QUALITY OF HEALTH SERVICES AT 
THE SUB-DISTRICT AND COMMUNITY 
LEVELS
ENDLINE STUDY APPENDICES
July 30, 2019
This publication was produced for review by the United States Agency for International Development. It 
was prepared by Management Systems International, a Tetra Tech Company, and Mathematica.

Appendix B. Sampling, Data Collection, Analysis Approach, and Ethics 
Approval 
B.1. Sampling Approach for the Quantitative Survey
We used a sampling strategy in which districts were the primary sampling unit (PSU). Based on a sample 
frame of health facilities in Ghana received from GHS before the baseline, we identified 202 eligible 
districts in Ghana’s 10 regions. Districts are highly sui2 as PSUs because they represent well-defined 
clusters of health care facilities and are sufficiently numerous to permit us to draw a representative 
sample. We randomly sampled districts from each region, sampling 39 percent of districts in each of the 
five focal regions and 25 percent of districts in each of the five nonfocal regions. We used these 
proportions because they allowed us to meet our targeted sample size while accounting for 
oversampling in the focal regions. In addition, by proportional sampling within each type of region, we 
minimized the need for weighting for the five-focal-region estimates. The sampling yielded an average of 
8.4 districts per focal region (between 5 and 10 districts each) and an average of 5.0 districts per 
nonfocal region (between 3 and 7 districts each). Nationwide, our sample consisted of 67 districts 
(Table B.1). 
After we had a random sample of districts in each region, we randomly sampled three subdistricts from 
each district (districts contain about 4 subdistricts on average, varying between 1 and 10), resulting in a 
total sample of 188 subdistricts within the selected districts (Table B.1). We then targeted for the 
survey all health centers and community-level CHPS zones in each sampled subdistrict listed in our 
sample frame. Our sample resulted in 610 facilities (470 CHPS zones and 140 health centers), which is 
about 23 percent of the full number of 2,643 of these facilities across Ghana. Figure B.1 shows the 
locations of the sampled facilities.
TABLE B.1. TARGET SAMPLE AND RESPONSE NUMBERS
Region
Target sample Number of completed 
surveys at baseline
Number of completed 
surveys at endline
Districts
Subdistri
cts
Subdistri
cts / 
district 
CHPS
Health 
centers 
Total 
facilities
CHPS
Health 
centers
Total 
facilities
CHPS
Health 
centers
Total 
facilities
Central 8 21 2.6 67 17 84 58 17 75 66 18 84
Greater
Accra 5 15 3 41 7 48 41 7 48 39 7 46
Northern 10 28 2.8 49 16 65 47 18 65 44 21 65
Volta 10 30 3 74 34 108 70 34 104 72 36 108
Western 9 26 2.9 64 14 78 64 14 78 61 16 77
Ashanti 6 16 2.7 47 14 61 45 16 61 47 13 61
Brong Ahafo 6 13 2.2 31 11 42 30 12 42 28 14 42
Eastern 7 21 3 52 13 65 52 13 65 51 14 65
Upper East 3 9 3 29 6 35 29 6 35 29 6 35
Upper West 3 9 3 16 8 24 16 8 24 16 8 34
TOTAL 67 188 2.8 470 140 610 451 146 597 453 153 607
Sources: Policy, Planning, Monitoring and Evaluation (PPME) Division of GHS provided the Evaluate team with the sample frame 
data pulled from DHIMS2.
Notes: Focal regions are highlighted in grey. The sample included one facility that converted from a health center to a 
polyclinic. This facility appears in the column for total surveys completed, but not in the columns for surveys completed at 
CHPS zones or health centers.
FIGURE B.1. MAP OF FOCAL REGION DISTRICTS 
The baseline data collection teams found the sample frame to be fairly accurate in the field, finding most 
facilities listed, and not finding many not listed. Some adjustments to the sample frame had to be made, 
however, including some health facilities listed in the frame that were closed down or did not exist, and 
others where CHPS zones had been upgraded to health centers. There also were two CHPS zones 
listed that were actually one zone. At endline, similar issues were encountered, including facilities that 
had been upgraded or downgraded, and a facility that had been converted to a polyclinic. Data collection 
at endline was extremely successful, with interviews at all facilities in the sample conducted, resulting in 
a response rate of 100 percent of targeted facilities. The endline survey also clarified that 108, or 24 
percent, of the CHPS zones did not have CHPS compounds. Therefore, the assigned CHOs operated 
from adjacent zones or health centers and provided services as outreach. Because these CHPS zones 
did not have permanent structures, and in line with CHPS policy, these zones used alternative facilities 
(such as churches, homes, or kiosks) when available, and access to extensive data and records often was 
lacking in these cases. 
B.2. Data Collection
Research team
The Evaluate team oversaw quantitative and qualitative data collections for all three data collection 
rounds—baseline, midline, and endline. TNS, a local data collection firm subcontracted for this work, 
conducted the baseline data collection. DevtPlan Consult, another local data collection firm, conducted 
the midline and endline data collection. For the endline, DevtPlan was responsible for hiring experienced 
interviewers with backgrounds in health research for both quantitative and qualitative data collections, 
which were fielded simultaneously. The project team consisted of the project director, two field 
managers (one for the survey team and one for the qualitative team), seven supervisors, 24 enumerators 
for the survey, and six interviewers for the qualitative data collection. Most of the enumerators, 
interviewers, and supervisors and one of the field managers hired for the project had worked on the 
baseline evaluation under TNS; almost all staff worked on the midline study. Most staff have tertiary 
education, extensive experience in research data collection, and strong skills in survey administration in 
health and related social research. The six supervisors for the survey were retired senior employees of 
GHS with practical experience in health facilities across the nation. Their presence in the field was 
helpful in gaining entrance to health facilities and for guiding the interviewing teams. The enumerators 
were divided into six teams, and the qualitative interviewers made up a seventh team with one 
supervisor. The careful composition of the teams enhanced the assimilation of training materials and 
their understanding of the questionnaire, as well as accurate interviewing and efficient data collection.
Ethics committee approval and informed consent
Consent forms, a permission letter from the Director General of Health, and a letter from the Ethical 
Review Committee were provided and made available again to the endline teams. These documents are 
provided at the end of this appendix.
Training
For the endline data collections, all interviewers were trained in the survey or qualitative interview 
guides and relevant data collection protocols January 7 - 18, 2019. The trainings were facilitated by 
Mathematica and Evaluate staff.
The survey pilot was conducted on the fourth day of survey training in the Ewutu Senya District in the 
Central region and the Shai Osudoku District in the Greater Accra region. After a detailed debriefing, 
the survey was revised. Because the pilot was conducted using the programmed tablets, the pilot 
allowed for refining the programming as well. The qualitative team also piloted the interview guides on 
the fourth day of the qualitative training at Ga-Dangbe. After debriefing, all seven guides were revised 
based on our field experiences. 
Data collection, processing, management, and procedures
Endline data collection began on January 14, 2019, and was completed on February 2, 2019. The teams 
moved throughout the country in vehicles rented for the fieldwork period. Quantitative facility 
interview data were collected via computer-assisted personal interviewing (CAPI) using tablets 
programmed by MSI staff, and data were uploaded to the DevtPlan server daily, unless connectivity 
issues interfered. If so, data were uploaded as soon as possible. Paper questionnaires were provided to 
interviewers as backup in case issues with the tablets should prevent electronic data collection. 
Evaluate staff preceded the team into the field and facilitated the qualitative interviews by conducting 
introductory visits following entry protocol at the various district health directorates, and DA offices. 
These meetings were used to share midline findings with district health management teams and DA 
officers and explained the purpose of the endline study to them. These visits expedited entry of the 
qualitative data team and provided it with contact information and appointments that simplified data 
collection. 
The qualitative interviews were audio recorded in the field and copied from recorders to a laptop at the 
end of each day’s work. Using a Mi-Fi for internet connection, the audios were uploaded onto a 
DevtPlan server as often as was feasible. Backups of the recordings were stored on a pen drive. 
Recordings were translated into English (when necessary) and transcribed by a separate team of about 
10 freelance transcribers after being uploaded, concurrent with the data collection activity. Each 
qualitative team member had two audio recorders, so that one could serve as a backup. 
The DevtPlan team followed data-checking and -cleaning protocols and shared data with clients when 
complete. Mathematica identified minor issues, which DevtPlan addressed. The quantitative and 
qualitative data were provided to the Evaluate team who conducted qualitative coding. Mathematica 
conducted quantitative data coding and analysis, and all report writing.
Supervision plan and quality control 
All teams were visited in the field and monitored by DevtPlan staff. Evaluate staff also provided external 
monitoring on process and quality of work. Monitoring also made data collection easier by providing 
extra vehicle support for the teams who covered large geographic areas. Accompanying interviewers 
also offered the opportunity to provide additional training, if needed, to ensure data were valid and 
reliable. 
DevtPlan also has internal, independent quality control (QC) staff who report directly to DevtPlan 
management and discuss findings with field teams for redress. The QC team verified, by telephone the 
interviews conducted. No fraudulent data were identified, and most issues identified were minor 
(including omission and incorrect entries such as incomplete telephone numbers and incorrect 
respondent/facility names). Some of these issues were corrected in the field. 
B.3. Analysis Approach
Quantitative data 
Using the survey data, the analysis for this report seeks to describe the baseline and endline 
characteristics of the sample across key indicators for the group of five focal regions and the country as 
a whole, to estimate the changes for these indicators between baseline and endline, and to assess 
whether those differences are statistically significant (at the 1, 5, or 10 percent level of significance). 
The sample for each indicator is restricted to facilities that reported the indicator in both baseline and 
endline, to ensure a consistent sample over time and avoid comparing means between different samples. 
Without this restriction, the estimated changes over time could, in part, reflect changes in the sample 
from baseline to endline, in addition to true changes in the underlying indicator, making it difficult to 
interpret the estimates. For cases in which an indicator was measured in the endline but not in the 
baseline survey, or was measured in a noncomparable way in the baseline survey, the sample includes all 
facilities that reported the indicator at endline, and we present only the endline levels. (Where available, 
we also report midline levels for these indicators in Appendix E, restricted to the sample of facilities that 
reported the indicator at midline and endline.)
The quantitative data analysis accounted for the sampling design. The reported means have been 
weighted to account for different sampling probabilities, largely driven by different proportions of 
districts sampled in the focal and nonfocal regions.1 These weights ensure that the results are 
representative of all CHPS zones or health centers in the focal and nonfocal regions, as well as for all 
regions combined. The baseline and endline data were analyzed in Stata version 15 (StataCorp) using the 
appropriate “svy” set of commands to obtain the correct standard errors for the estimated differences, 
taking the sampling approach into account.
Qualitative data 
For the qualitative data, the Evaluate team used NVivo to code the qualitative transcripts by question 
number, which were matched to analytic categories, then summarized the data coded to each category. 
Mathematica staff analyzed the data by triangulating information from multiple sources and identifying 
major themes that emerged from the data related to the research questions. This analysis enabled us to 
develop a key set of qualitative findings that took into account similarities and differences in perspectives 
across different participant types, providing a comprehensive picture of concepts of interest and enabling 
us to address the key research questions.
 
1 There also was some variation in the number of subdistricts in each district, and some rounding approximations.
B.4. Ethics Committee Approval Process: Consent Form
Health Facility Information Sheet and Consent Form 
USAID/MSI Ghana Evaluate for Health Project: National Endline Study 
Introduction: Ghana’s current investments in health are notable and, in particular, have resulted in substantial 
reductions in child mortality and malnutrition and increases in life expectancy. However, Ghana continues to 
confront unmet need for both expanded access to quality services and strengthened national and community-based 
health systems (USAID/Ghana’s Country Development Cooperation Strategy). To meet these challenges, 
USAID/Ghana seeks to achieve the following improvements in the Ghanaian health system: 1) increased access to 
integrated health services, 2) expanded availability of community-based resources, 3) strengthened and responsive 
health systems, and 4) improved health sector governance and accountability. These improvements will contribute to 
progress toward the Country Development Cooperation Strategy's objective to achieve equitable improvements in 
health status in Ghana. 
Since 2014, the Evaluate for Health (Evaluate) project has been providing overall monitoring and evaluation support 
to USAID’s entire health portfolio in Ghana by establishing baselines, building monitoring and evaluation capacity 
of implementing partners (including Government of Ghana institutions), developing and implementing studies and 
evaluations, building the research capacity of Ghana’s research institutions, implementing operations research to 
respond to evolving empirical evidence or country circumstances, and assessing health portfolio performance data in 
order to guide continual program improvement. 
The aim of the endline facility assessment is to guide program implementation and early target setting. The endline 
data collection activities will: 1) Gather primary data from health care facilities and stakeholders with respect to the 
quality and equity of Ghana’s health services and care; 2) Document the health system’s quality assurance and 
quality improvement culture; 3) The proposed endline study will also provide insight into geographic and gender 
equity through sex-disaggregated data and sample coverage of most of the country. You and your health facility are 
being invited to participate in this assessment that will be conducted in CHPS Compounds and Health Centers in all 
the 10 regions of Ghana.The endline study will involve the application of quantitative and qualitative assessment 
methods and will focus on: Quality of Care and Services; Continuum of Care; Culture of Quality Assurance and 
Quality Improvement; Community support for CHPS; Health Insurance.
Recruitment and Participation: You have been contacted because your health facility is one of the selected health 
facilities for the USAID/MSI endline study. You will be asked questions about quality of care and services, 
continuum of care, culture of quality assurance and quality improvement, community support for CHPS and health 
insurance. You will also be required to support with exist interviews of clients whose permissions have been sorted 
and they have accepted to be interviewed.
Assessment Follow-ups: You and your health facility will be visited at the health facility by the assessment team 
for interviews and observations once. In instances where, the assessment team is unable to complete its work your 
facility, a follow up visit will be arrange with you and an appropriate date will be agreed with you for the 
completion of the assessment in its entirety in your facility.
What are the risks in participating in the assessment? There is minimal risk to you and your health facility if you 
and your health facility are part of the assessment. The assessment may take longer duration than envisage. 
Competent and experienced health professionals who make up the assessment team will ensure that any potential 
discomfort and uneasiness is well managed and minimized. 
What are the benefits of participating in the assessment? The endline study will be use to assess the performance 
of the USAID Health Portfolio. It will also inform the USAID Health Portfolio and could lead to the intensification 
of efforts in areas where short comings have been identified. Your health facility needs may also be uncovered and 
this lead to potential support to your health facility to improve upon health delivery services. There may not be 
additional direct benefits to you and or your health facility. However, you and health facility’s participation will help 
to improve health service delivery that may eventually be beneficial to the whole community that you serve and the 
entire country.
What if new information becomes available? During the course of the assessment, you will be informed of any 
findings that may affect your decision to allow yourself and/or your health facility to continue participating in this 
assessment in its entirety.
Will you and/or facility be compensated for participating in this assessment? If you happen to be off duty, you 
will be refunded for the cost of traveling to your health facility to purposely attend to the assessment team to ensure 
a successful assessment exercise.
How will my confidentiality and that of my facility be maintained? If you decide to participate in the assessment 
with your health facility, the assessment team will collect health services delivery information about your health 
workers and health facility as part of the assessment. People who work for or with the donor (USAID), and others 
like the independent ethics committee or the institutional review board (IEC/IRB) for the assessment, will have 
access to this information. They will check to see if the assessment is going on well and to ensure your rights are 
protected. All assessment team members that collect information from your facility will keep it confidential. All 
records and data about you and your facility will be kept in locked cabinets. 
Voluntary withdrawal from the study: You and your facility may withdraw from the study at any point in time 
during the duration of the study. You will not be required to give any reason for this action. However, information 
collected from you will be used as part of the study’s analysis.
What if I have questions about the assessment regarding me and my health facility rights as research 
participants? If you have any questions about this assessment, if there are things that you do not understand about 
the assessment or if any member of your facility is offended by the assessment team, contact: Dr. Godwin Afenyadu, 
Project Director of USAID/Ghana Evaluate for Health Project, on 233247003111 or gafenyadu@msi-ghana.com
and/or Emmanuel Mahama, Senior Evaluation Advisor of USAID/Ghana Evaluate for Health Project on 
0208933496 or emahama@msi-ghana.com. Both can be located at MSI-Ghana office on Number F25B/8 Abafun 
Crescent, Labone, Accra. If you have any questions about the entire endline study and the participants rights, please 
contact Hannah Frimpong, administrator of the GHS ethics review committee on 0302 681109 or 244 516482 
or Hannah.Frimpong@ghsmail.org
Statement of understanding: I consent for me and my facility to participate in this assessment. I confirm that I 
have read the statements in the informed consent form for this assessment. I have been given time and opportunity 
to read the information carefully (or, have had it read to me), to discuss it with others and to decide whether I will 
take part in this assessment. I have had the opportunity to ask questions about this assessment and my questions 
have been answered to my satisfaction. 
I understand the conditions and procedures and know what the possible risks and benefits are for me and my facility 
participating in this assessment written above. My participation as well as that of the facility are voluntary and I 
may decide to discontinue myself and my facility’s participation or to withdraw from the assessment at any time 
without penalty or loss of any benefits or treatment to which we are entitled. The assessment may be discontinued 
without my consent by the assessment team conducting the study or by the donor of the study. 
I hereby give my voluntary informed consent for me and my facility to participate. I understand that I/my facility do 
not give up any of our legal rights by signing this form. I will be given a copy of this informed consent form to keep 
for my own information throughout the assessment.
Name and Signature of Head of Facility/ Designated Health Worker Date 
Name and Signature of Interviewer Date 
ETHICS COMMITTEE APPROVAL PROCESS: LETTER FROM THE DIRECTOR 
GENERAL OF HEALTH 
Appendix C: Additional Tables 
Table A. Characteristics of respondents of the facility survey (percentage of facilities)
CHPS Health centers
Focal regions All regions Focal regions All regions
Job titlea
Community health officer (CHO) 26.6 30.0 4.4 2.2
Community health nurse or enrolled nurse 57.4 53.2 23.9 19.3
Midwife or public health nurse midwife 17.6 17.2 39.7 35.6
Medical or physician assistant in charge of the full facility 0.0 0.3 31.3 37.7
Health care assistant clinical 0.3 0.7 1.0 0.5
Other 7.0 6.2 19.2 16.9
Respondent has worked in his or her role at the facility for at least one year 80.4 80.7 84.9 84.5
Sample size 269 438 98 153
Source: Health, Population, and Nutrition Office Health Systems midline survey data.
a Because respondents could hold more than one job title, multiple responses were possible. Therefore, percentages sum to more than 100.
Table B. Focal and non-focal regions for USAID’s health investments in Ghana 
WESTERN CENTRAL
GREATER 
ACCRA
VOLTA NORTHERN EASTERN ASHANTI
BRONG￾AHAFO
UPPER 
EAST
UPPER 
WEST
1 RING (Global Communities)
2 Systems for Health (URC)
3 SPRING (JSI)
4 MalariaCare (PATH)
5 MCSP (JHPIEGO)
6 WASH for Health (Global Communities)
7 Communicate for Health (FHI360)
8 GHSC- PSM (CHEMONICS) 
9 Africa Indoor Residual Spraying (IRS) (Abt)
10
Ghana Information for Improves Health 
Performance (GIIHP) – Boston University 
11 Ghana Social Marketing Program (PSI)
12 HealthKeepers Network
13 Health Finance and Governance (Abt) 
14 People for Health (SEND)
15 PreMaND (NHRC- Navrongo)
16 RISK (WAPCAS)
17 Saving Maternity Homes (Banyan Global)
18
Sustaining Health Outcomes through 
Private Sector (SHOPS) (Abt)
19 United States Pharmacopeia (USP)
20 Strengthening the Care Continuum (JSI)
21 Vector Works/PMI (JHU)
 FOCAL REGIONS NON FOCAL REGIONS Key Midline Study IPs Other IPs
Implementing Partners 
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 1
APPENDIX D: COMPREHENSIVE ENDLINE TABLES
This appendix presents a comprehensive set of tables that show the baseline and endline 
levels of all key indicators measured in the HPNO Health Systems survey, as well as the average 
facility-level change from baseline to endline for each indicator and whether this is statistically 
distinguishable from zero. The appendix presents each table first for CHPS zones in panel A and 
then for Health Centers in panel B. All tables display estimates for the focal regions (including 
the Central, Greater Accra, Northern, Volta, and Western regions), the non-focal regions 
(including the Upper East, Upper West, Ashanti, Brong Ahafo, and Eastern regions), and all 
regions combined. The estimates are weighted using weights that adjust for sampling 
probabilities to ensure that the results are representative of all CHPS zones or Health Centers in 
the focal and non-focal regions, as well as for all regions combined. 
The sample for each indicator is restricted to facilities that reported the indicator in both 
baseline and endline to ensure a consistent sample over time and avoid comparing means 
between different samples. Without this restriction, the estimated changes over time could partly 
reflect changes in the sample from baseline to endline in addition to true changes in the 
underlying indicator, making it difficult to interpet the estimates. For those cases in which an 
indicator was measured in the endline but not in the baseline survey, or was measured in a non￾comparable way in the baseline survey, the sample includes all facilities that reported the 
indicator at endline and we present only the endline levels. 
Although all respondents were administered the same survey questions, the response rate to 
different questions varied at both baseline and endline. In addition, some questions were only 
applicable to a subset of respondents (for example, questions on births at a facility were only 
relevant to facilities that offered delivery services, in which case the sample restriction above 
implies that the analysis sample was restricted to facilities that offered these services at both 
baseline and endline). As a result, in most cases the size of the samples used for our analysis 
within a table will vary slightly; in order to simplify the way we display the information, we 
present sample size ranges in the tables. The endline survey includes some questions that were 
added at midline. For that subset of indicators, we present midline and endline results and 
differences in Appendix E because we are unable to show baseline results or baseline-endline 
differences for those indicators. 
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 1
TABLES FOR CHPS AND HEALTH CENTERS
I. HEALTH FACILITY CHARACTERISTICS 
TABLE 4. AVERAGE NUMBER OF CLIENTS
CHPS Health Centers
Focal 
regions
Non￾focal 
regions
All 
regions
Focal 
regions
Non￾focal 
regions
All regions
Average (mean) number of clients facility has seen in previous two months:
At outpatient department 179.9 151.7 164.4 935.5 1229.5 1085.5
By the midwife 45.8 25.5 34.5 241.3 178.9 209.5
For family planning 48.8 44.6 46.5 161.0 138.1 149.3
Who were children 375.1 277.8 321.2 751.0 659.1 704.5
At prevention of mother-to-child transmission of HIV 
and early infant diagnosis unit 16.9 5.1 10.4 53.6 35.3 44.4
At adolescent health and development center 9.3 9.7 9.5 28.5 63.5 46.6
At nutritional rehabilitation center 8.2 26.4 18.4 7.9 130.5 70.4
Median number of clients facility has seen in previous two months:
At outpatient department 133.0 70.0 100.0 628.0 952.0 819.0
By the midwife 24.0 3.0 12.0 159.0 115.0 143.0
For family planning 32.0 32.0 32.0 80.0 84.0 82.0
Who were children 310.0 250.0 267.0 601.0 445.0 527.0
At prevention of mother-to-child transmission of HIV 
and early infant diagnosis unit 6.0 0.0 0.0 38.0 27.0 31.0
At ddolescent health and development center 0.0 0.0 0.0 5.0 20.0 12.0
At nutritional rehabilitation center 0.0 0.0 0.0 0.0 0.0 0.0
Sample size 255-267 166-171 421-438 95-98 53-55 150-153
Source: Health, Population, and Nutrition Office Health Systems endline survey data
Note: Means and medians are weighted to adjust for sampling probabilities. 
Sample sizes are reported as ranges because variables have different response rates.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 2
III. QUALITY OF CARE AND SERVICES
B. Integration of Care: Referrals and Follow-Up Care
TABLE 5A. REFERRALS OUT OF AND INTO A FACILITY AMONG CHPS
(PERCENTAGE OF FACILITIES, UNLESS OTHERWISE INDICATED) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Percentage of facilities with referral records, among facilities that referred clients in the last two months:
Records exist and seen 49.3 48.7 -0.6 52.7 42.3 -10.4** 51.1 45.2 -5.9*
Records exist, but not seen 10.7 5.7 -5.0** 5.1 2.5 -2.6 7.6 4.0 -3.7***
No records 40.1 45.6 5.6 42.2 55.2 13.0** 41.2 50.8 9.6***
Sample size 265 164 429
Percentage of facilities with referral record for the most recent referral, among facilities with referral records:
Record exists and seen 44.2 48.2 4.0 47.5 41.1 -6.4 46.0 44.3 -1.7
Record exists, but not seen 8.4 4.3 -4.1** 4.4 3.1 -1.2 6.2 3.7 -2.5**
No record 47.4 47.5 0.1 48.1 55.7 7.6* 47.8 52.0 4.2
Sample size 264 164 428
Referrals in previous two months:
Average percentage of all clients seen who were 
referred out of the facility
4.6 8.1 3.5 4.6 5.4 0.8 4.6 6.7 2.1*
Average percentage of clients who were referred 
out who returned with feedback notes, among 
facilities that referred clients out
21.5 37.4 15.8*** 29.6 29.7 0.1 25.6 33.6 8.0
Sample size 117-176 57-96 174-272
Source: Health, Population, and Nutrition Office Portfolio Health Systems baseline and endline survey data 
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates and because some variables apply to different subsets of respondents.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 3
TABLE 5B. REFERRALS OUT OF AND INTO THE FACILITY AMONG HCS 
(PERCENTAGE OF HCS, UNLESS OTHERWISE INDICATED) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Percentage of facilities with referral records, among facilities that referred clients in the last two months:
Records exist and seen 73.9 80.5 6.7 93.7 90.5 -3.1 84.0 85.6 1.7
Records exist, but not seen 13.3 8.4 -5.0 0.0 1.2 1.2 6.5 4.7 -1.8
No records 12.8 11.1 -1.7 6.3 8.2 1.9 9.5 9.6 0.1
Sample size 98 55 153
Percentage of facilities with referral record for the most recent referral, among facilities with referral records:
Record exists and seen 72.1 81.5 9.4* 91.0 90.5 -0.5 81.8 86.1 4.4
Record exists, but not seen 11.8 6.6 -5.2 2.6 1.2 -1.4 7.1 3.9 -3.3
No record 16.1 11.9 -4.2 6.3 8.2 1.9 11.1 10.0 -1.1
Sample size 98 55 153
Referrals in previous two months:
Average percentage of all clients seen who were 
referred out of the facility
10.9 13.9 3.1** 18.2 18.8 0.6 14.7 16.5 1.8
Average percentage of all clients seen who were 
referred into the facility†
n.a. 0.2 n.a. n.a. 0.4 n.a. n.a. 0.3 n.a.
Sample size 85 50 135
Source: Health, Population, and Nutrition Office Portfolio Health Systems baseline and endline survey data 
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
n.a. = not applicable (question not asked at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 4
TABLE 5.1A. COMMON REASONS FOR REFERRALS AMONG CHPS
(PERCENTAGE, AMONG CHPS CONDUCTING REFERRALS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Common reasons for referrals out of the facility in the previous two months, as documented among facilities conducting referrals:a
Malaria or severe malaria 45.6 50.8 5.2 47.7 65.6 17.9** 46.6 58.3 11.7**
Pregnancy-related complications 35.9 49.7 13.7*** 55.9 51.2 -4.7 46.1 50.5 4.4
Anemia 29.5 28.0 -1.5 25.4 31.4 6.0 27.4 29.7 2.3
Hypertension 14.2 21.8 7.6* 19.6 21.3 1.7 17.0 21.5 4.6
Accidents and injuries, such as 
snake bites, burns, and cuts
13.2 17.1 3.8 15.4 18.8 3.3 14.3 17.9 3.6
Skin diseases and ulcers 6.0 12.6 6.5* 15.5 17.6 2.1 10.8 15.1 4.3
Diarrhea 13.9 6.7 -7.2** 13.3 1.5 -11.7** 13.6 4.1 -9.5***
Pneumonia 4.5 5.0 0.5 5.7 3.4 -2.3 5.2 4.2 -1.0
Acute malnutrition† n.a. 5.0 n.a. n.a. 13.4 n.a. n.a. 9.4 n.a.
Diabetes† n.a. 3.9 n.a. n.a. 2.9 n.a. n.a. 3.4 n.a.
Upper respiratory tract infection 1.9 2.1 0.2 3.0 6.2 3.2 2.5 4.2 1.7
Stroke 1.2 1.9 0.7 2.3 0.0 -2.3 1.8 0.9 -0.8
Ear infection 2.3 1.7 -0.6 2.1 1.2 -0.9 2.2 1.4 -0.8
Typhoid 0.8 1.7 0.8 0.0 0.0 0.0 0.4 0.8 0.4
Intestinal worms 0.0 0.8 0.8 0.0 0.0 0.0 0.0 0.4 0.4
Cholera 4.2 0.0 -4.2** 1.5 0.0 -1.5 2.8 0.0 -2.8**
Rheumatism 0.0 0.0 0.0 0.0 3.7 3.7 0.0 1.9 1.9
Other† n.a. b 30.6 n.a. b n.a. b 36.7 n.a.b n.a. b 33.8 n.a.b
Sample sizec 119-172 60-93 179-265
Source: Health, Population, and Nutrition Office Portfolio Health Systems baseline and endline survey data 
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
a Because multiple responses were possible, percentages sum to more than 100.
b The “Other” category is not strictly comparable between baseline and endline because the former included “acute malnutrition” and “diabetes” and the latter had them as 
separate categories. Therefore, the baseline-endline difference was not assessed. 
c Sample sizes are reported as ranges because variables have different response rates.
n.a. = not applicable (question not asked at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 5
TABLE 5.1B. COMMON REASONS FOR REFERRALS AMONG HCS (PERCENTAGE, AMONG HCS CONDUCTING 
REFERRALS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Common reasons for referrals out of the facility in the previous two months, as documented among facilities conducting referrals:a
Pregnancy-related complications 43.6 69.0 25.4*** 63.4 84.1 20.7** 54.0 76.9 23.0***
Malaria or severe malaria 52.6 54.6 2.0 55.2 72.5 17.3* 54.0 63.9 10.0*
Anemia 56.9 47.6 -9.2 45.2 53.6 8.5 50.8 50.7 0.0
Accidents and injuries, such as 
snake bites, burns, and cuts
26.1 38.7 12.6** 40.0 47.7 7.7 33.3 43.4 10.1**
Hypertension 23.5 32.6 9.1 40.1 37.3 -2.8 32.2 35.1 2.8
Diabetes† n.a. 14.6 n.a. n.a. 17.2 n.a. n.a. 15.9 n.a.
Pneumonia 7.1 14.2 7.0 16.2 20.2 3.9 11.8 17.2 5.4
Stroke 0.0 9.7 9.7*** 12.4 4.6 -7.8 6.3 7.1 0.7
Upper respiratory tract infection 9.1 8.6 -0.4 13.8 13.4 -0.4 11.5 11.1 -0.4
Acute malnutrition† n.a. 2.5 n.a. n.a. 15.9 n.a. n.a. 9.4 n.a.
Skin diseases and ulcers 2.9 2.3 -0.7 22.0 12.0 -10.0 12.7 7.3 -5.4
Ear infection 4.7 1.9 -2.8 8.0 3.2 -4.8 6.4 2.6 -3.8
Rheumatism 0.0 1.3 1.3 5.3 0.0 -5.3 2.7 0.6 -2.1
Cholera 3.2 1.2 -1.9 0.0 0.0 0.0 1.5 0.6 -0.9
Diarrhea 11.4 1.0 -10.4*** 8.8 6.9 -1.9 10.0 4.1 -6.0**
Typhoid 1.9 1.0 -1.0 10.3 0.0 -10.3 6.2 0.5 -5.8*
Intestinal worms 0.0 1.0 1.0 0.0 3.2 3.2 0.0 2.1 2.1
Other† n.a. 47.2 n.a. n.a. 56.0 n.a. n.a. 51.8 n.a.
Sample size 75-86 43-50 119-136
Common reasons for referrals into the facility in the previous two months, among facilities receiving referrals:a
Malaria or severe malaria 49.1 62.8 13.8 39.1 58.5 19.4 42.5 59.9 17.5
Accidents and injuries, such as 
snake bites, burns, and cuts
26.8 46.3 19.5 19.4 44.5 25.1 21.9 45.1 23.2
Pregnancy-related complications 21.0 37.0 16.0 49.5 37.6 -11.9 39.8 37.4 -2.5
Anemia 16.5 21.0 4.5 0.0 51.9 51.9*** 5.6 41.4 35.8***
Upper respiratory tract infection 0.0 16.3 16.3** 10.2 10.2 0.0 6.8 12.2 5.5
Diarrhea 16.4 10.5 -5.9 14.1 27.7 13.6 14.9 21.9 7.0
Pneumonia 0.0 9.0 9.0 8.0 8.0 0.0 5.3 8.3 3.0
Cholera 4.5 6.0 1.5 12.5 8.0 -4.5 9.8 7.3 -2.5
Hypertension 15.0 5.9 -9.1 22.7 31.9 9.2 20.1 23.1 3.0
Acute malnutrition† n.a. -- c n.a. n.a. -- c n.a. n.a. -- c n.a.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 6
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Diabetes† n.a. -- c n.a. n.a. -- c n.a. n.a. -- c n.a.
Skin diseases and ulcers 0.0 0.0 0.0 17.6 5.7 -11.9 11.6 3.8 -7.9
Stroke† n.a. 0.0 n.a. n.a. 3.4 n.a. n.a. 2.0 n.a.
Ear infection 0.0 0.0 0.0 0.0 5.7 5.7 0.0 3.8 3.8
Rheumatism 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
Typhoid 6.0 0.0 -6.0 4.5 0.0 -4.5 5.0 0.0 -5.0
Intestinal worms 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
Other n.a. 33.2 n.a. b n.a. 30.3 n.a. b n.a. 31.5 n.a. b
Sample size 18-42 18-31 36-73
Source: Health, Population, and Nutrition Office Portfolio Health Systems baseline and endline survey data 
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates.
a Because multiple responses were possible, percentages sum to more than 100.
b The “Other” category is not strictly comparable between baseline and endline because the former included “acute malnutrition” and “diabetes” and the latter had them as 
separate categories. Therefore, the baseline-endline difference was not assessed. 
c Not reported because of small sample sizes (fewer than 10).
n.a. = not applicable (question not asked at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 7
C. Availability of Services 
TABLE 6A. AVAILABILITY OF MALARIA SERVICES AMONG CHPS (PERCENTAGE OF FACILITIES) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Malaria testing
Facility reported that all suspected cases of 
malaria were tested using RDT and/or microscopy 
in the last two months and the results were 
recorded in the register†
n.a. 65.9 n.a. n.a. 50.5 n.a. n.a. 57.4 n.a.
Sample size 265 169 434
Facility provided these reasons for not testing for malaria for every client with a provisional diagnosis of malaria, among facilities that did not test and record results for all 
clients with a provisional diagnosis:a
Insufficient supply of RDT† n.a. 77.8 n.a. n.a. 71.3 n.a. n.a. 74.1 n.a.
RDT/lab is not available at all times of the day 
and night†
n.a. 0.0 n.a. n.a. 14.2 n.a. n.a. 8.0 n.a.
Lack of skill in conducting RDT/microscopy† n.a. 0.0 n.a. n.a. 0.0 n.a. n.a. 0.0 n.a.
Other reasons† n.a. 31.5 n.a. n.a. 52.7 n.a. n.a. 43.5 n.a.
Sample size 22 14 36
Malaria treatment
Facility has at least one staff member providing 
treatment for malaria
85.4 81.7 -3.7* 75.9 73.8 -2.1 80.2 77.3 -2.8
Facility adhered to GHS protocol for malaria 
treatment in two previous monthsb†
n.a. 63.3 n.a. n.a. 45.5 n.a. n.a. 53.5 n.a.
Sample size 265-268 168-171 433-439
Source: Health, Population, and Nutrition Office Portfolio Health Systems baseline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * 
statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates and because some variables apply to different subsets of respondents.
a Because multiple responses were possible, percentages may sum to more than 100.
b Defined as testing all cases with provisional diagnosis of malaria and recording the treatment for all positive cases.
n.a. = not applicable (question not asked at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 8
TABLE 6B. AVAILABILITY OF MALARIA SERVICES AMONG HCS (PERCENTAGE OF HCS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Malaria testing
Facility reported that all suspected cases of 
malaria were tested using RDT and/or microscopy 
in the last two months and the results were 
recorded in the register†
n.a. 76.8 n.a. n.a. 57.6 n.a. n.a. 67.1 n.a.
Sample size 97 54 151
Facility provided these reasons for not testing for malaria for every client with a provisional diagnosis of malaria, among facilities that did not test and record results for all 
clients with a provisional diagnosis:a
Insufficient supply of RDT† n.a. 51.9 n.a. n.a. 71.3 n.a. n.a. 63.8 n.a.
RDT/lab is not available at all times of the day 
and night†
n.a. 11.5 n.a. n.a. 31.6 n.a. n.a. 23.8 n.a.
Lack of skill in conducting RDT/microscopy† n.a. 0.0 n.a. n.a. 0.0 n.a. n.a. 0.0 n.a.
Other reasons† n.a. 63.5 n.a. n.a. 37.7 n.a. n.a. 47.7 n.a.
Sample size 13 11 24
Malaria treatment
Facility has at least one staff member providing 
treatment for malaria
100.0 100.0 0.0 98.1 98.6 0.4 99.0 99.3 0.2
Facility adhered to GHS protocol for malaria 
treatment in two previous monthsb†
n.a. 74.1 n.a. n.a. 57.5 n.a. n.a. 65.7 n.a.
Sample size 96-97 53-55 149-152
Source: Health, Population, and Nutrition Office Portfolio Health Systems baseline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates and because some variables apply to different subsets of respondents.
a Because multiple responses were possible, percentages may sum to more than 100.
b Defined as testing all cases with provisional diagnosis of malaria and recording the treatment for all positive cases.
n.a. = not applicable (question not asked at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 9
TABLE 7A. AVAILABILITY OF FAMILY PLANNING COUNSELING AND CONTRACEPTIVES AMONG CHPS 
(PERCENTAGE OF CHPS, UNLESS OTHERWISE INDICATED)
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Family planning services offered:
Family planning counseling only 14.9 2.0 -12.9*** 5.8 1.0 -4.8*** 9.8 1.4 -8.4***
Contraceptives only 2.7 0.0 -2.7** 0.9 0.4 -0.5 1.7 0.2 -1.5**
Both 79.6 96.4 16.8*** 88.0 96.1 8.2** 84.2 96.3 12.0***
Neither 2.8 1.6 -1.2 5.4 2.4 -2.9 4.2 2.1 -2.2*
Sample size 269 171 440
Facility can provide long-acting 
methods of contraception on day of 
interview, among those with control 
cards for those methodsa†
n.a. 99.6 n.a. n.a. 99.5 n.a. n.a. 99.5 n.a.
Facility can provide at least 4 modern 
methods of family planning on day of 
interview, among facilities with 
control cards for those methods)b†
n.a. 57.4 n.a. n.a. 47.5 n.a. n.a. 52.3 n.a.
Number of clients receiving 
contraceptives for the first time from 
facility in previous two months 
(mean)†
n.a. 13.0 n.a. n.a. 9.9 n.a. n.a. 11.3 n.a.
Number of clients receiving 
contraceptives for the first time from 
facility in previous two months 
(median)†
n.a. 8.0 n.a. n.a. 6.0 n.a. n.a. 7.0 n.a.
Sample size 168-268 93-171 261-439
Source: Health, Population, and Nutrition Office Portfolio Health Systems baseline and endline survey data
Note: Percentages, means, and medians are weighted using weights that adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** 
statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates.
n.a. = not applicable (question not asked at baseline, or not comparable).
aLong-acting methods of contraception include hormonal implants and intrauterine devices (IUDs). 
bModern methods of family planning include hormonal implants, IUDs, oral contraceptives (combined or progestogen-only pills), injectable contraceptives, and 
condoms. 
†See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 10
TABLE 7B. AVAILABILITY OF FAMILY PLANNING COUNSELING AND CONTRACEPTIVES AMONG HCS 
(PERCENTAGE OF HCS, UNLESS OTHERWISE INDICATED)
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Family planning services offered:
Family planning counseling only 7.6 1.8 -5.8** 3.7 7.8 4.0 5.6 4.8 -0.8
Contraceptives only 0.0 0.0 0.0 1.2 0.0 -1.2 0.6 0.0 -0.6
Both 90.2 97.2 7.1** 90.6 92.2 1.7 90.4 94.7 4.3
Neither 2.3 1.0 -1.3 4.5 0.0 -4.5* 3.4 0.5 -2.9**
Sample size 98 55 153
Facility can provide long-acting 
methods of contraception on day of 
interview, among those with control 
cards for those methods†
n.a. 98.8 n.a. n.a. 100.0 n.a. n.a. 99.4 n.a.
Facility can provide at least 4 modern 
methods of family planning on day of 
interview, among facilities with 
control cards for those methods†
n.a. 82.1 n.a. n.a. 81.7 n.a. n.a. 81.9 n.a.
Number of clients receiving 
contraceptives for the first time from 
facility in previous two months 
(mean)†
n.a. 42.0 n.a. n.a. 32.2 n.a. n.a. 37.0 n.a.
Number of clients receiving 
contraceptives for the first time from 
facility in previous two months 
(median)†
n.a. 22.0 n.a. n.a. 19.0 n.a. n.a. 20.0 n.a.
Sample size 76-98 39-55 115-153
Source: Health, Population, and Nutrition Office Portfolio Health Systems baseline and endline survey data
Note: Percentages, means, and medians are weighted using weights that adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates.
n.a. = not applicable (question not asked at baseline, or not comparable).
aLong-acting methods of contraception include hormonal implants and intrauterine devices (IUDs). 
bModern methods of family planning include hormonal implants, IUDs, oral contraceptives (combined or progestogen-only pills), injectable contraceptives, and condoms.
†See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 11
TABLE 8A. AVAILABILITY OF DELIVERY AND ANTENATAL CARE SERVICES AMONG CHPS 
(PERCENTAGE OF CHPS, UNLESS OTHERWISE INDICATED)
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Delivery care
Facility conducts deliveries 25.8 44.2 18.4*** 23.8 28.5 4.7 24.7 35.6 10.9***
Sample size 269 170 439
Delivery care in the previous two months, among facilities conducting deliveries:
Average (mean) number of 
deliveries in the facility 6.2 10.4 4.3*** 7.8 8.3 0.6 6.9 9.4 2.5***
Average percentage of deliveries in 
which mother received at least two 
doses of sulfadoxine￾pyrimethamine, among all deliveries
83.2 89.5 6.3 87.0 93.6 6.6 85.2 91.7 6.5
Percentage of attended births that 
were registered at the facility†
n.a. 97.2 n.a. n.a. 97.3 n.a. n.a. 97.3 n.a.
Facility registered any home births† n.a. 30.7 n.a. n.a. 25.6 n.a. n.a. 27.9 n.a.
Average percentage of births in the 
facility that were emergency 
deliveries
2.6 2.1 -0.5 1.8 0.5 -1.2* 2.2 1.3 -0.9
Facility recorded reasons for all 
maternal deaths (among facilities 
with any maternal deaths)†
n.a. --a n.a. n.a. --a n.a. n.a. --a n.a.
Facility recorded reasons for all 
neonatal deaths (among facilities 
with any neonatal deaths)†
n.a. --a n.a. n.a. --a n.a. n.a. --a n.a.
Sample size 42-266 25-170 67-436
Antenatal care (ANC)
Facility provides ANC 65.5 70.7 5.2** 57.9 62.7 4.8 61.3 66.3 5.0**
Sample size 269 171 440
Availability of ANC registers, among facilities providing ANC:
Register exists and seen 96.3 98.1 1.8 94.6 95.4 0.8 95.4 96.7 1.3
Register exists, but not seen 2.5 1.3 -1.2 3.1 4.6 1.5 2.8 3.0 0.2
No register 1.2 0.6 -0.6 2.3 0.0 -2.3 1.8 0.3 -1.5
Sample size 159 87 246
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 12
Note: Percentages and means are weighted using weights that adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically significant at 
the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates and because some variables apply to different subsets of respondents.
a Not reported because of small sample sizes (fewer than 10).
n.a. = not applicable (question not asked at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
TABLE 8B. AVAILABILITY OF DELIVERY AND ANTENATAL CARE SERVICES AMONG HCS 
(PERCENTAGE OF HCS, UNLESS OTHERWISE INDICATED)
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Delivery care
Facility conducts deliveries 82.4 93.2 10.8*** 87.1 95.0 7.9** 84.8 94.1 9.3***
Sample size 98 55 153
Delivery care in the previous two months, among facilities conducting deliveries:
Average (mean) number of 
deliveries in the facility 28.0 36.4 8.4*** 24.9 27.6 2.8 26.3 31.8 5.4***
Average percentage of deliveries in 
which mother received at least two 
doses of sulfadoxine￾pyrimethamine, among all deliveries
80.5 82.1 1.6 77.0 85.6 8.6 78.7 84.0 5.3
Percentage of attended births that 
were registered at the facility†
n.a. 98.1 n.a. n.a. 99.8 n.a. n.a. 99.0 n.a.
Facility registered any home births† n.a. 41.5 n.a. n.a. 28.9 n.a. n.a. 35.1 n.a.
Average percentage of births in the 
facility that were emergency 
deliveries
2.2 2.8 0.6 4.8 1.8 -2.9* 3.5 2.3 -1.2
Facility recorded reasons for all 
maternal deaths (among facilities 
with any maternal deaths)†
n.a. --a n.a. n.a. --a n.a. n.a. --a n.a.
Facility recorded reasons for all 
neonatal deaths (among facilities 
with any neonatal deaths)†
n.a. --a n.a. n.a. --a n.a. n.a. --a n.a.
Sample size 74-98 45-55 119-153
Antenatal care (ANC)
Facility provides ANC 92.7 97.0 4.3** 92.1 98.6 6.4* 92.4 97.8 5.4**
Sample size 98 54 152
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 13
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Availability of ANC registers, among facilities providing ANC:
Register exists and seen 89.4 95.9 6.5* 95.1 100.0 4.9 92.3 98.0 5.7**
Register exists, but not seen 9.7 4.1 -5.7* 2.8 0.0 -2.8 6.3 2.0 -4.2*
No register 0.8 0.0 -0.8 2.1 0.0 -2.1 1.5 0.0 -1.5
Sample size 91 49 140
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages and means are weighted using weights that adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates and because some variables apply to different subsets of respondents.
a Not reported because of small sample sizes (fewer than 10).
n.a. = not applicable (question not asked at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 14
TABLE 9A. AVAILABILITY AND USE OF NUTRITION REGISTERS AMONG CHPS (PERCENTAGE OF FACILITIES) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Availability of nutrition register:
Register exists and seen 85.9 87.7 1.7 86.1 93.3 7.2 86.0 90.8 4.7
Register exists, but not seen 5.5 6.8 1.3 2.4 3.6 1.3 3.8 5.0 1.3
No register 8.6 5.6 -3.0* 11.5 3.1 -8.4** 10.2 4.2 -6.0***
Sample size 268 170 438
Data entered in the past two months among facilities with a nutrition register available:
Data exist and seen 68.6 85.6 17.1*** 71.9 90.9 19.0*** 70.4 88.6 18.2***
Data exist, but not seen 10.8 7.1 -3.7* 12.1 3.9 -8.2** 11.5 5.3 -6.2***
No data entered 20.6 7.3 -13.3*** 16.0 5.2 -10.8*** 18.0 6.1 -11.9***
Sample size 249 165 414
Specific types of data entered in the register, among facilities with data observed:
Child’s weight data 98.1 97.9 -0.3 99.2 98.5 -0.7 98.8 98.3 -0.5
Child’s age data 98.6 95.9 -2.7 99.2 97.4 -1.9 99.0 96.7 -2.2**
Child’s height data 18.6 11.5 -7.1 20.7 3.6 -17.0*** 19.8 6.8 -13.0***
Underweight, or weight-for-age data 74.5 61.9 -12.6** 86.6 61.2 -25.4*** 81.7 61.5 -20.2***
Infant and Young Child Feeding (IYCF) 
counseling data†
n.a. 41.7 n.a. n.a. 43.2 n.a. n.a. 42.6 n.a.
Sample size 165-214 126-153 291-367
Facility has nutrition register with entry 
within previous 30 days, among facilities 
that showed their nutrition register data
79.2 90.9 11.7*** 80.0 89.7 9.7* 79.7 90.2 10.6***
Availability of nutritional counseling materials:a
Materials exist and seen 62.5 76.2 13.7 67.5 66.5 -1.1 66.1 69.2 3.1
Materials exist but not seen 16.7 16.7 0.0 7.9 9.0 1.1 10.4 11.2 0.8
No materials 20.8 7.1 -13.7 24.5 24.5 0.0 23.5 19.6 -3.9
Sample size 44-145 45-101 89-246
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * 
statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates and because some variables apply to different subsets of respondents.
a Asked only for facilities in the Northern, Upper East, and Upper West regions. These indicators were not considered for the sample size ranges at the bottom of the table.
n.a. = not applicable (question not asked at baseline, or not comparable)
†See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 15
TABLE 9B. AVAILABILITY AND USE OF NUTRITION REGISTERS AMONG HCS (PERCENTAGE OF HCS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Availability of nutrition register:
Register exists and seen 91.1 96.2 5.1* 83.7 98.2 14.5** 87.3 97.2 9.9***
Register exists, but not seen 6.9 2.0 -4.9* 4.4 1.8 -2.6 5.6 1.9 -3.7
No register 2.0 1.8 -0.2 11.9 0.0 -11.9* 7.1 0.9 -6.2*
Sample size 97 55 152
Data entered in the past two months among facilities with a nutrition register available:
Data exist and seen 73.0 85.8 12.8** 79.9 92.8 12.9* 76.6 89.4 12.9***
Data exist, but not seen 22.1 7.4 -14.7*** 7.0 1.8 -5.2 14.2 4.5 -9.8***
No data entered 4.9 6.8 1.9 13.1 5.4 -7.7 9.2 6.1 -3.1
Sample size 93 55 148
Specific types of data entered in the register, among facilities with data observed:a
Child’s weight data 96.7 99.0 2.3 100.0 100.0 0.0 98.4 99.5 1.1
Child’s age data 99.0 97.1 -1.9 100.0 96.2 -3.8 99.5 96.6 -2.9*
Child’s height data 36.3 14.7 -21.6*** 25.4 19.7 -5.7 30.6 17.3 -13.4***
Underweight, or weight-for-age data 80.8 58.7 -22.0*** 86.0 82.6 -3.4 83.5 71.3 -12.2***
Infant and Young Child Feeding (IYCF) 
counseling data†
n.a. 40.9 n.a. n.a. 50.2 n.a. n.a. 45.9 n.a.
Sample size 74-83 44-51 118-134
Facility has nutrition register with entry 
within previous 30 days, among facilities 
that showed their nutrition register data
67.4 91.6 24.2*** 80.7 89.5 8.9 74.6 90.5 15.9**
Availability of nutritional counseling materials:b
Materials exist and seen 64.2 67.9 3.7 91.3 100.0 8.7 80.4 87.0 6.7
Materials exist but not seen 30.9 17.3 -13.6 8.7 0.0 -8.7 17.6 7.0 -10.7
No materials 4.9 14.8 9.9 0.0 0.0 0.0 2.0 6.0 4.0
Sample size 20-57 14-36 34-93
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates and because some variables apply to different subsets of respondents.
a Because multiple responses were possible, percentages may sum to more than 100.
b Asked only for facilities in the Northern, Upper East, and Upper West regions. These indicators were not considered for the sample size ranges at the bottom of the table.
n.a. = not applicable (question not asked at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 16
TABLE 10.1A. AVAILABILITY OF COMMUNITY-BASED SERVICES AMONG CHPS: HOME VISITS 
(PERCENTAGE OF CHPS, UNLESS OTHERWISE INDICATED) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Home visits
Facility staff (including community health officers, or CHOs) 
conducted at least one visit in the previous two months
96.9 100.0 3.1*** 97.8 100.0 2.2** 97.4 100.0 2.6***
Facility staff (including CHO) conducted at least one follow￾up home visit in the previous two months
78.9 70.9 -8.0 76.4 79.5 3.0 77.5 75.6 -1.9
Facility staff (including CHO) conducted at least one follow￾up home visit within the previous two months that was 
recorded in the register
39.1 48.3 9.2** 59.2 70.3 11.1 50.2 60.4 10.2**
Facility staff (including CHO) or other paid staff conducted 
at least 10 follow-up home visits in the previous two 
months
32.1 39.6 7.4 31.8 53.9 22.1** 31.9 47.5 15.6***
Facility staff (including CHO) or other paid staff conducted 
at least 24 follow-up home visits in the previous two 
months
11.0 15.5 4.5* 11.5 26.0 14.5*** 11.3 21.4 10.1***
Sample size 201-261 128-170 329-430
Average (mean) number of home and school visits by Facility staff (including CHO) in the previous two months:
Routine home visits conducted 26.5 81.6 55.0*** 27.7 124.8 97.1*** 27.2 105.4 78.3***
Follow-up home visits 10.5 19.0 8.6** 9.8 20.1 10.2** 10.1 19.6 9.5***
Clients needing special visits 5.1 10.3 5.2** 4.3 9.6 5.3*** 4.7 9.9 5.2***
Postnatal home visits conducted 6.9 7.3 0.5 4.0 9.5 5.5** 5.3 8.6 3.3***
School visits conducted 7.4 3.1 -4.3 2.8 3.4 0.6 4.9 3.3 -1.6
Sample size 261-267 168-171 430-437
Median number of home and school visits by facility staff (including CHO) in the previous two months:
Routine home visits conducted 10.0 35.0 25.0a 14.0 82.0 68.0 a 11.0 56.0 45.0 a
Follow-up home visits 4.0 5.0 1.0 a 5.0 10.0 5.0 a 5.0 8.0 3.0 a
Clients needing special visits 2.0 3.0 1.0 a 2.0 5.0 3.0 a 2.0 4.0 2.0 a
Postnatal home visits conducted 4.0 3.0 -1.0 a 3.0 5.0 2.0 a 3.0 4.0 1.0 a
School visits conducted 2.0 2.0 0.0 a 2.0 2.0 0.0 a 2.0 2.0 0.0 a
Sample size 261-267 168-171 430-437
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages, means, and medians are weighted using weights that adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically 
significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates and because some variables apply to different subsets of respondents.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 17
Tables 10A and 10B at baseline and midline included results on home visits, community health volunteers and, for CHPS zones, community health meetings. The content of the 
original Tables 10A and 10B is now found in Tables 10.1A, 10.1B, 10.2A, 25.1A, and 25.1B. 
a Statistical significance for the change in medians was not calculated.
†See Appendix E for midline and endline results for this indicator, which was added at midline.
TABLE 10.1B. AVAILABILITY OF COMMUNITY-BASED SERVICES AMONG HCS: HOME VISITS 
(PERCENTAGE OF HCS, UNLESS OTHERWISE INDICATED) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Home visits
Facility staff (including community health officers, or CHOs) 
conducted at least one visit in the previous two months 99.2 100.0 0.8 95.7 100.0 4.3 97.3 100.0 2.7*
Facility staff (including CHO) conducted at least one follow￾up home visit in the previous two months
78.2 72.1 -6.1 79.9 86.4 6.5 79.1 79.6 0.5
Facility staff (including CHO) conducted at least one follow￾up home visit within the previous two months that was 
recorded in the register
43.0 58.7 15.7 67.5 64.1 -3.5 55.9 61.5 5.6
Facility staff (including CHO) or other paid staff conducted 
at least 10 follow-up home visits in the previous two 
months
44.3 38.1 -6.2 46.5 73.0 26.5*** 45.4 56.4 10.9**
Facility staff (including CHO) or other paid staff conducted 
at least 24 follow-up home visits in the previous two 
months
14.5 13.9 -0.6 19.1 45.7 26.7*** 16.9 30.5 13.7***
Sample size 74-93 43-55 117-148
Average (mean) number of home and school visits by facility staff (including CHO) in the previous two months:
Routine home visits conducted 59.2 128.5 69.2** 39.4 217.2 177.8*** 48.9 174.7 125.8***
Follow-up home visits 11.3 31.2 19.9 14.2 40.7 26.5*** 12.8 36.2 23.4**
Postnatal home visits conducted 15.0 12.4 -2.6 12.5 15.5 3.0 13.7 14.0 0.3
School visits conducted 3.8 5.7 1.9** 30.3 12.3 -18.0 17.6 9.1 -8.4
Sample size 92-94 55 147-149
Median number of home and school visits by facility staff (including CHO) in the previous two months:
Routine home visits conducted 12.0 40.0 28.0 a 16.0 137.0 121.0 a 16.0 59.0 43.0 a
Follow-up home visits 6.0 5.0 -1.0 a 7.0 17.0 10.0 a 7.0 12.0 5.0 a
Postnatal home visits conducted 5.0 6.0 1.0 a 6.0 11.0 5.0 a 6.0 7.0 1.0 a
School visits conducted 2.0 2.0 0.0 a 4.0 5.0 1.0 a 3.0 4.0 1.0 a
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 18
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Sample size 92-94 55 147-149
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages, means, and medians are weighted using weights that adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Tables 10A and 10B at baseline and midline included results on home visits, community health volunteers and, for CHPS zones, community health meetings. The content of the 
original Tables 10A and 10B is now found in Tables 10.1A, 10.1B, 10.2A, 25.1A, and 25.1B. 
Sample sizes are reported as ranges because variables have different response rates and because some variables apply to different subsets of respondents.
a Statistical significance for the change in medians was not calculated.
†See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 19
TABLE 10.2A. AVAILABILITY OF COMMUNITY-BASED SERVICES AMONG CHPS: COMMUNITY HEALTH MEETINGS
(PERCENTAGE OF CHPS, UNLESS OTHERWISE INDICATED) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Community health meetings
At least one community health meeting (durbar) was held 
in last complete quarter†
n.a. 84.4 n.a. n.a. 88.1 n.a. n.a. 86.5 n.a.
Number of community health meetings (durbars) held in 
the last complete quarter (mean)†
n.a. 1.6 n.a. n.a. 1.6 n.a. n.a. 1.6 n.a.
Sample size 251-260 163-167 418-423
Key persons planning and organizing the last community health meeting, among facilities holding a community health meeting in the previous quarter:a
Community health officer (CHO) 58.8 69.0 10.2 62.3 47.1 -15.2* 60.9 55.6 -5.4
Community health volunteers (CHVs) 19.9 27.2 7.4 13.7 32.4 18.7** 16.1 30.4 14.3***
Community leaders not part of Community health 
committee (CHC)
21.0 22.3 1.3 8.7 26.4 17.7** 13.4 24.8 11.4***
CHC 16.9 58.8 41.9*** 11.9 62.7 50.9*** 13.8 61.2 47.4***
Someone else 41.9 32.7 -9.2 46.1 27.0 -19.1*** 44.4 29.2 -15.3***
Sample size 88 66 154
Key topics of discussion during last community health meeting, among facilities holding a community health meeting in the previous two months: a
Family planning 19.2 28.0 8.8 34.5 33.8 -0.7 28.6 31.5 3.0
Malaria (any topic) 29.4 30.0 0.6 27.8 25.3 -2.5 28.4 27.1 -1.3
Cholera 23.0 3.6 -19.5*** 21.7 10.6 -11.1 22.2 7.9 -14.3**
Maternal and child health 14.1 37.9 23.7*** 25.4 45.9 20.5* 21.1 42.8 21.7***
Antenatal care attendance 20.4 25.6 5.2 17.7 30.1 12.4* 18.8 28.3 9.6**
Newborn health 12.5 16.9 4.4 15.9 20.0 4.1 14.6 18.8 4.2
WASH (water and sanitation hygiene) 14.6 18.8 4.2 9.9 18.7 8.8 11.7 18.7 7.0*
Expanded Programme on Immunizations 10.9 20.1 9.2 13.4 21.4 8.0 12.4 20.9 8.4
Postnatal Care Attendance 8.5 16.4 7.9 15.6 12.6 -3.1 12.9 14.0 1.2
Administration of the health facility 10.1 18.7 8.6* 11.5 26.9 15.4 11.0 23.7 12.8**
Health Insurance 7.3 18.2 10.9** 10.8 15.8 5.0 9.5 16.8 7.3*
Injuries such as snake bites, burns, and so on 3.3 1.9 -1.3 9.6 4.9 -4.6 7.1 3.8 -3.4
Nutrition† n.a. 14.6 n.a. n.a. 16.6 n.a. n.a. 15.8 n.a.
Goodlife, Live it Well Campaign† n.a. 10.8 n.a. n.a. 14.2 n.a. n.a. 12.7 n.a.
HIV/AIDS 0.8 8.4 7.6** 2.1 8.0 5.9** 1.6 8.2 6.6***
Something else†,b n.a. c 55.3 n.a. c n.a. c 55.3 n.a.c n.a. c 55.3 n.a. c
Sample size 88-211 65-146 153-357
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 20
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages, means, and medians are weighted using weights that adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically 
significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates and because some variables apply to different subsets of respondents.
Tables 10A and 10B at baseline and midline included results on home visits, community health volunteers and, for CHPS zones, community health meetings. The content of the 
original Tables 10A and 10B is now found in Tables 10.1A, 10.1B, 10.2A, 25.1A, and 25.1B. 
a Because multiple responses were possible, percentages sum to more than 100.
b The “Something else” category is not strictly comparable between baseline and endline because the former included “Nutrition” and “Goodlife, Live it Well Campaign”, and 
the latter had them as separate categories. Therefore, the baseline-endline difference was not assessed. 
n.a. = not applicable (not measured at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 21
D. Staff Training
TABLE 11A. STAFF TRAINING FOR MALARIA CAREGIVING AMONG CHPS 
(PERCENTAGE OF CHPS, UNLESS OTHERWISE INDICATED) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Facility had at least one staff member trained in the following key aspects of malaria care in the previous 12 months:
Malaria case management 78.5 27.7 -50.7*** 64.1 24.2 -39.9*** 70.4 25.7 -44.7***
Malaria RDTs (including refresher training) 70.9 39.1 -31.8*** 57.4 27.6 -29.9*** 63.5 32.7 -30.8***
Malaria in pregnancy 61.5 26.9 -34.5*** 43.4 17.3 -26.1*** 51.3 21.5 -29.8***
Other trainings 87.5 100.0 12.5** 74.1 100.0 25.9** 79.4 100.0 20.6***
Sample size 259-266 169-171 428-436
Facilities receiving at least 2 clinical supervisory visits in the previous 12 months on:a
Malaria case management† n.a. 28.8 n.a. n.a. 33.6 n.a. n.a. 31.2 n.a.
Malaria RDTs (including refresher training)† n.a. 28.8 n.a. n.a. 32.8 n.a. n.a. 30.8 n.a.
Malaria data collating and reporting† n.a. 27.2 n.a. n.a. 31.8 n.a. n.a. 29.5 n.a.
Malaria supply chain management† n.a. 16.7 n.a. n.a. 22.1 n.a. n.a. 19.3 n.a.
Sample size 242-251 124-131 366-380
Facility had at least one staff member trained in 
each of the three key aspects of malaria care in 
the previous 12 monthsb
50.8 17.7 -33.0*** 34.8 11.4 -23.4*** 41.7 14.2 -27.6***
Facility had at least one staff member trained in 
any of the three key aspects of malaria care in the 
previous 12 monthsb
84.7 45.2 -39.5*** 70.6 35.5 -35.1*** 76.9 39.8 -37.1***
Facility had at least one staff member trained in 
any aspect of malaria care and received 
supportive supervision in the previous 12 
monthsc
59.5 31.7 -27.8*** 57.4 18.4 -39.0*** 58.4 24.3 -34.0***
Facility with at least one staff member receiving 
training plus in malaria treatment, among facilities 
with at least one staff member trained on the 
three key aspectsd†
n.a. 94.1 n.a. n.a. 100.0 n.a. n.a. 96.6 n.a.
Facility with at least one staff member receiving 
training plus in malaria treatmentd†, among all 
facilities
n.a. 18.7 n.a. n.a. 15.8 n.a. n.a. 17.3 n.a.
Facility had at least one CHV trained in malaria￾related topics in the previous 12 monthsc
46.2 31.5 -14.7*** 62.9 25.1 -37.8*** 55.5 27.9 -27.5***
Sample size 48-265 20-171 68-433
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 22
Note: Percentages and means are weighted using weights that adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically significant at 
the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates.
a Because multiple responses were possible, percentages may sum to more than 100.
b Key aspects of malaria care are malaria case management, malaria RDTs, and malaria in pregnancy.
c Includes malaria-related topics in general, not specific topics.
d Training plus is defined as receiving training in all three key aspects of malaria care (malaria in pregnancy, malaria case management, and RDTs) and supportive supervision in 
malaria case management and RDTs. The survey instrument did not measure supportive supervision in malaria in pregnancy.
n.a. = not applicable (question not asked at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
TABLE 11B. STAFF TRAINING FOR MALARIA CAREGIVING AMONG HCS 
(PERCENTAGE OF HCS, UNLESS OTHERWISE INDICATED) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Facility had at least one staff member trained in the following aspects of malaria care in the previous 12 months:
Malaria case management 85.3 31.9 -53.4*** 79.7 63.6 -16.1* 82.5 48.1 -34.4***
Malaria RDTs (including refresher training) 73.0 40.8 -32.2*** 62.6 59.4 -3.2 67.6 50.5 -17.1***
Malaria in pregnancy 68.7 32.2 -36.5*** 60.4 47.7 -12.7 64.4 40.2 -24.2***
Malaria microscopy 26.8 15.7 -11.0*** 30.6 27.3 -3.4 28.7 21.6 -7.2**
Other trainings 18.7 11.7 -7.0 28.9 13.2 -15.7* 24.1 12.5 -11.6**
Sample size 95-96 52-55 147-151
Facilities receiving at least 2 clinical supervisory visits in the last year on:a
Malaria case management† n.a. 41.0 n.a. n.a. 62.0 n.a. n.a. 51.9 n.a.
Malaria RDTs (including refresher training)† n.a. 42.1 n.a. n.a. 48.6 n.a. n.a. 45.4 n.a.
Malaria data collating and reporting† n.a. 40.9 n.a. n.a. 42.5 n.a. n.a. 41.7 n.a.
Malaria supply chain management† n.a. 19.5 n.a. n.a. 32.4 n.a. n.a. 26.3 n.a.
Sample size 89-95 52-54 141-149
Facility had at least one staff member trained in 
each of the three key aspects of malaria care in 
the previous 12 monthsb
57.7 27.4 -30.3*** 40.5 39.1 -1.3 48.8 33.5 -15.3***
Facility had at least one staff member trained in 
any of the three key aspects of malaria care in the 
previous 12 monthsb
86.6 45.4 -41.2*** 82.8 74.0 -8.7 84.7 60.1 -24.5***
Facility had at least one staff member trained in 
any aspect of malaria care and received 
supportive supervision in the previous 12 
monthsc
62.4 43.6 -18.9** 65.2 38.2 -27.0** 63.8 40.8 -23.0***
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 23
Facility with at least one staff member receiving 
training plus in malaria treatment, among facilities 
with at least one staff member trained on the 
three key aspectsd†
n.a. 90.3 n.a. n.a. 92.5 n.a. n.a. 91.6 n.a.
Facility with at least one staff member receiving 
training plus in malaria treatment, among all 
facilities d†
n.a. 24.4 n.a. n.a. 37.8 n.a. n.a. 31.1 n.a.
Sample size 24-97 21-55 45-152
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages and means are weighted using weights that adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates.
a Because multiple responses were possible, percentages may sum to more than 100.
b Key aspects of malaria care are malaria case management, malaria RDTs, and malaria in pregnancy.
c
Includes malaria-related topics in general, not specific topics. 
d Training in all three key aspects of malaria care (malaria in pregnancy, malaria case management, and RDTs) and supportive supervision in malaria case management and RDTs. 
The survey instrument did not measure supportive supervision in malaria in pregnancy.
n.a. = not applicable (question not asked at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 24
TABLE 12A. STAFF TRAINING FOR NUTRITION AND OTHER KEY CAREGIVING SERVICES AMONG CHPS 
(PERCENTAGE OF FACILITIES) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Facility had at least one staff member trained in the following in the previous 12 months:a
Infant and young child feeding (IYCF) 40.6 15.9 -24.8*** 53.2 16.9 -36.2*** 47.6 16.5 -31.2***
Community management of acute malnutrition 
(CMAM) 
28.9 18.5 -10.4** 38.3 9.7 -28.5*** 34.1 13.6 -20.5***
Management of acute malnutrition 30.5 19.0 -11.5*** 29.5 5.4 -24.1*** 30.0 11.4 -18.5***
Essential newborn care (ENC) 22.9 15.0 -7.9* 21.4 12.9 -8.5 22.0 13.8 -8.2**
Active management of third stage of labor (AMTSL) 13.4 8.0 -5.4* 18.2 6.5 -11.7*** 16.1 7.2 -8.9***
Anemia prevention control† n.a. 12.1 n.a. n.a. 8.9 n.a. n.a. 10.3 n.a.
Maternal, Neonatal and Child Health (MNCH) life 
saving skills†
n.a. 19.0 n.a. n.a. 10.8 n.a. n.a. 14.5 n.a.
Integrated Management of Neonatal Childhood Illness 
(IMNCI) †
n.a. 8.9 n.a. n.a. 8.6 n.a. n.a. 8.8 n.a.
Other trainings† n.a. b 60.2 n.a.b n.a. b 52.8 n.a.b n.a. b 56.0 n.a..
b
Sample size 260-268 167-171 428-439
Facility had at least one trained staff member receive supportive supervision in the previous 12 months:a
Infant and young child feeding (IYCF) 27.0 10.1 -16.9*** 39.5 13.9 -25.5*** 34.0 12.2 -21.8***
Community management of acute malnutrition 
(CMAM) or other undernutrition management 
practices
18.5 12.8 -5.7 29.8 8.7 -21.1*** 24.8 10.5 -14.3***
Management of acute malnutrition 18.2 12.4 -5.8* 22.9 3.2 -19.7*** 20.8 7.2 -13.6***
Essential newborn care (ENC) 11.8 8.8 -3.0 14.2 10.8 -3.4 13.2 9.9 -3.3
Active management of third stage of labor (AMTSL) 6.8 5.2 -1.6 10.8 4.4 -6.4** 9.0 4.8 -4.3**
Anemia prevention control† n.a. 7.3 n.a. n.a. 6.8 n.a. n.a. 7.0 n.a.
Maternal, Neonatal and Child Health (MNCH) life 
saving skills†
n.a. 10.0 n.a. n.a. 6.6 n.a. n.a. 8.1 n.a.
Integrated Management of Neonatal Childhood Illness 
(IMNCI)†
n.a. 6.6 n.a. n.a. 4.5 n.a. n.a. 5.4 n.a.
Facility with at least one staff member receiving training 
on all three critical skill areas in nutrition
n.a. 9.4 n.a. n.a. 3.7 n.a. n.a. 6.2 n.a.
Facility with at least one staff member receiving “training 
plus” in nutrition, among facilities with at least one staff 
member trained on all three critical skill areasc†
n.a. 71.4 n.a. n.a. -- e n.a. n.a. 71.3 n.a.
Facility with at least one staff member receiving “training 
plus” in maternal and neonatal careamong facilities with at 
n.a. 1.0 n.a. n.a. 0.5 n.a. n.a. 0.7 n.a.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 25
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
least one staff member trained in all three critical skill 
areasd†
Sample size 28-269 167-171 34-440
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data 
Note: Percentages are weighted to adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * 
statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates.
a Because multiple responses were possible, percentages may sum to more than 100.
b The “Other trainings” category is not strictly comparable between baseline and endline. Therefore, the baseline-endline difference was not assessed. 
c Training complemented by supportive supervision in critical skill areas in nutrition (infant and young child feeding, management of acute malnutrition, and community 
management of acute malnutrition).
d Training complemented by supportive supervision in critical skill areas in maternal & neonatal care (active management of third stage of labor, essential newborn care, and 
anemia prevention control).
e Not reported because of small sample sizes (fewer than 10).
n.a. = not applicable (question not asked at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 26
TABLE 12B. STAFF TRAINING FOR NUTRITION AND OTHER KEY CAREGIVING SERVICES AMONG HCS 
(PERCENTAGE OF HCS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Facility had at least one staff member trained in the following in the previous 12 months:a
Infant and young child feeding (IYCF) 56.0 25.6 -30.4*** 51.4 26.5 -24.8** 53.6 26.1 -27.5***
Community management of acute malnutrition 
(CMAM) 
40.3 23.6 -16.7** 39.4 28.5 -10.9 39.8 26.1 -13.7**
Management of acute malnutrition 37.4 22.9 -14.5** 36.4 22.4 -14.0 36.9 22.6 -14.2**
Essential newborn care (ENC) 60.2 37.5 -22.6*** 40.7 43.3 2.6 50.1 40.5 -9.6
Active management of third stage of labor (AMTSL) 42.2 19.2 -23.0*** 48.2 32.5 -15.7 45.3 26.1 -19.2***
Anemia prevention control† n.a. 15.5 n.a. n.a. 23.3 n.a. n.a. 19.5 n.a.
Maternal, Neonatal and Child Health (MNCH) life 
saving skills†
n.a. 36.2 n.a. n.a. 28.1 n.a. n.a. 32.1 n.a.
Integrated Management of Neonatal Childhood Illness 
(IMNCI) †
n.a. 9.9 n.a. n.a. 15.2 n.a. n.a. 12.6 n.a.
Other trainings† n.a. b 71.3 n.a.b n.a. b 55.2 n.a.b n.a. b 63.1 n.a.b
Sample size 93-98 54-55 147-153
Facility had at least one trained staff member receive supportive supervision in the previous 12 months:
Infant and young child feeding (IYCF) 40.6 17.6 -23.1*** 44.8 26.5 -18.3* 42.8 22.3 -20.6***
Community management of acute malnutrition 
(CMAM) or other undernutrition management 
practices
32.9 16.7 -16.2** 31.5 18.9 -12.6** 32.2 17.8 -14.4***
Management of acute malnutrition 32.5 17.0 -15.6** 32.8 13.7 -19.1** 32.7 15.3 -17.4***
Essential newborn care (ENC) 42.9 21.3 -21.6*** 29.1 35.2 6.1 35.8 28.5 -7.3
Active management of third stage of labor (AMTSL) 23.9 15.5 -8.4 36.5 23.7 -12.8 30.4 19.7 -10.7*
Anemia prevention control† n.a. 11.4 n.a. n.a. 19.4 n.a. n.a. 15.5 n.a.
Maternal, Neonatal and Child Health (MNCH) life 
saving skills†
n.a. 15.6 n.a. n.a. 23.0 n.a. n.a. 19.5 n.a.
Integrated Management of Neonatal Childhood Illness 
(IMNCI) †
n.a. 8.9 n.a. n.a. 14.0 n.a. n.a. 11.5 n.a.
Facility with at least one staff member receiving training 
on all three critical skill areas in nutrition
n.a. 17.6 n.a. n.a. 15.8 n.a. n.a. 16.7 n.a.
Facility with at least one staff member receiving “training 
plus” in nutrition, among facilities with at least one staff 
member trained on all three critical skill areasc†
n.a. 74.2 n.a. n.a. -- n.a. n.a. 75.1 n.a.
Facility with at least one staff member receiving “training 
plus” in maternal and neonatal care, among facilities with 
n.a. 3.6 n.a. n.a. 6.8 n.a. n.a. 5.2 n.a.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 27
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
at least one staff member trained in all three critical skill 
areas d†
Sample size 15-98 53-55 21-153
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data 
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates.
a Because multiple responses were possible, percentages may sum to more than 100.
b The “Other trainings” category is not strictly comparable between baseline and endline. Therefore, the baseline-endline difference was not assessed. 
c Training complemented by supportive supervision in critical skill areas in nutrition (infant and young child feeding, management of acute malnutrition, and community 
management of acute malnutrition).
d Training complemented by supportive supervision in critical skill areas in maternal & neonatal care (active management of third stage of labor, essential newborn care, and 
anemia prevention control).
n.a. = not applicable (question not asked at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 28
TABLE 13A. STAFF TRAINING FOR DATA TRACKING AND MANAGEMENT AMONG CHPS 
(PERCENTAGE OF CHPS)
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Training in malaria data tracking
Facility had at least one nurse or CHO 
trained in malaria data collating and 
reporting in the previous 12 months
71.4 32.4 -38.9*** 67.7 30.0 -37.6*** 69.3 31.1 -38.2***
Facility had at least one staff member trained 
in malaria data collating and reporting in the 
previous 12 months
79.9 31.9 -48.0*** 72.0 30.1 -41.8*** 75.4 30.9 -44.5***
Facility has a person in charge of records 
with training on malaria data reporting and 
tools in the previous 12 months
--a --a --a -- a -- a -- a -- a -- a -- a
Sample size 233-260 156-161 389-421
Training in other tracking and management topics
Facility had at least one staff member trained in the following in the previous 12 months:b
Supply chain and logistics management 33.3 25.9 -7.5* 27.5 15.6 -12.0*** 30.1 20.1 -10.0***
Supervision skills 20.9 9.2 -11.8*** 18.0 9.1 -9.0*** 19.3 9.1 -10.2***
Other training† n.a. 60.2 n.a. n.a. 52.8 n.a. n.a. 56.0 n.a.
Sample size 260-263 170-171 431-434
Facility had at least one staff member who was trained and received supportive supervision in any of the following in the previous 12 months:b
Supply chain and logistics management 23.3 19.2 -4.1 21.9 9.3 -12.7*** 22.5 13.6 -8.9***
Supervision skills 11.3 5.7 -5.6*** 13.7 7.2 -6.5** 12.6 6.5 -6.1***
Sample size 256-260 169-171 425-431
Facility maintains a list of when refresher 
trainings, new skills trainings, or professional 
development trainings are due and 
conducted†
n.a. 8.1 n.a. n.a. 1.6 n.a. n.a. 4.5 n.a.
Facility with at least one staff member 
receiving “training plus” in supply chain 
managementc†
n.a. 61.0 n.a. n.a. -- n.a. n.a. 62.6 n.a.
Facility with at least one staff member 
receiving “training plus”d†
n.a. 0.0 n.a. n.a. 0.5 n.a. n.a. 0.3 n.a.
Facility had unmet priority training needs in 
previous 12 monthse
n.a. 61.2 n.a. n.a. 33.2 n.a. n.a. 45.9 n.a.
Sample size 15-269 155-171 21-440
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 29
Note: Percentages are weighted to adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * 
statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates.
a Not reported because of small sample sizes (fewer than 10).
b Because multiple responses were possible, percentages may sum to more than 100.
c Training complemented by supportive supervision in critical skill areas in supply chain management (including supervision skills).
d Training plus (training and supportive supervision in critical skill areas) in malaria treatment, nutrition, supply chain management, and maternal & neonatal care, as training plus 
is defined for each of those. 
e Added at endline.
n.a. = not applicable (question not asked at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 30
TABLE 13B. STAFF TRAINING FOR DATA TRACKING AND MANAGEMENT AMONG HCS (PERCENTAGE OF HCS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Training in malaria data tracking
Facility had at least one staff member trained in malaria data collating and reporting in the previous 12 months:a
Nurses or CHOs 77.4 37.3 -40.1*** 72.9 53.7 -19.2** 75.1 45.7 -29.3***
Outpatient department in-charges 55.4 27.4 -28.0*** 38.7 36.4 -2.3 46.4 32.3 -14.1***
Records staff members 35.2 20.0 -15.2** 30.1 25.0 -5.1 32.4 22.7 -9.8**
Lab staff members 24.4 16.4 -7.9 26.6 22.3 -4.4 25.5 19.5 -6.1
Other staff members 15.7 6.8 -8.9** 34.0 17.0 -17.1** 25.8 12.4 -13.4***
Sample size 74-93 44-53 118-146
Facility had at least one staff member trained 
in malaria data collating and reporting in the 
previous 12 months
80.7 44.0 -36.6*** 88.3 66.5 -21.8*** 84.6 55.5 -29.0***
Facility has a person in charge of records 
with training on malaria data reporting and 
tools in the previous 12 months
53.1 48.7 -4.4 46.9 56.5 9.7 49.9 52.8 2.9
Sample size 87-92 50-53 137-145
Training in other tracking and management topics
Facility had at least one staff member trained in the following in the previous 12 months:a
Supply chain and logistics management 45.8 42.1 -3.8 46.0 40.7 -5.3 45.9 41.3 -4.6
Supervision skills 28.3 15.1 -13.2** 30.3 27.4 -2.9 29.3 21.3 -8.0
Other training† n.a. 71.3 n.a. n.a. 55.2 n.a. n.a. 63.1 n.a.
Sample size 93-96 53-54 147-150
Facility had at least one staff member who was trained and received supportive supervision in any of the following in the previous 12 months:a
Supply chain and logistics management 30.8 24.3 -6.5 36.8 26.3 -10.5 33.9 25.3 -8.6
Supervision skills 21.5 12.6 -8.9 24.6 25.5 1.0 23.1 19.2 -3.9
Sample size 74-98 44-55 16-153
Facility maintains a list of when refresher 
trainings, new skills trainings, or professional 
development trainings are due and 
conducted†
n.a. 9.4 n.a. n.a. 7.3 n.a. n.a. 8.3 n.a.
Facility with at least one staff member 
receiving “training plus” in supply chain 
managementb†
n.a. -- n.a. n.a. -- n.a. n.a. 82.7 n.a.
Facility with at least one staff member 
receiving “training plus”c†
n.a. 2.9 n.a. n.a. 2.6 n.a. n.a. 2.7 n.a.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 31
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Facility had unmet priority training needs in 
previous 12 monthsd
n.a. 71.1 n.a. n.a. 51.2 n.a. n.a. 60.7 n.a.
Sample size 91-95 53 144-148
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates.
a Because multiple responses were possible, percentages may sum to more than 100.
b Training complemented by supportive supervision in critical skill areas in supply chain management (including supervision skills).
c Training plus (training and supportive supervision in critical skill areas) in malaria treatment, nutrition, supply chain management, and maternal & neonatal care, as training plus is 
defined for each of those. 
d Added at endline.
†See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 32
E. Treatment Protocols and Sanitation and Infection Prevention 
TABLE 14A. AVAILABILITY OF TREATMENT PROTOCOLS AMONG CHPS (PERCENTAGE OF CHPS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Availability of written protocols for managing maternal and newborn care:
Protocols exist and seen 20.1 27.8 7.7* 27.1 27.2 0.1 24.0 27.5 3.5
Protocols exist, but not seen 7.3 8.3 1.0 4.6 3.9 -0.6 5.8 5.9 0.1
No protocols 72.6 63.9 -8.7** 68.3 68.9 0.5 70.2 66.7 -3.6
Sample size 263 169 432
Availability of written protocols for managing acute undernutrition:
Protocols exist and seen 28.4 30.7 2.3 32.9 36.9 4.1 30.9 34.1 3.3
Protocols exist, but not seen 9.0 9.8 0.8 8.1 8.5 0.4 8.5 9.1 0.6
No protocols 62.6 59.5 -3.1 59.1 54.6 -4.5 60.7 56.8 -3.9
Sample size 267 167 434
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
TABLE 14B. AVAILABILITY OF TREATMENT PROTOCOLS AMONG HCS (PERCENTAGE OF HCS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Availability of written protocols for managing maternal and newborn care:
Protocols exist and seen 56.7 66.7 10.0* 70.1 95.2 25.1*** 63.6 81.4 17.8***
Protocols exist, but not seen 19.8 11.3 -8.5** 12.4 1.5 -10.9** 16.0 6.3 -9.7***
No protocols 23.6 22.0 -1.6 17.5 3.3 -14.2*** 20.4 12.4 -8.1**
Sample size 96 55 151
Availability of written protocols for managing acute undernutrition:
Protocols exist and seen 41.2 41.1 -0.1 35.2 48.5 13.3 38.1 44.9 6.8
Protocols exist, but not seen 25.5 11.6 -13.9*** 12.1 3.6 -8.5 18.6 7.5 -11.1***
No protocols 33.3 47.3 14.0*** 52.7 47.9 -4.8 43.3 47.6 4.3
Sample size 96 55 151
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 33
TABLE 15A. SANITATION AND INFECTION PREVENTION AMONG CHPS (PERCENTAGE OF CHPS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Facility has access to water supply 
through piped water or bore holes†
n.a. 52.7 n.a. n.a. 64.5 n.a. n.a. 58.7 n.a.
Facility has a functional latrine or 
toilet†
n.a. 100.0 n.a. n.a. 98.7 n.a. n.a. 99.4 n.a.
Sample size 148-217 74-117 222-334
Key sanitation measures in place for prevention and control of infections:a
Hand-washing station/Veronica 
bucket 72.8 79.2 6.5** 69.8 62.9 -6.9** 71.1 70.2 -0.9
Staff consistently wear gloves 67.4 83.1 15.7*** 58.0 76.7 18.6*** 62.2 79.5 17.3***
Sample size 268 170-171 438-439
Key sterilization measures in place for prevention and control of infections:a
Availability of disinfectants 44.5 71.6 27.1*** 34.2 50.7 16.5* 38.8 60.1 21.2***
Protocol for mixing chlorine for 
disinfection 34.4 55.1 20.7*** 29.7 33.9 4.2 31.8 43.4 11.6***
Staff disinfects instruments 26.4 73.0 46.6*** 22.8 52.4 29.5*** 24.4 61.6 37.2***
Staff sterilizes equipment 9.6 53.7 44.1*** 10.1 41.9 31.8*** 9.9 47.2 37.3***
Availability of functioning 
sterilizing equipment such as 
boilers or autoclaves
11.1 15.7 4.6 5.3 7.0 1.7 7.9 10.9 3.0
Sample size 268 169 437
Key disposal measures in place for prevention and control of infections:a
Staff uses a sharps container 75.8 94.0 18.2*** 68.6 88.7 20.1*** 71.8 91.1 19.3***
Separation of waste disposal 43.4 79.4 36.0*** 43.2 62.8 19.6** 43.3 70.2 26.9***
Availability of polythene bags for 
waste†
n.a. 50.2 n.a. n.a. 43.7 n.a. n.a. 46.6 n.a.
Availability of a functioning 
incinerator 3.0 3.8 0.8 3.3 3.9 0.7 3.1 3.9 0.7
Sample size 268-269 171 439-440
Key measures in place for dealing with contagious clients for prevention and control of infections:a
Separating clients with contagious 
diseases from healthy clients 33.7 53.4 19.7*** 37.9 39.2 1.3 36.0 45.5 9.5**
Separating sick newborns from 
healthy newborns 6.4 37.6 31.2*** 8.6 30.9 22.4*** 7.6 33.9 26.2***
Sample size 256-262 168 424-430
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data 
Note: Percentages are weighted to adjust for sampling probabilities. Sample size varies across rows because of item nonresponse
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 34
Sample sizes are reported as ranges because variables have different response rates.
a Because multiple responses were possible (except for none), percentages sum to more than 100.
n.a. = not applicable (question not asked at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
TABLE 15B. SANITATION AND INFECTION PREVENTION AMONG HCS (PERCENTAGE OF HCS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Key sanitation measures in place for prevention and control of infections:a
Hand-washing station/Veronica 
bucket
96.8 93.9 -2.8 98.1 98.6 0.4 97.5 96.3 -1.2
Staff consistently wear gloves 87.4 90.4 2.9 96.9 96.7 -0.2 92.3 93.6 1.3
Sample size 98 55 153
Key sterilization measures in place for prevention and control of infections:a
Disinfectants 52.3 90.1 37.8*** 64.6 98.6 34.0*** 58.6 94.4 35.9***
Protocol for mixing chlorine for 
disinfection
52.6 83.3 30.7*** 66.5 88.6 22.2** 59.7 86.0 26.4***
Staff disinfects instruments 48.5 90.6 42.1*** 49.9 92.2 42.3*** 49.2 91.4 42.2***
Staff sterilizes equipment 32.5 82.3 49.8*** 51.7 90.3 38.6*** 42.3 86.4 44.1***
Functioning sterilizing equipment 
such as boilers or autoclaves
37.4 59.0 21.6*** 52.8 70.9 18.1** 45.2 65.1 19.8***
Sample size 98 55 153
Key disposal measures in place for prevention and control of infections:a
Staff uses a sharps container 79.7 99.0 19.3*** 84.0 100.0 16.0*** 81.9 99.5 17.6***
Separation of waste disposal 56.1 83.6 27.5*** 60.9 89.7 28.9*** 58.5 86.7 28.2***
Availability of polythene bags for 
waste†
n.a. 59.8 n.a. n.a. 77.3 n.a. n.a. 68.7 n.a.
Avaiialbility of a functioning 
incinerator
9.3 12.5 3.2 19.1 27.5 8.4 14.3 20.1 5.8
Sample size 98 54-55 152-153
Key measures in place for dealing with contagious clients for prevention and control of infections:a
Separating clients with contagious 
diseases from healthy clients
58.1 55.8 -2.3 68.5 61.8 -6.7 63.4 58.9 -4.6
Separating sick newborns from 
healthy newborns
18.7 51.4 32.7*** 23.8 56.7 32.9*** 21.3 54.1 32.8***
Sample size 96-97 55 151-152
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data 
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 35
Note: Percentages are weighted to adjust for sampling probabilities. Sample size varies across rows because of item nonresponse
Sample sizes are reported as ranges because variables have different response rates.
a Because multiple responses were possible (except for none), percentages sum to more than 100.
n.a. = not applicable (question not asked at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
F. Access to Supplies and Equipment
TABLE 16A. STOCK-OUTS AND SUPPLY CHAIN MANAGEMENT AMONG CHPS (PERCENTAGE OF CHPS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Facility has dedicated person responsible for 
ordering medicines and supplies
67.1 90.5 23.5*** 61.1 86.7 25.6*** 63.8 88.4 24.7***
Sample size 269 171 440
Standard operating procedures (SOP) manual:
Exists and seen 29.3 26.0 -3.3 7.9 10.5 2.7 17.2 17.3 0.1
Exists, but not seen 7.6 6.1 -1.6 4.6 3.9 -0.8 5.9 4.8 -1.1
No SOP manual 63.1 67.9 4.9 87.5 85.6 -1.9 76.8 77.9 1.0
Facility has utilized RRIRV (Report Requisition 
Issue and Receipt Voucher) to reorder 
commodities based on consumption†
n.a. 70.5 n.a. n.a. 64.7 n.a. n.a. 67.3 n.a.
Sample size 252-269 167-171 419-440
Frequency with which facility cannot supply clients’ needs due to a stock-out:
Once or more per week 10.7 22.9 12.3*** 5.9 6.9 1.0 8.2 14.6 6.4**
Once every two weeks 3.6 4.9 1.3 3.1 1.4 -1.6 3.3 3.1 -0.2
Once every three weeks 4.3 3.7 -0.6 2.0 1.6 -0.4 3.1 2.6 -0.5
Once per month 31.5 25.2 -6.3* 34.5 37.9 3.4 33.0 31.8 -1.2
Less often than once per month 50.0 43.2 -6.8 54.6 52.2 -2.4 52.4 47.9 -4.5
Sample size 250 143 393
Key sources of information for forecasting supply needs for malaria RDTs in the previous 12 months, among facilities that treat malaria:a
Number of malaria cases given a final 
diagnosis of malaria
35.5 43.6 8.0* 27.5 48.3 20.8*** 31.4 46.0 14.7***
Number of malaria cases given a provisional 
diagnosis of malaria
65.3 54.4 -10.9** 65.3 74.7 9.4 65.3 65.0 -0.3
Outpatient department attendance 34.4 40.9 6.5 46.2 46.5 0.2 40.5 43.8 3.3
Number of RDTs and microscopy tests 
performed
23.3 27.2 3.9 12.8 42.0 29.2*** 17.8 34.8 17.0***
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 36
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Some other data or method 14.5 21.6 7.2* 6.9 23.2 16.2** 10.6 22.4 11.8***
Sample size 195-197 110 305-307
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates and because some variables apply to different subsets of respondents.
a Because multiple responses were possible, percentages sum to more than 100.
n.a. = not applicable (question not asked at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
TABLE 16B. STOCK-OUTS AND SUPPLY CHAIN MANAGEMENT AMONG HCS (PERCENTAGE OF HCS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Facility has dedicated person responsible 
for ordering medicines and supplies 82.1 99.0 16.8*** 78.2 91.5 13.3* 80.1 95.1 15.0***
Sample size 97 55 152
Standard operating procedures (SOP) manual:
Exists and seen 40.8 44.8 4.0 24.3 39.5 15.2 32.1 42.0 9.9
Exists, but not seen 23.9 17.1 -6.8 24.9 19.1 -5.8 24.4 18.1 -6.3
No SOP manual 35.3 38.1 2.8 50.8 41.4 -9.4 43.5 39.9 -3.6
Facility has utilized RRIRV (Report 
Requisition Issue and Receipt Voucher) 
to reorder commodities based on 
consumption†
n.a. 83.4 n.a. n.a. 87.3 n.a. n.a. 85.3 n.a.
Sample size 88-97 52-54 140-151
Frequency with which facility cannot supply clients’ needs due to a stock-out:
Once or more per week 5.7 29.0 23.3*** 4.5 9.8 5.3 5.1 19.3 14.2***
Once every two weeks 4.7 6.2 1.5 3.9 2.7 -1.3 4.3 4.4 0.1
Once every three weeks 8.6 1.6 -7.0*** 0.0 4.5 4.5 4.3 3.1 -1.2
Once per month 27.4 31.2 3.7 38.8 35.1 -3.6 33.1 33.2 0.0
Less often than once per month 53.6 32.1 -21.5*** 52.8 47.9 -4.9 53.2 40.1 -13.1***
Sample size 96 52 148
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 37
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Key sources of information for forecasting supply needs for malaria RDTs in the previous 12 months, among facilities that treat malaria:a
Number of malaria cases given a final 
diagnosis of malaria 33.0 44.3 11.3* 40.5 50.5 10.0 36.7 47.4 10.6*
Number of malaria cases given a 
provisional diagnosis of malaria 64.5 64.3 -0.2 54.2 66.0 11.7 59.4 65.1 5.8
Outpatient department attendance 44.6 50.6 6.0 35.4 47.2 11.8 40.0 48.9 8.9
Number of RDTs and microscopy 
tests performed 30.2 32.1 1.9 17.2 72.4 55.2*** 23.7 52.3 28.6***
Some other data or method 9.4 16.2 6.8 11.1 19.2 8.0 10.3 17.7 7.4*
Sample size 94 50-51 144-145
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates and because some variables apply to different subsets of respondents.
a Because multiple responses were possible, percentages sum to more than 100.
n.a. = not applicable (question not asked at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 38
TABLE 17A. MANAGEMENT OF ESSENTIAL SUPPLIES AMONG CHPS (PERCENTAGE OF CHPS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Availability of control cards for specific commodities
Facility has control card for the following commodities related to nutrition, diarrhea, and infectious diseases:a
Albendazole for deworming 45.5 70.3 24.8*** 36.6 54.8 18.2*** 40.6 61.7 21.1***
First-line antibiotic treatment for 
severe acute malnutrition†
n.a. 64.5 n.a. n.a. 35.8 n.a. n.a. 48.6 n.a.
Iron and folic acid tablets 42.9 59.3 16.4*** 29.6 45.7 16.2*** 35.7 52.0 16.3***
Oral rehydration salts and zinc tablets 58.4 69.3 10.9*** 40.1 52.8 12.7*** 48.3 60.2 11.9***
Vitamin A 20.4 66.6 46.2*** 24.5 75.7 51.1*** 22.7 71.6 48.9***
Sample size 256-269 161-171 417-440
Facility has control card for the following immunization commodities: a
Polio 32.2 70.3 38.1*** 31.7 61.6 29.9*** 32.0 65.5 33.5***
Yellow fever 32.4 70.7 38.2*** 31.7 61.5 29.8*** 32.1 65.7 33.6***
Measles 32.1 70.8 38.7*** 32.3 61.5 29.2*** 32.2 65.7 33.5***
Rotarix 32.9 70.2 37.3*** 30.6 62.0 31.5*** 31.6 65.7 34.1***
Tetanus toxoid 30.3 58.3 28.0*** 29.4 60.4 31.0*** 29.8 59.4 29.7***
Pentavalent 33.1 71.1 37.9*** 33.6 61.7 28.1*** 33.4 65.9 32.5***
Pneumo 32.8 70.0 37.3*** 29.1 61.5 32.5*** 30.7 65.4 34.6***
Bacillus Calmette-Guerin 32.5 69.0 36.5*** 27.1 60.7 33.6*** 29.5 64.4 34.9***
Sample size 252-264 160-166 412-430
Facility has control card for the following malaria commodities: a
Pediatric syrup paracetamol 64.2 76.4 12.2*** 47.8 57.7 10.0 55.2 66.2 11.0***
Adult paracetamol 65.3 77.0 11.7*** 48.9 55.7 6.8 56.3 65.3 9.0***
Artesunate and amodiaquine 61.7 71.4 9.7*** 48.8 51.6 2.8 54.6 60.5 5.9**
Artemether and lumenfantrine 60.1 75.2 15.0*** 39.3 52.4 13.1** 48.7 62.7 14.0***
Malaria RDTs 48.1 76.8 28.7*** 41.3 57.4 16.1** 44.4 66.1 21.7***
Sulfadoxine pyrimethamine (SP) † n.a. 62.7 n.a. n.a. 40.0 n.a. n.a. 50.2 n.a.
Sample size 256-269 161-171 417-440
Facility has control card for the following family planning commodities, among facilities providing contraception: a
An injectable contraceptive 77.7 99.2 21.5*** 59.4 100.0 40.6*** 68.2 99.6 31.4***
Condoms 55.9 69.6 13.7*** 48.4 69.2 20.7*** 51.8 69.4 17.6***
A hormonal implant such as Implanon, 
Jadelle, Sino Implant II, or Norplant
35.6 77.6 42.0*** 19.4 73.6 54.2*** 26.7 75.4 48.7***
Combined oral contraceptive pills 57.9 74.3 16.4*** 33.9 67.6 33.7*** 44.8 70.7 25.9***
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 39
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Availability of control cards for specific commodities
Progestogen-only pill 17.9 43.7 25.8*** 5.1 28.8 23.7*** 10.9 35.6 24.7***
An intrauterine device 3.0 10.1 7.1*** 5.3 3.5 -1.8 4.2 6.5 2.3
Uterotonic drugs† n.a. 15.6 n.a. n.a. 12.1 n.a. n.a. 13.7 n.a.
Sample size 172-259 95-165 267-424
Availability of updated control cards for specific commodities
Facility has control card for the following nutrition commodities that was updated in the previous 30 days, among facilities with control cards available: a
Albendazole for deworming 15.7 39.5 23.9*** 12.2 40.7 28.5*** 13.8 40.2 26.4***
Iron and folic acid tablets 16.0 31.6 15.6*** 10.0 35.1 25.1*** 12.8 33.4 20.6***
Oral rehydration salts and zinc tablets 20.5 32.4 11.9*** 13.2 37.0 23.8*** 16.6 34.9 18.3***
Vitamin A 11.5 43.2 31.6*** 14.0 61.4 47.3*** 12.9 53.2 40.3***
First-line antibiotic treatment for 
severe acute malnutrition†
n.a. 36.7 n.a. n.a. 25.1 n.a. n.a. 30.3 n.a.
Sample size 253-269 150-171 412-440
Facility has control card for the following immunization commodities that was updated in the previous 30 days, among facilities with control cards available: a
Polio 25.0 52.8 27.8*** 21.5 51.5 29.9*** 23.1 52.1 29.0***
Yellow fever 24.5 52.2 27.7*** 21.1 50.7 29.5*** 22.7 51.4 28.7***
Measles 23.1 51.8 28.7*** 22.0 49.8 27.8*** 22.5 50.7 28.2***
Rotarix 25.4 54.6 29.3*** 21.1 51.3 30.2*** 23.0 52.8 29.8***
Tetanus toxoid 22.2 38.6 16.3*** 21.5 49.8 28.3*** 21.8 44.7 22.9***
Pentavalent 24.9 54.9 30.0*** 22.2 49.7 27.4*** 23.5 52.1 28.6***
Pneumo 24.6 52.6 28.0*** 21.5 49.2 27.7*** 22.9 50.8 27.8***
Bacillus Calmette-Guerin 23.8 48.1 24.3*** 14.6 48.7 34.1*** 18.8 48.4 29.6***
Sample size 250-263 153-162 403-423
Facility has control card for the following malaria commodities that was updated in the previous 30 days, among facilities with control cards available: a
Pediatric syrup paracetamol† n.a. 43.3 n.a. n.a. 42.3 n.a. n.a. 42.8 n.a.
Adult paracetamol† n.a. 43.2 n.a. n.a. 38.1 n.a. n.a. 40.4 n.a.
Artesunate and amodiaquine† n.a. 28.8 n.a. n.a. 26.1 n.a. n.a. 27.3 n.a.
Artemether and lumenfantrine† n.a. 39.6 n.a. n.a. 32.5 n.a. n.a. 35.7 n.a.
Malaria RDTs† n.a. 51.1 n.a. n.a. 44.2 n.a. n.a. 47.3 n.a.
Sulfadoxine pyrimethamine (SP) † n.a. 30.2 n.a. n.a. 27.0 n.a. n.a. 28.4 n.a.
Sample size 257-269 165-171 422-440
Facility has control card for the following family planning commodities that was updated in the previous 30 days, among facilities providing contraception with control cards 
available: a
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 40
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Availability of control cards for specific commodities
An injectable contraceptive† n.a. 60.7 n.a. n.a. 75.2 n.a. n.a. 68.2 n.a.
Condoms† n.a. 30.8 n.a. n.a. 40.9 n.a. n.a. 36.4 n.a.
A hormonal implant such as Implanon, 
Jadelle, Sino Implant II, or Norplant†
n.a. 42.3 n.a. n.a. 52.7 n.a. n.a. 48.1 n.a.
Combined oral contraceptive pills† n.a. 42.8 n.a. n.a. 49.9 n.a. n.a. 46.8 n.a.
Progestogen-only pill† n.a. 25.4 n.a. n.a. 20.5 n.a. n.a. 22.7 n.a.
An intrauterine device† n.a. 8.2 n.a. n.a. 4.3 n.a. n.a. 6.0 n.a.
Uterotonic drugs† n.a. 8.7 n.a. n.a. 7.5 n.a. n.a. 8.1 n.a.
Sample size 219-259 122-165 341-424
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
a Because multiple responses were possible, percentages may sum to more than 100.
Sample sizes are reported as ranges because variables have different response rates and because some variables apply to different subsets of respondents.
n.a. = not applicable (question not asked at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 41
TABLE 17B. MANAGEMENT OF ESSENTIAL SUPPLIES AMONG HCS (PERCENTAGE OF HCS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Availability of control cards for specific commodities
Facility has control card for the following commodities related to nutrition, diarrhea, and infectious diseases:a
Albendazole for deworming 75.1 84.7 9.7** 89.6 98.6 9.0** 82.7 92.0 9.3***
First-line antibiotic treatment for 
severe acute malnutrition†
n.a. 75.7 n.a. n.a. 78.0 n.a. n.a. 76.9 n.a.
Iron and folic acid tablets 68.7 75.1 6.4 83.7 88.2 4.5 76.5 81.9 5.4
Oral rehydration salts and zinc tablets 87.5 88.5 1.1 84.3 100.0 15.7*** 85.8 94.4 8.6**
Vitamin A 43.2 76.4 33.2*** 41.3 87.8 46.5*** 42.3 82.0 39.7***
Sample size 92-97 50-55 143-152
Facility has control card for the following immunization commodities: a
Polio 56.4 94.3 37.9*** 65.2 90.2 25.1*** 60.9 92.2 31.3***
Yellow fever 57.4 94.3 36.9*** 63.3 90.2 26.9*** 60.5 92.2 31.7***
Measles 56.4 95.4 39.0*** 64.9 88.8 23.9** 60.8 92.0 31.1***
Rotarix 56.8 94.3 37.5*** 63.3 90.2 26.9*** 60.2 92.2 32.0***
Tetanus toxoid 54.3 86.8 32.5*** 62.1 91.5 29.4*** 58.3 89.2 30.9***
Pentavalent 57.7 97.3 39.6*** 65.5 89.4 23.9** 61.7 93.3 31.6***
Pneumo 55.4 93.6 38.2*** 63.6 90.0 26.4*** 59.6 91.7 32.2***
Bacillus Calmette-Guerin 56.0 95.4 39.4*** 59.0 90.2 31.3*** 57.5 92.7 35.2***
Sample size 90-95 52-55 142-150
Facility has control card for the following malaria commodities: a
Pediatric syrup paracetamol 89.7 93.9 4.2 92.4 100.0 7.6* 91.1 97.0 5.9**
Adult paracetamol 90.5 93.4 2.9 88.6 98.6 10.0* 89.5 96.0 6.5**
Artesunate and amodiaquine 86.3 76.8 -9.5** 87.5 82.3 -5.2 86.9 79.6 -7.3**
Artemether and lumenfantrine 85.4 90.3 4.9 88.3 98.6 10.2** 86.9 94.5 7.6***
Malaria RDTs 75.8 86.0 10.1* 79.8 89.7 9.8 77.8 87.8 10.0**
Sulfadoxine pyrimethamine (SP) † n.a. 84.6 n.a. n.a. 87.2 n.a. n.a. 85.9 n.a.
Sample size 92-98 50-55 142-153
Facility has control card for the following family planning commodities, among facilities providing contraception: a
An injectable contraceptive 75.7 100.0 24.3*** 67.3 100.0 32.7*** 71.4 100.0 28.6***
Condoms 70.5 85.1 14.6** 60.8 82.9 22.2** 65.7 84.0 18.3***
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 42
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
A hormonal implant such as Implanon, 
Jadelle, Sino Implant II, or Norplant
63.7 92.3 28.6*** 58.4 92.9 34.5*** 61.1 92.6 31.5***
Combined oral contraceptive pills 67.6 87.7 20.0*** 54.8 82.2 27.3*** 61.3 84.9 23.7***
Progestogen-only pill 37.6 66.0 28.3*** 20.5 61.5 41.0*** 29.1 63.7 34.6***
An intrauterine device 32.8 39.0 6.1 17.6 32.2 14.5 25.3 35.6 10.3*
Uterotonic drugs† n.a. 63.7 n.a. n.a. 73.0 n.a. n.a. 68.4 n.a.
Sample size 68-95 41-52 109-147
Facility has control card for the following BEmONC commodities, among Health Centers: a
Parenteral antibiotics† n.a. 44.4 n.a. n.a. 63.4 n.a. n.a. 54.3 n.a.
Magnesium sulfate for preeclampsia 
and eclampsia†
n.a. 38.9 n.a. n.a. 59.7 n.a. n.a. 49.6 n.a.
Sample size 89 51-52 140-141
Availability of updated control cards for specific commoditiesa
Facility has control card for the following nutrition commodities that was updated in the previous 30 days, among facilities with control cards available:a
Albendazole for deworming 39.2 45.8 6.6 36.1 69.0 32.9*** 37.7 57.5 19.8***
Iron and folic acid tablets 36.2 46.4 10.2* 53.7 70.0 16.3 45.1 58.4 13.3**
Oral rehydration salts and zinc tablets 40.5 44.2 3.8 50.0 80.5 30.5*** 45.3 62.6 17.3***
Vitamin A 23.8 49.6 25.8*** 18.2 61.2 43.0*** 21.1 55.2 34.1***
First-line antibiotic treatment for 
severe acute malnutrition†
n.a. 49.9 n.a. n.a. 60.9 n.a. n.a. 55.6 n.a.
Sample size 88-97 47-55 136-152
Facility has control card for the following immunization commodities that was updated in the previous 30 days, among facilities with control cards available: a
Polio 44.1 69.4 25.3*** 47.5 75.1 27.5** 45.9 72.3 26.4***
Yellow fever 44.1 68.1 23.9*** 43.1 73.2 30.1*** 43.6 70.6 27.0***
Measles 45.2 63.7 18.5*** 48.0 74.8 26.8** 46.6 69.3 22.7***
Rotarix 46.4 66.7 20.3*** 46.2 74.8 28.6*** 46.3 70.8 24.5***
Tetanus toxoid 42.0 62.1 20.1*** 39.5 77.4 37.9*** 40.8 69.8 29.0***
Pentavalent 43.3 67.6 24.3*** 47.3 81.1 33.8*** 45.3 74.3 29.0***
Pneumo 43.9 67.1 23.1*** 46.0 75.7 29.7*** 45.0 71.4 26.4***
Bacillus Calmette-Guerin 41.8 63.9 22.1*** 41.6 76.3 34.7*** 41.7 70.1 28.4***
Sample size 88-91 48-50 136-141
Facility has control card for the following malaria commodities that was updated in the previous 30 days, among facilities with control cards available: a
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 43
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Pediatric syrup paracetamol† n.a. 51.3 n.a. n.a. 81.2 n.a. n.a. 66.6 n.a.
Adult paracetamol† n.a. 54.2 n.a. n.a. 76.1 n.a. n.a. 65.4 n.a.
Artesunate and amodiaquine† n.a. 29.8 n.a. n.a. 46.6 n.a. n.a. 38.1 n.a.
Artemether and lumenfantrine† n.a. 48.0 n.a. n.a. 71.0 n.a. n.a. 59.7 n.a.
Malaria RDTs† n.a. 67.6 n.a. n.a. 77.7 n.a. n.a. 72.6 n.a.
Sulfadoxine pyrimethamine (SP) † n.a. 48.5 n.a. n.a. 79.4 n.a. n.a. 64.3 n.a.
Sample size 95-98 52-55 147-153
Facility has control card for the following family planning commodities that was updated in the previous 30 days, among facilities providing contraception with control cards 
available: a
An injectable contraceptive† n.a. 67.1 n.a. n.a. 78.2 n.a. n.a. 72.9 n.a.
Condoms† n.a. 36.8 n.a. n.a. 54.6 n.a. n.a. 45.7 n.a.
A hormonal implant such as Implanon, 
Jadelle, Sino Implant II, or Norplant†
n.a. 52.7 n.a. n.a. 66.4 n.a. n.a. 59.5 n.a.
Combined oral contraceptive pills† n.a. 50.2 n.a. n.a. 60.1 n.a. n.a. 55.1 n.a.
Progestogen-only pill† n.a. 35.0 n.a. n.a. 42.4 n.a. n.a. 38.7 n.a.
An intrauterine device† n.a. 20.9 n.a. n.a. 25.2 n.a. n.a. 23.0 n.a.
Uterotonic drugs† n.a. 34.6 n.a. n.a. 57.1 n.a. n.a. 45.8 n.a.
Sample size 85-95 51-52 136-147
Facility has control card for the following BEmONC commodities that was updated in the previous 30 days, among Health Centers, among facilities with control cards available:
a
Parenteral antibiotics† n.a. 31.8 n.a. n.a. 53.8 n.a. n.a. 43.2 n.a.
Magnesium sulfate for preeclampsia 
and eclampsia†
n.a. 19.1 n.a. n.a. 42.0 n.a. n.a. 30.9 n.a.
Sample size 89 51-52 140-141
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates and because some variables apply to different subsets of respondents.
n.a. = not applicable (question not asked at baseline, or not comparable).
a Because multiple responses were possible, percentages may sum to more than 100.
†See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 44
TABLE 18A. STOCK-OUTS FOR SPECIFIC COMMODITIES IN PREVIOUS TWO MONTHS, AMONG CHPS WITH 
RELEVANT CONTROL CARDS (PERCENTAGE OF CHPS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Facility experienced stock-out of the following nutrition commodities, among facilities with relevant control cards:a
Albendazole for deworming 35.3 31.1 -4.2 9.3 17.2 7.9 22.9 24.5 1.6
Iron and folic acid tablets 30.4 33.0 2.6 21.2 2.9 -18.4** 26.6 20.5 -6.1
Oral rehydration salts (ORS) and 
zinc tablets
34.2 47.6 13.4* 25.3 7.4 -17.9** 30.2 29.5 -0.7
Vitamin A 18.6 17.4 -1.2 22.6 10.9 -11.7 21.1 13.4 -7.7
First-line antibiotic treatment for 
severe acute malnutrition†
n.a. 34.5 n.a. n.a. 16.5 n.a. n.a. 27.2 n.a.
Facility experienced stock out of any of 
4 nutrition commodities measured at 
baseline and endline (Albendazole, Iron 
and Folic Acid tablets, ORS and zinc 
tablets, Vitamin A)
69.3 70.2 0.9 50.6 32.0 -18.6* 61.2 53.7 -7.6
Sample size 39-172 34-64 73-236
Facility experienced stock-out of the following immunization commodities, among facilities with relevant control cards: a
Polio 10.6 8.7 -2.0 13.2 0.0 -13.2** 12.0 4.2 -7.7**
Yellow fever 10.1 10.3 0.2 20.7 0.0 -20.7** 15.6 5.0 -10.6***
Measles 9.6 4.0 -5.6 20.7 0.0 -20.7** 15.4 1.9 -13.5***
Rotarix 1.9 2.2 0.3 9.5 0.0 -9.5** 5.8 1.1 -4.7**
Tetanus toxoid 6.7 9.9 3.2 14.6 2.0 -12.6** 10.9 5.7 -5.2*
Pentavalent 19.9 9.9 -10.1* 20.2 0.0 -20.2*** 20.1 4.7 -15.4***
Pneumo 6.0 3.3 -2.6 11.7 2.4 -9.3 8.9 2.9 -6.1**
Bacillus Calmette-Guerin 20.9 13.0 -7.9 49.0 2.1 -47.0*** 34.5 7.7 -26.8***
Facility experienced stock out of any of 
8 immunization commodities 
43.0 29.0 -14.0 56.3 6.0 -50.3*** 49.9 17.0 -32.9***
Sample size 69-79 39-44 109-122
Facility experienced stock-out of the following malaria commodities, among facilities with relevant control cards:a
Pediatric syrup paracetamol 30.1 38.5 8.4 25.4 9.7 -15.8* 28.0 25.7 -2.3
Adult paracetamol 28.3 35.2 6.9 13.2 19.6 6.3 21.6 28.2 6.7
Artesunate and amodiaquine 24.6 54.6 30.0*** 13.6 34.7 21.1 19.8 45.9 26.1***
Artemether and lumenfantrine 23.0 44.5 21.5*** 22.2 31.4 9.3 22.6 38.9 16.2***
Malaria RDTs 22.2 8.3 -13.9** 24.5 2.5 -22.0*** 23.3 5.5 -17.9***
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 45
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Sulfadoxine pyrimethamine (SP)† n.a. 17.7 n.a. n.a. 4.9 n.a. n.a. 12.1 n.a.
Facility experienced stock out of any of 
5 malaria commodities measured at 
baseline and endline (Pediatric syrup 
paracetamol, Adult paracetamol, 
Artesunate and amodiaquine, 
Artemether and lumenfantrine, Malaria 
RDTs)
63.3 74.6 11.3 53.9 48.0 -5.9 59.1 62.9 3.8
Sample size 116-166 59-75 175-241
Facility experienced stock-out of the following family planning commodities, among facilities with relevant control cards: a
An injectable contraceptive 18.8 9.9 -8.9* 9.4 0.0 -9.4** 14.5 5.4 -9.1***
Condoms 13.1 40.8 27.7*** 12.1 37.8 25.8** 12.6 39.3 26.7***
A hormonal implant such as 
Implanon, Jadelle, Sino Implant II, or 
Norplant
16.4 11.8 -4.6 4.7 3.1 -1.5 12.2 8.7 -3.5
Combined oral contraceptive pills 14.4 17.4 3.0 14.6 9.7 -5.0 14.5 14.1 -0.4
Progestogen-only pill 6.7 35.5 28.8** --a --a -- a 5.2 27.7 22.5**
An intrauterine device -- b -- b -- b -- b -- b -- b -- b -- b -- b
Uterotonic drugs† n.a. 33.4 n.a. n.a. 21.5 n.a. n.a. 27.5 n.a.
Facility experienced stock out of any of 
6 family planning commodities measured 
at baseline and endline
80.0 76.1 -3.9 79.0 68.9 -10.1 79.7 73.6 -6.1
Sample size 22-132 13-55 25-187
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates and because some variables apply to different subsets of respondents.
a Not reported because of small sample sizes (fewer than 10).
a Because multiple responses were possible, percentages may sum to more than 100.
n.a. = not applicable (question not asked at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 46
TABLE 18B. STOCK-OUTS FOR SPECIFIC COMMODITIES IN PREVIOUS TWO MONTHS, AMONG HCS WITH
RELEVANT CONTROL CARDS (PERCENTAGE OF HCS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Facility experienced stock-out of the following nutrition commodities, among facilities with relevant control cards:a
Albendazole for deworming 21.5 41.6 20.1** 10.5 12.3 1.9 15.1 24.5 9.4*
Iron and folic acid tablets 35.7 42.5 6.8 9.4 24.3 14.9** 20.5 31.9 11.5**
Oral rehydration salts (ORS) and zinc tablets 37.2 46.8 9.6 10.8 20.7 10.0 23.0 32.8 9.8*
Vitamin A 29.3 15.6 -13.6 13.9 22.4 8.5 21.1 19.2 -1.9
First-line antibiotic treatment for severe acute 
malnutrition†
n.a. 35.1 n.a. n.a. 16.6 n.a. n.a. 25.4 n.a.
Facility experienced stock out of any of 4 nutrition 
commodities measured at baseline and endline 
(Albendazole, Iron and Folic Acid tablets, ORS and 
zinc tablets, Vitamin A) 
68.7 76.0 7.3 32.1 41.3 9.2 49.2 57.6 8.3
Sample size 27-73 16-46 43-118
Facility experienced stock-out of the following immunization commodities, among facilities with relevant control cards: a
Polio 8.4 4.1 -4.2 6.5 1.9 -4.5 7.3 2.9 -4.4
Yellow fever 9.4 13.6 4.2 3.6 2.7 -0.9 6.2 7.7 1.4
Measles 9.8 5.6 -4.3 3.6 0.0 -3.6 6.4 2.5 -3.9
Rotarix 8.1 4.7 -3.4 3.6 0.0 -3.6 5.6 2.1 -3.5
Tetanus toxoid 3.0 5.2 2.1 5.7 0.0 -5.7 4.5 2.3 -2.3
Pentavalent 17.0 2.9 -14.1** 13.9 0.0 -13.9** 15.4 1.4 -14.0***
Pneumo 2.8 10.1 7.3** 6.2 0.0 -6.2 4.6 4.7 0.0
Bacillus Calmette-Guerin 24.6 2.8 -21.8*** 23.4 4.7 -18.7* 24.0 3.8 -20.2***
Facility experienced stock out of any of 8 
immunization commodities acillus Calmette￾Guerin)
44.3 25.8 -18.5** 33.5 9.2 -24.3* 38.4 16.8 -21.6***
Sample size 45-50 30-34 77-84
Facility experienced stock-out of the following malaria commodities measured at baseline and endline, among facilities with relevant control cards: a
Pediatric syrup paracetamol 46.3 40.4 -5.9 15.9 15.1 -0.8 30.0 26.9 -3.2
Adult paracetamol 43.3 32.8 -10.5 10.5 29.3 18.8*** 25.9 31.0 5.0
Artesunate and amodiaquine 27.9 53.0 25.1** 0.0 56.0 56.0*** 13.8 54.5 40.8***
Artemether and lumenfantrine 28.4 44.9 16.5* 18.8 43.2 24.4*** 23.2 44.0 20.8***
Malaria RDTs 36.9 15.5 -21.4*** 13.1 17.4 4.3 24.2 16.5 -7.7
Sulfadoxine pyrimethamine (SP) † n.a. 21.1 n.a. n.a. 10.0 n.a. n.a. 15.4 n.a.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 47
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Facility experienced stock out of any of 5 malaria 
commodities (Pediatric syrup paracetamol, Adult 
paracetamol, Artesunate and amodiaquine, 
Artemether and lumenfantrine, Malaria RDTs)
80.0 78.4 -1.6 40.9 73.0 32.0*** 60.8 75.7 14.9***
Sample size 58-84 36-50 95-132
Facility experienced stock-out of the following family planning commodities, among facilities with relevant control cards: a
An injectable contraceptive 20.3 5.7 -14.7** 7.4 3.9 -3.4 14.1 4.8 -9.3**
Condoms 22.2 24.6 2.4 5.1 31.7 26.6** 14.4 27.8 13.4*
A hormonal implant such as Implanon, Jadelle, 
Sino Implant II, or Norplant 28.9 8.6 -20.3*** 14.9 4.6 -10.3 22.0 6.6 -15.4***
Combined oral contraceptive pills 5.6 5.1 -0.5 17.1 3.9 -13.2 11.0 4.5 -6.4
Progestogen-only pill 18.3 4.8 -13.5* -- b -- b -- b 25.5 3.3 -22.2*
An intrauterine device 33.4 10.8 -22.6 --b -- b -- b 29.7 7.0 -22.7
Uterotonic drugs† n.a. 26.9 n.a. n.a. 7.9 n.a. n.a. 16.8 n.a.
Facility experienced stock out of any of 6 family 
planning commodities measured at baseline and 
endline
64.3 42.4 -21.8* 64.0 36.2 -27.8 64.2 40.0 -24.1*
Sample size 22616 14185 16-99
Facility experienced stock-out of the following BEmONC commodities, among Health Centers with relevant control cards: a
Parenteral antibiotics† n.a. 18.5 n.a. n.a. 10.1 n.a. n.a. 13.4 n.a.
Magnesium sulfate for preeclampsia and 
eclampsia†
n.a. 20.6 n.a. n.a. 13.9 n.a. n.a. 16.6 n.a.
Sample size 38-41 31-32 70-72
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates and because some variables apply to different subsets of respondents.
a Because multiple responses were possible, percentages may sum to more than 100.
b Not reported because of small sample sizes (fewer than 10).
n.a. = not applicable (question not asked at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 48
TABLE 19A. AVAILABILITY OF ESSENTIAL SUPPLIES AMONG CHPS (PERCENTAGE OF CHPS)
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Among facilities with relevant control cards
Facility has the following nutrition commodities available:a
Albendazole for deworming 72.7 66.7 -6.0 90.8 87.4 -3.4 81.3 76.5 -4.8
Iron and folic acid tablets 85.5 62.3 -23.2*** 83.4 92.3 8.9 84.6 74.9 -9.7**
Oral rehydration salts and 
zinc tablets
67.6 40.5 -27.1*** 82.2 86.2 4.0 74.1 61.0 -13.1**
Vitamin A 87.8 74.3 -13.6 87.7 77.6 -10.0 87.7 76.3 -11.4**
First-line antibiotic treatment 
for severe acute 
malnutrition†
n.a. 63.9 n.a. n.a. 76.1 n.a. n.a. 68.8 n.a.
Facility has the following 4 
nutrition commodities available: 
Albendazole, Iron and Folic Acid 
tablets, ORS and zinc tablets, 
Vitamin A
14.8 10.5 -4.3 47.6 53.7 6.1 27.3 27.0 -0.3
Sample size 40-172 23-64 74-236
Facility has the following immunization commodities available: a
Measles 87.9 89.2 1.3 86.3 84.1 -2.3 87.1 86.6 -0.5
Polio 86.5 87.8 1.4 81.3 79.5 -1.8 83.8 83.6 -0.3
Pneumo 91.6 91.0 -0.6 84.4 86.6 2.2 87.9 88.7 0.9
Rotarix 96.5 95.9 -0.6 92.8 93.2 0.5 94.6 94.5 -0.1
Pentavalent 87.0 85.2 -1.7 83.3 92.7 9.4 85.0 89.2 4.2
Tetanus toxoid 88.0 82.8 -5.3 90.6 82.6 -8.0 89.4 82.7 -6.7
Yellow fever 96.0 93.7 -2.3 92.5 90.6 -1.9 94.2 92.1 -2.1
Bacillus Calmette-Guerin 76.4 81.0 4.5 70.6 69.9 -0.7 73.6 75.6 2.0
Facility has all of the above 
immunization commodities 
available
51.3 56.4 5.1 31.3 66.8 35.5*** 40.8 61.9 21.1***
Sample size 69-161 39-95 109-256
Facility has the following malaria commodities available: a
Pediatric syrup paracetamol 76.6 63.6 -13.0* 78.0 94.5 16.5* 77.2 77.4 0.1
Adult paracetamol 74.2 63.7 -10.4 91.8 79.9 -11.9 82.1 71.0 -11.1**
Artesunate and amodiaquine 81.4 30.4 -51.0*** 86.7 33.5 -53.2*** 83.7 31.8 -52.0***
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 49
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Artemether and 
lumenfantrine
81.0 51.6 -29.3*** 84.5 67.5 -17.0** 82.5 58.5 -24.0***
Malaria RDTs 84.5 96.5 12.0** 93.5 97.1 3.6 88.9 96.8 7.8**
Sulfadoxine pyrimethamine 
(SP)†
n.a. 79.2 n.a. n.a. 90.1 n.a. n.a. 84.0 n.a.
Facility has the following 5 
malaria commodities available 
(Pediatric syrup paracetamol, 
Adult paracetamol, Artesunate 
and amodiaquine, Artemether 
and lumenfantrine, Malaria 
RDTs)
45.1 8.9 -36.2*** 59.7 25.3 -34.4** 52.0 16.7 -35.3***
Sample size 91-165 43-75 134-240
Facility has the following family planning commodities available: a
An injectable contraceptive 94.8 94.0 -0.9 93.9 96.4 2.6 94.4 95.1 0.7
Condoms 89.2 57.7 -31.5*** 87.3 56.6 -30.7*** 88.2 57.1 -31.1***
A hormonal implant such as 
Implanon, Jadelle, Sino 
Implant II, or Norplant
79.7 91.6 11.9** 90.5 100.0 9.5 83.6 94.6 11.1**
Combined oral contraceptive 
pills
90.7 77.9 -12.8*** 85.5 84.6 -1.0 88.5 80.7 -7.7*
Progestogen-only pill 96.5 72.3 -24.3** --b -- b -- b 97.3 78.5 -18.8*
An intrauterine device -- b -- b -- b -- b -- b -- b -- b -- b -- b
Uterotonic drugs† n.a. 72.1 n.a. n.a. 83.3 n.a. n.a. 77.7 n.a.
Facility has all of the above family 
planning commodities available
-- b -- b -- b -- b -- b -- b -- b -- b -- b
Facility has no expired 
commodities (among vitamin A, 
Pentavalent, uterotonic drugs 
such as Oxytocin or 
ergometrine, malaria RDTs, 
Artesunate + amodiaquine, and 
injectable contraceptives), 
according to control cardsc†
n.a. 100.0 n.a. n.a. 100.0 n.a. n.a. 100.0 n.a.
Sample size 21-240 19-140 24-380
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 50
Sample sizes are reported as ranges because variables have different response rates.
a Because multiple responses were possible, percentages may sum to more than 100.
b Not reported because of small sample sizes (fewer than 10).
c Sample includes all facilities with a control card for at least one of these commodities.
n.a. = not applicable (question not asked at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 51
TABLE 19B. AVAILABILITY OF ESSENTIAL SUPPLIES AMONG HCS (PERCENTAGE OF HCS)
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Among facilities with relevant control cards
Facility has the following nutrition commodities available:a
Albendazole for deworming 80.5 61.3 -19.3** 92.1 87.8 -4.3 87.3 76.9 -10.5**
Iron and folic acid tablets 80.1 59.9 -20.3** 92.8 80.1 -12.7 87.4 71.5 -15.9**
Oral rehydration salts and zinc tablets 70.2 60.6 -9.5 95.6 87.1 -8.5 83.8 74.8 -9.0*
Vitamin A 83.6 80.0 -3.6 87.3 75.5 -11.7 85.5 77.6 -7.9
First-line antibiotic treatment for 
severe acute malnutrition
n.a. 70.3 n.a. n.a. 87.7 n.a. n.a. 79.3 n.a.
Facility has the following 4 nutrition 
commodities available: Albendazole, Iron 
and Folic Acid tablets, ORS and zinc tablets, 
Vitamin A
26.4 9.3 -17.1** 58.7 42.9 -15.8 41.7 25.3 -16.5**
Sample size 27-73 16-47 43-118
Facility has the following immunization commodities available: a
Measles 96.2 96.2 0.0 96.5 97.1 0.6 96.4 96.7 0.3
Polio 89.1 92.0 2.9 90.5 94.4 3.9 89.8 93.3 3.4
Pneumo 97.2 94.8 -2.4 96.4 97.0 0.6 96.8 96.0 -0.8
Rotarix 100.0 95.7 -4.3 93.7 100.0 6.3 96.6 98.0 1.4
Pentavalent 96.8 95.8 -1.1 91.3 95.7 4.5 93.7 95.8 2.1
Tetanus toxoid 91.9 93.8 1.9 96.1 93.4 -2.6 94.1 93.6 -0.5
Yellow fever 96.6 91.7 -4.9 96.3 96.9 0.6 96.4 94.5 -1.9
Bacillus Calmette-Guerin 92.5 98.1 5.6 90.1 100.0 9.9* 91.3 99.1 7.8**
Facility has all of the above immunization 
commodities available
80.9 71.9 -9.0 57.0 86.2 29.2*** 69.0 79.0 10.0*
Sample size 45-81 30-44 77-125
Facility has the following malaria commodities available: a
Pediatric syrup paracetamol 69.6 60.1 -9.5 86.5 92.1 5.6 78.7 77.3 -1.4
Adult paracetamol 58.7 68.7 10.0 93.7 87.3 -6.5 77.1 78.5 1.3
Artesunate and amodiaquine 77.8 36.6 -41.2*** 92.1 52.9 -39.2*** 85.1 45.0 -40.2***
Artemether and lumenfantrine 85.1 65.1 -20.0*** 88.1 85.8 -2.3 86.7 76.3 -10.4**
Malaria RDTs 77.3 89.0 11.7* 86.5 98.2 11.7* 82.2 93.9 11.7***
Sulfadoxine pyrimethamine (SP)† n.a. 82.1 n.a. n.a. 97.1 n.a. n.a. 89.9 n.a.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 52
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Facility has the following 5 malaria 
commodities available (Pediatric syrup 
paracetamol, Adult paracetamol, 
Artesunate and amodiaquine, Artemether 
and lumenfantrine, Malaria RDTs)
37.9 24.3 -13.6 69.3 42.6 -26.7 54.5 34.0 -20.5**
Sample size 48-84 29-50 77-131
Facility has the following family planning commodities available: a
An injectable contraceptive 80.3 95.8 15.5** 92.2 100.0 7.8 86.2 97.9 11.7**
Condoms 76.5 72.7 -3.8 82.1 70.2 -11.9 79.1 71.5 -7.6
A hormonal implant such as Implanon, 
Jadelle, Sino Implant II, or Norplant
79.6 92.6 12.9* 100.0 100.0 0.0 90.0 96.4 6.4**
Combined oral contraceptive pills 88.1 92.4 4.4 72.0 91.7 19.8 80.2 92.1 11.9*
Progestogen-only pill 71.0 90.4 19.4* -- -- -- 72.9 93.7 20.8
An intrauterine device 61.0 77.9 16.9 -- b -- b -- b 66.6 85.7 19.1**
Uterotonic drugs† n.a. 74.3 n.a. n.a. 89.7 n.a. n.a. 82.5 n.a.
Facility has all of the above family planning 
commodities available
-- b -- b -- b -- b -- b -- b -- b -- b --b
Sample size 22616 20-38 16-99
Facility has the following BEmONC commodities available (among Health Centers): a
Parenteral antibiotics† n.a. 73.7 n.a. n.a. 86.1 n.a. n.a. 81.2 n.a.
Magnesium sulfate for preeclampsia and 
eclampsia†
n.a. 77.9 n.a. n.a. 81.0 n.a. n.a. 79.8 n.a.
Facilities with one or more expired 
commodities (among vitamin A, 
Pentavalent, uterotonic drugs such as 
Oxytocin or ergometrine, malaria RDTs, 
Artesunate + amodiaquine, and injectable 
contraceptives) according to control 
cardsc†
n.a. 100.0 n.a. n.a. 100.0 n.a. n.a. 100.0 n.a.
Sample size 38-93 31-52 70-145
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates.
a Because multiple responses were possible, percentages may sum to more than 100.
b Not reported because of small sample sizes (fewer than 10). c Sample includes all facilities with a control card for at least one of these commodities.
n.a. = not applicable (question not asked at baseline, or not comparable). †See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 53
TABLE 20A. AVAILABILITY OF ESSENTIAL EQUIPMENT AMONG CHPS (PERCENTAGE OF CHPS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Facility has the following items for childbirth/delivery available and in working order, among facilities that conduct deliveries:a
Domiciliary midwifery kit† n.a. 57.5 n.a. n.a. 72.3 n.a. n.a. 64.1 n.a.
Sterile delivery kit† n.a. 73.6 n.a. n.a. 79.1 n.a. n.a. 76.0 n.a.
Suturing set† n.a. 70.9 n.a. n.a. 73.3 n.a. n.a. 72.0 n.a.
Hand held vacuum extractor 23.6 9.5 -14.1** 24.7 21.4 -3.2 24.1 15.0 -9.1**
An examination light 14.0 20.7 6.7 21.4 14.8 -6.6 17.5 17.9 0.4
An examination couch 57.0 50.5 -6.5 81.3 65.1 -16.2 68.6 57.5 -11.1
Postpartum hemorrhage, or PPH, pack for 
post-partum management
20.2 41.8 21.6*** 54.4 68.7 14.3 36.1 54.3 18.2***
Pre-eclampsia and eclampsia pack for 
management of eclampsia
9.9 38.2 28.3*** 30.8 55.2 24.3 19.5 46.0 26.4***
Resuscitation kits for resuscitating babies 49.0 58.5 9.5 61.6 75.9 14.3 55.0 66.7 11.8
Sample size 58-118 28-52 86-169
Facility has the following items for nutrition assessment and counselling available and in working order:a
A mid-upper arm circumference measuring 
tape, also known as a MUAC tape
57.6 83.2 25.5*** 41.3 81.3 40.0*** 48.6 82.1 33.5***
A tape measure 71.8 86.2 14.4*** 67.8 82.2 14.4*** 69.6 84.0 14.4***
A hanging scale or Salter weighting scale 95.8 91.3 -4.5** 85.1 87.8 2.7 89.9 89.4 -0.5
An adult weighing scale or bathroom scale 84.5 80.2 -4.3 81.0 83.8 2.8 82.6 82.2 -0.4
A baby-weighing scale or a newborn- or 
infant-weighing scale
47.8 43.5 -4.3 51.5 35.4 -16.1*** 49.8 39.0 -10.8***
An infantometer 14.3 12.9 -1.4 8.0 12.5 4.4 10.8 12.6 1.8
A weighing pant 68.4 63.6 -4.8 64.0 63.7 -0.2 65.9 63.7 -2.3
An Integrated Management of Neonatal 
and Childhood Illnesses chart booklet
50.1 42.4 -7.7* 24.0 33.9 9.9** 35.7 37.7 2.0
An infant and young child feeding register 34.0 47.0 13.0*** 30.4 57.7 27.3*** 32.0 52.9 20.9***
HemoCue Hb device and testing strips or 
coulter counter and testing strips†
n.a. 29.1 n.a. n.a. 17.3 n.a. n.a. 22.6 n.a.
Sample size 261-269 165-171 426-440
Facility has the following storage equipment available for use:a
A vaccine refrigerator 34.1 46.4 12.2*** 25.5 22.0 -3.5 29.4 32.9 3.6*
A vaccine fridge thermometer 40.4 42.9 2.5 25.6 21.5 -4.1 32.2 31.1 -1.1
An up-to-date temperature-monitoring 
sheet
32.8 37.3 4.5 18.4 16.9 -1.5 24.9 26.1 1.2
Ice packs 70.1 77.0 6.9*** 47.5 57.5 9.9* 57.6 66.2 8.6***
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 54
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
A cold box 34.8 30.4 -4.4 28.9 24.8 -4.2 31.6 27.3 -4.3*
An emergency storage plan 22.2 21.9 -0.4 21.3 11.2 -10.2*** 21.7 15.9 -5.8***
A vaccine carrier 89.4 89.2 -0.2 70.3 79.3 8.9* 78.9 83.7 4.8*
Clock or watch with second hand† n.a. 39.2 n.a. n.a. 33.1 n.a. n.a. 35.9 n.a.
Sample size 267-269 170-171 437-440
Facility has the following basic supplies available for use:a
A generator 27.4 5.1 -22.2*** 22.0 2.0 -20.0*** 24.4 3.4 -21.0***
A fire extinguisher 2.4 2.0 -0.4 0.8 4.1 3.2* 1.5 3.2 1.6*
Sample size 268 170 438
Facility meets minimum competency criteria 
for delivery of infant and young child feeding 
(IYCF)b†
n.a. 0.0 n.a. n.a. 0.0 n.a. n.a. 0.0 n.a.
Sample size 269 171 440
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates.
a Because multiple responses were possible, percentages may sum to more than 100.
b Includes quality service provision in the following areas: (1) Availability of all essential equipment in working order (6 items): Mid-upper-arm circumference tape (MUAC), 
hanging scale, bathroom weighing scale, infantometers, hemoglobin (HB) test kit; (2) Existence of at least one staff trained in the last 12 months in infant and young child feeding 
(IYCF); (3) Quality record keeping - completeness of infant records based on spot check of three records randomly pulled; (4) Availability of all nutrition commodities and 
supplies (5 items): Vitamin A capsules, Oral rehydration salts (ORS), Iron and Folic Acid tablets (IFAs), Infant and Young Child Feeding (IYCF) registers, and nutrition counseling 
materials (any of counseling cards, key messages leaflets, nutrition pamphlets, or other nutrition materials). 
n.a. = not applicable (question not asked at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
TABLE 20B. AVAILABILITY OF ESSENTIAL EQUIPMENT AMONG HCS (PERCENTAGE OF HCS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Facility has the following items for childbirth/delivery available and in working order:a
Domiciliary midwifery kit† n.a. 62.7 n.a. n.a. 81.0 n.a. n.a. 72.1 n.a.
Sterile delivery kit† n.a. 84.0 n.a. n.a. 98.7 n.a. n.a. 91.5 n.a.
Suturing set† n.a. 88.9 n.a. n.a. 88.2 n.a. n.a. 88.6 n.a.
Hand held vacuum extractor 42.8 40.9 -1.9 39.0 42.9 3.9 40.8 41.9 1.2
An examination light 47.0 45.9 -1.2 54.9 55.8 1.0 51.1 51.1 0.0
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 55
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
An examination couch 80.3 83.5 3.2 86.0 88.9 2.9 83.3 86.3 3.0
Postpartum hemorrhage, or PPH, 
pack for post-partum management
53.0 78.7 25.7*** 76.1 92.0 15.9* 65.2 85.7 20.5***
Pre-eclampsia and eclampsia pack 
for management of eclampsia
42.8 72.7 29.9*** 75.2 79.4 4.2 59.8 76.2 16.5***
Resuscitation kits for resuscitating 
babies
80.2 96.2 16.0*** 80.3 96.7 16.3** 80.3 96.4 16.2***
A large postpartum curette 20.6 31.3 10.7 29.8 46.9 17.1* 25.7 40.0 14.3**
Sample size 74-91 46-52 120-143
Facility has the following items for nutrition assessment and counselling available and in working order: a
A mid-upper arm circumference 
measuring tape, also known as a 
MUAC tape
72.0 92.6 20.7*** 46.6 87.5 40.9*** 59.2 90.0 30.8***
A tape measure 96.8 97.0 0.2 90.4 97.0 6.6* 93.5 97.0 3.5*
A hanging scale or Salter weighting 
scale
99.0 93.7 -5.3** 89.4 98.2 8.8** 94.1 96.0 1.9
An adult weighing scale or 
bathroom scale
97.3 91.2 -6.1*** 96.7 96.2 -0.5 97.0 93.7 -3.3
A baby-weighing scale or a 
newborn- or infant-weighing scale
82.3 83.0 0.7 91.2 91.6 0.4 86.9 87.4 0.5
An infantometer 26.7 45.2 18.5*** 34.7 32.4 -2.3 30.9 38.6 7.7
A weighing pant 73.8 68.8 -5.1 76.3 87.4 11.1 75.1 78.3 3.2
An Integrated Management of 
Neonatal and Childhood Illnesses 
chart booklet
67.4 63.9 -3.4 55.0 66.2 11.2 60.9 65.1 4.2
An infant and young child feeding 
register
56.4 68.7 12.4** 39.7 67.5 27.8*** 47.7 68.1 20.4***
HemoCue Hb device and testing 
strips or coulter counter and 
testing strips†
n.a. 54.7 n.a. n.a. 51.0 n.a. n.a. 52.8 n.a.
Sample size 91-98 53-55 145-153
Facility has the following storage equipment available for use: a 
A vaccine refrigerator 88.0 90.2 2.2 74.2 89.0 14.8** 81.0 89.6 8.6**
A vaccine fridge thermometer 84.9 85.9 1.0 81.1 89.0 8.0 83.0 87.5 4.6
An up-to-date temperature￾monitoring sheet
84.9 81.9 -3.0 74.1 87.9 13.8** 79.4 85.0 5.6
Ice packs 96.7 96.0 -0.8 91.8 100.0 8.2* 94.2 98.0 3.8
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 56
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
A cold box 68.1 63.6 -4.6 76.1 87.0 10.9 72.2 75.6 3.3
An emergency storage plan 53.7 57.6 3.8 75.8 65.1 -10.7 65.0 61.4 -3.6
A vaccine carrier 99.0 99.0 0.0 91.8 100.0 8.2* 95.3 99.5 4.2
Clock or watch with second hand† n.a. 65.5 n.a. n.a. 84.6 n.a. n.a. 75.2 n.a.
Sample size 98 55 153
Facility has the following basic supplies available for use: a
A generator 39.8 18.8 -21.0*** 54.2 21.6 -32.7*** 47.2 20.2 -26.9***
A fire extinguisher 17.9 27.5 9.6* 28.8 47.3 18.5** 23.5 37.6 14.1***
Sample size 98 55 153
Facilities meeting minimum 
competency criteria for delivery of 
infant and young child feeding (IYCF)b†
n.a. 0.0 n.a. n.a. 0.0 n.a. n.a. 0.0 n.a.
Sample size 98 55 153
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates.
a Because multiple responses were possible, percentages may sum to more than 100.
b Includes quality service provision in the following areas: 1) Availability of all essential equipment in working order: 6 items - Mid-upper-arm circumference tape (MUAC), 
hanging scale, bathroom weighing scale, infantometers, hemoglobin (HB) test kit; 2) Existence of at least one staff trained in the last 12 months in infant and young child feeding 
(IYCF); 3) Quality record keeping - completeness of infant records based on spot check of three records randomly pulled; 4) Availability of all nutrition commodities and 
supplies (5 items): Vitamin A capsules; Oral rehydration salts (ORS), Iron and Folic Acid tablets (IFAs); Infant and Young Child Feeding (IYCF) registers; and nutrition counseling 
materials (any of counseling cards, key messages leaflets, nutrition pamphlets, or other nutrition materials). We looked at commodities available the day of visit and commodities 
with bin card.
n.a. = not applicable (question not asked at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 57
TABLE 20.1A. AVAILABILITY OF COMMUNICATION TECHNOLOGY AMONG CHPS (PERCENTAGE OF CHPS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Availability of cell phones and cell phone features
Facility has working cell phone 13.9 35.2 21.3*** 21.0 43.2 22.3*** 17.8 39.6 21.8***
Facility has working cell phone
with short message service (SMS)
13.4 34.6 21.2*** 20.2 42.1 21.9*** 17.1 38.7 21.6***
Facility has working cell phone 
with multimedia service (MMS)
7.6 8.1 0.5 7.3 6.5 -0.8 7.4 7.2 -0.2
Facility has working cell phone 
with Internet access
6.5 4.5 -2.0 8.3 3.3 -5.0* 7.5 3.8 -3.7**
Facility has working cell phone 
with camera
9.5 24.0 14.5*** 10.3 19.3 9.0** 9.9 21.4 11.5***
Facility has a working smart phone 6.4 5.0 -1.5 7.2 3.8 -3.4 6.9 4.3 -2.5
Availability of computers and tablets
Facility has a working computer or 
tablet
8.4 42.4 34.0*** 6.6 15.9 9.3*** 7.4 27.8 20.4***
Facility has a working computer or 
tablet with Internet access
2.7 29.8 27.2*** 2.7 8.4 5.7** 2.7 18.0 15.3***
E-tracker application (Volta and Upper Eastern regions only)
Facility has a functioning computer 
or tablet that runs the DHIMS e￾tracker applicationa
n.a. 100.0 n.a. n.a. 100.0 n.a. n.a. 100.0 n.a.
Facility entered any client 
information into the e-tracker in 
previous two months, among 
facilities running the e-trackera
n.a. 61.6 n.a. n.a. 67.2 n.a. n.a. 64.7 n.a.
Facility used the e-tracker client 
transaction data to help make 
decisions about the delivery of 
health services in previous two 
months, among facilities that 
entered client information in the 
e-tracker in the last two monthsa
n.a. 54.7 n.a. n.a. 86.0 n.a. n.a. 72.4 n.a.
Sample size 41-268 20-170 61-438
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates.
a Added at endline. n.a. = not applicable (question not asked at baseline, or not comparable).
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 58
TABLE 20.1B. AVAILABILITY OF COMMUNICATION TECHNOLOGY AMONG HCS (PERCENTAGE OF HCS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Availability of cell phones and cell phone features
Facility has working cell phone 17.5 53.1 35.6*** 24.6 62.5 37.9*** 21.1 57.9 36.8***
Facility has working cell phone with 
short message service (SMS) 15.5 49.7 34.2*** 24.6 62.5 37.9*** 20.2 56.3 36.1***
Facility has working cell phone with 
multimedia service (MMS) 9.9 22.4 12.5** 14.1 20.6 6.5 12.1 21.4 9.4
Facility has working cell phone with 
Internet access 10.0 15.8 5.8 10.3 15.5 5.2 10.2 15.7 5.5
Facility has working cell phone with 
camera
11.2 35.1 23.8*** 16.6 40.9 24.2** 14.0 38.0 24.0***
Facility has a working smart phone 8.9 12.1 3.1 6.3 13.1 6.8 7.6 12.6 5.0
Availability of computers and tablets
Facility has a working computer or tablet 61.4 87.3 25.9*** 78.1 75.2 -3.0 69.9 81.1 11.2***
Facility has a working computer or tablet 
with Internet access 44.5 51.5 7.0 54.2 42.7 -11.5 49.5 47.0 -2.5
E-tracker application (Volta and Upper Eastern regions only)
Facility has a functioning computer or 
tablet that runs the DHIMS e-tracker 
applicationa
n.a. 100.0 n.a. n.a. -- b n.a. n.a. 95.2 n.a.
Facility entered any client information 
into the e-tracker in previous two 
months, among facilities running the e￾trackera
n.a. 74.8 n.a. n.a. -- b n.a. n.a. 69.8 n.a.
Facility used the e-tracker client 
transaction data to help make decisions 
about the delivery of health services in 
previous two months, among facilities 
that entered client information in the e￾tracker in the last two monthsa
n.a. 46.6 n.a. n.a. -- b n.a. n.a. 60.5 n.a.
Sample sizea 25-98 55 28-153
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates.
a Added at endline.b Not reported because of small sample sizes (fewer than 10).
n.a. = not applicable (question not asked at baseline, or not comparable).
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 59
TABLE 21A. HEALTH PROMOTION USING CAMPAIGN MATERIALS AMONG CHPS (PERCENTAGE OF CHPS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Facility displays GoodLife, Live it Well campaign 
materials†
n.a. 82.9 n.a. n.a. 72.3 n.a. n.a. 77.0 n.a.
Facility uses GoodLife, Live it Well campaign 
materials during health promotion activities†
n.a. 90.3 n.a. n.a. 84.9 n.a. n.a. 87.3 n.a.
Facility finds these materials very useful or 
moderately usefula
n.a. 100.0 n.a. n.a. 100.0 n.a. n.a. 100.0 n.a.
Sample sizea 240-269 146-171 386-440
Source: Health, Population, and Nutrition Office Health Systems Endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates.
a Added at endline. 
n.a. = not applicable (question not asked at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
TABLE 21B. HEALTH PROMOTION USING CAMPAIGN MATERIALS AMONG HCS (PERCENTAGE OF HCS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Facility displays GoodLife, Live it Well campaign 
materials†
n.a. 93.9 n.a. n.a. 92.6 n.a. n.a. 93.2 n.a.
Facility uses GoodLife, Live it Well campaign 
materials during health promotion activities†
n.a. 94.0 n.a. n.a. 87.9 n.a. n.a. 90.9 n.a.
Facility finds these materials very useful or 
moderately usefula
n.a. 100.0 n.a. n.a. 100.0 n.a. n.a. 100.0 n.a.
Sample sizea 93-98 48-55 141-153
Source: Health, Population, and Nutrition Office Health Systems Endline Survey Data
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates.
a Added at endline. 
n.a. = not applicable (question not asked at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 60
III. CULTURE OF QUALITY ASSURANCE AND QUALITY IMPROVEMENT
TABLE 22A. EXISTENCE OF QA/QI TEAMS AND PLANS AMONG CHPS (PERCENTAGE OF CHPS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Differenc
e
Baseline Endline Difference
Facility has a QA/QI action plan in place:
Plan exists and seen 30.4 45.3 15.0*** 37.4 51.4 14.0*** 34.3 48.7 14.4***
Plan exists, but not seen 17.5 21.5 4.0 12.5 18.1 5.6 14.7 19.6 4.9*
No plan 52.1 33.2 -18.9*** 50.1 30.5 -19.6*** 51.0 31.7 -19.3***
Sample size 265 168 433
Facility had used QA/QI nutritional 
information to improve services in the 
previous two months, among facilities 
with nutrition included as a topic in their 
action plan
37.1 89.9 52.9*** 53.9 55.3 1.4 49.2 65.0 15.8
Facility has implemented a malaria QI 
action plan in the previous two months, 
among facilities with malaria included as 
a topic in their action plan†
n.a. 66.0 n.a. n.a. 54.5 n.a. n.a. 58.7 n.a.
Sample size 19-79 21-66 40-145
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates.
n.a. = not applicable (question not asked at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 61
TABLE 22B. EXISTENCE OF QA/QI TEAMS AND PLANS AMONG HCS (PERCENTAGE OF HCS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Facility has an active QA/QI team 43.1 54.8 11.7** 40.8 62.3 21.5** 41.9 58.7 16.8***
Facility has an active QA/QI team that 
met at least once in the previous three 
months
29.9 44.0 14.1** 37.7 42.6 4.9 34.0 43.3 9.3*
Sample size 86 50 136
Facility has a QA/QI action plan in place:
Plan exists and seen 26.5 43.5 17.0*** 28.7 60.3 31.6*** 27.6 52.3 24.7***
Plan exists, but not seen 23.6 29.8 6.2 24.6 18.1 -6.5 24.1 23.6 -0.5
No plan 49.9 26.7 -23.2*** 46.8 21.6 -25.1*** 48.3 24.1 -24.2***
Sample size 93 55 148
Facility has an active QA/QI plana 22.3 39.3 17.0*** 29.8 40.0 10.2 26.2 39.7 13.4**
Facility had used QA/QI nutritional 
information to improve services in the 
previous two months, among facilities 
with nutrition included as a topic in their 
action plan
-- a -- a -- a -- a -- a -- a 17.6 73.9 56.3***
Facility has implemented a malaria QI 
action plan in the previous two months, 
among facilities with malaria included as 
a topic in their action plan†
n.a. 63.9 n.a. n.a. 72.9 n.a. n.a. 69.2 n.a.
Sample size 31-88 24-51 14-139
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note:Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates.
a Not reported because of small sample sizes (fewer than 10).
n.a. = not applicable (question not asked at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 62
TABLE 23A. DATA VALIDATION AMONG CHPS (PERCENTAGE OF CHPS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Facility validated the DHIMS2 
reports using source 
documents†
n.a. 85.3 n.a. n.a. 91.1 n.a. n.a. 88.5 n.a.
Sample size 264 169 433
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
n.a. = not applicable (question not asked at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
TABLE 23B. DATA VALIDATION AMONG HCS (PERCENTAGE OF HCS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Facility validated the DHIMS2 
reports using source 
documents†
n.a. 92.7 n.a. n.a. 95.8 n.a. n.a. 94.3 n.a.
Sample size 97 55 152
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
n.a. = not applicable (question not asked at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 63
TABLE 23.1A. DATA USE AMONG CHPS (PERCENTAGE OF CHPS)
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Facility used data generated for monthly reports for the following purposes in the previous 12 months:a
Plan community outreach 70.0 73.2 3.2 56.8 76.7 19.9*** 62.7 75.2 12.5***
Help allocate resources 64.3 64.2 -0.1 57.7 58.0 0.3 60.6 60.7 0.1
Improve supply chain and 
logistics 60.0 62.4 2.4 48.3 66.8 18.5*** 53.5 64.8 11.3***
Help develop action plans 54.4 69.1 14.7*** 54.0 72.5 18.5*** 54.2 71.0 16.8***
Identify training needs 44.4 52.1 7.8* 43.8 54.3 10.5* 44.0 53.3 9.3**
Plan or decide anything 
else 20.2 21.7 1.4 15.2 26.3 11.2** 17.3 24.3 7.0**
Sample size 163-176 110-111 273-287
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates.
a
Because multiple responses were possible, percentages sum to more than 100.
TABLE 23.1B. DATA USE AMONG HCS (PERCENTAGE OF HCS)
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Facility used data generated for monthly reports for the following purposes in the previous 12 months:a
Plan community outreach 82.8 84.7 1.9 71.4 97.5 26.0** 76.7 91.6 15.0**
Help allocate resources 87.4 76.9 -10.5* 76.3 88.0 11.6 81.5 82.7 1.2
Improve supply chain and 
logistics 79.0 74.2 -4.8 68.6 93.8 25.3*** 73.5 84.6 11.2*
Help develop action plans 74.7 71.3 -3.4 63.1 89.7 26.6*** 68.7 80.9 12.2**
Identify training needs 71.8 65.0 -6.8 62.7 67.0 4.3 67.1 66.1 -1.0
Plan or decide anything 
else 33.4 20.5 -13.0** 20.7 24.9 4.2 26.7 22.8 -3.8
Sample size 60-65 35-39 95-103
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates.a
Because multiple responses were possible, percentages sum to more than 100.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 64
TABLE 24A. DISPLAY OF DATA AND INFORMATION AMONG CHPS (PERCENTAGE OF CHPS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Facility has the following graphs or tables displayed:a
Maternal and child health or reproductive 
and child health
15.5 37.5 22.0*** 14.8 30.4 15.5*** 15.1 33.7 18.5***
Expanded Program on Immunization 49.1 64.8 15.7*** 48.0 77.0 29.1*** 48.5 71.4 22.9***
Malaria or insenticide-treated net 
distribution†
n.a. 21.2 n.a. n.a. 17.4 n.a. n.a. 19.1 n.a.
Sample size 262-264 157-171 419-435
Facility has at least one graph, or table with data 
from past month
24.8 4.4 -20.4*** 29.3 3.5 -25.8*** 27.3 3.9 -23.4***
Sample size 193 120 313
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates.
a Because multiple responses were possible, percentages sum to more than 100.
n.a. = not applicable (question not asked at baseline, or not comparable). †See Appendix E for midline and endline results for this indicator, which was added at midline.
TABLE 24B. DISPLAY OF DATA AND INFORMATION AMONG HCS (PERCENTAGE OF HCS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Facility has the following graphs or tables displayed:a
Maternal and child health or reproductive 
and child health
38.8 33.7 -5.1 35.1 57.7 22.6** 36.9 45.9 9.0
Expanded Program on Immunization 78.0 87.8 9.8** 81.7 89.1 7.3 79.9 88.4 8.5**
Malaria or insenticide-treated net 
distribution†
n.a. 30.3 n.a. n.a. 28.6 n.a. n.a. 29.4 n.a.
Sample size 95-97 53-55 148-152
Facility has at least one graph, or table with data 
from past month
38.9 2.7 -36.2*** 40.8 3.8 -36.9*** 39.9 3.3 -36.6***
Sample size 79 49 128
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates. a Because multiple responses were possible, percentages sum to more than 100. n.a. = not 
applicable (question not asked at baseline, or not comparable). †See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 65
IV. COMMUNITY AND GOVERNMENTAL SUPPORT FOR CHPS
TABLE 25A. COMMUNITY SUPPORT FOR CHPS (PERCENTAGE OF CHPS) 
Percentage of CHPS zones
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
CHPS has CHCs 54.8 94.7 40.0*** 69.3 99.4 30.1*** 62.8 97.3 34.5***
CHCs played a leading role in the previous 
12 months in developing a community health 
action plan, among CHPSs with a CHC
50.0 41.2 -8.8 48.2 65.8 17.6*** 48.9 56.5 7.6*
Sample size 139-260 113-163 252-423
Rating of CHCs’ effectiveness at mobilizing resources for the CHPS to provide services to the community, among CHPSs with CHCs:
Excellent 4.2 7.6 3.4 5.5 0.6 -4.9** 5.0 3.4 -1.6
Very good 7.6 15.3 7.6** 7.9 14.6 6.8* 7.8 14.9 7.1***
Good 34.2 45.9 11.7** 29.9 44.9 15.1** 31.6 45.3 13.7***
Fair 27.1 15.1 -12.1*** 22.3 26.4 4.2 24.2 22.0 -2.2
Poor 25.6 15.7 -9.9** 31.8 12.1 -19.6*** 29.4 13.5 -15.8***
CHCs do not do this at all 1.2 0.5 -0.7 2.7 1.2 -1.5 2.1 1.0 -1.2
Sample size 147 112 259
Rating of CHCs’ effectiveness at sensitizing and mobilizing the community for health action, among CHPSs with CHCs:
Excellent 2.2 3.7 1.5 3.3 1.4 -2.0 2.9 2.3 -0.6
Very good 13.5 21.4 7.9** 12.8 21.0 8.2 13.1 21.2 8.1**
Good 37.5 56.4 18.9*** 43.6 58.1 14.5* 41.2 57.4 16.2***
Fair 24.8 15.5 -9.3** 19.6 15.1 -4.5 21.6 15.2 -6.4
Poor 18.8 3.0 -15.8*** 18.0 3.7 -14.3*** 18.3 3.5 -14.9***
CHCs do not do this at all 3.2 0.0 -3.2* 2.7 0.7 -2.0 2.9 0.4 -2.4**
Sample size 147 113 260
Number of CHVs working with facility:
Number of CHVs (mean) 6.9 5.4 -1.5*** 4.7 4.2 -0.5** 5.7 4.7 -0.9***
Number of CHVs (median) 4.0 4.0 0.0a 3.0 4.0 1.0a 4.0 4.0 0.0a
Sample size 268 171 439
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 66
TABLE 25.1A. AVAILABILITY OF COMMUNITY-BASED SERVICES AMONG CHPS: COMMUNITY HEALTH 
VOLUNTEERS (PERCENTAGE OF CHPS) 
Focal regions Non-focal regions All regions
Baseline Endline Differenc
e
Baseline Endline Difference Baseline Endline Difference
Community health volunteers (CHVs)
Facility has at least one CHV 90.4 93.3 2.9 98.0 98.5 0.4 94.6 96.2 1.5
Sample size 268 171 439
Services offered by CHVs in the past 12 months:a
Home visits — assess, advise and educate on health 49.8 44.6 -5.2 50.3 62.7 12.4 50.1 55.1 5.0
Disease surveillance, identify cases, or report 39.8 55.9 16.0*** 55.0 66.8 11.8* 48.6 62.2 13.6***
Mobilize and sensitize community for health 
management action
31.0 38.8 7.8* 54.6 46.7 -7.9 44.7 43.4 -1.3
Provide first aid and treatment of minor ailments 29.5 8.5 -21.0*** 49.4 22.4 -27.0*** 41.0 16.5 -24.5***
Disseminate health promotion materials or information 29.2 42.5 13.3*** 44.9 54.5 9.6 38.3 49.4 11.2***
Communicate between CHO and community on health 
status of community
24.0 33.0 9.0** 49.2 33.7 -15.5* 38.6 33.4 -5.2
Assist CHO with home visits, outreach or work at the 
CHPS
30.2 59.2 29.0*** 32.5 64.0 31.4*** 31.6 62.0 30.4***
Support the organization of community health meetings 
(durbars)
19.4 42.0 22.6*** 40.5 74.0 33.5*** 31.6 60.5 28.9***
Home visits — follow-up on defaulters 23.1 29.5 6.4 36.5 45.7 9.2 30.9 38.9 8.0*
Refer clients to CHO for disease treatment, family 
planning or nutrition
27.5 27.2 -0.3 29.2 40.9 11.6* 28.5 35.1 6.6*
Support antenatal, postnatal or infant care 19.7 31.0 11.3*** 28.2 35.5 7.3 24.6 33.6 9.0**
Collaborate with CHO or support CHPS service 
delivery
15.6 32.6 17.1*** 23.5 29.4 5.9 20.2 30.8 10.6***
Assist in compiling and updating community register or 
profile
8.0 15.6 7.7** 15.8 24.2 8.4 12.5 20.6 8.1**
Provide condoms or family planning information 9.5 15.3 5.8* 12.4 29.6 17.3** 11.2 23.6 12.4***
Facilitate support group sessions† n.a. 13.4 n.a. n.a. 12.6 n.a. n.a. 13.0 n.a.
Something else† n.a. 21.3 n.a. n.a. 4.7 n.a. n.a. 11.9 n.a.
Sample size 232-251 164-168 396-419
Number of CHVs working with facility:
Number of CHVs (mean) 6.9 5.4 -1.5*** 4.7 4.2 -0.5** 5.7 4.7 -0.9***
Number of CHVs (median) 4.0 4.0 0.0b 3.0 4.0 1.0b 4.0 4.0 0.0b
Sample size 268 171 439
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 67
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages, means, and medians are weighted using weights that adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically 
significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates and because some variables apply to different subsets of respondents.
The content of this table was part of Table 10A at baseline and midline.
a Because multiple responses were possible, percentages sum to more than 100.
b Statistical significance for the change in medians was not calculated.
n.a. = not applicable (not measured at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
TABLE 25.1B. AVAILABILITY OF COMMUNITY-BASED SERVICES AMONG HCS: COMMUNITY HEALTH VOLUNTEERS
(PERCENTAGE OF HCS) 
Focal regions Non-focal regions All regions
Baseline Endline Differenc
e
Baseline Endline Difference Baseline Endline Difference
Community health volunteers (CHVs)
Facility has at least one CHV 87.8 88.5 0.7 95.1 92.2 -2.8 91.6 90.4 -1.1
Sample size 95 55 150
Services offered by CHVs in the past 12 months:a
Home visits — assess, advise and educate on health 43.6 45.1 1.5 62.9 59.2 -3.7 53.8 52.6 -1.2
Disease surveillance, identify cases, or report 56.5 53.5 -3.0 74.4 81.8 7.3 66.0 68.4 2.4
Mobilize and sensitize community for health 
management action 38.7 45.8 7.2 48.2 59.9 11.7 43.7 53.2 9.6
Provide first aid and treatment of minor ailments 46.2 12.0 -34.1*** 58.6 25.6 -33.0*** 52.7 19.2 -33.5***
Disseminate health promotion materials or information 35.6 55.9 20.4** 57.6 77.8 20.3** 47.2 67.5 20.3***
Communicate between CHO and community on health 
status of community 24.5 36.3 11.8* 50.2 42.1 -8.1 38.0 39.3 1.3
Assist CHO with home visits, outreach or work at the 
CHPS 35.0 59.4 24.4*** 46.1 63.5 17.4*** 40.9 61.6 20.7***
Support the organization of community health meetings 
(durbars) 25.4 48.9 23.5*** 57.4 73.8 16.3** 42.3 62.0 19.7***
Home visits — follow-up on defaulters 32.1 32.7 0.5 32.1 48.7 16.7** 32.1 41.2 9.1
Refer clients to CHO for disease treatment, family 
planning or nutrition 21.3 39.7 18.4*** 37.4 45.2 7.8 29.8 42.6 12.8***
Support antenatal, postnatal or infant care 29.0 31.5 2.6 36.9 37.2 0.3 33.1 34.5 1.4
Collaborate with CHO or support CHPS service 
delivery 20.0 14.6 -5.4 30.9 18.4 -12.6 25.8 16.6 -9.2
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 68
Assist in compiling and updating community register or 
profile 12.6 14.7 2.0 36.1 26.0 -10.1 24.9 20.6 -4.3
Provide condoms or family planning information 11.8 18.2 6.4 15.8 24.5 8.7 13.9 21.5 7.6*
Facilitate support group sessions† n.a. 15.5 n.a. n.a. 19.5 n.a. n.a. 17.6 n.a.
Something else† n.a. 15.5 n.a. n.a. 8.6 n.a. n.a. 11.9 n.a.
Sample size 78-86 46-51 124-137
Number of CHVs working with facility:
Number of CHVs (mean) 12.8 7.4 -5.3*** 12.7 7.3 -5.5*** 12.7 7.3 -5.4***
Number of CHVs (median) 6.0 5.0 -1.0b 7.0 5.0 -2.0b 6.0 5.0 -1.0b
Sample size 95 55 150
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages, means, and medians are weighted using weights that adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically 
significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates and because some variables apply to different subsets of respondents.
The content of this table was part of Table 10B at baseline and midline.
a Because multiple responses were possible, percentages sum to more than 100.
b Statistical significance for the change in medians was not calculated.
n.a. = not applicable (not measured at baseline, or not comparable).
†See Appendix E for midline and endline results for this indicator, which was added at midline.
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 69
V. HEALTH INSURANCE
TABLE 26A. HEALTH INSURANCE AMONG CHPS (PERCENTAGE OF CHPS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Facility submitted at least one National Health 
Insurance Scheme (NHIS) claim in previous two 
months
75.3 73.4 -2.0 72.8 58.0 -14.8*** 73.9 64.9 -9.1***
Sample size 258 167 425
Change in number of clients who are part of NHIS in previous two months:
Increase 60.9 38.0 -22.9*** 69.1 27.6 -41.5*** 65.4 32.4 -33.0***
Decrease 26.7 45.8 19.1*** 24.2 43.0 18.8** 25.4 44.3 18.9***
No change 12.4 16.2 3.8 6.6 29.4 22.8*** 9.3 23.3 14.1***
Facility’s respondent is aware of at least some 
health services not covered by NHIS
53.1 55.1 2.0 57.9 40.8 -17.2*** 55.7 47.2 -8.5***
Facility received reimbursements for one or 
more insurance claima
n.a. 47.0 n.a. n.a. 64.0 n.a. n.a. 55.9 n.a.
Facility received one or more insurance 
reimbursements within 6 months of submitting 
the claima
n.a. 26.0 n.a. n.a. 18.9 n.a. n.a. 21.8 n.a.
Sample size 59-218 47-136 106-354
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates.
a Added at endline.
n.a. = not applicable (question not asked at baseline, or not comparable).
APPENDIX TABLES FOR THE QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 70
TABLE 26B. HEALTH INSURANCE AMONG HCS (PERCENTAGE OF HCS) 
Focal regions Non-focal regions All regions
Baseline Endline Difference Baseline Endline Difference Baseline Endline Difference
Facility submitted at least one National Health 
Insurance Scheme (NHIS) claim in previous two 
months
96.1 97.1 1.0 94.6 91.4 -3.2 95.4 94.2 -1.2
Sample size 94 53 147
Change in number of clients who are part of NHIS in previous two months:
Increase 70.8 39.2 -31.6*** 69.1 39.8 -29.4*** 69.9 39.5 -30.5***
Decrease 19.4 57.1 37.7*** 29.2 48.1 18.9** 24.4 52.5 28.0***
No change 9.8 3.7 -6.1* 1.7 12.1 10.5** 5.6 8.0 2.4
Facility’s respondent is aware of at least some 
health services not covered by NHIS
62.5 68.9 6.4 67.9 61.5 -6.5 65.3 65.1 -0.2
Facility received reimbursements for one or 
more insurance claima
n.a. 70.0 n.a. n.a. 77.7 n.a. n.a. 74.1 n.a.
Facility received one or more insurance 
reimbursements within 6 months of submitting 
the claima
n.a. 24.1 n.a. n.a. 13.7 n.a. n.a. 18.4 n.a.
Sample size 44-93 30-53 74-146
Source: Health, Population, and Nutrition Office Health Systems baseline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. 
*** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * statistically significant at the 10 percent level.
Sample sizes are reported as ranges because variables have different response rates, or because some questions were asked to different sub-sets of respondents.
a Added at endline. 
n.a. = not applicable (question not asked at baseline, or not comparable).
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
APPENDIX E. MIDLINE AND ENDLINE RESULTS (PERCENTAGE OF FACILITIES) 
This appendix presents a set of tables that results from the midline and endline surveys, the difference between those 
results, and the significance of those differences. These tables include the subset of indicators for which we cannot report baseline 
results or baseline-endline differences because the survey questions used to calculate the indicators were added at midline. Where 
appropriate, a small number of additional indicators are included to provide context for the subset of indicators included in these 
tables. The sample used for these tables includes facilities that responded to the midline and endline surveys. In constrast, the analysis 
sample for most tables and figures in the report includes facilities that responded to the baseline and endline surveys. Because the two 
samples differ slightly, the endline results that appear in these tables may differ slightly from those that appear in the report.
III. QUALITY OF CARE AND SERVICES
B. Integration of Care: Referrals and Follow-Up Care
TABLE 5B: REFERRALS OUT OF AND INTO A FACILITY AMONG HCS 
Focal regions Non-focal regions All regions
Midline Endline Difference Midline Endline Difference Midline Endline Difference
From appendix table 5B: Referrals out of and into the facility among HCs
Referrals in previous two months: 
Average percentage of all clients seen 
who were referred into the facility
0.1 0.1 0.1*** 0.2 0.5 0.3* 0.1 0.3 0.2**
Sample size 72 48 120
Source: Health, Population, and Nutrition Office Portfolio Health Systems midline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * 
statistically significant at the 10 percent level. 
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
TABLE 5.1: COMMON REASONS FOR REFERRALS (PERCENTAGE OF FACILITIES)
Focal regions Non-focal regions All regions
Midline Endline Difference Midline Endline Difference Midline Endline Difference
From appendix table 5.2A: Referrals out of and into the facility among CHPS
Common reasons for referrals out of the facility in the previous two months, as documented among facilities conducting referrals:a
Acute malnutrition 2.5 4.0 1.5 5.6 15.0 9.4 4.0 9.3 5.3
Diabetes 3.4 4.9 1.5 0.0 5.0 5.0* 1.8 5.0 3.2**
Other 31.5 27.1 -4.4 48.8 41.5 -7.2 39.8 34.0 -5.8
Sample size 116 55 171
From appendix table 5.2B: Common reasons for referrals among HCs
Common reasons for referrals out of the facility in the previous two months, as documented among facilities conducting referrals:a
Acute malnutrition 5.6 2.8 -2.9 3.0 12.4 9.4* 4.3 7.8 3.5
Diabetes 8.2 14.9 6.7* 26.6 18.3 -8.3 17.8 16.7 -1.1
Something else 47.8 47.0 -0.8 66.0 55.0 -10.9 57.4 51.3 -6.2
Sample size 78 47-48 125-126
Common reasons for referrals into the facility in the previous two months, among facilities receiving referrals:a
Acute malnutrition --b -- b -- b -- b -- b -- b -- b -- b -- b
Diabetes -- b -- b -- b -- b -- b -- b -- b -- b -- b
Stroke 10.2 0.0 -10.2*** 0.0 7.3 7.3 3.7 4.7 1.1
Sample size 14 14 28
Source: Health, Population, and Nutrition Office Portfolio Health Systems midline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * 
statistically significant at the 10 percent level. 
Sample sizes are reported as ranges when variables have different response rates and when variables apply to different subsets of respondents. 
a Because multiple responses were possible, percentages may not sum to 100.
b Not reported because of small sample sizes (fewer than 10).
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
C. Availability of Services 
TABLE 6. AVAILABILITY OF MALARIA SERVICES AMONG CHPS (PERCENTAGE OF FACILITIES) 
Focal regions Non-focal regions All regions
Midline Endline Difference Midline Endline Difference Midline Endline Difference
From appendix table 6A: Availability of malaria services among CHPS
Facility reported that all suspected cases 
of malaria were tested using RDT and/or 
microscopy in the last two months and 
the results were recorded in the register
50.7 65.8 15.1*** 50.8 51.3 0.5 50.7 57.8 7.0*
Sample size 262 167 429
Facility provided these reasons for not testing for malaria for every client with a provisional diagnosis of malaria, among facilities that did not test and record results for all clients 
with a provisional diagnosis:a
Insufficient supply of RDT 93.7 75.8 -17.9 -- b -- b -- b 96.4 81.0 -15.5
RDT/lab is not available at all times of 
the day and night
24.1 0.0 -24.1* -- b -- b -- b 19.0 4.6 -14.4
Lack of skill in conducting 
RDT/microscopy
0.0 0.0 0.0 -- b -- b -- b 0.0 0.0 0.0
Other reasons 0.0 30.7 30.7** -- b -- b -- b 0.0 28.1 28.1*
Sample size 17 --b 25
Facility adhered to GHS protocol for 
malaria treatment in two previous months
44.7 63.6 18.9*** 48.8 46.0 -2.8 47.0 53.8 6.8**
Sample size 255 165 420
From appendix table 6B: Availability of malaria services among HCs
Facility reported that all suspected cases 
of malaria were tested using RDT and/or 
microscopy in the last two months and 
the results were recorded in the register
50.1 76.7 26.6*** 41.4 58.0 16.6** 45.7 67.3 21.6***
Sample size 96 52 148
Facility provided these reasons for not testing for malaria for every client with a provisional diagnosis of malaria, among facilities that did not test and record results for all clients 
with a provisional diagnosis:a
Insufficient supply of RDT -- b -- b -- b -- b -- b -- b 100.0 70.8 -29.2**
RDT/lab is not available at all times of 
the day and night
-- b -- b -- b -- b -- b -- b 18.2 22.9 4.7
Lack of skill in conducting 
RDT/microscopy
-- b -- b -- b -- b -- b -- b 0.0 0.0 0.0
Other reasons -- b -- b -- b -- b -- b -- b 0.0 42.5 42.5**
Sample size -- b -- b 16
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
Facility adhered to GHS protocol for 
malaria treatment in two previous months
44.5 73.3 28.8*** 34.3 58.7 24.3*** 39.5 66.1 26.6***
Sample size 93 49 142
Source: Health, Population, and Nutrition Office Portfolio Health Systems midline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * 
statistically significant at the 10 percent level. 
Sample sizes are reported as ranges when variables have different response rates and when variables apply to different subsets of respondents. 
a Because multiple responses were possible, percentages may not sum to 100.
b Not reported because of small sample sizes (fewer than 10).
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
TABLE 7. AVAILABILITY OF FAMILY PLANNING COUNSELING AND CONTRACEPTIVES (PERCENTAGE OF 
FACILITIES, UNLESS OTHERWISE INDICATED)
Focal regions Non-focal regions All regions
Midline Endline Difference Midline Endline Difference Midline Endline Difference
From appendix table 7A: Availability of family planning services among CHPS
Facility can provide long-acting methods 
of contraception on day of interview, 
among those with control cards for those 
methodsa
100.0 100.0 0.0 100.0 98.6 -1.4 100.0 99.4 -0.6
Facility can provide at least 4 modern 
methods of family planning on day of 
interview, among facilities with control 
cards for those methods)b
75.0 58.3 -16.7** 71.1 61.7 -9.4 73.5 59.6 -13.9
Number of clients receiving 
contraceptives for the first time from 
facility in previous two months (mean)
19.8 13.0 -6.8*** 10.5 9.9 -0.6 14.7 11.3 -3.4***
Number of clients receiving 
contraceptives for the first time from 
facility in previous two months (median)
12.0 8.0 -4.0 5.0 6.0 1.0 8.0 7.0 -1.0
Sample size 79-267 25-171 104-438
From appendix table 7B: Availability of family planning services among HCs
Facility can provide long-acting methods 
of contraception on day of interview, 
among those with control cards for those 
methodsa
98.8 98.5 -0.4 100.0 100.0 0.0 99.4 99.2 -0.2
Facility can provide at least 4 modern 
methods of family planning on day of 
interview, among facilities with control 
cards for those methods)b
69.1 86.9 17.8** 76.3 71.5 -4.9 71.8 81.0 9.2
Number of clients receiving 
contraceptives for the first time from 
facility in previous two months (mean)
43.6 42.0 -1.6 57.2 32.2 -25.0** 50.6 37.0 -13.5*
Number of clients receiving 
contraceptives for the first time from 
facility in previous two months (median)
22.0 22.0 0.0 34.0 19.0 -15.0 27.0 20.0 -7.0
Sample size 57-98 20-55 77-153
Source: Health, Population, and Nutrition Office Portfolio Health Systems midline and endline survey data
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
Note: Percentages are weighted to adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * 
statistically significant at the 10 percent level. 
Sample sizes are reported as ranges when variables have different response rates and when variables apply to different subsets of respondents. 
 
aLong-acting methods of contraception include hormonal implants and intrauterine devices (IUDs). 
bModern methods of family planning include hormonal implants, IUDs, oral contraceptives (combined or progestogen-only pills), injectable contraceptives, and 
condoms.
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
TABLE 8. AVAILABILITY OF DELIVERY AND ANTENATAL CARE SERVICES 
(PERCENTAGE OF FACILITIES, UNLESS OTHERWISE INDICATED)
Focal regions Non-focal regions All regions
Midline Endline Difference Midline Endline Difference Midline Endline Difference
From appendix table 8A: Availability of delivery and antenatal care services among CHPS
Facility conducts deliveries 47.7 44.2 -3.5 37.1 28.3 -8.8** 41.8 35.4 -6.4***
Sample size 269 171 440
Delivery care in the previous two months, among facilities conducting deliveries: 
Percentage of attended births that 
were registered at the facility 99.0 97.8 -1.2 98.0 96.6 -1.4 98.5 97.2 -1.3
Facility registered any home births 50.0 30.7 -19.3*** 35.8 25.8 -10.0* 42.1 27.9 -14.1***
Facility recorded reasons for all 
maternal deaths (among facilities with 
any maternal deaths)
-- a --a -- a -- a --a -- a -- a --a -- a
Facility recorded reasons for all 
neonatal deaths (among facilities with 
any neonatal deaths)
-- a --a -- a -- a --a -- a -- a --a -- a
Sample size 70-263 31-169 101-432
From appendix table 8B: Availability of delivery and antenatal care services among HCs
Facility conducts deliveries 90.7 93.2 2.5 91.0 95.0 4.0* 90.8 94.1 3.2**
Sample size 98 55 153
Delivery care in the previous two months, among facilities conducting deliveries:
Percentage of attended births that 
were registered at the facility 100.0 98.0 -2.0 99.6 100.0 0.4 99.8 99.0 -0.8
Facility registered any home births 45.8 41.8 -4.0 48.2 28.9 -19.3* 47.0 35.2 -11.8*
Facility recorded reasons for all 
maternal deaths (among facilities with 
any maternal deaths)
-- a --a -- a -- a --a -- a -- a --a -- a
Facility recorded reasons for all 
neonatal deaths (among facilities with 
any neonatal deaths)
-- a --a -- a -- a --a -- a -- a --a -- a
Sample size 79-97 46-55 125-152
Source: Health, Population, and Nutrition Office Portfolio Health Systems midline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * 
statistically significant at the 10 percent level. 
Sample sizes are reported as ranges when variables have different response rates and when variables apply to different subsets of respondents. 
a Not reported because of small sample sizes (fewer than 10).
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
TABLE 9. AVAILABILITY AND USE OF NUTRITION SERVICES (PERCENTAGE OF FACILITIES) 
Focal regions Non-focal regions All regions
Midline Endline Difference Midline Endline Difference Midline Endline Difference
From appendix table 9A: Availability of nutrition services among CHPS
Availability of nutrition register:
Register exists and seen 83.1 87.7 4.6 80.8 93.4 12.6 81.8 90.8 9.0**
Register exists, but not seen 7.1 6.7 -0.3 0.5 3.6 3.1 3.4 5.0 1.6
No register 9.8 5.5 -4.3** 18.8 3.1 -15.7** 14.8 4.2 -10.6***
Sample size 269 171 440
Specific types of data entered in the register, among facilities with data observed: 
Infant and Young Child Feeding (IYCF) 
counseling data
42.3 39.3 -2.9 51.0 42.7 -8.3* 47.2 41.2 -6.0*
Sample size 170 117 287
From appendix table 9B: Availability of nutrition services among HCs
Availability of nutrition register:
Register exists and seen 89.2 96.3 7.1** 93.5 98.2 4.6* 91.4 97.2 5.8***
Register exists, but not seen 2.3 2.0 -0.3 1.2 1.8 0.6 1.7 1.9 0.2
No register 8.6 1.8 -6.8*** 5.2 0.0 -5.2 6.9 0.9 -6.0***
Sample size 98 55 153
Specific types of data entered in the register, among facilities with data observed: 
Infant and Young Child Feeding (IYCF) 
counseling data
62.3 41.7 -20.5*** 53.4 49.7 -3.7 57.4 46.1 -11.3**
Sample size 74 47 121
Source: Health, Population, and Nutrition Office Portfolio Health Systems midline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * 
statistically significant at the 10 percent level. 
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
TABLE 10.2A. AVAILABILITY OF COMMUNITY-BASED SERVICES: COMMUNITY HEALTH MEETINGS
(PERCENTAGE OF FACILITIES, UNLESS OTHERWISE INDICATED) 
Focal regions Non-focal regions All regions
Midline Endline Difference Midline Endline Difference Midline Endline Difference
From appendix table 10.2A: Availability of community-based services among CHPS: Community health meetings
At least one community health meeting 
(durbar) was held in last complete quarter
88.0 84.7 -3.3 81.5 87.8 6.3 84.3 86.5 2.1
Number of community health meetings 
(durbars) held in the last complete 
quarter (mean)
1.7 1.6 0.0 2.1 1.6 -0.5** 1.9 1.6 -0.3**
Sample size 232 157 389
Key topics of discussion during last community health meeting, among facilities holding a community health meeting in the previous two months:a
Nutrition 16.9 14.1 -2.8 21.5 17.6 -3.9 19.5 16.1 -3.4
Goodlife, Live it Well Campaign 6.3 10.2 3.9* 14.9 13.5 -1.5 11.1 12.0 0.9
Something else 60.1 c 53.4 -6.8 c 55.2 c 52.5 -2.7c 57.4 c 52.9 -4.5 c
Sample size 167-168 108 275-276
Source: Health, Population, and Nutrition Office Portfolio Health Systems midline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * 
statistically significant at the 10 percent level. 
Sample sizes are reported as ranges when variables have different response rates and when variables apply to different subsets of respondents. 
a Because multiple responses were possible, percentages may not sum to 100.
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
D. Staff Training
TABLE 11. STAFF TRAINING FOR MALARIA CAREGIVING 
(PERCENTAGE OF FACILITIES, UNLESS OTHERWISE NOTED)
Focal regions Non-focal regions All regions
Midline Endline Difference Midline Endline Difference Midline Endline Difference
(From appendix table 11A) Staff training for malaria caregiving among CHPS
Facilities receiving at least 2 clinical supervisory visits in the previous 12 months on:a
Malaria case management 46.5 28.8 -17.7*** 59.0 33.6 -25.4*** 52.7 31.2 -21.6***
Malaria RDTs (including refresher 
training)
39.5 28.8 -10.7* 56.8 32.8 -24.0*** 48.0 30.8 -17.2***
Malaria data collating and reporting 44.8 27.2 -17.6*** 58.8 31.8 -27.0*** 51.7 29.5 -22.3***
Malaria supply chain management 36.4 16.7 -19.7*** 41.3 22.1 -19.2*** 38.8 19.3 -19.4***
Sample size 242-251 124-131 366-380
Facility with at least one staff member 
receiving training plus in malaria 
treatment, among facilities with at least 
one staff member trained on the three 
key aspectsb
81.5 93.5 12.1 100.0 100.0 0.0 88.5 96.0 7.5
Facility with at least one staff member 
receiving “training plus” in malaria 
treatment, among all facilitiesb
39.7 19.3 -20.4*** 55.0 13.9 -41.1*** 47.1 16.7 -30.4***
Sample size 32-226 12-112 44-338
From appendix table 11B: Staff training for malaria caregiving among HCs
Facilities receiving at least 2 clinical supervisory visits in the previous 12 months on:a
Malaria case management 61.7 41.0 -20.7*** 82.2 62.0 -20.2* 72.3 51.9 -20.4***
Malaria RDTs (including refresher 
training) 55.3 42.1 -13.2** 82.5 48.6 -33.9*** 69.2 45.4 -23.8***
Malaria data collating and reporting 61.5 40.9 -20.6*** 81.6 42.5 -39.2*** 71.9 41.7 -30.2***
Malaria supply chain management 55.1 19.5 -35.5*** 61.6 32.4 -29.2** 58.5 26.3 -32.2***
Sample size 89-95 52-54 141-149
Facility with at least one staff member 
receiving training plus in malaria 
treatment, among facilities with at least 
one staff member trained on the three 
key aspectsb†
93.1 95.9 2.7 100.0 95.1 -4.9 97.6 95.4 -2.2
Facility with at least one staff member 
receiving “training plus” in malaria 
treatmentb, among all facilities
48.6 26.0 -22.6*** 86.7 36.5 -50.2*** 68.1 31.4 -36.8***
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
Sample size 17-88 18-51 35-139
Source: Health, Population, and Nutrition Office Portfolio Health Systems midline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * 
statistically significant at the 10 percent level. 
Sample sizes are reported as ranges when variables have different response rates and when variables apply to different subsets of respondents. 
a Because multiple responses were possible, percentages may not sum to 100.
b Training in all three key aspects of malaria care (malaria in pregnancy, malaria case management, and RDTs) and supportive supervision in malaria case management 
and RDTs.
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
TABLE 12. STAFF TRAINING FOR NUTRITION AND OTHER KEY CAREGIVING SERVICES (PERCENTAGE OF 
FACILITIES) 
Focal regions Non-focal regions All regions
Midline Endline Difference Midline Endline Difference Midline Endline Difference
From appendix table 12A: Staff training for nutrition and other key caregiving services among CHPS
Facility had at least one staff member trained in the following in the previous 12 months:a
Anemia prevention control 28.3 12.3 -16.0*** 28.9 9.0 -19.9*** 28.6 10.5 -18.2***
Maternal, Neonatal and Child Health 
(MNCH) life saving skills
26.8 19.4 -7.4** 33.6 10.9 -22.6*** 30.6 14.6 -15.9***
Integrated Management of Neonatal 
Childhood Illness (IMNCI)
37.4 8.8 -28.5*** 29.9 8.7 -21.1*** 33.2 8.8 -24.4***
Other trainings 55.5 59.9 4.4 51.9 53.0 1.0. 53.5 56.0 2.5.
Sample size 256-263 169-170 425-433
Facility had at least one trained staff member receive supportive supervision in the previous 12 months:a
Anemia prevention control 18.3 7.5 -10.8*** 21.4 6.9 -14.5*** 20.0 7.2 -12.9***
Maternal, Neonatal and Child Health 
(MNCH) life saving skills
11.4 9.6 -1.8 22.7 6.7 -16.0*** 17.8 8.0 -9.8***
Integrated Management of Neonatal 
Childhood Illness (IMNCI)
22.8 6.1 -16.7*** 22.9 4.6 -18.2*** 22.8 5.3 -17.6***
Facility with at least one staff member 
receiving training on all three critical 
skill areas in nutrition
29.7 9.5 -20.2*** 36.6 3.7 -32.9*** 33.5 6.3 -27.2***
Facility with at least one staff member 
receiving “training plus” in nutritionb 
67.3 50.2 -17.1 -- d -- d -- d 75.0 50.8 -24.2
Facility with at least one staff member 
receiving “training plus” in maternal 
and neonatal carec
3.6 1.0 -2.6** 4.7 0.5 -4.2** 4.2 0.7 -3.5***
Sample size 13-269 168-171 15-440
From appendix table 12B: Staff training for nutrition and other key caregiving services among HCs
Facility had at least one staff member trained in the following in the previous 12 months:a
Anemia prevention control 35.9 15.4 -20.5*** 41.2 23.3 -17.9* 38.7 19.6 -19.1***
Maternal, Neonatal and Child Health 
(MNCH) life saving skills
58.5 35.6 -22.9*** 65.8 26.8 -39.0*** 62.2 31.1 -31.1***
Integrated Management of Neonatal 
Childhood Illness (IMNCI)
48.5 9.0 -39.5*** 41.9 13.7 -28.2*** 45.1 11.4 -33.8***
Other trainings 57.4 71.8 14.4 71.3 54.4 -17.0 64.5 62.9 -1.6
Sample size 91-97 53-55 146-151
Facility had at least one trained staff member receive supportive supervision in the previous 12 months:a
Anemia prevention control 20.9 11.1 -9.8* 34.7 19.4 -15.3 28.2 15.5 -12.7**
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
Focal regions Non-focal regions All regions
Midline Endline Difference Midline Endline Difference Midline Endline Difference
Maternal, Neonatal and Child Health 
(MNCH) life saving skills
30.2 14.4 -15.8*** 51.6 21.6 -30.0*** 41.4 18.2 -23.2***
Integrated Management of Neonatal 
Childhood Illness (IMNCI)
35.2 7.4 -27.8*** 34.3 12.4 -21.9*** 34.7 10.0 -24.7***
Facility with at least one staff member 
receiving training on all three critical 
skill areas in nutrition
41.4 17.6 -23.8*** 49.4 15.8 -33.6*** 45.5 16.7 -28.8***
Facility with at least one staff member 
receiving “training plus” in nutritionb 
-- c -- c -- c -- c -- c -- c 77.8 80.0 2.2
Facility with at least one staff member 
receiving “training plus” in maternal 
and neonatal cared
12.0 3.6 -8.5*** 20.8 6.8 -14.0* 16.5 5.2 -11.3***
Sample size 90-98 54-55 14-153
Source: Health, Population, and Nutrition Office Portfolio Health Systems midline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * 
statistically significant at the 10 percent level. 
Sample sizes are reported as ranges when variables have different response rates and when variables apply to different subsets of respondents. 
a Because multiple responses were possible, percentages may not sum to 100.
b Training complemented by supportive supervision in critical skill areas in nutrition (infant and young child feeding, management of acute malnutrition, and community 
management of acute malnutrition).
c Not reported because of small sample sizes (fewer than 10).
d Training complemented by supportive supervision in critical skill areas in maternal & neonatal care (active management of third stage of labor, essential newborn care, and 
anemia prevention control).
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
TABLE 13. STAFF TRAINING FOR DATA TRACKING AND MANAGEMENT (PERCENTAGE OF FACILITIES) 
Focal regions Non-focal regions All regions
Midline Endline Difference Midline Endline Difference Midline Endline Difference
From appendix table 13A: Staff training for data tracking and management among CHPS
Facility had at least one staff member trained in the following in the previous 12 months:a
Other training 55.5 59.9 4.4 51.9 53.0 1.0 53.5 56.0 2.5
Sample size 256 169 425
Facility maintains a list of when refresher 
trainings, new skills trainings, or 
professional development trainings are 
due and conducted
4.1 8.2 4.1* 6.7 1.6 -5.1** 5.5 4.5 -1.0
Facility with at least one staff member 
receiving “training plus” in supply chain 
managementb
-- -- -- -- -- -- -- -- --
Facility with at least one staff member 
receiving “training plus”c
3.3 0.0 -3.3*** 0.4 0.5 0.1 1.7 0.3 -1.4**
Sample size 267-268 171 438-439
From appendix table 13B: Staff training for data tracking and management among HCs
Facility had at least one staff member trained in the following in the previous 12 months:
Other training 57.4 71.8 14.4 71.3 54.4 -17.0 64.5 62.9 -1.6
Sample size 94 53 147
Facility maintains a list of when refresher 
trainings, new skills trainings, or 
professional development trainings are 
due and conducted
15.8 9.4 -6.4* 21.6 7.3 -14.3*** 18.8 8.3 -10.4***
Facility with at least one staff member 
receiving “training plus” in supply chain 
managementa
-- -- -- -- -- -- -- -- --
Facility with at least one staff member 
receiving “training plus”b
8.2 2.9 -5.4** 16.1 2.7 -13.4*** 12.3 2.8 -9.5***
Sample size 96-98 54-55 150-153
Source: Health, Population, and Nutrition Office Portfolio Health Systems midline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * 
statistically significant at the 10 percent level. 
Sample sizes are reported as ranges when variables have different response rates and when variables apply to different subsets of respondents. 
a Training complemented by supportive supervision in critical skill areas in supply chain management (including supervision skills).
b Training complemented by supportive supervision in critical skill areas in malaria treatment (malaria in pregnancy, malaria case management, and RDTs), nutrition (infant and 
young child feeding, management of acute malnutrition, and community management of acute malnutrition) supply chain management (including supervision skills), and 
maternal & neonatal care (active management of third stage of labor, essential newborn care, and anemia prevention control).
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
E. Treatment Protocols and Sanitation and Infection Prevention 
TABLE 15. SANITATION AND INFECTION PREVENTION (PERCENTAGE OF FACILITIES) 
Focal regions Non-focal regions All regions
Midline Endline Difference Midline Endline Difference Midline Endline Difference
From appendix table 15A: Sanitation and infection prevention among CHPS
Facility has access to water supply through 
piped water or bore holes 36.3 52.7 16.4*** 36.8 64.5 27.6*** 36.6 58.7 22.1***
Facility has a functional latrine or toilet 79.5 100.0 20.5*** 81.1 98.7 17.6** 80.3 99.4 19.1***
Sample size 147-215 74-117 221-332
Key disposal measures in place for prevention and control of infections:a
Availability of polythene bags for 
waste
50.7 50.2 -0.4 37.4 43.7 6.3 43.4 46.6 3.3
Sample size 269 171 440
From appendix table 15B: Sanitation and infection prevention among HCs
Key disposal measures in place for prevention and control of infections:
Availability of polythene bags for 
waste
58.9 59.8 0.9 71.3 77.3 6.0 65.2 68.7 3.5
Sample size 98 55 153
Source: Health, Population, and Nutrition Office Portfolio Health Systems midline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * 
statistically significant at the 10 percent level. 
Sample sizes are reported as ranges when variables have different response rates and when variables apply to different subsets of respondents. 
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
F. Access to Supplies and Equipment
TABLE 16. STOCK-OUTS AND SUPPLY CHAIN MANAGEMENT (PERCENTAGE OF FACILITIES)
Focal regions Non-focal regions All regions
Midline Endline Difference Midline Endline Difference Midline Endline Difference
From appendix table 16A: Availability and use of tools and mechanisms for supply chain management among CHPS
Facility has utilized RRIRV (Report 
Requisition Issue and Receipt Voucher) to 
reorder commodities based on 
consumption
55.0 70.5 15.6*** 47.2 64.7 17.5** 50.7 67.3 16.6***
Sample size 264 171 435
From appendix table 16B: Availability and use of tools and mechanisms for supply chain management among HCs
Facility has utilized RRIRV (Report 
Requisition Issue and Receipt Voucher) to 
reorder commodities based on 
consumption
71.8 83.3 11.5* 90.6 87.3 -3.3 81.5 85.4 3.8
Sample size 92 54 146
Source: Health, Population, and Nutrition Office Portfolio Health Systems midline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * 
statistically significant at the 10 percent level. 
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
TABLE 17. MANAGEMENT OF ESSENTIAL SUPPLIES (PERCENTAGE OF FACILITIES)
Focal regions Non-focal regions All regions
Midline Endline Difference Midline Endline Difference Midline Endline Difference
From appendix table 17A: Management of essential supplies among CHPS
Facility has control card for the following commodities related to nutrition, diarrhea, and infectious diseases:a
First-line antibiotic treatment for severe 
acute malnutrition
54.2 65.0 10.8*** 16.2 35.8 19.6*** 33.1 48.8 15.7***
Sample size 267 171 438
Facility has control card for the following malaria commodities:a
Sulfadoxine pyrimethamine (SP) 55.9 62.9 7.0** 34.4 39.7 5.2* 44.1 50.1 6.0***
Sample size 268 170 438
Facility has control card for the following family planning commodities, among facilities providing contraception:a
Uterotonic drugs 18.3 15.6 -2.7 15.9 12.1 -3.8 17.0 13.7 -3.3*
Sample size 259 165 424
Facility has control card for the following nutrition commodities that was updated in the previous 30 days, among facilities with control cards:a
First-line antibiotic treatment for 
severe acute malnutrition
38.1 36.8 -1.2 10.2 25.1 14.9*** 22.6 30.3 7.7**
Sample size 266 171 437
Facility has control card for the following malaria commodities that was updated in the previous 30 days, among facilities with control cards:a
Pediatric syrup paracetamol 55.0 43.6 -11.4** 33.3 42.3 9.0* 43.0 42.9 -0.1
Adult paracetamol 57.1 43.4 -13.7** 36.7 37.8 1.1 45.8 40.3 -5.5*
Artesunate and amodiaquine 47.5 28.8 -18.7*** 34.5 26.1 -8.4*** 40.3 27.3 -13.0***
Artemether and lumenfantrine 55.2 39.7 -15.5*** 33.9 32.5 -1.3 43.4 35.8 -7.6**
Malaria RDTs 63.3 50.9 -12.4*** 38.7 44.2 5.5 49.7 47.2 -2.5
Sulfadoxine pyrimethamine (SP) 41.8 30.5 -11.3*** 22.2 26.6 4.4 31.0 28.3 -2.6
Sample size 257-268 165-171 422-439
Facility has control card for the following family planning commodities that was updated in the previous 30 days, among facilities providing contraception with control cardsa
:
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
Focal regions Non-focal regions All regions
Midline Endline Difference Midline Endline Difference Midline Endline Difference
An injectable contraceptive 70.2 59.4 -10.8** 50.8 73.8 23.0** 60.5 66.6 6.1
Condoms 44.2 29.9 -14.3* 24.0 45.0 21.0*** 33.4 38.0 4.6
A hormonal implant such as Implanon, 
Jadelle, Sino Implant II, or Norplant
43.0 41.7 -1.3 28.5 52.0 23.5*** 35.2 47.2 12.0***
Combined oral contraceptive pills 36.6 43.1 6.5 18.3 52.6 34.3*** 26.8 48.2 21.4***
Progestogen-only pill 17.0 25.4 8.3** 6.4 22.7 16.3*** 11.3 23.9 12.6***
An intrauterine device 3.7 8.3 4.7** 0.4 4.9 4.5 1.9 6.5 4.6**
Uterotonic drugs 15.4 8.7 -6.7** 9.4 7.5 -1.9 12.1 8.1 -4.0**
Sample size 207-258 109-165 316-423
From appendix table 17B: Management of essential supplies among HCs
Facility has control card for the following commodities related to nutrition, diarrhea, and infectious diseases:a
First-line antibiotic treatment for 
severe acute malnutrition
80.0 76.2 -3.8 55.0 78.0 23.0*** 67.0 77.1 10.1**
Sample size 95 55 150
Facility has control card for the following malaria commodities:a
Sulfadoxine pyrimethamine (SP) 81.7 85.2 3.6 74.0 86.9 12.9 77.8 86.1 8.3*
Sample size 97 54 151
Facility has control card for the following family planning commodities, among facilities providing contraception:a
Uterotonic drugs 64.0 62.8 -1.2 55.5 72.3 16.8** 59.8 67.5 7.7*
Sample size 93 51 144
Facility has control card for the following BEmONC commodities, among Health Centers:a
Parenteral antibiotics 46.8 45.1 -1.6 55.8 63.1 7.2 51.6 54.8 3.1
Magnesium sulfate for preeclampsia 
and eclampsia
47.4 39.4 -7.9 55.7 61.3 5.6 51.7 50.7 -1.0
Sample size 78-80 47-49 127
Facility has control card for the following nutrition commodities that was updated in the previous 30 days, among facilities with control cards:a
First-line antibiotic treatment for 
severe acute malnutrition
56.5 51.0 -5.6 45.9 60.9 15.0** 51.0 56.1 5.1
Sample size 95 55 150
Facility has control card for the following malaria commodities that was updated in the previous 30 days, among facilities with control cards:a
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
Focal regions Non-focal regions All regions
Midline Endline Difference Midline Endline Difference Midline Endline Difference
Pediatric syrup paracetamol 76.8 51.3 -25.5*** 83.0 81.2 -1.7 80.0 66.6 -13.4***
Adult paracetamol 70.7 54.2 -16.5*** 83.7 76.1 -7.6 77.3 65.4 -11.9***
Artesunate and amodiaquine 56.0 28.9 -27.1*** 79.5 46.6 -32.9*** 67.8 37.8 -30.0***
Artemether and lumenfantrine 75.8 48.0 -27.8*** 83.0 71.0 -12.0* 79.4 59.7 -19.7***
Malaria RDTs 72.1 68.3 -3.8 84.9 77.7 -7.2 78.5 73.1 -5.5
Sulfadoxine pyrimethamine (SP) 64.2 48.5 -15.7*** 64.4 78.9 14.5** 64.3 63.9 -0.4
Sample size 93-98 52-55 145-153
Facility has control card for the following family planning commodities that was updated in the previous 30 days, among facilities providing contraception with control cards:a
An injectable contraceptive 76.8 67.1 -9.7* 73.5 77.7 4.2 75.1 72.6 -2.5
Condoms 57.3 36.8 -20.5*** 46.4 53.7 7.3 51.9 45.1 -6.8
A hormonal implant such as Implanon, 
Jadelle, Sino Implant II, or Norplant
65.8 52.3 -13.5** 57.9 65.7 7.8 61.9 58.9 -3.0
Combined oral contraceptive pills 53.0 49.6 -3.4 52.5 59.2 6.7 52.8 54.4 1.6
Progestogen-only pill 32.6 34.9 2.3 22.4 41.2 18.8** 27.5 38.0 10.5**
An intrauterine device 20.3 20.3 0.0 6.1 26.5 20.4*** 13.4 23.3 9.9***
Uterotonic drugs 44.8 34.0 -10.8 48.2 55.9 7.7 46.5 44.9 -1.6
Sample size 85-94 49-51 135-144
Facility has control card for the following BEmONC commodities that was updated in the previous 30 days, among Health Centers with control cards:a
Parenteral antibiotics 43.1 31.0 -12.1** 48.9 54.8 6.0 46.2 43.9 -2.3
Magnesium sulfate for preeclampsia 
and eclampsia
38.0 16.4 -21.7*** 34.2 46.2 12.0* 36.1 31.9 -4.2
Sample size 77-79 47-49 126
Source: Health, Population, and Nutrition Office Portfolio Health Systems midline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * 
statistically significant at the 10 percent level. 
Sample sizes are reported as ranges when variables have different response rates and when variables apply to different subsets of respondents. 
a Because multiple responses were possible, percentages may not sum to 100.
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
TABLE 18. STOCK-OUTS FOR SPECIFIC COMMODITIES IN PREVIOUS TWO MONTHS, AMONG FACILITIES WITH 
RELEVANT CONTROL CARDS (PERCENTAGE OF FACILITIES) 
Focal regions Non-focal regions All regions
Midline Endline Difference Midline Endline Difference Midline Endline Difference
From appendix table 18A: Stock-outs for specific commodities in previous two months, among CHPS with relevant control cards
Facility experienced stock-out of the following nutrition commodities, among facilities with relevant control cards:a
First-line antibiotic treatment for 
severe acute malnutrition
29.4 33.9 4.6 10.4 10.5 0.1 25.0 28.5 3.5
Sample size 123 21 144
Facility experienced stock-out of the following malaria commodities, among facilities with relevant control cards:a
Sulfadoxine pyrimethamine (SP) 12.6 17.1 4.5 6.3 0.0 -6.3 10.1 10.3 0.2
Sample size 129 48 177
Facility experienced stock-out of the following family planning commodities, among facilities with relevant control cards:a
Uterotonic drugs 31.8 39.9 8.1 0.0 15.2 15.2 15.5 27.3 11.7*
Sample size 24 16 40
From appendix table 18B: Stock-outs for specific commodities in previous two months, among HCs with relevant control cards
Facility experienced stock-out of the following nutrition commodities, among facilities with relevant control cards:a
First-line antibiotic treatment for 
severe acute malnutrition 19.6 31.5 11.9 7.7 13.5 5.8 14.1 23.2 9.1
Sample size 58 25 83
Facility experienced stock-out of the following malaria commodities, among facilities with relevant control cards:a
Sulfadoxine pyrimethamine (SP) 15.2 21.9 6.8 8.9 10.8 2.0 12.2 16.7 4.5
Sample size 73 34 107
Facility experienced stock-out of the following family planning commodities, among facilities with relevant control cards:a
Uterotonic drugs 18.9 23.2 4.3 16.6 12.1 -4.5 17.7 17.5 -0.3
Sample size 41 26 67
Facility experienced stock-out of the following BEmONC commodities, among Health Centers with relevant control cards:a
Parenteral antibiotics 6.9 13.4 6.6 10.6 17.7 7.1 9.2 16.1 6.9
Magnesium sulfate for preeclampsia 
and eclampsia 8.7 22.4 13.7 4.7 17.3 12.6 6.0 19.0 13.0**
Sample size 20-21 18-21 39-41
Source: Health, Population, and Nutrition Office Portfolio Health Systems midline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * 
statistically significant at the 10 percent level. 
Sample sizes are reported as ranges when variables have different response rates and when variables apply to different subsets of respondents. 
a Because multiple responses were possible, percentages may not sum to 100.
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
TABLE 19. AVAILABILITY OF ESSENTIAL SUPPLIES (PERCENTAGE OF FACILITIES)
Focal regions Non-focal regions All regions
Midline Endline Difference Midline Endline Difference Midline Endline Difference
From appendix table 19A: Availability of essential supplies among facilities with relevant control cards among CHPS
Facility has the following nutrition commodities available:a
First-line antibiotic treatment for 
severe acute malnutrition
74.7 67.2 -7.5 85.8 91.5 5.7 77.3 72.9 -4.4
Sample size 123 21 144
Facility has the following malaria commodities available:a
Sulfadoxine pyrimethamine (SP) 89.3 80.0 -9.3* 92.9 95.5 2.7 90.7 86.2 -4.5
Sample size 128 48 176
Facility has the following family planning commodities available:a
Uterotinic drugs 73.3 69.3 -4.0 90.6 85.2 -5.4 82.2 77.4 -4.7
Facility has no expired commodities 
(among vitamin A, pentavalent, uterotonic 
drugs such as Oxytocin or ergometrine, 
malaria RDTs, artesunate + amodiaquine, 
and injectable contraceptives), according 
to control cardsb
7.9 100.0 92.1*** 1.9 100.0 98.1*** 5.1 100.0 94.9***
Sample size 24-209 16-99 40-308
From appendix table 19B: Availability of essential supplies among facilities with relevant control cards among HCs
Facility has the following nutrition commodities available:a
First-line antibiotic treatment for 
severe acute malnutrition
75.8 72.7 -3.1 90.9 89.4 -1.5 82.8 80.5 -2.4
Sample size 58 25 83
Facility has the following malaria commodities available:a
Sulfadoxine pyrimethamine (SP) 91.6 83.4 -8.2** 100.0 96.0 -4.0 95.6 89.3 -6.2**
Sample size 73 34 107
Facility has the following family planning commodities available:a
Uterotonic drugs 88.7 78.5 -10.1* 87.1 89.9 2.8 87.9 84.4 -3.4
Sample size 41 26 67
Facility has the following BEmONC commodities available (among Health Centers) :a
Parenteral antibiotics 88.6 84.2 -4.4 77.0 96.6 19.6* 81.3 91.9 10.6
Magnesium sulfate for preclampsia and 
eclampsia
84.3 67.3 -17.0 92.2 79.0 -13.2 89.7 75.2 -14.4**
Facilities with one or more expired 
commodities (among vitamin A, 
Pentavalent, uterotonic drugs such as 
8.2 100.0 91.8*** 3.6 100.0 96.4*** 5.9 100.0 94.1***
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
oxytocin or ergometrine, malaria 
RDTs, artesunate + amodiaquine, and 
injectable contraceptives) according to 
control cardsa
Sample size 19-89 18-52 39-141
Source: Health, Population, and Nutrition Office Portfolio Health Systems midline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * 
statistically significant at the 10 percent level. 
Sample sizes are reported as ranges when variables have different response rates and when variables apply to different subsets of respondents. 
a Because multiple responses were possible, percentages may not sum to 100.
b Sample includes all facilities with a control card for at least one of these commodities. 
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
TABLE 20. AVAILABILITY OF ESSENTIAL EQUIPMENT (PERCENTAGE OF FACILITIES) 
Focal regions Non-focal regions All regions
Midline Endline Difference Midline Endline Difference Midline Endline Difference
From appendix table 20.1A Availability of essential equipment among CHPS
Facility has the following items for childbirth/delivery available and in working order, among facilities that conduct deliveries:a
Domiciliary midwifery kit 53.2 55.4 2.3 73.8 73.1 -0.8 62.4 63.3 0.9
Sterile delivery kit 73.4 72.9 -0.5 87.3 80.6 -6.7* 79.4 76.2 -3.2
Suturing set 54.6 71.6 16.9*** 77.9 73.3 -4.6 64.7 72.3 7.6*
Sample size 94-96 40-41 135-136
Facility has the following items for nutrition assessment and counselling available and in working order:a
HemoCue Hb device and testing 
strips or coulter counter and testing 
strips
14.7 28.6 13.9*** 17.4 17.4 0.0 16.2 22.4 6.3***
Sample size 268 170 438
Facility has the following storage equipment available for use:a
Clock or watch with second hand 25.9 39.2 13.3*** 23.3 33.1 9.8** 24.5 35.9 11.4***
Sample size 269 269 269
Facility meets minimum competency 
criteria for delivery of infant and young 
child feeding (IYCF)b
0.4 0.0 -0.4 0.0 0.0 0.0 0.2 0.0 -0.2
Sample size 269 171 440
From appendix table 20.1B: Availability of essential equipment among HCs
Facility has the following items for childbirth/delivery available and in working order, among facilities that conduct deliveries:a
Domiciliary midwifery kit 61.9 62.9 1.0 82.8 80.2 -2.6 72.6 71.7 -0.9
Sterile delivery Kit 92.1 83.3 -8.7** 98.4 98.6 0.2 95.3 91.1 -4.2**
Suturing set 86.2 90.4 4.2 91.5 87.7 -3.8 88.9 89.0 0.1
Sample size 86-87 49-50 135-137
Facility has the following items for nutrition assessment and counselling available and in working order:a
HemoCue Hb device and testing 
strips or coulter counter and testing 
strips
50.6 54.4 3.8 41.9 51.9 10.0 46.2 53.1 6.9
Sample size 95 53 148
Facility has the following storage equipment available for use:a
Clock or watch with second hand 69.7 65.5 -4.3 85.2 84.6 -0.6 77.6 75.2 -2.4
Sample size 98 55 153
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
Focal regions Non-focal regions All regions
Midline Endline Difference Midline Endline Difference Midline Endline Difference
Facility meets minimum competency 
criteria for delivery of infant and young 
child feeding (IYCF)b
0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
Sample size 97 55 152
Source: Health, Population, and Nutrition Office Portfolio Health Systems midline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * 
statistically significant at the 10 percent level. 
Sample sizes are reported as ranges when variables have different response rates and when variables apply to different subsets of respondents. 
a Because multiple responses were possible, percentages may not sum to 100.
b Includes quality service provision in the following areas: (1) availability of all essential equipment in working order (6 items): mid-upper-arm circumference tape (MUAC), 
hanging scale, bathroom weighing scale, infantometers, hemoglobin (HB) test kit; (2) existence of at least one staff trained in the last 12 months in infant and young 
child feeding (IYCF); (3) quality record keeping - completeness of infant records based on spot check of three records randomly pulled; (4) availability of all nutrition 
commodities and supplies (5 items): vitamin A capsules, oral rehydration salts (ORS), iron and folic acid tablets (IFAs), infant and young child feeding (IYCF) registers, 
and nutrition counseling materials (any of counseling cards, key messages leaflets, nutrition pamphlets, or other nutrition materials).
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
TABLE 21. HEALTH PROMOTION USING CAMPAIGN MATERIALS (PERCENTAGE OF FACILITIES)
Focal regions Non-focal regions All regions
Midline Endline Difference Midline Endline Difference Midline Endline Difference
From appendix table 21_A: Health promotion using campaign materials among CHPS
Facility displays GoodLife, Live it Well 
campaign materials
61.0 82.9 21.9*** 57.0 72.8 15.8*** 58.8 77.3 18.5***
Facility uses GoodLife, Live it Well 
campaign materials during health 
promotion activities
76.3 90.2 13.9*** 67.9 84.9 16.9*** 71.7 87.2 15.6***
Sample size 267-268 170-171 438
From appendix table 21_B: Health promotion using campaign materials among HCs
Facility displays GoodLife, Live it Well 
campaign materials
83.1 93.9 10.9*** 80.4 92.6 12.2 81.7 93.2 11.5**
Facility uses GoodLife, Live it Well 
campaign materials during health 
promotion activities
79.3 93.8 14.6*** 81.1 87.9 6.8 80.2 90.8 10.6***
Sample size 96-98 55 151-153
Source: Health, Population, and Nutrition Office Portfolio Health Systems midline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * 
statistically significant at the 10 percent level. 
Sample sizes are reported as ranges when variables have different response rates and when variables apply to different subsets of respondents. 
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
IV. CULTURE OF QUALITY ASSURANCE AND QUALITY IMPROVEMENT
TABLE 22. EXISTENCE OF QA/QI TEAMS AND PLANS (PERCENTAGE OF FACILITIES) 
Focal regions Non-focal regions All regions
Midline Endline Difference Midline Endline Difference Midline Endline Difference
From appendix table 22A: Existence of QA/QI teams and plans among CHPS
Facility has implemented a malaria QI 
action plan in the previous two months, 
among facilities with malaria included as a 
topic in their action plan
80.9 64.5 -16.4 78.7 73.9 -4.9 79.6 70.2 -9.4
Sample size 28 21 49
From appendix table 22B: Existence of QA/QI teams and plans among HCs
Facility has implemented a malaria QI 
action plan in the previous two months, 
among facilities with malaria included as a 
topic in their action plan
100.0 75.8 -24.2** 100.0 72.2 -27.8* 100.0 73.6 -26.4**
Sample size 15 12 27
Source: Health, Population, and Nutrition Office Portfolio Health Systems midline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * 
statistically significant at the 10 percent level. 
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
TABLE 23.1. DATA VALIDATION (PERCENTAGE OF FACILITIES) 
Focal regions Non-focal regions All regions
Midline Endline Difference Midline Endline Difference Midline Endline Difference
From appendix table 23A: Data validation among CHPS
Facility validated the DHIMS2 reports 
using source documents
88.1 85.7 -2.4 89.2 92.1 2.9 88.7 89.3 0.5
Sample size 262 168 430
From appendix table 23B: Data validation among HCs
Facility validated the DHIMS2 reports 
using source documents
95.3 92.4 -2.8 97.2 95.8 -1.4 96.2 94.2 -2.1
Sample size 94 55 149
Source: Health, Population, and Nutrition Office Portfolio Health Systems midline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * 
statistically significant at the 10 percent level. 
TABLE 24. DISPLAY OF DATA AND INFORMATION (PERCENTAGE OF FACILITIES) 
Focal regions Non-focal regions All regions
Midline Endline Difference Midline Endline Difference Midline Endline Difference
From appendix table 24A: Display of data and information among CHPS
Facility has the following graphs or tables displayed:a
Malaria or insecticide-treated net 
distribution
17.9 21.5 3.6 15.5 17.4 2.0 16.5 19.2 2.7
Sample size 261 171 432
From appendix table 24B: Display of data and information among HCs
Facility has the following graphs or tables displayed:
Malaria or insecticide-treated net 
distribution
20.5 30.6 10.2* 34.9 29.1 -5.8 27.8 29.9 2.0
Sample size 96 54 150
Source: Health, Population, and Nutrition Office Portfolio Health Systems midline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * 
statistically significant at the 10 percent level. 
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
TABLE 25.1.A AVAILABILITY OF COMMUNITY-BASED SERVICES: COMMUNITY HEALTH VOLUNTEERS
(PERCENTAGE OF FACILITIES, UNLESS OTHERWISE INDICATED) 
Focal regions Non-focal regions All regions
Midline Endline Difference Midline Endline Difference Midline Endline Difference
From appendix table 25.1A: Community health volunteers
Facility has at least one CHV† 92.9 93.0 0.2 98.4 98.5 0.1 95.9 96.0 0.1
Sample size 269 171 440
Services offered by CHVs in the past 12 months:b
Facilitate support group sessions 8.9 13.9 5.0* 13.5 12.8 -0.7 11.6 13.3 1.7
Something else 25.5 21.9 -3.6 15.6 4.8 -10.8** 19.8 12.1 -7.8**
Sample size 237 165 402
From appendix table 25.1B: Community health volunteers
Facility has at least one CHV† 81.8 87.4 5.7 96.3 92.2 -4.1 89.3 89.9 0.6
Sample size 94 55 149
Services offered by CHVs in the past 12 months:b
Facilitate support group sessions 14.2 17.5 3.2 7.3 18.2 10.9** 10.5 17.9 7.4**
Something else 23.0 14.6 -8.4* 22.7 9.0 -13.8*** 22.9 11.5 -11.3***
Sample size 78 49 127
Source: Health, Population, and Nutrition Office Portfolio Health Systems midline and endline survey data
Note: Percentages are weighted to adjust for sampling probabilities. *** Statistically significant at the 1 percent level; ** statistically significant at the 5 percent level; * 
statistically significant at the 10 percent level. 
Sample sizes are reported as ranges when variables have different response rates and when variables apply to different subsets of respondents. 
a This table was part of Table 10 in the midline report.
a Because multiple responses were possible, percentages may not sum to 100.
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
Appendix F: Evaluate for Health Endline Survey 2019
PART I: INTERVIEW INFORMATION
ALL
I1. FACILITY INFORMATION SECTION
INSTRUCTION: FILL IN THE FIRST SET OF QUESTIONS THAT START WITH I FROM THE SAMPLE 
LIST BEFORE THE VISIT.
IN WHAT REGION IS THE FACILITY?
Select one only
 CENTRAL............................................................................................................. 1
 GREATER ACCRA............................................................................................... 2
 NORTHERN ......................................................................................................... 3
 VOLTA.................................................................................................................. 4
 WESTERN............................................................................................................ 5
 UPPER EAST....................................................................................................... 6
 UPPER WEST...................................................................................................... 7
 ASHANTI .............................................................................................................. 8
 BRONG AHAFO ................................................................................................... 9
 EASTERN............................................................................................................. 10
ALL
I2. IN WHAT DISTRICT IS THE FACILITY?
Select one only
 DISTRICT 1 .......................................................................................................... 1
 DISTRICT 2 .......................................................................................................... 2
 DISTRICT 3 .......................................................................................................... 3
 DISTRICT 4 .......................................................................................................... 4
ALL
I3. IN WHAT SUB-DISTRICT IS THE FACILITY?
Select one only
 SUB-DISTRICT 1 ................................................................................................. 1
 SUB-DISTRICT 2 ................................................................................................. 2
 SUB-DISTRICT 3 ................................................................................................. 3
 SUB-DISTRICT 4….............................................................................................. 4
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
ALL
I6. WHAT IS THE NAME OF THE FACILITY?
Select one only
 FACILITY NAME 1 ............................................................................................... 1
 FACILITY NAME 2 ............................................................................................... 2
 FACILITY NAME 3 ............................................................................................... 3
 FACILITY NAME 4…............................................................................................ 4
ALL
I1.a. IS ALL FACILITY INFORMATION ABOVE CORRECT?
 YES .............................................................................................................1
 NO ...............................................................................................................0
IF I1a=2
I1.o. PLEASE TYPE CORRECTED INFORMATION.
CORRECTED INFORMATION
(STRING 700)
ALL; PLEASE ADD A DATE PICKER.
I8. WHAT IS THE DATE OF THIS (FIRST) VISIT?
DATE PICKER 
ALL
I8b. IS THIS A RETURN VISIT TO THE FACILITY TO CONDUCT OR COMPLETE THE INTERVIEW?
 YES .............................................................................................................1
 NO ...............................................................................................................0
IF I8b = 1
I8bi. NOTE BELOW WHY YOU HAD TO RETURN, THE NUMBER OF TIMES YOU HAD TO RETURN, 
AND SO ON. IF YOU ARE A DIFFERENT INTERVIEWER, PLEASE INCLUDE YOUR NAME AND 
WHY A CHANGE WAS MADE. ADD NOTES EACH TIME A RETURN VISIT IS MADE.
NOTES
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
(STRING 500)
IF I8b = 1
I8bii. WHAT IS THE DATE OF THE RETURN VISIT?
DATE PICKER 
PART 2: STAFF MEMBER INFORMATION AND CONSENT
ALL
A1. INSTRUCTIONS:
- GREET THE PEOPLE OF THE FACILITY.
- EXPLAIN THE PURPOSE OF YOUR VISIT. 
- LOCATE THE DESIRED RESPONDENT. 
o IN A CHPS COMPOUND, THAT WILL LIKELY BE THE COMMUNITY HEALTH 
OFFICER (CHO), COMMUNITY HEALTH NURSE, ENROLLED NURSE OR MIDWIFE. 
o IN A HEALTH CENTER, THAT WILL LIKELY BE THE MEDICAL ASSISTANT OR 
PHYSICIAN ASSISTANT IN CHARGE OF THE FULL FACILITY, AND/OR THE MIDWIFE 
IN CHARGE OF THE MATERNITY. 
- GIVE YOUR NAME AND ASK THE NAME OF THE RESPONDENT.
ALL; THIS IS NOT A REQUIRED QUESTION.
I9. WHAT ARE THE GPS COORDINATES OF THE FACILITY?
GPS COORDINATES ARE NOT REQUIRED IF YOU CANNOT GET THEM EASILY. 
GPS COORDINATES SHOULD BE GENERATED AT THE FACILITY CLOSE TO THE POINT OF 
DATA CAPTURE.
LEAVE A NOTE AT THE END OF THE SURVEY IF YOU CANNOT GET THE GPS COORDINATES.
TAP TO SET INTERVIEW LOCATION COORDINATES.
ALL
A2. IS THERE AN APPROPRIATE PERSON AT THE FACILITY TO INTERVIEW?
 YES .............................................................................................................1 GO TO A3
 NO ...............................................................................................................0 GO TO K3
IF A2=1; 
A3. Thank you for taking the time for this interview today. My name is …, and I am working for 
DevtPlan in support of the USAID Evaluate for Health Project.
We are conducting an endline study of health services in Ghana. The goal of this study is 
to help inform decision-makers about the integration of health services, availability of 
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
community-based resources, the strength of health systems, and health sector 
governance and accountability. This endline study is being funded by USAID Ghana, and 
was designed in close cooperation with the Ghana Health Service.
The purpose of this interview is to gather information from health facility staff on health 
care and services in CHPS zones and health centers. Specifically we will be asking about 
the resources available to you and the work you do. Your responses will be confidential, 
that is, none of your responses will be identified as yours with anyone outside of the study 
team and study sponsors. 
HAND CONSENT FORM. This is our study consent form, which was approved by GHS. 
Can you please read it and sign it if you are in agreement with it? 
READ CONSENT TEXT ALL WORD-FOR-WORD.
HAVE THE ETHICS REVIEW COMMITTEE APPROVED INFORMED CONSENT FORM IN HAND. 
WAIT FOR SIGNED CONSENT BEFORE BEGINNING THE INTERVIEW WITH ANY STUDY 
PARTICIPANT. 
ALL
A3b. DID THE RESPONDENT SIGN THE CONSENT FORM?
 YES.................................................................................................................1 GO TO A3d
 NO ..................................................................................................................2 GO TO K2 
IF A3=1
A4b. Do you have any questions about the interview? 
INSTRUCTION: ANSWER ANY QUESTIONS THE RESPONDENT MIGHT HAVE AND THEN 
CONTINUE.
IF A2=1
A4. To start, what is your full name?
INSTRUCTION: TYPE FIRST AND LAST NAMES.
FIRST NAME AND LAST NAME
(STRING 100)
INTERVIEW SECTIONS
IF A3b = 1
A3i2. WHAT IS THE START TIME OF THE INTERVIEW?
INSTRUCTION: DO NOT READ THIS QUESTION ALOUD. 
TIME PICKER 
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
ALL; A POP-UP WITH THE RELEVANT SUB-DISTRICT NAMES BASED ON DISTRICT CHOSEN. 
CODES SHOULD BE CONTINUOUS FOR ALL SUB-DISTRICTS, NOT DUPLICATED.
I3con. In what sub-district is this facility?
 SUB-DISTRICT 1 ................................................................................................. 1
 SUB-DISTRICT 2 ................................................................................................. 2
 SUB-DISTRICT 3 ................................................................................................. 3
 SUB-DISTRICT 4….............................................................................................. 4
 OTHER SUB-DISTRICT ...................................................................................... 99
IF I3=99
I3ocon. In what sub-district is this facility?
NAME OF SUB-DISTRICT
(STRING 100)
ALL
I3c. In the last two years, has there been a change in sub-district name in which this facility is 
located?
INSTRUCTION: MARK ‘YES’ IF THERE WAS A RE-DRAWING OF SUB-DISTRICT LINES AND/OR 
RENAMING OF THE SUB-DISTRICT. MARK ‘NO’ IF THE FACILITY ITSELF HAS PHYSICALLY 
MOVED TO A NEW SUB-DISTRICT.
 YES .............................................................................................................1
 NO ...............................................................................................................0
 DON’T KNOW / REFUSED .........................................................................98
IF I3c=1
I3ca. What was the previous name of the sub-district?
OLD NAME OF SUB-DISTRICT
(STRING 100)
ALL
I6con. What is the name of the facility?
Select one only
 FACILITY NAME 1 ............................................................................................... 1
 FACILITY NAME 2 ............................................................................................... 2
 FACILITY NAME 3 ............................................................................................... 3
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
 FACILITY NAME 4…............................................................................................ 4
 OTHER FACILITY NAME..................................................................................... 99
IF I6=99
I6ocon. What is the name of the facility?
NAME OF FACILITY
(STRING 100)
ALL
I6.2. In the past two years, has the name of this facility changed? 
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 2
 DON’T KNOW / REFUSED .................................................................................. 98
IF I6.2=1
I6FCb. What was the name of the facility before it changed?
NAME OF FACILITY
(STRING 100)
ALL
I4. Is this a CHPS zone with a compound, a CHPS zone without a compound, a Health Center, 
or something else? 
INSTRUCTION: NOTE THAT IN THE CHPS SYSTEM, THE “CHPS COMPOUND” IS THE 
FACILITY AND THE “CHPS ZONE” IS THE CATCHMENT AREA FOR SERVICE DELIVERY. IF 
A CHPS CATCHMENT AREA DOES NOT HAVE A “COMPOUND” BUT DOES HAVE A 
COMMUNITY HEALTH OFFICER (CHO), THE CHO WILL STILL BE INTERVIEWED AND THE 
“FACILITY” WILL BE CONSIDERED A CHPS ZONE.
Select one only
 CHPS ZONE WITH A COMPOUND .................................................................... 1
 CHPS ZONE WITHOUT A COMPOUND............................................................. 2
 HEALTH CENTER................................................................................................ 3
 SOMETHING ELSE.............................................................................................. 4
 DON’T KNOW....................................................................................................... 96
 REFUSED............................................................................................................. 97
IF I4 = 4
I5. In the past two years, has this facility been a CHPS, health center, or neither? 
 CHPS.................................................................................................................... 1
 HEALTH CENTER................................................................................................ 2
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
 NEITHER.............................................................................................................. 0 GO TO K2
 DON’T KNOW....................................................................................................... 96
 REFUSED............................................................................................................. 97
A. INTERVIEW WITH PRIMARY FACILITY RESPONDENT
ALL
A5. We will need a number of records, registers and reports for this interview. It might be easiest to 
collect them all before we begin, to make things go more quickly. Here are the ones we will need.
INSTRUCTION: HAND RESPONDENT LIST OF REGISTERS AND BOOKS NEEDED. DO NOT READ 
THE LIST ALOUD.
WAIT UNTIL THE RESPONDENT HAS COLLECTED THE RECORDS BEFORE CONTINUING THE 
INTERVIEW.
1. Home visits register
2. School visits register
3. Insurance records
4. Referral records or book
5. Birth records or delivery book or child welfare cards (CWC) records
6. Child welfare clinic register
7. Maternal / newborn records 
8. Antenatal care services (ANC) register
9. Nutrition register
10. Written protocols for maternal and newborn care, family planning counseling and other 
areas
11. Family planning register 
12. Malaria records
13. Facility action plan or master action plan
14. Quality Improvement (QI) action plan and indicators
15. Progress activity charts and tables for Maternal and Child Health (MCH) or Reproductive and 
Child Health (RCH) and other areas
16. Bin, tally or inventory control cards
17. Consulting room register
18. Monthly reports
19. Morbidity forms, records and reports
20. Logistics Management Standard operating procedures or SOP
21. Integrated Disease Surveillance and Response (IDSR)
22. Facility Monthly Report
23. Nutrition and Child Report
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
IF I5 ≠ 0.
[“ALL” THROUGHOUT THIS SURVEY SHOULD BE UNDERSTOOD TO MEAN ALL EXCEPT IF I5 = 
0.] 
A6. Now I would like to ask, what is your job title here?
SELECT ‘YES’ FOR ALL RESPONSES GIVEN. SELECT ‘NO’ FOR ALL OTHERS. 
IF R DOES NOT KNOW OR REFUSES TO ANSWER, SELECT 'DON'T KNOW / REFUSED' FOR 
ALL A6 RESPONSE OPTIONS.
MARK ALL 
A6_1. COMMUNITY HEALTH OFFICER OR CHO ..................................................... Y/N/DK-R
A6_2. MEDICAL OR PHYSICIAN ASSISTANT IN CHARGE OF THE FULL FACILITY Y/N/DK-R
A6_3. MIDWIFE OR PUBLIC HEALTH NURSE MIDWIFE.......................................... Y/N/DK-R
A6_4. COMMUNITY HEALTH NURSE OR ENROLLED NURSE................................ Y/N/DK-R
A6_5. HEALTH CARE ASSISTANT CLINICAL............................................................ Y/N/DK-R
A6_99. SOMETHING ELSE ........................................................................................ Y/N/DK-R
The purpose of this question is to understand the role or roles the respondent has at their facility. 
Select as many roles as applicable for this respondent. 
IF A6_99=YES
A6o. What is your job title here?
 JOB TITLE/S (STRING 300)
ALL
A7. How long have you been in this role here?
IF THEY HAVE MORE THAN ONE JOB TITLE, TAKE THE ONE THAT IS LISTED HIGHEST ON 
THE LIST IN A6. 
IF THE RESPONDENT DOES NOT KNOW, ENTER 96;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 97.
ENTER HERE THE NUMBER OF DAYS, WEEKS, MONTHS OR YEARS AND THE UNIT 
BELOW.
(RANGE 1-97)
A7u. Unit of duration
 DAYS.................................................................................................................... 1
 WEEKS................................................................................................................. 2
 MONTHS .............................................................................................................. 3
 YEARS.................................................................................................................. 4
 OTHER ................................................................................................................ 99
 DON’T KNOW....................................................................................................... 96
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
 REFUSED............................................................................................................. 97
IF A7u=99
A7o. How long have you been in this role here?
LENGTH OF SERVICE
(STRING 150)
ALL
A8. Are you working with community-based agents, community health volunteers, community 
surveillance volunteers or other volunteers? 
 YES.................................................................................................................. 1
 NO ................................................................................................................... 2 GO TO B6
 DON’T KNOW / REFUSED ............................................................................. 98 GO TO B6
IF A8=1
A9. How many of these volunteers work with your facility? 
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 996;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 997.
NUMBER OF VOLUNTEERS (RANGE 0-997)
B. WORK IN COMMUNITY
A8=1 
B1. WORK IN COMMUNITY
The first topic I would like to discuss is your relationship with the community and the 
volume of work you do here. I note that you have Community-based agents, community 
health volunteers, which are also known as CHVs, community surveillance volunteers or 
other volunteers. Who recruited and organized these volunteers?
SELECT ‘YES’ FOR ALL RESPONSES GIVEN. SELECT ‘NO’ FOR ALL OTHER RESPONSE 
OPTIONS. 
IF R DOES NOT KNOW OR REFUSES TO ANSWER, SELECT 'DON'T KNOW / REFUSED' 
FOR ALL B1 RESPONSE OPTIONS.
MARK ALL
B1_1. COMMUNITY HEALTH COMMITTEE, ALSO KNOWN AS CHC .................... Y/N/DK-R
B1_2. CHO.................................................................................................................. Y/N/DK-R
B1_3. COMMUNITY LEADERS WHO ARE NOT MEMBERS OF THE CHC ............ Y/N/DK-R
B1_99. SOMEONE ELSE ........................................................................................... Y/N/DK-R 
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
IF B1_99=YES
B1o. Who recruited and organized these volunteers?
RECRUITER/S AND ORGANIZER/S
(STRING 250)
A8=1
B2 SHOULD BE PROGRAMMED AS A QUESTION WITH INSTRUCTIONS BUT NO RESPONSES, 
FOLLOWED BY A SERIES OF Y/N QUESTIONS.
B2. For the next few questions in this section, I will refer to all the types of volunteers and agents 
we are discussing as CHVs. 
In the past 12 months, what types of services did the CHVs provide? 
PROBE IF ONLY ONE ANSWER IS GIVEN, “Anything else?”
SELECT ‘YES’ FOR ALL RESPONSES GIVEN. SELECT ‘NO’ FOR ALL OTHER RESPONSE 
OPTIONS. 
IF R DOES NOT KNOW OR REFUSES TO ANSWER, SELECT 'DON'T KNOW / REFUSED' FOR 
ALL B2 RESPONSE OPTIONS.
MARK ALL
B2_1. HOME VISITS – ASSESS, ADVISE OR EDUCATE ON HEALTH ........................................Y/N/DK-R
B2_2. HOME VISITS – FOLLOW-UP ON DEFAULTERS ...............................................................Y/N/DK-R
B2_3. PROVIDE CONDOMS OR FAMILY PLANNING INFORMATION .........................................Y/N/DK-R
B2_4. PROVIDE FIRST AID OR TREATMENT OF MINOR AILMENTS .........................................Y/N/DK-R 
B2_5. CONDUCT DISEASE SURVEILLANCE, IDENTIFY CASES OR REPORT ..........................Y/N/DK-R 
B2_6. COMMUNICATE BETWEEN CHO & COMMUNITY ON HEALTH STATUS OF COMMUNITY . Y/N/DK-R 
B2_7. DISSEMINATE HEALTH PROMOTION MATERIALS OR INFORMATION ..........................Y/N/DK-R 
B2_8. MOBILIZE OR SENSITIZE COMMUNITY FOR HEALTH MANAGEMENT ACTION............Y/N/DK-R 
B2_9. SUPPORT THE ORGANIZATION OF COMMUNITY HEALTH MEETINGS OR DURBARSY/N/DK-R 
B2_10. REFER CLIENTS TO CHO FOR DISEASE TREATMENT, FAMILY PLANNING, OR NUTRITION
...............................................................................................................................................Y/N/DK-R 
B2_11. ASSIST CHO WITH HOME VISITS, OUTREACH OR WORK AT THE CHPS ...................Y/N/DK-R 
B2_12. COLLABORATE WITH CHO OR SUPPORT CHPS SERVICE DELIVERY........................Y/N/DK-R 
B2_13. ASSIST IN COMPILING OR UPDATING COMMUNITY REGISTER OR PROFILE...........Y/N/DK-R 
B2_14. SUPPORT ANC, PNC OR INFANT CARE ..........................................................................Y/N/DK-R 
B2_15. FACILITATE SUPPORT GROUP SESSIONS……………………………………………. ......Y/N/DK-R 
B2_99. SOMETHING ELSE..............................................................................................................Y/N/DK-R 
IF B2_99=YES
B2o. In the past 12 months, what other types of services did the CHVs provide?
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
SERVICES
(STRING 150)
A8=1
B3. In the past 12 months, what kinds of support did this facility provide CHVs? 
PROBE IF ONLY ONE ANSWER IS GIVEN, “Anything else?”
SELECT ‘YES’ FOR ALL RESPONSES GIVEN. SELECT ‘NO’ FOR ALL OTHER RESPONSE 
OPTIONS. 
IF R DOES NOT KNOW OR REFUSES TO ANSWER, SELECT 'DON'T KNOW / REFUSED' 
FOR ALL B3 RESPONSE OPTIONS.
MARK ALL
B3_1. TRAINING, REFRESHERS OR CAPACITY BUILDING ............................................... Y/N/DK-R
B3_2. LOGISTICAL HELP (WITH PLANNING, KITS, PAMPHLETS, OR SUPPLIES, ETC.) Y/N/DK-R
B3_3. TRANSPORTATION SUPPORT................................................................................... Y/N/DK-R 
B3_4. PHYSICAL MOTIVATORS (T-SHIRT, HAT, ETC.)....................................................... Y/N/DK-R
B3_99. SOMETHING ELSE..................................................................................................... Y/N/DK-R 
B3_99=YES
B3o. In the past 12 months, what other kinds of support did this facility provide CHVs? 
SUPPORT
(STRING 250)
A8=1 
B4a. In the past 12 months, has any CHV provided you with a report, including verbal 
reports or updates to the community registers?
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 2 GO TO B6a1
 DON’T KNOW / REFUSED .................................................................................. 98
B4a=1
B4b. In the past 12 months, about how often have you received reports from CHVs, 
including verbal reports and updates to the community registers from CHVs?
INSTRUCTION: TRY TO PROBE TO DETERMINE AN ANSWER IN THE TOP FIVE 
RESPONSES, IF POSSIBLE.
Select one only
 ONCE OR MORE PER DAY ................................................................................ 1
 ONCE OR MORE PER WEEK, BUT NOT DAILY................................................ 2
 ONCE OR MORE PER MONTH, BUT NOT WEEKLY ........................................ 3
 ONCE OR MORE EVERY THREE MONTHS, BUT NOT MONTHLY ................. 4
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
 ONCE OR MORE PER YEAR, BUT NOT QUARTERLY..................................... 5
 IRREGULARLY .................................................................................................... 6
 DON’T KNOW....................................................................................................... 96
 REFUSED............................................................................................................. 97
B4a=1
B5. What topics do the reports cover?
PROBE IF ONLY ONE ANSWER IS GIVEN, “Anything else?”
SELECT ‘YES’ FOR ALL RESPONSES GIVEN. SELECT ‘NO’ FOR ALL OTHER RESPONSE 
OPTIONS. 
IF R DOES NOT KNOW OR REFUSES TO ANSWER, SELECT 'DON'T KNOW / REFUSED' 
FOR ALL B5 RESPONSE OPTIONS.
MARK ALL
B5_1. DATA ON HOME VISITS ..................................................................................... Y/N/DK-R
B5_2. NUMBER OF PREGNANCIES............................................................................. Y/N/DK-R
B5_3. BIRTHS................................................................................................................. Y/N/DK-R 
B5_4. SUPPORT GROUP ACTIVITIES……………………………………………………. Y/N/DK-R
B5_5. NUTRITION COUNSELING………………………………………………………….. Y/N/DK-R
B5_99. OTHER TOPICS.................................................................................................. Y/N/DK-R
B5_99=YES
B5o. What other topics do the reports cover? 
TOPICS
(STRING 250)
ALL; PROGRAMMER, ALLOW UP TO 4 DIGITS FOR ANSWERS. ASK SUB-QUESTION B6x1 AND 
B6x2 RIGHT AFTER EACH OTHER EXCEPT IF B6x1 = 0, DK OR REFUSED. IF B6a-f1 = 0, DK OR 
REFUSED SKIP B6a-f2 FOR THAT SUB-QUESTION.
B6. I’d like to ask you a bit about home and school visits. Would it be possible to look at your home 
and school visit registers and monthly reports for the next few questions? We’d like to ask about 
visits made by all staff members at the facility, except volunteers.
DOCUMENTS NEEDED: HOME VISITS REGISTER, SCHOOL VISITS REGISTER, AND MONTHLY 
REPORTS
In the last two complete months, can you please tell me the number of...
RECORD 
NUMBER
IF B6x1=0 and B6x1<9996, ASK RECORD 
NUMBER
a1. routine home visits 
you conducted?
| | | | |
DK = 9996 
REFUSED = 9997 
B6a2. Is this number from an 
up-to-date register or record, 
or is it an estimate?
Register = 1
Estimate = 2
DK / 
REFUSED = 98
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
RECORD 
NUMBER
IF B6x1=0 and B6x1<9996, ASK RECORD 
NUMBER
b1. follow-up home 
visits you 
conducted?
| | | | |
DK = 9996 
REFUSED = 9997 
B6b2. Is this number from an 
up-to-date register or record, 
or is it an estimate?
Register = 1
Estimate = 2
DK / 
REFUSED = 98
IF I4=1 OR 2 
c1. CHPS zone clients 
needing special 
visits that you 
visited?
| | | | |
DK = 9996 
REFUSED = 9997 
IF I4=1 OR 2 
B6c2. Is this number from an 
up-to-date register or record, 
or is it an estimate?
Register = 1
Estimate = 2
DK / 
REFUSED = 98
d1. post-natal home 
visits you 
conducted?
| | | | |
DK = 9996 
REFUSED = 9997 
B6d2. Is this number from an 
up-to-date register or record, 
or is it an estimate?
Register = 1
Estimate = 2
DK /
REFUSED = 98
e1. school visits you 
conducted? | | | | |
DK = 9996 
REFUSED = 9997 
B6e2. Is this number from an 
up-to-date register or record, 
or is it an estimate?
Register = 1
Estimate = 2
DK / 
REFUSED = 98
IF (I4 = 1 OR 2 OR I5=1)
B7a. Currently, how many communities are within this CHPS zone?
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 96;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 97.
NUMBER OF COMMUNITIES
(RANGE 0-99)
IF (I4 = 1 OR 2 OR I5=1)
B7b. Do you organize community health meetings, also called durbars, group discussions, or 
other such names?
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 2
 DON’T KNOW / REFUSED .................................................................................. 98
IF B7b = 1
B7c. In the last complete quarter, how many community health meetings did you hold?
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 996;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 997.
NUMBER OF MEETINGS
(RANGE 0-999)
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
IF B7b = 1 AND B7c >0 & < 996
B8. For the most recent community health meeting you held, who planned and organized it?
PROBE IF ONLY ONE ANSWER IS GIVEN, “Anyone else?”
SELECT ‘YES’ FOR ALL RESPONSES GIVEN. SELECT ‘NO’ FOR ALL OTHER RESPONSE 
OPTIONS. 
IF R DOES NOT KNOW OR REFUSES TO ANSWER THE QUESTION, SELECT 'DON'T KNOW 
/ REFUSED' FOR ALL B8 RESPONSE OPTIONS.
MARK ALL
B8_1. COMMUNITY HEALTH COMMITTEE, ALSO KNOWN AS CHC .................... Y/N/DK-R
B8_2. CHO.................................................................................................................. Y/N/DK-R
B8_3. COMMUNITY LEADERS WHO ARE NOT MEMBERS OF THE CHC ............ Y/N/DK-R
B8_4. COMMUNITY HEALTH VOLUNTEER/S OR CHVS ........................................ Y/N/DK-R
B8_5. COMMUNITY HEALTH WORKER ……….……………………………………….Y/N/DK-R
B8_99. SOMEONE ELSE ........................................................................................... Y/N/DK-R 
B8_99=YES
B8o. For the most recent community health meeting you held, who planned and organized it? 
PLANNERS AND ORGANIZERS
(STRING 250)
IF B7b = 1 AND B7c >0 & < 96
B9. In the last complete quarter, what were the topics of discussion during the community health 
meetings that you held?
PROBE IF ONLY ONE ANSWER IS GIVEN, “Anything else?”
SELECT ‘YES’ FOR ALL RESPONSES GIVEN. SELECT ‘NO’ FOR ALL OTHER RESPONSE 
OPTIONS. 
IF R DOES NOT KNOW OR REFUSES TO ANSWER THE QUESTION, SELECT 'DON'T KNOW 
/ REFUSED' FOR ALL B9 RESPONSE OPTIONS.
MARK ALL
B9_1. NEWBORN HEALTH...................................................................................... Y/N/DK-R
B9_2. MATERNAL AND CHILD HEALTH ................................................................. Y/N/DK-R
B9_3. FAMILY PLANNING ........................................................................................ Y/N/DK-R
B9_4. HIV/AIDS ......................................................................................................... Y/N/DK-R
B9_5. ANC ATTENDANCE ....................................................................................... Y/N/DK-R
B9_6. PNC ATTENDANCE ....................................................................................... Y/N/DK-R
B9_7. HEALTH INSURANCE .................................................................................... Y/N/DK-R
B9_8. MALARIA (ANY TOPIC) .................................................................................. Y/N/DK-R
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
B9_9. WASH (WATER AND SANITATION HYGIENE)............................................. Y/N/DK-R
B9_10. EPI-EXPANDED PROGRAMME ON IMMUNIZATIONS............................... Y/N/DK-R
B9_11. CHOLERA...................................................................................................... Y/N/DK-R
B9_12. INJURIES SUCH AS SNAKE BITES, BURNS, ETC. .................................... Y/N/DK-R
B9_13. ADMINISTRATION OF THE HEALTH FACILITY.......................................... Y/N/DK-R
 B9_14. NUTRITION……………………………………………………………………… Y/N/DK-R
 B9_15. GOODLIFE, LIVE IT WELL CAMPAIGN……………………………………… Y/N/DK-R
B9_99. SOMETHING ELSE ....................................................................................... Y/N/DK-R
B9_99=YES;
IF YOU CANNOT HAVE A FILL-IN AND A MARKED RESPONSE TO THE SAME QUESTION, ADD 
INSTRUCTION THAT READS, “IF RESPONDENT DOES NOT KNOW, ENTER 96; IF RESPONDENT 
REFUSES, ENTER 97.”
B9o. In the last complete quarter, what were the other topics of discussion during the 
community health meetings that you held? 
TOPICS
(STRING 250)
IF (I4 = 1 OR 2 OR I5=1)
B10a. Now I would like to know if there are Community Health Committees that assist this CHPS 
zone?
Select one only
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 0 GO TO C1a
 DON’T KNOW / REFUSED .................................................................................. 98
B10a=1
B10b. Currently, how many Community Health Committees are assisting this CHPS zone? 
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 96;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 97.
NUMBER OF (RANGE 0-99)
IF (I4 = 1 OR 2 OR I5=1) AND B10a ≠ 0 
B11a. Currently, do any of the communities in this CHPS zone have a Community Health Action Plan, 
also known as a CHAP, in place?
A CHAP IS A SET OF TIME-BOUND ACTIVITIES THAT THE FACILITY HAS AGREED TO WORK ON 
WITH THE COMMUNITY.
Select one only
 YES....................................................................................................................... 1
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
 NO ........................................................................................................................ 0
 DON’T KNOW / REFUSED .................................................................................. 98
IF [B11a=1] AND [B7a>1]
B11b. Currently, how many communities in this CHPS zone have a CHAP in place? 
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 996;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 997.
NUMBER OF 
(RANGE 0-999)
IF B11a = 1
B11c. In the past 12 months, have the Community Health Committees in your CHPS zone played 
a leading part in developing their Community Health Action Plans?
Select one only
 YES, AT LEAST ONE........................................................................................... 1
 NO ........................................................................................................................ 0
 DON’T KNOW....................................................................................................... 96
 REFUSED............................................................................................................. 97
[B11c=1] AND [B10b>1]
B11d. Currently, how many CHCs in this CHPS zone have played a leading part in developing their 
CHAP? 
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 996;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 997.
NUMBER OF CHCs
(RANGE 0-999)
IF (I4 = 1 OR 2 OR I5=1) AND B10a ≠ 0
B12. Now I am going to ask you to rate the overall effectiveness of the Community Health 
Committees in your CHPS Zone on a number of characteristics. I will ask you to rate their work 
as poor, fair, good, very good, or excellent. 
First, in your opinion, how effective are the Community Health Committees at mobilizing 
resources for the CHPS compound to help provide services to the community - poor, fair, good, 
very good, or excellent, or they don’t do it at all?
Select one only
 Poor...................................................................................................................... 1
 Fair ....................................................................................................................... 2
 Good .................................................................................................................... 3
 Very Good............................................................................................................ 4
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
 Excellent.............................................................................................................. 5
 They Don’t Do It At All........................................................................................ 95
 DON’T KNOW....................................................................................................... 96
 REFUSED............................................................................................................. 97
IF (I4 = 1 OR 2 OR I5=1) AND B10a ≠ 0
B13. In your opinion, how effective are the Community Health Committees at sensitizing the 
community for health action, poor, fair, good, very good, or excellent, or they don’t do it at all? 
Select one only
 Poor...................................................................................................................... 1
 Fair ....................................................................................................................... 2
 Good .................................................................................................................... 3
 Very Good............................................................................................................ 4
 Excellent.............................................................................................................. 5
 They Don’t Do It At All........................................................................................ 95
 DON’T KNOW....................................................................................................... 96
 REFUSED............................................................................................................. 97
C. CLIENTS TO FACILITY
ALL
C1. Now I would like to ask you about seeing clients at this facility and your referral system. 
In the last two complete months, how many clients were seen at this facility?
DOCUMENT NEEDED: FACILITY MONTHLY REPORT.
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 99,996;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 99,997.
NUMBER OF CLIENTS
(RANGE 0-99,999)
ALL
C1a. In the last two complete months, how many clients were seen at the Out Patient Department or 
OPD here?
DOCUMENT NEEDED: CD1 REPORT, INTEGRATED DISEASE SURVEILLANCE AND RESPONSE 
(IDRS), AND/OR MORBIDITY RETURNS. THE TOTAL ATTENDANCE SHOULD BE USED, AND NOT
THE REGISTRANTS.
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 99,996;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 99,997.
NUMBER OF CLIENTS
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
(RANGE 0-99,999)
ALL
C1b. In the last two complete months, how many clients were seen by the midwife, as recorded in 
your Midwifery Returns form, or Form A?
DOCUMENT NEEDED: FORM A OR MIDWIFERY RETURN FORM. THE TOTAL ATTENDANCE 
SHOULD BE USED, AND NOT THE REGISTRANTS.
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 99,996;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 99,997.
NUMBER OF CLIENTS
(RANGE 0-99,999)
ALL
C1c. In the last two complete months, how many clients were seen for family planning, as recorded in 
your Family Planning Report, or Form B?
DOCUMENT NEEDED: FORM B OR FAMILY PLANNING REPORT. THE TOTAL ATTENDANCE 
SHOULD BE USED, AND NOT THE REGISTRANTS.
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 99,996;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 99,997.
NUMBER OF CLIENTS
(RANGE 0-99,999)
ALL
C1d. In the last two complete months, how many children were seen at this facility, as recorded in 
your Child Health Returns, or Form C?
DOCUMENT NEEDED: FORM C, NUTRITION AND CHILD HEALTH REPORT, EPI, OR CHILD 
HEALTH RETURNS. THE TOTAL ATTENDANCE SHOULD BE USED, AND NOT THE 
REGISTRANTS.
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 99,996;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 99,997; IF NOT APPLICABLE, ENTER 
99,994.
NUMBER OF CLIENTS
(RANGE 0-99,999)
ALL
C1e. In the last two complete months, how many clients were seen at the Prevention of Mother-to￾Child Transmission of HIV and Early Infant Diagnosis unit, or the PMTCT/EID unit, as recorded in 
your PMTCT/EID report form?
DOCUMENT NEEDED: PMTCT/EID REPORT FORM. THE TOTAL ATTENDANCE SHOULD BE 
USED, AND NOT THE REGISTRANTS.
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 99,996;
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 99,997; IF NOT APPLICABLE, ENTER 
99,994.
NUMBER OF CLIENTS
(RANGE 0-99,999)
ALL
C1f. In the last two complete months, how many clients were seen at the Adolescent Health and 
Development center, or the ADHD centre, as recorded in your Adolescent Health Reports?
DOCUMENT NEEDED: ADOLESCENT HEALTH REPORTS. THE TOTAL ATTENDANCE SHOULD 
BE USED, AND NOT THE REGISTRANTS.
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 99,996;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 99,997; IF NOT APPLICABLE, ENTER 
99,994.
NUMBER OF CLIENTS
(RANGE 0-99,999)
ALL
C1g. In the last two complete months, how many clients were seen at the Nutritional Rehabilitation 
Centre, if you have one?
DOCUMENT NEEDED: NUTRITION FORM. THE TOTAL ATTENDANCE SHOULD BE USED, AND 
NOT THE REGISTRANTS.
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 99,996;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 99,997.
NUMBER OF CLIENTS
(RANGE 0-99,999)
ALL
C2a. In the last two complete months, have any clients been referred from this facility to another 
health facility?
INSTRUCTION: PLEASE DO NOT INCLUDE FOLLOW-UPS REFERRED BACK TO FACILITIES.
Select one only
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 0
 DON’T KNOW / REFUSED .................................................................................. 98
IF C2a=1
C2b. Do you have referral records for any of the clients referred from this facility to another health 
facility in the last two complete months?
INSTRUCTION: PLEASE DO NOT INCLUDE FOLLOW-UPS REFERRED BACK TO FACILITIES.
DOCUMENTS NEEDED: REFERRAL RECORDS OR REGISTERS AND MONTHLY REPORTS, IF 
AVAILABLE.
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
Select one only
 YES, RECORDS SEEN........................................................................................ 1
 YES, RECORDS NOT SEEN............................................................................... 2
 NO ........................................................................................................................ 0
 DON’T KNOW....................................................................................................... 96
 REFUSED............................................................................................................. 97
IF C2b=1 OR 2
C3. For the most recent client referred from this facility, may I see the referral record?
INSTRUCTION: INDICATE WHETHER THE MOST RECENT REFERRAL HAS BEEN RECORDED 
AND IF SO, WHETHER YOU HAVE SEEN THE RECORD. 
PLEASE DO NOT INCLUDE FOLLOW-UPS REFERRED BACK TO A FACILITY.
Select one only
 YES, REFERRAL WAS RECORDED, SEEN ...................................................... 1
 YES, REFERRAL WAS RECORDED, NOT SEEN.............................................. 2
 NO, REFERRAL WAS NOT RECORDED ........................................................... 0
 DON’T KNOW....................................................................................................... 96
 REFUSED............................................................................................................. 97
IF C2a=1
C4. In the last two complete months, among all the clients seen at this facility, how many clients 
were referred from this facility to another health facility? 
INSTRUCTION: PLEASE DO NOT INCLUDE FOLLOW-UPS REFERRED BACK TO FACILITIES.
DOCUMENTS NEEDED: REFERRAL RECORDS AND MONTHLY REPORTS, IF AVAILABLE.
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 9,996;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 9,997.
NUMBER OF CLIENTS REFERRED
(RANGE 0-9,999)
IF (C4 ≠ 0, 9,996 OR 9,997) AND C2a=1
C5. In the last two complete months, among all clients referred to other health facilities, what types 
of health issues most often led to clients being referred? 
DOCUMENT NEEDED: REFERRAL RECORDS, IF AVAILABLE.
PROBE IF ONLY ONE ANSWER IS GIVEN, “Anything else?”
SELECT ‘YES’ FOR ALL RESPONSES GIVEN. SELECT ‘NO’ FOR ALL OTHER RESPONSE 
OPTIONS. 
IF R DOES NOT KNOW OR REFUSES TO ANSWER THE QUESTION, SELECT 'DON'T KNOW 
/ REFUSED' FOR ALL C5 RESPONSE OPTIONS.
MARK ALL
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
C5_1. MALARIA OR SEVERE MALARIA..........................................................................Y/N/DK-R
C5_2. PREGNANCY-RELATED COMPLICATIONS.........................................................Y/N/DK-R
C5_3. CHOLERA ...............................................................................................................Y/N/DK-R
C5_4. ACCIDENTS AND INJURIES, SUCH AS SNAKE BITES, BURNS, AND CUTS....Y/N/DK-R
C5_5. TYPHOID.................................................................................................................Y/N/DK-R
C5_6. DIARRHEA..............................................................................................................Y/N/DK-R
C5_7. UPPER RESPIRATORY TRACT INFECTION........................................................Y/N/DK-R
C5_8. SKIN DISEASES AND ULCERS.............................................................................Y/N/DK-R
C5_9. HYPERTENSION ....................................................................................................Y/N/DK-R
C5_10. PNEUMONIA.........................................................................................................Y/N/DK-R
C5_11. ANEMIA.................................................................................................................Y/N/DK-R
C5_12. INTESTINAL WORMS ..........................................................................................Y/N/DK-R
C5_13. RHEUMATISM ......................................................................................................Y/N/DK-R
C5_14. EAR INFECTION...................................................................................................Y/N/DK-R
C5_15. STROKE................................................................................................................Y/N/DK-R
C5_16. ACUTE MALNUTRITION……………………………………………………….. ........Y/N/DK-R
C5_17. DIABETES……………………………………………………………………...............Y/N/DK-R
C5_99. SOMETHING ELSE ..............................................................................................Y/N/DK-R
C5=99
C5o. In the last two complete months, among all clients referred to other health facilities, what 
types of health issues most often led to clients being referred? 
HEALTH ISSUE/S
(STRING 250)
IF C4 ≠ 0, 9,996 OR 9,997
C6. In the last two complete months, have any decisions to refer a client to another health facility 
been influenced by whether the client had health insurance coverage or not?
Select one only
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 0
 DON’T KNOW / REFUSED .................................................................................. 98
IF (I4 = 1 OR 2 OR I5=1) AND C4 ≠ 0, 9,996 OR 9,997
C7. In the last two complete months, how many referred clients returned here with feedback notes 
from another health provider?
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
DOCUMENT NEEDED: REFERRAL RECORDS.
INSTRUCTION: FEEDBACK COULD ALSO BE COUNTED IF OBTAINED VIA PHONE OR 
PERSONAL VISITS, AS LONG AS FEEDBACK IS DOCUMENTED, SUCH AS REMARKS IN A 
REGISTER.
IF THE RESPONDENT DOES NOT KNOW, ENTER 996;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 997.
NUMBER OF CLIENTS WITH FEEDBACK NOTES
(RANGE 0-999)
IF (I4 = 3 OR I5=2)
C8. In the last two complete months, how many clients did this health center receive who were 
referred from another health facility?
DOCUMENT NEEDED: REFERRAL RECORDS OR REGISTER, IF AVAILABLE.
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 996;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 997.
NUMBER OF REFERRED CLIENTS RECEIVED
(RANGE 0-999)
IF (I4 = 3 OR I5=2) AND C8 ≠ 0
C9. In the last two complete months, among all clients referred to this health facility, what 
types of health issues most often led to clients being referred? 
DOCUMENT NEEDED: REFERRAL RECORDS, IF AVAILABLE.
PROBE IF ONLY ONE ANSWER IS GIVEN, “Anything else?”
SELECT ‘YES’ FOR ALL RESPONSES GIVEN. SELECT ‘NO’ FOR ALL OTHER RESPONSE 
OPTIONS. 
IF R DOES NOT KNOW OR REFUSES TO ANSWER THE QUESTION, SELECT 'DON'T KNOW 
/ REFUSED' FOR ALL C9 RESPONSE OPTIONS.
MARK ALL
C9_1. MALARIA............................................................................................................... Y/N/DK-R
C9_2. PREGNANCY-RELATED COMPLICATIONS.........................................................Y/N/DK-R
C9_3. CHOLERA .................................................................................................................Y/N/DK-R
C9_4. ACCIDENTS AND INJURIES, SUCH AS SNAKE BITES, BURNS, AND CUTS......Y/N/DK-R
C9_5. TYPHOID................................................................................................................... Y/N/DK-R
C9_6. DIARRHEA................................................................................................................Y/N/DK-R
C9_7. UPPER RESPIRATORY TRACT INFECTION.......................................................... Y/N/DK-R
C9_8. SKIN DISEASES AND ULCERS...............................................................................Y/N/DK-R 
C9_9. HYPERTENSION ......................................................................................................Y/N/DK-R 
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
C9_10. PNEUMONIA...........................................................................................................Y/N/DK-R 
C9_11. ANEMIA...................................................................................................................Y/N/DK-R 
C9_12. INTESTINAL WORMS ............................................................................................Y/N/DK-R 
C9_13. RHEUMATISM ........................................................................................................Y/N/DK-R 
C9_14. EAR INFECTION.....................................................................................................Y/N/DK-R 
C9_15. STROKE..................................................................................................................Y/N/DK-R 
C9_16. ACUTE MALNUTRITION………………………………………………………….........Y/N/DK-R 
 C9_17. DIABETES ………………………………………………………………………............Y/N/DK-R 
C9_99. SOMETHING ELSE ................................................................................................Y/N/DK-R 
C9_99=YES
C9o. In the last two complete months, among all clients referred to this health facility, what other 
types of health issues most often led to clients being referred? 
HEALTH ISSUE/S
(STRING 250)
ALL
C10. Now I would like to ask you about health insurance. Has your facility been accredited by the 
National Health Insurance Scheme, also known as NHIS, to provide health care? 
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 2
 DON’T KNOW / REFUSED .................................................................................. 98
IF C10=1 
C11. In the last two complete months, for how many claims did you record and submit National 
Health Insurance claims?
DOCUMENT NEEDED: INSURANCE RECORDS
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 99,996;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 99,997.
_________________________ NUMBER INSURANCE CLAIMS
(RANGE 0-99,999)
IF C10 = 1
C12. In the last 2 complete months, have you noticed an increase, decrease or no change in the 
number of clients who are seen at your facility who are part of the National Health Insurance 
Scheme? 
 INCREASE ........................................................................................................... 1
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
 DECREASE.......................................................................................................... 2
 NO CHANGE........................................................................................................ 3
 DON’T KNOW....................................................................................................... 96
 REFUSED……………………………………………………………………………….97
IF C10=1
C12a. In the last year, has this facility received reimbursements for one or more insurance claim? 
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 2
 DON’T KNOW / REFUSED .................................................................................. 98
IF C12a=1
C12b. In the last year, has this facility received one or more insurance reimbursements within 6 
months of submitting the claim?
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 2
 DON’T KNOW / REFUSED .................................................................................. 98
ALL
C13a. As far as you know, are there any health care services that one would need from a health care 
provider that are not covered by the National Health Insurance Scheme? 
Select one only
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 0
 DON’T KNOW / REFUSED .................................................................................. 98
C13a=1
C13b. As far as you know, what are the health care services that one would need from a health 
care provider that are not covered by the National Health Insurance Scheme? 
HEALTH SERVICE/S
(STRING 250)
D. PROGRAMS 
ALL
D1a. Now I would like to ask you a few questions about health promotion, specifically the 
GoodLife, Live it Well Campaign. Does this facility display GoodLife, Live it Well Campaign 
Materials? 
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
INSTRUCTION: OBSERVE AND ASK TO SEE IF THEY ARE DISPLAYING POSTERS, 
BROCHURES, OR CAR STICKERS, BEFORE ACCEPTING A ‘YES’ RESPONSE. 
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 0 
 DON’T KNOW / REFUSED .................................................................................. 98
ALL
D1b. In the last two complete months, has this facility used GoodLife, Live it Well Campaign 
materials such as posters or cue cards during health promotion activities with health clients?
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 0 
 DON’T KNOW / REFUSED .................................................................................. 98
IF D1b=1
D1c. How useful do you find these materials in your health promotion activities with health clients 
– very useful, moderately useful, or not useful?
 VERY USEFUL..................................................................................................... 1
 MODERATELY USEFUL...................................................................................... 2 
 NOT USEFUL....................................................................................................... 3
 DON’T KNOW....................................................................................................... 96
 REFUSED……………………………………………………………………………… 97
ALL
D2. Now I would like to ask you a bit about some of the health services you might provide. 
Does this facility provide antenatal care services, also known as ANC services? 
Select one only
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 0 GO TO D4
 DON’T KNOW / REFUSED .................................................................................. 98 GO TO D4
IF D2=1
D3. Does this facility have an antenatal care services or ANC services register? 
INSTRUCTION: ASK TO SEE REGISTER.
Select one only
 YES, REGISTER SEEN ....................................................................................... 1
 YES, REGISTER NOT SEEN............................................................................... 2
 NO ........................................................................................................................ 0
 DON’T KNOW....................................................................................................... 96
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
 REFUSED............................................................................................................. 97
ALL
D4. Does this facility conduct childbirth deliveries? 
 INSTRUCTION: THIS INCLUDES EMERGENCY BIRTHS.
Select one only
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 0
 DON’T KNOW / REFUSED .................................................................................. 98
IF D4 ≠ 0
D5. In the last two complete months, how many births occurred at this facility?
DOCUMENTATION: MATERNITY OR DELIVERY BOOK OR DOCUMENTATION FROM THE LABOR 
WARD.
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 9,996;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 9,997.
______________________NUMBER OF BIRTHS AT FACILITY
(RANGE 0-9,999)
IF D5 ≠ 0
D6. In the last two complete months, of all the births that occurred at this facility, how many were 
emergency deliveries?
DOCUMENTATION: BIRTH REGISTERS
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 996;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 997.
___________________NUMBER OF EMERGENCY DELIVERIES
(RANGE 0-999)
IF D5 ≠ 0
D7. In the last two complete months, how many births that occurred at this facility were 
registered by this facility? 
DOCUMENTATION: BIRTH REGISTERS 
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 996;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 997.
_______________________NUMBER OF BIRTHS REGISTERED
(RANGE 0-999)
ALL
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
D8. In the last two complete months, did this facility register any homebirths?
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 2
 DON’T KNOW / REFUSED .................................................................................. 98
IF D8=1
D9. In the last two complete months, how many homebirths did this facility register?
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 996;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 997.
_____________________NUMBER OF HOME DELIVERIES
(RANGE 0-999)
ALL
D10. For 2019, how many births should occur in this facility’s catchment area based on annual 
expected deliveries for this facility? 
DOCUMENTATION: ANC RECORDS 
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 9,996;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 9,997.
___________________________NUMBER OF PROJECTED BIRTHS IN AREA
(RANGE 0 - 9,999)
ALL
D11. In the last two complete months, has this facility had any neonatal deaths, by which I mean 
deaths of babies who were 0 to 28 days old? 
DOCUMENTATION: FACILITY SPREADSHEET OR REGISTER ON NEONATAL DEATHS
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 0 
 DON’T KNOW / REFUSED .................................................................................. 98
D11=1
D12. In the last two complete months, how many neonatal deaths have occurred in this facility?
DOCUMENTATION: FACILITY SPREADSHEET OR REGISTER ON NEONATAL DEATHS
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 996;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 997.
___________________NUMBER
(RANGE 0-999)
D11=1
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
D13a. In the last two complete months, has this facility recorded the cause of [all of] the neonatal 
death/s that occurred in this facility? 
INSTRUCTION: ASK TO SEE RECORD/S.
Select one only
 YES, RECORD/S SEEN....................................................................................... 1
 YES, RECORD/S NOT SEEN.............................................................................. 2
 NO ........................................................................................................................ 0
 DON’T KNOW....................................................................................................... 96
 REFUSED............................................................................................................. 97
D11=1
D13b. In the last two complete months, what were the main reasons for the neonatal deaths that 
occurred in this facility? 
DOCUMENTATION: FACILITY SPREADSHEET OR REGISTER ON NEONATAL DEATHS
PROBE IF ONLY ONE ANSWER IS GIVEN, “Anything else?”
SELECT ‘YES’ FOR ALL RESPONSES GIVEN. SELECT ‘NO’ FOR ALL OTHER RESPONSE 
OPTIONS. 
IF R DOES NOT KNOW OR REFUSES TO ANSWER THE QUESTION, SELECT 'DON'T KNOW 
/ REFUSED' FOR ALL D13b RESPONSE OPTIONS.
MARK ALL
D13b_1. INFECTION .................................................................................................. Y/N/DK-R 
D13b_2. PRE-TERM BIRTH COMPLICATIONS........................................................ Y/N/DK-R 
D13b_3. INTRA PARTUM RELATED......................................................................... Y/N/DK-R
D13b_4. CONGENITAL ABNORMALITIES................................................................ Y/N/DK-R
D13b_99. ANOTHER REASON ................................................................................. Y/N/DK-R
IF D13b_=99=YES
D13bo. In the last two complete months, what were the main reasons for the neonatal deaths that 
occurred in this facility? 
REASONS 
(STRING 250)
ALL
D14a. In the last two complete months, has this facility had any maternal deaths?
DOCUMENTATION: FACILITY SPREADSHEET OR REGISTER ON MATERNAL DEATHS 
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 0 
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
 DON’T KNOW / REFUSED .................................................................................. 98
IF D14a=1
D14b. In the last two complete months, how many maternal deaths have occurred in this facility?
DOCUMENTATION: FACILITY SPREADSHEET OR REGISTER ON MATERNAL DEATHS 
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 96;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 97.
___________________NUMBER OF MATERNAL DEATHS
(RANGE 0-99)
D14a=1
D15a. In the last two complete months, has this facility recorded the cause of [all of] the maternal 
death/s that occurred in this facility? 
INSTRUCTION: ASK TO SEE RECORD/S.
DOCUMENTATION: FACILITY SPREADSHEET OR REGISTER ON MATERNAL DEATHS 
Select one only
 YES, RECORD/S SEEN....................................................................................... 1
 YES, RECORD/S NOT SEEN.............................................................................. 2
 NO ........................................................................................................................ 0
 DON’T KNOW....................................................................................................... 96
 REFUSED............................................................................................................. 97
D14b >0<96
D15b. In the last two complete months, what were the main reasons for the maternal deaths that 
occurred in this facility?
DOCUMENTATION: FACILITY SPREADSHEET OR REGISTER ON MATERNAL DEATHS
PROBE IF ONLY ONE ANSWER IS GIVEN, “Anything else?”
SELECT ‘YES’ FOR ALL RESPONSES GIVEN. SELECT ‘NO’ FOR ALL OTHER RESPONSE 
OPTIONS. 
IF R DOES NOT KNOW OR REFUSES TO ANSWER THE QUESTION, SELECT 'DON'T KNOW 
/ REFUSED' FOR ALL D15b RESPONSE OPTIONS.
MARK ALL
D15b_1. HEMORRHAGE ........................................................................................... Y/N/DK-R 
D15b_2. ABORTION................................................................................................... Y/N/DK-R
D15b_3. HYPERTENSIVE DISORDERS ................................................................... Y/N/DK-R
D15b_4. ECTOPIC GESTATION................................................................................ Y/N/DK-R
D15b_5. UTERINE RUPTURE ................................................................................... Y/N/DK-R
D15b_6. PUERPERAL SEPSIS.................................................................................. Y/N/DK-R
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
D15b_99. ANOTHER REASON ................................................................................. Y/N/DK-R
IF D15b_=99=YES
D15bo. In the last two complete months, what were the main reasons for the maternal deaths 
that occurred in this facility? 
REASONS
(STRING 250)
ALL
D16. Does this facility have written protocols for managing maternal and newborn care?
INSTRUCTION: ASK TO SEE WRITTEN PROTOCOLS.
Select one only
 YES, PROTOCOL SEEN ..................................................................................... 1
 YES, PROTOCOL NOT SEEN............................................................................. 2
 NO ........................................................................................................................ 3
 DON’T KNOW....................................................................................................... 96
 REFUSED............................................................................................................. 97
IF D4 ≠ 0 AND IF D5 ≠ 0
D17. In the last two complete months, how many women who delivered at this facility received at 
least two doses of sulfadoxine-pyrimethamine, also known as SP?
INSTRUCTION: IF ONE WOMAN RECEIVED MORE THAN TWO DOSES, SHE SHOULD ONLY BE 
COUNTED ONCE. REFER TO FORM A, DELIVERY SHEET.
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 996;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 997.
________________________NUMBER OF WOMEN RECEIVED SP
(RANGE 0-999)
ALL
D18. Does this facility offer family planning counseling and provide contraception?
Select one only
 YES, FAMILY PLANNING COUNSELING ........................................................... 1
 YES, CONTRACEPTIVES ................................................................................... 2
 YES, BOTH........................................................................................................... 3
 NO ........................................................................................................................ 0 GO TO D20
 DON’T KNOW....................................................................................................... 96 GO TO D20
 REFUSED............................................................................................................. 97 GO TO D20
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
IF D18 = 2 OR 3
D19a. In the last two complete months, how many clients accepted contraceptives for the first time 
from this facility?
INSTRUCTION: ASK TO SEE THE FAMILY PLANNING RECORDS AND MONTHLY REPORTS.
IF THE RESPONDENT DOES NOT KNOW, ENTER 996;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 997.
__________________________NUMBER OF CLIENTS
(RANGE 0-999)
D18=2 OR 3.
D19b. In the last two complete months, based on your records, what contraceptives were 
accepted for the first time by these clients? 
DOCUMENT NEEDED: FORM B
PROBE IF ONLY ONE ANSWER IS GIVEN, “Anything else?”
SELECT ‘YES’ FOR ALL RESPONSES GIVEN. SELECT ‘NO’ FOR ALL OTHER RESPONSE 
OPTIONS. 
IF R DOES NOT KNOW OR REFUSES TO ANSWER THE QUESTION, SELECT 'DON'T KNOW 
/ REFUSED' FOR ALL D19b RESPONSE OPTIONS.
MARK ALL 
D19b_1. A HORMONAL IMPLANT: IMPLANON, IMPLANON NXT, JADELLE, SINO INPLANT II, OR 
NORPLANT ....................................................................................................................... Y/N/DK-R
D19b_2. AN INTRAUTERINE DEVICE, ALSO KNOWN AS AN IUD...................................... Y/N/DK-R 
D19b_3. AN INJECTABLE CONTRACEPTIVE: DEPO PROVERA OR NORIGYNON .......... Y/N/DK-R 
D19b_4. COMBINED ORAL CONTRACEPTIVE PILLS.......................................................... Y/N/DK-R
D19b_5. PROGESTOGEN-ONLY PILL, ALSO KNOWN AS POP.......................................... Y/N/DK-R
D19b_6. CONDOMS................................................................................................................ Y/N/DK-R
ALL
D20. Does this facility have a nutrition register, for example a growth monitoring register, 
nutrition education counseling register, child welfare clinic register or child health 
register?
INSTRUCTION: ASK TO SEE REGISTER. 
Select one only
 YES, REGISTER SEEN ....................................................................................... 1
 YES, REGISTER NOT SEEN............................................................................... 2
 NO ........................................................................................................................ 3 GO TO D24
 DON’T KNOW....................................................................................................... 96
 REFUSED............................................................................................................. 97
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
IF D20=1
D20o. What nutrition register does this facility have that I can see? 
INSTRUCTION: IF MORE THAN ONE IS SHOWN, SPECIFY ALL SEEN.
REGISTER 
(STRING 150)
IF D20=2
D20o2. What nutrition register does this facility have that I have not seen? 
INSTRUCTION: IF MORE THAN ONE IS MENTIONED, SPECIFY ALL MENTIONED.
REGISTER 
(STRING 150)
IF D20 = 1, 2, 96 OR 97
D21. In the last two complete months, has data been entered into the nutrition register?
INSTRUCTION: ASK TO SEE REGISTER.
Select one only
 YES, DATA SEEN ................................................................................................ 1
 YES, REPORTED BY RESPONDENT ............................................................... 2
 NO ........................................................................................................................ 3
 DON’T KNOW....................................................................................................... 96
 REFUSED............................................................................................................. 97
IF D21 = 1 
D22. I am going to ask you about different kinds of child data. 
In the last two complete months, has any [FILL with a-e] been entered into the nutrition register? 
Yes No D. K. Refused
a. child’s weight data
b. child’s age data
c. child’s height data
d. under-weight, or weight for age data, also known as 
Z scores or SD
e. Infant and Young Child Feeding, also known as 
IYCF, counseling data
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
IF D21 = 1; 
PROGRAMMER, CAN WE ALLOW FOR DAY, MONTH, AND/OR YEAR TO BE BLANK?
D23ai. What is the date of the most recent entry in the nutrition register? ENTER DATE HERE
INSTRUCTION: ASK TO SEE REGISTER.
 DON’T KNOW....................................................................................................... 96
 REFUSED............................................................................................................. 97
ALL
D24. Does this facility have written protocols for managing acute under nutrition?
INSTRUCTION: ASK TO SEE WRITTEN PROTOCOLS.
Select one only
 YES, PROTOCOL SEEN ..................................................................................... 1
 YES, PROTOCOL NOT SEEN............................................................................. 2
 NO ........................................................................................................................ 0
 DON’T KNOW....................................................................................................... 96
 REFUSED............................................................................................................. 97
ONLY IF I1 = 3, 6, OR 7 (REGION = NORTHERN, UE, OR UW)
D25. Does this facility have nutrition counseling cards, key nutrition messages leaflets, nutrition 
pamphlets, or other nutrition materials?
INSTRUCTION: ASK TO SEE MATERIALS.
Select one only
 YES, SEEN........................................................................................................... 1
 YES, NOT SEEN .................................................................................................. 2
 NO ........................................................................................................................ 0
 DON’T KNOW....................................................................................................... 96
 REFUSED............................................................................................................. 97
ALL
D26a. Currently does this facility have a working hand washing station or veronica bucket in 
place?
Select one only
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 0
 DON’T KNOW / REFUSED .................................................................................. 98
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
ALL
D26b. In the last two complete months, did staff in this facility consistently wear gloves when 
needed for prevention and control of infections?
Select one only
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 0
 DON’T KNOW / REFUSED .................................................................................. 98
ALL
D26o. Currently, what other sanitation measures does this facility have in place for prevention 
and control of infections?
INSTRUCTION: IF THERE ARE NO OTHER MEASURES, ENTER ‘NONE.’
SANITATION MEASURES 
(STRING 350)
ALL
D27. Please tell me which of the following sterilization measures this facility currently has in 
place for prevention and control of infections. Currently, does this facility … for 
prevention and control of infections?
MARK EACH SUBQUESTION
a. have a protocol in place for mixing chlorine for disinfection........................ Y/N/DK-R
b. have disinfectants .............................................................................................. Y/N/DK-R
c. disinfect instruments ......................................................................................... Y/N/DK-R
d. have functioning sterilizing equipment such as boilers or autoclaves........ Y/N/DK-R
e. sterilize equipment ............................................................................................. Y/N/DK-R
ALL
D27o. Currently, what other sterilization measures does this facility have in place for prevention 
and control of infections?
INSTRUCTION: IF THERE ARE NO OTHER MEASURES, ENTER ‘NONE.’
STERILIZATION MEASURES
(STRING 350)
ALL
D28. Please tell which of the following disposal measures this facility currently has in place for 
prevention and control of infections.
Currently, does this facility … for prevention and control of infections?
a. Use a sharps container...................................................................................... Y/N/DK-R
b. have available a functioning incinerator.......................................................... Y/N/DK-R
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
c. have separate waste disposal........................................................................... Y/N/DK-R
d. have available polythene bags for waste......................................................... Y/N/DK-R
ALL
D28o. Currently, what other disposal measures does this facility have in place for prevention and 
control of infections?
INSTRUCTION: IF THERE ARE NO OTHER MEASURES, ENTER ‘NONE.’
DISPOSAL MEASURES
(STRING 350)
ALL
D29. Please tell me which of the following measures this facility currently has in place for dealing with 
contagious clients for prevention and control of infections at the facility.
Currently, does this facility …
a. Separate sick newborns from healthy newborns? ......................................... Y/N/DK-R
b. Separate clients with contagious diseases from healthy clients?................ Y/N/DK-R
ALL
D29o. Currently, what other measures does this facility have in place for dealing with contagious 
clients for prevention and control of infections at the facility?
INSTRUCTION: IF THERE ARE NO OTHER MEASURES, ENTER ‘NONE.’
MEASURES 
(STRING 350)
IF I4=1
D30. What type of water supply does this facility have?
PROBE IF ONLY ONE ANSWER IS GIVEN, “Anything else?”
SELECT ‘YES’ FOR ALL RESPONSES GIVEN. SELECT ‘NO’ FOR ALL OTHER RESPONSE 
OPTIONS. 
IF R DOES NOT KNOW OR REFUSES TO ANSWER THE QUESTION, SELECT 'DON'T KNOW 
/ REFUSED' FOR ALL D30 RESPONSE OPTIONS.
MARK ALL
D30_1. PIPED WATER (MUST BE OBSERVED) Y/N/DK-R
D30_2. BORE HOLE (MUST BE OBSERVED) Y/N/DK-R
D30_3. WELL Y/N/DK-R
D30_99. OTHER Y/N/DK-R
IF D30_99=YES
D30o. What other type of water supply does this facility have?
WATER SUPPLY 
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
(STRING 150)
IF I4=1
D31. Does this facility have a functional toilet or latrine? 
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 0 
 DON’T KNOW....................................................................................................... 96
 REFUSED............................................................................................................. 97
D31=1
D32. What type of toilet or latrine does this facility have?
PROBE IF ONLY ONE ANSWER IS GIVEN, “Anything else?”
SELECT ‘YES’ FOR ALL RESPONSES GIVEN. SELECT ‘NO’ FOR ALL OTHER RESPONSE 
OPTIONS. 
IF R DOES NOT KNOW OR REFUSES TO ANSWER THE QUESTION, SELECT 'DON'T KNOW 
/ REFUSED' FOR ALL D32 RESPONSE OPTIONS.
MARK ALL
D32_1. FLUSH TOILET .......................................................................................Y/N/DK-R
D32_2. VENTILATED PIT LATRINE ...................................................................Y/N/DK-R
D32_99. OTHER ...................................................................................................Y/N/DK-R
IF D32_99=YES
D32o. What other type of toilet or latrine does this facility have?
TOILET OR LATRINE
(STRING 150)
E. MALARIA
ALL
E1. Now I would like to focus on malaria. 
Currently, how many staff members here typically provide treatment for malaria?
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 96;
 IF THE RESPONDENT REFUSES TO ANSWER, ENTER 97.
________________________NUMBER OF STAFF 
(RANGE 0-99)
IF E1 >0
E2. Could we please look at the consulting room register?
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
In the last two complete months, based on the register entries, how many clients seen at this 
facility had a provisional diagnosis of malaria?
DOCUMENTATION: CONSULTING ROOM REGISTER AND/OR MORBIDITY REPORTS.
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 9996;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 9997.
_________________NUMBER OF CLIENTS
(RANGE 0-9,999)
IF E2>0
E3a. In the last two complete months, how many clients with a provisional diagnosis of malaria and 
who were tested for malaria using a Rapid Diagnostic Test, also known as an RDT, or a 
microscopy test had their results recorded in the consulting room register? 
DOCUMENTATION: CONSULTING ROOM REGISTER AND/OR MORBIDITY REPORTS. 
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 996;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 997.
_________________NUMBER OF CLIENTS
(RANGE 0-9,999)
IF E2>0
E3b. In the last two complete months, how many clients with a provisional diagnosis of malaria and 
who were tested for malaria using a Rapid Diagnostic Test, also known as an RDT, or a 
microscopy test had a positive test result recorded in the consulting room register? 
DOCUMENTATION: CONSULTING ROOM REGISTER AND/OR MORBIDITY REPORTS.
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 996;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 997.
_________________NUMBER OF CLIENTS
(RANGE 0-9,999)
IF E2>0
E3c. In the last two complete months, how many clients with a provisional diagnosis of malaria and 
who were tested for malaria using a Rapid Diagnostic Test, also known as an RDT, or a 
microscopy test, and had a positive test result recorded in the consulting room register, had 
treatment results recorded? 
DOCUMENTATION: CONSULTING ROOM REGISTER AND/OR MORBIDITY REPORTS.
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 996;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 997.
_________________NUMBER OF CLIENTS
(RANGE 0-9,999)
[IF E2>0] AND [IF E2>E3a] 
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
E4i. In the last two complete months, were there client with provisional diagnosis of malaria who 
were not tested for malaria using RDT or microscopy test?
COMPARE E2 AND E3a
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 0 
 DON’T KNOW / REFUSED .................................................................................. 98
IF E4i=1
E4. In the last two complete months, what were some of the reasons that not every client with a 
provisional diagnosis of malaria was tested for malaria using an RDT or microscopy test? 
PROBE IF ONLY ONE ANSWER IS GIVEN, “Any other reason?”
SELECT ‘YES’ FOR ALL RESPONSES GIVEN. SELECT ‘NO’ FOR ALL OTHER RESPONSE 
OPTIONS. 
IF R DOES NOT KNOW OR REFUSES TO ANSWER THE QUESTION, SELECT 'DON'T KNOW 
/ REFUSED' FOR ALL E4 RESPONSE OPTIONS.
MARK ALL
E4_1. RDT / LAB IS NOT AVAILABLE AT ALL TIMES OF THE DAY AND NIGHT ...........Y/N/DK-R 
E4_2. INSUFFICIENT SUPPLY OF RDT ............................................................................Y/N/DK-R 
E4_3. LACK IN SKILL IN CONDUCTING RDT / MICROSCOPY........................................Y/N/DK-R
E4_4. DO NOT WANT TO WASTE CLIENT’S TIME OR DELAY CLIENT FURTHER.......Y/N/DK-R 
E4_5. THIS FACILITY DOES NOT TREAT MALARIA........................................................Y/N/DK-R
E4_6. CLIENT WAS DIAGNOSED BASED ON SYMPTOMS.............................................Y/N/DK-R
E4_7. TEST WERE CONDUCTED BUT RESULTS WERE NOT RECORDED .................Y/N/DK-R
E4_8. NO SPECIFIC REASON ...........................................................................................Y/N/DK-R
E4_99. ANOTHER REASON...............................................................................................Y/N/DK-R
IF E4_99=YES
E4o. What were the other reasons that not every client with a provisional diagnosis of malaria 
was tested for malaria using an RDT or microscopy test?
REASONS NOT TESTED
(STRING 150)
ALL; E5.b-d ONLY IF I4=3
E5. I will now read you a short list of staff members. Please tell me whether within the past 12 
months any of these types of staff members have been trained on malaria data collating and 
reporting. 
INSTRUCTION: MARK ‘YES’ IF ONE OR MORE STAFF WITHIN A CATEGORY HAVE BEEN 
TRAINED.
In the past 12 months, have one or more of the….been trained or coached on malaria data 
collating and reporting?
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
Yes No D. K. Refused
Not 
Applicable
a. Nurses or CHOs
b. Out Patient Department or OPD in-charges
c. Records staff members
d. Lab staff members
e. Other staff members? 
IF E5e=YES
E5o. In the past 12 months, who were the other staff members who were trained on malaria data 
collating and reporting?
OTHER STAFF MEMBERS
(STRING 150)
ALL
E6. In the past 12 months, has the person or one of the people in charge of records in this 
facility been trained on or received supportive supervision visits related to malaria data 
reporting and reporting tools, such as a Consulting Room or CR register, a morbidity 
register, or the monthly anti-malarial returns?
Select one only
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 0
 FACILITY DOES NOT HAVE A PERSON IN CHARGE OF RECORDS ............. 2
 DON’T KNOW....................................................................................................... 96
 REFUSED............................................................................................................. 97
This question determines if, within the last year, the person in charge of records has been trained on 
malaria data reporting and tools. 
ALL
E7. Now I am going to ask you how many staff members have participated in at least one 
training in the past 12 months on a series of topics related to malaria. Please do not 
include community health volunteers in these counts.
In the past 12 months, how many, if any of current staff members have participated in at 
least one training [FILL a-e]…
Number D. K. Refused
a. on Malaria in Pregnancy, also known as MIP?
b. on malaria case management?
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
Number D. K. Refused
c. or refresher training on malaria Rapid Diagnostic Tests, also 
known as RDTs?
d. ONLY IF I4=3 on malaria microscopy?
PROBE: Can be either Malaria Diagnostic Refresher Training 
(MDRT) or any formally organized training on parasite 
detection and species identification for malaria parasites.
e. on any other topic related to malaria? 
IF 0 < E7e < 96
E7o. In the past 12 months, on what other topics related to malaria have current staff members 
participated in at least one training?
OTHER TOPICS
(STRING 150)
ALL
E8. In the past 12 months, how many, if any, of the current staff members who were trained in any 
topic related to malaria received training that included supportive supervision?
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 96;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 97.
_______________________TRAINING AND SUPPORTIVE SUPERVISION
(RANGE 0-99)
ALL
E9. In the past 12 months, how many, if any, Supportive Supervision visits has this facility 
received from district level supervisors on…
IF THE RESPONDENT DOES NOT KNOW, ENTER 96; IF THE RESPONDENT REFUSES TO 
ANSWER, ENTER 97; IF THE QUESTION IS NOT APPLICABLE, ENTER 94
Number 
a. malaria case management?
b. malaria data collating and reporting? 
c. Rapid Diagnostic Tests?
d. supply chain management?
ALL
E10. In the past 12 months, how many, if any, community health volunteers participated in at least 
one training on a topic related to malaria?
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 96;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 97.
__________________________VOLUNTEER TRAINED IN MALARIA
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
(RANGE 0-99)
F. TRAINING AND SUPERVISOR RECORDS
ALL
F1. Does your facility maintain a list of when refresher trainings, new skills trainings, or 
professional development trainings are due and conducted? 
IF YES, ASK, Can I see it? 
DOCUMENTATION: TRAINING LIST/REGISTER 
INSTRUCTIONS: YOU MUST SEE THE LIST. THE LIST SHOULD INCLUDE DATES, AND 
WHEN (REFRESHER) TRAININGS ARE DUE AND WERE CONDUCTED. IF YOU DO NOT 
SEE THE LIST, THE ANSWER IS ‘NO.’
Select one only
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 0
 DON’T KNOW / REFUSED .................................................................................. 98
ALL;
START OF TRAINING LOOP.
PROGRAMMER: ASK F3-F6 FOR THE FIRST TRAINING TYPE / SUB-QUESTION F2[a-j] THAT IS 
NOT EQUAL TO 0, 96 OR 97. ASK ALL 4 QUESTIONS FOR THAT TRAINING TYPE, AND THEN 
ASK F2[b-k] ABOUT THE NEXT TRAINING TYPE. IF ELIGIBLE, ASK F3-F6 BEFORE MOVING TO 
F2 FOR THE NEXT TRAINING TYPE. CONTINUE TO ASK F3-F6 FOR ALL ELIGIBLE TRAINING 
TYPES [a-j], BEFORE MOVING TO THE NEXT TRAINING TYPE.
F2. Now I would like to ask you about different types of training for the staff in this facility. 
a. In the past 12 months, how many current staff 
members, not including community health 
volunteers, have participated in at least one training 
on supply chain and logistics management based on 
the Logistics Management Standard Operating 
Procedures Manual?
_____________STAFF TRAINED
(RANGE 0-97)
 DON’T KNOW 96 
 REFUSED 97
b. In the past 12 months, how many current staff members, 
not including community health volunteers, have 
participated in at least one training on Infant and Young 
Child Feeding, also known as IYCF?
_____________STAFF TRAINED
(RANGE 0-97)
 DON’T KNOW 96 
 REFUSED 97
c. In the past 12 months, how many current staff 
members, not including community health 
volunteers, have participated in at least one training 
on management of acute malnutrition?
_____________STAFF TRAINED
(RANGE 0-97)
 DON’T KNOW 96 
 REFUSED 97
d. In the past 12 months, how many current staff 
members, not including community health 
_____________STAFF TRAINED
(RANGE 0-97)
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
volunteers, have participated in at least one training 
on community management of acute malnutrition, 
also known as CMAM?
 DON’T KNOW 96 
 REFUSED 97
e. In the past 12 months, how many current staff 
members, not including community health 
volunteers, have participated in at least one training 
on anemia prevention control?
_____________STAFF TRAINED
(RANGE 0-97)
 DON’T KNOW 96 
 REFUSED 97
f. In the past 12 months, how many current staff 
members, not including community health 
volunteers, have participated in at least one training 
on supervision skills?
_____________STAFF TRAINED
(RANGE 0-97)
 DON’T KNOW 96 
 REFUSED 97
g. In the past 12 months, how many current staff 
members, not including community health 
volunteers, have participated in at least one training 
on Essential Newborn Care, also known as ENC?
_____________STAFF TRAINED
(RANGE 0-97)
 DON’T KNOW 96 
 REFUSED 97
h. In the past 12 months, how many current staff 
members, not including community health 
volunteers, have participated in at least one training 
on Maternal, Neonatal and Child Health life saving 
skills, also known as MNCH life saving skills?
_____________STAFF TRAINED
(RANGE 0-97)
 DON’T KNOW 96 
 REFUSED 97
i. In the past 12 months, how many current staff 
members, not including community health 
volunteers, have participated in at least one training 
on Integrated Management of Neonatal Childhood 
Illness, also known as IMNCI?
_____________STAFF TRAINED
(RANGE 0-97)
 DON’T KNOW 96 
 REFUSED 97
j. In the past 12 months, how many current staff 
members, not including community health 
volunteers, have participated in at least one training 
on Active Management of Third Stage of Labor, also 
known as AMTSL?
_____________STAFF TRAINED
(RANGE 0-97)
 DON’T KNOW 96 
 REFUSED 97
k. In the past 12 months, how many current staff 
members, not including community health 
volunteers, have participated in at least one training 
on any other topic? 
_____________STAFF TRAINED
(RANGE 0-97)
 DON’T KNOW 96 
 REFUSED 97
IF 0 < F2k < 96;
ASK THIS QUESTION AFTER F2k, IF ELIGIBLE. 
DO NOT ASK F3-F6 FOR THIS TRAINING. GO TO G1.
F2ko. In the past 12 months, on what other topics have current staff members participated in at 
least one training?
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
OTHER TOPICS
(STRING 150)
IF F2[a-j] ≠ 0, 96 OR 97.
F3[a-j]. For the training on [F2a-j], what was the title of the staff members who participated in that 
training? 
PROBE IF ONLY ONE ANSWER IS GIVEN, “Any other staff?”
SELECT ‘YES’ FOR ALL RESPONSES GIVEN. SELECT ‘NO’ FOR ALL OTHER RESPONSE 
OPTIONS. 
IF R DOES NOT KNOW OR REFUSES TO ANSWER THE QUESTION, SELECT 'DON'T KNOW 
/ REFUSED' FOR ALL RESPONSE OPTIONS.
MARK ALL
F3[a-j]_1. NURSES..................................................................................................... Y/N/DKR
F3[a-j]_2. COMMUNITY HEALTH OFFICER.............................................................. Y/N/DKR 
F3[a-j]_3. PHYSICIAN ASSISTANT ........................................................................... Y/N/DKR
F3[a-j]_4. MEDICAL ASSISTANT............................................................................... Y/N/DKR
F3[a-j]_5. MIDWIVES.................................................................................................. Y/N/DKR
F3[a-j]_6. LAB WORKERS.......................................................................................... Y/N/DKR
F3[a-j]_7. COMMUNITY BASED AGENTS OR VOLUNTEERS................................. Y/N/DKR
F3[a-j]_8. DISEASE CONTROL OFFICERS .............................................................. Y/N/DKR
F3[a-j]_9. BIOSTATISTICS OR RECORD OFFICERS OR DATA MANAGERS........ Y/N/DKR
F3[a-j]_10. NON-CLINICAL STAFF............................................................................ Y/N/DKR
F3[a-j]_99. OTHER STAFF......................................................................................... Y/N/DKR
IF F3[a-j]_99=YES
F3[a-j]o. What was the title of the other type of staff member who participated in that training?
OTHER TITLES
(STRING 150)
F2[a-j] >0 AND < 96
F4[a-j]. For the training on [F2a-j], what training approach was used - was it residential, facility￾based, on the job training, or something else? 
PROBE IF ONLY ONE ANSWER IS GIVEN, “Anything else?”
SELECT ‘YES’ FOR ALL RESPONSES GIVEN. SELECT ‘NO’ FOR ALL OTHER RESPONSE 
OPTIONS. 
IF R DOES NOT KNOW OR REFUSES TO ANSWER THE QUESTION, SELECT 'DON'T KNOW 
/ REFUSED' FOR ALL RESPONSE OPTIONS.
MARK ALL
F4[a-j]_1. RESIDENTIAL ............................................................................................ Y/N/DK-R 
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
F4[a-j]_2. FACILITY-BASED....................................................................................... Y/N/DK-R
F4[a-j]_3. ON THE JOB TRAINING, ALSO KNOWN AS OJT.................................... Y/N/DK-R
F4[a-j]_4. NON_RESIDENTIAL .................................................................................. Y/N/DK-R
F4[a-j]_99. SOMETHING ELSE.................................................................................. Y/N/DK-R
IF F4[a-j]_99=YES
F4[a-j]o. What was the other training approach used for that training?
OTHER TRAINING APPROACH
(STRING 150)
F2[a-j] >0 AND < 96
F5[a-j]. Was the training on [F5a-j] part of or followed by supportive supervision?
Select one only
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 0
 DON’T KNOW / REFUSED .................................................................................. 98
F2[a-j] >0 AND < 96
F6[a-j]. Who provided the training on [F5a-j]? 
PROBE IF ONLY ONE ANSWER IS GIVEN, “Anyone else?”
SELECT ‘YES’ FOR ALL RESPONSES GIVEN. SELECT ‘NO’ FOR ALL OTHER RESPONSE 
OPTIONS. 
IF R DOES NOT KNOW OR REFUSES TO ANSWER THE QUESTION, SELECT 'DON'T KNOW 
/ REFUSED' FOR ALL RESPONSE OPTIONS.
MARK ALL
F6[a-j]_1. SUB-DISTRICT........................................................................................... Y/N/DK-R
F6[a-j]_2. DISTRICT ................................................................................................... Y/N/DK-R
F6[a-j]_3. REGION...................................................................................................... Y/N/DK-R
F6[a-j]_99. NON-GHS, SUCH AS NGO OR DONOR PROJECT............................... Y/N/DK-R
IF F6[a-j]_99=YES 
F6[a-j]o. Who provided the training?
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER DK;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER R.
OTHER TRAINING PROVIDER
(STRING 150)
END OF TRAINING LOOP. 
LOOP THROUGH EACH ELIGIBLE TRAINING IN F2[a-j], THEN PROCEED TO F2k.
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
ALL
F8. In the last 12 months, were there any other priority training needs in your facility that were not 
met?
Select one only
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 0
 DON’T KNOW / REFUSED .................................................................................. 98
IF F8=1
F8a. In the last 12 months, what were the other priority training needs in your facility that were 
not met?
OTHER TRAINING NEEDS
(STRING 150)
G. ACTION PLANS AND QUALITY IMPROVEMENT
ALL
G1. Now I would like to ask a bit about [(INCLUDE IF (I4 = 3 OR I5=2)) quality assurance and] quality 
improvement within your facility.
Does this facility have a quality improvement or QA/QI action plan in place in which activities 
are scheduled for the current planning year 2019?
INSTRUCTION: ASK TO SEE PLAN. 
A QA/QI PLAN IS AN OVERALL MASTER PLAN TO IMPROVE QUALITY OF SERVICE DELIVERY
AT A FACILITY. AN ACTION PLAN IS THE PLAN WHICH DETAILS ACTIVITIES, SCHEDULES AND 
DEADLINES AND PERSONS RESPONSIBLE FOR CARRYING OUT THE PLAN. IN 
CIRCUMSTANCES WHERE THE MASTER PLAN HAS ALL THESE DETAILS BUT THERE IS NO 
SEPARATE ACTION PLAN-THE MASTER PLAN IS ACCEPTABLE AS AN ACTION PLAN. PLEASE 
NOTE, ANY ACTION PLAN WILL DO – COMMUNITY HEALTH ACTION PLAN, QI ACTION PLAN, 
ETC.
Select one only
 YES, PLAN SEEN ................................................................................................ 1
 YES, PLAN NOT SEEN........................................................................................ 2
 NO ........................................................................................................................ 0
 DON’T KNOW....................................................................................................... 96
 REFUSED............................................................................................................. 97
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
IF G1=1 OR 2
G2. What topics does the action plan include? 
PROBE IF ONLY ONE ANSWER IS GIVEN, “Anything else?”
SELECT ‘YES’ FOR ALL RESPONSES GIVEN. SELECT ‘NO’ FOR ALL OTHER RESPONSE 
OPTIONS. 
IF R DOES NOT KNOW OR REFUSES TO ANSWER THE QUESTION, SELECT 'DON'T KNOW 
/ REFUSED' FOR ALL RESPONSE OPTIONS.
MARK ALL
G2_1. NUTRITION...................................................................................................... Y/N/DK-R
G2_2. MALARIA.......................................................................................................... Y/N/DK-R
G2_3. MATERNAL HEALTH ...................................................................................... Y/N/DK-R
G2_4. NEONATAL, INFANT AND CHILD HEALTH ................................................... Y/N/DK-R
G2_99. OTHER SPECIFIC ACTION AREA................................................................ Y/N/DK-R
IF G2_99=YES
G2o. What other topics does the action plan include?
OTHER TOPICS
(STRING 150)
IF (I4 = 3 OR I5=2)
G3. Does this facility have a quality assurance or QA/QI team?
INSTRUCTION: A QA/QI TEAM IS AT LEAST TWO PEOPLE WHO REVIEW AT LEAST QUARTERLY 
IMPLEMENTATION OF THE FACILITY QA/QI ACTION PLAN ACTIVITIES AGAINST SERVICES.
Select one only
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 0
 DON’T KNOW / REFUSED .................................................................................. 98
IF G3 = 1
G4. In the last complete quarter, how many meetings has the quality assurance or QA/QI team 
held?
INSTRUCTION: IF THE RESPONDENT DOES NOT KNOW, ENTER 96;
IF THE RESPONDENT REFUSES TO ANSWER, ENTER 97.
___________________________NUMBER OF MEETINGS
(RANGE 0-99)
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
IF (G1 = 1 OR 2) & G2_1=1
G5. In the last two complete months, were steps taken to implement nutrition aspects of your 
facility’s QA/QI action plan?
INSTRUCTION: ASK TO SEE ANYTHING THEY CAN SHOW YOU TO VERIFY STEPS IN 
IMPLEMENTING NUTRITION ASPECTS OF THE ACTION PLAN, SUCH AS MINUTES OF 
MEETINGS, DATA REVIEWED FOR DECISION-MAKING, PHYSICAL IMPROVEMENTS OR NEW 
PROCEDURES AT THE FACILITY THAT CORRESPOND TO THE PLAN (E.G. NEW REGISTER). 
SELECT YES, IF AT LEAST ONE TYPE OF THE ABOVE EVIDENCE IS PROVIDED THAT 
SUPPORTS STEPS TAKEN. 
 YES STEPS WERE TAKEN, SAW SUFFICIENT EVIDENCE............................. 1
 NO STEPS WERE TAKEN OR SAW NO EVIDENCE (OR INSUFFICIENT) ...... 0
 DON’T KNOW....................................................................................................... 96
 REFUSED............................................................................................................. 97
IF (G1 = 1 OR 2) & G2_2=1
G6. In the last two complete months, were steps taken to implement malaria aspects of your 
facility’s QA/QI action plan?
INSTRUCTION: ASK TO SEE ANYTHING THEY CAN SHOW YOU TO VERIFY STEPS IN 
IMPLEMENTING MALARIA ASPECTS OF THE ACTION PLAN, SUCH AS MINUTES OF MEETINGS, 
DATA REVIEWED FOR DECISION-MAKING, PHYSICAL IMPROVEMENTS OR NEW PROCEDURES 
AT THE FACILITY THAT CORRESPOND TO THE PLAN (E.G. INCREASED COMMUNITY 
OUTREACH).. SELECT YES, IF AT LEAST ONE TYPE OF THE ABOVE EVIDENCE IS PROVIDED 
THAT SUPPORTS STEPS TAKEN. 
 YES STEPS WERE TAKEN, SAW SUFFICIENT EVIDENCE............................. 1
 NO STEPS WERE TAKEN OR SAW NO EVIDENCE (OR INSUFFICIENT) ...... 0
 DON’T KNOW....................................................................................................... 96
 REFUSED............................................................................................................. 97 
IF [G1 = 1 OR 2] & [G2=3, 4 OR 99]
G7. In the last two complete months, were steps taken to implement any other aspect of your 
facility’s QA/QI action plan?
INSTRUCTION: ASK TO SEE ANYTHING THEY CAN SHOW YOU TO VERIFY STEPS, SUCH AS 
MINUTES OF MEETINGS, DATA REVIEWED FOR DECISION-MAKING, PHYSICAL 
IMPROVEMENTS OR NEW PROCEDURES AT THE FACILITY THAT CORRESPOND TO THE PLAN 
(E.G. NEW REGISTERS OR IMPROVED STORAGE FACILITIES). 
SELECT YES, IF AT LEAST ONE TYPE OF THE ABOVE EVIDENCE IS PROVIDED THAT 
SUPPORTS STEPS TAKEN
 YES STEPS WERE TAKEN, SAW SUFFICIENT EVIDENCE............................. 1
 NO STEPS WERE TAKEN OR SAW NO EVIDENCE (OR INSUFFICIENT) ...... 0
 DON’T KNOW....................................................................................................... 96
 REFUSED............................................................................................................. 97
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
ALL 
G8. Can you please show me any progress activity graphs or tables you have in the facility 
here, and describe what they show?
INSTRUCTION: ASK TO SEE THE GRAPHS AND/OR TABLES AND SELECT BELOW ALL YOU SEE.
PROBE IF ONLY ONE ANSWER IS GIVEN, “Any others?”
SELECT ‘YES’ FOR ALL GRAPHS OR TABLES SEEN. SELECT ‘NO’ FOR ALL OTHER 
RESPONSE OPTIONS. 
IF R DOES NOT KNOW OR REFUSES TO ANSWER THE QUESTION, SELECT 'DON'T KNOW 
/ REFUSED' FOR ALL RESPONSE OPTIONS.
MARK ALL
G8_1. MATERNAL HEALTH (ANC OR PNC) GRAPH OR TABLE ........................... Y/N/DK-R 
G8_2. CHILD HEALTH GRAPH OR TABLE............................................................... Y/N/DK-R
G8_3. MALARIA, OR INSECTICIDE-TREATED NET (ITN) DISTRIBUTION GRAPH OR TABLE Y/N/DK-R
G8_4. EXPANDED PROGRAM ON IMMUNIZATION OR EPI GRAPH OR TABLE.. Y/N/DK-R
G8_99. OTHER TOPICS ............................................................................................ Y/N/DK-R
IF G8_99=YES
G8o. What are the topics of the other progress activity graphs or tables you have?
OTHER TOPICS
(STRING 150)
IF AT LEAST ONE G8_X =1; 
PROGRAMMER, ALLOW YEAR WITHOUT MONTH TO BE ENTERED, IF NEED BE.
G9m. For the graph or table that has the most up-to-date data on it, about what month does the 
data come from? 
 ____________MONTH
 DON’T KNOW....................................................................................................... 96
 REFUSED............................................................................................................. 97
IF AT LEAST ONE G8_X =1; 
PROGRAMMER, ALLOW YEAR WITHOUT MONTH TO BE ENTERED, IF NEED BE.
G9y. For the graph or table that has the most up-to-date data on it, about what year does that data 
come from?
 ___________YEAR
 DON’T KNOW....................................................................................................... 96
 REFUSED............................................................................................................. 97
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
ALL
G10. In the last two months, before this facility’s monthly DHIMS2 reports were submitted, did 
someone validate the reports using the source documents?
INSTRUCTION: DATA CAN BE VALIDATED BY A TEAM THAT IS INTERNAL OR EXTERNAL, AND 
AS SMALL AS ONE PERSON. IT JUST NEEDS TO BE ONE OR MORE PEOPLE WHO CHECK 
NUMBERS FOR DHIMS2 REPORTS AGAINST THE SOURCE DOCUMENTS BEFORE THE 
MONTHLY SUBMISSION. IN THEORY THE SUB-DISTRICT DATA MANAGER SHOULD VERIFY 
FOR CHPS (THAT SEVERAL CHPS’ DATA ARE AGGREGATED CORRECTLY) AND THE HEALTH 
CENTER MEDICAL ASSISTANT OR DATA MANAGER FOR HEALTH CENTERS (DATA 
AGGREGATED CORRECTLY FROM ALL DEPARTMENTS WITHIN THEIR CENTER).
Select one only
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 0
 DON’T KNOW / REFUSED .................................................................................. 98
IF [G1 = 1 OR 2] OR [AT LEAST 1 G8_X = 1]
G11. Now I will ask if you have used data generated for monthly reports and the facility graphs or 
tables that you prepared to do a series of planning and decision-making tasks. 
In the past 12 months, have you used these data to [FILL FROM a-f BELOW]?
Yes No D. K. Refused
a. plan community outreach?
b. improve supply chain and logistics?
c. identify training needs?
d. help develop or revise action plans?
e. help allocate resources?
f. plan or decide anything else? 
IF G11f = 1
G11fo. In the past 12 months, what else have you used these data to plan or decide?
OTHER PLANNING TASKS
(STRING 150)
ALL
G12. Does this facility have a functioning computer or tablet that runs the DHIMS e-tracker 
application?
Select one only
 YES....................................................................................................................... 1
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
 NO ........................................................................................................................ 0
 DON’T KNOW / REFUSED .................................................................................. 98
G12=1
G12a. In the last two complete months, has anyone at this facility entered any client information 
into the e-tracker? 
INSTRUCTION: TO COUNT THEY SHOULD HAVE AT LEAST ENTERED ONE CLIENT 
TRANSACTION IN THE LAST 2 COMPLETE MONTHS. 
Select one only
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 0
 DON’T KNOW / REFUSED .................................................................................. 98
G12a=1
G12b. In the last two complete months, has this facility used the e-tracker client transaction data 
to help make decisions about the delivery of health services?
Select one only
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 0
 DON’T KNOW / REFUSED .................................................................................. 98
G12b=1
G12c. In the last two complete months, for which services has this facility used the e-tracker 
client transaction data to help make decisions about the delivery of health services?
Select all that apply
 OPD ...................................................................................................................... 1
 FAMILY PLANNING ............................................................................................. 2
 ANTE NATAL CARE ............................................................................................ 3
 EXPANDED PROGRAM ON IMMUNIZATION .................................................... 4
 DELIVERY............................................................................................................ 5
 POST NATAL CARE ............................................................................................ 6
 GENERAL REGISTRATION ................................................................................ 7
 DON’T KNOW....................................................................................................... 96
 REFUSED............................................................................................................. 97
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
H. SUPPLIES
ALL
H1. Now I would like to talk about equipment, supplies and supply chain issues.
Can we look at your inventory control, bin or tally cards or inventory records? I would like to note 
for each supply on my list whether an inventory control card exists, whether there has been a 
stock-out in the last two complete months, and whether the item is available today. For six specific 
supplies, I would like to conduct an actual count of the quantity on hand. 
INSTRUCTION: LOOK AT THE INVENTORY CONTROL CARDS. WITH THE RESPONDENT, NOTE 
AND CHECK OFF EACH SUPPLY ON THE CHECKLIST BELOW THAT HAS AN INVENTORY 
CONTROL CARD, AND ANSWER THE RELEVANT QUESTIONS FOR EACH COMMODITY BEFORE 
MOVING ON TO THE NEXT COMMODITY. WHERE APPLICABLE COUNT COMMODITIES
H1.1. Is there an inventory control card for the commodity?
IF H1.1 = YES, ASK
H1.2. Has there been a stock-out for the commodity in the last 2 complete months? 
H1.3. Was the inventory card updated within the last 30 days? 
H1.4. Is the commodity available today?
IF H1.1 = YES AND COMMODITY IS HIGHLIGHTED IN GREEN, COUNT AND RECORD THE SUPPLY 
ON HAND, NOTING RESULTS IN H1.5 AND H1.6.
DOCUMENTS NEEDED: INVENTORY CONTROL, TALLY OR BIN CARDS. 
Commodity H1.1. 
Control 
card 
exists 
(Y/N/DK/
R)
H1.2. Stock￾out in last two 
complete 
months 
(Y/N/DK/R)
H1.3. Card 
updated in 
last 30 days
(Y/N/DK/R)
H1.4. Item 
available 
today (Y / N / 
DK / R)
IF H1.4=1
H1.5 
Actual 
Count￾Expired/
Unexpired, 
DK / R
IF H1.4=1
H1.6 For 
supplies 
counted, note 
unit, DK / R
NUTRITION COMMODITIES
a. Albendazole for 
deworming
b. Iron and Folic 
Acid tablets, 
also known as 
IFA tablets (WE 
WANT 
COMBINED 
TABLETS. IRON 
OR FOLIC ACID 
ALONE DO NOT 
QUALIFY. IRON 
3 IS ONE NAME)
c. Oral 
rehydration 
Salts and Zinc 
tablets
IF 
SEPARATE
, MUST 
HAVE 
BOTH
IF EITHER 
HAD A 
STOCKOUT, 
MARK YES
IF SEPARATE, 
BOTH MUST 
HAVE BEEN 
UPDATED
IF SEPARATE, 
MUST HAVE 
BOTH
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
Commodity H1.1. 
Control 
card 
exists 
(Y/N/DK/
R)
H1.2. Stock￾out in last two 
complete 
months 
(Y/N/DK/R)
H1.3. Card 
updated in 
last 30 days
(Y/N/DK/R)
H1.4. Item 
available 
today (Y / N / 
DK / R)
IF H1.4=1
H1.5 
Actual 
Count￾Expired/
Unexpired, 
DK / R
IF H1.4=1
H1.6 For 
supplies 
counted, note 
unit, DK / R
d. First-line 
antibiotic 
treatment, or 
amoxicillin for 
Severe acute 
malnutrition, 
also known as 
SAM 
BEmONC Commodities (Health Centers Only – IF (I4 = 3 OR I5=2))
e. Parenteral 
antibiotics
f. Magnesium 
Sulfate for 
preeclampsia 
and eclampsia
MALARIA COMMODITIES
g. Artemether + 
Iumenfantrine 
(ANY KIND IS 
FINE)
h. Pediatric syrup 
paracetamol
i. Adult 
paracetamol
j. Sulfadoxine 
Pyrimethamine 
(SP)
FAMILY PLANNING COMMODITIES: H1x-cc ONLY IF D18 = 2 OR 3
k. hormonal 
implant such as 
Implanon, 
Implanon NXT,
Jadelle, Sino 
Inplant II, or 
Norplant
l. An intrauterine 
device, also 
known as an 
IUD
m. combined oral 
contraceptive 
pills
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
Commodity H1.1. 
Control 
card 
exists 
(Y/N/DK/
R)
H1.2. Stock￾out in last two 
complete 
months 
(Y/N/DK/R)
H1.3. Card 
updated in 
last 30 days
(Y/N/DK/R)
H1.4. Item 
available 
today (Y / N / 
DK / R)
IF H1.4=1
H1.5 
Actual 
Count￾Expired/
Unexpired, 
DK / R
IF H1.4=1
H1.6 For 
supplies 
counted, note 
unit, DK / R
n. progestogen￾only pill, also 
known as PoP
o. condoms
Commodity counts
p. Vitamin A 1) bottles
2) boxes
3) pieces
4) sachets
5) maxi bags
6) mini bags
7) vials
8) capsules
9) other –
specify
q. Uterotonic 
drugs, such as 
Oxytocin or 
ergometrine 
SAME 
RESPONSE 
CATEGORIE
S
r. Malaria rapid 
diagnostic test 
kits, also known 
as RDTs
SAME 
RESPONSE 
CATEGORIE
S
s. Artesunate + 
amodiaquine (A
NY KIND IS 
FINE)
SAME
t. an injectable 
contraceptive
SAME
u. Pentavalent USE 
RESPONSE 
CATEGORIE
S FROM 
ABOVE
IMMUNIZATION COMMODITIES
v. BCG, also 
known as 
Bacillus 
Calmette-Guerin 
Vaccine
w. Pneumo
x. Polio vaccine
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
Commodity H1.1. 
Control 
card 
exists 
(Y/N/DK/
R)
H1.2. Stock￾out in last two 
complete 
months 
(Y/N/DK/R)
H1.3. Card 
updated in 
last 30 days
(Y/N/DK/R)
H1.4. Item 
available 
today (Y / N / 
DK / R)
IF H1.4=1
H1.5 
Actual 
Count￾Expired/
Unexpired, 
DK / R
IF H1.4=1
H1.6 For 
supplies 
counted, note 
unit, DK / R
y. Rotarix
z. Measles vaccin
aa. Yellow Fever 
vaccine
bb. Tetanus Toxoid
ALL FOR a; D4=1 FOR b-l
H2. Now I would like to go through a number of supplies and equipment to learn whether 
they are available today. I will start by asking about the current availability of a list of 
equipment required for childbirth. To start, 
Currently, does your facility have in working order a…
INSTRUCTION: THE PARTS OF EACH KIT ARE LISTED IN CASE THE PERSON DOES NOT 
KNOW WHAT THE KIT IS. YOU DO NOT NEED TO CHECK FOR EACH ITEM. 
Yes No D. K. Refused
a. Domiciliary midwifery kit? (INCLUDES PLASTIC 
SHEET, PLASTIC APRON, BLADE, CORD 
LIGATURES, TABLET OF MISOPROSTOL, COTTON 
WOOL OR GAUZE SWABS, GLOVES, AND SOAP) 
b. Sterile Delivery Kit? (INCLUDES GAUZE, ARTERY 
FORCEPS, BOWL TO RECEIVE PLACENTA, 
DISPOSABLE GLOVES, CORD CLAMP CORD 
LIGATURES, CORD SCISSORS, AND SPONGE￾HOLDING FORCEPS, OVUM AND/OR OBSTETRICS 
FORCEPS)
c. Suturing set? (INCLUDES NEEDLE HOLDER)
d. Hand held vacuum extractor?
e. An examination light?
f. An examination couch?
g. postpartum hemorrhage, or PPH, pack for post￾partum management? (NORMAL SALINE – 1.0 
LITRE, GIVING SET, CANNULA SIZE – 16/18G – 1, 
DISPOSABLE GLOVES, SURGICAL GLOVES, 
INJECTION OXYTOCIN – 40 UNITS, INJECTION 
ERGOMETRINE (ERGOT) – 1.0 MG, SYRINGE AND 
NEEDLES, COTTON SWAB, TOURNIQUET, 
PLASTER FOR SECURING LINE, CATHETER, PLAIN 
SPECIMEN BOTTLE FOR GROUPING AND CROSS￾MATCHING, CONDOM TAMPONADE SET)
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
Yes No D. K. Refused
h. Pre-eclampsia & eclampsia pack for management 
of eclampsia?
i. Resuscitation kits for resuscitating babies? 
(INCLUDES HEAT SOURCE (PREFERABLY A 
RADIANT HEATER) TO PREVENT HEAT LOSS (OR 
EXTRA BLANKETS AND LINEN CAN BE USED TO 
COVER THE NEWBORN), SUCTION DEVICE, SELF￾INFLATING BAG OF NEWBORN SIZE, TWO MASKS 
(FOR NORMAL AND SMALL NEW-BORNS) FOR 
VENTILATION, STERILE GLOVES, CLEAN COT 
SHEETS TO RECEIVE AND DRY BABY 
THOROUGHLY, SCISSORS TO CUT CORD, 
STERILE CORD TIES/CLAMPS, HEAD COVERING 
(CAP) FOR BABY, CLOCK, STETHOSCOPE)
PROGRAMMER: j-l BELOW ARE ONLY IF (I4 = 3 OR I5=2)
l. A large postpartum Curette?
ALL
H3. Now I would like to ask you about equipment required for nutrition assessment and 
counseling services. 
Currently, does your facility have in working order….
Yes No DK Refused
a. a mid-upper arm circumference measuring tape, also known as 
a MUAC tape?
b. a tape measure?
c. a Hanging scale or Salter weighing scale?
d. an Adult weighing scale or bathroom scale?
e. a Baby weighing scale or a newborn or infant weighing scale?
f. an Infantometer?
g. a weighing pant?
h. an Integrated Management of Neonatal and Childhood 
Illnesses chart booklet, also known as an IMNCI chart booklet?
i. an Infant and Young Child Feeding or IYCF register?
j. HemoCue Hb device and testing strips or coulter counter and 
testing strips? 
ALL
H4. Now I wanted to ask you about storage conditions and equipment. Currently, do you have in 
working order …
DOCUMENT NEEDED: INVENTORY RECORDS.
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
Yes No DK Refused
a. a vaccine refrigerator? 1 0 96 97
b. IF H4a=1: a vaccine fridge thermometer? 1 0 96 97
c. IF H4b=1: an up-to-date temperature monitoring sheet? 1 0 96 97
c.2. IF H4c = 1: What is the date of the most recent entry on the 
monitoring sheet?
DD/MM/YY
YY
96 97
d. Ice packs? 1 0 96 97
e. a cold box? 1 0 96 97
f. H4a=1: an emergency storage plan? 1 0 96 97
g. a vaccine carrier? 1 0 96 97
h. Clock or watch with second hand? 1 0 96 97
ALL
H5. Finally, I have a list of other important supplies and equipment required for running a health facility. 
INSTRUCTION: RECORD WHICH OF THESE IS AVAILABLE AT THIS FACILITY.
DOCUMENT NEEDED: INVENTORY RECORDS.
Currently, does your facility have [FILL FROM a-b BELOW]…
Yes No D. K. Refused
a. a generator?
b. a fire extinguisher?
ALL
H6. Is the Standard Operating Procedures, also known as the SOP, which contains the manual for 
logistics management and supply chain management available at this facility? 
INSTRUCTION: ASK TO SEE THE SOP IF THE ANSWER IS YES.
 YES, SEEN........................................................................................................... 1
 YES, NOT SEEN .................................................................................................. 2
 NO ........................................................................................................................ 0
 DON’T KNOW....................................................................................................... 96
 REFUSED............................................................................................................. 97
ALL
H7. In the last 2 complete months, did someone in your facility use the RRIRV or Report 
Requisition Issue and Receipt Voucher to record consumption of supplies for the purposes 
of reordering commodities?
 INSTRUCTION: ASK TO SEE THE RRIRV OR RIRV IF THE ANSWER IS YES.
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 0
 DON’T KNOW / REFUSED .................................................................................. 98
IF H7 = 1
H7o. In the last 2 complete months, who completed the RRIRV to record consumption of supplies for 
the purposes of reordering commodities?
STAFF TITLE AT FACILITY
(STRING 150)
ALL
H8. Is there one or more people here who are responsible for ordering supplies? 
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 0
 DON’T KNOW / REFUSED .................................................................................. 98
IF H8 = 1
H8o. Who in this facility is responsible for ordering supplies?
STAFF TITLE AT FACILITY
(STRING 150)
ALL
H9. In general, how often is this facility unable to provide a prescribed medication, vaccine or other 
supply a client needs due to a stock-out – once or more per week, once every two weeks, once 
every three weeks, once per month, or less often than that?
Select one only
 once or more per week ...................................................................................... 1
 once every two weeks........................................................................................ 2
 once every three weeks ..................................................................................... 3
 once per month................................................................................................... 4
 less often than once per month ........................................................................ 5
 NEVER…………………………………………………………………………… ........ 6
 DON’T KNOW....................................................................................................... 96
 REFUSED............................................................................................................. 97
ALL
H10. In general, if this facility does not have a supply or medicine a client needs, where do you direct 
the client to go to find it? 
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
(STRING 800)
ALL
H11. In the past 12 months, to forecast supply needs for malaria Rapid Diagnostic Tests, or 
RDTs, what information did this facility use?
PROBE IF ONLY ONE ANSWER IS GIVEN, “Anything else?”
SELECT ‘YES’ FOR ALL RESPONSES GIVEN. SELECT ‘NO’ FOR ALL OTHER RESPONSE 
OPTIONS. 
IF R DOES NOT KNOW OR REFUSES TO ANSWER THE QUESTION, SELECT 'DON'T KNOW 
/ REFUSED' FOR ALL RESPONSE OPTIONS.
MARK ALL
H11_1. NUMBER OF MALARIA CASES GIVEN A FINAL DIAGNOSIS OF MALARIA....... Y/N/DK-R
H11_2. NUMBER OF CASES WITH PROVISIONAL DIAGNOSIS OF MALARIA............... Y/N/DK-R
H11_3. OUTPATIENT DEPARTMENT OR OPD ATTENDANCE........................................ Y/N/DK-R
H11_4. NUMBER OF RDTS AND MICROSCOPY TESTS PERFORMED.......................... Y/N/DK-R
H11_99. SOME OTHER DATA OR METHOD ..................................................................... Y/N/DK-R
IF H11_99=YES
H11o. In the past 12 months, what other data or method was used to forecast supply needs for 
malaria RDTs?
DATA OR METHOD
(STRING 150)
J. PHONE SERVICE
ALL
J1. Finally, I wanted to ask you a few questions about telephone service at the facility.
Currently, does this facility have a working cell phone?
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 0
 DON’T KNOW / REFUSED .................................................................................. 98
IF J1 = 1
J2. Does the cellphone … [FILL FROM a-d BELOW]…
Yes No D. K. Refused
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
a. Have SMS capability? (SHORT MESSAGE SERVICE)
b. Have MMS capability? (MULTIMEDIA SERVICE)
c. Allow you to access the internet on it?
d. Have a camera?
IF J1 = 1
J3. Is the cellphone a Smartphone or a basic phone? 
 SMARTPHONE .................................................................................................... 1
 BASIC / YAM ........................................................................................................ 0
 DON’T KNOW....................................................................................................... 96
 REFUSED............................................................................................................. 97
ALL
J4. Currently, does this facility have a working computer or tablet? 
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 0
 DON’T KNOW / REFUSED .................................................................................. 98
IF J4=1
J5. Currently, does this facility have internet access for the computer or tablet? 
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 0
 DON’T KNOW / REFUSED .................................................................................. 98
K. CONCLUSION
ALL
K1. That was my last question for you. Before we conclude, do you have any 
questions about this interview for me? 
INSTRUCTION: ANSWER QUESTIONS AS COMPLETELY AS POSSIBLE AND PROCEED TO K2.
ALL
K2. Thank you so much for your help. Your answers are very helpful to us. 
INSTRUCTION: TAKE YOUR LEAVE OF THE RESPONDENT, AND THEN PROCEED TO 
SECTION L OF THE SURVEY.
ALL
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
K3bi. WHAT DATE DID YOU END THE INTERVIEW (THIS VISIT)?
DATE PICKER
ALL
K3bii. WHAT TIME DID YOU END THE INTERVIEW (THIS VISIT)?
TIME PICKER
ALL; PROGRAMMER, PREPARE FOR PHOTO OF THE FACILITY TO BE TAKEN AND GEO￾TAGGED HERE. NO MATTER WHETHER THE INTERVIEW IS COMPLETED OR NOT, THIS 
PHOTO SHOULD BE PROMPTED BEFORE THE INTERVIEWER LEAVES. HOWEVER, THE 
PHOTO SHOULD BE OPTIONAL.
K4. TAKE A PHOTO OF THE FRONT OF THE FACILITY BEFORE YOU LEAVE. TRY TO 
GET THE NAME OF THE FACILITY IN THE PHOTO OR TAKE MORE THAN ONE.
L. FOR INTERVIEWER
ALL
K3. WHAT IS THE CURRENT DISPOSITION CODE FOR THIS CASE?
(STRING 1)
Codes: 
1. INTERVIEW COMPLETE. COMPLETED ALL QUESTIONS 
2. NO ONE AT FACILITY. APPROPRIATE STAFF NOT PRESENT WHEN YOU VISIT THE HEALTH 
FACILITY.
3. STAFF NOT AVAILABLE. STAFF ARE PRESENT BUT DO NOT HAVE TIME TO RESPOND TO 
THE SURVEY. 
4. STARTED, BUT NOT COMPLETE. YOU BEGAN THE INTERVIEW WITH THE RESPONDENT, 
BUT WERE UNABLE TO FINISH.
5. REFUSED. THE RESPONDENT DECLINES TO PARTICIPATE, YOU SHOULD ALWAYS TRY A 
REFUSAL CONVERSION. BE SURE TO ASK THE RESPONDENT WHY THEY DO NOT 
WANT TO PARTICIPATE AND TO LISTEN TO THEIR CONCERNS. IF IT IS 
UNSUCCESSFUL, RECORD AS MUCH DETAIL AS YOU CAN ABOUT THE 
RESPONDENT’S CONCERNS.
6. FACILITY NOT ELIGIBLE. YOU FIND THE FACILITY IS NOT A CHPS ZONE OR A HEALTH 
CENTER AND WAS NOT A CHPS OR HEALTH CENTER IN THE LAST TWO YEARS, THE 
FACILITY WILL BE INELIGIBLE TO PARTICIPATE. THE CASE WILL BE CLOSED. THE 
FACILITY WILL ALSO BE INELIGIBLE IF IT WAS NOT IN ONE OF THE SELECTED SUB￾DISTRICTS AT BASELINE.
7. FACILITY NOT LOCATED. THE FACILITY IS NOT LOCATABLE – THERE IS NO WAY TO FIND 
ANY MEANS OF REACHING ANYONE AT THE SITE – THE CASE WILL BE CLOSED.
8. FACILITY NOT REACHABLE. THE FACILITY IS NOT REACHABLE – IF THERE IS NO WAY TO 
CONTACT ANYONE AT THE SITE - THE CASE WILL BE CLOSED. 
QUALITY OF HEALTH SERVICES ENDLINE STUDY REPORT 2019 – APPENDIX E
9. OTHER. USE ONLY WHEN AN ABOVE CODE DOES NOT ADEQUATELY DESCRIBE THE 
DISPOSITION OF THE CASE. IF THIS CODE IS USED, PLEASE CAREFULLY REVIEW 
ALL ABOVE DISPOSITION CODES BEFORE SELECTING “9 – OTHER”.
IF K3 = 9
K3o. WHAT IS THE CURRENT DISPOSITION OF THIS CASE?
DETAILED COMMENTS MUST BE WRITTEN TO DESCRIBE THE DISPOSITION OF THE CASE.
DISPOSITION OF CASE
(STRING 450)
IF K3 = 2, 3, 4, 9
K3b. DID YOU SET AN APPOINTMENT?
 YES....................................................................................................................... 1
 NO ........................................................................................................................ 0
ALL
L1. PLEASE NOTE WHETHER THERE WERE ANY UNUSUAL CIRCUMSTANCES THAT 
OCCURRED DURING THE INTERVIEW OR IF THERE WAS ANYTHING WORTHY OF 
NOTE. WAS ENTIRE INTERVIEW CONDUCTED IN ENGLISH? PLEASE NOTE. 
IF APPROPRIATE PERSON IS NOT AVAILABLE, INCLUDE DATE AND WHAT 
HAPPENED. IF FACILITY WAS INELIGIBLE, EXPLAIN WHY. 
(STRING 800)
USAID/Ghana Evaluate for Health Endline 160 DDHS Instrument
Appendix G: Qualitative Interview Guides
I. District Directors of Health Services (DDHS)
IN-DEPTH INTERVIEW GUIDE
To be conducted with the District Director of Health Services (DDHS), who is the head of the 
District Health Management Team (DHMT)/District Health Administration in each district. If 
the DDHS is not available on the day of the interview, another district health officer may be 
substituted, preferably the District Health Information Officer (DHIO) or the District Public 
Health Officer (DPHO). Do not read aloud what is in italics nor in bold.
Save file as:
End_[District]_[Sub-District]_[Interview Type]_[Respondent Name]_[Date].docx
(e.g. End_AOWIN_Dodowa_DDHS_Joseph Apiah_25-1-2019.docx) 
Introduction and consent 
The purpose of this section is to introduce the respondent to the study and request consent. 
Thank you for taking the time for this interview today. My name is [insert name], and I am 
working for DevtPlan Consult on the USAID/Ghana Evaluate for Health endline study of 
health services in Ghana. This study is funded by USAID and supported by GHS. The goal 
of this study is to help inform decision-makers about the availability and integration of health 
services at the community and sub-district levels, the strength of the health system, and 
health sector governance. 
The purpose of this interview is to gather information from DDHS about the quality of the 
healthcare system and services in your district, and specifically about the supply chain, use 
of GHS protocols, referrals, volunteer support to CHPS, and use of DHIMS2 data for 
management. The interview focuses on sub-district health centers and CHPS zones. We did 
a similar study two years ago, and are particularly interested in changes in the last two 
years.
Your responses will be confidential, that is, none of your responses will be identified as yours 
with anyone outside of the study team. I have a consent form you would need to sign to show 
you agree to participate in this interview. Could you read it now?
Once the form is signed:
Do you have any questions about the interview? 
Before we start, I would like to get your permission to record the interview. This will ensure 
that I remember your responses correctly. The recordings from everyone interviewed will be 
used for analysis only and will not be published or shared with anyone outside of the study 
team. You will not be identified in study reports. Do I have your permission to record the 
interview? 
USAID/Ghana Evaluate for Health Endline 161 DDHS Instrument
If yes, turn on voice recorder. Read in this information first and then start interview.
District
Sub-district
Date of Interview
Start time of interview
Name/s of Respondent/s
Interviewer Name
Interview Guide Type: DDHS
Background information
1. Before we get into the interview, could you tell me your name and how long you have 
served as the District Director of Health Services in this district? 
Quality of care 
2. I would like to start with a few questions about the quality of health care and services in 
your district. What is your overall assessment of the quality of health care and services 
in your district? 
PROBE: In terms of staff, infrastructure/equipment/supplies, access?
3. What do you consider to be the district’s best practices in terms of quality care and 
services? 
a. Are there any innovations in the district in providing health care or services? 
4. What challenges does the district face in terms of providing quality health care and 
achieving equitable improvements in the health status of Ghanaians in your district, sub￾districts and communities? 
5. For CHPS: Is there anything you would like to see improved about your CHPS?
a. In the last two years, have you noticed any changes in the types or quality of 
services offered at the CHPS in your district? 
i. If yes, What have the changes in services been? 
Probe for both type and quality of services. For quality of services, probe about 
training. 
6. For health centers: Is there anything you would like to see improved about your health 
centers?
a. In the last two years, have you noticed any changes in types or quality of services 
offered by health centers in your district? 
i. If yes, What have the changes in services been? 
Probe for both type and quality of services. For quality of services, probe about 
training. 
USAID/Ghana Evaluate for Health Endline 162 DDHS Instrument
Collaborating with USAID on health systems strengthening
7. Is your District Health Management Team currently working with USAID, or any USAID￾funded projects? 
a. If yes, What is the current relationship between your DHMT and USAID?
b. Has your relationship with USAID changed in any way over the last two years?
c. What projects have you worked on together, if any? 
If worked together,
i. What have been some of the successes of your organizations working 
together?
ii. What have been some of the challenges faced in working together?
iii. What would improve your ability to work together well?
Access to supplies and medicines through the supply chain
8. How would you describe access to essential commodities and equipment through the 
supply chain within CHPS zones and health centers? 
a. Are necessary supplies available at the CHPS and health centers?
b. What are the main challenges to ensuring the availability of basic medicines and 
supplies?
 c. In the last two years, has access to essential supplies and medicines changed in 
CHPS zones and Health Centers in your district?
i. If yes, How? 
Probe for frequency of stock outs and specific commodities. 
9. What processes are used to monitor the stock and use of medicines and supplies at 
CHPS zones and health centers?
 a. In the last 2 years, have there been any changes in the procedure for health 
centers and CHPS in reporting when supplies run out or are running low?
i. If yes, How have these procedures changed? 
b. How well does that system work for ensuring supplies and medicines are re￾stocked in time?
c. How often do you review and approve requests for basic medicines or supplies 
from CHPS zones and Health Centers?
10. Could data be better used to help ensure constant supplies of commodities and 
medicines in your district?
a. If yes, How? 
11. Do you know if data are used to forecast supply needs for Rapid Diagnostic tests – or 
RDTs, in CHPS and Health Centers in this district?
a. If yes, What data are used and how are they used?
12. Are there any other reasons you have not mentioned for stock-outs to occur in a Health 
Center or CHPS? 
a. If yes, What could be done to avoid these reasons?
USAID/Ghana Evaluate for Health Endline 163 DDHS Instrument
Protocols
13. Do staff at both Health Centers and CHPS in your district have the most current GHS 
protocols available for the following protocols: 
– Reproductive health
– Maternal and newborn care
– Infection Prevention and control
– Community-Based Management of Acute Malnutrition
Probe to determine if the answer is the same or different for Health Centers and CHPS, 
if necessary.
14. What system, if any, is in place to monitor the use of these protocols by staff in health 
centers and CHPS zones? 
a. If there is a system, How successful do you think this monitoring system is?
Referrals 
15. Are referrals and follow-up care tracked and information shared between CHPS zones 
and health centers? 
a. If so, how is this information shared? 
PROBE: Do clients have their own folders or records, which they bring to appointments?
b. Is this an effective way to share information? 
Volunteers
16. We are interested in learning more about whether the district health management team 
has any engagement with community health volunteers or CHVs. Has your district 
health management team interacted with any of the CHVs within the last 6 months?
a. If yes, Can you tell me the most common types of interactions that occurred? Clarify 
if needed: such as trainings, monitoring, meetings, etc.
b. Are there any challenges in working with the volunteers?
c. What is the most effective method of working with volunteers to encourage positive 
health behaviors? 
17. In your opinion, have CHVs been effective in encouraging community members to adopt 
positive health behaviors? 
a. Why or Why not?
Supporting CHPS Zones in the district
18. In the past year, has the District Assembly allocated funds to your District Health 
Management Team for health activities? 
If yes,
a. To what activities were those funds allocated? 
b. Do any of these activities support the CHPS Zones or Health Centers in the district?
c. How were decisions made regarding which activities to fund? By whom?
d. Are data used to determine what kind of activities are funded to support the health 
system? 
i. If yes, What data are used? How are they used? 
USAID/Ghana Evaluate for Health Endline 164 DDHS Instrument
e. During the last two years, have these funds increased, decreased or stayed the same?
f. In the past year, has the District Health Management Team received any of the 
allocated funds?
i. If yes, Were the planned activities implemented with the funds?
19. In the past year, apart from the District Assembly, has any other agency or organization allocated 
funds to your District Health Management Team for health activities? 
PROBE: For example, UNICEF, USAID, World Vision, CARE, or other NGOs
If yes,
a. In the past year, has the District Health Management Team received any of the 
funds?
b. Can you tell me what activities those funds were used for or will be used for?
c. Are any of these activities directed at supporting CHPS Zones or Health Centers in 
the district?
i. If so, How? 
d. How were decisions made regarding which activities to fund? 
e. During the last two years, have these funds increased, decreased or stayed the 
same?
20. In your role as DDHS, in what ways if any have you worked with your district assembly?
Probe who they worked with, such as a member of the District social or health 
committee, etc. Please ask them to describe this interaction.
21. How does the district assembly support CHPS Zones and Health Centers in your 
district? 
Probe for both financial and non-financial support.
22. In what non-financial ways does the DHMT provide support to CHPS Zones and Health 
Centers in your district?
a. In the last two years has this support increased, decreased, or stayed the same? 
Data Use
23. How do you make use of DHIMS 2 data?
a. What district level decisions are informed by the DHIMS 2 data?
b. What types of data from DHIMS 2 are most useful in decision-making?
c. How often do you use DHIMS 2 data in decision-making? 
d. Can you tell me about any decisions made in the last two months that were 
informed by data from DHIMS 2? 
e. Over the last two years, has your use of DHIMS 2 data changed? 
i. If so, How? 
f. Do you think the DHIMS 2 data are reliable, that is do they provide an 
accurate picture of the situation at the facilities?
g. What challenges or issues have you faced when trying to use the data?
h. In the last two years, has the quality of these data changed?
i. If yes, In what way(s)?
USAID/Ghana Evaluate for Health Endline 165 DDHS Instrument
24. Do any of the CHPS or health centers in this district use the e-tracker application to collect 
data? 
If yes,
a. About how many CHPS and health centers use the e-tracker application? 
b. Do you think the e-tracker application is useful? 
i. Why or Why not? 
c. Does the e-tracker make using data easier for decision making or planning 
purposes? 
i. If yes, How?
d. What challenges, if any, has the district faced while implementing or using the e￾tracker? 
25. Those are all the questions I have for you today. Is there anything else you think is 
important for us to know about how your District Health Management Team and the 
District Health Administration support the health services and system in your district? 
26. Thank you so much for your time. 
Pause voice recorder. 
End Time
Location of Interview
Respondent/s’ Sex
Language/s Used
Write notes and record them as soon as you are done. Note special circumstances, 
clarifications, things seen, etc. When done, be sure to shut your recorder to save file.
USAID/Ghana Evaluate for Health Endline 166 DA Instrument
2. District Assembly Members
IN-DEPTH INTERVIEW GUIDE
To be conducted with two district assembly members in each district: make an effort to 
interview the district coordinating director and the social services subcommittee head. If they 
are not available, a deputy can be interviewed. Do not read aloud what is in italics nor in 
bold. 
Save file as: End_[District]_[Sub-District]_[Interview Type]_[Respondent 
Name]_[Date].docx (e.g. End_AOWIN_Dodowa_DA_Joseph Apiah_25-1-2019.docx) 
Introduction and consent 
The purpose of this section is to introduce the respondent to the study and request consent. 
Thank you for taking the time for this interview today. My name is [insert name], and I am 
working for DevtPlan Consult on the USAID/Ghana Evaluate for Health endline study of 
health services in Ghana. This study is funded by the U.S. Agency for International 
Development (USAID) and supported by GHS. The goal of this study is to help inform 
decision-makers about the availability and integration of health services at the community 
and sub-district levels, the strength of the health system, and health sector governance. 
The purpose of this interview is to gather information from District Assembly members about 
the how their District Assembly supports the health services provided in their district. We will 
be asking about how decisions are made about support to the health system, and the extent 
to which data is used to inform decision-making. We did a similar study two years ago, and 
are particularly interested in changes in the last two years.
Your responses will be confidential, that is, none of your responses will be identified as yours 
with anyone outside of the study team. 
I have a consent form you would need to sign to show you agree to participate in this 
interview. Could you read it now? 
Once the form is signed: 
Do you have any questions about the interview? 
Before we start, I would like to get your permission to record the interview. This will ensure 
that I remember your responses correctly. The recordings from everyone interviewed will be 
used for analysis only and will not be published or shared with anyone outside of the study 
team. You will not be identified in study reports. 
Do I have your permission to record the interview? If yes, turn on voice recorder. Read in 
this information first and then start interview.
District
Sub-district
Date of Interview
Start time of interview
Name/s of Respondent/s
Interviewer Name
Interview Guide Type: DA
USAID/Ghana Evaluate for Health Endline 167 DA Instrument
Background information
1. Before we get into the interview, could you tell me your name, position in the District 
Assembly, and how long you have served in the District Assembly? 
2. Since you started working in the district assembly, can you tell me the kind of work you 
have focused on, or some examples of projects you have worked on recently? 
3. Can you tell me in general the kind of work that the district assembly does in health?
Quality of care 
4. What is your overall assessment of the quality of health care and services in your
district?
PROBE: in terms of staff, infrastructure, equipment, supplies, access
5. What do you consider the strong points of health care and services in your district?
6. What challenges does the district face in terms of providing quality health care and 
services?
7. In the last two years, has there been a change in the types or quality of services 
provided by the health centers in your district? 
a. If yes, What have the changes in the services been? 
b. Are there any things you would like to see improved about your health centers?
Supporting CHPS zones in the district
8. Can you tell me who in the district assembly is responsible for addressing health system 
issues?
9. How are decisions made on what support to provide to the health system in your district,
for example, logistical, equipment or supplies, or financial support?
10. There are many different health projects going on in Ghana. Are the results of any 
health projects going on in your district discussed at your quarterly district assembly 
meetings?
If yes,
a. How often are the results of health projects discussed?
b. What types of health projects get discussed?
11. Has your District Assembly incorporated any community action plans, or CAPs, or any 
projects from CAPs into your current district development plans? 
INTERVIEWERS: WE EXPECT SOME DAs ARE DOING THIS, BUT NOT ALL.
a. If yes, Are there any CAPs health related projects incorporated in the plans, 
such as projects related to CHPS?
i. If yes, What health issues are addressed in the plans? 
ii. How were decisions made to incorporate any health projects in the 
district plans?
b. Are there any projects from CAPS dealing with nutrition priorities incorporated 
in the plans?
USAID/Ghana Evaluate for Health Endline 168 DA Instrument
c. Have any actions been undertaken in implementing any of the health or 
nutrition in the current or most recent plans? 
i. If yes, Please tell me the steps that have been taken.
12. In your current or most recent budgets, has any money been allocated for District Health 
Management Teams for health activities?
a. If yes, Can you tell me what activities money has been allocated for?
b. How were decisions made to include funding for these activities?
c. Has the DHMT received any of the allocated money yet?
d. In the last two years, has the level of support given to the DHMT increased, 
decreased, or stayed the same? 
i.Why? 
13. How else does the District Assembly help support CHPS zones and health centers?
14. Do you have any suggestions about ways District Assemblies and their individual 
members could provide more support for CHPS zones and Health Centers?
Collaborating with USAID
15. Are you familiar with the U.S. Agency for International Development, which is also 
known as USAID?
PROBE. IF THEY DON’T KNOW ANYTHING ABOUT USAID AT ALL, SKIP TO 
QUESTION 18.
16. Does your District Assembly have any relationship with USAID or have you done any 
work with USAID?
 If yes,
a. What is the relationship between your district assembly and USAID?
b. What projects have you worked on together, if any? 
i. What have been some of the successes of your organizations working 
together?
ii. What would improve your ability to work together well?
17. What ideas do you have for how USAID and your District Assembly could work together 
in the future on health system issues and issues related specifically to CHPS zones?
18. Those are all the questions I have for you today. Is there anything else you think is 
important for us to know about how your District Assembly supports the health services 
and system in your district?
19. Thank you so much for your time.
Pause voice recorder. 
End Time
Location of Interview
Respondent/s’ Sex
Language/s Used
Write notes and record them as soon as you are done. Note special circumstances, 
clarifications, things seen, etc. When done, be sure to shut your recorder to save file.
USAID/Ghana Evaluate for Health Endline 169 SDHO Instrument
3. Sub-district health officers
IN-DEPTH INTERVIEW GUIDE
To be conducted with two sub-district health officers in each sub-district. Please try to 
interview the health center in-charge and then either the health information officer and/or the 
disease control officer. Make an effort to ensure one respondent is the sub-district health 
management team (SDHMT) leader. This could be the health center in-charge, a public 
health nurse, the health information officer or the disease control officer, but it should be the 
person who coordinates the management of the sub-district health team. Do not read aloud 
what is in italics nor in bold.
Save file as:
End_[District]_[Sub-District]_[Interview Type]_[Respondent Name]_[Date].docx 
(e.g. End_AOWIN_Dodowa_SDHO_Joseph Apiah_25-1-2019.docx) 
Introduction and consent 
The purpose of this section is to introduce the respondent to the study and request consent. 
Thank you for taking the time for this interview today. My name is [insert name] and I am 
working for DevtPlan Consult on the USAID/Ghana Evaluate for Health endline study of 
health services in Ghana. This study is funded by the U.S. Agency for International 
Development and supported by GHS. The goal of this study is to help inform decision￾makers about the availability and integration of health services at the community and sub￾district levels, the strength of the health system at these levels, and health sector 
governance. 
The purpose of this interview is to gather information from Sub-District health workers about 
community engagement in health care, data collection and quality improvement in the CHPS 
zones and health centers. We did a similar study two years ago, and are particularly 
interested in changes in the last two years.
Your responses will be confidential, that is, none of your responses will be identified as yours 
with anyone outside of the study team. 
I have a consent form you would need to sign to show you agree to participate in this 
interview. Could you read it now?
Once the form is signed: 
Do you have any questions about the interview? 
Before we start, I would like to get your permission to record the interview. This will ensure 
that I remember your responses correctly. The audio recordings from everyone interviewed 
will be used for analysis only and will not be published or shared with anyone outside of the 
study team. You will not be identified in study reports. 
Do I have your permission to record the interview? 
If yes, turn on voice recorder. Read in this information first and then start interview.
District
Sub-district
Date of Interview
USAID/Ghana Evaluate for Health Endline 170 SDHO Instrument
Start time of interview
Name/s of Respondent/s
Interviewer Name
Interview Guide Type: 
SDHO (Also referred to as Subdistrict Health Team Leader 
(SDHT))
Background information
1. Before we get into the interview, could you tell me your name, position, and how long 
you have served in your role? 
Quality of care
For CHPS:
2. What is your overall assessment of the quality of care given by CHPS in your sub￾district? 
a. Can you tell me about anything you would like to see improved about the CHPS in 
your sub-district?
b. In the last two years, have you noticed any changes in the types or quality of 
services offered by CHPS in your sub-district? 
PROBE: For both types and quality of services. 
i. If yes, What have the changes in the services been?
For health centers:
3. What is your overall assessment of the quality of care given by the health center in your 
sub-district? 
a. Can you tell me about anything you would like to see improved about the health 
center in your sub-district?
b. In the last two years, have you noticed any changes in the types or quality of 
services offered by the health center in your sub-district? 
PROBE: For both types and quality of services. 
i. If yes, What have the changes in the services been? 
Community engagement 
4. Are you are a member of or leader of the Sub-district Health Management Team or 
SDHMT?
5. We are interested in learning more about the sub-district health management team’s 
ongoing engagement with community health volunteers, which could be known as 
community health agents or other names for such volunteers. 
In the last 6 months, what types of support, if any, has the sub-district health 
management team provided to the community health volunteers? 
Such as training, etc. Support could be provided by the entire SDHMT or any member 
of it.
USAID/Ghana Evaluate for Health Endline 171 SDHO Instrument
6. Are there any challenges in providing sufficient support to the community health 
volunteers?
7. What role do the volunteers play in the community and what types of work do they do?
a. What role does the SDHMT play in the work volunteers do? 
Referrals
8. Are referrals and follow-up care tracked and information shared between CHPS zones 
and health centers? 
 If yes,
a. How is this information shared? 
PROBE: Do clients have their own folders or records, which they bring to 
appointments?
b. Is this an effective way to share information? 
PROBE: Do facilities use the system? 
9. How often do you think that individuals follow referrals?
a. If someone does follow a referral, do you think there is a good system for them to let 
CHPS know what happened at the other health facility?
b. How do you think this tracking system affects the quality of care?
Data 
10. Now I would like to ask you about the data that you collect for DHIMS 2. Regarding the 
DHIMS 2 data that you receive from the CHPS zones, can you tell me whether the 
CHPS staff generally follow the GHS guidelines regarding how they report their data? 
a. Do you validate the data you receive from the CHPS zones? 
i. How? 
b. What could be done better by the CHPS in regards to data collection and reporting?
c. Overall, how is the quality of the data that you receive from the CHPS for DHIMS 2?
11. Can all data you would like to use at the sub-district level be disaggregated to a level 
that is of use to you? 
 Probe for gender and CHP zone disaggregation. 
12. How does your health center use the DHIMS 2 data to inform how you are doing, what 
issues exist in your community, and decision-making?
a. Can you tell me about any decisions your health center made in the last quarter that 
were informed by data from DHIMS 2? 
Probe for examples.
13. Can you give me an example of when a CHPS Compound used the data they submitted 
to inform their decision-making?
14. Do you think that the data that are collected and entered in DHIMS 2 are useful to 
CHPS zones and health centers in improving community care?
USAID/Ghana Evaluate for Health Endline 172 SDHO Instrument
a. Why do you say that?
15. Do any of the CHPS or health centers in this district use the e-tracker application? 
If no, Skip to next section. If yes, 
a. About how many or what proportion of the CHPS and health centers in this sub￾district use the e-tracker application that you know of? 
b. Do you think the e-tracker application useful? 
i. Why or Why not? 
c. Does the e-tracker make using data easier for decision making or planning 
purposes? 
i. If yes, How? 
Probe for examples. 
d. What challenges, if any, has the sub-district faced while implementing or using the e￾tracker? 
Outbreak and Disease control 
16. When an outbreak of a disease occurs, is a special investigation conducted?
If yes,
a. How many cases of a disease have to be reported for a disease outbreak 
investigation to be introduced?
b. Who conducts the disease outbreak investigations and how are these investigations 
done?
c. Are health center staff, community health officers, and volunteers equipped with 
skills and materials to do disease outbreak investigations?
17. How are data collected from CHPS zones and health centers used to investigate or 
trigger investigations of disease outbreaks? 
18. In the last year, have any CHPS zones in your sub-district or this Health Center 
reported any cases of the following diseases? 
READ
Cholera
Meningitis
Yellow fever
Measles
Neonatal tetanus
Acute flaccid paralysis
Guinea Worm disease
Buruli Ulcer
19. Are disease outbreaks recorded and reported differently, depending on the type and 
severity of the disease?
a. If yes, Which diseases require the most prompt reporting?
Probe these diseases, if not mentioned 
Cholera
Meningitis
Yellow fever
Measles
Neonatal tetanus
Acute flaccid paralysis
Guinea Worm disease
Buruli Ulcer
USAID/Ghana Evaluate for Health Endline 173 SDHO Instrument
Supplies
20. In your opinion, in the last two years, have CHPS Zones and Health Centers in the sub￾district had access to the basic medicines and supplies they needed? 
21. Who monitors the supply of medicines and goods at CHPS Zones and Health Centers?
a. What is the process for conducting this monitoring?
22. What is the procedure for reporting when supplies run low or out? 
23. What is your opinion regarding how well data are used to ensure constant supplies of 
medicines and commodities?
24. Are data used to ensure small equipment such as blood pressure cuffs and 
stethoscopes are repaired or replaced in a timely manner?
a. If yes, What is the system for ensuring small equipment gets repaired or replaced in 
a timely way?
Guidelines and protocols
25. Do both Health Centers and CHPS in your sub-district have updated GHS protocols 
available for the following protocols: 
– Reproductive health
– Maternal and newborn care
– Infection Prevention and control
– Community-Based Management of Acute Malnutrition
Probe to determine if the answer is the same or different for Health Centers and CHPS, 
if necessary.
a. If yes, In your opinion, do staff apply these protocols? 
i. If not, Why do they not use these protocols?
26. What systems are in place to determine if up to date protocols are being used by staff? 
Probe for details.
Quality assurance and quality improvement 
27. Does the work plan of your health center include quality assurance and quality 
improvement, also known as QA/QI?
 If yes,
a. Is QA/QI integrated into your routine activities, and if so, can you tell me how QA/QI 
is integrated into your routine activities and the work plan of the health center?
b. In the past year, what QA/QI activities have been implemented, if any?
28. How are QA/QI data used to guide service quality improvement, that is, can you 
describe any data that are used by CHPS or Health Center staff to improve the services 
they provide?
29. Are you or anyone else involved in overseeing whether any CHPS or Health Center staff 
have quality improvement or QI plans?
a. If yes, Do you know whether any CHPS or Health Center staff have taken any steps 
to implement their quality improvement or QI plans in the last 60 days?
USAID/Ghana Evaluate for Health Endline 174 SDHO Instrument
i. If yes, Please tell me about the steps.
30. Those are all the questions I have for you today. Is there anything else you think is 
important for us to know about your sub-district’s community engagement in health care, 
or data collection and quality improvement in the CHPS zones and health center here?
31. Thank you so much for your time.
Pause voice recorder. 
End Time
Location of Interview
Respondent/s’ Sex
Language/s Used
Write notes and record them as soon as you are done. Note special circumstances, 
clarifications, things seen, etc. When done, be sure to shut your recorder to save file.
USAID/Ghana Evaluate for Health Endline 175 CHO Community Leader Instrument
4. Client satisfaction/perception of quality of care
INTERVIEW GUIDE
To be conducted with four community members in each community: Three women and one 
man. Find participants who have had some interaction with services in the CHPS zone within 
which their community is and perhaps a health center as well in the last 12 months. Do not read 
aloud what is in italics nor in bold. 
Save file as:
End_[District]_[Sub-District]_[Interview Type]_[Respondent Name]_[Date].docx
(e.g. End_AOWIN_Dodowa_C_Joseph Apiah_25-1-2019.docx) 
Introduction and consent 
The purpose of this section is to introduce the respondent to the study and request consent. 
Thank you for taking the time for this interview today. My name is [insert name], and I am 
working for DevtPlan Consult on the USAID /Ghana Evaluate for Health endline study of health 
services in Ghana. This study is funded by the U.S. Agency for International Development and 
supported by Ghana Health Services. 
The goal of this study is to help inform decision-makers about the availability of health resources 
at the community level, the quality of the health services at the community level, and how well 
the health system is governed.
The purpose of this interview is to gather information from members of the community like 
yourself regarding the quality of healthcare services you receive. I will be asking about your 
satisfaction with healthcare services, the communication between health care providers about 
your care when more than one facility provides care to you, and the extent of health insurance 
coverage in your community. 
The interview is expected to last 60-90 minutes, and focuses on sub-district health centers and 
CHPS zones.
Participation in this discussion is voluntary. You may skip any question you do not want to 
answer, and you may stop participating at any time. 
There is no risk and no direct advantage for participating in this study. 
However, studies such as this one can help the government of Ghana and development 
partners like USAID to design better programs to improve the health care system here and 
elsewhere.
None of your responses will be identified as yours in study reports or shared with anyone 
outside the study team and study sponsor. 
If you have any questions, concerns, or complaints about the study or your rights as a 
participant, please feel free to ask at any time. Should you have any questions I cannot answer, 
you may call Percy Anaab Bukari, who is leading our team, at 020 8401979.
USAID/Ghana Evaluate for Health Endline 176 CHO Community Leader Instrument
I have a consent form you would need to sign to show you agree to participate in this interview. 
Do you have any questions for me?
Hand form to respondent. 
By signing this form, you are saying that you consent to participate in this interview based on 
the information I just shared with you. You agree that you have had the opportunity to ask 
questions about it and your questions have been answered to your satisfaction.
By signing you agree that you understand your participation is voluntary and you may decide to 
discontinue your participation at any time without penalty or loss of any benefits.
Do you agree to participate?
If yes, Would you please sign or put your mark on this form?
Once the form is signed: Do you have any questions about the interview? 
Before we start, I would like to get your permission to record the interview. This will ensure that I 
remember your responses correctly. 
The recordings from everyone interviewed will be used for analysis only and will not be 
published or shared with anyone outside of the study team. You will not be identified in study 
reports. 
Do I have your permission to record the interview? 
If yes, turn on voice recorder. Read in this information first and then start interview.
District
Sub-district
Date of Interview
Start time of interview
Name/s of Respondents
Interviewer Name
Interview Guide Type: Client
Background Information
1. Before we get into the interview, could you tell me your name and age? 
2. Where do you live?
a. What is the name of the closest CHPS zone to where you live?
3. In total how many people live in your house with you?
a. Of those people, how many are children under the age of 15?
4. In the past 12 months, have you had any health services provided to you by CHPS staff 
either at a CHPS compound, at your home or elsewhere? 
USAID/Ghana Evaluate for Health Endline 177 CHO Community Leader Instrument
This can include counseling, antenatal care, primary health care through outreach services,
other services or treatment.
a. If yes: In general, what kind of services were provided to you? 
Patients’ rights
5. What health services do you think are supposed to be available from the CHPS in your 
community? 
PROBES: What services should they provide to you and the community? 
i. Maternal and reproductive health
ii. Child health services
iii. Disease surveillance and control
iv. Treatment of minor ailment 
v. Health education and counseling
6. Do you think that your CHPS provides the services they are supposed to?
Perceptions of quality of care at CHPS
7. How satisfied are you with the services and care you receive from your CHPS? 
a. Tell me about what you like about your CHPS.
b. Is there anything you would like to see improved about your CHPS?
i. If yes, What would you like to see improved?
c. What could you or would you do if there was something you were not happy with in the 
quality of services or care you received from the CHPS?
d. In the last two years, have you noticed any change in types or quality of services being 
offered by the CHPS in your community? 
i. If yes, What have the changes in the services been? 
8. In the last 12 months, have you or a family member received care or treatment at a CHPS 
compound, if there is one, or have you brought someone there to receive care? 
If yes, ask questions a - c. If not, skip to the next section – Perceptions of quality of care. 
a. I would like to ask you about the last few times you received care at the CHPS 
compound. The last times you went to the CHPS compound, about how long did you 
have to wait to be attended to or seen by staff of the facility?
b. About how long did the care provider spend in consulting or examining you? 
c. Did you have any tests taken during your visit at the CHPS compound? 
If yes,
i. About how long did you have to wait for tests to be performed at the CHPS 
compound?
ii. About how long did you have to wait for test results?
USAID/Ghana Evaluate for Health Endline 178 CHO Community Leader Instrument
9. Now I would like to ask you a bit about the CHPS staff. The last time you received services 
from a CHPS staff member, either at your home or at the CHPS compound, did they take 
the time to listen to you and answer your questions about why you wanted to see them? 
PROBE: Tell me about that.
a. How satisfied were you with the CHPS staff regarding how they listened to you?
b. Did you feel that they understood what your issue was? 
c. Did you like the way the CHPS staff gave you advice and information on options for 
your treatment? 
i. Why or Why not? 
ii. Did the CHPS compound have all the supplies needed for your treatment? This 
includes anything at all needed.
1) If not, What were they missing?
d. Was the CHPS staff member friendly to you? 
10. Has anyone at the CHPS ever referred you from the CHPS to another health facility?
If yes: Ask the following questions. If not, go to Question 11 in the next section. 
a. Which other health facility were you referred to?
b. Did you go?
c. Did you return to the CHPS staff to give them an update on what happened when you 
went?
d. Were you satisfied with the services received at the referral facility?
Perceptions of quality of care at health centers
11. Have you or anyone you care for received care at a Health Center? Not a hospital.
If yes: ask the following questions. If not, go to the next section, Health Promotion 
a. What is the name of the health center you or your family member received care from?
b. In general, what kind of services were provided to you or your family member?
c. Tell me about what you liked or did not like about the services received.
12. Now I would like to ask you about your experiences the last time you or someone you care 
for received care at a health center. The last time you went to a health center, about how 
long did it take you to be attended to by the health center staff?
a. Tell me about the amount of time the care provider spent in consulting or examining you 
or the person you care for? 
b. About how long did you have to wait for tests to be performed at the health center, if 
you had any?
c. Did you need to get anything from the pharmacy or dispensary?
i. If yes, How satisfied are you with the amount of time you had to wait for what you 
needed at the pharmacy or dispensary?
USAID/Ghana Evaluate for Health Endline 179 CHO Community Leader Instrument
13. Now I would like to ask you a bit about the Health Center staff. Did they take the time to 
listen to you regarding what you went to see them about? 
a. Did you feel that the staff understood what your condition was? 
b. Would you go back to this health center to receive treatment if you were sick or referred 
there again? 
i. If not, Why not? 
c. What is your general impression about the way the health center staff gave you 
information on options for treatment? 
i. How well did the staff address your concerns and explain the treatment strategy?
d. As far as you know, did the health center have all the health supplies needed for your 
treatment?
i. If not, What were they missing?
e. In general, was the health center staff member friendly to you? 
Health promotion 
14. Have you heard any radio advertisements or seen any posters, brochures or TV 
advertisements from the GoodLife, Live it Well?
 If yes: Ask the following questions. If not, go to Question in 16 the next section.
a. What have you heard or seen about GoodLife, Live it Well?
b. From what source did you hear or see something about GoodLife, Live it Well?
c. Did you hear or see any messages about family planning or child spacing from 
GoodLife, Live it Well?
i. If yes, What specifically did you hear or see on family planning or child spacing?
15. Have you changed any of your behaviors because of the GoodLife, Live it Well 
messages? 
a. If yes, What behaviors and why? 
b. If no, Why not?
c. What would make you change any of your behaviors? 
Community care linkage 
16. Is there a nurse from the CHPS who visits your community?
If yes,
a. How frequent are the visits?
b. What services does the CHO provide?
USAID/Ghana Evaluate for Health Endline 180 CHO Community Leader Instrument
Community engagement 
17. Overall, do you feel like you are able to influence or have a say in what happens at the 
CHPS in your community? 
If yes, probe if necessary: 
a. How are you able to influence things at the CHPS?
b. How do you contribute to supporting the CHPS in your community?
18. Now I would like to ask you a bit about the Community Health Committee (CHC) in your 
community. Do you have a CHC in this community?
If yes, ask these questions. If not, probe. If the answer is still no, go to Insurance.
a. Do you know who is on the Community Health Committee? 
b. Do you know what the Community Health Committee is supposed to do? Please explain 
c. How well do you think the CHC is doing to improve health care services in the CHPS 
zone?
d. How well do you think the CHC is advocating for patients’ rights on behalf of your 
community? 
i. Can you give any examples? 
e. Would you go to the CHC if you had ideas for things that should be improved at the 
CHPS? 
i. If yes: What would you do?
Insurance
19. Finally, I would like to ask you about health insurance. Are you a registered member of the 
National Health Insurance Scheme, or NHIS?
a. If yes, How long have you had NHIS insurance? 
i. Has having insurance changed where you receive health care? 
ii. Will you renew after your current NHIS subscription expires?
1. If no, What is your main reason for not renewing?
b. In your opinion, do NHIS card holders get better, the same, or worse service than non￾NHIS card holders? 
i. Why do you think that is so?
c. At CHPS, are there any health services that one would need that are not covered by 
NHIS? 
i. If yes, What are the services that are not covered by NHIS at CHPS?
d. Are there any health services that one would need from a health center that are not 
covered by NHIS? 
i. If yes, What are the services that are not covered by NHIS at health centers?
USAID/Ghana Evaluate for Health Endline 181 CHO Community Leader Instrument
20. Those are all the questions I have for you today. Is there anything else you think is important 
for us to know about health services and care in your community? 
21. Thank you so much for your time.
Pause voice recorder. 
End Time
Location of Interview
Respondent/s’ Sex
Language/s Used
Write notes and record them as soon as you are done. Note special circumstances, 
clarifications, things seen, etc. When done, be sure to shut your recorder to save file.
5. Community leaders
INTERVIEW GUIDE
To be conducted with two community leaders. One of these interviews should be with the 
community leader most knowledgeable about the CHPS. The second should be conducted with 
the CHO. Do not read aloud what is in italics nor in bold. 
Save file as:
End_[District]_[Sub-District]_[Interview Type]_[Respondent Name]_[Date].docx
(e.g. End_AOWIN_Dodowa_Leader_Joseph Apiah_25-1-2019.docx) 
Introduction and consent 
The purpose of this section is to introduce the respondent to the study and request consent. 
Thank you for taking the time for this interview today. My name is [insert name], and I am 
working for DevtPlan Consult on the USAID/Ghana Evaluate for Health endline study of health 
services in Ghana. This study is funded by the U.S. Agency for International Development and 
supported by Ghana Health Services. 
The goal of this study is to help inform decision-makers about the availability of health resources 
at the community level, the quality of the health services at the community level, and how well 
the health system is governed.
The purpose of this interview is to gather information from community leaders regarding the 
quality of healthcare in your community. I will be asking about the links between your community 
and the CHPS, the role of the Community Health Committee and community action plans in how 
health care is delivered here, how the community is engaged in health care service decisions, 
and the extent of insurance coverage in your community. 
The interview is expected to last 60-90 minutes.
USAID/Ghana Evaluate for Health Endline 182 CHO Community Leader Instrument
Participation in this discussion is voluntary. You may skip any question you do not want to 
answer, and you may stop participating at any time. 
There is no risk and no direct advantage for participating in this study. However, studies such as 
this one can help the government of Ghana and development partners like USAID to design 
better programs to improve the health care system here and elsewhere.
None of your responses will be identified as yours in study reports or shared with anyone 
outside the study team and study sponsor. 
If you have any questions, concerns, or complaints about the study or your rights as a 
participant, please feel free to ask at any time. Should you have any questions I cannot answer, 
you may call Percy Anaab Bukari, who is leading our team, at 020 8401979.
I have a consent form you would need to sign to show you agree to participate in this interview. 
Do you have any questions for me?
Hand form to respondent. 
By signing this form, you are saying that you consent to participate in this interview based on 
the information I just shared with you. You agree that you have had the opportunity to ask 
questions about it and your questions have been answered to your satisfaction.
By signing you agree that you understand your participation is voluntary and you may decide to 
discontinue your participation at any time without penalty or loss of any benefits.
Do you agree to participate?
If yes, Would you please sign or put your mark on this form?
Once the form is signed: Do you have any questions about the interview? 
Before we start, I would like to get your permission to record the interview. This will ensure that I 
remember your responses correctly. 
The recordings from everyone interviewed will be used for analysis only and will not be 
published or shared with anyone outside of the study team. You will not be identified in study 
reports. 
Do I have your permission to record the interview? 
If yes, turn on voice recorder. Read in this information first and then start interview.
District
Sub-district
Date of Interview
Start of interview
Name/s of Respondents
USAID/Ghana Evaluate for Health Endline 183 CHO Community Leader Instrument
Interviewer Name
Interview Guide Type: Leader
Background information
1. Before we get into the interview, could you tell me your name and your role in the 
community? 
a. How long have you been in that role?
Perceptions of quality of care 
2. What is your overall assessment of the quality of care given by CHPS in your community? 
a. Can you tell me about anything you would like to see improved about your CHPS?
b. In the last two years, have you noticed any changes in types or quality of services 
offered by CHPS in your community? 
i. If yes, What have the changes in the services been? 
3. What is your overall assessment of the quality of care given by health center in your 
community? 
a. Can you tell me about anything you would like to see improved about your health 
center?
b. In the last two years, have you noticed any changes in the types or quality of services 
offered by the health center in your sub-district? 
i. If yes, What have the changes in the services been? 
Community action plan
4. We want to speak with the community leaders because we know you have a good 
perspective of the whole community. One aspect of your community that we are interested 
in is your community action plan, or CAP. Could you tell me, does your community have a 
Community Action Plan, also known as a CAP?
a. If yes, Does this CAP include health activities? 
5. Does this community have a Community Health Action Plan, also known as a CHAP? 
Note: If so, in some communities this will be a part of the CAP and for others they will have 
a separate CHAP document.
IF THEY DO NOT HAVE A CHAP OR CAP WITH HEALTH ACTIVITIES SKIP TO QUESTION 
9.
6. Who created the Community Health Action Plan?
a. Can you describe the process and how it worked? 
b. When was this done?
c. Was data used to create the Action plan?
7. What activities are included in the community health action plan or CAP?
USAID/Ghana Evaluate for Health Endline 184 CHO Community Leader Instrument
a. Does the action plan contain Health Centers and CHPS activities?
b. Does your community action plan contain any activities related to nutrition? 
c. Has any part of this action plan been implemented? 
i. If yes, Which part/s? 
Role of the CHC
8. Does the community action plan support the goals of the CHPS? 
a. If yes, Which goals of the CHPS does it support? 
9. Is there a Community Health Committee or CHC in your community?
If yes,
a. How often does it meet?
b. How many members are there?
10. Does the Community Health Committee or CHC in your community support the goals of the 
CHPS?
a. If yes, How do they do that?
11. How does the CHC support CHPS activities? 
a. Has this support changed over the last two years, either increasing or decreasing? 
i. If decreased, Why? 
12. How does the CHC provide support for the CHPS delivery of service?
13. Does the CHC ensure that the CHPS has adequate resources to provide health care to the 
community? 
14. How does the CHC monitor the CHPS?
a. Does the CHC give feedback to the CHPS that helps the CHPS do their work better?
i. If yes, Do you have any examples?
15. Does your community have community health volunteers, or CHVs?
a. If yes, In what ways does the CHC support community health volunteers, or CHVs? 
Probes: 
i. Do they facilitate getting trainings for CHVs? 
ii. Do they make sure CHVs have all the resources they need?
iii. Do they monitor and give feedback to CHVs?
16. How well do you think the CHC supports the CHPS through their support of the community 
health volunteers?
17. How well do you think the CHC advocates for the CHPS to get support?
USAID/Ghana Evaluate for Health Endline 185 CHO Community Leader Instrument
a. Do you think they have been successful in their advocacy work?
i. Why or Why not?
b. Does the CHC advocate on behalf of the community health officer to district assembly 
members and politicians to get their support for your CHPS?
c. What do you think they have to work on to get more support for the CHPS and health 
services for your community?
Community engagement
18. Do you think that the CHC tries to generate community support for the CHPS?
a. If yes, do you have any example of how they generated community support for the 
CHPS? 
19. Does your CHC try to engage the community on an on-going basis?
a. If yes, How?
Health rights 
20. Could you please tell me the services CHPS supposed to provide? 
Probes: What are they supposed to do? Or, What are they supposed to take care of? 
i. Maternal and reproductive health
ii. Child health services
iii. Disease and surveillance and control
iv. Treatment of minor ailment 
vi. Health education and counseling
vii. Follow-up of defaulters and discharged patients 
21. Do you think that your CHPS is providing these services, or the services they are supposed 
to? 
a. If yes, How are these services being provided?
22. How satisfied are you with the quality of services and care you receive from your CHPS? 
23. Tell me about what you like or do not like about the CHPS.
Insurance
24. Next, I would like to ask you about the National Health Insurance Scheme, or NHIS. Do 
people in your community have access to the NHIS?
If yes,
a. Are many of your community members currently registered with NHIS? 
i. Could you guess how many out of every 10 community members belong?
b. Has the number of community members with health insurance changed over the past 
year? 
Probe if the change has been an increase or decrease. 
i.Why do you think this has [or has not] changed?
USAID/Ghana Evaluate for Health Endline 186 CHO Community Leader Instrument
25. Do you think insurance changes how and where people who are insured receive care? 
a. If yes, How?
26. In your opinion, do NHIS card holders get better, the same, or worse service than others? 
a. Why do you say that? 
27. Are there any services that one would need from a health provider that are not covered by 
NHIS?
a. If yes, which are they?
Community care linkage 
28. I would like to hear your thoughts on the relationship between your community, the CHC and 
the CHPS. 
Please describe the relationship between the CHC and CHPS Staff. 
a. How strong or weak do you think these relationships are and why?
b. How could these relationships be strengthened?
29. Please describe the relationship between the community members and the CHPS staff?
a. How strong or weak do you think these relationships are and why?
b. How could these relationships be strengthened?
30. How easy or difficult is it for community members to see the CHO for any questions they 
might have? 
31. Those are all the questions I have for you today. Is there anything else you think is important 
for us to know about health services and care in your community? 
32. Thank you so much for your time. 
Pause voice recorder. 
End Time
Respondent/s’ Sex
Language/s Used
Location/Community of Interview
Write notes and record them as soon as you are done. Note special circumstances, 
clarifications, things seen, etc. When done, be sure to turn off voice recorder to save file.
USAID/Ghana Evaluate for Health Endline 187 CHO Community Leader Instrument
6. Community leaders - CHO
INTERVIEW GUIDE
To be conducted with two community leaders. One of these interviews should be with the 
community leader most knowledgeable about the CHPS. The second should be conducted with 
the CHO. Do not read aloud what is in italics nor in bold. 
Save file as:
End_[District]_[Sub-District]_[Interview Type]_[Respondent Name]_[Date].docx
(e.g. End_AOWIN_Dodowa_Leader_Joseph Apiah_25-1-2019.docx) 
Introduction and consent 
The purpose of this section is to introduce the respondent to the study and request consent. 
Thank you for taking the time for this interview today. My name is [insert name], and I am 
working for DevtPlan Consult on the USAID/Ghana Evaluate for Health endline study of health 
services in Ghana. This study is funded by the U.S. Agency for International Development and 
supported by Ghana Health Services. 
The goal of this study is to help inform decision-makers about the availability of health resources 
at the community level, the quality of the health services at the community level, and how well 
the health system is governed.
The purpose of this interview is to gather information from CHPS staff members regarding the 
quality of healthcare at your CHPS. I will be asking about the links between the community here 
and the CHPS, the role of the Community Health Committee and community action plans in how 
health care is delivered here, how the community is engaged in health care service decisions, 
and the extent of insurance coverage in your community. 
The interview is expected to last 60-90 minutes.
Participation in this discussion is voluntary. You may skip any question you do not want to 
answer, and you may stop participating at any time. 
There is no risk and no direct advantage for participating in this study. However, studies such as 
this one can help the government of Ghana and development partners like USAID to design 
better programs to improve the health care system here and elsewhere.
None of your responses will be identified as yours in study reports or shared with anyone 
outside the study team and study sponsor. 
If you have any questions, concerns, or complaints about the study or your rights as a 
participant, please feel free to ask at any time. Should you have any questions I cannot answer, 
you may call Percy Anaab Bukari, who is leading our team, at 020 8401979.
I have a consent form you would need to sign to show you agree to participate in this interview. 
Do you have any questions for me?
Hand form to respondent. 
USAID/Ghana Evaluate for Health Endline 188 CHO Community Leader Instrument
By signing this form, you are saying that you consent to participate in this interview based on 
the information I just shared with you. You agree that you have had the opportunity to ask 
questions about it and your questions have been answered to your satisfaction.
By signing you agree that you understand your participation is voluntary and you may decide to 
discontinue your participation at any time without penalty or loss of any benefits.
Do you agree to participate?
If yes, Would you please sign or put your mark on this form?
Once the form is signed: Do you have any questions about the interview? 
Before we start, I would like to get your permission to record the interview. This will ensure that I 
remember your responses correctly. 
The recordings from everyone interviewed will be used for analysis only and will not be 
published or shared with anyone outside of the study team. You will not be identified in study 
reports. 
Do I have your permission to record the interview? 
If yes, turn on voice recorder. Read in this information first and then start interview.
District
Sub-district
Date of Interview
Start of interview
Name/s of Respondents
Interviewer Name
Interview Guide Type: Leader-CHO
Background information
1. Before we get into the interview, could you tell me your name and your role in the CHPS? 
a. How long have you been in that role?
Perceptions of quality of care 
2. What is your overall assessment of the quality of care given by your CHPS? 
a. Can you tell me about anything you would like to see improved about your CHPS?
b. In the last two years, have you noticed any changes in types or quality of services 
offered by your CHPS? 
i. If yes, What have the changes in the services been? 
3. What is your overall assessment of the quality of care given by the nearest health center to 
your community? 
USAID/Ghana Evaluate for Health Endline 189 CHO Community Leader Instrument
a. Can you tell me about anything you would like to see improved about your health 
center?
Access to supplies and medicines through the supply chain - ADDED
27. How would you describe access to essential commodities and equipment through the 
supply chain to your CHPS zone? 
a. Are necessary supplies available at your CHPS?
b. What are the main challenges to ensuring the availability of basic medicines and 
supplies?
 c. In the last two years, has access to essential supplies and medicines changed in your 
CHPS zone?
i. If yes, How? 
Probe for frequency of stock outs and specific commodities. 
28. What processes are used to monitor the stock and use of medicines and supplies at your 
CHPS zone?
 a. In the last 2 years, have there been any changes in the procedure for your CHPS 
zone in reporting when supplies run out or are running low?
i. If yes, How have these procedures changed? 
b. How well does that system work for ensuring supplies and medicines are re-stocked 
in time?
29. Could data be better used to help ensure constant supplies of commodities and medicines in 
your CHPS zone?
a. If yes, How? 
30. Are data used to forecast supply needs for Rapid Diagnostic tests – or RDTs, in your CHPS 
zone?
a. If yes, What data are used and how are they used?
Protocols - ADDED
31. Does your CHPS have the most current GHS protocols available for the following areas: 
– Reproductive health
– Maternal and newborn care
– Infection Prevention and control, and
– Community-Based Management of Acute Malnutrition?
32. What system, if any, is in place to monitor the use of these protocols by CHPS zone staff? 
a. If there is a system, How successful do you think this monitoring system is?
USAID/Ghana Evaluate for Health Endline 190 CHO Community Leader Instrument
Quality assurance and quality improvement - ADDED
33. Does the work plan of your CHPS zone include quality assurance also known as QA, or 
quality assurance and quality improvement, also known as QA/QI?
 If yes,
a. Is QA or QA/QI integrated into your routine activities, and if so, can you tell me how it is 
integrated into your routine activities and the work plan of the CHPS zone?
b. In the past year, what QA or QA/QI activities have been implemented, if any?
34. How are QA or QA/QI data used to guide service quality improvement, that is, can you 
describe any data that are used by CHPS staff to improve the services you provide?
35. If they have a QI plan, ask: Have you have taken any steps to implement your quality 
improvement or QI plan in the last 60 days?
i. If yes, Please tell me about the steps.
Referrals - ADDED
36. Are referrals and follow-up care tracked and information shared between CHPS zones and 
health centers? 
 If yes,
a. How is this information shared? 
PROBE: Do clients have their own folders or records they bring to appointments?
b. Is this an effective way to share information? 
PROBE: Do facilities use the system? 
37. How often do you think that individuals follow referrals?
a. If someone does follow a referral, do you think there is a good system for them to let 
CHPS know what happened at the other health facility?
b. How do you think this tracking system affects the quality of care?
Community action plan
4. We want to speak with you because we know you have a unique perspective of the 
community where you work. One aspect of your community that we are interested in is their 
community action plan, or CAP. Could you tell me, does your community have a 
Community Action Plan, also known as a CAP?
b. If yes, Does this CAP include health activities? 
6. Does this community have a Community Health Action Plan, also known as a CHAP? 
Note: If so, in some communities this will be a part of the CAP and for others they will have 
a separate CHAP document.
IF THEY DO NOT HAVE A CHAP OR CAP WITH HEALTH ACTIVITIES SKIP TO QUESTION 
9.
USAID/Ghana Evaluate for Health Endline 191 CHO Community Leader Instrument
6. Who created the Community Health Action Plan?
a. Can you describe the process and how it worked? 
b. When was this done?
c. Was data used to create the Action plan?
7. What activities are included in the community health action plan or CAP?
d. Does the action plan contain Health Centers and CHPS activities?
e. Does the community action plan contain any activities related to nutrition? 
f. Has any part of this action plan been implemented? 
i. If yes, Which part/s? 
Role of the CHC
8. Does the community action plan support the goals of the CHPS? 
a. If yes, Which goals of the CHPS does it support? 
9. Is there a Community Health Committee or CHC in your community?
If yes,
a. How often does it meet?
b. How many members are there?
10. Does the Community Health Committee or CHC in your community support the goals of the 
CHPS?
a. If yes, How do they do that?
11. How does the CHC support CHPS activities? 
a. Has this support changed over the last two years, either increasing or decreasing? 
i. If decreased, Why? 
12. How does the CHC provide support for the CHPS delivery of service?
13. Does the CHC ensure that the CHPS has adequate resources to provide health care to the 
community? 
14. How does the CHC monitor the CHPS?
a. Does the CHC give feedback to the CHPS that helps the CHPS do their work better?
i. If yes, Do you have any examples?
15. Does your community have community health volunteers, or CHVs?
a. If yes, In what ways does the CHC support community health volunteers, or CHVs? 
Probes: 
i. Do they facilitate getting trainings for CHVs? 
ii. Do they make sure CHVs have all the resources they need?
USAID/Ghana Evaluate for Health Endline 192 CHO Community Leader Instrument
iii. Do they monitor and give feedback to CHVs?
16. How well do you think the CHC supports the CHPS through their support of the community 
health volunteers?
17. How well do you think the CHC advocates for the CHPS to get support?
a. Do you think they have been successful in their advocacy work?
i. Why or Why not?
b. Does the CHC advocate to district assembly members and politicians to get their 
support for your CHPS?
c. What do you think the CHC has to work on to get more support for the CHPS and 
health services for your community?
Community engagement
18. Do you think that the CHC tries to generate community support for the CHPS?
a. If yes, Do you have any example of how they generated community support for the 
CHPS? 
19. Does your CHC try to engage the community on an on-going basis?
a. If yes, How?
Health rights 
20. Do you think that your CHPS is providing the services you are supposed to? 
a. If yes, How are these services being provided?
Insurance
21. Next, I would like to ask you about the National Health Insurance Scheme, or NHIS. Do 
people in the community in which you work have access to the NHIS?
If yes,
a. Are many of your community members currently registered with NHIS? 
i. Could you guess how many out of every 10 community members belong?
b. Has the number of community members with health insurance changed over the past 
year? 
Probe if the change has been an increase or decrease. 
i.Why do you think this has [or has not] changed?
22. Do you think insurance changes how and where people who are insured receive care? 
a. If yes, How?
23. In your opinion, do NHIS card holders get better, the same, or worse service than others? 
a. Why do you say that? 
24. Are there any services that one would need from a health provider that are not covered by 
NHIS?
USAID/Ghana Evaluate for Health Endline 193 CHO Community Leader Instrument
a. If yes, Which are they?
Community care linkage 
25. I would like to hear your thoughts on the relationships between the community where you 
work, the CHC and the CHPS. Please describe the relationship between the CHC and CHPS 
Staff. 
a. How strong or weak do you think this relationship is and why?
b. How could this relationship be strengthened?
26. Please describe the relationship between the community members and the CHPS staff?
a. How strong or weak do you think these relationships are and why?
b. How could these relationships be strengthened?
38. Those are all the questions I have for you today. Is there anything else you think is important 
for us to know about health services and care in your community? 
39. Thank you so much for your time. 
Pause voice recorder. 
End Time
Respondent/s’ Sex
Language/s Used
Location/Community of Interview
Write notes and record them as soon as you are done. Note special circumstances, clarifications, 
things seen, etc. When done, be sure to turn off voice recorder to save file.
7. Community Health Committee (CHC)
INTERVIEW GUIDE
To be conducted with up to six Community Health Committee members in each selected 
community. Do not read aloud what is in italics nor in bold. 
Save file as:
End_[District]_[Sub-District]_[Interview Type]_[Community Name]_[Date].docx; 
(e.g. End_AOWIN_Dodowa_CHC_Akea_25-1-2019.docx) 
Introduction and consent 
The purpose of this section is to introduce the respondent to the study and request consent. 
Thank you for taking the time for this interview today. My name is [insert name], and I am 
working for DevtPlan Consult on the USAID /Ghana Evaluate for Health endline study of health 
services in Ghana. This study is funded by the U.S. Agency for International Development and 
supported by Ghana Health Services. 
USAID/Ghana Evaluate for Health Endline 194 CHO Community Leader Instrument
The goal of this study is to help inform decision-makers about the availability of health resources 
at the community level, the quality of the health services at the community level, and how well 
the health system is governed.
The purpose of this discussion is to gather information from members of the Community Health 
Committee about your relationship with communities and how this affects healthcare. Specifically 
we will be asking about CHC roles and responsibilities, how CHCs support CHPS zones, and the 
links between communities and the CHPS. We did a similar study two years ago, and are 
particularly interested in changes in the last two years.
The discussion is expected to last 60-90 minutes.
Participation in this discussion is voluntary. You may skip any question you do not want to 
answer, and you may stop participating at any time. 
There is no risk and no direct advantage for participating in this study. 
However, studies such as this one can help the government of Ghana and development 
partners like USAID to design better programs to improve the health care system here and 
elsewhere.
None of your responses will be identified as yours in study reports or shared with anyone 
outside the study team and study sponsor. 
If you have any questions, concerns, or complaints about the study or your rights as a participant, 
please feel free to ask at any time. Should you have any questions I cannot answer, you may call 
Percy Anaab Bukari, who is leading our team, at 020 8401979.
I have a consent form you would need to sign to show you agree to participate in this interview. 
Do you have any questions for me?
Hand form to respondents. 
By signing this form, you are saying that you consent to participate in this interview based on 
the information I just shared with you. You agree that you have had the opportunity to ask 
questions about it and your questions have been answered to your satisfaction.
By signing you agree that you understand your participation is voluntary and you may decide to 
discontinue your participation at any time without penalty or loss of any benefits.
Do you agree to participate?
If yes, Would you please sign or put your mark on this form?
Once the form is signed:
Do you have any questions about the interview? 
Before we start, I would like to get your permission to record the interview. This will ensure that I 
remember your responses correctly. 
USAID/Ghana Evaluate for Health Endline 195 CHO Community Leader Instrument
The recordings from everyone interviewed will be used for analysis only and will not be 
published or shared with anyone outside of the study team. You will not be identified in study 
reports. 
Do I have your permission to record the interview? 
If yes, turn on voice recorder. Read in this information first and then start interview.
District
Sub-district
Interview Guide Type CHC
Location/Community of Interview
Date of Interview
Start time of interview
Interviewer Name
Note Taker Name
Background information
1. Before we get into the interview, would you each tell me your name and about your position 
within the CHC? 
2. Are there any members of the CHC who are not here today? 
a. If yes, How many are not here?
b. Are the missing people male or female?
History and operation of CHC
3. I want to begin by getting to know more about the history, operation, and composition of this 
CHC. Based on your knowledge, when and how was this CHC first established here? 
 Probe for year of formation.
a. How are members selected or elected to your CHC? 
4. How often do members of this CHC meet and where are meetings usually held? 
5. Does this CHC have documentation of meetings and activities? 
If yes, 
a. What types of documentation do you keep from meetings and activities? 
b. Is this documentation available to the community or public?
CHC roles and responsibilities
6. In your own words, what is the mission or purpose of this CHC?
7. Based on your experiences, what are the key responsibilities of the CHC members and 
what do you do to support the CHO? 
USAID/Ghana Evaluate for Health Endline 196 CHO Community Leader Instrument
Probe social and financial responsibility areas with examples below, if necessary: 
a. Serving as a liaison between the community and the CHPS or other health facilities 
b. Ensuring the welfare and security of CHVs and the CHO.
c. Supporting health programs such as health education, disease surveillance and 
advocacy. 
d. Mobilizing resources and support for the CHC, the CHO, the CHPS compound
8. In the last two years, what health programs and activities has the CHC supported at the 
facility and in the community?
a. Does the CHC help support durbars?
i. If yes, Usually, how many durbars are held every quarter or every year?
ii. Is this number of durbars appropriate, or would you like to see more or fewer?
9. Overall, which responsibilities has this CHC been the most successful in fulfilling to support 
the CHPS?
a. Why do you think that is? 
10. What areas do you think this CHC could work to improve on, if any?
a. What are the challenges that have hindered the work of the CHC? 
Linkages with the district assembly
11. Can you describe the relationship, if any, this CHC has with the District Assembly members 
of this electoral area?
If no relationship with the DA, go to question 12.
a. How regularly does the CHC meet with the assembly members?
b. In the past quarter, what support have the assembly members provided the CHC, the 
CHO or the CHPS?
PROBE: For training for CHC
Health volunteers
12. How are community health volunteers, or CHVs, chosen?
a. Does the CHC have up-to-date names and contact information for the CHVs? 
b. Does the CHC ensure that all CHVs are adequately trained?
c. How are CHVs currently supervised or monitored?
d. How does your CHC provide motivational support for volunteers? 
Probe types of support if necessary: Financial, social, transportation, food, training, 
guidance, coaching, supervision, communication or administrative.
Community Health Action Plan (CHAP) 
13. Does this community have a Community Action Plan, also known as a CAP? 
USAID/Ghana Evaluate for Health Endline 197 CHO Community Leader Instrument
a. If Yes, Does this CAP include health activities? 
b. If no, Why?
14. Does this community have a Community Health Action Plan, also known as a CHAP? 
Note: If so, in some communities this will be a part of the CAP and for others they will have 
a separate CHAP document.
IF THEY DO NOT HAVE A CHAP OR CAP WITH HEALTH ACTIVITIES SKIP TO Q18 IN THE 
NEXT SECTION.
15. Did this CHC participate in the process to come up with the Community Health Action Plan 
or the health activities in the CAP?
If yes,
a. Can you describe the process and how it worked? 
b. When was this done?
c. Was data used to create the Action plan?
16. What activities are included in the community health action plan or CAP?
a. What areas of health does the community health action plan or CAP address? 
b. Has any part of this action plan been implemented? 
17. Does this CHC have a separate work plan or action plan? 
a. If yes, What types of activities are on the plan? 
Community care linkage 
18. I would like to hear your thoughts on the relationships between your community, the CHC, 
and the CHPS staff. 
Please describe the relationship between the CHC and CHPS Staff. 
a. How strong or weak do you think this relationship is and why?
b. How could this relationship be strengthened?
19. Please describe the relationship between the community members and the CHPS staff? 
a. How strong or weak do you think these relationships are and why?
b. How could these relationships be strengthened?
20. How easy or difficult is it for community members to see the CHO for any questions they 
have? 
Referrals and insurance
21. I would like to ask you a bit about the patient or client referral system. From your 
perspective, do you think that individual clients follow referrals they receive from the CHPS, 
that is, do clients go to other health facilities if the CHPS staff refer them to go? 
USAID/Ghana Evaluate for Health Endline 198 CHO Community Leader Instrument
a. If not, What are the reasons people do not follow referrals?
b. If yes, If someone does follow a referral, do you think there is a good system for them to 
let the CHO know what happened at the other health facility they were referred to?
22. Finally, I would like to ask you about the National Health Insurance Scheme, or NHIS. Do 
people in your community have access to the NHIS?
a. Does having insurance change how and where community members can receive health 
care? 
i. If yes, How?
b. In your opinion, do NHIS card holders get better, the same, or worse service than 
others? 
i. If worse or better, Why? 
c. Are there any health services that one would need from a health service provider that are 
not covered by NHIS? 
i. If yes, which services are these?
23. Those are all the questions I have for you today. Is there anything else you think is important 
for us to know about how your Community Health Committee works and supports the health 
services and system in your community and community to care linkages? 
24. Thank you so much for your time. 
Pause voice recorder. 
End Time
Language/s Used
Names and Description of Participants (incl 
sex and home language)
Write notes and record them as soon as you are done. Note special circumstances, 
clarifications, things seen, etc. When done, be sure to turn off voice recorder to save file.