guidelines phc 2012

8/20/2019 Guidelines PHC 2012

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Indian Public Health Standards (IPHS)Guidelines for

Primary Health CentresRevised 2012

Directorate General of Health ServicesMinistry of Health & Family Welfare

Government of India


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Indian Public Health Standards IPHSGuidelines for

Primary Health Centres

Revised 2012

Directorate General of Health ServicesMinistry of Health & Family Welfare

Government of India


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CONTENTS

Message v

Foreword vi

Preface vii

Acknowledgements viii

Execuve Summary 1

Indian Public Health Standards for Primary Health Centres 3

Introducon ....................................................................................................................................................... 3

Objecves of Indian Public Health Standards (IPHS) for Primar Health Centres (PHC)....................................4

Services at the Primar Health Centre for Meeng the IPHS ............................................................................. 4

Infrastructure ..................................................................................................................................................12

Manpower ....................................................................................................................................................... 16

Drugs ............................................................................................................................................................... 17

The Transport Facilies with Assured Referral Linkages .................................................................................17

Laundr Services .............................................................................................................................................. 17

Dietar Facilies for Indoor Paents ...............................................................................................................17

Waste Management at PHC Level ...................................................................................................................17

Qualit Assurance ............................................................................................................................................ 17

Monitoring of PHC Funconing ....................................................................................................................... 18

Accountabilit ................................................................................................................................................. 18

Statuar and Regulator Compliance .............................................................................................................. 18

Annexures

Anneure 1: Naonal Immunizaon Schedule for Infants, Children and Pregnant Women .................19

Anneure 2: Laout of PHC .................................................................................................................... 21

Anneure 2A: Laout of Operaon Theatre ............................................................................................22


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Anneure 3: List of Suggested Equipment and Furniture Including Reagents and Diagnosc Kits .......23

Anneure 3A: Newborn Corner in Labour Room/OT ...............................................................................27

Anneure 4: Essenal Drugs for PHC .....................................................................................................29

Anneure 5: Universal Precauons ...................................................................................................... 45

Anneure 6: Check List for Monitoring b Eternal Mechanism ..........................................................46

Anneure 7: Job Responsibilies of Medical Ocer and Other Sta at PHC .......................................49

Anneure 8: Charter of Paents’ Rights for Primar Health Centre ...................................................... 63

Anneure 9: Proforma for Facilit Surve for PHC on IPHS ...................................................................64

Anneure 10: Facilit Based Maternal Death Review Form ....................................................................73

Anneure 11: Integrated Disease Surveillance Project Formats .............................................................77

Anneure 11A: Form P Weekl Reporng Format - IDSP ........................................................................... 78

Anneure 11B: Form L Weekl Reporng Format - IDSP ........................................................................... 79

Anneure 11C: Format for instantaneous reporng of Earl Warning Signals/Outbreaks

as soon as it is detected ..................................................................................................... 80

Anneure 12: List of Statutor and Regulator Compliances .................................................................. 81

Anneure 13: List of Abbreviaons .........................................................................................................82

References 84

Members of Task Force for Revision of IPHS 85


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Naonal Rural Health Mission (NRHM) was launched to strengthen the Rural Public Health

Sstem and has since met man hopes and epectaons. The Mission seeks to provide eecvehealth care to the rural populace throughout the countr with special focus on the States and

Union Territories (UTs), which have weak public health indicators and/or weak infrastructure.

Towards this end, the Indian Public Health Standards (IPHS) for Sub-Centres, Primar Health

Centres (PHCs), Communit Health Centres (CHCs), Sub-District and District Hospitals were

published in Januar/Februar, 2007 and have been used as the reference point for public health

care infrastructure planning and up-gradaon in the States and UTs. IPHS are a set of uniform standards envisaged

to improve the qualit of health care deliver in the countr.

The IPHS documents have been revised keeping in view the changing protocols of the eisng programmes and

introducon of new programmes especiall for Non-Communicable Diseases. Fleibilit is allowed to suit the

diverse needs of the states and regions.

Our countr has a large number of public health instuons in rural areas from sub-centres at the most peripheral

level to the district hospitals at the district level. It is highl desirable that the should be full funconal and deliver

qualit care. I strongl believe that these IPHS guidelines will act as the main driver for connuous improvement in

qualit and serve as the bench mark for assessing the funconal status of health facilies.

I call upon all States and UTs to adopt these IPHS guidelines for strengthening the Public Health Care Instuons

and put in their best eorts to achieve high qualit of health care for our people across the countr.

New Delhi

23.11.2011

(Ghulam Nabi Azad)

MESSAGE


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As envisaged under Naonal Rural Health Mission (NRHM), the public health instuons in rural

areas are to be upgraded from its present level to a level of a set of standards called “Indian

Public Health Standards (IPHS)”. The Indian Public Health Standards are the benchmarks for

qualit epected from various components of Public health care organizaons and ma be used

for assessing performance of health care deliver sstem.

As earl as 1951, the Primar Health Centres (PHCs) were established as an integral part of

communit development programme. Since then lot of changes have taken place. Currentl the

PHC covers a populaon of 20,000-30,000 (depending upon the geographical locaon) and is

occuping a place between a Sub-Centre at the most peripheral level and Communit Health Centre at block

level.

As seng standards is a dnamic process, need was felt to update the IPHS keeping in view the changing protocols

of eisng Naonal Health Programmes, introducon of new programmes especiall for Non-Communicable

Diseases and prevailing epidemiological situaon in the countr. The IPHS for PHC has been revised b a task

force comprising of various stakeholders under the Chairmanship of Director General of Health Services. Subject

eperts, NGOs, State representaves and health workers working in the health facilies have also been consulted

at dierent stages of revision.

The newl revised IPHS for PHC has considered the services, infrastructure, manpower, equipment and drugs into

two categories of Essenal (minimum assured services) and Desirable (the ideal level services which the states and

Union Territories (UTs) shall tr to achieve). PHCs have been categorized into two categories depending upon the

case load of deliveries. This has been done to ensure opmal ulizaon of resources. Sates/UTs are epected to

categorize the PHCs and provide infrastructure according to the laid down guidelines in this document.

I am sure this document will help the States Governments and Panchaa Raj Instuons to monitor eecvel as

to how man of the PHCs are conforming to IPHS and take measures to upgrade the remaining to desired level.

I would like to acknowledge the eorts put b the Directorate General of Health Services in preparing the guidelines.

Comments and suggesons for further improvement are most welcome.

(P.K.Pradhan)

FOREWORD


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PREFACE

Standards are a means of describing a level of qualit that the health care organizaons are

epected to meet or aspire to achieve. For the rst me under Naonal Rural Health Mission

(NRHM), an eort had been made to develop Indian Public Health Standards (IPHS) for a vast

network of peripheral public health instuons in the countr and the rst set of standards was

released in earl 2007.

A Primar Health Centre (PHC) serves as a rst port of call to a qualied doctor in the public

health sector in rural areas providing a range of curave, promove and prevenve health care.

A PHC providing 24-hour services and with appropriate linkages, plas an important role in increasing instuonal

deliveries thereb helping to reduce maternal mortalit and infant mortalit.

The IPHS for Primar Health Centres has been revised keeping in view the resources available with respect to

funconal requirements of Primar Health Centre with minimum standards for such as building, manpower,

instruments and equipment, drugs and other facilies etc. The revised IPHS has also incorporated the changed

protocols of the eisng health programmes and new programmes and iniaves especiall in respect of Non-

Communicable Diseases. The task of revision was completed as a result of consultaons held over man months

with task force members, programme ocers, Regional Directors of Health and Famil Welfare, eperts, healthfunconaries, representaves of Non-Government organizaons, development partners and State/Union Territor

Government representaves aer reaching a consensus. The contribuon of all of them is well appreciated. Several

innovave approaches have been incorporated in the management process to ensure communit and Panchaa

Raj Instuons’ involvement and accountabilit.

From Service deliver angle, PHCs ma be of two tpes depending upon the deliver case load – Tpe A and Tpe

B. The PHCs with deliver case load of less than 20 deliveries in a month will be of Tpe A and those with deliver

case load of 20 or more in a month will be of Tpe B. This has been done to ensure opmal ulizaon of manpower

and resources.

Seng standards is a dnamic process and this document is not an end in itself. Further revision of the standards

shall be undertaken as and when the Primar Health Centres will achieve a minimum funconal grade. It is hopedthat this document will be of immense help to the States/Union Territories and other stakeholders in bringing up

Primar Health Centres to the level of Indian Public Health Standards.

(Dr. Jagdish Prasad)


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Indian Public Health Standards (IPHS) Guidelines for PRIMARy HEALTH CENTRES viii

ACKNOWLEDGEMENTS

The revision of the eisng guidelines for Indian Public Health Standards (IPHS) for dierent levels of Health Facilies

from Sub-Centre to District Hospitals was started with the formaon of a Task Force under the Chairmanship of

Director General of Health Services (DGHS). This revised document is a concerted eort made possible b the advice,

assistance and cooperaon of man individuals, Instuons, government and non-government organizaons.

