{"name": "Tertiary_ISS_Form_Web_cloned", "type": "survey", "title": "FEDERAL MINISTRY OF HEALTH,\nIntegrated Supportive Supervision (ISS) tool for Tertiary Facilities,\nWeb Version 2018", "id_string": "Tertiary_ISS_Form_Web", "sms_keyword": "Tertiary_ISS_Form_Web", "default_language": "English", "version": "2019010801", "choices": {"yes_no": [{"label": "Yes", "name": "yes"}, {"label": "No", "name": "no"}], "yes0p25_no0": [{"label": "Yes", "name": "0.25"}, {"label": "No", "name": "0"}], "yes0p5_no0": [{"label": "Yes", "name": "0.5"}, {"label": "No", "name": "0"}], "yes1_no0": [{"label": "Yes", "name": "1"}, {"label": "No", "name": "0"}], "yes2_no0": [{"label": "Yes", "name": "2"}, {"label": "No", "name": "0"}], "yes3_no0": [{"label": "Yes", "name": "3"}, {"label": "No", "name": "0"}], "yes4_no0": [{"label": "Yes", "name": "4"}, {"label": "No", "name": "0"}], "yes5_no0": [{"label": "Yes", "name": "5"}, {"label": "No", "name": "0"}], "yes6_no0": [{"label": "Yes", "name": "6"}, {"label": "No", "name": "0"}], "yes10_no0": [{"label": "Yes", "name": "10"}, {"label": "No", "name": "0"}], "yes12_no0": [{"label": "Yes", "name": "12"}, {"label": "No", "name": "0"}], "indi_comm": [{"label": "No minutes", "name": "0"}, {"label": "One month's minutes available", "name": "1"}, {"label": "Two months' minutes available", "name": "2"}, {"label": "All minutes for quarter available", "name": "3"}], "tech_meeting": [{"label": "Yes", "name": "yes"}, {"label": "No", "name": "no"}, {"label": "Incomplete", "name": "incomplete"}], "latrines": [{"label": "At least four water closet functional latrines/toilets (either the flushable squatting closet or the sitting closet) two for staff: Male and female, two for patients: Male and female", "name": "1"}, {"label": "Floor without fissures", "name": "0.5"}, {"label": "Recently cleaned without visible fecal matter", "name": "0.5"}], "staffs": [{"label": "Medical Doctor", "name": "medical_doctor"}, {"label": "Consultant", "name": "consultant"}, {"label": "Nurse/Midwives (Double qualification)", "name": "nurse_midwive_double_qualification"}, {"label": "Nurses", "name": "nurses"}, {"label": "Midwives", "name": "midwives"}, {"label": "Dentist", "name": "dentist"}, {"label": "Dental Technician", "name": "dental_technician"}, {"label": "Dental Assistant", "name": "dental_assistant"}, {"label": "Anaesthesist", "name": "anaesthesist"}, {"label": "X-RAY Technician", "name": "xray_technician"}, {"label": "CHO", "name": "cho"}, {"label": "CHEW", "name": "chew"}, {"label": "JCHEW", "name": "jchew"}, {"label": "Nutrition Officer", "name": "nutrition_officer"}, {"label": "Nutrition Assistant", "name": "nutrition_assistant"}, {"label": "Environmental Health Officer", "name": "environmental_health_officer"}, {"label": "Environmental Health Technician", "name": "environmental_health_technician"}, {"label": "Environmental Health Assistant", "name": "environmental_health_assistant"}, {"label": "Pharmacist", "name": "pharmacist"}, {"label": "Medical Lab Scientist", "name": "medical_lab_scientist"}, {"label": "Lab Technician", "name": "lab_technician"}, {"label": "Lab Assistant", "name": "lab_assistant"}, {"label": "Medical Record Technician", "name": "medical_record_technician"}, {"label": "Medical Record Officer", "name": "medical_record_officer"}, {"label": "Health Education Officer", "name": "health_education_officer"}, {"label": "Health Education Assistant", "name": "health_education_assistant"}, {"label": "Pharmacy Technician", "name": "pharmacy_technician"}, {"label": "Pharmacy Assistant", "name": "pharmacy_assistant"}], "contract": [{"label": "Main", "name": "main"}, {"label": "Subcontracted", "name": "subcontracted"}], "admin_staff": [{"label": "Secretary", "name": "secretary"}, {"label": "Accountant", "name": "accountant"}, {"label": "Revenue Officer", "name": "revenue_officer"}, {"label": "Revenue Collectors", "name": "revenue_collectors"}, {"label": "Maintenance Officer", "name": "maintenance_officer"}, {"label": "Clerks", "name": "clerks"}, {"label": "Social Welfare Officers", "name": "social_welfare_officers"}, {"label": "Others", "name": "others"}], "non_medical": [{"label": "Security Guards", "name": "health_attendants"}, {"label": "Drivers", "name": "cleaners"}, {"label": "Account Officer", "name": "security_guards"}, {"label": "Director of Administration", "name": "drivers"}, {"label": "None", "name": "none"}], "facility_type": [{"label": "Public", "name": "public"}, {"label": "Private", "name": "private"}, {"label": "FBO", "name": "fbo"}, {"label": "NGO", "name": "ngo"}], "true_false": [{"label": "True", "name": "true"}, {"label": "False", "name": "false"}]}, "style": "theme-grid", "namespaces": "esri=\"http://esri.com/xforms\"\nenk=\"http://enketo.org/xforms\"", "children": [{"name": "start000000", "label": "Start", "type": "start"}, {"name": "end00000000", "label": "end", "type": "end"}, {"name": "time_started", "label": "Start time", "type": "calculate", "bind": {"calculate": "format-date-time(now(),'%H:%M')"}}, {"name": "GrpInformtn", "label": "Section 1.0 **General Information**", "type": "group", "children": [{"name": "demographics", "label": "Demographics", "type": "group", "children": [{"name": "nRespondent", "label": "1. Name of Respondent", "type": "text", "bind": {"required": "TRUE"}}, {"name": "StateName00", "label": "2. State", "type": "select one", "bind": {"required": "TRUE"}, "control": {"appearance": "autocomplete minimal w1"}, "itemset": "states.csv"}, {"name": "CalcState00", "label": "Calculate State", "type": "calculate", "bind": {"calculate": "if(${StateName00} = '','',once(now()))"}}, {"name": "LGAName0000", "label": "3. LGA Name", "type": "select one", "bind": {"required": "TRUE"}, "control": {"appearance": "autocomplete minimal w1"}, "itemset": "LGAs.csv", "choice_filter": "states = ${StateName00}"}, {"name": "CalcLGA0000", "label": "Calculate LGA", "type": "calculate", "bind": {"calculate": "if(${LGAName0000} = '','',once(now()))"}}, {"name": "WardName000", "label": "4. Name of Ward", "type": "text", "bind": {"required": "TRUE"}}, {"name": "CalcWard000", "label": "Calculate Ward", "type": "calculate", "bind": {"calculate": "if(${WardName000} = '','',once(now()))"}}, {"name": "FacilitName", "label": "5. Facility Name", "type": "select one", "bind": {"required": "TRUE"}, "control": {"appearance": "autocomplete minimal w2"}, "itemset": "facilities.csv", "choice_filter": "LGAs = ${LGAName0000} or LGAs = -88"}, {"name": "CalcFacilit", "label": "Calculate facility name", "type": "calculate", "bind": {"calculate": "if(${FacilitName} = '','',once(now()))"}}, {"name": "otheFacName", "label": "Input facility name", "hint": "Please remember to add facility to master facility list", "type": "text", "bind": {"required": "TRUE", "relevant": "${FacilitName} = 'other_facility'"}}, {"name": "FacilityTyp", "label": "6. Facility Type", "type": "select one", "bind": {"required": "TRUE"}, "control": {"appearance": "minimal"}, "children": [{"name": "public", "label": "Public"}, {"name": "private", "label": "Private"}, {"name": "fbo", "label": "FBO"}, {"name": "ngo", "label": "NGO"}]}, {"name": "ContraType0", "label": "7. Contract Type", "type": "select one", "children": [{"name": "main", "label": "Main"}, {"name": "subcontracted", "label": "Subcontracted"}]}, {"name": "SurveyLocat", "label": "8. Location of survey", "type": "geopoint", "bind": {"required": "TRUE"}, "control": {"appearance": "w4", "accuracyThreshold": "5"}}, {"name": "FacilityPic", "label": "9. Take a picture of the Facility", "type": "photo"}, {"name": "TotalPopul0", "label": "10. Total Catchment Population", "type": "integer", "bind": {"constraint": ". >=0", "required": "TRUE", "jr:constraintMsg": "Enter a positive integer"}}, {"name": "NumberBeds0", "label": "11a. Number of Beds", "type": "integer", "bind": {"constraint": ".>=0", "required": "TRUE", "jr:constraintMsg": "Enter a positive integer"}}, {"name": "NumBeds1000", "label": "Total number of beds", "type": "calculate", "bind": {"calculate": "${NumberBeds0} div ${TotalPopul0} * 1000"}}, {"name": "NoteBeds000", "label": "b. There are: ${NumBeds1000} beds per 1000 inhabitants", "type": "note"}, {"name": "MedStaff000", "label": "12. 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": "NumbrStaffs", "label": "13. Number of Qualified Staff", "type": "integer", "bind": {"constraint": ".