Indian Public Health standards for HWC PHC

Statistics as of 19th May 2022

1. INDIAN PUBLIC HEALTH STANDARDS for HWC-PHC Presenter : Dr. Pawan Kumar B Moderator : Dr. Rahul Hegde

2. At the end of seminar , audience should be able to understand the Importance of IPHS Infrastructure and Staffing pattern of PHC/UPHC Job responsibilities of Medical Officer and Staff Nurse Services provided in PHC/UPHC Specific learning objectives 2

3. Plan of presentation 1 Background 2 Introduction / Rationale behind Revision 3 Objectives of IPHS for HWC - PHC . 4 Types / Categories of PHC/UPHC . 5 Population Norms 6 General Principles of IPHS. 7 Criteria for IPHS Compliance 7 Service Provision . 8 Infrastructure of PHC 9 Human Resources 10 Medicines 11 Diagnostics & Equipments 12 Quality Assurance - NQAS 13 Implementation of IPHS 3

4. 1946 Bhore Committee Health survey & sanitation committee Recommended the establishment of health centres for providing integrated curative and preventive services. 1978 Alma-Ata Declaration G overnments to formulate national policies, strategies & plans of action to launch & sustain primary health care as part of national health system. It was left to each country to innovate, according to its own circumstances to provide primary health care and Health for All by 2000 . 2005, NRHM “ A ttainment of universal access to equitable, affordable & quality health care services, accountable & responsive to people’s needs, with effective inter-sectoral convergent action to address the wider social determinants of health” BACKGROUND 4

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6. Introduction Revised guidelines emphasize on the services to be delivered at each level of facility. 6

7. 2022 IPHS guidelines have been framed for Sub-District Hospitals (SDH) & District Hospitals (DH), Community Health Centres (CHC) – rural and urban, Health and Wellness Centre – Primary Health Centre (PHC) – rural and urban, including Multispecialty UPHC (Polyclinics) in urban areas, Health and Wellness Centre – Sub Health Centre (SHC) – rural and urban. 2022 IPHS norms support government health facilities to attain a minimum acceptable functional standard (essential) while striving and aspiring for improvement (desirable) so as to accelerate India’s progress towards achievement of Universal Health Coverage (UHC) and Sustainable Development Goal - 3 (SDG-3) in alignment with the National Health Policy 2017. 7

8. Objectives of IPHS for HWC-PHC 8

9. 1 HWC - PHCs In R ural areas, the states should aspire to make all PHCs functional as 24x7 facilities. Prioritization of PHCs conducting deliveries - 24x7 HWCPHCs. All other PHCs should continue to provide routine care along with preventive and promotive health interventions and function as PHCs-HWCs. 2 Urban HWC - PHCs Provide routine OPD care along with preventive and promotive health interventions and function as UPHCs-HWCs. UPHCs with indoor beds already conducting deliveries can continue to function as 24x7 UPHCs-HWCs. 3 Specialist UPHC/Polyclinic (urban): To further reduce morbidity and mortality by providing specialist services on ambulatory/day care basis, closer to the urban community. Limited to outpatient care. Types/Categories of PHC/UPHC 9

10. Population norm for HWC-PHC Type of PHC Facility Plain areas Hilly & Tribal Areas 1 Rural PHC 30,000 20,000 2 Urban PHC 50,000 - 3 Polyclinic 2.5 lakh – 3 lakh - 10

11. Defines standards in local context of country Suggests in-house hiring of clinical and critical staff Consideration of health needs of entire district as a whole to provide district health action plan. Implementation of national programmes at individual facilities. AYUSH services are desirable. Display of Citizens’ charter at entrance All HWC – PHCs should have façade branding as per GOI guidelines Provide information about the Various services being offered, timings, Responsibilities of patients and providers, Details of referral vehicles and facilities, The number of free drugs and diagnostics being provided and other citizen friendly information. Patients’ rights should be ensured, and they should also be made aware of their responsibilities e.g. To keep the facility clean and avoid spitting in corners, Avoiding overcrowding by attendants, Respecting visiting hours, Not causing any harm to public property or indulging in violence against healthcare professionals etc. General principles of IPHS 11

12. A facility will be deemed as IPHS compliant if it fulfills the criteria that it provides all the ‘essential’ services identified for that level of facility rendered through requisite Infrastructure, Human Resource, Drugs, and Equipment. The norms for service provision, infrastructural and human resource requirements, drugs, diagnostics and equipment, quality assurance, monitoring and governance will apply uniformly across all facilities in rural and urban areas. https://nhsrcindia.org/IPHS2022 Criteria for IPHS Compliance 12

13. The twelve packages envisaged under are: Comprehensive Primary Healthcare Services (CPHC) 13

14. Services at the PHC 14

15. Maternal and Child health care including Family planning a) Ante Natal Care Detecting Pregnancy ANC services – Minimum 4 Counselling Services Identification , management and referral of High – Risk pregnancies Detection of Alarming signs and appropriate referral Management of Anaemia , TB, Malaria, GDM as per appropriate guidelines . Referral to First Referral Units (FRUs)/other hospitals b) Intra Natal Care Promotion of institutional deliveries Assisted vaginal deliveries -- forceps / vacuum Manual removal of placenta Management of PIH including referral Minimum 48 hours of stay after delivery. Identification and basic fist aid treatment for PPH, Eclampsia, Sepsis and prompt referral Timely identification, initial management and referral of obstetric complications 15

16. Maternal and Child health care including Family planning C) post natal care Daily monitoring of newborn and mother with post discharge counseling for all births Six post-natal home visits by ASHA up to 42 days and at least one supervised visit by ANM 3 additional visits for LBW Tracking of missed and left out PNC Support for breast feeding and KMC for LBW babies Counselling on nutrition, hygiene, contraception, and immunization Provision of facilities under janani suraksha yojana (JSY) Tracking of left and missed out PNC E) new born care Management of neonatal hypothermia (provision of warmth / KMC) Infection protection, cord care and identification of sick newborn and prompt referral. Newborn care corner in labour room 16

17. F) Care of the child Exclusive Breast feeding & Complementary feeding Routine and Emergency care of sick children – IMNCI Immunization and tracking vaccination drop-outs. Management of severe acute malnutrition cases Growth Monitoring G) Family Welfare IEC activities and provision of contraceptives Permanent methods like Tubal ligation and vasectomy / NSV Counselling and appropriate referral for couples having infertility Maternal and Child health care including Family planning 17

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20. National Health Programmes National Health Programmes 20

21. Referral Services: Appropriate support for patient during transport Providing transport facilities either by PHC vehicle or other available referral transport 21

22. Training and Meeting Male and female multi purpose health workers Skill based training to ASHAs and paramedics Trainings in minor repairs and maintenance of available equipment Lab technician or some other paramedic should be trained in taking ECG . Monthly review meeting at PHC chaired by MO 22

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24. Community health services and outreach programme 24

25. INFRASTRUCTURE Centrally located in an easily accessible and visible area , with good road connectivity. Not a flood prone area. Adequate Public utilities. Minimizing exposure to pollution and vector breeding. Review Land utilization , necessary environmental , fire safety and administrative clearance. Space for future expansion. Adherence of laws. High Boundary wall Uniform color scheme 25

26. Way finding/signage Display of Layout of facilities Safety, caution , hazard signs Fire exit plan & Tactile pathways Contact numbers. Parking Garden and Green areas Environment friendly features Disabled and elder friendly access Non-skid & non-slippery circulation areas, corridors and ramps Illumination General OPD - 150 lux Wards , stairs , corridors – 100 lux Medical store & minor OT – 300 lux Emergency portable lights 26

