FEDERAL MINISTRY OF HEALTH, Integrated Supportive Supervision (ISS) tool for Secondary Health Facilities, Mobile Version 2018 (Updated June 2022) abia adamawa akwa_ibom anambra bauchi bayelsa benue borno cross_river delta ebonyi edo ekiti enugu fct gombe imo jigawa kaduna kano katsina kebbi kogi kwara lagos nasarawa niger ogun ondo osun oyo plateau rivers sokoto taraba yobe zamfara public private fbo ngo main subcontracted yes no yes no yes no yes no yes no 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) yes no Mobile phone functional with batteries AND call credit of a minimum of N1,000 List 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 yes no Timely Transmission of HMIS reports after verification of the SPHCDA of the monthly CPA invoice HMIS report is accurately filled completely according to the prevailing formats yes no 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) Through 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 yes no Vehicle log book available and maintained/filled Vehicle maintenance register available and filled Ambulance available and functional (contains basic first aid equipment) yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no Valid and renegotiated for the quarter under evaluation (signed by all authorised signatories) yes no Hospital RBF Committee involved (Chairman signed off on the plan): minutes of special meeting to prepare the BP available with signed attendance list. yes no 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 yes no BP may suggest to include them or to discourage if quality conditions are not met yes no Strategy includes at least once per quarter a capacity building session with HC in-charges on RH/FP yes no yes no yes no yes no Monthly report of treasury available and correctly filled Is the imprest account available? Theoretical balance of cash-book corresponds to liquidity in cash Is there a designated book keeper? yes no yes no yes no 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) yes no yes no yes no yes no yes no Up to 20% of curative consultations of the previous month: documented quantity in monthly management meetings yes no 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 yes no Each month an updated list of indigents from every community of the ward is validated and shared with the LGA and General Hospital. Details 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 yes no Fence exists, can be closed at night and there are no holes yes no Bin with lid accessible to clients which is not full, one for each ward yes no Waste disposal pit minimum 2 meters deep, lined with clay, concrete or brick or plastic, it is fenced and has a bright flag. The waste pit is a minimum of 15 meters from the health facility, minimum of 50 meters from a household, and 100 meters from a water source: except in cases where the available surface area does not allow for these distances (as certified by the LGA PHC department) Health Care Waste is not visible (covered by at the least 10 cm of soil or lime) The health facility maintains a register indicating the date of the creation of the pit(s), and the location (s) yes no No waste or medical waste in the courtyard (sharps, ampoules, plastics, gloves, used gauze, etc.) yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no Was the hospital fumigated for rodent and pest control at least once in the past six months? yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no Sufficient benches and or chairs protected against sun and rain and waiting area is not inside the consultation room yes no Easily visible in the consultation room waiting area, updated, with (i) unit price per item; (ii) price for a standard treatment of the drug Drugs 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. yes no yes no yes no yes no yes no yes no yes no yes no Electricity present in the form of current, functioning generator or functioning solar light yes no Identification of consulting staff in register yes no Clean blouse with identification tag and shoes (no slippers) yes no Correct numbering and closed at the end of the year month yes no Supervisor verifies entries in register for the last three Sundays yes no National protocol for diagnosis and treatment of simple (acute) and severe malaria yes no 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) yes no 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) yes no yes no 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) yes no yes no See last five cases of Diarrhea and review treatment according to diarrhoea protocol (five points for the five cases: all or nothing) yes no See last 100 cases in register, check diagnosis and calculate the rate (< 30 cases) yes no yes no Select any available qualified medical staff, and ask the question on TB dangers signs symptoms Answer 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 yes no Let nurse check BP and review measure yes no yes no yes no Available mattress, non-torn, plastic cover specific for OPD consultations only yes no Inspect in comparison with known weight of supervisor: after weighing, the balance should return to zero yes no Protocol is available in the consultation room The last five IMCI cases are traced in the register and comply with the IMCI strategy (all five) yes no (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 yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no Supervisor verifies the last 2 Sundays in laboratory register yes no yes no Supervisor verifies last five results yes no On plastic paper, in a color book, or put on wall Blood smear: Vivax, Ovale, Falciparum and Malariae Stools: Ascaris, entamoeba, ankylostoma and schistosome yes no functional objectives; immersion oil available, mirror or electricity blades, cover glass, GIEMSA available yes no At least 20 test kits available in the laboratory; non-expired yes no yes no Organic waste in a bin with lid and not full Security box for sharp objects available and destroyed according to waste disposal guidelines yes no yes no Reagents for AFB testing; stock control car for reagents is available and lists stock; at the least 30 non-recycled slides available for testing External 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 yes no Supervisor verifies guard duty's report - names, phone numbers and signatures Roster of staff on duty visibly displayed with phone contact yes no Each bed has a (i) plastic covered mattress, (ii) mosquito net, (iii) clean sheets, (iv) night table Number of functional beds available to patients yes no yes no yes no yes no yes no yes no yes no yes no yes