District Health Office Performance Evaluation Checklist

District Health Office Performance Evaluation Checklist

Draft 091118

No / Indicator/Performance Measure / Primary/Secondary Data Sources / Composite Criteria/Validation Criteria / Weight
1 / 50% of Health Centers have been supervised at least once per quarter / Supervision Report
Travel Request Form Signed /
  • Supervision Report Exists
  • At least 50% of all Health Centers have been supervised during the past quarter, and these do not include those Health Centers which have been supervised in the quarter preceding the evaluated quarter
  • These supervisory visits are the formative visits and are not the same as the Quantity or Quality Audit visits
If one or both criteria not met: 0 points / 15
2 / At least three Monthly Meetings with Health Center staff during the past quarter / Meeting Minutes
Participants List
Travel Request Forms Signed / Each of the three meeting reports need to have the following criteria:
  • Date and time indicated
  • Agenda available
  • Signed Participants list available
  • Discussion on the contents of the past month’s HC monthly reports using the Printed Monthly HC reports (from the HMIS database
  • Follow up of recommendations and tasks from previous meeting
  • Actionpoints listed with tasks attributed
If one or more criteria are lacking: 0 points / 20
3 / At least one half hour training on one specific topic, during the monthly HC staff meetings / Meeting Minutes
Participants List
Travel Request Forms Signed / In the meeting minutes, a description of the topic as follows:
  • Objective of the training
  • Short Description of the session, referring to the available national protocol
If above criteria are not met: 0 points / 5
4 / Monthly HCHMIS report entered in the HMIS database and Report Printed / Printed HCHMIS Monthly Cumulative Report
Data available in the HMIS DB
Monthly HCHMIS reports (original) /
  • Printed Monthly HCHMIS Report Available and Filed in a Specific File
  • Original Monthly HCHMIS Reports Available and Filed in the Specific HC Files
  • All HCHMIS Reports for all HCs in the district available
If one or more criteria not met: 0 points / 5
5 / Activity Calendar for the Month is Available / The Activity Calendar /
  • Monthly Activity Plan is available accordingto set format
  • Activity Calendar for the Current Month is visible on the wall of the District Health Office
If one or both criteria not met: 0 points / 5
6 / Participation in the Quarterly District RBF Steering Committee Meetings / District RBF Steering Committee Meeting Minutes
Participants List /
  • Three Printed Monthly District HMIS Cumulative Reports have been presented and discussed and or validated in the District RBF Steering Committee meeting.
  • Eventual changes suggested to the HMIS reports (missing data, data entry errors etc) are documented in the meeting minutes.
  • Meeting was held subject to the legal quorum defined in the District RBF Steering Committee agreement.
If one or both criteria are not met: 0 points / 10
7 / Management of the District Pharmacy / [list objectively verifiable primary tools used in Zambia at this level] /
  • Criterion 1
  • Criterion 2
  • Criterion 3
  • Etc
If any of the above criteria have not been met: 0 points / 40
8 / Organize quarterly HC RBFQuantity audits / Monthly Activity Calendar
RBF Audit Report
Travel Request Forms Signed /
  • 100% of all HC have had their three monthly RBF report- data audited during the past quarter
If one or both of the criteria not met: 0 points / 15
9 / Quarterly Quality Performance Evaluation of the HMOs done / HC Quality Performance Checklists
Travel Request Forms Signed /
  • All HC Quality performances for the past quarter evaluated before the end of the fourth month, using the designated Quality Checklists
  • Correct use of the HC Quality Performance Evaluation Form (all items filled) including the recommendation section
  • All HC performance evaluation forms correctly filed in a specific folder.
If one or more of the above criteria are not met: 0 points / 35
(Maximum XXX Points ) Grand Total

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