Data Collection Form 3 allows collection of all the data needed from remote health facilities to calculate process indicators PR27 and 29 and outcome indicator OT1 (see page 46). The form should be filled in in each remote health facility.
Name of drug outlet: |
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Location: |
.............................................................................. |
Data collectors: |
.............................................................................. |
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Date of data collection: |
.............................................................................. |
1. Collecting data for process indicator PR27:
• Enter the ordering date and the delivery date over the past year for the main orders. Start with the last order for which drugs have been received.
• If there are fewer than 10 orders per year, enter all the orders for the year.
1
Main orders |
2
Ordering date |
3
Delivery date |
4
Lead time (in days) |
No. 1 |
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No. 7 |
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No. 8 |
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No. 9 |
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No. 10 |
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2. Collecting data for process indicator PR29 and outcome indicator OT1:
• Review all the available records at the health facility to complete the table on page 199. Note sources (e.g. stockcards) below.
• Calculate the number of days during which the 10 listed drugs were out of stock during each of the 12 months preceding the survey and put this number in the appropriate columns (from 2 to 13).
• Check if the 10 listed drugs are available on the visiting day and write "Yes" or "No" in column 15. You should fill in column 15, even in the absence of records, as you just have to check if drugs are available the day of your visit.
• Column 1 should be completed by the monitoring unit before the survey. The drugs included in this table are the ones which have been selected for the drug basket (an example of such a basket is provided in Chapter IV, page 59).
No. |
1
Drug’s name
(INN) |
2
Month |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
11 |
12 |
13 |
14 Number of days of stockout |
15
Drugs available on the visiting day |
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-12 |
-11 |
-10 |
-9 |
-8 |
-7 |
-6 |
-5 |
-4 |
-3 |
-2 |
-1 |
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