Monitoring SC Level - MoHFW

POPULATION RESEARCH CENTRE (PRC), KERALA

Ministry of Health and Family Welfare, Govt. of India
MONITORING OF NHM PIP 2023-24
Sub Centre Level Monitoring Checklist
State

District

City/ Town

Block

Village/Ward

A. Service Delivery: Sub Centre

Name of facility
Year of establishment of the facility
Population covered by the SC
Number of wards/ villages under sub Number of wards ……………… Or
centre
Number of villages …………………
Number of Anganwadi centres under sub
centre

Whether the facility has been converted to Yes/No - …………

HWC If yes, Year of conversion …………..
Standalone/ Co-located Standalone/ Co-located- ………
(if Co-located), Co-located with: ………
Status of building Own building / building belongs to other
departments/rented building: …………….
If rented, method of payment of rent :
………………….
Last major renovation done( Provide Year
also)
Next Referral Point Facility name :
Distance:…………. Km

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Time taken to reach: ………… minutes

Indicator Remarks

1. List of Services available Services Yes Services Yes

/No /No

OPD Pharmacy
IPD Immunization
ANC RTI/ STI
Delivery AFHC
PNC Laundry Services for
delivery
IUCD Dietary Services for
JSSK beneficiaries
PPIUCD Others 1
OP Others 2
EC pills Others 3
Condoms Others 4
Injectables
Other
contraceptives
2. OPD Timing

3. Number of OPD cases Jan-23 Feb-23 March-23 Apr-23 May-23

5. Biomedical waste Sharp Pit/ Deep Burial Pit / Dispose at linked PHC/ Outsourced
management practices / Any other method(specify) :
………………………………………………..

6. Details of HR available in HR Sanctioned In position

the facility (Sanctioned and
In-place)

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Indicator Remarks

Regula Contractual
r

ANM( JPHN)/
MPW Female

MPW Male/JHI

ASHA

MLHP/CHO

Others

7. IT Services  Functional Tablet: Yes/No:-

 Laptop with CHO : Yes/No:-
 Electronic Tablets with MPWs (ANM): Yes/No -
 Smart phones given to all ASHAs: Yes/No -
 Internet connectivity: Yes/No -
 Quality/strength of internet connection
Good / Moderate / Poor:- ………………………

8. Availability of list of Yes/ No

essential medicines (EML)/
drugs (EDL) If yes, total number of drugs in EDL_________

2
9. Shortage of 5 priority drugs
from EDL in last 30 days, if 3
any 4

1
10. Drugs Available for 2
Hypertension & Diabetes:
3

11. Shortage of drugs for 1

Hypertension & Diabetes in
last 7 days 2

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 Monitoring SC Level - MoHFW

Indicator Remarks

12. Is ANM/JPHN dispensing

medicines for hypertension Yes/ No
and diabetes at SC
13. Availability of Testing kits/ Sufficient Supply /Minimal Shortage / Acute shortage ;
Rapid Diagnostic Kits ……………………….

14. Availability of:

Functional/Non -
functional/Not Available
BP instrument:
Thermometer
Glucometer
Weighing machine(Adult)
Weighing
machine(Pediatric)

BP instrument Type: Digital/Manual

15. Number of High risk women
identified during the last six
months
16. Number of all eligible couple
in the area
17. Number of Maternal Deaths Previous year:
in the SC area
Current year:
18. Number of Maternal Death Previous year:
Reviews conducted
Current year:

19. Number of Child Deaths in Previous year:

the SC area
Current year:

20. Number of Child Death Previous year:

Review conducted
Current year:

21. Availability of vaccines Yes/No

22. Availability of hub cutter Yes/No

23. Availability of micro-plan Yes/No

for immunization
24. Number of SNCU discharged
babies ANM/MPW followed
up in the last six months
25. Number of LBW babies
followed up in the last six
months

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 Monitoring SC Level - MoHFW

Indicator Remarks

26. Number of home deliveries

conducted by ANM
27. Number of home delivered
babies followed up in the last
six months
28. Availability of trained Yes/No
provider for IUCD/ PPIUCD
29. Utilization of FP services in No. of IUCD/PPIUCD insertions done ……………
last month
No. of Oral Pills distributed ………..
No. of condoms distributed……………..
No. of emergency pills distributed…………..
No. of other FP method used (Specify)……………
Camps conducted for IUCD insertion (& no. of cases done)
………….
Camps conducted for sterilization ( &no. of cases done)
………..

