{ "resourceType" : "Questionnaire", "id" : "espen-mda-supervision-hf", "meta" : { "tag" : [{ "system" : "https://icr.healthcampaigns.org/CodeSystem/icr-project-tag-cs", "code" : "espen", "display" : "ESPEN" }] }, "text" : { "status" : "extensions", "div" : "

Generated Narrative: Questionnaire espen-mda-supervision-hf

Tag: ESPEN (Details: ICR Project Tag code espen = 'ESPEN')

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LinkIDTextCardinalityTypeDescription & Constraints\"doco\"
\".\"\".\" EspenMDASupervisionHFESPEN MDA demo Form 5 (supervision at health facility): geographic coverage of villages treated, per-drug stock triplets (remaining/expired/concordance), distributor training, social mobilization, supervision area, pharmacovigilance, and free-text challenges/solutions/recommendations. No extraction templates: per ICRSupervisionReport (working doc §4.6) the QuestionnaireResponse itself is the supervision record.Questionnairehttps://icr.healthcampaigns.org/Questionnaire/espen-mda-supervision-hf#0.1.0
\".\"\".\"\".\" s_recorder_idSelect the recorder ID0..1string
\".\"\".\"\".\" s_stateSelect region1..1string
\".\"\".\"\".\" s_districtSelect district1..1string
\".\"\".\"\".\" s_health_facilityHealth facility1..1string
\".\"\".\"\".\" s_locationVillage1..1string
\".\"\".\"\".\" s_supervisor_LevelSupervisor level1..1choiceOptions: 5 options
\".\"\".\"\".\" s_date_startCampaign start date1..1date
\".\"\".\"\".\" s_date_endCampaign end date1..1date
\".\"\".\"\".\" s_diseaseDisease covered by the MDA1..*choiceValue Set: ICR NTD Disease
\".\"\".\"\".\" s_medicineSelect the medicine package1..*choiceValue Set: ICR MDA Medicine Package
\".\"\".\"\".\" locationGeographic coverage0..1group
\".\"\".\"\".\"\".\" s_nb_villages_totalTotal number of villages1..1integer
\".\"\".\"\".\"\".\" s_nb_villages_treatedNumber of villages treated1..1integer
\".\"\".\"\".\"\".\" s_nb_villages_non_treatedNumber of villages not treated0..1integer
\".\"\".\"\".\"\".\" s_reason_non_treatmentReasons for non-treatment0..*choiceEnable When: s_nb_villages_non_treated > 0
Options: 6 options
\".\"\".\"\".\" logistic_ivmIvermectine Medication Management0..1group
\".\"\".\"\".\"\".\" s_stock_remain_ivmIs there any Ivermectine remaining stock?1..1boolean
\".\"\".\"\".\"\".\" s_stock_expired_ivmAre there any expired Ivermectine medications?1..1boolean
\".\"\".\"\".\"\".\" s_stock_concordance_ivmDoes the physical stock of Ivermectine match the theoretical stock?1..1boolean
\".\"\".\"\".\" logistic_albAlbendazole Medication Management0..1group
\".\"\".\"\".\"\".\" s_stock_remain_albIs there any Albendazole remaining stock?1..1boolean
\".\"\".\"\".\"\".\" s_stock_expired_albAre there any expired Albendazole medications?1..1boolean
\".\"\".\"\".\"\".\" s_stock_concordance_albDoes the physical stock of Albendazole match the theoretical stock?1..1boolean
\".\"\".\"\".\" logistic_mebMebendazole Medication Management0..1group
\".\"\".\"\".\"\".\" s_stock_remain_mebIs there any Mebendazole remaining stock?1..1boolean
\".\"\".\"\".\"\".\" s_stock_expired_mebAre there any expired Mebendazole medications?1..1boolean
\".\"\".\"\".\"\".\" s_stock_concordance_mebDoes the physical stock of Mebendazole match the theoretical stock?1..1boolean
