Indian Public Health Standards



State Institute of Health & Family Welfare, Jaipur
Existing Standards


Ø Hospital Standards by Bureau of Indian
  Standards (BIS)
Ø BIS Standards considered very resource
 ...
Standards in IPHS………..

• Describe a level of quality that health care
  facilities are expected to meet .
• Setting stand...
Infrastructure:
      Number v/s Functionality
• March 2008, Impressive Numbers
      § 146036 SCs,
      § 23458 PHCs, an...
IPHS Genesis

• NRHM aims to
    Øreduce child and maternal deaths,
    Østabilize population and
    Øensure gender and d...
Need for IPHS


Ø Quality management
Ø Quality Assurance
Ø Effective, economical and accountable
  health care delivery sy...
Considerations in setting IPHS

ØMinimum resources available at the facilities.
ØMinimum functional level of institutions
...
Process of Formulating IPHS
• Constitution of Expert Committee under DGHS
• Discussion with members (ministry officials, S...
Why IPHS for Sub-Centres….

ØMost peripheral and first contact point

ØServices of acceptable standards to the
 people, th...
IPHS for Sub-Centres…




    SIHFW: an ISO 9001:2008 certified Institution   10
Location


Ø Not too close to an existing sub
  centre/PHC
Ø As far as possible, no person travels more
  than 3 km to rea...
Manpower

  HW(F)
  HW(M)
  Additional HW(F)




SIHFW: an ISO 9001:2008 certified Institution   12
Drugs

Ø Elementary drugs for minor ailments
  such as
     ØARI
     ØDiarrhea
     ØFever
     ØWorm infestation



    ...
Services
Ø All “Assured Services” (preventive, promotive,
  few curative and referral services and NHPs).
     •   Full im...
Other services
Ø Malaria prophylaxis
Ø JSY
Ø ARSH and school health services
Ø VHND
Ø Referral services
Ø AYUSH
Ø Training...
Other Norms for SC…
ØResidential Accommodation especially for the
 ANMs

ØMaintenance of equipment -through preventive
 ma...
SC also to ensure
ØAvailability of model citizen’s charter

Ø A grievance redressal mechanism,

ØConstitution of VHSC

ØIn...
Funding, Monitoring & Evaluation

• Assistance from Ministry of Health & FW, GOI
• Untied funds - currently Rs.10,000 per ...
Primary Health Centres


•   Population of 20,000-30,000
•   4-6 indoor beds
•   Link between SC and CHC
•   23458 (March ...
Why IPHS for Primary Health Centres..

     • PHC -first port of call to a qualified doctor
       in rural areas
     • R...
IPHS for PHC

Ø IPHS
     ØMinimum resources available
     ØMinimum functional standards
Ø Innovations
     ØConstitution...
24x7 PHC should …..
Ø Provide 24-hour delivery services, both
  normal and assisted
Ø Provide Obstetric First Aid and Refe...
Minimum requirements for PHC
ØBasis
  • Average case load of 40 patients per doctor
    per day,
  • 60% utilization of th...
Proposed Manpower at PHC
                        Existing         Recommended
Medical Officer         1        2(one AYUSH...
Services at PHC
Ø   MCH
Ø   24 X 7 Delivery & New born care
Ø   ARSH
Ø   Immunization
Ø   NH Programs
Ø   Permanent FP met...
Other services
Ø Referral transport
Ø ISM based treatment through AYUSH doctor
Ø Laboratory
   • Malaria
   • TB
   • STI/...
Facilities at PHC under IPHS
    •   Waiting
    •   OPD
    •   Wards
    •   Nursing station
    •   OT, MOT, Labor room...
Monitoring and Supervision
• MO to SC once a month
• Health Assistants Male and LHV to SC once a
  week
• Internal Mechani...
IPHS for CHCs: Objectives

