NRHM

ADILABAD DISTRICT, ANDHRA PRADESH
Action Based Monitoring- District Tour report (20th July 2010- 24th July 2010)
Prepared by: Dr. Rachana Parikh; MBBS, MPH Consultant NRHM, Ministry of Health and Family welfare, New Delhi

Table of Contents

List of Abbreviations .......................................................................................................... 2 Executive summary ............................................................................................................ 3

District Health Profile ................................................................................................. 6 Important Health Indicators ................................................................................... 6 Public Health Infrastructure in Adilabad ................................................................ 7 Human Resources in Adilabad .............................................................................. 10 Facility Assessment summary ................................................................................... 11 Gaps and Recommendations ........................................................................................... 20 Conclusion ........................................................................................................................ 26

Annexure 1: Road Map of Adilabad .......................................................................... 27 Annexure 2: Public Health Facilities in Adilabad ........................................................ 28 Annexure 3: Inspection forms of individual facilities ................................................. 29

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List of abbreviations

ABER AH AMG ANC APVVP ASHA BPL CEMONC CHC DCHS DH DLHS – 3 DM&HO DOTS HA HDS HMIS ICDS IMR IPD ITDA ITDA IUD JSY LHV MMR MPHA NICU NMR NRC OPD PHC PHI SBA SC VHND VHSC

Annual Blood Examination Rate Area Hospital Annual Maintenance Grant Antenatal Care Andhra Pradesh Vaidhya Vidhan Parishad Accredited Social Health Activist Below Poverty Line Comprehensive Emergency Obstetric and Neonatal Care Community Health Center District Coordinator of Hospital Services District Hospital District Level Household Survey – 3 District Medical and Health Officer Direct Observed Treatment Short course Health Assistant Hospital Development Society Health Management Information System (GoI) Integrated child Development Scheme Infant Mortality Rate In-Patient admissions Integrated Tribal Development Authority Integrated Tribal Development Authority Intrauterine device Janani Suraksha Yojana Lady Health Volunteer Maternal Mortality Rate Multi Purpose Health Assistants Neonatal Intensive Care Unit Neonatal Mortality Rate Nutritional Rehabilitation Center Out-Patient Department Primary Health Center Public Health Institution Skilled Birth Attendant Sub-center Village Health and Nutrition Day Village Health and Sanitation Committee

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3. Guided utilization of funds by the HDS and VHSC. 3.5% of its population living below poverty line. Majority of the CEMONC centers visited are not used. 6. Major gaps: 1. 8. 4. All aspects of antenatal care inclusive of hemoglobin testing. 7. The report is prepared for the district tour undertaken by the Consultant from 20th July 2010 to 24th July 2010. Biomedical waste management system is not in place and needs to be strengthened. Spurious reporting to be severely discouraged. 5. Improper and inadequate utilization of funds. 4. weight gain monitoring. Regular monitoring of all aspects of Maternal and Child Health with regular audit of maternal and infant deaths. Last year there were 37 notified outbreaks of diarrhea in the district. blood pressure measurement. The existing health facilities are highly underutilized. Regular monthly review meetings should be held at all levels. minimum 48 hours stay in the hospital post delivery. identification of high risk pregnancies. Many JSY beneficiaries are not given cash incentives The district does not have adequate number of PHIs. Weak Monitoring and supervision in general administration Poor performance and underutilization of Health facilities Village Health and Nutrition Days are neither planned nor conducted regularly. 2. Including monitoring responsibility in day to day activity schedule of all officers at all levels. Maternal mortality is high (385/ 100000 live births). ASHAs as well as Contractual Doctors. Irregular payments to ANMs. Micro-plans for VHNDs to be made meticulously and coordination with ICDS to be improved. There are no NICUs in the district. post natal follow up at home need to be strengthened.Executive Summary Adilabad is fifth largest district in Andhra Pradesh with 65% tribal area and 68. Important Recommendations: 1. at-least one check-up by Medical Officer and preparation of birth micro-plan are weak. 3|Page . Maternal and Child Health: Neonatal mortality accounts for 75% of the infant deaths in the district. 5. ABER is much below recommended value of at least 10%. 2. Major Public Health problems: Communicable diseases like malaria and diarrhea are common health problems in the district. Post natal care aspects like recording of weight of the newborn at birth.

10. 9. 4|Page . ORS distribution and sensitization of frontline functionaries and private practitioners to be initiated. under the authority of the in-charge officer of the referral hospital. Measures for prevention of diarrhea need to be strengthened. creation of posts of staff nurses at 24x7 PHCs. Accreditation of private institutions for JSY to be undertaken. Timely disbursement of funds to be ensured. to be expanded to other ANMs. 7. Strengthening of existing system of using burial pits and impervious sharp pits in every PHC. 8. ABER to be increased to 10% 11. The way ahead: Strengthening General Administration and monitoring. Sub-centers to be encouraged to conduct deliveries and SBA training recommended for ANMs of such selected sub-centers initially. ensuring proper utilization of the funds provided to different health facilities is of prime importance to achieve improvements across deliverables. 14. Regular payment of the staff nurses. Payment of the cash incentive should be done at the institution where the delivery has taken place. Fresh recruitment of specialists at referral hospitals and redeployment of specialist working at Primary level to the referral level. Ensuring that at least one HDS meeting took place in the coming quarter and patient facilities were taken as a top priority agenda. contracting out of disposal of waste produced by the PHI. Positive deviant case studies may be adopted to promote best practices and encourage creative use of the funds. 13.6. Fresh recruitment of MPHA males. 12.

Most of the working population is engaged in agriculture. 65% of the district area is tribal area with a population of 770. Literacy rate was 27.5%) are living below poverty line.8% of the district is covered by forest. The district is administratively divided into 52 mandals with 1748 revenue villages and 7 municipalities. There are 3335 habitations in the district. The density of population is 182 persons per km 2. 359. 44.162 households (68. in 2001. with a population of 2.000 (estimated for June 2010).106 (25. ANDHRA PRADESH Action Based Monitoring – 20th to 24th July 2010 Adilabad is the fifth largest district in Andhra Pradesh.73% of the population of the district).ADILABAD DISTRICT. which is much below the state and the national average.993.8%. 5|Page .

communicable diseases like malaria and diarrhea . 6 outbreaks of diarrhea following consumption of spoiled food. 2 diarrhea outbreaks following consumption of spoiled food. 111% (Form A of monitoring) 85% 7.06% (2009-10) 58.9 per 1000 live births 91.common health problems Table 1: Important Health indicators of the district Adilabad Indicators Crude Birth Rate Crude death rate Maternal Mortality Rate (MMR) Neonatal Mortality Rate (NMR) Neonatal deaths as a proportion of Infant deaths Infant Mortality Rate (IMR) Percentage of expected deliveries reported Percentage of institutional deliveries (of the total expected deliveries.71 (2009-10) 13.3% None last year.Important Health Indicators: Maternal and child health.2 0. 2009-10) Pregnant women tracking Percentage of fully immunized children (DLHS-3: 49%) Case Detection Rate of Tuberculosis among new sputum positive patients initiated on DOTS Treatment Success Rate among new sputum positive patients initiated on DOTS ABER for malaria API for malaria Prevalence of Leprosy per 1000 population Annual Case Detection Rate for Leprosy Outbreaks in the year 2009 (Jan-Dec) (Values as provided by the district.) Outbreaks in the year 2010 (Jan-July) 6|Page .1% (district data 2009).2% 0.District Health Profile . 66.) 6 (4 outbreaks of diarrhea following consumption of contaminated water.6 37 (31 outbreaks of diarrhea following consumption of contaminated water. especially neonatal care. for 2009) 23 per 1000 population 9 per 1000 population 385 per 100000 live births 44 per 1000 live births 75% (HMIS 2009-10) 63.

Table 2: Public Health Infrastructure in Adilabad Institutions Total Number of PHCs Number of tribal PHCs Number of 24*7 PHCs (Round the clock MCH centers) Average population served by each PHC Number of PHCs not conducting deliveries Number of PHCs conducting less than 10 deliveries a month Number of PHCs where >50% of all registered deliveries are home deliveries Total Number of sub-centers (SC) Number of Tribal sub-centers Average population served by a sub-center Number of sub-centers conducting deliveries Number of Community Health Centers (CHC) Number of CHCs conducting fewer than 20 deliveries a month Number of Post Partum Units Number of Urban Health Centers Number of Urban Family Welfare Centers Number of Government general Hospitals Number of Area Hospitals (AH) Both these AH conducting fewer than 20 deliveries a month District Hospitals (DH) 108 Service Ambulances 104 Service Ambulances Number of CEMONC centers Number 71 31 39 42155 22 23 55 469 186 6382 0 10 (4: DM&HO. 6: APVVP) 4 3 11 3 4 2 1 30 24 8 Communicable diseases:  Diarrhea: It is an important public health problem in the district.Public Health Infrastructure in Adilabad PHIs of Adilabad are highly underutilized. CEMONC centers appear neglected. Majority of the outbreaks occur due to 7|Page . Last year 37 outbreaks were recorded as mentioned above.

weight gain monitoring. Table 3: Situation Analysis of the 4 CEMONC centers visited. o Village Health and Nutrition Days (VHND): VHNDs are not being carried out in the district. these were not recorded. 2 Pediatricians (MCH).8% of children with diarrhea received ORS. blood pressure measurement. Further. 2 Obstetricians (CEMONC). 4 Anesthetists available. o Height.consumption of water from streams or open wells or bore-wells which are contaminated. DLHS 3 data suggests that only 39. Minimum required ABER is 10%. However. In two the sub-centers visited. In the third sub-center at Venkatapurum the ANMs would copy the details mentioned in the ANC cards of the women from private hospitals and enter into the registers.  Malaria: The ABER is 7. Further. o Hemoglobin testing. availability of the reagents was the weak link in both plain and ITDA area. which is responsible for food poisoning. although majority of the sub-centers in the ITDA area did have them. o No identification of high risk pregnancies or birth micro-plans being made. Maternal and Child Health:  Antenatal care: All aspects of antenatal care inclusive of hemoglobin testing. Micro-planning is not being done at sub-center level. 8|Page . identification of high risk pregnancies. No specialists No Obstetrician or Pediatrician. while nearly 60% of all the children with diarrhea did receive some treatment. CEMONC centers visited Laxetipet Civil Hospital MCH Nirmal Utnoor CHC (Tribal area) Mancherial AH Condition Locked Functioning Not being used No existing center Availability of Specialists None 1 Obstetrician (MCH). Some sub-centers did not have Sahli’s hemoglobin meter. Weight and Blood Pressure measurement. only 24. One sub-center did not have the BP instrument and weighing machine.9% of the households had access to piped water supply (DLHS -3).2% which is inadequate for surveillance. Often inappropriately stored meat and spoiled meat is consumed by the villagers. at-least one check-up by Medical Officer and preparation of birth micro-plan is weak and needs to be strengthened.

majority of which are either not functioning or do not have a specialist are contributory to the underutilization of public health facilities. Further. o During the visit. In many other institutions like the CHC Utnoor. Natal and post-natal care: o From table 2. NICU is established only at Nirmal MCH. shows that 56. However. All sub-centers and many PHCs do not conduct any deliveries. Further 72.  Post natal care of the mother and child: HMIS data for the year 2009-10. o Minimum 48 hours stay is not followed in the district. equipment like warmers and phototherapy units are available. it is evident that public health institutions at all levels conduct few deliveries. oxygen cylinders and some minor repairs in the section proposed to be NICU. o Home delivery continues to be high at 40%. this is presently not functioning for want of certain equipment like Air conditioners.1% of all the children received a check-up within the first 24 hours after birth.4% of all newborns got weighed at birth. but they are not used as there is no pediatrician or regular officer who could start and then scale up neonatal care in the CHC. o DLHS-3 data maintains that only 31. Delivery Registers were usually found to be devoid of condition of mother and the neonate on discharge.4% of the newborns received breast milk within first hour of birth.8% of all the newborns weighed at birth had low birth weight. 27. o No neonatal stabilization units or NICU in the district. o 10% of the expected deliveries are not reported. underutilization of referral centers as well as modest performance of CEMONC centers. Post-natal follow up registers were found to be incomplete during the visit. indicating that newborn care is inadequate and it is a direct contributory factor to the higher proportion of neonatal deaths in infant deaths. 9|Page .

Anesthesia Surgery Medicine Ophthalmology 5 4 0 3 2 1 2 0 0 1 0 1 From the above table it is evident that there is a huge shortfall of specialists in the district.Human Resources in Adilabad Gross shortfall in Specialists cadre. Interactions with some of them revealed that they were willing to be absorbed at the referral hospitals. During the visit it was found that as many as 10 specialists from different specialties were working as General Medical Officers in Primary Health Centers. other technical cadre like radiographers Table 4: Public Health Human Resource situation in the district: Human Resource Midwives ANM LHV PHN Nurse Technical cadre Multipurpose Health Workers [Male]. Rationalization must certainly include posting of these specialists at appropriate referral level to enhance the capacity of the referral centers of the district. Pediatrics Sp. This is an opportune moment as the district is preparing itself for ‘Rationalization’. shortfall = 280 Lab Technician Pharmacist Radiographer Medical cadre MO Sanctioned Positioned Vacant 987 97 28 131 304 77 85 10 166 923 67 7 91 189 57 79 1 195 64 30 21 40 115 20 6 9 16 regular MOs 3 4 0 2 2 0 Sp. 10 | P a g e . MPHA Males. Obstetrics Sp.

Sub-centre Assessment: Table 5: Summary of Sub-centre assessment of Adilabad Item Building condition Condition of toilets Services & performance Biomedical Waste Management Total Score Max 19 7 62 6 94 Kalwa SC 8 0 6 2 16 Muthnoor Venkatapuram SC SC 12 12 0 0 19 18 2 2 33 32 Average 10. and the waste is dumped with village waste or burnt outside the center. The referral structures scored better and attained 67. No proper storage was adopted. ASHAs were present and working in the area without any difficulty. This is regrettable. Bio-medical waste disposal mechanism not established yet. newborn and post natal follow-up. Equipment and supplies inclusive of drugs and financial matters inclusive of RKS and JSY are the main areas which need attention. However. 11 | P a g e . PHCs scored 39. VHNDs were not planned and therefore never conducted.3 2 27 Sub-center Kalwa (PHC Dilawarpur)  The ANM was unable to identify and perform the functions of a sub-center ANM like maintaining and updating immunization cards and registers.7 0 14.     Sub-center Muthnoor  Hemoglobin estimation was not being done as mentioned above in the section of Maternal and Child Care.8% of the maximum score. they were paid at an interval of 4-6 months. The drugs were dumped in the sub-center. follow up of ANC. as she had worked in OPDs only for all the 13 years of her work with the Government of AP.3% of the maximum attainable score and need improvement for all the items measured.Facility Assessment summary Sub-centers are very weak service delivery points.

Venketapurum 12 | P a g e . VHSC and Unties funds were not received for 2009-10. CPM and IFA tablets (SC-Venketapurum) VHND and immunization micro-plan display. and drug storage at SC. Biomedical waste disposal mechanism was out of place. ANM was staying at headquarter and there was no interference noted by her from the Gram Panchayat for utilization of funds. The Labor table at the sub-center (Venketapurum) The bills of purchase of PCM. weight and other important parameters including hemoglobin from ANC cards made by women in the private sector. Recording of height.    VHNDs were not being planned yet in the sub-center. Sub-center Venkatapuram (PHC Dhantepally)    Sub-center Untied funds were being used to purchase medicines like Paracetamol tablets and Iron Folic acid tablets for distribution to pregnant women. The sub-center does not conduct any delivery.

5.8 2 1. RKS and JSY funds management.5 1. 4.8 7 5 1 0 0 3 0 1.2 Infrastructure Services OutSourced Equipments and supplies Equipments in Labour room Equipments in OT Bio-medical Waste Management Central sterilization unit Records and reports Finance Total Score Major interventions are required towards improving: 1. Labor room equipment and establishing neonatal care corners Biomedical Waste management system.5 0. Waste disposal in backyard of a PHC 13 | P a g e OPD at a PHC visited . especially toilets and water supply Cleanliness and provision of linen.Primary Health Center Assessment: Table 6: Summary of scores attained by the PHCs Max PHC PHC PHC PHC PHC PHC Average Azipur Dilawarpur Echoda Indravelli Lingapur Narsapur score 34 19 14 4 11 17 18 13. Infrastructure.7 34.5 10 12 7 8 2 3 4 87 5 0 1 4 1 2 2 39 7 5 2 2 1 2 0 34 5 3 2 3 0 1 2 20 6 6 2 2 1 3 2 33 6 6 2 4 1 2 2 43 5 1 1 6 1 2 2 36 5. 2.7 3.7 3. 3.

Both the labor room and the Operation Theater are used as store rooms for medicines and condemned articles. on 21/07/2010. The PHC is one of the remotest places and was being headed by one Medical Officer who resided in the quarters provided in the PHC building. it was found to be closed at 7:20 p. 33 deliveries were conducted in the PHC in the month of June. It is a well performing PHC. No posts for staff nurses are sanctioned to this 24x7 MCH center. Thus. On the day of the visit. The general cleanliness of the PHC needs to be improved. while the OPD lies unused. RIMS.m. but hardly conducts any deliveries.     PHC Lingapur  The PHC was being run by a not-for-profit Trust. Lab technician post is vacant. Although the drug supply was sufficient. The PHC does not provide IUD insertion services.  14 | P a g e . PHC Narsapur   The PHC is a 24x7 PHC. There no staff nurses in the PHC. The Laboratory technician post is vacant and the ANMs do not have Hemoglobin meters. The OPD room is in good condition. no family planning surgeries were conducted in the last 1 year. Adilabad.PHC Azipur  The patient ward is being used as an OPD. This should be addressed most urgently. The operation theater is not functioning and hence. The patients are accommodated on beds arranged in the corridors. by 2 SBA trained ANMs who provide 24 hours services.    PHC Gudutnoor The PHC is a 24x7 PHC run by the Department of Community Medicine. No shortage of drugs. The complete staff was provided by the trust. There was a space crunch in the PHC for storage of drugs as well as wards. PHC Dhantepally   HDS funds are used to purchase Hemoglobin meter for sub-centers and repairs of the labor room. hemoglobin testing of the mothers did not take place in the PHC. in spite of it being a 24x7 PHC.

Apparently. Waste disposal at Lingapur PHC PHC Inderavelli     Medical team and patients at Lingapur PHC Hemoglobin measurement is not at all streamlined. the PHC had not received 75000 of the 175000 for the year 2009-10. but the ANC registers reported hemoglobin examinations done. The PHC is understaffed with only 1 MO and no staff nurses in-spite of it being a 24x7 PHC. Medicine cartons stacked at the end of the corridor of the PHC. no tests were being conducted. Disposal of Biomedical Waste seemed to be a problem in the PHC. As seen in the photograph below. drugs are stored in cartons in the corridors. Bio-medical waste disposal mechanism not established. The drug storage needed improvements. 15 | P a g e .  Mandal Parishad President was interviewed. with used infusion sets and bottles lying in gunny bags in the corridors of the PHC. There seemed to be a good harmony between the MO and the MPP. However.

3 3.PHC Narsapur     The PHC did not have a ward and the patients were accommodated in the corridor. There was no ward in the PHC and the patients were accommodated in the corridor. Labor room was devoid of basic equipment and lacked water supply and lights. the PHC was ill-maintained with inadequate lighting of the center and extremely dirty corridors. Their reports and cash books were maintained well. The Labor room in addition to being dirty did not have essential equipment and was inadequately illuminated. PHC Echoda  This is a 24x7 PHC located very close to the national highway.7 81. However.7 2. There were no spot lights. 16 | P a g e .3 RCH Hospital Nirmal This is a well performing Maternal and Child Hospital run by the APVVP. Essentially minor repairs were undertaken by the concerned HDS. The PHC is a high performing PHC with nearly 15-20 deliveries being conducted every month.7 0. It is the only hospital which provides facilities for Caesarian section and hysterectomy other than the District Hospital which is a teaching hospital. However.   Table 7: Summary of score of the Referral Hospitals Item Infrastructure Human Resource Services available Services Out-Sourced Equipments and supplies Equipments in Labour room Equipments in OT Bio-medical Waste Management Central sterilization unit Records and reports Finance Total Score Max 34 33 7 10 12 7 8 2 3 4 120 AH Mancherial 24 13 5 10 7 6 8 1 2 0 76 CHC Utnoor 30 15 3 10 9 4 2 2 3 2 80 MCH Nirmal 24 27 2 10 6 6 8 2 3 0 88 Average score 26 18. some areas needed attention.3 6 1. labor room and toilets. The store of medicines was not maintained well.3 5.3 10 7. The PHC had no water supply and the contingency worker was required to fill water for the patients and the labor room use from a nearby hand pump.

There is a Nutritional Rehabilitation center within less than a kilometer distance from the hospital. these issues need to be handled alternatively by the district authorities by calling upon alternative funding options. but not being used. However. effectively producing a shortage of 8 nurses at the CHC. its potentialities are not fully tapped. A beautiful CEMONC center with 40 beds is constructed and furnished. a regular in-charge officer and staff nurses. It is well constructed and maintained hospital. Presently. It was unclean and the instruments were not sterilized. The NICU was not functioning. the eligible beneficiaries are not being paid the due cash incentive. HDS: the Hospital Development Society is not functioning presently as the society is facing a dispute over membership issues and has sought help from the court of law to resolve the same. The CHC does not have any specialists appointed in the last 5 years. Since neither of the authorities was paying the due to the beneficiaries since last 6 months after the PP Unit stopped the payments of JSY cash incentives. JSY payments: The institute does not pay the cash incentive to the JSY beneficiaries directly. the patients are being sent to       17 | P a g e . In absence of the support from the HDS.     Labor room: It was not managed well and for a MCH the labor room was ill equipped. mainly because of absence of specialists. CHC Utnoor  The CHC is a referral center for 5 tribal mandals of the district and caters to patients from the surrounding area of about 50 kms radius. There is no regular doctor appointed since one year. Blood storage facilities are available and the doctors are confident of blood transfusion. 4 staff nurse positions are vacant. It issues a ‘NOT PAID’ certificate to the beneficiary who is then paid by the ANM of the area of her residence. while 3 are deputed to nutritional Rehabilitation Centers and 1 was deputed to Kagaznagar Hospital. but no blood is being stored for a generator problem. General cleanliness and patient facilities like lights and fans in the wards and corridors need to be addressed. JSY: There was confusion between the MCH Nirmal and the PP Unit Nirmal authorities regarding payment of cash incentive to the eligible deliveries of the Nirmal MCH. This center provides referral services for blood transfusion for correction of severe anemia in women and children.

Mattresses were all torn without covers. the beneficiaries admitted in the NRC – Utnoor can use this service very effectively. The hospital had very poor patient facilities. General cleanliness and hygiene needed to be maintained. 18 | P a g e . Biomedical waste disposal needs to be established. The hospital needed major repairs and up-gradation. which is not according to the guidelines of utilization of HDS. Adilabad District Hospital. Annual Maintenance Grants (AMG) and Untied funds. HDS: The funds were used to pay the salaries of the staff nurses appointed at the CEMONC center. If the blood storage unit at the CHC Utnoor is started. Unused phototherapy units at CHC Utnoor Unused Blood storage unit at CHC Utnoor The never used CMONC center ward at CHC Civil Hospital Laxetipet    The well maintained Operation theatre  This is run by the District Medical and Health Officer and receives HDS funds equivalent to that of a CHC. The scores were not calculated as the Medical superintendent as well as registers were not available for gathering information. It needed to upgrade the labor room sections and the wards.

Vaccines kept ina tray in the hospital ward Tubectomy ward with torn mattresses Labor room with broken windows Ward of the same hospital 19 | P a g e .

 Allocating separate POL for monitoring at the District for the District Officers and the DPMU to regularly take field visits and monitor the activities in the periphery.  The registers of the frontline functionaries may be reviewed during the same meeting by the Medical Officers and necessary technical guidance may be given to the frontline health functionaries. incomplete registers. SPURIOUS REPORTING BY FRONTLINE FUNCTIONARIES TO BE SEVERELY DISCOURAGED. use of wards as OPDs. REGULAR DEATH AUDITS OF MATERNAL AND CHILD DEATHS SHOULD BE CONDUCTED. Recommendation: STRENGTHENING OF MONITORING AND SUPPORTIVE SUPERVISION  Clearly defining monitoring roles of the Health Supervisory cadre and the Medical Officers at the PHC and including monitoring responsibility in their day to day activity schedule.  The monitoring may also include stock checking and facility surveys of the PHIs and ensure patient facilities. non-existent high-risk pregnancy identification. Gap 1: Weak Monitoring and supervision This is the root cause of issues like absence of wards in certain institutions. poor post-natal follow-up and no maternal and infant death audits in the district. 20 | P a g e . ensuring proper utilization of the funds provided to different health facilities is of prime importance to achieve improvements across deliverables. ineffective ANC with absent hemoglobin testing in primary set-ups.  Monthly review meetings to be conducted at all levels and minutes of the meeting may be reviewed by the District authorities to ensure coverage of topics.Gaps and Recommendations Strengthening General Administration and monitoring.

 Concerns like inadequate space at Anganwadi centers need to be addressed. Recommendation:  Improve coordination with ICDS department. It could be acquired on rent for the day. This is evident from the fact that 55 of 71 PHCs conduct less than 10 deliveries in a month. 21 | P a g e . These need to be upgraded to ensure proper natal care to both mother and child. None of the sub-centers conduct any deliveries. Monitoring and supervision needs to be strengthened. VHND micro-plans are not being made at the sub-center level in many places.  At least one sub-center in every PHC must be upgraded to provide delivery services and convert the home deliveries into institutional deliveries. insufficient supervision and guidance to the Anganwadi workers (vacancies of ICDS supervisor posts in large numbers) and inadequate participation. Gap 3: Village Health and Nutrition Days are not being carried out regularly. Recommendation: UPGRADATION OF THE NATAL CARE FACILITIES AND LABOR ROOMS IN PHCs. Gaps identified by District officials are insufficient place at Anganwadi centers. Higher thrust is required to be given in areas with high home deliveries. ENCOURAGING DELIVERIES IN THE SUB-CENTERS. Help from VHSCs should be sought in identification and acquiring of a place for conducting the VHND sessions.  Skilled Birth Attendants training is mandatory for the ANMs in the district.Gap 2: Underutilization of Health Facilities.  As explained in the facility assessment section. as majority of them have not conducted any deliveries in last 2 years. and submitted to the District for Monitoring purposes. insufficient equipment with the ANM like weighing scale.  Required equipment to be provided at the earliest. and in majority of the PHC areas home deliveries constitute more than 50% of the registered deliveries. many facilities do not have adequate facilities and equipment in the labor room.  VHND micro-planning procedure must be carried out up to village level every quarter.

TIMELY DISBURSEMENT OF FUNDS MUST BE ENSURED. dignified and respectable. o Adequate provision of lights and fans in the corridors. Separate toilets for males and female patients.  SUGGESTED TARGETS FOR THE NEXT QUARTER: o Provision of functioning and clean toilets at all levels. fans. DISTRICT HEALTH MISSION SHOULD MEET REGULARLY TO ADDRESS EMERGING ISSUES REGARDING NRHM.  The district may identify minimum standards of patient facilities to be provided by every PHI. Most of the PHIs and the concerned HDS have failed to preserve dignity to patients and pregnant women who chose to come to them for therapeutic services by not providing them with proper toilets. especially sub-center untied funds.  Regular review of the agenda setting and the maintenance of records should be undertaken. o Provision of a grievance box along with display of citizen’s charter.  ACHIEVE THESE TARGETS BY ENSURING THAT AT LEAST ONE HDS MEETING TOOK PLACE IN THE BEGINNING OF THE COMING QUARTER. including sub-center and suggest the HDS to take the patient facility issues as a priority. wards. o Provision of safe drinking supply and seating arrangement in waiting area and the wards.  The HDS.Gap 4: Improper/ Inadequate Utilization of the funds This is responsible for persistent inadequate facilities in spite of provision of HDS. including sub-centers. labor rooms and toilets. VHSC may be requested to undertake any other measures as deemed fit by the Society members to ensure that the patient receive services which are appropriate. Promotion of best practices through positive deviants may be undertaken. Timelines may be set for providing the same. Recommendation: GUIDED UTILIZATION OF THE FUNDS by HDS and SUB-CENTER and the VHSC. Timely disbursement of funds. This would help in supervising the activities as well as in creating a team spirit of the Medical Officers and give them an avenue to use their funds better. clean labor rooms and adequate lights. o Provision of proper mattresses and clean linen. 22 | P a g e . proper wards. mattresses and linen. AMG and Untied funds to all the PHIs for at least 2 years.

