healthcare delivery system

healthcare delivery system

1. Unit 2,part 1 HEALTH CARE DELIVERY SYSTEM
Learning objectives-
After going through this unit, you should be able to:
understand health care delivery system and Organisation of Health Care at Various Levels
describe the organisation at district level and block level.
state the delivery of health services at Sub-centre, PHC and CHC level
enumerate the functions of SC, PHC and CHC;
describe the manpower of SC, PHC and CHC
discuss the organogram at national level;
to understand primary health care services
Chapter Outline
Health care delivery system in India
Infrastructure and Health sectors, Delivery of health services at sub centre (SC)PHC, CHC, District
level, state level and national level,
Sustainable development goals (SDGs),
Primary Health Care and Comprehensive Primary Health Care (CPHC)- elements, principles
CPHC through SC/Health Wellness Center (HWC)
National Health Care Policies and Regulations o National Health Policy (1983, 2002, 2017)
National Health Mission (NHM): National Rural Health Mission (NRHM), National Urban Health
Mission (NUHM), NHM
National Health Protection Mission (NHPM) and Ayushman Bharat
Universal Health Coverage
Health Care Planning and Organization of Health Care at various levels
Health planning steps
Health planning in India –various committees and commissions on health and family welfare and Five
Year plans
Participation of community and stakeholders in health planning

2. HEALTH CARE DELIVERY SYSTEM
INTRODUCTION:
According to WHO, Health is a state of complete physical ,mental and social well-being and not merely the
absence of disease or infirmity’ .The words “health care delivery system” speak to the coming change in
addressing health and illness needs of clients in the 21
st
century .It is true that promotion of health is basic to
national progress.One of the essential parts of an improved health care system will be an emphasis on
prevention and the active participation of clients in their own health choices whereas scientists will continue
to search for and find cures to many illnesses.
In recent years ,two major themes have emerged in Health Care Delivery system:
• Health services should be organized to meet the needs of entire population .It should cover the full
range of preventive curative and rehabilitative services.
• Primary health care services supported by appropriate referral system.
CONCEPTS OF HEALTH CARE DELIVERY SYSTEM:
Health is a fundamental human right. Health care is a public right. Hence it implies that the state authority has
a responsibility for the health of its people National governments of all countries around the globe are striving
to improve and expand their health care delivery services. . In country like India, health care is completely a
governmental affair. Since independence, India has created a vast public health infrastructure comprising of
several Sub-centres, Public Health Centres (PHCs) and Community Health Centres (CHCs). It is estimated
that this vast infrastructure is only benefitted by 20% of the population, while 80% of healthcare needs are still
being provided by the private sector.
In rural areas especially, there are pockets of under-served populations where the vicious circle of poverty,
Hence health care delivery system should be organized in such a manner that it can meet the needs of entire
population. Primary health care is best way to provide health services to the community. Hence all the possible
necessary actions and attempts should be made to improve quality of life of the entire population by improving
education, research sectors and also implementing and promoting health related policy and in order to improve
a system within a country, it is utmost important to acquire knowledge of various policies,program, health
projects running internationally
The concepts of health has been changing over the years in response to an increase awareness of health and
its relevance to national progress: initially when health care was equated with patient care, the objective was
the achievement of negative health or freedom from disease through hospital system.The concepts, though
inconsistent with current awareness of health care, has never been totally eliminated even in this era of “Health
for All”.
With the emergence of the concepts of positive health, health care came to be conceived as an integrated care
containing promotive,preventive and curative elements that bear a longitudinal association with an individual
extending from “womb to tomb” and continuing in the state of health as well as disease.
Delivery of health care services is the burning issue of the present time. The concern is to develop system
which ensures need based comprehensive health care service to people at large especially those living in
remote and backward areas using available resources as effectively as possible.
SYSTEM IN INDIA:
India is a union of 29 states and 7 union territories under the constitution of India, the states are largely
independent in matters relating to the delivery of health care to the people. Each state, therefore, has developed

3. its own system of health care delivery, independent of the central government. The central responsibility
consists of mainly policy, planning, guiding, assisting, evaluating and coordinating the work of state health
ministries so that health services cover every part of the country and no states lags behind for want of these
services. The health care services organization in the country extends from the national level to village level
from the total organization structure, the Government of India can slice the structure of health care system at
centre,State,District and Local level.
DEFINITIONS
Health
Health is defined as," a dynamic state of complete physical, mental and social well-being and not merely an
absence of disease or infirmity." (WHO)
Health Care
Health care is defined as," multitude of services rendered to individuals, families or communities by the agents
of the health services or professions for the purpose of promoting , preventing, maintaining, monitoring or
restoring health." (OXFORD DICTIONARY)
System
A set of interrelated and independent parts designed to achieve a set of goals.
HEALTH CARE SYSTEM
Health care delivery system is a system in which the services related to health care delivered to the target
population.
Health care delivery system is an integral part of the government, responsible to central authority and
interrelated in its activities with a general conduct to governmental affairs
Health System
Health system covers a whole extent of health activities, health programmes, institutions providing medical
care such as hospitals, clinics and primary health care centres and the policies enunciated by governments to
provide optimal health care for its citizens.
In general health system defines as "Complex of facilities, organizations, and trained personnel engaged in
providing health care within a geographical area.
Level of organization.

4. ORGANIZATION OF HEALTH SERVICES AT THE CENTRE LEVEL:
Health care organisation at centre comprised of three organs .These are:
• Union Ministry of Health and Family Welfare.
• The Directorate general of health services
• Central council of Health and Family Welfare
▪ Union Ministry of health and family welfare:
▪ ORGANIZATION PATTER N:
Cabinet minister

Department of health Department of Family welfare
Joint secretary Additional secretary
Deputy secretary commissioner
Administrative staff Joint secretary
Administrative staff

Organization:
The Union Ministry of health and family welfare is headed by cabinet minister,a minister of state and deputy
health ministers. These are political appointments and have dual role to serve political as well as administrative
responsibilities for health.
Central level
State level
District level
block and village level
(community level and grass route level)

5. For all administrative purposes, the union health and family welfare minister seeks at the health secretariat
headed by the secretary. The Secretary is assisted by a number of additional, joint, deputy and assistant
secretary and various other administrative staff.
Further union ministry of health and family welfare comprised of 4 departments all headed by secretary level
person.
• The department of health
• The department of family welfare
• The department of Indian system of Medicine and Homeopathy
• Department of research
The Department of Health:-
The Department of Health deals with planning,co-ordination, programming, evaluation of medical and public
,health matters, including drug control and prevention of food adulteration.Department of Ayurveda,Yoga-
Naturopathy,Unani,Sidha and Homeopathy (AYUSH) and department of Health Research.Each of these
departments is headed by respective secretaries to Govt. of India.The department of Health and Family Welfare
is supported by a technical wing,the Directorate general of health services,headed by Director General of
Health Services (DGHS).

6. diagram -Official organs at National level

Department of Family Welfare:
The department of family welfare was created in 1966 within the ministry of health and family welfare.The
secretary to the Government of India in the ministery of health and family welfare is overall incharge of the
department of family welfare.He is assisted by the additional secretary and commissioner and one joint
secretary.
The department of FW deals with FW matters.The department is headed by secretary to the Govt. Of India,
union ministry of health and FW, who is supported and assisted by a team of two joint secretaries, two chief
directors, number of deputy secretaries, deputy commissioners, directors and other technical and
administrative officers in hierarchy.The following Technical Divisions of the Technical divisions of the FW
department.The following Technical Divisions are:
health
minister,deputy
health minister,state
health minister
central level health
organization
ministryof health
and family welfare
secretary
joint secretery
deputy secretary
various departments administrative staff
commissioner aor
director of family
welfare
joint secretary
deputy director
various departments administrative staff
DGHS
deputy DGHS
medical care and
hospital
nursing Advisor
deputy DGHS
public health
additional DGHS
general
administration
depputy DGHS
office staff
central council of
health

7. • Programme Appraisal co-ordination and training and sterilisation division.
• Technical Operations Division.
• Maternal and child health division.
• Evaluation and intelligence division.
• Mass education and media (including population education) division.
• Nirodh marketing division.
• Project division(area projects)

Functions: The functions of union health ministry are set –out in the seventh schedule of Article 246 of
the constitution of India under (a) union list function are central government responsibilities and
(b)concurrent list are both central and state government responsibilities



The Department of ISM and homeopathy:-
This department (ISM and H ) is headed by the secretory to the Govt. Of India. The secretary is assisted by
one joint secretary, one director,four advisors and several Dy. Advisors of Ayurved sidha, unani and
Homeopathy.There are 2 subordinate officers and 15 autonomous bodies under this department and more than
4000 persons are working in these offices and institutions.The total sanctioned strength of the departments in
groups A,B,C and D is 202 which include Secretariat and Technical Posts and senior level posts such as
Director (Ayurveda and Sidha),Adviser (Ayurveda),Adviser (Unani) and Adviser (homeopathy) have been
created for providing expert advice on policy formulation and Execution, complex technical and
Parmacopoeial matters.

