GUMBALLI PRIMARY HEALTH CENTRE
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- Title
- GUMBALLI PRIMARY HEALTH CENTRE
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GUMBALLI PRIMARY HEALTH CENTRE
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Run by
KARUNA TRUST
B R Hills - 571 441, Yelandur Taluk
Chamarajanagar District
Karnataka State.
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ANNUAL REPORT
1998-99
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GUMBALJLI PHC
Run by
karuna trust
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KARUNA Trust is a Voluntaiy Oigamsation committed to the cause of Rural Health and
Rural Development.
Objectives:
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socio-economic programmes.
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yelandur project-
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T. NARASIPUR PROJECT:
The T. Narasipur branch was started in 1996 in
Mrs. Renuka Nagaraju Charitable Family Trust collaboration with Dr. M. Nagaraju &
The Programmes being undertaken at
present are:
a) Community Health L;
b) Vocaiion 1 raining c) Primaiy Education and Literacy
d) Community Organisation
---i _e) Other Rural Development Programme.
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Gum ball j PHC
Progress Report
1998-99
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A New PHC (Gumballi) and associated sub-centres has been
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Department Government of Karnataka and handed over to Karana Tn^^^
Government order No. HFW 106 AP No.95, Bangalore dated 11-01 orTt/
took over the management Gumballi PHC and its 3 sub-centm from'oi-OS^rY7'
appointed tts won staff and runntng the PHC in its premises at GtuXm I^e foUol^
staff were appointed by the Kanina Trust.
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Medical Officer
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Pharmacist
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Lab Technician
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EDO
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Group ‘O’
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ANMs
- 4
Male Health Workers - 2
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L-MCH and Family Welfare (RCH Prof?rainme\
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Three 1,rib
lwlal
u ANMs specially
specialty trained
trained to work in tribal areas have been in-charge of the
sub-ccntrcs. Ihcy have provided Anti-natal care I
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to all the pregnant mothers - Registered
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conduced
Prr^h>AaxhC
200( "based
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'herapcu(lc doscs wtr« provided to all pregnant women. C/V4 4n •
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previous years.
increased considerably compared to
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2. Immunisation:
been immunised for BCG, DPT, P^o^McaX^LdCv"
the help of II. Refrigerator and Deep Freezers
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the Children
-^n ts maintained well with
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01. Malaria Eradication Programme.
02. Tuberculosis Control Programme
03. Family Welfare Programme.
04. Leprosy Elimination Programme.
05. Mental Health and Epilepsy Control Programme.
06. Bundness Control Programme.
07. Cancer Control Programme.
08. School Health Programme.
09. Aids Control Programme.
10. STD Control Programme.
11. Water and Sanitation Programme.
12. Goiter Control Programme.
13. Diarrhea Control Programme.
14. Diabetics Control Programme.
3 5. Filaria Control Programme.
16 Guinea Woim Elimination ITogiammc.
(Note : Detailed report is enclosed)
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4. ( urative senices*
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llic curative services are available tt PF-tp
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services were provided 24-hours a day Periodical
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to the PUC. Qualified Suigeons and ObG
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providing Special^ servi^s
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Pr™dcd
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visiting
visiting the
the PHC
PHC regularly
regularfy and
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tapes, cxlubitions and^pos^rs^it^yH^k 00111301’ c<,unflclinS’ 8«W diacuaeion, audio
In addhion the PHC hi dlTe tiX '
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80,100,8 °f PHC
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Ute causes and prevenhorJ ofsSt^T"6 "
Yehndur
the school children. Along with that nerson 11
nutrition, dental care wc^cwlai.tn
aware of the abov"ia^
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Malaria, were explained to
°f iodised saJ^ importance of
Sch°o1 tc-h™ were also made
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Nutrition:
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cluldren and provided health and nutrition education
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chcck»PS3 immunisation of
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7. Safe drinking water and sanitation :
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PHC has taken up the responsibility of providing safe drinking water by chlorination of
over-head tanks, wells and also created avvaicness about sate diinking water sanitation
and construction of sanitation latrine.
8. Provision of essential drugs :
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Thc PHC is committed to providing essential drugs and ail the essential drugs arc made
available al tlic PI 1C. Rational drug therapy is practiced in the PHC.
Jh Community Partfclpatlon;
Idle PHC ensured the Equitable Distribution of Primary health services by ensuring
access of health services to the poor and the marginalised especially SC and ST
communities by special efforts like Yellow Card Scheme.
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PHC stalf participated in the Grama Panchayat meetings at Gumbhalli and
Ycragambally.
Pillage Health Committees (VHCs) have been set up and these provide support in
various health activities in all the sub-centres.
. Mahila Swastha Sanghas were involved in all health programmes - motivation for
stcnhsations, immunisations - and tl1Cy participated in group discussions
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Local resources have been mobilised for the effective functioning of the PHC.
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10. The appropriate health technolo;HYj, Like ORF, traditional medicine, arc promoted in
(he area and the health stall aarc provided suitable training to do this.
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11. Morts arc being made to ensure Multi-sectorial approach for the intemted
opmeut of the people by the convergence of various senaces at community 1^1
Health, Education, ICDS, Panchayat Raj Institution, Public Engineering etc.
addition specialist services are also made available at PHC.
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io the health activities supervise the socio-economic activities.
Conitnunity Or^tinisafion:
a) Mahila Sn-asthya Sanghas:- There are five MSSs in C
Gumballi, Komaranapura,
Garuganur, Krishnapura and Uppinamole villages of PHC.
-. Health Baby shows and
health awareness camps are organised by MSSs.
SCVC" SHG fir°UPS haVC bCCn f0rniCd t0
^cro-financing and
Ecvnonuc Developm^ni:-
D^ACJiA prognmune: 12 DWACRA groups have been fo.
rmed in Gumballi,
Komaranapura, Ganiganur, Krishnapura and B R HilK They
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y arc being hujkivised by KT
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Ganiganur, Krishnapura and B R Hills villages.
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KVJC ProQramme:- a) Spinning Cotton and Polyvastra : 50 Women
b) Agarabathi rolling
• 60 Women
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H. Irainings to the various staff of PHC :
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for PHC .MIfon 04.01-98 by Dr. Molhi
2. CBR irming by Mr. Rajendra and Mr, Kevin of AciionAid.
T KCH training programme for one male Health Worker
u icrculosis training at Nil, Bangalore for two Male Health Workers & Lab Tech
6 MentalV1
Heart
Contr°l by Dr. Mills, U.S.A
6. Mental Health training by Dr. Kishore of NIMANS once a month
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15. Unison with (he Goven11ncnt:
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We had excellent co-operation and support at the Directorate and Secretariat level.
However, we had many difficulties and hardships at the District Health Office level due to
the mis-understanding of the punrose of the collaboration of NGO and the Government in
providing Primary Health Care to the people. -Hie formation of high power committee to
bnng about the collaboration is a good step and we look forward to better partnership at
the District Level.
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15x-(-onstr?hUs and Problems;
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1. Inadequate infrastructure for PHC. PIIC building has not been contracted and at
picscnl (he PHC is being run in tcmporaiy building.
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2. The non-availability of supervisory level of workers like LHV & Senior Health
Inspector as they have not been sanctioned.
3. The non-availability of IFA tablets, Vit ‘A’ drops, disposable dai’s delivery kits
Anti-Rabies Vaccine & Anti-snake Venome Scrum.
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Major Achievement of Guinbhalli PHC since July 1996
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1) Infrasucture:
a) P1IC RnihSng: The PHC docs not have the building and we arc running tlic PHC in
tho Kiu unn TiuhI building.
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b) Su^ntre buildings
The B R Hills sub-centre building has been renovated by
Karuna Trust funds. Hie newly built Komaranapura sub-centre building has been handed
Pe,r,t0 IFCai’una Trust- 11 has bcen fully equipped and the ANM stays in the sub-centre
building.
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2. Staff:
Medical officer and other paramedical staff have been appointed by the Karuna Trust and
re-onented m Pnmary Health Care. In addition a Lady Medical Officer visits the PHC
for vWOmCn Hcalth (RCH) Pr<)Brammc- The Medical officer was available at
Lnc PHC. throughout the Year.
3. Specialist Services & RefTerals:
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a) Regular Leproscopic and Tubectomy surgeries are being conducted by qualified
Surgeons,
b) Obstetrician & Gynecologist visits PHC once a month
c) General Surgeon visits the PHC every week.
d) Reflerals are made to District hospital & K.R. Hospital, Mysore.
4. Ambulance Services:
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A fully equipped ambulance service is available at PHC for various Medical Emergencies
Immunisation Programme and Family Planning Programmes.
5. Sickle Ceil Anemia Screening programme-
Tribal people suffer from a genetic disease calfed Sickle Cdl Anemia. Our Laboratory is
well equipped to diagnose Sickle Cell Anemia by Turbidity test and Electrophoresis.
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dHmprqvciiient in the Health Status of PHC Population.
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The Crude Btrth Rate, Crude Death Rate, Infant Mortality Rate, Child Mortality
Ratc,Undei- five Mortality Rate, Still Birth Rate, Perinatal Mortality Rate Nco-natd
Mortality Rate, Post natal Mortality Rate, Maternal Mortality Rate of the PHC area are
m'nCr
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°1StnCt’ S(a‘C “nd National I^vcl Figures. Mother and child care, Family
mng piopjarnmc and Immunisation Programmes have achieved greater success
comped to Dutuct, State and National Level . (Details are enclosed).
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_7. Blindness Control Programme:
Phe Cataract cases are screened by field staff and an experienced Opthalmic Suigeon does
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cxtraction and provides Intra-ocular lenses (IOLs) to all patients free of
8. Integration of CBR:
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The Primay Health Care includes Curative, Preventive, Promotivc and Rehabilitative
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?_«-Mental Health A Epilepsy Control Programme:-
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Hot Water Epilepsy is prcvalant in the PHC area and
a programme has been launched to
control the Epilepsy. With the help of NIMANS
we are provideng Mental Health
Programme to the PHC population.
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«n<l holistic approach to Primary Houhli Care
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Pr0?TT' Comn"mi,y
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rrasrammes. Reproductive and
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VITAL STATISTICS OF GUMBHALLI PHC 199K
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PHC
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HFA
1997-98
1998-99
1 .Crude Birth Rate
16.10
17.0
23.0
21.0
2.Crude Death Rate
5.6
5.4
7.6
9.0
3.Infant Mortality Rate
37.8
53
60.0
4.Still Birth Rate
36.6
21.2
23.3
5.Perinatal Mortality Rate
67.7
47.6
44.3
6.Neo-natal Mortality Rate
31.5
37.8
54.1
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7.Post natal Mortality Rate
5.4
B.Child Mortality Rate : (0.4 yrs.):
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9. Under 5 Mortality Rate
(0-5 yrs.)
18.5
1.56
12.4
23.5
9.03
7.2
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10. Maternal Mortality
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PROGRESS REPORT 1998-99
GUMBHALLI, PHC.
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PHC
1997-98 1998-99
%
%?
STATE
HFA
%
%
01. Birth weight of babies below:
2500 G.
7
9.7
30
10
02. Pregnant Mother receiving
ANC (3 visits)
102
92
70
100
03. Deliveries by Trained Birth
attenddnts
100
100
80
100
85
100
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04. Immunization Coverage
Pregnant Women)
100
100
Children
97.3
98
71.4
79
Eligible couples
682
650
Elective CPR
58.4
74
Permanent Methods
105 (26%)
109(23%)
63 (16%)
144 (36%)
77(16%)
160 (33 %)
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100
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05. Couple Protection Rato
(Cumulative)
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06. Family Planning
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Temporary Methods
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KARUNA TRUST (R)
MODEL PRIMARY HEALTH CENTRE GUMBALLI
\ ELANDUR TALUK, CIIAA1ARAJANAGAR DIST.
■IX
Receipts and Payments Accounts form July 1996 to March-99
_______ Receipts
I. Grants received from
ZP
H. Contribution from
Karuna Trust
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Amount
___________ Payment
Recurring Expenditure:
Amount
12,80,956-00
Salaries, PHC staff
Salaries Driver
4,86,813-00 Medicines
Administration Expenses
Vehicles maintenance
1 raveling Expanses
Miscellounce Expenses
Stall Bendits (PE)
12,43,328-00
32,400-00
2,89,751-00
26,316-00
1,15,253-00
4,654-00
3,450-00
38,508-00
Building Repairs & Mainten.ance:
Total
Hospital Building Repairs &
maintenance
17,67,769-00
_____
Total
14,109-00
^7^769-00
SUMMARY-
Grants received from ZP
p_
Rs. 12,80,956-00
Contribution from Karuna Trust Rs.
— 4,86,813-00
72 %
28 %
17,67,769-00
100 %
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karuna trust
PfiIMfW HEaiXH £kNTR£. SUJlBHLk.1 - YEkHWUR TALUK
CHAMARAJANAGAR district - KARNATAKA
RECEIPT AND PAYMENT ACCOUNT FOR THE MONTH OF
01/04/1998 TO 31/03/1999
RECEIP1S
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AMOUNT
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Grants received from
Zilla Panchayat:(73%)
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a _ To Salaries (90%)
b. To Medicines
c. To Administrate on
cos t
d. To Travelling Exp.
2.94,366
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4,49,6:j
By Medicines
1,11,2Ej
9,0(!