STEP 5: Accreditation should be done after ensuring that the license of the private nursing home is valid and the quality of services provided are optimum. but good institutional deliveries STEP 3: Private institutions in such areas with maximum proportion of clientele from the poor population should be preferred. none of them pay any cash incentive to the women delivered in their institution. The concerned ANM would the make the payment of the cash incentive. Identification of beneficiary: The district does not pay JSY cash incentive to the eligible deliveries in private institutions. However. the post-natal follow up and record maintenance at the sub-center must be very strong.Gap 5: Not all JSY beneficiaries are being given the cash incentives This is essentially a phenomenon at 2 levels 1. For this system to provide incentives fairly. 2. However. which is to be produced at the sub-center nearest to their residence. both these institutions provide natal care to many women every month. those institutions in the remaining pockets but having larger clientele from the poor population should be chosen for accreditation. Eligible beneficiaries are calculated at the district level only. but have not been able to generate exact number of back-logs in JSY payments. Recommendation: PAYMENT OF THE CASH INCENTIVE SHOULD BE DONE AT THE INSTITUTION WHERE THE DELIVERY HAS TAKEN PLACE. Presently. Responses from the MOs and ANMs are testimony to this. Deliveries at referral centers: Citing the example of CHC Utnoor and MCH Nirmal. which have minimum utilization of public health services. Since the district has more than 40% private institutional deliveries a sizeable proportion of the eligible beneficiaries are refused their due cash incentive. Many of the MOs and ANMs interacted with during the visit have identified lack of funds to pay JSY beneficiaries. In Nirmal MCH. STEP 4: Finally. UNDER THE AUTHORITY OF THE IN-CHARGE OFFICER OF THE REFERRAL HOSPITAL ACCREDITATION OF PRIVATE INSTITUTIONS FOR JSY STEP 1: A comprehensive list of all the facilities providing maternity services to be made as the first step. 23 | P a g e . there was a confusion with regards to the authority that should issue cash incentive. STEP2: Simultaneously pockets be identified in the district. issue of funds at the PHC and the sub-center were not according to the estimated number of eligible deliveries in the area. the referral hospitals issue a ‘NOT PAID’ certificate.

2. As most of the PHCs have a space crunch. ORS DISTRIBUTION AND SENSITIZATION of the frontline functionaries and private practitioners. Gap 8: Communicable diseases especially Diarrhea and Malaria have inadequate preventive and therapeutic services (as highlighted in the section of important health indicators Recommendation: The district administration needs to ensure: 1. the district may consider timely cleaning up of these pits to ensure that the PHCs and the sub-centers can carry out disposal of waste effectively. and /or CONTRACTING OUT OF DISPOSAL OF WASTE PRODUCED BY THE PHI. Strengthening monitoring of both active and passive surveillance is recommended. MINIMUM OF 10% ANNUAL BLOOD EXAMINATION RATE FOR MALARIA. Recommendation: The district needs to establish more number of PHCs and sub-centers to meet the IPHS standards. it must be ensured that the PHIs have adequate storing space for the waste till the waste can be collected at suitable intervals.Gap 6: The district does not have adequate number of Primary Health centers and sub-centers (see table 2). Gap 7: Nearly absent Biomedical Waste disposal Mechanism for Primary Care Recommendation: STRENGTHENING OF EXISTING SYSTEM OF USING BURIAL PITS AND IMPERVIOUS SHARP PITS IN EVERY PHC. ensuring piped treated water supply to all the households. 3. However. 24 | P a g e . and basic system of building the burial pit and sharp pit is already in place. PREVENTION OF DIARRHEA: Proper chlorination of existing sources.

in absence of concerned officers for various reasons. 25 | P a g e . Similarly. Gap 10: DM&HO is burdened with too many charges in absence of the concerned officers.Gap 9: Issues of Human Resources: 1. second ANMs appointed under NRHM have not received salaries for the months of February and March. Irregular payment of salaries to ANMs and Contractual Doctors and Honorarium to ASHAs Salaries of the RCH ANMs are understood to be pending since April 2010. Recommendation: THE STATE MUST IDENTIFY APPROPIATE PERSONS FROM THE DISTRICT AND RELIEVE THE DM&HO OF THE ADDITIONAL CHARGES. The DM&HO presently has additional charges of at least 6 other charges of District Programmes.  Redeployment of the specialists from the primary health centers to the referral centers. This might have a deleterious impact on his capacity of district administration. 2010. Gross shortfall of Specialist cadre.  Recruitment drive for MPHA males should be conducted and vacant positions must be filled as soon as possible. This is crucial to provide quality maternal and Child health services.  Fresh recruitment of specialists at competitive salaries.  Creation of posts of Staff Nurses in 24x7 PHCs. 2.  On-call services of the specialists may be hired as and when required especially in the facilities which have lower case load. Contractual doctors are also reported to have not received regular salaries. Interactions with ASHAs have pointed out that there is a delay in payment of their honorarium of about 4-6 months. MPHA males and staff nurses at 24x7 PHCs in the district Recommendations:  Regular payment of salaries and honorarium should be ensured.

VHSC and Sub-center Untied funds. Most crucial gaps identified are poor monitoring and supervision. Good coordination with the DCHS and the District team of Programme Officers Alert and active force of Medical officers. Additional Collector and the Additional DM&HO in-charge of the ITDA area of the district. the Public Health Institutions are the only reasonable source of healthcare. close to the towns.Conclusion The district has the strength to overcome its challenges with appropriate support from the state. improper utilization of funds of HDS. 2. Findings of the visit were communicated and most of the recommendations are drawn after the discussions. 26 | P a g e . Adilabad is a district which is mostly tribal. The district has a huge private sector. 3. Knowledgeable and experienced DM&HO. Hence in the difficult and remote areas. group of Medical Officers as well as the Collector. Strengths of the District: 1. which is essentially concentrated in the non tribal areas. The visit was concluded with a discussion with the district officers. 4. Hard working DPMU with an experienced DPO.

Annexure 1: Road Map of Adilabad District 27 | P a g e .

Annexure 2 28 | P a g e .

Total marks: 90 Building: Govt. Rachana Parikh District: Adilabad Location of Facility: Kalwa (PHC Dilawarpur) Stay in the SHC – No SBA trained: No The ANM does not conduct any deliveries in the sub-centre or in the sub-centre area.Annexure 3 Inspection forms of individual facilities Inspection form for Sub-Centre . Electricity is NOT available Item MOV Criteria Score Total score Building condition a) Walls and floor and roof intact b) Electrical wires not exposed c) Electric switch boards not broken d) Whitewashed e) overhead tank and running water available f) electricity available g) floor is clean on the day of visit h) ANM stay in the SHC Condition of toilets a) Doors are not damaged b) Floors are clean & Basins are not stained c) Running water present Services performance & a) Services offered and timings displayed 2 2 2 2 0 0 0 0 0 0 0 0 6/62 0/7 8/19 Date & time: 21/07/2010.Kalwa Name of the inspecting officer: Dr.m. b) Pregnant women and infant tracking register 0 maintained c) Micro plan for VHNDs available. 3:15 p. at least 90% of 0 planned VHNDs held in the last quarter d) Nischay kit available e) Kit A and B available 0 2 29 | P a g e .

) k) HMIS/IDSP formats getting reported l) ANM stays in the SHC m) SHC conducts deliveries n) The ANM is SBA trained o) 2nd ANM present p) Immunization cards updated Biomedical Management Waste a) Colour coded buckets used 2 0 0 0 0 0 0 2/6 b) Deep burial pit available where anatomical 0 waste is disposed (if the SHC conducts deliveries) c) Needle cutter in working condition 2 30 | P a g e .Item MOV Criteria Score Total score f) Delivery kit available (at least 2) 0 g) Weighing machine (mother / baby) and BP 2 apparatus (and stethoscope) available h) Hb estimations done i) Male worker present 0 0 j) Records of vector control activities undertaken 0 present (spraying. blood slides etc.

Summary: Item Building condition Condition of toilets Services & performance Biomedical Waste Management Total Score Maximum score 19 7 62 6 94 SHC score 8 0 6 2 16 31 | P a g e . Whether SHC untied funds have been utilized for facility improvement The cash books were not available to make any definite comment. 4. but was not taken in possession. Grievances / suggestions mentioned in the grievances box Serial Grievance Addressed at which level (Facility number level / district level / state level) No grievance box 5. The funds were however not used for any significant development of sub-center. This she claimed was due to the fact that she has been working as an OPD ANM since last 13 years. A new building was built for the sub-center. ANM is not aware of the way Nishchay kits should be used. Any suggestions / reflections that the ANM want to make The ANM was new to the functioning of the sub-center. VHND micro-plan is not made and VHNDs are therefore not conducted as per schedule. 3. She was not aware of immunization schedule too. 2.Qualitative responses 1. Whether the VHND micro plan for the last three months is made and whether VHND’s have been conducted as per the schedule by verification in the registers. Whether the ANM is using Nishchay kits and whether she is aware of the way they are to be used.

Total marks: 90 Building: Govt. at least 90% of 0 planned VHNDs held in the last quarter t) Nischay kit available u) Kit A and B available v) Delivery kit available (at least 2) 2 2 0 32 | P a g e . n) electricity available o) floor is clean on the day of visit p) ANM stay in the SHC Condition of toilets d) Doors are not damaged e) Floors are clean & Basins are not stained f) Running water present Services performance & q) Services offered and timings displayed r) Pregnant women and infant tracking register 1 maintained s) Micro plan for VHNDs available. Electricity is available Item MOV Criteria Score Total score Building condition i) Walls and floor and roof intact j) Electrical wires not exposed k) Electric switch boards not broken l) Whitewashed m) overhead tank and running water available 2 2 2 2 0 2 2 0 0 0 0 0 19/62 0/7 12/19 Date & time: 22/07/2010.m.Muthnoor Name of the inspecting officer: Dr.Inspection form for Sub-Centre . 10:30 p. Rachana Parikh District: Adilabad Location of Facility: Muthnoor (PHC Indravelli) Stay in the SHC – No SBA trained: No The ANM does not conduct any deliveries in the sub-centre or in the sub-centre area.

) aa) bb) HMIS/IDSP formats getting reported ANM stays in the SHC 2 10 0 0 0 0 0 2/6 cc) SHC conducts deliveries dd) ee) The ANM is SBA trained 2 ANM present nd ff) Immunization cards updated Biomedical Management Waste d) Colour coded buckets used e) Deep burial pit available where anatomical 0 waste is disposed (if the SHC conducts deliveries) f) Needle cutter in working condition 2 33 | P a g e . blood slides etc.Item MOV Criteria Score Total score w) Weighing machine (mother / baby) and BP 2 apparatus (and stethoscope) available x) Hb estimations done y) Male worker present 0 0 z) Records of vector control activities undertaken 0 present (spraying.

Any suggestions / reflections that the ANM want to make Summary: Item Building condition Condition of toilets Services & performance Biomedical Waste Management Total Score Maximum score 19 7 62 6 94 SHC score 12 0 19 2 33 34 | P a g e . 8. A toilet were available but was used as a storage for condemned articles and drugs. Whether the ANM is using Nishchay kits and whether she is aware of the way they are to be used. no sub-center untied funds were received for the last one year. 7. basic facilities like running water were not available. Whether SHC untied funds have been utilized for facility improvement The funds are used for sub-center development.Qualitative responses 6. 9. However. VHND micro-plan is not made and VHNDs are therefore not conducted as per schedule. ANM is aware of the way Nishchay kits should be used. Grievances / suggestions mentioned in the grievances box Serial Grievance Addressed at which level (Facility number level / district level / state level) No grievance box 10. However. Whether the VHND micro plan for the last three months is made and whether VHND’s have been conducted as per the schedule by verification in the registers.

4:15 p. Total marks: 90 Building: Private tracking 1 register maintained ii) Micro plan for VHNDs available. at least 90% of 2 planned VHNDs held in the last quarter jj) Nischay kit available kk)Kit A and B available ll) Delivery kit available (at least 2) 35 | P a g e 2 2 0 .Inspection form for Sub-Centre .Venkatapuram Name of the inspecting officer: Dr. Rachana Parikh District: Adilabad Location of Facility: Venkatapuram (PHC Indravelli) Stay in the SHC – No SBA trained: No The ANM does not conduct any deliveries in the sub-centre or in the sub-centre area. Electricity is available Item MOV Criteria Score Total score Building condition q) Walls and floor and roof intact r) Electrical wires not exposed s) Electric switch boards not broken t) Whitewashed u) overhead tank and running water available v) electricity available w)floor is clean on the day of visit x) ANM stay in the SHC Condition of toilets g) Doors are not damaged h) Floors are clean & Basins are not stained i) Running water present Services performance & gg) hh) Services offered and timings displayed Pregnant women and infant 2 2 2 2 0 2 2 0 0 0 0 0 18/62 0/7 12/19 Date & time: 23/07/2010.m.

) qq) HMIS/IDSP formats getting reported 2 0 0 0 5 2 0 2/6 rr) ANM stays in the SHC ss) SHC conducts deliveries tt) The ANM is SBA trained uu) 2 ANM present nd vv)Immunization cards updated Biomedical Management Waste g) Colour coded buckets used h) Deep burial pit available where anatomical 0 waste is disposed (if the SHC conducts deliveries) i) Needle cutter in working condition 2 36 | P a g e . blood slides etc.Item MOV Criteria Score Total score mm) Weighing machine (mother / baby) and BP 2 apparatus (and stethoscope) available nn) oo) pp) Hb estimations done Male worker present Records of vector control 0 0 activities 0 undertaken present (spraying.

