Ministries of Public Health & Sanitation, And Medical Services

Facilitative Supervision Tool for Reproductive Health Services

(For National and Provincial Levels)

PART A: FACILITY DATA

Date of visit: ………………Province: …………………District: ………………….…

Facility Name……………………………. Facility level/ Type ……………………………

Managing Authority: GOK/ Faith based /NGO / Private /Other

Contact person: …………………………..Designation: ………………………...

Telephone no.: ……………………………Email: ……………………………….

SUPERVISORY TEAM

No / Name / Title

Level of Supervision: National ……………………. Provincial ………………….

PART B: ADMINISTRATION

Facility infrastructure and management / Comments
Make observations and comments on the general appearance of the facility,
  • Infrastructure: (water, state of buildings, energy source)
  • Sanitation (cleanliness and waste disposal, toilets)

Is the service charter displayed?
Are there sign posts advertising Reproductive health services?
Is there a functional referral system (Communication, telephone, transport and radio system)
Is there an organogram in place
Is there a functional RH training and supervision team?
Comment on reporting issues (completeness, accuracy, rate, timeliness), and use of data for decision making
Which RH services do patients pay for and how much?
CADRE / Total / COMMENTS *
Doctors:
Clinical Officers:
Nurses:
Pharmacists/ Tech
PHTs/ PHOs
Nutritionists
Lab Technologist/ technicians
Lay counselors
HRIO/Tech.
Others

PART C:STAFFING PROFILE-

2: STAFF TRAINING:(Interview facility in-charge and fill in the responses/ comments in the relevant box regarding on staff training)

Questions / Yes/No / Comments
Does this facility conduct any CPD /CME on RH
Is any staff in this facility undergoing OJT (on-the-job training) on RH
Is anyone ready for certification?
What are the 3 priority training needs for staff in relation to RH

3: STAFF TRAINED IN RH:(Are there any staff in the facility trained in the following areas of RH?)

Comp RH / EOC / ENC / PAC / CTS / FP / ARH / FANC
MIP/ TB / D4D / Facilitative
Supervision / Post Rape/ Trauma / IMCI / VIA/
VILI
No of staff trained

EOC – Emergency Obstetric Care; PAC – Post + Abortion Care: CTS – Clinical Training Skills: FP – Family Planning; ARH – Adolescent Reproductive Health

FANC – Focused Antenatal Care: MIP – Malaria in Pregnancy: IMCI-integrated management of childhood illnesses; VIA/VILI – Visual inspection with acid /visual inspection with lugol’s iodine, D4D- data for decision making

CT / PMTCT / ART PAED / ART ADULT / IMAI / STI/
RTI / HBC / RH /HIV Integration -specify / RH commodity management / Other training courses
VCT / PITC
No of staff trained

* CT – Counseling and Testing, PMTCT – Prevention of Mother To Child Transmission, ART Paed – Antiretroviral Therapy (Pediatric) - , ART Adult – Antiretroviral Therapy (Adult), IMAI – Integrated Management of Adult Illnesses, STI/RTI – Sexually Transmitted Infections/ Reproductive Tract Infections, HBC – Home Based Care.

Comment on whether the staff are appropriately deployed

General observations and comments on staffing and training updates:

PART D:SERVICES OFFERED

1. FAMILY PLANNING

(Interview officer in charge of this service delivery point and confirm by observation where possible)

SERVICES / TICK AS APPROPRIATE / COMMENTS
Averageno of new cases per month
Averageno of revisits per month
  1. What family planning options are currently being provided in this facility?
/ Male condoms Female condoms
COCs POPs Injectables
IUCDs ECPsImplants
LAM Natural (specify)
TL VasectomyOthers
  1. Is dual method use promoted in this facility
/ YES NO
  1. In which other service areas/ units are FP counseling/commodities offered?
/ MCHPNC Female ward
CCC /ART centresVCTPACASRH
Others
  1. How does this unit promote male/ partnerinvolvement in FP services?
/ Give men priority
Group counselling for men
Special FP clinic days for men
Other, specify
  1. Observe and Comment on IP practices

