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
5
Number of Admission Bed
10
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
2
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
2
Number of Registered nurses
3
Number of Registered Midwives
1
Number of Pharmacists
0
Number of Pharmacy technicians
1
Number of Medical Lab scientists
0
Number of Lab technicians
0
Number of Lab Assistants
0
Number of CHEW
2
Number of Junior CHEW
0
Number of Lab Assistants
0
Number of Doctors
2
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
0
There is a duty roster for health personnel available
2
Number of qualified health personnel is adequate
2
Total medical staff strength
7
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
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
2
Number of resuscitaire
1
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
2
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
Rally hospital and maternity
Types of Accommodation
Shared Accommodation