IQHCS Final Report - Volume 2- Annexes

Improving Quality of Healthcare Services Project | 54
Evaluation Report
Annexes
Annex 1: Implemented Primary Health Care Standards (PHCSs) in four
Evaluated Districts
Standard
No.
Criteria
No.
Standard Details
No of PHCFs where PHCSs
Implemented
Total no of
PHCFs
where
PHCSs
Implemented
Malakand Chitral Abbottabad Swat
1.4 1.4.1.a Repair (mostly washrooms,
residences for HCPs, walls,
roofs, medicine racks)
7 3 9 10 29
1.4.2.b The facility has functioning
electricity
8 7 - 10 25
1.4.6.3 X-Ray viewer 5 - - -
5
1.4.6.5 ENT diagnostic set 5 - - - 5
1.4.7.g Additional equipment (mostly
geyser for hot water)
8 10 9 10 37
1.5 1.5.1.a Protected water source, water
tank or protected spring,
pump, well.
4 2 5 2 13
1.5.2.b A supply line and storage
system of clean water
5 1 - - 6
1.6 1.6.1.a The waiting area protects
clients from sun, rain.
2 5 4 2 13
1.6.3.c The waiting area has chairs or
other seating arrangements
4 - - 3 7

Evaluation Report
Standard
No.
Criteria
No.
Standard Details
No of PHCFs where PHCSs
Implemented
Total no of
PHCFs
where
PHCSs
Implemented
Malakand Chitral Abbottabad Swat
1.7 1.7.2.b Staff and clients have access to
separate latrines or toilets
which are lockable from the
inside.
1 - - - 1
1.8 1.8.4.d Covered pit 6 1 6 10 23
1.12 1.12.1.a Privacy - 1 - 1 2
1.12.8. Staff are provided with and use
protective equipment e.g.,
aprons
3 - - - 3
2.2 2.2.a Information about services 2 - 4 10 16
2.7 2.7.1.a Curtains/Rods for private
examination
- 2 - 4 6
2.11 2.11.3.c Health education messages 7 - - 10 17

Evaluation Report
Annex 2: Planned Secondary Health Care Standards* (SHCSs) in four Evaluated
Districts
Standard Name
Standard
No.
Criteria
No.
Criteria
Description
Hospitals where Project was Implemented
Chitral Kohat Malakand Mardan
HRM 1 1.5.6 Job description Y Y Y Y
1.5.10 Dress code
material for class
IV
Y Y Y Y
1.1. PIMS - Y Y Y
Patient Rights 2 2.1 IEC displays Y Y Y Y
2.2 Patient Complaints - Y Y Y
Service
Delivery
3 3.1.10 OPD Electronic
Queue
Management
System
- Y Y Y
3.1.2 Development of
waiting area
- Y Y -**
3.2.7 Biometric system
for staff guidance
- Y Y Y
3.1.3 Wheel Chairs Y - - -
3.1.3 Stretchers Y - - -
3.6 Documentation of
Care
Y - - -
16 16.7 Stairway and
Ramps Safety
Railings
Y - - -
Safe &
Appropriate
Environment
16.18 Telephone
Network
Y - - -
Safe &
Appropriate
Facilities
19 19.9 Nursing counter
chairs
Y - - -
*The table is meant for estimating standards invoked for implementation at SHCF. It does not show the total work items budgeted
in proposals
** The evidence in the photo gallery is not support by proposal in MMCTH Mardan