  1. Check for availability and use of the following guidelines, posters and job aids
/ National FP guidelines for service providers 2005
FP Check lists (DMPA, IUCD, COC, PG)
MEC cycle /chart
FP choices chart
Syndromic management chart
IEC materials on HIV CT
Others- specify
  1. Check for the following records
(Comment if correctly filled and up to date) / Daily activity register
Monthly reporting form
Quarterly reporting form
Client card / mother baby health card
Referral form
Display of service statistics
  1. Comment on:
/ Supplies
Equipment

2. YOUTH FRIENDLY SERVICES (YFS):

(Interview officer in charge of this service delivery point and confirm by observation where possible)

SERVICES / TICK AS APPROPRIATE / COMMENTS
Average No of clients seen per month
  1. Does this facility offer comprehensive Youth friendly services?
/ Yes No
  1. Are these services integrated or stand alone?
/ Integrated Stand alone
  1. What services are provided for youths in this facility?
/ CT FPSTI/HIV FANC
PACPost-rape care Life Skills Training mental healthCCC/ ARTothers, specify
  1. Is there a functional referral system for the youth?
/ Yes No
  1. Check for availability and use of the following guidelines, posters and job aids
/ Guidelines for Youth friendly services
Syndromic management chart
FP choices chart
FP Checklists [COC,DMPA,PG, IUCD]
MEC chart /wheel
IEC Materials on HIVCT
  1. Check for the following records
(Comment if correctly filled and up to date) / Daily activity register
Monthly reporting form
Quarterly reporting form
Client card
Referral form
  1. Comment on:
/ Supplies
Equipment

3: ANTENATAL CARE (ANC):

(Interview officer in charge of this service delivery point and confirm by observation where possible)

SERVICE / TICK AS APPROPRIATE / COMMENTS
Averageno of 1st visit per month
Averageno of 4th visit per month
  1. Are the following routinely assessed during physical examination
/ BP
Fetal assessment
Pallor
others, specify
  1. What ANC services are routinely offered to clients?
2b. What linkages are available for support services to HIV positive mothers? / TB screening
Provision of SP for IPT
PMTCT
TT
ANC profile (VDRL, HB, Blood group and RH, Urinalysis, )
others, specify
  1. Are clients counseled on the following?
/ IBP
4 ANC visits
Danger signs
Maternal Nutrition
Labour
Infant feeding / breast health
FP
others, specify
  1. Observeand comment on infection prevention practices

  1. Check for and review the following records
(Comment if correctly filled and up to date) / Daily activity register
Monthly reporting form
Quarterly reporting form
Client card / mother baby health card
Referral form
  1. Check for availability and use of the following guidelines, posters and job aids
/ FANC/MIP/ TB orientation package
FANC job aid
MIP job aid
TBjob aid
IBP poster
TT schedule
Danger signs in pregnancy poster
National guidelines for quality Obstetrics and perinatal care
IEC Materials on HIV CT
FP Choices chart
  1. Comment on:
/ Supplies
Equipment

4: GENERAL MATERNITY INPATIENT SERVICES(Antenatal, labor and postnatal)

(Interview officer in charge of this service delivery point and confirm by observation where possible)

SERVICE / TICK AS APPROPRIATE / COMMENTS
Average no of deliveries per month
No of neonatal deaths in last 3 mo
No. maternal deaths in last 3 mo
Average no of C/ sections /mo
  1. Are maternity in patient services offered 24hrs a day
/ YES
NO
  1. Are the following services offered this maternity unit
/ Cesarean section
Manual removal of placenta
A Blood transfusion
Vacuum extraction
Parenteral antibiotics
Magnesium Sulphate injection
Parenteral oxytocics
Essential new born care
PMTCT
post partum FP
Others, specify
  1. What health messages are shared with your clients?
/ Danger signs for mother and baby
Maternal Nutrition
Malaria prevention
Infant Feeding
Infant Immunization
4 postpartum visits
FP
Other, specify
  1. What components of PMTCT are offered in the maternity?
/ HIV prevention education
HIV counseling & testing
ARV prophylaxis (mother & infant)
Referrals to other HIV services
FP
Others, specify
  1. Comment on the referral system:
/ Timeliness
Communication
Transport
Referral forms
Feedback
  1. Observe and comment on infection prevention practices in the maternity unit

