Opposite Assemblies of God Church Cross River State ( Lat
5.7573848, Long
8.0853134 )
Costine Primary Health Center
Behind market Taraba State
( Lat
7.1956313, Long
10.0527825 )
General
Query
Response
Who is the Respondent ?
Any Dilapidated Hospital Building in the Premises of PHC ?
List of the building failures.
Check for any of these building failures(Broken Celling)
Check for any of these building failures(Damaged Door)
Check for any of these building failures(Damaged Windows)
Check for any of these building failures(Damaged Hospital Beds)
Check for any of these building failures(Damaged Tables)
Check for any of these building failures(Damaged Chairs)
Check for any of these building failures(Damaged Leaking roofs)
Check for any of these building failures(Damaged Medical Records)
Total of Specified Building failures Identified (out of 8)
Check for any of these building failures(None)
Does the PHC have these Areas within the Premises (Waiting Area)?
Does the PHC have these Areas within the Premises(Nurse-Station)?
Does the PHC have these Areas within the Premises(Intensive Care Unit)?
Does the center have clean and functional restrooms?
Total of Specified Areas (Out 0f 5)
No specified Areas(excluding restrooms)?
When Was the last Re-Stock for Pharmacy(In weeks)
When was the last renovation done ? (In Years)
Other Source of Water used at the PHC
What is the source of Power(Power Holding Company (National grid))?
What is the source of Power(Solar)?
What is the source of Power(Wind)?
What is the source of Power(Hybrid)?
What is the source of Power(Generator)?
What is the source of Power(Private Power provider (a power plant privately generating and selling power)?
Total of Specified Source of power (Out of 6)
No Source of Power?
How many Referrals to Larger Hospitals have occurred in the last 1 year
Reasons for Referral
Identify Shortages of Medical Supplies(Syringes)?
Identify Shortages of Medical Supplies(Bandages)?
Identify Shortages of Medical Supplies(Gloves)?
Identify Shortages of Medical Supplies(Personal Protective Equipment)?
Identify Shortages of Medical Supplies(Injection Ample)?
Identify Shortages of Medical Supplies(GV Ink)?
Identify Shortages of Medical Supplies(Scissors)?
Identify Shortages of Medical Supplies(Methylated Spirit)?
Identify Shortages of Medical Supplies(Dis-infectant)?
Identify Shortages of Medical Supplies(Medications)?
Identify Shortages of Medical Supplies(Blood Pressure Apparatus)?
Identify Shortages of Medical Supplies(Weighing Scale)?
Identify Shortages of Medical Supplies(Thermometer)?
Identify Shortages of Medical Supplies(Drip)?
Identify Shortages of Medical Supplies(Working Fridge for Vaccine)?
Identify Shortages of Medical Supplies(Oxygen Gas for Patient)?
Identify Shortages of Medical Supplies(Stretcher)?
Identify Shortages of Medical Supplies(Drip Stand)?
Total of specified Medical supplies shortages (Out of 18)
Identify Shortages of Medical Supplies(Others)?
Specify Other Shortages of Supplies for the PHC?
Specify Other Ways of Disposing Waste by the PHC?
Which of these Equipment are Available Labor Ward(Bed Pan)?
Which of these Equipment are Available Labor Ward(Delivery Bed)?
Which of these Equipment are Available Labor Ward(Fetal Heart Rate Monitor)?
Which of these Equipment are Available Labor Ward(Infusion Pumps)?
Which of these Equipment are Available Labor Ward(Neo-Natal Resuscitation Equipment)?
Total of Specified Labour ward Equipment Available (Out of 5)
Which of these Equipment are Available Labor Ward(Others)?
Specify Other equipment available in the Labor Ward in this PHC
Who is the Respondent at the PHC?
How many Doctors are Assigned to this PHC ?
How Many Nurses are Assigned to this PHC ?
Number of Community Health Extension (CHEW)
Number of Health Support Staff
Select which of these Staff are resident in the Community or PHC?
Select which of these Staff are resident in the Community or PHC(Nurse)?
Select which of these Staff are resident in the Community or PHC(Auxiliary Nurse)?
