3. Framework of Healthcare System in India
The fundamental rights guaranteed to all citizens by our
constitution are –
1) Right to Equality
2) Right to Freedom
3) Right against Exploitation
4) Right to Freedom of Religion
5) Cultural and Educational Rights
6) Right to Constitutional Remedies
Health as a Fundamental Right.
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6. Norms for Rural Healthcare Infrastructure
Level Functionaries Norms
Village VHG, ASHA, Trained Birth Attendant
(TBA), AWWa
1 for every village
Subcenter
(SC)
Health workers (male and female)
[HW (M) and HW (F)] one each
1 per 5,000 population (3,000 in
hilly and tribal areas)
PHC MO, nurses, and auxiliary HWs 1 per 30,000 population (20,000 in
hilly and tribal areas)
Community
health
center
MO, surgeon, physician, obstetrics
and gynecologist, anesthesiologist,
pediatrician, nurses and auxiliary
HWs
1 per 120,000 population (80,000
in hilly and tribal areas)
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7. Assured Services to be provided by a
Subcentre
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“Assured Services” mean the minimum required services which must be
provided by a healthcare establishment. The concept has grown in
importance ever since the IPHS have been introduced in our healthcare
system:
MCH
— Antenatal care (ANC): Registration for ANC, at least three antenatal (AN)
checks (first check as soon as possible after pregnancy but definitely within
26 weeks, second at 32 weeks, and third at 36 weeks), hemoglobin %,
urine sugar and albumin, send blood for grouping at PHC, iron and folic
acid (IFA) tablets, tetanus toxoid (TT) injection, identification of complicated
cases, and prompt identification/referral of high-risk pregnancies, malaria
prophylaxis in affected areas, education about pregnancy, childbirth, and
child care.
— Intra-natal care: Promotion of institutional delivery or provision of skilled
birth attendance at home.
— Postnatal care (PNC): Minimum of two PNC visits, the first within 48 hours
and the second between 7th and 10th day of birth. Institution of early
breast feeding within half an hour.
8. Assured Services to be provided by a
Subcentre
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MCH (Contd)
— Child care: Complete immunization as per the Universal
Immunization Programme; Vitamin A at 9, 18, 24, 30, and 36
months; control and management of childhood diseases,
especially diarrheas; acute respiratory infections (ARIs); fever;
and malnutrition.
— FM planning: Provision of all conventional contraceptives,
intrauterine device (IUD) insertion (if ANM is trained); referral
for safe medical termination of pregnancy (MTP).
— School health: School health examination, counseling, and
syndromic identification of sexually transmitted infections (STIs)
among adolescents.
9. Assured Services to be provided by a
Subcentre
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Control of locally endemic diseases, with particular emphasis on
malaria and other vector-borne diseases, tuberculosis, malaria, and
filariasis.
Hygiene and sanitation. Disinfection (chlorination) of public water
supplies (including wells); promotion of sanitation, especially for use
of latrines.
Participation in national health programs, particularly, National
Vector Borne Disease Control Programme, Revised National
Tuberculosis Control Program (RNTCP), National AIDS Control
Programme, National Leprosy Eradication Programme, National
Blindness Control Programme, and Integrated Disease Surveillance
Programme.
Curative services: For common and locally endemic diseases and
first aid in injuries.
Recording of vital events: Recording of births and deaths,
especially among mothers and children, and record of eligible
couples.
10. Drug Kits available at subcentre
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• Kit ‘A’ Kit ‘B’
Name of the Item Quantity
Oral rehydration
salt
150 packets
Tablet IFA (large) 15,000 tablets
Tablet IFA (small) 13,000 tablets
Vitamin A
solution
6 bottles of 100
ml each
Tablet Co-
trimoxazole
(pediatric)
1,000 tablets
Name of the Item Quantity
Tablets methylergometrine maleate
(0.125 mg)
500 tablets
Tablets paracetamol (500 mg) 500 tablets
Injection methylergometrine maleate 10 ampoules
Tablets mebendazole (100 mg) 300 tablets
Dicyclomine HCl (10 mg) 250 tablets
Chloramphenicol eye ointment (1%
w/w) in applicaps
500 applicap
Ointment povidone iodine (5%) 5 tubes
Cetrimide powder 125 g
Absorbent cotton 1 roll
Cotton bandage (4 cm width) 120 rolls
11. Drug Kits available at subcentre
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Kit “C”: This kit contains the detailed list of various medical and
surgical equipment, instruments, and reagents required to be available
at SC.
Additional drugs for use as skilled birth attendant by ANM/LHV:
This contains injections of gentamycin, magnesium sulfate, and
oxytocin; cap ampicillin; and tablets of metronidazole and misoprostol.
Kit for vaccines and other pediatric drugs: This contains vaccines
(BCG, DPT/Pentavalent, oral poliovirus vaccine, TT, and hepatitis B [if
being given]); syrups co-trimoxazole and paracetamol; tablet co-
trimoxazole; adhesive plaster; and antiseptics (povidone iodine 5%
and Savlon).
Kit of drugs related to various national health programs:
Chloroquine tablet and syp; Paracetamol tablet and syp; Primaquine
tablet 2.5 and 7.5 mg; tablet Diethylcarbamazine (in filarial endemic
areas); reference design kit for malaria; multidrug therapy for leprosy
patients; antitubercular treatment (if established for a directly observed
treatment center).
