box Clinical mentorship quality assessment finding summary
Name of zone_____________
Date of CM quality assessment conducted 14/11/17---------- -15/11/17----- --------------------
Degolo HC wereilu HC QZPH Total summary
1 General information Finding Finding Finding Finding
Total # of providers who received basic
1.1 mentorship training at visited health facilities 05 01
1.2 # of functional mentors at visited HFs 01 0
1.2.1 MD 0 0
1.2.2 HO 0 0
1.2.3 BSC 0 01
1.2.4 Clinical nurse 01 0
1.2.5 Masters in HIV and tropical disease 0 0
1.2.6 Other specify 0 0
Facility Ownership and program
2 monitoring
# of Mentor HFs that assign similar mentor/s
2.1 for specific HFs 01 2
How much allocated time is utilized by 1 day
2,2 mentors (Average in day) 1day
# of facilities that work on identified gaps
2.3 after CM feedback Yes 1
# of facilities that have HIV program specific
2.4 PMT No/ No
2.5 was death audit conducted regularly Yes Yes
2.6 Was test kit audit conducted? Yss Yes
Assay1
Assay2
Assay3
Assay1
Assay2
Assay3
Assay1
Assay2
Assay3
Assay1
Assay2
Assay3
2.7 If yes for Q2.6
61 4 65 4 4 bo
2.7.1 # of total received test kit during the last 9 months box box 5 box box box x
2.7.2 Test conducted during the last 9 months 1415 17 17
2.7.3 Failed during the last 9 months 0 0 0 0 0
31 1
2.7.4 Available in Hand box box 2 box
3 Mentor/s involvement
3.1 # mentors involved during internal mentorship 01 01
3.2 # mentors involved during external mentorship 01 NA
4 Mentorship performance
# of internal Mentorship conducted in the budget
4.1 year(october2024 to June 2025) 4 out of 9 2out of 9
# of external mentorship planed in the budget year
4.2 3 NA
# of external Mentorship provided in the budget
4.3 year 1 NA
# of external Mentorship support received in the
4.4 budget year 4/4 4/4
Some times
Some times
Some times
Some times
Compliance of standard clinical mentorship
Always
Always
Always
Always
Never
Never
Never
Never
tools (please put "x" under always, sometimes
5 or never column as per the response)
5.1 Chart abstraction tool Yes
5.2 Preceptor check list Yes
5.3 CM feedback register Yes
Always
Always
Always
Always
Never
Never
Never
Never
Some
Some
Some
Some
times
times
times
times
6 Mentorship approaches used by mentors
6.1 Chart review √ √
6.2 one-on-one √ √
6.3 case discussion √ √
6.4 Didactic presentation √ √
Remar
k
(if Rem Rem Rem
7 Type of Feedback provision Yes No any) Yes No ark Yes No ark Yes No ark
7.1 Verbal Yes
7.2 written Yes
7.3 Both Yes
8 Mentorship feedback is provided to Remar Rem Rem Rem
Yes No k Yes No ark Yes No ark Yes No ark
8.1 Health facility head Yes Yes
8.2 Health facility providers Yes Yes
8.3 MDT member Yes Yes
8.4 ZHD/Town/Woreda health office Yes Yes
HFs with mentee who received preceptor checklist
9 score in the last 9 months 1 1
10 Service quality
10.1 Target test (please see at least two OPD)
10.1.1 # of visited OPD during the assessment 03 03
10.1.2 # of OPD that implement HIV targeted test 03 03
10.1.3 Total client seen at OPD in the last 1 months 1401 800
10.1.4 Eligible for HIV test 27 26
10.1.5 Tested for HIV 27 26
10.1.6 Test positive 0 0
10.1.7 Linked to care 0 0
Chart review finding (Please review at least 05
10.2 chart at each site)
10.2.1 # of charts that reviewed 5 5
# of chart with attached Family matrix and
10.2.1.2 updated 5 4
10.2.1.3 # contact elicited in family matrix 7 6
10.2.1.4 # of elicited contact who tested for HIV 7 4
10.2.1.5 # of clients eligible for CPT 00 0
10.2.1.6 # of clients who received CPT 0 0
10.3 AHD service of package
10.3.1 # Clients with AHD during the budget year 01 0
10.3.2 # of clients with CD4 count lessthan100 cell/ml 0 0
# of clients with CD4 count lessthan100 cell/ml
10.3.3 and CrAg test was done 0 0
10.3.4 # of clients with positive CrAg test 0 0
10.3.5 # of clients provided with FPT or treatment 0 0
# of TB screen positive clients among clients with
10.3.6 AHD 01 0
10.3.7 LF LAm done for clients with screen positive 12
# of Gene Xpert done for clients with screen
10.3.8 positive 05
# clients received TB treatment or TPT as per the
10.3.9 result/s 12
10.4 Other vital service
10.4.1 TPT coverage from TX-CURR in % 95% 88.2%
10.4.2 # of women on ART from 15 to49 year of age 341
10.4.3 Never screen for cervical ca 153 186
10.4.4 # VL test done during the reporting period 626 742
10.4.5 Resuppression rate 85% 85%
# of Second HVL result (after completed EAS)
10.4.6 02 0
# of clients with second HVL result who Switch to
10.4.7 next regimen 01 0
10.5 HEI monitoring status at visited sites
# of HEI who monitored with Growth monitoring
10.5.1 curve 13/13 5/7
10.5.2 # of HEI who received Dual ARV prophylaxis 13/13 7/7
10.5.3 # of HEI who received CPT provision 12/12 6/7
# of HEI who received DBS test done within 02
10.5.4 months of age 12/12 7/7
Best experience, challenges and
11 recommendation
Best experience (if any) that includes (Base line,
gaps/challenges, action taken to overcome the
11.1 gaps/challenges and current performance) No best experience No best experience
Work load , no
involvement of other
mentors, transport cost Work load, lack of
, lack of AHD register AHD
11.2 Please list out bottleneck for Mentorship program and low perdiem REGISTRATION
conducts mentorship
by schedule & giving
Please put your recommendation to improve orientation training for
Clinical
11.3 mentorship quality mentors. mentorship Training
NB=1. Functional mentor/s means, mentors who currently provide mentorship service
