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Anm Template -Form Fill
Interviewer Information
Q01
Name of District (if applicable)
Q02
Interview No
Q03
Date of Interview
Q04
Time of Interview
Q05
Interviewer Name
Q06
Consent for Audio Recording Given
Yes
No
Demographic Information
A01
Respondent Name
A02
Name of District
A03
Name of Block
A04
Name of Village
A05
Age
A06
Education
A07
How long have you been working as ANM?
A08
Name of designated health facility
A09
Approximate households in the catchment areas
A10
Population of Catchment areas
In this section, I would like to know about your roles and responsibilities under COVID response, in addition to your routine duties. This would involve discussion about the services provided by you under COVID response.
B01
Are you presently, carrying out any of these routine services?
Organizing and conducting VHND
Institutional delivery
ANC
PNC
Routine Immunization
IFA and other supplements distribution
Tracking of HRPs
Referrals – HRPs, LBW etc.
HBNC
Follow-up
Screening of NCDs
OPD services in SCs
Routine Diagnostics test
family planning services
Any other (please specify)
B02
During lockdown, were you carrying out any of the routine activities?
Organizing and conducting VHND
Institutional delivery
ANC
PNC
Routine Immunization
IFA and other supplements distribution
Tracking of HRPs
Referrals – HRPs, LBW etc.
HBNC
Follow-up
Screening of NCDs
OPD services in SCs
Routine Diagnostics test
family planning services
Any other (please specify)
B03
When did you start performing the discontinued service?
B03_1
Organizing and conducting VHND
B03_2
Institutional delivery
B03_3
ANC
B03_4
PNC
B03_5
Routine Immunization
B03_6
IFA and other supplements distribution
B03_7
Tracking of HRPs
B03_8
Referrals – HRPs, LBW etc.
B03_9
HBNC
B03_10
Follow-up
B03_11
Screening of NCDs
B03_12
OPD services in SCs
B03_13
Routine Diagnostics test
B03_14
family planning services
B04
If you were not performing certain routine services, what were the reasons for not doing those routine services during lockdown?
B05
Did you face any difficulties availing payment before the lockdown period? What were they?
B06
In terms of COVID response, what are the services provided by you currently?
Counselling regarding Signs and symptoms of COVID
Tracking of symptoms of people in Home quarantine
Tracking of symptoms of people quarantined in facilities
Accompanying ASHA/AWW during community visit
Counseling on home quarantine
Counseling on social distancing and use of masks
Demonstrating Steps of handwashing
Referral of suspects to COVID facilities
Posted in COVID facility
Posted in other facility (Non-COVID)
Any other (please specify)
B07
In terms of COVID response, what are the services provided by you during lockdown?
Counselling regarding Signs and symptoms of COVID
Tracking of symptoms of people in Home quarantine
Tracking of symptoms of people quarantined in facilities
Accompanying ASHA/AWW during community visit
Counseling on home quarantine
Counseling on social distancing and use of masks
Demonstrating Steps of handwashing
Referral of suspects to COVID facilities
Posted in COVID facility
Posted in other facility (Non-COVID)
Any other (please specify)
B07A
How is the preparedness and service availability of your facility in response to COVID situation
B07A_1
Presence of hypochlorite solution or bleaching powder
Available
Not available
Available but inadequate
Don’t Know
B07A_2
Presence of soap
Available
Not available
Available but inadequate
Don’t Know
B07A_3
Presence of running water
Available
Not available
Available but inadequate
Don’t Know
B07A_4
Presence of Gloves
Available
Not available
Available but inadequate
Don’t Know
B07A_5
Presence of Masks-N-95/3 layered
Available
Not available
Available but inadequate
Don’t Know
B07A_6
PPE kits
Available
Not available
Available but inadequate
Don’t Know
B07A_7
Shift timings changed or increased for additional caseload
Yes
No
B07A_8
Facility timings
Yes
No
B07A_9
Following of social distancing norms
Yes
No
B07A_10
Display of IEC material on COVID
Yes
No
B08
Has the added responsibilities for COVID related work affected you in carrying out your regular work/routine activities? If yes, then in what ways?
B09
Are you getting any incentives in context of added or changed responsibilities due to COVID?
Yes
No
Communication
C01
Do you have any interactions with other FLWs – ASHA and AWW?
Yes
No
C02
In context of COVID response, what is the frequency of your interaction with other FLWs?
Yes, with increased frequency
Yes, with same frequency
Yes, with reduced frequency
None
C03
What are the platforms used for the interaction?
In-person
Telephonic
Online platform
Any other (please, specify)
C04
In context of COVID response, what is the role AWW and ASHA or What is the work they are doing?
C04A
In context of COVID response, How is your interaction with facility staff of nearby health facilities?
C05
Do you have any interactions with your supervisors?
Yes
No
C06
In context of COVID response, what is the frequency of your interaction with supervisor?
