FEDERAL MINISTRY OF HEALTH, Integrated Supportive Supervision (ISS) tool for Tertiary Facilities, Web Version 2018 Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No No minutes One month's minutes available Two months' minutes available All minutes for quarter available Yes No Incomplete At least four water closet functional latrines/toilets (either the flushable squatting closet or the sitting closet) two for staff: Male and female, two for patients: Male and female Floor without fissures Recently cleaned without visible fecal matter Medical Doctor Consultant Nurse/Midwives (Double qualification) Nurses Midwives Dentist Dental Technician Dental Assistant Anaesthesist X-RAY Technician CHO CHEW JCHEW Nutrition Officer Nutrition Assistant Environmental Health Officer Environmental Health Technician Environmental Health Assistant Pharmacist Medical Lab Scientist Lab Technician Lab Assistant Medical Record Technician Medical Record Officer Health Education Officer Health Education Assistant Pharmacy Technician Pharmacy Assistant Main Subcontracted Secretary Accountant Revenue Officer Revenue Collectors Maintenance Officer Clerks Social Welfare Officers Others Security Guards Drivers Account Officer Director of Administration None Public Private FBO NGO True False _ _ _ static_instance-yes_no-0 yes static_instance-yes_no-1 no static_instance-yes0p25_no0-0 0.25 static_instance-yes0p25_no0-1 0 static_instance-yes0p5_no0-0 0.5 static_instance-yes0p5_no0-1 0 static_instance-yes1_no0-0 1 static_instance-yes1_no0-1 0 static_instance-yes2_no0-0 2 static_instance-yes2_no0-1 0 static_instance-yes3_no0-0 3 static_instance-yes3_no0-1 0 static_instance-yes4_no0-0 4 static_instance-yes4_no0-1 0 static_instance-yes5_no0-0 5 static_instance-yes5_no0-1 0 static_instance-yes6_no0-0 6 static_instance-yes6_no0-1 0 static_instance-yes10_no0-0 10 static_instance-yes10_no0-1 0 static_instance-yes12_no0-0 12 static_instance-yes12_no0-1 0 static_instance-indi_comm-0 0 static_instance-indi_comm-1 1 static_instance-indi_comm-2 2 static_instance-indi_comm-3 3 static_instance-tech_meeting-0 yes static_instance-tech_meeting-1 no static_instance-tech_meeting-2 incomplete static_instance-latrines-0 1 static_instance-latrines-1 0.5 static_instance-latrines-2 0.5 static_instance-staffs-0 medical_doctor static_instance-staffs-1 consultant static_instance-staffs-2 nurse_midwive_double_qualification static_instance-staffs-3 nurses static_instance-staffs-4 midwives static_instance-staffs-5 dentist static_instance-staffs-6 dental_technician static_instance-staffs-7 dental_assistant static_instance-staffs-8 anaesthesist static_instance-staffs-9 xray_technician static_instance-staffs-10 cho static_instance-staffs-11 chew static_instance-staffs-12 jchew static_instance-staffs-13 nutrition_officer static_instance-staffs-14 nutrition_assistant static_instance-staffs-15 environmental_health_officer static_instance-staffs-16 environmental_health_technician static_instance-staffs-17 environmental_health_assistant static_instance-staffs-18 pharmacist static_instance-staffs-19 medical_lab_scientist static_instance-staffs-20 lab_technician static_instance-staffs-21 lab_assistant static_instance-staffs-22 medical_record_technician static_instance-staffs-23 medical_record_officer static_instance-staffs-24 health_education_officer static_instance-staffs-25 health_education_assistant static_instance-staffs-26 pharmacy_technician static_instance-staffs-27 pharmacy_assistant static_instance-contract-0 main static_instance-contract-1 subcontracted static_instance-admin_staff-0 secretary static_instance-admin_staff-1 accountant static_instance-admin_staff-2 revenue_officer static_instance-admin_staff-3 revenue_collectors static_instance-admin_staff-4 maintenance_officer static_instance-admin_staff-5 clerks static_instance-admin_staff-6 social_welfare_officers static_instance-admin_staff-7 others static_instance-non_medical-0 health_attendants static_instance-non_medical-1 cleaners static_instance-non_medical-2 security_guards static_instance-non_medical-3 drivers static_instance-non_medical-4 none static_instance-facility_type-0 public static_instance-facility_type-1 private static_instance-facility_type-2 fbo static_instance-facility_type-3 ngo static_instance-true_false-0 true static_instance-true_false-1 false Please remember to add facility to master facility list public private fbo ngo main subcontracted Health map of the health area available and on the notice board of the health facility showing population adjusted yearly, other health facilities, villages, main roads, natural barriers, special points and distance in Km, a legend/key showing specific age group population adjusted yearly (<1, <5, WCBA) 2 0 In a filing cabinet/shelf/cupboard and