DIRECTORATE GENERAL OF HEALTH SERVICES:

ORGANIZATION: The Director General of health services is the principal advisor to the union Government
in both the medical and public health matters. He is assisted by an additional Director General of Health
services, a team of deputies and a large administrative staff. The directorate comprises three main units,e.g.
medical care and hospitals, public health and general health administration.


union list
•International health relations and administration of post
quarantine
•Administration of central institutes such as the All India
Institute of Hygiene and Public Health Kolkata ,National
Institute for the control of communicable Diseases, Delhi
etc.
•Promotion of research through research centers and
other bodies.
•Regulation and development of medical,
pharmaceutical,dental and nursing professions.
•Establishment and maintenance of drug standards
•Censuses,collection and publication of other statistical
data
•Immigration and emigration
•Regulation of labor in working of mines and oil fields
•Coordination with states and with other ministries for
promotion of health.
concurrent list
•Prevention of extension of communicable
disease from one unit to another
•Prevention of adulteration of food stuffs
•Control of drugs and poisons
•Vital statistics
•Labor welfare
•Ports other than major
•Economic and social planning
•Population control and family planning.

8. Directorate gernal of health services

Director general of health services

Additional director general of health services

Deputy directorate general of health services

Administrative staff
FUNCTIONS:
• International health relations:- All major posts in the country and international airports are directly
controlled by the directorate general of health services.

• Control of drug standards:-The drugs control organization is a part of directorate general of health
services and is headed by the drug controller.Its primary function is to laydown and enforce standards
and to control the manufacture and distribution of drugs through both central and state government
officers.


• Medical store depots:-These depots supply the civil medical requirement of the central government
and of various state governments.These depots also handle supplies from foreign agencies.

• Postgraduate training:-The directorate general of health services is responsible for the administration
of national institutes, which also provide post – graduate training to different categories of health
personnel.
• Medical education:-DGHS is responsible for the administration of the following institutions:
-All India Institute of Hygiene and Public Health, Kolkata
-Nehru Hospital, Chandigarh
-Autonomous Institutes (AIIMS,PGI)
-Medical College,Goa etc
• Several other National Institutes, Laboratories and Hospitals.
✓ Medical research:-Medical Research in the country is organized largely through the Indian Council
of Medical Research, founded in New Delhi. The council plays a significant role in aiding, promoting
and coordinating scientific research on human diseases, their causation, prevention and cure.
✓ Central government health scheme:
-National health programs:The various national health programs for the eradication of malaria and
control of Tuberculosis, filarial, leprosy and other communicable diseases involve expenditure of crores of
rupees.
-Central health education bureau:-An outstanding activity of this bureau of educational material for
creating health awareness among the people.

9. -Health intelligence:-The central bureau of health intelligence was established in 1961 to centralize
collection, compilation, analysis, evaluation and dissemination of all information on health statistics for the
nation as a whole.
-National medical library{established in 1966}:-The aim is to help in the advancement of medical, health
and relatedsciences by collection, dissemination and exchange of information.

CENTRAL COUNCIL OF HEALTH : The central council of health was set up by a presidential order
in August,1952,under article263 of the constitution of India for promoting coordinated concerted action
between the center and the states in implementation of the all the programs and measures pertaining to
the health of the nation. The union health minister is the chairman and the state health ministers are the
members.

ORGANIZATION PATTERN of council:

Chair man (union health minister)

Members(state health minister)
FUNCTIONS:

• To consider and recommend broad outline of policies in regard to matters concerning health in all its
aspects such as the provision of remedial and preventive care, environmental hygiene , nutrition , health
education etc.
• To make proposal for legislation in the field of medical and public health matters
• To lay down the pattern of development in the country as a whole
• To make recommendations regarding distribution of available grants-in-aid.
• To review periodically the achievements in different areas through the utilization of funds available
from grants-in-aid.
• To established any organisations for promoting and maintaining cooperation between the central and
state health administrations.
CENTRAL FAMILY WELFARE COUNCIL: -
There is central family welfare council on the similar lines of central council of health. The union Health
Minister is the chair-person and Health Ministers are the members.The council meets as and when
necessary, but usually once in a year. It perform following functions:
• To consider and recommend broad policy outlines on all matters pertaining to family welfare
aspects.
• To review the implementation of the family welfare programmes.
• Promoting and maintaining co-ordination between centre and state Governments.
In addition, there are other high level advisory bodies which are as under.
• Population Advisory council:-It was set up in 1982. It is headed by the Union Health Minister
,Members of Parliament and expert people from the area of population control are the members.
This body does analysis of the implementation of the programme and accordingly advice the
Government.
• Cabinet sub-committee:-A Cabinet sub-committee headed by the Prime minister is also formed
to

10. • review the progress of family welfare programme.
The joint conference of the central council of health and the central family welfare council is held as and
when necessary. This is done to review the progress of various aspects of Health and Family Welfare
Programme, priorities are set, strategies are developed and recommended for implantation etc.
ORGANIZATION OF HEALTH SERVICES AT THE STATE LEVEL: -
Health being a state subject, state Governments have autonomy in dealing with health matters given in the
state list and some aspects given in the concurrent list.
Each state has organised the structure to provide health care services with some variations or the other.
Altogether there are 29 states and 7 union territories. The organisation structure is as under:
1. The state ministry of health and family welfare
2. State directorate of health.

11. HM state ministry
health and
family
welfare
principal health
secretary
joint seceretary
deputy seceretary
medical care medical
,nursing,pharmacy
education
others
directorate
of health
functional
directors
FOR
Special
functions-
leprosy,mc
h,tb,HIV
aids,statisti
c,services
etc
regional
director
dIStrict
level
program
officers
assistant
directors
CMHO
district
level
rural health
system
CHC
PHC
SC
VILLAGE LEVEL
WORKERS
urban
health
system
UCHC
UPHC
HEALTH POST/HWC -
SC
COMMUNITY LEVEL
WORKERS
PMO-district hospital
curative
services,refferal
cases from entire
district

12. State Ministry of Health and Family Welfare:

13. Organization pattern:
State Minister of Health and Family Welfare:

Deputy minister of health and family welfare

Health secretary

Additional and Deputy secretary

Administrative staff

Organization:
The State Ministry of Health and Family Welfare is headed by cabinet minister and deputy minister. The
minister of cabinet rank is the political head of the department of Health and FW . The Health minister has to
perform both the activities, i.e. political as well as administrative as follows:
Functions:
• As a member of the state legislature it is his duty to support and safeguard the total policies of the
govt. Because of the collective responsibility of the cabinet.
• As a member of ministry, he brings all the bills pertaining to his department for approval of the
legislature.
• As political head of the health department, he acts as an executive and administrator. He has to see the
policies approved by the legislature are faithfully implemented.
• As a member of government ,he performs ceremonial duties.
Health secretariat:-
Organization:-In order to keep a record of the policies framed by the political heads and to watch over their
implementation, he has to seek the help of an official which is known as “secretariat” .Health secretariat is the
official organ of the state health ministry. The secretary of the state government is a senior officer of the India
Administrative Services, is the administrative head and is assisted by additional secretary, deputy secretary
etc,. The main duties of health department are as follow:
Functions:-
• Assisting the minister in policy making in modifying policies from time to time and in the discharge
of the legislative responsibility.
• Framing draft legislation and rules and regulations.
• Coordination of policies and programs, supervision and control over their execution and review of
results.
• Budgeting and control of expenditure.
• Maintaining contact with government of India and other state governments.
• Overseeing the smooth and efficient running of administrative machinery.
State Health Directorate :-
Organization:-The Director of Health and Family Welfare is the principal advisor to the state government on
all matters relating to medicine and public health as he is technically qualified person in the field, may be

14. called as technical head of the department of health and family welfare .He is assisted by joint Director and
Deputy and Assistant Directors of major wing.


