USAID VMEP IP ACTIVITY SITE VISIT MONITORING REPORT

Sector(s) Implementing Partner Activity Location Name Key Visit ID

Hospital General Mpal. Santa Santa Teresa del Tuy - Hospital General Mpal. Santa Teresita de
Health RET
Teresita de Jesús Jesús - 2022-05-23
Date of Interview Municipality State GPS Coordinates
05/23/2022 Independencia Miranda 10.235217, -66.666557
Date of Last Visit No. of Previous Visits Comment
NA NA NA
Site Program Description
Hospital General Municipal Santa Teresita de Jesús is a hospital that provides primary health care services including, among others, adult and pediatric
emergencies, general medicine, pediatrics, vaccination, and gynecology. The Hospital has a pediatric emergency room on the ground floor and the adult emergency
room upstairs. RET activities at the site included the implementation of minor restoration, repair or substitution of water connections, pumps, tanks, and small parts
necessary to ensure the operation of water services. Additionally, as part of the program activities at this site, the project delivers training for mothers with children
under 6 months on exclusive breastfeeding and its importance in the proper nutrition of children and education for mothers with children (6 and 24 months) on the
need to change eating habits. To complement the actions of the health sector, the program supports the provision of medicines (pharmaceuticals), medical
equipment (durable), and medical supplies (consumables) to primary care health centers.
IP Grant Agreement Verified during the Site Visit
Sectors Subsectors
Health þ Health systems support ¨ Primary health care þ Pharmaceutical and medical commodities

WASH ¨ Hygiene promotion ¨ Water supply þ Sanitation ¨ Environmental health ¨ WASH non-food items (NFIs)

Methodology/Approach
On May 23, 2022, VMEP monitored the RET site in Independencia, Miranda state. A field team of 1 enumerator,1 TPM team lead, and 1 TPM national coordinator
conducted the site visit. The team collected quantitative data from beneficiaries that attended the health care facility during the day of the visit, two health care
staff, an IP point of contact; collected qualitative data from a community health promoter, observed the health care facility using a checklist tool and tested the
quality of water with a chlorine water test. The field team selected beneficiaries consecutively after they attended the consultation or breastfeeding workshops and
applied purposive sampling for the staff and IP point of contact.
Sample by Respondent Group
Sex of Respondent
Monitoring Tools Respondent Group Direct Observation
Male Female
[x] Beneficiaries (patient) Beneficiaries (patients) 1 19 NA
1
survey Health care staff 0 2 NA
[x] Health care staff survey IP point of contact 0 1 NA
[x] IP point of contact survey
[x] Community health promoter Community health promoter 0 1 NA
interview Direct site observation NA NA 1
[x] Direct site observation Water test NA NA 1
[x] Water test
Total 1 23 2
Summary of Findings
 This hospital provides primary health care 7 days per week and 24 hours per day. This primary assistance is complemented with the provision of medicines
(pharmaceuticals), medical equipment (durable), and medical supplies and WASH activities (water infrastructure and sanitation infrastructure).
 The community health worker carries out educational sessions, identification of cases that require intervention from the medical team, and accompanies the
basic health team.
 The main purposes for which the beneficiaries visited the health care facility are emergency services (60%) and pediatrics (35%).
 Although most beneficiaries are satisfied with the services received (65%), 35% beneficiaries report being somewhat dissatisfied or dissatisfied because there
are no medicines available, laboratory service is not provided, and because of the long waiting times. Subsequently, 45% beneficiaries had to wait more than
120 minutes to receive attention at the health care facility.
 Program staff, including the IP point of contact, have been trained in humanitarian principles, SEA, and Do No Harm.
 Staff members and community health promoter reported being satisfied with the training received.
 The health care staff has received personal protective elements. The monitor could verify the staff was wearing PPE at all times and that the IP delivered
medical supplies such as masks, gloves, boot covers, gowns, etc.
 The program carries out orientation or messaging activities on breastfeeding and/or nutrition to new mothers that attended the health care facility for childbirth.
 All beneficiaries interviewed confirmed that no one ever asked them for anything in exchange for receiving assistance in the health care facility.
 A few beneficiaries feel unsafe while waiting services (10%) and while receiving health services at the health care facility (5%).
 Monitors observed the health care facility is accessible to people with disabilities (flat site, no stairs, or has ramps, signs, safe walking paths, or handrails) and
there are adaptations to provide access to people with disabilities (priority in the attention).
 The health care facility has functional toilets for patient use but it does not have functional handwashing stations with soap or other cleaning products.
 The chlorine water test performed showed the water is not treated (chlorine level was 0.0mg/L).
 Beneficiaries and staff members do not know the channels to make complaints or feedback about the services. There were no posters or suggestion box at the
health facility, but staff was available to answer questions or provide information.
Potentially Adverse Programmatic Findings/Observations
Monitoring
# Theme Topic Flag Description Question ID
tool
1 Protection Safety Beneficiary 10% Two people reported feeling unsafe while waiting for services pp_na_b_safe_wait
survey 5% at the HCF. Among these, one also mentioned feeling unsafe pp_na_b_safe_attention
while being attended. The reasons they provided is that, even
2
 they have not been affected by any negative event, the
location where HCF is located is very unsafe. They have to
arrive very early [when it is still dark outside] to get on the
line to wait to be attended, and they must wait outside of the
facility.
Two beneficiaries reported not being treated with dignity and
Dignity and Beneficiary respect. They explained this is because they had to wait a
2 Protection 10% pp_na_b_respect
respect survey long time before being attended to, and because other people
were called in before them for consultation.
Precautions One beneficiary reported that doctor/nurse did not take
Beneficiary
3 COVID-19 by doctor or 5% precautions to protect from COVID-19. cv_na_b_caution
survey
nurse
Delivery Beneficiary Beneficiaries wait more than 120 minutes for services at the
4 Wait time 45% de_na_b_time_attention
effectiveness survey health care facility.
Beneficiary Beneficiaries do not know how to report a complaint about
95% cf_na_b_cfm_aware
survey the services received.
Complaints The health care staff members interviewed do not know how
Knowledge
5 and Feedback Staff survey NA to make a complaint related to the activities that are being cf_na_s_cfmstaff
of CFM
Mechanism implemented at the facility.
Direct At the health care facility, there are no posters or leaflets with
NA cf_na_m_poster
observation information of Complaints and Feedback Mechanisms.
Beneficiary Beneficiaries report not having access to functional
65% vf_w_b_hndwsh_station
WASH survey handwashing stations at the health care facility.
6 WASH
infrastructure Direct The health care facility does not have functional handwashing vf_w_m_hndwashs_st_p
NA
observation units with soap/antibacterial for patient use. a
*Note: N/A corresponds to questions from the IP POC survey, qualitative interviews, and site observation checklist where there is only one or two respondent/observations.

