Name of treatment .......................... |
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Technical factors |
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What level of training is required to provide the treatment? |
Low |
Medium |
High |
Can the treatment be provided only by a qualified health worker? |
Yes |
No |
Don't know |
Are special equipment, facilities or services required to provide the treatment? |
Yes |
No |
Don't know |
Is it easy for the person receiving the treatment to use it? |
Yes |
No |
Don't know |
Is the treatment effective only if it is taken in combination with others? |
Yes |
No |
Don't know |
Does the person using the treatment need the help of a skilled worker to use it? |
Yes |
No |
Don't know |
Would you start the treatment without being sure that you have enough supplies for as long as the treatment is necessary? |
Yes |
No |
Don't know |
Can the treatment be delivered easily to a large number of people? |
Yes |
No |
Don't know |
Financial factors |
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|
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What is the duration of the treatment? |
Short |
Medium |
Long |
What is the actual cost of the treatment? |
Low |
Medium |
High |
What are the other costs involved in the treatment (such as travel, food and necessary laboratory tests)? |
Low |
Medium |
High |
What are the costs involved in delivering the treatment to a sizeable number of people? |
Low |
Medium |
High |
Would you start providing the treatment if you didn't have enough money to pay for the full course? |
Yes |
No |
Don't know |
Social factors |
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How does the community view the treatment? |
Positive |
Negative |
Neutral |
What are the social implications for someone who goes for/uses the treatment? |
Positive |
Negative |
Neutral |
Is the treatment sensitive to the person seeking treatment? For example, can a sex worker access the treatment? |
Yes |
No |
Don't know |
Do cultural beliefs or practices have an impact on the treatment? |
Yes |
No |
Don't know |