espen-mda-supervision-hf
type: Questionnaire
node role: treeRoot
resource.id:
  value: espen-mda-supervision-hf
resource.meta:
  meta.tag:
    index: 0
    coding.system:
      value: https://icr.healthcampaigns.org/CodeSystem/icr-project-tag-cs
    coding.code:
      value: espen
    coding.display:
      value: ESPEN
domain resource.text:
  narrative.status:
    value: extensions
  narrative.div: Generated Narrative: Questionnaire espen-mda-supervision-hf Tag: ESPEN (Details: ICR Project Tag code espen = 'ESPEN') Structure LinkID Text Cardinality Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> EspenMDASupervisionHF 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 the campaign-form pattern (ICRCampaignFormResponse, working doc §4.6) the QuestionnaireResponse itself is the supervision record. Questionnaire https://icr.healthcampaigns.org/Questionnaire/espen-mda-supervision-hf#0.1.0 #xD; s_recorder_id Select the recorder ID 0..1 string #xD; s_state Select region 1..1 string #xD; s_district Select district 1..1 string #xD; s_health_facility Health facility 1..1 string #xD; s_location Village 1..1 string #xD; s_supervisor_Level Supervisor level 1..1 choice Options: 5 options #xD; s_date_start Campaign start date 1..1 date #xD; s_date_end Campaign end date 1..1 date #xD; s_disease Disease covered by the MDA 1..* choice Value Set: ICR NTD Disease #xD; s_medicine Select the medicine package 1..* choice Value Set: ICR MDA Medicine Package #xD; location Geographic coverage 0..1 group #xD; s_nb_villages_total Total number of villages 1..1 integer #xD; s_nb_villages_treated Number of villages treated 1..1 integer #xD; s_nb_villages_non_treated Number of villages not treated 0..1 integer #xD; s_reason_non_treatment Reasons for non-treatment 0..* choice Enable When: s_nb_villages_non_treated > 0 Options: 6 options #xD; logistic_ivm Ivermectine Medication Management 0..1 group #xD; s_stock_remain_ivm Is there any Ivermectine remaining stock? 1..1 boolean #xD; s_stock_expired_ivm Are there any expired Ivermectine medications? 1..1 boolean #xD; s_stock_concordance_i…
questionnaire.url:
  value: https://icr.healthcampaigns.org/Questionnaire/espen-mda-supervision-hf
questionnaire.version:
  value: 0.1.0
questionnaire.name:
  value: EspenMDASupervisionHF
questionnaire.status:
  value: active
questionnaire.experimental:
  value: false
questionnaire.subject type:
  value: Location
  index: 0
questionnaire.date:
  value: 2026-08-20T10:45:05+00:00
questionnaire.publisher:
  value: UNICEF
questionnaire.contact:
  index: 0
  contact detail.name:
    value: UNICEF
  contact detail.telecom:
    index: 0
    contact point.system:
      value: url
    contact point.value:
      value: https://www.unicef.org
questionnaire.description:
  value: 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 the campaign-form pattern (ICRCampaignFormResponse, working doc §4.6) the QuestionnaireResponse itself is the supervision record.
questionnaire.jurisdiction:
  index: 0
  codeable concept.coding:
    index: 0
    coding.system:
      value: http://unstats.un.org/unsd/methods/m49/m49.htm
    coding.code:
      value: 001
    coding.display:
      value: World
questionnaire.item:
  index: 0
  questionnaire.item.link id:
    value: s_recorder_id
  questionnaire.item.text:
    value: Select the recorder ID
  questionnaire.item.type:
    value: string
questionnaire.item:
  index: 1
  questionnaire.item.link id:
    value: s_state
  questionnaire.item.text:
    value: Select region
  questionnaire.item.type:
    value: string
  questionnaire.item.required:
    value: true
questionnaire.item:
  index: 2
  questionnaire.item.link id:
    value: s_district
  questionnaire.item.text:
    value: Select district
  questionnaire.item.type:
    value: string
  questionnaire.item.required:
    value: true
questionnaire.item:
  index: 3
  questionnaire.item.link id:
    value: s_health_facility
  questionnaire.item.text:
    value: Health facility
  questionnaire.item.type:
    value: string
  questionnaire.item.required:
    value: true
questionnaire.item:
  index: 4
  questionnaire.item.link id:
    value: s_location
  questionnaire.item.text:
    value: Village
  questionnaire.item.type:
    value: string
  questionnaire.item.required:
    value: true
questionnaire.item:
  index: 5
  questionnaire.item.link id:
    value: s_supervisor_Level
  questionnaire.item.text:
    value: Supervisor level
  questionnaire.item.type:
    value: choice
  questionnaire.item.required:
    value: true
  questionnaire.item.answer option:
    index: 0
    questionnaire.item.answer option.value string:
      value: National
  questionnaire.item.answer option:
    index: 1
    questionnaire.item.answer option.value string:
      value: Regional
  questionnaire.item.answer option:
    index: 2
    questionnaire.item.answer option.value string:
      value: District
  questionnaire.item.answer option:
    index: 3
    questionnaire.item.answer option.value string:
      value: Partner
  questionnaire.item.answer option:
    index: 4
    questionnaire.item.answer option.value string:
      value: Health facility
questionnaire.item:
  index: 6
  questionnaire.item.link id:
    value: s_date_start
  questionnaire.item.text:
    value: Campaign start date
  questionnaire.item.type:
    value: date
  questionnaire.item.required:
    value: true
questionnaire.item:
  index: 7
  questionnaire.item.link id:
    value: s_date_end
  questionnaire.item.text:
    value: Campaign end date
  questionnaire.item.type:
    value: date
  questionnaire.item.required:
    value: true
questionnaire.item:
  index: 8
  questionnaire.item.link id:
    value: s_disease
  questionnaire.item.text:
    value: Disease covered by the MDA
  questionnaire.item.type:
    value: choice
  questionnaire.item.required:
    value: true
  questionnaire.item.repeats:
    value: true
  questionnaire.item.answer value set:
    value: https://icr.healthcampaigns.org/ValueSet/icr-ntd-disease
    link: https://icr.healthcampaigns.org/ValueSet/icr-ntd-disease
questionnaire.item:
  index: 9
  questionnaire.item.link id:
    value: s_medicine
  questionnaire.item.text:
    value: Select the medicine package
  questionnaire.item.type:
    value: choice
  questionnaire.item.required:
    value: true
  questionnaire.item.repeats:
    value: true
  questionnaire.item.answer value set:
    value: https://icr.healthcampaigns.org/ValueSet/icr-mda-medicine-package
    link: https://icr.healthcampaigns.org/ValueSet/icr-mda-medicine-package
questionnaire.item:
  index: 10
  questionnaire.item.link id:
    value: location
  questionnaire.item.text:
    value: Geographic coverage
  questionnaire.item.type:
    value: group
  questionnaire.item.item:
    index: 0
    questionnaire.item.link id:
      value: s_nb_villages_total
    questionnaire.item.text:
      value: Total number of villages
    questionnaire.item.type:
      value: integer
    questionnaire.item.required:
      value: true

