Module A: A Scorecard For Monitoring And Evaluating Basic Water .

USAIDFROM THE AMERICAN PEOPLECriteria#Criteria Aaternal and Child/ Survival ProgramNotes and DefinitionsScoreNoYes6.1There are cleaning protocols and clearly describethe cleaning procedures for various wards andareas of the facility026.2The facility has a written cleaning schedule orcalendar that is updated and obviously used daily026.3The ward/room has a written summary of the rolesand responsibilities of the staff for cleaning026.4Patient beds are visibly clean026.5The 0.5% chlorine solution is available for use in theinstallation generated at the time of the visit036.6Cleaning materials (mops, detergent, bleach, etc.)are available026.7There are sufficient laundry services available towash and disinfect soiled linens026.8The cleaning staff report having received training oncleaning procedures in the last 24 months.026.9The facility staff report having received training oncleaning procedures in the last 24 months026.10Signs or posters are placed on walls or doorsreminding health workers to wash their hands atcritical times0210

USAIDFROM THE AMERICAN PEOPLECriteria#Criteria6.11The health care facility has an annual improvement/ management plan that includes WASH and/orinfection prevention action items Aaternal and Child/ Survival ProgramNotes and DefinitionsScoreNoYes03Total Score pointsTotal Points Possible 100 points70-79 points (Bronze)Official Certification Status (Circle Corresponding Status Level) 80-89 points (Silver)90-100 points (Gold)Recommendations for sharing annual certification results: It is important that certification results are shared with health carefacility staff and the public in order to maintain collective accountability and provide data for more informed decision-making.Suggested communication platforms for sharing annual certification results include radio, television, social media, Ministry ofHealth webpages and/or annual certificates that are posted in the health care facility.11

fltaternal and Child/ Survival ProgramModule B: A Scorecard for Monitoring and Evaluating Basic Water, Sanitation, Hygiene andInfection Prevention Standards in Labour & Delivery Rooms in NigeriaScorecard Purpose: Maintaining a basic level of cleanliness and infection prevention readiness is a pre-requisite to providingquality health care services. Newborns are especially vulnerable to infection during labour & delivery. This scorecard wasdeveloped using existing and emerging global and national standards for water, sanitation, hygiene (WASH) and infectionprevention in health care environments. The scorecard is meant to serve as a quality improvement, monitoring and evaluationtool. The scorecard consolidates lengthy guidelines and condense them into one useful monitoring and evaluation tool foruse among various stakeholders within the health system. The scorecard should be used for informal quarterly (or semiannual) monitoring visits, annual evaluation/certification visits, and routine supportive supervision visits.While this observational scorecard includes assessment information on the presence of critical WASH and infection preventioninfrastructure and supplies within a labour & delivery rooms, it does not evaluate the proper management and use (behavior)of the infrastructure and supplies assessed. Therefore, it is recommended that this tool be used in conjunction with otherinterventions to ensure consistent compliance with proper WASH and infection prevention behaviors among health care facilitystaff (clinical and non-clinical), patients and visitors. Other interventions may include (but are not limited to): Making improvements to infrastructure access and placementTraining health care facility staff (health workers and non-healthcare staff) on standards, roles and responsibilitiesImplementing systems of personal and collective responsibility and motivationEnsuring the presence of conveniently placed reminders to comply with proper hygiene and infection preventionproceduresScorecard Content: This scorecard lists various WASH and infection prevention criteria needed to achieve and maintain abasic level of cleanliness & infection prevention for mothers and newborns. The scorecard is divided into four sections, totally100 points:1. Descriptive Questions2. Labour (42 possible points)3. Delivery (43 possible points)1

