BANGLADESH

Health Facility Survey 2017

Final Report

Bangladesh Health Facility Survey

2017

Final Report

National Institute of Population Research and Training (NIPORT)

Ministry of Health and Family Welfare

Dhaka, Bangladesh

ICF

Rockville, Maryland, USA

Funded by

Government of the People’s Republic of Bangladesh

U.S. Agency for International Development (USAID), Bangladesh

February 2020
This report presents final findings of the 2017 Bangladesh Health Facility Survey (2017 BHFS), which was 

implemented by the National Institute of Population Research and Training (NIPORT). ICF provided technical 

assistance, and icddr,b assisted to monitor the field work and data collection. Associates for Community and 

Population Research (ACPR), a private research agency, was appointed to collect the data. The 2017 BHFS is 

part of the worldwide DHS Program, which assists countries in the collection of data to monitor and evaluate 

population, health, and nutrition programs. The survey was funded by the government of Bangladesh and the 

United States Agency for International Development (USAID).

Additional information about the 2017 BHFS may be obtained from the National Institute of Population Research 

and Training (NIPORT), 13/1 Sheikh Shaheb Bazar Road, Azimpur, Dhaka-1205 Bangladesh. Telephone: 88-02-

5861-1206; Internet: www.niport.gov.bd.

Information about The DHS Program can be obtained from ICF, 530 Gaither Road, Suite 500, Rockville, MD 

20850, USA. Telephone: 301-407-6500; Fax: 301-407-6501; Email: reports@DHSprogram.com; Internet: 

www.DHSprogram.com.

Cover photos:

Left: “New model of community clinic” © Community Based Health Care, DGHS, Ministry of Health and Family 

Welfare [Bangladesh]. Used with permission.

Right: “Domar UHC, Nilphamari” ©2011 ACPR. Used with permission.

Recommended citation:

National Institute of Population Research and Training (NIPORT) and ICF. 2019. Bangladesh Health Facility 

Survey 2017. Dhaka, Bangladesh: NIPORT, ACPR, and ICF.


Contents • iii

CONTENTS

TABLES AND FIGURES ..........................................................................................................................vii

FOREWORD ............................................................................................................................................ xiii

PREFACE ...................................................................................................................................................xv

CONTRIBUTORS TO THE REPORT ..................................................................................................xvii

ABBREVIATIONS AND ACRONYMS..................................................................................................xix

READING AND UNDERSTANDING TABLES FROM THE 2017 BANGLADESH HFS............ xxiii

MAP OF BANGLADESH........................................................................................................................xxx

1 OVERVIEW OF THE HEALTH SYSTEM IN BANGLADESH...............................................1

1.1 Health Status in Bangladesh................................................................................................1

1.2 Health, Population, and Nutrition Sector Program..............................................................1

1.3 Health Service Delivery System of Bangladesh ..................................................................3

1.3.1 Management Structure and Health Facilities under DGHS ...................................4

1.3.2 Management Structure and Health Facilities under DGFP....................................5

1.3.3 Urban Primary Health Care Services Delivery Project (UPHCSDP) ....................6

1.3.4 NGO Health Programs...........................................................................................6

1.3.5 Private Health Sector .............................................................................................6

1.4 Health Financing .................................................................................................................7

1.5 Health Stewardship..............................................................................................................8

2 METHODOLOGY..........................................................................................................................9

2.1 Overview .............................................................................................................................9

2.2 Institutional Framework and Objectives of the 2017 BHFS................................................9

2.2.1 Institutional Framework.........................................................................................9

2.2.2 Objectives of the 2017 BHFS ..............................................................................10

2.3 Data Collection Methods...................................................................................................10

2.4 Survey Implementation......................................................................................................11

2.4.1 Questionnaire Adaptation ....................................................................................11

2.4.2 Pre-test .................................................................................................................11

2.4.3 Main Training ......................................................................................................11

2.4.4 Data Collection ....................................................................................................12

2.4.5 Data Management and Report Writing ................................................................12

2.4.6 Data Analysis and Report Preparation .................................................................12

2.5 Sampling............................................................................................................................13

2.5.1 Sampling Methodology........................................................................................13

2.5.2 Sampling Frame...................................................................................................13

2.5.3 2017 BHFS Sample Size and Sample Allocation ................................................13

2.5.4 Sample of Health Facilities and Outcomes..........................................................13

2.5.5 Sample of Health Service Providers ....................................................................14

3 FACILITY-LEVEL INFRASTRUCTURE, RESOURCES, MANAGEMENT, 

AND SUPPORT ............................................................................................................................19

3.1 Background........................................................................................................................20

3.2 Availability of Services.....................................................................................................21

3.2.1 Overall Availability of Specific Client Services..................................................21

3.2.2 Availability of Basic Client Services...................................................................21

3.2.3 General Service Preparedness..............................................................................22
iv • Contents

3.3 Basic Management Systems to Support and Maintain Quality Services and 

Appropriate Client Utilization ...........................................................................................33

3.3.1 Supportive Management Practices for Providers.................................................33

3.3.2 Quality Assurance................................................................................................34

3.3.3 Client Feedback ...................................................................................................35

3.4 Availability of Human Resources for Health ....................................................................35

3.5 Management of Medical Waste in Health Care Facilities.................................................37

4 CHILD HEALTH SERVICES.....................................................................................................55

4.1 Background........................................................................................................................55

4.2 Availability of Child Health Services................................................................................56

4.2.1 Provision of Outpatient Curative Care, Child Growth Monitoring, Child 

Vaccination, and Nutrition Services ....................................................................56

4.2.2 Vitamin A Supplementation and Deworming......................................................57

4.2.3 Availability of Guidelines, Basic Equipment, and Trained Staff for Child 

Curative Care .......................................................................................................57

4.2.4 Availability of Medicines and Commodities for Sick Child Care .......................58

4.2.5 Infection Control in Sick Child Services .............................................................59

4.2.6 Laboratory Diagnostic Capacity ..........................................................................59

4.3 Readiness of Health Facilities to Provide Child Curative Care.........................................60

4.4 Basic Management and Administrative Systems...............................................................61

4.4.1 Personal Supervision and Training ......................................................................61

4.4.2 In-service Training by Topic ...............................................................................62

5 FAMILY PLANNING SERVICES .............................................................................................71

5.1 Background........................................................................................................................71

5.2 Family Planning Services..................................................................................................72

5.2.1 Availability of Family Planning Services............................................................73

5.2.2 Facilities Providing Modern Family Planning Methods and Services.................74

5.2.3 Frequency of Availability of Family Planning Services......................................75

5.2.4 Availability of Commodities on the Day of the Assessment ...............................76

5.2.5 Availability of Service Guidelines, Trained Staff, and Equipment......................76

5.2.6 Infection Control During Provision of Family Planning......................................76

5.2.7 Readiness to Provide Family Planning Services..................................................77

5.3 Basic Management and Administrative Systems...............................................................80

5.3.1 Training and Supervision.....................................................................................80

5.3.2 In-service Training by Topic ...............................................................................81

6 ANTENATAL CARE SERVICES ..............................................................................................93

6.1 Background........................................................................................................................93

6.2 Availability of ANC Services............................................................................................94

6.2.1 ANC Service Provision........................................................................................94

6.2.2 Availability of ANC Guidelines, Trained Staff, and Equipment .........................95

6.2.3 Availability of Laboratory Diagnostic Tests........................................................96

6.2.4 Availability of Medicines for Routine ANC........................................................96

6.2.5 Availability of Infection Control items................................................................97

6.3 Readiness of Health Facilities to Provide ANC Services..................................................97

6.4 Basic Management and Administrative Systems.............................................................101

6.4.1 Recent In-service Training and Supervision......................................................101

6.4.2 In-service Training by Topic .............................................................................101
Contents • v

7 DELIVERY AND NEWBORN CARE......................................................................................111

7.1 Background......................................................................................................................112

7.2 Availability of Maternal Health Services........................................................................113

7.2.1 Service Provision ...............................................................................................113

7.2.2 Guidelines, Trained Staff, and Equipment for Delivery Services......................115

7.2.3 Medicines and Commodities for Delivery Care.................................................116

7.2.4 Items for Infection Control during Provision of Delivery Care .........................117

7.3 Signal Functions for Emergency Obstetric and Newborn Care.......................................118

7.4 Readiness of Health Facilities to Provide Normal Delivery Services .............................119

7.5 Newborn Care Practices ..................................................................................................121

7.5.1 Routine Newborn Care ......................................................................................121

7.5.2 Availability of Essential Medicines for Newborn Care .....................................121

7.5.3 Availability of Equipment for Newborn Care Services.....................................122

7.6 Basic Management and Administrative Systems.............................................................123

7.6.1 Recent In-service Training and Supervision......................................................123

7.6.2 In-service Training in Newborn and Delivery Care by Topic ...........................123

8 NON-COMMUNICABLE DISEASES......................................................................................137

8.1 Background......................................................................................................................138

8.2 Availability of Services for Diabetes...............................................................................141

8.2.1 Service Provision ...............................................................................................141

8.2.2 Availability of Diagnostic Capacity and Medicines for Diabetes......................143

8.3 Availability of Services for Cardiovascular Diseases......................................................143

8.3.1 Service Provision ...............................................................................................143

8.3.2 Availability of Medicines and Commodities for Cardiovascular Diseases........145

8.4 Availability of Services for Chronic Respiratory Diseases .............................................145

8.4.1 Service Provision ...............................................................................................145

8.4.2 Availability of Medicines and Commodities for Chronic Respiratory Diseases147

8.5 Availability of Services for Hypertension .......................................................................147

8.5.1 Service Provision ...............................................................................................147

8.5.2 Availability of Medicines and Commodities for Hypertension .........................149

8.6 Availability of Services for Cervical Cancer...................................................................149

8.6.1 Availability of Screening Services for Cervical Cancer ....................................149

8.6.2 Service Guidelines.............................................................................................150

8.6.3 Trained Staff ......................................................................................................150

8.6.4 Equipment..........................................................................................................150

9 TUBERCULOSIS .......................................................................................................................161

9.1 Background......................................................................................................................162

9.2 Availability of TB Services.............................................................................................163

9.2.1 Service Provision ...............................................................................................163

9.2.2 Availability of Diagnostic Capacity and Medicines for TB Treatment .............165

9.3 Readiness of Health Facilities to Provide TB Services ...................................................165

REFERENCES .........................................................................................................................................171

APPENDIX A PERSONS INVOLVED IN THE SURVEY................................................................175

APPENDIX B SUMMARY INDICATORS .........................................................................................179

APPENDIX C QUESTIONNAIRES.....................................................................................................181

Tables and Figures • vii

TABLES AND FIGURES

1 OVERVIEW OF THE HEALTH SYSTEM IN BANGLADESH...............................................1

Table 1.1 Secondary and primary health care facilities in public sector................................5

2 METHODOLOGY..........................................................................................................................9

Table 2.1 Bangladesh health facility distribution by division and health facility type ........15

Table 2.2 Health facility sample allocation by division and health facility type .................15

Table 2.3 Results of facility contacts by background characteristics...................................16

Table 2.4 Distribution of surveyed facilities by background characteristics .......................17

Table 2.5 Distribution of interviewed providers..................................................................18

3 FACILITY-LEVEL INFRASTRUCTURE, RESOURCES, MANAGEMENT, 

AND SUPPORT ............................................................................................................................19

Table 3.1 Availability of specific services...........................................................................39

Table 3.2 Availability of basic client services.....................................................................40

Table 3.3 Availability of basic amenities for client services ...............................................41

Table 3.4 Availability of basic equipment ...........................................................................42

Table 3.5 Standard precautions for infection control...........................................................43

Table 3.6 Capacity for processing equipment for reuse.......................................................44

Table 3.7.1 Laboratory diagnostic capacity ............................................................................45

Table 3.7.2 Laboratory diagnostic capacity ............................................................................46

Table 3.8.1 Availability of essential medicines......................................................................47

Table 3.8.2 Availability of essential medicines......................................................................48

Table 3.9 Supportive management practices at the facility level.........................................49

Table 3.10 Quality assurance and client opinion ...................................................................50

Table 3.11 Staffing pattern in surveyed facilities ..................................................................51

Table 3.12.1 Sharps waste management ...................................................................................52

Table 3.12.2 Non-sharps waste management............................................................................53

Figure 3.1 Availability of basic client services in health facilities........................................22

Figure 3.2 Availability of electricity from national electricity grid line, by facility type .....24

Figure 3.3 Availability of regular electricity, by facility type*.............................................24

Figure 3.4 Availability of improved water source, by facility type.......................................25

Figure 3.5 Availability of privacy during consultations, by facility type..............................25

Figure 3.6 Availability of client latrine, by facility type .......................................................26

Figure 3.7 Availability of separate latrine for female clients, by facility type ......................26

Figure 3.8 Availability of communication equipment (land-line/mobile phone), by 

facility type ..........................................................................................................26

Figure 3.9 Availability of a functioning computer with Internet,* by facility type ..............27

Figure 3.10 Availability of emergency transport, by facility type ..........................................27

Figure 3.11 Availability of at least five basic amenities in health facilities, by facility 

type ......................................................................................................................28

Figure 3.12 Availability of at least seven items for infection control in health facilities, 

by facility type .....................................................................................................29

Figure 3.13 Capacity to conduct basic laboratory diagnostic tests in health facilities............30

Figure 3.14 Availability of all five basic laboratory diagnostic tests in health facilities, 

by facility type .....................................................................................................31

Figure 3.15 Availability of functional x-ray machine in health facilities, by facility type......31
viii • Tables and Figures

Figure 3.16 Availability of functional ultrasound machine in health facilities, by facility 

type ......................................................................................................................32

Figure 3.17 Availability of at least six essential medicines of a DDS kit in health 

facilities, by facility type......................................................................................33

Figure 3.18 Quality assurance and client opinion, by facility type .........................................35

Figure 3.19 Trends in physician positions filled, by facility type ...........................................36

Figure 3.20 Trends in physician positions filled in public health facilities, by facility 

type ......................................................................................................................36

Figure 3.21 Trends in nurse/midwife positions filled in different facilities............................37

Figure 3.22 Sharps waste management, by facility type .........................................................37

Figure 3.23 Non-sharps waste management, by facility type..................................................38

4 CHILD HEALTH SERVICES.....................................................................................................55

Table 4.1 Availability of child health services.....................................................................63

Table 4.2 Guidelines and equipment for child curative care services..................................64

Table 4.3 Trained staff for child curative care services.......................................................65

Table 4.4 Availability of essential and priority medicines and commodities ......................66

Table 4.5 Infection control and laboratory diagnostic capacity ...........................................67

Table 4.6 Readiness of health facilities to provide child curative care services..................68

Table 4.7 Supportive management for providers of child health services...........................69

Table 4.8 Training for child health service providers..........................................................70

Figure 4.1 Availability of child health services by type of facility .......................................56

Figure 4.2 Availability of three basic child health services ..................................................57

Figure 4.3 Availability of all four equipment items for outpatient curative care for sick 

children, by facility type ......................................................................................58

Figure 4.4 Availability of all six infection control items for child curative care, by 

facility type ..........................................................................................................59

Figure 4.5 Readiness of health facilities to provide child curative care, by facility type......60

Figure 4.6 Availability of items (tracer indicators) in health facilities for readiness to 

provide child curative care...................................................................................61

Figure 4.7 Provider training on topics related to child health in the last 24 months.............62

5 FAMILY PLANNING SERVICES .............................................................................................71

Table 5.1 Availability of family planning services..............................................................82

Table 5.2 Methods of family planning provided..................................................................83

Table 5.3 Methods of family planning provided1................................................................84

Table 5.4 Frequency of availability of family planning services.........................................85

Table 5.5 Availability of family planning commodities......................................................86

Table 5.6 Guidelines, trained staff, and basic equipment for family planning services.......87

Table 5.7 Items for infection control during provision of family planning .........................88

Table 5.8 Readiness of health facilities to provide family planning services......................89

Table 5.9 Supportive management for providers of family planning services.....................90

Table 5.10 Training for family planning service providers ...................................................91

Figure 5.1 Facilities providing modern FP methods and services, by method......................73

Figure 5.2 Facilities providing modern FP methods and services, by facility type...............74

Figure 5.3 Facilities providing LARC/PMs, by facility type ................................................74

Figure 5.4 Facilities providing male or female sterilization services, by facility type..........75

Figure 5.5 Percentage of facilities with FP commodities (oral pills, injectables, 

condoms, IUCDs, implants) available on the day of the survey ..........................76

Figure 5.6 Availability of at least four standard precaution items for infection control 

in family planning service areas, by facility type ................................................77
Tables and Figures • ix

Figure 5.7 Availability of FP guidelines in health facilities..................................................77

Figure 5.8 Availability of staff trained in FP at any time in health facilities ........................78

Figure 5.9 Availability of oral pills, by facility type.............................................................78

Figure 5.10 Availability of injectable, by facility type............................................................79

Figure 5.11 Availability of condoms, by facility type.............................................................79

Figure 5.12 Availability of items (tracer indicators) in health facilities for readiness to 

provide FP services..............................................................................................80

Figure 5.13 Readiness of health facilities to provide FP services, by facility type .................80

6 ANTENATAL CARE SERVICES ..............................................................................................93

Table 6.1 Availability of antenatal care services...............................................................103

Table 6.2 Guidelines, trained staff, and basic equipment for antenatal care services........104

Table 6.3 Diagnostic capacity............................................................................................105

Table 6.4 Availability of medicines for routine antenatal care ..........................................106

Table 6.5 Items for infection control during provision of antenatal care...........................107

Table 6.6 Readiness of health facilities to provide antenatal care services .......................108

Table 6.7 Supportive management for providers of antenatal care services......................109

Table 6.8 Training for antenatal care service providers.....................................................110

Figure 6.1 Availability of ANC services in health facilities, by facility type .......................94

Figure 6.2 Availability of ANC guidelines in health facilities, by facility type....................95

Figure 6.3 Availability of staff ever trained for ANC in health facilities, by facility 

type ......................................................................................................................95

Figure 6.4 Availability of equipment to support ANC services............................................96

Figure 6.5 Availability of laboratory diagnostic tests to support ANC services...................96

Figure 6.6 Availability of all six infection control items for antenatal care services, by 

facility type ..........................................................................................................97

Figure 6.7 Availability of items (tracer indicators) in health facilities indicating 

readiness to provide ANC services......................................................................98

Figure 6.8 Readiness of health facilities to provide ANC services, by facility type .............98

Figure 6.9 Readiness of district hospitals (DHs) to provide ANC services ..........................99

Figure 6.10 Readiness of mother and child welfare centers (MCWCs) to provide ANC 

services.................................................................................................................99

Figure 6.11 Readiness of upazila health complexes (UHCs) to provide ANC services..........99

Figure 6.12 Readiness of union health and family welfare centers (UHFWCs) to 

provide ANC services........................................................................................100

Figure 6.13 Readiness of nongovernmental (NGO) clinics to provide ANC services..........100

Figure 6.14 Readiness of private hospitals to provide ANC services ...................................101

7 DELIVERY AND NEWBORN CARE......................................................................................111

Table 7.1 Availability of maternal health services.............................................................125

Table 7.2 Guidelines, trained staff, and equipment for delivery services..........................126

Table 7.3 Availability of staff trained on normal delivery or newborn care......................127

Table 7.4 Medicines and commodities for delivery...........................................................128

Table 7.5 Items for infection control during provision of delivery care ............................129

Table 7.6 Signal functions for emergency obstetric care ...................................................130

Table 7.7 Readiness of health facilities to provide normal delivery services....................131

Table 7.8 Newborn care practices......................................................................................132

Table 7.9 Essential medicines for newborn care................................................................132

Table 7.10 Availability of equipment for newborn care services ........................................133

Table 7.11 Supportive management for providers of delivery care .....................................134

Table 7.12 Training for providers of normal delivery services: Immediate newborn 

care.....................................................................................................................135

Table 7.13 Training for providers of normal delivery services: Immediate newborn 

care.....................................................................................................................136
x • Tables and Figures

Figure 7.1a Availability of normal delivery services in health facilities, by facility type ....114

Figure 7.1b Availability of cesarean delivery services in health facilities, by facility 

type ....................................................................................................................115

Figure 7.2 Items to support quality provision of delivery services .....................................116

Figure 7.3 Items for infection control in delivery service area............................................118

Figure 7.4 Basic emergency obstetric and neonatal care (BEmONC) signal functions, 

by facility type ...................................................................................................119

Figure 7.5 Comprehensive emergency obstetric and neonatal care (CEmONC) signal 

functions, by facility type ..................................................................................119

Figure 7.6 Availability of items/tracer indicators in health facilities for readiness to 

provide normal delivery services.......................................................................120

Figure 7.7 Readiness of health facilities to provide normal delivery services, by 

facility type ........................................................................................................121

Figure 7.8 Availability of medicines for newborn care services in health facilities ...........122

Figure 7.9 Availability of equipment for newborn care services in health facilities...........123

8 NON-COMMUNICABLE DISEASES......................................................................................137

Table 8.1 Availability of diabetes services and guidelines, trained staff, and 

equipment for diabetes services.........................................................................151

Table 8.2 Diagnostic capacity and essential medicines for diabetes..................................152

Table 8.3 Availability of cardiovascular disease services and guidelines, trained staff, 

and equipment for cardiovascular disease services............................................153

Table 8.4 Availability of essential medicines and commodities for cardiovascular 

diseases ..............................................................................................................154

Table 8.5 Availability of chronic respiratory disease services and guidelines, trained 

staff, and equipment for chronic respiratory disease services............................155

Table 8.6 Availability of essential medicines and commodities for chronic respiratory 

diseases ..............................................................................................................156

Table 8.7 Availability of hypertension services and guidelines, trained staff, and 

equipment for hypertension services..................................................................157

Table 8.8 Availability of essential medicines and commodities for hypertension.............158

Table 8.9 Availability of cervical cancer diagnosis/screening services and guidelines, 

trained staff, and equipment for cervical cancer................................................159

Figure 8.1 Availability of diabetes services in health facilities, by facility type.................141

Figure 8.2 Trained staff, guidelines, and basic equipment to provide diabetes services.....142

Figure 8.3 Diagnostic capacity and medicines to provide diabetes services.......................143

Figure 8.4 Availability of cardiovascular disease services in health facilities, 

by facility type ...................................................................................................144

Figure 8.5 Trained staff, guidelines, and basic equipment to provide cardiovascular 

disease services..................................................................................................144

Figure 8.6 Commodities and medicines to provide cardiovascular disease services ..........145

Figure 8.7 Availability of chronic respiratory disease services in health facilities, 

by facility type ...................................................................................................146

Figure 8.8 Trained staff, guidelines, and basic equipment to provide chronic 

respiratory disease services................................................................................146

Figure 8.9 Commodities and medicines to provide chronic respiratory disease services ...147

Figure 8.10 Availability of hypertension services in health facilities, by facility type .........148

Figure 8.11 Trained staff, guidelines, and basic equipment to provide hypertension 

services, BHFS 2017..........................................................................................148

Figure 8.12 Medicines to provide services for hypertension.................................................149
Tables and Figures • xi

Figure 8.13 Availability of cervical cancer screening/diagnosis services in 

health facilities, by facility type.........................................................................149

Figure 8.14 Trained staff, guidelines, and basic equipment to diagnose/screen cervical 

cancer.................................................................................................................150

9 TUBERCULOSIS .......................................................................................................................161

Table 9.1 Availability of tuberculosis services, guidelines, and trained staff for 

tuberculosis services ..........................................................................................168

Table 9.2 Diagnostic capacity and availability of medicines for tuberculosis treatment...169

Table 9.3 Readiness of health facilities to provide TB services ........................................170

Figure 9.1 Availability of TB services (TB diagnostic, treatment and/or treatment 

follow-up services), by facility type ..................................................................164

Figure 9.2 Availability of items (tracer indicator) in health facilities (excluding CCs) 

for readiness to provide TB services..................................................................166

Figure 9.3 Readiness of health facilities to provide TB services, by facility, 

BHFS 2014 and BHFS 2017..............................................................................167

Foreword • xiii

FOREWORD

Md. Ali Noor

Secretary

Medical Education & Family Welfare Division

Ministry of Health and Family Welfare

Government of the People’s Republic of Bangladesh

he 2017 Bangladesh Health Facility Survey (2017 BHFS) is the fourth national health facility 

survey implemented in Bangladesh by the National Institute of Population Research and Training 

(NIPORT) with technical assistance from ICF, USA. The survey was funded by the Government of 

Bangladesh and the United States Agency for International Development (USAID).

The survey information was gathered on the availability of basic and essential health care services and the 

readiness of health facilities to provide quality services in child health, maternal and newborn care, family 

planning, tuberculosis, and non-communicable diseases. The survey data were collected from 1,524 health 

care facilities and 5,400 health care providers nationwide. It covered the country as a whole, eight 

administrative divisions, six types of public facilities, private hospitals with at least 20 beds, and NGO 

static·clinics and hospitals.

The survey showed that nearly all health facilities in Bangladesh offer antenatal care for women and 

curative care for children. A majority of the facilities provide family planning and child vaccination 

services. Less common services are for non-communicable disease and tuberculosis diagnosis or treatment 

and normal delivery. The availability of normal delivery services has increased across all types of health 

facilities with the most notable change among Union Health and Family Welfare Centers (UHFWCs).

The survey findings are revealing in terms of the depth and the diversity of challenges in facility 

preparedness and the volume of remaining tasks. It identified major weaknesses that require immediate 

action for improving the quality of health services. We should review the problems in service delivery, 

develop concrete and action-oriented preparedness plans, and regularly monitor service delivery. We urge 

all stakeholders to play active roles in trying to close the gaps in provision of quality health services to the 

Bangladeshi population.

I am greatly indebted and thankful to all who contributed to the 2017 BHFS. I would like to go on record 

with my sincere appreciation of the technical working group (TWG) members, representatives of 

Stakeholder Advisory Committee (SAC); officials of Directorate General of Health Services; Directorate 

General of Family Planning (DGFP); Save the Children, USA; the field staffs: data processing team and 

specially survey respondents.

Finally, I would like to thank NIPORT in conducting the survey. I appreciate ICF, USA and the United 

States Agency for International Development (USAID)/Bangladesh for providing technical assistance. I 

deeply acknowledge the Government of Bangladesh (GOB) and the USAID for the financial assistance 

that helped to ensure the ultimate success of this important national survey.

(Md. Ali Noor)

T

Preface • xv

PREFACE

Susanta Kumar Saha

Director General

National Institute of Population Research and Training (NIPORT)

Medical Education and Family Welfare Division

Ministry of Health and Family Welfare

he 2017 Bangladesh Health Facility Survey (2017 BHFS) is a nationally representative sample 

survey. The survey included the government, nongovernmental, and private health facilities. The 

National Institute of Population Research and Training (NIPORT) implemented the survey, and a 

private research agency, Associates for Community and Population Research (ACPR), was appointed to 

collect the data. The DHS Program of ICF, USA provided technical assistance. The International Center 

for Diarrheal Disease Research (icddr,b) assisted NIPORT to monitor the field work. Financial assistance 

was provided by the Government of Bangladesh and the United States Agency for International 

Development (USAID).

The Government of Bangladesh has made tremendous achievements in public health over the last few 

decades as health care facilities have gradually replaced home-based care. Under the fourth Health, 

Population and Nutrition Sector Program (HPNSP) 2016-2021, the Ministry of Health and Family Welfare 

(MOHFW) has made decisions to guide the result framework indicators of HPNSP through periodic 

assessment of health systems and quality of care provided by various health facilities. As part of this 

assessment effort, NIPORT conducted the 2017 BHFS under the Training, Research and Development 

(TRD) operational plan of the fourth HPNSP. NIPORT also conducted the 2014 BHFS under the previous 

health sector program of the MOHFW.

The 2017 BHFS assesses government, registered nongovernmental, and private health care facilities in 

Bangladesh in all eight divisions of the country. The intent is to provide a comprehensive picture of the 

availability of health services for maternal and child health, family planning, tuberculosis, and noncommunicable diseases. The survey assesses the general preparedness of the facilities in terms of 

availability of basic amenities, equipment, laboratory services, essential medicines, standard precautions 

for infection control, and human resources. Service-specific readiness of health facilities was measured in 

terms of the WHO recommended minimum conditions required to provide quality services for maternal, 

newborn, and child health care; family planning services; and treatment of diabetes, cardiovascular disease, 

and tuberculosis.

The 2017 BHFS collected information from 1,524 facilities managed by the government, non-government 

and private organizations. The survey also obtained information from 5,400 service providers of the 

selected facilities in eight divisions of the country. Doctors and the Sub-assistant Community of Medical 

Officers collected data using tablet computers. Forty data collection teams (two members each) were 

engaged from July-October 2017.

A Technical Working Group, consisting of representatives from NIPORT, icddr,b, ICF, Save the Children, 

MSH, ACPR, and USAID/Bangladesh, provided technical guidance in all aspects of survey 

implementation and assisted in preparing the preliminary report of the survey. A Stakeholder Advisory 

Committee under the chair of the Director General of NIPORT, with expert members from government,

nongovernmental, and international organizations, as well as researchers and professionals who work in 

T
xvi • Preface

the health, nutrition, and population sectors, contributed their expert opinions during survey 

implementation and approved the final report for printing.

The preliminary report was published in December 2018. The final report includes more detailed analysis 

of the survey results and different dimensions of the data. We hope the final report of the 2017 BHFS will 

prove useful to planners, researchers, and policymakers, and serve to enhance the understanding of 

important issues related to health service provision and readiness of health facilities and to meet the 

monitoring and evaluation need for providing quality health services.

This survey is an admirable collaboration between NIPORT, under the Ministry of Health and Family 

Welfare, and development partners. I would like to express my deep sense of appreciation for the 

contributions of different stakeholders who designed and implemented this survey and produced this

indispensable report. My sincere gratitude goes to all members of the Technical Advisory Committee and 

the Technical Working Group for their time, support, and valuable suggestions at every stage.

This final report is an outcome of the contributions of professionals of a number of organizations and 

individuals. I would like to acknowledge with great appreciation the individual researchers for their 

contributions to 2017 BHFS final report.

Special thanks go to the field supervisors and enumerators for their tireless efforts in making the fieldwork 

successful. I am also grateful to all staff of the health facilities who willingly cooperated with the survey 

teams and provided the information that we have analyzed in this report. We are deeply grateful to icddr,b 

for ensuring the quality of data through extensive field monitoring during field work.

I am deeply indebted and grateful to all the professionals of the Research Unit of NIPORT for completing 

the task competently. I also extend my thanks to ICF (USA), ACPR, and USAID (Bangladesh), for their 

cooperation and successful completion of the survey. Last, but not least, I would like to express my special 

gratitude to the honorable Secretary, Medical Education and Family Welfare Division, Ministry of Health 

and Family Welfare, Government of Bangladesh, for his valuable guidance and direction at every stage of 

the survey’s implementation.

(Susanta Kumar Saha)
Contributors to the Report • xvii

CONTRIBUTORS TO THE REPORT

NIPORT

Ms. Shahin Sultana

Senior Research Associate

Mr. Mohammed Ahsanul Alam

Evaluation Specialist

Mr. A.K.M Abdullah

Research Associate

DHAKA UNIVERSITY

Ms. Gaylan Peyari Tarannum Dana

Associate Professor

Department of Population Science

Ms. Shahnaz Nilima

Lecturer

Department of Statistics

Ms. Wasifa Tasnim Shamma

Lecturer

Department of Sociology

Ms. Eashrat Jahan Eyemoon

Lecturer

Department of Sociology

ICDDR,B

Mr. Md. Moinuddin Haider

Assistant Scientist 

Health Systems and Population Studies Division

Dr. Ahmed Ehsanur Rahman

Associate Scientist

Maternal and Child Health Division

Ms. Shema Mhajabin

Research Trainee

Maternal and Child Health Division

MEASURE EVALUATION/DATA FOR IMPACT

Ms. Shusmita Khan

Research Associate
xviii • Contributors to the Report

NATIONAL TB PROGRAM

Dr. ATM. Sanaul Bashar

Former Senior Technical Advisor

ICF

Dr. Hamdy Moussa

Senior International Health Lead, ICF, USA

Dr. Ahmed Al-Sabir

Consultant, ICF, USA

Mr. Rajendra Lal Dangol

Consultant, ICF, USA

Prof. Nitai Chakraborti

Consultant, ICF, USA

USAID/BANGLADESH

Dr. Kanta Jamil

Senior Monitoring, Evaluation and Research Advisor

Office of Population, Health, Nutrition, and Education
Acronyms and Abbreviations • xix

ACRONYMS AND ABBREVIATIONS

ACE angiotensin-converting enzyme

ACPR Associates for Community and Population Research

AHI assistant health inspector

AMTSL active management of the third stage of labor

ANC antenatal care

BCS Bangladesh Civil Service

BDHS Bangladesh Demographic and Health Survey

BEmONC basic emergency obstetric and neonatal care

BHFS Bangladesh Health Facility Survey

BMDC Bangladesh Medical & Dental Council

BRAC Bangladesh Rural Advancement Committee

CAPI computer-assisted personal interview

CC community clinic

CEmONC comprehensive emergency obstetric and neonatal care

CHCP community healthcare provider

CS Civil Surgeon

CSF cerebrospinal fluid

CT computed tomography

CVD cardiovascular disease

DALYS disability-adjusted life years

DD-FP Deputy Director-Family Planning

DDS drug and dietary supply

DGDA Directorate General of Drug Administration

DGFP Directorate General of Family Planning

DGHS Directorate General of Health Services

DH district hospital

DHS demographic and health survey

DM diabetes mellitus

DNS Directorate of Nursing Services

DOTS Directly Observed Treatment, Short-course

EDCL Essential Drugs Company Limited

EMO emergency medical officer

EmOC emergency obstetric care

EPI expanded program on immunization

ESP essential service package

FP family planning

FPI family planning inspector

FWA family welfare assistant

FWC family welfare center

FWV family welfare visitor
xx • Acronyms and Abbreviations

GDP gross domestic product

GOB Government of Bangladesh

GP general practitioner

HA health assistants

HED Health Engineering Department

HI health inspector

HLD high-level disinfection

HMIS health management information system

HPNSP Health, Population, and Nutrition Sector Program

HTN hypertension

ICDDR,B International Centre for Diarrhoeal Disease Research

ICT information and communications technology

IDF International Diabetes Foundation

IFSS Internet File Streaming System

IHD ischemic heart disease

IHFAN International Health Facility Assessment Network

IMCI integrated management of child illness

IMPAC integrated management of pregnancy and childbirth

IUCD intrauterine contraceptive device method

LAPM long-acting and permanent method

LGD Local Government Division

LLP local level planning

M&E monitoring and evaluation

MBDC Mycobacterial Disease Control

MCH-FP maternal and child health/family planning

MCWC maternal and child welfare center

MDG Millennium Development Goal

MDR-TB multiple-drug resistant TB

MIS management information system

MNCH maternal, neonatal, and child health

MNCS maternal, newborn, and child survival

MNH maternal and neonatal health

MOHFW Ministry of Health and Family Welfare

MOLGRD C Ministry of Local Government, Rural Development, and Cooperatives

NCD non-communicable disease

NCHS National Center for Health Statistics

NEMEW National Electro-medical & Engineering Workshop

NGO nongovernmental organization

NHSDP NGO Health Service Delivery Program

NIPORT National Institute of Population Research and Training

NSAPR National Strategy for Accelerated Poverty Reduction

NTP National Tuberculosis Control Program

OOP out-of-pocket purchase

OP operational plan

OPD outpatient department

ORS oral rehydration solution
Acronyms and Abbreviations • xxi

PHC primary health care

PIP program implementation plan

PNC postnatal care

PPP public private partnership

QA quality assurance

RCHCIB Revitalization of Community-based Healthcare Initiatives in Bangladesh

RD rural dispensary

RMO residential medical officer

SACMO sub-assistant community medical officer

SARA Service Availability and Readiness Assessment

SBA skilled birth attendant

SDGs Sustainable Development Goals

SMF state medical faculty

SPA service provision assessment

SWAp sector-wide approach

TB tuberculosis

TEMO Transport & Equipment Maintenance Organization

TRC technical review committee

TRD training, research, and development

TT tetanus toxoid

TWC technical working group

UFPO Upazila Family Planning Officer

UH&FPO Upazila Health & Family Planning Officer

UHC upazila health complex

UHFWC union health and family welfare center

UHS Upazila Health System

UPHCSDP Urban Primary Health Care Services Delivery Project

USAID U.S. Agency for International Development

USC union sub-center

USC/RD union sub-center/rural dispensary

WHO World Health Organization

Reading and Understanding Tables from the 2017 BHFS • xxiii

READING AND UNDERSTANDING TABLES 

FROM THE 2017 BANGLADESH HEALTH 

FACILITY SURVEY (BHFS)

he 2017 Bangladesh Health Facility Survey 

(BHFS) final report is based on 

approximately 72 tables of data. For quick 

reference, they are located at the end of each 

chapter and can be accessed through links in the 

pertinent text (electronic version). Additionally, 

this more reader-friendly version features about 85

figures that clearly highlight trends, subnational 

patterns, and background characteristics. The text

has been simplified to highlight key points in 

bullets and to clearly identify indicator definitions 

in boxes.

While the text and figures featured in each chapter 

highlight some of the most important findings from 

the tables, not every finding can be discussed or 

displayed graphically. For this reason, 2017 BHFS

data users should be comfortable reading and 

interpreting tables.

The following pages provide an introduction to the 

organization of 2017 BHFS tables, the presentation 

of background characteristics, and a brief summary 

of sampling and understanding denominators. In 

addition, this section provides some exercises for 

users as they practice their new skills in 

interpreting BHFS tables.

T
xxiv • Reading and Understanding Tables from the 2017 BHFS

Example 1: Availability of Basic Client Services

A Question Asked of All Surveyed Health Facilities

Table 3.2 Availability of basic client services

Among all facilities, the percentages offering the indicated basic client services and all basic client services, by background characteristics, 

Bangladesh HFS 2017

Background

characteristic

Child 

curative 

care

Child 

growth 

monitoring 

services

Child 

vaccination 

services

Any 

modern 

methods of 

family 

planning

Antenatal 

care 

services

Normal 

delivery

All basic 

client 

services 

with normal 

delivery1

All basic 

client 

services

without 

normal 

delivery

Number of 

facilities

Facility type

District and upazila 

public facilities 99.0 96.3 93.9 94.1 99.4 95.4 84.4 86.2 44

DH 100.0 96.8 93.5 79.0 100.0 100.0 71.0 71.0 5

MCWC 97.8 86.6 73.5 98.9 100.0 92.2 58.9 62.3 7

UHC 99.1 98.3 98.4 95.3 99.1 95.4 91.9 93.6 32

Union-level public 

facilities 97.7 76.3 74.8 87.9 95.7 52.5 35.1 54.9 361

UHFWC 97.0 81.8 73.7 97.7 99.5 64.7 43.5 59.4 250

USC/RD 99.3 63.9 77.2 65.8 87.2 24.9 16.2 44.6 111

Community clinic (CC) 98.8 90.1 95.8 91.1 100.0 6.5 6.1 80.6 1,012

NGO clinic/hospital 94.0 79.9 69.3 86.4 99.8 32.0 14.9 59.9 64

Private hospital 89.9 44.5 6.9 53.3 94.9 94.6 3.8 3.8 43

Location

Urban 92.4 71.5 55.0 78.7 97.6 72.0 28.7 47.1 108

Rural 98.6 86.4 89.6 90.0 98.9 19.8 14.5 73.5 1,416

Division

Barishal 99.3 97.4 89.0 93.8 99.6 29.0 23.7 83.4 113

Chattogram 96.1 74.2 86.8 90.7 98.5 27.6 16.4 63.7 288

Dhaka 98.2 89.3 85.0 87.5 98.9 25.8 14.5 74.4 304

Khulna 99.0 80.0 88.1 93.2 98.6 19.0 14.6 71.4 187

Rajshahi 96.7 88.3 84.5 91.5 97.6 24.7 17.1 72.0 220

Rangpur 99.6 85.7 90.9 76.4 99.1 19.5 14.6 66.2 193

Sylhet 99.7 94.5 83.3 96.1 99.7 19.4 10.3 78.0 96

Mymensingh 99.1 85.6 91.9 90.0 99.9 17.5 12.6 76.0 123

Total 98.1 85.3 87.2 89.2 98.8 23.5 15.5 71.7 1,524

Total excluding CCs 96.7 75.8 70.1 85.4 96.5 57.2 34.2 54.0 512

1 Basic client services include outpatient curative care for sick children, child growth monitoring, facility-based child vaccination services, any 

modern methods of family planning, antenatal care, and normal delivery.

Step 1: Read the title and subtitle, highlighted in orange in the table above. They provide a brief 

description of the information contained in the table. In this case, the table is about the provision of basic 

client services in health facilities assessed in the 2017 BHFS.

Step 2: Scan the column headings—highlighted in green in Example 1. They describe how the information 

is categorized. In this table, there are nine columns of data. The first six columns represent one basic client 

service—child curative care, child growth monitoring, child vaccination, any modern methods of family 

planning, antenatal care, and normal delivery. The seventh column shows what percent of facilities have 

ALL six basic client services, while the eighth column shows the percent of facilities with all basic client 

services EXCEPT normal delivery. Note that the very last column, in gray, lists the number of facilities 

surveyed. These numbers are the denominators, that is, the total number of facilities surveyed for each 

topic and each background characteristic. In this case, 1,524 facilities were surveyed. Of these 1,524 

facilities, 44 are district and upazila public facilities, 361 are union-level public facilities, 1,012 are public 

community clinics, 64 are NGO clinics/hospitals, and 43 are private hospitals. 

Step 3: Scan the row headings—the first vertical column highlighted in blue in Example 1. These show the 

different ways the data are divided into categories based on background characteristics. In this case, the 

table presents availability of basic client services by facility type, urban-rural location, and division. (Note 

1

3 2

4

5
Reading and Understanding Tables from the 2017 BHFS • xxv

that facility type is further divided into subcategories). Most of the tables in the 2017 BHFS will be divided 

into these same categories.

Step 4: Look at the row at the bottom of the table highlighted in pink. These figures represent the totals, or 

the percent of facilities that offer each of the six services, and the percent of facilities that offer ALL 

services. This table shows that services for child curative care (98.1%) are widely available in Bangladesh, 

while 15.5% of all facilities provide ALL six basic client services. 

Note that there is an additional column below the total which presents what the total would be if 

community clinics (CCs) are excluded.

Step 5: To find out what percent of health facilities in Khulna division offer child vaccination services, 

draw two imaginary lines, as shown on the table above. This shows that 88.1% of health facilities in 

Khulna division offer child vaccination services.

By looking at patterns by background characteristics, we can see how the provision of basic client services 

varies across Bangladesh. Resources are often limited; knowing how client services vary among types of 

health facilities can help programme planners and policymakers determine how to most effectively use 

resources.

*For the purpose of this document data are presented exactly as they appear in the table including decimal places. However, 

the text in the remainder of this report rounds data to the nearest whole percentage point.

Practice: Use the table in Example 1 above to answer the following questions:

a) Are normal delivery services more likely to be offered in urban or rural facilities?

b) In which division are modern methods of family planning least available?

c) Facilities in which category are most likely to offer ALL six basic client services?

Answers:

compared to 19.8% of rural facilities. , ormal delivery services 72.0% of urban facilities offer n — a) Urban

76.4%. — b) Rangpur division

84.4%. — c) District and upazila public facilities
xxvi • Reading and Understanding Tables from the 2017 BHFS

Example 2: Availability of Antenatal Care (ANC) Services

A Question Asked of a Subset of Surveyed Health Facilities

Table 6.1 Availability of antenatal care services

Among all facilities, the percentage offering antenatal care (ANC) services and, among facilities offering ANC services, the percentage 

offering the service on the indicated number of days per week, by background characteristics, Bangladesh HFS 2017

Percentage of 

facilities that 

offer ANC

Number of 

facilities

Percentage of facilities offering 

ANC where ANC services are 

offered on indicated days1

Number of 

facilities offering 

ANC

Background 

characteristic

Provides but not 

every day1

Provides every 

day1

Facility type

District and upazila public facilities 99.4 44 2.4 97.6 44

DH 100.0 5 4.8 95.2 5

MCWC 100.0 7 10.1 89.9 7

UHC 99.1 32 0.3 99.7 32

Union-level public facilities 95.7 361 20.4 79.6 346

UHFWC 99.5 250 21.8 78.2 249

USC/RD 87.2 111 17.0 83.0 97

Community clinic (CC) 100.0 1,012 5.9 94.1 1,012

NGO clinic/hospital 99.8 64 1.6 98.4 63

Private hospital 94.9 43 5.7 94.3 41

Location

Urban 97.6 108 3.9 96.1 105

Rural 98.9 1,416 9.3 90.7 1,401

Division

Barishal 99.6 113 3.4 96.6 112

Chattogram 98.5 288 5.0 95.0 284

Dhaka 98.9 304 7.2 92.8 300

Khulna 98.6 187 9.6 90.4 185

Rajshahi 97.6 220 12.4 87.6 214

Rangpur 99.1 193 12.2 87.8 192

Sylhet 99.7 96 10.5 89.5 96

Mymensingh 99.9 123 13.8 86.2 122

Total 98.8 1,524 8.9 91.1 1,506

Total excluding CCs 96.5 512 15.2 84.8 494

1 Every day refers to all working days when the facility is open.

Step 1: Read the title and subtitle. In this case, the table is about two separate groups: (a) all health 

facilities, and (b) facilities that offer antenatal care (ANC) services.

Step 2: Identify the two panels. First, identify the columns that refer to all facilities (a). Then, isolate the 

columns that refer only to facilities that offer ANC services (b).

Step 3: Scan the row headings to identify the background characteristics. In this table, availability of ANC 

services is presented by facility type, urban-rural location, and division.

Step 4: Find the national total and denominators for each panel. What percent of health facilities in

Bangladesh offer ANC services? It’s 98.8%. Now look at the denominator for the second panel (b). How 

many health facilities in Bangladesh surveyed in the 2017 BHFS offer ANC services? It’s 1,506, which 

represents 98.8% of the 1,524 health facilities in the survey sample. The second panel is a subset of the 

first panel.

When reading and using the 2017 BHFS tables, be sure to identify which group of facilities is being 

displayed. For example, look at the first column in panel b. It is NOT correct to say that 91.1% of health 

facilities provide ANC services every day. It IS correct to say that 91.1% of facilities offering ANC 

services provide these services every day.

1

3 2

4

a b
Reading and Understanding Tables from the 2017 BHFS • xxvii

Example 3: Understanding Sampling Weights in 2017 BHFS Tables

In the 2017 BHFS, the sample is 

a group of facilities that have 

been selected from a list of all 

health facilities in the country. 

The sample represents the entire 

health system, that is, all health 

facilities in Bangladesh. Most 

countries want to collect data 

and report information that 

represent facilities in the entire 

country as well as facilities in 

subnational areas like divisions.

In the case of the 2017 BHFS,

researchers also want to know 

about facilities of different types, 

as well as facilities run by 

different managing authorities 

(for example public, NGO, or 

private). We want the sample of 

district hospitals (DHs) surveyed 

to represent all district hospitals 

in the country, and we want the 

public community clinics (CCs) 

sampled to represent all public 

CCs. However, there are many 

more public CCs than DHs in 

Bangladesh. If we chose a simple random sample of facilities, we will only get a few DHs but hundreds of 

public CCs. However, just including a few DHs in our sample would not be enough DHs for meaningful 

analysis.

For example, let’s say that we have enough money to visit 1,524 facilities for a survey that should be 

representative of all facility types in Bangladesh (as shown in Table 2.4). In Bangladesh, health facilities 

are not evenly distributed; there are many more facility types, such as public CCs than others.

A sampling statistician can determine how many facilities of each type should be surveyed in order to get 

reliable statistics for the specific indicators the country wants. In the case of the 2017 BHFS, the blue 

column (1) shows the actual number of facilities selected and interviewed in each type, ranging from 62 

DHs to 325 CCs. The sampling statistician assures us that these are enough facilities to get reliable results 

for each type of facility.

But now there is a new challenge. With this distribution of facilities by type, some facility types are 

overrepresented and some types are underrepresented. For example, the unweighted column tells us that 62 

DHs were surveyed, which equals 4% of all facilities in the sample (1,524). But in reality, DHs comprise 

less than 1% of all health facilities in Bangladesh. On the other hand, 325 public CCs were surveyed, 

which equals 21% of the facilities in the sample. In actuality, about 66% of health facilities in Bangladesh 

are public CCs. Would our survey show the true state of health facilities in Bangladesh if we used this 

sample distribution?

In order to get statistics that are representative of the entire health system in Bangladesh, the distribution of 

health facilities in our sample needs to resemble the distribution of health facilities in Bangladesh. District 

Table 2.4 Distribution of surveyed facilities by background characteristics

Percent distribution and number of surveyed facilities, by background characteristics, 

Bangladesh HFS 2017

Background

characteristic

Weighted percent 

distribution of 

surveyed facilities

Number of facilities surveyed

Weighted Unweighted

Facility type

District and upazila public 

facilities 2.9 44 293

DH 0.3 5 62

MCWC 0.5 7 90

UHC 2.1 32 141

Union-level public facilities 23.7 361 677

UHFWC 16.4 250 479

USC/RD 7.3 111 198

Community clinic (CC) 66.4 1,012 325

NGO clinic/hospital1 4.2 64 123

Private hospital 2.8 43 106

Location

Urban 7.1 108 383

Rural 92.9 1,416 1,141

Division

Barishal 7.4 113 260

Chattogram 18.9 288 302

Dhaka 19.9 304 188

Khulna 12.3 187 164

Rajshahi 14.4 220 161

Rangpur 12.7 193 158

Sylhet 6.3 96 163

Mymensingh 8.0 123 128

Total 100.0 1,524 1,524

Total excluding CCs na 512 1,199

1 The NGO category includes facilities run by local governments.

na = Not applicable

3 2 1
xxviii • Reading and Understanding Tables from the 2017 BHFS

hospitals, for example, should only contribute a small amount to the total. Likewise, public CCs should 

contribute more. 

The number of facilities of each type is weighted or adjusted so that each type’s contribution to the total is 

proportionate to the actual distribution of health facilities in Bangladesh. The numbers in the purple 

column (2) represent the “weighted” numbers. The weighted values can be smaller or larger than the 

unweighted values. The total sample size of 1,524 facilities has not changed, but the distribution of the 

facilities by facility type has been adjusted to represent their contribution to the total number of facilities in 

the country.

How do statisticians weight each category? They recalculate the categories to reflect the real distribution of 

facilities in the country. If you were to compare the green column (3) to the actual distribution of facilities 

in Bangladesh, you would see that facilities of each type surveyed are contributing to the total sample with 

the same weight that they contribute to the total number of facilities in Bangladesh. The weighted number 

of health facilities in the survey now accurately represents how many facilities are public CCs—66% of 

the facilities in Bangladesh—and how few facilities are DHs—less than 1% of all health facilities in 

Bangladesh.

With sampling and weighting, it is possible to survey enough facilities to provide reliable statistics at both 

the national and division level, without distorting the overall distribution of facilities within the country. In 

general, only the weighted numbers are shown in each of the 2017 BHFS tables, so don’t be distressed if 

these numbers seem low—they may actually represent a larger number of facilities.

Note: Data from the actual, unweighted number of facilities are used for analysis. For example, even 

though the weighted number of district and upazila public facilities is only 44, the data collected from all 

293 of this facility type is used for analysis. The only difference is that the results are weighted after 

analysis to represent information from district and upazila public facilities in the proportion that they exist 

in the country.

xxx • Map of Bangladesh
Overview of the Health System in Bangladesh • 1

OVERVIEW OF THE HEALTH SYSTEM

IN BANGLADESH 1

1.1 HEALTH STATUS IN BANGLADESH

ealth status in Bangladesh has improved substantially over the past 2 decades. Life expectancy at 

birth has increased by 7 years for men and 10 years for women between 2000 and 2017 (SVRS 

2017). This improvement is due to a steady decline in childhood and maternal mortality. Between

two DHS surveys in 1999-2003 and 2017-2018, under-5 mortality dropped from 88 to 45 deaths per 1,000 

live births (BDHS 2017-2018). Maternal mortality also declined by 45% from 322 to 176 deaths per 

100,000 live births between 2001 and 2015 (WHO 2017). As a result, Bangladesh has achieved its

Millennium Development Goal 4 target for under-5 mortality (48 deaths per 1,000 live births) and now is 

expected to achieve by 2030 its Sustainable Development Goal 3 targets for under-5 mortality (25 deaths 

per 1,000 live births) and maternal mortality (70 deaths per 100,000 live births) (Health Bulletin 2017).

Evidence suggests that changing fertility behavior has been a major contributor to the steady decrease in 

mortality. Between 2000 and 2017-2018, the total fertility rate in Bangladesh declined by one child, from

3.3 in 1999-2000 to 2.3 in 2017-2018 (BDHS 2017-2018). Streatfield et al. (2012) estimate that 25% of the 

decrease in maternal mortality during the period was due to the decline in the fertility rate.

Bangladesh has also sustained a surprisingly rapid reduction in the rate of child undernutrition in the last 2

decades. The 2014 Bangladesh Demographic and Health Survey (BDHS) showed that Bangladesh had

achieved the MDG 1 target for percentage underweight among under-5 children (33%). Bangladesh has 

also reached the MDG 1 target for underweight (22%) (BDHS 2017-2018). Rapid wealth accumulation 

and large gains in parental education are the two largest drivers of such accomplishment, although health, 

sanitation, and demographic factors have played significant secondary roles (Headey et al. 2014).

Despite these achievements, Bangladesh continues to carry a high burden of disease that includes noncommunicable diseases (NCDs), tuberculosis, respiratory infections, and neuropsychiatric conditions. As a 

country, Bangladesh is committed to addressing these health problems.

1.2 HEALTH, POPULATION, AND NUTRITION SECTOR PROGRAM

The Health, Population, and Nutrition Sector Program (HPNSP) has been developed under the umbrella of

the national constitution. Guiding principles, such as Vision 2021, acknowledge that improved health is a 

necessary and critical condition for a country to transform from a developing to a middle-income 

economy. The program’s articulation and design link to the seventh 5-Year Plan of the government. Other 

guiding principles are drawn from national policies on health, nutrition, and population; government

strategies; and experience gained from implementing three successive sector programs in Bangladesh. This

HPNSP starts during a period of transition from the Millennium Development Goals (MDGs) to the 

Sustainable Development Goals (SDGs), which are to be achieved by 2030. The MDGs focused on healthsector specific goals, while the SDGs encompass a much broader agenda for change.

The vision of the HPNSP is to see people become healthier, happier, and economically productive—in 

essence, to make Bangladesh a middle-income country by 2021 (Vision 2021). The mission is to create 

conditions that give the people of Bangladesh the opportunity to reach and maintain the highest attainable 

level of health.

H
2 • Overview of the Health System in Bangladesh

Strategic Priorities for the Fourth-Sector Program

Eight strategic objectives have been formulated to cover all aspects of the health sector, including 

governance and stewardship, health systems, health services, and the wider determinants of health. The 

program’s implementation plan describes the following sector-specific strategic priorities:

▪ Strengthen governance and stewardship of the public and private health sectors

▪ Undertake institutional development for improved performance at all levels of the system

▪ Provide sustainable financing for equitable access to health care for the population and accelerated 

progress towards universal health coverage

▪ Strengthen the capacity of the MOHFW’s core health systems (financial management, procurement, 

and infrastructure development)

▪ Establish a quality health workforce available to all through public and private health service providers

▪ Improve health measurement and accountability mechanisms and build a robust evidence base for 

decision-making

▪ Improve equitable access to and utilization of quality health, nutrition, and family planning services

▪ Promote healthy lifestyle choices and a healthy environment

Strengthening of governance and stewardship requires substantial evolution in how the sector is managed.

Considerably more focus is needed from the MOHFW. Also, more emphasis must be placed on developing 

partnerships between the public and private sectors to ensure quality care for all as the country works 

towards universal health coverage. This will require a review of capacity in key areas and at different 

levels of the government combined with a range of institutional changes in structure and function.

Clear institutional roles and responsibilities are fundamental to improved performance across the sector.

Ensuring that correct actions take place at the appropriate level of the system, that institutional 

arrangements are effective, and that there is strong coordination and harmony at all levels will enable 

efficient and equitable use of resources. The current institutional set up at national and subnational levels 

needs review early in the new program with a view to rationalization, removal of duplication, 

establishment of new functions, and overall clarity of roles and responsibilities. Organizational capacity 

anssessments of all key institutions will provide a mechanism for capacity planning and monitoring of 

continuous improvement.

A major focus over the next 5 years will be to increase funding for essential health care services. This will 

be achieved by demonstrating economic gains from investment in health while ensuring efficient, 

effective, and equitable resource allocation. Financing of the sector will come under increasing pressure 

from the rise in population, the aging of the population, and the rapid growth of noncommunicable 

diseases. While per capita investment in health by the government is still low, economic growth continues 

in a positive direction. Nonetheless, the outlook for a proportionate rise in resources from government is 

not assured. Growth and sustainability in finances for health will require managing demand for services, 

efficient use of available resources, and establishing a convincing investment case for government, 

development partners, and the private sector.

To strengthen the capacity of the MOHFW’s core health systems of financial management, procurement, 

and infrastructure development that underpin administration and operations of the sector. Building capacity 

in systems and skills is key, as is strengthening of internal supervision and control.
Overview of the Health System in Bangladesh • 3

Human resources for health have been identified by all stakeholders in the sector as a key strategic priority.

Resource issues cut across all other strategic objectives because people are at the center of systems and 

services. Important priorities have been highlighted in the Human Resources for Health report (MOHFW 

2015). The need for a comprehensive review of Human Resources for Health (HRH) and the 

implementation of the Health Workforce Strategy and corresponding Action Plan are priorities.

Improvements in the way staff are selected, trained, distributed, and supported are recurrent themes in all 

reports looking at the health sector. The need for an improved human resources information system linked 

to DHIS has been advocated, as has the need to tackle issues of skill mix, task shifting, and contracting or 

outsourcing.

Based on experiences, situation assessments, and comprehensive analyses of the Health Population and 

Nutrition (HPN) sector program’s annual reviews in past years, advocacy efforts will need to target health 

sector managers so that they make better use of data and evidence in planning and decision-making. An 

institutionalized system for regular HIS training and updating of skills of staff must be established. Key 

research organizations will have to be strengthened, and ways to harmonize population-based health 

surveys will have to be explored. An effective mechanism will use all survey and research findings.

This strategic objective includes the main service delivery component of the fourth sector program. It 

captures primary, secondary, and tertiary services, including preventive and curative services. It is the 

major cost driver of the sector where the majority of human resources and supplies are focused. A major 

focus will be on improving service integration while ensuring individual services are of high quality and 

accessible to all. There is a clear emphasis on the need to scale up and strengthen community-based public 

health interventions while working towards achieving the goal of equity and quality of health services. 

Innovative approaches to improving efficiency are essential, as is ensuring motivated staff are present at 

their designated posts to deliver quality care to all of the population. Collaboration between the public and 

private sector will be a key element of ensuring access to specialist services as well as functional care in 

hard-to-reach areas and for vulnerable groups.

Investments in lifestyle choices and healthy environments will reduce the future costs of treating the 

rapidly expanding incidence of chronic noncommunicable diseases. The projected increase in chronic 

diseases, if unchecked, will require huge investments in specialist medical centers, diagnostic equipment, 

highly trained specialist health staff, and expensive pharmaceuticals. Given the funding gap that exists in 

the health sector, this will be a financial burden that the country will find difficult to afford. Reaching

young people with effective public health messages will be key to averting chronic diseases.

1.3 HEALTH SERVICE DELIVERY SYSTEM OF BANGLADESH

The health service delivery system of Bangladesh is an intricate web of public health departments, 

nongovernmental institutions (NGOs), and private institutions. Responsibilities and functions include

policy planning, regulation, implementation, health care delivery, and medical education. The MOHFW

formulates national policy, planning, and decision-making for the provision of health care and education. 

The national policies, plans, and decisions are translated into actions by implementing authorities across 

the country, from the national to the community level.

The DGHS, the DGFP, the Directorate of Nursing Services (DNS), and the Revitalization of Communitybased Healthcare Initiatives in Bangladesh Project (Community Clinics Project) (RCHCIB) deliver HPN 

services through various operational plans under HPNSDP. The Directorate General of Drug 

Administration (DGDA), the Directorate General of Health Engineering, the Essential Drugs Company 

Limited (EDCL), the Transport & Equipment Maintenance Organization (TEMO), and the National 

Electro-medical & Engineering Workshop (NEMEW) ensure logistics and supplies for providing HNP 

services.

The MOHFW and its relevant regulatory bodies (Bangladesh Medical & Dental Council (BMDC); State 

Medical Faculty (SMF); Homeo, Unani and Ayurvedic Board; and Bangladesh Pharmacy Council) have 
4 • Overview of the Health System in Bangladesh

indirect control over the system of public, NGO, and private sector health care providers. The delivery of 

health services in urban areas, including primary health care services, is mandated to the Ministry of Local 

Government, Rural Development and Cooperatives (MOLGRDC).

1.3.1 Management Structure and Health Facilities under DGHS

With more than 100,000 officers and staff members, the DGHS is the largest implementing authority under 

the MOHFW. In addition to operating health care delivery systems across the country, the DGHS provides 

technical assistance to the Ministry for new programs and interventions and for improvements in existing 

ones. The health care delivery system under DGHS extends from the national down to the community 

level. Activities are implemented under regular revenue setups and development programs.

The health care infrastructure under the DGHS includes six tiers: national, divisional, district, upazila (subdistrict), union, and ward. At the national level, there are institutions both for public health functions as 

well as for postgraduate medical education/training and specialized treatment of patients.

In each division, a divisional director for health governs activities, with assistance from deputy directors 

and assistant directors. There is one infectious disease hospital and one or more medical colleges at the 

divisional headquarters. Each medical college includes a hospital. Some divisional headquarters also have 

general hospitals and institutes of health technology. Divisional institutes provide tertiary-level care.

The civil surgeon is the district health manager responsible for delivering secondary and primary care 

services. In each district, there is a district hospital. Some district hospitals are managed by 

superintendents, while others are headed by civil surgeons. Some of the district headquarters have medical 

colleges with attached hospitals, medical assistant training schools, and nursing training institutes.

The Upazila Health & Family Planning Officer (UH&FPO) is the health manager at the upazila level. He 

or she manages all public health programs, including primary health care services in the upazila and the 

upazila hospital, which has 30 to 50 beds. Most upazilas have hospitals, except where the district 

headquarters are located; in those upazilas, the district hospital provides hospital services.

At the union level, there are three types of health facilities: rural dispensaries (RDs), union sub-centers 

(USCs), and UHFWCs. In addition to other lower level staff, each union health facility employs a medical 

doctor and has subassistant community medical officers (SACMOs) who provide health services. Only

outpatient services are available at union level facilities.

The MOHFW also has established community clinics (CCs) at the ward level; each CC serves an average 

of 6,000 people. There are currently 13,422 CCs (Health Bulletin 2017) in operation. The RCHCIB project 

is responsible for operationalizing the CCs. The CCs provide the basic health care package to the people in 

the community, that is, maternal and child health care, reproductive health and family planning services, 

immunization, nutrition education, micronutrient supplementation, health education and counseling, 

communicable disease control, treatment for minor ailments and first aid, and referral to higher-level 

health centers. Some CCs also have a community skilled birth attendant (SBA) and offer services for 

normal delivery. The CCs are managed by a 1-5 to 17-member management committee that is selected 

from the communities served by the CC. Local government representatives are included in the 

management committee, and at least four members must be female. There are also three community 

support groups, each including 15-17 members who work as unpaid community health volunteers and who 

assist the management committee and community clinic.

The Ministry has recruited and trained 13,822 full-time community health care providers (CHCPs) to 

operate the CCs and provide quality health care. The CHCPs have laptop computers and internet 

connections to update local health data in an online database that is used for evidence-based decisionmaking and planning. In addition to the CHCP, the existing domiciliary staff members of the DGHS and 

DGFP provide service to the CCs, with the DGHS staff available 3 days per week and the DGFP staff 
Overview of the Health System in Bangladesh • 5

available the other 3 days per week. At the ward or village level, there are also domiciliary health workers, 

with one for every 5,000 to 6,000 people in a ward or village. In total, there are 26,482 sanctioned posts of

domiciliary workers under DGHS: 20,908 health assistants (HAs), 4220 assistant health inspectors (AHIs), 

and 1,410 health inspectors (HIs) (Table 5.5, Page 94, Health Bulletin 2017).

Table 1.1 Secondary and primary health care facilities in public sector

Level Type of facility Type of service No. of facilities

District District hospital

General hospital

Hospital

Hospital

53

11

Total of district-level hospitals 64

Mother and child welfare center Hospital 62

Upazila Upazila health complex (50-bed)

Upazila health complex (31-bed)

Upazila health complex (10-bed)

Hospital

Hospital

Hospital

297

112

11

Total of upazila health complexes 420

Hospitals outside health complexes

31-bed hospital

30-bed hospital

25-bed hospital

Hospital

Hospital

Hospital

4

1

1

Mother and child welfare center Hospital 12

Union Union-level facilities under DGHS

20-bed hospital

10-bed hospital

*Union subcenter

*Union health and family welfare center

Hospital

Hospital

Outpatient only

Outpatient only

32

19

1,275

87

Union-level facilities under DGFP

Mother and child welfare center

Union health and family welfare

 center—Upgraded

Union health and family welfare center

Hospital

Hospital

Outpatient only

24

3,924

Ward Community clinic Outpatient only 13,442

Source: Health Bulletin 2017

1.3.2 Management Structure and Health Facilities under DGFP

The DGFP implements an MCH-based FP program with an extensive network of health facilities, satellite 

clinics, and domiciliary workers. The DGFP services outlets throughout the country. More than fifty 

thousand officials, service providers, and field workers work under the DGFP, whose Maternal and Child 

Health/Family Planning (MCH-FP) service delivery system extends from the district to the community 

level.

In each district, there is a MCH-FP clinic at the District Sadar Hospital and a separate Mother and Child 

Welfare Center (MCWC) that deliver MCH-FP services. A medical officer (clinic), family welfare visitors 

(FWVs), and dai (nurses) provide antenatal care (ANC), normal delivery, postnatal care (PNC), and child 

health care including an expanded program on immunization (EPI) and all contraceptives including 

sterilization in MCWCs. The FWVs at the MCH-FP clinics in the District Sadar Hospital provide ANC, 

normal delivery (limited facilities for “at-risk” cases), PNC, all contraceptives including sterilization, and 

follow-up services. Similar services are also available in model clinics attached to the public medical 

college hospitals. The Deputy Director-Family Planning (DD-FP) is the manager responsible for overall 

management of MCH-FP program at the district level, while the Divisional Director (Family Planning) is 

the program head at the divisional level.

The MCWCs provide services at the upazila level and below that are similar to those offered at the district 

level and have an equivalent staffing profile. Almost all upazila health complexes (UHCs) have MCH-FP 

units that provide ANC, normal delivery, PNC, child health care including EPI and health education, and 

all contraceptives including sterilization. The UHC MCH-FP units are led by a medical officer (MCH-FP) 

along with the FWVs. The Upazila Family Planning Officer (UFPO) is the manager responsible for overall 
6 • Overview of the Health System in Bangladesh

management of the FP program at the upazila level, while the medical officer (MCH-FP) is the upazila 

manager for MCH service delivery.

Almost all union level facilities can provide MCH-FP services. There are 3,924 union health and family 

welfare centers (UHFWCs) under the DGFP. The SACMO and FWVs provide ANC (with an emphasis on 

screening for “at-risk” pregnancies and referral), normal delivery at upgraded facilities, PNC, child health 

care including health education, and contraceptives that include clinical methods, and treatment of general 

patients. The FWVs are also assigned in some union sub-centers (USCs) and RDs under the DGHS to 

deliver MCH-FP services. The FWVs and SACMOs are responsible for delivering MCH-FP services and 

health education at more than 30,000 satellite clinics that are organized monthly at the community level by 

FP fieldworkers.

The DGFP maintains a unique network of community-based fieldworkers for domiciliary FP services. 

There are about 23,500 family welfare assistants (FWAs) who work throughout the country at the 

household level to distribute contraceptives and provide motivation, counseling, health education, and 

referrals for MCH-FP services. The FWAs also provide services at CCs and EPI outreach sites. The family 

planning inspector (FPI) is the union level supervisor who works under DGFP and supervises the FWAs’

activities.

1.3.3 Urban Primary Health Care Services Delivery Project (UPHCSDP)

The Local Government Division (LDG) of the Government of Bangladesh (GOB) is mandated to provide 

primary health care services to the urban residents. Since 1998, the LGD has implemented the Urban 

Primary Health Care Services Delivery Project (UPHCSDP) through a partnership among urban local 

government bodies and NGOs supported by local government. The project’s goal is to improve the health 

status of the urban population, especially the poor, through improved access to and utilization of efficient, 

effective, and sustainable primary health care services. The UPHCSDP delivers an expanded service 

delivery package through more than 150 health care centers; 25 of the centers provide in-patient facilities

that provide coverage for all city corporations and the four district municipalities of the country. The 

UPHCSDP services include MCH care, reproductive health and FP, nutrition, communicable and NCD 

control, limited curative care, and diagnostic services. The project is a unique model of a public-private 

partnership that provides primary health care to the urban poor, especially mothers and children.

1.3.4 NGO Health Programs

The GOB encourages the involvement of NGOs in delivering services that address the country’s health 

challenges. More than 4,000 NGOs, including international organizations (i.e., CARE, Save the Children 

and World Vision), large national NGOs (Bangladesh Rural Development Committee (BRAC), Concerned 

Women for Family Planning, and the Grameen Kalyan Health Program), and hundreds of small, local 

NGOs are active in the health sector in Bangladesh. The NGOs provide essential primary health care 

services through a nationwide network of static clinics, satellite clinics, and community service providers. 

The NGO Health Service Delivery Program (NHSDP), a USAID funded network of about 25 NGOs, 

deliver a broad package of MCH and FP services through more than 399 static clinics and about 8,800 

satellite clinics that serve about 20 million people in Bangladesh. Similarly, BRAC has a large communitybased network for delivering primary health care services that include essential health care; maternal, 

newborn, and child Survival services; communicable and noncommunicable disease control; nutrition

counseling; and other services. The BRAC health program has an estimated 55,000 CHWs who provide 

preventive care and simple curative care services to women and children in rural areas and urban slums.

1.3.5 Private Health Sector

The private health sector in Bangladesh includes large and small commercial companies, professionals 

(i.e., doctors and individual providers), and informal providers. The private sector includes health services 

provided at hospitals, nursing and maternity homes; clinics operated by doctors, nurses, midwives, and 
Overview of the Health System in Bangladesh • 7

paramedical workers; diagnostic facilities (i.e., laboratories and radiology units); and the sale of drugs 

from pharmacies, as well as unqualified static and itinerant drug sellers. As of 2016 (Health Bulletin 2017, 

page 66) the DGHS has registered 14488 (Health Bulletin 2017, Page 66) private hospitals, clinics, and 

diagnostic centers in Bangladesh. There are 5,622 (Health Bulletin 2017, page 66) registered private 

hospitals and clinics, and 9,123 (Health Bulletin 2017, page 66) registered private diagnostic centers. The 

total number of beds in the registered private hospitals and clinics is 48,725 (Health Bulletin 2017, page 

66). Local pharmaceutical companies manufacture and distribute most of the targeted products; the 

majority of Bangladeshis usually obtain their drugs from the private sector. Even among the rural residents 

and the urban poor, the most common source of drugs is from direct out-of-pocket (OOP) purchase from 

private sources.

1.4 HEALTH FINANCING

In Bangladesh 3 percent (BNHA 1997-2015) of the gross domestic product (GDP) is spent on health, of 

which the public sector contribution is less than one-third. In term of dollars, the total health expenditure in 

the country is US$ 37 per capita per annum (BNHA 1997-2015), with an annual growth rate of about 8 

percent (MOHFW 2015).

Historically, supply-side financing of health care services in Bangladesh has been the central strategy for 

improving the access of poor households to essential health care services. The bulk of health care financing 

comes from OOP expenditures, which suggests that people are willing to pay for better care. Sixty-seven

percent (Table 9, BNHA 1997-2015) of the total expenditure on health is privately financed through OOP

purchases, 23 percent is financed by the GOB from tax revenues and development outlays, 8 percent with 

international development assistance, and 2 percent is provided by NGOs (MOHFW 2015). A negative 

consequence of the large share of OOP purchases is the burden it places on the population in the lowest 

quintile who has the least ability to pay for health care.

Expenditure for curative care was 25 percent (BNHA 1997-2015, Table 28, Page 31) of total health 

expenditure in 2015, which is equivalent to $1.5 billion. This figure has grown very quickly in recent 

years, and has almost doubled in four years. Almost half of the expenditures for curative care is incurred 

for inpatient curative care, delivered primarily in private health facilities (MOHFW 2015).

Community financing mechanisms and risk-pooling systems are nearly non-existent except in small 

pockets of NGO innovation, which have a health insurance component within their package of microcredit programs. Voluntary health insurance schemes include spending that provides or reimburses

medical care for employees of business entities; this is 5 percent of the total expenditure on health.

To increase the financial protection for the entire population and decrease OOP payments at the point of 

service, the MOHFW has three strategic objectives under the Health Care Financing Strategy 2012-2032

(HEU 2012):

▪ Generate more resources for effective health services.

▪ Improve equity and increase health care access, especially for the poor and vulnerable.

▪ Enhance efficiency in resource allocation and utilization.

The goal of the Health Care Financing Strategy is to attain universal coverage by 2032 by extending 

financial risk protection and ensuring access to quality service. In response to the heavy reliance on OOP

purchases—which are inequitable and inefficient and have the most impact on the poor—the strategy set a 

target to cut OOP expenditures for health in half at the point of service from the current level of 67 percent

(BNHA 1997-2015) of total health expenditures to 32 percent by 2032.
8 • Overview of the Health System in Bangladesh

The strategy provides a framework for developing and advancing health financing in Bangladesh. The 

framework aims to increase the level of funding for health, ensure an equitable distribution of the health 

financing burden, improve access to essential health services, reduce the incidence of impoverishment 

caused by catastrophic health care expenditures, and improve the quality and efficiency of service delivery.

1.5 HEALTH STEWARDSHIP

The government is taking steps to improve its leadership and regulatory role to increase both equity and 

quality of health services, especially for the poor and the disadvantaged. The Health Care Financing 

Strategy includes the development of a new health policy; the revitalization of primary health care by 

ensuring that CCs have the required human resources, supplies, and logistics to function effectively; the 

recruitment and appropriate deployment of additional human resources for health; and the gradual 

extension of e-health services to the rural areas.

In spite of recent improvements, further steps are needed immediately to make health services responsive 

to the needs and demands of the population. The governance of the system is still considered weak in 

providing equitable services. Regulatory mechanisms, especially within the for-profit private sector, must 

be strengthened as soon as possible. Given the availability of a functional local government system, further 

decentralization of authority and responsibility with proper accountability at all levels must be

institutionalized.
Methodology • 9

METHODOLOGY 2

2.1 OVERVIEW

angladesh has an extensive network of public, private, and nongovernmental organization (NGO) 

facilities for providing basic health services. The Government of Bangladesh (GOB) is committed 

to strengthening health systems and improving the quality of care. In the past 15 years, 

investments in health facilities have expanded services and improved access to quality care. Subsequently, 

Bangladesh has achieved immense success in increasing health service coverage and utilization. Although 

service utilization is assessed and monitored intensively with various data sources, the improvements in 

health systems and quality of care have not been monitored systematically. Under the Health, Population 

and Nutrition Sector Program (HPNSP) 2016-2021, the Ministry of Health and Family Welfare (MOHFW) 

is committed to periodic assessments of health systems and quality of care provided by various health 

facilities. As part of this assessment effort, the National Institute of Population Research and Training 

(NIPORT) was entrusted with conducting the 2017 Bangladesh Health Facility Survey (BHFS) under the 

training, research, and development (TRD) operational plan of the HPNSP.

The 2017 BHFS is an assessment of health care facilities in the formal sector of Bangladesh. The survey 

provides information on the availability of basic and essential health care services1and the readiness of 

health facilities to provide quality services to clients. The 2017 BHFS is the fourth survey of its kind and 

follows the 2009, 2011 and 2014 BHFS surveys. As with the two previous surveys, the 2017 BHFS

collected information from all types of health facilities managed by the government, NGO clinics and 

hospitals, and private for-profit hospitals in all 64 districts of the country. Unlike the earlier surveys, the 

2017 BHFS used standardized questionnaires from the service provision assessment (SPA) component of 

USAID’s Demographic and Health Surveys (DHS) Program to collect information on the availability of 

services and the preparation of facilities to provide quality, effective, and efficient services to clients. The 

2017 BHFS focused primarily on the service readiness indicators that were jointly developed and proposed 

by WHO, USAID, the World Bank, the International Health Facility Assessment Network (IHFAN), and 

other stakeholders (WHO 2012). The 2014 and 2017 BHFS data are not strictly comparable to the 2009 

and 2011 survey results because the 2014 and 2017 BHFS used a different set of questionnaires and 

defined indicators slightly differently.

The 2017 BHFS provides information on child health, maternal and newborn care, family planning (FP), 

and services for selected non-communicable diseases (NCDs) (diabetes, cardiovascular diseases) and 

tuberculosis. For each of these services, the 2017 BHFS assessed whether components considered essential 

for quality service delivery were present and functioning. In general, the components that were assessed 

are those that are commonly considered important to various programs supported by the government and 

development partners. In some cases, however, the 2017 BHFS also assessed whether more sophisticated 

components were present, such as higher-level diagnostic and treatment modalities or support systems for 

health services that are usually introduced after basic-level services have been put in place.

2.2 INSTITUTIONAL FRAMEWORK AND OBJECTIVES OF THE 2017 BHFS

2.2.1 Institutional Framework

The 2017 BHFS was conducted under the authority of NIPORT. ICF provided technical assistance under 

the USAID-funded DHS Program (formerly MEASURE DHS). Associates for Community and Population 

1 Basic and essential health care services of interest in the 2017 BHFS included child health, family planning, maternal and newborn care, non-communicable diseases, and tuberculosis.

B
10 • Methodology

Research (ACPR), a private research agency, collected the data. Financial support for the survey was 

provided by the GOB and USAID. A Stakeholders Advisory Committee (SAC) and a Technical Working 

Group (TWG) oversaw all policy and technical issues related to the survey.

2.2.2 Objectives of the 2017 BHFS

The main objectives of the 2017 BHFS were to:

▪ Assess the availability of health services, including maternal and child health, family planning, 

diabetes, cardiovascular disease, tuberculosis, and nutrition services.

▪ Ascertain general preparedness of the health facilities and availability of basic amenities, equipment, 

laboratory services, essential medicines, standard precautions for infection control, and human 

resources at the facilities.

▪ Assess service-specific readiness of health facilities to provide maternal, newborn, and child health 

care; FP services; and treatment of diabetes, cardiovascular disease, and tuberculosis, measured in 

terms of the WHO-recommended minimum conditions required to provide quality services.

▪ Compare findings among facility types and managing authorities.

2.3 DATA COLLECTION METHODS

The 2017 BHFS used two types of data collection tools:

▪ Facility Inventory Questionnaire

▪ Health Care Provider Interview Questionnaire

Both the Facility Inventory and Health Care Provider Interview questionnaires were loaded onto tablet 

computers and administered as computer-assisted personal interviews (CAPIs).

The Facility Inventory Questionnaire obtained information on the availability of each priority service and 

the preparedness of the facilities to provide the service. The questionnaire also collected information on the 

availability of specific items (including their location and functional status), components of support 

systems (e.g., logistics, maintenance, and management), and facility infrastructure, including the service 

delivery environment. The data collectors interviewed the person most knowledgeable about the facility 

and its services. If another person or provider needed to provide specific information, the data collectors 

consulted that person or provider to obtain the information. However, the data collectors considered only 

observed items as available in the facility.

The Facility Inventory Questionnaire was organized into three modules:

▪ Module 1 collected information on service availability and included two sections.

▪ Module 2 collected information on general facility readiness. This module included seven sections 

that covered topics such as facility infrastructure (i.e., sources of water and electricity), staffing, health 

management information systems, health statistics, processing of instruments for re-use, health care 

waste management, availability of basic supplies and equipment, laboratory diagnostic capacity, and 

medicines and commodities.

▪ Module 3 collected information on service-specific readiness. The 12 sections in this module included 

specific service areas such as child health (child vaccination, growth monitoring, and curative care), 

FP, adolescent health, nutrition, antenatal care (ANC), delivery and newborn care, tuberculosis, NCDs, 

caesarean delivery, blood typing and compatibility, blood transfusion services, and general facility 

cleanliness.
Methodology • 11

▪ The Health Care Provider Interview Questionnaire collected information from a sample of health 

service providers. The data included qualifications, training, experience, continuing education, 

supervision received, and perceptions of the service delivery environment.

2.4 SURVEY IMPLEMENTATION

2.4.1 Questionnaire Adaptation

The 2017 BHFS questionnaires are based on generic questionnaires developed by The DHS Program. The 

questionnaires were adapted for Bangladesh health services in consultation with technical specialists and 

experts from the MOHFW, Directorate General of Health Services (DGHS), Directorate General of Family 

Planning Services (DGFP), and other key stakeholders knowledgeable about the health services and health 

sector program priorities covered by the BHFS. The questionnaire adaptation for the 2017 BHFS took 

place during March and April 2017 in Dhaka. A number of consultative meetings with stakeholders, visits 

to service provision sites, and a 2-day questionnaire adaptation workshop elicited the feedback needed to 

adapt the questionnaires. Attending the workshop were technical experts from the MOHFW; DGHS;

DGFP; WHO; USAID; Save the Children, USA; Dhaka University; the International Centre for Diarrheal

Disease Research, Bangladesh (icddr,b); and related research organizations.

After being prepared in English, both the Facility Inventory and Health Care Provider Interview 

questionnaires were translated into Bangla and loaded onto tablet computers, which were used during 

interviews to record responses to questions.

2.4.2 Pre-test

After adaptation and translation of the questionnaires and completion of the CAPI programs, the 

questionnaires and computer programs were pre-tested. The pre-test was conducted during June 2017 in 

non-sampled areas of Dhaka. Fourteen medical doctors were recruited (eight from icddr,b and six from 

ACPR). During the pre-test data collection, health facilities within Dhaka district were surveyed over a 4-

day period to test and refine the survey instruments and the computer programs. After the pre-test, the 

questionnaires and computer programs were finalized for the main data assessment. 

The pre-test also identified the pre-test interviewers who would become master trainers and field 

supervisors during the main survey. At the end of the pre-test, after receiving 3 weeks of training, 11 

medical doctors served as “master trainers” for training data collection enumerators.

2.4.3 Main Training

The main training for the 2017 BHFS was conducted from July 9-27, 2017, in Dhaka. Eighty enumerators 

were recruited for data collection (40 interviewers [sub-assistant community medical officers] and 40 team 

leaders [medical doctors]) and trained as interviewers in the application of survey instruments and 

computer programs.

The training included classroom lectures and discussions, practical demonstrations, mock interviews, roleplays, and field practice. The trainees were also given daily homework to conduct mock interviews among 

themselves with the survey tools. The first week of training was dedicated exclusively to training

interviewers on the use of paper questionnaires. This phase included 2 days of field practice to ensure that 

the trainees understood both the content of the questionnaires and approaches for organizing themselves 

while working in a health facility.

During the second week of training, trainees were introduced to tablet computers and then transitioned to 

the use of CAPI for both the Facility Inventory and Health Care Provider Interview questionnaires. This 

was done with completed paper questionnaires from the facilities visited during the pre-test. During the 

third training week, the trainees practiced all questionnaire types and CAPI approaches in teams and pairs. 
12 • Methodology

The eleven medical doctor interviewers from the pre-test conducted the training. Personnel from ICF 

provided support as needed.

2.4.4 Data Collection

After the training, 40 data collection teams with two interviewers were formed, with one interviewer on 

each team assigned to the role of team leader. Data collection was conducted from July to October 2017. 

On average, data collection took 1 day for each health facility.

Fieldwork supervision was coordinated by ACPR and NIPORT. The eleven medical doctor master trainers 

and seven trained data processing specialists formed the seven field supervision teams. The field 

supervision teams conducted periodic visits to their assigned data collection teams to review work and 

monitor data quality. Eight master trainers from icddr,b served as independent field monitors during data 

collection. In addition, supervisory teams and professionals from NIPORT periodically and simultaneously 

visited and monitored the data collection exercise.

2.4.5 Data Management and Report Writing

For data collection in every facility, the data collection team used two tablets, one for the Health Care 

Provider Interview Questionnaire data and the second for data from the Facility Inventory Questionnaire. 

After completing data collection in each facility, the team merged the inventory and health care provider 

data. The team leader then reviewed the file and conducted consistency and structural checks on the data to 

identify any errors or missing information. When a team was satisfied that data collection and entry were 

complete for the facility, the team sent the data to the BHFS central office in Dhaka via the Internet, using 

ICF’s Internet File Streaming System (IFSS). If the facility where the data were collected did not have 

access to the Internet or other modes of communication that could be used to securely send the completed 

files, the team sent the data from another location/facility with secure Internet access. The data were also 

backed up in a pen drive by the team.

Data received from the field were reviewed and checked at the central office with the technical assistance 

of ICF experts. If any inconsistencies or errors were identified by the central office, the data collection 

team members reviewed and rechecked the data. If necessary, the team visited the specific service facility 

again to obtain and resend the correct data to the central office.

Data editing and management activities commenced in July 2017 at the beginning of field work and ended 

in October 2017 at the end of data collection in the field.

2.4.6 Data Analysis and Report Preparation

The BHFS tabulation plan was based on the model DHS SPA tabulation plan. The preparation of the tables 

for the report was conducted from August through October 2017. Feedback from NIPORT and the BHFS 

TWG informed revision of the analysis plan.

Two conventions were observed during the analysis of the 2017 BHFS data:

▪ First, unless otherwise indicated, the 2017 BHFS considered only those items observed by the 

interviewers to be available.

▪ Second, in a majority of facilities, multiple health care providers contribute to the services received by 

clients. The health care provider who ultimately assessed the client, made the final diagnosis, and 

prescribed any treatment was therefore identified as the primary provider for the particular service.

▪ The final report was prepared with input from staff members of NIPORT, icddr,b, and MEASURE 

Evaluation. The ICF team provided technical oversight.
Methodology • 13

2.5 SAMPLING

2.5.1 Sampling Methodology

The sample for the 2017 Bangladesh Health Facility Survey (BHFS) was a stratified random sample of 

1,600 health facilities designed to provide representative results for Bangladesh, for the different facility 

types and different management authorities, and for each of the eight divisions of the country. 

Stratification was achieved by separating the health facilities by facility type within each division. Implicit 

stratification by management authorities was achieved by sorting the frame based on the management 

authorities within each explicit sampling stratum before sample selection.

The sample for the 2017 BHFS covered all types of registered health facilities in all eight divisions of the 

country: Barisal, Chittagong, Dhaka, Khulna, Mymensingh, Rajshahi, Rangpur, and Sylhet. The survey 

was designed to report results separately for the eight divisions and the six types of public health facilities 

included: community clinics (CCs), union subcenters/rural dispensaries (USC/RDs), union health and 

family welfare centers (UHFWCs), upazila health complexes (UHCs), mother and child welfare centers 

(MCWCs), and district hospitals (DHs). Results are also reported separately for NGO clinics and hospitals 

and private hospitals. UHFWCs include regular FWCs and upgraded FWCs (UpFWCs). 

2.5.2 Sampling Frame

A list of 19,811 registered health facilities, provided by the Ministry of Health and Family Welfare 

(MOHFW), was used as a sampling frame for sample selection. The allocation of the 2017 BHFS sample 

took the divisional distribution of the health facilities into account. At the same time, other factors such as 

indicator precision, at either the national or domain level, and budget allocation were considered. The 

distribution of registered health facilities by division and by facility type is presented in Table 2.1.

2.5.3 2017 BHFS Sample Size and Sample Allocation

The sample size determination was achieved by controlling the survey precision at the division level and 

by facility type at the national level. The precision level for oversampled districts was controlled as well. 

The formula used for the sample size calculation is 

( )

p

p

n 2

1



−

=

where 



is the requested survey precision, which is the relative standard error for estimating a proportion

p

. By controlling the relative standard error for an indicator at the 30% level (p = 0.30) within 15%

(



= 0.15) at domain level and within 20% (



= 0.20) at oversampled districts level, and to ensure that 

the survey precision is comparable across divisions, a sample of 1,600 health facilities was allocated based 

on a power allocation between sampling domains, divisions, oversampled districts, and health facility 

types. Table 2.2 presents the allocation of the 1,600 health facilities by division and facility type. Because 

of their small number, all of the 91 MCWCs and 62 DHs were selected in the sample. The same applies for 

NGO hospitals; all five NGO hospitals were sampled.

2.5.4 Sample of Health Facilities and Outcomes

Unlike the 2011 and 2014 BHFS surveys, the 2017 BHFS is designed to provide survey results separately 

for the eight administrative divisions, six types of public facilities, NGO static clinics/hospitals, and private 

hospitals. The BHFS sample was a combination of census (for DHs and MCWCs) and random samples 

(for other facility types). Table 2.3 presents an analysis of the 1,600 sampled facilities according to the 

outcomes of the visits to those facilities. In this table and in subsequent tables in the report, the total for 

facilities is shown including and excluding CCs. The reason for showing the total without community 
14 • Methodology

clinics is that CCs are the lowest level of facilities, are supported by community health care providers, and 

often are least likely to offer all of the health services and/or to have the items necessary for providing a 

service if they offer it. As shown, data were successfully collected from 95% of the 1,600 sampled 

facilities (a total of 1,524 facilities).

Interviewers were not able to survey about 5% of sampled facilities for various reasons, but mainly 

because some facilities were closed or not operational at the time of the survey. The survey protocol 

allowed for facilities that could not be surveyed to be replaced with the nearest facility of the same type, in 

the same district, and under the same managing authority. However, no facilities that met the replacement 

criteria were found. Consequently, BHFS data are available for 1,524 facilities. Table 2.4 shows the 

distribution of surveyed facilities by background characteristics.

2.5.5 Sample of Health Service Providers

The sample of health service providers was selected from providers who were present in the facility on the 

day of the assessment and who provided services assessed by the 2017 BHFS. For purposes of the BHFS 

data collection, a health service provider was defined as a person who provides consultation services, 

counseling, health education, or laboratory services to clients. Health workers were not eligible for 

interviewing, for example, if they only take measurements or complete registers and do not provide any 

type of professional client services. In each facility, the aim was to interview an average of eight providers 

who provided the range of services being assessed. In facilities with less than eight health care providers, 

all providers present on the day of the visit were interviewed. In facilities with more than eight providers, 

efforts were made to interview eight providers, including all of those who provided information for any 

section of the Facility Inventory Questionnaire and others involved in delivering services for which 

information was collected in the BHFS. In a few cases, the staff members present on the day of the 

assessment may not have been representative of the staff that usually provides the services being assessed.

The health care provider data were weighted during the analysis to account for differentials from oversampling or under-sampling of providers with a particular qualification in a facility type, location, or

division.

Table 2.5 shows the distribution of health care providers who were interviewed with the Health Care 

Provider Interview Questionnaire, by background characteristics and provider qualification. A total of 

5,400 providers were interviewed, with the highest percentage of interviews conducted in CCs (40%).

LIST OF TABLES

▪ Table 2.1 Bangladesh health facility distribution by division and health facility type

▪ Table 2.2 Health facility sample allocation by division and health facility type 

▪ Table 2.3 Results of facility contacts by background characteristics

▪ Table 2.4 Distribution of surveyed facilities by background characteristics

▪ Table 2.5 Distribution of interviewed providers
Methodology • 15

Table 2.1 Bangladesh health facility distribution by division and health facility type

Division CC USC/RD

UHFWC

UHC MCWC DH

NGO

FWC PH Total

Upgraded

FWC

Clinic

NHSDP Other Hospital

Barishal 1,061 58 208 28 34 10 6 14 34 1 13 1,467

Chattogram 2,400 238 468 203 89 18 11 101 55 0 164 3,747

Dhaka 2,431 308 422 184 75 14 14 114 167 3 215 3,947

Khulna 1,640 133 345 99 51 14 10 50 44 1 47 2,434

Mymensingh 1,147 114 195 45 30 4 3 20 22 0 14 1,594

Rajshahi 1,900 321 378 40 61 13 7 33 60 0 42 2,855

Rangpur 1,777 198 306 71 50 12 7 33 26 0 34 2,514

Sylhet 855 75 114 86 31 6 4 33 15 0 34 1,253

Bangladesh 13,211 1,445 2,436 756 421 91 62 398 423 5 563 19,811

DH = district hospital, MCWC = mother and child welfare center, UHC = upazila health complex, UHFWC = union health and family welfare center, USC/RD = union 

subcenter/rural dispensary, CC = community clinic, NGO = nongovernmental organization, PH = private hospital

Table 2.2 Health facility sample allocation by division and health facility type 

Division CC USC/RD

UHFWC

UHC MCWC DH

NGO

FWC PH Total

Upgraded

FWC Clinic Hospital

Barishal 41 31 108 12 26 10 6 27 1 13 275

Chattogram 48 50 63 44 25 18 11 18 0 36 313

Dhaka 45 23 26 20 15 14 14 18 3 21 199

Khulna 43 19 25 17 14 14 10 13 1 13 169

Mymensingh 39 18 22 13 12 4 3 11 0 9 131

Rajshahi 35 24 25 16 17 13 7 17 0 16 170

Rangpur 45 22 25 16 14 12 7 11 0 12 164

Sylhet 35 29 49 16 18 6 4 10 0 12 179

Bangladesh 331 216 343 154 141 91 62 125 5 132 1,600

DH = district hospital, MCWC = mother and child welfare center, UHC = upazila health complex, UHFWC = union health and family welfare 

center, USC/RD = union subcenter/rural dispensary, CC = community clinic, NGO = nongovernmental organization, PH = private hospital
16 • Methodology

Table 2.3 Results of facility contacts by background characteristics

Percent distribution of sampled facilities according to result of visit of the survey team to the facility, by background 

characteristics, Bangladesh HFS 2017

Background

characteristic Completed

Respondent 

not available Refused

Closed/

not yet 

operational Other

Total 

percent

Number of 

facilities 

surveyed

Facility type

District and upazila 

public facilities 99.7 0.0 0.0 0.3 0.0 100.0 294

DH 100.0 0.0 0.0 0.0 0.0 100.0 62

MCWC 98.9 0.0 0.0 1.1 0.0 100.0 91

UHC 100.0 0.0 0.0 0.0 0.0 100.0 141

Union-level public 

facilities 94.8 1.4 0.0 3.1 0.7 100.0 714

UHFWC 96.2 1.2 0.0 2.2 0.4 100.0 498

USC/RD 91.7 1.9 0.0 5.1 1.4 100.0 216

Community clinic 

(CC) 98.5 0.6 0.0 0.9 0.0 100.0 330

NGO clinic/hospital 94.6 0.0 0.0 4.6 0.8 100.0 130

Private hospital 80.3 0.0 0.8 15.2 3.8 100.0 132

Location

Urban 92.7 0.0 0.2 5.8 1.2 100.0 413

Rural 96.1 1.0 0.0 2.4 0.5 100.0 1,187

Division

Barishal 94.5 1.5 0.4 2.9 0.7 100.0 275

Chattogram 96.5 0.3 0.0 2.9 0.3 100.0 313

Dhaka 94.5 1.5 0.0 3.5 0.5 100.0 199

Khulna 97.0 1.8 0.0 1.2 0.0 100.0 169

Rajshahi 94.7 0.0 0.0 2.9 2.4 100.0 170

Rangpur 96.3 0.6 0.0 2.4 0.6 100.0 164

Sylhet 91.1 0.0 0.0 8.4 0.6 100.0 179

Mymensingh 97.7 0.0 0.0 1.5 0.8 100.0 131

Total 95.3 0.8 0.1 3.3 0.7 100.0 1,600

Total excluding CCs 94.4 0.8 0.1 3.9 0.9 100.0 1,270

Note: The percentages in some rows may not add up to 100% due to rounding. 

DH = district hospital, MCWC = mother and child welfare center, UHC = upazila health complex, UHFWC = union health 

and family welfare center, USC/RD = union subcenter/rural dispensary, CC = community clinic
Methodology • 17

Table 2.4 Distribution of surveyed facilities by background characteristics

Percent distribution and number of surveyed facilities, by background characteristics, 

Bangladesh HFS 2017

Background

characteristic

Weighted percent 

distribution of 

surveyed facilities

Number of facilities surveyed

Weighted Unweighted

Facility type

District and upazila public 

facilities 2.9 44 293

DH 0.3 5 62

MCWC 0.5 7 90

UHC 2.1 32 141

Union-level public facilities 23.7 361 677

UHFWC 16.4 250 479

USC/RD 7.3 111 198

Community clinic (CC) 66.4 1,012 325

NGO clinic/hospital1 4.2 64 123

Private hospital 2.8 43 106

Location

Urban 7.1 108 383

Rural 92.9 1,416 1,141

Division

Barishal 7.4 113 260

Chattogram 18.9 288 302

Dhaka 19.9 304 188

Khulna 12.3 187 164

Rajshahi 14.4 220 161

Rangpur 12.7 193 158

Sylhet 6.3 96 163

Mymensingh 8.0 123 128

Total 100.0 1,524 1,524

Total excluding CCs na 512 1,199

1 The NGO category includes facilities run by local governments.

na = Not applicable
18 • Methodology

Table 2.5 Distribution of interviewed providers

Percent distribution and number of interviewed providers, by background characteristics and 

provider qualification, Bangladesh HFS 2017

Background

characteristic

Weighted percent 

distribution of 

interviewed 

providers

Number of interviewed providers

Weighted Unweighted

Facility type

District and upazila public 

facilities 24.9 1,343 2,921

DH 7.1 383 825

MCWC 0.9 50 374

UHC 16.9 910 1,722

Union-level public facilities 16.6 895 977

UHFWC 11.6 625 688

USC/RD 5.0 270 289

Community clinic (CC) 40.4 2,182 437

NGO clinic/hospital 7.3 395 431

Private hospital 10.8 585 634

Location

Urban 32.1 1,732 2,961

Rural 67.9 3,668 2,439

Division

Barishal 6.6 357 813

Chattogram 19.3 1,043 1,067

Dhaka 25.1 1,355 729

Khulna 12.0 646 670

Rajshahi 13.6 736 649

Rangpur 10.7 580 542

Sylhet 5.8 314 468

Mymensingh 6.8 370 462

Provider type

Specialist1 3.1 169 304

General practitioner2 9.8 530 917

Paramedic3 22.3 1,202 1,756

Nurse/midwife4 17.1 922 1,390

Field supervisor5 0.1 8 6

Medical/pharmaceutical 

technician6 4.8 257 413

Other health providers7 42.8 2,312 614

Total 100.0 5,400 5,400

Total excluding CCs na 3,218 4,963

1 Specialist (consultant) medicine (including cardiology), specialist (consultant) general surgery, 

specialist (consultant) obstetrics/gynecology, specialist (consultant) pediatrics, specialist 

(consultant) psychiatry, specialist (consultant) anesthesia, or any other specialist not listed above

2 Medical officer (MBBS) (any non-specialist doctor, including assistant surgeon, emergency 

medical officer [EMO], indoor medical officer [IMO], maternal and child health/family planning 

medical officer [MCH/FP], or residential medical officer [RMO], regardless of designation or title) 

or medical officer—anesthetist or dental surgeon

3 SACMO/medical assistant, family welfare visitor (FWV), or paramedic in private/NGO

4 Nurse/midwife, matron, nursing supervisor, senior staff nurse, assistant nurse/staff nurse in 

private, midwife or DAI nurse

5 Health inspector or assistant health inspector

6 Medical technologist-laboratory or medical technologist Expanded Program on Immunization 

(EPI)

7 Family welfare assistant (FWA), health assistant, community health care provider (CHCP), TB 

leprosy control assistant (TLCA), counselor, nutritionist or health educator, other providers

na = Not applicable
Facility-level Infrastructure, Resources, Management, and Support • 19

FACILITY-LEVEL INFRASTRUCTURE, RESOURCES, 

MANAGEMENT, AND SUPPORT 3

Key Findings

▪ Nearly all health facilities in Bangladesh offer antenatal and 

postnatal care for women, care for sick children, health care 

for adolescents, and nutrition services. More than 85%

provide family planning and child vaccination services. Noncommunicable disease diagnosis or management, 

tuberculosis diagnosis or treatment, and normal delivery 

care services are less commonly available. Cesarean 

deliveries are available at 4% of facilities (Table 3.1).

