SOCIAL AUDIT OF HEALTH AND WELLNESS CENTRES

COMMUNITY LEVEL TOOL

(PART A)
Sr.No. Indicator Response

1 District

2 Block

3 Primary Health Center

4 Sub-Centre

5 Village

6 Date of Audit

7 Social Auditor's Name 1

I.REPRODUCTIVE AND CHILD HEALTH CARE

(Instructions: This tool is to be filled by asking questions to Pregnant Women (Section I.A) , Recently delivered mothers(Section I.B and I.C -in last 6
months), Mothers of children aged between 3 months to 59 months (Section I.D)

Write 1-Yes, 2-No and quantity wherever asked.

S No Question Detail 1 2 3 4 5

Beneficiary Name

Husband’s name

Revenue
Village/Ward Name

SC/ST/OBC
 Pregnant /Recently
delivered

I.A CARE AROUND PREGNANCY (Both Pregnant Women and Recently delivered Women to be interviewed) To be verified with ANC
register, MCP card etc

1 Was your pregnancy registered by ANM in

your area?
Write 1- Yes, 2- No

2 How many ANC check-ups did you get done?

Provide a number

3 Did you receive TT injection during

pregnancy? Write 1- Yes, 2- No

4 Did you receive 180 IFA tablets during

pregnancy? Write 1- Yes, 2- No

5 How was your overall experience for

receiving ANC check-ups?1-Good, 2-Average,
3- Poor

I.B Health Services around Delivery;

Recently delivered Women to be interviewed ;Data to be verified with MCP card , service records
Please ensure that women who had a still birth are not interviewed

1 Please Mention the place of delivery (1-

DH,2- Sub-district Hosp/CHC, 3-PHC , 4-
SC/HWC, 5-Private, 6-Home)

2 Was referral transport by health facility

arranged at the time of delivery?
Write 1- Yes, 2- No

3 Did you spend any money during delivery? If

yes, Under what heads did you incur
 expenditure during delivery? 1- Transport, 2-
Medicines, 3-Tests, 4- Food, 5- Blood
transfusion, 6-USG , 7- Others

4 How was your overall delivery experience at

hospital? 1-Good, 2-Average, 3-Poor

I.C Newborn Care and Post natal Care (Data to be verified wih MCP card , HBNC visit format, service records)

1 Was your child vaccinated at birth? Write 1-

Yes, 2- No

2 Did ASHA visit your home to check your and

newborn’s health? Write 1- Yes, 2- No

I.D Child Care ( 3 months to 59 months) (Data to be verified with MCP card , HBYC visit format, service records)

1 Did your child receive immunisations

regularly at HWC / VHND sessions? Write 1-
Yes, 2- No

2 Did your child receive Iron syrup regularly?

Write 1- Yes, 2- No

3 Did ASHA visit your home regularly to check

your child’s health(HBYC Visit)? Write 1- Yes,
2- No

II. ADOLESCENT HEALTH SERVICES

S No Question Detail 1 2 3 4 5

Name of Adolescent

Category-SC/ST/
OBC/minority
 1 Have you received Iron tablet (IFA Blue) in
your area? Write 1- Yes, 2- No

2 Have you received free sanitary napkin? Only

for adolescent girls Write 1- Yes, 2- No

3 Have you received Health check up at

school ? Write 1- Yes, 2- No

4 Are adolescent group meetings, Maitri

meetings etc. conducted in your area? Write
1- Yes, 2- No

III. CHRONIC CONDITIONS - NON-COMMUNICABLE DISEASE SERVICES

Data to be verified through OPD slip, service records.
S No Question Detail 1 2 3 4 5

Name of beneficiary

Category-SC/ST/
OBC/minority

1 Have you received the following services

regularly through HWC ?

For Diabetes

1.1 Blood sugar testing

1.2 Medicines for diabetes

For Hypertension

1.3 Blood pressure measurement

Medicines for hypertension

IV. CHRONIC CONDITIONS- COMMUNICABLE DISEASE SERVICES
Data to be verified through OPD slip, service records.
S No Question Detail 1 2 3 4 5

Name of Person

Category-SC/ST/
OBC/minority

1 Did you receive testing services through

HWC? ( For eg, sputum sample collection for
Tuberculosis ) Write 1- Yes, 2- No

2 Do you receive medicines / appropriate

treatment for your condition through HWC?

In case the patient is drop-out for DOTS,

probe further-

3 Why did you discontinue treatment for

DOTS? Write 1- Medicines not available , 2-
Difficult to consume medicines, 3- Expensive
to take medicines , 4- Others

V. ELDERLY HEALTH SERVICES

S No Question Detail 1 2 3 4 5

Name of Elderly

Category-SC/ST/
OBC/minority
 1 Are you suffering from any disease/
condition Write 1- Yes, 2- No

2 Are you visited by health workers for your

disease/condition? Write 1-Yes, 2-No

VI. PEOPLE WHO RECEIVED TREATMENT THROUGH PM-JAY

S No Question Detail 1 2 3 4 5

Name of person

Category-SC/ST/
OBC/minority

1 Were you able to get treatment from PM-JAY

facility? Write 1- Yes, 2- No

2 Were you satisfied with the treatment at

admitted PM-JAY facility? Write 1- Yes, 2- No

3 Did you incur any expenditure for seeking

treatment at PMJAY facility? Write 1-Yes, 2-
No

4 How much expenditure did you incur for

seeking care at PM-JAY facility?