Evaluation Report
Annex 3: Qualitative Questionnaires
Provincial level Qualitative Interviews - KP
Target Audience
1. Current & previous Project Directors, Improving Quality of Health Care Services (IQHCS)
2. Current Health Secretary, Dept of Health (DoH), GoPK
3. Current Chief Planning Officer, DoH, GoKP
4. Previous Chief Health, Planning &Development Department, GoKP
5. Additional Secretary Health for Development, DoH, GoKP
6. Current Chief Health Sector Reforms Unit, DoH, GoKP
7. Current Deputy Secretary Development-I, Finance Department, GoKP
8. Current Principal Advisor, Health Sector Support Program, GiZ Pakistan.
9. Current Chief Operating Officer, Peoples Primary Healthcare Initiative, Provincial Support Unit
10. Current Chief Field Officer, Citizen Engagement for Social Service Delivery (CESSD) Project
District level Qualitative Interviews - (05 Districts)
11. District Health Officers
12. District Support Managers – People’s Primary Healthcare Initiative (DSMs-PPHI)
13. Medical Superintendents (of concerned District Head Quarter Hospitals)
Thematic Areas
1. Overall Project :
 Understanding (concepts of quality in healthcare, need for prioritizing etc.)
 Implementation (problems at provincial & district level)
 Coordination 3600(at provincial and district levels, contributions of IQHCS in supporting
HCC, SHPI, improving health processes and outputs, lateral links, etc.)
 Achievements or failures
2. Issues of sustainability.
3. Future course of action.
4. Possible Alternatives.

Evaluation Report
Annex 4: Quantitative Questionnaire -1
IQHCS KP
CLIENT EXIT INTERVIEW
1. Name of Interviewer: ________________________________________________
2. Name & Address of Interviewee: _____________________________________________
3. Gender: ⁭Male/ Female 4. Age (Years): _________
5. Contact No. (If any)________________
6. Name & Type of Health Facility: _____________________________________________
7. Date of Interview: __________________
(The interviewer will introduce himself and explain purpose of interview. He/she will clearly mention that
the interview is for the purpose of assessment / evaluation of health services that would further
improvement. The information gathered and statements taken will not be disclosed at any level and
opinion of interviewee will be recorded for the purpose of assessment / evaluation of the project.)
A-General Information
Q.
No.
Question Response
1.1 What type of other
health facilities is
available in your
area?
(Multiple responses
possible)
1. Government
2. Private Practitioner
3. NGOs
4. Other ______________________
1.2 What is the reason of
your visit to this
government facility?
(Multiple responses
possible)
1. Close to home
2. Doctor is available
3. Drugs are available
4. Good attitude of staff
5. Cannot afford any other health care service
6. No other choice available
7. Other:_____________________
1.3 What is the
approximate distance
& time between your
residence and this
facility?
1.
2. ____________________Kilometers
3. ____________________Minutes

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1.4 What mean of
communication you
use for coming to this
facility?
1. On foot
2. Bicycle
3. Motorcycle
4. Own Vehicle
5. Public Transport
6. Taxi / Private Transport
7. Any other __________________
1.5 What is the frequency
of your visit to this
health facility?
1. First time visit
2. Visit whenever I need health care
1.6 Where do you prefer
to go in case of
emergency?
(Multiple responses
possible)
1. Government Health Facility
2. Private Health Facility
3. Other______________________
B- Specific Information
2.1 What is the purpose
of your visit today?
(Multiple responses
possible)
1. General medical problem
2. Child health care
3. Antenatal examination
4. Post natal checkup
5. Family planning
6. Other________________________
2.2 Who attended you
today?
(Multiple responses
possible)
1. Specialist (for RHCs only)
2. Lady doctor
3. Male doctor
4. LHV
5. Dispenser
6. Health Technician
7. Don’t Know
8. Other____________________
2.3 How long did you
wait before you
were first attended
to?
1. <5 min.
2. 5 - 10 min.
3. 11 – 15 min.
4. 16 – 20 min.
5. 21 – 30 min.
6. 31 - 45 min.
7. > 45 min.
2.4 Have you paid for
any services?
1. Yes 2. No.

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2.5 How much you paid
and for what
services?
(Multiple responses
possible)
Service Amount Paid (Rs.)
1. OPD (purchi fee) _____________
2. Test/s _____________
3. Medicines _____________
4. Inpatient or bed fee _____________
5. Others ______ _____________
2.6 Were you
prescribed any
medicines?
1. Yes 2. No.
2.7 Did you get the
medicines from this
facility?
1. All of them
2. Some of them
3. None
2.8 Were you
prescribed any
laboratory tests?
1. Yes 2. No.
2.9 Were the tests
performed in this
health facility?
1. All of them
2. Some of them
3. None
2.10 Were you
prescribed any
X-Ray, Ultra sound
tests?
1. Yes 2. No.
2.11 Did you receive any
health education
material (pamphlets,
brochures etc.) from
the facility?
1. Yes 2. No.

