SUB CENTER, PRIMARY HEALTH CENTER, COMMUNITY HEALTH CENTER

Mrs. Angela Harland Braver
Professor.
Community Health Nursing
UNIT :3
DELIVERY OF
COMMUNITY HEALTH
SERVICES

 According to democratic principles, it is the moral and
constitutional responsibility of the government of India to
provide health and social services to the citizens of
country.
 The scope and areas of social services are very extensive.
 Medical care and education are the basic components of
social services.
 There are various programmes for the welfare of women,
aged, handicapped , orphans and children are
implemented by the union and state governments.
 Since the population of the vulnerable section is very
large, the benefits of several government programmes do
not reach them adequately.
INTRODUCTION

 Lack of financial and other resources are the major
hindrances in social services although several national
and foreign agencies and institutions are making
generous contributions for social cause.
 Public health is a significant base of social services.
Government of India is making efforts to provide health
services to the grass root level right from the time of
independence; yet due to population explosion, this
objective is difficult to attain.
 To attain “Health for all”, nation needs extensive health
system or machinery, so that health services can be
made available to each person

HEALTH CARE DELIVERY SYSTEM
IN INDIA

 The health services in the public sector are conducted
by the union or state governments, which are as
follows:
1. Urban health services
2. Autonomous institutions
3. AYUSH
4. Rural health services
5. National health programmes
PUBLIC SECTOR

 These are rendered under NUHM.
1. URBAN HEALTH SERVICES

 The aim of NUHM is to improve the health status of the
urban poor, particularly the slum dwellers and other
vulnerable segment of the urban population.
 Under NUHM, support is provided to the states/UT’s for
strengthening and up gradation of existing health care
delivery infrastructure including Urban family welfare
centers, urban health posts and primary health centers.
 Urban health programmes is being implemented through
states and urban local bodies.
 As being the health is in the concurrent list, constitution
mandates the role of states, urban local bodies in the
management of urban health care system

 For the convenience existing urban health facilities are
described under the following headings:
a. Health services in metropolitan cities.
b. Sub divisional hospitals/ sub district hospitals
c. Urban – CHC
d. Urban- PHC
e. Urban family welfare centers
f. Urban health post
g. Specialty hospital
h. Teaching institution
i. Super speciality hospitals

 In the 7 metropolitan cities: Mumbai, Delhi, Kolkata,
Chennai, Ahmedabad, Hyderabad, and Bengaluru, the
urban health programme is being implemented through
Urban Local Bodies.
 The health care system in these cities include:
 3 tier system comprising of UFWC/ UHP/dispensaries/
maternity homes/ tertiary super specialty hospitals
 Community health workers/ volunteers
 Vast network of private hospitals/ NGO’s and charitable
trusts.
 For the other cities of the country, the state health
department decides if the urban health services would be
run by the local bodies or by the states itself.
HEALTH SERVICES IN
METROPOLITAN CITIES.

 The term district hospital means a hospital at the secondary
level, responsible for health care services of a districts
population.
 The size of the district hospital depends upon the size of the
population it serves. In India the population size of a district
varies from 35,000 to 30,00,000(census 2011)
 According to IPHS-2012, the district hospitals are graded as
per the number of beds
 Grade I- 500 beds,
 Grade II- 400 beds,
 Grade III- 300 beds
 Grade IV- 200 beds
 Grade V-100 beds
DISTRICT HOSPITALS

 The district hospitals provide effective, affordable
health care services, work as a secondary level referral
centers and provide wide ranging technical and
administrative support and training for the primary
health care.

 The term Sub-district/sub- divisional
hospital means a hospital at the secondary
referral level responsible for health care
services of a Sub-district/sub- division's
population.
 The sub- district hospitals are also
categorized as per the number of beds
 Category I- 31-50 beds
 Category –II- 51- 100 beds
 Sub-district/sub- divisional hospitals
provide effective and affordable health
care services for their defined population.
They work as referral center for
CHC/PHC/ Sub- centers and provide
education and training for primary health
care staff
SUB-DISTRICT/SUB-
DIVISIONAL HOSPITALS

 Under NUHM, U-CHC work as a satellite center
 U-CHC, can be set up for every 4-5 urban primary
health centres
 The U-CHC, would cater to a population of 2,50,000
 The U-CHC has indoor 30-50 bedded facility.
 U-CHC would be set up in cities with a population of
above 5 lakhs, wherever required.
 U-CHC are in addition to the existing facilities to cater
to the urban population in the locality.
 U-CHC may also be established in the metro cities for
every 5 lakh population with 100 beds.
URBAN COMMUNITY HEALTH
CENTERS (U-CHC)

 As per NUHM, U-PHC may be established for
approximately 50,000 to 60, 000 urban population. The new
U-PHC are preferably located within or near a slum for
providing preventive , promotive and OPD consultation
services, drug/contraceptive dispensing services and lab-
diagnosis.
 They also provide counseling for all communicable and non
– communicable diseases.
 NUHM, also support engagement of ANM’s for conducting
outreach services for targeted groups, particularly for slum
dwellers and the vulnerable population for providing
preventive and promotive health care services
URBAN PRIMARY HEALTH CENTER
(U-PHC)

 UFHC are functioning in urban areas from 1950 to
provide family planning services for urban population.
At present there are 1083 UFWCs functioning in various
states and UTs. In 1976, these were reorganized into 3
types by the department with the staffing pattern as
follows:
URBAN FAMILY WELFARE
CENTERS (UFWC)
Category Number Population covered in
thousands
Staffing pattern
Type I 326 10-25 ANM(1)/ FP field worker (1)
Type II 125 25-50 F.P. Ext. Edu/LHV (1) in addition
to above
Type III 632 Above 50 MO, preferabble female(1)
ANM and store keeper, cum
clerk (1)

 Under the revamping scheme in 1983, the government
of India established Urban Health Posts in 10 states and
Uts with a pre condition of locating them at slums or in
the near by area of slums.
 UHP are categorized in 4 types: A,B,C and D. These
posts are providing MCH, first aid, distribution of
contraceptives and other services in the urban areas.
URBAN HEALTH POST

In these hospitals , only certain diseases, age groups or
patients with specific problems are treated and specialists
and specially trained nurses care for the patients. TB
hospitals, pediatric hospitals, women or maternity
hospitals come under this group.
SPECIALTY HOSPITALS

 Hospitals associated with
medical colleges come under
this category. Along with
teaching and training of
doctors and nurses, these
hospitals provide complete care
to people of that area. These
serve as tertiary center for
referral services.
 Currently there are 612
government run and 291
private medical colleges.
TEACHING HOSPITALS

 In these hospitals super specialists of different
system/organs or diseases are trained and patients are also
treated.
 All India institute of medical sciences (AIMS) is an
example of such an institute. These institutes are centers of
excellence for health services.
 To enhance the super specialty and tertiary urban health
services and to decrease the patient load on AIMS Delhi,
Govt. of India opened such 6 institutes in various states
Jodhpur (Rajasthan), Bhopal (MP), Raipur (Chhattisgarh),
Patna (Bihar), Bhuvaneshwar (Odisha) and Rishikesh
(Uttaranchal). These institutes were established under
Pradhan Mantri Swasthya Suraksha Yojna (PMSSY)
SUPER SPECIALTY HOSPITALS

 Under this category , all such institutions are included
which receive central government aid but except few
important administrative matters, all other decisions are
made by the institute itself.
 AIMS Delhi, NIMHANS Bangalore are examples of
such central sponsored autonomous health institutes.
 Most of them are central government sponsored and
funded.
2. AUTONOMOUS INSTITUTES

 Government of India with the co-operation of state,
other institutions, global agencies is trying to face the
challenges of communicable, non communicable and
other serious diseases. For the fulfillment of this
purposes, the central government is conducting several
national health programmes. This could be helpful in
bringing down mortality and morbidity rates. Through
these programmes, quality of life and health of our
citizens also can be improved.
 In the health services of the country, national health
programmes are very significant
3. NATIONAL HEALTH PROGRAMMES

 A large part of our population have faith in AYUSH
systems of treatment and takes help medical help from the
same. Both in villages and cities, dispensaries of Indian
system of medicine are found.
 In Indian context, this is significant that better health care
can be provided by a suitable or safe combination of
AYUSH and Allopathy.
 Looking into the special role of AYUSH in Indian
population, as a special status, now the separate AYUSH
ministry has been created.
 NHP- 2017 also recognizes the need of standardization
and validity of Ayurveda medicines and establish an
effective quality control mechanism for AYUSH drugs.
4. AYUSH

 The rural health services are being implemented through
a network of primary health care systems: three tier
system.
 The three tier system: it is done according to the size of
the population
 Sub center
 Primary health center
 Community health center
5. RURAL HEALTH SERVICES

 These agencies provide help and strength to the public
health system
 They play a vital role in training, exhibition,
propaganda, and in also conducting various community
health programmes.
 Through the services of these agencies , a large part of
Indian population is benefitted.
 Several voluntary agencies work in India.
 A number of international agencies also make
significant contribution in the area of health.
B. VOLUNTARY HEALTH AGENCIES

 In the health care system, participation of private sector
is very significant. The private sector consists largely of
sole practioners or small nursing homes having 1-20
beds, serving an urban and semi urban areas and mainly
focused on curative care. 75% of service delivery for
mental health, dental health, orthopedics, vascular,
cancer diseases and about 40% of communicable
diseases and deliveries are provided by the private
sector.
 Services provided by the private sector can be mainly
classified into 3 groups:
C. PRIVATE SECTOR

 1. Private hospitals, Nursing homes and Clinics:
based of mixed economy and globalization,
private hospitals are being opened rapidly. From
small to large metropolitan cities, their network
is spreading.
 They are mainly therapeutic institutions and
provide health services to urban population only.
 The services are comparatively costly, hence the
poor and weaker section cannot get their
services.
 2. Private consultation centers: With the
increasing number of allopathic hospitals, the
tendency to start health consultation privately is
increasing among doctors. Medical council of
India and Indian Medical Association keep
professionals checks over them.

 In the rural areas, fake doctors or quacks
often start private clinics and consultation
which is a mockery of health care of
common people and is to be checked.
 3. Mission or Religious hospitals: these
hospitals are managed by mission, trust or
charitable institutions. In many parts of the
country, such hospitals and clinics provide
medical services either free of cost or at a
very cheap rate, to common people.
 Though they function mainly in urban areas,
they provide health care to rural population
also, through camps or community care
centers.

 Serious supply gaps and distribution inequalities
 Need for uniform standards and treatment protocols
 Need for cost control and quality assurance mechansims
 Regulations to protect consumer interests and
enforcement system
 Supporting the NGO/ Charitable trusts to serve the poor
in under served areas .
AN OVERVIEW OF THE PUBLIC HEALTH
SECTOR

 In the public sector, a Health Sub-center is the most
peripheral and first point of contact between the
primary health care system and the community.
 A Sub-center provides interface with the community at
the grass-root level, providing all the primary health
care services.
 The purpose of the Health Sub-center is largely
preventive and promotive, but it also provides a basic
level of curative care.
INDIAN PUBLIC HEALTH STANDARDS FOR
SUB-CENTERS

 As per population norms, there shall be one Sub-center
established for every 5000 population in plain areas and
for every 3000 population in hilly/tribal/desert areas. As
the population density in the country is not uniform,
application of same norm all over the country is not
advisable.
 The number of Sub-center and number of ANMs shall
also depend upon the case load of the facility and
distance of the village/habitations which comprise the
Sub-centers.
 There were 161,829 sub centers in India as of March 31,
2022.

a. To specify the minimum assured (essential) services
that Sub-center is expected to provide and the
desirable services which the states/UTs should aspire
to provide through this facility.
b. To maintain an acceptable quality of care for these
services.
c. To facilitate monitoring and supervision of these
facilities.
d. To make the services provided more accountable and
responsive to people’s needs.
OBJECTIVES OF THE INDIAN PUBLIC
HEALTH STANDARDS FOR SUB-CENTRE

 In view of the current highly variable situation of Sub
centers in different parts of the country and even with in
the same State, they have been categorized into two
types - Type A and Type B.
 Categorization has taken into consideration various
factors namely catchment area, health seeking behavior,
case load, location of other facilities like
PHC/CHC/FRU/Hospitals in the vicinity of the Sub-
centers. States shall be required to categorize their Sub-
centers into two types as per the guidelines given below
and provide services and infrastructure accordingly.
This shall result in optimum use of available resources.
CATEGORIZATION OF SUB-CENTERS

 Will provide all recommended services except that the
facilities for conducting delivery will not be available
here.
 However, the ANMs have been trained in midwifery,
they may conduct normal delivery in case of need. If
the requirement for this goes up , the sub center may be
considered for up gradation to Type B.
 The Sub-center in the following situations may be
included in this category.
TYPE A SUB CENTER

I. Sub-centers not having adequate space and physical infrastructure
for conducting deliveries, due to which providing labor room
facilities and equipment at these Sub-centers is not possible.
However there may still be demand for delivery services from the
community in these areas e,g, Sub-centers located in remote,
difficult, hilly, desert or tribal area. In such areas, the transport
facility is likely to be poor and the population is still dependent
on these Sub-centers for availing delivery facilities. In such
situations, ANMs would be required to conduct deliveries at
homes and ANMs of these Sub-centers should mandatorily be
Skilled Birth Attendance (SBA) trained. Such Sub-centers should
be identified for infrastructure up gradation for conversion to
Type B Sub-centers on priority.

ii. Sub-centers situated in the vicinity of other higher
health facilities like PHC/CHC/ FRU/Hospital, where
delivery facilities are available
iii. Sub-centers in headquarter area
iv. Sub-centers where at present no delivery or occasional
delivery may be taking place i.e. very low case load of
deliveries. If the case load increases, these Sub-centres
should be considered for up gradation to Type B

 One ANM (Essential),
 Two ANMs: (Desirable to split the population between
them and one of them provides outreach services and
the other is available at the Sub-centre)
 One Health Worker (Male) (Essential)
 Sanitation services should be provided through
outsourcing on part time basis
STAFF RECOMMENDED

 The facilities for conducting delivery will not be available
at these sub-centers and patients may usually be referred
to nearby centers providing delivery facilities.
 If the requirement for delivery services goes up , the sub
center may be considered for up gradation to Type B.
These Sub-centers should provide all other recommended
services and focus on outreach services, prevalent
diseases, tuberculosis, leprosy, Non-communicable
diseases, nutrition, water, sanitation and epidemics.
GUIDELINES

 It is also to be ensured that the Staff of these sub-
centers is provided training in all new programmes on
priority basis and refresher training is provided
regularly. •
 Extra payment should be provided to Staff posted in
difficult areas. •
 If there is shortage, Health Worker male should be
posted on priority basis in areas endemic for vector
borne diseases

 This would include following types of Sub-centers:
 i. Centrally or better located Sub-centers with good
connectivity to catchment areas.
 ii. They have good physical infrastructure preferably
with own buildings, adequate space, residential
accommodation and labor room facilities.
 iii. They already have good case load of deliveries from
the catchment areas.
 iv. There are no nearby higher level delivery facilities
TYPE B (MCH SUB-CENTRE)