Findings by Theme

This section reports key monitoring findings by theme for each assistance sector, forming the basis for analysis. Additionally, VMEP reports on how the COVID-19
pandemic affects the implementation of humanitarian assistance. The seven (7) themes are highlighted below.

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 # Themes Definition
1. Activity verification Seeks to determine whether the IP is providing the assistance goods and services as specified in the award and whether the IP is delivering
the assistance at the committed time. Answers questions that are factual, making it possible to prove/disprove them.
2. Relevance of assistance Seeks to determine whether assistance goods and services are "relevant" to [or needed by] the recipients. Relevance refers to the
appropriateness of the provided goods and services. Recipients include the beneficiaries as well as volunteers, community members, and
others who are part of the assistance delivery chain. Answer opinion or perception-type questions and are generally not provable or
disprovable.
3. Delivery effectiveness Seeks to determine whether the correct recipient population is targeted and the quality of the assistance (i.e., meeting a standard).
Effectiveness responses are generally factual, although some may be perceptual.
4. Access to assistance goods Seeks to determine whether recipients can gain access to the assistance. Access responses may be factual or perceptual.
and services
5. Availability of complaints Seeks to determine whether IP feedback or complaint mechanisms exist, if recipients know about these mechanisms, if these are used and
and feedback mechanisms whether feedback results in any IP response or action. Responses may be factual or perceptual.
6. Protection Seeks to identify safety or security issues associated with IP implementation. Responses may be factual or perceptual.

7. COVID-19 This section reports on how the COVID-19 pandemic is affecting the implementation of humanitarian assistance in targeted locations.

The analysis of most themes includes the perspectives of the beneficiaries and the IP point of contact, which is complemented with information gathered through
direct observation. Findings include a reference of the information source – the question codes analyzed – in the last column.

Thematic Findings of Health (Primary Sector)

Activity Verification (Fidelity)
Beneficiaries (patients)
Reported the purpose of the visit to the health care facility was:
60% - Emergency services vf_h_b_purp_emergency
Visit Purpose
35% - Pediatrics vf_h_b_purp_pedriatrics
5% - Gynecology vf_h_b_purp_other
Referrals 10% Beneficiaries were referred to another facility. vf_h_b_referred
Participation in
breastfeeding/nutrition 10% Beneficiaries participated in an activity to promote breastfeeding and nutrition. vf_fa_b_workshop
workshops
Nutrition practices Beneficiaries that participated in the nutrition workshops (n=2) report the following
promoted topics were covered:

4
 100% - Benefits of breastfeeding vf_h_b_breastfeeding
100% - Breastfeeding techniques vf_h_b_tech_bfeeding
50% - Common problems or situations during breastfeeding vf_h_b_problem_bfeeding
100% - Hygiene during lactation vf_h_b_hygiene_bfedding
50% - Management of expressed breast milk vf_h_b_milk_bfeeding
100% - Complementary feeding after 6 months of age vf_h_b_complemfeed
50% - Disadvantages of formula milk vf_h_b_formula
50% - Myths and false beliefs about breastfeeding vf_h_b_myths_bfeeding
Health care staff

