{"name": "Secondary_ISS_form_ODK_updated", "type": "survey", "title": "FEDERAL MINISTRY OF HEALTH, Integrated Supportive Supervision (ISS) tool for Secondary Health Facilities, Mobile Version 2018 (Updated June 2022)", "id_string": "Secondary_ISS_Form_ODK2", "sms_keyword": "Secondary_ISS_Form_ODK2", "default_language": "English", "version": "2019010801", "style": "pages", "namespaces": "esri=\"http://esri.com/xforms\"\nenk=\"http://enketo.org/xforms\"", "children": [{"name": "start000000", "type": "start"}, {"name": "end00000000", "type": "end"}, {"name": "timestarted", "label": "Calculate time started", "type": "calculate", "bind": {"calculate": "format-date-time(now(),'%H:%M')"}}, {"name": "GrpInformtn", "label": "**General Information**", "type": "group", "children": [{"name": "nRespondent", "label": "Name of Respondent", "type": "text", "bind": {"required": "TRUE"}}, {"name": "StateName00", "label": "State", "type": "select one", "bind": {"required": "TRUE"}, "control": {"appearance": "minimal"}, "children": [{"name": "abia", "label": "Abia"}, {"name": "adamawa", "label": "Adamawa"}, {"name": "akwa_ibom", "label": "Akwa-Ibom"}, {"name": "anambra", "label": "Anambra"}, {"name": "bauchi", "label": "Bauchi"}, {"name": "bayelsa", "label": "Bayelsa"}, {"name": "benue", "label": "Benue"}, {"name": "borno", "label": "Borno"}, {"name": "cross_river", "label": "Cross River"}, {"name": "delta", "label": "Delta"}, {"name": "ebonyi", "label": "Ebonyi"}, {"name": "edo", "label": "Edo"}, {"name": "ekiti", "label": "Ekiti"}, {"name": "enugu", "label": "Enugu"}, {"name": "fct", "label": "FCT"}, {"name": "gombe", "label": "Gombe"}, {"name": "imo", "label": "Imo"}, {"name": "jigawa", "label": "Jigawa"}, {"name": "kaduna", "label": "Kaduna"}, {"name": "kano", "label": "Kano"}, {"name": "katsina", "label": "Katsina"}, {"name": "kebbi", "label": "Kebbi"}, {"name": "kogi", "label": "Kogi"}, {"name": "kwara", "label": "Kwara"}, {"name": "lagos", "label": "Lagos"}, {"name": "nasarawa", "label": "Nasarawa"}, {"name": "niger", "label": "Niger"}, {"name": "ogun", "label": "Ogun"}, {"name": "ondo", "label": "Ondo"}, {"name": "osun", "label": "Osun"}, {"name": "oyo", "label": "Oyo"}, {"name": "plateau", "label": "Plateau"}, {"name": "rivers", "label": "Rivers"}, {"name": "sokoto", "label": "Sokoto"}, {"name": "taraba", "label": "Taraba"}, {"name": "yobe", "label": "Yobe"}, {"name": "zamfara", "label": "Zamfara"}]}, {"name": "CalcState00", "type": "calculate", "bind": {"calculate": "if(${StateName00} = '','',once(now()))"}}, {"name": "LGAName0000", "label": "LGA Name", "type": "select one external", "bind": {"required": "TRUE"}, "control": {"appearance": "minimal"}, "choice_filter": "states = ${StateName00}", "query": "LGAs"}, {"name": "CalcLGA0000", "type": "calculate", "bind": {"calculate": "if(${LGAName0000} = '','',once(now()))"}}, {"name": "WardName000", "label": "Name of Ward", "type": "select one external", "bind": {"required": "TRUE"}, "control": {"appearance": "minimal"}, "choice_filter": "LGAs = ${LGAName0000}", "query": "wards"}, {"name": "CalcWard000", "type": "calculate", "bind": {"calculate": "if(${WardName000} = '','',once(now()))"}}, {"name": "FacilitName", "label": "Facility Name", "type": "select one external", "bind": {"required": "TRUE"}, "control": {"appearance": "minimal"}, "choice_filter": "wards = ${WardName000}", "query": "facilities"}, {"name": "CalcFacilit", "type": "calculate", "bind": {"calculate": "if(${FacilitName} = '','',once(now()))"}}, {"name": "FacilityTyp", "label": "Facility Type", "type": "select one", "bind": {"required": "TRUE"}, "control": {"appearance": "minimal"}, "children": [{"name": "public", "label": "Public"}, {"name": "private", "label": "Private"}, {"name": "fbo", "label": "FBO"}, {"name": "ngo", "label": "NGO"}]}, {"name": "ContraType0", "label": "Contract Type", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "main", "label": "Main"}, {"name": "subcontracted", "label": "Subcontracted"}]}, {"name": "SurveyLocat", "label": "Location of survey", "type": "geopoint", "bind": {"required": "FALSE"}, "control": {"appearance": "placement-map"}}, {"name": "FacilityPic", "label": "Take a picture of the Facility", "type": "photo", "bind": {"required": "TRUE"}}, {"name": "TotalPopul0", "label": "Total Catchment Population", "type": "integer", "bind": {"required": "TRUE"}}, {"name": "NumberBeds0", "label": "Number of Beds", "type": "integer", "bind": {"required": "TRUE"}}, {"name": "NumBeds1000", "type": "calculate", "bind": {"calculate": "${NumberBeds0} div ${TotalPopul0} * 1000"}}, {"name": "NoteBeds000", "label": "There are: ${NumBeds1000} beds per 1000 inhabitants", "type": "note"}, {"name": "NumbrStaffs", "label": "Number of Qualified Staff", "type": "integer", "bind": {"required": "TRUE"}}, {"name": "CalcStaffs0", "type": "calculate", "bind": {"calculate": "${NumbrStaffs} div ${TotalPopul0} * 2000"}}, {"name": "NoteStaffs0", "label": "There are: ${CalcStaffs0} qualified staff per 2000 inhabitants", "type": "note"}, {"name": "MedStaff000", "label": "Medical Staff Total (complete six-monthly)", "type": "select all that apply", "bind": {"required": "TRUE"}, "control": {"appearance": "minimal"}, "children": [{"name": "medical_doctor", "label": "Medical Doctor"}, {"name": "consultant", "label": "Consultant"}, {"name": "nurse_midwive_double_qualification", "label": "Nurse/Midwives (Double qualification)"}, {"name": "nurses", "label": "Nurses"}, {"name": "midwives", "label": "Midwives"}, {"name": "dentist", "label": "Dentist"}, {"name": "dental_technician", "label": "Dental Technician"}, {"name": "dental_assistant", "label": "Dental Assistant"}, {"name": "anaesthesist", "label": "Anaesthesist"}, {"name": "xray_technician", "label": "X-RAY Technician"}, {"name": "cho", "label": "CHO"}, {"name": "chew", "label": "CHEW"}, {"name": "jchew", "label": "JCHEW"}, {"name": "nutrition_officer", "label": "Nutrition Officer"}, {"name": "nutrition_assistant", "label": "Nutrition Assistant"}, {"name": "environmental_health_officer", "label": "Environmental Health Officer"}, {"name": "environmental_health_technician", "label": "Environmental Health Technician"}, {"name": "environmental_health_assistant", "label": "Environmental Health Assistant"}, {"name": "pharmacist", "label": "Pharmacist"}, {"name": "medical_lab_scientist", "label": "Medical Lab Scientist"}, {"name": "lab_technician", "label": "Lab Technician"}, {"name": "lab_assistant", "label": "Lab Assistant"}, {"name": "medical_record_technician", "label": "Medical Record Technician"}, {"name": "medical_record_officer", "label": "Medical Record Officer"}, {"name": "health_education_officer", "label": "Health Education Officer"}, {"name": "health_education_assistant", "label": "Health Education Assistant"}, {"name": "pharmacy_technician", "label": "Pharmacy Technician"}, {"name": "pharmacy_assistant", "label": "Pharmacy Assistant"}]}, {"name": "NonMedStaff", "label": "Non-Medical Staff Total (complete six-monthly)", "type": "select all that apply", "bind": {"required": "TRUE"}, "control": {"appearance": "minimal"}, "children": [{"name": "health_attendants", "label": "Security Guards"}, {"name": "cleaners", "label": "Drivers"}, {"name": "security_guards", "label": "Account Officer"}, {"name": "drivers", "label": "Director of Administration"}, {"name": "others", "label": "Others"}, {"name": "other", "label": "Other"}]}, {"name": "NonMedStaff_other", "label": "Specify other.", "type": "text", "bind": {"relevant": "selected(../NonMedStaff, 'other')"}}, {"name": "AdminStaff0", "label": "Admin Staff Total (complete six-monthly)", "type": "select all that apply", "bind": {"required": "TRUE"}, "control": {"appearance": "minimal"}, "children": [{"name": "secretary", "label": "Secretary"}, {"name": "accountant", "label": "Accountant"}, {"name": "revenue_officer", "label": "Revenue Officer"}, {"name": "revenue_collectors", "label": "Revenue Collectors"}, {"name": "maintenance_officer", "label": "Maintenance Officer"}, {"name": "clerks", "label": "Clerks"}, {"name": "social_welfare_officers", "label": "Social Welfare Officers"}, {"name": "others", "label": "Others"}, {"name": "other", "label": "Other"}]}, {"name": "AdminStaff0_other", "label": "Specify other.", "type": "text", "bind": {"relevant": "selected(../AdminStaff0, 'other')"}}]}, {"name": "GroupGener0", "label": "General Management [max 49 points]", "type": "group", "children": [{"name": "RBFComFacMg", "label": "General Hospital RBF Committee Facility Management Committee meets once per month. This indicator is valued on an 'all or nothing basis' for all three monthly minutes. If one or more reports are missing, or incomplete, then 0 score. If all are complete as per the components, then 4.5 points", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "PropFileSys", "label": "Proper filing system", "type": "group", "bind": {"required": "TRUE"}, "children": [{"name": "PropFileSy1", "label": "In a filing cabinet/shelf/cupboard and accessible by the officer on duty (except individual staff files)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "PropFileSy2", "label": "Minimum documents to be filed include: (i) Monthly HMIS reports; (ii) Weekly surveillance reports; (iii) approved business plans; (iv) minutes of meetings; (v) patient cards (OPD; ANC; Partopgrahs; Family Planning and 'bed head tickets'); (vi) individual staff files.", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "PropFileSy3", "label": "Unique registration system: check if all patients attending the HF are issued a unique number on their hand cards that show complete identification (including age, sex ) complete location/address and differents dates their visited the different services for easy tracing of patients in CCSS", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}]}, {"name": "StaffDutRos", "label": "Staff duty roster (with phone number of each staff on duty) available and well displayed up to date for current month and visible for staff and patients to see", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ManTeamMeet", "label": "Management Team (HODs) Meetings conducted Monthly and minutes available. This indicator is valued on an 'all or nothing basis' for all three monthly minutes. If one or more reports are missing, or incomplete, then 0 score. If all are complete as per the components, then 4.5 points", "hint": "Each monthly minutes contains at least: (i) date of the meeting, (ii) agenda, (iii) signed list of participants; (iv) follow-up of decisions taken during the previous meeting; (v) in each issue section there is a description of the problem; (vi) in each issue section there is a list of developed recommendations or decisions taken; (vii) in each issue section there is a deadline to solve the issue; (viii) in each issue section there is a responsible named; (i) each month the monthly financial balance is discussed; (x) minutes of the meeting are signed by the chairman. (all or nothing)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "DedicCommuP", "label": "Availability of a dedicated mobile phone for communication between General Hospital, and health centers & Tertiary Institutions/Facilities", "hint": "Mobile phone functional with batteries AND call credit of a minimum of N1,000\nList of phone number of (i) health facility in-charges; (ii) PHC department; (iii) HSMB Key Officer; (iv) SPHCD PBF team available (sighted) and up to date", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "HMISReports", "label": "HMIS reports are filled, updated and transmitted to the HSMB/SMOH", "hint": "Timely Transmission of HMIS reports after verification of the SPHCDA of the monthly CPA invoice\nHMIS report is accurately filled completely according to the prevailing formats", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "HMISDataAna", "label": "HMIS data analysis report for the quarter being assessed concerning priority problems", "hint": "Ten priority health problems are followed each quarter and data have been updated up to the month prior to the quality evaluation visit (Monthly summary of the health problem classified at the closing of each month in the general register)\nThrough a chart, follow up on monthly (i) average length of stay; (ii) average bed occupancy rate, (iii) Bed turnover rate and (iv) income/expenses statements", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "FuncAmbulAv", "label": "Ambulance available and functional", "hint": "Vehicle log book available and maintained/filled\nVehicle maintenance register available and filled\nAmbulance available and functional (contains basic first aid equipment)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "MortuRoomAv", "label": "Availability of a room for a mortuary: (check-ins/outs mortuary registers), one strecher and one table", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "KitcInpatAv", "label": "Availability of a kitchen for inpatients/special diatery patient/growth monitoring demonstration.", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Gencomments", "label": "Key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "GenActionpl", "label": "Action Plan", "type": "text", "control": {"appearance": "multiline"}}, {"name": "Administrat", "label": "Administration", "type": "group", "children": [{"name": "HospitOrgan", "label": "Is there a hospital organogram? (Verify)", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "UpdNominRol", "label": "Do you have updated Nominal roll?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "WorkSchStaf", "label": "Do you have a work schedule for staff?