Hospital Assessment Checklist

Facility Profile (Please enter the date in Ethiopian Calendar-DD/MM/YYYY format)

Region Fill the name of the region where the
hospital exists Hospital Name Fill the name of the hospital

Zone Fill the name of the zone where the

hospital exists Facility Code

Woreda Fill the name of the Woreda where the

hospital exists Date (DD/MM/YYYY)

Section A: HIS structure and resources (30%)

1 Medical record Unit
The hospital has the inputs necessary for medical record unit:
1) Adequate space as per the standard? Standard hospital MRU size is - (Height 3m and 2 windows for fast track, at least 60 square meter space for a hospital)
2) Adequate number of shelves? Choose Yes if there is at least 1 free shelf exists during the assessment (Shelf standard is 2.75m height and 2m length with 25cm space
between the top of the shelf and the ceiling)
1.1
3) Adequate number of medical record unit staff? Based on the facility standard

4) Availability individual medical records (central register, Folder, service ID, patient card - these are taken as tracers). Give 0 if the item was not available even for a single day
and 1 if available all the time. Do same for each of the items. The final score will be a percentage of the sum of those items that were available all the time divided by the the
total number of items. (Example if 3 three of the items were available all the time then it will be 3/4 wich is 75%
Proper procedures /processes in the medical record unit
1) Centralized /unified medical record system/unit? Choose Yes if all individual medical record folders are kept in one centralized medical record unit.

2) Medical records are filed based on the label given on the shelves? First check if each cell of a shelve is labelled with consequent number. And then pick two individual
medical folders randomly if their MRNs fall within the labelled range.Choose Yes if both are satified.

1.2 3) The MRU is assisted by the use of an electronic system (Electronic Medical Record System)? Choose Yes if there is a functioning electronic system in the medical record
unit system.
4) Individual medical records are easily accessible for retrieving. Randomly take two samples and check if each of the records can be retrieved within three minutes.Choose
Yes if so and No if not
5) Completeness of central register? Randomly select five samples from list of patients visited the hospital in the last five days. Check if all of the data elements are recorded
for the sampled cases. Choose complete if it is 100% and Incomplete if not 100%.
2 HMIS Unit
The hospital has a well-organized HMIS unit.
1. Dedicated desk/office? A. YES B. NO
2.1
2. A functioning computer dedicated for DHIS 2 is in place? A. YES B. NO Make sure that the computer is functioning at the time of assessment
3. The HMIS unit has HIT or a personnel dedicated for the implementation of HMIS? A. YES B. NO
At least five currently upated manuals which facilitate the implementation of HIS are in place (It can be in a hard or soft copy format)
1. HMIS procedure/data recording and reporting? A. YES B. NO
2. HMIS Indicator reference guide? A. YES B. NO
2.2
3. HMIS disease classification (NCoD)? A. YES B. NO
4. Data quality manual? A. YES B. NO
5. Data use manual? A. YES B. NO
 Availability of registers and tally sheet in past three months (In the quarter being evaluate
2.3 Calculate as (Registers and tally sheets that were available all the time during the reporting period/ number of applicable registers and tally sheets)

The hospital has running cost for strengthening and implementation of HIS?
A. YES
B. NO
3 Choose Yes if the hospital has allocated budget for any of the hospital's HIS activities (Printing of recording and reporting formats, HIS training, mentoring etc)

The hospital conducted HIS alone/integrated supportive supervision* to health centers in the past quarter (Last three months)
4
Calculate as (Total number of visits conducted/expected number of visits during the period)
(Expected number of visits equals= # of times centers are visited* Number of months)
There is a documented evidence that shows HIS capacity building needs assessment is done (on data management, data quality, and data use) for the staff in the past 6 months.
A. HIS capacity needs assessment was conducted and took action/communicated to the next level in the last six months
B. HIS capacity needs assessment was conducted but didn't take action/was not communicated to the next level in the last six months.
5 C. HIS capacity needs assessment was not conducted in the last six months

6 Digitization
The hospital has a functional DHIS 2?
A. Yes and it is online
6.1 B. Yes but it is offline
C. No DHIS-2

The hospital has an internet connectivity (functional HealthNet, 3G/4G etc)

A. YES
6.2 B. NO
Choose Yes if the hospital has any form of internet connectivity

The hospital has implemented a full EMR system

A. Full EMR
6.3 B. Partial EMR (Any of the service units except MRU)
C. None

The hospital has implemented HRIS

A. YES
6.4 B. NO

Dagu-2 with eAPTS implementation status

A.The hospital is currently implementing Dagu-2 with eAPTS for pharmacy store management and dispensary services
6.5 B. The hospital is currently implementing Dagu-2 without eAPTS
C. The hospital is not currently implementing Dagu-2

Section B: Data quality (30%)

1 Data Completeness and consistency on individual medical records and registers
 Data completeness on the registers for one randomly selected data element from data elements listed on the most recent LQAS:

Calculate data completeness of the register

If register completeness check is not conducted, the facility gets 0

Steps to do register completenss:

Step 1: Select one data element randomly from the data elements selected for the recent LQAS/from all data elements if that sample is not available
Step 2: Locate the register related with the selected indicators (Example: if the selected indicator is number of deliveries attended by skilled birth attendant, then go to the delivery room and
refer to delivery register)
Step 3: Count the total number of clients who are recorded on the register during the quarter and take 5-10% of the total recoded clients in the specific register. To randomly select medical
records, divide the total number recorded individuals by the required number of the sample (e.g. 10) to obtain the sampling interval.
Step 4. Calculate data completeness on the register
Step 4.1: Agree on the most relevant and a must to be filled data elements from the register for analysis.
1.1 Example: Delivery by skilled birth attendant (Delivery register): [Patient name, age, date of delivery, mode of delivery, maternal status and newborn health outcome]
Step 4.2: Locate the sampled MRN on the register and check for completeness of data for each of the sampled individuals. Mark as “complete” or “incomplete”. Complete is defined as when
all of the selected data elements are recorded on the register for the sampled individual. Incomplete is defined as if one or more of the selected data elements are not recorded on the
register for the sampled individual.
Table X: Template for measuring data completeness on registers for selected indicators (Example on the Next worksheet)

Step 4.3: Calculate data completeness on the register by dividing the sum of MRNs with complete data [Column F) to the total number of sampled MRNs [Column G]

Data consistency between register and individual medical records for the indicator selected above during the last audit :

Calculate the consistency between register to individual medical record

If consistency of data on register is not checked against individual medical record, the facility gets 0

Consistency of data on the register with data on the individual medical records
Step 1: Consider the already agreed data elements (at Step 1 of the register completness)
Step 2: Locate the individual medical records (Patient cards and other associated cards) of sampled MRN from the MRU.
Step 3: Check if the reportable data elements written on the register are exactly matched with what is recorded on individual medical records.
Step 4: Calculate the consistency level: Mark as “Matched” or “Not matched” based on the findings for each of the sampled individuals.
“Matched” is defined as when all of the selected reportable data elements that are recorded on the registers for the sampled individual are also recorded the same on the individual medical
records.
1.2 “Not Matched” is defined as when at least one or more of the selected reportable data elements that are recorded on the registers for the sampled individual is not exactly the same as what
is recorded on the individual medical records. In addition, if the individual medical record is not physically available, then it is also considered as “Not matched”.