The staff members interviewed reported the health care facility provides the following services:
vf_h_s_emergency
- Emergency services
vf_h_s_maternal
- Maternal and child health services
vf_h_s_repodhealth
- Sexual and reproductive health
vf_h_s_phrmcy
- Pharmacy
vf_h_s_lab
- Laboratory services
vf_h_s_odont
- Odontology
vf_h_s_comdisease
Heath services provided - Screening/treatment of communicable diseases (diarrhea, acute respiratory infections)
vf_h_s_vbdisease
- Screening/treatment of VBD (dengue, malaria, zika, chikunguña) vf_h_s_nocomdisease
- Screening/treatment of non-communicable diseases (asthma, diabetes, etc.) vf_h_s_covid_19
- Screening/treatment of COVID-19 vf_h_s_envirohealth
- Environmental health and community health promotion

One out of two staff interviewed reported the health care facility provides the following services:
- Mental health and psychosocial counseling vf_h_s_psycho
Health care staff has been trained in the following themes related to his(her) job/duties: vf_h_s_training
- Care for people with disabilities vf_h_s_disab_tr15
- Differentiated care for adolescents vf_h_s_adoles_tr15
- Non-communicable diseases (diabetes, high blood pressure, cancer). vf_h_s_noncom_tr15
- Management of post-rape kits vf_h_s_postrape_tr15
Training - Workplace accident management vf_h_s_workacci_tr15
- Emergency medicine vf_h_s_emerg_tr15
- Communicable diseases (measles, diphtheria, malaria, tuberculosis) vf_h_s_commun_tr15
- Clinical protocols for comprehensive care for adolescents vf_h_s_clinical_tr15
- Maternal and child health vf_h_s_maternal_tr15
- Violence vf_h_s_violence_tr15
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 Staff member reports the health care facility refers patients in need of additional treatment to
Referrals vf_h_s_referral
other facilities.
Staff members interviewed have received personal protective elements to do their work at the
vf_na_s_ppe
Protective elements health care facility. The personal protective elements they received include face masks,
vf_na_s_ppe_desc
protective glasses, caps, gloves, surgical gowns, and surgical kits.
Supplies and One staff member reports having access to the necessary supplies and pharmaceuticals to treat
pharmaceuticals for health patients at this facility. The other staff members reported that because of the large number of vf_h_s_supplies
attention patients the medicines are not enough.
Community health promoter
The community health promoter reports that she conducts educational sessions, identification of
cases that require intervention from the medical team, and accompanies the basic health team in
vaccination activities, school hygiene, and care for social cases both within the hospital facilities
Heath services provided and in the homes of the families. These activities take place once a month. CHW interview

The community health worker reports she also carries out VBD prevention, COVID-19
prevention, and child abuse prevention workshops or activities in the communities.
The project has trained the community health worker in common childhood illnesses, COVID-
Training CHW interview
19, gender-based violence, among others.
IP point of contact
The IP supports the following services/activities at this health care facility: vf_h_i_emergency
- Emergency service vf_h_i_maternal
- Maternal and child health services vf_h_i_repodhealth
- Sexual and reproductive health vf_h_i_phrmcy
- Pharmacy and provision of essential medicines vf_h_i_lab
- Laboratory service vf_h_i_comdisease
- Screening/treatment of communicable diseases (diarrhea, acute respiratory infections) vf_h_i_vbdisease
Health care services - Screening/treatment of VBD (dengue, malaria, zika, chikungunya) vf_h_i_nocomdisease
supported - Screening/treatment of non-communicable diseases (asthma, diabetes, etc.) vf_h_i_psycho
- Mental health and psychosocial counseling vf_h_i_malnutrit_scre
- Screening and treating of malnutrition vf_h_i_malnutrit_treat
- Environmental health and community health promotion vf_h_i_envirohealth
- Infrastructure improvements include total and partial rehabilitation of eight hospital sanitary vf_h_i_infrastructure
rooms (hardware, toilets, taps, ceramic cleaning, lighting, painting, bathroom divisions), vf_h_i_infrastructure_expl
floating drinking water tanks, and tank base.
- Provision of medical supplies vf_h_i_supplies

