Post on 11-Mar-2023
KEY PERFORMANCE INDICATORS for
Hospital Services
prepared by:
Dr Sohail Iqbal Information System Expert
TRF+, Khyber Pakhtunkhwa
January 10, 2017
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Contents 1. Introduction…………………………………………………………………………………………………………………………………………………………………………………………… 1
2. Objectives……………………………………………………………………………………………………………………………………………………………………………………………… 2
3. System Design……………………………………………………………………………………………………………………………………………………………………………………….. 3
3.1. Management Levels ....................................................................................................................................................................................... 3
3.2. Performance domains .................................................................................................................................................................................... 4
3.3. Performance measures (KPIs) ........................................................................................................................................................................ 5
3.4. Data sources ................................................................................................................................................................................................... 6
3.5. Configuring Scorecards .................................................................................................................................................................................. 7
3.5.1. Benchmarks and Performance Standards .............................................................................................................................................. 8
3.5.3. Weightage / Formula / Scoring Engine .................................................................................................................................................. 8
3.5.4. Cascading Measures ............................................................................................................................................................................. 10
3.6. Processes and tools ...................................................................................................................................................................................... 10
3.6.1. Data collection process ........................................................................................................................................................................ 11
3.6.2. Data capture tools ................................................................................................................................................................................ 11
3.6.3. Web-based data management and reporting system ......................................................................................................................... 11
4. KPIs Summary List of Hospital Services (Total KPIs: 18, Total Score: 90)………………………………………………………………………………………………. 18
5. KPI Details of Hospitals Year: 2016 (Total KPIs: 18, Total Score: 90)……………………………………………………………………………………………………… 20
Annex – 1.1.1 Filled Post Index : Percentage of essential posts filled against sanctioned posts………………………………………………………………………… 38
Annex - 1.1.2 Staff Presence Index : Percentage of staff present……………………………………………………………………………………………………………………… 40
Annex - 1.3.1 : Drug Availability Index (DHIS) Secondary Level…………………………………………………………………………………………………………………………. 41
Annex - 1.3.2 : Essential Equipment Availability and Functionality Index (IMU) Secondary Level……………………………………………………………………… 42
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List of Abbreviations
CMW Community Midwife
DFID Department for International Development
DGHS Director General of Health Services
DHDC District Healthcare Development Center
DHIS District Health Information System
DoH Department of Health
DHO District Health Officer
DDOH Deputy District Health Officer
EPI Expanded Programme on Immunization
FP Family Planning
IMR Infant Mortality Rate
KPI Key Performance Indicator
LHW Lady Health Worker
M&E Monitoring and Evaluation
MDG Millennium Development Goals
MIS Management Information System
MMR Maternal Mortality Ratio
MNCH Maternal, Newborn and Child Health
NP National Programme
PHS Public Health Specialist
HSRP Health Sector Reform Project
RHIS Routine Health Information System
TA Technical Assistance
TBC TB Control
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TOT Training of Trainers
TRF Technical Resource Facility
WFP World Food Programme
WHO World Health Organization
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1. Introduction
The Government of the Khyber Pakhtunkhwa is committed to provide better health services to its people and took significant initiatives
in this direction. The prime focus is on the health service delivery, i.e. reduction of IMR, MMR and the improvement in mother and
child healthcare services through improving the access, quality and equity of the services.
The overall performance of the Department of Health (DoH) depends on the performance of its managers and health delivery
institutions. The performance can be measured through systematic collection of information (data) and the analysis of outcomes and
its impacts on the society.
Many MIS are functioning within the department, that collect data of the different vertical programees. However, in the context of
devolving and restructuring of the of health programmes, a comprehensive and integrated M&E system is deployed that would provide
basis for performance evaluation at various levels. For this purpose, the DoH took initiative and conceptualized an M&E system that
includes comprehensive system for data collection, reporting and validation. The system comprises of a set of agreed Key Performance
Indicators (KPIs) for monitoring of district health services and measure the performance of managerial / supervisory tiers including
Directorate General of Health Services Khyber Pakhtunkhwa (provincial level) and District Health Officers (District Heath
Management). The system measures the performance and direct corrective actions for the improvement of the health services.
Figure 1.1: Core Functions of Health System
Planning and Management
Monitoring and Supervision
Service DeliveryProgramme
Management
Goals
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The team of consultants held a series of consultative meetings in year 2016-2017 with the key stakeholders of Health Department
Khyber Pakhtunkhwa Including DGHS Khyber Pakhtunkhwa, Provincial coordinator DHIS, Deputy Coordinator DHIS, Project Director
IMU, Deputy Director EPI, representative from HSRU, Project Director Integrated Health Program, Program manager of Provincial TB
Program, M&E officer of MNCH program, Program manager of Hepatitis program, Manager Provincial Malaria Control (PoMC),
Database Administrator DHIS, DHO Swabi, MS of DHQs and THQs and provincial Team Lead TRF+. After a series of meetings and
exhaustive deliberations a final set of KPIs was agreed.
