This document provides guidance on achieving NABH "Output" standards in Primary Health Centers (PHCs) in India. It discusses several objective elements that PHCs should meet including: recording and analyzing utilization of services, maintaining statistics on key health indicators, reporting births and deaths to local authorities, conducting medical record audits, measuring patient and employee satisfaction, and utilizing a web-based health information system. The document contains many examples and templates for PHCs to use to collect and report data required to meet the national standards.

1. How to achieve NABH “Output”
Standards in PHCs
Dr J L Meena
State Quality Assurance Officer
Department of Health & Family welfare
Government of Gujarat
Email:- drjlmeena@gmail.com
Web:- www.gujhealth.gov.in/quality-assurance-program.htm
399

2. SECTION – D:
Outcome Standards

3. 33. Utilization Indices of the Centre
Objective Elements
• Centre to record all parameters as stated in the
monitoring section of the IPHS.
• Utilization of OPD, IPD, X-ray (only for CHC),
Labor Room, Man Power, Laboratory services,
Referral services (to & from the facility),
ambulance services, MLC services to be
analyzed and maintained for continuous
quality improvement.

4. Centre to record all parameters as stated in the
monitoring section of the IPHS
Sr.
No.
Procedure Monthly Progres
sive
1. Total new cases 1604 17747
Old cases 457 5030
Total OPD 2061 22777
Average OPD/Day 66 68
2. Total delivery 2 16
Total operation 0 0
Other IPD 60 398
Total IPD 62 414
Average IPD/Day 2 1.23
Total bed days 23 187
BOR 0.77 0.55
3. Details of operations
TL 0 0
N.S.V 0 0
MTP 0 0
Hydrocele 0 0
Other Operation 0 0
Total operation 0 0
Sr.
No.
Procedure Monthly Progre
ssive
4. Services of laboratory
Tested BS 2286 18324
Total No. of Sputum tested 44 543
Sickling test 0 0
Electrophoresis 0 0
Hb 63 674
Blood Group 14 265
Pregnancy test 37 292
No. of Urine test 25 391
Other 0 10
Total 2469 3499
5. Referral services
No. of patients referred from
PHC
5 31
No. of patients refer back to
PHC
0 0
How much patients got
Referral transport service
0 0
6 Other MLC 0 0
Total MLC 0 0

5. Centre to record all parameters as stated in the monitoring
section “National Health Prorgamm” of the IPHS
1Medical Care
2Reproductive And Child Health
*Antenatal Care
* Intranatal Care
* Postnatal Care
* New born Care
*Care Of the Child
* Family Planning
* MTP
* RTI / STI
* Nutritional Services
*Adolescent Health Care
3Integrated Disease Surveillance Project
4collection And Reporting of Vital Events
5BCC And Health Education
6Revised National T.B Control Programme
7
National Leprosy Eradication
Programme
8National Programme For Control Of Blindness
9
National Vector Borne Disease Control
Programme
10
Integrated Management Of Neonatal & Childhood
Illness
11National Aids Control Programme
12
National Programme Of Prevention & Control Of
Deafness
13National Cancer Control Programme
14National Mental Health Programme
15
National Programme On Prevention & Control Of
Diabetes cvd & stroke
16
National Iodine Deficiency Disordar Control
Programme
17
National Programme Of Prevention & Control Of
Fluorosis(In Endemic)
18National Tobacco Control Programme
19National Programme For Health care Of Elderly
20Oral Health
21Physical Medicin And Rehabilitation services
22Referal Services
23Training

6. Centre to record all parameters as stated in the monitoring
section “National Health Prorgamm” of the IPHS

7. Centre to record all parameters as stated in the monitoring
section “National Health Prorgamm” of the IPHS

8. 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%
Utilization of OPD, IPD, X-ray (only for CHC), Labor Room, Man Power, Laboratory
services, Referral services (to & from the facility), ambulance services, MLC services
to be analyzed and maintained for continuous quality improvement

9. OT UTILIZATION IN PERCENTAGE
OT Utilization
Operation Theatre = 01
Average time per case = 30 mins per
case
The OT functions for 4 hours per day
Working Note:-
If the OT works for 4 hours per day i.e. 240
mins, then at least 8 cases can be done.
Then per day 8 cases can be done (if OT
functions for 4 hours per day)
Therefore in one month = 8 * 26 = 208 cases
(The OT functions 6 days a week only)
Hence, the Utilization Rate for the month of
January 11 = 224 / 208 * 100 = 107.69%
Utilization of OPD, IPD, X-ray (only for CHC), Labor Room, Man Power, Laboratory
services, Referral services (to & from the facility), ambulance services, MLC services
to be analyzed and maintained for continuous quality improvement
Month
OT UTILIZATION
IN %(in round
figures)
TOTAL
OT(MINOR)
January 11 108% 224
February 11 63% 132
March 11 108% 225
April 11 65% 135
May 11 64% 133
June 11 80% 166
July 11 73% 151
August 11
71%
148
September 11
75%
156
October 11
68%
142