9,23
2,99,020
By Vehicle maintenance 54,76
(Ambulance-di ese1
and repairs)
BY Travelling Exp.
4,65{
Contribution from
Ka i una I r ur. L
& Action Aid: (27 %)
a. To Salaries 10%
b. To Salaries driver
c. Administration
cos t
d. To Vehicle mainte
nance
e. To Medicines
45,288
9,000
4
4,234
54,765
61,289
1,74,576
)
By PHU Salaries
(Approved)
By Salaries driver
books, electri
city charges)
2,99,020
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By Administration
expenses
(Stationary and
4,654
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PAYMENT
III . Due from Zi. Ila
Panchyat 0h:Nugar
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1,74,576
1.64,973
6,38,569
6,38,56
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For Karuna Trust (R)
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H. Sudarshan
(President).
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2£ RlillU COUPLES 1998’1999,
ANALYSIS OF ELIGIBLE COUPLES:
AGE -HISE
Age of [Totallnse-lTub-e-.'I.U.D,1 cc
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15-19 ; 56 ;
20-24 ; 433 :
25-29 ; 547 ;
35-39
226
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Living.'ECs ftoiy |ctoi>;
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1109; - ; Q; 6 1
8 I 15 ; 30 ; 29 ;
! i3o | 40 ; 63 ; 68 ; 301 ; 54 ;
1 123
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: 325 I 32 I 99 I 54 ] 460 I 20 I 12 [
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! 567 ;
9 ! 16 ; 26i ; 4 1 12 ;
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; 319 ;
8 ;
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; 226 |
; 195:
- 1 105; - ; 2; 7 ; 20
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980 ' 77 ■' 135 ! 160 ;iJ52 I 31 ; 43; 7 ; 278
Eliaiblg Cojaki; 1711 (15.84)
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AKALYSIS OF ELISB’E COUPLES-LIVE CHILDREX - WISE
1 79 4
Tubsctcay- 72.51, IUO- 5.71 , 0?- 11.81,
CO- 10.Ot,
Total; 1711'
7 I 8 I 9 ; 10 1 11 ; 12 ;
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1 i 357 ; 32 ] 60 ) 45 j 494 j
! 8 ; - ; o5 ;
4 I is I 2i ; 362 ; - ; 3 ; i! so;
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! 4 ; 22 ;
i ’so; 77 ; 135 ; ho 11352; 31 ; 43 ; 7; 2?8;
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£! ElieiSLE COUPLE?
SUJ C1MTR£
AHA:’SIS OF ELIGIBLE COUPLES:
AGE -RISE
bgt :f |Total|V2se-|Tube-|I.U.Dl CC
«:'! I £Cs ,'ctoiy|ctoiy!
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20-24 1174 I
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35-1’ ! 94 I
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Totii ; 642;
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AHAl^IS OF ELIGIBLE COUPLES-LIVE CHILDREN - WISE
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[ten I
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7
2 ; 10 ; 15 ;
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70 1 21
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120 1 2 | 2 1
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1 120 1 15 1 19 1 19 | 173 | - : 2 1 • 1 28 1
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31 [
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31 ;
1 57
1 510 }
Tubectoay: 75.9t, IUD: 6.1$,
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70 ;
1 79.4%
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| 30
1
: s; E.MjPeii '
I
9
3 1 15
1
No of iTcUl'VaseclTube IUD [MirodhfOral [Total;1 P.S
livingiECs ;toay |cto»y;
JPillsJF.M 1
I
I
I
i
Chil- ;
lAccepi
I
I
I
i
i
I
I
i
dren !
llors !
I
I
I
i
1
741
;
1 9
1112 1
2s-:9 lisa ;
30-14 ;il5 |
4
PUPA POPULP"^ 426?
OP: 11.2t, CC: 6.81
i
i
2 |
i
i
9 1 12 1
6
; los
:
6::
Total! 642 1 -
I
!
1
]
6
35
! 15 ; 7 : ■I -: is;
: 42-
I
■;
4 1
is:
141
20 ;
1 57 1 510 | 9 1 12 1 6 1 105 1
U
ij
O------■
<-
i
t
<•/ u
O
G
G
(J
u
G
'J
(j
u
j
G
*
J
U
<j
U
u
(J
u u
J
U
<J
(J
(J
-
«
<J
U O
ANALYSIS K ELIGIBLE COUPLES 1998-l;'-9
CENTRE 8 8 Hills POPULATION 1829
ahaim:s OF
ELIGIBLE COUPLES:
AGE -NISE
•
iii
'iii
‘iii
1
;
2 I
;
3
4
ANALYSIS OF ELIGIBLE COUPLES-UYE CHILDREN - WISE
; op JToUi; P.s; s.s; LU IRena
Age cf ;Totai;Yase-|Tube-|I.U.o; CC
i
Kite ! ECs ;ctosy!ctosy]
•
:f.« i
i
i
i
i
i
i
i
i
i
: 7 : S 19 ; io ; ii ; 12
: o :
2
:
! 27 ; 6 ; 16 ; is ; 6i ;
1
1 69;
I
8 ! 9 I 97 | 10 ; 3 I
4
2
I 104 I
I 75 :
i
i
4
3
I
56 ;
! 49
I
3
4
:
;
0
5
s I
35-39 ;
44 ;
1
36;
4
Total | JH
4
8
; 54
i:
;
:
! 40 ; - ; 1 I
I
: 6 ; -
;
:
i
I usii ; 35 ; 39 ; 253 ; 11 ; 5 ; i : 44
CEB : Sit
Tubectoey: 66.4%, IUD: 4.4H,
30:
!
: zs
39 ; 2 ;
i
2 : 3 ; 4
i:
I
6;
;
:
sa ;
;
1
0
30-34 ;
I
i
8
: 60 ;
3 ;
I
6
Ho of |7otal]U’ec|Tube ] IUD [XirodhjOral 'Total; P.S! S.S] E.^Reaa |
I
i
Living!ECs jtoay Jctosyl
iPillslF.N I
! ining',
i
ii
I
I
i
Chil- ;
IAccep!
i
i
i
JECs !
I
I
*
i
i
I
I
i
i
dren !
i
[Tors |
I
i
i
t
i
25-2? ; 97 I
7 I
i
i
6
20-2< !
40-44 ;
lining
I ECs
5
1
15-1' ; n ;
i
i
i
i
i
;ac«o!
iters '
i
i
94 ;
I
I
I
I
OP: 15. A,
CC: 13.8%
|
5
6
7; 8 : 9 : i: : ii :
:
|
6 ;
15 | 26 1 51 |
;
13
; u
; 97
;
;
i
i
4
I
: 55
I
38:
I 28 |
I
2 I 4 ! 34 ;
; 15;
: 12:
Total,1
314!
5
2
: i : 13;
I
i ; •
12 I
: io;
i : 2 ; 3 i ii;
4
r
*
-: 161
;
i
8;
: -: i:
0 1
J
l
2;
:
2;
; 168; ii ; 35 ; 39; 253; 11 ; 511 ; 44 ;
(J
o
r
c G C
C
G
G
tj
L
(j
O
u
(j
• '>
< *
p
u
G
U
C L
LUU
o
(j
O
O <J tj
(j G
n
n
(J
G G
r
fy
(j
(j
2F ELIGIBLE COUPLES,
£•22 CENTER GWBALLI POPULATION 479g
ANALYSIS GF ELIGIBLE COUPLES:
AGE -USE
Age of ;Totai;vase-;Tube-;i.U.;; CC
Wife
! OP ;[Total; I.S[ s.s; M JReea
i
i
!f.i : II
,‘inins
i
1 Accept
!ECs
i
[tors !
I
I ECs ictoiyjctoiy;
ANALYSIS OF ELIGIBLE COUPLES - LIVE CHILDREN - WISE
I
'•it
'•ii
i'ii
i
1
: 2 ; 3 ; 4 ; s :
6 !
7 ‘
8
I ' 1 io ; u ; 12
15-19 1 18 1
[
20-24 I 165 !
1 33 | 13 1 24
1 20 ] 90 1 2 j 3 1
25-29 ! 312 ]
; ns; 2i [si
[30 ; 260 [ j i
30-34 | 144 ;
; n3:
:
35-39
88 1
i
1
i
; 4
3
1
! 2
6
0
:
: 70
i
: nt:
! 25 : 19 I 20 ! 23 [ si ; - ; 20 ; - ; 64 ;
[
I
3 ! 4 ! 5
<?;
;
6 ; 7 ; 8 [ 9 ; io ; :i ; 12 ;
I
5 ; 7 ; 12 i n ;
i 19:
i ;
:
j?
2
1 258 ;
1 162 1 12 1 28 ! 22 1 224 | - ! 5 ! ■ ! 29 J
! 122 ; Il 81
1
13
3
! 204 ;
: uo;
7;
[
3
4
:
66;
: 64;
: i:
:
o
5
: 14;
: 141
76;
: 2 ; 78 :
40-44 1 28 1
! 27 ;
I 2? ;
Total ; 755 ]
I 425 1 35 1 65
;
i
i
i 6 J 12 [
6
Ho of [TotalIVaucilube [ IUD [RirodhjCril [Total! P-SJ S.S! • llReea j
I
■
tivingjECs ,'toiy [ctoiyl
iPiiisifj ;
lining!
I
i
I
i
Chil- !
[
1
'.Accepl
!ECs
1
I
i
i
I
i
i
dren [
;
llors !
I
:
! 61 ! 589 [ 11 ] 26 ;
CPR ; 78t
TUBECTOHY: 72.255 IUD: 5.9%, OP: 10.9%, CC: H.0%
; 129
Totall 755 !
4 [ 11 1 12 1 187 1
i
»
1 I
i
- !
; i:
65;
! 14 ! - ;
: 161
!
1 !
0 I
; <25 ; 35 ! 65 ; 64 ; 589 I 11 ! 26 : - [ 129 !
r
r
G U G U O f/ I
r
(
«x
G
L
G
FORM - 7
MONTHLY REPORT FROM P1IC/UIU3AIN/D1SPENSARY TO DISTRICT
(REPORT OF MEDICAL OFFICER)
I
General
6. Eligible Couples (as on kt April of the year): .1.G.SQ...
81
No
Soivics
ParfomiKnce
in correspon
ding month
lust year
Performinicc
in the repor
ting month
Cumulative
Performance till
corresponding
month of kst
year
Ciimnliirve
Performanc
6 till current
month
Plsmned
performanco
in current
year
1
2
3
4
5
I G'1-
I 6.?
1‘t'i
1
Ante Natal Caro
Ante Natal Cases
Registered
a) Total
____ b) Ixss thim l2 weeks
I 2 No.of prrgmuit woinnn
who had 3 check-ups
1.3 Total No. of high risk
pregnant women attend
Aliened and Treated at
PHC Referred of FRU
J.4 No. of 'IT closes
a) TTl
b) 'IT 2
'
c}J3cx>3tcr
’"
1.1
23__
13_
3^
.ao
LlSzl
-1L£2L
2A
06
32.
'X
Ol
03
gl
arp
~T~~{—
as^_^as
sg
04
S9
^76
~^3g~
J53jz
^7^
ag't
I ooz
J oe>:
roo?r
IS No. of Pregnant women
uniter treatment for
anemia
1.6
No. of Pregnant women
given proj)hylaxi3 for
____ nnmiiia
2,
Natal Caro
2.1 Total No. of delivers
_2,2. TIqw. .delivers
a) (i) by
ANM/LHV
b) by trained Birth
— Attendant
c) Untrained Biiih
Attendant
2.3 Institutional delivers
(Total)
a) atPHC
~
M. at Sub- Centres
2.4 DNivcricn referred to KRU
Las.
I 19
I
MH
lLia_
i-^rz
i Ra
raq
100^
03
) 5
L2.
'3
J 35
Qg
ma.
isu
OG
3L1
03.
03
03
05
03
O] .
is
J-W
i
Wk
SV
33
MW
60
<3
QSZ
~ZI J.D...
47^
?
J
o
M
3
3.1
J
3.2
c;_3 i
3
3.3
New bom status at birth
a) I .ess than 2.5_k<;
b) 2.5 kg. or more
c) No of high risk new
boms referred FR.U
)
4.2
5__
3^
U.
5.2
•v I
6.
6.1
BCG
F
M
F
23. qs log
04
95
72— -L5_n£
oo OQ_ Do
m ___
_LL
96
12.
71
06 13
21 so
u
13.
14- 13-
6s
oo oo oo loo
i
2
JS
as
oi~
00
5-3
5?7Z
36 39 35
.31__ 75.36
3
.. 1 $?3
OS
.2a
4
5
L2Q
LS
a|<
1 3^7,
£321
_____ _____
M
F
_M___ F
-J2Q
oo
O.<2
__DQ
... 0 7)
oh
M
F
M__ _ F
_1£5
do
1 sl
.... da.
—-1Q__ 1J. .. .0'8 .0.7
1J8 .. I OO ijMloq 216
qqz
DS4O8_j_l_i_
ns
j.ia
DPT 2
L3D.
rnz
^1L
I
ms
__ og Josl
osl j. a_ os i al 4j2—}J,3O44.
___ .DPT 3
II
az
----- Did 01 73- na ias
___ I3PT BOOSTER
-1jj- 1 J.3_ .016
.7
I
0^.
