MONITORING CHECKLIST

Date: 06.11.2018 District: Pakpattan Tehsil: Pakpattan

CEO: Dr. Rana Imtiaz Ahmed DHO: Dr. Riaz Ahmad MS/In Charge: Dr. Amman Ullah
Contact: 0300-9682994 Contact: 0300-6940865 Contact: 0300-9409245
Health Facility: DHQ Hospital Pakpattan Level: DHIS Code: 164035

SCREENING DESK (SD)

Status
Sr # List Comments
(Yes/No)
Operations:
Screening Desk Establishment Status
Is there a well-defined Central Registration Point (CRP) in the health Yes
1
facility?
2 Is Screening Desk (SD) established? Yes
3 Is SD operational? Yes
4 Is SD located within immediate vicinity of CRP? Yes
5 Is waiting area available near Screening Desk? Yes
Is SD area branded as per the set guidelines? (3 colored stripes, Yes
6
posters and backdrop)
Logistics Availability Status
Furniture, IT Equipment
Are tables present as per SOP requirement? (2 for DHQH and 2 For 4
7
THQH) Please mention the quantity.
Are Staff chairs present as per SOP requirement? (4 for DHQH and 3 4
8
For THQH) Please mention the quantity.
Are patient examination stool present as per SOP requirement? (4 for 4
9
DHQH and 3 For THQH) Please mention the quantity.
Are visitor’s chairs present as per SOP requirement? (4 for DHQH and 3 4
10
For THQH) Please mention the quantity.
Is the available furniture provided by NCDs Program? (if yes, check for Yes
11
receiving)
12 Has LED been displayed at SD? Yes
13 Are NCDs Health Messages being displayed on LED Yes
Screening Equipment and Supplies
Are Stethoscopes present as per SOP requirement? (4 for DHQH and 3 4
14
For THQH) Please mention the quantity.
Are BP apparatus (Mercury) present as per SOP requirement? (4 for 4
15
DHQH and 3 For THQH) Please mention the quantity.
 Are Adult Weighing Scale present as per SOP requirement? (4 for 2
16
DHQH and 3 For THQH) Please mention the quantity.
Are Measuring tapes present as per SOP requirement? (4 for DHQH 2
17
and 3 For THQH) Please mention the quantity.
Are Glucometers present as per SOP requirement? (4 for DHQH and 3 4
18
For THQH) Please mention the quantity.
Are Peak Flow Meters present as per SOP requirement? (4 for DHQH 4
19
and 3 For THQH) Please mention the quantity.
Are BSR (Blood Sugar) Strips present as per SOP requirement? Please 500 / Month
20
mention the quantity.
Are Mouth pieces present as per SOP requirement? Please mention 100
21
the quantity.
Data Entry
22 Are android tablets available at the Screening Desk? Yes
Are Android Tablets present as per SOP requirement? (4 for DHQH and Yes
23
3 For THQH) Please mention the quantity.
24 Are these android tablets provided by NCDs Program Yes
25 Upgraded ISA app installed on tablet? Yes
Is the internet connection connectivity functional at the Screening Yes
26
Desk?
Manuals and IEC Material
27 Is the IEC material available (Brochures)? Yes
28 Are standard guidelines for integrated management of NCDs available? Yes
Infection Control
Are Infection control equipment and supplies available at the Yes
29
Screening Desk?
HR:
Has the relevant HR been notified at SD? (4 paramedics for DHQH and 3 Yes
30
paramedics for THQH)
31 Are notified HR available at the time of the visit? Yes
Are there required number of paramedics as per SOP at SD? (Please Yes 2 Charge Nurse
32
mention the number of Paramedic staff available at SD)
33 Has the relevant HR been trained on screening methods and guidelines? Yes
Has the OPD (CRP) staff been oriented to refer all patients of age 40 and Yes
34
above years of age to Screening Desk (SD)?
Is staff based at SD following standard screening methods? (Screening for Yes
35
both communicable and non-communicable diseases)
36 Are all NCDs screening parameters being performed at SD? (Annex A) Yes

