Table 1.

Performance indicators/guidelines against which quality for Kamuli district health facilities was judged.

Health facility expected performance indicators or guidelines	Actual performance level	Source of data	Performance score
Structural performance guidelines/indicators
All health workers participate in identification of TB suspects	1 = Yes   2 = No	Interviewed health facility heads, TB focal persons, and in-charges ART	1 = good   2 = poor
Waiting times for; (i) Receiving laboratory results   (ii) Receiving treatment	(i) 1 = 24 hours 2 => 24 hours (50% and above of clients getting results after 24 hours)   (ii) 1 = immediate 2 => 1 day	Interviewed patients	1 = good   2 = poor
Process performance guidelines/indicators
Two sputum samples should be collected for diagnosis	All suspects should have two ZN smears done	Reviewed laboratory register data for 2010	1 = 81–100% = good   2 = 70–80% = fair   3 =< 70% = poor
The health facility in conjunction with the sub-county health worker, and community volunteers should trace all clients who have disappeared without getting treatment, and any other category of interest	1 = Yes 2 = No	Interviewed health facility heads, in-charges ART, and TB focal persons	1 = good   2 = poor
All TB suspects should be assessed using a symptom based approach	Percentage of TB suspects who were assessed by the laboratory with at least one ZN test	Reviewed the laboratory register and identified patients who were registered but no test done for them at all	1 = 0 patients = very good   2 = 1–3 patients = good   3 = 4 & > patients = poor
To assess and foster adherence to treatment, a patient-centered approach to administration of drug treatment, based on the patient's needs and mutual respect between the patient and the provider, should be developed for all patients. Supervision and support should be individualized and should draw on the full range of recommended interventions and available support services, including patient counseling and education	Each TB positive patients should be on community based-DOTs	Reviewed the unit TB treatment register	1 = all patients = good   2 = some patients not on DOTs = poor
Process performance guidelines/indicators
HIV testing and counseling should be recommended to all patients with, or suspected of having, tuberculosis	Every TB suspect should be advised to test for HIV	Interview with patients	1 = all patients = good   2 = some patients not advised = poor
Each healthcare facility caring for patients who have, or are suspected of having, infectious tuberculosis should develop and implement an appropriate tuberculosis infection control plan	Presence of a system of identifying coughing patients from waiting areas and other places	Interviewed health facility heads, in-charges ART, and TB focal persons	1 = good   2 = poor
Outcome performance guidelines/indicators
Cured	Percentage declared cured	Reviewed data in the treatment register for 2010	1 = 85–100% = good   2 = less than 85% = poor
Treatment failures	Number declared as failures	Reviewed data in the treatment register for 2010	1 = 0 patients = good   2 = 1 or > patients = poor
Defaulters	Percentage defaulters, no patient should default	Reviewed data in the treatment registers for 2010	1 = 0 patients = good   2 = 1–7 patients = fair   3 = 8 and > patients = poor
Died	Percentage died, no patient is expected to die	Reviewed data in the treatment register for 2010	1 = 0 = good   2 = 1–5 patients = fair   3 = 5 and > patients = poor