Evaluation report
Section 1: Facility Survey of CHCs
Compliance to Indian Public Health Standards (IPHS) developed under National Rural Health Mission (NRHM)
1. Preamble
Facility Survey of CHCs – Compliance to Indian Public Health Standards (IPHS) developed under the National Rural Health Mission (NRHM).
Under the National Rural Health Mission (NRHM) every state is required to upgrade their health facilities (PHCs and CHCs) to the prescribed Indian Public Health Standards (IPHS). The IPHS have been developed by the Ministry of Health and circulated to all states.
As part of the State’s commitment, Public Health Department (PHD), Government of Maharashtra, invited proposals for conducting the assessment of existing Rural Hospitals – RHs (CHCs) in Maharashtra against the prescribed IPHS. PHD identified 105 RHs (CHCs) which were assessed against the prescribed IPHS. Based on the findings of the assessment, these 105 RHs (CHCs) will be upgraded to the IPHS in the year 2007–08.
The following were the Terms of Reference (ToR) for the assessment assignment
The consultant organization would undertake the following
- Finalize the checklist (IPHS) and get it vetted by appropriate authority.
- Field visits to the 105 facilities by appropriate assessment teams*.
- Assess and record observations as per the checklist except the civil component.
- Submission of draft report with
- Identified gaps.
- Recommendations.
- Submission of final report after discussion with appropriate authority.
2. Survey Design & Methodology
Following is the technical outline for assessment of the 105 community health centres (CHCs) against the Indian Pubic Health Standards (IPHS).
Objectives
- Collect data for planning purposes*
- Assess the financial implications for upgradation.
* Gaps identified during the survey will be helpful in planning for the upgradation of the existing CHCs to the IPHS.
The micro–detailing (human resources, equipments, services etc) of the identified gaps will also bring forth the financial implications involved in the upgradation of each CHC to IPHS.
Sample
Survey 105 CHCs across the State. These were the facilities identified by the Public Health Department across the State.
3. Scope of work
The following was the scope of work (SOW) for this survey
- Finalize the checklist and get it vetted by appropriate authority.
- Schedule visits to the 105 facilities.
- Assess and record observations as per the checklist.
- Submission of draft report with
- Identified gaps.
- Cost implications for upgradation of the facility/ facilities to IPHS, except the civil component.
- Any policy decisions required (GR – related to HR, contracting etc.)
- Submission of final report after discussion with appropriate authority.
4. Target group
| Personnel | Purpose |
| Medical Superintendent | Facility assessment – checklist |
| Director | Policy |
| Addl. Director | Policy |
| Jt. Director Medical | Cost |
5. Survey team
Total 8 teams of investigators, each comprising of 2 specialists – 1 Public Health specialist, and 1 Bio Medical Engineer conducted the assessment of the 105 CHCs. Each team was assigned a circle. Further, 2 coordinators were involved to supervise and facilitate this survey. They were also the key personnel who were responsible for the activities listed under the scope of work section. 4 data entry operators were hired to quicken the process along with 2 statisticians. A total of 24 members formed the assessment workforce.
Following table gives an overview of the workforce that was involved in the assessment
| Survey team | Nos. |
| Public health specialist | 8 |
| Bio medical engineer | 8 |
| Coordinator | 2 |
| Data entry operator | 4 |
All the 16 investigators underwent training in the use of the assessment tool for conducting the interviews so as to ensure the quality of the data to be collected. This training was imparted by the coordinators.
6. Survey design
One–to–one interviews
The interviewer used the assessment tool to gather information from the Medical Superintendent. Observations were recorded in the prescribed format.
A list of common items related to upgradation was prepared.
The Director, Additional Director and the indicated Joint Directors were interviewed on issues related to policy and cost.
7. Data collection
- Primary data: Primary data for the study was collected by conducting interviews of target audience (mentioned above) at each of the 105 CHCs.
- Secondary data: Secondary data was collected at the Directorate level.
8. Data management
Data collection
Considering 8 teams are involved in the data collection, a total of 4 weeks were required to assess 105 hospitals. 1 week was required to collect information from the Directorate level on issues related to policy and cost.
Data entry, analysis and report (first draft)
The collected data was entered into SPSS statistical software for further analysis and giving recommendations. 3 weeks were required for this process. This included sharing the draft report. 1 week was required for finalizing the report.
Data quality
The coordinators overlooked the entire process of data collection and data entry and ensured the quality of the processed data.
9. Study tool
The assessment tool/check list (attached in annexure) was used to conduct the interviews at the facility level.
10. Study structure
The study structure is as shown in figure
Click Here to see the Study Structure – Figure
11. Time frame
This study was completed in 10 weeks
| Task | Time |
| Revise the IPHS checklist and get it vetted by the Client | 1 week |
| Scheduling of visits to the identified facilities | |
| Field visit for facility assessment and documentation of observations | 4 weeks |
| Information related to policy and cost from Directorate | 1 week |
| Data entry and data analysis and submission of draft report | 3 weeks |
| Submission final report after discussions | 1 week |
| Total | 10 weeks |
Section 2: Assessment findings
The following text presents the assessment findings of the facility. As indicated earlier, the findings are presented under 8 broad categories as prescribed by the Indian Public Health Standards.