-----09
b
.
dlasxld
aa.
opvT
115..28_ _9U _ ,W
0[-? Oh:
ov-:
11
*'■ HV 112
OPV 2__________
120 IQ7. JJ16
___
09
....
1 L1QZ_
KL_ 03 lag-, He? ISO.
417
112.
uaz
T- OPV3
: iw na. IS 09 Tas] qq 131 ,___
MEASLES
113
a
14
I08Z
12 nd LO 1Q_
7.2
Children more than 18
U3. lisTag- air
9
8Z
______months___
brri3Z
-
M
on
W'hJuii o \vcck.i »>( dclivciy
Cases detected and
treated
6J_ -Coses referred to FRU
7Immunization
7.1
!P.r4nLPJo^£ycar
F
oa. oa 01 04
03 03 OG 01
05- olJ.ol l.oa
Postal Nutd Care
No. of women given 3 post
natal check-ups
Complication referred to FR.U
Maternal Deatlis
During pregnancy,__
Dining Delivery
rti zsn
M
os 05 LM
__ CLQ 0Q__ OQ 00_.
_____
4.
4.1
1-
_
on. o.r oy. 05_ .linJjTL aa_^3
— .03 06
J
3
3
Pregnancy Outcoi 11e
No. of bii ths
a) Live births
b) StiB births
Order of Births 3.1
a) I st
b) -21,(1
m
7.3
7.4
D1XI Boostcr
OPV Booster
Full hniniinisation
Cluldren more Lhaji 10
years
DT
---------Children more than 10
years
7T
-ET_..b
-35_ ad— iia
aiT~
lOzj
~ i..aa_ 17.41'33 737 -115 IB
3a
aia__
11L . 02i IQ.... in 14- J14 _ I IS
50
55
106
34
ara
QfTZ
VS-
85-35 '
1o/ITd5 "2o1?sI3os
i
n
(
j
M
75
F
Chil<Irenjnorc tliaji_16 vcnis _
BIJ. F
T’f_______________
8.
>
3
O
o
J
■’J
3
3
3
3
9.2
ARI under 5 years (Pneumonia) OLI.QL
n) Cnses
b) Treated with Cotrimoxozolc
3
I
u) HaFcficd
3
3
9.3
h
3
Q
n
3
U
ok M
ot
01 01 06
31 01
DI 01
j
1
7'1 •fl 6qZ
. 6'2: .65
36
as
2216__
6^g
253
____
qx
CVi
ISlSL ^5 316
^3. 51 <A-S ai£
06 0?l 35t
si 45. ai6._
W on. i;/ Li '■z^L tr/_Li..Q«__ SS^
d) Dea Ills _________________
Acute Diarrhoeal diseases
under 5 years________________ 03. 06 06 05
41
a) Cases____________________ 03 01 0£_ 05
n.a.5ELSL..‘21
b) 'Treated with OR.S__________ 03 QA DA.
11Q
■ 253_B1_S1
c) Referred to
PHC/FRU________________ 01 03 03
.05
d) Deaths ________
C hi_1 (H 2C a ths_______
a) Within 1 week_____________ 00 QOjOQ C?..Q_ oo
-QU oq- O'
b) 1 Week to 1 month_________ 00 loo
Dolce. oo OO o I QI
c) 1 month to 1 year__________ Q.Q. 31... OQ or)
62l4o^Io^J^22 O| ot OO
d) 1 year to 5 years
oo" oo|Oo|oo
oo|5o loo |oi oo 120
10
sa
J
S
m 152 iso us. jQ?a_
sa
3
I
I 3
3 3
I 3
I 3
3 3
0 3
0 J
0 3
HTz
Deaths
3
[
ns_ m_
Neo Natal________________
Cases_________
Deaths,_________________
e) Whooping cough
_ Cases___________
Deaths__________________
f) Measles
Ca-scs
3
I 3
Tok
d) Tolunna olhex than
3
i
F
Cases___________________
Deaths
b) Poliomyelitis(Acute________
Flaccid ParalysisJ_
Cases_____________________
_Deaths____________
c) Neo Natal Tetanus_________
Cases___________________
Deaths-
J
i
na
M
D ip t h c ri a_________________
0
I
F
36
Adverse reactions reported after
immunisation
Vitamin A administration (9
months to 3 yrs.)
DO QQ.
93
Dose 1
11
03
(?O CXD
Dose _2
_____
___ l£k i.8
OQ_
Dose 3-5____________ ;______ DO OO oo OO
Childhood Diseases__________
Vaccine Preventable diseases
°o
9.
9.1
M
an
3^5U9
553
A£3
I,
r^rT
£H * b s
I
I
H
ii.i
11.2
1
111
Contraceptive Service
Eligible couples contacted
Mak Stejilisa hoii
a) Conventional_________
b) Non Scalpel__________
Female fitci ilnation
m
w'i? -h
■0 j
fed
£2 S
K £
3
2
1
¥
4j j
Q
v
£ £t£
A. >• 2.
*
QI
4_
06
OC?
O
5
98
f
V
L>
O
t
£
ss
O'f-
I 03
i 09
motivated___________
14-
04
I 03
I 03
followed up__________
14Total IUD insertions_____
Io
a) Cases followed up_____
Io
b) Complications________
c) Discontinued_________
Total Oral Pill users______
a) Old users
b) New users___________
13
c) Complication
__
d) Discontinued_________
Totd Condom users
39
Qi£
IQ
l^l
103
Q3
Jlc/L
43
44
HE. lux |6Q 66X
,44 ock 313
44 1C& Q13
m
1^)
31Q 116
Hl-
li/z' 169
co:
a) Total No ol < uiei
\\Q
133 CO
b) No.of cases
114
c
I
11.5
-r
i
-*»
r
11 6
it
o
2>
0
3
M
12.
!•
I6Q
135
13L
is
IBB,
55
156
F
2L
~L
M
Abortions___________
a) Spontaneous______
b) No._of NfITs at PJ1C
c) Casos followed up
d) Complications_____
c) Dcatlia___
M
1'
M
p
3
3
J
J
J
3
J
C
I J
3
C I
s!•
c
I 02>
!
1 3
I
3 0
1
3 J
3 J
B 0
3
- - .22 .
> i
...
SO
HI Facilities:
1. Transport: 2) Vehicle :
Total
2. X-ray Machine : Available: Yes
3. Status of cold chain equipments:
4
4
■>
Equipment
ILR - 300
D.E.Z - 300
3
J
Total Supplied
JLR^aoo _
I
J
G
___ oi
No.of Posts
Sanctioned
(VI
3
k
3
G '
I
3
c
Mf > (iii< hiding njiiroinlmQ
3
Hen tai Siugcoi i
_Staff Nurses/Nurses mid-wFfe^Pharmacist/ Compounder
Lab Tech./Lab Asst.
3
-E^liPK^phcr
3
Computer
Driver
3
~
"
(PHN/LHV)
c
C
1
OF DRUGS, VACCfNFS
SI.
Items
No
01 - Q^S Jackets
3
J
' 1
J
J
O
3
unit
QI.
O1
_J22___
^xZZ ___
0^
p^g^SUMMABLE.s AND EQUIPMENTS
Consumption
Stock in hand
Q7
g3o
__ iq-6
) S6Q
.1 S33
OG
333 g
/ 679
1-S-SOQ
9too
03 - Laparoscope
_0£ - _Nk2<ih Jackets
05 _ , .Oral Pill Packet
06 ICD^
07 _ Iron Solution
08 - —Vitanijr^A solntion
09 .JFA 1 .urge Tablets
10 IRA^tiialTTaNFs
’
DPT Vn<’< inn
12
13
14
15
Polio Vaccine
IT Vaccine
_
BCG Vaccine_________
DT Vaccine
J6_ _Mcasles Vaccine
' 17
18
RivsyipFFT
MTP Si action Apparatus
4
_ 13^00
'7350.
.. 9Q13Qfl*S
3 $50 Doscx
Doses ^6o 3X^25
Soroses 6'go Ccyi
£j-o Coeses go Doses
^0 rx>ses
IJ1 ‘J O 5
j
bo.ses
)O Do-SCs.
____
3
3
•1
3
3
1
J
Number of inspections made by MO, PHC during the montli:
l .I^HV....^
2. ANM
2. ANM
3
Number of Villages visited:
3
Note on Progress made :....
J
3
J
3
Bahince
_Shx:k
2_S3.
J2 _ Tubal Rings_____
H.
0
^)_1
01
£)1
'
-----------
Multi-purpose worker
Male
-——
Female
——————
3
Cj 1
si
’
Not in position since (mention
date for each vacancy)
—-
□mF
3
No.in Position
Supervisor (Malana Inspect^7)
(DEE)_____
_ _______ 1------- Z-
■c
1
No^Not woridng for more than a month
I I)KZ. MO
J
I
N(t^.
Ql
IV. VACAN CY POSITION:
Category
G ’
A 1
On Road
Qi
Working: Yes
J
I
<.
Total Working
__
___ Ql
oi
01
3. Male Health Workers
3X
j)
Slock Sufficient
for months
c1
c:
’J
I
-I
<
'X
I
NATIONAL HELAITI PROGRAMMES
1998-99
GUMBALLI PIIC
C
k
1
Pni'tk'ulara
<•)
i
' c I
O
0
v r
3
u
J
r
/1
kJ
I
c II
D
c
r
I .J
I
0
J
■j
t •J
>j
k*
c
r
<
1 J
a
.3
J
C
3
J
I
Cumulative
MB
PD 202
5
16
Total
2
218
5
1
i
1
15
9
12
1
202
_6_
38
195
_4_
3
J.12
X^ray
27
__07_
02
Eit.Pulm
07
02
6
47
207
" 4
4
0
'c
(
No. Enumerated______
Leprosy:
No. of cases registered________
No. of cases newly detected_____
No. of cases on treatment
No. of relapsed cases
_____
No. of reaction cases
No. of defaulter cases_________
JNo. of total RFT cases
No. of RFT during the month______
No. of RFT follow-up done
No. of total RFC cases
No. of RFC during the month
No. of smear taken during the month
During the
month
Tuberculosis :____________
No. of cases registered from beginning
No. of newly detected cases this month
No. of cases on treatment________
No. of defaulters_________________
No. of defaulters restarted
No. of sputum collected
No. offlputuxn collected this year
No. of sputum positive
No. of x-rays done
Epilepsy:________________ __
No, of cases regd. from beginning
No. of newly detected during month
No. of cases on treatment
Drug delivery point:
No. of cases attended actually
CHnfc:
No. of cases to be ait end cd
Ntx of GTCS
p. -4 .MA h'*-^t*»KrUA4
No. of defaulter cases
No. of defaulter started re treatment
Sputum 4-ve
~46
07
”03
Total
80
16
05
, 180
1548
37
Feb
45
HW
27
01
03
01
GTCS
70
10
30
OTHERS
33
total
179
__ [2_
33
33
----- ;
.
T3
I
J
J
Blindness Control :
JTotal No. of cases registered
No. of eases delected during the month
No, of cataract operation conducted this month
No. of cases pending this month
No. of Vit ‘A'deficicncy eases detected
No, of Vit * A’ deficiency cases treated_____
No. of eye problems treated during the month
_55_
02~
J8
17
105
105
04
< ’tasjcori
2?
1 otal no. of cases registered
No. of cases detected this month
No. of cases referred for treatment
No. of cases smear taken
No. of cases on treatment
05
02
20
Dental Health:
)
•)
)
No. of eases registered
No, of cases treatod during this month
Aids & STD,
No. of awareness programmes conducted______
No. of eases detected this month
No. of eases treated
No, of curicn Tefened
Diarrhoea:
No. of awareness programmes conducted
No, of eases detected during this period
No. of cases treated with ORS packets
~
Anaemia:
No. of eases registered____________
No. of eases detected during this period
No. of cases treated
Drinking water and Sanitation:
No. of toilets constructed during the year
No. of borcwcli Platform constructed during the
period
78
10
J51
48~
£78
178
I9?
122
190
26
2
AAtlioma
No. of Cases Registred______
School Heaith & ICDS:
No. of Schools in the control area
No. of Schools Health Programme____________
No. of Anganavadics in the control area________
Jjo. of Anganavadi Health Programme
^fo. of visit to Anganavadi
^o ofjjca]th education programmes conducted
f
54
10
10
11
11
IL
22
!
