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1. RURAL HEALTH CARE
SERVICES
SUBMITTEDTO: SUBMITTED BY:
RESPECTED PRAVEEN MA’AM RIYA TANWAR
TUTOR,CON BSC(H)Nsg. 4th year
VMMC &SJH Enrollment no :0195030661

2. BACKGROUND
In India healthcare services , is divided into two
segments – public and private . The public
health care system is responsible for
maintaining the primary health care
requirements in rural and urban areas and is
funded by the government . The private health
care segment is mainly focused in India is
mainly focused in urban centres.
However , the rural health care sector still faces
plethora of challenges and needs focused
policy level interventions.

3. INTRODUCTION
Rural health care services in general are
rendered by the government through a
network of health centres from the grass
root areas to the block level in the rural
areas and through hospital , dispensaries
,maternal , child health and family welfare
centres in the urban and rural areas .
Health care services is defined as a multiple
services provided to individuals , families ,
or communities by agents of the health
service or professions for the purpose of
maintaining, promoting , monitoring or

4. RURAL HEALTH CARE
SYSTEM IN INDIA
RURAL HEALTH CARE SYSTEM IN INDIA
INCLUDES :
Community Health Centre (CHC): A 30 bedded
Hospital/Referal Unit for 4 PHCs with
Specialized services
 primary Health Centre (PHC):A Referal Unit for
6 Sub Centres 4-6 bedded manned with a Medical
Officer In charge and 14 subordinate
paramedical staff
 Sub Centre: Most peripheral contact point
between Primary Health Care System &
Community manned with one HW(F)/ANM & one
HW(M)

5. POPULATION NORMS OF RURAL HEALTH
CARE SERVICES

6. SUB CENTER AND THEIR OBJECTIVES OF
INDIAN PUBLIC HEALTH STANDARDS (IPHS)
Definition : sub health centers (sub
centers) is the most peripheral and first
of contact between primary health care
system and the community.
Objectives
Achieve and maintain an acceptable
standard of quality of care.
Basic primary health care to the community
.
Make the services more responsive and
sensitive to the needs of the community .

7. CATEOGRIZATION OF SUB CENTRES
 TYPE A
- Type A sub centre will provide all
recommended services except that the
facilities for conducting delivery will not be
available .
- However , the ANMs has been trained in
midwifery , they may conduct normal
delivery in case of need .
- Sub –centres located in remote, difficult,
hilly ,desert or tribal areas are such
situations where ANMs would be required
to conduct deliveries at homes and ANM of
these sub – centres should mandatorily be

8. TYPE B ( MCH SUB- CENTRES )
-Centrally or better located sub –
centres with good connectivity to
catchment areas .
-They have good physical
infrastructure preferably with own
buildings , adequate space ,
residential accommodation and
labor room facilities .
-They already have good case load
of deliveries from the catchment
areas .

9. MANPOWER AND LOCATION
 A. STAFF FOR SUB – CENTRE : number of posts
1. Health Worker(Female)/ANM(1).
2. Additional Second ANM (on contract)(1)
3. Health Worker (Male)(1)
4. Voluntary Worker (Paid @ Rs.100/- ) (1)
• Total (excluding contractual staff) (3)
LOCATION
Not too close to an existing sub- center / PHC.
 As far as possible, no person travels more than 3
km to reach the sub-center.

10. SERVICES TO BE PROVIDED IN A
SUBCENTRE
 MATERNAL AND CHILD HEALTH
- Antenatal
- Intra – natal care
- Postnatal care
 Child health
 Family planning and contraception
 Counselling and appropriate referral for safe abortion services.
 Adolescent health care
 Assistance to school health services
 Control of local endemic disease
 Disease surveillance

11. Water quality monitoring
Promotion of sanitation
Field visit
Community needs assessment
Curative services
Training , coordination and
monitoring

12.  SITE OF SERVICES DELIVERY ANY BE AT A FOLLOWING
PLACES :
- In the village : village health and nutrition day /
immunization session .
- During house visit
- During house to house surveys
 It is desirable minimum of 6 hours of routine OPD
services in a day for 6 days in a week .

13.  MATERNAL HEALTH
- ANTENATAL CARE
Minimum 4 ANC check up including registration
associated services .
Recording tobacco used by all antenatal mothers .
Minimum laboratory investigations like urine test for
pregnancy confirmation, haemoglobin estimation ,urine
for albumin and sugar and linkage with PHC for other
required tests .
INTRA NATAL CARE
Skilled attendance at home deliveries when called .
Appropriate and timely referral of high risk cases which
are beyond their capacity of management .

14. Managing labor using partograph .
Identification and management of danger signs
during labor.
Proficient in identification and basic first – aid
treatment for PPH ,eclampsia , sepsis .
- POST NATAL CARE
Ensure post natal home visit on 0,3,7 and 42nd day
for deliveries at home and sub- centre .
Ensure 3,7 and 42nd day visit for institutional
deliveries cases .
In case of low birth weight baby ( less that 2500 g ),
additional visit are made on 14 ,21, 28 days.
Counselling on diet and rest , hygiene ,
contraception ,essential new born care ,
immunization , infant and young child feeding .

15.  CHILD HEALTH
New born care corner in the labor room to provide
essential new born care .
Counselling on infant and young child feeding .
Full immunization and vitamin A prophylaxis to the
children as per national guidelines.
 FAMILY PLANNING AND CONTRACEPTION
Education , motivation and counselling to adopt
appropriate family planning methods .
Provision of contraceptives
 SCHOOL HEALTH SERVICES
Screening , treatment of minor ailments , immunization ,
deworming , prevention and management of vitamin A
and nutritional deficiency anemia and referral services
through fixed day visits of school by existing ANM /MPW .
Staff of sub – centre shall provide assistance to school
health services as a member of team .

16.  CONTROL OF LOCAL ENDEMIC DISEASE
Assisting of detection , control ,and reporting of
local endemic diseases such as malaria , kala azar
, JE ,dengue etc.
Assistance in control of epidemic diseases
outbreaks as per programme guidelines .
 SUPPORT SERVICES
Laboratory services .
Waste disposal : guidelines for health care worker
for waste management and infection control in
sub- centres to be followed .
QUALITY ASSURANCE AND ACCOUNTABILITY
In order to ensure quality of services and patient
satisfaction, it is essential to ensure community
participation .

17. PRIMARY HEALTH CENTER ( PHC )
 Primary health care centre refers to the essential
health care that is based upon the scientifically
and socially acceptable method and technology .
 Primary health care is essential healthcare made
universally accessible to individuals and
acceptable to them , through their full
participation and at a cost that community and
control can afford .

18. POPULATION NORMS IN
PHC
 Bhore committee - PHC / 10- 20,000 population .
 Mudaliar committee (1962 ) – PHC / 40,000 population
.
 By fifth plan (1975- 80 )- PHC was catering health
needs of 10,00,000 population.
 National health plan (1983 ) – PHC / 30,000 in plain
areas & per 20,000 in hilly regions .

19. STAFFING PATTERN OF PHC

20. CHARACTERSTIC OF
PHC
Its availability should be at cost which the
community and country can afford to
maintain at every stage of their
development in a spirit of self reliance and
self development .
It requires joint effects of the health sector
and other health related factors via
education , food , agriculture, social welfare
, animal husbandry, rural reconstruction
etc. .

21. NATURE AND ELEMENTS
OF PHC
NATURE
Preventive , promotive ,curative
,rehabilitative ,supportive
ELEMENTS
Education concerning prevailing health
problem and the methods of prevailing
and controlling them .
Promotion of food supply and proper
nutrition .

22. An adequate supply of safe water
and safe basic sanitation .
Maternal and child health care
including family planning .
Immunization against major
infectious disease .
Prevention and controlling of locally
endemic disease.
Appropriate treatment of common
injuries and diseases.
Provision of essential drugs.

23. PRINCIPLES OF PRIMARY HEALTH
CARE
EQUITABLE DISTRIBUTION
COMMUNITY PARTICIPATION
INTERSECTORAL COORDINATION
APPROPRIATE TECHNOLOGY
PREVENTION

24. EQUITABLE DISTRIBUTION
Health services must be shared
equally irrespective of their ability
to pay .
Rich or poor / rural or urban must
have access to health services .
This has been termed as social
injustice .
PHC aims to readdress this
imbalance by shifting the centre of
gravity from cities to the rural areas
and bring these services as nears

25. COMMUNITY
PARTICIPATION
Involvement of individuals and community in
promotion of their own health and welfare ,
is an essential ingredient of PHC .
There must be continuing effort to secure
meaningful involvement of community in
planning ,implementing & maintaining of
health services .
Village health guide and dais are selected by
local community and trained locally in the
delivery of the primary health care to the
community they belong .
By overcoming cultural and communication
barriers , they provide primary health care in

26. INTER- SECTORAL
COORDINATION
There is an increasing realization that
Health for all cannot be provided by a
health sector alone .
To achieve such cooperation
,countries may have to review their
administrative system , reallocate their
resources ,& introduce suitable
legislation to ensure that coordination
takes place.
This require a strong a political value
to translate values into action .
An important approach is the inter-

27. APPROPRIATE
TECHNOLOGY
The term appropriate emphasized because
in some countries luxurious hospitals that
are totally inappropriate to the local needs
are built which absorbs a major part of the
national health budget ,effectively
blocking many improvement in general
health services .
This also implies not use of costly
equipment's , procedures , techniques
when cheaply , scientifically valid and
acceptable are available .

28. FUNCTION OF
PHC

29. MEDICAL CARE
- OPD services : 4 hours in the morning
and the 2 hours in the afternoon /
evening . Time schedule will vary from
state to state . Minimum attendance
should be 40 patients per doctor per day
.
- 24 hour emergency services :
appropriate management of injuries and
accident .
- First –aid , stabilization of the condition
of patient before referral .
- Dog bite /snake bite cases and other
emergency conditions .

30.  MCH INCLUDING FAMILY PLANNING
• ANTENATAL CARE
- Supplementation of folic acid and iron tablets
and TD immunization .
- Identification of high risk pregnancies and
appropriate management .
- Refer to other hospital in case of high
pregnancy beyond the management capability
of medical officer in PHC .
- Early registration of pregnancy and minimum
3 health check up .
 INTRANATAL CARE
- 24 hours services for normal delivery.
- Promotion of institutional delivery .
- Conducting assisted deliveries including
forceps and vacuum delivery when required .

31.  POST - NATAL CARE
- Initiation of breast feeding of delivery with in half- hour of delivery .
- Education on nutrition , hygiene .
- Provision of facilities under JANANI SURAKSHA YOJANA .
 NEW BORN CARE
- Essential new born care
- Facilities and care for neonatal resuscitation and
- Management of neonatal hypothermia and jaundice .
CARE OF THE CHILD
- Emergency care of sick child including integrated management
of childhood illness ( IMNCI ).
- Care of routine childhood illness.
- Promotion of breast feeding for 6 months .
- Full immunization of infant and children against infections.
- Vitamin A prophylaxis.

32.  TRAINING
- Initial and periodic training of paramedics in treatment of minor
ailments .
- Training of ASHA’s .
- Training of ANM and Lady health visitors in antenatal care and
skilled birth attendance .
- Training of AYUSH doctor in imparting health services related to
national health and family welfare programme .
 NUTRITIONAL SERVICES
- Diagnosis and management of malnutrition , anemia and vitamin.
- A deficiency and coordination .
 MONITORING AND SUPERVISION
- Monitoring and supervision of activities of sub-centres through
regular meetings/ periodic visits etc.
- Monitoring of national health programme .
- Monitoring activities of ASHA’s .
- Health assistants male and LHV should visit sub – centers once a

33. COMMUNITY HEALTH
CENTER ( CHC )
 The CHC is the third tier of the network of the
rural health care institutions , was required to act
primarily as referral centre ( for neighbouring
PHC , usually 4 in number ) for patients
requiring specialized health care services .
CHC are being established and maintained by
the state government under Min . needs
/basic minimum service & programme .
As per minimum norms , a CHC is required to
be manned four medical specialists i.e.
surgeon , physician , gynaecologist and
paediatrician supported by 21 paramedical
and other staff. It has 30 in door beds with 1
OT , x- ray , labour room and laboratory

34. BASIC CONCEPT OF CHC
CHC to provide referral health care for cases
from the primary level and for the cases in
need of specialist care .
4 PHC are included under each CHC –
80,000 population in hilly and tribal areas /
hilly areas and 1,20,000 population in plain
areas ,
CHC is 30 bedded hospital providing
specialist care in medicine , obstetrics ,
gynaecology , surgery and paediatrics .
upgradation to handle higher patient load ,
emphasise to give quality aspects to
increase the patient satisfaction .

35. OBJECTIVES OF CHC
To provide optimal expert care to the
community.
To achieve and maintain an
acceptable standard of quality of
care .
To make the services more sensitive
and the responsive to the need of
the community .

36. STAFFING PATTERN OF
CHC
Personal Existing strength Strength as per
IPHS
Qualification
Block health
officer
- - Sr.most specialist
General surgeon 1 1 MS/DNB gen .
surgery
Physician 1 1 MD/DNB gen.
medicine
Obstetrician &
gynecologist
1 1 MD/DNB/DGO
Pediatrician 1 1 MD/DNB/DCH
Anesthetist 1 MD/DNB
Public health
manager
1 MD//PG degree
with MBA
Eye surgeon 1/1 for every CHC MD/MS/DNB
Dental surgeon 1 BDS
General duty MO 6(atleast 2 F
doctors)
MBBS
Specialist of ayush 1 PG in AYUSH

37. INFRASTRUCTURE
 CHC should have
- 30 indoor beds ,1 operation theatre ,1 labour room, X
ray facilities and laboratory facilities ,Transport
facilities
 The centre should be located at the centre of the
block head quarter in order to improve access to the
patients .
 Common entrance zone with the registration facilities
and patient waiting hall .
 OPD zone
- Separate OPD rooms for the different specialists for
OPD,1 minor OT ,Injection / dressing room
,Observation room ,One pharmacy including AYUSH
drugs
 emergency area

38.  Critical care zone
- 1 labour room, New born care corner,1 operation
theatre
 Residential zone
- minimum 8 head quarters for doctors , minimum 8
quarters for staff nurses / paramedical staff,
minimum 2 quarters for ward boys ,minimum 1
quarter for driver
 Wards
- 4 ward each with 6 beds ( 2male ward & 2 female
wards ) , 4 private room , 2 isolation room
 Diagnostic zone
- Laboratory zone ,Imaging services , Other
investigations like ECG
 Administrative area

39.  CARE OF ROUTINE AND EMERGENCY CASES IN SURGERY .
- Dressing ,surgery for hernia , hydrocele ,
appendicitis .
- Emergency condition like intestinal obstruction
,haemorrhage etc.
- Other management including nasal packing ,
tracheostomy and foreign body removal etc.
 CARE OF ROUTINE AND EMERGENCY CASES IN MEDICINE.
- Daily OPD
- Handling all the routine and emergency cases .
 NEWBORN CARE AND CHILD HEALTH
- Essential new born care and resuscitation .
- Routine and emergency care of sick children.
- Full immunization of infant and children .

40.  FAMILY PLANNING
- Counselling , provision of contraceptives
,laparoscopic sterilization services and their follow up
.
- Safe abortion services .
 ALL NATIONAL HEALTH PROGRAMMES DELIVERED THROUGH
CHC’S .
 SCHOOL SERVICES
 OTHERS
- Blood storage services
- Essential laboratory services
- Referral ( transport ) services
MATERNAL DEATH REVIEW

41. ROLE OF NURSE IN RURAL AREAS
 a rural health nurse is a generalist who practices
professional nursing in communities .
 Rural nurses have close ties to and interaction with
the communities in which they practice .
 A strong and varied experience base is crucial in rural
nursing , as the population that the rural nurse must
care for ranges from infants to the elderly .
 Therefore , a rural nurse must know about every stage
of life .

42. Core competencies / skills needed :
Physical assessment and emergency trauma
management skills are vital to practice for a rural
nurse .
Critical care skills
An aptitude for teaching
Management skills
ability to adapt to the resources that are available.
Ability to use innovative and creative solutions to
the challenges that exist in locations without major
medical centres .

43. SUMMARY
 In this presentation , I have included –
Introduction to the rural health services , health care
delivery system , population norms in sub centre ,PHC
and CHC ,definition of sub centre , objectives of sub
centre ,categorization of sub centre ,staff pattern
,population , location , services provided by sub
centre ,
Definition of PHC , concept of PHC , population of
PHC , staffing pattern ,characteristics of PHC , nature
of PHC , elements of PHC , functions of PHC .
Definition of CHC , concept of CHC , objective of CHC
, staffing pattern of CHC ,infrastructure , and functions
of CHC .
Role of nurse in rural areas .