The document outlines the tiered structure of health care services in India, detailing the roles of primary, secondary, and tertiary care levels. It emphasizes the implementation of the Ayushman Bharat scheme and the transformation of existing health sub-centres into health and wellness centres aimed at providing comprehensive health care, including services for non-communicable diseases and maternal and child health. Additionally, it specifies the Indian Public Health Standards (IPHS) which guide the operational requirements for these health centres to ensure quality care and community responsiveness.

1. By. Kailash Nagar
Assist. Prof.
Dept. of Community Health Nsg.
Dinsha Patel College of Nursing,
Nadiad
Primary Health Centre
(IPHS-SS, PHC & CHC)

2. Tier of health care in India
The health care services in India are organized at three levels,
each level supported by the higher level, to which the patient is
referred.
Tertiary
State Hospital
Medical Colleges
Secondary
DH / CHC / Taluka Hospital
Primary
PHC / Sub Centre

3. Concept of Health and Wellness Centre
The Government of India has launched ambitious
health insurance scheme — Ayushman Bharat-
National Health Promotion Mission which will
leverage on comprehensive primary health care
through health and wellness centres for preventive,
promotive and curative care and will ensure seamless
continuum of care.

4. The National Health Policy, 2017 has envisioned
Health and Wellness Centres as the foundation of India’s
health 22 system. Existing sub-centres will be
transformed into Health and Wellness Centres.
Under this 1.5 lakh centres will bring health care
system closer to the homes of people. These centres will
provide comprehensive health care, including for
non-communicable diseases and maternal and child
health services.
These centres will also provide free essential drugs and
diagnostic services.

5. Indian Public Health Standards for
Sub-centre
The overall objective of IPHS is to provide health care
that is quality oriented and sensitive to the needs of the
community.
The objectives of IPHS for SubCentres are:
1. To provide basic Primary health care to the
community.
2. To achieve and maintain an acceptable standard of
quality of care.
3. To make the services more responsive and sensitive
to the needs of the community.

6. Minimum Requirement (Assured
Services) to be provided in a Sub-centre:
SC are expected to provide promotive, preventive
and few curative primary health care services as
below:
1. Antenatal care: ·
2. Intra-natal care: · Promotion of institutional deliveries ·
3. Postnatal care:
4. Immunization Services
5. Vitamin A prophylaxis to the children as per guidelines. ·
6. Prevention and control of childhood diseases like
malnutrition, infections, ARI, Diarrhea, Fever, etc.
7. Family Planning and Contraception
8. Adolescent health care

7. 9. Assistance to school health services.
10. Control of local endemic diseases such as malaria, kala azar,
japanese encephalitis, filariasis, dengue etc and control of
epidemics
11. Disease surveillance
12. Water Quality Monitoring: (Disinfection of water sources
/Testing of water quality using Rapid Test (Bacteriological)
13. Promotion of sanitation including use of toilets and appropriate
garbage disposal.
14. Field visits Community level households will be visited by
appropriate health/voluntary workers (such as ASHA, ANM,
MPW – male) for disease surveillance, community need
assessment, family welfare services, including RTI/STI
awareness.

8. 15. Community needs assessment
16. Curative Services: Provide treatment for minor ailments
including fever, diarrhea, ARI, worm infestation and First Aid.
17. Appropriate and prompt referral
18. Organizing Health Day at Anganwadi centres at least once in a
month with the help of Medical Officer of PHC, ASHA,
AWW, PRI, self-help groups etc.
19. Implementation of National Health Programmes:
20. Record of Vital Events, Maintenance of all the relevant records
concerning mother, child and eligible couples in the area.

9. Minimum Requirements at PHC
for meeting IPHS :
These standards would help monitor and
improve the functioning of PHCs.
Objectives of IPHS:
• To provide comprehensive health care (i.e.
preventive, promotive, curative services)
• To achieve and maintain an acceptable standard of
quality of care
• To make the services more responsive and
sensitive to the needs of the community.

