Standard Treatment Guidelines(STG) by Institute of Health & Family Welfare, Kolkata

Presentation on Facility Assessment

The STG was piloted from July to December 2009 in the districts of North & South 24 pgs. 64 facilities in North & 77 facilities in South 24 pgs were taken up in the pilot. Weekly pre-planned visits were carried out by faculty members of Kolkata based medical colleges and district and sub-division level officers from the districts. The outcome is considered to be encouraging and the Department has decided for state wide scale up.

Post pilot evaluation is under process.

District	PHC	BPHC	RH	TOTAL
N.24 PGS	42	15	7	64
S.24 PGS	52	16	9	77

Monitoring process

The visits were pre announced. Effort was be made to visit each facility at lease once in two months.
On reaching the facility the assessor/ the team leader met the in-charge and requested for necessary assistance.
A checklist with facilities for scoring and grading was used for the assessment.
On completion of the assessment i.e. filling up of the forms from A to E the assessor fills up Form F that helped him to compare the result of the present visit with previous visit. Not applicable for the first visit. He fills up the Form G (Action plan prepared at facility level at the end of the facility visit in consultation with the facility head and his colleagues).
This report is jointly signed by the assessor/leader of the team and the facility in-charge. The facility head initiates corrective activities at the facility level.
The assessor/team leader hands over copies of the filled up Forms A to G to the District Nodal Officer (DNO). The DNO prepares a consolidated report of all the Forms Gs in Form H i.e. actions to be taken at facility level (Consolidated). This report is shared with all the facility heads during the MIES meeting for review/discussion.
All data in forms A to G, generated during the facility visits, is entered at the district level and transmitted electronically to the state level to the SNO. This process has been introduced during the pilot and will continue.
The district nodal officer prepares a District Action Plan in Form I from the facility level action plans and takes remedial measures as required. The DNO shares copies of the facility and district action plans with the SNO
The state nodal officer prepares in Form J a consolidated State Action Plan from the reports he receives from the district. and takes remedial actions as per need.

Guidelines on filling up of the forms

There are 10 forms from A to J that are used for the facility assessment and follow up actions at the facility, district and state level as follows:
Form A: Providers’ Availability and practices
Form B: Infrastructure
From C: Infection Prevention Practices
Form D: Equipment drugs and other supplies
Form E: Output indicators for service quality assessment
Form F: Assessment results of three consecutive visits
Form G. Action plan prepared at facility level at the end of the facility visit
Form H: Actions to be taken at facility level (Consolidated) prepared by DNO.
Form I: Actions to be taken at district level (DNO)
Form: J: Actions to be taken at state level (Prepared by SNO

Check List with example

Facility details

This form is used for facility identification and other related information. Click to view.

Form A : Provider’s Availability & Practices

The purpose of questions in this section is to assess the availability of Medical, nursing, paramedical and support staff for providing different types of services and to assess their training needs. On the day of visit ask the MO In-charge or other staff, as identified by him/her, to answer the questions. Click to view details .

Form B : Infrastructure

Checklists are prepared on the following issues.

Cleanliness of facility
Facilities and privacy for clients
Services and facilities
Information and communication services

The purpose of these questions in this section is to observe cleanliness & maintenance of the facility, proper segregation of waste and others service provide to the clients/patients. Click to view details .

Form C : Infection Prevention Practices

The purpose of these questions in this section is to access the infection prevention measures being participated in the facility. This is not only important for the clients/patients but equally important for providers. Click to view details.

Form D : Equipment, Drugs & Other supplies

The purpose in this section is to assess the availability of equipment and other supplies, the working status of the equipment and adequacy of the available medicines. Click to view details.

Form E : Output Indicators for service quality assessment

This section deals with review records & calculate the data as required in the questions. Also write the total number of the information data required for the corresponding period in the last year. Compare the current data with that of the last year for the corresponding months by subtracting last year’s data from the current data. Also calculate the change of percentages. Click to view details.

Form F : Assessment Results of three consecutive visits

This form is use to put marks of different component (form A to form E) and calculate the total marks and percentage. Based on that percentage put the “Grade” (“A”, “B”,”C” & “D”) of any particular facility. Click to view details.

Form G : Action plan prepared at facility level at the end of the facility visit

The purpose of this form is to identify the problems/gaps of different components (form A to E), solutions and suggest interventions level wise i.e. at the facility, district or state. Click to view details.

Form H : Actions to be taken at facility level (consolidated) prepared by DNO
(Monthly summary report)

This report is to be consolidated from Facility visit reports (Form-G) at District level by the DNO. It refers to the actions to be taken up at the facility level. The report is to be shared with the facility heads and to be discussed during the monthly MIES meetings. Click to view details.

Form I : Actions to be taken at district level (consolidated) prepared by DNO
(Monthly summary report)

This report to be prepared from the facility visit reports (Form-G) taking into consideration the follow up actions to be taken up at the District level. It will be prepared by the DNO. Click to view details.

Form J : Actions to be taken at state level prepared by SNO (Monthly summary report)

This report is to be prepared from the facility visit reports (Form-G) by the SNO. He/She will enlist the follow up actions to be taken up at the State level. Click to view details.

Exit Interview

This is a questionnaire applied by the monitoring officer/assessor to ten OPD and five indoor (where applicable) clients. The assessor fills up the form basing on the response offered by the clients. Filled up exit interview forms are handed over to the DNO for data entry, compilation and interpretation. Click to view details.

Click to view Calculation based on the repots of the facility visits (Example form wise).

Few example of achievement during STG (July 2009-December 2009).

Click to view details.