Annex E: CHW Performance Checklist

Household Monitoring Visit and Education Session Observation Checklist

Prevention of PPH Project

CHW/TBA Name: / Health Facility Name:
District Name: / Supervisor Name:
S.NO / AREAS OF SUPERVISION / YES / NO
Observe the CHW/TBA meeting with the pregnant woman and her family members. Does he/she:
1 / Greet the family and then introduce himself/herself
2 / Explain the purpose of meeting
3 / Mention the length of time the meeting might take
4 / Listen to them when they talk or ask questions
5 / Use the flipchart while providing education
6 / Place the flipchart in the appropriate way so the pictures are directed toward the pregnant women and the text to him/her
7 / First ask the woman “what do you see in the picture?” at the start of every message/page?
8 / Answer the woman’s questions
9 / Ask questions in a manner to encourage interaction (two-way communication)
10 / Ask questions at the end of each message to know if the woman has understood it
11 / Use easy-to-understand and local language
12 / Ask the woman to repeat the messages conveyed to her and help her to repeat the messages
13 / Thank the pregnant woman and family members
14 / Fix the time of the next appointment
15 / Say good bye to the woman and family members
Observe the interaction of the CHW/TBA with the pregnant woman and support person and note if he/she provides necessary information about:
17 / Antenatal care
18 / Danger signs of pregnancy and what to do if they appear
19 / Importance of nutrition for pregnant woman
20 / Importance of delivering at a health facility
21 / Collecting money for emergency incidents
22 / Importance of identifying blood donor, determining blood groups and HIV status
23 / Provide the messages according to the flipcharts
Observe the interaction of the CHW/TBA with the pregnant woman and support person and note if he/she provides necessary information about:
24 / PPH and why is it dangerous
25 / Different ways of PPH prevention
26 / Three tablets of misoprostol and how it reduces the chance of PPH
27 / Misoprostol could be dangerous if it is taken before the delivery of the baby
28 / Correct time of taking the tablets when a woman has twins
29 / Not taking the drug for antepartum hemorrhage
30 / A woman should take all three tablets immediately after the delivery of the baby and before the delivery of placenta but it can be taken even after delivery of the placenta
31 / Side effects of the medicine and how to cope with them
32 / Types of PPH that need to be referred
33 / Causes of PPH and what to do if a woman is still bleeding after she took Misoprostol
34 / Ask thepregnant woman if she is having twins and advise accordingly
35 / Give misoprostol tablets to the woman, and instruct her to keep them in a safe place where they will be available at the time of delivery
36 / Ask the woman to repeat the messages conveyed to her and help her to repeat the messages
Check the monitoring form. Interview or observe the CHW/TBA to see if he/she can fill the correct information in the appropriate box of the required field:
FIRST VISIT
37 / Write the name of the pregnant woman and her husband
38 / Use the appropriate row for the first visit in the form
39 / Ask the woman for the number of months she has had no menstrual bleeding and mark appropriate number of crescents
40 / Mark the appropriate box after she finishes education
SECOND VISIT (8th month of gestation)
41 / Use the appropriate row for the second visit in the form
42 / Ask the woman if she has a single pregnancy or twins and mark the appropriate box
43 / Mark the appropriate box after she finishes education and gives the drug package
THIRD VISIT (Postpartum)
44 / Use the appropriate row for the third visit on the form
45 / Ask the woman if she delivered at a health facility and mark the appropriate box
46 / Ask the woman if she delivered at home
47 / Ask the woman if she had postpartum hemorrhage and was referred to a health facility and mark the appropriate box
48 / Ask the woman if she took, all (three), two, one, or none of the tablets given to her and mark the appropriate box
49 / Ask the woman to return the tablets if not taken
50 / Ask the woman if she had a fever after delivery or after taking the drug and mark the appropriate box
51 / Ask the woman if she had chills after delivery or after taking the drug and mark the appropriate box
52 / Ask the woman if she had vomiting after delivery or after taking the drug and mark the appropriate box
53 / Ask the woman if she had diarrhea after delivery or after taking the drug and mark the appropriate box

Comments and Suggestions: