3. • Objective of IPHS for CHC
• Types of CHC
• Population norms
• Services provided
• Human resources for health
• Physical infrastructure
• Implimentation of IPHS
• Funding
• CHC Bajakhana
LESSON
PLAN
4. INTRODUCTION
Community Health Centre form a part
secondary healthcare delivery
They provide referral health care for
cases from Primary Health
Centre/SC and for cases in need of
specialist care approaching directly
5. OBJECTIVES OF IPHS FOR CHC
1. To define a uniform benchmark ensuring high quality services that are accountable,
responsive, and sensitive to the needs of the community.
2. To specify the minimum assured (Essential) and achievable (Desirable) services that
are expected to be provided at CHCs in both rural and urban areas.
3. To achieve and maintain an acceptable standard of quality of care at public health
facilities.
4. To facilitate monitoring and supervision of the facilities.
5. To provide guidance and tools for governance and leadership.
6. To provide guidance on health systems strengthening components which includes
architectural design of facilities, human resources for health, drugs, diagnostics,
equipment, administrative and logistical support services to improve the overall health
related outcomes
6. IPHS 2012 OF CHC
30 bedded hospital
• 4 PHCs are included under each CHC thus catering
to approximately 80000 populations in tribal / hilly areas
and 120000 population for plain areas
Specialists
• physician
• OBG
• Surgeon
• Paediatrician
• Anesthesiologist
8. TYPES OF CHC
Non – FRU CHCs(
rural)
FRU CHCs(rural and
urban)
Block public health
unit (BPHU) – at block
headquarters level
9. POPULATION NORMS FOR CHC
Non – FRU CHC(rural) FRU -CHC
Tribal/ hilly area Plain area Metro city Non metro city
80000 1,20000 5 L 2.5 L
10. IPHS-SERVICES
Services Non-FRU - CHC FRU - CH FRU -CH FRU-UCHC FRU-UCHC
30 beds 30 beds 50 beds 50beds 100 beds
Emergency E E E E E
Intensive care &OT
OT - E E E E
Labour room E E E E E
NBSU E E E E E
Blood storage D E E E E
11. Services Non-FRU -
CHC
FRU -
CH
FRU -CH FRU-
UCHC
FRU-
UCHC
30 beds 30 beds 50 beds 50beds 100 beds
Common surgical procedures E E E E E
OP services
General medicine E E E E E
Gen surgery D E E E E
OBG D E E E E
Pediatrics D E E E E
Ophthalmology - - D D E
Orthopaedics - - D D E
Pathology/microbiology - D E E E
ENT - - D D D
12. Services Non-FRU -
CHC
FRU -
CH
FRU -CH FRU-
UCHC
FRU-
UCHC
30 beds 30 beds 50 beds 50beds 100 beds
Pre- anaesthetic check up D E E E E
Family medicine D D D D D
Physiotherapy E E E E E
PMR Services - - - - D
Family welfare clinic E E E E E
Counselling E E E E E
Nutrition E E E E E
Health and wellness services E E E E E
Immunization services E E E E E
13. Services Non-FRU -
CHC
FRU -
CH
FRU -
CH
FRU-
UCHC
FRU-
UCHC
30 beds 30
beds
50 beds 50beds 100 beds
Dental E E E E E
AYUSH D D D D D
NCD clinic (diagnosis,
followup, and referral, as
appropriate)
E E E E E
Cold chain services E E E E E
Integrated Counseling and Testing
services (HIV)
E E E E E
Maternal and child health (including
Family Planning
E E E E E
Dressing room E E E E E
14. Services Non-FRU -
CHC
FRU -
CH
FRU -
CH
FRU-
UCHC
FRU-
UCHC
30 beds 30 beds 50 50beds 100
beds
INTEGRATED COUNSELLING SERVICES
Tobacco cessation &Drug de-
addiction
E E E E E
Mental health E E E E E
Adolescent health E E E E E
Nutritional counselling and early
childhood development
E E E E E
Domestic violence and sexual
violence
E E E E E
