Pharmacy Services, Pharmaceuticals Supply and Medical Devices Management

Monitoring and Evaluation Aggregation and Reporting Tool for Health Centers

Health facility information

Reporting period ( Select from drop dawn list)

1 Name of Health Center:

2 Region:
3 Zone:
4 Woreda:
5 Number of beds:
7 Health Center Telephone number
8 Email:
Medical Devices Management
orting Tool for Health Centers

Write your response here Select Month Select Quarter

Hidar
Quarter Quarter 2
0

5
Pharmacy Services, Pharmaceuticals Supply Chain and Medical Devices Management
Monitoring and Evaluation Aggregation and Reporting Tool for Hospitals

A. enter number (for quantitative values)

B. if yes= 1; If no=0 (for yes or no for qualitative data)
C. if not applicable =NA
Monthly Reports QUARTER 1 QUARTER 2 QUARTER 3 QUARTER 4
1 PSMI 6. Essential drug availability Ham Neh Mes Q1 Tik Hid Tah Q2 Tir Yek Meg Q3 Miy Gin Sen Q4
1.1 Number of tracer drugs available througthout the month 25 25 50 0 0 21 18 39
1.2 Total number of tracer drugs (25) 25 25 25 75 25 25 25 75 25 25 25 75 25 25 25 75
% of essential drug availability 100% 0% 100% 67% 0% 0% 0% 0% 0% 0% 0% 0% 84% 72% 0% 52%
2 PSI 7. Percentage of encounters with antibiotic/s prescribed Ham Neh Mes Q1 Tik Hid Tah Q2- Tir Yek Meg Q3 Miy Gin Sen Q4
2.1 Total number of encounters with one or more antibiotics at OPD 30 30 0 0 1560 1620 3180
2.2 Total number of encounters at OPD 40 40 0 0 2140 2450 4590

Percentage of encounters with antibiotic/s prescribed 75% #DIV/0! #DIV/0! 75% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 73% 66% #DIV/0! 69%
3 PSI 8. Percentage of clients With 100% prescribed drugs filled Ham Neh Mes Q1 Tik Hid Tah Q2 Tir Yek Meg Q3 Miy Gin Sen Q4
3.1 Number of clients who received all prescribed drugs (B) 0 0 0 2120 2440 4560
3.2 Total number of clients who received prescriptions and then served by 2140 2450
0 0 0 4590
(OPD. EOPD, IPD, ART etc) pharmacies in this reporting period (P)
Percentage of clients with 100% Prescribed Drugs Filled #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 99% 100% #DIV/0! 99%
 A. enter number (for quantitative values)
B. if yes= 1; If no=0 (for yes or no for qualitative data)
C. if not applicable =NA
Quarterl Reports Q1 Q2 Q3
5 PSMI 2. Inventory Accuracy Rate
5.1 Number of items where stock record balance equals physical stock count
5.2 Total number of counted items
% of Inventory Accuracy Rate #DIV/0! #DIV/0! #DIV/0!
6 PSMI 4. Supplier Fill Rate
6.1 Total Number of each line items supplied with al least 80% of quantity ordered from EPSS for RDF pharmaceuticals
Total number of line items requested to EPSS in the quarter for RDF pharmaceuticals 100
6.2 Supplier Fill Rate for RDF by EPSS 0% #DIV/0! #DIV/0!

6.3 Total Number of each line items supplied with at least 80% of the quantity ordered from EPSS for program
pharmaceuticals
6.4
Total number of line items requested to EPSS in the quarter for program pharmaceuticals
Supplier Fill Rate for program by EPSS #DIV/0! #DIV/0! #DIV/0!
Total Number of each line items supplied with al least 80% of the quantity ordered from private suppliers for RDF
6.5
pharmaceuticals
6.6 Total number of line items requested to private suppliers in the quarter for RDF pharmaceuticals
Supplier Fill Rate for RDF by private suppliers #DIV/0! #DIV/0! #DIV/0!
7 PSMI 9. Availability of effective medical oxygen supply management system
7.1 Medical oxygen and consumable oxygen devices are included in the FSML (5) 5
7.2
Medical oxygen and consumable oxygen devices are included in the facility pharmaceutical quantification (5) 5
7.3 Presence of focal person for medical oxygen supply management (10)
7.4 Presence of policy for medical oxygen supply management (10) 10
7.5
Oxygen cylinders are checked during receiving to ensure proper filling (see signed receiving documents) (15)
7.6 Medical oxygen is stored in secured and separate area for empty and filled cylinders (10)
7.7 Presence of updated Bin card for medical oxygen stock management (for filled and empty cylinders) (check at oxygen
storeroom) (15)