- Status of the CHC against the IPHS
Category 1 – Services
The following table 1 presents the current status of availability of services
| S.No. | Category 1 (services) | Status |
| 1.1 | Specialist Services available (Yes/No) | |
| a. | Medicine | No |
| b. | Surgery | No |
| c. | OBG. | No |
| d. | Paediatrics | No |
| e. | National Health Programmes (Specify) | No |
| f. | Emergency Services (24 Hours) – medical & surgery | Yes |
| g. | 24 hour delivery services (normal & assisted) | Yes |
| h. | EmOC incl. Surgical interventions like Caesarean sections & other medical interventions | No |
| i. | New born care | No |
| j. | Emergency care of sick children | No |
| k. | Family planning services incl. sterilization | Yes |
| l. | Safe abortion services (MVA) | No |
| MTP services | No | |
| m. | Treatment of STI/RTI | Yes |
| n. | Laboratory | |
| Routine blood examination | Yes | |
| Urine examination | Yes | |
| Stool examination | Yes | |
| Biochemistry | Yes | |
| Serology | Yes | |
| Microscopy | Yes | |
| o. | Blood storage facility | |
| 1. In the institution | No | |
| 2. Tie up local blood bank | Yes | |
| p. | Referral transport service | Yes |
| Bed Occupancy Rate in the last 12 months (1– | 1 | |
| 1.2. | less than 40%, 2–40–60%, 3–More than 60% | |
| 1.3 | Average daily OPD Attendance | 100 |
| a. | Male | 50 |
| b. | Female | 50 |
| 1.4 | Types of Surgeries performed (specify) – under additional information | |
| 1.5.a. | Availability of counseling facility on HIV/AIDS/STD etc. (Yes/No) | Yes |
| b. | Is it a voluntary council and testing center | Yes |
| 1.6. | ||
| a. | Ante –natal Clinics | 4 |
| b. | Post –natal Clinics | 0 |
| c. | Immunization Sessions | 4 |
| 1.7. | Is separate septic labour room available | No |
| 1.8 | Availability of facilities for out –patient | No |
| department in Gynaecology/obstetric (Yes/No) | ||
| a. | Board/Name plates to guide the clients | No |
| b. | Adequate working space | Yes |
| c. | Privacy during examination | Yes |
| d. | Facility for counselling | Yes |
| e. | Separate toilet with running water | Yes |
| f. | Facility for sterilizing instruments | Yes |
| g. | Male specialist (OBGY) | No |
| h. | Female specialist (OBGY) | No |
Category 2 – Manpower
This category is further divided into – a. clinical manpower, b. support manpower and c. training of Medical Officers (MO)
Following table 2a indicates the status of clinical manpower in the CHC.
Table 2a: Clinical manpower available at the CHC
| S.No. | Personnel | IPHS Norm | Status |
| 1 | General Surgeon | 1 | 0 |
| 2 | Physician | 1 | 0 |
| 3 | Obstetrician/Gynecologist | 1 | 0 |
| 4 | Pediatrician | 1 | 0 |
| 5 | Anesthetist | 1 | 0 |
| 6 | Public Health Programme Manager | 1 | 0 |
| 7 | Eye Surgeon | 1 | 0 |
| 8 | Other specialists (if any) | Ortho | |
| 9 | General duty officers (Medical Officer) |
Following table 2b indicates the status of support manpower at the CHC.
Table 2b: Support Manpower at the CHC
| S.No. | Personnel | IPHS Norm | Status |
| 10 | Nursing staff | 7+3 | |
| a. | Public Health Nurse | 1 | 0 |
| b. | ANM | 1 | 0 |
| c. | Staff Nurse | 7 | 0 |
| d. | Nurse Midwife (Nursing sister) | 1 | 7 |
| 11 | Dresser | 1 | 0 |
| 12. | Pharmacist | 1 | 0 |
| 13. | Lab. Technician | 1 | 1 |
| 14 | Radiographer | 1 | 1 |
| 15 | Ophthalmic Assistant | 1 | 1 |
| 16 | Ward boys/nursing orderly | 2 | 1 |
| 19. | OPD Attendant | 1 | 4 |
| 0.2 | Statistical Assistant/Data entry Operator | 1 | 1 |
| 21 | OT Attendant | 1 | 0 |
| 0.22 | Registration Clerk | 1 | 0 |
| 23. | Any other staff (specify) | – | – |
Following table 2c indicates the status of training of MOs at the CHC.
Table 2c: Training of MOs in last 1 year at the CHC
| 2.24 | Available training in | Status |
| 1. | Sterilizations | |
| Mini lap tubectomy | 0 | |
| i. Laparoscopic tubectomy | 0 | |
| ii. Vasectomy | 0 | |
| iii. N.S.V | 0 | |
| 1. | IUD Insertions | 0 |
| 2. | Emergency contraception | 0 |
| 3. | RTI/STI,HIV/AIDS | 2 |
| 4. | Newborn care | 0 |
| 5. | Emergency obstetric care | 0 |
| 6. | Other subjects (mention) |
Category 3 – Investigation Facilities
Following table 3 indicates the status of investigation facilities at the CHC.
