Yellow Star Programme Supervisor Manual - Uganda Program For ...

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YELLOW STAR
PROGRAMME
SUPERVISOR
MANUAL
January 2002
THE REPUBLIC OF UGANDA
i INTRODUCTION
The mission statement of the Ministry of Health (MOH) states that: “The overall goal of
the health sector is the attainment of a good standard of health by all people in Uganda,
in order to promote a healthy and productive life.”
To achieve this end, we must ensure that good quality health services are offered to the
population. It is important that every health facility in Uganda provides a basic level of
services that are reliable, safe and trustworthy.
Clients have the right to receive good quality health care including access to friendly and
respectful treatment, drugs, medical equipment and supplies, competent health workers
and a clean service environment. Clients should feel comfortable visiting health facilities
and not be afraid or intimidated to seek services.
To accomplish the goal of providing good quality health services, health facilities must
continually evaluate the services they offer and find ways to make those services better
for their client. The Yellow Star Programme was developed as a means of encouraging
health professionals at all levels to improve the quality of health services through a
system of certification and recognition.
The Yellow Star Programme builds upon the existing foundation of health care services.
The programme is integrated with the National Supervision Guidelines and the current
supervision system in order to be consistent with policies and procedures already in
place. The programme is designed to institute a team approach to support better quality
services, involve communities in quality improvements, enhance health worker
performance and maintain quality through a standardized system.
The purpose of this manual is to provide a set of adaptable tools and guidelines to
facilitate the improvement of the quality of health services throughout the health care
system. This manual will support supervisors and health workers in their role of
improving the quality of care at their health facilities. The materials provided here have
been developed with feedback from many different stakeholders and field tested with
health workers and clients.
It is important to note that the Yellow Star Programme is a complement to quality
improvement activities that have already been implemented by the MOH. Improving the
quality of health services is an ongoing, evolving process aimed at providing the people
of Uganda with access to better health care services. If we work together as a team supervisors, health workers and the communities - we can truly make a difference in the
quality of health services provided to this country.
Professor F.G. Omaswa
Director General of Health Services
ii ACKNOWLEDGEMENTS
The Yellow Star Programme manual was produced by members of the Yellow
Star Working Group including:
 Professor E. Kaijuka, Commissioner of Health Services, Quality
Assurance, MOH
 Dr. H.M. Mwebesa, Asst. Commissioner of Health Services, Quality
Assurance, MOH
 Paul Kagwa, Asst. Commissioner of Health Services, Health Promotion &
Education, MOH
 Dr. G. Ssekitto, DDHS, Nakasongola District
 Dr. J. Ddamulira, Deputy DDHS, Ssembabule District
 Dr. S. Musisi, Deputy DDHS, Masaka District
 Dr. E. Rutebemberwa, Medical Superintendent, Kamuli Mission Hospital
 Daisy Okware, District Health Visitor, Kampala District
 Dr. V. David, Health Management & Quality Assurance Advisor, DISH II
Project
 Dr. Q. Okello, Regional Centre for Quality of Health Care
 Cheryl Lettenmaier, Communication Advisor, DISH II Project
 Tembi Matatu, Clinical Skills & Training Advisor, DISH II Project
 Margaret Brawley, Communication Manager, DISH II Project
 Dr. E. Ekochu, Supervision/Quality Assurance Specialist, DISH II Project
The manual was developed through a series of meetings over an 18-month
period. The health care standards were based on the Uganda National Minimum
Health Care Package and the National Supervision Guidelines. The standards
were reviewed and validated in seven districts at 29 health facilities. As part of
this testing, the standards were reviewed by health workers and clients in both
government and private health facilities. Representatives from all levels of the
health system from the MOH to Health Unit Management Committee also
participated.
The MOH wishes to thank members of the Yellow Star Working Group for their
invaluable contribution in completing the manual. The MOH also gratefully
acknowledges:
The Delivery of Improved Services for Health II Project for their active
involvement in the development process of the Yellow Star Programme;
All development partners and other organisations who reviewed the
standards and provided crucial feedback;
CARE and the individuals and health facilities who participated in the
validation exercises;
iii
McCann-MCL Ltd. which designed the Yellow Star logo, slogan and
promotional materials, the European Development Fund (EDF) for their
invaluable input on design and all the District Health Educators who
assisted in pre-testing the Yellow Star logo and materials.
Finally, special appreciation goes out to the Director General of Health Services,
Professor Omaswa and senior MOH management for their continual support and
contribution to this process.
iv ABBREVIATIONS - ACRONYMS
DHS District Health Services
DHT District Health Team
DDHS Director of District Health Services
DISH Delivery of Improved Services for Health Project
HC Health Centre
HMIS Health Management Information System
HSD Health Sub-District
HUMC Health Unit Management Committee
IEC Information Education Communication
IPC Inter-Personal Communication
IPW In-Patient Ward
LC Local Council
MAT Maternity Ward/Delivery
MCH Maternal Child Health Clinic
MP Member of Parliament
MOH Ministry of Health
NGO Non-Governmental Organization
OPD Out-Patient Department
QI Quality Improvement
QOC Quality of Care
v TABLE OF CONTENTS
INTRODUCTION ......................................................................................................................................... i
ACKNOWLEDGEMENTS ......................................................................................................................... ii
ABBREVIATIONS - ACRONYMS ........................................................................................................... iv
TABLE OF CONTENTS ............................................................................................................................ v
SECTION 1: ................................................................................................................................................ 1
YELLOW STAR ......................................................................................................................................... 1
Strategy.................................................................................................................................................. 1
SECTION 2: ................................................................................................................................................ 7
Infrastructure And Equipment ............................................................................................................. 8
Management Systems ....................................................................................................................... 10
Infection Prevention............................................................................................................................ 10
SECTION 3: .............................................................................................................................................. 13
Yellow Star Programme Description........................................................................................................ 13
Preparing For An Assessment Review...................................................................................................... 15
The Day Of The Assessment Review ......................................................................................................... 15
SECTION 4: .............................................................................................................................................. 18
The Assessment Tools.............................................................................................................................. 18
Inventory And Record Review ............................................................................................................ 48
In-Patient/Hospital Specific Standards .............................................................................................. 51
SECTION 5:................................................................................................................................................ 55
Star Health Worker Award For Supervisors...................................................................................... 62
SECTION 6: .............................................................................................................................................. 66
Implementing Activitiest to Improve Services or Performance............................................................ 70
SECTION 7: .............................................................................................................................................. 73
SECTION 8: .............................................................................................................................................. 80
SECTION 9: .............................................................................................................................................. 83
SECTION 10: ............................................................................................................................................ 91
SECTION 1: YELLOW STAR STRATEGY
1
SECTION 1:
YELLOW STAR
STRATEGY
SECTION 1: YELLOW STAR STRATEGY
2
In July 2000, the Ministry of Health (MOH) met with the District Health Services
and representatives from development partners to discuss ways to improve the
quality of health care services in Uganda.
Prior to the elimination of cost sharing, research illustrated a decline in the use of
services at government health facilities. Generally, this occurs when the quality of
service is poor. Community members do not to use services that they think are
poor quality. In fact, studies and supervision visits to health facilities found that
services need to be improved. With the abolishment of the cost sharing, there
has been a marked increase in the number of people using government health
facilities. However, there is still a need to improve the quality of services being
provided. In fact, it is more of a concern now than ever before.
All clients have the right to receive good quality health care including access to
friendly and respectful treatment, drugs, medical equipment and supplies,
competent health workers and a clean service environment. Clients should feel
comfortable visiting health facilities and not be afraid or intimidated to seek
services.
In order to address the issue of quality, the MOH developed the Yellow Star
Programme. The goal of the programme is to improve and maintain the quality
of services through a system of certification and recognition. Similar
programmes have been implemented in Egypt, Brazil and West Africa. The
Yellow Star Programme has four steps:
Step 1: Establishing the Basic Standards for Quality Health Care
A working group comprised of the MOH, District and development partner
representatives was formed to draft the Basic Standards for Quality Health
Services or “Basic Standards.” (A copy can be found in Section 2.) These health
care standards are based on the Uganda National Minimum Health Care
Package and the National Supervision Guidelines.
The standards were reviewed and validated in seven districts at 29 health
facilities. As part of this testing, the standards were reviewed by health workers
and clients in both government and private health facilities. Representatives
from all levels of the health system from the MOH to Health Unit Management
Committee also participated. Their input was vital to this process.
The final result is a list of 35 basic standards for quality health care services.
The standards measure quality from the client’s perspective, as well as the
health worker’s perspective. Specifically, these standards address six core
areas:
SECTION 1: YELLOW STAR STRATEGY
3
 infrastructure and equipment
 management systems
 infection prevention
 IEC materials and IPC skills of health
workers
 clinical services
 client/patient service
SECTION 1: YELLOW STAR STRATEGY
4
These standards will evolve over time. They will be regularly examined and
assessed for updates, changes, additions or deletions. Since, the goal is to
continually improve the level of quality at health facilities, it will be important to reevaluate the standard and if necessary, raise the level of expectation especially
as health facilities begin to regularly meet a certain standard.
Step 2: Communicating the Basic Standards throughout the Community
and the Health Care System
In order for the Yellow Star Programme to work effectively, community members
and health workers must understand what is meant by quality health care and
what these basic standards are. Working together we can improve the quality of
health services so that health facilities in your district can meet the 35 standards.
The purpose is to encourage all parties, including the community, to actively
participate in this quality improvement process. Every health facility belongs to
the community -- so what can the community do to help make it a place they are
proud of, a place they would go to for medical assistance?
A variety of materials have been developed to educate community members and
health workers about the program. Posters, radio announcements, informational
brochures and word-of-mouth will help them to understand what the Yellow Star
Programme is all about. In addition, each health facility will receive a Yellow Star
Activation Kit from their supervisor. This kit contains essential tools and
materials to help a health facility get started on meeting the standards. As a
supervisor, it is your job to educate the health facility staff about the Yellow Star
programme, encourage the staff’s active participation and monitor their progress.
Step 3: Monitoring and Certifying facilities that Meet and Maintain the Basic
Standards
You will monitor health facilities during your quarterly supervision visits using an
easy-to-follow assessment review process. This process will allow you to
evaluate whether or not a health facility is complying with each standard. You
will provide a copy of the results from each review to the staff of the health facility
and review the details with them so they understand where improvements can be
made. In addition, the results will be forwarded to the HSD and DHS to track
each health facility’s progress.
When a health facility meets all of the standards during two consecutive quarterly
supervisory visits, an independent review team will verify that the health facility
has met the standard criteria. If the outcome of the independent review team is
consistent with your reports, the facility will be certified as a Yellow Star facility.
Local leaders and district health officials will present the Yellow Star during a
SECTION 1: YELLOW STAR STRATEGY
5
highly publicised ceremony. Qualifying health facilities will receive wall markers
and certificates for display.
In order to retain the Yellow Star, health facilities must continue to meet all of the
Basic Standards every quarter. If a Yellow Star health facility fails to meet all the
standards during a supervisory visit, the facility will be given three additional
months to improve their problem areas. The health facility will then be reviewed
again and if the standards are still not met, the Yellow Star will be removed.
Step 4: Educating and Informing the Public about the Services They Can
Receive from Yellow Star Facilities
The main purpose of the Yellow Star Programme is to improve the quality of
health services and identify health facilities where good quality services are
offered. For this to happen, clients must learn what kind of service they can
expect and demand from Yellow Star facilities. This education process will take
place during community meetings, public award ceremonies and through the use
of mass media messages.
How You Can Help
As a supervisor, you play an important role in the implementation of the Yellow
Star Programme at health facilities you supervise, as well as educating the staff
of each health facility about quality health care services and how the health
facility community can benefit from the programme. You are an influential force
in this process -- use that influence to help improve and maintain good quality
health care services in your district. So what exactly can you do?
 Educate all the health facilities you supervise about the Yellow Star
Programme. Use the Activation Kit as your guide. Be sure to entertain and
answer all questions, concerns and comments from staff. It is vital that they
clearly understand the programme.
 Monitor all health facilities in your HSD quarterly during your regular
supervision visits. Conduct evaluations that are fair, open and honest.
 Help the staff of the health facility understand why the facility did not meet
certain standards and help them identify areas for improvement.
 Guide health workers to develop a plan of action to make quality
improvements at their health facility and monitor implementation of those
improvements.
 Acknowledge and praise good performance and quality improvement
efforts. Encourage staff to maintain those improvements.
 Participate in the Yellow Star award ceremonies.
 Give the District Health Services feedback about the Yellow Star Programme.
SECTION 1: YELLOW STAR STRATEGY
6
In order to successfully improve the quality of health care services in Uganda, the
entire health system has to work as a team. Each level of the system must be
committed to attaining and maintaining the “Basic Standards” and needs to
understand their role in supporting the health facilities.
You are an important member in this process. As a supervisor, you are the link
between the District and the health facilities. You help facilities to identify,
improve and monitor the quality of health services. You are the guiding light for
health workers -- a close reference that can be called upon for assistance. You
are an influential force in the quality improvement process. Not only will you be
helping to educate health facilities about the Yellow Star Programme, but you will
also be key to monitoring and evaluating, as well as improving performance.
As a committed Supervisor, you will help your community achieve and maintain
these basic standards. You will help to improve the health services for people in
your community and you will be recognised for those efforts. Improving health
services is a vital aspect of improving the welfare and well being of your
community. Here is your chance to make a big difference!
SECTION 2: BASIC STANDARDS FOR QUALITY HEALTH SERVICES
7
SECTION 2:
BASIC STANDARDS
FOR
QUALITY
HEALTH SERVICES
SECTION 2: BASIC STANDARDS FOR QUALITY HEALTH SERVICES
8
THE REPUBLIC OF UGANDA
Basic Standards for Quality Health Services
INFRASTRUCTURE AND EQUIPMENT
# Standard Operational Definition Means of Verification
1.1 Is there a reliable and clean supply of
water from a protected water source?
a. There is running water (pipe) within the facility,
OR there is a water tank within the facility,
OR there is a protected water source within 200 metres of the facility: borehole, water
tank or protected spring (with tubing of water for outflow, concrete slab, drainage and
the spring is at least 33 metres away from latrines/toilets) & temporary storage
containers (e.g. jerrycans or drums).
b. There is water flowing from this main source.
Observation of the water source and
check if water is flowing from the
source.
1.2 Does the facility have clean latrines or
toilets?
a. Latrines or toilets exist within the facility or facility compound.
b. Staff and clients have access to at least one latrine or toilet at any given time and the
client’s latrine or toilet is not locked.
c. Toilet bowl is clean and empty/latrine slab is clean.
d. Soap and water are available at the washing point near the toilet(s)/latrine(s).
Observation of toilets/latrines.
1.3 Does the facility have a rubbish pit for
disposal of refuse and medical waste?
Does the unit have a placenta pit (HC
3+)?
a. There is a rubbish pit within the compound (possibly a garbage bin in urban settings).
b. The pit (bin) is not overflowing and is properly used (i.e. rubbish is not disposed of
anywhere else).
c. There is a functional (i.e. concrete slab on top, air tight seal) placenta pit
within the compound (HC 3+)
Observation of rubbish pit and placenta
pit (garbage bin)
1.4 Does the facility have a functional
examination couch? (For a facility
carrying out deliveries, is there a
functional delivery couch? For in-patient
wards - are there beds with mattresses in
good shape?)
a. Examination couch (and delivery couch, in facilities carrying out deliveries) is present
in unit.
b. It is covered with a clean, untorn macintosh or a plastic sheet.
c. It is clean (i.e. there is no visible dust, stains or blood).
NOTE: For facilities with in-patient wards: Beds with mattresses are present in the unit.
Mattresses are clean and in acceptable shape.
Inspection of examination (and delivery
couch and in-patient beds if applicable)
1.5 Does the facility have basic
examination and emergency
equipment?
a. The following pieces of equipment are available, functional and registered in the
inventory:
HC 2: thermometer, baby weighing scale, timing device, ORS corner [including the
following ORT equipment: water jug, 2 cups and 2 spoons], fetoscope, BP cuff/machine,
stethoscope, adult weighing scale, lantern or alternate lighting source such as backup
generator, solar lamps, etc., equipment for boiling
HC 3: same as HC 2 + neonatal weighing scale, speculum + delivery kit
HC 4+: same as HC 3 + microscope, sterilizer/autoclave, anesthesia machine*, Csection sets (2)*, Laparotomy sets (2)*, refrigerator for blood*, cross matching
equipment*, blood for transfusion*
NOTE: thermometer, BP cuff and stethoscope must be in all functional clinic areas in the unit (i.e.
OPD, MCH, maternity, in-patient wards). However, it is not necessary to check the inventory
records for those 3 pieces.
*If a unit does not have an operational theatre then they will not be evaluated for these items.
Review of inventory record for all items
except thermometer, BP cuff,
stethoscope and blood bags.
Observation of items in OPD, MCH,
Maternity or In-patient Wards as
applicable. Inspect each item to see if
functioning properly.
1.6 Are men’s and women’s in-patient
wards separated?
a. Men’s beds and women’s beds are in separate wards or there are screens
or curtains between men’s beds and women’s beds on in-patient wards (HC4+).
Observation of in-patient wards.
SECTION 2: BASIC STANDARDS FOR QUALITY HEALTH SERVICES
9
# Standard Operational Definition Means of Verification
2.1 Do client registers exist and are they
well kept and up-to-date?
a. Registers exist in OPD, ANC and FP clinics/maternity.
b. Information on dates, patient characteristics (names, sex, age and address parish/village), diagnosis and treatment (dosage, times/day, # of days) are
written in the registers, as per the HMIS Manual.
Inspection of registers in clinic rooms.
2.2 Were monthly Summary Report forms
completed appropriately over the last 3
months?
a. Copies of the HMIS 105 forms for the last three months are present in the
unit OR the information is registered in the unit’s database. [These forms are
required to be completed and submitted by the 7th of each month. Therefore, if the
review takes place after the 7th then the form should be available for that particular
month.]
. b. The number of reported malaria visits for all ages for one month in the last
quarter corresponds to the number of cases in the OPD register(s) for the
same month (plus or minus 5%).
Review copies of HMIS 105 or unit
database. Pick one month in the last
quarter and compare the total number
of malaria cases (under 5 years and
over 5 years) with the register(s); totals
should be the same plus or minus 5%
.
2.3 Are there updated stock cards at the
facility store (register books) for at
least five randomly selected products?
a. Stock cards/register books at the facility store for the five selected products
are present in the store.
b. Stock cards are up to date and correspond to physical stock.
Randomly choose five drugs using the
list of essential drugs provided in the
assessment tool. Review availability of
stock cards. Compare registered
quantities with physical count at the
facility store.
2.4 Were the following
drugs/contraceptives available during
the past 3 months at the facility:
chloroquine, Fansidar®, cotrimoxazole,
ORS, measles vaccine, DPTHepB+hib vaccine, Depo-Provera®
and condoms?
a. Stock cards show the absence of a stock out for the mentioned
drugs/contraceptives for the past three months. [If the stock cards ever
show a 0, this indicates a stock out.]