>=0", "required": "TRUE", "jr:constraintMsg": "Enter a positive integer"}}]}, {"name": "NumStafQual_count", "type": "calculate", "bind": {"readonly": "true()", "calculate": "count-selected(${MedStaff000})"}}, {"name": "NumStafQual", "type": "repeat", "control": {"jr:count": "${NumStafQual_count}"}, "children": [{"name": "CalcStaffs0", "label": "Total staff per qualification", "type": "calculate", "bind": {"calculate": "${NumbrStaffs} div ${TotalPopul0} * 2000"}}, {"name": "NoteStaffs0", "label": "b. There are: ${CalcStaffs0} qualified staff per 2000 inhabitants", "type": "note"}, {"name": "NonMedStaff", "label": "15. 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": "none", "label": "None"}, {"name": "other", "label": "Other"}]}, {"name": "NonMedStaff_other", "label": "Specify other.", "type": "text", "bind": {"relevant": "selected(../NonMedStaff, 'other')"}}, {"name": "AdminStaff0", "label": "16. 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": "Section 1 General Management", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "PresMapHeal", "label": "1. Is there a map of health facility catchment area?", "hint": "Health map of the health area available and on the notice board of the health facility showing population adjusted yearly, other health facilities, villages, main roads, natural barriers, special points and distance in Km, a legend/key showing specific age group population adjusted yearly (<1, <5, WCBA)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "PropFileSys", "label": "2. Is there a proper filing system?", "hint": "In a filing cabinet/shelf/cupboard and accessible by the officer on duty (except individual staff files)\nMinimum 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.\nUnique 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 (in full please)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "4", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "StaffDutRos", "label": "3. Is staff duty roster available ?", "hint": "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", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "Techmeeting", "label": "4. How many technical meeting reports are available?", "hint": "Each monthly minutes contains at least: (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; (vi) minutes of the meeting are signed by the chairman. (three complete IMC meetings and one quarterly general staff meeting minutes available). For every meeting report that contains the above = 2 p. (max 4 reports)", "type": "integer", "bind": {"constraint": ". <= 4 and .>= 0", "required": "TRUE", "jr:constraintMsg": "Enter a positive integer"}}, {"name": "StandSheets", "label": "5. Are there standard Sheets for referral available", "hint": "At least 10 standard sheets are present during the evaluation", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "Avmobilphon", "label": "6. Does availability of dedicated mobile phone for communication between health facility and general hospital exist?", "hint": "Mobile phone functional with batteries and/or call credit of a minimum of N500 and contact details on the phone (e. g: Medical Director GH/Cottage Hospital, HF Staff, other PBF HFs OICs in the LGA, LGA PHC Dept. PBF Team and SPHCDA PIU &TA Team)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "HMISreports", "label": "7. Are HMIS reports filled, updated and transmitted to the LGA on schedule?", "hint": "Transmission of HMIS report is after verification of the SPHCDA of the monthly MPA invoice (including those of subcontracted HFs if applicable) and a signed receipt of acknowledgement is available", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "HMISdataRep", "label": "8. Is the HMIS data analysis report for the quarter being assessed concerning priority problems?", "hint": "Five priority health problems are followed each quarter and data have been updated up to the month prior to the supervisor's visit (all or nothing) (Monthly summary of the health problem classified at the closing of each month in the General register)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "RBFmeetings", "label": "9. Is the health Facility RBF Committee meetings conducted monthly and minutes available?", "hint": "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; (vi) minutes of the meeting are signed by the chairman. (3 complete RBF committee meeting minutes available, all or none: 3 points)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "3", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "MorturyAval", "label": "10. Is there a room for a mortuary?", "hint": "Availability of a room for a mortuary: corps not stored more than 12 hours (check-ins/outs mortuary registers), one strecher and one table", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "Kitchenaval", "label": "11. Is there an enclosed kitchen space?", "hint": "Availability of an enclosed kitchen space, separate from the main building, for inpatients", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "GroupGenera", "label": "Calculate Group Management", "type": "calculate", "bind": {"calculate": "coalesce(${PresMapHeal},0)+coalesce(${PropFileSys},0)+coalesce(${StaffDutRos},0)+coalesce(${Techmeeting},0)+coalesce(${StandSheets},0)+coalesce(${Avmobilphon},0)+coalesce(${HMISreports},0)+coalesce(${HMISdataRep},0)+coalesce(${RBFmeetings},0)+coalesce(${MorturyAval},0)+coalesce(${Kitchenaval},0)"}}]}, {"name": "BiznessPlan", "label": "Section 2 Business Plan", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "BiznessPla1", "label": "1. Does facility use a business plan?", "type": "select one", "children": [{"name": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "QuartBizPla", "label": "2. Are the quarterly business plan for the quarter under review made and accessible?", "hint": "Valid and renegotiated for the quarter under evaluation (signed by all authorised signatories)", "type": "select one", "bind": {"relevant": "${BiznessPla1} = '2'"}, "control": {"appearance": "minimal"}, "children": [{"name": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "BizPlaStake", "label": "3. Is business plan prepared with key stakeholders?", "hint": "Facility RBF Committee Members involved (Chairman signed off on the plan): minutes of special meeting to prepare the BP available with signed attendance list\nRepresentative (s) of subcontracted private clinics or health posts involved (if applicable)", "type": "select one", "bind": {"relevant": "${BiznessPla1} = '2'"}, "control": {"appearance": "w4"}, "children": [{"name": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "BizPlaGeoPl", "label": "4. Does business plan contain convincing geographic coverage plan?", "hint": "Strategies for sub-contracts\nOutreach strategies (EPI, FP; ANC) are used and planned for villages more than one hour away by foot", "type": "select one", "bind": {"relevant": "${BiznessPla1} = '2'"}, "control": {"appearance": "w4"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "BizPlaPract", "label": "5. Does the business plan analyze presence of trained and untrained informal practitioners in catchment area?", "hint": "HF has a list of informal practionners transmitted quarterly to the LGA for action, treats this subject in the BP, and suggests a strategy for dealing with informal practitioners", "type": "select one", "bind": {"relevant": "${BiznessPla1} = '2'"}, "control": {"appearance": "w4"}, "children": [{"name": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "BizPlaFinAc", "label": "6. Does business plan show a plan to assure financial accessibility for the population?", "hint": "Business plan shows negotiated rates between HF, Indigent Committee and community\nBusiness plan shows planning for the resources available for financing care for the indigents", "type": "select one", "bind": {"relevant": "${BiznessPla1} = '2'"}, "control": {"appearance": "w4"}, "children": [{"name": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "BizPlanScor", "label": "Business plan score", "type": "calculate", "bind": {"calculate": "coalesce(${BiznessPla1},0)+coalesce(${QuartBizPla},0)+coalesce(${BizPlaStake},0)+coalesce(${BizPlaGeoPl},0)+coalesce(${BizPlaPract},0)+coalesce(${BizPlaFinAc},0)"}}]}, {"name": "FinanceGrp0", "label": "Section 3 Finance", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "FinanDocsAv", "label": "1. Are financial and accounting documents available and well kept?", "hint": "Monthly financial report (income and expenditure books) available and correctly filled and signed by the Health Facility Officer in Charge", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "DocAvalQuar", "label": "2. Is the Document available (Indice Tool) to show that quarterly calculation of incomes, running costs, investments and variable performance subsidies are done?", "hint": "This document guarantees that income equals/balances the expenditures.