\".\"\".\"\".\" logistic_decDiethylcarbamazine Medication Management0..1group
\".\"\".\"\".\"\".\" s_stock_remain_decIs there any Diethylcarbamazine remaining stock?1..1boolean
\".\"\".\"\".\"\".\" s_stock_expired_decAre there any expired Diethylcarbamazine medications?1..1boolean
\".\"\".\"\".\"\".\" s_stock_concordance_decDoes the physical stock of Diethylcarbamazine match the theoretical stock?1..1boolean
\".\"\".\"\".\" logistic_pzqPraziquantel Medication Management0..1group
\".\"\".\"\".\"\".\" s_stock_remain_pzqIs there any Praziquantel remaining stock?1..1boolean
\".\"\".\"\".\"\".\" s_stock_expired_pzqAre there any Praziquantel expired medications?1..1boolean
\".\"\".\"\".\"\".\" s_stock_concordance_pzqDoes the physical stock of Praziquantel match the theoretical stock?1..1boolean
\".\"\".\"\".\" logistic_az_susAzytromicine Suspension Medication Management0..1group
\".\"\".\"\".\"\".\" s_stock_remain_az_susIs there any remaining stock of Azytromicine Suspension?1..1boolean
\".\"\".\"\".\"\".\" s_stock_expired_az_susAre there any expired Azytromicine suspension?1..1boolean
\".\"\".\"\".\"\".\" s_stock_concordance_az_susDoes the physical stock of Azytromicine suspension match the theoretical stock?1..1boolean
\".\"\".\"\".\" logistic_az_tabAzytromicine tablet Medication Management0..1group
\".\"\".\"\".\"\".\" s_stock_remain_az_tabIs there any remaining stock of Azytromicine tablet?1..1boolean
\".\"\".\"\".\"\".\" s_stock_expired_az_tabAre there any expired medications of Azytromicine tablet?1..1boolean
\".\"\".\"\".\"\".\" s_stock_concordance_az_tabDoes the physical stock of Azytromicine tablet match the theoretical stock?1..1boolean
\".\"\".\"\".\" logistic_tetraMedication Management0..1group
\".\"\".\"\".\"\".\" s_stock_remain_tetraIs there any remaining stock?1..1boolean
\".\"\".\"\".\"\".\" s_stock_expired_tetraAre there any expired medications?1..1boolean
\".\"\".\"\".\"\".\" s_stock_concordance_tetraDoes the physical stock match the theoretical stock?1..1boolean
\".\"\".\"\".\" s_trainingDistributor training0..1group
\".\"\".\"\".\"\".\" s_dc_trained_hNumber of male distributors trained1..1integer
\".\"\".\"\".\"\".\" s_dc_trained_fNumber of female distributors trained1..1integer
\".\"\".\"\".\"\".\" s_manual_usedDistributor manual used?1..1boolean
\".\"\".\"\".\" s_mobilisationSocial Mobilisation0..1group
\".\"\".\"\".\"\".\" s_population_informedWas the population informed before the campaign?1..1boolean
\".\"\".\"\".\"\".\" s_chanel_utilisesCommunication channels used1..*choiceOptions: 5 options
\".\"\".\"\".\" s_supervisionArea of supervision0..1group
\".\"\".\"\".\"\".\" s_dc_supervisedNumber of distributors supervised1..1integer
\".\"\".\"\".\"\".\" s_villages_supervisedNumber of villages supervised0..1integer
\".\"\".\"\".\" s_pharmacovigilancePharmacovigilance0..1group
\".\"\".\"\".\"\".\" s_side_effectWere any adverse effects reported?1..1boolean
\".\"\".\"\".\"\".\" s_sever_side_effectWere any serious adverse effects reported?1..1boolean
\".\"\".\"\".\" s_difficultesChallenges encountered0..1text
\".\"\".\"\".\" s_solutionsProposed solutions0..1text
\".\"\".\"\".\" s_recommandationsSupervisor recommendations0..1text

\"doco\" Documentation for this format

Options Sets

Answer options for s_supervisor_Level

Answer options for s_reason_non_treatment

Answer options for s_chanel_utilises

" }, "url" : "https://icr.healthcampaigns.org/Questionnaire/espen-mda-supervision-hf", "version" : "0.1.0", "name" : "EspenMDASupervisionHF", "status" : "active", "experimental" : false, "subjectType" : ["Location"], "date" : "2026-07-05T20:56:14+00:00", "publisher" : "UNICEF", "contact" : [{ "name" : "UNICEF", "telecom" : [{ "system" : "url", "value" : "https://www.unicef.org" }] }], "description" : "ESPEN MDA demo Form 5 (supervision at health facility): geographic coverage of villages treated, per-drug stock triplets (remaining/expired/concordance), distributor training, social mobilization, supervision area, pharmacovigilance, and free-text challenges/solutions/recommendations. No extraction templates: per ICRSupervisionReport (working doc §4.6) the QuestionnaireResponse itself is the supervision record.", "jurisdiction" : [{ "coding" : [{ "system" : "http://unstats.un.org/unsd/methods/m49/m49.htm", "code" : "001", "display" : "World" }] }], "item" : [{ "linkId" : "s_recorder_id", "text" : "Select the recorder ID", "type" : "string" }, { "linkId" : "s_state", "text" : "Select region", "type" : "string", "required" : true }, { "linkId" : "s_district", "text" : "Select district", "type" : "string", "required" : true }, { "linkId" : "s_health_facility", "text" : "Health facility", "type" : "string", "required" : true }, { "linkId" : "s_location", "text" : "Village", "type" : "string", "required" : true }, { "linkId" : "s_supervisor_Level", "text" : "Supervisor level", "type" : "choice", "required" : true, "answerOption" : [{ "valueString" : "National" }, { "valueString" : "Regional" }, { "valueString" : "District" }, { "valueString" : "Partner" }, { "valueString" : "Health facility" }] }, { "linkId" : "s_date_start", "text" : "Campaign start date", "type" : "date", "required" : true }, { "linkId" : "s_date_end", "text" : "Campaign end date", "type" : "date", "required" : true }, { "linkId" : "s_disease", "text" : "Disease covered by the MDA", "type" : "choice", "required" : true, "repeats" : true, "answerValueSet" : "https://icr.healthcampaigns.org/ValueSet/icr-ntd-disease-vs" }, { "linkId" : "s_medicine", "text" : "Select the medicine package", "type" : "choice", "required" : true, "repeats" : true, "answerValueSet" : "https://icr.healthcampaigns.org/ValueSet/icr-mda-medicine-package-vs" }, { "linkId" : "location", "text" : "Geographic coverage", "type" : "group", "item" : [{ "linkId" : "s_nb_villages_total", "text" : "Total number of villages", "type" : "integer", "required" : true }, { "linkId" : "s_nb_villages_treated", "text" : "Number of villages treated", "type" : "integer", "required" : true }, { "linkId" : "s_nb_villages_non_treated", "text" : "Number of villages not treated", "type" : "integer" }, { "linkId" : "s_reason_non_treatment", "text" : "Reasons for non-treatment", "type" : "choice", "enableWhen" : [{ "question" : "s_nb_villages_non_treated", "operator" : ">", "answerInteger" : 0 }], "repeats" : true, "answerOption" : [{ "valueCoding" : { "system" : "https://icr.healthcampaigns.org/CodeSystem/icr-missed-reason-cs", "code" : "not-visited", "display" : "Absence of DC" } }, { "valueCoding" : { "system" : "https://icr.healthcampaigns.org/CodeSystem/icr-missed-reason-cs", "code" : "refusal", "display" : "Population refusal" } }, { "valueCoding" : { "system" : "https://icr.healthcampaigns.org/CodeSystem/icr-missed-reason-cs", "code" : "medication-shortage", "display" : "Medication