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28. Waste Management Bio Waste Management Rules Designated central waste collection room within premises Disposal of human anatomical waste, solid waste and biotechnology waste within 48 hours. Construction of Deep burial pits if common biomedical treatment plan is at distance more than 75kms. General waste – Solid waste management rules Liquid waste – separate drainage system to ETP Disaster and emergency preparedness Fire Safety Electric Power supply Portable water supply Drainage And Sanitation 28

29. Infrastructure for clinical services 1. Out -Patient services Can hold maximum peak hour patient load Scope for future expansion 2. Screening and Holding area Open/Closed space to hold and screen infections, which can quickly be transmitted specially during epidemics, pandemics or new emerging diseases. 3. Registration Well ventilated , well lit with each counter of minimum 15sq.m . 2 counters – 1 dedicated to women, elderly and disabled. Computerized registration in printers with OPD registration slip mentioning date, patient particulars and OPD details. Patient calling system with electronic display and token system. 29

30. Infrastructure for clinical services 4. Waiting Area Adequate seating with message conveying people to provide seats to elderly, pregnant, disabled. Walls should have colourful wall paintings and carry posters imparting health education. Play area can also be built Essential - Fans ; Clean Drinking water ; Clean & gender sensitive toilets. Desirable – AC ; TV/LCD displaying facility information and health IEC 5. Consultation Room Minimum are of 12 sq.m to accommodate adequate furniture and examination equipment An examination table , Curtains , Xray view box and hand washing facilities. Avoid Red/Pink, blue and Yellow painting or curtains. Clear display of the services provided and cleaning schedule outside room Monthly performance chart of health facility inside consultation room. 30

31. 6. Immunization Room Waiting area of 3X4 m Cold chain facility 7. Counselling Room Designed in a way that it enables both interpersonal and group counselling Design of room should ensure privacy and confidentiality . 8. Clinical / Central Laboratory Adequate space for maintenance of cleanliness , hygiene to prevent cross-contamination and infections. Patient reception, registration, waiting area, nearby toilet facility Adequate sample collection area for blood , urine and faeces and sample processing area. Refrigeration , reagents, supplies, patient records & separate storage space for inflammable items. Not a thoroughfare and various testing areas should be clearly marked, single prick policy Ensure logical flow of specimen from receipt to disposal, zoning of restricted areas. Acid and alkali proof tabletop. Provision for safety – eye flushing devices , fire extinguishers., The use of PPE. 31

32. 9. Medical Imaging 11. Dressing / Injection room/Emergency 12. Minor OT 10. Drug Dispensing Counter Minimum space of 15sqm. Computerized system for receiving, inspecting, storing, and dispensing of drugs. Maintenance of record of medicine distribution and disposal. LASA drugs should be identified and stored separately . Cool dark space for storage of temperature sensitive drugs Principles for effective storage of drugs such as First In First Out (FIFO) and First Expiry First Out (FEFO), date of expiry, and pest and rodent control should be in place 32

33. 13. In-Patient Ward / Day Care Room PHC UPHC 24X7 PHC/UPHC Essential Desirable Essential Desirable Essential Desirable 2 Beds 4 Beds 2 Day care beds 4 Day care beds 6 Beds 4 Beds Adequate referral to higher centres for further management. Every bed should be provided with an IV stand, a bed side locker, and a stool for attendants. Oxygen cylinder and Ambu bags should be easily accessible and functional. 14. Health and Wellness Room Platform for community interaction for all health education and promotional activities. Room should be able to accommodate 18-20 persons Facilities to conduct Yoga, group counselling sessions on health, nutrition, adolescent and other health promotional activities. Equipped with training, audio-visual & IEC material. Primary objective is to provide preventive and promotive care, not curative services. 33

