Companion Guide_SDP

Version 6

1. Site observation

The checklists are organized by area of the SDP. Proceed from one area to the next, using the Companion Guide to complete each checklist. The indicators require that you talk with the staff responsible for the area and are marked in grey.

Entrance/waiting area/toilets

1.1.1
Signposting with information on opening times, services offered, and price list *

ASK PERSON RESPONSIBLE FOR FINANCIAL MANAGEMENT: - Are accounting procedures, roles and responsibilities clearly defined (i.e. cashier authorized to receive cash)? - Are pre-numbered receipts bearing the name of the organization issued for all cash receipts? - Are unused receipt books kept in a safe place and procedures are in place for issuing receipts? - Is all cash received receipted and recorded immediately and kept in a safe place? - Are staff aware of and participate in internal audit/control processes? • Mark sufficient if yes to ALL questions
- Sufficient
- Insufficient
- Not Observed
- N/A
1.1.2
SDP has signage in most prevalent local languages *

OBSERVE: Signage in SDP is in most prevalent local languages
- Sufficient
- Insufficient
- Not Observed
- N/A
1.1.3
Clients notified of right to no extra fees paid to SDP staff/providers *

OBSERVE: Sign in reception or waiting area states that staff members are not allowed to impose additional charges beyond what is listed in the schedule of fees
- Sufficient
- Insufficient
- Not Observed
- N/A
1.1.4
Clients notified of right to high quality services regardless of ability to pay *

OBSERVE: Display in reception/waiting area /online that high quality services will be provided to everyone in need, regardless of ability to pay
- Sufficient
- Insufficient
- Not Observed
- N/A
1.1.5
SDP has IPPF Clients Rights and Providers Needs Charter available *

OBSERVE: SDP has IPPF Clients Rights and Providers Needs Charter available as pamphlets or posters
- Sufficient
- Insufficient
- Not Observed
- N/A
1.1.6
Opening times convenient to clients *

OBSERVE: Open times include evening or weekend hours
- Sufficient
- Insufficient
- Not Observed
- N/A
1.1.7
Entrance clean and unobstructed *

OBSERVE: Entrance looks clean and unobstructed
- Sufficient
- Insufficient
- Not Observed
- N/A
1.1.8
Waiting room clean *

OBSERVE: Waiting room looks (no obvious rubbish lying on the floor, chairs are not dirty) and smells clean
- Sufficient
- Insufficient
- Not Observed
- N/A
1.1.9
Seating in waiting room *

OBSERVE: Enough chairs or benches for at least 5-10 clients to be seated
- Sufficient
- Insufficient
- Not Observed
- N/A
1.1.10
General maintenance *

OBSERVE: All must be yes: • SDP overall looks well-maintained • Toilet and hand washing facilities are functional • Toilet facilities have: o Toilet paper or water for washing o Soap o Waste bucket
- Sufficient
- Insufficient
- Not Observed
- N/A
1.1.11
Adequate light *

OBSERVE: Overhead lighting is bright enough
- Sufficient
- Insufficient
- Not Observed
- N/A
1.1.12
Accessible for persons with disabilities *

OBSERVE: All must be yes: Facility areas • No obstacles or furniture impedes movement through facility areas • Ramps follow international standards • Handles, grips, and handrails for support on the stairs and ramps • Tactile markings at the bottom and top of stairs and ramps • • Up-to-date and adjustable equipment (e.g. examination and delivery beds) • Sink inside the toilet room Visible and accessible signage • Signs and information in accessible formats
- Sufficient
- Insufficient
- Not Observed
- N/A
1.1.13
SDP environment is gender-neutral *

OBSERVE: SDP uses intake forms that allow patient to specify their gender (male, female, and gender-diverse options) and has accessible bathrooms for any gender (gender-neutral)
- Sufficient
- Insufficient
- Not Observed
- N/A
1.1.14
Welcoming environment for LGBTQI+ people *

OBSERVE: Accurate information available for LGBTQI+ people, including information on gender affirmation services
- Sufficient
- Insufficient
- Not Observed
- N/A
1.1.15
SDP has age-appropriate information, education and communication (IEC) materials are available for youth *

OBSERVE: IEC materials for youth are on display and accessible to clients
- Sufficient
- Insufficient
- Not Observed
- N/A

Registration

1.2.1
Privacy and confidentiality are maintained during client registration *

OBSERVE: Auditory privacy is maintained when client is registering and discussing the service they are seeking
- Sufficient
- Insufficient
- Not Observed
- N/A
1.2.2
Confidentiality of record keeping *

OBSERVE: Files are stored in a locked cabinet or digitally on a password-protected device
- Sufficient
- Insufficient
- Not Observed
- N/A

Consultation/counseling rooms

1.3.1
Clean and well ventilated consultation room *

OBSERVE: Consultation room looks and smells clean and is well-ventilated
- Sufficient
- Insufficient
- Not Observed
- N/A
1.3.2
Audio and visual privacy ensured in consultation room *

OBSERVE: Consultation room has audio and visual privacy (e.g., soundproofing and door, curtain, or screen for visual privacy)
- Sufficient
- Insufficient
- Not Observed
- N/A
1.3.3
Privacy is secured before information is exchanged between clients and service providers *

OBSERVE: Only necessary people are in the consultation rooms during client counselling and physical examinations
- Sufficient
- Insufficient
- Not Observed
- N/A
1.3.4
IEC materials are available *

OBSERVE IEC MATERIALS: • Mark sufficient if able to observe IEC materials are available in local languages AND are available on ALL of the following topics (can be brochures, posters, flipcharts, etc.): o SRH o Contraception o STIs/HIV prevention and care o Comprehensive abortion services/PAC (in legally restrictive settings)
- Sufficient
- Insufficient
- Not Observed
- N/A

Procedure rooms

1.4.1
Clean and well ventilated procedure room *

OBSERVE: Procedure room looks and smells clean and is well-ventilated
- Sufficient
- Insufficient
- Not Observed
- N/A
1.4.2
Audio and visual privacy ensured in procedure room *

OBSERVE: Procedure room has audio and visual privacy (e.g., soundproofing and door, curtain, or screen for visual privacy)
- Sufficient
- Insufficient
- Not Observed
- N/A

Instrument processing

1.5.1
Separate room available for processing instruments *

OBSERVE: SDP has a separate room for instrument processing
- Sufficient
- Insufficient
- Not Observed
- N/A
1.5.2
The SDP has guidelines for infection prevention and control displayed *

OBSERVE: Infection prevention guidelines are displayed in the instrument processing room AND include a clear, step-by-step process for decontamination, high-level disinfection (HLD), and sterilization
- Sufficient
- Insufficient
- Not Observed
- N/A
1.5.3
SDP has adequate personal protective equipment for infection prevention *

OBSERVE: SDP has at least 1 of each of the following: - Heavy duty gloves - Plastic aprons - Rubber boots Protective face shields or goggles
- Sufficient
- Insufficient
- Not Observed
- N/A
1.5.4
There is a functional committee or person responsible for infection prevention and control *

ASK RESPONSIBLE STAFF: - Is there someone in the SDP trained and responsible for infection prevention and control? • Mark sufficient if there is at least one person or a functional committee responsible
- Sufficient
- Insufficient
- Not Observed
- N/A
1.5.5
Decontamination of instruments (immediately after use and before cleaning) is performed according to the standards. *

ASK STAFF RESPONSIBLE FOR DECONTAMINATION: - How do you prepare high-level disinfection (HLD) solution? • Correct: Describe preparation of 0.5% chlorine from the available chlorine concentration or describe another HLD solution in use - How long are instruments soaked in decontamination solution? • Correct: At least 10 minutes - What do you do with instruments after you remove them from the decontamination solution? • Correct: Wash with soapy water and rinse with clean water MARK SUFFICIENT IF: 1. Staff provide correct responses to the three questions above AND 2. 3 buckets are used for HLD sterilization (chlorine solution, soapy water, clean water) AND 3. Containers holding the decontaminate solution are all in appropriate service delivery areas
- Sufficient
- Insufficient
- Not Observed
- N/A
1.5.6
Cleaning of instruments and equipment are performed according to guidelines *

ASK STAFF RESPONSIBLE FOR DECONTAMINATION: - How do you prepare high-level disinfection (HLD) solution? • Correct: Describe preparation of 0.5% chlorine from the available chlorine concentration or describe another HLD solution in use - How long are instruments soaked in decontamination solution? • Correct: At least 10 minutes - What do you do with instruments after you remove them from the decontamination solution? • Correct: Wash with soapy water and rinse with clean water MARK SUFFICIENT IF: 1. Staff provide correct responses to the three questions above AND 2. 3 buckets are used for HLD sterilization (chlorine solution, soapy water, clean water) AND 3. Containers holding the decontaminate solution are all in appropriate service delivery areas ASK STAFF RESPONSIBLE FOR CLEANING INSTRUMENTS: - How do you typically clean the instruments? • Correct: o Cleans the instruments using brush, under soapy water o Checks for the presence of blood or tissue o Rinses the instruments using running water o Air dries or dries with clean towel • Mark sufficient if ALL correct
- Sufficient
- Insufficient
- Not Observed
- N/A
1.5.7
The sterilization process is performed according to the standards *

ASK STAFF RESPONSIBLE FOR STERILIZING INSTRUMENTS: - How do you typically sterilize the instruments? • Correct: o Packaging of items done well o Autoclave: 20 minutes for unwrapped items or 30 minutes for wrapped items at 121 ºC (250 ºF) o Chemical sterilization: Disassembled instruments are totally immersed in sterilizing solution (2% glutaraldehyde for 10 hours or 24 hours in 8% formaldehyde) and the container covered with a lid o The HLD process is performed according to the standards (boiled for 20 mins with timing to start when the water comes to a rolling boil) o There is a system to monitor the effectiveness of the sterilization (e.g., indicator tape used for steam and dry heat sterilization) • Mark sufficient if ALL correct
- Sufficient
- Insufficient
- Not Observed
- N/A
1.5.8
Area organized according to infection prevention guidelines *

ASK STAFF RESPONSIBLE FOR STERILIZING INSTRUMENTS: - How is the instrument processing area organized? • Correct: o There is a one-way flow of instruments o The instrument processing area is organized into 4 distinct zones: (1) receiving, decontamination, and cleaning, (2) preparation and packaging; (3) sterilization; and (4) storage • Mark sufficient if ALL correct
- Sufficient
- Insufficient
- Not Observed
- N/A
1.5.9
The storage process of sterile or high-level disinfected items is performed according to the standards *

ASK STAFF RESPONSIBLE FOR STORAGE OF STERILE OR DISINFECTED INSTRUMENTS: - How do you typically store the instruments after sterilization? • Correct: o HLD items and sterile supplies are stored separately o Sterile or high-level disinfected packs and/or containers have expiration dates on them • Mark sufficient if ALL correct
- Sufficient
- Insufficient
- Not Observed
- N/A

Waste management

1.6.1
SDP has a separate place to store clean textiles *

OBSERVE: Clean textiles are stored in a separate place from laundering for soiled textiles
- Sufficient
- Insufficient
- Not Observed
- N/A
1.6.2
Waste is segregated and stored in clearly labeled bags or containers *

OBSERVE: Medical waste bins are lined with plastic bags, clearly labelled, and segregated (general waste, infectious/biohazard waste, and sharps)
- Sufficient
- Insufficient
- Not Observed
- N/A
1.6.3
Infection prevention practices during handling waste are performed according to the standards *

ASK STAFF RESPONSIBLE FOR WASTE HANDLING: - How is waste handled? • Correct: o Personnel wear personal protection equipment o Sharps containers are not emptied and reused o Sharps containers do not contain capped needles (suggests re-capping after use) o Medical waste bins and sharps container are no more than three quarters full • Mark sufficient if ALL correct
- Sufficient
- Insufficient
- Not Observed
- N/A
1.6.4
Waste storage methods do not harm public health or environment *