7.8 The facility usesinternal facility reporting and requesting forms (IFRR) for oxygen supply (check 3 recent reports from
maternal, inpatient, ICU and emergency) (15) 15
7.9 Presence of monthly consumption report (check 3 recent reports) (10) 11
7.10 Oxygen prescriptions contain flow rate and monitoring frequency (5)
Total score 46 0 0
No No No
Availability of effective medical oxygen supply management system; If >80%, Yes; If <80%, No.
8 PSMI 7. Availability of effective cold chain management system
8.1
The vaccines/products are stored in appropriate ice lined refrigerator (ILR) or deep freezer in the medicine store (10) 10 10
8.2
All ILR are fitted with the correct vaccine storage baskets and vaccines are arranged in appropriate compartment (10) 10 10
8.3 All refrigerators are attached to standardized functional UPS (10) 10 10
8.4 The temperature of the refrigerator is recorded at least twice per day (15) 15
8.5 The vaccine vial monitors are daily checked and recorded (10) 10
8.6 Presence of cold chain management policy/procedure (10) 10 10
8.7 Regular cleaning and maintaining functionality of refrigerator (10) 10
8.8 Regular vaccine utilization reporting and requesting practice using VRF (15) 15
8.9
The vaccine distribution to service delivery units is done by using cold boxes/vaccine carrier (10) 10 10 10
Total score 100 50 10
The cold chain management system is considered to be effective if ≥80%,Yes, If<80%, No Yes No No
9 PSMI 5. Wastage Rate
9.1 Total cost unusable stock of products 2 20 100
9.2 Total cost of stock available for sale ( beginning stock + quantity received) during the reporting period 3 200 800
Wastage rate (%) 67% 10% 13%
10 MDMI 2. Medical Equipment Management Information System (MEMIS) Functionality
10.1 Assigned biomedical focal person for MEMIS (10) 10 10
10.2 Availability of updated medical equipment inventory (both web based and signed hardcopy with seal) (each 15 point)(30) 30
10.3 Availability of file history for each medical device (at least five equipment) (each 6 point)(30) 10 12
10.4 Presence of maintenance and installation notification and work order system (check notification and work order form)(20) 20

10.5 Availability MEMIS manual and inventory SOP (each 5 point)(10) 10

Total score 80 22 0
Functionality of MEMIS if ≥80%, Yes, If < 80%, No Yes No No
11 MDMI 1. Healthcare Technology Management Committee (HTMC) Functionality
11.1 Confirm that each member is assigned with official letter(10) 10
11.2 Check an availability TOR of HTMC (16)
11.3 Check that HTMC Conduct regular meeting every 2 months with documented minutes(16)
11.4 Check the presence of HTMC action plan(16)
11.5 Check the presence of updated model medical device list approved by the committee(16)
11.6 Verify the availability of MDDP (10)
11.7 Ensures the execution of medical device and related policies, procedures, and guidelines and SOP (minute review)(16)
 Total score 10 0 0
Functionality of HTMC if ≥75%, Yes, If < 75%, No No No No
12 MDMI 3. Availability of standardized medical device maintainance workshop
12.1 Presence of office with furniture, computer, printer, and internet for workshop staffs (each 5 point)
12.2 Availability of store for testing tools, measuring equipment, spare parts, and personal protective devices (10)
12.3 Presence of maintenance, callibration and testing tools, appropriate gases (e.g. acetyline, oxygen) and other tools (20)
12.4 Check the availability of adequate PPE including safety shoes (10)
12.5
Availability of equiped maintainance training workshop capable of mechanical and electrical activities (20)

Presence of appropriate and adequate space walk way for transportation of medical devices (20)
Total score 0 0 0
Standardized biomedical workshop is available if ≥80%, Yes , if <80% , No No No No
13 MDMI 4. Percentage of Medical equipment installed and commissioned
13.1 Number of medical device installed and commissioned within the specific period 3
13.2 Total number of medical equipment delivered to the health facility that needs installation within the last three months 3 8
Percentage of medical equipment installed and commissioned 100% 0% #DIV/0!
14 MDMI 6. Percentage of Medical equipment work order performed
14.1 Number of medical equipment work order performed 2 1 1
14.2 Number of medical equipment requested for work order 2 10 1
Percentage of medical equipment repaired 100% 10% 100%
4 PSI 9: Percentage of medicines prescribed from the health facility medicine list
4.1 Total number of medicines prescribed from health facility medicine list
4.2 Total number of medicine prescribed
Percentage of medicines prescribed from the health facility medicine list #DIV/0! #DIV/0! #DIV/0!
 Q4

#DIV/0!

#DIV/0!

#DIV/0!

#DIV/0!

0
No

0
No

200
200
100%

0
No
 0
No

0
No

#DIV/0!

7
0%

#DIV/0!
 21
21.1
21.2

22
22.1
22.2
24.3
24.4
24.5
24.6
24.7

23
23.1
23.2
23.3
23.4
23.5
23.6

23.7
23.8
23.9
23.10
23.11
23.12
23.13

24
24.1
24.2

25
25.1

25.2

26
26.1
26.2
A. enter number (for quantitative values)
B. if yes= 1; If no=0 (for yes or no for qualitative data)
C. if not applicable =NA
Annual Reports
PSMI 1. Forecast Accuracy
Total number of items within acceptable forcast accuracy
Total number of sampled items

If fo
PSI 6. Antimicrobial stewardship program functionality
Assigned ASP members by official letter (7)
Inclusion of ASP’s role and responsibilities of the chair and secretary in their job description (7)
Presence of Terms of Reference and action plan (6)
Presence of antimicrobial drug use policy(10)
Categorizes antibiotics into Access, watch and reserve (AWaRe)(20)
Presence of prospective audit and feedback practice (on daily, weekly, monthly basis) (25)
Conducts review of the facility antimicrobial consumption/use and resistance at least annually (25)

Functionality of Antimicrobial stewa

PSMI 3. Percentage of good storage conditions (If the criteria is met put 1, if not put 0)
Products are arranged on shelves with arrows pointing up, and with identification labels, expiry dates, and manufacturing date
Products are stored and organized to FEFO procedures and are accessible for counting and general stock managemen
Outer cartons are in good condition (not crushed, perforated, stained, or otherwise visibly damaged).
Damaged and expired products are separated from usable products in the storeroom, and procedures exist for removin
Products are stored in a dry, well-lit, well-ventilated storeroom. (Visually inspect roof, walls, and floor of storeroom.)
Cartons and products are protected from direct sunlight.
There is no evidence of rodents or insects in the storage area. (Visually inspect the storage area for evidence of rodent
damage or contaminate the products.)
Storage area is secured with a lock and key but is accessible during normal working hours; access is limited to author
Products are stored at the appropriate temperature according to product temperature specifications (8°– 30°C) and inc
8°C), as required for certain products.
Roof is maintained in good condition to avoid sunlight and water penetration.
Storeroom is clean, with all trash removed, no evidence of food and drinks, products stored on sturdy shelves/bins, an
Current storage space is sufficient for existing products and planned program expansion. ( 106.28m2 (sum of two sep
Medical Supply and Medical Equipment, and Chemical))
Products are stored separately from insecticides, flammable products, and chemicals.

Per
If storage condition
MDMI 7. Percentage of Medical Equipment Functionality
Number of functional medical equipment in the health facility
Total number of medical equipment in the facility from updated ME inventory list
Percentage o
MDMI 8: Availability of medical devices as per the national standard
The total number of medical equipment available at health facility as
per the standard
Total expected number of medical equipment available at health
facility as per standard
% of Availability of Medical Equipm
CC3. Percentage of pharmacy workforce positions filled at health facilities
Number of pharmacy workforce at the health facility
Number of allowed pharmacy workforce positions
% of pharmacy workforce positions filled at the health facility
 Annual

10
10
100%
No

0
No

10
4
200
3
1
1

10
1
1
1
20
1
1
254
1954%
Yes
 2
5
40%

#DIV/0!

#DIV/0!
 13

13.1

13.2

13.3
13.4
13.5
13.6
13.7

13.8
13.9
13.10

14
14.1

14.2
14.3
14.4
14.5
14.6
14.7
14.8
14.9

15

15.1
15.2
15.3
15.4

15.5

15.6
15.7
15.8

15.9

15.10
15.11

16

16.1
16.2
16.3

16.4

16.5

16.6
16.7
16.8

17
17.1

17.2

17.3
17.4
17.5

17.6

17.7

17.8

17.9

17.10
17.11
17.12

17.13

17.14
17.15

18
18.1
18.2

19
20.1
20.2

20

20.1
20.2
20.3
20.4
20.5
20.6
20.7
20.8
20.9
20.10
20.11
20.12
20.13
A. enter number (for quantitative values)
B. if yes= 1; If no=0 (for yes or no for qualitative data)
C. if not applicable =NA

Semi-Annual Reports

PSMI 9. Availability of effective medical oxygen supply management system

Medical oxygen and consumable oxygen devices are included in the FSML (5)
Medical oxygen and consumable oxygen devices are included in the facility pharmaceutical
quantification (5)
Presence of focal person for medical oxygen supply management (10)
Presence of policy for medical oxygen supply management (10)
Oxygen cylinders are checked during receiving to ensure proper filling (see signed receiving
documents) (15)
Medical oxygen is stored in secured and separate area for empty and filled cylinders (10)
Presence of updated Bin card for medical oxygen stock management (for filled and empty cylinders)
(check at oxygen storeroom) (15)
The facility usesinternal facility reporting and requesting forms (IFRR) for oxygen supply (check 3
recent reports from maternal, inpatient, ICU and emergency) (15)
Presence of monthly consumption report (check 3 recent reports) (10)
Oxygen prescriptions contain flow rate and monitoring frequency (5)

Total score
Availability of effective medical oxygen supply management system; If ≥80%, Yes; If <80%, No.
PSMI 7. Availability of effective cold chain management system
The vaccines/products are stored in appropriate ice lined refrigerator (ILR) or deep freezer in the
medicine store (10)
All ILR are fitted with the correct vaccine storage baskets and vaccines are arranged in appropriate
compartment (10)
All refrigerators are attached to standardized functional UPS (10)
The temperature of the refrigerator is recorded at least twice per day (15)
The vaccine vial monitors are daily checked and recorded (10)
Presence of cold chain management policy/procedure (10)
Regular cleaning and maintaining functionality of refrigerator (10)
Regular vaccine utilization reporting and requesting practice using VRF (15)
The vaccine distribution to service delivery units is done by using cold boxes/vaccine carrier (10)
Total score
The cold chain management system is considered to be effective if ≥80%,Yes, If<80%, No