(Note: HC IIs are not required to have the listed vaccine in stock.)
Review of stock cards/register books.
2.5 Does the Health Unit Management
Committee meet once every quarter?
(For NGO facilities as stipulated by
governing body)
a. Minutes of meetings conducted during the last quarter (or as stipulated for
NGO facilities) are available at the facility.
Review of meeting minutes.
2.6 Does the facility have the guidelines
and standards required for
management of clients/patients?
a. Uganda Clinical Guidelines and IMCI Treatment Guidelines [chart-booklet or
wall chart] are available in all OPD consulting rooms.
Verify availability of both documents in
all OPD consulting rooms and make
sure they are accessible.
SECTION 2: BASIC STANDARDS FOR QUALITY HEALTH SERVICES
10
MANAGEMENT SYSTEMS
INFECTION PREVENTION
# Standard Operational Definition Means of Verification
3.1 Does the facility provide adequate
infection prevention/control in the area
of hand washing?
a. Soap and water are available at the washing point(s) in or near the
consulting room(s).
b. Providers wash their hands between clients and procedures.
Observation of available water and
soap. Observation of provider
practices.
3.2 Does the facility provide adequate
infection prevention/control in the area
of disposal of sharps and needles?
a. Labeled containers for sharp object disposal are available in the
examination, injection and dressing rooms and laboratory if applicable.
b. Staff safely disposes of sharp objects and needles in the container provided
and do not reuse disposable material. [i.e. Staff dispose needles in a sharps
container uncapped. The container is either burnt in an incinerator or
emptied in a deep pit/pit latrine, but not a placenta pit.]
Availability of labeled sharp object
containers in the examination, injection
dressing rooms and laboratory.
Observation of the absence of sharps
in the rubbish pit, receivers or in open
areas.
Observation of staff practices.
Interview with In-charge and other
providers on functionality of
incinerator.
3.3 Are the injection, dressing and
examination rooms (and delivery/labor
room(s) for facilities with delivery
services) clean service environments?
a. Dressing room(s), injection room(s) and examination room(s) [laboratory
and delivery room(s) where applicable] are mopped and free of soiled
materials.
b. A dustbin is available in the following areas: delivery rooms, dressing rooms,
laboratory, dental room and injection rooms.
Observation of rooms and dressing
trolleys.
3.4 Does the health unit have facilities for
disinfection?
a. Buckets, chlorine solution (e.g. JIK) and other disinfectants are available in
at least one area of the OPD, MCH, Maternity and In-patient Ward.
Observation of a bucket with
disinfectant prepared in those areas.
3.5 Is the staff following correct aseptic
techniques?
a. Health workers are performing according to guidelines the following aseptic
procedures: wound dressing, suturing, catheterisation, injections, Norplant
insertion or removal, intravenous infusion and dental extraction.
Observation of two aseptic procedures.
SECTION 2: BASIC STANDARDS FOR QUALITY HEALTH SERVICES
11
IEC/IPC
CLINICAL SERVICES
# Standard Operational Definition Means of Verification
5.1 Does the staff maintain a proper cold
chain?
For HCIII+:
a. Temperature monitoring chart is fixed on the refrigerator.
b. Temperatures are monitored twice daily, seven days per week.
c. Temperatures maintained between +2 and +8C.
d. Thermometer is in the refrigerator.
For all facilities:
a. vaccine carriers and ice packs available and in good condition
Observation of temperature chart, refrigerator
(if present in the unit), ice packs and vaccine
carriers.
5.2 Are immunization services provided on a
daily basis in this facility so as to reduce
“missed opportunities”?
a. For HCIII+: staff provides immunization to the child during the
same day/visit. For HCII: staff provides at least weekly
immunization services.
Review records, tally sheets and
immunization registers for dates.
5.3 Do all the children who visit the facility
have their weight plotted correctly on the
health card?
a. All under-five children coming to the facility are weighed.
b. Weight is accurately plotted on the child’s health card.
c. If more than one weight is plotted, a line is drawn to connect the
dots.
Review child health card of two children
exiting the consulting room(s) to see if weight
is accurately plotted.
5.4 Are providers giving technically appropriate
services?
a. Health workers are providing technically correct services,
according to current guidelines and supervision checklists in the
following areas: IMCI, ANC, Delivery, PNC, FP, STD, Malaria,
TB, Injury management, Dental care
Observation of one IMCI case and two cases
in any of the other mentioned areas and
assessment of the adequacy of case
management based upon compliance with
the checklists included in the NSG.
5.5 Are providers giving technically appropriate
inpatient care?
a. Health workers are prescribing appropriate treatment for the
stated diagnosis, according to Uganda Clinical Guidelines for the
following in-patients: sick children, medical and surgical.
b. In-patients are receiving treatment as prescribed.
Review medical records (registers, treatment
cards) of three clients.
Interview in-patients/caretakers about
treatment received.
# Standard Operational Definition Means of Verification
4.1 Are health education talks given to
clients?
a. Health facility conducts group health education sessions at least 4 times per
month for previous 3 months.
Observe registers for previous 3
months or posted schedules.
4.2 Do providers use appropriate teaching
aides during client
counseling/education?
a. Service providers use one of the following materials during client
counseling/education sessions: posters, sample foods or family planning
methods, anatomical models, brochures, leaflets, flipcharts or cue cards.
Observation during provider/client
interactions (see 5.4).
4.3 Are service providers encouraging
clients to actively discuss any problem
or concern about their health and
treatment during the visit?
a. Providers ask clients about their history and problems.
b. Providers invite clients to ask questions.
Observation during provider/client
interactions (see 5.4).
SECTION 2: BASIC STANDARDS FOR QUALITY HEALTH SERVICES
12
CLIENT SERVICES
# Standard (as per NSG) Operational Definition Means of Verification
6.1 Is the facility’s waiting area clean and
protected?
a. The waiting area protects clients from the sun and rain.
b. The floor is mopped. The area is clean of debris/trash. The walls
and ceiling are reasonably clean.
Observation of waiting area(s).
6.2 Does the facility have a private area for
physical examinations and/or deliveries?
a. Examination areas are either private rooms with doors that close
or areas sectioned off by curtains/screens.
b. Privacy is maintained during procedures
Observation of all examination rooms.
Observation of provider practices.
6.3 Are patients and their attendants received
in friendly and respectful manner?
Clients answer yes to the following questions:
a. Did the health worker direct you where to go next?
b. Did you feel you were treated respectfully by the health
worker(s) who you met at the health facility today?
Exit interviews with three clients
(representing both genders).
6.4 Do providers see clients on first-come,
first-serve basis?
a. There is a system in place to serve clients in the order in which
they arrive. Only extremely sick individuals are given priority over
others who are waiting.
Observe clients’ flow. Interview clients.
6.5 Do clients wait one hour or less after
arrival at the health facility before being
seen by a provider?
a. Clients state that they were seen in one hour or less from the time
he/she entered the facility for non-emergency cases.
Exit interviews with three clients
(representing both genders).
6.6 Does provider/dispenser provide
appropriate information to client regarding
treatment compliance?
a. Provider/dispenser instructs clients about the medication, the
amount of medication to take, what time of the day it should be
taken and for how long it should be taken.
b. Provider/Dispenser checks the client’s understanding.
Observation of three clients receiving
treatment at the dispenser’s window (or from
the provider if there is no dispenser).
6.7 Does the facility have a plan for referring
emergency cases?
a. The facility provides some type of assistance for moving a sick
patient to a referral facility, such as: communication to the next
level, ambulance, arranging community transport, or funds for
fuel or public transport.
Interview with the in-charge and one other
provider.
6.8 Does the facility have at least one staff
member trained in the following areas in
the OPD and MCH departments: IMCI, FP,
STD management, ANC/PNC, and Malaria
management?
a. The facility has at least one provider in OPD and one provider in
MCH offering these services to clients who has received inservice training specific to these services: IMCI, Family Planning,
STD management, and Malaria Management; and at least one
provider in either OPD or MCH offering services to clients who
has received in-service training in ANC/PNC.
Interview with in-charge and MCH/OPD
providers on site. Cross check information
with DDHS office
6.9 Does the facility post a list of available
services where the clients can see them?
a. A poster with listed services, in language understood by clients is
displayed in the waiting area where the clients can see it.
Observation of waiting area.
6.10 Is there a health provider available at all
times?
a. A qualified health provider is available 24 hours a day, 7 days a
week (A qualified provider = nurse, midwife, CO or MO) for
HC3+.
b. There is staff housing near the health facility OR in the unit, a
duty room is available for staff with sleeping accommodations.
Review the current duty roster. Observation
of staff housing or duty room with sleeping
accommodations.
SECTION 3: YELLOW STAR PROGRAMME DESCRIPTION
13
SECTION 3:
YELLOW STAR
PROGRAMME
DESCRIPTION
SECTION 3: YELLOW STAR PROGRAMME DESCRIPTION
14
The Ministry of Health has developed 35 Basic Standards for Quality Health
Services to assess the quality of services provided at health facilities. These
standards are a set of guidelines that demonstrate how each health facility in
Uganda should operate and what each facility should achieve during their daily
health worker – client interactions. Health facilities that can meet and maintain
these basic standards will be certified as Yellow Star health facilities.
THE ASSESSMENT REVIEW
Basic Standards will be monitored in the health facilities during a quarterly Yellow
Star Assessment Review. An assessment tool has been designed to determine
whether a facility has actually achieved the basic standards. (A copy of this tool
is located in Divider 4.) This tool will be used by the Supervision Team during
regular support supervision visits each quarter to evaluate the health facility.
When Are Assessment Reviews Conducted?
As a HSD supervisor, you currently conduct regular supervision visits to the
health facilities for technical or integrated support supervision. The supervisor or
supervisory team, under the Medical Officer In-Charge of the HSD, schedule
these supervisory visits and inform the health facilities accordingly.
The Yellow Star Assessment Review will be conducted at each facility during
these supervision visits on a quarterly basis. The supervision calendar should
clearly indicate which visits include the Yellow Star Assessment Review. (This is
the responsibility of the HSD In-Charge or one of the team members to whom
this task is delegated.) It is also important that the health facilities know the
schedule for their assessment reviews in advance so they can prepare.
If a facility meets all 35 standards for two consecutive assessments, the district
will send out an independent team to verify these findings. If the district team
confirms the findings, the health facility will be certified as a Yellow Star health
facility.
In order to retain the status as a Yellow Star health facility, a health facility must
continue to meet all 35 Basic Standards for Quality Health Services. If a health
facility fails to meet all the standards during a supervisory visit, they have a grace
period of three months to improve their problem areas. The health facility will
then be reviewed again and if the standards are still not met, the Yellow Star will
be removed.
Who Conducts the Assessment Review?
A team of 2–4 DHT/HSD Supervisors will conduct the Yellow Star assessment
review. The assessment process will be much quicker if more people are
involved. Larger health facilities will require a larger number of people on the
assessment team in order to complete the assessment review in one day.
SECTION 3: YELLOW STAR PROGRAMME DESCRIPTION
15
How Long Does an Assessment Review Take?
The assessment will take between 3 and 5 hours, depending on the size of the
facility, the client load and the number of persons on the supervision team. Be
sure that your team arrives at the health facility early so you can complete the
review during the one-day visit.
PREPARING FOR AN ASSESSMENT REVIEW
In preparation of the Assessment Review, the supervisory team should:
 Read the previous supervision reports or Yellow Star scoring sheets of the
facility you will visit
 Make sure you review the main problems previously identified
 Gather responses or elements of solutions that are under your control or the
control of the District to discuss with the health facility.
 Take a copy of the National Supervision Guidelines and copies of individual
checklists
 Take your Yellow Star Supervisor Manual.
THE DAY OF THE ASSESSMENT REVIEW
During the assessment review supervisors will:
Examine the OPD, MCH Clinic, the Maternity/Delivery Ward (as applicable)
and the IPW (as applicable);
Check client registers and written records;
Examine basic equipment and drug supply;
Interview health facility staff and clients; and
Observe client consultations with health workers.
Each assessment will take from 3 to 5 hours to complete, depending on the client
load, the size of the facility and the number of people on the supervisory team.
You can minimise disruption to health services while conducting assessments
and make the assessments a more positive experience by doing the following:
 Arrive at the health facility no later than 8:30 AM before services have begun
and meet with the staff to explain what will take place and what assistance
you will need
 Visit the health facility as a team of 2 to 4 people so that each supervisor can
be responsible for a separate unit in the facility
 Review written records promptly and return them to the appropriate units
 Introduce yourselves to clients and ask their permission to observe
consultations with health workers
 Conduct a meeting after the assessment is complete with the facility InCharge, health workers and HUMC to go over the findings, point out areas
where the facility needs to improve, and to facilitate a discussion among staff
about what can be done to improve the situation before the next assessment.
 Leave a copy of the Scoring Sheet at the Health Facility.
SECTION 3: YELLOW STAR PROGRAMME DESCRIPTION
16
RECORD KEEPING OF HEALTH FACILITY ASSESSMENT SCORES
Each Scoring Sheet comes in triplicate form to ease the duplication process.
Once the assessment is complete:
 Leave one copy of the Scoring Sheet with the health facility. File this
document in their Yellow Star Manual behind Section 7 for reference during
the next assessment visit.
 File the second copy at the Health Sub-District headquarters.
 Forward the third copy to District Health Services.
 Finally, record the health facility’s score regularly in a register, updated after
each assessment.
When a health facility meets all 35 standards on two consecutive quarterly
assessments, you must notify the DDHS. The DDHS will then send an
independent team to that health facility to verify the score. After verifying the
score, the independent team will set a date for the public ceremony to award the
facility the Yellow Star. The ceremony should be scheduled within one month of
the independent team’s visit.
AWARDING THE YELLOW STAR
The purpose of the Yellow Star award ceremony is to recognise the good work
that the health facility has done for it’s community and to invite community
members to use the services the health facility offers. The award ceremony also
gives you an opportunity to thank the community for any support they have given
the health facility to earn Yellow Star certification and to request their continued
support to maintain the Basic Standards for Quality Health Services. The
ceremony is also a good way to inform community members about the quality of
services they can expect to receive from the health facility.
The HSD and DHS will organise the public award ceremonies for Yellow Star
health facilities. You will:
Invite important leaders from the MOH, district and the community to speak
during the event;
Install the Yellow Star symbol on the health facility;
Organise radio announcements to publicise the ceremony;
Co-ordinate the programme for the day (speeches, entertainment, health
education, etc.); and
Organise press coverage on the day of the event so news of the health
facility’s good quality services appears on the radio and in the newspapers.
In preparation for this event, you can ask the health facility to:
Notify the local leaders to mobilise the community to participate in the
ceremony;
Hang informational posters in the community and at the health facility
advertising the ceremony; and
Give a speech during the event.
SECTION 3: YELLOW STAR PROGRAMME DESCRIPTION
17
More details about organising a Yellow Star award ceremony and a sample press
release and speech can be found in Section 9: Organising the Reward
Ceremony.
FOLLOW-UP MONITORING
Offering quality services is not a one-time affair. Once a facility has been
awarded the Yellow Star, you will continue the Quarterly Assessment Review to
make sure the facility maintains the Basic Standards over time. If, during one of
these reviews, the facility does not meet the 35 standards, you will discuss with
the staff at the end of the assessment to identify the cause(s) of the problem(s)
and the possible solution(s). You will remind the facility staff of the need to
continuously meet all 35 standards to maintain their Yellow Star status, and you
will help them to do so.
However, if during the next review, the facility still does not meet those 35
standards, you will have to notify the facility staff, the health Unit Management
Committee and the District that the Yellow Star should be removed until all
standards are met during two consecutive reviews.
SECTION 4: THE ASSESSMENT TOOLS
18
SECTION 4:
THE
ASSESSMENT
TOOLS
Guidelines for Using the
Tools
Assessment Tool
Sample Scoring Sheet
SECTION 4: THE ASSESSMENT TOOLS
19
The first part of this section is a handy reference guide that explains how the
assessment should be conducted, how to read the assessment tool, how the
assessment tool is scored and what will happen after the assessment review is
complete. A copy of the actual Assessment Tool and a sample Scoring Sheet
follows this section.
The Assessment Review
Organising the Visit
1. These visits should be scheduled in advance.
2. The staff of the health facility should be prepared for the assessment review.
Notify the facility of the exact date of the visit to make sure most (all) of the
staff, especially the In-Charge, is present on that day.
3. Upon arrival at the health facility, the supervisory team should greet the staff.
4. Supervisors may request the co-operation of health workers in the exercise,
be it for observing client-provider interactions or collecting the unit’s records.
5. Supervisors will ask the health workers to collect the following documents and
records for review, if they have not already done so:
Copies of HMIS 105 forms for the three previous months or unit database
Corresponding OPD registers (including the diagnoses for out-patients, so
that they can be cross-checked with the HMIS 105)
ANC/FP registers
Stock cards or register books for vaccines
Equipment inventory list
HUMC meeting minutes
Supervision records book
Duty roster/staff list
Health education activities schedule or registers (if any)
6. Supervisors will ask about the client load and when they can observe clients
receiving various services. If there are a limited number of clients on the
assessment day it is vitally important that the supervisors observe each case
in order to assess at least 3 client consultations. If the supervisors do not
observe 3 client consultations during the day of the assessment review, they
SECTION 4: THE ASSESSMENT TOOLS
20
will have to conduct the remaining observations during a subsequent
supervisory visit.
7. Supervisors will ask the in-charge to organise a meeting with the staff at a
convenient time at the end of the visit to discuss the results of the
assessment and the next steps.
Helpful Reminders for Supervisors
 Remember that the Yellow Star Assessment visit is part of the process of
supportive supervision.
 Minimise the disruption caused to the staff and the patients in the unit.
 Health facility staff should NOT be involved in the actual assessment process.
They can assist a supervisor by gathering records or directing the supervisor
to client observation, but they should not actually count inventory, register
numbers, give input on observations, etc.
 Talk to the health workers during the assessment, explain the assessment
methodology, the reasons used to select criteria.
 Take advantage of the assessment visit to identify problems and provide onsite support, while at the same time achieving the assessment objectives.
 Stop to ask questions and listen to the answers.
 Be fair, unbiased and consistent in your evaluation techniques.
 Give critical feedback to health facility staff, both positive and negative.
 Be open-minded and supportive of the work staff is doing.
The Assessment Review Tools
Every supervisor will need these assessment tools to evaluate a health facility on
the Basic Standards. The assessment tools are found in Section 4 of your
Yellow Star Manual and they include:
1. The Assessment Tool: This document tells you what the standards are, how
they are defined and how the standards can be verified during an assessment
review.
2. The Scoring Sheet(s): The document where a supervisor will record the
performance of a health facility for each standard.
The Assessment Tool
The Assessment Tool is divided into different sections. Each section contains a
group of standards that pertain to a particular location in the health facility (i.e.