Functions:-

✓ To provide adequate medical care through hospitals, dispensaries, health centres and mobile
domiciliary units both in rural and urban areas.
✓ To make proper arrangement for medical education and research.
✓ Proper implementation of National Health Programs.
✓ To make previsions for personal and impersonal health services. These are:-Immunization services,
nutrition, school health, Industrial health, Family planning, Rural and urban sanitation, control of fairs
and festivals, Drugs and food control etc.
✓ Control of food and drug administration
✓ Collection and dissemination of health information
✓ Control over ESI scheme
✓ Enforcement of professional bodies
✓ Setting of Laboratories
✓ Provision of Integrated family welfare services.
✓ Preparation for the enactment of health legislation.
✓ Promotion of indigenous system of medicine.
Health care organization at the District level:
The principle unit of administration in India is the district under a collector .There are 739 in year
2020.(previously 640 in 2011 census )district in India.Within each district there are 6 types of administrative
areas.
1. Sub-division
2. Tehsils(Taluks)

15. 3. Community Development Blocks
4. Municipalities and corporations
5. Panchayat and Villages
Panchayats
• Most of district in India are divided into two or more subdivision,Each incharge of an Assistant
Collector or Sub Collector.
• Each division is again divided into Taluks, incharge of a Thasildhar.A taluk usually comprises between
200 to 600 villages.
• The community development block comprisesapproximately 100 villages and about 80000 to 1,20,000
population, incharge of a Block Development Officer.
• Finally, there are the village panchayats, which are institutions of rural self-government.
• Local self government in the urban Areas of the District are organized into:
• Town Area Committee (in area with population ranging between 5,000 to 10,000). These are like
panchayats and provide sanitary services in the areas.
• Municipal Boards(in areas with population ranging between 10,000 and 2,00,000).The municipal
Board is headed by chairman/ President, elected usually by its members.The team of members ranges
from 3-5 years. The municipal Board looks after sanitation, drainage, water supply, construction and
maintenance of roads, registration of birth and death, education etc.
Corporations (with population above 2, 00,000).The corporation is headed by a Mayor. Its members are the
councillors who are elected from various wards of the city. The executive agency headed by the commissioner.
It carries the similar functions as that of Municipal Board but on a large and wider scale.

16. Local self Government in Rural (Panchayati Raj):
The panchayati Raj System is composed of three –tier structure of rural local self government meant to involve
people at various levels of administration .This system is introduced since 1957 to link villages to district.
• At village level: Panchayat
✓ Gram sabha
✓ Gram Panchayat
✓ Nyaya Panchayat

• At Block level :Panchayat samiti.
• At district Level: Zila parishaya
Panchayat (At village level):

Gram sabha:It is comprised of all adult men and women of the village.This body meets at least twice in a
year and discuss important issues and consider proposals pertaining to various developmental aspects
ancluding health matters etc.The gram sabha elects members of panchayat.
The Gram Panchayat: It is the executive organ of the gram sabha and anagency for planning and
development at thevillage level. The population covered varies from5000 to 15000 or more. The members
ofpanchayat hold offices for a period of 3to4 years.Every panchayat has an elected president(Sarpanch or
Sabhapati or Mukhia), a vicepresident and panchayat secretary. It covers thecivic administration including
sanitation andpublic health and work for the social andeconomic development of thevillage.
Nyaya Panchayat:It is comprised of 5 members from the panchayat.It tries to solve the dispute between two
parties/group/individual over certain matters on mutual consent.
Panchayat Samiti (at the block level):• The block consists of about 100 villages and a population of about
80,000 to 1,20,000. The panchayat samiti consists of Sarpanch, MLAs, MPs residing in block area,
representative of women, SC, ST and cooperative societies. The primary function of The Panchayat Samiti

17. is the execute the community development programme in the block. The Block development Officer and his
staff give technical assistance and guidance in development work.
Zila Parishad (at the district level): The Zila Parishad is the agency of rural local self government at the
district level . The members of Zila parishad include all heads of panchayat samiti in the district, MPs, MLAs,
representative of SC, ST and women and 2 persons of experience in administration, public life or rural
development. Its functions and powers vary from state to state.
District Health Organization: Since health is a state subject, there is no uniform health organisational set
up in the districts.Each state has developed its own pattern according to their own requirements. In
general,CMHO or CMO is incharge of district level health organization and he is assisted by 2/3deputy
CMHOs who supervised one half or two half of districts.they supervise work of BCMO at CHCs .
District hospital under principal medical officer provide curative services and treatment for reffered casesChief
Medical and Health Officer - CM & HO is a Director of health and family welfare service at the district in
rural area and are overall in-charge of the health and family welfare programmes in the rural area. CM&HO
is assisted by Dy. CMO, RCH officer and programme officers. Dy. CMO and RCH officer are assisted by
Block CMOs.
Principle Medical Officer (PMO)
Principle Medical Officer – PMO is a Director of health and family welfare service at the district in urban area
and is overall in-charge of the health and family welfare programmes in urban area.

18. FUNCTION OF HEALTH ORGANIZATION AT DISTRICT LEVEL :
• Coordinate health planning
• Investigate communicable disease
• Maintain free clinics for the early diagnosis of communicable disease
• Provide laboratory services to assist doctors
• Conduct clinics for administration of vaccines
• Collect vital statistics
• Provide MCH services
• Maintain a public health nursing service
• Supervise water supply and sewage disposal
• Conduct health education programs
• Promulgate rules and regulations
• Provide mental health services
• Provide family planning services.
Health care Organization at the block level:The organizational structure at the block level is
developed to provide health care services in the rural areas and part of the rural health scheme.It
consist of:

(1) At village level
(2) At sub center level
(3) At PHC level
(4) At CHC level

Infra structure
subcenters PHC CHC
Total number till march
2020
160713 (157411
rural+3302 urban)
30045 (R24855+U5190 5685 (R 5335+U350)
Population norms 3000-5000 20000-30000 80000-120000
Radial area in km 2.46 6.18 13.35
No.of village covered 4 26 120


village level
•panchayat
•gram
panchayat
•gram sabha
•nyay panchayat
block level
•panchay
at samiti
district level
•zila
panchay
at or zila
parisad

19. • Each block has one community health centre covering a population of 80,000-1,20000.
• Each CHC has 30 sanctioned beds .
• CHC is considered as the first referral unit for referring patients.
• Each CHC has three to four PHC. Each PHC covers a population of 30,000 in plain area 20,000 in
hilly and tribal areas.
• Each PHC has 5 to 6 subcentres.Each sub centre covers a population of 5000 in general and 3000 in
hilly,tribal and backward areas.

At village level:
At each village there is a village health post for 1000 population . At the village level, elementary services are
rendered by
(a) Village health guide(only in selected state most of state abolished this scheme after 2004)
(b) Local dais
(c) Anganwadi workers
(d) ASHA

Village health guides:-
• Village health guide is a person with anaptitude for social service and is not full time govt. functionary.
Recruited after shri vastav committee recommendation.
• Village health guides scheme was introduced on 2nd oct. 1977.
• They should be permanent resident of the local community, preferably women.
. Functions of Village health guides:
(1) Provide treatment for common minorailments
(2) First aid during accidents and emergency
(3) MCH care
(4) Family planning
(5) Health education

: Local dai • Most deliveries in rural areas are handled byuntrained dais

20. • . The training for dais given for 30working days
• . Each dai is paid stipend of Rs. 300during the training period.
The training is given at PHC,subcenters or MCH center for 2 days in a weekend on the remaining four days
of the week they accompany the health worker(female) to the village. During her training each dai is
required to conductat least 2 deliveries under the supervision andguidance of health worker (female), ANM
,healthassistant (female).

