The PhilCAT Certification Self-assessment and Survey Tool

PhilCAT CERTIFICATION STANDARDS Survey Criterion Evidence of Progress and Achievements Item (Completed by TB DOTS Center) Goal 1.

DOTS Center Rating*

Surveyors' Comments

Survey Team Rating*

The TB DOTS Center provides a safe and effective physical environment to its staff and patients. Signages and signs are placed for easy access The TB DOTS center is EA to the center. easily located and patients have convenient and safe access to the center. This standard will be achieved when: 1.1. There is appropriate Signages are placed to provide directions for EA signage bearing the name easy access to the center. of the TB DOTS center to assist patients accessing the center. 1.2. Physical access is The road to the center is spacious for easy EA appropriate for the needs access. of patients. Entrances and exits are 1.3. No parking sign is placed. clearly marked and free of EA obstruction and other hazardous conditions. 1.4. There are resources to Daily and hourly schedules as well as the inform patients of the duration of the treatment are posted to ensure daily and hourly schedule the quality of the service. EA of TB DOTS services, ensure the quality of patient waiting.

*Rating scale: 1. Non Achievement - The requirements of standard / criterion are not met. 2. Low Achievement - The requirements of standard / criterion are scarcely met 3. Moderate Achievement - The requirements of the standard / criterion are generally met in most circumstances. 4. Extensive Achievement - The requirements of the standard / criterion are fully met in the majority of circumstances and have been for some time.

The PhilCAT Certification Self-assessment and Survey Tool

OVERALL RATING AND COMMENTS, COMMENDATIONS AND RECOMMENDATIONS BY SURVEY TEAM (To be completed by survey team only. The survey team must make comments on items where the survey team disagrees or partially disagrees with information provided by the TB DOTS center.) Goal: The TB DOTS Center provides a safe and effective physical environment to its staff and patients. Standard 1: The TB DOTS center is easily located and patients have convenient and safe access to the center.

Rating (please tick appropriate overall rating for this standard)

NonAchievement

Low Achievement

Moderate Achievement

Extensive Achievement

*Rating scale: 1. Non Achievement - The requirements of standard / criterion are not met. 2. Low Achievement - The requirements of standard / criterion are scarcely met 3. Moderate Achievement - The requirements of the standard / criterion are generally met in most circumstances. 4. Extensive Achievement - The requirements of the standard / criterion are fully met in the majority of circumstances and have been for some time.

The PhilCAT Certification Self-assessment and Survey Tool

PhilCAT CERTIFICATION STANDARDS Survey Criterion Evidence of Progress and Achievements Item (Completed by TB DOTS Center) Goal 2.

DOTS Center Rating*

Surveyors' Comments

Survey Team Rating*

The TB DOTS Center provides a safe and effective physical environment to its staff and patients Structural and physical layout of the facility The TB DOTS Center provides facilities for the ensured the clients privacy and comfort. EA comfort and privacy of its patients and staff. This standard will be achieved when: 2.1. Housekeeping schedule is practiced to The TB DOTS center maintain cleanliness. maintains a clean and wholesome environment EA within and immediately outside its premises. 2.2 There are resources and processes to ensure the quality of patient waiting. The lighting in each area of the center is appropriate for the assigned purpose of the area. The privacy of the staffpatient encounter is assured. Pamphlet and magazines are provided for waiting patients. The room is well ventilated and well lit for the patients comfort.

EA

2.3

EA

2.4

Curtains are placed to provide privacy. EA

*Rating scale: 1. Non Achievement - The requirements of standard / criterion are not met. 2. Low Achievement - The requirements of standard / criterion are scarcely met 3. Moderate Achievement - The requirements of the standard / criterion are generally met in most circumstances. 4. Extensive Achievement - The requirements of the standard / criterion are fully met in the majority of circumstances and have been for some time.

The PhilCAT Certification Self-assessment and Survey Tool

OVERALL RATING AND COMMENTS, COMMENDATIONS AND RECOMMENDATIONS BY SURVEY TEAM (To be completed by survey team only. The survey team must make comments on items where the survey team disagrees or partially disagrees with information provided by the TB DOTS center.) Goal: The TB DOTS Center provides a safe and effective physical environment to its staff and patients. Standard 2: The TB DOTS center provides for the privacy and comfort of its patients and staff.