Maternity Ward or Out Patient Department) or a type of information or activity
(i.e. interviewing the in-charge, reviewing the health facility records). This is
SECTION 4: THE ASSESSMENT TOOLS
21
intended to make the assessment review run smoothly for the supervisors.
These sections include:
 LOCATION REVIEW: There are four different sections in the assessment tool
for the following locations in a health unit: Out-Patient Department (OPD),
Maternal Child Health (MCH) Clinic, Maternity/Delivery Room and In-Patient
Ward. The standards in each of these sections are designed for that part of
the health facility. The supervisor will use the appropriate section when
assessing services in each location. If the health facility does not have a
particular department, then that section of the assessment tool will not be
used. Likewise, in smaller health units where the OPD and MCH wards are
one and the same, the supervisory team will simply fill out the OPD section.
 INVENTORY & RECORDS: The standards in this section refer to things
involving written records of the health facility or inventory. If possible, the
necessary records or files can be collected by the health facility staff in
advance of the supervisor’s visit and placed in one location where the
supervisor can review them during the assessment review.
 CLINICAL OBSERVATIONS: This section involves actual observation of
client consultations with health workers. Read the section carefully so that
you are aware of the type of clients required for observation. Health workers
should guide supervisors into observations as cases appear on the day of the
assessment review.
 INTERVIEW WITH THE IN-CHARGE: This section requires a brief interview
with the in-charge of the health facility.
 IN-PATIENT/HOSPITAL: This section applies to hospitals and health facilities
that have in-patient wards. The standards can be assessed by examining the
in-patient department of the health facility (one of the ward, randomly chosen,
in the case of an hospital).
Organisation of the Assessment Tool
The assessment tool is made up of several columns.
# This is the number of the standard. The standards are numbered according
to one of six main categories: infrastructure and equipment; management
systems; IEC/IPC, infection prevention, clinical services and customer
service. (In the assessment tool, the numbers do not go in order because
they have been arranged to make the assessment review run smoothly.
Standard A standard is a statement of what is expected to
happen or to be provided. In this section, you will
find the general definition of each standard in the form
of a question.
SECTION 4: THE ASSESSMENT TOOLS
22
Means of Verification Explains the method that should be used to assess if
the standard has been achieved, for example, direct
observation, review of records, interview, etc.
Operational Definition Specifies the exact criteria used to determine whether
a standard is achieved. Some standards require that
several criteria must be met before one can say the
standard is achieved.
Assessment (Yes or No) Indicates if the health facility has met each criterion
for that standard. The supervisor will enter a yes in
the box if the health facility meets that criteria, and a
NO if the health facility does not. This section is
reproduced on the Scoring Sheet so the supervisor
does not have to write on the Assessment Tool. The
answers should be recorded on the Scoring Sheet.
Guidelines for Using the Assessment Tool Properly
Dividing the Work: The Supervisory team may work as one group during the
assessment review or they may split up into various sub-groups, each person
in charge of a different section of the assessment tool. It is up to the team to
decide. However, we highly recommend dividing the work by sections and
working individually or as a team of two. This will help the assessment review
to go much quicker. For example, one team member may do the clinical
observations, one team member may review the inventory and records and
one team member may do the location reviews of the OPD, etc.
Location Review Sections: Not every health facility will have an OPD, MCH
Clinic, Maternity/Delivery and In-Patient Department. If a health facility does
not have a particular department, then the supervisor will simply draw a line
through that assessment location on the scoring sheet. Obviously, one
cannot assess standards for a department that does not exist. For example,
a health centre II may not have a maternity ward or in-patient department. So
the supervisor will not evaluate the standards for those two locations.
Similarly, in smaller units the OPD and MCH clinic are often one and the
same. In this situation, he supervisor will only fill out the OPD Location
Review section. He/she will not fill out both the OPD and MCH.
If a health facility has more than one in-patient ward, the supervisory team will
randomly choose one in which to conduct the assessment.
Clinical Observation Section: If the health facility has several health workers,
the supervisory team will try to observe several of them interacting with clients
(one observation each) during clinical observations.
SECTION 4: THE ASSESSMENT TOOLS
23
There are opportunities when a supervisor can assess several standards
during one clinical observation. For example, when assessing Standard 5.4
(Are health workers giving technically appropriate services?), for each of the
three observations, supervisors can also assess Standards 4.2 (Use of
teaching aids) and 4.3 (Are health workers encouraging clients to ask
questions?). Supervisors may use this approach to save time.
Also included into the Clinical Observation section are the observation of
aseptic practices, the review of child health cards for evidence of growth
monitoring and the observation of the drug dispenser’s practices. The
assessment for each of these standards requires two or three separate
observations, distinct from the observation of services (i.e. Standards 4.2, 4.3
& 5.4).
If supervisors are not able to observe 3 cases for clinical observations during
their time at the health facility, then they will make all possible efforts to
complete the assessment on the next day or the closest possible date. The
scoring section for Clinical Observations will not be completed until 3 client
consultations are evaluated. Thus, it is vitally important that the supervisors
arrive early to have an opportunity to observe all clients who attend the facility
if it is a slow day.
Supervisors will answer ALL the questions included in the instrument, i.e.,
assess all proposed criteria. They will review the worksheet at the end of the
assessment review and before they leave the facility to make sure all the
answers have been recorded.
Supervisors will be as consistent as possible in their answers: if a given
question has resulted in a Yes in one location of the facility and the conditions
are similar in another location, there should be an identical response. For this
reason, it is recommended that the same supervisor assess each of the
sections designed for a particular location of the health facility (i.e. Maternity
Ward, OPD, etc.).
The Scoring Sheet
The Scoring Sheet is designed as a shortened format of the Assessment Tool. It
comes as a series of eight pages, each with three coloured copies (original in
white, two copies in yellow and pink). Those copies do not require the use of
carbon paper. Each sheet contains the following sections:
# This is the number of the standard. The standards
are numbered according to one of six main
categories: infrastructure and equipment;
management systems; IEC/IPC, infection prevention,
SECTION 4: THE ASSESSMENT TOOLS
24
clinical services and customer service. (The numbers
do not go in order on the scoring sheet because they
have been arranged to fit a particular location or type
of activity in order to make the assessment review run
smoothly.)
Standard A standard is a statement of what is expected to happen or to be
provided. In this section you will find the shortened definition of each standard.
Operational Definition Summarises in a short form the exact criteria used to
determine whether a standard is achieved. Some
standards require that several criteria must be met
before one can say the standard is achieved.
Assessment (Yes or No) Indicates if the health facility has met each criterion
for that standard. The supervisor will mark a YES in
the box if the health facility meets that criteria, and a
NO if the health facility does not.
Final Score Indicates the final score for the standard assessed. If
all boxes corresponding to this standard have been
answered with a Yes, then the supervisor will write
“1.” If one or more boxes have been filled with a No,
the supervisor will write “0.”
Comments Here, supervisors will write any remark that may
explain or justify the assessment for the
corresponding standard.
How to Score the Standards
All scores will eventually be recorded on the Scoring Sheet, not on the
Assessment Tool. Supervisors will use a photocopy of the Assessment Tool as a
reference guide and as an intermediary medium to record their findings (using a
pencil). At the end of the visit, supervision team members will regroup to
consolidate their results on the Scoring Sheet. On the Scoring Sheet the
supervisor will:
1. Use a strong hand and a pen, not a pencil, to make the carbon copies easier
to read. It is recommended to insert a cardboard/folder below each page
(that is, each set of three sheets of different colours) to avoid marking the
following pages.
2. Fill in the name of the district, the name of the health facility, the health
facility level and the date and quarter the Assessment Review is conducted.
This information should be written at the top of every scoring sheet. It is
SECTION 4: THE ASSESSMENT TOOLS
25
especially important if the supervisory team divides the sheets among the
supervisory team members.
3. In the “Assessment” column, write “Y” (Yes) or “N” (No) in each of the blank
boxes. All of the boxes need to be filled. However, supervisors should not
write into the shaded (grey or dark) boxes. Shaded boxes mean that the
criterion does not apply for that particular location or area.
Whenever there are several smaller columns in that column, it can mean:
 The assessment covers several locations within the health unit.
Supervisors must fill in one column for each location visited and assessed
(i.e. OPD, MCH clinic, Maternity/Delivery room, and In-Patient ward). In
order to avoid mistakes, supervisors should draw a vertical line through
the boxes corresponding to the locations that do not exist.
 The assessment method requires supervisors to observe several cases of
the same item; the observation number is written at the top of each
column.
 The criteria are different for various levels of health facilities. In that case,
only the column corresponding to the level of the visited facility is filled.
The facility level is written at the top of the column. Supervisors should
draw a vertical line through the columns corresponding to other levels.
REMEMBER: Supervisors can only use “Yes” and “No” answers and cannot
leave blanks.
Exceptions:
- In catholic NGO facilities, the assessment of Standard 2.4 will not include Depo
Provera® and condoms.
- For Standard 5.3, the weight plotting won’t be registered if the mother has not
brought the Child Health Card; if no child with a card can be found, the score
for this standard will be 0.
4. In the “Final Score” column, for each standard, write 1 or 0, according to the
result of the assessment.
 If all boxes in the corresponding assessment for this standard have been
answered with a Yes, then supervisors will write “1.”
 If one or more boxes have been filled with No, the supervisors will write
“0.”
For the Location Review Section: The answers in the assessment columns
must be Yes for all locations visited (OPD, MCH, Maternity and In-Patient
SECTION 4: THE ASSESSMENT TOOLS
26
Ward if applicable) and for all criteria before the supervisor can write “1” in the
score column.
5. There has been a minor change to Standard 2.4 that is not incorporated on
the Scoring Sheet. The drug Fansidar should be added to the current list of
seven products. Somewhere in that standard section, add a row and add
Fansidar to the list. The score for Standard 2.4 should be based on all eight
products, not just the seven products listed.
REMEMBER: Supervisors can only write “1” if all relevant boxes in the
assessment column have been answered with “Yes”.
Calculating the Overall Score for the Health Facility
The last section of the Scoring Sheet contains charts to help a supervisor
determine how to calculate the health facility’s overall score. Here are the
instructions a supervisor will follow when filling out these charts:
Table 1
Table 1 helps you to calculate the total score for Standards 1.5, 3.1, 3.2 and 6.2.
These standards are listed in two sections of the Assessment Tool. These two
scores must be combined in order to compile the final score for this standard.
For Standard 1.5: Look at the Location Review Section of the Scoring Sheet and
write the score from Standard 1.5 in the first box on Table 1. Then look at the
Inventory/Records Review Section of the Scoring Sheet and write the score from
Standard 1.5 in second box on Table 1. If the score for this standard is 1 in the
Location Review and 1 in the Inventory and Record Review, then the total score
will be 1; otherwise it is 0.
For Standards 3.1, 3.2 and 6.2: Look at the Location Review Section of the
Scoring Sheet and write the score from Standard 3.1, 3.2 and 6.2 in the first box
on Table 1. Then look at the Clinical Observations Section of the Scoring Sheet
and write the score from Standard 3.1, 3.2 and 6.2 in second box. If the score for
this standard is 1 in the Location Review and 1 in the Clinical Observations the
total score will be 1; otherwise it is 0.
Table 2
On Table 2 report the final scores by standard number. Supervisors will have to
refer back to the other pages of the Scoring Sheet (Location Review Summary,
Inventory and Records, Clinical Observations, Interview with In-Charge, InPatients/Hospital Specific Standards). Remember, you can only write 1 or 0 in
these boxes.
Table 3
In Table 3, calculate the total score and percentage of achievement for each
category and then for the health facility as a whole.
SECTION 4: THE ASSESSMENT TOOLS
27
From Table 2 add up the total score from the individual standards of the six
categories. (For example, Category 1: Infrastructure and Equipment has six
standards. If a health facility passed all six standards, their score would be 6.)
The total should never be higher than the number indicated in the “No. of items”
column.
To calculate the percentage of achievement, divide the score by the # of items
and multiply by 100. For instance, if your score for Category 1 equals 4, then the
percentage will be:
4 (score) divided by 5 (# of items) x 100 = 80%
BE CAREFUL when adding the scores of standards by category and calculating
percentages of achievement. For Health Centres II and III, there are only 5
standards in the first category (Infrastructure and Equipment) and 4 standards in
the fifth category (Clinical Services). For Health Centres IV and Hospitals, these
numbers are 6 and 5, respectively, as Standards # 1.6 and 5.5 have been added
for those health facilities with more complex levels. Similarly, Health Centres II
have only 9 standards in the sixth category (Client Services); higher-level
facilities have 10. Thus, the total number of standards is 32 for Health Centres II,
33 for Health Centres III, while it is 35 for Health Centres IV and Hospitals.
After the Assessment Review
Once the assessment review has been completed, the supervisor will review the
scoring sheet to make sure they have answered all the questions and not left any
boxes blank.
Supervisors will then meet with the health facility’s in-charge and all the staff to
discuss the results. Members of the Health Unit Management Committee should
also participate in this meeting. During this meeting, the supervisors will:
 Point out the good results achieved by the unit during the previous period and
acknowledge the persons or groups responsible for these achievements.
 Identify problems, review ongoing efforts aimed at correcting these problems,
and look for ways to increase these efforts or implement alternative solutions.
 If those problems refer to standards that were previously met, discuss
reasons why the performance level has fallen and ways to improve the
situation.
 Decide, along with the health facility staff, on the priority actions for the next
quarter and identify timeline, responsible person(s) and support needed from
other levels or institutions.
The supervisory team will then write on the last page of the scoring sheet any
comments from the supervision team or from the facility staff, in particular if there
SECTION 4: THE ASSESSMENT TOOLS
28
were any points of disagreement on the assessment of standards. Each member
of the supervisory team should print their names, write their signature and date.
The in-charge of the health facility will also write any comments about the
assessment and then write his or her name, sign and date the document.
Upon return to HSD or district office, the supervisor will report the results of the
assessment review to the HSD/District manager and insert the copy of the
scoring sheet into the database for the health facility.
How to File the Scoring Sheets
The Scoring Sheet has three copies for each assessment review. The
supervisor or supervisory team will staple the pages for each copy and distribute
the three completed copies as follows:
1. The original (white) in the Health Facility’s Yellow Star Binder behind
Divider 7.
2. One copy (yellow) will go back to the HSD for the HSD database.
3. The third copy (pink) will be given as soon as possible to the District for
the District database. There, the results will be entered into a
computerised database.
SECTION 4: THE ASSESSMENT TOOLS
29
Assessment Tool
for the
Basic Standards
for Quality Health
Services
THE REPUBLIC OF UGANDA
SECTION 4: THE ASSESSMENT TOOLS
30
Location Review: Out-Patient Department
# Standard Means of Verification Operational Definition Assessment
(Yes or No)
There is running water (pipe) within the facility.
OR
There is a water tank within the facility.
OR
There is a protected water source within 200 metres of the facility: borehole, water
tank or protected spring (with tubing of water for outflow, concrete slab, drainage
and the spring is at least 33 metres away from latrines/toilets) and temporary
storage containers (e.g., jerrycans or drums).
1.1 Is there a reliable and
clean supply of water
from a protected water
source?
Observation of the water
source and check if
water is actually flowing
from the source.
AND
There is water flowing from this main source.
Latrine(s) and/or toilet(s) exist within the facility or facility compound.
AND
Staff and clients have access to at least one latrine at any given time and the
client’s latrine/toilet is not locked.
AND
Latrine slab is clean/toilet bowl is clean and empty.
1.2 Does the facility have
clean latrines or toilets?
Observation of
toilets/latrines.
AND
Soap and water are available at the washing point near the toilet(s)/latrine(s).
Examination couch is present in unit.
AND
It is covered with a clean, untorn macintosh or plastic sheet.
1.4 Does the facility have a
functional examination
couch?
Inspection of
examination couch.
AND
It is clean (i.e. there is no visible dust, stains or blood).
The following pieces of equipment are available and functional:
1 Thermometer
1 BP cuff/machine
1.5 Does the facility have
basic examination
equipment?
Observation of item in
OPD. Inspect each item
to see if it is functioning
properly. If the OPD
shares the pre-clinic
functions with the MCH
clinic, then one set of
equipment is sufficient. 1 Stethoscope
SECTION 4: THE ASSESSMENT TOOLS
31
# Standard Means of Verification Operational Definition Assessment
(Yes or No)
3.1 Does the facility provide
adequate infection
prevention/ control in
the area of hand
washing?
Observation of available
water and soap.
Soap and water are available at the washing point(s) in or near the consulting
room(s).
3.2 Does the facility provide
adequate infection
prevention/ control in
the area of disposal of
sharps and needles?
Availability of labeled
sharp object containers
in the examination,
injection, dressing rooms
and laboratory.
There are labeled containers for sharp object disposal available in the examination,
injection, dressing rooms and laboratory.
Dressing room(s), injection room(s) examination room(s) dental room and
laboratory are mopped and free of soiled materials.
3.3 Are the injection,
dressing, examination
and laboratory rooms
clean service
environments?
Observation of rooms,
dressing trolleys,
examination couches.
AND
There is a dustbin available in the following areas: dressing rooms, injection
room(s), examination room(s), dental room and laboratory.
3.4 Does the health unit
have facilities for
disinfection?
Observation of a bucket
with disinfectant
prepared in those areas.
Buckets, chlorine solution (e.g. JIK) and other disinfectants are available in at least
one area of the OPD.
6.2 Does the facility have a
private area for physical
examination?
Observation of
examination rooms.
Examination areas are either private rooms with doors that close,
OR
Areas sectioned off by curtains/screens.
6.9 Does the facility post a
list of available services
where the clients can
see them?
Observation of poster in
OPD waiting area.
A poster with listed services in language understood by clients is displayed in the
OPD waiting area where the clients can see it.
SECTION 4: THE ASSESSMENT TOOLS
32
Location Review: Maternal and Child Health Clinic
If the MCH clinic is located within the OPD, do not fill out this section.
# Standard Means of Verification Operational Definition Assessment
(Yes or No)
There is running water (pipe) within the facility.
OR
There is a water tank within the facility.
OR
There is a protected water source within 200 metres of the facility: borehole, water
tank or protected spring (with tubing of water for outflow, concrete slab, drainage
and the spring is at least 33 metres away from latrines/toilets) and temporary
storage containers (e.g., jerrycans, drums).
1.1 Is there a reliable and
clean supply of water
from a protected water
source?
Observation of the water
source and check if
water is actually flowing
from the source.
AND
There is water flowing from this main source.
Latrine(s) and/or toilet(s) exist within the facility or facility compound.
AND
Staff and clients have access to at least one latrine at any given time and the
client’s latrine/toilet is not locked.
AND
Latrine slab is clean/toilet bowl is clean and empty.
1.2 Does the facility have
clean latrines or toilets?
Observation of
toilets/latrines.
AND
Soap and water are available at the washing point near the toilet(s)/latrine(s).
Examination couch is present in unit.
AND
It is covered with a clean, un torn Macintosh or plastic sheet.
