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Anbar
Najaf
Ninewa
Muthanna
Erbil
Diyala
Wassit
Basrah
Missan
Salah al-Din
Thi-Qar
Kirkuk
Dahuk
Qadissiya
Kerbala Babylon
Baghdad
Sulaymaniyah
Legend
Density of IDPs*Low High (44,004)(6)
Camp surveyed
Anbar6 Camps
Salah Al-Din3 Camps
Ninewa19 Camps
Dahuk11 Camps
Erbil4 Camps
Sulaymaniyah6 Camps
Kirkuk5 Camps
Diyala3 Camps
IRAQ IRAQ: Quality of Care 2018 Analysis (Health Facility Observation)
Production Date: 30 Dec 2018Product Name: WHO_IRQ_Quality of Care_Health Facility Observation_2018 Analysis Phase 1 - Phase 2_31122018 Email: [email protected] Infographic print size: A3 *Source IOM DTM 31-10-2018
Distribution of total surveyed Camps/PHCin Phase 1 and Phase 2
Camps/PHCsurveyedDec 2018
Phase 1&2 Page 1/3
Disclaimer: The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. All reasonable precautions have been taken by WHO to producethis map. The responsibility for its interpretation and use lies with the user. In no event shall the World Health Organization be liable for damages arising from its use.
7%
5%
55Camps/PHC
surveyedJun 2018
7%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Disposable gloves
Water and soap/hand sanitizer
Autoclaves/sterilizers
Infection Prevention and Control Procedures (IEC)
Medical waste bin and sharp needle box44% 51%
5%
44% 49%
46% 49%
65% 35%
60% 40%55% 45%
60% 40%
27% 62% 11%
49% 40% 11%
38% 55%
Yes Partial NoAvailability of Infection Prevention and Controlmeasures at PHCs in IDP camps
Phase 1Phase 2 Yes Partial No
Variation of performance obtained per Observation Indicator. Phase 1 to phase 2in 36 PHCs/Camps38%
9%4%
13% 13% 13% 15%
-4%
17%
4%
14%
-13%
-%
0
+%
IEC
Mat
eria
l
Ser
vice
s an
d w
orki
ng d
ays
adve
rts p
oste
d
Ora
l reh
ydra
tion
poin
t
Func
tiona
l sea
tsfo
r clie
nts
Inst
alla
tion
outle
tsar
e pr
oper
ly c
over
ed
Drin
king
wat
er fo
r clie
nts
Med
ical
was
te b
inan
d sh
arp
need
le b
ox
Wat
er fa
ucet
s an
dto
ilets
for c
lient
s
Dis
posa
ble
glov
es
Wat
er a
nd s
oap
/han
d sa
nitiz
er
Ste
riliz
atio
n
Infe
ctio
n pr
even
tion
and
cont
rol p
roce
dure
s
Pha
rmac
eutic
al s
uppl
ies
kept
pro
perly
0%
-13%
Dahuk
Anbar
Sulaymaniyah
Salah Al-Din
Ninewa
Kirkuk
Erbil
Diyala
Perfomance reached per PHCs in IDP camps for Health Facility ObservationWhere 1% represents worse performance and 100% better performance
PHCs in Phase 1
0 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
PHCs in Phase 2
Variation of performance in Health Facility Observation. Phase 1 to Phase 2in 36 PHCs/Camps
117%
71%
24%
0%
-11%
0%
24%15%
-9%-11%
-36%-17%-9%
129%
17%10%
110%
41%
4%6%
-16%
18% 15%
-30%
14%
117%
178%
-12%-7%
43%
-23%-22%
-19%-9%
-5%-%
0
+%
Amriy
at A
l Sal
amAm
riyat
Al S
alam
UIM
SBe
zabi
ze C
entra
lD
awod
ia C
amp
Kaba
rto 2
Cam
pKh
anke
Cam
pBe
rsiv
e 1
Cam
pBe
rsiv
e 2
Cam
pC
ham
ishk
u C
amp
Dar
kar C
amp
Al W
and
1 C
amp
Dib
aga
Layl
an 2
Cam
pLa
ylan
IDP
Naz
raw
a ca
mp
Yahy
awa
cam
pAs
Sal
amyi
ah 1
cam
pAs
Sal
amyi
ah 2
cam
pSa
lam
yiah
Nim
rud
cam
pEs
sian
Cam
pM
am R
asha
n C
amp
Shei
khan
Cam
pH
aj A
li ca
mp
Ham
mam
al-A
liel 1
cam
pH
amm
am a
l-Alie
l 2 c
amp
Qay
yara
h Ja
d’ah
3 C
amp
Qay
yara
h Ja
d’ah
5 c
amp
Qay
yara
h Ja
d’ah
6 c
amp
Qay
yara
h Ai
rstri
pQ
ayya
rah
Jad’
ah 1
&2Al
-Bas
atee
n C
amp
Al-S
haha
ma
Cam
pSu
rdas
h ca
mp
Taza
de C
amp
Arba
tAs
hti I
DP
Cam
p
Anbar Dahuk Di Er Kirkuk Ninewa SalahAl-Din Sulaymaniyah
-53%
42%
36%
44%
44%
89%
40%
78%
76%
49%
33%
58%
15%
56%
23%
11%
60%
22%
24%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Services and working days adverts posted
IEC Material
Oral rehydration point
Functional seats for clients
Installation outlets are properly covered
Drinking water for clients
Water faucets and toilets for clients
Pharmaceutical supplies kept properly
Health awareness practices and availableinfrastructure at PHCs in IDP camps
58%
46%
37%
51%
98%
51%
95%
77%
47%
35%
42%
7%
63%
14%
2%
49%
5%
23%
Yes Partial NoPhase 1Phase 2 Yes Partial No
In the first phase, 78% of PHCs in IDP camps had separate water faucets and toilets for patients. For the second phase this percentageincreased to 95%.
