KAYAKALP

PRESENTER: DR. RAM PRAGADEESH. S

MODERATOR: DR. PADMAJA R. WALVEKAR

07-04-2021
 CONTENTS
 Process of Assessment
 Assessment components
 Checklist
 Assessment scores
 Score card for assessment
 Kaykalp Assessment criterion for a PHC
 Strengths and Limitations
2
 Process of Assessment
LEVEL OF INTERNAL PEER EXTERNAL ASSESSMENT DECLARATION
FACILITY ASSESSMEN ASSESSMENT OF AWARDS
T (At least
(Every yearly)
quarter)
PHC • By facility • By similar • External assessor • District level
• Mandatory facility (PHC) nominated by District DECLARATIO
award
INTERNAL PEER
of other block levelEXTERNAL
award nomination nomination
N OF
ASSESSMENT ASSESSMENT
• Mandatory ASSESSMENT
committee committee
AWARDS
• For facilities with score
≥70%
DH & • By facility • By similar • External assessor • State level
SDH/CHC • Mandatory facility (DH, nominated by State level award
SDH/CHC) of award nomination nomination
other block or committee committee
district • For facilities with score 3

• Mandatory ≥70%
 Kayakalp assessment components
The Awards are finalized based on the weighted average Score obtained under two
criterias:
1. Kayakalp Score: (weightage 85%) 2. Mera Aspataal Score: (weightage 15%)

It is obtained under following parameters: The indicator is % of patients dissatisfied

a. Hospital/Facility Upkeep with the cleanliness.
b. b. Sanitation and hygiene
c. Waste Management
d. Infection control
e. Support Services
f. Hygiene Promotion
g. Cleanliness beyond Hospital/facility
Boundary wall

4
 Methodology for Calculating Weighted Average Score Under
Kayakalp
For example, in a Hospital A the following facility and state data is
given:
• % of patient dissatisfied with cleanliness at Hospital A - 15%
• External Assessment Score of Hospital A - 84%.
• Max. % dissatisfied with cleanliness in the State* - 25%
• Min. % dissatisfied with cleanliness in the State*- 10%

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 Kayakalp score assessment
• The Kayakalp score assessment is done using Checklists.

• There are four types of checklists for four different levels of health facilities:

1. Secondary care Level Checklist - Applicable to District Hospitals, Sub District/Taluk Hospital,
CHCs and UCHCs.
2. Checklist for 24X7 PHC/UPHC- Applicable to PHC/UPHC with indoor facilities and Labour
room.
3. Checklist for PHC/UPHC (Without Beds) - Applicable to ambulatory setups such as
Additional PHCs & Urban PHCs.
4. Checklist for HWCs-SC - Applicable to Sub Centre level Health and Wellness centre.

• Checklists can be accessed from: [Link]

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 KAYAKALP—Anatomy of Checklist

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 Themes for Assessment

A. Hospital B. Sanitation & C. Waste D. Infection

upkeep Hygiene (10) Management (10) Control (10)
(10)

E. Support F. Hygiene G. Beyond …

Services (5) promotions (5) Boundary wall
……..(10/6/4)
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 Assessment Method

OBSERVATION (OB) STAFF INTERVIEW (SI) PATIENT INTERVIEW (PI) RECORD REVIEW (RR)

Assessor may choose any of the method mentioned in

the checklist with respective checkpoint.
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 Compliance & Scoring Rules

 All Requirements in Checkpoint are Meeting

Full
Compliance 2  All Tracers given in Means of verification are
available
 Intent of check point is meeting

 Some of the requirements in checkpoints are

Partial
Compliance 1 meeting
 At Least 50% of tracers in Means of
verification are available
 Intent of check point is partially meeting

 Most of the requirements are not meeting

Non
Compliance 0  Less than 50% of tracers in Means of
verification are available
 Intent of Check point is not meeting
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 0

