World Bank Impact Evaluation of Health Results-Based Financing (RBF) Programs

Field Manual

Guidelines for Field Enumerators, Supervisors, Editors and Data Entry

Operators

Baseline Health Facility Survey1

Note to Principal Investigator:

Customize instructions based on your questionnaire: modify instructions if needed, delete instructions on questions not used in your country, order the instructions in accordance with your questionnaire.

Translate this document into the enumerators’ local language(s) if necessary. Use these instructions during the training of the enumerators and provide a copy to each

enumerator that they can use in the field. Notes to principal investigators appear in blue boxes. These notes can be removed when the

manual is adapted to the specific survey. Country-specific items that will clearly need adaptation, such as country name, appear

highlighted in yellow.

1This manual is based on the Water and Sanitation Program’s (WSP) Impact Evaluation of Handwashing and Total Sanitation Programs Enumerator Manual, April 3, 2008. The original manual was authored by Paul Wassenich. Matthew J. Mulligan and Elisa Rothenbuhler from the Results-Based Financing Impact Evaluation team revised this manual in April 2012.

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Table of ContentsIntroduction.......................................................................................................................................................3

1. Background on Results-Based Financing...........................................................................................32. Purpose of the study...........................................................................................................................33. Purpose and general structure of the survey......................................................................................44. Purpose of this manual.......................................................................................................................45. Outline of manual contents.................................................................................................................4

I. Team composition and team members role............................................................................................41. Field supervisor’s role, overview.........................................................................................................52. Field Editor’s role................................................................................................................................63. Field enumerator’s role.......................................................................................................................64. Data Entry Operator’s role..................................................................................................................6

II. General schedule....................................................................................................................................6III. Materials required for fieldwork...............................................................................................................7IV. Quick Instrument review..........................................................................................................................8V. General Instructions for Enumerators, Supervisors and Editors.............................................................9

1. How to administer surveys..................................................................................................................9a. Building rapport with the respondent...............................................................................................9b. Tips for conducting the interview...................................................................................................10c. Asking questions............................................................................................................................11d. Recording responses.....................................................................................................................12e. Font Typestyle...............................................................................................................................13f. Unique identification (ID) codes.....................................................................................................15g. Respondent versus subject............................................................................................................16h. Reference period...........................................................................................................................16i. Durations........................................................................................................................................17j. Dates..............................................................................................................................................17k. The “other” category......................................................................................................................17l. Absence of information or response..............................................................................................17m. Following skip patterns..............................................................................................................17n. Correcting mistakes.......................................................................................................................18o. Watching for units..........................................................................................................................18p. Non-Response...............................................................................................................................19q. Grades and Levels of education....................................................................................................19r. Recording Global Positioning System (GPS) coordinates.............................................................19s. Checking completed survey forms.................................................................................................19

2. Responsibilities of the Field Supervisor............................................................................................20a. Preparation for the fieldwork..........................................................................................................20b. During the fieldwork.......................................................................................................................20c. Maintaining motivation and morale................................................................................................21d. Monitoring enumerator performance..............................................................................................22e. Overseeing the quality of the questionnaires.................................................................................23

3. Responsibilities of the field editor......................................................................................................234. Field Data Entry Operator.................................................................................................................25

VI. Health Facility Instruments....................................................................................................................261. Preliminary instructions to Enumerators on Exit Interviews and Sampling.......................................27

a. Eligibility.........................................................................................................................................27b. Sampling Patients for Exit Interviews.............................................................................................28c. Introducing exit interviews to patients and obtaining consent........................................................29d. Allocating unique identification numbers (ID) to patients...............................................................30e. Overview of exit interview questionnaires......................................................................................30

2. Form F1: Health Facility Assessment...............................................................................................313. Form F2: Health Worker Interview....................................................................................................444. Form F3: Exit interview, Patient receiving Antenatal Care................................................................515. Form F4: Exit Interview, Caregiver of Child under age 5..................................................................566. Form F5: Community Health Worker Interview.................................................................................60

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Introduction

1. Background on Results-Based Financing

Principal investigator: This section covers general RBF notions that can be adjusted to reflect the specific intervention, hypotheses and research objectives of your impact evaluation.

Results-Based Financing (RBF) for Health is a national-level tool for increasing the quantity and quality of health services used or provided based on cash or in-kind payments to providers, payers, and consumers after predetermined health results (outputs or outcomes) have been achieved. It combines the use of incentives for health-related behaviors with a strong focus on results. RBF is an umbrella term that includes output-based aid, performance-based financing, provider payment incentives, vouchers, contracting linked to particular targets, and conditional cash payments and transfers to households.

In some countries, RBF may take the form of paying a bonus to health facilities that meet certain quantity or quality targets, such as percent of women delivering their babies in a facility. Other countries are designing RBF mechanisms to provide incentives and support to the poor to overcome hidden barriers to using services, such as the cost of transport.

2. Purpose of the study

The objective of this study is to investigate how Results-based Financing (RBF) mechanisms may be used to cost-effectively maximize impacts on maternal and childhood health outcomes.

The main hypotheses of the study are that results-based financing (RBF): Increases the quantity of health services delivered : The interventions are designed to

increase utilization of health services for maternal and childhood curative and preventative services by providing incentive payments to providers and/or users.

Improves the quality of the services provided: There is a concern that incentive payments to increase quantity of services provided will lead to a decrease in the quality of services provided, particularly in rural areas with limited human and capital resources. For this reason, incentive payments must be tied not only to the quantity of services, but the quality of services as well.

Improves the health status of the population : Through an increase in the use of preventive and curative health care, such as immunizations, pre-natal care, institutional delivery, or bed-net use campaigns, we anticipate a direct, positive impact on the child and maternal health status of treatment populations.

Improves the motivation and behavior of the health providers : Supply-side RBF programs are designed to pay health care providers additional bonus payments based on their performance, which provides incentives to providers to improve their motivation in the workplace and quality of services delivered.

Has no impact on the non-RBF services delivered : The study must also measure any externalities, positive or negative, associated with the RBF programs. There is concern that providers will shift their provision of care entirely to RBF services in order to increase the RBF bonus payments, at the expense of non-RBF services. For this reason, the study will also capture information on non-RBF services to identify if there is any shift in quality and quantity of non-RBF services as a result of the RBF program.

These hypotheses frame the content of the questionnaires that enumerators will administer. The results of the data analysis on each of these research questions will be used to inform

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maternal and child health policy recommendations. These analyses and policy recommendations can only be as good and accurate as the data they are based on.

3. Purpose and general structure of the survey

This health facility survey is designed to assess health system performance and health services utilization. Enumerators will collect information on health worker knowledge, training and practices; health worker satisfaction and motivation; patient satisfaction with, perceptions of and utilization of health services; patient financial status; and facility infrastructure, equipment, supplies and drug stocks. This information will be collected through interviews with health workers, patient exit interviews and an assessment of the heath facility. Enumerators will use five instruments to collect this information:

1. Health facility assessment (F1)2. Health worker interviews (F2)3. Exit interviews with patients receiving antenatal care (F3)4. Exit interviews with caretakers of patients under 5 years old (F4)5. Community health worker interviews (F5)

4. Purpose of this manual

The purpose of the field manual is to provide support to field enumerators. The field manual contains detailed information on procedures for carrying out fieldwork. All team members should prepare for fieldwork by familiarizing themselves with this field manual. Once in the field, the field manual serves as a detailed how-to-guide that describes: Procedures for sampling providers and patients at health facilities Conducting interviews with patients and providers Conducting facility assessments.

5. Outline of manual contents

The manual contains seven sections. Section I describes background information, the objectives of the study and survey, the

purpose of the field manual, and outlines the manual contents. Section II describes the team composition and overall team members’ roles. Section III describes the general schedule for the survey. Section IV lists the materials required for fieldwork. Section V shortly reviews the instruments. Section VI provides useful general instructions to field enumerators, field supervisors and field

editors, and describes the role of each of them in more detail than in section II. This section also includes information on exit interviews and sampling.

Section VII goes through each form of the health facility instrument, describes the purpose of each instrument, how to administer it, to whom and in what time. It then goes through each form question by question and provides question-specific explanations of the terms and approach to be used.

I. Team composition and team members role

Principal investigator: You may need to adjust this section to reflect the organization of your survey field teams.

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In the field, each team will have one field supervisor, three field enumerators and one field editor.

Team = 1 Field Supervisor + 1 Field Editor + 3 Field Enumerators + 1 Data Entry Operator

Field teams report to and are supervised by a field manager, who is not based in the field but manages and is responsible for several field teams.

Principal investigator: Please note the responsibilities of the field editor and field supervisor may be combined if the size of field teams has to be limited.

Principal investigator: If your survey team works with the Computer Assisted Field Entry (CAFE) method, the field editor will be responsible for data entry in the field. These responsibilities will have to be specified in the manual.

1. Field supervisor’s role, overview

Each field supervisor is the senior member of each field team. He/she is responsible for the well-being and safety of team members, as well as the completion of the assigned workload and the maintenance of data quality for that team. Each field supervisor receives his/her assignments from and reports to the field manager. The specific responsibilities of the field supervisor are to make the necessary preparations for fieldwork, to organize and direct the fieldwork, and to carry out data quality maintenance activities.

The field supervisor is also responsible for completing the Health Facility Assessment F1 form. Details of the responsibilities of the field supervisor are further described under sub-section 2 of section V.

The field supervisor reviews the forms deemed accurate (i.e. stamped and signed) by the field editor. The field supervisor will use red ball pen for making corrections in the forms s/he checks. If the field supervisor deems that a form is complete and accurate, s/he will stamp it with a red stamp and sign it. If the field supervisor does not find a form to be complete or accurate, the field supervisor will return it to the field editor for corrections. The field editor may then send the form back to the respective field enumerator to correct deficiencies with the respective patient or health worker. If it is not possible to correct a form’s deficiencies, the case will be discarded (if the deficiencies are extreme) and a new case will be sampled to serve as a replacement.

Note that in the case of the health facility assessment form F1, filled out by the field supervisor, the field editor still gets to review the form (see below for description of the field editor’s review process).

Satisfactory completion of work at all facilities in the geographic area (e.g. province, district) has to be certified by both the field supervisor and the field editor and submitted to the field manager for review and approval. Only when the field manager approves will the team members receive payment for their work. Without approval at these two levels, the team’s work will be deemed unsatisfactory and the team will not be paid.

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2. Field Editor’s role

Each field editor’s primary responsibility is to ensure correct editing of all completed forms at a health facility. The field editor will also be responsible for completing at least one Health Worker interview.

As soon as a field enumerator, or field supervisor in the case of the health facility assessment form F1, has completed a form, the field editor will review it for accuracy and completeness. It is important to review forms as soon as possible, before patients and health workers leave the facility so that missing questions can be completed and questions that have been completed inaccurately can be redone in a correct manner. If the field editor deems that forms are not complete, he or she will send them back to the respective field enumerator to correct the deficiencies with the respective patient or health worker. If it is not possible to correct a form’s deficiencies, the case will be discarded (if the deficiencies are extreme) and a new case will be sampled to serve as a replacement. The field editor will use green ball pen for making corrections in the forms s/he checks. If the field editor deems that a form is complete and accurate, he or she will stamp it with a green stamp and sign it. The field editor will send all approved forms to the field supervisor for approval. Once all forms from a facility have been stamped and signed by the field editor and field supervisor, the field editor will certify the team’s work at the facility as being complete and satisfactory.

Note that in the case of a health worker interview filled out by the field editor, the field editor still conducts a quick review of his/her work, and then hands on his/her form to the field supervisor for approval. The rest of the review process is as described above.

3. Field enumerator’s role

Since they are the ones who collect information from respondents, enumerators occupy the central role in the survey process.

The responsibilities of the health facility enumerators include the following:1. Completing all required interviews, observations and assessments, except for the health

facility assessment form F1, which is completed by the field supervisor.2. Checking completed survey forms to ensure that all questions were asked and all

responses neatly and legibly recorded. This should be done at the end of each interview while the enumerators are still in the presence of the patient or health worker, enabling the enumerators to ask any questions that were inadvertently skipped or for which responses were recorded illegibly.

Field enumerators will fill out forms with blue ball pen.

4. Data Entry Operator’s role

The data entry operator is responsible for implementing Computer Assisted Field Entry (CAFE), and is therefore responsible for entering data from questionnaires as they come out of the field and for performing immediate consistency checks. The data entry operator is also responsible for the maintenance and technical operations of all hardware and software used to enter data.

II. General schedule

Each team will spend a minimum of one day in a facility before continuing survey work at the next site in the sample.

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Principal Investigator: If your survey includes direct observation, adjust the instructions of the schedule to include direct observations. Direct observations should be conducted simultaneously with exit interviews (each patient being observed first, then interviewed at the end of the consultation).

The enumerators will spend the first part of the visit conducting exit interviews; during the second part of the visit, they will interview the health facility’s health workers who come to the facility on the appointed day in order to be interviewed.

The supervisor will spend the morning completing the facility assessment form F1. He/she will also assist the enumerators in conducting exit interviews.

The enumerators will help with the facility assessment if they finish exit interviews before the field supervisor finishes the facility assessment. [Following content specific to Community Health Worker surveys:] In some of the clinics one of the enumerators might have to travel to two selected health posts and interview two of the Community Health Workers.

It is imperative that the team arrive early at the facility—they should arrive well before the regular workday begins in the clinic, and should plan to spend a minimum of 1 day in each facility in order to complete all data collection. The whole team together, led by the field supervisor needs to greet the in-charge and other health workers upon arrival, give them the letter of introduction from the Ministry of Health, and explain to them the purpose of the survey and the steps involved in carrying it out. The team also needs to determine, through the help of facility staff, how many under-five patients and pregnant women are expected that day in order to figure out the appropriate sample scheme. This is explained in greater detail in sub-section 1of section VI.

III. Materials required for fieldwork

Before leaving for the field, the field supervisor is responsible for collecting adequate supplies from the field manager of all materials the team will need in the field. These items are listed below:

a. Fieldwork documents 5 copies of the Field Manual (one for the field supervisor, one for the

field editor, three each for the enumerators) Maps showing the location of all sampled facilities and all eligible

communities within the catchment area Letters of introduction to local authorities Survey instruments in appropriate languages, including extra copies in

case of wrong recording and including consent forms Field Supervisor’s Checklist and Clinic Checklist (IE Toolkit) Field supervisor’s Tracking Sheets (IE Toolkit)

One “Field supervisor’s Tracking Form - Log of Team Activity” per province

One “Log of Facility Assessment Work” per province One “Facility Coversheet” for each facility being assessed

Patient Lists for Exit Interviews (IE Toolkit) Cash management sheets (IE Toolkit) Enumerator Evaluation Forms (IE Toolkit) Laminated copies of the clinical case scenarios

Principal Investigator: The Results-Based Financing Impact Evaluation Toolkit provides several instruments that may be of use during field work.

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b. Supplies Blue pens for enumerators Red pens for the field supervisor Green pens for the field editor Clipboards, notepads, blank paper Staplers, stapler remover and staple pins Plastic folders and rubber bands for completed questionnaires Carrying bags Backpacks Flashlight and batteries Cell-phone and top-up cards Global Positioning System (GPS) device

If survey uses Computer-Assisted Field Entry (CAFE) method: Laptop(s) Power sources External hard drive for backups

c. Funds for transport arrangements

IV. Quick Instrument review

Principal investigator: Adjust the number of forms required based on agreed sampling. Adjust instrument list and instructions based on your instruments. Add Direct observations to the list if applicable, remove Community Health Workers if applicable.

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Instrument Data Collector / Enumerator Interviewee

Facility level and number of forms to be completed

Health Facilities

Basic Health Center

Comprehensive Health Center

District Hospital

F1: Health facility assessment Field supervisor Facility 1 1 1

F2: Heath worker interviews

Field enumerator + Field editor Health Worker 4 4 4

F3: Exit interviews, patients receiving

antenatal careField enumerator Patient 5 5 5

F4: Exit interviews, caretakers of patients

under 5 years oldField enumerator Caretaker 5 5 5

F5: Community Health Worker interviews Field enumerator Community

Health Worker 2 2 2

V. General Instructions for Enumerators, Supervisors and Editors

1. How to administer surveys

This section provides general instructions for field enumerators, field supervisors and, to a lesser extent, field editors to follow during the data collection process.

Successful interviewing is an art and should not be treated as a mechanical process. Each interview is a new source of information, so make it interesting and pleasant. The art of interviewing develops with practice, but there are certain basic principles, which, if followed, will help you become a successful enumerator.

a. Building rapport with the respondent

At the beginning of an interview, you and the respondent are strangers to each other. The respondent’s first impression of you will influence his/her willingness to cooperate with the survey. Be sure that your manner is friendly as you introduce yourself. Show the respondent the letter that you have been given that states you are working with the Ministry of Public Health. The following principles help to build rapport:

1. Make a good impression. When first approaching a respondent, do your best to make him/her feel at ease. With a few well-chosen words, you can put the respondent in the right frame of mind for the interview. Open the interview with a smile and greeting such as “good afternoon” and then proceed with your introduction.

2. Always have a positive approach. Never adopt an apologetic manner, and do not use words such as “Are you too busy?” Such questions invite refusal before you start. Rather, tell the respondent: “I would like to ask you a few questions” or “I would like to talk with you for a few moments.”

3. Stress confidentiality of responses. If the respondent is hesitant about responding to the interview or asks what the data will be used for, explain that the information you

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collect will remain confidential, no individual names will be used for any purpose, and all information will be grouped together to write a report. You should never mention other interviews or show completed questionnaires to other enumerators or field supervisors in front of a respondent or any other person.

4. Answer all questions from the respondent frankly. Before agreeing to be interviewed, the respondent may ask you some questions about the survey or why s/he was selected to be interviewed. Be direct and pleasant when you answer. However, if s/he asks health-related questions, direct his/her questions to the appropriate health personnel.

5. Minimize distractions as much as possible. The presence of other people during an interview can prevent you from getting frank, honest answers from a respondent. Many respondents change what they say, or simply say less, when other people are present. It is, therefore, very important that interviews be conducted in a setting that is as private as possible and that all questions be answered by the respondent without being influenced by the presence of others. If other people are present, explain to the respondent that some of the questions are private and ask to move the interview to a more private setting. Establishing privacy from the beginning will allow the respondent to be more attentive to your questions.

When interviewing health staff at health facilities:1. Reassure staff that individuals are not being tested. During the introduction, reassure

them that the data is not being used for promotions or sanctions, and no individuals will be identified in the study (stress confidentiality). Individual staff is not being graded, but the government is looking for overall areas of strengths and weaknesses among health workers.

2. Do not interfere with the day’s work. Make sure that the work that needs to be done at the health facility is not unduly interrupted because of the interviews or observations. Patient care remains the first priority at the health facility, and enumerators and field supervisors should try to stay out of the way. If possible, arrange for a special room with a high level of privacy for conducting interviews.

b. Tips for conducting the interview

1. Be neutral throughout the interview. Most people are polite and will tend to give answers that they think you want to hear. It is therefore very important that you remain absolutely neutral as you ask the questions. Never, either by the expression on your face or by the tone of your voice, allow the respondent to think that s/he has given the “right” or “wrong” answer to the question. Never appear to approve or disapprove of any of the respondent’s replies. For interviews with providers, it is especially important to ensure that they understand that you are not there to judge them personally and that their identities will not be revealed in any way.

