The document discusses the roles and functions of subcentres and primary health centres in India's public health system. Subcentres are the most peripheral unit and aim to provide basic primary healthcare services to populations of 3,000-5,000 through a female health worker and male multipurpose worker. Primary health centres serve larger populations of 20,000-30,000 and provide outpatient and inpatient services through medical officers and staff. Both play key roles in maternal and child health, family planning, immunization, disease control programs and acting as first referrals in rural areas. The document outlines the comprehensive services expected at each level according to Indian public health standards.

1. Sr. Susmita Halder
Sister tutor
School of Nursing Asia Heart Foundation

2.  The purpose of Health care services is To improve the health status of the
population
 Goals to be achieved have been fixed in terms of
1. mortality and morbidity reduction
2. Increase in expectation of life
3. Decrease in population growth rate
4. Improvements in nutrition status
5. Provision of basic Sanitation
6. Health manpower requirements and resources development and certain other
parameters like food production, literacy rate, reduced levels of poverty, etc

3. Varies widely from country to country and influenced by general and ever changing National state and
local Health problems, needs and attitudes as well as the available resources to provide these services.
A comprehensive list of Health services may be found in the Report of the WHO Expert Committee
1961 on “ Planning of public health services”
There’s a broad agreement that Health services should be
 Comprehensive
 Accessible
 Acceptable
 Provide scope for Community participation
 Available at a cost the community and country can afford
These are essential ingredients of primary health care which forms an integral part of country’s Health
system of which it is the central function and main agent for delivering Health care

4. 1. PUBLIC HEALTH SECTOR
1. PRIMARY HEALTH CARE
1. PRIMARY HEALTH CENTRES
2. SUBCENTRE
2. HOSPITALS/ HEALTH CENTRES
1. COMMUNITY HEALTH CENTRES
2. RURAL HOSPITALS
3. DISTRICT HOSPITAL / HEALTH CENTRES
4. SPECIALIST HOSPITAL
5. TEACHING HOSPITAL
3. HEALTH INSURANCE SCHEMES
1. EMPLOYEES STATE UNION
2. CENTRAL GOVERNMENT HEALTH SCHEME
4. OTHER AGENCIES
2. PRIVATE SECTOR
1. PRIVATE HOSPITALS POLYCLINIC NURSING HOME AND DISPENSERIES
2. GENERAL PRACTITIONERS AND CLINICS
3. INDIGENOUS SYSTEMS OF MEDICINE
1. AYURVEDAAND SIDDHA
2. UNANI AND TIBBI
3. HOMEOPATHY
4. UNREGISTERED PRACTITIONERS
4. VOLUNTARY HEALTH AGENCIES
5. NATIONAL HEALTH PROGRAMMES

5. 1.Subcentre
2.Primary Health centre

6. The sub centre is the peripheral outpost
of the existing health delivery system in
rural areas.
They are being established on the basis
of sub centrefor every 5000 population
in general and one for every 3,000
population in hilly tribal and backward
areas
As of March 2014 152326 subcentres are
established in the country
AREA OF
COVERAGE

7. MANPOWER
1. Female Health worker – auxiliary
Nurse Midwife ( ANM) -1
2. ANM-II
3. One male Health worker known as
Multipurpose Worker
4. The voluntary worker at sub centre
should be preferable trained birth
attendant and be paid 200 at least with
equal contribution by government of
India and concerned state

8. Manpower Existing Proposed
Health Worker Female 1 2
Health Worker Male 1 1
Voluntary worker to keep
the sub centre clean and
assist auxiliary nurse
midwife. She is paid by
auxiliary nurse midwife
from the contingency
fund@100 pm
1 1

9. FUNCTION In order to provide primary Health care in
sub centres Indian public health standards
are being prescribed to provide basic
promotive preventive and QQ rative
primary Health services to the community
and achieve and maintain an acceptable
standard of quality of care. The standards
would help monitor and improve
functioning of sub centres