10. Utilization of OPD, IPD, X-ray (only for CHC), Labor Room, Man Power, Laboratory
services, Referral services (to & from the facility), ambulance services, MLC services
to be analyzed and maintained for continuous quality improvement

11. Utilization of OPD, IPD, X-ray (only for CHC), Labor Room, Man Power, Laboratory
services, Referral services (to & from the facility), ambulance services, MLC services
to be analyzed and maintained for continuous quality improvement

12. LABORATORY UTILIZATION IN
PERCENTAGE
Utilization of OPD, IPD, X-ray (only for CHC), Labor Room, Man Power, Laboratory
services, Referral services (to & from the facility), ambulance services, MLC services
to be analyzed and maintained for continuous quality improvement
LABOUR ROOM UTILIZATION IN
PERCENTAGE
Month
TOTAL
TEST
LABORATORY
UTILIZATION %
Jan 11 689 111.83
Feb 11 528 93.93
Mar 11 665 117.7
Apr 11 705 119.6
May 11 1000 153.88
June 11 877 151.56
July 11 735 120.35
Aug 11 634 540.34
Sect 11 763 650
Oct 11 674 574.43
Nov 11 625 532.67
Month
TOTAL
DELIVERY
LABOUR ROOM
UTILIZATION(%)
Jan 11 7 2.91
Feb 11 10 4.03
Mar 11 21 8.75
Apr 11 22 8.87
May 11 13 5.24
June 11 17 6.85
July 11 7 2.91
Aug 11 19 7.91
Sect 11 18 7.25
Oct 11 21 8.46
Nov 11 12 5.35

13. LABORATORY TECHNICIAN UTILIZATION IN PERCENTAGE
Utilization of OPD, IPD, X-ray (only for CHC), Labor Room, Man Power, Laboratory
services, Referral services (to & from the facility), ambulance services, MLC services
to be analyzed and maintained for continuous quality improvement
 Working Note:- Average time per test as follow
 For blood for mp = 15 min.
 For HB= 10min.
 For blood group=5min.
 For HIV= 20min.
 Urine Alb, Sugar=5 min.
 Urine Pregnancy test=5min.
 Sputum AFB =30min.
 LT works 8 hours per day .total 24 days in a month ( 4 sunday+1day meeting in Ahmedabad +1 day
meeting at H.Q)
 8 hours*5days= 40hours (Monday to Friday)
 4 hours*1 = 4 (Saturday) i.e. 44 hours total in a week
 44 * 4 = 176 hours = 10560 min.
 If LT works for 10560 min in a month then it corresponds to 100%
 E.g : in month of oct.09 LT has done 12710 min. work, utilization rate of LT = 12710/10560*100 =
120.35

14. 34. Statistics
Objective Elements
• Statistics in terms of OPD attendance, BOR,
ALOS, BTO, Birth Rate, Death Rate, Minor and
Major Operations etc. to be documented and
reported.
• A bulletin is published every quarterly stating
the above details.

15. Statistics in terms of OPD attendance, BOR, ALOS, BTO, Birth Rate,
Death Rate, Minor and Major Operations etc. to be documented and
reported
Name of Indicator Month
July Aug Sep Oct Nov Dec Jan-11 Feb-11
Bed occupancy rate 23.88 /
month
21.11
/month
18.33m
onth
19.44/
month
17.7 /
month
38.7 /
month
39.78 /
month
21.42 /
month
Average length Of
stay
1.3
/month
1.22/
month
1.14/
month
1.12/
month
1.23 /
month
1.2
/month
1.42 /
month
1.38
/month
% Of institutional Of
delivery
86%/
month
94%/
month
94%/
Month
94%/
month
96% /
month
95%/
month
95%
Month
92% /
month
Incidence Of hospital
associated infection
2 1 1 1 0 1 2 1
No Of needle Prick
injuries / Month
0 0 0 0 0 0 1 0
NO Of instances Of
medication error
0 0 0 0 0 0 0 0
No of sentinel /Near
miss events/ Month
0 0 0 0 0 0 0 0

16. A bulletin is published every quarterly stating the
above details

17. 35. Reporting of Birth, Death and
Other Detail
Objective Elements
• All the birth and the death in the centre and the
population to be reported to the concerned Gram
Panchayats, Nagar Palikas, Municipal Authorities
and other local authorities.
• Incidence and prevalence of diseases to be
reported to the district authorities.
• Epidemics and communicable diseases to be
reported to the authorities.
• Accidents and mishaps should also be reported to
authorities as per decided timelines.