I gratefull acknowledge the valuable contribuon of all the members of the Task Force constuted to revise Indian

Public Health Standards (IPHS). The list of Task Force Members is given at the end of this document. I am thankful

to them individuall and collecvel.

I am trul grateful to Mr. P.K. Pradhan, Secretar (H & FW) for the acve encouragement received from him.

I also gratefull acknowledge the iniave, inspiraon and valuable guidance provided b

Dr. Jagdish Prasad, Director General of Health Services, Ministr of Health and Famil Welfare, Government of

India. He has also etensivel reviewed the document while it was being developed.

I sincerel acknowledge the contribuon of Dr. R.K Srivastava, E- DGHS and Chairman of Task Force constuted for

revision of IPHS who has etensivel reviewed the document at ever step, while it was being developed.

I sincerel thank Miss K. Sujatha Rao, E-Secretar (H&FW) for her valuable contribuon and guidance

in raonalizing the manpower requirements for Health Facilies. I would speciall like to thank

Ms. Anuradha Gupta, Addional Secretar and Mission Director NRHM, Mr. Manoj Jhalani Joint Secretar

(RCH), Mr. Amit Mohan Prasad, Joint Secretar (NRHM), Dr. R.S. Shukla Joint Secratar (PH), Dr. Shiv

Lal, former Special DG and Advisor (Public Health), Dr. Ashok Kumar, DDG Dr. N.S. Dharm Shaktu, DDG,

Dr. C.M. Agrawal DDG, Dr. P.L. Joshi former DDG, eperts from NHSRC namel Dr. T. Sunderraman,

Dr. J.N. Sahai, Dr. P. Padmanabhan, Dr. J.N. Srivastava, eperts from NCDC Dr. R.L. Ichhpujani, Dr. A.C. Dhariwal,

Dr. Shashi Khare, Dr. S.D. Khaparde, Dr. Sunil Gupta, Dr. R.S. Gupta, eperts from NIHFW Prof. B. Deoki Nandan,

Prof. K. Kalaivani, Prof. M. Bhaachara, Prof. J.K. Dass, Dr. Vivekadish, programme ocers from Ministr of

Health Famil welfare and Directorate General of Health Services especiall Dr. Himanshu Bhushan, Dr. ManishaMalhotra, Dr. B. Kishore, Dr. Jagdish Kaur, Dr. D.M. Thorat and Dr. Sajjan Singh yadav for their valuable contribuon

and guidance in formulang the IPHS documents.

I am grateful to the following State level administrators, health funconaries working in the health facilies and

NGO representaves who shared their eld eperience and greatl contributed in the revision work; namel:

Dr. Manohar Agnani, MD NRHM from Government of MP Dr. Junaid Rehman from Government of Kerala.


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Indian Public Health Standards (IPHS) Guidelines for PRIMARy HEALTH CENTRES ix

Dr. Kamlesh Kumar Jain from Government of Chhasgarh.

Dr. y.K. Gupta, Dr. Kiran Malik, Dr. Avdesh Kumar, Dr. Naresh Kumar, Smt. Prabha Devi Panwar, ANM and

Ms. Pushpa Devi, ANM from Government of Uar Pradesh.

Dr. P.N.S. Chauhan, Dr. Jaashree Chandra, Dr. S.A.S. Kazmi, Dr. L.B. Asthana, Dr. R.P. Maheshwari, Dr. (Mrs.) Pushpa

Gupta, Dr. Ramesh Makwana and Dr. (Mrs.) Bhusan Shrivastava from Government of Madha Pradesh.

Dr. R.S. Gupta, Dr. S.K. Gupta, Ms. Mamta Devi, ANM and Ms. Sangeeta Sharma, ANM from Government of

Rajasthan.

Dr. Rajesh Bali from Government of Harana.

NGO representaves: Dr. P.K. Jain from RK Mission and Dr. Sunita Abraham from Chrisan Medical Associaon of

India.

Tmt. C. Chandra, Village Health Nurse, and Tmt. K. Geetha, Village Health Nurse from Government of Tamil Nadu.

I epress m sincere thanks to Architects of Central Design Bureau namel Sh. S. Majumdar, Dr. Chandrashekhar,

Sh. Sridhar and Sh. M. Bajpai for providing inputs in respect of phsical infrastructure and building norms.

I am also etremel grateful to Regional Directors of Health and Famil Welfare, State Health Secretaries, State

Mission directors and State Directors of Health Services for their feedback.

I shall be failing in m dut if I do not thank Dr. P.K. Prabhakar, Deput Commissioner, Ministr of Health and Famil

Welfare for providing suggesons and support at ever stage of revision of this document.

Last but not the least the assistance provided b m secretarial sta and the team at Macro Graphics Pvt. Ltd. is

dul acknowledged.

(Dr. Anil Kumar)

Member Secretar-Task force

CMO (NFSG)

Directorate General of Health ServicesJune 2012 Ministr of Health & Famil Welfare

New Delhi Government of India


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Indian Public Health Standards (IPHS) Guidelines for PRIMARy HEALTH CENTRES 1

ExECUTIVE SUMMARy

Primar Health Centre is the cornerstone of rural

health services- a first port of call to a qualified

doctor of the public sector in rural areas for thesick and those who directl report or referred from

Sub-Centres for curative, preventive and promotive

health care.

A tpical Primar Health Centre covers a populaon

of 20,000 in hill, tribal, or dicult areas and 30,000

populaons in plain areas with 6 indoor/observaon

beds. It acts as a referral unit for 6 Sub-Centres and

refer out cases to CHC (30 bedded hospital) and higher

order public hospitals located at sub-district and

district level. However, as the populaon densit in

the countr is not uniform, the number of PHCs would

depend upon the case load. PHCs should become a

24 hour facilit with nursing facilies. Select PHCs,

especiall in large blocks where the CHC/FRU is over

one hour of journe me awa, ma be upgraded to

provide 24 hour emergenc hospital care for a number

of condions b increasing number of Medical Ocers,

preferabl such PHCs should have the same IPHS norms

as for a CHC.

Standards are the main driver for connuous

improvements in qualit. The performance of PrimarHealth Centres can be assessed against the set

standards. Seng standards is a dnamic process.

Currentl the IPHS for Primar Health Centres has

been revised keeping in view the resources available

with respect to funconal requirements of Primar

Health Centre with minimum standards such as

building, manpower, instruments and equipment,

drugs and other facilies etc. The revised IPHS has

incorporated the changed protocols of the eisnghealth programmes and new programmes and

iniaves especiall in respect of Non-communicable

diseases.

The overall objecve of IPHS for PHC is to provide

health care that is qualit oriented and sensive to

the needs of the communit. These standards would

also help monitor and improve the funconing of the

PHCs.

Service DeliverFrom Service deliver angle, PHCs ma be of twotpes, depending upon the deliver case load –

Tpe A and Type B.

Type A PHC: PHC with deliver load of less than

20 deliveries in a month,

Type B PHC: PHC with deliver load of 20 or more

deliveries in a month

All “Minimum Assured Services” or Essenal

Services as envisaged in the PHC should be

available. The services which are indicated asDesirable are for the purpose that we should

aspire to achieve for this level of facilit.

Appropriate guidelines for each Naonal

Programme for management of roune

and emergenc cases are being provided to the

PHC.


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Indian Public Health Standards (IPHS) Guidelines for PRIMARy HEALTH CENTRES2

Minimum Requirement forDeliver of the Above-menonedServices

The following requirements are being projected based

on case load of 40 paents per doctor per da, the

epected number of beneciaries for maternal andchild health care and famil planning and about 60%

ulizaon of the available indoor/observaon beds (6

beds). Besides one MBBS medical ocer, one AyUSH

medical ocer (desirable) has been provided to provided

choices to the people, wherever an AyUSH public

facilit is not available in the near vicinit. Manpower

has been raonalized. For Tpe B PHCs, addional sta

in the from of one MBBS medical ocer (desirable) one

Sta Nurse and one sanitar worker cum watchman

have been provided have been provided to take careof addional deliver case load. It would be a dnamic

process in the sense that if the ulizaon goes up, the

standards would be further upgraded.

Facilies

The document includes a suggested laout of PHC

indicang the space for the building and otherinfrastructure facilies. A list of manpower, equipment,

furniture and drugs needed for providing the assured

and desirable services at the PHC has been incorporated

in the document. A Charter of Paents’ Rights for

appropriate informaon to the beneciaries, grievance

redressal and constuon of Rogi Kalan Sami/

Primar Health Centre Management Commiee for

beer management and improvement of PHC services

with involvement of Panchaa Raj Instuons (PRI)

has also been made as a part of the Indian Public

Health Standards. The monitoring process and qualitassurance mechanism is also included.


