FHC Anad District Assessment

PHC Score Card
OPD PHC SCORE LABORATORY
90.81272084806 89.903846153846
NATIONAL HEALTH
PROGRAM 87% GENERAL
ADMINISTRATION
85.43165467626 84.651898734177
Area of Concernwise Score

Service Provision Patient's Right Input Support Services
90.625 96.875 80 86.1764705882353
Quality
Clinical Services Hospital Infection Control Management Outcome
86.85185185185 97.7011494252874 75.789473684211 98.9795918367347
Area of Concern - A Service Provision

Standard A1 Facility provides primary level curative services
Standard A2 The facility provides RMNCHA Services
Standard A3 The Facility provides Diagnostic Services, Para-clinical & support services.
Standard A4 The facility provides services as mandated in the National Health Programmes /State scheme(s).
Area of Concern B - Patients' Right
Standard B1 The facility provides the information to care seekers, attendants & community about the available services an
Standard B2 modalities
Services are delivered in a manner that is sensitive to gender, religious and cultural needs, and there are no ba
Standard B3 account of physical,
The facility maintainseconomic, cultural or social
privacy, confidentiality status.of patient, and has a system for guarding patient relate
& dignity
Standard B4 information.
The facility ensures that there are no financial barrier to access, and that there is financial protection given from
hospital services. Area of Concern - C Inputs
Standard C1 The facility has infrastructure for delivery of assured services, and available infrastructure meets the prevalen
Standard C2 The facility ensures the physical safety including fire safety of the infrastructure.
Standard C3 The facility has adequate qualified and trained staff, required for providing the assured services to the curren
Standard C4 The facility provides drugs and consumables required for assured services.
Standard C5 The facility has equipment & instruments required for assured list of services.
Area of Concern - D Support Services
Standard D1 The facility has a established Facility Management Program for Maintenance & Upkeep of Equipment & Infrast
Standard D2 provide safehas
The facility & Secure
definedenvironment to staff
procedures for & Users
storage, inventory management and dispensing of drugs in pharmacy an
Standard D3 care areas
The facility ensures availability of diet, linen, water and power backup as per requirement of service delivery &
Standard D4 services
The norms
facility has defined and established procedures for promoting public participation in management of hospi
Standard D5 transparency and accountability.
Hospital has defined and established procedures for Financial Management & monitoring of quality of outsou
Standard D6 services.
The facility is compliant with all statutory and regulatory requirement imposed by local, state or central gover
Standard D7 Roles & Responsibilities of administrative and clinical staff are determined as per govt. regulations and standar
Standard D8 procedures.
Hospital has defined and established procedure for monitoring & reporting of National Health Program as per
specifications Area of Concern - E Clinical Services
Standard E1 The facility has defined procedures for registration, consultation and admission of patients.
Standard E2 The facility has procedures for continuity of care of patient.
Standard E3 The facility has defined and established procedures for nursing care
Standard E4 The facility has defined procedure for drug administration & follows standard treatment guidelines defined by
Standard E5 The facility hasgovernment
state/Central defined and established procedures for maintaining, updating of patients’ clinical records and
Standard E6 The facility has defined and established procedures for discharge of patient.
Standard E7 The facility has defined and established procedures for Emergency Services and Disaster Management
Standard E8 The facility has defined and established procedures of diagnostic services
Maternal & Child Health Services
Standard E9 The facility has established procedures for Antenatal care as per guidelines
Standard E10 The facility has established procedures for Intranatal care as per guidelines
Standard E11 The facility has established procedures for postnatal care as per guidelines
Standard E12 The facility has established procedures for care of new born, infant and child as per guidelines
Standard E13 The facility has established procedures for abortion and family planning as per government guidelines and law
Standard E14 The facility provides Adolescent Reproductive and Sexual Health services as per guidelines
National Health Programmes
Standard E15 The facility provides National health Programme as per operational/Clinical Guidelines
Area of Concern - F Infection Control
Standard F1 The facility has infection control Programme and procedures in place for prevention and measurement of hosp
Standard F2 associated
The facilityinfection
has defined and Implemented procedures for ensuring hand hygiene practices and antisepsis
Standard F3 The facility ensures availability of material for personal protection, and facility staff follow standard precaution
Standard F4 protection.
The facility has standard procedures for processing of equipment and instruments
Standard F5 Physical layout and environmental control of the patient care areas ensures infection prevention
Standard F6 The facility has defined and established procedures for segregation, collection, treatment and disposal of Bio M
hazardous Waste. Area of Concern - G Quality Management
Standard G1 The facility has defined and established organizational framework & Quality policy for Quality Assurance
Standard G2 The facility has established system for patient and employee satisfaction
Standard G3 The facility have established system for assuring and improving quality of Clinical & support services by interna
Standard G4 program.
The facility has established, documented implemented and maintained Standard Operating Procedures for all k
processes and support services. Area of Concern - H Outcomes
Standard H1 The facility measures Productivity Indicators and ensures compliance with State/National benchmarks
Standard H2 The facility measures Efficiency Indicators and ensure to reach State/National Benchmark
Standard H3 The facility measures Clinical Care & Safety Indicators and tries to reach State/National benchmark
Standard H4 The facility measures Service Quality Indicators and endeavours to reach State/National benchmark
n
95%
88%
100%
ate scheme(s). 88%
out the available services and their 100%

l needs, and there are no barrier on 96%
m for guarding patient related 100%
nancial protection given from the cost of 85%
tructure meets the prevalent norms 75%

91%
sured services to the current case load 80%
75%
91%
s
keep of Equipment & Infrastructure to 84%
sing of drugs in pharmacy and patient 91%
rement of service delivery & support 88%
tion in management of hospital with 67%
nitoring of quality of outsourced 67%
y local, state or central government 100%
ovt. regulations and standards operating 93%
onal Health Program as per state 90%
f patients. 100%
88%
NA
tment guidelines defined by 75%
atients’ clinical records and their storage 91%
NA
saster Management 77%
81%
91%
NA
75%
er guidelines 94%
vernment guidelines and law 93%
uidelines 88%
lines 85%
l
n and measurement of hospital 100%
ractices and antisepsis 97%
ff follow standard precaution for personal 93%
95%
ention 100%
atment and disposal of Bio Medical and 99%
ent
y for Quality Assurance 72%
93%
& support services by internal & external 63%
Operating Procedures for all key 87%
benchmarks 100%
100%
nchmark 96%
enchmark 100%
Customized National Quality Assurance Standards for PHC State :Kerala
Checklist for OPD
Reference No. Measurable Element Checkpoint Compliance Assessment Means of Verification Remarks
Method
ME A1.1 The facility provides treatment of Availability of Consultation services for 2 RR/SI Common Cold, Fever, Diarrhoea, Bronchial
common ailments common illnesses Asthma, Foreign body in conjunctiva sac, etc.
ME A1.2 The facility provides Accident & Primary Management of wounds & 2 RR/SI Incision & drainage, Stitching Dressing
Emergency Services First Aid
RR/SI
Primary Management of trauma &
bone injuries 1 Splints
Emergency Management of Life 2 RR/SI Stabilization/ Primary Management of Medical
threatening conditions conditions like Shock, Ischemic Heart Disease,
CVA, Dyspnoea, Unconscious patients, Status
Epilepticus, etc.
Primary Management & stabilization 2 RR/SI Lavage & Antidotes

of Poisoning
Primary treatment for Dog Bite cases 2 RR/SI Anti Rabies Vaccines
ME A1.4 Services are available for the time OPD Services are available for time 2 RR/SI/PI
period as mandated mandate
Emergency Services are functional at 2 RR/SI
least during OPD hours
ME A1.5 The facility provides curatives & Availability of OPD services for 2 RR/SI
preventive services for the health diseases, specifically prevalent locally
problems and diseases, prevalent
locally.

ME A2.1 The facility provides Reproductive Availablity of Counselling Services 2 RR/SI For Family Planning, Abortion & Infertility
health Services
Provision of Contraceptives 2 RR/SI Condoms, Oral Pills, Progesterone Only pill
(POP), Emergency Contraceptives , IUCD
Insertion
Referral & Follow-up services 1 RR/SI For Permanent Methods of Family Planning,
Abortion & Infertility
Safe Abortion Services 1 RR/SI Primary Management of spontenous cases of
abortion.
Medical Method of abortion up to 8 Weeks with
referral linkages
ME A2.2 The facility provides Maternal health Availability of Functional ANC Clinic 2 RR/SI
Services
Early registration & Minimum 4 ANC 2 RR/SI
Check-up
Provision of Tetanus Toxoid and IFA 2 RR/SI
Nutritional & Health Counselling 2 RR/SI By MO. May be individual counselling/ group
counselling
Identification and management of 2 RR/SI PIH, Pre eclampsia, Severe Anaemia, IUGR,
High Risk and Danger signs during Multiple pregnancy, Bad Obstretics History
pregnancy
ME A2.3 The facility provides New-born health Identification, primary management 2 RR/SI
Services and prompt referral of sick newborns
ME A2.4 The facility provides Child health Routine & Emergency care of Sick 2 RR/SI Treatment of Diarrheal , Pneumonia, anaemia
Services Children etc.
Management of Malnutrition cases 1 RR/SI
Identification and referral of Severe 1 RR/SI

Acute Malnutrition cases to NRC/
Higher centre
Counselling on breast-feeding 2 RR/SI Exclusive for 6 months and adequate

complementary feeding from 6 months of age
while continuing breastfeeding
ME A2.5 The facility provides Adolescent Availability of Adolescent friendly 2 RR/SI At least for 2 hours on a fixed day in week
health Services clinic
ME A3.3 The facility provides pharmacy Availability of Drug Dispensing counter 2 RR/SI Allopathic medicine
services
ME A3.4 The facility provides medico legal Availability of Medico legal Services, as 2 RR/SI Check for Medico Legal cases (MLC) are
services per state's guidelines recorded at facility

Standard B1 The facility provides the information to care seekers, attendants & community about the available services and their modalities
ME B1.2 The facility displays the services and List of available services in the OPD OB OPD services, Emergency services, Labour room ,
entitlements available in its are prominently displayed Laboratory Services etc.
departments
2
Timings and days of the OPD and OB Including day and timing of fix day services like
other clinic services are displayed ANC, Immunization, Adolescent clinic etc. (as
applicable)
2
List of Available drugs prominently OB Should be updated as per current stock Not eaasy access to patients
displayed at drug dispensing counter
2
ME B1.4 Patients & visitors are sensitized and Availability of Booklets / Leaflets/ OB/SI IEC Corner
educated through appropriate IEC / brochures in the waiting area for
BCC approaches Health education and information
about different programmes &
schemes
2
ME B1.7 Information about the treatment is Patient is informed about the PI/RR Ask patients about what they have been
shared with patients or attendants, diagnosis, & Treatment Plan communicated about the treatment plan
regularly
2
OPD Slip/ Prescription containing RR
Diagnosis & treatment plan, is given to
patient
2
Method of Administration /taking of PI
the medicines is informed to patient/
their relative by pharmacist as per
doctors prescription at the dispensary
2
Standard B2 Services are delivered in a manner that is sensitive to gender, religious and cultural needs, and there are no barrier on account of physical, economic, cultural or social status.
ME B2.1 Services are provided in manner that Availability of female staff / attendant, 2 SI/OB
are sensitive to gender if a male doctor examines a female
patients
Dedicated Female OPD 2 OB Specially for ANC clients

Availability of Breast Feeding Corner 2 OB
ME B2.3 Access to facility is provided without There is no over crowding in the OPD 2 OB
any physical barrier
Standard B3 The facility maintains privacy, confidentiality & dignity of patient, and has a system for guarding patient related information.
ME B3.1 Adequate visual privacy is provided Availability of screen/ curtains in the 2 OB
at every point of care Examination Area
One Patient is seen at a time in the 2 OB
clinic
One clinic is not shared by two doctors 2 OB
at a time
ME B3.2 Confidentiality of patients records Patient records are kept in safe 2 OB/SI Check Patient records e.g.. OPD register are kept
and clinical information is maintained custody in OPD, and are stored in safe custody and are not accessible to
securely. unauthorized patients
ME B3.3 The facility ensures the behaviours of Behaviour of staff is empathetic and 2 PI/SI
staff is dignified and respectful, while courteous to patient & Attendant
delivering the services
Standard B4 The facility ensures that there are no financial barrier to access, and that there is financial protection given from the cost of hospital services.
ME B4.1 The facility provides cashless services OPD Consultation/ ANC Check up is 2 PI/SI/RR Check for there is no consultation fee/
to pregnant women, mothers and provided free of cost registration fee for JSSK beneficiaries or National
neonates as per prevalent Health Program Beneficiaries and NSSK
government schemes
ME B4.4 The facility provide free of cost Check for BPL patients are not charged 0 RR/SI
treatment to Below poverty line any services
patients without administrative
hassles
Area of Concern - C Inputs

Standard C1 The facility has infrastructure for delivery of assured services, and available infrastructure meets the prevalent norms
ME C1.1 Departments have adequate space as Clinics have adequate space for 2 OB/SI Adequate Space in Clinics (120 sq ft)
per patient or work load consultation and examination
ME C1.2 Amenities for Patients & Staff are Availability of waiting are with seating 2 OB Waiting area As per average OPD at peak time
available as per load arrangement
Availability of Fans, Coolers /Warmers 2 OB
and drinking water facilities as per
need
Availability of drinking water facilities 2 OB
Availability of functional toilets 1 OB Dry toilet with running water

ME C2.2 The facility ensures safety of OPD does not have temporary 2 OB Switch Boards all other electrical installations
electrical establishment connections and loosely hanging wires are intact &secure
ME C2.3 Physical condition of buildings are Floor of OPD is non slippery and even 2 OB
safe for providing patient care
ME C2.4 The facility Ensures fire Safety OPD has functional fire extinguisher 2 OB
Measures including fire fighting
equipment
Standard C3 The facility has adequate qualified and trained staff, required for providing the assured services to the current case load
ME C3.1 The facility has adequate medical Availability of Doctors for consultation 2 PI/RR One MO for a minimum of six hours per day and
officers as per service provision and during OPD hours for six days in a week
work load
ME C3.2 The facility has adequate nursing Availability of at least of one staff in 2 OB/RR Staff Nurse/ANM/ ophthalmic assistant (fixed
staff /Paramedic as per service Dressing room/Injection room day)Dresser/Others as per state norm
provision and work load
Availability of one Pharmacist at Drug 2 OB/RR
dispensing counter during OPD timings
ME C3.5 The Staff has been imparted Training of Doctor for FIMNCI 1 RR Check the staff about use of Oxytocin, Antibiotic
necessary trainings/skill set to enable & Magnesium sulphate
them to meet their roles &
responsibilities
Check the competency of ANM/Staff 2 SI Calculation of EDD and High risk pregnancy
nurse for conducting ANC as per
protocols
ME C4.1 The departments have availability of Availability of Drugs for ANC services 2 OB/RR IFA Tablets, Inj Tetanus Toxoid
adequate drugs at point of use
Availability of Vaccines at 2 OB/RR OPV, BCG, Hepatitis B, DPT, Measles, Vit A
Immunization Clinic
Availability of Contraceptives for 2 OB/RR Condoms, IUCD, ECP, OCP
Family Planning services
Availability of splints for bone 1 OB/RR
injury cases Splints including Thomas splint
ME C4.3 Emergency drug trays are maintained Emergency Drug Tray is maintained at 2 OB/RR/SI Drugs for managing anaphylactic reaction - Inj
at every point of care, where ever it injection room / Immunization Room Adrenalin, Inj Hydrocortisone Sodium Succinate,
may be needed Injection Chlorpheniramine,
IV Fluid, Tab Nitroglycerine
Inj. Dopamine
Inj Magsulf
IV Set
ME C5.1 Availability of equipment & Availability of functional Equipment 2 OB/SI BP apparatus, Thermometer, Weighing machine,
instruments for examination & & Instruments at OPD clinic Infant weighing scale, Facility for measuring
monitoring of patients height, Torch, Stethoscope, X-ray view box,
Tongue Depressor, Otoscope, Hand Sanitiser,
etc.
Availability of Instruments and 2 OB/SI Stethoscope, BP Apparatus, weighing Scale, Inch

Equipment for ANC Check up Tape, Facility for measuring height, Foetoscope,
Thermometer, wall clock, towel
ME C5.2 Availability of equipment & Availability of Dressing Instruments in 2 OB/SI Chittel's forcep, Artery Forceps, Blade, Normal
instruments for treatment Dressing Room/ Injection Room Forcep, Tooth Forcep, Needle Holder, Splints,
procedures, being undertaken in the Suture Material, Dressing Drums
facility
Availability of instruments for 2 OB/SI/ RR Tonometer,

refraction Direct Ophthalmoscope
Illuminated Vision Testing Drum
Trial Lens Sets with Trial Frames
Snellen & Near Vision Charts
Battery Operated Torch (2)
Slit lamp
Epilation forceps / Through Fixed day approach
the refractionist will carry/ all these instruments
are avialble in facility
Availability of instruments for 0 OB/SI Head Light

audiometry Ear specula
Ear syringe
Otoscope
Jobson Horne probe
Tuning fork ( 512 HZ)
Noise Maker
ME C5.3 Availability of equipment & Availability of diagnostic instruments 2 OB/SI Slides,

instruments for diagnostic at clinics / consultation rooms for PAP Lancet,
procedures being undertaken in the smear/ Acetic Acid Cusco Spaculum
facility Spatula
Fixer (spray)
Marker pen
Light Source
ME C5.4 Availability of equipment and Availability of functional 2 OB/SI Airway, Ambu's bag, Oxygen Cylinder with key,
instruments for resuscitation of Instruments for Resuscitation. Nebulizer, Suction Machine.
patients.
ME C5.5 Availability of equipments for Availability of equipment for 2 OB/SI Refrigerator, Crash cart/Drug trolley,
storage. storage for drugs instrumental trolley, dressing trolley
ME C5.7 Departments have patient furniture Availability of Fixtures 1 OB/SI Spot light, electrical fixture for equipment, X ray
and fixtures as per load and service view box
provision
Availability of furniture at clinics 2 OB/SI Doctors Chair, Patient Stool, Examination Table,
Attendant Chair, Table, Footstep, cupboard

