chc.pptx

Chc

1. Community health centrE Presentation by : Dr.Shifa Sherin.k PG student Department of community medicine GGSMCH Faridkot

2. Learning ObjectiveS To know about IPHS   2022 of CHC To know about Functioning of CHC Bajakhana

3. Objective of IPHS for CHC Types of CHC Population norms Services provided Human resources  for health Physical infrastructure Implimentation of IPHS Funding CHC Bajakhana Lesson plan

4. Introduction

5. Objectives of iphs for chc 1. To define a uniform benchmark ensuring 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 CHCs in both rural and urban areas. 3.  To achieve and maintain an acceptable standard of quality of care at public health facilities.  4.  To facilitate monitoring and supervision of the facilities. 5.  To provide guidance and tools for governance and leadership. 6. 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

6. Iphs 2012 of chc 30 bedded hospital 4 PHCs are included under each CHC thus catering to approximately 80000 populations in tribal / hilly areas and 120000 population for plain areas Specialists  physician OBG Surgeon Paediatrician Anesthesiologist

7. Indian public health standards 2022 chc

8. Types of chc

9. Population norms for chc Non – FRU CHC(rural) FRU -CHC Tribal/ hilly area Plain area Metro city Non metro city 80000 1,20000 5 L 2.5 L

10. IPHS-Services  Services Non-FRU - CHC FRU - CH FRU -CH FRU-UCHC FRU-UCHC 30 beds 30 beds 50 beds 50beds 100 beds Emergency  E E E E E Intensive care &OT  OT - E E E E Labour room E E E E E NBSU E E E E E Blood storage D E E E E

11. Services Non-FRU - CHC FRU - CH FRU -CH FRU-UCHC FRU-UCHC 30 beds 30 beds 50 beds 50beds 100 beds Common surgical procedures E E E E E OP services General medicine E E E E E Gen surgery D E E E E OBG D E E E E Pediatrics D E E E E Ophthalmology - - D D E Orthopaedics - - D D E Pathology/microbiology - D E E E ENT - - D D D

12. Services Non-FRU - CHC FRU - CH FRU -CH FRU-UCHC FRU-UCHC 30 beds 30 beds 50 beds 50beds 100 beds Pre- anaesthetic check up D E E E E Family medicine D D D D D Physiotherapy E E E E E PMR Services - - - - D Family welfare clinic E E E E E Counselling E E E E E Nutrition E E E E E Health and wellness services E E E E E Immunization services E E E E E

13. Services Non-FRU - CHC FRU - CH FRU -CH FRU-UCHC FRU-UCHC 30 beds 30 beds 50 beds 50beds 100 beds Dental  E E E E E AYUSH  D D D D D NCD clinic (diagnosis, management, followup, and referral, as appropriate) E E E E E Cold chain services E E E E E Integrated Counseling and Testing services (HIV) E E E E E Maternal and child health (including Family Planning E E E E E Dressing room E E E E E

14. Services Non-FRU - CHC FRU - CH FRU -CH FRU-UCHC FRU-UCHC 30 beds 30 beds 50 beds 50beds 100 beds INTEGRATED COUNSELLING SERVICES Tobacco cessation & Drug de- addiction E E E E E Mental health E E E E E Adolescent health E E E E E Nutritional counselling and early childhood development E E E E E Domestic violence and sexual violence E E E E E Health education and BCC E E E E E Health education for prevention of  STl E E E E E

15. Services Non-FRU - CHC FRU - CH FRU -CH FRU-UCHC FRU-UCHC 30 beds 30 beds 50 beds 50beds 100 beds IPD services General ward- gender based E E E E E Post operative ward - E E E E Isolation room D D D D D Maternity ward E E E E E Referral services E E E E E Laboratory Services E E E E E Diagnostic services Usg with colour droppler (including for newborns) D E E E E Digital x-ray E E E E E

