Introduction To reach required Ministry of Health standards, nutrition services in health facilities need strengthening. Accordingly, a comprehensive assessment is needed to provide a bench mark to improve the quality of nutrition services. The Nutrition Service Delivery Assessment (NSDA) Tool is specifically designed to assess the status and monitor the quality of implementation for nutrition services in health facilities. The NSDA tool helps generate evidence to inform decisions related to planning for improving nutrition service delivery within the health system. Overall Objective of the NSDA Tool The main objective of this assessment is to generate reliable information on the current status and functioning of the health facility in providing nutrition care and support services. This information will be used to inform plans aimed at enhancing capacity and improving the quality of nutrition service delivery in Uganda’s health facilities. Specific Objectives To assess human resource capacity to deliver nutrition services in health facilities To determine the availability of nutrition services in the health facility To ascertain the existence and functionality of the facility-community linkages To assess availability and functionality of quality improvement projects for nutrition To assess the availability of nutrition equipment, materials, supplies, and adequacy of storage To assess the management and use of nutrition data in health facilities Implementation Protocol The district and health facilities should have information about the assessment from the Ministry of Health (i.e., at least a week before the assessment date). On arrival in the district, the assessment team leader should report to the District Health Officer to brief him/her on the purpose of the assessment. The District Health Officer should introduce the assessment team to the health facility in charges. While at the health facility, the team leader and his/her team should: Introduce the purpose of the assessment exercise Administer the assessment tool accordingly Request to physically check for the availability of tools/equipment Ensure the tool is filled completely and accurately Fill in a summary of healthy facility findings in the form at the end of the tool Debrief the health facility manager one narrative summary report for the team Submit hard copies of the filled-in questionnaires to the team leader Submit your electronic summary report to the team leader and accountability report to the activity coordinator
A. General Health Facility Information To be answered by the health facility manager or his/her appointee(s). Circle the coding corresponding to the correct/observed response. Observe and verify records accordingly. A01 Level of health facility National Hospital Regional Hospital General Hospital 1 2 3 A02 Health facility ownership Government Private not for profit (PNFP) Private for profit (PFP) 1 2 3 A03 Does the health facility offer nutrition services? Yes No 1 2 A04 Does the health facility have a designated nutritionist? Yes (Skip to A08) No 1 2 A05 Does the health facility have a person in charge of nutrition? Yes No (Skip to A08) 1 2 A06 What is the cadre of the person in charge of nutrition services in the health facility? Cadre (specify)----------------------------------- A07 Has the person in charge of nutrition services received any in-service training in nutrition in the past two years? Yes No 1 2 A08 Does the health facility have an established quality improvement (QI) team? Yes No (Skip to A13) 1 2 A09 What is the composition of the health facility QI team? (Tick all that apply) Facility manager Heads of department/units Nutritionists CSO representative Community representative Other (specify)…………… 1 2 3 4 5 6 A10 Does the health facility have a QI work plan and budget? (Verify) Yes No 1 2 A11 Is the QI team functional (i.e., meets monthly and minutes are available)? Yes No 1 2 A12 Does the health facility leadership actively participate in the monthly QI meetings? Yes No 1 2 A13 Does the health facility have a continuous professional development (CPD)/continuous medical education (CME) schedule? Yes No (Skip to A15) 1 2 A14 Are nutrition topics included in the CPD/CME schedule? Yes No 1 2 A15 Is nutrition integrated in the health facility work plan and budget? Yes No 1 2 NO. QUESTION FILTERS
A16 Do you get regular (at least once per quarter) integrated support supervision that includes nutrition from the national/regional or district? (Verify with records) Yes No (skip to A18) 1 2 A17 Do you get regular feedback from the support supervision teams? (Verify with records) Yes No 1 2 A18 Does the health facility have an updated (bi-annual) equipment inventory? (HMIS 092) Yes No 1 2 Any other comments: Capacity to Offer Nutrition Services (A. General Health Facility Information) Poor Fair Good Excellent If: A03 (nutrition services) = No Must have: A03 (nutrition services) = Yes Must have: A03 (nutrition services) = Yes AND at least 2 'Yes' from below: A04 (nutritionist) = Yes or A05 (in charge of nutrition) = Yes A10 (QI team) = Yes A11 (QI team functional) = Yes Must have: A03 (nutrition services) = Yes A04 (nutritionist) or A05 (in charge of nutrition) = Yes AND at least 2 'Yes' from below: A10 (QI team) = Yes A11 (QI team functional) = Yes A12 (QI leadership) = Yes A13 (CPD/CME schedule with nutrition) = Yes A15 (budget and work plan) = Yes A18 (equipment inventory) = Yes
Nutrition Unit/Corner Less than 6 7 to 11 12 to 18 More than 18 OPD (0–4 yrs) Less than 5 5 to 10 11 to 15 More than 15 OPD (5+ yrs) Less than 5 5 to 10 11 to 15 More than 15 YCC Less than 5 5 to 10 11 to 15 More than 15 ANC Less than 4 4 to 8 9 to 14 More than 14 Maternity/PNC Less than 5 5 to 10 11 to 15 More than 15 ART Less than 6 7 to 11 12 to 18 More than 18 TB Less than 6 7 to 11 12 to 18 More than 18 TOTAL # (Poor/Fair/Good/Excellent) D. Community Linkages To be answered by health facility manager or his/her appointee(s). Circle the coding corresponding to the correct/observed response. D01 Do all of the following departments/clinics—nutrition unit, ART, and TB—have links with community-based health workers or volunteers? Yes No 1 2 D02 Do all of the following departments/clinics—nutrition unit, ART, and TB—receive clients referred from the community for nutrition services? (Probe for referral slips) Yes No 1 2 D03 What kinds of community structures exist to support continuum of nutrition care and support in the following departments/clinics: nutrition unit, ART, and TB? (Tick all that apply) Village health Vaccinators Expert clients Family support groups groups Specify……….… 1 2 3 4 5 D04 Is there a mechanism for periodical support of these groups in D03 by the health facility? Yes No (Skip to E01) 1 2 D05 What support mechanisms exist? (Tick all that apply) Supervision Training/mentorship Other Specify………… 1 2 3 Any comments:
G01 Kitchen Yes No 1 2 G02 Utensils (feeding cups, saucers, spoons, plates, bowls, sieves, sauce pans) Yes No 1 2 G03 Dietary scale able to weigh 5 g Yes No 1 2 G04 Manual whisks or electric blender Yes No 1 2 G05 Large containers for mixing/cooking food for the ward Yes No 1 2 G06 Tiffin or saucepans Yes No 1 2 G07 Source of fuel (gas, charcoal, firewood, electricity) Yes No 1 2 G08 Measuring cylinders (or suitable utensils for measuring ingredients and left overs) Yes No 1 2 G09 Jugs (1 litre and 2 litres) Yes No 1 2 Ingredients for making F75 and F100 G10 skimmed milk, whole dried milk, fresh whole milk or long-life milk Yes No 1 2 G11 Sugar Yes No 1 2 G12 Cereal flour Yes No 1 2 G13 Vegetable oil Yes No 1 2 G14 Safe water supply/drinking water Yes No 1 2 Other requirements G15 Locally available foods (for teaching/use in transition to home foods) Yes No 1 2 G16 Waste disposal facilities Yes No 1 2 G17 Soap for handwashing (liquid or bar) Yes No 1 2 G18 Running water Yes No 1 2 Any other comments: