The current license is displayed in the health facility.
2
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
3
Number of Admission Bed
7
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 Fire Safety Certificate
2
Firefighting equipment is available and adequate
2
Each firefighting equipment has a service sticker
0
There are at least two readily accessible and labelled exits
2
In general, ventilation is adequate
2
In general, illumination is adequate
2
There is a primary source of power
2
There is an alternate source of power
2
Potable water is available
2
Toilets are functional and adequate
2
Toilets are equipped with essentials for handwashing
2
Availability of cleaning agents and disinfectant
2
There are bathrooms with running water
2
There is(are) external drainage(s) e.g. gutter
2
External drainage(s) is(are) covered
2
Number of Doctors
1
Number of Registered nurses
2
Number of Registered Midwives
1
Number of Pharmacists
0
Number of Pharmacy technicians
0
Number of Medical Lab scientists
0
Number of Lab technicians
0
Number of Lab Assistants
0
Number of CHEW
0
Number of Junior CHEW
0
Number of Lab Assistants
0
Number of Doctors
0
Number of Registered nurses
0
Number of Registered Midwives
0
Number of Pharmacists
0
Number of Pharmacy technicians
0
Number of Lab scientists
0
Number of Lab tech
0
Number of CHEW
0
Number of Junior CHEW
0
Number of Admin/Account
0
Qualification certificates are available onsite
2
Current practicing licenses are available onsite
2
There is a duty roster for health personnel available
2
Number of qualified health personnel is adequate
2
Total medical staff strength
4
Total number of medical staff met on duty.
1
Total number of medical staff met on duty.
2
IEC materials on FP, immunization & nutrition seen
2
IEC materials on TB, HIV & handwashing seen
0
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
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
2
Labour room available
2
Laboratory
0.00
Pharmacy
0
Toilets
2
Immunization
2
Immunization available
2
Family planning
2
Family planning available
2
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
2
Labour room
2
Emergency room
2
Laboratory
0
Theatre
2
There is a counselling area
0
There is a compounding area
0
The size of the dispensing room (area) is adequate
2
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
2
Expired drugs and consumables are securely stored and disposed
2
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
49
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
0
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
2
There is an adequate dedicated space for emergency services
2
Clinical and nursing personnel are trained on Basic Life Support (BLS) or Advanced Cardiac Life Support (ACLS)
2
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
2
Qualified staff carry out ANC services
2
Evidence of refresher training for ANC staff in the last 2 years
2
ANC examination findings are well documented for each patient
2
ANC register for the facility is available and well filled
2
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
0
Incubator
0
Suction machine (manual)
2
Suction machine (automatic)
2
Suction machine (automatic)
1
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
2
Available equipment to check fetal heartbeat
3
Delivery packs are available
2
Newborn tags are available and used
2
There is a qualified staff trained in family planning
2
The family planning room has a lockable door and non- transparent window blinds
2
Family planning methods available with demonstration box/tray for potential users
0
There is a stock management process in place
2
There is proper documentation of chosen method and findings of examination during follow-up.
2
Categories of Facilities
Hospital
Type of Facility
Private
Types of building
Santos medical centre
Types of Accommodation
Stand-Alone