Provide Quality Health Care Service in India & beyond, Only Aim to improve the Quality Health Care Service in India. Dr. J. L. Meena

1. How to achieve NABH Standards in
PHCs
1
Dr J L Meena
State Quality Assurance Medical Officer
Department of Health & Family Welfare
Government of Gujarat
Member of NABH Accreditation Committee, QCI
Member of Quality Expert Group, Govt of India.
Email:- drjlmeena@gmail.com
Website:- https://gujhealth.gujarat.gov.in/quality-assurance-program.htm

2. NABH STANDARDS FOR PHC & CHC
SECTION – A: Infrastructure Standards
SECTION – B: Process Standards
SECTION – C: Governance Standards
SECTION – D: Outcome Standards

3. SECTION – A:
Infrastructure Standards

4. Physical Facilities
Objective Elements
The facility shall confirm to the FAR Norms
of that particular region as per the State
Government Rules.
For all expansion the space should be
acquired as per the standards.
Land scraping should be compulsory.
The facility should be fenced to guard
against entry of animals.

5. The facility shall confirm to the FAR (Floor Area Ratio)
Norms of that particular region as per the State
Government Rules.
PHC Gadboriad, Vadodara

6. The facility shall confirm to the FAR (Floor Area Ratio)
Norms of that particular region as per the State
Government Rules.

7. The facility shall confirm to the FAR (Floor Area Ratio)
Norms of that particular region as per the State
Government Rules.
PHC Sokhada, Vadodara

8. The facility shall confirm to the FAR (Floor Area Ratio)
Norms of that particular region as per the State
Government Rules.
PHC Champawadi, Tapi

9. For all expansion the space should be acquired as per
the standards.
PHC Gadboriad, Vadodara

10. For all expansion the space should be acquired as per
the standards.

11. Land scraping should be compulsory
PHC Khirasara, Rajkot

12. Land scraping should be compulsory
PHC Salun, Kheda

13. Land scraping should be compulsory
PHC Mahuwas, Navsari

14. Land scraping should be compulsory
PHC Champawadi, Tapi

15. Land scraping should be compulsory
PHC Gadboriad, Vadodara

16. The facility should be fenced to guard against entry of
animals.

17. Physical Facilities cont…
Objective Elements
Main entrance should be easily identifiable,
welcoming, well lit and with mattress.
Emergency Exits should be provided.
It should confirm to the covered area ration
vis-à-vis the size of plot.
Adequate circulatory space for movement
of traffic including trolley and wheel chairs
to be present.

18. Main entrance should be easily identifiable, welcoming, well
lit and with mattress.
PHC Jetalpur, AhmedabadPHC Mahuwas, Navsari

19. Main entrance should be easily identifiable, welcoming, well
lit and with mattress.
PHC Salun, Kheda

20. Main entrance should be easily identifiable, welcoming, well
lit and with mattress.
PHC Champawadi, Tapi

21. Emergency Exits should be provided.
PHC Salun, KhedaPHC Jetalpur, Ahmedabad

22. Emergency Exits should be provided.
PHC Gadboriad, Vadodara

23. Adequate circulatory space for movement of traffic
including trolley and wheel chairs to be present.
PHC Jetalpur, Ahmedabad

24. Adequate circulatory space for movement of traffic
including trolley and wheel chairs to be present.
PHC Gadboriad, Vadodara

25. Adequate circulatory space for movement of traffic
including trolley and wheel chairs to be present.
PHC Salun, Kheda

26. Physical Facilities cont……
Objective Elements cont….
Adequate ramps to be present to cater to
the requirements of immobile patients.
Accommodation (Semi-Full furnished)
facilities (as per grades) for the core staff i.e.
MO, Nurse, and Pharmacist to be available.
Laundry, Housekeeping, Security and Dietary
services may be out sourced as per a MOU
with the provider on certain quality criteria.

27. Adequate ramps to be present to cater to the
requirements of immobile patients.
PHC Sokhada, Vadodara

28. Adequate ramps to be present to cater to the
requirements of immobile patients.
PHC Sokhada, Vadodara

29. PHC Gadboriad, Vadodara
Adequate ramps to be present to cater to the
requirements of immobile patients.

30. Accommodation (Semi-Full furnished) facilities (as
per grades) for the core staff i.e. MO, Nurse, and
Pharmacist to be available.
PHC Salun, Kheda

31. Accommodation (Semi-Full furnished) facilities (as
per grades) for the core staff i.e. MO, Nurse, and
Pharmacist to be available.
PHC Sokhada, Vadodara

32. Accommodation (Semi-Full furnished) facilities (as
per grades) for the core staff i.e. MO, Nurse, and
Pharmacist to be available.
PHC Champawadi, Tapi

33. Accommodation (Semi-Full furnished) facilities (as
per grades) for the core staff i.e. MO, Nurse, and
Pharmacist to be available.
PHC Gadboriad, Vadodara

34. Laundry, Housekeeping, Security and Dietary services may be out
sourced as per a MOU with the provider on certain quality criteria.
PHC Gadboriad, Vadodara

35. Physical Facilities cont……
Objective Elements cont….
There should be 24X7 availability of
electricity and potable water supply with
identified alternate sources.
Arrangement for fire safety shall be
present.
Attendants lounge (temporary stay facility)
should be provided within the campus.
Adequate drainage system should be built-
in.

36. There should be 24X7 availability of electricity and
potable water supply with identified alternate
sources.
PHC Salun, Kheda

37. Arrangement for fire safety shall be present.
PHC Jetalpur, Ahmedabad

38. Arrangement for fire safety shall be present.
PHC Jetalpur, Ahmedabad

39. Arrangement for fire safety shall be present.
PHC Jetalpur, Ahmedabad

40. Arrangement for fire safety shall be present.

41. Arrangement for fire safety shall be present.
PHC Khirasara, Rajkot

42. Arrangement for fire safety shall be present.
PHC Khirasara, Rajkot

43. Arrangement for fire safety shall be present.
PHC Salun, KhedaPHC Jetalpur, Ahmedabad

44. Mock drill and training
PHC Mahuwas, Navsari

45. Mock drill and training
PHC Tankal, Kandolpada & Mahuwas, Navsari

46. Mock drill and training
PHC Tankal & Kandolpada Navsari

47. Mock drill and training
PHC Tankal, Navsari

48. Mock drill and training
DH Gandhinagar, Gandhinagar

49. Mock drill and training

50. Attendants lounge (temporary stay facility) should be
provided within the campus.
PHC Jetalpur, Ahmedabad

51. Attendants lounge (temporary stay facility) should be
provided within the campus.
PHC Salun, Kheda

52. Attendants lounge (temporary stay facility) should be
provided within the campus.
PHC Gadboriad, Vadodara

53. Attendants lounge (temporary stay facility) should be
provided within the campus.
PHC Mahuwas, Navsari

54. Adequate drainage system should be built-in.
PHC Salun, Kheda

55. 2. Functional Plan
Objective Elements cont….
• The building should have a functional plan having ear marked
space for waiting area, OPD, Labour Room, Minor OT, Major OT in
CHC, Sterilization Room, Pharmacy, Dressing Room, Injection
Room, X-ray Room, Dark Room, Patients Wards, Store Room (for
drugs, linen and equipments), Counseling Centers, Administrative
Office, Toilet (male & female) with running water facilities, Nurses
Room, Cold Chain Room, Immunization, post-mortem facility with
capacity of 2 bodies platform. Laboratory services should be as per
IPHS guidelines. There shall be rooms for other state run programs
like TB, Leprosy, Opthalmic, ICTC, Sickle Cell Anemia, ANC, FP,
CNDC.
• It should adhere to the requirements as stated in relevant IPHS
standards.
• CHC should have Blood storage facility.