NCDs Clinic
Sr Status
List Comments
# (Yes/No)
Location
1 Is the NCDs Clinic located within immediate vicinity of Screening Desk? Yes
2 Is waiting area available in NCDs clinic? Yes
Branding
Is the NCDs Clinic area is branded as per the guidelines? (3 color stripes Yes
3
present on walls)
4 Are posters and Backdrops being displayed at NCDs Clinic? Yes
Logistics
Furniture
Are tables present as per SOP requirement? (2 for DHQH and 2 For THQH) Yes
5
Please mention the quantity.
Are Staff chairs present as per SOP requirement? (2 for DHQH and 2 For Yes
6
THQH) Please mention the quantity.
7 Is patient examination couch with side screen available at NCDs clinic? Yes
Are visitor’s chairs present as per SOP requirement? (2 for DHQH and 2 Yes
8
For THQH) Please mention the quantity.
9 Is the furniture provided by NCDs program? Yes
Data Entry
10 Is Desktop Computer/Android Tablet available in the NCDs clinic? Yes
11 Is web portal and dashboard accessible on desktop/Android Tablet? Yes
Data entry operator able to demonstrate new patient registration and Yes
12
follow up on web portal?
13 Is internet connection available at the NCDs clinic? Yes
Printed Materials
14 Quantity of Muaawan-e-Sehat booklets available at NCDs clinic? Yes
15 Availability of standard guidelines for integrated management of NCDs? Yes
HR:
16 Has the relevant Doctor been notified and present at NCDs clinic? Yes
Has the relevant Data Entry Operator (DEO) been notified and present at Yes
17
NCDs Clinic?
Is the doctor trained on applying standard guidelines and protocols for Yes
18
integrated management of Non-Communicable diseases?
19 Is the Data entry operator trained on using NCDs Web portal Yes

Status of Availability of Medicines as per Essential Drug List for Non-Communicable Diseases:

Status of Availability of Medicines as per Essential Drug List for Non-

Communicable Diseases

Please mention name of each health facility monitored→ HF:

Quantity
Disease Catergory Name of Medicine Strength Dosage Form Available
Amlodinpine Besylate 5mg Tabs 11660
Lisinopril 5mg Tabs 0
Hpertension

Atenolol 100mg Tabs 0

Furosemide 20mg Tabs 0
Losartan Potassium 50mg Tabs 0
Atorvastatin 20mg Tabs 0
Aspirin 75mg Tabs 0
Metformin 500mg Tabs 0
Diabetes

Glibenclimide 5mg Tabs 1090

Insulin Comp 30/70 100 IU / ml 10 ml 9835
Insulin Comp NPH 101 IU / ml 10 ml 535
100 mcg /
373
Respiratory

(Asthma &

Salbutamol puff Inhaler

Diseases
Chronic

COPD)

250 mcg /
550
Beclomethasone puff Inhaler
Montelukast 10mg Tabs 0
 ANNEXURE A
Screening parameters
Sr. # Screening Parameters Y/N
1- Socio-Demographic Details
a. Name: Y
b. Relationship (S/W/O)
Y
c. Date of Birth (D/M/Y)
Y
d. Age:
e. Marital Status Y
f. Gender: Y
g. Contact Number: Y
h. CNIC: Y
i. Occupation: Y
j. Qualification
k. District Y
2- Risk Factor Assessment
a. Smoking
b. Alcohol
c. Physical activity Y
d. Excessive salt intake
e. Fruits and vegetables
f. Cervical cancer
3 Blood Pressure Y
4 Height Y
5 PEFR Y
6 Weight Y
7 Hip-Waist Ratio Y
8 BSR Y

Monitoring Information
Name of Monitor Dr. Rana Imtiaz Ahmed
Designation CEO, DHA, Pakpattan
Date Observed

CHIEF EXECUTIVE OFFICER

DHA, PAKPATTAN