fltaternal and Child/ Survival Program4. Cleaning & Administration for Labour and Delivery (15 possible points)Scorecard criteria apply to any health care facility where labour and delivery occur, regardless of facility level (primary,secondary, tertiary) or facility type (public, private, mission, etc.).Clean Clinic Certification Levels: Using the scorecard, local or state governments can assess facility infection preventionreadiness in a standardized fashion. Facilities should always be assessed with unannounced visits. Health care facility canattain various “cleanliness” certifications. Each certification is valid for one year or until an official government, certificationvisit is conducted. The three levels of certification are: A facility achieving a score of 70 – 79 points achieves a BRONZE certificationA facility achieving a score of 80-89 points achieves a SILVER certificationA facility achieving a score of 90-100 points achieves a GOLD certification.Recommended Scorecard Use for Various Health System Stakeholders: Healthcare and non-healthcare facility staff: This scorecard can be used by individual staff members within a healthfacility to understand the expectations of maintaining a basic level of infection prevention readiness within their ward.Staff members can use the scorecard to maintain awareness of their ward’s current infection prevention readinessstatus, identify needed improvements and prioritize improvements based on the weight of each criteria. Staff memberscan also use their familiarization with scorecard criteria to ensure compliance with basic WASH and infection preventionpractices among themselves and their colleagues, as well as patients and visitors. Ward supervisors, infection prevention and control committees, and Health Care Facility Administrators: This scorecardcan be used by health care facility leaders to continually monitor ward readiness status, identify gaps, prioritizeimprovements and shift or mobilize resources to improve and maintain a basic level of infection prevention readiness.The scorecards can also serve as a supporting tool in monitoring staff, patient and visitor compliance with basic hygieneand infection prevention practices. Local, State and Federal governments: This scorecard can be used by health system leaders to systematically collectconsistent, useful data for decision-making. Using the scorecard on a routine (annual or semi-annual basis) allows2

fltaternal and Child/ Survival Programhealth system leadership to assess facility IP readiness, reward high performing facilities and staff members, allocateresources to facilities in need and collect consistent data to assess risk in the event of a disease outbreak or naturaldisaster.Scoring Overview: This Scorecard consists of four sections1.2.3.4.Descriptive QuestionsLabour (42 possible points)Delivery (43 possible points)Cleaning & Administration for Labour and Delivery (15 possible points)Within each section is a list of basic WASH and infection prevention criteria. Each criteria is assigned a specific score. Thescorecard criteria apply to any health care facility where labour and delivery occur, regardless of facility level (primary,secondary, tertiary) or facility type (public, private, mission, etc.).This scorecard examines the spaces where labour & delivery occur. Sometimes labour & delivery occur in the samespace/room, while in other health care facilities they occur in different spaces/rooms. If labour &delivery occur in separatespaces/rooms, please complete Section 1: Labour portion of the scorecard in the space/room where labour commonlyoccurs, and complete Section 2: Delivery in the space/room where delivery commonly occurs. If labour and deliverycommonly occur in the same space/room, please assess the room/space twice – once using Section 1: Labour criteria anda second time using Section 2: Delivery criteria.Scoring Instructions:1. Read each criteria and mark the appropriate score by circling the score earned. If notes are provided for specificcriteria, review the notes before marking the score.2. If the criteria is met, the facility being assessed will be awarded the corresponding score (noted by circling thenumber in the “yes” column). If the criteria is not met, the ward being assessed will be awarded a score of “0” (notedby circling the number in the “no” column). No partial points are given.3

USAIDFROM THE AMERICAN PEOPLE fttaternal and Child/ Survival Program3. After Sections 1 and 2 are completed, please assess the labour & delivery room collectively using the Section 3:Cleaning and Administration for the Delivery Room.4. Upon assessing all of the criteria within the scorecard, the evaluator should added up the points earned for all threesections and note the final score in the last row of the scorecard.A Scorecard for Monitoring and Evaluating Basic Water, Sanitation, Hygiene and InfectionPrevention Standards in Labour and Delivery RoomsSection 1: Descriptive Questions:Question#Question:Response:1.1Date of Survey:1.2Enumerator Name:1.3Facility Name:1.4Facility Level (primary, secondary or tertiary):PrimarySecondary1.5Facility type (public, mission, private):PublicMission1.6State in which the health facility is located:Ebonyi StateKogi State1.7Within this facility, labour and delivery commonlyoccur:Within the same room4In separate roomsTertiaryPrivate

