SECOND ROUND FACILITY ASSESSMENT (LIVE)

SECOND ROUND FACILITY ASSESSMENT (LIVE)

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1.0 Section A - Facility identification & Health facility characteristics
1.1    Name of Interviewer
1.2    Date of facility assessment
Open the date time chooser
1.3    Region
1.4    District
1.5    Community
1.6    Type of Community
1.7    What type of health facility is this?
Basic Facilities

Note:

For the purpose of this assessment, the availability or presence of infrastructure,equipment and drugs must be observed (or seen) by the assessment team. If an element is not seen by the assessment team, it should be counted as unavailable. Exceptions to this rule, are noted as comments under the specific questions (in this case, it is specified to whom the question should be asked).

1.9    Is there a designated telephone available for  this facility (a functional land line or mobile phone- not personal)     

 

If yes, state main phone no.
1.10    Do you have a separate or designated room for counselling adolescent?
1.11    Do you have a main source of water in this facility?
1.12    Please specify the main source of water used in this facility
2.0 Section B - Staffing
2.1    How many midwives currently work in this unit?
(ask facility manager, administrator or senior staff member)   
2.2    How many adolescent focal persons work in this unit?
(Ask facility manager, administrator or senior staff member)   
2.3    What is the rank of the adolescent focal person?
(Ask facility manager, administrator or senior staff member)   
2.4    Are there any Standard Operating Protocols or Job Aids (Flipchart, posters) for staff?
3.0 Section C - Facility operation

3.1    How many days per week does this unit operate?

 

(Ask facility manager or assessment facilitator)    
3.2    Does this unit provide 24 hours/7 days a week service?
(Ask facility manager or assessment facilitator)
3.3    If No, indicate number of days and number of hours facility operates in a week   
3.4    Are there sign posts or any form of advertisements displaying the availability of adolescent health services?    
3.5    Are there guidelines and protocols for adolescent health care services available?
(Ask facility in-charge to see copies of guidelines or protocols)
3.6    Have you received any training on adolescent health care services within the last two years?
  
(On-site training, on the job training  and workshop training both acceptable) 
3.7    What type of training did you undergo
3.8    State at least two details of the training   
3.9    In the last 3 months, have you had any stock-outs with the medications, equipment and testing kits needed for adolescent health care for more than 7 continuous days?
(Verify from stock cards)
3.10    Do you do counselling and testing for HIV in this unit?
3.11    Do you treat STIs in this unit?   
3.12    Do you offer family planning services?
3.13    Do you offer comprehensive abortion care in this unit?
3.14    Do you offer walk-in services to adolescents?
4.0 Section D – Accessibility
4.1    Is the facility within the community or outside the community?   
4.2    Is the facility close to an area where adolescents converge?
4.3    Do you offer brochures/pamphlets after seeing the adolescent?
4.4    Do you offer community outreach programs?
4.5    If yes, how often in a year?   
4.6    What medications do you usually have available for adolescent health care services? List them.
4.7    What equipment do you usually have available for adolescent health care services?
5.0 Section E- Affordability
5.1    Are consultations free?   
5.2    If no, how much?
5.3    Are ALL medications free?
5.4    Are ALL medications covered by the NHIS?
5.5    If No, do clients complain about the medications being expensive?
5.6    Are family planning services free?
5.7    Are family planning services covered by NHIS?
5.8    Are ALL procedures done in this unit free?
5.9    If No, state procedures that are NOT free
5.10    Are ALL the procedures covered by NHIS?
6.0 Section F- Quality
6.1    Is there a confidentiality/privacy policy?
6.2    Are adolescents counseled in an open spaced or closed spaced room?
6.3    Do you counsel adolescent individually or in a group?
6.4    Do you seek for parental consent before attending to any adolescent?