Rating (please tick appropriate overall rating for this standard)

NonAchievement

Low Achievement

Moderate Achievement

Extensive Achievement

*Rating scale: 1. Non Achievement - The requirements of standard / criterion are not met. 2. Low Achievement - The requirements of standard / criterion are scarcely met 3. Moderate Achievement - The requirements of the standard / criterion are generally met in most circumstances. 4. Extensive Achievement - The requirements of the standard / criterion are fully met in the majority of circumstances and have been for some time.

The PhilCAT Certification Self-assessment and Survey Tool

PhilCAT CERTIFICATION STANDARDS Survey Criterion Evidence of Progress and Achievements Item (Completed by TB DOTS Center) Goal 3.

DOTS Center Rating*

Surveyors' Comments

Survey Team Rating*

The TB DOTS Center provides a safe and effective physical environment to its staff and patients. Proper procedures are strictly followed such EA The TB DOTS center provides for the safety of as hand washing, proper segregations of garbage and proper storage of drugs. its patients and staff. This standard will be achieved when: 3.1 There is adequate clean Hand washing area is available inside the EA water for personal hygiene center. and sanitation purposes. 3.2 The TB DOTS center Hand washing and after care of the EA maintains appropriate equipments are strictly followed to ensure levels of cleanliness and quality service. antisepsis of all physical areas, equipment and instruments. 3.3 General waste, sharps, Garbage cans are provided. They are EA pathological and properly labelled for proper segregations. infectious waste, pharmaceutical and chemical wastes are appropriately segregated, safely handled and disposed of according to accepted safe disposal practices. 3.4 TB drugs are securely TB drugs are properly stored in the cabinets. EA stored under appropriate storage conditions.

*Rating scale: 1. Non Achievement - The requirements of standard / criterion are not met. 2. Low Achievement - The requirements of standard / criterion are scarcely met 3. Moderate Achievement - The requirements of the standard / criterion are generally met in most circumstances. 4. Extensive Achievement - The requirements of the standard / criterion are fully met in the majority of circumstances and have been for some time.

The PhilCAT Certification Self-assessment and Survey Tool

PhilCAT CERTIFICATION STANDARDS Survey Criterion Evidence of Progress and Achievements Item (Completed by TB DOTS Center) 3.5

DOTS Center Rating*

Surveyors' Comments

Survey Team Rating*

Sputum and other body Sputum collection area is provided for the EA fluids are collected in a patient. safe and hygienic way. There are documented, 3.6 Flyers, pamphlets and posters are available EA disseminated and for further information about TB. implemented procedures to identify and address the risks of contamination of staff and patients from sources of infectious diseases. OVERALL RATING AND COMMENTS, COMMENDATIONS AND RECOMMENDATIONS BY SURVEY TEAM (To be completed by survey team only. The survey team must make comments on items where the survey team disagrees or partially disagrees with information provided by the TB DOTS center.) Goal: The TB DOTS Center provides a safe and effective physical environment to its staff and patients. Standard 3: The TB DOTS center provides for the safety of its patients and staff.

Rating (please tick appropriate overall rating for this standard)

NonAchievement

Low Achievement

Moderate Achievement

Extensive Achievement

*Rating scale: 1. Non Achievement - The requirements of standard / criterion are not met. 2. Low Achievement - The requirements of standard / criterion are scarcely met 3. Moderate Achievement - The requirements of the standard / criterion are generally met in most circumstances. 4. Extensive Achievement - The requirements of the standard / criterion are fully met in the majority of circumstances and have been for some time.

The PhilCAT Certification Self-assessment and Survey Tool

PhilCAT CERTIFICATION STANDARDS Survey Criterion Evidence of Progress and Achievements Item (Completed by TB DOTS Center)

DOTS Surveyors' Comments Survey Center Team Rating* Rating* Patients receive adequate and effective diagnostic and therapeutic services at every phase of their management from screening for TB to Goal rehabilitation. 4. Proper assessment is done by the physician EA All patients undergo a and health education is provided to the comprehensive patient. assessment to facilitate the planning and delivery of treatment. This standard will be achieved when: 4.1 EA Appropriate professionals Staffs documented the relevant information regarding patients health. obtain and document the relevant history for each patient. 4.2 The patient will undergo assessment by the EA A physician completes physician. and documents the relevant physical examination for each patient.

*Rating scale: 1. Non Achievement - The requirements of standard / criterion are not met. 2. Low Achievement - The requirements of standard / criterion are scarcely met 3. Moderate Achievement - The requirements of the standard / criterion are generally met in most circumstances. 4. Extensive Achievement - The requirements of the standard / criterion are fully met in the majority of circumstances and have been for some time.

The PhilCAT Certification Self-assessment and Survey Tool

OVERALL RATING AND COMMENTS, COMMENDATIONS AND RECOMMENDATIONS BY SURVEY TEAM (To be completed by survey team only. The survey team must make comments on items where the survey team disagrees or partially disagrees with information provided by the TB DOTS center.) Goal: Patients receive adequate and effective diagnostic and therapeutic services at every phase of their management from screening for TB to rehabilitation. Standard 4: Patients receive adequate and effective diagnostic and therapeutic services at every phase of their management from screening for TB to rehabilitation.

Rating (please tick appropriate overall rating for this standard)

NonAchievement

Low Achievement

Moderate Achievement

Extensive Achievement

*Rating scale: 1. Non Achievement - The requirements of standard / criterion are not met. 2. Low Achievement - The requirements of standard / criterion are scarcely met 3. Moderate Achievement - The requirements of the standard / criterion are generally met in most circumstances. 4. Extensive Achievement - The requirements of the standard / criterion are fully met in the majority of circumstances and have been for some time.

The PhilCAT Certification Self-assessment and Survey Tool

PhilCAT CERTIFICATION STANDARDS Survey Criterion Evidence of Progress and Achievements Item (Completed by TB DOTS Center)

DOTS Surveyors' Comments Survey Center Team Rating* Rating* Patients receive adequate and effective diagnostic and therapeutic services at every phase of their management from screening for TB to Goal: rehabilitation. Laboratory with qualified and trained EA 5. All patients have microscopists are available for diagnostic continuous access to accurate and reliable TB purposes. diagnostic tests. This standard will be achieved when: All patients undergo 5.1 Qualified and trained microscopists are EA sputum microscopy by a available to examine the sputum collected. qualified and trained microscopist. Procedures are being followed to ensure EA 5.1.1 The TB DOTS reliable results. center plans and implements policies and procedures for assuring the quality of sputum microscopy results. Laboratory is available for the examination EA 5.1.2 If sputum of the sputum. microscopy facilities are not available in the TB DOTS center, policies and procedures for referring patients to accessible centers are implemented and monitored for effectiveness.
*Rating scale: 1. Non Achievement - The requirements of standard / criterion are not met. 2. Low Achievement - The requirements of standard / criterion are scarcely met 3. Moderate Achievement - The requirements of the standard / criterion are generally met in most circumstances. 4. Extensive Achievement - The requirements of the standard / criterion are fully met in the majority of circumstances and have been for some time.

The PhilCAT Certification Self-assessment and Survey Tool

PhilCAT CERTIFICATION STANDARDS Survey Criterion Evidence of Progress and Achievements Item (Completed by TB DOTS Center) 5.1.3 External providers of sputum microscopy are contracted based on policies and procedures that include accreditation status and the presence of quality control systems. 5.2 Policies and procedures for referring patients to accredited and accessible X-ray facilities are implemented and monitored for effectiveness. Policies and procedures for referring patients to an appropriately constituted and accessible TB Diagnostic Committee are implemented and monitored for effectiveness. Laboratory results are being sent to the

DOTS Center Rating* EA

Surveyors' Comments

Survey Team Rating*

Patients for X-ray examination are being referred to accredited X-ray facilities such as NOPH. Correct procedures and policies are being followed.

EA

5.3

Proper procedure in referring patients to accessible TB Diagnostic Committee is being observed.

EA

*Rating scale: 1. Non Achievement - The requirements of standard / criterion are not met. 2. Low Achievement - The requirements of standard / criterion are scarcely met 3. Moderate Achievement - The requirements of the standard / criterion are generally met in most circumstances. 4. Extensive Achievement - The requirements of the standard / criterion are fully met in the majority of circumstances and have been for some time.

10

The PhilCAT Certification Self-assessment and Survey Tool

OVERALL RATING AND COMMENTS, COMMENDATIONS AND RECOMMENDATIONS BY SURVEY TEAM (To be completed by survey team only. The survey team must make comments on items where the survey team disagrees or partially disagrees with information provided by the TB DOTS center.) Goal: Patients receive adequate and effective diagnostic and therapeutic services at every phase of their management from screening for TB to rehabilitation. Standard 5: All patients have continuous access to accurate and reliable TB diagnostic tests.

Rating (please tick appropriate overall rating for this standard)

NonAchievement

Low Achievement

Moderate Achievement

Extensive Achievement

*Rating scale: 1. Non Achievement - The requirements of standard / criterion are not met. 2. Low Achievement - The requirements of standard / criterion are scarcely met 3. Moderate Achievement - The requirements of the standard / criterion are generally met in most circumstances. 4. Extensive Achievement - The requirements of the standard / criterion are fully met in the majority of circumstances and have been for some time.

11

The PhilCAT Certification Self-assessment and Survey Tool

PhilCAT CERTIFICATION STANDARDS Survey Criterion Evidence of Progress and Achievements Item (Completed by TB DOTS Center)

Survey Team Rating* Goal Patients receive adequate and effective diagnostic and therapeutic services at every phase of their management from screening for TB to rehabilitation. EA 6. A care plan is developed Treatment that is being implemented is according to the National TB program and and followed for all these are documented properly. patients. This standard will be achieved when: 6.1 All treatment is consistent National Tuberculosis Programs treatment is EA with the National strictly followed. Tuberculosis Program guidelines. 6.2 Flow charts of patient Flow chart is being posted in order for the EA management from entry to patient to be aware of the treatment. separation are used to facilitate quality care and are accessible to patients and staff. 6.3 DOTS partners are There is an assigned DOTS partner in each EA selected and assigned TB patient. These DOTS partner ensures that based on predetermined the patient will follow the treatment regimen. criteria and procedures and these are accessible to patients and staff.

DOTS Center Rating*

Surveyors' Comments

*Rating scale: 1. Non Achievement - The requirements of standard / criterion are not met. 2. Low Achievement - The requirements of standard / criterion are scarcely met 3. Moderate Achievement - The requirements of the standard / criterion are generally met in most circumstances. 4. Extensive Achievement - The requirements of the standard / criterion are fully met in the majority of circumstances and have been for some time.

12

The PhilCAT Certification Self-assessment and Survey Tool

PhilCAT CERTIFICATION STANDARDS Survey Criterion Evidence of Progress and Achievements Item (Completed by TB DOTS Center) 6.4 Education is provided to all patients to help them understand their medical condition and prognosis and to encourage their adherence to the treatment regimen and health promotion / illness prevention activities. An appropriately comprehensive evaluation of the patient's clinical progress is made and documented at each visit. Policies and procedures for detecting treatment defaulters and getting them back into treatment are implemented and monitored for effectiveness. Health teachings are provided by the staff to further help the patient enhance his/her knowledge regarding the nature of the disease and how it can be cured.

DOTS Center Rating* EA

Surveyors' Comments

Survey Team Rating*

6.5

Follow up visits and check ups are being done to evaluate the patients progress. Proper documentation is observed.

EA

6.6

Based on the records (TB registry), no defaulters have been documented.

EA

*Rating scale: 1. Non Achievement - The requirements of standard / criterion are not met. 2. Low Achievement - The requirements of standard / criterion are scarcely met 3. Moderate Achievement - The requirements of the standard / criterion are generally met in most circumstances. 4. Extensive Achievement - The requirements of the standard / criterion are fully met in the majority of circumstances and have been for some time.

13

The PhilCAT Certification Self-assessment and Survey Tool

OVERALL RATING AND COMMENTS, COMMENDATIONS AND RECOMMENDATIONS BY SURVEY TEAM (To be completed by survey team only. The survey team must make comments on items where the survey team disagrees or partially disagrees with information provided by the TB DOTS center.) Goal: Patients receive adequate and effective diagnostic and therapeutic services at every phase of their management from screening for TB to rehabilitation. Standard 6: A care plan is developed and followed for all patients.

Rating (please tick appropriate overall rating for this standard)

NonAchievement

Low Achievement

Moderate Achievement

Extensive Achievement

*Rating scale: 1. Non Achievement - The requirements of standard / criterion are not met. 2. Low Achievement - The requirements of standard / criterion are scarcely met 3. Moderate Achievement - The requirements of the standard / criterion are generally met in most circumstances. 4. Extensive Achievement - The requirements of the standard / criterion are fully met in the majority of circumstances and have been for some time.

14

The PhilCAT Certification Self-assessment and Survey Tool

PhilCAT CERTIFICATION STANDARDS Survey Criterion Evidence of Progress and Achievements Item (Completed by TB DOTS Center)

Survey Team Rating* Goal Patients receive adequate and effective diagnostic and therapeutic services at every phase of their management from screening for TB to rehabilitation. 7 EA Patients have continuous TB drugs are being monitored and stored properly for safety administration. access to safe and effective anti-TB medications throughout the duration of their treatment. This standard will be achieved when: 7.1 The TB DOTS Center has Inventory report of the TB drugs is EA developed and documented to assure that there is a implemented policies and continuous supply. procedures for assuring a continuous supply of TB drugs to all its patients for the entire six months duration of therapy. 7.2 The TB DOTS center Buffer stock of anti-TB drugs is always EA maintains an appropriate monitored to ensure there is always an buffer stock of anti-TB available stock. medications. 7.3 The TB DOTS Center has Drugs are properly stored and are being EA developed and checked for their expiration date. implemented policies and procedures for assuring the quality and safety of its TB drugs.
*Rating scale: 1. Non Achievement - The requirements of standard / criterion are not met. 2. Low Achievement - The requirements of standard / criterion are scarcely met 3. Moderate Achievement - The requirements of the standard / criterion are generally met in most circumstances. 4. Extensive Achievement - The requirements of the standard / criterion are fully met in the majority of circumstances and have been for some time.

DOTS Center Rating*

Surveyors' Comments

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The PhilCAT Certification Self-assessment and Survey Tool

OVERALL RATING AND COMMENTS, COMMENDATIONS AND RECOMMENDATIONS BY SURVEY TEAM (To be completed by survey team only. The survey team must make comments on items where the survey team disagrees or partially disagrees with information provided by the TB DOTS center.) Goal: Patients receive adequate and effective diagnostic and therapeutic services at every phase of their management from screening for TB to rehabilitation. Standard 7: Patients have continuous access to safe and effective anti-TB medications throughout the duration of their treatment.

Rating (please tick appropriate overall rating for this standard)

NonAchievement

Low Achievement

Moderate Achievement

Extensive Achievement

*Rating scale: 1. Non Achievement - The requirements of standard / criterion are not met. 2. Low Achievement - The requirements of standard / criterion are scarcely met 3. Moderate Achievement - The requirements of the standard / criterion are generally met in most circumstances. 4. Extensive Achievement - The requirements of the standard / criterion are fully met in the majority of circumstances and have been for some time.

16

The PhilCAT Certification Self-assessment and Survey Tool

PhilCAT CERTIFICATION STANDARDS Survey Criterion Evidence of Progress and Achievements Item (Completed by TB DOTS Center)

Survey Team Rating* Goal The management and staff adhere to clear and collaboratively developed policies and procedures for the efficient operation of the TB DOTS center. 8. Vision, mission, policies and procedures are EA Policies and procedures being developed and are followed so that the for providing care to staffs will be guided. patients are developed, disseminated, implemented and monitored for effectiveness. This standard will be achieved when: 8.1 The TB DOTS center's Staffs are aware of the vision and mission. EA policies and procedures These are implemented and being followed. are consistent with the organization's goals, statutory requirements, accepted standards, and the TB DOTS center's community responsibilities. 8.2 Policies and procedures Proper referral is being implemented. List of EA for patient referral to other referral centers, addresses and contact services are implemented persons is available. and monitored for effectiveness.

DOTS Center Rating*

Surveyors' Comments

*Rating scale: 1. Non Achievement - The requirements of standard / criterion are not met. 2. Low Achievement - The requirements of standard / criterion are scarcely met 3. Moderate Achievement - The requirements of the standard / criterion are generally met in most circumstances. 4. Extensive Achievement - The requirements of the standard / criterion are fully met in the majority of circumstances and have been for some time.

17

The PhilCAT Certification Self-assessment and Survey Tool

PhilCAT CERTIFICATION STANDARDS Survey Survey Item Survey Item Item 8.3 Patient default rates are No defaulters are being reported yet. But in monitored and policies and case there is, it will be documented. procedures are developed and implemented to improve default rates. The policies and procedures are monitored for effectiveness. 8.4 Policies and procedures are observed so that Policies and procedures each external group are aware of their roles for identifying and and responsibilities. working with external groups in providing DOTS services are developed, implemented and monitored for effectiveness.

Survey Item EA

Survey Item

Survey Item

EA

*Rating scale: 1. Non Achievement - The requirements of standard / criterion are not met. 2. Low Achievement - The requirements of standard / criterion are scarcely met 3. Moderate Achievement - The requirements of the standard / criterion are generally met in most circumstances. 4. Extensive Achievement - The requirements of the standard / criterion are fully met in the majority of circumstances and have been for some time.

18

The PhilCAT Certification Self-assessment and Survey Tool

OVERALL RATING AND COMMENTS, COMMENDATIONS AND RECOMMENDATIONS BY SURVEY TEAM (To be completed by survey team only. The survey team must make comments on items where the survey team disagrees or partially disagrees with information provided by the TB DOTS center.) Goal: The management and staff adhere to clear and collaboratively developed policies and procedures for the efficient operation of the TB DOTS center. Standard 8: Policies and procedures for providing care to patients are developed, disseminated, implemented and monitored for effectiveness.

Rating (please tick appropriate overall rating for this standard)

NonAchievement

Low Achievement

Moderate Achievement

Extensive Achievement

*Rating scale: 1. Non Achievement - The requirements of standard / criterion are not met. 2. Low Achievement - The requirements of standard / criterion are scarcely met 3. Moderate Achievement - The requirements of the standard / criterion are generally met in most circumstances. 4. Extensive Achievement - The requirements of the standard / criterion are fully met in the majority of circumstances and have been for some time.

19

The PhilCAT Certification Self-assessment and Survey Tool

PhilCAT CERTIFICATION STANDARDS Survey Criterion Evidence of Progress and Achievements Item (Completed by TB DOTS Center)

Survey Team Rating* Goal The management and staff adhere to clear and collaboratively developed policies and procedures for the efficient operation of the TB DOTS center. Records and reports were handled properly EA 9. Policies and procedures and securely to ensure consistency of the for managing patient information. information are developed, disseminated, implemented and monitored for effectiveness. This standard will be achieved when: 9.1 Each patient has a case number which is EA Each patient is uniquely being recorded in the TB registry logbook. identified from entry and The case number is consistent with NTP throughout the course of treatment card and all related documents. management. 9.2 The TB DOTS center maintains a database of patient records and related registries and enables the staff to easily access these databases. Policies and procedures for ensuring the security and confidentiality of patient information are developed, implemented and monitored for effectiveness. NTP forms are recorded properly, filled up correctly and is being updated with consistency. EA

DOTS Center Rating*

Surveyors' Comments

9.3

Records and reports are handled with confidentiality and only authorized personnel are allowed to access.

EA

*Rating scale: 1. Non Achievement - The requirements of standard / criterion are not met. 2. Low Achievement - The requirements of standard / criterion are scarcely met 3. Moderate Achievement - The requirements of the standard / criterion are generally met in most circumstances. 4. Extensive Achievement - The requirements of the standard / criterion are fully met in the majority of circumstances and have been for some time.

20

The PhilCAT Certification Self-assessment and Survey Tool

PhilCAT CERTIFICATION STANDARDS Survey Criterion Evidence of Progress and Achievements Item (Completed by TB DOTS Center) 9.4 The TB DOTS center submits complete and accurate reports to all relevant agencies in a timely manner. The TB DOTS center regularly reviews its records to assess and improve performance. All the reports are submitted on time. The staffs are aware of the deadlines.

DOTS Center Rating* EA

Surveyors' Comments

Survey Team Rating*

9.5

Staffs conduct meeting to improve and review center performance.

EA

*Rating scale: 1. Non Achievement - The requirements of standard / criterion are not met. 2. Low Achievement - The requirements of standard / criterion are scarcely met 3. Moderate Achievement - The requirements of the standard / criterion are generally met in most circumstances. 4. Extensive Achievement - The requirements of the standard / criterion are fully met in the majority of circumstances and have been for some time.

21

The PhilCAT Certification Self-assessment and Survey Tool

OVERALL RATING AND COMMENTS, COMMENDATIONS AND RECOMMENDATIONS BY SURVEY TEAM (To be completed by survey team only. The survey team must make comments on items where the survey team disagrees or partially disagrees with information provided by the TB DOTS center.) Goal: The management and staff adhere to clear and collaboratively developed policies and procedures for the efficient operation of the TB DOTS center. Standard 9: Policies and procedures for managing patient information are developed, disseminated, implemented and monitored for effectiveness.

