health care levels, structure and functions

1. HEALTH CARE
LEVELS,
STRUCTURE
AND FUNCTIONS
OF SC,PHC,CHC
DR.N.AKILAN
1ST YR PG
DEPT OF COMMUNITY MEDICINE

2. HEALTH PROBLEMS OF INDIA
1. Communicable disease problems
2. Non-communicable disease problems
3. Nutritional problems
4. Environmental sanitation problems
5. Medical care problems
6. Population problems

4. PRIMARY HEALTH CARE IN INDIA
1. Village
2. Sub-centre
3. Primary health centre
4. Community health centre
5. Health and wellness centre

5. 1. VILLAGE LEVEL
• ASHA scheme
• ICDS scheme
• Training of Local Dais

6. ASHA
• Accredited Social Health Activist (ASHA) for 1000 population
• Act as the interface between the community and the public health system.
• Honorary volunteer, receiving performance-based compensation
• Facilitate preparation and implementation of the Village Health Plan
• 8th std
• 25-45 years age group

7. ASHA - ACCREDITED SOCIAL HEALTH ACTIVIST

8. ANGANWADI WORKER
• ICDS scheme
• 1/ 400-800 population
• 1500/month honorarium
• Growth chart, immunization, supplementary nutrition, health
education
LOCAL DAIS
• Initiated in 2001-02
• One dai/village for making deliveries safe

9. Organizational Structure
• The health care infrastructure in rural areas has been developed
as a three tier system and is based on population norms.

11. Sub-centre - Categorization
Type A: Provide all recommended services except that the facilities for
conducting delivery will not be available.
Type B: Provide all recommended services including facilities for
conducting deliveries at the Sub-centre itself. ( MCH Sub-centre)
– They will be expected to conduct around 20
deliveries in a month.
– They should be provided with all labor room facilities and equipment including
Newborn care corner

12. Subcentre- Staffing Pattern

13. Services Provided
• Maternal Health:
ANC,PNC care, Post natal visits and organization of VHND
• Family planning and contraception
• Curative Services
Provide treatment for minor ailments including fever,
diarrhea, ARI, worm infestation and first aid to animal bite

14. Services provided
• Counselling- referral for MTP,
• Community need assessment
• Training of ASHA, traditional birth attendants
• National health programmes
• Promotion of medicinal herbs
• Record of vital events
• Co-ordination and monitoring
• Out reach/ field services

15. Services Provided
• School Health Services:
– Screening
– Treatment of minor ailments
– Immunization
– De-worming
– Prevention and management of Vitamin A and nutritional
deficiency anemia
• Control of Local Endemic Diseases
• Water and Sanitation
Disinfection of drinking water sources

17. Primary health centre (PHC)
• PHC is the first contact point between village community and Medical Officer.
• The PHCs were envisaged to provide an integrated curative and preventive
health care to the rural population with emphasis on preventive and
promotive aspects of health care.
• The Primary Health Center is expected to provide “essential health care”
including MCH and family planning.
• PHC should have its own building with 4-6 beds.

18. SERVICES PROVIDED- ESSENTIAL
• Medical care- Outdoor and indoor patient services
• Implementation of National Health programmes
• MCH care and family planning
• Health education and training
• Referral services
• Prevention and control of locally endemic diseases
• Collection and reporting of vital events
• Basic laboratory services
• Safe water supply and sanitation
• Training of health guides, health workers, local dais and health assistants

19. PHC- Types
• PHC may be of two types depending upon the delivery case load
• Type A - PHC with delivery load <20/month
• Type B - PHC with delivery load >20/month

20. SERVICES PROVIDED IN PHC
• Medical care- morning 4 hrs, evening 2 hrs – OPD,
24hrs emergency services,
Referral services
• Maternal and child health care
• Full range of family planning services
• Medical termination of pregnancy
• Health education – STI/RTI
• School health services

21. Cont…
• Adolescent health care
• Prevention and control of locally endemic diseases
• Collection and reporting of vital events
• Health education and behavioural change communication
• Promotion of sanitation
• Testing of water quality and disinfection of water
• National health programmes
• Appropriate and prompt referral

22. Cont…
• Record of vital events
• Training
• Basic lab services
• Monitoring and supervision
• Selected surgical procedures
• Mainstreaming of AYUSH
• Physical medical and rehabilitation services
• Maternal death review
• Functional linkage with sub-centres

23. PHC-Staffing pattern

25. Community Health Centre(CHC)
• The block is unit of rural planning and development and
comprises about 80,000 to 1.2 lakh population.
• One Community Health Center is established in each block.
• The officer in-charge of CHC is CHC or Block Medical Officer.
• Normally one CHC should have –
- 30 bed hospital .
- Specialist doctors in Pediatrics, Obstetrics, Medicine
and Surgery .
- Four Medical Officer.

28. Services Provided
• Care of Routine and Emergency Cases in Medicine
• Care of Routine and Emergency Cases in Surgery
• Maternal Health
-ANC check ups including Registration & associated services
-24 hour delivery services including normal and assisted
delivery and cesarean section
-Minimum 48 hours of stay after delivery
-post delivery care for managing Complications

29. Cont…
• Newborn care and child health
• Family planning
• Physical medicine and rehabilitation
• Oral health
• Adolescent health care
• Diagnostic services
• Maternal death review

30. Services Provided
• All National Health Programmes delivered through CHCs
• RBSK including School health services
• Others
• Blood storage facility
• Essential laboratory services
• Referral (transport) services

33. Health and wellness centre
• To deliver comprehensive health care
• Existing sub-centres with population coverage of 3000-5000 to be
converted to HWC’s
• SC-HWC team
• PHC/UPHC – HWC team
• First HWC inaugurated by PM on 14 April 2018 at Bijapur,
Chhattisgarh.

34. Expanded range of services
• Care in pregnancy and child birth
• Neonatal and infant health care services
• Childhood and adolescent health care services
• Family planning, contraceptive services and other reproductive health
care services
• Management of communicable diseases including national health
programmes
• Mx of common CD and OP care for acute simple illnesses and minor
ailments

35. Cont…
• Screening, prevention, control and management of NCD’s
• Care of common ophthalmic and ENT problems
• Basic oral health care
• Elderly and palliative health care services
• Emergency medical services
• Screening and basic management of mental health ailments

36. THANK YOU