Table Y: Template for measuring consistency of data of registers against individual medical records (Example on the Next worksheet)

Calculate consistency of data on the register with data on individual medical record by dividing those MRNs with matched data [Column F) to the total number of sampled MRNs [Column G]
 Data completeness on the individual medical records for randomly selected MRNs from the central medical register:

Calculate data completeness of the individual medical records

If register completeness check is not conducted, the facility gets 0

Completeness of data on individual medical records

Step 1. Randomly select 10 sample MRN from the central register (Register in the medical record room) from the list of patients who were seen in the last 03 days
Step 2. Locate the individual sampled MRNs from the shelves
Step 3: Calculate data completeness on the individual medical record
Step 3.1: For each sampled individual medical record, check if it contains the most relevant and a must to be filled data elements (Patient name, Sex, age, MRN, chief complaint, diagnosis,
HMIS diagnosis)
1.3 Step 3.2: Mark as “complete” or “incomplete”. Complete is defined as when all of the selected data elements are recorded on the individual medical record for the sampled individual.
Incomplete is defined as if one or more of the selected data elements are not recorded on the register for the sampled individual.
Table Z: Template for measuring data completeness on individual medical records
Step 3.3: Calculate data completeness on the individual medical record by dividing the sum of individual medical record with complete data [Column F] to the total number of sampled
individual medical records [Column G]

Data consistency between individual medical records and register for the selected MRNs from the central medical register:

Calculate the consistency between register to individual medical record

If consistency of data on register is not checked against individual medical record, the facility gets 0

Consistency of data on the individual medical records with data on the register
Step 1: Consider the 10 individual sampled individual medical records in step 1 of individual medical record completenss.
Step 2: For each card, identify the latest visit date and accordingly identify the respective register(s) based on the diagnosis (N.B check if the service delivery unit is written on the summary
sheet)
Step 3: Check if the data elements (diagnosis /the service rendered) written on the individual medical record are exactly matched with what is recorded on registers
Step 4: Mark as “Matched” or “Not matched” based on the findings for each of the sampled individuals. “Matched” is defined as when the diagnosis /the service rendered that is recorded on
1.4 the individual medical record for the sampled individual is also recorded the same on the registers. “Not Matched” is defined as when the diagnosis /the service rendered that is recorded on
the individual medical record for the sampled individual is not exactly the same as what is recorded the same on the registers or if it doesn’t exist on the register at all.

Table P: Template for measuring consistency of data of individual medical records against registers
Step 5: Calculate the consistency level by diving those with matched consistency [Column F] by total nyumber of sample [Column G]

2 Reporting accuracy/ Consistency between reports and records

The facility conducts data verification (reporting accuracy ratio) of reported and recounted data at department level before reporting to the HMIS unit
A. YES
B. NO
2.1
Choose Yes if there is docuemnted evidence that case teams/departments conducte data verification of all reported figures with recorded one.
 In the last three months, the health facility has conducted LQAS:

2.2 Calculate as total number of LQAS conducted (Column F)/expected number of LQAS (Column G)
Expected number of LQAS= Number of months * Types of reports

First LQAS score of the health center of the last month of the reporting period for the monthly service delivery report:

For Self assessment

2.3 Take the figure that the facility reported as its first LQAS score during its last report (Column G).
For verification: Reconduct the LQAS by following proper procedure

3 Completeness of reports (Representative and content)

The HMIS unit keeps a log book/uses electronic system that helps to track completeness and timeliness of reports from departments/case teams
A. YES
B. NO
3.1
Choose Yes if the facility documnets if it recieves reports from departmenets/case team and the time (PMT Log book has a table for this, if not facilities can have their own record)

Service Report completeness of the hospital (Reports sent- Representative completeness)

3.2 Calculate as total number of reports sent from the Hospital (Column F)/Total number of expected reports (Column G)
Total number of expected reports= Types of report* period

Disease Report completeness of the hospital (Reports sent- Representative completeness)

3.3 Calculate as total number of reports sent from the Hospital (Column F)/Total number of expected reports (Column G)
Total number of expected reports= Types of report* period

Content completeness in the previous quarter (in the past three months)

3.4 (Select 12 data elements randomly from the last month Service Delivery report and check the data completeness). Completeness= Data elements with complete data (Column F)/12 (Column
G)

4 Timeliness of reports
Service Reports of the hospital are sent according to the national reporting schedule (Service reporting timeliness)
4.1 Calculate as total number of service reports sent timely (Column F)/Total number of expected reports (Column G)

Disease Reports of the hospital are sent according to the national reporting schedule (Disease reporting timeliness)
4.2 Calculate as total number of disease reports sent timely (Column F) /Total number of expected reports (Column G)

Section C. Data use (40%)

 Avialbility of an annual hospital plan:
A. The hospital and each directorate has an annual plan
B. The hospital has an annual plan but targets not cascaded to directorates
C. The hospital doesn't have a plan at all
1
Choose A if the hospital has an annual plan and the directorates have target for major key indicators. Choose B and C accordingly.

Performance monitoring team (PMT) is in place and established according to national standard
A. PMT is in place and the members are put together based on the national standard
2
B. PMT is in place but the members are not put together based on the national standard
C. PMT is not established at all

PMT is convening on monthly basis with 50%+ members

3
Calculate as total number of PMTs held with 50%+ of its members [Column F]/ Total number expected PMT meetings [Column G]
Total number of expected PMT meetings equals the total number of months in the reporting period as it is expected to happen on a monthly basis

PMT is chaired by the head/delegate of the health facility as per the national standard
4 Calculate as total number of PMTs chaired by head/delegate of the health facility (Column F)/ Total number PMT meetings conducted (column G)

5 PMT/Quality improvement team is reviewing key performance indicators:

5.1 The health facility tracks performance/ indicators of all types (Coverage, quality and equity)
5.1.1. Tracked key HMIS indicators (Plan versus Performance for key indicators) A. YES B. NO
5.1.2. Evidence of analysis by any form of disaggregation (Age, sex, geography etc) A. YES B. NO
5.1.3. Quality of health care measured and monitored (Content of care, standard of care etc)- Clinical audit

Calculate as total number of clinical audit is conducted (Column F)/Total number of expected clinical audits (Column G)
Total number of expected reports= Departments/case teams eligible for audit* period

5.1.4. The hospital conducted regular Perinatal/maternal death review A. YES B. NO

Give YES if the hospital conducted Perinatal/maternal death review and No if it didn't conduct in the quarter.

Performance gaps are identified

A. YES
5.2 B. NO

Choose Yes if the hospital (PMT) identified indicators with performance gap from the list of analyzed data

Root cause analysis is done for low performing key indicators

A. Root cause is identified for all low performing key low performing indicators
5.3
B. Root cause is identified for only some low performing indicators
C. Root cause is not identified for all the low performing indicators
 Action plan with roles and responsibilities, resources and timeline is prepared for the identified priority problems/challenges
A. Action plan is prepared for all the identified priority problems/challenges
5.4 B. Action plan is prepared for some of the identified priority problems
C. Action plan has never been prepared at all

The action plan/intervention/QI projects is being implemented

A. There is documented evidence that previous action plan is monitored during the current PMT (Complete, partially complete and not implemented)
5.5 B. No action is taken

PMT action plan/meeting minutes copy were shared to case teams

5.6
Calculate as total number of times that case teams actually received the PMT meeting minute (Column F)/[Number of case teams * number of months PMT conducted]-Column G

Updated DHIS-2 dashboard for hospital's selected key indicators

A. The hospital has an updated DHIS-2 dashboard for selected key indicators
6 B. The hospital has a DHIS-2 dashboard for selected key indicators but it is not updated
C. The hospital has never created a DHIS-2 dashboard for its key indicators

Written feedback was given to service departments/directorates on the performance and data quality issues?
7
Calculate as total number of written feedback given on performance and data quality issues (Column F) / [total number of months in the period* total number of departments/directorates] -
Column G
The hospital practices Case team level/Directorate level performance and/or data quality review system

Calculate as total number of times directorates conducted performance and data quality review (Column F) / Expected number of directrate level performance and data quality review
8 Expected number of directorate level performance and data quality review: [Number of directorates* months]-(Column G)

Directorates have a program performance monitoring chart

9 Calculate as total number of directorates that have a performance monitoring chart (Column F)/ total number of directorates in the hospital - (Column G)

The hospital has displayed information in the form of table, chart, etc. based on selected indicators in the health facility compound
A. Information (Performance related) is displayed in the health facility compound
B. Information (Performance related) is not displayed in the health facility compound
10
Choose YES if performance of the hospital for key indicators is displayed at least in one place in the facility compound for public view.

The hospital analytic report printed and disseminated to the general public (brochure and/or newsletter and/or leaflet etc)
A. Every Quarterly
B. Every bi-annually
11 C. Annually
D. None
 The hospital held performance review meeting with the community quarterly?
A. YES
B. NO
12
Choose Yes if the hospital conducts review of its perfromance with community members or any of their representatives suhc as (Idirs, youth groups, women groups, elderly /releious figures
etc)

The hospital conducted review meeting A. YES B. NO

13 Give YES if the hospital conducted Perinatal/maternal death review and No if din't conduct in the quarter. (This can be program review, HIS review, catchment meeting etc)

Presence of any change in performance, quality, equity as a result of use of data for action
A. YES
B. NO
14
Choose YES if there is a documented evidence in the hospital that expalins chnage in health outocme (coverage, service uptake, quality, equity etc) becasue of the use of data

NB: Please carefully select specific quarter while filling the assessment checklist on "Hospital Ass Checklist" sheet. Then you have to manually fill "Current quarter assessment" Sheet. Every quarter
follow similar procedure and save the change. To update dashboard each quarter go to the Data tab> Data tools and click on refresh All. The "table template" sheet is aimed at guiding you to assess
question stated in data quality section. On the " Dashboard" sheet you can filter by years and quarters to see trends over time
 Hospital Assessment Checklist
Facility Profile (Please enter the date in Ethiopian Calendar-DD/MM/YYYY format) Date: Date:
Region Hospital Name Zewditu 2014
Zone Facility Code Quarter 2
Woreda Numerator Denominator Weight/Answer Score Numerator
Section A: HIS structure and resources (30%) 28.0
1 Medical record Unit 10.0
The hospital has the inputs necessary for medical record unit: 4.0
1) Adequate space as per the standard? A. YES B. NO YES 1.0
1.1 2) Adequate number of shelves? A. YES B. NO YES 1.0
3) Adequate number of medical record unit staff? A. YES B. NO YES 1.0
4) Availability of individual medical records (central register, Folder, service ID, patient card) 4 4 1 1.0 3
Proper procedures /processes in the medical record unit 6.0
1) Centralized /unified medical record system/unit? A. YES B. NO YES 1.0
2) Medical records are filed based on the label given on the shelves? A. YES B. NO YES 1.0
3) The MRU is assisted by the use of an electronic system (Electronic Medical Record System)? A. YES YES 1.0
1.2 B. NO
4) Individual medical records are easily accessible for retrieving (Randomly take two samples and
YES 2.0
check if record can easily (within three minutes for each) be retrieved)? A. YES B. NO
5) Completeness of central register? A. Complete B. Incomplete COMPLETE 1.0
2 HMIS Unit 8.0
The hospital has a well-organized HMIS unit. 3.0

2.1 1. Dedicated desk/office? A. YES B. NO YES 1.0

2. A functioning computer dedicated for DHIS 2 is in place? A. YES B. NO YES 1.0
3. The HMIS unit has HIT or a personnel dedicated for the implementation of HMIS? A. YES B. NO YES 1.0
At least five currently updated manuals which facilitate the implementation of HIS are in place 2.0
1. HMIS procedure/data recording and reporting? A. YES B. NO YES 0.4
2. HMIS Indicator reference guide? A. YES B. NO YES 0.4
2.2
3. HMIS disease classification (NCoD)? A. YES B. NO YES 0.4
4. Data quality manual? A. YES B. NO YES 0.4
5. Data use manual? A. YES B. NO YES 0.4
Availability of registers and tally sheet in past three months

2.3 Calculate as (Registers and tally sheets that were available all the time during the reporting period/ number of 9 9 3 3.0
applicable registers and tally sheets)

The hospital has running cost for strengthening and implementation of HIS?
3 A. YES NO 0.0
B. NO
 The hospital conducted HIS alone/integrated supportive supervision/mentorship* to health centers in the past three
months
4 8 8 1 1.0
Calculate as (Total number of visits conducted/expected number of visits during the period)
(Expected number of visits equals= # of times centers are visited* Number of months)

There is a documented evidence that shows HIS capacity building needs assessment is done (on data management,
data quality, and data use) for the staff in the past 6 months.
A. HIS capacity needs assessment was conducted and took action/communicated to the next level in the last six A. HIS capacity needs

5 months
assessment was conducted and
took action/communicated to 2.0
B. HIS capacity needs assessment was conducted but didn't take action/was not communicated to the next level in the next level in the last six
the last six months. months
C. HIS capacity needs assessment was not conducted in the last six months

6 Digitization 7.0
The hospital has a functional DHIS 2?
A. Yes and it is online
6.1 B. Yes but it is offline A. Yes and it is online 2.0
C. No DHIS-2

The hospital has an internet connectivity (functional HealthNet, 3G/4G etc)

6.2 A. YES YES 1.0
B. NO

The hospital has implemented an Electronic Medical record (EMR) system

A. Full EMR
6.3 B. Partial EMR (Any of the service units except MRU) A. Full EMR 2.0
C. None

The hospital has implemented HRIS

6.4 A. YES YES 1.0
B. NO

Dagu-2 with eAPTS implementation status

A.The hospital is currently implementing Dagu-2 with eAPTS for pharmacy store management and dispensary
services A. The hospital is currently
implementing Dagu-2 with
6.5 B. The hospital is currently implementing Dagu-2 without eAPTS eAPTS for pharmacy store 1.0
C. The hospital is not currently implementing Dagu-2 management and dispensary
services

Section B: Data quality (30%) 30.0

1 Data Completeness and consistency on individual medical records and registers 8.0

Data completeness on the registers for one randomly selected data element from data elements listed on the most
recent LQAS:
1.1 12 12 2 2.0
Calculate data completeness of the register
If register completeness check is not conducted, the facility gets 0
 Data consistency between register and individual medical records for the indicator selected above during the last
audit :
1.2 7 7 2 2.0
Calculate the consistency between register to individual medical record
If consistency of data on register is not checked against individual medical record, the facility gets 0

Data completeness on the individual medical records for randomly selected MRNs from the central medical register:
1.3 6 6 2 2.0
Calculate data completeness of the individual medical records
If register completeness check is not conducted, the facility gets 0

Data consistency between individual medical records and register for the selected MRNs from the central medical
register:
1.4 7 7 2 2.0
Calculate the consistency between register to individual medical record
If consistency of data on register is not checked against individual medical record, the facility gets 0
2 Reporting accuracy/ Consistency between reports and records 10.0

The facility conducts data verification (reporting accuracy ratio) of reported and recounted data at department level
before reporting to the HMIS unit
2.1 YES 2.0
A. YES
B. NO

In the last three months, the health facility has conducted LQAS:
2.2 12 12 4 4.0
Calculate as total number of LQAS conducted/expected number of LQAS
Expected number of LQAS= Number of months * Types of reports

First LQAS score of the hospital for the last month of the reporting period for the monthly service delivery report:
2.3 95% 4 4.0
During verification: Take two data element from the sample data elements in the LQAS and check for correctness

3 Completeness of reports (Representative and content) 8.0

The HMIS unit keeps a log book/uses electronic system that helps to track completeness and timeliness of reports
from departments/case teams
3.1 YES 1.0
A. YES
B. NO

Service Report completeness of the hospital (Reports sent- Representative completeness)

3.2 4 4 2 2.0
Calculate as total number of reports sent from the Hospital /Total number of expected reports
Total number of expected reports= Types of report* period

Disease Report completeness of the hospital (Reports sent- Representative completeness)

3.3 4 4 2 2.0
Calculate as total number of reports sent from the Hospital /Total number of expected reports
Total number of expected reports= Types of report* period
 Content completeness in the previous three months
3.4 4 4 3 3.0
(Select 12 data elements randomly from the last month Service Delivery report and check the data completeness).
Completeness= Data elements with complete data/12
4 Timeliness of reports 4.0

Service Reports of the hospital are sent according to the national reporting schedule (Service reporting timeliness)
4.1 4 4 2 2.0
Calculate as total number of service reports sent timely /Total number of expected reports