Health education and BCC E E E E E
Health education for prevention E E E E E
15. Services Non-FRU -
CHC
FRU -
CH
FRU -
CH
FRU-
UCHC
FRU-
UCHC
30 beds 30 beds 50 50beds 100
beds
IPD services
General ward- gender based E E E E E
Post operative ward - E E E E
Isolation room D D D D D
Maternity ward E E E E E
Referral services E E E E E
Laboratory Services E E E E E
Diagnostic services
Usg with colour droppler (including
for newborns)
D E E E E
16. CHC CH CH UCHC
30 beds 30 beds 50 beds 50beds 100 beds
Administrative Area&services
Birth and Death Registrations E E E E E
Server Room , Housekeeping
Room, Staff Room ,Condemnation
Multi purposes services
maintenance Room, Medical
records Room
E E E E E
Designated space for IEC E E E E E
Bio waste material management
with linkage to common
biomedical waste treatment
E E E E E
Finance E E E E E
Training and Orientation E E E E E
17. o. - CHC CH CH UCHC UCHC
30 beds 30
beds
50
beds
50beds 100 beds
• Monitoring and Supervision
• Monitoring and supervision of
activities of Sc thru regular
meetings/ periodic visits, by
LHV, HAM andMO etc.
• Monitoring of all NHPs by MO
with support of LHV, HAM and
Health educator.
• Monitoring activities of ASHAs
by LHV and ANM (in her SC
area).
• Health educator will monitor all
IEC and BCC activities HAM and
LHV should visit SCs once a
week.
E E E E E
18. Services Non-FRU
- CHC
FRU -
CH
FRU -
CH
FRU-
UCHC
FRU-
UCHC
30 beds 30
beds
50
beds
50beds 100 beds
Epidemic Control and Disaster
Preparedness
E E E E E
Nosocomial Disease reporting E E E E E
Immunization of Health care
workers
E E E E E
Clinical Governance:Incident
reporting (including Maternal
Death Surveillance and Response
(MDSR); Child Death Review
(CDR); Near miss reporting Audits
(including prescription audit)
E E E E E
19. Services Non-FRU -
CHC
FRU -
CH
FRU -CH FRU-
UCHC
FRU-UCHC
30 beds 30 beds 50 beds 50beds 100 beds
Hospital Management Information
System, IT Section, Reporting, Feedback&
Surveillance .
E E E E E
Server Room ,Internal Communication
system,Public addressal system,Token
Display system
E E E E E
Disabled friendly services,
Ambulance services
E E E E E
Disability certificate D E E E E
Skype, ZOOM etc. for consultation for a
higher identified centre
D D D D D
Security Services ,Housekeeping Services E E E E E
Central Sterilization Supply Department
(CSSD)/equipment sterilization services
E E E E E
Laundry services E E E E E
20. Services Non-FRU -
CHC
FRU -
CH
FRU -
CH
FRU-
UCHC
FRU-
UCHC
30 beds 30 beds 50 50beds 100 beds
Support Services
Registration Counter E E E E E
Pharmacy&Store E E E E E
Dressing room E E E E E
Telemedicine E E E E E
Dietary E E E E E
Effluent Treatment Plant (ETP) E E E E E
Power Sub-Station/Transformer E E E E E
Overhead water tank –
2independent water sources.
Separate tank for critical care
(450 L per bed per day)
15300 L 16200 L 16200L 16200L 45000 L
21. Services Non-FRU -
CHC
FRU -
CH
FRU -
CH
FRU-
UCHC
FRU-
UCHC
30 beds 30 beds 50 50beds 100 beds
Generator E E E E E
Use of power through solar panels D D D D D
Ambience ,Pest control services
,Horticulture
E E E E E
Rainwater harvesting in facilities
more than 500 square meter
D D D D D
Cafeteria,ATM D D D D D
Parking,Garden E E E E E
Suggestion & feedback System E E E E E
Staff Residences E E E E E
22. HUMAN RESOURCES FOR
HEALTH
• General surgeon 1
• Physician 1
• Obstetrician & gynecologist 1
• Pediatrician 1
• Anesthesist 1
• Public Health Manager (M.D.