OBSERVE THE WASTE STORAGE AREA. Mark sufficient if waste storage area is: • Locked AND • Clean AND • Organized AND • Protected from pests AND • Protected from the public AND • Well shaded to reduce heat build up
- Sufficient
- Insufficient
- Not Observed
- N/A
1.6.5
SDP has on-site or off-site final waste disposal mechanism *

IF ONSITE: Verify presence of fenced off waste disposal area with sanitary landfill and incinerator IF OFFSITE: Verify contract or agreement with a 2nd party (private company or bigger hospital)
- Sufficient
- Insufficient
- Not Observed
- N/A

Commodities

1.7.1
Supply chain SOP is available *

ASK PERSON RESPONSIBLE FOR LOGISTICS MANAGEMENT: - Do you have a standard operating procedure (SOP) or supply chain manual available? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.2
Stock record system used *

ASK RESPONSIBLE STAFF: - Does the SDP use a stock record system? - If yes, please describe the system and how it is used. OBSERVE THE RECORDS. • Mark sufficient if: o SDP has a manual or digital system (e.g., bin cards, stock register) used to track commodity movement o Records are up-to-date and accurate o Stock record system is reconciled regularly with physical stock counts
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.3
Functional logistic management system *

ASK RESPONSIBLE STAFF: - Does the SDP have an available and functional logistics management information system (e.g., LMIS/DHIS2 or equivalent)? - If yes, does it support forecasting, procurement planning, supply scheduling, quality assurance, and distribution monitoring? - Does the logistics management information system provide real-time stock tracking, alerts for re-ordering, and reporting? - Is there documentation of roles, responsibilities, and timelines? • Mark sufficient if yes to ALL questions
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.4
Documentation standards *

OBSERVE SUPPLY CHAIN MANAGEMENT DOCUMENTS: • The latest version of the Supply Chain Standard Operating Procedure’s (SOP’s) (and/or the Supply Chain Manual) has been reviewed in the last year, it is approved, dated and accessible AND • 5 random stock/inventory register entries from the past 3 months are complete, signed dated, authorised and filed AND • 5 random delivery notes from the past 3 months are complete, signed, dated, authorised and filed.
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.5
Commodity security for essential commodities *

OBSERVE STOCK RECORDS: Contraceptive and abortion commodity supply in past 3 months. • Mark sufficient if stock records show consistent availability AND no stock-outs reported for any essential commodity, e.g., no 0’s in the past 3 months for essential commodities (contraceptive stock and medical abortion pills)
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.6
Commodity security for range of contraceptive methods *

OBSERVE STOCK RECORDS: • Mark sufficient if SDP has had at least 5 contraceptive methods consistently available over the past 3 months, including: o At least 1 short-acting (pills, condoms, injectables, EC) o At least 1 long-acting (IUD or implant) o At least 1 client-controlled (pills, condoms, EC) o At least 1 provider-dependent (injectables, IUD, implant)
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.7
Store manager assigned *

ASK RESPONSIBLE STAFF: - Is there a named person responsible for inventory management, with duties clearly outlined? - Has a delegated substitute been identified? - Are key access control procedures in place for accessing the storage room and/or warehouse holding medical products? For example, only authorised staff (store manager and delegated substitute) having keys or access codes to the storage room, and any entry to the storage room is recorded in a key logbook, including date, time and name of person entering. • Mark sufficient if yes to ALL questions
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.8
Storage and handling process management *

ASK PERSON RESPONSIBLE FOR LOGISTICS MANAGEMENT: - Do you have a standard operating procedure (SOP) or supply chain manual available that details the processes around the storage and handling of medical products? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.9
Storage temperature *

OBSERVE RH COMMODITY STORAGE • Mark sufficient if temperatures are <30 °C and recorded daily with calibrated thermometer
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.10
Storage conditions *

OBSERVE RH COMMODITY STORAGE AND ASK RESPONSIBLE STAFF: - How often is the storage area cleaned? • Mark sufficient if storage area is cleaned daily and ventilated, pest-free, dry, with no direct sunlight
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.11
Storage cold chain maintained *

OBSERVE RH COMMODITY STORAGE: • Mark sufficient if cold chain products are stored < 8 °C with generator backup
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.12
Storage fire-fighting equipment *

OBSERVE RH COMMODITY STORAGE: • Mark sufficient if fire-fighting equipment present and serviced (based on documentation)
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.13
Storage cleanliness *

OBSERVE RH COMMODITY STORAGE: • Mark sufficient if cleaning equipment is stored outside the commodity storage area, and there is no eating, drinking, or smoking inside the commodity storage area
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.14
Pest and contamination control *

ASK PERSON RESPONSIBLE FOR LOGISTICS MANAGEMENT: - Are pest control and cleaning schedules implemented? - How are contamination risks prevented? • Mark sufficient if: o Pest control is implemented at least quarterly AND o Cleaning schedules are implemented at least daily AND o Contamination risks are assessed daily and prevented. Examples of contamination risk prevention include:  Pest control measures to prevent rodents/insects  Cleaning with non-toxic agents suitable for medical storage  Covering products during pest control treatments
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.15
Proper storage according to manufacturer’s guidelines *

OBSERVE RH COMMODITY STORAGE: • Mark sufficient if products are stored per their specific manufacturer instructions (e.g., oxytocin refrigerated)
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.16
Shelf organisation and labelling *

OBSERVE RH COMMODITY STORAGE: • Mark sufficient if: o Commodities are labelled with name, quantity, batch, expiry, storage condition AND o Commodities are arranged to avoid mix-ups
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.17
Inventory process management *

ASK PERSON RESPONSIBLE FOR LOGISTICS MANAGEMENT: - Do you have a standard operating procedure (SOP) or supply chain manual available that details the processes around inventory management? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.18
Stock and bin cards used *

OBSERVE LOGISTICS MANAGEMENT DOCUMENTATION: • Mark sufficient if: - Bin/stock cards are updated daily AND - Each item has a corresponding card AND - Entries reflect all stock movements
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.19
First-expiry-first-out (FEFO) system used *

OBSERVE RH COMMODITY STORAGE: • Mark sufficient if a random selection of 10% of all commodities (minimum 3 commodities) stock is arranged and issued using the First-Expiry-First-Out (FEFO) method, as shown by: - Products with earlier expiry dates placed in front or on top
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.20
Stock register accuracy *

OBSERVE STOCK REGISTER • Mark sufficient if the entries are legible, up-to-date, and reconciled with bin cards and physical counts
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.21
Safety stock management *

OBSERVE STOCK REGISTER OR LOGISTICS MANAGEMENT SYSTEM • Mark sufficient if the SDP has enough stock to last at least 3 months, and the stock record or system clearly shows the point at which the responsible person must reorder
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.22
SDP conducts regular stock takes *

OBSERVE STOCK COUNT RECORDS AND RH COMMODITY STORAGE • Mark sufficient if: - Records demonstrate that full physical stock takes occur at least quarterly AND - Discrepancies are documented and resolved, with adjustments authorised AND - There is consistency between the records and the physical stock available in the storage room for 1-2 randomly selected commodities
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.23
SDP verifies incoming deliveries *

ASK PERSON RESPONSIBLE FOR LOGISTICS MANAGEMENT: - How are incoming deliveries verified? • Mark sufficient if: - All incoming deliveries are verified against documentation (product name, batch number, expiry date, quantity, supplier)
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.24
SDP has waste management process management *

ASK PERSON RESPONSIBLE FOR LOGISTICS MANAGEMENT: - Do you have a standard operating procedure (SOP) or supply chain manual available that details the processes around commodity waste management (e.g., handling of expired, damaged, or recalled contraceptives)? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.25
SDP has system for quarantine and segregation of damaged/expired stock *

ASK PERSON RESPONSIBLE FOR LOGISTICS MANAGEMENT: - How do you manage contaminated, damaged, or sampled products? OBSERVE commodity quarantine area containing contaminated, damaged, or sampled products. • Mark sufficient if contaminated, damaged, or sampled products are quarantined and labelled separately
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.26
SDP has system for redistribution of near-expiry stock *

ASK PERSON RESPONSIBLE FOR LOGISTICS MANAGEMENT: - Does the SDP have a redistribution system for near-expiry commodities to prevent commodities from being wasted (e.g., transferring commodities from one SDP to another)? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.27
SDP has system for waste tracking *

OBSERVE WASTE LOG (OR STOCK REGISTER OR LOGISTICS MANAGEMENT SYSTEM IF WASTE LOG NOT AVAILABLE) • Mark sufficient if: - Stock register, LMIS, or a dedicated waste log shows quantity, reason, and authorization for contaminated, damaged, or sampled products AND - Register, LMIS, or logs demonstrate evidence of trend analysis or summaries (e.g., if there is a summary report available with graphs/tables/notes it can be used to observe trends).
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.28
Expiry monitoring system used *

OBSERVE EXPIRY MONITORING SYSTEM (REGISTER, LMIS, OR MONITORING SHEET) • Mark sufficient if: - Expiry tracking tools (register, LMIS, or monitoring sheet) demonstrate evidence of monthly checks AND - Near-expiry products are flagged and prioritised for use or redistribution AND - Expired items are quarantined and documented for reconciliation or return
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.29
Emergency and Humanitarian process management *

ASK PERSON RESPONSIBLE FOR LOGISTICS MANAGEMENT: - Do you have a standard operating procedure (SOP) or supply chain manual available that details the processes around emergency preparedness and humanitarian supply chain? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.30
Product reporting and recall process management *

ASK PERSON RESPONSIBLE FOR LOGISTICS MANAGEMENT: - Do you have a standard operating procedure (SOP) or supply chain manual available that details the processes around product recall and reporting? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.31
Product recall implementation *

ASK PERSON RESPONSIBLE FOR LOGISTICS MANAGEMENT: - Are recalled products quarantined and documented? If yes, OBSERVE DOCUMENTATION • Mark sufficient if: - Recall records demonstrate evidence of timely closure AND - Recall records demonstrate linkage to adverse event protocols, including link to service delivery records
- Sufficient
- Insufficient
- Not Observed
- N/A
1.7.32
Traceability and product tracking *

ASK PERSON RESPONSIBLE FOR LOGISTICS MANAGEMENT: - Are all products dispensed to clients recorded to enable recall traceability? • Mark sufficient if all products dispensed to all clients can be traced back to the batch/lot number through the recording system (e.g., stock cards, electronic LMIS), to allow the facility to identify which batches were dispensed and in what quantities, in the event of a recall
- Sufficient
- Insufficient
- Not Observed
- N/A

Laboratory

1.8.1
Sample handling SOP is available *

ASK PERSON RESPONSIBLE FOR LABORATORY MANAGEMENT: - Do you have a standard operating procedure (SOP) for sample handling? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A
1.8.2
Functional lab equipment *

OBSERVE THE LABORATORY EQUIPMENT AND ASK PERSON RESPONSIBLE FOR LABORATORY MANAGEMENT: - Is all necessary lab equipment functional and well-maintained? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A
1.8.3
Lab result turnaround time *

ASK PERSON RESPONSIBLE FOR LABORATORY MANAGEMENT: - What is the average result turnaround time? • Mark sufficient if average turnaround time is less than 1 hour for in-clinic tests AND less than 1 day for labs sent out of the clinic
- Sufficient
- Insufficient
- Not Observed
- N/A
1.8.4
Internal quality control *

ASK PERSON RESPONSIBLE FOR LABORATORY MANAGEMENT: - What procedures do you use for internal quality control? • Mark sufficient if answer includes quality control procedures such as calibration of the equipment and running known samples
- Sufficient
- Insufficient
- Not Observed
- N/A

2. Interview

The checklists are organized by topic and are intended to be completed through an interview with the person responsible for the topic of each checklist, using the Companion Guide for the interview questions and indicator benchmarks. You may need to interview more than one staff person to complete the checklists, e.g., you may need to speak with a clinical manager for the checklists related to service provision, and you may need to speak with an administrative manager to complete the checklist on staff training. Please note that the following checklists on tab "3. Document review" may be convenient to complete as you conduct the interviews with responsible staff: CHECKLIST 3.1 Human resources documentation CHECKLIST 3.2 Client documentation CHECKLIST 3.3 Adverse events documentation