Ø Provide optimal expert care to the
  community
Ø Achieve and maintain an acceptable
  standar...
CHC/FRU
Ø 30-bedded hospital located at the block
  headquarter,
Ø Secondary level of health care
Ø Specialist care
      ...
Infrastructure for IPHS CHC
Assured services at CHC
Ø Specialist care
     ØMedicine
     ØSurgery
     ØOb & Gy.
     ØPe...
Infrastructure for IPHS CHC
ØEntrance Zone and OPDs
ØAdmin. zone
ØEmergency Room/Casualty
ØTreatment room (MOT, Injection ...
Manpower at IPHS CHC
Ø Regular
      •   Surgery,
      •   Medicine,
      •   Obstetrics and Gynecology and
      •   Pe...
Specialists at CHC under IPHS
Personnel           Minimum requirement                             Proposed

General Surgeo...
Total Manpower for IPHS CHC
• Block Health Officer               • Ophthalmologist
• Physician                            ...
Ensuring Accountability and
                Quality
• Mandatory RMRS (RKS)
• A grievance redressal mechanism under
  super...
IPHS for Sub-divisional /Sub-
         district Hospitals
• 5-6 lakhs people.
• About 1200 such hospitals in the country w...
Need for IPHS for SDH

First Referral Units for specialist services from
neighboring Community Health Centres.

A Sub-dist...
Minimum Assured Services at SDH
 Ø OPD, indoor and emergency services
 Ø Consultation
     ØGeneral Medicine
     ØGeneral...
Other services at SDH

• Lab, X-ray,                         •    Ambulance services
  Ultrasound, ECG                    ...
IPHS for District Hospitals

  Ø Administrative unit
  Ø Pop. 2-5 million
  Ø 617 districts (Rajasthan: 33)




         S...
IPHS for DHs: objectives

• Provide comprehensive secondary health
  care (specialist and referral services).
• Achieve an...
DH and IPHS

Ø Services depend on size of bed
  compliment
Ø Norms vary based on bed compliment
Ø Norms developed for
    ...
Minimum Functional standards
       for DH: Areas
     • Physical infrastructure,
     • Manpower,
     • Diagnostic and i...
Thank You

For more details log on to
www. sihfwrajasthan.com
             or
 contact : Director-SIHFW
            on