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13
 A1. Pest Control & Animal
Control
Observe for the presence of
Check
stray animals Point
such as dogs,
cats, cattle, pigs, etc. within the Check for:
premises.
A1.1 No stray Also discuss
animals withthe
within the a. Usage of Mosquito nets
Ask the facility administration
facility staff.
facility premises by the patients
about pest control measures
Check at the entrance of the b. Availability of adequate
to control rodents and insect.
facility
A1.2 Pest Controlfor cattle trap. stock of Mosquito nets
Check records of engaging a
Measures are professional agency for the c. Wire Mesh in windows
implemented in the facility same d. Desert Coolers (if in
use) are cleaned
A 1.3 Measures for regularly/oil is sprinkled
Mosquito free environment e. No water collection for
are in place mosquito breeding
within the premises
f. Gambusia fish in
cultivation
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 Points to take into consideration
during assessment
1. All areas/departments of facility should be assessed for arriving scores.

2. Each checkpoint has its own exclusive requirements. No triangulation permitted.

3. There is no option for “Not Applicable”.

4. For ease of assessment, assessors may divide thematic areas amongst team members.

5. Any checkpoints starting with “No” are absolute checkpoints, having only full or
noncompliance..

6. Kayakalp checklist is facility level checklist. There are no departmental checklists.

7. For a checkpoint, where multiple items are required to be checked in more than one
department, the compliance will be based on the total score arrived for this checkpoint.
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16
 SCORECARD
» The score card for assessment is different based on the type
of health facility,

» SECTION A: DH / CHC / SDH (total score 600)

» SECTION B: PHC with beds (total score 360)
» SECTION C: PHC without beds (total score 240)
» SECTION D: HWC (total score 240)

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 First internal assessment scores 2015

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 Second internal assessment scores

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 Peer assessment scores

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External assessment scores

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 KAYAKALP CRITERION FOR A PHC

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 A1. Pest & Animal
A10. Work Place Control
A2. Landscaping , Gardening &
Management Yoga

A9. Water
A3. Maintenance of open area
Conservation

Theme A

A8. Removal of Junk A4. Hospital Appearance

Material
Hospital Upkeep

A7. Maintenance of A5. Infrastructure

Furniture & Fixtures Maintenance

A6. Illumination
07-04-2021 23
 A1. Pest Control & Animal
Control
Check Point
A1.1 No stray animals within the
facility premises

A1.2 Pest Control

Measures are
implemented in the facility

A 1.3 Measures for

Mosquito free environment
are in place

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 A2 Landscaping & Gardening

Check Point
• A 2.1 Front area/ Parks/ Open
spaces are well maintained

• A2.2 Internal Roads, Pathways, etc.

are even and clean

• A 2.3 Provision of Herbal Garden

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 A3 Maintenance of Open
Areas
Check Point
A3.1 There is no abandoned /
dilapidated building within the
premises
A3.2 No water logging in open
areas
A3.3 There is no unauthorised
occupation within the facility, nor
there is encroachment on PHC land

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 A4 PHC Appearance

Check Point
A4.1 Name of the facility is
prominently displayed at
the entrance

A4.2 Walls are well-plastered and

painted

A4.3 Uniform signage system in

the PHC

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 A5 Infrastructure
Maintenance
No. No
Seepage Cracks
Check Point
A5.1 PHC Infrastructure is Parking for
well maintained
Ambulanc
A5.2 PHC has intact boundary wall e
and functional gates at entry
No
A5.3 PHC has adequate facility forNo Chipped
parking of vehicles broke
Floor

n wall
Parking No Chipped
for plaster
vehicles
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 A6 ILLUMINATION

Check Point
A6.1 Adequate illumination inside the
building
A6.2 Adequate illumination in
Outside of the PHC
A6.3 Use of Energy efficiency
measures like CFL or LED

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 A7 Maintenance of Furniture & Fixture

Check Point
A7.1 Window and doors are
maintained

A7.2 Patients furniture are in

good condition

A7.3 Furniture at the nursing

station, staff room,
administrative office are
maintained

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 A8 Removal of Junk
Material
Check Point
A8.1 PHC has documented and
implemented States' Condemnation
policy