2. Never suggest answers to the respondent. If a respondent’s answer is not relevant to a question, do not prompt him/her by saying something like “I suppose you mean that….Is that right?” In many cases, respondents will agree with your interpretation of their answer, even when that is not what they meant. You should probe in such a manner that the respondent comes up with the relevant answer themselves, in their own words.

3. Do not change the wording or sequence of questions. The wording of the questions and their sequence in the questionnaire must be maintained. If the respondent has not understood the question, you should repeat the question slowly and clearly. Only if the respondent still does not understand at that point, may you reword the question, being careful not to alter the meaning of the original question.

4. Follow instructions carefully. For some questions on the survey instruments, it is required that you read the list of possible responses to the respondent. Such questions are accompanied by an instruction to “Read List.” When no such instruction accompanies the question, it is necessary that you refrain from reading the list of possible responses out loud or showing them to the respondent. Listen to the

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respondent reply in his/her own words, and then circle the relevant response(s) on the form without reading the responses out loud.

5. Handle hesitant respondents tactfully. If the respondent gives irrelevant or elaborate answers, do not stop him/her abruptly or rudely, but listen to what s/he has to say and then try to steer him/her back to the original question. If the respondent is reluctant or unwilling to answer a question, try to overcome his/her reluctance with tact and patience. If the respondent still refuses, simply record REFUSED and proceed as if nothing happened. Remember, the respondent cannot be forced to give an answer.

6. Do not form expectations. You must not form expectations of the ability and knowledge of the respondent.

7. Do not hurry the interview. Ask the questions slowly to ensure the respondent understands what is being asked. After you have asked a question, pause and give the respondent time to think. If the respondent feels hurried or is not allowed to formulate his/her own opinion, s/he may respond with ‘I don’t know” or give an inaccurate answer. Remind the respondent that there is no hurry and that his/her opinion is important.

At health facilities, follow these additional procedures for exit interviews of patients and interviews of staff.

1. Do not interfere with the care being provided. Unless you are conducting interviews or observations that require direct contact with the providers and/or patients, you should stay out of the way of the patient and the providers whenever possible. Do not offer advice to the provider or the patient, or respond with sounds or body movements that might be interpreted as approving or disapproving of the care. You must maintain neutrality, and not get in the way of the provider or the patient.

2. Ensure the respondent’s privacy. For exit interviews, ensure that the respondent is asked questions in a place that is away from other patients or providers, preferably outside the building or away from where patients are being seen. For interviews of staff, have each of them respond in a quiet place away from patients and other staff at a time when they can give you full attention.

c. Asking questions

It is very important that you ask each question exactly as it is written on the survey forms. When asking a question, be sure to speak slowly and clearly, so that the respondent will have no difficulty hearing and understanding the question. At times you may need to repeat the question to be sure that the respondent understands it. In such cases, do not change the wording of the question but repeat it exactly as it is written. If, after you have repeated a question, the respondent still does not understand it, make a note in the questionnaire that this question requires additional pilot testing in order to clarify wording. Enumerators are not responsible for rewording questions during interviews.

Several questions have additional instructions regarding how they should be asked. Possible responses to some questions should be read aloud to the respondent, while others should not be. In the latter case, the field enumerator should ask the question and then listen to the respondent’s spontaneous response without reading the list of replies on the survey form. In some cases, you may have to ask additional questions to obtain a complete answer from a respondent. This is called probing. If you do this, you must be careful that your probes are “neutral” and that they do not suggest an answer to the respondent. Probing requires both tact and skill; it is one of the most challenging aspects of conducting an interview. When specific instructions regarding how questions should be asked are required, they are always indicated on the survey forms.

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d. Recording responses

All enumerators will use pens with blue ink to complete all questionnaires. Field supervisors will do all their work using pens with red ink. Unless you are following a skip pattern, never leave a response blank! A blank is recorded as “missing information” because it is not known whether you asked the question or not. If a response is not in the affirmative, the ”no” option must be entered (coded as “2”). If the respondent doesn’t know the response to a question or refuses to answer, consult section l below for instructions.

Most of the questions have responses that are in form of number codes. To record a respondent’s answer, you merely record the number code that corresponds to the reply in the space provided.

Example where only one response is correct

(3.03)What was your primary mode of transportation today? (One way)

By foot 1 Bicycle 2

Animal 3

4

Private car

4

Public car/bus

5

Other 96 Specify

Sometimes there can be more than one option requiring a response in a question. In this case, the codes will be letters (a, b, c etc) rather than numbers. Be sure to record an appropriate response for each option.

Example where more than one option requires a response

(2.16)

From the advice given to you by the health

worker, how will you know if the child’s condition becomes

worse and should be brought back?

DO NOT READ OPTIONS ALOUD; RECORD "1" IF MENTIONED OR '2" IF NOT MENTIONED FOR

EACH.Mentioned……….1

Not Mentioned…..2

a. Fever does not go away after certain time 1b. Fever develops 2c. Child is unable to drink or is drinking poorly 1d. Change in consciousness 1e. Diarrhea persists 2f. Blood appears in the stool 2g. Child develops rapid or difficult breathing 1h. Child becomes sicker for any reason 1i. New symptoms develop 2j. Other 2

Specify

Responses for questions where the reply is not pre-coded should also be recorded in the space provided.

(3.02)

How long did it take you/the patient to reach this health facility from home today? (One way)

Minutes

30

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In some cases, responses include an OTHER category. The OTHER code should be recorded when the respondent’s answer is different from any of the pre-coded responses listed for the question and the respondents answer should be specified on the line provided. Before using the OTHER code, make sure that the answer does not fit in any of the other categories.

(1.06)

Type of Worker Doctor 1

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Assistant doctor 2 Nurse 3 Midwife 4 Auxiliary midwife 5 Other 96 Specify Vaccinator

For many questions, a numeric response is appropriate and should be entered in the available boxes.

(3.04)

How much did it cost (in local currency) for you/the patient to travel to the health facility today? (One way)

CURRENCY

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e. Font Typestyle

Pay close attention to the typestyles (fonts) used in the questionnaire. The table below lays out for you what you should do when you see a particular typestyle. The examples in the table below are in the typestyle noted.

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Typestyle Meaning ExamplesLower-case font

Questions or comments that the enumerator is to read word-for-word to the respondent.

Question response codes that the enumerator will read to the respondent as a set of choices the respondent is to use in answering the question.

Does the facility have a general outpatient consultation room?

Is this facility a district hospital, a health center or a health post?

District hospital ……………… 01Health center …………..……. 02Health post ……………………. 03Other, specify: ……………….. 96

Upper-case font

Instructions to the enumerator to guide in completing the questionnaire or in asking a particular question.

Question response codes that the enumerator will not read to the respondent, but which will be used to code the response provided by the respondent.

INTERVIEWER: LIST FULL NAMES OF ALL STAFF WORKING IN THE FACILITY. FOR EACH STAFF, ASK ALL THE QUESTIONS OF THIS SECTION, THEN MOVE TO NEXT STAFF. IF THERE ARE MORE THAN 21 STAFF, USE A NEW QUESTIONNAIRE.

What are the three main sources of funding or income (in the sense of incoming cash) for this facility?

a. MINISTRY OF HEALTH / DISTRICT HEALTH MANAGEMENT TEAMb. USER FEESc. DRUG SALES(…)

Mixed lower- and upper-case font

Questions that the enumerator reads word-for-word to the respondent, but that includes specific elements that the enumerator need to insert based on responses to earlier questions or other information of which the enumerator is aware. Lower case refers to the question that needs to be asked.Upper-case refers to the element that must be inserted.

What is [NAME]’s position in this facility?

Does [NAME] provide curative care for children directly?

Does your household own at least one [GOOD/ITEM]?

Arrow followed by text

Skip codes. Instructions to the enumerator as to which question should be asked next, based on the response to the current question or the individual respondent. The skip codes include the ► symbol.

► NEXT PERSON

► (6.01)

Underline Underlining is used to emphasize certain words. It can be used to highlight a specific

What is the distance between the health facility and your 14

To summarize, if the typestyle is in ‘lower-case,’ it is read to the respondent. If the typestyle is in ‘UPPER-CASE,’ it is not read to the respondent, but serves as an instruction or response code for the enumerator. Certain phrases in bold alert you to the key element of the question as you read it to your respondent, and elements in underline emphasize specific circumstances of the question.

f. Unique identification (ID) codes

It is vital that throughout the data collection process identification codes are used consistently and accurately. Identification codes ensure that all responses in the data can be appropriately represented in the data analysis, and any incorrect identification codes can result in the loss of large amounts of data or could change the results of the intervention.

Health Facility IdentifierThe cover of each questionnaire requires the generation of a unique identified for that health facility. These codes should be recorded on all forms from that health facility.

Staff Identification CodesEach staff member of the health facility will be given a two digit unique identification code that will be used throughout the series of interviews to identify that staff member and record responses by that staff member. The generation of these Staff ID codes will be in Section 4, the Staff Roster section, of the health facility questionnaire. The staff roster section of the questionnaire is laid out in landscape (horizontal) format. On each line of the questionnaire to be filled out, a number starting from 01 is displayed. An ID code is assigned to each individual listed on the staff roster, and the number depends on which row is used to record the presence of the individual in the facility. So the individual recorded first on the staff roster, i.e. on line 01, will have the individual ID code 01 within that household. The second individual recorded, on line 02, will have the individual ID code 02 within that facility. The ID code assigned to each staff member should be used for that same individual in all subsequent sections. These unique staff ID codes will be especially important for the Health Worker interview, Form F2. This is an extremely important instruction for you to follow in completing the questionnaire.

CHW Identification CodeThe CHW interview will require the generation of a unique identifier for each CHW on the cover of the questionnaire. The generation of this identifier is based on the health district number, a health facility number, and a health worker number. As with the health facility identifier, the health district code and the health facility number should be provided by your field supervisor. The health worker number should be 01 for the first CHW interviewed and 02 for the second CHW interviewed, since only one enumerator will be in charge of administering CHW interviews.

Patient Identification CodeThe exit interviews will require the generation of a unique identifier for each patient on the cover of the questionnaire. The generation of this identifier is based on the health district number, a health facility number, and a patient number. As with the health facility identifier, the health district code and the health facility number should be provided by your field supervisor. The generation of a consistent patient number is a bit trickier than the CHW number since multiple enumerators will be interviewing multiple patients. To address this difficulty, the enumerators should use a system where each enumerator is assigned a number for the first number of the two digit code and then will fill in the second number based on the order of the patients they interview. For instance one enumerator will be assigned a 0, and the patient ID for each interview that he/she performs should be 01, 02, 03, etc. The next enumerator will be assigned a 1, and each patient should be assigned the ID code 11, 12, 13, etc. The next enumerator will be assigned a 2, and each patient should be assigned the ID code 21, 22, 23, etc.

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However, if an enumerator interviews more than 10 patients from one facility, which is unlikely, than he/she should be assigned a second number that has not been used yet. The field supervisor will responsible for indicating to each enumerator which first ID number to start with.

g. Respondent versus subject

Subjects and respondents are not the same. The subject is the staff member or patient on whom the questions are addressed, and the respondent is the individual who is answering the questions, whether about themselves or for someone else. In most sections and especially in the exit interviews the questionnaire clearly states who should be answering the questions and for whom the questions are addressed. For example, questions on the exit interview for the child under 5 should be answered by a caretaker or mother: this is the respondent. However, the subject of the questions changes in the first section from the age of the child to what is the mother/caretakers relationship with the child. Thus it is important to pay attention to not only who should be answering the question, but for whom the question is directed. Additionally, in Section 4 of the Health facility questionnaire the respondent should be the head of the facility or the most knowledgeable member of the facility. The ID code for this individual should be record in 4.03. However, the subject is the staff members of the facility, and thus the questions are about each staff members of the facility. Again, it is important to pay attention to the respondent and the subject of each question, and when appropriate record their respective ID code.

h. Reference period

Questions with a reference period that asks whether or how often a particular activity was conducted during a given time period: “the reference period” or “recall period”.This survey uses the following reference periods:

The past 12 months preceding the time of the interview The past 3 months preceding the time of the interview The past 30 days preceding the time of the interview The past 7 days preceding the time of the interview The past 14 days preceding the time of the interview The last completed calendar month=the previous calendar month to the interview The last completed calendar year=the previous calendar year to the interview

You determine the reference period as follows: suppose the interview takes place on Tuesday, 17th of January, 2012, then:

For the reference period “last 12 months”, you use the period covered from January 2011 to January 2012.

For the reference period “last month”, you use the period covered from 17th of December, 2011 to 16th of January, 2012;

For the reference period “last 3 months”, you use the period covered from 17th of October, 2011 to 16th of January, 2012;

For the reference period “last week” or “last 7 days”, you use the period covered from 10th of January, 2012 to 16th of January, 2012

For the reference period “last 2 weeks” or “last 14 days”, you use the period covered from 3rd of January 2012 to 16thJanuary 2012.

For the reference period “last completed calendar month”, you use the period covered from 1st of December, 2011 to 31st of December, 2011.

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For the reference period “last completed calendar year”, you use the period covered from 1st of January, 2011 to 31st of December, 2011.

i. Durations

Some questions will require the respondent to estimate a duration of time within a certain time period. An example of this is Q1.23, “how many hours was electric power missing in the last 7 days?” For these type of questions please probe the respondent for an answer in hours. Furthermore, you should remind the respondent that one day is 24 hours long, and not 8 hours like a conventional work day. If a respondent thought that electric power was missing for 2 days within the last week then the correct response would be 48 hours.

j. Dates

Make sure you record the date in the format specified on the questionnaire. In general, you should record dates as MM/DD/YYYY, unless specified otherwise.

k. The “other” category

In order to include all possible responses that may be provided, many questions include a response option of “other” to record responses that are not covered by any of the pre-coded responses. When you use this code, you must write in a brief explanation of the category, preferably in the box where the response is recorded. The code for “other” is always “96”.

l. Absence of information or response

All questions that are not answered because of the skip pattern or general flow of the questionnaire should be left blank—no information should be recorded. However, there are cases where respondents will not answer an individual question, either because they do not know the answer or because they refuse to answer the question. If after asking the question a second time, you still cannot get a response, the following codes should be recorded:Refuse to answer... “Refusal” (or “R” if space in the questionnaire is small)Do not know........... “Don’t know” (or “DK” if space in the questionnaire is small)However, you should use these codes very rarely. Your Supervisor will warn you if s/he feels that you are unnecessarily or too frequently using these codes, as their excessive use may indicate a lack of effort on your part to collect the required information from the respondents.Please note the “Don’t know” code will be coded -7 at data entry. The “Refusal” code will be coded -8 at data entry. However it is not up to you to code those responses on the questionnaires, just record “Don’t know” / “DK” or “Refusal” / “R”.

m. Following skip patterns

It is very important to avoid asking respondent questions that are irrelevant to his/her situation. For example, a woman who is not pregnant should not be asked for how many months she has been pregnant. In cases where a particular response makes subsequent questions irrelevant, a “►” symbol will be found, followed by the number of the question that the data collector should jump to.

The questionnaire is designed with a system of skips that allows you to follow the logical sequence of questions based on responses to questions already provided. It is important to

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follow skip patterns carefully. If irrelevant questions are asked, the respondent may become irritated or disinterested. If, on the other hand, the field enumerator inadvertently skips over a relevant question when following a skip pattern incorrectly, valuable information is lost. Every question on a survey form must be answered unless a skip is indicated by a skip pattern or the respondent refuses to the answer the question. It is imperative that all enumerators be very conscientious when following skip patterns.

(2.01)Is there a Community Health Committee or Steering Committee for this health facility?

YES 1

NO 2► (2.08)

n. Correcting mistakes

It is very important that you record all answers neatly. For pre-coded responses, be sure that you write the code for correct response carefully. For open-ended responses, the reply should be written legibly so that it can be easily read. If you made a mistake in entering a respondent’s answer or the respondent changes his/her mind, be sure that you cross out the incorrect response and enter the right answer. Do not try to erase the answer, but proceed as illustrated below:

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o. Watching for units

Certain questions have to be recorded in a certain unit. Units are always specified in a question that requires numbers recorded in a specific unit. In general, age will be recorded in years only for adults, and in years AND months for children under 5 years old. For the latter, the age of children younger than one year old, e.g. 9 months old, should be recorded as “0” years and “9” months. Do not forget the “0”, as it allows making sure the number of years has not been omitted at data entry stage. The age of a child aged 4 years and 5 months will be recorded as “4” years and “5” months.Weight will be recorded in kilograms.Distances will be recorded in kilometers.Durations will be recorded in the most relevant unit for a given question (e.g. minutes, or days, or weeks).Certain answers may be recorded with one or more decimals. In this case, in the response box, a dot will be printed on the questionnaire, followed by the correct number of boxes for the number of decimals to be recorded.To avoid ending up with quantitative data that cannot be used during analysis, pay close attention to the unit you should record the answer in, and to the number of decimals needed (if any).

Principal investigator: Adjust units if necessary in the country of the study. If you do, make sure the questionnaire units are adjusted as well and match the instructions.

p. Non-Response

One major threat to data quality is a high rate of non-response. When potential respondents refuse to participate at a high rate, bias is often introduced. People who refuse tend to be different than people who consent to participate. It is therefore important that the team reduce the non-response rate as much as possible. If the respondent refuses to be interviewed, a reasonable and polite effort should be made to elicit consent from the respondent to participate in the study. Refusals may stem from misconceptions about the survey or other prejudices. The enumerator must consider the respondent’s point of view, adapt to it, and reassure him/her. In

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some cases, the field supervisor may have a better chance of carrying out the interview. Linguistic and ethnic barriers between the respondent and the enumerator can sometimes lead to refusal – it is best to limit this possibility by ensuring that enumerators have the same linguistic and ethnic background as the surveyed community members.

q. Grades and Levels of education

Principal investigator: Make sure this question captures the relevant levels or possible educational tracks, and possible grades, available in your country. The questions on both levels and grades of education must allow converting responses into years of schooling.

Levels: Examples of levels of education are “primary”, “secondary”, etc.Grades: Grades are understood as a number of years within a given level. You should pay attention to whether the question asks for the highest level or grade attended, versus the highest level or grade completed. When speaking about the “highest level of education completed”, make sure the respondent understands this is the highest level successfully completed, not the highest level attended. When speaking about the “grade”, you must record the highest year of school completed WITHIN the level mentioned by the respondent. Do not add up years completed in previous levels.

For example, say secondary school has three grades as a whole, and say a respondent repeated the 1st grade (or year) of secondary twice, then went on to the 2nd grade (or year) and successfully finished the 3rd grade (or year) of secondary school. The highest level of education attained is secondary. The highest grade of education attained, within that level, is three, regardless of the fact that the respondent spent four years in secondary school as a whole: what matters is that the respondent successfully graduated from his/her third grade (or year) of secondary school.

If the respondent reached secondary school, but did not complete any grade in secondary school (i.e. the respondent did not pass the first grade of secondary school), then you should record the highest level as secondary, and the highest grade as zero.

r. Recording Global Positioning System (GPS) coordinates

To record GPS coordinates, calibrate readings on GPS devices in order to have latitude and longitude in degrees, with decimals. Do not use the more complicated degrees/minutes/seconds reading, as it encounters a higher risk of erroneous entry on questionnaires and later on in the Data Entry Program.

s. Checking completed survey forms

It is the responsibility of the enumerator to review each survey form when finished with an interview or assessment. This review should be done before the respondent leaves, to ensure that every appropriate question was asked, that all answers are clear and reasonable, and that the handwriting is legible. Also check that the skip instructions were followed correctly. Minor corrections can be made, but any serious error should be clarified by the respondent. Simply explain to the respondent that you made an error and ask the question again.