Standard D1 The facility has a established Facility Management Program for Maintenance & Upkeep of Equipment & Infrastructure to provide safe & Secure environment to staff & Users
ME D1.5 The facility ensures comfortable Temperature control and ventilation in 1 RR/SI Check for and Optimal temperature and
environment for patients and service OPD ventilation is maintained in clinics for comfort
providers of staff & Patients
ME D1.7 Patient care areas are clean and Floors, walls, roof , sinks patient care 2 OB All area are clean with no dirt,grease,littering
hygienic and corridors are Clean and cobwebs
Surface of furniture and fixtures are 2 OB
clean
Toilets are clean with functional flush 1 OB
and running water
ME D1.8 Facility infrastructure is adequately Fixtures and Patient Furniture are 2 OB
maintained intact and maintained in OPD
ME D1.10 Facility has policy of removal of No condemned/Junk material in the 2 OB
condemned junk material OPD
Standard D2 The facility has defined procedures for storage, inventory management and dispensing of drugs in pharmacy and patient care areas
ME D2.2 The facility ensures proper storage of Drugs/ Injectable are stored in 2 OB
drugs and consumables containers/tray/and are labelled in
Injection Room/ Dressing Room
ME D2.3 The facility ensures management of Expiry dates' are maintained at 2 OB/RR
expiry and near expiry drugs emergency drug tray at Injection
Room
No expiry drug found at Injection 2 OB

Room
ME D2.4 The facility has established procedure Expenditure and left over records of 2 RR/SI
for inventory management vaccines is maintained at
techniques immunization clinic
Area of Concern - E Clinical Services

ME E1.1 The facility has established procedure Unique identification number is 2 RR
for registration of patients given to each patient during process of
registration
Patient demographic details are 2 RR Check for that patient demographics like Name,
recorded in OPD registration records age, Sex, Address etc.
ME E1.2 The facility has a established There is procedure for systematic 2 OB/SI Patient is called by Doctor/attendant as per
procedure for OPD consultation calling of patients one by one his/her turn on the basis of “first come first
examine” basis. / Token system
Every patient is offered a seat and is 2 OB No patient is consulted in standing position

examined as per clinical condition
Clinical staff is not engaged in 2 OB/SI

administrative work at OPD
ME E2.1 There is established procedure for Patient History is taken and recorded 2 RR/SI
initial assessment & Reassessment of
patients
Physical Examination is done and 2 RR/SI
recorded wherever required
Provisional Diagnosis is recorded 2 RR/SI
ME E2.2 The facility provides appropriate referral There is a system of referring patient 1 RR/SI Check for practice, availability of referral slip, is
linkages for transfer to other/higher from OPD to higher centre for there any information about the specialist
facilities to assure the continuity of care. specialist consultation doctors and there timings and day available
ME E2.4 Facility ensures follow up of patients There is system of follow up of the 1 RR/SI Check system of follow up visit of ANM, ASHA or
patients discharged from higher visit to PHC.
facilities
Standard E4 The facility has defined & follows procedure for drug administration, and standard treatment guidelines, as defined by the government
ME E4.1 Medication orders are written legibly Every Medical advice and 2 RR
and adequately procedure is accompanied with
date, time and signature
Check for the writing, It 2 RR/SI
comprehendible by the clinical staff
ME E4.2 There is a procedure to check drug Drugs are checked for expiry and 2 OB/SI Check in Injection room
before administration/ dispensing other inconsistency before
administration
Check single dose vial / ampules are 2 OB/RR Check for any open single dose vial with left
not used for more than one dose over content intended to be used later on
Check for separate sterile needle is 2 OB/RR/SI

used every time for multiple dose vial In multi dose vial needle is not left in the septum
Any adverse drug reaction is recorded 1 RR/SI

and reported
ME E4.4 Patient is counselled for self drug Patient is advised by doctor/ 2 PI
administration Pharmacist /nurse about the dosages
and timings .
ME E4.5 The facility ensures that drugs are Check for OPD slip if drugs are 1 RR
prescribed in generic name only prescribed under generic name only
ME E4.6 There is procedure of rational use of Check for Doctor are sensitized for 1 SI Ask the cases in which doctor prescribe the
drugs rational use of drugs specially antibiotics.
antibiotics
ME E4.7 Drugs are prescribed according to Check for that relevant Standard 1 OB/RR
Standard Treatment Guidelines treatment guideline are available at
point of use
Check staff is aware of the drug 1 SI

regime and doses as per STG
Check OPD ticket that drugs are 1 RR
prescribed as per STG
Standard E5 The facility has defined and established procedures for maintaining, updating of patients’ clinical records and their storage
ME E5.1 All the assessments, re-assessment Patient History, Complaints and 2 RR
and investigations are recorded and Examination Diagnosis/ Provisional
updated Diagnosis is recorded in OPD slip
ME E5.2 All treatment plan Written Prescription Treatment plan is 1 RR

prescription/orders are recorded in documented
the patient records.
ME E5.3 Procedures performed are written on Any dressing/injection, other 2 RR
patients records procedure recorded in the OPD slip
ME E5.4 Adequate form and formats are Check for the availability of OPD slip, 2 OB/RR
available at point of use Requisition slips etc.
ME E5.5 Register/records are maintained as OPD records are maintained 2 RR OPD register, Drug Expenditure Register
per guidelines Injection room register etc.
ME E7.1 There is procedure for Receiving and PHC has implemented system of 2 SI As care provider how they triage patient-
triage of patients sorting the patients in case of mass immediate, delayed, expectant, minimal, dead
casualty
ME E7.2 Emergency protocols are defined and Emergency protocols are available at 1 OB See for protocols of head injury, snake bite,
implemented point of use poisoning, drawing etc.
There is procedure for CPR 2 SI Ask for Demonstration on BLS (basic life support)
ME E7.4 The facility ensures adequate and Check for how ambulances are called 2 SI/OB Check availability of 102/hospital arrange the
timely availability of ambulances and patients are shifted ambulance
services
Ambulances are equipped for BLS 1 OB Ventilation & air way equipment, Portable
Oxygen, oxygen administration equipment, bag
& mask resuscitators, immobilization devices,
dressing& bandage & emergency drugs/ PHC
provide kit having all essential commodities
required for BLS
All unstable patients are transferred 1 SI/RR

(as decided by the Doctor), with one
paramedical staff
The Patient’s rights are respected 2 SI

during transport.
There is a daily checklist of all 2 RR
equipment and emergency
medications
Transfer register is maintained to 2 RR

record the detail of the referred
patient
Ambulance services are registered 2 OB e.g.: 108/ 102
ME E7.5 There is procedure for handling There is procedure for informing police 1 RR/SI Check for Police Information Register , Ask
medico legal cases method for informing police
There is procedure for preservation of 0 RR/SI Aspirations, Blood samples and Viscera
samples of MLC cases
Emergency has criteria for defining 1 RR/SI Criteria is defined based on cases and when to
medico legal cases do MLC like all the cases not attended by the
doctor/ criteria may vary from state to state
All rape/ sexual Harassment cases are 2 RR/SI Oral Contraceptive pill & Antibiotic
provided with adequate medications
as per the advise of examining doctor
before referring to Higher centre
Standard E8 The facility has defined and established procedures for diagnostic services
ME E8.3 There are established procedures for Clinics are provided with critical value 1 SI/RR
Post-testing Activities of different tests
Maternal & Child Health Services

Standard E9 The facility has established procedures for Antenatal care as per guidelines
ME E9.1 There is an established procedure for Facility provides and updates 2 RR Check Mother & Child Protection cards have
Registration and follow up of “Mother and Child Protection Card” been provided for each pregnant women at time
pregnant women. for registration/ First ANC
Facility ensures early registration of 2 RR/SI Check ANC records for ensuring that majority of
ANC ANC registration is taking place within 12th
week of Pregnancy in ANC register
Records are maintained for ANC 2 RR Records of each ANC check-up is maintained are
registered pregnant women maintained in ANC register
Clinical information of ANC is kept 2 RR/SI Check, if there is a system of keeping copy of
with ANC clinic ANC information like LMP, EDD, Lab
Investigation Findings , Examination findings etc.
with them
Staff has knowledge of calculating 2 SI Check with staff the expected pregnancies in her
expected pregnancies in the area area / How to calculate it.(Birth Rate X
Population/1000 Add 10% as correction factor
(Still Birth)
Tracking of Missed and left out ANC 1 RR/SI Check with ANM how she tracks missed out
ANC. Use of MCTS by generating work plan and
follow-up with ASHA, AWW etc.
Check if there is practice of recording Mobile no.
of clients/next to kin for follow up
All pregnant women get ANC checkup 2 RR/SI Ask staff about schedule of 4 ANC Visits
as per recommended schedule (1st - < 12 Weeks
2nd - < 26 weeks
3rd - < 34 weeks
4th >34 to term)
Check ANC register whether all 4 ANC covered
for most of the women (sample cases)
At least one ANC visit is attended by 2 RR/SI Preferably 3rd Visit (28-34 Weeks)
Medical Officer
ME E9.2 There is an established procedure for ANC check-up is done by Qualified SBA 2 RR/SI Check-up is done by a trained ANM, LHV, Staff
History taking, Physical examination, trained personnel Nurse or Medical Officer Only
and counseling of each antenatal
woman, visiting the facility.
At ANC clinic, Pregnancy is confirmed 2 RR/SI Check for ANC record that pregnancy has been
by performing urine test confirmed by using Pregnancy test Kit (Nischay
Kit)
Last menstrual period (LMP) is 2 RR/SI Check how staff confirms EDD & LMP, (EDD =
recorded and Expected date of Date of LMP+9 Months+7 Days) How she
Delivery (EDD) is calculated on first estimates if Pregnant women is unable to recall
visit first day of last menstrual cycle ('Quickening',
Fundal Height) .Check ANC records that it has
been written
Comprehensive Obstetric History is 1 RR/SI

recorded History of Pervious pregnancies including
complications and procedures done, if any, is
taken
History of Current or past systemic 2 RR/SI History of current or past systemic illness like
illnesses is taken & recorded Hypertension, Diabeties, Tuberculosis,
Rheumatic Heart Disease, Rh Incompatibility,
malaria, etc. is taken
History of Drug intake or allergies & 1 RR/SI Allergies to drugs, any treatment taken for
intake of Habit forming and Harmful infertility.
substances like Tobacco, Alcohol,
Passive smoking
Physical Examination of Pregnant 2 RR/SI/OB Pulse, Respiratory Rate , Pallor, Oedema

Women is done on every ANC visit
Weight measurement is measured on 2 RR/SI/OB Check any 3 ANC records/ MCP Card randomly
every ANC Visit to see that weight has been measured and
recorded at every ANC visit
Blood pressure is measured on every 2 RR/SI/OB Check any 3 ANC records/ MCP Card randomly
ANC Visit to see that Blood Pressure has been measured
and recorded at every ANC visit
Abdominal Examination is done as per 1 RR/SI/OB Measurement of Fundal Height (ask staff how
protocol she correspond fundal high with Gestational
Age)
Palpation for Foetal lie and Presentation Check
for findings recorded in MCPcard/ANC Records
Auscultation for fetal heart sound 2 RR/SI/OB

Breast examination is done 1 RR/SI/OB Observation and Correction of Flat or Inverted
Nipples
Palpation for any Lumps or Tenderness
History of past illness / pregnancy 2 RR/SI/OB

complication is taken and recorded
ME E9.3 The facility ensures of drugs & Hemoglobin test is done on every ANC 2 RR Check randomly any 3 MCP card/ ANC record for
diagnostics are prescribed as per visit Hemoglobin test is done at every ANC visit and
protocol values are recorded
Urine test for Sugar and Protein is on 2 RR Check randomly any 3 MCP card/ ANC record for
every ANC visit Urine for Sugar & Protein is done on every ANC
visit and findings are recorded
Blood Grouping and RH Typing is done 2 RR Check randomly any 3 MCP card/ ANC record for
for every pregnant woman confirming that blood grouping has been done
Test for HbsAg is done for every 2 RR Check the ANC records
pregnant women at least once in ANC
period
Test for HIV is done at least once in 2 RR Check the ANC records if the test has been done
ANC period at PHC or referral Hospital
Test for VDRL/ RPR is done at least 2 RR Check the ANC records if the test has been done
once in ANC period at PHC or referral Hospital
Screening for Malaria is done as per 2 RR In Non-endemic area for all clinically suspected
clinical protocol cases
In malaria endemic area all pregnant women
Tetanus Toxoid (2 Dosages/ Booster) 2 RR Check randomly any 3 ANC records for
have been during ANC visits confirming that TT1 (at the time of registration)
and TT2 (one month after TT1) has been given to
Primigravida & Booster dose for women getting
pregnant within three years of previous
pregnancy
ME E9.4 There is an established procedure for Staff can recognize the cases, which 2 SI/RR Anaemia, Bad obstetric history, CPD, PIH, APH,
identification of High risk pregnancy would need referral to Higher Medical Disorder complicating pregnancy,
and appropriate & Timely referral. Centre(FRU) Malpresentation, fetal distress, PROM,
obstructed labour, rapture uterus, & Rh negative
Staff is competent to identify 2 SI/RR Hypertension & Pre Ecalmpisa

Hypertension / Pregnancy Induced (Hypertension - Two consecutive reading taken
Hypertension four hours apart shows Systolic BP >140 mmHg
and/or Diastolic BP > 90 mmHg
Staff is competent to identify Pre- 2 SI/RR Pre - Eclampsia- High BP with Urine Albumin (+2)
Eclampisa Imminent eclampisa -BP >140/90 with positive
albumin 2++, severe headache, Blurring of
vision, epigastria pain & oligouria in Urine
Staff is competent to identify high risk 2 SI/RR Identification and referral of cases with
cases based on Abdominal Cephalo-pelvicpresentation, Malrpesentation,
examination medical disorder complicating pregnency, IUFD,
amniotic fluid abnormalities.
ME E9.5 There is an established procedure for Staff is competent to classify anaemia 2 SI/RR >11 g/dl -Absence of Anaemia
identification and management of according to Haemoglobin Level 7-11 g/dl Moderate Anaemia
anaemia <7 g/dl Severe Anaemia
Staff is aware of prophylactic & 2 SI/RR Prophylactic - one IFA tablet per day for at least
Therapeutic dose of IFA 100 days starting from first trimester
Therapeutic - 2 IFA tablet per day for three
months
Line listing of pregnant women with 1 SI/RR Check the records

moderate and sever anaemia
Improvement in haemoglobin label is 2 SI/RR Check the staff for intervention & track the
continuously monitored and recorded improvement in Haemoglobin level of anaemic
woman in subsequent ANC visit.
ME E9.6 Counselling of pregnant women is Pregnant women is counselled for 1 PI/SI Registration, Identification of institution as per
done as per standard protocol and Planning and preparation for Birth clinical condition
gestational age
Pregnant women is counselled 2 PI/SI A bloody, sticky discharge (Show) and regular
Recognizing sign of labour painful uterine contractions
Pregnant women is counselled Identify 1 PI/SI contact number of the ambulance is
and arrange for referral transport communicated
arrangement of alternate vehicle if ambulance
not available le on time
Pregnant women is counselled 2 PI/SI Swelling (oedema), bleeding even spoting,

recognizing danger signs during blured vision, headache, pain abdomen,
pregnancy vomiting, pyrexia, watery & foul smelling
discharge & Yellow urine
Pregnant women is counselled Diet & 2 PI/SI Increase Dietary Intake

Rest Diet rich in proteins, iron, vitamin A, vitamin C,
calcium and other essential micronutrients.
Pregnant women is counselled breast 2 PI/SI Initiate breastfeeding especially colostrum

feeding feeding within an hour of birth.
Do not give any pre-lacteal feeds. (Sugar, water,
Honey)
Ensure good attachment of the baby to the
breast.
Exclusively breastfeed the baby for six months.
Breastfeed the baby whenever he/she demands
milk. Follow the practice of rooming in.
Pregnant women is counselled for 2 PI/SI

Family planning Different Options available including
IUCD, vasectomy, long acting injectables, etc.
Standard E11 The facility has established procedures for postnatal care as per guidelines
ME E11.3 There is an established procedure for Danger signs :Excessive PV bleeding, breathing
Post partum counselling of mother difficulty, convulsion, severe headache,
abdominal pain, foul smelling lochia, urine
dribbling, perineal pain, painful & redness of
breast. Poor sucking/feeding,
abnormal cry,lethergy, failure to pass stool or
urine, not feeding at all, purulent eye or chord
discharge, yellow discoloration of eye,
convulsions, fever or feel cold
Check Mother is educated &

counselled about danger signs during
puerperium & baby 1 PI/SI
About importance of keeping baby warm,
proper positioning of baby to avoid suffocation,
Check Mother is counselled/ Educated immunization, hand washing & personal hygiene
during postnatal visit 2 PI/SI & appropriate care of cord
Standard E12 The facility has established procedures for care of new born, infant and child as per guidelines
ME E12.1 The facility provides immunization Availability of diluents for 2 OB/RR Match no. of dilutants With no. of measles
services as per guidelines Reconstitution of measles vaccine
Recommended temperature of 2 OB/SI/RR Check diluents are kept under cold chain at least
diluents is ensured before 24 hours before reconstitution
reconstitution Diluents are kept in vaccine carrier only at
immunization clinic but should not be in direct
contact of ice pack
Reconstituted vaccines are not used 2 SI/RR/OB Check when the vaccine vials opened,
after recommended time reconstituted and valid for use. Should not be
used beyond 4 hours after reconstitution
Time of opening/ Reconstitution is 2 OB/RR Check on vial

recorded on the vial
Staff is aware of the shelf life of Vit A 2 OB/RR/SI 6-8 weeks. Check for if date of opening has been
once it is opened and ensures it is not marked on the bottle.
given after shelf life
Staff checks VVM level before using 2 OB/SI Ask staff how to check VVM level and how to
vaccines identify discard point. 4 stages - use up to 3
stage)
Staff is aware of how check freeze 2 SI Ask staff to demonstrate how to conduct Shake
damage for T-Series vaccines test for DPT, DT and TT
Discarded vaccines are kept separately 2 OB Check for expired, frozen or with VVM beyond
the discard point vaccine stored separately
Check for DPT, DT, Hepatitis B, and TT 2 OB

vials are Kept in basket in upper
section of ILR
Availability of separate box for open & 2 OB

reused vaccines
Check for injection site is not cleaned 2 OB cleaning the injection site with a spirit swab
with sprit before administering before vaccination is not advisable as live
vaccine dose components of the vaccine are killed if they
come in contact with spirit
AD syringes are available as per 2 OB/RR Check for 0.1 ml AD syringe for BCG and 0.5 ml
requirement syringe for others are available
Vaccine recipient is asked to stay for 2 OB/SI
half an hour after vaccination to
observer any adverse effect following
immunization
Antipyretic drugs are available 2 OB/SI

