FEDERAL MINISTRY OF HEALTH, Integrated Supportive Supervision (ISS) tool for Secondary Health Facilities, Web Version 2018 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 No minutes One month's minutes available Two months' minutes available All minutes for quarter available >48 hours for Microscopy <48 hours for Microscopy >24 hours for GeneXpert <24 hours for GeneXpert Microscopy (Sputum AFB) GeneXpert Yes No Incomplete At least four water closet functional latrines/toilets (either the flushable squatting closet or the sitting closet) two for staff: Male and female, two for patients: Male and female Floor without fissures Recently cleaned without visible fecal matter Medical Doctor Consultant Nurse/Midwives (Double qualification) Nurses Midwives Dentist Dental Technician Dental Assistant Anaesthesist X-RAY Technician CHO CHEW JCHEW Nutrition Officer Nutrition Assistant Environmental Health Officer Environmental Health Technician Environmental Health Assistant Pharmacist Medical Lab Scientist Lab Technician Lab Assistant Medical Record Technician Medical Record Officer Health Education Officer Health Education Assistant Pharmacy Technician Pharmacy Assistant Main Subcontracted Secretary Accountant Revenue Officer Revenue Collectors Maintenance Officer Clerks Social Welfare Officers Security Guards Cleaners Account Officer Drivers None Public Private FBO NGO True False FMoH NPHCDA NACA SMoH SPHCDA SOML _ _ _ static_instance-yes_no-0 yes static_instance-yes_no-1 no static_instance-yes0_no0-0 yes static_instance-yes0_no0-1 no static_instance-yes1_no0-0 1 static_instance-yes1_no0-1 0 static_instance-yes0p5_no0-0 0.5 static_instance-yes0p5_no0-1 0 static_instance-yes2_no0-0 2 static_instance-yes2_no0-1 0 static_instance-yes2p5_no0-0 2.5 static_instance-yes2p5_no0-1 0 static_instance-yes6_no0-0 6 static_instance-yes6_no0-1 0 static_instance-yes8_no0-0 8 static_instance-yes8_no0-1 0 static_instance-yes10_no0-0 10 static_instance-yes10_no0-1 0 static_instance-yes4_no0-0 4 static_instance-yes4_no0-1 0 static_instance-yes3_no0-0 3 static_instance-yes3_no0-1 0 static_instance-yes5_no0-0 5 static_instance-yes5_no0-1 0 static_instance-yes19_no0-0 19 static_instance-yes19_no0-1 19 static_instance-yes20_no0-0 20 static_instance-yes20_no0-1 0 static_instance-yes28_no0-0 28 static_instance-yes28_no0-1 0 static_instance-yes4p5_no0-0 4.5 static_instance-yes4p5_no0-1 0 static_instance-indi_comm-0 0 static_instance-indi_comm-1 1 static_instance-indi_comm-2 2 static_instance-indi_comm-3 3 static_instance-micro_scopy-0 great_microscopy static_instance-micro_scopy-1 less_microscopy static_instance-micro_scopy-2 great_genexpert static_instance-micro_scopy-3 less_genexpert static_instance-diag_nosis-0 microscopy static_instance-diag_nosis-1 gene_xpert static_instance-tech_meeting-0 yes static_instance-tech_meeting-1 no static_instance-tech_meeting-2 incomplete static_instance-latrines-0 1 static_instance-latrines-1 0.5 static_instance-latrines-2 0.5 static_instance-staffs-0 medical_doctor static_instance-staffs-1 consultant static_instance-staffs-2 nurse_midwive_double_qualification static_instance-staffs-3 nurses static_instance-staffs-4 midwives static_instance-staffs-5 dentist static_instance-staffs-6 dental_technician static_instance-staffs-7 dental_assistant static_instance-staffs-8 anaesthesist static_instance-staffs-9 xray_technician static_instance-staffs-10 cho static_instance-staffs-11 chew static_instance-staffs-12 jchew static_instance-staffs-13 nutrition_officer static_instance-staffs-14 nutrition_assistant static_instance-staffs-15 environmental_health_officer static_instance-staffs-16 environmental_health_technician static_instance-staffs-17 environmental_health_assistant static_instance-staffs-18 pharmacist static_instance-staffs-19 medical_lab_scientist static_instance-staffs-20 lab_technician static_instance-staffs-21 lab_assistant static_instance-staffs-22 medical_record_technician static_instance-staffs-23 medical_record_officer static_instance-staffs-24 health_education_officer static_instance-staffs-25 health_education_assistant static_instance-staffs-26 pharmacy_technician static_instance-staffs-27 pharmacy_assistant static_instance-contract-0 main static_instance-contract-1 subcontracted static_instance-admin_staff-0 secretary static_instance-admin_staff-1 accountant static_instance-admin_staff-2 revenue_officer static_instance-admin_staff-3 