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HRH - TA Survey Form

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For MFO 2 TEMPLATE 3

CONTROL # Office-_____________ (e.g. HPDPB-01)


To be filled by office staff

SATISFACTION SURVEY ON TECHNICAL ADVISORY AND SUPPORT

Instruction: This form is used to assess the satisfaction of LGUs, other government
agencies and other health partners on the different technical support provided by the
Department of Health. Please fill – up the form for the DEPLOYMENT OF HUMAN
RESOURCES FOR HEALTH (HRH)

Good day. The DOH - Regional Office 02 would like to seek your feedback on the
technical assistance provided by this office. All information will be considered
“confidential”. Place put a check mark () on the box for your response. Thank you.

PART A. PERSONAL INFORMATION

DATE: (MONTH/ DAY/YEAR)

AGE: _SEX:___M____/ POSITION TITLE:___MHO_____

OFFICE: _____________________________________

PART B: TECHNICAL ASSISTANCE UTILITY, QUALITY AND TIMELINESS ASSESSTMENT

TYPE OF TA PROVIDED: deployment of HRH (DTTB/ Dentist/ Nurses/ Midwives/ PHA, Medical
Technologists/ UHC Implementers)

UTILITY OF TECHNICAL ASSISTANCE – Strongly Agree Disagree Strongly REFUSE TO


technical assistance provided is useful and agree disagree ANSWER
responsive
The technical assistance provided is useful
and responsive to our needs
QUALITY OF TECHNICAL ASSISTANCE- Strongly Agree Disagree Strongly REFUSE TO
HRH( competent, capable, committed) agree disagree ANSWER
I am satisfied with the quality of the TA
provided
TIMELINESS OF TECHNICAL ASSISTANCE- Strongly Agree Disagree Strongly REFUSE TO
deployed at a suitable time agree disagree ANSWER

The technical assistance provided is timely

PART C. OVER-ALL ASSESMENT VERY High Moderate Low REFUSE TO


HIGH (3) (2) (1) ANSWER
(4)
Please rate your over-all satisfaction with the
technical assistance provided by the office

Recommendations/ Suggestions:

Technical assistance for the RHMPP should complement the needs of the different birthing
centers to facilitate the delivery of Maternal and Child care services. This would give them the
opportunity to harness their skills especially in maternal delivery. Currently, the RHMMP’s are
assigned in the main RHU where there is no birthing center.

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