Nutrition Unit/Corner Less than 6 7 to 11 12 to 18 More than 18 OPD (0–4 yrs) Less than 5 5 to 10 11 to 15 More than 15 OPD (5+ yrs) Less than 5 5 to 10 11 to 15 More than 15 YCC Less than 5 5 to 10 11 to 15 More than 15 ANC Less than 4 4 to 8 9 to 14 More than 14 Maternity/PNC Less than 5 5 to 10 11 to 15 More than 15 ART Less than 6 7 to 11 12 to 18 More than 18 TB Less than 6 7 to 11 12 to 18 More than 18 TOTAL # (Poor/Fair/Good/Excellent) D. Community Linkages To be answered by health facility manager or his/her appointee(s). Circle the coding corresponding to the correct/observed response. D01 Do all of the following Yes 1 departments/clinics—nutrition unit, No 2 ART, and TB—have links with community-based health workers or volunteers? D02 Do all of the following Yes 1 departments/clinics—nutrition unit, No 2 ART, and TB—receive clients referred from the community for nutrition services? (Probe for referral slips) D03 What kinds of community structures Village health 1 exist to support continuum of nutrition Vaccinators 2 care and support in the following Expert clients 3 departments/clinics: nutrition unit, Family support groups 4 ART, and TB? (Tick all that apply) groups 5 Specify……….… D04 Is there a mechanism for periodical Yes 1 support of these groups in D03 by the No (Skip to E01) 2 health facility? D05 What support mechanisms exist? (Tick Supervision 1 all that apply) Training/mentorship 2 Other 3 Specify………… Any comments:
Nutrition Unit/Corner Less than 6 7 to 11 12 to 18 More than 18 OPD (0–4 yrs) Less than 5 5 to 10 11 to 15 More than 15 OPD (5+ yrs) Less than 5 5 to 10 11 to 15 More than 15 YCC Less than 5 5 to 10 11 to 15 More than 15 ANC Less than 4 4 to 8 9 to 14 More than 14 Maternity/PNC Less than 5 5 to 10 11 to 15 More than 15 ART Less than 6 7 to 11 12 to 18 More than 18 TB Less than 6 7 to 11 12 to 18 More than 18 TOTAL # (Poor/Fair/Good/Excellent) D. Community Linkages To be answered by health facility manager or his/her appointee(s). Circle the coding corresponding to the correct/observed response. D01 Do all of the following departments/clinics—nutrition unit, ART, and TB—have links with community-based health workers or volunteers? Yes No 1 2 D02 Do all of the following departments/clinics—nutrition unit, ART, and TB—receive clients referred from the community for nutrition services? (Probe for referral slips) Yes No 1 2 D03 What kinds of community structures exist to support continuum of nutrition care and support in the following departments/clinics: nutrition unit, ART, and TB? (Tick all that apply) Village health Vaccinators Expert clients Family support groups groups Specify……….… 1 2 3 4 5 D04 Is there a mechanism for periodical support of these groups in D03 by the health facility? Yes No (Skip to E01) 1 2 D05 What support mechanisms exist? (Tick all that apply) Supervision Training/mentorship Other Specify………… 1 2 3 Any comments:
Uganda-NSD-Tool-Hospitals-Sep2015.docx