34. 15. Labour Room (at 24X7 centres) Restricted entry and footwear Separate area for dirty linen and decontamination Standard Treatment Protocols during labour Essential drugs and equipment Enough power points for radiant warmer Autoclaving of delivery kits and other instruments Regular washing and mopping Privacy for women Each LDR unit should have enough space for one labor bed, space for alternate birthing positions and some area for the mother to move around. Ideally, it should be 350 sq. ft., however, in case of space constraints, minimum area of 15*15 (225) sq. ft. should be ensured for one LDR unit. Newborn care corner - Space within the labour room, (20-30 sq. ft in size), where a functional radiant warmer is present. Accessible from labour room and when a baby is placed, a trained nurse should be available for constant care. 16. ASHA Room 17. Communication Systems 18. Store Room OTHER SUPPORT SERVICES Residential Quarters (24X7 PHCs) Dietary Services Oxygen Support 34

35. Care at birth Resuscitation Warmth Weighing the neonate Labour Room 35

36. PHC UPHC Polyclinic E D E D E D MO MBBS 1 1 2 2 MO AYUSH 1 Dentist 1 1 1 Specialist 1* Staff Nurse 2 1 1 1 2 Pharmacist 1 1 1 1* Lab Technician 1 1 1 Optometrist 1 1 Health Worker (F) / ANM 1 5 5 Health Worker (M) / Health Assistant 1 Health Assistant (F) / Lady Health Visitor 1 1 1 Human resources for health 36

37. PHC UPHC Polyclinic Health Educator 1 1 1 Dental Assistant 1 1 1 Vaccine Logistic assistant / Cold Chain 1 1 1 Physiotherapist 1 Public Health Manager 1 1 Dresser 1 1 LDC -1 / Accountant 1 1 1 Data Entry Operator 1 1 1 Cleaning Staff 1 1 2 HR-MIS Leave and Training Reserve (15%) Conduct and Behavioural Standards Safety Measures for HRH Capacity Building Placement of qualified HRH Regular Training of MO , ensure implementation of National Health Programmes Induction, Skill Building and leadership trainings. Cross learning. Maintaining records of training attended by HRH 37

38. Job responsibilities of Medical Officer Clinical Work OP and Emergency Services Screen , refer, Cooperate and Coordinate On – Call Duty attend calls from in-patient Respectful attitude towards staff and patients. Performing duties with respect, dignity , privacy and modesty to patients Ensure Privacy and Confidentiality of patients. Other duties as MO if assigned. Public Health Work Make arrangement & provide guidance for rendering health care services at community and PHC level through Health Assistant ,HW and others . Train his health team various National Health and Family welfare programmes Prepare operational plans and ensure implementation to achieve targets of NHP Take necessary steps for institutionalizing public health surveillance and undertake timely actions in case of any outbreak . 38

39. Job responsibilities of Medical Officer ADMINISTRATIVE WORK Supervise work, scrutinize programmes of staff & suggest changes if necessary Hold monthly staff meetings to evaluate progress of work Ensure maintenance of records and registers at PHC and issue various kinds of certificate in capacity of MO. Organize training programmes for Staff and ASHA. Take actions timely for legal matters, medico legal cases, RTIs, court cases Appropriate utilization of funds as per guidelines & auditing procedures completed well in advance Dispose all obsolete / condemned items and vehicles as per Government orders. Monitor and guide activities of Hospital/PHC/CHC commities, Village Health and Sanitation committees . Performance audit of staff. Facilitate, coordinate, supervise, monitor and implement the provisions of all health sector acts and rules 39

40. Clinical Work Assess the needs of patients in ward, explain the medicines to be taken , make a nursing care plan. Give direct patient care and allotted responsibility to him/her by ward sister Provide comfort to the patient and maintain the safety of the patient (universal safety precaution). Friendly, courteous, and sympathetic while working with patients and ensure privacy and confidentiality of the patients. Carry out procedures of admission, discharge and transfer of patient of the ward. Take care that discharged patients have a proper understanding of the follow-up procedures and details of the diet, medication, exercise, etc. Maintain a duty room in readiness all the time . Job responsibilities of Staff Nurse 40