revenue_collectors static_instance-admin_staff-4 maintenance_officer static_instance-admin_staff-5 clerks static_instance-admin_staff-6 social_welfare_officers static_instance-non_medical-0 health_attendants static_instance-non_medical-1 cleaners static_instance-non_medical-2 security_guards static_instance-non_medical-3 drivers static_instance-non_medical-4 none static_instance-facility_type-0 public static_instance-facility_type-1 private static_instance-facility_type-2 fbo static_instance-facility_type-3 ngo static_instance-true_false-0 true static_instance-true_false-1 false static_instance-organizations-0 fmoh static_instance-organizations-1 nphcda static_instance-organizations-2 naca static_instance-organizations-3 smoh static_instance-organizations-4 sphcda static_instance-organizations-5 soml [First-name Last-name] Please remember to add facility to master facility list public private fbo ngo main subcontracted This indicator is valued on an 'all or nothing basis' for all three monthly minutes. 4.5 0 yes no yes no 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 they visited the different services for easy tracing of patients in CCSS yes no 1 0 4.5 0 (all or nothing) 4.5 0 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 1 0 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 2 0 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 6 0 Vehicle log book available and maintained/filled Vehicle maintenance register available and filled Ambulance available and functional (contains basic first aid equipment) 4 0 1 0 yes no 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 yes no Valid and renegotiated for the quarter under evaluation (signed by all authorised signatories) 1 0 Hospital RBF Committee involved (Chairman signed off on the plan): minutes of special meeting to prepare the BP available with signed attendance list. 2 0 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 1 0 BP may suggest to include them or to discourage if quality conditions are not met 1 0 Strategy includes at least once per quarter a capacity building session with HC in-charges on RH/FP 0.5 0 1 0 1 0 1 0 2 0 yes no yes no 3 0 28 0 3 0 10 0 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. yes no 4 0 yes no Up to 20% of curative consultations of the previous month: documented quantity in monthly management meetings 1 0 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 3 0 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 5 0 Fence exists, can be closed at night and there are no holes 2 0 Bin with lid accessible to clients which is not full, one for each ward 1 0 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) 19 19 No waste or medical waste in the courtyard (sharps, ampoules, plastics, gloves, used gauze, etc.) 1 0 2 0 yes no yes no yes no yes no 5 0 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 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 Sufficient benches and or chairs protected against sun and rain and waiting area is not inside the consultation room 1 0 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. 5 0 5 0 5 0 yes no yes no yes no yes no yes no Electricity present in the form of current, functioning generator or functioning solar light 1 0 Identification of consulting staff in register 1 0 Clean blouse with identification tag and shoes (no slippers) 1 0 Correct numbering and closed at the end of the year month 1 0 Supervisor verifies entries in register for the last three Sundays 1 0 National protocol for diagnosis and treatment of simple (acute) and severe malaria 1 0 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) 5 0 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) 5 0 1 0 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) 5 0 1 0 See last five cases of Diarrhea and review treatment according to diarrhoea protocol (five points for the five cases: all or nothing) 5 0 See last 100 cases in register, check diagnosis and calculate the rate (< 30 cases) 4 0 1 0 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 5 0 Let nurse check BP and review measure 1 0 1 0 1 0 Available mattress, non-torn, plastic cover specific for OPD consultations only 1 0 Inspect in comparison with known weight of supervisor: after weighing, the balance should return to zero 1 0 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) 2 0 (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 2 0 2 0 2 0 6 0 