i

Operational Integration of Key Child Survival Interventions

A Guide for District Health Management Teams

- -

Service

Information

Key Interventions

District

Health Facilities

World Health Organization Africa Region 2005

ii

Table of Contents

1. Introduction ...................................................................................................................................................... 1 1.1 Objective of the guide................................................................................................................ 1 1.2 Target audience for the guide .................................................................................................... 1 1.3 Content of the guide................................................................................................................... 1

2. Vision, strategic focus and components....................................................................................................... 2 2.1 Vision......................................................................................................................................... 2 2.2 Strategic focus............................................................................................................................ 2 2.3 Components ............................................................................................................................... 3

3 Integrated Planning and management of resources ..................................................................................... 4 3.1 Planning ..................................................................................................................................... 4 3.2 Managing resources .................................................................................................................. 5 3.3 Integrating Logistics management............................................................................................. 6

4. Re-vitalizing static and outreach services .................................................................................................... 7 4.1 Service area................................................................................................................................ 7 4.2 Detailed Planning....................................................................................................................... 7 4.3 Delivery of service..................................................................................................................... 7

5. Integrated Supportive supervision................................................................................................................ 8 5.1 Planning supportive supervision................................................................................................ 8 5.2 Conducting supportive supervision ........................................................................................... 8

6. Linking integrated services with communities ............................................................................................. 9 7. Integrated Monitoring for action................................................................................................................... 10

7.1 Collecting high quality data..................................................................................................... 10 7.2 Using generated data................................................................................................................ 10

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1. Introduction ntegrating routine service delivery is a cost effective means of achieving the reduction of childhood morbidity and mortality in the African Region. Communicable diseases continue to be the leading causes of childhood mortality in the African Region. The commonest causes of death and illness in the Region are acute respiratory

tract infections mainly Pneumonia, diarrhoeal diseases, malaria, tuberculosis, HIV/AIDS, vaccine preventable diseases and malnutrition. Epidemic-prone diseases such as meningococcal meningitis, cholera, yellow fever pose additional risks.

Many countries in the Africa Region are making efforts to scale up the delivery of essential health interventions toward the attainment of the millennium development goals(MDGs) aimed at reducing child and maternal mortality. However, progress is rather slow with great variation between countries and within districts in the countries. Besides, the efforts to address the observed disease burden has not always consciously promoted linkages or synergy between the different disease control initiatives.

Efforts are being made to increase coverage in routine immunization using Reaching Every District (RED) approach while at the same time it is being tried to accelerate the implementation of diseases control and monitor high quality SIAs integrated with other key child survival interventions like IMCI, ITN, deworming, Vitamin A supplementation, and monitoring through IDSR.

In almost all districts, immunization service infrastructure provides opportunities to offer more services, and can therefore be used as a platform for providing other key child survival interventions. Integrating key survival interventions with routine immunization services has a potential for increasing the cost-effectiveness of the interventions through synergy and improving the efficiency of the health system and support the attainment of the MDGs.

1.1 Objective of the guide This guide provides information and tools for successful implementation of the key child survival interventions at district level.

1.2 Target audience for the guide The guide targets the district health management teams (DHMT) but may also be used by supervisors and other stakeholders supporting immunisation and other child survival activities in the districts.

1.3 Content of the guide The guide covers:

Vision and strategic focus Components Operational considerations for Implementation

The guide also contains sample tools to support implementation aspects of the RED approach.

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2. Vision, strategic focus and components 2.1 Vision Reaching Every child in every District with an integrated package of key child survival interventions is the approach to contribute effectively to the achievement of the Millennium Development Goal of reducing by 2/3rd child mortality by 2015.

2.2 Strategic focus The integrated package includes EPI, IMCI, Malaria control, and supplementation of Vitamin A and other micronutrients which can be defined according to the specific needs and capacity of the districts. Table 1: Child hood threats and suggested interventions / activities that may be integrated with routine immunization Childhood Threats Possible interventions /activities to be integrated

with routine immunization Vaccine preventable diseases Measles vaccination, OPV vaccination, TT

vaccination Childhood illnesses/ conditions Vit A supplementation, Iron supplementation,

De-worming, ORT, Growth monitoring, Care of the sick Child (Cough, diarrhoea, Fever), Iron, Folic Acid

Malaria ITN distribution, IPT for pregnant women Monitoring of disease burden using IDSR,