Whether the ANM is using Nishchay kits and whether she is aware of the way they are to be used. 12. Any suggestions / reflections that the ANM want to make Summary: Item Building condition Condition of toilets Services & performance Biomedical Waste Management Total Score Maximum score 19 7 62 6 94 SHC score 12 0 18 2 32 37 | P a g e . 14. Grievances / suggestions mentioned in the grievances box Serial Grievance Addressed at which level (Facility number level / district level / state level) No grievance box 15. ANM is aware of the way Nishchay kits should be used. 13. VHND micro-plan is being made and VHNDs are being conducted as per schedule. This is not according to the guidelines of the utilization of untied funds of the sub-center.Qualitative responses 11. Whether the VHND micro plan for the last three months is made and whether VHND’s have been conducted as per the schedule by verification in the registers. Whether SHC untied funds have been utilized for facility improvement The funds were used to purchase medicines like iron-folic acid and paracetamol for regular use.

Inspection format for health facilities: PHC Indravelli Name of the Consultant: Dr. d. a. d. Rachana Parikh District: Adilabad Name of Facility: PHC Indravelli 1. b. 11:15 a. c. No. a. b. Total marks: 87 Deputed: 0 Deputed: 0 Functional: 6 Condition of wards Water supply Patient amenities Furniture Walls and floor and roof intact Electrical wires not exposed Electric switch boards not broken Electric bulbs in wards / pathways / toilets Whitewashed Signage boards present Rooms not dumped with condemned articles Mosquito screens present and devoid of holes Condemned articles not stored in the wards Window glasses not broken Door / Screens / Curtains / present for ensuring privacy of patient Availability of ceiling fans in wards Running water available for 24 hours in Labour room Running water available for 24 hours in OT Running water available for 24 hours in Toilets Purified drinking water available for drinking for patients in OP Purified drinking water available for drinking for patients in IP Doors are not damaged Floors are clean Basins are not stained water taps not damaged. Date & time: 21/7/2010. not broken Mattress not worn out. of ANM’s: Posted: 10 4. No. e. a. of Beds: 6 Sanctioned: 6 MCH beds: -I. b. No. f. d. c.m. No. a. of Doctors: 1 MBBS 2. cloth not torn. of Nurses: Posted: 3 3. g. Infrastructure Item MOV Criteria Building condition a. e. Condition of toilets a. f. e. d. pathway is not dirty Separate for male and female Seating arrangements are present in the OPD area Stools or chairs for attendants in the wards present Inpatients are provided with blankets in winter Cots are not rusted. b. c. c. c. No. e. b. cotton/coir not Score Total Score 1 4 1 1 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 1 1 1 1 0 2 2 38 | P a g e . b. of SBA trained Personnel: 3 5.

no Service Means of verification Score Total Score 1. 4. Would be scored on improvement and in a fresh inspection form) o Bed occupancy rate=(inpatient days of care/bed days available)×100 III. 2. Lipid Profile 4. casuality register Delivery register Delivery register. Haemogram 2. Drainage system not clogged 0 1 II. casuality register Duty roster. 5. 6.coming out Drainage a. Immunization register Delivery register FP register MTP register Blood transfusion register / Blood bank master register Equipments and reagents for conducting the tests are present. Sputum Examination 3. Human Resource (Self improvement score) Staff performance Baseline data (1st (monthly figure ) survey) Subsequent visit * % improvement Number of deliveries conducted per SBA 6 in a month (total) Number of OP cases per doctor 1010 Bed occupancy rate* 40% Number of CS per Obstetrician Number of cataract operations per ophthalmologist Chest symptomatic sputum population examination 7 rate Minor surgeries per doctor Antenatal care severely anaemic (under 7 gm%) managed rate IUD insertions per trained nurse MTP services per trained doctor nd rd o Indicative column. 24 hour doctor available 24 hour nurse available 24 hour delivery services available 24 hour newborn care services available 24 hour caesarean services (if FRU) Tubectomy services available Safe abortion services available 24 hour blood transfusion services Laboratory Services 1. 8. 3 etc. 3. 7. Paediatric ward register. Services available (applicable for BPHCs and above) NOT APPLICABLE Sl. Hormone Assay Duty roster. 9. subsequent visits (2 . lab record shows tests are conducted Lab register 39 | P a g e .

Urine Examination Availability of ECG Facility X Ray Facility with X-ray Technician available Ultrasound services available Ambulance ECG machine available & working X ray register – working status USG register – working status Records of operation [Number of ambulances. Services Out-Sourced Means of verification a. 3. 13. 11. 6.10. OT fumigated a. 12. 5. Floor is cleaned with disinfectant on the day of visit b. rainbow linen color maintained c. Item House keeping Sl. Food chart for inpatients Score 0 0 0 0 0 0 0 Total Score 0 2. Fuel for operation present a. Generator 0 3. 5. Food served to inpatients b. no 1. 2. Generator in working condition with designated horse power b. Food 0 V) Equipments and supplies Item MOV condition Score Total Score 40 | P a g e . 4. average (if more than one ambulance) number of breakdowns in the last one week. number of drivers available per shift] maintained Telephone number with dial tone OP register – number of adolescent beneficiaries ANC register OPD Register Register 1. 7 Functional telephone Adolescent sexual and reproductive health services Whether fixed day antenatal clinics are conducted Whether fixed day RTI/STI clinics are conducted Whether fixed day sterilization clinics are conducted Whether IEC material displayed Public Display of JSY Beneficiaries IV.

Oxytocin II. 3.Trolley Wheelchair Stretcher Sterilised gloves Average number of OP drugs available (monthly) Availability of life saving drugs present a. b. 3. Protocols displayed: Active management of 3rd stage of labor (also check case sheets) 12. a. not broken Sterilised gloves available Drug stock register Availability of. Spot light in labor room Vacuum extractor Resuscitation equipment for newborn – Bag and mask Resuscitation equipment for newborn – Laryngoscope and full set of endo-tracheal tubes Baby resuscitation table with infant warmer Mucous sucker Baby weighing machine Partograph Score 0 1 0 0 0 1 1 0 1 1 0 1 Total Score 6 9. 6. 7. not broken and not blood stained VII) Equipments in OT Equipments 1. Magnesium Sulphate IV. 5. I. (Calculate average number of surgeries per Day ) 41 | P a g e . Stretcher without rust b. 5. IV antibiotics Yes Yes No Yes 0 VI. 1 Score 0 0 0 1 1 Ceiling OT light/ Floor OT light (shadowless) Oxygen cylinder Boyles apparatus (only FRU) Suction apparatus Adequate quantity of linen1 Total Score 2 3 sets of linen per surgery per day. b. 2. Labor board not rusted. 4. Equipments in Labour room Equipment 1. 8. Misoprostol III. In working condition Trolley without rust In working condition Wheelchair without rust Yes Yes Yes Yes Yes Yes 1 2 1 1 1 1 2 a. Toilet attached to Labor room 11. 4. Privacy in Labor room (curtains etc) 10. 2.

Needle cutter in working condition d. Delivery register mentions about the details of the baby and condition of the mother Referral slips are issued to patients Score 1 1 1 Total Score 3 XI) Finance Head Number of mothers yet to receive the JSY money Score Total score 2 RKS JSY Full utilization of funds in 2009-10 JSY payments not pending till last week of the visit 2 0 42 | P a g e . b. Spinal anaesthesia set (FRU) 7. Functioning autoclave Usage of signalac tape usage of biological indicator swab test of sterile packs Score 1 No No No Total Score 1 X) Records and reports Item Separate column (in delivery register) for recording major complications leading to maternal death.6. metal sharps disposed in puncture proof containers h. no mix of infectious or non-infectious waste done e. c. Ante room present VIII. waste bins not overfilled f. disposable gloves and masks not reused 0 0 Waste management Score 0 0 1 0 0 0 0 1 Total Score 2 IX) Central sterilization unit MOV Autoclave a. Colour coded buckets used b. Item Bio-medical Waste Management MOV a. needles and syringes mutilated and disinfected before putting in waste bin g. d. Deep burial pit available where anatomical waste is disposed c.

Central sterilization unit X. Services Out-Sourced V. Equipments in OT VIII.Summary: Item I. Bio-medical Waste Management IX. III. Equipment in Labor room VII. Records and reports XI. Finance Total Score 43 | P a g e . Equipment and supplies VI. II. Infrastructure Human Resource Services available (applicable for BPHCs and above) Maximum marks 34 Self improvement score NA 7 10 12 7 8 2 3 4 87 Facility Score 11 NA 0 6 6 2 2 1 3 2 34 IV.

h. of Doctors: 1 MBBS (1 vacant) 7. f. Total marks: 87 Deputed: 0 Deputed: 0 Functional: 6 Condition of wards Water supply Patient amenities Furniture Walls and floor and roof intact Electrical wires not exposed Electric switch boards not broken Electric bulbs in wards / pathways / toilets Whitewashed Signage boards present Rooms not dumped with condemned articles Mosquito screens present and devoid of holes Condemned articles not stored in the wards Window glasses not broken Door / Screens / Curtains / present for ensuring privacy of patient Availability of ceiling fans in wards Running water available for 24 hours in Labour room Running water available for 24 hours in OT Running water available for 24 hours in Toilets Purified drinking water available for drinking for patients in OP Purified drinking water available for drinking for patients in IP Doors are not damaged Floors are clean Basins are not stained water taps not damaged. j. f. h. pathway is not dirty Separate for male and female Seating arrangements are present in the OPD area Stools or chairs for attendants in the wards present Inpatients are provided with blankets in winter Cots are not rusted. e.Inspection format for health facilities: PHC Dilawarpur Name of the Consultant: Dr. of Beds: 6 Sanctioned: 6 MCH beds: -II. i. 13:00 p. k. h. m. of ANM’s: Posted: 14 9. i. No. not broken Mattress not worn out. k. No. cotton/coir not Score Total Score 1 4 1 1 0 1 0 0 0 3 0 1 1 1 0 2 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 2 2 2 44 | P a g e . Infrastructure Item MOV Criteria Building condition h. Condition of toilets g. No. Date & time: 21/7/2010. i. f. No. cloth not torn. l. d. j. d. i. n. l. No. j. g. of Nurses: Posted: 2 8. of SBA trained Personnel: 2 10. c. j. Rachana Parikh District: Adilabad Name of Facility: PHC Lingapur 6.m. g.

coming out Drainage b. Drainage system not clogged 0 1

III. Human Resource (Self improvement score) Staff performance Baseline data (1st (monthly figure ) survey)

Subsequent visit * % improvement

Number of deliveries conducted per SBA 0 in a month (total) Number of OP cases per doctor 900 Bed occupancy rate* 40% Number of CS per Obstetrician Number of cataract operations per ophthalmologist Chest symptomatic sputum population examination rate Minor surgeries per doctor Antenatal care severely anaemic (under 7 gm%) managed rate IUD insertions per trained nurse MTP services per trained doctor nd rd o Indicative column; subsequent visits (2 , 3 etc. Would be scored on improvement and in a fresh inspection form) o Bed occupancy rate=(inpatient days of care/bed days available)×100 IV. Services available (applicable for BPHCs and above) NOT APPLICABLE Sl.no Service Means of verification Score

Total Score

1. 2. 3. 4. 5. 6. 7. 8. 9.

24 hour doctor available 24 hour nurse available 24 hour delivery services available 24 hour newborn care services available 24 hour caesarean services (if FRU) Tubectomy services available Safe abortion services available 24 hour blood transfusion services Laboratory Services 6. Haemogram 7. Sputum Examination 8. Lipid Profile 9. Hormone Assay

Duty roster, casuality register Duty roster, casuality register Delivery register Delivery register, Paediatric ward register, Immunization register Delivery register FP register MTP register Blood transfusion register / Blood bank master register Equipments and reagents for conducting the tests are present, lab record shows tests are conducted Lab register

45 | P a g e

10. 11. 12. 13.

10. Urine Examination Availability of ECG Facility X Ray Facility with X-ray Technician available Ultrasound services available Ambulance

ECG machine available & working X ray register – working status USG register – working status Records of operation [Number of ambulances, average (if more than one ambulance) number of breakdowns in the last one week, number of drivers available per shift] maintained Telephone number with dial tone OP register – number of adolescent beneficiaries ANC register OPD Register Register

1. 2. 3. 4. 5.

6. 7

Functional telephone Adolescent sexual and reproductive health services Whether fixed day antenatal clinics are conducted Whether fixed day RTI/STI clinics are conducted Whether fixed day sterilization clinics are conducted Whether IEC material displayed Public Display of JSY Beneficiaries V. Item House keeping

Sl. no 1.

Services Out-Sourced Means of verification d. Floor is cleaned with disinfectant on the day of visit e. rainbow linen color maintained f. OT fumigated c. Generator in working condition with designated horse power d. Fuel for operation present c. Food served to inpatients d. Food chart for inpatients

Score 1 0 0 0 0 0 0

Total Score 1

2.

Generator

0

3.

Food

0

V) Equipments and supplies Item MOV condition Score Total Score

46 | P a g e

Trolley Wheelchair Stretcher Sterilised gloves Average number of OP drugs available (monthly) Availability of life saving drugs present

c. d. c. d.

In working condition Trolley without rust In working condition Wheelchair without rust

Yes Yes Yes Yes No No 1 4

1 1 0 1 4

c. Stretcher without rust d. not broken Sterilised gloves available Drug stock register Availability of; V. Oxytocin VI. Misoprostol VII. Magnesium Sulphate VIII. IV antibiotics

Yes Yes No Yes

0

VII. Equipments in Labour room Equipment 13. 14. 15. 16. 17. 18. 19. 20. Spot light in labor room Vacuum extractor Resuscitation equipment for newborn – Bag and mask Resuscitation equipment for newborn – Laryngoscope and full set of endo-tracheal tubes Baby resuscitation table with infant warmer Mucous sucker Baby weighing machine Partograph

Score 0 0 0 0 0 1 1 0 1 1 0 1

Total Score 5

21. Privacy in Labor room (curtains etc) 22. Toilet attached to Labor room 23. Protocols displayed: Active management of 3rd stage of labor (also check case sheets) 24. Labor board not rusted, not broken and not blood stained

VII) Equipments in OT Equipments 8. 9. 10. 11. 12.
2

Score 0 0 0 1 1

Ceiling OT light/ Floor OT light (shadowless) Oxygen cylinder Boyles apparatus (only FRU) Suction apparatus Adequate quantity of linen2

Total Score 2

3 sets of linen per surgery per day. (Calculate average number of surgeries per Day )

47 | P a g e

n. l. (Separate column present but never filled) Delivery register mentions about the details of the baby and condition of the mother Referral slips are issued to patients Score 0 1 1 Total Score 2 XI) Finance Head Number of mothers yet to receive the JSY money Score Total score 0 RKS JSY Full utilization of funds in 2009-10 JSY payments not pending till last week of the visit 0 0 48 | P a g e . m. j. Ante room present IX. g. h. p. Spinal anaesthesia set (FRU) 14. Item Bio-medical Waste Management MOV i. Functioning autoclave Usage of signalac tape usage of biological indicator swab test of sterile packs Colour coded buckets used Deep burial pit available where anatomical waste is disposed Needle cutter in working condition no mix of infectious or non-infectious waste done waste bins not overfilled needles and syringes mutilated and disinfected before putting in waste bin metal sharps disposed in puncture proof containers disposable gloves and masks not reused 0 0 Waste management Score 0 0 1 0 0 0 0 1 Total Score 2 Score 1 No No No Total Score 1 X) Records and reports Item Separate column (in delivery register) for recording major complications leading to maternal death. o.13. f. k. IX) Central sterilization unit MOV Autoclave e.