(Verify)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "AnnWorkPlan", "label": "Do you have an annual work plan? (Verify)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "DutyRosTelC", "label": "Do you have a displayed duty roster with telephone contacts? (Verify)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ActivReport", "label": "Do you have activity report? (Verify)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "UpdStMovReg", "label": "Is there an up-to-date register for staff movement? (Verify in departments)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "LeaveRoster", "label": "Is there a leave roster for the Hospital?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "StaffAttReg", "label": "Is there a staff attendance register for monitoring staff attendance, lateness & absenteeism? (observe)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "MonManSMeet", "label": "Are there monthly management meetings of staff? (verify with report or minutes of last three meetings)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "MemMOHAttMt", "label": "Do members of the MOH attend these management meetings?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "MatChildSer", "label": "Do you have free maternal and child services?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Fal24HrServ", "label": "Does the facility provide 24 hour service?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "LastISSVisi", "label": "When was the last ISS visit conducted?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "MonSuperVis", "label": "Do you receive monthly supervisory visits from the State?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "SupFollPlan", "label": "Are supportive follow up plans implemented?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "CopSupRepAv", "label": "Are copies of supervisory visits reports available?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ListHospRef", "label": "Is there a list of Hosptital for referral", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ListTelConR", "label": "Is there a list of telephone contacts for referral?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "FuncAmbServ", "label": "Is there a functional ambulance service?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "EmerTelNumb", "label": "Are emergency telephone numbers conspicuously displayed?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Admcomments", "label": "Key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "AdmActionpl", "label": "Action Plan", "type": "text", "control": {"appearance": "multiline"}}]}, {"name": "GenManAdmSc", "type": "calculate", "bind": {"calculate": "if(${RBFComFacMg} = 'yes',4.5,0) + if(${PropFileSys} = 'yes',3,0) + if(${StaffDutRos} = 'yes',1,0) + if(${ManTeamMeet} = 'yes',4.5,0) + if(${DedicCommuP} = 'yes',1,0) + if(${HMISReports} = 'yes',2,0) + if(${HMISDataAna} = 'yes',6,0) + if(${FuncAmbulAv} = 'yes',4,0) + if(${MortuRoomAv} = 'yes',1,0) + if(${KitcInpatAv} = 'yes',1,0) + if(${HospitOrgan} = 'yes',1,0) + if(${UpdNominRol} = 'yes',1,0) + if(${WorkSchStaf} = 'yes',1,0) + if(${AnnWorkPlan} = 'yes',1,0) + if(${DutyRosTelC} = 'yes',1,0) + if(${ActivReport} = 'yes',1,0) + if(${UpdStMovReg} = 'yes',1,0) + if(${LeaveRoster} = 'yes',1,0) + if(${StaffAttReg} = 'yes',1,0) + if(${MonManSMeet} = 'yes',1,0) + if(${MemMOHAttMt} = 'yes',1,0) + if(${MatChildSer} = 'yes',1,0) + if(${Fal24HrServ} = 'yes',1,0) + if(${LastISSVisi} = 'yes',1,0) + if(${MonSuperVis} = 'yes',1,0) + if(${SupFollPlan} = 'yes',1,0) + if(${CopSupRepAv} = 'yes',1,0) + if(${ListHospRef} = 'yes',1,0) + if(${ListTelConR} = 'yes',1,0) + if(${FuncAmbServ} = 'yes',1,0) + if(${EmerTelNumb} = 'yes',1,0)"}}]}, {"name": "BiznessPlan", "label": "Business Plan [max 8.5 points]", "type": "group", "children": [{"name": "QuartBizPla", "label": "Quarterly business plan for the quarter under evaluation made and accessible", "hint": "Valid and renegotiated for the quarter under evaluation (signed by all authorised signatories)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "BizPlaStake", "label": "Business plan prepared with key stakeholders", "hint": "Hospital RBF Committee involved (Chairman signed off on the plan): minutes of special meeting to prepare the BP available with signed attendance list.", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "BizPlaHygMn", "label": "Business plan analyses Hygiene and waste management", "hint": "HF treats this subject in the BP (toilets; showers; medical and non-medical waste disposal; safe sharps disposal practices; general cleanliness; infection prevention), and suggests a strategy for improvement", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "BizPlaMedCr", "label": "Business plan analyses Quality of Medical Care", "hint": "BP may suggest to include them or to discourage if quality conditions are not met", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "BizPlaStrRi", "label": "Business plan contains convincing strategies to effectively ensure that at-risk women in the CH/LGA catchment area reaches the hospital", "hint": "Strategy includes at least once per quarter a capacity building session with HC in-charges on RH/FP", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "BizPlaFinAc", "label": "Business plan shows a plan to assure financial accessibility for the population", "type": "group", "children": [{"name": "BizPlaRateC", "label": "Business plan shows negotiated rates between HF, Indigent Committee and community", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "BizPlaMecGH", "label": "Business plan shows the mechanism how the GH identifies indigents, and how it assesses eligibility, and how it deals with decision making on difficult cases", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Bizcomments", "label": "Key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "BizActionpl", "label": "Action Plan", "type": "text", "control": {"appearance": "multiline"}}, {"name": "BizPlaFinCr", "label": "Business plan shows planning for the resources available for financing care for the indigents", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}]}, {"name": "BizPlanScor", "type": "calculate", "bind": {"calculate": "if(${QuartBizPla} = 'yes',1,0) + if(${BizPlaStake} = 'yes',2,0) + if(${BizPlaHygMn} = 'yes',1,0) + if(${BizPlaMedCr} = 'yes',1,0) + if(${BizPlaStrRi} = 'yes',0.5,0) + if(${BizPlaRateC} = 'yes',1,0) + if(${BizPlaMecGH} = 'yes',1,0) + if(${BizPlaFinCr} = 'yes',1,0)"}}]}, {"name": "FinanceGrp0", "label": "Finance [max 50 points]", "type": "group", "children": [{"name": "FinanDocsAv", "label": "Financial and accounting documents available and well kept", "hint": "Monthly report of treasury available and correctly filled Is the imprest account available?\nTheoretical balance of cash-book corresponds to liquidity in cash Is there a designated book keeper?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "BenPerfLess", "label": "Benefits + performance bonuses do not exceed 50% of total HF income through PBF and are fixed according to health facility resolutions and not from hierarchy. Additional contractual staff hired through health facility income as specified in the Business plan) is separately listed and does not count towards the bonus budget part Do you produce DRF / JVP account statements?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "BenPerfLe01", "label": "Bonuses are paid directly from health facility bank account into individual staff account. Calculated as follows (see manual): the total amount of monthly bonus to be paid per worker = individual indice value of the health worker multiplied by the monthly point value for the bonus multiplied by the individual performance score for the worker. Is an up-to-date record of expired and lost drugs available?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "MonPerfSyst", "label": "Existence of monthly performance bonus system is known by staff Are monthly DRF returns up to date?", "hint": "Take a random staff member and ask what his or her performance bonus was last month, and what his or her individual performance % was (through the use of the individual performacne evaluation) . If both are explained then 4 points. What is the mark-up on drugs? (for JVP)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "DocQuaIncCl", "label": "Document available (drawn from the Indice Tool) to show that quarterly calculation of incomes, running costs, investments and variable performance subsidies are done Does this hospital have a Drug Revolving Fund (DRF) / Joint Venture Pharmacy / Free Health Scheme?", "type": "group", "children": [{"name": "DocIncExpBl", "label": "This document guarantees that income equals/balances the expenditures. Running costs: = salaries, purchase of drugs and equipment, subcontracts, petty cash for small expenditures, maintenance and rehabilitation etc. Is the Drug Revolving Fund (DRF) account available?", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "DocQuaExcel", "label": "This document uses the MS Excel- based 'indice tool' for its information. The 'indice tool' is shown and the calculations for the coming quarter are explained to the verifier Is the Drug Revolving Fund (DRF) account available?", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Bizcomments", "label": "Key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "BizActionpl", "label": "Action Plan", "type": "text", "control": {"appearance": "multiline"}}, {"name": "DocQuaClInd", "label": "This document calculates the performance bonus using the indice tool. Performance bonuses are not larger than 50% of total income of the facility. Do you hold Monthly DRF/ JVP / FHS committee Meetings?", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}]}, {"name": "FinancScore", "type": "calculate", "bind": {"calculate": "if(${FinanDocsAv} = 'yes',2,0) + if(${BenPerfLess} = 'yes',10,0) + if(${MonPerfSyst} = 'yes',4,0) + if(${DocIncExpBl} = 'yes',3,0) + if(${DocQuaExcel} = 'yes',28,0) + if(${DocQuaClInd} = 'yes',3,0)"}}]}, {"name": "IndigCommit", "label": "Social Welfare Committee [max 9 points]", "type": "group", "children": [{"name": "Socwelfar01", "label": "Does the hospital have a social welfare unit?", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "PlanCareInd", "label": "Planning for Care for the social welfare expenditures", "hint": "Up to 20% of curative consultations of the previous month: documented quantity in monthly management meetings", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "IndCommMeet", "label": "social welfare committee meets monthly", "hint": "The Indigent committee meets monthly to review the care for the indigent category use. Each monthly minutes contain: (i) date of the meeting; (ii) signed list of participants; (iii) follow-up of decisions taken during the previous meeting; (iv) there is a list of developed recommendations or decisions taken; (v) each month the monthly financial balance is discussed; the amount spent on indigents patients is included in the monthly expenditures (vi) minutes of the meeting are signed by the chairman. (vi) each month the monthly updated list of indigents (with the updated lists from HCs) is validated and shared with the LGA. Each report according to norms = 1 point", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "IndPatSensi", "label": "List of Indigent Patients/Sensitization", "hint": "Each month an updated list of indigents from every community of the ward is validated and shared with the LGA and General Hospital.\nDetails of quartely activity plan to educate the indigents in every community on their priviledge to free care at the health facility and the report of activities effectively carried out during the quarter", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Indcomments", "label": "Key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "IndActionpl", "label": "Action Plan", "type": "text", "control": {"appearance": "multiline"}}, {"name": "IndiComScor", "type": "calculate", "bind": {"calculate": "if(${PlanCareInd} = 'yes',1,0) + if(${IndCommMeet} = 'yes',3,0) + if(${IndPatSensi} = 'yes',5,0)"}}]}, {"name": "HygMedWasDp", "label": "Hygiene and Medical Waste Disposal [max 42 points]", "type": "group", "children": [{"name": "HFFenceMain", "label": "Fence health facility available and well-maintained", "hint": "Fence exists, can be closed at night and there are no holes", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "GarbBinCour", "label": "Availability of a garbage bin in the courtyard", "hint": "Bin with lid accessible to clients which is not full, one for each ward", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "WastePitHF0", "label": "Waste pit for Health Care Waste is available and according to the norms", "hint": "Waste disposal pit minimum 2 meters deep, lined with clay, concrete or brick or plastic, it is fenced and has a bright flag.\nThe 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 (as certified by the LGA PHC department) \nHealth Care Waste is not visible (covered by at the least 10 cm of soil or lime) \nThe health facility maintains a register indicating the date of the creation of the pit(s), and the location (s)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "CourtClean0", "label": "Courtyard clean", "hint": "No waste or medical waste in the courtyard (sharps, ampoules, plastics, gloves, used gauze, etc.)