The Facility shall adhere to the norms for Primary and Secondary Register Column Headers as described in the applicable Performance Based Financing Manual. In the event pre-printed PBF registers are not available, the health facility shall design registers using the available office stationery according to the above mentioned norms. . All numbering, in all registers, from the first day of the PBF contracting, shall start with a ‘1’, and continue for the remainder of the calendar year. The following calendar year, the numbering should start with a new ‘1’, etc. The end of the month should be clearly indicated through a line. The numbering should continue into the following month, until the end the calendar year. Routine Health Management Information System (HMIS) data shall align with data from the PBF registers. Quality audits In order to ensure that the services performed by the HF meet satisfactory quality standards, specific Quality Indicators (as described in the latest PBF manual) will be assessed every quarter by the LGA PHC department. The results of these Quality Audits will be factored in the calculation of the overall performance of the HF and the final PBF invoice as follows: 25% of the total claimed earnings over the preceding months shall be added as “quality bonus” if the quality score for that quarter is 100%. If the HF’s quality score is 49% or less, the quality bonus is automatically ‘0’ for the evaluated quarter. A quality score between 50% and 99% will be prorated as follows: Quality Bonus = % Quality Score * (total earnings for all contracted services over the past three months). The quality audits shall be counter-verified regularly by an independent third party to be determined by the SPHCDA. If fraud is detected with the quality score, the present purchase contract may be terminated immediately by the SPHCDA. Validation of the Quarterly Consolidated PBF invoices The LGA PBF Steering Committee shall, on a quarterly basis, validate the Health Facility’s monthly PBF invoices and the quality score obtained.
represents three month’s protection and a FP visit for OAC should provide three month’s worth of pills. kept at the pharmacy; drugs register and stock cards conform. 14 FP: implants and IUDs Any new user of implant or IUD, during the evaluated month. FP register Eventual drugs and medical consumables dispensed through the prescriptions kept at the pharmacy; drugs register and stock cards conform. 15 FP: vasectomy and bilateral tuba ligation A vasectomy and bilateral tuba ligation carried out at this facility, during the evaluated month Theater register Family Planning Register 16 VCT/PMTCT/PIT test Any new VCT or PMTCT or PIT test carried out during the evaluated month. VCT/PMTC register Laboratory register; stock records 17 PMTCT: HIV+ pregnant mothers and children born to are treated according to protocol Any new HIV+ mother and newborn child treated according to the PMTCT protocol, during the evaluated month. ARV register; delivery room register PMTCT register; laboratory register; stock records. 18 STD treated Any new STD treated according to the syndromic treatment protocol, during the evaluated month Curative Care Register Drugs and medical consumables dispensed through the prescriptions kept at the pharmacy; drugs register and stock cards conform. 19 New Client put under ARV treatment Any new patient (pediatric or adult) HIV positive who started ARV (Antiretroviral therapy), including transferred in, during the evaluated month. ART Register Patient files
20 New AFB+ PTB patient A new AFB sputum positive Pulmonary Tuberculosis patient diagnosed, at the facility, during the past month. Tuberculosis register Laboratory register: Slides kept for assurance. 21 PTB patient completed treatment and cured A former AFB+ PTB patient completed DOTS, and cured after treatment proven by negative sputum examinations, during the past month. Tuberculosis register Laboratory register: Slides kept for assurance. Drugs register.