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INDIAN PUBLIC HEALTH STANDARDS FOR PRIMARyHEALTH CENTRES

IntroduconThe concept of Primar Health Centre (PHC) is not new

to India. The Bhore Commiee in 1946 gave the concept

of a PHC as a basic health unit to provide as close to the

people as possible, an integrated curave and prevenve

health care to the rural populaon with emphasis on

prevenve and promove aspects of health care.

The health planners in India have visualized the PHC

and its Sub-Centres (SCs) as the proper infrastructure

to provide health services to the rural populaon. The

Central Council of Health at its rst meeng held in

Januar 1953 had recommended the establishment

of PHCs in communit development blocks to provide

comprehensive health care to the rural populaon. These

centres were funconing as peripheral health service

instuons with lile or no communit involvement.

Increasingl, these centres came under cricism, as the

were not able to provide adequate health coverage,

partl, because the were poorl staed and equipped

and lacked basic amenies.

The 6th Five ear Plan (1983-88) proposed reorganizaon

of PHCs on the basis of one PHC for ever 30,000 rural

populaons in the plains and one PHC for ever 20,000

populaon in hill, tribal and desert areas for more

eecve coverage. However, as the populaon densit

in the countr is not uniform, the number of PHCs

would depend upon the case load. PHCs should become

funconal for round the clock with provision of 24 × 7

nursing facilies. Select PHCs, especiall in large blocks

where the CHC is over one hour of journe me awa,

ma be upgraded to provide 24 hour emergenc

hospital care for a number of condions b increasing

the number of Medical Ocers; preferabl such PHCs

should have the same IPHS norms as for a CHC. There

are 23673 PHCs funconing in the countr as on March

2010 as per Rural Health Stascs Bullen, 2010. The

number of PHCs funconing on 247 basis are 9107and

number of PHCs where three sta Nurses have been

posted are 7629 (as on 31-3-2011).

PHCs are the cornerstone of rural health services- a rst

port of call to a qualied doctor of the public sector in

rural areas for the sick and those who directl report

or referred from Sub-Centres for curave, prevenve

and promove health care. It acts as a referral unit for

6 Sub-Centres and refer out cases to Communit Health

Centres (CHCs-30 bedded hospital) and higher order

public hospitals at sub-district and district hospitals. It

has 4-6 indoor beds for paents.

PHCs are not spared from issues such as the inabilit to

perform up to the epectaon due to (i) non-availabilit

of doctors at PHCs; (ii) even if posted, doctors do not sta

at the PHC HQ; (iii) inadequate phsical infrastructure

and facilies; (iv) insucient quanes of drugs; (v) lack

of accountabilit to the public and lack of communit

parcipaon; (vi) lack of set standards for monitoring

qualit care etc.

Standards are a means of describing the level of qualit

that health care organizaons are epected to meet

or aspire to. Ke aim of these standards is to underpin

the deliver of qualit services which are fair and

responsive to client’s needs, provided equitabl and

deliver improvements in the health and wellbeing of the

populaon. Standards are the main driver for connuous


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improvements in qualit. The performance of health care

deliver organizaons can be assessed against standards.

The Naonal Rural Health Mission (NRHM) has provided

the opportunit to set Indian Public Health Standards

(IPHS) for Health Centres funconing in rural areas.

In order to provide opmal level of qualit health care,

a set of standards called Indian Public Health Standards

(IPHS) were recommended for Primar Health Centre(PHC) in earl 2007.

The nomenclature of a PHC varies from State to State

that include a Block level PHCs (located at block HQ and

covering about 100,000 populaon and with varing

number of indoor beds) and addional PHCs/New PHCs

covering a populaon of 20,000-30,000 etc. Regarding

the block level PHCs it is epected that the are

ulmatel going to be upgraded as Communit Health

Centres with 30 beds for providing specialized services.

Seng standards is a dnamic process. Currentl the

IPHS for Primar Health Centres has been revised

keeping in view the resources available with respect

to funconal requirement for PHCs having 6 beds

with minimum standards such as building manpower,

instruments, and equipment, drugs and other facilies

etc. The revised IPHS has incorporated the changed

protocols of the eisng health programmes and new

programmes and iniaves especiall in respect of Non-

communicable diseases.

It is desirable that on the basis of essenal services,

State/UT should issue the Government nocaon for

minimum mandate standard for services at PHC.

Objecves of Indian Public HealthStandards (IPHS) for PrimarHealth Centres (PHC)

The overall objecve of IPHS is to provide health care

that is qualit oriented and sensive to the needs of the

communit.

The objecves of IPHS for PHCs are:

To provide comprehensive primar health carei.

to the communit through the Primar Health

Centres.

To achieve and maintain an acceptable standardii.

of qualit of care.

To make the services more responsive andiii.

sensitive to the needs of the communit.

Services at the Primar HealthCentre for meeng the IPHSFrom Service deliver angle, PHCs ma be of two tpes,

depending upon the deliver case load – Tpe A and

Type B.

Type A PHC: PHC with deliver load of less than 20deliveries in a month,

Type B PHC: PHC with deliver load of 20 or moredeliveries in a month

All the following services have been classied as

Essenal (Minimum Assured Services) or Desirable

(which all States/UTs should aspire to achieve at this

level of facility).

Medical care

Essenal

OPD services: A total of 6 hours of OPD services

out of which 4 hours in the morning and 2 hours

in the aernoon for si das in a week. Time

schedule will var from state to state. Minimum

OPD aendance is epected to be 40 paents per

doctor per da. In addion to si hours of dut at

the PHC, it is desirable that MO PHC shall spend at

least two hours per da twice in a week for eld

dues and monitoring.

24 hours emergency services: appropriate

management of injuries and accident, First Aid,

stching of wounds, incision and drainage of

abscess, stabilisaon of the condion of the paent

before referral, Dog bite/snake bite/scorpion bite

cases, and other emergenc condions. These

services will be provided primaril b the nursing

sta. However, in case of need, Medical Ocer ma

be available to aend to emergencies on call basis.

Referral services.

In-paent services (6 beds).

Maternal and Child Health Care Including

Famil Planning

Essenal

a) Antenatal care

Earl registraon of all pregnancies idealli.

in the rst trimester (before 12th week of

pregnanc). However, even if a woman comes


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late in her pregnanc for registraon she should

be registered and care given to her according

to gestaonal age. Record tobacco use b all

antenatal mothers.

Minimum 4 antenatal checkups and provision ofii.

complete package of services.

Suggested schedule for antenatal visits:

1st visit: Within 12 weeks—preferabl as soon

as pregnanc is suspected—for registraon of

pregnanc and rst 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 providing iron and folic

acid tablets, injecon Tetanus Tooid etc (as per

the “guidelines for Ante-Natal Care and Skilled

Aendance at birth b ANMs and LHVs) Ensure,

at-least 1 ANC preferabl the 3rd visit, must be

seen b a doctor.

Minimum laborator invesgaons likeiii.

Haemoglobin, Urine albumin and sugar, RPR

test for sphilis and Blood Grouping and Rh

tping.

Nutrion and health counseling. Brief advice oniv.

tobacco cessaon if the antenatal mother is a

smoker or tobacco user and also inform about

dangers of second hand smoke.

Idencaon and management of high risk andv.alarming signs during pregnanc and labour.

Timel referral of such idened cases to FRUs/

other hospitals which are beond the capacit of

Medical Ocer PHC to manage.

Tracking of missed and le out ANC.vi.

Chemoprophlais for Malaria in high malariavii.

endemic areas for pregnant women as per

NVBDCP guidelines.

b) Intra-natal care: (24-hour deliver services both

normal and assisted)

Promoon of instuonal deliveries.i.

Management of normal deliveries.ii.

Assisted vaginal deliveries including forceps/iii.

vacuum deliver whenever required.

Manual removal of placenta.iv.

Av. ppropriate and prompt referral for cases needing

specialist care.

Management of pregnanc Induced hpertensionvi.

including referral.

Pre-referral management (Obstetric rst-aid) invii.

Obstetric emergencies that need epert assistance

(Training of sta for emergenc management to

be ensured).

Minimum 48 hours of sta aer deliver.viii.

Managing labour using Partograph.i.

c) Procient in idencaon and basic rst aid

treatment for PPH, Eclampsia, Sepsis and

prompt referral

As per ‘Antenatal Care and Skilled Birth Aendance

at Birth’ Guidelines

d) Postnatal CareEnsure postnatal care for 0 & 3i. rd da at the health

facilit both for the mother and new-born and

sending direcon to the ANM of the concerned

area for ensuring 7th & 42nd da post-natal home

visits. 3 addional visits for a low birth weight

bab (less than 2500 gm) on 14th da, 21st da and

on 28th da.

Iniaon of earl breast-feeding within one hourii.

of birth.

Counseling on nutrion, hgiene, contracepon,iii.essenal new born care (As per Guidelines of GOI

on Essenal new-born care) and immunizaon.

