Remarks Date: Signature of the Name of Supervisor: supervisor: 4 Care for the Indigents [max 4 points] YES NO 4.1 Planning for Care for the Indigents expenditures 1 0 5% of curative consultations of the previous month: documented quantity in monthly 4.1.1 management meetings Indigent committee meets monthly 4.2 The Indigent committee meets monthly to review the Care for the Indigent Category use. 0; Each monthly minutes contain: (i) date of the meeting; (ii) signed list of participants; (iii) 3 follow-up of decisions taken during the previous meeting; (iv) there is a list of developed 1; 2 4.2.1 recommendations or decisions taken; (v) each month the monthly financial balance is discussed; (vi) minutes of the meeting are signed by the chairman. Each report according to norms = 1 p Total Points (4) ../4 Remarks Date: Signature of the Name of Supervisor: supervisor: 5 Hygiene and Sterilization [max 31 points] YES NO 5.1 Fence health facility available and well-maintained 1 0 5.1.1 Fence exists, can be closed at night and there are no holes Availability of a garbage bin in the courtyard 5.2 1 0 Bin with lid accessible to clients which is not full 5.2.1 Presence of sufficient latrines/toilets which are well-maintained 5.3 1 0 At least two functional latrines/toilets 5.3.1
Remarks Date: Name of Supervisor: Signature of the supervisor: 4 Care for the Indigents [max 4 points] YES NO 4.1 Planning for Care for the Indigents expenditures 1 0 4.1.1 5% of curative consultations of the previous month: documented quantity in monthly management meetings 4.2 Indigent committee meets monthly 3 0; 1; 2 4.2.1 The Indigent committee meets monthly to review the Care for the Indigent Category use. Each monthly minutes contain: (i) date of the meeting; (ii) signed list of participants; (iii) follow-up of decisions taken during the previous meeting; (iv) there is a list of developed recommendations or decisions taken; (v) each month the monthly financial balance is discussed; (vi) minutes of the meeting are signed by the chairman. Each report according to norms = 1 p Total Points (4) ../4 Remarks Date: Name of Supervisor: Signature of the supervisor: 5 Hygiene and Sterilization [max 31 points] YES NO 5.1 Fence health facility available and well-maintained 1 0 5.1.1 Fence exists, can be closed at night and there are no holes 5.2 Availability of a garbage bin in the courtyard 1 0 5.2.1 Bin with lid accessible to clients which is not full 5.3 Presence of sufficient latrines/toilets which are well-maintained 5.3.1 At least two functional latrines/toilets 1 0
131214_PBF_UserManual_NG-FINAL.docx