Service Protocol Reference Guide for the Complementary Package of Health Services (CPA)
NSHPIC
Version 111009
No
Name CPA Service
Description
Primary Data Collection
Tools1
1
New outpatient consultation by Any new curative care OPD visit attended
a doctor
by a Doctor during the evaluated month
Curative Care Register
2
New outpatient consultation by Any new curative care OPD visit by an
a doctor of an indigent patient indigent patient attended by a Doctor
during the evaluated month. Indigents
identified according to local norms.
Maximum of 20% of all new curative
consultations and or admissions during
the previous month.
Counter-referral slip arrived at A counter-referral note filled by the MD,
the Health Center
sent to the health center, during the
evaluated month. The feedback must at
Indigent register
3
Carbon copy of the original
referral slip, filled in by the
MD.
Secondary Data Collection
Tools2
Original prescription for
drugs dispensed kept at the
pharmacy which includes
cost of drugs. Drugs register
and stock cards conform.
Lab/radiology register
contains proof of requested
exams.
Proceedings Indigent
committee
Community Client
Satisfaction Survey
Original prescription for
drugs and medical
consumables dispensed kept
See Annex ‘Primary Data Collection Tool Column Headers’. These registers ought to be well-legible with filled all columns filled in. The PBF column header
formats are mandatory. If information is lacking, automatically this service is not remunerated/validated. The verificator can use a red pen to cross out the
service and or to make annotations. If the mobile phone number is not recorded, the service risks not being remunerated. In case of absence of mobile phone
number the client can provide any number, i.e. from a family member, the neighbor, or the village chief. But a recorded number is mandatory. In the unlikely
case that the client has no number at all to provide, the patient will need to sign the register’s column header.
2
The secondary data collection tools can be partially at the health facility, partially with the client. They can be subject to scrutiny during either the routine data
verification exercises, and or during the community client satisfaction surveys. In case there is no trace of such services rendered in the secondary data collection
tools, then the service might be considered ‘not rendered’ ex-post, and sanctions will be applied as per contract.
1
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No
Name CPA Service
Description
Primary Data Collection
Tools1
least mention the diagnosis and treatment
received. The carbon copy of the referral
note is only remunerated when it is
accompanied by a short note with name,
date and signature of the health center incharge.
4
Minor Surgery
Any new minor surgical intervention
during the evaluated month. Minor
Surgery defined as (i) Suture; (ii)
Herniotomy; (iii) Subcutaneous cyst
removal; (iv) I&D; (v) amputation of a
finger/toe
Minor Surgery Register
5
Major Surgery (ex CS)
Any new major surgical intervention
during the evaluated month. Major
surgical intervention defined as a
laparatomy for any cause (bar CS), or
amputation of a large limb.
Theater register
6
Normal delivery
A normal delivery attended by a trained
attendant in this facility, during the
Delivery register
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Secondary Data Collection
Tools2
at the pharmacy which
includes cost of
drugs/consumables. Drugs
register and stock cards
conform. Lab/radiology
register contains proof of
requested exams. Original
referral slip available at the
Health Center
Original prescription for
drugs and medical
consumables dispensed kept
at the pharmacy which
includes cost of
drugs/consumables. Drugs
register and stock cards
conform. Lab/radiology
register contains proof of
requested exams.
Original prescription for
drugs and medical
consumables dispensed kept
at the pharmacy which
includes cost of
drugs/consumables. Drugs
register and stock cards
conform. Lab/radiology
register contains proof of
requested exams.
Partogram and inpatient file;
eventual drugs and medical
No
Name CPA Service
Description
Primary Data Collection
Tools1
evaluated month.
7
Assisted delivery
An assisted delivery attended by a Doctor
in this facility, during the evaluated
month.
Delivery register
8
CS
A CS carried out at this facility during the
evaluated month.
Delivery register or theater
register
9
Inpatient Day
General admission register for
each department
10
Postnatal consultation
11
First ANC consultation before
four months pregnancy
12
ANC standard visit (2-4)
One day admission of an admission of a
minimum of three days duration and
discharged alive, during the past month.
A post natal consultation held within 48
hours after giving birth, during the past
month.
A first ANC consultation occurs before 4
month’s pregnancy, during the evaluated
month.
Any 2-4th standard visit according to the
focused antenatal care visit schedule and
approach. Second visit between 24-28
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Secondary Data Collection
Tools2
consumables dispensed
through the prescriptions
kept at the pharmacy; drugs
register and stock cards
conform.
Partogram and inpatient file;
eventual drugs and medical
consumables dispensed
through the prescriptions
kept at the pharmacy; drugs
register and stock cards
conform.
Partogram and inpatient file;
eventual drugs and medical
consumables dispensed
through the prescriptions
kept at the pharmacy; drugs
register
In patient form kept at the
health facility
ANC register
ANC card kept at the health
facility
ANC register
ANC card kept at the health
facility.
ANC register
ANC card kept at the health
facility. Medical
prescriptions for
No
Name CPA Service
Description
Primary Data Collection
Tools1
weeks; third visit at 32 weeks and the
fourth visit at 36 weeks. During the
evaluated month.
13
FP: total of new users of
modern FP methods
14
FP: implants and IUDs
15
FP: vasectomy and bilateral
tuba ligation
16
VCT/PMTCT/PIT test
17
PMTCT: HIV+ pregnant
mothers and children born to
are treated according to
protocol
STD treated
18
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Any new or existing user of injectable
contraceptive or oral contraceptive pills,
during the past month. An injection
represents three month’s protection and a
FP visit for OAC should provide three
month’s worth of pills.
Any new user of implant or IUD, during
the evaluated month.
FP register
A vasectomy and bilateral tuba ligation
carried out at this facility, during the
evaluated month
Any new VCT or PMTCT or PIT test
carried out during the evaluated month.
Any new HIV+ mother and newborn
child treated according to the PMTCT
protocol, during the evaluated month.
Theater register
Any new STD treated according to the
syndromic treatment protocol, during the
evaluated month
Curative Care Register
FP register
VCT/PMTC register
ARV register; delivery room
register
Secondary Data Collection
Tools2
Ferrosulphate, Mebendazole
and Fansidar kept at the
pharmacy. Drugs register
and stock cards conform.
Eventual drugs and medical
consumables dispensed
through the prescriptions
kept at the pharmacy; drugs
register and stock cards
conform.
Eventual drugs and medical
consumables dispensed
through the prescriptions
kept at the pharmacy; drugs
register and stock cards
conform.
Family Planning Register
Laboratory register; stock
records
PMTCT register; laboratory
register; stock records.
Drugs and medical
consumables dispensed
through the prescriptions
kept at the pharmacy; drugs
register and stock cards
No
Name CPA Service
19
New Client put under ARV
treatment
20
New AAFB+ PTB patient
21
PTB patient completed
treatment and cured
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Description
Any new patient (pediatric or adult) HIV
positive who started ARV (Antiretroviral
therapy), including transferred in, during
the evaluated month.
A new AAFB sputum positive Pulmonary
Tuberculosis patient diagnosed, at the
facility, during the past month.
A former AAFB+ PTB patient completed
DOTS, and cured after treatment proven
by negative sputum examinations, during
the past month.
Primary Data Collection
Tools1
ART Register
Tuberculosis register
Tuberculosis register
Secondary Data Collection
Tools2
conform.
Patient files
Laboratory register: Slides
kept for counterverification/quality
assurance.
Laboratory register: Slides
kept for counterverification/quality
assurance.
Drugs register.