6 0 6 0 6 0 6 0 6 0 6 0 1 0 Supervisor verifies the last 2 Sundays in laboratory register 1 0 1 0 Supervisor verifies last five results 1 0 On plastic paper, in a color book, or put on wall Blood smear: Vivax, Ovale, Falciparum and Malariae Stools: Ascaris, entamoeba, ankylostoma and schistosome 0.5 0 functional objectives; immersion oil available, mirror or electricity blades, cover glass, GIEMSA available 0.5 0 At least 20 test kits available in the laboratory; non-expired 0.5 0 2.5 0 Organic waste in a bin with lid and not full Security box for sharp objects available and destroyed according to waste disposal guidelines 1 0 1 0 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 2 0 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 4 0 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 3 0 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 10 0 Clean place, well ventilated with all drugs on cupboards, labeled shelves Drugs and medical consumables stored on alphabetical order, first expired, first out basis 2 0 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 1 0 yes no A functioning water source or at the least 20L; soap available 2 0 Electricity, solar light or rechargeable battery lamp 1 0 Lined bin with lid and safe needle disposal container 1 0 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 5 0 At the least 10 forms available for use Verify three randomly selected partographs whether filled according to the norms 2 0 Identification of the skilled provider from names in the register 2 0 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 2 0 Plus a nurse trained in its use, and vacuum extractor effectively used 3 0 1 0 1 0 1 0 1 0 1 0 Content at the least 1 pair of scissors, 2 pliers and one needle holder 3 0 One sterilized box with needle holder, needles, 1 anatomical plier and 1 surgical plier Catgut and nylon sutures; antiseptic, local anesthetics, sterile swaps 2 0 Table in two parts with removable non-torn plasticized mattress and two functional leg supports 1 0 Sterile tying string or clip for umbilical cord 1% tetracycline eye ointment non-expired 1 0 Mattress covered in impermeable plastic Sheets, blankets and mosquito nets on each occupied bed 1 0 Focused ANC Policy available on request 1 0 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 2 0 1 0 0.5 0 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 1 0 Nurse; midwife, verified on ANC cards 1 0 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 0.5 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 2 * average monthly consumption (total yearly consumption/12) to calculate the security stock for Oral and injectable contraceptives. 1 0 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) 1 0 1 0 1 0 1 0 Plastered and painted wall of solid material Smooth cement floor Ceiling in good condition Windows with glass and curtains Doors that close 1 0 Penile and vaginal model on the table A box of condoms (male and female) on the table which has at the least 50 condoms 1 0 1 0 All counselling done by a trained counsellor (trained in the past two years) (Check certificate: original or photocopy certified by the HSMB) 1 0 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 Individual client cards available; planning for CD4 cell counts 1 0 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 2 0 Rifampicin-isoniazid-pyrazinamide : cp120+50+300mg Streptomycin 1 gr Etambutol tabs 400 mg 1 0 yes no yes no 1 0 2 0 20 0 5 0 5 0 Functioning steam sterilizer available Sterilizer in separate room from theater Use of chemical heat indicators Register for sterilizations used and completely filled 3 0 1 0 1 0 1 0 2 0 2 0 0.5 0 0.5 0 1 0 2 0 5 0 2 0 1 0 1 0 1 0 1 0 2 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 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 1 0 1 0 1 0 1 0 1 0 1 0 2 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 (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 2 0 2 0 2 0 6 0 6 0 6 0 6 0 6 0 6 0 6 0 1 0 1 0 1 0 8 0 8 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 6 0 6 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 [First-name Last-name] fmoh nphcda naca smoh sphcda soml [First-name Last-name] fmoh nphcda naca smoh sphcda soml [First-name Last-name] fmoh nphcda naca smoh sphcda soml [First-name Last-name] fmoh nphcda naca smoh sphcda soml [First-name Last-name] fmoh nphcda naca smoh sphcda soml yes no