Others: Provision of facilies under Jananiiv.

Suraksha yojana (JSy).

Tracking of missed and le out PNC.v.

e) New Born care

Facilies for Essenal New Born Care (ENBC) andi.

Resuscitaon (Newborn Care Corner in Labour

Room/OT, Details given in Anneure 3A).Earl iniaon of breast feeding with in one hourii.

of birth.

Management of neonatal hpothermia (provisioniii.

of warmth/Kangaroo Mother Care (KMC),

infecon protecon, cord care and idencaon

of sick newborn and prompt referral.


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f) Care of the child

Roune and Emergenc care of sick childreni.

including Integrated Management of Neonatal

and Childhood Illnesses (IMNCI) strateg and

inpaent care. Prompt referral of sick children

requiring specialist care.

Counseling on eclusive breast-feeding forii.

6 months and appropriate and adequate

complementar feeding from 6 months of age

while connuing breaseeding. (As per Naonal

Guidelines on Infant and young Child Feeding,

2006, b Ministr of WCD, Government of

India).

Assess the growth and development of the infantsiii.

and under 5 children and make mel referral.

Full Immunizaon of all infants and children againstiv.

vaccine preventable diseases as per guidelines

of GOI. (Current Immunizaon Schedule at

Annexure 1). Tracking of vaccinaon dropouts.

Vitamin A prophlais to the children as perv.

naonal guidelines.

Prevenon and control of roune childhoodvi.

diseases, infecons like diarrhoea, pneumonia

etc. and anemia etc.

Management of severe acute malnutrion casesvii.

and referral of serious cases aer iniaon of

treatment as per facilit based guidelines.

Janani Suraksha yojana

Janani Suraksha yojana (JSy) is a safe motherhoodintervenon under the Naonal Rural Health Mission

(NRHM) being implemented with the objecve of

reducing maternal and neo-natal mortalit b promong

instuonal deliver among the poor pregnant women.

This scheme integrates cash assistance with deliver

and post-deliver care.

While the scheme would create demand for instuonal

deliver, it would be necessar to have adequate number

of 24x7 deliver services centre, doctors, mid-wives,

drugs etc. at appropriate places. Mainl, this will entail

Linking each habitaon (village or a ward in anurban area) to a funconal health centre- public

or accredited private instuon where 24x7

deliver service would be available,

Associate an ASHA or a health link worker to each

of these funconal health centre.

It should be ensured that ASHA keeps track of all

epectant mothers and newborn. All epectant

mother and newborn should avail ANC and

immunizaon services, if not in health centres,

atleast on the monthl health and nutrion da,

to be organised in the Anganwadi or sub-centre.Each pregnant women is registered and a micro-

birth plan is prepared.

Each pregnant woman is tracked for ANC,

For each of the epectant mother, a place of deliver

is pre-determined at the me of registraon and

the epectant mother is informed,

A referral centre is idened and epectant

mother is informed,

ASHA and ANM to ensure that adequate fundis available for disbursement to epectant

mother,

ASHA takes adequate steps to organize transport

for taking the women to the pre-determined

health instuon for deliver.

ASHA assures availabilit of cash for

disbursement at the health centre and she

escorts pregnant women to the pre-determined

health centre.

ASHA package in the form of cash assistance for

referral transport, cash incenve and transaconal

cost to be provided as per guidelines.

Janani Shishu Suraksha Karakram (JSSK)

JJSSK launched on 1st of June of 2011 is an iniave

to assure free services to all pregnant women and

sick neonates accessing public health instuons.

The scheme envisages free and cashless services to

pregnant women including normal deliveries and

caesarian secon operaons and also treatment of sick

newborn (up to 30 das aer birth) in all Government

health instuons across State/UT.

This initiative supplements the cash assistance

given to pregnant women under the JSy and is

aimed at mitigating the burden of out of pocket

ependiture incurred b pregnant women and sick

newborns,


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g) Famil Welfare

Educaon, Movaon and Counseling to adopti.

appropriate Famil planning methods.

Provision of contracepves such as condoms, oralii.

pills, emergenc contracepves, IUCD inserons.

Referral and Follow up services to the eligibleiii.

couples adopng permanent methods

(Tubectom/Vasectom).

Counseling and appropriate referral for couplesiv.

having inferlit.

Permanent methods like Tubal ligaon andv.

vasectom/NSV, where trained personnel and

facilit eist.

Medical Terminaon of Pregnancies

Essenal

Counseling and appropriate referral for safe aboron

services (MTP) for those in need.

Desirable

MTP using Manual Vacuum Aspiraon (MVA)

technique will be provided in PHCs, where trained

personnel and facilit eist.

Medical Method of Aboron with linkage for

mel referral to the facilit approved for 2nd

trimester of MTP.

Management of Reproducve Tract

Infecons/Seuall Transmied Infecons

Essenal

Health educaon for prevenon of RTI/STIs.a.

Treatment of RTI/STIs.b.

Nutrion Services (coordinated with ICDS)

Essenal

Diagnosis of and nutrion advice to malnourisheda.

children, pregnant women and others.

Diagnosis and management of anaemia andb.

vitamin A decienc.

Coordinaon with ICc. DS.

School Health

Teachers screen students on a connuous basis and

ANMs/HWMs (a team of 2 workers) visit the schools

(one school ever week) for screening, treatment of

minor ailments and referral. Doctor from CHC/PHC will

also visit one school per week based on the screening

reports submied b the teams. Overall services to beprovided under school health shall include

Essenal

Health service provision

Screening, health care and referral:

Screening of general health, assessment of

Anaemia/Nutrional status, visual acuit,

hearng problems, dental check up, common skin

condions, Heart defects, phsical disabilies,

learning disorders, behavior problems, etc.

Basic medicines to take care of common ailments,

prevalent among oung school going children.

Referral Cards for priorit services at District/

Sub-District hospitals.

Immunizaon:

As per naonal schedule

Fied da acvit

Coupled with educaon about the issue

Entlements for Pregnant Women

Free and Zero epense deliver and Caesarian1.

Secon

Free Drugs and Consumables2.

Free Diagnoscs (Blood, Urine tests and3.

Ultrasonograph etc. as required.)

Free diet during sta in the health instuons (up4.to 3 das fro normal deliveries and upto 7 das

for caesarian deliveries)

Free provision of the Blood5.

Free transport from home to health instuons,6.

between facilies in case of referrals and drop

back from instuons to home.

Eempon from all kinds of user charges7.

Entlements for Sick newborn ll 30 days

aer Birth

Free and zero epense treatment1.

Free Drugs and Consumables2.

Free Diagnoscs3.

Free provision of the Blood4.

Free transport from home to health5.

instuons, between facilies in case of referrals

and drop back from instuons to home.

Eempon from all kinds of user charges6.


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Micronutrient (Vitamin A & IFA) management:

Weekl supervised distribuon of Iron-Folate

tablets coupled with educaon about the issue

Administraon of Vitamin-A in need cases.

De-worming

Biannuall supervised schedule

Prior IEC

Siblings of students also to be covered

Capacity building

Monitoring & Evaluaon

Mid Day Meal: in coordinaon with department

of school educaon, Ministr of Human Resource

Development

Desirable

Health Promong Schools

Counseling services

Regular pracce of yoga, Phsical educaon,health educaon

Peer leaders as health educators.

Adolescent health educaon-eisng in few places

Linkages with the out of school children

Health clubs, Health cabinets

First Aid room/corners or clinics.

Adolescent Health CareTo be provided preferabl through adolescent friendl

clinic for 2 hours once a week on a ed da. Services

should be comprehensive i.e. a judicious mi of promove,

prevenve, curave and referral services

Core package (Essenal)

Adolescent and Reproducve Health: Informaon,

counseling and services related to seual

concerns, pregnanc, contracepon, aboron,

menstrual problems etc.

Services for tetanus immunizaon of adolescents

Nutrional Counseling, Prevenon and

management of nutrional anemia

STI/RTI management

Referral Services for VCTC and PPTCT services and

services for Safe terminaon of pregnanc, if notavailable at PHC

Oponal/addional services (desirable): as per local need

Outreach services in schools (essenal) and community

Camps (desirable)

Periodic Health check ups and health educaon

acvies, awareness generaon and Co-curricular

acvies

Promoon of Safe Drinking Water and

Basic Sanitaon

Essenal

Disinfecon of water sources and Coordinaon

with Public Health Engineering department for

safe water suppl.

Promoon of sanitaon including use of toilets

and appropriate garbage disposal.

Desirable

Tesng of water qualit using H2S - Strip Test

(Bacteriological).