56. The building should have a functional plan having ear marked space for waiting area, OPD, Labour Room,
Minor OT, Major OT in CHC, Sterilization Room, Pharmacy, Dressing Room, Injection Room, X-ray Room,
Dark Room, Patients Wards, Store Room (for drugs, linen and equipments), Counseling Centers,
Administrative Office, Toilet (male & female) with running water facilities, Nurses Room, Cold Chain
Room, Immunization, post-mortem facility with capacity of 2 bodies platform. Laboratory services should
be as per IPHS guidelines. There shall be rooms for other state run programs like TB, Leprosy, Opthalmic,
ICTC, Sickle Cell Anemia, ANC, FP, CNDC.
PHC Jetalpur, Ahmedabad

57. The building should have a functional plan having ear marked space for waiting area, OPD, Labour Room,
Minor OT, Major OT in CHC, Sterilization Room, Pharmacy, Dressing Room, Injection Room, X-ray Room,
Dark Room, Patients Wards, Store Room (for drugs, linen and equipments), Counseling Centers,
Administrative Office, Toilet (male & female) with running water facilities, Nurses Room, Cold Chain
Room, Immunization, post-mortem facility with capacity of 2 bodies platform. Laboratory services should
be as per IPHS guidelines. There shall be rooms for other state run programs like TB, Leprosy, Opthalmic,
ICTC, Sickle Cell Anemia, ANC, FP, CNDC.

58. It should adhere to the requirements as stated in
relevant IPHS standards.
PHC Orna, Surat

59. CHC should have Blood storage facility.

60. Objective Elements Cont..
• Facility should have VIP room, furnished
and equipped with hydraulic cardiac bed,
pulse Oximeter, ECG and Central oxygen
line.
• There should be a dedicated room for
visiting doctors in OPD.
• OT, Labour room and dressing rooms
should have tiled (glazed) walls to height
of four feet to ensure easy cleaning.
2. Functional Plan Cont…

61. Facility should have VIP room, furnished and
equipped with hydraulic cardiac bed, pulse Oximeter,
ECG and Central oxygen line.
PHC Salun, Kheda

62. There should be a dedicated room for visiting
doctors in OPD.
PHC Salun, Kheda

63. There should be a dedicated room for visiting
doctors in OPD.
PHC Jetalpur, Ahmedabad

64. OT, Labour room and dressing rooms should have
tiled (glazed) walls to height of four feet to ensure
easy cleaning.
PHC Salun, Kheda

65. 3. Equipment and Instruments
Objective Elements cont….
• The facility should have adequate number of
equipments along with instruments as stated in
IPHS.
• The equipments should be in functional order
and have an up time of 98 %.
• All equipments should have insurance cover.
• There should be appropriate mechanism for
repair, maintenance and AMC of all the
equipments.

66. The facility should have adequate number of
equipments along with instruments as stated in
IPHS.
PHC Salun, Kheda PHC Jetalpur, Ahmedabad

67. The equipments should be in functional order and
have an up time of 98 %.

68. The equipments should be in functional order and
have an up time of 98 %.

69. The equipments should be in functional order and
have an up time of 98 %.

70. The facility should have adequate number of equipments
along with instruments as stated in IPHS.
PHC Gadboriad, Vadodara

71. All equipments should have insurance cover.

72. All equipments should have insurance cover.

73. There should be appropriate mechanism for repair,
maintenance and AMC of all the equipments.

74. There should be appropriate mechanism for repair,
maintenance and AMC of all the equipments.
PHC Salun, Kheda

75. There should be appropriate mechanism for repair,
maintenance and AMC of all the equipments.
PHC Gadboriad, Vadodara

76. Objective Elements cont….
• The instruments used should be adequately
disinfected, sterilixed and kept in good working
condition.
• Utilization of equipments should be monitored on
regular basis.
• Organization should have resources for ensuring
skill based training on use/handling of equipments.
• There should be simple yet effective Condemnation
Policy for equipments and instruments.
3. Equipment and Instruments Cont..