Table 3: Investigation facilities at the CHC
| S.No | IPHS Norm | Status |
| 1 | Availability of ECG facilities (Yes/No) | Yes |
| 2 | X–Ray facility (Yes/No) | Yes |
| 3 | Ultrasound facility (Yes/No) | No |
| 4 | Appropriate training to a nursing staff on ECG (Yes/No) | No |
| 5 | Any lab test/ diagnostic test outsourced to private lab/hospital (specify the test) | No |
| 6 | All necessary reagents, glassware and facilities for collection and transportation of samples (Yes/No) | Yes |
Category 4 – Physical Infrastructure
Following table 4 indicates the status of physical infrastructure at the CHC.
Table 4: Physical infrastructure at the CHC
| Sr.No. | Status | |
| 4.1 | Where is this CHC located | |
| a | Within Village Locality | Yes |
| b | Far from village locality | – |
| c | If far from locality specify in km | – |
| 4.2 | Building | |
| a | Is a designated government building available for the CHC | Yes |
| b | If there is no designated government building then where does the CHC located | |
| Rented premises | – | |
| Other government building | – | |
| Any other specify | – | |
| c | Area of the building (Total area in sq.mts.) | |
| d | What is the present stage of construction of the building | |
| Construction incomplete | Complete | |
| e | Compound Wall/Fencing(1–All around;2–Partial;3–None) | 2 |
| f | Condition of plaster on walls (1–Well plastered with plaster intact every where; 2–plaster coming off in some places; 3–plaster coming off in many places or no plaster) | 1 |
| g | Condition of floor (1–floor in good condition;2–Floor coming off in some places;3– Floor coming off in many places or on proper flooring) | 1 |
| h | Whether the cleanliness is Good/Fair/ Poor? (Observe) | |
| OPD | Fair | |
| OT | Fair | |
| Rooms | Fair | |
| Wards | Fair | |
| Toilets | Fair | |
| Premises (compound) | Poor | |
| I. | Are any of the following close to the hospital? (Observe) (Y/No) | |
| i | Garbage dump | No |
| ii | Cattle shed | No |
| iii | Stagnant pool | No |
| iv | Pollution from industry | No |
| 4.3 | Location of CHC | |
| a | Whether located at less than 2 hours of travel distance from the farthest village (Yes/No) | Yes |
| b | Whether the district headquarter hospital is located at a distance of less than 4 hours travel time? (Yes/No) | Yes |
| c | Feasibility to hold the workforce (e.g. availability of degree college railway station municipality industrial/mining belt) | Yes |
| 4.4 | Availability of private Sector Health Facility in the area | |
| a | Private laboratory/Hospital/Nursing Home (Yes/No) | Yes |
| b | Charitable Hospital (Yes/No)(specify) | No |
| c | Hospital run by NGO (Yes/No) | Yes |
| 4.5 | Prominent display boards in local language/Charter of Patient Rights (Yes/No) | No |
| 4.6 | Registration counters (Yes/No) | Yes |
| 4.7 | Pharmacy | |
| a | Pharmacy for drug dispensing and drug storage (Yes/No) | Yes |
| b | Counter near entrance of hospital to obtain contraceptives ORS packets Vitamin A and Vaccination (Yes/No) | No |
| 4.8 | Separate Public utilities for males and females (Yes/No) | Yes |
| 4.9 | Suggestion/ complaint box (Yes/No) | No |
| 4.1 | OPD rooms/cubicles (Yes/No)(Give numbers) | 2 |
| 4.11 | Adequate no of windows in the room for light and air in each room (Yes/No) | Yes |
| 4.12 | Family Welfare clinic (Yes/No) | No |
| 4.13 | Waiting room for patients (Yes/No) | Yes |
| 4.14 | Emergency Room/Casualty (Yes/No) | No |
| 4.15 | Separate wards for males and females (Yes/No) | Yes |
| 4.16 | No. of beds : Male | 15 |
| 4.17 | No. of beds : Female | 15 |
| No. of beds : Pediatrics | 0 | |
| 4.18 | Operation Theatre | |
| a | Operation Theatre available (Yes/No) | Yes |
| b | If operation theatre is present are surgeries carried out in the operation theatre | |
| Yes | ||
| No | No | |
| Sometimes | ||
| If operation theatre is present but surgeries are not being conducted there then what are the reasons for the same? | – | |
| c | ||
| Non–availability of doctors/anesthetist/staff | Yes | |
| Lack of equipment/poor physical state of the operation | Yes | |
| No power supply in the operation theatre | ||
| Any other reason (specify) | ||
| d | Operation Theatre used for obstetric/gynecological purpose (Yes/No) | Yes |
