Checklist for Monitoring Sub Centre

Name of the State :- ____________________________________________________________

Name of the District :- ____________________________________________________________
Name of the Block :- ____________________________________________________________
Name of PHC
Name of the SC :- ____________________________________________________________
Address :- ____________________________________________________________
Population covered
by SC (in numbers) :- ____________________________________________________________

Name of the ANM :- ___________________________________________________________

Contact Details :- Office :- ___________________ Mobile :- ___ __________________
Email :- __________________________________________________
Date of Visit :- _______________
Name & Signature of the person
collecting information :- __________________________________________________________

I Manpower
Personnel Recommended Sanctioned In Position Remarks
1 ANM/ Health Worker (Female) 1/2 Contractual
2 Health Worker (Male) 1 (optional)
3 Voluntary worker * 1 (optional)
4 ASHA
5 AWW
* Voluntary worker to keep the Sub Centre clean & assisting ANM.
She is paid by the ANM from her contingency fund @ Rs. 100 per month.

II Training Status (Kindly procure a copy of trained personnel)

Name of the Training Period of
Name of the Personnel & Contact Details
Received with the posting in
Designation (Ph & Email)
Date the SC
1
2
3

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III Feedback of Trained Personnel
Name of Trained Personnel (ANM 1) :-
Name & Date of the last training received :-
Questions Yes/No Remarks
1 Was the purpose/objective of taking the training fulfilled?
2 Was the duration of the training sufficient?
3 Was the course content sufficient?
What did you like most about the training that you received?
4
(put √ mark)
• Content
• Training Methodology Used
• Training skills
• Practical demonstration
• Training Environment
• Field Visits
• Accommodation & Food
Kindly state in detail
Any component (from the options above) of training that you
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are not satisfied with?

6 Any training materials given to you?

7 Are those materials available in the Sub Centre?
Do you feel the training that you received is beneficial to you
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in service delivery?

9 If No, Give the Reason (List out the problems)

Are you unable to utilize the skills learnt during the training
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at work place
11 If Yes, Give the Reasons (put √ mark)
• Inadequate training
• Lack of Infrastructure
• Lack of Drugs & Equipments
• Lack of supporting staff
• Administrative Problems
Any other training that you feel will be beneficial for your
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work? ( List the name of the trainings)

13 Any suggestions regarding training

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III Feedback of Trained Personnel
Name of Trained Personnel (ANM 2) :-
Name & Date of the last training received :-
Questions Yes/No Remarks
1 Was the purpose/objective of taking the training fulfilled?
2 Was the duration of the training sufficient?
3 Was the course content sufficient?
What did you like most about the training that you received?
4
(put √ mark)
• Content
• Training Methodology Used
• Training skills
• Practical demonstration
• Training Environment
• Field Visits
• Accommodation & Food
Kindly state in detail
Any component (from the options above) of training that you
5
are not satisfied with?

6 Any training materials given to you?

7 Are those materials available in the Sub Centre?
Do you feel the training that you received is beneficial to
8
you in service delivery?

9 If No, Give the Reason (List out the problems)

Are you unable to utilize the skills learnt during the training
10
at work place
11 If Yes, Give the Reasons (put √ mark)
• Inadequate training
• Lack of Infrastructure
• Lack of Drugs & Equipments
• Lack of supporting staff
• Administrative Problems
Any other training that you feel will be beneficial for your
12
work? ( List the name of the trainings)