Prevenon and control of locall endemic

diseases like malaria, Kala Azar, Japanese

Encephalis etc. (Essenal)

Collecon and reporng of vital events.(Essenal)

Health Educaon and Behaviour Change

Communicaon (BCC). (Essenal)

Other Naonal Health Programmes

Revised Naonal Tuberculosis Control Programme

(RNTCP)

Essenal

All PHCs to funcon as DOTS Centres to deliver treatmentas per RNTCP treatment guidelines through DOTS

providers and treatment of common complicaons

of TB and side eects of drugs, record and report on

RNTCP acvies as per guidelines. Facilit for Collecon

and transport of sputum samples should be available as

per the RNTCP guidelines.

Naonal Lepros Eradicaon Programme

Essenal

Health educaon to communit regardinga.

Lepros.Diagnosis and management of Lepros and itsb.

complicaons including reacons.

Training of lepros paents having ulcers forc.

self-care.

Counselling for lepros paents for regularit/d.

compleon of treatment and prevenon of

disabilit.


21/100


Integrated Disease Surveillance Project (IDSP)

Essenal

Weekl reporng of epidemic prone diseases in S,a.

P & L forms and SOS reporng of an cluster of

cases (formats for the data collecon are added in

Annexures 11, 11A, 11B, 11C).

PHC will collect and analse data fromb. Sub-Centre and will report informaon to district

surveillance unit.

Appropriate preparedness and rst level acon inc.

out-break situaons.

Laborator services for diagnosis of Malaria,d.

Tuberculosis, and tests for detecon of faecal

contaminaon of water (Rapid test kit) and

chlorinaon level.

Naonal Programme for Control of Blindness (NPCB)

Essenal The earl detecon of visual impairment anda.

their referral.

Detecon of cataract cases and referral forb.

cataract surger.

Provision of Basic treatment of common eec.

diseases.

Awareness generaon through appropriate IECd.

strategies for prevenon and earl detecon of

impaired vision and other ee condions.

Greater parcipaon/role of communit ine.

primar prevenon of ee problems.

Naonal Vector Borne Disease Control Programme

(NVBDCP)

Essenal in endemic areas

Diagnosis and Management of Vector borne Diseases is to

be undertaken as per NVBDCP guidelines for PHC/CHC:

Diagnosis of Malaria cases, microscopica.

conrmaon and treatment.

Cases of suspected JE and Dengue to be providedb.

smptomac treatment, hospitalizaon and case

management as per the protocols.Complete treatment to Kala-azar cases in Kala-c.

azar endemic areas as per naonal Polic.

Complete treatment of microlaria posive casesd.

with DEC and parcipaon in and arrangement

for Mass Drug Administraon (MDA) along with

management of side reacons, if an. Morbidit

management of Lmphoedema cases.

Naonal AIDS Control Programme

Essenal

IEC acvies to enhance awareness and prevenvea.

measures about STIs and HIV/AIDS, Prevenon of

Parents to Child Transmission (PPTCT) services.

Organizing School Health Educaon Programme.b.

Condom Promoon & distribuon of condoms toc.the high risk groups.

Help and guide paents with HIV/AIDS receivingd.

ART with focus on adherence.

Desirable

Integrated Counseling and Tesng Centre, STIa.

services.

Screening of persons praccing high-risk behaviourb.

with one rapid test to be conducted at the PHC

level and development of referral linkages with

the nearest ICTC at the District Hospital level for

conrmaon of HIV status of those found posiveat one test stage in the high prevalence states.

Risk screening of antenatal mothers with onec.

rapid test for HIV and to establish referral linkages

with CHC or District Hospital for PPTCT services

in the si high HIV prevalence states (Tamil

Nadu, Andhra Pradesh, Maharashtra, Karnataka,

Manipur and Nagaland) of India.

Linkage with Microscop Centre for HIV-TBd.

coordinaon.

Pre and post-test counseling of AIDS paents be.

PHC sta in high prevalence states.

Naonal Programme for Prevenon and Control of

Deafness (NPPCD)

Essenal

Earl detecon of cases of hearing impairmenta.and deafness and referral.

Basic Diagnosis and treatment services forb.

common ear diseases like wa in ear, otomcosis,

os eterna, Ear discharge etc.

IEC services for prevenon, earl deteconc.

of hearing impairment/deafness and greaterparcipaon/role of communit in primar

prevenon of ear problems.

Naonal Mental Health Programme (NMHP)

Essenal

Ea. arl idencaon (diagnosis) and treatment of

mental illness in the communit.


22/100


Basic Services: Diagnosis and treatment ofb.

common mental disorders such as pschosis,

depression, aniet disorders and epileps and

referral).

IEC acvies for prevenon, sgma removal,c.

earl detecon of mental disorders and greater

parcipaon/role of Communit for primar

prevenon of mental disorders.

Naonal Programme for Prevenon and Control of

Cancer, Diabetes, CVD and Stroke (NPCDCS)

Cancer

Essenal

IEC services for prevenon of cancer and earla.

smptoms.

Earl detecon of cancer with warning signalsb.

like change in Bladder/Bowel habits, bleeding

per rectum, blood in urine, lmph node

enlargement, Lump or thickening in Breast,

itching and/or redness or soreness of the nipples

of Breast, non healing chronic sore or ulcer in oral

cavit, dicult in swallowing, obvious change

in wart/mole, nagging cough or hoarseness of

voice etc.

Referral of suspected cancer cases with earlc.

warning signals for conrmaon of the diagnosis.

Desirable

PAP smear

Other NCD Diseases

Essenal

Health Promoon Services to modif individual,a.

group and communit behaviour especiall

through;

Promoon of Health Dietar Habits.i.

Increase phsical acvit.ii.

Avoidance of tobacco and alcohol.iii.

Stress Management.iv.

Earl detecon, management and referral ofb.

Diabetes Mellitus, Hpertension and otherCardiovascular diseases and Stroke through simple

measures like histor, measuring blood pressure,

checking for blood, urine sugar and ECG.

Desirable

Surve of populaon to idenf vulnerable, high risk

and those suering from disease.

Naonal Iodine Decienc Disorders Control

Programme (NIDDCP)

Essenal

IEC acvies to promote the consumpon ofa.

iodated salt b the people.

Monitoring of Iodated salt thrb. ough salt tesng kits.

Naonal Programme for Prevenon and Control ofFluorosis (NPPCF) (In aected (Endemic Districts)

Essenal

Referral Services.a.

IEC acvies to prevent Fluorosis.b.

Desirable

Clinical eaminaon and preliminar diagnosca.

parametres assessment for cases of Fluorosis if

facilies are available.

Monitoring of village/communit level acb. vit.

Naonal Tobacco Control Programme (NTCP)

Essenal

Ha. ealth educaon and IEC acvies regarding

harmful eects of tobacco use and second hand

smoke.

Promong quing of tobacco in the communit.b.

Providing brief advice on tobacco cessaon to allc.

smokers/tobacco users.

Makd. ing PHC tobacco free.

DesirableWatch for implementaon of ban on smoking in public

places, sale of tobacco products to minors, sale of

tobacco products within 100 ards of educaonal

instuons.

Naonal Programme for Health Care of Elderl

Essenal

IEC acvies on health aging.

Desirable

‘Weekl geriatric clinic at PHC’ for providing complete

health assessment of elderl persons, Medicines,Management of chronic diseases and referral services.

Oral Health

Essenal

Oral health promoon and check ups & appropriate

referral on idencaon.


23/100


Phsical Medicine and Rehabilitaon (PMR) Services

Desirable

Primar prevenon of Disabilies.a.

Screening, earl idencaon and detecon.b.

Counseling.c.

Issue of Disabilit Cercate for obvious Disabiliesd.

b PHC doctor.

Referral ServicesAppropriate and prompt referral of cases needing

specialist care including:

Stabilizaon of paent.a.

Appropriate support to paent during transport.b.

Providing transport facilies either b PHC vehiclec.

or other available referral transport.

Drop back home for paents as mandatedd.

under JSSK

TrainingEssenal

Imparng training to undergraduate medicala.

students and intern doctors in basic health care.

Orientaon training of male and female healthb.

workers in various Naonal Health Programmes

including RCH, Adolescent health services and

immunizaon

Skill based training to ASHAs.c.

Inial and periodic Training of paramedics ind.

treatment of minor ailments.

Periodic training of Doctors and para medicse. through Connuing Medical Educaon,

conferences, skill development trainings.

All health sta of PHC must be trained in IMEP.f.

Desirable

Othersg.

There should be provision of inducon trainingi.

for doctors, nursing and paramedical sta.

Whenever new/higher responsibilit is assignedii.

or new equipment/technolog is introduced,

there must be provision of training.

There must be mechanism for ensuring qualitiii.

assurance in trainings b Training feedback

and Training eecveness evaluaon.

Appropriate placement for trained personiv.

should be ensured.

Trainings in minor repairs and maintenancev.

of available equipment should be provided to

the user.

Training of para medics in indenng,vi.

forecasng, inventor and store management

Development of protocols for equipmentvii.

(operaon, prevenve and breakdown

maintenance).

