INTERGRATED PHC SUPERVISORY TOOL
A. GENERAL SERVICES
A.1.ADMINISTRATION: Signage Page 3
A.2.STAFF DRESS CODE Page 3
A.3.STAFF DEVELOPMENT Page 3
A.4.COMPLAINTS MANAGEMENT Page 3
A.5.WAITING TIME MANAGEMENT Page 4
A.6.INFECTION PREVENTION AND CONTROL Page 4
A.7.RESCUCITATION ROOM AND EQUIPMENT Page 4
A.8.PHARMACEUITICAL SUPPLIES Page 4
A.9.BULK SUPPLIES Page 4
A.10.LABORATORY SERVICES Page 4
A.11.MONITORING AND EVALUATION OF PROGRAMMES Page 5
A.12.ACCESS TO ALLIED SERVICES Page 5
A.13.INNOVATIONS AND BEST PRACTICES IMPLEMENTED Page 5
B. PROGRAMME INDICATORS MONITORING
B.1.STRATEGIC HEALTH PROGRAMS
B.1.1. MATERNAL CHILD WOMEN’S AND NUTRITION (MCWN)
B.1.1.1. REPRODUCTIVE HEALTH Page 6
B.1.1.2. MATERNAL HEALTH Page 6
B.1.1.3. CERVICAL CANCER SCREENING Page 6
B.1.1.4. EXPANDED PROGRAMME OF IMMUNISATION Page 6
B.1.1.5. INTEGRTED MANAGEMENT OF CHILDHOOD ILLNESSES Page 7
B.1.1.6. NUTRITION – PROGRAMME Page 8
B.1.1.7. ADOLESCENT AND YOUTH FRIENDLY SERVICES (AYFS) Page 8
B.1.2. HAST PROGRAMME
B.1.2.1.HIV TESTING SERVICES Page 8
B.1.2.2.ART PROGRAMME Page 9
B.1.2.3. MEDICAL MALE CIRCUMCISION PROGRAMME Page 9
B.1.2.4. TB PROGRAMME Page 9
B.2. OTHER HEALTH PROGRAMS
B.2.1. CDC – PROGRAMME Page 9
B.2.2. NON-COMMUNICABLE PROGRAMME Page 9
B.2.3. PHC WARD BASED OUTREACH SERVICES Page 10
NB All Tools in shaded cells are available in the Child Health Package and form part of the Child Health Dashboard
GROWING KWAZULU NATAL TOGETHER
PHC facility name: _____________________
District Office________________________________________________________________________________Sub-district: ______________
Date assessed Q1: Date assessed Q2: Date assessed Q3: Date assessed Q4:
Team that did assessment: Team that did assessment: Team that did assessment: Team that did assessment:
1.__________________________ 1.__________________________ 1.__________________________ 1.__________________________
2.__________________________ 2.__________________________ 2.__________________________ 2.__________________________
3.__________________________ 3.__________________________ 3.__________________________ 3.__________________________
4.__________________________ 4.__________________________ 4.__________________________ 4.__________________________
Report compiled by: Report compiled by: Report compiled by: Report compiled by:
Print: _______________________ Print: _______________________ Print: _______________________ Print: _______________________
Signature: ___________________ Signature: ___________________ Signature: ___________________ Signature: ___________________
Report received by: Report received by: Report received by: Report received by:
Print: _______________________ Print: _______________________ Print: _______________________ Print: _______________________
Signature: ___________________ Signature: ___________________ Signature: ___________________ Signature: ___________________
GROWING KWAZULU NATAL TOGETHER
ELEMENT ASSESSED DATE ASSESSED
METHOD OF Q1 Q2 Q3 Q4
COMMENTS
A. GENERAL SERVICES: MEASURE Y N Y N Y N Y N
A.1.ADMINISTRATION: Signage
1. All way-finding signage in place Checklist
2. Display board reflecting the facility name, service hours, physical
address, contact details and service package details is visible Checklist
displayed at the entrance of the facility
3. The NO WEAPONS, NO SMOKING, NO ANIMALS (except for
service animals), NO littering and NO HAWKERS sign is clearly sign Checklist
posted at the entrance of the facility
4. Facility grounds clean, trimmed and well maintained OBS
5. The Vision, Mission and Values of the district must be visibly
OBS
displayed
6. Batho Pele, Patients’ Rights wall charts 2. accessibly displayed OBS
7. PHC facility Catchment Map displayed OBS
8. Facility catchment population for the current FY displayed per
OBS
category and known to nurses
9. The facility organogram with the contact details of the manager is
displayed on a central notice board OBS
10. All service areas within the facility are clearly signposted Checklist
A.2.STAFF DRESS CODE