Disease Reports of the hospital are sent according to the national reporting schedule (Disease reporting timeliness)
4.2 4 4 2 2.0
Calculate as total number of disease reports sent timely /Total number of expected reports

Section C. Data use (40%) 40.0

Avialbility of an annual hospital plan:
A. The hospital and each directorate has an annual plan
1 B. The hospital has an annual plan but targets not cascaded to directorates A. The hospital and each
directorate has an annual plan 2.0
C. The hospital doesn't have a plan at all

Performance monitoring team (PMT) is in place and established according to national standard
A. PMT is in place and the members are put together based on the national standard A. PMT is in place and the
2 members are put together 1.0
B. PMT is in place but the members are not put together based on the national standard based on the national standard
C. PMT is not established at all

PMT is convening on monthly basis with 50%+ members

3 Calculate as total number of PMTs held with 50%+ of its members/ Total number expected PMT meetings 3 3 2 2.0
Total number of expected PMT meetings equals the total number of months in the reporting period as it is expected
to happen on a monthly basis
PMT is chaired by the head/delegate of the health facility as per the national standard
4 3 3 1 1.0
Calculate as total number of PMTs chaired by head/delegate of the health facility/ Total number PMT meetings
conducted
5 PMT/Quality improvement team is reviewing key performance indicators:
5.1 The health facility tracks performance/ indicators of all types (Coverage, quality and equity)
5.1.1. Tracked key HMIS indicators (Plan versus Performance for key indicators) A. YES B. NO YES 1.5
5.1.2. Evidence of analysis by any form of disaggregation (Age, sex, geography etc) A. YES B. NO YES 1.5
5.1.3. Quality of health care measured and monitored (Content of care, standard of care etc)- Clinical audit

Calculate as total number of clinical audit conducted /Total number of expected clinical audits 7 7 1.5 1.5
Total number of expected reports= Departments/case teams eligible for audit* period

5.1.4. The hospital conducted regular Perinatal/maternal death review

YES 1.5
Give YES if the hospital conducted Perinatal/maternal death review and No if it didn't conduct in the quarter.
 Performance gaps are identified
5.2 A. YES Yes 2.0
B. No

Root cause analysis is done for low performing key indicators A. Root cause is identified for
A. Root cause is identified for all of the prioritized low performing key low performing indicators all of the prioritized low
5.3 2.0
B. Root cause is identified for only some of the prioritized low performing indicators performing key low performing
indicators
C. Root cause is not identified for all the low performing indicators
Action plan with roles and responsibilities, resources and timeline is prepared for the identified priority
problems/challenges A. Action plan is prepared for
5.4 A. Action plan is prepared for all the identified priority problems/challenges all the identified priority 2.0
B. Action plan is prepared for some of the identified priority problems problems/challenges
C. Action plan has never been prepared at all
The action plan/intervention/QI projects is being implemented
A. There is documented
A. There is documented evidence that previous action plan is monitored during the current PMT (Complete, evidence that previous action
5.5 partially complete and not implemented) plan is monitored during the
current PMT (Complete, 2.0
B. No action is taken partially complete and not
implemented)

PMT action plan/meeting minutes copy were shared to case teams

5.6 3 3 2 2.0
Calculate as total number of times that case teams actually received the PMT meeting minute /[Number of
case teams * number of months PMT conducted]
Updated DHIS-2 dashboard for hospital's selected key indicators
A. The hospital has an updated DHIS-2 dashboard for selected key indicators A. The hospital has an updated
6 B. The hospital has a DHIS-2 dashboard for selected key indicators but it is not updated DHIS-2 dashboard for selected 2.0
C. The hospital has never created a DHIS-2 dashboard for its key indicators key indicators

Written feedback was given to service departments/directorates on the performance and data quality issues?
7 3 3 2 2.0
Calculate as total number of written feedback given on performance and data quality issues / [total number of
months in the period* total number of departments/directorates]
The hospital practices Case team level/Directorate level performance and/or data quality review system

Calculate as total number of times directorates conducted performance and data quality review / Expected number of
8 directrate level performance and data quality review 7 7 2 2.0
Expected number of directorate level performance and data quality review: [Number of directorates* months]

Directorates have a program performance monitoring chart

9 Calculate as total number of directorates that have a performance monitoring chart / total number of directorates in 7 7 2 2.0
the hospital
The hospital has displayed information in the form of table, chart, etc. based on selected indicators in the health
facility compound A. Information (Performance
10 A. Information (Performance related) is displayed in the health facility compound related) is displayed in the 2.0
health facility compound
B. Information (Performance related) is not displayed in the health facility compound
 The hospital has developed and disseminated analytic(brochure and/or newsletter and/or leaflet and/or report
and/or presentation etc) in the quarter
11 A. YES A. YES 2.0
B. NO

The hospital held performance review meeting with the community quarterly?
12 A. YES A. YES 2.0
B. NO

The hospital conducted review meeting in the quarter

A. The health facility conducted review meeting (any type: HIS/other program based) three times in the quarter
B. The health facility held review meeting (any type: HIS/other program based) twice in the quarter
13 C. The health facility held review meeting (any type: HIS/other program based) once in the quarter A. Three times 2.0
D. The health facility did not held performance review meeting in the last six months

Presence of any change in performance, quality, equity as a result of use of data for action
A. YES
14 B. NO A. YES 2.0

Summary
Expected Year 2014
HIS Structure and Resources 30% Quarter Q2
Data Quality 30% Ass. Date Date:
Data Use 40% No.Assessment Core Areas Score(%)
Total Score 100% 1 HIS Structure and Re 28%
IR Pathway Model 2 Data Quality 30%
3 Data Use 40%
Total 98%

Facility Status
Model Facility
 Date: Date: Date:
2014 2014 2015
Quarter 3 Quarter 4 Quarter 1
Denominator Weight/Answer Score Numerator Denominator Weight/Answer Score Numerator Denominator Weight/Answer Score Numerator
#DIV/0! #DIV/0! #DIV/0!
8.75 9 8
3.75 3 3
YES 1 YES 1 YES 1
YES 1 YES 1 YES 1
YES 1 YES 1 YES 1
4 1 0.75 4 1 0 4 1 0
5 6 5
NO 0 YES 1 YES 1
YES 1 YES 1 NO 0
YES 1 YES 1 YES 1

YES 2 YES 2 YES 2

COMPLETE 1 COMPLETE 1 COMPLETE 1

#DIV/0! #DIV/0! #DIV/0!
3 3 3
YES 1 YES 1 YES 1
YES 1 YES 1 YES 1
YES 1 YES 1 YES 1
1.6 2 2
NO 0 YES 0.4 YES 0.4
YES 0.4 YES 0.4 YES 0.4
YES 0.4 YES 0.4 YES 0.4
YES 0.4 YES 0.4 YES 0.4
YES 0.4 YES 0.4 YES 0.4

3 #DIV/0! 3 #DIV/0! 3 #DIV/0!

YES 2 YES 2 YES 2

 1 #DIV/0! 1 #DIV/0! 2 3 1 0.7

B. HIS capacity needs A. HIS capacity needs A. HIS capacity needs

assessment was conducted assessment was conducted assessment was
but didn't take action/was and took conducted and took
not communicated to the 1 action/communicated to the 2 action/communicated to 2
next level in the last six next level in the last six the next level in the last
months. months six months

5 4 4

A. Yes and it is online 2 A. Yes and it is online 2 A. Yes and it is online 2

YES 1 YES 1 YES 1

B. Partial EMR (Any of

B. Partial EMR (Any of the
service units except MRU) 1.0 C. None 0.0 the service units except 1.0
MRU)

YES 1 YES 1 NO 0

A. The hospital is currently A. The hospital is currently

implementing Dagu-2 with B. The hospital is currently implementing Dagu-2 with
eAPTS for pharmacy store 1 implementing Dagu-2 0.5 eAPTS for pharmacy store 1
management and without eAPTS management and
dispensary services dispensary services

#DIV/0! #DIV/0! #DIV/0!

#DIV/0! #DIV/0! #DIV/0!

2 #DIV/0! 2 #DIV/0! 2 #DIV/0!

 2 #DIV/0! 2 #DIV/0! 2 #DIV/0!

2 #DIV/0! 2 #DIV/0! 2 #DIV/0!

2 #DIV/0! 2 #DIV/0! 2 #DIV/0!

#DIV/0! #DIV/0! #DIV/0!

NO 0 YES 2 YES 2

4 #DIV/0! 4 #DIV/0! 4 #DIV/0!

95% 4 4.0 95% 4 4.0 4 0.2

#DIV/0! #DIV/0! #DIV/0!

YES 1 YES 1 YES 1

2 #DIV/0! 2 #DIV/0! 2 #DIV/0!

2 #DIV/0! 2 #DIV/0! 2 #DIV/0!

 3 #DIV/0! 3 #DIV/0! 3 #DIV/0!

#DIV/0! #DIV/0! #DIV/0!

2 #DIV/0! 2 #DIV/0! 2 #DIV/0!

2 #DIV/0! 2 #DIV/0! 2 #DIV/0!

#DIV/0! #DIV/0! #DIV/0!

A. The hospital and each B. The hospital has an annual B. The hospital has an
annual plan but targets
directorate has an annual 2 plan but targets not 1 not cascaded to 1
plan cascaded to directorates
directorates

B. PMT is in place but the B. PMT is in place but the B. PMT is in place but the
members are not put members are not put members are not put
together based on the 0.5 together based on the 0.5 together based on the 0.5
national standard national standard national standard

2 #DIV/0! 2 #DIV/0! 2 #DIV/0!

1 #DIV/0! 1 #DIV/0! 1 #DIV/0!

YES 1.5 YES 1.5 YES 1.5

NO 0 NO 0 NO 0

1.5 #DIV/0! 1.5 #DIV/0! 1.5 #DIV/0!

YES 1.5 NO 0.0 NO 0.0

NO 0 NO 0 NO 0

B. Root cause is identified

C. Root cause is not B. Root cause is identified for for only some of the
identified for all the low 0 only some of the prioritized 1 prioritized low performing 1
performing indicators low performing indicators indicators

B. Action plan is prepared B. Action plan is prepared for B. Action plan is prepared
for some of the identified 1 some of the identified 1 for some of the identified 1
priority problems priority problems priority problems

A. There is documented
evidence that previous
action plan is monitored
during the current PMT 2 B. No action is taken 0 B. No action is taken 0
(Complete, partially
complete and not
implemented)

2 #DIV/0! 2 #DIV/0! 2 #DIV/0!

B. The hospital has a DHIS-2 A. The hospital has an B. The hospital has a DHIS-
dashboard for selected key 2 dashboard for selected
indicators but it is not 1 updated DHIS-2 dashboard 2 key indicators but it is not 1
for selected key indicators
updated updated

2 #DIV/0! 2 #DIV/0! 2 #DIV/0!

2 #DIV/0! 2 #DIV/0! 2 #DIV/0!

2 #DIV/0! 2 #DIV/0! 2 #DIV/0!

A. Information B. Information B. Information

(Performance related) is (Performance related) is not (Performance related) is
displayed in the health 2 displayed in the health 0 not displayed in the 0
facility compound facility compound health facility compound
 A. YES 2 B. NO 0 B. NO 0

B. NO 0 A. YES 2 A. YES 2

B. Twice 1.5 C. Once 1.0 C. Once 1.0

A. YES 2 B. NO 0 A. YES 2

Summary Summary Summary

Year 2014 Year 2014 Year 2015

Quarter Q3 Quarter Q4 Quarter Q1

Ass. Date Date: Ass. Date Date: Ass. Date Date:
No. Assessment Core Areas Score(%) No. Assessment Core Areas Score(%) No. Assessment Core Areas Score(%)
1 HIS Structure and Resou 0% 1 HIS Structure and Resources 0% 1 HIS Structure and Resource 0%
2 Data Quality 0% 2 Data Quality 0% 2 Data Quality 0%
3 Data Use 0% 3 Data Use 0% 3 Data Use 0%
Total 0% Total 0% Total 0%

Facility Status Facility Status Facility Status

 Date: Date: Date:
2015 2015 2015
Quarter 2 Quarter 3 Quarter 4
Denominator Weight/Answer Score Numerator Denominator Weight/Answer Score Numerator Denominator Weight/Answer Score Numerator
#DIV/0! #DIV/0! #DIV/0!
9 9 9
3 3 3
YES 1 YES 1 YES 1
YES 1 YES 1 YES 1
YES 1 YES 1 YES 1
4 1 0 4 1 0 4 1 0 9
6 6 6
YES 1 YES 1 YES 1
YES 1 YES 1 YES 1
YES 1 YES 1 YES 1

YES 2 YES 2 YES 2

COMPLETE 1 COMPLETE 1 COMPLETE 1

#DIV/0! #DIV/0! #DIV/0!
3 3 3
YES 1 YES 1 YES 1
YES 1 YES 1 YES 1
YES 1 YES 1 YES 1
2 2 2
YES 0.4 YES 0.4 YES 0.4
YES 0.4 YES 0.4 YES 0.4
YES 0.4 YES 0.4 YES 0.4
YES 0.4 YES 0.4 YES 0.4
YES 0.4 YES 0.4 YES 0.4

3 #DIV/0! 3 #DIV/0! 3 #DIV/0! 5

YES 2 YES 2 YES 2

 1 #DIV/0! 1 #DIV/0! 1 #DIV/0! 6

A. HIS capacity needs B. HIS capacity needs A. HIS capacity needs

assessment was conducted assessment was conducted assessment was
and took but didn't take action/was conducted and took
action/communicated to 2 not communicated to the 1 action/communicated to 2
the next level in the last six next level in the last six the next level in the last
months months. six months

5 4 5

A. Yes and it is online 2 B. Yes but it is offline 1 A. Yes and it is online 2

YES 1 YES 1 YES 1

B. Partial EMR (Any of B. Partial EMR (Any of

B. Partial EMR (Any of the
service units except MRU) 1.0 the service units except 1.0 the service units except 1.0
MRU) MRU)

YES 1 YES 1 YES 1

A. The hospital is currently A. The hospital is currently A. The hospital is currently

implementing Dagu-2 with implementing Dagu-2 with implementing Dagu-2 with
eAPTS for pharmacy store 1 eAPTS for pharmacy store 1 eAPTS for pharmacy store 1
management and management and management and
dispensary services dispensary services dispensary services

#DIV/0! #DIV/0! #DIV/0!

#DIV/0! #DIV/0! #DIV/0!

2 #DIV/0! 2 #DIV/0! 2 #DIV/0! 4

 2 #DIV/0! 2 #DIV/0! 2 #DIV/0! 5

2 #DIV/0! 2 #DIV/0! 2 #DIV/0! 3

2 #DIV/0! 2 #DIV/0! 2 #DIV/0! 4

#DIV/0! #DIV/0! #DIV/0!

YES 2 YES 2 YES 2

4 #DIV/0! 4 #DIV/0! 4 #DIV/0! 3

4 0.2 4 0.2 85% 4 3.6

#DIV/0! #DIV/0! #DIV/0!

YES 1 YES 1 YES 1

2 #DIV/0! 2 #DIV/0! 2 #DIV/0! 5

2 #DIV/0! 2 #DIV/0! 2 #DIV/0! 5

 3 #DIV/0! 3 #DIV/0! 3 #DIV/0! 5

#DIV/0! #DIV/0! #DIV/0!

2 #DIV/0! 2 #DIV/0! 2 #DIV/0! 3

2 #DIV/0! 2 #DIV/0! 2 #DIV/0! 3

#DIV/0! #DIV/0! #DIV/0!

