FEDERAL MINISTRY OF HEALTH Integrated Supportive Supervision (ISS) Tool for PHC Web Version 2018 (Updated November 2019) 0 1 2 3 date of meeting agenda signed attendance list of participants follow up on decisions taken in previous meeting list of action points and recommendations monthly financial balances discussed minutes signed by chairman responsible persons and timeline Yes No Yes No Yes No Yes No No Yes No Yes population adjusted yearly other facilities within the ward villages main roads/foot path natural barriers (rivers, mountain, etc) special points/landmarks distance in KM/time legend/key for specific age group Hard to reach areas Delivered Collected Parents Caregiver National Grid Generator SolarLight Rechargeable Battery Kerosene Lamp Last 1 Month Last 2-3 Months More Than 3 Months Ago 1 pair of scissors 2 pairs of forceps One needle holder Not Available One sterilized box with needle holder, needles 1 anatomical plier 1 surgical plier Catgut and nylon sutures Antiseptic Local anesthetics Sterile swaps None Sterile tying string or clip for umbilical cord 1% tetracycline eye ointment non-expired 4% chlorhexidine gel MVA (Mucus extraction) None Mattress covered in impermeable plastic sheets Blankets Mosquito nets on each occupied bed None Yes No N/A Weight BP Fundal height (Gestational age) Parity Date of last menstruation Fetal heart rate Presentation Fetal movement recorded None Within the first three days Within the first seven days No Yes, fully implemented Yes, partially implemented No non availbility of vaccines/logistics no trained healthcare woker non avaibility of funds competing programs issues related with the community Traditional Leader Voluntary Community Mobilizer (VCM) Health Worker IPDs Team member Field Volunteer (FV) Religious leader Community Based organization Traditional birth Attendant Others None Onsite Offsite No Incinerator No minutes One month's minutes available Two months' minutes available All minutes for quarter available Yes No Incomplete 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 Floor without fissures Recently cleaned without visible fecal matter Door lockable from the inside, ceiling and super structure with roofing, without flies and no smell Proof of use of bleach used as a disinfectant (eg jik, hypo, etc) At least two bathing facilities (with floor without fissures, Door lockable from the inside, super structure with roofing) Bathing facility with running water, or container with at the least 20 L of water Evacuation of the waste water in a sanitation pit Waste disposal pit minimum 2 meters deep, lined with clay, concrete or brick or plastic, it is fenced and has a bright flag 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) Health Care Waste is not visible (covered by at the least 10 cm of soil or lime) The health facility maintains a register indicating the date of the creation of the pit(s), and the location (s) Waste disposal of non-contaminated waste in Black Bin with lid and foot pedal, lined and not full Waste disposal of contaminated HCW in Yellow Bins with lid and foot pedal, lined with cellophene bag and not full Waste disposal of organically HCW in Red Bins with lid and foot pedal, lined with cellophene bag and not full Protective gear for personnel managing HCW available; boots, plastic shorts, thick plastic/rubber gloves Walls with durable materials well painted, floor paved with cement without fissures, undamaged ceiling Consultation room and waiting space separated assuring confidentiality Windows with curtains Functional door with functional lock Running water (tap or water dispenser) with handwashing soap/liquid and clean towel available and used between patients Yes No Medical Doctor Specialist Consultant Resident Medical Officer Nurse/Midwives (Double qualification) Nurses CHO CHEW JCHEW Nutrition Officer/Dietician Nutrition Assistant Environmental Health Officer Environmental Health Technician Environmental Health Assistant Pharmacist Medical Lab Scientist Lab Technician Lab Assistant Health Record Technician Health Record Officer Health Education Officer Health Education Assistant Pharmacy Technician Pharmacy Assistant Main Subcontracted Community Volunteers (CHIPS) Head of Works Head Laundry Department Head Transport Health Attendants Cleaners Security Guards Drivers Account Clerk Administrative Head None Public Private Faith Based Organization (FBO) NGO Primary Health Centre Health Post Health Clinic Yes No True False FMoH NPHCDA NACA SMoH SPHCDA SOML LGHA Partners _ _ static_instance-one_observa-0 0 static_instance-one_observa-1 1 static_instance-one_observa-2 2 static_instance-one_observa-3 3 static_instance-contain_minutes-0 date_of_meeting static_instance-contain_minutes-1 agenda static_instance-contain_minutes-2 signed_attendance_list_of_parti static_instance-contain_minutes-3 follow_up_on_decisions_taken_in static_instance-contain_minutes-4 list_of_action_points_and_recom