\n Running costs equal: = salaries, purchase of drugs and equipment, subcontracts, petty cash for small expenditures, social marketing, maintenance and rehabilitation.", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "4", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "PerfBonuses", "label": "3. Performance bonuses do not exceed 50% of total HF income through PBF and are fixed according to health facility resolutions and not from a higher level", "hint": "Bonuses are paid directly from health facility bank account into individual staff accounts. 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.", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "10", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "MonthlBonus", "label": "4. Existence of monthly performance bonus system is known by staff", "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.", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "4", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "FinanGrpsco", "label": "Finance total", "type": "calculate", "bind": {"calculate": "coalesce(${FinanDocsAv},0)+coalesce(${DocAvalQuar},0)+coalesce(${PerfBonuses},0)+coalesce(${MonthlBonus},0)"}}]}, {"name": "IngredtCare", "label": "Section 4 Care for ingredients [max 10 points]", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "PlanCareInd", "label": "1. Is there a plan of Care for the Indigents expenditures?", "hint": "Upto 20% of curative consultations of the previous month: documented quantity in monthly management meetings", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "IndCommMeet", "label": "2. Indigent 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": "3", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "IndPatSensi", "label": "3. Is there a 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": "5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "IndiComScor", "label": "Indigent Commitee", "type": "calculate", "bind": {"calculate": "coalesce(${PlanCareInd},0)+coalesce(${IndCommMeet},0)+coalesce(${IndPatSensi},0)"}}]}, {"name": "HygMedWasDp", "label": "Section 5 Hygiene and Medical Waste Disposal [max 31 points]", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "HFFenceMain", "label": "1. Fence health facility available and well-maintained", "hint": "Fence exists, can be closed at night and there are no holes. A gatekeeper is available (except riverine areas)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "GarbBinCour", "label": "2. Availability of a garbage bin in the courtyard", "hint": "Bin with lid accessible to clients which is not full", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "WastePitHF0", "label": "5.1 Presence of sufficient latrines/toilets which are well-maintained (except riverine areas)", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "FourWatClos", "label": "3. 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": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "WitoutFlorF", "label": "4. Floor without fissures", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "0.5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "WitoutFecal", "label": "5. Recently cleaned without visible fecal matter", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "0.5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "DoorLockRof", "label": "6. Door lockable from the inside, ceiling and super structure with roofing, without flies and no smell", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "0.5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "Disinfectan", "label": "7. Proof of use of bleach used as a disinfectant (eg jik, hypo, etc)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "0.5", "label": "Yes"}, {"name": "0", "label": "No"}]}]}, {"name": "PresSufShow", "label": "5.2 Presence of sufficient showers which are well-maintained", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "TwoBathFaci", "label": "8. At least two bathing facilities (with floor without fissures, Door lockable from the inside, super structure with roofing)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "BatFacWater", "label": "9. Bathing facility with running water, or container with at the least 20 L of water", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "0.5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "EvWastWater", "label": "10. Evacuation of the waste water in a sanitation pit", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "0.5", "label": "Yes"}, {"name": "0", "label": "No"}]}]}, {"name": "WastePitAvl", "label": "11. Is the waste pit for Health Care Waste 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 (written support of the LGA health administration is required)\t\t\t\nHealth Care Waste is not visible (covered by at the least 10 cm of soil or lime)\t\t\t\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": "12", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "CourtyClean", "label": "12. Courtyard clean", "hint": "No waste or medical waste in the courtyard (sharps, ampoules, plastics, gloves,syringes,needles, used gauze, etc.)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "Nsterilizer", "label": "13. Sterilization according to norms using a pressure sterilizer", "hint": "Sterilizer functional (eg Autoclave)\nSterilization protocol available and followed (medical personnel present can explain the protocol or demonstrate the process)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "3", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "HygienDress", "label": "14. Hygienic conditions assured during wound dressing and injections", "hint": "Yellow and Red Bins for medical waste with lid and foot pedal, lined with bag and not full\nSecurity box for needles well positioned, and used (and not full)\t\t\t\nNeedle cutter available and used\t\t\t\nContainer/bowl with lid containing disinfectant used for putting used instruments", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "DipHeaWaste", "label": "15. Disposal of Health Care Waste according to National Norms", "hint": "Waste disposal of non-contaminated waste in Black Bin with lid and foot pedal, lined and not full\nWaste disposal of contaminated HCW in Yellow Bins with lid and foot pedal, lined with cellophene bag and not full\t\t\t\nWaste disposal of organically HCW in Red Bins with lid and foot pedal, lined with cellophene bag and not full\t\t\tProtective gear for personnel managing HCW available; boots, plastic shorts, thick plastic/rubber gloves", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "6", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "HygMedWasCl", "label": "Calculate Hygiene medical waste", "type": "calculate", "bind": {"calculate": "coalesce(${FourWatClos},0)+coalesce(${WitoutFlorF},0)+coalesce(${WitoutFecal},0)+coalesce(${DoorLockRof},0)+coalesce(${Disinfectan},0)+coalesce(${HFFenceMain},0)+coalesce(${GarbBinCour},0)+coalesce(${TwoBathFaci},0)+coalesce(${BatFacWater},0)+coalesce(${EvWastWater},0)+coalesce(${WastePitAvl},0)+coalesce(${CourtyClean},0)+coalesce(${Nsterilizer},0)+coalesce(${HygienDress},0)+coalesce(${DipHeaWaste},0)"}}]}, {"name": "CuratConsul", "label": "Section 6 Curative Consultations", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "ConWaitArea", "label": "1. Is condition in waiting area good?", "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": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "UnitFeeDrug", "label": "2. Is the 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": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "ExiWaitCard", "label": "3. Existence of waiting card system with numbers", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "ConsulRoomC", "label": "4. Consultation room in good condition", "hint": "Walls with durable materials well painted, floor paved with cement without fissures, undamaged ceiling\nConsultation room and waiting space separated assuring confidentiality\nWindows with curtains\nFunctional door with functional lock\nRunning water (tap or water dispenser) with liquid soap and clean towel available and used between patients", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "ConsulRoomL", "label": "5. 