Functions of dais:

:(1) MCH care
(2) Family planning
(3) Immunization
(4) Education about health
(5) Referral services
(6) Safe water and basic sanitation
(7) Nutrition

Anganwadi worker:
• Under the ICDS scheme(ministry of women and child development) there is an anganwadi worker for
a population of 800- 1000. They are under ministry of women and child developement
• There are about100 such workers in each ICDS project.
• The anganwadi worker is selected from the community and she undergoes training in various aspect
of health, nutrition and child development for 4 months
• . She is a part time worker and paid an honorarium of Rs.2000-4500 (different for different state)per
month for the services.

. Functions of anganwadi worker
(1) MCH care
(2) Family planning
(3) Immunization
(4) Education about health
(5) Referral services
(6) Safe water and basic sanitation
(7) Supplementary nutrition
(8) Nonformal education of children

Accredited Social Health Activist(ASHA)
• One of the key components of the National Rural Health Mission is to provide every village in the
country with a trained female community health activist – ‘ASHA’ or Accredited Social Health
Activist. Selected from the village itself and accountable to it.
• The general norm will be ‘One ASHA per 1000 population’.or 200-250 households
• ASHA must be primarily a woman resident of the village ‘Married/Widow/Divorced’ and preferably
in the Age group of 25 to 45 yrs.

21. • Roles and responsibilities of ASHA:• provide information to the community ondeterminants of health
such as nutrition, basicsanitation & hygienic practices, healthy living.
• She will counsel women on birthpreparedness, importance of safe delivery, breast-feeding and
complementaryfeeding etc.





























HEALTH INFRASTRUCTURE AT BLOCK LEVEL

22. SUB-CENTRE:

Objectives of the Indian Public Health Standards for Sub-Centre
a. To specify the minimum assured (essential) services that Sub-centre is expected to provide and the desirable
services which the states/UTs should aspire to provide through this facility.
b. To maintain an acceptable quality of care for these services.
c. To facilitate monitoring and supervision of these facilities.
•4/6 subbcenters
covered
ASHA,TBAs,AWWs
at village level
village level
•4/6 primary health
centers
panchayat
level •community health
centers
block level

23. d. To make the services provided more accountable and responsive to people’s needs.
A Sub-Centre is the smallest or the grass-root level of primary health care system in India. Situated in the
peripheries of every village in India, it serves as the link between the community and the health care system.
Usually, there are about 6 Sub-Centres under every Primary Health Centre (PHC,The sub-centre is the
peripheral outpost of the Indian healthcare system.
One subcentre caters to the healthcare needs of 5000 population in general and 3000 population in hilly, tribal
and backward .
SCs are assigned tasks relating to interpersonal communication in order to bring about behavioral change and
provide services in relation to maternal and child health, family welfare, nutrition, immunization, diarrhea
control and control of communicable diseases programs. The Ministry of Health & Family Welfare is
providing 100% central assistance to all the SCs in the country since April 2002 in the form of salaries, rent
and contingencies in addition to drugs and equipment areas..
As on 31st March 2019, there are a total 160713 Sub Centres (SCs) (157411 rural + 3302 urban) functioning
in India. Further, out of 157411 SCs, 7821 SCs have been converted into Health and Wellness Centres (HWCs)
in rural areas and out of 3302 urban SCs, 98 SCs have been converted into HWCs in urban areas
Services provided by subcentre:
▪ antenatal, natal, postnatal
▪ family planning and counselling
▪ treatment of common illnesses like respiratory tract infections, diarrhoea, fever, worm infestation
▪ prevention of malnutrition
▪ implementation of various national health programmes

Staff pattern of sub-centre:
MLHP (midlevel health provider) or CHO (community health officers) posted only in health wellness center
.they provide expanded range of primary health services.( Detail in ayushman bharat yojna)
▪ 1 female health worker – Auxiliary nurse midwife
▪ 1 male health worker – Multipurpose worker
▪ Voluntary worker to help the Auxillary urse midwife
Not-1 Female Health Assistant (Lady Health Visitor) and 1 Male Health Assistant at the PHC level are
given the supervision of 6 sub-centers

Categorization of Sub-Centers
In view of the current highly variable situation of Sub-centers in different parts of the country and even with
in the same State, they have been categorized into two types - Type A and Type B. Categorization has taken
into consideration various factors namely catchment area, health seeking behavior, case load, location of other
facilities like PHC/CHC/FRU/Hospitals in the vicinity of the Sub-centre.

Type A Type B
Type A Sub Centre will provide all recommended
services except that the facilities for conducting
delivery will not be available here. However, the
ANMs have been trained in midwifery, they may
conduct normal delivery in case of need
This would include following types of Sub-centers:
i. Centrally or better located Sub-centers with good
connectivity to catchment areas.
ii. They have good physical infrastructure preferably
with own buildings, adequate space, residential
accommodation and labour room facilities.
iii. They already have good case load of deliveries

24. from the catchmen t areas.
iv. There are no nearby higher level delivery
facilities



Functions of a Sub-Centre:
1.Maternal and Child Health
Maternal Health
i. Antenatal care:
• Early registration of all pregnancies, within first trimester (before 12th week of Pregnancy).However
even if a woman comes late in her pregnancy for registration, she should be registered and care given
to her according to gestational age.

Minimum 4 ANC including Registration Suggested schedule for antenatal visits:
1st visit: Within 12 weeks—preferably as soon as pregnancy is suspected—for
registration, history and first antenatal check-up
2nd visit: Between 14 and 26 weeks
3rd visit: Between 28 and 34 weeks
4th visit: Between 36 weeks and term
• Associated services like general examination such as height, weight, B.P., anaemia, abdominal
examination, breast examination, Folic Acid Supplementation (in first trimester),Iron & Folic Acid
Supplementation from 12 weeks, injection tetanus toxoid, treatment of anaemia etc.
• Recording tobacco use by all antenatal mothers.
• Minimum laboratory investigations like Urine
➢ Test for pregnancy confirmation, haemoglobin estimation, urine for albumin and sugar and linkages
with PHC for other required tests.
• Name based tracking of all pregnant women for assured service delivery. Identification of high risk
pregnancy cases. Identification and management of danger signs during pregnancy.
• Malaria prophylaxis in malaria endemic zones for pregnant women as per the guidelines of NVBDCP.
• Appropriate and Timely referral of such identified cases which are beyond her capacity of
management.
• Counselling on diet, rest, tobacco cessation if the antenatal mother is a smoker or tobacco user,
information about dangers of exposure.

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

25. Postnatal care:
Initiation of early breast -feeding within one hour of birth.
Ensure post-natal home visits on 0, 3, 7 and 42nd day for deliveries at home and Sub-centre
(both for mother & baby).
Ensure 3, 7 and 42nd day visit for institutional delivery (both for mother & baby) cases. In case of Low Birth
weight Baby (less than 2500 gm), additional visits are to be made on 14, 21 and 28th days.
During post-natal visit, advice regarding care of the mother and care and feeding of the newborn and
examination of the newborn for signs of sickness and congenital abnormalities as per IMNCI Guidelines and
appropriate referral, if needed.
Counselling on diet & rest, hygiene, contraception, essential newborn care, immunization, infant and young
child feeding, STI/RTI and HIV/AIDS.
Name based tracking of missed and left out PNC cases.


2 Child Health
Newborn Care Corner In The Labour Room to provide Essential Newborn Care.
Immunization Services.

3 . Family Planning and Contraception
Education, Motivation and counselling to adopt appropriate Family planning methods. Provision of
contraceptives such as condoms, oral pills,copper T and emergency contraceptives.
Home delivery of contraceptives(HDC) by ASHA worker to reduce unmet need of family planning for this
she can get payment of rupees 1 for MALA D and 2 rs for emergency pills

Safe Abortion Services (MTP)
Counselling and appropriate referral for safe abortion services (MTP)
Follow up for any complication after abortion/MTP and appropriate referral if needed.


Curative Services
Provide treatment for minor ailments including fever, diarrhea, ARI, worm infestation and First
Aid including first aid to animal bite cases (wound care, tourniquet (in snake bite) assessment and referral).
Appropriate and prompt referral.