 Such Sub-centers should be developed as a delivery facility and
should also cater to adjacent Type A sub centers areas for
delivery purpose.
 Type B Sub-center, will provide all recommended services
including facilities for conducting deliveries at the Sub-center
itself. They will be expected to conduct around 20 deliveries in
a month.
 They should be provided with all labor room facilities and
equipment including Newborn care corner.
 ANMs of these Sub-centers should be SBA trained. These
centers may be provided extra equipment, drugs, supplies,
materials, 2 beds and budget for smooth functioning. If number
of deliveries is 20 or more in a month, then additional 2 beds
will be provided.
GUIDELINES

 Two ANM (Essential)
 One Health Worker (Male): (Essential)
 One Staff Nurse or ANM (if Staff Nurse not available)
(Desirable, if number of deliveries at the Sub-centre is
20 or more in a month)
 Sanitation services should be provided through
outsourcing on full time basis
STAFF RECOMMENDED

 Maternal and Child Health
 Maternal Health
 i. Antenatal care: Essential
 Early registration of all pregnancies, within first trimester
(before 12th week of Pregnancy). However even if a
woman comes late in her pregnancy for registration, she
should be registered and care given to her according to
gestational age.
 Minimum 4 ANC including Registration Suggested
schedule for antenatal visits
SERVICES TO BE PROVIDED IN A SUB-
CENTER

 1st visit: Within 12 weeks—preferably as soon as
pregnancy is suspected—for registration, history and
first antenatal check-up
 2nd visit: Between 14 and 26 weeks
 3rd visit: Between 28 and 34 weeks
 4th visit: Between 36 weeks and term

 Associated services like general examination such as
height, weight, B.P., anemia, abdominal examination,
breast examination, Folic Acid Supplementation (in first
trimester), Iron & Folic Acid Supplementation from 12
weeks, injection tetanus toxoid, treatment of anemia etc.,
(as per the Guidelines for Antenatal care and Skilled
Attendance at Birth by ANMs and LHVs)
 Recording tobacco use by all antenatal mothers.
 Minimum laboratory investigations like Urine Test for
pregnancy confirmation, hemoglobin estimation, urine for
albumin and sugar and linkages with PHC for other
required tests.

 Name based tracking of all pregnant women for assured
service delivery.
 Identification of high risk pregnancy cases.
 Identification and management of danger signs during
pregnancy.
 Malaria prophylaxis in malaria endemic zones for
pregnant women as per the guidelines of NVBDCP.
 Appropriate and Timely referral of such identified cases
which are beyond her capacity of management.

 Counseling on diet, rest, tobacco cessation if the antenatal
mother is a smoker or tobacco user, information about
dangers of exposure to second hand smoke and minor
problems during pregnancy, advice on institutional
deliveries, pre-birth preparedness and complication
readiness, danger signs, clean and safe delivery at home if
called for, postnatal care & hygiene, nutrition, care of
newborn, registration of birth, initiation of breast feeding,
exclusive breast feeding for 6 months, demand feeding,
supplementary feeding from 6 months onwards, infant &
young child feeding and contraception.

 Provide information about provisions under current
schemes and programmes like Janani Suraksha Yojana.
 Identify suspected RTI/STI case, provide counseling,
basic management and referral services.
 Counseling & referral for HIV/AIDS.
 Name based tracking of missed and left out ANC cases.

 i. Intra-natal care:
 Essential
 Promotion of institutional deliveries
 Skilled attendance at home deliveries when called for
 Appropriate and Timely referral of high risk cases
which are beyond her capacity of management

 Managing labor using Partograph.
labor.
 Proficient in identification and basic fist aid treatment
for PPH, Eclampsia, Sepsis and prompt referral of such
cases as per’ Antenatal Care and Skilled Birth
Attendance at Birth’ or SBA Guidelines.
 Minimum 24 hours of stay of mother and baby after
delivery at Sub-center. The environment at the Sub-
center should be clean and safe for both mother and
baby.
ESSENTIAL FOR TYPE B SUB-CENTRE

 Postnatal care: Essential
 Initiation of early breast-feeding within one hour of birth.
 Ensure post-natal home visits on 0,3,7 and 42nd day for
deliveries at home and Sub-center (mother & baby).
 Ensure 3, 7 and 42nd day visit for institutional delivery
(both for mother & baby) cases.
 In case of Low Birth weight Baby (less than 2500 gm),
additional visits are to be made on 14, 21 and 28th days.
 During post-natal visit, advice regarding care of the mother
and care and feeding of the newborn and examination of the
newborn for signs of sickness and congenital abnormalities
as per IMNCI Guidelines and appropriate referral, if
needed.

 Counseling on diet & rest, hygiene, contraception,
essential newborn care, immunization, infant and young
child feeding, STI/RTI and HIV/AIDS.
 Name based tracking of missed and left out PNC cases

 Newborn Care Corner In The Labor Room to provide
Essential Newborn Care : Essential If the Deliveries
take Place at the Sub-center (Type B)
 Essential Newborn Care (maintain the body temperature
and prevent hypothermia [provision of
warmth/Kangaroo Mother Care (KMC)], maintain the
airway and breathing, initiate breastfeeding within one
hour, infection protection, cord care, and care of the
eyes, as per the guidelines for Ante-Natal Care and
Skilled Attendance at Birth by ANMs and LHVs.). Post
natal visits as mentioned under ‘Post natal Care’.
CHILD HEALTH : ESSENTIAL

 Counseling on exclusive breast-feeding for 6 months and
appropriate and adequate complementary feeding from 6
months of age while continuing breastfeeding. (As per
National Guidelines on Infant and Young Child Feeding,
2006, by Ministry of WCD, Government of India).
 Assess the growth and development of the infants and under
5 children and make timely referral.
 Immunization Services: Full Immunization of all infants and
children against vaccine preventable diseases as per
guidelines of Government of India.
 Vitamin A prophylaxis to the children as per National
guidelines. y Prevention and control of childhood
diseases like malnutrition, infections, ARI, Diarrhoea,
Fever, Anaemia etc. including IMNCI strategy

 Name based tracking of all infants and children to
ensure full immunization coverage.
 Identification and follow up, referral and reporting of
Adverse Events Following Immunization (AEFI)

 Education, Motivation and counseling to adopt
appropriate Family planning methods. •
 Provision of contraceptives such as condoms, oral
pills, emergency contraceptives, Intra Uterine
Contraceptive Devices (IUCD) insertions
(wherever the ANM is trained in IUCD insertion).
•
 Follow up services to the eligible couples
adopting any family planning methods (terminal/
spacing)
 Safe Abortion Services (MTP)
 Essential •
 Counseling and appropriate referral for safe
abortion services (MTP) for those in need. •
Follow up for any complication after abortion/
MTP and appropriate referral if needed.
FAMILY PLANNING AND CONTRACEPTION
ESSENTIAL

 Essential •
 Provide treatment for minor ailments including fever,
diarrhea, ARI, worm infestation and First Aid including first
aid to animal bite cases (wound care, tourniquet (in snake
bite) assessment and referral). •
 Appropriate and prompt referral.
 Desirable •
 Provide treatment as per AYUSH as per the local need.
ANMs and MPW (M) be trained in basic AYUSH drugs. •
 Once a month clinic by the PHC medical officer. LHV,
HWM and ANM should be available for providing assistance
CURATIVE SERVICES

 Adolescent Health Care
 Desirable •
 Education, counseling and referral. •
 Prevention and treatment of Anemia. •
 Counseling on harmful effects of tobacco and its cessation.
 School Health Services
 Essential •
 Screening, treatment of minor ailments, immunization, de-
worming, prevention and management of Vitamin A and
nutritional deficiency anemia and referral services through
fixed day visit of school by existing ANM/MPW •
 Staff of Sub-center shall provide assistance to school health
services as a member of team

 Control of Local Endemic Diseases
 Essential •
 Assisting in detection, Control and reporting of local
endemic diseases such as malaria, Kala Azar, Japanese
encephalitis, Filariasis, Dengue etc.
 •Assistance in control of epidemic outbreaks as per
programme guidelines

 Disease Surveillance, Integrated Disease Surveillance
Project (IDSP)
 Essential •
 Surveillance about any abnormal increase in cases of
diarrhea/dysentery, fever with rigors, fever with rash, fever
with jaundice or fever with unconsciousness and early
reporting to concerned PHC as per IDSP guidelines. •
 Immediate reporting of any cluster/outbreak based on
syndromic surveillance. •
 High level of alertness for any unusual health event,
reporting and appropriate action. •
 Weekly submission of report to PHC in’S’Form as per IDSP
guidelines.

