District: HSD: Health facility name: Health facility cde: Level: Telephne: Name f facility in-charge: Email: Date f supervisin visit: A. Health Facility Assessment 1. Is the health facility in-charge n duty? Yes N 2. Number f health prviders present? 3. Number f health prviders present wh cmpleted IPC training: a. Were the health prvider cmpetencies assessed? Yes N b. Is a cpy f the Health Prvider Perfrmance Appraisal Sheet attached? Yes N 4. Number f children under 5 in the waiting area? 5. Average time health prvider spends with each caregiver f children under 5? < 5 min 5-10 min 10-15 min >15 min 6. Are the 2012 Clinical Guidelines available? Yes N 7. Is the Jb Aid fr Children with Fever available? Yes N 8. Are there referral frms available? Yes N NA 9. Is there a functining thermmeter? Yes N 10. Is there a functining weighing scale available? Yes N 11. Are RDTs available? Yes N a. If n, why nt? b. Number f RDTs in stck: c. Brand f RDTs: d. Expiry date f RDTs: Supervisr Visit Checklist Page 1
12. Wh perfrms RDTs? a. Is this persn available every day? Yes N 13. Wh reads RDT results? a. Is this persn available every day? Yes N 14. Is micrscpy available? Yes N 15. Are the fllwing medicines available? a. Artesunate 50 mg suppsitries Yes N b. Artesunate 200 mg suppsitries Yes N c. Artemether/lumefantrine 20/120 mg tablets Yes N d. Artesunate 50 mg tablets Yes N e. Amdiaquine 153 mg tablets Yes N f. Amxicillin 125 mg tablets Yes N g. Amxicillin 250 mg tablets Yes N h. Ctrimxazle tablets Yes N Supervisr Visit Checklist Page 2
B. Health Prvider Assessment Health Prvider Cmpetencies fr IPC and Differential Diagnsis f Fever Cmpetencies are a written set f knwledge, skills, abilities, and attitudes that help define a standard level f jb perfrmance and t differentiate superir perfrmance frm average perfrmance under specified circumstances. Cmpetencies help t: Define the essential functins f a rle r jb. Identify the behaviurs required t be successful in a jb s that health prviders and their supervisrs are aware f what is expected f them. Identify areas f strengths and thse that need imprvement ver time. Observe fr behaviurs which can be used t give bjective feedback thugh dialgue. Drive perfrmance imprvement f an rganizatin r the health care system The Cmpetencies fr IPC and Differential Diagnsis f Fever is a list f bservable skills and behaviurs used t assess the health prvider s ability at using interpersnal cmmunicatin skills during patient assessment, diagnsis and treatment f children under 5 with fever. The Cmpetencies fr IPC and Differential Diagnsis f Fever is divided int Dmains, Cre Cmpetencies, Behaviurs and Perfrmance Levels. A dmain is an area f perfrmance. Fr the purpses f this training there are 3 dmains: 1. Patient Assessment 2. Diagnsis 3. Treatment A cre cmpetency describes the brad knwledge, skills and attitudes required t perfrm each dmain under each dmain. Every health prvider will be bserved fr the fllwing 10 cre cmpetencies: 1. Puts the child s caregiver at ease. 2. Asks medical histry questins in a manner the caregiver understands. 3. Listens t the caregiver s cncerns and respnses. 4. Cmmunicates infrmatin abut exam prcedures in a manner the caregiver understands. 5. Uses the Jb Aid fr Children with Fever crrectly t assess the cause f the child s fever. 6. Cmmunicates infrmatin abut diagnstic prcedures and test results in a manner the caregiver understands. 7. Cmmunicates the child s diagnsis at a level the caregiver can understand. 8. Uses the Jb Aid fr Children with Fever crrectly t cmmunicate diagnstic prcedures and results. 9. Cmmunicates infrmatin abut treatment recmmendatins in a manner the caregiver will understand and fllw. 10. Uses the Jb Aid fr Children with Fever crrectly t cmmunicate treatment recmmendatins fr malaria and nn-malaria fever. Behaviurs describe the specific knwledge, skills and attitudes which can be demnstrated and bserved by thers t determine whether the cre cmpetency is perfrmed. Supervisr Visit Checklist Page 3
