Joined Cluster partner Rapid Health Sector Assessment
Comprehensive compilation of all quantitative data that is to be collected. Please note that we will be aiming to add
August statistics for the final version of the report to the extent available before September 9th. Also please remember
that this is a collection of all data we seek to influence the assessment report, this is not one giant questionnaire that
we are taking from facility to facility. A lot of the information is already gathered and requires validation only;
methodologies include review of secondary data, KI interviews, observation, assessment reports of partners and focus
group discussions (RH).
A
GENERAL INFORMATION
1
Name & Position of the Key
Informant
2
Contact Phone/mail
3
District
4
Health Facility Name
5
Health Facility Level (MOH)
6
Catchment Population
7
Ownership
before
MOH
B
Now
UNWRA
NGO
other (describe)
INFRASTRUCTURE
1
Health Facility damaged
Fully Damaged
Partially Damaged
2
Service still in original
place?
Yes
No
3
Health facility status
Fully Functioning
Partially Functioning
Not Damaged
Non-functioning
Fully functioning = 100% of previous services functioning | partially functioning = when one or more of the usual services provided are not functioning
(please describe the situation in the comment section (e.g. only 3 basic services are functioning – or there is only minor change to the usual services)
4
5
Reason for closure of HF
If no – where did the facility
relocate to
Damaged
Alternative fixed building
replaced by mobile clinic
Please provide appropriate answer (Yes or No) & provide
numbers where applicable
1
Outpatient services
2
Inpatient services (medical, pediatrics,
obstetrics, gynecology)
3
Emergency department/room capacity
4
5
6
C1.
General clinical
services
Staffing
tent
facility closed with no replacement
other pls. describe
Distance to old structure < 10 min. on foot
HEALTH SERVICES
C
Security
Functioning
prior to the
conflict
0=No 1 = Yes
> 20 min on foot
Functioning
Now
0=No 1 = Yes
> 30 min. on foot
Number of
cases in July
2014
Number of
cases in August
2014
Inpatient capacity
Basic functioning laboratory
Comprehensive functioning Laboratory
7
Functional blood bank services
8
Imaging service (i.e., X-Ray, ultrasound, CT
Scan, MRI)
9
ICU services
1
Total number of consultations in OPD
2
Total number of admissions in hospital
Page 1 of 6
HEALTH SERVICES
C
Please provide appropriate answer (Yes or No) & provide
numbers where applicable
3
Number of NCD visits to PHC
4
Number of NCD admissions
5
Number of consultations in the emergency
department
6
Number of referred cases to the next higher
service facility within Gaza
7
Number of conflict related referrals to Israel
8
Number of conflict related referrals to Egypt
9
Number of conflict referrals to Westbank
10
Number of conflict related referrals to
elsewhere (Turkey etc)
11
Number of referrals outside of Gaza for
treatment of chronic illnesses
12
Number of conflict related injuries total
13
Number of conflict related injuries male <18
14
Number of conflict related injuries female < 18
15
Number of conflict related injuries male >18
16
Number of conflict related injuries female > 18
17
18
C2.
Key Indicators in
clinical services
Functioning
prior to the
conflict
0=No 1 = Yes
Functioning
Now
0=No 1 = Yes
Number of
cases in July
2014
Number of
cases in August
2014
Number of conflict related injuries male > 60
Number of conflict related injuries female > 60
19
Number of conflict related surgery
20
Number of elective surgery
21
Number of conflict related deaths total
22
Number of non trauma deaths
23
Number of conflict related deaths male <18
24
Number of conflict related deaths female < 18
25
Number of conflict related deaths male > 18
26
Number of conflict related deaths female > 18
27
Number of conflict related deaths male > 60
28
Number of conflict related deaths female > 60
29
Number of health staff injured on duty
30
Number of health staff injured off duty
31
Number of health staff who died on duty
32
Number of health staff who died off duty
33
Number of injuries as result from an attack on
the health facility (including ambulances)
34
Number of deaths as a result from an attack on
the health facility (including ambulances)
1
Counsel activities about breast feeding
(exclusive BF up to complete 6 months and
Page 2 of 6
HEALTH SERVICES
C
Please provide appropriate answer (Yes or No) & provide
numbers where applicable
Functioning
prior to the
conflict
0=No 1 = Yes
Functioning
Now
0=No 1 = Yes
Number of
cases in July
2014
Number of
cases in August
2014
continue BF with adding supplementary
feeding
2
Distribution of breast milk substitute (artificial
formula) inside PHC centers or shelters
3
Number of neonates seen at neonatal
emergency section
4
5
C3.
