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 Problems Identified:

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               Section 3: systems and services


                   A. Heath system

                                                                  Present     Not present     Number
                    Type of Facility/ institution


                    1. Governmental Hospital

                    2. Governmental  Dispensary

                    3. Rural Health Centre


                    4. Family health Centre

                    5. Mother &Child Health Centre

                    6. Family Planning Mobile services unit


                    7. Private Hospital

                    8. Private Dispensary

                    9. Private clinics


                    10. special Health Services for elderly

                    11. Rehabilitation health care facilities


                    12. Community Health worker

                    13. Traditional Birth Attendant



                   B. Education

                      o  Presence of schools:


                                 No
                                Yes                      Specify; .......................................
                                                            100
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