Perfrmance levels define hw well each cmpetency is perfrmed, r hw prficient the health prvider is at each cmpetency. Perfrmance levels are differentiated by: The extent f knwledge and experience. The frequency the cmpetency is applied well. The amunt f assistance and caching required fr imprvement. The ability t perfrm the cmpetency independently and with cnfidence. Level Descriptin f Perfrmance Level Rating Advanced Health prvider is very knwledgeable abut the tpic Has repeated experience with this cre cmpetency. Can demnstrate this cmpetency very well. Is capable f demnstrating almst all f the behaviurs fr this cmpetency withut assistance. May serve as a rle mdel r mentr peers n this cmpetency. Occasinally needs caching and supprt fr difficult r unique situatins. 3 Satisfactry Health prvider is knwledgeable abut the tpic. Has mderate experience with this cre cmpetency. Can demnstrate this cmpetency satisfactrily. Is capable f demnstrating mst f the behaviurs fr this cmpetency withut assistance. Needs caching and training in rder t imprve and demnstrate the advanced aspects r behavirs assciated with this cmpetency. 2 Unsatisfactry Health prvider has limited t very limited knwledge abut the tpic. Has limited experience with this cre cmpetency. Has difficulty demnstrating this cmpetency r may demnstrate a negative attitude. Is capable f demnstrating very few f the behaviurs fr this cmpetency withut assistance. Needs significant caching and additinal training in rder t imprve. 1 Health Prvider Perfrmance Assessment Checklist The health prvider perfrmance assessment is used t evaluate the level f behaviur change amng the health prviders wh attended the IPC Skills fr Differential Diagnsis f Fever in Children training and t determine if they apply what they learned at the health facility. It is used t determine hw many health prviders wh attended training are perfrming at a desired level f perfrmance in rder t create the desired impact. Supervisrs will scre the verall areas f perfrmance and then prvide psitive reinfrcement fr desired perfrmance and caching and mentring fr areas that need imprvement. The perfrmance assessment will als be used t determine hw much health prviders imprve with practice ver 3 supervisin visits. Alng with the training Preand Pst-Test scres, the perfrmance assessment will serve t evaluate areas f strengths and weakness amng health prviders and t recmmend additinal CME curses. Supervisr Visit Checklist Page 4
Directins fr Assessing Health Prvider Cmpetencies 1. Cmplete the tp f the Health Prvider Perfrmance Appraisal Summary Sheet fr each health prvider assessment. Make sure t include the health prvider s Pre and Pst-Test scres and the gap areas identified frm the Test Scring Tracking Sheet. 2. Observe the health prvider at the health facility while they are cnducting assessment, diagnsis and treatment fr children under 5 with fever. 3. Rate the health prvider based n the level f prficiency they demnstrate fr each f the ten cre cmpetencies with a rating f 3=Advanced, 2=Satisfactry, r 1=Unsatisfactry. 4. It may nt be pssible t bserve fr ALL the skills described, therefre it is imprtant t bserve fr specific examples when deciding what rating scre t give. If the health prvider demnstrates ne skill in level 3 and anther in level 2, then yu must chse the lwer rating; i.e. yu can nly scre the higher level if ALL skills are demnstrated in that higher level. 5. Write dwn cmments f specific examples fr why the scre was selected, what the health prvider did well, and what needs imprvement n the Health Prvider Perfrmance Appraisal Summary Sheet. 6. Write the rating fr each cmpetency and tally the ratings. Write the ttal scre f the Health Prvider Perfrmance Appraisal Summary Sheet. Ttal Rating f 21 t 30 = ADVANCED, can be selected t help train ther health prviders in the health facility n IPC skills and differential diagnsis f childhd fever. Ttal Rating f 11 t 20 = SATISFACTORY, may require additinal supervisin, additinal CMEs t imprve specific skills may be needed. Ttal Rating f 10 r less = UNSATISFACTORY, shuld attend additinal CMEs. Requires additinal supprt and supervisin. 7. Prvide the health prvider with feedback n yur bservatins. Use specific examples f the behaviurs yu bserved t describe the ratinale fr yur rating. 8. Discuss and agree t actin items fr imprvement. 9. Summarize areas fr imprvement and actin items n the Health Prvider Perfrmance Appraisal Summary Sheet. 10. Sign and date the Health Prvider Perfrmance Appraisal Summary Sheet and ask the health prvider t d the same. 11. File the Perfrmance Appraisal Summary Sheet with the SMP Prject Manager. 12. Give the health prvider a cpy f the Perfrmance Appraisal Summary Sheet. Supervisr Visit Checklist Page 5