I
4
I
J
Community Based Rehabilitation Programme (CBR)
CBR PROJECT
10.709
J’< >lnI | k rj mlnhun <.ovr i < <1
Number of disabled poisons in the wcu
as per previous month
detected this month
> ni
> 73
VI
13
SF&ll
20
MR
20
MB
04
Total
130
73
13
20
02
22
04
132
COMMUNin ORGANISATION:
2)
Action Plan
J
2>
J
2>
"3
3
2>
01. Meet on message for prevention of
disabilities
02. Meeting with PKl members
03. Meeting on health messages__________
04. Anganwadi meetings
________
05. Parents meetings
06. Meetings in schtx21h_______________
07. Video shows_________ ____________
03. Awareness programmes
09. Exhibition on disability______________
10. Participation in :
a. Village level PWD committee_______
b. Panchayat level PWD committee
c. Taluk level PWD committee
d. Mahila Sanghas
c. Youth clubs______________________
11. Street Plays_______________ _________
12. Mass rally for awareness_____________
13. No. of family members who work as
____ volunteers in CBR programmes
14. Whether member of Self Help Group
( PWD or Family )________________
15. Observance of Special Day for disabled
Cumulative
Achieved
Total
till last
during tills
month
month
~03
08
05
08
07
03
03
02
01
03
05
02
02
01
11
12
05
05
02
02
02
05
03
05
03
02
02
Yes
3
16. Participation by PWD in programmes
17. Participation by their families
Good
Good
2.6
Fair
Fan-
Poor
Poor
J
m
Pre-Schcol Children:
0 - 3 (Angiuiwadi)
3-5 (Creche/Balwadi)
EDUCATION:
Number of educabk* disabled children
VI
sraii
MR
03
MD
Total
01
04
20
07
08
13
13
06
05
02
26
01
02
04
02
09
03
51
No. of children going to school
SjJCCUll school
Integrated
No. of children who are drop-outs
01
No. of children who never wait to school
06
No. of children / parents motivated
01
03
03
21
02
05
No. of children motivated to join school during
this month
No. of children attending Resource Centres
No. of children in need of scholarship
: 03
02
04
09
13
03
02
18
10
03
:
No offlcholnrRhqw |>rovidod
13
No. of students going to college
)
No. of students getting scholarship
HEALTH:
Number of PWDa assessed by CBRW
No. of persons with severe disabilities
No. of persons screened by Medical Officers
No. of persons screened by Specialists (Referrals) :
No. of persons refered for surgery
No. of persons operated as on date
No. of persons eligible for aids and appliances
No. of persons who require aids 5. appliances
No. of aids & appliances distributed till now
HI
73
VI
13
SP&H
20
MR
22
MD
04 '
Total
132
18
10
06
09
04
38
69
10
20
19
04
122
49
01
20
19
04
93
14
14
09
09
22
06
01
by
KT
11
2X
06
28
05
12
by others
05
16
I:
I °
'- L0
C I
I
I °
I °
t
o
I
o
o
o
o
i
No. of persons using the alx)ve appliances
15
No. of persons not uiing the appliances
01
No. of cataract cases in the area
No. of cataract eases refened for surgery
No. of jxrrsons luidenvcni aurgcry
No. of school screening camps held
: Completed 1998
No. of children screened and remarks, if any
o
No. of children identified with Vit A deficiency
:
No. children given Vit “A" therapy
No. of nutrition education programmes held
D
05
No. of families growing kitchen gardens
JECWQMIC REHABILITATION;
Total number of disabled adults
57
No. of disabled adults employed
O
Adults employed: 07
Self employed
16
Agricultural/
}
casual workers ) H
others
)
No. of disabled unemployed
20
No. of persons recommended for VTCs
08
No. of jMrnons czlmitto<J in our VTC
06
Number of
Name & address
of beneficiary
under Srff Emptoyn^eirt scheme:
Amount
provided
by CBR/KT
Details
about
business
Daily
income
4 Persons Rs. 1500 Each
271
Repayment
particulars
Remarks
IK
G
I °
1 °
41 °
: iJ
: i
(Pafe 4)
No. of sheep distributed
No. of offsprings returned by beneficiaries
o
o
- f
- 1
98 -04}
:
06
:
97- 02 }
PH
SPAII
MR
MD
59
19
20
04
102
30
11
08
02
51
29
08
12
02
51
No. of pen.ojK eligible for (xsiwion
3
No. of persons already getting for pension
O
-J O
1 I
No. of persons who require for pension
o
No. of disabled pensions distributed
□
details of self HELP GROUPS
VI
I
I
□
I °
o
No. of SHGs fonned till now
07
Integrated
Only disabled
Total No. of inciiibcrB in Self help groups
06
01
154
No. of disabled persons in these groups
Total amount collected as subscriptions
o
•• I
18
: 5200
No. of persons provided loans
42
D
No. of groups availed loans from Banks
o
D
O
L
1°
1°
J °
J
I
J
V
J J
I
2S
0
FORM-6
MONTHLY REPORT FOR SUB-CEN’I'RE/URBAN HEALTH
POST/REVAMITNG CENTRE (REPORT OF ANM A1PVV (MALE )
’i-
I General
0
1. State..
0
3. PHC
2. District
4. Sub-Centre.QxTob/?lk 5. Population of 5- C‘ A.^.7..7.
7. Reporting for the month of. ...Cl/llf.6...N.7.7
M^yf^
8. Eligible Couples (as on 1st April of the year):
7
SI.
6. Population of PHC l.P.^5.7
o
Service
No.
1
0
2
3
4
0
a) IT 1_____________
0
5
6
Jal
2J
2.2
'O'
2.3
-y
r:
u
Ante Natal Care________
Ante Natal Cases
Registered
it) 'rptal________________
b) Less than 12 weeks
No.of pregnant women
who had 3 check-ups
Total No. of high ii.ik
pregnant women
referred________________
No. of TT doses________
Performance
in
correspon
ding niontii
kad year
Performance
in the repor
ting month
Cumulative
Performance
till
correwpon ding
month of 1es<
yem _______
Cumulative
Performsnc
e till current
month
Planned
performanc
e in current
year
1
2
3
4
5
Z5
/4 7
i&f
to?)
6^
6^
1007.
/o3
IU/-
A/
K
131 •/.
/?5-
^s~7.
77
AqQ
/03
/03
^'5
^6
03
06
61
'7
07
b) TT 2___________
/4
c) Booster______________
No. of Pregnant women
under treatment for
anemia__
No. of Pregnant women
given prophylaxis for
anemia_______________
(T5
Natal C^re
1 otn! No. of de live1 s
£?
Home delivers__________
oj
a) (i) by ANM________
071
(ii) by LHV__________
b) by trained Birth
Attendant_________ OSL
c) Untrained Birth
Attendant__________
Deliveries at Sub-centre J
£4
06
7/
01
3Z/
l 3
09
05~
78
H7
c3g
07
((6
0 ,Jj
7_£_
01
Q!
29
x
C
73/
9^7.
tat /■
&C
67
rr?
5S
J'
^7
kk
^7
c2z)
foo/Sf-f637
/3’/
)
M
2.4
Complicated deliveries'
_ referred to Pl 1C/FRU
3. _ Pregnancy Outcome
_ a) Live births
b) Still births
——
3 2 . £2123 of Huths 3,1 (a)
a) 1 st___
b) 2nd
c) 3rd
33
New bom status at birth
a) Less than 2.5 kg
b) 2.5 kg. or more_______
c) No. of high risk new
referred to PHCZ FRO
4.
Postal Natal Care
J
D
i
i
I
>
:>
Oo
24
Otf
QQ^. CO..
_ DET 2
DPT 3
_ OP VO
0PV1
OPV 2
"opyj
7.2
7,3
74
‘
’
’
'
-------
63
Q5~
OA
C7f
0(>
^7
nt
3-Z
37
357 ._3^
<•><■»
II
44
00
17
oo
I3
lo
do
07
oo
03
OO
04
03
OZ/
3^
00
54
<lo_ oc
Io
C3
03
51^/.
or*
rvi
!%.
K
/4
ol
36
-k
o^r
^6
66
/03
—4—
O/
9Z/_ . 03
2V £51 _Q2
04
66
Q3
07 27l 64
03
o3
24_
_M2£s1^5
^Children more than 18 mori~fh7
DPT Booster
OPV Booster
"
^Fp^LlTITireiLsation
Children more than 5 years
DT
---------(.'hildrcTj niorc (Jinn 10ycnj?i
rr
03
05"
__ 4o
___
nr»
Q4
oi
00
M~| F
oo
03
co
£2
2L
o(
j: F
3‘1
04
o4
03
O3
QI
0^
M
4-
44
No. of women given 3 post
natal check-ups
4.2
Complication referred to
PIbVJIRU____
5.
Maternal Dcatlxs
5.1
During pregnancy
_52
During delivery
5.3
Within 5 wccks'ofdZhvCTy
_ RTI/STI
6.
RT1/STI
~
6.1 _ Cases____
a) Detected_____
_ b) Treated
c) Referred_______ ~Z
7_ _ Immunization
7.1
Infant 0 to 1 year
BCG
____O/y
—
_
n
M
cL
4.1
Dm
zz
-0_21
23
o3
OS.
06
oh
54
€2
M.. 22 /Z2_.—24__
57t
'rf
<63
h
^-T
//sy.
//3 7.
57
±L_ 57 77
IL
63
97____
22
94
1(3'/-
?/?
______
/o4 />
67
_°x
^.L
27f
Q4
56
Q9
OS’
06
06
04
57
57
3^
___113/'
62 _21
2h£
ZO
3?
56
56
-£0_|
6S
3H
7z/
I't
/QR-/-
±^L
Z£A7ZJ
6Q 3jr
I '~
30
/o/ Z
//3/.
22_., ‘Vf
7/0
/?r
42
___ /o?-/
9/
j /co-/.
-
.i
- —
J
J
*
J
fh
J
H
Contraceptive Service
11.1
’11.2
Eligible couples contacted
Male Sterilisation________
a) Total no. of cases
motivated
b) No.of eases
followed up
11 J
I'cnialo BlcnliaaUoii
o
3
O
3
3
3
*>
?
J
13
13.1
.]
7
)
10
1. )
ii
)
J
1
PU P f
hh Hi H ■ i
<3 3-c
OG
a) Total No.of cases
6C
motivated
b) No.of cases
_____ followed up
11.4 _ Total IUD insertions_____
03
a) Cases followed up_____ 03
_ b) Complications
c) Discontinued_______
___
_
u) Expelled
11.5 _ Total Oral Pill users_______
_ a) Old Users __________
_ b) New Users _____
c) ComplicHtioj]
d) Discontinued______
11.6 _ Total Condom users
0Z.00
12.
Abortions
______
a) No. of women
referred for MTP
b) No. ofMTP done"
5
.1
p- 5
•t 2 s
*XF 3
d
r
kJ a. J
2 v 5
iL
J
?
i
11
Jtlx
3£
)
n
c) Cases followed up______
d) Complications
e) Deaths ____
Communicable Diseases
Malaria
a) No. of fever
identified
b) No. of blood smear
elides sent to PIK?
c) No.of fever cases
given presumptive
treatment
d) No.of Positive cases
of malaria
e) No. of positive cases
-.B’YSP.£‘L4icaJ treatment
0 No.of anti-mosquito
activities co-ordinated
g) No. of high risk
villages identified
2Ll
°4
Ay
As"
46
I <o 7-
■1H
6^ij
hl>
noy
74
6^
kL
4£
3r
6//
° ~7 5/ /> 3^-7^r
3<r
35-
2k.
2k.
35-
67^
&k
/05/
37/-
Z^2-/
^2Z
3^7o
<’
JI
£_J2.
r
t't
r-
F
ToUU
pCVCCKloy
t-
tv
off
!•>
Ok’
:760
:^b
/77 3n‘
5J?3"
X/JY)
ry
os
■S£a
336
/9? 3i£
i>^y
//■cfo
336 H? 3iP
J-tZD
<A
3 I
J
io3i-
O-Z
d
J
g-i)
377-’
H07.
07
07
pHC-lOO
079 8
Af^Q
f <2^
v
g( 00^
I <
V
^7.^7
(°9-^/.
1
(
3
F
7.51
Children more than 16 years
TT________
7.6
Adverse reactions reported
after immunisation
Vitamin A adniinistrd-tion(9
months to 3 yrs )
8.
I
F
M
F
M
F
?7
08
<v/
o/
77
72
^7 // 7o
<•*0
u/ 3(^
Dose 2
_24 Q3 OQ Co ^£_
So ($> ^LhDose 3-5
Co
CX3
CO
CO
Io
fb
SA
9.
Childhood Diseases
9.1
Vaccine Preventable diseases
__ a) Dipthcria__________
_____ i) Cases detected _______
_____ ii) Treated
iii) Referred
_
iv) Dea tiis
_ b) Poliomyalitis (AFP)
____ i) Cases detected_______
____ ii) Treated_______
_ ilQ Referred________
iv) Deaths
9.2
c) Neo Natid Tetanus"
____ i) Cases detected______
ii) Treated_______
iii) Referred__________
>
iv) Deaths_____
d) Measles_____
i) Cases detected
>
ii) Treated
iii) Referred
iv) Dea tlis ________
9.3
ARI under 5 years
(Pneumonia)________
01
£1
o
op
Q9
(O
lo
a) Treated with Co___ trim oxozole
Ol
-QL
QO
.Q?
P7 _J&. -Io. -JZZ/.
b) Referred to
PHC/FRU_________ ______
Q|
oi
of
03
^-0_
<%
OS'
_c) Deaths ____
9.4
Acute Diarrhoeal diseases
_____ under 5 years
PJL
o^___ 3^
a) Treated with ORS
>17 3 7
!///
Of
PeL. O^
■^7 _c2L
c) Rcfcircd to
IkL.
PHC/FRU
00
01
^1 O( j^jO.
^jL ~^1c) Dcnth.^
Child Deaths
a) Within 1 week
Oo
-------Qo
ex-*
Co
QI
0(
b) 1 Week to 1 month
oa
00
C-Q
oo_ Co
co
QQ
Oo _£L
c) 1 month to 1 year
-------- pq_ OO
£9_ -£SL
Co
09_
d) 1 year to 5 years
°2 P°
_______ 00
ct
Co
00
co
I 00
pc
O(
Dofto I
I
M
M
r./z
DO
<•><•
Ui
3X
co
3 77.
