1.1.a 1.1.b 1.2.

a
Population Total OPD Services
covered (in Coverage
numbers) Area (Sq.
Kms.)

TOTAL TOTAL TOTAL - NO TOTAL -

YES

Maharashtr Maharashtr Chiplun Adare 41956 265 1

a a ->
Ratnagiri Dadar 23605 43 1
Furus 12350 50000 1
Kapare 16417 5 1
Kharavate 22121 70 1
Rampur 22142 0 1
Savarde 40120 50 1
Shirgaon 21911 5000 1
Vahal 18226 0 1
Dapoli Anjarla 13777 1
Asud 28879 1
Kelashi 15018 1
Phansu 19200 1
Pisai 20728 1
Sakhaloli 16197 1
Umbarle 25829 1
Dabhol 22700 1
Guhagar Abloli 22929 160 1
Chikhali 25911 2 1
Hedavi 25674 20 1
Kolavali 20110 300 1
Talavali 20205 153 1
Khed Ambavali 22296 175 1
Furus 22523 42 1
Koregaon 19320 235 1
Lote 24460 90 1
Shiv Bk 41956 265 1
Tale 16923 1
Tisangi 41956 265 1
Wave 10150 1
Lanja Bhambed 15358 128 1
 Lanja
Jawade 14022 124 1
Ringane 14526 128 1
Satawali 17001 128 1
Shiposhi 10817 128 1
Wadilimbu 15450 128 1
Mandangad Devhare 15586 143 1
Kumble 16369 128 1
Panderi 19230 156 1
Rajapur Dhartale 24398 182 1
Jaitapur 18091 135 1
Jawalethar 10583 139 1

Karak 18280 121 1

Karawli
Kelwali 11802 140 1
Kumbhwad 15633 108 1
e
Oni 20433 140 1
Phufere 12699 139 1
Solgaon 20738 130 1
Ratnagiri Chanderai 36010 20 1
Hathkhamb 49185 13 1
a
Jakadevi 25865 35 1
Khanu 19581 15 1
Kotawade 32142 24 1
Malgund 21712 163 1
Pawas 33746 40 1
Watad 18386 63 1
MCLRR 76229 1
Ratnagiri
Devle 13269 900 1
Kadwai 15846 70 1
Kondumare 11734 16000 1

Makhajan 21933 70 1
Dhamapur 16540 65 1
Nive khurd 10698 536 1

Phungus 12645 15000 1

Sakharpa 13706 5280 1
Sayale 12555 25 1
Burambi 12542 1
Wandri 14538 146 1

1455467 98030 0 0 68
 1.2.b 1.2.c 1.2.d 1.2.e
Emergency services (24 Hours) Referral Services In-patient Services Emergency Obstetric Care including
surgical interventions like Caesarean
Sections and other medical
interventions

TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL -

YES YES YES

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

0 1 67 0 1 67 0 1 67 0
 1.2.e 1.3.a 1.3.b 1.4.a 1.4.b 1.5.a
Emergency Obstetric Care including Number of Bed Occupancy Rate in the last 12 months (1- less Males Females Is surgery for cataract done in the
surgical interventions like Caesarean beds than 40%; 2 - 40-60%; 3 - More than 60%) PHC?
Sections and other medical available
interventions

TOTAL - NO TOTAL - TOTAL TOTAL - 40 TOTAL - TOTAL - TOTAL TOTAL

YES - 60% less than More than
40% 60%

1 6 1 3 3
1 6 1 42 58
1 6 1 30 50
1 3 1 15 20
1 6 1 30 25
1 4 1 10253 11207
1 5 1 70 80
1 10 1 23 30
1 6 1 30 35
1 6 1 5 7
1 6 1 12 13
1 6 1 24 26
1 6 1 21 25
1 6 1 19 17
1 6 1 11 15
1 6 1 27 29
1 6 1 38 42
1 6 1 45 78
1 6 1 18 28
1 6 1 18 26
1 6 1 6 10
1 6 1 45 52
1 6 1 20 25
1 6 1 3 3
1 6 1 3 3
1 6 1 20 35
1 6 1 3 3
6 3 3
1 6 1 3 3
6 70 70
1 6 1 45 39
 1 6 1 22 15
1 6 1 60 30
1 6 1 35 32
1 6 1 40 42
1 6 1 40 33
1 6 1 13 20
1 6 1 27 31
1 3 1 6 7
1 6 1 24 32
1 6 1 22 26
1 6 1 13 19

1 2 1 9 13

1 6 1 8 12
1 6 1 18 23

1 6 1 25 30
1 6 1 6 8
1 6 1 11 15
1 6 1 12 18
1 7 30 35

1 6 1 50 70
1 6 2627 3999
8 30 70
1 6 1 15 23
1 6 1 40 50
1 15
1 4 1 7 10

1 6 1 10 18
1 6 1 30 50
1 6 1 15 25

1 6 1 20 30
1 6 1 25 30
1 1 1 20 15

1 6 1 40 20
1 6 1 42 68
1 10 1 8 10
1 1 20 30
1 6 1 35 40

51 14 402 0 27 26 9 14410 17059 0

 1.5.a 1.5.b 1.5.c 1.5.d
Is surgery for cataract done in the Is the primary management of wounds Is the primary management of fracture Are minor surgeries like draining of
PHC? done at the PHC? done at the PHC? abscess etc done at the PHC?

TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO

YES YES YES

1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1 1

1 1 1 1
1 1 1

1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1

1 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1 1

1 1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1 1

65 3 0 3 65 0 17 51 0 18
 1.5.d 1.5.e 1.5.f 1.6.1.a
urgeries like draining of Is the primary management of cases of Is the primary management of burns Ante-natal care
done at the PHC? poisoning / snake, insect or scorpion done at PHC?
bite done at the PHC?

TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL -

YES YES YES YES

1 1 1 1
1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
 1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1

1 1 1

1 1 1
1 1 1 1

1 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1 1

1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1

1 1 1
1 1 1 1
1 1 1 1

1 1 1 1
1 1 1 1
1 1 1 1

1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1

50 0 1 67 0 5 62 0 0 68
 1.6.1.b 1.6.1.c 1.6.1.d 1.6.1.e
Intranatal care (24 - hour delivery Post-natal care New born Care Child care including immunization
services both normal and assisted)

TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL -

YES YES YES

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

0 2 66 0 2 66 0 3 65 0
 1.6.1.e 1.6.1.f 1.6.1.g 1.6.1.h
Child care including immunization Family Planning MTP Management of RTI / STI

TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO

YES YES YES

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1

0 68 0 14 54 0 51 17 0 2
 1.6.1.h 1.6.1.i 1.6.2.a 1.6.2.b
nt of RTI / STI Facilities under Janani Suraksha Are antenatal clinics organized by the Is the facility for normal delivery
Yojana PHC regularly? available in the PHC for 24 hours?

TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL -

YES YES YES YES

1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
 1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1

1 1 1 1

1 1 1 1
1 1 1 1

1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1

1 1 1 1
1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1

1 1 1 1
1 1 1 1
1 1 1 1

1 1 1 1
1 1 1 1
1 1 1 1

1 1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1 1

65 0 0 68 0 1 67 0 3 65
 1.6.2.c 1.6.2.d 1.6.2.e 1.6.2.f
Is the facility for tubectomy and Is the facility for internal examination Is the treatment for gynecological If women do not usually go to the PHC
vasectomy available at the PHC? for gynaecological conditions available disorders like leucorrhoea, menstrual then what is the reason behind it?
at the PHC? disorders available at the PHC?

TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL -

YES YES YES

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

0 37 31 0 18 50 0 17 51 0
 1.6.2.f 1.6.2.g 1.6.2.h 1.6.2.i
If women do not usually go to the PHC, Is the facility for MTP (abortion) Is there any precondition for doing Do women have to pay for MTP?
then what is the reason behind it? available at the PHC? MTP such as enforced use of
contraceptives after MTP or asking for
husband's consent for MTP?

TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO

YES YES YES

1 1 1 1
1 1 1
1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
 1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1

1 1 1 1

1 1 1 1
1 1 1 1

1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1

1 1 1
1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1 1

1 1 1 1
1 1 1 1
1 1 1 1

1 1 1 1
1 1 1 1
1 1 1 1

1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1

40 23 0 55 12 0 51 15 0 64
 1.6.2.i 1.6.2.j 1.6.2.k 1.6.2.l
have to pay for MTP? Is treatment for anemia given to both Are the low birth weight babies Is there a fixed immunization day?
pregnant as well as non-pregnant managed at the PHC?
women?

TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL -

YES YES YES YES

1 1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1 1

3 0 2 66 0 30 38 0 1 67
 1.6.2.m 1.6.2.n 1.6.2.o 1.7.a
Is BCG and Measles vaccine given Is the treatment of children with Is the management of children Nutrition services
regularly in the PHC? pneumonia available at the PHC? suffering from diarrhea with severe
dehydration done at the PHC?

TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL -

YES YES YES

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

0 12 56 0 18 50 0 13 55 0
 1.7.a 1.7.b 1.7.c 1.7.d
Nutrition services School Health programmes Promotion of safe water supply and Prevention and control of locally
basic sanitation endemic diseases

TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO

YES YES YES

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

10 58 0 25 43 0 1 66 0 1
 1.7.d 1.7.e
and control of locally Disease surveillance and control of
eases epidemics
TOTAL - TOTAL - NO TOTAL -
YES YES
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1.7.f 1.7.g
Collection and reporting of vital Education about health / behaviour
statistics change communication
TOTAL - NO TOTAL - TOTAL - NO TOTAL -
YES YES
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
 1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1

1 1 1 1

1 1 1 1
1 1 1 1

1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1

1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1

1 1 1 1
1 1 1 1
1 1 1 1

1 1 1 1
1 1 1 1
1 1 1 1

1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1

67 0 0 68 0 0 68 0 0 68
 1.7.h 1.7.i 1.7.j 1.8.a
National Health Programmes including AYUSH services as per local Rehabilitation services Monitoring and supervision of activities
HIV/AIDS control programes preference of sub-centres through regular
meetings / periodic visits, etc.

TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL -

YES YES YES

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

0 1 67 0 56 12 0 35 33 0
 1.8.a 1.8.b 1.8.c 1.8.d
Monitoring and supervision of activities Monitoring of National Health Monitoring activities of ASHAs Visits of Medical Officer to all sub-
of sub-centres through regular Programmes centres at least once in a month
meetings / periodic visits, etc.

TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO

YES YES YES

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

0 67 0 0 67 0 0 67 0 0
 1.8.d 1.8.e 2.1 2.2 2.3
dical Officer to all sub- Visits of Health Assistants (Male) and Medical Officer Pharmacist Nurse - Midwife (Staff
east once in a month LHV to sub-centres once a week Nurse)

TOTAL - TOTAL - NO TOTAL - InPostion Sanctioned InPostion Sanctioned InPostion Sanctioned

YES YES

1 1 2 2 1 1 1 1
1 1 2 2 1 1 0 0
1 1 1 2 0 1 0 1
1 1 1 2 1 1 0 0
1 1 2 2 1 1 0 0
1 1 2 2 1 1 0 0
1 1 1 31 1 1 1 1
1 1 2 2 1 1 1 1
1 1 1 2 1 1 1 1
1 1 2 2 1 1 0 0
1 1 2 2 0 1 0 0
1 1 2 2 1 1 0 0
1 1 1 2 0 1 0 0
1 1 1 2 1 1 0 0
1 1 1 2 1 1 0 0
1 1 2 2 1 1 0 0
1 1 2 2 0 1 0 0
1 1 2
1 1 1 1 1 1 0 0
1 1 1 2 0 1 0 1
1 1 1 2 1 1 0 1
1 1 1 2 0 1 0 3
1 1 2 2 1 1 1 1
1 1 1 2 1 1 1 1
1 1 1 2 0 1 0 0
1 1 1 2 0 1 0 0
1 1 2 2 1 1 1 1
1 1 2 2 1 1 0 0
1 1 2 2 1 1 1 1
1 1 2 2 1 1 0 0
1 1 1 2 1 1 0 0
 1 1 1 2 1 1 0 0
1 1 1 2 0 1 0 0
1 1 1 2 0 1 0 0
1 1 1 2 0 1 0 0
1 1 1 2 1 1 0 0
1 1 2 2 1 1 0 0
1 1 2 2 1 1 0 0
1 1 2 2 1 1 0 0
1 1 1 2 0 1 0 0
1 1 1 2 0 1 0 0
1 1 1 2 1 1 0 0

1 1 1 2 1 1 0 0

1 1 1 2 1 1 0 0
1 1 1 2 0 1 0 0

1 1 1 2 1 1 0 0
1 1 1 2 0 1 0 0
1 1 0 2 1 1 0 0
1 1 2 2 1 1 0 0
1 1 2 0 1 0 0

1 1 2 2 0 1 2 2
1 1 2 2 1 1 0 0
1 1 2 2 1 1
1 1 2 2 1 1 0 0
1 1 0 1 1 1 2 2
1 1 2 2 1 1 0 0
1 4 2 2 5 6

1 1 1 1 0 1 1 1
1 1 2 2 1 1 0 1
1 1 1 2 1 1 0 1

1 1 2 2 1 1 0 1
1 1 1 2 1 1 0 0
1 1 0 1 1 1 0 0

1 1 1 2 1 1 0 0
1 1 1 1 0 1 1 1
1 1 1 2 1 1 0 0
1 1 1 2 0 1 1 1
1 1 1 1 0 1 1 1

66 0 0 67 90 161 47 68 21 31
 2.4 2.5 2.6 2.7 2.8
Health Worker (Female) Health Educator Health Assistant Clerks Laboratory Technician

InPostion Sanctioned InPostion Sanctioned InPostion Sanctioned InPostion Sanctioned InPostion Sanctioned

1 1 0 0 3 3 1 1 0 1
7 8 0 0 2 2 1 1 1 1
5 6 3 5 2 2 0 1 0 1
5 7 0 0 2 2 1 1 0 0
1 1 0 0 2 2 1 1 0 1
7 7 0 0 2 2 0 0 1 1
1 1 2 2 0 1 1 1 0 1
1 1 0 0 2 2 1 1 0 1
1 1 1 1 2 2 1 1 0 1
1 1 0 0 2 2 1 1 1 1
1 1 0 0 2 2 1 1 1 1
0 1 0 0 2 2 1 1 0 1
1 1 0 0 2 2 0 1 0 1
1 1 0 0 2 2 1 1 1 1
1 1 0 0 2 2 1 1 0 1
1 1 0 0 2 2 1 1 0 1
1 1 0 0 2 2 1 1 0 1