In the first phase, 44% of PHCs in IDP camps had oral rehydrationpoints. For the second phase, only 37%.
Infection prevention and control mesuasures improved for the second phase. Its performance increased around 15%, except DisposalGloves which decreased 4%.
38% of PHCs in IDP camps had medical waste bin and sharp needle box in the phase 1. In the Phase 2, 44%.
For the second phase, five PHCs in IDP camps increased in more than 100% the performance obtained in the first phase. Three PHCs in Ninewa, one in Kirkuk and another one in Anbar.
In both phases more than 50% of PHCs in IDP camps had equipment for sterilization.
In Ninewa, the PHCs in IDP camps had a better performance in thesecond phase than the first phase. Most of the PHCs obtained scoresthat exceed 50%, which suggests that its performance overcame morethan half of the expected.
In Anbar, the PHCs performance improved from the first to the secondphase. In second phase two of three surveyed PHCs reached 100% of the score which suggests a perfect performance.
For the second phase, the PHCs in IDP camps improved substantially the disposal of clear poster adverts of services and working days and hours. This indicator increased 38% for the second phase.
In general, the health awareness practices and the available infrastructurefor clients improved for the second phase, its performance increasedaround 10%.
7%
5%
5%
Anbar
Najaf
Ninewa
Muthanna
Erbil
Diyala
Wassit
Basrah
Missan
Salah al-Din
Thi-Qar
Kirkuk
Dahuk
Qadissiya
Kerbala Babylon
Baghdad
Sulaymaniyah
Legend
Density of IDPs*Low High (44,004)(6)
Camp surveyed
Anbar6 Camps
Salah Al-Din3 Camps
Ninewa19 Camps
Dahuk11 Camps
Erbil4 Camps
Sulaymaniyah6 Camps
Kirkuk5 Camps
Diyala3 Camps
IRAQ IRAQ: Quality of Care 2018 Analysis (Clinical Observation)
Distribution of total surveyed Camps/PHCin Phase 1 and Phase 2
47Camps/PHC
surveyedDec 2018
Phase 1&2 Page 2/3
Production Date: 2 Jan 2019Product Name: WHO_IRQ_Quality of Care_Clinical Observation_2018 Analysis Phase 1 - Phase 2_31122018 Email: [email protected] Infographic print size: A3 *Source IOM DTM 31-10-2018 Disclaimer: The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. All reasonable precautions have been taken by WHO to producethis map. The responsibility for its interpretation and use lies with the user. In no event shall the World Health Organization be liable for damages arising from its use.