10. FUNCTION
 Maternal Health care
 antenatal care
1. Early registration of pregnancy before 12 weeks of
pregnancy. Minimum 3 antenatal check UPS.
Recording of general check up with blood pressure
abdominal examination hemoglobin routine urine
Examination and blood group
2. Folic acid supplementation from first trimester and
folic acid and iron supplementation from 12 week
onwards
3. Tetenus toxoid immunization
4. Identification of high risk pregnancy and referral
5. Counselling on diet birth preparedness and rest

11. FUNCTION
Intranatal care
1.Promotion of institutional
deliveries
2.Skilled attendance at home
deliveries
3.Appropriate and prompt
referral in case of
complications

12. FUNCTION
Postnatal care
1. Minimum of two postpartum home
visits within first 48 hours and second
within 7 days of delivery
2. Initiation of breastfeeding within half
an hour of delivery
3. Counselling on diet hygiene
contraception and
4. Provision of facilities of JSY

13. FUNCTION
Child Health care
1. Essential newborn care as per guidelines
2. Promotion of exclusive breastfeeding for 6
months
3. Full immunization of all infants and
children against vaccine preventable
diseases
4. Vitamin A prophylaxis
5. Prevention and control of childhood diseases
like malnutrition acute respiratory infection
and diarrhoea et cetera

14. FUNCTION
Family planning and contraception
1. education motivation and counselling
to adopt appropriate family planning
method
2. Provision of contraceptives such as
condoms oral pills emergency
contraceptives intrauterine device
insertion
3. Follow-up services to The eligible
couples adopting permanent methods of
tubectomy and vasectomy

15. FUNCTION
 Counselling and appropriate referral for safe abortion services
 Adolescent Health care like education counseling and referral
 Water quality monitoring
 Assistance to school health services
 Promotion of sanitation including use of toilet and appropriate
garbage disposal
 Field visits by appropriate health workers for disease surveillance
Family welfare services including sexually transmitted infections
reproductive tract infections awareness
 Community need assessment
 Curative services for minor ailments like fever diarrhoea worm
infestation first aid appropriate and prompt referral when required
 To organise Health day at Anganwadi centres at least once a month
 Training of traditional birth attendants and ASHA VILLAGE
HEALTH and sanitation committee

16. FUNCTION
 National Health programmes
 National AIDS control programme
1. Information education communication activities to
enhance our anus and preventive measures about
sexually transmitted infections and HIV AIDS
2. Prevention of parent to child transmission services
and hiv-tb coordination
3. Counseling and referral of persons practicing high
risk behaviour in relation to HIV AIDS and STD
4. Linkage with microscope centre for HIV TB
coordination
condom to the high risk groups
Help and guide patients with HIV AIDS receiving Anti
retroviral therapy with focus on adherence

17. FUNCTION
National vector borne disease control
programme
National leprosy eradication programme
Integrated disease surveillance projects
Revised National tuberculosis control
programme
 National blindness control programme
Non communicable disease and cancer control
programs
Promotion of medicinal herbs
Recording of vital events

18. The concept of primary Health care is is not new
into India
The bhore committee in 1946 give the concept of
primary healthcare as a basic unit to provide as to
close the people as possible and integrated curative
and preventive health care to the rural population
with emphasis on preventive and promotive aspects
of healthcare

19. The Bhore committee in that having a
Health centre to serve a population of
10000 to 20000 with 6 medical officers,
public Health nurses and other
supporting staff. But in view of limited
resources the board committees
recommendations could not be fully
implemented even after a lapse of 60
years. ( Proposed on 1946)
Area
Of
Coverage

20. Area
Of
Coverage
According to Indian public health
standards PHC should cover 20000 to
30000 population with 6 beds as the
block level primary Health centres are
ultimately going to be upgraded as
Community Health centres for
providing specialised services

21. Staff Existing Recommended
Medical officer 1 3 (Atleast 1 female)
Ayush PRACTITIONERS Nil 1( Ayush aur any ISM system prevalent locally)
Account manager Nil 1
Pharmacist 1 2
Nurse midwife 1 5
Health workers 1 1
Health educator 1 1
Health assistant male and female 2 2
Clerks 2 2
Laboratory technician 1 2
Driver 1 Optional vehicles may be outsourced
Class IV 4 4