To collect data, a number of existing online and offline data sources have been identified and agreed with the key stakeholders for the
data collection of KPIs. The online data sources include: District Health Information System (DHIS), EPI MIS, LHW MIS, MNCH MIS and
IMU database. The sources regularly collect curative and preventive care indicators from health facilities and vertical / special health
programmes. Moreover, data for KPIs has also been collect from some offline data sources such as Provincial TB Programe (PTP),
Provincial Malaria Control (PoMC) and DGHS and DHO offices.
The M&E system has various management levels that include Directorate General Health Services, District Health Officers (DHO),
Deputy District Officers Health (DDOH) and Medical Superintendents (MS) of secondary care hospitals (DHQ and THQ). The evaluation
is based on Key Performance Indicators (KPI) from existing online and offline data sources as well as additional sources such as
supervisory checklists.
A mechanism for data validation is also been adopted to ensure reporting accuracy. The M&E system is of web-based software which
will be fed by various data sources including DHIS, MISs of vertical programmes. The software processes the data from all the sources
and calculate key performance indicators with balance scorecard methodologies.
2. Objectives
The main objective of the KPI system is to enable the Health Department for unbiased monitoring and performance analysis of various
offices and institutions of the department. The system will improve health service delivery and other services by measuring and
reporting key performance indicators in various domains. The emphasis is on result-based performance and monitoring instead of
process or activities based performance.
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The aim of the assignment is to design and develop a web-based performance monitoring and evaluation system for higher
management through online dashboards by using state of the art technologies. This document therefore presents outline of the
structural design of web-based M&E system as per assigned TORs, Inception Report and discussion with various stakeholders. As
already mentioned, the assignment will also build local capacity of the health department for improvement of the health systems on
sustainable basis.
The proposed structural design will pave a path towards detail designing, development and operations of the M&E system to achieve
overall objectives. On the basis of structural design, a web-based software system is developed and implemented in all districts of
Khyber Pakhtunkhwa for performance monitoring and evaluations.
3. System Design
This section presents structural design of the performance monitoring system, processes, data flows for measuring/capturing and
presentations of calculated KPIs scorecard on the dashboards. The detailed design specifications, particularly related to software
system is prepared during the system development and together with the document, shall form the overall set of technical
documentations to be used as reference material in future for system maintenance and its up-gradation.
3.1. Management Levels
As per assigned Terms of Reference (ToR) and agreed during the technical committee meetings, the following three management
levels of Khyber Pakhtunkhwa Health System have been directed for performance monitoring and evaluation:
1. Office of the Director General of Health Services (provincial level)
2. District Health Officers (25 districts)
3. Medical Superintendents of hospitals (THQs/DHQs)
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Figure 3.1: Management Levels of KPI System
3.2. Performance domains
Performance domains and sub-domains for each of these management units/levels have been defined separately. These domains and
sub-domains relate to the major functions of the specific management unit/level. A list of these performance domain and sub-domains
is given as under:
Management unit/level Domain Sub-domain
DHO
Planning and Management
Operational Planning
Human Resources
Financial Management
Medicines/supplies
Emergency transport
Monitoring and Supervision
Supervisory/monitoring visits
Feedback
MIS
Coordination Coordination
Service Delivery EPI
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Management unit/level Domain Sub-domain
Curative Care
Mother and Child Health
Programme management
National TB Control Programme
National Programme for FP&PHC
MNCH Programme
Malaria Control Programme
Polio Eradication
MS (Hospital)
Planning and Management
Human Resource
Financial Management
Medicines/Supplies
Emergency Transport
Monitoring and Supervision MIS
Hospital Management & Services
Service Quality
Service Delivery
Table 3.1: Management Levels / Domains / Subdomains
3.3. Performance measures (KPIs)
A detailed list of quantitative performance measures, or key performance indicators (KPIs), their definition and formula for
computing scores are given in Annexes. A summary is given as under:
Management Level Number of KPIs
District (DHO) 32
Hospital (MS) 18
Table 3.2: No of KPIs of each Management Level
Similarly, for DHO level, 32 unique indicators have been selected of which most indicators are quantifiable measures such as coverage
percentages and proportions while five KPIs are in fact composite indices calculated from other indicators.