11. All staff members wear an identification tag Checklist
12. Staff compliance to dress code policy Checklist
A.3.STAFF DEVELOPMENT
13. Skills Audit for current FY is conducted and submitted to sub district DOC
14. Training conducted as per skills audit need Training records reflect
DOC
planned training is conducted as per the district training programme
15. Percentage of staff completed 12 sessions on Adult Primary Care DOC
16. More than 80% of staff trained in IMCI (including 6 steps of initiation Staff Database Child
and 7 steps of follow up) Health file
A.4.COMPLAINTS MANAGEMENT
17. Complaints/compliments/suggestions boxes are visibly placed at
main entrance/exit OBS
18. Official complaint/compliment/suggestion forms and pen are
OBS
available
19. A standardized poster describing the process to follow to lodge a
complaint, give a compliment or suggestion is clearly sign posted OBS
next to the complaints/compliments/suggestions box
3
DATE ASSESSED
METHOD OF Q1 Q2 Q3 Q4
ELEMENT ASSESSED COMMENTS
MEASURE Y N Y N Y N Y N
A.5.WAITING TIME MANAGEMENT
20. Waiting times displayed per service area OBS
21. Patients are intermittently informed about delays OBS
A.6.INFECTION PREVENTION AND CONTROL
22. Waste is properly segregated as per Waste management policy OBS
23. Sharps containers are disposed of when they reach the limit mark OBS
24. Sharps containers are placed on work surface or in wall mounted
OBS
brackets
25. All toilets have complete hand-washing facility (Soap dispenser with
soap, toilet paper, hand-paper towel, functional bins with availability OBS
of running water
26. All service areas kept clean OBS
27. Quarterly Hand Hygiene audit done DOC
A.7.RESCUCITATION ROOM AND EQUIPMENT
28. Resuscitation room is equipped with functional, basic resuscitation
Tool 4 in CH File
equipment
29. Emergency trolley is restored daily or after each use Tool 4 in CH File
A.8.PHARMACEUITICAL SUPPLIES
Checklist
30. 90% of the medicines on the tracer medicine list are available
Tool 1 in CH File
OBS of reports
31. SVS reporting is completed weekly for all items
on phone
A.10. CCMDD
32. New Patient Registrations DOC
33. Total Patient Registrations (cumulative) DOC
34. Active Patients DOC
35. Total Dormant Patient DOC
36. Number of functional adherence clubs DOC
A.9.BULK SUPPLIES
37. Basic medical supplies (consumables) are available Checklist
A.10.LABORATORY SERVICES
38. Specimens are collected, packed, stored and prepared for
transportation according to the Primary Health Care Laboratory Checklist
Handbook
39. Functional SMS printer available OBS
40. Laboratory results are received within specified turnaround times Checklist
41. Required specimen collection materials and stationery Checklist
4
DATE ASSESSED
METHOD OF Q1 Q2 Q3 Q4
ELEMENT ASSESSED COMMENTS
MEASURE Y N Y N Y N Y N
A.11.MONITORING AND EVALUATION OF PROGRAMMES
42. There is an up-to-date facility Operational Plan with targets for the
DOC
current FY
43. There is a functional information Review committee DOC
44. Monthly performance is monitored against the facility targets and
OBS
displayed
45. Quarterly data monitoring against the Operational plan is conducted DOC
46. Quality improvement plans to address poor performance are
DOC
developed and monitored
47. Monthly data is signed off by facility manager before submission to the
DOC
next level
48. DHIMS and M&E SOP available DOC
49. HPRS registration against catchment population reached DOC
50. PSI’s captured and correct process followed DOC
A.12.ACCESS TO ALLIED SERVICES
51. Patients have access to a medical practitioner DOC
52. Patients have access to oral health services DOC
53. Patients have access to physiotherapy services DOC
54. Patients have access to dietetic services DOC
55. Patients have access to social work services DOC
56. Patients have access to ophthalmic service DOC
57. Patients have access to mental health services DOC
58. Facility have access to a pharmacist support DOC
A.13.INNOVATIONS AND BEST PRACTICES IMPLEMENTED
59. Evidence that innovations and best practices implemented are
