Ministry of Health Malaria Monitoring and Support Supervision Tool

Ministry of Health Malaria Monitoring and Support Supervision Tool

MINISTRY OF HEALTH

Checklist for Malaria supervision & monitoring at facility & community levels

District: ______HSD: ______Date of Supervision: ______

Health Facility: ______Health Facility Code: ______Level: ______

Ownership: ______

Name of Facility in-charge: ______Telephone: ______E-mail ______

Is the health facility in-charge currently on duty? Yes: ______No: ______(Tick Appropriate)

Names of Supervisors Cadre/ Title Contact Phone No. Signature

______

______

______

______

Name of person supervised Cadre/ Title Department Contact Phone No. Signature

______

______

______

______

______

______

Note: Department is the section of the health facility for which the health work was supervised, for example ANC Clinic, OPD, In Patient Department, Records/HMIS, Stores, and Lab

IPT /ANC Assessment

IPT /ANC Assessment / Operational Definition / Action taken by supervisor
Record figures for the following from the ANC Register for the respective months. Record the reason for missing figures.
ANC 1 / ANC 1st Visit
Month 1:November 2011
Month 2:December 2011
Month 3: January 2012
ANC 4th Visit
Month 1:November 2011
Month 2:December 2011
Month 3:January 2012
IPTP 1 / SP should be given to pregnant women twice from 16 weeks up to delivery at least 4 weeks apart.
Month 1:November 2011
Month 2:December 2011
Month 3: January 2012
IPTp 2
Month 1:November 2011
Month 2:December 2011
Month 3: January 2012
ANC 2 / Check availability of Antenatal documents to mothers during ANC visits? (such asAntenatal card , Maternal passport or Exercise books )
Yes they are available: ______No, they are not available: ______
If no, please give reasons why. / The ANC card or the Maternal passport is the record of the pregnant woman's RH data.
ANC 3 / Verify by observing if relevant IEC materials are available in this facility?
Yes or No
If yes, are they posted /displayed where health workers can see them when talking to the mothers? Yes or No
(Check the message, condition and position of the material) / A poster with malaria related intervention focusing on management of malaria in pregnancy displayed in the ANC room.
ANC 4 / Do you routinely provide folic acid and iron to pregnant women?
(Tick appropriate option)

Folic Acid Yes or No
Iron Yes or No

/ The folic acid is given to pregnant mothers during ANC visits to enhance Hb levels.
ANC 5 / Do you provide de-worming tabs to pregnant women? Yes or No / The de-worming tablets are given two times a month apart starting 2nd trimester to reduce the risk of anaemia attributed to worm infestation.
ANC 6 / Observe if the health worker administering IPTp under DOTs. Yes or No
(If clinic is running, verify by observing mothers taking Fansidar who are receiving IPTp under DOTs) / Health worker observes pregnant mother swallowing SP.
ANC 7 / Does this facility have the following IPTp commodities?
(Do actual verification of the commodities in stock) / Number in Stock
Cups
Number of boxes of water purification tablets
Jerrycans
ANC 8 / Record the numbers of health workers in this facility that have been trained to offer IPTp under DOTs.
Number of health workers: ______
ANC 9 / Record the cadre/title of the health worker supervised on how to administer IPTpin this facility.
Health worker 1 cadre/title:______
Health worker 2 cadre/title:______
ANC 10 / Check for availability of safe water ready for use within the ANC area for mothers to take IPT. Yes or No / The safe water in the ANC area is either boiled, treated or from the borehole.
ANC 11 / Is IPTp recorded correctly in and up to date:

ANC Register Yes or No
ANC Card Yes or No

(If the mothers are present check a few cards to confirm whether the cards are filled in correctly) / The IPT column in the ANC register should be updated and having
1 for IPTp1 in the IPTp Column
2 for IPTp2 in the IPTp Column
C for completed in the IPTp Column
There should be no ticks in the
IPTp Column.
ANC 12 / Check for availability of SP in the ANC clinic. Yes or No
ANC 13 / What challenges do you experience during administration of IPTp to mothers?
ANC 14 / Do you dispense LLIN through the ANC? Yes or No
If yes, are they?
Free
Subsidised cost
Full cost
Other
ANC 15 / In the last 3 months, how many LLINs did this facility receive?
Month / Number of LLINs received
November 2011
December 2011
January 2012
ANC 16 / In the last 3 months how many LLINs where distributed to pregnant mothers in this facility?
Month / Number of LLINs distributed
November 2011
December 2011
January 2012
ANC 17 / How many LLINs were in the store at the end of the following months?
Month / Number of LLINs
November 2011
December 2011
January 2012
ANC 18 / How many LLINs does the facility have currently?
Number of LLINs:______/ Number of LLINs in store at the time of support Supervision
ANC 19 / Check if LLINs given to the pregnant mothers are correctly recorded in the:

ANC Register Yes or No
LLIN counter book Yes or No

ANC 20 / Are Health Education talks about malaria given during ANC services? Yes or No
( Check for Health Education Plan if it includes topics on Malaria like IPTp, case management and LLINs) / Health facility conducts health education sessions containing malaria control and prevention messages targeting the Pregnant women.
The ANC health education talks should have IPTp, NET use & Early Malaria treatment seeking

Case Management

Case Management / Operational Definition / Action taken by supervisor
CM 1 / Does the facility have any staff trained in Malaria case management in the last 2 years? Yes or No / The facility has at least one provider trained in Malaria case Mgt as refresher training. This includes; management of uncomplicated malaria or severe malaria, including pre-referral mgt
Area of training / Number of health workers managing:
Uncomplicated malaria
Severe Malaria
Area of training / Number Trained:
Uncomplicated malaria
Severe Malaria
CM 2 / How many staff have been trained in clinical Audit?
(Applicableto only HCIVs and hospitals)
Number:______/ A committee formed to conduct regular clinical audit within the facility as part of quality assurance/improvement
CM 3 / Has the facility ever conducted a clinical Audit?
Yes or No
If yes , are action plans available?
Yes or No
CM 4 / Record the cadre/title of the health worker supervised on malaria case managementin this facility.
Health worker 1 cadre/title:______
Health worker 2 cadre/title:______
CM 5 / Observeif health workers giving treatment according to the National Malaria Treatment Guidelines. Yes or No
Record the number of health workers observed:______/ Health workers are providing correct treatment (Right drug, right dose & schedule) according to MOH ( i.e. malaria treatment guidelines)
Specify any deviations from the National Malaria Treatment Guidelines.
CM 6 / Verify by reviewing medical records ( Treatment charts, or conduct an interview with patients /caretakers)
Un complicated malaria
Patient 1 Yes or No
Patient 2 Yes or No
Patient 3 Yes or No
Treatment in severe malaria
Patient 1 Yes or No
Patient 2 Yes or No
Patient 3 Yes or No
CM 7 / Is malaria treatment based on lab diagnosis?
Yes or No
( Check Out/inpatient forms)
CM 8 / Record the number of malaria tests done by RDT in: / RDT is Rapid Diagnostic tests
November 2011 :
December 2011 :
January 2012:
CM 9 / Check the duty roster and verify if qualified health provider is available to provide services at all time.
Yes or No
(Verify by reviewing the current duty roster and confirm physical presence) / A qualified health provider is assigned 24 hours a day, 7 days a week
(A qualified provider = nurse, midwife, CO or MO)
CM 10 / Does the facility have treatment guidelines for management of Uncomplicated malaria and severe malaria located in OPD and Inpatient wards?
Yes or No
(Check for Clinical & treatment guidelines if there are available in the consultation rooms in the OPD and IP wards) / Treatment guidelines include the Uganda Clinical guidelines 2010 ,National Malaria Treatment guidelines for management of uncomplicated Malaria & Severe Malaria
CM 11 / Does the facility have a referral system for malaria emergency cases?
Yes or No
Check for the following / Ask the in charge and one other provider if the facility provides some type of assistance for transporting patients to a referral facility, such as communication to the next level, ambulance, arranging community transport and/or funds for public means.
Referral map Yes or No
Referral form Yes or No
Means of transport Yes or No
CM 12 / Record the number of under 5s where referred to upper levels for further management of malaria.
(Check the OPD register)
November 2011:
December 2011:
January 2012:
CM 13 / Record the number of under 5s referred that received pre-referral treatment.
( check the inpatient and OPD registers) / Pre-referral treatment should include management of the following:
1.Management of convulsions
2.High Temperature
3.Dehydration
4.Hypoglysemia (low blood sugar)
November 2011:
December 2011:
January 2012:
CM 14 / Does the facility have IEC materials displayed for Uncomplicated / severe malaria in OPD&IPW wards?
Check if IEC are displayed both in OPD and IP wards
OPD Yes or No
IPW Yes or No
CM 15 / Do the facility staff hold monthly CMEs including topics on Malaria case management? Yes or No
Check for CMEs Schedule and Plans / Health Facility Staff a supposed to frequently hold Continuing Medical Education (CMEs) sessions on the various topics.
CM 16 / Do HMIS registers exist and up-to-date? Yes or No
(Inspect the OPD and IPD registers in the clinic rooms) / Standard HMIS Registers exist in the OPD wards. The registers should be properly filled & completed.
All appropriate columns should be filled in – diagnosis and treatment( dosage ,times/days, re-attendance, drugs dispensed)
If there are counter books used as registers other than the pre-printed MOH registers information recorded should be like the pre-printed.