  ...
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IPHS

  1. 1. Indian Public Health Standards State Institute of Health & Family Welfare, Jaipur
  2. 2. Existing Standards Ø Hospital Standards by Bureau of Indian Standards (BIS) Ø BIS Standards considered very resource intensive in current scenario Ø No such standards for primary health care institutions SIHFW: an ISO 9001:2008 certified Institution 2
  3. 3. Standards in IPHS……….. • Describe a level of quality that health care facilities are expected to meet . • Setting standards is a dynamic process • Revision of standards will occur as and when the facilities achieve a minimum functional grade. • Standards are also flexible, to be applied keeping in view the needs of the States. SIHFW: an ISO 9001:2008 certified Institution 3
  4. 4. Infrastructure: Number v/s Functionality • March 2008, Impressive Numbers § 146036 SCs, § 23458 PHCs, and § 4276 CHCs. • Functionality ? For quality, equity& accountability § Infrastructure § Manpower § Logistics § Drugs § Equipment SIHFW: an ISO 9001:2008 certified Institution 4
  5. 5. IPHS Genesis • NRHM aims to Øreduce child and maternal deaths, Østabilize population and Øensure gender and demographic balance. • Required -restructuring the delivery mechanism for health services. • NRHM proposed- Øup gradation of public health institutions to achieve a level of set standards called “Indian Public Health Standards (IPHS)”. SIHFW: an ISO 9001:2008 certified Institution 5
  6. 6. Need for IPHS Ø Quality management Ø Quality Assurance Ø Effective, economical and accountable health care delivery system Ø Optimal level of services SIHFW: an ISO 9001:2008 certified Institution 6
  7. 7. Considerations in setting IPHS ØMinimum resources available at the facilities. ØMinimum functional level of institutions • Space, • Building, • Manpower, • Instruments, • Equipments, • Drugs ØStandards for periodic monitoring at State and Central Governments, and PRIs -how many are conforming to IPHS standards. SIHFW: an ISO 9001:2008 certified Institution 7
  8. 8. Process of Formulating IPHS • Constitution of Expert Committee under DGHS • Discussion with members (ministry officials, State Governments representatives, academicians, management experts, economists, donor agencies, public health professionals, and other organizations such as NGOs etc. • Circulation of draft IPHS • Putting drafts standard on website • Finalization of IPHS for public health institutions SIHFW: an ISO 9001:2008 certified Institution 8
  9. 9. Why IPHS for Sub-Centres…. ØMost peripheral and first contact point ØServices of acceptable standards to the people, through certain available guidelines. ØFirst step is to lay down norms and standards for Sub Centres. SIHFW: an ISO 9001:2008 certified Institution 9
  10. 10. IPHS for Sub-Centres… SIHFW: an ISO 9001:2008 certified Institution 10
  11. 11. Location Ø Not too close to an existing sub centre/PHC Ø As far as possible, no person travels more than 3 km to reach the sub-centre. SIHFW: an ISO 9001:2008 certified Institution 11
  12. 12. Manpower HW(F) HW(M) Additional HW(F) SIHFW: an ISO 9001:2008 certified Institution 12
  13. 13. Drugs Ø Elementary drugs for minor ailments such as ØARI ØDiarrhea ØFever ØWorm infestation SIHFW: an ISO 9001:2008 certified Institution 13
  14. 14. Services Ø All “Assured Services” (preventive, promotive, few curative and referral services and NHPs). • Full immunization and Vitamin A prophylaxis • Essential newborn care • Antenatal, natal and postnatal care • Prevention of malnutrition and common childhood diseases • Family planning services • Counseling. Ø Community needs assessment Ø Minimum laboratory services • Hemoglobin • Urine for albumin, sugar • Referral to PHC for blood grouping SIHFW: an ISO 9001:2008 certified Institution 14
  15. 15. Other services Ø Malaria prophylaxis Ø JSY Ø ARSH and school health services Ø VHND Ø Referral services Ø AYUSH Ø Training of TBAs, ASHA/Community Health Volunteers Ø Recording and reporting of vital events Ø Syndromic surveillance done and reported weekly to PHC Ø Water Quality Monitoring & Disinfection of water sources SIHFW: an ISO 9001:2008 certified Institution 15
  16. 16. Other Norms for SC… ØResidential Accommodation especially for the ANMs ØMaintenance of equipment -through preventive maintenance or prompt repair of non-functional equipment to ensure uninterrupted delivery of services, by making use of the untied funds ØPotable water for patients and staff and water ØWherever possible, uninterrupted power supply SIHFW: an ISO 9001:2008 certified Institution 16
