JezK

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Envelope-to: ali.reza@jack.ngo,
 dr.tabesh@jack.ngo
Delivery-date: Thu, 29 Sep 2022 04:32:40 -0400
MIME-Version: 1.0
From: Naseer Javed <naseerjaved2@gmail.com>
Date: Thu, 29 Sep 2022 01:31:16 -0700
Message-ID: <CAEQEN4ncVNkr=M_AGgE2pGPk2bhemQrvEL93aTfePiF_VskZZw@mail.gmail.com>
Subject: Monitoring Findings from Hosainkhil CHC, Tizeen BHC, and Gogamanda
 BHC (Sarubi district)
To: ali.reza@jack.ngo
Cc: dr.tabesh@jack.ngo, ashraf@jack.af, 
	"Dr.Mh.Barak Samim" <dr.mohammadbarak@gmail.com>, abdulbasirrahimi20@gmail.com, 
	Shaista Mehraban <smehraban@unicef.org>, Shafiqullah Safi <shsafi@unicef.org>, 
	Said M Yaqoob Azimi <sazimi@unicef.org>
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Dear Respected colleagues,

Greetings!

I hope this email finds you well!

Based on our plan, I monitored some clinics in Sarubi District. Below are
the main findings which need your kind consideration and follow-up.

*District: Surobi *

*HF: HusainKhil/Uzbeen CHC*

*Code:2922*

*Date of Visit:14/09/2022 *

*The main findings:*

1-     The head of the clinic was on leave and the nutrition nurse was
absent, she was also responsible for screening and OPD-SAM case management.

2-     The nutrition counselor was present.

3-     The GMP and screening were not properly done for the entire under 5
children.

4-     The register book for SAM cases did not fill in the last few days.

5-     The norms for the detection of SAM cases (MUAC, Z-Score, Edema) were
not properly followed.

6-     Poor stock or storage place for RUTF. It was stacked in the bathroom=
.

7-     Poor documentation.

8-     Unavailability of the ICE material.

9-     Appetite tests were not done for the OPDSAM patient.

10-  The NC needs a standard scale

11-  The NC did not take the MIYCN initial training yet.

12-  They had 3.5 carton RUTF which was a low amount of RUTF stock for this
Health facility.

13-  RUTF was not distributed through pharmacies.

*Recommended action:*

1-     NC needs training.

2-     Provide the RUTF supply.

3-     RUTF should be distributed through Pharmacy.

4-     Follow up supportive supervision visits.

5-     Provide the ICE material.

*District: Surobi *

*HF: Tizeen BHC*

*Code:41*

*Date of Visit:21/09/2022 *

*The main findings:*

1-     The head of the clinic was on leave on the date of monitoring and he
recently joined this clinic.

2-     The nutrition counselor was present and newly coming to this clinic.

3-     The register book for SAM cases did not fill in the last few weeks.

4-     Poor stock or storage place for RUTF.

5-     Poor documentation.

6-     Unavailability of the ICE material.

7-     They need a standard measuring board.

8-     The NC needs a standard scale.

9-     The NC did not take the MIYCN initial training yet.

10-  RUTF was not distributed through the pharmacy.

11-  Unavailability of stock cord.

*Recommended action:*

1-     NC needs training.

2-     RUTF should be distributed through Pharmacy.

3-     Follow up supportive supervision visits.

4-     Provide the ICE material.

Fortunately, JACK office colleagues also came during the supervision and we
corrected a lot of things together.

*District: Surobi *

*HF: Gogamanda BHC*

*Code:2160*

*Date of Visit:24/09/2022 *

*The main findings:*

1-     Unavailability of stock cord.

2-     Shortage of the SAM treatment cord.

3-     Unavailability of the signed prescription for RUTF distribution to
SAM cases.

4-     The GMP and screening were not properly done for the entire under 5
children.

5-     CHS hasn't had any nutrition agenda in the last three months=E2=80=
=99
minutes of the meeting & planning and in the last month=E2=80=99s referral =
sheets
he didn't have a single case of SAM.

6-     The NC did not take the MIYCN initial training yet.

*Recommended action:*

1-     Provide the SAM treatment card.

2-     Provide a stock card.

3-     NC needs training.

4-     RUTF should be distributed through the Pharmacy by signing a
prescription.

5-     Follow up supportive supervision visits.

During these visits, on-the-job training was done, I worked with them on
all affected parts and mentioned some action points to the HF staff for
further improvement of the program.

Best regards,

--=20

Dr. Naseer Ahmad Javed
MD, Internal Specialist
Nutritional Technical Extender, Kabul
Ph #: 0093788285428
        0093793688575
WhatsApp #: 0093788285428
Email: naseerjaved2@gmail.com

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<div dir=3D"ltr">Dear Respected =
colleagues,

Greetings!

I hope this email finds you well=
!=C2=A0

Based on our plan, I monitored s=
ome clinics in
Sarubi District. Below are the main findings which need your kind considera=
tion
and follow-up.

District:
Surobi

HF:
HusainKhil/Uzbeen CHC

Code:2922

Date
of Visit:14/09/2022

The
main findings:

=C2=A0

<p style=3D"line-height:11.75pt;background-image:initial;background-positio=
n:initial;background-size:initial;background-repeat:initial;background-orig=
in:initial;background-clip:initial;margin:0in 0in 0.0001pt 0.5in;font-size:=
11pt;font-family:Calibri,sans-serif">1-=C2=A0=C2=A0=C2=A0=
=C2=A0
The head of the clinic was on leave and the=
 nutrition
nurse was absent, she was also responsible for screening and OPD-SAM case
management.

<p style=3D"line-height:11.75pt;background-image:initial;background-positio=
n:initial;background-size:initial;background-repeat:initial;background-orig=
in:initial;background-clip:initial;margin:0in 0in 0.0001pt 0.5in;font-size:=
11pt;font-family:Calibri,sans-serif">2-=C2=A0=C2=A0=C2=A0=
=C2=A0
The nutrition counselor was present.

<p style=3D"line-height:11.75pt;background-image:initial;background-positio=
n:initial;background-size:initial;background-repeat:initial;background-orig=
in:initial;background-clip:initial;margin:0in 0in 0.0001pt 0.5in;font-size:=
11pt;font-family:Calibri,sans-serif">3-=C2=A0=C2=A0=C2=A0=
=C2=A0
The GMP and screening were not properly don=
e for the
entire under 5 children.

<p style=3D"line-height:11.75pt;background-image:initial;background-positio=
n:initial;background-size:initial;background-repeat:initial;background-orig=
in:initial;background-clip:initial;margin:0in 0in 0.0001pt 0.5in;font-size:=
11pt;font-family:Calibri,sans-serif">4-=C2=A0=C2=A0=C2=A0=
=C2=A0
The register book for SAM cases did not fil=
l in the last
few days.

<p style=3D"line-height:11.75pt;background-image:initial;background-positio=
n:initial;background-size:initial;background-repeat:initial;background-orig=
in:initial;background-clip:initial;margin:0in 0in 0.0001pt 0.5in;font-size:=
11pt;font-family:Calibri,sans-serif">5-=C2=A0=C2=A0=C2=A0=
=C2=A0
The norms for the detection of SAM cases (M=
UAC, Z-Score, Edema) were
not properly followed.

<p style=3D"line-height:11.75pt;background-image:initial;background-positio=
n:initial;background-size:initial;background-repeat:initial;background-orig=
in:initial;background-clip:initial;margin:0in 0in 0.0001pt 0.5in;font-size:=
11pt;font-family:Calibri,sans-serif">6-=C2=A0=C2=A0=C2=A0=
=C2=A0
Poor stock or storage place for RUTF. It wa=
s stacked in the bathroom.