shortage" } }, { "valueCoding" : { "system" : "https://icr.healthcampaigns.org/CodeSystem/icr-missed-reason-cs", "code" : "insecurity", "display" : "Insecurity" } }, { "valueCoding" : { "system" : "https://icr.healthcampaigns.org/CodeSystem/icr-missed-reason-cs", "code" : "difficult-access", "display" : "Difficult access" } }, { "valueCoding" : { "system" : "https://icr.healthcampaigns.org/CodeSystem/icr-missed-reason-cs", "code" : "not-required", "display" : "Not required" } }] }] }, { "linkId" : "logistic_ivm", "text" : "Ivermectine Medication Management", "type" : "group", "item" : [{ "linkId" : "s_stock_remain_ivm", "text" : "Is there any Ivermectine remaining stock?", "type" : "boolean", "required" : true }, { "linkId" : "s_stock_expired_ivm", "text" : "Are there any expired Ivermectine medications?", "type" : "boolean", "required" : true }, { "linkId" : "s_stock_concordance_ivm", "text" : "Does the physical stock of Ivermectine match the theoretical stock?", "type" : "boolean", "required" : true }] }, { "linkId" : "logistic_alb", "text" : "Albendazole Medication Management", "type" : "group", "item" : [{ "linkId" : "s_stock_remain_alb", "text" : "Is there any Albendazole remaining stock?", "type" : "boolean", "required" : true }, { "linkId" : "s_stock_expired_alb", "text" : "Are there any expired Albendazole medications?", "type" : "boolean", "required" : true }, { "linkId" : "s_stock_concordance_alb", "text" : "Does the physical stock of Albendazole match the theoretical stock?", "type" : "boolean", "required" : true }] }, { "linkId" : "logistic_meb", "text" : "Mebendazole Medication Management", "type" : "group", "item" : [{ "linkId" : "s_stock_remain_meb", "text" : "Is there any Mebendazole remaining stock?", "type" : "boolean", "required" : true }, { "linkId" : "s_stock_expired_meb", "text" : "Are there any expired Mebendazole medications?", "type" : "boolean", "required" : true }, { "linkId" : "s_stock_concordance_meb", "text" : "Does the physical stock of Mebendazole match the theoretical stock?", "type" : "boolean", "required" : true }] }, { "linkId" : "logistic_dec", "text" : "Diethylcarbamazine Medication Management", "type" : "group", "item" : [{ "linkId" : "s_stock_remain_dec", "text" : "Is there any Diethylcarbamazine remaining stock?", "type" : "boolean", "required" : true }, { "linkId" : "s_stock_expired_dec", "text" : "Are there any expired Diethylcarbamazine medications?", "type" : "boolean", "required" : true }, { "linkId" : "s_stock_concordance_dec", "text" : "Does the physical stock of Diethylcarbamazine match the theoretical stock?", "type" : "boolean", "required" : true }] }, { "linkId" : "logistic_pzq", "text" : "Praziquantel Medication Management", "type" : "group", "item" : [{ "linkId" : "s_stock_remain_pzq", "text" : "Is there any Praziquantel remaining stock?", "type" : "boolean", "required" : true }, { "linkId" : "s_stock_expired_pzq", "text" : "Are there any Praziquantel expired medications?", "type" : "boolean", "required" : true }, { "linkId" : "s_stock_concordance_pzq", "text" : "Does the physical stock of Praziquantel match the theoretical stock?", "type" : "boolean", "required" : true }] }, { "linkId" : "logistic_az_sus", "text" : "Azytromicine Suspension Medication Management", "type" : "group", "item" : [{ "linkId" : "s_stock_remain_az_sus", "text" : "Is there any remaining stock of Azytromicine Suspension?", "type" : "boolean", "required" : true }, { "linkId" : "s_stock_expired_az_sus", "text" : "Are there any expired Azytromicine suspension?", "type" : "boolean", "required" : true }, { "linkId" : "s_stock_concordance_az_sus", "text" : "Does the physical stock of Azytromicine suspension match the