Community Medicine) 1
This Photo by Unknown author is licensed under CC BY-SA-NC.
23. HUMAN RESOURCES FOR
HEALTH
• Opthalmologist 1 for every 5 CHCs
• Dental surgeon 1
• General Duty Medical Officers (MBBS) -
6 (including 2 lady med. officers)
• Specialist of AYUSH 1
• General Duty Medical Officers of
AYUSH-1
24. • COMMUNICABLE DISEASES PROGRAMMES
• NATIONAL VECTOR BORN DISEASE CONTROL PROGRAMME
• NATIONAL LEPROSY ERADICATION PROGRAMME
• NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS AND VISUAL IMPAIRMENT
• INTEGRATED DISEASE SERVILLANSE PROJECT
• NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF DEAFNESS
• NATIONAL MENTAL HEALTH PROGRAMME
• RMNCH+A
NATIONAL HEALTH PROGRAMMES
25. NATIONAL HEALTH PROGRAMMES
• NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF CANCER DIABETES CARDIOVASCULAR
DISEASES AND STROKE
• NATIONAL IODINE DEFICIENCY DISORDERS CONTROL PROGRAMME
• NATIONAL PROGRAM FOR PREVENTION AND CONTROL OF FLUOROSIS
• NATIONAL TOBACCO CONTROL PROGRAMME
• NATIONAL PROGRAMME FOR HEALTH CARE OF ELDERLY
• NATIONAL ORAL HEALTH PROGRAMME
• NATIONAL PROGRAMME FOR PALLIATIVE CARE
26. PHYSICAL INFRASTRUCTURE
• ENTRANCE ZONE
• Signage:Prominent display boards in local language
providing information regarding the services available
and timings of the CHC
• All the signages should be bilingual and pictorial
• Citizen charter should be displayed at OPD and
Entrance in local language including patient’s rights
and responsibilities
27. • OUTPATIENT DEPARTMENT
• Layout of the Out Patient Department
shall follow the functional flow of the
patients:
• Enquiry
• Registration
• Waiting
• Clinic
• Dressing room/injection room
This Photo by Unknown author is licensed under CC BY.
29. • NURSING STATION:
• Centred such that it serves all the clinics from that
place.
• Spacious enough to accommodate a work counter
(for preparing dressings ,medicines),hand washing
facilities,sinks,dressing tables etc.
• ADMINISTRATIVE ZONE:
• Separate rooms should be available for :
• Office
30. • RESIDENTIAL ZONE
• Minimum 8 quarters for doctors
• Minimum 8 quarters for staff nurses
• Paramedical staff
• Minimum 2 quarters for ward boys
• Minimum 1 quarter for driver
31. IMPLEMENTING IPHS AT CHCS
• Standards implemented in phased manner
• FIRST STAGE
• Ensure services with appropriate transport service
• Assure four general duty medical officers with seven staff nurses along with other
support services and physical qualities
• SECOND STAGE
• 24*7 CHCs may be upgraded to First Referral Units
• Minimum requirement of declaration of FRU:
• 1.Manpower:gynaecologist,anaesthetist,pediatrician.
• 2.Blood stroage facility with other supportive services
• 3.CHC’s as FRU will provide 24 hrs delivery services,emergency obstretics care and
newborn care
32. • THIRD STAGE(IPHS):Once the CHC has been classified as FRU,next step
would be to post other specialists and support man power as per IPHS.