55Camps/PHC
surveyedJun 2018
Clinical Observation per Health Worker at PHCs in IDP camps. Performance reached in phase 1 and phase 2 Phase 1 Phase 2
Yes Partial NoPhysician Observartion at PHCs in IDP camps Phase 1Phase 2 Yes Partial No
36%
35%
84%
15%
85%
22%
16%
49%
54%
60%
58%
64%
11%
16%
25%
15%
20%
29%
51%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
55%
Practice of hand hygiene before and afterpatient examination
Physician greeting the patient respectfully
Physician getting medical history
Physician performing physical assessmentor examination
Examination according to patient contidion
Treatment explained and patientunderstood
Physician delivering health promotionmessages
Patient notified when to return fornext appointment
53%
37%
79%
21%
88%
28%
21%
56%
47%
67%
44%
47%
16%
21%
12%
12%
28%
19%
44%
60%
45%
16%
55%
67%
55%
17%
45%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Practice of hand hygiene before andafter patient examination
Preparation for taking vital signs by informingthe patient about the procedure
Privacy conditions to patients
63%
26%
70%
60%
37%
14%
30%
Yes Partial NoNurse Observartion at PHCs in IDP camps Phase 1Phase 2 Yes Partial No
51%
29%
78%
15%
7% 77%
49%
71%
22%
85%
16%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Pharmacist greeting the patient respectfully
Pharmacist request info on allergies/othermedication
Treatment explained and patient understood
Potential side effects/management explained
Pharmacist wrote full information onmedication package
Yes Partial NoPharmacist Observartion at PHCs in IDP camps Phase 1Phase 2 Yes Partial No
70%
49%
88%
33%
25% 63%
30%
51%
12%
67%
12%
specimens
42%
36%
65%
69%
47%
67%
58%
64%
35%
31%
53%
33%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Procedure explained and patientunderstood
Practice of hand hygiene beforeputting on gloves
The technician puts on gloves beforehanding specimens
Disposal of sharps container for used syringes
Disposal of decontaminated solution forresuable lab equipment
Patients being notified ontime to obtainlab results
60%
70%
77%
79%
58%
72%
40%
30%
23%
21%
42%
28%
Yes Partial NoLaboratory Technician Observartion at PHCsin IDP camps
Phase 1Phase 2 Yes Partial No
7%
5%
7%
Physician Observation
36%
62%
84%
45%
85%
51%
44%49%
53%60%
79%
55%
88%
50% 51%56%
0%
25%
50%
75%
100%
Practice of hand Physician
patientgetting medical
Physicianhygiene before
examinationand after patient
greeting the
respectfully
Physician
historyperformingphysical
assessment
Examinationaccording to
patient condition
Treatmentexplained and
patientunderstood
Physiciandelivering
health promotionmessages
Patient
return for nextappointment
notified when to
Nurse Observation
45%50%
55%63%
56%
70%
Practice of handhygiene before
examinationand after patient
Preparation for takingvital signs by informing
the procedurethe patient about
Privacy conditionsto patients
Laboratory Technician Observation
42%36%
65% 69%
47%
67%60%
70%77% 79%
58%
72%
Procedureexplained and
patientunderstood
Practice of handhygiene before
putting on gloves
The technician putson gloves before
handling
Disposal of sharps containerfor used syringes
Disposal of decontaminated
solution for resuable
Patients being
obtain lab resultsnotified ontime to
Pharmacist Observation
understood
51%
29%
78%
15%
45%
70%
49%
88%
33%
57%
Pharmacist greetingthe patient
Pharmacistexplains potential
side effectsand management
Pharmacist request
medicationinfo on allergies/other
Treatmentexplained and
patientfull information onPharmacist wrote
medication packagerespectfullylab equipment
In the first phase, privacy conditions were met for 55% ofpatients. In the second phase, this percentage increased to 70%.
The lab technicians showed a significant improvement fromphase 1 the phase 2. The reached scores had a rise ofapproximately 20 percentage points. The hand hygieneimproved from 36% to 70%. In the second phase, 63% ofnurses said to practice hand hygiene.
In the first phase only 7% of patients in PHCs in IDPcamps were provided by full information on medicationpackage. In the second phase, it was 25%.
In the first phase only 15% of patients in PHCs in IDPcamps had a full description of drug potential side effectsand how to manage them. In the second phase, 33%.
In both phases less than 30% of physicians gave fullinstructions about the offered treatment and confirmedthat patients had full understanding. Around 50% of physicians did it partially.
For second phase, the physicians who follow up the guidelines to do a physical assessment increased from 15% to 21%.
In the first phase, 84% of physician asked about the client healthand symptoms and medical history. This percentage had a drop forthe second phase, in which 79% of physician did it.
For the second phase the health workers had a betterperformance, reaching scores up to 20 percentage pointsmore than the fisrt phase.
Most of the physicians is examining patients according to theirconditions. In both phases, more of 85% of physicians didthis differentiated examination.