10. 1. Medical care:
(a) OPD services: 4 hours in the morning and 2 hours in
the afternoon / evening. Minimum OPD attendance
should be 40 patients per doctor per day.
(b) 24 hours emergency services: Appropriate
management of injuries and accident, First Aid, Dog
bite/snake bite/scorpion bite cases, and other emergency
conditions
(c) Referral services
(d) In-patient services (6 beds)

11. 2. Maternal and Child Health Care including family
planning:
a) Antenatal care: Early registration of all pregnancies and minimum 3
antenatal checkups with minimum laboratory investigations.
b) Intra-natal care: (24-hour delivery services both normal and assisted)
Promotion of institutional deliveries, appropriate and prompt referral for cases
needing specialist care.
(c) Postnatal Care: Two postpartum home visits, first within 48 hours of
delivery, 2nd within 7 days through Sub-centre staff, essential new born care,
provision of facilities under Janani Suraksha Yojana (JSY).
d) New Born care & Care of the child : Emergency care of sick children
including Integrated Management of Neonatal and Childhood Illness (IMNCI),
full Immunization of all infants and children against vaccine preventable diseases,
Vitamin A prophylaxis to the children
e) Family Planning: Education, Motivation and counseling towards
family planning, Provision of contraceptives.

12. 3. Medical Termination of Pregnancies
4. Management of Reproductive Tract Infections / Sexually
Transmitted Infections
5. Nutrition Services (coordinated with ICDS)
6. School Health :
7. Adolescent Health Care :
8. Promotion of Safe Drinking Water and Basic Sanitation
9. Prevention and control of locally endemic diseases like
malaria, Kala azar, JE
10. Disease Surveillance and Control of Epidemics :

13. 11. Collection and reporting of vital events
12. Education about health / Behaviour Change
Communication (BCC)
13. National Health Programmes
14. Referral Services:
15. Training: (ASHA, AWW, TBA SBA, VHG, LHV)
16. Basic Laboratory Services:
17. Monitoring and Supervision:
18. AYUSH services
19. Rehabilitation:
20. Selected Surgical Procedures: The vasectomy, tubectomy
(including laparoscopic tubectomy), MTP, hydrocelectomy and cataract
surgeries as a camp/fixed day approach have to be carried out in a PHC having
facilities of O.T.
21. Record of Vital Events and Reporting

14. Duties of various health professionals engaged in
rendering services in public health system
1. Duties of Medical Officer, Primary Health Centre
I. Curative work
II. Preventive and promotive work
III. Training:
IV. Administrative Work:
2. Job Responsibilities of Health Educator
3. Job Responsibilities of Health Assistant Female /LHV – Lady Health
Visitor/Female Supervisor
1. Supervise and guide
2. Team Work
3. Supplies, equipment and maintenance of Sub-centres:
4. Records and reports :
5. Training
6. Maternal and Child Health:
7. Family Planning and Medical Termination of Pregnancy
8. Nutrition
9. Health Education:

15. d) Job Responsibilities of Health Assistant Male (Supervisor)
1. Supervise and guide
2. Team work
3. Supplies, equipment and maintenance of sub-centres
4. Records and reports
5. Malaria
6. Communicable Disease
7. Leprosy
8. Tuberculosis
9. Environmental Sanitation
10. Universal Immunization Programme
11. Family Planning

16. d) Job Responsibilities of Health Workers Female.
1. Maternal and Child Health:
2. Family Planning:
3. Medical Termination of Pregnancy:
4. Nutrition:
5. Universal Programme on Immunization (UIP)
6. Dai Training :
7. Communicable Diseases:
8. Vital Events:
9. Record Keeping:
10.Role of ANM as a facilitator of ASHA

17. Job Responsibilities of Health Worker (Male)
1. Malaria and other diseases under NVBDCP:
2. National Leprosy Eradication Programme :
3. National Blindness Control Programm
4. Revised National Tuberculosis Control
Programme :
5. Universal Immunization Programme :
6. Reproductive and Child Health Programme
7. Environment Sanitation :

18. Job responsibility of Mid-level
health care provider at sub-center
The trained MLP would broadly be expected to carry out
public health functions, ambulatory care, management
and leadership at the Health & Wellness Centers
(H&WCs). They would be expected to:
1. Implement National Programs
2. Administration and management at Health and Wellness
Centers (or Sub-centers)
3. Health education and encourage awareness about Family
Planning, Maternal and Child Health, and Non-Communicable
Diseases.

19. 4. Preventive, promotive and curative care
5. Identification of Danger Signs and Referral after pre-
referral stabilization
6. Implement Biomedical waste disposal guidelines and
Infection Control policies
7. Supervision of health workers for Maternal and Child
Health, Family Planning and Nutrition related services.