Table 5 Facility readiness for provision of immediate postpartum care tool

1.

5 or 0

Ask to see the written policy on facility stay after a normal delivery.

Observe 2-5 women from the time of delivery up to discharge. Indicate if the policy was implemented in their care.

There is a written policy on facility stay and mothers stay at the facility for at least 24 h following a normal delivery.

Healthy mothers stay at the facility for at least 24 h following a normal delivery

5 Points awarded if policy exists and is being implemented, otherwise facility scores 0 points

2.

15 to 0

Ask to see a checklist for routine monitoring of the woman post-delivery and at the time of discharge. Verify that the checklist is used in monitoring the mothers post-delivery and before discharge. Verify that the mother is examined prior to discharge and knows when to return. Check for a copy of the current MOH guidelines for postpartum care on the ward.

Facility has a checklist for monitoring the mother after delivery and examining her at the time of discharge. There is a written policy on postpartum visits and women are informed about when to return. (day 6 and at 6 weeks).

All postpartum mothers are monitored according to the guidelines and examined before discharge.

Assign score of the checklist 3, policy 2, examination 5, MOH guidelines 2, mother’s knowledge of when to come back 3.

3.

5 or 0

Ask to see the postpartum area. Observe and verify privacy/ cleanliness in the area. Check to see the postnatal beds.

There is a separate area for the provision of postpartum care with beds and a clean private environment (provides both visual and sound privacy). The place has accessible and clean wash rooms and toilets. (mopped floors, wall and ceilings free of cobwebs and in a good state of repair)

There is sufficient space or a ward assigned to the postpartum mothers.

If all the items are available 5 marks otherwise 0

4.

5or 0

Does the facility have tracer medicines and commodities for Basic Obstetric Care

Observation of availability on day of assessment and verification whether Stock card is up to date and quantities tally with physical stock

Check that the following are present;

Uterotonics (Oxytocin, misoprostol)

Magnesium Sulphate

Caps amoxicillin

Chlorhexidine

IV diazepam

IV hydralazine Vitamin K

Tetracycline eye ointment

Rectal diazepam

Ampicillin inj

Gentamicin inj

Ceftriaxone inj

Examination gloves

Surgical gloves

Gynecological gloves

Normal saline

IV cannulas

IV giving sets

Cotton

gauze

Blood giving sets

Blood in the blood bank/ fridge

Postpartum IUDs and other contraceptive methods

Score 5 if the facility has tracer medicines and commodities for Basic Obstetric Care and the stock cards are up to date.

5.

15 to 0

Ask to see checklist for postpartum counseling. Observe midwives as they counsel 3 women at discharge. If there is no patient use a mannequin. Note that the staff includes all the topics and the advice given to the mother is documented.

All postpartum women receive written and verbal information/ counseling before discharge

Staff counsel mothers before discharge. Checklist for postpartum counseling includes; self-care, hygiene, nutrition, family planning, breast care, perineal care, danger signs for mother and baby.

Assign score of; presence of guide 3, correct guide content 3, correct demonstration 3, recording of advice 2, written information given 5.

6.

15 or 0

Does the facility have tracer equipment for postnatal ward?

Observation of the equipment in the postnatal ward and check functionality

Thermometer

B.P machine

weighing scale (adult and baby)

Stethoscope

Speculums

Examination light

Sterilization Equipment

Examination bed

Suturing kit (needle holder, Stitch scissors

forceps, and sterile pack)

Suction machine

Ambu bags (adult and newborn)

Face mask (adult and newborn)

Airway (different sizes).

Sutures

Length meter

Oxygen cylinder and /or concentrator

Patient monitor

Pulse oximeter

Give a score of 15 if all equipment is present and in good working condition.

7.

5 or 0

Does the health facility have a functional transport system?

Observation

Of vehicles and vehicle logs

a) The facility has a functional motorized means of transport to cater for emergency transport of patients and clients.

b) A functional ambulance or other vehicle for emergency transportation for clients that is stationed at this facility or operates from this facility

OR Have access to an ambulance or other vehicle for emergency transport for clients that is stationed at another facility or that operates from another facility

Give a score of 5 if they have a functional transport system with up to date vehicle logs or access to a transport system that is reliable. Otherwise score as 0.

8.

10 or 0

Does the health facility have a functional health education program in the RMNCAH?

Observation of IEC materials in each service delivery area

a) Service providers use one or more of the following materials during client counseling/ education sessions:

 ✓ FP methods

 ✓ anatomical models (Pelvis & penis dildo)

 ✓ FP flipcharts or Cue cards

 ✓ sample foods or demonstration garden.

 ✓ Observation of the posters at RMNCAH Clinics

 ✓ Observe time table for health education.

 ✓ Observe Health Education session in the RMNCAH clinic. Topics observed can include any of the following.

 • HIV/AIDS/PMTCT

 • Birth and emergency preparedness plan

 • Maternal and Newborn danger signs

 • Maternal Nutrition

 • Infant and Young Child feeding

 • Early Infant Diagnosis of HIV

 • Immunization

 • Family planning

FP methods and brochures

Brochure on maternal and newborn danger signs

F/P flip charts

Give a score of 10 if the facility has all the indicators for a functional health education program. Otherwise give a score of zero.