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For hospitals or MS level, 18 unique indicators have been selected within three major performance domains. Most of these are
quantifiable measures including percentages and proportions while four KPIs are in fact composite indices calculated from other
indicators.
Software Interface: The system administration module of the software allows adding and changing individual KPIs and their
performance domains.
3.4. Data sources
A range of sources have been identified for data on key performance indicators. These include routine management information
system (DHIS, IMU, MNCH-MIS, EPI MIS and LHW-MIS) as well as third-party monitoring system (TPM/HRSP), special programmes,
office records, and hospital records. A list of data sources including in this system is given as under:
S.No. Data Source Type
1. DHIS Cell DHIS 2. Independent Monitoring Unit IMU Database 3. MNCH Program MNCH MIS 4. EPI Programme EPI MIS 5. LHW Programme LHW MIS 6. TBC Programme MIS 7. Malaria Programme MIS 8. LQAS Monitoring System 9. Director Budget Office Record
10. DHO Office Record 11. Minutes of meeting Office Record 12. MS Office Office Record 13. Minutes of meeting Office record 14. Hospital registers / record Hospital MIS/record
Table 3.3: Data Sources of KPI System
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3.5. Configuring Scorecards
An administrative module, accessible through secure login is used for configuring the scorecard, for adding or changing key
performance indicators, for assigning or changing weights of scorecard and for defining or altering formula of computation.
The scoring/weightage engine is dynamic in the sense that every time formula or weight for a particular KPI is changed, it will re-
calculate performance indices of all management units and time periods according to new configuration.
Figure 3.4: Configuration of KPI System
• Weights
• Scoring formula
• Benchmarks
• Define KPIs
• Linked to domains
• Performance domains and sub-domains
• Defines mgmt levels
• Linked to admin units
• CascadingManagement
LevelsDomains
Scoring Engine
KPIs
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3.5.1. Benchmarks and Performance Standards
For measuring performance according to set of standards, the following benchmarks have been developed after consultation with the
concerned officials of Health Department, Khyber Pakhtunkhwa:
a) For a qualitative indicator having dichotomous values such as yes/no, the scores will be assigned based on full (100% in case of
positive or ‘yes’) or NIL (0% in case of negative or ‘no’).
b) For quantitative indicators having scale variables (percentage or absolute number values), the ceiling/floor cut points is used as
the baseline or benchmark. Individual performance is measured in terms of variance between the KPI value and the benchmark
and scores is assigned based on their relative weightage.
3.5.2. Software Interface:
The system administration module of the software allows changes of benchmarks for individual KPIs and their relative scores. The
system is flexible to accommodate any change in KPIs.
3.5.3. Weightage / Formula / Scoring Engine
Weights to the performance scores is assigned at top management level based on subjective assessment of how important a
performance domain and its measures. The weights are expected to change from time to time as priorities concerning health system
management are changed. The scoring engine of the software is catered for this flexibility requirement through proper authentication
procedure. The rights to change weights is assigned to an authorized user at the provincial level.
The formula for computing performance scores based on KPI value and its relevant weightage is employed on the following methods.
Ceiling and Floor method
Ceiling and Floor are two performance extreme cut point assigned as benchmark. Ceiling is desired level and Floor is undesirable level
for KPI performance value.
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Figure 3.5: Scorecard Process of KPIs
Scorecard is calculated based on KPIs, performance standards/benchmarks and weightage system and converts utilization and service
statistics into scores. The balanced scorecard gives aggregate performance in all performance domains. The scorecard is completely
customizable and can be adapted to any performance management framework.
Figure 3.6: Performance Standards and Scorecard
Validation
Weights
KPI Values
Standards / Benchmarks
Scores
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The Scoring engine of the software is accessible to an authorized user at the provincial level only, who will be able to configure it by
assigning weights, changing scoring methods and formulas.
3.5.4. Cascading Measures
Since the three management units (DGHS, DHO and MS) work in a management hierarchy and the combined performance of a lower
unit reflects the performance of the higher management unit, therefore, overall aggregate performance score of a management unit
is assigned to its next higher unit. For instance, a district performance score will be computed by adding aggregate score of all hospitals
within that district to the performance of the district. Similarly, aggregate district scores will also reflect the performance of the
provincial level management unit (DGHS).
Figure 3.7: Cascading measures of Management Level
3.6. Processes and tools
This section describes processes and tools involved in the performance monitoring system for Khyber Pakhtunkhwa Health
Department.
MS
• Hospitals' aggregate score
DHO
• District's aggregate score
DGHS
• Province's aggregate score
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3.6.1. Data collection process
At each district, the DHIS Computer staff is designated as focal person for collecting M&E data from the sources indicated on KPI sheet.