Equipment and supplies XVII. Records and reports XXII. XIII. Equipments in OT XIX. XIV.Summary: Item XII. Infrastructure Human Resource Services available (applicable for BPHCs and above) Maximum marks 34 Self improvement score NA 7 10 12 7 8 2 3 4 87 Facility Score 14 NA 1 7 5 2 2 1 2 0 34 XV. Services Out-Sourced XVI. Finance Total Score 49 | P a g e . Bio-medical Waste Management XX. Central sterilization unit XXI. Equipment in Labor room XVIII.

Condition of toilets m. Rachana Parikh District: Adilabad Name of Facility: PHC Lingapur 11. of Nurses: Posted: 1 13. of SBA trained Personnel: 15. No. k. i. r. o. No. m. l. g. Date & time: 22/07/2010. Total marks: 87 Deputed: 0 Deputed: 0 Functional: 3 Condition of wards Water supply Patient amenities Furniture Walls and floor and roof intact Electrical wires not exposed Electric switch boards not broken Electric bulbs in wards / pathways / toilets Whitewashed Signage boards present Rooms not dumped with condemned articles Mosquito screens present and devoid of holes Condemned articles not stored in the wards Window glasses not broken Door / Screens / Curtains / present for ensuring privacy of patient Availability of ceiling fans in wards Running water available for 24 hours in Labour room Running water available for 24 hours in OT Running water available for 24 hours in Toilets Purified drinking water available for drinking for patients in OP Purified drinking water available for drinking for patients in IP Doors are not damaged Floors are clean Basins are not stained water taps not damaged. n. o.Inspection format for health facilities: PHC Lingapur Name of the Consultant: Dr. m. t. h.m. f. cotton/coir not Score Total Score 1 6 1 1 1 1 1 0 0 3 0 1 1 1 2 2 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 4 2 2 50 | P a g e . Infrastructure Item MOV Criteria Building condition o. not broken Mattress not worn out. of ANM’s: Posted: 14. r. u. q. n. n. q. 5:45 p. p. pathway is not dirty Separate for male and female Seating arrangements are present in the OPD area Stools or chairs for attendants in the wards present Inpatients are provided with blankets in winter Cots are not rusted. No. of Beds: 3 Sanctioned: 3 MCH beds: -III. cloth not torn. s. o. No. e. l. No. of Doctors: 1 MBBS (1 vacant) 12. p. k.

Haemogram 12. 8. Lipid Profile 14. 3. Drainage system not clogged 0 0 IV. 4. 2. Human Resource (Self improvement score) Staff performance Baseline data (1st (monthly figure ) survey) Subsequent visit * % improvement Number of deliveries conducted per SBA 4 in a month (total) Number of OP cases per doctor 30 per day Bed occupancy rate* 35% Number of CS per Obstetrician Number of cataract operations per ophthalmologist Chest symptomatic sputum population examination rate Minor surgeries per doctor Antenatal care severely anaemic (under 7 gm%) managed rate IUD insertions per trained nurse MTP services per trained doctor nd rd o Indicative column. subsequent visits (2 . 9. 7. casuality register Duty roster. 6.no Service Means of verification Score Total Score 1. casuality register Delivery register Delivery register. Sputum Examination 13. 5. 24 hour doctor available 24 hour nurse available 24 hour delivery services available 24 hour newborn care services available 24 hour caesarean services (if FRU) Tubectomy services available Safe abortion services available 24 hour blood transfusion services Laboratory Services 11. Paediatric ward register. Would be scored on improvement and in a fresh inspection form) o Bed occupancy rate=(inpatient days of care/bed days available)×100 V.coming out Drainage c. 3 etc. lab record shows tests are conducted Lab register 51 | P a g e . Hormone Assay Duty roster. Immunization register Delivery register FP register MTP register Blood transfusion register / Blood bank master register Equipments and reagents for conducting the tests are present. Services available (applicable for BPHCs and above) NOT APPLICABLE Sl.

12. Food served to inpatients f. average (if more than one ambulance) number of breakdowns in the last one week. Food chart for inpatients Score 1 0 0 1 1 0 0 Total Score 1 2. 3. 13. OT fumigated e.10. 6. Generator in working condition with designated horse power f. Urine Examination Availability of ECG Facility X Ray Facility with X-ray Technician available Ultrasound services available Ambulance ECG machine available & working X ray register – working status USG register – working status Records of operation [Number of ambulances. 15. 2. 7 Functional telephone Adolescent sexual and reproductive health services Whether fixed day antenatal clinics are conducted Whether fixed day RTI/STI clinics are conducted Whether fixed day sterilization clinics are conducted Whether IEC material displayed Public Display of JSY Beneficiaries VI. rainbow linen color maintained i. Services Out-Sourced Means of verification g. Item House keeping Sl. 4. Fuel for operation present e. Generator 2 3. Floor is cleaned with disinfectant on the day of visit h. no 1. Food 0 V) Equipments and supplies Item MOV condition Score Total Score 52 | P a g e . 11. 5. number of drivers available per shift] maintained Telephone number with dial tone OP register – number of adolescent beneficiaries ANC register OPD Register Register 1.

Privacy in Labor room (curtains etc) 34. 30. Misoprostol XI. IX. 26. Equipments in Labour room Equipment 25. 27. 31. 29. IV antibiotics Yes Yes No Yes 0 VIII. 16. Protocols displayed: Active management of 3rd stage of labor (also check case sheets) 36. 32. 3 Score 0 0 0 1 1 Ceiling OT light/ Floor OT light (shadowless) Oxygen cylinder Boyles apparatus (only FRU) Suction apparatus Adequate quantity of linen3 Total Score 2 3 sets of linen per surgery per day. f. Stretcher without rust f. Labor board not rusted. Toilet attached to Labor room 35. f. 19. (Calculate average number of surgeries per Day ) 53 | P a g e .Trolley Wheelchair Stretcher Sterilised gloves Average number of OP drugs available (monthly) Availability of life saving drugs present e. not broken and not blood stained VII) Equipments in OT Equipments 15. 28. Magnesium Sulphate XII. not broken Sterilised gloves available Drug stock register Availability of. e. 18. Spot light in labor room Vacuum extractor Resuscitation equipment for newborn – Bag and mask Resuscitation equipment for newborn – Laryngoscope and full set of endo-tracheal tubes Baby resuscitation table with infant warmer Mucous sucker Baby weighing machine Partograph Score 1 0 0 0 0 1 1 0 1 1 0 1 Total Score 6 33. In working condition Trolley without rust In working condition Wheelchair without rust No No Yes Yes No No 1 4 0 1 0 1 4 e. Oxytocin X. 17.

j. no mix of infectious or non-infectious waste done u. l. needles and syringes mutilated and disinfected before putting in waste bin w. Item Bio-medical Waste Management MOV q. Colour coded buckets used r. (Separate column present but never filled) Delivery register mentions about the details of the baby and condition of the mother Referral slips are issued to patients Score 0 1 1 Total Score 2 XI) Finance Head Number of mothers yet to receive the JSY money Score Total score 2 RKS JSY Full utilization of funds in 2009-10 JSY payments not pending till last week of the visit 2 0 54 | P a g e . disposable gloves and masks not reused 0 0 Waste management Score 0 0 1 0 0 1 1 1 Total Score 4 IX) Central sterilization unit MOV Autoclave i. waste bins not overfilled v. Deep burial pit available where anatomical waste is disposed s. metal sharps disposed in puncture proof containers x. Spinal anaesthesia set (FRU) 21. Needle cutter in working condition t. Ante room present X. Functioning autoclave Usage of signalac tape usage of biological indicator swab test of sterile packs Score 1 No No No Total Score 1 X) Records and reports Item Separate column (in delivery register) for recording major complications leading to maternal death. k.20.

Records and reports XXXIII. Services Out-Sourced XXVII.Summary: Item XXIII. Equipment in Labor room XXIX. Equipments in OT XXX. XXIV. XXV. Infrastructure Human Resource Services available (applicable for BPHCs and above) Maximum marks 34 Self improvement score NA 7 10 12 7 8 2 3 4 87 Facility Score 17 NA 3 6 6 2 4 1 2 2 44 XXVI. Bio-medical Waste Management XXXI. Equipment and supplies XXVIII. Central sterilization unit XXXII. Finance Total Score 55 | P a g e .

Walls and floor and roof intact 1 6 condition w. No. of SBA trained Personnel: 0 20. 13:45 p. pathway is not dirty 1 x. No. Electrical wires not exposed 1 x. not broken 0 0 h. of Doctors: 1 MBBS 17. Electric bulbs in wards / pathways / toilets 0 z. District: Adilabad Total marks: 87 Name of Facility: PHC Narsapur 16. of ANM’s: Posted: 13+11 (24) Deputed: 0 19. Condemned articles not stored in the wards 0 r. Floors are clean 1 u. Availability of ceiling fans in wards 0 Water p. Window glasses not broken 0 s.Inspection format for health facilities: PHC Narsapur Name of the Consultant: Dr. Basins are not stained 1 v. Purified drinking water available for drinking for patients in 0 OP t. of Beds: 10 Sanctioned: 10 Functional: 10 MCH beds: -IV. Electric switch boards not broken 1 y. Door / Screens / Curtains / present for ensuring privacy of 0 patient t.m. Mattress not worn out. No. cloth not torn. Infrastructure Item MOV Criteria Score Total Score Building v. of Nurses: Posted: 0 Deputed: 0 18. 1 w. Running water available for 24 hours in Toilets 2 s. Separate for male and female 0 Patient j. Purified drinking water available for drinking for patients in 0 IP Condition of s. No. Running water available for 24 hours in Labor room 2 6 supply q. cotton/coir not 0 56 | P a g e . Rooms not dumped with condemned articles 0 Condition of p. Rachana Parikh Date & time: 21/7/2010. Whitewashed 1 aa. No. Cots are not rusted. Running water available for 24 hours in OT 2 r. Inpatients are provided with blankets in winter 0 Furniture g. Stools or chairs for attendants in the wards present 0 l. water taps not damaged. Mosquito screens present and devoid of holes 0 0 wards q. Signage boards present 1 bb. Doors are not damaged 0 4 toilets t. Seating arrangements are present in the OPD area 1 1 amenities k.

3 etc. subsequent visits (2 . 6. Drainage system not clogged 1 1 V. 2. casuality register Delivery register Delivery register. lab record shows tests are conducted Lab register 57 | P a g e . Sputum Examination 18. Human Resource (Self improvement score) Staff performance Baseline data (1st (monthly figure ) survey) Subsequent visit * % improvement Number of deliveries conducted per SBA 2 per month (total) Number of OP cases per doctor 80/day Bed occupancy rate* Number of CS per Obstetrician Number of cataract operations per ophthalmologist Chest symptomatic sputum population examination rate Minor surgeries per doctor Antenatal care severely anaemic (under 7 gm%) managed rate IUD insertions per trained nurse MTP services per trained doctor nd rd o Indicative column. 7. Immunization register Delivery register FP register MTP register Blood transfusion register / Blood bank master register Equipments and reagents for conducting the tests are present. Hormone Assay Duty roster. 5. 24 hour doctor available 24 hour nurse available 24 hour delivery services available 24 hour newborn care services available 24 hour caesarean services (if FRU) Tubectomy services available Safe abortion services available 24 hour blood transfusion services Laboratory Services 16. Lipid Profile 19. Services available (applicable for BPHCs and above) NOT APPLICABLE Sl. 4.coming out Drainage d. 9.no Service Means of verification Score Total Score 1. Haemogram 17. 3. 8. Would be scored on improvement and in a fresh inspection form) o Bed occupancy rate=(inpatient days of care/bed days available)×100 VI. Paediatric ward register. casuality register Duty roster.

20. OT fumigated g. 13. rainbow linen color maintained l. Food 0 V) Equipments and supplies Item MOV condition Score Total Score 58 | P a g e . 12. Services Out-Sourced Means of verification j. 6. 5. Generator in working condition with designated horse power h. Fuel for operation present g. 3. 7 Functional telephone Adolescent sexual and reproductive health services Whether fixed day antenatal clinics are conducted Whether fixed day RTI/STI clinics are conducted Whether fixed day sterilization clinics are conducted Whether IEC material displayed Public Display of JSY Beneficiaries VII. Item House keeping Sl. Food served to inpatients h.10. no 1. Food chart for inpatients Score 0 0 0 0 0 0 0 Total Score 0 2. Generator 0 3. Floor is cleaned with disinfectant on the day of visit k. number of drivers available per shift] maintained Telephone number with dial tone OP register – number of adolescent beneficiaries ANC register OPD Register Register 1. 2. Urine Examination Availability of ECG Facility X Ray Facility with X-ray Technician available Ultrasound services available Ambulance ECG machine available & working X ray register – working status USG register – working status Records of operation [Number of ambulances. 4. average (if more than one ambulance) number of breakdowns in the last one week. 11.