A 8.2 No junk material within

the PHC premises

A8.3 PHC has demarcated

space for keeping condemned
junk material

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 A9- WATER CONSERVATION

Check Point
A9.1 Water supply system is
maintained in the PHC

A9.2 Preventive measures are

taken to reduce wastage and
reuse of water

A9.3 PHC has a functional rain

water harvesting system

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 A10 Work Place
Identify and remove
Management Organise everything
needed in proper
Check Point
unwanted/unused items order for easy • The Staff
from the workplace and operation periodically sorts
reduce clutter (Orderliness) useful and
(Removal/organisation unnecessary
) articles at work
stations
Maintain high
• Useful articles,
standard of
cleanliness records, drugs, etc.
(Cleanliness are arranged
) systematically
• Articles are labelled
Train and maintain for easy
discipline of the Set up the above recognition and
personnel engaged 3S as norms in easy retrieval.
(Self-discipline) every section of
the workplace
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 B1. Clean Circulation area

B10. Drainage and sewage B2. Cleanliness of Clinic room

management

B3. Clean procedure area

B9. Monitoring of Theme B
cleanliness activities

B8. Use of Standard Sanitation & B4. Cleanliness storage

methods for cleaning area
Hygiene

B5. Cleanliness roof top

B7. Use of Standard B6. Cleanliness Toilets

material and equipment
for cleaning
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 B1 Cleanliness of Circulation Area

Check Point
B1.1 No dirt/Grease/Stains/
Cobwebs/Bird Nest/ Dust/ vegetation
on the walls and roof in the PHC's
circulation area

B1.2 Corridors are cleaned at

least twice in a day with wet
mop

B1.3Surfaces are conducive for

effective cleaning

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 B2 Cleanliness of Wards

Check Point
No dirt/Grease/Stains/ Cobwebs/Bird
Nest/ Dust/ vegetation on the walls
and roof in the PHC's ward

Wards are cleaned at least

thrice in a day with wet mop

Surfaces are conducive for

effective cleaning

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 B3 Cleanliness of Procedure Areas

Check Point
No dirt/Grease/Stains/ Cobwebs/Bird
Nest/ Dust/ vegetation on the walls
and roof in the procedure area.

Procedure area are cleaned at

least twice in a day/ after every
procedure (as applicable)

Surfaces are conducive for

effective cleaning

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 B4 Cleanliness of Ambulatory & Diagnostic Areas

Check Point
No dirt/Grease/Stains and
Cobwebs/Bird Nest/ Dust on walls
and roof in Ambulatory & Diagnostic
area
Ambulatory and Diagnostic
areas are cleaned at least twice
in a day with wet mop

Surfaces are conducive of

effective cleaning

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 B5 Cleanliness of Auxiliary Areas

Check Point
No dirt/Grease/Stains and
Cobwebs/Bird Nest/ Vegetation/
Dust on walls and roof in Auxiliary
area
Auxiliary areas are cleaned at
least twice in a day with wet
mop

Surfaces are conducive of

effective cleaning

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 B6 Cleanliness of Toilets

Check Point
No dirt/Grease/Stains/ Garbage in
Toilets

No foul smell in the Toilets and

its dry

Toilets have running water and

functional cistern

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 B7 Use of standards materials and Equipment for Cleaning

Check Point
Availability of Detergent Disinfectant
solution / Hospital Grade Phenyl for
Cleaning purpose

Availability of carbolic Acid/

Reputed compound (Aldehyde
& other chemicals e.g.
Bacillocid) for surface cleaning
in procedure areas- Labour
Room, OT (As Applicable)

Availability of Cleaning
Equipment

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 B8 Use of Standard Methods for Cleaning

Check Point
Use of Three bucket system for
cleaning

Use unidirectional method and

outward mopping

No use of brooms in patient

care areas

07-04-2021 Direction of cleaning (Unidirectional)