▪ Almost three quarters of facilities offer basic client services 

(outpatient care for sick children, child growth monitoring, 

child vaccinations, modern methods of family planning, and 

antenatal care). Availability of these services has increased 

from 44% in 2014 BHFS to 72% in 2017 BHFS. If normal 

delivery care is added to the basic service package, 

however, only 16% of facilities qualify as full providers 

(Table 3.2 and Figure 3.1).

▪ Six basic amenities—regular electricity, an improved source 

of water, privacy during patient consultations, a latrine for 

clients, a land-line or mobile phone, and a computer with 

Internet access—are considered essential for rendering 

services in health facilities. Between 2014 and 2017, there 

were notable increases in the availability of regular 

electricity (from 22% to 43%), privacy during patient 

consultations (from 39% to 70%), a client latrine (from 72%

to 79%), and a computer with Internet access (from 37% to 

58%). Only the availability of functional land-line/mobile 

phones declined, from 20% in 2014 BHFS to 11% in 2017 

BHFS. There was no change in the availability of 

emergency transport (5%) (Table 3.3 and Figures 3.2

through 3.10).

▪ Twenty-eight percent of facilities had all six basic items of 

equipment for providing quality services (stethoscope, 

thermometer, blood pressure apparatus, adult scale, child or 

infant scale, and light source), as compared with 26% in 

2014 (Table 3.4).

▪ Nongovernmental (NGO) facilities are most likely to have 

standard precaution items for infection control, followed by 

private hospitals and district and upazila public facilities 

(Table 3.5 and Figure 3.12).

▪ The capacity of health facilities to conduct basic diagnostic 

tests is still very limited. The most widely available test is 

blood glucose, provided by only 20% of facilities. Only 4% of 

facilities offer all five basic diagnostic tests (hemoglobin, 

blood glucose, urine protein, urine glucose, and urine 

pregnancy tests). Fourteen percent of district and upazila 

facilities and negligible proportions of union-level facilities 

and community clinics provide all five basic tests. More than 

half of private hospitals and 40% of nongovernmental 
20 • Facility-level Infrastructure, Resources, Management, and Support

facilities offer the tests (Table 3.7.1, Figure 3.13, and Figure 

3.14).

▪ The majority of district and private hospitals have functional 

x-ray machines, and their availability has improved in the 

last 3 years. However, availability at district and upazila 

public facilities is comparatively low (22%) and has declined 

slightly between 2014 and 2017 (Table 3.7.1 and Figure

3.15).

▪ Among essential medicines, ciprofloxacin tablets/capsules

and omeprazole/cimetidine tablets/capsules are most widely 

available (above 90%) (Table 3.8.1).

▪ The percentages of filled physician (85%) and nurse (97%) 

positions are highest in NGO facilities (Table 3.11 and 

Figure 3.19).

▪ Removing offsite of sharps waste is most commonly 

removed offsite (33%), whereas non-sharps waste is most 

frequently disposed of through open burning (32%) (Table 

3.12.1, Table 3.12.2, Figure 3.22, and Figure 3.23).

3.1 BACKGROUND

o improve the health status of the population, a health system needs essential inputs and requisite 

support systems that promote effective, efficient delivery of health services. Although health care 

services can be offered under various conditions, some common inputs are crucial under all 

conditions to ensure the quality of services, their acceptability, and their utilization. These essential inputs 

include human resources and equipment as well as pharmaceutical and medical supplies.

This chapter reports results from the 2017 BHFS on the availability of basic health services and essential 

resources and on management and support systems at the facility level. The chapter is divided into the 

following parts:

▪ Availability of services. Section 3.2, including Tables 3.1 through 3.8.2 and Figures 3.1 through 

3.17, describes the availability of client services at health care facilities in Bangladesh and reports on a 

range of indicators recommended by WHO to assess the readiness of facilities to provide good-quality 

client services, including the availability of basic amenities and equipment, infection control 

processes, diagnostic capacity, and essential medicines.

▪ Basic management and support. Section 3.3, including Tables 3.9 and 3.10 and Figure 3.18, 

considers the extent to which essential management and administrative systems are in place to support 

the provision of quality services, including quality assurance monitoring and supportive management 

practices.

▪ Staffing. Section 3.4, including Table 3.11 and Figures 3.19 through 3.21, provides information on 

staffing patterns at the different facility levels.

▪ Medical waste management. Section 3.5, including Tables 3.12.1 and 3.12.2 and Figures 3.22 and 

3.23, provides information on management of medical waste at the different facility levels.

T
Facility-level Infrastructure, Resources, Management, and Support • 21

3.2 AVAILABILITY OF SERVICES

3.2.1 Overall Availability of Specific Client Services

Policymakers and program managers can use information on the overall availability of health services in 

Bangladesh to identify gaps in the provision of key services. Table 3.1 shows the percentages of all 

facilities that offer various client services.

Most health facilities (96%-99%) provide antenatal care, child curative care, adolescent health care, 

postnatal care, and nutrition services. Nine in 10 facilities offer postpartum family planning services, 

family planning services, and child vaccination services (through the government’s Expanded Program on 

Immunization [EPI]). One-third of facilities offer services for laboratory diagnosis (35%), noncommunicable disease diagnosis or management (33%), and tuberculosis (TB) diagnosis or treatment 

(30%). Although nearly one quarter of health facilities in Bangladesh provide normal delivery services, 

only 4% perform cesarean deliveries. This reflects that cesarean deliveries are performed only at hospitals.

Very few facilities provide blood grouping and typing (8%) or blood transfusion (4%) services.

3.2.2 Availability of Basic Client Services

The availability of a basic package of health services, the frequency with which these services are offered, 

the presence of qualified staff for their delivery, and the overall ease of access to the health care system all 

contribute to client utilization of services at a health facility.

The BHFS defines basic client services as the following:

▪ Outpatient curative care for sick children

▪ Child growth monitoring services

▪ Facility-based child vaccination services.

▪ Provision of any modern method of family planning (FP)

▪ Antenatal care (ANC)

▪ Normal delivery

Table 3.21and Figure 3.1 present information on the availability of FP and basic maternal and child health 

services. Nearly all facilities offer ANC (99%) and child curative care (98%) services. As can be seen in 

Table 3.2, upazila health complexes (UHCs) are most likely to provide the full range of basic client 

services (including normal delivery) (92%), followed by district hospitals (DHs) (71%), mother and child 

welfare centers (MCWCs) (59%), and union health and family welfare centers (UHFWCs) (44%). Private 

hospitals (4%), community clinics (CCs) (6%), nongovernmental (NGO) clinics/hospitals (15%), and 

union subcenters/rural dispensaries (USC/RDs) (16%) are less likely to provide all basic services.

1

In Table 3.2, summary statistics are presented for all facilities including CCs and excluding CCs. The results for all 

facilities including CCs are disaggregated by facility type, location, and division. A similar format is followed in most 

of the other tables in this report.
22 • Facility-level Infrastructure, Resources, Management, and Support

Figure 3.1 Availability of basic client services in health facilities

Table 3.2 shows that some major differences in service availability are observed when CCs are excluded 

from the analysis. The percentage of facilities that offer normal delivery increases from 24% to 57%, while 

the availability of child vaccinations declines from 87% to 70% and the availability of child growth 

monitoring services decreases from 85% to 76%. The increase in the percentage of facilities that offer 

delivery care is not surprising because very few CCs2currently offer delivery care. The decreases in child 

vaccination and child growth monitoring services point to the key role that CCs play in provision of these 

services.

The percentage of facilities providing the full package of basic services, including normal delivery, 

increased from 8% in 2014 to 16% in 2017, while the percentage of facilities offering all basic client 

services without normal delivery increased from 44% to 72%. The availability of each of the basic health 

services increased between 2014 and 2017.

3.2.3 General Service Preparedness

The BHFS collected information to assess the general preparedness of health facilities to offer quality 

health services. According to WHO (2013), an assessment of the general preparedness of a facility to 

provide quality services should consider the following six components:

▪ Basic amenities for client services

▪ Basic equipment to support quality health services

▪ Standard precautions for infection control in service delivery areas

▪ Capacity for adherence to standards for quality sterilization

▪ Diagnostic capacity

▪ Availability of essential medicine

During data collection, the BHFS interviewers verified that all components were present in the facility and 

in working order. The following sections present information from the 2017 BHFS on each of the six 

components for assessing general service preparedness.

2 District and upazila public facilities offer child vaccination services without external support, while other public 

facilities offer vaccination services with the help of outreach EPI programs.

93

62

78 81

97

18

44

8

98

85 87 89

99

24

72

16

Child

curative

care

Child

growth monitoring

Child

vaccination

Any modern method of

FP

Antenatal

care

Normal

delivery

All basic

services

without

normal

delivery

All basic

services

Percentage of facilities

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)
Facility-level Infrastructure, Resources, Management, and Support • 23

Basic Amenities for Client Services

The components reviewed here are neither necessary nor sufficient to provide quality services. However, 

the availability of the following basic amenities is important to a client’s satisfaction with health services 

rendered at a facility:

▪ Regular electricity

▪ Improved water source

▪ Visual and auditory privacy during consultations

▪ Client latrine

▪ Communication equipment (land-line/mobile phone)

▪ Computer with Internet access

In addition to these basic amenities, the 2017 BHFS considered the availability of emergency transport, 

another key component of client services. Emergency transport is expected to be available primarily in 

higher-level facilities; its availability also depends on the services provided by the facility. Table 3.3

provides information on the availability of basic amenities for client services.
24 • Facility-level Infrastructure, Resources, Management, and Support

Electricity. The 2017 BHFS

obtained information on the 

connectivity of facilities with the 

national electricity grid line and the 

availability of regular electricity

(Figure 3.2). Regular electricity is 

considered to be available at a 

facility if one of the following 

conditions is met: the facility is 

connected to a central power grid 

and the power supply was not 

interrupted for more than 2 hours at 

a time during normal working 

hours in the 7 days before the 

survey, the facility has a 

functioning generator with fuel 

available on the day of the survey,

or the facility has back-up solar 

power. Six of 10 health facilities 

are connected to the national 

electricity grid, as compared with 4 

of 10 facilities in 2014. With the 

exception of CCs (47%), most 

facilities of all types are connected 

to the national grid (82%-96%) 

(Table 3.3).

More than 4 in 10 facilities now 

have regular electricity, as 

compared with 22% of facilities in 

2014 (Table 3.3 and Figure 3.3).

Seventy-nine percent of district and 

upazila public facilities, 78% of 

NGO facilities, and all private 

hospitals have regular electricity. Since 2014, the availability of regular electricity has increased at unionlevel public facilities (from 28% to 32%) and CCs (from 9% to 41%).

Figure 3.2 Availability of electricity from national 

electricity grid line, by facility type

Figure 3.3 Availability of regular electricity,

by facility type*

41

97

72

21

96 90

60

96

82

47

92 90

Total

facilities

District &

upazila

public

Union-level

public

CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)

22

76

28

9

81

98

43

79

32 41

78

100

Total

facilities

District &

upazila

public

Union-level

public

CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)

* Regular electricity is considered to be available if facility is connected to a central power 

grid and there has not been an interruption in power supply lasting for more than 2 hours 

at a time during normal working hours in the 7 days before the survey, or facility has a 

functioning generator with fuel available on the day of the survey, or else facility has backup solar power.
Facility-level Infrastructure, Resources, Management, and Support • 25

Improved water source. Overall,

90% of facilities have an improved 

water source, as compared with 

87% in 2014. By facility type, the 

proportion with an improved water 

source varies from 88% in CCs to 

99% in NGO clinics/hospitals. 

Rural facilities (90%) are less likely 

than urban facilities (98%) and 

facilities in Mymensingh (79%) are 

less likely than those in the other 

divisions to have an improved 

water source (Figure 3.4).

Privacy during consultations.

Visual and auditory privacy is 

important in consultations with 

health care providers because it 

allows clients to express their 

problems without hesitation and in 

detail. Seven of 10 health facilities 

have the capacity to ensure privacy 

for clients during consultations, 

compared with 4 of 10 facilities in 

2014. Private (96%) and NGO 

(93%) facilities are more likely 

than public sector facilities to be 

able to provide privacy. The ability 

to provide privacy has improved 

since 2014 in all types of facilities

(Figure 3.5).

Figure 3.4 Availability of improved water source,

by facility type

Figure 3.5 Availability of privacy during consultations,

by facility type

87

96 88 85

95 98 90

98 93 88

99 96

Total

facilities

District &

upazila

public

Union-level

public

CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)

39 45 41

32

78

94

70 73 73

66

93 96

Total

facilities

District &

upazila

public

Union-level

public

CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)
26 • Facility-level Infrastructure, Resources, Management, and Support

Client latrine. Overall, 79% of 

health facilities have a functioning 

client latrine. Nine of 10 district 

and upazila, NGO, and private 

facilities have a functioning latrine. 

Availability of a client latrine 

improved between 2014 and 2017

(from 72% to 79%) (Figure 3.6).

The availability of an improved 

female toilet refers to a separate 

toilet for women with a functional 

water source. Seventeen percent

(39% excluding CCs) of facilities 

have a separate improved latrine for 

women. The availability of a 

separate toilet for women is very 

low in union-level facilities (25%)

and CCs (6%). Availability of a 

separate female toilet declined from 

26% in 2014 to 17% in 2017

(Figure 3.7).

Communication equipment.

Eleven percent of facilities have a 

functional land-line/mobile phone 

(Table 3.3 and Figure 3.8).

Availability of a land-line/mobile 

phone is highest at private facilities

(95%) and district and upazila 

public facilities (82%) and lowest 

at union-level facilities and CCs

(3% each). There is typically no 

provision for land-line or mobile 

phones at CCs; in some cases, 

however, providers at CCs can use 

their private mobile phones with 

the cost supported by the facility.

The percentage of facilities with 

land-line/mobile phones has 

decreased since 2014 (from 20% to 

11%) due to declines in their 

availability in union-level public 

facilities and CCs.

Figure 3.6 Availability of client latrine, by facility type

Figure 3.7 Availability of separate latrine for female 

clients, by facility type

Figure 3.8 Availability of communication equipment 

(land-line/mobile phone), by facility type

72

86

74 68

88 94

79

90

81 77

93 90

Total

facilities

District &

upazila

public

Union-level

public

CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)

26

74

35

14

71

83

17

64

25

6

72 76

Total

facilities

District &

upazila

public

Union-level

public

CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)

20

80

14 12

66

98

11

82

3 3

68

95

Total

facilities

District &

upazila

public

Union-level

public

CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)
Facility-level Infrastructure, Resources, Management, and Support • 27

Computer with Internet. Nearly 

60% (39% excluding CCs) of 

facilities have a functioning 

computer with Internet access.

Union-level public facilities are 

least likely to have a functioning 

computer with an Internet 

connection (22%) (Table 3.3, 

Figure 3.9).

Between 2014 and 2017, the 

availability of a computer with an 

Internet connection increased 

notably across all types of facilities.

Emergency transport. Overall, 

transport for emergencies is 

available in only 5% (15%

excluding CCs) of facilities (Table 

3.3, Figure 3.10). District and 

upazila public facilities (79%) and 

private hospitals (62%) are much 

more likely than NGO facilities 

(22%) to have transport for 

emergencies. At public facilities, 

emergency transport is expected to 

be available primarily in upperlevel facilities; availability also 

depends on the services provided 

by the facility. Thus, it is not 

surprising that there is considerable 

variability in the availability of 

emergency transport at public 

facilities. Ninety-seven percent of 

district hospitals, 82% of UHCs, and 56% of MCWCs have transport for emergencies, while union-level 

public facilities and CCs do not have emergency transport. The availability of transport for emergencies in 

public facilities has not improved since 2014.

In summary, the ideal facility should have a safe and welcoming environment with regular electricity, an 

improved water source, privacy during consultations, a client latrine, a land-line/mobile phone, and a 

computer with Internet access. Figure 3.11 presents information on the availability of at least five of these 

six amenities in health facilities in Bangladesh, by facility type.

Figure 3.9 Availability of a functioning computer with 

Internet,* by facility type

Figure 3.10 Availability of emergency transport,

by facility type

37

78

11

42

61

49 58

91

22

67 74 75

Total

facilities

District &

upazila

public

Union-level

public

CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)

* The facility has a functioning computer with access to the Internet that is not interrupted 

for more than 2 hours at a time during normal working hours, or facility has access to the 

Internet via a cellular phone inside the facility.

5

13

80

92

58

83

16

57

5

15

79

97

56

82

22

62

Total

facilities

Total

facilities

excluding

CC

District &

upazila

public

DH MCWC UHC NGO Private

Percentage of facilities

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)
28 • Facility-level Infrastructure, Resources, Management, and Support

Overall, more than 75% of district 

and upazila public facilities, private 

hospitals, and NGO clinics have at 

least five of the six specified 

amenities considered basic to 

provision of client services. In 

sharp contrast, only 15% of CCs 

and 5% of union-level public 

facilities have at least five basic 

amenities. These low percentages 

are primarily due to the limited 

availability of computers with 

Internet access at union-level 

facilities and the lack of availability 

of regular electricity in most CCs. 

The availability of at least five 

basic amenities improved between 

2014 and 2017 (from 11% to 19%) (Figure 3.11), and improvements occurred in all types of public health 

facilities other than union-level facilities.

Basic Equipment to Support Quality Health Services

Delivery of quality basic health services requires certain equipment. WHO and USAID have proposed a 

list of seven basic pieces of equipment that should be available at a health facility to guarantee its readiness 

to deliver basic health services (WHO 2012). The basic equipment considered necessary to support quality 

health services includes the following:

▪ Adult scale

▪ Child or infant scale

▪ Thermometer

▪ Stethoscope

▪ Blood pressure apparatus

▪ Light source

Table 3.4 provides information from the 2017 BHFS on the availability of this basic equipment. Facilities 

are most likely to have a stethoscope (94%), followed by a thermometer or adult weighing scale (86%

each) and a blood pressure apparatus (85%) (Table 3.4). More than half of facilities have an infant or child 

weighing scale (62%) and a light source (52%).

Overall, 28% of facilities have all six equipment items considered basic to providing quality client 

services, as compared with 26% in 2014. The availability of at least six equipment items is highest in NGO 

facilities and private hospitals (80% or more) and lowest in union-level facilities and CCs (23% each).

Basic Items for Infection Control in Service Delivery Areas

Around the world, infections acquired in a health facility (known as nosocomial infections) often 

complicate the delivery of health care. Strict adherence to infection control guidelines and constant 

vigilance are necessary to prevent such infections. It is essential that a health facility have the supplies and 

equipment for infection control appropriate to the services offered. Table 3.5 provides information on 18 

items considered important for compliance with standard precautions for infection control in service 

delivery areas.

Table 3.5 shows that only 11% (32% excluding CCs) of facilities have basic sterilization equipment for 

processing instruments for reuse. Such equipment includes:

Figure 3.11 Availability of at least five basic amenities 

in health facilities, by facility type

11

24

58

6 4

58

90

19

27

78

5

15

76

91

Total

facilities

Total

facilities

excluding

CC

District &

upazila

public

Unionlevel

public

CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)
Facility-level Infrastructure, Resources, Management, and Support • 29

▪ Functioning electric dry heat sterilizer

▪ Functioning electric autoclave

▪ Non-electric autoclave with a functioning heat source

As can be seen in Table 3.5, sterilization equipment is most often available at private hospitals (85%), 

district and upazila public facilities (72%), and NGO facilities (65%). CCs generally do not have provision 

for sterilization equipment, so it is not unexpected that less than 1% of these facilities reported having such 

equipment.

Slightly more than 7 in 10 facilities can safely dispose of sharps waste by incinerating or burning it, 

dumping it in a protected area, or storing it in a protected container for later removal. Sixty-four percent 

(63% excluding CCs) of facilities have containers for storage of sharps waste prior to disposal (sharps 

boxes). Syringes and needles for safely managing injections are available in nearly 8 of 10 facilities (Table 

3.5).

Disinfectants are available in 38% (55% excluding CCs) of facilities. Union-level public facilities and CCs 

are less likely than other types of facilities to have disinfectants (Table 3.5). Overall, 60% (70% excluding 

CCs) of facilities have soap and running water or alcohol-based hand disinfectant. DHs, MCWCs, UHCs, 

NGOs, and private hospitals are more likely to have soap and running water or alcohol-based hand 

disinfectant than union-level facilities and CCs.

Medical masks are available in 28% (40% excluding CCs) of facilities. Table 3.5 shows that 

comparatively few union-level facilities (28%) and CCs (21%) have medical masks. Seventeen percent 

(21% excluding CCs) of facilities have guidelines on standard precautions for infection control available in 

the general outpatient area.

Figure 3.12 presents information 

on an additional summary measure, 

the availability of at least seven 

items for infection control by 

facility type. District and upazila 

facilities (50%), NGO facilities 

(75%), and private hospitals (61%) 

have at least seven items for 

infection control. Considerably 

smaller proportions of union-level 

facilities (17%) and CCs (5%) have 

at least seven items.

The percentage of facilities with at 

least seven items for infection 

control has decreased since 2014, 

from 20% to 13%. The low 

proportion of facilities with at least seven items is due primarily to the limited availability of sterilization 

equipment, medical masks, and guidelines for standard precautions at union-level facilities and CCs.

Capacity for Adherence to Standards for Quality Sterilization or High-level Disinfection 

For most equipment used in client examinations, either sterilization or high-level disinfection (HLD) 

procedures are sufficient to prevent the spread of infection. However, to effectively kill the spores that 

cause illnesses such as tetanus, either dry heat sterilization or an autoclave system is required. This type of 

treatment is necessary for processing surgical equipment that will be reused, such as blade handles and 

scissors used to cut umbilical cords. The standard equipment necessary to process these types of 

instruments for reuse includes:

Figure 3.12 Availability of at least seven items for 

infection control in health facilities, by facility type

20

32

57

19 14

68

58

13

31

50

17

5

75

61

Total

facilities

including

CC

Total

facilities

excluding

CC

District &

upazila

public

Unionlevel

public

CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)
30 • Facility-level Infrastructure, Resources, Management, and Support

▪ Functioning electric dry heat sterilizer

▪ Functioning electric autoclave

▪ Non-electric autoclave with a functioning heat source

▪ Electric boiler or steamer

▪ Non-electric boiler or steamer with a functioning heat source

Depending on the size of the facility, equipment may be processed through different methods or at more 

than one site within the facility. The information presented in this chapter refers to the primary site in the 

facility where equipment is processed.

Table 3.6 reports on the capacity of health facilities to process instruments for reuse, including the 

availability of sterilization equipment and an automatic timer and knowledge of the correct processing 

time. Overall, 38% (65% excluding CCs) of facilities have the functioning equipment or items necessary to 

perform an accepted method of equipment processing. Thirty-two percent (57% excluding CCs) of 

facilities have both functioning equipment and correct knowledge of the processing time. Only 7% (19%

excluding CCs) of facilities have the necessary equipment, knowledge of processing time, and an 

automatic timer. Written guidelines for sterilization or HLD are available at 11% (23% excluding CCs) of 

facilities.

Diagnostic Capacity

Provision of diagnostic services, including laboratory tests and diagnostic imaging, is essential for clinical 

decision making and for enhancing delivery of quality health care. In fact, case management for conditions 

such as TB depends entirely on laboratory and/or imaging results. Tables 3.7.1 and 3.7.2 and Figures 3.13

and 3.14 present information on the diagnostic capacity of health facilities in Bangladesh. The items 

included in these tables and figures are based on the methodology proposed by WHO and USAID for 

measuring diagnostic capacity as a component of assessing general service preparedness (WHO 2012).

Table 3.7.1 shows that, overall, the 

capacity of health facilities to 

perform basic laboratory diagnostic 

tests is still very limited. Facilities 

are most likely to have the capacity 

to measure blood glucose; however, 

these tests are offered at only one in 

five facilities (Figure 3.13).

Figure 3.13 Capacity to conduct basic laboratory 

diagnostic tests in health facilities

7

5 6 7

12 12 10 11

20

17

Urine

pregnancy

Urine

glucose

Urine

 protein

Blood

glucose

Hemoglobin

Percentage of facilities

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)
Facility-level Infrastructure, Resources, Management, and Support • 31

The limited capacity of facilities to 

perform basic tests is further 

highlighted in Figure 3.14, which 

shows the proportion of facilities 

that can perform five basic tests. 

Since 2014, the capacity of 

facilities to perform each of these

basic tests has increased: 

hemoglobin, from 12% to 17%;

blood glucose, from 7% to 20%;

urine protein, from 6% to 11%;

urine glucose, from 5% to 10%;

and urine pregnancy tests, from 7%

to 12%. Only 4% of facilities 

perform all five of these basic 

diagnostic tests (Table 3.7.1 and 

Figure 3.14). Fourteen percent of 

district and upazila facilities provide all of the basic tests, as compared with more than half of private 

hospitals and 40% of NGO facilities. As expected, since they generally do not have provision for offering

these tests, only a negligible proportion of union-level facilities and CCs carry out all five basic laboratory 

tests.

Advanced laboratory diagnostic tests and equipment for diagnostic imaging were available only at district 

hospitals, UHCs, NGO facilities, and private hospitals. Private hospitals are more likely than other types of 

facilities to provide many of the advanced diagnostic tests; however, DHs are more likely than private 

hospitals to have the capacity to perform TB microscopy and TB rapid diagnostic tests.

Figure 3.15 shows the availability 

of a functional x-ray machine in 

district and upazila facilities, NGO 

facilities, and private hospitals. The 

majority of DHs (79%) have 

functional x-ray machines, and the 

availability of this equipment has 

improved slightly in the past 3 

years. Only 18% of UHCs have 

functional x-ray machines, and 

availability has decreased since 

2014. More than 65% of private 

hospitals have a functional x-ray 

machine, but only a negligible 

proportion (2%) of NGO facilities 

have this equipment.

Figure 3.14 Availability of all five basic laboratory 

diagnostic tests in health facilities, by facility type

Figure 3.15 Availability of functional x-ray machine in 

health facilities, by facility type

3

9

16

0.1 0.1

33 36

4

12 14

2 0.4

40

52

Total

facilities

Total

facilities

excluding

CC

District &

upazila

public

Unionlevel

public

CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)

24

2

62

73

22 22

2

66

79

18

District &

upazila

public

NGO Private DH UHC

Percentage of facilities

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)
32 • Facility-level Infrastructure, Resources, Management, and Support

The BHFS also obtained 

information on the availability of 

functional ultrasound machines. 

Seventy-four percent of DHs and 

14% of UHCs have a functional 

ultrasound machine, as compared 

with 63% and 4%, respectively, in 

2014 (Table 3.7.1 and Figure 

3.16). More than two-thirds of 

private hospitals and 26% of NGO 

facilities have ultrasound machines, 

with availability increasing over the 

past 3 years.

Table 3.7.2 presents information on 

diagnostic capacity by urban-rural 

location and division. The results 

show that the proportion of urban facilities offering basic laboratory tests varies from 19% for TB 

microscopy to 80% for hemoglobin, while the availability of basic tests in rural facilities ranges from less 

than 1% for TB microscopy, liver or renal function test to 17% for blood glucose. One-third or fewer urban 

health facilities offer any advanced-level tests, and these tests are virtually unavailable in rural areas. 

Diagnostic imaging also is generally limited to urban facilities.

An assessment of variations in diagnostic capacity by division shows that, overall, blood glucose tests are 

the most widely available basic tests, while advanced-level diagnostic tests are generally less available.

Across divisions, 6% or less of health facilities have imaging equipment available.

Availability of Essential Medicines

Consistent availability of essential medicines is critical to the delivery of quality health services. The 2017

BHFS assessed the availability of 14 essential medicines in concurrence with the service readiness 

indicators proposed by WHO and USAID (WHO 2012). Table 3.8.1 presents information on the 

availability of these medicines at health facilities.

Overall, ciprofloxacin tablets/capsules are the most widely available of these essential medicines; 95%

(93% excluding CCs) of facilities had ciprofloxacin available on the day of the survey. Public facilities and 

NGO facilities (over 90%) are more likely than private hospitals (78%) to have ciprofloxacin 

tablets/capsules. Omeprazole/cimetidine tablets/capsules are the next most widely available of the essential 

medicines.

Amitriptyline tablets, atenolol tablets, captopril tablets, glibenclamide tablets, and simvastatin tablets are 

least available; on average, in 6% or less of facilities have these essential medicines. The limited 

availability of these medicines reflects the fact that they are generally provided only at higher-level health 

facilities and are not expected to be available at lower-level facilities.

Table 3.8.2 shows that, with the exception of amoxicillin tablets/capsules, ciprofloxacin tablets/capsules, 

cotrimoxazole oral suspension, omeprazole/cimetidine tablets/capsules, paracetamol suspension, and 

salbutamol inhalers, urban-rural gaps in the availability of essential medicines are above 20%. Examining 

differences by division, ciprofloxacin tablets/capsules and omeprazole/cimetidine tablets/capsules are the 

most widely available medicines (88% or more in all divisions). On the other hand, medicines such as 

amitriptyline tablets/capsules, atenolol tablets/capsules, captopril tablets/capsules, ceftriaxone injectable, 

glibenclamide tablets/capsules, and simvastatin tablets/capsules are much less frequently available.

Figure 3.16 Availability of functional ultrasound 

machine in health facilities, by facility type

10 16

66 63

4

18

26

69 74

14

District &

upazila

public

NGO Private DH UHC

Percentage of facilities

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)
Facility-level Infrastructure, Resources, Management, and Support • 33

As another measure of the availability of drugs, the information obtained in the BHFS can be used to 

assess the availability of eight essential medicines included in the drug and dietary supply (DDS) kit. A

DDS kit is a box of pre-selected essential drugs and dietary items to be dispensed by community service 

providers at UHFWCs for patient management. They receive DDS kits at different intervals from the 

central warehouse, with the following items included:

▪ Amoxicillin tablets/capsules

▪ Amoxicillin syrup

▪ Paracetamol tablets

▪ Paracetamol syrup

▪ Tetracycline/chloramphenicol

eye ointment

▪ Cotrimoxazole

▪ Iron tablets

▪ Vitamin A capsules

Figure 3.17 shows the availability 

of at least six of the eight essential 

medicines in the DDS kit. Sixtytwo percent (38% excluding CCs) 

of health facilities have at least six 

of the medicines in the DDS kit, as 

compared with 77% (70%

excluding CCs) in 2014. Among 

public facilities, CCs (75%) are 

most likely to have at least six of 

the medicines. About 4 in 10 NGO 

facilities and private hospitals have 

at least six of the medicines.

3.3 BASIC MANAGEMENT SYSTEMS TO SUPPORT AND MAINTAIN QUALITY SERVICES 

AND APPROPRIATE CLIENT UTILIZATION

Basic management and administrative systems are necessary to ensure that health services are provided 

consistently at an acceptable level of quality. The 2017 BHFS elicited information on:

▪ Supportive management practices for providers

▪ Quality assurance

▪ Client feedback

3.3.1 Supportive Management Practices for Providers

Health facilities are considered to have supportive management practices if they had external supervision 

during the 6 months before the survey and if staff members received routine training and personal 

supervision. Table 3.9 presents information on supportive management practices.

External Supervision

Supervision by external managers has many benefits. It can help ensure that system-wide standards and 

protocols are followed at the facility level and promote an organizational culture that expects standards and 

protocols to be followed. External supervision provides an opportunity to expose staff members to a wider 

scope of ideas and relevant experiences. It can also motivate service providers, especially if the supervisor 

is supportive.

Figure 3.17 Availability of at least six essential 

medicines of a DDS kit in health facilities,

by facility type

77 70 74 73

81

60

45

62

38

48

35

75

42 45

Total

facilities

including

CC

Total

facilities

excluding

CC

District &

upazila

public

Unionlevel

public

CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)
34 • Facility-level Infrastructure, Resources, Management, and Support

Overall, 92% (88% excluding CCs) of facilities reported that they received external supervision in the 6 

months preceding the BHFS (Table 3.9). Recent supervision is common across all types of facilities, 

ranging from 53% among private hospitals to 96% among NGO facilities. Facilities in rural areas (94%) 

are more likely than facilities in urban areas (79%) to have external supervision.

Staff Training

Staff training is essential for updating health workers with knowledge, skills, and technical competence to 

improve the quality of health care services. The 2017 BHFS assessed whether health care providers had 

received any formal or structured in-service training related to the services they offer in the 24 months 

preceding the survey. If more than half of providers at a facility had received such training, the facility was 

deemed to have routine staff training.

Overall, 79% (65% excluding CCs) of facilities have routine staff training (Table 3.9). Private hospitals 

(24%) are less likely than other types of facilities to have routine staff training. Routine training is much 

more common in rural facilities (84%) than urban facilities (55%). The proportion of facilities with routine 

staff training varies considerably by division, from 73% in Chattogram to 88% in Sylhet.

Personal Supervision of Health Service Providers

While facility-level supervision is critical to support quality service provision throughout the health care 

system, personal supervision is essential to assess the work of individual staff members. Personal 

supervision identifies each employee’s strengths and weaknesses and provides appropriate support. The 

2017 BHFS defined a health facility as having personal supervision of health care providers if at least half 

of the providers reported being personally supervised at least once during the 6 months preceding the 

survey. Almost all facilities (95%) have routine staff supervision (Table 3.9).

Training and Personal Supervision

The combination of routine staff training and supervision is crucial to achieving competence and 

sustaining quality health service delivery. Overall, 74% (59% excluding CCs) of facilities have both 

routine staff training and personal supervision of health workers (Table 3.9). Only CCs (89%) exceed the 

national average with respect to routine training and personal supervision. The proportion of facilities with 

both routine training and personal supervision is much higher in rural (79%) than urban (52%) areas. By 

division, the percentage of facilities with both training and supervision varies from 63% in Chattogram to 

83% in Mymensingh.

Supportive Management Practices

A facility was considered to have supportive management practices if the facility had an external 

supervisory visit during the 6 months before the assessment and staff had received both routine training 

and supervision. Overall, 71% (55% excluding CCs) of facilities have all of these supportive management 

practices in place (Table 3.9). There is considerable variability in the extent of supportive management 

practices among the various facility types. For example, 53% of district and upazila public facilities have 

supportive management practices in place, as compared with 85% of public community clinics. Supportive 

management practices are much less common in private hospitals (8%) than in any of the public facilities 

or in NGO facilities (72%).

3.3.2 Quality Assurance

Quality assurance (QA) refers to a system for monitoring quality of care, identifying problems, and 

instituting changes to resolve those problems. QA systems require an established standard against which 

quality is measured. There must be systematic methods to assess results and develop interventions. The 

following are examples of QA activities and approaches:
Facility-level Infrastructure, Resources, Management, and Support • 35

▪ A supervisory checklist for health systems, which documents the presence of equipment and supplies, 

the completeness of health management information system accounts, and other process indicators.

▪ A supervisory checklist for health service provision, which verifies specific content in client 

assessments, treatments, or consultations. This list is often used to document the provision of care.

▪ A facility-wide review of mortality, which is a structured system to review the records of each client 

who dies. There is usually a committee established for this purpose.

▪ Audits of medical records or registers, which check medical records for specific items or information 

and assess adherence to protocols.

Overall, only 15% (20% excluding CCs) of facilities report that they have regular QA activities and have 

evidence of such activities (Table 3.10). NGO facilities (54%) are most likely and private hospitals (10%) 

are least likely to report QA activities and have supporting documentation. Among district and upazila 

facilities, 61% of DHs, 51% of UHCs, and 30% of MCWCs reported QA activities and provided 

documentation. In contrast, only 12% of union-level facilities and CCs have documented QA activities.

3.3.3 Client Feedback

Obtaining client feedback on health service delivery provides an opportunity for management to take 

remedial actions and to increase the satisfaction of health service users. Feedback is critical to providing 

health services that meets clients’ expectations. The 2017 BHFS assessed whether facilities have a system 

to elicit and review client opinion.

Overall, only 40% (46% excluding CCs) of facilities have systems to elicit and review client opinion 

(Table 3.10). NGO facilities (86%), district and upazila facilities (79%), and private hospitals (79%) are 

more likely than union-level facilities (31%) and CCs (37%) to have such systems in place. Among district 

and upazila facilities, 87% of DHs, 84% of UHCs, and 52% of MCWCs have client feedback systems.

The proportion of health facilities with quality assurance and client feedback systems in place has 

improved since 2014 in all facility types (Figure 3.18).

Figure 3.18 Quality assurance and client opinion, by facility type

3.4 AVAILABILITY OF HUMAN RESOURCES FOR HEALTH

WHO considers the health workforce to be one of the key building blocks in any health system. As part of 

its continuing effort to improve health service provision in the public sector, the Government of 

Bangladesh is committed to augmenting human resources for health.

10 14

46

6 8

29

21 26

35

61

20 22

81

53

15 20

49

12 12

54

10

40 46

79

31 37

86 79

Total

facilities

including

C C

Total

facilities

excluding

C C

District &

upazila

public

Unionlevel

public

C C NGO Private Total

facilities

including

C C

Total

facilities

excluding

C C

District &

upazila

public

Unionlevel

public

C C NGO Private

Percentage of facilities

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)

Quality assurance Client feedback
36 • Facility-level Infrastructure, Resources, Management, and Support

As part of the assessment of general preparedness for service delivery, the BHFS collected information on 

staffing patterns. Table 3.11 and Figures 3.19 through 3.21 show the percentages of sanctioned health care 

provider posts filled in the surveyed facilities, by provider category and type of facility.

Manager/administrator category: 

In district and upazila public 

facilities, 87% of 

manager/administrator posts are

filled. In NGO and private 

facilities, 98% and 94% of posts,

respectively, are filled (Table 

3.11).

Physician category: The BHFS 

obtained information on filled posts 

of physicians categorized as 

specialists and general 

practitioners. Among public 

facilities, specialists were expected 

and found only in DHs and UHCs, 

where 62% and 33% of specialist 

posts are filled, respectively. In NGO and private facilities, 76% and 21% of specialist posts, respectively,

are filled. In the general practitioner category, 86% of sanctioned posts are filled in NGO facilities, 68% in 

private hospitals, 63% in district and upazila public facilities, and 15% in union-level public facilities 

(Table 3.11).

The survey also examined the overall status of filled

physician posts by combining the specialist and 

general practitioner categories. The percentage of 

these sanctioned physician posts filled is lowest in 

union-level facilities (15%). In contrast, sanctioned 

physician posts are filled in 85% of NGO facilities,

53% of district and upazila facilities, and 47% of 

private hospitals (Table 3.11). Figure 3.19

compares filled physician posts in 2014 and 2017,

while Figure 3.20 shows trends in filled physician 

posts in public facilities during that period.

Figure 3.19 Trends in physician positions filled,

by facility type

Figure 3.20 Trends in physician 

positions filled in public health facilities,

by facility type

70 70

62

22

84 82

47 47 53

15

85

47

Total

facilities

including

CC

Total

facilities

excluding

CC

District &

upazila

public

Union-level

public

NGO Private

Percentage of facilities

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)

70

84

59

24

38

67 63

49

11

19

DH MCWC UHC UHFWC USC/RD

Percentage of facilities

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)
Facility-level Infrastructure, Resources, Management, and Support • 37

Nurse/midwife category: Staffing patterns for 

nurses are much better than those for physicians. 

Seventy-nine percent of sanctioned posts in private 

hospitals, 97% in NGO facilities, and 79% in district 

and upazila public facilities are filled (Table 3.11).

Between 2014 and 2017, the percentage of filled 

nurse/midwife positions increased in NGO facilities, 

remained similar in district and upazila facilities, and 

decreased drastically in private hospitals (Figure 

3.21).

Paramedic category: Staffing patterns and 

distributions of paramedic positions are more 

equitable across the different sectors. More than 

90% of paramedic positions are filled in NGO 

facilities and private hospitals. Vacancies in 

paramedic positions are highest in district and 

upazila public facilities (Table 3.11).

Field supervisor category: Field supervisors are found only in district and upazila public facilities. 

Among these facilities, 72% of sanctioned field supervisor posts are filled (Table 3.11).

3.5 MANAGEMENT OF MEDICAL WASTE IN HEALTH CARE FACILITIES

WHO considers poor medical waste management to be one of the key elements posing potential risks of 

infection, toxic effects, and injuries among health care workers, waste handlers, patients, and the 

community at large. As part of its continuing effort to control infections in public sector health care 

facilities, the Government of Bangladesh is committed to ensuring proper management of medical waste 

management. It is therefore essential that all medical waste materials be disposed of safely.

As part of the assessment of general preparedness for service delivery, the BHFS collected information on 

management of medical waste. Tables 3.12.1 and 3.12.2 and Figure 3.22 and 3.23 present information on 

final disposal of medical waste at the surveyed facilities.

Sharps waste: According to WHO

(2001), sharps waste includes 

needles, intravenous tubing with a 

needle attached, glass Pasteur 

pipettes, disposable glass pipettes, 

scalpels, razor blades, lancets, and 

broken glass that may be 

contaminated with blood or other 

potentially infectious material.

Overall, 3% (8% excluding CCs) of 

facilities use an incinerator to burn

their sharps waste. However, 25% 

(33% excluding CCs) of facilities 

practice open burning, 11% (10%

excluding CCs) dump waste 

without burning it, and 33% (23%

excluding CCs) remove waste

offsite. The most widely practiced method of managing sharps waste is removal offsite (Table 3.12.1 and 

Figure 3.22). Urban facilities are more likely than rural facilities to remove sharps waste offsite, while 

Figure 3.21 Trends in nurse/midwife 

positions filled in different facilities

Figure 3.22 Sharps waste management, by facility 

type

81 83

103

89 87 79 76

97

79

89

77 73

District

&

upazila

public

NGO Private DH MCWC UHC

Percentage of facilities

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)

3

8 9 8

1 3

8

25

33

42 37

22 17 11 10 9 11 11 8 9

3

33

23

15 12

39

56

76

Total

facilities

including

CC

Total

facilities

excluding

CC

District &

upazila

public

Unionlevel

public

CC NGO Private

Percentage of facilities

Incinerator Open burning Dump without burning Remove offsite

Sharps waste (N=1,524)
38 • Facility-level Infrastructure, Resources, Management, and Support

rural facilities are more likely to engage in open burning. Open burning (an average of 27% across 

divisions) and removal offsite (an average of 32%) are the most frequently used methods across the 

different divisions.

Non-sharps medical waste:

According to WHO (2001), nonsharps medical waste includes 

infectious waste (pathogens), 

pathological waste (human tissues, 

body parts, or fluids), 

pharmaceutical waste, genotoxic 

waste, chemical waste, and 

radioactive waste. Overall, 32%

(36% excluding CCs) of facilities 

engage in open burning to manage 

non-sharps waste. Three percent 

(5% excluding CCs) of facilities 

burn their medical waste using an 

incinerator. Public facilities (district 

and upazila, union level, and CCs) 

are most likely to dispose of their 

non-sharps waste through open burning, whereas private hospitals and NGO facilities are most likely to 

remove waste offsite (Table 3.12.2 and Figure 3.23). More than half of urban facilities dispose of their 

waste offsite, while one-third of rural facilities openly burn their waste. Open burning is the most widely 

used practice in all divisions.

LIST OF TABLES

▪ Table 3.1 Availability of specific services

▪ Table 3.2 Availability of basic client services

▪ Table 3.3 Availability of basic amenities for client services

▪ Table 3.4 Availability of basic equipment

▪ Table 3.5 Standard precautions for infection control

▪ Table 3.6 Capacity for processing equipment for reuse

▪ Table 3.7.1 Laboratory diagnostic capacity

▪ Table 3.7.2 Laboratory diagnostic capacity

▪ Table 3.8.1 Availability of essential medicines

▪ Table 3.8.2 Availability of essential medicines

▪ Table 3.9 Supportive management practices at the facility level

▪ Table 3.10 Quality assurance and client opinion

▪ Table 3.11 Among all facilities, the percentage of filled posts of provider categories and 

facility type, Bangladesh HFS 2017

▪ Table 3.12.1 Sharps waste management

▪ Table 3.12.2 Non-sharps waste management

Figure 3.23 Non-sharps waste management,

by facility type

3 5 6 5

1

4 5

32 36

43 40

30

22

9

15 13 12 14 16 14

5

17 18 16

6

16

46

80

Total

facilities

including

CC

Total

facilities

excluding

CC

District &

upazila

public

Unionlevel

public

CC NGO Private

Percentage of facilities

Incinerator Open burning Dump without burning Remove offsite

Non-sharps waste (N=1,524)
Facility-level Infrastructure, Resources, Management, and Support • 39

Table 3.1 Availability of specific services

Among all facilities, the percentages and numbers that offer specific services, 

Bangladesh HFS 2017

Service provided

Percentage of 

facilities offering 

service 

(weighted)

Number of facilities offering service

Weighted Unweighted

Curative care for sick children 98.1 1,495 1,487

Child growth monitoring 85.3 1,300 1,285

Child vaccination (EPI)1 87.2 1,328 1,176

Any family planning2 89.2 1,359 1,334

Antenatal care 98.8 1,506 1,495

Normal delivery 23.5 358 818

Cesarean delivery3 4.3 66 271

TB diagnosis or treatment4 8.7 132 302

Non-communicable disease5 33.4 509 711

Laboratory diagnostic6 34.5 526 723

Blood grouping and typing7 7.7 117 356

Blood transfusion8 3.7 57 231

Postnatal care9 95.8 1,460 1,465

Postpartum family planning10 90.8 1,384 1,370

Adolescent health11 98.2 1,497 1,483

Nutrition12 95.7 1,459 1,430

Total na 1,524 1,524

1 Routine series of DPT/pentavalent, polio, and measles vaccinations offered from the 

facility, excluding any outreach services

2 Facility provides, prescribes, or counsels clients on any of the following: contraceptive 

pills (combined or progestin only), injectables (progestin only), implants, intrauterine 

contraceptive devices (IUCDs), male condoms, female sterilization (tubal ligation), male 

sterilization (vasectomy), or lactational amenorrhea method (LAM).

3 Facility reports that it provides cesarean delivery services at the facility.

4 Facility reports that providers assigned to the facility diagnose TB, prescribe treatment 

for TB, or provide TB treatment follow-up services for clients put on treatment elsewhere.

5 Facility reports that it provides diagnosis or management of non-communicable 

diseases, especially diabetes and cardiovascular diseases.

6 Facility reports that it provides laboratory diagnostic services at the facility.

7 Facility reports that it provides blood grouping and typing services at the facility.

8 Facility reports that it provides blood transfusion services at the facility.

9 Facility reports that it provides postnatal care in facility.

10 Facility reports that it provides postpartum family planning services at the facility.

11 Facility reports that it provides adolescent health care at the facility.

12 Facility reports that it provides nutrition services at the facility.
40 • Facility-level Infrastructure, Resources, Management, and Support

Table 3.2 Availability of basic client services

Among all facilities, the percentages offering the indicated basic client services and all basic client services, by background characteristics, 

Bangladesh HFS 2017

Background

characteristic

Child 

curative 

care

Child 

growth 

monitoring 

services

Child 

vaccination 

services

Any 

modern 

methods of 

family 

planning

Antenatal 

care 

services

Normal 

delivery

All basic 

client 

services 

with normal 

delivery1

All basic 

client 

services 

without 

normal 

delivery

Number of 

facilities

Facility type

District and upazila 

public facilities 99.0 96.3 93.9 94.1 99.4 95.4 84.4 86.2 44

DH 100.0 96.8 93.5 79.0 100.0 100.0 71.0 71.0 5

MCWC 97.8 86.6 73.5 98.9 100.0 92.2 58.9 62.3 7

UHC 99.1 98.3 98.4 95.3 99.1 95.4 91.9 93.6 32

Union-level public 

facilities 97.7 76.3 74.8 87.9 95.7 52.5 35.1 54.9 361

UHFWC 97.0 81.8 73.7 97.7 99.5 64.7 43.5 59.4 250

USC/RD 99.3 63.9 77.2 65.8 87.2 24.9 16.2 44.6 111

Community clinic (CC) 98.8 90.1 95.8 91.1 100.0 6.5 6.1 80.6 1,012

NGO clinic/hospital 94.0 79.9 69.3 86.4 99.8 32.0 14.9 59.9 64

Private hospital 89.9 44.5 6.9 53.3 94.9 94.6 3.8 3.8 43

Location

Urban 92.4 71.5 55.0 78.7 97.6 72.0 28.7 47.1 108

Rural 98.6 86.4 89.6 90.0 98.9 19.8 14.5 73.5 1,416

Division

Barishal 99.3 97.4 89.0 93.8 99.6 29.0 23.7 83.4 113

Chattogram 96.1 74.2 86.8 90.7 98.5 27.6 16.4 63.7 288

Dhaka 98.2 89.3 85.0 87.5 98.9 25.8 14.5 74.4 304

Khulna 99.0 80.0 88.1 93.2 98.6 19.0 14.6 71.4 187

Rajshahi 96.7 88.3 84.5 91.5 97.6 24.7 17.1 72.0 220

Rangpur 99.6 85.7 90.9 76.4 99.1 19.5 14.6 66.2 193

Sylhet 99.7 94.5 83.3 96.1 99.7 19.4 10.3 78.0 96

Mymensingh 99.1 85.6 91.9 90.0 99.9 17.5 12.6 76.0 123

Total 98.1 85.3 87.2 89.2 98.8 23.5 15.5 71.7 1,524

Total excluding CCs 96.7 75.8 70.1 85.4 96.5 57.2 34.2 54.0 512

1 Basic client services include outpatient curative care for sick children, child growth monitoring, facility-based child vaccination services, any 

modern methods of family planning, antenatal care, and normal delivery.
Facility-level Infrastructure, Resources, Management, and Support • 41

Table 3.3 Availability of basic amenities for client services

Among all facilities, the percentages with indicated amenities considered basic for quality services, by background characteristics, Bangladesh HFS 2017

Background 

characteristic

Amenities

Number of 

facilities

National 

electricity 

grid

Regular 

electricity1

Improved 

water 

source2

Visual and 

auditory 

privacy3

Client 

latrine4

Communication 

equipment5

Computer 

with 

Internet6

Emergency 

transport7

Separate 

latrine for 

female 

clients

All 6 basic 

amenities8

Facility type

District and 

upazila public 

facilities 96.2 78.7 98.3 73.0 90.0 81.6 91.2 79.3 63.9 42.3 44

DH 95.2 96.8 98.4 64.5 96.8 88.7 98.4 96.8 74.2 50.0 5

MCWC 90.0 77.9 96.7 78.8 87.9 60.1 54.4 55.7 38.8 27.9 7

UHC 97.6 76.2 98.6 73.0 89.5 85.2 98.1 81.9 67.8 44.3 32

Union-level public 

facilities 82.3 31.5 92.5 72.7 80.9 2.6 22.4 0.5 25.3 0.0 361

UHFWC 83.4 35.4 92.8 76.7 84.2 3.3 16.9 0.7 27.0 0.0 250

USC/RD 79.7 22.8 91.9 63.6 73.4 0.9 34.9 0.0 21.6 0.0 111

Community clinic 

(CC) 46.5 41.1 88.0 66.3 76.6 3.2 67.0 0.0 5.5 0.8 1,012

NGO clinic/

hospital 91.8 77.9 99.1 92.5 93.1 67.8 73.8 22.3 72.0 40.8 64

Private hospital 90.1 100.0 96.0 95.6 90.4 95.2 75.4 61.9 76.2 61.8 43

Location

Urban 91.5 90.2 97.8 88.1 92.9 85.9 78.8 54.5 74.1 51.9 108

Rural 57.1 39.5 89.5 68.5 78.1 4.8 56.1 1.3 12.2 1.7 1,416

Division

Barishal 60.6 31.0 84.6 71.9 69.0 7.1 45.3 3.8 12.4 3.1 113

Chattogram 63.3 38.3 90.8 81.3 68.6 9.7 47.0 5.9 16.4 5.6 288

Dhaka 67.8 50.9 92.5 66.8 72.9 14.9 68.0 7.5 20.1 8.2 304

Khulna 59.3 45.8 93.9 67.6 95.8 8.5 59.6 4.4 17.4 4.3 187

Rajshahi 70.3 45.4 90.9 75.8 81.0 9.8 60.2 4.3 12.9 5.8 220

Rangpur 40.4 41.9 90.4 61.5 86.1 12.9 58.4 4.2 16.2 4.1 193

Sylhet 58.0 42.3 90.1 63.0 87.2 8.2 60.0 4.6 17.7 4.1 96

Mymensingh 41.9 40.5 79.4 60.6 82.2 8.2 57.8 2.5 17.4 2.1 123

Total 59.5 43.1 90.1 69.9 79.1 10.6 57.7 5.1 16.6 5.2 1,524

Total excluding CCs 85.3 47.1 94.1 77.1 84.0 25.3 39.2 15.2 38.7 13.9 512

Note: The indicators presented in this table comprise the basic amenities domain for assessing general service readiness within the health facility assessment 

methodology proposed by WHO and USAID (WHO 2012).

1 Facility is connected to a central power grid and there was no interruption in power supply lasting for more than 2 hours at a time during normal working hours 

in the 7 days before the survey, or facility has a functioning generator with fuel available on the day of the survey, or else facility has back-up solar power.

2 Water is piped into facility or piped onto facility grounds, bottled water is available, or water is available from a public tap or standpipe, a tube well or borehole, 

a protected dug well, a protected spring, or rainwater and the outlet from this source is within 500 meters of the facility.

3 A private room or screened-off space available in the general outpatient service area that is a sufficient distance from other clients so that a normal conversation 

could be held without the client being seen or heard by others

4 Facility has a functioning flush or pour-flush toilet, a ventilated improved pit latrine, or a composting toilet.

5 Facility has a functioning land-line telephone, a functioning facility-owned cellular phone, or a private cellular phone that is supported by the facility.

6 Facility has a functioning computer with access to the Internet that is not interrupted for more than 2 hours at a time during normal working hours, or facility has 

access to the Internet via a cellular phone inside the facility.

7 Facility has a functioning ambulance or other vehicle for emergency transport that is stationed at the facility and had fuel available on the day of the survey, or 

facility has access to an ambulance or other vehicle for emergency transport that is stationed at another facility or that operates from another facility.

8 The basic amenities include regular electricity, an improved water source, visual and auditory privacy, a client latrine, communication equipment, and a computer 

with Internet.
42 • Facility-level Infrastructure, Resources, Management, and Support

Table 3.4 Availability of basic equipment

Among all facilities, the percentages with equipment considered basic to quality client services available in the general outpatient service area, by 

background characteristics, Bangladesh HFS 2017

Background 

characteristic

Equipment

Number of 

Adult scale facilities

Child scale1

or infant 

scale2 Thermometer Stethoscope

Blood 

pressure 

apparatus3 Light source4

All basic 

equipment

Facility type

District and upazila 

public facilities 87.8 79.9 90.4 97.8 97.3 79.7 60.9 44

DH 90.3 80.6 88.7 98.4 96.8 87.1 66.1 5

MCWC 93.4 75.6 85.6 96.7 94.5 74.4 56.6 7

UHC 86.2 80.8 91.7 98.0 98.0 79.8 61.0 32

Union-level public 

facilities 75.2 56.3 67.5 95.5 89.8 50.4 23.0 361

UHFWC 80.4 58.1 67.9 94.6 90.6 52.7 25.1 250

USC/RD 63.5 52.2 66.5 97.5 87.9 45.1 18.3 111

Community clinic (CC) 88.2 60.0 91.6 93.0 82.0 46.8 22.8 1,012

NGO clinic/hospital 98.9 86.0 98.1 99.2 98.1 94.1 79.5 64

Private hospital 98.5 89.7 97.4 100.0 100.0 92.8 82.8 43

Location

Urban 94.2 88.2 96.1 99.3 99.1 92.5 79.3 108

Rural 85.2 59.6 85.5 93.8 84.4 48.8 24.1 1,416

Division

Barishal 87.3 75.7 89.3 94.6 81.3 54.8 31.1 113

Chattogram 79.3 61.8 84.0 94.8 86.4 43.6 20.6 288

Dhaka 87.1 45.1 83.4 91.6 78.3 42.5 18.5 304

Khulna 90.7 59.7 87.5 95.7 82.6 68.7 33.7 187

Rajshahi 90.9 60.6 88.6 93.0 86.9 58.6 36.9 220

Rangpur 87.4 68.2 88.9 98.2 98.2 51.9 27.2 193

Sylhet 90.6 79.1 89.5 93.6 84.9 60.1 44.9 96

Mymensingh 74.6 69.5 82.8 92.9 86.7 47.7 29.3 123

Total 85.9 61.6 86.3 94.2 85.4 51.9 28.0 1,524

Total excluding CCs 81.2 64.8 75.7 96.6 92.3 61.9 38.3 512

Note: The indicators presented in this table comprise the basic equipment domain for assessing general service readiness within the health facility 

assessment methodology proposed by WHO and USAID (WHO 2012).

1 A scale with a gradation of 250 grams, or a digital standing scale with a gradation of 250 grams or lower where an adult can hold a child to be 

weighed, available somewhere in the general outpatient area

2 A scale with a gradation of 100 grams, or a digital standing scale with a gradation of 100 grams where an adult can hold an infant to be weighed, 

available somewhere in the general outpatient area

3 A digital blood pressure machine or a manual sphygmomanometer with a stethoscope available somewhere in the general outpatient area

4 A spotlight source that can be used for client examination or a functioning flashlight available somewhere in the general outpatient area
Facility-level Infrastructure, Resources, Management, and Support • 43

Table 3.5 Standard precautions for infection control

Percentages of facilities with sterilization equipment somewhere in the facility and other items for standard precautions available in the general outpatient area of 

the facility on the day of the survey, by facility type, Bangladesh HFS 2017

Facility type

Total

Total 

excluding 

Items CCs

District 

and 

upazila 

public 

facilities DH MCWC UHC

Unionlevel 

public 

facilities UHFWC USC/RD

Community 

clinic 

(CC)

NGO 

clinic/

hospital

Private 

hospital

Sterilization equipment1 72.3 93.5 72.4 69.2 15.5 19.4 6.4 0.4 65.2 85.4 11.1 32.4

Equipment for high-level 

disinfection2 63.8 83.9 59.8 61.8 44.2 50.1 30.9 23.3 69.8 67.9 32.6 51.1

Safe final disposal of 

sharps waste3 73.8 85.5 76.8 71.4 68.0 68.9 65.8 72.3 84.0 95.9 72.5 72.8

Safe final disposal of 

infectious waste4 76.7 77.4 80.1 75.8 66.4 69.0 60.6 63.2 85.6 99.3 66.3 72.4

Appropriate storage of 

sharps waste5 74.6 72.6 75.6 74.6 59.2 65.2 45.6 64.7 84.2 50.1 64.1 62.8

Appropriate storage of 

infectious waste6 52.4 62.9 46.6 52.1 33.5 34.0 32.2 28.2 63.3 75.1 32.9 42.3

Disinfectant7 61.7 69.4 63.2 60.3 46.9 53.0 33.2 28.9 78.2 84.8 37.8 55.3

Syringes and needles8 81.6 79.0 86.6 80.9 76.6 85.4 56.7 75.4 96.0 81.7 76.9 79.9

Soap 76.6 87.1 74.5 75.6 67.7 69.3 64.2 69.0 95.3 81.2 70.4 73.1

Running water9 94.9 100.0 90.1 95.2 72.2 72.7 70.8 60.9 97.7 87.4 66.8 78.6

Soap and running water 75.4 87.1 72.3 74.4 59.1 59.7 57.6 49.2 94.4 80.2 55.1 66.7

Alcohol-based hand 

disinfectant 53.2 46.8 43.4 56.2 15.6 15.9 15.1 17.0 71.8 71.6 21.5 30.5

Soap and running water or 

else alcohol-based hand 

disinfectant 81.4 90.3 76.8 81.1 62.1 62.9 60.4 54.4 94.9 90.2 59.7 70.2

Latex gloves/other 

gloves10 81.8 79.0 84.4 81.6 72.2 80.0 54.6 78.9 95.8 83.2 78.2 76.9

Medical masks 57.0 59.7 72.2 53.3 28.2 31.6 20.3 21.2 71.3 73.9 27.5 39.8

Gowns 48.0 41.9 60.0 46.3 23.5 26.6 16.6 24.0 63.0 50.9 27.0 32.9

Eye protection 12.5 22.6 19.9 9.4 4.8 5.5 3.3 1.7 36.9 19.8 4.7 10.7

Guidelines for standard 

precautions11 22.1 25.8 31.2 19.6 15.1 16.2 12.7 15.4 55.7 18.6 17.3 21.0

Number of facilities 44 5 7 32 361 250 111 1,012 64 43 1,524 512

Note: The indicators presented in this table comprise the standard precautions domain for assessing general service readiness within the health facility assessment 

methodology proposed by WHO and USAID (WHO 2012).

1 Facility reports that some instruments are processed in the facility and the facility has a functioning electric dry heat sterilizer, a functioning electric autoclave, or 

a non-electric autoclave with a functioning heat source available somewhere in the facility.

2 Facility reports that some instruments are processed in the facility and the facility has an electric pot or other pot with a heat source for high-level disinfection by 

boiling or high-level disinfection by steaming, or else facility had chlorine, formaldehyde, CIDEX, or glutaraldehyde for chemical high-level disinfection available 

somewhere in the facility on the day of the survey.

3 The process of sharps waste disposal is incineration and the facility had a functioning incinerator with fuel on the day of the survey, or else the facility disposes 

of sharps waste by means of open burning in a protected area, dumping without burning in a protected area, or removal offsite with storage in a protected area 

prior to removal offsite.

4 The process of infectious waste disposal is incineration and the facility had a functioning incinerator with fuel on the day of survey, or else the facility disposes of 

infectious waste by means of open burning in a protected area, dumping without burning in a protected area, or removal offsite with storage in a protected area 

prior to removal offsite.

5 Sharps container observed in general outpatient service area

6 Waste receptacles observed in general outpatient service area

7 Chlorine-based or other country-specific disinfectants used for environmental disinfection available in the general outpatient area

8 Single-use standard disposable syringes with needles or else auto-disable syringes with needles available in the general outpatient area

9 Piped water, water in bucket with specially fitted tap, or water in pour pitcher available in the general outpatient area

10 Non-latex equivalent gloves are acceptable.

11 Any guideline for infection control in health facilities available in the general outpatient area
44 • Facility-level Infrastructure, Resources, Management, and Support

Table 3.6 Capacity for processing equipment for reuse

Percentage of facilities with the equipment and other items to support the final processing of instruments for reuse, by background characteristics, 

Bangladesh HFS 2017

Background 

characteristic

Percentage of facilities having:

Number of 

Equipment facilities 1

Equipment and 

knowledge of process 

time2

Equipment, 

knowledge of process 

time, and automatic 

timer3

Written guidelines for 

sterilization or HLD4

Facility type

District and upazila public 

facilities 92.4 83.6 43.0 25.6 44

DH 100.0 98.4 72.6 30.6 5

MCWC 90.0 85.6 44.5 33.2 7

UHC 91.8 80.9 38.4 23.2 32

Union-level public facilities 53.7 46.6 6.7 16.9 361

UHFWC 60.1 53.3 7.4 20.0 250

USC/RD 39.3 31.5 5.0 9.9 111

Community clinic (CC) 24.1 20.1 1.0 5.2 1,012

NGO clinic/hospital 83.9 73.0 42.2 67.3 64

Private hospital 98.2 90.9 64.5 10.3 43

Location

Urban 93.2 83.6 49.4 35.7 108

Rural 33.5 28.5 3.8 9.4 1,416

Division

Barishal 39.7 33.3 4.5 5.5 113

Chattogram 41.4 34.4 8.8 9.4 288

Dhaka 36.8 29.4 9.8 7.9 304

Khulna 41.5 36.1 6.5 20.0 187

Rajshahi 34.6 32.3 5.9 18.4 220

Rangpur 33.3 28.1 7.0 7.8 193

Sylhet 32.0 27.9 3.5 10.1 96

Mymensingh 40.5 39.9 4.7 10.0 123

Total 37.7 32.4 7.1 11.3 1,524

Total excluding CCs 64.5 56.8 19.1 23.4 512

1 Facility reports that some equipment is processed in the facility and facility has a functioning electric dry heat sterilizer, a functioning electric autoclave, 

a non-electric autoclave with a functioning heat source, an electric boiler or steamer, or a non-electric boiler or steamer with a functioning heat source 

available anywhere in the facility or high-level disinfectant used for sterilization or high-level disinfection of equipment for reuse.

2 Processing area has functioning equipment and power source for processing method and the responsible worker reports the correct processing time 

(or equipment automatically sets the time) and processing temperature (if applicable) for at least one method. Definitions for capacity for each method 

assessed were functioning equipment and the following processing conditions:

• Dry heat sterilization: temperature at 160°C-169°C and processed for at least 120 minutes, or temperature at least 170°C and processed for at least 

60 minutes

• Autoclave: wrapped items processed for at least 30 minutes, unwrapped items processed for at least 20 minutes

• Boiling or steaming: items processed for at least 20 minutes

• Chemical high-level disinfection: items processed in chlorine-based or glutaraldehyde or CIDEX or formaldehyde solution and soaked for at least 20 

minutes

3 An automatic timer here refers to a passive timer that can be set to indicate when a specified time has passed. It may be part of the sterilization process 

or the HLD equipment.

4 Handwritten instructions that are pasted on walls and clearly outline the procedures to follow for processing of equipment are acceptable.
Facility-level Infrastructure, Resources, Management, and Support • 45

Table 3.7.1 Laboratory diagnostic capacity

Among all facilities, the percentages with the capacity to conduct basic and advanced laboratory diagnostic tests in the facility, by background 

characteristics, Bangladesh HFS 2017

Laboratory tests

Facility type

Total

Total 

excluding 

CCs

District 

and 

upazila 

public 

facilities DH MCWC UHC

Unionlevel 

public 

facilities UHFWC USC/RD

Community 

clinic 

(CC)

NGO 

clinic/

hospital

Private 

hospital

Basic tests

Hemoglobin 74.0 87.1 44.4 78.4 14.4 18.3 5.5 9.2 74.6 79.7 17.0 32.5

Blood glucose 29.8 29.0 4.4 35.4 2.0 2.5 0.8 20.9 67.1 59.8 19.7 17.3

Urine protein 36.0 61.3 17.7 36.3 7.8 9.6 3.6 4.9 67.2 67.6 10.8 22.6

Urine glucose 32.2 58.1 18.8 31.4 6.6 7.9 3.7 4.2 64.7 71.6 10.0 21.5

TB microscopy 31.4 37.1 0.0 37.3 0.2 0.1 0.7 0.0 2.1 28.0 1.8 5.5

Syphilis rapid 

diagnostic test 31.5 77.4 3.4 30.8 0.0 0.0 0.0 0.0 48.1 68.6 4.8 14.4

General 

microscopy 45.8 69.4 3.3 51.6 0.2 0.1 0.7 0.0 39.3 54.6 4.6 13.6

Urine pregnancy 

test 64.1 88.7 21.0 69.7 9.3 11.6 3.9 4.3 79.4 76.5 12.4 28.3

Liver or renal 

function test (ALT 

or creatinine) 18.3 40.3 0.0 19.0 0.0 0.0 0.0 0.0 8.9 73.4 3.0 8.8

All 5 basic tests 

available1 13.6 21.0 1.1 15.2 1.5 2.2 0.1 0.4 39.5 51.5 4.1 11.5

Advanced-level 

diagnostic tests

Serum electrolytes 19.6 40.3 0.0 20.8 0.0 0.0 0.0 0.0 8.9 73.4 3.0 9.0

Full blood count 

with differentials 15.6 35.5 2.2 15.6 0.0 0.0 0.0 0.0 14.9 57.6 2.7 8.0

Blood typing and 

cross matching 12.0 27.4 0.0 12.4 0.0 0.0 0.0 0.0 11.6 23.9 1.5 4.5

Syphilis serology 5.0 17.7 0.0 4.2 0.0 0.0 0.0 0.0 14.8 27.1 1.5 4.5

Gram stain 13.4 17.7 0.0 15.6 0.1 0.0 0.2 0.0 4.2 57.3 2.2 6.5

Stool microscopy 30.8 54.8 2.2 33.4 0.0 0.0 0.0 0.0 20.5 46.5 3.1 9.1

CSF/body fluid 

counts 30.5 46.8 1.1 34.4 0.0 0.0 0.0 0.0 30.5 51.2 3.6 10.7

TB culture 2.7 6.5 0.0 2.8 0.0 0.0 0.0 0.0 0.0 7.9 0.3 0.9

TB rapid diagnostic 

test 17.2 32.3 0.0 18.7 0.4 0.0 1.3 0.0 0.8 16.6 1.1 3.2

Equipment for 

diagnostic 

imaging

X-ray machine 

(linked with TB) 11.7 37.1 0.0 10.5 0.0 0.0 0.0 0.0 0.6 30.8 1.2 3.7

X-ray machine 21.7 79.0 0.0 18.0 0.0 0.0 0.0 0.0 1.6 65.5 2.5 7.6

Ultrasonogram 17.9 74.2 0.0 13.5 0.0 0.0 0.0 0.0 26.3 69.1 3.6 10.6

CT scan 0.3 3.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 9.3 0.3 0.8

Number of facilities 44 5 7 32 361 250 111 1,012 64 43 1,524 512

Note: The basic test indicators presented in this table comprise the diagnostic capacity domain for assessing general service readiness within the 

health facility assessment methodology proposed by WHO and USAID (WHO 2012).

CSF = Cerebrospinal fluid 

CT = Computed tomography

1 Hemoglobin, blood glucose, urine protein, urine glucose, and urine pregnancy test
46 • Facility-level Infrastructure, Resources, Management, and Support

Table 3.7.2 Laboratory diagnostic capacity

Among all facilities, the percentages with the capacity to conduct basic and advanced laboratory diagnostic tests in the facility, by background characteristics, 

Bangladesh HFS 2017

Laboratory tests

Location Division

Urban Rural Barishal Total

Chattogram Dhaka Khulna Rajshahi Rangpur SylhetMymensingh

Basic tests

Hemoglobin 79.7 12.2 18.2 25.1 19.3 10.8 13.2 5.9 31.1 14.2 17.0

Blood glucose 53.2 17.2 10.6 25.5 25.6 15.9 17.6 12.2 15.4 25.1 19.7

Urine protein 58.4 7.2 8.8 13.2 11.0 11.0 6.4 4.6 16.5 19.7 10.8

Urine glucose 59.0 6.3 8.7 11.0 11.1 9.2 6.0 4.6 15.9 18.5 10.0

TB microscopy 18.6 0.6 1.3 2.9 2.1 1.6 1.8 1.1 0.6 1.8 1.8

Syphilis rapid 

diagnostic test 50.2 1.4 2.7 4.7 10.0 3.1 3.9 3.4 3.3 2.2 4.8

General microscopy 44.8 1.5 3.5 5.5 7.4 3.4 4.0 2.2 3.1 4.0 4.6

Urine pregnancy test 72.0 7.8 11.1 13.5 14.6 12.1 7.4 6.9 18.4 18.6 12.4

Liver or renal 

function test (ALT 

or creatinine) 35.8 0.5 2.0 3.1 5.4 2.3 2.7 1.9 1.9 1.4 3.0

All 5 basic tests 

available1 37.8 1.5 2.1 5.9 7.4 2.9 2.1 1.8 4.4 2.4 4.1

Advanced-level 

diagnostic tests

Serum electrolytes 36.0 0.5 2.0 3.3 5.4 2.3 2.7 1.9 1.9 1.5 3.0

Full blood count with 

differentials 32.6 0.4 1.9 2.9 5.4 2.2 2.0 1.5 1.3 1.3 2.7

Blood typing and 

cross matching 17.0 0.3 0.7 1.7 2.6 1.2 1.6 1.3 0.6 0.5 1.5

Syphilis serology 15.6 0.5 0.7 2.0 2.9 0.7 1.0 0.8 1.4 1.2 1.5

Gram stain 26.9 0.3 1.3 3.1 4.0 1.4 1.3 1.5 1.4 0.9 2.2

Stool microscopy 31.6 0.9 2.1 4.9 4.8 2.6 2.5 1.4 0.9 1.3 3.1

CSF/body fluid 

counts 38.8 0.9 2.2 2.4 7.1 4.2 2.2 2.9 2.5 2.7 3.6

TB culture 3.5 0.1 0.1 0.5 0.4 0.1 0.1 0.6 0.0 0.1 0.3

TB rapid diagnostic 

test 10.4 0.4 0.6 1.6 1.7 0.3 0.4 0.9 1.2 1.3 1.1

Equipment for 

diagnostic imaging

X-ray machine 

(linked with TB) 15.4 0.2 0.5 1.5 2.1 1.4 1.1 0.7 0.6 0.4 1.2

X-ray machine 31.2 0.4 1.5 3.4 4.2 2.4 1.6 1.6 1.9 1.2 2.5

Ultrasonogram 42.6 0.6 2.2 4.1 6.2 2.7 3.3 2.3 2.4 1.8 3.6

CT scan 3.7 0.0 0.0 0.3 0.8 0.1 0.2 0.0 0.1 0.0 0.3

Number of facilities 108 1,416 113 288 304 187 220 193 96 123 1,524

Note: The basic test indicators presented in this table comprise the diagnostic capacity domain for assessing general service readiness within the health facility 

assessment methodology proposed by WHO and USAID (WHO 2012).

CSF = Cerebrospinal fluid 

CT = Computed tomography

1 Hemoglobin, blood glucose, urine protein, urine glucose, and urine pregnancy test
Facility-level Infrastructure, Resources, Management, and Support • 47

Table 3.8.1 Availability of essential medicines

Percentages of facilities having the 14 essential medicines available, by background characteristics, Bangladesh HFS 2017

Essential medicines

Facility type

Total

Total 

excluding 

CCs

District 

and 

upazila 

public 

facilities DH MCWC UHC

Unionlevel 

public 

facilities UHFWC USC/RD

Community 

clinic 

(CC)

NGO 

clinic/

hospital

Private 

hospital

Amitriptyline tablets/capsules1 7.7 14.5 0.0 8.4 0.4 0.5 0.0 0.0 10.7 57.6 2.4 7.1

Amoxicillin tablets/capsules2 85.0 88.7 81.2 85.3 81.1 81.0 81.3 85.6 79.5 61.5 83.6 79.6

Atenolol tablets/capsules3 30.0 46.8 3.4 33.2 2.0 1.0 4.3 0.0 20.1 61.6 3.9 11.6

Captopril tablets/capsules4 53.9 83.9 9.0 59.2 5.1 1.2 13.9 0.0 36.5 74.2 6.4 19.0

Ceftriaxone injectable5 66.0 83.9 37.8 69.4 4.7 4.4 5.2 2.8 56.6 77.8 9.4 22.5

Ciprofloxacin tablets/capsules6 96.0 98.4 92.1 96.5 93.8 91.7 98.6 95.6 98.7 78.2 94.8 93.3

Cotrimoxazole oral 

suspension7 73.8 75.8 91.0 69.8 73.2 78.4 61.4 86.7 86.3 73.8 82.7 74.9

Diazepam tablets/capsules8 77.4 80.6 84.5 75.4 51.8 61.1 30.7 6.4 46.9 75.1 22.8 55.4

Diclofenac tablets/capsules9 90.6 98.4 77.8 92.2 62.8 60.5 68.2 60.8 87.1 80.4 63.8 69.7

Glibenclamide tablets/

capsules10 41.1 74.2 3.5 44.3 2.0 1.3 3.7 0.0 33.6 69.6 5.0 15.0

Omeprazole/cimetidine 

tablets/capsules11 95.5 98.4 85.5 97.3 90.7 88.5 95.5 93.5 98.7 80.7 92.7 91.2

Paracetamol oral suspension12 75.5 80.6 82.1 73.3 73.2 76.7 65.4 88.3 78.2 79.6 83.7 74.6

Salbutamol inhaler13 95.1 98.4 83.3 97.2 80.0 79.6 80.9 89.9 70.0 78.5 86.6 79.9

Simvastatin/atorvastatin

tablets/capsules

14 24.2 61.3 0.0 24.0 0.4 0.0 1.3 0.2 15.7 64.3 3.4 9.7

Number of facilities 44 5 7 32 361 250 111 1,012 64 43 1,524 512

Note: The indicators presented in this table comprise the essential medicines domain for assessing general service readiness within the health facility assessment 

methodology proposed by WHO and USAID (WHO 2012).

1 For management of depression in adults

2 First-line antibiotic for adults

3 Beta blocker for management of angina/hypertension

4 Vasodilator for management of hypertension

5 Second-line injectable antibiotic

6 Second-line oral antibiotic

7 Oral antibiotic for children

8 Muscle relaxant for management of anxiety or seizures

9 Oral analgesic

10 For management of type 2 diabetes

11 Proton pump inhibitor for treatment of peptic ulcer disease, dyspepsia, and gastroesophageal reflux disease

12 Fever reducer and analgesic for children

13 For management and relief of bronchospasms in conditions such as asthma and chronic obstructive pulmonary disease

14 For control of elevated cholesterol
48 • Facility-level Infrastructure, Resources, Management, and Support

Table 3.8.2 Availability of essential medicines

Percentages of facilities having the 14 essential medicines available, by background characteristics, Bangladesh HFS 2017

Essential medicines

Location Division

Urban Rural Barishal Total

Chattogram Dhaka Khulna Rajshahi Rangpur SylhetMymensingh

Amitriptyline tablets/

capsules1 27.4 0.5 1.1 2.4 5.2 0.6 1.8 1.5 3.2 1.0 2.4

Amoxicillin tablets/capsules2 73.8 84.3 83.2 78.3 81.9 83.7 82.0 92.2 82.1 90.7 83.6

Atenolol tablets/capsules3 37.3 1.4 3.3 4.8 5.2 1.8 2.8 4.1 6.2 2.0 3.9

Captopril tablets/capsules4 51.4 2.9 5.1 7.1 8.7 3.5 7.6 3.8 7.4 5.7 6.4

Ceftriaxone injectable5 63.4 5.3 9.8 9.2 12.1 13.4 5.5 6.6 12.5 5.8 9.4

Ciprofloxacin tablets/

capsules6 89.6 95.2 97.9 95.2 90.7 94.2 95.0 95.7 97.6 98.4 94.8

Cotrimoxazole oral 

suspension7 76.1 83.2 86.3 86.6 73.2 80.5 89.7 81.4 82.0 87.4 82.7

Diazepam tablets/capsules8 69.3 19.3 20.7 22.5 22.0 17.5 31.6 23.6 24.0 18.3 22.8

Diclofenac tablets/capsules9 85.8 62.1 67.2 68.2 57.0 54.1 66.0 57.6 71.5 81.9 63.8

Glibenclamide tablets/

capsules10 44.3 2.0 3.6 6.7 7.4 3.2 4.8 2.7 5.0 3.2 5.0

Omeprazole/cimetidine 

tablets/capsules11 90.5 92.9 95.0 92.1 91.0 93.3 88.3 95.5 96.2 96.2 92.7

Paracetamol oral 

suspension12 75.7 84.3 88.7 83.5 75.9 81.2 83.8 87.4 90.7 91.2 83.7

Salbutamol inhaler13 79.2 87.1 88.5 89.0 81.8 82.8 81.0 92.3 89.7 95.1 86.6

Simvastatin/atorvastatin

tablets/capsules

14 35.6 1.0 1.3 5.0 6.2 1.1 1.7 1.4 4.9 3.5 3.4

Number of facilities 108 1,416 113 288 304 187 220 193 96 123 1,524

Note: The indicators presented in this table comprise the essential medicines domain for assessing general service readiness within the health facility assessment 

methodology proposed by WHO and USAID (WHO 2012).

1 For management of depression in adults

2 First-line antibiotic for adults

3 Beta blocker for management of angina/hypertension

4 Vasodilator for management of hypertension

5 Second-line injectable antibiotic

6 Second-line oral antibiotic

7 Oral antibiotic for children

8 Muscle relaxant for management of anxiety or seizures

9 Oral analgesic

10 For management of type 2 diabetes

11 Proton pump inhibitor for treatment of peptic ulcer disease, dyspepsia, and gastroesophageal reflux disease

12 Fever reducer and analgesic for children

13 For management and relief of bronchospasms in conditions such as asthma and chronic obstructive pulmonary disease

14 For control of elevated cholesterol
Facility-level Infrastructure, Resources, Management, and Support • 49

Table 3.9 Supportive management practices at the facility level

Among all facilities, the percentages that had an external supervisory visit during the 6 months before the survey, and the percentages of facilities 

where at least half of the interviewed providers reported receiving routine work-related training and personal supervision recently, by background 

characteristics, Bangladesh HFS 2017

Background 

characteristic

Percentage of 

facilities with 

supervisory 

visit during the 

6 months 

before the 

survey1

Number of 

facilities

Percentage of facilities having routine:

Number of 

facilities where 

at least two 

eligible 

providers were 

interviewed 

with health 

worker 

interview 

questionnaire5 Staff training2

Personal 

supervision3

Training and 

personal 

supervision

Percentage of 

facilities with 

supportive 

management 

practices4

Facility type

District and upazila 

public facilities 93.5 44 60.0 98.4 57.7 53.0 43

DH 93.5 5 45.2 96.8 45.2 43.5 5

MCWC 92.3 7 71.4 97.5 67.7 62.7 6

UHC 93.8 32 60.0 98.8 57.6 52.5 32

Union-level public 

facilities 90.1 361 73.8 91.8 64.9 62.1 153

UHFWC 91.9 250 75.7 94.3 68.5 66.1 110

USC/RD 86.0 111 68.6 85.4 55.7 51.6 43

Community clinic (CC) 94.7 1,012 92.7 96.2 88.9 84.9 317

NGO clinic/hospital 95.8 64 74.3 98.2 74.3 71.7 59

Private hospital 52.9 43 24.1 82.9 15.2 7.8 41

Location

Urban 78.8 108 54.8 93.1 51.5 46.3 101

Rural 93.5 1,416 84.1 94.8 78.9 75.3 512

Division

Barishal 96.0 113 82.6 94.8 77.5 76.3 41

Chattogram 89.4 288 72.9 88.8 62.7 58.8 110

Dhaka 86.5 304 83.4 94.8 77.7 71.3 147

Khulna 97.5 187 76.4 98.0 74.4 73.9 77

Rajshahi 96.3 220 76.5 98.1 75.3 75.3 102

Rangpur 95.7 193 77.4 95.7 75.0 74.9 58

Sylhet 85.1 96 87.7 86.6 79.1 62.8 36

Mymensingh 96.8 123 85.8 98.8 82.7 75.9 42

Total 92.4 1,524 79.3 94.5 74.4 70.5 613

Total excluding CCs 88.0 512 64.9 92.8 58.8 55.1 296

1 Facility reports that it received at least one external supervisory visit from the district, regional, or national office during the 6 months before the 

survey.

2 At least half of all interviewed providers reported that they had received any in-service training as part of their work in the facility during the 24 

months before the survey. This training refers to structured sessions; it does not include individual instruction that a provider might have received

during routine supervision.

3 At least half of all interviewed providers reported that they had been personally supervised at least once during the 6 months before the survey. 

Personal supervision refers to any form of technical support or supervision from a facility-based supervisor or from a visiting supervisor. It may 

include, but is not limited to, review of records and observation of work, with or without any feedback to the health worker.

4 Facility had an external supervisory visit during the 6 months before the survey, and staff members have received routine training and supervision.

5

Interviewed providers who did not personally provide any clinical services assessed by the survey (for example, administrators who might have 

been interviewed) are excluded.
50 • Facility-level Infrastructure, Resources, Management, and Support

Table 3.10 Quality assurance and client opinion

Among all facilities, the percentages having quality assurance activities and documentation of quality assurance 

activities, and the percentages of facilities with a system for eliciting client opinion, by background characteristics, 

Bangladesh HFS 2017

Background 

characteristic

Percentage of facilities with

Number of facilities

Regular quality 

assurance activities 

and observed 

documentation of 

quality assurance 

activities1

System for 

determining client 

opinion and 

procedure for 

reviewing client 

opinion2

Facility type

District and upazila public facilities 48.6 79.4 44

DH 61.3 87.1 5

MCWC 29.9 52.3 7

UHC 50.7 84.1 32

Union-level public facilities 11.7 30.9 361

UHFWC 12.6 32.5 250

USC/RD 9.9 27.4 111

Community clinic (CC) 11.9 37.1 1,012

NGO clinic/hospital 53.6 85.8 64

Private hospital 10.3 78.7 43

Location

Urban 37.3 82.9 108

Rural 12.9 36.8 1,416

Division

Barishal 22.3 41.8 113

Chattogram 14.0 33.7 288

Dhaka 11.0 38.1 304

Khulna 15.9 40.9 187

Rajshahi 21.5 33.5 220

Rangpur 6.7 46.7 193

Sylhet 8.2 47.6 96

Mymensingh 21.2 51.8 123

Total 14.6 40.0 1,524

Total excluding CCs 20.0 45.9 512

1 Facility reports that it routinely carries out quality assurance activities and had documentation of a recent quality 

assurance activity. This could be a report or minutes of a quality assurance meeting, a supervisory checklist, a 

mortality review, or an audit of records or registers.

2 With respect to determining client opinion, systems asked about in the survey were as follows: suggestion box, 

client survey form, client interview form, official meeting with community leaders, informal discussion with clients 

or the community, email, facility's website, letters from clients/community, and text/SMS messages (no system 

documentation was conducted).
Facility-level Infrastructure, Resources, Management, and Support • 51

Table 3.11 Staffing pattern in surveyed facilities

Among all facilities, the percentages of filled health care provider posts, by facility type, Bangladesh HFS 2017

Facility type

Managers/

administrator1 Specialist2

General 

practitioner3

Specialist 

and 

general 

practitioner

Diagnostic 

specialist4

Paramedic5Nurse/mid

wife6

Field 

supervisor7

Medical/

pharmaceutical 

technician8

Other 

health care 

provider9

Other 

health 

provider10

Number of 

facilities

District and upazila 

public facilities 86.8 39.8 62.7 53.2 53.1 68.0 79.4 72.4 64.6 72.0 67.8 44

DH 78.4 61.5 70.9 67.1 54.4 - 88.6 - 81.4 78.8 78.6 5

MCWC - - 63.2 63.2 - - 76.5 - 29.4 33.3 78.9 7

UHC 87.4 33.2 60.0 48.5 52.0 67.2 73.4 72.3 62.2 69.8 66.1 32

Union-level public 

facilities - - 14.7 14.7 - 76.8 - - 31.7 78.8 85.7 361

UHFWC - - 10.6 10.6 - 75.4 - - 24.7 77.4 91.7 250

USC/RD - - 19.0 19.0 - 80.5 - - 44.2 85.6 75.3 111

Community clinic 

(CC) - - - - - - - - - 87.7 73.4 1,012

NGO clinic/hospital 97.8 75.7 86.2 85.0 - 95.2 96.7 - 92.7 95.2 93.5 64

Private hospital 94.3 21.1 68.4 46.5 57.6 92.9 79.0 - 97.1 65.7 118.1 43

Total 92.4 28.1 59.1 47.0 55.0 79.1 79.7 72.4 63.9 87.2 94.3 1,524

Total excluding CCs 92.4 28.1 59.3 47.1 55.0 79.0 79.7 72.4 64.1 83.5 94.7 512

Note: Numbers were provided by the facility in-charge.

“-” Means both sanctioned and filled posts reported none.

1 Superintendent, director/manager/coordinator, upazila health and family planning officer (UH&FPO), upazila family planning officer (UFPO)

2 Senior consultant (medicine), senior consultant (surgery), senior consultant (OBS/GYN), senior consultant (pediatrics), senior consultant (orthopedic surgery), senior 

consultant (eye), senior consultant (anesthesia), senior consultant ear nose and throat (ENT), senior consultant skin and venereal disease (VD), senior consultant (cardiology), 

junior consultant (medicine), junior consultant (surgery), junior consultant (OBS/GYN), junior consultant (pediatrics), junior consultant (orthopedic surgery), junior consultant 

(eye), junior consultant (anesthesia), junior consultant ear nose and throat (ENT), junior consultant skin and venereal disease (VD), junior consultant (cardiology)

3 Residential medical officer (RMO), medical officer (MO)/physician, anesthetist, emergency medical officer (EMO), indoor medical officer (IMO), indoor medical officer (IMO) 

cardiology, indoor medical officer (IMO) surgery, indoor medical officer (IMO) orthopedic surgery, indoor medical officer (IMO) medicine, indoor medical officer (IMO) pediatrics, 

indoor medical officer (IMO) OBS/GYN, medical officer (MO-blood transfusion), dental surgeon, assistant surgeon/equivalent, assistant registrar (medicine), assistant registrar 

(surgery), assistant registrar (OBS/GYN), assistant registrar (pediatric), medical officer (MO-clinic), medical officer (MCH-FP)

4 Consultant (radiology and imaging), consultant (pathologist), junior consultant (radiology), junior consultant (pathology), radiologist, pathologist, senior clinical pathologist, 

biochemist

5 Sub-assistant community medical officer (SACMO), family welfare visitor (FWV), paramedic

6 Matron, nursing supervisor, senior staff nurse, nurse midwife, staff nurse, assistant nursing attendant, midwife

7 Assistant upazila family planning officer (AUFPO), assistant family welfare officer, MCH-FP (AFWO), sanitary inspector, upazila family planning assistant

8 Pharmacist, medical technologist (LAB), medical technologist (blood transfusion), medical technologist (radiology), medical technologist (physiotherapy), medical technologist 

(dental), medical technician/EPI technician, medical technician biochemistry/hematology, medical technician blood transfusion (BT), electrocardiogram (ECG) technician, 

echocardiography (ECHO) technician, cardiographer

9 MO (homeopathic/Unani/ayurvedic), TB leprosy control assistant (TLCA), nutritionist/dietitian, health educator, community health care provider (CHCP), health assistant 

(HA), family welfare assistant (FWA), counselor, community mobilizer/service promoter

10 Female medical attendant, ward master, attendant (OT/LAB/dispensary/ward boy/emergency), storekeeper, statistician/statistical officer/statistical assistant, office assistant

CUM data entry operator/computer operator, other provider
52 • Facility-level Infrastructure, Resources, Management, and Support

Table 3.12.1 Sharps waste management

Among all facilities, the percentages that reported having different methods of sharps waste management, by 

background characteristics, Bangladesh HFS 2017

Background 

characteristic Incinerator Open burning

Dump without 

burning

Remove 

offsite

Number of 

facilities

Facility type

District and upazila public 

facilities 8.5 41.7 8.8 14.8 44

DH 11.3 27.4 4.8 41.9 5

MCWC 6.7 34.3 11.2 24.6 7

UHC 8.4 45.4 8.9 8.6 32

Union-level public facilities 8.3 37.0 10.7 12.0 361

UHFWC 8.1 37.0 11.2 12.6 250

USC/RD 8.9 37.1 9.4 10.4 111

Community clinic (CC) 1.1 21.5 11.1 38.6 1,012

NGO clinic/hospital 3.3 16.8 8.0 55.9 64

Private hospital 7.8 9.3 2.8 76.0 43

Location

Urban 7.1 15.1 4.2 58.4 108

Rural 3.0 26.0 11.0 31.5 1,416

Division

Barishal 0.8 41.6 6.8 23.2 113

Chattogram 4.4 17.9 17.3 38.1 288

Dhaka 3.1 25.2 8.5 37.8 304

Khulna 1.5 16.8 3.8 41.3 187

Rajshahi 2.5 34.8 9.0 28.1 220

Rangpur 4.5 22.0 15.6 26.3 193

Sylhet 7.3 27.3 9.0 33.4 96

Mymensingh 2.6 26.7 9.8 29.7 123

Total 3.3 25.2 10.6 33.4 1,524

Total excluding CCs 7.7 32.6 9.5 23.0 512
Facility-level Infrastructure, Resources, Management, and Support • 53

Table 3.12.2 Non-sharps waste management

Among all facilities, the percentages that reported having different methods of medical waste management, by 

background characteristics, Bangladesh HFS 2017

Background 

characteristic Incinerator Open burning

Dump without 

burning Remove offsite

Number of 

facilities

Facility type

District and upazila public 

facilities 6.0 42.5 12.2 16.0 44

DH 6.5 19.4 3.2 48.4 5

MCWC 4.5 35.6 15.6 24.5 7

UHC 6.2 47.4 12.8 9.4 32

Union-level public facilities 5.3 40.4 14.3 6.4 361

UHFWC 5.0 42.9 14.8 6.3 250

USC/RD 6.2 34.7 13.2 6.6 111

Community clinic (CC) 1.1 30.1 16.1 15.9 1,012

NGO clinic/hospital 4.1 21.8 13.5 46.1 64

Private hospital 4.9 9.4 5.4 79.7 43

Location

Urban 5.2 16.8 7.4 57.5 108

Rural 2.3 33.1 15.7 13.6 1,416

Division

Barishal 0.6 44.4 16.0 12.2 113

Chattogram 1.8 21.7 19.8 20.1 288

Dhaka 3.5 27.4 11.5 23.5 304

Khulna 1.4 35.4 14.5 18.2 187

Rajshahi 1.2 36.5 14.9 20.3 220

Rangpur 3.5 35.1 19.7 7.5 193

Sylhet 7.2 34.2 6.9 11.3 96

Mymensingh 2.1 35.7 13.3 6.0 123

Total 2.5 32.0 15.2 16.7 1,524

Total excluding CCs 5.2 35.6 13.3 18.3 512

Child Health Services • 55

CHILD HEALTH SERVICES 4

Key Findings

▪ Most of the facilities offer outpatient curative care for sick 

children (98%), child vaccination services (87%), and child 

growth monitoring (85%) (Table 4.1).

▪ The availability of three basic child health services 

(outpatient curative care, growth monitoring, and 

vaccination together) increased from 52% in 2014 to 77%

in 2017 (Figure 4.2).

▪ Only 4 in 10 health facilities offering outpatient curative 

care for sick children had four basic items of equipment 

(child scale, length or height board, thermometer, and 

stethoscope) available on the day of the survey. The 

availability of the four items has not improved since 2014 

(Table 4.2 and Figure 4.3).

▪ Almost 60% of facilities that offer child curative care have 

at least one provider trained in integrated management of 

childhood illness (IMCI). Over the last 3 years, the 

percentage of facilities with IMCI guidelines has declined 

from 51% in 2014 to 42% in 2017 (Table 4.6 and Figure 

4.6).

▪ Only 7% percent of facilities have all six infection control 

items (soap, running water, alcohol-based disinfectant, 

latex gloves, sharps container, and waste receptacle), this 

declined from 14% in 2014 (Figure 4.4).

▪ One-third of facilities had all six medicines considered 

essential to child health care (oral rehydration solution, 

amoxicillin syrup, paracetamol syrup/suspension, vitamin 

A capsules, mebendazole/albendazole, and zinc tablets) 

on the day of the survey (Table 4.4).

▪ Only 5% of facilities have all of the recommended tracer 

items for child curative care (guidelines, trained staff, 

drugs, and equipment) on site. Facility readiness to 

provide child curative care went down to 5% in 2017 from 

9% 2014 (Table 4.6 and Figure 4.5).

4.1 BACKGROUND

illions of children under age 5 die each year (WHO 2018), primarily from preventable causes. It 

is common for providers to treat a sick child’s most evident symptoms without conducting a full 

assessment of the child’s health status. For this reason, the World Health Organization and 

other collaborative agencies developed the integrated management of childhood illness (IMCI) strategy 

(WHO 1998). This strategy advocates using every visit to a health care provider as an opportunity not only 

to conduct a full assessment of the child’s current health and possible underlying problems but also to 

provide interventions, such as vaccinations, that can prevent illness or minimize its progression.

Bangladesh has adopted the IMCI strategy, and the country’s 4

th Health, Population and Nutrition Sector 

M
56 • Child Health Services

Program aims to strengthen the existing IMCI program (Government of the People’s Republic of 

Bangladesh 2017).

The IMCI strategy aims to reduce morbidity and mortality among children under age 5 through the 

following three activities:

▪ Improving health workers’ skills through training and supportive supervision

▪ Improving health systems, including equipment, supplies, organization of work, and referral systems

▪ Improving child care at the community and household levels in line with key family practices

The 2017 BHFS examined the availability of necessary services for assessing sick children for main 

symptoms (fever, cough, or difficult breathing; diarrhea; ear pain or discharge), nutrition and 

immunization status, feeding problems, and other potential problems and danger signs that indicate the 

need for immediate referral or hospital admission. The survey also assessed service readiness in facilities 

where services were available. IMCI guidelines were used as the basis for this assessment.

This chapter explores the following issues related to provision of quality child health services at health 

facilities: 

▪ Availability of child health services. Section 4.2, including Tables 4.1 through 4.5 and Figures 4.1

through 4.4, assesses the availability of child health services and of trained staff, equipment, 

guidelines, medicines, vaccines, infection control items, and laboratory diagnostic capacity 

necessary to provide those services. 

▪ Service readiness. Section 4.3, including Table 4.6 and Figures 4.5 and 4.6, addresses the overall 

readiness of facilities to provide quality child health services.

▪ Basic management and administrative systems. Section 4.4, including Tables 4.7 and 4.8 and 

Figure 4.7, summarizes two aspects of management and administrative systems that support quality 

services: personal supervision of and in-service training for providers of child health services.

4.2 AVAILABILITY OF CHILD HEALTH SERVICES

4.2.1 Provision of Outpatient Curative Care, Child Growth Monitoring, Child 

Vaccination, and Nutrition Services

The 2017 BHFS assessed the 

availability of child health services,

including the availability of 

curative care services for sick 

children, child growth monitoring

services, child vaccination services, 

and nutrition services. Table 4.1

and Figure 4.1 provide data on the 

availability of various types of 

basic child health services, and 

Figure 4.2 provides information on 

the availability of the three basic 

health services over time by type of 

facility.

Figure 4.1 Availability of child health services by

type of facility

99 98 99 94 90 96

76

90

80

45

94

75

96

69

7

91

59

87

62

4

District &

upazila public

Union-level

public

CC NGO Private

Percentage of facilities

Outpatient

curative care

for sick children

Growth monitoringChild

vaccination

All three

services
Child Health Services • 57

The percentage of facilities offering outpatient curative care has increased from 93% in 2014 to 98% in 

2017. In private facilities, the availability of these services has increased by 22 percentage points from 

68% in 2014 to 90% in 2017. With the exception of union subcenters/rural dispensaries (USC/RDs), more 

than 70% of public and nongovernmental (NGO) facilities provide child growth monitoring services, while 

fewer than half of private facilities (45%) offer these services. Child vaccination services are available in 

approximately 9 in 10 of all facilities. However only 7% of private facilities offer this service Ninety-three 

percent of facilities provide child nutrition services (BHFS 2014, Table 4.1, and Figure 4.1).

Seventy-seven percent of facilities 

provide all three basic child health 

services (outpatient curative care, 

growth monitoring, vaccination), 

shows an increase from 52% in 

2014. However, only 59% of 

union-level public facilities and 

62% of NGO facilities offer all 

three services. Moreover, only 4%

of private facilities provide the 

three services, a decline from 9% in 

2014. Around three in four facilities 

provide nutrition services in 

addition to these three basic 

services (Table 4.1 and Figure 

4.1).

