TOOL No. 2 BASELINE SURVEY CHECKLIST
Components: Situational Analysis and Resource Assessment
checklists
SITUATIONAL ANALYSIS
CHECKLIST
Location
Name of Region
Sub-regions
Population
Epidemiology
Summary of Local HIV history
HIV prevalence (current number of
infections)
HIV incidence (rate of new infections
in given timeframe)
Description of link with other relevant
diseases (i.e. TB,STI’s)
Prevalence (of other diseases)
Incidence (of other diseases)
Factors affecting Access to health
care (describe each of the below
factors and how they affect access to
health services)
Geography of region
Urban population
Rural population
Transportation
Income
Literacy
Gender roles
Language
Customs and beliefs
Education
Data and Description
1
RESOURCE ASSESMENT
CHECKLIST
Local Healthcare Infrastructure
Data and Description
Hospitals (number, locations,
catchment areas and populations,
capacity, average distance, traveling
time and costs for patients)
Clinics (number, locations, catchment
areas and populations, average
traveling distance and time and costs
for patients for each clinic)
Laboratory facilities (location,
capacities)
Pharmacy services (location and
capacities)
Health Personnel (both public and
private)
Physicians (number, distribution,
training, expertise)
Nurses (number, distribution, training,
expertise)
Pharmacists (number, distribution,
training, expertise)
Lab technicians (number, distribution,
training, expertise)
Counselors (number, distribution,
training, expertise)
Community Health Workers (number,
distribution, training, expertise)
Community Services
Government services
CBOs,NGOs,FBOs (location &
expertise)
2
Services currently offered (list name
of organization, description of service
including numbers served)
HBC
Psycho-social support
Emergency nutrition
Food security
Community health and education
outreach
Transportation assistance
Income generating activities
Collaboration
Opportunities for collaboration
Community leaders and gatekeepers
(identify leaders in various community
sectors i.e: traditional authority, local
political leaders, church leaders,
women’s groups, elders etc.)
3