41. Clinical Work Taking history of patient, prepare and assist in diagnosing procedure in ward. Provide minor dressing in emergency Administer drugs by injection upon written order by doctor Learn to handle special gadget and equipment. Give health education to patients and family members under care. Make records of all procedures and keep upto date. Take care of case sheets Antenatal , intranatal , postnatal care, asses the progress of labour using pantograph Assist doctors in any procedure in labour room. Normal delivery and repair episiotomy wounds Other duties if assigned Job responsibilities of Staff Nurse 41

42. Administrative Work Ensure that all articles are sterilized, all equipment, gadgets, electrical connections, light, fan etc. are maintained. Specimens are collected, labeled and dispatched. Escort the patient to and from the department. Ensure that the reports are received and given to the patients as well as the doctor is informed. Cultural and religious differences of the patients are respected. Ensure to carbolize the Labour room daily. All records, outcome indicators as per LaQshya guidelines are maintained. Make the ward clean and tidy, including the bed. Assist the ward sister in orientation programme of new staff and students and in the supervision of work of Group D allotted in the ward for maintenance of cleanliness and sanitation. Job responsibilities of Staff Nurse 42

43. Administrative Work Keep all articles well-arranged and maintain the inventory. Maintain all records and mandates. Accompany doctors and senior nursing officers during ‘ward round’. Help ward sister in indenting and checking of drugs, supplies and maintaining inventories. Perform the functions of the ward sister during her/his absence. Support and guide the ASHAs working in the PHC area. participate in staff education and staff meeting. Maintain good interpersonal relations with all other staff. Information about MLC cases to Head/Officer in charge. Co-operate in activities related to the National Health Programmes. Safe disposal of biomedical waste. Up to date with nursing knowledge by taking part in in-service education programmes. Job responsibilities of Staff Nurse 43

44. S r . N o . Staff B r eak up of a c tivities 1 G ene r al Medicine OPD = 60 pts/d a y I n v asi v e P r o c edu r es= 10 P r o c edu r es/ w eek 2 Obs t etrics & G yne c ologist OPD= 60 pts/d a y 3 Pediatrician OPD= 60 pts/d a y I n v asi v e P r o c edu r es= 10 P r o c edu r es/ w eek 4 Ophthalmologist OPD= 60 pts/d a y O T= 7 major su r geries/ w eek 5 Dermatologist OPD= 60 p a tie n t/d a y Minor Procedures (Skin biopsies, cauterization etc.) 10 Procedures/week 6 Psychiatrist OPD= 20-30 pts/d a y C onsult a tion f or r e f er r ed p a tie n t 7 Medical O ffi c er OPD = 75 p a tie n t/d a y IPD 10 pts per/D a y OT assistance, emergency and other duties 8 Dentist OPD = 20 pts/d a y Dental Procedures= 8-10 (30 min./patient) Minimum performance standards for human resource for health 44

45. S r . N o . Staff B r eak up of a c tivities 9 S taff nurse As per INC norms (for OPD, IPD shifts and specialist services) 10 Lab T echnician 100 tests/day (semi-autoanalyzer) 200 tests/day (autoanalyzer) 11 Physiotherapist 15-20 physiotherapy intervention/day (15-20 minutes/service) P h y siothe r a p y advi c e f or IPD p a tie n t 12 Counsellor 20-25 counselling sessions (Group/Interpersonal)/day (10-15 min/patient for i n t erpersonal c ounselling) 13 Op h thalmic A ssista n t 30-40 cases per d a y . Detection of cataract and other basic EYE ailments 10-12 min/pts for refractive assessment Linkages with RBSK team for refraction and issue of spectacles. A pp r opri a t e r e f er r als 14 De n tal A ssista n t Assist the Dentist during dental procedures M ai n tain de n tal labo ra t o r y r e c o r d s . Ensuring adherence to infection prevention protocols including sterilization. 15 Pharmacist 120 dispensations of prescription/day, maintain stock registers, store, i n v e n t o r y manageme n t 45

