The current license is displayed in the health facility.
0
Adequate in size
0
Well equipped
2
Adequate in size & number
2
Well equipped
2
Adequate in size
2
Well equipped
2
Wards
4
Adequate in size
2
Well equipped
2
Number of Wards
16
Number of Admission Bed
18
Labour room 2 admin
12
Adequate in size
2
Well equipped
2
Ventilation
2
Lighting
2
Painting
2
Roofing and ceiling
2
There is a designated sterilization area/CSSD
2
There is an instrument washing area
2
Autoclave(s) is(are) available, functional and adequate
2
Sterilization drums are available, functional and adequate
2
Indicator tape is used when sterilizing
0
Laboratory is available
2
Theatre
2
Theatre is available
2
Outpatient department
2
Inpatient department
2
Inpatient department available
2
Cleaning / laundry
0
Treatment room
2
Wards
2
Wards available
2
Labour room hand washing
0
Laboratory
2.00
Laboratory
2
Pharmacy
0
Toilets
2
Immunization
0
Family planning
0
Kitchen
0
This health facility is registered with the state's waste management agency
2
Waste bins and safety boxes are not filled to the brim
2
Labour room waste
0
Emergency room
0
Laboratory
2
Laboratory
2
Theatre
2
There is a counselling area
2
There is a compounding area
0
The size of the dispensing room (area) is adequate
0
Ventilation and illumination are adequate
2
Room temperature charts are available
0
There is a functional fridge where only medication is stored
0
Fridge temperature charts are available
0
There is a lockable DDA cupboard and register
0
Essential drugs are available and properly labelled in the health facility
0
Expired drugs and consumables are securely stored and disposed
0
Patient health records are filed individually
2
Shelves are adequate for storage of patient health records
2
Patient health records are securely stored
2
NHMIS registers are available and appropriately filled
2
NHMIS data is submitted monthly to state authorities
2
OBSERVATION/INPATIENT CARE
10
REFERRAL SERVICES
6
80% of beds are functional
0
At least, one metre space between beds
2
Mattresses completely sealed with mackintosh
2
Pillows
2
Number of Toilets
2
A trained personnel responsible for surgical services is readily available at the health facility
2
A trained personnel responsible for anaesthesia is readily available at the health facility
0
The theatre is adequate in size
2
The temperature/ humidity in the theatre is adequate
0
Daily temperature monitoring is done
0
There are adequate scrub facilities separate from the theatre room
2
There is a changing area with secure storage for belongings
2
There is a clearly marked red line
2
There is a functional anaesthetic machine
2
Anaesthetic gas(es) is/are available
0
There is a functional suction machine
2
The theatre bed is appropriate for surgeries performed
2
The theatre light is adjustable
2
There is a dedicated functional UPS for theatre light
0
Medical oxygen is available?
2
Medical oxygen cylinders are stored in secure upright brackets
2
The resuscitation tray is adequate
0
The lighting is adequate
2
There are no cracked tiles on the floor
2
Walls and tiles are clean
2
The recovery room is adequately equipped
2
A referral system is in place
2
There is a functional ambulance
0
Arrangements are in place for referral transportation (where there is no ambulance)
2
There is an emergency tray or crash cart
0
There is an adequate dedicated space for emergency services
0
Clinical and nursing personnel are trained on Basic Life Support (BLS) or Advanced Cardiac Life Support (ACLS)
0
Functional oxygen cylinder/concentrator
2
Ambu bag paediatrics
2
Ambu bag adult
2
Functional suction machine
2
Functional nebulizer
2
There are standard protocols for conducting ANC in the hospital
0
Qualified staff carry out ANC services
0
Evidence of refresher training for ANC staff in the last 2 years
0
ANC examination findings are well documented for each patient
0
ANC register for the facility is available and well filled
0
ANC register shows administration of Fesolate / Folic Acid, IPT, Tetanus Toxoid according to guidelines
2
There is evidence that all laboratory and ultrasound investigations are done according to WHO guideline
2
There is a health education register/schedule
2
Delivery bed(s) with stirrups
2
Angle poise lamp
2
Resuscitaire
2
Number of resuscitaire
2
Incubator
2
Number of incubators
5
Suction machine (manual)
2
Suction machine (automatic)
2
Suction machine (automatic)
0
Baby cots are adequate and functional
2
Suturing materials
2
Is medical oxygen available?
2
Medical oxygen cylinders stored in secure upright brackets
2
Parthographs are used to monitor delivery
0
Available equipment to check fetal heartbeat
3
Delivery packs are available
2
Newborn tags are available and used
2
Categories of Facilities
Hospital