static_instance-contain_minutes-5 monthly_financial_balances_disc static_instance-contain_minutes-6 minutes_signed_by_chairman static_instance-contain_minutes-7 responsible_persons_and_timeline static_instance-one_point-0 yes static_instance-one_point-1 no static_instance-two_points-0 yes static_instance-two_points-1 no static_instance-three_points-0 yes static_instance-three_points-1 no static_instance-four_points-0 yes static_instance-four_points-1 no static_instance-five_points-0 no static_instance-five_points-1 yes static_instance-ten_points-0 no static_instance-ten_points-1 yes static_instance-map_paramet-0 population_adjusted_yearly static_instance-map_paramet-1 other_facilities_within_the_war static_instance-map_paramet-2 villages static_instance-map_paramet-3 main_roads_foot_path static_instance-map_paramet-4 natural_barriers_rivers_mountai static_instance-map_paramet-5 special_points_landmarks static_instance-map_paramet-6 distance_in_km_time static_instance-map_paramet-7 legend_key_for_specific_age_gro static_instance-map_paramet-8 hard_to_reach_areas static_instance-RI_vaccines-0 delivered static_instance-RI_vaccines-1 collected static_instance-child_vaccine-0 parents static_instance-child_vaccine-1 caregiver static_instance-light_source-0 nationalgrid static_instance-light_source-1 generator static_instance-light_source-2 solarlight static_instance-light_source-3 rechargeablebattery static_instance-light_source-4 kerosenelamp static_instance-lga_routine-0 last_1_month static_instance-lga_routine-1 last_2_3_months static_instance-lga_routine-2 more_than_3_months_ago static_instance-obsboxavailopt-0 pair_of_scissors static_instance-obsboxavailopt-1 pairs_of_forceps static_instance-obsboxavailopt-2 one_needle_holder static_instance-obsboxavailopt-3 not_available static_instance-episiotoboxopt-0 one_sterilized_box_with_needle static_instance-episiotoboxopt-1 anatomical_plier static_instance-episiotoboxopt-2 surgical_plier static_instance-episiotoboxopt-3 catgut_and_nylon_sutures static_instance-episiotoboxopt-4 antiseptic static_instance-episiotoboxopt-5 local_anesthetics static_instance-episiotoboxopt-6 sterile_swaps static_instance-episiotoboxopt-7 none static_instance-equipnewboropt-0 sterile_tying_string_or_clip_fo static_instance-equipnewboropt-1 %_tetracycline_eye_ointment_non static_instance-equipnewboropt-2 %_chlorhexidine_gel static_instance-equipnewboropt-3 mva_mucus_extraction static_instance-equipnewboropt-4 none static_instance-patrmadeq-0 mattress_covered_in_impermeable static_instance-patrmadeq-1 blankets static_instance-patrmadeq-2 mosquito_nets_on_each_occupied static_instance-patrmadeq-3 none static_instance-yes_no_na-0 yes static_instance-yes_no_na-1 no static_instance-yes_no_na-2 n/a static_instance-ancform-0 weight static_instance-ancform-1 bp static_instance-ancform-2 fundal_height_gestational_age static_instance-ancform-3 parity static_instance-ancform-4 date_of_last_menstruation static_instance-ancform-5 fetal_heart_rate static_instance-ancform-6 presentation static_instance-ancform-7 fetal_movement_recorded static_instance-ancform-8 none static_instance-noenatal-0 within_the_first_three_days static_instance-noenatal-1 within_the_first_seven_days static_instance-noenatal-2 no static_instance-one_implement-0 yes_fully_implemented static_instance-one_implement-1 yes_partially_implemented static_instance-one_implement-2 no static_instance-session_planned-0 non_availbility_of_vaccines_logistics static_instance-session_planned-1 no_trained_healthcar_woker static_instance-session_planned-2 non_avaibility_of_funds static_instance-session_planned-3 competing_programs static_instance-session_planned-4 issues_related_with_the_community static_instance-care_giver-0 traditional_leader static_instance-care_giver-1 voluntary_community_mobilizer_v static_instance-care_giver-2 health_worker static_instance-care_giver-3 ipds_team_member static_instance-care_giver-4 field_volunteer_fv static_instance-care_giver-5 religious_leader static_instance-care_giver-6 community_based_organization static_instance-care_giver-7 traditional_birth_attendant static_instance-care_giver-8 others static_instance-care_giver-9 none static_instance-one_incinerator-0 onsite static_instance-one_incinerator-1 offsite static_instance-one_incinerator-2 no_incinerator static_instance-indi_comm-0 no_minutes static_instance-indi_comm-1 one_months_minutes_available static_instance-indi_comm-2 two_months_minutes_available static_instance-indi_comm-3 all_minutes_for_quarter_availab static_instance-tech_meeting-0 yes static_instance-tech_meeting-1 no static_instance-tech_meeting-2 incomplete static_instance-latrines-0 at_least_four_water_closet_func static_instance-latrines-1 floor_without_fissures static_instance-latrines-2 recently_cleaned_without_visibl static_instance-latrines-3 door_lockable_from_the_inside_c static_instance-latrines-4 proof_of_use_of_bleach_used_as