Do not recopy the questionnaires. As long as the answers are clear and readable, it is not necessary that the questionnaire itself be neat. Every time you transcribe the answer to a new question, you increase the chance of error. For this reason, using the work sheets to collect information is not allowed. Record ALL information on the survey forms that have been provided to you. Any calculations you make should be written in the margins or on the back of the questionnaires.

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Anything out of the ordinary should be explained either in the margins near the relevant question or in the comments section at the end. These comments are very helpful to the field supervisor and field editor in checking questionnaires. Comments are also read in the office and used to resolve problems encountered during data entry.

2. Responsibilities of the Field Supervisor

This section described the responsibilities of the field supervisor in details.

a. Preparation for the fieldwork

To prepare for the fieldwork, the field manager and each field supervisor must:1. Obtain maps that indicate large areas (states, provinces, districts, towns, etc.) as well as

the small areas (villages, census enumeration areas, etc.) for each area in which his/her team will be working. Maps may be available from the census bureau or another government office. Copies should be made in advance.

2. Become familiar with the area where the team will be working and determine best arrangements for travel and accommodations. Lodging should be reasonably comfortable, located as close as possible to the interview area, safe for the survey team, and provide secure space to store survey materials. The field supervisor is also responsible for figuring out how and where the team is going to take its meals.

3. Contact local authorities to inform them about the survey and gain their support and cooperation. Letters of introduction will be provided, but tact and sensitivity in explaining the purpose of the survey will help win the cooperation needed to carry out the survey. Local authorities can be helpful for identifying suitable local guides, translators, or in arranging accommodations and meals for the rest of the field team.

4. Plan the date and time of the survey in each health facility. In particular, the field supervisor must make sure that if exit interviews, direct observations or health worker interviews on specific services (e.g. antenatal care or child care services) are to be conducted, the survey will be planned during the days when those services are open for consultations. Similarly, the field supervisor must make sure the health facility in-charge will be available on the day of interview.

5. Obtain all monetary advances, supplies, and equipment necessary for the team to complete its assigned interviews from the field manager. Careful preparation by the field supervisor is important for facilitating the work of the team in the field, for maintaining enumerator morale, and for ensuring contact with the central office throughout the fieldwork.

6. Ensure that the travel plan is discussed with all team members. The travel plan should include appropriate arrangements for transportation including preparations for vehicle use, refueling, and a contingency plan for any unexpected maintenance.

7. Obtain the unique identification number (ID) of each health facility from the field manager.

b. During the fieldwork

During the fieldwork, each field supervisor will:1. Locate the facility that has been selected for inclusion in the survey by Ministry of Public

Health staff.2. Introduce the team to the in-charge and then explain to the clinic staff that some exit

interviews will be conducted and it is important that the health facility staff not be included in these interviews. Separate interviews with them will be conducted, during which time they can express their views. Exit interviews are for patients to express their views.

3. Have health facility unique ID number available to enumerators for filling out the forms.20

4. Inform each enumerator of their own unique ID number.5. Inform each enumerator of which ID number they should use for patients when starting

exit interviews (see section VI-1-d for more details on how to allocate those numbers).6. Assign work to enumerators and deploy them to sites.7. Make sure that assignments are carried out.8. Carry out quality control work.9. Conduct the Health Facility Assessment (F1).10. Perform the Health Worker Interviews (F2) if time is available and additional

enumerators are needed for health worker interviews. Other duties can be carried out in between health worker interviews, or if a health worker needs to leave to attend to patients or other essential duties. The exception is the health worker knowledge assessment module: once the module starts neither the supervisor nor the health worker should leave until all questions are answered.

11. Regularly send/communicate progress reports and information about the team’s location with every destination change to the central office.

12. Communicate any problems to the field manager on a periodic basis.13. Assume responsibility for upkeep of the communication equipment.14. Take charge of the team vehicle, ensuring that it is kept in good repair and that it is used

only for project work.15. Arrange lodging and food for the team.16. Maintain a positive team spirit. A congenial work atmosphere, along with careful

planning of field activities, contributes to the overall quality of the survey.17. Check all facility forms before leaving the facility to ensure that they are filled out

correctly. 18. Coordinate with the Field Editor on issues of non-response. 19. Observe enumerators’ work (see below).20. Chair daily team meetings and respond to enumerators’ queries or concerns (see

below).

c. Maintaining motivation and morale

The field supervisor plays a vital role in creating and maintaining motivation and morale among the enumerators—two elements that are essential to good-quality work. To achieve this, field supervisors must ensure that the enumerators—

Understand clearly what is expected of them Are properly guided and supervised in their work Receive recognition for good work Are stimulated to improve their work Work in tranquil and secure conditions.

In working with the enumerators it may be useful to adhere to the following principles: 1. Rather than giving direct orders, try to gain voluntary compliance before demanding it. 2. Without losing a sense of authority, try to involve the enumerators in making decisions,

and at the same time, see to it that the decision remains firm. 3. When pointing out an error, do so in private, in a tactful and friendly manner. Listen to

the enumerator’s explanation, show him/her that you are trying to help him/her, examine the causes of the problem together and finally explain your plan for improvement and correction.

4. When enumerators voice complaints, listen with patience and try to resolve them. 5. Try to foster team spirit and group work. 6. Under no circumstances show preference for one or another of the enumerators. 7. Try to develop a friendly and informal atmosphere.

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Finally, it is important to demonstrate punctuality, enthusiasm, and dedication in order to demand the same of other team members. An ill-prepared supervisor will not be able to demand high-quality work from enumerators and will soon lose credibility and authority. The collective conduct, morale and motivation of enumerators depend directly on the personal conduct, morale and motivation of their supervisor.

d. Monitoring enumerator performance

The field supervisors are to monitor enumerator performance with the aim of improving and maintaining the quality of the data collected. Close supervision of enumerators and editing of completed interviews are essential to ensure that accurate and complete data are collected. By checking the enumerators’ work regularly the field supervisor can ensure that the quality of the data collection remains high throughout the survey.

It is necessary to observe the enumerators more frequently at the beginning of the survey and again toward the end. In the beginning, the enumerators may make errors due to lack of experience or lack of familiarity with the questionnaire; these can be corrected with additional training as the survey progresses. It is also crucial during this initial phase of fieldwork to eliminate any enumerator error patterns before they become habits. Toward the end of the survey, enumerators may become bored or tired; lack of attention to detail may result in carelessness with the data. To maintain the quality of data, the field supervisor should check the performance of enumerators thoroughly at these times.

Observing the enumerators during interviewsThe purpose of the observation is to evaluate and improve enumerator performance and to look for errors and misconceptions that cannot be detected through editing. It is common for a completed questionnaire to be technically free of errors but for the enumerator to have asked a number of questions inaccurately. Each field supervisor, in addition to paying attention to how the enumerators words questions, can detect a great deal from watching how the enumerators conduct themselves, how they treat the respondent, and how they fill out the questionnaire.

When observing enumerators, the field supervisor should sit close enough to see what the enumerator is writing. This way, she/he can see whether the enumerator interprets the respondent correctly and follows the proper skip patterns. It is important to note all problem areas and issues to be discussed later in review session with the enumerator. The field supervisor should not intervene during the course of the interview and should try to conduct himself/herself in such a manner that prevents the enumerator from feeling nervous or uneasy.

After each observation, the field supervisor and enumerator should discuss the enumerator’s performance in a review session. The questionnaire should be reviewed, and the field supervisor should mention things that the enumerator did correctly as well as any problems or mistakes. The field supervisor should also listen to any feedback that the enumerator has to offer. Always acknowledge good work done by enumerators; positive feedback can help build morale.

Each enumerator should be observed closely during the first two days of fieldwork so that any errors made consistently are caught immediately. Additional observations of each enumerator’s performance should be made throughout the team’s time in the field.

To assist in evaluating enumerators supervisors can use the enumerator evaluation form, which is part of the Results-Based Financing for Health Impact Evaluation toolkit. The form can be asked to the few interviewees who are randomly visited by the supervisor. Asking the questions on the form will only take a short amount of time, and it can provide useful feedback on the enumerators’ relationship with the interviewee.

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Conducting team meetingsIn addition, each field supervisor is responsible for arranging and conducting daily team meetings to discuss common errors and provide a forum to address any issues the teams may encounter during the day. These team meetings should be held daily for the first week then at least every other day thereafter. At team meetings, the field supervisor should point out mistakes discovered during observation of interviews or noticed during questionnaire editing. She/he should discuss examples of actual mistakes, being careful not to embarrass individual enumerators. Re-reading relevant sections from the manual together with the team can help resolve problems. The field supervisor can also encourage the enumerators to talk about any situations they encountered in the field that were not covered in training. The group should discuss whether or not the situation was handled properly and how similar situations should be handled in the future. Team members can learn a lot from one another in these meetings and should feel free to discuss their own mistakes without fear of embarrassment. Review sessions are an opportunity to teach and improve performance. They are also an invaluable opportunity for the field supervisor to listen to and learn from enumerators.

The discussion points of team meetings should be summarized and submitted with the weekly progress reports to the field and project managers.

Non-ResponseThe field supervisors should discuss any issues of non-response with the enumerators and the data editors. The supervisor should ensure that all enumerators are following the correct guidelines on minimizing non-response. It will be important to monitor the techniques used by the enumerators, as well as the rates of non-response reported by the rest of the team. If the supervisor believes that one area or facility has issues with abnormally high rates of non-response, despite the appropriate techniques used by enumerators then he/she should consult the field manager.

Error rateThe field supervisor must ensure the questionnaire completion error rate remains low. A proposed norm is under 1%. The supervisor may set up sanctions if the error rate is above 1%. The field supervisor will seek daily feedback on the error rate from the field editor who calculates error rates (see below).

e. Overseeing the quality of the questionnaires

The field supervisor checks the questionnaires that have been deemed valid by the field editor. The field supervisor has the responsibility for the last check and the last validation of the questionnaires. Additionally, all facility forms should have been checked by the supervisor before leaving the facility. The field supervisor makes any comment or correction with a red pen. If the field supervisor comes up with a different diagnostic on the questionnaires than the field editor’s diagnostic, the field supervisor and field editor must discuss the issues. If the issue can be resolved, the field editor will be responsible for communicating with the enumerators, and sending them back to the respondent if needed. If the issue cannot be resolved, the field supervisor must make note of that issue for on the supervisor’s log and in the comments section of the instrument. It is then up to the analysis team to decide how to use this data.

3. Responsibilities of the field editor

The field editor must ensure that questionnaires are checked and corrected for completeness, legibility, and consistency. Every questionnaire must be completely checked in the field. This is necessary because even a small error can create much bigger problems after the information has been entered into the computer and tabulations have been run. Often, small errors can be

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corrected just by asking the enumerator. For example, if an answer of ‘02 MONTHS’ is inconsistent with another response, the enumerator may recall that the respondent said ‘2 years,’ and the error can easily be corrected. In other cases, the enumerator will have to go back to the respondent to get the correct information. Timely editing permits correction of questionnaires in the field.

The accumulation of even small errors can lead to major flaws in the analysis. Sometimes this can result in an entire questionnaire being omitted from the analysis. To prevent this careful recording and review of the responses is critical.

The field editor is responsible for calculating daily error rates regarding the completion of the questionnaires.

Error rate= Number of inaccurate or misclassified responses / Total number of responses

The numerator must include missing responses to questions that should not have been skipped.

The field editor, in collaboration with the field supervisor, may also consider to calculate a daily error rate based on a set of questions from the questionnaire. Questions that have been consistently misreported on by enumerators over the course of the field work or pre-testing must be included in the denominator of the error rate. Additional questions can be included in the denominator.

The field editor must report daily to the field supervisor on the error rate. If an enumerator’s daily error rate exceeds 1%, sanctions against enumerators may be considered.

As you are editing questionnaires in the field, it may help to try imagining how the questionnaire would look to a clerk in the office. Would he or she be able to read the responses? Are the answers consistent? Since editing is such an important task, we have prepared a set of instructions that describe the procedures for editing questionnaires.

Instructions for editing questionnairesThe following should be done before leaving the facility surveyed. Whenever possible, the field editor should check and correct the questionnaires as soon as they have been completed by the enumerator:

1. As you go through the questionnaires, if a response is missing (that is, there is no answer recorded because the question was not asked) or the response is inconsistent with other information in the questionnaire and you cannot determine the correct response, put a question mark (‘?’) next to the item with a green pen. Write the page number or the question number on the front or back of the questionnaire; this way, you can quickly remember later what problems you found. When you have completed the editing, discuss with each enumerator, individually, the observations you found. Any errors that you find frequently should be discussed with the whole team.

2. For every mistake or inconsistent answer found, the enumerator and/or field editor should go back to the respondent to clarify his or her response to the question.

***NOTE: UNDER NO CIRCUMSTANCES SHOULD YOU MAKE UP AN ANSWER***

If it is not possible to return to the respondent to resolve inconsistencies or missing information, the team editor should make a note of this in the editor’s log and in the comments section of the instrument. It is then up to the analysis team to decide how to use this data.

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3. In checking through each questionnaire, be sure that the numbers entered in boxes are readable.

4. In checking each questionnaire, make certain that the respondent was asked all questions appropriate for him or her (check that the enumerator followed the skip instructions). You will need to look for—

a) Questions for which a response is recorded when it appears there should be no response (in this case, cross out the response by drawing two lines through the code with your red pen)

b) Questions for which no response is recorded when it appears there should be a response (in this case, try to find the correct response as described in paragraph (2) above or leave blank).

*ALWAYS USE A GREEN PEN TO MAKE CORRECTIONS*

5. Check the ranges for all variables that are not pre-coded (e.g., a woman cannot have 24 sons living with her) and carry out the other consistency checks that are listed. Mark any inconsistencies with a red pen.

8. Once the field editor has checked and corrected the questionnaire, she/he should sign their name on the space provided on the front page.

Data qualityBefore leaving the facility, the field editor must check each completed interview form for completeness, legibility and consistency. If the forms have not been filled out in a complete and legible manner, the editor will have the enumerator go back to the respondent to collect the missing or illegible data. The editor should then pass on all materials that have already been reviewed to satisfaction to the field supervisor. It is especially important for the field editor and field supervisors to conduct careful reviews of all survey forms at the initial stages of fieldwork.

4. Field Data Entry Operator

Principal investigator: You may need to adjust this section to reflect the data entry method used in the country study.

The data entry operator is responsible for implementing Computer Assisted Field Entry (CAFE), and is therefore responsible for entering data from questionnaires as they are approved by both the field editor and field supervisor. The data entry operator is also responsible for conducting tabulations and inconsistency reports. He/She must hand these reports on to the field supervisor and field manager.

CAFE does not require the use of computers or hand-held devices to collect data. Interviewers will collect data using the paper questionnaire. CAFE involves a system for field data entry, where data entry operators are in the field with the survey team, and enter data into a laptop computer once data has been collected from the health facility using the paper questionnaire. Therefore, the data entry operator will need to ensure that the computer is functional and has sufficient access to electricity to recharge the battery. In the event of any technical problems with the computer that the data entry operator cannot solve, then he/she should contact both the field supervisor to update regarding the status of the data entry and also the field or data manager to address the technical issues. In the unlikely event that the computer is broken

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beyond basic repairs, the data entry operator will need to consult with the field or data manager to obtain a new computer.

Data from the questionnaires should be entered for each completed interview in the order they are collected and approved by both the field editor and field supervisor. Once all the data for one health facility are entered, the operator moves on to enter the data for the next health facility. In general, data entry operators should not leave their computers in the middle of entering data for a health facility. Before taking a break or stopping work for the day, all of the questionnaires for a health facility should be completely entered. The data can be entered onto the hard disk of the computer and then transferred to an external hard drive or USB stickand given to the supervisor for copying onto the supervisorsor the hard disk of the computer and then transferred to ars, the data entry o

With CAFE, we can obtain reliable and timely databases directly from the field. The integration of computer-based quality controls to fieldwork is the best survey data management paradigm available today. It is based on the notion that all inconsistencies in the questionnaires have to be checked while the interviewers are in the field, and corrected in follow-up visits. Therefore, the data entry operator should be responsible for completing checks for inconsistent or implausible data after inputting the data. The field manager will have immediate feedback on the performance of the field staff since we can conduct tabulations and inconsistency reports in the field and detect problems in the field early (analyze inconsistencies by team or even by interviewer). With CAFE, we’re also able to generate uniformity in quality across teams.

VI. Health Facility Instruments

The objective of the health facility survey is to evaluate health system and health system performance. Enumerators working on this portion of the survey will collect information on health worker knowledge, training and practices; health worker satisfaction; patient satisfaction; patient perceptions of health services; patient financial status; utilization of health services; and facility equipment, supplies and drug stocks. This information will be collected through interviews with health workers, patient exit interviews and an assessment of the heath facility.

The field teams will be provided with the sample of facilities in advance. When a team goes into the field, they therefore will already know which facilities to survey. The field supervisor is responsible for coordinating data collection organization with the field manager to ensure the team arrives at a facility on a day it is operational – and with operational services of interest.

In interviewing health workers and patients and carrying out the facility assessment, facility enumerators will use five different instruments:

1. Health Facility Assessment (F1)2. Health Worker Interview (F2)3. Exit interview with guardians of patients, under 5 years old (F3)4. Exit interview with pregnant women who received antenatal care (F4)5. Community Health Worker interview (F5)

These forms are a facility-level package. A team has not finished its work at a facility until ALL of these instruments have been completed, with the appropriate sample size for each. Just as the team’s work at a facility cannot be considered complete unless all of these forms have been completed, an individual instrument cannot be considered complete unless ALL questions have been completed accurately and thoroughly. This does not include questions that

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are appropriately skipped when an enumerator correctly follows an instrument’s skip patterns. If a single question has been skipped inappropriately or filled out inaccurately, the form is not considered complete. The field supervisor and field editor will not stamp and sign an instrument unless it is final. If an enumerator, field supervisor or field editor discovers that a question has been skipped inappropriately or filled out inaccurately, the enumerator who completed the form is responsible for going back to the respondent (or, if enumerators helped filling out the facility assessment form, the register book, drug storage room, MIAR form, etc.) to collect the missing information. If a question was skipped on the exit interview, the patient has left and cannot be reasonably tracked down and the enumerator cannot recall what the correct response should be, the supervisor makes a note in the supervisor’s log and in the comments section of the questionnaire.

A team’s work at a health facility should be completed within 1-2 days. Under unavoidable circumstances, a team may spend two consecutive days within a village or facility. It is imperative that teams work efficiently and that they review all forms immediately after they have been completed, so that mistakes can be corrected in a timely manner.

The following chapters contain a detailed explanation of how to use each of the five instruments that are part of the facility assessment.

