india karnataka phc quality assessment web viewprimary excision and care of burns. ... ddcs &...
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PART- 1
FORM 1: PHC QUALITY ASSESSMENT CHECKLIST
QUALITY ASSURANCE GROUP VISIT
IDENTIFICATION
State:__________________ District: ________________ Taluka: _________________
Block: ____________ Distance from District HQ (Kilometers) ________________________________________
Name & Address of Facility
PHC Staff respondents
Name Designation1 _____________________________ __________
2 ______________________________ __________
3 ______________________________ __________
4 ______________________________ __________
DQAG MembersName Designation
1. ____________________________ ____________
2. ____________________________ ____________ 3. ____________________________ ____________ 4. ____________________________ ____________
Date when last supervisory visit was made by DHO/CS/ADHO/THO to review QA ‘actions plan’ or to provide facilitative supervision on QA: ___________________________ Time started assessment: _________ Time ended assessment: ___________
Date of Assessment: __________ Signature of the Team Leader DQAG
1
GENERAL INFRASTRUCTURE MANAGEMENT
Q. No.
Sub-elements
Instructions: On day of visit. Ask MO I/C and/or other staff and fill
the following questions
Response
Score
(0)
Score
(1)
Score
(2)
Score
(3)
Score
(4)
A B C D E
QA.1 Compound Wall / fencing including bio fencing
None Partial All around but without gate
Compound with gate
QA.2 Condition of plaster on walls and paint
No plaster / Not painted in the past
two years
Plaster coming off in places
Well plastered
Not painted in the past one year
Well plastered and painted in past one
year
QA.3 Condition of floor No proper flooring Flooring coming off in a places
Floor in good condition
QA.4 Cleanliness Dirty with un cleared garbage.
Cobwebs in building
Stains on wall and floor. Needs
thorough cleaning
Fair Good Excellent
QA.5 Is a garbage dump close to the PHC
Yes No
QA.6 Surrounding environment of PHC with its compound
Unclean with weeds Unlevelled ground, but clean
Clean with saplings planted
Greenary present but not maintained
properly
Well maintained garden
2
Q. No.
Sub-elements
Instructions: On day of visit. Ask MO I/C and/or other staff and fill
the following questions
Response
Score
(0)
Score
(1)
Score
(2)
Score
(3)
Score
(4)
A B C D E
QA.7 Is there prominent display boards regarding service availability
No Yes, but not in good condition
In good condition but not properly
displayed
Highly visible and impactive
QA.8 Are IEC posters displayed properly and aesthetically
No Poor Fair Good Excellent
QA.9 Location of pharmacy No pharmacy / In inconvenient corner
In a conspicuous place easily identified
B + well fabricated counter
C + IEC displayed
QA.10 Pharmacy for drug storage and dispensing (cleanliness, maintenance of records and bin cards, arrangement of drugs etc.,)
No BIN cards or illegible BIN cards.
Badly maintained. Mediocre with incomplete BIN
cards
Well maintained. Updated properly
displayed BIN cards
QA.11 Waiting space for patients and wards
No Waiting area with out adequate seating
facility
Waiting area with adequate seating
facility
Well arranged with seats and safe drinking water
provision.
D + IEC well displayed
3
Q. No.
Sub-elements
Instructions: On day of visit. Ask MO I/C and/or other staff and fill
the following questions
Response
Score
(0)
Score
(1)
Score
(2)
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(3)
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(4)
A B C D E
QA.12 Emergency / Casualty room No Yes but not well set with water supply. No MLC register
Well set with stomach wash area and water supply
but without emergency
medicines. MLC register not updated
for more than a week
Well equipped including
emergency medicines.
MLC register updated but not as
on date
Well equipped including
emergency medicines.
MLC register updated as on date
QA.13 Availability of easy, free access to condoms
No. Box is kept but no condoms inside
Supplied at pharmacy on
request
Box with condoms kept for easy access
QA.14 Dressing Room No separate room or designated place for
dressing
No separate room but a clean
designated place for dressing
A separate dressing room with all
essential consumables for dressing but not
properly organised
A well organised dressing room. Cap
of consumable containers not
closed
Well organised, cleanly maintained with water supply.
4
Q. No.
Sub-elements
Instructions: On day of visit. Ask MO I/C and/or other staff and fill
the following questions
Response
Score
(0)
Score
(1)
Score
(2)
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(3)
Score
(4)
A B C D E
QA.15 Labour room No labour room Poor physical state. No Uninterrupted power supply and
water supply
As per specification but without
uninterrupted power and water supply. Use of designated
footwear
As per specification with uninterrupted
power and hot water supply. Suction machine with
oxygen cylinder
In excellent condition. With attached toilet.
Clearly displayed PPH & Eclampsia protocol. APGAR
scoring
QA.16 Wards No clear demarcated ward
Only post labour ward
Post labour ward with attached toilet
well maintained
C+ general ward well maintained
All wards with clean and tidy beds and
linen
QA.17 Toilets / wash rooms Unclean, non functional
Functional but not always clean. No
water supply inside
Functional with water supply but not
always clean
Clean
QA.18 Laboratory No lab Lab has only uni-ocular microscope
Lab has binocular microscope but with inadequate supply of consumables
Lab has binocular microscope but with adequate supply of
consumables
Well equipped, neatly maintained
lab with datum charts
QA.19 Bio Medical Waste management
Nil Only pit Clear segregation, collection system
established. But not proper disposal
Clear segregation, collection, and disposal system
established.
Laison with CTF/local bodies for effective final
disposal
5
Q. No.
Sub-elements
Instructions: On day of visit. Ask MO I/C and/or other staff and fill
the following questions
Response
Score
(0)
Score
(1)
Score
(2)
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(3)
Score
(4)
A B C D E
QA.20 Mortuary No Without PM table, without water
supply & electricity
With PM table, with water supply &
electricity, but not properly
maintained
With PM table, with water supply & electricity, well
maintained
QA.21 Cold chain room No Only ILR present and functioning
without stabilizer directly plugged in
ILR & deep freezer present and
functioning without stabilizer
ILR & deep freezer present and
functioning with stabilizer
QA.22 Store Room No store toom, or articles just piled up
or stocked up
Improperly maintained store
room
Clean and well arranged without
proper documentation
Clean and well arranged with
proper documentation
QA.23 Optometrist room No Present without Snell’s chart
Present with Snell’s chart and colour
identification
Score Obtained (max-74) =
6
SERVICES:
OPD Management
Q. No.
Sub-elements
Instructions: On day of visit ask MO I/C and/or other staff and fill the
following questions
Response
Score
(0)
Score
(1)
Score
(2)
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(3)
Score
(4)
A B C D E
QA.1 Out patient registration No registration Slip is issued but not recorded
Record of OP maintained
Record of OP maintained +
patients are guided
D + OP book given
QA.2 Availability of Doctor No doctor Incharge doctor is available some days
in a week
A doctor is available on all days, but not
residing in HQ
Doctor resides in the village where PHC is located
Doctor resides in the PHC boundaries
giving service round the clock
QA.3 Availability of drugs Essential drugs not available
Essential drugs available. Vital
drugs not available
Essential and vital drugs available.
Desired drugs not available
All VED drugs available but not in dispensing counter
All VED drugs available in
dispensing counter
QA.4 Dressing room quality of maintenance and service
No dressing room Dressing room present. Unclean,
no water supply and outlet.
Dressing room has water supply and
outlet, but not clean and tidy.
Dressing room clean, but no water supply nor outlet.
Dressing room clean with water
supply and outlet. All dressing
materials and chemicals available
7
Q. No.
Sub-elements
Instructions: On day of visit ask MO I/C and/or other staff and fill the
following questions
Response
Score
(0)
Score
(1)
Score
(2)
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(3)
Score
(4)
A B C D E
QA.5 Are patients reaching PHC after OPD hours attended to.