. Z> c 7 •
c^zy.
g^/»
38/.
677^
o
13.2
Cu.t.xJ.'tM
zLjt f --- -
Tuberculosis_____
11) No. of suspected
eases________
__ i) Identified
ii) Refereed______
b) No. of sputum
positive eases
c) No.of TH eases
followed up
oM
07
0 f
Io
02
Io
Og
Balance
Requirement
IV Interaction with Community:
A
Si. No.
Meeting with_____________
No. of Meetings
1___ Panchauat Health Committee
2____
M alula Swasthya Sangh
3
Anganwadi Workers_____
V. MONTHLY STOCK POSITION
?
SI
_No.
01
02
03
_04_
05
06
07
08_
09
10
Item
IP A l.mgn
U'A Small____________
Vitamin A____________
Opening
Bal 2u ice
1160 '
50
Received
Total
Consumption
3oon
3^00
476P
^(13O
l^oo
630
3o
Co-trimoxozole______
ORS Packet*__________
Mctliy]ci~gom chine
Cholorophenaramine
Paracetamol
Anti-Spasmodic tablets
Inj. Methylergometrinc
ii Mebendazole__________
12
Syringes & Needles
13
Vaccine day carrier
S tcriliser/Autoclave
Chloramphenicol
16
Cetrimide power______
17
Povidone ointment 5%
18
Cotton bandage
19
Contraceptives_____
_______ a) Nirodh_______
b) Oral Pills_______ _
c) IUDs______
20
Disposable delivery kit
21
Chloroquine Tab.
630
3^4
600
^£>o
■^9
09
loo
too
op
o
of
±L_
o/
Ll__
05-
5yo
600
Hyp
(T
1Z1A
(3
13
30&
63
03
o
.33
-- -ac'V%a~~-seMb«*sr~ «>
9 6p
IO
%
Sr-
>
X
r
X
x
VACCINE RECEIVED FROM PHC
SI.
No.
7
2
2
2
6
Name of
Vaccine
weekly
session 1
Date/Dosc
DPT
OPV
DT______
TT______
BCG
Measles
Vaccine
received for
weekly
session2
Date/Dose
<
Vaccine
received for
weekly
session 3
Datc/Dose
Vaccine
received for
weekly
session 4
Date/Dosc
Vaccine
received for
weekly
Vaccine
received
Total
I
.g~6 J
6C c/z&M
f i (<
j
I
i
df r^J
L.
Last training attended (mention month & year):
Dale of inspection made in rcjxjrting month by :
^.-3^
s'
i) MPW (Male)
ii) MPW (Female/ANM)
K/ - 3-
I.HV
MCKPHC) •
- -1
bee------ LLriJ.r.2.2----DMO----------- ---------------------
A note on the progress made as well as the handicap or achievement experienced in the field either br<cause
of shortage of essential supplies, vaccines of personnel essential to the programme and resistance
encountered on account of social and'culturul beliefs.
(Do not use more than this space)
Signature ANM
Signature (Male Health Worker)
z
ri
r
1
I»
jl
34
‘f
J
*
f
FORM - 6
monthly report for sub-centrivurban health
POSI7REVAMPING CENTR E (REPORT OF ANM /MP W^LE )
I General
3. PHC
12’
^Sub<xnU'c.B..-R.:k).V.^ 5. Population of PMC 10,732.
6. Population of .
7. Reporting for the month ol:
8. Eligible Couples (as on 1st April of the year):
SI.
No.
Service
)
1
-----2
3
Ante Natal Care
Ante Natal Cases
~
Registered
a^-Iotal________ ____
b) Less than 12 weeks
No.of pregnant women
who Iui<I 3 ohock-upa
Total No. of high risk
pregnant women
referred
~No, of TT doj^7Z~Z~
■<
-•
___ 1. a) IT 1
5
6
?.
2.1
2.2
2.3
- -b)7T^.___________
—. c) Rooster
No. of Pregnant women
under treatment for
anemia
No. of Pregnant women
given prophylaxis for
_ jmemia
-
Core
“
Total No, of ddw^I
Home delivers
a) (i) by ANM
(ii) by LHV
b) by trained Birth
Attendant
c) Untrained Birth
Attendant
! Deliveries at Sub-centre
Performance
in
correspon
ding month
liud year
Performance
in the repor
ting month
1
2
oa.
Cumulative
Performance
till
corresponding
month of last
year
3
06
0^'
Oo
.0.6
00
Q£EZ
...03-.... .
71-
Qo
n
ua
OQ
r-a.__
5
Qty
3.1
I Q7Z
/€9>f
‘33
3-0--
?5Z
_LL
07
I gvb
Ij pQ£>,
ZZZZ
io
32.
73^
S3
. .3>.s___ _33____ 1.1^
Bl
00
1
I OQ^.
'rsz?;
ns
121
__on
4
3q-
.L30-__
00
Planned
performanc
e in current
year
_o±_
_.Q^__
10
J.O__
01
01
Cumulative
Performanc
e tin current
month
no
-J22.
2.Q.
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3.1
32
Complicated deliveries
referred to PHC/FRU
Pregnancy Outcome
a) Live births
b) .Still biiths
Order of Bn ths 3.1 (u)
a) 1 st
3.3
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b) 2nd
c) 3rd_________
New bom statirs at birth
a) Less than 2,5 kg.________
b) 2.5 kg. or more______
c) No. of high risk new
boms referred to PHC/ FRU
Postal Natal Care
F
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5.1
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6.1
7.
7.1
No. of women given 3 post
natal check-ups
Com plication referred to
I
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. JIKZL'IILL_______
Maternal Deaths
During pregnancy
During delivery
Within 5 weeks of delivery
RTI/STI
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Cases
a) Detected _______
b) Treated_______________
c) Referred____________
Immunization
Infant 0 to 1 yc^r
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Full Immunisation
00
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JT___________
7.6
Adverse reactions rc|>orted
after immunisation
8.
Vitamin A administra-tion(9
months to 3 yra.)_________
Dose 1_________________
Dose 2
I k>ac 3 3
9.
Childhood Diseases_______
9.1
Vaccine Preventable diseases
a) Diptheria___________
i) Cases detected_______
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iii) Referred____________
iv) Deaths __________
b) Poliomyelitis (AFP)_____
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ii) Treated
__________
iii) Referred_____
iv) Deaths
__________
c) Neo Natal Tetanus
i) Cases detected
I "
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ii) Treated_________ _
iiij Referred
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_______
ARI under 5 years
(Pneumonia)________
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a) Treated with Cotrimoxozole______
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under 5 years___
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PHC/FRU_______ _ oo
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c) Deatlis
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Contraceptive Service
11.1
11.2
Eligible couples contacted
Male Sterilisation
a) Total no. of cases
D
C
1
11.3
c-
0
11.4
D
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r
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11.5
b) No.ol cases
followed up
Female sterilisation
a) Total No.of cases
motivated
b) No.of cases
followed up
'lotai IUD insertions_____
a) Cases followed up
b) Complications
c) Discontinued
___i) Removed
ii) Expelled
Total Oral Pill users
a} Old Useis
J
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______
_ b) New Users
c) Complication_______
d) Discontinued
H.6
Total Condom users
12.
Abortions_______
a) No. of women
__J£fSn‘c_<l f°r MTP
b) No. of M TP done ~~
c) Cases followed up
d) Complications
e) Deaths ____
13
Communicable Diseases
13.1
Malaria
a) No. of fever
Identified
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b) No. of blood smear
slides sent to PHC
c) No.of fever cases
given presumptive
treatment
d)_No.of Positive cases
_ ofmalaria
c) No.of positive cases
__ given radicaTtreatment
0 No.of anti-mosquito
activities co-ordinated
g) No. of high risk
. ___ vL!h)E£5 identified
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SI. No.
Meeting with
1___ Panchauat Health Committee
2____
Mahih Swasthya Saiigh
3
Anganwadj Workers
J
V. MONTHLY STOCK POSITION
J
>
\
J
! si.
Item
No
9S
SLO
O?7
oz;
06
o§
06 ]
Balance
Rc<|Ujroinont
ao
Opening
No. of Meetings
___ Qi____
01
QI
Received
Totnl
Balance
_oi_
J
Jl£
QJ>
66
IV Interaction with Community:
J
4
Tuberculosis______
Lqsa
c
a) No. of suspected
cases_________ Q3
i) Identified
_ ii) Referred____
b) No. of sputum
positive cases
c) No.of I B cases
followed up
OR
1FA Larg e
_____
02
1FA Small ________
03
Vitamin A
04
Co-tnmoxozole______
05
ORS Packets _______
06
Mcthylrrgomctrinc
_PZ__ Cholorophenaraminc
_08 JParncetamoJ
J)9
-111L3Tn?nHXIi^ tablets
Inj. Methylergometnne
ji
_Mebcndaz^e
12
Syringes & NecdleT
13
T^ctnedayj^iri er
14
Stenliser/Au tocla ve
/3gQ~ 1 OOP
1 OOO
<-^5
Coiwiijnj)b(>n
2380.02.3^
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11
11
08
03
o'3
noo
03
To
I
03
CJiloiamphenicol
16
Cetrimide power
Povidone
ointment 5%
11
Cotton bandage
'19
Contraceptives
a) Nirodh______
. '370
b) Oral Pills
o
c) IUDs
L3L
'20
Disposable delivery kit
21 [ Chloroquine Tab.iTfi 6
330
-SSo
I gp
1^0.
a^o
IT
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I
39
-U-
VACCINE RECEIVED FROM PHC
SI.
No.
2
2
2
4
5
6
Name of
Vaccine
weekly
session 1
Date/Dosc
DPT
OPV
DT
___
TT
IH < i
Measles
Vaccine
received for
weekly
session?
Date/Dose
Vaccine
received for
weekly
session 3
Date/Dosc
Vaccine
received for
weekly
session 4
Date/Dosc
Vaccine
received for
weekly
Vaccine
received
Total
Soloes
S -Dos qi
J?
Last training attended (mention month & year).
Date of inspection made in reporting month by :
o
i) MPW (Male)
ii) MPW (Fcmalc/ANM)
So - OS'
LI IV —ia-.O3.2_SS___
MO(PHC>^Q_ lOSl^9___
o
bki-:
........
DMO---------- ____________
J
of shorter
XSw
ofZ^aP 7
encountered on account of socij and culturSZ
expenenced in the field either because
“
Hnd rCS1Stance
(Do not use more than this space)
Signature ANM
Signature (Male Health Worker)
40
i*
1
4
I
1
FORM -6
4
MONTin>Y
POS17REVAM1
4
REPORT FOR SUB-CENTRE/URBAN HEALTH
’ING CENTRE (REPORT OF ANM /MPW (MALE )
General
I
A
i. sutc.Ha^mb^hcv.. 2.
_____
_
,v,i3,
District
4. Sub-Centre.Komo^>fV6. Population of PPIC Sfe
4
Cr 3. PIiC
6. Population of
.
7.Rcporting for die month of: ..MraXc.U. 139<i
5. Eligible Couples (as on 1st April of die vearV
6 I5
A
.4-091-
1st April of die year):
at.
No.
I
4
3ci vU c
J
J
1
2
)
3
I
)
Ante Natal Care
Ante Natal Cases
Regia Usrcd
_ a) Total
_______ _
_ b) Less tlian 12 weeks
No.of pregnant women
_ wiio had 3 check-ups
Total No. of high nsk
pregnant women
refereed
No. of JTiloic.
5
J
6
2.
2.1
1*01 formunce
in the repor
ting month
i
2
3
4
5
09
06
1 73 R.
9S
50
30
I Q6X
64
54
I I9Z
33.
:n
So
) gg
180
<3^
9o
90
55
<^-3
___ Laa>L_.
3-0
<^-3
8SZ
ID
05.
a)TTl________
OS
h) 7T 2
_ _05
c) Booster_______
No. of Pregnant women
under treatment for
anemia
No. of Pregnant women
given prophylaxis for
-An£inia
___ ®S)_by_^NM___I
©.by.Biiv
E£E
S'o°r:}
08
._23___
_Q3
Ol
Cumulative
Perfonnanc
e till current
month
^c/
...Id ___
I ^'3
—?a___ _2>S_
94
13
Q>\
.
._____
Planned
performanc
e in current
year
10
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03
11
OK
05 _
”
b) by trained Birth
Attendant
c) Untrained Birth
Attendant
61 Sub-centre
Cumulative
Performance
till
corresponding
month of last
______ _ycor
ia
os
____ 13_
Natal Care
Total No, of deli vers
2.2 Hgnic delivers
_____
2
Peituimanc<3
in
correspon
ding month
last year
5J_
3V _
IE
la.
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II 7Z
1 iV'Z_____
i
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111
1
1
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2.4
Complicated deliveries
referred to PI1C/FRU
3.
Pregnancy Outcome
a) Live births
b) Still births
3.2
Order of Births 3 J (a)
n) 1 k|
bJJncL
I c) 3rd
3.3
New bom status at birth
a} Less than 2.J kg.
b) 2.5 kg. or"niorc_______
c) No. of high risk new
boms referred to PHC/ pp^ij
4.
