Supportive Supervision Checklist for Health Wellness Centre-PHC/ UPHC SHC Meghalaya A. General Information arrowup6 Name of HWC * Catchment Population under HWC * District * East Garo Hills East Jaintia Hills East Khasi Hills North Garo Hills Ri-Bhoi South Garo Hills South West Garo Hills South West Khasi Hills West Garo Hills West Jaintia Hills West Khasi Hills Block * Supervising officers Name * Name of MLHP * Phone No. of MLHP * Date of visit * NIN of the facility * Is the HWC a delivery Point * Yes No B.1. Status of Human Resource and training details (Interview and fill) arrowup6 Provider * No. trained on NCD * No. available * No. trained in VIA training * No. trained in NCD app/MO Portal * Provider * No. trained on NCD * No. available * No. trained in VIA training * No. trained in NCD app/MO Portal * Provider * No. trained on NCD * No. available * No. trained in VIA training * No. trained in NCD app/MO Portal * Provider * No. trained on NCD * No. available * No. trained in VIA training * No. trained in NCD app/MO Portal * Provider * No. trained on NCD * No. available * No. trained in VIA training * No. trained in NCD app/MO Portal * Provider * No. trained on NCD * No. available * No. trained in VIA training * No. trained in NCD app/MO Portal * Provider * No. trained on NCD * No. available * No. trained in VIA training * No. trained in NCD app/MO Portal * Provider * No. trained on NCD * No. available * No. trained in VIA training * No. trained in NCD app/MO Portal * Provider * No. trained on NCD * No. available * No. trained in VIA training * No. trained in NCD app/MO Portal * Provider * No. trained on NCD * No. available * No. trained in VIA training * No. trained in NCD app/MO Portal * Provider * No. trained on NCD * No. available * No. trained in VIA training * No. trained in NCD app/MO Portal * Provider * SBA * Yes No Dakshata * Yes No PPIUCD * Yes No TB * Yes No Provider * SBA * Yes No Dakshata * Yes No PPIUCD * Yes No TB * Yes No Provider * TB * Yes No B.2(i) Expanded services available at PHC/UPHC arrowup6 Basic Ophthalmic care services * Training of team conducted * Yes No Drugs available * Yes No Diagnostics & consumables available * Yes No * Training of team conducted * Yes No Drugs available * Yes No Diagnostics & consumables available * Yes No * Training of team conducted * Yes No Drugs available * Yes No Diagnostics & consumables available * Yes No * Training of team conducted * Yes No Drugs available * Yes No Diagnostics & consumables available * Yes No * Training of team conducted * Yes No Drugs available * Yes No Diagnostics & consumables available * Yes No * Training of team conducted * Yes No Drugs available * Yes No Diagnostics & consumables available * Yes No B.2(ii) Expanded services available at PHC?UPHC (Check registers/ record to confirm) arrowup6 Basic Ophthalmic care services * Basic Screening Equipment available * Yes No Is screening done * Yes No Is follow-up done * Yes No * Basic Screening Equipment available * Yes No Is screening done * Yes No Is follow-up done * Yes No * Basic Screening Equipment available * Yes No Is screening done * Yes No Is follow-up done * Yes No * Basic Screening Equipment available * Yes No Is screening done * Yes No Is follow-up done * Yes No * Basic Screening Equipment available * Yes No Is screening done * Yes No Is follow-up done * Yes No * Basic Screening Equipment available * Yes No Is screening done * Yes No Is follow-up done * Yes No SectionB.3. Training details- Additional CPHC packages (Interview and fill) B.3. Training details- Provider: MO (MBBS)/ RMA arrowup6 No. trained in Eye care * No. trained in ENT care * No. trained in oral care * No. trained in mental health * No. trained in geriatric health * No. trained in EMS * B.3. Training details- Provider: Staff Nurse arrowup6 No. trained in Eye care * No. trained in ENT care * No. trained in oral care * No. trained in mental health * No. trained in geriatric health * No. trained in EMS * B.3. Training details- Provider: MPW (F) / (M) arrowup6 No. trained in Eye care * No. trained in ENT care * No. trained in oral care * No. trained in mental health * No. trained in geriatric health * No. trained in EMS * B.3. Training details- Provider: ASHA arrowup6 No. trained in Eye care * No. trained in ENT care * No. trained in oral care * No. trained in mental health * No. trained in geriatric health * No. trained in EMS * B.3. Training details- Provider: MLHP arrowup6 No. trained in Eye care * No. trained in ENT care * No. trained in oral care * No. trained in mental health * No. trained in geriatric health * No. trained in EMS * B.3. Training details- Provider: ANM (F) / (M) arrowup6 No. trained in Eye care * No. trained in ENT care * No. trained in oral care * No. trained in mental health * No. trained in geriatric health * No. trained in EMS * C. IT, Diagnostics and Logistics arrowup6 C.1 Desktop/ Laptop for MO (MBBS) * Not Available Available but not functional Available and functional C2. MPWs (F) / (M) at collocated SHC/SC have function tablet * Yes No C3. Number of ASHAs at collocated SHC/SC having functional smart phones * C.1 Desktop/ Laptop / Tablet for MLHP * Not Available Available but not functional Available and functional C3. No. of ANMs (F) / (M) having functional tablet * Diagnostic facilities at HWC (Check for functionality and tick the response) arrowup6 C4. Availability of diagnostic services: * In house lab Outsource (Hub/PPP mode) Both C5. Diagnostic ( inhouse Mandatory test) arrowup6 Haemoglobin * Available Not Available Blood Group * Available Not Available Human chorionic gonadotropin (HCG) (Urine test for pregnancy) – Rapid card test (dipstick) * Available Not Available Urine test for PH, specific gravity, leucocyte esterase glucose, bilirubin, urobilinogen, ketone, haemoglobin, protein, nitrite – Multipara meter Urine Strip (dipstick) * Available Not Available Urine Microscopy * Available Not Available 24 – hours urinary protein * Available Not Available If you are human, leave this field blank. Submit