PSI 1.Drug and Therapeutics Committee (DTC) Functionality

Official letter of assigned DTC members (2.5) and updated and approved TOR are available (2.5), (5)
Annual action plan is approved (5)
Documented minute that shows regular meetings, at least every two months (10)
Updated (annually) health facility specific pharmaceutical list prioritized by VEN (10)
Availability of medicine management policy and procedures (at least three policies) (Example:
procurement policy, formulary management policy, prescription management policy, stock transfer
policy, inventory management and storage policy, disposal policy (10)
Conduct pharmaceutical supply studies (at least one assessment report semi-annually) (ABC/VEN
reconciliation, stock status analysis, etc.) (10)
Conduct medicine use studies using indicator study method (at least annually) (10)
Conduct in-depth medicine use studies using medicine use evaluation (at least one study annually)(10)

Take actions based on the supply and medicine use study findings with report, minutes, letter of action
and any related document ( 20 )
ADE/AEFI reports are generated, monitored regularly and take actions on the finding (5)
Report its performance activities to the management (5)
Total score
Functionality of DTC if ≥75%, Yes, If < 75%, No
PS3: Drug information service functionality
Availability of required facilities (i.e. room, equipment, furniture, telephone, internet, reference
materials) and dedicated pharmacist(20)
Approved annual action plan for the fiscal year(5)
Availability of standard operating procedure(5)
Provides therapeutic and pharmaceutical information using standardized query and responses
formats(20)
Organizes medicine use education to patients and general public, and training program to the hospital
staff at least monthly (health education programs, community forums)(15)
Prepares and disseminate drug alerts/newsletters, new arrivals, bulletins, therapy updates, monographs,
error prone abbreviations, look-alike and sound alike medication at least monthly (20)
Provides poison information (5)
Prepare and disseminate performance reports monthly (10)
Total Score
Functionality of drug information service; if ≥75%, Yes; If < 75%, No.
PS5. APTS functionality
Presence of dedicated pharmacy accountant with office, computer, shelf, and file folders( 3.75)
Presence of standardized premises to keep patient safety, privacy, and satisfaction (entry and exit doors,
counter design, and workflow arranged as evaluator/biller à cashier a counselor at OPD pharmacy and
appropriate arrangement in other dispensing outlets(1.25)
Presence of properly recorded sales tickets and credit/free registers at dispensaries(3.75)
Bin ownership is implemented in dispensary (assigned names, FEFO arrangement, documented IFRR,
damage and expiry report)(1.25)
Implementation of pharmaceutical coding system in all dispensaries and stores (check M-19 health, M-
22 health, sales ticket, credit/free registers, inventory, and price control sheet) (2.5)
Presence of monthly reports for finance and services and quarter report for products (hint: see at least
last 3 reports) (10)

Presence of financial, product, and service audit report (internal) (hint: last 6 months) (10)
Presence of dispensing aiding materials (tablet counter, cutter, packaging material like envelope,
labeling material)(5)
Presence of prescribing and dispensing reference materials (at least soft or hard copy STG or
Formulary in dispensaries and OPD clinics, FSML in dispensaries)(2.5)
Evaluation of prescription using the standard checklist (check for DTP assessment, prescription
completeness, legality, legibility)(10)
Presence of proper labeling practice (hint: observe 5 patients randomly)(10)
Achievement of 100% patient knowledge on correct dosage (dose, frequency, route, & duration) (hint:
interview randomly selected 5 patients)(15)
Achievement of 80% patient satisfaction level on dispensing service (hint: use the health facility recent
report)(7.5)
Presence of good documentation practice (hint: take 5 prescriptions randomly and check their record)
(7.5)
Provision of reconstitution of oral powdered dosage form to patients(10)
Total score
Functionality of APTS, if ≥75%, Yes (1). If <75%, No (0)
PSI 12: Percentage of medicine actually dispensed
Total number of medicine dispensed
Total number of medicine prescribed
% of Medicine actually dispensed
PSI 11. Patients’ knowledge on correct dosage
Number of patients with adequate knowledge on correct dosage
Total number of patients interviewed
% of patients’ knowledge on correct dosage = total adequate/100 *100
PSI 10. Client satisfaction with dispensing services

The OPD pharmacy is easily accessible

The pharmacy is clean
The pharmacy room is adequate for the service
The pharmacy ensures reasonable privacy
The waiting area is convenient
The dispensers were welcoming to patients
The dispensers were ready to listen to my problems
Waiting time was appropriate
All your prescribed medicine was given
The medicines are affordable to you
I trust the competence of the dispensers
I received adequate information about how I should use my medicines
I am generally satisfied by the service I received
Total Yes (X)
Level of client satisfaction with dispensing service (Y=X/13*100)
Satisfaction: (≥80%) (If yes 1, If no 0)
1st half 2nd half
year year

5
10
10

15
10

15

5
75 0
No No

10

10
10
15
10
10

15

80 0
Yes No

2.5
10
10

10

10

10

0 20

58 20
No No

20 20
5
5

20 20

15
20 20
5
10
100 60
Yes No
 10

10

10
10

15

7.50
10
78 0
Yes No

4 100
6 150
67% 67%

100
100 100
100% 0%

1
1

1
 1
3 1
2308% 769%
Yes Yes
SC2. Essential Medicine availability
Q1 Q2 Q3 Q4 percentage o
percentage of essential drug 67% 0% 0% 52% 70%
availability 60%
50%
40%
30%
20%
10%
0%
Q1 Q2

PS7. Percentage of encounters with

antibiotic/s prescribed
Percentage
Q1 Q2 Q3 Q4
Percentage of encounters with
antibio
75% #DIV/0! #DIV/0! 69%
antibiotic/s prescribed 76%
74%
72%
70%
68%
66%
Q1 Q2

PS8. Percentage of clients With

100% prescribed drugs filled Q1 Q2 Q3 Q4 Percenta
Percentage of clients With 100% 0% 0% 0% 0%
Pres
Prescribed Drugs Filled 100%
80%
60%
40%
20%
0%
Q1 Q2

PS9: Percentage of medicines

prescribed from the health facility Percentage
medicine list Q1 Q2 Q3 Q4 the hea
Percentage of medicines prescribed Err:509 1200%
from the health facility medicine list Err:509 Err:509 Err:509
1000%
800%
600%
400%
200%
0%
Q1 Q2
 800%
600%
400%
200%
0%
Q1 Q2

SC3. Inventory Accuracy Rate Q1 Q2 Q3 Q4

percentage of Inventory Accuracy #DIV/0! #DIV/0! #DIV/0! #DIV/0! percentag
Rate
1200%
1000%
800%
600%
400%
200%
0%
Q1 Q2

SC4. Supplier Fill Rate Q1 Q2 Q3 Q4

Percentage of Supplier Fill Rate
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
Percentage
(For RDF)
1200%

1000%

800%

600%

400%

200%

0%
Q1 Q2

SC4. Supplier Fill Rate Q1 Q2 Q3 Q4 Percentag

Percentage of supplier Fill rate (for #DIV/0! #DIV/0! #DIV/0! #DIV/0! 1200%
private)
1000%

800%

600%

400%

200%

0%
Q1
SC8. Wastage Rate Q1 Q2 Q3 Q4
Wastage rate 67% 10% 13% 100%
120%

100%

80%

60%

40%

20%

0%
Q1
 percentage of essential drug availability
70%
60%
50% percentage of essential drug
40% availability
30%
20%
10%
0%
Q1 Q2 Q3 Q4

Percentage of encounters with

antibiotic/s prescribed
76% Percentage of encoun-
74% ters with antibiotic/s
prescribed
72%
70%
68%
66%
Q1 Q2 Q3 Q4

Percentage of clients With 100%

Prescribed Drugs Filled
100%
80% Percentage of clients With
100% Prescribed Drugs Filled
60%
40%
20%
0%
Q1 Q2 Q3 Q4

Percentage of medicines prescribed from

the health facility medicine list
1200%
1000%
Percentage of medicines pre-
800% scribed from the health facility
medicine list
600%
400%
200%
0%
Q1 Q2 Q3 Q4
800%
medicine list
600%
400%
200%
0%
Q1 Q2 Q3 Q4

percentage of Inventory Accuracy Rate

1200%
1000%
800% percentage of Inventory Ac-
curacy Rate
600%
400%
200%
0%
Q1 Q2 Q3 Q4

Percentage of Supplier Fill Rate (For RDF)

1200%

1000%

800%
Percentage of Supplier Fill Rate
(For RDF)
600%

400%

200%

0%
Q1 Q2 Q3 Q4

Percentage of supplier Fill rate (for private)

1200%

1000%

800%
Percentage of supplier Fill rate
(for private)
600%

400%

200%

0%
Q1 Q2 Q3 Q4
 Wastage rate
120%

100%

80%
Wastage rate
60%

40%

20%

0%
Q1 Q2 Q3 Q4
 Pharmacy Services, Pharmaceuticals Supply and Medical Devices Management
Monitoring and Evaluation Aggregation and Reporting Tool for Health Centers
Reports
1 PSMI 6. Essential drug availability
1.1 Number of tracer drugs available througthout the month
1.2 Total number of tracer drugs
% of essential drug availability
2 PSI 7. Percentage of encounters with antibiotic/s prescribed
2.1 Total number of encounters with one or more antibiotics at OPD
2.2 Total number of encounters at OPD

Percentage of encounters with antibiotic/s prescribed

3 PSI 8. Percentage of clients With 100% prescribed drugs filled
3.1 Number of clients who received all prescribed drugs (B)