Not attended to Yes attended to, but only by group D
Yes attended to, but only by group D and SN/JHAF
Yes attended to, by doctor only.
Yes attended to, by doctor, SN/JHAF,
and group D
QA.6 Primary wound care Only superficial wound dressing
done without application of
relevant antiseptics
Wounds dressings done with
application of antiseptics
Wounds dressing, suturing of wounds
done with only threads
Wounds dressing, suturing of wounds done with catguts
also
Wounds dressing, suturing of wounds done with catguts
also. Repair of earlobes
QA.7 . Primary care of injuries - orthopaedic
No orthopaedic support available
Slings, slabs and other supports are
only given
B + POP followup done
Closed reductions are done. No
inpatient admission. Referred out
Closed reductions done and admitted
QA.8 Minor Surgeries Only drainage of abscess done
Drainage of abscesses, excision of cysts (sebaceous)
etc.
Primary repair of incisional wounds
done
Excision of cysts on face and periorbital
area done
Bull gore and other animal inflicted
injuries attended to
QA.9 Management of burn injuries Not done Only application of antiseptic ointments and dressing done
Application of antiseptic ointments
dressing and correction of electrolyte
imbalance done
Primary excision and care of burns /
scald etc. done
Primary excision and care of burns.
Admission as inpatients and
adequate care given
8
Q. No.
Sub-elements
Instructions: On day of visit ask MO I/C and/or other staff and fill the
following questions
Response
Score
(0)
Score
(1)
Score
(2)
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(3)
Score
(4)
A B C D E
QA.10 Primary management of OP poisoning, insect bites,
Not attended to Stomach wash/primary care
B + Treated as inpatient
Score Obtained (max-38) =
Maternal Care
Q. No.
Sub-elements
Instructions: On day of visit ASK MO I/C and/or other staff and fill the
following questions
Response
Score
(0)
Score
(1)
Score
(2)
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(3)
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(4)
A B C D E
QA.1 Pre Natal More than 40% of ANC registered are
in 3rd trimester
ANC registration in 3rd trimester
between 30% and 40%
ANC registration in 3rd trimester less
than 30%, with all primy gravidas
given 2 doses of TT. Min 3 ANC
checkups
C + all primy gravidas given 2
doses of TT + 100 tabs of IFA. High risk pregnancies
identified. IV iron sucrose. More than
3 ANC
C +D + Health education on pregnancy, lactation,
immunisation, nutrition and benefits of
institutional deliveries
9
Q. No.
Sub-elements
Instructions: On day of visit ASK MO I/C and/or other staff and fill the
following questions
Response
Score
(0)
Score
(1)
Score
(2)
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(3)
Score
(4)
A B C D E
QA.2 Natal Deliveries conducted only in
day time
More than 30% of deliveries at night
10units of Oxytocin given. Usage of
partograph
B + Episiotomy given to all primy
gravidas Tab Misoprostol for
prevention of PPH. Complete
sterilisation of instruments
B + C + Child is breast fed within ½
hr of delivery
B + C + D + Usage of umbilical clip
QA.3 Post Natal No sanitary care or education given
Sanitary care and sanitary education
given
B + Clean post natal ward/room with facility for
warming food and milk
B + C + Madilu kit given ensuring 48 hrs stay. Education on immunization
and nutrition
B + C + D + food given to mother and
1 attendant
QA.4 child care No baby corner in labour room
Baby warmer with photo therapy
B + mucous suction apparatus used. Education on burping child
B + C + At birth dosage of BCG, OPV & Hep B
B + C + Clinical Child assessment
Score Obtained (max-16) =
Immunisation10
Q. No.
Sub-elements
Instructions: On day of visit ask MO I/C and/or other staff and fill the
following questions
Response
Score
(0)
Score
(1)
Score
(2)
Score
(3)
Score
(4)
A B C D E
QA.1 Place of immunisation No clear designated place in the PHC
Clear designated room but also used for other purposes
on non immunisation days
Room exclusively for immunisation
C + excellent IEC with display of
universal immunisation programme
D + IEC on nutrition,breast
feeding etc.,
QA.2 Cold chain maintenance T series vaccine found in deep
freezer
Used vials kept in ILR
No temp chart
Vaccines stored as separated boxes in provided baskets in ILR with T series at
the bottom.