index: 1
questionnaire.item.link id:
  value: s_nb_villages_treated
questionnaire.item.text:
  value: Number of villages treated
questionnaire.item.type:
  value: integer
questionnaire.item.required:
  value: true

index: 2
questionnaire.item.link id:
  value: s_nb_villages_non_treated
questionnaire.item.text:
  value: Number of villages not treated
questionnaire.item.type:
  value: integer

index: 3
questionnaire.item.link id:
  value: s_reason_non_treatment
questionnaire.item.text:
  value: Reasons for non-treatment
questionnaire.item.type:
  value: choice
questionnaire.item.enable when:
  index: 0
  questionnaire.item.enable when.question:
    value: s_nb_villages_non_treated
  questionnaire.item.enable when.operator:
    value: >
  questionnaire.item.enable when.answer integer:
    value: 0
questionnaire.item.repeats:
  value: true
questionnaire.item.answer option:
  index: 0
  questionnaire.item.answer option.value coding:
    coding.system:
      value: https://icr.healthcampaigns.org/CodeSystem/icr-missed-reason-cs
    coding.code:
      value: not-visited
    coding.display:
      value: Absence of DC
questionnaire.item.answer option:
  index: 1
  questionnaire.item.answer option.value coding:
    coding.system:
      value: https://icr.healthcampaigns.org/CodeSystem/icr-missed-reason-cs
    coding.code:
      value: refusal
    coding.display:
      value: Population refusal
questionnaire.item.answer option:
  index: 2
  questionnaire.item.answer option.value coding:
    coding.system:
      value: https://icr.healthcampaigns.org/CodeSystem/icr-missed-reason-cs
    coding.code:
      value: medication-shortage
    coding.display:
      value: Medication shortage
questionnaire.item.answer option:
  index: 3
  questionnaire.item.answer option.value coding:
    coding.system:
      value: https://icr.healthcampaigns.org/CodeSystem/icr-missed-reason-cs
    coding.code:
      value: insecurity
    coding.display:
      value: Insecurity
questionnaire.item.answer option:
  index: 4
  questionnaire.item.answer option.value coding:
    coding.system:
      value: https://icr.healthcampaigns.org/CodeSystem/icr-missed-reason-cs
    coding.code:
      value: difficult-access
    coding.display:
      value: Difficult access
questionnaire.item.answer option:
  index: 5
  questionnaire.item.answer option.value coding:
    coding.system:
      value: https://icr.healthcampaigns.org/CodeSystem/icr-missed-reason-cs
    coding.code:
      value: not-required
    coding.display:
      value: Not required