A. The hospital and each B. The hospital has an B. The hospital has an
annual plan but targets
directorate has an annual 2 annual plan but targets not 1 not cascaded to 1
plan cascaded to directorates
directorates

B. PMT is in place but the B. PMT is in place but the

C. PMT is not established at members are not put members are not put
all 0.0 together based on the 0.5 together based on the 0.5
national standard national standard

2 #DIV/0! 2 #DIV/0! 2 #DIV/0! 2

1 #DIV/0! 1 #DIV/0! 1 #DIV/0! 2

YES 1.5 YES 1.5 YES 1.5

NO 0 NO 0 NO 0

1.5 #DIV/0! 1.5 #DIV/0! 1.5 #DIV/0! 4

NO 0.0 NO 0.0 NO 0.0

NO 0 NO 0 NO 0

A. Root cause is identified B. Root cause is identified B. Root cause is identified

for all of the prioritized low for only some of the for only some of the
performing key low 2 prioritized low performing 1 prioritized low performing 1
performing indicators indicators indicators

A. Action plan is prepared B. Action plan is prepared B. Action plan is prepared

for all the identified priority 2 for some of the identified 1 for some of the identified 1
problems/challenges priority problems priority problems

A. There is documented A. There is documented

evidence that previous evidence that previous
action plan is monitored action plan is monitored
during the current PMT 2 during the current PMT 2 B. No action is taken 0
(Complete, partially (Complete, partially
complete and not complete and not
implemented) implemented)

2 #DIV/0! 2 #DIV/0! 2 #DIV/0! 3

A. The hospital has an B. The hospital has a DHIS- B. The hospital has a DHIS-
2 dashboard for selected 2 dashboard for selected
updated DHIS-2 dashboard 2 key indicators but it is not 1 key indicators but it is not 1
for selected key indicators
updated updated

2 #DIV/0! 2 #DIV/0! 2 #DIV/0! 4

2 #DIV/0! 2 #DIV/0! 2 #DIV/0! 5

2 #DIV/0! 2 #DIV/0! 2 #DIV/0! 5

A. Information B. Information B. Information

(Performance related) is (Performance related) is (Performance related) is
displayed in the health 2 not displayed in the health 0 not displayed in the 0
facility compound facility compound health facility compound
 A. YES 2 B. NO 0 B. NO 0

A. YES 2 B. NO 0 B. NO 0

C. Once 1.0 A. Three times 2.0 A. Three times 2.0

B. NO 0 B. NO 0 A. YES 2

Summary Summary Summary

Year 2015 Year 2015 Year 2015

Quarter Q2 Quarter Q3 Quarter Q4

Ass. Date Date: Ass. Date Date: Ass. Date Date:
No. Assessment Core Areas Score(%) No. Assessment Core Areas Score(%) No. Assessment Core Areas Score(%)
1 HIS Structure and Resources 0% 1 HIS Structure and Resource 0% 1 HIS Structure and Resource 0%
2 Data Quality 0% 2 Data Quality 0% 2 Data Quality 0%
3 Data Use 0% 3 Data Use 0% 3 Data Use 0%
Total 0% Total 0% Total 0%

Facility Status Facility Status Facility Status

 Date: Date: Date:
2016 2016 2016
Quarter 1 Quarter 2 Quarter 3 Q
Denominator Weight/Answer Score Numerator Denominator Weight/Answer Score Numerator Denominator Weight/Answer Score Numerator
9 #DIV/0! #DIV/0!
1 9 9
1 3 3
NO 0 YES 1 YES 1
NO 0 YES 1 YES 1
NO 0 YES 1 YES 1
9 1 1 4 1 0 4 1 0
0 6 6
NO 0 YES 1 YES 1
NO 0 YES 1 YES 1
NO 0 YES 1 YES 1

NO 0 YES 2 YES 2

INCOMPLETE 0 COMPLETE 1 COMPLETE 1

3.0 #DIV/0! #DIV/0!
0 3 3
NO 0 YES 1 YES 1
NO 0 YES 1 YES 1
NO 0 YES 1 YES 1
0 2 2
NO 0 YES 0.4 YES 0.4
NO 0 YES 0.4 YES 0.4
NO 0 YES 0.4 YES 0.4
NO 0 YES 0.4 YES 0.4
NO 0 YES 0.4 YES 0.4

5 3 3.0 3 #DIV/0! 3 #DIV/0!

NO 0 YES 2 YES 2
6 1 1.0 1 #DIV/0! 1 #DIV/0!

A. HIS capacity needs A. HIS capacity needs A. HIS capacity needs

assessment was assessment was assessment was
conducted and took conducted and took conducted and took
action/communicated to 2 action/communicated to 2 action/communicated to 2
the next level in the last the next level in the last the next level in the last
six months six months six months

2 3 5

B. Yes but it is offline 1 C. No DHIS-2 0 A. Yes and it is online 2

NO 0 YES 1 NO 0

B. Partial EMR (Any of B. Partial EMR (Any of

the service units except 1.0 the service units except 1.0 A. Full EMR 2.0
MRU) MRU)

NO 0 YES 1 YES 1

A. The hospital is A. The hospital is

B. The hospital is currently implementing currently implementing
Dagu-2 with eAPTS for Dagu-2 with eAPTS for
currently implementing 0.5 pharmacy store 1 pharmacy store 1
Dagu-2 without eAPTS
management and management and
dispensary services dispensary services

26 #DIV/0! #DIV/0!
8 #DIV/0! #DIV/0!

4 2 2.0 2 #DIV/0! 2 #DIV/0!

 5 2 2.0 2 #DIV/0! 2 #DIV/0!

3 2 2.0 2 #DIV/0! 2 #DIV/0!

4 2 2.0 2 #DIV/0! 2 #DIV/0!

8 #DIV/0! #DIV/0!

NO 0 NO 0 YES 2

3 4 4 4 #DIV/0! 4 #DIV/0!

95% 4 4.0 4 0.2 4 0.2

7 #DIV/0! #DIV/0!

NO 0 YES 1 YES 1

5 2 2 2 #DIV/0! 2 #DIV/0!

5 2 2 2 #DIV/0! 2 #DIV/0!
5 3 3 3 #DIV/0! 3 #DIV/0!

3 #DIV/0! #DIV/0!

4 2 1.5 2 #DIV/0! 2 #DIV/0!

4 2 1.5 2 #DIV/0! 2 #DIV/0!

31.25397 #DIV/0! #DIV/0!

A. The hospital and each B. The hospital has an A. The hospital and each
annual plan but targets
directorate has an annual 2 not cascaded to 1 directorate has an annual 2
plan plan
directorates

A. PMT is in place and B. PMT is in place but B. PMT is in place but the
the members are put the members are not members are not put
together based on the 1.0 put together based on 0.5 together based on the 0.5
national standard the national standard national standard

3 2 1.333333333 2 #DIV/0! 2 #DIV/0!

3 1 0.666666667 1 #DIV/0! 1 #DIV/0!

NO 0 YES 1.5 YES 1.5

YES 1.5 NO 0 NO 0

4 1.5 1.5 1.5 #DIV/0! 1.5 #DIV/0!

YES 1.5 NO 0.0 NO 0.0

 NO 0 NO 0 NO 0

A. Root cause is B. Root cause is B. Root cause is identified

identified for all of the identified for only some for only some of the
prioritized low 2 of the prioritized low 1 prioritized low 1
performing key low performing indicators performing indicators
performing indicators

A. Action plan is B. Action plan is

prepared for all the prepared for some of B. Action plan is prepared
identified priority 2 the identified priority 1 for some of the identified 1
problems/challenges problems priority problems

A. There is documented A. There is documented

evidence that previous evidence that previous
action plan is monitored action plan is monitored
during the current PMT 2 during the current PMT 2 B. No action is taken 0
(Complete, partially (Complete, partially
complete and not complete and not
implemented) implemented)

3 2 2 2 #DIV/0! 2 #DIV/0!

A. The hospital has an B. The hospital has a B. The hospital has a

updated DHIS-2 DHIS-2 dashboard for DHIS-2 dashboard for
dashboard for selected 2 selected key indicators 1 selected key indicators 1
key indicators but it is not updated but it is not updated

7 2 1.142857143 2 #DIV/0! 2 #DIV/0!