Yes, with increased frequency
Yes, with same frequency
Yes, with reduced frequency
None
C07
What are the platforms used for interaction?
In-person
Telephonic
Online platform
Any other (please, specify)
C08
What is the purpose of your interaction?
For routine activities
For activities related to COVID response
Challenges in community outreach
Receipt of Incentives
related to facilitiy resources
Any other (please, specify)
C09
Have you received any handholding/mentoring support from your supervisor on activities under COVID response?
Yes
No
C10
During the lockdown, have there been any monitoring visits made by your supervisor?
Yes
No
C11
Has there been any additional supervisor/ reporting authority pertaining to your activities for COVID response?
Yes
No
C12
How has your interaction with supervisor changed during the COVID situation?
Capacity Building
D01
Were you provided any training to carry out activities under COVID response?
Yes
No
D02
What were the areas of training?
Use of personal protection
Guidelines for Quarantine, Isolation
Signs, symptoms, of COVID
incubation period of COVID
Social distancing
Role of FLWs in prevention of COVID
Reporting
Hand washing
Donning and doffing of critical PPE,
Preparation of 1% chlorine solution
Laboratory testing
Performing routine activities during lockdown
Any other (please specify)
D03
Can you give us the following details about the trainings you attended?
D03_1
Who gave the training?
GoUP (State)
GoUP (district)
GoUP (block)
Any other partner
D03_2
When was the training given?
One week ago
2 weeks ago
1 month ago
More than a month ago
Don’t know
D03_3
How long was the training?
D03_4
Mode of training
In-person
Telephonic
Online platform
D03_5
Did the training cover all the activities you are currently doing in response to COVID?
Yes
No
D04
Were you provided any of these job aid resources to perform your responsibility for COVID response?
Guidelines
Protective gears
Reporting formats
Fliers/Posters
Any video aid – short films etc.
Modules
SMS
None
Tablets with learning resource materials
PPE
Any others
D05
Can you give us the following details about the resources you were provided
D05A
Provided by
D05A_1
Guidelines
GoUP
NGO
Local Leaders / institutions
Any other partners
D05A_2
Protective gears
GoUP
NGO
Local Leaders / institutions
Any other partners
D05A_3
Reporting formats
GoUP
NGO
Local Leaders / institutions
Any other partners
D05A_4
Fliers/Posters
GoUP
NGO
Local Leaders / institutions
Any other partners
D05A_5
Any video aid – short films etc.
GoUP
NGO
Local Leaders / institutions
Any other partners
D05A_6
Modules
GoUP
NGO
Local Leaders / institutions
Any other partners
D05A_7
SMS
GoUP
NGO
Local Leaders / institutions
Any other partners
D05A_8
None
GoUP
NGO
Local Leaders / institutions
Any other partners
D05A_9
Tablets with learning resource materials
GoUP
NGO
Local Leaders / institutions
Any other partners
D05A_10
PPE
GoUP
NGO
Local Leaders / institutions
Any other partners
D05B
When was it provided?
D05B_1
Guidelines
D05B_2
Protective gears
D05B_3
Reporting formats
D05B_4
Fliers/Posters
D05B_5
Any video aid – short films etc.
D05B_6
Modules
D05B_7
SMS
D05B_8
None
D05B_9
Tablets with learning resource materials
D05B_10
PPE
D05C
Were they adequate?
D05C_1
Guidelines
Yes
No
D05C_2
Protective gears
Yes
No
D05C_3
Reporting formats
Yes
No
D05C_4
Fliers/Posters
Yes
No
D05C_5
Any video aid – short films etc.
Yes
No
D05C_6
Modules
Yes
No
D05C_7
SMS
Yes
No
D05C_8
None
Yes
No
D05C_9
Tablets with learning resource materials
Yes
No
D05C_10
PPE
Yes
No
Community Response
E01
Has community been supportive in activities pertaining to COVID response?
Yes
No
E02
Has community been supportive pertaining to performing alternative mechanisms of your routine activities?
Yes
No
E03
What are the challenges` you have faced in performing your routine/alternative mechanism of routine activities or in activities pertaining to COVID response in lockdown?
E04
Have people from community reached out to you for seeking any of the health services during the lockdown?
ANC
PNC
Delivery
Immunization
IFA and other supplements
ORS and other medicine
Other medical emergencies
COVID related services
None
E05
How did you respond to the people reaching out to you for certain services during lockdown?
Not providing any services
Providing some essential services
Providing all services
Only providing those services which people ask for
Providing some services to select beneficiaries
E06
Do you think there will be changes in health seeking behavior and/or health outcomes, due to current lockdown situation? If yes, in what ways?
E07
Do you have any concerns while carrying out activities related to COVID response?
E08
In your opinion, what other steps could have been taken by GoUP under COVID response?
E09
We might contact you again in the few months’ time. Would you like to participate in follow up interview?
Yes
No
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