Kit of contraceptives: Contains Nirodh, oral pills, Copper-T (380-A),
and emergency obstetric care.
15. Objectives of IPHS for HWC-SHC and
UHWC
The broad objectives of the Indian Public Health Standards (IPHS) for
HWC-SHC and UHWCs include the following:
1. To define uniform benchmark to ensure high quality services that are
accountable, responsive, and sensitive to the needs of the
community.
2. To specify the minimum assured (essential) and achievable (desirable)
services that are expected to be provided at different levels of public
health facilities.
3. To provide guidance on health systems strengthening components
which includes architectural design of facilities, human resources for
health, drugs, diagnostics, equipment, administrative and logistical
support services to improve the overall health related outcomes
16. Objectives of IPHS for HWC-SHC and UHWC
4. To achieve and maintain an acceptable standard of quality of care at
public health facilities
5. To facilitate monitoring and supervision of the facilities
6. To provide guidance and tools for governance, leadership and
evaluation.
17. Types/Categories of
HWCs
In comparison with the IPHS guidelines of 2012, the
revised IPHS 2022 guidelines classify the HWCs as:
1. Health and Wellness Centres - Primary Health Centre:
a) HWC-PHC in rural areas
b) HWC- UPHC in urban areas
2. Health and Wellness Centres - Sub Health Centre:
a) Health and Wellness Centre - Sub Health Centre in
rural areas
b) Urban Health & Wellness Centre in urban areas
19. Services
The healthcare services to be provided at these
Centres include:
1. Health promotion,
2. Early identification,
3. Ensuring treatment adherence,
4. Follow-up care,
5. Ensuring continuity of care by appropriate referrals,
optimal home and community follow-up,
6. Disease surveillance,
7. Health promotion and prevention for the
8. Expanded range of CPHC services.
20. The 12 packages envisaged under
CPHC are:
1. Care in Pregnancy and Childbirth.
2. Neonatal and Infant Health Care Services
3. Childhood and Adolescent Health Care Services.
4. Family Planning, Contraceptive Services and other
Reproductive Health Care Services
5. Management of Communicable Diseases: National
Health Programme
6. Management of Common communicable diseases
and outpatient care for acute simple illness and
minor ailments
21. 7. Screening, Prevention, Control and Management
of Non-communicable Diseases
8. Care for Common Ophthalmic and ENT Problems
9. Basic Oral Health Care
10. Elderly and Palliative Health Care Services
11. Emergency Medical Services including Burns
and Trauma
12. Screening and Basic Management of Mental
Health Ailments
The twelve packages envisaged under
CPHC are:
27. Health & Wellness Centres (HWC):
Community Health Officer (CHO)
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The HWC – SHC (Rural areas) will be headed by a
Community Health Officer (CHO).
He / she will be a Doctor from the Indian system of Medicine
(BAMS / BUMS) or a BSc (Nursing) qualified nurse
AND will be additionally trained at designated medical
colleges for 6 months in selected aspects of community
health care.
The CHO would carry out public health functions, ambulatory
care, management and provide leadership at the HWC-SHC.
28. Duties of Community Health Officer (CHO)
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1) Ensure that all households in the service area are listed,
empanelled and a database is maintained
2) Provide clinical care as specified in the care pathways and
standard treatment guidelines.
3) Clinical care provision would include coordinating for care/
case management for chronic illnesses based on the
diagnosis and treatment plan made by the Medical
Officer/specialists and dispense drugs as per standing
orders by the medical officer.
4) Focus attention in screening for chronic conditions. Such
chronic conditions would include both non -communicable
diseases and chronic communicable diseases of
tuberculosis, leprosy and HIV.
29. Duties of Community Health Officer (CHO)
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4) Coordinate and lead local response to diseases outbreaks,
emergencies and disaster situations.
5) Support the team of MPWs and ASHAs in their tasks,
including on the job mentoring, and administrative functions
of the HWC.
6) Support and supervise collection of population-based data
by frontline workers to understand key causes of mortality,
morbidity with focus on vulnerable communities.
30. Services to be provided at HWC
Care in Pregnancy and Childbirth.
Neonatal and Infant Health Care
Services
Childhood and Adolescent Health
Care Services.
Family Planning, Contraceptive
Services and other Reproductive
Health Care Services
Management of Communicable
Diseases: National Health
Programme
Management of Common
communicable diseases and
outpatient care for acute simple
illness and minor ailments
Screening, Prevention, Control
and Management of Non-
communicable Diseases
Care for Common Ophthalmic
and ENT Problems
Basic Oral Health Care
Elderly and Palliative Health
Care Services
Emergency Medical Services
including Burns and Trauma
Screening and Basic
Management of Mental Health
Ailments
Yoga
Telemedicine consultation
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31. Diagnostic Services to be provided at HWC
• Hemoglobin
• Urine test using Dipstik
• Blood Sugar (using Strip)
• Malaria test (using RDK)
• HIV (Rapid Test)
• Dengue (Rapid test kits
• Cervical Cancer (using
VIA method)
• Iodine in salt
• Water testing for fecal
contamination and
chlorination (Field Kit)
• HbsAg test for Hep B (
• Microfilaria for lymphatic
Filariasis
• Syphilis
• Sputum for AFB
• other tests : tests for Sickle
cell and Thalassemia.
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