General

2.1.1
Reliable source of power *

ASK RESPONSIBLE STAFF: - Does the SDP have a reliable source of power? • Mark sufficient if SDP is connected to the power grid and/or has a working backup generator or solar power
- Sufficient
- Insufficient
- Not Observed
- N/A
2.1.2
Access to clean water *

ASK RESPONSIBLE STAFF: - Does the SDP have clean running water or access to a reliable water source? - Is the source ever interrupted? When was the last time it was interrupted? • Mark sufficient if SDP has a clean water source that has not been interrupted in the past 6 months
- Sufficient
- Insufficient
- Not Observed
- N/A
2.1.3
Registration system for walk-in and appointment clients *

ASK RESPONSIBLE STAFF: - Does the SDP have a registration system? - Is there a system for both appointment and walk-in clients? • Mark sufficient if there is a registration system (online or phone) and walk-in clients are accepted
- Sufficient
- Insufficient
- Not Observed
- N/A
2.1.4
Client flow mechanism *

ASK RESPONSIBLE STAFF: - Is there a client flow mechanism in the SDP? Please describe. Mark sufficient if client flow mechanism exists and is one-way (clients do not return to the waiting room except to exit)
- Sufficient
- Insufficient
- Not Observed
- N/A
2.1.5
Accessible to public transport *

ASK RESPONSIBLE STAFF: - How long does it take to walk to the SDP from the nearest public transportation stop? • Mark sufficient if SDP is within a 20-minute walk of public transportation
- Sufficient
- Insufficient
- Not Observed
- N/A
2.1.6
Physical security measures in place *

ASK RESPONSIBLE STAFF: What is the process and physical security measures in place to prevent unwanted people from entering the clinic to ensure safety of clients and staff? • Mark sufficient if there is a process to follow and physical barriers (such as gates, key cards, intercom, or security camera) are in place
- Sufficient
- Insufficient
- Not Observed
- N/A
2.1.7
Staff wellness/workplace programme in place *

ASK RESPONSIBLE STAFF: - Does the SDP offer support for coping with stress to prevent burnout? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A
2.1.8
Disasters Management Procedure in place *

ASK RESPONSIBLE STAFF: - What would be the procedure to follow if there is a disaster such as a fire or flood affecting the SDP? • Mark sufficient if there is a Disasters Management Procedure Plan that includes evacuation routes and key contacts such as police and fire department
- Sufficient
- Insufficient
- Not Observed
- N/A
2.1.9
SDP follows protocols on occupational post-exposure reporting, management, and follow-up *

ASK RESPONSIBLE STAFF: - What is the protocol for handling occupational injury involving exposure to blood and body fluids? • Correct: - There is a procedure for recording and reporting accidental injury (involving exposure to blood and body fluids) while working in the facility - Provision/Referral for post-exposure prophylaxis (PEP)
- Sufficient
- Insufficient
- Not Observed
- N/A
2.1.10
SDP has staff or volunteers who can speak the prevalent local languages *

ASK RESPONSIBLE STAFF: - Does the SDP have staff or volunteers who can speak the most prevalent local languages? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A

Client rights

2.2.1
Safeguarding processes are clear and posted *

ASK RESPONSIBLE STAFF: - Are safeguarding rights posted? • Correct: Yes (observed) - What is the process for reporting safeguarding concerns? • Correct: - Complete IPPF SafeReport or incident reporting form - Send report to the relevant incident reporting unit MARK SUFFICIENT IF: Manager provides correct responses to all questions above
- Sufficient
- Insufficient
- Not Observed
- N/A
2.2.2
Safeguarding policy references risks specific to marginalized groups *

ASK RESPONSIBLE STAFF: - Does the safeguarding policy reference risks specific to marginalized groups such as persons with disabilities, young people, older people, sex workers, and LGBTQI+ groups? • Mark sufficient if there the inclusion of marginalized groups is observed in the policy
- Sufficient
- Insufficient
- Not Observed
- N/A
2.2.3
Referral mechanism for young people and persons with disabilities to outside services *

ASK RESPONSIBLE STAFF: - Does the SDP have a referral mechanism for young people and persons with disabilities to access high quality health services not available in the SDP? • Mark sufficient if referral mechanism for high-quality services exists
- Sufficient
- Insufficient
- Not Observed
- N/A
2.2.4
SDP provides reasonable modifications to services for persons with disabilities *

ASK RESPONSIBLE STAFF: - What modifications to services are made for persons with disabilities? • Mark sufficient if: modifications are made, including signage that is easy to read AND at least one type of mobility aid (e.g., wheelchair or crutches) is available to clients
- Sufficient
- Insufficient
- Not Observed
- N/A
2.2.5
SDP has adolescent and youth-friendly health guidelines and policies in place *

ASK RESPONSIBLE STAFF: - Does the SDP have guidelines or a policy specific to provision of adolescent and youth-friendly services? • Mark sufficient if guidelines/policy includes the following - Treating adolescents and youth with respect - Freedom from stigma and discrimination
- Sufficient
- Insufficient
- Not Observed
- N/A
2.2.6
SDP has policy not to impose 3rd party authorization (parental/spousal/guardian) unless required by law *

ASK RESPONSIBLE STAFF: - Does the SDP have a policy against 3rd party authorization for services (e.g., from parents, spouses or guardians) prior to providing services? • Mark sufficient if - SDP has a policy against 3rd party authorization OR - SDP does not have a policy because 3rd party authorization is required by law Exception: For persons with disabilities, if communication is difficult or capacity is in question, a trusted 3rd party supportive decision-maker can provide authorization
- Sufficient
- Insufficient
- Not Observed
- N/A
2.2.7
SDP has policy/guidelines to provide all chosen services and minimize the number of visits required for clients *

ASK RESPONSIBLE STAFF: - Does the SDP have a policy/guidelines to provide all services a client chooses? - Does the SDP have a policy/guidelines to minimize the number of visits required for a client? • Mark sufficient if yes to both
- Sufficient
- Insufficient
- Not Observed
- N/A

IPES+ services

2.3.1
SDP facilitates access to a comprehensive and integrated package of essential services *

ASK RESPONSIBLE STAFF: - Does the SDP have a policy to facilitate access to a comprehensive and integrated package of essential services? - If yes, how is access facilitated and for which services? • Mark sufficient if SDP: - Offers services or referrals for ALL of the following : - SGBV - Sexual health and well-being - Contraception - Abortion care - STI/RTIs - HIV - Ob/Gyn - Fertility support
- Sufficient
- Insufficient
- Not Observed
- N/A
2.3.2
SDP provides sexual health and well-being services *

ASK RESPONSIBLE STAFF: - What services does the SDP provide related to sexual health and well-being? • Mark sufficient if SDP offers ALL of the following: - Sex and Sexuality Counselling, including sexual and gender diversity, sexual pleasure, concerns, and dysfunction - Menstrual health counselling and management
- Sufficient
- Insufficient
- Not Observed
- N/A
2.3.3
SDP provides contraception services *

ASK RESPONSIBLE STAFF: - What services does the SDP provide related to contraception? • Mark sufficient if SDP offers ALL of the following: - Counseling on all medically indicated appropriate contraceptive methods - Oral contraceptive pills - Condoms - Injectables/self-injectables - Implants - Intrauterine device - Emergency contraception
- Sufficient
- Insufficient
- Not Observed
- N/A
2.3.4
SDP provides abortion care *

ASK RESPONSIBLE STAFF: - What services does the SDP provide related to abortion care? • Mark sufficient if SDP offers ALL of the following: - Abortion counseling - Abortion provision - Treatment for incomplete abortion OR - Medical abortion OR - Surgical abortion
- Sufficient
- Insufficient
- Not Observed
- N/A
2.3.5
SDP provides STI/RTI services *

ASK RESPONSIBLE STAFF: - What services does the SDP provide related to STI/RTIs? • Mark sufficient if SDP offers ALL of the following: - Syndromic management of at least 3 STI/RTIs OR laboratory diagnosis (including by self-testing) - Etiological treatment of at least 3 STI/RTIs - Healthy sex and prevention counselling
- Sufficient
- Insufficient
- Not Observed
- N/A
2.3.6
SDP provides HIV services *

ASK RESPONSIBLE STAFF: - What services does the SDP provide related to HIV? • Mark sufficient if SDP offers ALL of the following: - Diagnostic test for HIV status (laboratory, rapid or self-testing) - Post-HIV test counselling (include condoms, risk reduction, offer of partner notification and testing) - Provision of condoms - Provision of PEP (for indicated sexual and occupational exposures) or referral for PEP in cases where provision is restricted (e.g., if PEP only provided in government facilities) - Provision of HIV care and treatment for PLWH or documented referral to care and treatment, including prevention of vertical transmission for pregnant women
- Sufficient
- Insufficient
- Not Observed
- N/A
2.3.7
SDP provides obstetrics and gynaecology services *

ASK RESPONSIBLE STAFF: - What services does the SDP provide related to obstetrics and gynaecology? • Mark sufficient if SDP offers ALL of the following: - Manual pelvic examination - Manual breast examination - Prevention and detection of cervical cancer (PAP smear or VIA or HPV testing, including self-testing) - Estimation of gestational age of pregnancy - Identification and management of danger signs of pregnancy
- Sufficient
- Insufficient
- Not Observed
- N/A
2.3.8
SDP provides fertility support services *

ASK RESPONSIBLE STAFF: - What services does the SDP provide related to fertility support? • Mark sufficient if SDP offers ALL of the following: - Consultation and detailed medical history taking - Counselling on maximizing fertility - Initial investigations (e.g., STI testing, semen analysis, ovulation testing including via self-testing, hysterosalpingogram)
- Sufficient
- Insufficient
- Not Observed
- N/A
2.3.9
SDP provides sexual and gender-based violence (SGBV) services *

ASK RESPONSIBLE STAFF: - What services does the SDP provide related to SGBV support? • Mark sufficient if SDP offers ALL of the following: - First-line clinical support to survivors of violence - Referral mechanisms for clinical, psychosocial and protection services
- Sufficient
- Insufficient
- Not Observed
- N/A

Diverse SOGIESC inclusive SRHR services SOGIESC = people with diverse Sexual Orientations, Gender Identities and Expressions, and Sex Characteristics

2.4.1
SDP has policy/guidelines that are inclusive of people with diverse SOGIESC *

ASK RESPONSIBLE STAFF: - Are SDP policies/guidelines inclusive of people with diverse sexual orientations, gender identities and expressions, and sex characteristics? - If yes, how? • Mark sufficient if policies include the following - Intake form allows clients to indicate the name and gender with which they identify - Clients should be addressed with the name, pronouns, and gender identity they indicated in the Intake Form - People with diverse SOGIESC treated with respect - Freedom from stigma and discrimination
- Sufficient
- Insufficient
- Not Observed
- N/A
2.4.2
SDP offers SRH information, services and other related services for people with diverse SOGIESC *

ASK RESPONSIBLE STAFF: - What information and services do the SDP offer for people with diverse sexual orientations, gender identities and expressions, and sex characteristics? • Mark sufficient if the manager describes information and services for people with diverse SOGIESC. Examples (ONLY, NOT REQUIRED): - Gender-affirming care (e.g., hormonal treatment, consultations) - Sexuality and pleasure counselling
- Sufficient
- Insufficient
- Not Observed
- N/A

Sexual and gender-based violence (SGBV) services

2.5.1
National protocols and/or standard operating procedure for SGBV available on site *

ASK RESPONSIBLE STAFF: - Does the SDP have an SOP for SGBV services available? - If yes, observe the SOP. • Mark sufficient if SOP can be observed
- Sufficient
- Insufficient
- Not Observed
- N/A
2.5.2
SDP has trained staff or volunteers available during operating hours to provide survivor-centred first-line violence support *