| e | Has OT enough space (Yes/No) | Yes |
| f | Is OT fitted with air conditioner? (Yes/No) | Yes |
| g | Is the air conditioner working (Yes/No) | Yes |
| h | Is generator available for OT? (Yes/No) | Yes |
| i | Is emergency light available in OT (Yes/No) | Yes |
| j | Is fumigation done regularly? (Yes/No) | Yes |
| k | Is the days of sterilization in a week displayed on the public notice on OT (Yes/No) | No |
| 4.19 | Labour room | |
| a | Labour room available (Yes/No) | Yes |
| b | If labour room is present are deliveries carried out in the labour room | |
| Yes | Yes | |
| No | ||
| c | If labour room is present but deliveries are not being conducted there then what are the reasons for the same | |
| Non–availability of doctors/staff | – | |
| Seepage in the labour room | ||
| No power supply in the labour room | ||
| Any other reason (specify) | ||
| 4.2 | X–Ray Room with dark room facility (Yes/No) | Yes |
| 4.21 | Laboratory | |
| a | Laboratory (Yes/No) | Yes |
| b | Are adequate equipment and chemicals available? (Yes/No) | Yes |
| c | Is laboratory maintained in orderly manner? (Yes/No) | Yes |
| 4.22 | Ancillary Rooms–Nurses rest room (Yes/No) | Yes |
| 4.23 | Water Supply :– | |
| a | Source of water | |
| 1–piped | ||
| 2–Bore well | Yes | |
| 3–well | ||
| 4–Other (specify) | ||
| b | Whether overhead tank and pump exist (Yes/No) | Yes |
| c | If overhead tank exist whether its capacity sufficient? (Yes/No) | Yes |
| d | If pump exist whether it is in working condition? (Yes/No) | Yes |
| 4.24 | Sewerage | |
| Type of sewerage system | ||
| 1–soak pit | ||
| 2–connected to local body/municipality | Yes | |
| 3–open drainage | ||
| 4.25 | Wasted disposal | |
| a | Is there an incinerator? (Yes/No) | No |
| b | If yes type (1–electric) | |
| 2–Other (specify) | ||
| c | If no how the medical waste disposed off? | Deep B P |
| 4.26 | Electricity | |
| a | Is there electric line in all parts of the hospital? | |
| 1–In all Parts | 1 | |
| 2–In some parts | – | |
| 3– None | – | |
| b | Regular power supply (1–Continuous Power Supply; | 4 |
| 2– Occasional power failure; | ||
| 3–Power cuts in summer only; | ||
| 4– Regular power cuts; in summer only; 4– Regular power cuts; | ||
| 5–No power supply | ||
| c | Stand by facility (generator) available (Yes/No) | Yes |
| 4.27 | Laundry facilities | |
| a | Laundry facility available (Yes/No) | No |
| b | If no is it outsourced? | On Contract basis |
| 4.28 | Communication facilities | |
| a | Telephone (Yes/No) | Yes |
| b | No. of diff. Telephone lines available | 1 |
| c | Personal Computer (Yes/No) | Yes |
| d | NIC Terminal (Yes/No) | No |
| e | E. Mail (Yes/No) | Yes |
| f. | Is CHC accessible by | |
| i | Rail (Yes/No) | Yes |
| ii | All whether road (Yes/No) | Yes |
| iii | Others (Specify) | |
| 4.29 | Vehicles (number of vehicles) | 1 |
| a | If running | |
| Sanctioned | ||
| Ambulance | 1 | |
| Jeep | – | |
| Car | – | |
| Available | ||
| Ambulance | 1 | |
| Jeep | – | |
| Car | ||
| On road | ||
| Ambulance | 1 | |
| Jeep | – | |
| Car | – | |
| b | If vehicle is not running (reason) | – |
| Driver not available | ||
| Ambulance | ||
| Jeep | ||
| Car | ||
| Money for POL not available | ||
| Ambulance | ||
| Jeep | ||
| Car | ||
| Money for repairs not available | ||
| Ambulance | ||
| Jeep | ||
| Car | ||
| 4.3 | Office room (Yes/No) | Yes |
| 4.31 | Store room (Yes/No) | Yes |
| 4.32 | Kitchen room (Yes/No) | No |
| 4.33 | Diet (Yes/No) | |
| a | Diet provided by hospital (Yes/No) | No |
| b | If no how diet is provided to the indoor patients? | Patient’s Own |
| 4.34 | Residential facility for the staff with living condition | |
| General Surgeon | No | |
| Physician | No | |
| Obstetrician/Gynecologist | No | |
| Pediatrics | No | |
| Anesthetist | No | |
| General Duty Medical Officer | No | |
| Public Health Programme Manager | No | |
| Eye Surgeon | No | |
| Public Health Nurse | No | |
| ANM | No | |
| Staff Nurse | No | |
| Nurse/Midwife | No | |
| Dresser | No | |
| Pharmacist/ Compounder | No | |
| Lab. Technician | No | |
| Radiographer | No | |
| Ophthalmic Assistant | No | |
| Ward boys/nursing orderly | No | |
| Sweepers | No | |
| Chowkidar | No | |
| OPD Attendant | No | |
| Statistical Assistant/Data entry operator | No | |