43. Magnesium Sulphate XVI. h. Toilet attached to Labor room 47. Equipments in Labour room Equipment 37. 26. 38. 24. Protocols displayed: Active management of 3rd stage of labor (also check case sheets) 48. 39. In working condition Trolley without rust In working condition Wheelchair without rust No No No No No No 1 4 0 0 0 1 4 g. IV antibiotics Yes Yes No No 0 IX. 4 Score 0 0 0 0 1 Ceiling OT light/ Floor OT light (shadowless) Oxygen cylinder Boyles apparatus (only FRU) Suction apparatus Adequate quantity of linen4 Total Score 1 3 sets of linen per surgery per day. Oxytocin XIV. Misoprostol XV. 25. 23. Spot light in labor room Vacuum extractor Resuscitation equipment for newborn – Bag and mask Resuscitation equipment for newborn – Laryngoscope and full set of endo-tracheal tubes Baby resuscitation table with infant warmer Mucous sucker Baby weighing machine Partograph Score 0 0 0 0 0 0 0 0 0 0 0 1 Total Score 1 45. 41. 40. Privacy in Labor room (curtains etc) 46.Trolley Wheelchair Stretcher Sterilised gloves Average number of OP drugs available (monthly) Availability of life saving drugs present g. Stretcher without rust h. (Calculate average number of surgeries per Day ) 59 | P a g e . Labor board not rusted. not broken and not blood stained VII) Equipments in OT Equipments 22. g. h. 44. 42. XIII. not broken Sterilised gloves available Drug stock register Availability of.

Colour coded buckets used z. o. Spinal anaesthesia set (FRU) 28. Ante room present XI. metal sharps disposed in puncture proof containers ff. Functioning autoclave Usage of signalac tape usage of biological indicator swab test of sterile packs Score yes No No No Total Score 1 X) Records and reports Item Separate column (in delivery register) for recording major complications leading to maternal death. Deep burial pit available where anatomical waste is disposed aa. no mix of infectious or non-infectious waste done cc. Delivery register mentions about the details of the baby and condition of the mother Referral slips are issued to patients Score 0 1 1 Total Score 2 XI) Finance Head Number of mothers yet to receive the JSY money Score Total score 2 RKS JSY Full utilization of funds in 2009-10 JSY payments not pending till last week of the visit 2 0 60 | P a g e . needles and syringes mutilated and disinfected before putting in waste bin ee. waste bins not overfilled dd. n. disposable gloves and masks not reused 0 0 Waste management Score 0 1 1 1 1 0 1 1 Total Score 6 IX) Central sterilization unit MOV Autoclave m. Needle cutter in working condition bb. p.27. Item Bio-medical Waste Management MOV y.

Services Out-Sourced XXXVIII. Records and reports XLIV. Finance Total Score 61 | P a g e . Equipment in Labor room XL. Infrastructure Human Resource Services available (applicable for BPHCs and above) Maximum marks 34 Self improvement score NA 7 10 12 7 8 2 3 4 87 Facility Score 18 NA 0 5 1 1 6 1 2 2 36 XXXVII. Equipments in OT XLI.Summary: Item XXXIV. Central sterilization unit XLIII. XXXVI. Equipment and supplies XXXIX. Bio-medical Waste Management XLII. XXXV.

No. gg. 18:45 p. of SBA trained Personnel: 3 25. cotton/coir not Score Total Score 1 2 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 62 | P a g e . i. ff. bb. of Doctors: 2 MBBS 22. cloth not torn. v. v. Condition of toilets y. x. not broken Mattress not worn out. No. No. of Beds: 6 Sanctioned: 6 MCH beds: -V. u. of ANM’s: Posted: 13 24. No. x. w.Inspection format for health facilities: PHC Echoda Name of the Consultant: Dr. hh. aa. j. Infrastructure Item MOV Criteria Building condition cc. dd. w. Rachana Parikh District: Adilabad Name of Facility: PHC Echoda 21. Total marks: 87 Deputed: 0 Deputed: 0 Functional: 6 Condition of wards Water supply Patient amenities Furniture Walls and floor and roof intact Electrical wires not exposed Electric switch boards not broken Electric bulbs in wards / pathways / toilets Whitewashed Signage boards present Rooms not dumped with condemned articles Mosquito screens present and devoid of holes Condemned articles not stored in the wards Window glasses not broken Door / Screens / Curtains / present for ensuring privacy of patient Availability of ceiling fans in wards Running water available for 24 hours in Labor room Running water available for 24 hours in OT Running water available for 24 hours in Toilets Purified drinking water available for drinking for patients in OP Purified drinking water available for drinking for patients in IP Doors are not damaged Floors are clean Basins are not stained water taps not damaged. u. ii. pathway is not dirty Separate for male and female Seating arrangements are present in the OPD area Stools or chairs for attendants in the wards present Inpatients are provided with blankets in winter Cots are not rusted. o. No.m. cc. z. Date & time: 21/7/2010. dd. ee. n. m. of Nurses: Posted: 3 23. y. y.

casuality register Duty roster.coming out Drainage e. casuality register Delivery register Delivery register. Sputum Examination 23. 5. 3. lab record shows tests are conducted Lab register 63 | P a g e . Paediatric ward register. Would be scored on improvement and in a fresh inspection form) o Bed occupancy rate=(inpatient days of care/bed days available)×100 VII. Drainage system not clogged 0 0 VI. 7. 9. subsequent visits (2 . 4.no Service Means of verification Score Total Score 1. Haemogram 22. Immunization register Delivery register FP register MTP register Blood transfusion register / Blood bank master register Equipments and reagents for conducting the tests are present. 8. 3 etc. Services available (applicable for BPHCs and above) NOT APPLICABLE Sl. Lipid Profile 24. Human Resource (Self improvement score) Staff performance Baseline data (1st (monthly figure ) survey) Subsequent visit * % improvement Number of deliveries conducted per SBA 40 per month (total) Number of OP cases per doctor 1000 Bed occupancy rate* 66% Number of CS per Obstetrician Number of cataract operations per ophthalmologist Chest symptomatic sputum population examination rate Minor surgeries per doctor Antenatal care severely anaemic (under 7 gm%) managed rate IUD insertions per trained nurse MTP services per trained doctor nd rd o Indicative column. Hormone Assay Duty roster. 6. 24 hour doctor available 24 hour nurse available 24 hour delivery services available 24 hour newborn care services available 24 hour caesarean services (if FRU) Tubectomy services available Safe abortion services available 24 hour blood transfusion services Laboratory Services 21. 2.

12. Urine Examination Availability of ECG Facility X Ray Facility with X-ray Technician available Ultrasound services available Ambulance ECG machine available & working X ray register – working status USG register – working status Records of operation [Number of ambulances. OT fumigated i. 7 Functional telephone Adolescent sexual and reproductive health services Whether fixed day antenatal clinics are conducted Whether fixed day RTI/STI clinics are conducted Whether fixed day sterilization clinics are conducted Whether IEC material displayed Public Display of JSY Beneficiaries VIII. Generator 0 3. 11. no 1. j. Item House keeping Sl. number of drivers available per shift] maintained Telephone number with dial tone OP register – number of adolescent beneficiaries ANC register OPD Register Register 1. 2. Services Out-Sourced Means of verification m. 6. Floor is cleaned with disinfectant on the day of visit n. average (if more than one ambulance) number of breakdowns in the last one week. 3. j. 13. 5. Food i. 25.10. Generator in working condition with designated horse power Fuel for operation present Food served to inpatients Food chart for inpatients Score 0 0 0 0 0 0 0 Total Score 0 2. 0 V) Equipments and supplies Item MOV condition Score Total Score 64 | P a g e . 4. rainbow linen color maintained o.

32. j. 54. i. i. 51. (Calculate average number of surgeries per Day ) 65 | P a g e . j. 30. Magnesium Sulphate XX. 55. 33. 31. IV antibiotics Yes Yes No No 0 X. Protocols displayed: Active management of 3rd stage of labor (also check case sheets) 60. Labor board not rusted. Toilet attached to Labor room 59. 56. Misoprostol XIX. 5 Score 0 0 0 1 1 Ceiling OT light/ Floor OT light (shadowless) Oxygen cylinder Boyles apparatus (only FRU) Suction apparatus Adequate quantity of linen5 Total Score 2 3 sets of linen per surgery per day. j. Privacy in Labor room (curtains etc) 58. Spot light in labor room Vacuum extractor Resuscitation equipment for newborn – Bag and mask Resuscitation equipment for newborn – Laryngoscope and full set of endo-tracheal tubes Baby resuscitation table with infant warmer Mucous sucker Baby weighing machine Partograph Score 0 0 0 0 0 1 1 0 0 0 0 1 Total Score 3 57. In working condition Trolley without rust In working condition Wheelchair without rust Stretcher without rust not broken No No No No No No 1 4 0 0 0 1 4 Sterilised gloves available Drug stock register Availability of.Trolley Wheelchair Stretcher Sterilised gloves Average number of OP drugs available (monthly) Availability of life saving drugs present i. Equipments in Labour room Equipment 49. 53. XVII. not broken and not blood stained VII) Equipments in OT Equipments 29. 52. Oxytocin XVIII. 50.

34. needles and syringes mutilated and disinfected before putting in waste bin mm. disposable gloves and masks not reused 0 0 Waste management Score 0 0 1 0 0 0 1 1 Total Score 3 IX) Central sterilization unit MOV Autoclave q. t. metal sharps disposed in puncture proof containers nn. Needle cutter in working condition jj. s. Deep burial pit available where anatomical waste is disposed ii. waste bins not overfilled ll. Spinal anaesthesia set (FRU) 35. Functioning autoclave Usage of signalac tape usage of biological indicator swab test of sterile packs Score 0 No No No Total Score 0 X) Records and reports Item Separate column (in delivery register) for recording major complications leading to maternal death. Colour coded buckets used hh. Delivery register mentions about the details of the baby and condition of the mother Referral slips are issued to patients Score 0 1 0 Total Score 1 XI) Finance Head Number of mothers yet to receive the JSY money Score Total score 2 RKS JSY Full utilization of funds in 2009-10 JSY payments not pending till last week of the visit 2 0 66 | P a g e . Item Bio-medical Waste Management MOV gg. Ante room present XII. r. no mix of infectious or non-infectious waste done kk.

XLVI. Central sterilization unit LIV. Services Out-Sourced XLIX.Summary: Item XLV. Equipment in Labor room LI. Infrastructure Human Resource Services available (applicable for BPHCs and above) Maximum marks 34 Self improvement score NA 7 10 12 7 8 2 3 4 87 Facility Score 4 NA 0 5 3 2 3 0 1 2 20 XLVIII. Finance Total Score 67 | P a g e . Records and reports LV. Equipment and supplies L. XLVII. Bio-medical Waste Management LIII. Equipments in OT LII.

Doors are not damaged 0 4 toilets ff. Running water available for 24 hours in Toilets 2 cc. Rooms not dumped with condemned articles 0 Condition of z. cloth not torn. Purified drinking water available for drinking for patients in 0 IP Condition of ee. Seating arrangements are present in the OPD area 1 1 amenities q. of Beds: 6 Sanctioned: 6 Functional: 6 MCH beds: -VI. Cots are not rusted. of SBA trained Personnel: 0 30. pathway is not dirty 1 jj. Electrical wires not exposed 1 ll. No. 17:45 p. of Doctors: 1 MBBS 27. Signage boards present 1 pp. Condemned articles not stored in the wards 0 bb. No. Electric switch boards not broken 1 mm. Inpatients are provided with blankets in winter 0 Furniture k. No. Basins are not stained 1 hh. No. Purified drinking water available for drinking for patients in 2 OP dd. Infrastructure Item MOV Criteria Score Total Score Building jj. water taps not damaged. of Nurses: Posted: 0 Deputed: 0 28. not broken 0 0 l. Stools or chairs for attendants in the wards present 0 r. District: Adilabad Total marks: 87 Name of Facility: PHC Azipur 26. of ANM’s: Posted: 16 Deputed: 0 29. Electric bulbs in wards / pathways / toilets 0 nn. Availability of ceiling fans in wards 0 Water z. Separate for male and female 0 Patient p. Window glasses not broken 0 cc. Rachana Parikh Date & time: 22/7/2010. 1 ii.m. cotton/coir not 0 68 | P a g e . Walls and floor and roof intact 1 5 condition kk. Door / Screens / Curtains / present for ensuring privacy of 0 patient dd. Whitewashed 1 oo. Mosquito screens present and devoid of holes 0 0 wards aa. Running water available for 24 hours in Labor room 2 8 supply aa. Floors are clean 1 gg. No.Inspection format for health facilities: PHC Azipur Name of the Consultant: Dr. Running water available for 24 hours in OT 2 bb. Mattress not worn out.

4. Immunization register Delivery register FP register MTP register Blood transfusion register / Blood bank master register Equipments and reagents for conducting the tests are present. 2. Hormone Assay Duty roster. casuality register Duty roster. subsequent visits (2 . Sputum Examination 28. 9. Services available (applicable for BPHCs and above) NOT APPLICABLE Sl. Paediatric ward register. lab record shows tests are conducted Lab register 69 | P a g e . Human Resource (Self improvement score) Staff performance Baseline data (1st (monthly figure ) survey) Subsequent visit * % improvement Number of deliveries conducted per SBA none Number of OP cases per doctor 30-40/day Bed occupancy rate* Number of CS per Obstetrician Number of cataract operations per ophthalmologist Chest symptomatic sputum population examination rate Minor surgeries per doctor Antenatal care severely anaemic (under 7 gm%) managed rate IUD insertions per trained nurse MTP services per trained doctor nd rd o Indicative column. 24 hour doctor available 24 hour nurse available 24 hour delivery services available 24 hour newborn care services available 24 hour caesarean services (if FRU) Tubectomy services available Safe abortion services available 24 hour blood transfusion services Laboratory Services 26. Drainage system not clogged 1 1 VII. 7. 3 etc.coming out Drainage f. 3. Haemogram 27. 6. 8. Lipid Profile 29. 5. Would be scored on improvement and in a fresh inspection form) o Bed occupancy rate=(inpatient days of care/bed days available)×100 VIII. casuality register Delivery register Delivery register.no Service Means of verification Score Total Score 1.

10. 11. 12. 13.

30. Urine Examination Availability of ECG Facility X Ray Facility with X-ray Technician available Ultrasound services available Ambulance

ECG machine available & working X ray register – working status USG register – working status Records of operation [Number of ambulances, average (if more than one ambulance) number of breakdowns in the last one week, number of drivers available per shift] maintained Telephone number with dial tone OP register – number of adolescent beneficiaries ANC register OPD Register Register

1. 2. 3. 4. 5.

6. 7

Functional telephone Adolescent sexual and reproductive health services Whether fixed day antenatal clinics are conducted Whether fixed day RTI/STI clinics are conducted Whether fixed day sterilization clinics are conducted Whether IEC material displayed Public Display of JSY Beneficiaries IX. Item House keeping

Sl. no 1.

Services Out-Sourced Means of verification p. Floor is cleaned with disinfectant on the day of visit q. rainbow linen color maintained r. OT fumigated k. Generator in working condition with designated horse power l. Fuel for operation present k. Food served to inpatients l. Food chart for inpatients

Score 0 0 0 0 0 0 0

Total Score 0

2.

Generator

0

3.

Food

0

V) Equipments and supplies Item MOV condition Score Total Score

70 | P a g e

Trolley Wheelchair Stretcher Sterilised gloves Average number of OP drugs available (monthly) Availability of life saving drugs present

k. l. k. l.

In working condition Trolley without rust In working condition Wheelchair without rust

No No No No No No 1 4

0 0 0 1 4

k. Stretcher without rust l. not broken Sterilized gloves available Drug stock register Availability of; XXI. Oxytocin XXII. Misoprostol XXIII. Magnesium Sulphate XXIV. IV antibiotics

Yes Yes No No

0

XI. Equipments in Labour room Equipment 61. 62. 63. 64. 65. 66. 67. 68. Spot light in labor room Vacuum extractor Resuscitation equipment for newborn – Bag and mask Resuscitation equipment for newborn – Laryngoscope and full set of endo-tracheal tubes Baby resuscitation table with infant warmer Mucous sucker Baby weighing machine Partograph

Score 0 0 0 0 0 0 0 0 0 0 0 0

Total Score 0

69. Privacy in Labor room (curtains etc) 70. Toilet attached to Labor room 71. Protocols displayed: Active management of 3rd stage of labor (also check case sheets) 72. Labor board not rusted, not broken and not blood stained

VII) Equipments in OT Equipments 36. 37. 38. 39. 40.
6

Score 0 0 0 0 1

Ceiling OT light/ Floor OT light (shadowless) Oxygen cylinder Boyles apparatus (only FRU) Suction apparatus Adequate quantity of linen6

Total Score 1

3 sets of linen per surgery per day. (Calculate average number of surgeries per Day )

71 | P a g e

41. Spinal anaesthesia set (FRU) 42. Ante room present XIII. Item Bio-medical Waste Management MOV oo. Color coded buckets used pp. Deep burial pit available where anatomical waste is disposed qq. Needle cutter in working condition rr. no mix of infectious or non-infectious waste done ss. waste bins not overfilled tt. needles and syringes mutilated and disinfected before putting in waste bin uu. metal sharps disposed in puncture proof containers vv. disposable gloves and masks not reused

0 0

Waste management

Score 0 0 1 1 0 0 1 1

Total Score 4

IX) Central sterilization unit MOV Autoclave u. v. w. x. Functioning autoclave Usage of signalac tape usage of biological indicator swab test of sterile packs Score yes No No No

Total Score 1

X) Records and reports Item Separate column (in delivery register) for recording major complications leading to maternal death. Delivery register mentions about the details of the baby and condition of the mother Referral slips are issued to patients Score 0 1 1

Total Score 2

XI) Finance Head Number of mothers yet to receive the JSY money

Score

Total score 2

RKS JSY

Full utilization of funds in 2009-10 JSY payments not pending till last week of the visit

2 0

72 | P a g e

Infrastructure Human Resource Services available (applicable for BPHCs and above) Maximum marks 34 Self improvement score NA 7 10 12 7 8 2 3 4 87 Facility Score 19 NA 0 5 0 1 4 1 2 2 34 LIX. Records and reports LXVI. Services Out-Sourced LX. Finance Total Score 73 | P a g e . LVII. Central sterilization unit LXV. Equipments in OT LXIII. Equipment in Labor room LXII.Summary: Item LVI. Bio-medical Waste Management LXIV. LVIII. Equipment and supplies LXI.

Condemned articles not stored in the wards 1 gg. 1 oo. of SBA trained Personnel: 10 35. Purified drinking water available for drinking for patients in 2 OP ii. No. Purified drinking water available for drinking for patients in 2 IP Condition of kk. Stools or chairs for attendants in the wards present 0 u. Infrastructure Item MOV Criteria Score Total Score Building qq. Whitewashed 1 vv. No. Electric bulbs in wards / pathways / toilets 1 uu. No.m.Inspection format for health facilities: CHC Utnoor Name of the Consultant: Dr. pathway is not dirty 1 pp. Rachana Parikh Date & time: 22/7/2010. Mosquito screens present and devoid of holes 0 4 wards ff. of ANM’s: Posted: 1 Deputed: 0 34. Electric switch boards not broken 1 tt. Separate for male and female 1 Patient s. of Beds: 50 Sanctioned: 50 + 40 (CEMONC) Functional: 50 MCH beds: -VII. cotton/coir not 1 74 | P a g e . Basins are not stained 1 nn. of Doctors: 5 (4 MBBS. Cots are not rusted. Doors are not damaged 1 6 toilets ll. surgeon) 32. cloth not torn. Electrical wires not exposed 1 ss. Mattress not worn out. water taps not damaged. Running water available for 24 hours in Labour room 2 8 supply ff. Running water available for 24 hours in OT 0 gg. No. No. window glasses not broken 1 hh. Signage boards present 1 ww. not broken 1 2 n. Availability of ceiling fans in wards 1 Water ee. 1 Dental Asst. Running water available for 24 hours in Toilets 2 hh. Inpatients are provided with blankets in winter 1 Furniture m. Rooms not dumped with condemned articles 1 Condition of ee. of Nurses: Posted: 10 Deputed: 0 33. Floors are clean 1 mm. District: Adilabad Total marks: 120 Name of Facility: CHC Utnoor 31. Door / Screens / Curtains / present for ensuring privacy of 1 patient ii. 14:00 p. Seating arrangements are present in the OPD area 1 2 amenities t. Walls and floor and roof intact 1 7 condition rr.

Would be scored on improvement and in a fresh inspection form) o Bed occupancy rate=(inpatient days of care/bed days available)×100 IX. 3. Services available (applicable for BPHCs and above) Sl. 5. Paediatric ward register. 24 hour doctor available 24 hour nurse available 24 hour delivery services available 24 hour newborn care services available 24 hour caesarean services (if FRU) Tubectomy services available Safe abortion services available 24 hour blood transfusion services Laboratory Services 31. Hormone Assay Duty roster. 7. lab record shows tests are conducted Lab register 2 2 2 0 0 0 0 0 2 75 | P a g e . 3 etc. 9.no Service Means of verification Score Total Score 12 1. 8.3% Number of CS per Obstetrician Number of cataract operations per ophthalmologist Chest symptomatic sputum population examination rate Minor surgeries per doctor Antenatal care severely anaemic (under 7 gm%) managed rate IUD insertions per trained nurse MTP services per trained doctor nd rd o Indicative column. subsequent visits (2 . Human Resource (Self improvement score) Staff performance Baseline data (1st (monthly figure ) survey) Subsequent visit * % improvement Number of deliveries conducted per SBA 6/SBA/m Number of OP cases per doctor 12065/m Bed occupancy rate* 52. Drainage system not clogged 1 1 VIII. 2. Lipid Profile 34. casuality register Delivery register Delivery register. Haemogram 32. Sputum Examination 33. casuality register Duty roster. 4. 6. Immunization register Delivery register FP register MTP register Blood transfusion register / Blood bank master register Equipments and reagents for conducting the tests are present.coming out Drainage g.

12. 2. 5. Urine Examination Availability of ECG Facility X Ray Facility with X-ray Technician available Ultrasound services available Ambulance ECG machine available & working X ray register – working status USG register – working status Records of operation [Number of ambulances. 7 Functional telephone Adolescent sexual and reproductive health services Whether fixed day antenatal clinics are conducted Whether fixed day RTI/STI clinics are conducted Whether fixed day sterilization clinics are conducted Whether IEC material displayed Public Display of JSY Beneficiaries X. Food served to inpatients n. 3. no 1. 13. Food 0 V) Equipments and supplies Item MOV condition Score Total Score 76 | P a g e . number of drivers available per shift] maintained Telephone number with dial tone OP register – number of adolescent beneficiaries ANC register OPD Register Register 0 2 0 2 1. Item House keeping 1 0 1 0 0 3 1 0 Sl. 11. Floor is cleaned with disinfectant on the day of visit t. average (if more than one ambulance) number of breakdowns in the last one week. Generator 2 3. OT fumigated m. 35. rainbow linen colour maintained u. 6. Generator in working condition with designated horse power n. Fuel for operation present m. 4. Food chart for inpatients Score 1 0 0 1 1 0 0 Total Score 1 2. Services Out-Sourced Means of verification s.10.

76. not broken Sterilized gloves available Drug stock register Availability of. IV antibiotics Yes Yes Yes Yes 2 XII. Spot light in labour room Vacuum extractor Resuscitation equipment for newborn – Bag and mask Resuscitation equipment for newborn – Laryngoscope and full set of endo-tracheal tubes Baby resuscitation table with infant warmer Mucous sucker Baby weighing machine Partograph Score 1 0 1 1 1 1 1 0 1 1 0 1 Total Score 9 81. 46. Oxytocin XXVI. 79. 47. 78. 44.Trolley Wheelchair Stretcher Sterilised gloves Average number of OP drugs available (monthly) Availability of life saving drugs present m. not broken and not blood stained VII) Equipments in OT Equipments 43. 74. 77. Equipments in Labour room Equipment 73. 75. (Calculate average number of surgeries per Day ) 77 | P a g e . Privacy in Labour room (curtains etc) 82. Stretcher without rust n. Labour board not rusted. XXV. 45. m. 80. Misoprostol XXVII. 7 Score 1 1 0 1 1 Ceiling OT light/ Floor OT light (shadowless) Oxygen cylinder Boyles apparatus (only FRU) Suction apparatus Adequate quantity of linen7 Total Score 4 3 sets of linen per surgery per day. n. n. Protocols displayed: Active management of 3rd stage of labour (also check case sheets) 84. Magnesium Sulphate XXVIII. Toilet attached to Labour room 83. In working condition Trolley without rust In working condition Wheelchair without rust Yes Yes Yes Yes Yes Yes 1 4 1 1 1 1 4 m.

Item Bio-medical Waste Management MOV ww. waste bins not overfilled bbb. Functioning autoclave Usage of signalac tape usage of biological indicator swab test of sterile packs Score Yes Yes No No Total Score 2 X) Records and reports Item Separate column (in delivery register) for recording major complications leading to maternal death. needles and syringes mutilated and disinfected before putting in waste bin ccc. Spinal anaesthesia set (FRU) 49. aa.48. (Separate column present but never filled) Delivery register mentions about the details of the baby and condition of the mother Referral slips are issued to patients Score 1 1 1 Total Score 3 XI) Finance Head Number of mothers yet to receive the JSY money Score Total score 2 RKS JSY Full utilization of funds in 2009-10 JSY payments not pending till last week of the visit 0 0 78 | P a g e . metal sharps disposed in puncture proof containers ddd. disposable gloves and masks not reused 0 0 Waste management Score 0 0 1 0 0 0 0 1 Total Score 2 IX) Central sterilization unit MOV Autoclave y. Colour coded buckets used xx. bb. Needle cutter in working condition zz. no mix of infectious or non-infectious waste done aaa. Ante room present XIV. z. Deep burial pit available where anatomical waste is disposed yy.

Equipments and supplies LXXII. Equipments in Labour room LXXIII. LXVIII. Records and reports LXXVII. Services Out-Sourced LXXI. Bio-medical Waste Management LXXV. Infrastructure Human Resource Services available (applicable for BPHCs and above) Maximum marks 34 Self improvement score 33 7 10 12 7 8 2 3 4 120 Facility Score 30 15 3 10 9 4 2 2 3 2 80 LXX. Equipments in OT LXXIV. LXIX. Finance Total Score 79 | P a g e .Summary: Item LXVII. Central sterilization unit LXXVI.

Running water available for 24 hours in Toilets 2 mm. of SBA trained Personnel: 10 No. Purified drinking water available for drinking for 2 patients in OP nn. Inpatients are provided with blankets in winter 1 Furniture o. Rachana Parikh Date & time: 22/7/2010. pathway is not dirty 1 vv.m. Walls and floor and roof intact 1 6 condition yy. of Nurses: Posted: 10 Deputed: 0 No. Infrastructure Item MOV Criteria Score Total Score Building xx. Condemned articles not stored in the wards 1 ll. District: Adilabad Total marks: 120 Name of Facility: Nirmal MCH No. Electrical wires not exposed 1 zz. Electric bulbs in wards / pathways / toilets 1 bbb. Running water available for 24 hours in Labour room 0 8 supply kk. cloth not torn. water taps not damaged. Doors are not damaged 1 3 toilets rr. Separate for male and female 1 Patient v. of ANM’s: Posted: 4 Deputed: 0 No.Inspection format for health facilities: Nirmal MCH Name of the Consultant: Dr. Door / Screens / Curtains / present for ensuring 1 privacy of patient nn. Cots are not rusted. Signage boards present 0 ddd. 0 uu. Availability of ceiling fans in wards 0 Water jj. Whitewashed 1 ccc. Stools or chairs for attendants in the wards present 0 x. cotton/coir not 0 80 | P a g e . of Beds: 40 Sanctioned: 40 Functional: 40 MCH beds: -VIII. Electric switch boards not broken 1 aaa. Purified drinking water available for drinking for patients in 2 IP Condition of qq. Basins are not stained 0 tt. Mattress not worn out. of Doctors: 4 Gynecologist (1 trained in LSAS) + 1 pediatrician + 2 MBBS + 1 Dentist No. Running water available for 24 hours in OT 2 ll. Rooms not dumped with condemned articles 1 Condition of jj. Floors are clean 0 ss. window glasses not broken 1 mm. Mosquito screens present and devoid of holes 0 3 wards kk. Seating arrangements are present in the OPD area 1 2 amenities w. not broken 1 1 p. 14:00 p.