Mother & child protection card is 2 OB/RR
available & updated
Counselling on adverse events and 2 RR/SI
follow up visits done(CEI)
Staff has knowledge & skills to 2 SI/RR
recognize minor and serious adverse
events (AEFI)
Staff knows what to do in case of 2 SI/RR Immidate report to MO

anaphylaxis
ME E12.4 Management of children presenting 2 SI/RR Check for adherence to clinical protocols
with fever, cough/ breathlessness is
done as per guidelines
Primary management of children with
fever, cough & breathlessness
ME E12.5 Management of children with severe 1 SI/RR
Acute Malnutrition is done as per
guidelines
Screening of children coming to OPDs
using weight for height and/or MUAC
ME E12.6 Management of children presenting Primary Management of Severe 1 SI/RR Check for the dosage and logarithm
diarrhoea is done per guidelines Dehydration & Prompt referral as per 100ml/kg of ringer lactate/Normal saline
clinical protocol Infants 30ml/kg -1hour + 70ml/perkg 5hr
for Child -30ml/kg-30min. + 70 ml/kg 2 1/2 hrs
ORS 5ml/kg/hr
reassessment
Management of Moderate 2 SI/RR ORS treatment at clinic for 4 hrs

Dehydration as per clinical protocol ask staff how determine the volume of ORS
given as per age and weight
Treatment of diahrrhea with no 2 SI/RR Give fluids, zinc supplements and food and
dehydration advise to continue ORS at home (Plan A)·
• Advise mother when to return immediately.·
• Follow up in 5 days if not improving.
Treatment of Persistent Diarrheal as 2 SI/RR Single Dose-Vit A

per clinical protocol Zinc Sulphate 20 mg daily for 14 Days
Follow up in 5 days
Treatment of Dysentery as per 1 SI/RR Treatment with Cotrimoxazole for 5 days

protocol
Availability of ORT corner 2 OB/SI With ORS, Mixing Utensils and instructions
displayed on how to use
Standard E13 The facility has established procedures for abortion and family planning as per government guidelines and law
ME E13.1 Family planning counselling services The client is given full information 1 PI/SI The importance of timely initiation of an FP
provided as per guidelines about optimal pregnancy spacing and method after childbirth, miscarriage,
its benefits, as a part of FP health or abortion will be emphasized.
education and counselling.
Client is counselled about the options 2 PI/SI

for family planning available
The client is informed additional 2 PI/SI

benefits of using condoms, such as
prevention of sexually transmitted
infections (STIs) & HIV
Staff is aware of case selecting criteria 2 SI/RR 49-22 years of age

for family planning Married
Youngest child is at least one year old
Spouse has not opted for sterilization
ME E13.2 The facility provides spacing method Pills are given only to those who meet 2 SI/RR Contraindication of COC in Breastfeeding
of family planning as per guideline the Medical Eligibility Criteria mothers within 6week and Hypertension
The client is given full information 2 SI/RR

about the risks, advantages, and
possible side effects before OCPs are
prescribed for her.
Staff has knowledge to counsel if a 2 SI
dose of the contraceptive is missed
Staff is aware of indication and 2 SI within 72 hours, second dose 12 house after first
method of administration of ECP dose
ME E13.3 The facility provides IUD service for IUD insertion is done as per standard 2 SI/RR No touch technique, Speculum and bimanual
family planning as per guidelines protocol examination, sounding of uterus and placement
Client is informed about the adverse 2 PI/SI Cramping, vaginal discharge, heavier
effect that can happen and their menstruation, checking of IUD
remedy
Follow up services are provided as per 2 SI Beneficiary are advised about indications for
protocols removal of IUD
Facility for removal of IUD are available
ME E13.4 The facility provide counselling Pre procedure Counselling is provided 2 PI/SI/ RR Counselling about available methods of
services for abortion as per guideline abortion
Post procedure Counselling provided 2 PI/SI Counsell about contraceptive needs & different
methods of contraception
Counselling on the follow-up visit 1 PI/SI
Standard E14 The facility provides Adolescent Reproductive and Sexual Health services as per guidelines
ME E14.1 The facility provides Promotive ARSH Counselling and provision of 2 SI/RR Check for the availability of Emergency
Services emergency contraceptive pills Contraceptive pills (Levonorgesterol)
Counselling and provision of reversible 2 SI/RR Check for the availability of Oral Contraceptive
Contraceptives Pills, Condoms and IUD
Availability and Display of IEC material 2 OB Poster Displayed, Reading Material hand-outs
etc.
Information and advice on sexual and 1 SI/PI Advice on topic related to Growth and
reproductive health related issues development, puberty, sexuality concern, myths
& misconception, pregnancy, safe sex,
contraception, unsafe abortion, menstrual
disorders, anemia, sexual abuse, RTI/STI's etc.
ME E14.2 The facility provides Preventive ARSH Services for Tetanus immunization 2 SI/RR TT at 10 and 16 year
Services
Services for Prophylaxis against 2 SI/RR Haemoglobin estimation, weekly IFA tablet, and
Nutritional Anaemia treatment for worm infestation
Counselling for puberty related 1 SI/RR
concerns
Counselling on Nutrition, Sexual Problems,

Contraceptive, Abortion, RTI/STI, Substance
abuse, Learning problems, Stress, Depression,
Suicidal Tendency, Violence, Sexual Abuse,
Other Mental Health Issues, health lifestyle,
risky behaviour
ME E14.3 The facility Provides Curative ARSH Treatment of Common RTI/STI's 2 SI/RR Privacy and Confidentiality, Treatment
Services compliance, Partner Management, Follow up
visit and referral
Treatment and counselling for 1 SI/RR Symptomatic treatment , counselling

Menstrual disorders
Treatment and counselling for sexual 2 SI/RR
concern for male and female
adolescents
Management of sexual abuse amongst 2 SI/RR ECP, Prophylaxis against STI, PEP for HIV and
Girls Counselling
ME E14.4 The facility Provides Referral Services Referral Linkages to ICTC and PPTCT 2 SI/RR
for ARSH
Privacy and confidentiality maintained 2 SI/RR Screens and curtains for visual
at ARSH clinic privacy,confidentaility policy displayed, one
client at a time

Standard F2 The facility has defined and Implemented procedures for ensuring hand hygiene practices and antisepsis
ME F2.1 Hand hygiene facilities are provided Availability of hand washing Facility at 2 OB Check for availability of wash basin near the
at point of use Point of Use point of use
Availability of running Water 2 OB Ask to Open the tap. Ask Staff water supply is
regular
Availability of antiseptic soap with 2 OB Check for availability/ Ask staff if the supply is
soap dish/ liquid antiseptic with adequate and uninterrupted
dispenser.
Display of Hand washing Instruction at 2 OB Prominently displayed above the hand washing
Point of Use facility , preferably in Local language
Availability of Alcohol based Hand rub 2 OB Check for availability/ Ask staff for regular
supply.
ME F2.3 The facility ensures standard Availability of Antiseptic Solutions at 2 OB/RR
practices and materials for antisepsis Dressings room, Immunization Room
Proper cleaning of procedure site with 2 OB/SI like before giving IM/IV injection, drawing blood,
antisepsis is done putting Intravenous and urinary catheter
Standard F3 The facility ensures availability of material for personal protection, and facility staff follow standard precaution for personal protection.
ME F3.1 The facility ensures adequate Clean gloves are available at point of 2 OB
personal protection Equipment as use
per requirements
Availability of Masks 2 OB
ME F3.2 The facility staff adheres to standard No reuse of disposable gloves, Masks, 2 OB/SI
personal protection practices caps and aprons.
Standard F4 The facility has standard procedures for decontamination, disinfection & sterilization of equipment and instruments
ME F4.1 The facility ensures standard practices Decontamination of operating & 2 SI Ask staff about how they decontaminate the
and materials for decontamination and Procedure surfaces procedure surface like Examination table ,
cleaning of instruments and procedures dressing table, Stretcher/Trolleys etc.
areas (Wiping with .5% Chlorine solution
Proper Decontamination of 2 SI
instruments after use Ask staff how they decontaminate the
instruments like Stethoscope, Dressing
Instruments, Examination Instruments, Blood
Pressure Cuff etc.
(Soaking in 0.5% Chlorine Solution, Wiping with
0.5% Chlorine Solution
Contact time for decontamination is 2 SI/OB 10 minutes

adequate
Cleaning of instruments after 2 SI Cleaning is done with detergent and running
decontamination water after decontamination
ME F4.2 The facility ensures standard practices High level Disinfection of 2 SI/RR Ask staff about method and time required for
and materials for disinfection and instruments/equipment is done as boiling
sterilization of instruments and per protocol in dressing room
equipment
ME F5.2 The facility ensures availability of Cleaning of patient care area with 2 SI
standard materials for cleaning and detergent solution
disinfection of patient care areas
ME F5.3 The facility ensures standard practices Staff is trained for spill management 2 SI Blood , body & Mercury spill
are followed for the cleaning and
Standard F6 The facility has defined and established procedures for segregation, collection, treatment and disposal of Bio Medical and hazardous Waste.
ME F6.1 The facility Ensures segregation of Availability of colour coded bins at 2 OB
Bio Medical Waste as per guidelines point of waste generation
and 'on-site' management of waste is
carried out as per guidelines
2 OB
Availability of Non chlorinated plastic

colour coded plastic bags
2 OB
Segregation of Anatomical and solied

waste in Yellow Bin
2
Segregation of infected plastic waste

in red bin
Display of work instructions for 2 OB
segregation and handling of
Biomedical waste
There is no mixing of infectious and 2 OB

general waste
ME F6.2 The facility ensures management of Availability of functional needle 2 OB See if it has been used or just lying idle
sharps as per guidelines cutters
Availability of puncture proof box 2 OB Should be available nears the point of
generation like nursing station and injection
room
Availability of post exposure 2 SI/OB Ask if available. Where it is stored and who is in
prophylaxis charge of that.
Staff knows what to do in condition of 2 SI Staff knows what to do in case of shape injury.
needle stick injury Whom to report. See if any reporting has been
done
Glass sharps are disposed in Blue 2
coded Cardbox
OB
Area of Concern - G Quality Management
ME G2.1 Patient satisfaction surveys are OPD Patient satisfaction survey done 2 SI/RR
conducted at periodic intervals on Periodic basis
Standard G3 The facility have established system for assuring and improving quality of Clinical & support services by internal & external program.
ME G3.1 The facility has established internal Internal Assessment of OPD is done at 2 SI/RR
quality assurance programme periodic Interval
Standard G4 The facility has established, documented implemented and maintained Standard Operating Procedures for all key processes and support services.
ME G4.1 Departmental standard operating Current version of SOP are available 1 RR/SI
procedures are available with process owner
ME G4.2 Standard Operating Procedures SOP covers all key processes of OPD 1 RR/SI Registration, Consultation, ANC Check Up,
adequately describes process and adequately Referral, Immunization, Patient Calling, drug
procedures Dispensing, counselling , Patient privacy &
confidentiality, record Maintenance etc.
ME G4.3 Staff is trained and aware of the Check Staff is a aware of relevant part 1 SI
procedures written in SOPs of SOPs
ME G4.4 Work instructions are displayed at Work instruction ANC check-up 2 OB
Point of use
Breast feeding 2 OB
Area of Concern - H Outcomes
ME H1.1 Facility measures productivity Indicators OPD per month 2 RR
on monthly basis
IUCD inserted per 1000 eligible female 2 RR
Adolescent OPD per month 2 RR

Children attended in OPD per month 2 RR
Patient Attended after OPD Hours 2 RR

ANC conducted per month 2 RR
Minor procedure conducted per 2 RR
month
No. of children immunized per month 2 RR
ME H2.1 Facility measures efficiency Indicators on OPD Per doctor 2 RR
monthly basis
Percentage of missed out ANCs 2 RR
Perentage of Follow up patients 2 RR
Percentage of client accepted limiting 2 RR
out of total counselled
Percentage drop out of DPT vaccine 2 RR
ME H3.1 Facility measures Clinical Care & Safety Percentage of Anaemia cases treated 2 RR
Indicators on monthly basis successfully at PHC
2 RR
Percentage of pregnant women given
thereputic dose of IFA
IUCD rejection/ Complication rate 2 RR Interval IUCD clients who returned with
complications, infections & expulsions
Percentage of high risk pregnancies 2 RR
detected during ANC
Percentage of AEFI cases reported 2 RR
2 RR
Percentage of children with diarrohea
treated with ORS & Zn
2 RR
Percentage of children with
pneumonia treated with antiboitic
ME H4.1 Facility measures Service Quality Patient Satisfaction Score for OPD 2 RR
Indicators on monthly basis
Waiting Time for Consultation 2 RR
Waiting time at Drug Distribution 2 RR
Counter
Average consultation time in OPD 2 RR
Consultation time for ANC 2 RR
OPD Score Card

OPD Score
90.8127208
Area of Concern wise Score
A Service Provision 90.3846153846154
B Patient Rights 94.4444444444444
C Inputs 89.2857142857143
D Support Services 90
E Clinical Services 87.9432624113475
F Infection Control 100
G Quality Manangement 78.5714285714286
H Outcome 100
Obtained Maximum Percent State :Kerala

A 47 52 90.38461538462
B 34 36 94.44444444444
C 50 56 89.28571428571
D 18 20 90
E 248 282 87.94326241135
F 56 56 100
G 11 14 78.57142857143
H 50 50 100
Total 514 566 90.81272084806
Customized National Quality Assurance Standards for PHC State :Kerala
Checklist for Laboratory
Reference no. Measurable Element Checkpoint Compliance Assessment Means of Verification Remarks
Method
ME A1.4 Services are available for the time period as All lab services are available at 2 RR/SI
mandated OPD timings
ME A2.1 The facility provides Reproductive health Availability of Laboratory test for 2 RR/SI VDRL /RPR
Services RTI/STI
ME A2.2 The facility provides Maternal health Availability of Essential tests for 2 RR/SI Pregnancy Test, Haemoglobin, Blood
Services ANC Group, HIV Testing , Blood Sugar,
HBsAG , Urine for Sugar & Protein,
VDRL
ME A3.1 The Facility provides Laboratory Services 2 RR/SI Routine Urine , Blood Sugar
Availability of clinical Pathology
Availability of Routine 2 RR/SI Haemoglobin, Platelets Counts,RBC,
Hemetology Tests WBC, Bleeding time ,Clotting Time &
Hepatitis B/ Australian antigen
Blood Grouping & RH Typing 2 RR/SI
Availability of Rapid Diagnostic 2 RR/SI Malaria , RTI/STI cases

Test
Availability / Linkage of 2 RR/SI
Microscopy Tests Blood Smear for Malaria
Wet Mount and Gram Staining for
RTI/STI & AFB (Sptum) for TB
Emergency lab services are 2 RR/SI Hb, Bleeding time/clotting time,

available for selected tests of Urine (albumin/sugar), Blood
haematology, biochemistry & grouping typing, HIV testing &
serology Peripheral smear

ME B1.2 The facility displays the services and List of test available with timing 2 RR/SI
entitlements available in its departments of collection of reports are
displayed outside laboratory
ME B1.6 There is established procedures for taking Consent is taken for HIV testing 2 RR/SI
informed consent before treatment and
procedures
ME B3.2 Confidentiality of patients records and Laboratory has system to ensure 2 OB/SI Lab registers & Copy of report are
clinical information is maintained the confidentiality of the reports kept at secured place
generated
ME B4.1 The facility provides cashless services to Availability of free diagnostic 2 PI/RR/SI
pregnant women, mothers and neonates as tests for JSSK beneficiaries
per prevalent government schemes
ME B4.4 The facility provide free of cost treatment Diagnostic tests are free for BPL 2 PI/RR/SI Blood Routine, Urine Routine , RBS
to Below poverty line patients without patients & BT/CT
administrative hassles

ME C1.1 Departments have adequate space as per Laboratory space is adequate for 1 OB/SI Adequate area for sample
patient or work load carrying out activities collection, waiting, performing test,
keeping equipment and storage of
drugs and records
ME C1.3 Departments have layout and demarcated Demarcated sample collection 2 OB/SI
areas as per functions area
Demarcated testing area 1 OB/SI
Demarcated washing and waste 1 OB/SI
disposal area
Unidirectional flow of services 1 OB/SI
ME C2.2 The facility ensures safety of electrical Laboratory does not have 2 OB
establishment temporary connections and
loosely hanging wires
ME C2.3 Physical condition of buildings are safe for Work benches are chemical 2 OB
providing patient care resistant
ME C2.4 The facility Ensures fire Safety Measures Laboratory has functional fire 2 OB
including fire fighting equipment extinguisher
ME C3.2 The facility has adequate nursing staff Availability of one lab technician 2 RR/SI During OPD hours
/Paramedic as per service provision and
work load
ME C3.5 The Staff has been imparted necessary Training on Diagnostic Equipment 2 RR
trainings/skill set to enable them to meet
their roles & responsibilities
Training on use of rapid kits 1 RR/SI
ME C4.2 The departments have adequate 2 OB/RR/SI Gram’s iodine, Crystal Violet stain, Need to check with from
consumables at point of use Safranine stain, JSB stains Laboratory Tech
Availability of Stains
2 OB/RR/SI
Cyan meth - haemoglobin/HCl for
Availability of reagents Hb estimation, ABO & Rh antibodies
2 OB/RR/SI
Acetone-Ethanol,
Immersion oil
Availability of Processing Buffer water,
chemicals Decolourising Solution
2 OB/RR/SI Uristix for urine albumin and sugar
analysis, PH strip, RPR test kits for
syphilis, Whole Blood Finger Prick
Availability of Rapid diagnostic HIV Rapid Test Kit
Kits
2 OB/RR/SI Smear Glass microslide
Lancet/ pricking needle
Reflux Condenser
Pipette
Test tubes
Glass rods
Glass slides Cover slips, Western
green, capillary tube
Availability of glassware
ME C5.3 Availability of equipment & instruments for 2 SI/OB Haemoglobino meter, Differential
diagnostic procedures being undertaken in blood cell counter /Naubers's
the facility chamber, Sahli's
Haemoglobinometer, Centrifuge
Instruments for Haematology
Instruments for Bio chemistry 2 SI/OB Colorimeter
2 SI/OB Simple miroscope for Malaria & Bi
noccular Microscope for RNTCP,
Tally counter
Instrument for Microscopy
Availability of Glucometer 2 SI/OB
Standard D1 The facility has a established Facility Management Program for Maintenance & Upkeep of Equipment & Infrastructure to provide safe & Secure environment to staff & Us
ME D1.1 The facility has system for maintenance of There is system of timely 1 SI/RR Ask for the procedure of repair,
critical Equipment corrective break down Check if some equipment is lying
maintenance of the equipments idle since long time due to
maintenance
ME D1.3 Operating and maintenance instructions Up to date instructions for 1 OB

are available with the users of equipment operation and maintenance of
equipments are readily available
Lab staff
ME D1.5 The facility ensures comfortable Adequate ventilation in 1 OB

environment for patients and service Laboratory
providers
ME D1.8 Facility infrastructure is adequately Fixtures and Furniture i.e Work 2 OB
maintained Benches intact and maintained
ME D1.10 Facility has policy of removal of No condemned/Junk material in 2 OB
condemned junk material the Laboratory
ME D2.4 The facility has established procedure for Expenditure & stock register of 2 RR
inventory management techniques consumbles are available at
laboratory