| OT Attendant | No | |
| Ambulance driver | No | |
| Registration Clark | No | |
| 4.35 | Dharamshala | |
| a | Facility for stay available (Yes/No) | No |
| b | Attached toilet available (Yes/No) | No |
| c | Cooking facility available (Yes/No) | No |
| 4.36a. | Is the CHC open for outpatient services for the stipulated OPD time | |
| Yes on all days excepting designated holidays | Yes | |
| No it always closes before time | – | |
| Only on some days it function for the stipulated time | – | |
| b. | If yes, specify stipulated OPD hours | 9am to 12pm |
| 5 –6pm | ||
| 4.37 | In cases where a patient needs to be admitted for inpatient. | |
| Yes patients who can be managed at CHC are always admitted | Yes | |
| Some deserving patients are not admitted but are referred to other facilities | ||
| Patients usually refused admission | ||
| 4.38 | Does the CHC provide treatment to emergency patients/victims of accident medical emergencies etc) at any time of the day/night? | |
| Emergency patients are given treatment where necessary they are referred higher level govt. hospital | Yes | |
| Emergency patients are often not treated referred to a public health care facility | – | |
| Emergency patients are often not treated referred to a private health care facility | – | |
| 4.39 | If referred to a higher –level health care facility how is the patient taken there? | |
| Free transport by hospital ambulance | Yes | |
| By Hospital ambulance but fuel and other charges have to be made by the patient | Yes | |
| Private/personal conveyance | ||
| 4.4 | Behavioral aspects | |
| a | How is the behavior of the CHC staff with the patient | |
| Courteous | Yes | |
| Casual/indifferent | – | |
| Insulting/indifferent | – | |
| b | Is there corruption in terms of charging extra money for any of the services? | No |
| c | Is a receipt always given for the money charged at the CHC | Yes |
| d | Is there any incidence of any sexual advances oral or physical abuse, sexual harassment by the doctors or any other paramedical? (Yes/ No) | No |
| e | Are woman patients interviewed in an environment that ensures privacy and dignity (Yes/ No) | Yes |
| f | Are examinations on woman patients conducted in presence of a woman attendant and procedures conducted under conditions that ensure privacy? (Yes/No) | Yes |
| g | Do patients with chronic illnesses receive adequate care ? | Yes |
| h | If the health center is unequipped to provide the services needed, are patients transferred immediately without delay, with all the relevant papers, to a site where the desired service is available? (Yes/ No) | Yes |
| i | Is there a publicly displayed mechanism whereby a complaint/ grievance can be registered (Yes/ No) | No |
Category 5 – Equipments
Following table 5 indicates the status of equipments at the CHC.
Table 5: Status of equipments at the CHC
| Equipment | Status |
| Blood storage unit | N |
| ECG machine | Y |
| X – Ray 100 mA | Y |
| OT air conditioner | Y(N.Wor) |
| Boyles apparatus | Y(N.Wor) |
| EMO machine (anaesthesia) | N |
| Cardiac monitor (OT) | Y |
| Defibrillator (OT) | N |
| Ventilator (OT) | N |
| Horizontal High Pressure Sterilizer | N |
| Vertical High Pressure sterilizer 2/3 drum capacity | Y |
| Shadow less lamp ceiling trek mounted | Y(N.Wor) |
| Shadow less lamp Pedestal for minor OT | Y(N.Wor) |
| OT care/fumigation apparatus | Y |
| Gloves dusting machines | N |
| Oxygen cylinder 660 Ltrs10 cylinders for 1 Boyles Apparatus | N |
| Nitrous Oxide cylinder 1780Ltr. 8 for one Boyles Apparatus | N |
| Hydraulic Operation Table | N |
| Ice lined freezers | Y |
| Deep freezers | Y |
| Refrigerators | Y |
| Intercom system | N |
| Personal Computer | Y |
| Ultra sound | N |
| KIT E – Laparotomy set | Y |
| KIT F – Standard surgical set | Y |
| KIT G – Inspection of IUD devise set | Y |
| KIT H – Vasectomy set | Y |
| KIT I – general purpose set | Y |
| KIT J – Standard surgical set | Y |
| KIT K – Embryotomy set | Y |
| KIT L – Evacuation of uterus set | Y |
| KIT M – Anaesthesia set | Y |
| KIT N – Neo natal resuscitation set | Y |
| KIT O – Lab test & blood transfusion set | Y |
| KIT P – Donor blood transfusion set | Y |
Category 6 – Drugs
Following table 6 indicates the status of drugs at the CHC.