1.4 Does the facility have a
functional examination
couch?
Inspection of
examination couch.
AND
It is clean (i e there is no visible dust stains or blood)
The following pieces of equipment are available and functional:
1 Thermometer
1 BP cuff/machine
1.5 Does the facility have
basic examination
equipment?
Observation of item in
MCH clinic. Inspect each
item to see if it is
functioning properly. If
the MCH clinic shares
the pre-clinic functions
with the OPD, then one
set of equipment is
sufficient
1 Stethoscope
SECTION 4: THE ASSESSMENT TOOLS
33
# Standard Means of Verification Operational Definition Assessment
(Yes or No)
3.1 Does the facility
provide adequate
infection prevention/
control in the area of
hand washing?
Observation of available
water and soap.
Soap and water are available at the washing point(s) in or near the consulting
room(s).
3.2 Does the facility
provide adequate
infection prevention/
control in the area of
disposal of sharps and
needles?
Availability of sharp
object containers in the
examination, injection
and dressing rooms.
There are labeled containers for sharp object disposal available in the examination,
injection and dressing rooms.
Dressing room(s), injection room(s) and examination room(s) are swept and free of
soiled materials.
3.3 Are the injection,
dressing and
examination rooms
clean service
environments?
Observation of rooms,
dressing trolleys,
examination couches.
AND
There is a dustbin available in the following areas: delivery rooms, dressing rooms,
and injection rooms.
3.4 Does the health unit
have facilities for
disinfection?
Observation of a bucket
with disinfectant
prepared.
Buckets, chlorine solution (e.g. JIK) and other disinfectants are available in at least
one area of the MCH.
6.2 Does the facility have a
private area for
physical examination?
Observation of
examination rooms.
Examination areas are either private rooms with doors that close,
OR
Areas sectioned off by curtains/screens.
6.9 Does the facility post a
list of available services
where the clients can
see them?
Observation of poster in
MCH waiting area.
A poster with listed services in language understood by clients is displayed in the
OPD waiting area where the clients can see it.
SECTION 4: THE ASSESSMENT TOOLS
34
Location Review: Maternity/Delivery Room
# Standard Means of Verification Operational Definition Assessment
(Yes or No)
There is running water (pipe) within the facility.
OR
There is a water tank within the facility.
OR
There is a protected water source within 200 metres of the facility: borehole, water
tank or protected spring (with tubing of water for outflow, concrete slab, drainage
and the spring is at least 33 metres away from latrines/toilets) and temporary
storage containers (e.g., jerrycans, drums).
1.1 Is there a reliable and
clean supply of water
from a protected water
source?
Observation of the water
source and check if
water is actually flowing
from the source.
AND
There is water flowing from this main source.
Latrine(s) and/or toilet(s) exist within the facility or facility compound.
AND
Staff and clients have access to at least one latrine at any given time and the
client’s latrine/toilet is not locked.
AND
Latrine slab is clean/toilet bowl is clean and empty.
1.2 Does the facility have
clean latrines or toilets?
Observation of
toilets/latrines.
AND
Soap and water are available at the washing point near the toilet(s)/latrine(s).
Delivery couch is present in unit.
AND
It is covered with a clean, untorn macintosh or plastic sheet.
1.4 Does the facility have a
functional delivery
couch?
Inspection of delivery
couch.
AND
It is clean (i.e. there is no visible dust, stains or blood).
The following pieces of equipment are available and functional:
1 Thermometer
1 BP cuff/machine
1.5 Does the facility have
basic examination
equipment?
Observation of item in
Maternity/Delivery
Room. Inspect each item
to see if it is functioning
properly.
1 Stethoscope
SECTION 4: THE ASSESSMENT TOOLS
35
# Standard Means of Verification Operational Definition Assessment
(Yes or No)
3.1 Does the facility
provide adequate
infection prevention/
control in the area of
hand washing?
Observation of available
water and soap.
Soap and water are available at the washing point(s) in or near the delivery
room(s).
3.2 Does the facility
provide adequate
infection prevention/
control in the area of
disposal of sharps and
needles?
Availability of labeled
sharp object containers
in the labor and delivery
rooms.
There are labeled containers for sharp object disposal available in the labor and
delivery rooms.
Delivery and labor room(s) are swept and free of soiled materials. 3.3 Are the delivery and
labor rooms clean
service environments?
Observation of rooms,
dressing trolleys,
examination couches.
AND
There is a dustbin available in the following areas: labor and delivery rooms,.
3.4 Does the health unit
have facilities for
disinfection ?
Observation of a bucket
with disinfectant
prepared.
Buckets, chlorine solution (e.g. JIK) and other disinfectants are available in at least
one area in Maternity/delivery room.
6.2 Does the facility have a
private area for
physical examination
and delivery?
Observation of delivery
rooms.
Delivery areas are either private rooms with doors that close,
OR
Areas sectioned off by curtains/screens.
SECTION 4: THE ASSESSMENT TOOLS
36
Location Review: In-Patient Ward
(In the case of an hospital, randomly choose one ward that is not the Maternity)
# Standard Means of Verification Operational Definition Assessment
(Yes or No)
There is running water (pipe) within the facility.
OR
There is a water tank within the facility.
OR
There is a protected water source within 200 metres of the facility: borehole, water
tank or protected spring (with tubing of water for outflow, concrete slab, drainage
and the spring is at least 33 metres away from latrines/toilets) and temporary
storage containers (e.g., jerrycans or drums).
1.1 Is there a reliable and
clean supply of water
from a protected water
source?
Observation of the water
source and check if
water is actually flowing
from the source.
AND
There is water flowing from this main source.
Latrine(s) and/or toilet(s) exist within the facility or facility compound.
AND
Staff and clients have access to at least one latrine at any given time and the
client’s latrine/toilet is not locked.
AND
Latrine slab is clean/toilet bowl is clean and empty.
1.2 Does the facility have
clean latrines or toilets?
Observation of
toilets/latrines.
AND
Soap and water are available at the washing point near the toilet(s)/latrine(s).
Beds with mattresses are present in unit. 1.4 Does the in-patient
ward have beds with
mattresses in good
shape?
Inspection of in-patient
beds.
AND
Mattresses are clean (i.e. there is no visible dust, stains or blood) and in acceptable
shape.
The following pieces of equipment are available and functional:
1 Thermometer
1 BP cuff/machine
1.5 Does the in-patient
ward have basic
examination
equipment?
Observation of item in
In-Patient Ward. Inspect
each item to see if it is
functioning properly.
1 Stethoscope
SECTION 4: THE ASSESSMENT TOOLS
37
# Standard Means of Verification Operational Definition Assessment
(Yes or No)
3.1 Does the facility
provide adequate
infection prevention/
control in the area of
hand washing?
Observation of available
water and soap.
Soap and water are available at the washing point(s) in or near the ward.
3.2 Does the facility
provide adequate
infection prevention/
control in the area of
disposal of sharps and
needles?
Availability of labeled
sharp object containers
in the examination,
injection and dressing
rooms.
There are labeled containers for sharp object disposal available in the examination,
injection and dressing rooms.
Ward is mopped and free of soiled materials. 3.3 Is the in-patient ward a
clean service
environment?
Observation of rooms,
dressing trolleys,
examination couches.
AND
There is a dustbin available in the dressing rooms and injections rooms.
3.4 Does the health unit
have facilities for
disinfection?
Observation of a bucket
with disinfectant
prepared.
Buckets, chlorine solution (e.g. JIK) and other disinfectants are available in one
area of the In-Patient Ward.
6.2 Does the facility have a
private area for
physical examination?
Observation of ward
rooms.
Examination areas are either private rooms with doors that close,
OR
Areas sectioned off by curtains/screens.
SECTION 4: THE ASSESSMENT TOOLS
38
Inventory and Records Review
# Standard Means of Verification Operational Definition Assessment
(Yes or No)
LEVEL II III IV H
There is a rubbish pit (or garbage bin) within the compound.
AND
The pit is not overflowing and is properly used (i.e. rubbish is not disposed of
anywhere else).
1.3 Does the facility have a
rubbish pit and a
placenta pit for disposal
of refuse and medical
waste?
Observation of rubbish
pit and placenta pit.
AND
There is a functional [ i.e. concrete slab on top, air tight] placenta pit within the
compound.
The following pieces of equipment are available, functional and registered in the
inventory:
LEVEL
II III IV H
Baby weighing scale
Timing device
ORS corner
Fetoscope
Adult weighing scale
Lantern
Sterilizer/autoclave OR stove and pans
Speculum
Delivery kit
Microscope
Anesthesia machine*
C-section sets (2)*
Laparotomy sets (2)*
Refrigerator for blood*
Blood matching equipment*
1.5 Does the facility have
examination and
emergency equipment?
Review of inventory
record. Inspect each
item to see if functioning
properly.
*If a unit does not have
an operational theatre
then they will not be
evaluated for these
items.
Blood for transfusion is
not listed in inventory so
you do not have to
check for blood bags in
the inventory.
Blood for transfusion * (Bags do not need to be registered in the inventory)
SECTION 4: THE ASSESSMENT TOOLS
39
# Standard Means of Verification Operational Definition Assessment
(Yes or No)
Registers exist in the OPD, ANC and FP clinics. 2.1 Do the OPD, ANC and
FP registers exist and
are they well kept and
up-to-date?
Inspection of registers in
clinic rooms for the
previous month.
AND
Information on dates, patient characteristics (names, sex, age and address –
parish/village), diagnosis and treatment (dosage, times/day, # days) are written in
the OPD registers.
Review copies of HMIS
105/or the unit database.
Copies of the HMIS 105 forms for the last three months are present in the unit.
OR
Information is registered in the unit’s database.
2.2 Were monthly
Summary Report forms
completed
appropriately over the
last 3 months? Pick one month in the
last quarter and
compare the total
number of malaria cases
(under 5 years and over
5 years) with the
register(s); totals should
be the same, plus or
minus 5%.
AND
The number of reported malaria visits for all ages for one month in the last quarter
corresponds to the number of cases in the OPD register(s) for the same month
(plus or minus 5%).
Month/Year: _________________
Total # on HMIS ______________ Total # in Register ______________
Stock cards/register books at the facility store for the five selected products are
present in the store and are up to date:
#1: Stock Card:
Store:
#2: Stock Card:
Store:
#3: Stock Card:
Store:
#4: Stock Card:
Store:
2.3 Are there updated
stock cards at the
facility store (register
books) for at least five
randomly selected
products?
Randomly choose five
drugs from the attached
list of essential drugs.
Review availability of
stock cards. Compare
registered quantities with
physical count at the
facility store.
#5: Stock Card:
Store:
SECTION 4: THE ASSESSMENT TOOLS
40
# Standard Means of Verification Operational Definition Assessment
(Yes or No)
Stock cards show the absence of a stock out for the mentioned products for the past
three months.
II III IV H
1. Chloroquine Tabs
2. Fansidar® (sulfadoxine-pyrimethamine –SP)
3. Cotrimoxazole
4. ORS
5. Measles Vaccine
6. DPT-HepB+hib Vaccine
7. Depo-Provera
2.4 Were these products
available during the
past 3 months:
chloroquine,
Fansidar®,
cotrimoxazole, ORS,
measles vaccine, DPTHepB+hib vaccine,
Depo-Provera® and
condoms?
Review of stock
cards/register books.
*Fansidar was a recent
addition to this standard. It
is not printed on the actual
Scoring Sheet. Please
write the product Fansidar
on the Scoring Sheet and
score appropriately.
8. Condoms
2.5 Does the Health Unit
Management
Committee meet once
every quarter?
Review of meeting
minutes.
Minutes of meetings conducted during the last quarter are available at the facility.
(For NGO facilities, available minutes should match the established frequency of
Board meetings, for instance twice a year).
4.1 Are health education
talks given to clients?
Observe registers from
previous 3 months or
posted schedules.
Health facility conducts group health education sessions at least 4 times per month,
for previous three months.
LEVEL:
I
I
III IV
H
Temperature monitoring chart is fixed on the refrigerator.
Temperatures are monitored twice daily, seven days per week.
Temperatures maintained between +2 and +8C.
Thermometer is in the refrigerator and vaccine carriers and ice packs are available
and in good condition.
5.1 Does the staff maintain
a proper cold chain?
Observation of
temperature chart,
refrigerator (if present in
unit), ice packs and
vaccine carriers.
Vaccine carriers and ice packs available and in good condition.
LEVEL:
I
I
III IV H 5.2. Are immunization
services provided on a
daily basis in this facility
so as to reduce “missed
opportunities”?
Review records, tally
sheets and immunization
registers for dates.
Staff provide immunization to the child during the same day/visit.
SECTION 4: THE ASSESSMENT TOOLS
41
Staff provide at least weekly immunization services. (Note: Only evaluate at HC II
level because refrigerator is often not available.)
# Standard Means of Verification Operational Definition Assessment
(Yes or No)
The waiting areas protect clients from the sun and rain. 6.1 Is the facility’s waiting
area clean and
protected?
Observation of waiting
area(s).
AND
The floor is mopped; the area is clean of debris/trash; the walls and ceiling are
reasonably clean.
CLIENT INTERVIEW #
Client answers yes to the following questions:
1 2 3
1. Did the health worker direct you where to go next?
6.3 Are patients and
attendants received in
friendly and respectful
manner?
Exit interviews with three
clients.
2. Did you feel you were treated respectfully by the health worker(s) who you met
at the health facility today?
6.4 Do providers see
clients on first-come,
first-serve basis?
Observe clients’ flow or
interview clients.
Interview clients.
There is a system in place to serve clients in the order in which they arrive. Only
extremely sick individuals are given priority over others who are waiting.
CLIENT INTERVIEW # 1 2 3 6.5 Do clients wait one
hour or less after arrival
at the health facility
before being seen by a
provider?
Exit interviews with three
clients.
Ask the client how long they waited before being seen by a health provider. The
standard is met if the client states that he/she was seen in one hour or less from the
time he/she entered the facility (for non-emergency cases) to the time he/she is first
assessed by a health workwer.
SECTION 4: THE ASSESSMENT TOOLS
42
Clinical Observations
# Standard Means of Verification Operational Definition Assessment
(Yes or No)
Uganda Clinical Guidelines are available in all OPD consulting rooms. 2.6 Does the facility have
the guidelines and
standards required for
management of
patients?
Verify availability of both
documents in the OPD
consulting rooms and
make sure they are
accessible.
AND
IMCI Treatment Guidelines are available in all OPD consulting rooms
LOCATION
O
PD
M
C
H
M
A
T
IP
W
3.1 Does the facility provide
adequate infection
prevention/control in
the area of hand
washing?
Observation of provider
practices.
Providers wash their hands between clients and
procedures.
LOCATION
O
PD
M
C
H
M
A
T
IP
W
3.2 Does the facility provide
adequate infection
prevention/control in
the area of disposal of
sharps and needles?
Observation of provider
practices.
Interview in-charge and
one other health worker
to verify if incinerator
functional
Staff safely dispose of sharp objects and needles in the container provided and
do not reuse disposable material. [i.e. Staff dispose needles in a sharps
container uncapped. The container is either burnt in an incinerator or emptied in
a deep pit/pit latrine, not a placenta pit.]
OBSERVATION # 1 2 3 4.2 Do providers use
appropriate teaching
aids during client
counseling/ education?
Observation during
provider/client
interactions.
Service providers use one of the following materials during client
counseling/education sessions: posters, sample foods or family planning
methods, anatomical models, brochures, leaflets, flipcharts, cue cards.
OBSERVATION # 1 2 3
Providers ask clients about their history and problems.
4.3 Are providers
encouraging clients to
actively discuss any
problem or concern
about their health and
treatment during the
visit?
Observation of
interaction with clients
and/or caretaker from
that day.
AND
Providers invite clients to ask questions.
SECTION 4: THE ASSESSMENT TOOLS
43
# Standard Means of Verification Operational Definition Assessment
(Yes or No)
Health workers are providing technically correct services, according to current
guidelines and supervision checklists, in IMCI and the following areas: ANC,
Delivery, PNC, FP, STD, malaria, TB, injury management, dental care.
[List type of service provided for each observation below.]
Observation #1: IMCI
Observation #2:
5.4 Are providers giving
technically appropriate
services?
Observation of one IMCI
case and two cases in
any of the other
mentioned areas and
assessment of the
adequacy of case
management based
upon the compliance
with the checklists
included in the NSG.
Observation #3:
Health workers are performing according to guidelines in the following aseptic
procedures: wound dressing, suturing, catheterisation, injections, Norplant
insertion/removal, intravenous infusion, dental extraction and/or simple theatre
procedures. [List type of service provided for each observation below.]
Observation #1:
3.5 Is staff following correct
aseptic techniques?
Observation of two
aseptic procedures. See
NSG checklists for
procedures.
Observation #2:
OBSERVATION # 1
2
The under-five child was weighed.
Weight is accurately plotted on the child's health card.
5.3 Do all the children who
visit the facility have
their weight plotted
correctly on the health
card?
Review child health card
of two children exiting
the OPD and/or MCH
clinic to see if weight is
accurately plotted.
If more than one weight is plotted, a line is drawn to connect the dots.
LOCATION
O
PD
M
C
H
M
A
T
IP
W
6.2 Does the facility have a
private area for physical
examinations and/or
deliveries?
Observation of provider
practices.
Privacy is maintained during procedures.
OBSERVATION # 1 2 3
Provider/dispenser instructs clients about the medication, the amount to take,
what time of the day it should be taken, and for how long it should be taken.
6.6 Does provider/
dispenser provide
appropriate information
to client regarding
treatment compliance?
Observation of three
clients receiving
treatment at the
dispenser’s window (or
from the provider if there
is no dispenser) AND Provider/dispenser checks the client’s understanding.
SECTION 4: THE ASSESSMENT TOOLS
44
Interview with the In-Charge
# Standard Means of Verification Operational Definition Assessment
(Yes or No)
6.7 Does the facility have a
plan for referring
emergency cases?
Interview with the incharge and one other
provider.
Ask the in-charge and one other provider if the facility provides some type of
assistance for sending a sick patient to a referral facility, such as:
communication to the next level; ambulance; arranging community transport;
and/or funds for fuel of public transport. Compare answers and see if similar.
The facility has at least one provider in OPD and one provider in MCH
offering these services to clients who has received in-service training specific
to these services: [If OPD and MCH clinic are one clinic, fill only one column.]
OPD
MCH
IMCI
Family Planning
STD management
ANC/PNC
(Even if there is no MCH, the health facility must still have at least one
provider trained in this area.)
6.8 Does the facility have
at least one staff
member trained in the
following areas in the
OPD and MCH
departments?
Interview with in-charge
and MCH/OPD providers
on site.
Malaria management
LEVEL
II I I I IV H
A qualified health provider is assigned 24 hours a day, 7 days a week. (A
qualified provider = nurse, midwife, CO or MO)
6.10 Is there a health
provider available at all
times?
* This standard should not
be assessed if the facility
does not offer in-patient
services (that is, if
Standard 1.6 and 5.5 do
not apply either).