77. The instruments used should be adequately
disinfected, sterilized and kept in good working
condition.
PHC Salun, Kheda

78. The instruments used should be adequately
disinfected, sterilized and kept in good working
condition.
PHC Salun, Kheda & Hadiyol, SK

79. Utilization of equipments should be monitored on
regular basis.

80. Utilization of equipments should be monitored on
regular basis.

81. Utilization of equipments should be monitored on
regular basis.
ECG UTILIZATION IN PERCENTAGE
Month
ECG Utilization in
%(in round figures)
Total
January 11 10% 221
February 11 11% 231
March 11 10% 223
April 11 05% 113
May 11 07% 149
June 11 06% 121
August 11 06% 125
September 11 06% 138
October 11 08% 167
ECG Utilization
ECG Average Time = 10 mins / ECG
ECG machine in the hospital = 03Per day =
24 ECG/machine (if one machine is used for
4 hrs)Per day = 72 ECG (Total no. of ECG that
can be done in one day if all the 3 machines
work for 4 hrs)
Working note:-
No. of ECG Machine = 03
Working hrs in a day = 4 hrs which is 240 min /
day
Average time taken for 1 ECG = 10 mins.
Hence total no. of ECG that can be done in:
•one machine per day = 240/ 10= 24
•3 machines per day = 24*3 = 72
•one month = 72 * 30 = 2160
Hence utilization rate for the month of January 11
= 221 / 2160 * 100 = 10.23%

82. Organization should have resources for ensuring skill
based training on use/handling of equipments.
PHC Salun, Kheda

83. Organization should have resources for ensuring skill
based training on use/handling of equipments.

84. There should be simple yet effective Condemnation
Policy for equipments and instruments.

85. There should be simple yet effective Condemnation
Policy for equipments and instruments.
PHC Salun, Kheda

86. 4. Man Power & Staffing
Objective Elements cont….
• The staffing norms as stated in IPHS to be
maintained.
• Roster for doctor and nurses to be displayed.
• Emergency call, Roster to be available for the
core staff i.e. Doctors, nurses and pharmacists.

87. Medical Officer
Male Supervisor Female supervisor
•MPHW
•FHW
•ASHA
•AWW
•MLW
•Other field
workers
AYUSH
•Pharmacist
•Laboratory
technician
•Staff nurses
•Class iv
•Driver
•Accountant
Security
The staffing norms as stated in IPHS to be maintained.

88. Sr.
No
Personnel Recommended Current Availability
Identified
Gaps Remarks
1 Medical Officer
2 (1 AYUSH and 1
MO
2 0
2 Pharmacist 1 1 0
3 Staff Nurse 3 2 1
4 Health Worker (Female) 7 6 1
Health Worker (Male) 7 5 0
5 Health Educator 1 1 0
6
Health Assistant (One male and
One female
2 1 1
7 Clerks 2 1 1
Contractual
8 Laboratory Technician 1 1 0
9 Driver
1
1 0
10 Security 2 2
10 Class IV 4 4 0
The staffing norms as stated in IPHS to be
maintained.

89. The staffing norms as stated in IPHS to be
maintained.
PHC Champawadi, Tapi

90. The staffing norms as stated in IPHS to be
maintained.
PHC Jetalpur, Ahmedabad

91. Roster for doctor and nurses to be displayed.
PHC Salun, Kheda

92. Emergency call, Roster to be available for the core
staff i.e. Doctors, nurses and pharmacists.
PHC Salun, Kheda

93. • Organization should have resources and be able to
demonstrate following trainings :
1. Managerial / Administrative training to MO / Head.
2. Programme implementation training to MO / Head.
3. Induction training to staff at all levels.
4. Job based skills training.
5. Special clinical skill training on minor surgical procedure,
obstetrics care, new born care, basic life support and
local anesthesia block.
6. Disaster Management.
4. Man Power & Staffing Cont…

94. 1. Managerial /
Administrative training to
MO / Head.
2. Programme
implementation training
to MO / Head.
State level training

95. 3. Induction training to staff
at all levels.
4. Job based skills training.
PHC Salun, Kheda

96. 5. Special clinical skill training on minor
surgical procedure, obstetrics care, new
born care, basic life support and local
anesthesia block.
6. Disaster Management
PHC Dabhoda-Gandhinagar & Salun-Kheda

97. 5. Drugs
Objective Elements cont….
• A unified formulary based pn workload, essential
drug list as specified by State Government to be
maintained.
• Availability of drugs and surgical consumable to
be ensured.
• Availability of drugs to be displayed along with
expiry dates.
• Medical Officers to prescribe drugs based on the
available formulary or essential drug list.