1. Preliminary instructions to Enumerators on Exit Interviews and Sampling

a. Eligibility

You will be performing exit interviews for the following types of clients:

Principal investigator: Patient eligibility may be different in your survey (e.g. you may only consider new patients). The patient consultation process may also be specific to your country. Adjust the following instructions accordingly.

i) Caretaker of any patients up to 5 years of age, both new and returning children: The patient could be any patient who is under the age of 5 and visits the facility. The patient could be visiting the facility for a number of reasons including curative, preventative, and/or monitoring visits. The enumerator will interview the caretaker of that patient, i.e. the person who brings the child in for consultation. If several people bring the child, ask who is mainly responsible for the child’s care. Interview that caregiver, regarding the under five child. After the patient and caregiver have completed all activities and are prepared to depart the facility, you or another enumerator should approach the patient to conduct the exit interview. More details on introducing the exit interview and obtaining consent is given in section c.

ii) Antenatal clients, both new and returning clients.In many facilities the client flow is as follows:

1) One provider “registers” the client.2) A different provider takes various measurements (temperature, weight, and blood

pressure) 3) A third provider sees the client and discusses the symptoms, problems, and then

advises. This provider will then write a prescription, if warranted.

Principal investigator: Adjust the instructions below depending on the objective of the exit interviews. If the exit interview must be regarding examinations or any other action taken at any time in the facility and by any provider, you should modify the instructions below, so that not only the third provider is taken into account. If the exit interview must only regard the interaction between the third provider and the patient, leave the instructions below as is, and make sure no “someone in the facility” appears in the exit interview forms and question specific instructions.

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The “consultation” is considered the interaction where questions are asked, advice given, and prescriptions are written. The primary provider, as far as the survey is concerned, is the one who actually ends up advising and writing the prescription, if warranted. In this case, the exit interview should be in regard to what was done by the last provider of the list (the third provider).

Refer to the staff roster of the health facility assessment form F1 to record the appropriate provider identification number (ID). After the client has completed all activities and is prepared to depart the facility, you or another enumerator should approach the patient to conduct the exit interview. More details on introducing the exit interview and obtaining consent is given in section c.

b. Sampling Patients for Exit Interviews

Note to the field supervisor:The field supervisor is responsible for making sure that the team is deployed in the health facility on the appropriate day for observing child care and antenatal care consultations. Whether child care and antenatal care services will be open must be planned ahead when announcing the survey to local authorities and planning the days of the survey.

What is the expected sample of patients?The goal is to observe 5 clients for each of the two groups: antenatal care, and children under 5. To increase the numbers of interviews at large facilities (e.g. outpatient departments associated with district hospitals), two days will be allocated. For most facilities, however, teams will only be present for one day.

How to select the patients for the interview?The specific scheme for sampling patients is determined not ahead of time, but once a team arrives at a facility. The first step in sampling for exit interviews is to estimate the expected patient load for the day. The estimate is made by looking at the patient register to gain an informed approximation of average daily volume of new patients and by asking health center staff how many patients for each group they expect to see that day. At each facility, the team should conduct five interviews for patients under five years old and five interviews for pregnant women receiving antenatal care. Therefore, if looking at the register and querying health center staff indicates that fewer than ten patients from each group are likely to receive care in the facility that day, the team should interview the first five patients in each group. If between 10 and 15 patients from each group are expected, the team should interview every other patient consultation in each group until five of each type have been conducted. The following table shows the sampling pattern that should be followed for different estimates of the daily patient load.

Table 1 Determining sampling pattern on basis of expected number of new patients

Expected # of patients in each group (patient under five years of age or

pregnant women for antenatal care)

Sampling pattern

<10 Select each eligible patient until 5 exit interviews in that group have been completed

11-15 Sample every second eligible patient until 5 exit interviews in that group have been completed

16-20 Sample every third eligible patient until 5 exit interviews in that group have been completed

>20 Sample every fourth eligible patient until 5 exit interviews in that group have been completed

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How to allocate enumerators to the interviews?During exit interviews, the field supervisor and the three enumerators should divide the jobs so that enough exit interviews are conducted in each group. If two separate clinic areas exist, one for children under-5 and one for pregnant women, then the enumerators may need to split up.

In order to properly analyze the data, it is necessary that a list of all eligible clients who attend the facility on the interview day be collected: a log of each child under 5 on the one hand, and of each woman coming for antenatal care on the other hand, must be recorded for the day of the visit (see IE Toolkit). This will allow describing how representative the service operation was on the day of the survey, using average number of clients on service days as the indicator. The health facility in-charge should be asked to ensure that the list is completed and the field supervisor must ensure that the data is collected prior to departing from the facility. The provider may be asked to complete the list as s/he sees clients, or, if the required information is listed in a register in an easily retrievable manner, field supervisors can collect the information at the end of the day from registers. The team must ensure that the data is collected from all relevant registers (some facilities have a different register for each provider seeing sick patients). The data forms (see IE Toolkit) must be included in the envelope with the questionnaires from the facility. This is the responsibility of the field supervisor.

c. Introducing exit interviews to patients and obtaining consent

The exit interviews conducted will be a random sample of patients attending the health center for the specific services on the day of the interview. At the close of the patient’s consultation, the enumerator should ask the client if s/he would agree to participate in an interview. Explain that as a part of the facility survey it is important to talk to some of the clients and that it will only take a few minutes. The enumerator must start by filling out the consent form. As this interview contains personal information and questions which may be of a sensitive nature, it is important that the patient or caregiver give permission to be interviewed by agreeing to conditions set out in the consent form. They must know that if they refuse to be interviewed, this will not affect their treatment in the health facility. If they agree to be interviewed, they are allowed to break off the interview at any time, or decline to answer certain questions if they choose. The patient has to sign or mark the form. It is necessary that you sign that the person has given permission for the interview. Your name and the date must be recorded on the form.

If in agreement, the enumerator will then start the exit interview of the client, under the following circumstances.

The exit interview should take place near the final service location for the facility (usually the pharmacy). Make the effort not to be too far from where the consultation takes place since it is easy then to lose the client. If possible a facility staff may be able to help direct the client to the exit enumerator. The pharmacy dispenser may be able to assist.

The location for conducting the exit interview should be quiet and provide auditory privacy. There should be a seat for the enumerator and for the client. The exit interview will be conducted after the client has completed all steps at the facility.

In order to minimize errors during data processing and data analysis, the observer should still fill out the cover sheet for any exit interview questionnaire even if the client refuses to give consent after being selected.

d. Allocating unique identification numbers (ID) to patients

In general, exit interviews will be conducted by several enumerators. They may also be conducted simultaneously (e.g. one enumerator interviewing pregnant women coming for antenatal care, one enumerator interviewing caretaker of child under five years old). They may also be conducted in different places (e.g. if antenatal care and child services are provided in different locations in the facility). For that reason, one cannot expect that enumerators will be

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able to communicate on where they stand on the use of patients IDs: one cannot start the first visit with a patient ID of 01, and expect that all following interviews will be subsequent numbers.

The field supervisor is responsible for indicating to each enumerator which first ID number to start with. Then each enumerator can add one additional unit to the ID number of the last completed interview for the subsequent interview.

If the total amount of exit interviews (for both antenatal care and child care) is ten, necessarily one enumerator could potentially conduct 10 interviews at most. The first enumerator can start patient exit interviews with number 01, then proceed to 02, 03, etc for subsequent patients. The second enumerator can start patient exit interviews with number 11, then proceed to 12, 13, etc. The third enumerator can start patient exit interviews with number 21, then proceed to 22, 23, etc.

e. Overview of exit interview questionnaires

The Exit Interview questionnaires are designed to collect information, from the client‘s perspective, about the client-provider interactions in each of the designated services. These are:

(1) Exit Interview for the caretaker of child under five(2) Exit Interview of antenatal care client

The exit interview assesses the client’s perception of information shared, examination and advice received. It also collects information on the opinion of the client about common areas of complaint when receiving services. The questionnaires include the following components:

(1) Cover Page(2) Identification: Patient history(3) Treatment and counselling: Understanding of examinations, treatments, and

advice received(4) Patient travel and expenditures(5) Patient satisfaction(6) Security and trust regarding the facility and its staff(7) Questions on the household of the patient: dwelling characteristics, household

structure, assets ownership(8) Community Health Worker: Characteristics and patient satisfaction

2. Form F1: Health Facility Assessment

Part 1: Purpose

The purpose of the Health Facility Assessment is to determine how well health facilities that provide Primary Health Care are functioning. This assessment looks at the circumstances in which health services are being provided and finds out if many of the important things needed to provide good health services are indeed present. This information will help the Ministry of Health know if those things needed are in place and being used to provide good quality care. The ultimate purpose is to be sure that the people are receiving the best medical care possible. For this reason, it is important the forms be filled out carefully, and to the best of your ability.

Part 2: How the facility assessment is to be done

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This assessment is to be carried out by the field supervisor, with assistance from field enumerators if needed, using three methods:1. Direct observation2. Review of the health facility records3. Asking questions to the senior health worker at the facility (the facility in-charge or manager).

1. Direct Observation. This involves looking at various parts of the health facility. This will require judgment by the person doing the survey. Judgments will have to be made on such things as the cleanliness of toilets, the condition of the roof and walls, and how sharp medical waste is being disposed. Since several hundred health facilities are being assessed by many different people, it is important that all the judgments are made in the same way. In this chapter, we give instructions and examples that help make similar assessments in all facilities. The person doing the observation must not let his or her feelings prevent similar evaluations applied in the same way in all facilities. Since not all health facilities are the same, sometimes certain services or equipment may not be present. If so, there is always a place to note that this is missing or that the question does not apply (not applicable). For many questions there will be a number of possible responses listed on the form. If you do not find the appropriate response, then circle “other” and enter the appropriate response in the space marked “specify.”

2. Review of health facility records. For many questions the person doing the assessment will have to review the health facility records. Sometimes this will be checking to see if the amount of a particular medicine is the same as shown on the stock card, or if some medicines have passed their expiry date. Other times it will be adding up the number of patients seen during a certain number of months. The information on deliveries will come from the delivery register. For information on immunizations, this information will come from the immunization register (e.g. Expanded Program on Immunization, EPI register). The assessment will also check to see if the Health Management Information Systems (HMIS) forms have been completed and turned in. During training, each person will have an opportunity to review each of these forms to understand how they should be filled out correctly.

3. Asking questions of the senior health worker (i.e. health facility in-charge or manager). Some answers to parts of the form will come from the senior health worker, or the second most senior health worker (e.g. deputy manager) if the senior health worker has been employed at the location for less than 2 months. Examples of these types of questions are: “How many people live in the catchment area for this clinic?”, “When was the last time a supervisor came to this health facility?” and “Does this clinic have a budget?”. It is necessary to ask these questions as they are written, and try not to explain them to the health worker. When you try to explain a question, it can become a different question from what other people are asking at other health facilities. It is ideal if the same person assesses every health facility. Since this can’t be done it is important that all people assessing the facilities do so in exactly the same way, so the results will have the same meaning. For some questions you will be asked to read a list of choices to the health worker, and ask his or her response.

Part 3: Who responds to this questionnaire?

This section requires someone who understands how a health facility functions, and its various parts. In addition the person doing this part should be familiar with the various registers kept in a well-run health facility. This person should be a doctor and someone who understands the Health Management Information System.

Part 4: Who administers this questionnaire?

The person doing this form should be the field supervisor. If other team members finish early, they can assist in filling out the form. For example, while one person is asking questions from the

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person in charge of the health facility, another person can be checking the stock cards for drugs. It is important at the end that the forms are NEVER separated: if the form has been split among the field supervisor and enumerator(s), it must be stapled together again when the form is completely filled out.

Part 5: How long will this part of the survey take and when to conduct it?

Working alone, it will probably take about 4-5 hours to complete this form. It is best to do many of these questions after all patients have left the health facility for the day, although you could review the repair of the health facility and check medicines for stock-outs while the clinic is functioning. It is particularly important to interview the senior health worker after patients have left because s/he should not be distracted from patient care responsibilities. Be careful to organize this part of the survey at the start of the day, so it is finished before too late in the day, and the rest of the team is not held up. At the same time, mistakes must be avoided so the survey must not be rushed. If the questionnaire is divided among several persons to complete various parts, the field supervisor is responsible for ensuring all the parts are put back together correctly.

Part 6: Sign the Visitor’s Book

Principal investigator: Check if the health facilities have a visitor’s book recording a log of all visitors of the health facility, distinct from a patient log. Adjust recommendations accordingly.

All teams are required to sign and date the visitor’s book once arriving at the facility. This signature will provide a record of the team’s visit to the assigned facility and will be checked later by a monitor.

Part 7: Review of the individual questions

All of the following information should be written by hand on the cover page in addition to fields already indicated:

name of the facility in-charge, name of the survey team leader, the telephone number of the facility in-charge and the email address of the facility in-charge if available. The field supervisor, the facility in-charge, and the field editor must sign, date and stamp

the Facility Assessment form (F1).These signatures and stamps will be used to verify the survey team’s work at the facility, independent of everything else that is asked on the instruments.

Principal investigator: Review instructions for each section and question. Make sure they match the questionnaire and intended objective of your questions. For section (6) Services and (7) General HMIS, insert instructions on how the field supervisor or enumerators are to verify the collected information: via register books such as patient registry, prescription registry or via other records.

Respondent: Unless otherwise stated, the head of the facility or deputy if absent or unavailable, or most informed health worker if absent or unavailable should be interviewed.

Cover page : Identification and location of the facility and consent

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Facility unique identifier code (ID): Record the Health District and Health Facility unique ID codes in the top right hand corner. The field supervisor with have the district and facility unique ID codes. Write in ARABIC numerals.Location. Record the (A) Province, (B) District, and (C) Village/town/locality where the facility is located.GPS reading of the facility. Record the latitudinal and longitudinal readings in the spaces provided.Facility name and location. Write the (A) name of the facility and (B) Summarized location i.e. address or any information that allows locating the facility.Enumerator name, code and date. Write down your (A) unique enumerator ID code (in ARABIC numerals) the (B) date of the visits, and date of any subsequent visit(s) if applicable (DD – MM – YYYY format).Interview. Write down (A) Result of the interview, whether it was complete, (B) the language of the enumerator and the respondent (in distinct cells) and (C) whether a translator was used.

Note: The field supervisor and field editor will also have to enter their respective unique ID code and date of review.

Consent. It is important to obtain the consent from the health facility in-charge. Please read out the consent statement verbatim. If the respondent does not agree to participate, do not fill out a consent form. However, you must record that the respondent refused to participate in the questionnaire in the “Result of the interview” cell. Proceed ahead only if the respondent agrees to participate by saying ‘YES”. In this case, fill out both the consent form and the questionnaire. If the respondent agrees to participate, s/he must sign or mark the consent form. You must also sign the consent form.Repeat this operation for any health worker that needs to be interviewed to complete form F1.Section (1) General information(A) General1.01 Are you in Charge of the facility? 1.02 Are you authorized to represent this facility? 1.03 What is your job title at this facility? 1.04 Is this facility a district hospital, a health center, or a health post?1.05 Who owns this facility?1.06 In what year was the facility commissioned? Ask the respondent what year the facility

was commissioned and record in a YYYY format (e.g 1941)1.07 When was the last major investment in the infrastructure? Ask when the last major

investment in infrastructure was for the facility. Major painting, pluming, extensions to the building, etc. should be included as major investments. Record the month and year.

1.08 Does this facility provided care round-the-clock? (i.e 24 hours) Ask if the facility provides care round the clock, i.e. all day from 12am to 12pm, and if it does, whether it provides care (i) formally i.e. officially or (ii) informally i.e. just in practice.

1.09 At what time of the day does outpatient care start? Ask the respondent what time patient care starts on weekdays, Saturdays, Sundays and Holidays.

1.10 What time does patient care end? Ask the facility in-charge what time patient care ends on weekdays, Saturdays, Sundays and Holidays. This time refers to the actual time the health worker stops attending to patients and not the health facility’s closing time.

1.11 On what days does the facility offer antenatal care clinics, and for how many hours on those days? Record a response for every day of the week. If a service is not offered on a particular day record a 0 to signify that 0 hours of antenatal care were offered that day.

1.12 On what days does the facility offer under 5 clinics, and for how many hours on those days? Record a response for every day of the week. If a service is not offered on a particular day record a 0 to signify that 0 hours of antenatal care were offered that day.

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1.13 What is the distance from the health facility to the nearest higher level health facility one way in kilometers? Ask the distance in km of a one way trip from the health facility to the nearest higher level health facility.

1.14 What are the three main sources of funding or income (in the sense of incoming cash) for this facility? For this question do not read the options out loud. Only record the top three sources listed. For all listed-possible responses that were not mentioned, record a 2.

1.15 Can you please tell me the amount received from each of the following sources in [LAST CALENDAR YEAR] in (CURRENCY)? Record a response from each source. If zero record “0000”.

1.16 Can you please tell me the total amount received in [LAST CALENDAR YEAR] in (CURRENCY)? This question asks you to determine the total amount received in (CURRENCY)? Record the total amount. If zero, record “0000”. Please confirm that this figure matches the total of the figures in 1.15. If not, ask the respondent again about 1.15 and make necessary corrections so that 1.15 and 1.16 match.

1.17 This question asks about the source of Information consulted to obtain budget figures. Record the source of information that you used to obtain and confirm the responses regarding funding or income received.

1.18 Can you please tell me whether the facility paid out any performance bonuses or salary top ups to staff in (LAST CALENDAR YEAR), in addition to salary/regular allowances? If the answer is no then record “2” and skip to Q1.21.

1.19 How much did the facility pay for performance bonuses or salary top ups to staff in (LAST CALENDAR YEAR) in (CURRENCY)?

1.20 This question asks about the source of Information consulted to obtain RBF expense figures for the salaries and salary bonuses. Record the source of information that you, the enumerator, used to confirm RBF expense figures.

1.21 What is the primary source of electricity? 1.22 Were there any electric power outages in the last 7 days? If the answer is no then

record “2” and skip to question Q1.25.1.23 How many hours was electric power missing in the last 7 days? The maximum number

of hours is 168.1.24 What is the primary source of water? Record the appropriate response and if the

response is surface water then skip to Q1.29 and if it is bottled water skip to Q1.271.25 Is this primary source of water used only by the facility, or is it shared with other

users?1.26 In the last 7 days, was there any time when there was no water available in the

facility? If the answer is no then record “2” and skip to Q1.29.1.27 In the last 7 days, for how many hours was there no water available at the facility?

Record the number of hours. The maximum number of hours possible is 168.1.28 How long does it take to fetch water from the primary source for the health facility,

one way on food in minutes? Record the number of minutes for a one way on foot trip to fetch water from the health facilities primary source of water. If the water source is in the facility record a 0.

1.29 Does the facility have a functioning two-way radio?1.30 Does the health facility have a phone line, whether a landline or a mobile line? Record

the appropriate response and if the response is yes then skip to Q1.34.1.31 Are there any phone services available in the community apart from the staffs’

personal phone that the health facility staff can use if needed? If the answer is no then record “2” and skip to Q1.36

1.32 How long does it take to reach those phone services? Record the answer in minutes.1.33 In the last 7 days, was there any time when the facility did not have any telephone

service whether landline or mobile? If the answer is no then record “2” and skip to Q1.36

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1.34 How many hours was telephone out in the last 7 days? Record the answer in hours. The maximum number of hours is 168.

1.35 Do any of the health facility staff have a mobile phone line?1.36 Does this facility refer patients to other facilities? If the answer is no then skip to

Q.1401.37 Where does the facility refer the following: For each option read aloud record the code

for whether the patient is referred to the hospital, clinic, health post, or does not refer.1.38 How far is the main referral facility from this facility one way in kilometers? Record

the distance in kilometers for a one way trip from the current health facility to the referral facility.