 Water and Sanitation
 Desirable •
 Disinfection of drinking water sources. •
 Promotion of sanitation including use of toilets and
appropriate garbage disposal

 Village Health and Nutrition Day (VHND)
VHND should be organised at least once in
a month in each village with the help of
Medical Officer, Health Assistant Female
(LHV) of PHC, HWM, HWF, ASHA, AWW
and their supervisory staff, PRI, Self Help
Groups etc. The number of VHNDs should
be enough to reach every
habitation/Anganwadi center at least once
in a month. The ANM is accountable for
these services, with the male worker also
taking a due share of the work, and being
in charge of logistics and organization,
especially vaccine logistics.
OUT REACH/FIELD SERVICES

 Participation of Anganwadi workers, ASHAs and
community volunteers would be essential for
mobilization of beneficiaries and local organizational
support. Each Village Health and Nutrition Day should
last for at least four hours of contact time between
ANMs, AWWs, ASHAs and the beneficiaries. The
services to be provided at VHND are listed as

 Early registration and Antenatal care for pregnant women – as per
standard treatment protocol for the SBA. •
 Immunization and Vitamin A administration to all under 5 children-
as per immunization schedule. •
 Coordination with ICDS programme for Supplementary nutritional
services, health check up and referral services, health and nutrition
education, immunization for children below 6 years, Pregnant &
Lactating Mother and health and nutrition education for all women
in the age group (15 to 45 years).
 •Family planning counseling and distribution of contraceptives. •
Symptomatic care and management of persons with minor illness
referred by ASHAs/AWWs or coming on their own accord. •
 Health Communication to mothers, adolescents and other members
of the community who attend the VHND session for whatever
reason.
ESSENTIAL

 Meet with ASHAs and provide training/support to them
as needed. •
Registration of Births and Deaths.
 Desirable •
 Symptom based care and counselling with referral if
needed for STI/RTI and for HIV/AIDS suspected cases. •
 Disinfection of water sources and promotion of
sanitation including use of toilets and appropriate
garbage disposal

 For skilled attendance at birth- where the
woman has opted or had to go in for a
home delivery. •
 Post natal and newborn visits – as per
protocol. •
 To check out on disease incidences
reported to Health Worker or she/he
comes across during house visits
especially where there it is a notifiable
disease. Notify the M.O. PHC
immediately about any abnormal increase
in cases of diarrhea/dysentery, fever with
rigors, fever with rash, flaccid paralysis
of acute onset in a child
HOME VISITS- ESSENTIAL

 Visits to houses of eligible couples who need contraceptive services,
but are not currently using them e.g. couples with children less than
three years of age, where women are married and less than 19 years
of age, where the family is complete etc. •
 Follow up of cases who have undergone Sterilization and MTP, as
per protocols especially those who can not come to the facility. •
 Visits to community based DOTS providers, leprosy depot holders
where this is needed. •
 Visits to support ASHA where further counseling is needed to
persuade a family to utilize required health services e.g.,
immunization dropouts, antenatal care dropouts, TB defaulter etc. •
 To take blood slides/do RDK test in cases with fever where malaria
is suspected.
DESIRABLE

 These surveys would be done once annually, preferably
in April. Some of the diseases would require special
surveys- but at all times not more than one survey per
month would be expected. Surveys would be done with
support and participation of ASHAs, Anganwadi
Workers, community volunteers, panchayat members
and Village Health Sanitation and Nutrition Committee
members. The Male Health worker would take the lead
and be accountable for the organization of these surveys
and the subsequent preparation of lists and referrals.
The surveys would include
HOUSE TO HOUSE SURVEY

 Age and sex of all family members. •
 Assess and list eligible couples and their
unmet needs for contraception. •
 Identify persons with skin lesions or
other symptoms suspicious of leprosy
and refer: essential in high leprosy
prevalence blocks. •
 Identify persons with blindness, list and
refer: Identify persons with hearing
impairment/ deafness, list and refer. •
 Annual mass drug administration in
filaria endemic areas
ESSENTIAL

 Identify persons with disabilities, list and refer and call
for counseling where needed. •
 Identify and list senior citizens who need special care
and support. •Identify persons with mental health
problems and Epilepsy; list and refer. •
 In high endemicity areas-survey for fever suspicious of
kala- azar, for epidemic management of malaria, for
detection of fluorosis affected cases etc. •
 Any other obvious disease/disorder; list and refer
DESIRABLE

 Essential •
 Focus group discussions for information gathering and
health planning.
 Health Communication especially as related to National
Health programmes through attending Village Health
Sanitation and Nutrition Committee meetings, ASHA
local review meetings and meetings with panchayat
members/sarpanch, Self Help Groups, women’s groups
and other BCC activities
COMMUNITY LEVEL INTERACTIONS

 Health Communication especially as related to National
Health programmes through attending Village Health
Sanitation and Nutrition Committee meetings, ASHA
local review meetings and meetings with panchayat
members/sarpanch, Self Help Groups, women’s groups
and other BCC activities
COORDINATION AND MONITORING

 Locally available medicinal herbs/ plants should be
grown around the sub center as per the guidelines of
AYUSH.
PROMOTION OF MEDICINAL HERBS

 Recording and reporting of vital events including births
and deaths, and in maintaining all records related to sub
centers
RECORD OF VITAL EVENTS

 Communicable Disease Programme
a. National AIDS Control Programme (NACP)
Essential
Condom promotion & distribution of condoms to the high risk groups.
Help and guide patients with HIV/AIDS receiving ART with focus on
adherence.
IEC activities to enhance awareness and preventive measures about STIs
and HIV/AIDS, PPTCT services and HIV-TB coordination.
Desirable
Linkage with Microscopy Centre for HIV-TB coordination.
HIV/STI Counseling, Screening and referral in Type B Sub-centers
(Screening in Districts where the prevalence of HIV/AIDS is high).
NATIONAL HEALTH
PROGRAMMES

 Collection of Blood slides of fever patients
 Rapid Diagnostic Tests (RDT) for diagnosis of Pf malaria in high Pf
endemic areas.
 Appropriate anti-malarial treatment.
 Assistance for integrated vector control activities in relation to
Malaria, Filaria, JE, Dengue, Kala-Azar etc. as prevalent in specific
areas. Prevention of breeding places of vectorsthrough IEC and
community mobilization. Where filaria is endemic, identification of
cases of lymphoedema/elephantiasis and hydrocele and their referrals
to PHC/CHC for appropriate management. The disease specific
guidelines issued by NVBDCP are to be followed.
 Annual mass drug administration with single dose of Diethyl
carbamazine (DEC) to all eligible population at risk of lymphatic
filariasis.
 Promotion of use of insecticidal treated nets, wherever supplied. y
Record keeping and reporting as per programme guidelines.
NATIONAL VECTOR BORNE DISEASE
CONTROL PROGRAMME (NVBDCP)

 Essential
 Health education to community regarding signs and
symptoms of leprosy, its complications, curability and
availability of free of cost treatment.
 Referral of suspected cases of leprosy (person with skin
patch, nodule, thickened skin, impaired sensation in
hands and feet with muscle weakness) and its
complications to PHC.
 Provision of subsequent doses of MDT and follow up of
persons under treatment for leprosy, maintain records
and monitor for regularity and completion of treatment
NATIONAL LEPROSY
ERADICATION PROGRAMME
(NLEP):