ME E1.1 The facility has established procedure for Unique laboratory identification 2 RR/OB
registration of patients number is given to each patient
sample
ME E2.2 The facility provides appropriate referral Laboratory has referral linkage 2 RR/SI
linkages for transfer to other/higher facilities for tests not available at the
to assure the continuity of care. facility
ME E5.4 Adequate form and formats are available at Standard Formats available 2 RR Printed formats for requisition and
point of use reporting are available
ME E5.5 Register/records are maintained as per Records are maintained at 2 RR Test registers, IQAS/EQAS Registers,
guidelines laboratory Expenditure registers, Accession list
etc.
ME E8.1 There are established procedures for Pre- Requisition of all laboratory test 2 RR/OB Request form contain information:
testing Activities is done in request form Name and identification number of
patient, name of authorized
requester, type of primary sample,
examination requested, date and
time of primary sample collection
and date and time of receipt of
sample by laboratory,
Instructions for collection and 1 RR/SI Instructions are given to

handling of primary sample are ASHA/ANM/MPW for collection of
communicated to those samples (Peripheral smear, sputum,
responsible for collection water sample
Laboratory has system in place to 1 SI/OB Check how slides/test tubes/vials

label the primary sample are marked (Permanent Glass
Marker is available)
Laboratory has system to trace 1 RR/SI
the primary sample from
requisition form
Laboratory has system in place to 1 RR/SI Transportation of sample includes:
monitor the transportation of the Time frame, temperature and
sample carrier specified for transportation
ME E8.2 There are established procedures for Testing procedure are readily 2 OB/SI
testing Activities available at work station and staff
is aware of it
Laboratory has Biological 2 OB/SI/RR
reference interval for its
examination of various results
Laboratory has identified critical 1 SI/RR Immediate notification for values is
intervals for the test in done to physician
consultation with Physician
ME E8.3 There are established procedures for Post- Laboratory has format for 2 RR
testing Activities reporting of results
Laboratory has system to provide 2 RR/SI
the reports within defined time
intervals
Laboratory has defined retention 2 SI/RR
period and disposal of used
sample
Laboratory has system to retain 2 SI/RR Copy of report/ Register entry
the copies of reported result and
promptly retrieved when
required

Standard F2 The facility has defined and Implemented procedures for ensuring hand hygiene practices and antisepsis
ME F2.1 Hand hygiene facilities are provided at Availability of hand hygiene 2 OB Check for availability of wash basin
point of use Facility at Point of Use near the point of use
Availability of running tap Water 2 OB Ask to Open the tap. Ask Staff
water supply is regular
Availability of antiseptic soap 2 OB Check for availability/ Ask staff if the
with soap dish/ liquid antiseptic supply is adequate and
with dispenser. uninterrupted
Display of Hand washing 2 OB Prominently displayed above the
Instruction at Point of Use hand washing facility , preferably in
Local language
Hand washing sink is wide and 1 OB
deep enough to prevent
splashing and retention of water
ME F2.2 The facility staff is trained in hand hygiene Adherence to 6 steps of Hand 2 SI Ask of demonstration
practices and they adhere to standard hand hygiene
washing practices
Staff aware of when to hand 2 SI
wash
ME F2.3 The facility ensures standard practices and Proper cleaning of procedure site 2 SI/RR like before drawing blood, and
materials for antisepsis with antisepsis collection of specimen
Standard F3 The facility ensures availability of material for personal protection, and facility staff follow standard precaution for personal protection.
ME F3.1 The facility ensures adequate personal Clean gloves are available at 2 OB
protection Equipment as per requirements point of use
Availability of lab aprons/coats 1 OB

Availability of Masks 2 OB
ME F3.2 The facility staff adheres to standard No reuse of disposable gloves and 2 OB/SI
personal protection practices Masks.
Check for no mouth pipetting is 2
done in the laboratory
Standard F4 The facility has standard procedures for decontamination, disinfection & sterilization of equipment and instruments
ME F4.1 The facility ensures standard practices and Decontamination of operating & 2 SI Ask staff about how they
materials for decontamination and cleaning of Procedure surfaces decontaminate work benches
instruments and procedures areas (Wiping with .5% Chlorine solution
Proper Decontamination of 2 SI/RR Decontamination of instruments
instruments after use and reusable of glassware are done
after procedure in 1% chlorine
solution/ any other appropriate
method
Contact time for decontamination 2 SI/RR 10 minutes

is adequate
Cleaning of instruments after 2 SI Cleaning is done with detergent and
decontamination running water after
decontamination
Staff know how to make chlorine 1 SI
solution
ME F5.2 The facility ensures availability of standard Availability of cleaning agent as 2 OB/RR Hospital grade phenyl, disinfectant
materials for cleaning and disinfection of per requirement detergent solution
patient care areas
ME F5.3 The facility ensures standard practices are Staff is trained for spill 2 SI
followed for the cleaning and disinfection of management
patient care areas
ME F6.1 The facility Ensures segregation of Bio Availability of colour coded bins 2 OB
Medical Waste as per guidelines and 'on- at point of waste generation
site' management of waste is carried out as
per guidelines
Availability of Non chlorniated 2 OB

plastic colour coded plastic bags
Segregation of Anatomical and 2 OB
solied waste in Yellow Bin
Segregation of infected plastic 2
waste in red bin
Display of work instructions for 2 OB
segregation and handling of
Biomedical waste
There is no mixing of infectious 2 OB
and general waste
ME F6.2 The facility ensures management of sharps Availability of functional needle 2 OB See if it has been used or just lying
as per guidelines cutters idle
Availability of puncture proof box 2 OB Should be available nears the point
of generation
Availability of post exposure 2 OB/SI/RR Ask if available. Where it is stored
prophylaxis and who is in charge of that.
Staff knows what to do in 2 SI Staff knows what to do in case of
condition of needle stick injury shape injury. Whom to report. See if
any reporting has been done
Glass sharps are disposed in Blue 2
coded Cardbox OB
ME F6.3 The facility ensures transportation and Disinfection of liquid waste 2 SI/OB
disposal of waste as per guidelines before disposal
ME G3.1 The facility has established internal quality Internal Assessment of 2 RR/SI MOV
assurance programme Laboratory is done at periodic
Interval
There is a system for In quality 2 RR/SI MOV
assurance in the lab
Control charts are prepared and 1 RR/SI
outliers are identified.
Corrective action is taken on the 2 RR/SI
identified outliers
ME G3.2 The facility has established external Cross Validation of Lab tests are 2 RR/SI
assurance programmes done and records are maintained
Corrective actions are taken on 1 RR/SI

abnormal values
Assessment visit by District 2 RR/SI At least once in a six month
quality assurance Unit is done at
periodic Interval
ME G4.1 Departmental standard operating Current version of SOP are 1 OB/RR
procedures are available available with process owner
ME G4.2 Standard Operating Procedures adequately SOP covers all key processes of 1 RR/SI
describes process and procedures Laboratory adequately
ME G4.3 Staff is trained and aware of the Check Staff is a aware of relevant 2 Si Adequately covers pre testing,
procedures written in SOPs part of SOPs testing and post testing processes
like sample collection, labelling,
testing processes, quality control ,
reporting, personal protection etc.
ME G4.4 Work instructions are displayed at Point of Work instruction/clinical 2 OB Test algorithm for different test,
use protocols are displayed Blood Grouping etc
ME H1.1 Facility measures productivity Indicators on No. of test done per 100 patient 2 RR
monthly basis
No. of Hb test done per ANC 2 RR
ME H2.1 Facility measures efficiency Indicators on No. of stockout of reagents & Kits 2 RR
monthly basis
ME H3.1 Facility measures Clinical Care & Safety No. of Hb reported less than 7 gm 1 RR
Indicators on monthly basis %
No. of Rapid diagnostic kits 2 RR
discarded because of
unsatisfectory reasons
Laboratory Score Card

Laboratory Score
89.90385
A Service Provision 100
B Patient Rights 100
C Inputs 87.5
D Support Services 78.5714285714286
F Infection Control 95.1612903225806
H Outcome 90
Obtained Maximum Percent State :Kerala

A 18 18 100
B 10 10 100
C 35 40 87.5
D 11 14 78.5714285714
E 27 32 84.375
F 59 62 95.1612903226
G 18 22 81.8181818182
H 9 10 90
Total 187 208 89.9038461538
Customized National Quality Assurance Standards for PHC State: Kerala
Checklist for National Health Program
Reference No. Measurable Element Checkpoint Compliance Assessment Means of Verification Remarks
Method
Standard A4 The facility provides services as mandated in the National Health Programmes /State scheme(s).
ME A4.1 The facility provides services under Case detection & Early diagnosis of 2 RR/SI Microscopy
National Vector Borne Disease Control malaria case
Programme as per guidelines
Management of malarial cases 2 RR/SI
Referral of malaria cases 2 RR/SI Cerebral Malaria, Septecemia,

Bacterial Pneumonia etc
RR/SI
Distribution of treated mosquito
net, indoor residual spray & larval
Preventive Activites for Malaria control 2 control Method
Diagnosis & treatment for local prevalent 2 RR/SI Lymphatic Filariasis
vector born Disease Dengue
Japanese Encephalitis
Chikungunya
Kala Azar (Leishmaniasis)
ME A4.2 The facility provides services under Availability of case detection & Early 2 RR/SI
Revised National TB Control Programme diagnosis of TB
as per guidelines
2 RR/SI
Availability / Linkage to microscopic centre
Availability of functional DOT Centre 2 RR/SI
Treatment of tuberculosis 2 RR/SI
Management of Common complication & 2 RR/SI
side effects of treatment
1 RR/SI
Linkage for chest X ray & culture sensitivity
of Mycobacterium bacilli for diagnosis of
TB
ME A4.3 The facility provides services under Early detection of leprosy & its 2 RR/SI Community empowerment &
National Leprosy Eradication Programme complications mobilization of self referral,
as per guidelines capacity building
Early referral of disabled cases 2 RR/SI Identification of cases having

disability their early referral &
follow up at village level
Diagnosis & treatment 2 RR/SI All reported and referred cases
examined following standard
procedure, diagnosed based on
cardinal signs and treated with
MDT & Management of Nerve
impairment
Referral Services for complicated laprosy 2 RR/SI Difficult to diagnosis cases,lepra

cases reaction difficult to
manage,Complicated ulcer,Eye
problem,cases of reconstructive
surgeries,person needs customized
footwear.
ME A4.4 The facility provides services under National Early detection of HIV 2 RR/SI Screening of Antenatal mothers,
AIDS Control Programme as per guidelines high risk behaviour cases and cases
referred by field worker
Availability/ Referral linkage with ICTC for 1 RR/SI
confirmation of HIV status
Condom Promotion & distribution among RR/SI
high risk groups 2
Counselling & guide patient with HIV/AIDS 2 RR/SI
for receiving ART
Support to patients receiving ART for their 2 RR/SI
adherence
Linkage with Microscopic centre for HIV TB 1 RR/SI
coordination
ME A4.5 The facility provides services under National Screening and correction of refractive 2 RR/SI Availabilityof refraction services at
Programme for control of Blindness as per errors PHC /outreach (Schools)
guidelines
Medical treatment for prevention &control 1 RR/SI Conjunctivitis, Night blindness, Stye
of common Eye diseases etc
Availability of diagnosis & Referral services 2 RR/SI
for cataract cases
Survey for prevalence of various eye 1 RR/SI Nutrition education (prevent vit A
diseases & Health Education for prevention deficiency), Water & sanitation
of various eye diseases education (Trachoma Control)
Maternal & child health education
(Reduce retinopathy of
prematurity), Health education
(Prevention of eye trauma,
hypertension & diabetic
retinopathy)
ME A4.6 The facility provides services under Mental Early identification & treatment of 2 RR/SI Evaluation of direct/ Referred cases
Health Programme as per guidelines common mental disorders in OPD from ANM/ community workers &
their appropriate cases. Anxiety
Neurosis, Mild depression
Referral of difficult cases to DH/ Psychiatric 2 RR/SI Meniac cases, schizophernia

Follow up of the cases having treatment at 1 RR/SI
higher central
ME A4.7 The facility provides services under National Geriatric clinic on fixed day for Conducting 2 RR/SI Every week, Display fixed day &
Programme for the health care of the elderly a routine health assessment & treatment time
as per guidelines
Sensitization on promotional, preventive 2 RR/SI
and rehabilitative aspects of geriatrics
ME A4.8 The facility provides services under National Health Promotion Services to modify 1 RR/SI Promotion of Healthy Dietary
Programme for Prevention and control of individual, group and community Habits.
Cancer, Diabetes, Cardiovascular diseases & behaviour Increase physical activity.
Stroke (NPCDCS) as per guidelines Avoidance of tobacco and alcohol.
Stress Management.
Early detection, management and referral 2 RR/SI history, measuring blood pressure,
of Diabetes Mellitus, Hypertension and checking for blood, urine sugar
other Cardiovascular diseases and Stroke
ME A4.9 The facility Provides services under Integrated Weekly reporting of epidemic prone 2 RR/SI S, P & L forms and SOS reporting of
Disease Surveillance Programme as per diseases any cluster of cases
Guidelines
Availability of Water Quality Tests 1 RR/SI Water samples are collected & sent
to public Health lab. for Quality
testing
ME A4.10 The facility provide services under National Early identification of cases of hearing 2 RR/SI At PHC and outreach
health Programme for prevention and control impairment
of deafness
Ear Screening Camps 1 RR/SI Organized as per state schedule (1
screening camp is orgnaized at
PHC/CHC/DH on rotation basis per
month)
Primary ear care for common problems 2 RR/SI Early treatment of Upper
respiratory infection, Impacted
Wax, Otitis Media,foreign body
removal
Rehabilitation services 1 RR/SI Reffered to Higher Centre
ME A4.11 The facility provides services under School Screening of general health of school going 2 RR/SI
Health Programme children
Early detection, diagnosis, treatment and 1 RR/SI Assessment of Anaemia/Nutritional
referal for health problems status, visual acuity, hearing
problems, dental check up,
common skin conditions, Heart
defects, physical disabilities,
learning disorders, behaviour
problems
Micronutrient (vit A & IFA) Management 1 RR/SI On fixed day, Weekly supervised
distribution of Iron-Folate tablets
coupled with
education about the issue and vit A
in needy cases
Deworming as per National guidelines 2 RR/SI

Health Promotion & health education 1 RR/SI Regular Practice of Yoga, Physical
education, Health education &
counselling services, personal
hygiene, HIV/AIDS, supply of IEC
package to schools,Health clubs,
Health cabinets &First Aid
room/corners or clinics
ME A4.12 The facility provides services under Universal Functional Immunization Clinic 2 RR/SI Fix day immunization
Immunization Programme
Immunization of Pregnant Women 2 RR/SI TT1 & 2
TT Booster
Immunization of Infants 2 RR/SI OPV 123, DPT 123, /Pentavalent
Hepatitis 123, Measles 1& 2
Immunization of Children 2 RR/SI DPT Booster, OPV Booster, JE , DT
booster, TT
Vit A 2 RR/SI 1st dose at 9 month with measles,
2nd to 9th dose 16 month with
DPT/OPV booseter, then 1 dose
every 6th month up to age of 5 yrs
2 RR/SI Microplanning, supervision &

storage of vaccines &
Management & logistic support for transportation
immunization program
ME A4.13 The facility provides services under National Promotion & monitoring for consumption 2 RR/SI
Iodine deficiency Programme of iodized salt
ME A4.14 The facility provides services under National Promotion of quitting of tobacco in the 2 RR/SI Health education and IEC activities
tobacco Control Programme community. regarding harmful effects of
tobacco use and passive smoke.
Counselling service on tobacco cessation to 2 RR/SI

all
smokers/tobacco users.
ME A4.15 The facility provides services as per local Avaialbility of Pallative care services for 2 RR/SI Home visits & Special Out patient
needs/ State specific health programmes bed ridden patients department
Availability of services during home visit 2 RR/SI Evaluate & treatment of Physcial
symptoms, Adjust medication,
psychosocial support, Empower &
teach patient for selfcare,
Empower & educate family to care
patient, Assess social problem.
Availability of procedures during home 2 RR/SI Adminstration of parenteral drugs,
visit Nasogastric tube, cathetrisation,
wound care, Mouth care, Bowel
care, Ascites tap, lyphodema
ME B1.2 The facility displays the services and Availability of Information for services 2 OB Pictorial & Local language
entitlements available in its departments under all National Health Program
ME B1.4 Patients & visitors are sensitised and Availability &display of IEC material for 2 OB Availability of information about
educated through appropriate IEC / BCC RNTCP facts of TB, do's & donot's, sure
approaches cure of TB, adverse effects of
having incomplete treatment.
Availability &display of IEC material for 2 OB Posters for Treated Mosquito nets,
NVBDCP Signs of maleria fever, preventing
Stagnant Water, Preventing
Maleria in pregnancy
Availability & display of IEC material under 2 OB Diabetic retinopathy, cataract,

National blindness control program is glucoma, refractive error,
available trochoma, prevention from corneal
blindness. Also IEC material for eye
donation
Availability of IEC kit for mental health 2 OB Poster with 10 feature of mental
program disorder & flip chart for use of
health educator
Availability of IEC material for National 2 OB For prevention & early detection of
Deafness Control Program hearing impairment & deafness
Provision of basic information on modes of 2 OB IEC activities to enhance awareness
transmission and prevention of HIV/AIDS & preventive measures about
for promoting behavioural change and STI ,HIV/AIDS & PPCT
reducing vulnerability.