Table 6: Status of Drugs at the CHC
| Sr.No. | Drug Name | Status |
| 1 | Oxygen | Y |
| 2 | Lignocaine Hydrochloride | Y |
| 3 | Diazepam | N |
| 4 | Acetyl Salicylic Acid | Y |
| 5 | Ibuprofen | Y |
| 6 | Paracetamol | Y |
| 7 | Pentazocine Lactate | N |
| 8 | Chloroquine Phosphate | Y |
| 9 | Adrenaline bititrate | Y |
| 10 | Chlorpheniramine Maleate | Y |
| 11 | Prednisolone | Y |
| 12 | Promethazine HCL | N |
| 13 | Phenobarbitone | N |
| 14 | Phenytoin Sodium | N |
| 15 | Albendazole | Y |
| 16 | Amoxicillin Powder | Y |
| 17 | Ciprofloxacin Hydrochloride | Y |
| 18 | Co–Trimoxazole | Y |
| 19 | Norfloxacine | Y |
| 20 | Doxycyline | Y |
| 21 | Metronidazole | Y |
| 22 | Clotrimazole | Y |
| 23 | Sulfadoxine + Pyrimethamine | N |
| 24 | Ferrous Salt | Y |
| 25 | Folic Acid | Y |
| 26 | Isosorbide Mononitrate/Dinitrate | N |
| 27 | Amlodipine | N |
| 28 | Digoxin | N |
| 29 | Benzioc Acid + Salicylic Acid | N |
| 30 | Miconazole | Y |
| 31 | Neomycin + Bacitracin | N |
| 32 | Silver Sulphadiazine | N |
| 33 | Benzyl Benzoate | Y |
| 34 | Acriflavin + Glycerin | N |
| 35 | Gentian Violet | N |
| 36 | Hydrogen Peroxide | Y |
| 37 | Povidone Iodine | Y |
| 38 | Bleaching Powder | N |
| 39 | Potassium Permanganate | N |
| 40 | Furosemide | Y |
| 41 | Aluminium Hydroxide + Magnesium Hydroxide | N |
| 42 | Domperidone | Y |
| 43 | Local Anaesthetic, Astringent and Antiinflammatory Medicine | N |
| 44 | Dicyclomine Hydrochloride | N |
| 45 | Oral Rehydration Salts | Y |
| 46 | Dexamithasone Sodium | Y |
| 47 | Ciprofloxacin Hydrochloride | Y |
| 48 | Tetracycline Hydrochloride | N |
| 49 | Alprozolam | N |
| 50 | Salbutamol Sulphate | Y |
| 51 | Etophyline Anhydrous | Y |
| 52 | Glucose | N |
| 53 | Glucose with Sodium Choride | N |
| 54 | Normal Saline | Y |
| 55 | Ringer Lactate | Y |
| 56 | Plasma Volume Expander | Y |
| 57 | Water for Injection | Y |
| 58 | Ascorbic Acid | N |
| 59 | Calcium Salts | Y |
| 60 | Multivitamins (As per Schedule V) | Y |
| 61 | Atentol | N |
| 62 | Floxitin | N |
| 63 | Amitryptiline Hcl | N |
| 64 | Bisacodyl | N |
| 65 | General Anaesthetic Drugs | Y |
| 66 | Tinidazole | Y |
| 67 | Daonil | Y |
| 68 | Haloperidol | Y |
| 69 | Sulpacetamide Eye Drops | N |
| Sr No. | Injections | |
| 1 | Cryst. Penicillin | Y |
| 2 | Inj. Procaine Penicillin | Y |
| 3 | Inj. Benzathine Penicilline (1.2) | N |
| 4 | Inj. Phenytoin Sodium 50mg/ml | N |
| 5 | Inj. Ampicillin | Y |
| 6 | Inj. Gentamicin | Y |
| 7 | Inj. Soda Bicarb | Y |
| 8 | Inj. Calcium Gluconate | N |
| 9 | Inj.KCI | N |
| 10 | Inj. Atropine | Y |
| 11 | Inj. Hyoscine N–butyl Bromide | N |
| 12 | Inj. Hydrocortisone | N |
| 13 | Inj. Syntocinon (synthetic oxytocin) | N |
| 14 | Inj. Methyl Ergometrine Maleate | Y |
| 15 | Inj. Isoxsuprine Hydrochloride | N |
| 16 | Inj. Aminophyllin | Y |
| 17 | Inj. Chloramphenicol | N |
| 18 | Inj. Mannitol | Y |
| 19 | Inj. Pethidine | Y |
| 20 | Inj Chlorpromazine | N |
Category 7 – Furniture
Following table 7 indicates the status of furniture at the CHC.
Table 7: Status of furniture at the CHC
| Sr. No. | Item | Norm | Status |
| 1. | Examination Table | 5 | 2 |
| 2. | Delivery Table | 2 | 2 |
| 3. | Footstep | 7 | 4 |
| 4. | Bed side Screen | 10 | 2 |
| 5. | Stool for patients | 10 | 5 |
| 1. | Arm board for adult & child | 2 | 0 |
| 2. | Saline stand | 10 | 10 |
| 3. | Wheel Chair | 3 | 3 |
| 4. | Stretcher on trolley | 2 | 2 |
| 5. | Oxygen trolley | 3 | 4 |
| 6. | Height measuring stand | 1 | 1 |
| 7. | Iron bed | 26 | 30 |
| 8. | Bed side locker | 35 | 35 |
| 9. | Dressing trolley | 3 | 3 |
| 10. | Mayo trolley | 1 | 1 |
| 11. | Instrument cabinet | 2 | 2 |
| 12. | Instrument trolley | 2 | 3 |
| 13. | Bucket | 8 | 2 |
| 14. | Attendant stool | 35 | 5 |
| 15. | Instrument tray | 10 | 6 |
| 16. | Chair | 20 | 20 |
| 17. | Wooden table | 10 | 14 |
| 18. | Almirah | 10 | 16 |
| 19. | Swab rack | 1 | 1 |
| 20. | Mattress | 30 | 35 |
| 21. | Pillow | 30 | 0 |
| 22. | Waiting bench for patients/attendants | 4 | 2 |
| 23. | Medicine cabinet | 3 | 2 |
| 24. | Side rail | 2 | 0 |
| 25. | Rack | 10 | 2 |
| 26. | Bed side attendant chair | 30 | 20 |
Category 8 – Quality Control
Following table 8 indicates the status of quality control at the CHC.