16. Services Non-FRU - CHC FRU - CH FRU -CH FRU-UCHC FRU-UCHC 30 beds 30 beds 50 beds 50beds 100 beds Administrative Area&services  Birth and Death Registrations  E E E E E Server Room , Housekeeping Room, Staff Room ,Condemnation Multi purposes services maintenance Room, Medical records Room  E E E E E Designated space for IEC  E E E E E Bio waste material management with linkage to common biomedical waste treatment facility E E E E E Finance E E E E E Training and Orientation E E E E E

17. Sr.No . Services Non-FRU - CHC FRU - CH FRU -CH FRU-UCHC FRU-UCHC 30 beds 30 beds 50 beds 50beds 100 beds Monitoring and Supervision Monitoring and supervision of activities of Sc thru regular meetings/ periodic visits, by LHV, HAM  andMO  etc.  Monitoring of all NHPs by MO with support of LHV, HAM and Health educator.  Monitoring activities of ASHAs by LHV and ANM (in her SC area).  Health educator will monitor all IEC and BCC activities HAM and LHV should visit SCs once a week.  Checking for  Inventory Management  tracking of missed out and left out ANC/PNC, Vaccinations  Timely payment of JSY beneficiaries.  Timely payment of TA/DA to ASHAs E E E E E Inventory Management  E E E E E Epidemic Control and Disaster Preparedness E E E E E Nosocomial Disease reporting E E E E E Immunization of Health care workers E E E E E Clinical Governance : Incident reporting (including Maternal Death Surveillance and Response (MDSR); Child Death Review (CDR); Near miss reporting Audits (including prescription audit) E E E E E

18. Services Non-FRU - CHC FRU - CH FRU -CH FRU-UCHC FRU-UCHC 30 beds 30 beds 50 beds 50beds 100 beds Epidemic Control and Disaster Preparedness E E E E E Nosocomial Disease reporting E E E E E Immunization of Health care workers E E E E E Clinical Governance : Incident reporting (including Maternal Death Surveillance and Response (MDSR); Child Death Review (CDR); Near miss reporting Audits (including prescription audit) E E E E E

19. Services Non-FRU - CHC FRU - CH FRU -CH FRU-UCHC FRU-UCHC 30 beds 30 beds 50 beds 50beds 100 beds  Hospital Management Information System,  IT Section, Reporting, Feedback& Surveillance . E E E E E Server Room , Internal Communication system, Public addressal system, Token Display system E E E E E Disabled friendly services, Ambulance  services  E E E E E Disability certificate D E E E E Skype, ZOOM etc. for consultation for a higher identified centre D D D D D Security Services , Housekeeping Services  E E E E E  Central Sterilization Supply Department (CSSD)/equipment sterilization services E E E E E Laundry services E E E E E

20. Services Non-FRU - CHC FRU - CH FRU -CH FRU-UCHC FRU-UCHC 30 beds 30 beds 50 beds 50beds 100 beds Support Services Registration Counter E E E E E Pharmacy&Store E E E E E Dressing room E E E E E Telemedicine E E E E E Dietary E E E E E Effluent Treatment Plant (ETP) E E E E E Power Sub-Station/Transformer E E E E E Overhead water tank – 2independent water sources. Separate tank for critical care areas (450 L per bed per day) 15300 L 16200 L  16200L  16200L  45000 L

21. Services Non-FRU - CHC FRU - CH FRU -CH FRU-UCHC FRU-UCHC 30 beds 30 beds 50 beds 50beds 100 beds Generator E E E E E Use of power through solar panels D D D D D Ambience , Pest control services , Horticulture E E E E E Rainwater harvesting in facilities more than 500 square meter D D D D D Cafeteria, ATM D D D D D Parking, Garden E E E E E Suggestion & feedback System E E E E E Staff Residences E E E E E

22. HUMAN RESOURCES  FOR HEALTH General surgeon 1 Physician 1 Obstetrician & gynecologist 1 Pediatrician 1 Anesthesist 1 Public Health Manager (M.D. Community Medicine) 1 This Photo by Unknown author is licensed under CC BY-SA-NC .