index: 11
questionnaire.item.link id:
  value: logistic_ivm
questionnaire.item.text:
  value: Ivermectine Medication Management
questionnaire.item.type:
  value: group
questionnaire.item.item:
  index: 0
  questionnaire.item.link id:
    value: s_stock_remain_ivm
  questionnaire.item.text:
    value: Is there any Ivermectine remaining stock?
  questionnaire.item.type:
    value: boolean
  questionnaire.item.required:
    value: true
questionnaire.item.item:
  index: 1
  questionnaire.item.link id:
    value: s_stock_expired_ivm
  questionnaire.item.text:
    value: Are there any expired Ivermectine medications?
  questionnaire.item.type:
    value: boolean
  questionnaire.item.required:
    value: true
questionnaire.item.item:
  index: 2
  questionnaire.item.link id:
    value: s_stock_concordance_ivm
  questionnaire.item.text:
    value: Does the physical stock of Ivermectine match the theoretical stock?
  questionnaire.item.type:
    value: boolean
  questionnaire.item.required:
    value: true

index: 12
questionnaire.item.link id:
  value: logistic_alb
questionnaire.item.text:
  value: Albendazole Medication Management
questionnaire.item.type:
  value: group
questionnaire.item.item:
  index: 0
  questionnaire.item.link id:
    value: s_stock_remain_alb
  questionnaire.item.text:
    value: Is there any Albendazole remaining stock?
  questionnaire.item.type:
    value: boolean
  questionnaire.item.required:
    value: true
questionnaire.item.item:
  index: 1
  questionnaire.item.link id:
    value: s_stock_expired_alb
  questionnaire.item.text:
    value: Are there any expired Albendazole medications?
  questionnaire.item.type:
    value: boolean
  questionnaire.item.required:
    value: true
questionnaire.item.item:
  index: 2
  questionnaire.item.link id:
    value: s_stock_concordance_alb
  questionnaire.item.text:
    value: Does the physical stock of Albendazole match the theoretical stock?
  questionnaire.item.type:
    value: boolean
  questionnaire.item.required:
    value: true

index: 13
questionnaire.item.link id:
  value: logistic_meb
questionnaire.item.text:
  value: Mebendazole Medication Management
questionnaire.item.type:
  value: group
questionnaire.item.item:
  index: 0
  questionnaire.item.link id:
    value: s_stock_remain_meb
  questionnaire.item.text:
    value: Is there any Mebendazole remaining stock?
  questionnaire.item.type:
    value: boolean
  questionnaire.item.required:
    value: true
questionnaire.item.item:
  index: 1
  questionnaire.item.link id:
    value: s_stock_expired_meb
  questionnaire.item.text:
    value: Are there any expired Mebendazole medications?
  questionnaire.item.type:
    value: boolean
  questionnaire.item.required:
    value: true
questionnaire.item.item:
  index: 2
  questionnaire.item.link id:
    value: s_stock_concordance_meb
  questionnaire.item.text:
    value: Does the physical stock of Mebendazole match the theoretical stock?
  questionnaire.item.type:
    value: boolean
  questionnaire.item.required:
    value: true

index: 14
questionnaire.item.link id:
  value: logistic_dec
questionnaire.item.text:
  value: Diethylcarbamazine Medication Management
questionnaire.item.type:
  value: group
questionnaire.item.item:
  index: 0
  questionnaire.item.link id:
    value: s_stock_remain_dec
  questionnaire.item.text:
    value: Is there any Diethylcarbamazine remaining stock?
  questionnaire.item.type:
    value: boolean
  questionnaire.item.required:
    value: true
questionnaire.item.item:
  index: 1
  questionnaire.item.link id:
    value: s_stock_expired_dec
  questionnaire.item.text:
    value: Are there any expired Diethylcarbamazine medications?
  questionnaire.item.type:
    value: boolean
  questionnaire.item.required:
    value: true
questionnaire.item.item:
  index: 2
  questionnaire.item.link id:
    value: s_stock_concordance_dec
  questionnaire.item.text:
    value: Does the physical stock of Diethylcarbamazine match the theoretical stock?
  questionnaire.item.type:
    value: boolean
  questionnaire.item.required:
    value: true