ASK RESPONSIBLE STAFF: - Does the SDP have staff or volunteers trained on LIVES (Listen, Inquire, Validate, Enhance safety and Support) available during operating hours to provide survivor-centred first-line violence support? • Mark sufficient if yes, and documentation of training available
- Sufficient
- Insufficient
- Not Observed
- N/A
2.5.3
SDP has trained clinician available during operating hours to provide SGBV clinical assessment *

ASK RESPONSIBLE STAFF: - Does the SDP have a trained clinician available during operating hours to provide SGBV clinical assessment? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A
2.5.4
SDP has a trained clinician available during operating hours to provide treatment for physical injuries and wound management *

ASK RESPONSIBLE STAFF: - Does the SDP have a trained clinician available during operating hours to provide treatment for physical injuries and wound management? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A
2.5.5
SDP has a trained clinician available during operating hours to provide evaluation for STIs/HIV and prevention of pregnancy after sexual violence *

ASK RESPONSIBLE STAFF: - Does the SDP have a trained clinician available during operating hours to provide evaluation for STIs/HIV and preventive care? • Mark sufficient if EC and PEP are available/ offered following sexual assault
- Sufficient
- Insufficient
- Not Observed
- N/A
2.5.6
SDP provides basic mental health assessment *

ASK RESPONSIBLE STAFF: - Does the SDP have a trained clinician available during operating hours to provide basic mental health assessments? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A
2.5.7
SDP has an up-to-date list of service providers for referrals for survivors of violence *

ASK RESPONSIBLE STAFF: - Does the SDP have a list of high- quality service providers for SGBV referrals? - If yes, which services does it include? - If yes, when was it last updated? • Mark sufficient if referral list was updated in the past year that includes ALL of the following services: - Clinical - Psychosocial - Protection - Legal services
- Sufficient
- Insufficient
- Not Observed
- N/A

Female genital mutilation (FGM) services

2.6.1
SDP has trained staff to provide FGM counseling *

ASK RESPONSIBLE STAFF: - Does the SDP have staff trained on FGM? - If yes, are they trained on FGM types, complications and management of through antenatal care? • Mark sufficient if yes to both questions
- Sufficient
- Insufficient
- Not Observed
- N/A
2.6.2
SDP does not engage in medicalization of FGM *

ASK RESPONSIBLE STAFF: - Does the SDP have any providers who engage in medicalization of FGM (e.g., offering a symbolic FGM procedure such making a small cut on the genitalia)? • Mark sufficient if no
- Sufficient
- Insufficient
- Not Observed
- N/A
2.6.3
SDP has a referral pathway in place for FGM clients *

ASK RESPONSIBLE STAFF: - Does the SDP have a referral pathway in place for FGM clients to access services such as reconstructive surgery, psychosocial counseling, fertility services, and urologic services? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A

Staff and provider training

2.7.1
Staff understand and know how to follow IPPF’s Clients Rights and Providers Needs Charter *

ASK RESPONSIBLE STAFF: - Have the staff had training that includes the Clients Rights and Providers Needs Charter? • Mark sufficient if training has occurred in the last 12 months
- Sufficient
- Insufficient
- Not Observed
- N/A
2.7.2
Service providers received training on SRH topics in the past 12 months *

ASK RESPONSIBLE STAFF: - When was the last time service providers received training on SRH topics? • Mark sufficient if training was within the past 12 months
- Sufficient
- Insufficient
- Not Observed
- N/A
2.7.3
Service providers have received training on the IPPF Client-Centred Clinical Guidelines (CCCGs) *

ASK RESPONSIBLE STAFF: - Have all service providers received orientation to the IPPF CCCGs? • Mark sufficient if ALL service providers have received orientation to the CCCGs
- Sufficient
- Insufficient
- Not Observed
- N/A
2.7.4
Service providers received VCAT training in the past 12 months *

ASK RESPONSIBLE STAFF: - Have ALL service providers in this SDP received VCAT training? - If yes, when was the last time service providers received VCAT training? • Mark sufficient if ALL service providers have received VCAT training within the past 12 months
- Sufficient
- Insufficient
- Not Observed
- N/A
2.7.6
Staff managing logistics and commodities received training or updates in the past 12 months *

ASK RESPONSIBLE STAFF: - Have ALL staff managing logistics and commodities received training or updates on the supply chain manual/SOPs (including the logistics management information system) in the past 12 months? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A
2.7.8
Relevant staff received training or updates on youth-friendly services in the past 12 months *

ASK RESPONSIBLE STAFF: - Have ALL relevant staff received training or updates on youth-friendly services in the past 12 months? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A
2.7.9
Relevant staff received training or updates on disability and age-associated healthcare needs in the past 12 months *

ASK RESPONSIBLE STAFF: - Have ALL relevant staff received training or updates on disability inclusive and age-associated SRH services in the past 12 months? - Did the training include content on how to respectfully provide SRH services to persons with disabilities and older people? • Mark sufficient if yes to both questions
- Sufficient
- Insufficient
- Not Observed
- N/A
2.7.10
Relevant staff received training or updates on LGBTQI+-friendly or diverse SOGIESC-inclusive SRH services in the past 12 months *

ASK RESPONSIBLE STAFF: - Have ALL relevant staff received training or updates on inclusive SRH services for LGBTQI+ people or people with diverse sexual orientations, gender identities and expressions, and sex characteristics in the past 12 months? - Did the training include content on how to respectfully provide SRHR services to LGBTQI+ people or people with diverse sexual orientations, gender identities and expressions, and sex characteristics? • Mark sufficient if yes to both questions
- Sufficient
- Insufficient
- Not Observed
- N/A
2.7.11
Relevant staff received training or updates on infection prevention and control in the past 12 months *

ASK RESPONSIBLE STAFF: - Have ALL relevant staff received training or updates on infection prevention and control in the past 12 months? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A
2.7.12
All staff have been trained on safeguarding *

ASK RESPONSIBLE STAFF: - Have ALL staff received training on safeguarding in the past 12 months? - If yes, did the training include SafeReport? • Mark sufficient if yes to both questions
- Sufficient
- Insufficient
- Not Observed
- N/A
2.7.13
Staff have been trained on identifying and responding to safeguarding risks specific to marginalized groups *

ASK RESPONSIBLE STAFF: - In the past 12 months, have ALL staff been trained on identifying and responding to safeguarding risks specific to marginalized groups such as persons with disabilities, young people, older people, sex workers, and LGBTQI+ groups? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A
2.7.5
Service providers received training on adverse events reporting in the past 12 months *

ASK RESPONSIBLE STAFF: - Have ALL service providers in this SDP received training on adverse events reporting? - If yes, when was the last time service providers received training on adverse event reporting? • Mark sufficient if ALL service providers have received training on adverse event reporting within the past 12 months
- Sufficient
- Insufficient
- Not Observed
- N/A
2.7.7
Staff received training or updates on laboratory procedures in the past 12 months *

ASK RESPONSIBLE STAFF: - Have ALL staff working in the laboratory received training or updates on laboratory procedures in the past 12 months? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A
2.7.14
All staff have been trained on emergency preparedness *

ASK RESPONSIBLE STAFF: - Have ALL staff received training on emergency preparedness (e.g., procedures in case of fire or flood) in the past 12 months? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A

Client referrals

2.8.1
SDP has an established referral system for services it does not provide *

ASK RESPONSIBLE STAFF: - Does the SDP have an established referral system for services it does not provide? • Mark sufficient if yes AND • OBSERVE: CMIS referrals are documented in client files
- Sufficient
- Insufficient
- Not Observed
- N/A
2.8.2
SDP has an up-to-date list of service providers for referrals *

ASK RESPONSIBLE STAFF: - Does the SDP have a list of high-quality service providers for referrals? - If yes, when was it last updated? • Mark sufficient if referral list was updated in the past 12 months
- Sufficient
- Insufficient
- Not Observed
- N/A
2.8.3
SDP records referrals and outcomes *

ASK RESPONSIBLE STAFF: - Does the SDP have a separate record/register that documents referrals and referral outcomes? - If yes, OBSERVE the record/register • Mark sufficient if record/register documents client ID/name, referral service, and follow up required (if any)
- Sufficient
- Insufficient
- Not Observed
- N/A

Client information systems

2.9.1
SDP has system for documenting services provided *

ASK RESPONSIBLE STAFF: - Does the SDP have a system for documenting the range of services provided? - If yes, what is the system? • Mark sufficient if SDP has an effective system such as open EMR or CMIS
- Sufficient
- Insufficient
- Not Observed
- N/A
2.9.2
SDP has an SOP in place for client follow-up *

ASK RESPONSIBLE STAFF: - Does the SDP have an SOP in place for client follow-up? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A
2.9.3
Client information recorded or updated regularly *

ASK RESPONSIBLE STAFF: - Is client information recorded or updated (manually or electronically) daily in a master register? - Is client information updated after every visit? • Mark sufficient if yes to ALL questions
- Sufficient
- Insufficient
- Not Observed
- N/A
2.9.4
Client records stored by unique ID *

ASK RESPONSIBLE STAFF: - Do client records have a unique ID number? - Are client records stored systematically by unique ID (rather than by name)? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A
2.9.5
Client records stored in a central area *

ASK RESPONSIBLE STAFF: - Are client records stored in one area, independent of service provided? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A

Quality monitoring

2.10.1
SDP has effective and continuous quality improvement systems in place *

ASK RESPONSIBLE STAFF: - Does the SDP have a system for continuous quality improvement? - If yes, please describe the system. • Mark sufficient if continuous quality improvement system includes ALL of the following elements: - Clients are empowered to take an active part - Community is empowered to take an active part - Performance data informs changes - Feedback from healthcare providers informs changes
- Sufficient
- Insufficient
- Not Observed
- N/A
2.10.2
SDP has an effective QoC Committee/Quality Assurance Team or focal person *

ASK RESPONSIBLE STAFF: - Does the SDP have a QoC Committee or Quality Assurance Team? - If yes, is there evidence that the committee/team is operational (e.g., Terms of Reference and records of meeting minutes available)? • Mark sufficient if yes to both questions
- Sufficient
- Insufficient
- Not Observed
- N/A
2.10.3
SDP conducts regular quality of care assessments and/or clinical audits *

ASK RESPONSIBLE STAFF: - Does the SDP have documented quality of care assessment and/or clinical audit plans such as provider competency assessments? - If yes, does the SDP also have response/action plans to address shortcomings in service delivery? - If yes, how many audits have been conducted in the past year? • Mark sufficient if yes to ALL questions and at least 1 audit has been conducted in the past 12 months
- Sufficient
- Insufficient
- Not Observed
- N/A
2.10.4
Managers and providers use self-assessment tools to identify areas for improvement *

ASK RESPONSIBLE STAFF: - Do both managers and providers use self-assessment tools to self-assess services, competencies, and identify areas for improvement? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A
2.10.5
SDP uses a quality assessment system based on national requirements and IPPF QOC standards/guidelines *

ASK RESPONSIBLE STAFF: - Does the SDP use a quality assessment system based on national requirements and IPPF QOC standards/ guidelines? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A
2.10.6
Staff participate in planning and decision-making *

ASK RESPONSIBLE STAFF: - Do all relevant staff participate in planning and decision-making for improving the quality of services? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A
2.10.7
SDP has evidence-based service delivery guidelines and protocols available *

ASK RESPONSIBLE STAFF: - Does the SDP have evidence-based service delivery guidelines and protocols available? - If yes, OBSERVE the guidelines and assess the following: • Updated in the past 5 years • Evidence-based • Include protocols for services listed under the IPPF comprehensive and integrated package of quality sexual and reproductive health services • Mark sufficient if yes to all of the above
- Sufficient
- Insufficient
- Not Observed
- N/A

Client engagement

2.11.1
SDP uses social media to raise awareness of services available and provide information/education on SRHR *

ASK RESPONSIBLE STAFF: - Does the SDP use media to raise awareness of services available? For example, Facebook, Instagram, Tik Tok, X (Twitter), WhatsApp. - Does the SDP use social media to provide information/education on SRHR? • Mark sufficient if yes to both questions.
- Sufficient
- Insufficient
- Not Observed
- N/A
2.11.3
Community mobilizers have been trained on effective mobilization techniques *

ASK RESPONSIBLE STAFF: - Have community mobilizers been trained on mobilization techniques? - If yes, please describe the techniques they have been trained on. • Mark sufficient if community mobilizers have been trained on ANY of the following: - Interpersonal communication - Facilitating group discussions/dialogues - Home visits
- Sufficient
- Insufficient
- Not Observed
- N/A
2.11.4
Community mobilizers have been trained on communication and messaging around male involvement *

ASK RESPONSIBLE STAFF: - Have community mobilizers been trained on communication and messaging around male involvement? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A
2.11.5
Community mobilizers have been trained on communication and messaging around young people *

ASK RESPONSIBLE STAFF: - Have community mobilizers been trained on communication and messaging around young people? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A
2.11.6
Community mobilizers have been trained on communication and messaging around persons with disability *

ASK RESPONSIBLE STAFF: - Have community mobilizers been trained on communication and messaging around persons with disabilities? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A
2.11.7
Community mobilizers have been trained on comprehensive SRHR *

ASK RESPONSIBLE STAFF: - Have community mobilizers been trained on comprehensive SRHR? FP? HIV? STIs? Comprehensive abortion care and/or PAC? • Mark sufficient if yes to all questions
- Sufficient
- Insufficient
- Not Observed
- N/A
2.11.8
Community mobilizers have appropriate tools and job aids *

ASK RESPONSIBLE STAFF: - Do community mobilizers have appropriate tools and job aids? - If yes, please describe the tools they use. • Mark sufficient if community mobilizers have ANY of the following: - Flip charts or books - FP methods counseling bags
- Sufficient
- Insufficient
- Not Observed
- N/A
2.11.9
Community mobilizers have a mobilization workplan that ensures coverage of allocated region *

ASK RESPONSIBLE STAFF: - Do community mobilizers have a mobilization workplan? - If yes, does the workplan ensure coverage of their allocated region? • Mark sufficient if yes to both questions
- Sufficient
- Insufficient
- Not Observed
- N/A
2.11.10
SDP has a community education strategy or SOP *

ASK RESPONSIBLE STAFF: - Does the SDP have a community education strategy or SOP? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A
2.11.11
Client exit interviews are done at the SDP to get client feedback *

ASK RESPONSIBLE STAFF: - Are client exit interviews conducted at the SDP to get client feedback? - If yes, how often? How many interviews are typically conducted? • Mark sufficient if client exit interviews are conducted at least every 2-3 years with at least 10 clients
- Sufficient
- Insufficient
- Not Observed
- N/A
2.11.12
Client feedback mechanism is in place *

ASK RESPONSIBLE STAFF: - Does the SDP have a regular client feedback mechanism (like a client suggestion box) in place? - If yes, are there multiple ways that clients can provide feedback to ensure accessibility for persons with disabilities (e.g., phone, SMS/Whatsapp, online form, email, in-person visit, Braille/audio)? • Mark sufficient if there is a client feedback mechanism AND it is available in multiple formats
- Sufficient
- Insufficient
- Not Observed
- N/A
2.11.13
Client feedback is routinely reviewed and used to improve services *

ASK RESPONSIBLE STAFF: - Is client feedback reviewed on a routine basis? - Is client feedback used to improve access and quality of services? • Mark sufficient if yes to both questions
- Sufficient
- Insufficient
- Not Observed
- N/A
2.11.2
SDP uses a range of communication channels to reach people with diverse SOGIESC, persons with disabilities, and older people and their carers *

ASK RESPONSIBLE STAFF: - How does the SDP reach people with diverse SOGIESC, persons with disabilities, older people, and their carers with information on available health services? • Mark sufficient if SDP has a plan to reach these populations AND uses multiple channels (e.g., TV, radio, print media, IEC materials, interpersonal communication/Community Health Workers, etc.).
- Sufficient
- Insufficient
- Not Observed
- N/A

3. Document review

The checklists are organized by type of documentation and are intended to be completed by talking with the person responsible for the topic of each checklist as you review the documentation. The Companion Guide includes the questions for the responsible staff and the indicator benchmarks. You may need to interview more than one staff person to complete the checklists, e.g., you may need to speak with a clinical manager to complete the checklist on adverse events documentation, and you may need to speak with an administrative manager to complete the checklist on human resources documentation.

Human resources documentation

3.1.1
SDP has a staffing needs plan and organogram *

OBSERVE AND ASK RESPONSIBLE STAFF: SDP has a staffing organogram and any staffing vacancies/needs identified
- Sufficient
- Insufficient
- Not Observed
- N/A
3.1.2
SDP provides each staff with a clear job description *

OBSERVE: whether the job descriptions are on file SELECT THREE JOB DESCRIPTIONS AT RANDOM AND COMPARE TO STAFF RECORDS: Is there evidence that staff have the required attributes and qualifications for their positions and were recruited on merit only? • Mark sufficient if job descriptions are on file and ALL selected at random for review demonstrate evidence that staff have the required qualifications for their positions
- Sufficient
- Insufficient
- Not Observed
- N/A
3.1.3
SDP provides comprehensive orientation to their staff *

ASK RESPONSIBLE STAFF and OBSERVE: - Are newly recruited staff provided with a formal induction that includes a safety and security briefing, inclusion and non-discrimination and mandatory safeguarding training, irrespective of rank or job title? • Mark sufficient if yes and records are observed
- Sufficient
- Insufficient
- Not Observed
- N/A
3.1.4
SDP conducts regular staff performance evaluations *

ASK RESPONSIBLE STAFF and OBSERVE: - Do records show that at least annual appraisal of all staff has been carried out for the last two years based on an agreed format and procedure that includes an opportunity for staff to review and comment on their own individual appraisal in writing? • Mark sufficient if yes
- Sufficient
- Insufficient
- Not Observed
- N/A
3.1.5
SDP is adequately staffed to provide continuous, uninterrupted integrated services *

OBSERVE: On the day of the assessment, the SDP is adequately staffed to provide continuous, uninterrupted integrated services
- Sufficient
- Insufficient
- Not Observed
- N/A
3.1.6
SDP has policy in place to ensure service providers receive appropriate training and supportive supervision on a regular basis *

ASK RESPONSIBLE STAFF and OBSERVE: - Does the SDP have a policy in place to ensure service providers receive appropriate training and supportive supervision? - If yes, how often do service providers in this SDP receive training and supportive supervision? • Mark sufficient if training or supportive supervision is provided at least annually and training records (including staff names, dates, and type of training) are available
- Sufficient
- Insufficient
- Not Observed
- N/A

Client documentation

3.2.1
Free services are available to clients for whom cost is a barrier *

OBSERVE: SDP records show at least one 0 fee service in the past 6 months
- Sufficient
- Insufficient
- Not Observed
- N/A
3.2.2
SDP has documented SOP/guideline for obtaining client consent according to the standard *

ASK RESPONSIBLE STAFF: - Does the SDP have a documented process/guidelines for obtaining client consent? - If yes, OBSERVE • Mark sufficient if includes the following: - Determination of the capacity of the client to make a decision - Consent form signature is not requested until clients have received information, answers to any questions, and have made a voluntary and informed choice - Clients are asked to sign a consent/assent document - Clients are informed that they can revoke their consent at any point in time and that the provider must respect their decision - Verbal consent is required for physical exam and when written consent cannot be written - For persons with disabilities: Person is supported in all ways necessary to obtain their consent independently/without coercion, and only when communication is difficult or capacity is in question to allow a trusted guardian supportive decision-maker – chosen by the client to provide consent for that specific health treatment. The client should always have the final say.
- Sufficient
- Insufficient
- Not Observed
- N/A
3.2.3
Consent for procedures is documented for all clients *

OBSERVE: Review 10 client records selected at random for documentation of consent for clinical procedures • Mark sufficient if written or verbal consent is documented in consent forms in all 10 client records
- Sufficient
- Insufficient
- Not Observed
- N/A

Adverse events documentation

3.3.1
There is a functional team/committee responsible for overseeing and responding to adverse events *

ASK RESPONSIBLE STAFF and OBSERVE: - Is there a team or committee in the SDP responsible for overseeing and responding to adverse events? • Mark sufficient if there is documentation of at least one person or a functional committee responsible
- Sufficient
- Insufficient
- Not Observed
- N/A
3.3.2
There is a system for reporting near misses and adverse events in place and operational *

ASK RESPONSIBLE STAFF: - Is there a system for reporting near misses and adverse events? If Yes, what is the system? • Correct: - Investigation conducted - Investigation report developed and disseminated - Reports available - Commodity-related adverse events reported through pharmacovigilance channels MARK SUFFICIENT IF: There is a system for reporting near misses and adverse events and reports were observed.
- Sufficient
- Insufficient
- Not Observed
- N/A
3.3.3
There is a process for debriefing following near misses and adverse events. *

ASK RESPONSIBLE STAFF and OBSERVE: - Is there a process for debriefing following near misses and adverse events? • Correct: - Yes, there is a process - Process includes ALL of the following AND documents were observed: - Action plan developed and reported - Action plans available
- Sufficient
- Insufficient
- Not Observed
- N/A
3.3.4
Abortion-related adverse events are recorded *

ASK RESPONSIBLE STAFF and OBSERVE: - How many abortion-related adverse events were recorded in the past year? (ASK TO OBSERVE RECORDS) • Correct: - If SDP had <100 abortions in past year: severe adverse events in <1.5% of abortion cases (can include 0 severe adverse events) - If SDP had ≥ 100 abortions in past year: severe adverse events in >0% and <1.5% of abortion cases (must be more than 0 severe adverse events, assuming that at high caseload sites, at least some severe adverse events are expected and 0 indicates poor reporting) Severe adverse events include: • Blood transfusions, surgery • IV antibiotics • Fluid resuscitation • Missed ectopic pregnancy • Hospital admission • Referral to a higher level facility
- Sufficient
- Insufficient
- Not Observed
- N/A
3.3.5
Implant-related adverse events are recorded *

ASK RESPONSIBLE STAFF: - How many implant-related adverse events were recorded in the past year? (ASK TO OBSERVE RECORDS) • Correct: - If SDP had <100 implant cases in past year: adverse events in <15% of implant cases (can include 0 adverse events) - If SDP had ≥ 100 implant cases in past year: adverse events in >0% and <15% of implant cases (must be more than 0 adverse events, assuming that at least some adverse events are expected and 0 indicates poor reporting) Adverse events include: • Infection/abscess at implant insertion site • Difficult removal • Expulsion of implant • Implant migration to another site due to improper insertion
- Sufficient
- Insufficient
- Not Observed
- N/A
3.3.6
IUD-related adverse events are recorded *
- Sufficient
- Insufficient
- Not Observed
- N/A
3.3.7
Tubal ligation-related adverse events are recorded *

ASK RESPONSIBLE STAFF: - How many tubal ligation-related adverse events were recorded in the past year? (ASK TO OBSERVE RECORDS) • Correct: - If SDP had <200 tubal ligation cases in past year: adverse events in <2% of tubal ligation cases (can include 0 adverse events) - If SDP had ≥ 200 tubal ligation cases in past year: adverse events in >0% and <2% of tubal ligation cases (must be more than 0 adverse events, assuming that at least some adverse events are expected and 0 indicates poor reporting) Adverse events include: • Complications of surgery (e.g., injury to bladder or bowel) and anesthesia
- Sufficient
- Insufficient
- Not Observed
- N/A
3.3.8
No scalpel vasectomy-related adverse events are recorded *

ASK RESPONSIBLE STAFF: - How many no scalpel vasectomy-related adverse events were recorded in the past year? (ASK TO OBSERVE RECORDS) • Correct: - Adverse events in <0.1% of no scalpel vasectomy cases (can include 0 adverse events) Adverse events include: • Infection at incision site or inside incision
- Sufficient
- Insufficient
- Not Observed
- N/A
3.3.9
Confidentiality-related adverse events are recorded *

