1.

Annexes
Clinical Mentoring Tools
A. SKILL CHECK LIST FOR HEALTH WORKERS
(N.B: The mentor should spend at least two-third of his/her stay in conducting one - on- one case
management observation)

Mentee: Mentor: Date: Facility

Qualification _________________ . Qualification_______________________

Please summarize the Mentee’s demonstrated knowledge and skills using the codes below:
Mentee Competency level assessment category
X= not applicable
1 = none: No demonstrated skills at all or does not perform the task (s) completely .Needs a
lot of support
2 = limited: Mentee demonstrates very limited strengths or skills in this area and
needs additional support
3 = some: Mentee demonstrates some ability or skills in this area.
4 = Strong: Mentee demonstrates excellent skills or strengths in this area
Completeness of Mentor’s assessment
A =Comprehensive assessment– skill was assessed completely, Mentor was able to observe
fully
B = Satisfactory assessment– assessment was satisfactory, although Mentee’s skill may
exceed that observed
C =Partial assessment—observations and scores based on incomplete
information.
R = Resource limits–skill or care limitation clearly related to resource limits.

Use the "comments” column to note key observations to be discussed later with the Mentee. In
addition, this space should be used to record explanations to why recommended practices were not
followed, to describe instances where the provider was particularly effective and/or to note
particularly useful advice provided by the Mentor to the Mentee.

Note: Clinical Mentors need to focus on knowledge and skill capacity building of mentees providing
care and treatment services using the Preceptor check list (A). The chart abstraction tool (B) is intended
to be used to review client charts, registers and oversee service integration/linkage with other units.

1. Two third of the mentoring time should be used for technical capacity building
2. One third of the mentoring time should be used for chart review and oversee service
integration/linkage with other units.

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 A. Preceptor Check List
Codes1-4,A-
Demonstrated knowledge and skills Comments C,R,X

Professional and Interpersonal skills

Provider is welcoming for the clients(Greets with dignity and
respect)
Briefly describe the purpose of the mentor ship program to the
patient (i.e., the mentee need to explain to his/her clients who the
mentor is and mentor’s purpose)
Patient centered (listens to patient’s ideas and concerns)
Creates trusting /supportive rapport with the patient (encourages
open communication- Uses recommended communication skills
to encourage and open the client to tell their stories)
Timely(doesn’t rush patient and doesn’t take too much time-
provides adequate time to address all concerns as well as does not
take unnecessary too much time when it is not needed)
Treats patient with empathy, dignity and respect (including
confidentiality; maintain slow speaking voice)
Assessment
Conducts focused and open discussion of medical, social and
family history and progress relevant to current complaint
including assessment of adherence
Uses team approach (shares information with adherence
counselor, efficient interaction and lack of duplication)
Conducts adequate physical examination(pertinent in relation to
medical story and current complaints)
Accuracy of assessment and diagnosis(including WHO staging)
Patient management and care plan

ART adherence, tolerance and side effects addressed.

Appropriate involvement of patient in development of a focused
management plan
Appropriateness of recommended drug treatment(ART and OIs)
Appropriateness of recommended laboratory tests
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Patient education on sexual and other risk behavior
Emotional and psycho-social support needs discussed and
addressed
Gave appropriate Referral as required
Develops appropriate follow up schedule
Documentation and recording

Appropriate history and physical examination findings are

documented on the respective formats
Documentations are complete and consistent
All required formats are updated and complete

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B. PMTCT Chart Abstraction tool and document review
ANC Performa Bottle Actions
nce(Docu necks Planed
ment (Causes (Mitigation
percentag for low s to
e for each perform address the
observatio ance bottle
n) necks
Review the ANC register at least 2 months from the date of
visit.
 What percentages of pregnant women have a documented HIV
status? (total number of women who have test results and total ANC clients
in the last two month)

 What percent of pregnant women are HIV positive?