 Essential
 Referral of suspected symptomatic cases to the PHC/Microscopy
center
 Provision of DOTS at Sub-center, proper documentation and
follow-up.
 Care should be taken to ensure compliance and completion of
treatment in all cases.
 Adequate drinking water should be ensured at Sub-center for
taking the drugs.
 Desirable
 Sputum collection centers established in Sub-center for collection
and transport of sputum samples in rural, tribal, hilly & difficult
areas of the country where Designated Microscopy Centers are not
available as per the RNTCP guidelines.
REVISED NATIONAL
TUBERCULOSIS CONTROL
PROGRAMME (RNTCP):

 Note: These services are to be provided at both types of
Sub-centers.
 National Programme for Control of Blindness (NPCB):
Essential
 Detection of cases of impaired vision in house to house
surveys and their appropriate referral. The cases with
decreased vision will be noted in the blindness register.
 Spreading awareness regarding eye problems, early
detection of decreased vision, available treatment and
health care facilities for referral of such cases. IEC is
the major activity to help identify cases of blindness
and refer suspected cataract cases.
NON-COMMUNICABLE DISEASE
(NCD) PROGRAMMES

 Desirable
 The cataract cases brought to the District Hospital by
MPW/ANM/and ASHAS.
 Assisting for screening of school children for
diminished vision and referral

 Essential
 Detection of cases of hearing impairment and
deafness during House to house survey and their
appropriate referral.
 Awareness regarding ear problems, early
detection of deafness, available treatment and
health care facilities for referral of such cases.
 Education of community especially the parents
of young children regarding importance of right
feeding practices, early detection of deafness in
young children, common ear problems and
available treatment for hearing impairment/
deafness.
NATIONAL PROGRAMME FOR PREVENTION
AND CONTROL OF DEAFNESS (NPPCD)

 Essential
 Identification and referral of common mental illnesses
for treatment and follow them up in community.
 IEC activities for prevention and early detection of
mental disorders and greater participation/role of
Community for primary prevention of mental disorders.
NATIONAL MENTAL HEALTH PROGRAMME

 Essential
 IEC Activities to promote healthy lifestyle sensitize the
community about prevention of Cancers, Diabetes, CVD
and Strokes, early detection through awareness
regarding warning signs and appropriate and prompt
referral of suspect cases.
NATIONAL PROGRAMME FOR PREVENTION AND
CONTROL OF CANCER, DIABETES, CARDIOVASCULAR
DISEASES AND STROKE

 Essential
 IEC Activities to promote consumption of iodized salt
by the community. Testing of salt for presence of Iodine
through Salt Testing Kits by ASHAs.
NATIONAL IODINE DEFICIENCY
DISORDERS CONTROL PROGRAMME

 Essential
 Identify the persons at risk of Fluorosis, suffering from
Fluorosis and those having deformities due to Fluorosis
and referral.
 Desirable
 Line listing of reconstructive surgery cases,
rehabilitative intervention activities and referral
services.
 Focused behavior change communication activities to
prevent Fluorosis.
IN FLUOROSIS AFFECTED (ENDEMIC)
AREAS

 Essential
 Spread awareness and health education regarding ill effects of
tobacco use especially in pregnant females and Non-
Communicable diseases where tobacco is a risk factor e.g.
Cardiovascular disease, Cancers, chronic lung diseases.
 Display of mandatory signage of “No Smoking” in the Sub-
center.
 Desirable
 Counseling for quitting tobacco.
 Awareness to public that smoking is banned in public places and
sale of tobacco products is banned to minors (less than 18 years)
as well as within 100 yards of schools and educational
institutions.
 Spread awareness regarding law on smoke free public places
NATIONAL TOBACCO CONTROL
PROGRAMME

 Desirable
 Health education on oral health and hygiene especially
to antenatal and lactating mothers, school and
adolescent children.
 Providing first aid and referral services for cases with
oral health problems.
ORAL HEALTH

 Desirable
 Health education on Prevention of Disability.
 Identification of Disabled persons during annual house
to house survey and their appropriate referral
DISABILITY PREVENTION

 Desirable
 Counseling of Elderly persons and their family members
on healthy ageing.
 Referral of sick old persons to PHC
NATIONAL PROGRAMME FOR HEALTH
CARE OF ELDERLY:

 Lab facilities: Minimum facilities of Urine Pregnancy
Testing, estimation of hemoglobin by using a approved
Hemoglobin Color Scale (only approved test strips should
be used), urine test for the presence of protein and sugar
by using Dipsticks should be available. (Instructions
should be followed from the leaflet provided by the
manufacturer)
 Electricity
 Water
 Telephone
 Assured referral linkages
 Toilets
 Waste disposal
SUPPORT SERVICES

 Internal mechanisms: Supportive supervision and
Record checking at periodic intervals by the Male and
Female Health supervisors from PHC (at least once a
week) and by MO of the PHC (at least once in a month)
etc.
 External mechanisms: Sub-centers will be under the
oversight of Gram Panchayats.
MONITORING MECHANISM

PHC’S are the corner stone of rural health
services- a first port of call to a qualified doctor
of the public sector in rural areas for the sick
and those who directly report or referred from
subcenter for curative, preventive and promotive
care. It acts as a referral unit for 6 sub centers
and refer out cases to CHC’s and higher order
public hospitals at sub district and district
hospitals.
PRIMARY HEALTH CENTERS

PHC is established to cover 30,000 population in
plains and 20,000 population in hilly/tribal
areas. There are 4-6 beds for patients and some
diagnostic facilities are also available.
SET UP

Medical Officer- 01
Staff Nurse- 03
ANM/HW(Female)- 01
LHV/ HW (Female)- 01
HA (Male)- 01
Lab technician- 01
Pharmacist – 01
Accountant cum data entry operator- 01
Group D worker- 03
Total- 13
STAFFING NORMS-MINIMUM NORMS

Staff Type A Type B
Essential Desirable Essential Desirable
MO-MBBS 1 1*
MO-AYUSH 1 1**
Accountant cum DEO 1 1
Pharmacist 1 1
Pharmacist-AYUSH 1 1
Nurse-midwife staff nurse 3 +1 4 +1
HW-F 1@ 1@
HA-M 1 1
HA-F/LHV 1 1
Health educator 1 1
Lab technician 1 1
Cold chain &vaccine logistic assistant 1 1
Multi skilled group D worker 2 2
Sanitary worker cum watchman 1 Total=13 Total=
18(13+5)
1
Total=14
+1
Total= 21
(14+7)
STAFFING FOR PHC (TYPE-A&TYPE-B)

*If the delivery case load is 30 or more per month. One
of the 2 medical officers should be female.
** to provide choice to the people where ever an AYUSH
public facility is not available near the vicinity.
@ for sub center area of PHC

 Medical care (OPD and IPD-6 bed services)
 Maternal and Child health care including family planning
services.
 MTP services
 Management of RTI/STI
 Nutrition services
 School health services
 Adolescent health care
 Promotion of safe drinking water and basic sanitation
services
 Collection and reporting of vital events
FUNCTIONS OF PHC

 Health education and behavior change communication
 National health programmes
 Referral services
 Training
 Basic Laboratory services
 Monitoring and supervision
 Mainstreaming of Ayush
 Selected surgical procedures
 Record of vital statistics and reporting
 Maternal death review

1. To provide comprehensive primary health care
to the community at PHC’s
2. To achieve and maintain an acceptable
standards of quality of care.
3. To make the services more responsive and
sensitive to the needs of the community
OBJECTIVES