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "HygAssurInj", "label": "Hygienic conditions assured during wound dressing and injections", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "HygAssur001", "label": "Bins for medical waste with lid and foot pedal lined with bag and not full", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "HygAssur002", "label": "Security box for needles well positioned, and used and not full", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "HygAssur003", "label": "Needle cutter available and used", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "HygAssur004", "label": "Container/bowl with lid containing disinfectant used for putting used instruments", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "DispHFWaste", "label": "Disposal of Health Care Waste according to National Norms", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "DispHFWas01", "label": "Waste disposal of non-contaminated waste in Black Bin with lid and foot pedal, lined with bag and not full", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "DispHFWas02", "label": "Waste disposal of contaminated HCW in Yellow Bins with lid and foot pedal, lined with bag and not full", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "DispHFWas03", "label": "Waste disposal of organically HCW in Red Bins with lid and foot pedal, lined with bag and not full", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "DispHFWas04", "label": "Protective gear for personnel managing HCW available; boots, plastic shorts, thick plastic/rubber gloves and a trolley to transport the HCW", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "RodPestCtrl", "label": "Rodent and Pest Control", "hint": "Was the hospital fumigated for rodent and pest control at least once in the past six months?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Coucomments", "label": "Key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "CouActionpl", "label": "Action Plan", "type": "text", "control": {"appearance": "multiline"}}, {"name": "PresSufShow", "label": "Presence of sufficient showers which are well-maintained", "type": "group", "children": [{"name": "ShowStafBed", "label": "One shower for staff in addition to one shower per ten beds", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ShowRunH2OC", "label": "Shower with running water, or container with at the least 20 L of water and cup for scooping", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "DoorLockIns", "label": "Door lockable from the inside but not from the outside, super structure with roofing, without flies (mosquito screening), floor clean", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "FuncLightng", "label": "Functional lighting", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "CleanSchNex", "label": "Cleaning schedule next to shower and shower smells of disinfectant or deodorant", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Shocomments", "label": "Key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "shoActionpl", "label": "Action Plan", "type": "text", "control": {"appearance": "multiline"}}]}, {"name": "PresSufLatr", "label": "Presence of sufficient latrines/toilets which are well-maintained (except riverine areas)", "type": "group", "children": [{"name": "H2OFunctLat", "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", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "FloorFissLs", "label": "Floor without fissures", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "RecClnLatFe", "label": "Recently cleaned toilet/latrine without visible fecal matter", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "DoorLockCei", "label": "Door lockable from the inside but not from the outside, ceiling, super structure with roofing, without flies (mosquito screening) and no smell", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "FunctLight0", "label": "Functional lighting", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "H2OCont20L0", "label": "Water container with at the least 20L of water OR functioning tap and soap for hand washing available for each toilet block", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ClenSchdNex", "label": "Cleaning schedule next to toilet", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "precomments", "label": "Key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "preActionpl", "label": "Action Plan", "type": "text", "control": {"appearance": "multiline"}}, {"name": "HygMedWasCl", "type": "calculate", "bind": {"calculate": "if(${HFFenceMain} = 'yes',2,0) + if(${GarbBinCour} = 'yes',1,0) + if(${WastePitHF0} = 'yes',19,0) + if(${CourtClean0} = 'yes',1,0) + if(${HygAssurInj} = 'yes',2,0) + if(${DispHFWaste} = 'yes',5,0) + if(${RodPestCtrl} = 'yes',0,0) + if(${ShowStafBed} = 'yes',1,0) + if(${ShowRunH2OC} = 'yes',1,0) + if(${DoorLockIns} = 'yes',1,0) + if(${FuncLightng} = 'yes',1,0) + if(${CleanSchNex} = 'yes',1,0) + if(${H2OFunctLat} = 'yes',1,0) + if(${FloorFissLs} = 'yes',1,0) + if(${RecClnLatFe} = 'yes',1,0) + if(${DoorLockCei} = 'yes',1,0) + if(${FunctLight0} = 'yes',1,0) + if(${H2OCont20L0} = 'yes',1,0) + if(${ClenSchdNex} = 'yes',1,0)"}}]}]}, {"name": "CuratConsul", "label": "Curative Consultations [max 104 points]", "type": "group", "children": [{"name": "ConWaitArea", "label": "Good conditions in waiting area", "hint": "Sufficient benches and or chairs protected against sun and rain and waiting area is not inside the consultation room", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "UnitFeeDrug", "label": "Unit fees of drugs displayed to the public", "hint": "Easily visible in the consultation room waiting area, updated, with (i) unit price per item; (ii) price for a standard treatment of the drug\nDrugs are all generics. An exception list with branded drugs for special cases or pathologies is allowed, this list needs to be signed off by the HMB and be current for the calendar year.", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ExiWaitCard", "label": "Existence of waiting card system with numbers", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ConsulRoomC", "label": "Consultation room in good condition", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ConsulRoom1", "label": "Walls with durable materials well painted, floor paved with cement without fissures, undamaged ceiling", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ConsulRoom2", "label": "Consultation room and waiting space separated assuring confidentiality", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ConsulRoom3", "label": "Windows with curtains", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ConsulRoom4", "label": "Functional door with functional lock", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ConsulRoom5", "label": "Running water (tap or water dispenser) with liquid soap and clean towel available and used between patients", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ConsulRoomL", "label": "Consultation room (where emergencies are received) has light around the clock (24/7)", "hint": "Electricity present in the form of current, functioning generator or functioning solar light", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ConsulStaff", "label": "Consultations are done by skilled staff", "hint": "Identification of consulting staff in register", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "StaffDressW", "label": "Consulting staff is well-dressed", "hint": "Clean blouse with identification tag and shoes (no slippers)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "NumbRegistr", "label": "Correct numbering of registers", "hint": "Correct numbering and closed at the end of the year month", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "SerAvail247", "label": "Service availability seven out of seven days 24/7", "hint": "Supervisor verifies entries in register for the last three Sundays", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "MalProcWall", "label": "Malaria protocol put on wall and accessible for staff", "hint": "National protocol for diagnosis and treatment of simple (acute) and severe malaria", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "SimMalTreat", "label": "Simple (acute) malaria correctly treated", "hint": "Register see last three cases of simple malaria and review treatment according to protocol (five points for the three cases; all three cases need to be treated according to the malaria protocol: all or nothing)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "SevMalTreat", "label": "Severe malaria correctly treated", "hint": "Register see last five cases of severe malaria and review treatment according to protocol (five points for the three cases; all three cases need to be treated according to the malaria protocol: all or nothing)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "WHOFLowDiag", "label": "WHO flow diagram for ARI put on wall and accessible for staff", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ARIProtocol", "label": "ARI protocol applied", "hint": "See last five cases of ARI and review treatment acc protocol; register mentions Temp; RR; cough yes/no; diagnosis (one point for each correct treatment according to protocol: max 5 points)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "WHOProcDiar", "label": "WHO protocol for Diarrhea put on wall and accessible for staff", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "DiarrProcAp", "label": "Diarrhea protocol applied", "hint": "See last five cases of Diarrhea and review treatment according to diarrhoea protocol (five points for the five cases: all or nothing)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "PropConAnti", "label": "Proportion of consultations treated with antibiotics <30%", "hint": "See last 100 cases in register, check diagnosis and calculate the rate (< 30 cases)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "MSFTreatGui", "label": "MSF Treatment guidelines available in consultancy room", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "KnwTubDang", "label": "Knowledge of tuberculosis danger signs symptoms and criteria for referral", "hint": "Select any available qualified medical staff, and ask the question on TB dangers signs symptoms\nAnswer must contain at least 4 of the following signs: (i) weight loss; (ii) loss of appetite; (iii) fever; (iv) cough of more than 15 days duration; (v) night sweating", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "StethBPMach", "label": "Stethoscope and BP machine available and functional", "hint": "Let nurse check BP and review measure", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "FuncThermAv", "label": "Thermometer available and functional", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "FuncOtosAva", "label": "Otoscope available and functional", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ExamBedOPDC", "label": "Examination bed for OPD consultations only", "hint": "Available mattress, non-torn, plastic cover specific for OPD consultations only", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "WeighScaleF", "label": "Weighing scale available and functional", "hint": "Inspect in comparison with known weight of supervisor: after weighing, the balance should return to zero", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "IntManChild", "label": "Integrated Management of Childhood Illnesses strategy is applied", "hint": "Protocol is available in the consultation room\nThe last five IMCI cases are traced in the register and comply with the IMCI strategy (all five)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "NutriStaUn5", "label": "Determination of nutritional status of all children under 5 who come for consultation", "hint": "(check five children under five through a random sampling method: take a random number between 1 and 3 and using this sampling interval select and check five consultations): all or nothing", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "NutriStaFem", "label": "Determination of nutritional status of all women with a sick child under 6 months of age (as above)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ScrenRecord", "label": "Screening record of nutritional status available, up to date and properly filled out", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Nutcomments", "label": "Key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "NutActionpl", "label": "Action Plan", "type": "text", "control": {"appearance": "multiline"}}, {"name": "DirObs3Und5", "label": "Direct observation of three consecutive children under five.", "hint": "The reviewer team will have to ensure it is available on a time that is suitable to see children through direct observation on the OPD. In case there are no patients to be seen, this indicator automatically carries 0 points. For each of the three children observe the following six elements wether they occur in the patient-doctor/nurse interaction. At the end provide feedback on your findings.", "type": "group", "children": [{"name": "FeverPerInt", "label": "Ask about fever and IF FEVER ask about (i) since when; (ii) persistent or intermittent (if question asked to the three children = 6 pts, if not = 0)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "CoughSinceW", "label": "Ask about cough and IF COUGH ask about since when (if question asked to the three children = 6 pts, if not = 0)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "DiarSincOft", "label": "Ask for diarrhea IF DIARRHOEA then ask (i) since when; (ii) how often per day; (iii) consistency - water or mucus or bloody; (iv) vomiting (if question asked to the three children = 6 pts, if not = 0)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "GenImpressn", "label": "GENERAL IMPRESSION: awake or tired? (if question asked to the three children = 6 pts, if not = 0)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "RespiRateCo", "label": "FIRST - COUNT RESPIRATION RATE (observe before touching child!!!) (if action taken on the three children = 6 pts, if not = 0)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "TempMeasure", "label": "Temperature (measure) (if taken on the three children = 6 pts, if not = 0)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "SkinPinchCh", "label": "Skin pinch (in case of diarrhea) OR chest auscultation (in case of cough) (if carried out on the three children = 6 pts, if not = 0)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Nutcomments", "label": "Key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "NutActionpl", "label": "Action