 B9 Monitoring of Cleanliness Activities

Check Point
Use of Housekeeping Checklist

Periodic Monitoring of
Housekeeping activities

Monitoring of adequacy and

quality of material used for
cleaning

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 B10 Drainage and Sewage Management

Check Point
Availability of closed drainage
system with adequate gradient

Availability of connection with

Municipal Sewage System/ soak
pit/ septic tank

No blocked/ over-flowing drains

in the facility

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 Implementation
of Biomedical
Segregation , Collection &
waste rule 16
transportation
Statuary Compliances

Sharp Management

Equipment & supplies

Theme C
of BMW

Storage of BMW
Liquid waste Waste
management Management

Disposal of BMW
Solid general waste
management
Management of
hazardous waste

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 C1 Segregation of Biomedical Waste

Check Point
Segregation of BMW is done as per
BMW management rule,2016 &
amendment

Display of work instructions for

segregation and handling of
Biomedical waste

Check if the staff is aware of

segregation protocol

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 C2 Collection and Transportation of Biomedical Waste

Check Point
The facility has linkage with a CWTF
Operator or has deep burial pit (with
prior approval of the prescribed
authority)

Biomedical waste bins are

covered

Transportation of biomedical
waste is done in closed
container/trolley

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 C3 Sharp Management

Check Point
Disinfection of Broken / Discarded
Glassware is done as per
recommended procedure

Sharp Waste is stored in

Puncture proof containers

Staff is aware of needle stick

injury Protocol

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 C4 Storage of Biomedical Waste

Check Point
Dedicated Storage facility is
available for biomedical waste

No Biomedical waste is stored

for more than 48 Hours

Access to waste storage facility

is secured

07-04-2021
 C5 Disposal of Biomedical waste

Check Point
PHC has adequate facility for
disposal of Biomedical waste

Facility manages recyclable

waste as per approved
procedure

Deep Burial Pit is constructed

as per norms given in the
Biomedical Waste Rules 2016 &
amendment

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 C6 Management Hazardous Waste

Check Point
Availability of Mercury Spill
Management Kit and Staff is aware
of Mercury Spill management

Disposal of used Disinfectant

solution like Glutaraldehyde

Disposal of Expired or
discarded medicine

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 C7 Solid General Waste Management

Check Point
Availability of Compost pit as per
specification

Disposal of General Waste

Innovations in managing
general waste

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 C8 Liquid Waste Management

Check Point
The laboratory has a functional
protocol for managing discarded
samples

Liquid waste is made safe

before mixing with other waste
water

The facility has treatment

facility for managing infectious
liquid waste

07-04-2021
 C9 Equipment and Supplies for Bio Medical Waste Management

Check Point
Availability of Bins for segregated
collection of waste at point of use

Availability of Needle/ Hub

cutter and puncture proof
boxes

Availability of Colour coded

liners for Biomedical waste and
general waste

07-04-2021
 C10 Statuary Compliances

Check Point
PHC has a valid authorization for
Bio Medical waste Management from
the prescribed authority

PHC submits Annual report to

pollution control board

PHC maintains records, as

required under the Biomedical
Waste Rules 2016 & amendment

07-04-2021
 Hand Hygiene
Environmental Control Personal Protective Equipments

Infection Surveillance
Personal Protective Practices

Theme D

Disinfection & Cleaning

Infection Control Program
Infection Control

Isolation & Barrier Nursing Autoclaving & Sterilization

07-04-2021 56
Spill Management
 D1 Hand Hygiene

Check Point
Availability of Sink and running
water at point of use

Display of Hand washing

Instructions

Staff is aware of standard hand

washing protocol

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 D2 Personal Protective Equipment (PPE)

Check Point
Use of Gloves during procedures
and examination

Use of Masks ,Head cap and

Lab coat, Apron etc.