Haemogram 37. 24 hour doctor available 24 hour nurse available 24 hour delivery services available 24 hour newborn care services available 24 hour caesarean services (if FRU) Tubectomy services available Safe abortion services available 24 hour blood transfusion services Laboratory Services 36. 4.5 - Subsequent visit * % improvement Number of OP cases per doctor Bed occupancy rate* Number of CS per Obstetrician Number of cataract operations per ophthalmologist Chest symptomatic sputum population examination rate Minor surgeries per doctor Antenatal care severely anaemic (under 7 gm%) managed rate IUD insertions per trained nurse MTP services per trained doctor nd rd o Indicative column. subsequent visits (2 .5% 55. Paediatric ward register. 3. 5.no Service Means of verification Score Total Score 22 1. 6. 3 etc. 2. Services available (applicable for BPHCs and above) Sl. casuality register Duty roster.coming out Drainage h. Human Resource (Self improvement score) Staff performance Baseline data (1st survey) (monthly figure ) Number of deliveries conducted per SBA 277 total (supervised by doctors) 2441 July 10 194. 7. Immunization register Delivery register FP register MTP register Blood transfusion register / Blood bank master register Equipments and reagents for conducting the tests are present. casuality register Delivery register Delivery register. lab record shows tests are conducted 2 2 2 2 2 2 2 2 2 81 | P a g e . Drainage system not clogged 1 1 IX. 8. 9. Sputum Examination Duty roster. Would be scored on improvement and in a fresh inspection form) o Bed occupancy rate=(inpatient days of care/bed days available)×100 X.

Food 0 V) Equipments and supplies Item 82 | P a g e MOV condition Score Total . Lipid Profile 39. 12. Food served to inpatients p. 2. 5. Fuel for operation present o. rainbow linen colour maintained x. Services Out-Sourced Means of verification v. 7 Functional telephone Adolescent sexual and reproductive health services Whether fixed day antenatal clinics are conducted Whether fixed day RTI/STI clinics are conducted Whether fixed day sterilization clinics are conducted Whether IEC material displayed Public Display of JSY Beneficiaries XI. 38. Item House keeping 1 0 1 1 1 5 1 0 Sl. 13. Generator in working condition with designated horse power p. Floor is cleaned with disinfectant on the day of visit w.10. 4. number of drivers available per shift] maintained Telephone number with dial tone OP register – number of adolescent beneficiaries ANC register OPD Register Register 0 2 2 0 1. average (if more than one ambulance) number of breakdowns in the last one week. 6. Generator 2 3. OT fumigated o. no 1. 11. Food chart for inpatients Score 0 0 0 1 1 0 0 Total Score 0 2. Urine Examination Availability of ECG Facility X Ray Facility with X-ray Technician available Ultrasound services available Ambulance Lab register ECG machine available & working X ray register – working status USG register – working status Records of operation [Number of ambulances. 3. Hormone Assay 40.

XXIX. p. Magnesium Sulphate XXXII. 89. Protocols displayed: Active management of 3rd stage of labour (also check case sheets) 96. Equipments in Labour room Equipment 85. Misoprostol XXXI. o. 92. 91. 51. Privacy in Labour room (curtains etc) 94. p. Ceiling OT light/ Floor OT light (shadowless) Oxygen cylinder Boyles apparatus (only FRU) Suction apparatus Score 1 1 1 1 Total Score 6 83 | P a g e . 88. Labour board not rusted. 52. 86. 87. IV antibiotics Yes Yes Yes Yes 2 XIII. Spot light in labour room Vacuum extractor Resuscitation equipment for newborn – Bag and mask Resuscitation equipment for newborn – Laryngoscope and full set of endo-tracheal tubes Baby resuscitation table with infant warmer Mucous sucker Baby weighing machine Partograph Score 0 0 1 1 0 1 1 0 1 1 0 0 Total Score 6 93. Stretcher without rust p. not broken and not blood stained VII) Equipments in OT Equipments 50. In working condition Trolley without rust In working condition Wheelchair without rust Yes Yes Yes Yes Yes Yes 1 4 1 1 1 1 4 o.Score Trolley Wheelchair Stretcher Sterilised gloves Average number of OP drugs available (monthly) Availability of life saving drugs present o. 90. not broken Sterilized gloves available Drug stock register Availability of. Oxytocin XXX. 53. Toilet attached to Labour room 95.

Deep burial pit available where anatomical waste is disposed ggg. (Separate column present but never filled) Delivery register mentions about the details of the baby and condition of the mother Referral slips are issued to patients XI) Finance Head Number of mothers yet to receive the JSY money Score 1 1 1 Total Score 3 Score Total score 0 RKS 8 Full utilization of funds in 2009-10 0 3 sets of linen per surgery per day. Needle cutter in working condition hhh. Adequate quantity of linen8 55. no mix of infectious or non-infectious waste done iii. Item Bio-medical Waste Management MOV eee. Spinal anaesthesia set (FRU) 56. Functioning autoclave Usage of signalac tape usage of biological indicator swab test of sterile packs Score Yes No Yes No Total Score 2 X) Records and reports Item Separate column (in delivery register) for recording major complications leading to maternal death. ff. ee.54.metal sharps disposed in puncture proof containers lll. Ante room present XV. disposable gloves and masks not reused 1 1 0 Waste management Score Outsourced Total Score 8 IX) Central sterilization unit MOV Autoclave cc. needles and syringes mutilated and disinfected before putting in waste bin kkk. (Calculate average number of surgeries per Day ) 84 | P a g e . Colour coded buckets used fff. dd. waste bins not overfilled jjj.

Records and reports LXXXVIII. Services Out-Sourced LXXXII. Equipments and supplies LXXXIII. Equipments in Labour room LXXXIV. Equipments in OT LXXXV. Infrastructure Human Resource Services available (applicable for BPHCs and above) Maximum marks 34 Self improvement score 33 7 10 12 7 8 2 3 4 120 Facility Score 24 27 2 10 6 6 8 2 3 0 88 LXXXI.JSY Summary: JSY payments not pending till last week of the visit 0 Item LXXVIII. LXXIX. Bio-medical Waste Management LXXXVI. Finance Total Score 85 | P a g e . Central sterilization unit LXXXVII. LXXX.

window glasses not broken 1 rr. Signage boards present 1 kkk.m. of SBA trained Personnel: 30 No. Walls and floor and roof intact 1 7 condition fff. of Doctors: 1 Orthopedics + 2 Anesthetists + 1 ENT + 5 MBBS No. Running water available for 24 hours in Toilets 2 rr. Running water available for 24 hours in Labor room 2 10 supply pp. cloth not torn. 16:20 p. Separate for male and female 0 Patient y.Rooms not dumped with condemned articles 1 Condition of oo. of Nurses: Posted: 30 Deputed: 0 No. Door / Screens / Curtains / present for ensuring privacy of 1 patient ss. pathway is not dirty 0 bbb.Inspection format for health facilities: AH Mancherial Name of the Consultant: Dr. water taps not damaged. Inpatients are provided with blankets in winter 0 Furniture q. of Beds: 40 Sanctioned: 40 Functional: 40 MCH beds: -IX. Seating arrangements are present in the OPD area 1 1 amenities z. Purified drinking water available for drinking for patients in 2 IP Condition of ww. Electric bulbs in wards / pathways / toilets 1 iii. Mosquito screens present and devoid of holes 0 4 wards pp. Electric switch boards not broken 1 hhh. Whitewashed 1 jjj. Infrastructure Item MOV Criteria Score Total Score Building eee. Cots are not rusted. Availability of ceiling fans in wards 0 Water oo. not broken 1 1 r. Floors are clean 0 yy. Electrical wires not exposed 1 ggg. District: Adilabad Total marks: 120 Name of Facility: AH Mancherial No. Mattress not worn out. Running water available for 24 hours in OT 2 qq. Rachana Parikh Date & time: 24/7/2010. cotton/coir not 0 86 | P a g e . Stools or chairs for attendants in the wards present 0 aa. Basins are not stained 0 zz. Doors are not damaged 0 0 toilets xx. 0 aaa. Purified drinking water available for drinking for patients in 2 OP ss. of ANM’s: Posted: 5 Deputed: 0 No. Condemned articles not stored in the wards 1 qq.

Hormone Assay Duty roster.no Service Means of verification Score Total Score 10 1. lab record shows tests are conducted Lab register 2 2 2 0 0 2 0 0 2 87 | P a g e . 3. 24 hour doctor available 24 hour nurse available 24 hour delivery services available 24 hour newborn care services available 24 hour caesarean services (if FRU) Tubectomy services available Safe abortion services available 24 hour blood transfusion services Laboratory Services 41. Would be scored on improvement and in a fresh inspection form) o Bed occupancy rate=(inpatient days of care/bed days available)×100 XI.coming out Drainage i. 9. 2. Haemogram 42. Drainage system not clogged 1 1 X. 4. Paediatric ward register. 6. subsequent visits (2 .65% Number of CS per Obstetrician Number of cataract operations per ophthalmologist Chest symptomatic sputum population examination rate Minor surgeries per doctor Antenatal care severely anaemic (under 7 gm%) managed rate IUD insertions per trained nurse 0.3 MTP services per trained doctor nd rd o Indicative column. casuality register Delivery register Delivery register. casuality register Duty roster. 8. 7. Services available (applicable for BPHCs and above) Sl. 3 etc. Immunization register Delivery register FP register MTP register Blood transfusion register / Blood bank master register Equipments and reagents for conducting the tests are present. Sputum Examination 43. Lipid Profile 44. 5. Human Resource (Self improvement score) Staff performance Baseline data (1st (monthly figure ) survey) Subsequent visit * % improvement Number of deliveries conducted per SBA 28 total Number of OP cases per month 13602 Bed occupancy rate* 58.

Item House keeping 1 1 1 0 0 3 0 0 Sl. 45. 6. Fuel for operation present q. 11. Food 2 V) Equipments and supplies Item MOV condition Score Total Score 88 | P a g e . Floor is cleaned with disinfectant on the day of visit z. number of drivers available per shift] maintained Telephone number with dial tone OP register – number of adolescent beneficiaries ANC register OPD Register Register 0 0 0 0 1. 13. 4. average (if more than one ambulance) number of breakdowns in the last one week. Generator in working condition with designated horse power r. Food chart for inpatients Score 1 0 0 1 1 1 1 Total Score 1 2. 12. OT fumigated q. 5.10. Food served to inpatients r. 2. rainbow linen colour maintained aa. Generator 2 3. Services Out-Sourced Means of verification y. no 1. Urine Examination Availability of ECG Facility X Ray Facility with X-ray Technician available Ultrasound services available Ambulance ECG machine available & working X ray register – working status USG register – working status Records of operation [Number of ambulances. 3. 7 Functional telephone Adolescent sexual and reproductive health services Whether fixed day antenatal clinics are conducted Whether fixed day RTI/STI clinics are conducted Whether fixed day sterilization clinics are conducted Whether IEC material displayed Public Display of JSY Beneficiaries XII.

r. Baby resuscitation table with infant warmer 102. 58. XXXIII. Equipments in Labour room Equipment 97. 9 Score 0 0 1 1 1 1 1 0 0 1 0 1 Total Score 7 Score 1 1 1 1 1 Ceiling OT light/ Floor OT light (shadowless) Oxygen cylinder Boyles apparatus (only FRU) Suction apparatus Adequate quantity of linen9 Total Score 6 3 sets of linen per surgery per day. not broken and not blood stained VII) Equipments in OT Equipments 57. q. Magnesium Sulphate XXXVI. Labour board not rusted. Privacy in Labour room (curtains etc) 106. Protocols displayed: Active management of 3rd stage of labour (also check case sheets) 108. Stretcher without rust r. Toilet attached to Labour room 107. (Calculate average number of surgeries per Day ) 89 | P a g e . 61. Resuscitation equipment for newborn – Bag and mask 100.Trolley Wheelchair Stretcher Sterilised gloves Average number of OP drugs available (monthly) Availability of life saving drugs present q. Baby weighing machine 104. Partograph 105. In working condition Trolley without rust In working condition Wheelchair without rust Yes Yes Yes Yes Yes Yes 1 4 1 1 1 1 4 q. Mucous sucker 103. Vacuum extractor 99. r. IV antibiotics Yes Yes Yes Yes 2 XIV. 59. Resuscitation equipment for newborn – Laryngoscope and full set of endo-tracheal tubes 101. not broken Sterilized gloves available Drug stock register Availability of. 60. Misoprostol XXXV. Spot light in labour room 98. Oxytocin XXXIV.

Spinal anaesthesia set (FRU) 63. no mix of infectious or non-infectious waste done qqq. needles and syringes mutilated and disinfected before putting in waste bin sss. Item Bio-medical Waste Management MOV mmm. hh. Ante room present XVI. Deep burial pit available where anatomical waste is disposed ooo. waste bins not overfilled rrr. Colour coded buckets used nnn. Needle cutter in working condition ppp. disposable gloves and masks not reused 1 0 Waste management Score Outsourced Total Score 8 IX) Central sterilization unit MOV Autoclave gg. (Separate column present but never filled) Delivery register mentions about the details of the baby and condition of the mother Referral slips are issued to patients XI) Finance Head Number of mothers yet to receive the JSY money Score 1 0 1 Total Score 2 Score Total score 0 RKS JSY Full utilization of funds in 2009-10 JSY payments not pending till last week of the visit 0 0 90 | P a g e . metal sharps disposed in puncture proof containers ttt.62. ii. jj. Functioning autoclave Usage of signalac tape usage of biological indicator swab test of sterile packs Score Yes No No No Total Score 1 X) Records and reports Item Separate column (in delivery register) for recording major complications leading to maternal death.

Records and reports XCIX. Services Out-Sourced XCIII. XCI. XC. Equipments and supplies XCIV. Infrastructure Human Resource Services available (applicable for BPHCs and above) Maximum marks 34 Self improvement score 33 7 10 12 7 8 2 3 4 120 Facility Score 24 13 5 10 7 6 8 1 2 0 76 XCII.Summary: Item LXXXIX. Equipments in Labour room XCV. Central sterilization unit XCVIII. Finance Total Score 91 | P a g e . Equipments in OT XCVI. Bio-medical Waste Management XCVII.