Evaluation Report
FOR Client Exit
Primary Health Care Facilities
(Pl ask the following part in the BHUs & RHCs)
C- IQHCS Specific Information & Related Client Satisfaction
3.1 What is the present condition
of health services provisions
at this facility?
1. Same as previous
2. Better than previous
3. Worse than previous
4. Don’t know
3.2 Have you ever heard about
the IQHCS Project?
1. Yes 2.No
3.3 Are the following
improvements been made to
the facility?
1. Staff has been provided
2. Medicines have been made available
3. The staff has been trained and now works better
4. HCPs conducting health sessions
5. Info about fee and other exemptions
6. Don’t know
7. Other_________________
3.4 Are you satisfied with these
improvements?
(Only choose the relevant
response in the previous question
for probing satisfaction)
1. Staff has been provided
a) Yes
b) No
c) Don't Know
2. Medicines have been made available
a) Yes
b) No
c) Don't Know
3. The staff has been trained and now works better
a) Yes
b) No
c) Don't Know
4. HCPs conducting health sessions
a) Yes
b) No

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c) Don't Know
5. Info about fee and other exemptions
a. Yes
b. No
c. Don't Know
3.5 Are there any specific
additions made to the
facility?
1. Repairs done (mostly infrastructure, white wash, etc.)
a.
2.The facility has functioning electricity
3. The waiting area protects clients from sun, rain.
4. The waiting area has chairs or other seating arrangements
5. Privacy during examination
6. Separate toilets for male/females
3.6 Do you feel satisfied with
these additions?
1. Repairs done
a) Yes
b) No
c) Why not (in response to no)
______________________
2.The facility has functioning electricity
a) Yes
b) No
______________________
3. The waiting area protects clients from sun, rain etc.
a) Yes
b) No
______________________

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4. The waiting area has chairs or other seating arrangements
a) Yes
b) No
______________________
5. Privacy during examination
a) Yes
b) No
______________________
6. Separate toilets for male/females
a) Yes
b) No
______________________

Evaluation Report
Annex 5: Quantitative Questionnaire -2
IQHCS-KP Project
Health Care Provider Questionnaire
1- BHU/RHC/DHQ: _______________________________
2- District: ___________________________
3- Designation of Respondent _________________________
4- Name of the Interviewer: _____________________________
5- Date: ________________
S
No.
Questions
In case of Yes, circle the
Agency Name
(in case of "No",
Skipto the next question)
Reasons for saying "No"
1
Has there been any repair done
recently?
(Please give agency name)
I. None
II. IQHCS
III. Donor
IV. District Govt.
V. Any other
b. ________
2
Are you satisfied with repairs?
I. Yes
II. No
(in case of no, please give
reasons in the next column) →
3
Has any agency recently
renovated the facility functioning
electrical bulbs/lamp etc.?
I. None
II. IQHCS
III. Donor
IV. District Govt.
V. Any other
________

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S
No.
Questions
Agency Name
(in case of "No",
4
Are you satisfied with the facility
functioning electricity?
I. Yes
II. No
5
Has the facility an X-Ray viewer?
I. None
II. IQHCS
III. Donor
IV. District Govt.
V. Any other
c. __________
6
Are you satisfied with the newly
provided X-Ray viewer?
I. Yes
II. No
7
Has the facility an ENT
diagnostic set?
I. None
II. IQHCS
III. Donor
IV. District Govt.
V. Any other
d. __________
8
provided ENT diagnostic set?
I. Yes
II. No
9
Has the facility a geyser for hot
water?
I. None
II. IQHCS
III. Donor
IV. District Govt.
V. Any other
e. ________

Evaluation Report
S
No.
Questions
Agency Name
(in case of "No",
10
provided geyser?
I. Yes
II. No
11 Has the facility protected water
source (water tank or protected
spring, pump, well)?
I. None
II. IQHCS
III. Donor
IV. District Govt.
V. Any other
f. ________
12
Are you satisfied with the
working of protected water
source (water tank or protected
spring, pump, well)?
I. Yes
II. No
13
Has the facility a supply line and
storage system of clean water?
I. None
II. IQHCS
III. Donor
IV. District Govt.
V. Any other
g. ________
14
function of supply line of clean
water?
I. Yes
II. No
15
Has the facility having its waste
pit covered?
I. None
II. IQHCS
III. Donor
IV. District Govt.
V. Any other
h. ________

