IPHS provided by National Rural Health Mission

1. INDIAN PUBLIC
HEALTH STANDARDS
FOR PHC
DR.ANJALI RAJ

2. CONTENTS
 INTRODUCTION
 NEED OF IPHS
 PRIMARY HEALTH CENTRE
 OBJECTIVES OF IPHS FOR PHC
 SERVICES IN PHC
 MANPOWER
 INFRASTRUCTURE
 REFERENCE

3. INTRODUCTION
 National Rural Health Mission (NRHM) was
launched in India in the year 2005 to strengthen the
Rural Public Health System.
 The Mission seeks to provide effective health care
to the rural populace throughout the country with
special focus on the States and Union Territories
(UTs), which have weak public health indicators
and/or weak infrastructure.

4. INDIAN PUBLIC HEALTH STANDARDS
 In order to provide optimal level of quality health
care, a set of standards called Indian Public Health
Standards (IPHS) were recommended for Sub-
centres, Primary Health Centres (PHCs),
Community Health Centres (CHCs), Sub-District
and District Hospitals in early 2007.
 IPHS are a set of uniform standards envisaged to
improve the quality of health care delivery in the
country.

5.  These IPHS guidelines acts as the main driver for
continuous improvement in quality and serve as the
bench mark for assessing the functional status of
health facilities.
 The IPHS documents have been revised keeping
in view the changing protocols of the existing
programmes and introduction of new programmes
especially for Non-Communicable Diseases.

6. NEED OF IPHS
 Quality management, quality assurance
 Effective economical and accountable Health care
delivery system
 Optimal level of services

7. PRIMARY HEALTH CENTRE (PHC)
 Basic health unit to provide an integrated curative
and preventive health care to the rural population
with emphasis on preventive and promotive aspects
of health care.
 PHCs are organized on the basis of one PHC for
every 30,000 rural populations in the plains and one
PHC for every 20,000 population in hilly, tribal and
desert areas for more effective coverage.

8. FUNCTIONS OF PHC
The functions of PHC in India cover all the 8
essential elements of primary health care as
outlined in the Alma-Ata Declaration. They are :
o Medical care
o MCH including family planning
o Safe water supply and basic sanitation
o Prevention and control of locally endemic diseases

9.  Collection and reporting of vital statistics
 Education about health
 National Health Programmes – as relevant
 Referral services
 Training of health guides, health workers, local dais
and health assistants
 Basic laboratory services

10. OBJECTIVES
 To provide comprehensive primary health care to
the community through the Primary Health Centres.
 To achieve and maintain an acceptable standard of
quality of care.
 To make the services more responsive and
sensitive to the needs of the community.

11. CLASSIFICATION OF PHC
 From the service delivery angle, PHCs may be
classified into two types, depending upon the
delivery case load :
 TYPE A PHC : PHC with delivery load of less than
20 deliveries in a month
 TYPE B PHC : PHC with delivery load of 20 or
more deliveries in a month

12. All services provided by PHCs have been classified
as;
- Essential (Minimum Assured Services) or
- Desirable (which all States/UTs should
aspire to achieve at this level of facility)

13. SERVICES AT THE PRIMARY HEALTH
CENTRE FOR MEETING THE IPHS
 MEDICAL CARE :
 OPD services: •
A total of 6 hours of OPD
services out of which 4 hours in the morning and 2
hours in the afternoon for six days in a week. Time
schedule will vary from state to state.
Minimum OPD attendance is expected to be 40
patients per doctor per day.

14.  24 hours emergency services : •
appropriate
management of injuries and accident, First Aid,
suturing of wounds, incision & drainage of abscess,
stabilization of the condition of the patient before
referral, Dog bite/snake bite/scorpion bite cases,
and other emergency conditions.
 Referral services
 In-patient services (6 beds)

15.  MATERNAL AND CHILD HEALTH CARE :
(including family planning )
 Ante natal care
 Intranatal care
 Post natal care
 New born care
 Care of child (According to IMNCI)

16. OTHER SERVICES
 MEDICAL TERMINATION OF PREGNANCIES :
Essential - Counseling and appropriate referral
for safe abortion services (MTP) for those in need.
Desirable - MTP using Manual Vacuum
Aspiration (MVA)
 MANAGEMENT OF REPRODUCTIVE TRACT
INFECTIONS / STIs
Essential - Health education for prevention of
RTI/STIs
Treatment of RTI/STIs

17.  NUTRITION SERVICES(Coordinated with ICDS) :
Essential - Diagnosis of and nutrition advice
to malnourished children, pregnant
women and others.
- Diagnosis and management of
anemia and vitamin A deficiency.
 SCHOOL HEALTH :
Essential - Screening of general health
- Basic medicines to take care of
common ailments
- Immunization and Deworming

18.  ADOLESCENT HEALTH CARE
 PROMOTION OF SAFE DRINKING WATER AND BASIC
SANITATION
 PREVENTION AND CONTROL OF LOCALLY ENDEMIC
DISEASES
 IMPLEMENTATION OF OTHER NATIONAL HEALTH
PROGRAMMES
 TRAINING
 FUNCTIONAL LINKAGES WITH SUB-CENTRES

19.  RECORDS OF VITAL EVENTS AND REPORTING
 MAINSTREAMING OF AYUSH (Desirable)
 SELECTED SURGICAL PROCEDURES (Desirable)
 MATERNAL DEATH REVIEW (Desirable)

20. BASIC LABORATORY AND DIAGNOSTIC
SERVICES
Essential Laboratory services includes ;
 Routine blood, urine and stool tests
 Diagnosis of RTI/STDs with wet mounting,
Grams stain etc.
 Sputum testing for mycobacterium
 Blood smear examination for malarial parasite
 Blood grouping and RH typing

21.  Rapid tests for pregnancy
 RPR test for Syphilis
 Rapid test kit for fecal contamination of water
 Estimation of chlorine level of water using
orthotoludine reagent.
 Blood sugar
Desirable laboratory services includes;
 Blood Cholesterol.
 ECG

22. INFRASTRUCTURE
 The PHC should have its own building with
- Outpatient Department : separate areas
for consultation and examination
- Wards : 4-6 beds
- Labour Room
- Waiting area
- Minor OT/Dressing Room/Injection Room
- Laboratory
- General store
- Operation Theatre (Optional)

23. - Waste disposal pit :As per GOI/Central
Pollution Control Board (CPCB) guidelines.
- Cold Chain room
- Logistics Room
- Generator room
- Office room
- Dirty utility room for dirty linen and used
items
OTHER FACILITIES include
- Residential Accommodation
- Computer
- Lecture Hall/Auditorium

26. TRANSPORT FACILITY
 It is desirable that the PHC has ambulance
facilities for transport of patients for timely and
assured referral to functional FRUs in case of
complications during pregnancy and child birth.
LAUNDARY SERVICES
 Provision for clean linen shall be made for admitted
patients. At least 5 sets of linen shall be made
available. Laundry Services may be available in
house or outsourced.

27. DIETRY FACILITIES FOR INDORE
PATIENTS
 Nutritious and well- balanced diet shall be provided
to all IPD patients keeping in mind their cultural
preferences.
WASTE MANAGEMENT
 Guidelines for Health Care Workers for Waste
Management and Infection Control in Primary
Health Centres” are to be followed

28. QUALITY ASSURANCE
 Periodic skill development training of the staff •
of
the PHC in the various jobs/responsibilities
assigned to them.
 Standard Treatment Protocol for all National •
Health Programmes and locally common disease
should be made available at all PHCs.

29. MONITORING OF PHC FUNCTIONING
This is important to ensure that quality is
maintained and also to make changes if necessary
 Internal Mechanisms: Record maintenance,
checking and supervision.
 Medical Audit
 Death Audit
 Patient Satisfaction Surveys: For both OPD and IPD
patients.

30.  External Mechanisms: Monitoring through the PRI/
Village Health Sanitation and Nutrition Committee
 Social audit

31. REFERENCE
 Park’s Textbook Of Preventive And Social Medicine-
23rd Edition
 Indian Public Health Standards (IPHS) Guidelines for
Primary Health Centres Revised 2012

32. THANK YOU