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": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "ConsulStaff", "label": "6. Consultations are done by skilled staff", "hint": "Identification of consulting staff in register", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "StaffDressW", "label": "7. Consulting staff is well-dressed", "hint": "Clean blouse with identification tag and shoes (no slippers)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "NumbRegistr", "label": "8. Correct numbering of registers", "hint": "Correct numbering and closed at the end of the year month", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "SerAvail247", "label": "9. 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": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "MalProcWall", "label": "10. 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": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "SimMalTreat", "label": "11. Is simple 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": "5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "WHOFLowDiag", "label": "12. Is there a WHO flow diagram for ARI put on wall and is it accessible for staff?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "ARIProtocol", "label": "13. Is 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": "5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "WHOProcDiar", "label": "14. Is the WHO protocol for Diarrhea put on wall and accessible for staff?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "DiarrProcAp", "label": "15. Is 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": "5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "PropConAnti", "label": "16. Is the 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": "4", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "MSFTreatGui", "label": "17. Is MSF Treatment guidelines available in consultancy room?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "KnwTubDang", "label": "18. Are you knowledgeable about 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": "5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "StethBPMach", "label": "19. Stethoscope and BP machine available and functional", "hint": "Let nurse check BP and review measure", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "FuncThermAv", "label": "20. Thermometer available and functional", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "FuncOtosAva", "label": "21. Otoscope available and functional", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "ExamBedOPDC", "label": "22. Is there an 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": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "WeighScaleF", "label": "23. 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": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "IntManChild", "label": "24. Is integrated Management of Childhood Illnesses strategy 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": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "NutristaWUC", "label": "6.1 Determination of nutritional status (weight, upper arm circumference, height)", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "NutriStaUn5", "label": "25. Determination of nutritional status of all children under 5 who come for consultation (check ten five children under five through a random sampling method: take a random number between 1 and 3 and using this sampling interval check five consultations)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "4", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "NutriStaFem", "label": "26. 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": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "ScrenRecord", "label": "27. Screening record of nutritional status available, up to date and properly filled out", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}]}, {"name": "DirObs3Und5", "label": "6.2 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", "control": {"appearance": "field-list"}, "children": [{"name": "FeverPerInt", "label": "28. 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": "6", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "CoughSinceW", "label": "29. 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": "6", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "DiarSincOft", "label": "30. 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": "6", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "GenImpressn", "label": "31. 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": "6", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "RespiRateCo", "label": "32. 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": "6", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "TempMeasure", "label": "33. Temperature (measure) (if taken on the three children = 6 pts, if not = 0)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "6", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "SkinPinchCh", "label": "34. 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": "6", "label": "Yes"}, {"name": "0", "label": "No"}]}]}, {"name": "ConsulScore", "label": "Consultation score", "type": "calculate", "bind": {"calculate": "coalesce(${ConWaitArea},0)+coalesce(${UnitFeeDrug},0)+coalesce(${ExiWaitCard},0)+coalesce(${ConsulRoomC},0)+coalesce(${ConsulRoomL},0)+coalesce(${ConsulStaff},0)+coalesce(${StaffDressW},0)+coalesce(${NumbRegistr},0)+coalesce(${SerAvail247},0)+coalesce(${MalProcWall},0)+coalesce(${SimMalTreat},0)+coalesce(${WHOFLowDiag},0)+coalesce(${ARIProtocol},0)+coalesce(${WHOProcDiar},0)+coalesce(${DiarrProcAp},0)+coalesce(${PropConAnti},0)+coalesce(${MSFTreatGui},0)+coalesce(${KnwTubDang},0)+coalesce(${StethBPMach},0)+coalesce(${FuncThermAv},0)+coalesce(${FuncOtosAva},0)+coalesce(${ExamBedOPDC},0)+coalesce(${WeighScaleF},0)+coalesce(${IntManChild},0)+coalesce(${NutriStaUn5},0)+coalesce(${NutriStaFem},0)+coalesce(${ScrenRecord},0)+coalesce(${FeverPerInt},0)+coalesce(${CoughSinceW},0)+coalesce(${DiarSincOft},0)+coalesce(${GenImpressn},0)+coalesce(${RespiRateCo},0)+coalesce(${TempMeasure},0)+coalesce(${SkinPinchCh},0)"}}]}, {"name": "FamPlanning", "label": "Section 7 Family Planning", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "QualStaffFP", "label": "1. At least one qualified staff trained in Family Planning\n (check certificate: original or photocopy certified by the LGA)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "ConfConsulR", "label": "2. Confidentiality in consultation room assured", "hint": "Room with closed doors, curtains at windows or non transparent glass", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "FPMethodVis", "label": "3. Family planning methods available and visible in demonstration box for potential users", "hint": "Condoms; OCP; Injectable; Implant; IUD; are available in the demonstration box (all five items) \nPenis model available on the desk; box with condoms available with at the least 50 condoms", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "NumCliOralC", "label": "4. Can staff correctly calculates number of clients expected monthly for oral and injectable contraceptives?", "hint": "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": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "BizPlaFPStr", "label": "5. Does business plan contain strategy to achieve FP targets?", "hint": "Collaboration with public sector, private sector and social marketing, mobile strategies, advocacy among local leaders etc. (explicit mention in the BP)\nInvolvement of HF staff in strategies (explicit mention of this in the BP)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "3", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "StockInjCon", "label": "6. Is security stock of oral and injectable contraceptives adequate?", "hint": "For example for 10.0000 pop (direct catchment population of the OPD) 84 doses of oral (3 month cycles) and injectable methods combined. Total number of women of child bearing age (15 - 49) - 22.5% times unmet need 25% divided by 12 (months) times 2 months (min supply) => result 84 doses). Note that each dose is for 3 months", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "IUDAvailUse", "label": "7. Is IUD available and are staff trained to use it?", "hint": "At least five IUDs and at the least one staff trained to use it (check certificate original or photocopy certified by the LGA)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "3", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "ImpMethodAv", "label": "8. Is implant method available and staff trained to use it?", "hint": "At least five implants available and staff trained to use it (check certificate original or photcopy certified by the LGA)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "3", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "StraAvailTP", "label": "9. Are Strategies available for transfer of persons to hospital seeking permanent FP methods?", "hint": "Referral system worked out - strategy to reduce prices; mobile strategy for surgery?", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "FPIcardAval", "label": "10. FP individual cards available and filled according to the format", "hint": "Check at least five cards for BP, hepatomegaly, varicose veins, weight (all cards; all elements checked)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "FamPlanScor", "label": "Family planning score", "type": "calculate", "bind": {"calculate": "coalesce(${QualStaffFP},0)+coalesce(${ConfConsulR},0)+coalesce(${FPMethodVis},0)+coalesce(${NumCliOralC},0)+coalesce(${BizPlaFPStr},0)+coalesce(${StockInjCon},0)+coalesce(${IUDAvailUse},0)+coalesce(${ImpMethodAv},0)+coalesce(${StraAvailTP},0)+coalesce(${FPIcardAval},0)"}}]}, {"name": "Laboratory0", "label": "Section 8 Laboratory", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "MedLabTecAv", "label": "1. Medical Laboratory technician available", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "LabOpen7Day", "label": "2. 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": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "LabExamVisi", "label": "3. List of laboratory examinations visible for the public with fees", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "MatchResult", "label": "4. Are results recorded correctly in laboratory register and do they match with results in inpatient sheets or OPD examination cards?", "hint": "Supervisor verifies last five results", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "3", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "ParasitDemo", "label": "5. 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": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "FuncMicrosc", "label": "6. 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": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "MalariaRapT", "label": "7. 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": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "CentFuncAvl", "label": "8. Centrifuge available and functional", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "WasteEvacua", "label": "9. Is 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": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "PersWashPip", "label": "10. Personnel adequately washes dirty pipettes in containers with antiseptic if pipettes are not disposable", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "LabEquipPTB", "label": "11. 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": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "LaboraScore", "label": "Laboratory total", "type": "calculate", "bind": {"calculate": "coalesce(${MedLabTecAv},0)+coalesce(${LabOpen7Day},0)+coalesce(${LabExamVisi},0)+coalesce(${MatchResult},0)+coalesce(${ParasitDemo},0)+coalesce(${FuncMicrosc},0)+coalesce(${MalariaRapT},0)+coalesce(${CentFuncAvl},0)+coalesce(${WasteEvacua},0)+coalesce(${PersWashPip},0)+coalesce(${LabEquipPTB},0)"}}]}, {"name": "InPatWards0", "label": "Section 9 In-patient Wards", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "GuardDutRos", "label": "1. Guard duty roster clearly visible for staff and followed up", "hint": "Supervisor verifies guard duty's report - names and signatures match", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "0.5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "FurnitAvail", "label": "2. 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": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "PatComfHygi", "label": "9.1 Patient comfort and hygiene", "type": "group", "bind": {"required": "TRUE"}, "control": {"appearance": "field-list"}, "children": [{"name": "TCleanWards", "label": "3. The wards are clean: no debris on the floor; and wards smell of disinfectant AND OR proof of use of bleach for cleaning the wards (around 12% hypoclorite)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "0.5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "BedSpaceMet", "label": "4. Space between the beds is at the least one meter", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "0.25", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "DrinkiWater", "label": "5. Each ward has access to drinking water", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "0.25", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "RunWaterCle", "label": "6. Each ward has running water or water dispenser with water, soap and a clean towel", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}]}, {"name": "WardLightAv", "label": "7. Light available in each ward", "hint": "Electricity; solar light or rechargeable battery lamp", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "0.5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "Confidentia", "label": "8. 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": "0.5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "InPatRegist", "label": "9. In patient register available and is well maintained", "hint": "check identity and hospital bed days", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "0.5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "RecFormHosp", "label": "10. Recording forms for hospitalizations available and well filled and well stored", "hint": "At least 10 blanks; supervisor verifies 5 filled forms\nWeight, temperature, and eventual laboratory exams recorded\t\t\t\nTreatment monitoring checked", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "InPatScore0", "label": "In patient total", "type": "calculate", "bind": {"calculate": "coalesce(${TCleanWards},0)+coalesce(${BedSpaceMet},0)+coalesce(${DrinkiWater},0)+coalesce(${RunWaterCle},0)+coalesce(${GuardDutRos},0)+coalesce(${FurnitAvail},0)+coalesce(${WardLightAv},0)+coalesce(${Confidentia},0)+coalesce(${InPatRegist},0)+coalesce(${RecFormHosp},0)"}}]}, {"name": "EsseDrugMan", "label": "Section 10 Essential Drugs Management/Pharmacy", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "PharTecAval", "label": "1. The Pharmacy Technician is available", "type": "select one", "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "StafStockED", "label": "2. Does staff maintain 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 essential drugs", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "3", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "HFPurDrugPh", "label": "3. 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": "3", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "PharDelivHF", "label": "4. 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": "10", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "DrugsStored", "label": "5. 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": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "AbsExpDrugs", "label": "6. 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": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "EssDrugScor", "label": "Essential drug score", "type": "calculate", "bind": {"calculate": "coalesce(${PharTecAval},0)+coalesce(${StafStockED},0)+coalesce(${HFPurDrugPh},0)+coalesce(${PharDelivHF},0)+coalesce(${DrugsStored},0)+coalesce(${AbsExpDrugs},0)"}}]}, {"name": "TracerDrugs", "label": "Section 11 Tracer Drugs", "hint": "min. stock = Monthly Av. Consumption times 2- Minimum stock is two months average consumption", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "Paracetamol", "label": "1. Paracetamol 500 mg tab", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "IbuprofenCp", "label": "2. Ibuprofen 200 mg caps", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "0.5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "Chlorphen2m", "label": "3. Chlorpheniramine 2 mg", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "Oxytocin10m", "label": "4. Oxytocin 10IU/ml vial", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "Mebendazole", "label": "5. Mebendazole 100 mg tab", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "FerrousSulf", "label": "6. Ferrous Sulfate 325 mg tab", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "Amoxicil500", "label": "7. Amoxicillin 500 mg caps", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "Amoxicil125", "label": "8. Amoxicillin 125 mg/5ml