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USAID / BASICS
Rapid Integrated Health Facility Assessment
3. HEALTH CARE WORKER INTERVIEW
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{PRONUM} Province Number/Name ## (F9) {PRONAME} _____________________________
{HWCAT} HW category # (1=Physician, 2=Nurse, 3=Midwife, 4=Health assistant)
{FACNUM} Facility Number/Name ## (F9) {FACNAME} ____________________________
{FACTYPE} Facility type # (1=Hospital, 2=Health Center, 3=Health Station)
{FACSTAT} Facility status # (1=Public, 2=Private)
{INUM} Interviewer no. ##
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1. Where does the health facility usually get
{SUPPLY} medications and supplies? ........................... #
(1=Government supplier, 2=NGO/ Mission,
3=Community pharmacy, 4=Private pharmacy supplier,
5=Other)
{SPEC1} Specify ____________________
{SUPRCV} 2. How are supplies usually received? .................. #
(1=Delivered to facility,
2=Picked up from the supplier,
3=Both)
3. What is the most common cause of a delay in delivery
{DELAY} of supplies? ........................................ #
(1=Inadequate transport, 2=Insufficient staff,
3=Administrative difficulties, 4=Rupture of stock at
the central store, 5=Financial problems, 6=Insufficient fuel,
7=Other)
{SPEC3} Specify ____________________
{SUPER} 4. Do you have a regular supervisor? ............ # (1=YES, 2=NO)
If NO, go to question 9
{SSUPVIS} 5. Do you have a schedule for supervisory visits? # (1=YES, 2=NO)
6. How many times have you had a visit from a supervisor:
{VISIT6} In the last six months .................... ## (number of times)
{VISIT12} In the last 12 months ..................... ## (number of times)
{SUPWH} Supervisor works here and sees worker daily ...... # (1 if ticked)
7. What did your supervisor do last time he/she supervised you?
(Code 1 all ticked responses)
{DELSUP} Delivered supplies (fuel, medicines, etc.) ........ #
{OBSIM} Observed immunization technique ................... #
{OBSMSC} Observed management of sick children .............. #
{REVREP} Reviewed reports prepared by health worker ........ #
{UPHWINF} Updated health worker on current information ...... #
{DISCPB} Discussed problems with supplies and equipment .... #
{OTHER7} Other ............................................. #
{SPEC7} Specify ____________________
8.a Did you receive feedback from that supervisory
{FBSUP} session? ................................... # (1=YES, 2=NO)
{FBFORM} .b IF YES, in what form? .......................#
(1=Supervisory register, 2=Written report, 3=Oral report,
4=Written + Oral reports, 5=Other)
{SPEC8} Specify ____________________
9. What are the most difficult problems that you face
in doing your job? (Code 1 all ticked responses)
{LTRAIN} Lack of training ....................... #
{LFB} Lack of feedback on performance ........ #
{MDBC} Caretakers don't bring children ........ #
{INTRP} Inadequate transport ................... #
{LTIME} Lack of time ........................... #
{LMOT} Lack of motivation ..................... #
{STSH} Staff shortages ........................ #
{PWE} Poor working environment ............... #
{LSTOCK} Lack of supplies and/or stock .......... #
{LSUP} Lack of supervision .................... #
{OTHER9} Other .................................. #
{SPEC9} Specify ____________________
10. Have you discussed these problems with
{DISPB} your supervisor? ........................ # (1=YES,2=NO, 9=N/A)
11. How many training sessions child health related
{NBTRA} have you received in the last 12 months? #
If NO training received, go to Question 14
12. What type of training was it?
{TYPETRA1} ________________ {TYPETRA2} _________________
{PRACT} 13. Did your last training involve clinical practice? # (1=YES,2=NO)
14. In this clinic, at what ages do you give:
(age in WEEKS but in MONTHS for Measles only)
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DPT1 ## DPT2 ## DPT3 ##
Polio0 ## Polio1 ## Polio2 ## Polio3 ##
BCG ##
Measles ##
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{KEYEPI} A. EPI vaccination schedule all correct? .... # (1=YES, 2=NO)
{WHOTT} 15. To whom do you give tetanus toxoid? ...... #
(1=Women of childbearing age (15-49),
2=Pregnant women, 3=Both 9=Don't know)