6
 The IP point of contact confirms the health care facility refers patients who need additional
Referrals vf_h_i_referral
treatment to other institutions.
The activities implemented in this health care facility are not carried out with the participation of vf_h_i_cluster
Health cluster
other health cluster institutions/organizations. vf_h_i_clusterperf
vf_na_i_training_hprincip
The implementer staff, including the IP point of contact interviewed, has been trained on
Staff training vf_na_i_training_sea
humanitarian principles, preventing sexual exploitation and abuse and Do No Harm approach.
vf_na_i_trainning_nharm
The program carries out orientation or messaging activities on breastfeeding and/or nutrition, in vf_h_i_nutri_act
Breastfeeding/nutrition particular training for mothers in exclusive breastfeeding and complementary feeding. The IP vf_h_i_nutri_act_type
promotion activities promotes the participation in these activities among the women that visited the health care vf_h_i_nutri_act_theme
facility for childbirth and prenatal consultation. vf_h_i_nutri_act_prom
Direct observation
co_na_m_days
Hours of operation The health care facility provides health services 7 days per week and 24 hours per day.
co_na_m_hours
vf_h_m_power
The health care facility has a functional power source. The main power source for the facility is
Power source vf_h_m_source
powerlines. The health care center does not have a backup generator.
vf_h_m_generator
Medicines and medical The monitor verified the health care facility had availability of the following medical supplies:
supplies - Mask, high filter, FFP2 / N95 / KN95, without valve vf_h_p_mask15
- Surgical gown (for surgeon), unsterilized, not knitted, disp, L vf_h_p_gown15
- Safety googles, side indirect ventilation vf_h_p_glasses15
- Surgical hairnet, bouffant, not knitted vf_h_p_cap15
- Boot covers, non-slip, elastic, pair vf_h_p_bootcover15
- Gloves, without dust, nitrile, L, disposable vf_h_p_gloves15
- Surgical mask, typeIIR, strap, disposable vf_h_p_quirmask15
The monitor verified the health care facility had availability of the following medicines or vf_h_m_k_9901023
medical supplies kits: vf_h_m_k_9901024
- IEHK2017 PEP Kit S9901023 (Contains drugs for emergency post-exposure prophylaxis of vf_h_m_k_9901029
human immunodeficiency virus) vf_h_m_k_9901030
- Kit IEHK2017 Kit Basic Unit (Interinstitutional Emergency Health Kit 2017, Basic Unit.
Contains essential drugs and medical devices (consumables and equipment) for a population

7
 of 1,000 for a period of three months.)
- Kit IEHK2017 supplementary module 2 (contains essential medical equipment (e.g. basic
diagnostic and sterilization equipment, medical utensils, minor surgical instruments sets for a
population of 1000 for a period of three months.)
- Kit IEHK2017 supplementary module 3 (Contains medical renewable material for a
population of 1000 for a period of three months).
The health facility has communication strategies promoting the prevention of Vector Borne
VBD prevention and vf_h_m_outreach_vbd
Diseases (VBDs) with information regarding vector control actions and rapid diagnostic tests for
testing vf_h_m_test_vbd
malaria, dengue, zika chikungunya testing in stock.
Breastfeeding/nutrition A breastfeeding/nutrition promotion activity was observed in real-time while the TPM team was
vf_h_m_nutri_workshop
promotion activity conducting the visit.
Relevance of Assistance
Beneficiaries (patients)
65% Beneficiaries are satisfied or somewhat satisfied with the services received at this
health care facility.
35% Beneficiaries are somewhat dissatisfied or dissatisfied with the services received.
ra_h_b_satisfied
These beneficiaries explain that they are dissatisfied because there are no medicines
available, the laboratory service is not provided and because of the long waiting
times, especially in providing service to children.
Satisfaction with services 100% Beneficiaries who participated in nutrition workshops are satisfied with the activity. ra_fa_b_satis_workshop
Beneficiaries would recommend family or friends to visit this health care facility for:
5% - General consultation ra_h_b_recom_general
50% - Emergency services ra_h_b_recom_emergency
5% - Laboratory services ra_h_b_recom_lab
20% - Pediatrics ra_h_b_recom_pediactrics
5% - Gynecology ra_h_b_recom_gynecology
Health care staff
Satisfaction with training The health facility staff are satisfied with the training received. ra_h_s_satisf_tr
Satisfaction with One of the health care facility staff reported being satisfied with the personal protective elements
ra_na_s_satif_ppe
protective elements received, the other one reported being somewhat satisfied with these elements.

8

Priority health issues
Future actions
Community health promoter
Priority health issues
Satisfaction with activities
and training
IP point of contact
Population needs
Priority health issues
Beneficiaries (patients)
Wait time
Diagnosis
1
“(…) Me siento bastante agradecida porque lo más beneficioso para mí es la educación, el conocimiento, el crecimiento y el ser capacitada. Por supuesto, eso me hace crecer como
profesional y como persona”.
The staff members report the priority health issues facing women, children, and vulnerable
served by this facility are:
- Hypertension
- Diabetes
ra_h_s_priorities
- Bronchial asthma
- Respiratory difficulties
- Surgical and obstetric emergencies
- Polytraumatism
One of the staff members reported the next actions/activities that could be carried out to give
continuity to this initiative/project is to enable an operating room, and to hire medical specialists ra_na_s_opinion
such as obstetricians and neonatologists.
The community health promoter reports that the priority health issues in the communities are
teenage pregnancy, the lack of medication for the elderly, and the lack of food in the households CHW interview
due to economic limitations.
The community health promoter is satisfied with the training received. “I feel quite grateful
because the most beneficial thing for me is education, knowledge, growth, and being trained. Of CHW interview
course, that makes me grow as a professional and as a person.”1
The current activities implemented in the health care facility respond to the population needs
ra_na_i_respond
when seeking health assistance.
The priority health issues facing women, children, and vulnerable served by this facility are
related to pediatrics (malnutrition, respiratory infections, diarrhea, fever), obstetrics (delivery ra_h_i_priorities
emergency), and adult emergency (diabetes, hypertension).
Delivery Effectiveness
45% Wait less than 30 minutes for services at the health care facility.
10% Wait between 30 and 60 minutes for services at the health care facility. de_na_b_time_attention
45% Wait more than 120 minutes for services at the health care facility.
45% Beneficiaries report that the health worker clearly explained the diagnosis. The de_h_b_diagnosis
9

Prescriptions
Child health services
(n=7, children assistances)
Change in nutrition
practices
Health care staff
Feedback on knowledge
application
Referrals
Community health promoter
Health services
IP point of contact
Vulnerable groups
Community interaction
Challenges to
2
“Muchas veces uno realiza los casos sociales, hace el informe, los manda a los entes competentes, pero la persona queda sin respuesta, entonces ahí viene la parte frustrante para uno,
porque uno considera entonces que no se hizo nada.”
beneficiaries that did not get a diagnosis explained the doctors prescribed medical
tests to complete the diagnosis.
Had medicines prescribed to them (or their child) by the health worker the day of the
55% de_h_b_presc
visit.
Of those that were prescribed (n=11) were not able to get the medicines at this health de_h_b_presc_get
82% care facility because the medicines were not available. The two beneficiaries that de_h_b_presc_no_get
were able to get the medicines at the facility did not have to pay for them. de_h_b_presc_pay
Of patients that sought assistance for a child, had their child weighed and measured
86% de_h_b_child_anthro
by the health worker.
Report that as a result of the nutrition workshops (n=2), they (or their family) have
0% de_h_b_change_workshop
changed their practices related to breast feeding or nutrition.
The implementing partner who trained the health care facility staff provided feedback on the way
de_h_s_training_followup
they apply the knowledge/practices acquired.
When patients in need of additional treatment are referred to other facilities, staff members keep
a record on a form or document and follow up on patients. The staff members explained that the
de_h_s_referral_regist
most serious cases are transferred by ambulance to other hospitals in the area. To follow up on
de_h_s_referral_follow_how
these cases, the staff contacts the medical center to which the patient was referred or directly by
phone with the patient.
The community health promoter reports that once she has identified cases through her interviews
with households and submits the report to the competent authorities, some cases remain CHW interview
unanswered and unfollowed, which is frustrating and feels like nothing was done.2
The IP point of contact reported an increase in the number of vulnerable people in the area
de_na_i_vulnerable
operations. The increase of vulnerable population has not affected the work of the person
de_na_i_vulnerable_afect
interviewed.
The program team meets with the community at the start of health assistance activities. The IP
de_na_i_reunion
point of contact has not faced any issues/incidents working with the local community members
de_na_i_incident
and leaders.
The implementing partner has not faced barriers to developing activities that support quality de_h_i_barriers
10
implementation health service delivery.
The IP has adapted the way activities are implemented in response to:
- Logistical issues by delaying the staff training process because there was no fuel available for de_na_i_logistica
the transport of the RET team to the Santa Teresa del Tuy area. de_na_i_logistica_expl
- Insecurity because of gang clashes in the city of Caracas in July 2021 that prevented the de_na_i_inseguridad
transport of the RET team to Santa Teresa del Tuy to start the implementation. de_na_i_inseguridad_expl
- The lack of pharmaceuticals has interfered with the completion of the project in the scheduled de_na_i_prod_basic
Program adaptation
times. There were delays in the arrival of supplies and medicines due to logistics and national de_na_i_prod_basic_expl
customs issues. de_h_i_medicalcom
- The lack of medical commodities caused the IP to implement educational and informative de_h_i_medicalcom_expl
talks for community health volunteers and professional staff such as nurses and paramedics to de_na_i_denial
offset the delay. de_na_i_funding
- The lack of funding delayed the completion of training. de_na_i_funding_expl
Direct observation
The health care facility has enough space for all the patients waiting (social distancing, no one
Waiting area de_h_m_waiting
sitting in the sun).
Medical waste is separated by type (infectious vs non-infectious) in the health care facility.
de_h_m_waste
Medical waste There is not a picture or illustration that describes appropriate waste disposal procedures.
de_h_m_waste_image
management The monitor observed the health care facility staff uses a sharps disposal box (e.g., for
de_h_m_sharp
hypodermic needles).
The health care facility has individual or separate consultation rooms to maintain privacy during
Consultation rooms de_h_m_consult_room
consultations.
de_h_m_workshop_time
de_h_m_lecture
The breastfeeding/nutrition activity took place in the postpartum room of the health care facility
de_h_m_discuss
with the participation of four women and lasted about 40 minutes. The methodologies used in the
de_h_m_participa
Breastfeeding/nutrition activity included lecture, group discussion, participatory activities, visual aids, demonstrations.
de_h_m_visual
promotion activity The session was interactive, with engaged participants asking questions and sharing comments
de_h_m_demos
and concerns. The IP team that implemented the activity had support material that they shared
de_h_m_interactive
with participants and were available to respond questions posed by the participants.
de_h_m_materials
de_h_m_guid_answer
Access to Assistance
Beneficiaries (patients)
Access to health care Reach the health care facility to receive assistance: aa_na_b_tiempo_desp