46. Medicines 46

47. List of essential medicines required at PHC 47

48. List of essential medicines required at PHC 48

49. List of essential medicines required at PHC 49

50. Diagnostics for PHC/UPHC – ESSENTIAL EQUIPMENT FOR PHC/CHC – ESSENTIAL Routine blood investigations Hemoglobinometer, 3 Part Haematology analyser*, Blood group kit , Microscopy, Rapid Card test, Manual with microscopy/Solubility test/Cover slip test, Rapid card tests for combined P. Falciparum and P. vivax, Multiparameter urine strip (dipstick), Turbidometer/Nephelometer, Glucometer Semi Automated Biochemistry analyser* Wet mounting, gram staining, Microscopy/Filaria Strip test ECG Blood cross matching, peripheral blood film Reticulocyte and AEC Bleeding time and clotting time Sickling test and Sickle cell test Rapid NESTROFT for screening Thalassemia DCIP test for screening hemoglobinopathy Screening G6PD deficiency Urine tests, Urine microscopy Stool for ova, cyst and occult blood RPR/VDRL HIV HBsAg AntiHCV Sputum , pus for AFB Blood Sugar, GTT, HbA1C LFT, RFT, Lipid Profile Serum Calcium Throat swab for Diphtheria VIA,rk39 for Kala Azar Stool for hanging drop – v.cholera Mantoux , Trop-I, Pap Smear Diagnostics & Equipments 50

51. Diagnostics for PHC/UPHC - DESIRABLE EQUIPMENT FOR PHC/CHC - DESIRABLE D- Dimer, S. Sodium, S. Potassium, Magnesium, Test for Filariasis , S.TSH (including for new-born screening), CRP (including newborn) (Quantitative) ESR Analyzer Turbidometer, Indirect ion selective electrode Electrolyte Analyzer *, Diagnostics & Equipments 51

52. Quality assurance 52

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54. Refe r ence No. Measu r able Element Checkpoint Comp- liance A sses s ment Method Mea n s of V erification A r ea of Concern - A Service P r ov is ion Standa r d A1 Facility provides primary level curative services ME A1.1 The facility p r ovides t r eatment of common ailments Availability of Consultation services for common illnesses RR/SI Common Cold, Feve r , Diarrhoea, B r onchial Asthma, Fo r eign body in conjunctival sac, etc. ME A1.2 The facility p r ovides Accident and Eme r gency Services Primary Management of wounds and Fi r st Aid RR/SI Incision and d r ainage, Stitching D r essing Primary Management of t r auma and bone injuries RR/SI Splints Eme r gency Management of Life th r eatening conditions RR/SI Stabilization/ Primary Management of Medical conditions like Shock, Ischaemic Heart Disease, CVA, Dyspnoea, Unconscious patient s , Status Epilepticu s , etc. Primary Management and stabilization of P oisoning / Snake Bite cases RR/SI Lavage, Antidote s , Anti- snake venom/ Anti scorpian venom Primary t r eatment for Dog Bite cases RR/SI Anti Rabies V accines ME A1.3 The facility p r ovides A YUSH Services Functional and Dedicated A YUSH Clinic RR/SI Ayurveda, Unanai, Siddha, Homeopath y , Natu r opathy as per State Guidelines ME A1.4 Services a r e available for the time period as mandated OPD Services a r e available for at least 6 Hou r s in a day RR/SI/PI Eme r gency Services a r e functional 24X7 RR/SI At least one ANM/ Nu r se/ LHV is available 24X7, MO Should be available on call Checkl i st for Outdoor D epartment Checklist-1 54