Review the current duty
roster and observation of
staff housing/duty room
with sleeping
accommodations.
AND
There is staff housing near the health facility.
OR
In the unit, a duty room is available for staff with sleeping accommodations.
SECTION 4: THE ASSESSMENT TOOLS
45
In-Patient/Hospital Specific Standards
# Standard Means of Verification Operational Definition Assessment
(Yes or No)
1.6 Are men and women’s
in-patient wards
separated?
Observation of in-patient
wards.
Men’s beds and women’s beds are in separate wards.
OR
There is a screen or curtains between men’s beds and women’s beds on inpatient wards.
Health workers are providing correct treatment (that is, diagnosis, treatment,
timing of medication) according to Uganda Clinical Guidelines for the
following in-patients: sick children, medical, and/or surgical. Review the
records of three in-patients and then interview the patient/caretaker about the
treatment received. Compare the record with client response.
Client #
1
2
3
1. Does the prescribed treatment match the UCG for the stated diagnosis?
2. What type of medication/care does the client say he/she is receiving?
Does this resemble the written record?
5.5 Are providers giving
technically appropriate
inpatient care?
Review of medical
records (registers,
treatment cards).
Interviews with
patients/caretaker about
treatment received.
3. How often does the client say he/she receives medication/care? Does this
match the record?
SECTION 4: THE ASSESSMENT TOOLS
46
HOW TO SELECT 5 DRUGS FOR ASSESSING WHETHER STOCK CARDS ARE AVAILABLE AND UPDATED:
Have someone randomly choose a number between one and five. Select the drug with that order number, then go
down the list selecting every fifth number from the first one. You should get a total of 5 drugs for which to
investigate the stock cards.
1. Amoxycillin caps 250 mg
2. Co-trimoxazole tab 480 mg
3. Erythromycin tab 250 mg
4. Benzathine Penicillin Inj.
5. Chloroquine tab 150 mg base
6. Sulfadoxine/pyrimithamine (Fansidar) tab 525 mg
7. Paracetamol tab 500 mg
8. Vitamin A cap 200,000 IU
9. Ferrous sulphate tab 200 mg
10. Folic acid tab 5 mg
11. Mebendazole tab 100 mg
12. Chloramphenical inj. 1 g vial
13. Quinine inj. 300 mg/ml
14. ORS sachet 1L
15. Ringer’s lactate bottle 500 ml or N/S bottle 500 ml
16. Dextrose 5% Solution bottle 500 ml
17. Measles vaccine
18. DPT vaccine
19. BCG vaccine
20. Depo-Provera
21. Microgynon cycle or LoFeminal cycle
22. Ovrette cycle
23. Condoms
24. Ergometrine inj. 0.2 mg/vial
25. Gloves
Example:
If the number chosen is 2, you will evaluate:
2. Cotrimoxazole
7. Paracetamol tab 500 mg
12. Chloramphenical inj. 1 g vial
17. Measles vaccine
22. Ovrette cycle
Note: if the facility does not have a fridge and does not provide daily immunization, and if your count happens to fall
on one of the vaccines, jump to the next number to pick and carry on until you have selected five products (you may
have to go back to the beginning of the list in order to do that). In the example above, if dealing with a Health
Centre II, you would take the products corresponding to the numbers: 2, 7, 12, 20 and 25. You would use the same
process if the facility you are assessing does not conduct deliveries and your count falls on number 24.
SECTION 4: THE ASSESSMENT TOOLS
47
LOCATION REVIEW
Assessment
(Yes or No)
# Standard Operational Definition
O
PD
M
C
H
M
at er ni ty IP
W
Final
Score
(1 or 0)
Comments/Notes
Pipe, water tank or protected water
source present
1.1 Clean and
reliable water
supply Water flowing from source
Latrines or toilets exist within
compound
Access is guaranteed
Latrine/toilet is clean
1.2 Clean latrines
or toilets
Soap and water available nearby
Examination/delivery couch or
mattresses present
Must be covered with clean, untorn
macintosh or plastic sheet
1.4 Functional
examination
couch
Couch is clean (no visible dust,
stains or blood)
Thermometer
BP cuff/machine
1.5 Basic
examination
equipment is
available and
functional Stethoscope
3.1 Facilities for
hand washing
Soap and water available in/near
consulting room(s)
3.2 Disposal of
sharps and
needles
Labeled sharp containers available
in examination, injection, dressing,
dental rooms and laboratory.
Dressing/injection/examination/lab
rooms/delivery room/IP ward clean
3.3 Clean service
environment
Dustbins available
3.4 Facilities for
disinfection
Bucket with chlorine solution
available in at least one area of
department
6.2 Private area
for
examination
Examination area separated
6.9 List of
services
available
List of services in understood
language available in waiting area of
OPD and MCH
SECTION 4: THE ASSESSMENT TOOLS
48
INVENTORY AND RECORD REVIEW
# Standard Operational Definition Assessment
(Yes or Not)
Final
Score
(1 or 0)
Comments/Notes
LEVEL II III IV H
Rubbish pit in compound
Pit not overflowing, properly used
1.3 Rubbish pit/
placenta pit
Placenta pit within compound
LEVEL II III IV H
Baby weighing scale
Timing device
ORS corner (jug, 2 cups and 2 spoons)
Fetoscope
Adult weighing scale
Lantern or alternative lighting
Sterilizers/autoclave OR stove and pans
Speculum
Delivery kit
Microscope
Anaesthesia machine*
C-Section sets (2)*
Laparotomy sets (2)*
Refrigerator for blood*
Cross-matching equipment*
1.5 Basic
examination/
Emergency
equipment is
available,
functional and
registered in
the inventory
(*if HC IV or
Hospital does
not have an
operational
theatre, then
do not
evaluate for
these items.)
Blood for transfusion*
Registers exist in clinics 2.1 OPD, ANC and
FP registers upto-date
Info on patient characteristics written
Copies HMIS 105 for last three months
are present
2.2
Monthly report
correctly
completed
No. of malaria visits for one month = no.
in register for the same month (plus or
minus 5%) Month/Year __________
Total # on HMIS ____________
Total # in Register ____________
Stock cards present and updated for:
#1
Stock Card: Store:
#2
Stock Card: Store:
#3
Stock Card: Store:
#4
Stock Card: Store:
2.3
Updated stock
cards
#5
Stock Card: Store:
SECTION 4: THE ASSESSMENT TOOLS
49
# Standard Operational Definition Assessment
(Yes or No)
Final
Score
(1 or 0)
Comments/Notes
LEVEL
Following available in last 3 months:
II III IV H
Chloroquine tabs
Fansidar
Cotrimoxazole tabs
ORS
Measles Vaccine
DPT-HepB+hib
Vaccine
2.4 Availability of
essential
products
Depo-Provera
Condoms
2.5 HUMC meets
every quarter
Minutes of HUMC meeting available.
4.1 Health
education
talks are given
to clients
Group education
sessions occur 4 times
a month
LEVEL II III IV H
Monitoring chart on refrigerator
Temp. monitored 2/day, 7day/wk
Temp. maintained between +2 and +8C
5.1 Maintenance
of cold chain
Thermometer in fridge (HC III +)
Vaccine carriers/ice packs OK (all)
LEVEL II III IV H
Immunization provided same day
5.2 Immunization
services
provided
Immunization provided each week
Waiting area protected from sun/rain 6.1 Waiting area
clean and
protected Floor mopped, clean
CLIENT INTERVIEW #: 1 2 3
Health worker directed where to go
6.3 Clients
received in
friendly and
respectful
manner Felt treated respectfully
6.4 First-come,
first-served
system
System to serve clients in order
CLIENT INTERVIEW #: 1 2 3 6.5 Waiting time
less than one
hour Waited less than one hour
SECTION 4: THE ASSESSMENT TOOLS
50
CLINICAL OBSERVATIONS
# Standard Operational Definition Assessment (Yes or No) Final Score (1 or 0) Comments/Notes
Uganda Clinical Guidelines 2.6 Guidelines for
case
management IMCI Guidelines (chart-booklet or wall chart)
LOCATION OP
D
M
C
H
M
A
T
IP
W
3.1 Facilities for
hand washing
Providers wash hands between clients and
procedures
LOCATION OP
D
M
C
H
M
A
T
IP
W
3.2 Disposal of
sharps and
needles
Staff safely dispose of sharps and needles
OBSERVATION #: 1 2 3 4.2 Using of
teaching aids
during
counseling
Provider uses IEC materials during sessions
OBSERVATION #: 1 2 3
Provider asks about history and problems
4.3 Providers
encourage
clients to
discuss
problems Provider invites client to ask questions
Provider gives correct services in IMCI and two
other services: ANC, delivery, PNC, FP, STD,
malaria, TB, injury management, dental care
Obs. #1: IMCI
Obs. #2:
5.4 Providers give
technically
appropriate
services
Obs. #3:
Aseptic procedures correctly performed: wound
dressing, suturing, catheterisation, injection,
Norplant insertion/removal, IV infusion, dental
extraction
Obs. #1:
3.5 Staff follows
correct aseptic
techniques
Obs. #2:
OBSERVATION #: 1 2
Under-five child is weighed
Weight plotted on child’s health card
5.3 All children
have weight
plotted on
health card
If more than one weight is plotted, line drawn to
connect dots
SECTION 4: THE ASSESSMENT TOOLS
51
CLINCAL OBSERVATIONS CONTINUED
LOCATION O
PD
M
C
H
M
A
T
IP
W
6.2
Private area
for
examination
Privacy maintained during
procedures
OBSERVATION # 1 2 3
Instructs clients on drug, dose, time
and day
6.6
Provider/dispe
nser gives
information on
treatment
compliance Checks client’s understanding
INTERVIEW WITH THE IN-CHARGE
# Standard Operational Definition Assessment
(Yes or No)
Final
Score
(1 or 0)
Comments/Notes
6.7 Plan for
referring
emergency
cases
Facility provides some type of
assistance to referrals.
At least one staff member trained in
these areas in OPD & MCH:
OPD MCH
IMCI
Family Planning
STD Management
Antenatal/postnatal care
6.8 At least one
staff
member
trained in
IMCI, FP,
STD,
ANC/PNC,
malaria
mgmt in
OPD and
MCH Malaria Management
LEVEL II III IV H
Provider available 24 hours a day, 7
days a week
6.10 Qualified
provider
available at
all times
Staff housing or duty room available
IN-PATIENT/HOSPITAL SPECIFIC STANDARDS
# Standard Operational Definition Assessment
(Yes or No)
Final
Score
(1 or 0)
Comments/Notes
1.6 Men and
women inpatient wards
separated
Men and women’s beds in different
wards or separated by curtains
CLIENT #
Correct treatment for sick child, medical
or surgical patient. Comparison of
records and patient’s responses.
1 2 3
Treatment matches diagnosis
Medications received resembles
prescription
5.5 Providers give
technically
appropriate inpatient care
Frequency and time of medication
SECTION 4: THE ASSESSMENT TOOLS
52
CALCULATE THE FACILITY OVERALL SCORE
Table 1: Calculate the overall score for Standard 1.5 (basic equipment available), 3.1 (hand washing), 3.2
(sharps & needles) and 6.2 (Private examination area):
Standard1.5 Standard 3.1 Standard 3.2 Standard 6.2
Score from Location Review
section
Score from Inventory/Records for
1.5, and scores from Clinical
Observations section for 3.1, 3.2
and 6.2
TOTAL SCORE
Total score will be “1” if score for both sections is “1”; otherwise it will be “0”.
Table 2: Calculate final scores by category using the scores from the previous sections (Location Review
Summary, Inventory and Records, Clinical Observations, Interview with In-Charge, In-Patients/Hospital
Specific Standards) and the summary scores above for standards 1.5, 3.1, 3.2 and 6.2 (marked with *
below). Remember, you can only write 1 or 0 in the boxes.
Standards
1.1 1.2 1.3 1.4 1.5* 1.6 1. Infrastructure and
Equipment
2.1 2.2 2.3 2.4 2.5 2.6 2. Management
Systems
3.1* 3.2* 3.3 3.4 3.5 3. Infection
Prevention
4.1 4.2 4.3 4. IEC/IPC
5.1 5.2 5.3 5.4 5.5 5. Clinical Services
6.1 6.2* 6.3 6.4 6.5 6.6 6.7 6.8 6.9 6.10 6. Client
Services
SECTION 4: THE ASSESSMENT TOOLS
53
Table 3: Total score and percentage of achievement for the facility
Category Elements to add to obtain
the score
Score No. of
Items
Percentag
e HC II - III: 1.1 to 1.5 5 1. Infrastructure &
Equipment HC IV – Hosp: 1.1 to 1.6 6
2. Management
Systems
2.1 to 2.6 6
3. Infection
Prevention
3.1 to 3.5 5
4. IEC/IPC 4.1 to 4.3 3
HC II – III: 5.1 to 5.4 4 5. Technical Skills
HC IV – Hosp: 5.1 to 5.5 5
HC II: 6.1 to 6.9 9 6. Client
Services HC III – Hosp: 6.1 to 6.10 10
Sum of all categories
HC II: 32
HC III: 33
Total
HC IV – Hosp: 35
ACTIONS TO BE TAKEN BY SUPERVISOR(S) (Description of action, date of completion)
COMMENTS/NOTES OF SUPERVISOR(S)
SUPERVISORY TEAM MEMBERS (Date, Printed Name & Signature)
SECTION 4: THE ASSESSMENT TOOLS
54
ACTIONS TO BE TAKEN BY HEALTH FACILITY
(Description of action, Responsible party, date of completion)
COMMENTS/NOTES OF HEALTH FACILITY IN-CHARGE
HEALTH FACILITY IN-CHARGE (Date, Printed Name & Signature)
____________________________________________________________________________________
_______
SECTION 4: THE YELLOW STAR ACTIVATION KIT
55
SECTION 5:
THE
YELLOW STAR
ACTIVATION KIT
SECTION 5: THE YELLOW STAR ACTIVATION KIT
56
Implementation Guidelines for Supervisors
Hello and welcome to the Yellow Star Activation Kit Implementation Guidelines for
Supervisors. As a supervisor, you play an important role in sensitising, implementing
and monitoring health facilities for the Yellow Star Programme. These implementation
guidelines will help direct you through the process. If you have any questions, please
contact the District Health Services.
Process
Every health facility should receive one Yellow Star Activation Kit. In order to ensure
that the materials in the Activation Kit are used and displayed properly, you must
explain the meaning of each item to the staff of the health facility and physically place
the contents of the Kit in the appropriate locations within the health facility. Please do
not leave the contents of the Activation Kit in the box at the facility and ask the staff to
arrange for the display of the contents. But don’t worry – it’s easy. This section will
guide you through the work.
Contents
Each Activation Kit contains (at a minimum) the following items:
 1 Yellow Star Health Facility Manual
 3 Health Worker Pledges in English and local language
 3 Yellow Star Community Posters in English and local language
 2 Posters Describing the Basic Standards
 1 Sticker for the Stock Room
 1 Sticker for the Dispensary
 3 Stickers about Washing Your Hands
As the level of the health facility increases, the number of posters and stickers
increases to compensate for the larger venue. Hence, a hospital will be given more
than 3 Wash Your Hand Stickers or 3 Community Posters.
Please double check that all these items are located in the Activation Kit before you go
to the health facility. If you are missing an item, notify the District Health Services and
request the item from the supply closet.
Sensitising the Health Facility about the Yellow Star Programme
During your next regularly scheduled supervisory visits to the health facility, bring along
the Activation Kit. Be sure to alert the staff of the health facility in advance that you are
coming to brief them on the new Yellow Star Programme by the Ministry of Health. Ask
that all staff and the HUMC be available for a two-hour briefing. This briefing should be
scheduled at a time when client load at the health facility is low so that the briefing does
not interfere with their regular work. If this proves to be too difficult, arrange to brief the
staff in two shifts so that one group caters to clients while the other attends your
briefing.
Please note the briefing should include ALL employees of the health facility, from the
clinical officer to the cleaner and members of the HUMC. The Basic Standards for
SECTION 5: THE YELLOW STAR ACTIVATION KIT
57
Quality Health Services affect every aspect of a health facility and all employees will
have an important role to play. It is important that everyone understand this new
programme.
The agenda for the briefing should look something like this:
I. Yellow Star Strategy Summary
II. Description of the Basic Standards for Quality Health Services
III. Yellow Star Programme Description: How does this whole thing work?
IV. Evaluation & Scoring
V. What’s Your Role?
VI. How to Get the Community Involved
VII. The Activation Kit
VIII. The Way Forward: What can the facility do now? What’s the next step?
The Briefing: Helpful Hints for Discussion by Agenda Item
The goal of the briefing is to sensitise the staff of the health facility about the Yellow Star
Programme and gain their commitment to achieving and maintaining the basic
standards. Keeping that in mind, it is important that the format of the meeting remain
open so if they don’t understand a certain point, they are free to ask questions.
I. Yellow Star Strategy Summary
Pull out the Yellow Star Health Facility Binder. Explain to the staff that this binder is for
all employees at the health facility and should be stored in a central, easy to access
location. It should be used as a reference tool and information storage for the Yellow
Star Programme. At least one copy of all documents should remain in the binder at all
times.
The Health Facility Binder begins with an introduction from the MOH, followed by a
contents page that can help direct users to the appropriate location for materials. Flip to
the divider labelled “Yellow Star Strategy.” Behind this divider you will find copies of the
summary of the Yellow Star strategy. Distribute copies to the staff, but be sure that at
least one copy of the strategy remains in the binder.
Discuss the strategy with staff. Ask if they have questions. Encourage an open
discussion. If they have questions you cannot answer, tell them you will find out the
answer and get back to them.
II. Description of the Basic Standards for Quality Health Services
Flip to the divider labelled “Basic Standards.” Behind this divider you will find copies of
the list of Basic Standards. The standards are organised into six core areas:
infrastructure and equipment; management systems; infection prevention, IEC/IPC,
SECTION 5: THE YELLOW STAR ACTIVATION KIT
58
clinical service; and customer service. Distribute copies to the staff, but be sure that at
least one copy of the standards remains in the binder.
Discuss each standard individually with the group. Review the operational definition and
means of verification. It is important that the group understands the meaning of each
standard, as their health facility will be assessed on these criteria.
III. Yellow Star Programme Description
Now that the staff has a good idea of what the programme is all about and how the
standards are defined, take this opportunity to discuss with them how the whole
program works. There is one copy of the programme description in the Health Facility
Binder behind the “Programme Description” Divider. Refer to this as you discuss the
policies, guidelines and rules behind the Yellow Star Programme.
IV. Evaluation & Scoring
The next topic for discussion is actually ‘how’ the health facility will be evaluated. Pull
out a copy of the Assessment Tool, Scoring Guidelines and Scoring Recording Sheet
from the divider labelled “Evaluation Tools.” Explain how this tool works (i.e. how you,
as a supervisor will fill it out), how the scoring for each standard works and show them a
copy of the Scoring Recording Sheet in triplicate and describe how the reports will be
tracked and stored. (There are multiple Scoring Sheets in this section of the health
facility binder. Each time a supervisor comes to do the evaluation, he or she will use
one of these blank forms. The forms will be replenished as needed.)