The data is collected on prescribed forms and then input in the online web-based system either through a web-browser using a
PC/Notebook connected to internet, or in cases where internet connectivity is not readily available, or facing electricity load-shedding
issues, then an Android tablet shall be used to input data through GPRS communication system. The designated DHIS computer staff
of the district will also collect data from the THQ and DHQ hospitals in the district.
Once data will be captured on the form, it will be checked for completeness, consistency and accuracy before entering into the system.
A signed hardcopy shall be filed for record and future reference.
3.6.2. Data capture tools
The following data collection forms are used for capturing data from the sources.
1. Annual KPI sheet
2. Quarterly KPI sheet
3. Monthly KPI sheet
4. Composite indices worksheet
For composite indices such as staff presence index or drugs availability index, separate forms shall be used to input specific data and
calculate composite index value.
3.6.3. Web-based data management and reporting system
Important Design Considerations:
• Flexibility: The software system is designed keeping the “extensibility” as key design element. The software is flexible to allow
changes in performance domains, measures (KPIs), their benchmarks, scoring methods and relative weightage.
• Integration: The structural design and technology platform is taken into consideration for future integration with other systems.
This is particularly important if move towards comprehensive and integrated HIS is made in the future. The performance
management system has easy interfaces with the new online data collection/reporting systems without requiring any significant
changes in its programming code or underlying database.
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• Compliance to standards: Standards for data exchange such as XML is ensured for compatibility of the system across various
platforms.
• Layered approach:
Main modules of Online Software:
a. Data capture/entry module
b. Configuration module
c. Executive dashboard
d. WebGIS for spatial presentation of performance data
e. System administration
Web application:
It facilitates online extraction of data from various sources including DHIS, as well as other data systems. An admin control panel
enables the system administrator to configure the scoreboard and control access, whereas a data management user interface
allows sub-offices to upload their KPI data.
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Figure 3.8: Web Application System Architecture
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WEB-BASED PERFORMANCE MONITORING SYSTEM FOR KHYBER PAKHTUNKHWA HEALTH DEPARTMENT
SYSTEM ARCHITECTURE DIAGRAM
Figure 3.9: Cascading Measures of KPIs
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KPI dashboard:
KPI dashboard is an online highly interactive user interface that allows managers to view and analyze performance from different
viewpoints. Depending upon the level of management hierarchy, the dashboard provides relevant view to its end-users.
Currently available on web-browsers, this can be extended to mobile gadgets such as tablets and smartphones.
The dashboards are built for using latest GIS and charting tools that provide ranking, comparison and drill-down facilities to end-
users.
Technology Platform
The following technology options have been selected for various components of this online system:
1. Web-based forms PHP
2. Web database Postgres
3. Dashboard Graphs Fusion Charts
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Figure 3.10: Provincial Level KPI Dashboard for Hospital Performance
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4. KPIs Summary List of Hospital Services (Total KPIs: 18, Total Score: 90)
Domain Subdomain KPIs Weight Value Type
Performance Range Interval
Data Source
Planning and Management
(30)
Human Resource (10)
Filled Posts Index 5 % THQ= [80 - 50] DHQ= [80 - 50]
M IMU
Staff Presence Index 5 % THQ= [80 - 50] DHQ= [80 - 50]
M IMU
Financial Management (5) Budget Consumption 5 % THQ= [80 - 50] DHQ= [80 - 50]
Annual MS Office
Medicine/Supplies (10)
Drug Availability 5 % THQ= [80 - 50] DHQ= [80 - 50]
M DHIS