Note: 1. Trainings should commensurate with job responsibilies

for each categor of health personnel.

Note: 2. Since ECG machine is envisaged in PHCs hence labtechnician or some other paramedic should be trained in

taking ECG.

Basic Laborator and Diagnosc Services

Essenal Laboratory services including

Roune urine, stool and blood tests (Hb%,i.

platelets count, total RBC, WBC, bleeding and

clong me).

Diagnosis of RTI/STDs with wet mounng, Gramsii.

stain, etc.

Sputum tesng for mcobacterium (as periii.

guidelines of RNTCP).Blood smear eaminaon malarial.iv.

Blood for grouping and Rh tping.v.

RDK for Pf malaria in endemic districts.vi.

Rapid tests for pregnanc.vii.

RPR test for Sphilis/yAWS surveillance (endemicviii.

districts).

Rapid test kit for fecal contaminaon of water.i.

Esmaon of chlorine level of water using ortho-.

toludine reagent.

Blood Sui. gar.

Desirable

Bii. lood Cholesterol.

ECiii. G.

Validaon of reports: periodic validaon of laborator

reports should be done with eternal agencies like District

PHC/Medical college for Qualit Assurance. Periodic

calibraon of Laborator and PHC equipment.

Monitoring and Supervision

Essenal

Monitoring and supervision of acvies of Sub-i.

Centre through regular meengs/periodic visits, b

LHV, Health Assistant Male and Medical Ocer etc..

Monitoring of all Naonal Health Programmesii.

b Medical Ocer with support of LHV, Health

Assistant Male and Health educator.

Monitoring acvies of ASHAs b LHV and ANMiii.

(in her Subcentre area).


24/100


Health educator will monitor all IEC and BCCiv.

acvies

Health Assistants Male and LHV should visit Sub-v.

Centres once a week.

Checking for tracking of missed out and le outvi.

ANC/PNC, Vaccinaons etc. during monitoring

visits and qualit parameters (including using

Partograph, AMTSL, ENBC etc.) during deliverand post deliver.

Timel pament of JSy beneciaries.vii.

Timel pament of TA/DA to ASHAs.viii.

Desirable

MO should visit all Sub-Centres at least once in ai.

month. This will be possible onl if more than one

Medical Ocer is posted in the PHC.

Funconal Linkages with Sub-Centres

Essenal

There shall be a monthl review meeng at PHC

chaired b MO (or in-charge), and aended b all

the Health Workers (Male and Female) and Health

Assistants (Male and female).

On the spot Supervisor visits to Sub-Centres.

Organizing Village Health and Nutrion da at

Anganwadi Centres.

Desirable

ASHAs and Anganwadi Workers should aend

monthl review meengs. Medical Ocer should

orient ASHAs on selected topics of health care.

Mainstreaming of AyUSH

Desirable

Provision of one AyUSH Doctor and one AyUSH

Pharmacist has been made at PHC to provide

choices to the people wherever an AyUSH

public facilit is not available in the near vicinit.

The AyUSH doctor at PHC shall aend paents

for sstem specic AyUSH based prevenve,

promove and curave health care and take

up public health educaon acvies including

awareness generaon about the uses of medicinalplants and local health pracces.

The signboard of the PHC should menon AyUSH

facilies.

AyUSH Doctor should support in implementaon

of naonal health programmes aer requisite

training if required.

Locall available medicinal herbs/plants should be

grown around the PHC.

Selected Surgical Procedures

(Desirable)

The vasectom, tubectom (including laparoscopic

tubectom), MTP, hdrocelectom as a ed da

approach have to be carried out in a PHC having facilies

of O.T. During all these surgical procedures, universal

precauons will be adopted to ensure infecon

prevenon. These universal precauons are menoned

at Annexure 5.

Record of Vital Events and ReporngEssenal

Recording and reporng of Vital stascs includinga.

births and deaths.

Maintenance of all the relevant records concerningb.

services provided in PHC.

Maternal Death Review (MDR).

(Desirable)

Facilit Based MDR shall be conducted at the PHC, the

form is given at Annexure 10.

InfrastructureThe PHC should have a building of its own. The

surroundings should be clean. The details are as

follows:

PHC Building

Locaon

It should be centrall located in an easil accessible area.

The area chosen should have facilies for electricit, all

weather road communicaon, adequate water suppl

and telephone. At a place, where a PHC is alread located,

another health centre/SC should not be established to

avoid the wastage of human resources.

PHC should be awa from garbage collecon, cale

shed, water logging area, etc. PHC shall have properboundar wall and gate.

Area

It should be well planned with the enre necessar

infrastructure. It should be well lit and venlated with

as much use of natural light and venlaon as possible.


25/100


The plinth area would var from 375 to 450 sq. metres

depending on whether an OT facilit is opted for.

Sign-age

The building should have a prominent board displaing

the name of the Centre in the local language at the gate

and on the building. PHC should have pictorial, bilingual

direconal and laout sign-age of all the departments

and public ulies (toilets, drinking water).

Prominent displa boards in local language providing

informaon regarding the services available/user

charges/fee and the mings of the centre. Relevant IEC

material shall be displaed at strategic locaons.

Cizen charter including paent rights and responsibilies

shall be displaed at OPD and Entrance in local language.

Entrance with Barrier free access

Barrier free access environment for eas access to non-ambulant (wheel-chair, stretcher), semi-ambulant,

visuall disabled and elderl persons as per guidelines

of GOI.

Ramp as per specicaon, Hand- railing, proper

lightning etc must be provided in all health facilies

and retroed in older one which lack the same. The

doorwa leading to the entrance should also have a

ramp facilitang eas access for old and phsicall

challenged paents. Adequate number of wheel chairs,

stretchers etc. should also be provided.

Disaster Prevenon Measures

For all new upcoming facilies in seismic 5 zone or other

disaster prone areas.

Building and the internal structure should be made

disaster proof especiall earthquake proof, ood proof

and equipped with re protecon measures.

Earthquake proof measures - structural and non-

structural should be built in to withstand quake as per

geographical/state govt. guidelines. Non-structural

features like fastening the shelves, almirahs, equipmentetc. are even more essenal than structural changes

in the buildings. Since it is likel to increase the cost

substanall, these measures ma especiall be taken

on priorit in known earthquake prone areas.

PHC should not be located in low ling area to prevent

ooding as far as possible.

Fire ghng equipment – re enguishers, sand

buckets etc. should be available and maintained to be

readil available when needed. Sta should be trained

in using re ghng equipment.

All PHCs should have Disaster Management Plan in line

with the District Disaster management Plan. All health

sta should be trained and well conversant with disaster

prevenon and management aspects. Surprise mock

drills should be conducted at regular intervals.

Waing Area

This should have adequate space and seanga.

arrangements for waing clients/paents as per

paent load.

The walls should carr posters imparng healthb.

educaon.

Booklets/leaets in local language ma be providedc.

in the waing area for the same purpose.

Toilets with adequate water suppl separate ford. males and females should be available. Waing

area should have adequate number of fans,

coolers, benches or chairs.

Safe Drinking water should be available in thee.

paent’s waing area.

There should be proper noce displaing departments

of the centre, available services, names of the doctors,

users’ fee details and list of members of the Rogi Kalan

Sami/Hospital Management Commiee.

A locked complaint/suggeson bo should be provided

and it should be ensured that the complaints/suggesonsare looked into at regular intervals and addressed.

The surroundings should be kept clean with no water-

logging and vector breeding places in and around the

centre.

Outpaent Department

The outpaent room should have separate areasa.

for consultaon and eaminaon.

The area for eaminaon should have sucientb.

privac.

In PHCs with AyUSH doctor, necessarc.infrastructure such as consultaon room for

AyUSH Doctor and AyUSH Drug dispensing area

should be made available.

OPD Rooms shall have provision for ample naturald.

light, and air. Windows shall open directl to the

eternal air or into an open verandah.


26/100


Adequate measures should be taken for crowde.

management; e.g. one volunteer to call paents

one b one, token sstem.

One room for Immunizaon/Famil Planning/f.

Counseling.

Wards 5.5 m 3.5 m each

There should be 4-6 beds in a Primar Health Centre.a. Separate wards/areas should be earmarked for

males and females with the necessar furniture.

There should be facilies for drinking water andb.

separate clean toilets for men and women.

The ward should be easil accessible from the OPDc.

so as to obviate the need for a separate nursing

sta in the ward and OPD during OPD hours.

Nursing staon should be located in such a wad.

that health sta can be easil accessible to OT and

labour room aer regular clinic mings.

Proper wrien handover shall be given to incominge.

sta b the outgoing sta.Dirt ulit room for dirt linen and used items.f.

Cooking should not be allowed inside the wardsg.

for admied paents.

Cleaning of the wards, etc. should be carried outh.

at regular intervals and at such mes so as not to

interfere with the work during peak hours and

also during mes of eang. Cleaning of the wards,

Labour Room, OT, and toilets should be regularl

monitored.