Any other drugs other than vaccine
Temp chart updated till last week. No power cut details.
C + Thermometer is optimally
functioning
D + 1 foot space all around ILR and
deep freezer. Stabilizer is clearly visible in proximity. No more than 1mm
frosting
QA.3 Vaccine stock Some or all vaccines stock out
Expired vaccine stored
Partially used vaccine vials
present
Vaccines present but no
corresponding solvents
Vaccines and solvents available but solvents not
stored at ILR temp.
Vaccines and solvents available
and solvents stored at ILR temp.
11
Q. No.
Sub-elements
Instructions: On day of visit ask MO I/C and/or other staff and fill the
following questions
Response
Score
(0)
Score
(1)
Score
(2)
Score
(3)
Score
(4)
A B C D E
QA.4 Usage of AD syringe Not available Use disposable other than AD
syringe
Use AD syringe
QA.5 IEC of immunisation None displayed Randomly displayed
Displayed in waiting room
Displayed in waiting room as
well as immunisation room
D + education sessions on
immunisation conducted
Trickler bag/box maintained
QA.6 Immunisation day No fixed day Planned days only Fixed day of the week (Thursday)
C + Out reach immunisation done under supervision
QA.7 Vaccine distribution Not done Supplied to SCs day before
immunisation
Supplied to SC on the day of
immunisation in 4 pack vaccine carrier
Total Score (max-22)=
12
Wound Management
Q. No.
Sub-elements
Instructions: On day of visit ask MO I/C and/or other staff and fill the
following questions
Response
Score
(0)
Score
(1)
Score
(2)
Score
(3)
Score
(4)
A B C D E
QA.1 Availability of consumables for dressing
Only povidone I2 or tincture iodine
available
A + spirit available B + antiseptic solutions/ointments available with clean
neat dressing materials
C + POP powder available
D + antiseptic tunnules available
QA.2 Orthopaedic management None Only sprains managed
Closed reduction of limbs done with immobilisation
Post immobilisation POP application
done
QA.3 Burn/Scald injury management Only primary management
A + antiseptic tunnules
In patient management of
burn/scald injuries present
QA.4 Dog/animal bite Only Primary wound care
A + only TT given B + ARV given appropriately
C + education on post exposure profile access
D + high risk pre exposure
vaccination education given
QA.5 Snake bite Only primary wound care
A + TT given B + ASV C + in patient care
13
Q. No.
Sub-elements
Instructions: On day of visit ask MO I/C and/or other staff and fill the
following questions
Response
Score
(0)
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(1)
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(2)
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(3)
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(4)
A B C D E
QA.6 Bee and other Insect bites Only primary wound care
A + TT given B + outpatient line of medical care
given
C + in patient care
QA.7 Eye injuries Preliminary primary care done
A + sterile bandaging done
Foreign bodies from congenctival sack
removed under local anaesthesia
Score Obtained (max-23) =
In-patient Care
Q. No.
Sub-elements
Instructions: On day of visit ask MO I/C and/or other staff and fill the
following questions
Response
Score
(0)
Score
(1)
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(2)
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(3)
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(4)
