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Supervisory checklist for TB Unit/ Microscopy Centre/ PHI - Health Facility
Learning ObjectivesSupervisory checklist for TB Unit/ DMC/ PHI - Health Facility
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At the Tuberculosis Unit (TU), the presiding supervisory team uses a standardized checklist mandated by the National TB Elimination Programme (NTEP) during their periodic supervisory visits. The report and copies of the checklist may be shared with appropriate authorities within 1 week of completing the supervisory visit.
These appropriate authorities include the Central TB Division, Ministry of Health and Family Welfare (MoHFW) and respective district and state authorities, who will in turn initiate remedial measures in a timely and appropriate manner.
The TB Unit/ Designated Microscopy Centre (DMC)/ Peripheral Health Institute (PHI) Health Facility Checklist is shown in the table below.
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Name of the TB Unit/ DMC/ PHI: Name of District and State: Date of Visit: Facilities Visited: |
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| 1 | Interact with the Medical Officer (MO) to know their involvement in TB case detection. Look at the Outpatient Department (OPD) register to know what % of adult OPD patients are being referred for sputum microscopy. | % |
| 2 | % of MOs trained in NTEP on the management of TB cases. (Assess their knowledge on NTEP, Cartridge-based Nucleic Acid Amplification Test (CBNAAT)/ Truenat services, newer Drug-resistant TB (DR-TB) drug regimen, Nikshay Poshan Yojana, etc.) | % |
| 3 | Is the MO regularly undertaking supervisory visits? (Observe the field visits undertaken by the MOs in the supervisory register) | Y/N |
| 4 | Information, Education and Communication (IEC)/ Advocacy, Communication and Social Mobilisation (ACSM) activities undertaken by the MO? (Enquire about the ACSM activities like school health programs, village health sanitation and nutrition meetings, community orientation meetings etc. undertaken, and observe for visible IEC wallpapers/ banners etc. in the PHI and its vicinity) | Adequate/ Not adequate |
| Designated Microscopy Centres | ||
| 5 | Are the sputum samples being tested as soon as they are received? (Observe for the presence of Laboratory Technician (LT) availability on all days, availability of Binocular/ Fluorescence Microscope(BM/ FM), the average time taken from the time of sample receipt to smear result reported (lab turnaround time) | Y/N |
| 6 | Is the LT trained in performing smear microscopy? (Assess their knowledge of the smear microscopy procedure) | Y/N |
| 7 | Lab turnaround time - Average time taken from the time of sample receipt to smear result reported | (in days) |
| 8 | Are chest symptomatics offered chest X-ray? (either directly or linked with an X-ray centre - % of chest symptomatic offered) | Y/N |
| 9 | Is there provision for collection and transport of samples of key populations/ TB notified patients to the CBNAAT/ Truenat lab available? (Review the transport mechanism available) | Y/N |
| 10 | Are presumptive TB patients offered HIV testing? (% offered HIV testing – Check in the Lab register) | Y/N |
| 11 | Are there adequate supplies of reagents, slides and other consumables for the next month? (Check for the reagents availability, quantity and labelling of expiry date) | Y/N |
| 12 | Does the DMC have continuous water and electricity supply? | Y/N |
| Treatment Services | ||
| 13 | Are all diagnosed patients notified in the TB notification register? (Cross check the lab register with the TB notification register and look for the Nikshay id) | Y/N |
| 14 | Are all notified patients initiated on treatment? (Including those referred/ transferred out) | Y/N |
| 15 | Average time taken for treatment initiation from the time of diagnosis? (Calculate for 30 recent patients including those transferred/ referred out) | (in days) |
| 16 | Are TB-notified patients offered HIV testing? (% offered HIV testing – Check in the TB notification register/ Nikshay) | Y/N |
| 17 | Are TB-notified patients offered Diabetes Mellitus (DM) testing? (% offered DM testing – Check in the TB notification register/ Nikshay) | Y/N |
| 18 | Are TB notified patients screened for Tobacco usage? (% screened for tobacco usage – Check in the TB notification register/ Nikshay) | Y/N |
| 19 | Nikshay Poshan Yojana - % of TB notified patients who have been offered Nikshay Poshan Yojana (Patients currently in the PHI for the last 1 year may be taken) | % |
| Treatment Supporters | ||
| 20 | Does the treatment supporter require training/ sensitisation? (Assess knowledge in Directly Observed Therapy Short-course (DOTS), treatment card maintenance, patient services, Nikshay Poshan Yojana) | Y/N |
| 21 | Is the treatment supporter monitoring daily drug intake by the patient (either directly/ digital adherence)? (Check the treatment card – cross-match with drugs issued and pills taken) | Y/N |
| 22 | % of honorarium received? (Ask whether the treatment supporter has received the honorarium for all eligible patients who have completed their treatment) | % |
| Field Supervisors (Senior Treatment Supervisor (STS)/ TB Health Visitor (TBHV)/ General Health System (GHS) Staff) | ||
| 23 | Is an individual vehicle available for field visits? | Y/N |
| 24 | % of TB notified patients currently on treatment in whom home visits have been undertaken? (Cross check with the treatment card/ Lat. long. coordinates captured in Nikshay/ patient interaction) | % |
| 25 | % of TB notified patients currently on treatment linked to a treatment supporter? | % |
| 26 | % of children identified in whom chemoprophylaxis with Isoniazid has been given? | % |
| 27 | Has the staff received the salary & POL to date? If No, record the issues therein? | Y/N |
| 28 | % of private notified patients in whom public health actions have been provided? | % |
| Senior TB Lab Supervisors (STLS)/ GHS staff | ||
| 29 | Is the STLS reviewing slides preserved by the LT during the On-site Evaluation (OSE)? | Y/N |
| 30 | Are the reports of TU-OSE done by the STLS available in the DMC? (Check for the copy of at least the last month) | Y/N |
| 31 | Is corrective action as suggested in the TU-OSE report being carried out by the DMC? (Current status may be used as an assessment of the corrective actions taken) | Y/N |
| 32 | Assess 2 slides to check if they match with the OSE report? | Matches/ Does Not match |
| Drug Store | ||
| 33 | Is the stock register maintained as per guidelines? | Y/N |
| 34 | Are the drug stocks adequate as per the suggested norms? | Adequate/ inadequate |
| 35 | Are the stocks matching with Nikshay Aushadhi? | Y/N |
| 36 | Is bio-medical waste from the DMC disposed of as per Bio-Medical Waste (management and handling) Rules 2016 | |
| Comments and Recommendations: (Use an extra sheet, if required) | ||
| 1 | ||
| 2 | ||
| 3 | ||
| 4 | ||
| Name and signature of the visiting team members with their designation: | ||
Resources
- NTEP Training Modules (5-9) for Programme Managers & Medical Officers, 2020.
- Supervision and Monitoring Strategy, RNTCP, 2012.
Assessment
| Question | Answer 1 | Answer 2 | Answer 3 | Answer 4 | Correct answer | Correct explanation | Page id | Part of Pre-test | Part of Post-test |
| The TB Unit/ Designated Microscopy Centre (DMC)/ Peripheral Health Institute (PHI) Health Facility Checklist covers which of the following thematic areas? | Advocacy, Communication and Social Mobilisation | Direct Benefit Transfer | Stock availability | All of the above | 4 | The TU level checklist covers ACSM, DBT and stock availability as well as other parameters at the TU level. | | Yes | Yes |
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