13 Any suggestions regarding training

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IV Facility Monitoring for Sub Centre
A Infrastructure
Yes/No/
Functional (mark F)/
Questions Remarks
Non-Functional
(mark NF)
Is a designated Government building available for the
1
Sub Centre?
2 Where is this Sub Centre located?
• Within village locality
• Far from village locality
• If far from locality (specify in km)
3 Separate examination room available
4 Patient examination table available
Fully furnished & equipped Labour room as per
5
Annexure 1 available?
6 If Labour room is present, are deliveries carried out in
the Labour room?
7 If Yes, Availability of New born care facilities
• New Born Table
• Pediatrics Ambu Bag & Mask
• Radiant Warmer / 200 Watt Lamp
• Mucus Sucker / Suction Machine
• Oxygen Hood & Cylinder
If Labour room is present, but deliveries not being
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conducted there, then what are the reasons for the same?
• Staff not staying at SC
• Poor condition of the Labour room
• No power supply in the Labour room
• Any other specify
9 Is proper water supply available?
10 Is regular electric supply available?
11 Is power back up available?
Are separate toilets for males & females available &
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functional?
13 Are colour coded dustbins for waste disposal available?
14 Is bio-medical waste pit available?
15 Is Telephone facility available & functional?
16 Is transport facility for movement of staff available &
functional?
Is residential facility for the staff available & in livable
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condition?
Availability of essential drugs
18
(as per Annexure II enclosed)
19 Is transport for referral available & functional?
20 Name of the nearest referral centre (Mention the distance)

V Health Services

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A Maternal Health Services Yes / No Remarks
Ante-natal Care
• Is the Antenatal care provided?
(Inj. T.T, IFA tablets, Weight & BP checkup & Hb estimation)
Intra-natal Care
• Deliveries conducted at Sub Centre , If Yes
 Hand Washing facility available & utilized
 Sterilized gloves used
• Managing Labour using Partograph (Ask to show for last delivery conducted)
• Identification & Management of danger signs during Labour
• First aid treatment for PPH, Eclampsia & Sepsis
• Minimum 6 hours of stay post delivery
• Are the facilities under Janani Suraksha Yojana provided?
• Is the facility for referral of complicated cases of pregnancy /
delivery available at Sub centre for 24 hours?
Post-natal care (Essential)
• Breast Feeding (within 1 hour of Birth)
• Advise mother on exclusive Breast feeding
Syndromic management of RTI/STI
B Family Planning Services
• Is IUCD inserted?
• Are the OCP, Emergency pills & condoms distributed?
• Referred for Permanent Method
C Child Health Services
Essential New Born Care
• Prevention of Hypothermia (KMC)
• Maintain airway & breathing
• Cord Care
• Eye Care
Immunization services ( If Yes )
• Are the Immunization services as per Government schedule
• Hub cutter used
• Proper disposal of sharps
Care of Sick Children
• Is the ORS available for managing Diarrhea
• Is the treatment of minor illness like fever, cough, cold,
worm disinfestation etc. available
• Is VHND organized every month? ( If Yes )
 Is the growth of infants & children monitored
 Nutrition Counselling provided
D Adolescent Health
• TT Immunization
• IFA Tablets
• Nutrition Counselling
• Counselling for menstrual hygiene & menstrual disorders
• Counselling for RTI/STI
E Disease Control
• Is the facility for taking peripheral blood smear in case of
fever available?
• Is it a DOT centre?

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VI Feedback from the Community (Take from 3 beneficiaries)
Beneficiary 1 Beneficiary 2 Beneficiary 3
Questions Yes/No Yes/No Yes/No
1 Does the Sub Centre open regularly?
2 Is the ANM available all the time?
3 What services do you receive from Sub Centre?
• ANC
(TT Inj., IFA Tablets ,BP, Hb recording ,Hb estimation)
• Delivery
• Immunization
• Contraceptives
4 Any fee for service is charged from you?
5 Is JSY money received timely?
6 Is VHND organized every month?
7 Is ANM present during VHND?
8 What services do you get during VHND?
9 How is the behaviour of ANM with you
• Courteous
• Casual/Indifferent
• Insulting/Derogatory
10 Does the ANM counsel you on
• Birth preparedness
• Family Planning
• Diet/Nutrition
11 Does the ANM visit home for postnatal care?
Are the following services given during postnatal
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visit?
• Examination of mother
• Examination of newborn
• Counselling on diet/nutrition, rest, hygiene,
family planning
• Counselling on breast feeding & child care
13 Are the immunization services regular?
14 Is the supply of OCP & Condom regular?
Are you satisfied by the services provided by the
15
ANM/Sub Centre?

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 Annexure I
Sub Center

List of Furniture’s in Labour Room

Sr.No. Items Yes/No Remarks

1 Examination Table
2 Labour table with Mattress, pillow and Kelly’s pad
3 McIntosh Sheet
4 Writing Table
5 Armless chairs
6 Medicine chest
7 Labour table
8 Wooden screen
9 Foot step
10 Coat rack
11 Bed side table
12 Stool
13 Almirahs
14 Lamp
15 Side wooden racks
16 Fans
17 Tube lights
18 Basin stand
19 Buckets
20 Mugs
21 Kerosene stove
22 Sauce pan with lid
23 Water receptacle
24 Rubber / plastic shutting
25 Talquist Hb scale
26 Drum with tap for storing water
27 Hypochlorite solution/bleach
28 Black Disposal bags
29 Red Disposal Bags

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List of Equipments and consumables

Sr.No. Items Yes/No Remarks

1 Basin 825 ml., (Stainless Steel
2 Basin deep (capacity 6litre)
3 Tray instrument/Dressing with cover
4 Flashlight
5 Torch (ordinary
6 Dressing Drum. with cover
7 Hemoglobinometer –set Sahli type
8 Weighing Scale, Adult
9 Weighing Scale, Infant
10 Weighing Scale (baby)
11 Tissue Forceps
12 Sterilizer
13 Surgical Scissors straight
14 Sims Uterine Depressor/Retractor
15 Measuring Jug
16 Surgeon’s Scrubbing Brush with white
Nylon Bristles
17 Sphygmomanometer
18 Kelly’s hemostat Forceps straight
19 Vulsellum Uterine Forceps curved
20 Cusco’s/Graves Speculum vaginal bi-valve
21 Sims Speculum vaginal double ended
22 Uterine Sound
23 Cheatle’s Forcep
24 Vaccine Carrier
25 Ice pack box
26 Sponge holder
27 Plain Forceps
28 Suture needle straight & curved
29 Clinical Thermometer oral & rectal
30 Room Heater/Cooler for immunization
clinic with
electrical fittings
31 Foetoscope
32 Dressing Forceps (spring type)
33 Artery Forceps, straight,
34 Cord cutting Scissors
35 Stethoscope
36 Hub Cutter
37 Ambu Bag
38 Measuring Tape
39 I/V Stand
40 Tracking Bag and Tickler Box
(Immunization)

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 Annexure II
Sub Center

List of Drugs in sub centre

Sr.No. Items Yes/No Remarks

1 Methylergometrine Tablets IP
2 Paracetamol Tablets IP
3 Methylergometrine Injection IP
4 Albendazole Tablets IP
5 Dicyclomine Tablets IP
6 Chloramphenicol Eye Ointment IP
7 Povidone IodineOintment USP
8 Cotton Bandage (As per Schedule F II)
9 Absorbent Cotton IP
10 Inj. Gentamycin
11 Inj. Magnesium Sulphate
12 Inj. Oxytocin
13 Cap. Ampicillim
14 Tab. Metronidazole
15 Tab. Misoprostol 200 _g
16 BCG, DPT, OPV, Measles, TT (vaccines)
17 Vitamin A syrup
18 ORS Packets
19 Ringer’s lactate
20 Normal saline
21 N/5 in 5% dextrose
22 5% and 10% dextrose
23 Nirodh
24 Oral pills
25 Copper – T (380-A)
26 Emergency contraceptive pills
Medicines and other consumables required for different National
disease control programmes

28 Tab. and syrup Chloroquine

29 Tab. Primaquine (2.5 mg and 7.5 mg)
30 Tab. DEC (Di Ethyle Carbamazine–only in
filaria endemic areas)
31 Anti leprosy drugs (MDT Blister Packs)
32 Anti-tuberculosis drugs(only in DOT
centres)
33 Rapid Diagnostic Kits for Malaria under
National Vector Borne Disease Control
Programme

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