Date of visit:
Researcher:	YES (1)	NO (0)
Records and supplies
Has list of pregnant women in area of coverage
For each pregnant women, schedules 2 visits during pregnancy noted on List of Pregnant Women or calendar
Has list of mothers having newborns
Schedules post natal home visits
Has all job aids (counseling cards, registers, equipment)
TOTAL score (out of 5)
Good communication skills
Greeting.
Explains why she is visiting today.
Acts with confidence.
Speaks in a gentle tone of voice, shows respect
Uses simple words in local language.
Uses any training aids appropriately
Asks the woman if s/he has any questions.
Answers clearly.
Thanks her for visit.
Says when s/he will return.
TOTAL score (out of 10)
Hand Washing
Removes bracelet and watch
Wets hands and arms to elbow
Applies soap and scrub arms, hands and nails
Rinses with clean water
Air dries with hands up
TOTAL score (out of 5)
Pregnancy Home Visit 1
Good Communication Skills(Above)
Uses counseling cards/referral notes
Counsels on importance of ANC
Counsels on danger signs during pregnancy
Counsels on health facility delivery
Counsels on good nutrition and rest
Counsels on individual birth plans
Completes Pregnant Mothers register
TOTAL score (out of 8)
Pregnancy Home Visit 2
Good Communication skills (above)
Uses counseling cards appropriately
Counsels on Birth Plan
Counsels/screens for danger signs
Counsels on breastfeeding
Counsels on good nutrition and rest
Counsels on immediate newborn care
Completes Mother and Newborn Form correctly
TOTAL score (out of 8)
Postnatal home visit
Good Communication skills (above)
Uses counseling cards appropriately
Conducts immediate newborn care (drying and wrapping in warm clothes)
Assists in initiation of breastfeeding within one hour)
Provides cord care
Observes a breastfeed
Teaches correct positioning and attachment appropriately
Assesses newborn (weight, respiration, temperature)
Provides eye care
Counsels on continued newborn care
TOTAL score (out of 10)
Skills checklist
Appropriately warms the newborn
Correctly weighs the newborn
Correctly counts respiratory rate
Correctly takes newborn temperature
TOTAL score (out of 4)