Ministry of Health

Supervision Checklist

Reproductive health (BEmONC, CEmONC)

BEmONC or CEmONC site

Name of facility

Name of district

District Health Officer

Supervisor

Date of supervision

RH supervision ZHSO North 1

A: Infrastructure and environment

RH supervision ZHSO North 2

Appearance of facility, and surroundings
(clean, free of litter?)
Reception and examination area
Client flow and privacy
Water, electricity
Maintenance of patient toilette/ latrines
Proper waste management?

Maternal Emergency preparedness

Communication 24 hours available
Ambulance available 24 hours
DH: CS staff available 24 hours (duty
rosta?)
DH: Lab staff available 24 hours for blood
(duty roster)
DH: Blood available? What groups?

Staff Available
Number of nurses
Trained in BEmONC?
Cos
Trained in BEmONC
Lab technicians
Duty roster?
Med assistants
Trained in BEmONC

RH supervision ZHSO North 3

2. ANC:
A) Equipment, material and stationary
Examination couch
Weighing scales
Measuring tape
Foetal scope / Doppler
Clean Linen
Height measurement
Gestation calendar
Drugs: Iron, SP, Parecetamol, Folic acid
Stepping stool
Yellow Health passports
Water and cups for fansidar
Register

B) MANAGEMENT OF ANC CLIENTS

Yes/no/ REMARKS
1. Greetings, presentation
2. History taken and documented?
3. Lab exams: Hb, Syphilis, urine and sugar
4. PMTCT: HCT done, result discussed
4. Comprehensive examination of pregnant woman:
(paleness, breasts, abdomen, oedema etc...) all
findings recorded
5. Foetal growth and position is checked and
Recorded (compared with weeks of pregnancy)
6. Foetal heart is checked and recorded
7. Health education topics relevant to the needs
of pregnant women given
Counselling on self care, nutrition, breast
feeding and place of delivery is done and
recorded
8. Risk factors are identified and appropriate
action is taken and recorded, RDV communicated
10. Fansidar given in DOTS
11. drugs prescribed, ok for pregnancy?
12. Observations:

RH supervision ZHSO North 4

3. Maternity
a) Equipment, supplies and stationary
Number of maternity beds,
Antenatal, postnatal and kangaroo
bed nets available?
Special beds for severe cases?
Oxygen concentrator?
BP machine, stethoscopes
Emergency tray –what is in?
(ambu bags? Drugs? Iv drugs?)
Infection prevention material available? Chlorine,
buckets, mops, heavy duty gloves, surf,
Drugs in maternity? Documentation?

MANAGEMENT OF POSTNATAL MOTHERS AND BABIES

Yes/no REMARKS
Rooming in is practiced
Vital signs e.g. BP, Temp., Pulse,
Respirations, lochia, perinium and fundal height are
checked twice daily and recorded.
Daily examination of baby, EBF is encouraged and
practiced, Cord care done daily and recorded
Wound care done on post c/s pts.
Patients with infected wound and babies are isolated.
Episiotomies are inspected and cleaned
Nursing care plans are available
Adequate counselling done for:
Nutrition, Self care
Baby care, EBF
Family Planning
Danger signs
Postnatal clinic check up after 1/52 and 6/52
Emotional support in cases of SB/NND
HIV/AIDS
Records for PN mothers for 1 week and 6 weeks are
available.

Organization of maternity, statistics

Number and cadres of staff, plan of guards
Staff in uniform?

RH supervision ZHSO North 5

Total deliveries last 3 months
Vacuum extraction
Stillbirths
Breech deliveries/
Twin deliveries
Maternal Deaths
Neonatal deaths
PPH
APH
Eclampsia
Post partum infection mothers
Post partum infection neo-nates
Post abortional care, MVA
Infection prevention committee membership
Referrals how many, why?
For DH: MDA available??
Labour ward
Equipment and supplies
Delivery beds
Number of delivery sets, vaginal specula
Tear repair sets?
Fridge? Or vaccine carrier with ice packs?
Adult scale
Infant scale
BP machines
Stethoscopes
Fetoscopes - Doppler?
Thermometers
Suction machine
Resuscitation tray
Vacuum extractor and sets
Spotlight
Oxygen concentrator
Heater for neo-nates
Guidelines for management of obstetric
complications, PMTCT
Other guidelines or posters
Drugs: oxytocin (cold??)
Mg Sulphate
RL Other IV solutions
Antibiotics, (Ampi, Genta, Metronidazole, peni G,
Chloram)

RH supervision ZHSO North 6

Pain killers (Ibuprogen, Diclofenac, others)
Antihyertensive drugs p.e. hydralazine
Sutures and L.A.
Cleaning materials and disinfectant available
Chlorine, 3 buckets
Skin disinfection of mothers?
Autoclave
Stove for boiling
Protective wear available? long gloves
Referral system in place?
How many? Why and where?