Integrated EPI, RBM, IMCI monitoring tool Strategy for implementing this integration in the African Region is the Reaching Every District strategy. Specific actions needed for implementing the RED strategy include:

Inter agency coordination committee should be expanded to include all child survival issues Using a district focus for assessment, problem solving, planning, training, budgeting and

implementation of key child survival interventions Prioritizing health facilities for intervention, based upon performance and number of un-reached

children. Providing adequate funding to health facilities to improve access to high quality of key child survival

interventions services, involving all stakeholders Providing essential commodities and services (quality vaccines, injection, sterilisation and waste

disposal equipment and other key intervention supplies Breast feeding counselling, anti-malarial, ORT, antibiotics for Pneumonia, ITNs, Vit A. A, Iron supplementation, anti Helmimthics) in sufficient quantities at the right time at all levels.

Ensuring that health care services are functional and have a fixed strategy immunisation schedule and transport, with other equipment available for outreach strategies (see mobile strategies and SOS strategies) to ensure that people have constant access to immunisation and other health care services;

Motivating people sufficiently for immunisation and key child survival interventions (well thought out social communication activities to stimulate demand, convince those who are hard to reach and encourage community participation) for the effective utilisation of the available services;

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Ensuring the quality of reception and services is guaranteed and relevant information is provided regularly to maintain the motivation levels of the beneficiaries.

Regularly analysing and using data to monitor progress towards set targets/milestones and impacts In almost all districts immunisation services are relatively more developed and can therefore be used as platform for other interventions. Empowerment of the district is key to plan, implement and monitor is key to the implementation of the integrated package. This will also strengthen the entire health system for primary health care delivery, and is an important element for sustainability.

2.3 Components Based on most common barriers to achieving immunisation and other integrated intervention goals, the integrated intervention package will be based on the five operational components of the Reaching Every District strategy.

A) Re-vitalize static and outreach integrated child survival interventions regular outreach for communities that are under-served.

Revitalizing outreach is an essential strategy of integrated child survival interventions in all areas where populations are under-served, whether urban or rural, near or remote. The basis for successful outreach implementation is the existence of a fully operational health facility equipped with a functional refrigerator, supplied with potent vaccines, injection equipment and other integrated key intervention supplies, and manned with an adequately trained, paid and supervised health worker, who has either a functional means of transportation or funds to pay for transportation to outreach sites.

B) Supportive supervision on-site training by supervisors.

Supportive supervision should build the capacity to carry out safe, good quality immunization and other integrated intervention services in the district by providing regular on site training and assistance. It also offers the opportunity to integrate supervision of other key integrated interventions like RBM, IMCI, etc.

C) Links between community and service regular meetings between community and health staff.

Immunization and other integrated key intervention (including community IMCI at community level )services need to integrate better into community structures in an environment of consultation between the community and health managers working towards goal of increasing demand by communities.

D) Monitoring for action regular tracking of progress and response as required

Countries should conduct a critical review of their data systems and improve their data quality at all levels and for the other integrated key interventions. Monitoring systems must be strengthened to direct planning and managerial action at the district level and be interpreted and used at health facility level.

E) Planning and management of resources better management of human and financial resources.

All countries should aim for sustainable financing based upon a Financial Sustainability Plan that includes diagnosis of the current financial situation, future funding prospects, and a strategic plan for moving towards financial sustainability based on the required needs. At each level, plans should contain details of the human and financial resources required to reach every district in a sustainable manner but for realization of integrated implementation, coordinated plan is key.

Source: RED approach 2004,Access working group paper

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3 Integrated Planning and management of resources

3.1 Planning The planning process helps to expose all the problems associated with Integrated Child Survival Interventions and to develop appropriate strategies for resolving them. A well formulated plan should first of all propose solutions to the following critical issues, which all the program managers are often confronted with at district level:

How to increase immunization coverage and reach every child in the district? How to increase the coverage of some other key interventions (ITNs, Vit A, etc.) How to maintain the quality of immunization services? What can be done to reduce dropout rates and missed opportunities?