Urban facilities are less likely than rural facilities to provide child health services. This is probably because 

urban areas have large numbers of private facilities, where service availability is low.

The 2017 BHFS results show that child health services are not well integrated. For example, although 90%

of private facilities provide outpatient curative care and 45% provide growth monitoring services, only 7%

provide immunization services. This results in a very low overall level of availability (4%) of the three 

child health services together. Lack of integration is also very high in union-level public facilities: 98%

provide outpatient curative care for sick children, 76% growth monitoring services, 75% immunization 

services, and only 59% provide all three services in combination (Table 4.1).

4.2.2 Vitamin A Supplementation and Deworming

The 2017 BHFS results show that vitamin A supplementation for children is available in only 61% (38%

excluding public community clinics [CCs]) of health facilities in Bangladesh. District and upazila public 

facilities (66%) and CCs (72%) are more likely to provide vitamin A supplementation than union-level 

public facilities (31%), private hospitals (45%), and NGO facilities (56%) (Table 4.1). Since 2014, the 

availability of vitamin A supplementation has declined in all types of facilities other than private facilities. 

In private facilities, availability of vitamin A supplementation increased by 8 percentage points between 

2014 and 2017 (from 37% to 45%).

Except for private facilities (72%), deworming services are widely available across the different types of 

facilities (with a range of 90% in NOG facilities to 98% in district and upazila public facilities).

4.2.3 Availability of Guidelines, Basic Equipment, and Trained Staff for Child 

Curative Care

Facilities providing curative care for sick children should have basic equipment, necessary medicines, and 

trained staff to provide quality services. The 2017 BHFS examined the availability of these components. 

Figure 4.2 Availability of three basic child

health services

52

69

47

78

51

35

54 51

9

77

90

62

98

61 54

87

62

4

Total

facilities

District

hospital

MCWC UHC UHFWC USC/RD CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)

Note: The three basic child health services are outpatient curative care for sick 

children, child growth monitoring, and child vaccination.
58 • Child Health Services

Table 4.2 summarizes information on the availability of relevant guidelines and basic equipment for sick 

child care at facilities providing outpatient curative care for children.

Only 4 in 10 of facilities have guidelines for IMCI and growth monitoring, with wide variation in 

availability across facilities. Seven in 10 district hospitals (DHs), 6 in 10 upazila health complexes (UHCs) 

and NGO facilities, and 4 in 10 union-level public facilities have IMCI guidelines, as compared with only 

3% of private facilities. NGO facilities (62%) are most likely to have growth monitoring guidelines,

followed by district and upazila public facilities (49%). Only one in four union-level public facilities have 

growth monitoring guidelines, and private facilities are least likely to have these guidelines (8%) (Table 

4.2).

There are gaps in the availability of 

basic equipment needed for care of 

sick children (Table 4.2 and Figure 

4.3). Thermometers (90%) and 

stethoscopes (95%) are widely 

available across facilities. A 

functioning length or height board 

was available in 77% (60%

excluding CCs) of facilities on the 

day of the survey. A child scale is 

available in fewer than half of 

facilities overall; however, three 

quarters of district and upazila

public facilities, NGO facilities, 

and private facilities have a child 

scale. Only 38% of facilities have 

all four items available. Unionlevel public faculties (28%), CCs 

(39%) and private facilities (40%) are less likely to have all four items as compared to other type of 

facilities. Among other necessary items, 47% of facilities have child scales, 65% have growth charts, 61% 

have tape for measuring mid-upper arm circumference (MUAC), and 53% have timers.

In-service training on IMCI and growth monitoring is important for the provision of quality child health 

services. The 2017 BHFS results show that around half of facilities that provide curative care for sick 

children have at least one provider who has ever been trained in IMCI or growth monitoring. However, the 

percentage of facilities that have a staff member with recent training (in the past 24 months) in IMCI and 

growth monitoring is much lower (21% and 26%, respectively) (Table 4.3). Private hospitals are least 

likely (about 20%) to have a provider trained in IMCI or growth monitoring. The percentage of facilities 

with a provider ever been trained in IMCI did not change between 2014 and 2017.

4.2.4 Availability of Medicines and Commodities for Sick Child Care

A range of medicines and commodities are essential to provide curative care for sick children. Both WHO 

and USAID have proposed a set of essential and priority medicines and commodities that facilities should 

have available to support provision of health services for sick children (WHO 2013). Overall, essential 

medicines are in better supply than priority medicines in Bangladesh’s health facilities that offer curative 

care for sick children (Table 4.4). Among the essential medicines, a majority of facilities had 

mebendazole/albendazole (92%) paracetamol (syrup or suspension) (84%), amoxicillin (syrup, suspension, 

or dispersible) (74%), and zinc tablets (69%) in stock on the day of the survey visit. About half of facilities 

had cotrimoxazole (syrup, suspension, or dispersible) and vitamin A capsules. Only one third of facilities 

had all six essential medicines available on the day of the survey visit, this shows a decrease from 42% in 

Figure 4.3 Availability of all four equipment items

for outpatient curative care for sick children,

by facility type

42

79

66 64

40

27

41

66

44 38

73

51

69

30 24

39

66

40

Total

facilities

District

hospital

MCWC UHC UHFWC USC/RD CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,433)

BHFS 2017

(N=1,495)

Note: The four equipment items are a child scale, a length or height board, a 

thermometer, and a stethoscope.
Child Health Services • 59

2014. CCs (44%), NGO facilities (25%), and private facilities (31%) were more likely to have the six 

essential medicines than union-level public facilities (4%).

District and upazila public facilities with amoxicillin dropped from 80% in 2014 to 59% in 2017, during 

the period cotrimoxazole syrup from 74% to 44%, and with vitamin A capsules decreased from 60% to 

41%. Similar reductions were observed in union-level public facilities.

In terms of priority medicines, 7% of district and upazila public facilities had ampicillin powder for 

injection, 43% had ceftriaxone powder for injection, 34% had gentamycin for injection, and 8% had 

benzathine benzylpenicillin for injection. The availability of these priority medicines is relatively higher in 

private facilities. For the most part, these medicines are not available in union-level public facilities and 

CCs.

4.2.5 Infection Control in Sick Child Services

Infection control is one of the most essential health service components. Table 4.5 summarizes 

information related to the availability of necessary infection control items, including hand cleaning

materials, gloves, and means for disposing of sharps and infectious waste. Six in 10 facilities that provide 

curative care services for sick children had some means for hand cleaning—either both soap and running 

water or alcohol-based hand disinfectant—on the day of the survey visit NGO facilities (95%) were most 

likely to have hand cleaning items, followed by private facilities (89%) and district and upazila public 

facilities (78%). Seventy-eight percent of facilities had latex gloves, and 64% had sharps containers; only 

one-third had waste receptacles. 

The availability of all six infection 

control items (soap, running water, 

alcohol-based disinfectant, latex 

gloves, sharps container, and waste 

receptacle) on the day of survey 

visit was very low, at 7% (a 

decrease from 14% in 2014)

(Figure 4.4).

4.2.6 Laboratory 

Diagnostic Capacity

The 2017 BFHS gathered 

information on two laboratory tests 

that are particularly important in 

diagnosing conditions among 

children: hemoglobin testing and 

stool microscopy. Table 4.5 shows that hemoglobin tests and stool microscopy are limited in Bangladesh’s

facilities, only 17% offer hemoglobin tests and 3% stool microscopy. However, some facilities, including 

mother and child welfare centers (MCWCs), union-level public facilities, and CCs are not designed to 

conduct stool microscopy.

Hemoglobin testing is available in most private sector hospitals (83%) as well as in three quarters of public 

and NGO facilities. Stool microscopy on the other hand is more available in private hospitals only.

Although still very low, the availability of hemoglobin testing has increased from 8% to 14% in unionlevel facilities and from 4% to 9% in CCs during the last 3 years; while it has decreased from 97% to 87%

in district hospitals.

The availability of stool microscopy has dropped from 73% in 2014 to 55% in 2017 in district hospitals 

and from 43% to 34% in upazila health complexes during the same period. Since 2014, the availability of 

Figure 4.4 Availability of all six infection control items 

for child curative care, by facility type

14

32 34 31

11 8 12

42 39

7

31

22 16

5 6 4

42

32

Total

facilities

District

hospital

MCWC UHC UHFWC USC/RD CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,433)

BHFS 2017

(N=1,495)

Note: The six infection control items are soap, running water, alcohol-based 

disinfectant, latex gloves, sharps container, and waste receptacle.
60 • Child Health Services

stool microscopy has increased in NGO facilities and decreased in private facilities (BHFS 2014 and 

Table 4.5).

4.3 READINESS OF HEALTH FACILITIES TO PROVIDE CHILD CURATIVE CARE

WHO has identified specific tracer indicators or items that facilities must have to be considered ready to 

provide child curative care. The 2017 BFHS used 10 items from the list of WHO tracer indicators to assess 

the overall readiness of Bangladesh facilities to provide child curative care (WHO 2013):

▪ IMCI guidelines: National or other guidelines on IMCI available at facility.

▪ IMCI trained staff: At least one provider received in-service training on at least some components of 

IMCI.1

▪ Equipment: Child scale, thermometer, and growth chart.

▪ Medicines: Oral rehydration solution (ORS), zinc tablets or syrup, amoxicillin (syrup, suspension, or 

dispersible), paracetamol syrup or suspension, and mebendazole/albendazole.

Information on the availability of 

these 10 items at health facilities 

providing child curative care is 

presented in Table 4.6, Figure 4.5,

and Figure 4.6. Overall, only 5% 

(3% excluding CCs) of facilities 

have all 10 items, indicating a lack 

of a systems approach in the 

provision of sick children’s curative 

care. Only 1 in 10 district and 

upazila public facilities, and NGO 

facilities have all 10 items.

1 This indicator differs from the WHO recommendation of at least one service provider with in-service training on IMCI 

in the last 24 months.

Figure 4.5 Readiness of health facilities to provide 

child curative care, by facility type

9

23

8

26

4

6

10

17

3

5 5

1

14

2 1

6

9

<1

Total

facilities

District

hospital

MCWC UHC UHFWC USC/RD CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,433)

BHFS 2017

(N=1,495)
Child Health Services • 61

The five essential medicines

required for a facility to be ready to 

provide sick child curative care 

were widely available across 

facilities on the day of the survey 

visit, ranging from 69% of facilities 

with zinc tablets or syrup to 92% 

with mebendazole or albendazole

(Table 4.4 and Figure 4.6).

Overall readiness declined 

substantially in all types of 

facilities between 2014 and 2017. 

(BHFS 2014 and Figure 4.5).

4.4 BASIC MANAGEMENT 

AND ADMINISTRATIVE 

SYSTEMS

4.4.1 Personal Supervision 

and Training

Training and supervision are essential management functions in building capacity and ensuring quality of 

services. Periodic in-service training keeps providers up-to-date and helps to refresh their knowledge and 

skills. Regular supervision is also an important source to support and direct. Table 4.7 provides 

information on recent training related to child health as well as information on personal supervision.

Around one-third (one-fourth excluding providers from CCs) of interviewed providers of child health 

services reported receiving in-service training related to child curative care in the 24 months before the 

assessment (Table 4.7). Providers from CCs (45%) were more likely to have received child care related 

training than providers from other public facilities and NGO facilities; few of the private hospital providers 

received child care related training in the 24 months preceding the survey (12%).

Supervision of child health care providers is common throughout health care facilities in Bangladesh; 94%

of providers reported receiving personal supervision in the last 6 months (Table 4.7).

Only 32% (22% excluding providers from CCs) of providers of child health services had recently received 

both personal supervision and in-service training. Providers from CCs were most likely to have received

recent personal supervision and in-service training (43%). Less than a quarter of providers in other public 

and NGO facilities reported that they received recent supervision and training, and only 12% of providers 

in private facilities received supervision and training.

Figure 4.6 Availability of items (tracer indicators)

in health facilities for readiness to provide child 

curative care

92

84

74

69

81

65

90

47

56

42

88

86

81

66

79

44

94

61

54

51

Mebendazole/albendazole

Paracetamol

Amoxicillin

Zinc tablets or syrup

ORS

Growth chart

Thermometer

Child scale

IMCI trained staff

IMCI guidelines

Percentage of facilities

BHFS 2014

(N=1,433)

BHFS 2017

(N=1,495)
62 • Child Health Services

4.4.2 In-service Training by Topic

Providers of child health services 

were asked about in-service 

training on specific topics related to 

child health. Table 4.8 shows that 

only 3 in 10 providers have ever 

received training on different child 

health topics including diarrhea 

diagnosis or treatment, IMCI, acute 

respiratory infection (ARI), and the 

Expanded Program on 

Immunization (EPI) or cold chain. 

However, only 10% had received 

training on these topics in the 24 

months preceding the survey.

The percentage of providers 

reporting that they received 

necessary training on child health in the 24 months preceding the survey, including training on IMCI, ARI,

diarrhea diagnosis/treatment, and EPI/cold chain, has declined since 2014 (Figure 4.7).

LIST OF TABLES

▪ Table 4.1 Availability of child health services

▪ Table 4.2 Guidelines and equipment for child curative care services

▪ Table 4.3 Trained staff for child curative care services

▪ Table 4.4 Availability of essential and priority medicines and commodities

▪ Table 4.5 Infection control and laboratory diagnostic capacity

▪ Table 4.6 Readiness of health facilities to provide child curative care services

▪ Table 4.7 Supportive management for providers of child health services

▪ Table 4.8 Training for child health service providers

Figure 4.7 Provider training on topics related to

child health in the last 24 months

16

21

14

20

12 14

9

13

EPI/cold chain IMCI ARI Diarrhea

diagnosis or

treatment

Percentage of facilities

BHFS 2014

(N=3,385)

BHFS 2017

(N=4,204)
Child Health Services • 63

Table 4.1 Availability of child health services

Among all facilities, the percentages offering specific child health services at the facility, by background characteristics, Bangladesh HFS 2017

Background 

characteristic

Percentage of facilities that offer:

Number of 

facilities

Outpatient 

curative 

care for sick 

children

Growth 

monitoring

Child 

vaccination1

Diagnosis

of and/or 

treatment 

for child 

nutrition

All 3 basic 

child health 

services2

All 4 basic 

child health 

services3

Routine 

vitamin A 

supplement

ation

Deworming 

for children

Facility type

District and upazila 

public facilities 99.0 96.3 93.9 95.6 91.2 88.5 65.7 97.8 44

DH 100.0 96.8 93.5 96.8 90.3 87.1 69.4 100.0 5

MCWC 97.8 86.6 73.5 92.1 62.3 61.1 40.0 97.8 7

UHC 99.1 98.3 98.4 96.2 97.5 94.6 70.8 97.5 32

Union-level public 

facilities 97.7 76.3 74.8 91.7 58.6 55.9 31.2 91.9 361

UHFWC 97.0 81.8 73.7 93.4 60.5 58.7 33.4 92.7 250

USC/RD 99.3 63.9 77.2 87.8 54.4 49.5 26.2 90.3 111

Community clinic 

(CC) 98.8 90.1 95.8 94.9 86.8 83.3 72.1 95.0 1,012

NGO clinic/hospital 94.0 79.9 69.3 89.5 62.4 61.3 56.1 90.1 64

Private hospital 89.9 44.5 6.9 76.3 3.8 3.8 45.1 71.7 43

Location

Urban 92.4 71.5 55.0 84.8 48.9 47.4 55.5 83.7 108

Rural 98.6 86.4 89.6 94.0 79.1 75.8 61.2 94.3 1,416

Division

Barishal 99.3 97.4 89.0 98.3 87.9 87.7 71.7 97.2 113

Chattogram 96.1 74.2 86.8 91.5 67.5 66.4 61.5 93.0 288

Dhaka 98.2 89.3 85.0 93.2 79.3 75.9 63.8 94.2 304

Khulna 99.0 80.0 88.1 98.0 73.5 73.4 49.9 94.1 187

Rajshahi 96.7 88.3 84.5 80.8 77.0 63.1 52.0 87.8 220

Rangpur 99.6 85.7 90.9 98.3 79.5 79.5 65.5 96.3 193

Sylhet 99.7 94.5 83.3 99.4 79.4 79.1 59.8 93.6 96

Mymensingh 99.1 85.6 91.9 96.8 82.2 79.7 67.8 94.6 123

Total 98.1 85.3 87.2 93.4 76.9 73.8 60.8 93.5 1,524

Total excluding CCs 96.7 75.8 70.1 90.5 57.3 55.0 38.4 90.5 512

1 Facility routinely provides DPT/Pentavalent, polio, and measles vaccinations to children.

2 Outpatient curative care for sick children, growth monitoring, and child vaccination

3 Outpatient curative care for sick children, growth monitoring, child vaccination, and diagnosis of and/or treatment for child nutrition
64 • Child Health Services

Table 4.2 Guidelines and equipment for child curative care services

Among facilities that offer outpatient curative care for sick children, the percentages having indicated guidelines and equipment, by background characteristics, 

Bangladesh HFS 2017

Background 

characteristic

Guidelines Equipment

Number of 

facilities 

offering 

outpatient 

curative 

care for 

sick 

IMCI children

Growth 

monitoring

Child 

scale1

Length or 

height 

board

ThermometerStethoscopeAll 4 items

available2

Infant 

scale3

Growth 

chart

MUAC 

tape Timer

Facility type

District and upazila 

public facilities 57.9 49.3 74.9 85.2 97.1 99.6 66.3 77.5 75.7 66.3 67.8 44

DH 71.0 45.2 77.4 91.9 95.2 100.0 72.6 79.0 82.3 75.8 75.8 5

MCWC 28.6 41.0 63.7 72.9 88.7 97.8 51.3 70.5 60.2 50.0 64.9 7

UHC 62.2 51.7 77.0 86.9 99.2 100.0 68.5 78.7 78.0 68.4 67.3 32

Union-level public 

facilities 40.4 25.7 45.3 53.4 76.1 96.8 27.9 46.2 50.1 38.8 53.8 353

UHFWC 41.9 27.1 46.6 56.4 76.0 95.7 29.5 48.5 54.4 41.3 53.0 243

USC/RD 36.9 22.5 42.3 47.0 76.4 99.4 24.3 41.0 40.6 33.2 55.7 110

Community clinic 

(CC) 42.2 42.6 44.5 85.1 93.1 94.2 38.8 42.8 71.4 70.6 49.4 1,000

NGO clinic/hospital 56.6 61.7 70.6 89.1 98.8 100.0 66.0 75.8 70.2 64.8 74.4 60

Private hospital 3.4 7.6 75.6 48.5 99.3 100.0 40.2 84.1 16.0 18.5 86.9 39

Location

Urban 41.6 40.8 75.7 73.4 98.2 99.9 59.0 78.5 54.5 49.5 81.9 100

Rural 41.8 38.5 45.4 77.1 89.0 95.0 36.7 44.7 65.8 62.3 50.9 1,396

Division

Barishal 50.3 42.6 42.3 75.7 91.4 94.6 35.7 62.5 73.8 82.7 49.8 112

Chattogram 40.8 38.2 49.7 74.1 86.8 95.2 36.8 50.0 61.8 53.7 48.9 277

Dhaka 43.4 35.4 38.6 70.2 85.3 93.0 28.0 32.1 72.3 46.6 47.0 298

Khulna 48.1 43.6 50.9 81.4 92.5 95.6 45.3 47.2 61.9 62.5 64.1 185

Rajshahi 36.9 32.8 43.4 71.8 94.4 93.6 32.8 37.3 51.8 62.2 51.5 212

Rangpur 38.2 44.5 52.7 85.0 91.3 98.9 46.2 58.9 64.0 66.7 63.1 193

Sylhet 36.1 31.2 64.9 89.2 95.1 100.0 57.9 55.4 66.7 76.8 57.1 96

Mymensingh 41.6 43.1 47.9 80.0 84.6 95.5 38.8 53.5 75.0 72.0 45.5 122

Total 41.8 38.6 47.4 76.9 89.6 95.4 38.2 47.0 65.1 61.4 52.9 1,495

Total excluding CCs 41.0 30.7 53.3 60.2 82.5 97.7 36.8 55.5 52.1 42.8 60.1 495

1 A scale with a gradation of 250 grams, or a digital standing scale with a gradation of 250 grams or less where an adult can hold a child to be weighed

2 Child scale, length or height board, thermometer, and stethoscope

3 A scale with a gradation of 100 grams, or a digital standing scale with a gradation of 100 grams where an adult can hold an infant to be weighed
Child Health Services • 65

Table 4.3 Trained staff for child curative care services

Among facilities that offer outpatient curative care for sick children, the percentages having indicated trained staff, by background 

characteristics, Bangladesh HFS 2017

Background 

characteristic

Trained staff Number of 

facilities offering 

outpatient 

curative care for 

sick children

IMCI1 Growth monitoring2

During the past 

24 months At any time

During the past 

24 months At any time

Facility type

District and upazila public facilities 32.7 75.9 34.7 67.3 44

DH 30.6 71.0 29.0 71.0 5

MCWC 10.1 57.0 16.9 47.9 7

UHC 37.8 80.6 39.4 70.9 32

Union-level public facilities 10.4 51.6 13.7 41.0 353

UHFWC 10.6 54.6 15.1 43.8 243

USC/RD 9.8 44.8 10.5 34.6 110

Community clinic (CC) 25.0 58.8 30.1 52.5 1,000

NGO clinic/hospital 14.3 43.4 25.2 42.7 60

Private hospital 9.2 19.7 13.1 20.7 39

Location

Urban 22.1 47.7 27.1 46.6 100

Rural 20.8 56.6 25.6 49.2 1,396

Division

Barishal 29.3 65.2 35.0 59.2 112

Chattogram 26.1 48.6 27.1 44.4 277

Dhaka 26.4 59.8 26.2 51.0 298

Khulna 21.0 58.2 20.9 44.6 185

Rajshahi 13.6 56.7 28.2 51.6 212

Rangpur 14.5 49.8 10.7 35.3 193

Sylhet 19.2 52.6 38.3 57.2 96

Mymensingh 12.4 62.6 29.8 62.3 122

Total 20.9 56.0 25.7 49.0 1,495

Total excluding CCs 12.7 50.2 16.9 41.9 495

1 At least one provider of child health services in the facility reported receiving in-service training in IMCI. Training refers only to inservice training. The training must have involved structured sessions; it does not include individual instruction that a provider might 

have received during routine supervision.

2 At least one provider of child health services in the facility reported receiving in-service training in growth monitoring. Training refers 

only to in-service training. The training must have involved structured sessions; it does not include individual instruction that a provider 

might have received during routine supervision.
66 • Child Health Services

Table 4.4 Availability of essential and priority medicines and commodities

Among facilities offering outpatient curative care services for sick children, the percentages where indicated essential and priority medicines to support care for th

facility on the day of the survey, by background characteristics, Bangladesh HFS 2017

Background 

characteristic

Essential medicines Pr

ORS

1

Amoxicillin 

syrup, 

suspension,

or dispersible

1

Cotrimoxazole syrup, 

suspension,

or dispersible

Paracetamol 

syrup or 

suspension

1

Vitamin A 

capsules

1

Mebendazole/

albendazole

Zinc tablets 

or syrup

All 6 

essential 

medicines

available

2

Ampicillin 

powder for 

injection

Ceftria

powde

injec

Facility type

District and upazila 

public facilities 84.8 58.8 44.3 75.5 40.8 81.6 60.8 12.9 7.5 43

DH 93.5 58.1 33.9 77.4 33.9 69.4 54.8 11.3 11.3 64

MCWC 31.9 82.9 77.2 81.7 12.5 89.6 33.0 1.1 2.3 23

UHC 94.8 53.8 38.8 73.9 47.8 81.8 67.7 15.6 8.0 44

Union-level public 

facilities 37.2 64.0 60.8 73.0 10.0 85.0 32.7 3.5 0.1 0

UHFWC 25.8 70.4 70.2 76.2 9.6 86.0 28.8 3.7 0.0 0

USC/RD 62.4 50.1 39.9 65.8 11.0 82.9 41.2 3.1 0.1 0

Community clinic (CC) 95.2 79.7 51.5 87.9 61.0 96.6 81.6 44.3 0.0 0

NGO clinic/hospital 93.5 54.9 42.9 79.7 52.7 83.2 81.0 25.3 29.6 34

Private hospital 77.7 51.7 27.4 84.9 51.8 66.6 70.5 31.0 40.3 77

Location

Urban 82.5 54.6 38.1 78.6 53.0 77.3 73.2 24.7 27.8 51

Rural 80.5 75.0 53.5 83.9 47.5 93.1 68.9 33.2 0.6 1

Division

Barishal 83.5 79.6 58.9 89.1 54.1 92.2 76.1 39.1 1.0 4

Chattogram 76.0 78.0 52.0 83.8 41.8 93.6 72.0 29.4 2.5 5

Dhaka 80.0 67.6 40.2 75.8 48.6 86.5 66.5 30.3 5.7 7

Khulna 83.3 64.9 52.8 79.8 44.5 92.8 62.9 33.8 1.8 3

Rajshahi 79.9 75.9 54.9 84.1 50.9 95.5 66.3 35.0 0.7 3

Rangpur 86.8 73.6 68.7 87.7 52.6 94.5 64.5 34.8 1.3 2

Sylhet 79.0 78.2 46.8 89.0 51.4 92.4 75.6 35.9 3.7 5

Mymensingh 79.2 79.4 52.1 91.2 43.1 91.1 79.5 28.4 0.9 3

Total 80.7 73.7 52.5 83.6 47.8 92.1 69.1 32.7 2.5 4

Total excluding CCs 51.4 61.5 54.6 74.9 21.1 83.1 43.9 9.1 7.4 14

Note: The essential medicines comprise the medicines and commodities indicators for assessing readiness to provide preventative and curative child health 

methodology proposed by WHO and USAID (WHO 2012).

ORS = Oral rehydration solution 

1 These medicines and commodities are also in the group of priority medicines for children.

2 ORS, amoxicillin syrup/suspension or dispersible, paracetamol syrup/suspension, vitamin A capsules, mebendazole/albendazole, and zinc tablets or syrup
Child Health Services • 67

Table 4.5 Infection control and laboratory diagnostic capacity

Among facilities offering outpatient curative care services for sick children, the percentages with indicated items for infection control observed to be available at the service site 

on the day of the survey and the percentages with the indicated laboratory diagnostic capacity in the facility, by background characteristics, Bangladesh HFS 2017

Background 

characteristic

Items for infection control

Laboratory 

diagnostic capacity Number of 

facilities 

offering 

outpatient 

curative care 

for sick 

Soap children

Running 

water1

Soap and 

running 

water

Alcoholbased 

hand 

disinfectant

Soap and 

running 

water or else 

alcoholbased hand 

disinfectant

Latex 

gloves2

Sharps 

container

Waste 

receptacle3All 6 items 

available4

At least 4 

items 

available

Hemoglobin5

Stool 

microscopy6

Facility type

District and upazila 

public facilities 73.0 88.5 71.1 48.4 78.4 75.5 70.2 49.7 18.8 66.6 74.7 31.1 44

DH 83.9 91.9 83.9 51.6 88.7 72.6 66.1 64.5 30.6 71.0 87.1 54.8 5

MCWC 76.1 89.9 73.9 41.0 78.5 81.8 75.0 46.6 21.7 68.3 45.4 - 7

UHC 70.7 87.7 68.6 49.6 76.9 74.6 69.8 48.2 16.4 65.6 79.1 33.7 32

Union-level public 

facilities 67.9 71.3 58.8 16.2 62.3 72.7 59.3 34.4 5.3 46.7 14.4 - 353

UHFWC 69.2 71.6 59.0 16.6 62.7 80.7 65.4 35.5 4.9 49.1 18.3 - 243

USC/RD 65.1 70.7 58.5 15.2 61.3 55.0 45.9 31.8 6.2 41.4 5.6 - 110

Community clinic 

(CC) 69.4 60.6 49.6 16.5 54.4 79.1 65.5 28.5 3.5 39.7 9.3 - 1,000

NGO clinic/hospital 95.0 97.5 94.0 72.4 94.5 96.3 82.7 59.2 42.4 88.7 73.0 21.8 60

Private hospital 79.0 89.2 79.0 71.0 89.4 81.1 46.9 70.9 32.1 74.1 82.6 46.5 39

Location

Urban 84.1 91.6 82.2 64.9 88.4 84.7 66.8 66.4 35.8 78.2 80.5 32.3 100

Rural 69.5 64.4 53.0 17.9 57.4 77.7 64.2 30.4 4.6 42.6 12.3 0.9 1,396

Division

Barishal 54.7 59.7 41.9 20.9 46.6 71.8 73.2 48.7 9.8 49.3 17.6 2.0 112

Chattogram 73.1 70.8 59.4 17.8 62.8 82.2 60.7 34.8 4.3 46.0 25.6 5.1 277

Dhaka 74.5 72.7 62.0 23.2 66.1 80.3 64.3 24.3 8.7 47.0 18.6 4.5 298

Khulna 82.0 64.8 59.0 18.5 63.2 78.7 64.5 31.5 4.7 46.1 10.6 2.5 185

Rajshahi 72.5 61.1 51.1 21.1 55.5 81.7 67.2 48.9 7.6 51.1 13.2 2.5 212

Rangpur 76.8 65.4 59.7 21.0 64.3 73.8 57.5 30.3 7.6 45.2 5.6 1.3 193

Sylhet 57.2 66.3 46.6 24.5 53.7 74.7 69.7 23.5 6.2 35.0 31.2 0.9 96

Mymensingh 48.0 57.8 39.2 24.4 45.4 72.5 66.6 20.0 4.4 28.8 14.3 1.3 122

Total 70.4 66.2 55.0 21.0 59.5 78.2 64.4 32.8 6.7 45.0 16.9 3.0 1,495

Total excluding CCs 72.5 77.4 65.7 30.1 69.7 76.4 62.2 41.6 13.1 55.7 32.1 9.0 495

“-” Means facilities do not have provision of stool microscopy test.

Note: The laboratory diagnostic capacity indicator measures presented in the table comprise the diagnostics domain for assessing readiness to provide preventative and 

curative child health services within the health facility assessment methodology proposed by WHO and USAID (WHO 2012). MCWCs, union-level facilities, and CCs do not 

provide stool microscopy tests.

1 Piped water, water in bucket with specially fitted tap, or water in pour pitcher

2 Non-latex equivalent gloves are acceptable.

3 Waste receptacle with plastic bin liner

4 Soap, running water, alcohol-based disinfectant, latex gloves, sharps container, and waste receptacle

5 Facility had functioning equipment and reagents for colorimeter, hemoglobinometer, or HemoCue.

6 Facility had a functioning microscope with glass slides and formal saline (for concentration method) or normal saline (for direct method) or Lugol’s iodine solution.
68 • Child Health Services

Table 4.6 Readiness of health facilities to provide child curative care services

Among facilities that offer outpatient curative care for sick children, the percentages with IMCI guidelines, staff trained in IMCI, basic equipment, and essential 

medicines available on the day of the survey, and the percentage with all items, by background characteristics, Bangladesh HFS 2017

Background 

characteristic

IMCI 

guidelines

Staff 

trained in 

IMCI (at 

any time)1

Child 

scale2

ThermometerGrowth 

chart

Zinc 

tablets or 

syrup ORS

Amoxicillin 

syrup, 

suspension, or 

dispersible

Paracetamol 

syrup or 

suspension

Mebendazole/

albendazole

All 10 

items

available

Number of 

facilities 

offering 

outpatient 

curative 

care for 

sick 

children

Facility type

District and upazila 

public facilities 57.9 75.9 74.9 97.1 75.7 60.8 84.8 58.8 75.5 81.6 11.1 44

DH 71.0 71.0 77.4 95.2 82.3 54.8 93.5 58.1 77.4 69.4 4.8 5

MCWC 28.6 57.0 63.7 88.7 60.2 33.0 31.9 82.9 81.7 89.6 1.2 7

UHC 62.2 80.6 77.0 99.2 78.0 67.7 94.8 53.8 73.9 81.8 14.1 32

Union-level public 

facilities 40.4 51.6 45.3 76.1 50.1 32.7 37.2 64.0 73.0 85.0 1.3 353

UHFWC 41.9 54.6 46.6 76.0 54.4 28.8 25.8 70.4 76.2 86.0 1.6 243

USC/RD 36.9 44.8 42.3 76.4 40.6 41.2 62.4 50.1 65.8 82.9 0.8 110

Community clinic 

(CC) 42.2 58.8 44.5 93.1 71.4 81.6 95.2 79.7 87.9 96.6 6.2 1,000

NGO clinic/hospital 56.6 43.4 70.6 98.8 70.2 81.0 93.5 54.9 79.7 83.2 9.0 60

Private hospital 3.4 19.7 75.6 99.3 16.0 70.5 77.7 51.7 84.9 66.6 0.2 39

Location

Urban 41.6 47.7 75.7 98.2 54.5 73.2 82.5 54.6 78.6 77.3 6.9 100

Rural 41.8 56.6 45.4 89.0 65.8 68.9 80.5 75.0 83.9 93.1 5.0 1,396

Division

Barishal 50.3 65.2 42.3 91.4 73.8 76.1 83.5 79.6 89.1 92.2 9.9 112

Chattogram 40.8 48.6 49.7 86.8 61.8 72.0 76.0 78.0 83.8 93.6 5.2 277

Dhaka 43.4 59.8 38.6 85.3 72.3 66.5 80.0 67.6 75.8 86.5 2.0 298

Khulna 48.1 58.2 50.9 92.5 61.9 62.9 83.3 64.9 79.8 92.8 7.6 185

Rajshahi 36.9 56.7 43.4 94.4 51.8 66.3 79.9 75.9 84.1 95.5 5.7 212

Rangpur 38.2 49.8 52.7 91.3 64.0 64.5 86.8 73.6 87.7 94.5 5.7 193

Sylhet 36.1 52.6 64.9 95.1 66.7 75.6 79.0 78.2 89.0 92.4 1.1 96

Mymensingh 41.6 62.6 47.9 84.6 75.0 79.5 79.2 79.4 91.2 91.1 6.3 122

Total 41.8 56.0 47.4 89.6 65.1 69.1 80.7 73.7 83.6 92.1 5.2 1,495

Total excluding CCs 41.0 50.2 53.3 82.5 52.1 43.9 51.4 61.5 74.9 83.1 3.0 495

ORS = Oral rehydration solution

1 At least one provider of child health services in the facility reported receiving in-service training in IMCI. Training refers only to in-service training. The training must 

have involved structured sessions; it does not include individual instruction that a provider might have received during routine supervision.

2 A scale with a gradation of 250 grams, or a digital standing scale with a gradation of 250 grams or less where an adult can hold a child to be weighed
Child Health Services • 69

Table 4.7 Supportive management for providers of child health services

Among interviewed child health service providers, the percentage who report receiving training related to their work and 

personal supervision during the specified time periods, by background characteristics, Bangladesh HFS 2017

Percentage of interviewed providers who received:

Number of 

interviewed child 

health service 

providers

Background 

characteristic

Training related to 

child health during 

the 24 months 

preceding the survey1

Personal supervision 

during the 6 months 

preceding the survey2

Training related to 

child health during 

the 24 months and 

personal supervision 

during the 6 months 

preceding the survey

Facility type

District and upazila public 

facilities 23.8 96.6 22.9 823

DH 22.2 96.5 21.8 192

MCWC 23.9 95.6 21.9 39

UHC 24.2 96.7 23.4 592

Union-level public facilities 25.6 90.3 22.4 777

UHFWC 25.7 92.5 22.6 552

USC/RD 25.3 84.7 22.2 225

Community clinic (CC) 44.8 95.7 43.3 2,093

NGO clinic/hospital 24.5 97.1 24.4 251

Private hospital 12.3 81.8 11.8 262

Location

Urban 22.7 94.0 22.3 958

Rural 37.2 94.1 35.3 3,246

Division

Barishal 43.2 95.2 40.7 309

Chattogram 30.3 88.7 28.6 727

Dhaka 35.1 93.8 33.9 975

Khulna 28.8 97.1 27.8 544

Rajshahi 36.6 96.2 34.7 561

Rangpur 25.2 96.1 24.8 507

Sylhet 45.9 89.8 40.4 267

Mymensingh 37.5 97.8 37.1 314

Total 33.9 94.1 32.4 4,204

Total excluding CCs 23.1 92.5 21.5 2,112

1 Training refers only to in-service training. The training must have involved structured sessions; it does not include individual 

instruction that a provider might have received during routine supervision.

2 Personal supervision refers to any form of technical support or supervision from a facility-based supervisor or from a visiting 

supervisor. It may include, but is not limited to, review of records and observation of work, with or without any feedback to the 

health worker.
70 • Child Health Services

Table 4.8 Training for child health service providers

Among interviewed child health service providers, the percentages who report receiving in-service training on topics related to child health during 

the specified period before the survey, by background characteristics, Bangladesh HFS 2017

Percentage of providers of child health services who reported that they received in-service training on:

Number of 

interviewed 

child health 

service 

providers

EPI/cold chain IMCI ARI

Diarrhoea diagnosis or 

treatment

Background 

characteristic

During the 

past 

24 months At any time

During the 

past 

24 months At any time

During the 

past 

24 months At any time

During the 

past 

24 months At any time

Facility type

District and upazila 

public facilities 6.5 22.9 7.9 33.1 5.8 26.0 6.2 27.6 823

DH 6.4 26.3 6.8 32.3 5.1 27.0 6.0 27.8 192

MCWC 3.8 24.2 4.6 28.2 5.0 27.0 3.9 28.1 39

UHC 6.7 21.8 8.5 33.7 6.1 25.6 6.4 27.5 592

Union-level public 

facilities 7.3 34.2 8.2 43.8 5.0 37.9 5.7 39.6 777

UHFWC 7.3 35.8 8.3 45.9 5.0 39.3 5.8 41.2 552

USC/RD 7.1 30.3 7.9 38.7 4.8 34.7 5.3 35.8 225

Community clinic 

(CC) 16.5 45.1 20.0 53.2 11.8 35.7 19.9 51.1 2,093

NGO clinic/hospital 8.9 23.7 5.9 20.1 6.2 21.0 8.8 25.8 251

Private hospital 5.1 8.8 2.9 8.1 3.6 7.7 8.3 14.0 262

Location

Urban 7.9 21.8 7.7 25.2 5.9 21.0 7.7 25.2 958

Rural 12.8 39.2 15.3 47.9 9.3 34.7 14.8 45.1 3,246

Division

Barishal 10.2 36.4 18.7 53.0 11.7 42.1 15.6 46.5 309

Chattogram 10.8 24.6 16.8 37.0 12.9 29.4 12.0 31.9 727

Dhaka 10.8 36.8 15.0 39.4 4.6 23.3 11.2 34.2 975

Khulna 10.5 31.9 12.0 43.0 6.2 28.1 11.5 40.0 544

Rajshahi 13.6 41.7 10.8 46.2 9.4 42.2 17.4 54.7 561

Rangpur 8.3 33.5 9.7 40.9 7.1 30.6 8.6 39.4 507

Sylhet 26.5 48.5 15.3 45.2 12.0 29.7 15.5 39.0 267

Mymensingh 9.3 39.6 8.8 50.4 9.0 42.4 21.0 53.6 314

Total 11.7 35.2 13.6 42.7 8.5 31.6 13.2 40.6 4,204

Total excluding CCs 6.9 25.4 7.2 32.4 5.3 27.5 6.6 30.1 2,112

EPI = Expanded Program on Immunization 

IMCI = Integrated management of childhood illness 

ARI = Acute respiratory infection
Family Planning Services • 71

FAMILY PLANNING SERVICES 5

Key Findings

▪ Eighty-six percent of health facilities provide modern 

family planning (FP) services. The proportion of facilities 

offering family planning methods has increased from 78% 

in 2014 to 86% in 2017 (Table 5.2 and Figure 5.1).

▪ Although the availability of modern FP methods in district 

hospitals (DHs) and private clinics has increased notably 

since 2014, 31% of DHs and 75% of private facilities still 

do not provide family planning methods (Figure 5.2).

▪ Only one quarter of facilities provide long-acting reversible 

contraceptives or permanent methods (LARC/PMs), and 

few provide male or female sterilization. Over the past 3 

years, however, the availability of LARC/PMs has 

increased substantially at all types of facilities other than 

community clinics (Table 5.2 and Figures 5.3 and 5.4).

▪ Family planning methods were in stock at 78% of facilities 

on the day of the survey, a decrease from the figure 

reported in 2014 (87%) (Table 5.5 and Figure 5.5).

▪ Nearly half of facilities had FP guidelines at the service 

site. Overall, the availability of FP guidelines has 

decreased slightly from 54% in 2014 to 49 % in 2017

(Table 5.8 and Figure 5.7).

▪ Over half (56%) of the facilities offering FP had staff who 

received in-service FP training at any time before the 

survey. The proportion of facilities with trained staff has 

changed only minimally since 2014 (Table 5.8 and Figure 

5.8).

▪ The availability of injectables was much lower in 2017 

(61%) than in 2014 (79%) (Table 5.8 and Figure 5.10).

▪ Only 22% of facilities are at a level of readiness to provide 

FP services. The readiness to provide FP services 

increased substantially among UHCs, UHFWCs and 

NGOs between 2014 and 2017, but overall readiness

among all facilities has declined slightly from 25% to 22% 

during the same period (Table 5.8 and Figure 5.13).

▪ The percentage of facilities with four specified infection 

control items available has increased from 40% in 2014 to

47% in 2017 (Table 5.7 and Figure 5.6).

5.1 BACKGROUND

amily planning (FP) is important for the health of a mother and her children, as well as the family’s 

economic situation. FP comprises a group of activities that permit couples to decide freely on the 

spacing and number of their children. FP improves the health of mothers, children, and entire 

families and 

F

is a key element in upholding reproductive rights. Therefore, wherever maternal health, 
72 • Family Planning Services

reproductive health, or child health services are provided, facilities should strive to increase the appropriate 

use of FP and contraceptive services and to provide client education.

The Government of Bangladesh has a National Population Policy (MOHFW 2012) that seeks to reduce 

fertility to replacement level, and the 4th Health, Population and Nutrition Sector Development Program 

(HPNSP) has embraced strategies for making FP services available, accessible, acceptable, and affordable 

for all women and men of reproductive age at public, private, and nongovernmental (NGO) health 

facilities. The HPNSP strategies strive to increase overall use of FP to 75% by 2022 (MOHFW 2012).

Over the past four decades, Bangladesh has made remarkable progress in increasing the utilization of 

modern family planning methods among currently married women. According to the 2017 Bangladesh 

Demographic and Health Survey (BDHS), the contraceptive prevalence rate (CPR) increased from 56% to 

62% between 2007 and 2017.

Use of modern contraceptive methods has increased by 4 percentage points since 2007, from 48% to 52%. 

However, use of modern methods declined from 54% to 52% between 2014 and 2017, mainly due to a 

decline in use of oral pills and injectables. The pill is by far the most widely used method (25%), followed 

by injectables (11%). Nine percent of currently married women use a long-acting or permanent method 

such as female or male sterilization, implants, or intrauterine contraceptive devices (IUCDs). Ten percent 

of women use traditional methods, primarily the rhythm method (periodic abstinence). The 4th HPNSP 

aims to reach 50% use of modern methods in Sylhet and Chattogram by 2022. Since 2014, use of modern 

methods in Sylhet has increased from 41% to 45%; however, there has been a slight decline in Chattogram,

from 47% to 45% (NIPORT et al. 2014; NIPORT et al. 2017). The 4th HPNSP aims to reach a CPR of 

75% by 2022.

▪ Availability of FP services. Section 5.2, including Tables 5.1 through 5.5 and Figures 5.1 through 

5.5, examines the availability of FP services. FP services are considered available if a facility provides 

FP methods to clients at the facility, prescribes methods that the client must obtain elsewhere, or 

counsels about FP.

▪ Availability of guidelines, trained staff, equipment, and infection control items. Sections 5.2.5 

and 5.2.6, including Tables 5.6 and 5.7 and Figure 5.6, address the extent to which facilities that offer 

FP family services have the capacity to support quality services, including the necessary service 

guidelines, trained staff, equipment, and infection control materials.

▪ Readiness of health facilities to provide FP services. Section 5.2.7, including Table 5.8 and 

Figures 5.13, describes the readiness of health facilities to offer FP services using the WHO-specified 

items or tracer indicators that facilities must have to be considered ready to offer such services.

▪ Basic management and administrative systems. Sections 5.3, including Tables 5.9 and 5.10,

evaluate aspects of training and supervision that are important to support the delivery of high-quality 

FP services.

5.2 FAMILY PLANNING SERVICES

Family planning (FP) methods differ in how they function and in their effectiveness, side effects, and 

mode of use. The acceptability and desirability of FP methods also differ among users. Thus, a facility that 

offers a wide variety of FP methods is best able to meet client needs. Although a broad mix of methods is 

optimal, facilities are expected to differ in the exact mix of methods they offer because of differences in 

provider qualifications, training, and the infrastructure required to provide certain methods safely. Methods 

that can be offered safely with minimal training are pills, injectables, and condoms, along with counseling 

on FP methods. Safely offering implants, IUCDs, female sterilization, and male sterilization requires a 

higher level of skill and a more developed infrastructure.
Family Planning Services • 73

The 2017 BHFS obtained information on the availability of family planning services (modern FP methods, 

longer-acting permanent methods [LAPMs], and male or female sterilization) at each of the public, private, 

and NGO health facilities in the survey sample. This section of the report uses the following definitions in 

assessing the availability of FP services:

▪ A facility is considered to offer FP services if the facility reports that it provides a specified FP 

method, prescribes the method for clients to obtain elsewhere, or counsels clients on the method. 

Facilities in this category do not necessarily provide FP methods to clients.

▪ A facility is said to provide FP services if the facility reports that it stocks a specific method and 

makes it available to clients when they visit the facility. Facilities in this category provide FP methods

to clients.

5.2.1 Availability of Family Planning Services

Table 5.1 shows the availability of 

FP services at facilities that provide

a method, prescribe the method for 

clients to obtain elsewhere, or 

counsel clients on the method (i.e., 

facilities that do not necessarily 

provide an FP method to the client).

The findings show that about 9 in 

10 of all health facilities offer FP 

services for modern methods. 

Mother and child welfare centers 

(MCWCs) (99%), union health and 

family welfare centers (UHFWCs) 

(98%), upazila health complexes 

(UHCs) (95%), community clinics

(CCs) (91%), and NGO 

clinics/hospitals (86%) are more likely than private hospitals (53%) and district hospitals (DHs) (79%) to 

provide these services.

Fifty percent (75% excluding CCs) of facilities offer long-acting and permanent methods. Almost all 

MCWCs (98%), UHCs (95%) and UHFWC (98% in both cases), offer long-acting permanent methods.

While private hospitals (48%) and union subcenters/rural dispensaries (USC/RDs) (52%) are least likely to 

offer long-acting permanent methods.

Thirty-one percent (38% excluding CCs) of health facilities offer male or female sterilization. UHCs 

(85%) and MCWCs (81%) are more likely to offer male and female sterilization than private hospitals 

(45%) and NGO clinics/hospitals (42%).

The Directorate General of Family Planning has emphasized strengthening postpartum family planning 

(PPFP) services, and the 2017 survey was the first BHFS to assess the percentage of facilities offering 

these services. Table 5.1 shows that 91% (86% excluding CCs) of facilities offer PPFP services. More 

than 90% of MCWCs, UHCs, UHFWCs, CCs, and NGO clinics offer postpartum family services; private 

hospitals (44%) are least likely to offer these services.

There have been only minimal increases since 2014 in the percentages of facilities offering long-acting and 

permanent methods (from 48% to 50%) and male or female sterilization (from 29% to 31%). However, the 

availability of any modern FP method (including emergency contraceptives) has increased from 81% in 

2014 to 89% in 2017 (Table 5.1).

Figure 5.1 Facilities providing modern FP methods

and services, by method

78

28

5

86

26

4

Any modern FP method Any LARC/PM Male and female

sterilization

Percentage of facilities

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)
74 • Family Planning Services

5.2.2 Facilities Providing Modern Family Planning Methods and Services

This section describes the extent to which modern FP methods are provided at different types of facilities.

More than 8 in 10 facilities (86%) provide at least one modern FP method (Table 5.2, Figure 5.2).

Figure 5.2 Facilities providing modern FP methods

and services, by facility type

Results from Table 5.2 show that one quarter of facilities in Bangladesh provide long-acting reversible 

contraceptives or permanent methods (LARC/PMs), that is, IUCDs, implants, and male or female 

sterilization (Table 5.2). Although there was a slight overall decline in the availability of LARC/PMs 

between 2014 (31%) and 2017 (26%), the availability of these methods increased among all of the 

individual types of facilities other than CCs (Figure 5.3).

Figure 5.3 Facilities providing LARC/PMs, by facility type

Results from Table 5.2 also show that less than 5% of all facilities provide male or female sterilization 

Since 2014, there have been notable increases in the availability of sterilization in DHs (from 34% to 47%) 

and MCWCs (from 57% to 71%). The availability of sterilization has also increased notably in private 

facilities, although the proportion of such facilities providing this service is still quite low (Figure 5.4).

78

58

97 98

90

59

77

84

14

86

69

99 95 97

64

89 83

25

Total

facilities

DH MCWC UHC UHFWC USC/RD CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)

31

60 55

89 93

68

40

16

66

14

26

69 66

96 95

84

46

4

69

19

Total

facilities

Total

facilities

excluding

CCs

DH MCWC UHC UHFWC USC/RD CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)
Family Planning Services • 75

Figure 5.4 Facilities providing male or female sterilization services, 

by facility type

The percentages of facilities offering modern FP methods slightly increased from 2014 to 2017 (Figure 

5.1), with the availability of these methods rising by more than 10 percentage points at DHs, CCs, and 

private facilities.

Table 5.3 shows that combined or progestin-only oral pills and male condoms (85% each) are the most 

commonly provided temporary modern FP methods. The availability of oral pills and male condoms has 

increased since 2014. More than 60% of facilities provide progestin-only injectables, a proportion similar 

to that in 2014. MCWCs, UHCs, and UHFWCs are more likely to provide these three FP methods than 

other facilities while private hospitals are the least likely to provide these methods.

One-fourth of all facilities provide IUCDs, and a negligible proportion (6%) offer one- or two-rod 

implants. There are no notable differences between 2014 and 2017 in the percentages of facilities 

providing IUCDs and implants.

5.2.3 Frequency of Availability of Family Planning Services

The 2017 BHFS collected information on the frequency of availability of FP services to determine whether 

facilities provide services regularly to meet clients’ needs. Nearly 80% of all facilities reported that they 

provide family planning services every day. Almost all district and upazila public facilities (96%), NGO 

clinics (99%), and private hospitals (99%) that offer family planning services provide these services every 

day (Table 5.4). However, relatively small proportions of union-level facilities (72%) and community 

clinics (78%) offer FP services every day. The percentage of facilities offering services every day has 

increased slightly since 2014 (from 75% to 79%). Frequency of service availability varies by location. 

Urban facilities (98%) are more likely to provide FP services every day than rural facilities (77%). By 

division, the proportion of facilities offering FP services every day varies from 63% in Mymensingh to 

93% in Barishal (Table 5.4).

5

12

64

34

57

70

21

4 6

13

67

47

71 70

11

18

All facilities Total

facilities

excluding

CCs

District &

upazila

public

DH MCWC UHC NGO Private

Percentage of facilities

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)
76 • Family Planning Services

5.2.4 Availability of Commodities on the Day of the Assessment

Stock outs of FP methods can put a woman at risk of unintended pregnancy. To obtain information on 

stock outs, the 2017 BHFS assessed the availability on the day of the survey of each method reportedly

provided. Table 5.5 shows that 

78% of health facilities providing 

FP commodities (oral pills, 

injectables, condoms, IUCDs, and 

implants) actually had every 

method that they provide on hand 

on the day of the survey. The 

proportion of facilities with stock 

outs on the day of the survey was 

higher in 2017 than in 2014.

Commodity stock outs at CCs and 

USC/RDs were higher in 2017 than 

in 2014. However, almost 90% of 

private facilities had FP 

commodities in stock, as compared 

with only 53% in 2014 (Figure 

5.5).

5.2.5 Availability of Service Guidelines, Trained Staff, and Equipment

The 2017 BHFS gathered data on the percentage of facilities having guidelines, trained staff, and basic 

equipment for family planning services. Almost half (69% excluding CCs) of facilities offering modern FP 

services have guidelines on family planning at their service site (Table 5.6). NGO (87%) and District and 

upazila (86%) facilities are most likely to have FP guidelines while private hospitals are least likely to have 

these documents (5%). The availability of FP guidelines also differs by location; 63% of urban facilities 

have guidelines, as compared with 48% of rural facilities.

Over half of facilities (56%) have staff trained in family planning at any time, and 28% have staff trained 

during the last 24 months. Eighty-eight percent of district and upazila facilities have staff trained at any 

time, but a much lower percentage of these facilities have staff trained during the preceding 24 months. 

Private hospital and CCs are least likely to have staff members trained in FP.

Overall, 85% (92% excluding CCs) of facilities have a blood pressure apparatus, while only small 

percentages of facilities have a pelvic model for IUCDs demonstration and a model for showing condom 

use.

The survey assessed the presence of an examination bed or couch and an examination light, items needed 

to conduct a quality pelvic examination for FP clients. Most facilities (85%) had an examination bed or 

couch, and 54% had a light.

5.2.6 Infection Control During Provision of Family Planning

Infection control is essential in family planning procedures such as insertion or removal of IUCDs, 

injectables and implants. Table 5.7 presents data on the percentage of facilities offering six infection 

control items (soap, running water, alcohol-based hand disinfectant, latex gloves, sharps container, and 

waste receptacle) during provision of modern FP methods. Only 7% of facilities offer all six items. 

However, 47% have at least four items available. In 2014, 15% of facilities offered all six items and 40% 

offered four items. The percentage of facilities offering at least four infection control items is highest 

among NGO clinics/hospitals (96%) and lowest among CCs (40%). Most facilities have latex gloves

Figure 5.5 Percentage of facilities with FP 

commodities (oral pills, injectables, condoms, IUCDs, 

implants) available on the day of the survey

87 81

92

85 87 87 87 88

53

78

86 88 83 85

76 75

88 87

Total

facilities

DH MCWC UHC UHFWC USC/RD CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,201)

BHFS 2017

(N=1,314)
Family Planning Services • 77

(80%) and soap (70%), whereas few facilities have alcohol-based hand disinfectant (23%) or a waste 

receptacle (33%).

Figure 5.6 Availability of at least four standard precaution items for 

infection control in family planning service areas, by facility type

5.2.7 Readiness to Provide Family Planning Services

To provide quality family planning services to clients, facilities should have family planning guidelines, 

appropriately trained providers, and certain supplies and equipment. Table 5.8 and Figure 5.7 present 

information on availability of guidelines. The findings revealed that 49% of facilities providing FP had 

guidelines available on the day of the survey. UHCs were most likely (91%) and private hospitals were 

least likely (5%) to have FP guidelines (Table 5.8).

Figure 5.7 Availability of FP guidelines in health facilities

Between 2014 and 2017, there was a large decline in the availability of guidelines at DHs (from 84% to 

61%), while the percentage of MCWCs with guidelines did not change. UHCs and UHFWCs showed large 

increases. Fewer than half of CCs have FP guidelines available, as compared with 87% of NGOs. At 

private facilities, the availability of guidelines fell drastically between 2014 and 2017, from 36% to only 

5%. The overall availability of FP guidelines has decreased slightly since 2014 (from 54% to 49%), mainly 

due to a decrease in availability at CCs (from 49% to 39%). There is a need to ensure that guidelines are 

available at all facilities, and the problem of lack of availability should be relatively easy to solve.

40

52

89

79 79

43 38 34

79 84

47

62

86

76 82

53 54

40

96

69

Total

facilities

Total

facilities

excluding

CCs

DH MCWC UHC UHFWC USC/RD CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,260)

BHFS 2017

(N=1,359)

54

63

84

76 74

59 56

49

78

36

49

69

61

76

91

72

58

39

87

5

Total

facilities

Total

facilities

excluding

CCs

DH MCWC UHC UHFWC USC/RD CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,260)

BHFS 2017

(N=1,359)
78 • Family Planning Services

Training is also an important management function to support health care providers. In particular, periodic 

in-service training can keep providers up to date and help them refresh their knowledge and skills.

Over half (56%) of facilities that offer FP have staff who received in-service FP training at any time before 

the survey. Private facilities are least likely to have trained staff (28%). In the last 3 years, the availability 

of trained staff has increased at 

UHCs, UHFWCs, and NGO

facilities. Overall, however, there 

has been almost no change in the 

proportion of facilities with trained 

staff since 2014 (Figure 5.8 and 

Table 5.8).

In addition to service guidelines 

and adequately trained staff, certain 

basic equipment and FP methods 

are necessary to provide quality 

family planning services. They 

include a blood pressure apparatus 

and samples of FP methods (pills, 

injectables, and condoms).

A large majority (85%) of health 

facilities offering modern family planning methods had a blood pressure apparatus available on the day of 

the visit. A blood pressure apparatus was almost universally available at MCWCs, UHCs, NGO clinics,

and private hospitals. The percentage of facilities with a blood pressure apparatus did not change between 

2014 and 2017.

Figure 5.9 shows that 91% of health facilities had oral pills on the day of the survey. The availability of 

oral pills is universal at UHCs (100%) and nearly universal at MCWCs (98%). Over 90% of UHFWCs, 

CCs, and NGO facilities have oral pills available. However, only 33% of private facilities have oral pills, a 

decrease from 44% in 2014. Eighty-two percent of DHs have oral pills available, as compared with 95% in 

2014. It is important to maintain a high level of readiness in this area (Table 5.8).

Figure 5.9 Availability of oral pills, by facility type

Overall, there has been a decline in the availability of injectables across facilities. Eighty percent of DHs 

have injectables available, as compared with 92% in 2014. MCWCs and UHCs maintained high levels of 

availability (above 90% in both survey periods). There is concern regarding the declining availability of 

injectables at UHFWCs, USC/RDs, and CCs. The largest decline took place at private facilities (from 42%

to only 11%) (Figure 5.10 and Table 5.8).

88 91 95 98 98 92 90 87 91

44

91 91

82

98 100 95

84 91 96

33

Total

facilities

Total

facilities

excluding

CCs

DH MCWC UHC UHFWC USC/RD CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,260)

BHFS 2017

(N=1,359)

Figure 5.8 Availability of staff trained in FP at any time

in health facilities

57

73

93

81

71

58

50

77

29

56

74

92 88 86

58

45

86

28

Total

facilities

DH MCWC UHC UHFWC USC/RD CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,260)

BHFS 2017

(N=1,359)
Family Planning Services • 79

Figure 5.10 Availability of injectable, by facility type

Although there has been an overall decline in the availability of condoms, high proportions of MCWCs, 

UHCs, and UHFWCs have condoms readily available. The decline in availability was largest at DHs. A 

declining trend was also observed at USC/RDs and CCs (Figure 5.11 and Table 5.8).

Figure 5.11 Availability of condoms, by facility type

79

89 92 96 94 92 85

73

97

42

61

79 80

92 94

83

71

52

88

11

Total

facilities

Total

facilities

excluding

CCs

DH MCWC UHC UHFWC USC/RD CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,260)

BHFS 2017

(N=1,359)

91 93 95 99 96 96 90 90 92

34

86 89 82

97 99 95

83 85 88

32

Total

facilities

Total

facilities

excluding

CCs

DH MCWC UHC UHFWC USC/RD CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,260)

BHFS 2017

(N=1,359)
80 • Family Planning Services

WHO has specified a set of items 

or tracer indicators that facilities 

must have to be considered ready to 

offer FP services (Figure 5.12) 

(WHO 2012). Data from the 2017 

BHFS were used to construct a 

slightly less restrictive measure of 

FP service readiness that is 

appropriate for the Bangladesh

context. The following six

items/indicators were included in 

this measure of the readiness of 

health facilities to provide FP 

services:

▪ Trained staff. At least one 

staff person who has ever 

received in-service FP training.

▪ Guidelines. National or any other FP guidelines.

▪ Equipment. Blood pressure apparatus.

▪ Commodities. Oral pills, injectables, and condoms.

According to the WHO criteria, only 22% of facilities are ready to provide quality FP services (i.e., all six 

items/indicators are available) (Table 5.8 and Figure 5.13). Overall, FP service readiness has declined 

slightly since 2014 (from 25% to 22%) due to a decrease in the availability of guidelines and FP 

commodities (mainly injectables). The service readiness of DHs, CCs, and private facilities decreased in 

the last 3 years, while the readiness of other public facilities and NGO facilities increased notably.

Although MCWCs have not shown any substantial improvement over time, service readiness has increased 

notably at UHCs and UHFWCs.

Figure 5.13 Readiness of health facilities to provide FP services,

by facility type

5.3 BASIC MANAGEMENT AND ADMINISTRATIVE SYSTEMS

5.3.1 Training and Supervision

Supportive management for FP providers, including in-service training and personal supervision, is needed 

to ensure quality services. Training related to FP involves in-service training with structured sessions, 

25

40

51

64

55

36 34

17

53

5

22

51

41

67 72

54

33

9

71

0

Total

facilities

Total

facilities

excluding

CCs

DH MCWC UHC UHFWC USC/RD CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,260)

BHFS 2017

(N=1,359)

Figure 5.12 Availability of items (tracer indicators) in 

health facilities for readiness to provide FP services

86

61

91

85

56

49

91

79

88

85

57

54

Condoms

Injectables

Oral pills

Blood pressure apparatus

Staff trained in FP at any

time

Guidelines on FP

Percentage of facilities

BHFS 2014

(N=1,260)

BHFS 2017

(N=1,359)
Family Planning Services • 81

while personal supervision includes technical support or supervision from a facility-based supervisor or 

from a visiting supervisor. Table 5.9 presents the percentage of FP service providers who reported having 

training and supervision according to facility type, location, and division.

Twenty-seven percent (excluding providers at CCs) of service providers reported receiving training related 

to FP during the 2 years before the survey (Table 5.9), a slight increase from 2014 (22% excluding CCs). 

Conversely, 95% of providers received personal supervision during the 6 months before the survey.

Overall, 23% of providers received both training related to FP during the past 2 years and personal 

supervision during the past 6 months. Service providers at MCWCs and UHFWCs are most likely to have 

received both in-service training and supervision, whereas providers at USC/RDs and UHC are least likely 

to have received training and supervision.

5.3.2 In-service Training by Topic

Table 5.10 presents information on the types of in-service training and the extent of training received by 

family planning service providers at any time before the survey or during the past 24 months. This training 

incorporates FP counseling, FP-related clinical issues, insertion or removal of IUCDs and implants, FP for 

HIV-positive clients, postpartum FP, vasectomy, tubal legation, and emergency contraception.

Approximately half of providers have received training on FP counseling at some point, but only 16%

received such training during the past 24 months of the survey. Similarly, one-fourth of providers have 

received training on FP-related clinical issues, but only a small percentage received training during the past 

24 months. The proportion of providers receiving training on insertion or removal of IUCDs (25%) is 

twice as high as the proportion receiving training on insertion or removal of implants (12%). Almost 38%

of providers have received training on postpartum FP, with nearly 13% reporting such training during the 

last 24 months.

In general, providers in urban areas are more likely than those in rural areas to have received training 

during the last 24 months. For example, 13% of urban providers received training on FP-related clinical 

issues, as compared with 6% of rural providers. Similarly, 11% of providers in urban areas reported having 

training on insertion or removal of IUCDs, as compared with 6% in rural areas. Seven percent of providers 

in urban areas reported that they had been trained on insertion or removal of implants, compared with 3%

in rural areas. The percentages of providers receiving training on postpartum FP are the same in urban and 

rural areas.

Overall, the percentages of providers receiving training on FP services have decreased since 2014. For 

instance, the percentage of providers who reported having training on FP-related clinical issues at any time 

fell from 32% to 25%. The percentage of providers receiving training on insertion or removal of implants

at any time was also higher in 2014 (29%) than in 2017 ( 12%) (Table 5.10).

LIST OF TABLES

▪ Table 5.1 Availability of family planning services

▪ Table 5.2 Methods of family planning provided

▪ Table 5.3 Methods of family planning provided

▪ Table 5.4 Frequency of availability of family planning services

▪ Table 5.5 Availability of family planning commodities

▪ Table 5.6 Guidelines, trained staff, and basic equipment for family planning services

▪ Table 5.7 Items for infection control during provision of family planning

▪ Table 5.8 Readiness of health facilities to provide family planning services

▪ Table 5.9 Supportive management for providers of family planning services

▪ Table 5.10 Training for family planning service providers
82 • Family Planning Services

Table 5.1 Availability of family planning services

Among all facilities, the percentages that provide, prescribe, or counsel clients on methods of family planning, by background 

characteristics, Bangladesh HFS 2017

Methods of family planning (FP)

Number of 

facilities

Background

characteristic

Percentage offering 

any modern FP 

(including an 

emergency 

contraceptive)1

Percentage offering 

any long-acting and 

permanent 

methods2

Percentage offering 

male or female 

sterilization3

Percentage offering 

postpartum FP 

services4

Facility type

District and upazila public 

facilities 94.1 93.7 81.5 95.8 44

DH 79.0 79.0 61.3 88.7 5

MCWC 98.9 97.8 81.2 96.7 7

UHC 95.3 94.9 84.5 96.6 32

Union-level public facilities 87.9 75.6 - 88.7 361

UHFWC 97.7 85.9 - 97.6 250

USC/RD 65.8 52.4 - 68.8 111

Community clinic (CC) 91.1 37.2a- 93.2 1,012

NGO clinic/hospital 86.4 79.6 42.1 93.4 64

Private hospital 53.3 47.6 45.0 44.0 43

Location

Urban 78.7 74.6 53.9 76.4 108

Rural 90.0 48.1 29.1 91.9 1,416

Division

Barishal 93.8 41.6 22.6 95.2 113

Chattogram 90.7 54.9 39.5 91.1 288

Dhaka 87.5 51.2 26.5 87.3 304

Khulna 93.2 55.5 33.0 92.7 187

Rajshahi 91.5 49.4 24.4 89.2 220

Rangpur 76.4 31.2 18.0 87.4 193

Sylhet 96.1 47.6 32.5 96.5 96

Mymensingh 90.0 67.3 55.7 96.3 123

Total 89.2 50.0 30.8 90.8 1,524

Total excluding CCs 85.4 75.3 37.5 86.2 512

“-” Means male or female sterilization is not offered at union level public facilities or at public community clinic

1 Facility provides, prescribes, or counsels clients on any of the following: contraceptive pills (combined or progestin only), injectables 

(progestin only), one-rod implants, two-rod implants, intrauterine contraceptive devices (IUCDs), male condoms, female sterilization 

(tubal ligation) or male sterilization (vasectomy), and emergency contraceptives.

2 Facility provides, prescribes, or counsels clients on any of the following long-term and permanent methods of family planning: one-rod 

implants, two-rod implants, intrauterine contraceptive devices (IUCDs), female sterilization (tubal ligation), and male sterilization 

(vasectomy).

3 Providers in the facility perform male or female sterilization or counsel clients on male or female sterilization.

4 Facility provides postpartum family planning (PPFP) services or counsels clients on PPFP.

a The only long-acting and permanent methods that community clinics provide are injectables.
Family Planning Services • 83

Table 5.2 Methods of family planning provided

Among all facilities, the percentages that provide clients with specific modern family planning methods, by 

background characteristics, Bangladesh HFS 2017

Methods of family planning (FP)

Number of 

facilities

Background

characteristic

Percentage that 

provide any 

modern FP 

(including an 

emergency 

contraceptive)1

Percentage that 

provide any longacting and 

permanent 

methods2

Percentage that 

provide male or 

female sterilization3

Facility type

District and upazila public 

facilities 92.9 91.8 67.4 44

DH 69.4 66.1 46.8 5

MCWC 98.9 95.6 71.3 7

UHC 95.0 94.7 69.6 32

Union-level public facilities 86.8 72.1 - 361

UHFWC 97.2 83.5 - 250

USC/RD 63.5 46.2 - 111

Community clinic (CC) 88.7 3.6a- 1,012

NGO clinic/hospital 83.1 69.3 10.5 64

Private hospital 25.2 19.3 17.9 43

Location

Urban 66.9 61.4 30.1 108

Rural 87.9 22.8 2.5 1,416

Division

Barishal 91.1 23.5 4.6 113

Chattogram 88.4 25.9 5.6 288

Dhaka 81.9 26.6 5.9 304

Khulna 90.7 25.3 2.7 187

Rajshahi 89.3 31.6 4.6 220

Rangpur 75.5 20.7 2.4 193

Sylhet 95.9 18.9 2.4 96

Mymensingh 86.4 26.4 4.7 123

Total 86.4 25.5 4.4 1,524

Total excluding CCs 81.7 69.0 13.1 512

“-” Means male or female sterilization is not offered at union level public facilities or at public community clinic

1 Facility provides any of the following: contraceptive pills (combined or progestin only), injectables (progestin

only), one-rod implants, two-rod implants, intrauterine contraceptive devices (IUCDs), male condoms, female 

sterilization (tubal ligation) or male sterilization (vasectomy), and emergency contraceptives.

2 Facility provides any of the following long-term and permanent methods of family planning: one-rod implants, 

two-rod implants, intrauterine contraceptive devices (IUCDs), female sterilization (tubal ligation), and male 

sterilization (vasectomy).

3 Providers in the facility perform male or female sterilization.

a Among the long-acting and permanent methods, community clinics provide only injectables.
84 • Family Planning Services

Table 5.3 Methods of family planning provided1

Among all facilities, the percentages that provide clients with specific modern family planning methods, by facility type, Bangladesh HFS 2017

Facility type

Total

Total 

excluding 

Methods provided CCs

District 

and 

upazila 

public 

facilities DH MCWC UHC

Unionlevel 

public 

facilities UHFWC USC/RD

Community 

clinic 

(CC)

NGO 

clinic/

hospital

Private 

hospital

Combined or progestinonly oral pill 92.5 66.1 98.9 95.0 86.2 96.9 61.9 87.4 83.1 17.4 85.1 80.6

Progestin-only injectable 89.0 64.5 92.3 91.8 76.7 86.4 54.8 64.5 77.1 6.8 67.0 71.9

Male condom 92.3 66.1 97.8 95.0 86.5 97.2 62.4 87.1 78.5 17.9 84.8 80.3

Intrauterine contraceptive 

device 91.1 59.7 95.6 94.7 71.5 83.2 45.1 - 66.8 7.0 24.9 67.2

Implant (one or two rods) 77.5 27.4 80.1 84.4 10.4 - - - 29.6 4.9 6.2 18.1

Tubal ligation 66.5 45.2 70.2 68.8 5.7 - - - 9.4 17.7 4.2 12.4

Vasectomy 62.6 14.5 69.1 68.3 6.2 - - - 6.6 5.7 3.7 11.1

At least 1 modern method 92.9 69.4 98.9 95.0 86.8 97.2 63.5 88.7 83.1 25.2 86.4 81.7

At least 2 temporary 

modern methods2 92.7 67.7 98.9 95.0 86.0 96.9 61.5 87.9 79.7 17.4 85.3 80.1

At least 4 temporary 

modern methods2 90.2 58.1 93.4 94.2 68.1 78.9 43.8 3.2 67.5 5.4 23.8 64.7

Any LAPM 91.8 66.1 95.6 94.7 72.1 83.5 46.2 3.6 69.3 19.3 25.5 69.0

Male or female sterilization 67.4 46.8 71.3 69.6 6.4 7.6 3.6 0.0 10.5 17.9 4.4 13.1

Number of facilities 44 5 7 32 361 250 111 1,012 64 43 1,524 512

“-” Means the specific family planning methods are not provided at this type of facility

1 To be considered as providing a specific family planning method, the facility must report that it stocks the method and makes it available to clients without clients 

having to go elsewhere to obtain it. In the case of vasectomy and tubal ligation, the facility reports that providers in the facility perform the procedures. A dash 

means that this type of facility does not provide the specific family planning method.

2 Any methods other than male or female sterilization
Family Planning Services • 85

Table 5.4 Frequency of availability of family planning services

Among facilities that offer any family planning services, the percentages that offer the services 

every day or less frequently than every day, by background characteristics, Bangladesh HFS 

2017

Percentage of facilities offering 

family planning services where 

services are offered on 

indicated days1:

Number of 

facilities offering 

any family 

planning 

services

Background 

characteristic

Provides but not 

every day2

Provides every

day2

Facility type

District and upazila public facilities 3.9 96.1 42

DH 4.1 95.9 4

MCWC 7.9 92.1 7

UHC 3.0 97.0 31

Union-level public facilities 28.2 71.8 318

UHFWC 26.0 74.0 245

USC/RD 35.5 64.5 73

Community clinic (CC) 21.8 78.2 922

NGO clinic/hospital 0.9 99.1 55

Private hospital 0.6 99.4 23

Location

Urban 1.9 98.1 85

Rural 22.9 77.1 1,274

Division

Barishal 6.7 93.3 106

Chattogram 11.7 88.3 261

Dhaka 22.5 77.5 266

Khulna 20.5 79.5 175

Rajshahi 34.3 65.7 201

Rangpur 27.3 72.7 148

Sylhet 10.5 89.5 93

Mymensingh 36.8 63.2 110

Total 21.5 78.5 1,359

Total excluding CCs 21.0 79.0 437

1

Includes services for contraceptive pills (combined or progestin only), injectables (combined or 

progestin only), implants, intrauterine contraceptive devices (IUCDs), male condoms, periodic 

abstinence, tubal ligation, vasectomy, or any other family planning method such as diaphragms

or spermicides

2 Every day refers to all working days when the facility is open.
86 • Family Planning Services

Table 5.5 Availability of family planning commodities

Among facilities that provide the indicated modern family planning method, the percentages where the commodity was observed to be available 

on the day of the survey, by background characteristics, Bangladesh HFS 2017

Background

characteristic

Combined or 

progestin-only 

oral pills

Progestin-only 

injectables Male condoms

Intrauterine 

contraceptive 

devices

One-rod 

Implants

Two-rod 

implants

Every method 

provided by 

facility was 

available on 

day of survey

Facility type

District and upazila public 

facilities 99.4 98.0 98.5 95.0 97.4 70.3 84.3

DH 97.6 97.5 97.6 91.9 81.3 66.7 85.7

MCWC 97.7 98.7 97.7 96.5 97.2 81.9 87.6

UHC 100.0 97.9 98.8 94.9 98.2 67.8 83.4

Union-level public facilities 94.5 91.7 93.8 89.7 - - 82.7

UHFWC 96.2 93.5 95.8 89.8 84.7

USC/RD 88.8 85.5 87.1 - - - 75.7

Community clinic (CC) 94.9 72.6 89.0 - - - 75.0

NGO clinic/hospital 100.0 98.6 97.3 93.8 84.6 57.7 87.5

Private hospital 98.7 88.6 95.6 78.9 75.6 64.1 87.1

Location

Urban 98.8 98.3 97.4 94.8 90.8 66.8 87.1

Rural 95.0 78.9 90.5 82.0 63.0 41.3 77.2

Division

Barishal 96.6 86.3 88.5 82.4 76.5 64.0 78.2

Chattogram 96.7 84.4 90.3 89.8 78.0 43.1 80.4

Dhaka 99.2 85.8 95.6 89.2 76.8 57.3 83.9

Khulna 95.4 78.9 95.3 92.0 80.3 38.8 78.0

Rajshahi 89.5 75.8 81.6 70.2 78.7 78.3 71.0

Rangpur 90.3 69.7 89.8 83.3 95.2 73.7 69.7

Sylhet 99.8 91.6 97.2 98.8 93.4 74.5 93.5

Mymensingh 94.0 70.7 89.6 70.0 42.0 23.2 65.5

Total 95.2 80.1 90.8 84.0 75.6 52.9 77.7

Total excluding CCs 95.8 93.3 94.8 90.7 77.5 56.7 83.6

“-” Means the specific family planning methods are not provided at this type of facility.

Note: To be considered as offering a specific method, the facility must report that it stocks the method and makes it available to clients without 

clients having to go elsewhere to obtain it. The denominators for each characteristic-method combination are different and are not shown in the 

table. The combined oral contraceptive pill, injectable contraceptive, and male condom measures presented in the table comprise the medicines 

and commodities domain for assessing readiness to provide family planning services within the health facility assessment methodology proposed 

by WHO and USAID (2012). Each commodity or method shown in this table was observed to be available in the service area or location where 

commodities are stored, and at least one of the observed commodities or methods was valid, that is, within the expiration date. A dash means 

that this type of facility does not provide the specific family planning method.
Family Planning Services • 87

Table 5.6 Guidelines, trained staff, and basic equipment for family planning services

Among facilities offering any modern family planning methods, the percentage having family planning guidelines, the percentage having at least one staff member 

recently trained on family planning service delivery, and the percentage with the indicated equipment observed to be available on the day of the survey, by 

background characteristics, Bangladesh HFS 2017

Percentage of facilities offering 

any modern family planning 

and having: Equipment Number of 

facilities 

offering any 

modern 

family 

planning 

methods

Background 

characteristic

Guidelines 

on family 

planning1

Staff 

trained in 

family 

planning 

during past 

24 months2

Staff 

trained in 

family 

planning at 

any time2

Blood 

pressure 

apparatus3

Examination light

Examination bed 

or couch

Samples of 

family 

planning 

methods

Pelvic 

model for 

IUCD

Model for 

showing 

condom 

use

Other 

family 

planningspecific 

visual aid4

Facility type

District and upazila 

public facilities 86.2 49.9 87.6 93.7 79.4 94.8 81.9 36.6 32.7 83.9 42

DH 61.2 38.8 73.5 87.8 71.4 85.7 69.4 22.4 14.3 69.4 4

MCWC 76.2 58.2 92.2 95.5 82.1 94.4 80.0 39.5 42.8 76.3 7

UHC 91.4 49.4 88.4 94.0 79.7 96.0 83.9 37.6 32.6 87.4 31

Union-level public 

facilities 68.6 37.1 79.1 90.8 51.0 88.2 68.1 16.2 17.6 73.2 318

UHFWC 71.9 42.0 85.5 91.1 52.7 88.6 69.7 15.8 17.8 74.2 245

USC/RD 57.6 20.4 57.7 89.9 45.3 87.0 62.8 17.8 17.3 69.7 73

Community clinic 

(CC) 38.7 23.1 44.8 82.0 51.0 81.8 55.2 3.5 6.7 58.9 922

NGO clinic/hospital 86.6 54.5 86.0 97.7 95.5 98.9 82.0 48.1 57.1 83.4 55

Private hospital 4.5 14.8 27.7 95.2 83.5 96.2 18.0 0.7 0.0 24.8 23

Location

Urban 62.8 46.6 74.3 95.3 88.8 95.9 66.2 36.0 36.8 66.9 85

Rural 47.6 27.1 54.3 84.6 51.9 83.9 59.0 7.5 10.3 63.2 1,274

Division

Barishal 44.9 23.9 46.2 78.1 54.5 78.3 62.2 8.2 14.9 70.1 106

Chattogram 53.9 33.1 61.9 84.6 42.1 84.7 60.5 8.1 12.4 63.2 261

Dhaka 38.7 38.6 60.2 80.2 47.3 82.8 54.2 10.4 15.1 58.8 266

Khulna 64.7 18.0 49.3 86.9 77.7 85.9 73.2 10.0 10.1 61.3 175

Rajshahi 44.9 20.7 56.4 86.8 58.4 90.1 37.6 7.3 5.8 54.3 201

Rangpur 59.3 11.6 37.8 97.4 50.4 92.3 66.7 17.7 21.3 64.1 148

Sylhet 27.6 54.9 81.0 84.6 62.5 86.0 57.8 3.8 10.4 69.2 93

Mymensingh 46.8 26.6 48.5 85.1 52.1 71.8 77.0 5.9 3.8 83.0 110

Total 48.5 28.3 55.5 85.3 54.2 84.7 59.5 9.3 12.0 63.4 1,359

Total excluding CCs 69.2 39.3 78.1 92.2 61.0 90.6 68.6 21.4 23.1 72.9 437

Note: The measures presented in the table on guidelines for family planning and staff trained in FP comprise the staff and training domains, and blood pressure 

apparatus comprises the equipment domain, for assessing readiness to provide family planning services within the health facility assessment methodology 

proposed by WHO and USAID (2012).

IUCD = Intrauterine contraceptive device

1 National guidelines/manual or any other guidelines/instructions/job aid/checklist on family planning

2 The facility had at least one interviewed staff member providing the service who reports in-service training in some aspect of family planning. The training must 

have involved structured sessions; it does not include individual instruction that a provider might have received during routine supervision.

3 A functioning digital blood pressure apparatus or a manual sphygmomanometer with a stethoscope

4 Flip charts or leaflets
88 • Family Planning Services

Table 5.7 Items for infection control during provision of family planning

Among facilities offering any modern family planning methods, the percentages with indicated items for infection control observed to be available at the service site on 

the day of the survey, by background characteristics, Bangladesh HFS 2017

Percentage of facilities offering any modern family planning methods that have items for infection control

Number of 

facilities 

offering any 

modern 

family 

planning 

methods

Background 

characteristic Soap

Running 

water1

Soap and 

running 

water

Alcoholbased hand 

disinfectant

Soap and 

running 

water or 

else 

alcoholbased hand 

disinfectant

Latex 

gloves2

Sharps 

container

Waste 

receptacle3

All 6 items 

available4

At least 

4 items 

available

Facility type

District and upazila 

public facilities 81.0 92.8 78.1 59.1 85.0 92.8 77.8 51.9 25.7 81.4 42

DH 89.8 95.9 89.8 51.0 91.8 87.8 81.6 67.3 34.7 85.7 4

MCWC 78.5 92.2 76.3 47.3 80.9 92.1 80.8 47.2 24.7 76.3 7

UHC 80.5 92.6 77.1 62.7 85.1 93.6 76.6 51.1 24.9 82.0 31

Union-level public 

facilities 70.4 74.7 62.7 22.7 67.2 80.9 64.6 36.2 6.0 53.2 318

UHFWC 71.6 75.2 64.1 22.4 68.8 83.2 63.3 36.1 4.7 53.1 245

USC/RD 66.1 73.1 58.0 24.0 61.8 73.2 68.9 36.7 10.2 53.7 73

Community clinic 

(CC) 67.7 62.0 49.4 17.3 54.5 78.4 64.8 28.4 3.8 40.1 922

NGO clinic/hospital 97.4 97.3 96.3 75.1 97.7 98.4 91.8 67.4 46.5 95.9 55

Private hospital 74.4 84.1 74.4 67.9 89.3 85.1 39.7 67.2 25.6 68.7 23

Location

Urban 87.6 92.2 85.0 66.0 90.9 92.1 73.0 68.4 37.7 84.5 85

Rural 68.9 66.1 53.8 20.1 58.7 79.5 65.4 30.8 5.0 44.7 1,274

Division

Barishal 56.1 59.8 44.5 19.6 47.0 73.6 74.8 47.1 9.9 48.5 106

Chattogram 70.5 68.5 57.4 20.9 62.1 82.1 61.4 35.9 4.4 47.2 261

Dhaka 78.0 76.6 65.2 22.9 69.8 83.4 65.0 23.0 8.3 48.7 266

Khulna 82.3 65.1 58.5 20.0 62.8 78.5 62.4 30.5 5.2 46.2 175

Rajshahi 70.3 64.6 52.5 28.1 60.4 85.3 67.1 49.0 7.4 53.3 201

Rangpur 74.9 69.6 62.3 22.9 64.9 74.9 64.2 33.9 10.8 52.8 148

Sylhet 54.1 65.1 45.3 23.6 52.1 75.7 71.9 22.3 7.0 34.4 93

Mymensingh 50.2 61.8 41.0 26.7 47.8 80.2 69.9 21.6 5.1 35.2 110

Total 70.0 67.7 55.7 23.0 60.7 80.3 65.8 33.2 7.1 47.1 1,359

Total excluding CCs 75.0 79.8 69.0 35.1 73.9 84.4 68.0 43.2 14.0 62.1 437

1 Piped water, water in bucket with specially fitted tap, or water in pour pitcher

2 Non-latex equivalent gloves are acceptable.

3 Waste receptacle with plastic bin liner

4 Soap, running water, alcohol-based hand disinfectant, latex gloves, sharps container, and waste receptacle
Family Planning Services • 89

Table 5.8 Readiness of health facilities to provide family planning services

Among facilities that offer any modern family planning methods, the percentage with family planning guidelines, the percentage with at least one staff 

member recently trained on family planning service delivery, the percentage with the indicated contraceptive commodities available on the day of the 

survey, and the percentage with all items, by background characteristics, Bangladesh HFS 2017

Percentage of facilities offering any modern family planning and having: Number of 

facilities 

offering any 

modern family 

planning 

methods

Background

characteristic

Guidelines on 

family 

planning1

Staff trained in 

family 

planning at 

any time2

Blood 

pressure 

apparatus3

Combined or 

progestin-only 

oral pills

Progestin-only 

injectables Male condoms

All 6 items 

available

Facility type

District and upazila 

public facilities 86.2 87.6 93.7 97.8 92.6 96.7 68.4 42

DH 61.2 73.5 87.8 81.6 79.6 81.6 40.8 4

MCWC 76.2 92.2 95.5 97.7 92.1 96.6 67.2 7

UHC 91.4 88.4 94.0 99.8 94.3 98.6 72.1 31

Union-level public 

facilities 68.6 79.1 90.8 92.6 80.0 92.3 49.4 318

UHFWC 71.9 85.5 91.1 95.4 82.6 95.2 54.2 245

USC/RD 57.6 57.7 89.9 83.5 71.1 82.6 33.2 73

Community clinic 

(CC) 38.7 44.8 82.0 91.1 51.9 85.1 8.6 922

NGO clinic/hospital 86.6 86.0 97.7 96.2 88.0 88.4 70.6 55

Private hospital 4.5 27.7 95.2 33.3 11.3 32.0 0.0 23

Location

Urban 62.8 74.3 95.3 80.6 71.6 76.8 51.9 85

Rural 47.6 54.3 84.6 91.6 59.7 87.0 20.4 1,274

Division

Barishal 44.9 46.2 78.1 93.7 68.0 85.0 25.8 106

Chattogram 53.9 61.9 84.6 93.9 62.8 87.7 24.7 261

Dhaka 38.7 60.2 80.2 87.0 52.7 85.5 19.3 266

Khulna 64.7 49.3 86.9 92.5 65.4 91.9 27.1 175

Rajshahi 44.9 56.4 86.8 87.0 61.9 77.4 21.5 201

Rangpur 59.3 37.8 97.4 89.2 60.4 88.8 22.1 148

Sylhet 27.6 81.0 84.6 99.6 60.2 92.9 16.6 93

Mymensingh 46.8 48.5 85.1 89.9 56.1 85.8 19.8 110

Total 48.5 55.5 85.3 90.9 60.5 86.4 22.3 1,359

Total excluding CCs 69.2 78.1 92.2 90.5 78.6 89.1 51.3 437

Note: The measures presented in the table on guidelines for family planning and staff trained in FP comprise the staff and training domains, and blood 

pressure apparatus comprises the equipment domain, for assessing readiness to provide family planning services within the health facility assessment 

methodology proposed by WHO and USAID (2012).

1 National guidelines/manual or any other guidelines/instructions/job aid/checklist on family planning

2 The facility had at least one interviewed staff member providing the service who reports receiving in-service training in some aspect of family planning. 

The training must have involved structured sessions; it does not include individual instruction that a provider might have received during routine 

supervision.

3 A functioning digital blood pressure apparatus or a manual sphygmomanometer with a stethoscope
90 • Family Planning Services

Table 5.9 Supportive management for providers of family planning services

Among interviewed family planning service providers, the percentage who report receiving training related to their work and personal 

supervision during the specified time periods, by background characteristics, Bangladesh HFS 2017

Percentage of interviewed providers who received:

Number of 

interviewed providers 

of family planning 

services

Background 

characteristic

Training related to 

family planning during 

the 24 months 

preceding the survey1

Personal supervision 

during the 6 months 

preceding the survey2

Training related to 

family planning during 

the 24 months and 

personal supervision 

during the 6 months 

preceding the survey

Facility type

District and upazila public facilities 18.8 97.3 18.4 438

DH 15.6 98.2 15.6 102

MCWC 34.6 95.9 32.5 42

UHC 17.6 97.1 17.3 294

Union-level public facilities 32.9 92.1 29.5 644

UHFWC 35.9 92.7 32.4 522

USC/RD 19.9 89.8 17.1 122

Community clinic (CC) 21.3 95.5 20.9 1,692

NGO clinic/hospital 29.0 98.4 29.0 264

Private hospital 22.3 71.1 21.1 97

Location

Urban 25.0 94.2 24.9 569

Rural 23.8 94.6 22.6 2,565

Division

Barishal 19.0 94.7 18.6 262

Chattogram 29.4 92.3 27.6 554

Dhaka 32.5 93.8 32.0 705

Khulna 13.2 97.7 12.2 409

Rajshahi 16.9 97.1 14.7 433

Rangpur 9.4 95.7 9.4 332

Sylhet 42.7 86.0 41.9 230

Mymensingh 25.9 98.6 24.9 209

Total 24.0 94.5 23.0 3,134

Total excluding CCs 27.2 93.4 25.5 1,442

1 Training refers only to in-service training. The training must have involved structured sessions; it does not include individual instruction 

that a provider might have received during routine supervision.

2 Personal supervision refers to any form of technical support or supervision from a facility-based supervisor or from a visiting supervisor. 

It may include, but is not limited to, review of records and observation of work, with or without any feedback to the health worker.
Table 5.10 Training for family planning service providers

Among interviewed family planning (FP) service providers, the percentages who report receiving in-service training on topics related to family planning during the specifi

characteristics, Bangladesh HFS 2017

Percentage of providers of FP services who report receiving in-service training on:

Counseling on FP

FP-related clinical 

issues

1

Insertion/removal 

of IUCD

Insertion/removal 

of Implant

FP for HIV+ 

clients Postpartum FP Vasectomy 

Background 

characteristic

During 

the past 

24 

months

At any 

time

During 

the past 

24 

months

At any 

time

During 

the past 

24 

months

At any 

time

During 

the past 

24 

months

At any 

time

During 

the past 

24 

months

At any 

time

During 

the past 

24 

months

At any 

time

During 

the past 

24 

months

At any 

time

Facility type

District and upazila 

public facilities 11.5 37.4 7.6 22.8 10.1 30.8 6.0 21.0 2.7 7.1 8.6 28.7 3.9 12.3 

DH 13.1 32.8 7.0 16.4 8.5 22.4 5.4 15.8 3.7 6.0 6.1 22.8 1.9 7.4 

MCWC 21.0 66.9 10.2 44.9 17.9 63.4 11.4 38.8 6.0 17.2 20.2 64.4 5.7 24.4 

UHC 9.6 34.7 7.4 21.8 9.6 29.0 5.4 20.3 1.9 6.1 7.8 25.6 4.4 12.3 

Union-level public 

facilities 20.7 68.7 8.4 37.1 14.7 55.9 4.5 14.1 1.9 11.4 17.1 55.4 1.6 7.7 

UHFWC 22.4 70.7 9.1 38.9 16.2 58.0 5.1 15.5 2.0 12.1 19.2 58.6 1.9 8.4 

USC/RD 13.3 60.4 5.5 29.5 8.2 46.8 1.8 7.8 1.6 8.4 7.8 41.8 0.2 4.5 

Community clinic 

(CC) 15.6 41.9 5.9 20.1 2.2 11.3 2.0 7.7 1.2 4.4 11.5 34.6 1.0 4.4 

NGO clinic/hospital 19.4 50.0 10.1 28.3 9.3 27.9 3.7 14.1 3.1 9.3 14.6 37.1 2.9 6.2 

Private hospital 17.9 33.5 22.3 31.0 12.0 16.4 6.9 11.3 12.1 18.7 21.5 32.6 8.5 15.6 

Location

Urban 16.6 42.8 12.6 28.7 11.4 30.1 7.0 20.0 5.0 10.9 13.2 33.6 5.0 12.8 

Rural 16.4 48.2 6.4 24.2 5.8 23.5 2.6 9.6 1.4 6.2 12.7 39.2 1.2 5.3 

Division

Barishal 12.2 37.5 9.1 25.8 6.7 20.7 3.9 11.9 0.8 4.5 9.1 29.8 1.5 6.1 

Chattogram 22.0 52.0 7.5 30.2 8.2 34.0 3.3 11.0 0.9 7.9 16.0 43.2 2.4 8.6 

Dhaka 22.4 53.7 9.7 28.1 8.9 22.3 5.1 12.4 5.1 12.1 17.5 44.4 3.1 8.7 

Khulna 7.4 35.4 3.8 13.7 4.2 18.8 1.4 7.5 1.5 6.5 6.7 26.3 0.0 1.7 

Rajshahi 12.0 48.8 4.1 24.3 3.6 26.3 1.8 10.8 0.6 4.5 7.0 38.3 1.1 3.9 

Rangpur 4.5 34.6 3.2 15.4 3.2 19.6 1.3 10.7 1.7 4.4 6.0 29.3 1.1 6.5 

Sylhet 27.3 62.9 12.6 33.2 8.8 25.9 4.0 14.7 2.1 5.4 20.5 49.9 2.3 11.6 

Mymensingh 21.1 47.5 13.8 29.5 11.0 28.5 7.1 16.3 0.7 3.6 19.3 39.2 2.8 6.1 

Total 16.4 47.2 7.5 25.0 6.8 24.7 3.4 11.5 2.0 7.1 12.8 38.2 1.9 6.7 

Total excluding CCs 17.5 53.4 9.4 30.7 12.1 40.5 5.0 16.0 3.1 10.2 14.3 42.4 3.0 9.3 

Note: Training refers only to in-service training. The training must have involved structured sessions; it does not include individual instruction that a provider might have r

IUCD = Intrauterine contraceptive device

1 Any training on clinical management of family planning methods, including managing side effects

Antenatal Care Services • 93

ANTENATAL CARE SERVICES 6

Key Findings

▪ Almost all facilities in Bangladesh reported offering 

antenatal care (ANC) services (Table 6.1 and Figure 6.1).

▪ Fewer than half of the facilities offering ANC services had 

ANC guidelines available on the day of the survey. Over 

half of facilities had at least one staff member who 

received in-service training related to ANC (Table 6.2 and 

Figures 6.2 and 6.3).

▪ Private facilities are least likely to have trained staff (26%) 

and ANC guidelines (7%) (Table 6.2 and Figures 6.2 and 

6.3).

▪ Between 2014 and 2017, the proportion of facilities with 

staff trained in ANC increased from 49% to 55%. The 

availability of ANC guidelines decreased slightly, from 

50% in 2014 to 46% in 2017 (Figures 6.2 and 6.3).

▪ Twenty-five percent of facilities are able to conduct tests

for urine protein, 22% are able to test for urine glucose, 

and 17% are able to test for hemoglobin. Although the 

overall testing capacity remains low, the capacity to 

conduct these three basic tests has improved in the last 3 

years (Table 6.3 and Figure 6.5).

▪ Nine in 10 health facilities had all medicines essential for 

routine ANC services (iron tablets, folic acid tablets, and 

combined iron and folic acid tablets) available on the day 

of the survey (Table 6.4).

▪ Only 4% of facilities are at the level of readiness 

necessary to provide quality ANC services. Public sector 

district hospitals are most likely (45%) to be ready to offer

ANC services, while CCs (1%) and private hospitals (2%) 

are least ready (Table 6.6 and Figure 6.8).

▪ Overall, there was no improvement in service readiness 

between 2014 and 2017. Service readiness increased 

only among union-level facilities (from 3% to 7%) (Table 

6.6 and Figure 6.8).

6.1 BACKGROUND

ntenatal care (ANC) is the gateway for many critical maternal, newborn, and child health care 

services. ANC is also often the first opportunity for a woman and her family to interact with the 

health system. The provision of ANC by a medically trained provider is intended to monitor the 

status of a pregnancy, identify the complications associated with the pregnancy, and prevent adverse 

pregnancy outcomes. For the most effective outcomes, there should be regular ANC throughout 

pregnancy.

The results of the 2017 Bangladesh Demographic and Health Survey (BDHS) showed a sharp increase in 

the percentage of women who had at least one ANC visit with a medical provider. Eighty-two percent of 

A
94 • Antenatal Care Services

women age 15-49 with a live birth in the 3 years preceding the survey received ANC from a medically 

trained provider, an increase of 18 percentage points from the figure reported in the 2014 BDHS (64%) 

and 27 percentage points from the figure reported in the 2011 BDHS (55%). Between 2014 and 2017, the 

proportion of women who had the recommended four or more ANC visits during their most recent

pregnancy increased from 31% to 47%. This offers evidence that Bangladesh is close to achieving the 

Health, Population and Nutrition Sector Program’s target of 50% of pregnant women completing at least 

four ANC visits by 2022 (Ministry of Health and Family Welfare [MOHFW] 2017). The 2017 BDHS 

results showed that only 43% of rural women, as compared with 59% of urban women, had at least four 

ANC visits.

Data from the 2017 BHFS related to delivery of ANC services will be useful in the country’s continuing 

efforts to improve ANC care. This chapter explores the results of the 2017 BHFS in the following key 

areas related to provision of ANC services at health facilities in Bangladesh:

▪ Availability of ANC services. Section 6.2, including Tables 6.1 through 6.5 and Figures 6.1 through 

6.6, examines the availability of ANC services at health facilities, including the availability of basic 

amenities and equipment, diagnostic capacity, essential medicines, and infection control processes.

▪ Readiness of health facilities to provide ANC services. Section 6.3, including Table 6.6 and 

Figures 6.7 through 6.14, addresses the readiness of facilities to provide quality ANC services.

▪ Basic management and administrative systems. Section 6.4, including Tables 6.7 and 6.8, considers 

supervision and recent in-service training of providers that support quality services.

6.2 AVAILABILITY OF ANC SERVICES

6.2.1 ANC Service Provision

Almost all health facilities (99%) in Bangladesh offer ANC services (97% excluding public community 

clinics [CCs]) (Table 6.1). Nine of 10 facilities offer ANC services during all working days in a week. 

Almost all district and upazila public facilities (98%), public community clinics (94%), nongovernmental 

(NGO) facilities (98%), and private facilities (94%) offer ANC services on all working days. Union-level 

public facilities are less likely (80%) to offer services on all working days. The proportion of facilities that 

offer ANC services on all working days varies by region, from 86% in Mymensingh to 97% in Barishal 

(Table 6.1).

The overall availability of ANC 

services increased slightly between 

2014 and 2017. As can be seen in 

Figure 6.1, availability of ANC 

services in private hospitals 

increased more rapidly over that 

period (from 79% to 95%) than 

availability in other types of 

facilities. In rural areas, the 

percentage of facilities offering 

ANC services on all working days 

increased from 84% to 91%

between 2014 and 2017 (Table 6.1

and 2014 BHFS Table 6.1).

Figure 6.1 Availability of ANC services in health facilities, 

by facility type

97 95 99 95 99 98

79

99 97 99 96 100 100 95

Total

facilities

Total

facilities

excluding

CC

District &

upazila

public

Unionlevel

public

CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)
Antenatal Care Services • 95

6.2.2 Availability of ANC Guidelines, Trained Staff, and Equipment

Availability of ANC service guidelines, appropriately trained providers, and certain supplies and 

equipment, such as those for infection control, contributes to the provision of quality services. In addition, 

the capacity to perform basic diagnostic tests and offer routinely dispensed medicines enhances services.

About half of the facilities (46%) offering ANC had guidelines on ANC available on the day of the survey. 

NGO facilities are most likely to have ANC guidelines (75%), while private facilities are least likely to 

have them (7%) (Table 6.2). 

Facilities in Sylhet are 

comparatively less likely (30%)

than those in other divisions to have 

guidelines. The percentage of 

facilities in Dhaka with ANC 

guidelines has decreased since 2014 

(from 40% to 35%), while there has 

been an increase among facilities in 

Chattogram (from 39% to 56%)

(Table 6.2 and 2014 BHFS Table 

6.2). The most notable declines

have been among private facilities

(from 25% to 7%) and district and 

upazila public health facilities

(from 70% to 60%) (Figure 6.2).