accessible by the officer on duty (except individual staff files) Minimum documents to be filed include: (i) Monthly HMIS reports; (ii) Weekly surveillance reports; (iii) approved business plans; (iv) minutes of meetings; (v) patient cards (OPD; ANC; Partopgrahs; Family Planning and 'bed head tickets'); (vi) individual staff files. Unique registration system: check if all patients attending the HF are issued a unique number on their hand cards that show complete identification (including age, sex ) complete location/address and differents dates their visited the different services for easy tracing of patients in CCSS (in full please) 4 0 Staff duty roster (with phone number of each staff on duty) available and well displayed up to date for current month and visible for staff and patients to see 1 0 Each monthly minutes contains at least: (i) date of the meeting; (ii) signed list of participants; (iii) follow-up of decisions taken during the previous meeting; (iv) there is a list of developed recommendations or decisions taken; (v) each month the monthly financial balance is discussed; (vi) minutes of the meeting are signed by the chairman. (three complete IMC meetings and one quarterly general staff meeting minutes available). For every meeting report that contains the above = 2 p. (max 4 reports) At least 10 standard sheets are present during the evaluation 1 0 Mobile phone functional with batteries and/or call credit of a minimum of N500 and contact details on the phone (e. g: Medical Director GH/Cottage Hospital, HF Staff, other PBF HFs OICs in the LGA, LGA PHC Dept. PBF Team and SPHCDA PIU &TA Team) 1 0 Transmission of HMIS report is after verification of the SPHCDA of the monthly MPA invoice (including those of subcontracted HFs if applicable) and a signed receipt of acknowledgement is available 2 0 Five priority health problems are followed each quarter and data have been updated up to the month prior to the supervisor's visit (all or nothing) (Monthly summary of the health problem classified at the closing of each month in the General register) 1 0 Each monthly minutes contain: (i) date of the meeting; (ii) signed list of participants; (iii) follow-up of decisions taken during the previous meeting; (iv) there is a list of developed recommendations or decisions taken; (v) each month the monthly financial balance is discussed; (vi) minutes of the meeting are signed by the chairman. (3 complete RBF committee meeting minutes available, all or none: 3 points) 3 0 Availability of a room for a mortuary: corps not stored more than 12 hours (check-ins/outs mortuary registers), one strecher and one table 1 0 Availability of an enclosed kitchen space, separate from the main building, for inpatients 1 0 2 0 Valid and renegotiated for the quarter under evaluation (signed by all authorised signatories) 2 0 Facility RBF Committee Members involved (Chairman signed off on the plan): minutes of special meeting to prepare the BP available with signed attendance list Representative (s) of subcontracted private clinics or health posts involved (if applicable) 2 0 Strategies for sub-contracts Outreach strategies (EPI, FP; ANC) are used and planned for villages more than one hour away by foot 1 0 HF has a list of informal practionners transmitted quarterly to the LGA for action, treats this subject in the BP, and suggests a strategy for dealing with informal practitioners 2 0 Business plan shows negotiated rates between HF, Indigent Committee and community Business plan shows planning for the resources available for financing care for the indigents 2 0 Monthly financial report (income and expenditure books) available and correctly filled and signed by the Health Facility Officer in Charge 5 0 This document guarantees that income equals/balances the expenditures. Running costs equal: = salaries, purchase of drugs and equipment, subcontracts, petty cash for small expenditures, social marketing, maintenance and rehabilitation. 4 0 Bonuses are paid directly from health facility bank account into individual staff accounts. Calculated as follows (see manual): the total amount of monthly bonus to be paid per worker = individual indice value of the health worker multiplied by the monthly point value for the bonus multiplied by the individual performance score for the worker. 10 0 Take a random staff member and ask what his or her performance bonus was last month, and what his or her individual performance % was (through the use of the individual performacne evaluation) . If both are explained then 4 points. 