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S
No.
Questions
Agency Name
(in case of "No",
16
function of pit cover?
I. Yes
II. No
i.
17 Are the Staff provided with and
use protective equipment e.g.,
aprons etc?
I. None
II. IQHCS
III. Donor
IV. District Govt.
V. Any other
j. ________
18
provided protective equipment
e.g., apron?
I. Yes
II. No
19 Are Curtains/Rods for private
examination provided in the
facility?
I. None
II. IQHCS
III. Donor
IV. District Govt.
V. Any other
k. ________
20
curtains provided in the rooms?
I. Yes
II. No
l.
21
Have Staff and clients access to
separate toilets?
I. None
II. IQHCS
III. Donor
IV. District Govt.
V. Any other

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S
No.
Questions
Agency Name
(in case of "No",
m. ________
22
Are you satisfied with having
separate toilets for clients?
I. Yes
II. No
Secondary Level Questions
23
Are you satisfied with uniforms
provided to you?
(Ask this question only from support
staff)
I. Yes
II. No
24
telephone landline provided to
you?
(Ask this question only from support
staff)
I. Yes
II. No
25
Are you satisfied with the chairs
provided to the nursing station?
(Ask this question only from nurses)
I. Yes
II. No

Evaluation Report
Annex 6: Primary Health Care Standards at Khyber Pakhtunkhwa& scoring scale used for 3rd Party
Validation survey
Rating Scale: 1. No achievement, 2. Achievement with problems, 3.Full achievement
Standard S.No Measurable Criteria (Total= 102) Score Remarks
1,1
A Primary Care Management Committee plans and
manages its resources, supports the Service's
processes and communicates decisions and
information to relevant persons and organizations.
1 a. The Primary Care Management Committee includes representatives from
local government, staff and users.
2
b. Clients/Users who are members of the committee are provided with
information to enable them to contribute to the decisions of the health
committee.
3
c. All members of the committee are oriented and trained in the
Khyber Pakhtunkhwa healthcare system, processes for running meetings and
in basic management skills.
4
d. The committee meets regularly according to a set agenda that
includes follow-up from the last meeting.
5
e. Minutes of meetings are kept for five years and are available at the
facility.
6
f. An annual planning process results in an annual plan which is
implemented and reviewed on a regular basis.
7
g. The annual plan includes goals, planned actions, staffing and
financial and physical resources to implement the planned actions.
8
h. Monthly HIMS/DHIS Reports are submitted to EDO Health and
include progress against the annual plan, identify problems and make
recommendations.
1.2
Client/Patient information is registered, coded,
analyzed and used as a mechanism for monitoring
and planning
1 a. Client/Patient registers are used, up to date, complete and accurate.
2
b. Written information in the registers includes dates, client/ patient
characteristics
(Name, sex, age and address), diagnosis and treatment (dosage, times/day, no
of days) and follow-up in line with operating procedures.
3
c. Registers used to document client/patient information include but
are not limited to:

Evaluation Report
3.1
i. Health card (mother and child) which is maintained and used as a
mechanism
for informing the client/patient about their care;
3.2
ii. Immunization card which is maintained and used as a mechanism for
informing the client/patient about their care;
3.3
iii. Register of expectant mothers and deliveries which is maintained and
analyzed
3.4 iv. OPD registers.
4 d. A consistent disease coding system is used and analyzed
5
e. Analysis of the information is used by staff and results are fed back
to the community.
1.3
Notifiable diseases are reported promptly and
appropriate action is taken to minimize the spread of
the disease.
1 a. A list of notifiable diseases is available.
2
b. Notifiable diseases are reported within a specified time period, but
no longer than
24 hours.
3
c. Procedures for managing notifiable diseases are based on infection
control principles, are used and roles and responsibilities are clearly defined.
4 d. The 'Zero report' is completed and submitted weekly (for polio)
1.4
The equipment and utilities are functional, meet the
defined needs of planned services, and are properly
maintained and used.
1
a. Equipment is registered, maintained, repaired and disposed of
according to an equipment maintenance and replacement schedule.
2 b. The facility has functioning electricity and natural gas.
3
c. A backup generator in working condition and the budget for its
maintenance and for its fuel are available.
4 d. A stretcher and at least two examination couches,
4.1 i. are available
4.2 ii. are clean with no visible dust, stains or blood, and
4.3 iii. Are covered with a clean, uniform Macintosh or a plastic sheet.
5
e. Each health worker providing curative services has the following
functioning equipment:
5.1 i. Thermometer