 What percent of pregnant women have documentation of
receipt of ARVs?(check cohort and ANC register)
 What percentages of pregnant women have documented
syphilis testing?
 What percent of reactive pregnant women treated for
syphilis?
Check pregnant women, who are on cohort register for the last 6
months, what percentage of the eligible pregnant mothers have
timely CD4/VL documentation on the register.
CD4 (%)
VL (%)
Take 5 random charts of HIV positive pregnant women, who are on
cohort register for the last 6 months, what percentage of the eligible
pregnant mothers took
 TB screening
 INH preventive therapy
 CPT
 have timely CD4
 Have timely VL testing.
 have documented wt, ht, BMI or MUAC

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  Prevention counseling (FP, condom use)
 WHO clinical staging/ T-staging
 Prevention plan(disclosure, STI, Psychosocial support)
 Check intake form for completeness and update on index case
family testing

Review re-testing practice by checking recently initiated clients

against the retesting register (draw 3 newly initiated client charts)
Check HEI , who are on cohort register for the last 6 months,
 what percentage HEI have documentation of their NVP
receipt
 How many of the identified HEIs have DBS done (No.& %)
 How many HEI who are 18 months old have Antibody test
 How many of HEI have DBS positive results
 How many HEI who are 18 months old have positive
antibody test.
Take 5 random HEI charts, what percentage HEI have
documentation of their
 NVP receipt
 CPT
 Growth chart
 Immunization
Review last three months record on mother baby cohort
register(Completeness and updates)\
Probe: check like NVP, CPT, INH areas for completeness
PMTCT cohort monitoring reporting format properly filled?
Probe: - Is it up to date, and legible? Abbreviations used are
standard ones?
Is the Wall chart for mother properly filled
Is the Wall chart for HEI properly filled
Are the Maternal & HEI PMTCT Cohort Wall Charts displayed on
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the wall in the PMTCT clinic?
If Not, why?
Is the facility implementing continuous quality to improve the quality of
RMNCH/PMTCT services?
How often the CQI project implemented?

Does the health institution use data for planning and decision making at
facility level?
If No, why? ----------------------------------------------------------
If yes, verify documentation of regular data analysis and use evidences.
What has been done for those LTFU (e.g. Tracing)
Observe evidences of those lost are brought back to care
Mechanisms of tracing lost to follow clients
AVAILABLITY OF TOOLS YES No
 Revised PMTCT guideline
 PMTCT services desktop reference
 Revised enhanced postnatal prophylaxis job aid for HEI
 Maternal and HEI report formats
 Maternal and HEI wall chart
 PMTCT cohort monitoring SOP
 Continuous quality improvement(CQI) checklist
Check the availability and expiry date of 1e, NVP prophylaxis and AZT
syrup

L&D

Review the L&D register at least 3 months prior from the current date of
visit,

 Is there routine provision of PITC for eligible pregnant

women attending L&D(Y/N)
 What percentages of new pregnant women have documented
HIV status during L&D?
 What percentage of new pregnant women have
documentation of receipt of ARVs during L&D receipt
 What percentages of HIV exposed newborns have
documentation of their ARV prophylaxis (NVP) receipt? (Out of
those who are born at the 3 months prior to the visit).

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Do you communicate PMTCT provider to document NVP
prophylaxis immediately?

If not why ------------------------------------------

Take 5 random MRN from L&D register which is NVP documented

and what percent of NVP documented on Mother baby cohort
register at PMTCT room

MSG

No of HIV positive pregnant & BF mother’s registered on MSG

register in this month.

Is there lost to follow up HIV positive pregnant & BF mothers in

this month?

If Yes to Q above,
Do Lost to follow up cases traced and their tracing outcomes
properly register?

How many times per week did MSG members participate in coffee
ceremony?

Check the lesson discussed during coffee ceremony.

Laboratory
Laboratory machines Failure If YES specify
YES NO which machine
Do you use Genexpert devices for
EID
Stock out of Lab Supplies (sample If YES Specify
collection as well as reagents YES
NO

Interpretation of performance observation findings: Poor <50%, Fair=50-75%, Good= 75-

90%, Very good >90%