11
 75% - In less than 30 minutes
15% - Between 30 minutes to one hour
10% - Between one and two hours
Beneficiaries use the following means of transportation to the health care facility: aa_na_b_transp
65% - Public transportation
15% - Walking
facility 15% - Private vehicle (car or motorcycle)
5% - Other
Beneficiaries had difficulty accessing a means of transport to reach the health care
aa_na_b_transport
20% facility because of the limited availability of public transport (n=3) and the lack of
aa_na_b_transport_expl
money (n=1)
Beneficiaries faced logistical problems getting to the health care facility (lack of fuel aa_na_b_logisticos
15%
and limited transportation services). aa_na_b_logisticos_cuales
There were no beneficiaries with disabilities to report on accessibility to the health
Disability access 0% aa_na_b_dissability
care facility.
Community health promoter
The community health promoter reports the main issues when accessing the communities are
Access barriers related to insecurity (robbery or assault). To overcome this difficulty, they turn to community CHW interview
leaders to accompany them in the activities.
IP point of contact
The IP has identified people with disabilities among the beneficiaries and has protocols for them aa_na_i_benef_disability
to access the health care facility. The IP point of contact explained they carried out trainings with aa_na_i_disability_protocol
PASDIS personnel (Proceso de Atención integral en Salud para personas con Discapacidad) to
Disability access
refer people with disabilities to the care program. The objective of RET was to strengthen the
link between the community and these government entities, always including people with
disabilities in their group of community health volunteers.
Direct observation
aa_na_m_logistics
The field team did not observe any barriers that limit access to the distribution point, including
aa_na_m_burocr
logistical problems (lack of fuel, electricity, transport, communications, roads), bureaucratic or
aa_na_m_protests
Access barriers political restrictions, presence of government authorities interfering with or politicizing
aa_na_m_insecurity
distribution or claiming the benefits generated by the assistance provided, protests/riots, presence
aa_na_m_intimidate
of armed groups, or isolated distribution point.
aa_na_m_politiz
Access for vulnerable The program has strategies to serve vulnerable people. For pregnant women for example, they aa_na_m_access_vulnr