A district plan should take into consideration the situation in the different service areas, i.e. health facility performance. The health facilities should develop their plans and these are aggregated into a district one.

a) Who should participate in planning? Aim at a widest possible representation of stakeholders At the health facility level

- Health facility in charge and staff (this includes communicator/health educator) - Representative(s) from the community (local health committee, local authority, include community

association, if existing) - Representatives from local NGOs, if existing - Members from district health management team - Community development extension workers/community based workers

At district level

- Members of the DHMT - Communicators/Health Education staff, if not member of the DHMT - Representatives from health facilities in the district (selected if too many) - Representatives from district Administration - Representatives from other social sectors related to health - Representatives from NGOs (in the district) - Member from Regional HMT or National level, if applicable

b) Steps in the process

Step 1: Familiarize participants with red approach and its implementation Step 2: Microplanning by each health facility team with support from DHMT members. Some important considerations in planning include: Understand the current situation, Review possible

Planning should be systematic and have a problem solving approach analyzing situation of achievements and barriers; available human, material and financial resources; prioritizing; setting realistic targets with milestones; including sustainability issues and regular reviews of implementation and achievement to facilitate timely revision of plans

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solutions, Set objectives, service delivery strategies, Determine resource requirements, Develop communication plan, Develop supervision and monitoring plan, and Determine costs Analyze past 2-3 years data on service coverage for all services provided e.g. dose and dropout rates DPT1- (or combination), Vitamin A coverage, ANC coverage, IPT by health facility service area. Has there been a satisfactory increase in coverage?

Set vaccination and other intervention service delivery coverage objectives for the year. The objectives should be realistic - compare past performance; examine strategies necessary; determine resources needed and available. Step 3: Aggregate health facility plans into district level plan showing identified needs, budget estimates and how they will be managed, and an implementation schedule (refer to annex 10 example of micro plan). Cost the planned activities and including communication, supervision, monitoring and evaluation. Avoid double costing. (For more details on micro-planning, consult the AFRO Planning Guide).

3.2 Managing resources The resources expected to fund immunization and other integrated services are to be mobilized from public, private sectors, NGOs and from community. The mobilization of resources to support integrated services should be coordinated in very complementary way to be on time, and efforts should be made by all programs to ensure fund availability. Joint planning with involvement of the stakeholders and managing resources efficiently which demonstrate results are critical to mobilizing more resources.

To manage resources efficiently: Plan and deploy resources according to situation analysis, objective and most appropriate strategies,

taking into account needs/availability; Know and declare resources made available by all stakeholders. Include locally (Local Authority and

community) mobilized resources, both cash and in kind; Identify gaps and utilize existing coordination mechanisms at district level to raise funds and monitor

implementation; Pull resources from the different sources and utilize all integration opportunities e.g.

o transport for distribution shared with different programmes; minimum package for outreach (such as Vitamin A supplementation, distribution of antimalarials, antibiotics, ORT, antihelminthics, insecticide treated nets, antibiotics for pneumonia, etc)

o plan together activities that involve same person and same time to avoid duplication. Distribute resources on the basis of equity (needs) and not equally; Conduct regular preventive maintenance of equipment (cold chain, transport); Update inventory of equipment annually (include models, locations, working status, repair history and

spare parts) Account for the resources at the disposal (funds, equipment, vaccines, syringes and needles,

time, etc).

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3.3 Integrating Logistics management The implementation of the above-described operational components of the RED Approach cannot be effective without a proper logistics support. It is crucial to first get logistics right in order to start implementing the RED Approach. All integrated operations (e.g. integrated service delivery in fixed, outreach and mobile sessions, monitoring, supervision, communication, etc.) depend on effective and efficient logistics, which includes:

1. Management (forecasting, ordering, storage and distribution of vaccines & injection materials, Vitamin A, anti-malarials, anti-helminthics, antibiotics )

2. Transport management, 3. Safe disposal of wastes, 4. Maintenance management for all major and minor equipment.

Logistics activities at district level are outlined below:

Include logistics data on your district map o Include logistics information in your detailed district health map (this map may be drawn by hand).

a) Ensure availability of all supplies for the integrated intervention Ensure correct training of health facility staff in forecasting needs, handling, monitoring use of

supplies and wastage, etc.; Correct monitoring for availability of supplies at level of the district Correctly assess of the needs of the district Determine the optimal frequency of re-supply and establish a schedule During implementation, the supervisor must always bear in mind the idea of bundling both in the

collection and in the distribution of inputs. In simple words, this means that each time the district store or a health facility is supplied with the necessary supplies

o Make supply management tools available at all levels; monitor the stocks of supplies at all levels;, Monitor supply use (wastage and usage rates by health facility);

o Make sure that new policies and technologies are well known at district and health facilities C) Ensure availability and reliability of transport and communication