Use of Heavy Duty Gloves and

gumboot by waste handlers

07-04-2021
 D3 Personal Protective Practices

Check Point
The staff is aware of use of gloves,
when to use (occasion) and its type

Correct method of wearing and

removing PPEs

No re-use of disposable
personal protective equipment

07-04-2021
 D4 Decontamination and Cleaning of Instruments

Check Point
Staff knows how to make Chlorine
solution

Decontamination of operating
and Surface examination table,
dressing tables etc. after every
procedures

Decontamination and cleaning

of instruments after use

07-04-2021
 D5 Disinfection & Sterilization of Instruments

Check Point
Adherence to Protocols for
sterilization

Adherence to Protocol for High

Level disinfection

Use of autoclave tape for

monitoring of sterilization

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 D6 Spill Management

Check Point
Staff is aware of how to manage
spills

Availability of spill management

Kit

Spill management protocols are

displayed at points if use

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 D7 Isolation and Barrier Nursing

Check Point
Infectious patients are not mixed for
general patients

Maintenance of adequate bed to

bed distance in wards

Restriction of external foot wear

in critical areas

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 D8 Infection Control Program

Check Point
Infection Control Committee is
constituted and functional in the
PHC

Antibiotic Policy is
implemented at the facility

Immunization and medical

check-up of Service Providers

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 D9 Hospital Acquired Infection Surveillance

Check Point
Facility measures the Health care
associated infections

Facility reports all notifiable

diseases and events

Regular Monitoring of infection

control practices

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 D10 Environment Control

Check Point
Cross-ventilation at Patient Care
areas (ward, labour room and
dressing room)

Preventive measures for air

borne infections has been taken

Adequate number of Air-

exchange in Laboratory

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 Theme E – Support
Service Storage space
Water housekeeping
Sanitation Services
Outreach
Laundry & services
Linen Services

07-04-2021 67
 E1 Laundry Services & Linen Management

Check Point
The facility has adequate stock
(including reserve) of linen

Bed-sheets and pillow cover are

stain free and clean

Bed-sheets and linen are

changed daily

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 E2 Water Sanitation

Check Point
The facility receives adequate
quantity of water as per requirement

There is storage tank for the

water and tank is cleaned
periodically

Drinking Water is tested and

chlorinated

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 E3 Pharmacy and Stores

Check Point
Medicines are arranged
systematically

Cold storage equipment's are

clean and managed properly

Cold storage equipment are not

used for storing other items,
than vaccine .

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 E4 Security Services

Check Point
One Security Guard per shift

Departments are locked after

working hours

Security personal reprimands

attendants, who found
indulging into unhygienic
behaviour - spitting, open field
urination & defecation, etc.

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 E5 Outreach Services

Check Point
Biomedical waste generated during
outreach session are transported to
the PHC on the same day
ASHA's are promoting
cleanliness and hygiene
practices

Medical officers monitor

cleanliness and hygiene of
outreach sessions and sub
centres.

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 Theme F – Hygiene
Promotion
Information,
Leadership & Training &
Education &
Team Work Capacity
Community Communication
Building
Monitoring &
Patients
Staff Hygiene
Participation
and Dress
Code

07-04-2021 73
 F1 Community Monitoring & Patient Participation

Check Point
Local community and organisations
are involved in monitoring and
promoting cleanliness

Patients are made aware of

their responsibility of keeping
the health facility clean

The Health facility has a system

to take feed-back from patients
and visitors for maintaining the
cleanliness of the facility

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 F2 Information Education and Communication

Check Point
IEC regarding importance of
maintaining hand hygiene is
displayed in PHC premises

IEC regarding Swachhta

IEC on Hand hygiene IEC on Swachhata Abhiyaan
Abhiyan is displayed within the
facilities’ premises

IEC regarding use of toilets is

displayed within PHC premises

IEC on use of toilets IEC regarding Water Sanitation

07-04-2021
 F3 Leadership and Team work

Check Point
Cleanliness and infection control
committee has representation of all
cadre of staff including Group ‘D’
and cleanings staff

Roles and responsibility of

different staff members have
been assigned and
communicated

PHC leadership review the

progress of the cleanliness
drive on weekly basis

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 F4 Training and Capacity Building and Standardization

