EVALUATIVE QUESTIONNAIRE FOR HEALTH FACILITIES PART OF AN EMERGENCY TRANSPORT SCHEME

About this tool:This questionnaire is to be used as part of a qualitative study that interviews the health facilitiesthe emergency transport scheme transports women to.The purpose of this questionnaire is to evaluate the emergency transport scheme and determine its strengths and challenges. This questionnaire focuses on exploring health facilities’ awareness and utilisation of the ETS for referral purposes. This questionnaire was originally used in Nigeria so some references may be specific to Nigeria only, feel free to change and adapt.

G1 / Local Government Area
G2 / Ward/s
G3 / Urban/Rural area
G4 / Health facility name
G5 / Date
G6 / Time
G7 / Interviewer
  • Key interviewee – the facilities in charge or a Community Health Extension Worker
  • Briefly introduce yourself and the programme, including the purpose of your interview
  • Assure the participants of confidentiality on all information volunteered. No reference will be made to any names, if the findings of the study are published. They may refuse to answer any question. However, emphasises thattheir open and candid answer to the questions will be highly appreciated and will remain confidential.
  • INFORMED CONSENT: Participation in the study is voluntary and participants can withdraw at any time. The interview will be recorded but only for the purpose of analysis. Participants’ personal information will be de-identified to maintain anonymity. Ensure that verbal consent to participate are obtained.
  • Inform the interviewees that you may need to follow up on some of their answers via telephone later on in the week. Agree on the person who should be contacted for follow up.
  • Ask for permission to take pictures (of vehicles, motor-parks) and also if they have material (especially records of women transported)
  • Ask if anyone has any questions before starting and ask for their patience as theinterview will take some time to complete (45 minutes – 1 hour)

General
HF1 / Name, Job title and contact details of the person interviewed
HF2 / Description of their responsibilities
Health Services and emergency
HF3 / What services does your health facility offer?
Probe whether they offer BEOC/CEOC
HF4 / What is the catchment area of your health facility?
Radius from HF (List of villages if available)
HF5 / Can you estimate the population that it covers?
HF6 / How many pregnant women visit the health facility each month?
HF7 / How many of them come for institutional delivery?
HF8 / And how many instead come for an emergency during pregnancy?
HF9 / What is the proportion of newborn babies that visit the facility each month?
NB: newborn is up to 28 days of age
HF10 / How many of them come for an emergency?
Organisation structure and data collection
HF11 / Is this health facility open 24/7?
HF11a / If not, where would a woman go if she enters labour at night?
HF12 / How far is that hospital from this village?
HF13 / What type of data do you record regarding maternal and newborn patients?
Probe record of women’s health condition before reaching hospital
HF14 / Do you record maternal and newborn deaths?
If yes, how many did you have last year?
Make sure you keep separate mothers and newborns
Referral System
HF15 / Do you have a referral focal person in this facility?
HF15a / If yes, who is that person?
Make sure you write down their details
HF15b / If yes, what are their responsibilities?
HF16 / Where do you refer a patient to in this area?
Maternal and newborn referral only
HF17 / How far is the referral hospital?
HF18 / How would you organise transport for the patient who needs referral?
HF19 / What type of transport?
HF20 / How much would the transport cost
  • On an ambulance?
  • On a car?
  • On a tricycle?
  • On a motorbike?
  • On an ox cart?
  • On a boat (if applicable)

HF21 / How long would it take to reach the referral hospital
  • On an ambulance?
  • On a car?
  • On a tricycle?
  • On a motorbike?
  • On an ox cart?
  • On a boat (if applicable)

ETS
HF22 / Have you ever heard about the ETS scheme (run by NURTW)?
If no, Transaid to explain what the ETS is
HF23 / What is your opinion about the scheme?
HF24 / Has your facility ever been involved in the scheme?
If not, why not?
HF24a / If yes, what is the health facility involvement?
(eg. call ETS driver for referral, etc)
HF25 / Do you have any story to illustrate this?
HF26 / Do you have record of ETS drivers’ contact details?
HF26a / If yes, where do you keep them and how often are they updated?
HF27 / Do you ever call an ETS driver for a referral case?
HF27a / If not, why not?
HF27b / If yes, do you call the driver / the call centre/ the LGA FP?
HF27c / If yes, how long on average does it take for the driver to reach the facility?
END OF QUESTIONNAIRE – THANK YOU!

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