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30
Exhibit 4:
Health Facility Sample Survey
A. OPD Clinics
Name oI Clinic/Dispensary: General /Single/Multiple Specialty
Address: Ward No:
1) Name oI Departments in which Specialties OIIered. ** II Yes 1 or No 0
II it is multi speciality clinic then pls. Iill no. oI doctors
* Includes all MBBS, MD, Part time Consultant, Iull time consultant who does practice in a particular specialty. But excludes interns.
2) Facilities available:
Facilities Available Yes/No
2.1 Continuous electricity supply thought consultation timings
2.2 Municipality water
2.3 PuriIied water*
2.4 Laboratory Services
2.5 X-ray
2.6 USG
2.7 Computers speciIic Ior clinic
* By PuriIied water we mean any Iorm oI treatment done, so as to get improved quality oI water
3) On an average,
a) What is the OPD Cases (New & Repeat) per day:
b) No. oI OPD cases that you send to laboratories
c) No. oI OPD cases that you send to radiology Iacility:
II 2.4, 2.5, 2.6 are Yes then pls. ignore 3b, 3c
4) Remarks
Date:
Name oI Surveyor:
Specialty Name
Available Yes/No``
No. of doctors`
Total Time Consultation in AM Total Time Consultation in PM
ENT
General Physician
OB&G
Oncology
Opthal.
Ortho.
Paeds.
Physiotherapy
Psych
Skin
Surgery
Dental
Cardiac
Urologist
Neurologist
Family Planning
Diabetes Clinic
TB Clinic
Pain Clinic
Venereal Diseases
Laser Eye Correction
Telemedicine
Gastro enterologist
31
B. Inpatient Facility Survey
Name oI Facility: General Hospital/Single/Multiple Specialty
Address: Ward No:
1.1 Name oI Departments in which Specialties OIIered. ** II Yes 1 or No 0
* Includes all MBBS, MD, Part time Consultant, Iull time consultant who does practice in a particular specialty. But excludes interns.
II segregation is not possible then Total Number oI DOCTORS
II segregation is not possible then Total Number oI NURSES
II segregation is not possible then Total Number oI BEDS
Out oI Which Total number oI ICU beds is
On an average what is the Bed Occupancy
1.2 II any specialty is oIIered separately
Specialty Yes/No
Diabetes Clinic
TB Clinic
Pulmonary Medicine
Caesarean Section
High Risk Pregnancy Clinic
Pain Clinic
Radiation Therapy
Chemotherapy
Oncology Surgery
Cataract Removal
Laser Eye Correction
Cornea Clinic
Joint Replacement Surgery
Cosmetic Surgery
Burns Ward
Venereal Diseases
Specialty Yes/No
Isolation Ward
Laproscopic Surgery
Endoscopic procedures
Telemedicine
Gastro enterologist
SICU
PICU
NICU
MICU
ICCU
Specialty Name
Available Yes/No``
No. of doctors` No. Of Nurses No. of Beds (Including ICU`s)
ENT
Medicine
OB&G
Oncology
Opthal.
Ortho.
Paeds.
Physiotherapy
Psych
Skin
Surgery
Dental
Cardiac
Urologist
Neurologist
Family Planning
Trauma Care
32
2 Facilities available:
Facilities Available Yes/No
2.1 Emergency Iacility (24 hours)
2.2 Blood bank
2.3 Laboratory
2.3.1 If 2.3 is Yes Separate laboratory
(a) Pathology
(b) Microbiology
(c) Bio-Chemistry
(d) Histo-Pathology
2.3.1 If 2.3 is Yes and 2.3.1 is No: Combined laboratory
2.4 Radiology
II 2.4 is Yes
2.4.1 X-Ray
2.4.2 USG
2.4.3 Doppler
2.4.4 CT-Scan
2.4.5 MRI
2.4.6 IITV
2.4.7 C-Arm IITV
2.4.8 Mammography
2.5 24 Hour non stop electricity supply
2.6 Municipality water
2.7 PuriIied water*
* By PuriIied water we mean any Iorm oI treatment done, so as to get improved quality oI water
3 Availability oI Equipments
Equipment Yes/No Remarks (No.s)
OT`s
Dental Chairs
Cell Counter
ABG Gas Analyser
Non invasive Ventilators
Invasive Ventilators
DeIibrillators
ECG Analog
Central Monitoring Station (in ICU)
Incinerator
Stretcher
Dialysis Machine
Lithotripers
Endoscopes
Laproscopes
4 Availability oI
Computer Facility Yes/No
Stand Alone Computers
HIS
33
Exhibit 5
Sample Distribution within Vasna Ward
SIum LIG MIG HIG
Aktanagar 3 3
Ayojanagar 4 4
Bhavana Flats 4 3 7
Bhavana Tenament 4 1 3 8
Chamunda Nagar 13 13
Chandra Nagar 2 2
Dharnidhar Soceity 2 8 10
Dungarsi Nagar 2 2
Ganeshkunj Soceity 4 4
Guptanagar 19 19
Haajam Society 5 5
shawar Krupa 2 2
Jadiba Nagar 13 13
Kundan Apartment 8 2 1 11
Lavaniya Soceity 5 2 7
Manekbaug Soceity 5 5
Mangal Talavadi 22 1 23
Mittal Apartment 2 4 1 7
Nr. Umiya Vizan 2 2
Omnagar 18 1 19
Pratapkunj Society 1 1 3 5
Pravinnagar-1 13 1 14
Punjan Apartment 5 5
Rajivnagar 24 24
Raval Nagar 13 13
Riddhi Flats 2 4 6
Sawashsinagar 8 8
Sayojan Nagar 8 8
Shivshaktinagar 1 1 2
Shivshankarngar 19 19
Shrinagar 5 5
Shrinathpark Society 2 2
Someshwarnagar 15 15
Sorainagar 10 10
Sumadhur Society 2 2
Swaminarayan Nagar 4 4
Vasna Gam 7 1 8
Yogeshwarnagar 20 4 24
TotaI 252 18 16 54 340
Number of HousehoIds
TotaI
3
4
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40
Exhibit 12
Health Status: Vasna Ward
41
References:
|1| Rakesh Mohan, Shubhagato Dasgupta: The 21
st
centurv. Asia Becomes Urban,
Economic and Political Weekly, Januray 15, 2005.
|2| The World bank (1999). The World development Report 1999: Entering the
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st
centuray, OxIord University Press, New York.
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Government of India for Urban Health Planning and National Guidelines, Activity report 135,
EHP, Environmental Health Project, USAID, August 2004.
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challenges and opportunities. Lessons from India Familv Welfare Urban Slums profect.
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http://www.makingcitieswork.org/www/urbanthemes/urbanhealth/urbanizationandhealth/ur
banhealthdoc
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