1 1 0 0 2 2 1 1 0 1
0 1 0 0 2 2 0 1 0 1
0 1 0 0 2 2 1 1 0 0
0 0 2 1 1 1 1 1 1
1 1 0 0 3 3 1 1 0 1
1 1 0 0 2 3 1 1 0 1
1 1 0 0 3 3 1 1 0 1
1 1 0 0 2 2 1 1 0 1
1 1 0 0 3 3 1 1 0 1
1 1 0 0 2 2 1 1 0 1
1 1 0 0 3 3 1 1 0 1
1 1 0 0 2 2 1 1 0 1
0 1 0 0 2 2 1 1 1 1
 1 1 0 0 2 2 1 1 1 1
0 1 0 0 2 2 1 1 0 1
1 1 0 0 2 2 1 1 0 1
1 1 0 0 2 2 1 1 0 1
1 1 0 0 2 2 1 1 0 1
0 1 0 0 1 2 1 1 1 1
1 1 0 0 2 2 1 1 0 1
0 1 0 0 2 2 1 1 0 1
1 1 0 0 3 3 1 1 0 1
1 1 0 0 3 3 1 1 1 1
1 1 0 0 2 3 1 1 0 1

0 1 0 0 3 3 1 1 0 1

1 1 0 0 3 3 1 1 0 1
1 1 0 0 3 3 1 1 0 1

1 1 0 0 3 3 1 1 0 1
0 1 0 0 2 3 1 1 0 1
1 1 0 0 2 3 1 1 0 1
1 1 0 0 2 2 1 1 0 0
1 1 0 1 2 2 1 1 1 1

1 1 0 0 2 2 1 1 0 1
1 1 0 0 2 2 1 1 0 1
6 6 3 3 1 1 1 1
1 1 0 0 2 2 1 1 1 0
7 7 2 2 1 1 0 1
1 1 0 0 2 2 1 1 0 1
7 7 0 0 0 0 2 2 2 2

4 4 0 0 3 3 1 1 0 0
1 1 0 1 2 2 1 1 0 1
1 1 0 0 1 2 1 1 0 1

1 1 0 0 2 2 1 1 0 1
1 1 0 0 2 2 1 1 0 1
1 1 1 0 3 3 1 1 0 0

1 1 0 0 2 2 1 1 1 1
1 1 1 1 1 1 1 1 0 1
1 1 0 0 1 2 1 1 0 0
1 1 0 0 2 2 1 1
6 6 0 0 2 2 1 1 1 1

102 115 8 13 139 147 64 67 17 60

 2.9 2.10 2.11 2.12 4.1
Driver Class IV Ayush Practitioner Account Manager Routine urine, stool and blood tests

InPostion Sanctioned InPostion Sanctioned InPostion Sanctioned InPostion Sanctioned TOTAL - NO

1 1 5 5 0 0 0 0 1
1 1 3 4 0 0 0 0 1
1 1 3 4 0 0 0 0 1
1 1 2 5 0 0 0 0 1
1 1 4 4 0 0 0 0 1
1 1 4 4 0 0 0 0
1 1 4 4 0 0 0 1 1
1 1 4 4 0 0 0 0
1 1 4 4 0 0 0 1 1
1 1 3 4 0 0 0 0
1 1 3 4 0 0 0 0
1 1 3 4 0 0 0 0
1 1 3 4 0 0 0 0
1 1 3 4 0 0 0 0
1 1 3 4 0 0 0 0
1 1 4 4 0 0 0 0
1 1 1 4 0 0 0 0

0 1 2 5 0 0 0 0 1
0 1 2 4 0 0 0 1 1
1 1 2 5
1 1 2 3
1 1 5 5 0 0 0 0 1
1 1 3 5 0 0 0 0 1
1 1 5 5 0 0 0 0 1
0 1 4 4
1 1 5 5 0 0 0 0 1
1 1 1 4 0 0 0 0 1
1 1 5 5 0 0 0 0 1
1 1 3 3 0 0 0 0 1
1 1 2 4 0 0 0 0 1
 1 1 3 5 0 0 0 0 1
1 1 3 5 0 0 0 0 1
1 1 3 5 0 0 0 0 1
1 1 3 5 0 0 0 0 1
1 1 3 5 0 0 0 0 1
1 1 4 4 0 0 0 0 1
1 1 3 4 0 0 0 0 1
1 1 3 4 0 0 0 0 1
1 1 1 5 0 0 0 0
1 1 2 5 0 0 0 0
1 1 1 5 0 0 0 0 1

1 1 3 5 0 0 0 0 1

1 1 1 5 0 0 0 0
1 1 2 5 0 0 0 0 1

1 1 2 5 0 0 0 0
1 1 3 5 0 0 0 0
1 1 2 5 0 0 0 0 1
0 1 4 4 0 0 0 0 1
1 1 5 5 0 0 0 0

0 1 5 5 0 0 0 0
1 1 5 5 0 0 0 0 1
1 1 5 5 1 1 1 1
1 1 3 4 0 0 0 0
1 1 4 5
1 1 4 4 0 0 1 1 1
0 0 1 2 0 0 0 0 1

0 0 4 4 0 0 0 0
1 1 2 4 0 0 0 0 1
0 1 3 5 0 0 0 0

1 1 2 4 0 0 0 0
1 1 4 4 0 0 0 0 1
0 0 2 5 0 0 0 0

1 1 4 4 0 0 0 0 1
0 1 2 4 0 0 0 0
1 1 2 5 0 0 0 0 1
1 1 3 4 0 0 0 0
1 1 3 4 0 0 0 0

57 64 206 295 1 1 2 5 0 37
 4.1 4.2 4.3 4.4
ne, stool and blood tests Blood grouping Bleeding time, clotting time Diagnosis of RTI/STDs with wet
mounting, grams stain, etc.

TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL -

YES YES YES YES

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1 1
1 1 1 1
1 1 1

1 1 1

1 1 1 1
1 1 1

1 1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1 1

1 1 1 1
1 1 1
1 1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1

1 1 1 1
1 1 1
1 1 1 1

1 1 1 1
1 1 1
1 1 1 1

1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1 1

31 0 47 21 0 28 40 0 49 17
 4.5 4.6 4.7 4.8
Sputum testing for TB Blood smear examination for malaria Rapid tests for pregnancy RPR test for Syphills / YAWS
parasite surveillance

TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL -

YES YES YES

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

0 46 22 0 38 30 0 7 61 0
 4.8 4.9 5.1.a 5.1.b
RPR test for Syphills / YAWS Rapid Tests for HIV Is a designated government building If there is no designated government
surveillance available for the PHC? (Yes / No) building, then where is PHC located

TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL -

YES YES YES Other Rent
Free
Building
(Panchayat
Voluntary
Organizatio
n Building)

1 1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1
 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1 1
1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1 1
1 1 1 1

1 1 1
1 1 1
1 1 1 1

1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1

59 8 0 19 49 0 4 64 0 16
 5.1.b 5.1.c 5.1.e 5.1.f
o designated government Area of the Compound Wall / Fencing (1-All around; 2-Partial; 3- Condition of plaster on walls (1- Well plastered with
en where is PHC located building None) plaster intact every where; 2- Plaster coming off in
(Total area some places; 3- Plaster coming off in many places
in Sq. mts.) or no plaster)

TOTAL - TOTAL TOTAL - All TOTAL - TOTAL - TOTAL - TOTAL - TOTAL -

Rented Around None Partial Plaster Plaster Well
premises coming off coming off plastered
in many in some with plaster
places or no places intact every
plaster where