Maintain an up-to-date inventory of existing transport equipments (cars, mottos, bicycles, boats, etc.); Assess the possibilities to use existing public transport: itineraries, costs and schedules Assess monthly distances to cover by each vehicle of the district headquarter for collection and

delivery of vaccines, drugs, injection materials and other supplies (ITNs, Vitamin A), supervision, monitoring, and mobile sessions; and assess needs for public transport use and its cost;

Assist each health facility to do the same; Make sure the above-mentioned activities take into account the needs of the entire district minimum

activity package; Prepare an integrated transport plan based on the above information and budget for it in the district

micro plan; Assess possibilities of using existing communication equipments both public and private (radio links,

telephone, etc.), their frequencies and working time.; assess the cost of using them and budget for it in the district micro plan.

The items that are needed for the implementation of the minimum package activities, at district and health facility levels should be in the right place, at the right time, in right quantities, at the right quality, in the right condition and at the right cost. Coordination of procurement is essential.

A critical pre-requisite for implementing effective and efficient logistics is existence of a qualified officer with excellent knowledge of the areas of responsibilities-options and conditions, and having data on area served (accessibility, transport and storage capacities). If such an officer is not available, then requesting and obtaining his/her recruitment by either the MoH or the Communities would be a priority for the DHMT.

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To reach every eligible child and woman (including the under served), it is important to re-vitalize outreach services; for that it is necessary to know where they are located; how many they are by location, why any population groups underserved, what it takes to reach them. It is also important to establish which other child survival interventions are feasible to add on. Many districts may have large groups of populations living in hard to reach areas.

4. Re-vitalizing static and outreach services

The key issues to be considered in revitalizing static and outreach integrated package of child survival services include the service area, detailed planning and delivery of services .

4.1 Service area Obtain (or draw) a map of the district (Annex 1.1); Map out the location of all facilities and their target population by villages they serve and include schools

(community resources); Assign to each facility an area of responsibility (service area) and provide with a map of the area or help to

draw one; Adjust the limits of the service areas according to the natural demarcation.

4.2 Detailed Planning Support each facility to conduct the following: Dotermine target population by the most appropriate strategy: fixed, outreach, mobile, and, include all

under-served locations and groups (Annex 1. map 1) Determine whether the problems of under-served populations are access-related or quality-related and

adopt necessary action accordingly Determine number of sessions per month/quarter for each strategy that is applicable; Discuss schedule of sessions with community through local authorities and opinion leaders, and reach

consensus on involvement of the community to make the sessions effective. In some cases the services can only be delivered every three months. Particular reference and planning is needed for the minimum package when conducting services for areas with poor accessibility.

4.3 Delivery of service Ensure health facilities are operational (functional fridge, available vaccines and injection equipment, supplies for other

integrated interventions, transport for outreach, trained and supervised health workers); Support health facility to:

- Use checklist to prepare outreach service delivery- vaccines and injection equipment, stationery, supplies for other integrated interventions, health education materials, and equipment for other primary care tasks (e.g. weighing scales), medicines etc. as applicable;

- Provide adequate information to caretaker - date and time of the next session of services, place of next immunization; number of visits still needed (child and/or woman); possible side effects and what to do should they occur

- Track targeted children and women by keeping registers and updating them monthly; communicate non-starters (newborns) and defaulters to community focal points for follow up and ensuring completion of schedule.

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5. Integrated Supportive supervision

Important issues to be addressed in planning and conducting integrated supportive supervision and outlined below.

5.1 Planning supportive supervision Plan to conduct regular supervisory visits - monthly/bi-monthly or quarterly; Arrange for more visits to lesser performing health facilities; Prepare a supervision map of the district showing the different supervision routes with

their distances, durations frequency and dates, the types of vehicle to be used, the number of people who should go, the total cost of each route, etc;

Incorporate supervision in district micro-plan and budget for it; Each supervisory visit should have clear objectives.