23. HUMAN RESOURCES  FOR HEALTH Opthalmologist 1 for every 5 CHCs Dental surgeon 1 General Duty Medical Officers (MBBS) -6 (including 2 lady med. officers) Specialist of AYUSH 1 General Duty Medical Officers of AYUSH-1

24. COMMUNICABLE DISEASES PROGRAMMES NATIONAL VECTOR BORN DISEASE CONTROL  PROGRAMME NATIONAL LEPROSY ERADICATION  PROGRAMME NATIONAL  PROGRAMME  FOR CONTROL OF BLINDNESS AND VISUAL IMPAIRMENT INTEGRATED DISEASE SERVILLANSE PROJECT NATIONAL  PROGRAMME  FOR PREVENTION AND CONTROL OF DEAFNESS NATIONAL MENTAL HEALTH  PROGRAMME RMNCH+A NATIONAL HEALTH PROGRAMMES

25. NATIONAL HEALTH PROGRAMMES NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF CANCER DIABETES CARDIOVASCULAR DISEASES AND STROKE NATIONAL IODINE DEFICIENCY DISORDERS CONTROL PROGRAMME NATIONAL PROGRAM FOR PREVENTION AND CONTROL OF FLUOROSIS NATIONAL TOBACCO CONTROL PROGRAMME NATIONAL PROGRAMME FOR HEALTH CARE OF ELDERLY NATIONAL ORAL HEALTH PROGRAMME NATIONAL PROGRAMME FOR PALLIATIVE CARE

26. PHYSICAL INFRASTRUCTURE ENTRANCE ZONE Signage: Prominent display boards in local language providing information regarding the services available and timings of the CHC All the signages should be bilingual and pictorial Citizen charter should be displayed at OPD and Entrance in local language including patient’s rights and responsibilities

27. OUTPATIENT DEPARTMENT Layout of the Out Patient Department shall follow the functional flow of the patients: Enquiry Registration  Waiting  Clinic Dressing room/injection room This Photo by Unknown author is licensed under CC BY .

28. Billing Diagnostics(lab/X-ray) Pharmacy Exit WARDS: Separate for males and females

29. NURSING STATION: Centred such that it serves all the clinics from that place. Spacious enough to accommodate a work counter (for preparing dressings ,medicines),hand washing facilities,sinks,dressing tables etc. ADMINISTRATIVE ZONE: Separate rooms should be available for : Office Stores

30. RESIDENTIAL ZONE Minimum 8 quarters for doctors Minimum 8 quarters for staff nurses Paramedical staff Minimum 2 quarters for ward boys Minimum 1 quarter for driver

31. IMPLEMENTING IPHS AT CHCs Standards implemented in phased manner FIRST STAGE Ensure services with appropriate transport service Assure four general duty medical officers with seven staff nurses along with other support services and physical qualities SECOND STAGE 24*7 CHCs may be upgraded to First Referral Units Minimum requirement of declaration of FRU: 1.Manpower:gynaecologist,anaesthetist,pediatrician. 2.Blood stroage facility with other supportive services 3.CHC’s as FRU will provide 24 hrs delivery services,emergency obstretics care and newborn care

32. THIRD STAGE(IPHS): Once the CHC has been classified as FRU,next step would be to post other specialists and support man power as per IPHS. The CHCs declared as IPHS apart from FRU must provide: 1.Care of routine and emergency cases in surgery 2.Care of routine and emergency cases in medicine  3.Services of a public health manager 4.Delivery of all NHPs

33. FUNDING 1.Untied fund . 2.annual maintenance grant . 3.RKS grant. These funds shall be kept in the bank account of the Rogi Kalyan Samiti

34. ENSURING QUALITY

35. CHC BAJAKHANA Rural Health Centre (RHC) is located at village Bajakhana , Block Bajakhana , District Faridkot.  This centre is an integral part of the Department of Community Medicine, Guru Gobind Singh Medical College,Faridkot  The field practice area is composed of 95 villages where home-based comprehensive health care is provided. It covers a population of 230635