ASK RESPONSIBLE STAFF: - How many confidentiality-related adverse events were recorded in the past year? (ASK TO OBSERVE RECORDS) • Correct: - 0 confidentiality-related adverse events Adverse events include: • Data breaches resulting in loss of confidentiality • Unauthorized disclosure of client information
- Sufficient
- Insufficient
- Not Observed
- N/A
3.4.10
Commodity-related adverse events are recorded *
- Sufficient
- Insufficient
- Not Observed
- N/A

Asset documentation

3.2.1
SDP has a fixed asset register *

ASK PERSON RESPONSIBLE FOR FIXED ASSETS: - Does the SDP have a fixed asset register? - If yes, OBSERVE the fixed asset register. • Mark sufficient if a comprehensive and current inventory of fixed assets (e.g., equipment, furniture) is maintained, showing acquisition date, status, and condition.
- Sufficient
- Insufficient
- Not Observed
- N/A
3.2.2
Effective assets disposal and renewal plan *

ASK PERSON RESPONSIBLE FOR FIXED ASSETS: - Does the SDP have an assets disposal and renewal plan for damaged, unused, and old equipment? - If yes, please describe the plan. • Mark sufficient if a written plan exists that outlines processes and timelines for replacing non-functional, obsolete, or unused items. Implementation is regularly reviewed
- Sufficient
- Insufficient
- Not Observed
- N/A
3.2.3
SDP has a maintenance plan *

ASK PERSON RESPONSIBLE FOR FIXED ASSETS: - Does the SDP have an asset and infrastructure maintenance plan, agreement, schedule, and budget in place? • Mark sufficient if a maintenance plan includes a service agreement, maintenance schedule, and dedicated budget for equipment upkeep and repairs.
- Sufficient
- Insufficient
- Not Observed
- N/A

4. Provider observation Rules

Do not enter assessment data on this tab. This sheet will auto-populate based on your entries in the Technical Competency Checklist (following tabs), which is used to complete the provider observation. Please note that the "N/A" column on this tab is populated using the applicability information entered on the "Instructions_Prov Obs" tab. For additional information about the benchmarks for "Sufficient", please review the Companion Guide.

4.1 General service provision

4.1
SDP meets general service provision requirements *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.1. GENERAL SERVICE PROVISION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No

4.2 Contraception service provision

4.2.1
SDP meets general contraceptive service provision requirements *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.2. CONTRACEPTION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No
4.2.2
SDP meets oral contraception service provision requirements *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.2. CONTRACEPTION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No
4.2.3
SDP meets emergency contraception service provision requirements *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.2. CONTRACEPTION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No
4.2.4
SDP meets injectable contraception service provision requirements *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.2. CONTRACEPTION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No
4.2.5
SDP meets self-injectable (DMPA-SC) contraception service provision requirements *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.2. CONTRACEPTION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No
4.2.6
SDP meets IUD insertion service provision requirements *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.2. CONTRACEPTION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No
4.2.7
SDP meets IUD removal service provision requirements *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.2. CONTRACEPTION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No
4.2.8
SDP meets implant insertion service provision requirements *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.2. CONTRACEPTION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No
4.2.9
SDP meets implant removal service provision requirements *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.2. CONTRACEPTION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No
4.2.10
SDP meets suprapublic minilaparotomy service provision requirements *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.2. CONTRACEPTION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No
4.2.11
SDP meets vasectomy service provision requirements *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.2. CONTRACEPTION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No

4.3 Comprehensive abortion care service provision

4.3.1
SDP meets general comprehensive abortion care provision requirements *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.3. CAC SERVICE PROVISION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No
4.3.2
SDP meets harm reduction model requirements (severely legally restricted contexts) *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.3. CAC SERVICE PROVISION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No
4.3.3
SDP meets surgical abortion service provision requirements *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.3. CAC SERVICE PROVISION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No
4.3.4
SDP meets medical abortion service provision requirements *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.3. CAC SERVICE PROVISION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No
4.3.5
SDP meets immediate postabortion care and follow-up service provision requirements *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.3. CAC SERVICE PROVISION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No
4.3.6
SDP meets post-abortion contraception service provision requirements *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.3. CAC SERVICE PROVISION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No

4.4 Sexually transmitted infection service provision

4.4.1
SDP meets general STI provision requirements *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.4. STI SERVICE PROVISION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No
4.4.2
SDP meets STI testing provision requirements *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.4. STI SERVICE PROVISION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No
4.4.4
SDP meets contraception counseling requirements for STI clients *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.4. STI SERVICE PROVISION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No
4.4.3
SDP meets requirements for sharing test results and post-test counseling *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.4. STI SERVICE PROVISION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No

4.5 HIV/AIDS service provision

4.5.1
SDP meets counseling requirements for HIV testing clients *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.5. HIV/AIDS SERVICE PROVISION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No
4.5.2
SDP meets HIV testing provision requirements *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.5. HIV/AIDS SERVICE PROVISION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No
4.5.3
SDP meets requirements for sharing test results and post-test counseling and treatment *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.5. HIV/AIDS SERVICE PROVISION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No

4.6 Sexual health and well-being service provision

4.6.1
SDP meets requirements for sexuality and gender support service provision *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.6. SEXUAL HEALTH & WELL-BEING SERVICE PROVISION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No
4.6.2
SDP meets requirements for menstrual health service provision *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.6. SEXUAL HEALTH & WELL-BEING SERVICE PROVISION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No

4.7 Gynaecology service provision

4.7.1
SDP meets general breast and cervical cancer prevention and screening requirements *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.7. GYNECOLOGY SERVICE PROVISION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No
4.7.2
SDP meets breast cancer screening requirements *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.7. GYNECOLOGY SERVICE PROVISION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No
4.7.3
SDP meets cervical cancer screening requirements *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.7. GYNECOLOGY SERVICE PROVISION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No
4.7.4
SDP meets requirements for fertility care *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.7. GYNECOLOGY SERVICE PROVISION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No
4.7.5
SDP meets requirements for menopause care *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.7. GYNECOLOGY SERVICE PROVISION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No

4.8 Obstetrics service provision

4.8.1
SDP meets confirmation of pregnancy requirements *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.8. OBSTETRICS SERVICE PROVISION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No
4.8.2
SDP meets prenatal care service provision requirements *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.8. OBSTETRICS SERVICE PROVISION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No
4.8.3
SDP meets labor and delivery care service provision requirements *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.8. OBSTETRICS SERVICE PROVISION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No
4.8.4
SDP meets postnatal care service provision requirements *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.8. OBSTETRICS SERVICE PROVISION: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No

4.9 Sexual and gender-based violence service provision

4.9.1
SDP meets SGBV service provision requirements *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.9. SGBV: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No
4.9.2
SDP meets FGM service provision requirements *

REVIEW TECHNICAL COMPETENCY CHECKLIST 4.9. SGBV: • Mark sufficient if ALL providers assessed scored at least 80%
- Yes
- No

4.1 General

Per provider

1) The 9 tabs that follow (4.1 - 4.9) constitute the IPPF Technical Competency Checklist and are intended to be completed on a computer during an in-person provider observation conducted by an MA QOC focal point, consultant clinical assessor, or SDP staff undertaking self-assessment. The Technical Competency Checklist will be used to assess whether the standards are met on tab "4. Provider observation". 2) Clinical assessors should have skills matched to the service being observed (e.g., the assessor must be trained in dilatation and evacuation (D&E) to observe and assess technical competency for a D&E procedure) 3) Prior to conducting an observation of a service with a real client, the client's consent should be taken. Please find the suggested consent language in the "Instructions" at the top of each tab. 4) To complete the checklists: a) Complete the "Applicability" section below to determine which checklists are relevant to complete for providers at the SDP. Complete the "Answer" column using the dropdown menu. b) Review the tabs applicable to the SDP and identify at least one provider to assess per service offered at the SDP. The form provides space for you to complete technical competency checklists for up to four providers per service. c) Enter each provider's name and their designation in the "" box at the top of the relevant checklist. "Provider 1" can be different between checklists (e.g., on the "Contraception" checklist, Provider 1 may be "Luisa", while on the "CAC" checklist, Provider 1 may be "Marta"). Indicate whether each observation is with a client or a simulation. d) Complete the "Assessment" section of the checklist ("Sufficient", "Insufficient", "Not observed", or "N/A"). Tips for completing the "Assessment" section of the checklists: – Mark your selection with any character, e.g., "X". – Mark only one column in each row, e.g., put "X" in "Sufficient" and do not enter anything in the "Insufficient", "Not observed", or "N/A" columns. – Ensure that you mark a selection in each row of the checklist, i.e., do not leave any rows blank. e) After the observation, give the provider feedback on criteria that were marked as "Insufficient". f) Please ensure that the checklist is as complete as possible, minimizing use of the "Not observed" column. Tips for using the "Not observed" and "N/A" columns in the checklists: – "Not observed" should be used when the service is available at the SDP, but it could not be observed. This could be due to lack of time or the assessor was unable to observe the full procedure, e.g., the assessor was not able to see the entirety of a procedure well enough to assess whether the provider completed the procedure according to the SOP. – "N/A" should only be used when the service is NOT available at the SDP. In most cases, this will be reflected through the Applicability questions above. However, there are some instances where a service might be offered but not all methods are offered at the SDP. For example, if an SDP offers comprehensive abortion care (CAC) but dilatation and evacuation (D&E), the D&E item on checklist 4.3.3 should be marked as "N/A". The reason for marking “N/A” should be included in the “Comments” section. 5) As you complete the applicable checklists for at least one provider per service offered at the SDP, tab "4. Provider observation" will auto-populate with the indicator scoring. Please note the following definitions: "Sufficient = All providers assessed scored ≥80% Insufficient = At least one provider scored <80% Not observed = Service offered at SDP, but not observed N/A = Service not offered at SDP" 6) If you have any questions, please contact Nathalie Kapp at nkapp@ippf.org.

4.1 General

4.1.1.Q1
Greets clients and treats them with kindness, dignity and respect *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.1.1.Q2
Gives the client the choice to meet alone (without partner or carer) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.1.1.Q3
Only required clinical staff are present, unless requested by the client *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.1.1.Q4
Asks client about her current or prior experience with SRH *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.1.1.Q5
Provides information on other relevant SRH services *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.1.1.Q6
Applies no unnecessary medical or administrative restrictions to exclude youth or other clients services *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.1.1.Q7
Does not impose a third party authorization requirement, unless required to do so by law *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.1.1.Q8
Uses language the client understands *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.1.1.Q9
Does not coerce/pressure clients (services are voluntary, respect rights) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.1.1.Q10
Maintains client´s privacy and confidentiality throughout the counseling session *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.1.1.Q11
Records session in medical records *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.1.1.Q12
Provider obtains informed consent and documents it in medical record prior to starting examinations and procedures *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.1.1.Q13
Provider gives information about reproductive coercion and intimate partner violence (only asked in the absence of their partner) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.1.1.Q14
Provider sensitively asks client whether she has experienced reproductive coercion or intimate partner violence or (only asked in the absence of their partner) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.1.1.Q15
Provider gives a supportive and validating response to the client and does not pressure the client to disclose reproductive coercion or intimate partner violence. *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.1.1.Q16
If client reports reproductive coercion, provider sensitively inquires about the type of reproductive coercion they are experiencing and adapts counseling to help the client find the contraceptive or abortion method that will work best for them (e.g., using contraception or abortion covertly if needed). *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.1.1.Q17
If a client reports intimate partner violence provider responds supportively and offers referral to violence support services. *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.1.1.Q18
Provider performs regular hand hygiene/ hand washing (before and after seeing each client) *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.2 Contraception

Per provider

Complete as many sections as possible through direct observation. If no clients are available for observation, please simulate a) the General Contraception Counseling section and b) at least three clinical procedures. Please indicate whether the observation is with a client or a simulation using the dropdown box under each provider's name. The assessor should use the MA's SOPs to aid in completion of the observation. After the observation, give the provider feedback on criteria that were marked as "Insufficient". CLIENT CONSENT: I am observing your provider today as part of our quality of care monitoring. If you agree, I will observe the service your provider gives you today. I will not record your identity at any point (e.g. name, address, etc.). You are not required to agree to the observation - if you do not want to be part of the observation, this will not affect the service you are provided. Do you have any questions for me? Do you want to take part in the observation? SIMULATION: Please note that you should not perform any clinical procedures during a simulation - instead please ask the provider to role play what s/he would do with a real client.