Operaon Theatre (Oponal)

To facilitate conducng selected surgical procedures

(e.g. vasectom, tubectom, hdrocelectom etc.).

It should have a changing room, sterilizaon areaa.

operang area and washing area.

Separate facilies for storing of sterile andb.

unsterile equipment/instruments should be

available in the OT.

The Plan of an ideal OT has been anneed showingc.

the laout.

It would be ideal to have a paent preparaond.

area and Post-Operave area. However, in view

of the eisng situaon, the OT should be wellconnected to the wards.

The OT should be well-equipped with all thee.

necessar accessories and equipment.

Surgeries like laparoscop/cataract/Tubectom/f.

Vasectom should be able to be carried out in

these OTs.

OT shall be fumigated at regular intervals.g.

One of the hospital sta shall be trained inh.

Autoclaving and PHC shall have standard Operave

procedure for autoclaving.

OT shall have power back up (generator/Invertor/i.

UPS). OT should have restricted entr. Separate

foot wear should be used.

Labour Room (3.8 m 4.2 m)

Essenal

Conguraon of New Born care cornera.

Clear oor area shall be provided in the roomy

for newborn corner. It is a space within the

labour room, 20-30 sq in size, where a

radiant warmer (Funconal) will be kept.

Ogen, sucon machine and simultaneousl-y

accessible electrical outlets shall be provided

for the newborn infant in addion to the

facilies required for the mother. Both

Ogen Clinder and Sucon Machine should

be funconal with their ps cleaned andcovered with sterile gauze etc for read to use

condion. They must be cleaned aer use and

kept in the same wa for net use.

The Labour room shall be provided with ay

good source of light, preferabl shadow-less.

Resuscitaon kit including Ambu Bag (Paediatricy

size) should be placed in the radiant warmer.

Provision of hand washing and containmenty

of infecon control if it is not a part of the

deliver room.

The area should be awa from draught ofy

air, and should have power connecon for

plugging in the radiant warmer.

There should be separate areas for sepc andb.

asepc deliveries.

The Labour room should be well-lit and venlatedc.

with an aached toilet and drinking water facilies.

Facilies for hot water shall be available.

Separate areas for Dirt linen, bab wash, toilet,d.

Sterilizaon.

Standard Treatment Protocols for commone.

problems during labour and for newborns to be

provided in the labour room.Labour room should have restricted entr.f.

Separate foot wear should be used.

All the essenal drugs and equipment (funconal)g.

should be available.

Cleanliness shall alwas be maintained in Labourh.

room b regular washing and mopping with

disinfectants.


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Labour Room shall be fumigated at regular intervali.

(Desirable).

Deliver kits and other instruments shall be j.

autoclaved where facilit is available.

If Labour Room has more than one labour tablek.

then the privac of the women must be ensured

b having screens between 2 labour tables.

Minor OT/Dressing Room/Injecon Room/

EmergencThis should be located close to the OPD to catera.

to paents for minor surgeries and emergencies

aer OPD hours.

It should be well equipped with all the emergencb.

drugs and instruments.

Privac of the paents should be ensured.c.

Laborator (3.8 m 2.7 m)

Sucient space with workbenches and separatea.

area for collecon and screening should beavailable.

Should have marble/stone table top for plaormb.

and wash basins.

General store

Separate area for storage of sterile and commona.

linen and other materials/drugs/consumable

etc. should be provided with adequate storage

space.

The area should be well-lit and venlated andb.

rodent/pest free.

Sucient number of racks shall beyprovided.

Drugs shall be stored properl andy

sstemacall in cool (awa from direct

sunlight), safe and dr environment.

inammable and hazardous material shall bey

secured and stored separatel

Near epir drugs shall be segregated and storedc.

separatel

Sucient space with the storage cabins separateld.

for AyUSH drugs be provided.

Dispensing cum store area: 3 m 3 m

Infrastructure for AyUSH doctor

Based on the sstem of medicine being pracced,

appropriate arrangements should be made for the

provision of a doctor’s room and a dispensing room cum

drug storage.

Waste disposal pit - As per GOI/Central Polluon

Control Board (CPCB) guidelines.

Cold Chain room – Size: 3 m 4 m

Logiscs Room – Size: 3 m 4 m

Generator room – Size: 3 m 4 m

Oce room 3.5 m 3.0 m

Dirt ulit room for dirt linen and used items

Residenal Accommodaon

Essenal

Decent accommodaon with all the amenies likes

24-hrs. water suppl, electricit etc. should be available

for Medical Ocer, nursing sta, pharmacist, laborator

technician and other sta.

If the accommodaon can not be provided due to an

reason, then the sta ma be paid house rent allowance,

but in that case the should be staing in near vicinit of

PHC so that the are available 24 × 7, in case of need.

Boundar wall/Fencing

Essenal

Boundar wall/fencing with Gate should be provided

for safet and securit.

Environment friendl features

Desirable

The PHC should be, as far as possible, environment

friendl and energ ecient. Rain-Water harvesng,

solar energ use and use of energ-ecient bulbs/equipment should be encouraged.

Other amenies

Essenal

Adequate water suppl and water storage facilit (over

head tank) with pipe water should be made available.

Computer

Essenal

Computer with Internet connecon should be provided

for Management Informaon Sstem (MIS) purpose.

Lecture Hall/Auditorium

Desirable

For training purposes, a Lecture Hall or a small Auditorium

for 30 Person should be available. Public address sstem

and a black board should also be provided.


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The suggested laout of a PHC and Operaon Theatre is

given at Annexure 2 and Annexure 2A respecvel. The

Laout ma var according to the locaon and shape of

the site, levels of the site and climac condions. The

prescribed laout ma be implemented in PHCs et to

be built, whereas those alread built ma be upgraded

aer geng the requisite alteraon/addions. The

funds ma be made available as per budget provisionunder relevant strategies menoned in NRHM/RCH-II

program and other funding projects/programs.

Equipment and FurnitureThe necessar equipment to deliver the assureda.

services of the PHC should be available in adequate

quant and also be funconal.

Equipment maintenance should be given specialb.

aenon.

Periodic stock taking of equipment and prevenve/c.

round the ear maintenance will ensure properfunconing equipment. Back up should be made

available wherever possible. A list of suggested

equipment and furniture including regents and

diagnosc kits is given in Annexure 3.

Manpower

To ensure round the clock access to public health facilies,

Primar Health Centres are epected to provide 24-hour

service with basic Obstetric and Nursing facilies. Under

NRHM, PHCs are being operaonalized for providing

24 x 7 services in various phases b placing at least 3

Sta Nurses in these facilies. If the case load is there,

operaonalizaon of 24 x 7 PHC ma be undertaken in a

phase-wise manner according to availabilit of manpower.

This is epected to increase the instuonal deliveries

which would help in reducing maternal mortalit.From Service deliver angle, PHCs ma be of two tpes,

depending upon the deliver case load – Type A and

Type B.

Type A PHC: PHC with deliver load of less than 20

deliveries in a month,

Type B PHC: PHC with deliver load of 20 or more

deliveries in a month

Select PHCs, especiall in large blocks where the CHC is

over one hour of journe me awa, ma be upgraded to

provide 24 hour emergenc hospital care for a number

of condions b increasing number of Medical Ocers,

preferabl such PHCs should have the same IPHS norms

as for a CHC.

The manpower that should be available in the PHC is

given in the table below:

For Tpe B PHCs, addional sta in the from of

one MBBS medical ocer (desirable, If the case

load of deliver cases is more than 30 per

month) one Sta Nurse and one sanitar worker

Sta Type A Type B

Essenal Desirable Essenal Desirable

Medical Ocer- MBBS 1 1 1#

Medical Ocer –AyUSH 1^ 1^

Accountant cum Data Entr Operator 1 1

Pharmacist 1 1

Pharmacist AyUSH 1 1

Nurse-midwife (Sta-Nurse) 3 +1 4 +1

Health worker (Female) 1* 1*

Health Assistant. (Male) 1 1

Health Assistant. (Female)/Lad Health Visitor 1 1

Health Educator 1 1

Laborator Technician 1 1Cold Chain & Vaccine Logisc Assistant 1 1

Mul-skilled Group D worker 2 2

Sanitar worker cum watchman 1 1 +1

Total 13 18 14 21

Manpower: PHC

* For Sub-Centre area of PHC.# If the deliver case load is 30 or more per month. One of the two medical ocers (MBBS) should be female.^ To provide choices to the people wherever an AyUSH public facilit is not available in the near vicinit.


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cum watchman have been provided have been

provided to take care of addional deliver case

load.

Medical Ocer should be available on call dut to

manage emergencies.

Accommodaon for at least one MO and 3 Sta

Nurses will be provided.

One of the Class IV emploee ma be idened ashelper to Cold Chain & Vaccine Logisc Assistant

& trained.