  1. Check for the following records
(Comment if correctly filled and up to date) / Admission register
Delivery register
Monthly reporting form
Mother child booklet
Referral form
Birth Notification forms
Maternal Death Notification forms
  1. Check for availability and use of the following guidelines, posters and job aids
/ National guidelines for quality Obstetric and perinatal care
Mg sulphate job aid
AMTSL job aid
MIP job aid
TB job aid
FP choices chart
IEC Materials on HIV CT
Danger signs for mother and baby poster
Infant and young child feeding policy chart
Breastfeeding poster
Neonatal resuscitation chart
Infection prevention chart
PMTCT guidelines
POPPHI poster
Kangaroo mothercare
Others -specify
  1. Comment on:
/ Supplies
  1. Comment on:
/ Equipment

6: LABOUR WARD:(Interview officer in charge of this service delivery point and confirm by observation where possible)

SERVICE / TICK AS APPROPRIATE / COMMENTS
  1. Which of the following services are offered in the labor ward?
/ Partograph (available, in use, correctly filled- check)
AMTSL
Resuscitation of the newborn
Others
  1. What systems are in place to manage obstetric and newborn emergencies? (emergency tray , equipment, etc)

  1. Is the partograph available, in use, and well filled

  1. Comment on:
/ Supplies
  1. Comment on:
/ Equipment

7: POST PARTUM/NEWBORN CARE (POST NATAL WARD)

(Interview officer in charge of this service delivery point and confirm by observation where possible)

SERVICES / TICK AS APPROPRIATE / COMMENTS
  1. What assessment is offered routinely to the post partum mother?
/ Temp
BP
Pulse
Mood changes
Vaginal bleeding
Others, specify
  1. What immediate newborn care is provided in the maternity?
/ Check breathing
Keep baby warm
Breastfeeding
Hygiene and cord care
ARV prophylaxis for exposed newborn
Others, specify
  1. What common neonatal conditions/ complications are encountered in this facility
/ Asphyxia Jaundice Birth injuries
Low birth weight Prematurity
Ophthalmia NeonatorumSepsis
Others, specify
  1. Check for the following records
(Comment if correctly filled and up to date) / Postnatal register
Monthly reporting form
Mother and child health booklet
Referral form
  1. Comment on:
/ Supplies
  1. Comment on:
/ Equipment

8: POSTNATAL CLINIC/CHILD WELFARE CLINIC

(Interview officer(s) in charge of the concerned service delivery point(s) and confirm by observation where possible)

SERVICES / TICK AS APPROPRIATE / COMMENTS
  1. Does the facility offer targeted post partum care? YES / NO
/ Care of normal post partum mother from delivery to 6 weeks
Management of maternal complications
Family planning
Care of the new born
Screening forRT cancers
CT for HIV
  1. What common health conditions among infants have been managed in the past 3 months?
/ ARI MalariaMalnutrition
Diarrhea Local infections
Others, specify
  1. Comment on the linkage between the postnatal clinic and comprehensive care centers and community support for HIV positive mothers and their babies.