5.2 Conducting supportive supervision During supervisory visits:

observe a service session (see if standard procedures are followed), interview clients to get their views on quality of services as they leave the facility (exit

interview), observe the interaction between health workers and caretakers at the health center (quality

of the dialogue: are key messages on immunization and other integrated interventions given, how these messages are given);

arrange for staff meetings without adding extra burden to the health facility staff or disrupting the services,

follow-up on recommendations made during previous visits, check the availability of stock of vaccines and other supplies (ITN, IPT, ORT) state of the

equipment, and quality of the cold chain re-stock, take immediate corrective actions whenever possible and note any problems for further action (Annex 1.4 integrated supervision check list )

review health center records, coverage charts, and log books and discuss with health facility staff

note in the Supervision Book (provide each health facility with one) your observations, as well as problem areas and recommendations to implement before next visit.

Use supervisory visit to distribute up-dates and supplies for the health facility During the visit organize on-site training, structured according to observed weaknesses

and new information Introduce a self-assessment/feedback system

Supportive supervision promotes quality outcomes by strengthening communication, focusing on problem-solving, facilitating teamwork and providing leadership and support to empower health providers to monitor and improve their own performance.

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6. Linking integrated services with communities

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Well-planned communication Integrated communication activities will enable the district to: Generate support for the key integrated child survival interventions from political leaders and decision

makers; Improve quality of services through interaction between health workers and clients, continuous public

information and timely response to adverse events and rumours; Help to reach the hard to reach, hard to convince, left-outs (un-reached) and drop-outs (who did not

complete the service); Enhance community ownership by linking them with the services and building partnership.

In order to strengthen the linkages of the integrated services with communities, important considerations include the following:

Sensitize key opinion leaders (such as religious and community leaders) in the community in order to gain their cooperation, support and participation of their communities;

Establish community focal points at district and facility levels; Involve community in planning and monitoring of the integrated services; Use existing community structures for communication e.g. CBOs, religious groups; Advocate for support for the integrated child survival interventions with heads of other sectors

(administrative authorities, education, social services, information, etc); Mobilize and organize community groups such as scouts, school children and teachers, and other

volunteers and assign them specific roles as defaulter tracking; Hold regular meetings and share progress, problems and impact of child survival interventions in the

district with relevant agencies and community leaders as a feedback; Disseminate information on a regular basis to the community through; community meetings, local radio,

house-to-house visits by community health workers and volunteers, IEC materials, community announcers etcinclude response to any adverse events and rumours;

Conduct training for health workers and community educators to strengthen their interpersonal communication skills and ensure proper information is given;

Supervise communication activities as part of integrated supervision (include communication questions in the checklists and observe health worker IPC with caretakers);

Conduct exit interviews and focus group discussions with community members (to understand their satisfaction) and conduct KAP on child survival interventions (to improve communication messages and activities).

Communities are the beneficiaries of the services and therefore they must be linked to the services! Strengthening the link between community and services can only be achieved through the involvement and effective empowerment of community in the management of the services. This will create awareness, stimulate demand, help convince those that are hard to reach and encourage community participation.

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Monitoring for action: generating basic information and using it to direct the programme planning, measuring progress, identifying areas needing specific interventions and, revision of plan including IDSR strategy to generate information. Timely and reliable data is crucial!

7. Integrated Monitoring for action

Monitoring for action that is effective for the management of the integrated services requires the following: A functioning health information system that provides quality data accurate, timely and consistent. Adequate resources human, materials and financial. Regular analysis and review of collected data. Feed forward and feedback of information according to established deadlines. Taking appropriate action when required

It is essential that districts collect high quality data and make adequate use of the generated data.

7.1 Collecting high quality data Establish best estimate of the target population of the district, each health facility service area and by

village. Provide adequate tally sheets that contain all the needed variables to all health facilities and monitor

each strategy (fixed, outreach/mobile) separately (Annex 1.1 & 1.2). Keep a checklist to track report submission by facility and record date report received for follow up

with facilities not/or submitting late. Check records and discuss with health facility staff during supervisory visit. Keep a back up file of reports at district and facility levels for verification when needed. Investigate cases and outbreaks of vaccine-preventable diseases (measles, neonatal tetanus, yellow

fever, HiB infection, acute flaccid paralysis) according to national procedures.