ME C3.3 The facility has adequate Health workers Availability of Multiple Health worker/ 2 SI/RR
as per requirement MPW as per guideline
ME C3.5 The Staff has been imparted necessary Training of Medical officer for RNTCP 2 RR/SI Module 1-4, TB-HIV module
trainings/skill set to enable them to meet
their roles & responsibilities
Training on Lab technician for RNTCP 2 RR/SI LT module & EQA module
Training for Pharmacist RNTCP 2 RR/SI DOTS

Training for MPW module under RNTCP 2 RR/SI Senior treatment supervisor
module, TB Health visitor module &
MPW /Health assistant module
training as applicable
Training of Aganwadi workers/ 1 RR/SI DOT provider module on TB, DOT

ANM/Community volunteer under provider module on TB-HIV
RNTCP
Re-training is conducted as per 1 RR/SI
retraining schedules of RNTCP
Induction training for newly appointed LT 2 RR/SI
working for NVBDCP
Reorientation training for LT working for 0 RR/SI
NVBDCP
2 RR/SI Orientation & refresher training of
Medical Officers of PHCs in
community ophthalmology &
Training of Medical officer under National Prevention of Blindness
Blindness Control Program
Training of MO for mental health program 1 RR/SI 6 days training each year for
doctors at district level under
DMHP for early identification,
diagnosis and management of
common mental disorders
Training of Health Worker for Mental 1 RR/SI 2 days training each year for health
health Program workers of PHC (All paramedical
staff, ANM/ Nursing staff, Health
educator )
Training of Medical Officer for National 1 RR/SI Sensitization about program,

Deafness Control Program Creating of awareness regarding
preventable diseases of ear,
reorientation in early diagnosis &
treatment of common ear diseases,
Training of nurse/ ANM/ AWW supervisors 0 RR/SI Sensitization about program&

at PHC on National Deafness Control awareness regarding ear & hearing
Program care,enable them to identify
deafness at early stage & motivate
them for awareness generation at
community level
Training of MO on National Program for 2 RR/SI At least 1 MO is trained
Health care of elderly
Training of Paramedics staff for National 2 RR/SI At least 2 nurses are trained
Program for Health care of elderly
Training of MO on immunization 1 RR/SI 3 day training at district level
Training of Health workers on 1 RR/SI 2 day training for ANM, LHV
immunization
Training of Cold chain handlers on 1 RR/SI 2 day training at district level to
immunization designated cold chain handler
(ANM, Clerk or Pharmacist
Training on NACP 2 RR/SI
Training on leprosy 2 RR/SI
Training on IDSP 2 RR/SI
Training on School health Program 2 RR/SI
Training on Tabacco control 2 RR/SI
ME C4.1 The departments have availability of
adequate drugs at point of use
Availability of Anti tuberculor drugs under As per internationally accepted first
RNTCP 2 OB/RR/SI line treatment regimen
Chloroquine phosphate,Primaquine
Availability of first dose drugs under

NVBDCP 1 OB/RR/SI
Artesunate,Pyrimethamine,Quinine
sulphate,Sulfadoxine +
Pyrimethamine
Subsequent doses are arranged from block

CHC and proovided to patient 2 OB/RR/SI
Availability of first dose of Drugs for 1 Availability of MDT
National Leprosy Eradication Program OB/RR/SI Availability of Prednisolone
Availability of Drugs for Mental Health 2 Tab. Diazapam 5mg
Program Inj. Promethazine 50mg
OB/RR/SI
Standard D8 Hospital has defined and established procedure for monitoring & reporting of National Health Program as per state specifications
ME D8.1 The facility provides monitoring & Reporting is done on Form 01 (MF 2) 2 RR For reporting of blood smear by
reporting services under National Vector surveillance worker/MPW/Passive
Borne Disease Control Programme agency etc.e.g., patient’s name,
age, sex and village, etc. A code
number is given to each patient in
terms of blood smear number. This
will help in identification of each
fever case screened, for tracing out
to provide radical treatment and
also for follow up
Reporting is done on Form 02 (MF 4) 2 RR Monthly reporting of malaria

program of PHC , it provides details
of the worker wise blood smears
received and their results.
Reporting is done on Form 03 (MF 5) 2 RR Monthly epidemiological report of

malaria program of PHC, it provides
species wise details of the positive
cases and radical treatment
provided
Reporting is done on Form 08 (MF 16) 2 RR for reporting drug distribution

centre, fever treatment depots &
malaria clinics
ME D8.2 The facility provides services monitoring & Availability of Quarterly reports on New 2 RR
reporting services under Revised National and retreatment cases of TB
TB Control Programme
Availability of Quarterly report on sputum 2 RR

conversion of New and retreatment cases
registered 4-6 month earlier
Availability of Quarterly report on result of 2 RR
treatment of TB patient registered 13-15
month earlier.
Availability of Monthly report on Program 2 RR
Management, Logistics and Microscopy by
Peripheral Health Institutions
Monthly report on programme 1 RR Before 5th of next month
management, logistics and microscopy
filled at all healthcare facilities & sent to
CMO/DTO/ concerned TU within defined
period
ME D8.3 The facility provides monitoring & Reporting is done on MLF -04 under NLEP 2 RR Monthly progress report from PHC
reporting services under National Leprosy to District regarding different
Eradication Programme as per guidelines DPMR activities
ME D8.4 The facility provides services under Details of referral to & from various 1 RR
National AIDS Control Programme facilities
ME D8.9 The facility provide monitoring & reporting Check form S is filled for information 2 RR Form for syndromic surveillance
service for Integrated disease surveillance required reporting
Programme Check -Form S contain information
about State, district, block, year,
Name of reporting unit, name of
reporting person, name of
supervisor ,reporting week, Cases:
Male or female <5 yrs or >5yrs,
Deaths : Male or female <5 yrs or
>5yrs, total of each along with date
& signature
Reporting format (Form S) are sent to PHC 2 RR Form S is filled in triplicate, Health
as per guidelines worker place carbon papers
between each page of form S. First
& second page (Yellow & green)
sent to MO PHC while third (Blue)
copy is kept by Health worker
Check form P is filled for information 2 RR Form for presumptive surveillance

required reporting
Form P contain information Name
of reporting unit, state, district,
Block,Name of officer incharge
along with signature, IDSP
reporting week, No.of cases under
each disease and syndrome
Reporting format (Form P) are sent to DSU 2 RR Form P will be filled in duplicate
as per guidelines (two copies), Surveillance officer
may place carbon paper in
between 2 sheets, One copy (blue )
is retained by MO and other
(Yellow) will be sent to DSU
Check form L is filled for information 2 RR Form for Laboratory surveillance

required reporting
Form L contain information for
Name of Lab, state, district, block,
Name & signature of officer
incharge along with information
about no, of samples tested and
no. of sample found positive.
Format also include line listing of
positive cases except malaria cases
along with age &sex breakage
Reporting format (Form L) are sent to 2 RR Form L will be filled in duplicate

District Surveillance Unit (DSU) as per (Blue & Yellow), PHC retain blue
guidelines copy while Yellow will be sent to
DSU
PHC ensures the submission of data from 2 RR By Monday of every week

Sub centre & other rural reporting points
PHC ensure submission of data to DSU 2 RR By Tuesday of every week
MO is aware of what to do with form S 1 RR/SI Form S (Yellow coloured) copy is
submitted by sub centre submitted to DSU by PHC,
Simultaneously MO I/C for disease
surveillance of PHC will analyse the
information available in form S
w.r.t occurance of any target
disease above expected frequency
ME D8.10 The facility provide services under Reporting format on PHC 1 RR Contain detail of PHC, village, no.
National Programme for prevention and of doctors at PHC are trained ,
control of deafness number of cases identified
between 0-5, 6-15, 16-50, >50 yrs
(separately male & female), no. of
cases treated, no. of cases
referred, to whom and reason of
referral.
ME D8.12 The facility provides monitoring & Staff Know AEFI cases to be reported 2 SI Death , Anaphylaxis, Toxic Shock
reporting services under Universal immediately to MO/ District Immunization Syndrome, Hospitalization ,
Immunization Programme Officer Disablity etc.
Formats for First Information Report & 1 RR

Preliminery Investigation Report are
available at the faclity
Staff is awrae of Cycle time for reporting 2 SI 24 hrs for FIR
FIR/PIR 7 Days for PIR
Routine Monthly reporting is done to 2 RR Check for the records
District Immunization Officer
ME E5.4 Adequate form and formats are available Availability of Form / Format for testing 2 RR/OB Mycobacteriology
at point of use and Diagnosis of TB under RNTCP culture/sensitivity test form
Laboratory form for sputum
examination
tuberculosis treatment Card
referral treatment form
transfer form
Availability of formats for National Leprosy 2 RR/OB Assessment of disability &Nerve

Eradication Program function/Disability assessment
form (P1/S1/T1), Sensory
assessment, Predisolone Card
(P4/S4/T4), Referral Slip for
ASHA/HW/PHC/CHC (P5/S5)
ME E5.5 Register/records are maintained as per Availability of Records for RNTCP 2 RR TB laboratory monthly abstract
guidelines Referral/Treatment Register
TB Register
Blind register is maintained at facility 2 RR Blind register have information on

name of district, block /PHC,
village, name of patient along with
address and age, visual acuity (Left
& right), Main cause of blindness, &
outcome)
Availability of records for National Leprosy 2 RR Disability register (P1/S1), Record

Eradication Program of lepra reactions/Neuritis cases
(form P3/S3/T3)
Availability of Records for School Health 1 RR Health appraisal register (Appraisal
Program register contain information on
date of visit1, visit2 &visit 3,
class,name & type of school, name
of student,age, height, weight,
clincal diagnosis, treatment,
referred to, follow up and
immunization status), Referral
register
Drug stock register
ME E 8.4 There are established procedures for Medical Practioner fills standardized 2 OB/RR
Laboratory Diagnosis of Tuberculosis as laboratory form for sputum
per prevelant Guidelines examination
Laboratory staff follow guideline for 2 RR/SI Two sample will be collected: Early
collecting sputum for smear microscopy morning-Spot
Laboratory staff/ health worker provide 2 SI/PI Provide guidence about steps how
guidance to patient for sputum to collect the sputum
collection
Laboratory staff is aware of 2 SI/RR Ziel Neelsen /(1% Carbol fuchsion,
methodology for smear preparation & 25% Sulphuric Acid, 0.1%
staining slides Methylene blue). If Laboratory is
not designated DMC, give full
compliance
Staff is aware of how to examine and 2 SI/RR If Laboratory is not designated

interpetate sputum smear DMC, give full compliance
Instruction to Ziel Neelsen Staining 2 OB If Laboratory is not designated

procedure &interpretation chart are DMC, give full compliance
displayed at working station
ME E 8.5 There are established procedures for Availability of Standard operating 1 SI/RR
Laboratory Diagnosis of Malaria as per procedure for equipments required for
prevelant Guidelines malarial diagnosis
Availability of Standard operating 1 SI/RR

procedure for processes required for
malarial diagnosis
National Health Programmes

Standard E15 The facility provides National health Programme as per operational/Clinical Guidelines of the Government
ME E15.1 The facility provides services under Health worker/Health professionals are 2 SI/RR Fever is cardinal symptom. It may
National Vector Borne Disease Control skilled to identify cases of suspected be intermittent with or without
Programme as per guidelines malaria priodicity or continuous, Fever in
many cases accompanied with
rigours & chills. Headache,
myalgia, arthralgia, anorexia,
nausea & vomiting.
Microscopic result is available within 2 RR Within 24 hrs. If in Pf predominant

defined period area result is not available with in
24 hrs. check the provision of RDT
Treatment for confirmed P. Vivax Malaria 2 SI/RR P.vivax cases should be treated
is done as per protocols with chloroquine for three days
and Primaquine for
14 days.
Staff is aware of cases contraindicated for 2 SI/RR Primaquine is used to prevent

administration of Primaquine relapse but is contraindicated in
pregnant
women, infants and individuals
with G6PD deficiency.
Patient on malaria treatment (specially on 2 SI/RR/PI Patients should be instructed to
Primaquine) are provided with information report back in case of haematuria
about when to report back or high colored urine / cyanosis or
blue coloration of lips and
Primaquine should be stopped
Algorithm for treatment & diagnosis of 2 SI/RR Check for availability of Alogrithm
malaria is available with treating physician
Identification of drug resistance /failure 2 SI/RR

cases especially falciparum is done as per
protocols
ME E15.2 The facility provides services under Decision on treatment is taken based on 2
Revised National TB Control Programme Drug sensitivity pattern & history of anti TB
as per guidelines treatment
Staff is aware of pre treatment evaulation 2

of MDR_TB
Pre treatment counselling is provided to 2

all TB patients
Education & counselling is provided to 2 About Disease, treatment, schedule

patients' family & adherence to treatment,
transmission of disease
&consequences of irregualr
treatment
Patient identity card is prepared 2
Treatment card is open for each patient 2 In duplicate when required
Treatment of new TB patient is done as per 2 SI/RR

internationally accepted first line
treatment regimen
Staff is aware of drugs & duration of 2 The initial phase consist of two
treatment of New TB patients in initial months of Isoniazid (H), Rifampicin
phase (R), Pyrazinamide (Z), and
Ethambutol (E )as per weight band
category
Staff is aware of drugs & duration of 2 SI/RR The continuation phase should
treatment of New TB patients in consist of three drugs (Isoniazid,
continuation phase Rifampicin and Ethambutol) given
for at least four months as per
weight band categories
Staff is aware of drugs & duration of 2 SI/RR (2) HRZES +(1) HRZE IP will be of
treatment of previously treated cases of 12 weeks where injection
TB in initial phase Streptomycin will be stopped after
8 weeks as per weight bands
Staff is aware of drugs & duration of 2 SI/RR 5 HRE
treatment of previously treated cases of
TB in continuation phase
PHC provide drugs for intial & 2 SI/RR
continuation phase as per revised regimen
Staff is aware of conditions in which 1 OB/RR Extended by three to six months in

duration of continuation phase is special situations like bone & joint
increased TB, spinal TB with neurological
involvement and neuro-
tuberculosis
Staff is aware of drug formulation for fixed 2 SI/RR Fixed dose combinations (FDCs) of
dose combination of four, three & two four drugs (Isoniazid, Rifampicin,
drugs Pyrazinamide, and Ethambutol),
and three drugs (Isoniazid,
Rifampicin and Ethambutol) and
two drugs (Isoniazid and
Rifampicin) are recommended
Staff is aware re treatment regimen 2 SI/RR Retreatment regimen containing
first-line drugs:
2HREZS/1HREZ/5HRE.
Retreatment for Patient returning
after lost to follow up, relapse ,
new TB patients failing with first
treatment course
Staff is aware of classification based on 2 SI/RR Mono resistance (MR), poly drug
drug resistance resitance (PDR), multidrug
resitance (MDR), Rifampicin
resitance (RR) Extensive drug
resistance (X DR)
Staff is aware of drug regimen for MDR TB 2 SI/RR 6-9 month Kanamycin,
cases Levofloxacin, Ethmabutol,
Pyrazinamide, Ethionamide,
cycloserine - IP. 18 month
Levofloxacin, Ethmabutol,
Ethionamide & cycloserine- CP
Algorithm for treatment is available with 2 SI/RR

treating physician for MDR /RR TB cases
with additional resitance
HIV testing of all TB cases is ensured 2 SI/RR
Staff is aware of Patient flow in case of DR- 2 SI/RR registration of cases in DR-TB
TB patients register, pre treatment evaluation,
treatment cards, initation of
treatment, issue of IP box , follow
up etc
ME E15.3 The facility provides services under History taking as per guidelines 2 SI/RR Includes duration of lesion,
National Leprosy Eradication Programme duration of disability if any, family
as per guidelines history/ contact history &previous
treatment
Examination of skin as per guidelines 2 SI/RR Include information No. of patches,

colour of patch, morphology of
patch, nodule, infiltration, test for
loss of sensation in patch
Physical Examination as per guidelines 1 SI/RR Dryness of hands & feet, swelling &
redness of patches and joints,
Wasting of muscle, visible
deformity in hand, feet,
eye,Redness on palm or sole,
callous, Blister, ulcer,High stepping
gait or any change in
gait,Appearance of new lesions or
expansion of existing
lesion,Absence of blink in the
eyes,Redness and watering in the
eyes
Examination of eye as per guidelines 1 SI/RR Look for any redness of the
eye,Note “watering from the eye”
from history and
observation,Observe for blink –
Present or Absent, Look for lid gap
or inability to close one or both
eyes (Lagophthalmos)
and check for normal strength of
eye closure,Check the visual acuity
of each eye separately, using a
Snellen’s chart or
by counting fingers at 6 meters
Management of disability grade I as per 2 SI/RR If the duration of disability grade 1

guidelines i.e. anaesthesia along the course of
trunk nerve is recent (< 6 months),
a course of Prednisolone is to be
started to treat neuritis.
Standard adult treatment regimen for MB 2 SI/RR Rifampicin: 600mg once in month,
leprosy is followed Clofazimine: 300mg once in month
& 50mg every day, Dapsone: 100
mg (for 12 month)
Standard adult treatment regimen for PB 2 SI/RR Rifampicin: 600 mg once in month,
leprosy is followed Dapsone; 100 mg daily (for 6
month)
Standard children (10-14yrs) treatment 2 SI/RR MB: Rifampicin:450mg once in
regimen for MB leprosy is followed month,Clofazimine: 150mg once in
month,50 mg daily, Dapsone: 50
mg daily (12month). PB:
Rifampicin: 450 mg once in month,
Dapsone; 50 mg daily (for 6 month)
Staff is aware of adverse reactions to MDT 2 SI/RR Like Red urine, anaemia, brown
and their management discoloration of skin, gastro
intestinal upset. Management
reassurance, given iron and folic
acid, counselling & give drug with
food
Staff is aware of leprosy reaction and their 2 SI/RR 2 types of reaction: Type 1-
treatment Reversal reaction, Type 2- Erthyma
Nodosum leprosum(ENL)
Referral out of Patient as per guideline 2 SI/RR Referral of cases where lepra
reaction is difficult to
manage,complicated ulcer, eye
problem,reconstruction surgery
cases, persons needing gradeII foot
wear,follow up of RCS
Referral in of the patient as per guidelines 2 SI/RR Referral of the cases having
reaction, disability, neuritis and
ulcer.
ME E15.4 The facility provides services under Check the method to declare client HIV 2 SI/RR A client is declared to be HIV-
National AIDS Control Programme as per Positive positive when the same blood
guidelines sample is tested three times using
kits with different
antigens/principles and the result
of all three tests is positive.
Criteria to diagnosis the cases of HIV in 2 SI/RR Such cases require testing after 12
window period weeks
ME E15.5 The facility provides services under Availability of protocols for visual acuity 1 SI/OB Check flow chart/ Instruction
National Programme for control of measurement for children available with POA
Blindness as per guidelines
Availability of protocols for visual acuity 2 SI/OB Check flow chart/ Instruction
measurement for aged/ adult aged 45yrs available with POA
ME E15.6 The facility provides services under Elementary diagnosis of Mental disorders 2 SI/RR
Mental Health Programme as per as per guidelines
guidelines
Treatment of functional psychosis as per 1 SI/RR
guidelines
Treatment of uncomplicated cases of 1 SI/RR
psychiatric cases associated with physical
diseases as per guidelines
Management of uncomplicated 1 SI/RR
psychosocial problems as per guidelines
Epidemiological surveillance of mental 1 SI/RR
disorders as per guideline
ME E15.7 The facility provides services under Health assessment for elderly person 2 SI/RR
National Programme for the health care based on simple clinical examination
of the elderly as per guidelines relating to vision, joints, hearing, chest, BP
and simple
investigations including blood sugar, etc. is
done
A simple questionnaire will be filled up 1 SI/RR

during the first visit of each Elderly as per
guideline and record updated and
maintained
ME E15.9 The facility provide service for Integrated PHC has defined schedule for testing of 2 SI/RR Frequency of testing is decided by
disease surveillance Programme drinking water sources MO on basis of incidence of water
borne diseases. During out break
test must be done at least once in a
day
Health worker is competant to conduct 1 SI/RR Test Ortho Toludine test (using
test for drinking water sources at village chloroscope). Accepted value on
level consumer side is 0.2 -0.8 ppm
Presumptive surveillance register is 2 RR/OB
available at PHC
MO/ treating Physician is using 2 RR/OB
Presumptive surveillance register for
recording of cases during routine OPD
activities.
Presumptive surveillance register contain 2 RR/OB Recording of date &personal details

information as per requirement (Name, age& Sex) of case as well
as write probable diagnosis of
disease based on clinical
examination or record of
presenting symptoms
Hospital has system in place to count and 2 RR/OB Check total is available on Top left
fill weekly total of cases before starting the hand corner of the every page of
new week register
There is some designated person to 2 RR/SI MO confirm the information before
supervise the job and confirm information submission
before submitting
Laboratory technician of PHC is aware of 1 RR/SI Laboratory assistant/technician at
IDSP target diseases required to be PHC are required to report for
reported on weekly basis Malaria, Tuberculosis & Typhoid
Staff is aware of what to do in case they 2 SI During analysis of data if staff
recognize early signals of outbreak encounter unusual increase in
no.of cases in a particular category,
they have to notify on telephone
same to DSU, A written report
/mail can follow subsequently.
ME E15.10 The facility provide services under Diagnosis & treatment of chronic 2 SI/RR
National Programme for prevention and supportive otitis media (CSOM) (Safe type)
control of deafness as per standard treatment guideline
Diagnosis & treatment of chronic 2 SI/RR
supportive otitis media (CSOM) (unsafe
type) as per standard treatment guideline
ME E15.11 The facility provides services under School Action plan for school health is available at 1 RR/SI There is fixed as school health day,
Health Programme PHC level Each school should be visited 3
times/ year
School medical team is formed at PHC level 0 RR/SI
Medical Examination of the student is 1 SI/RR Medical examination include

done as per guidelines general health checkup,Physical
measurement & personal hygiene,
Eye examination, Ear discharge&
hearing problem,Common dental
defects,congenital heart
defects,disability screening,
learning disoders, behaviour
disoders,stress and anxiety etc
Eye care services are provided as per 1 SI/RR Screening by teacher, PMOA
guideline assesssment & conformation, order
of spectacles & supply of spectacles
Dental care services are provided as per 2 SI/RR screening by teacher, sent to
guidelines dental camp at block level, filling,
extraction and referral during camp
De worming as per guidleines 2 SI/RR Biannually administration of