Between 2014 and 2017, the overall 

availability of trained ANC 

providers increased from 49% to 

55% (Figure 6.3). Availability of 

trained staff increased among all 

facilities except private facilities. 

Although 55% of facilities offering

ANC had at least one staff person 

with in-service ANC training, only 

27% of facilities had at least one 

staff person with training during the 

past 24 months (Table 6.2). District 

and upazila public facilities are 

most likely (86%) to have at least 

one staff person with training on 

ANC at any time, and private 

facilities are least likely (26%) to 

have at least one trained staff 

person at any time.

Figure 6.2 Availability of ANC guidelines in health facilities, 

by facility type

Figure 6.3 Availability of staff ever trained for ANC in health 

facilities, by facility type

50

70

48 48

73

25

46

60

50 44

75

7

Total

facilities

District &

upazila

public

Union-level

public

CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,508)

BHFS 2017

(N=1,506)

49

84

50 46

60

28

55

86

54 54

64

26

Total

facilities

District &

upazila

public

Union-level

public

CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,508)

BHFS 2017

(N=1,506)
96 • Antenatal Care Services

Among the facilities offering ANC, 86% had a blood pressure apparatus, 95% had a stethoscope, 88% had 

an adult weighing scale, and 85% had an examination bed or couch. A smaller proportion had measuring 

tape available (42%), and only 4%

had a fetal stethoscope (Table 6.2).

The availability of most of the 

health facility equipment (adult 

stethoscope, adult weighing scale, 

measuring tape, examination bed or

couch) necessary during a physical 

examination has improved slightly 

over the past 3 years, but the 

availability of a fetal stethoscope 

has declined notably (from 15% in 

2014 to 4% in 2017) (Figure 6.4).

6.2.3 Availability of 

Laboratory Diagnostic Tests

Performing basic laboratory tests onsite saves time for both the client and the provider. It also makes it 

much more likely that the client receives the test results and the provider can act on them. In general, the 

basic laboratory tests important in ANC are lacking in most facilities that offer ANC services. Among the 

facilities offering ANC, 25% have the capacity to conduct tests for urine protein, 22% have the capacity to 

test for urine glucose, and 17% have the capacity to test for hemoglobin (Table 6.3). Only 1% of facilities 

overall have the capacity to conduct tests for blood grouping and Rhesus factor; 23% of district hospitals

(DHs), 13% of private facilities, and 6% of NGO facilities are able to conduct these tests (Table 6.3).

Private facilities are more likely to have the capacity to conduct the indicated tests than district and upazila 

public facilities, union-level public 

facilities, and public community 

clinics. Also, urban facilities are 

much more likely than rural 

facilities to have the capacity to 

conduct these tests (Table 6.3).

Although the overall capacity of 

health facilities to conduct tests

remains low, there has been some 

improvement since 2014 in the 

capacity to conduct urine protein, 

urine glucose, and hemoglobin tests 

(Figure 6.5).

6.2.4 Availability of Medicines for Routine 

ANC

Pregnant women should take iron supplements and/or folic acid to combat anemia and improve pregnancy 

outcomes. Table 6.4 reports the availability of these medicines, which are essential for the provision of 

routine ANC services. The results showed that most of the facilities offering ANC services had essential 

medicines for ANC available on the day of the survey (Table 6.4). Private facilities are less likely to have 

these medicines than district and upazila public facilities, union-level public facilities, community clinics,

and NGO facilities. Of note, rural facilities are more likely than urban facilities to have these medicines 

available (Table 6.4).

Figure 6.4 Availability of equipment to support

ANC services

Figure 6.5 Availability of laboratory diagnostic tests to 

support ANC services

78

36

15

83

92 85 87

42

4

88 95

86

Examination bed

or couch

Measuring

tape

Fetal

stethoscope

Adult

weighing

scale

Stethoscope

Blood

pressure

(BP)

apparatus

Percentage of facilities

BHFS 2014

(N=1,508)

BHFS 2017

(N=1,506)

6

1

18 19

12

6

1

22 25

17

Syphilis Blood

grouping and

Rhesus factor

Urine

glucose

Urine

protein

Hemoglobin

Percentage of facilities

BHFS 2014

(N=1,508)

BHFS 2017

(N=1,506)
Antenatal Care Services • 97

6.2.5 Availability of Infection Control items

Infection control is very important to ensure the overall quality of ANC services. Sixty-one percent (72%

excluding CCs) of facilities that offer ANC services have either soap and running water or alcohol-based 

disinfectant, while 80% (81% excluding CCs) have latex gloves. Although 64% of facilities have a sharps 

container, only 33% (41% excluding CCs) have a waste receptacle (Table 6.5). The likelihood of a facility 

having items essential for infection control varies by facility type. For example, private facilities are more 

likely (71%) to have a waste receptacle than district and upazila facilities (49%), union-level facilities 

(33%), and CCs (28%).

Overall, only 7% (14% excluding CCs) of facilities have all six of the specified infection control items 

(Table 6.5); however, the percentage of facilities with at least four items available increased from 40% to 

46% between 2014 and 2017 (Table 6.5 and 2014 BHFS Table 6.5). Relatively high proportions of NGO 

facilities (42%) and private 

hospitals (33%) have all six items 

available. Urban facilities (38%)

are almost eight times as likely as 

rural facilities (5%) to have all of 

the indicated infection control items 

(Table 6.5).

The overall percentage of facilities 

with all six infection control items 

decreased from 14% in 2014 to 7% 

in 2017 (Figure 6.6). Moreover, the 

availability of these items 

decreased in all facility categories 

(Figure 6.6).

6.3 READINESS OF 

HEALTH FACILITIES TO PROVIDE ANC SERVICES

WHO has identified a set of items/tracer indicators that a facility needs in order to offer quality ANC 

services (WHO 2012). BHFS data were used to construct a slightly less restrictive and Bangladeshcontext-appropriate version of the WHO-recommended ANC service readiness measure. The measure 

requires all of the following items/tracer indicators to be available for a health facility to be considered 

ready to offer quality ANC services:

▪ Trained staff—At least one provider of ANC ever receiving in-service ANC training

▪ Guidelines—National or other ANC guidelines at the facility

▪ Equipment—Blood pressure apparatus

▪ Diagnostic capacity—Hemoglobin test and urine protein test

▪ Medicines—Iron or folic acid tablets

Although individual readiness items are available at all facilities, only 4% of facilities (11% excluding 

CCs) have all six items/tracer indicators (trained staff, guidelines, blood pressure apparatus, hemoglobin 

test, urine protein test, iron or folic acid tablets) available as per the WHO recommendations (Table 6.6).

Moreover, the availability of the six items declined from 2014 to 2017 in district hospitals (from 56% to 

45%, upazila health complexes (from 45% to 32%), and NGO clinics (from 33% to 23%). The six items 

are more likely to be available in district and upazila public health facilities (31%) and NGO facilities 

(23%) than in other types of facilities. Only 2% of private hospitals and 1% of community clinics have the 

six items available. The limited capacity of CCs to conduct testing for hemoglobin (9%) and urine protein

(19%) results in a low level of readiness for ANC services.

Figure 6.6 Availability of all six infection control

items for antenatal care services, by facility type

14 20

37

10 11

46 38

7

14 23

5 4

42 33

Total

facilities

Total

facilities

excluding

CC

District &

upazila

public

Unionlevel

public

CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,508)

BHFS 2017

(N=1,506)

Note: The facility had the following six infection control items: soap, running 

water, alcohol-based hand disinfectant, latex gloves, sharps container, and 

waste receptacle.
98 • Antenatal Care Services

Only a quarter of the facilities 

offering ANC services have the 

capacity to conduct urine protein 

testing, which is important for early 

detection of preeclampsia. Less 

than one-fifth (17%) of facilities 

have the capacity to perform 

hemoglobin testing, which is 

necessary to detect anemia. Fortysix percent of facilities have 

guidelines on ANC, and 55% have 

staff who have received in-service 

ANC training (Table 6.6 and

Figure 6.7). While staff members 

may have been oriented to ANC 

during their basic training, inservice training is important to keep them updated. The insufficiency of ANC guidelines and trained staff 

may impact the readiness of facilities to provide quality ANC services. Relatively high percentages of 

facilities have iron or folic acid tablets (93%) and a blood pressure apparatus (86%) available (Table 6.6).

No notable changes in overall ANC 

readiness have been observed since 

2014. In the last 3 years, service 

readiness has increased only among 

union-level facilities (from 3% to 

7%); in other public, NGO, and 

private health facilities, service 

readiness has declined noticeably

(Figure 6.8). Many mothers in 

Bangladesh suffer from anemia, 

and it is estimated that one in five 

maternal deaths are due to 

preeclampsia or eclampsia. To 

detect these conditions, hemoglobin 

and urine protein testing are 

extremely useful. The BHFS results 

indicate that most facilities in Bangladesh that provide ANC are not adequately prepared to detect these 

pregnancy-related conditions.

Figure 6.7 Availability of items (tracer indicators) in health 

facilities indicating readiness to provide ANC services

Figure 6.8 Readiness of health facilities to provide

ANC services, by facility type

93

25

17

86

55

46

96

19

12

87

49

50

Iron or folic acid tablets

Urine protein testing capacity

Hemoglobin testing capacity

Blood pressure apparatus

Staff trained for ANC at any

time

ANC guidelines

Percentage of facilities

BHFS 2014

(N=1,508)

BHFS 2017

(N=1,506)

4

12

42

3 1

33

8

4

11

31

7

1

23

2

Total

facilities

Total

facilities

excluding

CC

District &

upazila

public

Unionlevel

public

CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,508)

BHFS 2017

(N=1,506)
Antenatal Care Services • 99

Figure 6.9 presents data on the 

readiness of district hospitals (DHs)

to provide ANC services. Most of 

the DHs (86%) offering ANC 

services have staff trained in ANC,

and three in five have ANC 

guidelines. A blood pressure 

apparatus and iron or folic acid 

tablets are universally available at 

DHs. Most have the capacity to 

conduct hemoglobin (87%) and 

urine protein (86%) testing. Nearly

half of DHs have all six 

items/tracer indicators available as 

per the WHO recommendations.

Figure 6.10 presents information 

on the readiness of mother and 

child welfare centers (MCWCs) to 

provide ANC services. Just over 

half of MCWCs (53%) have ANC 

guidelines, and 79% have staff 

trained in ANC. Almost all 

MCWCs have a blood pressure 

apparatus and iron or folic acid 

tablets available. Approximately 

half have the capacity to conduct 

hemoglobin testing (44%) and urine

protein testing (43%). Although the 

overall availability of the six items 

at MCWCs has not changed since 

2014, the readiness of these 

facilities to conduct hemoglobin 

and urine protein testing has 

increased substantially.

Data on the readiness of upazila 

health complexes (UHCs) to 

provide ANC services are shown in 

Figure 6.11. Most UHCs (87%) 

offering ANC services have staff 

trained in ANC, and three in five 

have ANC guidelines. A blood 

pressure apparatus and iron or folic 

acid tablets are universally 

available at UHCs. Seventy-nine 

percent of UHCs facilities have the 

capacity to conduct hemoglobin 

testing, and 68% have the capacity 

to conduct urine protein testing. 

Thirty-two percent of UHCs have 

all six items available as per WHO 

recommendations.

Figure 6.9 Readiness of district hospitals (DHs) to provide 

ANC services

Figure 6.10 Readiness of mother and child welfare centers

(MCWCs) to provide ANC services

Figure 6.11 Readiness of upazila health complexes (UHCs)

to provide ANC services

95

86

87

100

86

63

45

100

87

97

98

85

72

56

Iron or folic acid tablets

Urine protein testing

capacity

Hemoglobin testing

capacity

Blood pressure apparatus

Staff trained for ANC at

any time

ANC guidelines

All six items

Percentage of facilities

BHFS 2014

(N=1,508)

BHFS 2017

(N=1,506)

94

43

44

98

79

53

16

97

34

28

92

84

71

15

Iron or folic acid tablets

Urine protein testing

capacity

Hemoglobin testing

capacity

Blood pressure apparatus

Staff trained for ANC at

any time

ANC guidelines

All six items

Percentage of facilities

BHFS 2014

(N=1,508)

BHFS 2017

(N=1,506)

97

68

79

99

87

61

32

100

73

76

99

83

70

45

Iron or folic acid tablets

Urine protein testing capacity

Hemoglobin testing capacity

Blood pressure apparatus

Staff trained for ANC at any

time

ANC guidelines

All six items

Percentage of facilities

BHFS 2014

(N=1,508)

BHFS 2017

(N=1,506)
100 • Antenatal Care Services

Figure 6.12 presents data on the 

readiness of union health and 

family welfare centers (UHFWCs)

to provide ANC services. Just over 

half of UHFWCs (54%) have ANC 

guidelines and 60% have staff 

trained in ANC. All most all 

UHFWCs have a blood pressure 

apparatus and iron or folic acid 

tablets. Approximately one-fifth 

have the capacity to conduct 

hemoglobin testing and urine

protein testing. The readiness of 

these facilities to conduct 

hemoglobin and urine protein tests

increased substantially between 

2014 and 2017. There was also a 

slight rise in the percentages of 

UHFWCs with guidelines and trained staff members. The overall availability of the six items increased 

from 3% to 9% during the last 3 years.

Information on the readiness of 

NGO clinics to provide ANC 

services is presented in Figure 

6.13. Three in four NGO facilities

offering ANC services have ANC 

guidelines, and 64% have staff 

trained in ANC. Almost all NGO 

facilities have a blood pressure 

apparatus (98%) and iron or folic 

acid tablets (92%). Most have the 

capacity to conduct urine protein 

testing (84%). Approximately onefourth of NGO facilities have all six 

items as per the WHO

recommendations.

Figure 6.12 Readiness of union health and family welfare 

centers (UHFWCs) to provide ANC services

Figure 6.13 Readiness of nongovernmental (NGO) clinics to 

provide ANC services

96

21

18

92

60

54

9

97

12

8

84

54

50

3

Iron or folic acid tablets

Urine protein testing capacity

Hemoglobin testing capacity

Blood pressure apparatus

Staff trained for ANC at any

time

ANC guidelines

All six items

Percentage of facilities

BHFS 2014

(N=1,508)

BHFS 2017

(N=1,506)

92

84

75

98

64

75

23

95

75

69

98

60

73

33

Iron or folic acid tablets

Urine protein testing capacity

Hemoglobin testing capacity

Blood pressure apparatus

Staff trained for ANC at any

time

ANC guidelines

All six items

Percentage of facilities

BHFS 2014

(N=1,508)

BHFS 2017

(N=1,506)
Antenatal Care Services • 101

Figure 6.14 presents data on the 

readiness of private hospitals to 

provide ANC services. Only a 

quarter of private facilities (26%) 

have staff trained in ANC, and 7% 

have ANC guidelines. A blood 

pressure apparatus is universally

available at private facilities. Most 

of these facilities have the capacity 

to conduct hemoglobin (82%) and 

urine protein (79%) testing. Only 

8% of private facilities have all six 

items as per the WHO 

recommendations. The overall 

availability of the six items has not 

changed since 2014.

6.4 BASIC MANAGEMENT 

AND ADMINISTRATIVE SYSTEMS

6.4.1 Recent In-service Training and Supervision

In-service training and personal supervision related to ANC are key elements in ensuring supportive 

management of staff who provide ANC services. Training is critical to ensuring that personnel have the 

knowledge and skills to provide quality ANC services. Personal supervision helps sustain health worker 

capacity because it identifies a provider’s strengths and weaknesses. Table 6.7 presents information on 

recent in-service training (during the 24 months preceding the survey) and recent personal supervision 

(during the 6 months preceding the survey) of ANC providers.

Providers who have received recent in-service training can be expected to have more up-to-date knowledge 

about their particular service area. Table 6.7 shows that 19% (14% excluding providers at CCs) of ANC 

providers received ANC training during the 24 months preceding the survey. Twenty-six percent of ANC 

providers at CCs received recent in-service ANC training, along with 21% of providers at NGO facilities, 

12% of providers at district and upazila public facilities, 15% of providers at union-level facilities, and 

10% of providers at private hospitals. Providers at rural health facilities (21%) are more likely than 

providers at urban facilities (14%) to have received recent ANC training. This difference can be attributed 

to the concentration of CCs in rural areas.

The great majority of health workers who provide ANC services are supervised on a routine basis. At least 

9 in 10 providers at public facilities (97% at district and upazila facilities, 90% at union-level public 

facilities, and 96% at CCs) reported receiving personal supervision during the 6 months preceding the 

BHFS visit (Table 6.7). Ninety-six percent of providers at NGO facilities and 81% of providers at private 

hospitals received recent personal supervision.

6.4.2 In-service Training by Topic

Table 6.8 shows the percentages of providers of ANC services who reported ever receiving training on 

specific topics related to ANC and who reported receiving training on a given topic during the 24 months 

preceding the survey. Providers were most likely to report having ever received training on ANC 

counseling (40%), followed by family planning (39%) and pregnancy complications (34%). Around one 

third of providers have received in-service training on ANC screening. Providers are least likely to have 

received training on sexually transmitted diseases (10%).

Figure 6.14 Readiness of private hospitals to provide 

ANC services

78

79

82

98

26

7

2

82

79

87

95

28

25

8

Iron or folic acid tablets

Urine protein testing capacity

Hemoglobin testing capacity

Blood pressure apparatus

Staff trained for ANC at any

time

ANC guidelines

All six items

Percentage of facilities

BHFS 2014

(N=1,508)

BHFS 2017

(N=1,506)
102 • Antenatal Care Services

LIST OF TABLES

▪ Table 6.1 Availability of antenatal care services

▪ Table 6.2 Guidelines, trained staff, and basic equipment for antenatal care services

▪ Table 6.3 Diagnostic capacity

▪ Table 6.4 Availability of medicines for routine antenatal care

▪ Table 6.5 Items for infection control during provision of antenatal care

▪ Table 6.6 Readiness of health facilities to provide antenatal care services

▪ Table 6.7 Supportive management for providers of antenatal care services

▪ Table 6.8 Training for antenatal care service providers
Antenatal Care Services • 103

Table 6.1 Availability of antenatal care services

Among all facilities, the percentage offering antenatal care (ANC) services and, among facilities offering ANC services, the percentage 

offering the service on the indicated number of days per week, by background characteristics, Bangladesh HFS 2017

Percentage of 

facilities that 

offer ANC

Number of 

facilities

Percentage of facilities offering 

ANC where ANC services are 

offered on indicated days1

Number of 

facilities offering 

ANC

Background 

characteristic

Provides but not 

every day1

Provides every

day1

Facility type

District and upazila public facilities 99.4 44 2.4 97.6 44

DH 100.0 5 4.8 95.2 5

MCWC 100.0 7 10.1 89.9 7

UHC 99.1 32 0.3 99.7 32

Union-level public facilities 95.7 361 20.4 79.6 346

UHFWC 99.5 250 21.8 78.2 249

USC/RD 87.2 111 17.0 83.0 97

Community clinic (CC) 100.0 1,012 5.9 94.1 1,012

NGO clinic/hospital 99.8 64 1.6 98.4 63

Private hospital 94.9 43 5.7 94.3 41

Location

Urban 97.6 108 3.9 96.1 105

Rural 98.9 1,416 9.3 90.7 1,401

Division

Barishal 99.6 113 3.4 96.6 112

Chattogram 98.5 288 5.0 95.0 284

Dhaka 98.9 304 7.2 92.8 300

Khulna 98.6 187 9.6 90.4 185

Rajshahi 97.6 220 12.4 87.6 214

Rangpur 99.1 193 12.2 87.8 192

Sylhet 99.7 96 10.5 89.5 96

Mymensingh 99.9 123 13.8 86.2 122

Total 98.8 1,524 8.9 91.1 1,506

Total excluding CCs 96.5 512 15.2 84.8 494

1 Every day refers to all working days when the facility is open.
104 • Antenatal Care Services

Table 6.2 Guidelines, trained staff, and basic equipment for antenatal care services

Among facilities offering antenatal care (ANC) services, the percentage having guidelines, at least one staff member recently trained on ANC service 

delivery, and the indicated equipment observed to be available on the day of the survey, by background characteristics, Bangladesh HFS 2017

Percentage of facilities offering 

ANC that have: Equipment

Number of 

facilities 

offering 

ANC

Background 

characteristic

Guidelines 

on ANC1

Staff 

trained for 

ANC 

during the 

past 24 

months2

Staff 

trained for 

ANC at 

any time2

Blood 

pressure 

apparatus3

Stethoscope

Adult 

weighing 

scale

Fetal 

stethoscopeMeasuring 

tape4

Examination bed 

or couch

Facility type

District and upazila 

public facilities 60.3 45.7 85.5 98.8 98.8 97.0 15.2 57.5 98.8 44

DH 62.9 32.3 85.5 100.0 100.0 95.2 17.7 61.3 98.4 5

MCWC 53.4 35.6 79.0 97.8 97.8 94.5 17.9 52.5 93.3 7

UHC 61.4 49.9 86.9 98.9 98.9 97.9 14.3 58.0 100.0 32

Union-level public 

facilities 50.4 15.7 53.5 90.6 94.0 81.8 3.2 31.1 85.3 346

UHFWC 53.9 18.0 59.7 91.5 93.4 85.4 3.7 34.6 88.6 249

USC/RD 41.4 9.7 37.5 88.0 95.4 72.6 1.9 22.1 76.8 97

Community clinic 

(CC) 44.2 29.6 54.2 83.2 94.0 89.2 1.4 42.4 83.1 1,012

NGO clinic/hospital 75.1 37.8 63.8 98.0 100.0 100.0 15.4 72.3 99.8 63

Private hospital 6.6 17.1 26.4 97.7 98.4 98.5 38.8 54.2 96.0 41

Location

Urban 46.6 34.1 57.8 97.4 98.9 97.1 24.8 64.3 98.1 105

Rural 46.3 26.3 54.4 85.5 94.2 87.8 2.2 40.1 84.2 1,401

Division

Barishal 51.8 25.2 51.3 80.0 94.3 86.0 2.8 49.0 75.7 112

Chattogram 55.8 33.6 57.3 86.2 95.1 82.0 7.2 36.9 89.1 284

Dhaka 35.1 32.3 52.8 81.0 92.7 93.5 3.6 36.9 86.3 300

Khulna 66.0 27.9 56.9 86.6 95.3 93.1 5.9 61.6 87.9 185

Rajshahi 37.8 17.8 57.1 87.4 93.1 89.9 2.9 37.4 85.0 214

Rangpur 48.7 11.2 39.7 98.4 98.8 91.8 1.0 41.0 90.0 192

Sylhet 30.3 35.2 63.3 85.0 95.8 89.9 2.4 38.6 83.1 96

Mymensingh 41.2 31.8 64.6 85.7 91.4 76.9 0.7 40.5 71.7 122

Total 46.4 26.9 54.6 86.4 94.5 88.4 3.8 41.8 85.1 1,506

Total excluding CCs 50.9 21.3 55.4 92.8 95.5 86.9 8.8 40.6 89.2 494

Note: The guidelines for ANC and staff trained in ANC comprise the training domain and the blood pressure apparatus indicator comprises the 

equipment domain for assessing readiness to provide ANC services within the health facility assessment methodology proposed by WHO and 

USAID (2012).

1 National ANC guidelines/protocol/manual or other guidelines/protocol/manual relevant to antenatal care

2 Facility has at least one interviewed staff member providing ANC services who reports receiving in-service training in some aspect of antenatal 

care. The training must have involved structured sessions; it does not include individual instruction that a provider might have received during routine 

supervision.

3 Functioning digital blood pressure apparatus or else a functioning manual sphygmomanometer and a stethoscope

4 For measuring fundal height
Antenatal Care Services • 105

Table 6.3 Diagnostic capacity

Among facilities offering antenatal care (ANC) services, the percentages with the capacity to conduct the indicated tests in the facility, by 

background characteristics, Bangladesh HFS 2017

Percentage of facilities offering ANC that have the indicated tests

Number of 

facilities 

offering ANC

Background 

characteristic Hemoglobin1 Urine protein2 Urine glucose3

Blood grouping 

and Rhesus 

factor4 Syphilis5

Facility type

District and upazila public facilities 74.4 66.1 61.3 4.6 42.7 44

DH 87.1 85.5 88.7 22.6 87.1 5

MCWC 44.4 43.3 38.8 0.0 6.7 7

UHC 79.1 68.3 62.1 3.0 43.9 32

Union-level public facilities 15.0 18.1 15.2 - - 346

UHFWC 18.4 21.3 18.2 - - 249

USC/RD 6.4 10.0 7.4 - - 97

Community clinic (CC) 9.2 19.4 17.1 - - 1,012

NGO clinic/hospital 74.8 83.7 80.2 5.6 58.9 63

Private hospital 81.6 79.3 77.9 12.6 73.9 41

Location

Urban 80.8 78.6 77.4 9.0 60.5 105

Rural 12.4 20.7 18.1 0.1 1.6 1,401

Division

Barishal 18.2 22.0 23.7 0.3 3.3 112

Chattogram 25.3 27.7 21.9 0.9 6.0 284

Dhaka 19.5 25.1 23.0 1.7 11.4 300

Khulna 11.0 23.8 21.9 0.4 4.4 185

Rajshahi 13.5 30.2 27.0 0.5 4.5 214

Rangpur 5.8 7.3 7.2 0.1 3.3 192

Sylhet 31.2 39.4 35.4 0.5 3.4 96

Mymensingh 14.2 27.5 25.1 0.1 3.0 122

Total 17.2 24.8 22.2 0.7 5.7 1,506

Total excluding CCs 33.5 35.9 32.8 2.2 17.4 494

"-” Means Blood grouping and Rhesus factor and Syphilis tests are not offered at union-level public facilities or at public community clinics.

Note: The hemoglobin and urine protein measures presented in the table comprise the diagnostics domain for assessing readiness to provide 

ANC services within the health facility assessment methodology proposed by WHO and USAID (2012).

1 Capacity to conduct any hemoglobin test in the facility

2 Dip sticks for urine protein

3 Dip sticks for urine glucose

4 Anti-A, anti-B, and anti-D reagents, plus an incubator, Coomb’s reagent, and glass slides 

5 Rapid test for syphilis, Venereal Disease Research Laboratory (VDRL) test, or polymerase chain reaction (PCR) or rapid plasma reagin 

(RPR)
106 • Antenatal Care Services

Table 6.4 Availability of medicines for routine antenatal care

Among facilities offering antenatal care (ANC) services, percentages with essential medicines for ANC observed to be available on 

the day of the survey, by background characteristics, Bangladesh HFS 2017

Percentage of facilities offering ANC that have indicated medicines Number of 

facilities offering 

ANC

Background 

characteristic Iron tablets Folic acid tablets

Combined iron 

and folic acid

Iron or folic acid 

tablets

Facility type

District and upazila public facilities 92.0 95.1 87.6 96.1 44

DH 95.2 93.5 87.1 95.2 5

MCWC 90.0 93.3 84.5 94.4 7

UHC 91.9 95.7 88.3 96.6 32

Union-level public facilities 88.9 93.8 81.2 94.5 346

UHFWC 88.9 95.0 80.3 95.5 249

USC/RD 88.7 90.9 83.7 92.1 97

Community clinic (CC) 90.3 92.0 88.0 92.8 1,012

NGO clinic/hospital 87.9 91.4 83.6 91.5 63

Private hospital 74.4 78.0 65.0 78.0 41

Location

Urban 84.1 87.9 77.2 88.1 105

Rural 89.9 92.4 86.3 93.2 1,401

Division

Barishal 89.1 92.1 85.8 92.2 112

Chattogram 78.2 81.4 74.7 82.8 284

Dhaka 92.7 91.7 88.8 93.6 300

Khulna 94.3 96.2 91.0 96.2 185

Rajshahi 93.6 97.4 91.7 97.5 214

Rangpur 99.5 99.7 95.4 99.7 192

Sylhet 80.4 84.9 78.9 85.3 96

Mymensingh 85.2 96.5 74.5 97.2 122

Total 89.5 92.1 85.6 92.9 1,506

Total excluding CCs 87.8 92.3 80.7 92.9 494

Note: The medicines presented in the table comprise the medicines and commodities domain for assessing readiness to provide ANC 

services within the health facility assessment methodology proposed by WHO and USAID (2012).
Antenatal Care Services • 107

Table 6.5 Items for infection control during provision of antenatal care

Among facilities offering antenatal care (ANC) services, the percentages with indicated items for infection control observed to be available at the service site on 

the day of the survey, by background characteristics, Bangladesh HFS 2017

Percentage of facilities offering ANC that have items for infection control

Number of 

facilities 

offering 

ANC

Background 

characteristic Soap

Running 

water1

Soap and 

running 

water

Alcoholbased 

hand 

disinfectant

Soap and 

running 

water or 

else 

alcoholbased 

hand 

disinfectant

Latex 

gloves2

Sharps 

container

Waste 

receptacle3

All 6 items 

available4

At least 4 

items 

available

Facility type

District and 

upazila public 

facilities 75.3 90.8 72.8 52.5 81.0 84.1 70.5 49.4 22.6 71.3 44

DH 90.3 96.8 90.3 46.8 91.9 75.8 66.1 59.7 24.2 75.8 5

MCWC 74.5 89.0 72.3 44.5 76.8 85.5 74.4 44.5 21.1 69.0 7

UHC 73.3 90.3 70.3 55.1 80.2 85.0 70.3 48.9 22.7 71.1 32

Union-level public 

facilities 69.7 72.2 60.1 19.5 64.3 77.4 61.4 32.9 5.0 49.0 346

UHFWC 71.2 72.7 61.3 20.2 66.0 83.2 64.7 33.9 4.2 51.3 249

USC/RD 65.8 71.1 57.2 17.6 60.1 62.5 52.7 30.1 7.1 42.9 97

Community clinic 

(CC) 68.6 61.6 49.9 17.0 55.0 78.9 63.5 28.4 3.7 39.4 1,012

NGO clinic/

hospital 94.6 94.9 92.9 71.0 94.2 95.5 84.6 63.0 41.8 90.4 63

Private hospital 83.5 88.0 82.0 76.4 94.2 84.6 47.0 71.0 33.3 74.1 41

Location

Urban 86.8 91.6 84.3 67.6 91.1 88.1 68.5 69.5 37.8 81.2 105

Rural 69.3 65.1 53.4 19.0 58.3 79.0 63.3 29.9 4.6 42.9 1,401

Division

Barishal 56.0 61.4 44.9 22.8 49.4 72.7 74.1 49.4 12.1 50.4 112

Chattogram 72.1 69.2 58.4 19.7 63.1 83.1 57.2 32.8 3.7 45.6 284

Dhaka 74.6 73.7 62.9 24.1 66.9 81.0 63.9 24.5 9.4 46.7 300

Khulna 83.5 67.0 61.0 19.8 65.1 80.1 64.6 32.4 4.6 48.8 185

Rajshahi 71.9 61.9 50.4 23.9 57.1 83.1 66.4 46.6 7.4 50.7 214

Rangpur 76.8 66.3 60.1 21.4 64.6 75.2 58.5 31.5 8.3 45.7 192

Sylhet 57.7 65.9 46.7 24.8 53.8 77.1 70.2 23.4 6.5 35.3 96

Mymensingh 48.7 61.3 41.9 25.7 48.2 76.2 65.3 21.9 4.6 33.0 122

Total 70.5 67.0 55.6 22.4 60.6 79.6 63.7 32.7 6.9 45.6 1,506

Total excluding CCs 74.5 78.1 67.3 33.7 72.1 80.9 64.0 41.3 13.6 58.3 494

1 Piped water, water in bucket with specially fitted tap, or water in pour pitcher

2 Non-latex equivalent gloves are acceptable.

3 Waste receptacle with plastic bin liner

4 Soap, running water, alcohol-based hand disinfectant, latex gloves, sharps container, and waste receptacle
108 • Antenatal Care Services

Table 6.6 Readiness of health facilities to provide antenatal care services

Among facilities that offer antenatal care (ANC) services, the percentages with the indicated items considered important for the provision of 

quality ANC services, by background characteristics, Bangladesh HFS 2017

Background 

characteristic

Guidelines 

on ANC1

Staff trained 

for ANC at 

any time2

Blood 

pressure 

apparatus3

Hemoglobin 

testing 

capacity

Urine 

protein 

testing 

capacity

Iron or folic 

acid tablets All 6 items

Ultrasonography

Number of 

facilities 

offering 

ANC

Facility type

District and upazila 

public facilities 60.3 85.5 98.8 74.4 66.1 96.1 30.9 4.0 44

DH 62.9 85.5 100.0 87.1 85.5 95.2 45.2 17.7 5

MCWC 53.4 79.0 97.8 44.4 43.3 94.4 15.6 1.1 7

UHC 61.4 86.9 98.9 79.1 68.3 96.6 32.1 2.6 32

Union-level public 

facilities 50.4 53.5 90.6 15.0 18.1 94.5 6.6 - 346

UHFWC 53.9 59.7 91.5 18.4 21.3 95.5 8.5 - 249

USC/RD 41.4 37.5 88.0 6.4 10.0 92.1 1.8 - 97

Community clinic 

(CC) 44.2 54.2 83.2 9.2 19.4 92.8 1.2 - 1,012

NGO clinic/hospital 75.1 63.8 98.0 74.8 83.7 91.5 22.9 12.3 63

Private hospital 6.6 26.4 97.7 81.6 79.3 78.0 2.0 7.9 41

Location

Urban 46.6 57.8 97.4 80.8 78.6 88.1 23.4 9.1 105

Rural 46.3 54.4 85.5 12.4 20.7 93.2 2.8 0.2 1,401

Division

Barishal 51.8 51.3 80.0 18.2 22.0 92.2 6.0 0.1 112

Chattogram 55.8 57.3 86.2 25.3 27.7 82.8 5.2 0.1 284

Dhaka 35.1 52.8 81.0 19.5 25.1 93.6 3.0 2.5 300

Khulna 66.0 56.9 86.6 11.0 23.8 96.2 3.4 0.2 185

Rajshahi 37.8 57.1 87.4 13.5 30.2 97.5 5.2 1.2 214

Rangpur 48.7 39.7 98.4 5.8 7.3 99.7 2.4 0.4 192

Sylhet 30.3 63.3 85.0 31.2 39.4 85.3 6.6 0.5 96

Mymensingh 41.2 64.6 85.7 14.2 27.5 97.2 4.1 0.5 122

Total 46.4 54.6 86.4 17.2 24.8 92.9 4.3 0.8 1,506

Total excluding CCs 50.9 55.4 92.8 33.5 35.9 92.9 10.5 2.6 494

"-” Means ultrasonography is not offered at union-level public facilities or at public community clinics.

Note: Guidelines for ANC and staff trained in ANC comprise the training domain and the blood pressure apparatus indicator comprises the 

equipment domain for assessing readiness to provide ANC services within the health facility assessment methodology proposed by WHO and 

USAID (2012

1 National ANC guidelines or other guidelines relevant to ANC

2 Facility has at least one interviewed staff member providing ANC services who reports receiving in-service training in some aspect of ANC. The 

training must have involved structured sessions; it does not include individual instruction that a provider might have received during routine 

supervision.

3 Functioning digital blood pressure apparatus or a functioning manual sphygmomanometer and a stethoscope
Antenatal Care Services • 109

Table 6.7 Supportive management for providers of antenatal care services

Among interviewed antenatal care (ANC) providers, the percentages who received training related to their work and 

personal supervision during the specified time periods, by background characteristics, Bangladesh HFS 2017

Percentage of interviewed providers who received:

Number of 

interviewed ANC 

service providers

Background 

characteristic

Training related to 

ANC during the 

24 months 

preceding the 

survey1

Personal 

supervision during 

the 6 months 

preceding the 

survey2

Training related to 

ANC during the 

24 months and 

personal 

supervision during 

the 6 months 

preceding the 

survey

Facility type

District and upazila public facilities 11.9 96.8 11.7 821

DH 10.7 98.1 10.5 212

MCWC 18.3 95.0 16.9 46

UHC 11.8 96.5 11.8 563

Union-level public facilities 15.1 90.2 13.2 762

UHFWC 15.6 91.2 13.2 566

USC/RD 13.6 87.5 13.2 195

Community clinic (CC) 25.5 95.6 23.7 2,036

NGO clinic/hospital 20.5 96.4 19.9 299

Private hospital 9.7 80.5 9.2 330

Location

Urban 13.6 92.9 13.3 1,053

Rural 21.4 94.0 19.7 3,194

Division

Barishal 19.5 95.2 18.3 312

Chattogram 24.4 88.8 22.9 768

Dhaka 22.2 92.6 20.0 992

Khulna 17.6 97.5 17.1 523

Rajshahi 13.6 96.6 12.3 581

Rangpur 7.8 96.3 7.8 495

Sylhet 27.6 87.9 24.6 270

Mymensingh 23.7 97.6 23.3 306

Total 19.4 93.7 18.1 4,247

Total excluding CCs 13.8 92.1 13.0 2,212

1 Training refers only to in-service training. The training must have involved structured sessions; it does not include 

individual instruction that a provider might have received during routine supervision.

2 Personal supervision refers to any form of technical support or supervision from a facility-based supervisor or from a 

visiting supervisor. It may include, but is not limited to, review of records and observation of work, with or without any 

feedback to the health worker.
110 • Antenatal Care Services

Table 6.8 Training for antenatal care service providers

Among interviewed antenatal care (ANC) service providers, the percentages who reported receiving in-service training on topics related to ANC during the 

specified period before the survey, by background characteristics, Bangladesh HFS 2017

Percentage of interviewed providers of ANC who reported receiving in-service training on:

Number of 

interviewed 

ANC 

service 

providers

ANC counseling ANC screening

Complications of 

pregnancy Family planning1

Sexually transmitted 

infections2

Background 

characteristic

During the 

past 24 

months

At any 

time

During the 

past 24 

months

At any 

time

During the 

past 24 

months

At any 

time

During the 

past 24 

months

At any 

time

During the 

past 24 

months

At any 

time

Facility type

District and upazila 

public facilities 7.7 30.4 6.4 25.3 6.7 26.6 10.8 24.5 2.3 9.7 821

DH 4.9 30.6 3.8 25.0 5.0 30.1 8.3 21.0 3.0 9.9 212

MCWC 10.5 48.3 10.4 41.2 8.6 42.0 32.3 69.2 4.0 20.9 46

UHC 8.5 28.9 7.0 24.2 7.1 24.0 10.0 22.1 1.9 8.7 563

Union-level public 

facilities 9.8 41.1 6.5 31.1 8.3 32.7 27.3 65.5 4.0 19.8 762

UHFWC 11.3 45.1 7.5 35.5 9.6 35.5 31.7 73.3 4.0 20.7 566

USC/RD 5.6 29.4 3.4 18.5 4.5 24.3 14.5 43.0 3.8 17.2 195

Community clinic 

(CC) 21.5 47.1 14.0 34.9 17.0 40.2 18.6 38.4 2.6 6.9 2,036

NGO clinic/

hospital 15.1 38.3 7.6 26.7 8.9 28.4 25.5 51.0 10.1 20.2 299

Private hospital 8.7 16.1 5.8 12.8 8.3 16.0 6.8 10.3 0.9 1.2 330

Location

Urban 9.6 29.7 6.6 23.7 8.6 26.5 12.7 26.0 3.3 9.9 1,053

Rural 17.1 43.1 11.2 32.2 13.4 35.8 20.0 43.7 3.2 10.4 3,194

Division

Barishal 14.2 41.8 12.9 34.6 14.4 40.8 16.8 35.6 1.1 10.2 312

Chattogram 20.2 43.5 14.0 31.4 16.5 34.7 22.6 46.3 2.6 8.5 768

Dhaka 16.6 36.9 6.7 26.1 12.7 32.4 22.9 42.0 5.3 13.4 992

Khulna 15.4 41.2 13.4 34.9 12.4 31.6 10.3 29.3 3.5 7.9 523

Rajshahi 10.2 40.7 8.0 31.2 8.0 38.5 13.0 39.5 2.5 10.5 581

Rangpur 6.0 26.2 3.7 19.7 4.8 22.5 7.3 26.6 1.8 5.9 495

Sylhet 19.0 48.0 13.8 32.9 17.1 37.3 35.9 58.6 3.2 15.7 270

Mymensingh 20.9 48.4 13.7 38.6 13.0 34.8 18.9 37.0 2.9 10.5 306

Total 15.3 39.8 10.1 30.1 12.2 33.5 18.2 39.3 3.2 10.2 4,247

Total excluding CCs 9.6 33.0 6.5 25.6 7.8 27.3 17.9 40.1 3.7 13.3 2,212

Note: Training refers only to in-service training. The training must have involved structured sessions; it does not include individual instruction that a provider 

might have received during routine supervision.

1

Includes training in any of the following: general counseling for family planning, insertion and/or removal of intrauterine contraceptive device (IUCD), 

insertion and/or removal of implants, performing vasectomy, performing tubal ligation, clinical management of family planning methods including managing 

side effects, family planning for HIV-positive women, postpartum family planning, injectable contraceptives, and emergency contraceptive pills

2

Includes training in any of the following: diagnosing and treating sexually transmitted infections (STIs), the syndromic approach to diagnosing and 

managing STIs, and treatment of drug-resistant STIs
Delivery and Newborn Care • 111

DELIVERY AND NEWBORN CARE 7

Key Findings

▪ Overall, 6 in 10 health facilities (excluding community 

clinics [CCs]) offer normal delivery services. Almost all 

district hospitals (DHs), mother and child welfare centers 

(MCWCs), upazila health complexes (UHCs), and private 

hospitals offer delivery services, as compared with 53% of 

union-level public facilities, 32% of nongovernmental 

(NGO) clinics, and 7% of CCs (Table 7.1 and Figure 

7.1a).

▪ The availability of normal delivery services has increased 

from 18% in 2014 to 24% in 2017 (Figure 7.1a).

▪ Cesarean delivery services are available in all DHs and 

private hospitals but only 62% of MCWCs and 24% of 

UHCs provide Cesarean delivery services (Table 7.1 and 

Figure 7.1b).

▪ Forty-five percent of facilities have at least one staff 

person trained in delivery care, 12% have guidelines 

related to basic or comprehensive emergency obstetric 

care, and 83% have a delivery pack. The percentages of 

facilities with care guidelines, a suction apparatus, a 

manual vacuum extractor, a vacuum aspirator or dilation 

and curettage kit, and a partograph have decreased 

substantially since 2014 (Table 7.2 and Figure 7.2).

▪ One-fourth of facilities have at least one staff member 

trained in integrated management of pregnancy and 

childbirth and post-abortion care (Table 7.3). Around 40% 

of facilities have a staff member trained in routine labor 

and delivery care or active management of the third stage 

of labor.

▪ Essential life-saving drugs and commodities are often not 

available. For example, injectable magnesium sulphate 

(for management of eclampsia) is available in only 14% of 

facilities (Table 7.4).

▪ Overall, only 1% of facilities (versus 2% in 2014) have all 

of the 13 items (e.g., equipment, medicines) considered to 

be essential by WHO to provide quality services. Since 

2014, there have been declines in the availability of some 

of these tracer items (e.g., a suction apparatus, 

antibiotics, magnesium sulphate) and increases in the 

availability of others (e.g., trained staff, delivery packs, 

skin disinfectant). There has been little change in the

availability of examination lights, gloves, oxytocin, and 

intravenous solution (Table 7.7 and Figure 7.6).

▪ Only 11% (excluding CCs) of facilities had performed all 

seven basic signal functions for obstetric care in the last 3 

months. In addition, only 5% of facilities had performed all 

nine signal functions (Table 7.6).
112 • Delivery and Newborn Care

▪ Around one-third of providers have received in-service 

training on newborn resuscitation. Approximately twothirds (excluding CCs) of facilities have a newborn bag 

and mask for management of birth asphyxia (Table 7.2

and Table 7.13).

▪ Measurement of birth weight is fundamental in identifying 

low birth weight babies and providing optimum care. Only 

43% of facilities have an infant scale (Table 7.10).

▪ Overall, only 66% of facilities have suction bulbs. 

However, suction bulbs are almost universally available at 

district and upazila public facilities (Table 7.10).

▪ The availability of certain types of equipment for newborn 

care services, including as incubator, a suction apparatus 

with a catheter, an infant scale, a fetal stethoscope, and a 

thermometer for low body temperature, has increased 

substantially since 2014 (Figure 7.9).

7.1 BACKGROUND

angladesh showed remarkable progress in improving the maternal mortality rate (MMR) and the 

neonatal mortality rate (NMR) in the era of the Millennium Development Goals (MDGs). The 

MMR decreased from 322 per 100,000 live births in 2001 to 196 per 100,000 live births in 2016

and the NMR fell from 87 per 1,000 live births in 1990 to 28 per 1,000 live births in 2014. In accord with 

the Sustainable Development Goals (SDGs), the Government of Bangladesh has set the ambitious target of 

reaching an MMR of 121 per 100,000 live births and an NMR of 18 per 100,000 live births by 2022 in the 

4th Health, Population and Nutrition Sector Development Program (HPNSDP), with an emphasis on 

maternal and newborn care.

Continuous care during pregnancy and childbirth is important in reducing both maternal and newborn 

deaths. There is definitive global evidence that the availability of emergency obstetric and neonatal care 

(EmONC) and skilled attendance at childbirth is crucial to saving the lives of mothers and newborns. 

Institutional delivery care saves lives because a skilled birth attendant is immediately available to manage 

complications during labor and delivery or to refer the mother to the next level of care.

Hemorrhage and eclampsia alone are responsible for 55% of maternal deaths. A significant number of 

women die during the pregnancy and delivery period; the pregnancy-related morality rate is 206 per 

100,000 live births. The Bangladesh Maternal Mortality Survey (BMMS) has emphasized that after a 

significant reduction in the MMR from 2001 to 2010, this decline has begun to stall. No important 

differences in the MMR were found between the 2010 (194 maternal deaths per 100,000 live births) and 

2016 (196 maternal deaths per 100,000 live births) BMMS surveys. Only 37% of pregnant women had 

four or more antenatal care (ANC) visits as recommended by WHO. Around half of births occurred at 

health facilities and were attended by medically trained providers. It is important to note that one in three 

births were cesarean section (C-section) deliveries and that two in three facility deliveries were done via Csection. Overall, however, the percentage of women receiving the complete continuum of maternity care 

(ANC, delivery care, and postnatal care from medically trained providers) increased significantly between 

2010 and 2016, from 19% to 43%.

Although there have been remarkable reductions in NMRs worldwide, there are existing challenges to 

achieving SDG and national targets. In the least developed countries, the frequency of postnatal care 

(PNC) within 2 days of birth is very low, inhibiting physical examinations of newborns for danger signs 

and symptoms. In Bangladesh, the major causes of neonatal deaths include prematurity, infections, and 

intrapartum complications such as birth asphyxia. These preventable deaths could be eliminated with 

B
Delivery and Newborn Care • 113

increases in recommended ANC, births attended by medically trained providers, and PNC visits. 

Bangladesh is committed to addressing preventable causes of child mortality and to reaching the SDG 

target of reducing the NMR to 12 per 1,000 live births by 2030. The development of the “Promise 

Renewed Declaration: Bangladesh Call to Action 2013” and the inclusion of the National Newborn Health 

Program (NNHP) in the 4th HPNSDP are examples of the Bangladesh government’s continuous efforts to 

reduce the NMR.

Bangladesh has also reviewed its Maternal, Neonatal, Child, and Adolescent Health (MNC&AH) 

operational plan under the 4th HPNSDP. The HPNSDP focuses on strengthening safe deliveries at home, 

providing around-the-clock EmONC services at the upazila level, and developing a functional referral 

system from community facilities to upazila-level hospitals. To deliver high-quality MNC&AH services

and to achieve national outcomes, the Government of Bangladesh articulated the HNPSP and the 

Bangladesh Every Newborn Action Plan (BENAP) within the Health System Strengthening (HSS) 

framework.

This chapter explores the following key issues related to provision of quality delivery and newborn care 

services at health facilities in Bangladesh:

▪ Availability of maternal health services. Section 7.2, including Tables 7.1 through 7.5 and Figures

7.1a through 7.3, examines the availability of maternal health services, including the availability of 

service guidelines, staff with up-to-date training, basic items that support quality provision of delivery 

services, and items for infection control.

▪ Signal functions for emergency obstetric and newborn care. Section 7.3, including Table 7.6, 

Figure 7.4, and Figure 7.5, explores the extent to which facilities that provide normal delivery care 

performed nine signal functions at least once during the 3 months before the survey.

▪ Readiness of health facilities to provide normal delivery services. Section 7.4, including Table 7.7, 

Figure 7.6, and Figure 7.7, provides information on the readiness of health facilities to provide 

normal delivery services according to WHO criteria.

▪ Newborn care practices. Section 7.5, including Tables 7.8 through 7.10 and Figures 7.8 and 7.9,

provides information on routine newborn care practices in health facilities and the availability of 

essential medicines for newborns.

▪ Basic management and administrative systems. Section 7.6, including Tables 7.11 through 7.13,

considers the extent to which essential management and administrative systems are in place to support 

quality services, including personal supervision and in-service training for providers of delivery and 

newborn care.

7.2 AVAILABILITY OF MATERNAL HEALTH SERVICES

7.2.1 Service Provision

Table 7.1, Figure 7.1a, and Figure 7.1b provide information on the availability of various maternal health 

services. Although ANC and PNC are offered across all types of health facilities, normal delivery services 

are offered at only 24% (57% excluding public community clinics [CCs]) of facilities (Table 7.1). Normal 

delivery services are widely available in district hospitals (DHs) (100%), upazila health complexes (UHCs)

(95%), private hospitals (95%), and mother and child welfare centers (MCWCs) (92%). However, only

32% of nongovernmental (NGO) clinics/hospitals, 65% of union health and family welfare centers 

(UHFWCs), 25% of union subcenters/rural dispensaries (USC/RDs), and 7% of CCs provide normal 

delivery services. Urban facilities (72%), as expected, are much more likely than rural facilities (20%) to 

offer normal delivery services. Facilities in the newly introduced Mymensingh division (18%), which has 

been separated from Dhaka, are least likely to offer normal delivery care, while facilities in Barishal (29%) 
114 • Delivery and Newborn Care

are most likely to offer such care. Fifty-six percent of facilities (excluding CCs) offer ANC, normal 

delivery, and PNC services in combination.

As expected, since union-level facilities and CCs do not perform cesarean section deliveries, only a very

small proportion of health facilities overall (4%) provide cesarean services. All district hospitals, twothirds of MCWCs, and only one-fourth of UHCs offer cesarean delivery services. Cesareans are available 

in 97% of private hospitals and 11% of NGO facilities. Fifty-seven percent of urban facilities perform 

cesarean deliveries, as compared with less than 1% of rural facilities.

Among facilities that offer normal delivery services, 60% (2% (excluding CCs) reported having a provider 

on-site or on-call 24 hours per day for delivery care. However, only 29% of facilities (35% (excluding 

CCs) were able to show the supporting duty schedule on the day of the visit. DHs (92%) and UHCs (85%) 

are more likely than other facilities to have providers on-site or on-call 24 hours a day and to have a 24-

hour duty schedule. All private hospitals offering normal delivery services report having providers on-site 

or on-call 24 hours per day, but only about three-fourths were able to show the supporting duty schedule.

The availability of normal delivery services has increased in the last 3 years across almost all types of 

facilities. The gain has been particularly notable in union-level public facilities (Figure 7.1a).

Figure 7.1a Availability of normal delivery services in health 

facilities, by facility type

Figure 7.1b shows the availability of cesarean delivery services at different types of health facilities. As 

noted above, almost all DHs and private hospitals offer cesarean services, as compared with only onefourth of UHCs. Because UHCs are the primary care referral facilities, their capacity to offer cesarean

services should be strategically increased (Figure 7.1b). There have been no notable changes since 2014 in 

the availability of C-section services across the different individual types of facilities. However, there has 

been a slight overall increase in the availability of cesarean sections, from 12% (excluding CCs) in 2014 to 

13% (excluding CCs) in 2017.

18

39

98

90 97

36

11 7

31

93

24

57

100

92 95

65

25

7

32

95

Total

facilities

Total

facilities

excluding

CC

DH MCWC UHC UHFWC USC/RD CC NGO Private

Percentage of facilities

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)
Delivery and Newborn Care • 115

Figure 7.1b Availability of cesarean delivery services in health 

facilities, by facility type

7.2.2 Guidelines, Trained Staff, and Equipment for Delivery Services

The quality of delivery services depends partly on the availability of guidelines, staff with up-to-date 

training, and certain basic equipment. Table 7.2 reports the extent to which these elements were available 

on the day of the survey in facilities that offer normal delivery services.

Only 12% of facilities offering normal delivery services had guidelines related to basic emergency 

obstetric care (BEmOC) or comprehensive emergency obstetric care (CEmOC). DHs (36%), MCWCs 

(22%), and UHCs (22%) were slightly more likely to have guidelines than other types of public facilities. 

NGO facilities were most likely to have guidelines (38%), and private hospitals were least likely (only 

5%). Urban facilities (17%) were slightly more likely than rural facilities (11%) to have any of the 

guidelines for BEmOC or CEmOC. Facilities in Khulna (28%) were more likely than those in other 

divisions to have guidelines; only 4% each of facilities in Barishal and Mymensingh and 8% of facilities in 

Dhaka had guidelines available.

Only 11% of facilities had staff who had received training in delivery care in the last 24 months. NGO 

facilities (36%) and district and upazila health facilities (22%) were most likely to have staff with recent 

training. Forty-five percent of facilities had at least one staff person who had been trained in delivery care 

at any time. Private clinics/hospitals (16%) were least likely to have at least one staff person with training

in delivery care at any time.

Emergency transport may be critical if a woman needs to be referred to another facility for more 

specialized care. About one-third (35% excluding CCs) of facilities had emergency transport. DHs (97%) 

and UHCs (86%) were more likely than MCWCs (65%) to have emergency transport. Only 11% of CCs 

and 9% of union-level public facilities reported the availability of emergency transport.

With respect to the equipment necessary to support routine delivery care, 63% (64% excluding CCs) of 

facilities had an examination light and 76% (77% excluding CCs) had gloves available on the day of the 

survey visit. In addition, 83% (85% excluding CCs) had a delivery pack, and around three-fourths had a 

delivery bed. More than 80% of district and upazila public facilities, NGO clinics, and private hospitals 

had a delivery bed, along with 75% of union-level facilities and 66% of CCs. Facilities were less likely to 

have a suction apparatus (mucus extractor) (31%). A neonatal bag and a mask were available in 55% of 

facilities. The availability of a neonatal bag and mask was almost universal in DHs (98%) and relatively 

high in UHCs (89%), MCWCs (83%), and private hospitals (88%). In contrast, only half of union-level 

facilities and one quarter of CCs had a bag and mask. Only 20% of facilities overall had partographs, with 

4

12

98

55

20 15

95

4

13

100

62

24

11

97

Total facilities Total facilities

excluding CC

DH MCWC UHC NGO Private

Percentage of facilities

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)
116 • Delivery and Newborn Care

the highest percentage among NGO clinics (65%). Less than half of DHs, MCWCs, and UHCs had 

partographs available.

There have been substantial 

decreases since 2014 in the 

percentages of facilities having 

guidelines on BEmOC or CEmOC, 

a suction apparatus, a manual

vacuum extractor, a vacuum

aspirator, a dilation and curettage 

(D&C) kit, and a partograph 

(Figure 7.2). In addition, there has 

been a 3% decrease in the 

availability of emergency transport 

and a 2% decline in the availability 

of an examination light. The 

availability of delivery packs has 

increased from 60% to 83%. There 

have also been increases in the 

availability of delivery beds, 

gloves, and neonatal bags and 

masks.

Table 7.3 presents information on 

the availability of staff with inservice training in areas related to delivery or newborn care. The table considers staff who have ever 

received in-service training and staff who received training within the 24 months before the survey.

Only 6% of facilities that offer normal delivery services have providers who received in-service training in 

integrated management of pregnancy and childbirth (IMPAC) during the 24 months preceding the survey;

24% (23% excluding CCs) of facilities have at least one provider who has ever received in-service training 

in IMPAC (Table 7.3). District and upazila public facilities are more likely than union-level facilities, 

CCs, and private hospitals to have a provider with in-service training at any time. Only 9% of facilities 

have providers who had received in-service training on routine care for labor and delivery during the past 

24 months, while 41% (43% excluding CCs) have at least one provider who has ever received in-service 

training.

Fifty percent (51% excluding CCs) of facilities reported having at least one staff member who had ever 

received in-service training in neonatal resuscitation, but only 21% had at least one staff member with 

recent in-service training on the subject (Table 7.3). Forty percent (41% excluding CCs) of facilities have 

a staff member who has ever received in-service training in active management of the third stage of labor 

(AMTSL). However, only 9% (10% excluding CCs) of facilities have staff who received this training 

during the 24 months before the survey. Even fewer facilities have staff with in-service training in postabortion care or emergency obstetric care at any time. Only 23% of facilities (24% excluding CCs) have at 

least one staff member who has ever received training in post-abortion care, while 19% (20% excluding 

CCs) have at least one staff member who has received training in emergency obstetric care. Less than 10%

of facilities reported that staff received training on these subjects during the 24 months before the survey.

7.2.3 Medicines and Commodities for Delivery Care

Table 7.4 presents information on the availability of essential medicines and commodities for delivery care 

and priority medicines for mothers.

Figure 7.2 Items to support quality provision of 

delivery services

76

76

20

55

24

20

31

83

63

30

45

12

73

71

25

46

29

25

48

60

65

33

39

27

Delivery bed

Gloves

Partograph

Neonatal bag & mask

Vaccum aspirator or D&C kit

Manual vaccum extractor

Suction apparatus

Delivery pack

Examination light

Emergency transport

EQUIPMENT & SUPPLIES

Staff trained in delivery care at

any time

Guidelines on BEmOC or

CEmOC

Percentage of facilities

BHFS 2014

(N=280)

BHFS 2017

(N=358)
Delivery and Newborn Care • 117

Essential Medicines and Commodities

On the day of the survey, only around one-third of facilities (31%) offering normal delivery services had 

injectable uterotonics as required for active management of the third stage of labor and postpartum 

hemorrhage. Although availability was relatively high among DHs (89%) and MCWCs (75%), only 61%

of UHCs had injectable uterotonics on the day of the visit. Moreover, less than one-fifth (18%) of unionlevel facilities and 10% of CCs had injectable uterotonics available. Facilities were least likely to have 

injectable magnesium sulphate (14%), which is essential for management of eclampsia. Only 42% of DHs, 

26% of MCWCs, and 28% of UHCs had injectable magnesium sulphate. Private hospitals (48%) were 

most likely to have this essential medicine. Only 6% of union-level facilities and no CCs had injectable 

magnesium sulphate available. Nearly 60% of district and upazila public facilities had injectable 

antibiotics, which are required for management of puerperal sepsis. Within district and upzila public 

facilities, DHs (84%) were more likely than MCWCs (41%) and UHCs (59%) to have injectable 

antibiotics. Around two-thirds of NGO clinics and private hospitals had injectable antibiotics available. 

Only one-third of facilities (38% excluding CCs) had intravenous (IV) fluids with infusion sets, which are 

essential for managing severe postpartum hemorrhage. Availability was highest among DHs (74%). Only 

two-thirds of UHCs and less than half of MCWCs had intravenous fluids.

Priority Medicines for Mothers

Table 7.4 also provides information on the availability of WHO-defined priority medicines for mothers on 

the day of the survey. In general, these priority medicines were not widely available, and they were much 

more likely to be available in higher-level facilities than in lower-level facilities. Moreover, even among 

higher-level facilities, there was considerable variation in their availability. Sodium chloride injectable 

solution ( 38%) and azithromycin capsules or tablets (21%) were the most widely available priority 

medicines; 70% or more of DHs, private hospitals, and NGO facilities reported having these medications. 

Fifty-seven percent of facilities had misoprostol capsules or tablets, which are important for management 

of postpartum hemorrhage. Although 61% of union-level facilities had misoprostol capsules or tablets, 

they were available at less than 40% of DHs and UHCs. Misoprostol was available in around two-thirds of 

NGO clinics and private hospitals. Overall, private hospitals were more likely than DHs and NGO 

facilities to have priority medicines for mothers.

7.2.4 Items for Infection Control during Provision of Delivery Care

Infection control is vital during delivery care. Table 7.5 shows the proportion of facilities that had items 

considered important for infection control available at the service site on the day of the survey visit. 

Overall, 72% of facilities had either soap and running water or alcohol-based hand disinfectant, with the 

availability of these items almost universal in DHs, MCWCs, NGO clinics, and private hospitals. 

However, less than half of CCs and three-fourths of union-level facilities had these items available. 

Eighteen percent (19% excluding CCs) of facilities had all six items for infection control, and 61% (65%

excluding CCs) had at least four items. Most DHs (86%), MCWCs (77%), private hospitals (75%), and 

NGO facilities (90%) had at least four infection control items, while only 43% of CCs had at least four 

items.
118 • Delivery and Newborn Care

Figure 7.3 shows that there has 

been no improvement since 2014 in 

the percentage of facilities with 

infection control items available. In 

2014, 24% of health facilities had 

all six items for infection control 

available on-site; this proportion 

had declined to 18% by 2017, 

mainly due to a decrease in the 

availability of soap and/or alcoholbased hand disinfectant. There were 

no significant differences in the 

availability of at least four items 

and the availability of a waste 

receptacle between the two surveys. 

The availability of a sharps 

container, latex gloves, and running water increased from 2014 to 2017, while the availability of soap 

decreased by 15%. There was a 10% decrease in the availability of alcohol-based hand disinfectant 

between the two surveys.

7.3 SIGNAL FUNCTIONS FOR EMERGENCY OBSTETRIC AND NEWBORN CARE

Complications of labor and delivery can be expected to occur in some deliveries. About 15% of mothers 

develop life-threatening complications during delivery. In such situations, facilities must be equipped to 

provide emergency obstetric and neonatal care (EmONC). Within EmONC, there are nine signal functions 

layered in three levels: obstetric first aid, basic emergency obstetric and neonatal care (BEmONC), and 

comprehensive emergency obstetric and neonatal care (CEmONC). Facilities were considered to be

BEmONC facilities if they performed the seven basic signal functions over a designated 3-month period.

Facilities were considered to be CEmONC facilities if they performed all nine signal functions over the 

designated period.

In the 2017 BHFS, facilities providing normal delivery care were asked whether they had performed any of 

the specified signal functions at least once during the 3 months preceding the survey. Only 11% of 

facilities had performed all seven basic signal functions (BEmONC) in the last 3 months (Table 7.6). 

Fifty-seven percent of DHs had performed the seven basic signal functions, with much lower estimates 

among MCWCs (24%) and UHCs (25%). Only 1% of union-level facilities and 14% of CCs had 

performed the basic signal functions in the last 3 months, along with 39% of private hospitals and 9% of 

NGO clinics.

All district and private hospitals offering normal delivery services had performed cesarean sections in the 

past 3 months. Around two-thirds of MCWCs and one-fourth of UHCs performed cesarean sections during 

that period.

Only 5% (6% excluding CCs) of facilities had performed all nine signal functions (CEmONC) in the past 3

months. Although, as noted, all DHs and private hospitals had performed cesarean sections in the past 3

months, only 55% of DHs and 29% of private hospitals had performed all nine signal functions during that 

period. In addition, only 8% of MCWCs and 5% of UHCs performed all nine signal functions.

Between 2014 and 2017, there was a slight overall decline in the percentage of facilities that performed the 

seven basic signal functions (Figure 7.4). It is encouraging that higher proportions of CCs and private 

hospitals reported performing the seven basic functions in 2017 than in 2014. The proportion of facilities 

that performed all nine signal functions increased notably among private clinics (from 16% to 29%) but 

declined among NGO clinics (from 9% to 5%) (Figure 7.5).

Figure 7.3 Items for infection control in delivery 

service area

18

61

50

73

76

40

79

75

24

60

48

66

71

50

72

90

All 6 items available

At least 4 items available

Waste receptacle

Sharps container

Latex gloves

Alcohol-based hand disinfectant

Running water

Soap

Percentage of facilities

BHFS 2014

(N=280)

BHFS 2017

(N=358)
Delivery and Newborn Care • 119

Figure 7.4 Basic emergency obstetric and neonatal care (BEmONC) 

signal functions, by facility type

Figure 7.5 Comprehensive emergency obstetric and neonatal care 

(CEmONC) signal functions, by facility type

7.4 READINESS OF HEALTH FACILITIES TO PROVIDE NORMAL DELIVERY SERVICES

WHO assesses the readiness of health facilities for normal delivery services according to the availability of 

specific items/tracer indicators. In this section of the report, data from the 2017 BFHS are used to construct 

a slightly less restrictive and Bangladesh-context-appropriate version of the WHO measure. This measure 

of readiness to provide normal delivery services includes the following 13 items/tracer indicators:

▪ Trained staff: At least one provider trained in delivery care at any time

▪ Guidelines: National or other BEmOC or CEmOC guidelines available at the facility

▪ Equipment:

o Examination light

o Delivery pack

o Suction apparatus

o Neonatal bag and mask

o Partograph

o Gloves

13 17

53

23

36

1

8

0

28 32

11 11

57

24 25

1 1

14 9

39

Total

facilities

Total

facilities

excluding

CC

DH MCWC UHC UHFWC USC/RD CC NGO Private

Percentage of facilities

BHFS 2014

(N=280)

BHFS 2017

(N=358)

4 6

49

6 5

9

16

5 6

55

8 5 5

29

Total facilities Total facilities

excluding CC

DH MCWC UHC NGO Private

Percentage of facilities

BHFS 2014

(N=280)

BHFS 2017

(N=358)
120 • Delivery and Newborn Care

▪ Medicines and commodities:

o Injectable oxytocin

o Injectable antibiotic

o Magnesium sulphate

o Skin disinfectant

o Intravenous solution with infusion set

Table 7.7, Figure 7.6, and Figure 7.7 show the availability of these items/tracer indicators for assessing a 

health facility’s readiness for normal delivery services.

Eighty-three percent of facilities have a delivery pack, 76% have gloves, and 63% have an examination 

light (Table 7.7). Approximately half of facilities have a neonatal bag and mask, staff trained in delivery 

care at any time, and skin disinfectant, and around one-third have a suction apparatus, injectable uterotonic 

oxytocin, and intravenous fluids with an infusion set. Overall, less than 1% of facilities have all of the 13 

items are considered to be essential by WHO to provide BEmOC and CEmOC services. Five percent of 

DHs and NGO clinics have all 13 items. Availability is 1% or less at other types of facilities.

The availability of guidelines, a 

suction apparatus, a partograph, 

antibiotics, and magnesium 

sulphate has decreased markedly 

since 2014. Conversely, there have 

been substantial increases in the 

availability of trained staff, a 

delivery pack, a neonatal bag and 

mask, and skin disinfectant. There 

has been little change in the

availability of examination lights, 

gloves, oxytocin, and IV solution 

(Figure 7.6).

Figure 7.6 Availability of items/tracer indicators in 

health facilities for readiness to provide normal 

delivery services

27

39

65

60

48

46

25

71

34

33

22

27

36

2

12

45

63

83

31

55

20

76

31

19

14

52

32

1

Guidelines on BEmOC or CEmOC

Trained staff in IMPAC at any time

Examination light

Delivery pack

Suction aparatus

Neonatal bag and mask

Partograph

Gloves

Oxytocin

Antibiotic

Magnesium sulphate

Skin disinfectant

IV solution

Percentage having 13 items

Percentage of facilities

BHFS 2014

(N=280)

BHFS 2017

(N=358)
Delivery and Newborn Care • 121

Although the estimates were already very low in 2014, the availability of the 13 essential items for 

conducting normal deliveries has decreased across all types of facilities (Figure 7.7).

Figure 7.7 Readiness of health facilities to provide normal delivery 

services, by facility type

7.5 NEWBORN CARE PRACTICES

7.5.1 Routine Newborn Care

Routine newborn care is crucial to ensure the survival of newborns. Table 7.8 presents information 

regarding routine for newborn care practices at facilities offering normal delivery services.

Around 95% of all types of facilities engage in routine newborn practices such as drying and wrapping 

newborns to keep them warm and initiating breastfeeding within the first hour (Table 7.8). Initiation of 

breastfeeding within the first hour is universal at MCWCs, UHCs, CCs, and NGO clinics/hospitals. 

Around 5% of public facilities report that they give newborns a full bath shortly after birth as a routine 

component of newborn care, as compared with 10% of private hospitals. Approximately 95% of DHs, 

MCWCs, upazila hospitals, and private hospitals; 85% of union-level facilities; and 66% of CCs apply 

7.1% chlorohexidine for cord care as a routine component of newborn care. DHs, UHCs, CCs, USC/RDs,

and private hospitals are more likely to engage in the practice of delivering to the abdomen (skin to skin) 

than MCWCs, UHFWCs, and NGO clinics/hospitals. District and upazila public facilities (around 90%) 

are more likely than union-level public facilities (68%) and CCs (58% to suction newborns with a suction 

bulb and weigh newborns immediately after delivery. All private hospitals weigh newborns immediately 

after delivery as part of routine newborn care. There are significant differences by facility type in 

administration of vitamin K to newborns. Eighty-four percent of DHs; 66% of MCWCs, 65% of UHCs, 

63% NGO clinics; 91% of private hospitals; and 22% of union-level public facilities administer vitamin K.

7.5.2 Availability of Essential Medicines for Newborn Care

Nearly 70% of facilities had amoxicillin syrup or suspension available on the day of the visit (Table 7.9). 

Availability was highest among CCs (91%) and MCWCs (87%). Around half of DHs (58%), UHCs (56%), 

NGO clinics (55%), and private hospitals (52%) had amoxicillin available on the day of the visit. 

Injectable gentamicin was available in only 16% of facilities; availability was highest in private hospitals 

(76%). Less than half of DHs (44%) and UHCs (40%) had gentamicin on the day of the visit. In addition, 

gentamicin was available in only 11 of MCWCs and 3% of union-level public facilities. The availability of 

ceftriaxone was relatively high among DHs and private hospitals (89% each). About two-thirds of UHCs 

and three-fourths of NGO clinics had ceftriaxone available. Around half of facilities offering normal 

delivery services had 7.1% chlorhexidine present on the day of the visit. Availability was highest in

2 3

12

8 7

<1 <1 <1

10

1 1 <1

5

1 <1 <1 <1 <1

5

<1

Total

facilities

Total

facilities

excluding

CC

DH MCWC UHC UHFWC USC/RD CC NGO Private

Percentage of facilities

BHFS 2014

(N=280)

BHFS 2017

(N=358)
122 • Delivery and Newborn Care

MCWC (65%) and lowest in UHCs 

and private hospitals (41% each). 

About 41% of had 7.1%

chlorhexidine on the day of the 

visit.

The availability of 7.1%

chlorohexidine has increased by 

20% since 2014 (Figure 7.8). 

There has been a smaller increase 

in the availability of antibiotic eye 

ointment for newborns. The 

availability of injectable 

gentamicin, injectable ceftriaxone, 

injectable ampicillin, and 

amoxicillin syrup/suspension has 

decreased by 3% to 11% since 

2014.

7.5.3 Availability of Equipment for Newborn Care Services

Half of DHs, 19% of UHCs, and 41% of private hospitals have incubators for newborns (Table 7.10).

Thirty-three percent of facilities in urban areas have incubators, as compared with 3% of facilities in rural

areas.

Eighty-nine percent of district and upazila public facilities and 84% of private hospitals have suction bulbs. 

However, suction bulbs are available at only around two-thirds of union-level public facilities and NGO 

clinics.

A neonatal bag and a mask are available at 89% of district and upazila public facilities, 88% of private 

hospitals, and 76% of NGO clinics. Half of union-level public facilities and one quarter of CCs have a 

neonatal bag and mask.

Thirty-eight percent of facilities have a timer for assessing respiratory rates. Timers are available at around 

half of district- and subdistrict-level public facilities, NGO clinics, and private hospitals, along with about 

one-third of union-level public facilities and one quarter of CCs.

Fewer than half of facilities offering delivery services have an infant scale. Availability is highest among 

NGO clinics (79%). Around two-thirds of district and upazila public facilities and private hospitals, onethird of union-level public facilities, and one quarter of CCs have an infant scale.

Overall, there has been a decrease in the availability of equipment for newborn care since 2014 (Figure 

7.9). There have been substantial declines in the availability of a thermometer for low body temperature, a 

fetal stethoscope, an infant scale, and a suction apparatus with a catheter. There have also been decreases

in the availability of incubators and thermometers. On the other hand, there has been an increase of around 

10% in the availability of newborn bags and masks and suction bulbs.

Figure 7.8 Availability of medicines for newborn care 

services in health facilities

31

16

23

69

7

52

24

19

28

80

14

32

Antibiotic eye ointment for newborn

Injectable gentamicin

Injectable ceftriaxone

Amoxicillin syrup/suspension

Ampicillin injection

7.1% chlorhexidine

Percentage of facilities

BHFS 2014

(N=280)

BHFS 2017

(N=358)
Delivery and Newborn Care • 123

Figure 7.9 Availability of equipment for newborn care services in 

health facilities

7.6 BASIC MANAGEMENT AND ADMINISTRATIVE SYSTEMS

7.6.1 Recent In-service Training and Supervision

Supportive management practices such as training and supervision play a significant role in ensuring

quality of care. In-service training in maternal and newborn health care not only improves the knowledge 

of delivery care providers but enhances their skills. Table 7.11 presents information on specific in-service 

training reported by providers of normal delivery or newborn care services within 6 months or 24 months 

of the survey.

One-fourth of providers received training related to delivery care and/or newborn care during the 24 

months preceding the 2017 BHFS (Table 7.11). Around 30% of providers at public facilities received 

training during the 24 months preceding the survey, as compared with 9% of providers at private hospitals. 

Similar proportions of delivery care providers from urban and rural areas received recent training.

Supportive supervision helps to sustain providers’ knowledge and skills. More than 90% of providers 

across all type of public facilities reported that they received personal supervision during the 6 months 

preceding the survey. Around four-fifths of delivery care providers at private hospitals received recent 

personal supervision. Interestingly, providers at rural facilities (94%) were more likely than those at urban 

facilities (91%) to report receiving personal supervision. More than 90% of delivery care providers in all 

divisions other than Sylhet and Chattogram received personal supervision during the 6 months preceding 

the survey.

7.6.2 In-service Training in Newborn and Delivery Care by Topic

Table 7.12 shows the percentages of providers who reported receiving specific in-service training related 

to delivery and newborn care. Around 10% of providers of delivery care or newborn services received 

training in early and exclusive breastfeeding, thermal care, sterile cord cutting and care, and kangaroo 

mother care for low birth weight babies during the 24 months preceding the survey. The proportion of 

providers who reported that they had ever received training in these areas was more than twice as high as 

the proportion who reported receiving training in the 24 months preceding the survey. Only 5% of 

providers reported receiving training on newborn infection management during the 24 months preceding 

the survey.

Table 7.13 presents information on specific in-service training related to newborn care services. Around 

one-third of providers of normal delivery and newborn care services had received training on newborn 

resuscitation at any time. However, only 14% reported receiving such training in the past 24 months.

18

48 55

46

59

33

88

21

9

31

66

55

43

11

87

8

Incubator Suction

apparatus

with

catheter

Suction

bulb with

penguin

sucker

Newborn

bag and mask

Infant

scale

Fetal

stethoscope

Thermo- meterThermo- meter for

low body

temperature

Percentage of facilities

BHFS 2014

(N=358)

BHFS 2017

(N=280)
124 • Delivery and Newborn Care

Eleven percent of providers at private hospitals and 22% at NGO clinics had ever received training on 

resuscitation.

Around one-third of providers had ever received in-service training on application of 7.1% chlorhexidine 

(for umbilical cord care), but only 15% reported receiving such training in the past 24 months. One in 10 

providers at private hospitals had training on chlorhexidine application.

Ten percent of providers had received in-service training on emergency triage assessment (ETAT) at any 

time, with only 3% reporting such training during the past 24 months.

Only 20% of providers had ever received training in essential newborn care, and only 10% had training in 

comprehensive newborn care.

Less than 20% of providers had been trained in integrated management of childhood illness (IMCI) at any 

time, and 5% had received such training in the past 24 months. Around one-quarter of providers at unionlevel facilities and one-fifth of providers at district and subdistrict public facilities had ever been trained in 

IMCI. Only small percentages of providers at private hospitals (4%) and NGO clinics (14%) had been 

trained in IMCI.

LIST OF TABLES

▪ Table 7.1 Availability of maternal health services

▪ Table 7.2 Guidelines, trained staff, and equipment for delivery services

▪ Table 7.3 Availability of staff trained on normal delivery or newborn care

▪ Table 7.4 Medicines and commodities for delivery

▪ Table 7.5 Items for infection control during provision of delivery care

▪ Table 7.6 Signal functions for emergency obstetric care

▪ Table 7.7 Readiness of health facilities to provide normal delivery services

▪ Table 7.8 Newborn care practices

▪ Table 7.9 Essential medicines for newborn care

▪ Table 7.10 Availability of equipment for newborn care services

▪ Table 7.11 Supportive management for providers of delivery care

▪ Table 7.12 Training for providers of normal delivery services: Immediate newborn care

▪ Table 7.13 Training for providers of normal delivery services: Immediate newborn care
Delivery and Newborn Care • 125

Table 7.1 Availability of maternal health services

Among all facilities, the percentages offering specific maternity services and the full range of maternity services and, among facilities that offer normal delivery 

services, the percentages having a skilled provider available on-site or on-call 24 hours a day to conduct deliveries, with or without an observed duty schedule, by 

background characteristics, Bangladesh HFS 2017

Percentage of facilities offering:

Number of 

facilities

Percentage of 

facilities offering 

normal delivery 

services that have:

Number of 

facilities 

offering 

normal 

delivery 

services

Background 

characteristic

Antenatal 

care 

(ANC)

Normal 

delivery 

service

Cesarean 

delivery

Postnatal 

care 

(PNC)

ANC and 

normal 

delivery 

service

ANC, 

normal 

delivery, 

and 

cesarean 

delivery

ANC, 

normal 

delivery,

and PNC 

ANC, 

normal 

delivery, 

PNC, and 

cesarean 

delivery

Provider 

of delivery 

care 

available 

on-site or 

on-call 24 

hours/day, 

with 

observed 

duty 

schedule

Provider 

of delivery 

care 

available 

on-site or 

on-call 24 

hours/day, 

with or 

without 

observed 

duty 

schedule

Facility type

District and upazila 

public facilities 99.4 95.4 38.1 98.4 95.4 38.1 94.6 37.3 44 83.5 95.7 42

DH 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 5 91.9 98.4 5

MCWC 100.0 92.2 62.2 97.7 92.2 62.2 91.1 61.1 7 71.2 89.3 6

UHC 99.1 95.4 23.8 98.3 95.4 23.8 94.5 22.9 32 84.7 96.6 31

Union-level public 

facilities 95.7 52.5 - 93.1 52.5 - 51.8 - 361 12.5 60.0 190

UHFWC 99.5 64.7 - 98.4 64.7 - 64.2 - 250 11.6 63.3 162

USC/RD 87.2 24.9 - 81.2 24.9 - 23.8 - 111 17.7 40.8 28

Community clinic 

(CC) 100.0 6.5 - 96.4 6.5 - 6.3 - 1,012 0.0 6.6 66

NGO clinic/hospital 99.8 32.0 11.2 98.7 32.0 11.2 32.0 11.2 64 60.6 75.4 20

Private hospital 94.9 94.6 97.1 95.5 92.4 92.4 90.7 90.7 43 78.2 100.0 41

Location

Urban 97.6 72.0 56.8 97.6 71.2 54.9 70.4 54.2 108 76.9 98.5 78

Rural 98.9 19.8 0.3 95.6 19.8 0.3 19.5 0.3 1,416 15.3 49.0 281

Division

Barishal 99.6 29.0 2.3 95.9 28.9 2.2 27.1 2.2 113 17.9 54.4 33

Chattogram 98.5 27.6 5.3 95.7 27.4 5.1 27.2 4.9 288 29.0 64.1 80

Dhaka 98.9 25.8 7.4 98.2 25.8 7.4 25.8 7.4 304 35.0 71.6 78

Khulna 98.6 19.0 3.8 93.3 19.0 3.3 19.0 3.3 187 31.3 50.6 36

Rajshahi 97.6 24.7 3.1 94.9 24.7 3.0 23.6 3.0 220 19.0 52.5 54

Rangpur 99.1 19.5 3.0 94.4 19.3 2.9 19.2 2.7 193 32.8 39.2 38

Sylhet 99.7 19.4 3.7 95.3 19.4 3.7 19.2 3.6 96 36.4 70.0 19

Mymensingh 99.9 17.5 1.6 98.0 17.5 1.6 17.5 1.6 123 27.5 69.3 21

Total 98.8 23.5 4.3 95.8 23.4 4.2 23.1 4.1 1,524 28.7 59.8 358

Total excluding CCs 96.5 57.2 12.8 94.5 57.0 12.4 56.3 12.2 512 35.2 71.7 292

“-” Means cesarean delivery is not offered at union-level public facilities or at public community clinics.
126 • Delivery and Newborn Care

Table 7.2 Guidelines, trained staff, and equipment for delivery services

Among facilities offering normal delivery services, the percentages having guidelines, at least one staff member recently trained in delivery care, and basic equipment for routine 

delivery available in the facility on the day of the survey, by background characteristics, Bangladesh HFS 2017

Percentage of facilities 

offering normal delivery 

services that have: Equipment

Number 

of 

facilities 

offering 

normal 

delivery 

services

Background 

characteristic

Guidelines on 

BEmOC 

or 

CEmOC1

Staff 

trained in 

delivery 

care 

during 

the past 

24 

months2

Staff 

trained in 

delivery 

care at 

any time2

Emergency 

transport3Examination light4Delivery 

pack5

Suction 

apparatus 

(mucus 

extractor)

Manual 

vacuum 

extractor

Vacuum 

aspirator 

or D&C 

kit6

Neonatal 

bag and 

mask

Partograph7 Gloves8Delivery 

bed

Sterilization 

equipment9

Facility type

District and 

upazila 

public 

facilities 23.2 21.6 59.2 84.4 82.9 89.1 60.2 38.6 53.4 89.3 43.2 74.7 85.9 74.5 42

DH 35.5 21.0 64.5 96.8 93.5 93.5 79.0 59.7 74.2 98.4 46.8 82.3 88.7 93.5 5

MCWC 21.8 21.6 66.2 65.3 87.9 95.1 62.5 34.0 56.8 83.1 46.9 83.0 90.5 78.5 6

UHC 21.5 21.7 56.9 86.4 80.2 87.1 56.8 36.3 49.4 89.3 41.9 71.8 84.5 70.7 31

Union-level

public 

facilities 9.5 10.7 47.0 9.1 50.3 82.1 14.9 10.5 9.8 48.6 15.7 77.6 74.8 22.8 190

UHFWC 9.6 12.0 50.4 10.0 52.8 82.1 15.7 10.8 10.1 49.6 15.8 76.8 75.8 25.1 162

USC/RD 8.9 2.8 27.0 4.1 35.7 82.2 9.8 8.5 8.5 42.4 15.1 82.0 68.8 9.7 28

Community 

clinic (CC) 10.4 0.0 35.6 10.8 58.6 74.2 9.4 20.0 15.2 25.8 0.0 73.9 66.3 0.0 66

NGO clinic/

hospital 37.5 36.4 78.4 73.3 97.1 87.4 77.3 24.5 28.0 76.0 64.6 91.5 86.1 79.9 20

Private 

hospital 4.5 9.1 16.4 83.6 91.2 93.7 89.3 44.2 73.8 88.0 21.5 69.0 84.1 87.3 41

Location

Urban 16.8 18.2 40.9 82.9 89.5 92.6 75.3 39.1 60.4 86.7 36.4 73.3 85.4 80.4 78

Rural 11.1 9.4 45.7 15.8 55.6 80.4 18.9 14.9 14.2 46.5 14.8 77.2 73.7 22.7 281

Division

Barishal 4.1 7.2 34.3 21.0 52.8 79.5 26.5 9.4 20.0 49.9 16.1 72.8 80.4 24.5 33

Chattogram 15.2 13.7 52.7 28.0 58.8 78.2 29.4 16.1 28.8 59.0 24.2 77.7 68.1 34.1 80

Dhaka 7.5 20.5 55.4 36.6 67.5 80.6 39.5 17.9 27.1 58.3 16.1 77.0 80.4 44.5 78

Khulna 27.8 5.7 42.4 34.7 67.8 81.3 28.8 27.7 24.3 55.5 17.5 70.1 76.5 38.5 36

Rajshahi 12.3 7.1 38.3 33.7 60.4 88.9 37.7 22.6 12.0 52.9 12.7 75.8 74.6 34.1 54

Rangpur 14.7 0.9 34.5 30.2 80.2 94.5 22.8 40.9 37.0 40.4 21.5 88.4 81.9 25.7 38

Sylhet 9.6 13.9 37.9 26.9 63.3 81.6 32.0 8.5 16.2 71.1 29.5 70.6 75.2 40.9 19

Mymensingh 4.3 10.5 35.1 17.5 44.4 85.2 15.1 15.1 18.0 55.1 27.9 70.6 79.7 31.3 21

Total 12.3 11.3 44.7 30.3 62.9 83.1 31.1 20.2 24.2 55.2 19.5 76.4 76.2 35.2 358

Total 

excluding 

CCs 12.7 13.8 46.7 34.7 63.9 85.1 36.0 20.2 26.2 61.8 23.9 76.9 78.5 43.2 292

Note: The indicators presented in this table comprise the staff training and equipment domains for assessing readiness to provide delivery care within the health facility 

assessment methodology proposed by WHO and USAID (2012).

1 Basic emergency obstetric care (BEmOC) guidelines or comprehensive emergency obstetric care (CEmOC) guidelines

2 Facility has at least one interviewed staff member providing the service who reports receiving in-service training in delivery care. The training must have involved structured 

sessions; it does not include individual instruction that a provider might have received during routine supervision.

3 Facility had a functioning ambulance or other vehicle for emergency transport stationed at the facility and had fuel available on the day of the survey, or facility has access to 

an ambulance or other vehicle for emergency transport that is stationed at another facility or that operates from another facility.

4 A functioning flashlight is acceptable.

5 Either the facility had a sterile delivery pack available at the delivery site or all of the following individual equipment must be present: cord clamp, episiotomy scissors, scissors 

(or blade) to cut cord, suture material with needle, and needle holder.

6 Facility had a functioning vacuum aspirator or else a dilation and curettage (D&C) kit available.

7 A blank partograph at the service site

8 Disposable latex gloves or equivalent available at the service site

9 Facility reports that some instruments are processed in the facility and the facility has a functioning electric dry heat sterilizer, a functioning electric autoclave, or a non-electric 

autoclave with a functioning heat source available somewhere in the facility.
Delivery and Newborn Care • 127

Table 7.3 Availability of staff trained on normal delivery or newborn care

Among facilities that offer normal delivery services, the percentages with staff trained on specific topics related to delivery and newborn care, by background 

characteristics, Bangladesh HFS 2017

Percentage of facilities offering normal delivery or newborn care services that report having at least one staff member with 

in-service training

Number 

of 

facilities 

offering 

normal 

delivery 

services

Background 

characteristic

Training 

on 

IMPAC 

during 

the past 

24 

months

Training 

on 

IMPAC 

at any

time

Training 

on 

routine 

care for 

labor and 

delivery 

during 

the past 

24 

months

Training 

on 

routine 

care for 

labor and 

delivery 

at any

time

Training 

on 

AMTSL 

during 

the past 

24 

months

Training 

on 

AMTSL 

at any

time

Training 

on emergency 

obstetric 

care/lifesaving 

skills 

during 

the past 

24 

months

Training 

on emergency 

obstetric 

care/lifesaving 

skills at 

any time

Training 

on postabortion 

care 

during 

the past 

24 

months

Training 

on postabortion 

care at 

any time

Training 

on 

neonatal 

resuscitation 

during 

the past 

24 

months

Training 

on 

neonatal 

resuscitation at 

any time

Facility type

District and upazila 

public facilities 15.0 42.7 17.6 60.1 16.9 55.3 11.4 38.9 11.0 35.0 50.8 79.2 42

DH 11.3 48.4 17.7 59.7 19.4 59.7 12.9 46.8 14.5 54.8 50.0 80.6 5

MCWC 15.7 41.1 16.8 64.9 18.0 63.8 12.0 51.9 9.6 49.3 42.3 73.3 6

UHC 15.4 42.2 17.7 59.1 16.3 52.9 11.1 35.0 10.8 28.9 52.7 80.2 31

Union-level public 

facilities 3.6 20.6 8.1 41.9 8.1 40.7 1.5 16.1 5.4 21.8 17.2 50.9 190

UHFWC 3.9 22.6 9.0 44.5 9.5 43.4 1.7 17.5 6.1 24.2 17.6 52.1 162

USC/RD 1.5 9.2 2.8 27.0 0.0 24.6 0.0 8.0 1.2 7.8 15.4 43.8 28

Community clinic 

(CC) 4.5 26.6 0.0 33.1 0.0 34.5 0.0 13.0 0.0 18.8 21.6 44.6 66

NGO clinic/hospital 12.8 29.4 27.2 65.6 29.9 65.6 7.7 28.8 28.2 47.6 14.3 49.6 20

Private hospital 6.1 12.0 8.9 17.4 4.5 15.1 8.4 14.0 7.9 13.7 9.8 20.8 41

Location

Urban 12.6 31.0 14.3 38.0 12.4 36.9 10.3 28.7 12.8 29.4 28.4 48.0 78

Rural 4.0 21.9 7.4 41.8 7.4 40.6 1.6 15.9 4.9 21.7 18.9 50.1 281

Division

Barishal 4.6 16.0 7.6 24.1 5.4 30.7 2.0 8.3 4.1 13.9 18.1 40.9 33

Chattogram 6.8 16.6 12.7 47.6 12.3 50.9 5.1 18.2 5.9 23.3 17.8 44.0 80

Dhaka 6.9 25.6 16.1 49.5 15.3 47.9 5.7 21.5 16.6 26.0 36.2 56.5 78

Khulna 10.7 31.4 2.9 36.7 2.9 31.2 1.5 21.1 2.8 14.2 24.5 54.9 36

Rajshahi 3.0 28.8 4.4 36.4 5.2 36.4 1.8 24.5 0.6 29.6 12.0 51.7 54

Rangpur 0.2 23.7 0.9 35.1 0.9 26.8 0.9 14.7 0.9 13.5 14.0 49.7 38

Sylhet 6.8 25.7 11.1 41.2 8.1 31.6 4.2 22.6 7.6 36.4 25.2 58.9 19

Mymensingh 9.7 30.1 4.0 40.0 5.2 35.8 3.3 10.9 7.9 33.6 7.6 36.3 21

Total 5.9 23.9 8.9 41.0 8.5 39.8 3.5 18.7 6.6 23.4 21.0 49.6 358

Total excluding CCs 6.2 23.2 10.9 42.8 10.4 41.0 4.3 20.0 8.1 24.4 20.8 50.7 292

Note: Training refers only to in-service training. The training must have involved structured sessions; it does not include individual instruction that a provider might 

have received during routine supervision.

IMPAC = Integrated management of pregnancy and childbirth

AMTSL = Active management of third stage of labor
128 • Delivery and Newborn Care

Table 7.4 Medicines and commodities for delivery

Among facilities offering normal delivery services, the percentages with essential medicines and commodities for delivery care and priority medicines 

for mothers observed to be available on the day of the survey, by facility type, Bangladesh HFS 2017

Facility type

Total

Total 

excluding 

Medicines CCs

District 

and 

upazila 

public 

facilities DH MCWC UHC

Unionlevel

public 

facilities UHFWC USC/RD

Community 

clinic 

(CC)

NGO 

clinic/

hospital

Private 

hospital

Essential medicines 

for delivery1

Injectable uterotonic 

(oxytocin)2 66.2 88.7 74.8 60.9 17.6 17.3 19.5 9.9 78.8 71.5 31.4 36.3

Injectable antibiotic3 59.3 83.9 41.0 59.4 1.1 1.3 0.4 0.0 66.9 70.3 19.3 23.7

Injectable magnesium 

sulphate2 29.1 41.9 26.4 27.7 5.6 4.8 10.3 0.0 37.7 47.9 13.9 17.1

Injectable diazepam 50.1 77.4 45.8 46.8 3.1 3.4 0.9 0.0 67.6 72.9 19.6 24.0

Skin disinfectant 68.8 79.0 67.4 67.6 45.0 45.7 40.7 42.7 77.3 71.4 52.2 54.3

Intravenous fluids with 

infusion set4 62.3 74.2 42.3 64.6 26.1 26.1 26.2 4.6 50.9 64.5 32.2 38.4

Priority medicines for 

mothers5

Sodium chloride 

injectable solution 75.5 82.3 53.2 79.1 26.7 27.4 22.7 6.3 75.5 84.2 38.0 45.1

Injectable calcium 

gluconate 12.8 8.1 4.9 15.2 3.6 3.3 5.9 0.0 28.1 63.1 12.2 14.9

Ampicillin powder for 

injection 7.8 11.3 2.5 8.3 0.0 0.0 0.0 0.0 26.0 41.5 7.1 8.7

Injectable 

metronidazole 28.9 46.8 24.1 27.2 0.9 1.0 0.0 0.0 39.1 78.4 14.9 18.3

Misoprostol capsules 

or tablets 42.9 35.5 66.4 39.2 61.4 62.9 52.7 49.3 63.5 63.5 57.4 59.2

Azithromycin capsules 

or tablets or oral 

liquid 61.4 82.3 12.2 68.5 1.6 0.9 5.6 0.0 74.5 79.1 21.2 26.0

Cefixime capsules or 

tablets 35.2 58.1 7.3 37.4 0.6 0.2 2.7 0.0 82.9 82.1 18.4 22.6

Benzathine benzyl 

penicillin powder for 

injection 8.6 11.3 1.2 9.7 0.5 0.5 0.6 6.0 12.3 19.2 5.2 5.1

Injectable 

bethamethasone/ 

dexamethasone 43.0 66.1 8.4 46.6 2.0 1.1 7.1 4.6 37.2 76.4 17.7 20.7

Nifedipine capsules or 

tablets 3.6 9.7 0.0 3.4 0.0 0.0 0.0 0.0 25.7 56.4 8.3 10.1

Number of facilities 

offering normal 

delivery services 42 5 6 31 190 162 28 66 20 41 358 292

Note: The essential medicines presented in this table comprise the medicines domain for assessing readiness to provide basic obstetric care within 

the health facility assessment methodology proposed by WHO and USAID (2012).

1 All essential medicines for delivery were assessed and must be available at the service delivery site.

2

Injectable uterotonic (e.g., oxytocin) and injectable magnesium sulphate are also classified as priority medicines for mothers.

3

Injectable penicillin, injectable gentamicin, injectable ampicillin, or injectable ceftriaxone

4 Normal saline solution, lactated Ringer’s solution, or 5% dextrose solution

5The priority medicines for mothers are defined by WHO; the list is published at http://www.who.int/medicines/publications/A4prioritymedicines.pdf.
Delivery and Newborn Care • 129

Table 7.5 Items for infection control during provision of delivery care

Among facilities offering normal delivery services, the percentages with indicated items for infection control observed to be available at the service 

site on the day of the survey, by background characteristics, Bangladesh HFS 2017

Percentage of facilities offering normal delivery services that have items for infection control

Number 

of 

facilities 

offering 

normal 

delivery 

services

Background 

characteristic Soap

Running 

water1

Soap and 

running 

water

Alcoholbased 

hand 

disinfectant

Soap and 

running 

water or 

else 

alcoholbased and 

disinfectant

Latex 

gloves2

Sharps 

container

Waste 

receptacle3

All 6 

items 

available4

At least 4 

items 

available

Facility type

District and upazila 

public facilities 77.9 97.1 76.8 60.6 83.7 74.7 75.0 58.1 28.3 73.6 42

DH 90.3 96.8 90.3 58.1 93.5 82.3 82.3 66.1 35.5 85.5 5

MCWC 84.2 95.2 83.0 62.8 89.2 83.0 76.8 57.7 33.6 77.1 6

UHC 74.7 97.5 73.4 60.5 81.0 71.8 73.4 56.9 26.1 71.0 31

Union-level public 

facilities 73.9 77.2 65.5 31.5 70.1 77.6 72.7 39.6 10.0 58.2 190

UHFWC 74.5 77.6 66.4 33.2 71.8 76.8 70.5 40.7 10.1 57.9 162

USC/RD 70.5 75.0 60.2 21.7 60.6 82.0 85.2 33.0 9.6 60.1 28

Community clinic 

(CC) 60.6 55.8 46.8 23.7 46.8 73.9 77.7 46.1 12.8 43.2 66

NGO clinic/hospital 97.4 100.0 97.4 61.4 98.2 91.5 87.2 69.6 37.3 89.6 20

Private hospital 90.6 93.9 88.5 76.5 93.0 69.0 54.3 82.2 39.8 74.7 41

Location

Urban 87.6 94.6 84.9 66.0 89.6 73.3 65.8 73.3 35.2 75.0 78

Rural 71.7 74.4 63.0 33.1 66.6 77.2 74.5 42.8 12.7 57.0 281

Division

Barishal 66.0 72.3 55.0 27.7 57.9 72.8 74.2 63.0 14.8 60.3 33

Chattogram 75.1 80.3 67.7 42.5 75.5 77.7 69.7 54.3 15.5 64.3 80

Dhaka 77.2 85.2 73.0 28.5 76.0 77.0 71.1 42.9 13.2 57.4 78

Khulna 79.1 77.8 69.6 35.7 71.3 70.1 79.3 53.3 14.5 58.3 36

Rajshahi 77.8 68.3 62.4 43.2 65.4 75.8 72.9 51.9 18.9 64.6 54

Rangpur 77.7 81.7 77.5 61.4 79.2 88.4 80.7 50.4 35.4 67.2 38

Sylhet 65.2 70.9 55.1 41.9 60.5 70.6 71.2 38.3 15.6 50.4 19

Mymensingh 73.2 89.6 73.2 55.9 74.4 70.6 61.6 30.6 17.6 55.0 21

Total 75.2 78.8 67.8 40.3 71.6 76.4 72.6 49.5 17.6 60.9 358

Total excluding CCs 78.5 84.0 72.5 44.0 77.2 76.9 71.5 50.2 18.7 64.9 292

1 Piped water, water in bucket with specially fitted tap, or water in pour pitcher

2 Non-latex equivalent gloves are acceptable.

3 Waste receptacle with plastic bin liner

4 Soap, running water, alcohol-based hand disinfectant, latex gloves, sharps container, and waste receptacle
130 • Delivery and Newborn Care

Table 7.6 Signal functions for emergency obstetric care

Among facilities offering normal delivery services, the percentages reporting that they performed the signal functions for emergency obstetric care at least once during 

the 3 months before the survey, by background characteristics, Bangladesh HFS 2017

Percentage of facilities that 

applied parenteral: Percentage of facilities that carried out:

Percentage of facilities that 

carried out:

Number of 

facilities 

offering 

normal 

delivery 

services

Background 

characteristic Antibiotics Oxytocin

Anticonvulsants

Assisted 

vaginal 

delivery

Manual 

removal 

of 

placenta

Removal 

of 

retained 

products 

of 

conception 

(MVA)

Neonatal 

resuscitation

Blood 

transfusionCesarean

delivery

Three 

signal 

functions1

Seven 

signal 

functions2

All 9 

signal 

functions3

Facility type

District and 

upazila 

public 

facilities 85.2 92.1 52.8 61.7 80.3 65.7 75.9 41.1 39.2 49.5 28.5 11.4 42

DH 96.8 95.2 88.7 75.8 96.8 90.3 93.5 98.4 100.0 82.3 56.5 54.8 5

MCWC 77.1 84.3 42.3 67.6 82.1 65.2 77.3 19.2 65.1 39.9 24.2 8.3 6

UHC 85.1 93.2 49.5 58.4 77.4 62.0 72.9 36.8 24.3 46.5 25.1 5.4 31

Union-level

public 

facilities 16.7 41.9 3.8 42.5 55.9 35.8 46.0 - - 2.4 1.1 - 190

UHFWC 16.7 42.6 4.0 41.8 55.0 35.9 45.6 - - 2.6 1.2 - 162

USC/RD 16.8 38.1 2.5 47.2 61.8 35.5 48.6 - - 1.4 0.4 - 28

Community 

clinic (CC) 23.2 46.5 13.8 47.3 50.6 35.3 49.0 - - 13.8 13.8 - 66

NGO clinic/

hospital 74.7 74.1 42.7 51.9 60.4 41.4 64.7 23.1 28.9 35.8 9.0 5.1 20

Private 

hospital 98.8 100.0 63.0 83.8 87.2 75.5 90.8 61.7 100.0 62.4 39.0 29.3 41

Location

Urban 89.9 92.9 57.3 71.5 81.2 66.8 83.1 53.4 75.5 56.0 33.5 22.0 78

Rural 24.3 47.1 10.1 45.1 56.2 37.7 48.7 2.0 1.5 8.4 5.2 0.2 281

Division

Barishal 35.7 49.5 10.4 45.0 60.5 46.8 49.6 7.5 7.7 9.3 6.1 1.6 33

Chattogram 36.6 67.9 21.7 58.9 52.1 37.2 63.1 18.5 19.1 19.7 9.5 7.4 80

Dhaka 38.6 51.7 20.3 46.5 50.4 45.7 45.0 12.3 26.9 17.0 9.6 3.8 78

Khulna 38.0 56.1 18.4 42.1 79.0 44.0 48.2 16.2 17.6 16.9 10.3 7.0 36

Rajshahi 37.9 56.9 11.3 51.4 68.5 43.9 66.3 9.6 12.1 10.8 5.5 4.4 54

Rangpur 54.2 61.0 47.9 81.6 82.0 68.7 72.5 15.6 15.3 47.9 40.6 8.3 38

Sylhet 36.6 53.5 16.9 27.4 65.3 38.4 57.0 9.4 18.6 14.7 3.4 0.4 19

Mymensingh 26.4 46.5 11.1 25.7 54.1 21.1 39.8 7.4 9.2 11.1 5.5 1.0 21

Total 38.5 57.1 20.3 50.9 61.6 44.0 56.2 13.1 17.5 18.7 11.4 4.9 358

Total excluding 

CCs 42.0 59.4 21.8 51.7 64.1 46.0 57.8 16.1 21.5 19.8 10.8 6.1 292

“-” Means blood transfusion and cesarean delivery services are not provided at union-level public facilities or at public community clinics.