36. CHC BAJAKHANA CHC covers 5 PHCs PHC Bargari PHC Panjgrahi PHC Gurusar PHC Rodikapura PHC Hareno

37. SERVICES PROVIDED OPD Services  IP Services Lab facilities  Immunization Services M.C.H Services Emergency Services Referral Services Awareness about water and Sanitation Care

38. Implementation of various National Health programmes RNTCP NRHM Family planning UIP NACP Covid control  programme

39. Man power Senior medical officer Medical officer Lady medical officer Senior pharmacist Staff Nurse (5) LHV Radiographer MPHW(F) MPHW(M) LT-1,LT-2 AYUSH –AMO(3) Information assistant . Trained Dai W.A (4) Chownkidar Sweeper Senior Assistant Junior Assistant (2) Clerk Accountant

40. REGISTRATION OPD slip for new patient is made @ Rs. 10 which is valid for 1 Month .  An entry register is maintained to calculate (1)Total income generated (2)no. of investigations done (3)no. of male,female and children patients

41.   OPD register ANC register   RCH register Children immunization register  Survey register Eligible couple register Cu T register Birth and death register COVID 19 Vaccine register Stock register Daily expense register Pharmacy Registers maintained

42. NURSING STATION Here BP, BMI of each patient is done & recorded on the card.  Immunization Clinic : Record of the immunization being done on Wednesday is maintained here.    EMERGENCY SERVICES   provided here.  First aid is provided by the nursing students being posted there for their ongoing training.  Dressing & suturing is done here

43. OPD Medical officer  - Dr.Avtarjeet Singh LMO – Dr.Kirandeep Kaur

44.  INVESTIGATIONS B R E, BT,CT, Blood grouping Sputum AFB, HBsAg , HCV, VDRL  ,Widal test,lgG&M for dengue Blood urea, ESR,RBS, Pregnancy test,URE RFT,LFT S.Albumin , Protein,bilirubin T/D S.Ca Cholestrol,TG RAT , Sample collection for RT PCR -  COVID19 ECG X-RAY

45. Field visit 95 villages 40 MPHW (M) 74 MPHW(F) 33 CHO 213 ASHA 11 ASHA facilitators

46. They collect the baseline data and then keep on adding changes at regular intervals.  Baseline  Data : Head of the family, Caste, family members, eligible couples, FP Status, Sen. Citizen, Pregnant, 0-5 children  Changes : if   new family has come or gone. (immigrant/ local)  New births and deaths  Eligible couples : Wife/ husband/ age/ parity incl. no. of abortions/ children(M/ F)/ DOB of youngest child/  FP Method  Maternity services : EDD, Date of ANC Visits, Delivery (Date/type/place/by whom) Each ANM maintains a record of the population of their villages by maintaining the family folders.

47. HEALTH MANAGEMENT INFORMATION SYSTEM Monthly reports Weekly AFP, Measles,VPD surveillance reports IDSP Daily Dengue survey

48. Funding User charges from patients Medicine supply – Punjab government Ayushman Bharat scheme Baba Farid patient care fund MP fund –Ambulance Donation from people

49. Summary The 2022 IPHS norms will retain the earlier approach of supporting government health facilities to attain a minimum acceptable functional standard  while striving and aspiring for improvement  so as to accelerate India’s progress towards achievement of UHC and SDG3 in alignment with the National Health Policy, 2017.  Norms for CHCs and UCHCs for delivery of secondary health care. It aims to support states with implementation of IPHS at public health facilities .

50. SUMMARY Secondary care specialist services closer to the community are envisaged to be delivered at the two types of CHCs  with assured multidirectional linkages . Services should be offered and distributed across the district in such a way that out-of-pocket expenditure of the community is reduced, especially for the vulnerable and marginalised . Apart from curative services, there should a strong focus on health promotion, prevention, palliation, and rehabilitation at both primary and secondary levels of facilities.