Table 8: Status of quality control at the CHC
| S.No. | Category 1 (services) | Status |
| 1.1 | Specialist Services available (Yes/No) | |
| a. | Medicine | No |
| b. | Surgery | No |
| c. | OBG. | No |
| d. | Pediatrics | Yes |
| e. | National Health Programmes (Specify) | Yes |
| f. | Emergency Services (24 Hours) – medical & surgery | Yes |
| g. | 24 hour delivery services (normal & assisted) | Yes |
| h. | EmOC incl. Surgical interventions like Caesarean sections & other medical interventions | No |
| i. | New born care | Yes |
| j. | Emergency care of sick children | Yes |
| k. | Family planning services incl. sterilization | Yes |
| l. | Safe abortion services (MVA) | No |
| MTP services | No | |
| m. | Treatment of STI/RTI | Yes |
| n. | Laboratory | |
| Routine blood examination | Yes | |
| Urine examination | Yes | |
| Stool examination | Yes | |
| Biochemistry | Yes | |
| Serology | Yes | |
| Microscopy | Yes | |
| o. | Blood storage facility | |
| 1. In the institution | Yes | |
| 2. Tie up local blood bank | No | |
| p. | Referral transport service | Yes |
| Bed Occupancy Rate in the last 12 months (1– | 3 | |
| 1.2. | less than 40%, 2–40–60%, 3–More than 60% | |
| 1.3 | Average daily OPD Attendance | 250 |
| a. | Male | 40 |
| b. | Female | 60 |
| 1.4 | Types of Surgeries performed (specify) – under additional information | |
| 1.5.a. | Availability of counseling facility on HIV/AIDS/STD etc. (Yes/No) | Yes |
| b. | Is it a voluntary council and testing center | Yes |
| 1.6. | ||
| a. | Ante –natal Clinics | 4 |
| b. | Post –natal Clinics | 4 |
| c. | Immunization Sessions | 4 |
| 1.7. | Is separate septic labour room available | No |
| 1.8 | Availability of facilities for out –patient | No |
| Department in Gynaecology/obstetric (Yes/No) | ||
| a. | Board/Name plates to guide the clients | No |
| b. | Adequate working space | Yes |
| c. | Privacy during examination | Yes |
| d. | Facility for counseling | Yes |
| e. | Separate toilet with running water | Yes |
| f. | Facility for sterilizing instruments | Yes |
| g. | Male specialist (OBGY) | No |
| h. | Female specialist (OBGY) | No |
Additional Information
R.H. Akot CHC
R.H. Akot CHC is located in Akot block of Akola district.
It is not recognized as a FRU.
It is a 30 bedded hospital.
Blood Storage and tie up with local blood bank not present.
Types of surgeries performed at R.H. Akot CHC – FP.
Section 3
GAPS at the facility
Cost implications for upgradation to IPHS
The following text indicates the GAPS at the assessed CHC against the 8 broad categories. It also indicates, wherever relevant, the approximate cost implication to upgrade this CHC to Indian Public Health Standards (IPHS).
GAPS at the CHC and cost implications for upgradation to IPHS
Category 1 – Services The following table 1 presents the GAPS related to services at the CHC.
Table 1: Services GAPS at the CHC
| Category 1 (services) | GAPS |
| Medicine | X |
| Surgery | X |
| OBG. | X |
| Paediatrics | X |
| National Health Programmes (Specify) | X |
| EmOC incl. Surgical interventions like Caesarean sections & other medical interventions | X |
| New born care | X |
| Emergency care of sick children | X |
| Safe abortion services (MVA) | X |
| MTP services | X |
| Is separate septic labour room available | X |
| Board/Name plates to guide the clients | X |
| Female specialist (OBGY) | X |
Category 2 – Manpower
Following table 2a indicates the GAPS in clinical manpower at the CHC and its cost implication for upgradation.
Table 2a: Clinical manpower GAPS at the CHC
| Personnel | GAPS | Requirement | Unit cost | Annual cost |
| Public Health Nurse | X | 1 | 12000/mth | 144000 |
| ANM | X | 1 | 8000/mth | 72000 |
| Staff Nurse | X | 7 | 10000/mth | 840000 |
| Dresser | X | 1 | 6000/mth | 72000 |
| Ward boy | X | 1 | 6000/mth | 72000 |
| OT Attendant | X | 1 | 6000/mth | 72000 |
| Registration clerk | x | 1 | 8000/mth | 96000 |
| Total | 1368000 |
Following table 2c indicates the GAPS in training of MOs at the CHC.
Table 2c: Training of MOs in last 1 year at the CHC
| Available training in | GAPS |
| Sterilizations | |
| Mini lap tubectomy | X |
| Laparoscopic tubectomy | X |
| Vasectomy | X |
| N.S.V | X |
| IUD Insertions | X |
| Emergency contraception | X |
| Newborn care | X |
| Emergency obstetric care | X |
Category 3 – Investigation Facilities
Following table 3 indicates the GAPS in investigation facilities at the CHC.
Table 3: Investigation facilities GAPS at the CHC
| IPHS Norm | GAPS |
| Ultrasound facility | X |
| Appropriate training to a nursing staff on ECG | X |
| Any lab test/ diagnostic test outsourced to private lab/hospital | X |
Category 4 – Physical Infrastructure
Following table 4 indicates the GAPS in physical infrastructure at the CHC and its cost implication for upgradation to IPHS.