<p style=3D"line-height:11.75pt;background-image:initial;background-positio=
n:initial;background-size:initial;background-repeat:initial;background-orig=
in:initial;background-clip:initial;margin:0in 0in 0.0001pt 0.5in;font-size:=
11pt;font-family:Calibri,sans-serif">7-=C2=A0=C2=A0=C2=A0=
=C2=A0
Poor documentation.

<p style=3D"line-height:11.75pt;background-image:initial;background-positio=
n:initial;background-size:initial;background-repeat:initial;background-orig=
in:initial;background-clip:initial;margin:0in 0in 0.0001pt 0.5in;font-size:=
11pt;font-family:Calibri,sans-serif">8-=C2=A0=C2=A0=C2=A0=
=C2=A0
Unavailability of the ICE material.

<p style=3D"line-height:11.75pt;background-image:initial;background-positio=
n:initial;background-size:initial;background-repeat:initial;background-orig=
in:initial;background-clip:initial;margin:0in 0in 0.0001pt 0.5in;font-size:=
11pt;font-family:Calibri,sans-serif">9-=C2=A0=C2=A0=C2=A0=
=C2=A0
Appetite tests were not done for the OPDSAM=
 patient.

<p style=3D"line-height:11.75pt;background-image:initial;background-positio=
n:initial;background-size:initial;background-repeat:initial;background-orig=
in:initial;background-clip:initial;margin:0in 0in 0.0001pt 0.5in;font-size:=
11pt;font-family:Calibri,sans-serif">10-=C2=A0 <sp=
an dir=3D"LTR">The NC needs a standard scale

<p style=3D"line-height:11.75pt;background-image:initial;background-positio=
n:initial;background-size:initial;background-repeat:initial;background-orig=
in:initial;background-clip:initial;margin:0in 0in 0.0001pt 0.5in;font-size:=
11pt;font-family:Calibri,sans-serif">11-=C2=A0 <sp=
an dir=3D"LTR">The NC did not take
the MIYCN initial training yet.

<p style=3D"line-height:11.75pt;background-image:initial;background-positio=
n:initial;background-size:initial;background-repeat:initial;background-orig=
in:initial;background-clip:initial;margin:0in 0in 0.0001pt 0.5in;font-size:=
11pt;font-family:Calibri,sans-serif">12-=C2=A0 <sp=
an dir=3D"LTR">They had 3.5 carton
RUTF which was a low amount of RUTF stock for this Health facility.

<p style=3D"line-height:11.75pt;background-image:initial;background-positio=
n:initial;background-size:initial;background-repeat:initial;background-orig=
in:initial;background-clip:initial;margin:0in 0in 8pt 0.5in;font-size:11pt;=
font-family:Calibri,sans-serif">13-=C2=A0 RUTF was not
distributed through pharmacies.

Recommended
action:

1-=C2=A0=C2=A0=C2=A0=C2=
=A0
NC needs=C2=A0training.

2-=C2=A0=C2=A0=C2=A0=C2=
=A0
Provide the RUTF supply.

3-=C2=A0=C2=A0=C2=A0=C2=
=A0
RUTF should be distributed through Pharmacy=
.

4-=C2=A0=C2=A0=C2=A0=C2=
=A0
Follow up supportive supervision visits. </=
p>

5-=C2=A0=C2=A0=C2=A0=C2=
=A0
Provide the ICE material.

=C2=A0

District:
Surobi

HF:
Tizeen BHC

Code:41

Date
of Visit:21/09/2022

The
main findings:

=C2=A0

<p style=3D"margin:0in 0in 0.0001pt 0.75in;line-height:11.75pt;background-i=
mage:initial;background-position:initial;background-size:initial;background=
-repeat:initial;background-origin:initial;background-clip:initial;font-size=
:11pt;font-family:Calibri,sans-serif">1-=C2=A0=C2=A0=C2=
=A0=C2=A0
The head of the clinic was on leave on the =
date of monitoring and he recently joined this clinic.