From service point of view, PHC’S may be of two
types:
Type –A, Type B
Type –A PHC
PHC with delivery load of less than 20 deliveries in a
month
Type –B PHC
PHC with delivery load of 20 or more deliveries in a
month
The services are as follows:
SERVICES TO BE PROVIDED IN PHC

 Essential:
 OPD Services:
 A total of 6 hours of OPD services out of which 4 hours
in the morning and 2 hours in the afternoon for 6 days in
a week. Time schedule may vary from state to state.
Minimum OPD attendance should be 40 patients per
doctor per day.
 24 hour emergency services: appropriate management of
injuiries and accidents, first aid, stabilization of the
condition of the patients before referral, dog bite/ snake
bite/ scorpion bite cases and other emergency conditions
 In- patient services.(6 beds)
1. MEDICAL CARE

 Essential: A. Antenatal care:
 Early registration of all pregnancies ideally in the first
trimester
 Minimum 4 antenatal checkups and provision of complete
package of services. Associated services like providing iron
and folic acid tablets, injections TT
 Minimum laboratory investigations like Hb, urine albumin,
sugar RPR test for syphilis.
 Nutrition and health counseling, brief advice on tobacco
cessation if the antenatal mother is a smoker or tobacco user.
pregnancy and labor. Timely referral of such cases to FRU’S
other hospitals.
 Tracking of missed and left out ANC.
2. MATERNAL AND CHILD HEALTH CARE
INCLUDING FAMILY PLANNING

 B. Intra natal care (24 hour delivery services- both
normal and assisted)
 Promotion of institutional deliveries
 Conducting of normal deliveries
 Assisted vaginal deliveries including forceps /vaccum
delivery whenever required.
 Manual removal of placenta
 Appropriate and prompt referral for cases needing
specialist care
 Managing labour using partograph
 Minimum 48 hours of stay after delivery

 C. Proficient in identification and basic first aid treatment
for PPH, eclampsia, sepsis, and prompt referral.
 D. Post natal care:
• Ensure post natal care for 0 and 3rd day at the health
facility both for the mother and new born ad sending
direction to the ANM of the concerned area for ensuring
7th and 42nd day post natal visits.
• Initiation of early breast feeding
• Education on nutrition, hygiene, contraception and
essential newborn care.
• Provision of facilities under JSY
• Tracking of missed and left out PNC

 E. Newborn care:
• Facilities for essential new born care and resuscitation
• Management of neonatal hypothermia, infection prevention, cord care,
identification of sick newborn and immediate referral
 F. Care of the child:
• Routine and emergency care of children including IMNCI
• Counseling on exclusive breastfeeding and on infant and young child
feeding
• Full immunization of all infants and children against vaccine
preventable diseases as per guidelines of GOI.
• Vitamin A prophylaxis
• Growth monitoring
• Prevention and control of routine childhood diseases, infections like
diarrhoea, pneumonia
• Management and referral of severe acute malnutrition cases.

 G. Family welfare:
• Education , motivation and counseling to adopt
appropriate family planning measures
• Provision of contraceptives such as condoms, oral pills,
emergency contraceptives, IUD insertions
• Permanent measures like vasectomy and tubectomy
• Follow up services
• Counseling and appropriate referrals for couples having
infertility.

 Essential:
 Counseling and appropriate referral for safe
abortion services for those in need
 Desirable:
 MTP using manual vacuum aspiration
technique will be provided in the PHC
where trained personnel and faculty exist.
 Medical methods of abortion and referral to
the approved facility for MTP of 2nd
trimester.
3. MEDICAL TERMINATION OF
PREGNANCIES

 Essential:
 Health education for prevention of RTI/STI
 Treatment of RTI/STI
 5. Nutrition services (coordinated with ICDS)
 Essential:
 Diagnosis and management of malnutrition, anemia, and
vitamin A deficiency
4. MANAGEMENT OF REPRODUCTIVE
TRACT INFECTIONS/ STI

 Teachers screen students and ANMs visit the schools for screening ,
treatment of minor ailments and referral. Doctors from CHC/PHC
will also visit.
 Essential :
 Health service provision:
 Screening health care and referral
 Basic medicines to take care of common ailments
 Immunization
 Micronutrient management
 Deworming
 Desirable:
 Counseling services
 Regular practice of yoga and health education
 First aid rooms /corners
6. SCHOOL HEALTH

 To be provided preferably through adolescent friendly clinic for 2
hours once a week on a fixed day. Services should be
comprehensive.
 Core package (essential)
 Adolescent and reproductive health, counseling and services
related to sexual health, pregnancy, contraception, abortion,
menstrual problems
 TT immunization
 Nutritional counseling, prevention and management of nutritional
anaemia
 STI/RTI management
 Optional services (desirable)
 Outreach services in schools and community camps
 Periodic health checkups and health education activity
7. ADOLESCENT HEALTH CARE

 Essential:
 Disinfection of water sources and coordination
with public health engineering department for
safe water supply
 Promotion of sanitation including use of toilets
and appropriate garbage disposal.
 Desirable:
 Testing of water quality using bacteriological
strips
9. Prevention and control of locally endemic
diseases.
10. Collection and reporting of vital events
11. Health education and behavior change
communication
8. PROMOTION OF SAFE DRINKING
WATER AND BASIC SANITATION

 RNTCP-Essential
 All PHCs to function as DOTS Centers to deliver treatment as
per the RNTCP protocols through DOTS providers and
treatment of common complications of TB and side effects of
drugs, records and reports on RNTCP activities as per
guidelines.
 NLEP- Essential
 Health education
 Diagnosis and management of leprosy and its complications
 Training and counseling
 IDSP: Essential
 Weekly reporting of epidemic prone diseases.
 Appropriate preparedness
 Laboratory services
12. NATIONAL HEALTH PROGRAMMES

 NPCB: Essential
 The early detection of visual impairments and their referral
 Detection of cataract cases and referral for cataract surgery
 Provision of basic services for diagnosis and treatment of common
eye diseases.
 Awareness generation
 Participation of the community in prevention of eye diseases.
 NVBDCP: Essential
 Diagnosis of malaria cases, microscopic confirmation and
treatment
 Cases of suspected JE and dengue to be provided symptomatic
treatment, hospitalization and case management as per the protocol
 Complete treatment to kala azar cases
 Complete treatment of microfilaria positive cases with DEC and
participation and arrangement of MDA

 NACP: Essential
 IEC activities to enhance awareness and preventive measures about
STIs and HIV/AIDS, prevention of parents to child transmission
services.
 Organizing school health education programmes
 Condom promotion and distribution of condoms to the high risk
groups
 Help and guide patients with HIV/AIDS receiving ART with focus on
adherence.
 Desirable:
 ICTC
 Screening of persons with high risk behavior
 Risk screening of antenatal mothers
 Linkage with microscopy centers for HIV-TB coordination
 Pre and post test counseling of AIDS patients by PHC staff in high
prevalence states.

 NPPCD: Essential: early detection of cases of hearing impairment
and deafness and referral
 Basic diagnosis
 IEC services
 NMHP: Essential: early identification and treatment of mental
illnesses in the community.
 Basic services for diagnosis and treatment of common mental
disorders
 IEC activities for prevention
 National programme for prevention and control of cancer, diabetes,
CVD and stroke.
 Cancer: Essential:
 IEC services for prevention of cancer and early symptoms
 Early detection of cancer with warning signals
 Referrals of suspected cancer cases for confirmation of diagnosis

 Essential
 Health promotion services to modify individual group and
community behavior
 Early detection , management and referral of DM, Hypertension,
and other CVDS
 Desirable:
 Survey of population to identify vulnerable , high risk and those
suffering with the disease
 National IDD and control programme:
 IEC activities to promote the consumption of iodized salt by the
people
 Monitoring of iodized salt through salt testing kits
 National programme for prevention and control of Fluorosis- in
affected districts – referral services and IEC activities.
OTHER NON COMMUNICABLE DISEASES

 National tobacco control programme: Essential
 Health education and IEC activities regarding harmful effects of tobacco
 Promoting quitting of tobacco in the community
 Making PHC tobacco free
 Desirable: watch for implementation of ban on smoking in public places,
sale of tobacco products within the 100 meters of educational
institutions.
 National programme for health care of elderly: essential: IEC activities
on healthy ageing. Desirable: weekly geriatric clinic at PHC.
 Oral health: oral health check ups and appropriate referral on
identification
 Physical medicine and rehabilitation services: Desirable: primary
prevention of disabilities, counseling, community based rehabilitation
services. Issue of disability certificate for disabilities by PHC doctor.

