Staff survey | ||
There is good collaboration between my facility and traditional birth atendants | Likert scale 1 (strongly agree)-5 (strongly disagree) | |
Patient survey | Questions (asked of maternity patients only) | |
Were you ensured of privacy at the delivery? | Y/N | |
Did you get a hot drink after the delivery? | Y/N | |
Did you get anything to eat after the delivery? | Y/N | |
Did you receive sanitary pads after the delivery? | Y/N | |
Were you given warm bathing water after the delivery? | Y/N | |
Self-assessment | ||
Total number of macerated still births at the facility in the last 12 months | Provide number from maternity register | |
Total number of fresh still births at the facility in the last 12 months | Provide number from maternity register | |
Total number of deliveries in the facility in the last 12 months | Provide number from maternity register | |
Number of maternal deaths in the facility in the last 12 months | Provide number from maternity register | |
Total number of perinatal deaths | Provide number from maternity register | |
Total number of live births at the facility during the last 12 months | Provide number from maternity register | |
Facilitator checklist | Instruction | |
Total number of correctly filled out partographs in the last month | Look at the documentation of 10 randomly selected deliveries in the last month and enter number of times this was the case | |
Does the facility practice kangaroo mother care | Y/N | |
If yes, can staff members give a demonstration and explain when and how it should be used? | Y/N | |
in the equipment dimension | ||
The following basic equipment is available and functional: Weighing scale for newborns, scissors/blade, suction apparatus, disinfectant for cleaning perineum, drip stand, torches/portable lights | Y/N in each case. Yes only to be ticked if equipment is both available and functional on day of assessment | |
in the amenities dimension | ||
Are the following basic amenities for service provision of maternity unit for level 2 and 3 available according to norms and standards: three examination coaches, three screens, two delivery beds, 10 delivery kits, one resuscitation tray, oxygen, incubator, maternity beds, MWV kids, five stiching trays, CS kits, etc | Y/N in each case | |
Does the labour ward provide privacy for clients? | Y/N in each case | |
in the infection control dimension | ||
Does the facility have a functional placental pit; is it lockable, is it concretelined with depth greater than 1 m, is it inside the facility compound secured from unauthorised access? | Y/N in each case | |
in the drugs dimension | ||
Are the following available on day of assessment: antibiotics for newborn sepsis according to guidelines; ARVs or PMTCT according to guidelines; oxytocic according to guidelines, dextrose 5%; normal saline; ringer lactate; IV infusion set etc | Y/N in each case | |
also aspects covered in the supplies, referral and community interface dimensions | ||
Manager interview | ||
Are the standard clinical guidelines available for active management of 3rd stage of labour? | Y/N | |
Is the implementation of this guideline in the daily routine work discussed with members of the clinical team? | Y/N | |
in the community dimension | ||
Do health promotion activities covering the importance of delivering at a facility take place at least quarterly? | Y/N | |
also aspects covered in the referral and critical incident reporting dimensions |