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5.2 ii. Stethoscope
5.3 iii. BP machine
5.4 iv. Screen for privacy
5.5 v. Gloves, masks, apron
5.6 vi. Torch.
6
f. The following additional functioning equipment is available in the
facility and ready to use:
6.1 i. Baby weighing scale, fetoscope, neonatal weighing scale, speculum
6.2
ii. Refrigerator, stools, lantern or alternate lighting source such
as solar lamps or torch, equipment for boiling/sterilizer, timing device,
stainless steel bowls, kidney bowls, dressing drum, gloves, masks, aprons
6.3
iii. Adult weighing scale, nebuliser, suction machine, oxygen cylinder(?),
X-ray viewer, suture set, needle safety box, resuscitation kit
6.4
iv. ORS corner [including the following ORT equipment: water jug: 2 cups and
2 spoor
6.5 v. ENT diagnostic set
6.6 vi. D&Cset
7
g. Additional equipment, based on the defined needs of the planned
services, is available and functioning.
1.5
There is a reliable, clean and safe supply of water
from a protected water source.
1
a. Running water (pipe) is available within the facility OR there is water tank
within the
facility OR there is a protected water source within 200 meters of the
facility: borehole, water tank or protected spring (with tubing of water for
outflow, concrete slab, drainage and the spring is at least 33 meters away
from latrines/toilets) and
2
b. A supply line and storage system keeps water clean and free from
contamination.
1.6 The waiting area is clean and protected.
1 a. The waiting area protects clients/patients from the sun, rain and extremes of
2
b. There are designated separate male and female waiting areas and toilets/
latrines.
3 c. The waiting area has chairs or other seating arrangements.
4 d. The floor is swept or mopped and is clean of debris/ trash.

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5
e. The walls and ceiling are intact with no broken masonry and are free from
dirt
and stains.
1.7 The facility has clean latrines or toilets.
1 a. Latrines or toilets exist within the facility or facility compound.
2
b. Staff and clients/patients have access to separate latrines or toilets
which are clearly signed and are lockable from the inside.
3 c. The client/patient latrine or toilet is not locked from the outside.
4 d. The toilet bowl is clean and empty and/or the latrine slab is clean.
5
e. Soap and water are available at the washing point near the toilet (s)/
latrine(s)
1.8
The facility compound is clean and uses a rubbish pit
for disposal of refuse and medical
1 a. The compound is free from litter such as plastic bags, refuse and medical
waste.
waste. 2
b. There is a rubbish pit within the compound (possibly a garbage bin in urban
settings)
3
c. The pit (bin) is not overflowing and is properly used, i.e. rubbish is
not disposed of anywhere else
4
d. Medical waste is disposed of in a functional covered pit, e.g. not
accessible for children and animals, within the compound.
1.9
The staff work to written Operating Procedures for
managing the Primary Care services, written
guidelines for management of clients/patients and
written guidelines for common illnesses.
1 a. Standard Operating Procedures are used for managing the facility,
finances, equipment,
2
b. National and Provincial Treatment Guidelines for the priority illnesses are
available at the facility, form the basis of regular training for relevant staff
and are followed in providing care to the patients/clients.
3
c. Where National and Provincial Treatment Guidelines are not
available they are developed and used by the Primary Care Service.
4
d. Written guidelines for the management of clients/patients exist and are
used, e.g. confidentiality, privacy, registration, recording and coding.
1.1
Primary Care staffs are available for service delivery
during all official times.
1 a. An updated roster is kept of who is on duty at what time.
2 b. A qualified healthcare provider is available whenever the facility is open.
1.11
Staff are appointed, trained and evaluated in
accordance with documented procedures, job
descriptions and service needs.
1 a. Staff appointments are made in line with the required qualifications and
experience for the job and the job description.
2
b. All staff is oriented to the Primary Care services and their specific positions
through a documented induction programme.