Albendazole
Anaemia Management 2 SI/RR Weekly IFA tablet given to
adolescent girls, distribution
through class teachers
School environment survey is done by PHC 2 SI/RR Survey includes safe water & clean
staff as per guideline sanitation, hygienic class room &
environment, Quality of food
provided
ME E15.12 The facility provides services under Staff is aware of when not to give 2 SI If child had severe allergic reactions
Universal Immunization Programme pentavalent vaccines in previous dose of immunization
and if Child has severe acute illness
Staff is aware of how to cover if some of 2 SI DPT can be given till 2 year, OPV till
the dosages missed 5 year. Do not start the schedule if
some dosages are missed , instead
administer the dosage needed to
complete the series
Staff is aware of what to do if a child 2 SI

completely missed the vaccination up to 9
months of age
Check for Sub centre Micro plan for 1 RR
Immunization is available at PHC
Check for Micro plan are adequately 1 RR
prepared
Staff is aware of how to calculate the no. of 1 SI/RR
Beneficiaries (pregnant women & Infants
for every vaccination)
Staff is aware of how to calculate the 1 SI/RR No. of Beneficiaries X
quantity of vaccines and syringes based on Wastage/Dosages per multidoages
estimated beneficiaries vial
Check for PHC has prepared map with 2 SI/RR Check for whether map dipcating
route of alternate vaccine Delivery and route for supplying vaccines to
sessions site different sites /immunization
session has been prepared
Check for supervision plan has been 2 RR

prepared for immunization activities
Daily plan for Alternative Vaccine Delivery 1 RR Check for Session site, distance
is prepared from ILR point and Travel time,
time of delivering and collecting
vaccines is filled correctly
ME E15.14 The facility provides services under Linkages with tobacco cessation facility 1 SI/RR Check for doctor aware of nearest
National tobacco Control Programme tobacco cessation facility Check
how many patients are referred to
cessation centre
Doctor/ Staff are skilled for tobacco 2 SI Ask about 5 As and 5 Rs Full form
cessation counselling for R s & A s
Facility has been declared tobacco free 2 OB Restriction on use of tobacco
zone product by staff or visitors
Check for any specific community level 2 SI/PI
activity is done for generating awareness
ME E 15.15 The facility provide services under 2 RR/SI
Pallative care Program Check availability of community
Palliative care Nurse, volunteer
Facility has adequate staff for Palliative from Community based
care organizations
1 RR
MO has completed foundation
course in pain management/ Basic
MO is trained for palliative care activities certificate course in Palliative care
Staff involved in Home care is trained for 2 RR
palliative care activities JHI, JPHN & supervisors etc.
2 RR
Received 3 week Certificate course
Community Palliative care nurse is trained in community Palliative Nursing
for Palliative care care
1 RR
Patient require Palliative care are identified
& registration of patient is arranged by
Medical Officer Check register in maintained
2 RR
Check data is available on number of
patient's requiring palliative care in Check data is updated on defined
catering population intervals
Check the availability of Home care visits 1 RR Check patient's are getting visits as
plan per their needs
1 RR/SI Check there is no stock out of
Drugs & supplies are available regularly drugs.
Facility has provision to purchase drugs 2 RR/SI For the drugs not available
from LSGI (Local self Govt. Institutions) regularly through KMSCL
Regular meetings are conducted by 2 RR/SI
Medical officer with Home care team
Separate OPD services are available for 1 SI/PI/RR
Palliative care patients At least once in week
Adequate medicine is given to patients 1 RR/SI 1 Month /extended up to 6 weeks
registered under Palliative care on Medical officers' direction
Vehicle is available for Home care visits 2 SI/OB Either of facility /provided by CBO
Home Visit kit is available with staff 2 SI/OB
involved in home care visits
2 SI/OB BP apparatus, Glucometer,
Home visit kit contain monitoring devices Stethoscope, Torch
Home visit kit contain grooming tools 2 SI/OB Nail cutter, Shaving kit & Scissors
2 SI/OB
Catheter (different sizes), Urobag,
Sterile gloves, Sterile water,
Syringe, Ryle's tube, suction tub,
SV set, IV set, cotton ,gauze, Sterile
bin with dressing material,
Home visit kit contain consumables Adhesive plaster, paper plaster
2 SI/OB
Betadine lotion, Cremaffin,
Bisacodyl suppository, IVF NS 500
ml, Inj. Metrogyl, Xylocaine jelly,
Paracetamol, Norflox, Ranitidine,
Home visit kit contain drugs Sucralphate
Material in kit is available in adequate 1 SI/OB Check how staff calculate the
quantity requirement for each day
1 SI/OB
Meloxicam, Dextropropoxyphene,
Paracetamol, Dexamathazone,
cetrizine, Sodium valproate,
Fluconazole, Liq. Paraffin+ mil of
magnesia, Metoclopramide,
Bisacodyl, Sodium Phosphate
enema, Omeprazole, Aldactone,
Ethamsylate, Lignocaine gel,
Drugs are available in facility for palliative Imipramine, Fluoxetine,
care Haloperidol
1 SI/RR
Check staff is aware of classification
of pain ( Nociceptive & Neuropathic
Palliative care nurse is trained in Pain) & strategies used for its
assessment of pain assessment
2 SI/RR
Ask the staff about Hand washing,
PPE, disposal of waste, including
Standard Precaution are followed by Staff dressings contaminated with blood
during home visit & body fluids etc.
2 SI/RR
Communication with family,

anticipatory planning including
psychosocial & spiritual needs,
symptom control like pain,
Staff is aware of end of life care & care agitation, respiratory tract
after death prcoesses secretion & care of death
ME F6.1 The facility Ensures segregation of Bio Availability of colour coded bins at point of 2 OB
Medical Waste as per guidelines and 'on- waste generation
site' management of waste is carried out
as per guidelines
2 OB
Availability of Non chlorniated plastic

colour coded plastic bags
2 OB
Segregation of Anatomical and solied

waste in Yellow Bin
2
Segregation of infected plastic waste in red

bin
Display of work instructions for segregation 2 OB
and handling of Biomedical waste
There is no mixing of infectious and 2 OB

general waste
ME F6.2 The facility ensures management of Availability of functional needle cutters 1 OB See if it has been used or just lying
sharps as per guidelines idle
Availability of puncture proof box 2 OB Should be available nears the point
of generation like nursing station
and injection room
Availability of post exposure prophylaxis 2 SI/OB Ask if available. Where it is stored
and who is in charge of that.
Staff knows what to do in condition of 2 SI Staff knows what to do in case of
needle stick injury shape injury. Whom to report. See
if any reporting has been done
Glass sharps are disposed in Blue coded 2
Cardbox
OB
ME G2.1 Patient satisfaction surveys are conducted Client feed back is done for services 2 RR School health Program , VHND
at periodic intervals provide
ME G3.1 The facility has established internal Internal Assessment of National Health 2 RR/SI
quality assurance programme Program is done at periodic Interval
ME G3.2 The facility has established external assurance Quality Assurance of designated 1 RR/SI Onsite evaluation at least once in a
programmes microscopy centre is done at regular month/ decided as per
intervals performance of DMC
Inspection of microscope, supplies and 1 RR/SI

laboratory is done as per checklists
5 Positive and 5 Negative slides are re 1 RR/SI

examined by systematic random
method by STLS
Feedback on smear, stains,reading and 0 RR/SI
reporting is given
Sample slides are systematically selected 1 RR/SI Onsite evaluation at least once in a
for rechecking (RBRC) along with result month/ decided as per
during QA visit by STLS performance of DMC
Feedback on RBRC slides is given to MC 1 RR/SI
under information to CMO/CS
DMC is supervised by DTO/MO-TB as 1 RR/SI
per their tour programme
Feedback is given for Observations & 1 RR/SI
recommendations for corrective action
by DTO/MO-TB
Laboratory has system in place to cross 1 RR/SI
check all positive slides & 10% or 5% of the
negative blood smear slides (to check 3%
of CML & 1.5 % Regional Medical
Laboratory)
There is system in place for coding of all 1 RR/SI

the examined slides by zonal malaria
officer
Laboratory has system to collect all coded 1 RR/SI
negative slides examined during last month
&dispatch it to concerned cross checking
laboratory
Laboratory has system to send all positive 1 RR/SI

slides to Regional office of health & family
welfare/ state laboratories for cross
checking
Laboratory has system to keep the report 1 RR/SI

sent after cross checking of slides
Laboratory has system to participate in 1 RR/SI
EQAS program organized by NRL/
designated laboratoroy
There is system in place for Performance 1 RR/SI
Evaluation of laboratory technician
Supervision for efficiency of laboratory is 1 RR/SI
done
ME G4.1 Departmental standard operating Current version of SOP are available with 2 SI/RR/OB
procedures are available process owner
ME G4.2 Standard Operating Procedures SOP covers all key processes of National 2 SI/RR
adequately describes process and Health Programs adequately
procedures
PHC has process & procedure for National 2 SI/RR
Vector Borne Disease Control Programme
PHC has Process & procedure for Revised 2 SI/RR

National TB Control Programme
PHC has Process & procedure for National 2 SI/RR
Leprosy Eradication Programme
PHC has process & procedure for National 2 SI/RR
AIDS Control Programme
PHC has process &procedure for National 2 SI/RR
Programme for control of Blindness
PHC has process &procedure for Mental 2 SI/RR

Health Programme
PHC has process & procedure for 2 SI/RR
Integrated disease surveillance Programme
PHC has process & procedure for School 2 SI/RR

Health Programme
PHC has process & procedure for Universal 2 SI/RR
Immunization Programme Programme
ME G4.3 Staff is trained and aware of the Check Staff is a aware of relevant part of 2 SI
procedures written in SOPs SOPs
ME G4.4 Work instructions are displayed at Point Work instruction/clincal protocols are 2 OB
of use displayed

ME H1.1 Facility measures productivity Indicators on No. of sputum culture reported postive 2 RR
monthly basis
No. of pherpherial smear reported postive 2 RR
for malaria
No. of water sample collected & sent per 2 RR
month
No. of school visited under School health 2 RR
program
No. of HIV positive cases reported 2 RR
Percentage of women HIV positive out of 2 RR
total registered
ME H2.1 Facility measures efficiency Indicators on Percentage of DOTS cases completed 2 RR
monthly basis successfully
Failure rate including Death & defaults 2 RR
under RNTCP
No. of children referred to higher centre 2 RR
under School Health Program
No. of refrection error detected 2 RR
No. of Diabetic & hypetensive cases are 2 RR
detected
ME H3.1 Facility measures Clinical Care & Safety Percentage of suspected TB cases are 2 RR
Indicators on monthly basis referred to HIV
Monthly blood examination rate (MBER) 2 RR
Multidrug treatment completion rate 2 RR
under NLCP
NHP Score Card

NHP Score
85.43165468
A Service Provision 88.1818181818182
B Patient Rights 100
C Inputs 75.8620689655172
D Support Services 90
F Infection Control 95.4545454545455
H Outcome 100
Obtained Maximum Percent State: Kerala

A 97 110 88.18181818182
B 14 14 100
C 44 58 75.86206896552
D 45 50 90
E 181 212 85.37735849057
F 21 22 95.45454545455
G 45 62 72.58064516129
H 28 28 100
Total 475 556 85.43165467626
Customized National Quality Assurance Standards for PHC
Checklist for General/ Adminstration
Reference No. Measurable Element Checkpoint Compliance Assessment Means of Verification
Method
ME A3.6 The facility provides administrative Monitoring & supervision of 2 SI/RR Check for records of periodic
services Activities of Sub centre visits by Meical officer, LHV etc.
LHV/ MPW/HA should visit sub
cnetre once in week
Monitoring & supervision of 2 SI/RR Ask Medical officer about target

National Health Program of National Health Program &
their monitoring mechanism
Monitoring & supervision of 2 SI/RR By MO/ANM.

Activities of ASHA
Monthly review meeting with sub 2 SI/RR Attended by ANM, Health
centre worker & Health Assistant.
Check for records of meeting
Support & supervision for village 2 SI/RR

Health & Nutrition day
ME A3.7 The facility provides support Availability of laundry services 2 SI/RR
services
ME B1.1 The facility has uniform and user- Direction to PHC is displayed from 2 OB
friendly signage system the Access road
All functional areas identified 2 OB OPD, IPD, Labour Room,
by their respective signage Emergency Room, Injection
Room, MO I/C Office etc.
Name of the facility 2 OB With facility of illumination in

prominently displayed at front night
of hospital building
Facility lay out with Directions to 2 OB
different departments displayed
All signage are in uniform colour & 2 OB

user friendly
ME B1.2 The facility displays the services and Entitlement under different 2 OB
entitlements available in its schemes are displayed
departments
Important numbers like MO I/C, 2 OB
ANM, ambulance , Nearest FRU
etc are displayed
List of sub centre catered by PHC 2 OB Preferably with Details of ANM

is displayed like their Name & Mb. No.
ME B1.3 The facility has established citizen Citizen Charter is prominently 2 OB Preferably near entrance or
charter, which is followed at all displayed OPD area
levels
Citizen Charter Includes the Cycle 2 OB
time for Critical Processes
Citizen Charter includes Rights & 2 OB

Responsibilities of Patients
ME B1.5 Information is available in local All Information is in local language 2 OB
language and easy to understand
ME B1.8 The facility has defined and Availability of complaint box and 2 OB
established grievance redressal display of process for grievance re
system in place addressal and whom to contact is
displayed
There is defined frequency of 2 SI/RR

collecting complaints from
complaint box
Records of patient complaints 2 RR

suggestion are maintained
There is system of periodic review 2 RR/SI
of patient complaints
There is evidence of action taken 2 RR
on complaints
Standard B2 Services are delivered in a manner that is sensitive to gender, religious and cultural needs, and there are no barrier on account of physical, economic,
cultural or social status.
ME B2.1 Services are provided in manner Facility has separate toilets for 2 OB
that are sensitive to gender male & female
ME B2.2 Religious and cultural preferences Cultural and Religious preferences 2 SI
of patients and attendants are taken of patients are Honoured and
into consideration while delivering there is no discrimination based
services on them
ME B2.3 Access to facility is provided Availability of Ramp for the 2 OB Gradient should not be steeper
without any physical barrier entrance of PHC Building than 1:12
Handrails are provided with the 2 OB
ramp & Stairs
Approach road to hospital is 2 OB
accessible without congestion or
encroachment
Internal Pathways and corridors of 2 OB
the facility are without any
obstruction / Protruding Object
Availability of atleast one Disable 1 OB
friendly toilet
Availability of Wheel chair or 2 OB
stretcher for easy Access
ME B2.4 There is no discrimination on basis There is no discrimination on basis 2 SI
of social and economic status of the of social and economic status of
patients the patients
ME B3.3 The facility ensures the behaviours Behaviour of staff is empathetic 2 PI
of staff is dignified and respectful, and courteous to patients and
while delivering the services visitors
ME B3.4 The facility ensures privacy and Check for special precaution is 2 RR/SI HIV, Leprosy , Abortion,
confidentiality to every patient, taken for maintaining privacy & domestic Violence, Adolescence
especially of those conditions confidentiality of cases having pregnancy
having social stigma, and also social stigma
safeguards vulnerable groups
ME B4.1 The facility provides cashless Availability of Free drop back 1 RR/SI
services to pregnant women,
mothers and neonates as per
prevalent government schemes
Availability of Free referral 2 RR/SI

vehicle/Ambulance services
ME B4.2 The facility ensures that drugs Check that patients have not 2 PI/SI/RR For General Patients other than
prescribed are available at spent on purchasing drugs or JSSK
Pharmacy and wards consumables from outside.
ME B4.3 It is ensured that facilities for the Check that patients have not 2 PI/SI/RR For General Patients other than
prescribed investigations are spent on Diagnostics from JSSK
available at the facility outside.
ME B4.5 The facility ensures timely If any other expenditure occurred 2 PI/SI/RR For JSSK Beneficiaries and BPL
reimbursement of financial it is reimbursed from hospital Patients
entitlements and reimbursement to
the patients
Check for compensation/ 2 PI/SI/RR JSY