1.39 Does the facility have access to any kind of transportation (to pick up patients or take them to a referral facility)? If the answer is no then record “2” and skip to Q1.44

1.40 How many working [VEHICLES] does the facility have access to?1.41 In the last 7 days, was there any time when there was no transportation available for

patients? If the answer is no then record “2” and skip to Q1.441.42 How many days was transportation unavailable in the last 7 days? Record the number

of days that transportation was unavailable in the last 7 days. The maximum number of days possible is 7.

1.43 Does the facility own a functioning computer?(B) Universal Precautions1.44 Does the facility have a general outpatient consultation room? Ask first if they have

such a room and if they do then politely ask if you can see it. If they do not have such a room then record “03” and skip to Q1.49

1.45 Is this room equipped with a safety box of closed container present for disposal of used sharps? Please ask if you can see it, and then record the appropriate response.

1.46 Does the room have posted procedures for decontamination procedures steps? Please ask if you can see it, and then record the appropriate response.

1.47 Does the room have a basin with a water source and soap? Please ask if you can see it, and then record the appropriate response.

1.48 What disinfectant(s) are being used in the facility? Read the options aloud and then record a “1” if they use the mentioned disinfectant or a “2” if they do not.

1.49 In the last 30 days, was there any time when the facility ran out of disinfectant(s)? If the answer is no then record” 2” and skip to Q1.52.

1.50 In the last 30 days for how many days was the facility out of disinfectant(s)?1.51 Is there a functional incinerator for disposing of medical waste? Please ask to see the

incinerator, and then record the appropriate response.1.52 What procedure is used for decontaminating medical equipment after initial use? Do

not read the options aloud, but instead record just a single response. If the respondent mentions more than one technique ask which one is the most commonly used and then record that one. If equipment is never reused then record “07” and skip to Q1.55.

1.53 What procedure is used for sterilizing medical equipment before reuse? Do not read the options aloud, but instead record just a single response. If the respondent mentions more than one technique ask which one is the most commonly used and then record that one.

1.54 Is the protocol for sterilizing equipment displayed? 1.55 Is there a provision for the disposal of biomedical waste? If the answer is no then skip

to the next section Q2.011.56 How is biomedical waste disposed of? Do not read the options aloud, but instead record

just a single response. If the respondent mentions more than one technique ask which one is the most commonly used and then record that one.

Section (2) Administration and Management2.01 Is there a Hospital/Health Center Executive Committee for this health facility? If the

answer is no then skip to Q2.08

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2.02 How many members are on this Committee?2.03 Is there a representation of any of the following on this Committee?2.04 In the last 12 months, how many Hospital/Health Center Executive Committee

meetings were held? Record the number of meetings held in the last 12 months. If it is zero then record “000”

2.05 Does the facility have written records of the Hospital/Health Center Executive Committee meetings (minutes, decisions, etc.)? If the facility does report that they have them, then ask to see if. Report whether they do not have them, they have them and you saw them, of they have they but you did not see them.

2.06 What initiatives were taken by the Hospital/Health Center Executive Committee and implemented in the last 12 months? Do not read the options aloud, but instead wait for the respondent to list responses. For reach of the response that matches a response on the list record a “1.” For all other record a “2.”

2.07 Has a facility budget been developed for the current financial year? Has the facility developed its own work plan for this year, not just given a work plan by the NGO supporting it or by the Provincial Health Department? Ask to see the work plan. If health staff report having a plan but do not show it to you, record “2”; If no work plan is present, record “3.”

2.08 Has a facility workplan been developed for the current financial year? Has the facility developed its own work plan for this year, not just given a work plan by the NGO supporting it or by the Provincial Health Department? Ask to see the work plan. If health staff report having a plan but do not show it to you, record “2”; If no work plan is present, record “3” and skip to Q2.11.

2.09 Who was involved in setting this work plan? The intent here is to find out who contributed to the work plan development. Write more than one option if multiple parties were involved in setting the work plan.

2.10 Are priority health-related activities identified in this workplan for the current financial year? In doing the work plan were certain activities prioritized over others, or was every activity given equal emphasis? If the answer is no then skip to Q2.12.

2.11 Now I will read you a list of services. For each service, please tell me whether this service is a priority or not a priority for this fiscal year. Record “1” for activities that the respondent considers a priority, and “2” for activities that are not priorities.

2.12 How many health facility staff meetings were held in the last 3 months? For this you will probably have to rely on the memory of the senior health worker. This is an important measure of internal administration.

2.13 Do all facility staff have written job descriptions? Determine whether all staff have written job descriptions, some, or none and record appropriately.

2.14 In the last 3 months, how many visits were made by a district hospital representative for supervision or technical assistance? If the answer is zero, then record a “0.”

2.15 -2.19

In the last 3 months, how many visits were made by [AGENCY] for supervision or technical support? Record the number of visits by the specific agency for supervision or technical support. If the answer is zero record a 0.

2.20 In the last 12 months, how many times was the performance of staff assessed internally, that is, by persons within the facility? If the number of times is zero, then record a zero and skip to Q2.22

2.21 Is the result of this internal staff performance assessment linked to staff salary or incentive payment?

2.22 In the last 12 months, how many times was the performance of staff assessed externally, that is, by persons from outside the facility, e.g. the District Health Management Team? This set of questions (2.22 to 2.25) is to find out whether the assessment of staff and facility performance is linked to the financial aspects such as staff salary, incentives and facility finance.

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2.23 Is the result of the staff performance assessment linked to staff salary or incentive payment?

2.24 In the last 12 months, how many times was the performance of the facility as a whole assessed externally, that is, by persons from outside the facility? If the number of times is zero, then record a zero and skip to Q2.26

2.25 Is the result of the external performance assessment of the facility linked to facility financing?

2.26 Does the facility obtain information on patient opinion through client surveys, a complaint/suggestion box or another method? If the answer is no then skip to the next section, Q3.01.

2.27 Is there a formal mechanism to inform the staff about patient opinion?2.28 In the last 12 months, have any changes occurred as a result of patient opinion?

Section (3) General Human ResourcesRequest the facility head of human resources or in-charge to show the human resources records for the facility.(A) Human Resources Management3.01-3.03

Inquire about who has the authority to hire staff, dismiss staff, and determine staff’s compensation respectively. Read each option aloud, and for each possible response record a 1 if the respondent indicated the person/entity has the authority, or “2” if the person/entity does not have the authority

Principal investigator: For the following questions 3.04-3.07, adjust instructions based on national system. Delete “Authorized” from the questionnaire and this manual if not applicable to the country of the study.3.04-3.07

For the following questions determine the number of staff for each position that meet the requirements in the question, i.e. that can be hired (question 3.04) or that are currently employed (question 3.05). If there are zero staff in a specific position for one of the questions then record a “0”. If possible please review staff records. “Authorized” positions mean positions that can be filled in (but they may not be filled in): if caps on certain categories of workers are set by the Ministry of Health or other authority for this facility, then the amounts recorded in 3.04 to 3.06 cannot exceed this cap. Question 3.07 however can record non-authorized workers, i.e. workers that would exceed the official cap.

(B) Community Health Workers3.08 How many villages are supported by this facility?3.09 How many community health posts are supported by this facility? Community health

posts are facilities where community health workers provide services in a community. Write down the number of community health posts that are supported through this health facility. If none, write "00" and skip to section 3.3 staff roster.

3.10 Does the health facility catchment area have active CHW(s)? This question asks whether there are any active CHWs in the facility catchment area. By “active” we mean that the CHWs should be providing health services to the community. If the answer is no then record “2” and skip to Q3.14

3.11 Write down the number of male and female community health workers active in the catchment area.

3.12 Is there any CHW who has stopped working in the last 12 months? If the answer is no then record “2” and skip to Q3.14.

3.13 Write down the number of male and female community health workers who have stopped working in the last 12 months in the catchment area of the facility.

3.14 Does the health facility have a specially designated Community Health Supervisor (CHS)? This question asks whether the facility has a designated Community Health Supervisor (CHS). Choose the appropriate response. If the answer is no then skip to the next section, Q4.01

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3.15 Write down the number of community health supervisors that work from this facility. 3.16 In the last 3 months, did the Community Health Supervisor(s) do any of the following

activities? Read all the options aloud and record a “1” if the CHS had done the respective activity, or a “2” if the CHW had NOT done the activity.

Section (4): Staff Roster4.01 Please list the full names of all the staff working in the facility according to the roster. For

each staff member ask questions Q4.01 - 4.16, and once finished with all questions for that staff member then move on to next staff member. Once you have completed the list from the roster, ADD any new staff listed by the administrator and ask questions 3.20 - 3.35 for the new providers.

4.02 Please record the gender of the staff member.4.03 Please record the ID code of the respondent: the respondent should be the health facility

in-charge or best informed staff member.4.04 Please record the health worker’s age in years. This will allow calculation of average age

of health workforce.4.05 Read all possible responses aloud. Please record the highest academic qualification that

the worker has obtained. You may select “other”, record “96” and specify the qualification if the health worker indicates none of the stated degrees match his/her highest academic qualification.

4.06 Please record the position of the staff member using the codes provided below. This will help in determining whether the health worker distribution is according to the policy guidelines and needs of the community. If the staff member holds a non clinical position please skip to Q4.08.

4.07 Please record the year in which the staff member received his/her clinical degree. This will help in determining the retraining needs for the health workforce.

4.08 Please record the year of appointment of the staff member at this health facility. Please record in YYYY format, e.g. 1988.

4.09 Please record the salary scale of the respondent: Respondents’ contract may include a specific salary scale based on a predetermined level of the health worker. The salary scale may be a number or letter(s) based on the national classification of health worker level.

4.10- 4.12

These questions are to determine the number of working hours the staff member spends at the facility and caring for patients, and this information will help in determining the amount of time spent by workers in relation to the incentives provided to them.

4.13 Please record whether the staff member works in a private health practice in addition to the members work at this health facility.

4.14- 4.15 This set of questions is to determine absenteeism among the health workers.

4.16 Please record the services that the staff member is providing today. If the staff is providing multiple services, then record each service mentioned up to a maximum of 5 different types of services.

Section (5) Laboratory5.01 Does the facility provide laboratory services? If the answer is no then please skip to the

next section, Q6.01. If the facility does provide laboratory services please answer the following questions regarding the type of services provided.

(A) Lab tests5.02-5.04

For each type of test mentioned in a. – p. please record the answers to each of the three questions regarding whether the tests can be performed, the number of times it was performed, and whether it is responses are confirmed in records.

5.05-5.08

These questions are used to collect more information on the lab equipment available at the facility

Section (6) Services

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Principal investigator: Insert instructions on how the field supervisor or enumerators are to verify the collected information: via register books such as patient registry, prescription registry or via other records.(A) Vaccination Services6.01 Does this facility provide immunization services? If facility does not provide

immunization services then record a “2” and skip to Q6.14.6.02 Is there a separate room or area for immunizations?6.03 Are immunizations regularly given to children at the facility or in outreach activities?6.04 Is there a vaccination outreach work plan for the current year?6.05 In the last 30 days, on how many days did the facility staff do vaccination outreach in

the community? 6.06 Does this facility have a [STORAGE METHOD] for storing vaccines?6.07 Is a temperature log kept? If such a log is kept, then ask to see the log. If no log is kept

then record “3” and then skip to Q6.11.6.08-6.10

Please answer these questions according to the information on the facility’s temperature log

6.11 Are immunization cards issued to every child starting his/her immunization schedule? If the answer is no then record “2” and skip to Q6.14.

6.12 After a child starts its immunization schedule, where are the immunization cards kept? If the answer is given to caregiver to bring for next visit, or other then please record the respective number and skip to Q6.14.

6.13 Could you show me some cards that belong to specific patients? Politely ask to see examples of patients’ immunization cards, while being cautious to maintain each patient’s privacy. You can explain to the respondent that the purpose is only to assess whether the cards are present, but that the information on each card will neither be recorded nor disclosed.

(B) Antenatal Care Services6.14 Are antenatal services provided at this facility? If the answer is no then record “2” and

skip to Q6.23.6.15 Are pregnant women seen at specific times that are separate from times allocated to

other patients consultations?6.16 In the last 30 days, how many days has antenatal care been available to women?6.17 In the last 6 months, how many times did the facility hold meetings with Traditional

Birth Assistants?6.18 In the last 6 months, on how many days did the facility staff do outreach in the

community for antenatal care?6.19 In the last 6 months, were iron and folate routinely prescribed? Routinely is to be

considered as “at least in 60% of the antenatal care consultations”. Please ask to see records, and record the appropriate response depending on whether you saw the records or not.

6.20 Do women who come to the facility for antenatal care get an antenatal or maternal health card? If the answer is no then record a “2” and skip to Q6.23.

6.21 Where are the maternal health cards kept once issue to a mother? If the answer is either given to a mother to bring for next visit or other, please record the respective response and then skip to Q6.23.

6.22 Could you show me some cards that belong to specific patients?(C) Delivery and Postpartum Services6.23 Are delivery services offered by the facility, either in the facility or in the community?

If the answer is no then record “2” and skip to Q6.26.6.24 Do facility staff assist with deliveries only in the facility, only in the community, or in

both the facility and the community?6.25 Does this health facility have the capacity to manage emergency caesarian sections?

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6.26 Are postpartum care services offered at the facility? If the answer is no then record “2” and skip to Q6.32.

6.27 Are postpartum services offered at specific hours only, during general outpatient hours, or both at specific hours and during general outpatient hours?

6.28 In the last 30 days, on how many days was postpartum care available to women?6.29 In the last 6 months, how many postpartum outreach clinics were held by this facility?6.30 In the last 12 months, how many maternal deaths were recorded at the facility? Please

check the records. 6.31 In the last 12 months, how many maternal deaths were recorded in the community

(excluding those at the facility)? Please check the records.(D) Tuberculosis Services6.32 What tuberculosis services doe this health facility provide? If the answer is none then

record “04” and skip to Q6.26.6.33 Is there a Tuberculosis Corner in the health facility? This is typically a place in the

facility where patients with tuberculosis are seen and provided drugs. If the answer is no then record “2” and skip to Q6.35.

6.34 Who manages the Tuberculosis Corner in this health facility?6.35 Is there a Tuberculosis Register? If the answer is yes, ask to see the register and then

record the appropriate answer. 6.36 Is there a Suspect Tuberculosis Register? If the answer is yes, ask to see the register and

then record the appropriate answer.6.37 Do patients who come for tuberculosis treatment get a tuberculosis treatment card? If

the answer is no then record “2”, and skip to the Malaria Services section if present or the next section Q6.40.

6.38 Where are the tuberculosis treatment cards kept once issues to a patient? If the answer is given to patient to bring for next visit then record the appropriate response, and skip to the Malaria Services section if present or the next section Q6.40.

6.39 Could you show me some cards that belong to specific patients? Politely ask to see examples of patients immunization cards, while being cautious to maintain each patients privacy. You can explain to the respondent that the purpose is only to assess whether the cards are present, but that the information on each card will neither be recorded nor disclosed.

(E) Malaria Services6.40-6.43

How many patients in the past 6 completed months have been classified as the following:(6.40) # suspected cases of malaria(6.41) # laboratory confirmed cases of PF (plasmodium falciparum) malaria(6.42) # laboratory confirmed cases of other (non- plasmodium falciparum) malaria(6.43) # malaria cases treated with ACT

Ask to see the patient registers in order to gather this information. Record in the spaces provided the total numbers for each category. Write “000” if there were no patients for that category. Write “DK” if it is unclear or the respondent does not know the answer for a particular category.

6.44 Does the facility provide treatment according to the National Malaria Treatment guidelines? Ask the facility in-charge. If s/he responds yes and shows the guidelines, record “1”. If s/he responds yes and cannot show the guidelines, record “2”. If s/he responds no, record “1”.

Section (7) General Health management Information Systems (HMIS)7.01 Do you have an estimate of the size of the catchment population that this facility

services, that is, the target, or total population living in the area served by this facility? If the answer no then record “2” and skip to Q7.03.

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7.02 How many people is the catchment? For categories a. through f. record the respective total population.

Principal investigator: Insert instructions in the cell below on how the field supervisor or enumerators are to verify the collected information: via register books such as patient registry or via other records.7.03- 7.12

For these questions ask to see the register that shows the total number of patients attended in this facility in the last completed calendar month. If some categories cannot be identified from the register then record “Don’t Know” for these categories.

7.13-7.18

For these questions use the records at the facility to determine if the report is completed for the last calendar month. Also ask the respondent if the report is completed for the previous calendar month if the report is not in the records. Record the appropriate response.

Section (8) Health Services Utilization Based on Health Management Information Systems(HMIS)Please ask the facility in charge to provide written records for services provided through this facility. Ask questions 8.01-8.04 for each service before moving to the next service.8.01-8.04

These questions ask about whether the facility provides the service in house and/or as outreach, the number of days per week the service is offered, the total price for each service visit/ procedure (besides registration fees) in the local currency, and lastly the number of outpatients and inpatients in the register who received care in the last 6 full months

Section (9) User Fees9.01 Do patients pay for consultation or doctor’s fees? Please check question 1.14, possible

response b. on user fees: questions 9.01 and 1.14-b. should be matching. Probe if not.9.02 Do patients pay laboratory fees for tests?9.03 Do patients pay fees for x-ray tests? While the previous question asked about all tests,

this question is to determine if patients specifically pay for x-rays.9.04 Do patients pay fees for supplies (e.g. compresses, syringes, etc.)?9.05 Do patients pay fees for medicine? If the answer is no, record “2”, and then skip to

Q9.08.9.06 What percentage of the drug cost is charged to patients?9.07 Is this percentage charged based on the wholesale or retail price?9.08 Depending on the answers to questions 9.01, 9.02, 9.03, 9.04, and 9.05 establish

whether the facility charges any patient fees or not. If the facility does not charge patient fees then record “02” and skip to Q9.14

9.09 Who was involved in setting the fees? Read all the options aloud and for each option allow the respondent to determine if the option was involved in setting fees.

9.10 In the last 3 months, where did the facility direct revenue from user fees? Read all the options aloud and for each option allow the respondent to determine if the facility directed revenue to that option.

9.11 Are any of the following individuals exempt from paying fees? Read all the options aloud and for each option allow the respondent to determine if individual was exempt from paying fees.

9.12 Who decides which patients are exempt from paying fees? Read all the options aloud and for each option allow the respondent to determine if the option decided who was exempt from paying fees.

9.13 Do exempt patients receive a special exemption card that allows them to receive services for free?

9.14 Does the facility participate in a health insurance scheme? If the answer is no then record “2” and skip to the next section, Q10.01.

9.15 What type of health insurance? Determine what health insurance scheme the facility participates in.

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9.16 What services are covered under the health insurance scheme? Read all the options aloud and for each option allow the respondent to determine if it is covered under the health insurance scheme.

9.17 Where are the funds collected through the insurance scheme allocated by the facility? Read all the options aloud and for each option allow the respondent to determine if collected funds were allocated to it.

Section (10) Leadership Attention: The respondent should only be the head of the facility. Please record his/her ID code, which should be listed on the staff roster.10.01- 10.05

Questions 10.01 through 10.05 involve reading the respondent a scenario and four options, and then allowing the respondent to determine which option most closely matches what s/he would do in this specific situation. Please read the scenario first and then the four options. Only one answer can be chosen.