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3 c. The induction programme includes:
3.1
i. The Service's mission, values, goals and relevant planned actions
for the year
3.2 ii. Services provided
3.3 iii. Roles and responsibilities
3.4 iv. Relevant policies and procedures, including confidentiality
3.5 v. Use of equipment
3.6 vi. Safety
3.7 vii. Emergency preparedness
3.8 viii. Quality improvement.
4
d. All staff has a copy of their job description that is kept current, the job
description includes the responsibilities, accountabilities, tasks, performance
measures and reporting relationships.
5 e. All staff has a copy of their conditions of employment.
6
f. Well-maintained and secure staff housing with all utilities is provided
as per staff terms and conditions.
7
g. Staff performance is evaluated annually with the staff member against
their job
description and agreed targets and is used to identify strengths, areas for
improvement
8 h. Accurate and complete personnel records are kept at the facility.
9
i. Staff receives ongoing in-service training relevant to their job and the
healthcare service and in areas such as health and safety, quality
improvement and client/patient rights.
10
j. Documents guide the work of staff and cover staff appointments,
performance evaluations, disciplinary procedures and terms and conditions
of employment.
1.12
The health and safety of clients/patients, staff and
visitors are protected.
1
a. The Service are designed to allow service delivery to be safe, accessible and
respect clients/patients’ needs for privacy.
2
b. The Service are inspected annually by the Works and Services
Department and declared safe.

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3
c. A current Safety Certificate has been issued and is displayed in the
facility.
4 d. Chemicals, drugs and equipment are stored safely.
5
e. Risks and hazards are identified and eliminated isolated or minimized
as appropriate.
6
f. Guidelines exist for major risks and hazards and are known to the
staff.
7
g. Incidents, accidents and near misses are reported and analyzed to identify
causes and the analysis is used to improve systems and processes, e.g. needle
stick injuries.
8
h. Staff is provided with and uses protective equipment, e.g. gloves,
apron, masks.
9
i. Staff is trained in fire safety and other emergencies and drills are
practiced regularly.
10
j. Staff health is protected by the provision of immunization for
infections such as Hepatitis A and B and influenza.
1.13
Client/Patient feedback is collected and used to
improve services.
1
a. Client/Patient have access to a culturally appropriate feedback
mechanism, e.g.
Suggestion box, questionnaires, regular interviews with clients by an
independent person.
2
b. Data collected on client/patient satisfaction with services and
treatment is analyzed and used to improve services.
1.14
Clients/Patients have the right to complain about
services and treatment and their complaints are
investigated in a fair and timely manner.
1
a. Clients/Patients are informed of their right to express their concerns or
complain either verbally or in writing.
2
b. A documented process which is fair and timely is used for collecting,
reporting and investigating complaints.
3
c. Clients/Patients are informed of the progress of the investigation at regular
intervals and are informed of the outcome.
1.15
The Service identifies opportunities to continuously
improve its processes and services, makes
improvements and evaluates theireffectiveness.
1
a. Performance indicators for priority diseases and key processes are
measured, reported and used for continuous improvement.
2
b. Performance data from activities such as audits, complaints, incident
reports,
Satisfaction surveys and risk assessments are collected, analyzed and used to
identify improvement opportunity. This is coordinated by the quality group.