Shown only: When “4.2.2” equals [NO]

4.2.1 General Contraceptive Counseling

4.2.1.Q1
Asks client about her current or prior experience with family planning methods *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.1.Q2
Provides information on benefits and disadvantages of methods meeting client's needs and desires *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.1.Q3
Asks client if she has questions or concerns and addresses each *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.1.Q4
Describes how to use relevant methods and what to expect (including side effects and mentrual changes) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.1.Q5
Uses job aids and displays to demonstrate relevant methods *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.1.Q6
Explains condom use for dual protection to prevent STIs/ HIV/ pregnancy *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.1.Q7
Asks client her preferred method/s and respects choice *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.1.Q8
Assesses the client's medical eligibility for the chosen method *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.1.Q9
Helps client plan for how to use the correctly and manage common side effects *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.1.Q10
If the client is not eligible for the chosen method, the provider helps the client to choose another method *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.2.2 ORAL CONTRACEPTIVES

Shown only: When “4.2.3” equals [NO]

4.2.2.Q1
Describes characteristics of both types of OCs: Progestin- only Pill & Combined OC *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.2.Q2
Explains possible side effects *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.2.Q3
Provides clear instructions on dosing and how to manage forgotten pills *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.2.Q4
Dispenses OCs or provides prescription *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.2.Q5
Explains when client needs to return for follow-up or for warning signs *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.2.3 EMERGENCY CONTRACEPTION

Shown only: When “4.2.4” equals [NO]

4.2.3.Q1
Describes characteristics of both types of EC: pills and IUD *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.3.Q2
Follows emergency IUD insertion according to SOP and/or manufacturer guidelines within 120 hours of unprotected sex *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.3.Q3
Provides emergency contraceptive pills within 120 hours of unprotected sex *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.2.4 INJECTABLE CONTRACEPTIVES

Shown only: When “4.2.5” equals [NO]

4.2.4.Q1
Describes characteristics of available Injectables (NET-EN, DMPA IM or DMPA-SC) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.4.Q2
Explains possible side effects including changes in bleeding *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.4.Q3
Verifies the correct vial, dosage, and expiration date before administration *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.4.Q4
Performs proper hand hygiene *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.4.Q5
Provide injection according to SOP and/or manufacturer guidelines *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.4.Q6
Explains when the client should return for next dose or for warning signs *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.2.5 SELF-INJECTABLE CONTRACEPTIVES

Shown only: When “4.2.6” equals [NO]

4.2.5.Q1
Describes characteristics of available Injectables (NET-EN, DMPA IM or DMPA-SC) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.5.Q2
Explains possible side effects including changes in bleeding *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.5.Q3
Explains and shows the client how to self-inject *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.5.Q4
Observes the client self-inject *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.5.Q5
Discusses a plan for storage and disposal *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.5.Q6
Offers printed information for the client to guide on how to use *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.5.Q7
Explains when the client should administer next dose or for warning signs *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.2.6 IUD INSERTION

Shown only: When “4.2.7” equals [NO]

4.2.6.Q1
Describes characteristics of available IUDs (copper or levonorgestrel) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.6.Q2
Explains possible side effects, rare complications and danger signs *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.6.Q3
Explains the step-by-step process of insertion, using models or illustrations *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.6.Q4
Inserts IUD according to SOP and/or manufacturer guidelines *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.2.7 IUD REMOVAL

4.2.7.Q1
Removes IUD according to SOP and/or manufacturer guidelines *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.2.8 IMPLANT INSERTION

Shown only: When “4.2.8” equals [NO]

4.2.8.Q1
Describes characteristics of available choices of implants (e.g. 1-rod vs 2-rod) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.8.Q2
Explains side effects and rare complications *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.8.Q3
Inserts implants according to SOP and/or manufacturer guidelines *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.2.9 IMPLANT REMOVAL

4.2.9.Q1
Removes implant according to SOP and/or manufacturer guidelines *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.2.10 SUPRAPUBIC MINILAPAROTOMY

Shown only: When “4.2.9” equals [NO]

4.2.10.Q1
Ensures that the client has been appropriately counseled and consented for the procedure *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.10.Q2
informs the client about what will happen before it happens and what she can expect to feel *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.10.Q3
Follows SOP for sedation and analgesia *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.10.Q4
Follows SOP for minilaparotomy procedure *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.10.Q5
Follow-post operative protocols *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.2.11 VASECTOMY

Shown only: When “4.2.10” equals [NO]

4.2.11.Q1
Ensures that the client has been appropriately counseled and consented for the procedure *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.11.Q2
informs the client about what will happen before it happens and what he can expect to feel *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.11.Q3
Follows SOP for local anaesthesia *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.11.Q4
Follows SOP for vasectomy procedure *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.2.11.Q5
Follow-post operative protocols *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.3 CAC

Per provider

Complete as many sections as possible through direct observation. If no clients are available for observation, please simulate a) sections 4.3.1 and b) at least 1 clinical procedure. Please indicate whether the observation is with a client or a simulation using the dropdown box under each provider's name. The assessor should use the MA's SOPs to aid in completion of the observation. After the observation, give the provider feedback on criteria that were marked as "Insufficient". CLIENT CONSENT: I am observing your provider today as part of our quality of care monitoring. If you agree, I will observe the service your provider gives you today. I will not record your identity at any point (e.g. name, address, etc.). You are not required to agree to the observation - if you do not want to be part of the observation, this will not affect the service you are provided. Do you have any questions for me? Do you want to take part in the observation? SIMULATION: Please note that you should not perform any clinical procedures during a simulation - instead please ask the provider to role play what s/he would do with a real client.

Shown only: When “4.3.2” equals [NO]

4.3.1 General CAC Service Provision Principles

4.3.1.Q1
Confirm pregnancy if the client unsure *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.3.1.Q2
Determine gestational age (first day of LMP alone or in combination with physical exam or ultrasound) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.3.1.Q3
Provides information and counselling free from coercion *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.3.1.Q4
Provides information about abortion and post-abortion options available to the fullest extent of the law *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.3.1.Q5
Explains the post-abortion or abortion care services available (surgical, medical and self-care) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.3.1.Q6
Supports client to make an informed choice of method (surgical, medical, self-care) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.3.1.Q7
Explains the process comprehensively *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.3.1.Q8
Offers information on postabortion contraceptive options *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.3.1.Q9
Refers to antenatal care any client who decides to continue the pregnancy *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.3.2 Harm reduction model for severely restricted legal contexts

Shown only: When “4.3.3” equals [NO]

4.3.2.Q1
Counselling and information provided on the safest methods of abortion self-care (i.e. misoprostol) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.3.2.Q2
Post-abortion care (managment of complications, provision of contraception, other SRH services) is provided *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.3.3 Surgical Abortion or Surgical management for PAC or CAC including incomplete abortion

Shown only: When “4.3.4” equals [NO]

4.3.3.Q1
Ensures that the client has been appropriately counseled and consented for the procedure *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.3.3.Q2
Informs the client about what will happen before it happens and what she can expect to feel *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.3.3.Q3
Follows SOP for sedation and analgesia - See CCCG Chapter 5, page 189 Appendix 1: How to administer a paracervical block *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.3.3.Q4
Follows SOP for MVA - See CCCG Chapter 5, page 190 Appendix 2: How to perform vacuum aspiration *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.3.3.Q5
Follows SOP for dilatation and evacuation (D&E) - See CCCG Chapter 5, page 191-192: Appendix 3: How to perform dilatation and evacuation *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.3.3.Q6
Provides discharge instructions including signs of complications, follow-up visit, what to do in the event of an emergency *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.3.4 Medical Abortion or Medical management for PAC- including incomplete abortion and abortion self-care

Shown only: When “4.3.5” equals [NO]

4.3.4.Q1
Ensures that the client has been appropriately counseled and consented for the procedure *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.3.4.Q2
Follows SOP for medical abortion in-clinic or for home care (CCCGs Chapter 5, 3.2) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.3.4.Q3
Provides information on how to take the medication(s) correctly *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.3.4.Q4
Provide correct dosage and regimen of either misoprostol + mifepristone OR misoprostol alone *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.3.4.Q5
Gives choice of taking the medication at facility or at home (either all doses or second dose) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.3.4.Q6
Provides information including signs of complications including ongoing pregnancy, follow-up visit, and where to access help if necessary *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.3.4.Q7
Offers pain medication *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.3.4.Q8
Offers post-abortion follow-up (in clinic or remote ) *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.3.5 Immediate Post Abortion Care and Follow up

4.3.5.Q1
Provider follows-post operative SOPs *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.3.5.Q2
Informs what to expect in the coming days, when they can resume normal activity including sexual intercourse *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.3.5.Q3
Informs on signs of complications including ongoing pregnancy, and where to access help if necessary *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.3.5.Q4
Offers follow-up visit (in clinic or remote) *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.3.6 Contraceptive counselling for post-abortion clients

4.3.6.Q1
Ensure client understands that acceptance of a contraceptive method is not a precondition for abortion *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.3.6.Q2
For clients who choose to adopt contraception, provide it at the time of abortion (according to medical eligibility) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.3.6.Q3
Contraceptive method is provided as per SOP *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.4 STIs

Per provider

Complete as many sections as possible through direct observation. If no clients are available for observation, please simulate 4.4.1 and 4.4.3. Please indicate whether the observation is with a client or a simulation using the dropdown box under each provider's name. The assessor should use the MA's SOPs to aid in completion of the observation. After the observation, give the provider feedback on criteria that were marked as "Insufficient". CLIENT CONSENT: I am observing your provider today as part of our quality of care monitoring. If you agree, I will observe the service your provider gives you today. I will not record your identity at any point (e.g. name, address, etc.). You are not required to agree to the observation - if you do not want to be part of the observation, this will not affect the service you are provided. Do you have any questions for me? Do you want to take part in the observation? SIMULATION: Please note that you should not perform any clinical procedures during a simulation - instead please ask the provider to role play what s/he would do with a real client.

Shown only: When “4.4.2” equals [NO]

4.4.1 General STI Service Provision Principles

4.4.1.Q1
Asks about medical history, signs and symptoms of STIs *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.4.2 STI Testing

Shown only: When “4.4.4” equals [NO]

4.4.2.Q1
Performs appropriate physical exam *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.4.2.Q2
Informs client of option of STI self-testing (if available) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.4.2.Q3
Appropriate samples (blood or body fluids) taken for STI testing and diagnosis *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.4.3 Sharing results and post test counselling

4.4.3.Q1
Determines diagnosis consistent with syndromic or etiological (i.e. testing) diagnosis *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.4.3.Q2
Delivers diagnosis sensitively *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.4.3.Q3
Asks client if (s)he has questions about diagnosis *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.4.3.Q4
Explains suggested treatment regimen *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.4.3.Q5
Prescribes the appropriate antimicrobial treatment according to national protocols or follows WHO guidelines *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.4.3.Q6
Discusses recommended plan for follow-up *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.4.3.Q7
Explains the importance of contact tracing of sexual partner(s) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.4.3.Q8
Offers HIV testing services (counseling, testing or self-testing) *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.4.4 Contraceptive counselling for STI/RTI Clients

4.4.4.Q1
Explains condom use for dual protection to prevent STIs/ HIV/ pregnancy *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.4.4.Q2
Provider offers contraceptive counselling *
- Sufficient
- Insufficient
- Not Observed
- N/A

10.