16. On what occasion would you give tetanus toxoid?
(Code 1 all ticked responses)
{ANTCV} Antenatal clinic visit .......................... #
{VCS} Visit for curative services of mother ........... #
{VCIT} Visit with child for immunization or treatment .. #
17. On what days are immunizations given?
{NBDVAC} Number of immunization days/week ......... # (Number of days)
18.a Does the health facility have an
{ANTENAT} antenatal clinic? ........................ # (1=YES, 2=NO)
.b If YES, on what days is the clinic held?
{NBDANC} Number of clinic days/week ............... # (Number of days)
.c If NO, why are antenatal clinics not held?
(Code 1 all ticked responses)
{DK18} Doesn't know ...... # {NOTRAING} No training ....... #
{NOSTAFF} No staff .......... # {NOSPACE} No space available #
{NOSUPP} No supplies ....... # {OTHER18} Other ............. #
{SPEC18} Specify ____________________
19. What are the signs that would make you refer
a child to the next level of health facility?
(Code 1 all ticked responses)
{LETH} Child is lethargic/abnormally sleepy/unconscious #
{NRESP} Child has not responded to usual treatment ...... #
{UNWELL} Child looks very unwell ......................... #
{NED} Child is not eating or drinking ................. #
{HFEV} Child has a very high fever ..................... #
{DEHYD} Child has severe dehydration .................... #
{VOMIT} Child vomits everything ......................... #
{MALNUT} Child has severe malnutrition/anemia ............ #
{PNEUM} Child has severe pneumonia ...................... #
{CONV} Child has had convulsions ....................... #
{OTHER19} Other ........................................... #
{SPEC19} Specify _______________
{KEYREF} B. Health worker knows at least 3 signs for referral? # (1=YES, 2=NO)
20.a Have you ever wanted to refer a child to the
next level of health faciliyi but have not
{WREF} been able to do so? ...................... # (1=YES, 2=NO)
If NO, go to question 21
.b If YES, why could you not refer the child?
(Code 1 all ticked responses)
{HFAR} Next level HF too far # {REFUS} Mother refuse to go #
{NTRAV} No transport available # {NOFUEL} No fuel available #
{MONEY} Parents didn't have # {OTHER20} Other ............. #
enough money {SPEC20} Specify ___________________
21. What do you see as your role in communicating with
caretakers when they bring their child to the health facility?
(Code 1 all ticked responses)
{INFDS} Giving information on danger signs to watch for ..... #
{INFHOM} Giving information on what to do at home ............ #
{INFMED} Giving information on how to give medicine at home .. #
Finding out what caretakers have done at home
{FSYMP} and what are the symptoms of the child's illness .... #
{INFPREV} Giving information on how to prevent illness ........ #
{INFCB} Telling caretakers when to come back to the H.F. .... #
{UNSTD} Ensuring that mothers understand what to do at home #
{GGTLK} Giving group talks .................................. #
{OTHER21} Other ............................................... #
{SPEC21} Specify _______________________
22. What prevents you from communicating with caretakers
when they bring their child to the health facility?
(Code 1 all ticked responses)
{DKHOW} I don't know how .......................... #
{NOROLE} It isn't really my role ................... #
{SOMELSE} Someone else does it ...................... #
{NOTIME} No time ................................... #
{NOLIST} They do not listen ........................ #
{NOUND} They don't understand what we say ......... #
{LANG} Language barriers prevent effective comm. #
{NOMAT} I don't have any education materials ...... #
{NOIMP} It is not important ....................... #
{OTHER22} Other ..................................... #
{SPEC22} Specify ________________________
END OF THE HEALTH WORKER INTERVIEW
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