Adolescent Health Care

School Health Services
Screening, treatment of minor ailments, immunization, de-worming, prevention and management of Vitamin
A and nutritional deficiency anemia and referral services through fixed day visit of school by existing
ANM/MPW.
Staff of Sub-centre shall provide assistance to school health services as a member of team

26. Disease Surveillance, Integrated Disease Surveillance Project (IDSP)
Surveillance about any abnormal increase in cases of diarrhea/dysentery, fever with rigors,fever with rash,
fever with jaundice or fever with unconsciousness and early reporting to concerned PHC as per IDSP
guidelines.
Immediate reporting of any cluster/outbreak based on syndromic surveillance.

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

Out reach/Field Services

Village Health and Nutrition Day (VHND)

Home Visits
Coordination and Monitoring
Coordinated services with AWWs, ASHAs, Village Health Sanitation and Nutrition Committee PRI etc.

HOUSE TO HOUSE SERVICES
These surveys would be done once annually, preferably in April. Some of the diseases would require special
surveys- but at all times not more than one survey per month would be expected. Surveys would be done with
support and participation of ASHAs, Anganwadi Workers, community volunteers, panchayat members and
Village Health Sanitation and Nutrition Committee members.

National Health Programmes
Communicable Disease Prgrammes-Kit A and B are being supplied at present biannually. Contents of the
kits may be revised from time to time

Promotion of Medicinal Herbs
Desirable Locally available medicinal herbs/plants should be grown around the Sub-centre as per the
guidelines of Department of AYUSH.

Record of Vital Events
Recording and reporting of vital events including births and deaths, particularly of mothers and infants to the
health authorities.

Funds for SC
As part of Rural Health National Mission, it is proposed to provide rs. 10,000 as untied fund. In joint account
of

27. ▪

Physical Infrastructure
A Sub-centre should have its own building or be rented in a central location with easy access to
population.
Location Sub-centre to be located within the village for providing easy access to the people and safety
of the ANM and within 3 km to reach of people the Sub-centre.
The Sub-centre village has some communication net work (road communication/public transport/ post
office/telephone).
Sub-centre should be away from garbage collection, cattle shed, water logging area etc.
the concerned Panchayat should also be consulted in Building and Lay out Boundary
wall/fencing:Boundary wall/fencing with Gate should be provided for safety and security.
Residential facility sepate for femal and maleHealth Worker , if need is felt, may be provided by expanding
the Sub-centre building to the first floor or on rented, The entrance to the Sub-centre should be well lit and
easy to locate. It should have provision for easy access for disabled and elderly. Provision of ramp with railing
to be made for use of wheel chair/stretcher trolley, wherever feasible.
Type B Sub-centre should have, about 4 to 5 rooms with facilities of
Waiting Room ,
One Labour Room with one labour table and Newborn corner ,
One room with two to four beds (in case the no. of deliveries at the Sub-centre is 20 or more, four beds will
be provided) ,
One room for store ,
One room for clinic/office ,
One Toilet facility each in labour room ward room and in waiting area (Essential)

28. Furniture at sub center level quantity Subcentre Equipment Kit (Kit –
C) and other additional
equipment
Examination Table 1
Item description Quantity/kit
1.Basin Kidney 825 ml (28 OZ)
Stainless steel,
2. Tray instrument/Dressing with
co
3. Flashlight Box-type pre-
focussed 4 cell 1
4. Jar Dressing with cover 0.945
litre stainless steel 1
5. Hemoglobinometer –set Sahl 1
type complete 1
6. Scale bath room
metric/Avoirdupois 125kg/280 lb 1
7.Sheeting plastic clear PVC CM x
180 cm 2
8. Forceps Tissue – 160 mm 1
9. Forceps sterilizer (Utility) 200
vaughm ss 1
10.Scissors surgical straight
140mm S/B, ss 1
11.Reagent strips for urine test 1
12 SIMS Uterine
Depressor/Retractor 1
13. Measure 1 litre Jug –ss 1
14. Basin solution deep
Approx.6litre ss
Ref: IS: 5764 1
15. Brush Surgeon’s white Nylon
Bristles 2
16.Sphygmomanometer 17.
Battery Dry cell 1.5, D type for 10C
4
18. Scale, Infant metric 1
19. Lancet ss(Magedorn needle) 75
mm pkt of 6 1
20. Forceps hemostat straight Kelly
140mm ss 1
21. Forceps uterine vulsellum
curved 25.5 cm 1
22. Speculum vaginal bi-valve
cusco’s/Graves medium 1 23.
Speculum vaginal double ended
Sims ISS Medium 1
24. Measure ½ litre jug-SS 1
25.Sound, Uterine Graduated 1
26. Sterilization kit - 2
Writing table 3
Armless chairs 5
Medicines chest 1
Labour table 1
Wooden table 1
Foot steps 1
Coat rack 1
Bed side table 1
Stools 2
Almirahs 1
Lamp 3
Side wooden racks 2
Fans 3
Tubelights 3
Basin stand

1

29. 27. Vaccine Carrier - 2
28.Ice pack box - 4
29. Sponge holder - 10
30. Forceps - 20
31. Suture needle straight - 12
32. Suture needle curved - 12
33. Kidney tray - 4(big) & 4 (small)
34. Syringe - 12(10cc)
35. Disposable gloves - 20
36. Mucus extractor - 4
37. Clinical Thermometer oral &
rectal - 1 each
38. Torch - 2
39. Urethral catheter, 12fr, rubber 1
40. Foetoscope 1
41. Rack-Blood sedimentation
Westergren 6-unit 1
42. Scale, weighing (baby) hanging
type,
colour coded 5 kg 1
43. Forceps, spring type, dressing
160mm,
stainless steel 1
44. Forceps artery, straight, pean
160mm
Stainless steel 2
45. Scissors, cord cutting, busch,
curved on flat,
46. Can enema with tubing and clip
1
47. Talquist Hb scale 1
48. Haemoglobin Colour Scale
(WHO approved) 1
49. Uristix (urine test for the
presence of protein) 1 full container
50. Diastix (urine test for the
presence of sugar) 1 full container
51. Stethoscope 1
52. Micro-glass slides 1 Pkt for 100
slides per annum
53. Disposable lancet (Pricking
needles)
54. Disposable Sterile Swabs
55. Slide boxes of 25 slides 2

30. Waiting area ( 3300mm x 2700mm)
• Prominent display boards in local language providing information regarding the services available and
the timings of the Sub-centre.
• Visit schedule of ANM
• Suggestion/complaint boxes for the patients/visitors and also information regarding the person
responsible for redressal of complaints.
Labour Room (4050mm x 3000mm)
Clinic Room (3300mm x 3300mm)
Examination room (1950mm x 3000mm)
Toilet (1950mm x 1200mm)
The location of the toilet except that adjacent to the labour room preferably be located outside the building of
the Sub-centre.
Residential Accommodation: this should be made available to the Health workers with each one having 2
rooms, kitchen, bathroom and WC. Residential facility for one ANM is as follows which is contiguous with
the main subcentre area
· Room –1 (3300mmx2700mm)
· Room –2(3300mmx2700mm)
· Kitchen –1(1800mmx2015mm)
· W.C (1200mmx900mm)

31. · Bath Room (1500mmx1200mm)
One ANM must stay in the Sub-centre quarter and houses may be taken on rent for the other/ANM/Male
Health worker in the sub-centre village. The idea is to ensure that at least one worker is available in the
subcentre village after the normal working hours. For specification the “Guide to health facility design”
issued under Reproductive and Child Health Programme (RCH - I & II) of Government of India, Ministry of
Health & Family Welfare may be referred Residential Accommodation: this should be made available to the
Health workers with each one having 2 rooms, kitchen, bathroom and WC. Residential facility for one ANM
is as follows which is contiguous with the main subcentre area.
One ANM must stay in the Sub-centre quarter and houses may be taken on rent for the other/ANM/Male
Health worker in the sub-centre village. The idea is to ensure that at least one worker is available in the
subcentre village after the normal working hours. For specification the “Guide to health facility design” issued
under Reproductive and Child Health Programme (RCH - I & II) of Government of India, Ministry of Health
& Family Welfare may be referred.
Drugs:
The list of drugs that should be available as per the guidelines and accurate records of stock should be
maintained.