4 0 Upto 20% of curative consultations of the previous month: documented quantity in monthly management meetings 2 0 The Indigent committee meets monthly to review the care for the indigent category use. Each monthly minutes contain: (i) date of the meeting; (ii) signed list of participants; (iii) follow-up of decisions taken during the previous meeting; (iv) there is a list of developed recommendations or decisions taken; (v) each month the monthly financial balance is discussed; the amount spent on indigents patients is included in the monthly expenditures (vi) minutes of the meeting are signed by the chairman. (vi) each month the monthly updated list of indigents (with the updated lists from HCs) is validated and shared with the LGA. Each report according to norms = 1 point 3 0 Each month an updated list of indigents from every community of the ward is validated and shared with the LGA and General Hospital. Details of quartely activity plan to educate the indigents in every community on their priviledge to free care at the health facility and the report of activities effectively carried out during the quarter 5 0 Fence exists, can be closed at night and there are no holes. A gatekeeper is available (except riverine areas) 1 0 Bin with lid accessible to clients which is not full 1 0 1 0 0.5 0 0.5 0 0.5 0 0.5 0 1 0 0.5 0 0.5 0 Waste disposal pit minimum 2 meters deep, lined with clay, concrete or brick or plastic, it is fenced and has a bright flag The waste pit is a minimum of 15 meters from the health facility, minimum of 50 meters from a household, and 100 meters from a water source except in cases where the available surface area does not allow for these distances (written support of the LGA health administration is required) Health Care Waste is not visible (covered by at the least 10 cm of soil or lime) The health facility maintains a register indicating the date of the creation of the pit(s), and the location (s) 12 0 No waste or medical waste in the courtyard (sharps, ampoules, plastics, gloves,syringes,needles, used gauze, etc.) 1 0 Sterilizer functional (eg Autoclave) Sterilization protocol available and followed (medical personnel present can explain the protocol or demonstrate the process) 3 0 Yellow and Red Bins for medical waste with lid and foot pedal, lined with bag and not full Security box for needles well positioned, and used (and not full) Needle cutter available and used Container/bowl with lid containing disinfectant used for putting used instruments 2 0 Waste disposal of non-contaminated waste in Black Bin with lid and foot pedal, lined and not full Waste disposal of contaminated HCW in Yellow Bins with lid and foot pedal, lined with cellophene bag and not full Waste disposal of organically HCW in Red Bins with lid and foot pedal, lined with cellophene bag and not full Protective gear for personnel managing HCW available; boots, plastic shorts, thick plastic/rubber gloves 6 0 Sufficient benches and or chairs protected against sun and rain and waiting area is not inside the consultation room 1 0 Easily visible in the consultation room waiting area, updated, with (i) unit price per item; (ii) price for a standard treatment of the drug Drugs are all generics. An exception list with branded drugs for special cases or pathologies is allowed, this list needs to be signed off by the HMB and be current for the calendar year. 1 0 1 0 Walls with durable materials well painted, floor paved with cement without fissures, undamaged ceiling Consultation room and waiting space separated assuring confidentiality Windows with curtains Functional door with functional lock Running water (tap or water dispenser) with liquid soap and clean towel available and used between patients 5 0 Electricity present in the form of current, functioning generator or functioning solar light 1 0 Identification of consulting staff in register 2 0 Clean blouse with identification tag and shoes (no slippers) 1 0 Correct numbering and closed at the end of the year month 1 0 Supervisor verifies entries in register for the last three Sundays 2 0 National protocol for diagnosis and treatment of simple (acute) and severe malaria 1 0 Register see last three cases of simple malaria and review treatment according to protocol (five points for the three cases; all three cases need to be treated according to the malaria protocol: all or nothing) 5 0 1 0 See last five cases of ARI and review treatment acc protocol; register mentions Temp; RR; cough yes/no; diagnosis (one point for each correct treatment according to protocol: max 5 points) 5 0 1 0 See last five cases of Diarrhea and review treatment according to diarrhoea protocol (five points for the five cases: all or nothing) 5 0 See last 100 cases in register, check diagnosis and calculate the rate (< 30 cases) 4 0 1 0 Select any available qualified medical staff, and ask the question on TB dangers signs symptoms Answer must contain at least 4 of the following signs: (i) weight loss; (ii) loss