no Let nurse check BP and review measure yes no yes no Inspect in comparison with known weight of supervisor: after weighing, the balance should return to zero yes no Correct numbering and closed at the end of the month yes no Electricity; solar light or rechargeable battery lamp yes no Women in separate ward from men; the inside of the wards are not visible from the outside yes no Check identity and hospital bed days yes no (i) full personal data of patient (ii) date and time of admission (iii) mobile phone number (iv) date and time of first examination by midwife/Dr (v) Anamnesis (vi) Past history (all or nothing for the five patients) yes no blood pressure; frequency and rhythm of heartbeat; body temperature; weight; height; respiration rate frequency; assessment of obstetrical condition (all or nothing for the five patients) yes no yes no (all or nothing for the five patients) yes no 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) yes no (i) full personal data of patient (ii) date and time of admission (iii) mobile phone number (iv) date and time of first examination by MD (v) history taking (vi) Past history (all or nothing for the five patients) yes no (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) yes no (all or nothing for the five patients) yes no (all or nothing for the five patients) yes no (i) full personal data of patient (ii) date and time of admission (iii) mobile phone number (iv) date and time of first examination by midwife/Dr (v) history taking (vi) Past history (all or nothing for the five patients) yes no 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) yes no (all or nothing for the five patients) yes no yes no (all or nothing for the five patients) yes no Supply in register corresponds with physical supply: random sample of three ED yes no Latest Pharmaceutical Council of Nigeria certified distribution center list for the State available Last procurement list is shown which shows the certified distributor which sold the drugs All drugs and medical consumables are (i) NAFDAC certified and (ii) Generic yes no Supervisor verifies whether quantity requisitioned equals quantity served Drugs to clients are uniquely dispensed through prescriptions. Prescriptions are stored and accessible Drugs and medical consumables prescribed, are all in generic form yes no Clean place, well ventilated with all drugs on cupboards, labeled shelves Drugs and medical consumables stored on alphabetical order, first expired in - first out basis yes no Supervisor verifies randomly three drugs and 2 consumables Out of date drugs well separated from stock Destruction protocol for out of date drugs available and applied yes no A functioning water source or at the least 20L; soap available yes no Electricity, solar light or rechargeable battery lamp yes no Lined bin with lid and safe needle disposal container yes no Walls with durable materials and painted Curtain between delivery bed and door Delivery room should have proof of use of bleach as a disinfectant for cleaning (eg jik, hypo, etc) Floor should be levelled with cement or tiles, without fissures and ceiling not damaged Windows with curtains and functional door yes no At the least 10 forms available for use Verify three randomly selected partographs whether filled according to the norms yes no Identification of the skilled provider from names in the register yes no 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 yes no Plus a nurse trained in its use, and vacuum extractor effectively used yes no yes no yes no yes no yes no yes no Content at the least 1 pair of scissors, 2 pliers and one needle holder yes no One sterilized box with needle holder, needles, 1 anatomical plier and 1 surgical plier Catgut and nylon sutures; antiseptic, local anesthetics, sterile swaps yes no Table in two parts with removable non-torn plasticized mattress and two functional leg supports yes no Sterile tying string or clip for umbilical cord 1% tetracycline eye ointment non-expired yes no Mattress covered in impermeable plastic Sheets, blankets and mosquito nets on each occupied bed yes no Focused ANC Policy available on request yes no yes no All: Examinations: weight - BP, uterus height, Parity, Date of last menstruation All: Laboratory: albuminuria, glucose All: Obstetrical examination done: Fetal heart rate, Uterine height, presentation, Fetal movement recorded yes no yes no yes no Complete identity, state of vaccinations, date visit, whether high risk pregnancy or not/danger signs All columns well filled including the identification of problems if any, and actions taken yes no Nurse; midwife, verified on ANC cards yes no Group meeting held before FP consultation (check the schedule of health education sessions) Existence of updated IEC report with (a) topic, (b) number of participants, (c) leader of activity and (d) date and (e) signature yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no 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) yes no yes no yes no yes no Plastered and painted wall of solid material Smooth cement floor Ceiling in good condition Windows with glass and curtains Doors that close yes no Penile and vaginal model on the table A box of condoms (male and female) on the table which has at the least 50 condoms yes no yes no All counselling done by a trained counsellor (trained in the past two years) (Check certificate: original or photocopy certified by the HSMB) yes no Individual client cards available; planning for CD4 cell counts yes no 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. Each PTB patient has a contact address and/or phone number in both the register and the individual card yes no Rifampicin-isoniazid-pyrazinamide : cp120+50+300mg Streptomycin 1 gr Etambutol tabs 400 mg yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no Functioning steam sterilizer available Sterilizer in separate room from theater Use of chemical heat indicators Register for sterilizations used and completely filled yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no Six Key Messages: (1) What vaccine(s) was given (2) The number of visits a child still needs in order to be fully immunized (3) What side effects may occur and how to treat them (4) The place and time of the next immunization (5) To bring the child for immunization even if he/she is sick (6) To take good care of the immunization card and bring it during the next visit yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no (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 yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no Note: E must equal D