Postal Natal Care
~
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4.1
No. of women given 3 post
natal check-ups
4.2
Complication referred to
PHC/FRU
5.
Maternal Deaths
5.1
> hiring pregnancy
5 2 _|_D£iring delivery
5.3
Within 5 weeks of delivery
RTI/STl
f
6.
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■
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Ca.--.c3
•QjDetected
b) Treated
c) Referred
7.
JniiiHinivuHoii
’
Infant 0 to 1 year
BCG~
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7.3 ^Children more than 5 years
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IT
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_____
3
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03
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Child Deaths
a) Within 1 week
------- ±11 Week to 1 montli__
---------- c) 1 month to 1 year
------- L^) 1 year to 5 ycys
£££ CF. I OF I o)
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a) Treated witfi ORS
c) Referred to
PHCVFRU
Deaths ~~
~
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ARI under 5 years
JTncumonia)
a) Treated with Co_, frhnoxozole
b) Referred to
___ PHCVFRU
c) Dea dis
__
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_ d) Measles
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.
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__ 0 Cases detected
u) Treated
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iy^Deaths
~~
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—__ Lofjor EoJooJaZ
laldhood I )i5('jinc'i
-1 J lQll'l£l\syaUablc_(i,5CU3c;1
a) Diptheria
-JlC^ses detected
u) Treated
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a
■
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Dose 1
Dose 2
Dose T5~~
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Contraceptive Service
II I
11.2
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Male Sterilisation
a) Total no. of cases
motivated
b) No. of cases
followed np
11 J
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----- dd^. o:x
a) lotal No.of cases
motivated
04oa
b) No. of cases
followed up
02
11.4
Fotal IUD insertions
0)1
----- ------- a) Cases followed up
q •!
____ Q3
b) Complications
'
F^cofitinued
i) Removed
ii) Expelled
I 11.5 Total Oral Pill users
a) Old Users_______
_____ b) New Users
________ <-oinplK^hjn
d) Discontinued
11.6
Total Condom users ~
1 E?0
12.
S1£L_
Abortions
a) No. of women
--- referred for M'H5
t^NojlfH^done
"
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O
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4
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dd
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29
a) No. of fever
identified
b) No. of blood smear
__ h!!lL e , Pile
c) No.of fever cases
given presumptive
treatment
d) No.of Positive cases
of malaria
e) No. of positive cases
/ 600)
—treatment
0 No.of anti-mosquito
-------- activities co-ordinated
g) No. of high risk
' ' '
__ — villages identified
_
3-3 id
03
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d) Complications
c) ITcnlhn
13 _ - Coilinnmic^
~~
13.1 __ Malaria
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'I\ibercu]osis______
a) No. of suspected
cases______
i) Identified
ii) Referred
b) No. of sputum
positive cases
c) No of TB cases
followed up
O
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06
IV Interaction with Community:
4
O
SI. No.
Meeting with _____
_J__ . Panchauat Health Committee
?
2___
3
J
1
D
Mahila Swasthya Sangh
. AJ1g:q> wadi Workers
No. of Meetings
__ax___
oa
._. dtz
V. MONTOLY STOCK POSITION
•O
1
J
SI.
No.
Item
O
O
61
II’A Large
IFA Small
Vitamin A
02
a
03
O
a
1
0
o
o
d
04~
Opening
Balance
Received
Total
) ! 0Q~' OOOQ. ^13.0
Consumption
Balance
Requirement
_3£iiG__42?UQ__
0?2)g
- 1-2-0 5.
Co-triinoxozole
05
ORS Packets
_06_ Mcthylergometrine T4»
_07_ Cholorophenaramine
0R_ Paracetamol
099___ Anti-Spasmodic
______________tablets
lfi__ JnJ NNbylergoinctrine
11
Mebendazole
JZ Syringes & Needles
J3
Vaccine day carrier
Stchliser/Autocla
ve
11
Chloramphenicol
16
C chimidc power
Povidone ointment 5%
Cotton bandage
19
Contraceptives
a) Nirodh
f±o£
9.0 0
clo 6
) 5“ O
GO
■^0.
^oo
Ol
Pl
Ol
I Ad
6^0
IL
11
u
n
t
b) o^TpiTh
c) IUDs________
r
L
n
20
21
Disposable delivery kit
Chloroquine Tab.
-LihS.
_2£
SQO
—
—=_____ QA_
1 1^ I 3oo
aa
OQ
.3^21
•8S
az
■i
-4
U
'■>,}
;<iC-3ir,-S_Li.
c
J
J
J
0
VACCINE RECEIVED FROM PHC
SI.
No.
3
3
2
J
2
3
3
4
3
2
6
Name of
Vaccine
weekly
session 1
Date/Dose
DPT
OPV
DI
II
BCG
Measles
Vaccine
received for
weekly
sessioji2
Date/Dose
Vaccine
received for
weekly
session 3
Date/Dose
Vaccine
received for
weekly
session 4
Date/Dose
Vaccine
received for
weekly
3
Total
^¥O£>QSgs.
-ZOJ^QSC^
^cpos5\s_
lODoseS I O
s
StWc!;
S looses
3
3
Vaccine
received
Last training attended (mention month & year).
Date of inspection made in reporting month by :
3
3
3
J
3
IJ
3
i) MPW (Male)
ii) MPW (1-cnialc/ANM)
lhv_
MOfPJICT-.*
____
BEE — —
DMO--------- _________
3
4
3
3
3
3
A note on the progress made as well as the handrcap or achievement expenenced in the field either because
of shortage of essential supplies, vaccines of personnel essential to theZgramme and n^e
encountered on account of social and cultural beliefs.
3
3
3
3
3
'1
n
..
u
3
s>
(Do not use more tlian this space)
Signature AN
Signature (Male Health Worker)
*
c
c
c
o
I
FORM 2
PHC ACTION PLAN
•i
3>
c
2)
c 1 o
I
o
3
SI.
No
c
£
1
c
o
o
-I
7
J
•I
i o
J
c 1
4
*>
I
C
J
J
r I 2>
I
* I
J
I
c II J“
-I
_______
P.n.c
No. of Sub- centres under PHC—CHS—
(As on 1st April)
Population of PHC ( fetal of population under sub -ccntrea)
J
C
£
Population of S.C------------ j—
Biith Raic- Drit/.State
Eligible couples------- -------------
District -CtlL
£
c
c
YCsr -m-agoo.__
A. General Information r—
State
6
T
Service
Performance
in last year
Antenatal Care
Total ANC cases registered in the PHC area
No. of liigli nsk pregnant women
-Treated
^Referred fo~FRU
N°2_2f TT doses given
TT1
TT2______ __________
booster_________
No. of pregnant women with anemia treated
No. of pi optuini ivoouMi
Given prophyaxis with IP A tablets.
|Nalal care
Total no. of delivers in the area
No. of home dcHveiy by
i
<4/
an
_53_
36
jlsi
a^l
03
03
TkD_
fls7
2sg
339
933
H3
1P3
39
ao
eft
_UL
)^D
Hl
■asg
I to
£0
ap
3^4
Isa
b) Trained birth attendant
_____ c) Untrained birth attendant
8
]No. of institutional deliveries
a) At PHC
b) At Sub-ccntre
9
No. of Pregnant women referred to ZFRU for
delivery
Neo-Natal care
10
No. of sick new boms referred
Treated
"
Referred
~
Tl” MTP
No. of Ml’Ps referred to
FRU/ Dis trict
A7
I
53^
JZ3X_
H9
a) ANM7rJlV
Planned pcdormancc
current year compiled
from sub- centre plan
HrrnH-i
LM
Jlk
1 QrT
13^
S3
SS’
£3.
<5o
37
1 5
ax
33.
ax
az
2S
a-v
so
SO
13
07
07
21
79
07
•2^-
a^+-
Off,
02
0-1
M
0'2.
r
/
I
I
SL
No
F
13
>
Service
Performance
in l.iHt ycai'
Male
RTI/STI
No. of cases
a^Jdciidfied bj^ANM
b) Dealt with al PHC~
Female
<\\ yx xJ
J_51
ii) Related
Immunization
No. of infants immunized (0-1 year)
DPf-1
-----
'IH
--------
'2)C
9[zv
'21^
9^4-
J_Q9__ I 08 2ii. ±S.
su^
18
------ ajx—|-a9-a._|2j_o2i___ HZSjHll
log Qn 18
--------------
PPI -3________
OPV-4)__________
.OP_V_-1_______
__ 3U W
OPV _7
______ '
_2HSL
OPV -3
?JL_ 935----- Measles
'■2i a
15
No of cluldrcn immunized (more than 18 months)
1
I
I
H
I 0 8 217
J 08 |a 17
IE
IE
9/Q
/ 85
±O2£
] 07
9/4- IS
908
| 7q
! OS
I 05
9/0
LQE
9.-1
) no
Oo
1W i-L.
spi
9 EH
989
I 05
J_09
Ex>»a 1SS3 90
I 08 9)7
108 914 )g i
33 s <$S) 5<'t- I
18
No. of children immunized (more than 16 years)
IT
IFA
“
21
No. ofchildrengivcnJFA small (below 5 yean, )
No. of children administcrctl Vit-A
(9 monilu to 3 yearn)'
-----------Dose 1
-------- —------- ----------- 1 QEo
Pose 2
’ -------------------------- -J2J £
Dose 3-5
“ ---- -------- -------------ARI
------------— /HE
NPijof PQ^cs under 5 with pneumonia
a) Identified by ANM
------ rl) 6
5) Apeiidcd at PHC
~~
- ------------- 9l 6
—if
ii) Referred
9 2’.X__
■JOV
1 I 8
7?^
33^
IX_ I 09
36
log
a ix _ _ St
co trim ox o zol c
-—
~
<J6
roET1S3
_ ___ J
l<o
-1
) 08 |9| 7 |E
18
.10£.
I 09
No. of children immurized (n^rel^TcT^f"
1
I 05
I 09
^11
913
17
20
108
1g
18
16
19
log
1 08 31?
I Og
Jj?£L
__
-l.Q£L__ I J o 8 77 7
7 12
_pF V B oo8 ter
No. of children immunized (more thanTyeam) ~
1
JOS'
1 51
I5|
i) Treated
14
ExpectedRequirement I
for cBurnt year
Male
Femalc|/<7~ HcJ-
1 OQ
55
an
■ ■log
/8
I7
|g I
IoE|if7|!8~
jog 10 ,
log ^?)7 18
S4- I o9
J]
SI.
No
Service
Performance
Expected RcquEcm-Int rVc‘ ^5
in last year
AoCN^
for current year
Of
JhC'/e<rx.
’
SJ
"1 civget
Male
Female
Acute diarrhoeal / diseases
^22 _ TTe^of ca^cii uudcr 5_
312g-
a) Identified by ANM
_ _E Attended at PHC_
_ OJTreated _with ORS
ii) Referred
Family Fhiuning
23
Male sterilisation
39<
-.^E
3^
) 6Q_
1
■ _alConY£ntiQnal______
24
25
b) NSV
___________
Female sterilisation
a) Abdominal
b) Laproscopic
JUI-) Insertion
a) By ANN^
6>6
J?) By niQ__
~3
_QraL£ills_uscrs__________
27
Condoms users
1^2
1 63
I 63
J-7.S.____
I 63
) Og
172
1^.
SR
163
81
) 63
83
&0
306 a?
3&6 g7
163
!13. C
39
) 0<3
ri
09 ‘
—-----------
Items
No
x
2
1
4
Contraceptives
Nirodh Pieces
Oral Pill Cycles
nibs____
Tubal Kings
Dm kits _
5
Vaccine Doses
DPT
7_ QPV
TT
._8
__2__ .BC(J ZZ
10
11
Measles
DT
‘
Prophylactic^ru^
_12_. JFATakLarge
JLL_. IFA Tab. Small,
Vit. A Solution_
JJ.___________
15
ORS Packets
_CjQirhHQxa2.Q.k_____
Tablet Paediatric
16
I
_1__ i
__ :n
3^
3.3
yr 'rig
33
lacashe.
0?
0?
I
Q±
03
log go?,j
I
Materials & Supplies:
Sl
l
r
Quantity used in
previous year
on 1st April
-l^Q.
._saao
__ LOA-O
Stock position
U d5
___ --------------------- ___ I 10
Additional quantity
required in current year
CNA
lOQ^G.^
I 3000 15-6^
5^
I 5?Ss|p
~ 33 ~~5a?
i
333
- - JJ7L9 D^_
^60
- g 35
--J3qX)05x-5
—
___
- £0130L__
- Sqi1^Q__ _
-A£)_01U_____
5 67
5^00
3 5-0 Dos<s 9^3-0 Doses
3.^0
313. SO.,
_ S_3_Q
i
Sa
-L°W&se I QOQ Doses .
lOOC?
1 OOOr>o3^S
------ Lo±g joos^s
E?
