2. Comprehensive primary health care
(CPHC)
Preventive, promotive, curative, palliative & rehabilitative
services at from door-step to tertiary care hospital from
newborn to elderly at zero OOP
2
Susasthya
Kendra
Sasthya-
sathi
3. 3
• Health & Wellness Centre –
SHC (@5000 population)
SC Team
Community Health Officer:
BSc/ GNM trained in 6
months BPCCHN
ANMs
5 ASHAs (@1 per 1,000
population)
• Health & Wellness Centre –
PHC (@30,000) / UPHC
(@50,000)
PHC/UPHC team
At least - 1 MBBS Doctor
1 Staff nurse
1 Pharmacist
1 Lab Technician
Comprehensive Primary Health Care Team
PHC
Sub-
Centre
Sub-
Centre
Sub-
Centre
Sub-
Centre
Sub-
Centre
6. Infrastructure components
• Building & Branding
• Clinic room, Store, Lab corner, waiting area, toilet
(M & F)
• Water, sanitation & electricity with power back
up (preferably inverter)
• Approach path with directional signage at main
roadway
• Main signage and citizen’s charter
• Grievance box
• Waste disposal system (pit)
6
8. Expanded basket of services
8
1. Care in pregnancy and child-birth.
2. Neonatal and infant health care services.
3. Childhood and adolescent health care services.
4. Family planning, Contraceptive services and other
Reproductive Health Care services.
5. Management of Communicable diseases including
National Health Programmes.
6. Management of Common Communicable Diseases
and Outpatient care for acute simple illnesses and
minor ailments.
9. Expanded basket of services (contd.)..
9
7. Screening, Prevention, Control and Management of
Non-Communicable diseases.
8. Care for Common Ophthalmic and ENT problems.
9. Basic Oral health care.
10.Elderly and Palliative health care services.
11.First-aid & emergency Medical Services.
12.Screening and Basic management of Mental health
ailments.
Newer services to be rolled out in phases
10. Core skills for expanded services
10
Health care
services
Expected skill areas
Care in pregnancy &
Childbirth
Basic ANC, PNC, BEmOC (delivery points) services, Blood grouping
and Rh typing, primary management & timely referral of high risk &
complicated pregnancy
Neonatal & Infant
health
Identification and management of high risk newborn - low birth
weight/ preterm/ sick newborn and sepsis (with referral as
required), Management of birth asphyxia (Type B SHC), referral and
follow up of congenital anomalies, Management of ARI/Diarrhoea
and other common illness and referral of severe cases, Screening,
referral and follow up for disabilities and developmental delays,
Routine Immunization, AEFI management
Child & Adolescent
health
Routine Immunization, AEFI management, VPD surveillance,
Management (with timely referral as needed) of ear, eye and throat
problems, skin infections, worm infestations, febrile seizure,
poisoning, injuries/accidents, insect and animal bites, management
of SAM, Counseling of substance abuse, mental health issues
11. Core skills for expanded services
11
Health care
services
Expected skill areas
FP, Contraceptive
services
All types of spacing FP services including ANTARA, Medical methods
of abortion (up to 7 weeks of pregnancy) on fixed days at the HWC
by PHC/UPHC MO, Post abortion contraceptive counselling,
Identification and management (with referral as needed) of
RTIs/STIs, dysmenorrhoea, vaginal discharge, mastitis, breast lump,
pelvic pain, pelvic organ prolapse
Communicable &
General OPD care
Identification and management (with referral as needed) in cases of
ARI, diarrhoea, cholera, dysentery, typhoid, hepatitis and
helminthiasis and Management of common aches, joint pains, and
common skin conditions, (rash/urticaria)
Diagnosis, (or sample collection) treatment (as appropriate for that
level of care) and follow up care for vector borne diseases –Malaria,
Dengue, Chikungunya, Filaria, Kalazar, Japanese Encephalitis, TB and
Leprosy, HIV
12. Core skills for expanded services
12
Health care
services
Expected skill areas
Non-communicable
diseases
Screening, early diagnosis & treatment with referral wherever
necessary of Hypertension, Diabetes, Oral-breast-cervical Cancers,
Screening and follow up care for occupational diseases
(Pneumoconiosis, dermatitis, lead poisoning), fluorosis, respiratory
disorders (COPD and asthma) and epilepsy, Confirmation and
referral for de-addiction – tobacco/ alcohol/ substance abuse
Mental health issues
Detection and referral of patients with severe mental disorders,
Confirmation and referral to de-addiction centres, Dispense follow
up medication by the Psychiatrist, Counseling and follow up of
patients with Severe Mental Disorders, Management of Violence
related concerns
13. Core skills for expanded services
13
Health care
services
Expected skill areas
Care for Common
Ophthalmic and
ENT problems
Screening for visual acuity, near & distant vision, colour vision,
blindness and refractive errors, of common eye problems
(conjunctivitis, acute red eye, trachoma, spring catarrh, xeropthalmia)
////// Management of common colds, ASOM, injuries, pharyngitis,
laryngitis, rhinitis, URI, sinusitis, epistaxis, Early detection of hearing,
impairment and deafness with referral and common diseases like
otomycosis, otitis externa, ear discharge etc. ////// Manage common
throat complaints (tonsillitis, pharyngitis, laryngitis, sinusitis), First aid
for injuries/stabilization and then referral, Removal of Foreign Body.
(Eye,Ear, Nose and throat), Identification and referral of thyroid
swelling, discharging ear, blocked nose, hoarseness and dysphagia
Basic Oral health
care
Screening for gingivitis, periodontitis, malocclusion, dental caries,
dental fluorosis, dental caries, periodontal diseases, malocclusion and
oral cancers with referrals, Management of conditions
like apthous ulcers, candidiasis and glossitis, first aid for tooth trauma,
with referral, Counselling for tobacco cessation and referral to Tobacco
Cessation Centres
14. Core skills for expanded services
14
Health care
services
Expected skill areas
Elderly & Palliative
health care services
Arrange for suitable supportive devices from higher centres to the
elderly /disabled persons to make them ambulatory, Management
of common geriatric ailments
Counselling, supportive treatment, Pain Management and
provision of palliative care with support of ASHA
Emergency medical
services including
Trauma & Burns
Stabilization care and first-aid before referral in cases
of - poisoning, trauma, minor injury, burns, respiratory arrest and
cardiac arrest, fractures, shock, chocking, convulsion, drowning,
animal bites and haemorrhage, infections (abscess andcellulitis),
acute gastro intestinal conditions and acute genito urinary
condition
Identify and refer cases for surgical correction – lumps and bumps
(cysts/ lipoma/ haemangioma/ganglion), anorectal problems,
haemorrhoids, rectal prolapse, hernia, hydrocele, varicoele,
epidymo-orchitis, lymphedema, varicose veins, genital ulcers, bed
ulcers,lower urinary tract symptoms (Phimosis, paraphimosis), and
atrophic vaginitis.
15. Microplanning & calculation of
beneficiary
• Est. No. of Live birth = B.R x Population
• Est. No. of PW = Live birth + 10% (abortion, still birth)
• Est. No. PW with complication = 15% of total PW
• Est. No. Eligible couples = Population x 17%
• Sick Newborn = Live birth x 10%
• Est. beneficiary for NCD = Population x 37%
– target for yearly screening of hypertension & diabetes = 37% of
total population (51% male, 49% female)
– target for yearly screening of Oral cancer = 37% of population/5
= 7.4% of total pop
– target for yaerly screening of Breast & Cervical cancer = (37% of
pop x 49%)/5 = 3.6% of total pop
15
16. Activity schedule (Mon-Fri)
16
Day Activity Time Person involved
Monday
Routine SC/HWC clinic activities 9 am – 3 pm CHO + 1st ANM
Field activities, Junior WIFS and home
visit as per plan
As per work plan 2nd ANM + ASHA
Tuesday
NCD clinic & wellness activities 9 am – 3 pm CHO + 2nd ANM
Field activities and home visit as per
plan
As per work plan 1st ANM + ASHA
Wednesday
Immunization Day & VHND at sub-
centre/HWC (1st Wednesday of every
month)
9 am – 3 pm
CHO + 1st ANM + 2nd ANM + all
ASHAs
VHSND /Suswasthya Dibas at outreach
village (2nd, 3rd, 4th & 5th Wednesday)
9 am – 3 pm
CHO, 1st ANM & 2nd ANM (any two by
rotation - as per work plan)
Routine SC/HWC clinic activities 9 am – 3 pm
CHO, 1st ANM & 2nd ANM (rest one,
who will not attend VHSND - as per
work plan) + all ASHA
Thursday
VHND at outreach session (2nd, 3rd, 4th
& 5th Thursday)
9 am – 3 pm CHO, 1st ANM & 2nd ANM (any two by
rotation - as per work plan) + ASHA
of respective village
VHSND /Suswasthya Dibas at sub-
centre/HWC (1st Thursday)
9 am – 3 pm
Routine SC/HWC clinic activities 9 am – 3 pm
CHO, 1st ANM & 2nd ANM (rest one,
who will not attend VHND/ VHSND -
as per work plan)
Friday
NCD clinic & wellness activities 9 am – 3 pm CHO + 1st ANM
Field activities and home visit as per
plan
As per work plan 2nd ANM + ASHA
17. Activity schedule (Saturday)
17
Day Activity Time Person involved
1st Saturday
Block MIS (RMNCH+A etc.)
meeting with medical education
10 am onward CHO, 1st ANM & 2nd ANM
2nd Saturday
Block PH meeting & ASHA
convergence meeting with medical
education & CHO meeting
10 am onward
CHO, 1st ANM & 2nd ANM +
ASHA
3rd Saturday
SC/HWC convergence meeting
with AWW, SHG etc. as per norm
9 am – 3 pm (as
per joint plan)
1st ANM & 2nd ANM
Routine SC/HWC clinic with special
focus on CD
9 am – 3 pm CHO
4th Saturday
GPHQ CHCMI meeting as per norm
9 am – 3 pm (as
per joint plan)
1st ANM & 2nd ANM
Routine SC/HWC clinic with special
focus on NCD
9 am – 3 pm CHO
5th Saturday
Routine SC/HWC clinic & Leprosy
meeting
9 am – 3 pm CHO + 2nd ANM
Field activities and home visit as
per plan
As per priority
work plan
1st ANM
19. CHO job responsibility
• Administrative
• All package of
healthcare
services
• Supportive
supervision
• Miscellaneous
19
20. Assigned activity at PHC-S.K
• Overall in-charge: PHC MO (posted/ detailed) - will
supervise all the adm. activity in addition to clinical
services. Conduct a monthly meeting with all staff
(including ASHAs) of co-located SC
• Pharmacist: Record & monthly reporting (offline &
online – Ab-HWC mobile app/portal), in addition to
store maintenance etc.
• Staff nurse: Help pharmacist in record & reporting
and co-ordination with HAF/ANM of co-located SC
20
21. Susasthya Kendra Untied Fund
• Rs. 25000/- biannually
• Existing SC A/C. will be
transformed to
Susasthya Kendra A/C.
• CHO, HA (F) /1st ANM
& Pradhan – any two
• Sr. PHN/PHN - in
absence of 1st ANM
• 4th Saturday GP
meeting decision for
expenditure –
essential except
exigency
21
22. Observation of health days
22
• 31 health days –
round the year as
per order
• Additional days - as
per respective
programme division
• Rs. 10000/- per year
(max.) out of untied
fund can be used
• Wellness days –
Tuesday & Friday
27. Diagnostic facilities at SC-S.K
27
Hemoglobin
Human chorionic gonadotropin (HCG) (Urine test for
pregnancy)
Urine test for glucose, protein
Blood sugar
Malaria test (Smear & RDT)
HIV (Antibodies to HIV 1&2)
Water testing for fecal contamination and chlorination (H2S)
Hematology – Slide preparation for blood smear
Filariasis (endemic areas only) –FST
Visual Inspection – Acetic Acid
Rapid Test Kit for Syphilis –RDT
Others...
29. Record and Report
• Compilation of monthly report from existing
programmes
• Offline data source: Clinic register, NCD register,
ASHA family folder and checklist, Matrima..
• Reporting period will be as per original timeline
of programmes and existing norms – 21st ~ 20th
• Timeline: SK to Block by 7th, Block to Dist HQ by
10th and Dist HQ to State CPHC cell by 12th
29
30. Performance indicators
30
Average no. of OPD cases per month
Proportion of Pregnant Women (PW) registration within 12 weeks
Proportion of Pregnant Women (PW) received Complete ANC
Proportion of High risk Pregnant Women (PW) received follow up care
Proportion of Newborns who received 6/7 (Complete) HBNC visits
Proportion of Full immunization
Proportion of Complete Immunization
Average no. of Health Promotion sessions conducted by CHO
Proportion of target children (5-10 yrs.) consumed 4 Pink IFA (Junior WIFS)
Proportion of population screened (New beneficiary) for NCD among
eligible population
Proportion of new cases of Hypertension among eligible population
screened
Proportion of new cases of Diabetes among eligible population screened
Proportion of Hypertension cases managed
Proportion of Diabetes cases managed
No. of Presumptive TB cases referred to MO from S.K
Proportion of fever cases screened for malaria
31. HWC portal & mobile app
• url: https://ab-hwc.nhp.gov.in/
• User Id & password: State, District & S.K.
• Nature of data input:
– Basic information and infrastructure
• 8 Essential criteria for operational S.K in portal
– Building & Branding, HR, essential drugs & investigations, NCD
& CPHC training, Community outreach (Family folder & CBAC),
Universal Screening of at least 4 out of 5 major NCDs (HTN,
DM, Oral-Breast-Cervical CA)
– Daily report
– Service delivery report
– wellnss activity report
31
32. SKMIS portal
• Performance linked payment
• Quarterly team based incentive
• Basic personal information of CHO, HA(F), 2nd ANM &
ASHA
• Entry of eligible staff (based on attendance criteria)
to be entered
• Monthly performance to be entered
• PLP will be calculated based on weighted combined
score of performance indicators & payment slab
• PLP statement - both for S.K. and Block authority for
financial audit purpose 32
33. Record & Report - AB-HWC portal -
State ranking criterias
1. % of SHCs, PHCs and U-PHCs operationalized as HWCs out of total in the State
2. % of HWC met functionality criteria against the total target criteria –
a) Availability of HR (MO for PHC, UPHC & CHO for Sub-centre HWC)
b) Training completed (NCD & CPHC)
c) Branding Completed
d) Availability of essential Medicines
e) Availability of essential Diagnostics
f) Population Enumeration initiated
g) Screening initiated for all four NCDs (Hypertension, Diabetes, Oral & Breast
Cancer)
h) IT applications in use (CPHC-NCD)
i) Tele-consultation
j) Wellness Activity started
3. % of HWCs which had submitted at least 24 daily entries during last month
4. % of HWCs which have submitted the monthly service delivery report for last month
34. CPHC - roles & responsibilities
• State level
• District level
• Block/ ULB level
• S.K. level
34