0 1 1
0 1 1
3000 1 1
1 5 1 1
1 1
1 216 1 1
1 1
1 1
900 1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1500 1 1
1 1
200 1 1
1 1
1 1
616 1 1
0 1 1
0 1 1
1 1600 1 1
0 1 1
0 1
0 1 1
0
89 1 1
 89 1 1
89 1 1
89 1 1
89 1 1
89 1 1
3541 1 1
9004 1 1
1
3000 1 1
1400 1 1
2500 1 1

1 1400 1

3000 1 1
3000 1 1

3000 1 1
2000 1 1
2000 1 1
4400 1 1
1 1

1 1
1 1
160 1 1
1 525 1 1
1 1
1 1
37 1 1

40 1 1
7000 1 1
16000 1 1

1 1
1000 1 1
0 1 1

1 1
5280 1 1
1 1
1 1
1200 1 1

7 78058 0 51 6 8 0 12 11 42
 5.1.g 5.1.h.i 5.1.h.ii
Condition of floor (1- Floor in good condition; 2- OPD Rooms
Floor coming off in some places; 3- Floor coming off
in many places or no proper flooring)

TOTAL - TOTAL - TOTAL - TOTAL - TOTAL - TOTAL - TOTAL -

Floor Floor Floor in Fair Good Poor Fair
coming off coming off good
in many in some condition
places or no places
proper
flooring

1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1
1 1
1
1 1
 1 1
1 1
1 1
1 1
1 1
1 1
1 1
1
1 1
1 1
1 1

1 1 1

1 1 1
1 1

1 1
1 1 1
1 1
1 1 1
1 1

1 1 1
1 1
1 1
1 1
1 1 1
1 1
1 1

1 1
1 1
1 1

1 1
1 1
1 1

1 1
1 1
1 1
1 1 1
1 1

0 2 15 48 0 6 62 0 0 7
5.1.h.ii 5.1.h.iii 5.1.h.iv
Wards Toilets

TOTAL - TOTAL - TOTAL - TOTAL - TOTAL - TOTAL - TOTAL - TOTAL -

Good Poor Fair Good Poor Fair Good Poor

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1

1 1
1 1 1

1 1 1
1 1
1 1 1
1 1
1 1 1

1 1
1 1 1
1 1 1
1 1 1
1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1
1 1 1

60 1 0 8 59 1 0 13 54 1
 5.1.h.v 5.1.I.i 5.1.I.ii
Premises (compound) Garbage dump Cattle shed

TOTAL - TOTAL - TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL -

Fair Good Poor YES YES

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

0 15 51 2 0 46 21 0 57 11
 5.1.I.iii 5.1.I.iv 5.1.j 5.2.a
Stagnant pool Pollution from industry Is boundary wall with gate existing? Whether located at an easily
(Yes / No) accessible area? (Yes/No)

TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL -

YES YES YES

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1
1 1 1

0 56 11 0 58 10 0 18 50 0
 5.2.a 5.2.b 5.2.c 5.2.d 5.2.e 5.3 5.4
Whether located at an easily Distance of Travel time Distance of Distance of Prominent display boards regarding Registration counters (Yes/No)
accessible area? (Yes/No) PHC (in (in minutes) PHC (in PHC (in service availability in local language
Kms.) from to reach the Kms.) from Kms.) from (Yes/No)
the farthest PHC from the CHC District
village in farthest Hospital
coverage village in
area coverage
area

TOTAL - NO TOTAL - TOTAL TOTAL TOTAL TOTAL TOTAL - NO TOTAL -

YES YES

1 265 90 120 120 1

1 25 12 24 124 1
1 40 1 30 116 1
1 50 60 35 130 1
1 4 20 25 125 1
1 20 0 25 100 1
1 15 60 10 76 1
1 10 10 20 126 1
1 20 45 30 90 1
1 15 45 24 184 1
1 28 60 10 170 1
1 24 60 35 195 1
1 21 50 30 162 1
1 24 60 12 172 1
1 16 40 17 154 1
1 18 45 11 171 1
1 20 45 30 190 1
1 40 110 32 65 1
1 37 95 15 135 1
1 0 45 25 90 1
1 23 60 50 48 1
1 25 1 50 100 1
1 45 60 25 165 1
1 300 110 40 300 1
1 265 90 120 120 1
1 90 25 150 1
1 265 90 120 120 1
1 70 2 50 150 1
1 265 90 120 120 1
1 21 2 21 144 1
1 20 45 15 65 1
 1 45 60 12 57 1
1 30 90 30 75 1
1 20 45 12 65 1
1 30 90 27 51 1
1 30 90 22 30 1
1 30 90 15 237 1
1 30 90 12 210 1
1 47 120 45 210 1
1 15 30 22 42 1
1 27 70 35 60 1
1 31 50 20 110 1

1 37 60 7 95 1

1 32 70 26 126 1
1 30 90 40 115 1

1 18 30 13 62 1
1 30 60 22 105 1
1 35 70 18 60 1
1 26 24 0 22 1
1 23 60 15 1

1 25 60 33 1
1 20 120 5 30 1
1 20 45 17 17 1
1 163 45 35 35 1
1 25 75 20 20 1
1 15 40 45 45 1
1 0 30 1

1 20 1 16 45 1
1 60 90 30 70 1
1 18 30 12 60 1

1 60 90 30 90 1
1 34 45 11 50 1
1 15 60 10 45 1

1 15 1 15 45 1
1 16 1 16 50 1
1 20 1 10 55 1
1 5 8 50 1
1 146 20 20 30 1

4 64 3324 3546 1874 6694 0 1 67 0

 5.4 5.5.a 5.5.b 5.6
Registration counters (Yes/No) Pharmacy for drug dispensing and Counter near entrance of PHC to Separate public utilities for males and
drug storage (Yes/No) obtain contraceptives, ORS packets, females (Yes/No)
Vitamin A and Vaccination (Yes / No)

TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO

YES YES YES

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

2 66 0 1 67 0 3 65 0 4
 5.6 5.7
ublic utilities for males and Suggestion / complaint box (Yes/No)
es/No)
TOTAL - TOTAL - NO TOTAL -
YES YES
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
5.8 5.9
OPD rooms / cubicles (Yes/No) (Give Adequate no. of windows in the room
numbers) for light and air in each room (Yes/No)
TOTAL - NO TOTAL - TOTAL - NO TOTAL -
YES YES
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
 1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1 1
1 1 1 1

1 1 1 1

1 1 1 1
1 1 1 1

1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1

1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1 1

1 1 1 1
1 1 1 1
1 1 1 1

1 1 1 1
1 1 1 1
1 1 1

1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1

64 0 0 68 0 3 65 0 3 65
 5.10 5.11 5.12 5.13
Family Welfare Clinic Waiting room for patients Emergency Room / Casualty Separate wards for males and females

TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL -

YES YES YES

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
 1 1 1
1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

0 7 60 0 9 59 0 24 44 0
 5.13 5.14 5.15 5.16.a 5.16.b
Separate wards for males and females No. of No. of Operation Theatre available If operation theatre is present, are
beds : Male beds : surgeries carried out in the operation
Female theatre?

