Indicator: |
Availability of STG for common local conditions |
| |
Availability of Essential Drug List (EDL) at the facility |
Public Health Facility Facility #____ (1-30) |
Facility _______________________ |
Date ________________________ |
Location ______________________ |
Investigator __________________ |
Tick box with correct answer
Standard treatment guidelines available |
Yes1 |
No |
National STG |

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STG for URTI |

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STG for Diarrhoea |

|

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STG for Pneumonia |

|

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STG for Malaria |

|

|
STG for Tuberculosis |

|

|
Others: |

|

|
EDL available |
Yes1 |
No |
National EDL |

|

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Provincial/District |

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Primary EDL |

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Others: |

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STG is available in this facility2 |
Yes1 |
No  |
EDL is available in this facility3 |
Yes1 |
No  |
Notes |
1. |
Mark “yes” only if the facility is able to show you the document. |
2. |
The facility is considered to have an STG if any one of the above STGs is available provided it was developed by an independent group and is not associated with promoting pharmaceutical products. |
3. |
Before the survey, the most up-to-date version of EDL must be identified. The facility is considered to have an EDL if any one of the above EDLs is available. |