Laboratory

Laboratory / Operational Definition / Action taken by supervisor
LB1 / What techniques do you use to diagnose malaria in this facility?
Microscopy Yes or No
Rapid Diagnostic Tests (RDTs) Yes or No
LB2 / Does the health facility have a designated space for carrying out Malaria Microscopy/RDTs? Yes or No
Is the Lab adequate? Yes or No
How is the Flow?
Poor or Fair or Good or Excellent / Water, Ventilation, 4sqM,
How is the organization, hygiene and waste management?
Poor or Fair or Good or Excellent
LB3 / Are the testing protocols available (standard operating Procedures) for:

RDTS Yes or No
Microscopy Yes or No

/ Standard Operating Procedures
LB 4 / Is there a skilled human resource available to carry out malaria tests? / skilled human resource are available /verify with in charge
Lab technician Yes or No
Lab assistant Yes or No
Microscopist Yes or No
Lab Technologist Yes or No
Other Specify
LB6 / Check the duty roster and verify ifthelab personnel is available at all times. Yes or No
(Review the current duty roster of the lab personnel) / 7 days a week (A qualified provider = Lab Technician, Lab Assistant, Technologist etc)
LB7 / What type of functional microscope(s) is currently being used in the laboratory unit?
(Indicate as appropriate in the table below) / Identify and check the number microscopes available and their power source (i.e Key: Power source: 1. =Natural light 2. =Electric light)
Monocular Yes or No
Binocular Yes or No
Others , Specify
LB8 / Does the facility have dysfunctional microscopes?
Yes or No
LB9 / How long have they been un functional?
LB10 / Does the facility have repair plans for the equipment? Yes or No / Discuss and find out the plans for repairing them.
LB 11 / Is there a microscope maintenance log? Yes or No
LB 12 / How many lab technicians / assistants been trained in Microscopy/ RDT? / Laboratory staff at the facility
Number of Technicians: ______
Number of Assistants: ______
Number of Microscopists: ______
Other specify cadre:______
Provide Number______
LB 13 / Who prepares the stain used at this facility laboratory?
Commercially prepared Yes or No
Sub District referral laboratory Yes or No
Regional hospital laboratory Yes or No
Others , specify
LB 14 / What challenges do you face with the source of the stains?
LB15 / Is there a system for quality assurance of the stains?
Yes or No / Test samples with known positive and Negative
LB16 / Is there an established system for quality assurance of slides read? Yes or No / Note and discuss whether the system exists and describe how it is followed and how the systems works
LB17 / Does lab staff label the specimen (slide) with the Lab identification number in the lab register?
Yes or No / The patients should be entered in the register before getting the sample.
LB18 / Check if the lab data is correctly filled in. Yes or No / All columns properly filled as per HMIS guidelines
LB 19 / How many malaria lab tests were done in the last 3 months using:
RDTs (0-4 year olds)
Number
Month / No Tested / No Positive
November 2011
December 2011
January 2012
Microscopy tests (0-4 yrs)
Month / No Tested / No Positive
November 2011
December 2011
January 2012
LB20 / Did the facility experience any stock out of lab supplies in the last three months?
(Indicate with Yes or No) / Inquire how they order and manage their supplies stock cards/ register books at the facility store.
November 2011 Yes or No
December 2011 Yes or No
January 2012 Yes or No
LB21 / Do HMIS registers exist and up-to-date? Yes or No
(Inspect the LAB registers in the clinic rooms) / Standard HMIS Registers exist in the LAB. The registers should be properly filled & completed.
All appropriate columns should be filled in – diagnosis and treatment
( dosage ,times/days
If there are counter books used as registers other than the pre-printed MOH registers information recorded
should be like the pre-printed