6.5    What is the average waiting time between the arrival of the adolescent and the consultation?    

 

6.6    What is the average number of clients you attend to in a day?
6.7    Is there a hospital policy to handle disrespectful/disorderly adolescents?   
7.0 Section G- Legal/Referal Services

7.1       Are adolescents who have experienced sexual and gender based violence referred  to legal services

7.2       If yes, which service?
0
7.3        Are adolescents with complicated cases referred to other facilities?
7.4     If yes, which facility?
0
Score Summary

Basic Facilities
Code Question Response Marks
F19

1.9    Is there a designated telephone available for  this facility (a functional land line or mobile phone- not personal)     

 
F19A If yes, state main phone no.  
F110 1.10    Do you have a separate or designated room for counselling adolescent?
F111 1.11    Do you have a main source of water in this facility?
F112 1.12    Please specify the main source of water used in this facility
       
    TOTAL: 0

2.0 Section B - Staffing
Code Question Response Marks
F21 2.1    How many midwives currently work in this unit?
F22 2.2    How many adolescent focal persons work in this unit?
F23 2.3    What is the rank of the adolescent focal person?
F24 2.4    Are there any Standard Operating Protocols or Job Aids (Flipchart, posters) for staff?
    TOTAL 0

 

3.0 Section C - Facility Operation
Code Question Response Marks
F31

3.1    How many days per week does this unit operate?

 
F32 3.2    Does this unit provide 24 hours/7 days a week service?
F33 3.3    If No, indicate number of days and number of hours facility operates in a week  

Days:

Hours:

 No score
F34 3.4    Are there sign posts or any form of advertisements displaying the availability of adolescent health services?    
F35 3.5    Are there guidelines and protocols for adolescent health care services available?
F36 3.6    Have you received any training on adolescent health care services within the last two years?
  
F37 3.7    What type of training did you undergo
F38 3.8    State at least two details of the training   
F39 3.9    In the last 3 months, have you had any stock-outs with the medications, equipment and testing kits needed for adolescent health care for more than 7 continuous days?
F310 3.10    Do you do counselling and testing for HIV in this unit?
F311 3.11    Do you treat STIs in this unit?   
F312 3.12    Do you offer family planning services?
F313 3.13    Do you offer comprehensive abortion care in this unit?
F314 3.14    Do you offer walk-in services to adolescents?
       
    TOTAL 0

 

4.0 Section D- Accessibilty
Code Question Response Marks
F41 4.1    Is the facility within the community or outside the community?   
F42 4.2    Is the facility close to an area where adolescents converge?
F43 4.3    Do you offer brochures/pamphlets after seeing the adolescent?
F44 4.4    Do you offer community outreach programs?
F45

4.5    If yes, how often in a year?   :

1-2 times
3-4 times
5-6 times
7-12times
F46 4.6    What medications do you usually have available for adolescent health care services? List them.
F47 4.7    What equipment do you usually have available for adolescent health care services?
       
       
    TOTAL 0

 

5.0 Section E- Affordability
Code Question Response Marks
F51 5.1    Are consultations free?   
F52 5.2    If no, how much?:
1-50 Ghana Cedis
51-100 Ghana Cedis
101-200 Ghana Cedis
201-500 Ghana Cedis
 
F53 5.3    Are ALL medications free?
F54 5.4    Are ALL medications covered by the NHIS?
F55 5.5    If No, do clients complain about the medications being expensive?
F56 5.6    Are family planning services free?
F57 5.7    Are family planning services covered by NHIS?
F58 5.8    Are ALL procedures done in this unit free?
F59 5.9    If No, state procedures that are NOT free
F510 5.10    Are ALL the procedures covered by NHIS?
       
    TOTAL 0

 

6.0 Section F- Quality
Code Question Response Marks
F61 6.1    Is there a confidentiality/privacy policy?
F62 6.2    Are adolescents counseled in an open spaced or closed spaced room?
F63 6.3    Do you counsel adolescent individually or in a group?
F64 6.4    Do you seek for parental consent before attending to any adolescent?
F65

6.5    What is the average waiting time between the arrival of the adolescent and the consultation?    

 

:
<15 minutes
15-30 minutes
>30 minutes
F66 6.6    What is the average number of clients you attend to in a day?:
1-20 Adolescents
21-40 Adolescents
41-60 Adolescents
over 60 Adolescents
F67 6.7    Is there a hospital policy to handle disrespectful/disorderly adolescents?   
       
    TOTAL 0

 

7.0 Section G- Legal/Referal Services
Code Question Response Marks
F71

7.1       Are adolescents who have experienced sexual and gender based violence referred  to legal services
F72 7.2       If yes, which service?
DOVVSU
Traditional leaders
Other


 		 0
F73 7.3        Are adolescents with complicated cases referred to other facilities?
F74

7.4     If yes, which facility?
 STI Treatment
 TB/HIV
 RH/FP
 Psycho Social Support
 PLHIV Support Group
 Legal Services




0
       
       
    TOTAL: 0
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