3.2 Total number of clients who received prescriptions and then served by (OPD. EOPD,
IPD, ART etc) pharmacies in this reporting period (P)
Percentage of clients with 100% Prescribed Drugs Filled
4 PSI 9: Percentage of medicines prescribed from the health facility medicine list
4.1 Total number of medicines prescribed from health facility medicine list
4.2 Total number of medicine prescribed
Percentage of medicines prescribed from the health facility medicine list
5 PSMI 2. Inventory Accuracy Rate
5.1 Number of items where stock record balance equals physical stock count
5.2 Total number of counted items
% of Inventory Accuracy Rate
6 PSMI 4. Supplier Fill Rate
6.1 Total Number of each line items supplied with al least 80% of quantity ordered from
EPSS for RDF pharmaceuticals
Total number of line items requested to EPSS in the quarter for RDF pharmaceuticals
6.2 Supplier Fill Rate for RDF by EPSS
6.3 Total Number of each line items supplied with at least 80% of the quantity ordered from
EPSS for program pharmaceuticals
6.4 Total number of line items requested to EPSS in the quarter for program
pharmaceuticals
Supplier Fill Rate for program by EPSS
Total Number of each line items supplied with al least 80% of the quantity ordered from
6.5
private suppliers for RDF pharmaceuticals

6.6 Total number of line items requested to private suppliers in the quarter for RDF
pharmaceuticals
Supplier Fill Rate for RDF by private suppliers
7 PSMI 9. Availability of effective medical oxygen supply management system
Total score
 Availability of effective medical oxygen supply management system; If >80%, Yes; If
<80%, No.
8 PSMI 7. Availability of effective cold chain management system
Total score
The cold chain management system is considered to be effective if ≥80%,Yes, If<80%,
No
9 PSMI 5. Wastage Rate
9.1 Total cost unusable stock of products
9.2 Total cost of stock available for sale ( beginning stock + quantity received) during the
reporting period
Wastage rate (%)
MDMI 2. Medical Equipment Management Information System (MEMIS)
10
Functionality
Total score
Functionality of MEMIS if ≥80%, Yes, If < 80%, No
11 MDMI 1. Healthcare Technology Management Committee (HTMC) Functionality
Total score
Functionality of HTMC if ≥75%, Yes, If < 75%, No
12 MDMI 3. Availability of standardized medical device maintainance workshop
12.1 Presence of office with furniture, computer, printer, and internet for workshop staffs (each
5 point)
12.2 Availability of store for testing tools, measuring equipment, spare parts, and personal
protective devices (10)
12.3 Presence of maintenance, callibration and testing tools, appropriate gases (e.g. acetyline,
oxygen) and other tools (20)
12.4 Check the availability of adequate PPE including safety shoes (10)
12.5 Availability of equiped maintainance training workshop capable of mechanical and
electrical activities (20)
Presence of appropriate and adequate space walk way for transportation of medical
devices (20)
Total score
Standardized biomedical workshop is available if ≥80%, Yes , if <80% , No
13 MDMI 4. Percentage of Medical equipment installed and commissioned
13.1 Number of medical device installed and commissioned within the specific period
13.2 Total number of medical equipment delivered to the health facility that needs installation
within the last three months
Percentage of medical equipment installed and commissioned
14 MDMI 6. Percentage of Medical equipment work order performed
14.1 Number of medical equipment work order performed
14.2 Number of medical equipment requested for work order
Percentage of medical equipment repaired
13 PSMI 9. Availability of effective medical oxygen supply management system
13.1 Medical oxygen and consumable oxygen devices are included in the FSML (5)
13.2 Medical oxygen and consumable oxygen devices are included in the facility
pharmaceutical quantification (5)
13.3 Presence of focal person for medical oxygen supply management (10)
13.4 Presence of policy for medical oxygen supply management (10)
13.5 Oxygen cylinders are checked during receiving to ensure proper filling (see signed
receiving documents) (15)
13.6
Medical oxygen is stored in secured and separate area for empty and filled cylinders (10)
13.7 Presence of updated Bin card for medical oxygen stock management (for filled and empty
cylinders) (check at oxygen storeroom) (15)
13.8 The facility usesinternal facility reporting and requesting forms (IFRR) for oxygen supply
(check 3 recent reports from maternal, inpatient, ICU and emergency) (15)
13.9 Presence of monthly consumption report (check 3 recent reports) (10)
13.10 Oxygen prescriptions contain flow rate and monitoring frequency (5)
Total score
Availability of effective medical oxygen supply management system; If ≥80%, Yes; If
<80%, No.
14 PSMI 7. Availability of effective cold chain management system
14.1 The vaccines/products are stored in appropriate ice lined refrigerator (ILR) or deep freezer
in the medicine store (10)
14.2 All ILR are fitted with the correct vaccine storage baskets and vaccines are arranged in
appropriate compartment (10)
14.3 All refrigerators are attached to standardized functional UPS (10)
14.4 The temperature of the refrigerator is recorded at least twice per day (15)
14.5 The vaccine vial monitors are daily checked and recorded (10)
14.6 Presence of cold chain management policy/procedure (10)
14.7 Regular cleaning and maintaining functionality of refrigerator (10)
14.8 Regular vaccine utilization reporting and requesting practice using VRF (15)
14.9 The vaccine distribution to service delivery units is done by using cold boxes/vaccine
carrier (10)
Total score
The cold chain management system is considered to be effective if ≥80%,Yes, If<80%,
No
15 PSI 1.Drug and Therapeutics Committee (DTC) Functionality
15.1 Official letter of assigned DTC members (2.5) and updated and approved TOR are
available (2.5), (5)
15.2 Annual action plan is approved (5)
15.3 Documented minute that shows regular meetings, at least every two months (10)
15.4 Updated (annually) health facility specific pharmaceutical list prioritized by VEN (10)
Availability of medicine management policy and procedures (at least three policies)
(Example: procurement policy, formulary management policy, prescription management
15.5
policy, stock transfer policy, inventory management and storage policy, disposal policy
(10)
 Conduct pharmaceutical supply studies (at least one assessment report semi-annually)
15.6
(ABC/VEN reconciliation, stock status analysis, etc.) (10)
15.7 Conduct medicine use studies using indicator study method (at least annually) (10)
15.8 Conduct in-depth medicine use studies using medicine use evaluation (at least one study an
Take actions based on the supply and medicine use study findings with report, minutes,
15.9
letter of action and any related document ( 20 )