Neonatal Health
Number of neonatal admitted cases
Number of neonatal deaths
6
Number of Premature cases out of admission
number in the neonatal department
7
Neonatal feeding inside the unit - (milk
formula)
8
Neonatal feeding inside the unit - (expressed
breast milk)
1
Expanded Programme of Immunisation:
routine immunization against all national
target diseases
2
Vaccination coverage: how many children were
vaccinated in
3
4
C4.
Child Health
Cold chain functioning
Screening of malnutrition (growth monitoring
by anthropometric measurement W/A, H/A,
W/H)
5
Diarrhea and other (RTI, meningitis….) acute
illness diseases management
6
Continue active PKU and TSH screening
programme
1
Screening of malnutrition or anemia for
pregnant & lactating women
2
C5.
Nutrition
Screening of malnutrition or anemia for
children at 12 months old
3
Screening of malnutrition (growth monitoring
by anthropometric measurement W/A, H/A,
W/H)
4
Provision of supplementary micronutrients for
children
1
assess pregnancy
2
birth and emergency plan
3
C6.
Antenatal care
advise/counsel on nutrition of the mother
5
self-care and family planning
6
preventive treatment(s) as appropriate
7
tetanus toxoid
1
2
3
C7.
Essential
newborn care
Skilled care during childbirth for clean and safe
normal delivery
basic newborn resuscitation + warmth,
vit K supplementation
Page 3 of 6
HEALTH SERVICES
C
Please provide appropriate answer (Yes or No) & provide
numbers where applicable
4
1
2
3
1
2
C8.
Basic Emergency
Obstetric Care
(BEmOC
C9.
Comprehensive
Emergency
Obstetric Care
(CEmOC)
assisted vaginal delivery
Basic emergency obstetric care plus caesarian
section plus safe blood transfusion
safe abortion care including antibiotic
prophylaxis, uterine evacuation using MVA or
medical methods if needed, treatment of
abortion complications
Examination of mother and newborn in the
health facility for minimum 6 hours
C10.
Post Natal Care
Examination of mother and newborn in the
health facility for minimum 6 days
4
Number of post natal home visits
1
Maternal mortality
2
Number of CSs
3
Number of Antenatal visits
4
Number of Normal Deliveries
5
Number of preterm deliveries
8
9
C11.
Key Indicators
for
Reproductive
Health
Number of newborn < 2500 gram
Number of inducted deliveries
Number of IUFD/SB
Number of abortion
10
Number of bleeding before delivery
11
Number of bleeding after delivery
12
Number of early neonatal deaths within 1st
week
13
Number of newborn admission to the ICU
14
Number of referral cases due to pregnancy
complications
15
Syndromic management of sexually
transmitted infections
1
E warn system established and currently
implemented (core information)
2
3
Number of
cases in August
2014
removal of retained products with manual
vacuum aspiration (MVA) if needed
Examination of mother and newborn up to 6
weeks
7
0=No 1 = Yes
Number of
cases in July
2014
manual removal of placenta
3
6
0=No 1 = Yes
Functioning
Now
clean cord care
1
2
Functioning
prior to the
conflict
C12.
Communicable
Diseases
Are general infection control measures in place
(hand washing facilities, sanitizers, sterile
gloves….)