I
I
!■
_ ^2^230__
3^
^6
5500
5 600 '
3
fe
1
P£:
It
I
M
0
Equipments & Facilities
1. PHC Building Owned or Rented
'J
SLN0:>:
^Joj Available •<; HuTunctionihg:-
-------------------- i - ------------------
b
o
J2L ____ .Vchick_____________
CH
02
Refrigerator
03 ___ ELR
-CL1
04 _____ ___________________________
O I
05
Cold Box______________
__________
I 50
.06
JVaccine/ Day Carrier
0’5
07 __ X-Ray machine___
_0£L __ JUUKils_IZZ_____ _Z
0’3
_Q2_
Examination Table ________
O 1
JO
2y_«&hjngJMachinc; (Infant)
03
11 ___ EP Instrument ________
O£t
12 ___ Slcthcwonc~
0 I
13
Needles
14
Syringes
_ 1 5___
15
Autoclave___________
01
16
Steam Sterilizer Drugs
05
17
Operation Ilicatre
0
0
0
J
I
I
0
J
I
I 0
D
3
J
0
3
0
_11_ ___ MIP_SuctionAspirators__________
J
19 ___ Jjlfrljipjpgnl for Infant Resucitation
20_ __Microscope &J^bJEquipment
< ?.L_ ___ Qxygeni Cyl uidcr________________
22
I^abour Room I able & Equipment
23 _ Q T- Tablc________________
24
Surgical Equipments relating to PI IC
expertise
0
!
ii
*)
»
9
i
J
.
J
n
•v
J
■
'I
so
__ (M
.
0 I
O I
CH
CH
QI
ISO
03
03
01
03
0JO I
is
or
OS
03,
0 I
O)
> c
1
□
!
J
STAFF POSH ION
3
I
; i
. i
■>
J
- S
- S 3
- I C>
01
Medical Olficer -1
Number
sanctioned
Number in.
Ol
Ol
Ol
Oi
Medical Olliccr - 2
0J
Lady Mcdkal ( Mllccr
04
Dental Surgeon
05
Staff Nurse/ Nurse Midwife
06
Pharmacist / Compounder
Ol
O I
07
Ijib. Technical/ Lab. Asstt.
O I
o\
08
Radiographer
09
Computer
10
Malaria Supervisor
11
Block extn. Educator
12
Public Health Nurse
13
Lady Health Visitor
14
Driver
15
Multi purpose Worker - Male
16
Multi Puqxxsc Woikcr - Female
J
- a
C^gory uf Sialt
02
3
-
Sl.No,
5
- §
- §
3
i
4
-
- i
3
- i
J
Number vacant
since that date
2)
2?
I
J
oa
1
I
17
Class - IV Staff
03
03
O I
O I
j
I
I
i
I
S"l
pH £ -ioO
_______ ry/fo
073^8
/o/ v
1 9 V <•
q»>5<as1- L5‘-VjC>
10
ii
Neo-Natal care
No. of sick new boms referred
KHT
... —
No. of women referred for MTP
phir>tioj
cioce qo
_______ ^<^xX
_0A
04
01 ^.-Ol
I
TRI / STI
12
01
No. of cases detected & ref cn cd
|
a^y
aJ3
39-
3)3
I?
Female
Male
Male
Female
-J
7^
■
liiiinunisatlon
13
No. of infants immunised (0-1 year)
BCG
DPT-1
DPT -2
DPT -3
opvar”
OPV-f
— OPV-2
—rr
’OPV-3----Measles
~nr No. of cKHdrenlmmuhise’d
|g
3^-
91
33
!g
391£
ai
aa
15.
3^
S3
91___ _
9‘i-'
ig
19
13
1.3
13
12
13
37 CS
is
is
19
37 ifl3
13
12_
37 |Q3
27 03
____ Li
_ia
3/ 03
)3
•13
3? 03
is?
12
03
)g
i g~
99
.11
.15__. "59-
(more than 18 months)
DPI Boonior
'15
16
)6
OPV Booster
No. of children immujiiscd
(more Ilian 5 years)
DT___
No. of children immunised
(more titan 10 years)
as
ia
18
19
3? <22
92.
37 frT
37 02.
*
I,
if
rL_
I I
No. of cHnUr^ lmihuhiscd---------- (more than 16 years)
_ Tr
IFA
---- --------
17
i
■lot
0%'
08
No. of children given IFA small
(below 5 ycara )
No. of cliildi cn adxiunistcrcd Vit-A~
(9 months to 3 years)
Dose 1
Dose 2
' Dose 3-5 .......
)e
l$?
r/
34 03
Ii:
3<t- o3
Co
1^_
i I 0 l 0^
-Q1Z OS
L
99-
93
_ _I3_
[2S /.S
.L?.
1g
__IS.
3?
36
55
!l
02
)h 03
S-3
III
.ss
< -
W'
I
IJ
‘J
>
A
I
FORM 1
SUB CENTRE (S.C) ACTION PI.AN
A. General Information
state
District
P.H.C
Sub- centre —Ej--E47.1j_L1.Sj______
Year -1^3_^Q0Q_
Population of S.C —LSSSl _
Birth Rate- DisF.State --2PjLLQ.OO
Eligible couples----
(As on 1st April)
7
No. of Villages under the sub - centre
"J()
ANC-(lV>L>uh(ioil X Bn th rate) t 10%
JOOQ
SI.
No.
1 '•''^''1
Consultation with
No. of
Consultation
1.
Panchayat or health committee of the
Panchayat____________________
2.
Anganwadi worker / TI3 A
37
Women in Mahila S was thya Sangh
4.__ [TanTnica on HouscT) IiouacTasis
SI.
When consultation made
(month of year)
I g>
L^
fionih____
Homlb____
2E
Service
Performance
in last year
No
♦
Antenatal Care
2
3
registered in die area
------of7 high risk pregnant women detected and
No.
referred
No. of Tf doses given
~
rn
--------- ------- ------
Boos ter
No. of preghahrw^
No. oi pregnant women
given prophyaxfo with IF A tablets.
—
M
52
1 I
q-3
4^
47
04
06
Rj
"4F
A-\
01,
07
04
04
.44
aa.
3'1
Natal care
6
Total no. of delivers in the area
7 TJo. of home delivery by
~------^'ANNT/niV---------- ------------ ------------------------g— b) Trained birth attendant
No. ci institutional deliveries
—-----------9
No. of Pregnant women referred to PHC/FRU for
delivery
Planned
j>crfomiancc
_ in current year
ygoer
Ho4b
04-
“TIT------------ ----------------------------------4
"5
"2c>
DEL1VEKY/UVE B1R111- (Population x Rirth rate)
) 000
30
03
6^
JTJ
03
34
99
41
04
OSL
03
03
90__ _0.3L
3o
04
A3__ OS
OS
J3
37
f4
13
74
14
09
03
F1
4
I
pi3 0'5y^CKjrxe an
Ic^sV y^oci
mtxmce 3r-) CveuVe^
*
ARI
'Tc«a J
f
20
No. of cases under 5 with pneumonia
- Treated with co-trimoxozolc
- Referred
9o
Acute diarrhoeal diseases
21
No. of cawcs under 5
.___ . i_C‘WC8 healed with ORS
I
I - Referred
'J
22
j
No. of eligible couples who accepted permanent
methods out of couples with
a) 3 or more chiidrcn
b) 2____ zzzzz------ ---------
23
c) 1 child
No. ol eligible couples who accepted 'temporary
Methods
_ 2iud
~ Orai Mh
- Condoms
- -------------------------------
I
JA
3ZJH
I
\<\
09
32.^3
IB (U
I
Hale
35
3S_
ao
1*5
L£
09
^0
Al
2J2
2s
'50
Z11__
93
17-
as
/4-
07
ag B
Cm A
)ooJZ
Pflxc-ci-ol
Family Planning
J
£
[
I
!
16
t-
I
1?___ 91 _
JAL
06
11
is
J
>
1L_ 15
0E__33.__' OS
35
51
97
■
I
■
It
I
RiJl.
liiEf
1
Ii
i
I1
S4
1
BUn
I
i
INVENTORY of vaccines and drugs
si.
No
9
I.
2
3
)
4
5
6
Item
Unit
Requirement Actual quantity
Assessed last rcce- ived last
year_______ year_____
ORS Packets
8
36
Metronidazole Tablets
Co-trimoxazole
^00
^-OO
L>QOCj
MOOO
3ooo
5000
i aoo
lo?o
iso
I 900
I’aiacclainol
Chloroquine
Antiseptic solution
SEdes for blood tests
4-0
10
Ihcnnomctcr
0“J.
14
15
—I
I
I
~i
-I
4-0 <5
SBoH-le^ SBoHles
Gloves
Al
4-0
09
(> pc^rs
IFA Large
z^^OO
IFA small tablets
Vit - A solution
4-oo nt
Condom
CNA
16
Oral pills
17
IUDs
18
Syringe & Needles
I
:
01
9
13
56
4A0
Uristix
44
12
a^-
-
SBoVHes
I3D kits
(Disposable (Delivery Kits)
11
Requirement
(
for current
i
year
^0
4-4 0
zJ
7
Surplus or
shortage
hst year
I 939.0
^/so
/ 0593
45^9
loom
300 Ml-
il
'I
Ifij;
^VOOHt
6 NR
..^60 33&)
I
Q^60
6 7 rd
) 9o Neales
.
6
loo/f
SO
09
IS
1 l£A
IS
1
t
i
SI
IF
1 So
J
tf
'I'
fe
>-
55
I unu aiiun
—
R
i■
4'
*
facilha' in sub - centre
*
SI.
Selected equipment and supplies
J
A.
J
3
3
Yes
Facilities
(Mliccr
Accommodation (including residence^
~T~ Water
“r~ Electricity
"
3
i
3
t
3
3
<
3
i
3
r
3
i
3
i
$
No
__
Yes
II
G^OOgS
furniture & Equipment
1
Examination tabic
DcncEcs for clients
"
Cupboard foFdrugs
~
4
Foot Stools
5
Vcssclls foFWatcFstorages
6
Water disposal containers
7
Brooms and mops forTcampiJ
a Steam sterilizer
DeliveryTits
TO Torch ligEt
“
"——
TT Stove
__
"———
12 _Wcighting scale
13 BP Apparatus~
14 I LicmogI()Finomctcr~~
...... o
15 Vaccine
------- : carrier
Nk)
T
T
NO
No
NO
1 / ftoocl
yes
oo<r
Mo
No
yes
1 / ^OO cl
Nt>
NO
Ye <j
1/
T/C^ooJ-
Zes__
No
/?-
T6TTUDT&
c
Quantity/Qiiality
1
*2
3
3
Available
No
I
Fdo
C.
I EC Materia]
dl
1H
Poster
Minlch
J
19
HpCIiart
J
_______
0
I
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Signature (ANM).
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form 1
J
SUB-CENTRE (S.C) ACTION PLAN
A. GcncraJ^nfomuu
iJ11* oirna don —-_______
State J&axnoLa
•-—
Kci
District
■ ?/(XT) Q Q n V-
J
-LBAkJSooo
Year
Population of S.C -£12518
Birth Rafe- Dist/.Statc -20Z12£>O
Eligible couples 25.5
( As on 1 st April)
p.ilc
Sub- centre -SVAfc.i
j
No. of Villages undci the sub - centre jQ'
J
ANC=(PopiX^M x Birthfrate)+10%
“Togo
SI.
J
?•
4.’
DEIJTVTRY/LIVE BIRTH:
I anchayat or health committee of the
Panchayat
No. of
Consultation
TWomen^inMahila Svvasth^a Sanoh '
—Lhj™Ijgg.on house to house basis
Hon Hi
JJX
3^-
Service
____
rC^,9r±n lhc ‘Vea
7
I
refe^J
Prcgn3nt womcn KtedHKd
* cAurreo
3 _ _N°. ofTTTloscs given
--------------
rii~~——
7 TT2
Booster
------------------- ------’-------- ------------------ --'
—---------- -------------
~T
—
•~T - No. 04pregnantwomen ------- ‘—--------------given piophyaxis with II-A tablets.
Natal care
TotaJ no, of delivera m the area
Jjq. ofhomedejrwry^ ----------- “-------- -------
a) ANM/LHV
performance
in current year
I6
^06
I 03
I 03
I 0
ICKb
EJ
3.1
13S.
96
99
I6
01___ _
I (Xb
12___
oq___
02___
a os
) oq-
1 o —.01
53__
05
53
log
63r~T^—|
53.
i
_
05
i
~--------------
--------------- —------J^oHhegnant women refeSTio PHCTFRUTor
Honfh
1.155
---------------------------
b) Traijicd bhhptta^Ent
3
H’kinncd
yecct
1
fir
Hon th
Performance
in last yc.u
Antenatal Care
"7
ao
When consultation made
(month of year)
__ A------------------------------------------------------
SI.
No
6
4-99-3
(Population x Birth rate)
rooo
Consultation with
No.
1.
J
~
J6
ao
3l
31
I
3q
39
I 09- _ oq__
HO .. 06
—03.
35
39- _ 02
3909
]
fe.'
r
J
~I 0'S
—~r
-----t fl | ^£ | (jm<:>y
10
Neo-Natal care
No. ol aick new boras rcfciTcd
MTp
11
No. of women referred for MTP
t
05
»
3
s
iri / sn
J
12
No. of cartes delected
referred
Male
3
13
J
J ' 14
T5
16
Mon^h. TcU
ID
01
5^0
<44
on
ono
Female
Male
61
i
r
3-f
Female
nU-
I
Immunisation
No. of infanta immunised (0-1 year)
BCG
DPT -1
’ DPT^2
DPT 3
J
^eoY
I 0 ~
—————-
5^
3_3
-
bpv-o..