4.5 HIV AIDS

Per provider

Complete as many sections as possible through direct observation. If no clients are available for observation, please simulate all sections. Please indicate whether the observation is with a client or a simulation using the dropdown box under each provider's name. The assessor should use the MA's SOPs to aid in completion of the observation. After the observation, give the provider feedback on criteria that were marked as "Insufficient". CLIENT CONSENT: I am observing your provider today as part of our quality of care monitoring. If you agree, I will observe the service your provider gives you today. I will not record your identity at any point (e.g. name, address, etc.). You are not required to agree to the observation - if you do not want to be part of the observation, this will not affect the service you are provided. Do you have any questions for me? Do you want to take part in the observation? SIMULATION: Please note that you should not perform any clinical procedures during a simulation - instead please ask the provider to role play what s/he would do with a real client.

Shown only: When “4.5.2” equals [NO]

4.5.1 Counseling for HIV testing clients

4.5.1.Q1
Follows pre-test counseling checklist (national protocol, if available) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.5.1.Q2
Informs client of option of HIV self-testing (if available) *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.5.2 HIV Testing Services Process

Shown only: When “4.5.3” equals [NO]

4.5.2.Q1
Provides HIV testing per SOP or manufacturer guidelines *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.5.3 Post-Test Counseling and Treatment

4.5.3.Q1
Relays results according to protocols *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.5.3.Q2
Post-test counseling and results are provided to all clients, regardless of the results *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.5.3.Q3
Provides post-exposure prophylaxis (PEP) as needed *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.5.3.Q4
Provides condoms as needed *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.5.3.Q5
Provides pre-exposure prophylaxis (PrEP) counselling as needed *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.5.3.Q6
Provider follows HIV SOP, including delivery of antiretrovirals (ARVs) for those who test positive for HIV or refers (site depending) and delivery of cotrimoxazole to all HIV patients as prophylaxis. *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.5.3.Q7
Discusses the importance of contact tracing of sexual partner(s) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.5.3.Q8
Offers STI testing services (counseling, testing and results disclosure) and appropriate management *
- Sufficient
- Insufficient
- Not Observed
- N/A

11.

4.6 Sexual Health

Per provider

Shown only: When “4.6.1” equals [NO]

4.6.1 Sexuality and Gender Support

4.6.1.Q1
Offers client- specific, non-directive and non-judgemental advice about sexuality, including sexual orientation, and pleasure *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.6.1.Q2
Uses inclusive language/reflects client's language *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.6.1.Q3
Asks about/discusses sexual dysfunction, possible causes and treatment *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.6.1.Q4
Addresses transgender clients with the name, pronouns and gender preferred by client *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.6.1.Q5
Discusses gender affirming care for transgender people considering it (hormone therapy and surgical treatment) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.6.1.Q6
Offers or refers for gender-affirming therapies for clients meeting criteria *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.6.1.Q7
Offers transgender clients needed SRH care (cervical/breast cancer screening, contraception, SGBV services, etc) *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.6.2 Menstrual Health

4.6.2.Q1
Explains puberty stages, normal signs and symptoms *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.6.2.Q2
Answers questions on menstrual hygeine and management *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.6.2.Q3
Provides relevant information on healthy menstrual hygeine and management *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.6.2.Q4
Treats or refers client for evaluation or management of menstrual disorder/disease *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.6.2.Q5
Explains proper use of sanitary pads, cups and tampons *
- Sufficient
- Insufficient
- Not Observed
- N/A

12.

4.7 Gynecology

Per provider

Complete as many sections as possible through direct observation. If no clients are available for observation, please simulate 4.7.1, 4.7.2, and 4.7.3. Please indicate whether the observation is with a client or a simulation using the dropdown box under each provider's name. The assessor should use the MA's SOPs to aid in completion of the observation. After the observation, give the provider feedback on criteria that were marked as "Insufficient". CLIENT CONSENT: I am observing your provider today as part of our quality of care monitoring. If you agree, I will observe the service your provider gives you today. I will not record your identity at any point (e.g. name, address, etc.). You are not required to agree to the observation - if you do not want to be part of the observation, this will not affect the service you are provided. Do you have any questions for me? Do you want to take part in the observation? SIMULATION: Please note that you should not perform any clinical procedures during a simulation - instead please ask the provider to role play what s/he would do with a real client.

4.7.1 Breast and Cervical Cancer Prevention/Screening (all clients)

Shown only: When “4.7.2” equals [NO]

4.7.1.Q1
Offers HPV vaccination to appropriate clients (where available) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.7.1.Q2
Administers HPV vaccination according to SOPs (where available/ appropriate) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.7.1.Q3
Informs the client about cervical and breast cancer screening options *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.7.2 Breast Cancer Screening

Shown only: When “4.7.3” equals [NO]

4.7.2.Q1
Follows breast cancer screening/physical exam SOP *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.7.2.Q2
Refers for treatment for suspected/confirmed breast cancer *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.7.3 Cervical Cancer Screening

Shown only: When “4.7.4” equals [NO]

4.7.3.Q1
Offers available cervical cancer screening options (pap smear, VIA/VILI or HPV testing) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.7.3.Q2
Informs client of option of HPV self-testing (if available) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.7.3.Q3
Provides cervical precancer treatment (with thermal ablation, cryotherapy or surgical methods, per local SOPs) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.7.3.Q4
Refers for treatment for cervical cancer or precancer (if unable to treat at SDP) *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.7.4 Fertility Care

Shown only: When “4.7.5” equals [NO]

4.7.4.Q1
Counselling on maximizing fertility provided *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.7.4.Q2
Offer services for infertility, fertility preservation (cancer treatment), and for same-sex / HIV discordant couples (where legal) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.7.4.Q3
Initiate investigation and management of infertility for both members of the couple *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.7.4.Q4
Referrals in place for higher level treatment (IVF, etc) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.7.4.Q5
Detailed medical history relevant to fertility conducted counselling *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.7.4.Q6
Provides client-specific nondirective advice about subfertility when subfertility suspected *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.7.4.Q7
Gives comprehensive information about subfertility services available (including for referral) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.7.4.Q8
Initial investigations conducted (e.g. blood tests, semen analysis) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.7.4.Q9
Management is offered with hormone/ ovulation induction, when indicated *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.7.4.Q10
Management with assisted conception, and surgical treatment provided or referred appropriately *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.7.4.Q11
Diagnostic - Performs any diagnostic imaging in relation to subfertility services, as indicated *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.7.4.Q12
Exam -Perfoms physical examination of the client (including visual inspection, palpation, auscultation and vital signs), to rule out abnormalities as causes of subfertility *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.7.5 Menopause Support

4.7.5.Q1
Informs the client about recognising the main symptoms of perimenopause and menopause *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.7.5.Q2
Offers treatment and/or management of bothersome symptoms of menopause *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.7.5.Q3
Informs the client on need for contraception until age 55 or until menopause is confirmed *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.7.5.Q4
Informs the client about how to maintain a satisfying, pleasurable sexual life with aging, and STI prevention *
- Sufficient
- Insufficient
- Not Observed
- N/A

13.

4.8 Obstetrics

Per provider

Complete as many sections as possible through direct observation. If no clients are available for observation, please simulate 4.8.1 and 4.8.2. Please indicate whether the observation is with a client or a simulation using the dropdown box under each provider's name. The assessor should use the MA's SOPs to aid in completion of the observation. After the observation, give the provider feedback on criteria that were marked as "Insufficient". CLIENT CONSENT: I am observing your provider today as part of our quality of care monitoring. If you agree, I will observe the service your provider gives you today. I will not record your identity at any point (e.g. name, address, etc.). You are not required to agree to the observation - if you do not want to be part of the observation, this will not affect the service you are provided. Do you have any questions for me? Do you want to take part in the observation? SIMULATION: Please note that you should not perform any clinical procedures during a simulation - instead please ask the provider to role play what s/he would do with a real client.

4.8.1 Confirmation of pregnancy

Shown only: When “4.8.2” equals [NO]

4.8.1.Q1
Confirms pregnancy and estimates gestational age/delivery date *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.8.2 Prenatal client care (all prenatal clients)

Shown only: When “4.8.3” equals [NO]

4.8.2.Q1
Follows recommended schedule of interventions for antenatal care (at least 8 scheduled visits, WHO/CCCG guidelines) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.8.2.Q2
Develops or reviews birth plan, giving consideration to any clinical changes or mobility difficulties, the appearance of warning signs, or changes in the client’s wishes *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.8.2.Q3
Assess (screen) for risk factors for high-risk pregnancy and refer appropriately for high level care *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.8.2.Q4
Gives nutritional advice and promotes healthy behaviors *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.8.2.Q5
Conducts routine tests recommended for stage of pregnancy (1. regular measurement of blood pressure, weight and presence of proteinuria 2. full blood count at 12, 26 and 36 weeks 3. midstream urine culture/gram stain at 12, 26, 34 weeks 4. HIV, syphilis testing at 12 weeks 5. screening for gestational diabetes (24-28 weeks) 6. screening for tobacco, alcohol and drug use at each visit 7. one ultrasound before 24 weeks to determine gestational age, detect fetal anomalies and multiple pregnancies) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.8.2.Q6
Conducts additional investigations/interventions as indicated (setting or risk factors) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.8.2.Q7
Discusses/ offers options for postnatal contraception *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.8.3 Labor and delivery

Shown only: When “4.8.4” equals [NO]

4.8.3.Q1
For all health centers (Basic EmONC): Providers follow BEmONC SOP including all SEVEN signal functions of basic EmONC: parenteral administration of antibiotics, parenteral anticonvulsants, parenteral uterotonics, manual removal of the placenta, removal of retained products of conception, assisted vaginal delivery, and neonatal resuscitation with a bag and mask *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.8.3.Q2
Establishes stage of labour (WHO Labour Care Guide) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.8.3.Q3
Management of normal labour for term pregnancies (WHO Labour Care Guide) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.8.3.Q4
Transfer clients with complications to CEmONC facility *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.8.3.Q5
For clients with HIV: Follows prevention or elimination of vertical transmission standard operating procedures (SOP) and/or referral pathway *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.8.4 Postnatal client care (all postnatal clients)

4.8.4.Q1
Observes client and baby with post-natal care for 24 hours after birth, observing for any warning signs *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.8.4.Q2
Assessed for vaginal bleeding, uterine contraction, fundal height, temperature, and heart rate (pulse) during the first 24 hours after birth *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.8.4.Q3
Refers newborns for further assessment and management if any warning signs are present *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.8.4.Q4
Breastfeeding and skin-to-skin contact initiated within the first hour after birth *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.8.4.Q5
Gives newborns 1 mg vitamin K intramuscularly after birth *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.8.4.Q6
Discharge from facility includes individualized package of care and follow-up, including contraceptive counselling/ services *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.8.4.Q7
Provides discharge card /Immunization card at the facility *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.8.4.Q8
Follow-up postnatal visits include: physical healing and function, breastfeeding, emotional well-being, and counselling on nutrition, hygeine and sex *
- Sufficient
- Insufficient
- Not Observed
- N/A

14.

4.9 SGBV

Per provider

Shown only: When “4.9.2” equals [NO]

4.9.1 SGBV service provision

4.9.1.Q1
Follows SGBV standard operating procedures (SOPs) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.9.1.Q2
Provides counselling using LIVES approach *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.9.1.Q3
Provides clinical care management *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.9.1.Q4
Provides forensic exam and collection [depending on legal setting] *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.9.1.Q5
Provides referral to outside SGBV services (e.g., legal, shelter, psychosocial, medical) *
- Sufficient
- Insufficient
- Not Observed
- N/A

4.9.2 FGM service provision

4.9.2.Q1
Provides consultation and first line counselling *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.9.2.Q2
Addresses FGM implications for survivors' sexual health (pain during sex, decreases in libido or refraining from the practice, etc) *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.9.2.Q3
Provides treatment for direct complications (vaginal tears, wound infections) and refers for more complicated cases *
- Sufficient
- Insufficient
- Not Observed
- N/A
4.9.2.Q4
Provider offers referal for relevant services (e.g. advanced psychological support, safe housing, further medical support, legal guidance) *
- Sufficient
- Insufficient
- Not Observed
- N/A

* denotes a required question. The asterisk and answer options on this page are for reference; you cannot enter answers here.