Equipment Availability / Functionality 5 % THQ= [80 - 50] DHQ= [80 - 50]
M IMU
Emergency Transport (5) Ambulance Utilization 5 Per
Ambulance THQ: [15 - 5]
DHQ: [30 - 10] Q DHIS
Monitoring and Supervision
(15) Monitoring/Supervision (15)
Administrative Review Meetings 5 % THQ=[80 – 50] DHQ=[80 - 50]
Q MS Office
Clinical Audits 5 Y/N THQ=[1 – 0] DHQ=[1 - 0]
Q MS Office
Referrals 5 %
THQ= [30 - 10] DHQ= [10 - 0]
(Inverse) Q MS Office
Service Delivery (45)
Service Quality (5) Protocols and guidelines Displayed for IMCI, IYCF, EmOC, Infection prevention, infectious diseases and waste management
5 Y/N THQ=[1 – 0] DHQ=[1 - 0]
M IMU
Service Delivery (40)
Health Facility Utilization Rate (Average Daily OPD)
5 Number THQ=[150 - 250] DHQ= [300 - 400] M DHIS
Bed Occupancy Rate 5 Rate THQ = [70 - 40] DHQ = [80 - 50]
M DHIS
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Average Length of Stay 5 Days THQ = [1 - 2] DHQ = [1 - 3]
M DHIS
OT Services Availability 5 % THQ=[100 – 50] DHQ=[100 - 50]
M DHIS
Lab Services Availability 5 % THQ=[60 – 40] DHQ=[80 - 60]
M DHIS
Comprehensive EmONC Services Status 5 Y/N THQ=[1 – 0] DHQ=[1 - 0]
Q IMU
Total Institutional Deliveries 5 Number THQ=[20 – 40]
DHQ=[40 - 100] M DHIS
Cesarean Section Services 5 Y/N THQ=[1 - 0] DHQ=[1 - 0]
M DHIS
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5. KPI Details of Hospitals Year: 2016 (Total KPIs: 18, Total Score: 90)
1. Domain: Planning & Management Weight 30
1.1 Sub-domain: Human Resource Weight 10
1.1.1 KPI: Filled Posts Index Definition Essential posts filled against sanctioned posts
Data Capture Point IMU
Data Entry Method Automatic
Interval Monthly
Data Type Percentage Value
Criteria / Formula Composite index calculated from sanctioned filled and vacant posts
(See in Annex 1.1.1 for detailed calculation method)
Performance Range THQ: [80 - 50]
DHQ: [80 - 50]
Scoring formula Performance >= Upper Limit Score = 5
Performance <= Lower Limit Score = 0
Otherwise Score = ((Performance – Lower Limit)/(Upper Limit – Lower Limit)) x 5
Weight 5
Discussion
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1. Domain: Planning & Management Weight 30
1.1 Sub-domain: Human Resource Weight 10
1.1.2 KPI: Staff Presence Index Definition Staff not absent from duty at the time of monitoring visit
Data Capture Point IMU
Interval Monthly
Data Type Percentage Value
Criteria / Formula Composite index (See in Annex 1.1.2 for detailed calculation method)
Data Entry Method Automatic
Performance Range THQ: [80 - 50]
DHQ: [80 - 50]
Scoring formula
Performance >= Upper Limit Score = 5
Performance <= Lower Limit Score = 0
Otherwise Score = ((Performance – Lower Limit)/(Upper Limit – Lower Limit)) x 5
Weight 5
Discussion
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1. Domain: Planning & Management Weight 30
1.2 Subdomain: Financial Management Weight 5
1.2.1 KPI: Budget Consumption Definition
% budget consumption as actual expenditure versus budget released on selected budget items Salary and non-Salary (medicines, POL, Utilities, M&R)
Data Capture Point MS office as well as from provincial accounts office
Interval Annually
Data Type Percentage Value
Criteria / Formula Numerator: Expenditure on selected Budget items
Denominator: Released Budget
Data Entry Method Manual (by DHIS Cell)
Performance Range THQ: [80 - 50]
DHQ: [80 - 50]
Scoring Formula
Performance >= Upper Limit Score = 5 Performance <= Lower Limit Score = 0 Otherwise Score = (Performance – Lower Limit)/(Upper Limit – Lower Limit) x 5
Weight 5
Discussion
• Data capturing point for the KPI is DHIS
• This will be captured from DHIS Monthly report of June where accumulative budget release and consumption value during year should be stored
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1. Domain: Planning & Management Weight 30
1.3 Subdomain: Medicines/Supplies Weight 10
1.3.1 KPI: Drug Availability Definition Essential medicines availability and balance
Data Capture Point DHIS
Interval Monthly
Data Type Percentage value
Criteria / Formula
Composite index Calculated from Drug availability mentioned in Annex 1.3.1
Numerator: No of Drugs Available
Denominator: No of Essential Drugs mentioned in the list
Data Entry Method Automatic
Performance Range THQ: [80 - 50]
DHQ: [80 - 50]
Scoring Formula
Performance >= Upper Limit Score = 5 Performance <= Lower Limit Score = 0 Otherwise Score = (Performance – Lower Limit)/(Upper Limit – Lower Limit) x 5
Weight 5
Discussion
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1. Domain: Planning & Management Weight 30
1.3. Subdomain: Medicines/Supplies Weight 10
1.3.2 KPI: Equipment Availability / Functionality
Definition Availability and Functionality of essential diagnostic equipment at the hospital
Data Capture Point IMU
Interval Monthly
Data Type Percentage value
Criteria / Formula
Composite index Calculated from equipment list mentioned in Annex 1.3.2
Numerator: No of functional equipment
Denominator: Total No of Essential equipment mentioned in the list
Data Entry Method Automatic
Performance Range THQ: [80 - 50]
DHQ: [80 - 50]
Scoring Formula
Performance >= Upper Limit Score = 5 Performance <= Lower Limit Score = 0 Otherwise Score = (Performance – Lower Limit)/(Upper Limit – Lower Limit) x 5
Weight 5
Discussion From secondary tool – for THQ, DHQ, Cat C and D hospitals
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1. Domain: Planning & Management Weight 30
1.4. Subdomain: Emergency Transport Weight 5
1.4.1 KPI: Ambulance Utilization Definition
Utilization of Ambulance in Hospital for emergency transfer of Patients (Per Ambulance Patients transfer)
Data Capture Point DHIS
Interval Quarterly
Data Type Per Ambulance Patient Transfer
Criteria / Formula Numerator: No of Patients transfer through Ambulance in a Quarter
Denominator: No of Functional Ambulance in Hospitals
Data Entry Method Manual
Performance Range THQ: [15 - 5]
DHQ: [30 - 10]
Scoring Formula
Performance >= Upper Limit Score = 5 Performance <= Lower Limit Score = 0 Otherwise Score = (Performance – Lower Limit)/(Upper Limit – Lower Limit) x 5
Weight 5
Discussion
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2. Domain: Monitoring & Supervision Weight 15
2.1 Subdomain: Monitoring & Supervision Weight 15
2.1.1 KPI: Administrative Review Meetings Definition
Review meetings on KPIs and DHP Implementation and % of action items addressed
Data Capture Point MS Office – Minutes of Meeting
Interval Quarterly
Data Type Percentage Value
Criteria / Formula Numerator: # of action points addressed from previous quarter
Denominator: Total number of action points to be addressed
Data Entry Method Manual (by DHIS Coordinator – after reviewing minutes of the meeting)
Performance Range THQ: [80 - 50]
DHQ: [80 - 50]
Scoring formula
Performance >= Upper Limit Score = 5 Performance <= Lower Limit Score = 0 Otherwise Score = (Performance – Lower Limit)/(Upper Limit – Lower Limit) x 5
Weight 5
Discussion
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2. Domain: Monitoring & Supervision Weight 15
2.1 Subdomain: Monitoring & Supervision Weight 15
2.1.2 KPI: Clinical Audits Definition Clinical Audits Held in the hospital
Data Capture Point MS Office – Minutes of Meeting
Interval Quarterly
Data Type Yes/No
Criteria / Formula Yes = 1, No=0
Data Entry Method Manual ( by DHIS Coordinator – after reviewing evidence of audit and verified by DMO)
Performance Range THQ: [1 - 0]
DHQ: [1 - 0]
Scoring Formula Performance = 1 Score = 5 Performance = 0 Score = 0
Weight 5
Discussions
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2. Domain: Monitoring & Supervision Weight 15
2.1 Subdomain: Monitoring & Supervision Weight 15
2.1.3 KPI: Referrals Definition Total Referral from the hospital
Data Capture Point MS Office
Interval Quarterly
Data Type Percentage Value
Criteria / Formula Numerator: Total Number referred to other Hospital
Denominator: total number of emergency patients
Data Entry Method Manual (by DHIS Coordinator – after reviewing hospital records)
Performance Range
THQ: [30 -10]
DHQ: [10 - 0] (Inverse)
Scoring formula Performance >= Upper Limit Score = 5 Performance <= Lower Limit Score = 0 Otherwise Score = (Performance – Lower Limit)/(Upper Limit – Lower Limit) x 5
Weight 5
Discussions
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3. Domain: Service Delivery Weight 45
3.1 Subdomain: Service Quality Weight 5
3.1.1 KPI: Protocols and Guidelines Displayed for IMCI, IYCF, EmOC, Infection Prevention, Infectious Diseases and Waste Management