<p style=3D"margin:0in 0in 0.0001pt 0.75in;line-height:11.75pt;background-i=
mage:initial;background-position:initial;background-size:initial;background=
-repeat:initial;background-origin:initial;background-clip:initial;font-size=
:11pt;font-family:Calibri,sans-serif">2-=C2=A0=C2=A0=C2=
=A0=C2=A0 The
nutrition counselor was present and newly coming to this clinic.

<p style=3D"margin:0in 0in 0.0001pt 0.75in;line-height:11.75pt;background-i=
mage:initial;background-position:initial;background-size:initial;background=
-repeat:initial;background-origin:initial;background-clip:initial;font-size=
:11pt;font-family:Calibri,sans-serif">3-=C2=A0=C2=A0=C2=
=A0=C2=A0 The
register book for SAM cases did not fill in the last few weeks.

<p style=3D"margin:0in 0in 0.0001pt 0.75in;line-height:11.75pt;background-i=
mage:initial;background-position:initial;background-size:initial;background=
-repeat:initial;background-origin:initial;background-clip:initial;font-size=
:11pt;font-family:Calibri,sans-serif">4-=C2=A0=C2=A0=C2=
=A0=C2=A0 Poor
stock or storage place for RUTF.

<p style=3D"margin:0in 0in 0.0001pt 0.75in;line-height:11.75pt;background-i=
mage:initial;background-position:initial;background-size:initial;background=
-repeat:initial;background-origin:initial;background-clip:initial;font-size=
:11pt;font-family:Calibri,sans-serif">5-=C2=A0=C2=A0=C2=
=A0=C2=A0 Poor
documentation.

<p style=3D"margin:0in 0in 0.0001pt 0.75in;line-height:11.75pt;background-i=
mage:initial;background-position:initial;background-size:initial;background=
-repeat:initial;background-origin:initial;background-clip:initial;font-size=
:11pt;font-family:Calibri,sans-serif">6-=C2=A0=C2=A0=C2=
=A0=C2=A0 Unavailability of the
ICE material.

<p style=3D"margin:0in 0in 0.0001pt 0.75in;line-height:11.75pt;background-i=
mage:initial;background-position:initial;background-size:initial;background=
-repeat:initial;background-origin:initial;background-clip:initial;font-size=
:11pt;font-family:Calibri,sans-serif">7-=C2=A0=C2=A0=C2=
=A0=C2=A0 They need a standard
measuring board.

<p style=3D"margin:0in 0in 0.0001pt 0.75in;line-height:11.75pt;background-i=
mage:initial;background-position:initial;background-size:initial;background=
-repeat:initial;background-origin:initial;background-clip:initial;font-size=
:11pt;font-family:Calibri,sans-serif">8-=C2=A0=C2=A0=C2=
=A0=C2=A0 The NC needs a standard scale.</p=
>

<p style=3D"margin:0in 0in 0.0001pt 0.75in;line-height:11.75pt;background-i=
mage:initial;background-position:initial;background-size:initial;background=
-repeat:initial;background-origin:initial;background-clip:initial;font-size=
:11pt;font-family:Calibri,sans-serif">9-=C2=A0=C2=A0=C2=
=A0=C2=A0 The NC did not take
the MIYCN initial training yet.

<p style=3D"margin:0in 0in 0.0001pt 0.75in;line-height:11.75pt;background-i=
mage:initial;background-position:initial;background-size:initial;background=
-repeat:initial;background-origin:initial;background-clip:initial;font-size=
:11pt;font-family:Calibri,sans-serif">10-=C2=A0 <s=
pan dir=3D"LTR">RUTF was not
distributed through the pharmacy.

<p style=3D"margin:0in 0in 8pt 0.75in;line-height:11.75pt;background-image:=
initial;background-position:initial;background-size:initial;background-repe=
at:initial;background-origin:initial;background-clip:initial;font-size:11pt=
;font-family:Calibri,sans-serif">11-=C2=A0 Unavailability of
stock cord.