Section (11) AutonomyAttention: The respondent should only be the head of the facility. Please record his/her ID code, which should be listed on the staff roster.11.01-11.09

These questions determine how work is organized and how decisions are made within the facility. For each question please read the scenario and then allow the respondent to determine if they feel the statement is true. Use the following response codes for each question.1 - Most of the time 2 - More than half of the time 3 – Less than half of the time4 – Only rarely5 - Never

Section (12) Direct ObservationAttention: There is no respondent for this section. All the questions involve direct observations of the facility from walking around the facility. Please seek permission to walk around the facility, and if permission was granted then answer each question by confirming with a direct observation.12.01 Is there a reception/registration room in this facility?12.02 Is there a waiting room in this facility?12.03 Is there a separate waiting room for women in this facility?12.04 Is there a room with auditory and visual privacy for patient consultations in this

facility?12.05 Is there a minor surgery theater in this facility?12.06 Is there heating in patient areas during winter in this facility?12.07 Are there observation beds in this facility? If no then record “2” and skip to Q12.12.12.08 If there are observation beds then record the number of beds present.12.09 Are there separate wards for men and women in this facility? If no then record “2” and

skip to Q12.12.12.10 Record the number of beds for men.12.11 Record the number of beds for women.12.12 Is a functional toilet facility available for patients?12.13 Are there separate toilet facilities for male and female patients?12.14 Does the facility have accommodations for health workers who are on-call during non-

routine hours, e.g. night shift?(B) Posting of User Fees12.15 Is there any posting in the facility that shows the user fees for outpatient visits?

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12.16-12.18

Is there any posting in the facility that shows Laboratory fees, X ray fees, and supplies fees, respectively, for outpatients?Check to see if there are postings for each different type of fees, and also whether it is publically posted for everyone to see. This would be in an area that is easily accessible and visible to patients.

12.19 Is any of the following posted publicly for patients to see?Ask to see the document posted in the facility, and then record whether it is posted and if you saw it.

(C) National Protocols12.20 – 12.44

For each of the protocols / guidelines/ materials ask the facility head or best informed staff member to see them. Record whether the protocol / guidelines / materials were seen or not seen. They must be seen by you the enumerator to count.

Section (13) Equipment (Direct Observation)Attention: There is no respondent for this section. All the questions involve direct observations of the facility from walking around the facility. Please seek permission to walk around the facility, and if permission was granted then answer each question by confirming with a direct observation.13.01 Where is the outpatient equipment located? Determine whether it is kept in a separate

outpatient room, a room that is also used for other activities, or other.13.02 For each of the equipment listed below, record the number of each functioning and

available each item that the facility owns. For instance if the facility owns three thermometers, but only two are functional then you should record “2.” If the facility does not have one functioning or available item of equipment then record “98” for that type of equipmentSterilizing Equipment

13.03 Where is the sterilization equipment located? Determine whether it is kept in a separate sterilization room, a room that is also used for other activities, or other.

13.04 Similar instructions as Q 13.02, record the number of each functional and available type of equipment. Record a “98” if not functional or available. Vaccination Equipment

13.05 Where is the vaccination equipment located? (Vaccine fridge paraffin or electric cold box, or vaccine carriers) Determine whether it is kept in a separate vaccination room, a room that is also used for other activities, or other.

13.06 Follow instructions for Q13.02 and Q13.04.Antenatal Care Equipment

13.07 Where is the antenatal care equipment located? (Fetoscope, blood pressure instrument, tape measure, adult weighing scale) Determine whether it is kept in a separate antenatal care room, a room that is also used for other activities, or other.

13.08 Follow instructions for Q13.02, Q13.04, and Q13.06.Delivery and Neonatal Equipment

13.09 Where is the delivery and neonatal equipment located? Determine whether it is kept in a separate antenatal care room, a room that is also used for other activities, or other.

13.10 Follow instructions for Q13.02, Q13.04, Q13.06, and 13.08.Section (14) Drug and Vaccine Storage Availability14.01 Do the following entities have the authority to procure drugs and equipment for this

facility, …?14.02 Could you bring me to the place in this facility that is used to store drugs? If there is no

such place then record “3” and then skip to the next section, Q15.01.14.03 For this question please note if the place in the facility that is used to store drugs is a

separate room from the rest of the facility.14.04 Does this pharmacy serve only to store and dispense drugs, or does it also serve for

other purposes? The pharmacy may serve other purposes (e.g. consultation), especially if the pharmacy is not in a separate room.

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14.05 Can the doors and windows be locked to keep the pharmacy secured?14.06 For this question please note how the area that is used to store drugs looks. Does it look

clean, partially dirty, or dirty?14.07 Again please observe the area that is used to store drugs and determine if the ceiling,

walls, floors, and windows look dry and free from traces of water infiltration.14.08 Please observe the area that is used to store drugs and determine if the windows are

covered to keep the sunlight out.14.19 Please note if the drugs are kept on an elevated platform in the room that the facility

uses to store drugs. 14.10 Does the pharmacy maintain stock cards or stock register? If the respondent responds

with a yes, then please ask to see the cards/register.14.11-14.15

For these questions please answer 14.11 through 14.15 for each drug before moving on to the next drug. These questions are to determine the strength of the drugs in stock, how much the facility chargers for each drug, and whether the drug is available and/or in stock.

Section (15) Catchment area15.01 What is the catchment population of this facility? Record responses from both the

Central Statistical Office (CSO) and the Facility Headcount.15.02 Please provide a list of the villages that fall in the catchment area of this facility? For

each village list the name, the population, and the distance from the health facility in kilometers.

Thank the respondents for their time.

3. Form F2: Health Worker Interview

Part 1: Purpose

The purpose of this section of the survey is to understand the level of health worker training, supervision, knowledge, and satisfaction with work. The information you collect here will guide the Ministry of Health in designing programs to strengthen the training and education of health workers as well as improve their job satisfaction.

Part 2: How the health worker interview is to be done

Health worker selection

Principal investigator: Adjust sample sizes and gender requirements based on your survey. Remove requirement on vaccinator (and adjust requirements on other health workers) if not applicable to your survey.

For this section of the survey you must select a health worker to interview. Select a minimum of 4 health workers to be interviewed. Eligible health workers given priority include doctors, nurses, assistant doctors, midwife/auxiliary midwife, and vaccinators. If no midwife or auxiliary midwife is present, a Community Health Worker Supervisor (CHWS) can be interviewed; or if a CHWS is not present, any other health worker that is present may be interviewed for the F5.

At least one of the health workers must be a female, if present. If more than one female health worker is in the facility, then interview 2 male and 2 female health workers.

If more than 4 health workers are present, select one doctor (if not available, one assistant doctor), one nurse, one midwife (if not available, one auxiliary midwife), and one vaccinator.

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If fewer than 4 health workers are present, select as many as are present at the facility and who fit into the above categories. If you don’t reach the four count with those, complete by interviewing any other health worker present at the health facility in order to complete four F2 forms in total.

Consent to be interviewed

Principal investigator: You must make sure that examples of consents are included in the training.

The interview starts with a consent form. As this interview contains personal information and questions which may be of a sensitive nature, it is important that the health worker give permission to be interviewed by agreeing to conditions set out in the consent form. They must know that if they refuse to be interviewed, this will not affect their standing in the health facility. If they agree to be interviewed, they are allowed to break off the interview at any time, or decline to answer certain questions if they choose. It is not necessary to get the health worker to sign the form, though it is necessary that you sign that the person has given permission for the interview. Your name and the date must be recorded on the form.

Conducting the interview

There is only one health worker form. Fill out one form for each health worker interviewed.

It is important that the health worker who is now being interviewed does not feel that s/he is being inspected. The health worker needs to be reassured that this is private information, and will not have any names attached to it. It will not be shared with provincial health directors or anyone else.

Part 3: Who administers this questionnaire?

It is important that the person who does this section be thorough and not leave out important parts. On the other hand, the person doing this part should be able to move quickly through the form, especially in sections assessing the knowledge of health providers (vignettes).

Enumerators will conduct this interview. The field supervisor may also conduct one or more health worker interviews if s/he has completed the health facility assessment form (F1) before enumerators have completed health workers interviews.

Part 4: How long will this part of the survey take?This part of the survey may take about 1.5 hours.

Part 5: Review of the individual questions

Cover Page: Identification and location of the facility and consent

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Health Worker unique identifier code (ID): Record the Health District, Health Facility and Health Worker unique ID codes in the top right hand corner. The field supervisor with have the district and facility unique ID codes. The unique health worker ID will be taken from the facility assessment form F1, section 4 that was completed by the field supervisor. Write in ARABIC numerals.Location. Record the (A) Province, (B) District, and (C) Village/town/locality where the facility is located.GPS reading of the facility. Record the latitudinal and longitudinal readings in the spaces provided.Facility name and location. Write the (A) name of the facility and (B) Summarized location i.e. address or any information that allows locating the facility.Enumerator name, code and date. Write down your (A) unique enumerator ID code (in ARABIC numerals) the (B) date of the visits, and date of any subsequent visit(s) if applicable (DD – MM – YYYY format).Interview. Write down (A) Result of the interview, whether it was complete, (B) the language of the enumerator and the respondent (in distinct cells) and (C) whether a translator was used.

Note: The field supervisor and field editor will also have to enter their respective unique ID code and date of review.Consent. It is important to obtain the consent from the health worker. Please read out the consent statement verbatim. If the respondent does not agree to participate, do not fill out a consent form. However, you must record that the respondent refused to participate in the questionnaire in the “Result of the interview” cell. Proceed ahead only if the respondent agrees to participate by saying ‘YES”. In this case, fill out both the consent form and the questionnaire. If the respondent agrees to participate, s/he must sign or mark the consent form. You must also sign the consent form.Section 1: General Health Worker InformationThis section gathers general information on the staff working at the health facility.1.01 May I know your name?1.02 Enter the Health Worker ID code from the staff roster in form F1.1.03 Please write down the gender of the health worker.1.04 How old are you? Write the age of health worker in years.1.05 What is your marital status? Please record the appropriate response, and if the

answer is single, widowed, or divorced/ separated then skip to Q1.07.1.06 Do you live with your spouse?1.07 Do you have children?1.08 How many school-going children live with you?1.09 Were you born in this district?1.10 Who is your employer?1.11 What type of employment contract do you have with your employer?1.12 What is the highest level of education you ever completed?1.13 How many year (s) and month(s) have you been working after formal completion of

your highest training? Record the answer in both years and month, and if it is less than a year write down “0” for years and record the number of months.

1.14 How many year(s) and month(s) have you worked as a health worker at this facility? Record the answer in both years and month, and if it is less than a year write down “0” for years and record the number of months.

1.15 What is your position as a health worker as designated by the Ministry of Health?1.16 In the past 3 months, have you done the following activities? Please read each option

aloud and record a “1” if the health worker provided the service at least once in the last 3 months, and a “2” if not. If the health worker has worked at the facility for less than 3 months then ask the respondent to include only the services that s/he has provided at the facility.

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Section 2: Staff Training2.01 “For each subject I mention, I would like to know the most recent time you were

trained.” This training includes only the training received after undergoing professional education. For example, training received as part of the MBBS or MD program should not be mentioned here. This timing of the training can be before or after the current job at this facility. Please record whether the training was less than a year ago, more than a year ago, or the health worker was never trained in that subject.

2.02 Are there other training needs you personally feel you need for your present job? Ask the health worker if there is a particular type of training that they need in order for them to perform their duties and circle “YES” or “NO”. If no then record “2” and skip to Q3.01.

Section 3: Hours and duties3.01 How many hours per week are you contracted to work at this facility? 3.02 We realize that health workers cannot always fulfill their duties and stick to their

assigned schedules. In the last 30 days, how many days were you absent from work?3.03 In the last 7 days, how many days did you work at this facility?3.04 In the last 7 days, how many hours did you work at this facility in total?3.05 In comparing to 12 months ago, would you say the number of hours you work in a

week have increased, decreased or remained the same?3.06 Have you ever been absent from work without authorized leave?3.07 The last time you were away from work without authorized leave, what type of

activity were you doing? Do not read the options aloud, but instead record “1” for every option mentioned a “2” for those that were not mentioned.

3.08 When you are away from the facility without authorized leave, do any of the following occur? For this question read the options aloud.

3.09 How many individual patients did you see on your last full working day? In this count, do not include the numbers of patients or community members seen by the provider as part of outreach/sensitization activities.

Section 4: SalaryThis section aims to identify if the salary of health worker has changed as compared to a year ago, what determines this change, and if the salary payment has been done on time or not.4.01 What is your current monthly net salary?4.02 What was your monthly net salary one year ago?4.03 What is your current salary scale?4.04 Over the past 2 years, has your salary increased because of the following reasons?

Read the options aloud.4.05 In the last 12 months, did you receive all your due salary according to the payment

schedule? If the answer is yes then record “1” and skip to Q4.14.4.06 What day of the month are you supposed to receive your salary? Record the number

of the day. For instance if it is on the 8th day of the month record “08.”4.07 Last month, how many days was your salary delayed?4.08 Have you received your salary in totality?4.09 The previous month (2 months ago), how many days was your salary delayed?4.10 Have you received it in totality? Please determine if the respondent received their

whole salary, or if they are still missing part of it.4.11 In the last 12 months, those times that you did not receive your full salary on time,

what reason was usually given for you not being paid? Do not read the options aloud, but instead record “1” for every option mentioned a “2” for those that were not mentioned.

4.12 For the last 12 months, have you received all the salary due to you, even if it was not according to the payment schedule? If the answer is yes then record “1” and skip to Q4.14.

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4.13 How many months’ salary are you currently owed regarding the past 12 months? Enter the number of months from 1 month to 12 months.

4.14 If you were to leave your current job, where would you go?4.15 What would be the lowest monthly net salary you would accept to work in your

proffered job?Section 5: Other compensationThis section aims to identify and measure the additional benefits that the health workers might be receiving as part of their primary job. The included options for these are housing, hard-to-reach area, travel, service volume, and other. Country teams should change the list as needed.5.01 Do you currently receive any of the following benefits as part of your primary job?

Read the options aloud.5.02 Do you currently receive a housing allowance? If the answer is no then record “2”

and skip to Q5.05.5.03 How often is the housing allowance paid?5.04 How much did you receive in the last period or at your last ad hoc payment for the

housing allowance in (Currency)?5.05 Do you currently receive a “Rural Hardship” allowance (for working in rural areas)?

If the answer is no then record “2” and skip to Q5.08.5.06 How often is the Rural Hardship allowance paid?5.07 How much did you receive in the last period or at your last ad hoc payment for the

Rural Hardship allowance in (Currency)?5.08 Do you normally receive a travel allowance for outreach activities? If the answer is

no then record “2” and skip to Q6.01.5.09 In the last 3 months, how much did you receive as travel allowance for outreach

activities in (Currency)? Section 6: Supervision (internal and external)This section includes questions on the supervision that the health worker receives while performing his/her duties. The list includes questions on actual activities that were performed in relation to supervision and the worker’s perception of issues related to work and supervision. The supervisor may come from the MOPH at the provincial level or from the NGO supporting the health facility.6.01 Within the facility, is there anyone who is responsible for supervising your work?

This could include providing feedback on your performance, giving you advice, discussing your career with you? If the answer is no then record “2” and skip to Q6.07.

6.02 Within the facility, who is responsible for supervising your work?6.03 What is the position of your supervisor as designated by the Ministry of Health?6.04 When was the last time you met with this internal supervisor to discuss your

performance of your career development?6.05 Within the last 12 months, have you discussed any job difficulties with your internal

supervisor? If the answer is no then record “2” and skip to Q6.07.6.06 After these discussions, did you notice a lot of improvements, some improvement or

no improvements?6.07 Outside of this health facility, is there anyone who is responsible for supervising

your work? This could include providing feedback on your performance, giving you advice, discussing your career with you? If the answer is no then record “2” and skip to Q7.01.

6.08 Who outside the facility is responsible for supervising your work?6.09 In the last 12 months, how many times have you met with this external supervisor?6.10 When was the last time you met with your external supervisor to discuss your

performance or your career development? If the answer is never then record “05” and skip to Q7.01.

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6.11 The last time that you met this external supervisor, what did [HE/SHE] do to supervise your work? Please do not read the options aloud, but instead record “1” if the option is mentioned and a “2” if it is not mentioned.

6.12 Within the last 12 months, have you discussed any job difficulties with your external supervisor? If the answer is no then record “2” and skip to Q7.01.

6.13 After these discussions, did you notice a lot of improvement, some improvement or no improvements?

Section 7: Supplemental IncomeThis includes questions on additional income that the worker might be getting from working outside this facility. This should not be a one-off activity but last for at least one month.7.01 Do you have any other job or activity to supplement your income from this health

facility? If the answer is no then record “2” and skip to Q8.01.7.02 What kind of job or activity is this? Read the options aloud.7.03 What was the main reason that you are doing this other job or activity? Do not

read the options aloud, and only record one response.7.04 How long have you been doing this additional job or activity? Record both the year

and the months.7.05 How many hours did you spend on this other work in the last 7 days?7.06 What is your monthly net income in this other work in (Currency)? The value should

be based on the income from last month.Section 8: WHO Well-being index8.01-8.05

These questions involve reading a series of statements to the respondent about how the respondent is feeling. Have the respondent indicate whether s/he feels the way described in the statement most of the time, more than half of the time, less than half of the time, or never.

Section 9: Health Worker Satisfaction9.01 – 9.25

These questions involve reading a series of statements to the respondent regarding their satisfaction with their current job. The respondent should determine if s/he is satisfied, neither satisfied nor unsatisfied, or unsatisfied with each statement.

Section 10: Personal Drive10.01 – 10.37

These questions involve reading a series of statements to the respondent regarding their work environment. The respondent should indicate whether s/he feels the described statement is true most of the time, more than half of the time, less than half of the time, only rarely, or never.

Section 11: InnovationThis section involves determining how health workers would respond to certain scenarios. 11.01-11.05

Each of these questions involves reading the respondent a scenario, and then asking what the respondent would do in this situation. For all these questions, the responses should not be read aloud, and each possible response should only be recorded with a “1” if it is mentioned. If one of the options is not mentioned a “2” should be recorded.

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Section 12: Staff KnowledgeThis section uses case based scenarios to determine the knowledge of the health worker.

It is very important that the health worker DOES NOT see the survey form where you are recording his/her answers. Many of the options should not be read aloud and therefore it is important that s/he cannot see them. When specified, the health worker may look at the laminated case scenario cards.

DO NOT let the health worker see the case scenario card and then leave to take care of a patient. Let the health worker leave, if need be, after asking all of the questions pertaining to a case scenario. Do not let the health worker leave with a case scenario and then return to answer questions about that case scenario; ask those corresponding questions before s/he leaves.

Please DO NOT administer the knowledge assessment section to Community Health Worker Supervisors.

This statement should be read before proceeding “The following set of questions are an assessment of your knowledge of basic disease protocols. This assessment will not affect your employment at this facility, nor does it affect your standing as a practitioner in this area. This is a tool simply to help the Ministry of Health obtain information on how to improve training of facility staff in the future. I will present you with situations that you would observe in the clinic. Please answer the questions to the best of your knowledge.”

12.01 Determining if the health worker is a doctor, assistant doctor, or a nurse. If the health worker is none of these then record “2” and end the survey.

12.02 At how many months and weeks of age should a child receive the following vaccines? Read the vaccines and have the respondent determine in weeks and months when the vaccine should be given.