A B C D E
QA.1 Bed occupancy during the assessment period
No occupancy in a month
No occupancy for any fortnight
Occupancy only for MCH care
C + MLC and RTA cases
D + chronic or acute medical and
surgical cases
14
Q. No.
Sub-elements
Instructions: On day of visit ask MO I/C and/or other staff and fill the
following questions
Response
Score
(0)
Score
(1)
Score
(2)
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(3)
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(4)
A B C D E
QA.2 Life saving emergency drugs No IV fluids available
Only IV fluids available
B + IV broncho dialators and
oxygen available and used
C + Local anaesthetics
available and used
D + Respiratory stimulants available
QA.3 Diet No diet given Only two times meal given
Breakfast and two meals given
C + Provision for warming food
QA.4 Availability of health care providers
Only Gp D on duty in the night
A + Staff nurse residing in campus
A + Staff nurse on duty
C + Doctor giving services on call in
night also
C + Doctor residing in campus and
giving services in night also
QA.5 Hygiene No water supply Limited period water supply
Round the clock water supply
B/C + hotwater supplied
QA.6 Linen No linen or unclean, torn/damaged
bedsheets/blankets/ screens/curtains
Bed sheets, blankets, screens
and curtains undamaged but
unclean
Bed sheets and blankets, clean and
undamaged, but screens and curtains
unclean
Bed sheets, blankets, screens and curtains clean and undamaged
D + In-patient clothing given to
patients
Score obtained (max-22) =
15
PREVENTIVE CARE (Communicable diseases)
Q. No.
Sub-elements
Instructions: On day of visit ask MO I/C and/or other staff and fill the
following questions
Response
Score
(0)
Score
(1)
Score
(2)
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(3)
Score
(4)
A B C D E
QA.1 Diligent monitoring Provisional diagnosis not
recorded in the OPD register (Only
Symptoms recorded)
Provisional diagnosis recorded with treatment, but
no record of address & no daily
abstract
Provisional diagnosis, treatment and address clearly
recorded, but no daily abstract put.
Provisional diagnosis, treatment and address clearly recorded, and daily
abstract put
IEC activities of possible public
health challenge of that period planned
and done
QA.2 Diligent preventive health care activity
Staff nurse/pharmacist/ HQ JHAF only
records the noticed trend but no
communication given to concerned
people
Directions on preventive health
care given to health education staff
The MO and Senior health assistants are
well aware of the situation and action
taken
Junior Health Assistants
implement the health care activity after the report of
outbreak
Junior Health Assistants
implement the preventive health
care activity in time before the outbreak
QA.3 Malaria - Filaria - NVBDCP No passive smears collected only active smears
collected and sent for examination
Active & Passive smears collected but smears are stained after >5 days of date of
collection
B but smears stained before 5 days of date of
collection
C+ smears examined after 7 days of date of
collection
C + smears examined within 7
days of date of collection
16
Q. No.
Sub-elements
Instructions: On day of visit ask MO I/C and/or other staff and fill the
following questions
Response
Score
(0)
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(1)
Score
(2)
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(3)
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(4)
A B C D E
QA.4 Malaria - Filaria - NVBDCP contd.. DDCs established DDCs & Fever treatment depots
established
Malaria clinics conducted
Regular planned spraying conducted
QA.5 Radical Treatment for malaria RT initiated after 10 days of
confirmation
RT initiated between 8-10 days
of confirmation
RT initiated between 5-7 days of
confirmation
RT initiated between 3-5 days of
confirmation
RT initiated between within 3
days of confirmation
QA.6 RNTCP (Tuberculosis) No sputums collected. Chest symptomatic are
referred to another institutions
Sputums from chest symptomatic
collected and sent for examination on
the same day of collection
Sputum smears are prepared (good
quality) and sent for examination
Sputum smears are prepared, stained and examined on
the same day
D+ categorisation done and treatment
initiated.