V. What’s Your Role?
It’s important that ALL the staff at the health facility and HUMC members understand
what an important role they play in the implementation of this program. Everyone can
have a direct impact on this programme. The goal is to encourage an open atmosphere
of communication among co-workers and the community. Get them to talk about how
can they work together as a team to make some quality improvements at their health
facility and meet the standards. Specifically, get them to discuss:
 Who should be in charge of overseeing this program for their facility?
 Who can help organise and prepare the necessary records for the assessment
team?
 How could they go about doing their own pre-evaluation before you arrive next
quarter for an official visit? (This way they could see how well they are meeting the
standards.)
 Are there things they can identify immediately which need to be improved? How
could they improve these things – what is the plan of action? Who could be in
charge of quality improvement activities?
VI. How to Get the Community Involved
Turn to the Divider labelled “Community Involvement.” Read this section out loud with
the group. The goal is to create a Yellow Star Committee consisting of 1 or 2 health
workers from the facility and 1 or 2 representatives from the HUMC. This group will
SECTION 5: THE YELLOW STAR ACTIVATION KIT
59
focus specifically on the Yellow Star Standards and help the health facility to identify
problems and implement plans to improve the situation. These people should
determine a time and location to hold regular meetings -- either monthly or quarterly, but
the meeting should be open to the public so other people can attend if they wish.
The above is a suggested approach to initiating and maintaining HUMC and health
facility involvement in the Yellow Star Programme. Health facilities and HUMCs may
discover other mechanisms to meet this goal. They should feel free to adapt or change
the suggested method to best fit their health facility. After all, people who work with the
health facility regularly will know how to best involve its key players in the programme.
Furthermore, if the HUMC is not currently holding meetings, as a group, you could
discuss ways to encourage the committee to meet on a regular basis and be more
involved in the business of the health facility.
You have already discussed potential areas that need improvement at the facility. Now
talk about ways to involve the whole community in these projects, not just the HUMC.
Someone should take detailed notes of this discussion for future reference.
VII. The Activation Kit
Now take out all the items in the Activation Kit and explain what they are and how they
will be used or displayed. Explain to the staff that it is your job to place these items in
the appropriate locations in the health facility. Encourage them to use the pieces, as
they will help them to improve the quality of services they offer their clients.
3 Health Worker Pledge: This charter contains a summary of the basic standards.
Read the charter out loud to the staff. Discuss it. Does everyone agree that these are
fair and true principles that health workers should abide by? Hopefully, they think so.
Then have each staff member of the health facility sign their name at the bottom of each
pledge demonstrating that they believe in quality health care and will try to provide good
quality services to their clients. Inform staff that the pledge posters will be displayed in
customer waiting areas.
3 Yellow Star Community Posters: These posters are to educate clients and
perspective clients about the Yellow Star Programme. Hang these posters in the
waiting room or public areas around the health facility for clients to read.
2 Posters Describing the Basic Standards: This poster outlines the basic standards
in simple terminology. It can be used as a reference tool for health workers and clients.
Your supervisor should have placed this poster in a busy location at your health facility
where it can easily be referenced.
Helpful Reminders for Health Workers: There are several items that are handy little
reminders for “staff eyes-only!” All of the items should be placed in areas where health
workers can easily access the message. These include the following:
SECTION 5: THE YELLOW STAR ACTIVATION KIT
60
 1 Sticker for the Stock Room: This sticker should be placed in the prominent
location in the stock room, possibly on the inside of the door to be seen by the
stock clerk. The idea is to remind the stock clerk to check the stock every day
and maintain the minimum balance at all times to avoid stock outs of drugs.
 1 Sticker for the Dispensary: This sticker should be placed in the dispensary or in
an area that is used to dispense drugs. It is meant to remind those health
workers who give out drugs the importance of explaining to a client, when and
how to take the medication in addition to making sure the client understands the
instructions.
 3 Stickers about Washing Your Hands: These stickers should be placed above
sinks with running water in consultation rooms, treatment rooms or staff
latrines/toilets. Please do not put the stickers above just any sink in the health
facility. It should be located in a consultation room, treatment room or staff toilets
because the idea is to remind health workers about the importance of washing
their hands between every client and procedure!
Each item in the Activation Kit has important message about client service. Take this
opportunity to discuss good customer service with the staff. Use the key messages
below:
 Health care is a service delivery industry – we are in business to SERVE the
people!
 Clients come to the health facility to receive assistance of some kind. We want our
clients to keep coming back. For that to occur the clients must feel happy and
satisfied with the services we provide.
 Research shows that clients are not happy with some of the current services. In
addition to the clients understandable desire for accessible drugs, equipment and
supplies (things often out of the control of health workers), clients want a health
worker who treats them with respect, is concerned about their welfare and wants to
help. Put yourself in their shoes – wouldn’t you want the same thing?
 We want to show clients that as their health worker, we care about them! We want
to offer them the best possible services given our resources and we want to give
them friendly, respectful treatment.
 As a health worker, it is important that you are not only technically competent, but
that you have a warm, friendly attitude.
 Sick people are not always the easiest people in the world to deal with, but as a
health worker, you have to remember that they are sick! They don’t feel well and
they may be cranky or irritable. But if you can offer services in a friendly, warm
manner you may actually be taking the first step in making them feel better.
 If you are having a bad day, try not to take it out on the client. It’s always better to
excuse yourself and take a quick break or ask a fellow co-worker to take over the
case.
The Health Facility Manual: This is the core resource piece on the Yellow Star
Programme for the health facility. Inside the manual are multiple copies of the strategy
SECTION 5: THE YELLOW STAR ACTIVATION KIT
61
and standards as well as single copies of the programme description, scoring
guidelines, assessment tool and scoring sheets. These are things you have already
discussed with the staff. Please review the other information in the manual that staff
will find useful for the programme.
Activation Kit: A brief summary of the materials previously discussed in this
section (stickers, etc.) and how they should be used.
Making Improvements: This is a reference piece to help supervisors and health
workers think of ways to improve the health services at the facility and score
better on the assessment review. There is also information here about how to
get the community involved in the quality improvement process, and a short
guide to planning and implementing activities.
Tracking Our Results: This is the place where the health facility should store its
copies of the scoring sheets after a supervisory team has conducted the
quarterly review of the health facility. It is a good piece to reference as they try to
figure out what things to improve at the facility.
Health Worker Newsletters: The MOH created a newsletter for health workers.
Health workers are an important asset to Uganda’s health care industry and the
newsletter is a forum of discussion, questions and concerns for this audience.
The newsletters will discuss medical issues like quality care and recognise health
workers and facilities that are offering good customer service and meeting the
standards. The newsletter will be provided to health workers on a quarterly
basis. Each health facility will receive multiple copies, but staff should keep at
least one reference copy here in this section.
Star Health Worker Award: Behind this section health workers will find
information about the Star Health Worker Award. The Star Health Worker Award
is a way of recognising health workers who demonstrate good customer service
to their clients. Health Sub-District Supervisors will bestow this award to
recipients in their HSD. The HSD Supervisors will meet, discuss and determine
3 winners every quarter. The awards can be given at any time during the quarter
and to any cadre of service health worker. Specifically, supervisors will be
looking for health workers who show their clients they respect them by listening
attentively, encouraging them to discuss problems, giving clear instructions,
spending quality time with them, providing a welcoming environment and offering
services in a friendly manner. (See Section 8 in your manual for more details.)
Winners of the Star Health Worker Award will receive a certificate and a gift. In
addition, a second certificate will be posted in the customer waiting area so that
others can appreciate work well done.
Also in this section, is a recording sheet for the supervisor and/or health facility to
fill out when someone at the health facility wins the award. This should be filled
out anytime an employee is bestowed the Star Health Worker Award.
SECTION 5: THE YELLOW STAR ACTIVATION KIT
62
STAR HEALTH WORKER AWARD FOR
SUPERVISORS
In addition, since HSD Supervisors are a critical link in the supervision program,
an influential factor in the Yellow Star Program and also health workers, it is just
as important to acknowledge those of you who provide good client care to your
patients.
Therefore, every six months the District Health Team (DHT) will award the Star
Health Worker Award to one HSD Supervisor. For more details on this activity,
please visit Section 8 of your Yellow Star Manual.
Community Involvement: This section is filled with tools and materials a health
facility can use to get the community involved with the Yellow Star Programme.
The packet of information contains key messages and sample projects. It is
recommended that each facility create a Yellow Star Committee consisting of one
or two health workers and two people from the HUMC. This group can help the
facility to identify problem areas and then plan, implement and assess quality
improvement projects.
IX. The Way Forward
The last agenda item provide the staff the opportunity to ask questions about the
programme and discuss the timing of the health facility’s first evaluation for the Yellow
Star Programme. Let staff know when you will be coming to conduct the assessment
review and discuss what preparation needs to be done. There is a section in the
program description of their manual (Section 3) that discusses helpful hints in preparing
for a review. Be sure to bring this to their attention.
Placing Materials from the Activation Kit Around the Facility
It is your job as a supervisor to physically place items from the Activation Kit throughout
the health facility. Here’s how it should work:
1. 3 Health Worker Pledges: After every staff member has signed the bottom of each
poster, they should be hung on the wall in the customer waiting area and other
public places of the health facility. The posters should be in a location where they
are clearly readable by the health facility’s customers. We want clients to know that
the service health workers at this facility care about them!
2. 3 Yellow Star Community Posters: These posters should also be displayed in
areas where customers can read them, possibly the waiting area and the
examination room(s).
3. 2 Posters Describing the Standards: These posters are for the clients and health
workers. The poster will help clients understand the basic standards in an easy to
understand format. The poster can also be a quick reference tool for health workers.
Display these posters in public areas accessible to both clients and health workers.
SECTION 5: THE YELLOW STAR ACTIVATION KIT
63
4. 1 Sticker for the Stock Room: This sticker should be placed in the prominent
location in the stock room possibly on the door or other accessible location. The
sticker should remind the stock clerk to check the stock every day and maintain the
minimum balance at all times to avoid stock outs of drugs.
5. 1 Sticker for the Dispensary: This sticker should be placed in the dispensary or in
an area that is used to dispense drugs. It is meant to remind those health workers
who give out drugs the importance of explaining to a client when and how to take the
medication in addition to making sure the client understands the instructions.
6. 3 Stickers about Washing Your Hands: These stickers should be placed above
sinks with running water in consultation rooms, treatment rooms or staff
latrines/toilets. Stickers should NOT be placed above any old sink. The idea is to
remind health workers about the importance of washing their hands between every
client and procedure so the stickers should be displayed above sinks in consultation
rooms, treatment rooms and staff toilets.
Follow Up
As with any programme, supervision is an essential factor to the equation. During
subsequent supervisory visits, it is important to talk with the staff and determine what
types of activities they are undertaking to improve the quality of services. Also, making
recommendations, suggestions or helping them to problem solve will go a long way
towards the growth of this programme.
It is also important to inquire about ongoing concerns with the Yellow Star Programme
and find out if the health facility is conducting regular village meetings to educate the
community.
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64
THE ACTIVATION KIT IS WHAT EVERY HEALTH FACILITY NEEDS AS A SUPPORT TO BEGIN IMPLEMENTING THE
YELLOW STAR PROGRAMME. CAREFULLY READ THROUGH THE ITEMS BELOW AND THEN DISPLAY THE
MATERIALS AS OUTLINED. YOU CAN ALSO REFER TO ‘SECTION 5: ACTIVATION KIT’ IN YOUR MANUAL FOR MORE
INFORMATION ABOUT THESE MATERIALS.
Contents of the Activation Kit
Each Activation Kit contains (at a minimum) the following items:
 1 Yellow Star Health Facility Manual
 3 Health Worker Pledges in English and local language
 3 Yellow Star Community Posters in English and local language
 2 Posters Describing the Basic Standards
 1 Sticker for the Stock Room
 1 Sticker for the Dispensary
 3 Stickers about Washing Your Hands
As the level of the health facility increases, the number of posters and stickers increases to
compensate for the larger venue. Hence, a hospital will be given more than 3 Wash Your Hand
Stickers or 3 Community Posters.
How to Use the Activation Kit
1. Health Worker Pledge: The pledge poster lists four basic principles the staff of the health
facility should follow. At the bottom of the poster are lines for signatures. Read the pledge
out loud to the staff. Discuss it especially after supervision visits and assessment of the
facility on the Yellow Star Programme basic standards for quality of care. Have each staff
member of the health facility sign their name at the bottom of each pledge after the second
assessment, demonstrating that they believe in quality health care and will try to provide
good quality services to their clients. After all the staff members sign the poster, display the
pledge in the client waiting area.
2. Yellow Star Community Posters in English & Your Local Language: These posters are
to educate clients and perspective clients about the Yellow Star Programme. Hang these
posters in the waiting room or public areas around the health facility for clients to read.
3. Posters Describing the Basic Standards: This poster outlines some of the basic
standards in simple language. It can be used as a reference tool for health workers and
clients. The posters should be placed in busy locations at your health facility where clients
and health workers can read them.
4. Helpful Reminders for Health Workers: There are three types of reminders for health
workers. All of the items should be placed in areas where health workers can easily read
them as they perform their daily duties. Please display them as recommended below:
 Sticker for the Stock Room: This sticker should be placed in the prominent location in the
stock room(s), possibly on the inside of the door to be seen by the stock clerk. The idea
is to remind staff working in the stock room to check stock every day and maintain the
minimum balance at all times to avoid stock outs of drugs.
 Sticker for the Dispensary: This sticker should be placed in the dispensary or in an area
that is used to dispense drugs. It is meant to remind those health workers who give out
drugs the importance of explaining to a client, when and how to take the medication in
addition to making sure the client understands the instructions.
 Stickers about Washing Your Hands: These stickers should be placed above sinks with
running water in consultation rooms, treatment rooms or staff latrines/toilets. Please do
not put the stickers above just any sink in the health facility. It should be located in a
SECTION 6: THE YELLOW STAR ACTIVATION KIT
65
consultation room, treatment room or staff toilets because the idea is to remind health
workers about the importance of washing their hands between every client and
procedure!
SECTION 6: MAKING IMPROVEMENTS
66
SECTION 6:
MAKING
IMPROVEMENTS
SECTION 6: MAKING IMPROVEMENTS
67
How to Work Together to Improve the Quality of Health Services
In order to achieve the Basic Standards for Quality Health Services and maintain them
over time, everyone needs to get involved: the MOH, political leaders, development
partners, health workers and the community.
The MOH, district governments and development partners continue to support training
and supervision of health workers, health education activities, HMIS and provision of
drugs and supplies to health units. However, these activities are only the foundation of
health services. We must also seek ways to continuously improve the services we
provide to the community and the way those services are provided. The goal is to offer
the community good quality health services, services they can trust.
WHAT IS QUALITY?
Quality is a measure of how good something is. An object or service has quality if it
meets or exceeds what the user expects. For example, you might consider a restaurant
to have good quality service if, in addition to the food being good, the waiter is polite
and brings you the food quickly. In this case, showing respect and serving food
promptly would be things that are important to you, things you expect.
The quality of a health service can be defined in a similar way. You can assess the
quality of health care by comparing the way the service is delivered with what you
expect. For example, you might consider health services to be of quality if you do not
have to wait a long time to be seen by a health worker. The MOH has defined the
expected quality of service delivery for health care by establishing the Basic Standards
for Quality Health Services. The MOH expects every health facility to meet those
standards. If a health facility meets all of the standards, it means that this health facility
is providing health services the community can trust, in the context of the current
situation in Uganda. Of course, these are minimal standards and we will need to
maintain our efforts towards better quality, even after each facility meets those basic
standards. For instance, the National Supervision Guidelines provide a more
comprehensive set of quality standards in the form of checklists for technical
supervision.
WHY SHOULD WE IMPROVE THE QUALITY OF HEALTH SERVICES?
If quality services are provided, both the health worker and clients will be satisfied and
confident of the services. On the other hand, poor quality services will result in their
dissatisfaction, at great cost both to the health system and the client. If a client is not
managed properly by a health worker, it could cause that person to be sick for a
longer period of time than necessary and might make her have to visit the health
centre many times. This costs the client time and money, in addition to feeling sick
for a longer period. At the same time, each new visit increases the workload of the
health workers.
Sometimes it is hard to notice the results of poor quality service. An example is the
frustration that patients feel when they have to wait a long time to receive services.
SECTION 6: MAKING IMPROVEMENTS
68
They may not voice any complaints to the health workers, but they may decide not to
return to that facility in the future. Factors like these may not be openly visible and yet
they effect the quality of service at a health facility.
It is important for both the clients and health workers to feel satisfied with the quality of
services being offered!
IMPROVING PERFORMANCE & SERVICES
Improving performance or a service is a continuous, day to day process that requires
each actor in the system to play his/her part. In the health care system this means that
health workers need to work with their clients to understand how they want services
provided and try to meet those expectations, versus simply providing services the way
they think is best for people.
One can try to improve the quality of health services by looking at how the services are
delivered. Health workers should constantly be looking for opportunities to improve
their performance and the services offered at their health facility. Your role as a
supervisor is to provide support in problem solving and being a role model.
Improving the quality of a service requires that we look at the main cause of the problem
rather than focusing on a symptom. For example, clients may not be visiting the health
facility because they feel the health workers are rude to them. This rudeness by health
workers may be the result of worker frustration. But why are the health workers
frustrated? -- Are there too many clients? Is there a shortage of health workers? Are
the health workers working long hours? – You cannot improve this situation unless you
determine why the health workers are frustrated and try to eliminate or reduce those
frustrations.
There are five key things to remember as you start to focus on improving quality in a
health facility. These are things that may help guide the process of making changes
and providing better services to your clients.
1. MEET THE NEED OF THE CLIENTS
For a service to be of value it must meet the needs of the user or in this case, the
client. Clients are actually customers because customers are people who use a
service even if there is no cash payment involved. A customer is the person who
receives the service, while the health worker is the one who gives the service. This
service relationship means that the health worker must seek to meet the needs of
the client in order to maintain their confidence. If these needs are not met, the client
will be dissatisfied and will likely go away to seek care from other health workers.
This is one reason why some health facilities have a low client load and why clients
seek services from private clinics, drug shops or traditional healers.
Sometimes, a health worker may actually become a client. For example, a nurse in
a hospital is a client of the pharmacist/store keeper when she goes to the store to
SECTION 6: MAKING IMPROVEMENTS
69
collect drugs. When that nurse returns to the ward with the drugs she becomes a
health worker providing a service to her client.
Putting ourselves in the “client’s shoes” is a good way to understand what the clients
are expecting from us. Let us ask ourselves how we would like to be treated if we
had to seek care in this facility.
2. LOOK AT SYSTEMS & PROCESSES
There are a series of steps and activities that must take place in order to deliver a
service. Sometimes it is important to look closely at the steps in the process and
see if there are any weak areas or places which could be changed or fixed to make
the whole system run more smoothly. Search for ways to improve each step of the
process and over time, the quality of that service will improve.
Often we have a tendency to blame the persons providing the service, but in most
cases the problems are related to weak steps in the process. Before blaming
anyone, look for the root causes of a problem rather than the symptoms. Then
search for ways of improving each step of the process. Over time, these
improvements will lead to better quality service.
3. USE RELIABLE INFORMATION TO MAKE DECISIONS
Quality is a measure of how good something is. Measurement is therefore important
in improving quality. Measurement is done by collecting data about the activities
we do, and transforming it into information for making decisions. Reliable
information can be used to:
 identify problems;
 plan services;
 identify resources needed (people, supplies, money);
 monitor and evaluate services; and
 make day to day decisions.
Sources of data for quality improvement include HMIS registers or reports, simple
research surveys organised in the health facility or the community to get an answer
to a specific question, or listening to what the community commonly says about
services at the health facility. Health workers can review information collected and
use it to evaluate services offered and develop ways to improve the quality of that
service.
4. WORK AS A TEAM
A team is a group of people who work together for a common goal for which they
share responsibility. Delivery of health services depends on good teamwork. For
example, treating a patient requires a “team” of people – someone who registers the
patient, someone who examines the patient and prescribes treatment and someone
to dispense the medication.
When you work together as a team:
 There are more ideas about how to solve a problem because different people
contribute from their knowledge or experience.
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70
 Everyone can discuss and agree on the goal.
 The responsibilities and the workload will be shared.
 Team members can provide support to each other when needed.
5. PRACTICE GOOD COMMUNICATION
Communication is the way a message is passed from one person to another. Good
communication is an important part of providing quality health care services and
satisfying the client. If the steps in the process of communication are weak, then the
result can be poor quality services.
Good communication between health workers and clients improves the quality of
care. For example, a health worker needs to explain to a client what their illness is
and the treatment required. The health worker also needs to check that a client has
understood everything they were told. If the client does not understand the
instructions for taking the medication then the client may not take the medication as
required and may not get better.
Good communication is also important for improving relationships between team members
in the facility, between health workers and their supervisors or community leaders. As you
share ideas, problems and decisions, your solutions will prove to be lasting.
IMPLEMENTING ACTIVITIES TO IMPROVE SERVICES OR PERFORMANCE
The process of improving quality will be different for each facility depending on its
circumstances. As a supervisor, it is your job to help the health workers identify the key
problem areas and then develop a plan to fix those problems.
Here are some guidelines that will help you support health workers as they begin quality
improvement activities at their facilities:
 Quality improvement is an integral part of supportive supervision. The goal of
supervision is to help health workers do their job better. The Yellow Star
assessment process, the quality improvement tools you share with the health
workers will contribute to this goal.
 Remember - YOU are a part of the team. As you work with the health facility staff to
develop plans to improve services, some responsibilities may fall on your shoulders
– that is all part of this process. It’s a team approach to the work. This is a great
chance to show the health workers how you can work with them as a team member.
 Help conduct an “informal, internal” assessment review of the Basic Standards, help
the in-charge to organise an Internal Supervision (self-assessment) as per the
National Supervision Guidelines, or review a recent supervision report with health
workers to help them decide what the main problems are for their facility.
 Help select a problem that is important to the health facility and community, and if
not addressed will cause some health or management risks. Remember that the
SECTION 6: MAKING IMPROVEMENTS
71
problem identified should also be something which the health facility, HSD or district
has some control over so that the chances of solving the problem are good.
 Help the In-charge to identify and organise a team that will act as a volunteer
problem solving committee – the Yellow Star Working Group or Committee. Each
committee should consist of 1 or 2 health workers from the health facility and at
least 2 members from the HUMC. The committee could also have members from
the community who could assist through their position or skills. This committee
should meet on a regular basis at the health facility to review develop plans for
improving service, implement those plans and assess the progress or outcome. On
occasion, you should meet with this volunteer committee.
 Help the health facility and the Yellow Star committee to define problems clearly.
What is known about the problem? If there is not enough information about the
problem, encourage the group gather more from available sources such as HMIS
and then write a clear problem statement. The problem statement should be specific
and should not contain blame or a proposed solution.
 Help the team to analyse the problem. Some methods or tools you may use include
brainstorming, cause and effect charts, flow charts or statistics. These will help you
define the root causes of you problem. As a supervisor, you will get additional
training in the use of these tools. You should also encourage the team to use the
MOH Manual of Quality Improvement Methods for guidance in the use of these
tools.
 Assist them to set a desired expectation or standard by deciding on how the
situation should be after the problem is solved; Make sure that everybody in the
team agrees with this objective. Ideally, the desired expectation should correspond
to one of the Basic Standards.
 Discuss possible solutions to the problem and help the team choose one that is
achievable and most likely to solve the problem. Encourage the group to implement
the proposed plan of action. This may involve re-organising resources in the facility
or bringing additional resources from the HSD, district, local government or
community.
Some examples of proposed solutions to problems often faced by health facilities are:
Working with the community to dig a new pit latrine, rubbish pit, staff accommodation
or additional structure for the health facility.
Organising the work of the registration clerk and filing records in order to reduce
client waiting time.
Supervising the dispenser and helping him/her to give proper instructions on drug
doses to patients.
Distributing IEC materials among health workers and promoting their use.
Developing a system to ensure that there is never a stock out of essential drugs.
Creating a program to encourage health workers to wash their hands between
patients, treatments and after using the latrine.
Analysing the flow of clients and implementing ways to reduce client waiting time.
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72
 Together with the team, evaluate the results of their actions. What change has
occurred? Was the desired result achieved? If not, what further actions should be
taken in order to improve the situation? Can the solution be made simpler?
 If the team is satisfied that the problem is solved, select a new issue and start the
problem solving cycle again.
 During supervisory visits, follow up on decisions made during problem cycles. Make
sure that the changes the team makes and the standards they achieve are
maintained over time.
 You are an important link between health workers and the HSD or district. Share
your experiences with other supervisors who may come across similar problems in
their health facilities. As a supervisor, your role is important for sharing lessons
learned with others to speed up the process of quality improvement at all health
facilities.
 Communicate to all groups concerned, including the clients, the changes taking
place at the health unit and ask for their support.
With practice, implementing quality improvement activities at health facilities will
become easier. As a supervisor, you will continue to receive training to help guide
health workers in this process. The more improvements a health facility can make, the
better chance they have of achieving and maintaining the Basic Standards for Quality
Health Services and getting the YELLOW STAR!
SECTION 7: TRACKING RESULTS
73
SECTION 7:
TRACKING RESULTS
SECTION 7: TRACKING RESULTS
74
There are two main reasons for keeping track of results from each Yellow Star
assessment review for health facilities in your Health Sub-District:
It allows you to monitor the progress of health facilities as they try to achieve and
maintain the basic standards.
Tracking the results also helps you to identify problems at a particular health facility.
Once a problem is identified you can help direct the efforts of the staff at that health
facility to implement a solution in the days or weeks following the supervision visit.
Together with the health workers and the HUMC you should prioritize the problems
and implement solutions by using different quality improvement methods (see
Section 6: Making Improvements).
In order to easily assess the progress of different health facilities use the Yellow Star
Checklist found in Section 7: “Tracking Results” of your manual.
1. Fill in the appropriate information along the top of the page -- write the name of the
district, sub-district and health facility, as well as the level of the unit. Every health
facility should have its own page or Yellow Star Checklist. Therefore, you should
have a Yellow Star Checklist for every health facility you supervise located in your
Yellow Star manual.
2. At the end of the assessment review, write the month and year of the assessment in
the top-most box of the first free column.
3. Then, working your way down, record from Table 2 of the Yellow Star Scoring Sheet
the results of the assessment for each of the 35 standards listed.
You can record this information in several ways:
 Write a 1in the box if the standard was met and 0 if it was not;
 Place an X in the box if the standard was met, but leave the box blank if the
standard was not achieved; or
 Shade the box if the standard was met, but leave the box blank if the
standard was not met.
We recommend that you use one of the last two suggested methods. This will enable
you to get a visual impression of the performance of your health facility. For example, a
category of standards where there is more blackened cases (or more Xs) means a good
performance in this category over time, while a white area indicates the need for more
improvement.
SECTION 7: TRACKING RESULTS
75
Sample Checklist for Health Facility A
Month and Year of Assessment #
Standard 2/01 5/01 8/01
1. Infrastructure and Equipment
1.1 Reliable and clean supply of water
1.2 Clean latrine and toilets
1.3 Disposal of refuse and medical waste
1.4 Functional couches/beds
1.5 Basic examination/treatment equipment
1.6 Men’s and women’s ward separated
Sub-total 3 4 5
From the example above, you can quickly notice the areas that need
improvement at the health facility (i.e. any white spaces). During each
assessment review, the facility has scored well for standards 1.1, 1.4
and 1.6. In other words, the health facility met each of these standards
during each assessment review. For Standards 1.2 and 1.5, we can
see that the health facility did not meet these standards during their
earlier assessment reviews. However, over time it seems the facility
has been able to make some improvements in these areas, so the
standard was met on subsequent assessment reviews. However, it
appears that the health facility is still having problems meeting
Standard 1.3 – disposal of refuse and medical waste. This might be
one area that the health facility and HUMC target for improvement in
the upcoming months.
4. In the rows labeled “Sub-total,” you will write the number of standards that have
been achieved for that particular section. In other words, the total number of shaded
boxes, boxes with Xs or boxes with the number one. (The numbers listed in your
sub-total boxes should equal the numbers written in the “Score” column of Table 3
on the Scoring Sheet.)
In the example for Health Facility A, you can see that over time, the
health facility has improved in the area of Infrastructure and Equipment.
In February, they only met three of the six standards, but in August the
health facility had made great improvements and met five of the six
standards.
5. Finally, in the “Total Score” row, write the sum of the figures you calculated for each
of the sub-total boxes in that column. The number you get should equal the total
that you got in the last box of the “Score” column in Table 3 of the Scoring Sheet for
this assessment.
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76
6. Finally, divide the Total Score by the number of standards applicable for your level
of facility (32 for HC II, 33 for HC III, and 35 for HC IV and hospitals) and multiply by
100 to obtain the percentage of achievement.
Total score divided by # of applicable standards X 100 = your percentage
Again, this number should be the same as the number obtained in the lower right
box of Table 3.
For each assessment conducted (one per quarter), you will fill one column of the
Yellow Star Checklist. Remember to write the appropriate date on the top of the
column. If the health facility is successful at improving the quality of their health
services over time, the page will get blacker and blacker towards the right side.
Alternatively, if you see a wide blank area in a given category of standards, you will
know that the health facility needs to work seriously in that area.
When the percentage of achievement equals 100% for two consecutive
assessment reviews, you will notify the district of that health facility’s good
performance. The district will then organize an independent team to verify this
assessment. If the results are consistent, the health facility will be awarded the
Yellow Star.
Once a health facility has obtained the Yellow Star, you will continue to monitor the
quality of services provided by the health facility. If a Yellow Star assessment
review reveals a
decrease in the percentage of achievement, you should work with the health facility
to identify the problem(s) and solution(s). In order to do this, review the more
detailed Scoring Sheet to identify the specific area that was lacking. In this way, the
health facility can quickly return to an optimal level of performance, which will help
to prevent the removal of the Yellow Star from their facility.
7. Fill in the Yellow Star Checklist at the end of each assessment review. You might
want to do this at the same time the health facility completes their own Yellow Star
Checklist. Remember to keep the clearly labeled Checklist in your Yellow Star
manual.
8. Encourage the health workers to post a copy of the Yellow Star Checklist in the
health facility to communicate the results of their efforts to all health workers, clients
and community members.
9. Back at the HSD headquarters, keep the Yellow Star Checklist for all health facilities
under your supervision in your Yellow Star manual. You can use these checklists to
perform an analysis of the quality of services in your HSD. For example, these
checklists might help you identify which category of standards, or one particular
standard is most difficult to meet. Then you can decide on the possible solutions to
this problem and begin to identify external resources if they are needed. If you want,
you could post a copy of all the sheets in your office to communicate to all
SECTION 7: TRACKING RESULTS
77
supervisors and interested stakeholders the results of your efforts towards improved
quality of health care.
10. Do not forget to send a copy of the scoring sheet for the facility you just visited to the
District.
SECTION 7: TRACKING RESULTS
78
YELLOW STAR CHECKLIST
Facility: _____________________ Level: _______ HSD: _________________ District:
___________________
Month and Year of Assessment #
Standard
1. Infrastructure and Equipment
1.1 Reliable and clean supply of water
1.2 Clean latrine and toilets
1.3 Disposal of refuse and medical waste
1.4 Functional couches/beds
1.5 Basic examination/treatment equipment
1.6 Men’s and women’s ward separated
Sub-total
2. Management Systems
2.1 Up-to-date client registers
2.2 Monthly reports correctly filled
2.3 Stock cards available
2.4 Absence of stock outs of essential drugs
2.5 HUMC meeting regularly
2.6 Treatment guidelines available
Sub-total
3. Infection prevention/control
3.1 Adequate hand washing
3.2 Adequate disposal of sharps/needles
3.3 Clean service environment
3.4 Facilities for disinfection
3.5 Correct aseptic techniques
Sub-total
4. IEC/IPC
4.1 Health education talks given
4.2 Use of visual aids
SECTION 7: TRACKING RESULTS
79
4.3 Encouragement to discuss problems
Sub-total
5. Clinical services
5.1 Maintenance of proper cold chain
5.2 No missed opportunity for immunization
5.3 Children weight plotted on health card
5.4 Technically appropriate services
5.5 Technically appropriate in-patient care
Sub-total
6. Customer service
6.1 Waiting area clean and protected
6.2 Private area for examination/delivery
6.3 Friendly and respectful reception
6.4 First-come first-serve system
6.5 Waiting time less than 1 hour
6.6 Information on treatment compliance
6.7 Support for referral of patients
6.8 Staff members trained
6.9 List of services available
6.10 Qualified provider available all time
Sub-total
Total score
Percentage achievement (=total score/# standards)
(Number of Standards: 35 for Hospitals & HCIV, 33 for HC III and 32 for HC II.)
SECTION 8: STAR HEALTH WORKER AWARD
80
SECTION 8:
STAR
HEALTH WORKER
AWARD
SECTION 8: STAR HEALTH WORKER AWARD
HW2 81
What Is the Star Health Worker Award?
The Star Health Worker Award is an award given to health workers who respect their
clients and continually demonstrate good customer relations with their clients.
What are ‘good client relations?’
Health care is a service delivery profession – you are in the business to SERVE the
people! Your clients come to the health facility to get help with their health problems. It
is important that your clients keep coming back, but this will only happen if your clients
are happy and satisfied with the services provided.
Clients want a health worker who treats them with respect, is concerned about their
welfare and wants to help. Put yourself in their shoes – wouldn’t you want the same
thing?
You should show clients that you care about them! You should offer your clients the
best possible services and give those services in a friendly, respectful manner.
As a health worker, it is important that you are not only technically competent, but that
you have a warm, friendly attitude. Sick people are not always the easiest people in the
world to deal with, but as a health worker, you have to remember that they are sick!
They may not feel well and they may be irritable. But if you can offer services in a
friendly, respectful manner you will be taking the first step in making them feel better.
Specifically, good client relations means that as a health worker you:
 Demonstrate a friendly, helpful and caring attitude toward all the clients they interact
with.
 Respect your clients.
 Make the clients feel comfortable.
 Welcome the clients to the health facility and ask about their health problem.
 Explain procedures, treatments, reasons for delays, etc.
 Do not make the clients wait a long time.
 Listen attentively to the clients.
 Encourage the clients to discuss their problem and ask questions.
 Spend quality time with the clients. Do not rush through the consultation.
 Demonstrate a positive attitude even under pressure.
Who qualifies for the award?
Every employee at a health facility who works or interacts with the clients.
Who gives the award?
The Star Health Worker Award is given to recipients by the HSD Supervisors. The
HSD supervisors will meet every quarter and identify 3 health workers in their HSD who
deserve to receive this award. The HSD Supervisor will present the award during
regular supervision visits.
What does it mean?
SECTION 8: STAR HEALTH WORKER AWARD
HW2 82
Winners of the Star Health Worker Award will be given a certificate and a gift to
acknowledge and reward their good client service skills. In addition, a second certificate
with a photograph if possible, will be displayed in the waiting area of the health facility to
let clients and other staff members know that this person has been recognised for their
efforts.
More importantly, it means that individuals who receive this award demonstrate a
friendly, helpful and caring attitude to all the clients they interact with! They respect
their clients and are a role model to other health workers.
Can I receive the award more than once?
Absolutely! If you continually demonstrate good interpersonal skills with your clients
better than anyone else in the HSD you increase your chances of receiving this award
multiple times!
SECTION 9: ORGANIZING THE REWARD CEREMONY
HW2 83
SECTION 9:
ORGANISING THE
REWARD CEREMONY
SECTION 9: ORGANIZING THE REWARD CEREMONY
84
Organising the Reward Ceremony for a Yellow Star Health
Facility
Once a health facility is eligible for the Yellow Star certification, the District Health
Services and the Health Sub-District should begin to immediately organise an award
ceremony. The co-ordination for this event should be the responsibility of the point
person the District has selected for the Yellow Star Programme. This point person
should work closely with the HSD to arrange all the details of the award ceremony. The
date for the ceremony should be agreed upon with the health facility when the
independent district team visits the facility to verify that it has meet the Basic Standards
for two consecutive quarters. The independent team should report this date to the
District’s Yellow Star Programme focal person.
Purpose of the Event
The purpose of the event is to recognise the good job that the health workers have been
doing and to educate community members about the quality of services they should
expect and request at the health facility. Another purpose is to ask the community to
continue assisting the health workers to maintain good quality services and to give the
health workers feedback, both positive and negative, about the quality of services.
Who should be invited to the ceremony?
Since the purpose of the ceremony is to recognise and reward the health workers who
work in the facility for their good work, the district should invite high level leaders to the
ceremony. These may include the MP for that area, the LCV Chairman, the Secretary
for Health and the DDHS. If there are other highly influential people in the community,
they should also be invited. An invitation letter should be written and delivered to these
individuals informing them of the date, time and location of the ceremony. If you would
like any of these individuals to speak at the event, be sure to ask them to prepare a
short speech and outline for them some key talking points. Remember that the purpose
of the event is to discuss quality health care services, not local campaign messages,
graduated taxes or education!
In addition to prominent and influential leaders, of course, the entire community served
by the health facility should be mobilised to attend.
Agenda Ideas
Your ceremony will be most effective if it is entertaining as well as educational. Try to
avoid overloading the event with speeches. Identify local music or drama groups in the
community, brief them about the purposes of the event and the Yellow Star Programme
and ask them to prepare songs, dance and drama for the event. Organise an
interactive game with the audience such as a quiz or contest with simple prizes (e.g.
bars of soap, wash basins, T-shirts, caps, etc.) Intersperse such activities with
speeches.