of appetite; (iii) fever; (iv) cough of more than 15 days duration; (v) night sweating 5 0 Let nurse check BP and review measure 1 0 1 0 1 0 Available mattress, non-torn, plastic cover specific for OPD consultations only 1 0 Inspect in comparison with known weight of supervisor: after weighing, the balance should return to zero 1 0 Protocol is available in the consultation room The last five IMCI cases are traced in the register and comply with the IMCI strategy (all five) 2 0 4 0 2 0 2 0 6 0 6 0 6 0 6 0 6 0 6 0 6 0 2 0 Room with closed doors, curtains at windows or non transparent glass 2 0 Condoms; OCP; Injectable; Implant; IUD; are available in the demonstration box (all five items) Penis model available on the desk; box with condoms available with at the least 50 condoms 2 0 2 * average monthly consumption (total yearly consumption/12) to calculate the security stock for Oral and injectable contraceptives. 1 0 Collaboration with public sector, private sector and social marketing, mobile strategies, advocacy among local leaders etc. (explicit mention in the BP) Involvement of HF staff in strategies (explicit mention of this in the BP) 3 0 For example for 10.0000 pop (direct catchment population of the OPD) 84 doses of oral (3 month cycles) and injectable methods combined. Total number of women of child bearing age (15 - 49) - 22.5% times unmet need 25% divided by 12 (months) times 2 months (min supply) => result 84 doses). Note that each dose is for 3 months 2 0 At least five IUDs and at the least one staff trained to use it (check certificate original or photocopy certified by the LGA) 3 0 At least five implants available and staff trained to use it (check certificate original or photcopy certified by the LGA) 3 0 Referral system worked out - strategy to reduce prices; mobile strategy for surgery? 2 0 Check at least five cards for BP, hepatomegaly, varicose veins, weight (all cards; all elements checked) 2 0 1 0 Supervisor verifies the last 2 Sundays in laboratory register 1 0 1 0 Supervisor verifies last five results 3 0 On plastic paper, in a color book, or put on wall Blood smear: Vivax, Ovale, Falciparum and Malariae Stools: Ascaris, entamoeba, ankylostoma and schistosome 1 0 functional objectives; immersion oil available, mirror or electricity blades, cover glass, GIEMSA available 2 0 At least 20 test kits available in the laboratory; non-expired 2 0 1 0 Organic waste in a bin with lid and not full Security box for sharp objects available and destroyed according to waste disposal guidelines 2 0 1 0 Reagents for AFB testing; stock control car for reagents is available and lists stock; at the least 30 non-recycled slides available for testing External Quality assurance protocol for PTB testing available and implemented: slides sampled and sent for quality control according to protocol, and latest report, as per protocol, is available and shows results as per cut-off point of the protocol 2 0 Supervisor verifies guard duty's report - names and signatures match 0.5 0 Each bed has a (i) plastic covered mattress, (ii) mosquito net, (iii) clean sheets, (iv) night table Number of functional beds available to patients 1 0 0.5 0 0.25 0 0.25 0 1 0 Electricity; solar light or rechargeable battery lamp 0.5 0 Women in separate ward from men; the inside of the wards are not visible from the outside 0.5 0 check identity and hospital bed days 0.5 0 At least 10 blanks; supervisor verifies 5 filled forms Weight, temperature, and eventual laboratory exams recorded Treatment monitoring checked 1 0 1 0 Supply in register corresponds with physical supply: random sample of three essential drugs 3 0 Latest Pharmaceutical Council of Nigeria certified distribution center list for the State available Last procurement list is shown which shows the certified distributor which sold the drugs All drugs and medical consumables are (i) NAFDAC certified and (ii) Generic 3 0 Supervisor verifies whether quantity requisitioned equals quantity served Drugs to clients are uniquely dispensed through prescriptions. Prescriptions are stored and accessible Drugs and medical consumables prescribed, are all in generic form 10 0 Clean place, well ventilated with all drugs on cupboards, labeled shelves Drugs and medical consumables stored on alphabetical order, first expired in - first out basis 2 0 Supervisor verifies randomly three drugs and 2 consumables Out of date drugs well separated from stock Destruction protocol for out of date drugs available and applied 1 0 1 0 0.5 0 1 0 1 0 1 0 1 0 1 0 0.5 0 1 0 0.5 0 1 0 1 0 1 0 1 0 1 0 0.5 0 1 0 1 0 Min stock = 10; MAC applies only when higher than 10 0.5 0 Min stock = 10; MAC applies only when higher than 10 0.5 0 Min stock = 10; MAC applies only when higher than 10 0.5 0 Min stock = 5L; MAC applies only when higher than 5L 0.5 0 Min stock = 5L; MAC applies only when higher than 5L 0.5 0 0.5 0 0.5 0 0.5 0 A functioning water source or at the least 20L; soap available 2 0 Electricity, solar light or rechargeable battery lamp 1 0 Bin with lid and lining and safe needle disposal container, specific for the maternity room use only 1 0 Walls with durable materials and painted Curtain between delivery bed and door Delivery room should have proof of use of bleach as a disinfectant for cleaning (eg jik, hypo, etc) Floor should be levelled with cement or tiles, without fissures and ceiling not damaged Windows with curtains and functional door 5 0 At the least 10 forms available for use Verify three randomly selected partographs whether filled according to the norms 2 0 Identification of the skilled provider from names in the register 2 0 1 0 1 0 1 0 1 0 Content at the least 1 pair of scissors, 2 pliers and one needle holder 1 0 One sterilized box with needle holder, needles, 1 anatomical plier and 1 surgical plier Catgut and nylon sutures; antiseptic, local anesthetics, sterile swaps 1 0 Table in two parts with removable non-torn plasticized mattress and two functional leg supports 1 0 Sterile tying string or clip for umbilical cord 1% tetracycline eye ointment non-expired 2 0 Mattress covered in impermeable plastic Sheets, blankets and mosquito nets on each occupied bed 1 0 Target = population * 4% / 12 : asked from any medical personnel dealing with care for clients The target population concerns the ward population (or the defined catchment pop in case ward has more PBF primary contract holders) 1 0 Presence of a fridge - temp form available, filled twice a day including the day of the visit Temperature remains between 2 and 8C in register sheet Supervisor verifies functionality of thermometer Temperature between 2 and 8C also according to the thermometer 4 0 Presence of a chemical temperature indicator (this is a specific piece of paper different from the thermometer) which shows temperature acc to the norms 1 0 Freezing compartment: Measles Non-freezing compartment: BCG, Penta + HepB, TT, thinners Absence of vaccines which are expired Readable labels on all vaccines 1 0 BCG, Penta, Polio, Yellow Fever, HBV, Measles, Tetanus, Hib, IPV, Vit A Presence of stock control cards for all vaccines; concordance paper and physical stock verified 1 0 If kerosene fridge: stock of at the least 14L Kerosene; if solar fridge: battery not damaged 1 0 At the least 5 1 0 Auto-blocking at least 30; for dilution - at least 3 1 0 1 0 At the least 10 1 0 System is capable of identifying drop outs and Fully Vaccinated Children 1 0 Sufficient benches and or chairs, protected against sun and rain 1 0 1 0 Balance calibrated to zero + pants available, clean and in good condition 1 0 Group meeting held before vaccinations (check the schedule of health education sessions) Existence of updated IEC report with (a) topic, (b) number of participants, © leader of activity, (d) date and (e) signature 1 0 Schedule, record of appointments, well arranged invidual charts 2 0 Fixed strategy; and strategy for distant villages: catchment area covers entire ward or defined catchment population if multiple PBF primary contract holders 1 0 1 0 All: Examinations: weight - BP, uterus height, Parity, Date of last menstruation All: Laboratory: albuminuria, glucose All: Obstetrical examination done: Fetal heart rate, Uterine height, presentation, Fetal movement recorded 5 0 2 0 1 0 Complete identity, state of vaccinations, date visit, whether high risk pregnancy or not/danger signs All columns well filled including the identification of problems if any, and actions taken 2 0 Nurse; midwife, verified on ANC cards 1 0 Group meeting held before FP consultation (check the schedule of health education sessions) Existence of updated IEC report with (a) topic, (b) number of participants, (c) leader of activity and (d) date and (e) signature 1 0 Plastered and painted wall of solid material Smooth cement floor Ceiling in good condition Windows with glass and curtains Doors that close 1 0 Penis model on the table A box of condoms (male and female) on the table which has at the least 50 condoms 1 0 1 0 At the least one staff trained as a counselor All counseling done by a trained counselor (check certifcicate) 1 0 Individual client cards available; planning for CD4 cell counts 1 0 Each AFB PTB patient has a person attached to him/her who supervises DOTS: proof of mobile phone number of such a supervisor is registered on treatment card. Each PTB patient has a contact address and/or phone number in both the register and the individual card 2 0 Rifampicin-isoniazid-pyrazinamide : cp120+50+300mg Etambutol tabs 400 mg 1 0 Note: E must equal D