Incentives are given on time to Family Planning
beneficiaries

ME C1.1 Departments have adequate space Adequate space as per services 1 OB/SI Check for all departments and
as per patient or work load available & Workload services comfortably
accommodated
Ideally space should be 375-450
sq mt
Patient care area/Spaces are not 2 OB Like storage/ Administrative

used for any other purpose work etc.
ME C1.2 Amenities for Patients & Staff are Availability of Dedicated Toilets 2 OB/SI
available as per load for Staff
Availability of Staff Duty room 2 OB/SI
ME C1.3 Departments have layout and Pharmacy & Lab are easily 2 OB
demarcated areas as per functions accessible from the OPD
ME C1.4 The facility has adequate circulation Corridors of PHC are wide enough 2 OB
area and open spaces according to for movement of Stretcher and
need and local law general patient traffic
ME C1.5 The facility has infrastructure for Availability of Telephone 0 OB/SI Preferably at least one
intramural and extramural connection functional landline connection
communication
Availability of internet connection 1 OB/ SI Wired or wireless
ME C2.2 The facility ensures safety of PHC has mechanism for periodical 2 SI/RR
electrical establishment check / test of all electrical
installation
Danger sign is displayed at High 2 OB
voltage electrical installation
All electrical panels are covered 2 OB
and has restricted access
ME C2.3 Physical condition of buildings are PHC premises has intact boundary 0 OB
safe for providing patient care wall
Hospital has functional gate at the 2 OB

entrance
All the windows in PHCs are 1 OB
secured with grills & wiremesh
ME C2.4 The facility Ensures fire Safety Fire exit signs are displayed at 2 OB
Measures including fire fighting critical areas
equipment
There is system to track the expiry 2 OB/RR Check some for some fire
dates and periodic refilling of the extinguishers valid expiry date
extinguishers
Periodic Training is provided for 2 RR/SI
using fire extinguishers
Staff is skilled to operate fire 2 SI Ask staff for demonstration
extinguishers
Periodic mock drills for fire safety 2 RR/SI
are organized at the PHC
ME C3.1 The facility has adequate medical Availability of Allopathic Medical 2 RR/SI
officers as per service provision and Officer (M.B.B.S)
work load
ME C3.2 The facility has adequate nursing Availability of atleast three 2 RR/SI Including Junior Public Health
staff /Paramedic as per service nursing staff Nurse.
provision and work load
Availability of lab technician 2 RR/SI
Availability of at least one 2 RR/SI

pharmacist
ME C3.3 The facility has adequate Health Availability of at least one lady 1 RR/SI
workers as per requirement health visitor
Availability of at least one Male 2 RR/SI
health worker
ME C3.4 The facility has adequate support Availability of at least one 2 RR/SI
staff Accountant / Data Entry Operator
Availability of at least two 1 RR/SI

housekeeping staff
ME C3.5 The Staff has been imparted Training of Doctor for RTI/STI RR/SI
necessary trainings/skill set to
enable them to meet their roles &
responsibilities
2
Training of staff on infection 2 RR/SI
control
Training of staff on Bio Medical 2 RR/SI
Waste Management
Training on Basic Life Support 1 RR/SI
(BLS)
Training of Data Entry operator/ 1 RR/SI HMIS/MCTS /other inforamtion
Junior Public Health Nurse/ Junior system as applicable
Health Inspector
ME C4.1 The departments have availability of 2 OB/ RR/SI
adequate drugs at point of use Paracetamol, Acetyl Salicylic
Acid, Ibuprofen,Diclofenac
Analgesics,Antipyretics, Sodium,Betamethasone
Nonsteroidal Anti-Inflammatory Sodium, Calcium Gluconate,
Medicines, Medicines For Gout, Flunarizine, Indomethacin Cap,
Rheumatoid Disorders Mefenamic Acid,
2 OB/ RR/SI
Chlorpeniramine
Maleate ,Pheniramine Maleate,
Cinnarizine,Cetirizine,
Hydrocortisone Sodium
Succinate ,Dexamethasone ,Adr
Antiallergic And Medicines Used enaline Bitartrate, Atropine
In Anaphylaxis Sulfate, Prednisolone,
Antidotes And Other Substances 0 OB/ RR/SI
Used In Poisoning Charcoal
2 OB/ RR/SI
Carbamezapine, Phenytoin
Sodium ,Sodium
Valproate,Phenobarbitone,Clob
Anti-Epileptic & Anti Convulsant azam , Clonazepam,
Medicines Gabapentin,
2 Mebendazole, Albendazole,
Intestinal Anthelmintics Ivermectin
1 Diethyl Carbamazine
Anti-Filarial Medicines Dihydrogen
1 OB/ RR/SI
Benzathine
Penicillin ,Amoxicillin,Ampicillin,
Cloxacillin,Cephalexin,
Erythromycin,Azithromycin,Cipr
ofloxacin,
Norfloxacin,Sulfamethoxazole+T
rimethoprim,Doxycycline, Co-
Trimoxazole, Cloxacillin
Anti Bacterial Medicines Cap,Ofloxacin ,
Anti Microbial 2 OB/ RR/SI
2 OB/ RR/SI
Ferrous Sulfate, Ferrus
Fumarate ,Folic Acid , Iron Folic
Anti -Anaemic Medicines Acid
Anti Fungal Medicines 1 OB/ RR/SI Griseofulvin, Fluconazole
2 OB/ RR/SI
Chloroquine
Phosphate,Sulfadoxine +
Pyrimethamine ,Diloxanide
Furoate,Metronidazole,Ciproflo
Anti Protozoal Medicines xacin +Tinidazole
Anti-Viral Medicines 1 OB/ RR/SI Acyclovir,Oseltamivir
Anti- Malerial 0 OB/ RR/SI Hydroxy Chloroquine
Medicines Affecting Coagulation 0 OB/ RR/SI Tranexamic Acid
1 OB/ RR/SI
Antineoplastic,
Immunosuppressives And Hydroxy Urea Cap, Losartan
Medicines Used In Palliative Care Potassium,Ondansetron
Anti-Parkinsonism Medicines 2 OB/ RR/SI
2 OB/ RR/SI
Metoprolol, Glyceryl
Trinitrate,Isosorbide Dinitrate ,
Isosorbide Mononitrate,
Amlodipine, Enalapril,
Telmisartan,Prazosin,Methyl
Dopa ,Digoxin, Atorvastatin,
Carvedilol,Chlorthalidone ,Clopi
dogrel,
Diltiazem ,Diltiazem ,Enalapril
Maleate, Nifedipine,
Propranolol,Ramipril, Warfarin
Cardiovascular Medicines Sodium,
0 OB/ RR/SI
Tannic Acid, Choline Salicylate
Soln.+Benzalkonium ,Chloride
Soln+Lignocaine
Hcl,Metronidazole,Chlorhexidin
Dental Preparations e Mouth Wash, Verapamil,
1 OB/ RR/SI
Clotrimazole, Miconazole
Nitrate,Silver
Sulfadiazine ,Framycetin,Povido
ne Iodine,Permethrin,Benzyl
Benzoate ,Betamethasone
Propionate,Calamine,
Clobetasole
Propionate,Clotrimazole Cream,
Dermatological Medicines Salicylic Acid Ointment,
2 OB/ RR/SI
Hydrochlorothiazide,Frusemide,
Amiloride
Diuretics Hydrochloride,Spironolactone
2 OB/ RR/SI
Gentamicin,
Gentamicin+Betamethasone ,Cl
otrimazole,Normal
Saline,Xylometazoline,Wax
Dissolvent ,Oxymetazoline
Hydrochloride Nasal
Solution,Sodium Bicarbonate
Ear, Nose And Throat Medicines Ear Drops
1 OB/ RR/SI
Magnesium Hydroxide
+Aluminium
Tab.,Hydroxide+Activated,Dime
thicone/Simethicone,
Liver, Kidney, Gall Stones, Omeprazole,Ranitidine,
Antacids And Other Anti Ulcer Pantoprazole,Sucralfate
Medicines Suspension
2 OB/ RR/SI
Domperidone,Metoclopramide,
Prochlorperazine ,
Antiemetic Medicines Promethazine,
0 OB/ RR/SI
Beclomethasone Dipropionate+
Anti Hemorrhoidal Medicines Phenylephrine + Lignocaine
2 OB/ RR/SI
Dicyclomine,
Dimethicone/Simethicone,Hyos
Anti Spasmodic Medicines cine Butyl Bromide
1 OB/ RR/SI Bisacodyl,Ispaghula Husk,
Laxative Medicines Lactulose
2 Ors(Oral Rehydration Salt)
Medicines Used In Diarrhoea I.P/Who ,
1
Ethinyl Oestradiol +
Levonorgestre,Norethisterone,
Medroxy Progesterone
Acetate,Glimepiride,
Levothyroxine,Metformin ,
Thyroxine Sodium,Insulin
Hormones, Other Endocrine Human Long Acting Inj, Insulin
Medicines And Contraceptives Human Regular/Nph Inj,
2 Tetanus Toxoid Vaccine, Rabies
Immunological Agents Vaccine
Muscle / Relaxant & 1 Methocarbamol,Turpentine
Cholinesterase Inhibitors Liniment
1
Ciprofloxacin,Ciprofloxacide,Chl
oramphenicol,Flurbiprofen,Tim
olol,Pilocarpine,Dexamethasone
Eye Drops,Moxifloxacin Eye
Ophthalmological /Preparations Drops ,
Oxytocics And Antioxytocics 2
1
Alprazolam,Diazepam,Amitriptyl
ine , Betahistine, Carbidopa +
Levodopa, Chlordiazepoxide,
Chlorpromazine , Clozapine,
Escitalopram ,Fluoxetine ,
Fluphenazine Decanoate,
Haloperidol,Lithium
Carbonate ,Lorazepam ,Nitrazep
am , Olanzapine,Quetiapine,
Risperidone, Sertraline ,Sodium
Valproate, Topiramate,
Psycotherapeutic Medicines Trifluoperazine, Trihexyphenidyl
1
Etophylline+Theophylline,Salbut
amol,
Budesonide,Noscapine,Dextrom
ethorphan,Bromohexine
Hydrochloride,Bromhexine,Bud
esonide Nebulising
Medicines Acting On Respiratory Solution,Cefixime,Ipratropium
System Nebulising Solution,
Solutions Correcting Water, 2 Dextrose, Sodium Chloride,
Electrolyte And Acid Base Ringers Lactate,
2
Vitamin B Complex, Vitamin
B12/ Cyanocobalamin,Vitamin
C,Vitamin Multi Tab(Film
Coated),Calcium Carbonate
With Vitamin D3, Zinc
Sulphate,Thiamine
Vitamines And Minerals
ME C4.2 The departments have adequate Availability of consumbles/ tubes 2 SI/RR Disposable gloves, disposable
consumables at point of use needle & syringe, Folley's
catheter, IV cannula, IV cannula
with injection port, IV set with
22 G needle, Ryles tube, Suction
catheter, Absorbant cotton
gauze, adhesive tape,
Mackinthosh.
Avaialbility of disposal for dressing 1 SI/RR Catgut NO.1/0 RB 34-40 MM

Needle, 70-90 CM, Surgical silk
2-0, 1/2 Circle cutting needle
30MM,70-90 CM, BP blade
ME C5.5 Availability of Equipment for Availability of ILR & Deep freezer 2 OB/SI
Storage for cold chain
ME C5.6 Availability of functional equipment 2 OB/SI Buckets for mopping, Separate
and instruments for support & mops for labour room and
outreach services circulation area
Equipment for Cleaning
Availability of computer for HMIS 2 OB/SI
and MCTS reporting
Standard D1 The facility has a established Facility Management Program for Maintenance & Upkeep of Equipment & Infrastructure to provide safe & Secure
ME D1.1 The facility has system for environment to staff
PHC ensures that all euipments & Users ILR, deep freezer , Lab
1 RR/SI
maintenance of critical Equipment are covered under AMC including equipments etc.
preventive maintenance
Contact details of the agencies 1 RR/SI

responsible for maintenance are
communicated to the staff
ME D1.3 Operating and maintenance Up to date instructions for 2 OB/RR/SI
instructions are available with the operation and maintenance of
users of equipment ILR/Deep freezer are readily
available
ME D1.4 The facility provides adequate Adequate Natural Light/ 2 OB

illumination level at patient care Illumination at patient care area/
areas working stations
Natural light/ Illumination in 2 OB

circulation area
There is provision of adequate 2 OB
illumination at entrance & access
road to PHC specially in night
ME D1.6 Exterior of the facility building is Interior of Patient care areas are 2 OB
maintained appropriately plastered & painted
PHC Building is 1 OB
painted/whitewashed in uniform
colour
No unwanted/outdated posters 2 OB
on hospital boundary and building
walls
ME D1.7 Patient care areas are clean and PHC has a system for safe disposal 2 OB/RR/SI
hygienic of general waste
Schedule for cleaning is defined 1 OB/RR/SI
and implemented
ME D1.8 Facility infrastructure is adequately Check for there is no seepage , 1 OB
maintained Cracks, chipping of plaster
PHC has system for periodic 1 RR/SI
maintenance of Building
There is no clogged/over flowing 2 OB
drain in facility
PHC has arrangements for 2 OB/SI
disposal of sewage
ME D1.9 Facility maintains the open area Space is earmarked for parking of 2 OB Check for vehicles are not
and landscaping of them Vehicles parked randomly in front of PHC
and two wheelers are not kept
inside PHC Buildings
No water logging/Marsh in side 2 OB

the premises of the PHC
There is no abandoned 2 OB
/dilapidated building in the
premises
Proper landscaping and 2 OB
maintenance of Open Space /
Gardens
There is no encroachment in and 2 OB
around
the hospital
Provision of Rain water harvesting 2 OB/SI
ME D1.10 Facility has policy of removal of No condemned/Junk material in 2 OB

condemned junk material the in the corridors, storage ,
administrative area
Periodic removal of junk material 2 OB
done at the PHC
Hospital has designated covered 2 OB/SI
place to keep junk/condemned
material
ME D1.11 Facility has established procedures Pest control measures are evident 2 OB/SI
for pest, rodent and animal control at facility
No stray animal in the PHC 2 OB
ME D1.12 The facility has security system in There is restriction on entry of 2 OB/SI
place at patient care areas vendors and hockers inside the
premise of the PHC premises
Responsibility and timing of 1 OB/SI
opening and closing different
department is fixed
There is established procedure for 1 OB/SI
safe custody of keys the time of
shift change
ME D2.1 There is established procedure for PHC has process to consolidate 1 RR/SI
Estimation, indenting & and calculate the consumption of
Procurement of drugs and all drugs and consumables
consumables
Forecasting of drugs and 1 RR/SI

consumables is done scientifically
based on consumption
Facility has a established 1 RR/SI

procedures for local purchase of
drugs in emergency conditions
PHC has system for timely placing 2 RR/SI
requisition to district drug store
ME D2.2 The facility ensures proper storage There is specified place to store 2 OB
of drugs and consumables medicines in Pharmacy and drug
store
Narcotic medicines are kept in 2 OB/SI As per Narcotic act, Narcotic

double lock medicines are kept in 2 Keys
with 2 locks kept by 2 different
persons
All the shelves/racks containing 2 OB

medicines are labelled in
pharmacy and drug store
Product of similar name and 2 OB
different strength are stored
separately
Heavy items are stored at lower 2 OB
shelves/racks
Fragile items are not stored at the 2 OB
edges of the shelves.
Sound alike and look alike 1 OB
medicines are stored separately in
patient care area and pharmacy
Drug store and pharmacy has 2 OB/SI/RR

system of inventory Management
Drugs and consumables are stored 2 OB

away from water and sources of
heat,
direct sunlight etc.
Drugs are not stored at floor and 2 OB

adjacent to wall
ME D2.3 The facility ensures management of There is a earmarked area for 2 OB
expiry and near expiry drugs keeping near expiry drugs
There is a earmarked area for 1 OB
keeping expiry drugs distant to
regular drugs to avoid mixing
There is a established process for 2 RR/SI
disposal fo expiry drugs
There is process to intimate OPD/ 2 RR/SI
Different departments about near
expiry drugs for early
consumption
There is system about availability 1 RR/SI

of surplus / near expiry drugs to
other nearby facility / district
stores
ME D2.4 The facility has established Physical verification of inventory 1 RR/SI

procedure for inventory is done periodically
management techniques
Facility uses bin card system 2 OB
First expiry first out system is 2 RR/SI

established for drugs
Stores has defined minimum stock 2 RR/SI

category of drug as per there
consumption pattern
Drugs are categorized in Vital, 2 RR/SI

Essential and Desirable
ME D2.5 There is process for storage of Check vaccines are kept in 2 OB (Top to bottom) : Hep B, DPT,
vaccines and other drugs, requiring sequence DT, TT, BCG, Measles, OPV
controlled temperature
Work instruction for storage of 2 OB

vaccines are displayed at point of
use
ILR and deep freezer have 2 OB/RR/SI
functional temperature
monitoring devices
There is system in place to 2 OB/RR/SI Temp. of ILR: Min +2OC to 8Oc
maintain temperature chart of ILR in case of power failure min
temp. +10OC . Daily
temperature log are maintained
There is system in place to 2 OB/RR/SI Temp. of Deep freezer cabinet

maintain temperature chart of is maintained between -15OC to
deep freezers -25OC.Daily temperature log
are maintained
Check thermometer in ILR is in 2 OB

hanging position
ILR and deep freezer has 2 OB
functional alarm system
Conditioning of ice packs is done 2 SI Check if staff is aware of how to
prior to transport condition ice pack (water beads
on the surface of ice pack and
sound of water is heard on
shaking it
Staff is aware of Hold over time of 2 SI

cold storage equipments
Standard D3 The facility ensures availability of diet, linen, water and power backup as per requirement of service delivery & support services norms
ME D3.1 The facility has adequate Availability of 24x7 running and 2 OB/SI Check for source of water (near
arrangement storage and supply for potable water by water body, ground water,
portable water in all functional muncipal supply etc.) Check for
areas the measure taken to ensure
availability of water in areas has
any scarcity
Hospital has adequate water 2 OB 450-500 per bed per day

storage facility as per
requirements
All water tanks are kept tightly 2 OB
closed
Periodic cleaning of water tanks 2 OB
carried out
PHC periodically tests the quality 2 RR/SI
of water from the source
(municipal supply, bore well etc)
for bacterial and chemical content
Chlorination of water is done as 2 RR/SI

per requirement
RO/ Filters are available for 2 OB
potable drinking water
ME D3.2 The facility ensures adequate power Power backup is available 0 OB/SI Generator/Inventor/Solar
backup in all patient care areas as
per load
Use of energy efficient bulbs for 1 OB
light
ME D3.4 The facility provides Clean and Clean linen are provided to all the 2 OB
adequate linen as per requirement occupied beds
Linen is changed every day and 2 SI/RR

whenever it get soiled
PHC has inhouse /Outsourced 2 SI/OB Washing Machine separate

arrangement of washing the linen Washing area for inhouse
laundry. If Linen are washed out
side PHC ensure Hygiene of the
place and water used .
PHC has adequate sets of Linen 2 RR/SI At least 5 sets