7.2 Using generated data Generated data should be analyzed and shared with stakeholders. Key variables and indicators to be analyzed

include the following: Vaccination coverage and drop-out rates by strategy (fixed, outreach) and month, Morbidity and mortality data of Malaria, Pneumonia, Diarrhoea, VPDs other epidemic prone

diseases on weekly and or monthly basis Supplies distribution/administration, stocks and coverage District vaccine stocks and other

supplies/ anti-malarials, antibiotics, ORT, contingency stocks for epidemic prone diseases (in months). Use maps, graphs and charts to illustrate performance, as required

Ensure a wall chart for monitoring coverage and drop-out is kept by each health facility and is up-dated monthly. Check if health facility uses monitoring charts and interpret them correctly using indicators & epidemic thresholds, where applicable. Conduct regular (monthly/quarterly) reviews of analyzed data: During the reviews, the Health facilities should involve community focal points, and Districts should involve facility staff, other programme officers and local non-health authorities. Use the opportunity of review meetings to compare trends of administrative coverage of services with disease incidence/deaths to see if the corresponding reduction is achieved, and use the conclusions of the reviews for any necessary corrective measures and planning. Always commend good performance.

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ANNEXES

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Annex 1 Example of Micro plan for integrated child survival activities

Table 1: Population Data Population Target Population Villages fixed strategy 148 Fixed 279644 Fixed 12864 Villages outreach 87 Outreach 67170 Outreach 3090 Villages mobiles 86 Mobile 46415 Mobile 2135 Total villages 321 Total 393229Total 18089

*Estimated needs of the health district of Mavanga Target population fixed and outreach 15953

Target pop. Target coverage Doses Waste factor Needs Reserve Annual need Monthly needBCG 15953 0.8 1 2 25525 6381 31906 2659 DPT 15953 0.8 3 1.33 50922 12730 63652 5304 OPV 15953 0.8 4 1.43 73001 18250 91251 7604 Measles 15953 0.8 1 1.33 16974 4243 21217 1768 Yellow fever 15953 0.8 1 1.33 16974 4243 21217 1768 TT 15953 0.8 2 1.33 33948 8487 42435 3536 *Estimated needs for fixed and outreach services c. SYRINGE And other commodities NEEDS estimate

Target pop. Target coverage Doses Waste factor Needs Reserve Annual need Monthly needBCG 15953 0.8 1 1.1 14039 3510 17548 1462 DPT 15953 0.8 3 1.1 42116 10529 52645 4387 Measles 15953 0.8 1 1.1 14039 3510 17548 1462 Yellow fever 15953 0.8 1 1.1 14039 3510 17548 1462 TT 15953 0.8 2 1.1 28077 7019 35097 2925 140386 11699 Antibiotics ORT Antimalarials ITNs Vitamin A ***Estimation of target groups:

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1

Health Facility Reporting Form Month. Year

Health Facility District..

Static Static O/reach O/reach

DoseStatic O/reach Total Static O/reach Total Opened Administe

redBroken/Expi

red/VVM change

BCG

OPV0OPV1OPV2OPV3

DTP1*Protected at birth DTP2DTP3Slept under net last Fever last 2 weeksAppropriate drug for

HepB-birth**Hep1**Hep2Hep3

Hib1Hib2Hib3

Measles1Exlusive breast fed Fever last 2 weeksApprpropriate drug ORTYellow fever**Vit A supplAntibiotics

Static O/reach Total Static O/reach Total Static O/reach TotalTT1TT2TT3TT4TT5

Children > 1 yr of age

Catchment target population

Children < 1 yr of age Vaccine doses

Child bearing women

Children < 1 year of age

Child-bearing womenPregnant Non-preg. Post part.

Annexes:1.2 Health facility reporting form

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Tool for Conducting Integrated EPI, RBM, IMCI RED Review Meeting

Targets Questions to ask Comments Coverage Indicators 1. DPT3 coverage by HF/District

80%

2. Dropout by HF/District 10% 3. ITN 80% 4. Appropriate anti-malarial 80% 5. ORS coverage 80% 6. Vitamin A 80% 7. Exclusive breast feeding until 6 months

80%

Why has 80% not been reached?

Compare with and examine inputs and logistics. Seek resources from local or national. Link to district

microplanning.