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56. Quality assurance Kayakalpa LaQshya Quality improvement initiative, which aims to improve facility-based quality of care around birth, which normally takes place in the Labour Room and Maternity OT of a high case-load facility Mera Aspataal (My Hospital) ICT based platform which captures ‘Voice of Patients’ visiting and receiving care from the healthcare facilities. Inputs received on Mera Aspataal support facilities to identify the “ Dissatisfiers ” and to take up further actions to mitigate them. promote Cleanliness, Hygiene, and Infection Prevention. It is an award scheme in which facilities are assessed at three-level (Internal, Peer, External) using objective checklist covering eight thematic areas . Hospital Upkeep Support Services Sanitation & Hygiene, Hygiene Promotion Waste Management Beyond the hospital boundary. Infection control Facilities scoring 70% and above after external assessment are recognized and incentivized 56

57. Continuous monitoring, mentoring, ownership by the staff along with continuous support and encouragement by supervisors and higher levels of management Internal mechanisms like systematic and proper record keeping and ensuring timely reporting mechanism Institutional structures operational for community-based monitoring such as Village Health Sanitation and Nutrition Committees (VHSNC) and Community Action for Health - monitor delivery of preventive, promotive and curative services as part of CPHC primary health centre is also responsible for monitoring and supervision of activities of SC,VHNDs/UHNDs, special outreach, ASHA, IEC/BCC, Implementation of national health programs, Timely payment of various entitlements Implementation of IPHS 57

58. Jan Arogya Samiti / Rogi Kalyana Samiti 58

59. A system of annual performance appraisals that is objective, built upon key performance indicators from job descriptions and is linked to promotions, incentives and contract renewal should be introduced (or strengthened) by the state and implemented through the medical officer at the PHC/UPHC (and the HWCs in its jurisdiction). Accountability 59

60. Grievance redressal 60

61. Information and Communication Technology 61

62. Intersectoral Convergence Education department school-based health promotion camps . ICDS Delivery of six services, viz. supplementary nutrition, pre-school non-formal education, nutrition and health education, immunization, health check-up and referral services at Anganwadi Centres Village Health and Nutrition Days/Urban Health and Nutrition Days act as a platform for interfacing between community and the health system Panchayati Raj/ULBs Address spread of outbreaks of communicable diseases such as dengue, chikungunya , malaria for sanitation drives, vector control, controlling water accumulation, water testing, chlorination in tanks/wells, cleaning of drains etc. To ensure participation of community during the times of disaster Removal of garbage and general waste is also the responsibility of Panchayat/ULB/Municipality . 62

63. A nn e xur es | 91 A NNE X UR E 11 C hec k list f or Daily Rounds S. N o . Obse r v e/Moni t or and guide D a t e: 1 2 3 4 5 6 7 8 9 10 1. Displ a y of du t y r os t er and p r esen c e of staff accordingly in their respective duty station 2. S taff is in p r oper uni f orm & mai n tains decorum 3. Department/Service Area wise protocols and performance displayed in respective service areas. 4. Clinical p r a c ti c es as per the S o P s in each se r vi c e a r ea 5. P ri v a c y during p a tie n t s ’ e xamin a tion is mai n tained in all se r vi c e a r eas 6. Quality of services maintained by nursing and other junior staff 7. W a r d s ’ r eadiness f or do c t or s ’ r ound 8. I n f e c tion c o n t r ol p r o t o c ols a r e adhe r ed 9. BMW is se gr eg a t ed p r operly 10. Adherence to handing over-taking over p r o t o c ols in all critical a r eas 11. Re c o r ds of IPD a r e mai n tained and c omple t e in each se r vi c e a r ea 12. Availability of stock required in every service area (drugs, gloves, mask, inj. etc.) 13. Ne c essa r y equipme n t a r e a v ailable and fun c tional in e v e r y se r vi c e a r ea 14. Sterilization of the instruments is as per p r o t o c ols in 14.1 Ope r a tion the a t r e 14.2 Labour Room 14.3 C asual t y 14.4 A n y other depa r tme n t 63