13. Referral services: appropriate and prompt referral of cases needing
specialist care including- stabilizing of patients, appropriate support
for patients during transport, providing transport facilities either by
PHC vehicle or other available referral transport. Drop back home for
patients as mandated under JSSK
14. Training: Essential:
• Imparting training to undergraduate medical students and intern
doctors in basic health care.
• Orientation training of male and female multipurpose health workers
in various national health programmes including RCH and
immunization
• Skill based training to ASHA’s
• Initial and periodic training of paramedics in treatment ailments
• Periodic training of doctors and paramedics through continuing
medical education, conferences, skill development trainings,
• All health staff of PHC must be trained in IMEP

 Desirable:
• There should be provision of induction training for doctors,
nursing and paramedical staff.
• Training for new technology introduction
• Quality assurance in training
• Appropriate placement of trained person
• Training of minor repairs and maintenance of available equipment
for users.
• Training of paramedics in indenting, forecasting, inventory, and
store management
• Development of protocols for equipment

15. Basic Laboratory services: Essential:
• Routine urine, stool and blood tests (HB,
platelet count, total RBC, WBC, bleeding
time, clotting time)
• Diagnosis of RTI/STI with wet mounting,
grams stain
• Sputum testing for mycobacterium
• Blood smear examination for malaria
• Rapid diagnostic test- pregnancy
• Rapid test kit for fecal contamination of
water
• Estimation of chlorine level of water using
orthotoludine reagent
• Desirable: Blood cholesterol and ECG

16. Monitoring and supervision: Essential
• Monitoring and supervision of activities of sub center through
regular meetings/ periodic visits, etc.
• Monitoring of all National health programmes
• Monitoring activities of ASHAs
• MO should visit all sub centers at least once in a month
• Health assistants male and LHV should visit sub centers once a
week

17. Functional linkages with sub center: Essential:
• There shall be a monthly review meeting at PHC chaired by MO and
attended by all the multi purpose workers and health assistants.
• Organizing VHND at anganwadi centers.
• Desirable:
• ASHAs and AWW should attend monthly review meeting.
• Medical officers should orient ASHA on selected topic of health care
18. Mainstreaming of AYUSH: Desirable:
• Provision of one AYUSH doctor and one AYUSH pharmacist at PHC
• The signboard of PHC should be mentioned in AYUSH facilities.
• AYUSH doctors should support implementation of national health
programmes.
• Locally available medicinal herbs plants should be grown around the
PHC

19. Selected Surgical Procedures: Desirable:
The vasectomy , tubectomy, MTP, hydrocelectomy, and cataract
surgeries as a camp/ fixed day approach have to be carried out in
the PHC having facilities of OT. During all these surgical
procedures universal precautions will be adopted to ensure
infection prevention.
20. Record of vital statistics and reporting:
Recording and reporting of vital statistics including births and
deaths.
Maintenance of all the relevant records concerning services
provided in the PHC.
21. Maternal death review
Desirable:
Facility based MDR, shall be conducted at the PHC.

 The community health centers provide secondary level
of health care in rural health services. These were
designed to provide referral as well as specialist health
care to the rural population. In order to provide quality
care in these CHCs , IPHS are prescribed
COMMUNITY HEALTH CENTERS

 CHC is established to cover 1,20,000 population in the plains and
80,000 population in hilly and tribal areas. Community health
center is established in each community development block.
 Each CHC has 30 beds, an X ray room , a delivery room, OT and
laboratory. This works as a referral center for 4 PHCs.
SET UP

 Doctors -04 (Paediatrics, Gynaecologists, Physician, Surgeon)
 Nurses -07
 Dresser -01
 Pharamcist -01
 Lab Assistant- 01
 Radiographer -01
 Ward Boy- 02
 Sweepers- 03
 Dhobi- 01
 Mali- 01
 Chowkidar-01
 Ayah-01
 Class IV worker- 01
 Total- 25
STAFFING NORMS

 Specialty services
 Surgical services
 Medical services
 Maternal health services
 Newborn care and child health services
 Family planning services
 National health programmes
 Other services: school health, adolescent health,
outreach services, blood storage, diagnostics, referral,
MDR, record of vital statistics.
FUNCTIONS OF CHC

 IPHS for CHC are being formulated to provide optimal
specialist care to the community and achieve and maintain
an acceptable standard quality of care. It is hoped that
these standards would help to monitor and improve the
functioning of CHC’S. According to IPHS, facilities and
human resource management at CHC. According to IPHS,
facilities and human resource management at CHC would
be improved and accountability will be shared by
community.
 It is mandatory for every CHC to have Rogi Kalyan Samiti
to ensure accountability. Every CHC shall also have the
charter of Patient’s rights displayed at the entrance. A
grievance redressal mechanism under the overall
supervision of RKS would also be set up.
IPHS FOR CHC’S

 To provide optimal expert care to the community.
 To achieve and maintain an acceptable standard of
quality of care
 To ensure that services at CHC are appropriate with
universal best practices and are responsive and sensitive
to the clients needs and expectations.
OBJECTIVES OF IPHS FOR CHC’S

1. Care of routine and emergency cases in surgery
Essential:
a. This includes dressings, incision and drainage and
surgery for hernia, hydrocele, appendicitis,
haemorrhoids, fistula and stitching of injuries
b. Handling of emergencies like intestinal obstruction,
haemorrahage
c. Other management including nasal packing,
tracheostomy, foreign body removal
d. Fracture reduction and putting splint/plast cast
e. Conducting daily OPD
SERVICES TO BE PROVIDED AT THE CHC

2. Care of routine and emergency cases in medicine
Essential:
a. Specific mention is being made of handling of all
emergencies like dengue, haemorrhagic fever, cerebral
malaria and others like snake bite cases, poisoning,
congestive heart failure, left ventricular failure,
pneumonias, acute respiratory conditions, burns, shock
and acute dehydration.
b. In case of national health programmes appropriate
guidelines should be followed.
c. Conducting daily OPD.

3. Maternal health:
Essential:
a. Minimum 4 ANC including registration: Ist visit- within 12
weeks, 2nd week- between 14 and 26 week, 3rd week- between
28- 34 weeks, 4th visit- between 36 weeks and term.
b. 24 hour delivery service including normal and assisted
deliveries. Managing labour using partograph.
c. All referred cases of complications in pregnancy, labour and
post natal period must be adequately treated
d. Ensure post natal care for 0 and 3rd day at the health facility
both for the mother and newborn and sending direction to the
ANM of the concerned area for ensuring 7th and 42nd day post
natal home visits.
e. Minimum 48 hours of stay after delivery, 3-7 days stay post
delivery for managing complications.