Impact Indicators - Surveillance 1. Trend

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Integrated monitoring and supervisionHealth Facility Level

Supervision of Planned activities and interventionsPlanning Basis in this district

GENERAL Evidence based with rational allocation of resources

Health Facility Incharge NameDistrict Name (Choose First) NyangaName of Health FacilityType of Facility/OwnershipType of VisitIs the supervisor trained in or oriented in or is accompanied with members oriented in all interventionsFALSE . FALSESTATE if Support to Supervision is needed (type of support)

Total number of all H/ workers

INTERVENTIONSHW Skilled Problems with

PATIENT FLOW AND TRIAGEIMCI General Danger SignsAre Children Under 5 MalariaCorrectly Managed? Pneumonia

AnemiaDiarrhoeaDrugs Equipment and Supplies Management Funding Authority

Safe mother hood Drugs Delivery Antenatal Care0

Malaria Drugs Equipment Management

Immunization/Growth Monitoring Vaccines Equipment Drop out rate0

HIV/STD Prevention and Management Drugs ARV Management0

TB DOTS Drugs Materials/Equipment Management0

IDSR (Surveillance) Data Use Reporting Records0

Child Health Drugs Equipmenet/supplies Management0

7 0

HEALTH FACILITY MANAGEMENTHuman Resources Persons trained and availability. Refer to your Data Base

Toilet, Water, Power, Environmental sanitation. Toilets Water Environment sanit0

Power Power Source Cleanliness0

Linkage with the community Outreach Committees Health Days0

Perception of servic Services needing improvementIEC Materials0

Care of material structures in the facility, Equipment Buildings0

Epidemic preparedness. 00

Observations and comments on services provided, Expectations Areas that might need emphasis or actions are:No comment 0 0 0 0No comment 0 0 0 0No comment 0 0 0 0No comment 0 0 0 0No comment 0 0 0 0

Action TakenAnnex 1.4 Integrated Supervision checklist

Observation of Case Management

Annex IIa. Integrated monitoring and supervision tool

Annex IIb: FOR EVERY INTEVENTION WHAT CONDITIONS HAVE TO BE IN PLACE IN ORDER TO CATEGORISE THE SERVICES PROVIDED AS ACCEPTABLE / NOT ACCEPTABLE / NEED IMPROVEMENT

Intervention Drugs Equipment and Supplies Management Safe Motherhood 1. Oxytocin

2. Diazepam 3. Micronutrients 4. contraceptives

1. Delivery packs 2. Resuscitation equipment 3. BP machine 4. Partogram

1. Goal oriented ANC 2. Use of partogram 3. Correct obstetric emergency management

TB DOTS 1. Rifampicin 2. INH 3. Ethambuto 4. PZA

1. Specimen jars 2. Registers 3. TB cards

1. Registration 2. Counseling 3. Dispensing of correct drugs

STD HIV Prevention and Treatment

1. ARVs 2. Antibiotics STI syndromic Kanamycin, Benz,

Metro, Doxy, Erythro 3. Cotrimoxazole

1. Test kits HIV & RPR 2. Condoms 3. Gloves

1. H/E 2. Pre-post test counseling 3. Contact tracing 4. Correct syndromic management 5. Counseling 6. Follow up

Malaria 1. QUININE 2. Sp and chloroquine 3. 1st line Antimalaria 4. Antipyretic

1. Slides 2. IV Fluids and equipment for administration of

Quinine

1. Correct Management 2. Correct Counseling 3. Correct Follow up

Immunization and Growth Monitoring

All Vaccines Emergency Drugs for management of AEFI (Atropine and adrenalin) Vitamin A

Salter Scale Cold Chain Equipment Child Health Card AD Syringes and Needles Safety boxes

Management of the Cold Chain Counseling Correct Schedule Correct Immunization Tech Documentation

Child Health Antibiotics for Pneumonia and Antimalaria for Malaria ORS

Salt and Sugar Solution

HMIS N/A 1. communication system 2. stationery 3. calculator

1. Accuracy 2. Timeliness 3. Completeness 4. Analysis of data 5. Data utilization

IMCI General Danger signs Pneumonia Malaria, Diarrhea and Anemia

Checking for Assessment, Classification, Treatment, Counseling, Follow up, Referral

Assessment, Classification, Treatment, Counseling, Follow up, Referral

Where 3 or more conditions or variables are used All of the conditions met or present Acceptable Two Conditions not met or missing Needs Improvement More than two Conditions not met or Missing Not Satisfactory For IMCI: Indicate whether Checking for GDS, Assessment, Classification, Treatment, Counseling Follow up and Referral was done correctly.

Map 1: Planning Strategy for Service delivery

X km

Mobile strategy

Pop 500

Pop 654

Pop 211

Pop 1125

Pop 99

Pop 89

Pop 187

5 km

Pop 221

Pop 400

10 km

Fixed strategy

Outreach strategy

Health Center

Pop 688 Pop 339

Pop 675

Pop 1898

Pop 312