I care stakeholders survey
The aim of this survey is to evaluate the current situation  of primary health care (PHC) services and its supporting functions (such as centers, platform, training programs, diploma or other professional studies, etc)  in your institution and the level of participation of senior students of school of medicine and other allied health sciences schools (how and to what limit senior students and other students in the training year can share in the primary health care clinic in your institution) .
The main goal is to improve the compactness and skills of the medical and health sciences graduates to provide high quality medical and health services to the patients.
One of the main goal is to find out the specific needs of each single university /related faculty. Therefor it will be good if we know your faculty, university/institution and country

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1- University, Faculty, department *
2- Country *
3-Name (optionally)
4- Profession *
5- Position *
6- Years of experience in the current institution *
7- Years of involvement in primary health care *
8- Age *
9- Gender *
10- Do you have a primary health care center in your institution *
11- Do you have a primary health care center in your institution *
If previous question is no, Why?
If answer of previous question is  yes, Are they involved in the delivery of primary health care center services in any manner?
Clear selection
12- How do you describe their participation in the delivery of services *
If previous question is no, why?
13- How many senior students are involved in your primary health care unit(s)or any other center *
14- Number of students with respect to service *
1-3
4-6
7-9
more than 10
Family Medicine
Pediatric
Obstetric
ENT
Dentistry
Nutrition
Ophthakmology
Physiothreapy
Pharmacy
Others
15- Please specify the activities that they participate in; you may select more than one answer *
Required
If others Specify, please?
16- Please mention the main the services provided by the primary health care center (or any similar center   Namely……..) ; you may select more than one answer *
Required
17- Please mention the main specialties covering the services provided by the primary health care center or the other center . you may select more than one answer *
Required
If others, please specify
18- What is the seniority level of the physician providing medical consultation: ; you may select more than one answer *
Required
If others please specify
19- Kindly mention all health  professionals involved in the delivery of care in the center; you may select more than one answer *
Required
If others please specify?
20- Are there any instruments, devices, or platforms (such as cameras, displays, health information system…) in the center that help senior students to learn and participate in the service delivery? *
If yes please mention some, if no why not?
21- Do you have at your institute any relevant platform for PHC or any other specialization? *
If yes, kindly mention some of function of the platform, if no please why not?
22- Describe the main functions, units, activities and structure of existing PHC *
23- Do you have any In-service training or capacity building activities run by the primary health care center or other health units in your institution (such as life support training, simulation training…)? *
24- What is the number of patients per year who have access to the PHC center *
25- What is the number of the available clinical staff running the PHC center by category (Physician/ doctor) *
26- What is the number of the available clinical staff running the PHC center by category (Registered nurse) *
27- What is the number of the available clinical staff running the PHC center by category (Practical nurse) *
28- What is the number of the available clinical staff running the PHC center by category (Pharmacist ) *
29- What is the number of the available clinical staff running the PHC center by category (Dentist ) *
30- What is the number of the available clinical staff running the PHC center by category (Physiotherapist ) *
31- What is the number of the available clinical staff running the PHC center by category (Dietitian ) *
32- What is the number of the available clinical staff running the PHC center by category (Medical lab technician) *
33- What is the number of the available clinical staff running the PHC center by category (Social worker) *
34- What is the number of the available clinical staff running the PHC center by category (Psychosocial therapist) *
35- What is the number of the available clinical staff running the PHC center by category (Speech therapist) *
36- What is the number of the available clinical staff running the PHC center by category (other) specify *
37- Kindly suggest technological tools such as devices, applications, sensors. to facilitate patient-physician   distance communication and conduct eHealth activities such as diagnoses, consultation, treatment etc. *
38- Define main stakeholders for your institution and state the type of cooperation or relation with them. *
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