The job responsibilies of the dierent personnel are given

in Annexure 7. Funds ma be made available for hiring

addional manpower as per provision under NRHM.

Drugs

Essenal:

All the drugs available in the Sub-Centre shoulda.

also be available in the PHC. All the drugs asper state/UT essenal drug list shall be available.

In addion, all the drugs required for the Naonalb.

Health Programmes and emergenc management

should be available in adequate quanes so

as to ensure compleon of treatment b all

paents.

Adequate quanes of all drugs should bec.

maintained through periodic stock-checking,

appropriate record maintenance and inventor

methods. Facilies for local purchase of drugs

in mes of epidemics/outbreaks/emergencies

should be made available.

Drugs of that discipline of AyUSH to be maded.

available for which the doctor is present.

The list of suggested drugs is given in

Annexure 4.

The Transport Facilies withAssured Referral Linkages

Referral Transport FacilitIt is desirable that the PHC has ambulance facilies

for transport of paents for mel and assured

referral to funconal FRUs in case of complicaons

during pregnanc and child birth. This ma be

outsourced either through Govt/PPP model or linkages

with Emergenc Transport sstem should be in place.

Transport for Supervisor and Other

Outreach Acvies

It is desirable that the vehicle is made available through

outsourcing.

Laundr ServicesProvision for clean linen shall be made for admiedpaents. At least 5 sets of linen shall be made available.

Laundr Services ma be available in house or

outsourced.

Dietar Facilies for indoorPaents

Desirable

Nutrious and well- balanced diet shall be provided

to all IPD paents keeping in mind their culturalprefernces. A suitable arrangement with a local

agenc like a local women’s group/NGO/Self-Help

Group for provision of nutrious and hgienic food at

reasonable rates ma be made wherever feasible and

possible.

Waste Management at PHCLevel

“Guidelines for Health Care Workers for Waste

Management and Infecon Control in Primar HealthCentres” are to be followed.

Qualit AssurancePeriodic skill development training of the sta

of the PHC in the various jobs/responsibilies

assigned to them.

Standard Treatment Protocol for all Naonal

Health Programmes and locall common disease

should be made available at all PHCs.

Regular monitoring is another important means.A few aspects that need denite aenon are:

Interacon and Informaon Echange withi.

the client/paent:

Courtes should be etended to paents/

clients b all the health providers including

the support sta.


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All relevant informaon should be

provided as regards the condion/illness

of the client/paent.

Atude of the health care providers

needs to undergo a radical change so

as incorporate the feeling that client is

important and needs to be treated with

respect.

Cleanliness should be maintained in allii.

areas.

Monitoring of PHC funconing

This is important to ensure that qualit is maintained

and also to make changes if necessar.

Internal Mechanisms: Record maintenance, checking

and supervision.

Medical Audit

Death Audit

Paent Sasfacon Surveys: For both OPD and IPD

paents.

Evaluaon of Complaints and suggesons received;

External Mechanisms: Monitoring through the PRI/

Village Health Sanitaon and Nutrion Commiee/Rogi

Kalan Sami/communit monitoring framework. (as

per guidelines of GOI/State Government). A checklist

for the same is given in Annexure 6. A format for

conducng facilit surve for the PHCs to have baseline

informaon on the gaps in comparison to Indian Public

Health Standards and subsequentl to monitor the

availabilit of facilies as per IPHS guidelines is given at

Annexure 9.

Social audit

Accountabilit

To ensure accountabilit, the Charter of Paents’

Rights should be made available in each PHC (as

per the guidelines given in Annexure 8). Ever PHC

should have a Rogi Kalyan Sami/Primary Health

Centre’s Management Commiee for improvement

of the management and service provision of the

PHC (as per the Guidelines of Government of India).

This commiee will have the authorit to generate its

own funds (through users’ charges, donaon etc.) and

ulize the same for service improvement of the PHC. The

PRI/Village Health Sanitaon and Nutrion Commiee/Rogi Kalan Sami should also monitor the funconing

of the PHCs.

Statuar and RegulatorCompliance

PHC shall fulfil all the statuar and regulator

requirements and compl to all the regulations

issued b local bodies, state and union of India. PHC

shall have cop of these regulations/Acts. List of

statuar and regulator compliances is given in

Annexure 12.


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Vaccine When to give Dose Route Site

For Pregnant Women

TT-1 & 2 Earl in pregnanc and 4 weeks

aer TT-1*

[one dose (booster)* if previousl

vaccinated within last 3 ears]

0.5 ml Intra-muscular Upper Arm

TT-Booster If pregnanc occur within three

ears of last TT vaccinaons*

0.5 ml Intra-muscular Upper Arm

For Infants

BCG At birth (for instuonal

deliveries) or along with DPT-1

(upto one ear if not given earlier)

0.1 ml (0.05 ml for

infant up to 1 month)

Intra-dermal Le Upper Arm

Hepas B- 0 At birth for instuonal deliver,preferabl within 24 hrs of deliver 0.5 ml Intra-muscular Outer Mid-thigh (Antero-lateral side of mid thigh)

OPV - 0 At birth for instuonal deliveries

within 15 das

2 drops Oral Oral

OPV 1, 2 & 3 At 6 weeks, 10 weeks & 14 weeks 2 drops Oral Oral

DPT 1, 2 & 3 At 6 weeks, 10 weeks & 14 weeks 0.5 ml Intra-muscular Outer Mid-thigh (Antero-

lateral side of mid thigh)

Hepas B- 1,

2 & 3

At 6 weeks, 10 weeks & 14 weeks 0.5 ml Intra-muscular Outer Mid-thigh (Antero-

lateral side of mid-thigh)

Measles 1 & 2 At 9-12 months and 16-24 months 0.5 ml Sub-cutaneous Right upper Arm

Vitamin-A

(1st dose)

At 9 months with measles 1 ml (1 lakh IU) Oral Oral

For Children

DPT booster 16-24 months 0.5 ml Intra-muscular Outer Mid-thigh (Antero-

lateral side of mid-thigh)

2nd booster at 5 ears of age 0.5 ml Intra-muscular Upper Arm

Anneure 1

NATIONAL IMMUNIZATION SCHEDULE FOR INFANTS,

CHILDREN AND PREGNANT WOMEN

Immunizaon programme provides vaccinaon against seven vaccine preventable diseases

ANNExURES


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Vaccine When to give Dose Route Site

OPV Booster 16-24 months 2 drops Oral Oral

JE^ 16-24 months 0.5 ml Sub-cutaneous Upper Arm

Vitamin A

(2nd to 9th dose)

2nd dose at 16 months with DPT/

OPV booster. 3rd to 9th doses are

given at an interval of 6 months

interval ll 5 ears age

2 ml (2 lakh IU) Oral Oral

DT Booster 5 ears 0.5 ml Intra-muscular Upper Arm

TT 10 ears & 16 ears 0.5 ml Intra-muscular Upper Arm

* TT-2 or Booster dose to be given before 36 weeks of pregnanc.

^ JE in Selected Districts with high JE disease burden (currentl 112 districts)

A full immunized infant is one who has received BCG, three doses of DPT, three doses of OPV, three doses of Hepas B and Measles before

one ear of age.

Note: The Universal Immunizaon Programme is dnamic and hence the immunizaon schedule needs to be updated from me to me.


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A n n e x u r e 2

L A y O U T O F

P H C

T O I L E T

1 5 0 0 X

1 5 0 0

T O I L E T

1 5 0 0 X

2 1 0 0

T O I L E T

1 5 0 0 X

1 8 0 0

D I R T Y

L I N E N

1 8 0 0 X 2 0 0 0

L A D I E S W A R D

5 5 0 0 X 3 5 0 0 S

T R E L I S A T I O N

3 8 8 5 X 2 1 0 0

G E N T ’ S W A R D

5 5 0 0 X 3 5 0 0

N U R S E S

R O O M

3 1 0 0 X 3 5 0 0

L A B .

3 0 0 0 X 3 5 0 0

M . O .

3 5 0 0 X 4 5 0 0

M . O .

3 5 0 0 X 4 5 0 0

E N T R A N C E

3 0 0 0 X 4 5 0 0

R

E G I S T R A T I O N

& R E C O R D

3 0 0 0 X 3 0 0 0

M I N O R O . T . /

D R E S S I N G /

I N J E C T I O N .

4 0 0 0 X 4 5 0 0

D I S P E

N S I N G

C U M S T O R E .

3 0 0 0

X 3 5 0 0

O F F I C E

3 0 0 0 X 3 5 0 0

G E N E R A L

S T O R E

2 1 0 0 X 3 5 0 0

G E N T ’ S

T O I L

E T

2 2 0 0 X 3 5 0 0

L A D I E

S

T O I L E

T

2 2 0 0 X 3

5 0 0

C O L D

C H A I N

2 1 0 0 X 3 5 0 0

I M M U N I�

guidelines phc 2012

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