Select which of these Staff are resident in the Communityor PHC(Doctor)
Select which of these Staff are resident in the Communityor PHC(Patient)
Select which of these Staff are resident in the Communityor PHC(Relative of Patient)
Select which of these Staff are resident in the Communityor PHC(Matron)
Select which of these Staff are resident in the Communityor PHC(Mid-Wife)
Select which of these Staff are resident in the Communityor PHC(Community Health Extension Worker)
Select which of these Staff are resident in the Communityor PHC(Others)
Select which of these Staff are resident in the Communityor PHC(None)
Mention Other Staff residing in the community or neighboring community of the PHC
Tell us which of these staff works in this PHC?
Tell us which of these staff works in this PHC(Mid-Wife)?
Tell us which of these staff works in this PHC(Community Health Extension Worker)?
Tell us which of these staff works in this PHC(Pharmacist)?
Tell us which of these staff works in this PHC(Medical Record Staff)?
Tell us which of these staff works in this PHC(Auxiliary Nurse)
Tell us which of these staff works in this PHC(Security Personnel)
Tell us which of these staff works in this PHC(Laboratory Scientist)
Tell us which of these staff works in this PHC(Others)
List any Category of Medical Staff working at this PHC probably not captured in the list
Specify the Type of Training and Organisers(NPHCDA)
Specify the Type of Training and Organisers(Ministry of Health)
Specify the Type of Training and Organisers(Private Institution)
Specify the Type of Training and Organisers(Hospital Management Board)
Specify the Type of Training and Organisers(Unspecified Organiser)
Total Numer of Specfied type of trainers or Organizers (out of 5)
Specify the Type of Training and Organisers(None)
Identify 2 most common means of Transportation to PHC(On Foot)
Identify 2 most common means of Transportation to PHC(On Animal Aided device)
Identify 2 most common means of Transportation to PHC(On Bicycle)
Identify 2 most common means of Transportation to PHC(Motor Cycle (Bike or OKada)
Identify 2 most common means of Transportation to PHC(Keke Maruwa)
Identify 2 most common means of Transportation to PHC(Public Cars)
Identify 2 most common means of Transportation to PHC(Public Buses)
Identify 2 most common means of Transportation to PHC(Commercial Fleet service (e.g Bolt Urber)
Identify 2 most common means of Transportation to PHC(Canoe)
Total of Specified Means of transoportation to PHC(Out of 9)
Identify 2 most common means of Transportation to PHC(Others)
What is the Estimated number of persons that use this PHC Annually
What is the Calculated number of persons that use this PHC Daily(Totally Annually/365 Days) (Kindly note that most of the ones with zeros have very low annual patronage)
Percentage of Patients able to afford payments for Health Care (In Percentage) (Total Patients that can afford/Total Patients annually)*100
Estimated/Average Total Mortality in the last 5 years (in persons)
Tell us Specific Areas that needs Improvement | Challenges in the PHC
General Comments About the PHC
General
Query
Response
Who is the Respondent ?
Any Dilapidated Hospital Building in the Premises of PHC ?
List of the building failures.
Check for any of these building failures(Broken Celling)
Check for any of these building failures(Damaged Door)
Check for any of these building failures(Damaged Windows)
Check for any of these building failures(Damaged Hospital Beds)
Check for any of these building failures(Damaged Tables)
Check for any of these building failures(Damaged Chairs)
Check for any of these building failures(Damaged Leaking roofs)
Check for any of these building failures(Damaged Medical Records)
Total of Specified Building failures Identified (out of 8)
Check for any of these building failures(None)
Does the PHC have these Areas within the Premises (Waiting Area)?
Does the PHC have these Areas within the Premises(Nurse-Station)?
Does the PHC have these Areas within the Premises(Intensive Care Unit)?
Does the center have clean and functional restrooms?
Total of Specified Areas (Out 0f 5)
No specified Areas(excluding restrooms)?
When Was the last Re-Stock for Pharmacy(In weeks)
When was the last renovation done ? (In Years)
Other Source of Water used at the PHC
What is the source of Power(Power Holding Company (National grid))?
What is the source of Power(Solar)?
What is the source of Power(Wind)?
What is the source of Power(Hybrid)?
What is the source of Power(Generator)?
What is the source of Power(Private Power provider (a power plant privately generating and selling power)?
Total of Specified Source of power (Out of 6)
No Source of Power?
How many Referrals to Larger Hospitals have occurred in the last 1 year
Reasons for Referral
Identify Shortages of Medical Supplies(Syringes)?
Identify Shortages of Medical Supplies(Bandages)?