Plan", "type": "text", "control": {"appearance": "multiline"}}]}, {"name": "ConsulScore", "type": "calculate", "bind": {"calculate": "if(${ConWaitArea} = 'yes',1,0) + if(${UnitFeeDrug} = 'yes',5,0) + if(${ConsulRoomC} = 'yes',5,0) + if(${ConsulRoomL} = 'yes',1,0) + if(${ConsulStaff} = 'yes',1,0) + if(${StaffDressW} = 'yes',1,0) + if(${NumbRegistr} = 'yes',1,0) + if(${SerAvail247} = 'yes',1,0) + if(${MalProcWall} = 'yes',1,0) + if(${SimMalTreat} = 'yes',5,0) + if(${SevMalTreat} = 'yes',5,0) + if(${WHOFLowDiag} = 'yes',1,0) + if(${ARIProtocol} = 'yes',5,0) + if(${WHOProcDiar} = 'yes',1,0) + if(${DiarrProcAp} = 'yes',5,0) + if(${PropConAnti} = 'yes',4,0) + if(${MSFTreatGui} = 'yes',1,0) + if(${KnwTubDang} = 'yes',5,0) + if(${StethBPMach} = 'yes',1,0) + if(${FuncThermAv} = 'yes',1,0) + if(${FuncOtosAva} = 'yes',1,0) + if(${ExamBedOPDC} = 'yes',1,0) + if(${WeighScaleF} = 'yes',1,0) + if(${IntManChild} = 'yes',2,0) + if(${NutriStaUn5} = 'yes',2,0) + if(${NutriStaFem} = 'yes',2,0) + if(${ScrenRecord} = 'yes',2,0) + if(${FeverPerInt} = 'yes',6,0) + if(${CoughSinceW} = 'yes',6,0) + if(${DiarSincOft} = 'yes',6,0) + if(${GenImpressn} = 'yes',6,0) + if(${RespiRateCo} = 'yes',6,0) + if(${TempMeasure} = 'yes',6,0) + if(${SkinPinchCh} = 'yes',6,0)"}}]}, {"name": "Laboratory0", "label": "Laboratory [max 12 points]", "type": "group", "children": [{"name": "MedLabSciAv", "label": "Medical laboratory scientist is available", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "LabOpen7Day", "label": "Laboratory is open every day of the week", "hint": "Supervisor verifies the last 2 Sundays in laboratory register", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "LabExamVisi", "label": "List of laboratory examinations visible for the public with fees", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "DQAResulReg", "label": "DQA Results recorded correctly in laboratory register and match with results in inpatient sheets or OPD examination cards", "hint": "Supervisor verifies last five results", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ParasitDemo", "label": "Availability of parasites demonstrations", "hint": "On plastic paper, in a color book, or put on wall\nBlood smear: Vivax, Ovale, Falciparum and Malariae\nStools: Ascaris, entamoeba, ankylostoma and schistosome", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "FuncMicrosc", "label": "Microscope available and functional", "hint": "functional objectives; immersion oil available, mirror or electricity\nblades, cover glass, GIEMSA available", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "MalariaRapT", "label": "Malaria rapid test kits available", "hint": "At least 20 test kits available in the laboratory; non-expired", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "FunctnEquip", "label": "Equipment available and functional; (i) centrifuge; (ii) electrophoresis machine; (iii) hematocentrifuge; (iv) clinical chemistry analyzer; (v) hemoglobinometer (manual or automated)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "WasteEvacua", "label": "Waste evacuation correctly carried out", "hint": "Organic waste in a bin with lid and not full\nSecurity box for sharp objects available and destroyed according to waste disposal guidelines", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "PersWashPip", "label": "Personnel adequately washes dirty pipettes in containers with antiseptic if pipettes are not disposable", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "LabEquipPTB", "label": "Laboratory equipment for testing for PTB", "hint": "Reagents for AFB testing; stock control car for reagents is available and lists stock; at the least 30 non-recycled slides available for testing\t\t\t\nExternal Quality assurance protocol for PTB testing available and implemented: slides sampled and sent for quality control according to protocol, and latest report, as per protocol, is available and shows results as per cut-off point of the protocol", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Lbcommentss", "label": "key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "LBactionpla", "label": "action plan", "type": "text", "control": {"appearance": "multiline"}}, {"name": "LaboraScore", "type": "calculate", "bind": {"calculate": "if(${MedLabSciAv} = 'yes',1,0) + if(${LabOpen7Day} = 'yes',1,0) + if(${LabExamVisi} = 'yes',1,0) + if(${DQAResulReg} = 'yes',1,0) + if(${ParasitDemo} = 'yes',0.5,0) + if(${FuncMicrosc} = 'yes',0.5,0) + if(${MalariaRapT} = 'yes',0.5,0) + if(${FunctnEquip} = 'yes',2.5,0) + if(${WasteEvacua} = 'yes',1,0) + if(${PersWashPip} = 'yes',1,0) + if(${LabEquipPTB} = 'yes',2,0)"}}]}, {"name": "InPatWards0", "label": "In-patient Wards [max 165.5 points]", "type": "group", "children": [{"name": "GuardDutRos", "label": "Guard duty roster clearly visible for staff and followed up", "hint": "Supervisor verifies guard duty's report - names, phone numbers and signatures\nRoster of staff on duty visibly displayed with phone contact", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "FurnitAvail", "label": "Furniture available and in good state", "hint": "Each bed has a (i) plastic covered mattress, (ii) mosquito net, (iii) clean sheets, (iv) night table\nNumber of functional beds available to patients", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "PatComfHygi", "label": "Patient comfort and hygiene\nThe wards are clean: no debris on the floor; and wards smell of bleach or disinfectant", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "PatComfH001", "label": "Walls with durable materials well painted, floor paved with cement without fissures, undamaged ceiling", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "PatComfH002", "label": "Space between the beds is at the least one meter", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "PatComfH003", "label": "Bed screen available for patient confidentiality", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "PatComfH004", "label": "Windows with curtains and net", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "PatComfH005", "label": "Functional door with functional lock", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "PatComfH006", "label": "Each ward has access to drinking water in the ward", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "PatComfH007", "label": "Each ward has running water or water dispenser with water, soap and a clean towel for each patient", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "StethBPMac2", "label": "Stethoscope and BP machine available and functional", "hint": "Let nurse check BP and review measure", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "FunctThermo", "label": "Thermometer available and functional", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "WeighScale2", "label": "Weighing scale available and functional", "hint": "Inspect in comparison with known weight of supervisor: after weighing, the balance should return to zero", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "NumInPatReg", "label": "Correct numbering of in-patient registers", "hint": "Correct numbering and closed at the end of the month", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "WardLiteAv0", "label": "Light available in each ward", "hint": "Electricity; solar light or rechargeable battery lamp", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Confidentia", "label": "Confidentiality", "hint": "Women in separate ward from men; the inside of the wards are not visible from the outside", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "INcommentss", "label": "key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "INactionpla", "label": "action plan", "type": "text", "control": {"appearance": "multiline"}}, {"name": "InPatRegist", "label": "In patient register available and is well maintained", "hint": "Check identity and hospital bed days", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "InPatCareGy", "label": "In-patient Care Gyn/Obs ward: systematic random sample of 5 patient files from discharged patients who have delivered from the delivery register from the last quarter.", "hint": "Each of the files is assessed according to the five following categories. Scoring is all or nothing for each of the five categories for each of the five files. Max 55 points", "type": "group", "children": [{"name": "PatFilKeySt", "label": "Each patient file meets key standard requirements", "hint": "(i) full personal data of patient\n(ii) date and time of admission\n(iii) mobile phone number\n(iv) date and time of first examination by midwife/Dr\n(v) Anamnesis\n(vi) Past history (all or nothing for the five patients)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "CliExamDone", "label": "Clinical examination done", "hint": "blood pressure; frequency and rhythm of heartbeat; body temperature; weight; height; respiration rate frequency; assessment of obstetrical condition\n(all or nothing for the five patients)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "CliDiagJust", "label": "Justification of clinical diagnosis and elaborate description of obstetrical proceedings (including post partum hemorrhage; pre-eclampsia; premature birth etc.). Compliance with MSF 'obstetric guidelines'.", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "DRExamNotes", "label": "Notes on midwife/Dr daily examinations which include clinical examination", "hint": "(all or nothing for the five patients)", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "PartographF", "label": "Partograph: both sides filled correctly", "hint": "opening; prolapses; VE each 4 hours at the least; frequency and rhythm of heartbeat of mother and child each 30 min at the least; contractions every 30 min (all or nothing for the five patients)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "PAcommentss", "label": "key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "PAactionpla", "label": "action plan", "type": "text", "control": {"appearance": "multiline"}}]}]}, {"name": "InPatPedWad", "label": "In-patient Care Pediatric ward: systematic random sample of 5 patient files from discharged patients from the admission register from the last quarter.", "hint": "Each of the files is assessed according to the five following categories. Scoring is all or nothing for each of the five categories for each of the five files. Max 35 points", "type": "group", "children": [{"name": "PatFilePedS", "label": "Each patient file meets key standard requirements", "hint": "(i) full personal data of patient\n(ii) date and time of admission\n(iii) mobile phone number\n(iv) date and time of first examination by MD\n(v) history taking\n(vi) Past history\n(all or nothing for the five patients)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "CliExamPedi", "label": "Clinical examination done", "hint": "(frequency and rhythm of heartbeat; body temperature; weight; height; respiration rate frequency; in-depth examination of affected system (all or nothing for the five patients)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "LabExamDiag", "label": "Scope of laboratory and other examination corresponds to clinical diagnosis and is compliant with clinical protocols and results of lab tests. Compliance with MSF 'treatment guidelines'.", "hint": "(all or nothing for the five patients)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "DrExamNotes", "label": "Notes on Dr daily examinations which include clinical examination", "hint": "(all or nothing for the five patients)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "CLcommentss", "label": "key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "CLactionpla", "label": "action plan", "type": "text", "control": {"appearance": "multiline"}}]}, {"name": "InPatCarSur", "label": "In-patient Care Surgical ward: systematic random sample of 5 patient files from discharged patients who had large surgical procedures from the admission register from the last quarter.", "hint": "Each of the files is assessed according to the five following categories. Scoring is all or nothing for each of the five categories for each of the five files. Max 45 points", "type": "group", "children": [{"name": "PatFileSurg", "label": "Each patient file meets key standard requirements", "hint": "(i) full personal data of patient\n(ii) date and time of admission\n(iii) mobile phone number\n(iv) date and time of first examination by midwife/Dr\n(v) history taking\n(vi) Past history (all or nothing for the five patients)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "CliExamSurg", "label": "Clinical examination done", "hint": "blood pressure; frequency and rhythm of heartbeat; body temperature; weight; height; respiration rate frequency; assessment of surgical condition; clinical diagnosis and justification (all or nothing for the five patients)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "RepSurgProc", "label": "Report on surgical procedure and anesthetic method used", "hint": "(all or nothing for the five patients)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "NoteDrDaily", "label": "Notes on doctor's daily examinations which include clinical examination", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "RegPostInfe", "label": "Registration of post operative infection, if any", "hint": "(all or nothing for the five patients)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "TheComments", "label": "key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "Thactionpla", "label": "action plan", "type": "text", "control": {"appearance": "multiline"}}]}, {"name": "InPatScore0", "type": "calculate", "bind": {"calculate": "if(${GuardDutRos} = 'yes',2,0) + if(${FurnitAvail} = 'yes',8,0) + if(${PatComfHygi} = 'yes',5,0) + if(${StethBPMac2} = 'yes',1,0) + if(${FunctThermo} = 'yes',1,0) + if(${WeighScaleF} = 'yes',1,0) + if(${NumInPatReg} = 'yes',1,0) + if(${WardLiteAv0} = 'yes',2,0) + if(${Confidentia} = 'yes',1,0) + if(${InPatRegist} = 'yes',2,0) + if(${PatFilKeySt} = 'yes',10,0) + if(${CliExamDone} = 'yes',10,0) + if(${CliDiagJust} = 'yes',10,0) + if(${DRExamNotes} = 'yes',5,0) + if(${PartographF} = 'yes',20,0) + if(${PatFilePedS} = 'yes',10,0) + if(${CliExamPedi} = 'yes',10,0) + if(${LabExamDiag} = 'yes',10,0) + if(${DrExamNotes} = 'yes',5,0) + if(${PatFileSurg} = 'yes',10,0) + if(${CliExamSurg} = 'yes',10,0) + if(${RepSurgProc} = 'yes',10,0) + if(${NoteDrDaily} = 'yes',10,0) + if(${RegPostInfe} = 'yes',5,0)"}}, {"name": "EsseDrugMan", "label": "Essential Drugs Management [max 20 points]", "type": "group", "children": [{"name": "StafStockED", "label": "Staff maintains stock cards for ED showing security stock levels = monthly average consumption (MAC= at least last six months Consumption divided by six) * 2 (two months monthly average consumption)", "hint": "Supply in register corresponds with physical supply: random sample of three ED", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "HFPurDrugPh", "label": "Health facility purchases drugs, equipment and consumables from the Pharmaceutical Council of Nigeria certified distributor, approved by SMOH/SPHCDA", "hint": "Latest Pharmaceutical Council of Nigeria certified distribution center list for the State available\nLast procurement list is shown which shows the certified distributor which sold the drugs\nAll drugs and medical consumables are (i) NAFDAC certified and (ii) Generic", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "PharDelivHF", "label": "Main pharmacy store delivers drugs to health facility departments according to requisition", "hint": "Supervisor verifies whether quantity requisitioned equals quantity served\nDrugs to clients are uniquely dispensed through prescriptions. Prescriptions are stored and accessible\nDrugs and medical consumables prescribed, are all in generic form", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "DrugsStored", "label": "Drugs stored correctly", "hint": "Clean place, well ventilated with all drugs on cupboards, labeled shelves\nDrugs and medical consumables stored on alphabetical order, first expired in - first out basis", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "AbsExpDrugs", "label": "Absence of out of date drugs or drugs with unreadable labels", "hint": "Supervisor verifies randomly three drugs and 2 consumables\nOut of date drugs well separated from stock\nDestruction protocol for out of date drugs available and applied", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "EScommentss", "label": "key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "ESactionpla", "label": "action plan", "type": "text", "control": {"appearance": "multiline"}}, {"name": "EssDrugScor", "type": "calculate", "bind": {"calculate": "if(${StafStockED} = 'yes',4,0) + if(${HFPurDrugPh} = 'yes',3,0) + if(${PharDelivHF} = 'yes',10,0) + if(${DrugsStored} = 'yes',2,0) + if(${AbsExpDrugs} = 'yes',1,0)"}}]}, {"name": "OGgroup0011", "label": "O&G", "type": "group", "children": [{"name": "Maternity00", "label": "Maternity [max 31 points]", "type": "group", "children": [{"name": "SuffH20Soap", "label": "Sufficient water with antiseptic soap and liquid antiseptic in delivery room", "hint": "A functioning water source or at the least 20L; soap available", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "LiteDeliv24", "label": "Light in delivery room 24 hours", "hint": "Electricity, solar light or rechargeable battery lamp", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "WasteMatern", "label": "Waste from Maternity correctly handled", "hint": "Lined bin with lid and safe needle disposal container", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "DelivRoomMn", "label": "Delivery room is well-maintained", "hint": "Walls with durable materials and painted\nCurtain between delivery bed and door\nDelivery room should have proof of use of bleach as a disinfectant for cleaning (eg jik, hypo, etc)\nFloor should be levelled with cement or tiles, without fissures and ceiling not damaged\nWindows with curtains and functional door", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "AvailPartog", "label": "Availability and use of the partograph", "hint": "At the least 10 forms available for use\nVerify three randomly selected partographs whether filled according to the norms", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "DelivPerson", "label": "Deliveries performed by skilled personnel", "hint": "Identification of the skilled provider from names in the register", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "AvailScaleW", "label": "Availability of scales for weight/length, an obstetrical stethoscope and an aspirator", "hint": "Scale to measure height; scale to measure weight (check functionality), measuring tapes to measure the newborn's length/ head circumference, aspirator plunged into a non-irritating antiseptic or functional manual/electric aspirator", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "FuncVaccExt", "label": "Availability of a functional vacuum extractor", "hint": "Plus a nurse trained in its use, and vacuum extractor effectively used", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ResuscAreaN", "label": "Is there a resuscitation area for the newborn?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "NeonAmbubag", "label": "If yes, is there a neonatal ambubag with face masks of sizes 0 and 1?", "type": "select one", "bind": {"required": "TRUE", "relevant": "${ResuscAreaN} = 'yes'"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "PengSuctDev", "label": "Is there a penguin suction device or a functional electric aspirator?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "WorkersENCC", "label": "Has any of the workers been trained on ENCC?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "NumWorkENCC", "label": "How many workers?", "type": "integer", "bind": {"required": "TRUE", "relevant": "${WorkersENCC} = 'yes'"}}, {"name": "SterilGlove", "label": "Availability of at the least 10 pairs of sterile gloves", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "SterilObsBx", "label": "Availability of at the least 2 sterilized obstetrical boxes", "hint": "Content at the least 1 pair of scissors, 2 pliers and one needle holder", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "EpisiotoBox", "label": "Availability of at the least one episiotomy box", "hint": "One sterilized box with needle holder, needles, 1 anatomical plier and 1 surgical plier\nCatgut and nylon sutures; antiseptic, local anesthetics, sterile swaps", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "DelivrTable", "label": "Delivery table in good state", "hint": "Table in two parts with removable non-torn plasticized mattress and two functional leg supports", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "EquipNwborn", "label": "Available equipment for care of the newborn", "hint": "Sterile tying string or clip for umbilical cord\n1% tetracycline eye ointment non-expired", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "AdeqInPatRm", "label": "Adequate in-patient rooms", "hint": "Mattress covered in impermeable plastic\nSheets, blankets and mosquito nets on each occupied bed", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "MateComment", "label": "key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "MateActions", "label": "key actions", "type": "text", "control": {"appearance": "multiline"}}, {"name": "MaternitCal", "type": "calculate", "bind": {"calculate": "if(${SuffH20Soap} = 'yes',2,0) + if(${LiteDeliv24} = 'yes',1,0) + if(${WasteMatern} = 'yes',1,0) + if(${DelivRoomMn} = 'yes',5,0) + if(${AvailPartog} = 'yes',2,0) + if(${DelivPerson} = 'yes',2,0) + if(${AvailScaleW} = 'yes',2,0) + if(${FuncVaccExt} = 'yes',3,0) + if(${ResuscAreaN} = 'yes',1,0) + if(${NeonAmbubag} = 'yes',1,0) + if(${PengSuctDev} = 'yes',1,0) + if(${WorkersENCC} = 'yes',1,0) + if(${SterilGlove} = 'yes',1,0) + if(${SterilObsBx} = 'yes',3,0) + if(${EpisiotoBox} = 'yes',2,0) + if(${DelivrTable} = 'yes',1,0) + if(${EquipNwborn} = 'yes',1,0) + if(${AdeqInPatRm} = 'yes',1,0)"}}]}, {"name": "AntenatCare", "label": "Antenatal Care [max 7.5 points]", "type": "group", "children": [{"name": "FacPractANC", "label": "Does the facility practise focused ANC?", "hint": "Focused ANC Policy available on request", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "WeighScale3", "label": "Weighing scale present, functional and calibrated to zero", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ANCFormHFAv", "label": "ANC form for HF available and well filled in: last five forms verified", "hint": "All: Examinations: weight - BP, uterus height, Parity, Date of last menstruation\nAll: Laboratory: albuminuria, glucose\nAll: Obstetrical examination done: Fetal heart rate, Uterine height, presentation, Fetal movement recorded", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ANCFormAdmn", "label": "ANC form for HF shows the administration of Ferrous Sulphate/Folic Acid and Mebendazole", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ANCCardsMom", "label": "ANC cards for mother available: at least 10 in stock", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ANCRegister", "label": "ANC register available and well filled in", "hint": "Complete identity, state of vaccinations, date visit, whether high risk pregnancy or not/danger signs\nAll columns well filled including the identification of problems if any, and actions taken", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ANCCondPers", "label": "ANC conducted by qualified personnel", "hint": "Nurse; midwife, verified on ANC cards", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "GrpIECBCC00", "label": "Group IEC/BCC", "hint": "Group meeting held before FP consultation (check the schedule of health education sessions)\nExistence of updated IEC report with (a) topic, (b) number of participants, (c) leader of activity and (d) date and (e) signature", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "MateComment", "label": "key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "MateActions", "label": "key actions", "type": "text", "control": {"appearance": "multiline"}}, {"name": "AntenatScor", "type": "calculate", "bind": {"calculate": "if(${FacPractANC} = 'yes',1,0) + if(${WeighScaleF} = 'yes',0.5,0) + if(${ANCFormHFAv} = 'yes',2,0) + if(${ANCFormAdmn} = 'yes',1,0) + if(${ANCCardsMom} = 'yes',0.5,0) + if(${ANCRegister} = 'yes',1,0) + if(${ANCCondPers} = 'yes',1,0) + if(${GrpIECBCC00} = 'yes',0.5,0)"}}]}, {"name": "Familpan001", "label": "FAMILY PLANNING", "type": "group", "children": [{"name": "Familpan002", "label": "At least one qualified staff trained in Family Planning (check certificate: original or photocopy certified by the HSMB)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Familpan003", "label": "Confidentiality in consultation room assured", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Familpan004", "label": "Room with closed doors, curtains at windows or non transparent glass", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Familpan005", "label": "Family planning methods available and visible in demonstration box for potential users", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Familpan006", "label": "Condoms (male and female); OCP; Injectable; Implant; IUD are available in the demonstration box", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Familpan007", "label": "Family Planning Models available: Penis: Vaginal; box with condoms available with at the least 50 condoms", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Familpan008", "label": "FP Counselling Materials available (pasted on wall and/or on desk) including information on: FP methods available, benefits and side effects, what to do if complications arise, follow up visit", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Familpan009", "label": "Staff correctly calculates number of clients expected monthly for oral and injectable contraceptives", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Familpan010", "label": "2 * average monthly consumption (total yearly consumption/12) to calculate the security stock for Oral and injectable contraceptives.", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Familpan011", "label": "Staff correctly calculates number of clients expected monthly for implants and IUDs", "hint": "For example for 100.000 population (target is entire LGA catchment pop) = 100.000 population times 22.5% (women in child bearing age) times 25% (unmet need) times 8% (estimated part for those that choose long term methods) divided by 12 months times 10% (share of the implants and IUDs estimated for the Hospital, assuming that 90% is supposed to be done at lower levels of care)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}]}, {"name": "Familpan014", "label": "IEC/BCC", "type": "group", "children": [{"name": "Familpan015", "label": "Group meeting held before FP consultation (check the schedule of health education sessions)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Familpan016", "label": "Existence of updated IEC report with (a) topic, (b) number of participants, (c) leader of activity and (d) date and (e) signature", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Familpan017", "label": "Are there jobaids, posters, leaflets available for use (sight)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Familpancom", "label": "Key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "Familpanact", "label": "Action Plan", "type": "text", "control": {"appearance": "multiline"}}, {"name": "FamPlanScor", "type": "calculate", "bind": {"calculate": "if(${Familpan002} = 'yes',1,0) + if(${Familpan003} = 'yes',1,0) + if(${Familpan004} = 'yes',1,0) + if(${Familpan005} = 'yes',1,0) + if(${Familpan006} = 'yes',1,0) + if(${Familpan007} = 'yes',1,0) + if(${Familpan008} = 'yes',1,0) + if(${Familpan009} = 'yes',1,0) + if(${Familpan010} = 'yes',1,0) + if(${Familpan011} = 'yes',1,0) + if(${Familpan015} = 'yes',1,0) + if(${Familpan016} = 'yes',1,0) + if(${Familpan017} = 'yes',1,0)"}}]}]}, {"name": "HIVTBGroup0", "label": "HIV/TB [max 8 points]", "type": "group", "children": [{"name": "HIVCounslRm", "label": "Well-equipped HIV counselling room ensuring privacy:", "hint": "Plastered and painted wall of solid material\nSmooth cement floor\nCeiling in good condition\nWindows with glass and curtains\nDoors that close", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "HIVTreatICC", "label": "Availability of IEC/BCC materials related to HIV treatment and prevention", "hint": "Penile and vaginal model on the table\nA box of condoms (male and female) on the table which has at the least 50 condoms", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "HTSCounsReg", "label": "Existence of a HTS/PMTCT counselling register and lab register acc norms", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "StaffCounsl", "label": "At the least one staff trained as a counsellor (trained in the past two years)", "hint": "All counselling done by a trained counsellor (trained in the past two years) (Check certificate: original or photocopy certified by the HSMB)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "RefSysHIVPt", "label": "Referral system and follow up for HIV positive clients", "hint": "Individual client cards available; planning for CD4 cell counts", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "RefSysTBPat", "label": "Referral system and follow up for TB patients", "hint": "Each AFB PTB patient has a person attached to him/her who supervises DOTS: proof of mobile phone number of such a supervisor is registered on treatment card.