Records and Reports at subcenter

1. Eligible Couple Register including Contraception
2. Maternal and Child Health Register: a. Antenatal, intra-natal, postnatal b. Under-five register: i.
Immunization ii. Growth monitoring c. Above Five Child immunization d. Number of HIV/STI screening and
referral
3. Births and Deaths Register
4. Drug Register
5. Equipment Furniture and other accessories Register
6. Communicable diseases/Epidemic Register/ Register for Syndromic Surveillance
7. Passive surveillance register for malaria cases.
8. Register for records pertaining to Janani Suraksha Yojana.
9. Register for maintenance of accounts including untied funds.
10. Register for water quality and sanitation
11. Minor ailments Register
12. Records/registers as per various National Health Programme guidelines (NLEP, RNTCP, NVBDCP, etc.)

Note: 1. As many registers as possible should be integrated. 2. Health Management Information System
(HMIS) Reporting Format for Sub-Centre may be strictly followed for collection, recording and reporting of
Data

Quality control_by

1. Citizen’s charter of availablr services in local language (Yes/No) assess by Record Keeping and Reporting
Births & Deaths Other registers Reports sent to PHC No. of Fever cases No. of Blood slides prepared No. of

32. Malaria positive cases reported No. of cases given radical treatment No. of cases of minor illnesses - treated –
referred etc
2. Internal monitoring: supportive supervision and record checking at periodic intervals by the male and female
Health Assistants from PHC (at least once a week) and by MO (at least once in a month)
3. External monitoring: Village Health Sanitation and Nutrition Committee, evaluation by independent
external agency
4. Availability of various guidelines issued by GOI or State Govt. (Specify)

Primary Health Care (PHC)

Primary health care (PHC) is essential health care made universally accessible to individuals and acceptable
to them, through full participation and at a cost the community and country can afford. It is an approach to
health beyond the traditional health care system that focuses on health equity-producing social policy. Primary
health-care (PHC) has basic essential elements and objectives that help to attain better health services for all.
A primary health center (PHC) is established in a plain area with a population of 30, 000 people and in
hilly/difficult to reach/tribal areas with a population of 20, 000and is the first contact point between the village
community and the medical officer. PHCs were envisaged to provide integrated curative and preventive health
care to the rural population with emphasis on the preventive and promotive aspects of health care.
The PHCs are established and maintained by the State Governments under the Minimum Needs Program
(MNP)/Basic Minimum Services (BMS) Program.
There are 30045 Primary Health Centres (PHCs) (24855 rural + 5190 urban) functioning in Indiat till march
2019. Further, out of 24855 rural PHCs, 8242 PHCs have been converted into HWCs in rural areas and out of
5190 urban PHCs, 1734 PHCs have been converted into HWCs
As per minimum requirement, a PHC is to be staffed by a medical officer supported by 14 paramedical and
other staff. Under NRHM, there is a provision for two additional staff nurses at PHCs on a contract basis.
It acts as a referral unit for 5-6 SCs and has 4-6 beds for in-patients. The activities of PHCs involve health-
care promotion and curative services.
Essential Elements of Primary Health Care (PHC):
There are 8 elements of primary-health care (PHC). That listed below-
1. E– Education concerning prevailing health problems and the methods of identifying, preventing and
controlling them.
2. L– Locally endemic disease prevention and control.
3. E– Expanded programme of immunization against major infectious diseases.
4. M– Maternal and child health care including family planning.
5. E– Essential drugs arrangement.
6. N– Nutritional food supplement, an adequate supply of safe and basic nutrition.
7. T– Treatment of communicable and non-communicable disease and promotion of mental health.
8. S– Safe water and sanitation.

33. STAFFING PATTERN
STAFF ESSENTIIAL
Type A Type B
Medical Officer – MBBS 1 1
Medical Officer – AYUSH - -
Accountant cum data entry operator 1 1
Pharmacist 1 1
Nurse – Midwife (Staff – Nurse) 3 4
Health Worker (Female) 1 1
Health Assistant (Male) 1 1
Health Assistant (Female)/ Lady Health Visitor 1 1
Health Educator
Laboratory Technician 1 1
Multi Skilled group D worker 2 2
Watchman 1 1
TOTAL 13 14


Principles of Primary Health Care (PHC):
Behind these elements lies a series of basic objectives that should be formulated in national policies in order
to launch and sustain primary health-care (PHC) as part of a comprehensive health system and coordination
with other sectors.
1. Improvement in the level of health care of the community.
2. Favorable population growth structure.
3. Reduction in the prevalence of preventable, communicable and other disease.
4. Reduction in morbidity and mortality rates especially among infants and children.
5. Extension of essential health services with priority given to the undeserved sectors.
6. Improvement in basic sanitation.
7. Development of the capability of the community aimed at self-reliance.
8. Maximizing the contribution of the other sectors for the social and economic development of the
community.
9. Equitable distribution of health care– according to this principle, primary care and other services to
meet the main health problems in a community must be provided equally to all individuals irrespective
of their gender, age, and caste, urban/rural and social class.
10. Community participation-comprehensive healthcare relies on adequate number and distribution of
trained physicians, nurses, allied health professions, community health workers and others working as
a health team and supported at the local and referral levels.
11. Multi-sectional approach-recognition that health cannot be improved by intervention within just the
formal health sector; other sectors are equally important in promoting the health and self- reliance of
communities.
12. Use of appropriate technology- medical technology should be provided that accessible, affordable,
feasible and culturally acceptable to the community.

34. PHC Building
Location: It should be located in an easily accessible area. The building should have a prominent board
displaying the name of the Centre in the local language.
• The area chosen should have the facility for electricity, all weather road communication, adequate
water supply, telephone.

35. • It should be well planned with the entire necessary infrastructure. It should be well lit and ventilated
with as much use of natural light and ventilation as possible. The plinth area would vary from 375 to
450 sq. meters depending on whether an OT facility is opted for.
• Entrance: It should be well-lit and ventilated with space for Registration and record room, drug
dispensing room, and waiting area for patients.
• The doorway leading to the entrance should also have a ramp facilitating easy access for handicapped
patients, wheel chairs, stretchers etc.
Waiting area:
• This should have adequate space and seating arrangements for waiting clients / patients
• The walls should carry posters imparting health education.
• Booklets / leaflets may be provided in the waiting area for the same purpose.
• Toilets with adequate water supply separate for males and females should be available.
• Drinking water should be available in the patient’s waiting area.
There should be proper notice displaying wings of the centre, available services, names of the doctors, users’
fee details and list of members of the Rogi Kalyan Samiti / Hospital Management Committee. A locked
complaint / suggestion box should be provided and it should be ensured that the complaints/suggestions are
looked into at regular intervals and the complaints are addressed.
The surroundings should be kept clean with no water-logging in and around the centre and vector breeding
places.
Outpatient Department:
• The outpatient room should have separate areas for consultation and examination.
• The area for examination should have sufficient privacy.
• In PHCs with AYUSH doctors, necessary infrastructure such as consultation room for AYUSH Doctor
and AYUSH Drug dispensing should be made available.
Wards 5.5x3.5 m each:
• There should be 4-6 beds in a primary health centre. Separate wards/areas should be earmarked for
males and females with the necessary furniture.
• There should be facilities for drinking water and separate and clean toilets for men and women. The
ward should be easily accessible from the OPD so as to obviate the need for a separate nursing staff in
the ward and OPD during OPD hours.
• Nursing station should be located in such a way that health staff can be easily accessible to OT and
labour room after regular clinic timings.
• Clean linen should be provided and cleanliness should be ensured at all times.
• Cooking should not be allowed inside the wards for admitted patients
• A suitable arrangement with a local agency like a local women’s group for provision of nutritious and
hygienic food at reasonable rates may be made wherever feasible and possible. Cleaning of the wards,
etc. should be carried out at such times so as not to interfere with the work during peak hours and also
during times of eating.