Remarks Date: Name of Supervisor: Signature of the supervisor: 4 Care for the Indigents [max 4 points] YES NO 4.1 Planning for Care for the Indigents expenditures 1 0 4.1.1 5% of curative consultations of the previous month: documented quantity in monthly management meetings 4.2 Indigent committee meets monthly 3 0; 1; 2 4.2.1 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; (vi) minutes of the meeting are signed by the chairman. Each report according to norms = 1 p Total Points (4) ../4 Remarks Date: Name of Supervisor: Signature of the supervisor: 5 Hygiene and Sterilization [max 31 points] YES NO 5.1 Fence health facility available and well-maintained 1 0 5.1.1 Fence exists, can be closed at night and there are no holes 5.2 Availability of a garbage bin in the courtyard 1 0 5.2.1 Bin with lid accessible to clients which is not full 5.3 Presence of sufficient latrines/toilets which are well-maintained 5.3.1 At least two functional latrines/toilets 1 0
7.7 Stock of oral and injectable contraceptives is adequate 2 0 7.7.1 For example for 100.000 pop 100 doses of oral (3 month cycles) and injectable methods combined 7.8 IUD available and staff trained to use it (certificate available) 7 0 7.8.1 at least 20 IUDs and at the least one staff trained to use it (Section 7: FP) 7.9 Implant method available and staff trained to use it (certificate available) 7 0 7.9.1 at least 20 implants available and staff trained to use it 7.10 FP individual cards available and filled according to the format 4 0 7.10.1 Check at least five cards for BP, hepatomegaly, varicose veins, weight Total Points (31) ../31 Remarks 8 Laboratory [max 12 points] YES NO 8.1 Medical laboratory scientist is available 1 0 8.2 Laboratory is open every day of the week 1 0 8.2.1 Supervisor verifies the last 2 Sundays in laboratory register 8.3 List of laboratory examinations visible for the public with fees 1 0 8.4 Results recorded correctly in laboratory register and match with results in inpatient sheets or OPD examination cards 1 0 8.4.1 Supervisor verifies last five results 8.5 Availability of parasites demonstrations 0.5 0 8.5.1 On plastic paper, in a color book, or put on wall 8.5.2 Blood smear: Vivax, Ovale, Falciparum and Malariae 8.5.3 Stools: Ascaris, entamoeba, ankylostoma and schistosome 8.6 Microscope available and functional 0.5 0 8.6.1 functional objectives; immersion oil available, mirror or electricity
8.6.2 blades, cover glass, GIEMSA available 8.7 Malaria rapid tests available 0.5 0 8.7.1 At the least 20 tests available in the laboratory; non-expired 8.8 Equipment available and functional; (i) centrifuge; (ii) electrophoresis machine; (iii) hematocentrifuge; (iv) clinical chemistry analyzer; (v) hemoglobinometer (manual or automated) 2.5 0 8.9 Waste evacuation correctly carried out 1 0 8.9.1 Organic waste in a bin with lid 8.9.2 Security box for sharp objects available and destroyed according to waste disposal guidelines 8.11 Personnel adequately washes dirty pipettes in containers with antiseptic 1 0 8.12 Laboratory equipment for testing for PTB 2 0 8.12.1 Reagents for AAFB testing; stock control car for reagents is available and lists stock; at the least 30 non-recycled slides available for testing 8.12.2 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 Total Points (12) ../12 Remarks (Laboratory) 9 In-patient Wards [max 155 points] YES NO 9.1 Guard duty roster clearly visible for staff and followed up 2 0 9.1.1 Supervisor verifies guard duty's report - names, phone numbers and signatures 9.2 Furniture available and in good state 8 0 9.2.1 Each bed has a (i) plastic covered mattress, (ii) mosquito net, (iii) clean sheets, (iv) night table 9.3 Patient comfort and hygiene 5 0 9.3.1 The wards are clean: no debris on the floor; and wards smell of disinfectant 9.3.2 Space between the beds is at the least one meter