Check Point
Bio medical waste Management
training has been provided to the
staff

Infection control Training has

been provided to the staff

PHC has documented Standard

Operating procedures for
Cleanliness, Bio-Medical waste
management and Infection
Control

07-04-2021
 F5 Staff Hygiene and Dress Code

Check Point
PHC has dress code policy for all
cadre of staff

There is a regular monitoring of

hygiene of staff

Identity cards and name plates

have been provided to all staff

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 Theme G. Beyond hospital
boundary
Cleanliness of Aesthetics of
Promotion of approach road & surrounding Maintenance
swachhata surrounding area of surrounding
in area area
surrounding
areas

07-04-2021 79
 G1 Promotion of Swachhata & Coordination with Local bodies
Check Point
Local community actively participates during
Swachhata Pakhwara(Fortnight)

Implementation of IEC activities related to '

Swachh Bharat Abhiyan'

Community awareness by organising

cultural programme and competitions

The Facility coordinates with local Gram

Panchayat/Urban local bodies and NGOs for
improving Swachhata in vicinity of the health
facility

Facility coordinates with other departments

for improving Swachhata
07-04-2021
G2 Leadership & tapping alternative source of funding for Swachhata
Check Point
Surrounding area is declared Open Defecation
Free

The Facility has undertaken initiative for

community mobilization in the surrounding
for improving Swachhata

The Facility endeavours to attract financial

support from other organisations

Facility endeavours to attract financial

support from local support

The facility engages the local Community for

reducing household pollutions in the vicinity

07-04-2021
 G3 Cleanliness of approach road and surrounding area
Check Point
Area around the facility is clean, neat and tidy

On the way signages are available

Approach road are even and free from pot-

holes

All drains/sewer are covered.

Functional street lights are available on the

approach road

07-04-2021
 G4 Public Amenities in Surrounding Area
Check Point
Availability of Public toilets/ Urinal in surrounding
Area

Such toilets/Urinal are neat & clean

Presence of Safe Drinking Water facility

outside the boundary wall

Availability of adequate parking facilities for

Public Transport such as Cycle Rickshaw,
Tanga, Auto, Taxi

Vendors & hawkers have designated place

outside the facility
07-04-2021
 G5 Aesthetics of Surrounding area
Check Point
Parks and green areas in the surrounding area
are well maintained

There are no stray animals in surrounding

area

Illumination in surrounding area

No unwanted/broken/torn/ loose hanging

posters/billboards.

No loose hanging wires in and around bill

boards, electrical polls etc.

07-04-2021
 G6 Maintenance of surrounding area and Waste Management
Check Point
Availability of bins for General recyclable and
biodegradable wastes

Availability of garbage storage area/ compost

pit

Innovations in managing waste

Surrounding areas are well maintained

Regular repairs and maintained of roads,

footpaths and pavements

07-04-2021
 Strengths
 Periodic assessment enables to know the growth and functioning of
a health care facility.

 Provides opportunities for upgradation of health care facilities.

 Incentives can provoke staff for better functioning.

 Benefit for the public towards better health care.

 It is only improving current status and no new materials required.

 Feedback from stake holders will improve the health care and public
perception towards government sectors will change.

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 Limitations
 Tedious process of filling the score card.

 Lack of training and sensitization.

 Lack of accuracy in few checkpoints.

 Subjective variations and errors.

 Lot of disparity between scores assessment.

 Lack of funds for improving health care facilities.

 It is only for government sectors.

07-04-2021 87
 References
 Award to public health facilities 2019 – Kayakalp, MOHFW, GOI pdf

 NHSRC_Kayakalp Coffeetable Book 2018 - Kayakalp, MOHFW, GOI pdf

 Government of Karnataka, Health and Family Welfare, NHM, Kayakalpa.

 Assessment scores 2015-16, GOK, HFW, NHM, pdf

 Checklists: [Link]

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 THANK
YOU

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