• The CHCs declared as IPHS apart from FRU must provide:
• 1.Care of routine and emergency cases in surgery
• 2.Care of routine and emergency cases in medicine
• 3.Services of a public health manager
• 4.Delivery of all NHPs
33. FUNDING
1.Untied fund .
2.annual maintenance grant .
3.RKS grant.
• These funds shall be kept in the bank account of the
Rogi Kalyan Samiti
34. ENSURING QUALITY
A citizen charter should
be displayed in CHC
Monitoring should be
done through RKS which
will ensure community
control in management
Routine monitoring by
district health authority at
least once in a month
35. CHC BAJAKHANA
• Rural Health Centre (RHC) is located at village
Bajakhana, Block Bajakhana, District Faridkot.
• This centre is an integral part of the Department of
Community Medicine, Guru Gobind Singh Medical
College,Faridkot
• The field practice area is composed of 95 villages
where home-based comprehensive health care is
provided. It covers a population of 230635
37. SERVICES PROVIDED
• OPD Services
• IP Services
• Lab facilities
• Immunization Services
• M.C.H Services
• Emergency Services
• Referral Services
• Awareness about water and Sanitation Care
38. • Implementation of various National Health programmes
• RNTCP
• NRHM
• Family planning
• UIP
• NACP
• Covid control programme
39. MAN POWER
• Senior medical officer
• Medical officer
• Lady medical officer
• Senior pharmacist
• Staff Nurse (5)
• LHV
• Radiographer
• MPHW(F)
• MPHW(M)
• LT-1,LT-2
• AYUSH –AMO(3)
• Information assistant .
• Trained Dai
• W.A (4)
• Chownkidar
• Sweeper
• Senior Assistant
• Junior Assistant (2)
• Clerk
• Accountant
40. REGISTRATION
• OPD slip for new patient is made @ Rs. 10 which is
valid for 1 Month .
• An entry register is maintained to calculate
• (1)Total income generated
• (2)no. of investigations done
• (3)no. of male,female and children patients
41. • OPD register
• ANC register
• RCH register
• Children immunization
register
• Survey register
• Eligible couple register
• Cu T register
• Birth and death register
• COVID 19 Vaccine register
• Stock register
• Daily expense register
PHARMACY
REGISTERS MAINTAINED
45. • They collect the baseline data and then keep on
adding changes at regular intervals.
• Baseline Data : Head of the family, Caste, family
members, eligible couples, FP Status, Sen. Citizen,
Pregnant, 0-5 children
• Changes : if new family has come or gone.
(immigrant/ local)
• New births and deaths
• Eligible couples : Wife/ husband/ age/ parity incl.
no. of abortions/ children(M/ F)/ DOB of youngest
child/ FP Method
• Maternity services : EDD, Date of ANC Visits, Delivery
(Date/type/place/by whom)
• Each ANM maintains a record of the population of
their villages by maintaining the family folders.
47. FUNDING
• User charges from patients
• Medicine supply – Punjab government
• Ayushman Bharat scheme
• Baba Farid patient care fund
• MP fund –Ambulance
• Donation from people
48. SUMMARY
• Secondary care specialist services
closer to the community are
envisaged to be delivered at the
two types of CHCs with assured
multidirectional linkages . Services
should be offered and distributed
across the district in such a way
that out-of-pocket expenditure of
the community is reduced,
especially for the vulnerable and
marginalised. Apart from curative
services, there should a strong
focus on health promotion,
prevention, palliation, and
rehabilitation at both primary and
secondary levels of facilities.
49. REFERENCES
• •Park K. Health Care of The Community Park’s
textbook of preventive and social medicine, 26th ed.
Jabalpur: M/s Banarsidas Bhanot Publishers; 2021.
p.1000-1001.
• •Handbook of Indian Public Health
Standards(IPHS)community health centre , Volume -2,
Ministry of Health and Family welfare,GOI,
https://nhsrcindia.org/IPHS2022
• Rogi Kalyan Samities :: National Health Mission
(nhm.gov.in)