36. Operation Theatre:
• It should have a changing room, sterilization area operating area and washing area.
• Separate facilities for storing of sterile and unsterile equipments / instruments should be available
in the OT.
• The Plan of an ideal OT has been annexed showing the layout.
• It would be ideal to have a patient preparation area and Post-OP area. However, in view of the
existing situation, the OT should be well connected to the wards.
• The OT should be well-equipped with all the necessary accessories and equipment f. Surgeries
like laparoscopy / cataract / Tubectomy / Vasectomy should be able to be carried out in these OTs.
Labour Room (3800x4200mm):
• There should be separate areas for septic and aseptic deliveries.
• The LR should be well-lit and ventilated with an attached toilet and drinking water facilities. Plan has
been annexed.
• Dirty linen, baby wash, toilet, Sterilization
Minor OT/Dressing Room/Injection Room/Emergency:
• This should be located close to the OPD to cater to patients for minor surgeries and emergencies
after OPD hours.
• It should be well equipped with all the emergency drugs and instruments.
Labour Room (3800x4200mm):
• There should be separate areas for septic and aseptic deliveries.
• The LR should be well-lit and ventilated with an attached toilet and drinking water facilities. Plan has
been annexed. c) Dirty linen, baby wash, toilet, Sterilization
Minor OT/Dressing Room/Injection Room/Emergency:
• This should be located close to the OPD to cater to patients for minor surgeries and emergencies after
OPD hours.
• It should be well equipped with all the emergency drugs and instruments.
Laboratory (3800x2700mm):
• Sufficient space with workbenches and separate area for collection and screening should be available.
• Should have marble/stone table top for platform and wash basins
General store:
• Separate area for storage of sterile and common linen and other materials/ drugs/ consumable
etc. should be provided with adequate storage space.
• The area should be well-lit and ventilated and should be rodent/ pest- free.
Dispensing cum store area: 3000x3000mm

37. Infrastructure for AYUSH doctor: Based on the specialty being practiced, appropriate arrangements should be
made for the provision of a doctor’s room and a dispensing room cum drug storage.
Immunization/FP/counseling area: 3000x4000mm
Office room 3500x3000mm
Dirty utility room for dirty linen and used items
Boundary wall with gate
Residential Accommodation:
Decent accommodation with all the amenities like 24-hrs. water supply, electricity, etc. should be available
for medical officers and nursing staff, pharmacist and laboratory technician and other staff
Equipment and Furniture:
• The necessary equipment to deliver the assured services of the PHC should be available in adequate
quantity and also be functional.
• Equipment maintenance should be given special attention.
• Periodic stock taking of equipment and preventive/ round the year maintenance will ensure proper
functioning equipment. Back up should be made available wherever possible.

FUNCTIONS
The Government of India's initiative to create and expand the presences of Primary Health Centres throughout
the country is consistent with the eight elements of primary health care outlined in the Alma-Ata declaration.
These are listed below:
• Provision of medical care
• Maternal-child health including family planning
• Safe water supply and basic sanitation
• Prevention and control of locally endemic diseases
• Collection and reporting of vital statistics
• Education about health
• National health programmes, as relevant
• Referral services
• Training of health guides, health workers, local dais and health assistants
• Basic laboratory workers
Apart from the regular medical treatments, PHC in India have some special focuses.
• Infant immunization programs: Immunization for newborns under the national immunization
program is dispensed through the PHC. This program is fully subsidised
• Anti-epidemic programs: The PHC act as the primary epidemic diagnostic and control centres for the
rural India. Whenever a local epidemic breaks out, the system's doctors are trained for diagnosis. They
identify suspected cases and refer for further treatment.

38. • Birth control programs: Services under the national birth control programs are dispensed through the
phcs. Sterilization surgeries such as vasectomy and tubectomy are done here. These services, too, are fully
subsidised.
• Pregnancy and related care: A major focus of the PHC system is medical care for pregnancy and child
birth in rural India. This is because people from rural India resist approaching doctors for pregnancy care
which increases neonatal death. Hence, pregnancy care is a major focus area for the PHC.
• Emergencies: All the PHC store drugs for medical emergencies which could be expected in rural areas.
For example antivenoms for snake bites, rabies vaccinations, etc.
FUNCTIONS

Medical care
OPD services: A total of 6 hours of OPD services out of which 4 hours in the morning and 2 hours in the
afternoon for six days in a week.
24 hours emergency services
Refferal services
In patient services

Maternal and Child Health Care Including Family Planning
a) Antenatal care: Services are provided as same as sub center level. Additional services are
laboratory investigations like Hemoglobin, Urine albumin and sugar, RPR test for syphilis and Blood
Grouping and Rh typing.

b) Intra-natal care: (24-hour delivery services both normal and assisted)
Management of normal deliveries.
Assisted vaginal deliveries including forceps.
Vacuum delivery whenever required. Manual removal of placenta

c) Proficient in identification and basic first aid treatment for PPH, Eclampsia, Sepsis and
prompt referral

d) Postnatal Care: As same as sub center level

e) New Born care

f) Care of the child
i. Routine and Emergency care of sick children including Integrated Management of Neonatal and Childhood
Illnesses (IMNCI) strategy and inpatient care. Prompt referral of sick children requiring specialist care.
• Counseling on exclusive breast-feeding for 6 months and appropriate and adequate complementary
feeding from 6 months of age while continuing breastfeeding.
• Assess the growth and development of the infants and under 5 children and make timely referral.
• Full Immunization of all infants and children against vaccine preventable diseases
• Tracking of vaccination dropouts. Vitamin A prophylaxis to the children as per v.
national guidelines.

39. • Prevention and control of routine childhood diseases, infections like diarrhoea, pneumonia etc. and
anemia etc.
• Management of severe acute malnutrition cases and referral of serious cases after initiation of
treatment.

g) Family Welfare
i. Education, Motivation and Counseling to adopt appropriate Family planning methods.
Permanent methods like Tubal ligation and vasectomy/NSV, where trained personnel and
facility exist.

Medical Termination of Pregnancies
Counseling and appropriate referral for safe abortion services (MTP) for those in need.


Management of Reproductive Tract Infections/Sexually Transmitted I nfections
a. Health education for prevention of RTI/STIs.
b. Treatment of RTI/STIs.

Nutrition Services (coordinated with ICDS)
a. Diagnosis of and nutrition advice to malnourished children, pregnant women and others.
b. Diagnosis and management of anaemia and vitamin A deficiency.
c. Coordination with ICDS.

School Health
Teachers screen students on a continuous basis and ANMs/HWMs (a team of 2 workers) visit the schools (one
school every 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 submitted by the teams.

Adolescent Health Care
To be provided preferably through adolescent friendly clinic for 2 hours once a week on a fixed day. Services
should be comprehensive i.e. a judicious mix of promotive, preventive, curative and referral services

Adolescent and Reproductive Health: Information, counseling and services related to sexual
concerns, pregnancy, contraception, abortion, menstrual problems etc.

Integrated Disease Surveillance Project (IDSP)
As same as SC level

Physical Medicine and Rehabilitation (PMR) Services
a. Primary prevention of Disabilities.
b. Screening, early identification and detection.
c. Counseling.
d. Issue of Disability Certificate for obvious Disabilities by PHC doctor.

40. Training

Basic Laboratory and Diagnostic Services
Essential Laboratory services including
i. Routine urine, stool and blood tests (Hb%, platelets count, total RBC, WBC, bleeding and
clotting time).
ii. Diagnosis of RTI/STDs with wet mounting, Grams stain, etc.
iii. Sputum testing for mycobacterium (as per guidelines of RNTCP).
iv. Blood smear examination for malaria.
v. Blood for grouping and Rh typing.
vi. RDK for Pf malaria in endemic districts.
vii. Rapid tests for pregnancy.
viii. RPR test for Syphilis/YAWS surveillance (endemic districts).
ix. Rapid test kit for fecal contamination of water.
x. Estimation of chlorine level of water using ortho -toludine reagent.
xi. Blood Sugar.



Monitoring and Supervision

Functional Linkages with Sub -Centres
There shall be a monthly review meeting at PHC chaired by MO (or in-charge), and attended by all the Health
Workers (Male and Female) and Health Assistants (Male and female).
On the spot Supervisory visits to Sub -Centres.
Organizing Village Health and Nutrition day at Anganwadi Centres.
ASHAs and Anganwadi Workers should attend monthly review meetings. Medical Officer should orient
ASHAs on selected topics of health care.

Mainstreaming of AYUSH


Record of Vital Events and Reporting

Maternal Death Review (MDR).

Health Education and Behaviour Change Communication (BCC).