  17. 17. SC also to ensure ØAvailability of model citizen’s charter Ø A grievance redressal mechanism, ØConstitution of VHSC ØInvolvement of PRI SIHFW: an ISO 9001:2008 certified Institution 17
  18. 18. Funding, Monitoring & Evaluation • Assistance from Ministry of Health & FW, GOI • Untied funds - currently Rs.10,000 per SC under NRHM) • One HA (Female) and one HA (Male) located at the PHC are entrusted with the task of supervision of all the Sub-centres under a PHC. SIHFW: an ISO 9001:2008 certified Institution 18
  19. 19. Primary Health Centres • Population of 20,000-30,000 • 4-6 indoor beds • Link between SC and CHC • 23458 (March 2008), • Rajasthan: 10742 (March, ‘09) SIHFW: an ISO 9001:2008 certified Institution 19
  20. 20. Why IPHS for Primary Health Centres.. • PHC -first port of call to a qualified doctor in rural areas • Referring unit for 6 Sub-centres • Referral unit to CHCs and DH • Provides a range of curative, promotive and preventive health care services. SIHFW: an ISO 9001:2008 certified Institution 20
  21. 21. IPHS for PHC Ø IPHS ØMinimum resources available ØMinimum functional standards Ø Innovations ØConstitution of RMRS ØInvolvement of PRI and ØCitizens’ Charter SIHFW: an ISO 9001:2008 certified Institution 21
  22. 22. 24x7 PHC should ….. Ø Provide 24-hour delivery services, both normal and assisted Ø Provide Obstetric First Aid and Referrals to First Referral Units (FRUs)/other hospitals, for high risk pregnancy cases beyond the capability of Medical Officer, PHC. Ø Provide 24 hours emergency services for management of injuries and accidents. Ø Provide emergency care of sick children SIHFW: an ISO 9001:2008 certified Institution 22
  23. 23. Minimum requirements for PHC ØBasis • Average case load of 40 patients per doctor per day, • 60% utilization of the available indoor/ observation beds (6 beds). • Standards upgraded with utilization ØManpower • One more medical officer (AYUSH or lady doctor) and two more staff nurses existing total staff strength of 15 in the PHC SIHFW: an ISO 9001:2008 certified Institution 23
  24. 24. Proposed Manpower at PHC Existing Recommended Medical Officer 1 2(one AYUSH or LMO) Pharmacist 1 1 Nurse-midwife (Staff 1 3 (for 24-hour PHCs) (Nurse) (2 may be contractual) Health workers (F) 1 1 Health Educator 1 1 Health Asstt. (M&F) 2 2 Clerks 2 2 Laboratory Technician 1 1 Driver 1 Optional/vehicles out-sourced. Class IV 4 4 Total 15 17/18 SIHFW: an ISO 9001:2008 certified Institution 24
  25. 25. Services at PHC Ø MCH Ø 24 X 7 Delivery & New born care Ø ARSH Ø Immunization Ø NH Programs Ø Permanent FP methods-TT/ vasectomy / NSV Ø MTP using MV technique (if trained personnel and facility exists) Ø common eye diseases and Refraction Services Ø School Health Ø Nutrition (coordinated through ICDS) Ø Selected surgeries SIHFW: an ISO 9001:2008 certified Institution 25
  26. 26. Other services Ø Referral transport Ø ISM based treatment through AYUSH doctor Ø Laboratory • Malaria • TB • STI/RTI • Enteric • Routine –Urine, stool, blood Ø IDSP Ø Training Ø Waste Mgt. Ø Laundry (outsourced) SIHFW: an ISO 9001:2008 certified Institution 26
  27. 27. Facilities at PHC under IPHS • Waiting • OPD • Wards • Nursing station • OT, MOT, Labor room • Laboratory • Accommodation • Store • Dispensing • Electricity, Telephone, Water SIHFW: an ISO 9001:2008 certified Institution 27
  28. 28. Monitoring and Supervision • MO to SC once a month • Health Assistants Male and LHV to SC once a week • Internal Mechanism: Record maintenance, checking and supportive supervision • External Mechanism: Monitoring through the PRI / Village Health Committee / RMRS (as per guidelines of State Government). • Charter of Patients’ Rights available at PHC • RMRS SIHFW: an ISO 9001:2008 certified Institution 28
  29. 29. IPHS for CHCs: Objectives Ø Provide optimal expert care to the community Ø Achieve and maintain an acceptable standard of quality of care Ø Make the services more responsive and sensitive to the needs of the community SIHFW: an ISO 9001:2008 certified Institution 29
  30. 30. CHC/FRU Ø 30-bedded hospital located at the block headquarter, Ø Secondary level of health care Ø Specialist care • Medicine • Surgery • Ob & Gy. • Pediatrics • Anesthesia • Public health Ø 80,000 -1,20,000 pop. Ø Catchment-4 PHCs Ø Referral point for PHCs (FRU for obstetric emergencies an ISO 9001:2008 certified Institution SIHFW: 30
  31. 31. Infrastructure for IPHS CHC Assured services at CHC Ø Specialist care ØMedicine ØSurgery ØOb & Gy. ØPediatrics Ø Blood storage unit Ø Operation theatre, labor room, X-ray laboratory, ECG . Ø Referral transport Ø NH Programs SIHFW: an ISO 9001:2008 certified Institution 31
