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Proforma for CHCs

District:_________________________

Tehsil/Taluk/Block ___________________________

Location Name of CHC:________________________

Is This Health Facility Recognized as FRU? (Yes/No)

Date of Data Collection

Day Month Year

Name and Signature of the Person Collecting Data

I. Services

S.No. Observation Points Observations

1.1. Population covered (in numbers)


1.2. Specialist services available (Yes/No)
a. Medicine
b. Surgery
c. OBG
d. National Health Programmes (Specify)
e. Emergency services (24 Hours)
24 - hour delivery services including normal
f.
and assisted deliveries
Emergency Obstetric Care including surgical
g. interventions like Caesarean Sections and other
medical interventions
Full range of family planning services
h.
including Laproscopic Services
i. Safe abortion services
j Treatment of STI / RTI
Essential Laboratory Services (Specify the type
k
of lab tests conducted)
Blood storage facility(are all blood group
l
blood available?)
m Referral transport service(which vehicle)
1.3. Types of Surgeries performed (specify)
1.4. HIV / AIDS

1
Availability of Counseling facility on HIV/
a.
AIDS / STD etc. (Yes/No)
Is it a Voluntary Council and Testing Centre
b.
(VCTC)?
1.5. Service availability
a. Ante-natal Clinics
b. Post-natal Clinics
c. Immunization Sessions
Number of cases of caeserian delivery (During
1.6. last one year)
1.7. Is separate septic labour room available
Availability of facilities for out-patient
1.8. department in Gynecology/ obstetric (Yes /
No)
a. Board /Name plates to guide the clients
b. Adequate working space
c. Privacy during examination
d. Facility for counselling
e. Separate toilet with running water
f. Facility for Sterilizing instruments
g. Male specialist
h. Female specialist

II. Manpower

Current Availability at CHC


S.No. Personnel IPHS Norm
(Indicate Numbers)

A. Clinical Manpower
2.1. General Surgeon 1
2.2. Physician 1
2.3. Obstetrician / Gynaecologist 1
2.4. Public Health Programme Manager 1
2.5. General duty officers (Medical Officer)
B. Support Manpower

S.No. Personnel IPHS Norm Current Availability at CHC (Numbers)

2.6. Nursing Staff 9

a. Public Health Nurse 1


b. ANM 1
c. Staff Nurse
7
d. Nurse/Midwife
2.7. Dresser 1

2
2.8. Pharmacist / compounder 1
2.9. Lab. Technician 1
2.10. Radiographer 1
2.11. Ward boys / nursing orderly 2
2.12. Sweepers 3
2.13. Chowkidar 1
2.14. OPD Attendant 1
2.15. Statistical Assistant / Data entry operator 1
2.16. OT Attendant 1
2.17. Registration Clerk 1
2.18. Any other staff (specify)

III. Investigative Facilities

S.No. Current Availability at CHC

3.1. Availability of ECG facilities (Yes / No)


3.2. X-Ray facility (Yes / No)
3.3. Ultrasound facility (Yes / No)
3.4. Appropriate training to a nursing staff on ECG (Yes / No)
3.5. Lab test facilities (specify kind of tests done)
Any lab test / diagnostic test outsourced to private lab /
3.6.
hospital (please specify the test)
All necessary reagents, glassware and facilities for collection
3.7.
and transportation of samples (Yes / No)

IV. Physical Infrastructure (As per specifications)


S.No. Observations
4.1. Where is this CHC located?
a. Within Village Locality
b. Far from village locality
c. If far from locality specify in km
4.2. Building
a. Area of the building (Total area in Sq. mts.)
b. What is the present stage of construction of the building
Construction complete
Construction incomplete
c. Compound Wall / Fencing (1-All around; 2-Partial; 3-None)
Condition of plaster on walls (1- Well plastered with plaster
d. intact every where; 2- Plaster coming off in some places; 3-
Plaster coming off in many places or no plaster)
Condition of floor (1- Floor in good condition; 2- Floor
e. coming off in some places; 3- Floor coming off in many places
or no proper flooring)
f. Whether the cleanliness is Good / Fair / Poor?(Observe)
OPD
OT
Rooms
Wards

3
Toilets
Premises (compound)
g. Can the MMU be parked in the premises?
4.3. Location
Whether located at less than 2 hours of travel distance from the
a.
office? (Yes/No)
Whether the district head quarter hospital located at a distance
b.
of less than 4 hours travel time? (Yes/No)
4.4. Availability of Private Sector Health Facility in the area
a. Private laboratory/hospital/Nursing Home (Yes/No)
b. Charitable Hospital (Yes/No) (specify)
c. Hospital run by NGO (Yes/No)
Prominent display boards in local language / Charter of Patient
4.5.
Rights (Yes/No)
4.6. Registration counters (Yes/No)
4.7. Pharmacy
a. Pharmacy for drug dispensing and drug storage (Yes/No)
Counter near entrance of hospital to obtain contraceptives,
b.
ORS packets, Vitamin A and Vaccination (Yes / No)
4.8. Separate public utilities for males and females (Yes/No)
4.9. Suggestion / complaint box (Yes/No)
4.10. OPD rooms / cubicles (Yes/No) (Give numbers)
Adequate no. of windows in the room for light and air in each
4.11.
room (Yes/No)
4.12. Family Welfare Clinic (Yes/No)
4.13. Waiting room for patients (Yes/No)
4.14. Emergency Room / Casualty (Yes/No)
4.15. Separate wards for males and females (Yes/No)
4.16. No. of beds : Male
4.17. No. of beds : Female
4.18. Operation Theatre
a. Operation Theatre available (Yes/No)
If operation theatre is present, are surgeries carried out in the
b.
operation theatre?
Yes
No
Sometimes

c. If operation theatre is present, but surgeries are not being


conducted there, then what are the reasons for the same?
Non-availability
Lack of equipmentof doctors
/ poor/ anaesthetist / staffof the operation
physical state
theatre
No power supply in the operation theatre
Any other reason (specify)
Operation Theatre used for obstetric / gynaecological purpose
d.
(Yes / No)
e. Has OT enough space (Yes / No)
f. Is OT fitted with air conditioner? (Yes / No)
g. Is the air conditioner working? (Yes / No)
h. Is generator available for OT? (Yes / No)
i. Is emergency light available in OT? (Yes / No)
j. Is fumigation done regularly? (Yes / No)

4
Is the days of sterilization in a week displayed on the public
k.
notice on OT? (Yes / No)
Available
4.19. Operaion Theatre Equipment (Yes/No)
Working (Yes/No)

Boyles apparatus
EMO Machine
Cardiac Monitor for OT
Defibrillator for OT
Ventilator for OT
Horizontal High Pressure Sterilizer
Vertical High Pressure sterilizer 2/3 drum capacity
Shadowless lamp ceiling trak mounted
Shadowless lamp pedestal for minor OT
OT care / fumigation apparatus
Gloves & dusting machines

Oxygen cylinder 660 Ltrs 10 cylinders for 1 Boyles Apparatus

Nitrous Oxide Cylinder 1780 Ltr. 8 for one Boyles Apparatus

Hydraulic Operation Table


4.20. Labour room
a. Labour room available? (Yes/ No)
If labour room is present, are deliveries carried out in the
b.
labour room?
Yes
No
Sometimes

c. If labour room is present. but deliveries are not being conducted there, then what are the reasons for the same?