MVA = Manual vacuum aspiration

1 Antibiotics, oxytocin, and anticonvulsants

2 Antibiotics, oxytocin, anticonvulsants, assisted vaginal delivery, manual removal of placenta, removal of retained products of conception, and neonatal resuscitation

3 Antibiotics, oxytocin, anticonvulsants, assisted vaginal delivery, manual removal of placenta, removal of retained products of conception, neonatal resuscitation, blood 

transfusion, and cesarean delivery
Delivery and Newborn Care • 131

Table 7.7 Readiness of health facilities to provide normal delivery services

Among facilities that offer normal delivery services, the percentages with 13 readiness items, by background characteristics, Bangladesh HFS 2017

Background 

characteristic

Guidelines on 

BEmOC1

or 

CEmOC1

Staff 

trained 

in 

delivery 

care at 

any

time2

Examination 

light3

Delivery 

pack4

Suction 

apparatus

Neonatal 

bag and 

mask

Partograph5 Gloves6

Injectable 

uterotonic 

oxytocin

Injectable 

antibiotic

Magnesium 

sulphate

Skin 

disinfectant

Intravenous 

fluids 

with 

infusion 

set

All 13 

items7

Number 

of 

facilities 

offering 

normal 

delivery 

services

Facility type

District and 

upazila public 

facilities 23.2 59.2 82.9 89.1 60.2 89.3 43.2 74.7 66.2 59.3 29.1 68.8 62.3 0.7 42

DH 35.5 64.5 93.5 93.5 79.0 98.4 46.8 82.3 88.7 83.9 41.9 79.0 74.2 4.8 5

MCWC 21.8 66.2 87.9 95.1 62.5 83.1 46.9 83.0 74.8 41.0 26.4 67.4 42.3 1.2 6

UHC 21.5 56.9 80.2 87.1 56.8 89.3 41.9 71.8 60.9 59.4 27.7 67.6 64.6 0.0 31

Union-level

public facilities 9.5 47.0 50.3 82.1 14.9 48.6 15.7 77.6 17.6 1.1 5.6 45.0 26.1 0.0 190

UHFWC 9.6 50.4 52.8 82.1 15.7 49.6 15.8 76.8 17.3 1.3 4.8 45.7 26.1 0.0 162

USC/RD 8.9 27.0 35.7 82.2 9.8 42.4 15.1 82.0 19.5 0.4 10.3 40.7 26.2 0.0 28

Community 

clinic (CC) 10.4 35.6 58.6 74.2 9.4 25.8 0.0 73.9 9.9 0.0 0.0 42.7 4.6 0.0 66

NGO clinic/

hospital 37.5 78.4 97.1 87.4 77.3 76.0 64.6 91.5 78.8 66.9 37.7 77.3 50.9 5.1 20

Private hospital 4.5 16.4 91.2 93.7 89.3 88.0 21.5 69.0 71.5 70.3 47.9 71.4 64.5 0.0 41

Location

Urban 16.8 40.9 89.5 92.6 75.3 86.7 36.4 73.3 69.4 66.8 38.9 71.1 61.9 1.2 78

Rural 11.1 45.7 55.6 80.4 18.9 46.5 14.8 77.2 20.9 6.1 7.0 46.9 23.9 0.1 281

Division

Barishal 4.1 34.3 52.8 79.5 26.5 49.9 16.1 72.8 18.7 10.7 8.1 32.7 22.1 0.0 33

Chattogram 15.2 52.7 58.8 78.2 29.4 59.0 24.2 77.7 36.1 25.0 22.8 53.6 28.4 0.1 80

Dhaka 7.5 55.4 67.5 80.6 39.5 58.3 16.1 77.0 35.7 22.8 11.2 46.6 37.5 0.4 78

Khulna 27.8 42.4 67.8 81.3 28.8 55.5 17.5 70.1 26.3 18.3 8.7 57.8 36.3 0.0 36

Rajshahi 12.3 38.3 60.4 88.9 37.7 52.9 12.7 75.8 28.1 12.7 9.8 49.0 26.9 0.9 54

Rangpur 14.7 34.5 80.2 94.5 22.8 40.4 21.5 88.4 24.9 20.0 17.2 73.0 39.8 1.1 38

Sylhet 9.6 37.9 63.3 81.6 32.0 71.1 29.5 70.6 39.0 18.9 20.6 50.0 35.5 0.4 19

Mymensingh 4.3 35.1 44.4 85.2 15.1 55.1 27.9 70.6 39.9 16.1 7.5 61.0 32.5 0.0 21

Total 12.3 44.7 62.9 83.1 31.1 55.2 19.5 76.4 31.4 19.3 13.9 52.2 32.2 0.4 358

Total excluding 

CCs 12.7 46.7 63.9 85.1 36.0 61.8 23.9 76.9 36.3 23.7 17.1 54.3 38.4 0.5 292

1 Basic emergency obstetric care (BEmOC) guidelines or comprehensive emergency obstetric care (CEmOC) guidelines

2 Facility has at least one interviewed staff member providing the service who reports receiving in-service training in delivery care. The training must have involved 

structured sessions; it does not include individual instruction that a provider might have received during routine supervision.

3 A functioning flashlight is acceptable.

4 Either the facility had a sterile delivery pack available at the delivery site or all of the following individual equipment must be present: cord clamp, episiotomy scissors, 

scissors (or blade) to cut cord, suture material with needle, and needle holder.

5 A blank partograph at the service site

6 Disposable latex gloves or equivalent available at the service site

7 Guidelines on BEmOC or CEmOC, at least one staff person trained in delivery care at any time, examination light, delivery pack, suction apparatus, neonatal bag and 

mask, partograph, gloves, injectable uterotonic oxytocin, injectable antibiotic, magnesium sulphate, skin disinfectant, and intravenous fluids with infusion set
132 • Delivery and Newborn Care

Table 7.8 Newborn care practices

Among facilities offering normal delivery services, the percentages reporting that the indicated practice is a routine component of newborn care, by facility type, 

Bangladesh HFS 2017

Facility type

Total

Total 

excluding 

Newborn care practices CCs

District 

and 

upazila 

public 

facilities DH MCWC UHC

Unionlevel

public 

facilities UHFWC USC/RD

Community 

clinic 

(CC)

NGO 

clinic/

hospital

Private 

hospital

Delivery to the abdomen

(skin to skin) 94.1 95.2 86.8 95.4 85.6 84.6 90.9 87.7 85.0 90.9 87.5 87.5

Drying and wrapping 

newborns to keep 

warm 96.5 98.4 92.9 97.0 94.4 94.9 91.9 100.0 98.2 97.3 96.2 95.4

Initiation of 

breastfeeding within 

the first hour 99.8 98.4 100.0 100.0 98.1 98.1 98.1 100.0 100.0 100.0 99.0 98.7

Routine complete (headto-toe) examination of 

newborns before 

discharge 95.8 98.4 95.1 95.5 88.0 88.1 87.8 95.5 96.7 92.0 91.3 90.3

Suctioning the newborn 

with suction bulb 91.2 96.8 91.6 90.3 68.0 68.8 63.4 58.1 73.7 90.7 71.8 74.9

Weighing the newborn 

immediately upon 

delivery 90.4 98.4 88.1 89.6 62.5 63.8 54.8 66.0 96.5 100.0 72.6 74.1

Administration of vitamin 

K to newborn 67.0 83.9 66.4 64.6 22.4 22.6 21.0 12.4 62.7 91.0 35.8 41.1

Application of 7.1% 

chlorhexidine for cord 

care 94.9 95.2 95.2 94.8 84.8 84.3 88.3 66.0 72.1 94.3 82.9 86.7

Giving full bath shortly 

after birth1 4.6 6.5 3.7 4.6 4.1 4.1 4.3 0.0 4.7 9.6 4.1 5.0

Number of facilities 

offering normal 

delivery services 42 5 6 31 190 162 28 66 20 41 358 292

1

Immersing newborn in water within minutes/hours after birth

Table 7.9 Essential medicines for newborn care

Among facilities that offer normal delivery services, the percentages with essential medicines for newborns observed to be available on the day of the survey, 

by facility type, Bangladesh HFS 2017

Facility type

Total

Total 

excluding 

CCs

Essential medicines 

for newborn care

District 

and 

upazila 

public 

facilities DH MCWC UHC

Unionlevel

public 

facilities UHFWC USC/RD

Community 

clinic 

(CC)

NGO 

clinic/

hospital

Private 

hospital

Antibiotic eye 

ointment for 

newborn 45.5 56.5 10.8 51.1 10.5 7.2 30.0 67.5 45.0 48.9 31.4 23.3

Injectable gentamicin 35.6 43.5 10.9 39.5 2.6 2.7 2.0 0.0 35.6 75.7 16.1 19.7

Injectable ceftriaxone 67.5 88.7 43.4 69.3 1.1 1.3 0.4 0.0 75.5 88.7 22.9 28.0

Amoxicillin syrup/ 

suspension 60.9 58.1 86.7 56.0 68.9 69.0 68.8 90.6 55.3 52.2 69.3 64.5

Ampicillin injection 7.8 11.3 2.5 8.3 0.0 0.0 0.0 0.0 26.0 41.5 7.1 8.7

7.1% chlorhexidine 

solution 45.8 53.2 65.1 40.6 57.4 57.8 54.8 44.5 60.4 41.1 52.0 53.7

Number of facilities 

offering normal 

delivery services 42 5 6 31 190 162 28 66 20 41 358 292

Note: The essential medicines and antibiotic eye ointment for newborn measures presented in this table comprise the medicines domain for assessing 

readiness to provide basic obstetric care within the health facility assessment methodology proposed by WHO and USAID (2012).
Delivery and Newborn Care • 133

Table 7.10 Availability of equipment for newborn care services

Among facilities that offer normal delivery services, the percentages having indicated equipment, by background characteristics, Bangladesh 

HFS 2017

Background 

characteristic Incubator

Suction 

apparatus 

with 

catheter

Suction 

bulb or 

penguin 

sucker

Newborn 

bag and 

mask Timer

Infant 

scale

Fetal 

stethoscopeThermometer

Thermometer for 

low body 

temperature

Number of 

facilities 

offering 

normal 

delivery 

services

Facility type

District and upazila 

public facilities 21.5 60.2 89.3 89.3 45.8 63.0 15.2 95.3 12.4 42

DH 50.0 79.0 95.2 98.4 45.2 74.2 25.8 95.2 25.8 5

MCWC 10.8 62.5 89.3 83.1 49.2 65.3 13.4 87.9 15.9 6

UHC 19.4 56.8 88.4 89.3 45.2 60.7 13.9 96.9 9.6 31

Union-level public 

facilities 1.9 14.9 66.2 48.6 32.6 36.4 5.7 78.3 5.2 190

UHFWC 2.2 15.7 66.8 49.6 31.9 37.6 6.3 79.4 6.0 162

USC/RD 0.0 9.8 62.5 42.4 36.3 29.3 2.3 71.9 0.4 28

Community clinic 

(CC) 0.0 9.4 42.7 25.8 27.7 23.7 0.0 97.1 6.0 66

NGO clinic/hospital 17.5 77.3 62.0 76.0 58.5 78.8 28.2 100.0 12.5 20

Private hospital 41.3 89.3 84.0 88.0 57.6 65.8 42.2 96.0 16.3 41

Location

Urban 33.2 75.3 82.3 86.7 56.3 65.9 28.9 95.8 16.1 78

Rural 2.5 18.9 62.0 46.5 32.3 36.5 6.2 84.5 5.6 281

Division

Barishal 5.8 26.5 76.0 49.9 29.9 33.7 8.1 89.3 1.9 33

Chattogram 13.0 29.4 59.3 59.0 52.4 38.8 13.2 89.4 10.2 80

Dhaka 13.2 39.5 59.6 58.3 35.0 36.1 18.7 81.5 8.8 78

Khulna 6.0 28.8 66.4 55.5 29.5 52.4 5.5 90.0 17.1 36

Rajshahi 8.4 37.7 70.1 52.9 30.4 43.1 8.1 93.2 6.4 54

Rangpur 6.5 22.8 81.7 40.4 37.6 57.4 8.8 87.6 3.7 38

Sylhet 1.7 32.0 66.2 71.1 40.6 50.7 9.7 78.0 5.1 19

Mymensingh 3.8 15.1 66.4 55.1 31.8 48.6 3.4 80.9 2.6 21

Total 9.2 31.1 66.4 55.2 37.5 42.9 11.2 87.0 7.8 358

Total excluding CCs 11.3 36.0 71.7 61.8 39.7 47.2 13.7 84.7 8.3 292

Note: The essential equipment items for newborn care presented in this table comprise the medicines domain for assessing readiness to 

provide basic obstetric care within the health facility assessment methodology proposed by WHO and USAID (2012).
134 • Delivery and Newborn Care

Table 7.11 Supportive management for providers of delivery care

Among interviewed providers of normal delivery or newborn care services, the percentages who report receiving training 

related to their work and personal supervision during the specified time periods, by background characteristics, Bangladesh 

HFS 2017

Percentage of interviewed providers who received:

Number of 

interviewed 

providers of 

normal delivery or 

newborn care 

services

Background 

characteristic

Training related to 

delivery and/or 

newborn care 

during the 24 

months preceding 

the survey1

Personal 

supervision during 

the 6 months 

preceding the 

survey2

Training related to 

delivery and/or 

newborn care 

during the 24 

months and 

personal 

supervision during 

the 6 months 

preceding the 

survey

Facility type

District and upazila public facilities 26.6 96.3 25.9 917

DH 30.1 96.2 29.3 249

MCWC 28.4 95.9 27.2 46

UHC 25.1 96.4 24.5 622

Union-level public facilities 27.5 92.5 25.8 453

UHFWC 27.6 92.7 25.6 382

USC/RD 27.0 91.4 27.0 70

Community clinic (CC) 30.6 100.0 30.6 152

NGO clinic/hospital 27.7 95.4 27.5 115

Private hospital 9.3 78.0 8.7 344

Location

Urban 23.5 91.4 23.0 1,009

Rural 24.9 93.6 23.8 971

Division

Barishal 24.3 98.0 24.0 141

Chattogram 20.2 86.6 18.3 403

Dhaka 30.8 91.7 29.9 509

Khulna 27.9 96.1 27.3 230

Rajshahi 24.9 98.2 24.8 277

Rangpur 15.0 93.3 15.0 207

Sylhet 24.5 85.7 22.5 107

Mymensingh 15.2 94.2 15.1 107

Total 24.2 92.5 23.4 1,980

Total excluding CCs 23.6 91.9 22.8 1,828

1 Training here refers only to in-service training. The training must have involved structured sessions; it does not include 

individual instruction that a provider might have received during routine supervision.

2 Personal supervision refers to any form of technical support or supervision from a facility-based supervisor or from a 

visiting supervisor. It may include, but is not limited to, review of records and observation of work, with or without any 

feedback to the health worker.
Delivery and Newborn Care • 135

Table 7.12 Training for providers of normal delivery services: Immediate newborn care

Among interviewed providers of normal delivery or newborn care services, the percentages who report receiving in-service training on topics related to delivery and 

newborn care during the 24 months preceding the survey, by background characteristics, Bangladesh HFS 2017 

Percentage of interviewed providers of normal delivery or newborn care services who report receiving in-service training in: Number of 

interviewed 

providers of 

normal 

delivery or 

newborn 

care 

services

Early and exclusive 

breastfeeding

Newborn infection 

management Thermal care

Sterile cord cutting 

and care

Kangaroo mother care 

for low birth weight 

babies

Background 

characteristic

During the 

past 24 

months At any time

During the 

past 24 

months At any time

During the 

past 24 

months At any time

During the 

past 24 

months At any time

During the 

past 24 

months At any time

Facility type

District and 

upazila public 

facilities 14.8 35.8 7.0 15.3 13.3 27.5 17.8 35.9 13.2 27.6 917

DH 16.3 38.3 8.7 21.1 16.1 33.3 21.3 39.1 15.3 32.9 249

MCWC 18.9 44.8 9.3 24.2 15.1 38.8 19.0 44.4 15.4 37.1 46

UHC 13.9 34.1 6.1 12.3 12.0 24.4 16.4 34.0 12.2 24.7 622

Union-level public 

facilities 13.2 44.1 3.0 16.6 10.5 32.2 15.8 43.6 10.8 30.1 453

UHFWC 12.6 42.8 3.2 14.6 10.5 31.8 15.6 42.7 11.0 29.4 382

USC/RD 16.1 51.1 2.2 27.7 10.2 34.2 16.8 48.4 9.7 33.9 70

Community clinic 

(CC) 17.9 41.2 0.0 8.7 6.2 27.7 6.1 41.6 3.1 30.1 152

NGO clinic/

hospital 10.5 27.8 7.6 13.4 6.1 17.3 13.4 27.1 7.4 17.3 115

Private hospital 6.8 12.2 4.7 9.6 4.7 9.6 5.3 11.8 4.1 8.8 344

Location

Urban 14.0 30.6 7.5 16.2 11.8 24.3 15.2 30.8 11.0 23.3 1,009

Rural 12.0 36.6 2.7 11.7 8.6 25.5 12.8 36.1 8.8 25.7 971

Division

Barishal 13.8 36.8 8.0 16.6 13.8 33.7 17.6 39.1 12.0 28.4 141

Chattogram 12.5 29.2 4.9 12.4 7.6 18.6 10.6 25.7 8.8 16.9 403

Dhaka 15.4 32.1 7.5 14.8 14.8 24.9 18.8 34.3 12.4 23.7 509

Khulna 16.3 38.2 2.0 9.4 8.9 23.7 18.0 37.5 9.2 25.9 230

Rajshahi 12.9 40.3 5.3 21.6 7.9 32.7 12.2 40.5 9.9 35.0 277

Rangpur 7.1 30.8 3.3 9.5 10.0 24.8 8.9 30.8 8.7 23.8 207

Sylhet 12.3 34.3 5.4 17.7 9.3 28.1 13.3 31.9 10.5 27.9 107

Mymensingh 7.8 29.8 1.4 8.1 3.8 16.4 6.6 30.4 3.8 19.6 107

Total 13.0 33.6 5.2 14.0 10.2 24.9 14.0 33.4 10.0 24.5 1,980

Total excluding CCs 12.6 32.9 5.6 14.4 10.5 24.7 14.7 32.7 10.5 24.0 1,828

Note: Training here refers only to in-service training. The training must have involved structured sessions; it does not include individual instruction that a provider 

might have received during routine supervision.
136 • Delivery and Newborn Care

Table 7.13 Training for providers of normal delivery services: Immediate newborn care

Among interviewed providers of normal delivery or newborn care services, the percentages who report receiving in-service training on topics related to delivery and newborn 

care during the 24 months preceding the survey, by background characteristics, Bangladesh HFS 2017

Percentage of interviewed providers of normal delivery or newborn care services who report receiving in-service training in: Number of 

interviewed 

providers of 

normal 

delivery or 

newborn 

care 

services

Newborn 

resuscitation using 

bag and mask

Essential newborn 

care

Umbilical cord care 

(use of 7.1% 

chlorhexidine)

Emergency triage 

assessment training 

(ETAT)

IMCI guidelines

(0-59 days)

Comprehensive 

newborn care

Background 

characteristic

During the 

past 24 

months

At any 

time

During the 

past 24 

months

At any 

time

During the 

past 24 

months

At any 

time

During the 

past 24 

months

At any 

time

During the 

past 24 

months

At any 

time

During the 

past 24 

months

At any 

time

Facility type

District and 

upazila public 

facilities 18.1 38.0 10.4 21.9 18.6 35.9 4.1 11.6 5.2 18.3 5.0 10.6 917

DH 23.0 40.9 14.3 27.9 21.3 37.6 4.8 13.9 4.1 16.4 5.6 14.0 249

MCWC 19.4 44.8 13.2 33.9 18.8 44.9 3.4 14.1 3.1 17.9 4.6 14.2 46

UHC 16.1 36.2 8.6 18.6 17.5 34.6 3.9 10.4 5.8 19.2 4.8 8.9 622

Union-level

public 

facilities 12.4 40.3 9.0 24.9 19.4 42.0 2.2 9.0 5.5 23.6 4.7 14.3 453

UHFWC 12.7 41.8 9.6 25.6 19.2 41.0 2.5 9.1 5.5 23.4 4.3 13.2 382

USC/RD 10.4 32.3 5.6 21.2 20.6 47.2 0.5 8.7 5.6 24.9 7.0 20.5 70

Community 

clinic (CC) 14.9 35.1 5.1 30.2 5.1 43.6 0.0 15.7 9.4 22.7 6.4 10.9 152

NGO clinic/

hospital 6.7 22.0 6.7 14.8 13.3 22.5 4.4 11.8 7.0 13.6 1.1 5.7 115

Private hospital 4.8 10.5 4.3 7.8 5.1 9.8 0.4 2.3 1.9 4.2 2.1 5.6 344

Location

Urban 15.2 31.1 9.7 20.0 15.6 29.2 3.4 10.5 4.9 14.9 4.6 10.1 1,009

Rural 11.9 34.2 7.0 20.8 14.5 36.2 2.0 8.9 5.4 19.5 4.0 10.5 971

Division

Barishal 16.3 37.2 11.3 25.4 19.0 37.8 6.3 10.5 3.0 19.5 3.1 7.8 141

Chattogram 10.3 26.5 7.5 16.9 10.2 25.2 2.9 7.5 4.2 12.9 3.8 9.2 403

Dhaka 19.7 34.0 11.6 21.8 20.6 31.3 2.9 10.0 7.1 17.3 5.8 12.4 509

Khulna 16.2 35.9 8.0 17.6 17.2 40.0 2.7 7.7 4.0 12.8 2.1 4.3 230

Rajshahi 10.2 37.1 7.2 24.1 16.2 39.9 2.8 14.6 7.1 22.9 6.2 14.4 277

Rangpur 9.9 31.8 4.3 18.5 8.9 32.4 1.2 5.7 2.9 18.0 2.1 6.5 207

Sylhet 12.4 34.0 8.7 23.6 14.3 27.0 0.6 11.4 6.2 20.7 6.0 18.2 107

Mymensingh 4.9 24.3 4.2 16.8 8.0 31.2 1.9 13.4 2.3 18.8 3.0 9.5 107

Total 13.6 32.6 8.4 20.4 15.1 32.6 2.7 9.7 5.1 17.2 4.3 10.3 1,980

Total excluding 

CCs 13.5 32.4 8.7 19.5 15.9 31.7 3.0 9.2 4.8 16.7 4.1 10.3 1,828

Note: Training here refers only to in-service training. The training must have involved structured sessions; it does not include individual instruction that a provider might have 

received during routine supervision.
Non-communicable Diseases • 137

NON-COMMUNICABLE DISEASES 8

Key Findings

Diabetes

▪ Over half of health facilities in Bangladesh offer services 

for diabetes (that is, providers in the facility diagnose, 

prescribe treatment for, or manage patients with 

diabetes), a substantial increase from 18% in 2014 (Table 

8.1 and Figure 8.1).

▪ Seventeen percent of facilities had guidelines for 

diagnosis and management of diabetes available on the 

day of the survey, while 33% had staff ever trained in 

diabetes (Table 8.1 and Figure 8.2).

▪ Nine in 10 facilities had a blood pressure apparatus and 

an adult weighting scale. Height boards/stadiometers

were less widely available (77%) (Table 8.1 and Figure 

8.2).

▪ Fifty-four percent of facilities had blood glucose testing 

capacity, while 46% had urine protein and urine glucose

testing capacity (Table 8.2 and Figure 8.3).

▪ Forty percent of facilities had metformin available, and 

29% had injectable insulin. Only 9% of facilities had 

glibenclamide, while 19% had injectable glucose solution.

(Table 8.2 and Figure 8.3).

Cardiovascular Diseases

▪ Two in five facilities offer services for cardiovascular 

diseases (CVDs), a substantial increase from 16% in 2014

(Table 8.3 and Figure 8.4).

▪ Only 9% of facilities had guidelines for the diagnosis and 

management of CVD, while 41% had staff ever trained in 

CVD services (Table 8.3 and Figure 8.5).

▪ A large majority of facilities had a stethoscope (96%), a 

functioning blood pressure apparatus (91%), and an adult 

weighing scale (86%) available (Table 8.3 and Figure 8.5).

▪ Among essential medicines, calcium channel blockers 

were most likely to be available, followed by beta blockers 

and aspirin (Table 8.4 and Figure 8.6).

▪ Sixty-nine percent of district hospitals (DHs), 71% of 

upazila health complexes (UHCs), and 88% of private 

hospitals had oxygen available (Table 8.4).

Chronic Respiratory Diseases

▪ Overall, 62% of facilities provide services for chronic 

respiratory diseases (Table 8.5 and Figure 8.7).

▪ Less than one in five (17%) facilities had guidelines for 

chronic respiratory diseases, and one-fourth had staff ever 
138 • Non-communicable Diseases

trained in chronic respiratory diseases (Table 8.5 and 

Figure 8.8).

▪ Almost all facilities had a stethoscope. The availability of 

peak flow meters and spacers for inhalers is low even at 

higher level public facilities (Table 8.5 and Figure 8.8).

▪ Salbutamol inhalers/tablets were the most widely available

essential medicines for the treatment of chronic 

respiratory diseases (Table 8.6 and Figure 8.9).

▪ Sixty-nine percent of DHs, 73% of UHCs, and 89% of 

private hospitals had oxygen available (Table 8.6).

Hypertension

▪ Seven in 10 facilities offer hypertension services (Table 

8.7 and Figure 8.10).

▪ Seventeen percent of facilities had guidelines for 

hypertension, and 29% had staff ever trained in 

hypertension (Table 8.7 and Figure 8.11).

▪ Ninety-five percent of facilities had a stethoscope, 91%

had a blood pressure apparatus, and 86% had an adult 

scale (Table 8.7 and Figure 8.11).

▪ Medicines for hypertension were available mainly in DHs, 

UHCs, private hospitals, and nongovernmental (NGO)

clinics (Table 8.8).

Cervical Cancer

▪ Overall, 3% of health facilities in Bangladesh (8%

excluding CCs) offer screening/diagnosis services for 

cervical cancer (Table 8.9 and Figure 8.13).

▪ Thirty-nine percent of facilities had screening services for 

cervical cancer, while 16% had staff with recent training in 

cervical cancer services (Table 8.9 and Figure 8.14).

▪ Speculums were widely available at all types of public 

facilities other than CCs and union subcenters/rural 

dispensaries (USC/RDs) (Table 8.9).

8.1 BACKGROUND

on-communicable diseases (NCDs, also known as chronic diseases), specifically diabetes, 

cardiovascular disease, hypertension, stroke, chronic respiratory diseases, and cancer, account for 

almost 70% of all deaths globally. In numbers around the world, NCDs kill more than 36 million 

people each year. Cardiovascular diseases (CVDs) account for most NCD deaths, followed by cancers, 

respiratory diseases, and diabetes. The deaths and disability caused by these NCDs are avoidable; 

approximately 80% of heart disease and stroke, 80% of type 2 diabetes, and 30% of cancer can be 

prevented by eliminating common risk factors including smoking, unhealthy diets, and physical inactivity

(WHO 2017a).

Each year, 15 million people die from a NCD between the ages of 30 and 69 years; over 85% of these 

"premature" deaths occur in low- and middle-income countries such as Bangladesh and are too often 

premature (that is, occurring before 70 years of age) (WHO 2013). This growing burden compounds 

already stressed health systems, disproportionately affecting the poorest populations and hindering 

countries’ social and economic development (Islam 2014). Addressing health and NCDs is essential if 

interventions are to have a sustainable impact on development and on achievement of the Sustainable 

N
Non-communicable Diseases • 139

Development Goal (SDG) targets. Failure to do so could compound current health problems and affect the 

overall development of countries, such as Bangladesh, with emerging economies (Pullar 2018).

Despite their public health importance, NCDs in Bangladesh have been overshadowed by the country’s 

focus on communicable diseases and maternal and child health. In terms of numbers of lives lost due to ill 

health, disability, and early death (disability-adjusted life years, or DALYS), NCDs (inclusive of injuries) 

account for 61% of the total disease burden in the country, as compared with 39% from communicable 

diseases, maternal and child health, and nutrition combined (Engelgau 2011). In 2007, Bangladesh had an 

estimated 7.7 qualified health care providers (Bangladesh Health Watch, 2008) per 10,000 population 

(WHO recommends 25.0 [WHO 2006]); however, physicians and nurses account for only 5% of all health 

care providers, as most of these individuals are informally trained and cater to the needs of the majority, 

particularly the poor. Until recently, few health workers were trained in NCD prevention and management,

although the number has started to increase since 2013 (World Bank 2013).

Every year there are 580,000 deaths from these NCDs in Bangladesh, which is 67% of the total number of 

deaths in the country. This is a significant social and economic development issue. NCDs can result in 

families losing their primary income earner, which can lead to poverty and withdrawal of family members 

from employment and educational opportunities to care for affected loved ones. The continuing care 

required for these diseases and often expensive treatment interventions can result in immense pressure on 

the health system and potentially catastrophic costs to families through out-of-pocket expenditures. Over 

the period 2011 to 2025, global total economic losses among low- and middle-income countries stemming 

from the four major NCDs are estimated at US$ 7 trillion. Preventing and reducing morbidity and 

mortality from NCDs is therefore vital to achieving sustainable development (WHO 2017b). In 

Bangladesh, total health expenditures (public and private) accounted for 3.5% of gross domestic product 

(GDP) in 2011. Per capita health expenditure—inadequate to secure basic services—was about US$ 23 in 

2011 (Engelgau et al. 2011; World Bank 2013). Although the budget allocated for the NCD line directorate 

increased to US$ 70 million for 2011-2016, this and the portion allocated for NCD awareness are not

sufficient to address the growing NCD challenges, particularly those related to CVDs.

In the 3rd Sector Program (HPNSDP 2011-2016), control of NCDs was given priority but with inadequate 

resource allocation. The operational plan was categorized as focusing on conventional as well as 

nonconventional NCDs. Most of the resources were used in purchasing of equipment, training of 

manpower, and arsenicosis and emergency-related activities. The Mid Term Review (MTR 2014) 

recommended that the health system reconsider its response by realigning efforts to tackle NCDs in a 

comprehensive manner. The role of private sector service providers in addressing NCDs has also been 

emphasized in the MTR 2014, but with provision of more effective regulatory mechanisms in terms of 

service provision and quality of care (MoHFW 2017).

Currently, NCD treatment is provided only at the tertiary level given their impact, it is extremely important 

for the Bangladesh health care system to develop the capacity to appropriately diagnose and treat NCDs at 

secondary level as well. Some of the key strategies for the management of NCDs in Bangladesh include 

prevention through raising awareness and advocating for policies that minimize exposure to CVD risk 

factors, early diagnosis via hypertension screening, and appropriate patient management through followup, and improved availability of diagnostic and medical supplies. Training is critical. The health workers in 

Bangladesh are not efficiently trained in NCD treatment in the primary health care system. Currently, NCD 

treatment is provided only at the tertiary level. The 4th Health, Population and Nutrition Sector Program 

(4th HPNSP) has divided the overall NCD spectrum in two components. Component A consists of 

conventional non-communicable diseases (cardiovascular diseases, diabetes, chronic obstructive 

pulmonary disease [COPD], cancer), while Component B consists of non-conventional NCDs (e.g., eye 

conditions, dental health conditions, birth defects) (MoHFW 2017). This chapter assesses how well 

Bangladesh’s health care system is addressing the following conventional NCDs: diabetes, cardiovascular 

disease, hypertension, respiratory disease, and cervical cancer.
140 • Non-communicable Diseases

Diabetes is defined by a fasting blood glucose level of 7.0 mmol/L or above (WHO 2006). Findings from 

the 2011 Bangladesh Demographic and Health Survey (BDHS) suggest that diabetes has become epidemic 

among the adult population of Bangladesh. An estimated 11% of the study participants had diabetes, and 

around 25% were pre-diabetic (National Institute of Population Research and Training [NIPORT] 2013). 

According to the International Diabetes Federation (IDF), diabetes poses a daunting challenge to the 

sustainable development of Bangladesh. Nearly half of the population with diabetes is undiagnosed; among 

those diagnosed with diabetes, only 1 in 3 are treated, and roughly 1 in 13 achieve the recommended 

treatment targets (Latif et al. 2011).

Cardiovascular diseases have become a major, growing contributor to mortality and disability in Southeast 

Asia and rank among the top 10 causes of death in Bangladesh (Ghaffar et al. 2004; WHO 2004). 

According to the Bangladesh Bureau of Statistics (BBS 2008), cardiovascular disease causes 27% of the 

deaths in Bangladesh. The 2016 Bangladesh Maternal Mortality and Health Care Survey (NIPORT et al.

2012) estimated that circulatory diseases are the second leading cause of death among women of 

reproductive age (13-49 years) in Bangladesh, accounting for 23% of total deaths. This was a marked 

increase of 7 percentage points from the 2010 Bangladesh Maternal Mortality and Health Care Survey 

(NIPORT 2012), which reported a figure of 16%.

Chronic respiratory diseases, chronic diseases of the airways and the other structures of the lungs, 

represent a wide array of serious diseases. Preventable chronic respiratory diseases include asthma and 

respiratory allergies, COPD, occupational lung diseases, sleep apnea syndrome, and pulmonary 

hypertension. They constitute a serious public health problem in all countries throughout the world, in lowand middle-income countries such as Bangladesh, and in deprived populations (WHO 2007). The 

prevalence of COPD in Bangladesh is 13.5% according to GOLD (Global Initiative for Obstructive Lung 

Disease) criteria and 10.3% according to LLN (lower limit of normal) criteria. COPD prevalence is higher 

among rural than urban residents and higher among males than females (Dewan 2015).

In the 2011 BDHS (NIPORT 2013), hypertension or raised blood pressure was classified into four broad 

groups using the American Heart Association (AHA) classification scheme (AHA 2017). Findings from 

that survey suggest that hypertension has become an epidemic among the adult population of Bangladesh.

Thirty-two percent of women and 19% of men have elevated blood pressure or are currently taking 

medicine to lower their blood pressure. An additional 28% of women and men are pre-hypertensive

(NIPORT 2013). Improving hypertension control is imperative for the overall health system of any country 

because complications of hypertension account for 53% of CVD-related mortality worldwide every year. 

Although the condition is highly preventable, hypertension is the most prevalent risk factor for CVD and 

stroke (Kearney 2005; Lim 2012). Controlling hypertension needs much attention in countries such as 

Bangladesh. For example, according to the 2011 BDHS, 45% of women and 57% of men in Bangladesh 

are not aware that they have elevated blood pressure. Moreover, although 45% of women and 36% of men 

with hypertension are taking medication for their condition, over half of them do not have their blood 

pressure controlled to normal levels (NIPORT 2013).

Cancer is a global problem, accounting for almost 13% of all deaths worldwide. This equates to more than 

7 million people a year (Sharma et al. 2011). The 2016 Bangladesh Maternal Mortality and Health Care 

Survey (NIPORT et al. 2012) estimated that cancer is the leading cause of death among women of 

reproductive age (13-49 years) in Bangladesh, accounting for 24% of overall deaths. Cervical cancer is the 

fourth most frequent cancer among women worldwide and the most frequent cancer among women in 

Africa, Asia, and South America, with an estimated incidence of 528,000 per year and 266,000 annual 

cervical cancer deaths (Globocan 2012). Cervical cancer is the second leading cancer, in terms of both 

incidence and mortality, among Bangladeshi women (Globocan 2012). Although there is effective 

screening for cervical cancer, it continues to be a health care problem in developing countries where 

screening programs are limited (Saslow 2012; Denny 2017).
Non-communicable Diseases • 141

Using the information in the 2017 BHFS, this chapter addresses questions about the availability of services 

for selected NCDs. The chapter is organized as follows:

▪ Diabetes. Section 8.2, including Tables 8.1 and 8.2 and Figures 8.1, 8.2, and 8.3, presents 

information on the availability of diabetes diagnostic and treatment services.

▪ Cardiovascular diseases. Section 8.3, including Tables 8.3 and 8.4 and Figures 8.4, 8.5, and 8.6,

presents information on the availability of cardiovascular disease diagnostic and/or treatment services.

▪ Chronic respiratory diseases. Section 8.4, including Tables 8.5 and 8.6 and Figures 8.7, 8.8, and 

8.9, presents information on the availability of diagnostic and/or treatment services for chronic 

respiratory diseases.

▪ Hypertension. Section 8.5, including Tables 8.7 and 8.8 and Figures 8.10, 8.11, and 8.12, presents 

information on the availability of hypertension diagnostic and/or treatment services.

▪ Cervical cancer. Section 8.6, including Table 8.9 and Figures 8.13 and 8.14, presents information on 

the availability of cervical cancer screening services.

8.2 AVAILABILITY OF SERVICES FOR DIABETES

8.2.1 Service Provision

Integrating diabetes diagnosis and treatment into relevant health services increases the opportunities for 

case detection and treatment follow-up. In health facilities in Bangladesh, clients who seek health care 

specifically for symptoms of diabetes are usually seen in a general outpatient department (OPD). However, 

there are also specific diabetic clinics or service areas in some health facilities.

Figure 8.1 Availability of diabetes services in health facilities,

by facility type

Availability of Services for Diabetes

Table 8.1 and Figure 8.1 show that 53% (48% excluding community clinics [CCs]) of health facilities in 

Bangladesh offer diabetes services. This is a marked increase from the 18% figure (26% excluding CCs) 

reported in 2014.

Nearly all district hospitals (DHs) (100%), private hospitals (98%), upazila health complexes (UHCs)

(97%), and nongovernmental (NGO) facilities (85%) offer diabetes services. Availability of diabetes 

services at these facilities has increased since 2014.

18

26

71

95

9

81

11 18 16 14

42

80

53 48

89

100

47

97

31 29 35

56

85

98

Total

facilities

Total

facilities

excluding

CC

District

&

upazila

public

DH MCWC UHC Unionlevel

public

facilities

UHFWC USC/RD CC NGO Private

BHFS 2014

(N=1548)

BHFS 2017

(N=1524)
142 • Non-communicable Diseases

In the Bangladesh context, CCs primarily provide screening and referral services for diabetes cases. Figure 

8.1 shows considerable increases since 2014 in the percentages of CCs (from 14% to 56%) and union-level 

facilities (from 11% to 31%) offering diabetes services.

Both urban (from 55% to 87%) and rural (from 13% to 51%) facilities have also exhibited marked 

increases in diabetes service availability since 2014. All divisions have exhibited increases as well. 

Facilities in Rajshahi (67%), Sylhet (65%), and Barishal (57%) are more likely to offer diabetes services

than facilities in Rangpur (41%).

Service Guidelines

Availability of service guidelines 

does not necessarily translate into 

use of these guidelines. However, it 

at least ensures that, if needed, they

will be available for easy reference. 

Among facilities that offered

diabetes services, only 17% (14%

excluding CCs) had guidelines for 

the diagnosis and management of 

diabetes. This was a decrease from 

26% (28% excluding CCs) in 2014

(Table 8.1 and Figure 8.2).

Trained Staff

Fourteen percent (both overall and excluding CCs) of facilities that offered diabetes services had at least 

one staff member who had received in-service training in diabetes services during the 24 months before the 

survey (Table 8.1 and Figure 8.2), a decrease from 20% (9% excluding CCs) in 2014. Among public 

facilities, 14% of CCs (which mainly provide diabetes screening services), 19% of DHs, 28% of UHCs, 

and 3% of union-level facilities had staff members recently trained in diabetes services. Urban facilities 

(23%) were almost twice as likely as rural facilities (13%) to have trained staff. Facilities in Khulna are 

most likely to have staff with recent in-service training in diabetes services (21%), while facilities in 

Rajshahi are least likely to have trained staff (4%). The proportions of facilities with staff who had ever 

received any relevant in-service training were higher than the proportions of facilities with staff who had 

received recent training.

Equipment

There have been increases since 2014 in the percentages of facilities offering diabetes services that had a 

blood pressure (BP) apparatus (from 84% to 89%), an adult weighing scale (from 78% to 90%), and a 

height board (from 54% to 77%) available on the day of the survey (Table 8.1 and Figure 8.2).

Figure 8.2 Trained staff, guidelines, and basic 

equipment to provide diabetes services

20

35

26

54

78 84

14

33

17

77

90 89

Trained

staff

(last 24 months)

Trained

staff

(ever)

GuidelinesHeight

board

Adult

weighing

scale

BP

apparatus

BHFS 2014

(N=275)

BHFS 2017

(N=813)
Non-communicable Diseases • 143

8.2.2 Availability of Diagnostic Capacity and Medicines for Diabetes

Table 8.2 and Figure 8.3 present 

information from the 2017 BHFS 

on the availability of infrastructure 

and resources that support diabetes 

diagnostic and treatment services.

Diagnostic Capacity

Among facilities providing diabetes 

services, 54% (56% excluding 

CCs) had blood glucose testing 

capacity, 46% (49% excluding 

CCs) had urine protein testing 

capacity, and 46% (49% excluding 

CCs) had urine glucose testing

capacity on the day of the survey 

(Table 8.2 and Figure 8.3). The availability of blood glucose testing has increased since 2014, while the 

availability of urine protein and urine glucose testing has decreased (Figure 8.3).

Private hospitals and NGO facilities were more likely than district and upazila public facilities to have the 

capacity to conduct all three tests (blood glucose, urine protein, and urine glucose). While 22% of CCs had

blood glucose testing capacity, none had urine protein or urine glucose testing capacity (Table 8.2).

Urban facilities were much more likely than rural facilities to offer diagnostic tests. Division-level results 

showed that, overall, Dhaka had the highest proportion of facilities providing the three diagnostic services 

(Table 8.2).

Medicines

Forty percent (43% excluding CCs) of facilities that offered diabetes services had metformin available on 

the day of the visit, and 9% (10% excluding CCs) had glibenclamide. Twenty-nine percent (31% excluding 

CCs) of facilities had injectable insulin, and 19% (21% excluding CCs) had injectable glucose solution 

(Table 8.2 and Figure 8.3).

The availability of metformin has increased since 2014 (from 28% to 40%), while there have been 

decreases in the availability of glibenclamide (from 17% to 9%), injectable insulin (from 32% to 29%), and 

injectable glucose solution (from 20% to 19%). Medicines for diabetes require a prescription from a 

physician, and thus CCs and union-level public facilities generally do not have the capacity to offer these 

medicines. However, a small proportion of union-level facilities reported having metformin (1%) and 

injectable insulin (4%). Among the other facilities, private hospitals and DHs were more likely to have 

medicines for the management of diabetes than mother and child welfare centers (MCWCs), UHCs, and 

NGO facilities.

As expected, urban facilities were more likely to be equipped with essential medicine than rural facilities. 

8.3 AVAILABILITY OF SERVICES FOR CARDIOVASCULAR DISEASES

8.3.1 Service Provision

Table 8.3 and Figures 8.4 and 8.5 provide information on the availability of services for cardiovascular 

diseases. Table 8.3 and Figure 8.5 also present information on the availability of service guidelines, 

trained staff, and equipment that support the provision of quality cardiovascular disease services.

Figure 8.3 Diagnostic capacity and medicines to 

provide diabetes services

49 50 52

20

32

17

28

46 46

54

19

29

9

40

Urine

glucose

Urine

protein

Blood

glucose

Injectable

glucose

solution

Injectable

insulin

GlibenclamideMetformin

BHFS 2014

(N=73)

BHFS 2017

(N=144)
144 • Non-communicable Diseases

Figure 8.4 Availability of cardiovascular disease services in health facilities, 

by facility type

Availability of Services for Cardiovascular Diseases

Table 8.3 and Figure 8.4 show that 42% (51% excluding CCs) of health facilities in Bangladesh offer 

cardiovascular disease services, an increase from the 16% figure (28% excluding CCs) reported in 2014. 

The percentages of DHs (100%), private hospitals (97%), UHCs (95%), NGO facilities (52%), CCs (38%),

and union-level facilities (41%) offering cardiovascular disease services have also increased.

There have been marked increases in the availability of cardiovascular disease services in both urban (from 

55% to 77%) and rural (from 13% to 40%) facilities. In addition, provision of these services has increased 

in all divisions. Facilities in Sylhet (69%), Barishal (66%), and Rajshahi (50%) are most likely to offer 

cardiovascular disease services, while facilities in Khulna (31%) are least likely to provide such services.

Service Guidelines

Among facilities offering cardiovascular disease services, 9% (11% excluding CCs) had guidelines for the 

diagnosis and management of cardiovascular diseases available on the day of the survey. This was a 

decrease from 23% (22% excluding CCs) in 2014 (Table 8.3 and Figure 8.5).

Trained Staff

Fourteen percent (12% excluding 

CCs) of facilities offering

cardiovascular disease services had 

at least one staff member who had 

received in-service training in 

cardiovascular disease services 

during the 24 months before the 

survey (Table 8.3 and Figure 8.5). 

In 2014, this proportion was 11%

(9% excluding CCs). Among public 

facilities, 15% of CCs (which 

mainly provide cardiovascular 

disease screening services), 26% of 

DHs, 40% of UHCs, and 7% of 

union-level facilities had staff with 

recent training. Urban facilities (20%) were more likely than rural facilities (13%) to have trained staff. 

Facilities in Chattogram were most likely to have staff with recent in-service training (20%), while 

16

28

71

95

10

81

17

27 23

10

37

77

42

51

87

100

40

95

41 39 43 38

52

97

Total

facilities

Total

facilities

excluding

CC

District

&

upazila

public

DH MCWC UHC Unionlevel

public

facilities

UHFWC USC/RD CC NGO Private

BHFS 2014

(N=1548)

BHFS 2017

(N=1524)

Figure 8.5 Trained staff, guidelines, and basic 

equipment to provide cardiovascular disease services

11

27 23

78

88

95

14

41

9

86 91 96

Trained

staff

(last 24 months)

Trained

staff

(ever)

GuidelinesAdult

weighing

scale

BP

apparatus

Stethoscope

BHFS 2014

(N=250)

BHFS 2017

(N=643)
Non-communicable Diseases • 145

facilities in Mymensingh were least likely to have staff with training (5%). Again, the percentages of 

facilities with staff who had ever received in-service training were higher than the percentages with staff 

who had received recent training.

Equipment

In terms of equipment, 96% of facilities had a stethoscope, 91% had a blood pressure apparatus, and 86% 

had an adult weighing scale. These percentages represent slight increases since 2014 (Table 8.3 and 

Figure 8.5). 

8.3.2 Availability of Medicines and Commodities for Cardiovascular Diseases

The 2017 BHFS collected data on 

the availability of essential 

medicines and commodities to 

support treatment of patients with 

cardiovascular diseases. Table 8.4

and Figure 8.6 show that beta 

blockers and calcium channel 

blockers (amlodipine/nifedipine) 

were the most available medicines. 

Among facilities offering

cardiovascular disease services, 

32% (36% excluding CCs) had beta 

blockers available on the day of the 

survey visit, and 39% (44%

excluding CCs) had calcium 

channel blockers. By comparison,

28% (32% excluding CCs) of facilities had aspirin, 11% (13% excluding CCs) had thiazide diuretics, and 

7% (the same percentage excluding CCs) had angiotensin-converting enzyme (ACE) inhibitors (enalapril). 

Forty-nine percent (56% excluding CCs) of facilities had oxygen in either cylinders or concentrators or an 

oxygen distribution system. Overall, the availability of medicines and commodities decreased between 

2014 and 2017.

Private hospitals were more likely than other types of facilities to have all essential medicines available. 

Among public facilities, DHs were most likely to have the essential medicines and commodities. Because a 

prescription is needed from a physician, CCs are not able to offer anti-hypertensive medications; however, 

some union-level facilities had essential medicines and commodities available (Table 8.4).

8.4 AVAILABILITY OF SERVICES FOR CHRONIC RESPIRATORY DISEASES

8.4.1 Service Provision

Table 8.5 and Figures 8.7 and 8.8 provide information from the 2017 BHFS on the availability of services 

for respiratory diseases. The table also presents information on the availability of service guidelines, 

trained staff, and equipment that support the provision of quality services for respiratory diseases.

Availability of Services for Respiratory Diseases

Table 8.5 and Figure 8.7 show that 62% (68% excluding CCs) of all health facilities can diagnose, 

prescribe treatment for, and manage patients with chronic respiratory diseases. DHs (100%), UHCs (97%), 

and private hospitals (97%) are more likely to provide services for respiratory diseases than other facilities. 

Fifty-nine percent of CCs, 49% of MCWCs, and 61% of union-level facilities provide respiratory disease 

services.

Figure 8.6 Commodities and medicines to provide 

cardiovascular disease services

54

25

38 43

16 13

49

28

39

32

11 7

Oxygen Aspirin Calcium

channel

blockers

Beta

blockers

Thiazide ACE

inhibitors

BHFS 2014

(N=84)

BHFS 2017

(N=120)
146 • Non-communicable Diseases

Figure 8.7 Availability of chronic respiratory disease services in health facilities, 

by facility type

Eighty-five percent of urban facilities provide services for respiratory diseases, as compared with 60% of 

rural facilities. Facilities in Barishal (79%) are most likely to offer services for respiratory diseases, while 

facilities in Dhaka (50%) are least likely to offer such services.

Service Guidelines

Seventeen percent (13% excluding CCs) of facilities offering services for respiratory diseases had 

guidelines for the diagnosis and management of these diseases available at the service site on the day of the 

survey (Table 8.5 and Figure 8.8). NGO hospitals/clinics (31%) and DHs (23%) were most likely to have 

guidelines available. Guidelines were much more widely available in facilities in Khulna (27%) than in 

facilities in the other divisions.

Trained Staff

Among facilities that offer services 

for respiratory diseases, 9% (7%

excluding CCs) had at least one 

staff member who had received inservice training in respiratory 

diseases during the 24 months 

before the survey (Table 8.5 and 

Figure 8.8). UHCs (29%), DHs 

(27%), and CCs (11%) were more 

likely than NGO facilities (5%) and 

private hospitals (7%) to have at 

least one staff member with recent 

training. Union-level public 

facilities were least likely to have 

trained staff (4%). Facilities in 

Chattogram (18%) were most likely 

to have staff with recent in-service training, and facilities in Rajshahi (5%) were least likely to have staff 

with recent training.

Equipment

Overall, 95% (98% excluding CCs) of facilities offering services for respiratory diseases had a 

stethoscope, 3% (6% excluding CCs) had a peak flow meter, and 2% (6% excluding CCs) had spacers for 

62

68

90

100

49

97

61 58

66

59

73

97

Total

facilities

Total

facilities

excluding CC

District

&

upazila

public

DH MCWC UHC Unionlevel

public

facilities

UHFWC USC/RD CC NGO Private

Figure 8.8 Trained staff, guidelines, and basic 

equipment to provide chronic respiratory 

disease services

9

25

17

2 3

95

Trained

staff

(Last 24 months)

Trained

staff

(Ever)

GuidelinesSpacers

for

inhalers

Peak

flow meter

Stethoscope

(N=944)
Non-communicable Diseases • 147

inhalers available at the relevant service sites (Table 8.3 and Figure 8.8). Variations in the availability of 

these items by location and division are minor. Stethoscopes are available at a large majority of facilities.

8.4.2 Availability of Medicines and Commodities for Chronic Respiratory Diseases

The 2017 BHFS collected data on 

the availability of essential 

medicines and commodities to 

support the treatment of patients 

with respiratory diseases. Table 8.6

and Figure 8.9 show that 

salbutamol inhalers or tablets were 

the most widely available (85%

overall and 77% excluding CCs) of

the medicines considered essential 

for the treatment of chronic 

respiratory diseases. Three percent 

of facilities (7% excluding CCs) 

had beclomethasone inhalers, 7%

(15% excluding CCs) had 

prednisolone tablets, 10% (22%

excluding CCs) provided 

hydrocortisone injections, and 2% (4% excluding CCs) had injectable epinephrine. Fourteen percent (32%

excluding CCs) of facilities had oxygen in either cylinders or concentrators or an oxygen distribution 

system.

Overall, private hospitals were more likely to have the essential medicines and commodities than other 

types of facilities (Table 8.6). Among public facilities, as expected, DHs were generally most likely to 

have the medicines and commodities. 

8.5 AVAILABILITY OF SERVICES FOR HYPERTENSION

8.5.1 Service Provision

Table 8.7 and Figures 8.10 and 8.11 provide information from the 2017 BHFS on the availability of 

services for hypertension. The table also presents information on the availability of service guidelines, 

trained staff, and equipment that support the provision of quality services for hypertension.

Availability of Services for Hypertension

Table 8.7 shows that 70% (72% excluding CCs) of health facilities can diagnose, prescribe treatment for, 

and manage patients with hypertension. DHs (100%), UHCs (98%), and private hospitals (95%) are more 

likely to provide services for hypertension than other facilities. Sixty-nine percent of CCs, 53% of 

MCWCs, and 65% of union-level facilities provide hypertension services.

Eighty-eight percent of urban facilities provide services for hypertension, as compared with 69% of rural 

facilities. Barishal and Sylhet (82% each) has the highest proportion of facilities that offer hypertension 

services, while Dhaka (58%) has the lowest.

Figure 8.9 Commodities and medicines to provide 

chronic respiratory disease services

14

2

10 7

3

85

Oxygen Injectable

epinephrine

Hydrocortisone

injection

Prednisolone

tablets

Beclo- methasone

inhaler

Salbutamol

inhaler or

tablets

(N=610)
148 • Non-communicable Diseases

Figure 8.10 Availability of hypertension services in health facilities, by facility type

Service Guidelines

Seventeen percent (14% excluding 

CCs) of facilities offering services 

for hypertension had guidelines for 

the diagnosis and management of 

hypertension available at the 

service site on the day of the survey 

(Table 8.7 and Figure 8.11). NGO 

facilities (34%), DHs (24%), UHCs 

(16%), and CCs (18%) were most 

likely to have guidelines available. 

Guidelines were much more widely 

available in facilities in Rangpur 

(29%) than in facilities in the other 

divisions.

Trained Staff

Among facilities that offer services for hypertension, 10% (the same percentage excluding CCs) had at 

least one staff member who had received in-service training in hypertension during the 24 months before 

the survey (Table 8.7 and Figure 8.11). UHCs (39%), DHs (26%), and private hospitals (17%) were more 

likely than union-level facilities (6%) to have at least one staff member with recent training. NGO clinics 

were least likely to have trained staff (5%). Facilities in Chattogram (15%) were more likely than facilities 

in other divisions to have staff with recent training.

Equipment

Overall, 95% (99% excluding CCs) of facilities that offer services for hypertension had a stethoscope

available at the relevant service sites (Table 8.7 and Figure 8.11). The proportion of facilities having an 

adult scale and a blood pressure apparatus is also high across all facility types.

70 72

91

100

53

98

65 63

70 69

86

95

Total

facilities

Total

facilities

excluding CC

District

&

upazila

public

DH MCWC UHC Unionlevel

public

facilities

UHFWC USC/RD CC NGO Private

Figure 8.11 Trained staff, guidelines, and basic 

equipment to provide hypertension services,

BHFS 2017

10

29

17

95 91 86

Trained

staff

(last 24 months)

Trained

staff

(ever)

GuidelinesStethoscopeBlood

pressure

apparatus

Adult

scale

(N=1,068)
Non-communicable Diseases • 149

8.5.2 Availability of Medicines and Commodities for Hypertension

The 2017 BHFS collected data on the availability of 

essential medicines and commodities to support the 

treatment of patients with hypertension. Table 8.8

and Figure 8.12 show that only 3% of facilities (4%

excluding CCs) had ACE inhibitors, 6% (7%

excluding CCs) had thiazide, 24% (28% excluding 

CCs) had angiotensin receptor blockers (ARBs), and 

26% (31% excluding CCs) had calcium channel 

blockers available on the day of the survey visit.

ARBs and calcium channel blockers were most 

likely to be available in DHs (65% and 62%, 

respectively), UHCs (45% and 43%), private 

hospitals (64% and 71%), and NGO clinics/hospitals 

(35% and 42%). ACE inhibitors and thiazide were 

not widely available. Urban facilities were more likely to have ARBs and calcium channel blockers (50%

and 53%, respectively) than their rural counterparts (Table 8.8).

8.6 AVAILABILITY OF SERVICES FOR CERVICAL CANCER

Table 8.9 and Figure 8.13 provide information from the 2017 BHFS on the availability of services for 

cervical cancer. The table also presents information on the availability of service guidelines, trained staff, 

and equipment that support the provision of quality services for cervical cancer.

Figure 8.13 Availability of cervical cancer screening/diagnosis services in

health facilities, by facility type

8.6.1 Availability of Screening Services for Cervical Cancer

Table 8.9 shows that 3% (8% excluding CCs) of health facilities provide screening services for cervical 

cancer. DHs (65%), UHCs (38%), MCWCs (22%), and private hospitals (21%) are more likely to provide 

screening services for cervical cancer than other facilities. Seventeen percent of NGO clinics/hospitals, and 

only 1% of union-level facilities provide cervical cancer screening services.

Twenty-eight percent of urban facilities provide screening services for cervical cancer, as compared with 

only 1% of rural facilities. Overall, the availability of cervical cancer screening services is very low across 

divisions.

3

8

38

65

22

38

1 1 1 <1

17 21

Total

facilities

Total

facilities

excluding CC

District

&

upazila

public

DH MCWC UHC Unionlevel

public

facilities

UHFWC USC/RD CC NGO Private

Figure 8.12 Medicines to provide 

services for hypertension

26 24

6

3

Calcium

channel

blockers

ARBs Thiazide ACE

inhibitors

(N=245)
150 • Non-communicable Diseases

8.6.2 Service Guidelines

Thirty-nine percent (37% excluding CCs) of 

facilities that offer screening services for cervical 

cancer had guidelines for screening available at the 

service site on the day of the survey (Table 8.9 and 

Figure 8.14). NGOs (72%), DHs (50%), and CCs 

(51%) were most likely to have guidelines available. 

Guidelines were much more widely available in 

facilities in Barishal (62%) than in facilities in the 

other divisions.

8.6.3 Trained Staff

Among facilities offering screening services for 

cervical cancer, 16% (18% excluding CCs) had at 

least one staff member who had received in-service 

training in cervical cancer screening during the 24 months before the survey (Table 8.9 and Figure 8.14). 

MCWCs (40%), DHs (35%), and UHCs (29%) were more likely than other facilities to have at least one 

staff member with recent training. No union-level public facilities or CCs had trained staff. Facilities in 

Khulna (34%) and Rajshahi (26%) were more likely than facilities in other divisions to have staff with 

recent training.

8.6.4 Equipment

Overall, 71% (79% excluding CCs) of facilities that offer screening services for cervical cancer had a 

speculum available at the relevant service site (Table 8.9 and Figure 8.14). A speculum was available at a 

large majority of DHs, MCWCs, UHCs, and private hospitals, while no CCs or union subcenters/rural 

dispensaries (USC/RDs) had a speculum available. Rural facilities (61%) were less likely than urban 

facilities (76%) to have a speculum available. All facilities in Rajshahi and Rangpur had a speculum, and 

availability was high in most other divisions with the exception of Sylhet.

LIST OF TABLES

▪ Table 8.1 Availability of diabetes services and guidelines, trained staff, and equipment for 

diabetes services

▪ Table 8.2 Diagnostic capacity and essential medicines for diabetes

▪ Table 8.3 Availability of cardiovascular disease services and guidelines, trained staff, and 

equipment for cardiovascular disease services

▪ Table 8.4 Availability of essential medicines and commodities for cardiovascular diseases

▪ Table 8.5 Availability of chronic respiratory disease services and guidelines, trained staff, and 

equipment for chronic respiratory disease services

▪ Table 8.6 Availability of essential medicines and commodities for chronic respiratory diseases

▪ Table 8.7 Availability of hypertension services and guidelines, trained staff, and equipment for 

hypertension services

▪ Table 8.8 Availability of essential medicines and commodities for hypertension

▪ Table 8.9 Availability of cervical cancer diagnosis/screening services and guidelines, trained 

staff, and equipment for cervical cancer

Figure 8.14 Trained staff, guidelines,

and basic equipment to diagnose/screen 

cervical cancer

16

39

71

Trained staff

(last 24 months)

Guidelines Speculum

(N=43)
Non-communicable Diseases • 151

Table 8.1 Availability of diabetes services and guidelines, trained staff, and equipment for diabetes services

Among all facilities, the percentages that offer services for diabetes, and among facilities that offer services for diabetes, the percentages with guidelines, at least 

one staff member recently trained on diabetes, at least one staff member ever trained on diabetes, and the indicated equipment observed to be available at the 

service site on the day of the survey, by background characteristics, Bangladesh HFS 2017

Percentage 

of facilities 

offering both 

diagnosis 

and 

treatment 

services for 

diabetes

Percentage 

of facilities 

offering any 

services for 

diabetes1

Number of 

facilities

Percentage of facilities offering 

services for diabetes that have: Equipment

Number of 

facilities 

offering 

services for 

diabetes

Background

characteristic

Guidelines 

for the 

diagnosis 

and 

managemen

t of diabetes

Trained staff

(last 24 

months)2

Trained staff

(ever)3

Blood 

pressure 

apparatus4

Adult 

weighing 

scale

Height 

board or 

stadiometer

Facility type

District and upazila 

public facilities 74.8 89.3 44 17.8 25.8 57.5 95.5 83.9 66.9 39

DH 91.9 100.0 5 24.2 19.4 58.1 96.8 90.3 75.8 5

MCWC 18.7 46.7 7 9.8 12.0 26.1 92.9 85.7 59.6 3

UHC 84.5 96.9 32 17.7 28.2 60.7 95.5 82.7 66.4 31

Union-level public 

facilities 7.8 31.0 361 7.4 2.8 7.8 93.0 78.2 55.1 112

UHFWC 7.3 29.2 250 8.6 0.6 4.8 94.7 85.3 59.6 73

USC/RD 9.1 34.8 111 5.2 7.1 13.5 89.7 64.7 46.6 39

Community clinic 

(CC) 0.9 55.9 1,012 17.8 13.8 36.0 85.6 90.9 83.0 565

NGO clinic/hospital 51.9 85.1 64 33.1 25.8 41.5 97.8 98.7 84.5 54

Private hospital 94.3 97.7 43 1.2 16.5 31.4 100.0 98.5 44.1 42

Location

Urban 70.3 86.9 108 15.8 23.2 41.2 98.8 94.4 64.6 94

Rural 4.8 50.8 1,416 16.6 12.6 32.2 87.3 89.1 78.1 719

Division

Barishal 13.4 57.2 113 11.3 12.7 27.7 81.1 90.6 70.7 65

Chattogram 10.8 51.2 288 12.0 19.8 40.7 92.5 78.4 66.7 148

Dhaka 13.1 49.7 304 14.2 20.0 34.9 78.8 89.2 72.9 151

Khulna 7.4 52.2 187 31.4 21.1 45.6 88.8 93.0 85.3 98

Rajshahi 6.0 66.9 220 16.2 3.7 30.2 90.3 96.1 73.2 147

Rangpur 6.3 41.1 193 35.2 5.3 21.6 99.0 94.1 88.8 80

Sylhet 14.2 64.8 96 2.5 14.0 26.2 86.3 94.3 82.9 62

Mymensingh 3.8 51.3 123 6.2 9.2 27.5 96.0 86.6 86.2 63

Total 9.4 53.3 1,524 16.5 13.8 33.3 88.6 89.7 76.5 813

Total excluding CCs 26.3 48.3 512 13.6 13.8 27.1 95.6 87.0 61.6 247

Note: The indicators presented in this table comprise the staff and training and equipment domains for assessing readiness to provide services for diabetes within 

the health facility assessment methodology proposed by WHO and USAID (2012).

1 Providers in the facility diagnose, prescribe treatment for, or manage patients with diabetes.

2 At least one interviewed provider of diabetes services reported receiving in-service training in diabetes services during the 24 months preceding the survey. The 

training must have involved structured sessions; it does not include individual instruction that a provider might have received during routine supervision.

3 At least one interviewed provider of diabetes services reported ever receiving in-service training in diabetes services. The training must have involved structured 

sessions; it does not include individual instruction that a provider might have received during routine supervision.

4 Functioning digital blood pressure machine or manual sphygmomanometer with stethoscope
152 • Non-communicable Diseases

Table 8.2 Diagnostic capacity and essential medicines for diabetes

Among facilities offering both screening and treatment services for diabetes, the percentages having the indicated diagnostic capacity 

and essential medicines observed at the service site on the day of the survey, by background characteristics, Bangladesh HFS 2017

Diagnostic capacity Medicines

Number of 

facilities 

offering both 

diagnosis 

and 

treatment 

services for 

diabetes

Background

characteristic

Blood 

glucose1

Urine 

protein2

Urine 

glucose3 Metformin

GlibenclamideInjectable 

insulin

Injectable 

glucose 

solution

Facility type

District and upazila 

public facilities 48.2 40.0 34.7 40.2 7.3 32.7 13.4 33

DH 54.4 63.2 59.6 64.9 8.8 56.1 19.3 4

MCWC 11.8 41.2 41.2 0.0 0.0 0.0 0.0 1

UHC 48.9 36.2 30.4 38.1 7.4 30.5 13.1 27

Union-level public 

facilities 1.4 3.2 3.2 0.6 0.0 4.4 0.0 28

UHFWC 2.2 4.9 4.9 0.4 0.0 0.9 0.0 18

USC/RD 0.0 0.0 0.0 0.8 0.0 10.7 0.0 10

Community clinic 

(CC) 22.2 0.0 0.0 0.0 0.0 0.0 0.0 9

NGO clinic/hospital 80.1 74.3 73.1 53.0 1.7 12.0 6.5 33

Private hospital 79.8 69.3 73.5 65.8 25.0 64.2 52.1 40

Location

Urban 71.5 63.5 64.3 53.3 16.1 45.3 33.1 76

Rural 33.4 27.1 25.6 25.2 1.3 11.1 3.7 68

Division

Barishal 35.0 21.7 20.8 14.9 3.3 16.6 4.0 15

Chattogram 53.8 45.8 45.6 48.9 10.7 33.6 28.4 31

Dhaka 65.9 63.8 65.8 45.4 14.3 38.3 19.6 40

Khulna 57.4 41.7 38.5 26.5 7.1 10.2 8.6 14

Rajshahi 65.0 49.1 46.8 46.2 6.5 35.9 23.9 13

Rangpur 36.3 42.2 41.3 40.5 12.1 29.9 19.6 12

Sylhet 33.5 26.9 23.9 32.4 0.0 21.0 20.9 14

Mymensingh 67.6 55.6 61.0 60.7 5.8 22.3 17.8 5

Total 53.6 46.4 46.1 40.0 9.1 29.2 19.2 144

Total excluding CCs 55.7 49.4 49.1 42.7 9.7 31.1 20.5 135

Note: The indicators presented in this table comprise the diagnostics and medicines and commodities domains for assessing readiness 

to provide services for diabetes within the health facility assessment methodology proposed by WHO and USAID (2012).

1 Facility had a functioning glucometer and unexpired glucose test strips in the facility on the day of the survey or else the facility has 

a functioning blood chemistry analyzer.

2 Facility had unexpired urine dipsticks for testing for urine protein available in the facility on the day of the survey.

3 Facility had unexpired urine dipsticks for testing for urine glucose available in the facility on the day of the survey.
Non-communicable Diseases • 153

Table 8.3 Availability of cardiovascular disease services and guidelines, trained staff, and equipment for cardiovascular disease services

Among all facilities, the percentages offering services for cardiovascular diseases, and among facilities offering services for cardiovascular diseases, the percentages having 

guidelines, at least one staff member recently trained on cardiovascular diseases, at least one staff member ever trained on cardiovascular diseases, and the indicated 

equipment observed to be available at the service site on the day of the survey, by background characteristics, Bangladesh HFS 2017

Percentage 

of facilities 

offering both 

diagnosis 

and 

treatment 

services for 

cardiovascular 

diseases

Percentage 

of facilities 

offering any 

services for 

cardiovascular 

diseases1

Number of 

facilities

Percentage of facilities offering services 

for cardiovascular diseases that have: Equipment

Number of 

facilities 

offering 

services for 

cardiovascular 

diseases

Background

characteristic

Guidelines 

for diagnosis 

and management of 

cardiovascular 

diseases

Trained staff

(last 24 

months)2

Trained staff

(ever)3 Stethoscope

Blood 

pressure 

apparatus4 Adult scale

Facility type

District and upazila 

public facilities 63.8 86.5 44 12.0 35.9 68.6 97.2 95.5 84.3 38

DH 93.5 100.0 5 22.6 25.8 71.0 98.4 96.8 90.3 5

MCWC 16.6 39.9 7 8.5 8.5 27.8 97.2 94.5 89.0 3

UHC 69.6 94.5 32 10.6 39.9 72.0 96.9 95.4 82.9 31

Union-level public 

facilities 7.4 40.5 361 6.9 6.6 26.0 99.0 96.0 76.5 146

UHFWC 6.9 39.4 250 6.7 3.9 21.7 99.1 95.8 79.9 99

USC/RD 8.7 43.1 111 7.3 12.2 34.7 98.9 96.4 69.5 48

Community clinic 

(CC) 1.4 37.9 1,012 8.4 14.8 46.7 93.2 86.7 87.7 384

NGO clinic/hospital 23.2 51.9 64 37.2 1.8 18.2 98.6 96.4 100.0 33

Private hospital 84.0 97.1 43 0.6 17.0 26.6 100.0 100.0 98.5 42

Location

Urban 55.9 76.8 108 13.3 19.7 36.2 99.2 98.7 94.6 83

Rural 4.2 39.5 1,416 8.6 12.8 41.2 94.9 89.5 85.0 560

Division

Barishal 6.1 66.1 113 7.5 9.4 23.1 91.9 79.8 88.7 75

Chattogram 9.8 33.8 288 8.8 20.4 50.2 91.7 88.7 76.8 97

Dhaka 10.3 35.1 304 18.9 16.8 41.5 95.6 87.4 86.9 107

Khulna 7.4 31.2 187 6.7 18.9 41.7 99.2 89.2 80.8 58

Rajshahi 6.6 49.8 220 6.7 10.7 55.7 95.7 95.7 93.7 109

Rangpur 5.2 36.7 193 12.6 15.7 42.4 99.2 98.8 87.9 71

Sylhet 10.7 68.6 96 4.7 9.3 31.7 93.6 92.9 91.6 66

Mymensingh 4.0 48.3 123 3.0 5.4 23.6 99.1 93.7 81.5 59

Total 7.9 42.2 1,524 9.2 13.7 40.5 95.5 90.7 86.3 643

Total excluding CCs 20.7 50.6 512 10.5 12.0 31.4 98.8 96.6 84.1 259

Note: The indicators presented in this table comprise the staff and training and equipment domains for assessing readiness to provide services for cardiovascular diseases 

within the health facility assessment methodology proposed by WHO and USAID (2012).

1 Providers in the facility diagnose, prescribe treatment for, or manage patients with cardiovascular diseases.

2 At least one interviewed provider of cardiovascular disease services reported receiving in-service training in cardiovascular diseases during the 24 months preceding the 

survey. The training must have involved structured sessions; it does not include individual instruction that a provider might have received during routine supervision.

3 At least one interviewed provider of cardiovascular disease services reported ever receiving in-service training in cardiovascular diseases. The training must have involved 

structured sessions; it does not include individual instruction that a provider might have received during routine supervision.

4 Functioning digital blood pressure machine or manual sphygmomanometer with stethoscope
154 • Non-communicable Diseases

Table 8.4 Availability of essential medicines and commodities for cardiovascular diseases

Among facilities offering both screening and treatment services for cardiovascular diseases, the percentages having the indicated 

essential medicines and commodities observed at the service site on the day of the survey, by background characteristics, Bangladesh 

HFS 2017

Percentage of facilities offering services for cardiovascular diseases that have

the indicated medicines and commodities

Number of 

facilities 

offering both 

diagnosis and 

treatment 

services for 

cardiovascular 

diseases

Background

characteristic

ACE inhibitors 

(enalapril) Thiazide

Beta blockers 

(atenolol)

Calcium 

channel 

blockers 

(amiodipine/ 

nifedipine) Aspirin Oxygen1

Facility type

District and upazila 

public facilities 0.0 3.4 36.2 43.4 31.5 70.3 28

DH 0.0 6.9 46.6 60.3 55.2 69.0 4

MCWC 0.0 6.6 20.4 13.8 0.0 53.6 1

UHC 0.0 2.6 35.0 41.5 28.5 71.4 23

Union-level public 

facilities 0.0 0.0 2.8 4.7 0.0 4.8 27

UHFWC 0.0 0.0 1.9 4.5 0.0 7.5 17

USC/RD 0.0 0.0 4.2 5.0 0.0 0.0 10

Community clinic 

(CC) 0.0 0.0 0.0 0.0 0.0 0.0 14

NGO clinic/hospital 4.8 9.7 35.1 47.3 16.5 41.7 15

Private hospital 19.6 30.0 61.8 71.4 61.3 87.6 36

Location

Urban 12.1 20.3 51.8 59.4 48.6 74.8 60

Rural 0.8 1.5 11.9 17.2 6.7 22.9 59

Division

Barishal 0.0 5.6 39.2 31.9 25.4 46.4 7

Chattogram 9.9 16.2 33.2 37.7 32.0 37.6 28

Dhaka 10.6 11.4 38.9 50.0 40.4 67.4 31

Khulna 2.0 6.1 19.0 21.6 12.3 34.9 14

Rajshahi 3.4 9.3 14.2 31.1 20.7 39.4 14

Rangpur 7.1 7.9 40.8 34.5 29.5 57.0 10

Sylhet 0.0 15.1 39.5 50.2 19.1 49.4 10

Mymensingh 2.8 2.8 26.3 32.6 7.1 54.2 5

Total 6.5 11.0 32.0 38.5 27.8 49.1 120

Total excluding CCs 7.3 12.5 36.3 43.6 31.6 55.6 106

Note: The indicators presented in this table comprise the medicines and commodities domain for assessing readiness to provide services 

for cardiovascular diseases within the health facility assessment methodology proposed by WHO and USAID (2012).

1

In cylinders or concentrators or an oxygen distribution system
Non-communicable Diseases • 155

Table 8.5 Availability of chronic respiratory disease services and guidelines, trained staff, and equipment for chronic respiratory disease services

Among all facilities, the percentages offering services for chronic respiratory diseases, and among facilities offering services for chronic respiratory diseases, the percentages 

having guidelines, at least one staff member recently trained on chronic respiratory diseases, at least one staff member ever trained on chronic respiratory diseases, and the 

indicated equipment observed to be available at the service site on the day of the survey, by background characteristics, Bangladesh HFS 2017

Percentage 

of facilities 

offering both 

diagnosis 

and 

treatment 

services for 

chronic 

respiratory 

diseases

Percentage 

of facilities 

offering any 

services for 

chronic 

respiratory 

diseases1

Number of 

facilities

Percentage of facilities offering services 

for chronic respiratory diseases that have: Equipment

Number of 

facilities 

offering 

services for 

chronic 

respiratory 

diseases

Background

characteristic

Guidelines 

for diagnosis 

and 

management 

of chronic 

respiratory 

diseases

Trained staff

(last 24 

months)2

Trained staff

(ever)3 Stethoscope4

Peak flow 

meter5

Spacers for 

inhalers

Facility type

District and upazila 

public facilities 85.1 90.0 44 15.7 27.4 55.5 97.3 15.3 15.7 40

DH 98.4 100.0 5 22.6 27.4 64.5 98.4 17.7 24.2 5

MCWC 35.3 48.9 7 16.1 9.2 13.7 97.8 9.0 6.7 3

UHC 93.9 97.4 32 14.6 29.4 58.7 97.0 15.6 15.4 32

Union-level public 

facilities 43.6 60.6 361 10.4 3.8 19.4 98.1 0.1 0.5 219

UHFWC 42.9 58.2 250 12.1 2.5 16.3 98.4 0.2 0.7 146

USC/RD 45.3 66.0 111 7.0 6.3 25.6 97.4 0.0 0.0 73

Community clinic 

(CC) 34.1 59.0 1,012 18.8 10.8 26.0 93.0 0.7 0.0 597

NGO clinic/hospital 45.4 73.0 64 31.0 5.0 10.7 99.0 9.4 2.4 46

Private hospital 94.6 97.4 43 0.9 7.1 19.5 100.0 25.9 31.1 42

Location

Urban 72.7 84.9 108 14.4 12.7 26.6 99.3 20.3 18.3 92

Rural 37.5 60.2 1,416 16.8 9.1 24.5 94.5 0.8 0.5 852

Division

Barishal 54.7 79.3 113 19.2 11.4 25.1 93.2 6.2 1.0 90

Chattogram 32.6 54.9 288 13.6 17.5 31.4 94.8 3.0 2.5 158

Dhaka 25.2 50.2 304 10.9 6.1 17.8 88.3 6.0 6.2 152

Khulna 48.7 60.9 187 27.4 9.9 25.5 98.6 0.9 1.4 114

Rajshahi 41.6 69.4 220 20.0 4.6 20.6 96.1 1.9 1.7 152

Rangpur 50.0 64.2 193 23.1 8.0 27.8 99.3 0.8 1.1 124

Sylhet 50.7 73.3 96 6.9 11.9 28.5 94.1 0.8 1.6 71

Mymensingh 40.2 67.2 123 6.8 6.3 22.3 96.6 0.7 0.7 82

Total 40.0 61.9 1,524 16.6 9.4 24.7 95.0 2.7 2.3 944

Total excluding CCs 51.7 67.8 512 12.6 7.1 22.4 98.3 6.2 6.2 347

1 Providers in the facility diagnose, prescribe treatment for, or manage patients with respiratory disease.

2 At least one interviewed provider of services for chronic respiratory diseases reported receiving in-service training in chronic respiratory diseases during the 24 months 

preceding the survey. The training must have involved structured sessions; it does not include individual instruction that a provider might have received during routine 

supervision.

3 At least one interviewed provider of services for chronic respiratory diseases reported ever receiving in-service training in chronic respiratory diseases . The training must 

have involved structured sessions; it does not include individual instruction that a provider might have received during routine supervision.

4 Functioning stethoscope

5 Functioning peak flow meter
156 • Non-communicable Diseases

Table 8.6 Availability of essential medicines and commodities for chronic respiratory diseases

Among facilities offering both treatment and screening services for chronic respiratory diseases, the percentages having the indicated 

essential medicines and commodities observed at the service site on the day of the survey, by background characteristics, Bangladesh 

HFS 2017

Percentage of facilities offering services for chronic respiratory diseases that have

the indicated medications and commodities

Number of 

facilities 

offering both 

diagnosis and 

treatment 

services for 

chronic 

respiratory 

diseases

Background

characteristic

Salbutamol 

inhaler or 

tablets

Beclomethasone inhalerPrednisolone 

tablets

Hydrocortisone 

injection

Injectable 

epinephrine Oxygen1

Facility type

District and upazila 

public facilities 91.2 3.9 12.0 45.6 1.3 70.7 38

DH 93.4 3.3 36.1 60.7 6.6 68.9 5

MCWC 81.1 0.0 0.0 21.8 3.1 53.3 2

UHC 91.6 4.4 9.2 45.3 0.3 72.5 30

Union-level public 

facilities 78.2 0.0 1.3 0.4 0.0 7.0 158

UHFWC 73.4 0.0 1.1 0.0 0.0 8.9 107

USC/RD 88.4 0.0 1.5 1.3 0.0 3.1 50

Community clinic 

(CC) 91.5 0.0 0.0 0.0 0.0 0.0 346

NGO clinic/hospital 60.0 3.5 32.4 34.9 5.7 34.1 29

Private hospital 71.5 36.8 58.2 74.5 21.5 89.0 41

Location

Urban 77.4 19.7 38.0 58.5 13.3 69.9 79

Rural 86.4 0.4 1.8 2.3 0.1 5.4 532

Division

Barishal 89.8 0.3 2.3 4.9 0.4 7.6 62

Chattogram 84.9 4.0 9.4 16.0 2.6 22.1 94

Dhaka 72.8 9.1 18.5 23.7 4.6 32.1 77

Khulna 76.8 0.7 3.3 5.5 1.0 8.6 91

Rajshahi 91.1 1.4 3.9 6.6 0.8 8.9 91

Rangpur 90.0 2.0 3.9 3.8 1.0 6.1 97

Sylhet 90.7 2.7 7.6 8.5 2.7 14.5 49

Mymensingh 89.2 2.8 1.8 6.0 1.3 9.4 49

Total 85.2 2.9 6.5 9.5 1.8 13.7 610

Total excluding CCs 77.0 6.6 14.9 22.0 4.1 31.6 264

Note: The indicators presented in this table comprise the medicines and commodities domain for assessing readiness to provide services 

for cardiovascular diseases within the health facility assessment methodology proposed by WHO and USAID (2012).

1

In cylinders or concentrators or an oxygen distribution system
Non-communicable Diseases • 157

Table 8.7 Availability of hypertension services and guidelines, trained staff, and equipment for hypertension services

Among all facilities, the percentages offering services for hypertension, and among facilities offering services for hypertension, the percentages having guidelines, at least 

one staff member recently trained on hypertension, at least one staff member ever trained on hypertension, and the indicated equipment observed to be available at the 

service site on the day of the survey, by background characteristics, Bangladesh HFS 2017

Percentage 

of facilities 

offering both 

diagnosis 

and 

treatment 

services for 

hypertension

Percentage 

of facilities 

offering any 

services for 

hypertension1

Number of 

facilities

Percentage of facilities offering services 

for hypertension that have: Equipment

Number of 

facilities 

offering 

services for 

hypertension

Background

characteristic

Guidelines 

for diagnosis 

and 

management 

of 

hypertension

Trained staff

(last 24 

months)2

Trained staff

(ever)3 Stethoscope4

Blood 

pressure 

apparatus5 Adult scale

Facility type

District and upazila 

public facilities 83.3 91.1 44 16.8 34.2 65.3 97.1 97.1 84.0 40

DH 96.8 100.0 5 24.2 25.8 71.0 98.4 98.4 90.3 5

MCWC 36.6 53.2 7 14.8 8.6 23.1 95.9 93.8 87.4 4

UHC 91.5 98.0 32 15.9 38.5 69.4 97.1 97.3 82.6 32

Union-level public 

facilities 27.5 65.1 361 11.6 6.4 21.7 98.6 95.4 76.2 235

UHFWC 24.1 63.2 250 11.8 4.8 18.8 99.1 96.8 81.5 158

USC/RD 35.1 69.5 111 11.3 9.8 27.6 97.6 92.4 65.4 77

Community clinic 

(CC) 3.5 68.9 1,012 17.6 10.3 30.0 93.4 87.9 87.7 697

NGO clinic/hospital 53.8 85.8 64 34.1 5.0 16.5 99.1 98.7 98.7 54

Private hospital 90.2 94.9 43 1.5 17.4 27.2 100.0 100.0 98.5 41

Location

Urban 72.6 87.6 108 15.4 18.1 34.4 99.3 99.4 94.1 95

Rural 11.7 68.7 1,416 16.6 9.6 28.1 94.9 90.1 85.2 973

Division

Barishal 21.4 81.5 113 22.0 7.9 19.3 93.4 83.7 87.7 92

Chattogram 22.2 67.8 288 10.0 14.5 31.8 95.7 92.1 73.8 195

Dhaka 15.9 58.0 304 19.8 10.9 26.3 89.9 86.2 88.4 176

Khulna 15.7 66.7 187 27.5 13.9 30.1 99.6 89.2 88.5 125

Rajshahi 12.3 78.7 220 13.4 6.8 37.3 94.2 92.0 95.3 173

Rangpur 11.4 66.1 193 28.7 11.7 26.5 99.3 99.8 85.7 128

Sylhet 17.7 82.2 96 6.1 8.1 26.8 94.7 89.4 89.4 79

Mymensingh 10.3 81.1 123 2.4 5.6 23.0 97.1 93.9 82.6 99

Total 16.1 70.1 1,524 16.5 10.4 28.7 95.3 90.9 86.0 1,068

Total excluding CCs 40.8 72.4 512 14.4 10.4 26.3 98.7 96.6 82.8 370

1 Providers in the facility diagnose, prescribe treatment for, or manage patients with hypertension.

2 At least one interviewed provider of hypertension services reported receiving in-service training in hypertension services during the 24 months preceding the survey. The 

training must have involved structured sessions; it does not include individual instruction that a provider might have received during routine supervision.

3 At least one interviewed provider of hypertension services reported ever receiving in-service training in hypertension services. The training must have involved structured 

sessions; it does not include individual instruction that a provider might have received during routine supervision.

4 Functioning stethoscope

5 Functioning digital blood pressure machine or manual sphygmomanometer with stethoscope
158 • Non-communicable Diseases

Table 8.8 Availability of essential medicines and commodities for hypertension

Among facilities offering services for hypertension, the percentages having the indicated essential medicines and 

commodities observed at the service site on the day of the survey, by background characteristics, Bangladesh HFS 

2017

Percentage of facilities offering services for hypertension that have

the indicated medications

Number of 

facilities offering 

both diagnosis 

and treatment 

services for 

hypertension

Background

characteristic

ACE inhibitors 

(enalapril) Thiazide

Angiotensin 

receptor blockers 

(losartan)

Calcium channel 

blockers 

(amiodipine/ 

nifedipine)

Facility type

District and upazila 

public facilities 0.0 2.2 44.4 42.5 37

DH 0.0 6.7 65.0 61.7 5

MCWC 0.0 3.0 3.0 6.2 3

UHC 0.0 1.4 44.7 42.6 30

Union-level public 

facilities 0.0 0.0 5.9 6.2 99

UHFWC 0.0 0.0 0.1 3.4 60

USC/RD 0.0 0.0 14.7 10.5 39

Community clinic 

(CC) 0.0 0.0 0.0 0.0 36

NGO clinic/hospital 0.9 5.4 34.8 42.1 34

Private hospital 18.5 30.5 63.9 71.2 39

Location

Urban 8.5 16.9 50.3 52.8 78

Rural 0.4 0.7 11.6 13.4 166

Division

Barishal 0.0 1.6 17.1 11.3 24

Chattogram 3.3 8.1 24.5 23.2 64

Dhaka 6.8 7.3 33.4 39.1 48

Khulna 0.9 2.8 13.5 13.0 29

Rajshahi 2.8 5.9 28.5 34.0 27

Rangpur 3.2 5.5 20.6 24.4 22

Sylhet 0.0 8.1 24.0 35.2 17

Mymensingh 2.3 2.1 19.4 22.5 13

Total 3.0 5.9 24.0 26.0 245

Total excluding CCs 3.6 6.9 28.1 30.5 209
Non-communicable Diseases • 159

Table 8.9 Availability of cervical cancer diagnosis/screening services and guidelines, trained staff, and equipment for 

cervical cancer

Among all facilities, the percentages offering diagnosis/screening services for cervical cancer, and among facilities offering 

diagnosis/screening services for cervical cancer, the percentages having guidelines, at least one staff member recently trained on 

cervical cancer screening, and the indicated equipment observed to be available at the service site on the day of the survey, by 

background characteristics, Bangladesh HFS 2017

Percentage of 

facilities offering 

diagnosis/ 

screening 

services for 

cervical cancer1

Number of 

facilities

Percentage of facilities offering 

diagnosis/screening services for 

cervical cancer that have: Equipment

Number of 

facilities offering 

diagnosis/ 

screening 

services for 

cervical cancer

Background

characteristic

Guidelines for 

screening of 

cervical cancer Trained staff2 Speculum

Facility type

District and upazila 

public facilities 38.0 44 34.3 31.1 99.2 17

DH 64.5 5 50.0 35.0 100.0 3

MCWC 22.3 7 29.9 40.2 100.0 2

UHC 37.5 32 31.0 29.0 98.9 12

Union-level public 

facilities 0.8 361 3.5 0.0 81.5 3

UHFWC 0.9 250 4.3 0.0 100.0 2

USC/RD 0.5 111 0.0 0.0 0.0 1

Community clinic 

(CC) 0.4 1,012 50.7 0.0 0.0 4

NGO clinic/hospital 16.5 64 71.9 13.6 26.2 10

Private hospital 20.6 43 12.5 3.4 100.0 9

Location

Urban 27.5 108 37.8 18.6 76.0 30

Rural 0.9 1,416 40.0 11.0 60.8 13

Division

Barishal 3.4 113 62.4 23.4 43.0 4

Chattogram 2.5 288 23.2 9.9 90.1 7

Dhaka 4.4 304 53.4 15.7 62.2 13

Khulna 1.8 187 49.4 33.5 83.9 3

Rajshahi 2.6 220 24.4 25.7 100.0 6

Rangpur 0.9 193 32.4 4.3 100.0 2

Sylhet 4.7 96 16.1 5.1 30.5 5

Mymensingh 2.2 123 27.5 9.8 81.2 3

Total 2.8 1,524 38.5 16.3 71.4 43

Total excluding CCs 7.6 512 37.2 17.9 78.5 39

1 Providers in the facility diagnose/screen for cervical cancer.

2 At least one interviewed provider of cervical cancer diagnosis/screening diseases services reported receiving in-service training in 

cervical cancer during the 24 months preceding the survey. The training must have involved structured sessions; it does not include 

individual instruction that a provider might have received during routine supervision.

Tuberculosis • 161

TUBERCULOSIS 9

Key Findings

▪ One in 11 facilities provide tuberculosis (TB) services (i.e., 

TB diagnostic, treatment, and/or treatment follow-up 

services). Availability of TB services has increased since 

2014 (from 6% to 9%) (Table 9.1, Figure 9.1).

▪ TB services are available in 98% of upazila health 

complexes (UHCs), 90% of district hospitals (DHs), 48% 

of private hospitals, and 13% of nongovernmental (NGO) 

facilities. Although other public health facilities are not 

specifically assigned to provide TB services, 6% of unionlevel public facilities and 4% of community clinics (CCs)

reported offering these services (Table 9.1).

▪ Sixty-four percent of private hospitals and 41% of DHs 

have TB x-ray machines, as compared with only 11% of 

UHCs (Table 9.2).

▪ Among facilities that offer TB services, 38% had any 

guideline for TB available. UHCs and DHs were most 

likely to have guidelines (87% and 84%, respectively). 

Only 9% of private hospitals had guidelines available 

(Table 9.3).

▪ Three out of five facilities had at least one staff member 

who had ever received in-service training on TB. 

Availability of trained staff increased from 47% in 2014 to 

57% in 2017 (Table 9.3, Figure 9.2).

▪ Between 2014 and 2017, the availability of TB diagnosis 

smear microscopies remained the same (38%) among all 

facilities that provide TB services. Seventy-five percent of 

UHCs, 61% of DHs, 67% of private hospitals, 28% NGOs, 

16% of union level facilities and 10% of CCs that provide 

TB services have provision of TB diagnosis smear 

microscopies in the facilities (Table 9.2 and Figure 9.2).

▪ Availability of first-line medicines for treating TB (any 

combination of pyrazinamide, rifampicin, ethambutol, and 

isoniazid) were available in four out of ten facilities 

providing TB services. However, majority of DHs (84%), 

UHCs (87%), NGO clinics (65%) USC/RDs (63%) had 

first-line medicines for treating TB. Overall, availability of 

medicine was much lower in 2017 (39%) compared to 

2014 (59%) (Table 9.3).

▪ WHO identified a list of tracer items (guideline, trained 

staff, essential equipment and commodities) to be 

available for a facility to be considered ready to provide 

quality TB services. Based on modified WHO criteria 

relevant for Bangladesh, 36% of DHs, 58% of UHCs, 28% 

of NGO clinics and 18% of USC/RDs are considered 

ready to provide TB services. None of the private facilities 

had the readiness to provide TB services (Table 9.3 and 

Figure 9.3).
162 • Tuberculosis

▪ Overall, the readiness to provide TB services among all 

facilities (excluding CCs) has increased from 23% in 2014 

to 27% in 2017. The readiness to provide TB services 

improved substantially among UHCs from 36% to 58%, 

and among and union level USC/RDs from 0 % to 18% in 

the three-year period (Table 9.3 and Figure 9.3).

9.1 BACKGROUND

angladesh is one of the 30 high-burden countries for tuberculosis (TB) as defined by the World 

Health Organization (WHO). In Bangladesh, the estimated incidence rate for all forms of TB is 

221 per 100,000 population (WHO Global Report 2018). Combating TB was included in the 

Millennium Development Goals (MDGs); in the Sustainable Development Goals (SDGs), it has been 

placed under health-related targets to reduce the TB epidemic (United Nations. Sustainable Development 

Goals; 17 Goals to Transform the World. 2016). The target has been set to reduce TB incidence and TBrelated deaths by 90% and 95%, respectively, in the year 2035 in comparison with 2015 (WHO 

Tuberculosis Fact Sheet 2016).

The Mycobacterium Disease Control (MBDC) unit of the Directorate-General of Health Services (DGHS), 

which is part of the Bangladesh Ministry of Health and Family Welfare (MOHFW), oversees the National 

Tuberculosis Control Program (NTP). The MBDC implements the NTP in partnership with 44 national and 

international nongovernmental organizations (NGOs). The Global Fund, the United States Agency for 

International Development (USAID), and WHO are the main development partners in TB efforts in 

Bangladesh. These development partners support the Bangladesh government through different

implementing agencies such as the Bangladesh Rural Development Committee (BRAC); the International 

Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b); the Damien Foundation; and Management 

Science for Health (MSH). Every organization plays some roles in the whole process. For instance, BRAC

supports TB service delivery through directly observed treatment, short-course (DOTS) centers.

Under the NTP, TB diagnostic and treatment services are available free of charge in public and private 

facilities throughout the country. Diagnosis and care for TB are provided through all upazila health 

complexes (UHCs) and district hospitals (DHs), 44 chest disease clinics, eight chest disease hospitals 

linked to these clinics, four divisional chest disease hospitals, DOTS centers within public and private 

medical college hospitals, workplaces, prisons, combined military hospitals, and other defense hospitals 

run by Bangladesh Rifles, the Bangladesh Police, and Bangladesh Ansar (2015-2016 Bangladesh National 

Tuberculosis Prevalence Survey). The goal is to reduce morbidity, mortality, and transmission of TB until 

the disease is no longer a public health problem. Union level public health or community clinics (CCs) are 

not mandated to provide TB services; these facilities primarily screen and refer clients to UHCs or other 

facilities. The country has a laboratory network at the national, regional, district, and upazila levels. Smear 

microscopy is the primary TB diagnosis tool in the country. There are 1,106 microscopy laboratories 

throughout Bangladesh under the NTP. In addition, the country has a network of 220 Gene Xpert machines 

to detect and confirm TB cases.

The NTP introduced the DOTS strategy in 1993, followed by an MOHFW mandate to notify TB in 2014. 

The NTP has been implementing the Stop TB Strategy since 2006 (Annual TB Report 2017). DOTS 

services have been available in all UHCs since 1998, and 100% DOTS coverage was reached in 2007 

(Annual TB Report 2017). The DOTS strategy involves the following five components:

▪ Secure political commitment with adequate and sustained financing.

▪ Ensure early case detection and diagnosis through quality-assured bacteriology.

▪ Provide standardized treatment with supervision and patient support.

▪ Ensure effective drug supply and management.

▪ Monitor and evaluate performance and impact.

B
Tuberculosis • 163

This chapter provides an overview of TB services in Bangladesh secondary and primary health care 

facilities and highlights the key aspects of TB-related client services, including the availability of 

diagnostic capacity, trained staff, and medicines. The chapter is organized as follows:

▪ Availability of TB services. Section 9.2, including Tables 9.1 and 9.2 and Figure 9.1, presents 

information on the availability of TB diagnostic and treatment services in Bangladesh.

▪ Readiness of health facilities. Section 9.3, including Table 9.3 and Figures 9.2 and 9.3, provides 

information on the availability of WHO-recommended items/tracer indicators that are necessary to 

offer quality TB services.

9.2 AVAILABILITY OF TB SERVICES

9.2.1 Service Provision

Achieving effective TB control requires concerted efforts at all levels. Table 9.1 and Figure 9.1 present 

information from the BHFS on several key measures of the preparedness of primary- and secondary-level 

health facilities that offer TB diagnostic, treatment, and/or treatment follow-up services.

Availability of TB Services

Almost all DHs (90%) and UHCs (98%) offer TB diagnostic, treatment, and/or treatment follow-up 

services (Table 9.1 and Figure 9.1). Among public sector facilities, DHs and UHCs are more likely than 

other facility types to provide TB services. Although union-level public facilities and CCs are not 

specifically assigned to provide TB services, 6% of union-level facilities (8% of union subcenters/rural 

dispensaries [USC/RDs] and 5% of union health and family welfare centers [UHFWCs]) and 4% of CCs 

do so. Nearly half of private facilities (48%) and 13% of NGO facilities provide TB diagnostic, referral, 

treatment, and/or TB treatment follow-up services.

Nine percent of all health facilities (17% excluding CCs) offer TB services, an increase from 6% in 2014 

(Figure 9.1). There are divisional differentials in the availability of TB services. Facilities in Dhaka (15%) 

are more likely to provide TB services than facilities in other divisions.

As shown in Table 9.1, 13% (8% excluding CCs) of all health facilities provide referrals for TB diagnostic 

services. DHs (36%), UHCs (43%), and CCs (16%) are more likely than other facility types to provide 

such referrals.