Definition Protocol and guidelines displayed for IMCI, IYCF, EmOC, Infection prevention, infectious diseases and waste management displayed
Data Capture Point IMU
Interval Monthly
Data Type Yes / No
Criteria / Formula Yes=1, No=0
Data Entry Method Automatic
Performance Range THQ = [1 - 0] DHQ = [1 - 0]
Scoring formula Performance = 1 Score = 5
Performance = 0 Score = 0
Weight 5
Discussion
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3. Domain: Service Delivery Weight 45
3.2 Subdomain: Service Delivery Weight 40
3.2.1. KPI: Health Facility Utilization Rate (Average Daily OPD)
Definition Average no outdoor patient visited hospital per day
Data Capture Point DHIS
Interval Monthly
Data Type Number
Criteria / Formula Numerator: Total OPD attendance (New + Follow up)
Denominator: Number of working days
Data Entry Method Automatic
Performance Range Benchmarks
THQ = [150 - 250] DHQ = [300 - 400]
Scoring Formula Performance >= Upper Limit Score = 5
Performance <= Lower Limit Score = 0
Otherwise Score = (Performance – Lower Limit)/(Upper Limit – Lower Limit) x 5
Weight 5
Discussion
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3. Domain: Service Delivery Weight 45
3.2 Subdomain: Service Delivery Weight 40
3.2.2 KPI: Bed Occupancy Rate Definition Per day average filled Beds in hospital
Data Capture Point DHIS
Interval Monthly
Data Type Percentage Value
Criteria / Formula Numerator: Average Beds filled daily
Denominator: Total Number of Beds
Data Entry Method Automatic
Performance Range THQ = [70 - 40] DHQ = [80 - 50]
Scoring Formula
Performance >= Upper Limit Score = 5
Performance <= Lower Limit Score = 0
Otherwise Score = (Performance – Lower Limit)/(Upper Limit – Lower Limit) x 5
Weight 5
Discussion
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3. Domain: Service Delivery Weight 45
3.2 Subdomain: Service Delivery Weight 40
3.2.3 KPI: Average Length of Stay Definition The number of days a patient stayed in a hospital for treatment.
Data Capture Point DHIS
Interval Monthly
Data Type Days
Criteria / Formula Numerator: Total inpatient days
Denominator: Total discharges.
Data Entry Method Automatic
Performance Range THQ = [1 - 2] DHQ = [1 - 3]
Scoring Formula Performance >= Upper Limit Score = 5
Performance <= Lower Limit Score = 0
Otherwise Score = (Performance – Lower Limit)/(Upper Limit – Lower Limit) x 5
Weight 5
Discussion
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3. Domain: Service Delivery Weight 45
3.2 Subdomain: Service Delivery Weight 40
3.2.4 KPI: OT Services Availability Definition
Hospital provided Surgical Procedure performed under General Anesthesia and Spinal Anesthesia
Data Capture Point DHIS
Interval Monthly
Data Type %
Criteria / Formula
Numerator: Does GA performed more than one (1/0) + Does SA performed more than one 1/0)
Denominator: 2 (GA and SA Provided from DHIS List)
Data Entry Method Automatic
Performance Range THQ = [100 - 50] DHQ = [100 - 50]
Scoring Formula Performance = 1 Score = 5 Performance = 0 Score = 0
Weight 5
Discussion
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3. Domain: Service Delivery Weight 45
3.2. Subdomain: Service Delivery Weight 40
3.2.5 KPI: Lab Services Availability Definition Essential Lab services provided in the hospital
Data Capture Point DHIS
Interval Monthly
Data Type %
Criteria / Formula Numerator: Does CT Scan performed more than one (1/0) + Does Ultrasonographies performed more than one (1/0) + Does ECG performed more than one (1/0) + Does X-Rays performed more than one (1/0) + Does Lab Investigations performed more than one (1/0)
Denominator: 5 (Essential Lab Services Provided e.g. CT Scan, Ultrasonographies, ECG, X-Rays, Lab Investigations)
Data Entry Method Automatic
Performance Range THQ = [60 - 40] DHQ = [80 – 60]
Scoring Formula Performance >= Upper Limit Score = 5
Performance <= Lower Limit Score = 0
Otherwise Score = (Performance – Lower Limit)/(Upper Limit – Lower Limit) x 5
Weight 5
Discussion
Revised KPIs of Hospital Services 2016 – 2017
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3. Domain: Service Delivery Weight 45
3.2 Subdomain: Service Delivery Weight 40
3.2.6 KPI: Comprehensive EmONC Services Status
Definition Nine Signal of Comprehensive EmONC Services available in the hospital ?
