Level 3B
Comprehensive Health Centre)
CHECKLIST FOR CATEGORIZATION OF HEALTH FACILITIES
SECTION A: FACILITY INFORMATION
Registration/Gazette name:
Master facility No: Registration No:
Physical Location: Contact details:
County: Name of contact:
Sub-County: Qualification of contact person
Address: Code:
Town/Market : Phone Number:
Building/Plot No: Email:
Current Facility Level
Facility Ownership: Government/public entity ☐
Faith Based ☐
Private ☐
Other ☐
Catchment Population:
Monthly outpatient workload:
In patient bed capacity:
Description of location(prominent landmark):
Mandatory requirements: a. Inpatient bed capacity of at least 24 beds (Mandatory)
6 for the male, 6 for the Female, 6 for the paediatric & 6
for the maternity ward
b. Outpatient services
c. Caesarean section services
d. Blood transfusion services
e. Radiologic & imaging services
f. Functional maternity theatre
Grading Scale
(kindly grade each section as indicated) Yes=2, Partial= 1, No=0
SECTION B: SERVICES OFFERED
Does the facility offer any of the following services? ( Yes=2, Partial= 1, No=0)
YES PARTIAL NO REMARKS
(a) Curative services
(b) Outpatient services
(c) Inpatient services
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Level 3B
Comprehensive Health Centre)
CHECKLIST FOR CATEGORIZATION OF HEALTH FACILITIES
(d) Functional referral services
(e) Limited emergency inpatient care
(f) Oral health services
(g) Individual health education
(h) Caesarean section services
(mandatory)
(i) Surgical procedures
(j) Blood transfusion services
(mandatory)
(k) Radiologic & imaging services
(mandatory)
(l) Maternity services (mandatory)
(m) Antenatal care
(n) Family planning
(o) Immunization services
(p) Transportation of bodies
(q) Laboratory services (Class C)
(r) Outreach services
(s) Outpatient Pharmacy services
TOTAL:
SECTION C: FACILITY INFRASTRUCTURE
Does the facility have the following infrastructure? ( Yes=2, Partial= 1, No=0)
YES PARTIAL NO REMARKS
(a) Three (3) consultation rooms
(b) One (1) treatment/procedure room
(c) One (1) minor theatre
(d) One (1) records room
(e) Inpatient bed capacity of at least
24 beds (Mandatory)
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Level 3B
Comprehensive Health Centre)
CHECKLIST FOR CATEGORIZATION OF HEALTH FACILITIES
6 for the male, 6 for the
Female, 6 for the paediatric & 6 for
the maternity ward
(f) One (1) drugs store
(g) General supplies store
(h) Labour ward with capacity of two
(2) beds with one (1) resuscitaire
(i) Delivery room with two (2) delivery
coaches
(j) Laboratory room
(k) Community services room/public
health office
(l) Functional maternity theatre with
one (1) resuscitaire (Mandatory)
(m) Central sterilization services unit
(Mandatory)
(n) Basic radiological & imaging
facilities
(Mandatory)
(o) Laundry with laundry machine
(p) Permanent constructed kitchen
structure
(q) Staff housing for at least two
(2)members
of staff/ call rooms
(r) Protected incinerator/burning
chamber
(s) Protected placenta pit/macerator
(t) Transport services
(u) Facility communication equipment
(e.g. mobile phones,intercoms,
walkie talkie)
(v) Clean piped water supply
(w) Fence & gate
(x) Protected composite pit/holding area
under lock & key
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Level 3B
Comprehensive Health Centre)
CHECKLIST FOR CATEGORIZATION OF HEALTH FACILITIES
(y) Appropriate waste segregation
(z) Medical waste management system
(aa) Cloak rooms for patients
(bb) Cloak rooms for staff
(cc) Ramp/disability friendly walkways
(dd) Adequate ventilation ,lighting and
bed spacing
(ee)Constant power supply
(ff) Functional holding room for bodies
(gg) CCTV system
TOTAL:
SECTION C: PERSONNEL (Indicate Number)
Does the facility have the following personnel? ( Yes=2, Partial= 1, No=0)
YES PARTIAL NO REMARKS
(a) Two (2) medical officers
(b) Two( 2)Public health officers
(c) Two (2 ) public health technicians
(d) Six general clinical officers
(e) One graduate clinical officer
(f) One specialized clinical officer or
clinical officer ENT
(g) Clinical officer lung and skin
(h) Clinical officer paediatrics
(i) Clinical officer reproductive health
(j) Three BScN Nurses
(k) Eight theatre nurses
(l) Two Kenya Enrolled Community
Health Nurses
(m) Nineteen Kenya Registered
Community Health Nurses
(n) Two Kenya Registered
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Level 3B
Comprehensive Health Centre)
CHECKLIST FOR CATEGORIZATION OF HEALTH FACILITIES
Nurses/mental health and psychiatric
(o) Six Registered Nurse/midwives
(p) Three Nurse anaesthetist /clinical
officer
(q) One sign language staff
(r) One Pharmacist
(s) Four (4) pharmaceutical
technologists
(t) Two (2) plaster
technologists/technicians
(u) One (1) Orthopaedic technologists
(v) Three (3) general physiotherapists
(w) Three (3) occupational therapists
(x) One (1) Dental officer
(y) Two (2) Community Oral Health
Officer
(z) Two (2) dental technologists
(aa) Four (4) health promotion officers
(bb) Two (2) medical social workers
(cc) One health administrative officer
(dd) Four clerks
(ee)One ICT officer
(ff) One Supply chain assistant
(gg) Two nutrition and dietetic officers
(hh) Ten medical laboratory
technologists/technicians
(ii) Nutrition & dietetic technician
(jj) Two cooks
(kk) Four drivers
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Level 3B
Comprehensive Health Centre)
CHECKLIST FOR CATEGORIZATION OF HEALTH FACILITIES
(ll) Four security officers
(mm) Two mortuary attendants
(nn) Ten support staff (others)
TOTAL:
SECTION 7: FINDINGS AND RECOMMENDATIONS
Findings
Recommendations
REGISTERED OWNER/IN-CHARGE OF THE FACILITY
Name: Designation
Qualifications Regulatory body:
Registration No: Licence No.
Phone Number Email:
Date: Signature:
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Level 3B
Comprehensive Health Centre)
CHECKLIST FOR CATEGORIZATION OF HEALTH FACILITIES
INSPECTION TEAM
Name Organization Signature
1.
2.
3.
4.
Dated this……………………………………………………………..day of………………………………………………………….. 2019
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