QA.7 DOTS None Cat-1 DOTS only given
Cat-1 & 2 DOTS given
C + Cards not updated
C + cards properly updated
QA.8 Leprosy None IEC on leprosy done, but no cases
identified
IEC done but only PB cases detected
and treatment initiated
C+ MB cases also detected and
treatment initiated
D + cards updated
Score obtained (max-32) =
17
PREVENTIVE CARE (Non Communicable diseases)
Q. No.
Sub-elements
Instructions: On day of visit ASK MO I/C and/or other staff and fill the
following questions
Response
Score
(0)
Score
(1)
Score
(2)
Score
(3)
Score
(4)
A B C D E
QA.1 Blindness control No examinations of the eye done
Screening for cataract done only
in PHC on designated dates by
optometrist (PMOA)
B + Screening for cataract done by MO on all days
C + school health screening also done
D + screening done on planned days of
camps
QA.2 Anaemia Only Assessment of anaemia done
Only IFA tabs distributed
B + IEC displayed in PHC
C + IEC on local nutrition done. Hb % done (Sahli’s
method)
D + follow up of anaemia done and
recorded
QA.3 School Health Checkup No clear plan Plan clear but not followed
Plan clear and followed. Reporting
delayed
Timely reporting Followup of referred students
done
QA.4 Anganwadi Health Checkup No clear plan Plan clear but not followed
Plan clear and followed but not
covering all anganwadis during
each quarter
Plan clear and followed covering
all anganwadis during each quarter
C + adequate stock of ORS and
optimally utilised
Score Obtained (max-16) =
18
FAMILY WELFARE PROGRAMME
Q. No.
Sub-elements
Instructions: On day of visit ask MO I/C and/or other staff and fill the
following questions
Response
Score
(0)
Score
(1)
Score
(2)
Score
(3)
Score
(4)
A B C D E
Temporary Methods
QA.1 Contraceptive Condoms No IEC on CC nor free CC dispensing
box
Box of CC present but empty. Few
posters of IEC on CC in non
conspicuous places
B + CC present in the box and IEC on
CC in clearly visible places
C + adequate stock stocked in the PHC
D + regular issual and recording of issual of CC to
health assistants. IEC on CC
exhibited on shandy days in shandy
QA.2 Oral Contraceptive Pills No IEC on OCP. No stock of OCP or
no distribution in the past month
IEC on OCP present in non-
conspicuous places. OCP dispensed to
health assistants but not dispensed in
PHC.
IEC on OCP in clearly visible places. OCP
dispensed during OPD regularly.
Relevant records maintained
C + Awareness on OCP given during
mahila arogya sangha meetings
D + IEC on OCP exhibited on shandy
days in shandy.
QA.3 Emergency Contraceptive Pills No IEC on ECP. No stock
IEC on ECP present in non-conspicuous
places. ECP dispensed to health assistants but not
dispensed in PHC.
IEC on ECP in clearly visible places. ECP
dispensed during OPD. Relevant
records not maintained
IEC on ECP in clearly visible places. ECP
dispensed during OPD. Relevant
records maintained
D + appropriate counselling given
19
Q. No.
Sub-elements
Instructions: On day of visit ask MO I/C and/or other staff and fill the
following questions
Response
Score
(0)
Score
(1)
Score
(2)
Score
(3)
Score
(4)
A B C D E
QA.4 Intra uterine contraceptive device No IEC on ECP. No stock
IEC on IUD present in non-conspicuous
places. IUD inserted only on designated days.
IEC on IUD in clearly visible places. IUD
insertions done as when required by the beneficiary.
Relevant records maintained
C + awareness and counselling done before and after insertion of IUD
D + awareness given on adverse
effects if occurs and also on where to
seek help
Permanent methods
QA.5 Mini-Lap tubectomy No IEC on Tubectomy.
IEC on tubectomy present in non-
conspicuous places. Tubectomy not
conducted
IEC on tubectomy in clearly visible
places. Tubectomy conducted. Relevant records maintained
C + arrangement for food done for
beneficiary and attendant.
D + incentives given during discharge.
QA.6 Laproscopic tubectomy No IEC on Tubectomy.