index: 15
questionnaire.item.link id:
  value: logistic_pzq
questionnaire.item.text:
  value: Praziquantel Medication Management
questionnaire.item.type:
  value: group
questionnaire.item.item:
  index: 0
  questionnaire.item.link id:
    value: s_stock_remain_pzq
  questionnaire.item.text:
    value: Is there any Praziquantel remaining stock?
  questionnaire.item.type:
    value: boolean
  questionnaire.item.required:
    value: true
questionnaire.item.item:
  index: 1
  questionnaire.item.link id:
    value: s_stock_expired_pzq
  questionnaire.item.text:
    value: Are there any Praziquantel expired medications?
  questionnaire.item.type:
    value: boolean
  questionnaire.item.required:
    value: true
questionnaire.item.item:
  index: 2
  questionnaire.item.link id:
    value: s_stock_concordance_pzq
  questionnaire.item.text:
    value: Does the physical stock of Praziquantel match the theoretical stock?
  questionnaire.item.type:
    value: boolean
  questionnaire.item.required:
    value: true

index: 16
questionnaire.item.link id:
  value: logistic_az_sus
questionnaire.item.text:
  value: Azytromicine Suspension Medication Management
questionnaire.item.type:
  value: group
questionnaire.item.item:
  index: 0
  questionnaire.item.link id:
    value: s_stock_remain_az_sus
  questionnaire.item.text:
    value: Is there any remaining stock of Azytromicine Suspension?
  questionnaire.item.type:
    value: boolean
  questionnaire.item.required:
    value: true
questionnaire.item.item:
  index: 1
  questionnaire.item.link id:
    value: s_stock_expired_az_sus
  questionnaire.item.text:
    value: Are there any expired Azytromicine suspension?
  questionnaire.item.type:
    value: boolean
  questionnaire.item.required:
    value: true
questionnaire.item.item:
  index: 2
  questionnaire.item.link id:
    value: s_stock_concordance_az_sus
  questionnaire.item.text:
    value: Does the physical stock of Azytromicine suspension match the theoretical stock?
  questionnaire.item.type:
    value: boolean
  questionnaire.item.required:
    value: true

index: 17
questionnaire.item.link id:
  value: logistic_az_tab
questionnaire.item.text:
  value: Azytromicine tablet Medication Management
questionnaire.item.type:
  value: group
questionnaire.item.item:
  index: 0
  questionnaire.item.link id:
    value: s_stock_remain_az_tab
  questionnaire.item.text:
    value: Is there any remaining stock of Azytromicine tablet?
  questionnaire.item.type:
    value: boolean
  questionnaire.item.required:
    value: true
questionnaire.item.item:
  index: 1
  questionnaire.item.link id:
    value: s_stock_expired_az_tab
  questionnaire.item.text:
    value: Are there any expired medications of Azytromicine tablet?
  questionnaire.item.type:
    value: boolean
  questionnaire.item.required:
    value: true
questionnaire.item.item:
  index: 2
  questionnaire.item.link id:
    value: s_stock_concordance_az_tab
  questionnaire.item.text:
    value: Does the physical stock of Azytromicine tablet match the theoretical stock?
  questionnaire.item.type:
    value: boolean
  questionnaire.item.required:
    value: true

index: 18
questionnaire.item.link id:
  value: logistic_tetra
questionnaire.item.text:
  value: Medication Management
questionnaire.item.type:
  value: group
questionnaire.item.item:
  index: 0
  questionnaire.item.link id:
    value: s_stock_remain_tetra
  questionnaire.item.text:
    value: Is there any remaining stock?
  questionnaire.item.type:
    value: boolean
  questionnaire.item.required:
    value: true
questionnaire.item.item:
  index: 1
  questionnaire.item.link id:
    value: s_stock_expired_tetra
  questionnaire.item.text:
    value: Are there any expired medications?
  questionnaire.item.type:
    value: boolean
  questionnaire.item.required:
    value: true
questionnaire.item.item:
  index: 2
  questionnaire.item.link id:
    value: s_stock_concordance_tetra
  questionnaire.item.text:
    value: Does the physical stock match the theoretical stock?
  questionnaire.item.type:
    value: boolean
  questionnaire.item.required:
    value: true