IPC Cre Cmmpetencies fr PATIENT ASSESSMENT: 1. Puts the child and the caregiver at ease: Greets the caregiver and the child curteusly. Makes eye cntact and is pleasant. Prvides a space fr privacy and cnfidentiality and ffers the caregiver a place t sit. If pssible, remves any barriers f cmmunicatin such as a desk r table between the prvider and caregiver. Determines the caregiver s preferred language. Obtains the caregiver s name, the child s name and residence. Intrduces self and rle at the health facility. Interacts with the child. If the child is crying r irritable, tries t calm r distract the child. Thanks the caregiver fr bringing the child t the health facility. Identifies the reasn fr the caregiver s visit by asking an apprpriate pening questin. (e.g., What brings yu t the health facility tday? What is the reasn fr yur visit tday?) Shws empathy verbally r nn-verbally by recgnizing the caregiver s cncern ver the utcme f their sick child. Encurages the caregiver t express her/his feelings. Demnstrates respect and interest in the caregiver s cncerns. Gives praise the caregiver fr recgnizing the child s symptms early and fr bringing the child t the health facility fr care. 2. Asks medical histry questins in a manner the caregiver understands: Explains t the caregiver that he/she is ging t ask questins abut the child s illness. Uses simple nn-medical wrds the caregiver understands. Smetimes uses cllquial r slang terms that are easier t understand. Begins by asking pen-ended questins that allw the caregiver t describe and reveal infrmatin. (E.g., What mre can yu tell me abut yur child s cugh? Tell me mre abut yur child s symptms). Rephrases the questin in anther way if the caregiver des nt understand the questin. (e.g. When did the cugh start? Hw many days and nights has the child had a cugh?) Asks prbing questins based n specific pints the caregiver has made t gather mre infrmatin. (E.g., Has the child had this illness befre? Tell me mre abut yur child s rash; did the rash appear with ther symptms?) Supervisr Visit Checklist Page 6
Asks sufficient questins t elicit a cmplete medical histry. (e.g. Is there anything else that yu are wrried abut? Have yu already given the child any treatment?) Asks abut symptms f alternative diagnses that have similar signs and symptms. 3. Listens t the caregiver s cncerns and respnses: Allws time fr the caregiver t respnd t questins. Allws the caregiver t tell their stry and cmplete statements withut interruptin. Clarifies statements that are unclear by asking the caregiver t explain what they meant. Peridically summarizes and paraphrases what the caregiver has said t cnfirm understanding. Observes the caregiver s nn-verbal cues (bdy language, facial expressin, rhythm f speech) and cnfirms what she/he bserves. Accepts the caregiver s views and feelings in a nn-judgmental manner. Leans twards the caregiver when she/he is talking and makes eye cntact. Shws the caregiver they are listening and encurages the caregiver t express themselves freely by ndding r by saying wrds such yes, OK, r mmhmm. 4. Cmmunicates infrmatin abut exam prcedures in a manner the caregiver understands: Explains that he/she will be examining the child and asks permissin t undress the child. Encurages the caregiver t ask questins. 5. Uses the Jb Aid fr Children with Fever crrectly t assess the cause f the child s fever: Shws the caregiver the pictures and refers t the cues n the back f each card. Fllws the sequence f cards in the crrect rder: Takes the patient histry Assesses fr all danger signs and signs f severe illness Cnducts the physical exam Supervisr Visit Checklist Page 7