Recommended
action:

=C2=A0

Fortunately, JACK office col=
leagues also came during
the supervision and we corrected a lot of things together.

=C2=A0

District:
Surobi

HF:
Gogamanda BHC

Code:2160

Date
of Visit:24/09/2022

The
main findings:

<p style=3D"line-height:11.75pt;background-image:initial;background-positio=
n:initial;background-size:initial;background-repeat:initial;background-orig=
in:initial;background-clip:initial;margin:0in 0in 0.0001pt 0.5in;font-size:=
11pt;font-family:Calibri,sans-serif">2-=C2=A0=C2=A0=C2=A0=
=C2=A0
Shortage of the SAM treatment cord.

<p style=3D"line-height:11.75pt;background-image:initial;background-positio=
n:initial;background-size:initial;background-repeat:initial;background-orig=
in:initial;background-clip:initial;margin:0in 0in 0.0001pt 0.5in;font-size:=
11pt;font-family:Calibri,sans-serif">3-=C2=A0=C2=A0=C2=A0=
=C2=A0
Unavailability of the signed prescription f=
or RUTF
distribution to SAM cases.

<p style=3D"line-height:11.75pt;background-image:initial;background-positio=
n:initial;background-size:initial;background-repeat:initial;background-orig=
in:initial;background-clip:initial;margin:0in 0in 0.0001pt 0.5in;font-size:=
11pt;font-family:Calibri,sans-serif">4-=C2=A0=C2=A0=C2=A0=
=C2=A0
The GMP and screening were not properly don=
e for the
entire under 5 children.

<p style=3D"line-height:11.75pt;background-image:initial;background-positio=
n:initial;background-size:initial;background-repeat:initial;background-orig=
in:initial;background-clip:initial;margin:0in 0in 0.0001pt 0.5in;font-size:=
11pt;font-family:Calibri,sans-serif">5-=C2=A0=C2=A0=C2=A0=
=C2=A0
CHS hasn&#39;t had any nutrition agenda in =
the last three months=E2=80=99 minutes of the meeting &amp; planning and in=
 the last month=E2=80=99s referral sheets he didn&#39;t have a single case =
of SAM.

<p style=3D"line-height:11.75pt;background-image:initial;background-positio=
n:initial;background-size:initial;background-repeat:initial;background-orig=
in:initial;background-clip:initial;margin:0in 0in 8pt 0.5in;font-size:11pt;=
font-family:Calibri,sans-serif">6-=C2=A0=C2=A0=C2=A0=C2=
=A0
The NC did not take the MIYCN initial train=
ing yet.

<p class=3D"MsoNormal" style=3D"line-height:11.75pt;background-image:initia=
l;background-position:initial;background-size:initial;background-repeat:ini=
tial;background-origin:initial;background-clip:initial;margin:0in 0in 8pt;f=
ont-size:11pt;font-family:Calibri,sans-serif">Recommended action:=

=C2=A0

During
these visits, on-the-job training was done, I worked with them on all affec=
ted
parts and mentioned some action points to the HF staff for further improvem=
ent
of the program.=C2=A0

Best
regards,=C2=A0

-- <div dir=3D"l=
tr" data-smartmail=3D"gmail_signature"><div dir=3D"ltr"><div> </div><div=
> </div><div>Dr. Naseer Ahmad Javed </div><div>MD, Internal Specialist=C2=A0 </div><=
div><div>Nutritional Technical=C2=A0E=
xtender, Kabul</div><div>Ph #:=
 0093788285428</div><div>=C2=
=A0 =C2=A0 =C2=A0 =C2=A0 0093793688575</div><div>WhatsApp #: 0093788285428</div><div>Email: <a href=3D"mailto:naseerjaved2@gmail.com" t=
arget=3D"_blank">naseerjaved2@gmail.com</a>=C2=A0</div><div>=C2=A0</div><div> </div></div></div></div></div>

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