Publicity
Make sure you publicise the event well. Write a press release and give copies to all
media representatives in the district together with an invitation to the ceremony. Offer to
provide transportation to reporters or other media representatives. Distribute flyers and
SECTION 9: ORGANIZING THE REWARD CEREMONY
85
posters in the communities surrounding the health facility during the week prior to the
event. Organise radio announcements on the local radio stations and meet with the
local leaders and request them to mobilise for the event. If your budget permits,
arrange for the ceremony to be video taped. This is something you can later distribute
to the TV stations for more publicity.
Speeches
Speeches are an opportunity to get your messages across to the community. But, your
messages will never get across if you do not prepare speeches for your speaking
guests and brief them about the purpose of the event and the Yellow Star programme.
A sample speech about the programme follows these guidelines.
Press Releases
One very important way to let everyone know about the quality of services at a health
facility is through the press. Radio reaches most households, and newspapers are read
by most of the district leaders. Press releases help ensure that the message you want
to get across to these important audiences is the message that appears in the
newspaper and on radio and television.
For each awards ceremony, and every time a heath facility is awarded the Yellow Star,
you should write press releases and distribute them to all the newspapers, radio
stations and television stations that reach your area. Remember, you want all the
important political leaders to support the Yellow Star programme. So, it is important to
reach district political leaders with this information as well as the people who will be
served by the health facilities.
Press releases should be one page in length. The first sentence should include the
information who, what, where, when, and why. You should give the press release a
snappy title that will draw attention to it. If you have photographs of the ceremony or the
health facility, make additional copies and distribute them with the press release to the
newspapers. Think carefully about the main information that you want to get across
through the media and highlight that information. A sample press release follows these
guidelines.
SECTION 9: ORGANIZING THE REWARD CEREMONY
86
How to Organise a Successful Awards Ceremony
Here are some tips that will help you organise very successful awards ceremonies for the health
facilities you supervise when they reach Yellow Star status.
 Check the budget for awards ceremonies in the district workplan. Plan a ceremony that will
not exceed this budget.
 Form a committee to help you organise the event. These may include the Health Educator,
NGO or CBO representatives in your area, local leaders, Community Development
Assistants, and other members of the supervision team.
 Have a meeting to organise the event. During the meeting, agree on who should be invited,
the guest of honour, the venue, what will take place during the event, and a budget for the
event. Assign various responsibilities to individuals for follow-up. Take minutes of the
meeting and schedule follow-up meetings to check on progress.
 When planning the agenda, keep the event’s overall purposes in mind. These are to honour
the health workers who are providing good quality services in this facility; to inform the
community about the services they should expect and ask for at the health facility and about
the meaning of the Yellow Star; and to ask the community to work with the health facility
staff to maintain good quality services.
 Plan an event that is entertaining and fun as well as informative. There are several ways to
do this:
- Engage a local music and dance group to perform between speeches.
- Invite the health facility staff, community members, or school groups to put together
small dramas with information about the Yellow Star and what it means.
- Organise a quiz for community members about the Yellow Star and the services they
can expect at the health facility. Winners can receive small prizes—bars of soap,
mosquito nets, plastic basins or buckets, etc.
- Organise tours of the health facility for community members, during which the health
worker explain the services offered and answer questions.
 Plan to publicise the event in the area around the health facility. You can do this in a
number of ways:
- About 2 weeks before the ceremony, meet with the Health Unit Management
Committee and other local leaders to plan the event, and to ask them to notify people
in their areas about the event. If you involve the community leaders in the planning
process, you will have a better-attended event.
- About one week before the event, contact the local leaders again to remind them
about the event. Ask the leaders to put up posters prior to the event throughout the
communities and in the health facility.
- Budget for local mobilisers to go from house to house inviting people to the event.
- Place announcements about the event on the local radio station.
- On the day of the event, walk through the community with a megaphone inviting
people to attend.
 Make a list of all the equipment and supplies you will need during the ceremony and gather
them together well in advance. Don’t forget to organise shelter for guests, chairs or
benches, and a megaphone or public address system.
 Write speeches and press releases for the event. Give copies of the press release to local
newspaper, radio and television reporters along with invitations to the event. On the day of
the event, give copies of the press release to any media representatives who attend.
 Prior to the event, rehearse any songs or drama performances to make sure they carry the
correct messages. I
SECTION 9: ORGANIZING THE REWARD CEREMONY
87
PRESS RELEASE
For Release 12 November, 2001
Bukoto Health Centre Recognised for Good Quality Services
During a ceremony on 12 November 2001, in the village of Bukoto, the Honourable Justice
Sebatinde awarded the coveted Yellow Star to Bukoto Health Centre for providing good
quality health services. Bukoto Health Centre is the first health Centre in Kabalea District to
receive this award, which is part of the Ministry of Health’s Yellow Star programme to
improve health services.
According to Justice Sebatinde, the award signifies that Bukoto Health Centre has met all
35 standards of care set by the Ministry of Health during 2 consecutive monitoring visits by
the district health services. The standards ensure that the health facility is clean, well
equipped and stocked, and offers services 24 hours each day. In addition, every client who
enters the health facility will be treated competently and respectfully. According to Justice
Sebatine, “This means that the health workers will listen to you, discuss your concerns,
answer your questions, and give you clear instructions and advise; and a qualified health
worker who has had recent training to provide all the essential health services will be
available 24 hours a day, every day of the week. Finally, no client will wait longer than one
hour to receive services, even on a very busy day.”
The Yellow Star programme was launched in Kabalea District in July 2001. All health
facilities in the district have joined the programme and are working to meet the standards
and receive the “Seal of Quality.” Teams of supervisors are visiting each health facility in
the district every 3 months to supervise the services and to monitor the quality of care.
Once a health facility meets all 35 standards for six months in a row, the district health
services verifies the assessment and certifies the health facility as a Yellow Star facility.
According to Dr. Mugyenyi, District Director of Health Services for Kabalea, we can expect
to see many more facilities in the district receive the symbol. “Since July, all health facilities
in the district have been working hard to meet the 35 standards. In some facilities it has
been more difficult than in others because of staffing shortages or problems with the
infrastructure. Where the communities are involved and helping the health workers,
services are improving rapidly. I think we can look forward to having several “Seals of
Quality” on health facilities here in the next few months.”
Community members in the villages surrounding Bukoto Health Centre were extremely
proud of their health centre. According to the Health Centre In-Charge Sr. Rose Kalya, the
health centre could never have met all the standards if the community members had not
helped. “Even though our services are very good, we could not qualify for the Yellow Star
until we put in a new latrine. We appealed to the community for help and a group of men
helped us dig the new latrine. Then, community members donated bricks so that we could
build a new structure. It is truly thanks to this spirit of community ownership that we have
succeeded.”
The Yellow Star programme is now active in 12 districts of Uganda. The Ministry of Health
plans to expand to the rest of the country next year.
For more information, contact the District Health Educator, Kabalea District
SECTION 9: ORGANIZING THE REWARD CEREMONY
88
SECTION 9: ORGANIZING THE REWARD CEREMONY
89
Sample Speech for Guest of Honour during Awards Ceremony
Invited Guests, ladies and gentlemen, today is a very important day for the people of
[name of community], because today we are awarding the Yellow Star to [name of
health facility]. I would like to personally thank each one of you for the work you have
done to help [name of health facility] achieve this award, because it is a great honour to
this community, it is a great honour to this subcounty, and it is a great achievement for
the district of [name of district].
I use the word achievement because the Yellow Star is only awarded to health facilities
that meet very rigorous standards of health care set by the Ministry of Health. Over the
past months, [name of facility] has been working to meet these 35 standards, and has
been monitored by a supervisory team every quarter. For the past 2 quarters, [name of
facility] has met all of these standards. Let me explain briefly what the 35 standards are
and what services you can expect and demand from this health facility and any health
facility bearing the Yellow Star.
First of all, every client who enters this health facility will be treated respectfully. This
means that the health workers will listen to you, discuss your concerns, answer your
questions, and give you clear instructions and advise.
Secondly, the health facility will be clean and equipped with all the essential equipment
and drugs to care for the most common ailments, and to provide preventive services.
Thirdly, a qualified health worker who has had recent training to provide all the essential
health services will be available 24 hours a day, every day of the week.
Finally, no client will wait longer than one hour to receive services, even on a very busy
day.
As clients of this health facility, you are entitled to this quality of services. We invite all
of you to visit the health facility and tell the staff what you think of the services. Tell all
your friends about the new improved quality of services at [name of facility], and invite
them to try it out.
Now that [name of facility] has been awarded the Yellow Star, we must all help to
maintain these standards. [Name of facility] will continue to receive supervisory
monitoring visits every quarter to ensure that the standards are met. If [name of facility]
falls below the standards during one of these visits, the supervisory team will give the
facility a warning, and will help them to correct the problem. If on the second quarterly
monitoring visit, [name of facility] fails to meet all 35 standards, the Yellow Star will be
removed until the facility corrects the situation.
[Name of facility] belongs to all of us. It is our community health facility. We can ensure
that the facility continues to offer good quality services. We can help the health worker
in their job. How can we do that? Whenever we visit the health facility, we should tell
the health workers how they are performing. If the services are good, tell them and
SECTION 9: ORGANIZING THE REWARD CEREMONY
90
thank them. If there were problems with the services, tell them so that they can
improve. If we see things that need improving at the health facility, think of how we as a
community can help. Perhaps the grounds need cleaning or the rubbish pit is full.
Why not put together a community work party to clean the grounds or dig a new rubbish
pit? Perhaps the facility has no water. Why not organise amongst ourselves to help
haul water each day?
[Name of facility] is our community health facility. We can be proud of it today because
it is a Yellow Star facility. And, we can continue to be proud of our facility as long as we
insist on and help the health workers to offer good quality services. Let’s not ask what
the health facility can do for us unless we also ask what we can do for the health facility.
Congratulations to us all for what we have achieved.
SECTION 10: COMMUNITY INVOLVEMENT
91
SECTION 10:
COMMUNITY INVOLVEMENT
SECTION 10: COMMUNITY INVOLVEMENT
92
Helping the Health Facility to Involve its Community in the Yellow Star Programme!
Health workers play an important role in educating the people in their community about
the Yellow Star Programme and how the community can participate. The health facility
is a direct link to the community. The easiest way to get the community involved is to
use resources already available to the health facility. Each health facility should have a
Health Unit Management Committee (HUMC) made up of community members. The
HUMC should be meeting at least once every quarter to discuss overall management of
the health facility and identify problems and solutions. [If the health facility does not
currently have a HUMC, please work with the staff to establish this community group.]
1. The health facility should involve the HUMC in the Yellow Star Programme from the
very beginning. The committee should be invited to attend the introductory meeting
that you conduct with the staff about the programme. Also, staff of the health facility
should inform the HUMC of the date of their Yellow Star assessment review and invite
the HUMC members to be present for the evaluation and findings.
2. The HUMC should identify two focal persons to act as community point persons for
the Yellow Star Programme. The health facility should also identify one or two health
workers to act as focal persons for the health facility. These individuals will form the
Yellow Star Committee. Their main purpose is to work together (with the health facility
and the community) to monitor the progress of the health facility in the Yellow Star
Programme and institute improvements at the health facility that would enable the
facility to meet the Basic Standards. The Yellow Star Committee should meet on a
regular basis at the health facility. This group should also invite the HSD Supervisory
Team to attend their meetings
NOTE: The above is a suggested approach to initiating and maintaining HUMC and
health facility involvement in the Yellow Star Programme. Health facilities and
HUMCs may discover other mechanisms to meet this goal. They should feel free to
adapt or change the suggested method to best fit their health facility. After all,
people who work with the health facility regularly will know how to best involve its
key players in the programme. As a group you may decide to involve the whole
HUMC on the Yellow Star Committee or you may want to involve community
members and leaders in the committee. Whatever you decide, make sure the Yellow
Star Committee is an efficient, working body that helps the health facility to meet the
standards.
3. The First Meeting: At the first meeting of the Yellow Star Committee, the members
should determine the best way to assess the status of the health facility. If the
health centre were to go through an assessment review today – how would the
facility do? There are a few ways to go about determining this information:
A. The Yellow Star Committee could conduct an informal assessment review of
its own and determine where the health facility needs to make improvements.
In Section 4 of the Yellow Star binder for the health facility, there are copies of
all the evaluation tools (guidelines, assessment tool, and scoring sheets).
The group could pretend they are supervisors and conduct an actual
assessment review following the instructions. Determine the score of the
SECTION 10: COMMUNITY INVOLVEMENT
93
health facility. Look at standards where the health facility scored a zero. Why
did they score a zero? How can this be improved?
B. Another way to go about assessing the health facility is for the Yellow Star
Committee to review the standards and discuss areas where they believe the
facility is weak. How could these areas be improved?
C. Finally, the team should also consider asking the community what they think
about the health facility. They could conduct an informal survey. Create a list
of questions to ask local community members about the health facility.
Examples: 1) Does your family use the health facility? If no, why not? 2)
How often has your family been to the health facility in the last 6 months? 3)
What do you like about the health facility? 4) What do you dislike? 5) Are the
health workers friendly and welcoming? 6) Do you feel you have received
correct treatment? 7) What do you think we should improve about the health
facility? These types of questions will help you to understand exactly what
the community thinks about the services offered at the health facility. You
may be able to determine areas for improvement based on their responses.
4. After the Yellow Star Committee has been able to identify some areas that could use
improvement – the next step is to figure out which areas to address first. The team
should try to determine what areas – if fixed - are most important to the overall well
being of the community. They should pick something that is within their resource
capability to fix. In other words, they should not pick a problem that depends on
outside assistance. The group should create a list of items that need improvement
and number them beginning with the most important. They should agree as a group
on what areas are most important to fix first and address at least one problem a
quarter.
5. Once the Yellow Star Committee has identified a list of areas that need
improvement, they should start the planning process. As a group they should
discuss the following:
Why is this % that would most likely fix this problem
6. The team should then develop a plan of action for fixing the problem. A plan of
action is a list of all the activities they want to do and how to do those activities. The
plan of action also lists the person or persons who will do the activities and when the
activities will be done. A plan of action will help the group to:
 Remember all the work that has to be done.
 Be well organized in performing the activities.
 Complete the activities.
Sample plan of action:
SECTION 10: COMMUNITY INVOLVEMENT
94
What to Do How to Do It
(Activity)
Who Will Do It Resources
Needed
When It Will Be
Done
A. For the first column of the table labeled “What To Do,” the group should write
down the things they want to do to prevent the problem. For example, if the
group decides that health workers washing their hands between clients is
something that needs to happen, then that should be written in the first column.
B. In the second column labeled “How to Do It” the group should list all the activities
the Yellow Star Committee, other health workers or the community need to do so
that the item listed in the first column gets done. For example, if they want health
workers to wash their hands between clients and treatments, the group may have
to organise health education with the health workers about the importance of
washing hands between clients.
C. The group should choose people responsible for making sure the activity will be
done and write the name(s) of people responsible in the third column labeled
“Who Will Do It.”
D. Resources are things the team needs to do the activity. The team should decide
what things they need to complete the activity and list them in the fourth column
labeled “Resources Needed.” For instance they might need soap and clean
water at each location where a health worker treats patients.
E. The group should decide on a time when the activity will be finished. This should
be written in the last column of the table, labeled “When It Will Be Done.”
F. The plan of action should look similar to the one below.
G. The plan of action should be kept so the group can refer to it when needed and
continually check the progress of the plan.
Plan of Action to Encourage Dispensers to Explain Medication
& Make Sure the Client Understands Treatment
What to Do How to Do It
(Activity)
Who Will Do It Resources
Needed
When It Will Be
Done
Educate
dispenser(s) and
health workers on
importance of
telling the client the
name/type of the
drug, the amount of
medication to take
and when to take
the drug. Educate
on the importance
of checking to
make sure the
education session
with dispenser and
health workers
on the job training
and supervision
Nankunda
Dr. Kato
health education
materials
notebook for notes
pen
August 20 at staff
meeting.
Once a month –
supervision of all
dispensers and
health workers
dispensing
medication.
SECTION 10: COMMUNITY INVOLVEMENT
95
client understands
this information.
Remind
dispenser(s) and
health workers
about this
information.
Create reminder
cards to hang up at
the dispenser(s)
window with key
messages
Jennifer
paper, markers,
masking tape
September 1
H. The team should then implement their plan of action. They should educate the
responsible parties and make sure they understand what they should do.
Responsible parties might include other health workers, other members of the
HUMC, the community or you, the supervisor.
I. As a supervisor, you should monitor their plan of action during regular supervisory
visits. Were the activities completed on time? What is the status of the plan? What
type of follow up action needs to occur?
J. Once all the activities have been completed, the group should discuss the results of
their plan of action. Has the behaviour changed? Has the situation improved? Has
the problem been solved? If not, what further steps could be taken to change the
problem? They should discuss other possible solutions and implement new plans of
action if necessary. If the situation has improved and the problem is solved, the
group could move on to a new problem on the list. The Yellow Star assessment
review conducted every quarter will also identify problems that can be addressed by
the group.
K. The Yellow Star Committee may identify some problems that require assistance
from other sources – such as the District or Ministry of Health. Often, when using
outside resources, a problem could take longer to solve because the process is out
of your control. Nonetheless, the Yellow Star Committee could still develop a plan of
action to get the process started. For example, if the health facility needs a
microscope, the plan of action could be to order the piece of equipment from the
district and a responsible party to follow up on the request. As a supervisor, you can
help to assist this process.
L. The group should track the activities they do to improve the quality of services at the
health facility by keeping the work plans for the improvements or writing their
achievements in a book.
M. The Yellow Star Committee should assess the health facility at least once a year to
determine if the health facility has maintained improvements over time and to identify
new areas that require adjustment.
Every health facility has different needs and different things that require improvement.
The Yellow Star Committee, with assistance from the health workers, supervisors and
HUMC will have to identify wh at areas are most important to fix at the health facility.
Nevertheless, here are a few suggestions of areas that might require improvement:
 Building new pit latrines/toilets
SECTION 10: COMMUNITY INVOLVEMENT
96
 Building staff accommodation so a health worker is available to help all clients 24
hours a day, 7 days a week.
 Devising a way to shorten client-waiting periods to one hour or less.
 Health workers washing hands between clients and treatments.
 Digging new rubbish pits so sharps are disposed of correctly.
 Plotting the weight of a child on a health card correctly.
 Health workers or dispenser telling clients how to take medication correctly and
checking understanding
 Health workers encouraging clients to discuss their problems and ask questions.
 Health workers using IEC materials during counseling
 Providing health education talks to the community on a regular basis.
 Keeping stock cards up-to-date.
 Having a clean service environment
 Referral plan for emergency cases in place.
 Private areas for examinations
 Constant and clean supply of water

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