TOTAL - NO TOTAL - TOTAL TOTAL TOTAL - NO TOTAL - TOTAL - NO TOTAL -

YES YES YES

1 3 3 1 1
1 3 3 1 1
1 4 4 1 1
1 3 3 1
1 3 3 1 1
1 1 4 1 1
1 3 3 1
1 4 4 1 1
1 5 5 1
1 3 3 1
1 3 3 1
1 3 3 1
1 3 3 1 1
1 3 3 1 1
1 3 3 1
1 3 3 1
1 3 3 1
1 3 3 1 1
1 3 3 1 1
1 3 3 1 1
1 2 3 1 1
1 6 1 1
1 3 3 1 1
1 3 3 1 1
1 3 3 1 1
1 3 3 1 1
1 3 3 1 1
1
1 3 3 1 1
1 1 1
1 3 3 1 1
 1 3 3 1 1
1 3 3 1 1
1 3 3 1 1
1 3 3 1 1
1 3 3 1 1
1 3 3 1 1
1 2 4 1 1
1 2 1 1
1 3 3 1 1
1 3 3 1 1
1 3 3 1 1

1 1 1 1 1

1 3 3 1 1
1 3 3 1 1

1 3 3 1 1
1 3 3 1 1
1 3 3 1 1
1 3 3 1 1
1 2 5 1 1

1 3 3 1 1
1 2 4 1 1
1 3 5 1 1
1 3 3 1 1
1 2 4 1 1
1 4 4 1 1
1 0 0 1 1

1 3 3 1 1
1 3 3 1 1
1 3 3 1

1 4 4 1 1
1 3 3 1 1
1 1 1 1 1

1 3 3 1
1 2 4 1 1
1 4 6 1 1
1 2 2 1 1
1 3 3 1

12 56 185 209 0 12 55 0 26 28
 5.16.c.i 5.16.c.ii 5.16.c.iii 5.16.d
Non-availability of doctors /staff Lack of equipment / poor physical state No power supply in the operation Operation Theatre used for obstetric /
of the operation theatre theatre gynaecological purpose (Yes / No)

TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL -

YES YES YES

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
 1

1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1

0 37 14 0 36 17 0 34 18 0
 5.16.d 5.16.e 5.17.a 5.17.b
Operation Theatre used for obstetric / Has OT enough space Labour room available? If labour room is present, are deliveries
gynaecological purpose (Yes / No) carried out in the labour room?

TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO

YES YES YES

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1
1
1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1
 1
1
1
1
1
1
1 1
1
1 1 1
1 1 1
1 1 1

1 1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1

1 1 1
1 1 1
1 1 1
1 1 1
1
1 1 1
1 1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1 1

1 1 1
1 1 1
1 1 1
1 1 1 1
1

41 11 0 20 33 0 4 63 0 4
 5.17.b 5.17.c.i 5.17.c.ii 5.17.c.iii
m is present, are deliveries Non-availability of doctors / staff Poor condition of the labour room No power supply in the labour room
n the labour room?

TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL -

YES YES YES YES

1 1 1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1 1
1
1
1 1 1 1

1
1
1
1
1
1
1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1

1 1 1 1
1
1
 1
1
1
1
1
1
1

1 1 1 1
1 1 1 1
1 1 1 1

1 1 1

1 1 1 1
1 1 1 1

1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1

1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1
1 1 1

1 1 1 1
1 1 1 1
1 1 1 1

1 1 1 1
1 1 1 1
1 1 1

1 1 1 1
1 1 1 1
1 1 1 1
1 1 1
1

60 0 32 11 0 38 5 0 33 10
 5.17.d 5.18.a 5.18.b 5.18.c
Is separate areas for septic and Laboratory Are adequate equipment and Is laboratory maintained in orderly
aseptic deliveries available? chemicals available? (Yes/No) manner? (Yes / No)

TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL -

YES YES YES

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1
1 1
1 1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1
1 1
 1 1
1 1
1 1
1 1
1 1
1 1
1 1
1
1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1

1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1

0 25 19 0 32 33 0 40 26 0
 5.18.c 5.19 5.20.a 5.20.b
Is laboratory maintained in orderly Ancillary Rooms - Nurses rest room Source of water (1- Piped; 2- Bore well/ hand Whether overhead tank and pump
manner? (Yes / No) (Yes/No) pump / tube well; 3- Well; 4- Other (specify)) exist (Yes / No)

TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - TOTAL - TOTAL -

YES YES Bore Piped Well
well/hand
pump/tube
well

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1
1 1 1
1 1 1
1 1 1
 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1
1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1

1 1 1
1 1 1
1 1 1
1 1
1 1 1

44 22 0 45 18 0 17 25 26 0
 5.20.b 5.20.c 5.20.d 5.21.a
Whether overhead tank and pump If overhead tank exist, whether its If pump exist, whether it is in working Type of sewerage system ( 1- Soak pit;
exist (Yes / No) capacity sufficient? (Yes/No) condition? (Yes / No) 2- Connected to Municipal Sewerage)

TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL -

YES YES YES Connection
to Municipal
Sewerage

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1 1
 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1
1 1
1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1 1

1 1 1
1 1 1
1 1 1
1 1 1 1
1 1

8 60 0 7 60 0 8 59 0 6
 5.21.a 5.22.a 5.23.a 5.23.b
erage system ( 1- Soak pit; Is there a Proper mechansim for waste Is there electric line in all parts of the PHC? (1- In all Stand by facility (generator) available
ed to Municipal Sewerage) disposal? parts; 2- In some parts; 3- None) in working condition (Yes / No)

TOTAL - TOTAL - NO TOTAL - TOTAL - In TOTAL - In TOTAL - TOTAL - NO

Soak Pit YES all Parts some Parts None

1 1 1
1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1
1 1 1
1 1 1
1 1
1 1 1
1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1 1
1 1
 1 1 1
1 1 1 1
1 1 1
1 1 1
1 1
1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1
1 1
1 1 1 1
1 1 1
1 1 1
1 1

1 1 1 1
1 1 1
1 1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1
1 1 1

58 0 5 63 0 62 5 1 0 10
 5.23.b 5.24.a 5.24.b 5.25.a
cility (generator) available Laundry facility available(Yes/No) If no, is it outsourced? Telephone (Yes/No)
ondition (Yes / No)

TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL -

YES YES YES YES

1 1 1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1 1
 1 1 1 1
1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1 1
1 1 1 1

1 1 1 1

1 1 1
1 1 1 1

1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1

1 1 1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1 1
1 1 1 1

1 1 1
1 1 1 1
1 1 1

1 1 1 1
1 1 1 1
1 1 1

1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1

58 0 59 9 0 43 24 0 2 66
 5.25.b 5.25.c 5.25.d 5.25.e.i
Personal Computer (Yes/No) NIC Terminal (Yes/No) E.Mail (Yes / No) Rail (Yes / No)

TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL -

YES YES YES

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1

1 1 1
1 1 1
1 1
1 1 1
1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

0 4 64 0 45 19 0 2 66 0
 5.25.e.i 5.25.e.ii 5.26 5.27
Rail (Yes / No) All whether road (Yes / No) Vehicle (jeep/other vehicle) available? Office room (Yes/No)
(Yes / No)

TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO

YES YES YES

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1

1 1 1
1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

60 6 0 2 64 0 1 67 0 4
 5.27 5.28
(Yes/No) Store room (Yes/No)
TOTAL - TOTAL - NO TOTAL -
YES YES
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
5.29 5.30.a
Kitchen (Yes / No) Diet provided by hospital (Yes/No)
TOTAL - NO TOTAL - TOTAL - NO TOTAL -
YES YES
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
 1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1 1
1 1 1 1

1 1 1 1

1 1 1 1
1 1 1 1

1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1

1 1 1 1
1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1

1 1 1 1
1 1 1 1
1 1 1 1

1 1 1 1
1 1 1 1
1 1 1

1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1

64 0 3 65 0 41 27 0 23 45
 5.31.i 5.31.ii 5.31.iii 5.32.a
Medical Officer Pharmacist Nurses How is the behaviour of the PHC staff
patient

TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL -

YES YES YES

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

0 7 61 0 8 60 0 6 61 0
 5.32.a 5.32.b 5.32.c 5.32.d
How is the behaviour of the PHC staff with the Any fee for service is charged from the Is there corruption in terms of charging Is a receipt always given for the money
patient users? (Yes / No). If yes, specify. extra money for any of the service charged at the PHC? (Yes / No)
provided? (Yes / No)

TOTAL - TOTAL - TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL -

Casual/Indiff Courteous Insulting/der YES YES
erent ogatory

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1
1 1 1
1 1
1 1 1
 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

3 63 0 0 66 2 0 66 2 0
 5.32.d 5.32.e
Is a receipt always given for the money Is there any incidence of any sexual
charged at the PHC? (Yes / No) advances. oral or physical abuse,
sexual harassment by the doctors or
any other paramedical? (Yes / No)
5.32.f 5.32.g
Are woman patients interviewed in an Are examinations on woman patients
environment that ensures privacy and conducted in presence of a woman
dignity? (Yes / No) attendant, and procedures conducted
under conditions that ensure privacy?
(Yes / No)

TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO

YES YES YES

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

6 62 0 65 3 0 1 67 0 1
 5.32.g 5.32.h 5.32.i 5.32.j
ations on woman patients Do patients with chronic illnesses If the health centre is unequipped to Is there a publicly displayed
n presence of a woman receive adequate care and drugs for provide the services how and where mechanism, whereby a
nd procedures conducted the entire duration? (Yes / No) the patient is referred and how patients complaint/grievance can be
tions that ensure privacy? transported? registered? (Yes / No)

TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL -

YES YES YES YES

1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
 1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1

1 1 1 1

1 1 1 1
1 1 1 1

1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1

1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1

1 1 1 1
1 1 1 1
1 1 1 1

1 1 1 1
1 1 1 1
1 1 1 1

1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1

67 0 1 67 0 1 67 0 2 65
 5.32.k.a 5.32.k.b 5.32.k.c 5.32.k.d
Malaria Measles Gastroenteritis Jaundice

TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL -

YES YES YES

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

0 65 3 0 62 6 0 62 5 0
 5.32.k.d 5.32.l
Jaundice If yes, did the PHC staff responded Does the doctor do private practice
immediately to stop the further spread during or after the duty hours? (Yes/
of the epidment No)
TOTAL - NO TOTAL - TOTAL - NO TOTAL -
YES YES
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
5.32.m 5.32.n
Are there instances where patients
from particular social background
(dalits, minorities, villagers) have faced
derogatory or discriminatory behavior
or service of poorer quality?
TOTAL - NO TOTAL - TOTAL - NO
YES
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1
1
1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
 1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1

1 1 1 1

1 1 1 1
1 1 1 1

1 1 1 1
1 1 1
1 1 1 1
1 1 1 1
1 1 1

1
1 1 1 1
1 1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1 1

1 1 1 1
1 1 1 1
1 1 1 1

1 1 1 1
1 1 1 1
1 1 1 1

1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1

64 4 0 37 26 0 63 4 0 63
 5.32.n 5.32.o 9.1 9.2
stances where patients Have patients with specific health Citizen's charter (Yes/No) Constitution of Rogi Kalyan Samiti
lar social background problems (HIV/AIDS, leprosy) suffered (Yes/No) (give a list of office order
orities, villagers) have faced discrimination in any form? notifying the members)
or discriminatory behavior
f poorer quality?

TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL -

YES YES YES YES

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1
1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

3 0 61 6 0 8 56 0 0 67
 9.3 9.4 9.5 6
Internal monitoring (Social audit External monitoring /Gradation by PRI Availability of Standard Operating Are Equipment Available As per the pre
through Panchayati Raj Institution / (Zila Parishad)/ Rogi Kalyan Samitis Procedures (SOP) / Standard
Rogi Kalyan Samitis, medical audit, Treatment Protocols (STP)/ Guidelines
technical audit, economic audit,
disaster preparedness audit etc.
(Specify)

TOTAL - NO TOTAL - TOTAL - NO TOTAL - TOTAL - NO TOTAL -

YES YES YES

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

0 0 67 0 0 67 0 2 65 0
 6 7 8
Are Equipment Available As per the prescribed list? Are Drugs Available As per the prescribed list? Are Furniture Available As per the prescribed list?

TOTAL - TOTAL - Not TOTAL - TOTAL - TOTAL - Not TOTAL - TOTAL - TOTAL - Not
Available Available Partially Available Available Partially Available Available
Available Available

1 1 1
1 1 1
1 1 1
1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1 1
1 1 1
1 1 1
1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1
1 1 1
1 1 1
1 1
 1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1 1
1 1 1
1 1 1

1 1 1

1 1 1
1 1 1

1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

1 1 1
1 1
1 1 1
1 1
1 1
1 1 1
1 1

1 1
1 1 1
1 1

1 1 1
1 1
1 1

1 1 1
1 1 1
1 1
1 1
1 1 1

46 0 21 0 41 0 25 0 37 0
8 9 10 11
s per the prescribed list? Whether one month supply of essential drugs Whether one month supply of essential vaccines Whether one month supply of essentia
available? available? contraceptives available?

TOTAL - TOTAL - TOTAL - Not TOTAL - TOTAL - TOTAL - Not TOTAL -

Partially Available Available Partially Available Available Partially
Available Available Available

1 1
1 1
1 1
1 1 1
1 1
1 1
1 1

1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1
1 1
1 1
1 1 1
1 1
1 1
1 1
1 1
1 1
1 1 1
1 1
1 1
1 1 1
 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1
1 1
1 1

1 1

1 1
1 1

1 1
1 1
1 1
1 1
1 1

1 1
1 1 1
1 1
1 1 1
1 1 1
1 1
1 1 1

1 1 1
1 1
1 1

1 1
1 1 1
1 1 1

1 1
1 1
1 1 1
1 1 1
1 1

30 0 58 0 9 0 62 1 4 0
 11
Whether one month supply of essential
contraceptives available?