\nEach PTB patient has a contact address and/or phone number in both the register and the individual card", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "AntTuberDrg", "label": "Availability of anti-tuberculosis drugs", "hint": "Rifampicin-isoniazid-pyrazinamide : cp120+50+300mg\nStreptomycin 1 gr\nEtambutol tabs 400 mg", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "HIVTBScore0", "type": "calculate", "bind": {"calculate": "if(${HIVCounslRm} = 'yes',1,0) + if(${HIVTreatICC} = 'yes',1,0) + if(${HTSCounsReg} = 'yes',1,0) + if(${StaffCounsl} = 'yes',1,0) + if(${RefSysHIVPt} = 'yes',1,0) + if(${RefSysTBPat} = 'yes',2,0) + if(${AntTuberDrg} = 'yes',1,0)"}}, {"name": "CommentsHIV", "label": "key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "actionplaHI", "label": "action plan", "type": "text", "control": {"appearance": "multiline"}}]}, {"name": "SurgeryGrp0", "label": "Surgery [max 55 points]", "type": "group", "children": [{"name": "BloodbEmerg", "label": "Blood bank: emergency preparedness", "type": "note"}, {"name": "BloodbEme01", "label": "is there a functional blood bank?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "BloodbEme02", "label": "How many doctors perform surgery in this facility?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "BloodbEme03", "label": "How many consultant surgeons operate in this facility?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "BloodbEme04", "label": "Does this facility conduct specialized surgeries?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "BloodbEme05", "label": "List the specialties:", "type": "text", "bind": {"required": "TRUE", "relevant": "${BloodbEme04} = 'yes'"}}, {"name": "TransCertSf", "label": "Availability of one transfusion certified staff member (Check certificate: original or photocopy certified by the HSMB)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "AvailReagXM", "label": "Availability of reagents for grouping and X-matching, properly stored", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Min2UnBlood", "label": "Minimum 2 units of fresh blood O rhesus negative type, non expired available", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "BloodStoreN", "label": "Blood stored according to the norms (between 2 to 4C); refrigerator is functional; has power back up system (functional generator) or kerosene type with stock of kerosene; temperature measured twice daily", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "HIVHepBTest", "label": "HIV, Syphilis test, and HepB tests available, and blood stored has been tested", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Sterilenorm", "label": "Is Sterilization according to the norms?", "hint": "Functioning steam sterilizer available\nSterilizer in separate room from theater \nUse of chemical heat indicators \nRegister for sterilizations used and completely filled", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Minorsurgry", "label": "Is minor surgery done in a separate room from the major surgical procedures?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Theaterlamp", "label": "Is there a functioning theater lamp?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "TheaterTabl", "label": "Is there functioning theater table?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Preparednes", "label": "Preparedness", "type": "group", "children": [{"name": "Sterilesets", "label": "Is there at least one sterilized major surgery set available, with date of sterilization indicated on the pack?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "SterilezeCS", "label": "Is there at least one sterilized CS set available, with date of sterilization indicated on the pack?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "RingLactate", "label": "Is there at least 4 L of Ringers Lactate available in the theater?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Colloidsbag", "label": "Is there at least 2 bags of Colloids available in the theater?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "DisinfClean", "label": "Does theater smell of disinfectant, and cleaning schedule is available?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Staffanesth", "label": "Is there a nursing/technical Staff trained in anesthesia is presently on duty (at the least ketamine or spinal)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "QualfMedDoc", "label": "Qualified Medical Doctor with experience doing CS presently on duty", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Nurseonduty", "label": "Nursing Staff trained in theater procedures presently on duty (Check certificate: original or photocopy certified by the HSMB)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Commentspre", "label": "key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "actionplapr", "label": "action plan", "type": "text", "control": {"appearance": "multiline"}}]}, {"name": "SurgeryCalc", "type": "calculate", "bind": {"calculate": "if(${TransCertSf} = 'yes',2,0) + if(${AvailReagXM} = 'yes',2,0) + if(${Min2UnBlood} = 'yes',20,0) + if(${HIVHepBTest} = 'yes',5,0) + if(${BloodStoreN} = 'yes',5,0)+if(${Sterilenorm} = 'yes',3,0) + if(${Minorsurgry} = 'yes',1,0) + if(${Theaterlamp} = 'yes',1,0) + if(${TheaterTabl} = 'yes',1,0)+if(${Sterilesets} = 'yes',2,0) + if(${SterilezeCS} = 'yes',2,0) + if(${RingLactate} = 'yes',0.5,0) + if(${Colloidsbag} = 'yes',0.5,0) + if(${DisinfClean} = 'yes',1,0) + if(${Staffanesth} = 'yes',2,0) + if(${QualfMedDoc} = 'yes',5,0) + if(${Nurseonduty} = 'yes',2,0)"}}]}, {"name": "Immunizaton", "label": "Immunization [Max 48 points]", "type": "group", "children": [{"name": "IdentifInfo", "label": "Identification Information", "type": "note"}, {"name": "HighRiskPol", "label": "Is this a high risk settlement for polio?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "VCMworkSett", "label": "Is there a VCM working in this settlement?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "FindHealtFa", "label": "Findings at the Health Facility (Should be answered only on sighting evidence).", "type": "group", "children": [{"name": "HealtREWPla", "label": "Does the Health Facility have updated REW Microplan?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "HealthFaImm", "label": "Does the Health Facility have updated Immunization section plan?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "HFimplement", "label": "Does the HF Implement all Immunization session plan both outreach and fixed?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "PlanSesionM", "label": "Were all session planned for last month conducted?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "HfRImonitor", "label": "Does the HF have an updated RI monitoring chat", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Solacoldcha", "label": "Does the health facility have electrical / Solar cold chain equipment (refrigerator, solar etc.) to store vaccines?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ColdchainEq", "label": "Is the cold chain equipment fully functional,", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Temprachart", "label": "is there a temperature chart regularly maintained and updated on each of the equipment", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "VaccinStore", "label": "are the vaccines stored properly inside the equipment", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "VaccinLedge", "label": "Does the health facility have an updated vaccine ledger?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Wastedispos", "label": "Is there a waste disposable system in the HF or Plan to dispose waste appropriately", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "HeaFundinRI", "label": "Has the Health facility received timely funding for RI (in last 3 months)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "FunctionVDC", "label": "Is there a functional Village Development committee (VDC)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "CommunutyRI", "label": "Is there evidence that the community is involved in organizing RI session", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Commentspre", "label": "key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "actionplapr", "label": "action plan", "type": "text", "control": {"appearance": "multiline"}}]}, {"name": "ObserveRout", "label": "Observation during Routine Immunization Session", "type": "group", "children": [{"name": "PlanRoutImm", "label": "Is the planned routine immunization session being conducted?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Healtworker", "label": "Has the health worker, providing services been formally trained in Routine Immunization ?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ExTargetAge", "label": "Does the health worker know the expected number of target age children for this particular session?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "DiluentVacc", "label": "Is the health worker using the right diluents for each of vaccine administered (BCG, Measles, YF)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "CorrectVacc", "label": "Does Health Worker give the vaccine correctly i.e. at the correct site, using correct route and with correct dose", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "OneSyringeD", "label": "Does Health Worker use only one syringe/needle for each dose of antigen given", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "DisposSyrin", "label": "Does Health Worker dispose of used syringes / needle into safety box immediately", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "TallyVaccin", "label": "Does health worker tally each vaccine given correctly ?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ChildHeCard", "label": "Does health worker record on the child health / vaccination card correctly?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Sixmessages", "label": "Does health worker provide the 6 key messages to parent / caregiver correctly * (see below for the messages)", "hint": "Six Key Messages: (1) What vaccine(s) was given\n (2) The number of visits a child still needs in order to be fully immunized \n(3) What side effects may occur and how to treat them\n (4) The place and time of the next immunization \n(5) To bring the child for immunization even if he/she is sick \n(6) To take good care of the immunization card and bring it during the next visit", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "DefineeAEFI", "label": "Does health worker know definition of AEFI? (Adverse events following immunization)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "AEFI3months", "label": "Has health worker recorded any AEFI in the last 3 months?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Antigen3mon", "label": "Are there any stock out of any of the antigens in the last 3 months?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "RIproductSe", "label": "Are any other products or services being provided together with RI session?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "CommentsVac", "label": "key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "actionplaVa", "label": "action plan", "type": "text", "control": {"appearance": "multiline"}}]}, {"name": "ColdchainSy", "label": "COLD CHAIN SYSTEM", "type": "group", "children": [{"name": "UpdateChain", "label": "Is there an updated cold chain inventory of all cold chain in the H/F", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "FuncRefridg", "label": "Are there functional refridgerators or cold chain equipment at the LGA?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "MaintFreeze", "label": "Are all freezers, refridgerators and other cold chain equipment routinely maintained?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "PentVaccine", "label": "Is pentavalent vaccine stored in the right compartment in the refridgerator?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "PentVacTemp", "label": "Is the pentavalent vaccine kept at the temperature between 2\u00b0c and 8\u00b0c?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ChemcalTemp", "label": "Is there a chemical Temperature Indicator?