static_instance-shower-0 at_least_two_bathing_facilities static_instance-shower-1 bathing_facility_with_running_w static_instance-shower-2 evacuation_of_the_waste_water_i static_instance-waste_pit-0 waste_disposal_pit_minimum_2_me static_instance-waste_pit-1 the_waste_pit_is_a_minimum_of_1 static_instance-waste_pit-2 health_care_waste_is_not_visibl static_instance-waste_pit-3 the_health_facility_maintains_a static_instance-waste_disposal-0 waste_disposal_of_non_contamina static_instance-waste_disposal-1 waste_disposal_of_contaminated static_instance-waste_disposal-2 waste_disposal_of_organically_h static_instance-waste_disposal-3 protective_gear_for_personnel_m static_instance-consultation_room-0 walls_with_durable_materials_we static_instance-consultation_room-1 consultation_room_and_waiting_s static_instance-consultation_room-2 windows_with_curtains static_instance-consultation_room-3 functional_door_with_functional static_instance-consultation_room-4 running_water_tap_or_water_disp static_instance-six_points-0 yes static_instance-six_points-1 no static_instance-staffs-0 medical_doctor static_instance-staffs-1 specialist_consultant static_instance-staffs-2 resident static_instance-staffs-3 medical_officer static_instance-staffs-4 nurse_midwive_double_qualification static_instance-staffs-5 nurses static_instance-staffs-6 cho static_instance-staffs-7 chew static_instance-staffs-8 jchew static_instance-staffs-9 nutrition_officer_dietician static_instance-staffs-10 nutrition_assistant static_instance-staffs-11 environmental_health_officer static_instance-staffs-12 environmental_health_technician static_instance-staffs-13 environmental_health_assistant static_instance-staffs-14 pharmacist static_instance-staffs-15 medical_lab_scientist static_instance-staffs-16 lab_technician static_instance-staffs-17 lab_assistant static_instance-staffs-18 health_record_technician static_instance-staffs-19 health_record_officer static_instance-staffs-20 health_education_officer static_instance-staffs-21 health_education_assistant static_instance-staffs-22 pharmacy_technician static_instance-staffs-23 pharmacy_assistant static_instance-contract-0 main static_instance-contract-1 subcontracted static_instance-non_medical-0 community_chips static_instance-non_medical-1 head_of_works static_instance-non_medical-2 head_laundry_department static_instance-non_medical-3 head_transport static_instance-non_medical-4 health_attendants static_instance-non_medical-5 cleaners static_instance-non_medical-6 security_guards static_instance-non_medical-7 drivers static_instance-non_medical-8 account_clerk static_instance-non_medical-9 director_of_administration static_instance-non_medical-10 none static_instance-facility_type-0 public static_instance-facility_type-1 private static_instance-facility_type-2 fbo static_instance-facility_type-3 ngo static_instance-levelcare-0 primary_health_centre static_instance-levelcare-1 health_post static_instance-levelcare-2 clinic static_instance-yes_no-0 yes static_instance-yes_no-1 no static_instance-true_false-0 true static_instance-true_false-1 false static_instance-organizations-0 fmoh static_instance-organizations-1 nphcda static_instance-organizations-2 naca static_instance-organizations-3 smoh static_instance-organizations-4 sphcda static_instance-organizations-5 soml static_instance-organizations-6 lgha static_instance-organizations-7 partners Please remember to add facility to master facility list Please remember to add facility to master facility list public private fbo ngo primary_health_centre health_post clinic yes no how many how many how many how many how many how many how many how many how many how many how many how many how many how many how many how many how many how many how many how many how many how many how many how many how many how many how many how many how many how many how many how many how many how many how many how many yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no n/a yes no yes no n/a yes no yes no n/a yes no yes no n/a yes no yes no n/a yes no yes no n/a yes no yes no n/a yes no yes no n/a yes no yes no n/a yes no yes no n/a yes no yes no n/a yes no yes no yes no yes no yes no yes no yes no Check for minutes of meetings yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no Note: E must equal D yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no onsite offsite no_incinerator yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no Identification of consulting staff in register (names, rank and signature) yes no yes no Clean cloths and footwear and name tags yes no Correct numbering and closed at the end of the month yes no Supervisor verifies entries in register for the last three Sundays yes no National protocol for diagnosis and treatment of simple and severe malaria yes no See last five cases of simple malaria on register and review treatment according to protocol (max 5 points all or nothing) yes no yes no See