DOC
documented
5
B. PROGRAMME INDICATORS MONITORING
DATE ASSESSED
METHOD OF Q1 Q2 Q3 Q4
ELEMENT ASSESSED COMMENTS
MEASURE Y N Y N Y N Y N
B.1.STRATEGIC HEALTH PROGRAMS
B.1.1. MATERNAL CHILD WOMEN’S AND NUTRITION (MCWN)
B.1.1.1. REPRODUCTIVE HEALTH
60. Contraceptive guideline available DOC
61. All methods of contraceptives available Pharmacy stock cards
62. Target of 2 Implanon per nurse per day achieved Tick and DHIS
63. Target of 1 IUCD insertion per nurse per day achieved Tick and DHIS
64. Facility monthly male condom distribution target achieved Bin Card
65. Facility monthly female condom distribution target achieved Bin Card
66. Couple Year Protection Rate target of 70% achieved DHIS
B.1.1.2. MATERNAL HEALTH
67. ANC offered daily Tick register
68. Maternal guideline available DOC
69. Evidence of clinical audits conducted for ANC clients as per BANC
Audit review
protocol (Review audit results and QIP)
70. Facility reached target of 66% ANC <20wks DHIS
71. Ante-Natal indicators monitored monthly (ANC <20wks, ANC retest,
Dashboard
ANC HAART initiation)
B.1.1.3. CERVICAL CANCER SCREENING
DISCA assessment
72. Evidence that DISCA tool is conducted at least quarterly
report
73. Target of 2 pap smear / nurse/day achieved DHIS
74. Cervical cancer screening results reflects good adequacy PR
75. Results are monitored and acted upon PR
B.1.1.4. EXPANDED PROGRAMME OF IMMUNISATION
76. Guidelines available
EPI guideline
Vaccinators manual DOC
Cold Chain Manual
Surveillance Manual
77. Adverse event following immunization monitored DOC
78. Check if vaccine conditions adequate and all vaccines available and
Tool 2 in CH File
viable (100%=Yes)
6
DATE ASSESSED
METHOD OF Q1 Q2 Q3 Q4 COMMENTS
ELEMENT ASSESSED
MEASURE Y N Y N Y N Y N
B.1.1.5. INTEGRTED MANAGEMENT OF CHILDHOOD ILLNESSES
79. Functional rehydration corner with register (100%=Yes) Tool 3 in CH File
80. IMCI Chart booklet available in all consulting rooms:
Acute Stream (Sick)
Preventative Stream (EPI) OBS
Communicable Diseases (HIV/TB)
(Yes = 100% of rooms have IMCI Chart Booklets)
81. All children are triaged and rapid appraisal repeated hourly on back of
Triage & IMCI
IMCI form)
recording form
(Review 5 Child Patient Health Records from queue Yes =100%)
82. 2 Skills Assessments done per month:
Both assessments were done
Tools 6a & 6b in
Average score more than 80% and
CH file
None of audit scores were below 60%
All conditions met Yes = 1
83. Five Well Child Patient Health Record Audits were done during the
quarter
All 5 audits were done
Tool 7 in CH file
Average score more than 80% and
None of 5 audits scores were below 60%
All conditions met Yes = 1
84. Five Sick Child Patient Health Record Audits were done during the
quarter
All 5 audits were done
Tool 8 in CH file
Average score more than 80% and
None of 5 audits scores were below 60%
All conditions met Yes = 1
85. Five Road to Health Record Audits were done during the month
All 5 audits were done
Average score more than 80% and Tool 9 in CH file
None of 5 audits scores were below 60%
All conditions met Yes = 1
7
DATE ASSESSED
COMMENTS
METHOD OF Q1 Q2 Q3 Q4
ELEMENT ASSESSED
MEASURE Y N Y N Y N Y N
B.1.1.5. INTEGRTED MANAGEMENT OF CHILDHOOD ILLNESSES continues
86. Five HIV-Infected Child Patient Health Record Audits were done
during the quarter (Yes=5)
All 5 audits were done
Tool 10 in CH file
Average score more than 80% and
None of 5 audits scores were below 60%
All conditions met Yes = 1
87. Six Caregiver Interviews were done during the quarter
All 6 interviews were done
Tool 11a &11b in
Average score more than 80% and
CH file
None of 5 audits scores were below 60%
All conditions met Yes = 1
87. NHLS reports monitored and actioned:
NHLS VL monitored and actioned
Tool 12 in CH file
NHLS PCR monitored and actioned
All conditions met Yes = 1
88. Monitoring and Evaluation:
Child health data elements verified monthly and
Indicators monitored and Tool 13 & 14 in
Appropriate action plans identified for indicators in” CH file
red” and “yellow”