98. A unified formulary based pn workload, essential drug list as
specified by State Government to be maintained.

99. A unified formulary based pn workload, essential drug list as
specified by State Government to be maintained.

100. Availability of drugs and surgical consumable to be
ensured.
PHC Salun, Kheda

101. Availability of drugs to be displayed along with
expiry dates.
PHC Salun, Kheda

102. Medical Officers to prescribe drugs based on the
available formulary or essential drug list.

103. Medical Officers to prescribe drugs based on the
available formulary or essential drug list.
PHC Salun, Kheda

104. • Medicines dispensed should have clear
instruction on dose and schedule for
consumption purposes.
• Consumption report of the drugs to be
submitted to the district authorities of the
particular district.
• Minimum balance and re-order level to be
maintained.
5. Drugs Cont…

105. Medicines dispensed should have clear instruction
on dose and schedule for consumption purposes.
PHC Salun, Kheda

106. Consumption report of the drugs to be submitted to
the district authorities of the particular district.
DAY
CAP:AMOXYCILLINE
250Mg
CAP:AMPICILLINE500
Mg
CAP:AMPICILLINE250
Mg
CAP:AMOXYCILLINE
500Mg
CAP:CLOXACILLINE
250Mg
CAP:DOXY100MG
CAP:FLUCONAZOLE
150Mg
CAP:OMEPRAZOLE20
Mg
1 3 4 5 6 7 8 9 10
DAY 1 0 0 0 0 0 0 0 0
DAY 2 0 0 0 0 0 0 0 0
DAY 3 56 0 0 0 16 36 6 0
DAY 4 102 0 0 0 24 32 2 0
DAY 5 68 0 0 0 4 58 0 10
DAY 6 134 0 0 0 6 68 4 0
DAY 7 0 0 0 0 0 0 0 0
WEEK -1 360 0 0 0 50 194 12 10

107. Minimum balance and re-order level to be
maintained. “Medicine with balance sheet”
PHC Sokhada, Vadodara

108. • Lead time of sourcing the drugs and
consumable to be maximum of 1 week.
• Drugs shall be stored in well lit and well
ventilated rooms.
• Certain drugs to be kept in the refrigerator.
• The Temperature of the refrigerator to be
maintained at 2 to 6 degree centigrade.
5. Drugs Cont…

109. Lead time of sourcing the drugs and consumable to
be maximum of 1 week.
PHC Gadboriad, Vadodara

110. Drugs shall be stored in well lit and well ventilated
rooms.
PHC Khirasara, Rajkot

111. Drugs shall be stored in well lit and well ventilated
rooms.

112. Drugs shall be stored in well lit and well ventilated
rooms.
PHC Salun, Kheda

113. Certain drugs to be kept in the refrigerator.
PHC Salun, Kheda

114. The Temperature of the refrigerator to be
maintained at 2 to 6 degree centigrade.
PHC Dabhoda, Gandhinagar

115. The Temperature of the refrigerator to be
maintained at 2 to 6 degree centigrade.

116. Objective Elements
• There should be at least one ambulance.
• Local network of ambulances should be
outsourced and linked to PHC / CHC block.
• Driver for the same to be available all the
times.
• Ambulance should be in working condition all
the time.
6. Transport and Ambulances

117. There should be at least one ambulance.
PHC Gadboriad, Vadodara

118. There should be at least one ambulance.
PHC Jetalpur, Ahmedabad

119. Local network of ambulances should be outsourced
and linked to PHC / CHC block.
PHC Salun, Kheda PHC Jetalpur, Ahmedabad