64. 92 | INDIAN PUBLIC HEALTH STANDARDS | Health and Wellness Centre - Primary Health Centre S. N o . Obse r v e/Moni t or and guide D a t e: 1 2 3 4 5 6 7 8 9 10 15. Only s t erili z ed/au t ocl av ed instrume n ts a r e used in se r vi c e a r eas 16. Re c o r ds of s t eriliz a tion a r e mai n tained 17. Cleanliness and check the cleaning chec k list f or c ompletion in the bel o w me n tioned a r eas (OPD, Wards, Labor room, OT, Lab. & diagnostic r oom s , I nje c tion & d r essing r oom, T oilets e tc .) as per cleaning p r o t o c ols 18. P r esen c e of junk or unne c essa r y i t em in se r vi c e a r eas 19. Availability of linens and quality of laundry services 20. A v ailabili t y of f ood t o p a tie n ts is on tim e , hot and f r esh and quali t y of f ood is good 21. Requisitions f or special diet a r e se n t t o dietician/kitchen and is served accordingly 22. V isiting times a r e mai n tained Round ta k en b y (Please tick and sign): MO/Health F acilit y I n char ge: S taff Nurse: A n y O the r : 64

65. Current Scenario – 31 st March 2021 Rural Urban Total Subcentres 156101 1718 157819 PHCs 25140 (3966 – Hilly/Tribal) 5439 30579 CHCs 5481 470 5951 SDH 1224 DH 764 Subcentres 8891 550 9441 PHCs 2141 390 2531 CHCs 182 30 212 SDH 150 DH 22 INDIA KARNATAKA 65 RHS 2020-21

66. TODAY 66 https://ab-hwc.nhp.gov.in/

67. TODAY 67

68. As on 31-03-21 Subcentres PHCs CHCs SDH 430 77 8 4 Dakshina Kannada TODAY 68

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70. Current Scenario – 31 st March 2021 Required Sanctioned In position vacant Doctors India 25140 40143 31716 8762 Karnataka 2141 2406 1801 605 Nursing Staff India 25140 47995 34420 14463 Karnataka 2141 2939 2623 316 Doctors India 5439 8229 6809 1530 Karnataka 390 414 364 50 Nursing Staff India 5439 10949 8058 2967 Karnataka 390 681 592 89 70 PHC UPHC

71. Required In position vacant PHC (Tribal) India 5015 3966 1464 Karnataka 173 31 142 Current Scenario – 31 st March 2021 Karnataka Required Sanctioned In position vacant Doctors 31 28 20 8 Nursing Staff 31 33 29 4 Average population of PHC India – 35602 Karnataka - 17643 71 RHS 2020-21

72. 1. Govt. of India (2022). Indian Public Health Standards for Primary Health Centre, Revised, Ministry of Health and Family Welfare, New Delhi. http://nhm.gov.in/images/pdf/guidelines/iphs/iphs-revised-guidlines-2022/03-PHC_IPHS_Guidelines-2022.pdf 2. Govt. of India (2022). Rural Health Statistics in India (2020-21), Ministry of Health and Family Welfare, New Delhi. https://main.mohfw.gov.in/sites/default/files/rhs20-21_1.pdf 3. Official Website Ayushman Bharat I HWC https://ab-hwc.nhp.gov.in/ 4. Govt. of India (2022). National Quality Assurance Standards for Public Health Facilities Revised (2020), Ministry of Health and Family Welfare, New Delhi. http://qi.nhsrcindia.org/sites/default/files/National%20Quality%20Assurance%20Standards%202020.pdf References 72

73. Health and Wellness Centre – Primary Health Centre , Natekal , Mangalore Acknowledgement Health and Wellness Centre – Primary Health Centre 24x7 , Doddahejjaji , Doddaballapura , Bangalore Rural 73

74. THANK YOU 74