Non-availability of doctors / staff


Seepage in the labour room
No power supply in the labour room
Any other reason (specify)
4.21. X-ray room with dark room facility (Yes/No)
4.22. Laboratory:
a. Laboratory (Yes/No)
b. Are adequate equipment and chemicals available? (Yes/No)
c. Is laboratory maintained in orderly manner? (Yes / No)
4.23. Cold Chain Available?
In working condition?
d. Deep freezers (Yes / No)
e. Refrigerators (Yes / No)
4.24. Blood Storage Unit
a. Blood Storage Unit available(Yes/No)
Is the CHC having linkage with district blood bank? (Yes /
b.
No)
c. Is regular blood supply available? (Yes / No)
4.25. Ancillary Rooms - Nurses rest room (Yes/No)

5
4.26. Water supply
Source of water (1- Piped; 2- Bore well/ hand pump / tube
a.
well; 3- Well; 4- Other (specify))
b. Whether overhead tank and pump exist (Yes / No)
If overhead tank exist, whether its capacity sufficient?
c.
(Yes/No)
d. If pump exist, whether it is in working condition? (Yes / No)
4.27. Sewerage
Type of sewerage system ( 1- Soak pit; 2- Connected to
Municipal Sewerage)
4.28. Waste disposal
a. Is there an incinerator? (Yes / No)
b. If yes, type (1- electric; 2- Other (specify)
c. If no, how the medical waste disposed off?
4.29. Electricity
Is there electric line in all parts of the hospital? (1- In all parts;
a.
2- In some parts; 3- None)
Regular Power Supply (1- Continuous Power Supply; 2-
b. Occasional power failure; 3- Power cuts in summer only; 4-
Regular power cuts; 5- No power supply
c. Stand by facility (generator) available (Yes / No)
4.31. Communication facilities
a. Telephone (Yes/No)
b. Number of different telephone lines available
c. Personal Computer (Yes/No)
e. E.Mail (Yes / No)
f. Is CHC accesible by
ii. All whether road (Yes / No)
iii. Others (Specify)
4.32. Vehicles Number of Vehicles
a. If running On Road(yes/no) Number
Ambulance
Jeep
Car
Current
Availability If available, area in Sq. mts.)
at CHC
4.33. Office room (Yes/No)
4.34. Store room (Yes/No)
4.35. Residential facility for the staff with living condition
General Surgeon
Physician
Obstetrician / Gynaecologist
Paediatrics
Anaesthetist
General Duty Medical Officer
Eye Surgeon
Public Health Nurse
ANM
Staff Nurse
Nurse/Midwife

6
Dresser
Pharmacist / compounder
Lab. Technician
Radiographer
Ward boys / nursing orderly
Sweepers
Chowkidar
OPD Attendant
Statistical Assistant / Data entry operator
OT Attendant
Ambulance driver
Registration Clerk
4.36. Accommodation facility for families of admitted patients
a. Facility for stay available (Yes / No)
b. Attached toilet available (Yes / No)
c. Cooking facility available (Yes / No)
4.37. Working Hours
Is the CHC open for outpatient services for the
a. Observations
stipulated OPD time?
Yes, on all days excepting designated holidays
No, it always closes before time
Only on some days it functions for the stipulated time
b. If yes, specify stipulated OPD hours
In cases where a patient needs to be admitted for inpatient
4.38
care, is he/she admitted?
Yes, patients who can be managed at CHC are always
admitted
Some deserving patients are not admitted but are referred to
other facilities
Patients usually refused admission
Does the CHC provide treatment to emergency patients
4.41. /victims of accident medical emergencies etc) at any time of
the day/ night?

Emergency patients are given treatment. Where necessary,


they are referred higher level Govt. hospital
Emergency patients are often not treated, referred to a public
health care facility
Emergency patients are often not treated, referred to a private
health care facility
If referred to a higher-level health care facility, how is the
4.42.
patient taken there?
Free transpbrt by hospital ambulance
By hospital ambulance, but fuel and other charges have to be
made by the patient
Private/ personal conveyance
If the health centre is unequipped to provide the services
needed, are patients transferred immediately without de1ay,
with all the relevant papers, to a site where the desired service
is available? (Yes / No)

V (A). Equipment (As per list)

7
V (A). Equipment (As per list)
Remarks / Suggestions / Identified
Equipment Available Functional
Gaps

V (B). Drugs (As per essential drug list)

Remarks / Suggestions / Identified


Drug Available
Gaps

VI. Furniture
Current
S.No. Item Availability If available, numbers
at CHC
6.1. Examination Table
6.2. Delivery Table
6.3. Footstep
6.4. Bed Side Screen
6.5. Stool for patients
6.6. Arm board for adult & child
6.7. Saline stand
6.8. Wheel chair
6.9. Stretcher on trolley
6.10. Oxygen trolley
6.11. Iron bed
6.12. Bed side locker
6.13. Dressing trolley
6.14. Mayo trolley
6.15. Instrument cabinet
6.16. Instrument trolley
6.17. Bucket
6.18. Attendant stool
6.19. Instrument tray
6.20. Chair
6.21. Wooden table
6.22. Almirah
6.23. Swab rack
6.24. Mattress
6.25. Pilow
6.26. Waiting bench for patients / attendants
6.27. Medicine cabinet
6.28. Side rail
6.29. Rack
6.30. Bed side attendant chair