12.03 Imagine a mother brings in her 9 month old child for routine immunization. You find the child has a fever, a read throat, and a runny nose, but no other signs of illness. Should you give the immunization?

12.04- 12.10

These questions involve first reading the respondent a case scenario, and then a question that will determine how the health worker would proceed in such a situation. All case scenarios should be read word for word, and there should be case cards that can be given to the respondent for reference. Do not read the options aloud, and once the respondent finishes answering the question ask if there is “anything else.” Multiple responses are allowed, and each option mentioned should be recorded with a “1”Section 13: Protocol-based vignettesAll answers in this section are confidential

13.01-13.08

Please read the case first, and then ask the questions that determine what the health worker would do in this situation. Please do not read the options allowed, and record a “1” if the option is mentioned and a “2” if not.

At the end of the questionnaire, do not forget to thank the respondents for their time.

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4. Form F3: Exit interview, Patient receiving Antenatal Care

Part 1 Purpose

The purpose of this exit interview is to learn who the users of health services are, to appreciate their perspectives, and to measure what happened during their health care visit. The information you collect here will guide the Ministry of Health in designing training programs to strengthen health services for pregnant women and young children. There will be some economics questions to help understand if levels of wealth influence utilization of health services.

Part 2 Who administers this questionnaire?

This section does not require someone with a clinical background. It is important that the person who does this section be thorough and does not leave out important parts. On the other hand, the person doing this part should be able to move quickly through the form, because for some patients, it may take some time to respond.

The person doing this form should be the enumerator.

Part 3 How long will this part of the survey take?

This part of the survey may take longer than the consultation itself, so there is a worry that several patients at a time may be waiting for their exit interview. It is important to be aware of this, and reassure those waiting that you will not take any more time than is necessary. Patients (pregnant women) should not become frustrated and leave before you have a chance to interview them. The field supervisor is also responsible for allocating enumerators in such a way that the wait is minimized. Each questionnaire should require about 20-30 minutes to complete.

Part 4 Review of the individual questions

Principal investigator: Some of the questions in the questionnaire include “Did someone in the facility do …”. If the exit interview must only regard the interaction between the main provider and the patient (not between any other preliminary examination provider and the patient), make sure no “someone in the facility” appears in the exit interview forms, and adjust question-specific instructions in for form F3.

Cover Page: Identification and location of the facility and consent Patient unique identifier code (ID): Record the Health District, Health Facility and Patient unique ID codes in the top right hand corner. The field supervisor with have the district and facility unique ID codes. S/he will also provide each enumerator with the starting number to use for their first exit interview. The enumerator will add one unit to this ID number for each subsequent interview (see preliminary instructions on exit interviews for more details). Write in ARABIC numerals.Location. Record the (A) Province, (B) District, and (C) Village/town/locality where the facility is located.GPS reading of the facility. Record the latitudinal and longitudinal readings in the spaces provided.Facility name and location. Write the (A) name of the facility and (B) Summarized location i.e. address or any information that allows locating the facility.Enumerator name, code and date. Write down your (A) unique enumerator ID code (in ARABIC numerals) the (B) date of the visits, and date of any subsequent visit(s) if applicable (DD – MM –

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YYYY format).Interview. Write down (A) Result of the interview, whether it was complete, (B) the language of the enumerator and the respondent (in distinct cells) and (C) whether a translator was used.

Note: The field supervisor and field editor will also have to enter their respective unique ID code and date of review.Consent. It is important to obtain the consent from both the health worker and the patient. Please read out the consent statement verbatim. For each of the health worker and patient, if the respondent does not agree to participate, do not fill out a consent form. However, you must record that the respondent refused to participate in the questionnaire in the “Result of the interview” cell. If the health worker and/or the patient refuse to participate and they say ‘NO’, wait for the next sampled patient.Proceed ahead only if both respondents agree to participate by saying ‘YES”. In this case, fill out the two consent forms and the questionnaire. If the respondents both agree to participate, they must sign or mark their consent form. You must also sign the two consent forms.Section 1: Identification

The first five questions should be addressed to the health worker.1.01 Enter the Health Worker ID code from the facility staff roster in form F1. This should be

for the health worker who saw the client.1.02 Record the name of the health worker1.03 Record the sex of the Health Worker.1.04 What is your status as a health worker as designated by the Ministry of Health?1.05 What is the type of facility?

All of the following should be asked to the patient.1.06 Can you tell me how old you are?1.07 Can you read and write? The enumerator may ask the respondent to read one

sentence from the form to confirm the status of the respondent. It must be noted that the respondent has never been to any formal school (as asked in the previous question) but can still read and write.

1.08 What is the highest level of education that you completed, and how many years(or grades) of school have you completed within that level? This question requires two separate answers, one for the highest level of education, and another for the number of year(or grades) completed within that level. Please refer to general instructions on completing the questionnaire for further instructions.

1.09 What is your marital status? If the caregiver is single, widowed, or divorced/separated then skip to the next section Q2.01.

1.10 What is the highest level of education that your spouse / partner completed, and how many years (or grades of school has your spouse/ partner completed within that level? This question should be answered in the same manner as 1.08 except that it is about the spouse/ partner. Please refer to general instructions on completing the questionnaire for further instructions.

Section 2: Treatment and Counseling2.01 During this visit to the health center, how many health workers provided care to you?

This includes any doctors, nurses, pharmacist, lab technician, midwife, etc. who directly took care of you or provided you with advice or medicine?

2.02 What is the name of the (first) health worker who provided care to you?2.03 Please enter the health worker ID code for the worker listed above. The ID code should

be listed on the facility staff roster. If the respondent only saw one health worker skip to Q2.10.

2.04-2.09

For these questions list both the names and the ID codes of all health workers the respondent saw. These questions should only be answered if the respondent reports seeing more than one health worker.

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2.10 Do you have an antenatal-care card/book, or an immunization card with you today? Please ask to see it if they mention they have one. If not seen, it is kept with the facility, or they do not use one then skip to Q2.15.

2.11 Check the antenatal care card/book, or immunization card. Determine if there is a note or record of the client having received a tetanus toxoid vaccine.

2.12 Using the same document determine how many weeks the client has been pregnant for.

2.13 Also using the card/book determine if the client has received intermittent preventative treatment (IPT) again Malaria. If it is a non malarious area then chose “Not Applicable”

2.14 Does the card/book mention the blood type of the client.2.15 How long have you been pregnant? Record the time in either months or weeks but

not both.2.16 Is this your first pregnancy?2.17 Is this your first antenatal visit at this facility for this pregnancy? If yes then record “1”

and skip to Q2.19.2.18 Including this visit, how many antenatal care visits have you had for this pregnancy to

this health facility?2.19 How many antenatal care visits have you have had for this pregnancy to other health

facilities?2.20 During this visit, were you weighed?2.21 During this visit, was your height measured?2.22 During this visit, did someone measure your blood pressure? Please explain to the

respondent the process of recording a blood pressure.2.23 During this visit, did you give a urine sample? Please explain to the respondent the

process of collecting a urine sample. 2.24 During this visit, did you give a blood sample? Please explain to the respondent the

process of collecting a blood sample. 2.25 During this visit, did you schedule your delivery in the facility? Ask her if she and the

health made accommodations to give birth in the health facility.2.26 During this visit, did the provider palpate your tummy? Please explain the process of

palpating the stomach.2.27 During this visit, did the health worker estimate your delivery or due date? Ask if the

health worker gave the respondent an approximate date of when she would give birth.2.28 During this visit, was your uterine height measured? Please explain the process of

measuring uterine height.2.29 During this visit, did a health worker ask for your blood type?2.30 During this visit, did a health worker give you advice on your diet (this is, what to eat

and drink) during pregnancy? If no then record “2” and skip to Q2.32.2.31 What did the health worker advise you to eat during pregnancy? Please do not read

the options aloud, but instead record the categories that the respondent mentions with a “1.” You may probe the respondent by asking if there was anything else.

2.32 During this visit, did a health worker give you iron pills, folic acid or iron with folic acid, or give you a prescription for them? Please show the respondents what these pills looks like. If the answer is no then record “2” and skip to Q2.36.

2.33 Please ask to see the respondents pills or prescription 2.34 During this or previous visits, has a health worker discussed with you the side effects

of the iron pill?2.35 Please tell me any side effect of the iron pill that you know of. Do not read the

options aloud or cite answers, instead allow the respondent to determine her own answers. You may probe the respondent for more answers by saying “anything else?”

2.36 During this visit, has a health worker given or prescribed any antimalarial pills for you? If no then record “2” and skip to Q2.38

2.37 Please ask to see the respondent’s antimalarial pills or prescription.

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2.38 Do you own an Insecticide Treated Net (ITN), that is a net that has been treated with an insecticide to protect you from mosquito bites? If no then record “2” and skip to Q2.40

2.39 Last night, did you sleep under an insecticide treated net?2.40 During this visit, did a health worker off you an Insecticide Treated Net free of

charge?2.41 During this visit, did a health worker offer to sell you an Insecticide Treated Net?2.42 During this visit or previous visits, has a health worker asked you whether you had

ever received a tetanus toxoid injection?2.43 Have you ever received a tetanus toxoid injection, including one you may have

received today? If no then record “2” and skip to Q2.452.44 Including any Tetanus Toxid injection you received today, how many times in total

during your lifetime have you received a Tetanus Toxoid injection? Please reiterate to the respondent that this includes all tetanus toxoid injections and could have been at any facility.

2.45 During this visit or previous visits, has a health worker talked with you about any signs of complications (danger signs) that should warn you of problems with the pregnancy? If no then record “3” and skip to Q2.48

2.46 Please tell me any signs of complications (danger signs) during pregnancy that you know of. Do not read the options aloud or cite answers, instead allow the respondent to determine her own answers. You may probe the respondent for more answers by saying “anything else?”

2.47 What did the health worker advise you to do if you experienced any of the warning signs during pregnancy? Do not read the options aloud or cite answers, instead allow the respondent to determine her own answers. You may probe the respondent for more answers by saying “anything else?”

2.48 During this visit, did a health worker talk with you about using family planning after the birth of your baby? If no then record “2” and skip to Q3.01

2.49 During this visit, did the health worker discuss with you any specific method of family planning? If no then record “2” and skip to Q3.01

2.50 Which family planning methods did the health worker discuss? Do not read the options aloud or cite answers, instead allow the respondent to determine her own answers. You may probe the respondent for more answers by saying “anything else?”

Section 3: Patient travel and expenditure3.01 How far is your household from this health facility in kilometers?3.02 How long did it take you/the patient to reach this health from home today? This

answer should be the total minutes for a one way trip from the home to the health facility.

3.03 What was your primary mode of transportation today? This should be for a one way trip.

3.04 How much did it cost in (Currency) for you/the patient to travel to the health facility today? This should be the total one-way cost incurred for both the caregiver and the patient to come to the facility.

3.05 How long did you/ the patient wait in the health facility before being seen in consultation by the health worker?

3.06 Do you think waiting time was too long?3.07 How long did you/the patient spend with the doctor or nurse during the

consultation?3.08 Was a registration/ consultation/ doctor fee charged? If no then record “2” and skip

to Q3.10.3.09 How much was paid in (Currency) for this?3.10 Was a laboratory test done? If no then record “2” and skip to Q3.12.3.11 How much was paid in (Currency) for this?

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3.12 Was an xray done? If no then record “2” and skip to Q3.14.3.13 How much was paid for this in (Currency)3.14 Were medicine dispensed to you at the pharmacy in the health center? If no then

record “2” and skip to Q3.16.3.15 How much was paid in (Currency) for this?3.16 How much was spent in total in Currency at this facility for this visit, not including

transportation costs? Check to see if the total amount equals the amounts reported previously. If the amounts do not match, probe the respondent on the difference in price. If the difference is due to costs not asked about in the survey, then the total amount should include those extra costs. You can make note of what those extra costs were at the bottom of the page. If the difference is due to costs asked about in the survey, correct the previous questions accordingly so that the sum of each cost matches the total cost.If nothing was paid then record “O” and skip to Q3.18.

3.17 Where did the money come from that was used to pay for health care today? Do not read the options aloud, but instead record all options mentioned with a “1” and all others not mentioned with a “2.”

3.18 Is the child covered under a health insurance scheme? If no then record “2” and skip to the next section Q4.01.

3.19 What type of health insurance is this? Is it Public, Private or both?3.20 In the last 12 months, how many months has the household been enrolled in the

insurance scheme?Section 4: Patient satisfaction4.01 What was the most important reason you chose this health facility today instead of

a different source of care? Do not read the options allowed, and have the respondent pick only one answer.

4.02 What was the next most important reason you chose this health facility today instead of a different source of care? This should be the second most important reason for choosing this health facility. Do not read the options allowed, and have the respondent pick only one answer.

4.03 - 4.16

These questions involve reading the respondent a series of statements regarding this health facility. The respondent should then decide if s/he agrees, neither agrees nor disagrees, or disagrees with each statements, or alternatively if the statement does not apply.

Section 5: Security and Trust5.01 -5.09

These questions involve reading the respondent a series of statements regarding security and trust in this health facility. The respondent should then decide if s/he agrees, neither agrees nor disagrees, or disagrees with each statements, or alternatively if the statement does not apply.

Section 6: Questions about the household6.01 Does your household own any land, including land where you have a house?6.02 If you were to sell the land you own, how much do you think you would receive for

it in (Currency)?6.03 For your home, what is the main material used for the following: Wall, Rooftop and

Floor? Do not read the options aloud, and record responses for reach the wall, rooftop, and floor separately.

6.04 How many rooms does your household have? (Including rooms outside the main dwelling, excluding kitchen and bathrooms) For the purpose of this question, a “room” is a space large enough for an adult to lie down in (even if they never would), enclosed by solid walls (not separated by curtains). This should not include a small latrine or water closet, but it should include a bathroom if it has a bathtub or shower and a toilet. Similarly, it should not include a small cooking area outside the dwelling, but it should include a kitchen located inside the house.

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6.05 How many people live in your household? Write down the total number of people in the household belonging to each of the categories specified. If none belong to a specific age category write “00”. Members of the household include all adults (both male and female) and children who usually live in the same household and eat food cooked from the same kitchen. It does not include visitors, or people who are from the household but spend most of the year living elsewhere.Household Assets

6.06 How many [Asset]s does your household own? For each category record the number items that the household owns. If the household does not at least one item in the category then record a “0.”

6.07 For each animal record the number of animals that the household owns. If the household does not own that animal then record a “0.”

Section 8: Traditional Birth Attendant.8.01 Do you know any traditional birth attendant (TBA) in your community? If the answer

is no then record “2” and please end the survey.8.02 Have you used Traditional Birth Attendant services in the last month, either in your

own home, in the community or in the health post? If the answer is no then record “08” and skip to Q8.04.

8.03 What services did the TBA provide you? Do not read the options aloud, and record each option mentioned by the respondent with a “1” and all others not mentioned with a “2.”

8.04 – 8.05

These questions involve reading statements regarding the work done by the Traditional Birth Attendant (TBA). Please allow the respondent to determine if they agree, neither agree nor disagree, or disagree with each statement.

Thank the respondents for their time.

5. Form F4: Exit Interview, Caregiver of Child under age 5

Part 1: Purpose

The purpose of this exit interview is to learn who the users of health services are, to appreciate their perspectives, and to measure what happened during their health care visit. The information you collect here will guide the Ministry of Health in designing training programs to strengthen health services for children. There will be some economics questions to help understand if levels of wealth influence utilization of health services.

Part 2: Who administers this questionnaire?

This section does not require someone with a clinical background. It is important that the person who does this section be thorough and does not leave out important parts. On the other hand, the person doing this part should be able to move quickly through the form, because for some patients, it may take some time to respond.

The person doing this form should be the enumerator.

Part 3: How long will this part of the survey take?

This part of the survey may take longer than the consultation itself, so there is a worry that several patients at a time may be waiting for their exit interview. It is important to be aware of this, and reassure those waiting that you will not take any more time than is necessary. Patients and caretakers should not become frustrated and leave before you have a chance to interview

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them. The field supervisor is also responsible for allocating enumerators in such a way that the wait is minimized. Each questionnaire should require about 20-30 minutes to complete.

Part 4: Review of the individual questions

Principal investigator: Some of the questions in the questionnaire include “Did someone in the facility do …”. If the exit interview must only regard the interaction between the main provider and the patient (not between any other preliminary examination provider and the patient), make sure no “someone in the facility” appears in the exit interview forms, and adjust question-specific instructions in for form F4.

Cover Page: Identification and location of the facility and consent Patient unique identifier code (ID): Record the Health District, Health Facility and Patient unique ID codes in the top right hand corner. The field supervisor with have the district and facility unique ID codes. S/he will also provide each enumerator with the starting number to use for their first exit interview. The enumerator will add one unit to this ID number for each subsequent interview (see preliminary instructions on exit interviews for more details). Write in ARABIC numerals.Location. Record the (A) Province, (B) District, and (C) Village/town/locality where the facility is located.GPS reading of the facility. Record the latitudinal and longitudinal readings in the spaces provided.Facility name and location. Write the (A) name of the facility and (B) Summarized location i.e. address or any information that allows locating the facility.Enumerator name, code and date. Write down your (A) unique enumerator ID code (in ARABIC numerals) the (B) date of the visits, and date of any subsequent visit(s) if applicable (DD – MM – YYYY format).Interview. Write down (A) Result of the interview, whether it was complete, (B) the language of the enumerator and the respondent (in distinct cells) and (C) whether a translator was used.

Note: The field supervisor and field editor will also have to enter their respective unique ID code and date of review.Consent. It is important to obtain the consent from both the health worker and the caretaker of the patient. Please read out the consent statement verbatim. For each of the health worker and caretaker, if the respondent does not agree to participate, do not fill out a consent form. However, you must record that the respondent refused to participate in the questionnaire in the “Result of the interview” cell. If the health worker and/or the patient refuse to participate and they say ‘NO’, wait for the next sampled patient/caretaker.Proceed ahead only if both respondents agree to participate by saying ‘YES”. In this case, fill out the two consent forms and the questionnaire. If the respondents both agree to participate, they must sign or mark their consent form. You must also sign the two consent forms.Section 1: Identification

The first five questions should be asked to the Health Worker1.01 Enter the Health Worker ID code from the facility staff roster in form F1. This should

be for the health worker who saw the client.1.02 Name of Health Worker1.03 Sex of the Health Worker1.04 What is your status as a health worker as designated by the Ministry of Health?

Please list the status or position type of the health worker as designated by the Ministry of Health.

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1.05 What is the type of facility? Use the official MOPH classification for the facility. If the in-charge tells you a different facility type than the official MOPH classification, circle the code corresponding to the official MOPH classification and write a note in the space provided at the end of the questionnaire explaining that the in-charge reported a different facility type. All of the following should be asked to the caregiver of the patient.

1.06 Is it the first time the child is brought to this facility for this disease of this purpose of the visit?

1.07 What is the child’s sex? Record whether the child is a male or female. It is important that you record the sex of the child, not of the caretaker.

1.08 What is the age of the child? Record both the age in years and in months. If the child is 5 year or older then stop the observation and move to the next sampled child.

1.09 How are you related to the child?1.10 Can you read and write? This should be addressed to the caregiver regarding whether

the caregiver can read and write.1.11 What is the highest level and grade of education that you completed? Similarly this

should be addressed to the caregiver regarding the highest level of education that the caregiver achieved. Please refer to general instructions on completing the questionnaire for further instructions.