 F. Proficiency in identification and management of all complications
including PPH, eclampsia, sepsis etc. during PNC.
 G. Essential and emergency obstetric care including surgical
interventions.
 H. providing JSY and JSK as per guidelines.
4. Newborn care and Child Health:
Essential:
a. Essential newborn care and resuscitation by providing newborn corner
in the labour room and operation theatre.
b. Early initiation of breast feeding within one hour of birth and
promotion of exclusive breast feeding for 6 months.
c. New born stabilization unit
d. Counseling on infant and young child feeding as per IMNCI
guidelines.
e. Routine and emergency care of sick children including facility based
IMNCI strategy.
f. Full immunization of infants and children against vaccine preventable
diseases and vitamin A prophylaxis.

g. Prevention and management of routine childhood diseases,
infections and anemia.
h. Management of malnutrition cases.
i. Provision of JSSK as per guidelines.
5.Family planning
Essential:
a. Full range of family planning services including IEC,
counseling, provision of contraceptives, NSV, Laparoscopic
sterilization services and their follow up.
b. Safe abortion services as per MTP act
Desirable:
MTP facility approved for 2nd trimester of pregnancy

6. National health programmes
a. RNTCP: should provide diagnostic services through established
diagnostic services through the microscopy centers which are
already established in the CHCs and treatment services as per the
technical guidelines and operational guidelines for tuberculosis
control.
b. HIV/AIDS control programme: ICTC, blood storage center, STI
clinic.
c. NVBDCP: The CHC are to provide diagnostic /linkages to diagnosis
and treatment facilities for routine and complicated cases of
malaria, filaria, dengue, JE, kala azar in the respective endemic
zones.
d. NLEP: diagnosis and treatment of cases and complications including
reactions of leprosy along with counseling of patients on prevention
of deformity and cases of uncomplicated ulcers.

 E. NPCB: Vision testing with vision charts. Refraction. Early
detection of visual impairments and their referral. IEC activities.
 Desirable: removal of foreign bodies, diagnosis and treatment of
common eye diseases. Surgical services including catract by IOL
implantations.
 F. IDSP: CHC will function as a peripheral unit and collate,
analyse and report information to district surveillance
 G. NPPCD: early detection of cases of hearing impairment and
deafness and referral. Provision of basic diagnosis and treatment
services for common ear diseases. IEC strategies.
 H. NMHP: Early identification, diagnosis and treatment of common
mental disorders. IEC activities for prevention, removal of stigma
and early detection of mental disorders. Follow up care of detected
cases who are on treatment.

 I NPCDCS:
 Cancer control:
Essential: a. Early detection and referral of suspected cancer cases
b. Screening for cervical, breast and oral cancers
c. Education about BSE
d. PAP smear for cancer cervix
Desirable: a. Basic equipment such as indirect laryngoscope, punch biopsy
forceps and consumable for early cancer detection.
b. PPP for lab investigations and confirmation of diagnosis with early
warning signals.
Diabetes, CVD and strokes
Desirable:
a. Early detection: Survey of people through simple measures as history,
checking blood sugar.
b. Health promotion, focus will be on health preservation.

 C. Modify individual, group and community behavior through
interventions like- promotion of healthy dietary habits, promotion
of physical activity, avoidance of tobacco and alcohol, stress
management.
 D. Treatment and timely referral (complicated cases)of DM, HTN,
IHD, CHF. Assured investigations: urine albumin and sugar, blood
sugar, blood lipid profile, KFT, ECG
 J. National IDD programme: IEC activities in the form of posters,
pamphlets, interpersonal communication to promote the
consumption of iodized salt through salt testing kits.
 K. National programme for prevention and control of fluorosis:
Essential: clinical examination and preliminary diagnostic parameters
assessment for cases of fluorosis if facilities are available.

 Monitoring of village /community level fluorosis surveillance and
IEC activities. Referral services.
 L. National tobacco control programme:
Essential:
Health education and IEC activities regarding harmful effects of
tobacco and second hand smoke. Promoting quitting of tobacco in the
community and offering brief advice to all smokers and tobacco users.
Making the premises of CHC tobacco free and display of mandatory
signs.
Desirable : setting up tobacco cessation clinic.
M. National programme for health care of elderly:
Desirable: medical rehabilitation services. Compilation of elderly data
from PHC and forwarding the same to district nodal officers.
Visits to the homes of the disabled/ bed ridden persons by rehabilitation
workers on receiving information from PHC/ Sub center
Geriatric clinic- twice a week.

 N. Physical medical and rehabilitation
 Essential: primary prevention of disabilities. Screening
early identification and detection. Counseling. Issue of
disability certificate for obvious disabilities by CHC
doctors based rehabilitation services.
 Desirable: basic treatment like exercises and heat
therapy, ROM exercises , cervical and lumbar traction,
referral to high centers and follow up.
 O. Oral health:
 Dental care and dental health education services as well
as root canal treatment and filling/ extraction of routine
and emergency cases. Oral health education

 7. Other services:
 A. School health: Teachers screen students on a continuous basis
and ANMs/HWMs visit the schools for screening, treatment of
minor ailments and referral. Doctors from CHC/PHC will also visit
one school per week. Main services include-
 Essential: Health service provision: Screening health care and
referral- screening of general health, assessment of anemia/
nutritional status, visual and hearing problems, dental check up
physical disabilities , heart problems, skin conditions, learning and
behavior disorders. Basic medicines for common ailments.
Referral cards for sub district or district hospitals.
 Immunization: As per national schedule. Fixed day activity.
 Micronutrient (vit A and IFA) management
 De- worming: biannually supervised schedule. IEC. Siblings of
students to be covered.
 Capacity building
 Monitoring and evaluation
 Mid day meal

 Desirable: health promoting schools- counseling services. Regular
practice of yoga, physical and health education. Linkage with the out
of school children. Health clubs/ cabinets. First aid room/ corners or
clinics.
 B. Adolescent health care: to be provided preferably through
adolescent friendly clinic for 2 hours once a week on a fixed day.
Services should be comprehensive.
 Essential: adolescent and reproductive health information counseling
and services related to sexual concern, pregnancy, contraception,
abortion, menstrual problems. Tetanus immunization. Nutritional
counseling , prevention and management of nutritional anemia.
STI/RTI management. Referral services, PPTCT services. Safe
termination of pregnancy if not available at PHC. Additional services
as per local needs.

 Outreach services in schools and community camps:
provide health check ups and health education
activities, awareness generation and co curricular
activities.
 C. Blood storage facility.
 D. Diagnostic Services: in addition to lab facilities and
x-ray, ECG should be made available in the CHC with
appropriate training to a nursing staff. All necessary
reagents glassware and facilities for collecting and
transport of samples.
 E. referral services
 Maternal death review.

Personnel Essential Qualification
Block public health unit
Block medical officer/
medical superintendent
01 Senior most specialist/ GDMO preferably
with experience in public health
Public health specialist 01 MD(PSM)/MD/MD community medicine
or PG with MBA/DPH/MPH
PHN 01
Desirable- +01
Specialty Services
General Surgeon 01 MS/DNB (General surgery)
Physician 01 MS/DNB (General medicine)
Obstetrician and
Gynecologist
01 DGO/MD/DNB
Paediatrician 01 DCH/MD Paediatrics/DNB
Anaesthetist 01 MD (Anesthesia)/DNB/DA/LSAS trained MO
STAFFING PATTERN

Personnel Essential Qualifications
General Duty officer
Dental surgeon 01 BDS
General duty MO 02 MBBS
MO-AYUSH 01 Graduate in AYUSH
Nurses and paramedicals
Staff Nurse 10
Pharmacist 1, +1 desirable
Pharmacist –AYUSH 01
Lab technician 02
Radiographer 01
Dietician +1 desirable
Ophthalmic assistant 01

Dental assistant 01
Cold chain and vaccine logistic assistant 01
OT technician 01
Community based rehabilitation worker 01, +1 desirable
Counselor 01
Administrative staff
Registration clerk 02
DEO 02
Account assistant 01
Administrative assistant 01
Group D Staff
Dresser 01
Ward boys 05
Driver 01, 3 desirable Total 46, 52- desirable

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