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3
c. Improvements are planned, appropriate action is taken, the effectiveness of
the action is evaluated and the results are feedback to staff and
clients/patients.
4
d. All relevant legal requirements are identified and compliance is
monitored.
Section 2: Service Provision (Standards = 18)
Standard S.No Measurable Criteria (Total= 75)
2.1
The facility and the services provided are easily
accessible to the catchment area population
1 a. The facility is located within 5 km of the patient.
2
b. Costs involved in using the services are addressed in the annual plan
and steps are taken to minimize costs, such as fees, drugs, lost income, and
transportation costs.
3
C. Major obstacles affecting access for clients/ patients to the facility and
its services are addressed in the annual plan and steps are taken to minimize
them, e.g.
3.1 i. The attitude of employees working at the facility;
3.2
ii. The perception of the need and utility of health care by the
community;
3.3
iii. Cultural constraints on clients about using the facility and its
services.
2.2
A list of available services and applicable fees is
posted where the clients/ patients can see them.
1
a. A poster with listed services, opening times and emergency contacts
during closing times is displayed in a prominent place where the
clients/patients can see it. The text is in an understandable format, e.g. local
or national language.
2
b. A list with all fees and possible exemptions is displayed in a prominent
area where the clients/patients can see it. The text is in an understandable
format, e.g. local or national language.
2.3
Clients/Patients and their attendants are received in a
friendly and respectful manner irrespective of their
sex, age, race, religion or physical appearance
1
a. Clients/Patients are treated in a kind, patient and respectful manner at
all stages from registration through to end of service.
2
b. The healthcare provider uses open ended questions (why, who, what,
when, how) to obtain information from clients/patients.
3
c. The healthcare provider listens carefully to what the clients/patients
say and does not jump to conclusions.
4
d. The healthcare provider explains to the client/patient the diagnosis,
care management, and follow-up.

Evaluation Report
5
e. The healthcare provider takes feedback from the client/patient to
ensure the client/patient understands the message communicated.
2.4
Providers give priority to extremely sick
clients/patients and those of extreme age (early
newborns and elderly).
1 a. A system using the time of arrival recorded on the registration chit is
used to prioritize clients/patients.
2
b. The order prioritizes extremely sick clients/patients first, those of
extreme ages (elderly and babies) second and then others.
3
c. Extremely sick clients/patients are seen by the healthcare provider
within five minutes, and those of extreme ages within 15 minutes.
2.5
Providers use a defined process for referring
emergency cases.
1 a. SOPs exist for identification of types of clients/patients who need to
be refereed.
2
b. A referral form provides sufficient information to allow continuity
of care.
3 c. When possible transportation to the referral facility is provided.
4
d. In other cases, the Service provides some type of assistance for
moving a sick client/patient to a referral facility such as communication to the
next level, or arranging community transport.
5 e. A copy of the referral form is kept at the facility.
2.6
Non-priority clients/patients wait no more than one
hour after arrival at the facility before being seen by
the provider.
1
a. A system is used to prioritize the order in which non-priority
clients/patients are seen on a first-come first-serve basis.
2 b. Waiting times are no more than one hour and are monitored.
3 c. Waiting times are analyzed and results used to improve services.
2.7
The privacy of patients/clients is ensured during
consultation and examination.
1 a. Consultations and examinations are held behind curtains/screens at
all times.
2 b. Healthcare providers ensure privacy at the time of consultation.
2.8
All clients/patients receive appropriate assessment,
diagnosis, plan of care, treatment and care
management, and follow-up
1 a. The registration chit is completed promptly for all clients/patients.
2
b. The time the client/patient arrives is documented on the registration
chit and monitored
3
c. Basic assessment is undertaken and includes temperature, blood
pressure, and symptom identification.
4
d. Basic assessment for children under five includes weight,
immunization status, temperature, level of consciousness and symptom
identification.
5 e. A client/patient history is taken and documented.

Evaluation Report
6
f. Treatment and care management is provided in accordance with the
assessment, test results, diagnosis and care management guidelines.
7 g. Referrals to other services are made when required.
8 h. Appointments for future care are made.
9 i. Results of previous care are used in follow-up visits.
2.9
National and Provincial 1
a. Healthcare providers provide technically correct services according to
guidelines for but not limited to the following areas:
Treatment guidelines are available and used for those 1.1 i. First Aid and Rmergentcy care, injury management, minor surgical
procedures
services listed as offered. 1.2 ii. 1 MCI, ANC, Delivery, PNC, Family planning
1.3
iii. Malaria, TB & DOTS, HIV/AIDS VCT, STD, Diarrhea, Polio, Hepatitis,
HIV/AIDS, Measles, ARI, Hypertension, Diabetes, Anaemia,Common skin
problems, EPI
1.4 vi. Dental care.
2 b. Staff is trained to follow these guidelines.
3 c. Justification is available for variations from the guidelines.
2.1
All Children who visit the facility have their weight
plotted correctly on their health card and have their
immunization
1 a. All under five children coming to the facility are weighed.
status checked. 2
b. Weight is accurately plotted on the child's health card and follow-
up action taken based on the plot.
3 c. Immunization status is checked and missing immunizations given
4 d. Weight and vaccination information are given to the parent/carer.
2.11
Healthcare providers regularly educate their clients
on health issues in a way that is easy to understand.
1 a. Healthcare providers conduct group health education sessions at least
four times a month.
2
b. Healthcare providers use the following materials during client/patient
Counseling/education sessions: posters, family planning material, brochures,
leaflets, flipcharts and cue cards.
3
c. Health education messages (posters and charts with pictures and
minimal text) are visibly posted in prominent areas within the facility.
4
d. Health education written material is available for clients/patients to
read and take home.