index: 19
questionnaire.item.link id:
  value: s_training
questionnaire.item.text:
  value: Distributor training
questionnaire.item.type:
  value: group
questionnaire.item.item:
  index: 0
  questionnaire.item.link id:
    value: s_dc_trained_h
  questionnaire.item.text:
    value: Number of male distributors trained
  questionnaire.item.type:
    value: integer
  questionnaire.item.required:
    value: true
questionnaire.item.item:
  index: 1
  questionnaire.item.link id:
    value: s_dc_trained_f
  questionnaire.item.text:
    value: Number of female distributors trained
  questionnaire.item.type:
    value: integer
  questionnaire.item.required:
    value: true
questionnaire.item.item:
  index: 2
  questionnaire.item.link id:
    value: s_manual_used
  questionnaire.item.text:
    value: Distributor manual used?
  questionnaire.item.type:
    value: boolean
  questionnaire.item.required:
    value: true

index: 20
questionnaire.item.link id:
  value: s_mobilisation
questionnaire.item.text:
  value: Social Mobilisation
questionnaire.item.type:
  value: group
questionnaire.item.item:
  index: 0
  questionnaire.item.link id:
    value: s_population_informed
  questionnaire.item.text:
    value: Was the population informed before the campaign?
  questionnaire.item.type:
    value: boolean
  questionnaire.item.required:
    value: true
questionnaire.item.item:
  index: 1
  questionnaire.item.link id:
    value: s_chanel_utilises
  questionnaire.item.text:
    value: Communication channels used
  questionnaire.item.type:
    value: choice
  questionnaire.item.required:
    value: true
  questionnaire.item.repeats:
    value: true
  questionnaire.item.answer option:
    index: 0
    questionnaire.item.answer option.value coding:
      coding.system:
        value: https://icr.healthcampaigns.org/CodeSystem/icr-communication-channel-cs
      coding.code:
        value: radio
      coding.display:
        value: Radio
  questionnaire.item.answer option:
    index: 1
    questionnaire.item.answer option.value coding:
      coding.system:
        value: https://icr.healthcampaigns.org/CodeSystem/icr-communication-channel-cs
      coding.code:
        value: town-criers
      coding.display:
        value: Town criers
  questionnaire.item.answer option:
    index: 2
    questionnaire.item.answer option.value coding:
      coding.system:
        value: https://icr.healthcampaigns.org/CodeSystem/icr-communication-channel-cs
      coding.code:
        value: community-leaders
      coding.display:
        value: Community leaders
  questionnaire.item.answer option:
    index: 3
    questionnaire.item.answer option.value coding:
      coding.system:
        value: https://icr.healthcampaigns.org/CodeSystem/icr-communication-channel-cs
      coding.code:
        value: schools
      coding.display:
        value: Schools
  questionnaire.item.answer option:
    index: 4
    questionnaire.item.answer option.value coding:
      coding.system:
        value: https://icr.healthcampaigns.org/CodeSystem/icr-communication-channel-cs
      coding.code:
        value: posters
      coding.display:
        value: Posters

index: 21
questionnaire.item.link id:
  value: s_supervision
questionnaire.item.text:
  value: Area of supervision
questionnaire.item.type:
  value: group
questionnaire.item.item:
  index: 0
  questionnaire.item.link id:
    value: s_dc_supervised
  questionnaire.item.text:
    value: Number of distributors supervised
  questionnaire.item.type:
    value: integer
  questionnaire.item.required:
    value: true
questionnaire.item.item:
  index: 1
  questionnaire.item.link id:
    value: s_villages_supervised
  questionnaire.item.text:
    value: Number of villages supervised
  questionnaire.item.type:
    value: integer

index: 22
questionnaire.item.link id:
  value: s_pharmacovigilance
questionnaire.item.text:
  value: Pharmacovigilance
questionnaire.item.type:
  value: group
questionnaire.item.item:
  index: 0
  questionnaire.item.link id:
    value: s_side_effect
  questionnaire.item.text:
    value: Were any adverse effects reported?
  questionnaire.item.type:
    value: boolean
  questionnaire.item.required:
    value: true
questionnaire.item.item:
  index: 1
  questionnaire.item.link id:
    value: s_sever_side_effect
  questionnaire.item.text:
    value: Were any serious adverse effects reported?
  questionnaire.item.type:
    value: boolean
  questionnaire.item.required:
    value: true

index: 23
questionnaire.item.link id:
  value: s_difficultes
questionnaire.item.text:
  value: Challenges encountered
questionnaire.item.type:
  value: text

index: 24
questionnaire.item.link id:
  value: s_solutions
questionnaire.item.text:
  value: Proposed solutions
questionnaire.item.type:
  value: text

index: 25
questionnaire.item.link id:
  value: s_recommandations
questionnaire.item.text:
  value: Supervisor recommendations
questionnaire.item.type:
  value: text