Data Capture Point IMU
Data Entry Method Automatic
Interval Quarterly
Data Type Yes / No
Criteria / Formula Yes=1, No=0
Performance Range THQ = [1 - 0] DHQ = [1 - 0]
Scoring formula Performance = 1 Score = 5 Performance = 0 Score = 0
Weight 5
Discussion
Revised KPIs of Hospital Services 2016 – 2017
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3. Domain: Service Delivery Weight 45
3.2 Subdomain: Service Delivery Weight 40
3.2.7 KPI: Total Institutional Deliveries Definition Number of Deliveries Conducted in the hospital
Data Capture Point Online DHIS
Interval Monthly
Data Type Number
Criteria / Formula Number of Deliveries Conducted in a month
Data Entry Method Automatic
Performance Range THQ = [20 - 40] DHQ = [40 - 100]
Scoring formula
Performance >= Upper Limit Score = 5
Performance <= Lower Limit Score = 0
Otherwise Score = (Performance – Lower Limit)/(Upper Limit – Lower Limit) x 5
Weight 5
Discussions
Revised KPIs of Hospital Services 2016 – 2017
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3. Domain: Service Delivery Weight 45
3.2 Subdomain: Service Delivery Weight 40
3.2.8 KPI: Cesarean Section Services Definition Cesarean Section perform in Hospital during month
Data Capture Point DHIS
Interval Monthly
Data Type Yes / No
Criteria / Formula Yes=1, No=0
Data Entry Method Automatic
Performance Range THQ = [1 - 0] DHQ = [1 - 0]
Scoring formula Performance = 1 Score = 5 Performance = 0 Score = 0
Weight 5
Discussions
Revised KPIs of Hospital Services 2016 – 2017
38
Targets, Criteria and Formulas of Composite Index KPIs
Annex – 1.1.1 Filled Post Index : Percentage of essential posts filled against sanctioned posts
Facility Type THQ DHQ
Criteria
Essential Staff Sanctioned Weight Sanctioned Staff Sanctioned Weight
Specialists Doctors 4 20 Specialists Doctors 8 20
MO (Male) 2 15 MO (Male) 3 15
MO (Female) 1 15 MO (Female) 1 15
Dental Surgeon 1 5 Dental Surgeon 1 5
Nurses 3 10 Nurses 10 10
Medical Technician 2 10 Medical Technician 3 10
EPI Technician 1 5 EPI Technician 1 5
LHV 2 10 LHV 5 10
Cleaners 3 5 Cleaners 4 5
Ambulance Drivers 1 5 Ambulance Drivers 2 5
20 100 38 100
Filled Post index of THQ = (No of Specialist post filled (max 4) / 4) * 20 +
(No of MO (Male) post filled (max 2) / 2) * 15 +
(No of MO (Female) post filled (max 1) / 1) * 15 +
(No of Dental Surgeon post filled (max 1) / 1) * 5 +
(No of Nurses post filled (max 3) / 3) * 10 +
(No of Medical Technician post filled (max 2) / 2) * 10 +
(No of EPI Technician post filled (max 1) / 1) * 5 +
(No of LHV post filled (max 2) / 2) * 10 +
(No of Cleaner post filled (max 3) / 3) * 5 +
(No of Ambulance Driver post filled (max 1) / 1) * 5
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Filled Post index of DHQ = (No of Specialist post filled (max 8) / 8) * 20 +
(No of MO (Male) post filled (max 3) / 3) * 15 +
(No of MO (Female) post filled (max 1) / 1) * 15 +
(No of Dental Surgeon post filled (max 1) / 1) * 5 +
(No of Nurses post filled (max 10) / 10) * 10 +
(No of Medical Technician post filled (max 3) / 3) * 10 +
(No of EPI Technician post filled (max 1) / 1) * 5 +
(No of LHV post filled (max 5) / 5) * 10 +
(No of Cleaner post filled (max 4) / 4) * 5 +
(No of Ambulance Driver post filled (max 2) / 2) * 5
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Annex - 1.1.2 Staff Presence Index : Percentage of staff present
Facility Type THQ / DHQ
Criteria
Essential Staff Positions
Specialists Doctors
MO (Male)
MO (Female)
Dental Surgeon
Nurses
Medical Technician
EPI Technician
LHV
Cleaners
Ambulance Drivers
Formula Formula: (Staff present / Staff filled in above positions) * 100
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Annex - 1.3.1 : Drug Availability Index (DHIS) Secondary Level
Drug List: (18 Essential Medicines and 9 Vaccine for all HF type included in DHIS)
Criteria
Essential Medicine List (From DHIS) Vaccine List (From DHIS)
Cap. Amoxicillin Syp. Amoxicillin Tab. Contrimoxazole Syp. Cotrimoxazole Tab. Metronidazole Syp. Metronidazole Inj. Ampicillin Tab. Diclofenac Syp. Paracetamol Inj. Diclofenac Tab. Chloroquin Syp. Salbutamol Syp. Antihelminthic I/V infusions Inj. Dexamethasone Tab. Iron / Folic Acid ORS Oral pills (COC)
BCG vaccine Pentavalent vaccine Polio vaccine Heptatitis-B vaccine Measles vaccine Tetanus Toxiod Anti Rabies Vaccine Anti Snake Venom Vaccine Syringes