suspension", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "0.5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "Cotrimox480", "label": "9. Co-trimoxazol 480 mg tab", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "Cotrimox40m", "label": "10. Co-trimoxazol 40mg/200mg - 5ml susp", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "0.5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "Doxycycl100", "label": "11. Doxycycline 100 mg caps", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "Erythrom250", "label": "12. Erythromycin 250 mg tab", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "Coartemet20", "label": "13. Co-artemeter 20/120 mg tab (1; 2 3 and 4)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "Sulfadoxine", "label": "14. Sulfadoxine/pyrimethamine 500 mg tab", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "ZincORSsach", "label": "15. Zinc-ORS sachet", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "CondomInPat", "label": "16. Condom", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "0.5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "Metronid200", "label": "17. Metronidazol 200 mg tab", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "Sterileglov", "label": "18. Sterile gloves", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "Venflon18G1", "label": "19. Venflon 18G or 22G", "hint": "Min stock = 10; MAC applies only when higher than 10", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "0.5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "ChlohexiGel", "label": "20. Chlohexidine Gel", "hint": "Min stock = 10; MAC applies only when higher than 10", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "0.5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "IVGivingSet", "label": "21. IV giving set", "hint": "Min stock = 10; MAC applies only when higher than 10", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "0.5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "RingersLact", "label": "22. Ringers lactate 500 ml", "hint": "Min stock = 5L; MAC applies only when higher than 5L", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "0.5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "Dextrose500", "label": "23. Dextrose 5% 500 ml", "hint": "Min stock = 5L; MAC applies only when higher than 5L", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "0.5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "Syringee5ml", "label": "24. Syringe 5ml", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "0.5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "Syringe10ml", "label": "25. Syringe 10ml", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "0.5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "ScalpVeinNd", "label": "26. Scalp vein needle", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "0.5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "EsseDrugCal", "label": "Calculate essential drug", "type": "calculate", "bind": {"calculate": "coalesce(${Paracetamol},0)+coalesce(${IbuprofenCp},0)+coalesce(${Chlorphen2m},0)+coalesce(${Oxytocin10m},0)+coalesce(${Mebendazole},0)+coalesce(${FerrousSulf},0)+coalesce(${Amoxicil500},0)+coalesce(${Amoxicil125},0)+coalesce(${Cotrimox480},0)+coalesce(${Cotrimox40m},0)+coalesce(${Doxycycl100},0)+coalesce(${Erythrom250},0)+coalesce(${Coartemet20},0)+coalesce(${Sulfadoxine},0)+coalesce(${ZincORSsach},0)+coalesce(${CondomInPat},0)+coalesce(${Metronid200},0)+coalesce(${Sterileglov},0)+coalesce(${Venflon18G1},0)+coalesce(${ChlohexiGel},0)+coalesce(${IVGivingSet},0)+coalesce(${RingersLact},0)+coalesce(${Dextrose500},0)+coalesce(${Syringee5ml},0)+coalesce(${Syringe10ml},0)+coalesce(${ScalpVeinNd},0)"}}]}, {"name": "Maternity00", "label": "Section 12 Maternity", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "SuffH20Soap", "label": "1. 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": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "LiteDeliv24", "label": "2. Light in delivery room 24 hours", "hint": "Electricity, solar light or rechargeable battery lamp", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "WasteMatern", "label": "3. Waste from Maternity correctly handled", "hint": "Bin with lid and lining and safe needle disposal container, specific for the maternity room use only", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "DelivRoomMn", "label": "4. 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": "5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "AvailPartog", "label": "5. 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": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "DelivPerson", "label": "6. Deliveries performed by skilled personnel", "hint": "Identification of the skilled provider from names in the register", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "AvailScaleW", "label": "12.1 Availability of scales for weight/length, an obstetrical stethoscope and an aspirator", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "TapeMeasLen", "label": "7. Tape to measure length", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "ScaleMeasWe", "label": "8. Scale to measure weight (check functionality)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "AspDisinfet", "label": "9. Aspirator plunged into a non-irritating disinfectant or functional manual/electric aspirator", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}]}, {"name": "SterilGlove", "label": "10. Availability of at the least 10 pairs of sterile gloves", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "SterilObsBx", "label": "11. 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": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "EpisiotoBox", "label": "12. 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": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "DelivrTable", "label": "13. 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": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "EquipNwborn", "label": "14. 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": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "AdeqInPatRm", "label": "15. 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": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "MaternitCal", "label": "Calculate Maternity", "type": "calculate", "bind": {"calculate": "coalesce(${SuffH20Soap},0)+coalesce(${LiteDeliv24},0)+coalesce(${WasteMatern},0)+coalesce(${DelivRoomMn},0)+coalesce(${AvailPartog},0)+coalesce(${DelivPerson},0)+coalesce(${TapeMeasLen},0)+coalesce(${ScaleMeasWe},0)+coalesce(${AspDisinfet},0)+coalesce(${SterilGlove},0)+coalesce(${SterilObsBx},0)+coalesce(${EpisiotoBox},0)+coalesce(${DelivrTable},0)+coalesce(${EquipNwborn},0)+coalesce(${AdeqInPatRm},0)"}}]}, {"name": "EpiPreSchCo", "label": "Section 13 EPI and pre-school consultation", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "CorTargVacc", "label": "1. Does personnel calculates correctly target for fully vaccinated children?", "hint": "Target = population * 4% / 12 : asked from any medical personnel dealing with care for clients\nThe target population concerns the ward population (or the defined catchment pop in case ward has more PBF primary contract holders)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "EpiiFridgee", "label": "2. Is there an EPI fridge", "hint": "Presence of a fridge - temp form available, filled twice a day including the day of the visit \nTemperature remains between 2 and 8C in register sheet \nSupervisor verifies functionality of thermometer \nTemperature between 2 and 8C also according to the thermometer", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "4", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "ChemTempInd", "label": "3. Chemical Temperature Indicator", "hint": "Presence of a chemical temperature indicator (this is a specific piece of paper different from the thermometer) which shows temperature acc to the norms", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "AppStoreVac", "label": "4. Appropriate storage of vaccines", "hint": "Freezing compartment: Measles \nNon-freezing compartment: BCG, Penta + HepB, TT, thinners \nAbsence of vaccines which are expired \nReadable labels on all vaccines", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "AppStockVac", "label": "5. Appropriate stock of vaccines", "hint": "BCG, Penta, Polio, Yellow Fever, HBV, Measles, Tetanus, Hib, IPV, Vit A \nPresence of stock control cards for all vaccines; concordance paper and physical stock verified", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "ColdChainMa", "label": "6. Cold