30. Number of individuals above

30 years of age in the area
31. Number of Community
Based Assessment Checklists
filled in the last 6 months
32. Report for number of With Score below 4:
individuals for whom CBAC
form has been filled in last With Score 4 and above:
six months.
33. Whether universal screening Yes/No
of NCD has started
34. Number of individuals Screened Confirmed
screened for the following in
last 6 months: a. Hypertension

b. Diabetes

c. Oral Cancer

d. Breast Cancer

e. Cervical Cancer

35. Number of new patients who Number of new patients

had initiated treatment for
Hypertension (HTN), Advised for Lifestyle management:
Diabetes(DM) and others Initiated Medicines for Hypertension:
during last six months Initiated Medicines for Diabetes:

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 Monitoring SC Level - MoHFW

Indicator Remarks

Initiated Medicines for Others:

36. Source of getting drugs/ From SC-HWC:

medications for individual.
From Linked PHC:
From other govt. facilities: (Specify)
From Private. Chemist shop:

37. Number of patients taking

medication for HTN and DM
from the SC during last six
months
38. Average Cost of taking
medication for HTN per
individual per month (if
taken from Pvt sources)
39. Average Cost of taking
medication for DM per
individual per month (if
taken from Pvt sources)
40. Availability of:  Tele-consultation services : Yes/No -

 HWC App : Yes/No -

41. Number of individuals who
utilized tele-consultation
services in the last six month
42. Whether wellness activities Yes/No
are performed
If yes, Frequency:
43. Whether reporting weekly Yes/No
data in S form under IDSP
IF Yes, Do you report every week Yes/No

If Yes how many times did you report in the last month…..

44. What are the major

communicable diseases in
the SC area
45. Status of Tuberculosis in the Current
Indicators Last year
area: year

Number of presumptive TB patients

identified:

Number of presumptive TB patients

referred for testing

Number of TB patients diagnosed

out of the presumptive patients

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Indicator Remarks

referred

Number of TB patients taking

treatment under the Sub centre area

Number of TB patients receiving

NPY through DBT

50. Are anti-TB drugs available Yes/ No

at the Sub Centre?
If yes, number of patients currently taking anti-TB drugs from
the SC?

51. Number of Malaria cases Last year:

reported in the SC area
Current Year:

52. Malaria slides collected

during the last six months
53. Number of Leprosy cases Last year:
reported in the SC area
Current Year:

54. Is there any Grade II Yes/No

deformity cases reported in
the SC area If yes Number of cases:

55. ASHA

 Are Functional HBNC Kits Yes/No

(weighing scale/ digital
thermometer/ blanket or
warm bag) available with
ASHAs?
 Are Drug Kits (PCM/ Yes/NoI
Amoxicillin/ IFA/ ORS/
Zinc/ IFA Syrup/
Cotrimoxazole) available
with ASHAs?
 ASHA Incentives: Any Time Yes/No If Yes, Average delay
lag /Delay in Payment after
submission of voucher.

56. Number of Village Health &

Sanitation days conducted in
last 6 months
57. Frequency of VHSNC/ MAS
meeting
58. Whether CHOs and HWC Yes/No
staffs are involved in
VHSNC/ MAS meeting

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Indicator Remarks

59. Incentives:  Performance Incentives is disbursed to CHOs on monthly

basis: Yes/No
 Team-based incentive being disbursed for all HWC staffs:
Yes/No
60. How much fund was Fund Received last year:
received and utilized by the
facility under NHM? Fund utilized last year:

Items/ Activities for which the Untied Fund was utilised:

Reasons for underutilization of fund (if any)

61. Availability of ambulance Yes/No

services in the area
 How many cases from the Number of cases referred out:
Sub Centre were referred to
PHC in last six months?
Types of cases referred out: