What to Ask / Learn During a Sub-Center Visit

1. Physical Infrastructure & Setup

• Location, coverage area (population served - norm: 5,000 in plains, 3,000 in hilly/tribal areas)
• Building type - government-owned or rented?
• Availability of electricity, water supply, sanitation/toilet
• Residential facility for ANM (live-in quarters)?
• Cold chain equipment (vaccine refrigerator, ice packs)
• Labour room: is it functional?
• Waiting area, examination room, delivery area

2. Human Resources

• Is ANM (Female Health Worker) posted and present?
• Is Male Health Worker posted and present?
• Is ASHA (Accredited Social Health Activist) active and synergized with ANM?
• Vacancies, absenteeism, workload distribution
• Whether a Community Health Officer (CHO) is posted (under Ayushman Bharat HWC upgrade)

3. Maternal & Child Health (MCH) Services

• Antenatal Care (ANC): Registration of pregnant women, number of ANC visits being provided, BP/weight/abdominal examination, IFA tablets, TT injections, blood/urine testing
• Postnatal Care (PNC): Home visits within 48 hours of delivery, follow-up visits
• Delivery services: Institutional delivery promotion, availability of Normal Delivery services
• New-born care: Weighing, Vitamin K, referral for low-birth-weight babies
• Child health: Growth monitoring, IYCF (Infant and Young Child Feeding) counselling

4. Immunization Services

• Schedule followed (EPI/Universal Immunization Programme)
• Vaccines available and cold chain maintained
• VHSND (Village Health, Sanitation & Nutrition Day) - frequency and attendance
• Coverage data: BCG, OPV, DPT, Measles, Pentavalent, TT doses
• Adverse Events Following Immunization (AEFI) tracking

5. Family Planning Services

• Counselling for delaying/spacing pregnancies
• Distribution of condoms, OCPs (Oral Contraceptive Pills), Emergency Contraceptive Pills
• Registration and follow-up of eligible couples
• Safe abortion services - referral and counselling
• Post-abortion contraceptive counselling
• Sterilization referrals

6. Nutrition Services

• Identification of malnourished children and pregnant/lactating mothers
• IFA (Iron Folic Acid) supplementation
• Vitamin A administration
• Linkage with Anganwadi / ICDS for supplementary nutrition
• Counselling on diet and healthy eating

7. Disease Control & Surveillance

• Malaria: Blood smear/RDT testing, antimalarial provision, bed-net distribution
• Tuberculosis (TB): Sputum collection, DOTS referral and follow-up
• Leprosy: Case detection and MDT referral
• Filaria: MDA (Mass Drug Administration) coverage
• Diarrhea/ARI in children: ORS distribution, IMNCI protocol use
• RTI/STI/HIV-AIDS: Health education, condom promotion, referral
• Outbreak reporting: Is the ANM reporting disease clusters/outbreaks to PHC?

8. Non-Communicable Disease (NCD) Screening

• Hypertension and diabetes screening using CBAC (Community Based Assessment Checklist)
• Oral cancer, breast cancer, cervical cancer screening
• Provision of free monthly drugs to chronic illness patients
• Referral of positive/suspected cases to PHC

9. Adolescent Health

• SABLA/RKSK program activities
• VHSND sessions targeting adolescents
• Counselling on menstrual hygiene, nutrition, delaying marriage
• RTI/STI prevention information
• Linkage with AFHC (Adolescent Friendly Health Clinics)

10. Mental Health

• Community awareness about mental disorders (depression, psychosis, epilepsy, substance abuse)
• Screening using CIDT tool or PHQ-2 (included in CBAC form)
• Referral of identified cases to PHC/CHC

11. Home Visit Activities

• Prioritized households visited (pregnant women, new-borns, sick children, elderly)
• Record of visits maintained
• ASHA coordination for identifying missed beneficiaries
• Care for homebound/bedridden elderly

12. Records, Reports & Registers

• ANC register (Registration no., EDD, TT, IFA, blood group, complications)
• Immunization register
• Eligible couple register (ECR)
• Birth and death register
• Daily OPD register
• Stock/drug register
• Village Health Register
• HMIS (Health Management Information System) data submission - is it up to date?

13. Drugs, Supplies & Equipment

• Essential medicines available (ORS, IFA, OCPs, Misoprostol, Chloroquine, Albendazole, etc.)
• Drug stock register maintained, no expired drugs
• Equipment - BP apparatus, weighing scale (adult + infant), fetoscope/Doppler, haemoglobin meter, rapid test kits (malaria, pregnancy, urine dipstick)

14. Intersectoral Coordination

• Coordination with Panchayati Raj Institutions (PRIs) / Village Health Sanitation & Nutrition Committee (VHSNC)
• Linkage with ASHA, AWW (Anganwadi Worker), school health
• Community awareness campaigns (Swachh Bharat, open defecation free status)
• Referral transport linkage (102/108 ambulance)

15. Supervisory & Quality Aspects

• Last supervisory visit from PHC MO / Lady Health Visitor (LHV)?
• Training received by ANM in the last year?
• Grievance redressal mechanism
• Citizens' charter displayed?
• Cleanliness protocols followed?

Summary Table