INSTRUCTIONS: I would like to ask you some questions about the health of mothers and their “Now, newborn children.” E. PREVENTION OF EXCESS MATERNAL AND NEWBORN MORBIDITY AND MORTALITY No. Question Response Yes............1 SKIP TO E3 E1 No...................................2 Are normal deliveries performed in Do not know ........99 SKIP TO E3 this facility? 1 Training issues………… Supplies/equipment 2 issues………… Management 3 issues………… Not authorized to provide ………… 4 E2 (If no) What is the main reason that 5 No indication…………. this service is not being provided? No 6 clients …………... Other (specify) ____________________7 Do not know…………………...99 General medical 1 doctor …………. Nurse midwife …………2 Nurse ………….3 E3 What staff currently perform normal 4 Clinical officer……… deliveries in this facility? Medical assistant …………5 Other (specify) _________________6 Do not know…………………...99 Visibly pregnant women ………...1 Community skilled 2 Who receives clean delivery kits birth attendants………... 3 distributed from this facility? TBAs………... E5 We do not distribute clean delivery 4 kits…... Other (specify) __________________ 5 (Circle all that apply) Do not know…………………...99 How many clean delivery kits have E6 been distributed in the past three Number: ______________ months?
INSTRUCTIONS: “Now, I would like to ask you some questions about the health of mothers and their newborn children.” E. PREVENTION OF EXCESS MATERNAL AND NEWBORN MORBIDITY AND MORTALITY No. Question Response E1 Are normal deliveries performed in this facility? Yes............1 SKIP TO E3 No...................................2 Do not know ........99 SKIP TO E3 E2 (If no) What is the main reason that this service is not being provided? Training issues………… 1 Supplies/equipment issues………… 2 Management issues………… 3 Not authorized to provide ………… 4 No indication…………. 5 No clients …………... 6 Other (specify) ____________________7 Do not know…………………...99 E3 What staff currently perform normal deliveries in this facility? General medical doctor …………. 1 Nurse midwife …………2 Nurse ………….3 Clinical officer……… 4 Medical assistant …………5 Other (specify) _________________6 Do not know…………………...99 E5 Who receives clean delivery kits distributed from this facility? (Circle all that apply) Visibly pregnant women ………...1 Community skilled birth attendants………... 2 TBAs………... 3 We do not distribute clean delivery kits…... 4 Other (specify) __________________ 5 Do not know…………………...99 E6 How many clean delivery kits have been distributed in the past three months? Number: ______________
5a.-Health-Facility-Assessment-Tool.docx