VII. OVERALL SERVICES AT HEALTH AND WELLNESS CENTRE

A group of 10-12 people from each village to be asked the following questions for assessing the availability and accessibility of services at HWC.
Ensure the inclusion of 50% members from marginalised and vulnerable groups in the discussion-
Use the following responses 1- Always/Yes , 2- Sometimes , 3- Never
S No Question Detail Group 1 Group 2 Group 3 Group 4 Group 5

Village Name

1 Is CHO available at SC-HWC everyday? 1-

Always/Yes , 2- Sometimes , 3- Never

2 Are outpatient services for fever, cough,

diarrhoea, minor injuries etc provided? 1-
Always/Yes , 2- Sometimes , 3- Never

3 Are ANC services provided in your area? 1-

Always/Yes , 2- Sometimes , 3- Never

4 Is normal delivery conducted at centre (services

should be available for all) 1- Always/Yes , 2-
Sometimes , 3- Never

5 Are immunization services provided in your area?

1- Always/Yes , 2- Sometimes , 3- Never

6 Are Family Planning services available in you

area? 1- Always/Yes , 2- Sometimes , 3- Never

7 Is Tuberculosis testing available in your area? 1-

Always/Yes , 2- Sometimes , 3- Never

8 Is malaria testing available through HWC? Write

1- Always/Yes , 2- Sometimes , 3- Never
9 Is DOTS treatment provided for Tuberculosis at
HWC? 1- Always/Yes , 2- Sometimes , 3- Never

10 Are testing services for chronic conditions, such

as, diabetes, hypertension and cancers provided
at HWC? 1- Always/Yes , 2- Sometimes , 3-
Never
11 Are patients of diabetes, hypertension followed
 up? 1- Always/Yes , 2- Sometimes , 3- Never

12 Are VHND sessions conducted in your area? 1-

Always/Yes , 2- Sometimes , 3- Never
13 List the services available at VHND? 1-ANC, 2-
Immunisation, 3- THR distribution, 4-Weight
measurement of children, 5- Health education 6-
Other

14 Are yoga sessions conducted at the HWC? 1-

Always/Yes , 2- Sometimes , 3- Never
15 Is referral transport facility available in your
area? 1- Always/Yes , 2- Sometimes , 3- Never

16 Are essential medicines provided for fever, cold,

diarrhoea, diabetes, hypertension? 1-
Always/Yes , 2- Sometimes , 3- Never
17 How would you rate the overall experience at
HWC ?

1-Good/2-Average/3-Unsatisfactory

18 How would you rate the Staff behaviour?

1-Good/2-Average/3-Unsatisfactory

19 How much expenditure did you incur on availing

services at HWC?

20 Under what heads did you incur those

expenditures?1- Transport 2- Medicines 3-Tests
4-OPD charges 5-Other
 PART B
This part contains sections to be discussed with ASHAs and PRI members of catchment area of HWC
Section 1 – Interview of ASHAs
All ASHAs of participating villages/areas to be interviewed

S No Question Detail 1 2 3 4 5

Name of ASHA

Village Name

Category-SC/ST/
OBC/minority

1 Have you received any training in last one

year? Write 1- Yes, 2- No

2 Have you received HBNC and HBYC kit for

making home visits to newborn/child??
Write 1- Yes, 2- No

3 Is your drug kit regularly refilled? Write 1-

Yes, 2- No

4 Are your grievances acknowledged and

addressed through health facility? Write 1-
Yes, 2-No

5 Do you receive you incentives regularly for

your work? Write 1-Yes, 2-No
Section 2- Interview of PRI Members
Discussion with PRI members will be held , including those who are members of different committees such as VHSNC and JAS. For verification
of responses refer to Monthly meeting registers, Bank Passbook and records-

SNo Question Response Comments

1 Does the HWC open regularly to provide

services to the community?

2 Are medicines available at facility to be

given in sufficient quantities to patients as
required?

3 Are VHND services conducted regularly in

your area?

4 Are transport facilities available to take

pregnant women / serious cases to
hospitals in need?

5 Do patients with chronic conditions

receive appropriate care from service
providers both at home and facility?

6 How would you rate the quality of

services provided through HWC? 1-
Good , 2- Average , 3- Bad

7 Committee Related Questions-

8 Are JAS committee meetings held

regularly?

9 Do the members attend JAS meeting

regularly?
10 When did committee receive its last
untied fund amount of Rs 50,000?
11 Has a separate bank account been
created for untied funds?1- Yes, 2- No

12 Under what heads are untied fund

amount spent? 1- Medicines , 2- Referral
transport 3- Tests, 4- Consumables 5-
Cleanliness of facility , 6- Health
promotion , 7- Exercise and equipment, 8-
Others

13 Are records maintained for meetings and

untied fund expenditure? Write 1-Yes, 2-
No