last three cases of ARI and review treatment according to protocol (all or nothing) yes no yes no See last three cases of Diarrhea and review treatment according to protocol (all or nothing) yes no See last 100 cases in register, check diagnosis and calculate the rate (< 30 cases) (In case less than 100 cases during the quarter calculate 30% of the cases in the register) yes no yes no yes no yes no yes no yes no yes no yes no yes no Let health worker check BP and review measure yes no yes no yes no Non-torn, plastic cover, specific for the OPD consultations only yes no Inspect in comparison with known weight of supervisor: after weighing, the balance should return to zero yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no IMCI (Integrated Management of Childhood Illness) (if question asked to the three children = 3 points, if 2 = 2, if 1 = 1 if not = 0 point) 0 1 2 3 (if question asked to the three children = 3 points, if 2 = 2, if 1 = 1 if not = 0 point) 0 1 2 3 (if question asked to the three children = 3 points, if 2 = 2, if 1 = 1 if not = 0 point) 0 1 2 3 (if question asked to the three children = 3 points, if 2 = 2, if 1 = 1 if not = 0 point) 0 1 2 3 (if question asked to the three children = 3 points, if 2 = 2, if 1 = 1 if not = 0 point) 0 1 2 3 (if question asked to the three children = 3 points, if 2 = 2, if 1 = 1 if not = 0 point) 0 1 2 3 (if question asked to the three children = 3 points, if 2 = 2, if 1 = 1 if not = 0 point) 0 1 2 3 yes no yes no Room with closed doors, curtains at windows or non transparent glass yes no Condoms; OCP; Injectable; Implant; IUD; are available in the demonstration box (all five items) Penis model available on the desk; box with condoms available with at the least 50 condoms yes no For example for 10.000 population (target is entire ward catchment pop) = 10.000 * 22.5% * 25%/12 * 4 * 90% (assuming 25% unmet need; 22.5% target population; 90% of oral/inject AC at HC level. Ask any medical personnel involved in care for clients to explain this target calculation. Total number of women of child bearing age (15 - 49) divided by four. Note that each dose is for 3 months (one blister per month for three months or one injection of depoprovera covers three months) yes no Collaboration with public sector, private sector and social marketing, mobile strategies, advocacy among local leaders etc. (explicit mention in the BP) Involvement of HF staff in strategies (explicit mention of this in the BP) yes no For example for 10.0000 pop 84 doses of oral (3 month cycles) and injectable methods combined. Total number of women of child bearing age (15 - 49) - 22.5% times unmet need 25% divided by 12 (months) times 2 months (min supply) times 90% delivered at health center level => result 84 doses). Note that each dose is for 3 months yes no At least five IUDs and at the least one staff trained to use it (check certificate original or photocopy certified by the LGA) yes no At least five implants available and staff trained to use it (check certificate original or photcopy certified by the LGA) yes no yes no yes no Check at least five cards for BP, hepatomegaly, varicose veins, weight (all cards; all elements checked) yes no yes no yes no yes no Supervisor verifies the last 4 Sundays in laboratory register yes no yes no Supervisor verifies last five results yes no yes no yes no yes no functional objectives; immersion oil available, mirror or electricity blades, cover glass, GIEMSA available yes no At the least 20 tests available in the laboratory; non-expired yes no yes no Organic waste in a bin with lid with disinfectant Security box for sharp objects available and destroyed according to waste disposal guidelines yes no yes no PTB (Pulmonary Tuberculosis Blood Test) yes no AFB (Acid Fast Bacillus) yes no PTB (Pulmonary Tuberculosis Blood Test) yes no Supervisor verifies guard duty's report - names and signatures match yes no Each bed has a (i) non-torn plastic covered mattress, (ii) mosquito net, (iii) clean sheets, (iv) night table yes no yes no yes no yes no yes no Electricity; solar light or rechargeable battery lamp yes no Women in separate ward from men; the inside of the wards are not visible from the outside yes no check identity and hospital bed days yes no yes no yes no yes no yes no Average Monthly Consumption (AMC= six months Consumption divided by six) * 2 (two Average Monthly Consumption) Supply in register corresponds with physical supply: random sample of three essential drugs yes no yes no yes no yes no Supervisor verifies whether quantity requisitioned equals quantity served Drugs to clients are uniquely dispensed through prescriptions. Prescriptions are stored and accessible Drugs and medical consumables prescribed, are all in generic form yes no Clean place, well ventilated with all drugs on cupboards, labeled shelves Drugs and medical consumables stored in therapeutical and alphabetical order, first expired - first