  1. Check for availability and use of the following guidelines, posters and job aids
/ FP choices chart
FP check lists (COC, DMPA, IUCD, PG, etc)
MEC wheel/ chart
Syndromic management chart
Breast feeding chart
IYCF policy chart
IEC materials forHIV CT
  1. Observe and comment on infection prevention practices

  1. Check for the following records
(Comment if correctly filled and up to date) / Daily activity register
Monthly reporting form
Quarterly reporting form
Client card / mother baby health card
Referral form
  1. Comment on:
/ Supplies
  1. Comment on:
/ Equipment

9: VOLUNTARY COUNSELLING AND TESTING (VCT) ROOM

(Interview officer in charge of this service delivery point and confirm by observation where possible)

SERVICES / TICK AS APPROPRIATE / COMMENTS
  1. What other HIV services are provided in this unit?
/ Individual counseling and testing
Couple counseling
Prevention for negatives
Prevention with Positives
Referral to HIV care and treatment
FP services
Others, specify
  1. What family planning options are provided in this unit?
/ Male condoms
Female condoms
COCs
POPs
Injectables
IUCDs
ECPs Implants
LAM Natural -specify
Other, specify
  1. Is dual method use promoted in this facility
/ YES NO
  1. Does the VCT have linkages to any of the following services?
/ CCC ANC PNC
CWC Maternity FP
TB clinicSTI clinic
Support groups
Youth friendly centers
Post Rape Care
Others, specify
  1. Check for availability and use of the following guidelines, posters and job aids
/ FP choices chart
Syndromic management chart
FP /VCT brochure
FP check lists[DMPA,COC,IUCD ,PG]
MEC-CHART/WHEEL
  1. Check for the following records
(Comment if correctly filled and up to date) / VCT register (capturing FP)
Monthly reporting form
Referral form
Other- specify
  1. Comment on:
/ Supplies
  1. Comment on:
/ Equipment

11: COMPREHENSIVE CARE CENTRE (CCC /ART) SERVICES

(Interview officer in charge of this service delivery point and confirm by observation where possible)

SERVICES / TICK AS APPROPRIATE / COMMENTS
  1. What RH services are provided for HIV positive clients?
/ Positive preventio education
Early infant diagnosis for exposed infants
FP
PRC
Cervical Cancer screening
STI/ RTI screening
Clinical breast examination (M/F)
Others, specify
  1. Specify all the units in this facility providing ARVs?
/ IPD MCH PNC
Maternity CWC
Other (specify) ………………
  1. What FP services are provided in this clinic
/ Counseling
Methods specify…….
  1. Comment on the linkages between this unit and other RH services for HIV positive mothers and their babies

  1. Comment on infection prevention practices

  1. Check for availability and use of the following guidelines, posters and job aids
/ FP choices chart
Syndromic management chart
FP check lists (COC, DMPA, IUCD, PG, etc)
MEC Chart/ wheel
IYCF policy chart
  1. Check for the following records
(Comment if correctly filled and up to date) / Daily activity register (capturing RH services)
Monthly reporting form
Client card
Referral form
  1. Comment on:
/ Supplies
  1. Comment on:
/ Equipment

12: COMMUNITY INVOLVEMENT AND PARTICIPATION

(Interview officer in charge of this service delivery point and confirm by observation where possible)

SERVICES / TICK AS APPROPRIATE / COMMENTS
  1. What RH services are provided at community level and by whom?

  1. What is being done to sensitize / mobilize the community and create demand for RH services?

  1. What community based referral system is in place(specify)

  1. Is community MDR in place?
(verbal autopsy)
  1. Check for availability and use of the following guidelines, posters and job aids
/ Community Strategy
Reproductive Health Community package
Family Planning Brochure
ANC Brochure
HBC/OVC/FP curriculum
FP Checklist (Pregnancy, COC - Kiswahili versions)

13. LABORATORY:

(Interview officer in charge of this service delivery point and confirm by observation where possible)

Are the following tests done in this laboratory? / COMMENTS
Urinalysis
HB
Blood group and RH
AFBs
HVS
HIV rapid tests
Syphilis test
Malaria rapid tests
DBS kits
Pregnancy test
Semen analysis
Observe and comment on infection prevention practices

14. RECOMMENDATIONS / WAY FORWARD

1