Evaluation Report
2.12
Clients/Patients are given accurate information about
their medication regime to enable them to manage it.
1
a. The healthcare provider/dispenser instructs clients/patients about
the medication, the amount of medication to take, what time to the day it
should be taken and for how long it should be taken.
2
b. The healthcare provider/dispenser checks that the client/patient
understands the instructions.
2.13
Staffs follows correct aseptic techniques and wash
their hands between clients/patients.
1
a. Health workers perform the following aseptic procedures in line with SOPs
or guidelines: wound dressing, suturing, catheterization, injections,
intravenous infusion and dental extraction.
2
b. Sips (where possible liquid soap) and water or antiseptic gel are
available at the washing point(s) in or near the consulting/examination
room(s) and a clean hand towel or alternate is available.
3 c. Hand washing instructions are posted above the washing point(s).
4
d. Healthcare providers wash their hands between clients/patients and
between procedures.
2.14
Rational prescribing is practiced to minimize the risk
of drug resistance, ensure appropriate treatment and
enable cost-effective care.
1 a. An essential drug list is available and followed.
2 b. Good prescribing practice guidelines for antibiotics are available and
followed.
3 c. The probable diagnosis is written on the prescription
4
d. If the diagnosis changes as a result of follow-up assessment or test
results the
prescription is reviewed. !
2.15
Essential drugs and supplies are available at all times
during open hours.
1 a. Stock cards are up to date and correspond to physical stock.
2 b. There is a stock of the essential drugs.
3 c. There is a process for checking date of expiry.
4 d. No expired drugs are in stock.
2.16
The cold-chain for vaccines is 1
a. A Cold Chain procedure for vaccines is used and includes clear
directions on the following practices:
maintained 1.1
i. Vaccine stock management including vaccine storage, potency,
stock quantities, stock records, and arrival report
1.2 ii. Equipment for vaccine transport and storage
1.3 iii. Maintenance of equipment
1.4 iv. Control and monitoring of temperature
1.5 v. Cold chain during immunization sessions

Evaluation Report
1.6 vi. Syringes, needles and sterilization and
1.7 vii. Breakdown of equipment and emergency actions to minimize risks.
2.17 Items for single use are not reused. 1 a. Disposal systems and processes for single-use items are available and
used.
2.18 Sharps and needles are used and disposed of safely.
1 a. Labeled needle safety boxes are available in the examination, injection
and dressing rooms.
2
b. Staff safely disposes of sharp objects and needles in the containers
provided.

Evaluation Report
ANNEX 7 –Selected Picture Gallery
BHU-NAGAR, Lower-Chitral–Preparations for weather and pest control

Evaluation Report
BHU-HARNO, Abbottabad–Solar-geyser, sewage line repair, PPHI pathways, Flower-beds & Partition
MARDAN MEDICAL COMPLEX HOSPITAL – OPD Registration Waiting Area Seating & EQMS

Evaluation Report
DHQH Chitral– Before & After – Safety Railings

Evaluation Report
DHQTH Kohat (KDA) – Before & After – OPD Registration Waiting-Area Seating
BHU-KHAAR (Malakand) – Paint job

Evaluation Report
RHC-KHAZANA (Shamozai Valley, Swat) -Solar-powered water supply

IQHCS Final Report - Volume 2- Annexes

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