out basis yes no Supervisor verifies randomly three drugs and 2 consumables Out of date drugs well separated from stock Destruction protocol for out of date drugs available and applied yes no Correctly calculated yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no Min stock = 10; AMC applies only when higher than 10 yes no yes no yes no yes no Min stock = 10; AMC applies only when higher than 10 yes no Min stock = 5L; AMC applies only when higher than 5L yes no Min stock = 5L; AMc applies only when higher than 5L yes no yes no yes no yes no yes no yes no yes no yes no Bin with lid and lining and safe needle disposal container, specific for the maternity room use only yes no yes no yes no yes no yes no Identification of the skilled provider from names in the register yes no yes no Table in two parts with removable non-torn plasticized mattress and two functional leg supports yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no Sight referral slip yes no yes no Basic Emergency Obstetric and Newborn Care, Expanded Life Saving Skills Modified Life Saving Skills Life Saving Skills yes no Basic Emergency Obstetric and Newborn Care, Expanded Life Saving Skills Modified Life Saving Skills Life Saving Skills yes no yes no yes no yes no yes no yes no yes no yes no Check the register for IPT, 1, 2, etc yes no yes no yes no yes no Nurse; midwife CHO or CHEW, verified on ANC cards yes no yes no yes no yes no yes no within_the_first_three_days within_the_first_seven_days no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no Oral rehydration treatment yes no IMCI (Integrated Management of Childhood Illness) yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no IYCF (Infant and young child feeding) yes no yes no yes no yes no yes no yes no yes no yes no MUAC (Mid Upper Arm Circumference) yes no yes no yes no yes no yes no yes no yes no yes no EBF (Exclusive Breast Feeding) yes no yes no yes no yes no GMP (Growth Monitoring and Promotion) EBF (Exclusive Breast Feeding) yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no delivered collected yes no yes no yes no yes no yes no yes no yes no yes no yes no (see above for the six messages) yes no yes no yes no The component of AEFI kit include; adrenaline, paracetamol injection, 2ml syringes, cotton wool, etc. yes no yes no yes no yes no yes no yes no yes no yes no Supervisor verifies functionality of thermometer yes no Presence of a chemical temperature indicator (this is a specific piece of paper different from the thermometer) which shows temperature acc to the norms yes no yes no yes no yes no yes no (All or None) yes no yes no yes no yes no yes no yes no yes no yes no At the least 5 yes no Auto-blocking at least 30; for dilution - at least 3 yes no yes no At the least 10 yes no System is capable of identifying drop outs and Fully Vaccinated Children yes no yes no yes no yes no last_1_month last_2_3_months more_than_3_months_ago yes no last_1_month last_2_3_months more_than_3_months_ago yes no yes no yes no yes_fully_implemented yes_partially_implemented no Sufficient benches and or chairs, protected against sun and rain yes no yes no Balance calibrated to zero + pants available, clean and in good condition yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no traditional_leader voluntary_community_mobilizer_v health_worker ipds_team_member field_volunteer_fv religious_leader community_based_organization traditional_birth_attendant others none parents caregiver yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no see evidence from supervision logbook see evidence from supervision logbook yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no Plastered and painted wall of solid material Smooth cement floor Ceiling in good condition Windows with glass and curtains Doors that close yes no Penis model on the table A box of condoms on the table which has at the least 50 condoms Wall stickers Posters (score Yes for any) yes no yes no At the least one staff trained as a counselor All counseling done by a trained counselor (check certifcicate) yes no Individual client cards available; planning for CD4 cell counts yes no Each Acid Fast Bacillus (AFB)+ PTB patient has a person attached to him/her who supervises DOTS: proof of in register; mobile phone number of such a supervisor is registered Each Pulmonary tuberculosis test(PTB) patient has a contact address and/or phone number in both the register and the individual card yes no Rifampicin-isoniazid-pyrazinamide : cp120+50+300mg Etambutol tabs 400 mg yes no yes no yes no yes no yes no yes no yes no yes no [First-name Last-name] fmoh nphcda naca smoh sphcda soml lgha partners [First-name Last-name] fmoh nphcda naca smoh sphcda soml lgha partners [First-name Last-name] fmoh nphcda naca smoh sphcda soml lgha partners [First-name Last-name] fmoh nphcda naca smoh sphcda soml lgha partners [First-name Last-name] fmoh nphcda naca smoh sphcda soml lgha partners yes no