8
9
Proforma for PHCs

Identification

District:_________________________

Tehsil/Taluk/Block ___________________________

Location Name of PHC:________________________

Is the PHC providing 24 hours and 7 days delivery facilities

Date of Data Collection

Day Month Year

Name and Signature of the Person Collecting Data

I. Services
S.No. Observation points Observations
1.1. Population covered (in numbers)
1.2. Assured Services available (Yes/No)
a. OPD Services
b. Emergency services (24 Hours)
c. Referral Services
d. In-patient Services
1.3 Number of beds available
1.4. Average daily OPD Attendence
a. Males
b. Females
1.5. MCH Care including Family Planning
1.5.1. Service availability (Yes / No)
a. Ante-natal care
b. Intranatal care (24 - hour delivery services both
normal and assisted)
c. Post-natal care
d. New born Care
e. Child care including immunization
f. Family Planning
g. MTP
h. Management of RTI / STI
1.5.2. Availability of specific services (Yes / No)
a. Are antenatal clinics organized by the PHC
regularly?
b. Is the facility for tubectomy and vasectomy
available at the PHC?
c. Is the facility for internal examination for
gynaecological conditions available at the PHC?

d. Is the treatment for gynecological disorders like


leucorrhoea, menstrual disorders available at the
PHC?

e. If women do not usually go to the PHC, then


what is the reason behind it?
f. Is the facility for MTP (abortion) available at
the PHC?
g. Is there any precondition for doing MTP such as
enforced use of contraceptives after MTP or
asking for husband's consent for MTP?

h. Do women have to pay for MTP?


i. Is treatment for anemia given to both pregnant
as well as non-pregnant women?
j Is there a fixed immunization day?
k How is the vaccine received at PHC and
distributed to Sub Centres?
1.6. Other fuctions and services performed (Yes /
No)
g. Education about health / behaviour change
communication
h. National Health Programmes including
HIV/AIDS control programes

II. Manpower

Existing Current Availability at PHC


S.No. Personnel Recommended
pattern (Indicate Numbers)

2 (one may be
from AYUSH
and one other
2.1. Medical Officer 1 Medical Officer
preferrably a
Lady Doctor)

2.2. Pharmacist 1 1
3 (for 24 hour
2.3. Nurse - Midwife (Staff Nurse) 1 PHCs))

2.4. Health Worker (Female) 1 1


2.5. Health Educator 1 1
2.6. Health Assistant (One male and One female 2 2
2.7. Clerks 2 2
2.8. Laboratory Technician 1 1
2.9. Driver 1
2.10. Class IV 4 4
Total 15 17/18

III. Essential Laboratory Services

S.No. Current Availability at PHC

3.1. Routine urine, stool and blood tests


3.2. Blood grouping
3.3 Bleeding time, clotting time
3.4. Diagnosis of RTI/STDs with wet mounting, grams stain, etc.
3.5 Sputum testing for TB
3.6 Blood smear examination for malaria parasite
3.7 Rapid tests for pregnancy
3.8 RPR test for Syphills / YAWS surveillance
3.9 Rapid tests for HIV
3.1 Others (specify)

IV. Physical Infrastructure (As per specifications)

4.1 a. Where is this PHC located?


Within Village Locality
Far from village locality
If far from locality specify in km
b. Area of the building (Total area in Sq. mts.)
c. What is the present stage of construction of the building
Construction complete
Construction incomplete
d. Compound Wall / Fencing (1-All around; 2-Partial; 3-None)
Condition of plaster on walls (1- Well plastered with plaster
e. intact every where; 2- Plaster coming off in some places; 3-
Plaster coming off in many places or no plaster)
Condition of floor (1- Floor in good condition; 2- Floor coming
f off in some places; 3- Floor coming off in many places or no
proper flooring)
g Whether the cleanliness is Good / Fair / Poor?(Observe)
OPD
Rooms
Wards
Toilets
Premises (compound)
h Is boundary wall with gate existing? (Yes / No)
4.2. Location
a. Whether located at an easily accessible area? (Yes/No)
b. Distance of PHC (in Kms.) from the Office
Travel time (in minutes) to reach the PHC from farthest village
c.
in coverage area
d. Distance of PHC (in Kms.) from the CHC
e. Distance of PHC (in Kms.) from District Hospital
Prominent display boards regarding service availability in local
4.3.
language (Yes/No)
4.4. Registration counters (Yes/No)
4.5 Pharmacy
a. Pharmacy for drug dispensing and drug storage (Yes/No)
Counter near entrance of PHC to obtain contraceptives, ORS
b.
packets, Vitamin A and Vaccination (Yes / No)
4.6 Separate public utilities for males and females (Yes/No)
4.7 Suggestion / complaint box (Yes/No)
4.8 OPD rooms / cubicles (Yes/No) (Give numbers)
Adequate no. of windows in the room for light and air in each
4.9
room (Yes/No)
4.10 Family Welfare Clinic (Yes/No)
4.11 Waiting room for patients (Yes/No)
4.12 Emergency Room / Casualty (Yes/No)
4.13 Separate wards for males and females (Yes/No)
4.14 No. of beds : Male
4.15 No. of beds : Female
4.16 Operation Theatre (if exists)
a. Operation Theatre available (Yes/No)
If operation theatre is present, are surgeries carried out in the
b.
operation theatre?
Yes
No
Sometimes

c. If operation theatre is present, but surgeries are not being


conducted there, then what are the reasons for the same?
Non-availability of doctors /staff

Lack of equipment / poor physical state of the operation theatre


No power supply in the operation theatre
Any other reason (specify)
Operation Theatre used for obstetric / gynaecological purpose
d.
(Yes / No)
e. Has OT enough space (Yes / No)
4.17 Labour room
a. Labour room available? (Yes/ No)
If labour room is present, arc deliveries carried out in the labour
b.
room?
Yes
No
Sometimes
If labour room is present. but deliveries are not being conducted
c.
there, then what are the reasons for the same?
Non-availability of doctors / staff
Poor condition of the labour room
No power supply in the labour room
Any other reason (specify)
Is separate areas for septic and aseptic deliveries available?
d.
(Yes / No)
4.18 Laboratory:
a. Laboratory (Yes/No)
b. Are adequate equipment and chemicals available? (Yes/No)
c. Is laboratory maintained in orderly manner? (Yes / No)
4.19 Ancillary Rooms - Nurses rest room (Yes/No)
4.20 Water supply
Source of water (1- Piped; 2- Bore well/ hand pump / tube well;
a.
3- Well; 4- Other (specify))
b. Whether overhead tank and pump exist (Yes / No)
c. If overhead tank exist, whether its capacity sufficient? (Yes/No)
d. If pump exist, whether it is in working condition? (Yes / No)
4.21 Sewerage
Type of sewerage system ( 1- Soak pit; 2- Connected to
Municipal Sewerage)
4.22 Waste disposal
How the waste material is being disposed (please specify)?
4.23 Electricity
Is there electric line in all parts of the PHC? (1- In all parts; 2-
a.
In some parts; 3- None)
Regular Power Supply (1- Continuous Power Supply; 2-
b. Occasional power failure; 3- Power cuts in summer only; 4-
Regular power cuts; 5- No power supply
Stand by facility (generator) available in working condition
c.
(Yes / No)
4.24 Communication facilities
a. Telephone (Yes/No)
b. Personal Computer (Yes/No)
c. E.Mail (Yes / No)
d. Is PHC accesible by
i. Rail (Yes / No)
ii. All whether road (Yes / No)
iii. Others (Specify)
4.25 Vehicles
Vehicle (jeep/other vehicle) available? (Yes / No)
Current
Availability at If available, area in Sq. mts.)
PHC
4.26 Office room (Yes/No)
4.27 Store room (Yes/No)
4.28 Residential facility for the staff with all amenities
Medical Officer
Pharmacist
Nurses
Other staff
4.29 Behavioral Aspects (Yes / No)
Any fee for service is charged from the users? (Yes / No). If
a.
yes, specify.
Is there corruption in terms of charging extra money for any of
b.
the service provided? (Yes / No)
Is a receipt always given for the money charged at the PHC?
c.
(Yes / No)

If the health centre is unequipped to provide the services how


d.
and where the patient is referred and how patients transported?

Is there a publicly displayed mechanism, whereby a


e
complaint/grievance can be registered? (Yes / No)

V. Equipment (As per list)

Remarks / Suggestions / Identified


Equipment Available Functional
Gaps

VI. Drugs (As per essential drug list)

Remarks / Suggestions / Identified


Drug Available
Gaps

VII. Furniture

Current
S.No. Item Availability at If available, numbers
PHC
8.1. Examination Table
8.2. Delivery Table
8.3. Footstep
8.4. Bed Side Screen
8.5. Stool for patients
8.6. Arm board for adult & child
8.7. Saline stand
8.8. Wheel chair
8.9. Stretcher on trolley
8.10. Oxygen trolley
8.11. Height measuring stand
8.12. Iron bed
8.13. Bed side locker
8.14. Dressing trolley
8.15. Mayo trolley
8.16. Instrument cabinet
8.17. Instrument trolley
8.18. Bucket
8.19. Attendant stool
8.20. Instrument tray
8.21. Chair
8.22. Wooden table
8.23. Almirah
8.24. Swab rack
8.25. Mattress
8.26. Pilow
8.27. Waiting bench for patients / attendants
8.28. Medicine cabinet
8.29. Side rail
8.30. Rack
8.31. Bed side attendant chair
8.32. Others
ons Remarks
ent Availability at PHC
(Indicate Numbers)
ailability at PHC

is the MO trained in MVA


available, area in Sq. mts.)
arks / Suggestions / Identified
Gaps

arks / Suggestions / Identified


Gaps

If available, numbers
rained in MVA
Proforma for Sub Centres

Identification

District:_________________________

Tehsil/Taluk/Block ___________________________

Name of the Village

Location Name of Sub Centre:________________________

Date of Data Collection

Day Month Year

Name and Signature of the Person Collecting Data

I. Services

S.No. Observation Points Observations


1.1. Population covered (in numbers)
1.2. MCH Care including Family Planning
1.2.1. Service availability (Yes / No)
a. Ante-natal care
b. Intranatal care
c. Post-natal care
d. New born Care
e. Child care including immunization
f. Family Planning and contraception
g. Assistance to school health services
h. Treatment of minor ailments
i. First aid (specify)
1.2.2. Availability of specific services (Yes / No)
a. Does the doctor visit the Sub centre at least once
in a month?
b. Is the day and time of this visit fixed?
c. Are the residents of the village aware of the
timings of the doctor's visit?
d. Does the Health Assistant (male) or LHV visit
the Sub Centre at least once a week?
e. Is the Antenatal care (Inj. T.T, IFA tablets,
weight and BP checkup) provided by those in
the Sub centre?
f. Is the facility for referral of complicated cases
of pregnancy / delivery available at Sub centre
for 24 hours?

g. Does the ANM/any trained personnel


accompany the woman in labor to the referred
h. care facility
Are the at the timeservices
Immunization of referral?
as per
Government schedule provided by the Sub
centre
i. Is the ORS for prevention of diarrhea and
dehydration available in the Subcentre?
Is the treatment of minor illness like fever,
j. cough, cold, worm disinfestation etc. available
in the Sub centre
k. Is the facility for taking Peripheral blood smear
in case of fever for detection available in the
Sub centre?
l. Are the contraceptive services like insertion of
Copper-T, distributing Oral contraceptive pills
or condoms provided by the Sub centre?
m. Is it a DOT centre?

II. Manpower

Current Availability at Sub Centre


S.No. Personnel Existing Recommended
(Indicate Numbers)

2.1. Health Worker (Female) 1 1 or 2 (Optional)

2.2. Health Worker (Male) 1 1 or 0 (optional;


may be replaced
by female health
worker)

2.3. Voluntary worker to keep the Sub Centre clean 1 (optional) 1 (optional)
and assisting ANM. She is paid by the ANM
from her contingency fund @ Rs. 100 per
month

III. Physical Infrastructure (As per specifications)

Current
S.No. Availability at If available, area in Sq. mts.)
Sub Centre
3.1. Location
a. Where is this Sub Centre located?
Within Village Locality
Far from village locality
If far from locality specify in km
b. Whether located at an easily accessible area? (Yes/No)

c. The distance of Sub Centre (in Kms.) from the office

Travel time to reach the Sub Centre from the remotes place in
d.
the coverage area
e. The distance of Sub Centre (in Kms.) from the PHC
f. The distance of Sub Centre (in Kms.) from the CHC
3.2. Building
Is a designated government building available for the Sub
a.
Centre? (Yes / No)
b. If there is no designated government building, then where does the Sub Centre located
Rented premises
Other government building
Any other specify
c. Area of the building (Total area in Sq. mts.)
d. What is the present condition of the existing building
e. What is the present stage of construction of the building
Construction complete
Construction incomplete
f. Compound Wall / Fencing (1-All around; 2-Partial; 3-None)
Condition of plaster on walls (1- Well plastered with plaster
g. intact every where; 2- Plaster coming off in some places; 3-
Plaster coming off in many places or no plaster)
Condition of floor (1- Floor in good condition; 2- Floor coming
h. off in some places; 3- Floor coming off in many places or no
proper flooring)
i. Whether the cleanliness is Good / Fair / Poor?(Observe)
j Is boundary wall with gate existing? (Yes / No)
3.3. Prominent display boards in local language (Yes/No)
3.4. Separate public utilities for males and females (Yes/No)
3.5. Suggestion / complaint box (Yes/No)
3.6. Labour room
a. Labour room available? (Yes/ No)
If labour room is present, are deliveries carried out in the labour
b.
room?
Yes
No
Sometimes
If labour room is present, but deliveries not being conducted
c.
there, then what are the reasons for the same?
Staff not staying
Poor condition of the labour room
No power supply in the labour room
Any other specify
3.7. Clinic Room
3.8. Examination room
3.9. Water supply
Source of water (1- Piped; 2- Bore well/ hand pump / tube well;
a.
3- Well; 4- Other (specify))
b. Whether overhead tank and pump exist (Yes / No)
c. If overhead tank exist, whether its capacity sufficient? (Yes/No)
d. If pump exist, whether it is in working condition? (Yes / No)
3.10. Waste disposal
How the medical waste disposed off (please specify)?
3.11. Electricity
Regular electric supply available? (Yes / No)
3.12. Communication facilities
a. Telephone (Yes/No)
3.13. Transport facility for movement of staff (Yes / No)
Current
If available,
3.14. Residential facility for the staff Availability at
area in Sq. mts.)
Sub Centre
Health Worker (Female)
3.15. Whether Health Worker (Male) available in the Sub Centre?
3.16. Is he staying at Sub Centre Head Quarter village? (Yes / No)