TOTAL - TOTAL - Not TOTAL -

Available Available Partially
Available

1
1
1
1
1
1
1

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
 1
1
1
1
1
1
1
1
1
1
1

1
1

1
1
1
1
1

1
1
1
1
1
1
1

1
1
1

1
1
1

1
1
1
1
1

61 0 6
 1 2
Population covered (in numbers) TOTAL
Total Coverage Area (Sq. Kms.) TOTAL
OPD Services TOTAL - NO
TOTAL - YES
Emergency services (24 Hours) TOTAL - NO
TOTAL - YES
Referral Services TOTAL - NO
TOTAL - YES
In-patient Services TOTAL - NO
TOTAL - YES
TOTAL - NO
TOTAL - YES
Number of beds available TOTAL
TOTAL - 40 - 60%
TOTAL - less than 40%
TOTAL - More than 60%
Males TOTAL
Females TOTAL
Is surgery for cataract done in the PHC? TOTAL - NO
TOTAL - YES
Is the primary management of wounds done at the PHC? TOTAL - NO
TOTAL - YES
Is the primary management of fracture done at the PHC? TOTAL - NO
TOTAL - YES
Are minor surgeries like draining of abscess etc done at the PHC? TOTAL - NO
TOTAL - YES
TOTAL - NO
TOTAL - YES
Is the primary management of burns done at PHC? TOTAL - NO
TOTAL - YES
Ante-natal care TOTAL - NO
TOTAL - YES
Intranatal care (24 - hour delivery services both normal and assisted) TOTAL - NO
TOTAL - YES
Post-natal care TOTAL - NO
TOTAL - YES
New born Care TOTAL - NO
TOTAL - YES
Child care including immunization TOTAL - NO
TOTAL - YES
Family Planning TOTAL - NO
TOTAL - YES
MTP TOTAL - NO
MTP
TOTAL - YES
Management of RTI / STI TOTAL - NO
TOTAL - YES
Facilities under Janani Suraksha Yojana TOTAL - NO
TOTAL - YES
Are antenatal clinics organized by the PHC regularly? TOTAL - NO
TOTAL - YES
Is the facility for normal delivery available in the PHC for 24 hours? TOTAL - NO
TOTAL - YES
Is the facility for tubectomy and vasectomy available at the PHC? TOTAL - NO
TOTAL - YES
TOTAL - NO
TOTAL - YES
TOTAL - NO
TOTAL - YES
If women do not usually go to the PHC, then what is the reason behind it? TOTAL - NO
TOTAL - YES
Is the facility for MTP (abortion) available at the PHC? TOTAL - NO
TOTAL - YES
TOTAL - NO
TOTAL - YES
Do women have to pay for MTP? TOTAL - NO
TOTAL - YES
Is treatment for anemia given to both pregnant as well as non-pregnant women? TOTAL - NO
TOTAL - YES
Are the low birth weight babies managed at the PHC? TOTAL - NO
TOTAL - YES
Is there a fixed immunization day? TOTAL - NO
TOTAL - YES
Is BCG and Measles vaccine given regularly in the PHC? TOTAL - NO
TOTAL - YES
Is the treatment of children with pneumonia available at the PHC? TOTAL - NO
TOTAL - YES
TOTAL - NO
TOTAL - YES
Nutrition services TOTAL - NO
TOTAL - YES
School Health programmes TOTAL - NO
TOTAL - YES
Promotion of safe water supply and basic sanitation TOTAL - NO
TOTAL - YES
Prevention and control of locally endemic diseases TOTAL - NO
TOTAL - YES
Disease surveillance and control of epidemics TOTAL - NO
TOTAL - YES
Collection and reporting of vital statistics TOTAL - NO
TOTAL - YES
Education about health / behaviour change communication TOTAL - NO
TOTAL - YES
National Health Programmes including HIV/AIDS control programes TOTAL - NO
TOTAL - YES
AYUSH services as per local preference TOTAL - NO
TOTAL - YES
Rehabilitation services TOTAL - NO
TOTAL - YES
TOTAL - NO
TOTAL - YES
Monitoring of National Health Programmes TOTAL - NO
TOTAL - YES
Monitoring activities of ASHAs TOTAL - NO
TOTAL - YES
Visits of Medical Officer to all sub-centres at least once in a month TOTAL - NO
TOTAL - YES
Visits of Health Assistants (Male) and LHV to sub-centres once a week TOTAL - NO
TOTAL - YES
Medical Officer InPostion
Sanctioned
Pharmacist InPostion
Sanctioned
Nurse - Midwife (Staff Nurse) InPostion
Sanctioned
Health Worker (Female) InPostion
Sanctioned
Health Educator InPostion
Sanctioned
Health Assistant InPostion
Sanctioned
Clerks InPostion
Sanctioned
Laboratory Technician InPostion
Sanctioned
Driver InPostion
Sanctioned
Class IV InPostion
Sanctioned
Ayush Practitioner InPostion
Sanctioned
Account Manager InPostion
Sanctioned
Routine urine, stool and blood tests TOTAL - NO
Routine urine, stool and blood tests
TOTAL - YES
Blood grouping TOTAL - NO
TOTAL - YES
Bleeding time, clotting time TOTAL - NO
TOTAL - YES
Diagnosis of RTI/STDs with wet mounting, grams stain, etc. TOTAL - NO
TOTAL - YES
Sputum testing for TB TOTAL - NO
TOTAL - YES
Blood smear examination for malaria parasite TOTAL - NO
TOTAL - YES
Rapid tests for pregnancy TOTAL - NO
TOTAL - YES
RPR test for Syphills / YAWS surveillance TOTAL - NO
TOTAL - YES
Rapid Tests for HIV TOTAL - NO
TOTAL - YES
Is a designated government building available for the PHC? (Yes / No) TOTAL - NO
TOTAL - YES
If there is no designated government building, then where is PHC located TOTAL - Other Rent Free
Building (Panchayat
Voluntary Organization
Building)

TOTAL - Rented premises

Area of the building (Total area in Sq. mts.) TOTAL

Compound Wall / Fencing (1-All around; 2-Partial; 3-None) TOTAL - All Around
TOTAL - None
TOTAL - Partial
TOTAL - Plaster coming off
in many places or no plaster

TOTAL - Plaster coming off

in some places
TOTAL - Well plastered with
plaster intact every where

TOTAL - Floor coming off in

many places or no proper
flooring
TOTAL - Floor coming off in
some places
TOTAL - Floor in good
condition
OPD TOTAL - Fair
TOTAL - Good
TOTAL - Poor
Rooms TOTAL - Fair
TOTAL - Good
TOTAL - Poor
Wards TOTAL - Fair
TOTAL - Good
TOTAL - Poor
Toilets TOTAL - Fair
TOTAL - Good
TOTAL - Poor
Premises (compound) TOTAL - Fair
TOTAL - Good
TOTAL - Poor
Garbage dump TOTAL - NO
TOTAL - YES
Cattle shed TOTAL - NO
TOTAL - YES
Stagnant pool TOTAL - NO
TOTAL - YES
Pollution from industry TOTAL - NO
TOTAL - YES
Is boundary wall with gate existing? (Yes / No) TOTAL - NO
TOTAL - YES
Whether located at an easily accessible area? (Yes/No) TOTAL - NO
TOTAL - YES
Distance of PHC (in Kms.) from the farthest village in coverage area TOTAL
Travel time (in minutes) to reach the PHC from farthest village in coverage area TOTAL