Table 4: Physical infrastructure GAPS at the CHC
| GAPS | Cost | |
| Compound Wall/Fencing | X | 200000 |
| Prominent display boards in local language/Charter of Patient Rights (Yes/No) | X | |
| Family Welfare clinic (Yes/No) | X | |
| Emergency Room/Casualty (Yes/No) | X | |
| No. of beds : Pediatrics | X | |
| If operation theatre is present are surgeries carried out in the operation theatre | X | |
| Is the days of sterilization in a week displayed on the public notice on OT (Yes/No) | X | |
| Dharamshala | X | 500000 |
| Is there a publicly displayed mechanism whereby a complaint/ grievance can be registered (Yes/ No) | X | |
| Total | 700000 |
Category 5 – Equipments
Following table 5 indicates the GAPS in equipments at the CHC and its cost implication for upgradation to IPH.
Table 5: GAPS of equipments at the CHC
| Equipment | GAPS | Cost |
| Blood storage unit | X | 75000 |
| EMO machine (anaesthesia) | X | 50000 |
| Defibrillator (OT) | X | 100000 |
| Ventilator (OT) | X | 500000 |
| Horizontal High Pressure Sterilizer | X | 150000 |
| Gloves dusting machines | X | 15000 |
| Oxygen cylinder 660 Ltrs10 cylinders for 1 Boyles Apparatus | X | 5500 |
| Nitrous Oxide cylinder 1780Ltr. 8 for one Boyles Apparatus | X | 7000 |
| Hydraulic Operation Table | X | 39000 |
| Intercom system | X | 98000 |
| Ultra sound | X | 300000 |
| Total | 1339500 |
Category 6 – Drugs
Following table 6 indicates the GAPS in drugs at the CHC.
Table 6: GAPS of Drugs at the CHC
| Drug Name | GAPS |
| Diazepam | X |
| Pentazocine Lactate | X |
| Promethazine HCL | X |
| Phenobarbitone | X |
| Phenytoin Sodium | X |
| Sulfadoxine + Pyrimethamine | X |
| Isosorbide Mononitrate/Dinitrate | X |
| Amlodipine | X |
| Digoxin | X |
| Benzioc Acid + Salicylic Acid | X |
| Neomycin + Bacitracin | X |
| Silver Sulphadiazine | X |
| Acriflavin + Glycerin | X |
| Gentian Violet | X |
| Bleaching Powder | X |
| Potassium Permanganate | X |
| Aluminium Hydroxide + Magnesium Hydroxide | X |
| Local Anaesthetic, Astringent and Antiinflammatory Medicine | X |
| Dicyclomine Hydrochloride | X |
| Tetracycline Hydrochloride | X |
| Alprozolam | X |
| Glucose | X |
| Glucose with Sodium Choride | X |
| Ascorbic Acid | X |
| Atentol | X |
| Floxitin | X |
| Amitryptiline Hcl | X |
| Bisacodyl | X |
| Sulpacetamide Eye Drops | X |
| Injections | |
| Inj. Benzathine Penicilline (1.2) | X |
| Inj. Phenytoin Sodium 50mg/ml | X |
| Inj. Calcium Gluconate | X |
| Inj.KCI | X |
| Inj. Hyoscine N–butyl Bromide | X |
| Inj. Hydrocortisone | X |
| Inj. Syntocinon (synthetic oxytocin) | X |
| Inj. Isoxsuprine Hydrochloride | X |
| Inj. Chloramphenicol | X |
| Inj Chlorpromazine |
Category 7 – Furniture
Following table 7 indicates the GAPS in furniture at the CHC and its cost implication for upgradation to IPHS.
Table 7: GAPS in furniture at the CHC
| Item | Gaps | Requirement | Unit Cost | Cost |
| Examination Table | X | 3 | 5000 | 15000 |
| Bed side Screen | X | 8 | 2000 | 16000 |
| Stool for patients | X | 5 | 1500 | 7500 |
| Arm board for adult & child | X | 2 | 500 | 1000 |
| Bucket | X | 6 | 150 | 900 |
| Attendant stool | X | 30 | 1500 | 45000 |
| Instrument tray | X | 4 | 150 | 600 |
| Pillow | X | 30 | 200 | 6000 |
| Medicine cabinet | X | 1 | 5000 | 5000 |
| Side rail | X | 2 | 2000 | 4000 |
| Rack | X | 8 | 3000 | 24000 |
| Bed side attendant chair | X | 10 | 500 | 5000 |
| Total | 130000 |
Category 8 – Quality Control
Following table 8 indicates the GAPS in quality control at the CHC.
Table 8: GAPS in quality control at the CHC
| Particular | GAPS |
| Patients charter (Yes/No) | X |
| External monitoring (Gradation by PRI (Zilla Parishad) Rogi Kalyan Samitis | X |
| Availability of standard Operating procedures (SOP)/ Standard Treatment Protocols (STP)/Guidelines(Please provide a list) | X |
Section 4: Comments
The following comments are related to the 8 categories against which the CHC was assessed
- Overall this CHC needs inputs under all the categories of the IPHS.
- Inputs related to this CHC include specialist, equipments, drugs, physical infrastructure, and improvement in quality control mechanism.
