Where applicable, there is a shaded waiting area at program service delivery sites with safe drinking water and wash facilities available; CP staff members deal with beneficiaries in a polite and friendly manner; A panaflexe (a poster/chart that visually communicates emblems, images and phrases), in local vernacular where required explaining complaint/feedback mechanism is posted in waiting area; CP staff members, delivering services at community level, understand well and adhere to work timings; CP staff has properly explained the beneficiaries/children in use of recreational kit material or any other material being distributed by CP staff; Minimum Standards for CP Interventions Friendly Space Minimum Standards Following facilities are available at CFS: Toilet facility Safe drinking water Adequate light and ventilation Hand washing facility Indoor and Outdoor equipment for playing and recreation CFS has child friendly physical environment including: CFS is located at a safe and secure place CFS is clean and tidy Children have enough to work and play There are posters and illustrations on the wall There is display of children’s work in CFS Children are choosing and accessing play material with minimal assistance CFS has proper seating arrangements encourage participation Toys are available in good conditions and are culturally and age appropriate CFS is providing child friendly learning environment including:
02 tables for Outpatient Department (OPD), out of these 01 table is for Male OPD and 01 for Female OPD; 03 chairs for OPD, out of these 01 for Male OPD, 01 for Female OPD and 01 is being used as per need; 02 Examination Stools; 02 shade/umbrella for OPD; 01 for medicine supplies; 01 lock and key; 02 benches; 02 medical privacy curtains; 02 canopies; Equipment includes: Dressing Drum Kidney Tray B.P Set Mercury Stethoscope Needle Holder Forceps Steel Bucket Artery Forceps Curved Artery Forceps Dressing Tray Waste Paper Bucket Emergency Box Tongue Depressor Steel Examination Torch Weighing Machine Fetoscope Needle Cutter Thermometers Safety Ambu Bag Ambu Bag (Adult) Mobile Health Facility Leadership
8 Has distribution point two different entry and exit points? Yes=1, No=2 9 Is safe drinking available at distribution point? Yes=1, No=2 10 Is ‘Accountability to Beneficiary’ panaflex clearly displayed in the waiting area/distribution Yes=1, No=2 Mobile Health Facility Monitoring Checklist S. No. Questions Codes (Please select one code only) Responses (Please put a code here) 1 Are all designated health staff members presents at health facility? Technical and Support Staff is present=1, Only Medical staff is present=2, Only Support Staff is present=3, None of them is present=4 2 Are sufficient medicines (according to drug list)? Yes=1, No=2 3 Is medicine supply chain smooth? Yes=1, No=2 4 Are health facility staff members coming and leaving on time? Yes=1, No=2 5 Is doctor taking minimum 5 minutes to examine a patient? Yes=1, No=2 6 Is safe drinking available at mobile health facility? Yes=1, No=2 7 Is mobile clinic set up in an easily accessible location? Yes=1, No=2
Cash for Work Monitoring Checklist S. No. Questions Codes (Please select one code only) Responses (Please put a code here) 1 Are all beneficiaries working on cash for work site above 18 years of age? Yes=1, No=2 2 Are all beneficiaries working on cash for work site fall under one of the agreed criteria? Yes=1, No=2 3 Are beneficiaries working on cash for work site aware of terms and conditions (wages, working hours etc? Yes=1, No=2 4 Is attendance of cash for work beneficiaries maintained on attendance sheet? Yes=1, No=2 5 Are cash for work beneficiaries abiding by work timings? Yes=1, No=2 6 Is ‘Accountability to beneficiaries’ site standards clearly displayed at cash for work site? Yes=1, No=2, Yes but not clearly displayed=3
S. No. Questions Codes (Please select one code only) Responses (Please put a code here) 1 Does beneficiary fall under one of the agreed criteria? Yes=1, No=2 2 Did beneficiary pay any money/favors to SC staff to get enterprise assistance? Yes=1, No=2 3 Does beneficiary seem improving his business? Yes=1, No=2 4 Is business economically appropriate? Yes=1, No=2 5 Is business improving services at community level? Yes=1, No=2 6 Is there a child under 18 years of age working at supported business? Yes=1, No=2 Food Voucher Monitoring Checklist
3 Does it take less than 3 minutes to fill a 20-litre container at the water point? Yes=1, No=2 4 Is water point > 15m from a latrine pit? Yes=1, No=2 5 Is water point < 500m from dwelling? Yes=1, No=2 6 Is there 1 latrine available for 50 persons? Yes=1, No=2 7 Are latrines being used by all beneficiaries (men, women, children elder)? Yes=1, No=2 8 Has a latrine maintenance kit been provided with each latrine (latrine brush, mob, and bucket)? Yes=1, No=2 9 Is there stagnating waste water ponds in the village? Yes=1, No=2 10 Is there 01 shower place available for 50 people? Yes=1, No=2 11 Is there 01 washing basin or washing place for 100people? Yes=1, No=2 12 Were 02 Hygiene sessions conducted in the village Yes=1, No=2 13 Were 02 hygiene volunteers trained in the village? Yes=1, No=2 14 Is soap being used in HHs for hand washing? Yes=1, No=2 15 Prior to the start of the activities, were meetings conducted with community to seek their feedback and participation? Yes=1, No=2 Annex III: Community Feedback Form Date of feedback received ------------------ Beneficiary /non-beneficiary Name Name ------------------------------ Village ---------------------- UC no ----------------------------- Email (if any) ----------------------------------------------- Feedback Sector Livelihood Health Education Protection Nutrition Food Aid Phone
Annex V: M&E Action Plan Tracker Format M&E Action Plan Tracker Date of Update District Program/Sector Action Plan Agreed (as per M&E and A report) Date of visit Initial agreed date of completion - per report Accountable person Action plan achieved? (To be filled by DPM in Yes or NO) Comments from Accountable Persons for any delay / issue implementing agreed action Comments from Line Manager of Accountable Person
VI: Beneficiary Feedback and Complaint Tracking Database Beneficiary Feedback and Complaint Tracking Database Date complaint received Complaint Received By Hotline or Feedback Form Sector/ Name of Can we call the (Y/N) Can we visit the (Y/N) No. (if permitted) Village UC District Description of Complaint Person complaint referred to (field program manager, program coordinator, etc.) Description of investigation and resolution process (by A.O., field staff, etc.) Description of resolution Staff member who communicated resolution to complainant Date closed*