USAIDFROM THE AMERICAN PEOPLE fttaternal and Child/ Survival ProgramSection 2: Scorecard for Labour Room/SpaceScoreCriteria #CriteriaNotes and DefinitionsNoYes03Note: water purificationsupplies are expected to bepresent regardless of whetheran improved water source ison site (unless the facilityreceives municipal water thatcontains residual chlorine)01Improved Toilet Facilitiesinclude: Piped toilet systems Septic tank systems Pour-flush systems Latrine Latrines with animpermeable, cleanableflooring surface (cement,tile, plastic)032.1 Water2.1.12.2.2Water is available within the labour ward at the time ofvisit, either through a piped system, or in the form ofstored water with tap (like veronica bucket with tap)Supplies needed to purify drinking water (either acertified filter, Water guard sachets, or boiling supplies)are available at the time of visit OR packaged water(bottled or sachet) is available in the ward at the timeof visit2.2 Sanitation2.2.1The labour ward has an improved toilet or latrine thatis functional at the time of the visit and dedicated foruse only by women who are in labour5

USAIDFROM THE AMERICAN PEOPLE fttaternal and Child/ Survival ProgramScoreCriteria #2.2.22.2.32.2.42.2.52.2.6CriteriaNotes and DefinitionsThe toilet facility commonly used by mothers(regardless of whether it is dedicated to labour &delivery ward) is accessible for women with limitedmobility (such as women who are in labour or whorecently gave birth)The toilet facility commonly used by mothers(regardless of whether it is dedicated to the labour &delivery) has a handwashing station with soap andwater present at the time of survey.Accessible: with sufficient areaand adequate devices forsupport and mobilization andfree from obstacles(if there are no toilet facilities,record a "0")(if there are no toilet facilities,record a "0"). Thehandwashing station shouldbe located within the toiletstall or immediately outsidethe stall.The toilet facility commonly used by mothers(regardless of whether it is dedicated to the labour &(if there are no toilet facilities,delivery ward) has a waste disposal bin in the toilet stall record a "0")to manage menstrual hygiene and menstrual wasteRemoved dust, dirt and noThe toilet facility common used by mothers (regardlessodorsof whether it is dedicated to labour & delivery room) is(if there are no toilet facilities,generally cleanrecord a "0")The toilet facility commonly used by mothers(regardless of whether it is dedicated to labour &(if there are no toilet facilities,delivery room) provides adequate privacy for the user,record a "0")including functioning doors with functional locks andimpermeable walls that provide privacy6NoYes0103010101

USAIDFROM THE AMERICAN PEOPLE fttaternal and Child/ Survival ProgramScoreCriteria #CriteriaNotes and Definitions2.3.1At least one sink (or handwashing station) with flowingwater and soap (or alcohol-based hand sanitizer) isavailable within the labour room. The handwashingstation has a water receptacle or drainage system tocollect/drain flowing water.Either a sink/handwashingstation with soap & water mustbe present OR alcohol-basedsanitizer (not stored on aperson) must be present withinthe ward2.3.2A stock of disposable hand drying materials (towels ortissues) is available within each ward /space at the timeof the surveyNoYes0501012.3 Hygiene2.4 Infection Prevention2.4.1Beds for patients are separated by a distance of 2meters from the edge or one bed to the nearest pointof the next bedNo two beds should be closerthan 2 meters from oneanother. This criteria includesthe space between beds (sideby side) and the space fromend to end (across the aisle)2.4.2If the space within the ward does not allow for 2mdistance between beds/cots, a maximum amount ofspace between beds exists within the room.Using a another bed inbetween02A stock of sterile gloves is available in the labour roomat the time of the surveyTo be considered sterile,gloves must be stored inoriginal containers andpackaging and labeled assterile gloves042.4.37