IV. Equipment (As per list)

Remarks / Suggestions / Identified


Equipment Available Functional
Gaps

V. Drugs (As per essential drug list)

Remarks / Suggestions / Identified


Drug Available
Gaps

VI. Furniture

Current
If available,
S.No. Item Availability at
numbers
Sub Centre
6.1. Examination Table
6.2. Writing Table
6.3. Armless chairs
6.4. Medicine chest
6.5. Labour table
6.6. Wooden screen
6.7. Foot step
6.8. Coat rack
6.9. Bed side table
6.10. Stool
6.11. Almirahs
6.12. Lamp
6.13. Side wooden racks
6.14. Fans
6.15. Tube lights
6.16. Basin stand
6.17. Buckets
6.18. Mugs
6.19. Kerosene stove
6.20. Sauce pan with lid
6.21. Water receptacle
6.22. Rubber / plastic shutting
6.23. Talquist Hb scale
6.24. Drum with tap for storing water
6.25. Others (specify)
vations Remarks
urrent Availability at Sub Centre
(Indicate Numbers)

If available, area in Sq. mts.)


d
If available, whether
staff staying or not?

Remarks / Suggestions / Identified


Gaps

Remarks / Suggestions / Identified


Gaps

Remarks /
Suggestions /
Identified Gaps
LIST OF EQUIPMENTS IN CHC
I Standard Surgical Set Quantity Remarks
1 Tray, instrument/dressing with cover
2 Gloves surgeon, latex sterilizable, size 6
3 Gloves surgeon, latex sterilizable, size 6-1/2
4 Gloves surgeon, latex sterilizable, size 7
5 Gloves surgeon, latex sterilizable, size7-1/2
6 Gloves surgeon, latex sterilizable, size 8
7 Forceps, sponge holding
8 Forceps, artery, straight
9 Forceps hysterectomy, curved
10 Forceps, hemostatic, mosquito, straight
11 Forceps, tissue, allis ,straight
12 Forceps, uterine, tenaculum,
13 Forceps, tissue spring type,
14 Forceps, towel,
15 . Forceps, tissue, Babcock, 195 mm, stainless steel
16 Forceps, sterilizer, Cheatle,
13 Needle holder, , straight
14 Knife-handle surgical for minor surgery # 3
15 Knife-handle surgical for major surgery # 4
16 Knife-blade surgical, size 11, for minor surgery
17 Knife-blade surgical, size 15 for minor surgery
18 Knife blade surgical, size 22, for major surgery,
19 Needles, suture triangular point
20 Needles, suture, round bodied,
21 Retractor, abdominal, Deavers
22 Retactor, double-ended abdominal
23 Scissors, operating curved mayo
24 Scissors, operating, straight, blunt point
25 Scissors, gauze, straight,
26 Scisssors ligature, spencer straight,
27 Holder, needle straight, Mayo-Hegar
28 Suction tube,
29 Clamp intestinal, Doyen, curved
30 Clamp intestinal, Doyen straight,
31 Syringe, anaesthetic (control), 10 ml, luer-glass
32 Syringe, hypodermic, 10 ml glass,
33 Needles, hypodermic
34 Uterine elevator (Ranathlbod), stainless steel
35 Hook, obstetric, Smellie, stainless steel
36 . Bowl, sponge, 600 ml, stainless steel
38 Sterilizer, instrument with burner
39 Drum, sterilizing cylindrical -
40 Towel, trolley
41 Gown, operation, cotton
42 Cap. operation, surgeon's
43 Gauze absorbent non-sterile
44 Macintosh, operation, plastc
45 Cotton wool absorbent
46 Table instrument adjustable type with tray
47 Holder, needle straight, Mayo-Hegar
48 Catheter, urethral, rubber, Foley's
49 Catheter, urethral, Nelaton,
50 Forceps, Vulsellum, duplay double curved
51 Speculum vaginal bi-valve, Cusco-medium
52 Speculum, vaginal, Sim's double-ended
53 Dilator, uterine, double - ended hegar,
54 Curette, uterine, sim's blunt
55 Curette, uterine, sim's sharp
56 Forceps, ovum
57 NSV Kit
58 Laproscope
Equipment for Anaesthesia
1 Facemask, plastic w/rubber cushion & headstrap,
2 Airway Guedel or Berman, autoclavable rubber,
3 Laryngoscope, set
4 Catheter, endotracheal w/cuff, rubber
5 Catheter, urethral, stainless steel
6 Forceps, catheter, Magill, adult
7 Connectors, catheter, straight/curved, 3, 4, 5 mm
8 Cuffs for endotracheal catheters
9 Breathing tubes, hoses, connectors
10 Valve, inhaler, chrome-plated brass, Y-shape
11 Bag, breathing, self inflating, anti-static rubber,
12 Vaporiser, halothane, dial setting
13 Vaporiser, ether or methoxyflurane, wick type 2
14 Intravenous set
15 Needle, spinal
16 Syringe, anesthetic, control 5ml Luer mount glass
17 Cells
IUD Insertion Kit (Essential)
1 sterilization tray with cover
2 Bowl, metal sponge, 600 ml
3 Forceps sponge holding, straight
4 Sound uterine simpson,
5 Forceps uterine tenaculum
6 Forceps tissue
7 Anterior vaginal wall retractor
8 Torch with batteries
9 Gloves surgeon, latex, size 7,
10 Gloves surgeon, latex size 6
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
Refrigerator.
Cold Boxes (Small & Large
Waste disposal twin bucket
Thermometers Alcohol (stem)
Binocular microscope
Adult weighing Scale
Mucus extractor with suction tube and a foot operated suction machine
Sponge holding forceps
Valsellum uterine forceps
Tenaculum uterine forceps
MVA syringe and cannulae of sizes 4-8
Kidney tray
strainer for tissues
Torch without batteries
Battery dry cells 1.5 volt (large size)
Bowl for antiseptic solution for soaking cotton swabs
Tray containing chlorine solution for keeping soiled instruments
Head Light
B.P. Apparatus table model
Stethoscope
NSV instruments set.
Minilap kits
Room Heater
ECG machine ordinary - 1
labour table
Suction machine
Facility for Oxygen administration
Sterilisation equipment
24-hour running water
Electricity supply with back-up facility (generator with POL)
Attached toilet facilities
* Inj. Oxytocin
* Inj. Diazepam
* Tab. Nifedepine
* Magnesium sulphate
* Inj. Lignocaine hydrochloride
* Inj. Methyl ergometrine maleate
* IV Haemaccel
* Sterilised cotton and gauze
Cusco’s vaginal speculum (each of small, medium and large size)
Sim’s vaginal speculum – single & double ended - (each of small, medium and large size)
Anterior Vaginal wall retractor
Sterile Gloves
Sterilised cotton swabs and swab sticks in a jar with lid
Kidney tray for keeping used instruments
Bowl for antiseptic solution
Antiseptic solution: Chlorhexidine 1% or Cetrimide 2, povidone iodine solution
Chittle forceps
. Proper light source / torch
Requirements of the laboratory
Reagent
For Cyan meth - haemoglobin method for Hb estimation
Uristix for urine albumin and sugar analysis
ABO & Rh antibodies
Glassware and other equipment
1. Colorimeter for Hb estimation
2. Test tubes
3. Pipettes
4. Glass rods
5. Glass slides
6. Cover slips
7. Light Microscope
8. Differential blood cell counter
List of Furniture at PHC
The list is indicative and not exhaustive. The Furniture/fittings and Medical and Surgical itmes
are to be provided as per need and availability of space and services provided by the PHC)
Essential Furniture
Examination table
Writing tables with table sheets
Plastic chairs (for in-patients’ attendants)
Armless chairs
Table FP/Counseling
Bench for waiting area
Wheel chair
Stretcher on trolley
Wooden screen
Foot step
Bed side table
16. Stool 10
17. Medicine chest 1
18. Lamp 3
19. Side Wooden racks 4
20. Fans 6
21. Tube light 8
22. Basin 2
23. Basin stand 2
24. Buckets 4
25. Mugs 4
26. LPG stove 1
27. LPG cylinder 2
28. Sauce pan with lid 2
29. Water receptacle 3
30. Rubber/plastic shutting 2 meters
31. Drum with tap for storing water 2
32. Mattress for beds 12
33. Foam Mattress for OT table 2
34. Foam Mattress for labour table 2
35. Bed sheets 15
36. Pillows with covers 15
37. Blankets 12
38. Baby blankets 4
39. Towels 12
40. Curtains with rods 20
metres
41. Dustbin 5
42. Coloured Puncture proof bags as per need
43. Generator (5 KVA with POL for immunization purpose) 1
Essential Medical/Surgical items
1. Blood Pressure Apparatus 3
2. Stethoscope 3
3. Tongue Depressor 10
4. Torch 2
Thermometer Clinical
Hub cutter
Needle Destroyer
Labour table
OT table
10. Arm board for adult
Instrument trolley
I V stand
Shadowless lamp light (for OT)
Macintosh for labour and OT table
Kelly’s pad for labour and OT table
Red Bags
Black bags
Black Board/Overhead Projector

Oxygen Inhalation
Diazepam Injection 5 mg / ml
Acetyl Salicylic Acid Tablets 300mg & 50 mg
Ibuprofen Tablets 400 mg
Paracetamol Injection 150 mg / ml
Paracetamol Syrup 125 mg / 5ml
Chlorpheniramine Maleate Tablets 4 mg
Dexchlorpheniramine Maleate Syrup 0.5 mg / 5 ml
Dexamethasone Tablets 0.5 mg
Pheniramine Maleate Injection 22.75 mg / ml
Promethazine Tablets 10 mg, 25 mg
Promethazine Capsules 250 mg, 500 mg
Ampicillin Capsules 250 mg., 500 mg
Benzylpenicillin Injection 5 lacs, 10 lacs units
Cloxacillin Capsules 250 mg, 500 mg
Procaine Benzylpenicillin Injection Crystalline penicillin (1 lac units)+ Procaine penicillin (3lacs units)
Gentamicin Injection 10 mg / ml, 40
mg / ml
Activated Charcoal Powder
Antisnake Venom Ampoule
(Lyophilyzed Polyvalent Serum)
Carbamazepine Tablets 100 mg, 200 mg
Syrup 20 mg / ml
Phenytoin Sodium Capsules or Tablets 50
mg,100 mg Syrup 25
mg / ml
Mebendazole Tablets 100 mg
Suspension 100 mg/ 5 ml
Albendazole Tablets 400m
Diethylcarbamazine Citrate Tablets 150 mg
Amoxycillin Powder for suspension
125 mg / 5 ml
Capsules 250 mg, 500 mg
Acetyl Salicylic Acid Tablets75 mg,100mg,350mg.
Glyceryl Trinitrate Sublingual Tablets 0.5
mg Injection 5 mg/ml
Isosorbide 5 Mononitrate Tablets 10 mg.
Propranolol Tablets 10mg,40mg
Injection 1mg/ml.
Amlodipine Tablets 2.5 mg, 5 mg, 10
mg
Atenolol Tablets 50 mg,100 mg
Enalapril Maleate Tablets 2.5 mg, 5 mg, 10
mg Injection 1.25 mg / ml
Methyldopa Tablets 250 mg
Tab.Metoprolol Tablets 25 mg, 50 mg, 100 mg
Hydrochlorthiazide Tablets 12.5, 25 mg
Tab Captopril Tablets 25 mg
Tab.Isosorbide Dinitrate(Sorbitrate Tablets 5mg, 10 mg
Benzoic Acid +Salicylic Acid Ointment or Cream
6%+3%
Miconazole Ointment or Cream 2%
Framycetin Sulphate Cream 0.5%
Methylrosanilinium
Chloride (Gentian Violet) Aqueous solution 0.5%
Neomycin +Bacitracin Ointment 5 mg + 500 IU
Povidone Iodine Solution and Ointment 5%
Silver Nitrate Lotion 10%
Nalidixic Acid Tablets 250 mg, 500 mg
Nitrofurantoin Tablets 100 mg
Norfloxacin Tablets 400 mg
Tettracycline Tablets or Capsules 250
mg
Griseofulvin Capsules or Tablets 125
mg, 250 mg
Nystatin Tablets 500,000 IU
Pessaries 100,000 IU
Metronidazole Tablets 200 mg, 400 mg
Syrup
Dextran Injection6%
Silver Sulphadiazine Cream 1%
Betamethasone Cream / Ointment 0.05%
Dipropionate Calamine Lotion
Zinc Oxide Dusting Powder
Glycerin Solution
Benzyl Benzoate Lotion 25 %
Benzoin Compound Tincture
Chlorhexidine Solution 5% (conc. for
dilution)
Ethyl Alcohol 70% Solution
Gentian Violet Paint 0.5%, 1%
Hydrogen Peroxide Solution 6%
Bleaching Powder Powder
Formaldehyde IP Solution
Potassium Permanganate Crystals for solution
Furosemide Injection, 10 mg/ ml,
Tablets 40 mg
Aluminium Hydroxide+ Magnesium Suspension
Hydroxide Tablet
Omeprazole Capsules 10, 20, 40 mg,
Ranitidine Hydrocholoride Tablets 150 mg, 300 mg
Injection 25 mg / ml
Domperidone Tablets 10 mg
Metoclopramide Tablets 10 mg
Injection 5 mg / ml
Dicyclomine Hydrochloride Tablets 10 mg,
Injection 10 mg / ml
Hyoscine Butyl Bromide Tablets or 10 mg
Injection 20 mg / ml
Bisacodyl Tablets/ suppository 5 mg
Isphaghula Granules
Oral Rehydration Salts Powder for solution As per
IP
Oral Contraceptive pills
Condoms (Nirodh)
Copper T (380 A)
Prednisolone Tablets 5 mg, 10 mg
Glibenclamide Tablets 2.5 mg, 5 mg
Insulin Injection (Soluble) injection 40 IU / ml
Metformin Tablets 500 mg
Rabies Vaccine Injection
Tetanus Toxoid Injection
Chloramphenicol Eye Drops Drops/Ointment 0.4%, 1%
Ciprofloxacin Hydrochloride Eye Drops Drops/Ointment 0.3%
Gentamicin Eye/ Ear Drops 0.3%
Miconazole Cream 2%
Sulphacetamide Sodium Eye Drops Drops10%, 20%, 30%
Tetracycline Hydrochloride Eye oint Ointment 1%
Prednisolone Sodium Phosphate Eye Drops 1%
Xylometazoline Nasal Drops Drops 0.05%, 0.1%
Diazepam Tablets 2 mg, 5 mg, 10 mg
Aminophylline Injection 25 mg / ml
Beclomethasone Dipropionate Inhalation 50 mg, 250
mg/dose
Salbutamol Sulphate Tablets 2 mg, 4 mg
Syrup 2 mg / 5 ml
Inhalation 100 mg / dose
Dextromethorphan Tablets 30 mg
