "caregiver"}], "light_source": [{"label": "National Grid", "name": "nationalgrid"}, {"label": "Generator", "name": "generator"}, {"label": "SolarLight", "name": "solarlight"}, {"label": "Rechargeable Battery", "name": "rechargeablebattery"}, {"label": "Kerosene Lamp", "name": "kerosenelamp"}], "lga_routine": [{"label": "Last 1 Month", "name": "last 1 month"}, {"label": "Last 2-3 Months", "name": "last 2-3 months"}, {"label": "More Than 3 Months Ago", "name": "more than 3 months ago"}], "yes_no_na": [{"label": "Yes", "name": "yes"}, {"label": "No", "name": "no"}, {"label": "N/A", "name": "n/a"}], "one_implement": [{"label": "Yes, fully implemented", "name": "yes, fully implemented"}, {"label": "Yes, partially implemented", "name": "yes, partially implemented"}, {"label": "No", "name": "no"}], "session_planned": [{"label": "non availbility of vaccines/logistics", "name": "non_availbility_of_vaccines_logistics"}, {"label": "no trained healthcare woker", "name": "no_trained_healthcar_woker"}, {"label": "non avaibility of funds", "name": "non_avaibility_of_funds"}, {"label": "competing programs", "name": "competing_programs"}, {"label": "issues related with the community", "name": "issues_related_with_the_community"}], "care_giver": [{"label": "Traditional Leader", "name": "traditional leader"}, {"label": "Voluntary Community Mobilizer (VCM)", "name": "voluntary community mobilizer (vcm)"}, {"label": "Health Worker", "name": "health worker"}, {"label": "IPDs Team member", "name": "ipds team member"}, {"label": "Field Volunteer (FV)", "name": "field volunteer (fv)"}, {"label": "Religious leader", "name": "religious leader"}, {"label": "Community Based organization", "name": "community based organization"}, {"label": "Traditional birth Attendant", "name": "traditional birth attendant"}, {"label": "Others", "name": "others"}, {"label": "None", "name": "none"}], "one_incinerator": [{"label": "Onsite", "name": "onsite"}, {"label": "Offsite", "name": "offsite"}, {"label": "No Incinerator", "name": "no incinerator"}], "indi_comm": [{"label": "No minutes", "name": "0"}, {"label": "One month's minutes available", "name": "1"}, {"label": "Two months' minutes available", "name": "2"}, {"label": "All minutes for quarter available", "name": "3"}], "tech_meeting": [{"label": "Yes", "name": "yes"}, {"label": "No", "name": "no"}, {"label": "Incomplete", "name": "incomplete"}], "latrines": [{"label": "At least four water closet functional latrines/toilets (either the flushable squatting closet or the sitting closet) two for staff: Male and female, two for patients: Male and female", "name": "1"}, {"label": "Floor without fissures", "name": "0.5"}, {"label": "Recently cleaned without visible fecal matter", "name": "0.5"}, {"label": "Door lockable from the inside, ceiling and super structure with roofing, without flies and no smell", "name": "0.5"}, {"label": "Proof of use of bleach used as a disinfectant (eg jik, hypo, etc)", "name": "0.5"}], "shower": [{"label": "At least two bathing facilities (with floor without fissures, Door lockable from the inside, super structure with roofing)", "name": "1"}, {"label": "Bathing facility with running water, or container with at the least 20 L of water", "name": "0.5"}, {"label": "Evacuation of the waste water in a sanitation pit", "name": "0.5"}], "waste_pit": [{"label": "Waste disposal pit minimum 2 meters deep, lined with clay, concrete or brick or plastic, it is fenced and has a bright flag", "name": "3"}, {"label": "The waste pit is a minimum of 15 meters from the health facility, minimum of 50 meters from a household, and 100 meters from a water source except in cases where the available surface area does not allow for these distances (written support of the LGA health administration is required)", "name": "3"}, {"label": "Health Care Waste is not visible (covered by at the least 10 cm of soil or lime)", "name": "3"}, {"label": "The health facility maintains a register indicating the date of the creation of the pit(s), and the location (s)", "name": "3"}], "waste_disposal": [{"label": "Waste disposal of non-contaminated waste in Black Bin with lid and foot pedal, lined and not full", "name": "1.5"}, {"label": "Waste disposal of contaminated HCW in Yellow Bins with lid and foot pedal, lined with cellophene bag and not full", "name": "1.5"}, {"label": "Waste