120. Driver for the same to be available all the times.
PHC Salun, Kheda

121. Ambulance should be in working condition all the
time.
PHC Jetalpur, AhmedabadPHC Champawadi, Tapi

122. • Emergency drugs to be available in the
ambulance.
• Basic resuscitation kit to be available in the
ambulance.
• The Stretcher trolleys and wheel chairs in the
ambulance to be in working condition all the
times.
6. Transport and Ambulances Cont…

123. Emergency drugs to be available in the ambulance.
PHC Salun, Kheda

124. Basic resuscitation kit to be available in the
ambulance.
PHC Salun, Kheda

125. The Stretcher trolleys and wheel chairs in the ambulance to
be in working condition all the times.

126. The Stretcher trolleys and wheel chairs in the
ambulance to be in working condition all the
times.
PHC Salun, Kheda

127. The Stretcher trolleys and wheel chairs in the
ambulance to be in working condition all the
times.
PHC Mahuwas, Navsari

128. 7. Communication Facilities
Objective Elements
• The center should have adequate
stationeries for written communication.
• At least 2 telephone (24X7) connections to
be available in the facility.
• An internet connection to be available.
• Arrangements for a public address system to
be available.

129. The center should have adequate
stationeries for written communication.
PHC Gadboriad, Vadodara

130. At least 2 telephone (24X7) connections to be
available in the facility.
PHC Salun, Kheda

131. An internet connection to be available.
PHC Salun, Kheda

132. An internet connection to be available.
PHC Gadboriad, Vadodara

133. Arrangements for a public address system to be
available.
PHC Salun, Kheda

134. • Organization should use Signboards, Posters or /
and wall painting displayed the activities and
services (along with timings) at the facility and the
important contact numbers at prominent sites in
the campus as well as in all villages. These should
be in local language.
• Campaigns for National Health Programs should
be displayed in the form of wall painting or
boards.
• Lay out map of the facility and signage shall be in
vernacular and symbols to address the needs of
vulnerable patients.
7. Communication Facilities Cont…

135. Organization should use Signboards, Posters or / and wall
painting displayed the activities and services (along with
timings) at the facility and the important contact
numbers at prominent sites in the campus as well as in
all villages. These should be in local language.
PHC Gadboriad, Vadodara

136. Organization should use Signboards, Posters or / and wall painting displayed the
activities and services (along with timings) at the facility and the important
contact numbers at prominent sites in the campus as well as in all villages. These
should be in local language.
PHC Salun, Kheda

137. Organization should use Signboards, Posters or / and wall painting
displayed the activities and services (along with timings) at the facility
and the important contact numbers at prominent sites in the campus
as well as in all villages. These should be in local language.

138. Organization should use Signboards, Posters or / and wall painting displayed the
activities and services (along with timings) at the facility and the important
contact numbers at prominent sites in the campus as well as in all villages. These
should be in local language.

139. Organization should use Signboards, Posters or / and wall painting displayed the
activities and services (along with timings) at the facility and the important
contact numbers at prominent sites in the campus as well as in all villages. These
should be in local language.
PHC Salun, Kheda

140. Campaigns for National Health Programs should be
displayed in the form of wall painting or boards.

141. Campaigns for National Health Programs should be
displayed in the form of wall painting or boards.
PHC Salun, Kheda

142. Lay out map of the facility and signage shall be in
vernacular and symbols to address the needs of
vulnerable patients.

143. Lay out map of the facility and signage shall be in
vernacular and symbols to address the needs of
vulnerable patients.
PHC Khirasara, Rajkot

144. Lay out map of the facility and signage shall be in
vernacular and symbols to address the needs of
vulnerable patients.
PHC Salun, Kheda

145. Lay out map of the facility and signage shall be in
vernacular and symbols to address the needs of
vulnerable patients.
PHC Orna, Surat

146. Lay out map of the facility and signage shall be in vernacular
and symbols to address the needs of vulnerable patients.
PHC Salun, Kheda

147. Lay out map of the facility and signage shall be in vernacular
and symbols to address the needs of vulnerable patients.

148. Lay out map of the facility and signage shall be in vernacular
and symbols to address the needs of vulnerable patients.

149. Health for All