Six percent (15% excluding CCs) of health facilities offer TB diagnostic services. DHs (86%), UHCs 

(94%), and private facilities (48%) are most likely to provide diagnostic services.

Six percent of health facilities (13% excluding CCs) offer TB treatment and/or TB treatment follow-up 

services. TB treatment and/or treatment follow-up services are much more likely to be available in UHCs 

(95%) and DHs (79%) than in other types of facilities. Twenty percent of private hospitals and 13% of 

NGO facilities provide these services.
164 • Tuberculosis

Figure 9.1 Availability of TB services (TB diagnostic, treatment and/or treatment 

follow-up services), by facility type

Availability of Guidelines

National guidelines for the diagnosis and treatment of TB are expected to be available at all TB service 

sites. Eighty-five percent of UHCs and 80% of DHs had guidelines for the diagnosis and treatment of TB 

on the day of the survey visit. Diagnosis and treatment guidelines were available at two-thirds of NGO 

facilities (65%) but only 6% of private facilities. Overall, guidelines for diagnosis and treatment of TB 

were available in 37% of health facilities (51% excluding CCs) offering any TB services (Table 9.1).

Guidelines for the diagnosis and treatment of multidrug-resistant TB (MDR-TB) were available in more 

than half of DHs (57%) and UHCs (58%) on the day of the survey visit. Half of NGO facilities had MDRTB diagnosis and treatment guidelines available, as compared with only 4% of private facilities. Overall, 

guidelines for the diagnosis and treatment of MDR-TB were available in 24% of facilities (36% excluding 

CCs) that offer TB services.

Guidelines for management of HIV and TB co-infection were available in 33% of UHCs and 29% of DHs, 

while 37% of NGO facilities and less than 1% of private facilities had such guidelines. Overall, guidelines 

for the management of HIV and TB co-infection were available in only 11% of facilities (17% excluding 

CCs) offering TB services.

Thirty-eight percent of DHs and 22% of UHCs had guidelines for TB infection control, as compared with 

33% of NGO facilities and 6% of private facilities. Overall, 19% of facilities (18% excluding CCs) that 

offer any TB services had guidelines for TB infection control available on the day of survey visit (Table 

9.1).

Trained Staff

Fifty-seven percent of UHCs and nearly half of DHs (48%) had at least one provider who had received inservice training in TB services during the 24 months before the survey (Table 9.1). Fifty-two percent of 

NGOs and 5% of private facilities had trained staff. Union-level public facilities (11%) were less likely 

than CCs (19%) to have trained staff. Overall, 28% of all facilities (32% excluding CCs) offering TB 

services had at least one provider who had received training in TB services during the 24 months before 

the survey (Table 9.1).

6

13

73

2

91

4 2

13

23

9

17

90

1

98

6 4

13

48

Total

facilities

Total

facilites

excluding

CC

DHs MCWCs UHCs Unionlevel

public

CC NGOs Private

BHFS 2014

(N=1,548)

BHFS 2017

(N=1,524)
Tuberculosis • 165

9.2.2 Availability of Diagnostic Capacity and Medicines for TB Treatment

There are two types of TB: pulmonary (affecting the lungs) and extra-pulmonary (affecting other parts of 

the body in addition to the lungs). The highest priority for TB control services is identification and 

successful treatment of patients who are suffering from pulmonary TB. The most cost-effective tool for 

screening pulmonary TB disease is microscopy examination of sputum by the Ziel-Neelsen method. 

Moreover, sputum examination is the most reliable procedure for diagnosis of pulmonary TB. The 2017 

BHFS assessed the availability of TB diagnostic capacity and medicines for TB treatment in facilities that 

offered any TB services. Table 9.2 presents the results of these assessments.

Diagnostic Capacity

There are different types of diagnostic tools for TB. As noted, the most common and cost-effective tool for 

diagnosis of TB is microscopy examination of a patient’s sputum. Chest x-rays (radiological examination 

of the lungs) and Gene Xpert are also commonly used, along with tuberculin skin tests (Mantoux tests), 

cultures of TB bacilli, molecular tests, and fine needle aspiration cytology (FNAC) and biopsies. Early 

case detection and diagnosis are critical for TB control, and in recent years the NTP has taken steps to 

increase the number of TB service facilities with adequate diagnostic tools and equipment. Table 9.2

describes the availability of TB diagnosis capacity in health facilities that offered TB services on the day of 

the survey visit. The availability of TB diagnosis smear microscopy services was assessed through 

observation of a functioning microscope, slides, and stains for Ziehl-Neelson tests (carbol-fuchsin, sulfuric 

acid, and methyl blue) or a fluorescence-LED microscope with all stains (sulfuric acid, methyl blue, 

auramine stain). TB diagnosis smear microscopies were available in 61% of DHs, 75% of UHCs, and 67%

of private hospitals. TB rapid diagnostic test kits were observed in 36% of DHs, 19% of UHCs, and 27%

of private hospitals. TB x-ray equipment was found in 64% of private hospitals and 41% of DHs but only 

11% of UHCs. Sixteen percent of private facilities had a solid or liquid culture medium (e.g., MGIT 960)

available, as compared with only 7% of DHs and 3% of UHCs.

Overall, TB diagnosis smear microscopy was available in 38% of all facilities (53% excluding CCs) that 

offer TB services. TB rapid diagnostic test kits were available in 11% of facilities (17% excluding CCs),

and TB x-ray equipment was available in 14% of facilities (22% excluding CCs). Only 4% of facilities 

(5% excluding CCs) had a solid or liquid culture medium for diagnosing TB. Union- and lower-level 

health facilities did not have the capacity for providing most TB diagnostic services. However, 16% of 

union-level facilities and 10% of CCs had TB smear microscopy available.

9.3 READINESS OF HEALTH FACILITIES TO PROVIDE TB SERVICES

WHO recommends assessing readiness to provide TB services based on the availability of specific 

items/tracer indicators. In this section of the report, data from the 2017 BHFS are used to construct a 

slightly less restrictive and Bangladesh-context-appropriate version of the WHO measure. The measure 

includes the following four items/tracer indicators:

▪ Trained staff: At least one provider ever receiving in-service training on TB

▪ Guidelines: Any guidelines for TB

▪ Diagnostic capacity: TB microscopy

▪ Medicines: First-line TB medicines
166 • Tuberculosis

Table 9.3 and Figures 9.2 present 

information on the availability of 

these items/indicators at health 

facilities offering TB services. 

Ninety-two percent of UHCs, 77%

of DHs, 78% of NGO facilities, 

52% of CCs, and 45% of unionlevel facilities have staff who ever 

received in-service training on TB. 

Guidelines for TB were available in 

87% of UHCs, 84% of DHs, and 

65% of NGO . Availability of 

trained staff (14%) and guidelines 

(9%) were low among private 

facilities. Among union- and lowerlevel public facilities, availability 

of trained staff and guidelines 

varied widely by type of facility. 

The availability of trained staff was high at USC/RDs (68%) and CCs (52%) but low at UHFWCs (30%). 

Guidelines were available at 37% of UHFWCs, 27% of USC/RDs, and 10% of CCs. Overall, 57% of 

facilities (60% excluding CCs) offering TB services had at least one provider who had ever received inservice training on TB. More than one-third (38%) of facilities (52% excluding CCs) had guidelines for TB 

services.

TB microscopy was available in 61% of DHs, 75% of UHCs, 67% of private hospitals, and 28% of NGO

facilities. Overall, 38% of facilities (53% excluding CCs) that offer TB services had TB microscopy 

available.

First-line TB medications are generally available in DHs (84%), UHCs (87%), USC/RDs (63%), and NGO

facilities (65%). Overall, 39% of facilities (53% excluding CCs) offering TB services have first-line 

treatment medications.

As Figure 9.3 shows, readiness to provide TB services has increased slightly since 2014, from 17% (23% 

excluding CCs) to 18% (27% excluding CCs). Over the same period, readiness to provide TB services has 

improved substantially among UHCs (from 36% to 58%) and USC/RDs (from 0% to 18%); however, 

readiness to provide services has not improved at other types of facilities. The limited overall level of 

readiness is not surprising given that mother and child welfare centers (MCWCs), UHFWCs, and CCs do 

not have the capacity for providing many of the TB service components.

Figure 9.2 Availability of items (tracer indicator) in 

health facilities (excluding CCs) for readiness to 

provide TB services

59

38

47

59

39 38

57

38

First-line TB medicationTB microscopy Staff training for

TB

Guidelines for TB

BHFS 2014

(N=91)

BHFS 2017

(N=132)
Tuberculosis • 167

Figure 9.3 Readiness of health facilities to provide TB services, by facility, 

BHFS 2014 and BHFS 2017

LIST OF TABLES

▪ Table 9.1 Availability of tuberculosis services, guidelines, and trained staff for tuberculosis 

services

▪ Table 9.2 Diagnostic capacity and availability of medicines for tuberculosis treatment

▪ Table 9.3 Readiness of health facilities to provide TB services

17

23

38

<1

36

<1 <1 <1

28

<1

18

27

36

<1

58

<1

18

<1

28

<1

Total

facilities

Total

facilities

excluding CC

DH MCWC UHC UHFWC USC/RD CC NGO Private

BHFS 2014

(N=91)

BHFS 2017

(N=132)
168 • Tuberculosis

Table 9.1 Availability of tuberculosis services, guidelines, and trained staff for tuberculosis services

Among all facilities, the percentages offering any tuberculosis (TB) referral, diagnostic, treatment, and/or treatment follow-up services, and among facilities offering any TB 

services, the percentages having TB guidelines and at least one staff member recently trained in TB services, by background characteristics, Bangladesh HFS 2017

Percentage of all facilities offering:

Number of 

facilities

Percentage of facilities offering any TB services 

that have guidelines for:

Trained 

staff4

Number of 

facilities 

offering 

any TB 

diagnostic, 

treatment,

and/or 

treatment 

follow-up 

services

Background 

characteristic

Any

referral for 

TB 

diagnosis1

Any TB 

diagnostic 

services2

Any TB 

diagnostic 

or referral 

services

Any TB 

treatment 

and/or 

treatment 

follow-up 

services3

Any TB 

diagnostic, 

treatment,

and/or 

treatment 

follow-up 

services

Diagnosis 

and 

treatment 

of TB

Diagnosis 

and 

treatment 

of MDR-TB

Management of 

HIV and 

TB coinfection

TB 

infection 

control

Facility type

District and upazila 

public facilities 36.2 77.9 79.9 78.3 81.9 44 84.2 57.6 32.4 23.6 55.9 36

DH 35.5 85.5 88.7 79.0 90.3 5 80.4 57.1 28.6 37.5 48.2 4

MCWC 3.4 0.0 3.4 1.2 1.2 7 - - - - - 0

UHC 43.4 93.6 95.1 94.8 98.2 32 84.7 57.8 33.0 21.5 56.8 32

Union-level public 

facilities 5.0 4.6 7.1 4.1 6.1 361 32.8 26.5 0.4 15.8 10.9 22

UHFWC 4.0 4.5 6.2 2.7 5.2 250 36.7 26.7 0.0 19.6 5.7 13

USC/RD 7.1 4.8 9.1 7.3 8.1 111 27.2 26.1 1.1 10.3 18.4 9

Community clinic 

(CC) 16.0 1.8 17.5 3.0 4.4 1,012 9.7 0.0 0.0 18.9 18.9 45

NGO clinic/hospital 8.1 7.1 15.2 13.1 13.1 64 64.6 49.5 37.1 33.3 52.2 8

Private hospital 5.1 48.3 48.3 20.3 48.3 43 5.5 3.7 0.7 5.5 5.0 21

Location

Urban 13.7 39.7 43.9 31.0 42.9 108 52.8 39.1 23.1 18.8 36.5 46

Rural 13.3 3.7 15.6 4.5 6.1 1,416 28.1 15.7 5.1 18.3 22.9 86

Division

Barishal 10.2 3.9 12.1 3.9 4.4 113 45.8 27.9 13.2 27.4 43.3 5

Chattogram 13.7 6.3 17.5 6.6 8.6 288 33.5 21.6 8.2 12.4 22.5 25

Dhaka 12.1 9.7 19.1 10.4 15.2 304 31.3 15.9 10.4 15.7 25.1 46

Khulna 10.3 9.3 17.5 4.9 9.6 187 42.8 32.6 14.8 11.5 25.8 18

Rajshahi 22.9 5.0 25.9 6.7 8.0 220 38.2 25.2 8.8 47.4 42.6 17

Rangpur 2.4 3.3 4.9 4.3 4.9 193 45.5 36.4 19.2 9.2 12.5 9

Sylhet 14.4 4.5 17.9 3.6 5.0 96 47.5 28.8 16.8 21.9 47.8 5

Mymensingh 22.6 3.0 24.2 5.1 5.5 123 39.0 36.1 11.4 7.7 24.7 7

Total 13.3 6.2 17.6 6.4 8.7 1,524 36.7 23.9 11.4 18.5 27.6 132

Total excluding CCs 8.1 14.9 17.8 13.0 17.1 512 50.7 36.2 17.2 18.3 32.1 87

"-” Means facilities do not have provision of TB services.

Note: The guidelines and trained staff indicators presented in this table comprise the staff and training domain for assessing readiness to provide TB services within the health 

facility assessment methodology proposed by WHO and USAID (2012).

"-” Means facilities do not have provision of TB services.

MDR-TB = multidrug-resistant tuberculosis

1 Facility reports that it refers clients outside the facility for TB diagnosis, and a register was observed indicating clients who had been referred for TB diagnosis.

2 Facility reports that providers in the facility make a diagnosis of TB by using any of the following methods: sputum smear only, x-ray only, either sputum or x-ray, or both 

sputum and x-ray.

3 Facility reports that it adheres to one of the following TB treatment regimens or approaches:

• Directly observe for 2 months and follow up for 4 months

• Directly observe for 6 months

• Follow up clients only after the first 2 months of direct observation elsewhere

• Diagnose and treat clients while in the facility as inpatients and then discharge elsewhere for follow-up

• Provide clients with the full treatment with no routine direct observation phase

• Diagnose, prescribe, or provide medicines with no follow-up

4 At least one interviewed provider of any of the following TB services reported receiving in-service training relevant to the particular TB service during the 24 months preceding 

the survey: TB diagnosis and treatment, management of HIV and TB co-infection, MDR-TB treatment and identification of need for referral, DOTS treatment, or TB infection 

control. The training must have involved structured sessions; it does not include individual instruction that a provider might have received during routine supervision.
Tuberculosis • 169

Table 9.2 Diagnostic capacity and availability of medicines for tuberculosis treatment

Among facilities offering any tuberculosis (TB) diagnostic, treatment, and/or treatment follow-up services, the percentages that had TB and HIV 

diagnostic capacity and medicines for TB treatment available in the facility on the day of the survey, by background characteristics, Bangladesh HFS 

2017

Percentage of facilities that have the following TB 

diagnostic capacity

Percentage of facilities 

that have:

Percentage of facilities 

that have the following 

medicines for

treating TB

Number of 

facilities 

offering any 

TB 

diagnostic, 

treatment,

and/or 

treatment 

follow-up 

services

Background

characteristic

TB smear 

microscopy1

Culture 

medium2

TB rapid 

diagnostic 

test kits TB x-ray

HIV 

diagnostic 

capacity3

System for 

diagnosing 

HIV among 

TB clients4

First-line 

treatment 

for TB5

Injectable 

streptomycin

Facility type

District and upazila 

public facilities 73.1 3.3 21.0 14.2 5.9 4.5 86.1 60.6 36

DH 60.7 7.1 35.7 41.1 12.5 14.3 83.9 48.2 4

MCWC 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0

UHC 75.0 2.8 19.0 10.7 5.1 3.1 86.7 62.5 32

Union-level public 

facilities 16.4 0.0 6.5 0.0 0.0 0.0 31.2 23.5 22

UHFWC 13.3 0.0 0.0 0.0 0.0 0.0 9.5 8.5 13

USC/RD 20.7 0.0 16.0 0.0 0.0 0.0 62.6 45.1 9

Community clinic 

(CC) 9.7 0.0 0.0 0.0 0.0 0.0 9.7 0.0 45

NGO clinic/hospital 27.6 0.0 5.8 4.9 4.9 4.9 64.6 57.9 8

Private hospital 67.2 16.3 26.6 63.7 40.2 15.5 14.8 8.3 21

Location

Urban 64.8 8.1 21.1 35.9 19.7 9.1 59.0 41.5 46

Rural 24.0 1.0 6.1 2.5 2.0 1.2 27.4 16.8 86

Division

Barishal 68.0 1.6 14.8 11.0 6.2 0.0 55.4 17.0 5

Chattogram 44.6 5.5 16.4 17.7 7.4 3.7 33.8 20.3 25

Dhaka 35.5 2.6 11.3 13.8 9.9 5.0 31.4 19.3 46

Khulna 32.8 1.5 1.7 14.1 6.2 2.0 38.7 21.1 18

Rajshahi 31.0 1.9 5.5 14.4 9.4 4.0 49.1 38.6 17

Rangpur 49.4 12.9 12.5 14.6 6.3 3.3 45.9 38.5 9

Sylhet 25.8 0.0 24.0 11.6 10.0 13.5 52.8 47.7 5

Mymensingh 39.2 2.0 21.0 7.1 5.1 0.0 41.8 36.1 7

Total 38.3 3.5 11.4 14.2 8.2 4.0 38.5 25.4 132

Total excluding CCs 53.0 5.2 17.2 21.5 12.5 6.0 53.3 38.6 87

Note: The indicators presented in this table comprise the diagnostics and medicines and commodities domains for assessing readiness to provide 

services for TB within the health facility assessment methodology proposed by WHO and USAID (2012).

1 Functioning microscope, slides, and all stains for Ziehl-Neelson test (carbol-fuchsin, sulfuric acid, methyl blue) or fluorescence-LED microscope 

with all stains (sulfuric acid, methyl blue, auramine stain) were available in the facility on the day of the survey visit.

2 Solid or liquid culture medium (e.g., MGIT 960)

3 HIV rapid diagnostic test kits available in TB service area

4 Record or register indicating TB clients who had been tested for HIV

5 Four-drug fixed-dose combination (4FDC) available, or else isoniazid, pyrazinamide, rifampicin, and ethambutol are all available, or a combination 

of these medicines, to provide first-line treatment.
170 • Tuberculosis

Table 9.3 Readiness of health facilities to provide TB services

Among facilities that offer any tuberculosis (TB) diagnostic, treatment, and/or treatment follow-up services, the percentages that had the indicated 

items available in the facility on the day of the survey, by background characteristics, Bangladesh HFS 2017

Background

characteristic

Any guidelines

for TB1

Trained staff at

any time2 TB microscopy3

First-line TB 

medications4 All 4 items

Number of facilities 

offering any TB 

diagnostic, 

treatment, and/or 

treatment follow-up 

services

Facility type

District and upazila 

public facilities 86.7 90.1 73.1 86.1 55.1 36

DH 83.9 76.8 60.7 83.9 35.7 4

MCWC - - - - - 0

UHC 87.0 91.9 75.0 86.7 57.8 32

Union-level public 

facilities 32.8 45.2 16.4 31.2 7.3 22

UHFWC 36.7 29.5 13.3 9.5 0.0 13

USC/RD 27.2 67.9 20.7 62.6 18.0 9

Community clinic 

(CC) 9.7 52.2 9.7 9.7 0.0 45

NGO clinic/hospital 64.6 78.1 27.6 64.6 27.6 8

Private hospital 8.5 14.4 67.2 14.8 0.0 21

Location

Urban 54.8 57.6 64.8 59.0 29.3 46

Rural 28.8 56.8 24.0 27.4 11.9 86

Division

Barishal 45.8 67.3 68.0 55.4 28.6 5

Chattogram 36.0 52.3 44.6 33.8 16.9 25

Dhaka 32.3 57.6 35.5 31.4 11.8 46

Khulna 42.8 38.7 32.8 38.7 15.0 18

Rajshahi 38.7 71.0 31.0 49.1 23.7 17

Rangpur 45.5 48.0 49.4 45.9 31.8 9

Sylhet 50.9 61.0 25.8 52.8 15.5 5

Mymensingh 41.8 86.9 39.2 41.8 33.3 7

Total 37.9 57.1 38.3 38.5 18.0 132

Total excluding CCs 52.4 59.7 53.0 53.3 27.3 87

"-” Means facilities do not have provision of TB services.

1 National guidelines for the diagnosis and treatment of TB, guidelines for the management of HIV and TB co-infection, or guidelines related to MDRTB treatment.

2 At least one interviewed provider of any of the following TB services reported receiving in-service training relevant to the particular TB service: TB 

diagnosis and treatment, management of HIV and TB co-infection, MDR-TB treatment and identification of need for referral, DOTS treatment, or TB 

infection control. The training must have involved structured sessions; it does not include individual instruction that a provider might have received 

during routine supervision.

3 Functioning microscope, slides, and all stains for Ziehl-Neelson test (carbol-fuchsin, sulfuric acid, methyl blue) or fluorescence-LED microscope with 

all stains (sulfuric acid, methyl blue, auramine stain) were available in the facility on the day of the survey visit.

4 Four-drug fixed-dose combination (4FDC) available, or else isoniazid, pyrazinamide, rifampicin, and ethambutol are all available, or a combination 

of these medicines, to provide first-line treatment.
References • 171

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Appendix A • 175

PERSONS INVOLVED IN THE SURVEY Appendix A

MEMBERS OF THE STAKEHOLDER ADVISORY COMMITTEE (SAC), TECHNICAL WORKING 

GROUP (TWG) AND SAMPLE REVIEW COMMITTEE (SRC)

Stakeholder Advisory Committee (SAC)

Director General, NIPORT Chairman

Chief Coordinator, Community Based Health Care (CBHC),MOHFW Member

M.M Reza, Chief Technical Advisor, PMMU, Azimpur Member

Director General, Health Economics Unit (HEU), MOHFW Member

Project Director, Urban Primary Health Care Service Delivery Project, MOLGED Member

Deputy Chief (Health Services Division), MOHFW Member

Deputy Chief (Medical Education and Family Welfare Division), MOHFW Member

Deputy Chief, Population Planning Wing, Planning Commission Member

Director (MCH-Services) & Line Director (MCHAH), Director General of Family 

Planning (DGFP)

Member

Line Director, Clinical Contraception, Services Delivery Program, Director 

General of Family Planning (DGFP)

Member

Line Director (FSD), Director General of Family Planning (DGFP) Member

Director & Line Director (CBHC), Director General of Health Services (DGHS) Member

Director, PHC & Line Director, MNC & AH, Director General of Health Services 

(DGHS)

Member

Line Director (Hospital Service Management), Director General of Health Services 

(DGHS)

Member

Line Director (Planning, Monitoring and Research), Director General of Health 

Services (DGHS)

Member

Director, Census Wing, Bangladesh Bureau of Statistics (BBS) Member

Prof. Nurul Islam, Pro-Vice Chancellor, World University of Bangladesh Member

Prof. Nitai Chakraborti, Department of Statistics and Informatics, Dhaka 

University

Member

Dr. Kanta Jamil, Senior M& E and Research Advisor, OPHNE, USAID,

Bangladesh

Member

Dr. Halida Hanum Akhter, NGO Health Services Delivery Project (NHSDP) Member

Dr. Ishtiaq Mannan, Deputy Country Director, Save the Children Member

Representative, Marie Stops Clinics Society Member

Dr. Imtiaz Mannan, Senior Advisor-Advocacy & Communications, Ma Moni:

Health Strengthening Project, Health & Nutrition Sector, Save the Children

Member

Dr. Mahbub Elahi Chowdhury, Scientist, Centre for Equity and Health Systems,

icddr,b

Member

Dr. Ahmed Ehsanur Rahman, Assistant Scientist, Maternal & Child Health

Division, icddr,b

Member

Mohammad Golam Kibria, Senior Technical Advisor-HIS, MSH Member

Dr. Ahmed Al-Sabir, Consultant, ICF International, USA Member

Representative, WHO, Dhaka, Bangladesh Member

Representative, UK aid Bangladesh Member

Representative, SIDA, Dhaka, Bangladesh Member

Representative, World Bank, Dhaka, Bangladesh Member

Representative, CIDA, Dhaka, Bangladesh Member

Representative, JICA, Dhaka, Bangladesh Member
176 • Appendix A

Representative, Data collecting firm Member

Shahin Sultana, Sr. Research Associate, NIPORT Member

Mohammed Ahsanul Alam, Evaluation Specialist, NIPORT Member

Md. Rafiqul Islam Sarker, Director (Research), NIPORT Member Secretary

Technical Working Group (TWG)

Md. Rafiqual Islam Sarker, Director (Research), NIPORT Chairman

Dr. Kanta Jamil, Senior Monitoring and Evaluation Advisor, USAID Member

Dr. Ahmed Al Sabir, Consultant, ICF, USA Member

Dr. Mahbub Elahi Chowdhury, Scientist, Centre for Equity and Health Systems, 

icddr,b

Member

Dr. Imtiaz Mannan, Senior Advisor-Advocacy & Communications, Ma Moni-HSS 

Project, Health & Nutrition Sector, Save the Children

Member

Dr. Ahmed Ehsanur Rahman, Assistant Scientist, Maternal & Child Health 

Division, icddr,b

Member

Mohammad Golam Kibria, Senior Technical Advisor-HIS, MSH Member

Representative, Data collecting firm Member

Mohammed Ahsanul Alam, Evaluation Specialist, NIPORT Member

A.K.M Abdullah, Research Associate, NIPORT Member

Shahin Sultana, Senior Research Associate, NIPORT Member Secretary

Sample Review Committee (SRC)

Md Rafiqual Islam Sarker, Director (Research), NIPORT Chairman

Prof. Nurul Islam, Pro-Vice Chancellor, World University of Bangladesh, Dhaka Member

Prof. Nitai Chakraborti, Department of Statistics & Informatics, University of 

Dhaka

Member

Prof. Sayed Shahadat Hossain, Dept. of Applied Statistics, University of Dhaka Member

Director (Census wing), Bureau of Statistics (BBS) Member

Dr. Mizanur Rahman, MEASURE Evaluation, Dhaka Member

Dr. Ahmed Al-Sabir, Consultant, ICF, USA Member

Mohammed Ahsanul Alam, Evaluation Specialist, NIPORT, Dhaka Member

Shahin Sultana, Senior Research Associate, NIPORT Member Secretary

NIPORT PROFESSIONALS

Mr. Susanta Kumar Saha Director General

Ms. Rownaq Jhahan Director-General (Former)

Mr. Md. Rafiqul Islam Sarker Director (Research)

Ms. Shahin Sultana Senior Research Associate

Mr. Mohammed Ahsanul Alam Evaluation Specialist

ICF PROFESSIONALS

Hamdy Moussa Mahmoud Elkasabi

Christopher Gramer Nancy Johnson

Greg Edmondson Michelle Winner

Anne Linn Sally Zweimueller

Trinadh Dontamsetti Joan Wardell

Rajendra Dangol Ahmed Al-Sabir

Nitai Chakraborty
Appendix A • 177

USAID

Dr. Kanta Jamil Senior M&E and Evaluation Advisor (OPHNE)

ACPR FIELD IMPLEMENTATION TEAM

Prof. Dr. Sekander Hayat Khan Team Leader

Mr. A. P. M. Shafiur Rahman Co-team Leader

Dr. K. M. Rezaul Haque Public Health Specialist

Ms. Tauhida Nasrin Operations/Logistics Manager

Ms. Ilmul Jahan Tani IT Specialist

Mr. S M Salamat Ullah Survey Specialist

Mr. Kh. Khairul Bashar Data Processing Specialist

Training Team

Dr. Hamdy Moussa Mr. Rajendra Dangol

Dr. Ahmed Al-Sabir Ms. Ilmul Jahan Tani

Dr. Md. Abul Hasnat Sujon Dr. Ataya Rabbi Mahmud

Dr. Md. Marufuzzaman Khan Dr. Lee Shanta Mondol

Dr. Md. Sakil Sayeed Dr. Sk. Mohammed Sakhawat Hossain

Dr. Hazera Muyeena Dr. Afrin Rahman

Dr. Asif Ahmed Chowdhury Dr. Eumna Rahman

Dr. Md. Bilal Chowdhury Taseen Dr. Shafiul Islam

Dr. Nazmul Haque Chowdhury Dr. Md. Saddam Hossain

Dr. Md. Zahid Hassan Zihad

Data Processing Team

Mr. Md. Mizanur Rahman Hassan

Mr. M. A. Hashib Shaon

Ms. Papia Akter

Mr. Md. Abul Kalam

Mr. Md. Ariful Islam

QUALITY CONTROL OFFICERS

icddr,b ACPR

Dr. Md. Abul Hasnat Sujon Dr. Asif Ahmed Chowdhury

Dr. Ataya Rabbi Mahmud Dr. Eumna Rahman

Dr. Md. Marufuzzaman Khan Dr. Md. Bilal Chowdhury Taseen

Dr. Lee Shanta Mondol Dr. Shafiul Islam

Dr. Md. Sakil Sayeed Dr. Nazmul Haque Chowdhury

Dr. Sk. Mohammed Sakhawat Hossain Dr. Md. Saddam Hossain

Dr. Hazera Muyeena Dr. Md. Zahid Hassan Zihad

Dr. Afrin Rahman
178 • Appendix A

Medical Officer-cum-Enumerator Medical Assistant-cum-Enumerator

Dr. Papri Akter Mst. Champa Khatun

Dr. Zinia Afroz Mst. Rabeya Khatun

Dr. Shu-Lakkhona Haque Ms. Shrabony Khan Jui

Dr. Sabrina Binte Shahadut Ms. Afroja Akter

Dr. Nuzhat Kabir Ms. Anu Khatun

Dr. Kamrus Samaout Ms. Fatima Amin

Dr. Farjana Rahman Ms. Musharat Mahera Habiba

Dr. Mst. Mousume Akter Mr. Md. Sourov Sarker

Dr. Shakila Bristy Mr. Sagar Dev

Dr. Farzana Tanzin Priya Mr. Md. Ataul Karim

Dr. Sathi Rani Saha Mr. Md. Abdullah Al Mamun

Dr. Uma Sarker Mr. Md. Majidur Rahman

Dr. Adnin Parvin Mr. Md. Alomgir Hossen

Dr. Md. Abeed Hasan Mr. Syduzzaman

Dr. Apu Das Mr. Md. Alomgir Hossain Sumon

Dr. Julhas Uddin Mr. Rupon Debnath

Dr. Md. Samiul Islam Mr. Abdul Bashir

Dr. Md. Nazmul Hasan Mr. Shah Neyaz

Dr. Md. Mustasin Huda Khan Mr. Shahadat Hossen

Dr. Md. Razwanur Rahman Mr. Polash Kumar Saha

Dr. Golam Fakhruddin Mr. Md. Dween Islam

Dr. Tanvir Shahriar Rabbi Mr. Muhammad Nurul Islam Khan

Dr. Tauhidul Islam Mr. Md. Anamul Haque

Dr. Md. Rakibul Hasan Mr. Md. Anisur Rahman

Dr. Md. Hasan Kabir Mr. Tawhidul Islam

Dr. Ayinuddin Ahmed Bhuiyan Mr. Gopal Mondal

Dr. Nafiz Riasat Mr. Md. Jahid Hassan

Dr. Monisha Roy Mr. Md. Rakibul Islam

Dr. Md. Mahmudul Hasan Mr. Md. Sharif Hosen

Dr. Shahriar Karim Sajid Mr. Md. Juwel Islam Joni

Dr. Md. Sajedul Islam Mr. Md. Sadekur Rahman Tareq

Dr. Md. Omar Faruk Mr. Md. Abdul Motin

Dr. Kamol Hasda Mr. Md. Abdul Motin

Dr. Md. Fayom-Ben-Quddus Mr. Al-Amin Hosen

Dr. Md. Ahsan Habib Mr. Mohasin Uddin

Dr. Md. Ashiul Amin Mr. Hamidul Islam

Dr. Amit Kumar Biswas Mr. Ratan Guha

Dr. Md. Daud Ahmad Talukder Mr. Md. Abdul Aziz

Dr. Kazi Akram Hossain Mr. Sohel Ahmed

Dr. Sudipta Barua Mr. Md. Kawsar Hossain
Appendix B • 179

BANGLADESH HEALTH FACILITY 

SURVEY (BHFS) SUMMARY INDICATORS Appendix B

Indicator BHFS 2014 BHFS 2017

AVAILABILITY OF BASIC CLIENT SERVICES % %

Child curative care 93 98

Child growth monitoring 62 85

Child vaccination 78 87

Any modern method of family planning 81 89

Antenatal care service 97 99

Normal delivery 18 24

Availability of all basic client services1

All facilities 8 16

All facilities excluding CCs 19 34

All basic client services excluding normal delivery care

All facilities 44 72

All facilities excluding CCs 44 54

Availability of electricity from national electricity grid line

All facilities 41 60

District and upazila public facilities 97 96

Union-level public facilities 72 82

Community Clinic 21 47

Availability of regular electricity

All facilities 22 43

District and upazila public facilities 76 79

Union-level public facilities 28 32

Community Clinic 9 41

Availability of client latrine

All facilities 72 79

District and upazila public facilities 86 90

Union-level public facilities 74 81

Community Clinic 68 77

Availability of all six basic amenities2

All facilities 4 5

All facilities excluding CCs 10 14

Availability of six types of equipment services3

All facilities 26 28

All facilities excluding CCs 35 38

Transport for emergencies4

All facilities 5 5

All facilities excluding CCs 13 15

District Hospital 92 97

UHC 83 82

Availability of five basic diagnostic tests5

All facilities 3 4

All facilities excluding CCs 9 12

District and upazila public facilities 16 14

Availability of functional x-ray machines

All facilities 2 3

All facilities excluding CCs 7 8

District hospitals public 73 79

Upazila health complex (UHC) public 22 18

Availability of ultrasound machine

All facilities 3 4

All facilities excluding CCs 8 11

District hospitals public 63 74

Upazila health complex (UHC) public 4 14

Availability of essential medicines6

All facilities 77 62

All facilities excluding CCs 70 38

% of service provider positions functionally vacant in

Physicians in district and upazila-level public facilities 38 44

Nurse/midwife in district and upazila-level public facilities 19 20

At least one staff trained in IMPAC7in the last 24 months

% of public health facilities 10 6

Continued...
180 • Appendix B

Indicator BHFS 2014 BHFS 2017

CHILD HEALTH SERVICES % %

Availability of three basic child health services8

All facilities 52 77

All facilities excluding CCs 47 57

Overall readiness9 of facilities to provide child curative care

All facilities 9 5

All facilities excluding CCs 8 3

Public facilities excluding CCs 7 2

AVAILABILITY OF FAMILY PLANNING (FP) SERVICES % %

Any modern FP methods

All facilities 78 86

All facilities excluding CCs 78 82

Long-acting, reversible contraceptives or permanent methods

All facilities 31 26

All facilities excluding CCs 60 69

Male/female sterilization services

All facilities 5 4

All facilities excluding CCs 11 13

Overall readiness10 to provide family planning (FP) services

All facilities 25 22

All facilities excluding CCs 40 51

Public facilities excluding CCs 38 52

ANTENATAL CARE SERVICES % %

Availability of antenatal care services

All facilities 97 99

All facilities excluding CCs 95 97

Readiness11 of health facilities to provide ANC services

All facilities 4 4

All facilities excluding CCs 12 11

Public facilities excluding CCs 8 9

DELIVERY AND NEWBORN CARE % %

Availability of normal delivery services

All facilities 18 24

All facilities excluding CCs 39 57

Availability of cesarean delivery services

All facilities 4 4

All facilities excluding CCs 12 13

Readiness12 to provide normal delivery services

All facilities 2 <1

All facilities excluding CCs 3 1

1 Basic client services include outpatient curative care for sick children, child growth monitoring, facility-based child 

vaccination services, any modern methods of family planning, antenatal care, and normal delivery.

2 All six basic amenities include regular electricity (Facility is connected to a central power grid, and there has not been an

interruption in power supply lasting for more than 2 hours at a time during normal working hours in the 7 days before the 

survey, or facility has a functioning generator with fuel available on the day of the survey, or else facility has back-up solar 

power), improved water source (Water is piped into facility or piped onto facility grounds, or else water from a public tap or 

standpipe, a tube well or borehole, a protected dug well, protected spring, or rain water, or bottled water and the outlet from 

this source is within 500 meters of the facility), visual and auditory privacy (A private room or screened-off space available in 

the general outpatient service area that is a sufficient distance from other clients so that a normal conversation could be held 

without the client being seen or heard by others), client latrine (The facility had a functioning flush or pour-flush toilet, a 

ventilated improved pit latrine, or composting toilet), communication equipment (The facility had a functioning land-line 

telephone, a functioning facility-owned cellular phone or a private cellular phone that is supported by the facility), and 

computer with internet (The facility had a functioning computer with access to the internet that is not interrupted for more than 

2 hours at a time during normal working hours, or facility has access to the internet via a cellular phone inside the facility).

3 Basic client services include outpatient curative care for sick children, child growth monitoring, facility-based child 

vaccination services, any modern methods of family planning, antenatal care, and normal delivery.

4 The facility had a functioning ambulance or other vehicle for emergency transport that is stationed at the facility and had 

fuel available on the day of the survey, or facility has access to an ambulance or other vehicle for emergency transport that

is stationed at another facility or that operates from another facility.

5 Five basic diagnostic tests are hemoglobin, blood glucose, urine protein, urine glucose, and urine pregnancy test.

6 Defined as availability of at least six of eight essential medicines of a DDS kit: amoxicillin tablet/capsule, amoxicillin syrup, 

cotrimoxazole, paracetamol tablet, paracetamol syrup, tetracycline eye ointment, iron tablet, and vitamin A capsule.

7

IMPAC stands for Integrated management of child birth and pregnancy.

8 Outpatient curative care, growth monitoring, and vaccination

9 The percentages that possess the IMCI guideline, IMCI staff trained at any time, basic equipment (Child scale, thermometer, 

and growth chart) and essential medicines (ORS, zinc tablets/syrup, amoxicillin syrup/suspension/dispersible, paracetamol

syrup/suspension, and mebendazole/albendazole) available on the day of the survey.

10 The measure of the readiness of health facilities to provide FP services includes availability of six items/indicators on 

Trained staff (at least one staff person who ever received in-service FP training), National or any other FP guidelines, 

Equipment (blood pressure apparatus) and Commodities (Oral pill, injectables, and condom).

11 The measure of the readiness of health facilities to provide ANC services includes availability of six items/indicators on 

Trained staff (at least one staff person who ever received in-service ANC training), National or any other ANC guidelines, 

Equipment (blood pressure apparatus), Diagnostic capacity (Hemoglobin test, urine protein test), and Medicines (Iron or folic 

acid tablets).

12 The measure of the readiness to provide normal delivery services includes the following 13 items/tracer indicators: Trained 

staff (At least one provider ever trained in delivery care at any time), National or other BEmOC or CEmOC guideline available 

at the facility, Equipment (Examination light, Delivery pack, Suction apparatus, Neonatal bag and mask, Partograph and 

Gloves) and Medicines and commodities (Injectable oxytocin, Injectable antibiotic, Magnesium sulphate, Skin disinfectant, 

and Intravenous solution with infusion set).
QUESTIONNAIRES Appendix 

C

Appendix C • 181

2017 BANGLADESH HEALTH FACILITY 

SURVEY

INVENTORY QUESTIONNAIRE

Appendix C • 183
184 • Appendix C
001 NAME OF FACILITY _________________________________________________________________________

001A ADDRESS: _________________________________________________________________________________

002 DIVISION . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

003 DISTRICT (ZILA) . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

004 UPAZILA/THANA . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

005 UNION/WARD . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

006 FACILITY NUMBER . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

TYPE OF FACILITY (COUNTRY SPECIFIC)

DISTRICT HOSPITAL (DH) ....................... .. ............ 01

UPAZILA HEALTH COMPLEX (UHC) .................... .. ............ 02

MOTHER AND CHILD WELFARE CENTER (MCWC) ............ .. ............ 03

UNION HEALTH AND FAMILY WELFARE CENTER (UnHFWC) ....... .. ............ 04

UNION HEALTH AND FAMILY WELFARE CENTER (UnHFWC-UPGRADED) .. ............ 05

UNION SUBCENTER (UnSC) / RURAL DISPENSARY ............ .. ............ 06

COMMUNITY CLINIC . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 08

NGO CLINIC . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 09

PRIVATE HOSPITAL . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

NGO HOSPITAL . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

SMILING SUN CLINIC OF NGO HEALTH SERVICE DELIVERY PROJECT (NHSDP) ......... 12

008 OWNERSHIP (MANAGING AUTHORITY)

GOVERNMENT/PUBLIC (MOHFW) .................... .. ............ 1

LOCAL GOVERNMENT . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

NGO (NAME) _________________________ ................. .. ............ 3

PRIVATE-FOR-PROFIT . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

009 URBAN/RURAL

URBAN . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

RURAL . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

010 INPATIENT ONLY

YES . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

2 3

DATE DAY

MONTH

YEAR

INTERVIEWER NAME INT. NUMBER

RESULT RESULT

RESULT CODES 

1 = FACILITY COMPLETED

2 = FACILITY RESPONDENTS NOT AVAILABLE

3 = POSTPONED / PARTIALLY COMPLETED

4 = FACILITY REFUSED

5= FACILITY CLOSED / NOT YET FUNCTIONAL

6 = OTHER

(SPECIFY)

FACILITY IDENTIFICATION

007

INTERVIEWER VISITS

1 FINAL VISIT

Appendix C • 185
TOTAL NUMBER OF PROVIDERS INTERVIEWED. . . . . . . . . . . . . . . . . . . . . . . . . 

SET DEFAULT SETTINGS FOR GPS UNIT 

- SET COORDINATE SYSTEM TO LATITUDE / LONGITUDE

- SET COORDINATE FORMAT TO DECIMAL DEGREE

- SET DATUM TO WGS84

STAND IN A LOCATION AT THE ENTRANCE OF THE FACILITY WITH PLAIN VIEW OF THE SKY

1 TURN GPS MACHINE ON AND WAIT UNTIL SATELITE PAGE CHANGES TO "POSITION" 

2 WAIT 5 MINUTES

3 PRESS "MARK"

4 HIGHLIGHT "WAYPOINT NUMBER" AND PRESS "ENTER"

5 ENTER X-DIGIT FACILITY CODE / FACILITY NUMBER

6 HIGHLIGHT "SAVE" AND PRESS "ENTER"

7 PAGE TO MAIN MENU, HIGHLIGHT "WAYPOINT LIST" AND PRESS "ENTER" 

8 HIGHLIGHT YOUR WAYPOINT

9 COPY INFORMATION FROM WAYPOINT LIST PAGE

BE SURE TO COPY THE WAYPOINT NAME FROM THE WAYPOINT LIST PAGE TO VERIFY THAT YOU ARE 

ENTERING THE CORRECT WAYPOINT INFORMATION ON THE DATA FORM

010 WAYPOINT NAME (FACILITY NUMBER) WAYPOINT NAME

012 LATITUDE N/S . . . . . . . . . . . . a

DEGREES/DECIM b c . 013 LONGITUDE E/W . . . . . . . . . . . . a

DEGREES/DECIM b c

FACILITY GEOGRAPHIC COORDINATES

.

TOTAL NUMBER OF PROVIDER INTERVIEWS 

186 • Appendix C
FIND THE MANAGER, THE PERSON IN-CHARGE OF THE FACILITY, OR THE MOST SENIOR HEALTH WORKER RESPONSIBLE FOR CLIENT 

SERVICES WHO IS PRESENT AT THE FACILITY. READ THE FOLLOWING GREETING:

Good day! My name is _____________________. We are here on behalf of the National Institute of Population Research and Training (NIPORT) and 

Ministry of Health and Family Welfare (MOHFW) conducting a survey of health facilities to assisst the Government of knowing more

about health services in BANGLADESH

Now I will read a statement explaining the study. 

Your facility was selected to participate in this study. We will be asking you questions about various health services. Information collected about 

your facility during this study may be used by NIPORT, the MOHFW, organizations supporting services in your facility, and researchers, for planning service 

improvement or for conducting further studies of health services.

Neither your name nor the names of any other health workers who participate in this study will be included in the dataset or in any report; however, there

is a small chance that any of these respondents may be identified later. Still, we are asking for your help in order to collect this information. 

You may refuse to answer any question or choose to stop the interview at any time. However, we hope you will answer the questions, which will benefit the 

services you provide and the nation. 

If there are questions for which someone else is the most appropriate person to provide the information, we would appreciate if you introduce us to that 

person to help us collect that information.

At this point, do you have any questions about the study? Do I have your agreement to proceed?

INTERVIEWER'S SIGNATURE INDICATING CONSENT OBTAINED

100 May I begin the interview? YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . 2 STOP

.

.

CONSENT

201

EXPLAIN TO THE RESPONDENT AT THE START OF THIS INTERVIEW THAT THERE ARE QUESTIONS ON MANAGEMENT MEETINGS AND 

QUALITY ASSURANCE ACTIVITIES THAT REQUIRE LOOKING AT RECORDS OF THOSE MEETINGS AND ACTIVITIES. IT WILL THEREFORE 

BE HELPFUL IF RECORDS PERTAINING TO MANAGEMENT MEETINGS AND QUALITY ASSURANCE ACTIVITIES ARE GATHERED, IF THEY 

ARE NOT READILY AVAILABLE AT THE LOCATION WHERE YOU ARE CONDUCTING THE INTERVIEW. 

MONTH

HOURS MINUTES

101

YEAR

INTERVIEW START TIME

DAY

THANK THE RESPONDENT AT THE END OF EACH SECTION OR SUBSECTION BEFORE PROCEDING TO 

THE NEXT DATA COLLECTION POINT

EXPLAIN ALSO THAT THERE IS A SUBSECTION ON HEALTH STATISTICS (NUMBER OF OUTPATIENT VISITS AND 

INPATIENT DISCHARGES) FOR THE IMMEDIATE PAST ONE COMPLETE MONTH. IT WILL BE HELPFUL TO ALSO START GATHERING 

SUCH INFORMATION IF INFORMATION IS NOT READILY AVAILABLE WHERE THE INTERVIEW IS BEING CONDUCTED.

Appendix C • 187
102 Does this facility offer any of the following client services? In other words, is there 

any location in this facility where clients can receive any of the following services: NO DONE

01 Child vaccination services, either at the facility or as outreach 1 2

02 Growth monitoring services, either at the facility or as outreach 1 2

03 Curative care services for children under age 5, either at the facility or as outreach 1 2

04 Any family planning services-- including modern methods, fertility awareness 1 2

methods , male or female surgical sterilization

05 Antenatal care (ANC) services 1 2

07 Normal delivery 1 2

10 Diagnosis, treatment prescription or treatment follow-up for TB 1 2

14 Diagnosis or management of non-communicable diseases, specifically diabetes 1 2

cardiovascular diseases, and chronic respiratory conditions in adults 

16 Cesarean delivery (Cesarean section) 1 2

17 Laboratory diagnostic services, including any rapid diagnostic testing. 1 2

18 Blood grouping and typing services 1 2

19 Blood transfusion services 1 2

20* Postnatal care (PNC) services 1 2

21* Postpartum family planning (PPFP) services 1 2

22* Adolecent health services 1 2

23* Nutrition services 1 2

110 Does this facility routinely provide in-patient care? YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 112

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

111 Does this facility have beds for overnight observation? YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 200

112 Excluding any delivery and/or maternity beds, how many (overnight) # OF OVERNIGHT/ 

or (in-patient) beds in total does this facility have, both for adults and INPATIENT BEDS . . . . . . .

children? DON’T KNOW . . . . . . . . . . . . . . . . . . . . . . .998

113* How many beds in total does this facility have # OF BEDS 

according to GOB circular/license?

USE CIRCULAR IN PUBLIC, LICENSE IN PRIVATE AND NGO FACILITIESDON’T KNOW . . . . . . . . . . . . . . . . . . . . . . .998

114* Current number of beds with budget allocation? # OF BEDS 

DON’T KNOW . . . . . . . . . . . . . . . . . . . . . . .998

SERVICE AVAILABILITY

INPATIENT (INDOOR) SERVICES

SECTION 1: GENERAL SERVICE AVAILABILITY AND INPATIENT SERVICES

MODULE 1: GENERAL INFORMATION AND SERVICE AVAILABILITY

YES

188 • Appendix C
200 I have a few questions about how surgical instruments, such as YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

speculums, forceps, and other metal equipment are processed NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 210

for re-use in this facility.

Are instruments that are used in the facility processed (i.e., sterilized or 

high-level disinfected) for re-use?

201 Is the final processing done in this facility, outside this facility, or both? ONLY IN THIS FACILITY. . . . . . . . . . . . . . . . . . . 1

BOTH IN THIS FACILITY AND OUTSIDE . . . . . 2

ONLY AT AN OUTSIDE FACILITY. . . . . . . . . . . 3

210 YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

FACILITIES STOCKS NO MEDICINES. . . 2 300

PROBE 

211 CHECK Q102.04 FAMILY PLANNING NO FAMILY PLANNING

SERVICES AVAILABLE SERVICES 213

212 Are contraceptive commodities generally stored in the family planning STORED IN FP SERVICE AREA. . . . . . . . 1

service area, or are they stored in a common area with other STORED WITH OTHER MEDICINES. . . . 2

medicines? FP COMMODITIES NOT STOCKED. . . . . 3

213 CHECK Q102.10 TUBERCULOSIS NO TUBERCULOSIS

SERVICES AVAILABLE SERVICES 300

214 Are medicines for the treatment of TB generally stored STORED IN TB SERVICE AREA. . . . . . . . 1

in the TB service area or are they stored in a common area STORED WITH OTHER MEDICINES. . . . 2

with other medicines? TB MEDICINES NOT STOCKED. . . . . . . . 3

PROCESSING OF INSTRUMENTS

STORAGE OF MEDICINES

SECTION 2: GENERAL FILTER QUESTIONS

Does this facility store or keep any medicines (including antibiotics, 

analgesics), vaccines or contraceptive commodities in the facility? I 

am referring to medicines/commodities that are meant to be given or 

sold to clients when a provider prescribes them.

Appendix C • 189
300* YES, 24-HR STAFF. . . . . . . . . . . . . . . . . . .1

NO 24-HOUR STAFF. . . . . . . . . . . . . . . . . 2 310

301 Is there a duty schedule or call list for 24-hour staff coverage? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

DUTY SCHEDULE NOT MAINTAINED. . . 2 310

302 May I see the duty schedule or call list for 24-hour staff coverage? SCHEDULE OBSERVED. . . . . . . . . . . . . . 1

SCHEDULE REPORTED NOT SEEN. . . . 2

310 Does this facility have a land line or cellular phone that is YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

available to call outside at all times client services are offered? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 313

CLARIFY THAT IF FACILITY OFFERS 24-HOUR EMERGENCY

SERVICES, THEN THIS REFERS TO 24-HOUR AVAILABILITY.

311 May I see the land line or cellular phone? OBSERVED . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED NOT SEEN. . . . . . . . . . . . . . . 2

312 Is it functioning? YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

ACCEPT REPORTED RESPONSE NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

313 Does this facility have a private YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

cellular phone that is reimbursed by the facility or higher authority? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 319

314 May I see the private OBSERVED . . . . . . . . . . . . . . . . . . . . . . . . 1

cellular phone that is reimbursed by the facility or higher authority? REPORTED NOT SEEN. . . . . . . . . . . . . . . 2

315 Is it functioning? YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

ACCEPT REPORTED RESPONSE NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

319 Does this facility have a computer? YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

(any type of computer: desktop, laptop or tablet)? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 322

320 May I see the computer? OBSERVED . . . . . . . . . . . . . . . . . . . . . . . . 1

(any type of computer: desktop, laptop or tablet)? REPORTED NOT SEEN. . . . . . . . . . . . . . . 2

321 Is it functioning? YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

ACCEPT REPORTED RESPONSE NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

322 Is there access to email or internet via computer and/or mobile phone YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

within the facility? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 330

ACCEPT REPORTED RESPONSE.

323 Is the email or internet routinely available for at least 2 hours on YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

days that client services are offered? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

ACCEPT REPORTED RESPONSE.

24-HOUR STAFF COVERAGE

MODULE 2: GENERAL SERVICE READINESS

SECTION 3: 24-HOUR STAFF COVERAGE - INFRASTRUCTURE

COMMUNICATION

EXTERNAL SUPERVISION - USER FEES - SOURCES OF REVENUE

Is there a health care worker present at the facility at all 

times, or officially on call for the facility at all times (24 hours 

a day) for emergencies? Specifically, I am referring to 

medical specialists, medical officers, nurses and paramedics.

190 • Appendix C
330 What is the most commonly used source of water for the facility PIPED INTO FACILITY. . . . . . . . . . . . . . . . 01

at this time? PIPED ONTO FACILITY GROUNDS. . . . . 02 332

PUBLIC TAP/STANDPIPE. . . . . . . . . . . . . 03

TUBEWELL/BOREHOLE . . . . . . . . . . . . 04

PROTECTED DUG WELL. . . . . . . . . . . . 05

UNPROTECTED DUG WELL. . . . . . . . . . 06

PROTECTED SPRING . . . . . . . . . . . . . . 07

OBSERVE THAT WATER IS AVAILABLE FROM SOURCE OR IN UNPROTECTED SPRING. . . . . . . . . . . . 08

THE FACILITY ON THE DAY OF THE VISIT. E.G., CHECK THAT RAINWATER . . . . . . . . . . . . . . . . . . . . 09

THE PIPE IS FUNCTIONING. BOTTLED WATER . . . . . . . . . . . . . . . . 10

CART W/SMALL TANK/DRUM . . . . . . 11

TANKER TRUCK . . . . . . . . . . . . . . . . . . 12 332

SURFACE WATER

(RIVER/DAM/LAKE/POND). . . . . . . . . . 13

OTHER (SPECIFY) 96

DON'T KNOW . . . . . . . . . . . . . . . . . . . . 98 332

NO WATER SOURCE . . . . . . . . . . . . . . 00 340

331 Is water outlet from this source available onsite, within 500 meters ONSITE. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

of the facility, or beyond 500M of facility? WITHIN 500M OF FACILITY. . . . . . . . . . . . 2

REPORTED RESPONSE IS ACCEPTABLE BEYOND 500M OF FACILITY. . . . . . . . . . . 3

332 Is there routinely a time of year when the facility has a severe shortage YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

or lack of water? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

340 Is this facility connected to the national electricity grid, YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

including polli biddut? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

DON'T KNOW. . . . . . . . . . . . . . . . . . . . . . . 8 342

341 During the past 7 days, was electricity (excluding any ALWAYS AVAILABLE. . . . . . . . . . . . . . . . . 1

back-up generator) available during the times when the SOMETIMES INTERRUPTED. . . . . . . . . . 2

facility was open for services, or was it ever interrupted DON'T KNOW. . . . . . . . . . . . . . . . . . . . . . . 8

for more than 2 hours at a time?

CONSIDER ELECTRICITY TO BE ALWAYS AVAILABLE

IF INTERUPTED FOR LESS THAN 2 HOURS AT A TIME.

342 Does this facility have other sources of electricity, YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

such as a generator or solar system? NO OTHER SOURCE. . . . . . . . . . . . . . . . . 2 350

343 What other sources of electricity does this facility have? FUEL-OPERATED GENERATOR. . . . . . . A

BATTERY-OPERATED GENERATOR. . . . B

PROBE FOR ANSWERS AND CIRCLE ALL THAT APPLY SOLAR SYSTEM. . . . . . . . . . . . . . . . . . . . . C

OTHER (SPECIFY)___________________X

344 CHECK Q343 GENERATOR USED GENERATOR NOT USED

(EITHER "A" OR "B" CIRCLED) (NEITHER "A" NOR "B" CIRCLED) 350

345 Is the generator functional? YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

ACCEPT REPORTED RESPONSE FROM DON'T KNOW. . . . . . . . . . . . . . . . . . . . . . . 8 346A

KNOWLEDGEABLE RESPONDENT.

346 Is fuel (or a charged battery) available today for YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

the generator? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

DON'T KNOW. . . . . . . . . . . . . . . . . . . . . . . 8

ACCEPT REPORTED RESPONSE FROM

KNOWLEDGEABLE RESPONDENT.

346A Does this facility have a program for routine preventive YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

maintenance of the generator? NO ROUTINE MAINTENANCE. . . . . . . . . 2

DON'T KNOW. . . . . . . . . . . . . . . . . . . . . . . 8 346C

346B Is the person responsible for routine preventive maintenance of the ONSITE SATFF. . . . . . . . . . . . . . . . . . . . . . 1

generator an onsite facility staff, or does this person OUTSIDE SUPPORT. . . . . . . . . . . . . . . . . 2

come from outside the facility? BOTH ONSITE AND OUSIDE STAFF. . . . 3

DON'T KNOW. . . . . . . . . . . . . . . . . . . . . . . 8

346C Does this facility have assigned person responsible for YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

operating the generator? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

DON'T KNOW. . . . . . . . . . . . . . . . . . . . . . . 8

POWER SUPPLY

SOURCE OF WATER

Appendix C • 191
350 YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 352C

351 WITHIN THE PAST 6 MONTHS . . . . . . . . 1

MORE THAN 6 MONTHS AGO. . . . . . . . . 2 352C

351A

# OF SUPERVISORY VISITS

DON’T KNOW. . . . . . . . . . . . . . . . . . . . 98

352 The last time during the past 6 months that a supervisor DON'T

from outside the facility visited, did he or she do any of the following: YES NO KNOW

01 Use a checklist to assess the quality of available health services data? 1 2 8

02 Discuss performance of the facility based on available health 1 2 8

services data?

352A YES, RECORDS MAINTAINED. . . . . . . . . 1

NO, RECORDS NOT MAINTAINED. . . . . . 2 352C

352B OBSERVED . . . . . . . . . . . . . . . . . . . . . . . .1

REPORTED NOT SEEN. . . . . . . . . . . . . . . 2

352C YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

FACILITY DOES NOT HAVE CHW. . . . . . 2 360

352D YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 360

352E YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 352G

352F May I see the monthly community level supervision schedule? OBSERVED . . . . . . . . . . . . . . . . . . . . . . . .1

REPORTED NOT SEEN. . . . . . . . . . . . . . . 2

352G

# OF SUPERVISORY VISITS

DON’T KNOW. . . . . . . . . . . . . . . . . . . . 98

Does this facility maintain records of written comments made by 

supervisors from outside the facility when they make their supervisory 

visits?

May I see records of written comments or suggestions made by a 

supervisor from outside the facility during a visit in the past 6 months?

IF MORE THAN 95 PUT 95

How many supervision visits to community level in the past six months 

were carried out by health facility staff?

During the past 6 months, how many supervisory visits has this facility 

received from an upper level office/higher authority?

When was the last time a supervisor from any upper level office came 

here on a supervisory visit? Was it within the past 6 months or more 

than 6 months ago?

Is there a monthly community level supervision schedule created by 

health facility staff?

Now I would like to ask a few questions about community level 

supervision of community Health Workers. Does this facility have, or 

work with Community Health Workers (CHWs)? 

Do staff from this facility do community level supervision of the CHWs?

Does this facility receive any external supervision from the any 

upper level facility/higher authority?

EXTERNAL SUPERVISION

192 • Appendix C
360* YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 370

361 Does the facility charge a fixed fee that covers all services that FIXED FEE COVERING ALL SERVICES . . . . . 1 363

a client receives, or are there separate fees for different components NO, CHARGE FEE FOR SEPARATE ITEMS. . . 2

of the services provided by the facility?

PROBE.

362 Does this facility have a fee for the following items:

READ OUT EACH RESPONSE CATEGORY AND CIRCLE 

APPROPRIATELY

01 CLIENT HEALTH CARD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

02 REGISTRATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

03 CONSULTATION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

04 MEDICINES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

05 VACCINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

06 CONTRACEPTIVE COMMODITIES. . . . . . . . . . . . . . . . . . . . . . . . . . . . 

07 NORMAL DELIVERIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

08 SYRINGES AND NEEDLES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

09 CESAREAN SECTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

13 LABORATORY TESTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

17* TICKET AND ADMISSION FEES . . . . . . . . . . . . . . . . . . . . . . . . 

18* BED/CABIN CHARGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

19* CLIENT VOLUNTARY CONTRIBUTION . . . . . . . . . . . . . . . . . . . . . . . . . .

363 Are the official fees posted or displayed so that the client can YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

easily see them? NO POSTED FEES. . . . . . . . . . . . . . . . . . . 2 364A

364 May I see the posted fees? OBSERVED, ALL FEES POSTED. . . . . . . 1

OBSERVED, SOME BUT NOT ALL FEES. 2

364A YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

DON'T KNOW. . . . . . . . . . . . . . . . . . . . . . . 8 370

364B Does this facility follow any written guidelines/office order/instructions YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

on exemption of user fees? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 370

364C May I see the guidelines/office order/instructions on exemption of user feesOBSERVED . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED NOT SEEN. . . . . . . . . . . . . . . 2

370 Now, I would like to ask about the sources of revenue or MINISTRY OF HEALTH. . . . . . . . . . . . . . . A

funding for this facility. Tell me if the facility received any OTHER PUBLIC MINISTRIES. . . . . . . . . . B

revenue or funding from any of the listed resources MEDICAL SCHEMES (INSURANCE). . . . .C

during the 2016 - 2017 financial year. SOCIAL SECURITY FUND. . . . . . . . . . . . . D

If someone else is more appropriate to provide financial REIMBURSEMENT BY EMPLOYER. . . . . E

information, please feel free to invite that person or refer GOVT. CONTRIBUTION TO PRIVATE. . . F

me to that person. DONOR AGENCIES/NGOs. . . . . . . . . . . . G

FAITH-BASED. . . . . . . . . . . . . . . . . . . . . . .H

CIRCLE ALL THAT APPLY. PROBE FOR EACH. COMMUNITY PROGRAMS. . . . . . . . . . . . I

USER FEES. . . . . . . . . . . . . . . . . . . . . . . .. J

OTHER (SPECIFY)___________________X

NONE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Y

USER FEES

Does this facility have any routine user-fees or charges for client 

services, including charges for health cards and for client registration? 

These could be routine fees for some services or for medicines

1 2

1 2

1 2

2

1

YES

SOURCES OF REVENUE

1 2

Does this facility ever exempt clients from user fees? In other words, are 

any of this facility's clients exempted from user fees? 

1 2

1 2

2

REVIEW THE POSTED FEES AGAINST THE LIST OF ITEMS IN Q362 

TO DETERMINE IF ALL FEES ARE POSTED

1 2

1

1 2

1 2

NO

1

2

2

1

Appendix C • 193
400 Please tell me:

c) For each qualification / occupational category, among those currently posted/attached and working in the facility, how many are part-time

QUALIFICATION / OCCUPATIONAL CATEGORY 

01* SUPERINTENDANT

02* DIRECTOR/MANAGER/COORDINATOR

03* UPAZILA HEALTH &FAMILY PLANNING OFFICER (UH&FPO)

04* SENIOR CONSULTANT(MEDICINE)

05* SENIOR CONSULTANT(SUGERY)

06* SENIOR CONSULTANT(OBS.&GYN.)

07* SENIORCONSULTANT (PEDIATRICS)

08* SENIOR CONSULTANT (ORTHOPEDIC SURGURY)

09* SENIOR CONSULTANT (EYE)

10* SENIOR CONSULTANT (ANESTHESIA)

11* CONSULTANT (RADIOLOGY AND IMAGING)

12* CONSULTANT (PATHOLOGIST)

13* SENIOR CNSULTANT(ENT)

14* SENIOR CONSULTANT(SKIN & VD)

15* SENIOR CONSULTANT (CARDIOLOGY)

16* JUNIOR CONSULTANT(MEDICINE)

17* JUNIOR CONSULTANT(SUGERY)

18* JUNIOR CONSULTANT(OBS.&GYN.)

19* JUNIOR CONSULTANT (PEDIATRICS)

20* JUNIOR CONSULTANT (ORTHOPEDIC SURGURY)

21* JUNIOR CONSULTANT (EYE)

22* JUNIOR CONSULTANT (ANESTHESIA)

23* JUNIOR CONSULTANT (RADIOLOGY )

24* JUNIOR CONSULTANT (PATHOLOGIST)

25* JUNIOR CONSULTANT(ENT)

26* JUNIOR CONSULTANT(SKIN & VD)

27* JUNIOR CONSULTANT(CARDIOLOGY)

28* RESIDENTIAL MEDICAL OFFICER (RMO)

29* MEDICAL OFFICER (MO)/PHYSICIAN

30* RADIOLOGIST

31* PATHOLOGIST

SECTION 4: STAFFING - MANAGEMENT - CLIENT OPINION

 POSTED ATTACHED/ DEPUTED-OUT PART TIME

 DEPUTED-IN

QUALITY ASSURANCE - TRANSPORT - HMIS AND HEALTH STATISTICS

STAFFING

 (b1) (b2) (b3) ( c )

a) How many staff in each of the following qualification / occupational categories are santioned (expected) to work in this facility. 

b1) For each qualification / occupational category, how many are currently posted and working in the facility in total, either full time or part time 

(a)

SANCTIONED

b2) For each qualification / occupational category, how many are currently attached/deputed in and working in the facility

b3) For each qualification / occupational category, how many are currently deputed out

194 • Appendix C
32* SENIOR CLINICAL PATHOLOGIST

33* ANESTHETIST

34* EMERGENCY MEDICAL OFFICER (EMO)

35* INDOOR MEDICAL OFFICER (IMO) 

36* INDOOR MEDICAL OFFICER (IMO) CARDIOLOGY

37* INDOOR MEDICAL OFFICER (IMO) SURGERY

38* INDOOR MEDICAL OFFICER (IMO) ORTHOPEDIC SURGERY

39* INDOOR MEDICAL OFFICER (IMO) MEDICINE

40* INDOOR MEDICAL OFFICER (IMO) PEDIATRIC

41* INDOOR MEDICAL OFFICER (IMO) GYN & OBS

42* MEDICAL OFFICER (MO-BLOOD TRANSFUSION)

43* DENTAL SURGEON

44* ASSISTANT SURGEON/EQUIVALENT

45* MO (HOMEOPATH/UNANI/AYURVEDIC)

46* ASSIST REGISTRAR (MEDICINE)

47* ASSIST REGISTRAR (SURGERY) 

48* ASSIST REGISTRAR (OBS/GYN)

49* ASSIST REGISTRAR (PEDIATRIC)

50* UPAZILA FAMILY PLANNING OFFICER (UFPO)

51* MEDICAL OFFICER (MO-CLINIC)

52* MEDICAL OFFICER (MCH-FP)

53* ASSIST UPAZILA FP OFFICER (AUFPO)

54* ASSIST FAMILY WELFARE OFFICER,MCH-FP(AFWO)

55* SUB ASSISTANT COMMUNITY MEDICAL OFFICER 

(SACMO)

56* FAMILY WELFARE VISITOR (FWV)

57* MATRON

58* NURSING SUPERVISOR

59* SENIOR STAFF NURSE

60* NURSE MIDWIFE

61* STAFF NURSE

62* ASSISTANT NURSING ATTENDANT

63* MIDWIFE

64* PARAMEDIC

65* PHARMACIST

66* MEDICAL TECHNOLOGIST (LAB)

67* MEDICAL TECHNOLOGIST (BLOODTRANSFUSION)

68* MEDICAL TECHNOLOGIST (RADIOLOGY)

69* MEDICAL TECHNOLOGIST (PHYSIOTHERAPY)

70* MEDICAL TECHNOLOGIST (DENTAL)

Appendix C • 195
71* MEDICAL TECHNICIAN EPI/EPI TECHNICIAN

72* MEDICAL TECHNICIAN BIOCHEMISTRY/HEMATOLOGY

73* TB LEPROSY CONTROL ASSISTANT (TLCA)

74* MEDICAL TECHNICIAN (BT)

75* ECG TECHNICIAN

76* ECHO TECHNICIAN

77* CARDIOGRAPHER

78* BIOCHEMIST

79* NUTRITIONIST/DIETICIAN

80* HEALTH EDUCATOR

81* SANITARY INSPECTOR

82* FEMALE MEDICAL ATTENDANT

83* WARD MASTER

84* ATTENDANT (OT/LAB/DISPENSARY/WARD BOY/EMERGENCY)

85* COMMUNITY HEALTH CARE PROVIDER (CHCP)

86* HEALTH ASSISTANT (HA)

87* FAMILY WELFARE ASSISTANT (FWA)

88* COUNSELOR

89* COMMUNITY MOBILIZER/SERVICE PROMOTER

90* STORE KEEPER

91* STATISTICIAN/STATISTICAL OFFICER/STATISTICAL ASSISTAN

92* OFF ASSITANT CUM DATA ENTRY OPERATOR/

COMPUTER OPERATOR

93* UPAZILA FAMILY PLANNING ASSISTANT (UFPA)

94* OTHER-1

95* OTHER-2

96* TOTAL

196 • Appendix C
430 Does this facility have any system for determining clients' opinions YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

about the health facility or its services? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 440

431 Please tell me all the methods that this facility uses to SUGGESTION BOX. . . . . . . . . . . . . . . . . . . . . . . . . . . . A

elicit client opinion CLIENT SURVEY FORM. . . . . . . . . . . . . . . . . . . . . . . . B

CLIENT INTERVIEW FORM. . . . . . . . . . . . . . . . . . C

OFFICIAL MEETIING

CIRCLE ALL METHODS MENTIONED AND PROBE: ANY MORE? WITH COMMUNITY LEADERS. . . . . . . . . . . . . . . . . . D

INFORMAL DISCUSSION WITH 

CLIENTS OR THE COMMUNITY. . . . . . . . . . . . E

EMAIL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F

FACILITY'S WEBSITE. . . . . . . . . . . . . . . . . . . G

LETTERS FROM CLIENTS/COMMUNITY. . . . . . . . . . H

TEXT/SMS MESSAGES/CALLS. . . . . . . . . . . . . . . . . . . . . . . . . I

OTHER_______________________________ X

DON’T KNOW. . . . . . . . . . . . . . . . . . . . . . . . . . . . Z

440 Does this facility routinely carry out quality assurance activities? YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

An example may be facility-wide review of mortality, or periodic NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

audit of registers. DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 450

441 Is there an official record of any quality assurance YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

activities carried out during the past year? NO, RECORDS NOT MAINTAINED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 450

442 May I see a record of any quality assurance activity? OBSERVED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . . . . . . . . . . 2

A REPORT OR MINUTES OF A QA MEETING, A SUPERVISORY

CHECKLIST, A MORTALITY REVIEW, AN AUDIT OF RECORDS

OR REGISTERS ARE ALL ACCEPTABLE.

450 Does this facility have a functional ambulance or other vehicle YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

for emergency transportation for clients that is stationed at this facility NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 452

and that operates from this facility? 

451 May I see the ambulance (or other vehicle)? OBSERVED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . . . . . . . . . . 2 453

452 Does this facility have access to an ambulance or other vehicle YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

for emergency transportation for clients that is stationed at another NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 460

facility or that operates from another facility? 

453 Is fuel available today? YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

ACCEPT REPORTED RESPONSE FROM KNOWLEDGEABLE NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

RESPONDENT. DON'T KNOW. . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

454* For each type of vehicles that is stationed at this facility 

and used for emergency transport of clients including A) Ambulance D) Engine boat

 ambulance, rickshaw, boat and three wheelers, please tell me: 

B) Richshaw Van E) Speed boat

How many of this type of vehicle the facility currently owns, 

rents, or has full-time access to? 

C) Boat F) Auto/Three wheelers

X) Other _______________________________ 

TRANSPORT FOR EMERGENCIES

CLIENT OPINION AND FEEDBACK

QUALITY ASSURANCE

NOTIFY THE RESPONDENT THAT THIS SUBSECTION REQUIRES LOOKING AT RECORDS OF QUALITY ASSURANCE ACTIVITIES. 

IT WILL THEREFORE BE HELPFUL IF SUCH RECORDS ARE GATHERED BEFORE PROCEEDING WITH THE INTERVEIW. 

Appendix C • 197
460 Does this facility have a system in place to regularly collect YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

health/family planning services data? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 470

461* Please tell me: 

a)

b) How frequently the reports are compiled, and

c) Finally, I would like to see a copy of the most re

01 HOSPITAL ACTIVITY 1 2 1 c 2 c3 c 4 c

02

02 EPI 1 2 1 c 2 c3 c 4 c

03

03 FAMILY PLANNIING 1 2 1 c 2 c3 c 4 c

04

04 TB/LEPROSY 1 2 1 c 2 c3 c 4 c

05

05 LABORATORY 1 2 1 c 2 c3 c 4 c

06

06 MORBIDITY / MORTALITY 1 2 1 c 2 c3 c 4 c

07

07 MALARIA + KALA AZAR 1 2 1 c 2 c3 c 4 c

08

08 NOTIFIABLE DISEASE 1 2 1 c 2 c3 c 4 c

09

09 IMCI 1 2 1 c 2 c3 c 4 c

10

10 EQUIPMENT STATUS 1 2 1 c 2 c3 c 4 c

11

11 MATERNAL HEALTH 1 2 1 c 2 c3 c 4 c

12

12 FAMILY PLANNIING COMMODITIES 1 2 1 c 2 c3 c 4 c

13

13 ADOLESCENT HEALTH 1 2 1 c 2 c3 c 4 c

14

14 NUTRITION 1 2 1 c 2 c3 c 4 c

15

15 NEWBORN HEALTH 1 2 1 c 2 c3 c 4 c

16

16 DGFP.MIS-3 1 2 1 c 2 c3 c 4 c

464

464 Does this facility have a designated person, such as a YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

statistician, who is responsible for health services NO DEDICATED PERSON. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 470

data in this facility?

465 Who is responsible for health services data in this facility? DATA MANAGER/HMIS PERSON/STATISTICIAN. . . . . . . . . . . . . . . . . . . . . . 1

FACILITY IN-CHARGE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

PROBE TO DETERMINE WHO THIS PERSON IS OTHER SERVICE PROVIDER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

470 CHECK Q110 INPATIENT CARE NO INPATIENT

SERVICES AVAILABLE CARE SERVICES 472

471

# OF DISCHARGES 

DON’T KNOW. . . . . . . . . . . . . . . . . . . . . 9998

472 How many outpatient client visits were made to this 

facility in the last completed calendar month [MONTH] for # OF CLIENT VISITS 

both adults and children? DON’T KNOW. . . . . . . . . . . . . . . . . . . . . 9998

IF MORE THAN 9,990 CLIENT VISITS, ENTER 9,990 AS MAXIMUM

b 1

1

YES NO

HOW FREQUENTLY ARE REPORTS COMPILED?

ASSESSMENT BEFORE PROCEEDING WITH QUESTIONS IN THIS SUBSECTION

REPOR

TED 

NOT 

SEEN

b 1 2

b

2

2

2

(b) ( c)

COPY OF 

RECENT REPORT 

MONTHLY 

OR MORE 

OFTEN

FIND THE PERSON RESPONSIBLE FOR HEALTH INFORMATION SYSTEMS. INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE 

HMIS

If this facility regularly compiles the following 

reports containing health services information 

(a)

REPORT 

COMPILED?

b 1 2

b 1 2

How many live discharges were made in the last completed 

calender month [MOHTH] for all conditions, both for adults and 

children? By this, I mean the number of patients who were 

admitted and then discharged alive.

NOTIFY THE RESPONDENT THAT THIS SUBSECTION REQUIRES THAT SOME STATISTICS ARE GATHERED, IF SUCH INFORMATION 

IS NOT READILY AVAILABLE AT THE LOCATION WHERE THE INTERVIEW IS BEING CONDUCTED. 

HEALTH STATISTICS

2

b 1 2

b 1 2

b 1 2

b 1

b 1

b 1

EVERY 

2-3 

MONTHS

EVERY 

4-6 

MONTH

S

LESS OFTEN THAN EVERY 6 

MONTHS

OBSERV

ED

b 1 2

b 1 2

b 1 2

2

b 1 2

b 1 2

198 • Appendix C
500 CHECK Q201: ARE ANY EQUIPMENT PROCESSED IN THE FACILITY?

NO (CODE 3 CIRCLED)

YES

(CODES 1 or 2 CIRCLED) GO TO NEXT SECTION OR SERVICE SITE

501 ASK IF EACH OF THE INDICATED ITEMS BELOW IS USED BY THE FACILITY AND AVAILABLE. IF AVAILABLE, ASK TO SEE IT. ASK IF IT IS FUNCTIONING OR NOT

FOR EXAMPLE: "Do you use [METHOD] in facility?" IF YES, ASK: "May I see it?" THEN "Is it functioning?" 

ITEM YES NO DON'T KNOW

01 ELECTRIC AUTOCLAVE (PRESSURE & WET HEAT) 1 b 2 b 3 1 2 8

2

02 NON-ELECTRIC AUTOCLAVE (PRESSURE & WET HEAT) 1 b 2 b 3 1 2 8

3

03 ELECTRIC DRY HEAT STERILIZER 1 b 2 b 3 1 2 8

4

04 ELECTRIC BOILER OR STEAMER (NO PRESSURE) 1 b 2 b 3 1 2 8

5

05 NON-ELECTRIC POT WITH COVER FOR BOILING/STEAM 1 2 3

06 HEAT SOURCE FOR NON-ELECTRIC EQUIPMENT (STOVE OR COOKER) 1 b 2 b 3 1 2 8

7

07 AUTOMATIC TIMER (MAY BE ON EQUIPMENT) 1 b 2 b 3 1 2 8

8

08 TST INDICATOR STRIPS/OTHER ITEM THAT INDICATES PROCESS IS COMPLETE 1 2 3

09 ANY CHEMICALS FOR CHEMICAL HLD 1 2 3

502 CHECK Q501. FOR EACH OF THE FOLLOWING METHODS OF STERILIZATION/HIGH LEVEL DISINFECTION THAT IS USED IN THE FACILITY, ASK YOUR

RESPONDENT AND INDICATE THE PROCESSING DETAILS, INCLUDING PROCESSING TIME, RECOMMENDED PRESSURE, ETC.

(1) (2) (3) (4) (5)

AUTOCLAVE DRY HEAT STERILIZATION STEAM HIGH LEVEL CHEMICAL HIGH LEVEL

(steam with pressure) DISINFECTION (HLD) DISINFECTION (HLD)

A Method USED . . . . . 1 USED . . . . . . 1 USED . . . . . . . . . . . . . 1 USED . . . . . . . 1 USED . . . . . 1

NOT USED . . 2 2 NOT USED . . 2 3 NOT USED . . . . . . . . 2 4 NOT USED . . 2 5 NOT USED . . 2 503

B Temperature TEMPERATURE TEMPERATURE

(centigrade)

AUTOMATIC . . . . 666 AUTOMATIC . . . . 666

DON'T KNOW . . . . 998 DON'T KNOW . . . . 998

C Pressure PRESSURE

AUTOMATIC 666

DON'T KNOW 998 1E

D Units of pressure UNITS OF PRESSURE:

KG/SQ CM . . 1

ATM PRESSURE . . 2

KILOPASCAL (LB/IN2 3

MILLIMETER HG . . 4

DON’T KNOW. . . . . . 8

E What is the duration MINUTES MINUTES MINUTES MINUTES MINUTES

in minutes when 

instrument is not 

wrapped in cloth AUTOMATIC . . . . 666 AUTOMATIC . . . . . . 666 DON'T KNOW. . . .998

for [METHOD]? NOT USED. . . . . . . . 995

DON'T KNOW . . . . 998 DON'T KNOW . . . . . . 998 DON'T KNOW . . . . . . . . 998 DON'T KNOW . . . . 998

F What is the duration MINUTES WRAPPED

in minutes when 

instrument is 

wrapped in cloth AUTOMATIC . . . . . . 666

for autoclave? NOT USED. . . . . . . . 995

DON'T KNOW . . . . 998

ALCOHOL. . . . . . . . 01

G Chemical BETADINE . . . . . . . 02

disinfectant CHLORINE. . . . . . . . 03

used CIDEX . . . . . . . . . . . 04

FORMALDEHYDE. . 05

GLUTERALDEHYDE 06

LYSOL. . . . . . . . . . . 07

DON'T KNOW. . . . . 98

503 Does this facility have any guideline/protocol/manual on final YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

processing or sterilization of surgical instruments? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 NEXT SECTION 

504 May I see the guideline/protocol/manual on processing or sterilization of equipment? OBSERVED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

HAND-WRITTEN GUIDELINES POSTED ON WALLS IN AREA WHERE 

EQUIPMENT IS PROCESSED OR STERILIZED IS ACCEPTABLE

BOILING (HLD) 

SECTION 5: PROCESSING OF INSTRUMENTS FOR REUSE

(A) USE AND AVAILABILITY (B) FUNCTIONING

OBSERVED REPORTED NOT SEEN NOT USED

KNOWLEDGEABLE ABOUT PROCESSING OF SURGICAL INSTRUMENTS IN THE FACILITY. INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND PROCEED.

ASK TO BE SHOWN THE MAIN LOCATION WHERE SURGICAL INSTRUMENTS ARE PROCESSED/STERILIZED IN THE FACILITY FOR REUSE. FIND THE PERSON MOST 

Appendix C • 199
600 Now I would like to ask you a few questions about BURN IN INCINERATOR:

waste management practices for sharps waste, 2-CHAMBER INDUSTRIAL (800-1000+°C). . . . . . . . . . . 02

such as needles or blades. 1-CHAMBER DRUM/BRICK. . . . . . . . . . . . . . . . . . . . . . . 03

OPEN BURNING

How does this facility finally dispose of FLAT GROUND-NO PROTECTION. . . . . . . . . . . . . . . . . 04

sharps waste (e.g., filled sharps boxes)? PIT OR PROTECTED GROUND. . . . . . . . . . . . . . . . . . . 05.

DUMP WITHOUT BURNING

PROBE TO ARRIVE AT CORRECT RESPONSE FLAT GROUND-NO PROTECTION. . . . . . . . . . . . . . . . . 06

COVERED PIT OR PIT LATRINE. . . . . . . . . . . . . . . . . . .07

NOTE! OPEN PIT-NO PROTECTION. . . . . . . . . . . . . . . . . . . . .08.

PROTECTED GROUND OR PIT. . . . . . . . . . . . . . . . . . . 09.

IF ANY OF THE RESPONSES 02 - 09 TAKE PLACE REMOVE OFFSITE

OUTSIDE THE FACILITY, THEN THE CORRECT STORED IN COVERED CONTAINER. . . . . . . . . . . . . . . 10

RESPONSE TO CIRCLE WILL BE IN THE STORED IN OTHER PROTECTED

CATEGORY OF "REMOVE OFFSITE" ENVIRONMENT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.

STORED UNPROTECTED. . . . . . . . . . . . . . . . . . . . . . . . 12

OTHER______________________________________ 96

(SPECIFY)

NEVER HAVE SHARPS WASTE . . . . . . . . . . . . . . . . . . . . .95

601 Now I would like to ask you a few questions SAME AS FOR SHARP ITEMS. . . . . . . . . . . . . . . 01

about waste management practices for medical BURN IN INCINERATOR:

waste other than sharps, such as used bandages 2-CHAMBER INDUSTRIAL (800-1000+°C). . . . . . 02

1-CHAMBER DRUM/BRICK. . . . . . . . . . . . . . . 03

OPEN BURNING

How does this facility finally dispose of FLAT GROUND-NO PROTECTION. . . . . . . . . . . 04

medical waste other than sharps boxes? PIT OR PROTECTED GROUND. . . . . . . . . . . . . 05

DUMP WITHOUT BURNING

PROBE TO ARRIVE AT CORRECT RESPONSE FLAT GROUND-NO PROTECTION. . . . . . . . . . . 06

COVERED PIT OR PIT LATRINE. . . . . . . . . . . . 07

NOTE! OPEN PIT-NO PROTECTION. . . . . . . . . . . . . . . 08

PROTECTED GROUND OR PIT. . . . . . . . . . . . . 09

IF ANY OF THE RESPONSES 02 - 09 TAKE PLACE REMOVE OFFSITE

OUTSIDE THE FACILITY, THEN THE CORRECT STORED IN COVERED CONTAINER. . . . . . . . . 10

RESPONSE TO CIRCLE WILL BE IN THE STORED IN OTHER PROTECTED

CATEGORY OF "REMOVE OFFSITE" ENVIRONMENT. . . . . . . . . . . . . . . . . . . . . . . 11

STORED UNPROTECTED. . . . . . . . . . . . . . . . . 12

OTHER ________________________________________96

(SPECIFY)

NEVER HAVE OTHER MEDICAL WASTE. . . . . . . . 95

602 CHECK Q600 

FACILITY-BASED WASTE DISPOSAL NEITHER FACILITY-BASED WASTE DISPOSAL

OR WASTE REMOVED OFFSITE NOR REMOVAL OFFSITE 604

(ANY CODE OTHER THAN "95" CIRCLED) (CODE "95" CIRCLED)

603 ASK TO SEE THE PLACE USED BY THIS FACILITY NO WASTE VISIBLE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

FOR DISPOSAL OF SHARPS WASTE AND INDICATE WASTE VISIBLE, BUT PROTECTED AREA. . . . . . . . . . . . 2

THE CONDITION OBSERVED. IF SHARPS WASTE IS WASTE VISIBLE, NOT PROTECTED. . . . . . . . . . . . . . . . . 3

DISPOSED OFF-SITE, OBSERVE THE SITE WHERE IT WASTE SITE NOT INSPECTED. . . . . . . . . . . . . . . . . . . . . . 8

IS STORED PRIOR TO COLLECTION FOR OFF-SITE

DISPOSAL. IF SITE NOT INSPTECTED, CIRCLE '8'.

604 CHECK Q601 

FACILITY-BASED WASTE DISPOSAL NEITHER FACILITY-BASED WASTE DISPOSAL

OR WASTE REMOVED OFFSITE NOR REMOVAL OFFSITE 606

(ANY CODE "02" TO "96" CIRCLED) (CODE "01" OR "95" CIRCLED)

605 ASK TO SEE THE PLACE USED BY THIS FACILITY NO WASTE VISIBLE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

FOR DISPOSAL OF MEDICAL WASTE AND INDICATE WASTE VISIBLE, BUT PROTECTED AREA. . . . . . . . . . . . 2

THE CONDITION OBSERVED. IF MEDICAL WASTE IS WASTE VISIBLE, NOT PROTECTED. . . . . . . . . . . . . . . . . 3

DISPOSED OFF-SITE, OBSERVE THE SITE WHERE IT WASTE SITE NOT INSPECTED. . . . . . . . . . . . . . . . . . . . . . 8

IS STORED PRIOR TO COLLECTION FOR OFF-SITE

DISPOSAL. IF SITE NOT INSPTECTED, CIRCLE '8'.

FIND THE PERSON RESPONSIBLE FOR WASTE MANAGEMENT ACTIVITIES IN THE FACILITY. INTRODUCE 

YOURSELF AND EXPLAIN THE PURPOSE OF THE ASSESSMENT BEFORE PROCEEDING WITH THE QUESTIONS

SECTION 6: HEALTH CARE WASTE MANAGEMENT AND CLIENT LATRINE

200 • Appendix C
606 CHECK Q600 AND Q601

INCINERATOR USED INCINERATOR NOT USED

(EITHER "2" OR "3" CIRCLED) (NEITHER "2" NOR "3" CIRCLED) 610

607 ASK TO BE SHOWN THE INCINERATOR INCINERATOR OBSERVED. . . . . . . . . . . . . . . . . . . . 1

INCINERATOR REPORTED NOT SEEN. . . . . . . . . . 2

608 Is the incinerator functional today? YES 1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

ACCEPT REPORTED RESPONSE FROM DON'T KNOW. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 610

KNOWLEDGEABLE RESPONDENT.

609 Is fuel available today for the incinerator? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

ACCEPT REPORTED RESPONSE DON'T KNOW. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

610 Do you have any guidelines on health care waste YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

management available in this service area? This may be NO GUIDELINE AVAILABLE. . . . . . . . . . . . . . . . . . . . . . . . . 2 620

part of the infection prevention guideline or protocol.

611 May I see the guidelines on health care waste OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

management? REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

620 Is there a toilet (latrine) in functioning condition FLUSH OR POUR FLUSH TOILET

that is available for general outpatient client use? FLUSH TO PIPED SEWER SYSTEM. . . . . . . . . . . . . . . .11

FLUSH TO SEPTIC TANK . . . . . . . . . . . . . . . . . . . . . . . . 12

IF YES, ASK TO SEE THE CLIENT TOILET AND FLUSH TO PIT LATRINE. . . . . . . . . . . . . . . . . . . . . . . . . 13

INDICATE THE TYPE. THIS MUST BE TOILET FLUSH TO SOMEWHERE ELSE. . . . . . . . . . . . . . . . . . . 14

FACILITIES FOR THE MAIN OUTPATIENT SERVICE FLUSH, DON'T KNOW WHERE. . . . . . . . . . . . . . . . . . . .15

AREA. PIT LATRINE

VENTILATED IMPROVED PIT LATRINE. . . . . . . . . . . . . 21

PIT LATRINE WITH SLAB. . . . . . . . . . . . . . . . . . . . . . . . 22.

PIT LATRINE WITHOUT SLAB / OPEN PIT. . . . . . . . . . 23.

COMPOSTING TOILET . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

BUCKET TOILET. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

HANGING TOILET / HANGING LATRINE. . . . . . . . . . . . . . 51.

NO FUNCTIONING FACILITY / BUSH / FIELD. . . . . . . . . . 61 700 .

620A ASK TO SEE THE CLIENT TOILET AND PRIVACY

INDICATE THE PRIVACY AND FUNCTION OF THE TOILET UNLOCKED DOOR WHEN NOT IN USE A

THIS MUST BE TOILET FACILITIES FOR CAN BE LOCKED FROM INSIDE WHEN USE B

THE MAIN OUTPATIENT SERVICE AREA. TOILET STALL HAVE WALLS WITHOUT MAJOR HOLESC

FUNCTION

WATER AVAILABLE D

SOAP AVAILABLE E

NO CRACK OR LEAK IN THE TOILET STRUCTURE F

HOLE OR PIT IS NOT BLOCKED G

CLEANLINESS

DRY H

MINIMAL ODOR I

CLEAN APPEARANCE J

CLEANING PRODUCTS VISIBLE K

620B YES, SEPARATE SANITARY/TOILET

FACILITY FOR THE USE OF FEMALE CLIENTS . . . . 1

NO SEPARATE TOILETS, ONLY COMBINED TOILETS. . .2

CLIENT LATRINE

Is there a separate sanitary toilet/latrine facility for the use of 

female clients?

Appendix C • 201
700 I would like to know if the following items are available

today in the main service area and are functioning

ASK TO SEE ITEMS.

01 ADULT WEIGHING SCALE 1 b 2 b 3 1

02 CHILD WEIGHING SCALE [250 GRAM GRADATION] 1 b 2 b 3 1

03 INFANT WEIGHING SCALE [100 GRAM GRADATION] 1 b 2 b 3 1

04 STADIOMETER (OR HEIGHT ROD) FOR MEASURING 1 b 2 b 3 1

HEIGHT

05 MEASURING TAPE [FOR HEAD CIRCUMFERENCE] 12 3

06 THERMOMETER 1 b 2 b 3 1

07 STETHOSCOPE 1 b 2 b 3 1

08 DIGITAL BP APPARATUS 1 b 2 b 3 1

09 MANUAL BP APPARATUS 1 b 2 b 3 1

10 LIGHT SOURCE 1 b 2 b 3 1

(FLASHLIGHT ACCEPTABLE)

11 SELF-INFLATING BAG AND MASK [ADULT] 1 b 2 b 3 1

12 SELF-INFLATING BAG AND MASK [PEDIATRIC] 1 b 2 b 3 1

13 NEBULIZER 1 b 2 b 3 1

14 SPACERS FOR INHALERS 1 2 3

15 PEAK FLOW METERS 1 b 2 b 3 1

16 PULSE OXIMETER 1 b 2 b 3 1

17 OXYGEN CONCENTRATORS 1 b 2 b 3 1

18 FILLED OXYGEN CYLINDER WITH FLOW METER 1 b 2 b 3 1

19* FILLED OXYGEN CYLINDER WITHOUT FLOW METER 1 b 2 b 3 1

20 OXYGEN DISTRIBUTION SYSTEM 1 b 2 b 3 1

21 INTRAVENOUS INFUSION KITS - ADULT 1 2 3

22 INTRAVENOUS INFUSION KITS - PEDIATRIC 1 2 3

23* GLUCOMETER 1 b 2 b 3 1

24* TAPE FOR MID-UPPER ARM CIRCUMFERENCE (MUAC) 1 2 3

25* TONGUE DEPRESSOR (WOODEN/METALLIC) 1 2 3

2 8

2 8

2 8

2 8

OBSERVED AVAILABLE YES NO

8

8

8

8

KNOW

2

NOT DON’T

SECTION 7: BASIC SUPPLIES - CLIENT EXAMINATION ROOM

BASIC SUPPLIES AND EQUIPMENT

(A) AVAILABLE (B) FUNCTIONING

8

8

8

8

2

2

2

2

8

8

2

8

2 8

2

2

2

2

2

2

2

CLIENT WAITING AREA

AT THIS POINT TELL YOUR RESPONDENT THAT YOU WOULD LIKE TO SEE SOME BASIC SUPPLIES AND EQUIPMENT

USED IN THE PROVISION OF CLIENT SERVICES. YOU WOULD LIKE TO SEE IF THESE SUPPLIES AND EQUIPMENT 

BE TAKEN TO THE GENERAL OUTPATIENT AREA.

ARE AVAILABLE IN THE GENERAL OUTPATIENT AREA. IF YOU ARE NOT IN THE GENERAL OUTPATIENT AREA, ASK TO 

8

2

8

8

REPORTED

NOT SEEN

202 • Appendix C
710 STANDARD PRECAUTIONS AND CONDITIONS FOR 

CLIENT EXAMINATION

01 RUNNING WATER (PIPED, BUCKET WITH TAP OR POUR PITCHER) 1 2 3

02 HAND-WASHING SOAP (MAY BE LIQUID SOAP) 1 2 3

03 ALCOHOL-BASED HAND RUB 1 2 3

04 WASTE RECEPTACLE (PEDAL BIN) WITH LID AND PLASTIC BIN LINER 1 2 3

06

05 OTHER WASTE RECEPTACLE 1 2 3

06 SHARPS CONTAINER ("SAFETY BOX") 1 2 3

07 DISPOSABLE LATEX/OTHER GLOVES 1 2 3

08 DISINFECTANT/ANTISEPTICS [E.G., CHLORINE, HIBITANE, ALCOHOL] 1 2 3

09 SINGLE-USE STANDARD DISPOSABLE SYRINGES WITH NEEDLES OR 1 2 3

AUTO-DISABLE SYRINGES WITH NEEDLES

10 MEDICAL MASKS 1 2 3

11 GOWNS 123

12 EYE PROTECTION [GOGGLES OR FACE PROTECTION] 1 2 3

13 GUIDELINES FOR STANDARD PRECAUTIONS 1 2 3

711 DESCRIBE THE SETTING OF THE ROOM OR PRIVATE ROOM. . . . . . . . . . . . . . . . . . . . . . . 

SERVICE AREA OTHER ROOM WITH 

AUDITORY AND VISUAL PRIVACY. . . . . . 

VISUAL PRIVACY ONLY. . . . . . . . . . . . . . . . .

NO PRIVACY. . . . . . . . . . . . . . . . . . . . . . . . . . 

720 Is there a waiting area for clients where they YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

are protected from the sun and rain? NO PROTECTED CLIENT WAITING AREA . . . . . . . . . . . . 2

ASK TO SEE THE CLIENT WAITING AREA. 

MUST BE THE WAITINGAREA IN THE MAIN

OUTPATIENT SERVICE AREA.

3

4

NOT SEEN

REPORTED, NOT

OBSERVED AVAILABLE

1

2

CLIENT EXAMINATION ROOM

CLIENT WAITING AREA

YOU DO NOT SEE.

INDICATE IF THE FOLLOWING ITEMS ARE AVAILABLE IN THE ROOM OR AREA. ASK TO BE SHOWN ITEMS THAT 

SERVICES ARE OFFERED. OBSERVE THE CONDITION UNDER WHICH MOST CLIENT EXAMINATION TAKE PLACE. 

AT THIS POINT ASK TO BE SHOWN THE ROOM OR AREA IN THE GENERAL OUTPATIENT AREA WHERE MOST CLIENT 

Appendix C • 203
800 CHECK Q102.17

DIAGNOSTIC SERVICES NO DIAGNOSTIC SERVICES

AVAILABLE IN FACILITY

GO TO NEXT SECTION OR SERVICE SITE

801 Does this facility do any hemoglobin testing on site, i.e. YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

in the facility? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 829

802 Please tell me if: (a) (b) (c)

a) Any of the following hemoglobin test IS THE ITEM IN

equipment is used in this facility, USED WORKING ORDER?

b) All items needed for the test are 

available, and NOT

c) Equipment is in working order 

01 Hematology analyzer 1 b 2 1 c 2 c 3 1 2 8

 (for total lymphocyte count, full 02 02

 blood count, platelet count, etc.)

02 HemoCue 1 b 2 1 c 2 c 3 1 2 8

04 04

03 Microcuvette 1 2 3

(with valid expiration date)

04 Colorimeter or hemoglobinometer 1 b 2 1 c 2 c 3 1 2 8

07 07

05 Drabkin's solution 1 2 3

(for colorimeter and hemoglobinometer)

06 Pipette (for measuring blood volume) 1 b 2 1 2 3

07

07 Tallquist paper for hemoglobin test 1 b 2 1 2 3

(with valid expiration date) 829

AVAILABLE

AVAILABLE. IF INFORMATION IS NOT IN THAT LOCATION ASK IF IT IS ANYWHERE ELSE IN THE FACILITY AND 

YES

KNOW

GO THERE TO COMPLETE THE QUESTIONNAIRE. 

ASK TO BE SHOWN THE MAIN LABORATORY OR LOCATION IN THE FACILITY WHERE MOST TESTING IS DONE TO START

TEST OF INTEREST, ASK AND GO TO THE MAIN LOCATION IN THE FACILITY WHERE THE INFORMATION WILL BE

DATA COLLECTION. INTRODUCE YOURSELF AND EXPLAIN THE PURPOSE OF THE SURVEY. FOR EACH OF THE

Yes No NO DON'T

SECTION 8: DIAGNOSTICS

REPORTED,

OBSERVED NOT SEEN

HEMATOLOGY

EQUIPMENT/ALL ITEMS FOR TEST 

AVAILABLE?

204 • Appendix C
829* Does this facility do any blood cholesterol level testing YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

in the facility? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

830 Does this facility do any blood glucose testing YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

in the facility? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 832

831 Please tell me if: (a) (b) (c)

a) Any of the following blood glucose 

test equipment is used in this facility USED

b) Equipment is available, and

c) Equipment is in working order Yes No NOT

 

01 Glucometer 1 b 2 1 c 2 c 3 1 2 8

832 832

02 Glucometer test strips 1 c 2 c 3 1 2 8

832

832 Does this facility do any liver function tests (such as YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

ALT & AST) or renal function tests (such as NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 836

serum creatinine) on site?

833 Does this facility have a blood chemistry analyzer YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

that provides serum creatinine, LFTs and glucose? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 836

834 May I see the blood chemistry analyzer? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED, NOT SEEN. . . . . . . . . . . . . . . . . . . . . . . . 2

835 Is the blood chemistry analyzer functioning? YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

ACCEPT REPORTED RESPONSE

836 Does this facility do any urine chemistry testing YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

using dipsticks and/or urine pregnancy test on site? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 838

837 (A) USED

IF DONE/USED ASK TO SEE IT AND NOTE IF VALID/UNEXPIRED

01 Dip sticks for urine protein 1 2 1 2 3 4

02

02 Dip sticks for urine glucose 1 2 1 2 3 4

03

03 Urine pregnancy test 1 2 1 2 3 4

838

838 Do you ever send blood or urine outside the YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

facility for blood chemistries, LFTs, urinalysis NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 840

or pregnancy tests?

839 INDICATE IF THERE IS AN OBSERVED RECORD

OF RESULTS FOR TESTS CONDUCTED OUTSIDE

YES NO YES NO

01 Blood chemistries (e.g. glucose, sodium, potassium etc.) 1 b 2 1 2

02

02 Liver Function Test (LFT) 1 b 2 1 2

03

03 Urinalysis 1 b 2 1 2

04

04 Pregnancy test 1 b 2 1 2

840

AVAILABLE

NORMALLY

NOT SEEN

YES

Please tell me if any of the following dipstick test is done (or 

used) in this location. If done or used, I will like to see one. 

OBSERVED

REPORTED,

NONE VALID

EQUIPMENT/ALL ITEMS FOR TEST 

KNOW

(A) SEND SPECIMEN (B) RECORD OF TEST

OUTSIDE FOR TEST RESULTS OBSERVED

NOT TODAY

AVAILABLE?

b

b

b

CLINICAL CHEMISTRY

AVAILABLE

REPORTED

IS THE ITEM IN WORKING

ORDER OR UNEXPIRED?

(B) OBSERVED AVAILABLE

AT LEAST

ONE VALID

Yes No AVAILABLE

NOT SEEN

NO DON'T

Appendix C • 205
840 Please tell me if: (a) (b) (c )

a) Any of the following EQUIPMENT

is used in the facility

b) Is available, and 

c) Equipment is functioning No NO DON'T

 KNOW

01 LIGHT MICROSCOPE 1 b 2 1 c 2 c 3 1 2 8

02 02

02 ELECTRON MICROSCOPE 1 b 2 1 c 2 c 3 1 2 8

03 03

03 REFRIGERATOR IN LAB AREA 1 b 2 1 c 2 c 3 1 2 8

04 04

04 INCUBATOR 1 b 2 1 c 2 c 3 1 2 8

05 05

05 TEST TUBES 1 b 2 1 2 3

06

06 CENTRIFUGE FOR CSF 1 b 2 1 c 2 c 3 1 2 8

MICROSCOPY 07 7

07 CULTURE MEDIUM 1 b 2 1 2 3

08

08 GLASS SLIDES AND COVERS 1 b 2 1 2 3

848

EQUIPMENT/

PARASITOLOGY/BACTERIOLOGY

TEST USED

NORMALLY

REPORTED AVAILABLE

OBSERVED NOT SEEN NOT TODAY

EQUIPMENT/ALL ITEMS FOR TEST IS THE ITEM IN

AVAILABLE?

YES

WORKING ORDER?

Yes

206 • Appendix C
848 Does this facility do any GRAM STAINING? YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 850

849 Please tell me if the following are (a) (b)

used and are available today.

IF USED ASK TO SEE IT

01 Crystal violet or Gentian violet 1 b 2 1 2 3

02

02 Lugol's iodine / Lugol's solution 1 b 2 1 2 3

03

03 Acetone or Acetone alcohol 1 b 2 1 2 3

04

04 Neutral red, carbol fuchsin, or other 1 b 2 1 2 3

counter stain 850

850* Do you ever send any specimen outside for YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Gram staining , India Ink staining NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 852

or for culture?

851 INDICATE IF THERE IS AN OBSERVED RECORD

OF RESULTS FOR TESTS CONDUCTED OUTSIDE

YES NO YES

01 Gram stain 1 b 2 1

02

02 India ink stain 1 b 2 1

04

04 Specimen for culture 1 b 2 1

852

852 Does this facility do STOOL MICROSCOPY? YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 854

853 Please tell me if the following are (a) (b)

used and are available today.

USED

Yes No

01 Formal saline (for concentration method) 1 b 2 1 2 3

02

02 Normal saline (for direct microscopy) 1 b 2 1 2 3

03

03 Lugol's iodine / Lugol's solution 1 b 2 1 2 3

854

REPORTED, AVAILABLE

NOT SEEN NOT TODAY

REPORTED, AVAILABLE

NO

2

OUTSIDE FOR TEST RESULTS OBSERVED

2

Yes No

(B) RECORD OF TEST

OBSERVED

2

AVAILABLE?

NORMALLY

EQUIPMENT/ALL ITEMS FOR TEST 

AVAILABLE?

(A) SEND SPECIMEN

OBSERVED

USED

NOT SEEN NOT TODAY

EQUIPMENT/ALL ITEMS FOR TEST 

NORMALLY

Appendix C • 207
854 Does this facility do any syphilis testing on site, i.e., YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

in the facility? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 859

855 Do you use syphilis rapid diagnostic test to YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

diagnose syphilis at this service site? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 857

856 May I see a sample syphilis rapid diagnostic test (RDT) OBSERVED, AT LEAST 1 VALID. . . . . . . . . . . . . . . . . 1

kit? OBSERVED, NONE VALID. . . . . . . . . . . . . . . . . . . . . 2

REPORTED AVAILABLE, NOT SEEN. . . . . . . . . . . . 3

CHECK TO SEE IF AT LEAST ONE IS VALID NONE AVAILABLE TODAY. . . . . . . . . . . . . . . . . . . . . . 4

857 Other than syphilis RDT, does this facility conduct YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

any other syphilis testing in the facility? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 859

858 Please tell me if: (a) (b) (c )

a) Any of the following syphilis test or test TEST IS THE ITEM IN

equipment is used in this facility, CONDUCTED WORKING ORDER?

b) All items needed for the test are 

available, and

c) Equipment is in working order 

01 VDRL 1 b 2 1 2 3

02

02 PCR for STIs (CTN) 1 b 2 1 2 3

03

03 Rotator or shaker 1 c 2 c 3 1 2 8

04

04 Rapid plasma reagin test (RPR) 1 b 2 1 2 3

05 05

05 Treponema Pallidum Hemaglutination 1 b 2 1 2 3

Assay (TPHA) 859 859

859 Does this facility do any chlamydia testing on site, i.e., YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

in the facility? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 861

860 Please tell me if: (a) (b)

a) Any of the following chlamydia test, TEST

test equipment, or stain is used CONDUCTED

in the facility;

b) All items needed for the test are 

available, and

01 Geimsa stain 1 b 2 1 2 3

02

02 PCR for CHLAMYDIA 1 b 2 1 2 3

861

OBSERVED NOT SEEN

No REPORTED NOT YES NO DON'T

ARE ALL ITEMS FOR TEST 

OBSERVED NOT SEEN AVAILABLE KNOW

ARE ALL ITEMS FOR TEST 

CHLAMYDIA

REPORTED

AVAILABLE?

AVAILABLE

Yes No

SYPHILIS

NOT

AVAILABLE?

Yes

208 • Appendix C
861 Does this facility do any TB tests on site? YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 865

862 Please tell me IF: (a) (b) (c )

a) Any of the following TB tests IS THE ITEM IN

or equipment is used in the facility WORKING ORDER?

b) All items needed for the test are

available Yes No NO DON'T

c) Equipment is functioning KNOW

01 Ziehl-Neelson test for AFB 1 2

05

02 Carbol-Fuchsin 1 b 2 1 2 3

03

03 Sulphuric Acid (20 - 25% concentration) 1 b 2 1 2 3

or Acid Alcohol 04

04 Methylene Blue 1 b 2 1 2 3

05

05 Fluorescence Microscope (FM) - LED 1 b 2 1 c 2 c 3 1 2 8

06 06

06 1 b 2 1 2 3

07

07 Biosafety hood / cabinet 1 b 2 1 2 3

08

08 Auramine stain for Fluorescence Microscope 1 b 2 1 2 3

863

863 YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 865

864 May I see a sample TB rapid diagnostic test (RDT) kit? OBSERVED, AT LEAST 1 VALID. . . . . . . . . . . . . . . . . 1

OBSERVED, NONE VALID. . . . . . . . . . . . . . . . . . . . . 2

CHECK TO SEE IF AT LEAST ONE IS VALID REPORTED AVAILABLE, NOT SEEN. . . . . . . . . . . . 3

NONE AVAILABLE TODAY . . . . . . . . . . . . . . . . . . . . . 4

865 Do you maintain any sputum containers at this service YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

site for collecting sputum specimen? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 867

866 May I see a sample sputum container? OBSERVED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED, NOT SEEN. . . . . . . . . . . . . . . . . . . . . . . 3

NONE AVAILABLE TODAY . . . . . . . . . . . . . . . . . . . . . 4

867 Does this laboratory send sputum outside the YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

facility for TB testing? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

DON'T KNOW. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 870

868 Do you maintain records of result of YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

sputum tests conducted elsewhere? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 870

869 May I see the record or register? OBSERVED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED, NOT SEEN. . . . . . . . . . . . . . . . . . . . . . . 2

870 Is there a system for quality control (either internal YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

or external) for the TB sputum smears assessed NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 880

in this laboratory?

871 INTERNAL QC / QA ONLY. . . . . . . . . . . . . . . . . . . . . . 1

EXTERNAL QC / QA ONLY. . . . . . . . . . . . . . . . . . . . . . 2

INTERNAL & EXTERNAL QC / QA. . . . . . . . . . . . . . . . 3

PROBE TO DETERMINE WHICH TYPE OF QUALTY SEND SLIDE FOR RE-READING. . . . . . . . . . . . 4

CONTROL IS USED OTHER (SPECIFY)________________________ 6

872 Are records maintained of the results from the quality YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

control (internal or external) procedures? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 880

873 Are records maintained for the internal QC / QA procedures, RECORDS FOR IQC / IQA ONLY. . . . . . . . . . . . . . . . . 1

the external QC / QA procedures, or for both internal and RECORDS FOR EQC / EQA ONLY. . . . . . . . . . . . . . . .2

external QC / QA procedures? RECORDS FOR BOTH INTERNAL

AND EXTERNAL QC / QA PROCEDURES. . . . . . . . 3

NORMALLY

REPORTED AVAILABLE

NOT SEEN NOT TODAY

EQUIPMENT/ALL ITEMS FOR TEST 

Please tell me which type of Quality Control / Quality 

Assurance practice is followed by this facility

Do you use TB rapid diagnostic test (such as GeneExpert) to 

diagnose TB at this laboratory / service site? 

AVAILABLE?

EQUIPMENT/

TEST USED

YES

OBSERVED

Culture / growth medium for Mycobacterium 

Tuberculosis (e.g., MGIT 960)

TUBERCULOSIS

Appendix C • 209
880 Does this facility perform diagnostic X-rays, YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

ultrasound, or computerized tomography? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

IF YES, ASK TO GO TO WHERE THE EQUIPMENT SKIP TO NEXT SECTION

IS LOCATED AND SPEAK WITH THE MOST 

KNOWLEDGEABLE PERSON. 

881 Please tell me if: (a)

a) If any of the following imaging equipment IS THE ITEM IN

is used in the facility WORKING ORDER?

b) if it is available today, and

c) if it is functioning today NO DON'T

 KNOW

01 1 b 2 1 c 2 c 3 1 2 8

02 02

02 X-RAY MACHINE 1 b 2 1 c 2 c 3 1 2 8

04 03

03 UNEXPIRED FILM FOR X-RAY 1 2 3

04

04 ULTRASOUND SYSTEM / MACHINE 1 b 2 1 c 2 c 3 1 2 8

05 05

05 CT SCAN 1 b 2 1 c 2 c 3 1 2 8

NEXT SKIP TO NEXT SECTION

SECTION ALL SKIP TO NEXT SECTION

THANK YOUR RESPONDENT FOR THE TIME AND HELP PROVIDED AND PROCEED TO THE NEXT 

DATA COLLECTION SITE

DIGITAL X-RAY MACHINE NOT 

REQUIRING FILM

Yes No

OBSERVED NOT SEEN NOT TODAY

REPORTED AVAILABLE

NORMALLY

USED AVAILABLE?

EQUIPMENT

YES

DIAGNOSTIC IMAGING

EQUIPMENT

(b) (c )

210 • Appendix C
900 CHECK Q210 

FACILITY STORES FACILITY STORES NO MEDICINES

MEDICINES

GO TO NEXT SECTION

I would like to know if the following medicines are available today in this facility. If any of the medicines I mention is stored in 

another location in the facility, please tell me where in the facility it is stored so I can go there to verify. 

901 Are any of the following antibiotics available in this facility/location

today?

CHECK TO SEE IF AT LEAST ONE IS VALID 

(NOT EXPIRED)

01 AMOXICILLIN TABLET/CAPSULE (Bacterial infections in adults) 1 3 4 5

02 1 3 4 5

03 AMOXICILIN+CLAVULINATE (AUGMENTIN) TABS (broad spectrum antibiotics) 1 3 45

04 AMPICILLIN INJECTION (Broad spectrum antibiotic) 1 3 4 5

05 AZITHROMYCIN TABS/CAPS (antibiotic) 1 3 4 5

06 AZITHROMYCIN SYR/SUSPENSION (antibiotic) 1 3 4 5

07 BENZATHINE BENZYLPENICILLIN (POWDER) FOR INJECTION 1 3 4 5

08 CEFIXIME TABS/CAPS (antibiotic) 1 3 4 5

09 CEFTRIAXONE INJECTION (Injectable antibiotic) 1 3 4 5

10 CIPROFLOXACIN (2nd-line oral antibiotic) 1 3 4 5

11 CO-TRIMOXAZOLE (TABS) 960 mg (Oral antibiotics-adult formation) 1 3 4 5

SULPHAMETHOXAZOLE 800 mg+TRIMETHOPRIM 160 mg

12 1 3 45

13 DOXYCYCLINE /CAP [Broad spectrum antibiotic] 1 2 3 4 5

14 ERYTHROMYCIN [Broad spectrum antibiotic, oral tabs] 1 3 4 5

15 ERYTHROMYCIN [oral suspension] 1 3 4 5

16 GENTAMYCIN INJECTION (Broad spectrum injectable antibiotic) 1 3 4 5

17 METRONIDAZOLE TABLETS [antibiotic/amebecide/antiprotozoal] 1 3 4 5

18 METRONIDAZOLE INJECTION 1 3 4 5

19 PENICILLIN INJECTION (Broad spectrum injectable antibiotic) 1 3 4 5

20 TETRACYCLINE [Broad spectrum antibiotic, oral caps] 1 3 4 5

21 TETRACYCLINE EYE OINTMENT 1 3 4 5

23* CHLORAMPHENICOL EYE DROP 0.5% 1 3 4 5

24* CHLORAMPHENICOL EYE OINTMENT1% 1 3 4 5

25* CIPROFLOXACIN EYE DROP 0.3% 1 3 4 5

26* AMPICILLIN CAPSULE (Broad spectrum antibiotic) 1 3 4 5

IN THE FACILITY. INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS

SECTION 9.1: GENERAL MEDICINES AND SUPPLY ITEMS

2

2

2

AVAILABLE

2

ONE VALID NONE VALID NOT SEEN TODAY/DK

2

2

2

2

2

2

2

2

2

2

2

2

SECTION 9: MEDICINES AND COMMODITIES

(A) OBSERVED (B) NOT OBSERVED

AVAILABLE

REPORTED NOT

AVAILABLE AVAILABLE

2

2

2

2

2

2

NEVER 

ANTIBIOTICS

2

AMOXICILLIN SYRUP/SUSPENSION OR DISPERSIBLE PEDIATRICDOSED TABLETS (Oral antibiotics for children)

CO-TRIMOXAZOLE SUSPENSION OR DISPERSIBLE PEDIATRICDOSED TABLET 120 mg (Oral antibiotics for children)

AT LEAST AVAILABLE

2

ASK TO BE SHOWN THE MAIN LOCATION IN THE FACILITY WHERE MEDICINES AND OTHER SUPPLIES ARE STORED.

FIND THE PERSON MOST KNOWLEDGEABLE ABOUT STORAGE AND MANAGEMENT OF MEDICINES AND SUPPLIES 

Appendix C • 211
27* CEFALEXIN CAPSULE 1 3 4 5

28* CEFALEXIN DRY SYRUP 1 3 4 5

29* CEFRADINE CAPSULE 1 3 4 5

30* CEFRADINE DRY SYRUP 1 3 4 5

31* CIPROFLOXACIN DRY SYRUP 1 3 4 5

32* CLOXACILLIN CAPSULE 1 3 4 5

33* CLOXACILLIN DRY SYRUP 1 3 4 5

34* FLUCLOXACILLIN CAPSULES 1 3 4 5

35* FLUCLOXACILLIN DRY SYRUP 1 3 4 5

36* PENICILLIN-V TABLETS 1 3 4 5

37* PENICILLIN-V DRY SYRUP 1 3 4 5

38* LEVOFLOXACIN TABLETS 1 3 4 5

902 Are any of the following medicines for the treatment of 

worm infestations available in the facility/location today?

CHECK TO SEE IF AT LEAST ONE IS VALID (NOT EXPIRED)

01 ALBENDAZOLE TABLET (400mg) 1 3 4 5

02 MEBENDAZOLE CHEWABLE TABLET (100mg OR 500mg) 1 3 4 5

03* MEBENDAZOLE SUSPENSION (100mg/5ml) 1 3 4 5

04* LEVAMISOLE TABLET (40mg) 1 3 4 5

05* LEVAMISOLE SYRUP (40mg/5ml) 100ML/250ML/450ML 1 3 4 5

(A) OBSERVED

2

2

2

2

2

2

2

AT LEAST AVAILABLE

ONE VALID NONE VALID

(B) NOT OBSERVED

AVAILABLE

REPORTED NOT

AVAILABLE NEVER 

TODAY/DK

AVAILABLE

NOT SEEN

2

REPORTED NOT

NEVER 

AVAILABLE

AVAILABLE AVAILABLE

AVAILABLE

2

2

2

2

2

AVAILABLE

MEDICINES FOR WORM INFESTATION

(A) OBSERVED (B) NOT OBSERVED

AT LEAST AVAILABLE

2

2

ONE VALID NONE VALID NOT SEEN TODAY/DK

2

2

212 • Appendix C
903 Are any of the following medicines for the management of 

non-communicable diseases available in the facility/location today? 

CHECK TO SEE IF AT LEAST ONE IS VALID (NOT EXPIRED)

01 AMITRIPTYLINE (Depression) 1 3 4 5

02 AMLODIPINE TABLETS (CCB for high blood pressure) 1 3 4 5

03 ATENOLOL (Beta-blocker, Angina/hypertension) 1 3 4 5

04 BECLOMETHASONE INHALER 1 3 4 5

05 BETAMETHASONE INJECTION 1 3 4 5

06 CAPTOPRIL (Vaso-dilatation, cardiac hypertension) 1 3 4 5

07 DEXAMETHASONE TABLET/INJECTION (ORADEXON) 1 3 4 5

08 DIAZEPAM INJECTION (Anxiety/muscle relaxant/anticonvulsant) 1 3 4 5

09 ENALAPRIL CAPSULE/TABLET (A.C.E INHIBITOR) 1 3 4 5

10 LOSARTAN POTASSIUM 25 mg, 50 MG, 100 mg 1 3 4 5

11 EPINEPHRINE INJECTION 1 3 4 5

12 FRUSEMIDE (DIURETIC) tablet/injection 40 mg 1 3 4 5

13 THIAZIDE DIURETIC 1 3 4 5

14 GLIBENCLAMIDE (Oral treatment for type-2 diabetes) 1 3 4 5

15 GLUCOSE INJECTABLE SOLUTION 1 3 4 5

16 HEPARIN INJECTION 1 3 4 5

17 HYDROCORTISONE INJECTION 100 mg 1 3 4 5

18 INSULIN INJECTIONS [ANTI DIABETIC] 1 3 4 5

19 ISOSORBIDE DINITRATE TABLET 10 mg 1 3 4 5

20 METFORMIN TABLETS 500 mg, 850 mg 1 3 4 5

21 NIFEDIPINE TABLETS/CAPSULES (CCB for high blood pressure) 1 3 4 5

22 OMEPRAZOLE CAP 20 mg, 40 mg (Gastro-esophageal reflux) INJECTION 40 mg1 3 4 5

23 PREDNISOLONE Tablet 5 mg, 10mg, 20 mg / Suspension 1 3 4 5

24 SALBUTAMOL INHALER (Bronchospasms/Chronic asthma) 1 3 4 5

25 SIMVASTATIN (High cholesterol) 1 3 4 5

26 ASPIRIN TABLETS 75 mg 1 3 4 5

27* SALBUTAMOL TABLET 2mg or 4 mg (Bronchospasms/Chronic asthma) 1 3 4 5

28* SALBUTAMOL SYRUP (2mg or 4 mg) (Bronchospasms/Chronic asthma) 1 3 4 5

29* AMINOPHYLLINE TABLET (100mg) 1 3 4 5

30* ANTACID CHEWABLE TABLET/SUSPENSION (ALUM. HYDROXIDE + MAG. HY1 3 4 5

31* DIAZEPAM 5MG TABLETS/INJECTION 10 mg 1 3 4 5

32* GLICLAZIDE Tablet, 80 Mg 1 3 4 5

33* GLYCERINE TRINITRATE Tablet 2.6 mg 1 3 4 5

34* GLIMEPIRIDE TABLET (SECRIN) 1,2, 3,4 mg 1 3 4 5

35* RANITIDINE Tablet 150 Mg 1 3 4 5

36* PANTOPRAZOLE Tablet 20 mg, 40 mg / Injection 40 mg 1 3 4 5

37* ESMOPRAZOLE Tablet 20 mg, 40 mg / Injection 40 mg 1 3 4 5

38* ATOVASTATIN Tablet 10 mg, 20 mg 1 3 4 5

39* ROSUVASTATIN Tablet 10 mg, 20 mg 1 3 4 5

40* CLOPIDOGRELTABLET 75 mg 1 3 4 5

41* THEOPHYLLINE Tablet 200 mg, /Syrup 1 3 4 5

42* IPRATROPIUM BROMIDE (IPREX) , Respiratory Solution 1 3 4 5

43* SULBUTAMON RESPIRATORY SOLUTION 1 3 4 5

44* MENNITOL 20 % Infusion (Osmosol 20% IV) 1 3 4 5

45* VITAMIN B COMPLEX TABLETS 1 3 4 5

46* CHLORPHENIRAMINE TAB 4 mg 1 3 4 5

47* MICRONUTRRIENT PWODER 1 3 4 5

NEVER 

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

MEDICINES FOR NON-COMMUNICABLE DISEASES

NOT SEEN

(B) NOT OBSERVED

REPORTED

(A) OBSERVED

AVAILABLE

AVAILABLE

AVAILABLE

NOT

2

2

2

2

2

2

2

2

AT LEAST AVAILABLE

2

ONE VALID

2

NONE VALID TODAY/DK

AVAILABLE

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

2

Appendix C • 213
904 Are any of the following anti-fungal medicines 

available in the facility/location today? 

CHECK TO SEE IF AT LEAST ONE IS VALID (NOT EXPIRED)

01 FLUCONAZOLE CAPS 50mg , 150mg, 200 mg

02 MICONAZOLE VAGINAL PESSARY 1 3 4 5

03 MICONAZOLE CREAM 1 3 4 5

04 NYSTATIN ORAL SUSPENSION 1 3 4 5

05 NYSTATIN VAGINAL PESSARY/CREAM 1 3 4 5

06* GRISEOFULVIN TABLET (500mg) 1 3 4 5

07* GENTIAN VIOLET 2% TOPICAL SOLUTION 1 3 4 5

08* NEOMYCIN & BACITRACIN SKIN OINTMENT 10mg 1 3 4 5

09* KETOCONAZOLE Tablet 200 mg / ointment 1 3 4 5

11* BENZOIC ACID 6% AND SALICYLIC ACID 3% (WHITFIELDS OINTMENT) 1 3 45

906 Are any of the following medicines for maternal health

available in the facility/location today?

CHECK TO SEE IF AT LEAST ONE IS VALID (NOT EXPIRED)

01 CALCIUM GLUCONATE INJECTION 1 3 4 5

02 FOLIC ACID TABLETS 5 mg 1 3 4 5

03 IRON TABLETS 400 mg 1 3 4 5

04 IRON 200 mg + FOLIC ACID 60 mg COMBINATION TABLET 1 3 4 5

05 MAGNESIUM SULPHATE INJECTION 2.5 gm /5ml/INFUSION 4% 1 3 4 5

06 MISOPROSTOL TABLET 1 3 4 5

07 OXYTOCIN OR OTHER INJECTABLE UTEROTONIC 1 3 4 5

08 TETANUS TOXOID VACCINE 1 3 4 5

09 ORAL REHYDRATION SALTS (ORS) SACHETS 1 3 4 5

10 VITAMIIN A CAPSULE 50 , 000 IU/ 2 Lac IU 1 3 4 5

11* ZINC SULPHATE TABLETS 10mg, 20 mg / SYRUP 1 3 4 5

12* CALCIUM LACTATE TABLET 300 mg 1 3 4 5

13* FERROUS SULPHATE + FOLIC ACID + ZINC CAPSULE 1 3 4 5

14* FERROUS FUMERATE + FOLIC ACID TABLET 1 3 4 5

15* ZINC SULPHATE SYRUP 1 3 4 5

16* METHYL ERGOMETRINE TABLET/INJECTION 125 micro gram, 200 micro gram 1 3 4 5

17* ERGOMETRINE TABLET 1 3 4 5

18* GENTIAN VIOLET 1% 1 3 4 5

19* NYSTATIN DROPS 1 3 4 5

20* INJECTION NALOXONE HYDROCHLORIDE 1 3 4 5

21* 7.1 % CHLORHEXIDINE 1 3 4 5

22* CHLORHEXIDINE CREAM (60 ml bottle) 1 3 4 5

23* COTRIMOXAZOLE VT 200 mg 1 3 4 5

24* CALCIUM CARBONATE TABLET 500 mg 1 3 4 5

25* CHLORPHENIRAMINE MALEATE SYRUP (2mg/5ml) 60 ml 1 3 4 5

26* LIDOCAINE INJECTION 1% (50ml) 1 3 4 5

NOT SEEN

(A) OBSERVED

2

2

2

2

2

2

2

NOT

AT LEAST 

NOT SEEN TODAY/DK AVAILABLE

NEVER 

NEVER 

TODAY/DK

AVAILABLE

ONE VALID

AVAILABLE

ANTI-FUNGAL MEDICINES

AT LEAST AVAILABLE

NONE VALID

2

2

2

REPORTED

(B) NOT OBSERVED

2

AVAILABLE

(B) NOT OBSERVED

2

2

2

2

AVAILABLE

REPORTED

AVAILABLE

NOT

AVAILABLE

MATERNAL AND CHILD HEALTH

AVAILABLE

2

2

2

2

2

NONE VALID

2

2

2

2

2

2

2

2

AVAILABLE

ONE VALID

2

2

2

2

2

2

2

(A) OBSERVED

214 • Appendix C
907 Are any of the following intravenous fluids 

available in the facility/location today?

CHECK TO SEE IF AT LEAST ONE IS VALID (NOT EXPIRED)

01 NORMAL SALINE 500 ML, 1000ML 1 3 4 5

02 RINGERS LACTATE SOLUTION 1000 ML 1 3 4 5

03 DEXTROSE IN NORMAL SALINE 0.9 % (DNS) 500 ML, 1000ML 1 3 4 5

04* 5 % DEXTROSE IN AQUA (D/A) 500 ML, 1000ML 1 3 4 5

05* CHOLERA SALINE 500 ML, 1000 ML 1 3 4 5

06* HARTMAN’S SOLUTION 1000 ML 1 3 4 5

908 Are any of the following OTHER medicines 

available in the facility/location today?

CHECK TO SEE IF AT LEAST ONE IS VALID (NOT EXPIRED)

01 DICLOFENAC TABLETS (50 mg) OR SUSTAINED RELEASE TABS (100mg) 1 3 45

02 PARACETAMOL TABLET 500 mg 1 3 4 5

03* PARACETAMOL SYRUP OR SUSPENSION 1 3 4 5

04* PARACETAMOL DISPERSIBLE PEDIATRIC-DOZED TABLET 1 3 4 5

05* INDOMETHACIN CAPSULE 25 mg 1 3 4 5

07* DICLOFENAC SODIUM INJECTION 75 mg 1 3 4 5

08* PETHIDINE INJECTION (100mg/2ml OR 25mg/1ml) 1 3 4 5

09* IBUPROFEN TABLET 200 mg, 400 mg/syrup 1 3 4 5

10* NAPROXEN SODIUM 250, mg 500 mg 1 3 4 5

11* ACECLOFENAC TAB, 100 mg 1 3 4 5

12* TRAMADOL HYDROCHLORIDE CAP, 50 mg, 100mg 1 3 4 5

13* KETORALAC HYDROCHLORIDE, 10 mg/ INJ, 30 MG , 60 MG 1 3 4 5

14* DICLOFENAC SODIUM SUPPOSITORY 12.5 mg, 25 mg, 50mg 1 3 4 5

15* DROTAVERINE HYDROCHLORIDE TABLET 40 mg / INJECTION 40 mg 1 3 4 5

16* HYOSCINE –N – BUTYL BROMIDE TABS (BUTAPEN) / INJECTION, 20 mg 1 3 4 5

17* TIEMONIUM METHYLE SULPHATE TAB, 50 mg /Injection5mg/2 ml 1 3 4 5

909 OBSERVE THE PLACE WHERE THE MEDICINES ASSESSED SO FAR ARE STORED AND INDICATE THE 

PRESENCE (OR ABSENCE) OF EACH OF THE FOLLOWING STORAGE CONDITIONS.

01 ARE THE MEDICINES OFF THE FLOOR?

02 ARE THE MEDICINES PROTECTED FROM WATER

03 ARE THE MEDICINES PROTECTED FROM THE SUN?

04 IS THE ROOM CLEAN OF EVIDENCE OF RODENTS (BATS, RATS) OR PESTS (ROACHES, ETC)?

05 IS THE STORAGE ROOM WELL VENTILATED?

910 ARE THE MEDICINES ORGANIZED ACCORDING TO DATE OF YES, ALL MEDICINES. . . . . . . . . . . . . . . . . . . . . . 1

EXPIRATION ("first expire, first out")? YES, ONLY SOME MEDICINES. . . . . . . . . . . . . . . . 2

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

911 What system does this facility use to monitor the amount of COMPUTER SYSTEM UPDATED DAILY. . . . . . . . . . . 1

medicines received, the amount issued, and the amount present LEDGER/STOCK CARD UPDATED DAILY. . . . . . . . . . 2

today? COMPUTER SYSTEM NOT UPDATED 

DAILY, BUT THERE IS DAILY RECORD OF

DISTRIBUTED MEDICINES. . . . . . . . . . . . . . . . . . . 3

LEDGER/STOCK CARD NOT UPDATED 

DAILY, BUT THERE IS DAILY RECORD OF

DISTRIBUTED MEDICINES. . . . . . . . . . . . . . . . . . . 4

ASK TO SEE THE SYSTEM AND RECORD OBSERVATION OTHER SYSTEM (SPECIFY) 6

912 Do you have the following supply items available in the facility/location today? OBSERVED REPORTED, NOT

NOT SEEN AVAILABLE

01 SINGLE-USE STANDARD DISPOSABLE SYRINGES WITH NEEDLES 1 2 3

OR AUTO-DESTRUCT SYRINGES WITH NEEDLES

02 INFUSION SET FOR IV SOLUTION 1 2 3

03 CANULA FOR ADMINISTERING IV FLUIDS 1 2 3

04 LATEX GLOVES 12 3

05 ALCOHOL-BASED HAND RUB 12 3

06 HAND WASHING SOAP 12 3

07 DISINFECTING SOLUTION 12 3

AVAILABLE

AT LEAST AVAILABLE

FEVER REDUCING AND PAIN MEDICINES

AVAILABLE

(A) OBSERVED

1 2

2

STORAGE CONDITION: ANTIBIOTICS & GENERAL MEDICINES

2

2

NO

1

SUPPLY ITEMS

1

1

ONE VALID

REPORTED

AVAILABLE

ONE VALID NOT SEEN

2

2

2

2

2

2

2

2

2

2

(B) NOT OBSERVED

TODAY/DK

2

(B) NOT OBSERVED

AVAILABLE

2

AVAILABLE

AVAILABLE NEVER 

NONE VALID

NEVER 

2

2

AVAILABLE

NOT

2

NONE VALID

2

1

2

2

2

YES

AVAILABLE

(A) OBSERVED

INTRAVENOUS FLUIDS

REPORTED NOT

AVAILABLE

2

NOT SEEN TODAY/DK

2

2

2

AT LEAST 

Appendix C • 215
920 CHECK Q212 CONTRACEPTIVES STORED IN FP SERVICE

AREA OR NOT STOCKED AT ALL IN FACILITY

CONTRACEPTIVES STORED WITH OTHER MEDICINES (RESPONSE 1 OR 3 CIRCLED)

IN COMMON LOCATION (RESPONSE 2 CIRCLED)

PROCEED TO NEXT SECTION (TB MEDS?)

921* Are any of the following CONTRACEPTIVE commodities

available in the facility/location today? 

CHECK TO SEE IF AT LEAST ONE IS VALID 

(NOT EXPIRED)

01 COMBINED ORAL CONTRACEPTIVE PILLS 1 3 4 5

02 PROGESTIN-ONLY CONTRACEPTIVE PILLS 1 3 4 5

04 PROJESTIN-ONLY INJECTABLE CONTRACEPTIVES (DEPO) 1 3 4 5

05 MALE CONDOMS 1 3 4 5

07 INTRAUTERINE CONTRACEPTIVE DEVICE 1 3 4 5

08* ONE ROD IMPLANT 1 3 4 5

09* TWO ROD IMPLANT (ZADELL) 1 3 4 5

10 EMERGENCY CONTRACEPTIVE PILLS (E.G., PROSTINOL 2) 1 3 4 5

922 OBSERVE THE LOCATION WHERE CONTRACEPTIVE COMMODITIES ARE STORED AND INDICATE 

THE PRESENCE (OR ABSENCE) OF EACH OF THE FOLLOWING STORAGE CONDITIONS

01 ARE THE COMMODITIES OFF THE FLOOR?

02 ARE THE COMMODITIES PROTECTED FROM WATER

03 ARE THE COMMODITIES PROTECTED FROM THE SUN?

04 IS THE ROOM CLEAN OF EVIDENCE OF RODENTS (BATS, RATS) OR PESTS (ROACHES, ETC)?

05 IS THE STORAGE ROOM WELL VENTILATED?

923 ARE THE CONTRACEPTIVE COMMODITIES ORGANIZED YES, ALL COMMODITIES. . . . . . . . . . . . . . . . . . . . 1 

ACCORDING TO DATE OF EXPIRATION ("first expire, first out") NOT ALL COMMODITIES. . . . . . . . . . . . . . . . . . . . 2

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

924 What type of system does this facility use to monitor COMPUTER SYSTEM UPDATED DAILY. . . . . . . . 1

the amount of contraceptive commodities received, LEDGER/STOCK CARD UPDATED DAILY. . . . . . . 2

the amount issued, and the amount present today? COMPUTER SYSTEM NOT UPDATED 

DAILY, BUT THERE IS DAILY RECORD OF

DISTRIBUTED COMMODITIES. . . . . . . . . . . . . . 3

LEDGER/STOCK CARD NOT UPDATED 

DAILY, BUT THERE IS DAILY RECORD OF

DISTRIBUTED COMMODITIES. . . . . . . . . . . . . . 4

ASK TO SEE THE SYSTEM AND RECORD OBSERVATION OTHER SYSTEM 6

(SPECIFY)

925 PRESENTLY INTERVIEWING IN PRESENTLY INTERVIEWING IN

PHARMACY FAMILY PLANNING SERVICE AREA

PROCEED TO NEXT SECTION OR SERVICE SITE THANK THE RESPONDENT IN THE FP SERVICE AREA

AND CONTINUE TO NEXT SECTION OR SERVICE SITE

AVAILABLE

2

ONE VALID

2

NEVER 

1 2

TODAY/DK

2

2

2

1

NO

1 2

1

YES

STORAGE CONDITION - CONTRACEPTIVE COMMODITIES

2

1

2

AVAILABLE

2

2

SECTION 9.2: CONTRACEPTIVE COMMODITIES

AT LEAST 

NONE VALID

NOT

AVAILABLE

REPORTED

NOT SEEN

2

2

AVAILABLE AVAILABLE

(A) OBSERVED (B) NOT OBSERVED

216 • Appendix C
930 CHECK Q214

ANTI-TB MEDICINES STORED IN TB SERVICE

ANTI-TB MEDICINES STORED WITH OTHER MEDICINES AREA OR NOT STOCKED AT ALL IN FACILITY

IN COMMON LOCATION (RESPONSE 2 CIRCLED) (RESPONSE 1 OR 3 CIRCLED)

PROCEED TO NEXT SECTION

931* Are any of the following TB medicines available in the 

facility/location today?

CHECK TO SEE IF AT LEAST ONE IS VALID 

(NOT EXPIRED)

01 ETHAMBUTOL TABS (E) 1 3 4 5

02 ISONIAZID TABS (INH, H) 1 3 4 5

03 PYRAZINAMIDE (Z) 1 3 4 5

04 RIFAMPICIN (R) 1 3 4 5

05 RIFAMPICIN+ISONIAZID- RH 75/50 mg- (2FDC) Child 1 3 4 5

06 RIFAMPICIN + ISONIAZID -RH 150/75 mg- 2FDC Adult 1 3 4 5

07 RIFAMPICIN + ISONIAZID + PYRAZINAMIDE (RHZ)- 75/50/150 mg- 3FDC Child1 3 4 5

08 RIFAMPICIN + ISONIAZID + ETHAMBUTOL (RHE)- 1 3 4 5

150/75/275- 3FDC Adult

09 RIFAMPICIN + ISONIAZID+ PYRAZINAMIDE + ETHAMBUTOL 1 3 4 5

(RHZE)- 150/75/400/275- 4FDC Adult

10 STREPTOMYCIN (S 1000) INJECTABLE 1 3 4 5

935 PRESENTLY INTERVIEWING IN PRESENTLY INTERVIEWING IN

PHARMACY TB SERVICE AREA

PROCEED TO NEXT SECTION OR SERVICE SITE THANK THE RESPONDENT IN THE TB SERVICE AREA

AND CONTINUE TO NEXT SECTION OR SERVICE SITE

NOT

2

2

2

AVAILABLE

TODAY/DK

AT LEAST NEVER 

2

2

AVAILABLE

NONE VALID NOT SEEN

2

2

2

REPORTED

(A) OBSERVED

AVAILABLE AVAILABLE

2

2

ONE VALID AVAILABLE

(B) NOT OBSERVED

SECTION 9.3: ANTI-TB DRUGS

Appendix C • 217
1000 CHECK Q102.01 NO CHILD

CHILD VACCINATION SERVICES

VACCINATION SERVICES AVAILABLE

NEXT SECTION OR SERVICE SITE

1001 Now I would like to ask you specifically about vaccination services for children under 5 years. For each of the 

following services, please tell me whether the service is offered by your facility, and if so, how many days 

per month the service is provided at the facility, and how many days per month as outreach, if any.

CHILD VACCINATION SERVICE (a) (b)

# OF DAYS PER # OF DAYS PER

(USE A 4-WEEK MONTH TO CALCULATE # OF DAYS MONTH SERVICE IS

PROVIDED AT FACILITY THROUGH OUTREACH

01 Routine DPT+HepB+Hib (i.e., pentavalent) # OF DAYS # OF DAYS

00=NO 00=NO

SERVICE SERVICE

02 Routine polio vaccination (i.e., OPV) # OF DAYS # OF DAYS

00=NO 00=NO

SERVICE SERVICE

03 Routine measles vaccination (i.e., Measles - Rubella) # OF DAYS # OF DAYS

00=NO 00=NO

SERVICE SERVICE

04 BCG vaccination # OF DAYS # OF DAYS

00=NO 00=NO

SERVICE SERVICE

05* Inactivated polio vaccination (i.e., IPV) # OF DAYS # OF DAYS

00=NO 00=NO

SERVICE SERVICE

06* Pneumococcal vaccination (i.e., PCV) # OF DAYS # OF DAYS

00=NO 00=NO

SERVICE SERVICE

1002 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1004

1003 May I see the guidelines? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1006

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . 2

1004 Do you have any other guidelines for child vaccinations YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

available in this service area today? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1006

1005 May I see the other guidelines? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . 2

1006 ASK YOUR RESPONDENT TO SHOW YOU ITEMS OBSERVED REPORTED, NOT

REQUIRED FOR VACCINATION SERVICES NOT SEEN AVAILABLE

01 Blank/unused individual child vaccination cards or booklets (EPI card) 1 2 3

02 Tally sheets 12 3

03 Summary forms / monthly report 1 2 3

CHILD HEALTH SERVICES

SECTION 10: CHILD VACCINATION

MODULE 3: SERVICE-SPECIFIC READINESS

MONTH SERVICE IS PROVIDED

Do you have the national guidelines for child vaccinations (i.e. EPI 

SOHAYIKA) available in this service area today?

TO BE SHOWN THE MAIN LOCATION WHERE CHILD AND ADOLESCENT VACCINATION SERVICES ARE PROVIDED IN THE FACI

FIND THE PERSON MOST KNOWLEDGEABLE ABOUT CHILD VACCINATION SERVICES IN THE FACILITY.

INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS.

218 • Appendix C
1007 Does this facility routinely store any vaccines, or are ROUTINELY STORE VACCINES. . . . . . . . . . . 1

all its vaccines either picked up from another facility STORES NO VACCINES. . . . . . . . . . . . . . 2 1014

or delivered when services are being provided?

1008 REFRIGERATOR OBSERVED. . . . . . . . . . . . . 1

REFRIGERATOR NOT OBSERVED. . . . . . . . . 2 1014

1009 Do you maintain a cold-chain temperature monitoring chart? YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1012

1010 May I see the cold-chain temperature monitoring chart? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . 2 1012

1011 CHECK WHETHER THE TEMPERATURE RECORD WAS YES, COMPLETED . . . . . . . . . . . . . . . . . . . . . . 1

COMPLETED TWICE DAILY FOR EACH OF THE PAST 30 DAYS, NO, NOT COMPLETED . . . . . . . . . . . . . . . . . . 2

INCLUDING WEEKENDS AND PUBLIC HOLIDAYS.

1012 Please tell me if each of the following vaccines is available 

in the facility today. If available, I would like to see it.

IF AVAILABLE, CHECK TO SEE IF AT LEAST ONE IS VALID

(NOT EXPIRED, VACCINE VIAL MONITOR UNCHANGED (NOT FROZE

01 DPT+HepB+Hib [PENTAVALENT] 2 3 5

02 ORAL POLIO VACCINE (i.e., OPV) 2 3 5

03 MEASLES VACCINE AND DILUENT (i.e., MR) 2 3 5

04 BCG VACCINE AND DILUENT 2 3 5

05* INACTIVATED POIO VACCINE (i.e., IPV) 2 3 5

06* PNEUMOCOCCAL VACCINE (i.e., PCV) 2 3 5

1013 WHAT IS THE TEMPERATURE IN THE VACCINE BETWEEN +2 AND +8 DEGREES. . . . . . . . . . 1

REFRIGERATOR? ABOVE +8 DEGREES. . . . . . . . . . . . . . . . . . . . 2

BELOW +2 DEGREES. . . . . . . . . . . . . . . . . . . . 3

CENTIGRATE/CELSIUS DEGREES THERMOMETER NOT FUNCTIONAL. . . . . . . 4

NO THERMOMETER. . . . . . . 5

1014 How many vaccine carriers do you have? ONE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

TWO OR MORE SETS. . . . . . . . . . . . . . . . . . . . 2

ASK TO SEE THE VACCINE CARRIERS. REPORTED NONE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1016

RESPONSE FROM KNOWLEDGEABLE RESPONDENT 

IS ACCEPTABLE.

1015 How many sets of ice packs or cool water packs do you have? ONE SET. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

TWO OR MORE SETS. . . . . . . . . . . . . . . . . . . 2

ASK TO SEE THE ICE PACKS. NO ICE PACKS, USE PURCHASED ICE. . . . . 3

REPORTED RESPONSEACCEPTABLE NO ICE PACKS. . . . . . . . . . . . . . . . . . . . . . . . . 4

NOTE: 4-5 ICE PACKS MAKE ONE SET

ASK TO BE TAKEN TO THE AREA WHERE VACCINES ARE 

STORED. ASK TO SEE THE VACCINE REFRIGERATOR.

(B) NOT OBSERVED

NOT

(A) OBSERVED

AVAILABLE

TODAY/DK

AVAILABLE

NOT SEEN

AVAILABLE

REPORTED

ONE VALID

AVAILABLE

1

NONE VALID

1 4

1 4

4

1 4

1 4

1 4

AT LEAST NEVER 

AVAILABLE

Appendix C • 219
1016* Now I would like to ask you specifically about vaccination services for adolescent. For each of the 

following services, please tell me whether the service is offered by your facility, and if so, how many days 

per month the service is provided at the facility, and how many days per month as outreach, if any.

ADOLESCENT VACCINATION SERVICE (a) (b)

# OF DAYS PER # OF DAYS PER

(USE A 4-WEEK MONTH TO CALCULATE # OF DAYS MONTH SERVICE IS

PROVIDED AT FACILITY THROUGH OUTREACH

01 TT vaccine # OF DAYS # OF DAYS

00=NO 00=NO

SERVICE SERVICE

1017* YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1019

1018* May I see the guideline/protocol/manual? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1021

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . 2

1019* Do you have any other guideline/protocol/manual for adolescent vaccinYES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

available in this service area today? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1021

1020* May I see the other guideline/protocol/manual? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . 2

1021* Please tell me if each of the following vaccines is available 

in the facility today. If available, I would like to see it.

IF AVAILABLE, CHECK TO SEE IF AT LEAST ONE IS VALID

(NOT EXPIRED, VACCINE VIAL MONITOR UNCHANGED (NOT FROZE

01 TT vaccine 23 5

1022* Now I would like to ask you specifically about vaccination services for mothers. For each of the 

following services, please tell me whether the service is offered by your facility, and if so, how many days 

per month the service is provided at the facility, and how many days per month as outreach, if any.

MOTHER VACCINATION SERVICE (a) (b)

# OF DAYS PER # OF DAYS PER

(USE A 4-WEEK MONTH TO CALCULATE # OF DAYS MONTH SERVICE IS

PROVIDED AT FACILITY THROUGH OUTREACH

01 TT vaccine # OF DAYS # OF DAYS

00=NO 00=NO

SERVICE SERVICE

1023* YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1025

1024* May I see the guideline/protocol/manual? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1027

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . 2

1025* Do you have any other guideline/protocol/manual for mother vaccinatioYES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

available in this service area today? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1027

1026* May I see the other guideline/protocol/manual? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . 2

1027* Please tell me if each of the following vaccines is available 

in the facility today. If available, I would like to see it.

IF AVAILABLE, CHECK TO SEE IF AT LEAST ONE IS VALID

(NOT EXPIRED, VACCINE VIAL MONITOR UNCHANGED (NOT FROZE

01 TT vaccine 23 5

Do you have the national guideline/protocol/manual for mother 

vaccinations available in this service area today?

(A) OBSERVED (B) NOT OBSERVED

AVAILABLE

REPORTED NOT

AT LEAST AVAILABLE AVAILABLE AVAILABLE NEVER 

AT LEAST AVAILABLE AVAILABLE AVAILABLE NEVER 

ONE VALIDNONE VALID NOT SEEN TODAY/DK AVAILABLE

4

NOT SEEN TODAY/DK AVAILABLE

1

(A) OBSERVED (B) NOT OBSERVED

AVAILABLE

REPORTED NOT

MONTH SERVICE IS PROVIDED

ONE VALIDNONE VALID

1 4

MONTH SERVICE IS PROVIDED

Do you have the national guideline/protocol/manual for adolescent 

vaccinations available in this service area today?

220 • Appendix C
1050 ASSESS THE ROOM OR AREA FOR THE ITEMS LISTED GENERAL INFORMATION [Q710]. . . . . . . . . . 11

BELOW. FOR ITEMS THAT YOU DO NOT SEE, CHILD CURATIVE CARE [Q1251]. . . . . . . . . . 13

ASK YOUR RESPONDENT TO SHOW THEM TO YOU. FAMILY PLANNING [Q1351]. . . . . . . . . . . . . . . 14

ANTENATAL CARE [Q1451]. . . . . . . . . . . . . . . 15

IF THE SAME ROOM OR AREA HAS ALREADY BEEN DELIVERY [Q1651]. . . . . . . . . . . . . . . . . . . . . . 17

ASSESSED, INDICATE WHERE THE DATA ARE RECORDED TUBERCULOSIS [Q1951]. . . . . . . . . . . . . . . . . 19

NCD [Q2351]. . . . . . . . . . . . . . . . . . . . . . . . . . . 22

NOT PREVIOUSLY SEEN. . . . . . . . . . . . . 31

1051 STANDARD PRECAUTIONS AND CONDITIONS FOR REPORTED, NOT

CLIENT EXAMINATION NOT SEEN AVAILABLE

01 RUNNING WATER (PIPED, BUCKET WITH TAP OR POUR PITCHER) 1 2 3

02 HAND-WASHING SOAP (MAY BE LIQUID SOAP) 1 2 3

03 ALCOHOL-BASED HAND RUB 1 2 3

04 WASTE RECEPTACLE (PEDAL BIN) WITH LID AND PLASTIC BIN LINER 1 2 3

06

05 OTHER WASTE RECEPTACLE 1 2 3

06 SHARPS CONTAINER ("SAFETY BOX") 1 2 3

07 DISPOSABLE LATEX/OTHER GLOVES 1 2 3

08 DISINFECTANT/ANTISEPTICS [E.G., CHLORINE, HIBITANE, ALCOHOL] 1 2 3

09 SINGLE-USE STANDARD DISPOSABLE SYRINGES WITH NEEDLES OR 1 2 3

AUTO-DISABLE SYRINGES WITH NEEDLES

10 MEDICAL MASKS 12 3

11 GOWNS 12 3

12 EYE PROTECTION [GOGGLES OR FACE PROTECTION] 1 2 3

13 GUIDELINES FOR STANDARD PRECAUTIONS 1 2 3

1052 DESCRIBE THE SETTING OF THE CHILD VACCINATION PRIVATE ROOM. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

SERVICE DELIVERY ROOM OR AREA. OTHER ROOM WITH 

AUDITORY AND VISUAL PRIVACY. . . . . . . . . . 2

VISUAL PRIVACY ONLY. . . . . . . . . . . . . . . . . . . . . . . . . 3

NO PRIVACY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

THANK YOUR RESPONDENT AND MOVE TO YOUR NEXT DATA COLLECTION POINT IF DIFFERENT FROM 

CURRENT LOCATION.

OBSERVED

STANDARD PRECAUTIONS

NEXT SECTION / SERVIC

Appendix C • 221
1100 CHECK Q102.02 GROWTH MONITORING NO GROWTH

SERVICES AVAILABLE MONITORING SERVICES

NEXT SECTION OR SERVICE SITE

1101 Please tell me the number of days per month that growth (a) (b)

monitoring services are offered in this facility, # OF DAYS PER

and the number of days per month as outreach, if any. MONTH SERVICE IS

PROVIDED AT FACILITY

USE A 4-WEEK MONTH TO CALCULATE # OF DAYS

01 Child growth monitoring # OF DAYS # OF DAYS

00=NO

SERVICE

1102 Do you have any guidelines for growth monitoring available YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

in this service area today? NO GUIDELINE AVAILABLE. . . . . . . . . . . . . . . 2 1103A

1103 May I see the guidelines for growth monitoring? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

(family health card) REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . 2

1103A Do you have any guideline/protocol/manual for SAM and MAM available YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

in this service area today? NO GUIDELINE AVAILABLE. . . . . . . . . . . . . . . 2 1104

1103B May I see the guideline/protocol/manual for SAM and MAM? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . 2

1104 I would like to know if the 

following items are available 

in this service area and are 

functioning. I would like to see OBSERVED

them.

01 CHILD WEIGHING SCALE 1 b 2 b 3 1 8

(250GRAM GRADATION) 02

02 INFANT WEIGHING SCALE 1 b 2 b 3 1 8

(100 GRAM GRADATION) 03

03 HEIGHT OR LENGTH BOARD 1 b 2 b 3 1 8

04

04 1 2 3

05 GROWTH CHARTS 1 2 3

06* 1 2 3

(MUAC)

THANK YOUR RESPONDENT AND MOVE TO YOUR NEXT DATA COLLECTION POINT IF DIFFERENT FROM 

CURRENT LOCATION.

DON’T 

(B) FUNCTIONING

REPORTED

THROUGH OUTREACH

2

TAPE FOR MEASURING HEAD CIRCUMFERENCE

KNOW

TAPE FOR MID-UPPER ARM CIRCUMFERENCE 

NOT SEEN

2

2

NOT

AVAILABLE

(A) AVAILABLE

YES NO

# OF DAYS PER MONTH

SERVICE IS PROVIDED

INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS.

FACILITY. FIND THE PERSON MOST KNOWLEDGEABLE ABOUT GROWTH MONITORING SERVICES IN THE FACILITY.

ASK TO BE SHOWN THE MAIN LOCATION WHERE GROWTH MONITORING SERVICES ARE PROVIDED IN THE

SECTION 11: CHILD GROWTH MONITORING SERVICES

222 • Appendix C
1200 CHECK Q102.03 CURATIVE CARE NO CURATIVE CARE

SERVICES AVAILABLE SERVICES

NEXT SECTION OR SERVICE SITE

1201 Please tell me the number of days per month that (a) (b)

consultations or curative care for children under 5 are # OF DAYS PER # OF DAYS PER

offered in this facility, and the number of days per month as MONTH SERVICE IS

outreach, if any. PROVIDED AT FACILITY THROUGH OUTREACH

(VILLAGE LEVEL) 

USE A 4-WEEK MONTH TO CALCULATE # OF DAYS ACTIVITIES

01 Consultation or curative care services for sick children # OF DAYS # OF DAYS

00=NO

SERVICE

1202 Please tell me if providers of child health services in this facility provide the following services NO

01 DIAGNOSE AND/OR TREAT CHILD MALNUTRITION 2

02 PROVIDE VITAMIN A SUPPLEMENTATION TO CHILDREN 2

03 PROVIDE IRON SUPPLEMENTATION TO CHILDREN 2

04 PROVIDE ZINC SUPPLEMENTATION TO CHILDREN 2

05* PROVIDE DEWORMING TO CHILDREN 2

06* PROVIDE SEPSIS MANAGEMENT FOR CHILDREN 2

07* PROVIDE ORAL ANTIBIOTIC TO CHILDREN 2

08* PROVIDE PARENTERAL (INJECTABLE) ANTIBIOTIC TO CHILDREN 2

09* PROVIDE PARENTERAL (INJECTABLE) ANTIBIOTIC TO NEWBORNS 2

10* PROVIDE KANGAROO MOTHER CARE FOR PRETERM AND LOW BIRTH WEIGHT BABIES 2

11* PROVIDE RESUSCITATION FOR MANAGEMENT OF BIRTH ASPHYXIA 2

12* PROVIDE SPECIAL CARE (SCANU) FOR CRITICALLY ILL NEWBORNS 2

1203 Do providers of services for sick children in this facility YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

follow the IMCI guidelines in the provision of services to NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

children under 5 years?

1203A* Do this facility have separate IMCI corner? YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

1204 Do you have the IMCI guideline/protocol/manual (chart booklet) for theYES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

and management of childhood illnesses available in this NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1206

service area today?

1205 May I see the IMCI guideline/protocol/manual? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1208

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . 2

1206 Do you have any (other) guideline/protocol/manual for the diagnosis anYES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

management of childhood illnesses available in this NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1208

service site today? 

1207 May I see the other guideline/protocol/manual? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . 2

1208 Does this facility have a system whereby certain observations YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

and parameters are routinely carried out on sick children NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1210

before the consultation for the presenting illness?

IF YES, ASK TO SEE THE PLACE WHERE THESE 

ACTIVITIES TAKE PLACE BEFORE THE CONSULTATION

1209 OBSERVE IF THE BELOW ACTIVITIES ARE BEING DONE

ROUTINELY. IF YOU DO NOT SEE AN ACTIVITY, ASK: 

Is [ACTIVITY YOU DO NOT SEE] routinely conducted for 

all sick children?

01 Weighing the child 2 38

02 Plotting child’s weight on graph 2 3 8

03 Taking child’s temperature 2 38

04 Assessing child’s vaccination status 2 3 8

05 Providing group health education 2 3 8

06 Administer fever-reducing medicines and/or sponge for fever 2 3 8

07 Triaging of sick children, i.e., prioritizing sick children 2 3 8

based on the severity of their condition

08* Taking child’s height/lengh measurement 2 3 8

09* Taking MUAC measurement 2 38

1

1

1

1

1

1

1

1

OBSERVED

ACTIVITY 

REPORTED

ACTIVITY NOT

ROUTINELY 

CONDUCTED

DON’T 

1

ACTIVITY

INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS.

FIND THE PERSON MOST KNOWLEDGEABLE ABOUT CURATIVE CARE SERVICES IN THE FACILITY. 

ASK TO BE SHOWN THE LOCATION IN THE FACILITY WHERE CURATIVE CARE SERVICES ARE PROVIDED. 

YES

1

1

1

1

1

MONTH SERVICE IS PROVIDED

1

1

1

1

KNOW

1

NOT SEEN

1

1

SECTION 12: CHILD CURATIVE CARE SERVICES

Appendix C • 223
1210

OBSERVED

01 CHILD WEIGHING SCALE 1 b 2 b 3 1 8

(250GRAM GRADATION) 02

02 INFANT WEIGHING SCALE 1 b 2 b 3 1 8

(100 GRAM GRADATION) 03

03 THERMOMETER 1 b 2 b 3 1 8

04

04 STETHOSCOPE 1 b 2 b 3 1 8

05

05 Timer or watch with 1 b 2 b 3 1 8

seconds hand 06

06 Staff has watch with seconds hand or other device 1 2 3

(e.g., cell phone) that can measure seconds

07 Calibrated 1/2 or 1-liter measuring jar for ORS 1 2 3

08 Cup and spoon 1 2 3

09 ORS PACKETS OR SACHETS 1 2 3

10 At least 3 buckets 1 2 3

(for cleaning used cups)

11 Examination bed or couch 1 2 3

1211 Please tell me if you have any of the following 

materials. 

IF YES, ASK TO SEE

01 IMCI chart booklet 1 2 3

02 IMCI mother's cards (IMCI card) 1 2 3

03 Other visual aids for teaching caretakers 1 2 3

04* IMCI register 1 2 3

05* Sick newborn care register 1 2 3

1212 Are individual health records (i.e., child welfare card or YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

booklet) for sick children maintained at this service site? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1250

1213 May I see an unused copy of the individual records? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . 2

2

2

2

(A) AVAILABLE (B) FUNCTIONING

REPORTED NOT YES NO DON’T 

2

2

NOT SEEN AVAILABLE KNOW

I would like to know if the following items are 

available in this service area. I would like to see 

them. For equipment and instruments, I would like 

to know if they are functioning.

224 • Appendix C
1250 ASSESS THE ROOM OR AREA FOR THE ITEMS LISTED GENERAL INFORMATION [Q710]. . . . . . . . . . 11

BELOW. FOR ITEMS THAT YOU DO NOT SEE, CHILD VACCINATION [Q1051]. . . . . . . . . . . . . 12

ASK YOUR RESPONDENT TO SHOW THEM TO YOU. FAMILY PLANNING [Q1351]. . . . . . . . . . . . . . . 14

ANTENATAL CARE [Q1451]. . . . . . . . . . . . . . . 15

DELIVERY [Q1651]. . . . . . . . . . . . . . . . . . . . . . 17

IF THE SAME ROOM OR AREA HAS ALREADY BEEN TUBERCULOSIS [Q1951]. . . . . . . . . . . . . . . . . 19

ASSESSED, INDICATE WHERE THE DATA ARE RECORDED NCD [Q2351]. . . . . . . . . . . . . . . . . . . . . . . . . . . 22

NOT PREVIOUSLY SEEN. . . . . . . . . . . . . 31

1251 STANDARD PRECAUTIONS AND CONDITIONS FOR REPORTED, NOT

CLIENT EXAMINATION NOT SEEN AVAILABLE

01 RUNNING WATER (PIPED, BUCKET WITH TAP OR POUR PITCHER) 1 2 3

02 HAND-WASHING SOAP (MAY BE LIQUID SOAP) 1 2 3

03 ALCOHOL-BASED HAND RUB 1 2 3

04 WASTE RECEPTACLE (PEDAL BIN) WITH LID AND PLASTIC BIN LINER 1 2 3

06

05 OTHER WASTE RECEPTACLE 1 2 3

06 SHARPS CONTAINER ("SAFETY BOX") 1 2 3

07 DISPOSABLE LATEX/OTHER GLOVES 12 3

08 DISINFECTANT/ANTISEPTICS [E.G., CHLORINE, HIBITANE, ALCOHOL] 1 2 3

09 SINGLE-USE STANDARD DISPOSABLE SYRINGES WITH NEEDLES OR 1 2 3

AUTO-DISABLE SYRINGES WITH NEEDLES

10 MEDICAL MASKS 12 3

11 GOWNS 12 3

12 EYE PROTECTION [GOGGLES OR FACE PROTECTION] 1 2 3

13 GUIDELINES FOR STANDARD PRECAUTIONS 1 2 3

1252 DESCRIBE THE SETTING OF THE SICK CHILD PRIVATE ROOM. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

SERVICE DELIVERY ROOM OR AREA. OTHER ROOM WITH 

AUDITORY AND VISUAL PRIVACY. . . . . . . . . . 2

VISUAL PRIVACY ONLY. . . . . . . . . . . . . . . . . . . . . . . 3

NO PRIVACY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

STANDARD PRECAUTIONS

OBSERVED

NEXT SECTION / SERVIC

Appendix C • 225
1253* CHECK Q102.22 ADOLESCENT HEALTH SERVICE ADOLESCENT HEALTH SERVICE

PROVIDED NOT PROVIDED 1261

1254* Is there a dedicated room/area for adolescent health service? YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . . . . . 2 1256

1255* DESCRIBE THE SETTING OF THE ADOLESCENT HEALTH SERVICE PRIVATE ROOM. . . . . . . . . . . . . . . . . . . . . . . . . . 1

ROOM OR AREA. OTHER ROOM WITH 

AUDITORY AND VISUAL PRIVACY. . . . . . 2

VISUAL PRIVACY ONLY. . . . . . . . . . . . . . . . . . . 3

NO PRIVACY. . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

1256* How many days each week areadolescent health srvice

available at this facility? DAYS PER WEEK. . . . . . . . . . . . . . . . . .

LESS OFTEN THAN ONCE/WEEK. . . . . . . 0

1257* Do you have the adolescent health guideline/protocol/manual availabl YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

in this service area today? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1259

1258* May I see the adolescent health guideline/protocol/manual? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1261

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . . . 2

ACCEPTABLE IF PART OF OTHER GUIDELINES

1259* Do you have any other adolescent health guideline/protocol/manual YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

available in this service area today? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1261

1260* May I see the other guideline/protocol/manual? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . . . 2

1261* CHECK Q102.23 NUTRITION SERVICES NUTRITION SERVICES

PROVIDED NOT PROVIDED 1300

1262* Is there a dedicated room/area for nutrition services? YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . . . . . 2 1264

1263* DESCRIBE THE SETTING OF THE NUTRITION SERVICES PRIVATE ROOM. . . . . . . . . . . . . . . . . . . . . . . . . . 1

ROOM OR AREA. OTHER ROOM WITH 

AUDITORY AND VISUAL PRIVACY. . . . . . 2

VISUAL PRIVACY ONLY. . . . . . . . . . . . . . . . . . . 3

NO PRIVACY. . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

1264* How many days each week are nutrition services

available at this facility? DAYS PER WEEK. . . . . . . . . . . . . . . . . .

LESS OFTEN THAN ONCE/WEEK. . . . . . . 0

1265* Do you have the SAM/MAM guideline/protocol/manual available YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

in this service area today? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1267

1266* May I see the SAM/MAM guideline/protocol/manual? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1300

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . . . 2

ACCEPTABLE IF PART OF OTHER GUIDELINES

1267* Do you have any other nutrition guideline/protocol/manual available YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

in this service area today? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1300

1268* May I see the other nutrition guideline/protocol/manual? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . . . 2

THANK YOUR RESPONDENT AND MOVE TO YOUR NEXT DATA COLLECTION POINT IF DIFFERENT FROM 

CURRENT LOCATION.

ADOLESCENT HEALTH SERVICES

NUTRITION SERVICES

226 • Appendix C
1300 CHECK Q102.04 NO FAMILY

FAMILY PLANNING PLANNING SERVICES

SERVICES

NEXT SECTION OR SERVICE SITE

1301 How many days in a month are family planning 

services offered at this facility? NUMBER OF DAYS

USE A 4-WEEK MONTH TO CALCULATE # OF DAYS

1302 Does this facility provide (i.e., stock the commodity) or 

prescribe, counsel or refer clients for any of the 

following modern methods of family planning:

01 COMBINED ORAL CONTRACEPTIVE PILLS 1 2 3

02 PROGESTIN-ONLY CONTRACEPTIVE PILLS 1 2 3

04 PROGESTIN-ONLY INJECTABLE CONTRACEPTIVES (DEPO) 1 2 3

05 MALE CONDOMS 1 2 3

07 INTRAUTERINE CONTRACEPTIVE DEVICE (IUCD) 1 2 3

08* ONE ROD IMPLANT 1 2 3

09* TWO RODS IMPLANT (ZADELL) 1 2 3

10 EMERGENCY CONTRACEPTIVE PILLS (E.G., PROSTINOL 2) 1 2 3

12 VASECTOMY (MALE STERILIZATION) 1 2 3

13 TUBAL LIGATION (FEMALE STERILIZATION) 1 2 3

15* COUNSEL CLIENTS ON LACTATION AMENORRHEA (LAM) 2 3

1303 Do you have the family planning guidelines/manual YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

available at this service area today? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1305

1304 May I see the family planning guidelines/manual? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1307

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . 2

1305 Do you have any other guidelines/instructions/job aid/checklist YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

on family planning available at this service area today? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1307

1306 May I see the other guidelines/instructions/jobaid/checklist? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . 1

 (e.g., IUCD card, IMPLANT card, concent form, admission form, REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . 2

payment record, admission register etc.,)

1307 Are individual records or cards (e.g., IUCD card, IMPLANT card, etc.,) YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

maintained at this service site for family planning clients? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1309

1308 May I see a blank copy of the individual records or card? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . 2

SECTION 13: FAMILY PLANNING

(STOCK THE NO

INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS.

FIND THE PERSON MOST KNOWLEDGEABLE ABOUT FAMILY PLANNING SERVICES IN THE FACILITY.

ASK TO BE SHOWN THE LOCATION IN THE FACILITY WHERE FAMILY PLANING SERVICES ARE PROVIDED. 

COUNSEL, OR 

REFER

PROVIDE PRESCRIBE/ 

COMMODITY)

Appendix C • 227
1309 Does this facility have a system whereby certain observations YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

and parameters are routinely carried out on family planning NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1311

clients before the consultation takes place? 

IF YES, ASK TO SEE THE PLACE WHERE THESE 

ACTIVITIES TAKE PLACE.

1310 OBSERVE IF THE BELOW ACTIVITIES ARE BEING DONE

ROUTINELY. IF YOU DO NOT SEE AN ACTIVITY, ASK: 

Is [ACTIVITY YOU DO NOT SEE] routinely done for all 

family planning clients? 

01 Weighing of clients 2 38

02 Taking blood pressure 2 38

03 Conducting group health education sessions 2 3 8

1311 Do family planning providers in this facility routinely diagnose ROUTINELY DIAGNOSE AND TREAT STIs. . . . . . . . . . . 1

and treat RTIs/STIs, or are RTIs/STIs clients referred to another DIAGNOSE BUT REFER ELSEWHERE 

provider or location for STI diagnosis and treatment? FOR TREATMENT. . . . . . . . . . . . . . . . . . . . . . . . . . 2

REFER ELSEWHERE IN FACILITY FOR DIAGNOSIS 

AND TREATMENT. . . . . . . . . . . . . . . . . . . . . . . . . . .3

REFER OUTSIDE FACILITY FOR DIAG & TREATMENT. 4

PROBE TO ARRIVE AT THE RIGHT ANSWER NO DIAGNOSIS / TREATMENT / REFERRAL. . . . . . . . . 5

1314 I would like to know if the 

following items are available 

in this service area today DON’T 

and are functioning KNOW

01 DIGITAL BP APPARATUS 1 b 2 b 3 1 2 8

02

02 MANUAL BP APPARATUS 1 b 2 b 3 1 2 8

03

03 STETHOSCOPE 1 b 2 b 3 1 2 8

04

04 EXAMINATION LIGHT 1 b 2 b 3 1 2 8

(FLASHLIGHT OK) 05

05 EXAMINATION BED OR 

COUCH 1 2 3

06 SAMPLE OF FP METHODS 1 2 3

07 OTHER FP-SPECIFIC 1 2 3

VISUAL AIDS [E.G., FLIP

CHARTS, LEAFLETS]

08 PELVIC MODEL FOR IUCD 1 2 3

09 MODEL FOR SHOWING 1 2 3

CONDOM USE

AVAILABLE

NOT

(A) AVAILABLE

OBSERVED YES NO

ACTIVITY ACTIVITY NOT

1

1

1

ACTIVITY REPORTED

KNOW

EQUIPMENT AND SUPPLIES

DON’T 

OBSERVED NOT SEEN DONE

ROUTINELY 

REPORTED

NOT SEEN

(B) FUNCTIONING

228 • Appendix C
1315 CHECK Q1302.07 & 08 & 09 IUCD OR IMPLANT NEITHER IUCD NOR IMPLANT

PROVIDED IN FACILITY PROVIDED IN FACILITY 1321

ASK TO BE TAKEN TO THE ROOM OR LOCATION WHERE IUCDs AND/OR IMPLANTS ARE INSERTED OR REMOVED

1316 Please show me the following items for the provision of 

IUCD or Implant methods:

01 STERILE GLOVES 1 2 3

02 ANTISEPTIC SOLUTION (E.G., POVIDON IODINE) 1 2 3

03 SPONGE HOLDING FORCEPS 1 2 3

04 STERILE GAUZE PAD OR COTTON WOOL 1 2 3

05* GALLIPOT (FOR ANTISEPTIC SOLUTION) 1 2 3

1317 CHECK Q1302.07 IUCD IUCD NOT 

PROVIDED IN FACILITY PROVIDED IN FACILITY 1319

1318 Please show me the following items for the provision of 

IUCD:

01 CUSCO VAGINAL SPECULUM - SMALL 1 2 3

02 CUSCO VAGINAL SPECULUM - MEDIUM 1 2 3

03 CUSCO VAGINAL SPECULUM - LARGE 1 2 3

04 TENACULM (VOLSELLUM FORCEPS) 1 2 3

05 UTERINE SOUND 1 2 3

06* STRAIGHT ARTERY FORCEPS 1 2 3

07* STRAIGHT CUTTING SCISSORS 1 2 3

08* HIGH STOOL FOR SITTING 1 2 3

09* 0.5% CHLORINE SOLUTION IN RED BUCKET WITH LID 1 2 3

10* BLUE BUCKET (FOR WASTE DISPOSAL) 1 2 3

11* IUCD IN STERILE PACKAGING 1 2 3

12* KELLY FORCEPS 1 2 3

1319 CHECK Q1302.08 & 09. IMPLANT IMPLANT NOT 

PROVIDED IN FACILITY PROVIDED IN FACILITY 1321

1320 Please show me the following items for the provision of 

Implant:

01 LOCAL ANESTHETIC (E.G., 1% LIDOKAINE) 1 2 3

02 STERILE SYRINGE AND NEEDLE 1 2 3

03 CANULA AND TROCHAR FOR INSERTING IMPLANT 1 2 3

04 SEALED IMPLANT PACK 1 2 3

05 SCAPEL WITH BLADE (SURGICAL BLADE WITH HANDLE) 1 2 3

07* ARM REST / SIDE TABLE 1 2 3

08* MARKER PEN 1 2 3

09* SURGICAL DRAPE 1 2 3

10* NORMAL BANDAGE OR BUTTERFLY BANDAGE 1 2 3

11* BAND AID 1 2 3

12* ELASTOMETRIC MATTRESS DRESSING 1 2 3

NOT SEEN AVAILABLE

OBSERVED

AVAILABLE

REPORTED NOT

REPORTED

NOT SEEN AVAILABLE

OBSERVED NOT

OBSERVED

REPORTED NOT

NOT SEEN

Appendix C • 229
1321 Where are equipment such as specula or forceps that are FP SERVICE SITE. . . . . . . . . . . . . . . . . 1

used in the provision of family planning services processed CENTRAL LOCATION IN FACILITY. . . . . 2 1350

for re-use? BOTH LOCATIONS. . . . . . . . . . . . . . . . . 3

NO EQUIPMENT PROCESSED 

IN FACILITY. . . . . . . . . . . . . . . . . . . . 4 1350

1322 What is the final processing method used for family AUTOCLAVE. . . . . . . . . . . . . . . . . . . . . . . . . . A

planning equipment at this service site? DRY HEAT STERILIZATION. . . . . . . . . . . . . . . B

SOAK IN CHLORINE SOLUTION. . . . . . . . . C

PROBE FOR ALL METHODS USED BOIL OR STEAM. . . . . . . . . . . . . . . . . . . . . . . D

WASH WITH SOAP AND WATER. . . . . . . . . . E

SOAK IN OTHER CHEMICAL SOLUTION. . . . F

230 • Appendix C
1350 ASSESS THE ROOM OR AREA FOR THE ITEMS LISTED GENERAL INFORMATION [Q710]. . . . . . . . . . 11

BELOW. FOR ITEMS THAT YOU DO NOT SEE, CHILD VACCINATION [Q1051]. . . . . . . . . . . . . 12

ASK YOUR RESPONDENT TO SHOW THEM TO YOU. CHILD CURATIVE CARE [Q1251] . . . . . . . . . . 13

ANTENATAL CARE [Q1451]. . . . . . . . . . . . . . . 15

DELIVERY [Q1651]. . . . . . . . . . . . . . . . . . . . . . 17

IF THE SAME ROOM OR AREA HAS ALREADY BEEN TUBERCULOSIS [Q1951]. . . . . . . . . . . . . . . . . 19

ASSESSED, INDICATE WHERE THE DATA ARE RECORDED NCD [Q2351]. . . . . . . . . . . . . . . . . . . . . . . . . . . 22 1353

NOT PREVIOUSLY SEEN. . . . . . . . . . . . . . . . 31

1351 STANDARD PRECAUTIONS AND CONDITIONS FOR REPORTED, NOT

CLIENT EXAMINATION NOT SEEN AVAILABLE

01 RUNNING WATER (PIPED, BUCKET WITH TAP OR POUR PITCHER) 1 2 3

02 HAND-WASHING SOAP (MAY BE LIQUID SOAP) 1 2 3

03 ALCOHOL-BASED HAND RUB 1 2 3

04 WASTE RECEPTACLE (PEDAL BIN) WITH LID AND PLASTIC BIN LINER 1 2 3

06

05 OTHER WASTE RECEPTACLE 1 2 3

06 SHARPS CONTAINER ("SAFETY BOX") 1 2 3

07 DISPOSABLE LATEX/OTHER GLOVES 1 2 3

08 DISINFECTANT/ANTISEPTICS [E.G., CHLORINE, HIBITANE, ALCOHOL] 1 2 3

09 SINGLE USE STANDARD DISPOSABLE SYRINGES WITH NEEDLES 1 2 3

OR AUTO-DISABLE SYRINGES WITH NEEDLES

10 MEDICAL MASKS 12 3

11 GOWNS 12 3

12 EYE PROTECTION [GOGGLES OR FACE PROTECTION] 1 2 3

13 GUIDELINES FOR STANDARD PRECAUTIONS 1 2 3

1352 DESCRIBE THE SETTING OF THE FP SERVICE PRIVATE ROOM. . . . . . . . . . . . . . . . . . . . . . . . . 1

ROOM OR AREA. OTHER ROOM WITH 

AUDITORY AND VISUAL PRIVACY. . . . . . 2

VISUAL PRIVACY ONLY. . . . . . . . . . . . . . . . . . . 3

NO PRIVACY. . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

1353 CHECK Q212 FP COMMODITIES STORED IN FP

FP COMMODITIES STORED IN OTHER LOCATION SERVICE AREA (RESPONSE 1 CIRCLED) 921

OR NOT STOCKED (RESPONSE 1 NOT CIRCLED)

OBSERVED

STANDARD PRECAUTIONS

Appendix C • 231
1353A CHECK Q1302.12 VASECTOMY VASECTOMY NOT

PROVIDED IN FACILITY PROVIDED IN FACILITY 1353F

1353B

ASSESS THE ROOM OR AREA FOR THE ITEMS LISTED ROOM / AREA ASSESSED IN Q1353H . . . . . . 11 1353D

BELOW. FOR ITEMS THAT YOU DO NOT SEE, ROOM / AREA NOT PREVIOUSLY ASSESSED31

ASK YOUR RESPONDENT TO SHOW THEM TO YOU.

 

1353C

DON’T 

KNOW

01* OPERATING THEATRE TABLE 1 b 2 b 3 1 2 8

02* OPERATING THEATRE LIGHT 1 b 2 b 3 1 2 8

03* INSTRUMENT TROLLEY 1 b 2 b 3 1 2 8

04* STERILIZER DRUM 1 b 2 b 3 1 2 8

05* BIG CURVE SCISSORS FOR 1 b 2 b 3 1 2 8

CUTTING GAUZE OR BANDAGE

06* SCISSORS FOR CUTTING 1 b 2 b 3 1 2 8

CLOTH

07* DIGITAL BP APPARATUS 1 b 2 b 3 1 2 8

09* MANUAL BP APPARATUS 1 b 2 b 3 1 2 8

10* STETHOSCOPE 1 b 2 b 3 1 2 8

11* WEIGHING SCALE (ADULT) 1 b 2 b 3 1 2 8

12* GALLIPOT OR CUP FOR 1 2 3

ANTISEPTIC SOLUTION

13* KIDNEY TRAY 1 2 3

14* INSTRUMENT FOR PV 1 2 3

EXAMINATION

15* LIFTER AND LIFTER JAR 1 2 3

16* DRESSING JAR WITH LID/COVER 1 2 3

17* SALINE STAND 1 2 3

18* TALQUEST BOOK 1 2 3

19* IRON COT 1 2 3

20* THERMOMETER 1 b 2 b 3 1 2 8

21* GOWN FOR CLIENTS 1 2 3

IF THE SAME ROOM OR AREA HAS ALREADY BEEN ASSESSED, 

INDICATE WHERE THE DATA ARE RECORDED. IF NOT 

PREVIOUSLY ASSESSED, CIRCLE "31" AND ASSESS THIS 

SERVICE SITE

(A) AVAILABLE (B) FUNCTIONING

OBSERVED REPORTED NOT YES NO

VASECTOMY AND TUBAL LIGATION (TUBECTOMY)

ASK TO BE SHOWN THE LOCATION IN THE FACILITY WHERE VASECTOMY SERVICES ARE PROVIDED. 

FIND THE PERSON MOST KNOWLEDGEABLE ABOUT VASECTOMY SERVICES IN THE FACILITY.

INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS.

I would like to know if the following items are available in this service area today. For some of the items, I would like to know if they are 

functioninng. If any of the items are maintained elsewhere in the facility, please tell me where in the facility they are kept.

NOT SEEN AVAILABLE

232 • Appendix C
22* GOWN FOR PROVIDER 1 2 3

23* TROLLEY SHEET 1 2 3

24* DRAW SHEET 1 2 3

25* CAP 1 2 3

26* MASK 1 2 3

27* GLOVES COVER 1 2 3

28* BED SHEET 1 2 3

29* BLANKET 1 2 3

30* MATTRESS 1 2 3

31* PILLOW WITH COVER 1 2 3

32* MOSQUITO NET 1 2 3

33* CURTAIN 1 2 3

34* COTTON 1 2 3

35* SURGICAL GAUZE 1 2 3

36* POVIDON IODINE SOLUTION 1 2 3

37* SURGICAL GLOVES (SIZE 6.5) 1 2 3

38* SURGICAL GLOVES (SIZE 7) 1 2 3

39* DISPOSABLE STERILE 1 2 3

SYRINGE (5 ML)

40* DISPOSABLE STERILE 1 2 3

SYRINGE (10 ML)

41* URISTICK GP 1 2 3

(FOR GLUCOSE/ALBUMIN TEST)

42* ELASTOMETRIC DRESSING 1 2 3

MATTRESS SIZE 10x5 CM

43* DISPOSABLE STERILE LANCET 1 2 3

44* SILK THREAD 1 2 3

KNOW

REPORTED NOT YES NO DON’T 

(A) AVAILABLE (B) FUNCTIONING

OBSERVED

NOT SEEN AVAILABLE

Appendix C • 233
1353D

DON’T 

KNOW

1* NON-SURGICAL VASECTOMY 1 2 3

KIT

2* RING FORCEPS*** 1 b 2 b 3 1 2 8

3* VAS DISECTING FORCEPS*** 1 b 2 b 3 1 2 8

4* SMALL SURGICAL SCISSORS*** 1 b 2 b 3 1 2 8

5* CONDOM 1 2 3

1353E Please tell me if any of the following medicines 

are available at this services site today. 

I would like to see them.

CHECK TO SEE IF AT LEAST ONE IS VALID 

(NOT EXPIRED)

01* INJECTION XYLOCAINE 1% 1 2 3

02* ANTIBIOTIC (CIPROFLOXACIN OR AZITHROMYCIN) 1 2 3

03* PARACETAMOL TABLETS 1 2 3

04* VITAMIN B-COMPLEX TABLETS 1 2 3

AVAILABLE AVAILABLE AVAILABLE NEVER 

4 5

4

AT LEAST 

(A) OBSERVED

Do you have any of the following 

items available at this service 

site today? If available I will like 

to see them. For some of the 

items I will like to know if they 

are functioning.

OBSERVED REPORTED NOT

5

4 5

4 5

(B) NOT OBSERVED

AVAILABLE

REPORTED NOT NO, OR

(A) AVAILABLE (B) FUNCTIONING

ONE VALID NONE VALID NOT SEEN TODAY/DK AVAILABLE

YES NO

NOT SEEN AVAILABLE

234 • Appendix C
1353F CHECK Q1302.13 TUBAL LIGATION (TUBECTOMY) TUBAL LIGATION (TUBECTOMY)

PROVIDED IN FACILITY NOT PROVIDED IN FACILITY 1400

1353G

ASSESS THE ROOM OR AREA FOR THE ITEMS LISTED ROOM / AREA ASSESSED IN Q1353C. . . . . . 11 1353I

BELOW. FOR ITEMS THAT YOU DO NOT SEE, ROOM / AREA NOT PREVIOUSLY ASSESSED31

ASK YOUR RESPONDENT TO SHOW THEM TO YOU.

 

1353H

DON’T 

KNOW

01* OPERATING THEATRE TABLE 1 b 2 b 3 1 2 8

02* OPERATING THEATRE LIGHT 1 b 2 b 3 1 2 8

03* INSTRUMENT TROLLEY 1 b 2 b 3 1 2 8

04* STERILIZER DRUM 1 b 2 b 3 1 2 8

05* BIG CURVE SCISSORS FOR 1 b 2 b 3 1 2 8

CUTTING GAUZE OR BANDAGE

06* SCISSORS FOR CUTTING 1 b 2 b 3 1 2 8

CLOTH

07* DIGITAL BP APPARATUS 1 b 2 b 3 1 2 8

09* MANUAL BP APPARATUS 1 b 2 b 3 1 2 8

10* STETHOSCOPE 1 b 2 b 3 1 2 8

11* WEIGHING SCALE (ADULT) 1 b 2 b 3 1 2 8

12* GALLIPOT OR CUP FOR 1 2 3

ANTISEPTIC SOLUTION

13* KIDNEY TRAY 1 2 3

14* INSTRUMENT FOR PV 1 2 3

EXAMINATION

15* LIFTER AND LIFTER JAR 1 2 3

16* DRESSING JAR WITH LID/COVER 1 2 3

17* SALINE STAND 1 2 3

18* TALQUEST BOOK 1 2 3

19* IRON COT 1 2 3

20* THERMOMETER 1 b 2 b 3 1 2 8

21* GOWN FOR CLIENTS 1 2 3

I would like to know if the following items are available in this service area today. For some of the items, I would like to know if they are 

functioninng. If any of the items are maintained elsewhere in the facility, please tell me where in the facility they are kept.

IF THE SAME ROOM OR AREA HAS ALREADY BEEN ASSESSED, 

INDICATE WHERE THE DATA ARE RECORDED. IF NOT 

PREVIOUSLY ASSESSED, CIRCLE "31" AND ASSESS THIS 

SERVICE SITE

(A) AVAILABLE (B) FUNCTIONING

OBSERVED REPORTED NOT YES NO

ASK TO BE SHOWN THE LOCATION IN THE FACILITY WHERE TUBECTOMY / TUBAL LIGATION SERVICES ARE PROVIDED. 

FIND THE PERSON MOST KNOWLEDGEABLE ABOUT TUBECTOMY / TUBAL LIGATION SERVICES IN THE FACILITY.

INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS.

NOT SEEN AVAILABLE

Appendix C • 235
DON’T 

KNOW

22* GOWN FOR PROVIDER 1 2 3

23* TROLLEY SHEET 1 2 3

24* DRAW SHEET 1 2 3

25* CAP 1 2 3

26* MASK 1 2 3

27* GLOVES COVER 1 2 3

28* BED SHEET 1 2 3

29* BLANKET 1 2 3

30* MATTRESS 1 2 3

31* PILLOW WITH COVER 1 2 3

32* MOSQUITO NET 1 2 3

33* CURTAIN 1 2 3

34* COTTON 1 2 3

35* SURGICAL GAUZE 1 2 3

36* POVIDON IODINE SOLUTION 1 2 3

37* SURGICAL GLOVES (SIZE 6.5) 1 2 3

38* SURGICAL GLOVES (SIZE 7) 1 2 3

39* DISPOSABLE STERILE 1 2 3

SYRINGE (5 ML)

40* DISPOSABLE STERILE 1 2 3

SYRINGE (10 ML)

41* URISTICK GP 1 2 3

(FOR GLUCOSE/ALBUMIN TEST)

42* ELASTOMETRIC DRESSING 1 2 3

MATTRESS SIZE 10

43* DISPOSABLE STERILE LANCET 1 2 3

44* SILK THREAD 1 2 3

NOT SEEN AVAILABLE

(A) AVAILABLE (B) FUNCTIONING

OBSERVED REPORTED NOT YES NO

236 • Appendix C
1353I

DON’T 

KNOW

01* TUBECTOMY KIT 1 2 3

02* BP HANDLE*** 1 b 2 b 3 1 2 8

03* NEEDLE HOLDER*** 1 b 2 b 3 1 2 8

04* BABOCK TISSUE FORCEP*** 1 b 2 b 3 1 2 8

05* LONG STRAIGHT ARTERY 1 b 2 b 3 1 2 8

FORCEP (MEDIUM)***

06* CURVED MOSQUITO 1 b 2 b 3 1 2 8

ARTERY FORCEP***

07* ALICE TISSUE FORCEP*** 1 b 2 b 3 1 2 8

08* PLAIN DISECTING FORCEP*** 1 b 2 b 3 1 2 8

09* TOOTH DISECTING FORCEP*** 1 b 2 b 3 1 2 8

10* MAYO SCISSORS*** 1 b 2 b 3 1 2 8

11* SPONGE HOLDING FORCEP*** 1 b 2 b 3 1 2 8

12* RETRACTOR*** 1 b 2 b 3 1 2 8

13* STERILE CHROMIC CATGUT/PJA 1 2 3

14* 1 2 3

15* CUTTING CURVED NEEDLE 1 2 3

16* CUTTING STRAIGHT NEEDLE 1 2 3

17* 1 2 3

1353J Please tell me if any of the following medicines 

are available at this services site today. 

I would like to see them.

CHECK TO SEE IF AT LEAST ONE IS VALID 

(NOT EXPIRED)

01* INJECTION ATROPINE SULPHATE (0.6MG/ML) 1 2 3

02* INJECTION PROMETHAZINE (12.5MG/ML) 1 2 3

03* INJECTION PETHIDINE (25MG/ML) 1 2 3

04* INJECTION PENTAJOSIN (30MG/ML) 1 2 3

05* INJECTION XYLOCAINE (1%) 1 2 3

06* DIAZEPAM TABLETS (5MG) 1 2 3

07* ANTIBIOTIC (CIPROFLOXACIN OR AZITHROMYCIN) 1 2 3

08* PARACETAMOL TABLETS 1 2 3 4 5

09* IRON + FOLIC ACID TABLETS 1 2 3

THANK YOUR RESPONDENT AND MOVE TO YOUR NEXT DATA COLLECTION POINT IF DIFFERENT FROM 

CURRENT LOCATION.

4 5

4 5

NO, OR

AT LEAST AVAILABLE AVAILABLE AVAILABLE NEVER 

ONE VALID NONE VALID NOT SEEN TODAY/DK AVAILABLE

REPORTED NOT

4 5

4 5

4 5

4 5

4 5

4 5

Do you have any of the following (A) AVAILABLE (B) FUNCTIONING

items available at this service 

site today? If available I will like 

to see them. For some of the 

items I will like to know if they 

are functioning.

OBSERVED REPORTED NOT YES NO

NOT SEEN AVAILABLE

CURVED ROUND BODY 

NEEDLE

(A) OBSERVED (B) NOT OBSERVED

AVAILABLE

STERILE SURGICAL BLADE 

SIZE 10

Appendix C • 237
1400 CHECK Q.102.05 ANC SERVICES NOT

ANC SERVICES AVAILABLE IN FACILITY

AVAILABLE IN FACILITY

NEXT SECTION OR SERVICE SITE

1401 How many days in a month are antenatal care services

offered at this facility? NUMBER OF DAYS/MONTH

USE A 4-WEEK MONTH TO CALCULATE # OF DAYS

1402 Do this facility provide any of the following services to pregnant women as 

part of routine ANC?

01 IRON SUPPLEMENTATION

02 FOLIC ACID SUPPLEMENTATION

02a* COMBINED IRON AND FOLIC ACID SUPPLEMENTATION

05* PROVIDE MISOPROSTOL TABLET/CAPSULE FOR HOME-BASED DELIVERIES

1406 Do ANC providers in this facility provide any of the 

following tests from this site to pregnant women as 

part of ANC?

IF YES, ASK TO SEE THE TEST KIT OR EQUIPMENT.

IF TEST NOT DONE IN ANC, PROBE TO DETERMINE

IF THE TEST IS DONE ELSEWHERE IN THE FACILITY 

CHECK TO SEE IF AT LEAST ONE TEST KIT OF EACH

TEST IS VALID/UNEXPIRED 

02 URINE PROTEIN TEST 1 2 3

03 URINE GLUCOSE TEST 1 2 3

04 ANY RAPID TEST FOR HEMOGLOBIN 1 2 3

05 SYPHILIS RAPID DIAGNOSTIC TEST 1 2 3

06* VDRL test for syphilis 1 2 3

1 2

45 6

(B) NOT OBSERVED

5

6

NO

2

SECTION 14: ANTENATAL CARE

1

2

YES

ASK TO BE SHOWN THE LOCATION IN THE FACILITY WHERE ANTENATAL CARE SERVICES ARE PROVIDED.

1

INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS.

FIND THE PERSON MOST KNOWLEDGEABLE ABOUT ANTENATAL CARE SERVICES IN THE FACILITY.

AT LEAST 

ONE 

VALID

(A) OBSERVED

AVAILABLE

6

45 6

4 5

6

4

4 5

2

AVAILABLE 

ELSEWHERE 

IN FACILITY

NO, OR 

NEVER 

AVAILABLE

NONE 

AVAILABLE 

TODAY

REPORETED 

AVAILABLE 

NOT SEEN

AVAILABL

E NONE 

VALID

1

238 • Appendix C
1408 Do ANC providers in this facility routinely diagnose and ROUTINELY DIAGNOSE AND TREAT RTIs/STIs. . . . . . . . 1

treat RTIs / STIs, or are RTI/STI clients referred to another provider DIAGNOSE BUT REFER ELSEWHERE FOR TREATMENT2

or location for diagnosis and treatment? REFER ELSEWHERE IN FACILITY FOR DIAG & TREATM3

REFER OUTSIDE FACILITY FOR DIAG & TREATMENT. . 4

NO DIAGNOSIS / TREATMENT / REFERRAL. . . . . . . . . . . 5

1409 Do you have theANC guideline/protocol/manual available YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

in this service area today? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1411

1410 May I see the ANC guideline/protocol/manual? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1415

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . . 2

ACCEPTABLE IF PART OF OTHER GUIDELINES

1411 Do you have any other ANC guideline/protocol/manual available YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

in this service area today? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1415

1412 May I see the other guideline/protocol/manual? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . . 2

1415 Do you have visual aids for client education YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

on subjects related to pregnancy or antenatal care NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1417

available in this service area today?

1416 May I see the visual aids for client education? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . 2

1417 Are individual client cards or records for ANC YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

clients maintained at this service site? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1419

1418 May I see a blank copy of the client records or cards? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . 2

1419 Does this facility have a system whereby YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

observation or parameters for ANC clients NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1421

are routinely carried out before the consultation?

IF YES, ASK TO SEE THE PLACE WHERE THESE 

ACTIVITIES TAKE PLACE.

Appendix C • 239
1420 OBSERVE IF THE BELOW ACTIVITIES ARE BEING DONE

ROUTINELY. IF YOU DO NOT SEE AN ACTIVITY, ASK: 

Is [ACTIVITY YOU DO NOT SEE] routinely done for all 

antenatal care clients? 

01 Weighing of clients 2 38

02 Taking blood pressure 2 38

03 Conducting group/individual health education sessions 2 3 8

04 Urine test for protein 2 38

05 Blood test for anemia (hemoglobin) 2 3 8

08 Measuring client's height 2 38

09* Ultrasonography 2 38

10* Urine test for glucose 2 38

11* Blood test for glucose 2 38

12* HBsAg 2 38

1421 I would like to know if the 

following items are available 

in this service area and are DON’T 

functioning. KNOW

01 DIGITAL BP APPARATUS 1 b 2 b 3 1 2 8

02

02 MANUAL BP APPARATUS 1 b 2 b 3 1 2 8

03

03 STETHOSCOPE 1 b 2 b 3 1 2 8

04

04 EXAMINATION LIGHT 1 b 2 b 3 1 2 8

(FLASHLIGHT OK) 05

05 FETAL STETHOSCOPE/PINNARD 1 b 2 b 3 1 2 8

06

06 ADULT WEIGHING SCALE 1 b 2 b 3 1 2 8

07

07 EXAMINATION BED OR COUCH 1 2 3

08 TAPE MEASURE FOR FUNDAL HEIGHT 1 2 3

1422 Please tell me if any of the following medicines 

are available at this services site today. 

I would like to see them.

CHECK TO SEE IF AT LEAST ONE IS VALID 

(NOT EXPIRED)

01 IRON TABLETS (INDIVIDUAL TABLETS) 1 2 3 4 5

02 FOLIC ACID TABLETS (INDIVIDUAL TABLETS) 1 2 3 4 5

03 COMBINED IRON AND FOLIC ACID TABLETS 1 2 3 4 5

07* MISOPROSTOL TABLET 1 2 3 4 5

1

1

1

DON’T 

(A) OBSERVED

EQUIPMENT AND SUPPLIES FOR ROUTINE ANC

1

1

1

ONE VALID NONE VALID

OBSERVED NOT SEEN KNOW

YES NO

NO, OR

NOT SEEN

NOT

(B) FUNCTIONING

OBSERVED REPORTED

(B) NOT OBSERVED

AVAILABLE

AVAILABLE AVAILABLE

ACTIVITY

ACTIVITY 

REPORTED

1

ACTIVITY NOT

ROUTINELY 

NOT SEEN

NOT

1

1

(A) AVAILABLE

AVAILABLE

REPORTED

AVAILABLE NEVER 

TODAY/DK

1

DONE

AT LEAST 

AVAILABLE

240 • Appendix C
1450 ASSESS THE ROOM OR AREA FOR THE ITEMS LISTED GENERAL INFORMATION [Q710]. . . . . . . . . . 11

BELOW. FOR ITEMS THAT YOU DO NOT SEE, CHILD VACCINATION [Q1051]. . . . . . . . . . . . . 12

ASK YOUR RESPONDENT TO SHOW THEM TO YOU. CHILD CURATIVE CARE [Q1251] . . . . . . . . . . 13

FAMILY PLANNING [Q1351]. . . . . . . . . . . . . . . 14

DELIVERY [Q1651]. . . . . . . . . . . . . . . . . . . . . . 17

IF THE SAME ROOM OR AREA HAS ALREADY BEEN TUBERCULOSIS [Q1951]. . . . . . . . . . . . . . . . . 19

ASSESSED, INDICATE WHERE THE DATA ARE RECORDED NCD [Q2351]. . . . . . . . . . . . . . . . . . . . . . . . . . . 22

NOT PREVIOUSLY SEEN. . . . . . . . . . . . . 31

1451 STANDARD PRECAUTIONS AND CONDITIONS FOR REPORTED, NOT

CLIENT EXAMINATION NOT SEEN AVAILABLE

01 RUNNING WATER (PIPED, BUCKET WITH TAP OR POUR PITCHER) 1 2 3

02 HAND-WASHING SOAP (MAY BE LIQUID SOAP) 1 2 3

03 ALCOHOL-BASED HAND RUB 1 2 3

04 WASTE RECEPTACLE (PEDAL BIN) WITH LID AND PLASTIC BIN LINER 1 2 3

06

05 OTHER WASTE RECEPTACLE 1 2 3

06 SHARPS CONTAINER ("SAFETY BOX") 1 2 3

07 DISPOSABLE LATEX/OTHER GLOVES 1 2 3

08 DISINFECTANT/ANTISEPTICS [E.G., CHLORINE, HIBITANE, ALCOHOL] 1 2 3

09 SINGLE-USE STANDARD DISPOSABLE SYRINGES WITH NEEDLES OR 1 2 3

AUTO-DISABLE SYRINGES WITH NEEDLES

10 MEDICAL MASKS 12 3

11 GOWNS 12 3

12 EYE PROTECTION [GOGGLES OR FACE PROTECTION] 1 2 3

13 GUIDELINES FOR STANDARD PRECAUTIONS 1 2 3

1452 DESCRIBE THE SETTING OF THE ANC SERVICE PRIVATE ROOM. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

ROOM OR AREA. OTHER ROOM WITH 

AUDITORY AND VISUAL PRIVACY. . . . . . . . . . . . 2

VISUAL PRIVACY ONLY. . . . . . . . . . . . . . . . . . . . . . 3

NO PRIVACY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

1453* CHECK Q102.20 PNC SERVICE PNC SERVICE

PROVIDED NOT PROVIDED 1600

1454* Is there a dedicated room/area for postnatal care (PNC) examination? YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . . . . . 2 1456

1455* DESCRIBE THE SETTING OF THE PNC SERVICE PRIVATE ROOM. . . . . . . . . . . . . . . . . . . . . . . . . 1

ROOM OR AREA. OTHER ROOM WITH 

AUDITORY AND VISUAL PRIVACY. . . . . . 2

VISUAL PRIVACY ONLY. . . . . . . . . . . . . . . . . . . 3

NO PRIVACY. . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

1456* How many days each week are PNC srvice

available at this facility? DAYS PER WEEK. . . . . . . . . . . . . . . . . .