18. All the birth and the death in the centre and the population
to be reported to the concerned Gram Panchayats, Nagar
Palikas, Municipal Authorities and other local authorities
Village Wise Sex Ratio 2010
Sr.no. Village Male Female
Total Birth Sex Ratio
1 Jetalpur 88 79 167 897
2 Gamadi 16 14 30 875
3 Chosar 20 21 41 1005
4 Istolabad 17 19 36 1011
6 Giramatha 24 26 50 1008
7 Naz 32 36 68 1012
8 Bareja -1 67 42 109 626
9 Bareja -2 67 61 128 910
11 Bareja-3 67 64 131 955
13 Bareja-4 65 68 133 1046
S], 463 430 893 929

19. Incidence and prevalence of diseases to be reported
to the district authorities “by IDSP”

20. Epidemics and communicable diseases to be
reported to the authorities “by IDSP”

21. Accidents and mishaps should also be
reported to authorities as per decided
timelines

22. 36. Medical Records
Objective Elements
• The contents of the medical records are pre defined.
• An audit of the medical records is carried out every
quarter.
• The records are kept at for pre defined duration as per
the policy.
• There shall be provisions for storing and retrieval of
the records.
• All entries by the doctors and nurses are legible and
complete.
• All records must be computerized for accurate record
maintenance.

23. The contents of the medical records are pre defined

24. The contents of the medical records are pre defined

25. The contents of the medical records are pre defined

26. The contents of the medical records are pre defined

27. An audit of the medical records is carried out every
quarter
65%
70%
75%
80%
85%
90%
76%
80%
90%
77%
90%
% of cases where initial assessment of indoor
patients completed within time limits

28. 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
52%
57%
80%
47%
88%
% of cases where in care plan is documented &
signed by the Medical officer
An audit of the medical records is carried out every
quarter

29. The records are kept at for pre defined duration as per the
policy as per Government of Gujarat Guideline

30. The records are kept at for pre defined duration as per the
policy as per Government of Gujarat Guideline

31. There shall be provisions for storing and retrieval of
the records

32. All entries by the doctors and nurses are legible and
complete

33. All records must be computerized for accurate record
maintenance

34. 37. Patient & Employee Satisfaction
Survey
Objective Elements
• On going mechanism of conducting patient satisfaction
through involvement of consumer forums, RKS and PRI
members shall be present.
• On going mechanism of conducting employee
satisfaction shall be present.
• Centre should have Grievance Redress Policy and
mechanism.
• Centre should have in use feedback mechanism like
use of feedback forms, suggestion forms to be
dropped in suggestion / complaint boxes at identified
places.

35. On going mechanism of conducting patient
satisfaction through involvement of consumer
forums, RKS and PRI members shall be present

36. On going mechanism of conducting patient
satisfaction through involvement of consumer
forums, RKS and PRI members shall be present

37. On going mechanism of conducting patient
satisfaction through involvement of consumer
forums, RKS and PRI members shall be present
0
10
20
30
40
50
60
70
80
90
100
82
86
81 80 82
74 77 76
80 79
96 94
89
82 81 82
92
88
%
QUESTIONS

38. On going mechanism of conducting employee
satisfaction shall be present

39. Centre should have Grievance Redress Policy and
mechanism

40. Centre should have Grievance Redress Policy and
mechanism

41. Centre should have Grievance Redress Policy and
mechanism “ Remarks & suggestions in Visit book ”

42. Centre should have in use feedback mechanism like use of feedback
forms, suggestion forms to be dropped in suggestion / complaint
boxes at identified places

43. Centre should have in use feedback mechanism like use of feedback
forms, suggestion forms to be dropped in suggestion / complaint
boxes at identified places

44. Centre should have in use feedback mechanism like use of feedback
forms, suggestion forms to be dropped in suggestion / complaint
boxes at identified places

45. 38. Health Information System
Objective Elements
• Community statistics like IMR, MMR, Birth Rate,
Death Rate etc. to be documented and
reported.
• Reporting of all the details to be done through a
web based health information system to the
authorities on a daily, weekly, monthly and
annual basis.
• Health Information System tools should be as
per the state directives.

46. Community statistics like IMR, MMR, Birth Rate,
Death Rate etc. to be documented and reported
Sr.
no.
Indicators 2004 2005 2006 2007 2008 2009
1 Total Birth 814 778 820 763 736 802
2 Total Death 210 225 172 194 165 168
3
Total infant
death
25 21 27 21 17 22
4
Total Maternal
death
02 0 01 0 0 0

47. Reporting of all the details to be done through a web based health
information system to the authorities on a daily, weekly, monthly and
annual basis

48. Health Information System tools should be as per
the state directives

49. Health for All