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ChemTempLGA", "label": "Is there a chemical temperature indicator in the LGA?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "SupprtSuper", "label": "Is there supportive supervision?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "SupervsPlan", "label": "Is there a supportive supervisory plan?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ConductPlan", "label": "Is supportive supervision being conducted as planned?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "SuperReport", "label": "Are there supervisory report with identified action points?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "CommentsSu1", "label": "key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "actionplaSu", "label": "action plan", "type": "text", "control": {"appearance": "multiline"}}]}, {"name": "CommuntLink", "label": "COMMUNITY LINKAGE", "type": "group", "children": [{"name": "LGAmeetRept", "label": "Are there any reports/minutes of meetings between LGA officials and community leaders or other influential people to discuss RI?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "DistribuIEC", "label": "Is there evidence of distribution of IEC material to the health facility (see record of names of HFs and the numbers of IEC materials collected)?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "CommentsCom", "label": "key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "actionplCom", "label": "action plan", "type": "text", "control": {"appearance": "multiline"}}]}, {"name": "Wastemanage", "label": "WASTE MANAGEMENT", "type": "group", "children": [{"name": "LGAwasteDis", "label": "Does LGA have appropriate waste disposal facility?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "WastDisPlan", "label": "does the LGA have a waste disposal plan?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "CommentsWas", "label": "key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "actionplWas", "label": "action plan", "type": "text", "control": {"appearance": "multiline"}}]}, {"name": "ImmunoCalcu", "type": "calculate", "bind": {"calculate": "if(${HighRiskPol} = 'yes',1,0) + if(${VCMworkSett} = 'yes',1,0)+if(${HealtREWPla} = 'yes',1,0) + if(${HealthFaImm} = 'yes',1,0) + if(${HFimplement} = 'yes',2,0) + if(${PlanSesionM} = 'yes',1,0) + if(${HfRImonitor} = 'yes',1,0) + if(${Solacoldcha} = 'yes',1,0) + if(${ColdchainEq} = 'yes',1,0) + if(${Temprachart} = 'yes',1,0) + if(${VaccinStore} = 'yes',1,0) + if(${VaccinLedge} = 'yes',1,0) + if(${Wastedispos} = 'yes',1,0) + if(${HeaFundinRI} = 'yes',1,0) + if(${FunctionVDC} = 'yes',1,0) + if(${CommunutyRI} = 'yes',1,0)+if(${PlanRoutImm} = 'yes',1,0) + if(${Healtworker} = 'yes',1,0) +if(${LGAmeetRept} = 'yes',1,0) + if(${DistribuIEC} = 'yes',1,0) + if(${Wastemanage} = 'yes',1,0) + if(${LGAwasteDis} = 'yes',1,0) + if(${WastDisPlan} = 'yes',1,0)+if(${ExTargetAge} = 'yes',1,0) + if(${DiluentVacc} = 'yes',1,0) + if(${CorrectVacc} = 'yes',1,0) + if(${OneSyringeD} = 'yes',1,0) + if(${DisposSyrin} = 'yes',1,0) + if(${TallyVaccin} = 'yes',1,0) + if(${ChildHeCard} = 'yes',1,0) + if(${Sixmessages} = 'yes',1,0) + if(${DefineeAEFI} = 'yes',1,0) + if(${AEFI3months} = 'yes',1,0) + if(${Antigen3mon} = 'yes',1,0) + if(${RIproductSe} = 'yes',1,0)+ if(${UpdateChain} = 'yes',1,0) + if(${FuncRefridg} = 'yes',2,0) + if(${MaintFreeze} = 'yes',1,0) + if(${PentVaccine} = 'yes',1,0) + if(${PentVacTemp} = 'yes',1,0) + if(${ChemcalTemp} = 'yes',1,0) + if(${ChemTempLGA} = 'yes',1,0) + if(${SupprtSuper} = 'yes',1,0) + if(${SupervsPlan} = 'yes',1,0) + if(${ConductPlan} = 'yes',1,0) + if(${SuperReport} = 'yes',1,0)"}}]}, {"name": "ChildHealth", "label": "CHILD HEALTH AND NUTRITION [Max 75 Points]", "type": "group", "children": [{"name": "ServiceProv", "label": "Service Provision", "type": "note"}, {"name": "TrStaffIMCI", "label": "Are staffs trained in the management of common childhood illness (IMCI)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Trained2yar", "label": "How many have been trained/ retrained in the past 2 years?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "TrainedStaf", "label": "ARE STAFF TRAINED IN THE FOLLOWING?:", "type": "group", "children": [{"name": "CareOgivers", "label": "Counseling of care givers", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "InfantsFeed", "label": "Infant and young child feeding", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "NutriEducat", "label": "Nutrition Education", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "FoodDemonst", "label": "Food Demonstration", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Growthmonit", "label": "Growth monitoring and promotion", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "VitaminAsup", "label": "Vitamin A supplementation", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ThDeworming", "label": "Deworming", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "CommentsTra", "label": "key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "actionplTra", "label": "action plan", "type": "text", "control": {"appearance": "multiline"}}, {"name": "calcultrain", "type": "calculate", "bind": {"calculate": "if(${TrStaffIMCI} = 'yes',1,0) + if(${Trained2yar} = 'yes',1,0) + if(${CareOgivers} = 'yes',1,0) + if(${InfantsFeed} = 'yes',1,0) + if(${NutriEducat} = 'yes',1,0) + if(${FoodDemonst} = 'yes',1,0) + if(${Growthmonit} = 'yes',1,0) + if(${VitaminAsup} = 'yes',1,0) + if(${ThDeworming} = 'yes',1,0)+if(${IMCIguideli} = 'yes',1,0) + if(${ContinusEBF} = 'yes',1,0) + if(${ComplemtFed} = 'yes',1,0) + if(${MothersDiet} = 'yes',1,0) + if(${AppropWeigh} = 'yes',1,0)+if(${IYCFguideli} = 'yes',1,0) + if(${AcuteMalnut} = 'yes',1,0) + if(${DefiControl} = 'yes',1,0) + if(${JobAidsAval} = 'yes',1,0)+ if(${Thermometer} = 'yes',1,0) + if(${TongueDepre} = 'yes',1,0) + if(${FoodDemoMat} = 'yes',1,0) + if(${InfantWeigh} = 'yes',1,0) + if(${AdultsWeigh} = 'yes',1,0) + if(${CircumTapes} = 'yes',1,0) + if(${HeightMeasr} = 'yes',1,0) + if(${AdultHeight} = 'yes',1,0) + if(${Monitorcard} = 'yes',1,0)+ if(${NutriStatu5} = 'yes',2,0) + if(${NutriWomenS} = 'yes',2,0) + if(${ScreenRecrd} = 'yes',2,0)+ if(${NutriStatu5} = 'yes',2,0) + if(${NutriWomenS} = 'yes',2,0) + if(${ScreenRecrd} = 'yes',2,0)+ if(${AskIfFeverr} = 'yes',6,0) + if(${AskIFCoughh} = 'yes',6,0) + if(${AskDiarhoea} = 'yes',6,0) + if(${GeneImpress} = 'yes',6,0) + if(${First-Count} = 'yes',6,0) + if(${TempMeasChi} = 'yes',6,0) + if(${SkinPinches} = 'yes',6,0)"}}]}, {"name": "PatientMnag", "label": "Patient Management", "type": "group", "children": [{"name": "IMCIguideli", "label": "Are Treatment of children done according to IMCI guidelines?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ContinusEBF", "label": "Is there continous promotion of Exclusive BreastFeeding (EBF) in the facility?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ComplemtFed", "label": "Is appropriate and adequate complementary feeding and nutrition counseling conducted?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "MothersDiet", "label": "Is there a demonstration and preparation of adequate diet for mothers?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "AppropWeigh", "label": "Is weighing, plotting, interpretation and counseling appropriately done?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "CommentsPat", "label": "key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "actionplPat", "label": "action plan", "type": "text", "control": {"appearance": "multiline"}}]}, {"name": "GuideJobAid", "label": "Guidelines and Job aids", "type": "group", "children": [{"name": "IYCFguideli", "label": "Is IYCF Guideline available and in use?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "AcuteMalnut", "label": "Is Severe Acute Malnutrition Guidelines available and in use?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "DefiControl", "label": "Is Micronutrient deficiency Control Guidelines available and in use?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "JobAidsAval", "label": "Are Jobaids available", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "CommentsGud", "label": "key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "actionplGud", "label": "action plan", "type": "text", "control": {"appearance": "multiline"}}]}, {"name": "EquipmAvail", "label": "Equipment availability and Supplies", "type": "group", "children": [{"name": "Thermometer", "label": "Thermometer", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "TongueDepre", "label": "Tongue Depressor", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "FoodDemoMat", "label": "Food demonstration materials/tools/equipments (cooking utensils)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "InfantWeigh", "label": "Infant weighing scales", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "AdultsWeigh", "label": "Adult weighing scales", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "CircumTapes", "label": "Mid-Upper Arm Circumference Tapes", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "HeightMeasr", "label": "Height Measuring Boards for children", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "AdultHeight", "label": "Adult Heightometers", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Monitorcard", "label": "Growth Monitoring card", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "CommentsEqp", "label": "key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "actionplEqp", "label": "action plan", "type": "text", "control": {"appearance": "multiline"}}]}, {"name": "NutriStatus", "label": "Determination of nutritional status", "type": "group", "children": [{"name": "NutriStatu5", "label": "Determination of nutritional status of all children under 5 who come for consultation", "hint": "(check five children under five through a random sampling method: take a random number between 1 and 3 and using this sampling interval select and check five consultations): all or nothing", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "NutriWomenS", "label": "Determination of nutritional status of all women with a sick child under 6 months of age (as above)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ScreenRecrd", "label": "Screening record of nutritional status available, up to date and properly filled out", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}]}, {"name": "DirectObsev", "label": "Direct observation of three consecutive children under five. The reviewer team will have to ensure it is available on a time that is suitable to see children through direct observation on the OPD. In case there are no patients to be seen, this indicator automatically carries 0 points. For each of the three children observe the following six elements wether they occur in the patient-doctor/nurse interaction. At the end provide feedback on your findings.", "type": "group", "children": [{"name": "AskIfFeverr", "label": "Ask about fever and IF FEVER ask about (i) since when; (ii) persistent or intermittent (if question asked to the three children = 6 pts, if not = 0)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "AskIFCoughh", "label": "Ask about cough and IF COUGH ask about since when (if question asked to the three children = 6 pts, if not = 0)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "AskDiarhoea", "label": "Ask for diarrhea IF DIARRHOEA then ask (i) since when; (ii) how often per day; (iii) consistency - water or mucus or bloody; (iv) vomiting (if question asked to the three children = 6 pts, if not = 0)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "GeneImpress", "label": "GENERAL IMPRESSION: awake or tired? (if question asked to the three children = 6 pts, if not = 0)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "First-Count", "label": "FIRST - COUNT RESPIRATION RATE (observe before touching child!!!) (if action taken on the three children = 6 pts, if not = 0)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "TempMeasChi", "label": "Temperature (measure) (if taken on the three children = 6 pts, if not = 0)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "SkinPinches", "label": "Skin pinch (in case of diarrhea) OR chest auscultation (in case of cough) (if carried out on the three children = 6 pts, if not = 0)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "CommentsObs", "label": "key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "actionplObs", "label": "action plan", "type": "text", "control": {"appearance": "multiline"}}]}, {"name": "ChildhealtS", "type": "calculate", "bind": {"calculate": "if(${TrStaffIMCI} = 'yes',1,0) + if(${Trained2yar} = 'yes',1,0) + if(${CareOgivers} = 'yes',1,0) + if(${InfantsFeed} = 'yes',1,0) + if(${NutriEducat} = 'yes',1,0) + if(${FoodDemonst} = 'yes',1,0) + if(${Growthmonit} = 'yes',1,0) + if(${VitaminAsup} = 'yes',1,0) + if(${ThDeworming} = 'yes',1,0)+if(${IMCIguideli} = 'yes',1,0) + if(${ContinusEBF} = 'yes',1,0) + if(${ComplemtFed} = 'yes',1,0) + if(${MothersDiet} = 'yes',1,0) + if(${AppropWeigh} = 'yes',1,0)+if(${IYCFguideli} = 'yes',1,0) + if(${AcuteMalnut} = 'yes',1,0) + if(${DefiControl} = 'yes',1,0) + if(${JobAidsAval} = 'yes',1,0)+ if(${Thermometer} = 'yes',1,0) + if(${TongueDepre} = 'yes',1,0) + if(${FoodDemoMat} = 'yes',1,0) + if(${InfantWeigh} = 'yes',1,0) + if(${AdultsWeigh} = 'yes',1,0) + if(${CircumTapes} = 'yes',1,0) + if(${HeightMeasr} = 'yes',1,0) + if(${AdultHeight} = 'yes',1,0) + if(${Monitorcard} = 'yes',1,0)+ if(${NutriStatu5} = 'yes',2,0) + if(${NutriWomenS} = 'yes',2,0) + if(${ScreenRecrd} = 'yes',2,0)+ if(${NutriStatu5} = 'yes',2,0) + if(${NutriWomenS} = 'yes',2,0) + if(${ScreenRecrd} = 'yes',2,0)+ if(${AskIfFeverr} = 'yes',6,0) + if(${AskIFCoughh} = 'yes',6,0) + if(${AskDiarhoea} = 'yes',6,0) + if(${GeneImpress} = 'yes',6,0) + if(${First-Count} = 'yes',6,0) + if(${TempMeasChi} = 'yes',6,0) + if(${SkinPinches} = 'yes',6,0)"}}]}, {"name": "Surveilance", "label": "Surveillance [Max 51 points]", "type": "group", "children": [{"name": "FocalPerson", "label": "Focal Person", "type": "note"}, {"name": "SurvelFocal", "label": "Is there a surveillance focal person located in the health facility?