RH supervision ZHSO North 7

. MANAGEMENT OF PATIENTS DURING LABOUR AND DELIVERY
Yes/no REMARKS
Partograph is used for each delivery
Maternal vital signs (BP, Temp, Pulse, Respiration)
are observed according to Standard protocol.
Progress of labor (contraction, descent and
dilatation) is observed according to graph
DH: Urine is checked for volume, albumin, ketone
Foetal heart is monitored according to graph
Mothers are not confined to bed during early labour.
Bladder is emptied regularly during labour
Proper action is taken when risks are identified
during labour and delivery.
Mothers are given adequate psychological
or pharmacological pain relief during labour.
Active management is practiced for third Stage of
labour.
Blood loss and placenta are properly examined and
recorded.
Maternal and neonatal conditions are properly
monitored and recorded during 4th stage of labour.
Mothers are treated with dignity during Labour and
delivery.
Breast feeding is initiated within the first hour of
delivery.
Observation in labour ward and maternity

RH supervision ZHSO North 8

FP

RH supervision ZHSO North 9

Materials and supplies
Examination couch
Scales
BP machine, stethosocpe
Specula
Light source
Drugs:
Depotprovera
Lofemenal
Ovrette
DH: Norplant
IUCD
Stockcards for all drugs? FEFO?
Stockouts for last three months
Stocklevel months
Stationary
Register
IEC materials
What available:
Statistics last three months New clients subsequent dropout
Lofemenal
Depoprovera
IUCD
Norplant
TL
CLIENT CARE (OBSERVATION OF SERVICE DELIVERY)
AREA OBSERVED y/n COMMENTS/RECOMME-
NDATIONS
Client information and
Education.
Introduction to methods
provided to FP clients.
FP education is given to
pregnant mothers, postnatal
mothers and underfive clinics
attenders.
Interpersonal
Communication and
Counselling conducted.

Client is told about all

mechanisms of action and side
effects of each method.

RH supervision ZHSO North 10

Client is given an opportunity
to discuss rumours and
misconceptions and is given
facts to explain the rumours.
Client is told about HTC
Client history and
Examination.
Examination done according to
protocol
Observations

RH supervision ZHSO North 11

Post Abortal Care/ Manual Vacuum Aspiration
Number of cases last 3 months
No of referred to surgery
MVA sets
Ambu bag
BP machine
Emergency tray
What in?
Light source

Treatment guidelines

Cleaning materials, disinfectant available

Protective wear available
State of repair and cleanliness of room
Problems with MVA

RH supervision ZHSO North 12

For CEmONC site: Theatre and Lab
Number and cadres of staff, call guard for
anesthetic technician and lab tech?
Staff in uniform
Running water? Lights? Spare bulbs?
Number of maternal cases (CS. Evacuation)
(emergency, elective)
Op book?
Anesthesia: Loco regional, spinal, general
What is used
Anesthetic machine , drugs? Intubation?
Laryngoscope, spare battery?
Drugs available: and missing

Possibility of blood transfusion

What stocked?
How much time to get blood in the night
Oxygen concentrator
Pulse oxymeter
Emergency tray
What in
Infant resuscitation table, suction, ambu bag
Operating tables
Light
How many C-section kits?

Availability of sutures, absorbable and non

absorbable

Instruments

Non-functional equipment
State of repair and cleanliness of room

RH supervision ZHSO North 13

Air conditioning
Infection prevention committee
Cleaning materials and disinfectant available
Protective wear, sterile gowns, gloves, hats,
masks available
Soap ? clothes, shoes?
Patient towels, iodine, gauze
Clear separation for sterile part of theatre?
How is decontamination done
How is sterilisation done, who sterilises?
Clean and dirty areas? Indicator paper?

Generator
Ambulance present, driver guard rotation plan?
Communication system with HC, staff on guard
Room for people on guard?
Observations

RH supervision ZHSO North 14

 Summary report Health facility Supervision
Facility District District Health Supervisors Date of
Officer supervision

Strengths

Weaknesses

Action points Responsible

officer

RH supervision ZHSO North 15