Rating (please tick appropriate overall rating for this standard)

NonAchievement

Low Achievement

Moderate Achievement

Extensive Achievement

*Rating scale: 1. Non Achievement - The requirements of standard / criterion are not met. 2. Low Achievement - The requirements of standard / criterion are scarcely met 3. Moderate Achievement - The requirements of the standard / criterion are generally met in most circumstances. 4. Extensive Achievement - The requirements of the standard / criterion are fully met in the majority of circumstances and have been for some time.

22

The PhilCAT Certification Self-assessment and Survey Tool

PhilCAT CERTIFICATION STANDARDS Survey Criterion Evidence of Progress and Achievements Item (Completed by TB DOTS Center) Goal 10.

DOTS Center Rating*

Surveyors' Comments

Survey Team Rating*

The TB DOTS center staff provide efficient and competent DOTS services. Staffs undergo trainings and seminars to EA The TB DOTS Center provide quality care to TB patients. has an adequate number of qualified personnel skilled in providing DOTS services.

This standard will be achieved when: 10.1 An adequate number of qualified and appropriately trained personnel provide and are accountable for the following functions: 10.1.1 Leadership, management and overall responsibility for the operations, resources and performance of the TB DOTS center 10.1.2 Clinical patient care services 10.1.3 Diagnostic services, including sputum microscopy 10.1.4 Drug management

The center is equipped of well trained staff (physicians, nurse, midwives and microscopist).

EA

City Health Officer is available for leadership management of the center.

EA

Nurses are capable of providing care to the patient. Trained medical technologist is capable of performing diagnostic services. Staffs instruct patients in drug administration

EA EA

EA

*Rating scale: 1. Non Achievement - The requirements of standard / criterion are not met. 2. Low Achievement - The requirements of standard / criterion are scarcely met 3. Moderate Achievement - The requirements of the standard / criterion are generally met in most circumstances. 4. Extensive Achievement - The requirements of the standard / criterion are fully met in the majority of circumstances and have been for some time.

23

The PhilCAT Certification Self-assessment and Survey Tool

PhilCAT CERTIFICATION STANDARDS Survey Criterion Evidence of Progress and Achievements Item (Completed by TB DOTS Center) and DOTS partner as well as in monitoring patients compliance. Staffs observe confidentiality of patients record. Staffs do have monthly salary for their services. A written job description is being signed by each staffs.

DOTS Center Rating*

Surveyors' Comments

Survey Team Rating*

10.1.5 Information management 10.1.6 Financial management 10.2 Personnel follow clear job descriptions, responsibilities and accountabilities. All personnel are responsible for safety in the workplace and the quality of the service they deliver. Personnel receive up to date training based on training needs assessment.

EA EA EA

10.3

Staffs are aware and follow procedure in infection control.

EA

10.4

Certificates are available as proof of the training and seminars joined by the staff.

EA

*Rating scale: 1. Non Achievement - The requirements of standard / criterion are not met. 2. Low Achievement - The requirements of standard / criterion are scarcely met 3. Moderate Achievement - The requirements of the standard / criterion are generally met in most circumstances. 4. Extensive Achievement - The requirements of the standard / criterion are fully met in the majority of circumstances and have been for some time.

24

The PhilCAT Certification Self-assessment and Survey Tool

OVERALL RATING AND COMMENTS, COMMENDATIONS AND RECOMMENDATIONS BY SURVEY TEAM (To be completed by survey team only. The survey team must make comments on items where the survey team disagrees or partially disagrees with information provided by the TB DOTS center.) Goal: The TB DOTS center staff provide efficient and competent DOTS services. Standard 10: The TB DOTS Center has an adequate number of qualified personnel skilled in providing DOTS services.

Rating (please tick appropriate overall rating for this standard)

NonAchievement

Low Achievement

Moderate Achievement

Extensive Achievement

*Rating scale: 1. Non Achievement - The requirements of standard / criterion are not met. 2. Low Achievement - The requirements of standard / criterion are scarcely met 3. Moderate Achievement - The requirements of the standard / criterion are generally met in most circumstances. 4. Extensive Achievement - The requirements of the standard / criterion are fully met in the majority of circumstances and have been for some time.

25