12
 have a route system to accompany them from the beginning of pregnancy until the end of it.
people Low-risk cases are treated in the health care facility and serious cases, depending on the aa_na_m_access_vulnr_expl
complexity, are transferred to other hospitals.
The health care facility is accessible (is it a flat site, no stairs or has ramps, signs, safe walking aa_na_m_disability_access
Disability access paths, handrails) and has adaptations to serve people with disabilities (priority in the attention aa_na_m_other_disap
and they don't have to queue). aa_na_m_disab_access_expl
Availability of Effective Complaints and Feedback Mechanism
Beneficiaries (patients)
Knowledge of CFM 5% Know how to report a complaint about the services received. cf_na_b_cfm_aware
The one beneficiary that knows how to report a complaint, concern, or request related
cf_n_b_cfm_tfn
to the services at the health care facility would communicate these through the
cf_na_b_cfm_tms
suggestion box and client response staff / helpdesk.
cf_na_b_cfm_box
CFM use 100%
cf_na_b_cfm_help
Prior to the visit, RET mentioned they have permanent CFM, including a suggestion
cf_na_b_cfm_other
box and email. They also conduct Monitoring, Evaluation, and Reporting surveys
cf_na_b_cfm_cuales
using a representative sample.
The beneficiary that knows how to report a complaint has not reported a complaint
Complaint reporting 0% cf_na_b_complaint
about services at the health care facility.
Health care staff
The health care staff members interviewed do not know how to make a complaint related to the cf_na_s_cfmstaff
Knowledge of CFM
activities that are being implemented at the facility.
Community health promoter
The community health workers report that as a complaints and feedback mechanism, during the
workshops, the project carries out a pre and post-test to identify the satisfaction and acceptance
CFM use CHW interview
of the participants. So far, the community health promoter has not received complaints about the
activities.
IP point of contact
CFM implementation The program has a Complaints and Feedback Mechanism (CFM) to request and receive patient cf_na_i_cfm_aware
feedback from activities implemented at the health care facility. The channels through which cf_na_i_cfm_box
patients can make their reports are suggestion box, email and HCF staff. cf_na_i_cfm_mail
The use of the CFM is promoted within the patients and community through the IP staff, the cf_na_i_cfm_staff
HCF staff, print and electronic media, and community representatives. cf_na_i_cfm_promote
cf_na_i_cfm_promote_ipstaff
cf_na_i_cfm_promote_staff
13
 cf_na_i_cfm_promote_media
cf_na_i_cfm_promote_com
CFM use The staff that implements the activities have access to or receives information on the issues cf_na_i_cfm_information
raised by the beneficiaries through the feedback mechanisms. So far, patients and volunteers cf_h_i_compl_other
have expressed their satisfaction with the activities implemented. cf_h_i_compl_other_expl
The program has not received any sensitive or non-sensitive complaints. cf_na_i_nosensitive
Handling of complaints cf_na_i_sensitive
cf_na_i_followup
Direct observation
At the health care facility, there are no posters or leaflets with information of Complaints and cf_na_m_poster
CFM visibility
Feedback Mechanisms.
At the health care facility, there were staff available in the waiting room to answer questions and
Staff availability cf_na_m_staff_avail
provide CFM information to patients.
CFM implementation There was no complaint box/desk at the health facility. cf_na_m_box_cfm
Protection
Beneficiaries (patients)
Report someone asked them for a favor, money, or service in exchange for receiving
0% pp_na_b_favor
assistance in this health care facility.
Corruption
Report that someone asked them for a favor, money, or service in exchange for
0% pp_fa_b_workshop_favor
participating in the breastfeeding/nutrition workshops.
Report feeling safe:
- when travelling to the health care facility pp_na_b_safe
100% - while waiting services at the health care facility pp_na_b_safe_wait
90% - while receiving health services at the health care facility pp_na__safe_not_wait_expl
Safety
95% As the hospital is located in an insecure area, the beneficiaries that feel unsafe (n=2) pp_na_b_safe_attention
explained they feel unsafe at the health care facility because they arrive early and pp_na_b_safe_not_atten_expl
have to wait in an open area and because there have been cases of robbery in the
hospital.
Report being treated with dignity and respect by the health care staff. The two
patients (10%) that reported not being treated with dignity and respect explained this
Dignity and respect 90% pp_na_b_respect
is because they had to wait a long time and because other people were called in
before them.
Health care staff

14
 Staff members report not to have been asked for a favor, money, or service in exchange to be
Corruption pp_h_s_favor
enrolled in the trainings.
IP point of contact
The IP point of contact reports that no one has been asked for anything in return for the health
Corruption pp_na_i_askmoney
services or activities.
Direct observation
The monitor did not find evidence of patients being asked for something in return or being
Corruption pp_na_m_cobros
charged for the health services provided.

Thematic Findings of WASH (Complementary Sector)

Beneficiaries (patients)
VBD prevention
Activity Verification (Fidelity)
Beneficiaries received orientation or guidance on how to prevent Vector-Borne diseases
25% vf_w_b_vbd_guide
(VBD) such as Dengue, malaria, Zika or chikungunya.

75% Report there is access to properly functioning toilets at the health care facility. vf_w_b_toil_access
WASH infrastructure Report there is access to properly functioning handwashing stations. Out of the seven
vf_w_b_hndwsh_station
35% beneficiaries that reported access to functional handwashing stations, one reported it was
vf_w_b_hndwsh_soap
equipped with soap or another cleaning product.
Health care staff
One of the staff members interviewed report having access to clean water at the health care facility
vf_w_s_clean_water
Access to clean water and receiving guidance or information about safe water management (water purification and
vf_w_s_guid_received
chlorination), the other one did not.
The staff members interviewed reported that at the health care facility they have access to fully vf_w_s_toil_access
WASH infrastructure functioning bathrooms and handwashing sinks, but they are not equipped with soap or other cleaning vf_w_s_hndwsh_station
product. vf_w_s_hndwsh_soap
IP point of contact
The IP point of contact reported that the project is supporting activities related to water system vf_w_i_wsrepair
WASH activities supported repairs, construction/rehabilitation of toilets, and construction/rehabilitation of handwashing vf_w_i_crtoilets
facilities. vf_w_i_crhandwashing
Direct observation