LESS OFTEN THAN ONCE/WEEK. . . . . . . 0

1457* Do you have the PNC guideline/protocol/manual available YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

in this service area today? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1459

1458* May I see the PNC guideline/protocol/manual? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1600

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . . 2

ACCEPTABLE IF PART OF OTHER GUIDELINES

1459* Do you have any other PNC guideline/protocol/manual YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

available in this service area today? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1461

1460* May I see the other guideline/protocol/manual ? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . . 2

1461* Do you have the postpartum family planning YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

guideline/protocol/manual available in this service area today? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1600

1462* May I see the postpartum family planning guideline/protocol/manual? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . . 2

THANK YOUR RESPONDENT AND MOVE TO YOUR NEXT DATA COLLECTION POINT IF DIFFERENT FROM 

CURRENT LOCATION.

NEXT SECTION / SERVICE S

STANDARD PRECAUTIONS

OBSERVED

POSTNATAL CARE SERVICES

Appendix C • 241
1600 CHECK Q102.07 NORMAL DELIVERY

NORMAL DELIVERY NOT AVAILABLE

AVAILABLE

NEXT SECTION OR SERVICE SITE

1601 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1604

1602 Is there a duty schedule or call list for YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

24-hr staff assignment? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1604

1603 May I see the duty schedule or call list for 24-HR staff OBSERVED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

assignment? REPORTED, NOT SEEN. . . . . . . . . . . . . . . . . . . . . .2

1604 Please tell me if any of the following (B) PROVIDED IN PAST 3 MONTHS

interventions have ever been carried out by 

providers as part of their work in 

this facility, and if so, whether the 

intervention has been carried out at least

once during the past 3 months.

01 PARENTERAL ADMINISTRATION OF 1 b 2 8 1 2 8

ANTIBIOTICS (IV OR IM) 02 02

02 PARENTERAL ADMINISTRATION OF 1 b 2 8 1 2 8

OXYTOCIC (IV OR IM) 03 03

03 PARENTERAL ADMINISTRATION OF 1 b 2 8 1 2 8

ANTICONVULSANT FOR HYPERTENSIVE 04 04

DISORDERS OF PREGNANCY

/PREVENTION OF ECLAMPSIA (IV OR IM)

04 ASSISTED VAGINAL DELIVERY 1 b 2 8 1 2 8

05 05

05 MANUAL REMOVAL OF PLACENTA 1 b 2 8 1 2 8

06 06

06 REMOVAL OF RETAINED PRODUCTS 1 b 2 8 1 2 8

OF CONCEPTAION 07 07

07 NEONATAL RESUSCITATION 1 b 2 8 1 2 8

08 08

08 CORTICOSTEROIDS FOR PRE-TERM LABOR 1 b 2 8 1 2 8

NOTE: THIS IS NOT A SIGNAL FUNCTION 1605 1605

1605 Do you have the national guideline/protocol/manual for BEmONC YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

available in this service site? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1607

1606 May I see the guideline/protocol/manual for BEmONC ? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . 2

1607 Do you have the national guideline/protocol/manual for CEmOC? YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1609

ACCEPTABLE IF PART OF ANOTHER GUIDELINE.

1608 May I see the national guideline/protocol/manual for CEmOC? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . 2

NO

SIGNAL FUNCTIONS

DK NO DK

SECTION 16: DELIVERY AND NEWBORN CARE

YES

Is a person skilled in conducting deliveries present at the facility 

today or on call at all times (24 hours a day), including weekends, 

to provide care? Specifically, I am referring to medical 

specialists, medical officers, nurses, and family welfare visitors 

and midwives.

INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS.

FIND THE PERSON MOST KNOWLEDGEABLE ABOUT DELIVERY SERVICES IN THE FACILITY.

YES

ASK TO BE SHOWN THE LOCATION IN THE FACILITY WHERE NORMAL DELIVERY SERVICES ARE PROVIDED.

(A) EVER PROVIDED IN FACILITY

242 • Appendix C
1609 Do you have guideline/protocol/manual on management of YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

pre-term labor? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

ACCEPTABLE IF PART OF ANOTHER GUIDELINE.

1610 May I see the guideline/protocol/manual on management OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . 1

of pre-term labor? REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . 2

1611 Does this facility practice Kangaroo Mother Care for YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

low birth weight babies? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1613

1612 Is there a separate room or space for Kangaroo Mother YES, SEPARATE ROOM. . . . . . . . . . . . . . . . . 1

Care or is it integrated into the main postnatal ward? YES, INTEGRATED . . . . . . . . . . . . . . . . . . . . . 2

1613 Do providers of delivery services in this facility use partograph YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

to monitor labor and delivery? NO USE OF PARTOGRAPH. . . . . . . . . . . . . . . 2 1615

1614 Are partographs used routinely (for all cases) or selectively (only for ROUTINELY. . . . . . . . . . . . . . . . . . . . . . . . . . . 1

some cases) to monitor labor and delivery in this facility? SELECTIVELY. . . . . . . . . . . . . . . . . . . . . . . . . 2

1615 How many dedicated maternity beds are available in # OF DEDICATED

this facility? MATERNITY BEDS. . . . 

DON'T KNOW . . . . . . . . . . . . . . . . . . . 998

1616 How many dedicated delivery beds are available in # OF DEDICATED

this facility? DELIVERY BEDS. . . . 

DON'T KNOW. .. . . . . . . . . . . . . . . . . . . 998

1617 Does the facility conduct regular reviews of YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

maternal or newborn deaths or “near-misses”? NO, DOES NOT PARTICIPATE. . . . . . . . . . . . 2 1622

1618 Are reviews done for mothers only, FOR MOTHERS ONLY. . . . . . . . . . . . . . . . . 1

newborns only, or for both mothers and newborns? FOR NEWBORNS ONLY. . . . . . . . . . . . . 2 1621

FOR BOTH MOTHERS AND NEWBORNS. . . . 3

1619 How often are reviews of maternal deaths or 

"near misses" carried out? EVERY: WEEKS

ONLY WHEN CASE OCCURS. . . . . . . . . . . . . 53

DON'T KNOW. . . . . . . . . . . . . . . . . . . . . . . . . . 98

1620 CHECK Q1618: 

RESPONSE "3" RESPONSE "3" 

CIRCLED NOT CIRCLED 1622

1621 How often are reviews of newborn deaths 

or "near misses" carried out? EVERY: WEEKS

ONLY WHEN CASE OCCURS. . . . . . . . . . . . . 53

ALWAYS WITH MATERNAL REVIEWS. . . . 95

DON'T KNOW. . . . . . . . . . . . . . . . . . . . . . 98

1611

Appendix C • 243
1622 I would like to know if the 

following items are available 

in this delivery area and are 

functioning. YES NO DON’T

KNOW

01 INCUBATOR 1 b 2 b 3 1 2 8

02 OTHER EXTERNAL HEAT 1 b 2 b 3 1 2 8

SOURCE

03 EXAMINATION LIGHT 1 b 2 b 3 1 2 8

(FLASHLIGHT OK)

04 SUCTION APPARATUS 1 b 2 b 3 1 2 8

WITH CATHETER

05 SUCTION BULB 1 b 2 b 3 1 2 8

OR PENGUIN SUCKER

06 MANUAL VACUUM EXTRACTOR 1 b 2 b 3 1 2 8

(FOR VACUUM-ASSISTED DELIVERY)

07 VACUUM ASPIRATION KIT OR 1 b 2 b 3 1 2 8

D&C KIT

08 NEWBORN BAG & MASK 1 b 2 b 3 1 2 8

(AMBU BAG & MASK)

09 THERMOMETER 1 b 2 b 3 1 2 8

10 THERMOMETER FOR 1 b 2 b 3 1 2 8

LOW-BODY TEMPERATURE

11 INFANT SCALE 1 b 2 b 3 1 2 8

12 FETAL STETHOSCOPE 1 b 2 b 3 1 2 8

13 1 b 2 b 3 1 2 8

14 1 b 2 b 3 1 2 8

15 STETHOSCOPE 1 b 2 b 3 1 2 8

1623

1623 Do you have any of the following items? If yes, I would like to see them

01* DELIVERY BED COMPLETE WITH RODS AND STIRRUPS 1 2 3

02 DELIVERY KIT 12 3

03 CORD CLAMP/THREAD 12 3

04 SPECULUM 12 3

05 EPISIOTOMY SCISSORS 12 3

06 SCISSORS OR BLADE TO CUT CORD 1 2 3

07 SUTURE MATERIAL WITH NEEDLE 1 2 3

08 NEEDLE HOLDER 12 3

09 FORCEPS (LARGE) 12 3

10 FORCEPS (MEDIUM) 12 3

11 SPONGE HOLDER 12 3

12 BLANK PARTOGRAPH 12 3

13* STAIRS (FOR CLIMBING ONTO DELIVERY BED) 1 2 3

1623a* Does this facility routinely provide active management YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

of third stage labor (AMTSL)? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

NOT

AVAILABLE

EQUIPMENT AND SUPPLIES FOR ROUTINE DELIVERIES

OBSERVED

NOT SEEN

NOT SEEN

MANUAL BLOOD PRESSURE 

MACHINE

DIGITAL BLOOD PRESSURE 

APPARATUS

(A) AVAILABLE (B) FUNCTIONING

REPORTED NOT 

AVAILABLE

OBSERVED

REPORTED

244 • Appendix C
1624 Does this facility routinely observe any of the following 

postpartum or newborns related practices?

01 Delivery to the abdomen (Skin to Skin) 1 2 8

(placement of baby to mother`s abdomen/chest)

02 Drying newborns to keep them warm 1 2 8

03 Initiation of breastfeeding within the first hour 1 2 8

04 Routine, complete (head-to-toe) examination of newborn 1 2 8

before discharge

06 Suction of the newborn by means of suction bulb or penguin sucker 1 2 8

07 Weigh the newborn immediately 1 2 8

08 Administer Vitamin K to newborn 1 2 8

10 Give full bath (immerse newborn in water) shortly 1 2 8

(i.e., within a few minutes/hours) after birth

11 Give the newborn prelacteal liquids 1 2 8

14* Provide maternal Vitamin A 1 2 8

15* Chlorhexitine 7.1 percent for cord care 1 2 8

1625 Please tell me if any of the following medicines or 

items are available at this service site today. 

I would like to see them.

CHECK TO SEE IF AT LEAST ONE IS VALID (NOT EXPIRED)

02 INJECTABLE ANTIBIOTIC (E.G., CEFTRIAXONE) 1 2 3 4 5

03 INJECTABLE UTEROTONIC (E.G., OXYTOCIN) 1 2 3 4 5

04 MAGNESIUM SULPHATE 1 2 3 4 5

05 INJECTABLE DIAZEPAM 1 2 3 4 5

06 IV SOLUTION (RINGER LACTATE) WITH INFUSION SET 1 2 3 4 5

07 SKIN DISINFECTANT (OTHER THAN CHLORHEXIDINE) 1 2 3 4 5

08* 7.1% CHLORHEXIDINE SOLUTION (UMBILICAL CORD CLEANSING) 1 2 3 4 5

YES NO DON’T KNOW

AVAILABLE

(A) OBSERVED (B) NOT OBSERVED

NEVER 

TODAY/DK

AVAILABLE

NOT

NOT SEEN AVAILABLE

AVAILABLE

REPORTED

ONE VALID

AT LEAST 

NONE VALID

NO, OR

AVAILABLE

Appendix C • 245
1650 ASSESS THE ROOM OR AREA FOR THE ITEMS LISTED GENERAL INFORMATION [Q710]. . . . . . . . . . 11

BELOW. FOR ITEMS THAT YOU DO NOT SEE, CHILD VACCINATION [Q1051] . . . . . . . . . . . . 12

ASK YOUR RESPONDENT TO SHOW THEM TO YOU. CHILD CURATIVE CARE [Q1251]. . . . . . . . . . 13

FAMILY PLANNING [Q1351]. . . . . . . . . . . . . . . 14

IF THE SAME ROOM OR AREA HAS ALREADY BEEN ANTENATAL CARE [Q1451]. . . . . . . . . . . . . . . 15

ASSESSED, INDICATE WHERE THE DATA ARE RECORDED TUBERCULOSIS [Q1951]. . . . . . . . . . . . . . . . . 19

NCD [Q2351]. . . . . . . . . . . . . . . . . . . . . . . . . . . 22

NOT PREVIOUSLY SEEN. . . . . . . . . . . . . 31

1651 STANDARD PRECAUTIONS AND CONDITIONS FOR 

CLIENT EXAMINATION

01 RUNNING WATER (PIPED, BUCKET WITH TAP OR POUR PITCHER) 1 2 3

02 HAND-WASHING SOAP (MAY BE LIQUID SOAP) 1 2 3

03 ALCOHOL-BASED HAND RUB 1 2 3

04 WASTE RECEPTACLE (PEDAL BIN) WITH LID AND PLASTIC BIN LINER 1 2 3

06

05 OTHER WASTE RECEPTACLE 1 2 3

06 SHARPS CONTAINER ("SAFETY BOX") 1 2 3

07 DISPOSABLE LATEX/OTHER GLOVES 1 2 3

08 DISINFECTANT/ANTISEPTICS [E.G., CHLORINE, HIBITANE, ALCOHOL] 1 2 3

09 SINGLE-USE STANDARD DISPOSABLE SYRINGES WITH NEEDLES OR 1 2 3

AUTO-DISABLE SYRINGES WITH NEEDLES

10 MEDICAL MASKS 12 3

11 GOWNS 12 3

12 EYE PROTECTION [GOGGLES OR FACE PROTECTION] 1 2 3

13 GUIDELINES FOR STANDARD PRECAUTIONS 1 2 3

1652 DESCRIBE THE SETTING OF THE DELIVERY SERVICE PRIVATE ROOM. . . . . . . . . . . . . . . . . . . . . . . . 1

ROOM OR AREA. OTHER ROOM WITH 

AUDITORY AND VISUAL PRIVACY. . . . . . . 2

VISUAL PRIVACY ONLY. . . . . . . . . . . . . . . . . 3

NO PRIVACY. . . . . . . . . . . . . . . . . . . . . . . . . . 4

THANK YOUR RESPONDENT AND MOVE TO YOUR NEXT DATA COLLECTION POINT IF DIFFERENT FROM 

CURRENT LOCATION.

NOT SEEN

NOT

AVAILABLE

OBSERVED REPORTED,

NEXT SECTION / SERVICE

STANDARD PRECAUTIONS

246 • Appendix C
1900 CHECK Q102.10 NO TB SERVICES

TB SERVICES IN FACILITY

OFFERED IN FACILITY

NEXT SECTION OR SERVICE SITE

1901 How many days in a month are tuberculosis services

offered at this facility? NUMBER OF DAYS / MONTH

USE A 4-WEEK MONTH TO CALCULATE # OF DAYS

1902 Do providers in this facility make diagnosis that a YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

client has tuberculosis? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1904

1903 What is the most common method used SPUTUM SMEAR ONLY. . . . . . . . . . . . . . . . . . . . . . 1

by providers in this facility for diagnosing TB? X-RAY ONLY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

EITHER SPUTUM OR X-RAY. . . . . . . . . . . . . . . . . . 3

PROBE TO DETERMINE METHOD USED. BOTH SPUTUM AND X-RAY. . . . . . . . . . . . . . . . . . .4

CLINICAL SYMPTOMS ONLY. . . . . . . . . . . . . . . . . . 5

1904 Do providers in this facility ever refer clients outside this YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

facility for TB diagnosis? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1908

1905 Does this facility have an agreement with a YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

referral site for TB test results to be returned NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

to the facility either directly or through the client?

1906 Is there a record/register of clients who are referred YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

for TB diagnosis? REGISTER NOT KEPT. . . . . . . . . . . . . . . . . . . . . . . 2 1908

1907 May I see the records or register of clients referred for TB testing? REGISTER SEEN (PAPER) . . . . . . . . . . . . . . . . . . . 1

REGISTER SEEN (ELECTRONIC). . . . . . . . . . . . . 2

CHECK THE RECORDS TO SEE TB DIAGNOSIS RESULTS ARE REGISTER REPORTED, NOT SEEN. . . . . . . . . . . . 3

RECORDED

1908 Do providers in this facility prescribe treatment for YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

TB or manage patients who are on TB treatment? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1910

1909 2M INTENSIVE PHASE, 4M CONTINUATION PHASE. . . . 1

6M INTENSIVE PHASE. . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

FOLLOW UP CLIENTS ONLY AFTER FIRST

2M INTENSIVE PHASE ELSEWHERE. . . . . . . . . . . . . 3

PROBE TO ARRIVE AT CORRECT RESPONSE DIAGNOSE AND TREAT WHILE INPATIENT

DISCHARGE ELSEWHERE FOR F/UP. . . . . . . . . . . . . 4

PROVIDE FULL TREATMENT, WITH NO

ROUTINE DIRECT OBSERVATION PHASE. . . . . . . . . 5

DIAGNOSE, PRESCRIBE/PROVIDE MEDICINES

ONLY, NO F/UP. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

DIAGNOSE ONLY, NO TREATMENT

OR PRESCRIPTION OF MEDICINE. . . . . . . . . . . . . . . 7

1910 CHECK Q1902 AND Q1908 NO TB DIAGNOSIS

OR TREATMENT IN FACILITY

TB DIAGNOSIS OR

TREATMENT IN FACILITY NEXT SECTION OR SERVICE SITE

1911 Does this facility have a system for testing YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

TB patients for HIV infection? NO SYSTEM. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1913

1912 May I see the system, or evidence of such a system? SYSTEM OR REGISTER OBSERVED. . . . . . . . . . . . . . . . . 1

SYSTEM OR REGISTER REPORTED, NOT SEEN. . . . . . 2

THE SYSTEM MAY BE IN THE FORM OF A REGISTER

SECTION 19: TUBERCULOSIS

ASK TO BE SHOWN THE LOCATION IN THE FACILITY WHERE TB SERVICES ARE PROVIDED.

FIND THE PERSON MOST KNOWLEDGEABLE ABOUT PROVISION OF TB SERVICES IN THE FACILITY.

INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS.

TB DIAGNOSIS

TB TREATMENT

What treatment regimen or approach is followed by providers 

in this facility for newly diagnosed TB ? i.e., for new patients, 

not for retreatment?

Appendix C • 247
1913 Is HIV rapid diagnostic testing available from this YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

service site? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1915

1914 May I see a sample HIV rapid diagnostic test (RDT) kit? OBSERVED, AT LEAST 1 VALID. . . . . . . . . . . . . . . . . . . . . 1

OBSERVED, NONE VALID. . . . . . . . . . . . . . . . . . . . . . . . . .2

CHECK TO SEE IF AT LEAST ONE IS VALID REPORTED AVAILABLE, NOT SEEN. . . . . . . . . . . . . . . . . 3

NOT AVAILABLE TODAY. . . . . . . . . . . . . . . . . . . . . . . . . . . 4

1915 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1917

1916 OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED, NOT SEEN. . . . . . . . . . . . . . . . . . . . . . . . . . . 2

1917 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1919

THIS MAY BE PART OF OTHER GUIDELINE

1918 May I see the guideline/protocol/manual for the management of OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

HIV and TB co-infection? REPORTED, NOT SEEN. . . . . . . . . . . . . . . . . . . . . . . . . . . 2

1919 Do you have any guideline/protocol/manual related to MDR-TB YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

treatment available in this service area? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1921

THIS MAY BE PART OF OTHER GUIDELINE

1920 May I see the guideline/protocol/manual on treatment of MDR-TB? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED, NOT SEEN. . . . . . . . . . . . . . . . . . . . . . . . . . . 2

1921 CHECK Q1903 RESPONSES 1, 3 OR 4 RESPONSES 1, 3 OR 4

CIRCLED NOT CIRCLED 1950

1922 Do you maintain any sputum containers at this service site YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

for collecting sputum specimen? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1950

1923 May I see a sputum container? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED, NOT SEEN. . . . . . . . . . . . . . . . . . . . . . . . . . . 2

NOT AVAILABLE TODAY. . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Do you have the national guideline/protocol/manual for the 

diagnosis and treatment of TB available in this service area? 

May I see the national guideline/protocol/manual?

Do you have any guideline/protocol/manual for the management 

of HIV and TB co-infection available in this service area? 

248 • Appendix C
1950 ASSESS THE TB ROOM OR AREA FOR THE ITEMS . GENERAL INFORMATION [Q710]. . . . . . . . . . . . . . . . . . . . 11

LISTED BELOW. CHILD VACCINATION [Q1051] . . . . . . . . . . . . . . . . . . . . . . 12

FOR ITEMS THAT YOU DO NOT SEE, ASK YOUR CHILD CURATIVE CARE [Q1251]. . . . . . . . . . . . . . . . . . . . 13

RESPONDENT TO SHOW THEM TO YOU. FAMILY PLANNING [Q1351]. . . . . . . . . . . . . . . . . . . . . . . . 14

ANTENATAL CARE [Q1451]. . . . . . . . . . . . . . . . . . . . . . . . 15

IF THE SAME ROOM OR AREA HAS ALREADY BEEN DELIVERY SERVICES [Q1651]. . . . . . . . . . . . . . . . . . . . . . 17

ASSESSED, INDICATE WHERE THE DATA ARE NCD [Q2351]. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

RECORDED NOT PREVIOUSLY SEEN. . . . . . . . . . . . . . . . . . . . . . . . . . 31

1951 STANDARD PRECAUTIONS AND CONDITIONS FOR OBSERVED REPORTED, NOT

CLIENT EXAMINATION NOT SEEN AVAILABLE

01 RUNNING WATER (PIPED, BUCKET WITH TAP OR POUR PITCHER) 1 2 3

02 HAND-WASHING SOAP (MAY BE LIQUID SOAP) 1 2 3

03 ALCOHOL-BASED HAND RUB 1 2 3

04 WASTE RECEPTACLE (PEDAL BIN) WITH LID AND PLASTIC BIN 1 2 3

LINER. 06

05 OTHER WASTE RECEPTACLE 1 2 3

06 SHARPS CONTAINER ("SAFETY BOX") 1 2 3

07 DISPOSABLE LATEX/OTHER GLOVES 1 2 3

08 DISINFECTANT/ANTISEPTICS [E.G., CHLORINE, HIBITANE, ALCOHOL] 1 2 3

09 SINGLE USE STANDARD DISPOSABLE SYRINGES WITH NEEDLES, OR 1 2 3

AUTO-DISABLE SYRINGES WITH NEEDLES

10 MEDICAL MASKS 12 3

11 GOWNS 12 3

12 EYE PROTECTION [GOGGLES OR FACE PROTECTION] 1 2 3

13 GUIDELINES FOR STANDARD PRECAUTIONS 1 2 3

1952 DESCRIBE THE SETTING OF THE ROOM OR AREA PRIVATE ROOM. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

OTHER ROOM WITH 

AUDITORY AND VISUAL PRIVACY. . . . . . . . . . . . . . . 2

VISUAL PRIVACY ONLY. . . . . . . . . . . . . . . . . . . . . . . . . . . 3

NO PRIVACY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

1953 CHECK Q214 TB MEDICINES STORED IN TB

TB MEDS STORED IN OTHER LOCATION SERVICE AREA (RESPONSE 1 CIRCLED) 931

OR NOT STOCKED (RESPONSE 1 NOT CIRCLED)

THANK YOUR RESPONDENT AND MOVE TO YOUR NEXT DATA COLLECTION POINT IF DIFFERENT FROM 

CURRENT LOCATION.

STANDARD PRECAUTIONS

1953

Appendix C • 249
2300 CHECK Q102.14 CHRONIC DISEASE SERVICES CHRONIC DISEASE SERVICES NOT

AVAILABLE FROM FACILITY AVAILABLE FROM FACILITY

NEXT SECTION OR SERVICE SITE

2301 Do providers in this facility diagnose and/or manage YES, DIAGNOSE ONLY. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

diabetes. YES, TREAT ONLY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

YES, DIAGNOSE AND TREAT. . . . . . . . . . . . . . . . . . . . . . . 3

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2310

2302 Do you have the national guidelines for the diagnosis YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

and management of diabetes available in this NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2304

service area?

2303 May I see the national guidelines? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2310

REPORTED, NOT SEEN. . . . . . . . . . . . . . . . . . . . . . . . . . . 2

2304 Do you have any other guidelines for the diagnosis YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

and management of diabetes available in this NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2310

service area?

2305 May I see the other guidelines? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED, NOT SEEN. . . . . . . . . . . . . . . . . . . . . . . . . . . 2

2310* Do providers in this facility diagnose and/or manage YES, DIAGNOSE ONLY. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

cardio-vascular diseases including coronary heart disease YES, TREAT ONLY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

in patients? YES, DIAGNOSE AND TREAT. . . . . . . . . . . . . . . . . . . . . . . 3

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2315

2311* Do you have the national guideline/protocol/manual YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

for the diagnosis and management of cadio-vascular disease NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2313

available in this service area?

2312* May I see the national guideline/protocol/manual OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2315

for the diagnosis and management of cadio-vascular disease? REPORTED, NOT SEEN. . . . . . . . . . . . . . . . . . . . . . . . . . . 2

2313* Do you have any other guideline/protocol/manual YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

for the diagnosis and management of cadio-vascular disease NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2315

available in this service area?

2314* May I see the other guideline/protocol/manual ? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED, NOT SEEN. . . . . . . . . . . . . . . . . . . . . . . . . . . 2

2315* Do providers in this facility diagnose and/or manage YES, DIAGNOSE ONLY. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

hypertension patients? YES, TREAT ONLY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

YES, DIAGNOSE AND TREAT. . . . . . . . . . . . . . . . . . . . . . . 3

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2320

2316* Do you have the national guideline/protocol/manual YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

for the diagnosis and management of hypertension NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2318

available in this service area?

2317* May I see the national guideline/protocol/manual OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2320

for the diagnosis and management of hypertension? REPORTED, NOT SEEN. . . . . . . . . . . . . . . . . . . . . . . . . . . 2

2318* Do you have any other guideline/protocol/manual YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

for the diagnosis and management of hypertension NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2320

available in this service area?

2319* May I see the other guideline/protocol/manual? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED, NOT SEEN. . . . . . . . . . . . . . . . . . . . . . . . . . . 2

ASK TO BE SHOWN THE LOCATION IN THE FACILITY WHERE CLIENTS WITH NON-COMMUNICABLE OR CHRONIC 

CONDITIONS SUCH AS DIABETES AND CARDIOVASCULAR DISEASES ARE SEEN. FIND THE PERSON MOST 

KNOWLEDGEABLE ABOUT PROVISION OF SUCH SERVICES IN THE FACILITY. INTRODUCE YOURSELF, 

EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS.

SECTION 23: NON-COMMUNICABLE DISEASES

DIABETES

CARDIO-VASCULAR DISEASES/HYPERTENSION

250 • Appendix C
2320* Do providers in this facility diagnose and/or manage YES, DIAGNOSE ONLY. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

asthma/chronic obstructive pulmonary diseases (COPD) in YES, TREAT ONLY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

patients? YES, DIAGNOSE AND TREAT. . . . . . . . . . . . . . . . . . . . . . . 3

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2325

2321* Do you have the national guideline/protocol/manual for the diagno YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

and management of asthma/COPD NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2323

available in this service area?

2322* May I see the national guideline/protocol/manual for the diagnosis OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2325

and management of asthma/COPD? REPORTED, NOT SEEN. . . . . . . . . . . . . . . . . . . . . . . . . . . 2

2323* Do you have any other guideline/protocol/manual for the diagnosis YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

and/ management of asthma/COPD NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2325

available in this service area?

2324* May I see the other guideline/protocol/manual? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED, NOT SEEN. . . . . . . . . . . . . . . . . . . . . . . . . . . 2

2325* Do providers in this facility screen patients for cervical cancer YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

(either through visual inspection with Acetic Acid/Vinegar (VIA), NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2330

pap smear or Human Papillomavirus (HPV) test)?

2326* Do you have the national guideline/protocol/manual for YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

cervical cancer screening available in this service area? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2328

2327* May I see the national guideline/protocol/manual for OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2330

cervical cancer screening? REPORTED, NOT SEEN. . . . . . . . . . . . . . . . . . . . . . . . . . . 2

2328* Do you have any other guideline/protocol/manualfor YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

cervical cancer screening available in this service area? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2330

2329* May I see the other guideline/protocol/manual? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED, NOT SEEN. . . . . . . . . . . . . . . . . . . . . . . . . . . 2

RESPIRATORY

CERVICAL CANCER

Appendix C • 251
2330 ASSESS THE ROOM OR AREA FOR THE BASIC GENERAL INFORMATION SECTION (Q700). . . . . . . . . . . . . . 1 2350

SUPPLIES AND EQUIPMENT LISTED BELOW. NOT PREVIOUSLY SEEN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

IF THE SAME ROOM OR AREA HAS ALREADY BEEN 

ASSESSED, INDICATE WHERE THE DATA ARE 

RECORDED

2331 I would like to know if the following items are available

today in the main service area and are functioning

ASK TO SEE ITEMS.

01 ADULT WEIGHING SCALE 1 b 2 b 3 1 2 8

02

02 CHILD WEIGHING SCALE [250 GRAM GRADATION] 1 b 2 b 3 1 2 8

03

03 INFANT WEIGHING SCALE [100 GRAM GRADATION] 1 b 2 b 3 1 2 8

04

04 STADIOMETER [OR HEIGHT ROD] FOR 1 b 2 b 3 1 2 8

MEASURING HEIGHT 05

05 MEASURING TAPE [FOR CIRCUMFERENCE] 1 2 3

06 THERMOMETER 1 b 2 b 3 1 2 8

07

07 STETHOSCOPE 1 b 2 b 3 1 2 8

08

08 DIGITAL BP APPARATUS 1 b 2 b 3 1 2 8

09

09 MANUAL BP APPARATUS 1 b 2 b 3 1 2 8

10

10 LIGHT SOURCE (FLASHLIGHT ACCPTABLE) 1 b 2 b 3 1 2 8

11

11 SELF-INFLATING BAG AND MASK [ADULT] 1 b 2 b 3 1 2 8

12

12 SELF-INFLATING BAG AND MASK [PEDIATRIC] 1 b 2 b 3 1 2 8

13

13 MICRONEBULIZER 1 b 2 b 3 1 2 8

14

14 SPACERS FOR INHALERS 1 2 3

15 PEAK FLOW METERS 1 b 2 b 3 1 2 8

16

16 PULSE OXIMETER 1 b 2 b 3 1 2 8

17

17 OXYGEN CONCENTRATORS 1 b 2 b 3 1 2 8

18

18 FILLED OXYGEN CYLINDER 1 b 2 b 3 1 2 8

19

19 OXYGEN DISTRIBUTION SYSTEM 1 b 2 b 3 1 2 8

20

20 INTRAVENOUS INFUSION KITS - ADULT 1 2 3

21 INTRAVENOUS INFUSION KITS - PEDIATRIC 1 2 3

BASIC SUPPLIES AND EQUIPMENT

(A) AVAILABLE (B) FUNCTIONING

OBSERVED YES NO KNOW

DON’T

AVAILABLE

NOT

NOT SEEN

REPORTED

252 • Appendix C
2350 ASSESS THE ROOM OR AREA FOR THE ITEMS GENERAL INFORMATION [Q710]. . . . . . . . . . . . . . . . . . . . 11

LISTED BELOW. FOR ITEMS THAT YOU DO NOT CHILD VACCINATION [Q1051] . . . . . . . . . . . . . . . . . . . . . . 12

SEE, ASK YOUR RESPONDENT TO SHOW THEM TO CHILD CURATIVE CARE [Q1251]. . . . . . . . . . . . . . . . . . . . 13

YOU. FAMILY PLANNING [Q1351]. . . . . . . . . . . . . . . . . . . . . . . . 14

ANTENATAL CARE [Q1451]. . . . . . . . . . . . . . . . . . . . . . . . 15

IF THE SAME ROOM OR AREA HAS ALREADY BEEN DELIVERY SERVICES [Q1651]. . . . . . . . . . . . . . . . . . . . . . 17

ASSESSED, INDICATE WHERE THE DATA ARE TUBERCULOSIS [Q1951]. . . . . . . . . . . . . . . . . . . . . . . . . . 19

RECORDED NOT PREVIOUSLY SEEN. . . . . . . . . . . . . . . . . . . . . . . . . . 31

2351 STANDARD PRECAUTIONS AND CONDITIONS FOR 

CLIENT EXAMINATION

01 RUNNING WATER 1 2 3

(PIPED, BUCKET WITH TAP OR POUR PITCHER)

02 HAND-WASHING SOAP (MAY BE LIQUID SOAP) 1 2 3

03 ALCOHOL-BASED HAND RUB 1 2 3

04 WASTE RECEPTACLE (PEDAL BIN) WITH LID AND 1 2 3

PLASTIC BIN LINER 06

05 OTHER WASTE RECEPTACLE 1 2 3

06 SHARPS CONTAINER ("SAFETY BOX") 1 2 3

07 DISPOSABLE LATEX GLOVES 1 2 3

08 DISINFECTANT/ANTISEPTICS [E.G., CHLORINE, HIBITANE, ALCOHOL] 1 2 3

09 SINGLE USE STANDARD DISPOSABLE SYRINGS WITH NEEDLES, 

OR AUTO-DISABLE SYRINGES WITH NEEDLES 1 2 3

10 MEDICAL MASKS 1 2 3

11 GOWNS 12 3

12 EYE PROTECTION [GOGGLES OR FACE PROTECTION] 1 2 3

13 GUIDELINES FOR STANDARD PRECAUTIONS 1 2 3

2352 DESCRIBE THE SETTING OF THE ROOM OR PRIVATE ROOM. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

SERVICE AREA OTHER ROOM WITH 

AUDITORY AND VISUAL PRIVACY. . . . . . . . . . . . . . . . . 2

VISUAL PRIVACY ONLY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

NO PRIVACY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

THANK YOUR RESPONDENT AND MOVE TO YOUR NEXT DATA COLLECTION POINT IF DIFFERENT FROM 

CURRENT LOCATION.

OBSERVED

REPORTED,

NOT SEEN

NOT

AVAILABLE

CLIENT EXAMINATION ROOM

NEXT SECTION / SERVICE

Appendix C • 253
2500 CHECK Q102.16 CESAREAN DELIVERY NOT 

CESAREAN SECTION DONE IN FACILITY

DONE IN FACILITY

NEXT SECTION OR SERVICE SITE

2501 Does the facility have a health worker who can perform YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Cesarean delivery (section) present at the facility or on call 24 hours NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2504

a day (including weekends and on public holidays)?

2502 Is there a duty schedule or call list for 24-hr staff assignment? YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

24-HOUR DUTY SCHEDULE NOT MAINTAINED. . 2 2504

2503 May I see the duty schedule or call list for 24-HR staff SCHEDULE OBSERVED. . . . . . . . . . . . . . . . . . . . . 1

assignment? SCHEDULE REPORTED, NOT SEEN. . . . . . . . . . . 2

2504 YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2507

2505 Is there a duty schedule or call list? YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

24-HOUR DUTY SCHEDULE NOT MAINTAINED. . 2 2507

2506 May I see the duty schedule or call list? SCHEDULE OBSERVED. . . . . . . . . . . . . . . . . . . . . 1

SCHEDULE REPORTED, NOT SEEN. . . . . . . . . . . 2

2507 Have Cesarean deliveries been performed in this facility YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

during the past 3 months? NO. . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . 2

2510 Please tell me if the 

following equipment are

available at this site today and

is functioning. I would like 

to see them

01 ANESTHESIA MACHINE 1 b b 3 1 2 8

02 TUBINGS AND CONNECTORS (TO 1 b b 3 1 2 8

CONNECT ENDOTRACHEAL TUBE)

03 OROPHARYNGEAL AIRWAY 1 b b 3 1 2 8

(ADULT)

04 OROPHARYNGEAL AIRWAY 1 b b 3 1 2 8

(PEDIATRIC)

05 MAGILLS FORCEPS - ADULT 1 b b 3 1 2 8

06 MAGILLS FORCEPS - PEDIATRIC 1 b b 3 1 2 8

07 ENDOTRACHEAL TUBE 1 b b 3 1 2 8

CUFFED SIZES 3.0 - 5.0

08 ENDOTRACHEAL TUBE 1 b b 3 1 2 8

CUFFED SIZES 5.5 - 9.0

09 INTUBATING STYLET 1 b b 3 1 2 8

10 SPINAL NEEDLE 1 b b 3 1 2 8

11* OT TABLE 1 b b 3 1 2 8

12* OT LIGHT 1 b b 3 1 2 8

13* IV STAND 1 b b 3 1 2 8

14* EMERGENCY POWER SUPPLY 1 b b 3 1 2 8

15* INSTRUMENT SET FOR CESAREAN 1 3

DELIVERY

16* AIR CONDITIONER 1 b b 3 1 2 8

17* OXYGEN CYLINDER WITH FLOWMETE1 b b 3 1 2 8

18* OXYGEN CYLINDER WITHOUT FLOWM1 b b 3 1 2 8

19* STERILE GLOVES 1 3

20* DISINFECTANT 1 3

THANK YOUR RESPONDENT AND MOVE TO YOUR NEXT DATA COLLECTION POINT IF DIFFERENT FROM CURRENT LOCATION

SECTION 25: CESAREAN DELIVERY

Does this facility have an anesthetist present in the facility or on call 24 

hours a day (including weekends and on public holidays)?

2

2

2

2

2

AVAILABLE YES NO

ASK TO SEE THE ROOM OR AREA WHERE CESAREAN DELIVERIES ARE DONE AND ASK TO SEE THE ITEMS BELOW

(A) AVAILABLE (B) FUNCTIONING

REPORTED NOT DON’T

2

2

ASK TO BE SHOWN THE LOCATION IN THE FACILITY WHERE CESAREAN DELIVERIES ARE DONE. 

FIND THE PERSON MOST KNOWLEDGEABLE ABOUT PROVISION OF SUCH SERVICES IN THE FACILITY.

INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS.

2

KNOW

2

2

OBSERVED NOT SEEN

2

2

2

2

2

2

2

2

2

2

254 • Appendix C
2600 CHECK Q102.18 BLOOD TYPING SERVICES NOT

BLOOD TYPING SERVICES AVAILABLE FROM FACILITY

AVAILABLE FROM FACILITY

NEXT SECTION OR SERVICE SITE

2601 Please tell me if any of the following reagents or 

equipment is available at this services site today. 

I would like to see them.

CHECK TO SEE IF AT LEAST ONE IS VALID 

(NOT EXPIRED)

01 Anti-A Reagent 1 2 3 4 5

02 Anti-B Reagent 1 2 3 4 5

03 Anti-D Reagent 1 2 3 4 5

04 COOMB'S REAGENT 1 2 3 4 5

05 Anti-A,B Reagent 1 2 3 4 5

(A) OBSERVED (B) NOT OBSERVED

SECTION 26: BLOOD TYPING AND COMPATIBILITY TESTING

REPORTED NOT

AVAILABLE

NEVER 

ONE VALID NONE VALID NOT SEEN TODAY/DK AVAILABLE

AT LEAST AVAILABLE AVAILABLE AVAILABLE

Appendix C • 255
2700 CHECK Q102.19 BLOOD TRANSFUSION NOT

BLOOD TRANSFUSION AVAILABLE FROM FACILITY

AVAILABLE FROM FACILITY

NEXT SECTION OR SERVICE SITE

2701* What is the source of the blood that is transfused in MEDICAL COLLEGE HOSPITAL BLOOD BANK A

this facility? DISTRICT HOSPITAL BLOOD BANK B

BLOOD BANK IN THE FACILITY C

RELATIVES DONATING DIRECTLY. . . . . . . . . . . . . . . . . . .D

PROBE FOR A COMPLETE LIST OF SOURCES RED CRESCENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E

OF BLOOD. OTHER______________________________________ X

(SPECIFY)

2702 Has blood transfusion been done in this facility in an YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

obstetric context (i.e., for maternal care) during the NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

past 3 months?

2710 Is blood that is transfused in this facility screened, YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

either in this facility or externally, for any NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2720

infectious diseases prior to transfusion?

2711 Is the blood that is transfused screened only in the ONLY IN THIS FACILITY. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

facility, only at an external facility, or both? ONLY AT AN EXTERNAL FACILITY. . . . . . . . . . . . . . . . . . . 2

BOTH INTERNALLY AND EXTERNALLY. . . . . . . . . . . . . . . 3

2712 Is the blood that is transfused in the facility screened, 

either in this facility or externally, for any of the 

following infectious diseases? 

IF YES, ASK: Is the blood "always", "sometimes", or 

"rarely" screened?

01 HIV 1 4

02 SYPHILIS 1 4

03 HEPATITIS B 1 4

04 HEPATITIS C 1 4

05 MALARIA 1 4

2713 Do you ever send blood sample outside the facility for YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

screening for any of the tests mentioned above? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2720

2714 For which of the following tests do you send blood sample

outside the facility for screening? 

ASK TO SEE DOCUMENTATION NO NO

01 HIV 1 b 2 1 2

02

02 SYPHILIS 1 b 2 1 2

03

03 HEPATITIS B 1 b 2 1 2

04

04 HEPATITIS C 1 b 2 1 2

05

05 MALARIA 1 b 2 1 2

2720

2 3

IN THE FACILITY INTRODUCE YOURSELF, EXPLAIN THE PURPOSE OF THE SURVEY AND ASK THE FOLLOWING QUESTIONS.

YES

2 3

(A) SEND SPECIMEN OUT (B) RECORD OF OUTSIDE TEST

YES

2 3

2 3

2 3

SECTION 27: BLOOD TRANSFUSION SERVICES

ALWAYS SOMETIMES RARELY NO

SCREENING FOR INFECTIOUS DISEASES

ASK TO BE SHOWN THE LOCATION IN THE FACILITY WHERE BLOOD IS COLLECTED, STORED, PROCESSED OR HANDLED 

PRIOR TO TRANSFUSION. FIND THE PERSON MOST KNOWLEDGEABLE ABOUT PROVISION OF BLOOD TRANSFUSION SERVICES

256 • Appendix C
2720 Has the facility run out of blood for more than one day YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

anytime during the past 3 months? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

2721 YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2724

2722 May I see the blood bank fridge or other refrigerator? OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2724

2723 WHAT IS THE TEMPERATURE IN THE BLOOD BETWEEN +2 AND +6 DEGREES. . . . . . . . . . . . . . . . . . . . 1

BANK FRIDGE OR OTHER REFRIGERATOR? ABOVE +6 DEGREES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

BELOW +2 DEGREES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

THERMOMETER NOT FUNCTIONAL. . . . . . . . . . . . . . . . . 4

2724 Do you have any guideline/protocol/manual on the appropriate use YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

of blood and safe transfusion practices? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2725A

2725 May I see the guideline/protocol/manual on appropriate use of blood and OBSERVED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

safe blood transfusion? REPORTED NOT SEEN. . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

2725A* Please tell me if any of the following items 

 is available at this services site today. 

I would like to see them.

CHECK TO SEE IF AT LEAST ONE IS VALID 

(NOT EXPIRED)

01 Disposable blood transfusion set 1 2 3 4 5

02 Blood bags 1 2 3 4 5

Is there a blood bank fridge or other refrigerator available for 

blood storage in this service area?

BLOOD STORAGE

(A) OBSERVED (B) NOT OBSERVED

AVAILABLE

REPORTED NOT

AT LEAST AVAILABLE AVAILABLE AVAILABLE NEVER 

ONE VALID NONE VALID NOT SEEN TODAY/DK AVAILABLE

Appendix C • 257
3000 ASSESS GENERAL CLEANLINESS / CONDITIONS OF FACILITY YES NO

01 FLOOR: SWEPT, NO OBVIOUS DIRT OR WASTE 1 2

02 COUNTERS/TABLES/CHAIRS: WIPED CLEANNO OBVIOUS DUST OR WASTE 1 2

03 NEEDLES, SHARPS OUTSIDE SHARPS BOX 1 2

04 SHARPS BOX OVERFLOWING OR TORN/PIERCED 1 2

05 BANDAGES/INFECTIOUS WASTE LYING UNCOVERED 1 2

06 WALLS: SIGNIFICANT DAMAGE 1 2

07 DOORS: SIGNIFICANT DAMAGE 1 2

08 CEILING: WATER STAINS OR DAMAGE 1 2

09* WASTE SEGREGATED ACCORDING TO COLOR PIN 1 2

AT THE SOURCE OF WASTE GENERATION?

.

INTERVIEW END TIME .

THANK YOUR RESPONDENT AND MOVE TO YOUR NEXT DATA COLLECTION POINT IF DIFFERENT FROM 

CURRENT LOCATION.

SECTION 30: GENERAL FACILITY LEVEL CLEANLINESS

258 • Appendix C
INTERVIEWER'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW

COMMENTS ABOUT RESPONDENT:

COMMENTS ON SPECIFIC QUESTIONS:

ANY OTHER COMMENTS:

SUPERVISOR'S OBSERVATIONS

NAME OF THE SUPERVISOR: DATE:

Appendix C • 259
260 • Appendix C
Facility Number:

Provider SERIAL Number: [FROM STAFF LISTING FORM]

Provider Sex: (1=MALE; 2=FEMALE)

Provider Status:

(1=Posted; 2=Attached)

Interviewer Code:

INDICATE IF PROVIDER WAS YES, PREVIOUSLY INTERVIEWED . . . . . . . 1

PREVIOUSLY INTERVIEWED IN

ANOTHER FACILITY.

IF YES, RECORD NAME AND NAME & NUMBER OF FACILITY END

FACILITY NUMBER WHERE

HE/SHE WAS INTERVIEWED NO, NOT PREVIOUSLY INTERVIEWED 2

READ THE FOLLOWING CONSENT FORM

Now I will read a statement explaining the study. 

You may refuse to answer any question or choose to stop the interview at any time. However, we hope you will collaborate with the study.

Do you have any questions about the study? Do I have your agreement to proceed?

Interviewer's signature

SIGNATURE OF INTERVIEWER INDICATES INFORMED CONSENT WAS PROVIDED.

101 May I begin the interview now? YES. . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . 2 END

Good day! My name is _____________________. We are here on behalf of the National Institute of Population Research and Training (NIPORT) and 

the Ministry of Health and Family Welfare conducting a survey of health facilities to assist the government in knowing more about health services in 

Bangladesh.

2017 BANGLADESH HEALTH FACILITY SURVEY

HEALTH PROVIDER INTERVIEW

2

MONTH YEAR

10

DAY

Your facility was selected to participate in this study. We will be asking you several questions about the types of services that you personally provide, as well as questions 

about training you have received. 

The information you provide us may be used by NIPORT, the MOHFW, other organizations or researchers, for planning service improvements or further studies of 

services.

Neither your name nor that of any other health worker respondents participating in this study will be included in the dataset or in any report; however, there is a small 

chance that any of the respondents may be identified later. Still, we are asking for your help to ensure that the information we collect is accurate.

Appendix C • 261
102 I would like to ask you some questions about your educational

background. 

How many years of education have you completed in total, YEARS. . . . . . . . . . . . . 

starting from your primary, secondary and further education? MONTHS. . . . . . . . . . . . . 

103 What is your current qualification? For example, SPECIALIST/CONSULTANT MEDICINE [INCLUDING CARD01

Are you a generalist medical doctor SPECIALIST/CONSULTANT GENERAL SURGERY. . . . . . . 02

or a specialist medical doctor? SPECIALIST/CONSULTANT OBSTETRICS / GYNECOLOGY03

SPECIALIST/CONSULTANT PEDIATRICS. . . . . . . . . . . . . . 04

SPECIALIST/CONSULTANT PSYCHIATRY. . . . . . . . . . . . . . 05

IN CASE OF NURSE/SACMO/TECHNOLOGISTS/ SPECIALIST/CONSULTANT ANESTHESIA. . . . . . . . . . . . . . 06

FP PERSONNELS/NUTRITIONIST , ASK ANY OTHER SPECIALIST/CONSULTANT NOT LISTED ABO07

What is your current occuaptional category?

BOTH SENIOR AND JUNIOR CONSULTANTS ARE INCLUDED . . 08

IN CONSULTANT CATEGORY

MEDICAL OFFICER - ANESTHETIST. . . . . . . . . . . . . . . . . . 09

DENTAL SURGEON. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

SACMO / MEDICAL ASSISTANT. . . . . . . . . . . . . . . . . . . . . . 11

MATRON. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

NURSING SUPERVISOR. . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

SENIOR STAFF NURSE . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

ASSISTANT NURSE / STAFF NURSE (IN PRIVATE). . . . . . 15

FAMILY WELFARE VISITOR (FWV) . . . . . . . . . . . . . . . . . . . 16

FAMILY WELFARE ASSISTANT (FWA). . . . . . . . . . . . . . . . . 17

HEALTH ASSISTANT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

COMMUNITY HEALTH CARE PROVIDER. . . . . . . . . . . . . . . 19

HEALTH INSPECTOR. . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

ASSISTANT HEALTH INSPECTOR. . . . . . . . . . . . . . . . . . . . 21

NUTRITIONIST. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

HEALTH EDUCATOR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

MEDICAL TECHNOLOGIST - LABORATORY. . . . . . . . . . . . 25

MEDICAL TECHNOLOGIST - EPI.. . . . . . . . . . . . . . . . . . . 26

MIDWIFE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

PARAMEDICS (IN PRIVATE/NGO). . . . . . . . . . . . . . . . . . . 31

NURSE MIDWIFE 32

TB LEPROSY CONTROL ASSISTANT (TLCA) 33

OTHER NON-CLINICAL/NON-TECHNICAL STAFF 95

OTHER CLINICAL STAFF NOT LISTED ABOVE __________96

(SPECIFY)

104 What year did you graduate (or complete) with this qualification?

YEAR

IF NO TECHNICAL QUALIFICATION ASK: 

What year did you complete any basic training for your current

occupational category?

105 In what year did you start working in this facility? YEAR

YOU MAY PROBE BY ASKING "HOW LONG HAVE YOU WORKED IN THIS FACILITY"?

108 Are you a manager or in-charge for any clinical services? YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

1. EDUCATION AND EXPERIENCE

MEDICAL OFFICER (MBBS) (ANY NON-SPECIALIST 

DOCTOR, INCLUDING ASSISTANT SURGEON, EMO, 

IMO, MCH/FP, RMO, REGARDLESS OF DESIGNATION 

OR TITLE)

262 • Appendix C
200

01 Standard precautions, including hand hygiene, cleaning and disinfection, 1 3

waste management, needle stick and sharp injury prevention?

02 Any specific training related to injection safety practices or safe injection practices? 1 3

03 Health Management Information Systems (HMIS) or reporting requirements for any service? 1 3

04 Confidentiality and rights to non-discrimination practices for people living with HIV/AIDS 1 3

05* Any specific training related to adolescent health services? 1 3

06* Any specific training related to nutrition services? 1 3

07* Any specific training related to screening for cervical cancer through visual inspection with acetic acid/pap smear/ 1 3

human papilloma virus (HPV) test

2

2

2

NO 

PAST 24 MONTHS

WITHIN OVER 

IF YES, ASK: Was the training, training update or refresher training within the past 24 months or more than 24 

months ago? AGO

2. GENERAL TRAINING / NON-COMMUNICABLE DISEASES

TRAINING OR

IN-SERVICE

24 MONTHS UPDATES

2

Have you received any in-service training, training updates or refresher training in any of the following topics [READ 

TOPIC]

I will like to ask you a few questions about in-service training you have received related to your work. In-service training 

refers to training you have received related to your work since you started working. I will start with some general topics. 

Note that the training topics I will mention may have been covered as stand alone trainings, or they may have been 

covered under another training topic. 

YES, YES,

2

2

2

Appendix C • 263
201 CHECK Q103 FOR PROVIDER OCCUPATIONAL CATEGORY / QUALIFICATION 

CODE 25 (MEDICAL TECHNOLOGIST LABORATORY) CIRCLED 700

CODE 25 (MEDICAL TECHNOLOGIST LABORATORY) NOT CIRCLED

202 In your current position, and as a part of your work for this facility, do you YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

personally provide any services that are designed to be NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 

youth or adolescent friendly? i.e., designed with the specific aim to 

encourage youth or adolescent utilization?

203 YES, WITHIN PAST 24 MONTHS. . . . . . 1

YES, OVER 24 MONTHS AGO. . . . . . . 2

NO TRAINING OR UPDATES. . . . . . . . . 3

207 In your current position, and as a part of your work for this facility, do you YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

personally diagnose and/or manage diabetes? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

208 YES, WITHIN PAST 24 MONTHS. . . . . . 1

YES, OVER 24 MONTHS AGO. . . . . . . 2

NO TRAINING OR UPDATES. . . . . . . . . 3

209 In your current position, and as a part of your work for this facility, do you YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

personally diagnose and/or manage cardio-vascular diseases such as NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

hypertension?

210 Have you received any in-service training, training updates or refresher training YES, WITHIN PAST 24 MONTHS. . . . . . 1

on the diagnosis and/or management of cardio-vascular diseases? YES, OVER 24 MONTHS AGO. . . . . . . 2

NO TRAINING OR UPDATES. . . . . . . . . 3

211 In your current position, and as a part of your work for this facility, do you YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

personally diagnose and/or manage chronic respiratory conditions such as NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

chronic obstructive pulmonary disease (COPD)?

212 Have you received any in-service training, training updates or refresher training YES, WITHIN PAST 24 MONTHS. . . . . . 1

on the diagnosis and/or management of chronic respiratory diseases? YES, OVER 24 MONTHS AGO. . . . . . . 2

NO TRAINING OR UPDATES. . . . . . . . . 3

I will now ask you a few questions about services you personally provide in your current position in this facility and any in-service training, training updates or refresher 

trainings you may have received related to that service. Please remember we are talking about services you provide in your current position in this facility. The training 

topics I will mention may have been covered as a stand-alone training, or covered as part of another training topic.

CHRONIC RESPIRATORY DISEASES

IF YES: Was the training, training update or refresher training within the past 24 months or more 

than 24 months ago?

Have you received any in-service training, training updates or refresher training on topics 

specific to youth or adolescent friendly services?

Have you received any in-service training, training updates or refresher training on topics 

specific to the diagnosis and/or management of diabetes? 

IF YES: Was the training, training update or refresher training within the past 24 months or more 

than 24 months ago?

DIABETES

CARDIO-VASCULAR DISEASES

IF YES: Was the training, training update or refresher training within the past 24 months or more 

than 24 months ago?

IF YES: Was the training, training update or refresher training within the past 24 months or more 

than 24 months ago?

264 • Appendix C
300 In your current position, and as a part of your work for this facility, do you YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

personally provide any child vaccination services? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

301 In your current position, and as a part of your work for this facility, do you YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

personally provide any child growth monitoring services? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

302 In your current position, and as a part of your work for this facility, do you YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

personally provide any child curative care services? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

303 YES . . . . . . . . . . . . . . . . . . . . . . . 1

NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 400

304 Have you received any in-service training or training updates 

in any of the following topics [READ TOPIC]

01 EPI OR COLD CHAIN MONITORING 3

02 INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES 3

06 DIAGNOSIS AND/OR TREATMENT OF ACUTE RESPIRATORY INFECTIONS 3

07 DIAGNOSIS AND/OR TREATMENT OF DIARRHEA 3

08 MICRONUTRIENT DEFICIENCIES AND/OR NUTRITIONAL ASSESSMENT 3

09 BREASTFEEDING 3

10 COMPLIMENTARY FEEDING IN INFANTS 3

13* EARLY CHILDHOOD DEVELOPMENT 3

14 OTHER TRAINING ON CHILD HEALTH (SPECIFY)___________________________________________ 3

15* INFANT AND YOUNG CHILD FEEDING TRAINING (IYCF TRAINING) 3

16* SAM and MAM TRAINING 3

400 In your current position, and as a part of your work for this facility, do you YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

personally provide any family planning services? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

401 YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 500

403 Have you received any in-service training, training updates or refresher training 

in any of the following topics [READ TOPIC]

01 GENERAL COUNSELING FOR FAMILY PLANNING 2 3

02 IUCD INSERTION AND/OR REMOVAL 2 3

03 IMPLANT INSERTION AND/OR REMOVAL 2 3

04 PERFORMING VASECTOMY 2 3

05 PERFORMING TUBAL LIGATION 2 3

06 CLINICAL MANAGEMENT OF FP METHODS, INCLUDING MANAGING SIDE EFFECTS 2 3

07 FAMILY PLANNING FOR HIV POSITIVE WOMEN 2 3

08 POST-PARTUM FAMILY PLANNING 2 3

09* INJECTABLE CONTRACEPTIVES 2 3

10* EMERGENCY CONTRACEPTIVE PILL 2 3

11 OTHER TRAINING ON FAMILY PLANNING (SPECIFY)________________________________________ 2 3

1

1

1

1

YES, NO 

3. CHILD HEALTH SERVICES

YES,

Have you received any in-service training, training updates or refresher training on topics 

related to child health or childhood illnesses?

IF YES: Was the training, training update or refresher training within the past 24 months or more than 24 

months ago?

PAST 24 MONTHS TRAINING OR

IN-SERVICE

Have you received any in-service training, training updates or refresher training on topics 

related to family planning?

1 2

IF YES: Was the training, training update or refresher training within the past 24 months or more 

than 24 months ago?

UPDATES

2

OVER 

1

WITHIN IN-SERVICE

24 MONTHS AGO

1

1

UPDATES

WITHIN OVER 

1

YES, YES, NO 

2

1

1

1

4. FAMILY PLANNING SERVICES

24 MONTHS TRAINING OR

24 MONTHS

PAST 

1

1

AGO

1

1

1

1

1

1

1 2

2

2

2

2

2

2

2

1

Appendix C • 265
500 In your current position, and as a part of your work for this facility, do you YES, ANTENATAL. . . . . . . . . . . . . . . . . 1

personally provide any antenatal care or postnatal care services? YES, POSTNATAL. . . . . . . . . . . . . . . . . . 2

YES, BOTH. . . . . . . . . . . . . . . . . . . . . . 3

IF YES, PROBE AND INDICATE WHICH SERVICES ARE PROVIDED NO, NEITHER. . . . . . . . . . . . . . . . . . . . . 4

501 YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 503

502 Have you received any in-service training, training updates or refresher training 

in any of the following topics [READ TOPIC]

01 ANC screening (e.g., blood pressure, sugar&albumin, anemia)? 2 3

02 Counseling for ANC (e.g., nutrition,birth planning, FP and newborn care)? 2 3

03 Complications of pregnancy and their management? 2 3

04 Nutritional assessment of the pregnant woman, such as Body Mass 2 3

Index calculation and Mid-Upper Arm circumference measurement?

06* Postnatal care (PNC) (blood pressure checkup, examine perineum and abdomen, test urine for albumin) 2 3

07* Postnatal care counselling (breast feeding, nutrition, FP, anemia) 2 3

08* Management of pre-eclampsia/eclampsia 2 3

09* Antenatal corticosteroids for threatened preterm labor 2 3

10* Prevalence of postpartum hemorrhage (management of PPH) 2 3

503 Do you personally provide any services that are specifically geared PREVENTIVE COUNSELING. . . . . A

toward preventing mother-to-child transmission of HIV? HIV TEST COUNSELING. . . . . . . . . . B

CONDUCT HIV TEST. . . . . . . . . . . . . C

IF YES, ASK: Which specific services do you provide? PROVIDE ARV TO MOTHER. . . . . . . . D

PROVIDE ARV TO INFANT. . . . . . . . . E

INDICATE WHICH OF THE LISTED SERVICES ARE PROVIDED AND NO PMTCT SERVICES. . . . . . . . . . . . Y

PROBE: Anything else?

504* YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 506

505 Have you received any in-service training, training updates or refresher training 

in any of the following topics [READ TOPIC]

02 Newborn nutrition counseling of mother with HIV? 2 3

03 Infant and young child feeding 2 3

04 Modified obstetric practices as relates to HIV (e.g., not rupturing membranes)? 2 3

1

IF YES: Was the training, training update or refresher training within the past 24 months or more 

than 24 months ago?

IF YES: Was the training, training update or refresher training within the past 24 months or more 

than 24 months ago?

1

1

1

AGO UPDATES

Have you received any in-service training, training updates or refresher training on 

topics related to antenatal care or postnatal care?

5. MATERNAL HEALTH SERVICES

ANC - PNC 

AGO UPDATES

1

OVER 

IN-SERVICE

WITHIN 

Have you received any in-service training, training updates or refresher training on topics 

related to maternal and/or newborn health?

YES, YES,

YES, YES, NO 

IN-SERVICE

PAST 24 MONTHS TRAINING OR

24 MONTHS

PAST 24 MONTHS TRAINING OR

NO 

1

24 MONTHS

1

1

1

1

1

1

WITHIN OVER 

266 • Appendix C
506 In your current position, and as a part of your work for this facility, do you YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

personally provide delivery services? By that I mean conducting the NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 509

actual delivery of newborns?

507 During the past 6 months, approximately how many deliveries have you

conducted as the main provider (include deliveries conducted for TOTAL

private practice and for facility)? DELIVERIES

508 When was the last time you used a partograph? NEVER. . . . . . . . . . . . . . . . . . . . . . . . . . 0

WITHIN PAST WEEK. . . . . . . . . . . . . . 1

WITHIN PAST MONTH. . . . . . . . . . . . . 2

WITHIN PAST 6 MONTHS. . . . . . . . . . 3

OVER 6 MONTHS AGO. . . . . . . . . . . . 4

509 YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 511

510

01 Integrated Management of Pregnancy and Childbirth (IMPAC)? 2 3

02 Comprehensive Emergency Obstetric Care (CEmOC)? 2 3

03 Routine care for labor and normal vaginal delivery? 2 3

04 Active Management of Third Stage of Labor (AMTSL)? 2 3

05 Emergency obstetric care (EmOC)/Life saving skills (LSS) - in general? 2 3

06 Post abortion care? 2 3

07 Special delivery care practices for preventing mother-to-child transmission of HIV? 2 3

511 In your current position, and as a part of your work for this YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

facility, do you personally provide care for the newborn? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 

512 YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 600

513

01 Neonatal resuscitation using bag and mask (Helping Babies Breath, HBB) 2 3

02 Early and exclusive breastfeeding 2 3

03 Newborn infection management (including injectable antibiotics) 2 3

04 Thermal care (including immediate drying and skin-to-skin care) 2 3

05 Sterile cord cutting and appropriate cord care 2 3

06 Kangaroo Mother Care (KMC) for low birth weight babies 2 3

08* Essential Newborn Care 2 3

09* Umblical cord care (use of 7.1% chlorhexidine) 2 3

10* Emergency traige assessment training (ETAT) 2 3

11* IMCI guidelines (0-59 days) 2 3

12* Special care newborn unit (SCANU) 2 3

13* Comprehensive on newborn care 2 3

AGO UPDATES

1

1

1

1

1

YES, NO 

TRAINING OR

IF YES: Was the training, training update or refresher training within the past 24 months or more 

than 24 months ago?

IF YES: Was the training, training update or refresher training within the past 24 months or more 

than 24 months ago?

24 MONTHS AGO

1

24 MONTHS

1

1

1

Have you received any in-service training, training updates or refresher training on topics 

related to delivery care?

Have you received any in-service training, training updates or refresher training in any of the following topics 

[READ TOPIC] 

Have you received any in-service training, training updates or refresher training on topics 

related to newborn care?

Have you received any in-service training, training updates or refresher training in any of the following 

topics [READ TOPIC] 

1

DELIVERY SERVICES

1

IN-SERVICE

PAST 

WITHIN 

YES, NO 

TRAINING OR

OVER IN-SERVICE

PAST 24 MONTHS

UPDATES

1

1

1

1

1

1

WITHIN 

1

1

YES,

YES,

NEWBORN CARE SERVICES

24 MONTHS

OVER 

Appendix C • 267
600 In your current position, and as part of your work for this facility, do you YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

personally provide any STI services? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 

601 YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 603

602

01 Diagnosing and treating sexually transmitted infections (STIs) 2 3

02 The syndromic management for STIs 2 3

03 Drug resistance to STI treatment medications 2 3

603 Now I will ask if you provide certain TB-related services. For each service, 

regardless of whether you currently provide it, I will also ask if you have [READ SERVICE]?

received related in-service training, training updates or refresher training

(a) (b)

READ THE QUESTIONS FROM COLUMNS A AND B

01 Diagnosis of tuberculosis based on sputum tests using AFB Smear Microscopy 1 2 1 2

02 Diagnosis of tuberculosis based on clinical symptoms or TB Diagnostic Algorithm 1 2 1 2

03 Treatment prescription for tuberculosis 1 2 1 2

04 Treatment follow-up services for tuberculosis 1 2 1 2

05 Direct Observation Treatment Short-course (DOTS) strategy 1 2 1 2

06 Management of TB - HIV co-infection 1 2 1 2

07 Management of MDR-TB or identification and referral of MDR-TB suspects 1 2 1 2

UPDATES

3

3

3

1

1

IF YES, within 24 months or over?

3

3

3

3

Do you provide

TUBERCULOSIS 

TRAINING

NO

24 MONTHS AGO

PAST 

6. SEXUALLY TRANSMITTED INFECTIONS - TB

24 MONTHS TRAINING OR

Have you received training or training 

update on [SERVICE]? 

IF YES: Was the training, training update or refresher training within the past 24 months or more 

than 24 months ago?

24 MONTHS

YES, WITHIN

24 MONTHS

SEXUALLY TRANSMITTED INFECTIONS 

1

YES, YES, NO 

WITHIN OVER IN-SERVICE

Have you received any in-service training, training updates or refresher training on 

topics related to STI services?

Have you received any in-service training, training updates or refresher training in any of the following topics 

[READ TOPIC] 

YES NO

YES, OVER

268 • Appendix C
700 In your current position, and as a part of your work for this facility, YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

do you personally conduct laboratory tests? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 800

CIRCLE 'NO' IF THE PROVIDER ONLY COLLECTS SPECIMENS.

701 Please tell me if you personally conduct any of the following tests as part of your work in

this facility

01 Microscopic examining of sputum for diagnosing tuberculosis 

02 HIV rapid testing

04 Hematology testing, such as anemia testing

06 Malaria microscopy

07 Malaria rapid diagnostic test (mRDT)

702 YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

 NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 800

703

01 Microscopic examination of sputum for diagnosing tuberculosis 2 3

02 HIV testing 2 3

04 Blood screening for HIV prior to transfusion? 2 3

05 Blood screening for Hepatitis B prior to transfusion? 2 3

06 Tests for monitoring ART such as TLC and serum creatinine. 2 3

07 Malaria microscopy 2 3

08 Malaria rapid diagnostic test (mRDT) 2 3

YES NO

UPDATES

OVER 

Have you received any in-service training, training updates or refresher training on topics 

related to the different diagnostic tests you conduct?

Have you received any in-service training, training updates or refresher training in any of the following 

topics [READ TOPIC]

IF YES: Was the training, training update or refresher training within the past 24 months or more 

than 24 months ago?

1

7. DIAGNOSTIC SERVICES 

1 2

1

1

1

1

2

WITHIN IN-SERVICE

1 2

1

TRAINING OR

1

1 2

1

PAST 24 MONTHS

24 MONTHS AGO

2

YES, YES, NO 

1

Appendix C • 269
800 Now I want to ask you a few more questions about

your work in this facility.

In an average week, how many hours do you work in this AVERAGE HOURS

facility? IF WEEKS ARE NOT CONSISTENT, ASK THE PER WEEK WORKING

RESPONDENT TO AVERAGE OUT HOW MANY HOURS IN THIS FACILITY

PER MONTH AND THEN DIVIDE THIS BY 4.

801 Now I would like to ask you some questions about YES, IN THE PAST 3 MONTHS. . . . . . . . . . . . . . . . . . . . . . . . 1

supervision you have personally received. This YES, IN THE PAST 4-6 MONTHS. . . . . . . . . . . . . . . . . . . . . 2

supervision may have been from a supervisor YES, IN THE PAST 7-12 MONTHS. . . . . . . . . . . . . . . . . . . . . 3

either in this facility, or from outside the facility. YES, MORE THAN 12 MONTHS AGO. . . . . . . . . . . . . . . . 4

Do you receive technical support or supervision NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 804

in your work?

IF YES, ASK: When was the most recent time?

802 How many times in the past six months has 

your work been supervised? NUMBER OF TIMES. . . . . . . . . . . . . . . . . . .

EVERY DAY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . '96

803 The last time you were personally supervised, did 

your supervisor do any of the following: YES NO DK

01 Check your records or reports? CHECKED RECORD 1 2 8

02 Observe your work? OBSERVED WORK 1 2 8

03 Provide any feedback (either positive or negative) FEEDBACK 1 2 8

on your performance? 05 05

04 Give you verbal or written feedback that you were doing VERBAL PRAISE 1 2 8

your work well?

05 Provide updates on administrative or technical PROVIDED UPDATES 1 2 8

issues related to your work?

06 Discuss problems you have encountered? DISCUSSED PROBLEMS 1 2 8

804 Do you have a written job description of your YES, OBSERVED . . . . . . . . . . . 

current job or position in this facility? YES, REPORTED, NOT SEEN . . 

IF YES, ASK: May I see it? NO

805 Are there any opportunities for promotion in your YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

current job? NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

UNCERTAIN/DON'T KNOW. . . . . . . . . . . . . . . . . . . . . . .

806 Which type(s) of salary supplement do you receive, if any? MONTHLY OR DAILY SALARY 

SUPPLEMENT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

PERDIEM WHEN ATTENDING 

TRAINING. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PROBE: Anything else? DUTY ALLOWANCE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

PAYMENT FOR EXTRA ACTIVITIES 

(NOT ROUTINELY PROVIDED). . . . . . . . . . . . . . . . . . . 

OTHER ________________________________

(SPECIFY)

NONE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

807 In your current position, what non-monetary incentives TIME OFF / VACATIONS . . . . . . . . . . . . . . . . . . . . . . . . . A

have you received for the work you do, if any? UNIFORMS, BACKPACKS, CAPS, etc.. . . . . . . . . . . . . . . . B

DISCOUNT MEDICINES, FREE TICKETS

FOR CARE, VOUCHERS, etc. . . . . . . . . . . . . . . . . . C

TRAINING. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D

FOOD RATION / MEALS. . . . . . . . . . . . . . . . . . . . . . . . . E

PROBE BY ASKING: Anything else? Any other options? SUBSIDIZED HOUSING . . . . . . . . . . . . . . . . . . . . . . . . F

HEALTH INSURANCE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G

OTHER: ___________________________________ X

NONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

1

3

8. WORKING CONDITIONS IN FACILITY

Y

B

X

D

C

A

2

1

2

8

Y

270 • Appendix C
808 Among the various things related to your working MORE SUPPORT FROM 

situation that you would like to see improved, can SUPERVISOR. . . . . . . . . . . . . . . . . . . . . . .A

you tell me the three that you think would most MORE KNOWLEDGE / UPDATES

improve your ability to provide good quality of care TRAINING. . . . . . . . . . . . . . . . . . . . . . . . . . B

services? Please rank them in order of importance, MORE SUPPLIES/STOCK. . . . . . . . . . . . . . . . C

with 1 being the most important. BETTER QUALITY EQUIPMENT/

SUPPLIES. . . . . . . . . . . . . . . . . . . . . . . . D RANKING

ENTER LETTER CORRESPONDING WITH THE LESS WORKLOAD 

 1ST MENTIONED INTO THE 1ST BOX, AND REPEAT (i.e. MORE STAFF). . . . . . . . . . . . . . . . . E

WITH THE 2ND AND 3RD. BETTER WORKING HOURS /

 FLEXIBLE TIMES. . . . . . . . . . . . . . . . F

IF THE PROVIDER ONLY MENTIONS 1 OR 2 ITEMS MORE INCENTIVES

PUT CODE "Y" IN THE REMAINING BOX OR BOXES. (SALARY, PROMOTION,

HOLIDAYS). . . . . . . . . . . . . . . . . . G

TRANSPORTATION FOR 

REFERRAL PATIENTS. . . . . . . . . . . . . H

PROVIDING ART. . . . . . . . . . . . . . . . . . . . I

PROVIDING PEP. . . . . . . . . . . . . . . . . . . J

DO NOT READ CHOICES TO YOUR RESPONDENT INCREASED SECURITY. . . . . . . . . . . . . . . K .

BETTER FACILITY 

INFRASTRUCTURE. . . . . . . . . . . . . . . L

MORE AUTONOMY

/ INDEPENDENCE. . . . . . . . . . . . . . . . . M

EMOTIONAL SUPPORT FOR 

STAFF (COUNSELING /

 SOCIAL ACTIVITIES). . . . . . . . . . . . N

OTHER (SPECIFY) __________________. . . .X

NO PROBLEM. . . . . . . . . . . . . . . . . . . . . . . . . . Y

THANK YOUR RESPONDENT AND MOVE TO THE NEXT DATA COLLECTION POINT

Appendix C • 271
272 • Appendix C
FACILITY NUMBER TOTAL NUMBER OF PROVIDERS LISTED ON ALL 5 SHEETS INTERVIEWER CODE

NAME OF PROVIDER

SELECTED FOR 

HEALTH WORKER 

INTERVIEW

04050607080910111214151617181920

MALARIA

(1) (2) (3) (4) (5)

01020313

(6)

DELIVERY

ANTENATAL 

CARE

FAM PLANNING

PMTCT

CONDUCT 

LABORATORY 

TESTS

PROVIDER 

QUALIFICATION 

CODE

GENDER 1-M 2-F 

INTERVIEWED FOR 

INVENTORY

01020304050607

SURGERY

STAFF LISTING FORM: HEALTH WORKERS AVAILABLE ON DAY OF VISIT

CHILD HEALTH PROV SERIAL NUMBER

OTHER CLIENT 

SERVICES

HIV 

COUNSELING 

AND TESTING

HIV/AIDS 

RELATED

SERVICES PROVIDED IN FACILITY

T PRESCRIBE ARDIAGNOSIS/TREATMENT

TB

STI

NCD

(7)

070809

1617181920

LIST ALL CLINICAL STAFF / PROVIDERS WHO ARE PRESENT TODAY IN THIS FACILITY. COMPILE THIS LIST AS THE TEAM MOVES FROM ONE SERVICE AREA (OR DEPARTMENT) TO ANOTHER OBTAINING INFORMATION ON THE SERVICES THAT THE FACILITY PROVIDES AND FOR WHICH INVENTORY SECTIONS ARE BEING COMPLETED, AND/OR FOR WHICH CLIENT-PROVIDER OBSERVATIONS ARE BEING DONE. WRITE THE HEALTH WORKER'S QUALIFICATION CODE IN COLUMN 3 "PROVIDER QUALIFICATION CODE", AND THE PROVIDER'S GENDER UNDER COLUMN 4 "GENDER". PUT CHECK MARKS IN THE APPROPRIATE HEADINGS UNDER COLUMN 5 "SERVICES PROVIDED IN FACILITY" TO INDICATE THE SERVICE THAT THE PROVIDER PROVIDES IN THE FACILITY. IN COLUMN 6 "INTERVIEWED FOR INVENTORY", 

CIRCLE THE LINE NUMBER IF THE PROVIDER WAS INTERVIEWED FOR ANY SECTION OF THE INVENTORY QUESTIONNAIRE. FINALLY, IN COLUMN 7 "SELECTED FOR HEALTH WORKER INTERVIEW" CIRCLE THE LINE NUMBER IF THE PROVIDER IS SELECTED TO BE INTERVIEWED WITH THE INDIVIDUAL HEALTH WORKER QUESTIONNAIRE.

010203040506101112131415161718

1415

1920

080910111213

Appendix C • 273
PROVIDER QUALIFICATION CATEGORY:

SPECIALIST/CONSULTANT MEDICINE [INCLUDING CARDIOLOGY]. . . . . . . . 01 MATRON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12SPECIALIST/CONSULTANT GENERAL SURGERY. . . . . . . . . . . . . . . . . . . . . . . 02 NURSING SUPERVISOR . . . . . . . . . . . . . . . . . . . . . . . . . . . 13SPECIALIST/CONSULTANT OBSTETRICS / GYNECOLOGY. . . . . . . . . . . . . . . 03 SENIOR STAFF NURSE . . . . . . . . . . . . . . . . . . . . . . . . . . . 14SPECIALIST/CONSULTANT PEDIATRICS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 04 ASSISTANT NURSE / STAFF NURSE (IN PRIVATE). . . . . . . . . 15SPECIALIST/CONSULTANT PSYCHIATRY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05 FAMILY WELFARE VISITOR (FWV) . . . . . . . . . . . . . . . . . . 16SPECIALIST/CONSULTANT ANESTHESIA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06 FAMILY WELFARE ASSISTANT (FWA). . . . . . . . . . . . . . . . 17ANY OTHER SPECIALIST/CONSULTANT NOT LISTED ABOVE. . . . . . . . . . . . .07 HEALTH ASSISTANT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

COMMUNITY HEALTH CARE PROVIDER. . . . . . . . . . . . . . 19HEALTH INSPECTOR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

. . . . . . . . . . . . . . . . . 08 ASSISTANT HEALTH INSPECTOR. . . . . . . . . . . . . . . . . . . 21

NUTRITIONIST. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22HEALTH EDUCATOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23MEDICAL TECHNOLOGIST - LABORATORY. . . . . . . . . . . 25

MEDICAL OFFICER - ANESTHETIST. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .09 MEDICAL TECHNOLOGIST - EPI.. . . . . . . . . . . . . . . . . . . . 26DENTAL SURGEON. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 MIDWIFE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30SACMO / MEDICAL ASSISTANT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 PARAMEDICS (IN PRIVATE/NGO) . . . . . . . . . . . . . . . . . . . . . . . .31

NURSE MIDWIFE 32TB LEPROSY CONTROL ASSISTANT (TLC) 33OTHER NON-CLINICAL/NON-TECHNICAL STAFF 95

OTHER CLINICAL STAFF NOT LISTED ABOVE_______________96

(SPECIFY)

MEDICAL OFFICER (MBBS) (ANY NON-SPECIALIST DOCTOR, INCLUDING ASSISTANT SURGEON, EMO, IMO, MCH/FP, RMO, REGARDLESS OF DESIGNATION OR TITLE)

274 • Appendix C
FACILITY NUMBER INTERVIEWER CODE

NAME OF PROVIDER

2122

TB

OTHER CLIENT 

SERVICES

NCD

DELIVERY

FAM PLANNING

CHILD HEALTH

SURGERY

CONDUCT 

LABORATORY 

TESTS

PRESCRIBE ART

HIV COUNSELING 

AND TESTING

DIAGNOSIS/TREATMENT

C

N

A

PMTCT

28293031

(1) (2) (3) (4)

PROVIDER 

QUALIFICATION 

CODE

GENDER

21222324252627

(5)

NUMBER

PROV

SERIAL

HIV/AIDS 

RELATED

MALARIA

333435

STAFF LISTING FORM: HEALTH WORKERS AVAILABLE ON DAY OF VISIT

SERVICES PROVIDED IN FACILITY

STI

29

272829

2324252627

23

LIST ALL CLINICAL STAFF / PROVIDERS WHO ARE PRESENT TODAY IN THIS FACILITY. COMPILE THIS LIST AS THE TEAM MOVES FROM ONE SERVICE AREA (OR DEPARTMENT) TO ANOTHER OBTAINING INFORMATION ON THE SERVICES THAT THE FACILITY PROVIDES AND FOR WHICH INVENTORY SECTIONS ARE BEING COMPLETED, AND/OR FOR WHICH CLIENT-PROVIDER OBSERVATIONS ARE BEING DONE. WRITE THE HEALTH WORKER'S QUALIFICATION CODE IN COLUMN 3 "PROVIDER QUALIFICATION CODE", AND THE PROVIDER'S GENDER UNDER COLUMN 4 "GENDER". PUT CHECK MARKS IN THE APPROPRIATE HEADINGS UNDER COLUMN 5 "SERVICES PROVIDED IN FACILITY" TO INDICATE THE SERVICE THAT THE PROVIDER PROVIDES IN THE FACILITY. IN COLUMN 6 "INTERVIEWED FOR INVENTORY", 

CIRCLE THE LINE NUMBER IF THE PROVIDER WAS INTERVIEWED FOR ANY SECTION OF THE INVENTORY QUESTIONNAIRE. FINALLY, IN COLUMN 7 "SELECTED FOR HEALTH WORKER INTERVIEW" CIRCLE THE LINE NUMBER IF THE PROVIDER IS SELECTED TO BE INTERVIEWED WITH THE INDIVIDUAL HEALTH WORKER QUESTIONNAIRE.

242526

2122

INTERVIEWED FOR 

INVENTORY

SELECTED FOR 

HEALTH WORKER 

INTERVIEW

(6) (7)

28

303132333435363740

383940

303132333435

323637 37

383940

3839

36

Appendix C • 275
PROVIDER QUALIFICATION CATEGORY:

SPECIALIST/CONSULTANT MEDICINE [INCLUDING CARDIOLOGY]. . . . . . . . 01 MATRON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12SPECIALIST/CONSULTANT GENERAL SURGERY. . . . . . . . . . . . . . . . . . . . . . . 02 NURSING SUPERVISOR . . . . . . . . . . . . . . . . . . . . . . . . . . . 13SPECIALIST/CONSULTANT OBSTETRICS / GYNECOLOGY. . . . . . . . . . . . . . . 03 SENIOR STAFF NURSE . . . . . . . . . . . . . . . . . . . . . . . . . . . 14SPECIALIST/CONSULTANT PEDIATRICS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 04 ASSISTANT NURSE / STAFF NURSE (IN PRIVATE). . . . . . . . . 15SPECIALIST/CONSULTANT PSYCHIATRY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05 FAMILY WELFARE VISITOR (FWV) . . . . . . . . . . . . . . . . . . 16SPECIALIST/CONSULTANT ANESTHESIA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06 FAMILY WELFARE ASSISTANT (FWA). . . . . . . . . . . . . . . . 17ANY OTHER SPECIALIST/CONSULTANT NOT LISTED ABOVE. . . . . . . . . . . . .07 HEALTH ASSISTANT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

COMMUNITY HEALTH CARE PROVIDER. . . . . . . . . . . . . . 19HEALTH INSPECTOR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

. . . . . . . . . . . . . . . . . 08 ASSISTANT HEALTH INSPECTOR. . . . . . . . . . . . . . . . . . . 21

NUTRITIONIST. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22HEALTH EDUCATOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23MEDICAL TECHNOLOGIST - LABORATORY. . . . . . . . . . . 25

MEDICAL OFFICER - ANESTHETIST. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .09 MEDICAL TECHNOLOGIST - EPI.. . . . . . . . . . . . . . . . . . . . 26DENTAL SURGEON. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 MIDWIFE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30SACMO / MEDICAL ASSISTANT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 PARAMEDICS (IN PRIVATE/NGO) . . . . . . . . . . . . . . . . . . . . . . . .31

NURSE MIDWIFE 32TB LEPROSY CONTROL ASSISTANT (TLC) 33OTHER NON-CLINICAL/NON-TECHNICAL STAFF 95

OTHER CLINICAL STAFF NOT LISTED ABOVE_______________96

(SPECIFY)

MEDICAL OFFICER (MBBS) (ANY NON-SPECIALIST DOCTOR, INCLUDING ASSISTANT SURGEON, EMO, IMO, MCH/FP, RMO, REGARDLESS OF DESIGNATION OR TITLE)

276 • Appendix C
FACILITY NUMBER INTERVIEWER CODE

(7) (1)

R

STAFF LISTING FORM: HEALTH WORKERS AVAILABLE ON DAY OF VISIT

(2) (3) (4) (5) (6)

SERVICES PROVIDED IN FACILITY

LIST ALL CLINICAL STAFF / PROVIDERS WHO ARE PRESENT TODAY IN THIS FACILITY. COMPILE THIS LIST AS THE TEAM MOVES FROM ONE SERVICE AREA (OR DEPARTMENT) TO ANOTHER OBTAINING INFORMATION ON THE SERVICES THAT THE FACILITY PROVIDES AND FOR WHICH INVENTORY SECTIONS ARE BEING COMPLETED, AND/OR FOR WHICH CLIENT-PROVIDER OBSERVATIONS ARE BEING DONE. WRITE THE HEALTH WORKER'S QUALIFICATION CODE IN COLUMN 3 "PROVIDER QUALIFICATION CODE", AND THE PROVIDER'S GENDER UNDER COLUMN 4 "GENDER". PUT CHECK MARKS IN THE APPROPRIATE HEADINGS UNDER COLUMN 5 "SERVICES PROVIDED IN FACILITY" TO INDICATE THE SERVICE THAT THE PROVIDER PROVIDES IN THE FACILITY. IN COLUMN 6 "INTERVIEWED FOR INVENTORY", 

CIRCLE THE LINE NUMBER IF THE PROVIDER WAS INTERVIEWED FOR ANY SECTION OF THE INVENTORY QUESTIONNAIRE. FINALLY, IN COLUMN 7 "SELECTED FOR HEALTH WORKER INTERVIEW" CIRCLE THE LINE NUMBER IF THE PROVIDER IS SELECTED TO BE INTERVIEWED WITH THE INDIVIDUAL HEALTH WORKER QUESTIONNAIRE.

R T

G 

ROFN

R O

R KER

T N

DIAGNOSIS/TREATMENT G

NHTY

TRA

G INLG

O FD

ON 

FOKROW N IEN NI H LT A YRO A E B LES GNI DE WYRR OTI A AED T

O WH

EW

CLI

ESYR

NNA

AEH

YR

CT OTASDE PROV E IB R SNU

STIWIE Y OR

ER D

A ICR

NAME OF PROVIDER

A RIA

E CTE

TH L

E VI R C R E E IC VTC REV A PL

D HREG CUD AROST S ID A

TEA

SERIAL RC

S

UOC

S TE

RVIO NT E ID V I IF LE REDNAME OF PROVIDER A

LA

C LEE

ALE

RET

EHT

VRE

C

N

CTM

V LIE

P M A

DILH

GRU

DNO

OBA

STE

A V/ALEDCNUMBER BI T SER C V T D N R TENEV VOR LAU EDO DNE

414244

AM

5960

SEEH T INT OESNA MPEDAFHCUSOC

LA

TEV HIER

444546474849505152535960

CN

414243

TBTSRP V HINA

5455565758

4849505152

48495152

4755

5056

4353545657585960

535455

4546

T IN

414243444546475758

V INRPUQOCEG

Appendix C • 277
PROVIDER QUALIFICATION CATEGORY:

SPECIALIST/CONSULTANT MEDICINE [INCLUDING CARDIOLOGY]. . . . . . . . 01 MATRON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12SPECIALIST/CONSULTANT GENERAL SURGERY. . . . . . . . . . . . . . . . . . . . . . . 02 NURSING SUPERVISOR . . . . . . . . . . . . . . . . . . . . . . . . . . . 13SPECIALIST/CONSULTANT OBSTETRICS / GYNECOLOGY. . . . . . . . . . . . . . . 03 SENIOR STAFF NURSE . . . . . . . . . . . . . . . . . . . . . . . . . . . 14SPECIALIST/CONSULTANT PEDIATRICS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 04 ASSISTANT NURSE / STAFF NURSE (IN PRIVATE). . . . . . . . . 15SPECIALIST/CONSULTANT PSYCHIATRY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05 FAMILY WELFARE VISITOR (FWV) . . . . . . . . . . . . . . . . . . 16SPECIALIST/CONSULTANT ANESTHESIA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06 FAMILY WELFARE ASSISTANT (FWA). . . . . . . . . . . . . . . . 17ANY OTHER SPECIALIST/CONSULTANT NOT LISTED ABOVE. . . . . . . . . . . . .07 HEALTH ASSISTANT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

COMMUNITY HEALTH CARE PROVIDER. . . . . . . . . . . . . . 19HEALTH INSPECTOR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

. . . . . . . . . . . . . . . . . 08 ASSISTANT HEALTH INSPECTOR. . . . . . . . . . . . . . . . . . . 21

NUTRITIONIST. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22HEALTH EDUCATOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23MEDICAL TECHNOLOGIST - LABORATORY. . . . . . . . . . . 25

MEDICAL OFFICER - ANESTHETIST. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .09 MEDICAL TECHNOLOGIST - EPI.. . . . . . . . . . . . . . . . . . . . 26DENTAL SURGEON. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 MIDWIFE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30SACMO / MEDICAL ASSISTANT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 PARAMEDICS (IN PRIVATE/NGO) . . . . . . . . . . . . . . . . . . . . . . . .31

NURSE MIDWIFE 32TB LEPROSY CONTROL ASSISTANT (TLC) 33OTHER NON-CLINICAL/NON-TECHNICAL STAFF 95

OTHER CLINICAL STAFF NOT LISTED ABOVE_______________96

(SPECIFY)

MEDICAL OFFICER (MBBS) (ANY NON-SPECIALIST DOCTOR, INCLUDING ASSISTANT SURGEON, EMO, IMO, MCH/FP, RMO, REGARDLESS OF DESIGNATION OR TITLE)

278 • Appendix C
FACILITY NUMBER TOTAL NUMBER OF PROVIDERS LISTED ON ALL 5 SHEETS INTERVIEWER CODE

STAFF LISTING FORM: HEALTH WORKERS AVAILABLE ON DAY OF VISIT

R

(1) (2) (3) (4) (5)

SERVICES PROVIDED IN FACILITY

(6) (7)

LIST ALL CLINICAL STAFF / PROVIDERS WHO ARE PRESENT TODAY IN THIS FACILITY. COMPILE THIS LIST AS THE TEAM MOVES FROM ONE SERVICE AREA (OR DEPARTMENT) TO ANOTHER OBTAINING INFORMATION ON THE SERVICES THAT THE FACILITY PROVIDES AND FOR WHICH INVENTORY SECTIONS ARE BEING COMPLETED, AND/OR FOR WHICH CLIENT-PROVIDER OBSERVATIONS ARE BEING DONE. WRITE THE HEALTH WORKER'S QUALIFICATION CODE IN COLUMN 3 "PROVIDER QUALIFICATION CODE", AND THE PROVIDER'S GENDER UNDER COLUMN 4 "GENDER". PUT CHECK MARKS IN THE APPROPRIATE HEADINGS UNDER COLUMN 5 "SERVICES PROVIDED IN FACILITY" TO INDICATE THE SERVICE THAT THE PROVIDER PROVIDES IN THE FACILITY. IN COLUMN 6 "INTERVIEWED FOR INVENTORY", 

CIRCLE THE LINE NUMBER IF THE PROVIDER WAS INTERVIEWED FOR ANY SECTION OF THE INVENTORY QUESTIONNAIRE. FINALLY, IN COLUMN 7 "SELECTED FOR HEALTH WORKER INTERVIEW" CIRCLE THE LINE NUMBER IF THE PROVIDER IS SELECTED TO BE INTERVIEWED WITH THE INDIVIDUAL HEALTH WORKER QUESTIONNAIRE.

N

ROF

R T

G 

ON 

O FD

R O

R KER

T NYGNHT DIAGNOSIS/TREATMENT TRA G INLG

R

OTIA

DEWYR

FOKROW N IEYRO N NI H LT A A E B LES GNI

ER D

A ICR WIE Y OR

ED T

O WH

EWPROV

CLI

ES

CT OTA NNA AEH YRYRSDEA E IB R SNU

STI

NAME OF PROVIDER

E IDV

I IFLE

RED

RVIO NTE CT E

TH L

E VI R C R E E IC V CUD AROST TC A PL

D HREG REV S ID A

TEA

A RIA

RCS

UOC

S TESERIAL NAME OF PROVIDER V

OR

LAU

EDO

DNE

R TENEV C LE E

ALE

RET

EHT

VRE

DNO

OBA

STE

C

N

CTM

P M A

DILH

GRU

V LIE

A V/ALE ALAB SER C V T D NI T DCNUMBER R

P

UQOCEG T INV IN

SEEH T IN

6162636465666869707172737475767778

TO

ES

OC

LA

TENA MPAFHCUSED V HIERA M

TB

77 7763646566676970717273747576

7173747576

7980

7980

78

697078

6162

RP

727980

68

636465666768

V HINATSCN

6162

67

Appendix C • 279
PROVIDER QUALIFICATION CATEGORY:

SPECIALIST/CONSULTANT MEDICINE [INCLUDING CARDIOLOGY]. . . . . . . . 01 MATRON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12SPECIALIST/CONSULTANT GENERAL SURGERY. . . . . . . . . . . . . . . . . . . . . . . 02 NURSING SUPERVISOR . . . . . . . . . . . . . . . . . . . . . . . . . . . 13SPECIALIST/CONSULTANT OBSTETRICS / GYNECOLOGY. . . . . . . . . . . . . . . 03 SENIOR STAFF NURSE . . . . . . . . . . . . . . . . . . . . . . . . . . . 14SPECIALIST/CONSULTANT PEDIATRICS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 04 ASSISTANT NURSE / STAFF NURSE (IN PRIVATE). . . . . . . . . 15SPECIALIST/CONSULTANT PSYCHIATRY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05 FAMILY WELFARE VISITOR (FWV) . . . . . . . . . . . . . . . . . . 16SPECIALIST/CONSULTANT ANESTHESIA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06 FAMILY WELFARE ASSISTANT (FWA). . . . . . . . . . . . . . . . 17ANY OTHER SPECIALIST/CONSULTANT NOT LISTED ABOVE. . . . . . . . . . . . .07 HEALTH ASSISTANT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

COMMUNITY HEALTH CARE PROVIDER. . . . . . . . . . . . . . 19HEALTH INSPECTOR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

. . . . . . . . . . . . . . . . . 08 ASSISTANT HEALTH INSPECTOR. . . . . . . . . . . . . . . . . . . 21

NUTRITIONIST. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22HEALTH EDUCATOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23MEDICAL TECHNOLOGIST - LABORATORY. . . . . . . . . . . 25

MEDICAL OFFICER - ANESTHETIST. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .09 MEDICAL TECHNOLOGIST - EPI.. . . . . . . . . . . . . . . . . . . . 26DENTAL SURGEON. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 MIDWIFE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30SACMO / MEDICAL ASSISTANT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 PARAMEDICS (IN PRIVATE/NGO) . . . . . . . . . . . . . . . . . . . . . . . .31

NURSE MIDWIFE 32TB LEPROSY CONTROL ASSISTANT (TLC) 33OTHER NON-CLINICAL/NON-TECHNICAL STAFF 95

OTHER CLINICAL STAFF NOT LISTED ABOVE_______________96

(SPECIFY)

MEDICAL OFFICER (MBBS) (ANY NON-SPECIALIST DOCTOR, INCLUDING ASSISTANT SURGEON, EMO, IMO, MCH/FP, RMO, REGARDLESS OF DESIGNATION OR TITLE)

280 • Appendix C
FACILITY NUMBER TOTAL NUMBER OF PROVIDERS LISTED ON ALL 5 SHEETS INTERVIEWER CODE

90 909193 9394 9495 9596 9697 9798 9899 99

91

83 8384 8485 8586 8687 8788 888992 92

(5)

89

(6) (7)

INTERVIEWED FOR 

INVENTORY

SELECTED FOR 

HEALTH WORKER 

INTERVIEW

81 8182 82

STAFF LISTING FORM: HEALTH WORKERS AVAILABLE ON DAY OF VISIT

(1) (2)

81828384858687888990919293949596979899

(3) (4)

LIST ALL CLINICAL STAFF / PROVIDERS WHO ARE PRESENT TODAY IN THIS FACILITY. COMPILE THIS LIST AS THE TEAM MOVES FROM ONE SERVICE AREA (OR DEPARTMENT) TO ANOTHER OBTAINING INFORMATION ON THE SERVICES THAT THE FACILITY PROVIDES AND FOR WHICH INVENTORY SECTIONS ARE BEING COMPLETED, AND/OR FOR WHICH CLIENT-PROVIDER OBSERVATIONS ARE BEING DONE. WRITE THE HEALTH WORKER'S QUALIFICATION CODE IN COLUMN 3 "PROVIDER QUALIFICATION CODE", AND THE PROVIDER'S GENDER UNDER COLUMN 4 "GENDER". PUT CHECK MARKS IN THE APPROPRIATE HEADINGS UNDER COLUMN 5 "SERVICES PROVIDED IN FACILITY" TO INDICATE THE SERVICE THAT THE PROVIDER PROVIDES IN THE FACILITY. IN COLUMN 6 "INTERVIEWED FOR INVENTORY", 

CIRCLE THE LINE NUMBER IF THE PROVIDER WAS INTERVIEWED FOR ANY SECTION OF THE INVENTORY QUESTIONNAIRE. FINALLY, IN COLUMN 7 "SELECTED FOR HEALTH WORKER INTERVIEW" CIRCLE THE LINE NUMBER IF THE PROVIDER IS SELECTED TO BE INTERVIEWED WITH THE INDIVIDUAL HEALTH WORKER QUESTIONNAIRE.

SERIAL

DIAGNOSIS/TREATMENT

OTHER CLIENT 

SERVICES

HIV/AIDS 

RELATED

MALARIA

TB

STI

NCD

DELIVERY

FAM PLANNING

CHILD HEALTH PROV NUMBER NAME OF PROVIDER

PROVIDER 

QUALIFICATION 

CODE

GENDER

ANTENATAL CARE

PMTCT

SURGERY

CONDUCT 

LABORATORY 

TESTS

SERVICES PROVIDED IN FACILITY

PRESCRIBE ART

HIV COUNSELING 

AND TESTING

Appendix C • 281
PROVIDER QUALIFICATION CATEGORY:

SPECIALIST/CONSULTANT MEDICINE [INCLUDING CARDIOLOGY]. . . . . . . . 01 MATRON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12SPECIALIST/CONSULTANT GENERAL SURGERY. . . . . . . . . . . . . . . . . . . . . . . 02 NURSING SUPERVISOR . . . . . . . . . . . . . . . . . . . . . . . . . . . 13SPECIALIST/CONSULTANT OBSTETRICS / GYNECOLOGY. . . . . . . . . . . . . . . 03 SENIOR STAFF NURSE . . . . . . . . . . . . . . . . . . . . . . . . . . . 14SPECIALIST/CONSULTANT PEDIATRICS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 04 ASSISTANT NURSE / STAFF NURSE (IN PRIVATE). . . . . . . . . 15SPECIALIST/CONSULTANT PSYCHIATRY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 05 FAMILY WELFARE VISITOR (FWV) . . . . . . . . . . . . . . . . . . 16SPECIALIST/CONSULTANT ANESTHESIA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06 FAMILY WELFARE ASSISTANT (FWA). . . . . . . . . . . . . . . . 17ANY OTHER SPECIALIST/CONSULTANT NOT LISTED ABOVE. . . . . . . . . . . . .07 HEALTH ASSISTANT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

COMMUNITY HEALTH CARE PROVIDER. . . . . . . . . . . . . . 19HEALTH INSPECTOR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

. . . . . . . . . . . . . . . . . 08 ASSISTANT HEALTH INSPECTOR. . . . . . . . . . . . . . . . . . . 21

NUTRITIONIST. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22HEALTH EDUCATOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23MEDICAL TECHNOLOGIST - LABORATORY. . . . . . . . . . . 25

MEDICAL OFFICER - ANESTHETIST. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .09 MEDICAL TECHNOLOGIST - EPI.. . . . . . . . . . . . . . . . . . . . 26DENTAL SURGEON. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 MIDWIFE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30SACMO / MEDICAL ASSISTANT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 PARAMEDICS (IN PRIVATE/NGO) . . . . . . . . . . . . . . . . . . . . . . . .31

NURSE MIDWIFE 32TB LEPROSY CONTROL ASSISTANT (TLC) 33OTHER NON-CLINICAL/NON-TECHNICAL STAFF 95

OTHER CLINICAL STAFF NOT LISTED ABOVE_______________96

(SPECIFY)

MEDICAL OFFICER (MBBS) (ANY NON-SPECIALIST DOCTOR, INCLUDING ASSISTANT SURGEON, EMO, IMO, MCH/FP, RMO, REGARDLESS OF DESIGNATION OR TITLE)

STAFF LISTING FORM: HEALTH WORKERS AVAILABLE ON DAY OF VISIT

282 • Appendix C

ADDITIONAL DHS PROGRAM RESOURCES

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