9 2 1.111111111 2 #DIV/0! 2 #DIV/0!

5 2 2 2 #DIV/0! 2 #DIV/0!

B. Information
A. Information (Performance related) is B. Information
(Performance related) is (Performance related) is
displayed in the health 2 not displayed in the 0 not displayed in the 0
health facility
facility compound compound health facility compound
 A. YES 2 B. NO 0 B. NO 0

A. YES 2 A. YES 2 B. NO 0

B. Twice 1.5 B. Twice 1.5 B. Twice 1.5

B. NO 0 A. YES 2 A. YES 2

Summary Summary Summary

Year 2016 Year 2016 Year 2016

Quarter Q1 Quarter Q2 Quarter Q3

Ass. Date Date: Ass. Date Date: Ass. Date Date:
No. Assessment Core AreasScore(%) No. Assessment Core AreasScore(%) No. Assessment Core AreasScore(%)
1 HIS Structure and Resourc 9% 1 HIS Structure and Resour 0% 1 HIS Structure and Resourc 0%
2 Data Quality 26% 2 Data Quality 0% 2 Data Quality 0%
3 Data Use 31% 3 Data Use 0% 3 Data Use 0%
Total 66% Total 0% Total 0%

Facility Status Facility Status Facility Status

Candidate Facility
 Date: Date: Date:
2016 2017 2017
Quarter 4 Quarter 1 Quarter 2
Denominator Weight/Answer Score Numerator Denominator Weight/Answer Score Numerator Denominator Weight/Answer Score Numerator
#DIV/0! #DIV/0! #DIV/0!
9 9 9
3 3 3
YES 1 YES 1 YES 1
YES 1 YES 1 YES 1
YES 1 YES 1 YES 1
4 1 0 4 1 0 4 1 0
6 6 6
YES 1 YES 1 YES 1
YES 1 YES 1 YES 1
YES 1 YES 1 YES 1

YES 2 YES 2 YES 2

COMPLETE 1 COMPLETE 1 COMPLETE 1

#DIV/0! #DIV/0! #DIV/0!
3 3 3
YES 1 YES 1 YES 1
YES 1 YES 1 YES 1
YES 1 YES 1 YES 1
2 2 2
YES 0.4 YES 0.4 YES 0.4
YES 0.4 YES 0.4 YES 0.4
YES 0.4 YES 0.4 YES 0.4
YES 0.4 YES 0.4 YES 0.4
YES 0.4 YES 0.4 YES 0.4

3 #DIV/0! 3 #DIV/0! 3 #DIV/0!

YES 2 YES 2 YES 2

 1 #DIV/0! 1 #DIV/0! 1 #DIV/0!

A. HIS capacity needs A. HIS capacity needs A. HIS capacity needs

assessment was assessment was conducted assessment was
conducted and took and took conducted and took
action/communicated to 2 action/communicated to 2 action/communicated to 2
the next level in the last the next level in the last six the next level in the last
six months months six months

5 6 5

A. Yes and it is online 2 A. Yes and it is online 2 A. Yes and it is online 2

YES 1 YES 1 YES 1

B. Partial EMR (Any of B. Partial EMR (Any of

the service units except 1.0 A. Full EMR 2.0 the service units except 1.0
MRU) MRU)

YES 1 YES 1 YES 1

A. The hospital is A. The hospital is currently A. The hospital is

currently implementing implementing Dagu-2 with currently implementing
Dagu-2 with eAPTS for Dagu-2 with eAPTS for
pharmacy store 1 eAPTS for pharmacy store 1 pharmacy store 1
management and
management and dispensary services management and
dispensary services dispensary services

#DIV/0! #DIV/0! #DIV/0!

#DIV/0! #DIV/0! #DIV/0!

2 #DIV/0! 2 #DIV/0! 2 #DIV/0!

 2 #DIV/0! 2 #DIV/0! 2 #DIV/0!

2 #DIV/0! 2 #DIV/0! 2 #DIV/0!

2 #DIV/0! 2 #DIV/0! 2 #DIV/0!

#DIV/0! #DIV/0! #DIV/0!

YES 2 YES 2 YES 2

4 #DIV/0! 4 #DIV/0! 4 #DIV/0!

4 0.2 95% 4 4.0 4 0.2

#DIV/0! #DIV/0! #DIV/0!

YES 1 YES 1 YES 1

2 #DIV/0! 2 #DIV/0! 2 #DIV/0!

2 #DIV/0! 2 #DIV/0! 2 #DIV/0!

 3 #DIV/0! 3 #DIV/0! 3 #DIV/0!

#DIV/0! #DIV/0! #DIV/0!

2 #DIV/0! 2 #DIV/0! 2 #DIV/0!

2 #DIV/0! 2 #DIV/0! 2 #DIV/0!

#DIV/0! #DIV/0! #DIV/0!

B. The hospital has an B. The hospital has an B. The hospital has an
annual plan but targets annual plan but targets
not cascaded to 1 annual plan but targets not 1 not cascaded to 1
cascaded to directorates
directorates directorates

B. PMT is in place but B. PMT is in place but the B. PMT is in place but the
the members are not members are not put members are not put
put together based on 0.5 together based on the 0.5 together based on the 0.5
the national standard national standard national standard

2 #DIV/0! 2 #DIV/0! 2 #DIV/0!

1 #DIV/0! 1 #DIV/0! 1 #DIV/0!

YES 1.5 YES 1.5 YES 1.5

NO 0 NO 0 NO 0

1.5 #DIV/0! 1.5 #DIV/0! 1.5 #DIV/0!

NO 0.0 NO 0.0 NO 0.0

NO 0 NO 0 NO 0

B. Root cause is B. Root cause is identified B. Root cause is identified

identified for only some for only some of the for only some of the
of the prioritized low 1 prioritized low performing 1 prioritized low 1
performing indicators indicators performing indicators

A. Action plan is
prepared for all the B. Action plan is prepared B. Action plan is prepared
identified priority 2 for some of the identified 1 for some of the identified 1
problems/challenges priority problems priority problems

B. No action is taken 0 B. No action is taken 0 B. No action is taken 0

2 #DIV/0! 2 #DIV/0! 2 #DIV/0!

B. The hospital has a B. The hospital has a DHIS- B. The hospital has a
DHIS-2 dashboard for 2 dashboard for selected DHIS-2 dashboard for
selected key indicators 1 key indicators but it is not 1 selected key indicators 1
but it is not updated updated but it is not updated

2 #DIV/0! 2 #DIV/0! 2 #DIV/0!

2 #DIV/0! 2 #DIV/0! 2 #DIV/0!

2 #DIV/0! 2 #DIV/0! 2 #DIV/0!

B. Information B. Information B. Information

(Performance related) is (Performance related) is (Performance related) is
not displayed in the 0 not displayed in the health 0 not displayed in the 0
health facility compound facility compound health facility compound
 B. NO 0 B. NO 0 B. NO 0

B. NO 0 B. NO 0 B. NO 0

B. Twice 1.5 B. Twice 1.5 B. Twice 1.5

B. NO 0 B. NO 0 A. YES 2

Summery Summary Summary

Year 2016 Year 2017 Year 2017

Quarter Q4 Quarter Q1 Quarter Q2

Ass. Date Date: Ass. Date Date: Ass. Date Date:
No. Assessment Core AreasScore(%) No. Assessment Core Areas Score(%) No. Assessment Core AreasScore(%)
1 HIS Structure and Resour 0% 1 HIS Structure and Resources 0% 1 HIS Structure and Resourc 0%
2 Data Quality 0% 2 Data Quality 0% 2 Data Quality 0%
3 Data Use 0% 3 Data Use 0% 3 Data Use 0%
Total 0% Total 0% Total 0%

Facility Status Facility Status Facility Status

 Date:
2017 2017
Quarter 3 Quarter 4
Denominator Weight/Answer Score Numerator Denominator Weight/Answer Score
#DIV/0! #DIV/0!
8 7
2 3
YES 1 YES 1
NO 0 YES 1
YES 1 YES 1
4 1 0 4 1 0
6 4
YES 1 YES 1
YES 1 YES 1
YES 1 YES 1

YES 2 NO 0

COMPLETE 1 COMPLETE 1
#DIV/0! 7.0
3 3
YES 1 YES 1
YES 1 YES 1
YES 1 YES 1
2 2
YES 0.4 YES 0.4
YES 0.4 YES 0.4
YES 0.4 YES 0.4
YES 0.4 YES 0.4
YES 0.4 YES 0.4

3 #DIV/0! 2 3 3 2.0

YES 2 YES 2
 1 #DIV/0! 1 #DIV/0!

