QST PHC-BHCPF Ebonyi supplementary Mobile Version yes no abia adamawa anambra akwa_ibom bauchi bayelsa benue borno cross_river delta ebonyi edo ekiti enugu federal_cap gombe imo jigawa kaduna kano katsina kebbi kogi kwara lagos nasarawa niger ogun ondo osun oyo plateau rivers sokoto taraba yobe zamfara Please remember to take necessary steps to add this facility to the master facility list primary_health_center primary_health_clinic health_post general_hospital com_health_centre prim_health_centre clinic_mat_home health_post mobile_clinic dispensary rural urban peri-urban yes no [First-name Last-name] yes no medical_doctor nurse_midwife registered_nurse Mid_wife chew Jchew pharmacist Lab_technician Health_records_officer Environmental_health_officer other government Private_not-for-profit/NGO private_not-for-profit/Faith-based private_for-profit other government Private_not-for-profit/NGO private_not-for-profit/Faith-based private_for-profit other government Private_not-for-profit/NGO private_not-for-profit/Faith-based private_for-profit other government Private_not-for-profit/NGO private_not-for-profit/Faith-based private_for-profit other primary_health_center primary_health_clinic health_post *If applicable *If applicable zero_to_ten_minutes eleven_to_twenty_minutes greater_than_twenty_minutes zero_to_ten_minutes eleven_to_twenty_minutes greater_than_twenty_minutes yes no yes no yes no yes no yes no yes no yes no yes no transport_health_worker transport_patient na other yes no yes no Please ask to see the guidelines yes no yes no Ask to see the document yes no yes no na delay_in _submission hq_not approving_qip other ask to see the document yes no yes no na yes no yes no yes no na no_renovation light_renovation modest_renovation significant_renovation no_renovation light_renovation modest_renovation significant_renovation no_renovation light_renovation modest_renovation significant_renovation nofence yes no yes no yes no yes no electric_power_grid fuel_operated_generator________ battery_operated_generator solar_system other_electricity_source Please remember to take necessary steps to add this facility to the master facility list no_source_of_power_supply fuel_operated_generator battery_operated_generator solar_system other_alternative_power_source yes no piped_into_facility piped_onto_facility_grounds public_tap_standpipe borehole protected_dug_well unprotected_dug_well protected_spring_______________ unprotected_spring rainwater bottled_water cart_w_small_tank_drum truck surface_water other_source_of_water 0_10_minutes 11_20_minutes >_20_minutes yes no no_water_source piped_into_facility piped_onto_facility_grounds public_tap_standpip borehole protected_dug_well unprotected_dug_well protected_spring_______________ unprotected_spring_____________ rainwater bottled_water cart_w_small_tank_drum tanker_truck surface_water other_alternative_water_source 0_10_minutes 11_20_minutes >_20_minutes yes no no_functioning_toilet bush flush_toilet flush_toilet_but_no_water vip_latrine covered_pit_latrine_no_slab____ uncovered_pit_latrine_w__slab other_specify yes no no_functioning_toilet bush flush_toilet flush_toilet_but_no_water vip_latrine covered_pit_latrine_no_slab_ uncovered_pit_latrine_w__slab other_specify yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no weekly biweekly monthly quarterly yearly other yes no hard_copy_reports during_meeti chalk_board posters other yes no state local state_local yes no state local state_local delay_submission_quality delay_receive_authority unable_provide_timely_account audit_issues capacity_problems other yes no yes no yes no yes no yes no yes no yes no no_alignment less_than_60_spent more_than_60_spent *Insert service cost *Insert service cost *Insert cost *Insert service cost *Insert service cost *Insert service cost Ask to see the boards yes no yes no yes no yes no yes no yes no Doctors, nurses, midwives, CHEWs, lab scientist/technician, dentist, pharmacy scientist/technician, environmental officer, and medical record officer Drivers, cleaners, gardeners, security personnel, and health attendants/ward miads yes no seldom often always none avail_no_monitoring avail_monitored none proc_exist_not_monitor doc_proc_exist_implemented *Only health workers information should be collected super_intindent specialist medical_officer comm_health_officer chew junior_chew environ_health_offic bsc_nurse regist_nurse regist_midwife psych_nurse dentist pharmacist Lab_technician_technologist volunteer other male female yes no yes no sick_maternity training_seminar official_mission approved_absence not_his_her_shift field_outreach_work not_approved_absence retreive_salary strike other yes no couns_services couns_comm_services yes no yes no none araf_present_not_used araf_present_used yes no yes no yes no yes no elect_rech_lamp elect_only no none present_unused present_used yes no by appropriate agency e.g. MOH, Dev partners, certified CBOs and others not_offered no_evidence docum_evidence no_tapes tapes_avail_no_doc tapes_doc_avail yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no spot check workers in ANC, OPD and family planning against roster no_duty_roster duty_ros_not_foll duty_ros_foll Cross check referral register, facility copy of form and return/feedback slips. yes no please check the referral register zero_to_ten_minutes eleven_to_twenty_minutes greater_than_twenty_minutes zero_to_ten_minutes eleven_to_twenty_minutes greater_than_twenty_minutes yes no by appropriate structure e.g. LGA, development partners, MOH, certified CBOs yes no yes no yes no Use checklist as appropriate against one consultation. yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no It will take some time to get the results. Please make a preliminary diagnosis. yes no yes no yes no yes no yes no 20 units in 500 ml dextrose or normal saline to run at 20 drops per minute for about 2 hours yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no It will take some time to get the results. Please make a preliminary diagnosis. yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no It will take some time to get the results. Please make a preliminary diagnosis. yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no no_ppe ppe_unused ppe_used yes no no_privacy privacy_inadequate privacy_adequate yes no yes no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes no off_in_charge medical_officer pharm_tech pharm_ass pharmacist chew jchew lab_tech other off_in_charge medical_officer pharm_tech pharm_ass pharmacist chew jchew lab_tech other fac_itself high_level_fac combination other supplier_to_facility facility_arrange_del other supplier facility other yes no yes no hard_copy_reports during_meeti chalk_board posters other yes no yes no yes no yes no no_record record_not_uptodate records_uptodate yes no weekly biweekly monthly quarterly yearly other no_drug_list list_pres_not_displayed list_pres_displayed yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no yes_obs no Observe functioning yes_obs no yes_obs no yes_obs no yes no yes no yes no no_lab_list list_pres_not_displayed list_pres_displayed yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no no_form_reg some_form_avail_not_uptodate all_form_avail_uptodate not_rep_graph rep_graph_not_display rep_graph_display not_analyzed analyzed analyzed_shared analyzed_decision yes no info_not_corres some_info_corres all_info_corres yes no yes no no_outreach outreach_occ_not_scheduled outreach_plan_occ yes no weekly biweekly monthly quarterly yearly other no_pub_avail no_evidence_pub evidence_pub_avail exec_by_fac_sole plan_w_local_comm plan_impl_w_loc_fac_man none not_regular regular_monthly yes no yes no weekly biweekly monthly quarterly yearly other yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no weekly biweekly monthly quarterly yearly other yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no yes no *In minutes