Other National Health Programmes

Funds For PHC
Untied Fund is provided to PHC is 25,000.
Annual Maintenance grant is 50,000.

42. COMMUNITY HEALTH CENTRE:

Health care delivery in India has been envisaged at three levels namely primary, secondary and tertiary. The
secondary level of health care essentially includes Community Health Centres (CHCs), constituting the First
Referral Units (FRUs) and the Sub-district and District Hospitals. The CHCs were designed to provide referral
health care for cases from the Primary Health Centres level and for cases in need of specialist care approaching
the centre directly.
4 PHCs are included under each CHC thus catering to approximately 80,000 populations in tribal/hilly/desert
areas and 1,20,000 population for plain areas.
CHC is a 30-bedded hospital providing specialist care in Medicine, Obstetrics and Gynecology, Surgery,
Paediatrics, Dental and AYUSH. There are 5685 Community Health Centres (CHCs) (5335 rural + 350 urban)
functional in the country
These centres are however fulfilling the tasks entrusted to them only to a limited extent. The launch of the
National Rural Health Mission (NRHM) gives us the opportunity to have a fresh look at their functioning.

Objectives of Indian Public Health Standards (IPHS) for CHCs:
• To provide optimal expert care to the community.
• To achieve and maintain an acceptable standard of quality of care.
• To ensure that services at CHC are commensurate with universal best practices and are responsive and
sensitive to the client needs/expectations.




STAFFING PATTERN
PERSONNEL STRENGTH
General Surgeon 1
Physician 1
Obstetrician and gynaecologist 1
Paedtrician 1
Anaesthetist 1
Public Health Manager 1
Eye Surgeon 1
Dental Surgeon 1
General Duty Medical Officer 6
Specialist Of AYUSH 1
General Duty Medical Officer
AYUSH
1
Total 16

43. SUPPORT MANPOWER
Staff Nurses 19
Public Health Nurse 1
ANM 1
Pharmacist 3
Pharmacist AYUSH 1
Lab Technician 3
Radiographer 2
Opthalmic Assistant 1
Dresser 2
Ward Boys 5
Sweepers 5
Chowkidars 5
Dhobi 1
Mali 1
Aya 5
Peon 2
OPD Attendant 1
Registration Clerk 2
Data Entry Operator 2
Accountant 1
OT Technician 1
TOTAL 64

Functions of CHC

Care of Routine and Emergency Cases in Surgery

This includes dressings, incision and drainage, and surgery for Hernia, Hydrocele, Appendicitis,
Haemorrhoids, Fistula, and stitching of injuries. Handling of emergencies like Intestinal
Obstruction, Haemorrhage, etc.
Other management including nasal packing, tracheostomy, foreign body removal etc.
Fracture reduction and putting splints/plaster cast.
Conducting daily OPD.

Care of Routine and Emergency Cases
in Medicine

Maternal Health
Services are provided as same as SC, PHC. Additional services are Proficiency in identification and
Management of all complications including PPH, Eclampsia, Sepsis etc. during PNC. Essential and
Emergency Obstetric Care including surgical interventions like Caesarean Sections and other medical
interventions. Provisions of Janani Suraksha yojana (JSy) and Janani Shishu Suraksha karyakram

Newborn Care and Child Health

44. Essential Newborn Care and Resuscitation by providing Newborn Corner in the Labour Room and Operation
Theatre (where caessarian takes place). Early initiation of breast feeding with in one hour of birth and
promotion of exclusive breast-feeding for 6 months. Newborn Stabilization Unit . Counseling on Infant and
young child feeding as per IYCF guidelines. Routine and emergency care of sick children including Facility
based IMNCI strategy. Full Immunization of infants and children against Vaccine Preventable Diseases .


Family Planning
Full range of family planning services(cafeteria or Basket approach) including IEC, counseling, provision of
Contraceptives, Non Scalpel Vasectomy (NSV), Laparoscopic Sterilization Services and their follow up. Safe
medical and surgical Abortion Services
Other National Health Programmes
Communicable and non communicable diseases programmes
RNTCP, HIV/AIDS control programme, NVBDCP, NLEP, National programme for control of Blindness,
National programme for prevention and control of deafness, National Mental Health Programme etc.

Other Services
microscopy centres .
HIV/AIDS Control Programme: Integrated Counselling and Testing Centre.
Blood Storage Centre.
Sexually Transmitted Infection clinic.

School Health:
Screening of general health, assessment of Anaemia/Nutritional status, visual acuity, hearing problems, dental
check up, common skin conditions, Heart defects, physical disabilities, learning disorders, behavior problems,
etc. Basic medicines to take care of common ailments, prevalent among young school going children. Referral
Cards for priority services at District / Sub-District hospitals.

Immunization –complete immunization aas per NIS

Micronutrient (Vitamin A & IFA) management:
Weekly supervised distribution of Iron-Folate tablets coupled with education about the issue Administration
of Vitamin-A in needy cases.
De-worming
Biannually supervised schedule(10 feb and 10 August) Prior IEC Siblings of students also to be covered
Capacity building Monitoring & Evaluation
Mid Day Meal supervision
Adolescent Health Care – Adolescent and reproductive health information and counseling and services related
to sexual concerns, pregnancy, contraception, abortion. Nutritional counselling

BloodStorageFacilityDiagnosticServices
In addition to the lab facilities and X-ray, ECG should be made available in the CHC with appropriate training
to a nur sing staff/Lab Technician.

45. All necessary reagents, glass ware and facilities for collecting and transport of samples should be made
available.

Referral Services

Maternal Death Review – the form must be completed for all deaths, in pregnant women or within 42 days
after termination of pregnancy irrespective of duration or site of pregnancy.


Role of Panchayati Raj Institutions in Management of SC, PHC, CHC
Panchayati raj instiutions plays a vital role in health care delivery system in rural areas. There are various
members in panchayat who have responsibility in health management. Most public health services arre
delivered by the Health deptt. of state govt. that is not directly accountable to the gram panchayats. Gram
Panchayats are expected to monitor the access and quality of delivery of those services. Elected representatives
must have knowledge and skills to monitor the quality of services.
NRHM envisages the following roles of PRI
• States to indicate in their MoUs the commitment for devolution of funds, functionaries and
programmes for health, to PRI’s.
• The District Health Mission to be led by the Zila Parishad. The DHM will control, guide, manages all
public health institutions in the district, sub centres, PHC and CHC.
• ASHAs would be selected by and be accountable to the village panchayat.
• Preparation of village health plan, and promote inter sectoral integration.
• Each sub centre will have an untied fund for local action rs 10,000 per annum. This fund will be
desposited in a joint bank account of ANM and sarpanch and operated by ANM in consultation with
village health committee.
• PRI involvement in Rogi Kalyan Samiti for good hospital management.

46. • Provision of training to members of PRIs.




Health & Wellness Centres (HWCs):
There 17895 HWCs functional in India as on 31st
March 2019.
Out of these, there are 7919 and 9976 are
functional at the level of HWC-SCs and HWC-PHCs
respectively. Further, out of these HWCs 16063 are
located in rural areas and 1832 are located in urban
areas .
First Referral Unit (FRUs):
As on 31st March 2019, there are 3204 FRUs
functioning in the country. FRUs are those upgraded
CHC or subdivisional hospital having Operation
Theatre facilities, functional Labour Room(facility
of LSCS) and Blood Storage/ linkage facility.Not
every CHC function as FRUs in india.

CONCLUSION:
A health care delivery system consists of all organizations, people and actions whose primary intent is to
promote, restore or maintain health. This includes efforts to influence determinants of health as well as more
direct health-improving activities. Health care delivery in India has been envisaged at three levels namely
primary, secondary and tertiary. The secondary level of health care essentially includes Community Health
Centres (CHCs), constituting the First Referral Units (FRUs) and the Sub-district and District Hospitals. The
CHCs were designed to provide referral health care for cases from the Primary Health Centres level and for
cases in need of specialist care approaching the centre directly. 4 PHCs are included under each CHC.People-
centred and integrated health services are critical for reaching universal health coverage. Health care delivery
system was initially started from central government of India. The scope of health services varies widely from
country to country and influenced by general and ever changing national, state and local health problem, need
attitude as well as the available resources.


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