Standard D4 The facility has defined and established procedures for promoting public participation in management of hospital with transparency and accountability.
ME D4.1 The facility has established procures RKS is registered under societies 0 RR
for management of activities of Rogi registration act
Kalyan Samitis
RKS meeting are held at 2 RR/SI
prescribed interval
Minutes of meeting are recorded 1 RR
Participation of community 1 RR/SI
representatives/NGO is ensured
RKS generates its own resources 0 RR/SI
from donation/leasing of space
ME D4.2 The facility has established Community based 2 RR/SI
procedures for community based monitoring/social audits are done
monitoring of its services at periodic intervals
PHC involves gram panchyat 1 RR/SI

members in decision making &
management of services
ME D4.3 The facility has established PHC monitors the activities 2 RR/SI Check for the records that
procedure for supporting and assigned to ASHAs ASHAs attends Monthly Review
monitoring activities of community meetings
health work -ASHA
Incentives and TA/DA to ASHAs 2 RR/SI Check for there Is no backlog

are paid on time
PHC supports in skill development 2 RR/SI Check for timely trainings have
of ASHAs been provided to ASHAs, MO
orient ASHA at monthly review
meeting
PHC ensures timely supply of 2 SI/RR Condoms, NISCHAY Kit, ORS

consumables to ASHAs etc.
There is system of taking feedback 1 SI/RR
from ASHAs to improve the
services
Standard D5 Hospital has defined and established procedures for Financial Management & monitoring of quality of outsourced services.
ME D5.1 The facility ensures the proper There is system to track and 1 RR/SI
utilization of fund provided to it ensure that funds are received on
time
Funds/Grants provided are 1 RR/SI
utilized in specific time limit
There is no backlog in payment to 1 RR/SI
beneficiaries as per their
entitlement under different
schemes
Salaries and compensation are 1 RR/SI

provided to contractual staff on
time
Facility provides utilization 1 RR/SI
certificate for funds on time
ME D5.2 The facility ensures proper planning Facility prioritize the resource 2 RR/SI
and requisition of resources based available
on its need
Requirement for funds are sent to 2 RR/SI
state on time
ME D5.3 There is established system for Check for that Contract 1 SI/OB
contract management for out sourced document has provision for
services deducation of payment if quality
of services is not good
Payment to the outsourced 2 RR/SI

services are made on time
ME D5.4 There is a system of periodic review of Facility as defined criteria for 2 RR/OB
quality of out sourced services assessment of quality of
outsorced services
Regular monitoring and 1 RR/SI
evaluation of staff is done
according against defined criteria
Actions are taken against non 1 RR/SI
compliance / deviation from
contractual obligations
Standard D6 The facility is compliant with all statutory and regulatory requirement imposed by local, state or central government
ME D6.1 The facility has requisite licences Availability of authorization for 2 RR
and certificates for operation of handling Bio Medical waste from
hospital and different activities pollution control board
ME D6.2 Updated copies of relevant laws, Availability of copy of Bio medical 2 RR

regulations and government orders waste management and handling
are available at the facility rule 1998
Code of Medical ethics 2002 2 RR
Updated of Medical Termination 2 RR

of Pregnancy
ME D6.3 The facility ensures its processes are Staff is aware of requirements of 2 RR/SI
in compliance with statutory & legal medico legal cases
requirement
Any positive report of notifiable 2 RR/SI
disease is intimated to designated
authorities
No Smoking sign is displayed at 2 RR/SI
the prominent places in PHC
Indian Tabaco control Act 2003 2 RR/SI
Standard D7 Roles & Responsibilities of administrative and clinical staff are determined as per govt. regulations and standards operating procedures.
ME D7.1 The facility has established job Job description of MO I/C is 2 RR Check for PHC has documented
description as per govt guidelines defined & approved Job discription for
MOI/C
MO I/C is aware of his/her role & 2 SI Check for MO is aware of his

responsibilities responsiblities curative arvices,
National Health Programs and
Monitoring & Supervision
Job description of ANM/ nursing 2 RR Check for PHC has documented

staff is defined & approved Job discription for
Nursing Staff/ANM
ANM/ Nursing Staff is aware of 2 SI Check Staff is Aware of the Job

her role & responsibilities description
Job description of Pharmacist is 2 RR Check for PHC has documented
defined & approved Job discription for
Pharmacist
Pharmacist is aware of her role & 2 SI Check Pharmacist is Aware of
responsibilities the Job description
Job description of LHV is defined 2 RR Check for PHC has documented
& approved Job discription for
LHV
LHV is aware of her role & 2 SI Check Staff is Aware of the Job
responsibilities description
Job description of Health 2 RR Check for PHC has documented
Assistant/ Male Health Worker is & approved Job discription for
defined Health Assistant/ Malw Health
Worker
Health Assistant/ Male health 2 RR Check Staff is Aware of the Job

worker is aware of her role & description
responsibilities
ME D7.2 The facility has a established Duty roster of all staff is 2 RR/SI
procedure for duty roster and prepared, updated and
deputation to different communicated
departments
Field visit plan of of MoIC is 1 RR

prepared
Field visit plan of of ANM is 2 RR
prepared
Field visit plan of of LHV is 1 RR
prepared
ME D7.3 The facility ensures the adherence All clinical and support staff 2 OB
to dress code as mandated by its adhere to their respective dress
administration / the health code
department
Standard D8 Hospital has defined and established procedure for monitoring & reporting of National Health Program as per state specifications
ME D8.15 Facility Reports data for Mother & Facility reports data regarding 2 RR Check for all antenatal &
Child Tracking System as per Guidelines Antenatal, Delivery and Postnatal delivery cases registered at PHC
care for availed services are entred in MCTS
Facility reports data about child 2 RR Check all child immunization
immunization in MCTS cases are enterd in MCTS
Facility utilizes MCTS data for 1 SI Ask staff how they utilize data
action planning for action planning
Facility utilizes MCTS data for 2 RR/SI Check for MCTS is used for
tracing of missed out missed out immunization/ANC
immunization and ANC cases cases
ME D8.16 Facility Reports data for HMIS System HMIS data is reported on monthly 2 RR
as per Guidelines basis
All data elements of HMIS are 2 RR Check HMIS report for filling up
reported of all elements
ME E2.2 The facility provides appropriate Facility maintains list of higher 2 RR/SI
referral linkages for transfer to centres where patient can be
other/higher facilities to assure the managed.
continuity of care.
Facility ensures the referral 2 RR/SI

patient to public healthcare
facilities
ME E5.6 The facility ensures safe and PHC has designated and secure 2 OB/SI
adequate storage and retrieval of place to keep Medico legal
medical records records
Establish procedure for Safe 1 OB/SI

keeping and retrieval of records
Hospital has policy for retention 2 RR
period for different kinds of
records
Hospital has policy for safe 2 RR
disposal of records
ME E7.3 The facility has disaster Facility has established plan for 2 SI
management plan in place accommodating high patient load
due to situation like disaster/
mass casualty or disease outbreak

Standard F1 The facility has infection control Programme and procedures in place for prevention and measurement of hospital associated infection
ME F1.1 There is Provision of Periodic Immunization of Staff is done 2 RR/SI All staff involved directly or
Medical Check-up and indirectly in patient care
immunization of staff
Medical Check-up support staff is 2 RR/SI Cleaning Staff
done for infectious diseases
ME F1.2 The facility has established There is designated person for 2 RR/SI
procedures for regular monitoring monitoring of Infection Control
of infection control practices and Practices
rates
There is system of monitoring 2 RR/SI IUD insertion etc.

infection rates
ME F5.2 The facility ensures availability of Cleaning of patient care area with 2 RR/SI
standard materials for cleaning and detergent solution
ME F6.3 The facility ensures transportation Facility as arrangement for 2 RR/SI Linkage with CTF or Deep Burial
and disposal of waste as per disposal of infectious waste Pit
guidelines
Demarcated area for secure 2 OB
storage of BMW before disposal
Check for any sign of burning of 2 OB
waste in PHC premises
Log book /Record of waste 2 RR
generated is maintained
Display of Bio Hazard sign at the 2 OB
point of storage and generation
Availability of Sharp pit as per 2 OB Give full complaince if attached
specification with CWTF
Availability of Deep Burial Pit as 2 OB Give full complaince if attached
per specification with CWTF
Check availability of prior 2 OB Give full complaince if attached
approval from pollution control with CWTF
board for deep burial pit
Check linkage with municiple 2 OB
corporation/ separate pit for
General waste disposal
Deep Burial Pit is not Located near 2 OB Give full complaince if attached
the patient care area or habitation with CWTF
Staff knows how to maintain deep 2 OB Give full complaince if attached

burial pit with CWTF
Deep Burial pit not located near 2 OB Give full complaince if attached
source of water with CWTF
Standard G1 The facility has defined and established organizational framework & Quality policy for Quality Assurance
ME G1.1 The facility has a quality team in Quality Team has been 2 RR/SI
place established at the PHC
There is designated person for co 2 RR/SI
coordinating overall quality
assurance program at the facility
Team members are delegated 1 RR/SI
their respective roles &
Responsibilties
ME G1.2 The facility defines & Disseminate Quality policy are defined and 2 OB Displayed prominently at critical
its quality policy displayed in local language places in a way that staff and
Visitors can read it easily
Staff is aware of the Quality Policy 1 SI
ME G1.3 The facility periodically defines Quality objectives are defined for 2 RR/SI
Monitor its quality objectives the PHC
Quality Objectives covers all 1 RR/SI Maternal Health, National
critical to quality areas Health Program, Patient
Satisfaction , Immunization etc.
Quality objectives are SMART 1 RR/SI Specific, Measurable,

Attainable, Repeatable & Time
bound
There is system for monitoring of 1 RR/SI
performance toward quality
objectives
ME G1.4 The facility reviews quality of its Quality team meets monthly and 2 RR/SI
services at periodic intervals review the quality activities
Minutes of meeting are recorded 1 RR/SI
Results for internal /External 2 RR/SI
assessment are discussed in the
meeting
PHC performance and Quality 1 RR/SI
indicators are reviewed in
meeting
Progress on time bound action 2 RR/SI
plan is reviewed
Quality team review that all the 2 RR/SI
services mentioned in RMNCHA
are delivered as per guideline
Quality team review that all the 1 RR/SI
services mentioned in National
Health Program are delivered as
per guideline
Resolution of the meeting are 1 RR/SI

effectively communicated to
hospital staff
Quality team report regularly to 1 RR/SI
DQAC about Key Performance
Indicators and Quality Scores
ME G2.1 Patient satisfaction surveys are There is person designated to co 2 RR/SI
conducted at periodic intervals ordinate satisfaction survey
Patient feedback form are 2 RR
available in local language
Adequate sample size is taken to 2 RR/SI At least 30 per Month for
conduct patient satisfaction separately OPD
There is procedure to conduct 2 RR/SI

employee satisfaction survey at
periodic intervals
ME G2.2 The facility analyses the patient There is procedure for 2 RR/SI
feed back, and root-cause analysis compilation of patient feedback
forms
Patient feedback is analysed on 2 RR/SI Overall department

monthly basis wise/attribute wise score are
calculated
Root cause analysis is done for 1 RR/SI
low performing attributes
Results of Patient satisfaction 2 RR/SI
survey are recorded and
disseminated to concerned staff
There is procedure for analysis of 2 RR/SI
Employee satisfaction survey
There is procedure for root cause 2 RR/SI
analysis of Employee satisfaction
survey
ME G2.3 The facility prepares the action There is procedure for preparing 2 RR/SI
plans for the areas, contributing to Action plan for improving patient
low satisfaction of patients satisfaction
There is procedure to take 1 RR/SI

corrective and preventive action
There is procedure for preparing 2 RR/SI
action plan for improving
employee satisfaction
ME G3.1 The facility has established internal There is a system if Daily round of 1 SI/RR
quality assurance programme MOI/C to all department of PHC
ME G3.2 The facility has established external Assessment visit is done by 2 RR/SI At least once in six month
assurance programmes District Quality assurance Unit
Periodically
ME G3.3 The facility conducts the periodic PHC Periodical conducts 2 RR/SI
prescription/ medical/death audits Medical/Prescription Audit
Community based Maternal death 1 RR/SI

audits are conducted by PHC
periodically
ME G3.4 The facility ensures non Non Compliance/ Gaps found in 1 RR/SI
compliances are enumerated and the internal Assessment is done
recorded adequately
Over all and departmental Quality 2 RR/SI
scores are generated
ME G3.5 Action plan is made on the gaps Action plan prepared the Non 1 RR/SI
found in the assessment / audit Compliance and gaps found in
process assessment
ME G3.6 Corrective and preventive actions Corrective and preventive action 1 RR/SI
are taken to address issues, taken as per action plan
observed in the assessment & audit
ME G3.7 The facility uses method for quality PHC maps critical processes and 1 RR/SI
improvement in services identify non value adding
activities
Facility implements Plan do check 1 RR/SI
act (PDCA) approach to identify
the critical processes
ME G3.8 The facility uses tools for quality PHC uses quality tools for 1 RR/SI 5s, Prioritization, 7 Quality tools,
improvement in services measurement and improvement Mistake proofing etc.
ME G4.1 Departmental standard operating Current version of SOP are 1 RR/SI For support services and
procedures are available available with process owner Administration
ME G4.2 Standard Operating Procedures SOP covers all key processes 1 RR/SI
adequately describes process and support and administrative
procedures processes adequately
ME G4.3 Staff is trained and aware of the Check Staff is a aware of relevant 2 RR/SI
procedures written in SOPs part of SOPs
ME G4.4 Work instructions are displayed at Work instruction/clinical 2 OB
Point of use protocols are displayed

ME H2.1 Facility measures efficiency Indicators Stock out percent of supplies for 2 RR
on monthly basis RMNCHA
Non availability of nursing days 2 RR
Non availability of doctor days 2 RR
Non availability of support 2 RR
services
ME H4.1 Facility measures Service Quality Staff Satisfaction Score 2 RR
Indicators on monthly basis
General Admin. Score Card
General Admin.
Score 84.651899
A Service Provision 100
B Patient Rights 97.0588235294118
C Inputs 76.027397260274
D Support Services 85.546875
F Infection Control 100
H Outcome 100
Obtained Maximum Percent State: Kerala

A 12 12 100
B 66 68 97.058823529
C 111 146 76.02739726
D 219 256 85.546875
E 13 14 92.857142857
F 34 34 100
G 70 92 76.086956522
H 10 10 100
Total 535 632 84.651898734
State: Kerala
Remarks
ervices.
Outsourced
able services and their modalities
no barrier on account of physical, economic,

ding patient related information.
n given from the cost of hospital services.
e meets the prevalent norms

astructure.
rvices to the current case load
ervices.
services.
& Infrastructure to provide safe & Secure

in pharmacy and patient care areas
vice delivery & support services norms
hospital with transparency and accountability.
of quality of outsourced services.

state or central government
s and standards operating procedures.
Program as per state specifications

.
linical records and their storage
Disaster Management
ement of hospital associated infection
ction prevention
sal of Bio Medical and hazardous Waste.

y for Quality Assurance
faction
vices by internal & external program.
s for all key processes and support services.
l Benchmark
tional benchmark

FHC Anad District Assessment

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PHC Score Card

OPD PHC SCORE LABORATORY

Area of Concernwise Score

90.625 96.875 80 86.1764705882353

86.85185185185 97.7011494252874 75.789473684211 98.9795918367347

Area of Concern - A Service Provision

out the available services and their 100%

tructure meets the prevalent norms 75%

Primary Management & stabilization 2 RR/SI Lavage & Antidotes

Standard A2 The facility provides RMNCHA Services

Identification and referral of Severe 1 RR/SI

Counselling on breast-feeding 2 RR/SI Exclusive for 6 months and adequate

Area of Concern B - Patients' Right

Dedicated Female OPD 2 OB Specially for ANC clients

Area of Concern - C Inputs

Availability of drinking water facilities 2 OB

Availability of functional toilets 1 OB Dry toilet with running water

Availability of Instruments and 2 OB/SI Stethoscope, BP Apparatus, weighing Scale, Inch

Availability of instruments for 2 OB/SI/ RR Tonometer,

Availability of instruments for 0 OB/SI Head Light

ME C5.3 Availability of equipment & Availability of diagnostic instruments 2 OB/SI Slides,

Area of Concern - D Support Services

No expiry drug found at Injection 2 OB

Area of Concern - E Clinical Services

Every patient is offered a seat and is 2 OB No patient is consulted in standing position

Clinical staff is not engaged in 2 OB/SI

Check for separate sterile needle is 2 OB/RR/SI

Any adverse drug reaction is recorded 1 RR/SI

Check staff is aware of the drug 1 SI

ME E5.2 All treatment plan Written Prescription Treatment plan is 1 RR

All unstable patients are transferred 1 SI/RR

The Patient’s rights are respected 2 SI

Transfer register is maintained to 2 RR

Ambulance services are registered 2 OB e.g.: 108/ 102

Maternal & Child Health Services

Comprehensive Obstetric History is 1 RR/SI

Physical Examination of Pregnant 2 RR/SI/OB Pulse, Respiratory Rate , Pallor, Oedema

Auscultation for fetal heart sound 2 RR/SI/OB

History of past illness / pregnancy 2 RR/SI/OB

Staff is competent to identify 2 SI/RR Hypertension & Pre Ecalmpisa

Line listing of pregnant women with 1 SI/RR Check the records

Pregnant women is counselled 2 PI/SI Swelling (oedema), bleeding even spoting,

Pregnant women is counselled Diet & 2 PI/SI Increase Dietary Intake

Pregnant women is counselled breast 2 PI/SI Initiate breastfeeding especially colostrum

Pregnant women is counselled for 2 PI/SI

Check Mother is educated &

Time of opening/ Reconstitution is 2 OB/RR Check on vial

Check for DPT, DT, Hepatitis B, and TT 2 OB

Availability of separate box for open & 2 OB

Antipyretic drugs are available 2 OB/SI

Staff knows what to do in case of 2 SI/RR Immidate report to MO

Management of Moderate 2 SI/RR ORS treatment at clinic for 4 hrs

Treatment of Persistent Diarrheal as 2 SI/RR Single Dose-Vit A

Treatment of Dysentery as per 1 SI/RR Treatment with Cotrimoxazole for 5 days

Client is counselled about the options 2 PI/SI

The client is informed additional 2 PI/SI

Staff is aware of case selecting criteria 2 SI/RR 49-22 years of age

The client is given full information 2 SI/RR

Counselling on Nutrition, Sexual Problems,

Treatment and counselling for 1 SI/RR Symptomatic treatment , counselling

Area of Concern - F Infection Control

Contact time for decontamination is 2 SI/OB 10 minutes

Availability of Non chlorinated plastic