22. Objective 1. To provide comprehensive primary
Health care to the community through
the primary Health centres
2. To achieve and maintain an acceptable
standard of quality of care
3. To make the services more responsible
and sensitive to the needs of the
community

23. Function
The functions of primary Health centre in India cover 8 essential elements of
primary Health care as outlined in Alma ata declaration
1. Medical care
2. MCH including family planning
3. Safe water supply and basic sanitation
4. Prevention and control of locally endemic diseases
5. Collection of reporting of vital events
6. Education about health
7. National Health programmes
8. Referral services
9. Training of health guide health workers local dies and health assistant
10. Basic laboratory services

24. Outpatient department services should be given 4 hours in
morning and 2 hours in afternoon or evening. Time
schedule will vary from state to state. Minimum OPD
attendance should be 40 patients per doctor per day
24 hours emergency services like appropriate management
of injuries and accident first ate stabilization of condition
of patient before referral dog bite snake bite scorpion bite
cases and other emergency conditions
Referral services
Inpatient services with 6 beds

25. Antenatal care
 Early registration of pregnancy and minimum 3 antenatal check
UPS
 Minimum laboratory investigation such as hemoglobin urine
albumin and sugar
 Nutrition and health counselling
 Supplementation of folic acid and iron tablets and tetanus toxoid
immunization
 Identification of high risk pregnancy is an appropriate management
 Referral to first referral unit or other hospital in case of high risk
pregnancy beyond the management capability of medical officer in

26. Intranatal care
24 Hour services for Normal delivery
Promotion of institutional delivery
Conducting assisted deliveries including forceps and
vaccum delivery whenever required
Manual removal of placenta
Appropriate and prompt referral for cases needing
specialist care

27. Postnatal care
A minimum of two postpartum home visits first 48 hours
for delivery and second within 7 days Through sub centre
staff
Initiation of breastfeeding within half an hour of delivery
Education on nutrition hygiene and contraception
Provision of facilities under Janani Suraksha Yojana

28. Newborn care
Essential newborn care
Facilities and care for neonatal resuscitation
Management of neonatal hypothermia and
jaundice

29. Care of child
Emergency care of sick child including integrated
management of neonatal and childhood illness
Care of routine childhood illness
Promotion of breastfeeding for 6 months
Full immunization of all infants and children against
vaccine preventable diseases as per guidelines
Vitamin A prophylaxis

30. National Health programmes
 revise national tuberculosis control
programme
National programme for control of blindness
National vector borne disease control
programme
National AIDS control programme

31.  Full range of family planning services including counseling and appropriate referral for couples
having infertility
 Medical terminationof pregnancy using manual vacuum aspiration technique wherever train
personal and facility exist
 Health education for prevention and management of reproductive tract infections and sexually
transmitted infections
 Nutrition services like diagnosis and management of malnutrition and anaemia and vitamin A
deficiency and coordination with integrated child development services
 School health services
 Adolescent Health care
 disease surveillance and control of epidemics
 Collection and reporting of vital events
 Promotion of sanitation including use of toilet and appropriate garbage disposal
 testing of water quality and sanitation and disinfection of water sources

32. Appropriate and prompt referral of cases needing special
care and providing transport facilities either by primary
Health care vehicle or other referral transport.
The funds should be made available for referral transport
as per the provision of National rural Health mission
comes under reproductive child health II program
Recording ofvital event reporting of births and deaths and
maintenance of all relevant records concerning services
providing in primary Health centre

33. Training
1. Health workers and traditional birth attendants
2. Initial and periodic training of paramedics treatment of minor elements
3. Training of accredited social health activities
4. Periodic training of doctors through continuous medical education conferences
skill development training on emergency Obstetric care
5. Training of auxiliary nurse midwife and lady health visitor in antenatal care and
skilled birth attendants
6. Training under integrated management of neonatal and childhood illness
7. Training of pharmacist on Ayush component with standard module
8. Training of Ayush doctor in imparting health services related to National Health
and Family welfare programme

34. 1. Routine urine stool and blood test
2. Bleeding time clotting time
3. Diagnosis of reproductive tract infections or sexually transmitted diseases with
with mounting gram stain
4. Sputum testing for tuberculosis
5. Blood smear examination for malarial parasite
6. Rapid test for pregnancy
7. RPR for syphilis surveillance
8. Rapid test kit for fecal contamination of water
9. Rapid diagnostic tests for typhoid and malaria
10. Estimation of chlorine level of water using orthotolidine reagent

35. 1. Monitoring and supervision of activities of sub centres
through regular meetings periodic visits
2. Monitoring of all National Health programmes
3. Monitoring activities of accredited social health activities
4. Medical officer should visit all sub centres at least once a
month
5. Health assistant male and lady health visitor should
visit subcenters once a week

36. Vasectomy
 tubectomy including laparoscopic tubectomy
 medical termination of pregnancy
Hydrocelotomy
Cataract surgeries

37. As on 31st March 2014 5363 Community Health centres were
established by upgrading primary Health centres each Community
Health centre covering a population of 80000 to 1.2 lakh one in each
community development block 30 beds and speciality in surgery
medicine obstetrics and gynaecology and paediatrics with x-ray and
laboratory facilities for strengthening preventive and promotive
aspects of healthcare a new non medical post called community
health officer has been created at each Community centre the
community health officer is selected from among the supervisory
category of staff at the PHC and primary district level with minimum
of 7 years experience in rural health programs.

38. AREA OF
COVERAGE
Each CHC covers 80000- 1. 2 Lakh
population with 30 beds and speciality
is in surgery medicine gynaecology
obstetrics and pediatrics with x-ray and
laboratory facilities

39. Existing clinical manpower
1. General surgeon- 1
2. Physician-1
3. Obstetrician / Gynaecologist- 1
4. Pediatrician -1
Existing support manpower
Nurse midwife ( 1 ANM & 1 PHN Family welfare will be appointed under the
asha scheme) – 7 +2
Dresser (certified by Red cross or Saint Johns ambulance) -1
Pharmacist or compounder – 1
Lab technician-1
Radiographer-1
Ophthalmic assistant-1 (ophthalmic assistant may be placed whenever it does not
exist through re deployment or contract basis) 0-1
Ward boy on nursing orderly – 2
Sweepers, security guard, OPD attendant- 3
Statistical assistant or data entry operator- 5
OT attendant
Registration clerk
MANPOWER

40. FUNCTION 1. Care of routine and emergency cases in surgery
A. this includes incision and drainage and surgery for hernia hydrocele
appendicitis hemorrhoids fistula etc
B. Handling of emergencies like intestine obstruction hemorrhage Etc
2. Care of routine and emergency cases in medicine including handlingof
all images in relation to the National Health programmes at per
guidelines like dengue hemorrhagic fever cerebral malaria appropriate
guidelines are already available under such program which should be
compiled in a single manual
3. 24 hour delivery services including normal and assisted deliveries
4. Essential and emergency obstetric care including surgical
interventions like cesarean sections and other medical interventions
5. Full range of family planning services including laparoscopic services

41. FUNCTION
6. Safe abortion services
7. Newborn care
8. Routine and emergency care of sick children
9. Order management including nasal packing tracheostomy
foreign body removal et cetera
10. All the National Health programmes should be delivered
through Community Health centres with integration with
the existing programs like binus control integrated disease
surveillance project is vital to provide comprehensive
services

42. a. Revised National tuberculosis control programme is expected to provide
diagnostic services to the microscopic centres which are already
established and treatment services as per protocol
b. HIV AIDS control programme services will be provided
c. National vector borne disease control programme
d. National leprosy eradication programme
e. National programme for control of blindness includes intraocular lens
implantation and one eye surgeon is being appointed for every 5 lakh
population
f. Integrated disease surveillance project includes related services for
diagnosis of malaria tuberculosis typhoid and tests for detection of fecal
contamination of water and chlorination level also peripheral
surveillance unit and analyse and report information to district
surveillance unit
FUNCTION

43. 11. Others
a. Blood storage facility
b. Essential laboratory services
c. Referral services
d. Transport services
FUNCTION