1.12 What is your marital status? If the caregiver is single, widowed, or divorced/separated then skip to the next section Q2.01.

1.13 What is the highest level and grade of education that your spouse / partner completed? Please refer to general instructions on completing the questionnaire for further instructions.

Section 2: Treatment and counselingThis section should be introduced by stating “Now I would like to ask you some questions about this visit to the health center.”2.01 What is the purpose of the child’s visit to the health center today? Record a “1” if

the purpose applies and a “2” if not. Well baby check-up indicates a routine visit to check on the child’s health when the child is not sick. It includes preventive care, with the exception of vaccination/immunization and child growth monitoring.

2.02 How long ago in days did this illness start?2.03 What was the reason for bringing the child to the health facility today? Do not read

the options aloud; instead record a “1” by each option if it is mentioned and a “2 if it is not mentioned. It is not limited to on only one option.

2.04 Did you come to this facility on your own, or based on a referral from another facility, or based on a referral from a community health worker?

2.05 Did someone in the health facility ask the age of the child?

2.06 Did someone in the facility weigh the child? In many facilities some of the physical examinations (e.g. measurements of weight, temperature, blood pressure) are done by a different provider at a different location than by the consulting provider.

2.07 Did someone in the facility measure the height of the child? Does the health worker measure the child’s height? Either standing up or lying down on a height board, if too young to stand upright.

2.08 Did someone in the facility plot the child’s height over weight? In addition to being recorded individually, the height and weight of the child should be plotted on the same sheet of paper.

2.09 Did the health worker physically examine the child?2.10 At this visit, did the health worker also tell you that there was something wrong

with the child? If no then record “2” and skip to Q2.24.2.11 What did the health worker say was wrong with the child? Do not read the options

aloud, but instead record all options mentioned with a “1” and all others not mentioned with a “2”

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2.12 Did the health worker tell you things to do at home to help treat the child’s illness? If the answer is no then record “2” and skip to Q2.14.

2.13 What did the health worker tell you to do? Do not read the options aloud, but instead record all options mentioned with a “1” and all others not mentioned with a “2”

2.14 Did the health worker tell you to bring the child back if the child’s condition becomes worse? If the answer is no then record “2” and skip to Q2.16.

2.15 From the advice given to you by the health worker, how will you know if the child’s condition become worse and should be brought back? Do not read the options aloud, but instead record all options mentioned with a “1” and all others not mentioned with a “2”

2.16 Did the child receive any medicine or prescriptions today from the facility? If the child received neither medicine nor a prescription at the health facility then record “03” and skip to Q2.23 If the child received medicine at the facility and a prescription to fill outside the facility, record “01”.

2.17 In total, how many medications were given or prescribed to the child?2.18 What medicines were given at the facility? Answer this question if the child received

medications at the facility and Q2.16 was recorded as “01.” Ask to check the medicines given to the child for confirmation.

2.19 What medicines were prescribed? Answer this question if the child received prescription to fill outside the health facility and Q2.16 was recorded as “02.” Ask to check the prescriptions given to the child for confirmation.

2.20 How long does it take you to travel from this health facility to the locations (pharmacy) where you get the prescribed medicine using your usual mode of transportation? Make sure to ask for the time in minutes for a one way trip.

2.21 Did the health worker thoroughly explain how to take the medicines? This includes how often, when during the day, for how long, and what to do with any medicines remaining at the end of the prescribed treatment course. If any of these were told, circle “YES.”

2.22 Did the health worker (s) tell you about possible adverse reactions (side effects) that the given/prescribed medicine might have?

2.23 Did the health worker give you a specific date to bring the child back to the health facility for a follow-up visit?

2.24 Is the child immunization card available? If no then record “2” and skip to Q2.26.2.25 For this question look at the status of immunizations on the immunization card.

Record a “01” for each vaccine that the child received and “02” for each vaccine that the child did not receive.

2.26 Did you child receive an immunization today?2.27 Following the last immunization the child received (whether today or in the past),

does the child need to receive more immunization(s)? Determine if the last immunization received by the child was the last immunization needed according to the immunization schedule of if the child will still need to receive more immunizations. If the child still needs to receive more immunizations then record “1” and skip to Q2.29.

2.28 What is the date of return for the child’s next immunization? Record the day, the month, and the year the child needs to return for his/her next immunization.

2.29 Did the health worker ask you to bring back the child to receive immunization another day? If no then record “2” and skip to the next section Q3.01.

2.30 When did the health worker ask you to bring the child back? Record the month and the year.

Section 3: Patient Travel and Expenditure Please see the notes for the similar section in F3. While questions are asked in the same way, this survey may ask about different tests or the wording may not be identical.

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Section 4: Patient SatisfactionPlease see the notes for the similar section in F3. While questions are asked in the same way, the wording may not be identical. Section 5: Security and TrustPlease see the notes for the similar section in F3. While questions are asked in the same way, the wording may not be identical. Section 6 and 7: Questions about the household and Household AssetsPlease see the notes for the similar section in F3. While questions are asked in the same way, the wording may not be identical. Please not that Section 7 in this survey is included in Section 6 in F3, along with questions about the household.Section 8: Community Health Worker8.01 Do you know of any community health workers (CHW) in your community? If the

answer is no then record “2” and end the survey.8.02 Do you have both male and female Community Health Worker in your community?8.03 Have you used Community Health Worker services in the last month, either in your

own home, in the community or in the health post? If the answer is no then record “08” and skip to Q8.05.

8.04 What services did the Community Health Worker provide you? Do not read the options aloud, but instead record all options mentioned with a “1” and all others not mentioned with a “2.”

8.05 - 8.06

These two questions involved reading the respondent two statements relating to work done by the Community Health Workers. The respondent should indicated if they agree, neither agree nor disagree, or disagree with the statement.

Thank the respondents for their time.

6. Form F5: Community Health Worker Interview

Part 1: Purpose

The purpose of the Community Health Worker Interview is to determine how well Community Health Workers (CHWs) are trained to provide Primary Health Care. The CHW interviews look at the knowledge, aptitude, and performance (KAP) of CHWs as well as their incentives to provide care, how well their co-workers perform –such as supervisors—and any barriers that CHWs may encounter that inhibit their ability to provide quality care. Lastly, it looks at their overall satisfaction with their job, the facility where they work, and their own capability, as well as that of their facility, to provide adequate care for the types of illnesses most commonly seen in the community. This information will help the Ministry of Health determine if CHWs are receiving adequate training or inputs to be able to provide quality services to the people. Ultimately, this information will be used for the proper allotment of time and monetary investment of future training and inputs to ensure the people receive the best health care possible. For this reason, as with all the forms, it is of up-most importance to fill out the form carefully, and to the best of your ability.

Part 2: How the Community Health Worker Interview is to be done

How to select Community Health Workers?

Two community health workers should be interviewed per health facility. If there is only 1 CHW in the health post, interview just him/her. If there are 2 then interview them both. If there are more than 2 then try to interview 1 male and 1 female. At least one of the health workers must be a female, if present.

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For this section of the survey you might encounter two scenarios. Please conduct the survey according to the scenario that you encounter.

Scenario 1: It is possible that CHWs can be contacted in advance so that they have sufficient notice to come to the health facility on the appointed day. The field manager with help from the Provincial Health Directors will make the first attempt to find out how many CHWs work in the catchment area of each facility and to select two to participate in the survey according to protocol. The field manager will, with the help of facility staff, get in touch with CHWs to notify them of the appointed day and time for coming to the facility. If, however, the field manager and health facility staff are unable to find out how many CHWs work in the catchment area or unable to contact them ahead of time, responsibility falls to the field supervisor. In such case, the field supervisor will have to make sure that CHWs are notified of the appointed date. In some cases, the field supervisor will have to notify the facility upon arriving that the survey team would like to interview CHWs in the afternoon. In this case, facility staff will contact the CHWs and request that they come to the facility in the afternoon. In rare cases where this is not possible, the enumerators may only be able to interview one CHW for that facility, or in very rare instances the enumerators may be unable to interview any CHWs for that facility.

Scenario 2: If the CHW cannot be contacted in advance or they cannot make it to the facility to be interviewed, an enumerator will travel to the health post where the CHWs provide their services. This enumerator will carry the necessary documentation to conduct the interview the CHWs and join the team at the end of the day. If possible, the CHW can be contacted via phone from the facility which they work under.

Allocating unique identification numbers (IDs) to Community Health Workers

Since only one enumerator will be in charge of administering CHW interviews, the enumerator may start using the ID number 01 for the first CHW and number 02 for the second CHW. Obtaining consent to be interviewed

The interview starts with the consent form. As this interview contains personal information and questions which may be of a sensitive nature, it is important that the CHW give permission to be interviewed by agreeing to conditions set out in the consent form. They must know that if they refuse to be interviewed, this will not affect their standing in the health facility. If they agree to be interviewed, they are allowed to break off the interview at any time, or decline to answer certain questions if they choose. The CHW has to sign or mark the form. It is necessary that you sign that the person has given permission for the interview. Your name and the date must be recorded on the form.

Part 3: Who administers the questionnaire

This section does not require someone with a clinical background and should be completed by a survey team member that is not staying in the clinic and that is able to visit the health posts. It is important that the person who does this section be thorough and not leave out important parts. On the other hand, the person doing this part should be able to move quickly through the form.

This part of the form should be completed by an enumerator.

Part 4: How long will this part of the survey take

This part of the survey may take 30 minutes to an hour.

Part 5: Review of individual questions

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Cover Page: Identification and location of the facility and consent Community Health Worker unique identifier code (ID): Record the Health District, Health Facility and Community Health Worker unique ID codes in the top right hand corner. The field supervisor with have the district and facility unique ID codes. The unique health worker ID will be taken from the facility assessment form F1, section 4 that was completed by the field supervisor. Write in ARABIC numerals.Location. Record the (A) Province, (B) District, and (C) Village/town/locality where the facility is located.GPS reading of the facility. Record the latitudinal and longitudinal readings in the spaces provided.Facility name and location. Write the (A) name of the facility and (B) Summarized location i.e. address or any information that allows locating the facility.Enumerator name, code and date. Write down your (A) unique enumerator ID code (in ARABIC numerals) the (B) date of the visits, and date of any subsequent visit(s) if applicable (DD – MM – YYYY format).Interview. Write down (A) Result of the interview, whether it was complete, (B) the language of the enumerator and the respondent (in distinct cells) and (C) whether a translator was used.

Note: The field supervisor and field editor will also have to enter their respective unique ID code and date of review.Consent. It is important to obtain the consent from the community health worker. Please read out the consent statement verbatim. If the respondent does not agree to participate, do not fill out a consent form. However, you must record that the respondent refused to participate in the questionnaire in the “Result of the interview” cell. Proceed ahead only if the respondent agrees to participate by saying ‘YES”. In this case, fill out both the consent form and the questionnaire. If the respondent agrees to participate, s/he must sign or mark the consent form. You must also sign the consent form.Facility name and ID code. Write (A) the name of the facility and (B) enter the identification code for this facility. The facility in-charge will have the facility ID code. Write it in ARABIC numerals.Location. Write down the (A) Province, (B) District and (C) Village/ Town in which the facility is located.Enumerator code and date. Write down your (A) enumerator code (in ARABIC numerals) and the (B) date. The time when the interview starts and ends should also be mentioned on the cover page.Consent obtained? Read the consent statement verbatim to the respondent and confirm that the community health worker give consent to be interviewed. If the community health worker gives consent, mark “YES”. If not, mark “NO” and conclude the interview.Interview with Community Health WorkerSection 1. General InformationThis section includes questions on demographic and educational background of the CHW and the distance and travel time associated with service provision by the CHW.1.01 What is your specialization?1.02 Please record whether the community health worker is a male or a female.1.03 How old are you?1.04 Are you from this village? If no then record “2” and skip to Q1.06.1.05 How long have you lived in this village in years? Record the number of years that the

respondent lived in the village. If the respondent lived in the village for less than a year record “0”

1.06 What is your marital status?1.07 Who recruited you?1.08 What was the eligibility criteria for becoming a member of the CHW cooperative?

Read all the options aloud.62

1.09 What was the membership fee for the CHW cooperative in (Currency)? 1.10 What is the highest level of education you ever obtained? If none then record “09”

and skip to Q1.12.1.11 What grade did you complete in this level? Please refer to general instructions on

completing the questionnaire for further instructions.1.12 Have you ever attended a literacy course?1.13 Can you read and write? 1.14 How long have you worked as a Community Health Worker? Record both the

number of years and months. For instance if someone worked for 5 years and 3 months then record a “5” for years and “3” for months.

1.15 How often do you work as a Community Health Worker?1.16 What is the distance between the health facility and your village, one way in

kilometers?1.17 How much time does it usually take you to travel to the health facility, on foot one

way in minutes?1.18 What is the number of household that you are currently responsible for?1.19 How many households did you visit in the past month?1.20 What is the distance between your house and the farthest house in the village, one

way in kilometers? If the value is less than one kilometer then record “0.”1.21 How much time does it usually take you to travel to the farthest house on foot one

way in minutes?1.22 What is the distance between your house and the closest house in the village, one

way in kilometers? If the value is less than one kilometer then record “0.”1.23 How much time does it usually take you to travel to the closest house, on foot one

way in minutes?1.24 Do you work independently or in a team? If the CHW works independently then

record “01” and skip to Q1.26.1.25 How many Community Health Workers are on your team, you expected?1.26 Are there any Traditional Birth Attendants (TBA) in your village? If there are no TBAs

then record “2” and skip to Q1.28.1.27 Do you collaborate with Traditional Birth Attendants (TBA) in the area?1.28 Do you have access to any kind of transportation (e.g. to pick up patients in the

sector for transport to health facility)? If no then record “2” and skip to Q2.01.1.29 For Community Health related purposes, do you use public transportation?1.30 For Community Health related purposes, how many working [VEHICLES] do you have

access to? Read all the options aloud.1.31 In the last 7 days, how many hours was any transportation not available?Section 2: Training and ServicesThis section includes questions on the training that the CHW has received and the services that s/he has provided to the community in the past 3 months.2.01 Have you ever received training in the following, i.e. a training course lasting a full

day or more? Reach each option aloud and then allow the CHW to respond whether or not s/he has received a training course in that field.

2.02 Who provided you with your training? Only ask this question if the CHW reported being training in at least one subject. Read the options aloud.

2.03 In the last 12 months, have you received any training, i.e. a training course lasting a full day or more? If no then record “2” and skip to Q2.06.

2.04 What are some of the topics that were covered in this/these training/s? Read all the options aloud.

2.05 Who provided you with your training? Only ask this question if the CHW reported being training in at least one subject. Read the options aloud.

2.06 Which of the following services have you provided within the past 3 months? Read all the options aloud.

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Section 3: Community Health Worker PaymentsThis section includes questions on monetary and non-monetary payments that the CHW might be receiving. Also includes questions on fees that the CHW might be charging for service delivery in the community. All the monetary amounts should be written in local currency.3.01 Do you receive monetary payment for your work as a Community Health Worker

from the Community Health Worker cooperative or a health facility? If no then record “2” and skip to Q3.04.

3.02 In the last 3 months, how much did you receive for your work as a Community Health Worker in (Currency)?

3.03 How much in (Currency) of the monetary payment was provided by the following sources in the last 3 months? Read all the options aloud.

3.04 Do you receive any in-kin payment for you work as a Community Health Worker from the Community Health Worker cooperative or a health facility? If no then record “2” and skip to Q3.07

3.05 In the last 3 months, what type of in-kind payments did you receive? Read all the options aloud.

3.06 If you evaluate the amount of in-kind payments in (Currency), how much of the in-kin payment was provided by the following sources in the last 3 months? Read all options aloud.

3.07 Patients sometimes contribute to a Community Health Workers’ income in the form of a per-consultation payment. Do you collect a patient fee? If no then record “2” and skip to Q3.10.

3.08 What is the patient fee for a preventative care visit for child growth monitoring in (Currency)? Read the options aloud, and if there is no fee record a “0.”

3.09 What is the patient fee for a curative care visit for malaria in (Currency)?3.10 Do you receive any in-kind payment (other than money) from patients? If no then

record “2” and skip to Q3.12.3.11 What type of payment did you receive in the last 3 months? Read all options aloud3.12 Does your cooperative invest in income-generating activities? If no then record “2”

and skip to Q4.01.3.13 What percentage of profit from income-generating activities do you receive? Record

the percentage as a number from 0-100 without a “%.”3.14 Does this percentage vary based on your performance as a Community Health

Worker?3.15 How much did you receive in the last 3 months from this payment in (Currency)?Section 4: SupervisionCHW service delivery is overseen by a supervisor who makes regular visits and provides recommendations to the CHW. The questions in this section cover the supervision that the CHW receives.4.01 Do you have a supervisor? If no then record “2” and skip to Q5.01.4.02 Where is your supervisor based? Read all the options aloud.4.03 In the past 12 months, how many times has (have) your supervisor(s) come to

discuss/ supervise your work?4.04 When was the last time you met with your supervisor(s)?4.05 On his/her last visit, did the supervisor write his/her recommendations in a

supervision book that you keep? If the CHW responds yes then ask to see the book.4.06 What did the supervisor do when you met? Do not read the options aloud. Record

the responses with a “1” if mentioned and if not mentioned record a “2.”Section 5: Steering Committee5.01 Does your area receive support or guidance from a Steering Committee? If no then

record “2” and skip to Q6.01.5.02 Is there representation of any of the following on this Steering Committee? Read all

the options aloud.

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5.03 When is the last time the Steering Committee met?5.04 In the last 12 months, did you receive any support from the Steering Committee? If

no then record “2” and skip to Q6.01.5.05 What types of support did you receive? Read all the options aloud.Section 6: Community Health Worker ResourcesA CHW need material and moral support and recognition to perform his/ her duties properly. This section includes questions on the support that the CHW receives from the health facility, government, NGO and the community.6.01-6.05

These questions all follow the same format, and are used to determine what types of support were received by the various organizations. “ In the last 12 months, has a (Organization) supported you with any of the following?” Read all options aloud.

6.06 Did you ever receive a Community Health Worker kit with essential supplies and drugs? If no then record “2” and skip to Q6.09.

6.07 Do you share this kit with other Community Health Workers? If no then record “2” and skip to Q6.09.

6.08 How many other Community Health Workers do you share the kit with?6.09 Which of the following do you currently have in supply in the Community Health

Worker kit? Read all the options aloud. Determine if the CHW has the supply in complete stock, incomplete stock, usually has but not in stock, and not usually in stock.

6.10 What are the biggest difficulties that you face in doing your job? Do not read the options aloud, and only record with a “1” if mentioned. For all other options not mentioned record “2.”

Section 7: Community Health Worker Satisfaction7.01 – 7.24

These questions are used to determine the satisfaction of CHWs with their current role. All answers are confidential and will not have any impact on the CHW. Each question involves reading a statement, and then having the CHW determine if they are satisfied, neither satisfied nor dissatisfied, or unsatisfied with the statement.

Section 8: Community Health Worker Motivation8.01 – 8.10

These questions are used to determine the motivation of CHWs. All answers are confidential and will not have any impact on the CHW. Each question involves reading a statement, and then having the CHW determine if they are agree, neither agree nor disagree, or disagree with the statement.

Thank the community health worker for taking time to complete the interview.

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