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "TrainedFoca", "label": "Has the focal person been trained/re-trained in the last 1 year?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "SurvelGuide", "label": "Does the focal person have surveillance guideline booklet?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "AFPmeaslesY", "label": "Does the focal person know the case definiton of AFP, measles, yellow fever, NNT, GWD , CSM,Lassa Fever, cholera and other epidemic prone diseases", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "AFP3Diffren", "label": "Does the surveillance focal person know at least three differentials of AFP and other diseases as written above?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "Stoolcollec", "label": "Does the surveillance focal person know the stool collection procedure for AFP?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ActiveCases", "label": "Is the focal person aware of the importance of active case search and immediate reporting of AFP, GWD, Measles, NNT etc", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "AFP6Montths", "label": "Has the focal person reported any AFP case in the last six months?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ActiveCase2", "label": "Active Case Search/Supervision", "type": "group", "children": [{"name": "ACSsupervHF", "label": "Were ACS/supervisions conducted in the HF in the last three months based on records?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ACS3monPrio", "label": "Were the ACS conducted in the last three months based on prority?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "MissPriorit", "label": "Were missed priority diseases detected on record review?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ACSofHFLGAs", "label": "Is there evidence (smart action points with signature and signed register) of ACS/supervision by the State/LGA to the HF in the last three months?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ACSpartners", "label": "Is there evidence (smart action points with signature and signed register) of ACS/supervision by partners in the last 3 months?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "CommentsCas", "label": "key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "actionplCas", "label": "action plan", "type": "text", "control": {"appearance": "multiline"}}]}, {"name": "FeedbaLogic", "label": "Feedback and Logistics", "type": "group", "children": [{"name": "FeedbackAFP", "label": "Does the focal person receive regular feedback (lab results) on AFP cases and other priority diseases reported?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "CaseDefinit", "label": "Is there case definition of priority diseases displayed?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "DiseasePost", "label": "Are posters for priority diseases available?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "DataToolsAv", "label": "Are data tools available for reporting surveillance?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "AFPspecimen", "label": "Are AFP specimen containers available?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "CommentsFDL", "label": "key comments", "type": "text", "control": {"appearance": "multiline"}}, {"name": "actionplFDL", "label": "action plan", "type": "text", "control": {"appearance": "multiline"}}, {"name": "ClinicFamil", "label": "Is the clinician familiar with standard case definition of AFP, GWD, NNT, Measles, Yellow Fever and Meningitis", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "PriotDiseas", "label": "Does the clinician know the diffentials of priority diseases as listed above?", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "CilnicRegis", "label": "Is there a clinic register?", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "DiagSignsSy", "label": "Does the clinic register contain column for diagnosis/signs and symptoms?", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ACSevidence", "label": "Is there any evidence of ACS in the register in the last three months?", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "AFPcase6mon", "label": "Has any of the clinicians seen any AFP case and other priority diseases in the last six months?", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "FeedbClinic", "label": "Does the clinician receive regular feedback on cases reported?", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "TimePrioDis", "label": "Is the clinician aware of the importance of timely reporting of priority diseases?", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}, {"name": "ClinicActiv", "label": "Is the clinician aware of the importance of active case search and the immediate reporting of AFP, GWD, NNT, Measles, Yellow Fever and Meningitis?", "type": "select one", "children": [{"name": "yes", "label": "Yes"}, {"name": "no", "label": "No"}]}]}, {"name": "Suvellcalcu", "type": "calculate", "bind": {"calculate": "if(${SurvelFocal} = 'yes',1,0) + if(${TrainedFoca} = 'yes',1,0) + if(${SurvelGuide} = 'yes',1,0) + if(${AFPmeaslesY} = 'yes',8,0) + if(${AFP3Diffren} = 'yes',8,0) + if(${Stoolcollec} = 'yes',1,0) + if(${ActiveCases} = 'yes',1,0) + if(${AFP6Montths} = 'yes',1,0) + if(${ACSsupervHF} = 'yes',1,0) + if(${ACS3monPrio} = 'yes',1,0) + if(${MissPriorit} = 'yes',1,0) + if(${ACSofHFLGAs} = 'yes',1,0) + if(${ACSpartners} = 'yes',1,0) + if(${FeedbackAFP} = 'yes',1,0) + if(${CaseDefinit} = 'yes',1,0) + if(${DiseasePost} = 'yes',1,0) + if(${DataToolsAv} = 'yes',1,0) + if(${AFPspecimen} = 'yes',1,0) + if(${ClinicFamil} = 'yes',6,0) + if(${PriotDiseas} = 'yes',6,0) + if(${CilnicRegis} = 'yes',1,0) + if(${DiagSignsSy} = 'yes',1,0) + if(${ACSevidence} = 'yes',1,0) + if(${AFPcase6mon} = 'yes',1,0) + if(${FeedbClinic} = 'yes',1,0) + if(${TimePrioDis} = 'yes',1,0) + if(${ClinicActiv} = 'yes',1,0)"}}]}, {"name": "GrandSummat", "type": "calculate", "bind": {"calculate": "${GenManAdmSc} + ${BizPlanScor} + ${FinancScore} + ${IndiComScor} + ${HygMedWasCl} + ${ConsulScore} + ${FamPlanScor} + ${LaboraScore} + ${InPatScore0} + ${EssDrugScor} + ${MaternitCal} + ${AntenatScor} + ${HIVTBScore0} + ${SurgeryCalc} + ${ImmunoCalcu} + ${ChildhealtS} + ${Suvellcalcu}"}}, {"name": "GranPercent", "type": "calculate", "bind": {"calculate": "round((${GrandSummat} div 814.5 * 100),2)"}}, {"name": "CashReceipt", "label": "Cash Receipts for Quarter", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "CostRecover", "label": "Cost recovery (User-charges exclude drugs)", "type": "integer"}, {"name": "DrugRevenue", "label": "Drug revenues", "type": "integer"}, {"name": "CostRecPreP", "label": "Cost recovery (pre-payments)", "type": "integer"}, {"name": "SalarieGovt", "label": "Salaries from Government and other sources", "type": "integer"}, {"name": "PBFSubsidy0", "label": "PBF subsidies from fund holders", "type": "integer"}, {"name": "ContribOthr", "label": "Contributions from other sources", "type": "integer"}, {"name": "OtherReceip", "label": "Other", "type": "integer"}, {"name": "TotalFinanc", "type": "calculate", "bind": {"calculate": "${CostRecover} + ${DrugRevenue} + ${CostRecPreP} + ${SalarieGovt} + ${PBFSubsidy0} + ${ContribOthr} + ${OtherReceip}"}}]}, {"name": "ExpenQuartr", "label": "Expenditure by Component for Quarter", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "SalariesExp", "label": "Salaries", "type": "integer", "control": {"appearance": "w2"}}, {"name": "PerfBonuses", "label": "Performance bonuses", "type": "integer", "control": {"appearance": "w2"}}, {"name": "DrugMedCons", "label": "Drugs and medical consumables", "type": "integer", "control": {"appearance": "w2"}}, {"name": "SubsContrac", "label": "Subsidies for sub-contractors", "type": "integer", "control": {"appearance": "w2"}}, {"name": "CleanCosts0", "label": "Cleaning and office costs", "type": "integer", "control": {"appearance": "w2"}}, {"name": "TranspCosts", "label": "Transport costs", "type": "integer", "control": {"appearance": "w2"}}, {"name": "SocialMarkt", "label": "Social marketing", "type": "integer", "control": {"appearance": "w2"}}, {"name": "InfrasRehab", "label": "Infrastructural rehabilitation", "type": "integer", "control": {"appearance": "w2"}}, {"name": "EquipFurnit", "label": "Equipment and furniture", "type": "integer", "control": {"appearance": "w2"}}, {"name": "CostIndigen", "label": "Costs for indigent patients", "type": "integer", "control": {"appearance": "w2"}}, {"name": "OtherExpens", "label": "Other (trainings, etc)", "type": "integer", "control": {"appearance": "w2"}}, {"name": "TotalExpens", "type": "calculate", "bind": {"calculate": "${SalariesExp} + ${PerfBonuses} + ${DrugMedCons} + ${SubsContrac} + ${CleanCosts0} + ${TranspCosts} + ${SocialMarkt} + ${InfrasRehab} + ${EquipFurnit} + ${CostIndigen} + ${OtherExpens}"}}, {"name": "NetChngCash", "type": "calculate", "bind": {"calculate": "${TotalFinanc} - ${TotalExpens}"}}]}, {"name": "OpenCashBal", "label": "Opening Cash Balances for Quarter", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "BankBalOpsQ", "label": "Bank balance at the beginning of the quarter (Operations bank account)", "type": "integer"}, {"name": "BankBalDrug", "label": "Bank balance at the beginning of the quarter (Operations Drugs bank account)", "type": "integer"}, {"name": "CashHandQtr", "label": "Cash at hand at the beginning of the quarter", "type": "integer"}, {"name": "NetCashAvai", "type": "calculate", "bind": {"calculate": "${BankBalOpsQ} + ${BankBalDrug} + ${CashHandQtr} + ${NetChngCash}"}}]}, {"name": "ClosCashBal", "label": "Closing Cash Balances for Quarter", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "BankBalEndO", "label": "Bank balance at the end of the quarter (operation bank account)", "type": "integer"}, {"name": "BankBalEndD", "label": "Bank balance at the end of the quarter (drugs bank account)", "type": "integer"}, {"name": "CashHandEnd", "label": "Cash at hand at the end of the quarter", "type": "integer"}, {"name": "TotCashBalE", "type": "calculate", "bind": {"calculate": "${BankBalEndO} + ${BankBalEndD} + ${CashHandEnd}"}}]}, {"name": "SumFinancia", "label": "Summary of Financials", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "TotFinanNot", "label": "Total Financing (A) is: \u20a6${TotalFinanc}", "type": "note", "control": {"appearance": "w1"}}, {"name": "TotExpenNot", "label": "Total Expenditure (B) is: \u20a6${TotalExpens}", "type": "note", "control": {"appearance": "w1"}}, {"name": "NetChngNote", "label": "Net Change in Cash (C = A - B) is: \u20a6${NetChngCash}", "type": "note", "control": {"appearance": "w1"}}, {"name": "NetCashNote", "label": "Net Cash Available (D) is: \u20a6${NetCashAvai}", "type": "note", "control": {"appearance": "w1"}}, {"name": "TotCashNote", "label": "Total closing Cash Balance (E) is: \u20a6${TotCashBalE}", "hint": "Note: E must equal D", "type": "note", "control": {"appearance": "w1"}}]}, {"name": "FormSummary", "label": "**Summary**", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "GenManageSc", "label": "General Management = ${GenManAdmSc}", "type": "note", "control": {"appearance": "w2"}}, {"name": "BizPlanScoe", "label": "Business Plan = ${BizPlanScor}", "type": "note", "control": {"appearance": "w2"}}, {"name": "FinanceScor", "label": "Finance = ${FinancScore}", "type": "note", "control": {"appearance": "w2"}}, {"name": "IndigenScor", "label": "Indigent Committee = ${IndiComScor}", "type": "note", "control": {"appearance": "w2"}}, {"name": "HygieneScor", "label": "Hygiene = ${HygMedWasCl}", "type": "note", "control": {"appearance": "w2"}}, {"name": "ConsulScord", "label": "OPD = ${ConsulScore}", "type": "note", "control": {"appearance": "w2"}}, {"name": "FamPlanScoe", "label": "Family Planning = ${FamPlanScor}", "type": "note", "control": {"appearance": "w2"}}, {"name": "LaboraScord", "label": "Laboratory = ${LaboraScore}", "type": "note", "control": {"appearance": "w2"}}, {"name": "InPatScored", "label": "Inpatient Wards = ${InPatScore0}", "type": "note", "control": {"appearance": "w2"}}, {"name": "EssenDrugSc", "label": "Essential Drugs Management = ${EssDrugScor}", "type": "note", "control": {"appearance": "w2"}}, {"name": "MaternitySc", "label": "Maternity = ${MaternitCal}", "type": "note", "control": {"appearance": "w2"}}, {"name": "AntenatScoe", "label": "ANC = ${AntenatScor}", "type": "note", "control": {"appearance": "w2"}}, {"name": "HIVTubeScor", "label": "HIV/TB = ${HIVTBScore0}", "type": "note", "control": {"appearance": "w2"}}, {"name": "Surgeryscor", "label": "Surgery = ${SurgeryCalc}", "type": "note", "control": {"appearance": "w2"}}, {"name": "ImmunizeSco", "label": "Immunization = ${ImmunoCalcu}", "type": "note", "control": {"appearance": "w2"}}, {"name": "ChildHealty", "label": "ChildHealth = ${ChildhealtS}", "type": "note", "control": {"appearance": "w2"}}, {"name": "SurvellanSc", "label": "Survellance = ${Suvellcalcu}", "type": "note"}, {"name": "GrandTotalF", "label": "**Grand Total = ${GrandSummat} out of a Maximum 814.5 points**", "type": "note", "control": {"appearance": "w2"}}, {"name": "GrandPerNot", "label": "**Percentage score for HF is: ${GranPercent}%**", "type": "note", "control": {"appearance": "w2"}}]}, {"name": "meta", "type": "group", "control": {"bodyless": true}, "children": [{"name": "instanceID", "type": "calculate", "bind": {"readonly": "true()", "calculate": "concat('uuid:', uuid())"}}, {"name": "instanceName", "type": "calculate", "bind": {"calculate": "concat(${start000000},' ',${timestarted},'_','ISS_SHC','_',${FacilitName}, '_', jr:choice-name(${StateName00},'${StateName00}'))"}}]}]}