  32. 32. Infrastructure for IPHS CHC ØEntrance Zone and OPDs ØAdmin. zone ØEmergency Room/Casualty ØTreatment room (MOT, Injection / dressing room) ØWards- male and female with space between beds ØOther Services • CSSD • Electricity with Back-up, Water, Telephones • Laundry & Waste mgt. • Separate toilets for male & female • Maintenance and sanitation facility • Computerization for record and surveillance. SIHFW: an ISO 9001:2008 certified Institution 32
  33. 33. Manpower at IPHS CHC Ø Regular • Surgery, • Medicine, • Obstetrics and Gynecology and • Pediatrics. Ø Contractual • Anesthetist and • Public Health Program Manager Ø Support manpower • Public health Nurse • ANM in addition to the existing staff. • Ophthalmic Assistant Ø Recommended • One Ophthalmologist for every 5 CHCs • One Dental Surgeon, • 6 GDMOs, • One AYUSH specialist and • One AYUSH general doctor SIHFW: an ISO 9001:2008 certified Institution 33
  34. 34. Specialists at CHC under IPHS Personnel Minimum requirement Proposed General Surgeon 1 1 Physician 1 1 Ob. & Gy. 1 1 Pediatrics 1 1 Anesthetist - 1 Public Hlth. Health - 1 Manager. Eye surgeon - 1 Total 4 6/7 SIHFW: an ISO 9001:2008 certified Institution 34
  35. 35. Total Manpower for IPHS CHC • Block Health Officer • Ophthalmologist • Physician (one for 5 CHCs) • Surgeon • 6 GDMO (2 LMOs) • Ob. & Gy. • 1 AYUSH specialist • Paediatrician • 1 AYUSH GDMO • Anesthetist • Support Manpower (total 64) includes: • Public Health Manager • 19 S/N, 1 PHN, 1ANM and 1 • Dental Surgeon Ophthalmic Assistant SIHFW: an ISO 9001:2008 certified Institution 35
  36. 36. Ensuring Accountability and Quality • Mandatory RMRS (RKS) • A grievance redressal mechanism under supervision of RMRS (RKS) • Social audit by involvement of the community through RMRS (RKS) is recommended. • Charter of Patients’ Rights displayed prominently at the entrance. • Standard Operating Procedures and Standard Treatment Protocols • External monitoring through PRIs, & internal monitoring SIHFW: an ISO 9001:2008 certified Institution 36
  37. 37. IPHS for Sub-divisional /Sub- district Hospitals • 5-6 lakhs people. • About 1200 such hospitals in the country with number of beds ranging from 50 to 100 beds or more. • Two IPHS Standards for SDH have been prepared according to bed strength - for 31- 50 beds and 51-100 beds. SIHFW: an ISO 9001:2008 certified Institution 37
  38. 38. Need for IPHS for SDH First Referral Units for specialist services from neighboring Community Health Centres. A Sub-district/Sub-divisional Hospital provides emergency obstetric and neo-natal care It also saves travel time to the DH ,reduces the workload of the district hospital. SIHFW: an ISO 9001:2008 certified Institution 38
  39. 39. Minimum Assured Services at SDH Ø OPD, indoor and emergency services Ø Consultation ØGeneral Medicine ØGeneral Surgery ØObstetric & Gynecology ØPediatrics ØAnesthesia ØOrthopedics ØENT ØRadiologist and sonologist ØOphthalmology ØCommunity Health ØSkin & VD, RTI/STI ØDental care ØAYUSH SIHFW: an ISO 9001:2008 certified Institution 39
  40. 40. Other services at SDH • Lab, X-ray, • Ambulance services Ultrasound, ECG • Dietary services • Blood transfusion and • Laundry services storage, • Security services • Physiotherapy • Housekeeping • Medico • Inventory Mgt. legal/postmortem* • Waste management SIHFW: an ISO 9001:2008 certified Institution 40
  41. 41. IPHS for District Hospitals Ø Administrative unit Ø Pop. 2-5 million Ø 617 districts (Rajasthan: 33) SIHFW: an ISO 9001:2008 certified Institution 41
  42. 42. IPHS for DHs: objectives • Provide comprehensive secondary health care (specialist and referral services). • Achieve and maintain an acceptable standard of quality of care. • Make services more responsive and sensitive to the needs of the people SIHFW: an ISO 9001:2008 certified Institution 42
  43. 43. DH and IPHS Ø Services depend on size of bed compliment Ø Norms vary based on bed compliment Ø Norms developed for • 101-200 beds, • 201-300 beds and • 301-500 beds. SIHFW: an ISO 9001:2008 certified Institution 43
  44. 44. Minimum Functional standards for DH: Areas • Physical infrastructure, • Manpower, • Diagnostic and investigation facilities, • Equipment , • Drugs and • Other supportive services SIHFW: an ISO 9001:2008 certified Institution 44
  45. 45. Thank You For more details log on to www. sihfwrajasthan.com or contact : Director-SIHFW on sihfwraj@yahoo.co.in

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