USAIDFROM THE AMERICAN PEOPLE fttaternal and Child/ Survival ProgramScoreCriteria #CriteriaNotes and Definitions2.4.4A stock of sterile or high-level disinfected gauze or(cotton/wool swab) is available in the room at the timeof the survey2.4.5The bed (or bed covers) are made of waterproofmaterials2.4.6The beds are visibly cleanTo be considered sterile,gauze must be stored inoriginal packaging andlabeled as sterile. To beconsidered disinfected, thegauze must have beenautoclaved and be stored in ahigh-level disinfectioncontainerMaterials that are waterproof(such as vinyl, plastic, nylon,polyurethane) must be used asthe mattress material ormattress cover materialNoYes020201020101012.5 Shower/bathing2.5.12.5.22.5.32.5.4There is a functional shower or bathing area (withwater)The shower/bathing facility is a dedicated facility onlyfor expecting mothers or those who recently deliveredAdequate drainage is available and no standing wateris present within the shower/bathing areaThe bathing area includes doors, partitions or screens,and functional locks for privacy8Functional is defined ashaving flowing water availableat the time of survey

USAIDFROM THE AMERICAN PEOPLE fttaternal and Child/ Survival ProgramScoreCriteria #2.5.5CriteriaNotes and DefinitionsThe path to the bathing area is easily accessible forpeople with limited mobility and free of obstaclesPath to the bathing area iswithout obstacles or elevationchanges (stairs). The bathingstall door is at least 80 cmwide and there is enoughspace for a companion toprovide assistance ifnecessary. The shower stallsare not used for storage andare free for bathing.NoYes012.6 Health Care Waste2.6.1The waste is segregated safely in at least three separatebins: one for general waste, one for infectious waste,and one for sharps waste022.6.2The waste containers are clearly labeled and/or colorcoded to communicate the type of waste they contain012.6.3Appropriate protective equipment (utility gloves, mask,If not all equipment is present,goggles, rubber boots) is available for staff to use whenassign a score of “0”transporting or disposing of hospital solid waste.01Total Score for Labour Ward9/ 42 points

USAIDFROM THE AMERICAN PEOPLE fttaternal and Child/ Survival ProgramSection 3: Scorecard for Delivery Room/Space3.1 Water in the delivery room/space3.1.1Water is available within the delivery room at the timeof visit, either through a piped system, or in the form ofstored water with tap (like veronica bucket with tap)0505013.2 Hygiene in the delivery room/space3.2.13.2.2At least one sink (or handwashing station) with flowingwater and soap and (or alcohol-based hand sanitizer)is available within the ward. The handwashing stationhas a water receptacle or drainage system tocollect/drain flowing water.A stock of disposable materials for hand drying (towelsor tissues) is available within each ward /space at thetime of the survey10

USAIDFROM THE AMERICAN PEOPLE fttaternal and Child/ Survival Program3.3 Infection Prevention3.3.1A stock of sterile or disinfected blades (or scissors) isavailable in the room at the time of the survey3.3.2a stock of sterile cord clamps (or sterile cord ties) isavailable in the room at the time of the survey (note: tobe awarded points, the observer must be able to verifythat the clamps/ties are sterile at time of survey)3.3.3A stock of sterile gloves is available in the room at thetime of the survey11To be awarded points, theobserver must be able toverify that the blades aresterile or disinfected at time ofsurvey. To be consideredsterile, blades must be sealedin sterile packaging. Forscissors and blades to beconsidered disinfected, theyshould have been disinfectedusing an autoclave or othermeans of disinfection. Fordisinfection, there must be adisinfection agent (likechlorine or alcohol) availablewithin the ward at the time ofsurveyTo be considered sterile, thecord clamps/ties must besealed in sterile packaging orsterilized using autoclave orother means of sterilizationTo be considered sterile,gloves must be stored inoriginal containers andpackaging and labeled assterile gloves040404

USAIDFROM THE AMERICAN PEOPLE3.3.4 fttaternal and Child/ Survival ProgramA stock of high level disinfected elbow length gloves isavailable in the room at the time of the survey3.3.5A stock of sterile or high-level disinfected gauze (orcotton/wool swab) is available in the room at the timeof the survey3.3.6Chlorhexidine gel for use on the umbilical cord isavailable in the ward/room at the time of visitTo be considered sterile,gauze must be stored inoriginal packaging andlabeled as sterile. To becons

Continuity, coverage, quality. Give a higher score to water quality, more than availability. Requires Ministry of Health water quality testing 0 : 3 : 2.6 ; Drinking water is stored safely in a clean tank or container with a lid and tap OR the piped water is of drinking water quality (suitable for human consumption) 0 : 1 : 2.7