Anbar
Najaf
Ninewa
Muthanna
Erbil
Diyala
Wassit
Basrah
Missan
Salah al-Din
Thi-Qar
Kirkuk
Dahuk
Qadissiya
Kerbala Babylon
Baghdad
Sulaymaniyah
Legend
Density of IDPs*Low High (44,004)(6)
Camp surveyed
Follow-up
General Physician
Mother and Child Health
Other
Reason for patients visitingthe PHC Phase 1
Phase 2
Distribution of total surveyed Camps/PHC in Phase 1 and Phase 2
39%
56%
6%31%
44%
25%
12%
85%
2%2%
6%
94%
100%61%
6%
33%
17%
67%
17%
25%
63%
13%
13%
83%
4%7%
70%
3%
19%
68%
13%19%
70%
11%
94%
6%
100%
Salahal-Din
87%
10%
20%
77%
3%
Sulay
Dahuk
IRAQ IRAQ: Quality of Care 2018 Analysis (Health Worker & Patient exit interview) Phase 1&2 Page 3/3
Production Date: 4 Jan 2019Product Name: WHO_IRQ_Quality of Care_Health Worker & Patient exit interview_2018 Analysis Phase 1 - Phase 2_31122018 Email: [email protected] Infographic print size: A3 *Source IOM DTM 31-10-2018 Disclaimer: The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. All reasonable precautions have been taken by WHO to producethis map. The responsibility for its interpretation and use lies with the user. In no event shall the World Health Organization be liable for damages arising from its use.
47Camps/PHC
surveyedDec 2018
55Camps/PHC
surveyedJun 2018
75% 72%63%
70%62%
88%
51%
69%
98%
75%79%
60%
90%90%
52%
74%
0
20%
40%
60%
80%
100%
Anbar DahukDiyala ErbilKirkukNinewa Salah al-DinSulaymaniyah
Performance reached per PHCs in IDP camps according patients interviewWhere 1% represents worse performance and 100% better performance
Phase 1Phase 2
PHCs in Phase 1PHCs in Phase 2
Training received by Health Workers in the phase 1 and phase 2
Availability of needed health services by patientsPrivacy during the patient examination
Follow up appointment givenAvailability of prescribed medication
Satisfaction with the healthcare services received
Laboratory test results explained to patient
Aspects evaluated:
YesNo
Without variation from phase 1 to phase 2
Increase in the number of trained workers from phase 1 to phase 2Decrease in the number of trained workers from phase 1 to phase 2
73% 27%
11%89%89% 11%
9%91%
76% 24%82% 18%
56% 44%
21%79%72% 28%
37%63%56% 44%56% 44%
79% 21%
67% 33%
Disease managementCommunication skills
WorkplannigStandards of care
SupervisionProblem solving
Reproductive Health
Health educationOther topics
Infection Control
Phase 1 Phase 2Pharmacist
82% 18%89% 11%89% 11%
67% 33%65% 35%74% 26%
22%78%89% 11%
9%91%13%87%
5%95%80% 20%
13%87%
25%75%16%84%
28%72%79% 21%
26%74%28%72%16%84%
79% 21%26%74%
51%49%51%49%
9%91%
67% 33%
Laboratory Technician Phase 1 Phase 2
Disease managementCommunication skills
WorkplannigStandards of care
SupervisionProblem solving
Reproductive Health
Health educationOther topics
Infection Control
Nurse44%56%
24%76%80% 20%
31%69%13%87%
82% 18%71% 29%
71% 29%31%69%
44%35%65%
67% 33%33%67%30%
72% 28%70% 30%
51%49%49% 51%
28%72%
51%49%
Phase 1 Phase 2
Disease managementCommunication skills
WorkplannigStandards of care
SupervisionProblem solving
Reproductive Health
Health educationOther topics
Infection Control
56%
70%
47% 53%24%76%
82% 18%65% 35%
13%87%73% 27%
25%75%
47%53%33%67%
33% 67%40%60%
60% 40%65% 35%
23%65% 35%
44%56%40%60%51%49%
33%67%
51%49%
Phase 1 Phase 2PhysicianDisease managementCommunication skills
WorkplannigStandards of care
SupervisionProblem solving
Reproductive Health
Health educationOther topics
Infection Control
77%
More than 84% of the patients interviewed were satisfied in the healthservices provided at PHCs in IDP camps in both phases.
The number of nurses that received any training about Health Education inthe PHCs in IDP camps had a rise of 22 percentage point from phase 1 tothe phase 2.
For the second phase, physicians had a drop of 11 percentage points inthe Infection Control training
In both phases, the main reason for patients visiting the PHC was a GeneralPhysician appointment.
In the second phase, Anbar, Ninewa and Kirkuk Governorates reachedmore than 90% of expected performance in patient satisfaction, patientprivacy and health services provided. From the first phase to the secondphase all the governorates improved their performance, except for Erbil.
In the second phase, in Diyala,100% of interviewed patients went to thePHCs for General Physician appointment in Diyala. For the first phase,61% of patients did it.
In Anbar, Follow-up appointments represented more than 30% of the patientvisits to the PHCs in IDP camps at the time of interview in both phases.
Management, Infection Control and Health Education were the trainingsessions with the highest attendance in both phases. Around 50% of healthworkers have received training in these three topics.
3%
20%
