Province:______
Number of Facility/Health Post: HF, ______HP, ______
Number of MIAR reports received for the quarter:______
Overall findings (use box below): Comments on data quality dimensions (accuracy, reliability, precision, completeness, timeliness, integrity, and confidentiality) and practices adversely affecting these (compilation errors; copying; general maintenance of records, etc).
Laboratory data:
Client service registers/tally sheets (MIAR, MAR):
Stock records:
Training/Meeting:
Data management practices:
IEC Materials:
Final recommended action(s) for correction, if applicable:
Date for corrective action(s) to be completed, if applicable:
Describe any actions/feedback provided to HMIS or other MoPH/BPHS program managers:
Name and designation of
person completing report ______
Date submitted (feedback):______
Contact information (phone number,email): Signature
100
Rating for DQA: ( )= ------= M,
number of checked indicators
1. A: If all required information is satisfied (75%--90%),
3. B: If the required information needs changes to be improved (50%--75%),
5. C: If the required information needs more intervention orrevision (less than 50%),
Note: DQA assessment tool should be rated for each health facility/HP and SCORE should be reported in each quarterly feedback reports to Central level. Maximum marks should be 100, and 100 should be devided per number of checked indicators/activities, then "M" will be base for each indicators and score should be given out of "M". At least 4 indicators should be checked per visits; more than 4 indicators per visits are preferred to be checked.
Note: In order to have proof-based DQA, the feedback should be sent to respective entitiy by the signature of PHD and a copy must be kept in office.
Site Visits Summary Information (con't.)
Date / Name of District/Health Facilities / No.of DQA site visits / Health Facility Incharge Contact No.
Note: In order to have proof-based DQA, the feedback must be sent to respective entity by the signature of PHD and a copy must be kept in office.