Chain maintenance", "hint": "If kerosene fridge: stock of at the least 14L Kerosene; if solar fridge: battery not damaged", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "Coldpackfrn", "label": "7. Cold packs are well frozen", "hint": "At the least 5", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "SyingeAvail", "label": "8. Syringes available", "hint": "Auto-blocking at least 30; for dilution - at least 3", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "Wastecolect", "label": "9. Waste collection availability of safe disposal box", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "StocU5Avail", "label": "10. Stock of U5 growth cards available", "hint": "At the least 10", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "ChildImmReg", "label": "11. Child immunization register well maintained & Monthly monitoring chart well filled and updated", "hint": "System is capable of identifying drop outs and Fully Vaccinated Children", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "GudWaitarea", "label": "12. Conditions in waiting area for immunization services", "hint": "Sufficient benches and or chairs, protected against sun and rain", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "NumbPatient", "label": "13. Patients receive numbered waiting buttons according to their arrival", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "BabyWeighSc", "label": "14. Baby weighing scale available and in working condition", "hint": "Balance calibrated to zero + pants available, clean and in good condition", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "GrupIEC_BCC", "label": "15. Group IEC/BCC", "hint": "Group meeting held before vaccinations (check the schedule of health education sessions) \nExistence of updated IEC report with (a) topic, (b) number of participants, \u00a9 leader of activity, (d) date and (e) signature", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "RecoDropOut", "label": "16. Existence of a system to recover drop-outs", "hint": "Schedule, record of appointments, well arranged invidual charts", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "EpiPreSchCi", "label": "EPI/Pre school total", "type": "calculate", "bind": {"calculate": "coalesce(${CorTargVacc},0)+coalesce(${EpiiFridgee},0)+coalesce(${ChemTempInd},0)+coalesce(${AppStoreVac},0)+coalesce(${AppStockVac},0)+coalesce(${ColdChainMa},0)+coalesce(${Coldpackfrn},0)+coalesce(${SyingeAvail},0)+coalesce(${Wastecolect},0)+coalesce(${StocU5Avail},0)+coalesce(${ChildImmReg},0)+coalesce(${GudWaitarea},0)+coalesce(${NumbPatient},0)+coalesce(${BabyWeighSc},0)+coalesce(${GrupIEC_BCC},0)+coalesce(${RecoDropOut},0)"}}]}, {"name": "AntenatCare", "label": "Section 14 Antenatal Care", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "BizPlansANC", "label": "1. Business plan contains convincing strategies to effectively conduct ANC for all pregnant women in catchment area", "hint": "Fixed strategy; and strategy for distant villages: catchment area covers entire ward or defined catchment population if multiple PBF primary contract holders", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "WeighScale0", "label": "2. Weighing scale present, functional and calibrated to zero", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "ANCFormHFAv", "label": "3. 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": "5", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "ANCFormAdmn", "label": "4. ANC form shows the administration of Ferrous Sulphate/Folic Acid and Mebendazole and SP (for the last five forms above)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "ANCCardsMom", "label": "5. ANC cards for mother available: at least 10 in stock", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "ANCRegister", "label": "6. 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": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "ANCCondPers", "label": "7. ANC conducted by qualified personnel", "hint": "Nurse; midwife, verified on ANC cards", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "GrpIECBCC00", "label": "8. 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": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "AntenatScor", "label": "Antenatal score", "type": "calculate", "bind": {"calculate": "coalesce(${BizPlansANC},0)+coalesce(${WeighScale0},0)+coalesce(${ANCFormHFAv},0)+coalesce(${ANCFormAdmn},0)+coalesce(${ANCCardsMom},0)+coalesce(${ANCRegister},0)+coalesce(${ANCCondPers},0)+coalesce(${GrpIECBCC00},0)"}}]}, {"name": "HIVTBGroup0", "label": "Section 15 HIV/TB", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "HIVCounslRm", "label": "1. 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": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "HIVTreatICC", "label": "2. Availability of IEC/BCC materials related to HIV treatment and prevention", "hint": "Penis model on the table\t\t\t\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": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "VCTCounsReg", "label": "3. Existence of a VCT/PMTCT counseling register and lab register according to the norms", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "StaffCounsl", "label": "4. Staff trained in counseling (certificate original or certified by LGA)", "hint": "At the least one staff trained as a counselor\t\t\t\nAll counseling done by a trained counselor (check certifcicate)", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "RefSysHIVPt", "label": "5. Referral system and follow up for HIV clients", "hint": "Individual client cards available; planning for CD4 cell counts", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "RefSysTBPat", "label": "6. 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": "2", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "AntTuberDrg", "label": "7. Availability of anti-tuberculosis drugs", "hint": "Rifampicin-isoniazid-pyrazinamide : cp120+50+300mg\nEtambutol tabs 400 mg", "type": "select one", "bind": {"required": "TRUE"}, "children": [{"name": "1", "label": "Yes"}, {"name": "0", "label": "No"}]}, {"name": "HIVTBScore0", "label": "HIV/TB score", "type": "calculate", "bind": {"calculate": "coalesce(${HIVCounslRm},0)+coalesce(${HIVTreatICC},0)+coalesce(${VCTCounsReg},0)+coalesce(${StaffCounsl},0)+coalesce(${RefSysHIVPt},0)+coalesce(${RefSysTBPat},0)+coalesce(${AntTuberDrg},0)"}}]}, {"name": "GrandSummat", "label": "Calculate Grand summary", "type": "calculate", "bind": {"calculate": "coalesce(${GroupGenera},0)+coalesce(${BizPlanScor},0)+coalesce(${FinanGrpsco},0)+coalesce(${IndiComScor},0)+coalesce(${HygMedWasCl},0)+coalesce(${ConsulScore},0)+coalesce(${FamPlanScor},0)+coalesce(${LaboraScore},0)+coalesce(${InPatScore0},0)+coalesce(${EssDrugScor},0)+coalesce(${EsseDrugCal},0)+coalesce(${MaternitCal},0)+coalesce(${EpiPreSchCi},0)+coalesce(${AntenatScor},0)+coalesce(${HIVTBScore0},0)"}}, {"name": "GranPercent", "label": "Total Grand Percent", "type": "calculate", "bind": {"calculate": "round((${GrandSummat} div 345 * 100),2)"}}, {"name": "CashReceipt", "label": "Section 16 Cash Receipts for Quarter", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "CostRecover", "label": "1. Cost recovery (User-charges exclude drugs)", "type": "integer", "bind": {"constraint": ".>=0", "required": "TRUE", "jr:constraintMsg": "Enter a positive integer"}, "control": {"appearance": "w2"}}, {"name": "DrugRevenue", "label": "2. Drug revenues", "type": "integer", "bind": {"constraint": ".>=0", "required": "TRUE", "jr:constraintMsg": "Enter a positive integer"}, "control": {"appearance": "w2"}}, {"name": "CostRecPreP", "label": "3. Cost recovery (pre-payments)", "type": "integer", "bind": {"constraint": ".>=0", "required": "TRUE", "jr:constraintMsg": "Enter a positive integer"}, "control": {"appearance": "w2"}}, {"name": "SalarieGovt", "label": "4. Salaries from Government and other sources", "type": "integer", "bind": {"constraint": ".>=0", "required": "TRUE", "jr:constraintMsg": "Enter a positive integer"}, "control": {"appearance": "w2"}}, {"name": "PBFSubsidy0", "label": "5. PBF subsidies from fund holders", "type": "integer", "bind": {"constraint": ".>=0", "required": "TRUE", "jr:constraintMsg": "Enter a positive integer"}, "control": {"appearance": "w2"}}, {"name": "ContribOthr", "label": "6. Contributions from other sources", "type": "integer", "bind": {"constraint": ".>=0", "required": "TRUE", "jr:constraintMsg": "Enter a positive integer"}, "control": {"appearance": "w2"}}, {"name": "OtherReceip", "label": "7. Other", "type": "integer", "bind": {"constraint": ".>=0", "required": "TRUE", "jr:constraintMsg": "Enter a positive integer"}, "control": {"appearance": "w2"}}, {"name": "TotalFinanc", "label": "Finance score", "type": "calculate", "bind": {"calculate": "${CostRecover} + ${DrugRevenue} + ${CostRecPreP} + ${SalarieGovt} + ${PBFSubsidy0} + ${ContribOthr} + ${OtherReceip}"}}]}, {"name": "ExpenQuartr", "label": "Section 17 Expenditure by Component for Quarter", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "SalariesExp", "label": "1. Salaries", "type": "integer", "bind": {"constraint": ".>=0", "required": "TRUE", "jr:constraintMsg": "Enter a positive integer"}, "control": {"appearance": "w2"}}, {"name": "PerfBonusee", "label": "2. Performance bonuses", "type": "integer", "bind": {"constraint": ".>=0", "required": "TRUE", "jr:constraintMsg": "Enter a positive integer"}, "control": {"appearance": "w2"}}, {"name": "DrugMedCons", "label": "3. Drugs and medical consumables", "type": "integer", "bind": {"constraint": ".>=0", "required": "TRUE", "jr:constraintMsg": "Enter a positive integer"}, "control": {"appearance": "w2"}}, {"name": "SubsContrac", "label": "4. Subsidies for sub-contractors", "type": "integer", "bind": {"constraint": ".>=0", "required": "TRUE", "jr:constraintMsg": "Enter a positive integer"}, "control": {"appearance": "w2"}}, {"name": "CleanCosts0", "label": "5. Cleaning and office costs", "type": "integer", "bind": {"constraint": ".>=0", "required": "TRUE", "jr:constraintMsg": "Enter a positive integer"}, "control": {"appearance": "w2"}}, {"name": "TranspCosts", "label": "6. Transport costs", "type": "integer", "bind": {"constraint": ".>=0", "required": "TRUE", "jr:constraintMsg": "Enter a positive integer"}, "control": {"appearance": "w2"}}, {"name": "SocialMarkt", "label": "7. Social marketing", "type": "integer", "bind": {"constraint": ".>=0", "required": "TRUE", "jr:constraintMsg": "Enter a positive integer"}, "control": {"appearance": "w2"}}, {"name": "InfrasRehab", "label": "8. Infrastructural rehabilitation", "type": "integer", "bind": {"constraint": ".>=0", "required": "TRUE", "jr:constraintMsg": "Enter a positive integer"}, "control": {"appearance": "w2"}}, {"name": "EquipFurnit", "label": "9. Equipment and furniture", "type": "integer", "bind": {"constraint": ".>=0", "required": "TRUE", "jr:constraintMsg": "Enter a positive integer"}, "control": {"appearance": "w2"}}, {"name": "CostIndigen", "label": "10. Costs for indigent patients", "type": "integer", "bind": {"constraint": ".>=0", "required": "TRUE", "jr:constraintMsg": "Enter a positive integer"}, "control": {"appearance": "w2"}}, {"name": "OtherExpens", "label": "11. Other (trainings, etc)", "type": "integer", "bind": {"constraint": ".>=0", "required": "TRUE", "jr:constraintMsg": "Enter a positive integer"}, "control": {"appearance": "w2"}}, {"name": "TotalExpens", "label": "Total expenses", "type": "calculate", "bind": {"calculate": "${SalariesExp} + ${PerfBonusee} + ${DrugMedCons} + ${SubsContrac} + ${CleanCosts0} + ${TranspCosts} + ${SocialMarkt} + ${InfrasRehab} + ${EquipFurnit} + ${CostIndigen} + ${OtherExpens}"}}, {"name": "NetChngCash", "label": "Total net change cash", "type": "calculate", "bind": {"calculate": "${TotalFinanc} - ${TotalExpens}"}}]}, {"name": "OpenCashBal", "label": "Section 18 Opening Cash Balances for Quarter", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "BankBalOpsQ", "label": "1. Bank balance at the beginning of the quarter (Operations bank account)", "type": "integer", "bind": {"constraint": ".>=0", "jr:constraintMsg": "Enter a positive integer"}}, {"name": "BankBalDrug", "label": "2. Bank balance at the beginning of the quarter (Operations Drugs bank account)", "type": "integer", "bind": {"constraint": ".>=0", "jr:constraintMsg": "Enter a positive integer"}}, {"name": "CashHandQtr", "label": "3. Cash at hand at the beginning of the quarter", "type": "integer", "bind": {"constraint": ".>=0", "jr:constraintMsg": "Enter a positive integer"}}, {"name": "NetCashAvai", "label": "Total net cash available", "type": "calculate", "bind": {"calculate": "${BankBalOpsQ} + ${BankBalDrug} + ${CashHandQtr} + ${NetChngCash}"}}]}, {"name": "ClosCashBal", "label": "Section 19 Closing Cash Balances for Quarter", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "BankBalEndO", "label": "1. Bank balance at the end of the quarter (operation bank account)", "type": "integer", "bind": {"constraint": ".>=0", "jr:constraintMsg": "Enter a positive integer"}}, {"name": "BankBalEndD", "label": "2. Bank balance at the end of the quarter (drugs bank account)", "type": "integer", "bind": {"constraint": ".>=0", "jr:constraintMsg": "Enter a positive integer"}}, {"name": "CashHandEnd", "label": "3. Cash at hand at the end of the quarter", "type": "integer", "bind": {"constraint": ".>=0", "jr:constraintMsg": "Enter a positive integer"}}, {"name": "TotCashBalE", "label": "Total cash balance", "type": "calculate", "bind": {"calculate": "${BankBalEndO} + ${BankBalEndD} + ${CashHandEnd}"}}]}, {"name": "SumFinancia", "label": "Section 20 Summary of Financials", "type": "group", "control": {"appearance": "field-list"}, "children": [{"name": "TotFinanNot", "label": "1. Total Financing (A) is: \u20a6${TotalFinanc}", "type": "note", "control": {"appearance": "w1"}}, {"name": "TotExpenNot", "label": "2. Total Expenditure (B) is: \u20a6${TotalExpens}", "type": "note", "control": {"appearance": "w1"}}, {"name": "NetChngNote", "label": "3. Net Change in Cash (C = A - B) is: \u20a6${NetChngCash}", "type": "note", "control": {"appearance": "w1"}}, {"name": "NetCashNote", "label": "4. Net Cash Available (D) is: \u20a6${NetCashAvai}", "type": "note", "control": {"appearance": "w1"}}, {"name": "TotCashNote", "label": "5. Total closing Cash Balance (E) is: \u20a6${TotCashBalE}", "hint": "Note: E must equal D", "type": "note", "control": {"appearance": "w1"}}]}, {"name": "FormSummary", "label": "Section 21 **Summary**", "type": "hidden"}, {"name": "GenManageSc", "label": "1. General Management = ${GroupGenera}", "type": "hidden", "control": {"appearance": "w2"}}, {"name": "BizPlanScoe", "label": "2. Business Plan = ${BizPlanScor}", "type": "hidden", "control": {"appearance": "w2"}}, {"name": "FinanceScor", "label": "3. Finance = ${FinanGrpsco}", "type": "hidden", "control": {"appearance": "w2"}}, {"name": "IndigenScor", "label": "4. Indigent Committee = ${IndiComScor}", "type": "hidden", "control": {"appearance": "w2"}}, {"name": "HygieneScor", "label": "5. Hygiene = ${HygMedWasCl}", "type": "hidden", "control": {"appearance": "w2"}}, {"name": "ConsulScord", "label": "6. OPD = ${ConsulScore}", "type": "hidden", "control": {"appearance": "w2"}}, {"name": "FamPlanScod", "label": "7. Family Planning = ${FamPlanScor}", "type": "hidden", "control": {"appearance": "w2"}}, {"name": "LaboraScorr", "label": "8. Laboratory = ${LaboraScore}", "type": "hidden", "control": {"appearance": "w2"}}, {"name": "InPatScored", "label": "9. Inpatient Wards = ${InPatScore0}", "type": "hidden", "control": {"appearance": "w2"}}, {"name": "EssenDrugSc", "label": "10. Essential Drugs Management = ${EssDrugScor}", "type": "hidden", "control": {"appearance": "w2"}}, {"name": "TraceDrugSc", "label": "11. Tracer Drugs = ${EsseDrugCal}", "type": "hidden", "control": {"appearance": "w2"}}, {"name": "MaternitySc", "label": "12. Maternity = ${MaternitCal}", "type": "hidden", "control": {"appearance": "w2"}}, {"name": "EPIConsScor", "label": "13. EPI = ${EpiPreSchCi}", "type": "hidden", "control": {"appearance": "w2"}}, {"name": "AntenatScoe", "label": "14. ANC = ${AntenatScor}", "type": "hidden", "control": {"appearance": "w2"}}, {"name": "HIVTubeScor", "label": "15. HIV/TB = ${HIVTBScore0}", "type": "hidden", "control": {"appearance": "w2"}}, {"name": "GrandTotalF", "label": "16. **Grand Total = ${GrandSummat} out of a Maximum 345 points**", "type": "hidden", "control": {"appearance": "w2"}}, {"name": "GrandPerNot", "label": "17.**Percentage score for HF is: ${GranPercent}%**", "type": "hidden", "control": {"appearance": "w2"}}, {"name": "meta", "type": "group", "control": {"bodyless": true}, "children": [{"name": "instanceID", "type": "calculate", "bind": {"readonly": "true()", "calculate": "concat('uuid:', uuid())"}}, {"name": "instanceName", "type": "calculate", "bind": {"calculate": "concat(${start000000},' ',${time_started},'_','ISS_TEF','_',jr:choice-name(${FacilitName},'${FacilitName}'), '_', jr:choice-name(${StateName00},'${StateName00}'))"}}]}]}