15.10 ADE/AEFI reports are generated, monitored regularly and take actions on the finding (5)
15.11 Report its performance activities to the management (5)
Total score
Functionality of DTC if ≥75%, Yes, If < 75%, No
16 PS3: Drug information service functionality
16.1 Availability of required facilities (i.e. room, equipment, furniture, telephone, internet,
reference materials) and dedicated pharmacist(20)
16.2 Approved annual action plan for the fiscal year(5)
16.3 Availability of standard operating procedure(5)
16.4 Provides therapeutic and pharmaceutical information using standardized query and
responses formats(20)

Organizes medicine use education to patients and general public, and training program to
16.5
the hospital staff at least monthly (health education programs, community forums)(15)

Prepares and disseminate drug alerts/newsletters, new arrivals, bulletins, therapy updates,
16.6 monographs, error prone abbreviations, look-alike and sound alike medication at least
monthly (20)
16.7 Provides poison information (5)
16.8 Prepare and disseminate performance reports monthly (10)
Total Score
Functionality of drug information service; if ≥75%, Yes; If < 75%, No.
17 PS5. APTS functionality
Presence of dedicated pharmacy accountant with office, computer, shelf, and file
17.1
folders( 3.75)
Presence of standardized premises to keep patient safety, privacy, and satisfaction (entry
and exit doors, counter design, and workflow arranged as evaluator/biller à cashier a
17.2
counselor at OPD pharmacy and appropriate arrangement in other dispensing
outlets(1.25)

17.3 Presence of properly recorded sales tickets and credit/free registers at dispensaries(3.75)

17.4 Bin ownership is implemented in dispensary (assigned names, FEFO arrangement,

documented IFRR, damage and expiry report)(1.25)
Implementation of pharmaceutical coding system in all dispensaries and stores (check M-
17.5 19 health, M-22 health, sales ticket, credit/free registers, inventory, and price control
sheet) (2.5)
Presence of monthly reports for finance and services and quarter report for products (hint:
17.6
see at least last 3 reports) (10)
17.7
Presence of financial, product, and service audit report (internal) (hint: last 6 months) (10)
17.8 Presence of dispensing aiding materials (tablet counter, cutter, packaging material like
envelope, labeling material)(5)
Presence of prescribing and dispensing reference materials (at least soft or hard copy STG
17.9
or Formulary in dispensaries and OPD clinics, FSML in dispensaries)(2.5)

17.10 Evaluation of prescription using the standard checklist (check for DTP assessment,
prescription completeness, legality, legibility)(10)
17.11 Presence of proper labeling practice (hint: observe 5 patients randomly)(10)
Achievement of 100% patient knowledge on correct dosage (dose, frequency, route, &
17.12
duration) (hint: interview randomly selected 5 patients)(15)