IEC on tubectomy present in non-
conspicuous places. Tubectomy not
conducted
IEC on tubectomy in clearly visible
places. Tubectomy conducted. Relevant records maintained
C + arrangement for food done for
beneficiary and attendant.
D + incentives given during discharge.
QA.7 No Scalpel Vasectomy No IEC on NSV. IEC on NSV present in non-
conspicuous places. NSV not conducted
IEC on NSV in clearly visible places. NSV
conducted. Relevant records maintained
C + awareness given to spread
message of NSV in community
D + incentives given immediately
after procedure
20
Q. No.
Sub-elements
Instructions: On day of visit ask MO I/C and/or other staff and fill the
following questions
Response
Score
(0)
Score
(1)
Score
(2)
Score
(3)
Score
(4)
A B C D E
QA.8 Achievements Only Laproscopic tubectomy services
given.
Laproscopic and Mini-lap tubectomy
services given
C + NSV services given
D + regular followup of
sterilisation cases done
QA.9 PC & PNDT No IEC IEC present in non-conspicuous places.
IEC in clearly visible places
Awareness and counselling on female child
importance in public
gathering/meetings
Score Obtained (max-35) =
OTHER SERVICES
Q. No.
Sub-elements
Instructions: On day of visit ask MO I/C and/or other staff and fill
the following questions
Response
Score
(0)
Score
(1)
Score
(2)
Score
(3)
Score
(4)
A B C D E
QA.1 Laboratory services Only blood smear examination for
malarial parasite done
A + urine for sugar & albumin done
B + blood grouping by Sahli’s method +
BT, CT
C + sputum smears examined
D + Pregnancy test done
21
Q. No.
Sub-elements
Instructions: On day of visit ask MO I/C and/or other staff and fill
the following questions
Response
Score
(0)
Score
(1)
Score
(2)
Score
(3)
Score
(4)
A B C D E
QA.2 Medico Legal Cases None attended to. Only referred
Attended to. Documentation not
clear
Attended to. Documentation
clear
C + needed cases reported to legal authorities after a
week
C + needed cases reported to legal
authorities within a week
QA.3 Post mortem No post mortems done PMs done but no PM register
PMs done. PM register present. Documentation
delay
PMs done, PM register update. But
PM reports submission to legal authorities delayed
PMs done. PM Register update.
Reports submitted promptly.
QA.4 Medical examination for insurances
Not done or no records Done + Proper documentation
QA.5 Medical Termination of Pregnancies
Reported to have done but no records
maintained
Done. Documentation
improper
Done. Proper Documentation
D + in patient care given
QA.6 Arogya Raksha Samithi / RKS ARS non functional ARS meeting very rarely
ARS meeting only once a quarter
ARS meeting alternate months
ARS meeting every month
Score Obtained (max-22) =
22
SUMMARY OBSERVATION SHEET
Sl No. Component Observations Directions for improvement
1 Infrastructure Management
2 OPD Management
3 Maternal Care
4 Immunisation
5 Wound Management
6 In-patient Management
7 Preventive Care (Communicable diseases)
8 Preventive Care (Non-Communicable diseases)
9 Other services
10 General Remarks
SUMMARY REPORT23
Infrastructure Management
OPD Management Maternal Care Immunisation Wound
managementIn-patient Service
Total Score applicable 74 38 16 22 23 22
Score obtained
Preventive Care
Communicable diseases
Preventive Care Non-
Communicable diseases
Family welfare Other Services Total
Service Quality Index (Score reduced to 10
pts total)(= 10x S / 300)
Total Score applicable 32 16 35 22 300 10
Score obtained
SQI Less than 4 4 to 4.9 5 to 6.9 7 to 8.9 9 to 10
Grading Needs Improvement Satisfactory Good Very Good Excellent
Grade E D C B A
Signature of Members of DQAG: 1. ……………………………………………………….. 2. …………………………………………………………………
3. ………………………………………………………… 4. …………………………………………………………………..
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