15
 The main sources of water for the facility are piped water and water purchased from outside vendor
vf_w_m_watsource
(water truck). The water from the aqueduct is treated.
vf_w_m_watreat
There is at least one water storage tank to serve the staff and patients at the facility but in case of
vf_w_m_storage
water shortages or rationing, the amount of water stored in the tank is not sufficient for the health
vf_w_m_storage_dur
care facility to operate for two days.
The health care facility does not have functional handwashing units with soap/antibacterial for patient
use. The handwashing area in the area of hospitalization of children there is a shower and a basin vf_w_m_hndwashp_st_pa
(sink) and the bathroom of the general emergency area does not have a sink because the pieces were vf_w_m_hndwashp_st_pa
WASH infrastructure stolen and the hospital authorities decided not to put them back. There is no picture or illustration that _im
explains the appropriate technique for handwashing.
The health care facility has functional handwashing units with soap/antibacterial for staff in vf_w_m_hndwashs_st_staf
consultation rooms or nearby. There is no picture or illustration that explains the appropriate vf_w_m_hndwashs_st_staf
technique for handwashing. _im
There are functional toilets for patient use at the health care facility where health services are
vf_w_m_toilets
regularly provided. The toilet in the pediatric area is restored and clean and the one for the employees
vf_w_m_toilets_func
is also in good condition, however, the one for the emergency area is damaged. The director of the
de_w_m_toilets_comment
hospital claimed that the pieces of the toilet were stolen and have not been replaced.
The water test showed that the level of chlorine in the water is 0.0mg/L. The drinking water supply to
Water quality vf_w_m_resul_watest2
the hospital is carried out by pipes and occasionally by tanker trucks.
Delivery Effectiveness
Beneficiaries (patients)
Beneficiaries that received guidance on how to prevent Vector-Borne diseases (VBD)
VBD prevention measures 100% such as Dengue, malaria, Zika or chikungunya (n=5) report the most common measures de_w_b_vbd_prev
taken are to cover the containers with water and avoid stagnation of water.
87% Beneficiaries that reported access to toilets (n=15) report the toilets are clean. de_w_b_toil_clean
WASH infrastructure Beneficiaries that reported access to toilets (n=15) report the toilets have locks on the
46% de_w_b_toil_lock
doors.
IP point of contact
The IP point of contact reported that the water and sanitation facilities of the health facility are not
WASH infrastructure adequate for the provision of services because the water comes with a lot of waste and is not suitable de_w_i_washinfr
for human consumption. The water is not chlorinated.
Health care staff
WASH infrastructure The health staff members interviewed reported the toilets are in good condition, they are clean and de_fa_s_bathrooms

16
 have locks.
Direct observation
de_w_m_clean_toil
Toilets at the health facility are clean, have locks and there and are located in areas that offer de_w_m_lock_toil
WASH infrastructure
sufficient privacy for beneficiaries. The toilets are not separate for men and women. de_w_m_privacy
de_w_m_septoilets

COVID-19
Beneficiaries (patients)
Received orientation or guidance on how to prevent COVID-19. The keys aspects
adopted by beneficiaries to prevent COVID-19 are:
Prevention guidance and - Use of masks cv_na_b_covid_guide,
65%
knowledge - Handwashing cv_na_b_covid_prev
- Use of antibacterial gel or alcohol
- Social distancing
Report the doctor/nurse took precautions to protect them from COVID. The most
common precautions taken by the doctor/nurse are:
- Use of face masks or face shield
Precautions by doctor or cv_na_b_caution
95% - Use of antibacterial gel
nurse cv_h_b_caution_expl
- Use of gloves
One beneficiary reported that doctor/nurse did not take precautions to protect from
COVID-19.
Health care staff
Training Staff member interviewed has been trained in management of COVID-19. cv_h_s_covid_tr15
Screening/ treatment of
This health care facility provides screening/treatment of COVID-19. vf_h_s_covid_19
COVID-19
IP point of contact
The IP point of contact reported that there have been changes in the way activities are implemented cv_h_i_covid19
Program adaptation
in response to COVID-19 by forcing changes in implementation strategies. cv_h_i_covid19_expl
The IP communicates the requirements in the case that they or anyone from the staff were impacted cv_na_i_trainning_covid
Response to COVID-19
by/showed symptoms of COVID-19 while implementing activities. When a case occurs, the hospital cv_na_i_training_covid_ex
cases
epidemiology staff is notified for them to do discard and intervention tests. pl

17
 COVID-19
Direct observation
The staff working at the health care facility wear personal protective elements (PPE) for attending to
Staff wearing PPE cv_na_m_protec_elem
patients.
COVID-19 prevention There is evidence of communication strategies promoting prevention of COVID-19 (e.g., flyers,
cv_h_m_outreach_cov19
promotion posters) in the health care facility.

18
 Activity Monitoring Photos
Pharmacy Health care facility waiting area

Patient toilets Patient handwashing stations Sharps disposal box

19
COVID-19 prevention poster Water test results Staff wearing PPE

20
HCF entrance Record of delivery of the IEHK2017 Kit HCF water tank
supplementary module 2

21
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