10.3 Main pharmacy store delivers drugs to health facility departments according to requisition 10 0 10.3.1 Supervisor verifies whether quantity requisitioned equals quantity served 10.3.2 Drugs to clients are uniquely dispensed through prescriptions. Prescriptions are stored and accessible 10.3.3 Drugs and medical consumables prescribed, are all in generic form 10.4 Drugs stored correctly 2 0 10.4.1 Clean place, well ventilated with all drugs on cupboards, labeled shelves 10.4.2 Drugs and medical consumables stored on alphabetical order, first in - first out basis 10.5 Absence of out of date drugs or drugs with unreadable labels 1 0 10.5.1 Supervisor verifies randomly three drugs and 2 consumables 10.5.2 Out of date drugs well separated from stock 10.5.3 Destruction protocol for out of date drugs available and applied Total Points (20) ../20 Remarks (EDM) 11 Tracer Drugs (min. stock = Monthly Av. Consumption times 2- Minimum stock is two months average consumption) [max 30 points] Available YES = or > MAC X 2 Available NO < MAC X 2 11.1 Paracetamol 500 mg tab 0.5 0 11.2 Acetyl salicylic Acid 30 mg tab 0.5 0 11.3 Ibuprofen 200 mg caps 0.5 0 11.4 Promethazine 25 mg tab 0.5 0 11.5 Promethazine HCL 50mg/ml vial 0.5 0 11.6 Oxytocin 10IU/ml vial 0.5 0 11.7 Methergine 0.2 ug tab 1 0 11.8 Mebendazole 100 mg tab 0.5 0 11.9 Ferrous Sulfate 325 mg tab 1 0 11.10 Propranolol 80 mg tab 0.5 0
11.11 Nifedipine 10 mg caps 0.5 0 11.13 Amoxicillin 500 mg caps 0.5 0 11.14 Amoxicillin 125 mg/5ml suspension 0.5 0 11.15 Ampicillin 1 gr vial 1 0 11.16 Ampicillin 250 mg vial 1 0 11.17 Gentamicin 40mg/ml vial 1 0 11.18 Metronidazol 500mg/100ml vial 1 0 11.19 Co-trimoxazol 480 mg tab 0.5 0 11.20 Co-trimoxazol 40mg/200mg - 5ml susp 0.5 0 11.21 Doxycycline 100 mg caps 0.5 0 11.22 Erythromycin 250 mg tab 1 0 11.23 Co-artemeter 20/120 mg tab (types 1; 2 3 and 4 all available) 1 0 11.24 Quinine sulfate 200 mg tab 1 0 11.25 Quinine hydrochloride 300 mg/ml vial 1 0 11.26 Sulfadoxine/pyrimethamine 500 mg tab 0.5 0 11.27 ORS sachet 1 0 11.28 Condom 0.5 0 11.29 IUD 1 0 11.30 Contraceptive pill monthly cycle 1 0 11.31 DMPA 150mg vial 1 0 11.32 Contraceptive implant 1 0 11.33 Venflon 18G 0.5 0 11.33.1 Min stock = 10; MAC applies only when higher than 10 11.34 Venflon 22G 0.5 0 11.34.1 Min stock = 10; MAC applies only when higher than 10 11.35 IV giving set 1 0 11.35.1 Min stock = 10; MAC applies only when higher than 10 11.36 Ringers lactate 1L 1 0 11.36.1 Min stock = 5L; MAC applies only when higher than 5L (Section 11: Tracer Drugs) 11.37 Dextrose 5% 1L 1 0
Annex 13: Business Plan for Health Centers PBF-Business Plan for Health Centers Version 28 October, 2011 Analysis of results Month 1 – Month 3 [Year] & plan for Months 4 – 6 [Year] GENERAL INFORMATION LGA……… Health center……………… Population [Year]: ……… Are there sub-contracted private clinics or health posts? Yes / no If yes, which? ………………… Qualified staff: ….. Non qualified staff: …. HEALTH CENTRE STATISTICS [Years] Months OPD Visits New cases Hospital bed days Assisted deliveries in health facility Nr of women using FP (new + re-attendants) oral (3 months) & Injectables Nr ANC visits (new) Nr ANC visits (standard visits) EXTERNAL CONSULTATIONS What is the monthly target for OPD consultations in your Ward: ...……………
Annex 15: Individual Performance Evaluation Template Individual Performance Evaluation for Health Staff Criteria 25% Score 50% Score 100% Score Max Score 1 Professional Awareness includes the following: (20 points) Timeliness Arrived frequently late (at the least four times past month) Arrived sometimes late (1 to 3 times per month) Was always on time 8 Availability Has been frequently absent from his/her service without any clear motive (at the least four times past month) Has been a few times absent from his service without clear motive (1 to 3 times per month) Was never absent from his/her service without known and valid motive 8 Uniform Did not wear a uniform during working hours (even once per month) Neglected uniform (dirty or torn or not ironed) Uniform always worn and proper (washed ; ironed and not torn) 4 2 Team spirit includes the following: (30 points) Interpersonal Relationship Frequently in conflict with colleagues (reported more than once to his/her superior during the past month) Sometimes in conflict with colleagues (reported once to his/her superior) Never in conflict with colleagues 8 Collaborative spirit Frequently refused to assist colleagues when asked Sometimes refused to assist colleagues Never refused to assist colleagues 8