Capacity to isolate patients with suspected
communicable disease (Procedures, space,
PPE, disinfectant, trained staff)
Page 4 of 6
HEALTH SERVICES
C
Please provide appropriate answer (Yes or No) & provide
numbers where applicable
1
Functioning
prior to the
conflict
Functioning
Now
0=No 1 = Yes
0=No 1 = Yes
Number of
cases in July
2014
Number of
cases in August
2014
Cardiovascular management (incl. HTN)
2
Diabetes management
C13.
3
End Stage Kidney Disease (ESKD) management
Noncommunicable
Diseases and
mental health
4
5
Cancer management
Mental Health Services in PHC
6
Community Mental Health Centers
7
MH specific Inpatient services
1
Medical waste segregated from general solid w
2
C.14
Environmental
Health
3
Incinerator in place
Facility has sufficient quantity of
water/patient/day (PHC=5l inpatient=40 – 60 l)
Facility has sufficient sanitation capacity (1
toilet to 10 inpatient or 1 to 20 OPD patients)
4
D
HUMAN RESOURCES (please specify the number of the available core staff ON AVERAGE during 24 hours)
1
Doctors
Before the conflict(#: ____) During the conflict (#:_______)After the conflict (#:_______)
2
Nurse
Before the conflict(#: ____) During the conflict (#:_______)After the conflict (#:_______)
3
Midwife
Before the conflict(#: ____) During the conflict (#:_______)After the conflict (#:_______)
4
Technicians
Before the conflict(#: ____) During the conflict (#:_______)After the conflict (#:_______)
5
Pharmacists
Before the conflict(#: ____) During the conflict (#:_______)After the conflict (#:_______)
6
Others (specify)
Before the conflict(#: ____) During the conflict (#:_______)After the conflict (#:_______)
E
GENERAL INFORMATION
1
Name & role of the KI
2
Contact Phone/mail
3
District
4
Name of Shelter site
5
Shelter manager:
6
7
Shelter Population
(Number of….)
Government
other (pls. Specify)
Female < 5
male < 5
female < 18
male < 18
female > 18
male > 18
female > 60
male > 60
female total
male total
Shelter space in meter
square (observation!)
F
1
UNWRA
SHELTER INFRASTRUCTURE
Nr of Toilets already in place
Page 5 of 6
2
Nr of Toilets currently being
constructed
3
Observation of open
defecation
Yes
No
4
Availability of hand washing
facilities
Yes
No
5
Availability of
showers/bathing areas
Yes
No
6
Availability of soap and
water in toilets?
Quantity of water for
drinking &
washing/person/day
7
8
9
10
Quality of water
Proximity to closest
functioning health center
Proximity to closest
functioning general hospital
100%
more than 50%
< 3 l/person
2
> 10 l/person
Good for consumption
yes
Good for washing but not for consumption
yes
> 15 l/person
no
no
< 10 min. on foot
> 20 min on foot
> 30 min. on foot
< 10 min. on foot
> 20 min on foot
> 30 min. on foot
G
1
> 5 l/person
less than 50%
SERVICES IN SHELTER
Health services available on
site
If yes please circle
appropriate
Yes
No
Health post
EPI
other (please describe)
Which of the following
services are provided
ANC
injuries
4
Early Warning System in
place
Yes
no
please inspect documentation for completeness,
request to have the system of reporting explained
What are the top 3
morbidities (in order of
highest numbers)
1
6
PNC
(indicate frequency)
3
5
MNCH
mobile clinic
general clinical services
dressing of
2
3
Are health promotion
activities in place, if yes
please inquire which topics
are being addressed and
frequency and type of
sessions
H
HUMAN RESOURCES IN SHELTER
1
Doctor
Yes
No
> than 50% of the time
< than 50% of the time
2
Nurse
Yes
No
> than 50% of the time
< than 50% of the time
3
Midwife
Yes
No
> than 50% of the time
< than 50% of the time
4
Health Promoter
Yes
No
> than 50% of the time
< than 50% of the time
5
Other (describe)
Yes
No
> than 50% of the time
< than 50% of the time
Page 6 of 6