A. HIS capacity needs A. HIS capacity needs

assessment was assessment was
conducted and took conducted and took
action/communicated to 2 action/communicated to 2
the next level in the last the next level in the last
six months six months

5 5

A. Yes and it is online 2 A. Yes and it is online 2

YES 1 YES 1

B. Partial EMR (Any of B. Partial EMR (Any of

the service units except 1.0 the service units except 1.0
MRU) MRU)

YES 1 YES 1

B. The hospital is currently B. The hospital is currently

implementing Dagu-2 0.5 implementing Dagu-2 0.5
without eAPTS without eAPTS

#DIV/0! #DIV/0!
#DIV/0! #DIV/0!

2 #DIV/0! 2 #DIV/0!
 2 #DIV/0! 2 #DIV/0!

2 #DIV/0! 2 #DIV/0!

2 #DIV/0! 2 #DIV/0!

#DIV/0! #DIV/0!

YES 2 YES 2

4 #DIV/0! 4 #DIV/0!

95% 4 4.0 75% 4 3.2

#DIV/0! #DIV/0!

YES 1 YES 1

2 #DIV/0! 2 #DIV/0!

2 #DIV/0! 2 #DIV/0!
 3 #DIV/0! 3 #DIV/0!

#DIV/0! #DIV/0!

2 #DIV/0! 2 #DIV/0!

2 #DIV/0! 2 #DIV/0!

#DIV/0! #DIV/0!
B. The hospital has an
annual plan but targets C. The hospital doesn't
not cascaded to 1 have a plan at all 0
directorates

B. PMT is in place but the A. PMT is in place and the

members are not put members are put together
together based on the 0.5 based on the national 1.0
national standard standard

2 #DIV/0! 2 #DIV/0!

1 #DIV/0! 1 #DIV/0!

YES 1.5 NO 0
NO 0 YES 1.5

1.5 #DIV/0! 1.5 #DIV/0!

NO 0.0 YES 1.5

NO 0 Yes 2

B. Root cause is identified B. Root cause is identified

for only some of the for only some of the
prioritized low performing 1 prioritized low performing 1
indicators indicators

B. Action plan is prepared B. Action plan is prepared

for some of the identified 1 for some of the identified 1
priority problems priority problems

A. There is documented
evidence that previous
action plan is monitored
B. No action is taken 0 during the current PMT 2
(Complete, partially
complete and not
implemented)

2 #DIV/0! 2 #DIV/0!

B. The hospital has a B. The hospital has a DHIS-

DHIS-2 dashboard for 2 dashboard for selected
selected key indicators 1 key indicators but it is not 1
but it is not updated updated

2 #DIV/0! 2 #DIV/0!

2 #DIV/0! 2 #DIV/0!

2 #DIV/0! 2 #DIV/0!

B. Information B. Information
(Performance related) is (Performance related) is
not displayed in the 0 not displayed in the health 0
health facility compound facility compound
 B. NO 0 B. NO 0

B. NO 0 A. YES 2

B. Twice 1.5 A. Three times 2.0

A. YES 2 A. YES 2

Summery Summary
Year 2017 Year 2017

Quarter Q3 Quarter Q4
Ass. Date Date: Ass. Date Date:
No. Assessment Core Areas Score(%) No. Assessment Core Areas Score(%)
1 HIS Structure and Resource 0% 1 HIS Structure and Resource 0%
2 Data Quality 0% 2 Data Quality 0%
3 Data Use 0% 3 Data Use 0%
Total 0% Total 0%

Facility Status Facility Status

Table X: Template for measuring data completeness on registers for selected indicators
Example: Delivery attended by skilled birth attendant
Indicator
(SBA)
Register Example: Delivery register
Data
Mark as “Complete” or
Sampled MRN completeness on
“incomplete”
registers
168 Complete
175 Complete
182 Complete
189 Incomplete
196 Complete
204 Incomplete
7/10=70%
211 Incomplete
218 Complete
225 Complete
232 Complete
Total sampled
Total MRNs with complete data= 7
MRNs=10

Table Z: Template for measuring data completeness on individual medical records

Data
Mark as “Complete” or completeness on
Sampled MRN
“incomplete” individual
medical records
168 Complete
175 Complete
182 Complete
189 Incomplete
196 Complete
204 Incomplete
5/10=50%
211 Incomplete
218 Incomplete
225 Incomplete
232 Complete
Total sampled
Total Individual medical records
individual medical
with complete data= 5
records=10

Name of the Register Data elements selected for checking register completeness
Family planning
Table Y: Template for measuring consistency of data of registers against individual medical re
Example: Delivery
Indicator attended by skilled birth
attendant (SBA)
Register Example: Delivery register
Data Consistency level of
Mark as “Matched” or
Sampled MRN registers against individual
“Not matched”
medical record
168 Matched
175 Matched
182 Not matched
189 Not matched
196 Not matched
204 Not matched
6/10=60%
211 Matched
218 Matched
225 Not matched
232 Matched
Total sampled Total MRNs with
MRNs=10 matched data= 6

Table P: Template for measuring consistency of data of individual medical records against reg

Data Consistency level of

Mark as “Matched” or
Sampled MRN individual medical record
“Not matched”
against register

168 Not matched

175 Not matched
182 Matched
189 Not matched
196 Not matched
204 Matched
4/10=40%
211 Not matched
218 Not matched
225 Matched
232 Not matched
Total sampled Total MRNs with
MRNs=10 matched data= 4
nst individual medical records
Year 2014
Quarter Q2
Assessment Date 30/06/2014

Assessment Core Areas Expected Score Assessment Score

HIS Structure and Resources 30% 29%
Data Quality 30% 27%
Data Use 40% 33%
Total Score 100% 89%
IR Pathway Candidate Facility
 Zewditu
This dashboard summerizes Current Quarter Information Revolution (IR) self assessment result & compares it with the expected IR result and tracks the IR trend of the facility with
respect to HIS, Data Quality, Data Use and Total Score. The insight from the dashboard can be used to improve Facility IR implimentation strategy.

Current Quarter Assesment Result IR Trend

Year 2014 IR Pathway Candidate Facility This shape represents a
slicer. Slicers are
HIS Structure and Resources Trend
Quarter Q2 supported in Excel
2010 or later. 21%

IR Assessment Result If the shape was

modified in an earlier
HIS Structure and Resources Data Quality Data Use version of Excel, or if
the workbook was
saved in Excel 2003 or
earlier, the slicer
This shape represents a
cannot be used.
slicer. Slicers are
29% supported in Excel
33%
2010 or later.
0% 0%
If the shape was
2014 Q2 Q3 Q4
modified in an earlier
version of Excel, or if
the workbook was
27% saved in Excel 2003 or
earlier, the slicer cannot
be used. Data Quality Trend

22%
Expected Score VS Assessment Result
Assessment Score Expected Score

33%
Data Use
40%

27% 0% 0%
Data Quality 2014 Q2 Q3 Q4
30%

29%
HIS Structure and Resources Data Use Trend
30%

23%

IR Pathway
Emerging: A facility whose total Score is less than or equal to 65%
Candidate: A facility whose total Score is between 65% and 90%
Model: is where facility total score is greaterthan or equal to 90%

0% 0%
2014 Q2 Q3 Q4

Total Score Trend

66%

0% 0%
2014 Q2 Q3 Q4