Identify Shortages of Medical Supplies(Gloves)?
Identify Shortages of Medical Supplies(Personal Protective Equipment)?
Identify Shortages of Medical Supplies(Injection Ample)?
Identify Shortages of Medical Supplies(GV Ink)?
Identify Shortages of Medical Supplies(Scissors)?
Identify Shortages of Medical Supplies(Methylated Spirit)?
Identify Shortages of Medical Supplies(Dis-infectant)?
Identify Shortages of Medical Supplies(Medications)?
Identify Shortages of Medical Supplies(Blood Pressure Apparatus)?
Identify Shortages of Medical Supplies(Weighing Scale)?
Identify Shortages of Medical Supplies(Thermometer)?
Identify Shortages of Medical Supplies(Drip)?
Identify Shortages of Medical Supplies(Working Fridge for Vaccine)?
Identify Shortages of Medical Supplies(Oxygen Gas for Patient)?
Identify Shortages of Medical Supplies(Stretcher)?
Identify Shortages of Medical Supplies(Drip Stand)?
Total of specified Medical supplies shortages (Out of 18)
Identify Shortages of Medical Supplies(Others)?
Specify Other Shortages of Supplies for the PHC?
Specify Other Ways of Disposing Waste by the PHC?
Which of these Equipment are Available Labor Ward(Bed Pan)?
Which of these Equipment are Available Labor Ward(Delivery Bed)?
Which of these Equipment are Available Labor Ward(Fetal Heart Rate Monitor)?
Which of these Equipment are Available Labor Ward(Infusion Pumps)?
Which of these Equipment are Available Labor Ward(Neo-Natal Resuscitation Equipment)?
Total of Specified Labour ward Equipment Available (Out of 5)
Which of these Equipment are Available Labor Ward(Others)?
Specify Other equipment available in the Labor Ward in this PHC
Who is the Respondent at the PHC?
How many Doctors are Assigned to this PHC ?
How Many Nurses are Assigned to this PHC ?
Number of Community Health Extension (CHEW)
Number of Health Support Staff
Select which of these Staff are resident in the Community or PHC?
Select which of these Staff are resident in the Community or PHC(Nurse)?
Select which of these Staff are resident in the Community or PHC(Auxiliary Nurse)?
Select which of these Staff are resident in the Communityor PHC(Doctor)
Select which of these Staff are resident in the Communityor PHC(Patient)
Select which of these Staff are resident in the Communityor PHC(Relative of Patient)
Select which of these Staff are resident in the Communityor PHC(Matron)
Select which of these Staff are resident in the Communityor PHC(Mid-Wife)
Select which of these Staff are resident in the Communityor PHC(Community Health Extension Worker)
Select which of these Staff are resident in the Communityor PHC(Others)
Select which of these Staff are resident in the Communityor PHC(None)
Mention Other Staff residing in the community or neighboring community of the PHC
Tell us which of these staff works in this PHC?
Tell us which of these staff works in this PHC(Mid-Wife)?
Tell us which of these staff works in this PHC(Community Health Extension Worker)?
Tell us which of these staff works in this PHC(Pharmacist)?
Tell us which of these staff works in this PHC(Medical Record Staff)?
Tell us which of these staff works in this PHC(Auxiliary Nurse)
Tell us which of these staff works in this PHC(Security Personnel)
Tell us which of these staff works in this PHC(Laboratory Scientist)
Tell us which of these staff works in this PHC(Others)
List any Category of Medical Staff working at this PHC probably not captured in the list
Specify the Type of Training and Organisers(NPHCDA)
Specify the Type of Training and Organisers(Ministry of Health)
Specify the Type of Training and Organisers(Private Institution)
Specify the Type of Training and Organisers(Hospital Management Board)
Specify the Type of Training and Organisers(Unspecified Organiser)
Total Numer of Specfied type of trainers or Organizers (out of 5)
Specify the Type of Training and Organisers(None)
Identify 2 most common means of Transportation to PHC(On Foot)
Identify 2 most common means of Transportation to PHC(On Animal Aided device)
Identify 2 most common means of Transportation to PHC(On Bicycle)
Identify 2 most common means of Transportation to PHC(Motor Cycle (Bike or OKada)
Identify 2 most common means of Transportation to PHC(Keke Maruwa)
Identify 2 most common means of Transportation to PHC(Public Cars)
Identify 2 most common means of Transportation to PHC(Public Buses)
Identify 2 most common means of Transportation to PHC(Commercial Fleet service (e.g Bolt Urber)
Identify 2 most common means of Transportation to PHC(Canoe)
Total of Specified Means of transoportation to PHC(Out of 9)
Identify 2 most common means of Transportation to PHC(Others)
What is the Estimated number of persons that use this PHC Annually
What is the Calculated number of persons that use this PHC Daily(Totally Annually/365 Days) (Kindly note that most of the ones with zeros have very low annual patronage)
Percentage of Patients able to afford payments for Health Care (In Percentage) (Total Patients that can afford/Total Patients annually)*100
Estimated/Average Total Mortality in the last 5 years (in persons)
Tell us Specific Areas that needs Improvement | Challenges in the PHC
General Comments About the PHC
Building structure
Query
Response
Does the health care center have a well-built and Maintained structure ?
Does the PHC have a Perimeter Fence?
If yes Has part of the Perimeter Fence or Gate given way?
Building structure
Query
Response
Does the health care center have a well-built and Maintained structure ?
Does the PHC have a Perimeter Fence?
If yes Has part of the Perimeter Fence or Gate given way?
Infrastructure
Query
Response
Total Number of Hospital Beds?
How many wards in Total do you?
How many consulting rooms?
List of the Specific Areas in PHC within the Premises ?
Does the PHC have these Areas within the Premises(Functional Pharmacy)?
Number of Clean and Functional Restrooms?
If Pharmacy is available How Often is it Re-stocked ?(In weeks)
What is the source of Water used at the PHC?
What is the source of Power?
List of Shortages of Medical Supplies
How is Hospital Waste Disposed?
Does the PHC have a Functional Ambulance ?
List of Equipment are Available Labor Ward
Identify 2 most common means of Transportation to PHC
Infrastructure
Query
Response
Total Number of Hospital Beds?
How many wards in Total do you?
How many consulting rooms?
List of the Specific Areas in PHC within the Premises ?
Does the PHC have these Areas within the Premises(Functional Pharmacy)?
Number of Clean and Functional Restrooms?
If Pharmacy is available How Often is it Re-stocked ?(In weeks)
What is the source of Water used at the PHC?
What is the source of Power?
List of Shortages of Medical Supplies
How is Hospital Waste Disposed?
Does the PHC have a Functional Ambulance ?
List of Equipment are Available Labor Ward
Identify 2 most common means of Transportation to PHC
Staff Strength/Personnel
Query
Response
Number of health workers assigned to PHC?
Number of Health Workers Actively practicing on Site
Mention the Position of Health worker and Number at the PHC?
What is the frequency of Availability of Doctor(s) in the PHC Weekly
Does this PHC work on Weekends?
Staff Strength/Personnel
Query
Response
Number of health workers assigned to PHC?
Number of Health Workers Actively practicing on Site
Mention the Position of Health worker and Number at the PHC?
What is the frequency of Availability of Doctor(s) in the PHC Weekly
Does this PHC work on Weekends?
Staff Support
Query
Response
When was the most Recent Recruitment for Health Staff Carried Out?
Are the staff members satisfied with their working conditions?
Is there a system in place to address staff grievances or concerns?
Are there regular training and development opportunities for staff members?
Is there a mechanism for recognizing and rewarding staff members' efforts?
Have Health care workers received a training in the last 5years?
List of Type of Training and Organisers
Staff Support
Query
Response
When was the most Recent Recruitment for Health Staff Carried Out?
Are the staff members satisfied with their working conditions?
Is there a system in place to address staff grievances or concerns?
Are there regular training and development opportunities for staff members?
Is there a mechanism for recognizing and rewarding staff members' efforts?
Have Health care workers received a training in the last 5years?
List of Type of Training and Organisers
General Information
Query
Response
How Many Communities Rely on this PHC for Health Care
What is the Estimated number of persons that use this PHC Annually.1
Ratio of Patients able to afford payments for Health Care
Rate the Quality of Treatment in this PHC
Rate the Immunization Services Provided in the PHC
Give a General Rating for the PHC
General Information
Query
Response
How Many Communities Rely on this PHC for Health Care
What is the Estimated number of persons that use this PHC Annually.1
Ratio of Patients able to afford payments for Health Care
Rate the Quality of Treatment in this PHC
Rate the Immunization Services Provided in the PHC