61
5'1
OPV-1
———---OPV -2
OPV-3 --------------- -
^3_
61
Mcaalca
No. of children immunisc'd
-----
(more than 18 months)
DPT Booster_
OPV Booster
No. of chUdiTn-mimimiscT
(more than 5 ycaia)
_ JLL_
No. of children immunised
(more than 10 years)
“'I
_TT____________________
17 No. of children immunised
(more than 16 years)
Tf
IFA "
"—— --------18
No. of children given IFA small
19
(below 5 years )
No. of children adinimstereTTVINA—
._L?.P39I14s to 3 years)
Dose 1
’
Dose 2
’
~
Dose 3-5
—-
. A-l
^8
■^3
^5
.Jfkf
^18
4-3
4-5
41
•37
4B
48
40
4^
S6
^-0
^8
G^.
35
r'rl
6bL
I
-j£E3_ 3S_ OL
•4‘t
951 08
15 ,08!
25 7./
9s_ og|
SI
_|_hTZZJhsIJosi
‘ I T—£i:i.
95 0 VI
9S 08
^4
9s 08
Qg 08
46
Ir
53_._S
!
48
48
WJ
46
46
9q 08
4 zf
4^
08
105
)ia
1S3
ia^
9^ 9)
r/a
_sa
a.s
938
337
ig
48
73
4-7
4-7
4^5 40 J
9S OB
95 OB
lb
173
1451
285
ao~
aa
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II
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3
- 4KP »<. U
I V>cfc eJ pe1
-ff'n cu.Vtre«A\ ^€g<y-
ARI
I
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20
J1
21
No. of cascs under 5 with pneumonia
I - Treated with c4tiimoxozo]e--------I-Rcicrrcd ~~~~
Acute diarrhoeal diseases
J^o. of cases under 5
_-7Sc8 treated’^tFORS3
^Referred
"
’
Ort.
30
>
4
No of eligible couples who accepted permanent
metiiods out of couples with
a) 3 or more children
■BT2
-----------------------c) 1 child
^Teligiblc ccmples wEo
acceptedtemporary
Methods
-IUD
^rranraE-------------
-CondoniH-—————
J
35 oy ’
4?
..go__ |_oj?
Io
go-
14-1
14
31
53
53
J1L
U2L
3J___
'4-31IQJ
43 ia
31
^0
60
So Io
.47
ao____
GS os •
4-2 I Oj-
o/ <A 1
Family Planning
22
48
<^L
4-6
3090
CM R
)ooX
50
30
33
___
_aL_
63
1 IS-___
___
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1
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J
INVENTORY OF VACCINES AND DRUGS
O
Unit
Requirement Actual quantity
Assessed last rece- ived last
year_______ year_________
SL
No
Item
1.
ORS Packets
3^o
2
Mctniniihzolo Tablets
1030
3
Co-trimoxazolc
^i-ooo
) ooo
2ooo
^Vooo
4
Paracetamol
^Faoo
aaoo
9.ooo
W"iO
5
Chloroquine
1 SOO
gs6
as^-
I 900
6
Antiseptic solution
S BoHic
7
Uris tlx
8
DD kits
(Disposable (Delivery Kits)
1 03
9
Slides for blood tests
^-0
10
Thermometer
Surplus or
shortage
last year
931
I A-3
I OOO
01
O
Gloves
11
____
12 IF A large
Requirement
for current
year_______
1 03
) OO~
^K)
^-0
Oi
1 (3 6 OQ)
91'30 0
13
IFA small tablets
ao.ooo
9ozooo
14
Vit - A solution
3ooHl
9OOHL
Condom
C KH4
15600
^OOrtL
i
300HL
■
15
9I
16
Oral pills
17
IUDs
18
Syringe & Needles
C'lMn
|oov
37
70
[ |QVX<
■
C31
I
9<5os)
3%
5 s^-
S %Vltsl3>
3oc Ne-c/'A
083 e
I
I
60
I
5
■
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)
J
FACILITY IN SUB - CENTRE
SL
No
Selected equipment and supplies
Available
Yes
A.
Quantity/Quail ty
No
Facilities
OflicCT
1
~2~~ AccommoifaLjon (including r^idcncc)
4
Water
, Electricity
II
Furniture & Equipment
No
1
Examination table
TT“ "Trenches For clients
T~
Cupboar(Tfor drugs
""Foot Stoots
'5“‘
Vcsscih for Water storages
6
Water disposal containers
7
Bi oornn and mops for cleaning
8
Steam sterilizer
DcliveryTdts
——10 Torch light
Stove
“———12“ "Weighting scale
~
~
13
BP Apparatus
‘T4 Uaemoglobinometcr
f5_ Vaccine carrier
4
IEZ
~rr~
""16 TUDidte———————
7eS
1 / <%oocQ
1 / (AcoJ
Yes
yes
/(^oocf
) /fioeJ
NO
1 / <&OO(J
• / Ciood
Yes
/cg'
1 / CbooS
o-
c.
I EC Material
17
I’(Miter
' 18 ‘
Models
19 Tlip“CTurt
______
^-7
Signature (ANM).
h
FORM 1
O
)
SUB-CENTRK (S.C) ACTION PLAN
Year 1^9^000
A. General Infornution —- -------------State
District
PJJC Vgctjrribaxrf
______
)
Population of S.C
26S . „
Birth Rate- Dist/.Sutc -^2/
Eligible courses ------ ^45.—
Sub- centre
No. of Villages under tlic sub - ccntrc
(Ab on 1st April)
ao
ANC^Population x Birth rate)+10%
S3.
No.
1.
)
2.
3^
4.
SL
No
O
4-Q63.
SO
DEIIVERY/LIVE BIRTH (Pppulatian x Birth rate)
I ODO
Consultation with
No. of
Consultation
Panchayat or health committee of the
Panchayat________________________
Anganwadi worker / TB A_____________
Women jn Mahila SwaMhya Sangh
Families on house to house basts
Service
Wlicn consultition made
(month of year)
1%
iC
ia
EajQxj Meyn-ih
Mqvith.
~^\ce c>- HonAh.
a4-
Performance
in Last year
Planned
performance
in current year
Antenatal Care
1
2
3
4
5
6
7
Total ANC cases registered in the area
No. of lugh ruik jnognant women detected and
referred
No. of TT doses given
JTH__________ ___
_ ______
TIT
-------------------------Booster
Jl(2-_pf pregnant women with ancThLTtfcafcd
No. of pregnant women
given prophyaxia with IF A tablets.
Natal care
Total no_. of delivers in the area
No. of home delivery by
a) ANM/lHV
8
9
b) Trained birth attendant
No. of institutional deliveries
No. of Pregnant women referred to PHC/FRU for
delivery
I OH
OS
14-
14-
01
180
9>0
Qo
188
QS-
±L
_3S_
£35
OS
08
01
Qq-
a
lag
04-
83.,
4a
<u.
lYo
IS
16
)6
os
14aji
a-j
Q3
S409
9431
31
3)
08
03 .
08
03
I
03
01
t
!
pev
c\n<e
o o ’l exf >| < | PCatC
10
11
INeo-INatid care
No. of dek new boms referred
MTP
No. of women referred for MTP
'.iQxqV
13
DPT -2
l)PT-3
09
01
Qo
5I/
^-3
39
511
0-3
Male
Female
Male
Female
0-2.
3^
<4-3
0-3
0-1
83
85
<4-3
85
14
15
16
/ 17
1%
4-Q-
_o_py-o~
OPV -1
QPV -2
OPV-3
Measles
No. of children immunised
(more than 18 months)
DPT Bo<)ster
OPV Booster
No. ol children iiiunmiiscd
(more than 5 years)
DT________________
No. of children immunised
(more tiian 10 years)
<4-3
oc
ftL
36
<4-3
^3
')3
'36
■3 6
TJ 3__
30
3/Q.
- Hr
I
8
Q'F
0-2-
SG
oa
SG Qf{
2S
§5
I
I
ol
-
34 ■
fe1
A-3
36
No. of diildren immunised
(more tlian 16 years)
0'1.
2S_|Q£..
i
irB ■■
80 0*1.
Ol
£9
_TI____ _____
18
19
i
r
3 ft
c
<j
oi.
oi
85 oi.
A-3
^4-3
^3
■ S-
I-
sSSkh
_rr_______________
IFA
d
.O/
QI
No. of cases detected & referred
Immunisation
No. of infants immuniacd (0-1 year)
BCG___________
DPT -f
~
s-
09
TRI/STI
12
H
08
fAav>v>cd/
yvx-xxDce. jfv, <\Avc* ’ * 9 yr •( xx
/fox
Hcnth
oil
■
~
’........
No. of children given IFA small
(below 5 years )
No. of children administered Vi^A
(9 montlis to 3 years)
Dose 1
Dose 2
~
- ------Dose 3-5
_9.q.
^4 1
ab
__
0-6
io
13
i \
oe
39
39
LH
Hi
ai/
SLL^.
<4-a<;|3S
^3
25 Oi.
08
0%
i
o
fas
IE
O?
ass 31
O:
fe
irIP
C3
te
fe
t-•.'■>.
■
ss
p-
8
d
]Vx*tn4?Jl
J
ie'an lc<sV y qqcc
0
*
ARI
20
.6
3
;!
16
LL
ia-
No. of cases under 5 with pneumonia
^Treated with co-trimoxozole
- Referred
3
J
1
3
f,
u
3
21
Acute diarrhoeal diseases
No. of cases under 5
- Cases treated with ORS
- Referred
I
n
I
3
ya
22
1 a
1 KIZ_ZZZZ___“Z--------------------
•:
4
J
J
3
3
c) 1 child
_________ 2"
23
No. ofeligiblc couples who accepted temporary
Methods
_ -IUD ____
-OrnlPilh
- Condoms
4-3
o^
1^6
10
"63
IQ
05
I 6
■3C^
ri a
1
■
i w’j.
th
(NQ
)OO>4
33
36
I 3
I Ol
59
_33._
3i
I->
■-/1___
17
52
1 o
I
0%
Jcxage)-
3
L
S3
Is
_
No. of eligible couples who accepted permanent
inctlKxla put of couples with
a) 3 or more children
3
oi
Family Planning
J
I
Mon+h,^
as
A-0
□
n>
^it jetk*
~Tcxy\el RiuetOAjJ
_£L
64’VV
*
INVENTORY OF VACCINES AND DRUGS
SL
No
Item
1.
ORS Packets
2
Metronidazole Tablets
3
Co-trinioxazolc
4
Paracetamol
5
Cliloroquinc
6
Antiseptic solution
7
Urbtix
8
DD kits
(Disposable (Delivery Kits)
)
3
)
3
J
3
)
J
J
0
j
3
Unit
Requirement Actual quantity
Assessed last rece- ived last
year _
_ JY?3!___
260
12.6
1 ooo
^>000 •
<1-00 0
r.noo
cooo
1900
goo
) 900
5 BoHlC
BBoVMe
5 Bol-Uc
O1
9o
Slides for blood tests
10
Thermometer
OSl
11
Gloves
)o
12
IF A huge
13
gq_
9o
9-0
06 poAtS
500
95950
IFA small tablets
30,000
1 9915
14
Vit - A solution
gOO ML
)OO It L-
15
Condom
ONjy ) OOZ
I9T0 •3430
16
Oral [nils
17
IUD/1
^5^0
x 9-^6
&
Requirement
for current
year_______
I '33
9
18
Surplus or
shortage
last year
JT’J
'P/
04
06 peAxs ,
1 5-100
v{OOHl
gOOHL
CrxiPi
looZ
I 990 4o go
90851- 4W
30
31
MhcA\ils
95-6 M eeiles.
6^7-
Syringe & Needles
3^ rJe&bes
i
I
6s
r
I
o
3
<5^
o
0
o
FACILITY IN SUB - CENTRE
D
0
SL
No
D
0
Selected equipment and supplies
Available
Yes
o
A.
a ’
Qi^Hitity/Quality
No
Facilfties
D
1
3
2
3:
3_
4
3
*5
3
3
*
0
4
0
)
y 3
/ '0
Electricity
R
3
-4
Officer
Accommcxfation (Tik hiding roHnlciK o)
I Water________ __________
'/(Aocj<r
yes
^ooX
7^9
Qlood
Furniture & Equipment
1
Examination table
2
Benches for clients
3
J^pFoard for drugs
4 _ Foot Stools__________
5 _ J/cjgglklgl Water storages__
6
Water disposal containers
.7___ Brooms and mops for cleaning
J_ Steam sterilizer
_9__ Delivery kits______
J O' Torch light
_____
11
Stove_____
12 Weighting scale
~~
13 JTPjXpparatus
~----------IJ2£E!2S] °^n o m ct cr
JI
15" Vaccine carrier
16 lUDki^--------------------
_____ •
V-e.5
___
7?^
___
yes
__ 1 / ^Oorj
; 7C^oo j
769
7 <’5
__
7es
C?h'-»oo
‘/($jO©<J
*/G500(|
__
7e<3
____ 765
___ _ /es
1765
~
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!
"^/CEjoocJ
No
IEC Material
J7
t.*5
Poster
IKModobi
___
19 Flip Chart
__________
7 es
CoocxJ)
765
Qsood .
Signature (ANM).
66
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7948.pdf
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