Distance of PHC (in Kms.) from the CHC TOTAL

Distance of PHC (in Kms.) from District Hospital TOTAL
Prominent display boards regarding service availability in local language (Yes/No) TOTAL - NO
TOTAL - YES
Registration counters (Yes/No) TOTAL - NO
TOTAL - YES
Pharmacy for drug dispensing and drug storage (Yes/No) TOTAL - NO
TOTAL - YES
TOTAL - NO
TOTAL - YES
Separate public utilities for males and females (Yes/No) TOTAL - NO
TOTAL - YES
Suggestion / complaint box (Yes/No) TOTAL - NO
TOTAL - YES
OPD rooms / cubicles (Yes/No) (Give numbers) TOTAL - NO
TOTAL - YES
Adequate no. of windows in the room for light and air in each room (Yes/No) TOTAL - NO
TOTAL - YES
Family Welfare Clinic TOTAL - NO
TOTAL - YES
Waiting room for patients TOTAL - NO
TOTAL - YES
Emergency Room / Casualty TOTAL - NO
TOTAL - YES
Separate wards for males and females TOTAL - NO
TOTAL - YES
No. of beds : Male TOTAL
No. of beds : Female TOTAL
Operation Theatre available TOTAL - NO
TOTAL - YES
If operation theatre is present, are surgeries carried out in the operation theatre? TOTAL - NO
TOTAL - YES
Non-availability of doctors /staff TOTAL - NO
TOTAL - YES
Lack of equipment / poor physical state of the operation theatre TOTAL - NO
TOTAL - YES
No power supply in the operation theatre TOTAL - NO
TOTAL - YES
Operation Theatre used for obstetric / gynaecological purpose (Yes / No) TOTAL - NO
TOTAL - YES
Has OT enough space TOTAL - NO
TOTAL - YES
Labour room available? TOTAL - NO
TOTAL - YES
If labour room is present, are deliveries carried out in the labour room? TOTAL - NO
TOTAL - YES
Non-availability of doctors / staff TOTAL - NO
TOTAL - YES
Poor condition of the labour room TOTAL - NO
TOTAL - YES
No power supply in the labour room TOTAL - NO
TOTAL - YES
Is separate areas for septic and aseptic deliveries available? TOTAL - NO
TOTAL - YES
Laboratory TOTAL - NO
TOTAL - YES
Are adequate equipment and chemicals available? (Yes/No) TOTAL - NO
TOTAL - YES
Is laboratory maintained in orderly manner? (Yes / No) TOTAL - NO
TOTAL - YES
Ancillary Rooms - Nurses rest room (Yes/No) TOTAL - NO
TOTAL - YES
TOTAL - Bore well/hand
pump/tube well
TOTAL - Piped
TOTAL - Well
Whether overhead tank and pump exist (Yes / No) TOTAL - NO
TOTAL - YES
If overhead tank exist, whether its capacity sufficient? (Yes/No) TOTAL - NO
TOTAL - YES
If pump exist, whether it is in working condition? (Yes / No) TOTAL - NO
TOTAL - YES
Type of sewerage system ( 1- Soak pit; 2- Connected to Municipal Sewerage) TOTAL - Connection to
Municipal Sewerage
TOTAL - Soak Pit
Is there a Proper mechansim for waste disposal? TOTAL - NO
TOTAL - YES
Is there electric line in all parts of the PHC? (1- In all parts; 2- In some parts; 3- None) TOTAL - In all Parts
TOTAL - In some Parts
TOTAL - None
Stand by facility (generator) available in working condition (Yes / No) TOTAL - NO
TOTAL - YES
Laundry facility available(Yes/No) TOTAL - NO
TOTAL - YES
If no, is it outsourced? TOTAL - NO
TOTAL - YES
Telephone (Yes/No) TOTAL - NO
TOTAL - YES
Personal Computer (Yes/No) TOTAL - NO
TOTAL - YES
NIC Terminal (Yes/No) TOTAL - NO
TOTAL - YES
E.Mail (Yes / No) TOTAL - NO
TOTAL - YES
Rail (Yes / No) TOTAL - NO
TOTAL - YES
All whether road (Yes / No) TOTAL - NO
TOTAL - YES
Vehicle (jeep/other vehicle) available? (Yes / No) TOTAL - NO
TOTAL - YES
Office room (Yes/No) TOTAL - NO
TOTAL - YES
Store room (Yes/No) TOTAL - NO
TOTAL - YES
Kitchen (Yes / No) TOTAL - NO
TOTAL - YES
Diet provided by hospital (Yes/No) TOTAL - NO
TOTAL - YES
Medical Officer TOTAL - NO
TOTAL - YES
Pharmacist TOTAL - NO
TOTAL - YES
Nurses TOTAL - NO
TOTAL - YES
How is the behaviour of the PHC staff with the patient TOTAL - Casual/Indifferent

TOTAL - Courteous
TOTAL -
Insulting/derogatory
Any fee for service is charged from the users? (Yes / No). If yes, specify. TOTAL - NO
TOTAL - YES
TOTAL - NO
TOTAL - YES
Is a receipt always given for the money charged at the PHC? (Yes / No) TOTAL - NO
TOTAL - YES
TOTAL - NO
TOTAL - YES
TOTAL - NO
TOTAL - YES
TOTAL - NO
TOTAL - YES
TOTAL - NO
TOTAL - YES
TOTAL - NO
TOTAL - YES
TOTAL - NO
TOTAL - YES
Malaria TOTAL - NO
TOTAL - YES
Measles TOTAL - NO
TOTAL - YES
Gastroenteritis TOTAL - NO
TOTAL - YES
Jaundice TOTAL - NO
TOTAL - YES
TOTAL - NO
TOTAL - YES
Does the doctor do private practice during or after the duty hours? (Yes/ No) TOTAL - NO
TOTAL - YES
TOTAL - NO
TOTAL - YES
TOTAL - NO
TOTAL - YES
Citizen's charter (Yes/No) TOTAL - NO
TOTAL - YES
TOTAL - NO
TOTAL - YES
TOTAL - NO
TOTAL - YES
External monitoring /Gradation by PRI (Zila Parishad)/ Rogi Kalyan Samitis TOTAL - NO
External monitoring /Gradation by PRI (Zila Parishad)/ Rogi Kalyan Samitis
TOTAL - YES
TOTAL - NO
TOTAL - YES
Are Equipment Available As per the prescribed list? TOTAL - Available
TOTAL - Not Available
TOTAL - Partially Available

Are Drugs Available As per the prescribed list? TOTAL - Available

TOTAL - Not Available
TOTAL - Partially Available

Are Furniture Available As per the prescribed list? TOTAL - Available

TOTAL - Not Available
TOTAL - Partially Available

Whether one month supply of essential drugs available? TOTAL - Available

TOTAL - Not Available
TOTAL - Partially Available

Whether one month supply of essential vaccines available? TOTAL - Available

TOTAL - Not Available
TOTAL - Partially Available

Whether one month supply of essential contraceptives available? TOTAL - Available

TOTAL - Not Available
TOTAL - Partially Available
 3
1455467
98030
0
68
1 MCLRR
67
1
67
1 MCLRR
67
51
14
402
27
26
9
14410
17059
65
3
3
65
17
51
18
50
1 MCLRR
67
5
62
0
68
2 MCLRR
66
2 MCLRR
66
3 MCLRR
65
0
68
14
54
51
17
2 MCLRR
65
0
68
1 MCLRR
67
3
65
37
31
18
50
17
51
40
23
55
12
51
15
64
3
2
66
30
38
1 MCLRR
67
12
56
18
50
13
55
10
58
25
43
1
66
1
67
0
68
 0
68
0
68
1
67
56
12
35
33
0
67
0
67
0
67
0
66
0
67
90
161
47
68
21
31
102
115
8
13
139
147
64
67
17
60
57
64
206
295
1
1
2
5
37
 31
47
21
28
40
49
17
46
22
38
30
7
61
59
8
19
49
4
64

16

7
78058
51
6
8

12

11

42

15

48
6
62
0
7
60
1
 8
59
1
13
54
1
15
51
2
46
21
57
11
56
11
58
10
18
50
4
64
3324

3546
1874
6694
1
67
2
66
1
67
3
65
4
64
0
68
3
65
3
65
7
60
9
59
 24
44
12
56
185
209
12
55
26
28
37
14
36
17
34
18
41
11
20
33
4
63
4
60
32
11
38
5
33
10
25
19
32
33
40
26
44
22
45
18

17
25
26
8
60
 7
60
8
59

6
58
5
63
62
5
1
10
58
59
9
43
24
2
66
4
64
45
19
2
66
60
6
2
64
1
67
4
64
3
65
41
27
23
45
7
61
8
60
6
61
 3
63

0
66
2
66
2
6
62
65
3
1
67
1
67
1
67
1
67
2
65
65
3
62
6
62
5
64
4
37
26
63
4
63
3
61
6
8
56
0
67
0
67
0
67
2
65
46
0

21
41
0

25
37
0

30
58
0

9
62
1

4
61
0