l
Dextrose IV infusion 5% isotonic
500 ml bottle
Normal Saline IV Infusion 0.9% 500 ml
bottle
Potassium Chloride Syrup 1.5 gm/5 ml, 200 ml
Ringer Lactate IV infusion 500 ml
Sodium Bicarbonate injection
Ascorbic Acid Tablets 100 mg, 500 mg
Calcium salts Tablets 250 mg, 500 mg
Multivitamins Tablets (As per Schedule V)
Broad spectrum antibiotic /antifungal ear drops
STI syndromic treatment kit As per Need
Clofazimine Tablets 100mg (loose)
Prednisolone Tablets 5 & 10mg
Drugs and Logistics for Immunization
Emergency drug kit to manage Anaphylaxis – ( to deal with AEFI)
(Inj. Adrenaline,
Inj. Hydrocortisone,
Inj. Dexamethasone,
Ambu bag (Paediatric),
sterile hypodermic syringe for single use with reuse prevention feature 2ml and 5ml syringes,
Needles( Size 24, 22, 20)
Drugs under RCH for Primary Health Centre
1 Diazepam Injection IP Diazepam IP 5 mg / ml; 2 ml in each
ampoule 50 ampoules
2 Lignocaine Injection IP Lignocaine Hydrochloride IP 2% w / v;
30 ml in each vial 10 vials
3
Pentazocine Injection IP
Pentazocine Lactate IP eq. to
Pentazocine 30 mg / ml; 01 ml in each
ampoule
50 ampoules
4 Dexamethasone Injection
Dexamethasone Sodium Phosphate IP
eq. to Dexamethasone Phosphate, 4 mg
/ ml.; 02 ml in each ampoule
100
ampoules
5 Promethazine Injection
IP
Promethazine hydrochloride IP, 25 mg /
ml; 02 ml in each ampoule 50 ampoules
6 Methylergometrine
Injection IP
Methylergometrine maleate, 0.2 mg /ml;
01 ml in each ampoule
150
ampoules
7 Etofylline BP plus
Anhydrous Theophylline
IP Combination Injection
(As per standards
provided)
Etofylline BP 84.7 mg / ml &
Theophylline IP eq. to Theophylline
anhydrous, 25.3 mg / ml; 02 ml in each
ampoule
100
ampoules
8
Adrenaline Injection IP
0.18% w/v Adrenaline tartrate or
Adrenaline Tartrate IP eq. to adrenaline
1 mg / ml; 01 ml in each ampoule
50 ampoules.
9 Methylergometrine
Tablets IP
Methylergometrine maleate IP, 0.125
mg 500 tablets
10 Diazepam Tablets IP Diazepam IP 5 mg 250 tablets
11 Paracetamol Tablets IP Paracetamol IP 500 mg 1000 tablets
12 Co-trimoxazole
combination of
Trimethoprim &
Sulphamethoxazole
Tablets IP (Adults)
Trimethoprim IP 80mg /
Sulphamethoxazole IP 400mg 2000 tablets
13 Amoxycillin Capsules IP Amoxycylline Trihydrate IP eq. to
amoxycylline 250 mg
capsules
14 Doxycycline Capsules IP Doxycycline Hydrochloride eq. to
Doxycycline100 mg 500 capsules
15 Metronidazole Tablets IP Metronidazole IP 200 mg 1000 tablets
16 Salbutamol Tablets IP Salbutamol sulphate eq. to Salbutamol 2
mg 1000 tablets
17 Phenoxymethylpenicillin
Potassium Tablets IP
Phenoxymethylpenicillin Potassium IP
eq. to Phenoxymethylpenicillin 250mg
2000 tablets
18 Menadione Injection USP
(Vitamin K3)
Menadione USP 10mg / ml; 01 ml in
each ampoule
ampoules
19 Atropine Injection IP Atropine Sulphate IP 600μg / ml; 02 ml
in each ampoule 50 ampoules
20 Fluconazole Tablets (As
per standards provided) Fluconazole USP 150 mg 500 tablets
21 Methyldopa Tablets IP Methyldopa IP eq. to Methyldopa
anhydrous 250 mg 500 tablets
22 Oxytocin Injection IP Oxytocin IP 5.0 I.U. / ml; 02 ml in each
ampoule
ampoules
23 Phenytoin Injection BP
(in solution form)
Phenytoin Sodium IP 50 mg / ml; 02 ml
in each ampoule 25 ampoules
24 Cephalexin Capsules IP Cephalexin IP eq. to Cephalexin
anhydrous 250 mg
1000
capsules
25
Compound Sodium
Lactate Injection IP
0.24 % V/V of Lactic Acid ( eq. to
0.32% w/v of Sodium Lactate), 0.6 %
w/v Sodium Chloride, 0.04 % w/v
Potassium Chloride and 0.027 % w/v
Calcium Chloride; 500 ml in each
bottle/pouch.
200 FFS
pouches /
BFS Bottles
26
Dextrose Injection IP Dextrose IP, 5% w/v; 500 ml in each
bottle/pouch.
100 FFS
pouches /
BFS bottles
27 Sodium Chloride
Injection IP
Sodium Chloride IP 0.9 % w / v; 500 ml
in each bottle/pouch.
100 FFS
pouches /
BFS bottles
28 Lindane Lotion USP Lindane IP 1%w/v; each tube
containing 50 ml 100 tubes
29
Dextran 40 Injection IP
Dextrans 10 % w/v; 500 ml in each
bottle 5 bottles
30 Infusion Equipment IV Set with hypodermic needle 21G of
1.5” length 200
Ciprofloxacin Hydrochloride Tablets 500 mg I tablet 1000 Tablets
2 Doxycycline Hydrochloride Capsules 100 mg I cap 6000
Capsules
3 Erythromycin Estolate Tablets 250 mg I tablet 1000 Tablets
4 Benzathine Penicillin Injection 24 lakhs units/vial 1000 vials
5 Tinidazole Tablets 500 mg tablet 5000 Tablets
9. Gramma Benzene Hexachloride
Application (Lindane Application)
1 % w/v 10 Bottles
10. Distilled Water 10001 Ampoules
Drugs and Consumables for MVA:
• Syringe for local anaesthesia (10 ml) and Sterile Needle (22-24 gauge)
• Chlorine solution
• Antiseptic solution (savlon)
• Local Anaesthetic agent (injection 1% Lignocaine, for giving para cervical block)
• Sterile saline/sterile water for flushing cannula in case of blockage
• Infection prevention equipment and supplies
List for SC
S.no. Item Quantity
1 Examination Table
2 Writing table
3 Bench for waiting area
4 Armless chairs
5 Labour table
6 Wooden screen
7 Foot step
8 Clock
9 Bed side table
10 Stool
11 Lamp
12 Side Wooden racks
13 Fans
14 Tube light
15 Basin stand
16 Buckets
17 Mugs
18 Kerosene stove
19 Sauce pan with lid
20 Water Mug / Jug
21 Waste disposal twin bucket, hypochlorite solution/bleach
22 Dust Bin with lid 1
23 Rubber/plastic sheet 2 meters
24 Drum with tap for storing water 1
25 Waste disposal twin bucket, hypochlorite solution/bleach
26 Disposable Jars
27 Black Disposal bags
28 Red Disposal Bags
29 Battery Dry cell 1.5, D type for 10C
30 Basin
31 Tray instrument/Dressing with cover
32 Flashlight / Torch Box-type pre-focused (4 cell)
33 Torch (ordinary) 2
34 Dressing Drum with cover
35 Hemoglobinometer –set Sahli type complete
36 Weighing Scale
37 Plastic Sheet clear PVC 180 cm long
38 Tissue Forceps
39 Sterilizer
40 Surgical Scissors straight 140mm, ss
41 Sims Uterine Depressor/Retractor
42 Measuring Jug 1 litre
43 Surgeon’s Scrubbing Brush with white Nylon
44 Sphygmomanometer Aneroid 300 mm with cuff
45 Kelly’s hemostat Forceps straight
46 Vulsellum Uterine Forceps curved
47 Cusco’s/Graves Speculum vaginal bi-valve medium
48 Sims Speculum vaginal double ended ISS Medium
49 . Uterine Sound Graduated
50 Cheatle’s Forcep
51 Ice pack box
52 Sponge holder
53 Plain Forceps
54 Suture needle straight
55 . Suture needle curved
56 . Kidney tray 4(big) & 4(small)
57 Clinical Thermometer oral & rectal 1 each
58 Room Heater
59 Dressing Forceps (spring type),
60 Artery Forceps, straight,
61 Talquist Hb scale
62 Stethoscope
63 HUB Cutter
64 . I/V Stand
65 A labour table with Mattress, pillow and Kelly’s pad
66 McIntosh Sheet
67 Suction machine
68 Facility for Oxygen administration
69 Sterilization equipment
70 24-hour running water
71 Electricity supply with back-up facility (generator with POL)
72 Attached toilet facilities
73 Inj. Oxytocin
74 Inj Magnesium sulphate
75 Inj. Methyl ergometrine maleate
76 Methylergometrine Tablets
77 Paracetamol Tablets IP Paracetamol IP 500 mg 1000 tablets
78 Albendazole Tablets IP Albendazole IP400 mg 200 tablets
79 Povidone Iodine Ointment
80 Cotton Bandage
81 Absorbent Cotton
82 Inj. Gentamycin
83 Inj. Magnesium Sulphate
84 Inj. Oxytocin
85 Cap. Ampicillim
86 Tab. Metronidazole
87 Tab. Misoprostol 200 g
88 Tab. Cotrimoxazole 80+400mg (for adults)
89 Tab. Albendazole 400 mg
90 Adhesive tape (leucoplast & Micropore)
91 Savlon solution (Anti-septic Solution)
92 Betadine solution (Povidone Iodine solution 5%)
93 Nirodh
94 Oral pills
95 Copper – T (380-A)
96 Emergency contraceptive pills
Registers in Sub-centre
Eligible Couple Register including Contraception
Maternal and Child Health Register:
Antenatal, intra-natal, postnatal
Under-five register:
Immunisation
Growth monitoring
Above Five Child immunization
Number of HIV/STI screening and referral
Births and Deaths Register
Drug Register
Equipment Furniture and other accessories Register
Register for records pertaining to Janani Suraksha Yojana
Register for maintenance of accounts including untied funds.

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