17.13 Achievement of 80% patient satisfaction level on dispensing service (hint: use the health
facility recent report)(7.5)
17.14 Presence of good documentation practice (hint: take 5 prescriptions randomly and check
their record) (7.5)
17.15 Provision of reconstitution of oral powdered dosage form to patients(10)
Total score
Functionality of APTS, if ≥75%, Yes (1). If <75%, No (0)
18 PSI 12: Percentage of medicine actually dispensed
18.1 Total number of medicine dispensed
18.2 Total number of medicine prescribed
% of Medicine actually dispensed
19 PSI 11. Patients’ knowledge on correct dosage
20.1 Number of patients with adequate knowledge on correct dosage
20.2 Total number of patients interviewed
% of patients’ knowledge on correct dosage = total adequate/100 *100
PSI 10. Client satisfaction with dispensing services
20
20.1 The OPD pharmacy is easily accessible
20.2 The pharmacy is clean
20.3 The pharmacy room is adequate for the service
20.4 The pharmacy ensures reasonable privacy
20.5 The waiting area is convenient
20.6 The dispensers were welcoming to patients
20.7 The dispensers were ready to listen to my problems
20.8 Waiting time was appropriate
20.9 All your prescribed medicine was given
20.10 The medicines are affordable to you
20.11 I trust the competence of the dispensers
20.12 I received adequate information about how I should use my medicines
20.13 I am generally satisfied by the service I received
Total Yes (X)
Level of client satisfaction with dispensing service (Y=X/13*100)
Satisfaction: (≥80%) (If yes 1, If no 0)
 21 PSMI 1. Forecast Accuracy
21.1 Total number of items within acceptable forcast accuracy
21.2 Total number of sampled items
Forcast accuracy
If forecast accuracy ≥ 80%, acceptable
22 PSI 6. Antimicrobial stewardship program functionality
22.1 Assigned ASP members by official letter (7)
Inclusion of ASP’s role and responsibilities of the chair and secretary in their job
22.2
description (7)
24.3 Presence of Terms of Reference and action plan (6)
24.4 Presence of antimicrobial drug use policy(10)
24.5 Categorizes antibiotics into Access, watch and reserve (AWaRe)(20)
Presence of prospective audit and feedback practice (on daily, weekly, monthly basis)
24.6
(25)
Conducts review of the facility antimicrobial consumption/use and resistance at least
24.7
annually (25)
Total Score
Functionality of Antimicrobial stewardship, if ≥75%, Yes. If <75%, No
PSMI 3. Percentage of good storage conditions (If the criteria is met put 1, if not put
23
0)
23.1 Products are arranged on shelves with arrows pointing up, and with identification labels, expiry da
Products are stored and organized to FEFO procedures and are accessible for counting
23.2
and general stock management.
Outer cartons are in good condition (not crushed, perforated, stained, or otherwise visibly
23.3
damaged).
Damaged and expired products are separated from usable products in the storeroom, and
23.4
procedures exist for removing them from inventory.
Products are stored in a dry, well-lit, well-ventilated storeroom. (Visually inspect roof,
23.5
walls, and floor of storeroom.)
23.6 Cartons and products are protected from direct sunlight.
There is no evidence of rodents or insects in the storage area. (Visually inspect the storage
23.7 area for evidence of rodents [droppings] or insects that can damage or contaminate the
products.)
Storage area is secured with a lock and key but is accessible during normal working
23.8
hours; access is limited to authorized personnel.
Products are stored at the appropriate temperature according to product temperature
23.9 specifications (8°– 30°C) and including cold chain storage (2°– 8°C), as required for
certain products.
23.10 Roof is maintained in good condition to avoid sunlight and water penetration.
Storeroom is clean, with all trash removed, no evidence of food and drinks, products
23.11
stored on sturdy shelves/bins, and boxes organized neatly.
Current storage space is sufficient for existing products and planned program expansion. (
23.12 106.28m2 (sum of two separate stores:- Medicine and Medical Supply and Medical
Equipment, and Chemical))
23.13 Products are stored separately from insecticides, flammable products, and chemicals.
Total number of met criteria
Percentage of good storage conditions
If storage condition score is ≥80%, Yes, If < 80%, No.
24 MDMI 7. Percentage of Medical Equipment Functionality
24.1 Number of functional medical equipment in the health facility
24.2 Total number of medical equipment in the facility from updated ME inventory list
Percentage of Medical Equipment Functionality
25 MDMI 8: Availability of medical devices as per the national standard
The total number of medical equipment available at health facility as
25.1
per the standard
Total expected number of medical equipment available at health
25.2
facility as per standard
% of Availability of Medical Equipment as per the national standard
26 CC3. Percentage of pharmacy workforce positions filled at health facilities
26.1 Number of pharmacy workforce at the health facility
26.2 Number of allowed pharmacy workforce positions
% of pharmacy workforce positions filled at the health facility
s Management
Health Centers
Annual Aggregation

89
300
30%

3210
4630
69%

4560

4590

99%

0
0
#DIV/0!

0
0
#DIV/0!

0
100
0%
0

0
#DIV/0!
0

0
#DIV/0!

12
 No

40
No

322
1203
27%

26
No

3
No

0
No

3
3
100%

2
2
100%

5
5
10
10

15

10

15

15

5
90
Yes

10

10
10
15
10
10

15

80
Yes

10
10

10
10

10
20

75
Yes

20
5
5
20

15

20

5
10
100
Yes

10
 10

10
10

15

7.50
10
78
Yes

4
6
67%

100
100
100%

1
1

3
2308%
Yes
 10
10
100%
No

0
No

10
4

200

1
1

10

1
20

1
 1
254
1954%
Yes

2
5
40%

#DIV/0!

#DIV/0!