theoretical stock?", "type" : "boolean", "required" : true }] }, { "linkId" : "logistic_az_tab", "text" : "Azytromicine tablet Medication Management", "type" : "group", "item" : [{ "linkId" : "s_stock_remain_az_tab", "text" : "Is there any remaining stock of Azytromicine tablet?", "type" : "boolean", "required" : true }, { "linkId" : "s_stock_expired_az_tab", "text" : "Are there any expired medications of Azytromicine tablet?", "type" : "boolean", "required" : true }, { "linkId" : "s_stock_concordance_az_tab", "text" : "Does the physical stock of Azytromicine tablet match the theoretical stock?", "type" : "boolean", "required" : true }] }, { "linkId" : "logistic_tetra", "text" : "Medication Management", "type" : "group", "item" : [{ "linkId" : "s_stock_remain_tetra", "text" : "Is there any remaining stock?", "type" : "boolean", "required" : true }, { "linkId" : "s_stock_expired_tetra", "text" : "Are there any expired medications?", "type" : "boolean", "required" : true }, { "linkId" : "s_stock_concordance_tetra", "text" : "Does the physical stock match the theoretical stock?", "type" : "boolean", "required" : true }] }, { "linkId" : "s_training", "text" : "Distributor training", "type" : "group", "item" : [{ "linkId" : "s_dc_trained_h", "text" : "Number of male distributors trained", "type" : "integer", "required" : true }, { "linkId" : "s_dc_trained_f", "text" : "Number of female distributors trained", "type" : "integer", "required" : true }, { "linkId" : "s_manual_used", "text" : "Distributor manual used?", "type" : "boolean", "required" : true }] }, { "linkId" : "s_mobilisation", "text" : "Social Mobilisation", "type" : "group", "item" : [{ "linkId" : "s_population_informed", "text" : "Was the population informed before the campaign?", "type" : "boolean", "required" : true }, { "linkId" : "s_chanel_utilises", "text" : "Communication channels used", "type" : "choice", "required" : true, "repeats" : true, "answerOption" : [{ "valueCoding" : { "system" : "https://icr.healthcampaigns.org/CodeSystem/icr-communication-channel-cs", "code" : "radio", "display" : "Radio" } }, { "valueCoding" : { "system" : "https://icr.healthcampaigns.org/CodeSystem/icr-communication-channel-cs", "code" : "town-criers", "display" : "Town criers" } }, { "valueCoding" : { "system" : "https://icr.healthcampaigns.org/CodeSystem/icr-communication-channel-cs", "code" : "community-leaders", "display" : "Community leaders" } }, { "valueCoding" : { "system" : "https://icr.healthcampaigns.org/CodeSystem/icr-communication-channel-cs", "code" : "schools", "display" : "Schools" } }, { "valueCoding" : { "system" : "https://icr.healthcampaigns.org/CodeSystem/icr-communication-channel-cs", "code" : "posters", "display" : "Posters" } }] }] }, { "linkId" : "s_supervision", "text" : "Area of supervision", "type" : "group", "item" : [{ "linkId" : "s_dc_supervised", "text" : "Number of distributors supervised", "type" : "integer", "required" : true }, { "linkId" : "s_villages_supervised", "text" : "Number of villages supervised", "type" : "integer" }] }, { "linkId" : "s_pharmacovigilance", "text" : "Pharmacovigilance", "type" : "group", "item" : [{ "linkId" : "s_side_effect", "text" : "Were any adverse effects reported?", "type" : "boolean", "required" : true }, { "linkId" : "s_sever_side_effect", "text" : "Were any serious adverse effects reported?", "type" : "boolean", "required" : true }] }, { "linkId" : "s_difficultes", "text" : "Challenges encountered", "type" : "text" }, { "linkId" : "s_solutions", "text" : "Proposed solutions", "type" : "text" }, { "linkId" : "s_recommandations", "text" : "Supervisor recommendations", "type" : "text" }] }