IPC Cre Cmmpetencies fr DIAGNOSIS: 6. Cmmunicates infrmatin abut diagnstic prcedures and test results in a manner the caregiver understands: Prvides clear infrmatin n what prcedures r labratry tests will be cnducted. Explains why the tests are needed. Explains what the child might experience and hw lng the prcedure r test will take. Explains the meaning f labratry and diagnstic test results. 7. Cmmunicates the child s diagnsis at a level the caregiver can understand: Explains what he/she thinks is the cause f the child s fever at a level the caregiver can understand. Explains why he/she suspects the child has the stated diagnsis. Stresses the imprtance f adhering t negative test results. Elicits the caregiver s beliefs, reactin r cncerns abut the diagnsis. 8. Uses the Jb Aid fr Children with Fever crrectly t cmmunicate diagnstic prcedures and results: Shws the caregiver the pictures and refers t the cues n the back f each card. Fllws the sequence f cards in the crrect rder t cmmunicate malaria diagnstic testing and results: Test fr malaria Psitive malaria test results Negative malaria test results Explains why a negative malaria test result means the child des nt have malaria. Explains which nn-malaria febrile illness he/she thinks the child has and why. Supervisr Visit Checklist Page 8
IPC Cre Cmmpetencies fr TREATMENT: 9. Cmmunicates infrmatin abut treatment recmmendatins in a manner the caregiver will understand and fllw. Prvides infrmatin n the recmmended treatment. The name f the treatment, what it is fr and why it is needed. Hw the treatment is t be taken. The number f tablets t be swallwed r crushed and mixed with water. The number f times the dse shuld be taken daily and fr hw lng. Cunsels the patient n the imprtance f adherence t treatment recmmendatins. Encurages the caregiver t ask questins. Asks the caregiver t repeat back infrmatin abut the diagnsis and treatment t cnfirm it was understd crrectly. Elicits the caregiver s willingness t accept and fllw the recmmended treatment. Cmmunicates when t cme back if the child des nt imprve r wrsens. Cmmunicates when t return fr a fllw-up t check if the child is imprving. (Children with pneumnia shuld return fr fllw-up in 2 days). Gives infrmatin t the caregiver abut hw t prevent the illness in the future. (e.g. Sleep under LLIN, r breastfeed exclusively fr the first 6 mnths). 10. Uses the Jb Aid fr Children with Fever crrectly t cmmunicate treatment recmmendatins fr malaria and nn-malaria fever. Shws the caregiver the pictures and refers t the cues n the back f each card. Fllws the sequence f cards in the crrect rder t cmmunicate treatment f malaria and management f fever. Fllws the sequence f cards in the crrect rder t cmmunicate the treatment recmmendatins fr nn-malaria fever and management f fever. Supervisr Visit Checklist Page 9
C. Health Prvider Perfrmance Appraisal Summary Sheet Health Prvider: Supervisr: Pre-Test Scre: Pst-Test Scre: Gap Areas: Date: Health Facility: TOTAL SCORE: Cre Cmpetency Rating Cmpetencies discussed; need fr perfrmance imprvement Actin items agreed upn N/A* 1. Puts the child s caregiver at ease. 2. Asks medical histry questins in a manner the caregiver understands. 3. Listens t the caregiver s cncerns and respnses. 4. Cmmunicates infrmatin abut exam prcedures in a manner the caregiver understands. 5. Uses the Jb Aid fr Children with Fever crrectly t assess the cause f the child s fever 6. Cmmunicates infrmatin abut diagnstic prcedures and test results in a manner the caregiver understands. 7. Cmmunicates the child s diagnsis at a level the caregiver can understand. 8. Uses the Jb Aid fr Children with Fever crrectly t Supervisr Visit Checklist Page 10
Cre Cmpetency cmmunicate diagnstic prcedures and results. Rating Cmpetencies discussed; need fr perfrmance imprvement Actin items agreed upn N/A* 9. Cmmunicates infrmatin abut treatment recmmendatins in a manner the caregiver will understand and fllw. 10. Uses the Jb Aid fr Children with Fever crrectly t cmmunicate treatment recmmendatins fr malaria and nn-malaria fever. Signature f Health Prvider: Signature f Observer: *NOT bserved r NO need t imprve Date: Date: Supervisr Visit Checklist Page 11