44. Rural hospitals
It is now proposed to upgrade the rural dispensaries to
primary Health centres. Present a good number of primary
Health centres are located at sub-division taluka for tehsils
which also have hospitals search primary Health centres
may be shifted to interior rural areas it is proposed to
convert the sub division hospitals into subdivision health
centres so as to cover a population of 5 lakh these centres
will have an epidemiological wing attached to them

45. District hospitals
These are proposed to convert the distance hospitals in to district health centre hospital
differs from health centre in following respects
 In a hospital services provided are mostly curative in a Health centre the services are
preventive promotive and curative
 Hospital has no catchment area that is it has no definite area of responsibility patients
may be drawn from any part of the country I help centre on the other hand is
responsible for definite area and population
 The health team in a Health centre is a optimum mix of Medical and paramedical
Worker where is in hospital the team consists only the curative staff that is doctors
compounders nurses it cetera today the role of hospital in the community is being
debated the current opinion is that the hospital should not remain and ivory tower of
disease in the community but also should take an active part in providing health
services to the community

46. Under the multipurpose wordpress scheme it has been suggested to
the states to have an integrated set up at the district level by having
a chief medical officer of the district with three deputy chief medical
officers drawn from the kada for existing civil surgeons district health
officer and district family welfare officers with each of deputy chief
medical officer has been in charge of one third of history for all Health
Family welfare and maternal child health programs it has been
suggested that the district pattern should be based on number of
primary Health care centres

47. There is no universal Health insurance in India. Health
insurance at present limited to industrial workers and their
health families. The Central Government employees are
also covered by the health insurance under the banner
Central Government Health scheme

48. The ESI scheme introduced by an act of parliament in 1948 is a
unique piece of social legislation in India. It has introduced for the
first time in India the principle of contribution by the employer and
employee. The act provides for medical care in cash in kind benefits in
the contingency of sickness maternity employment injury and pension
for dependence on the death of worker because of employment injury.
The act covers implies drawing wages not exceeding rupees 15000 per
month

49. Central Government Health scheme known as contributory health service scheme for Central Government
employees was first introduced in new Delhi 1954 to provide comprehensive medical care to Central
Government employees the scheme is based on principle of cooperative effort by the employee and the employer
to the mutual advantage of both.
 Out Patient care through network of dispensaries
 Supply of necessary drugs
 Laboratory and x-ray investigations
 Domiciliary visits
 Hospitalization facilities at Government as well as private hospitals recognised for the purpose
 Specialised consultation
 pediatrics services including immunization
 Antenatal natal and postnatal services
 Emergency treatment
 supplier of optical and internal AIDS at reasonable rate
 Family welfare services

50. The scope of the scheme has gradually extended over the years to cover the cities
outside Delhi as well as other sectors of population such as employees of the
autonomous organisations retired Central government servants veedos receiving
family pension members of parliament ex governors and retired judges
The scheme now covers besides Delhi the cities of Mumbai Allahabad merath
Kanpur Patna Kolkata Nagpur Chennai Hyderabad Bangalore Jaipur Pune
Lucknow Ahmedabad bhuvaneshwar and Jabalpur
The scheme which started with 16 allopathic dispensaries in 1954 covering 2.3 lakh
beneficiaries has now 320 dispensaries or hospitals in various systems of medicine
provide service to about 42.7 600000 beneficiaries there is also a yoga centre under
the scheme in Delhi

51. The employees State insurance scheme and Central
Government Health scheme also convert to large group of
wage earners in the country they are will organise Health
insurance schemes and we are providing reasonable
medical care + some essential preventive and promotive
Health services experience in other countries have shown
that Health insurance is a logical step towards National
lization of the health services

52. Defence Medical service
Defence Medical services have their own organisation for
medical care to defence personnel under the banner armed
forces Medical services
the services provided are integrated and comprehensive
embracing preventive promotive and security services
curative services

53. Health care of railway employees
The railways provide comprehensive health care services
through the agency of railway hospitals health units and
clinics. Environmental sanitation is taking care of my
health inspector in Big stations. A chief Health inspector
supervises the divisions work. Health checkup of employees
is provided at the time of entry into services and thereafter
at early intervals our Lady medical officers midwives
health visitors who look after maternal child health and
school health services. Specialised services are also
available at the divisional hospitals

54. Thank you🌼