All conditions met Yes = 1
B.1.1.6. NUTRITION – PROGRAMME
89. Infant and young child feeding guidelines available OBS
90. MAUC available where well and sick child visits happen and at vital
OBS
station (Yes=100%)
91. Supplementary feeding available (Enridged porridge and RUTF) OBS
92. Nutritional Supplement Audit Tool:
Tool 5 in CH file
Achieved above 80%
8
DATE ASSESSED COMMENTS
METHOD OF Q1 Q2 Q3 Q4
ELEMENT ASSESSED
MEASURE Y N Y N Y N Y N
B.1.1.7. ADOLESCENT AND YOUTH FRIENDLY SERVICES (AYFS)
93. AYFS guideline available DOC
94. Evidence that youth profile has been conducted, analyzed and
DOC
used for planning youth interventions
95. AYFS programme is functional (Through youth zone) Checklist
B.1.2. HAST PROGRAMME
B.1.2.1 HIV TESTING SERVICES
96. HIV Test kits available as per current testing Algorithm Pharmacy Stock
(Screening: Advance Quality and Confirmatory: ABON) cards
97. HIV Testing Services Guideline available DOC
98. Provider Initiated counseling and Testing conducted and register
HTS register
signed
99. Evidence of Rapid Test Quality monitoring i.e. (IQC) conducted
DOC
weekly and as per new test kit batch prior use.
100. Evidence that facility conducts Proficiency testing Biannually PT report
101. Latest HST register available and captured on Tier.net OBS
102. Index contact tracing available and updated OBS
B.1.2.2. ART PROGRAMME
103. Availability of UTT SOP 2016 with Algorithm DOC
104. Clinical stationery sections well completed PR
105. Monthly reports generated from Tier.net and signed off by OMN DOC
106. Monthly ART initiation target achieved DOC
107. Defaulter rate is < 5% of TROA PR
108. Viral Load completion at 6 months and 12months is 90% Tier.net
109. ART national consolidated guidelines (2020) is available
110. HAST barometers to monitor and improve HAST performance are
OBS
available and up to date
111. Functionality of literacy classes OBS
112. Capturing of HTS, TB, ART and PrEP on Tier.net, modules
TIER.NET
active?
113. Call centers are functional DOC
114. Number of functional adherence clubs. DOC
B.1.2.3. MEDICAL MALE CIRCUMCISION
115. MMC recruited and referred for circumcision 15 to 49 yrs. DOC
116. MMC adverse events reported DOC
117. MMC register available and up to date DOC
9
DATE ASSESSED
COMMENTS
METHOD OF
ELEMENT ASSESSED Q1 Q2 Q3 Q4
MEASURE
Y N Y N Y N Y N
B.1.2.4. TB PROGRAMME
118. National TB guideline available (Adult 2014 and Child 2015) DOC
119. Use Tier.net analysis for TB DOC
120. 90% of clients 5yrs and older screened for TB DHIS
121. 90% of clients with a positive TB results initiated on treatment Tier.net
122. 90% of clients on treatment with good outcomes (completion rate Tier.net
Case Identification
123. Turnaround times for sputum’s is within 48hrs
Register
B.2. OTHER HEALTH PROGRAMS
B.2.1. CDC – PROGRAMME
124. SOP for notifiable medical conditions and output response DOC
125. Availability of reporting forms for notifiable conditions OBS CDC file
126. Evidence of weekly reporting on notifiable conditions including
DOC Review
zero reporting
127. SOP for notifiable medical conditions and output response DOC
B.2.2. NON-COMMUNICABLE PROGRAMME
128. Evidence of screening for HPT Is available PR
129. Evidence of screening for Diabetes is available PR
130. Evidence screening for Mental Health is available Wed DHIS
131. 90%Clients screened for >40yrs Hypertension Wed DHIS
132. 90% clients screened for>40Yrs Diabetes Wed DHIS
133. 35% of clients seen screened for mental disorders Wed DHIS
134. Monthly HTS targets established and monitored using Barometer DOC
B.2.3. PHC WARD BASED OUTREACH SERVICES
135. School Health Team (SHT) and Family Health Teams (FHT) I
DOC
ternaries are signed by OMN
136. There is a functional referral system between (SHT) and the
DOC
facility
137. There is a functional referral system between FHT and the facility DOC
138. Evidence that Outreach team data is captured Wed DHIS
139. Evidence of health issues discussed at Operation Sukuma Sakhe
DOC
(OSS) meetings
140. Weekly meeting with OM with minutes DOC
10