disposal of organically HCW in Red Bins with lid and foot pedal, lined with cellophene bag and not full", "name": "1.5"}, {"label": "Protective gear for personnel managing HCW available; boots, plastic shorts, thick plastic/rubber gloves", "name": "1.5"}], "consultation_room": [{"label": "Walls with durable materials well painted, floor paved with cement without fissures, undamaged ceiling", "name": "1"}, {"label": "Consultation room and waiting space separated assuring confidentiality", "name": "1"}, {"label": "Windows with curtains", "name": "1"}, {"label": "Functional door with functional lock", "name": "1"}, {"label": "Running water 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HMIS MSF", "type": "select one", "control": {"appearance": "minimal w1"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "HMISregiste", "label": "b. HMIS Registers", "type": "select one", "control": {"appearance": "minimal w1"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "weeklySurve", "label": "c. Weekly surveillance reports", "type": "select one", "control": {"appearance": "minimal w1"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "Businesspla", "label": "d. Approved business plans;", "type": "select one", "control": {"appearance": "minimal w1"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "Minutemeetg", "label": "e. Minutes of meetings;", "type": "select one", "control": {"appearance": "minimal w1"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "IndivPatien", "label": "f. 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NHMIS health facility Td register", "type": "select one", "bind": {"relevant": "${RelevantNhm} = 'yes'"}, "control": {"appearance": "w1"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}, {"name": "n/a", "label": "N/A"}]}, {"name": "NHMISancHea", "label": "22. NHMIS health facility daily ANC register", "type": "select one", "bind": {"relevant": "${RelevantNhm} = 'yes'"}, "control": {"appearance": "w1"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}, {"name": "n/a", "label": "N/A"}]}, {"name": "NHMISopdHea", "label": "23. NHMIS health facility daily OPD register", "type": "select one", "bind": {"relevant": "${RelevantNhm} = 'yes'"}, "control": {"appearance": "w1"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}, {"name": "n/a", "label": "N/A"}]}, {"name": "NHMISfprHea", "label": "24. NHMIS health facility daily FP register", "type": "select one", "bind": {"relevant": "${RelevantNhm} = 'yes'"}, "control": {"appearance": "w1"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}, {"name": "n/a", "label": "N/A"}]}, {"name": "NHMISlabHea", "label": "25. NHMIS health facility labour/delivery register", "type": "select one", "bind": {"relevant": "${RelevantNhm} = 'yes'"}, "control": {"appearance": "w1"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}, {"name": "n/a", "label": "N/A"}]}, {"name": "NHMISipcHea", "label": "26. NHMIS health facility IPC register", "type": "select one", "bind": {"relevant": "${RelevantNhm} = 'yes'"}, "control": {"appearance": "w1"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}, {"name": "n/a", "label": "N/A"}]}, {"name": "NHMIScalcul", "type": "calculate", "bind": {"calculate": "coalesce(${RelevantNhm},0)+coalesce(${NHMISmsfHea},0)+coalesce(${NHMISfacHea},0)+coalesce(${NHMIgmpHeal},0)+coalesce(${NHMISimmHea},0)+coalesce(${NHMIStalHea},0)+coalesce(${NHMIStdfHea},0)+coalesce(${NHMISancHea},0)+coalesce(${NHMISopdHea},0)+coalesce(${NHMISfprHea},0)+coalesce(${NHMISlabHea},0)+coalesce(${NHMISipcHea},0)"}}]}, {"name": "Actionpla1j", "label": "2.0 Action plan", "type": "text", "control": {"appearance": "minimal w2"}}, {"name": "keycomment2", "label": "2.0 Key Comments", "type": "text", "control": {"appearance": "minimal w2"}}, {"name": "BizPlTotal0", "type": "calculate", "bind": {"calculate": "coalesce(${FilingScore},0)+coalesce(${NHMIScalcul},0)"}}]}, {"name": "meta", "type": "group", "control": {"bodyless": true}, "children": [{"name": "instanceID", "type": "calculate", "bind": {"readonly": "true()", "calculate": "concat('uuid:', uuid())"}}, {"name": "instanceName", "type": "calculate", "bind": {"calculate": "concat(${start000000},' ',${time_started},'_','ISS_PHC','_',jr:choice-name(${FacilitName},'${FacilitName}'), '_', jr:choice-name(${StateName00},'${StateName00}'))"}}]}]}