Drug Verification

Drug Verification / Operational Definition / Action taken by supervisor
DV1 / Are there updated stock cards at the facility store?
Yes or No
Please check for the following drugs(record the numbers) / Check out for Stock cards /register books in the drugs store as on the date of supervision. Every drug transaction should be recorded in the daily summaries. Check for delivery notes/ requisition and issue vouchers.
Record quantities of yellow Artemether/Lumefantrine according to the number of boxes containing 30 doses
Drug / Number on the Stock Card / Actual number in the Store
Artemether/Lumefantrine (boxes)
SP(Fansidar)
IV Quinine
Oral Quinine
Artesunate( Rectal)
5% Dextrose
50% Dextrose
Artemether(
Injectable)
Number of LLINs
DV2 / Was there any stock out of the following drugs in the last three months? (Indicate with Yes or No) / Check the stock cards if at any moment there was zero stock during the month
Drug / Month 1
Nov2011 / Month2
Dec2011 / Month3
Jan 2012
Artemether/Lumefantrine
SP(Fansidar)
IV Quinine
Oral Quinine
Artesunate( Rectal)
Artemether( Injectable)
DV3 / What is done when the Health Facility experiences stocks of different medicines and supplies?

Behaviour Change Communication

BCC / Operational Definition / Action taken by supervisor
BCC1 / In the last three months, have any community awareness activities been conducted in this catchment area in the following malaria services?
Use of LLINs Yes or No
Sanitation Yes or No
IPTp Yes or No
Malaria treatment Yes or No
Treatment seeking behavior for
Severe malaria cases Yes or No
BCC2 / Record the cadre/title of the health worker providing health education talks at this facility.
Health worker 1 cadre/title:______
Health worker 2 cadre/title:______
BCC3 / Are Health Education talks about malaria given to clients at OPD?
Yes or No
(Check for Health Education Work Plans) / Health facility conducts group health education sessions at least 4 times a month for the previous months.
OPD health education talks should have IPTp, NET use and seeking malaria treatment
BCC4 / Check for availability ofIEC materials to support community awareness activities.
Yes or No / These may include job aides, grain sacks among others.
BCC5 / Are there appropriate jobaides usedduring the health education talks at the facility & community? Yes or No
(Observe a teaching session to confirm) / Health educator uses one of the following materials during client counseling /education sessions
posters leaflets and flipcharts/ grain sacks etc
BCC6 / Are there Health Education reports for activities conducted in the last quarter?
Yes or No
If no why? / The reports are compiled by the Health educatorsafter implementation of activities
BCC7 / Are the Health. Education reports submitted to the:
Facility In-charge Yes or No
DHE Yes or No
DHI Yes or No
If no why? / Reports written after implementation of field activities

HMIS

HMIS / Operational Definition / Action taken by supervisor
ME1 / Does the facility have aRecords Assistant?
Yes or No / A qualified personnel to enter in the data or Availability of records officers /HMIS point person at the health facility
ME 2 / Is the Records Assistant at this facility trained in HMIS records system or M&E? Yes or No / In-service training about Health Management Information systems
ME 3 / Is there a computer for data management at the Health Facility? Yes or No
ME 4 / Does the facility have a data base?
Electronic Yes or No
Manual (Filling system) Yes or No
ME 5 / Were weekly and monthly HMIS summary reports forthe last 3 monthscompleted appropriately? / Information is entered in the unit database.
HMIS 33b November 2011 Yes or No
December 2011 Yes or No
January 2012 Yes or No / HMIS 33b- Weekly epidemiological surveillance report
HMIS 105 November 2011 Yes or No
December 2011 Yes or No
January 2012 Yes or No / HMIS 105 - OPD form
HMIs 106 November 2011 Yes or No
December 2011 Yes or No
January 2012 Yes or No / HMIS 106- Quarterly Summary
HMIS 108 November 2011 Yes or No
December 2011 Yes or No
January 2012 Yes or No / HMIS 108 - Inpatient Summary
ME 6 / Malaria cases trends for 3 months(Admissions/Deaths / Pick the data from HMIS registers/ reports at the health facility
0 - 4
Month / November
2011 / December
2011 / January
2012
Admissions
Deaths
5 years old
Month / November
2011 / December
2011 / January
2012
Admissions
Deaths
ME 7 / Data quality assessment (Pick one month in the last quarter and compare the total number of malaria cases (0-4 yrs) with the register. Totals should be the same +/-5% / The number of malaria cases for the same month should correspond to the number of cases in the OPD register +/-5%
Month/Year ………………….
Total HMIS......
Total in register......
ME 8 / OPD malaria cases for the last three months
0-4 years
November
2011 / December
2011 / January
2012
0-4yrs
Above 5 yrs
5 years and above
November
2011 / December
2011 / January
2012
0-4yrs
Above 5 yrs
ME 9 / Is there evidence of data analysis and utilization?
Yes or No
( Check for up to date Malaria graph) / HMIS data plotted on graphs for a specific period of time.

Support Supervision