Indian Public Health Standards For Primary Health Centre

IPHS provided by National Rural Health Mission

1. INDIAN PUBLIC HEALTH STANDARDS FOR PHC DR.ANJALI RAJ

2. CONTENTS INTRODUCTION NEED OF IPHS PRIMARY HEALTH CENTRE OBJECTIVES OF IPHS FOR PHC SERVICES IN PHC MANPOWER INFRASTRUCTURE REFERENCE

3. INTRODUCTION National Rural Health Mission (NRHM) was launched in India in the year 2005 to strengthen the Rural Public Health System. The Mission seeks to provide effective health care to the rural populace throughout the country with special focus on the States and Union Territories (UTs), which have weak public health indicators and/or weak infrastructure.

4. INDIAN PUBLIC HEALTH STANDARDS In order to provide optimal level of quality health care, a set of standards called Indian Public Health Standards (IPHS) were recommended for Sub- centres , Primary Health Centres (PHCs), Community Health Centres (CHCs), Sub-District and District Hospitals in early 2007. IPHS are a set of uniform standards envisaged to improve the quality of health care delivery in the country.

5. These IPHS guidelines acts as the main driver for continuous improvement in quality and serve as the bench mark for assessing the functional status of health facilities. The IPHS documents have been revised keeping in view the changing protocols of the existing programmes and introduction of new programmes especially for Non-Communicable Diseases.

6. Need of iphs Quality management, quality assurance Effective economical and accountable Health care delivery system Optimal level of services

7. PRIMARY HEALTH CENTRE (PHC) Basic health unit to provide an integrated curative and preventive health care to the rural population with emphasis on preventive and promotive aspects of health care. PHCs are organized on the basis of one PHC for every 30,000 rural populations in the plains and one PHC for every 20,000 population in hilly, tribal and desert areas for more effective coverage.

8. FUNCTIONS OF PHC The functions of PHC in India cover all the 8 essential elements of primary health care as outlined in the Alma-Ata Declaration. They are : Medical care MCH including family planning Safe water supply and basic sanitation Prevention and control of locally endemic diseases

9. 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 services

10. OBJECTIVES To provide comprehensive primary health care to the community through the Primary Health Centres. To achieve and maintain an acceptable standard of quality of care. To make the services more responsive and sensitive to the needs of the community.

11. Classification of phc From the service delivery angle, PHCs may be classified into two types, depending upon the delivery case load : TYPE A PHC : PHC with delivery load of less than 20 deliveries in a month TYPE B PHC : PHC with delivery load of 20 or more deliveries in a month

12. All services provided by PHCs have been classified as; - Essential (Minimum Assured Services) or - Desirable (which all States/UTs should aspire to achieve at this level of facility)

13. Services at the Primary Health Centre for meeting the IPHS 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. Time schedule will vary from state to state. Minimum OPD attendance is expected to be 40 patients per doctor per day.

14. 24 hours emergency services :  appropriate management of injuries and accident, First Aid, suturing of wounds, incision & drainage of abscess, stabilization of the condition of the patient before referral, Dog bite/snake bite/scorpion bite cases, and other emergency conditions. Referral services In-patient services (6 beds)

15. MATERNAL AND CHILD HEALTH CARE : (including family planning ) Ante natal care Intranatal care Post natal care New born care Care of child (According to IMNCI)

16. Other services MEDICAL TERMINATION OF PREGNANCIES : Essential - Counseling and appropriate referral for safe abortion services (MTP) for those in need. Desirable - MTP using Manual Vacuum Aspiration (MVA) MANAGEMENT OF REPRODUCTIVE TRACT INFECTIONS / STIs Essential - Health education for prevention of RTI/STIs Treatment of RTI/STIs

17. NUTRITION SERVICES(Coordinated with ICDS) : Essential - Diagnosis of and nutrition advice to malnourished children, pregnant women and others. - Diagnosis and management of anemia and vitamin A deficiency. SCHOOL HEALTH : Essential - Screening of general health - Basic medicines to take care of common ailments - Immunization and Deworming

18. ADOLESCENT HEALTH CARE PROMOTION OF SAFE DRINKING WATER AND BASIC SANITATION PREVENTION AND CONTROL OF LOCALLY ENDEMIC DISEASES IMPLEMENTATION OF OTHER NATIONAL HEALTH PROGRAMMES TRAINING FUNCTIONAL LINKAGES WITH SUB-CENTRES

19. RECORDS OF VITAL EVENTS AND REPORTING MAINSTREAMING OF AYUSH ( Desirable ) SELECTED SURGICAL PROCEDURES ( Desirable ) MATERNAL DEATH REVIEW ( Desirable )

20. Basic Laboratory and Diagnostic Services Essential Laboratory services includes ; Routine blood, urine and stool tests Diagnosis of RTI/STDs with wet mounting, Grams stain etc. Sputum testing for mycobacterium Blood smear examination for malarial parasite Blood grouping and RH typing

21. Rapid tests for pregnancy RPR test for Syphilis Rapid test kit for fecal contamination of water Estimation of chlorine level of water using orthotoludine reagent. Blood sugar Desirable laboratory services includes; Blood Cholesterol. ECG

22. INFRASTRUCTURE The PHC should have its own building with - Outpatient Department : separate areas for consultation and examination - Wards : 4-6 beds - Labour Room - Waiting area - Minor OT/Dressing Room/Injection Room - Laboratory - General store - Operation Theatre (Optional)

23. - Waste disposal pit :As per GOI/Central Pollution Control Board (CPCB) guidelines. - Cold Chain room - Logistics Room - Generator room - Office room - Dirty utility room for dirty linen and used items OTHER FACILITIES include - Residential Accommodation - Computer - Lecture Hall/Auditorium

24. TRANSPORT FACILITY It is desirable that the PHC has ambulance facilities for transport of patients for timely and assured referral to functional FRUs in case of complications during pregnancy and child birth. LAUNDARY SERVICES Provision for clean linen shall be made for admitted patients. At least 5 sets of linen shall be made available. Laundry Services may be available in house or outsourced.

25. DIETRY FACILITIES FOR INDORE PATIENTS Nutritious and well- balanced diet shall be provided to all IPD patients keeping in mind their cultural preferences. WASTE MANAGEMENT Guidelines for Health Care Workers for Waste Management and Infection Control in Primary Health Centres” are to be followed

26. QUALITY ASSURANCE Periodic skill development training of the staff  of the PHC in the various jobs/responsibilities assigned to them. Standard Treatment Protocol for all National  Health Programmes and locally common disease should be made available at all PHCs.

27. MONITORING OF PHC FUNCTIONING This is important to ensure that quality is maintained and also to make changes if necessary Internal Mechanisms: Record maintenance, checking and supervision. Medical Audit Death Audit Patient Satisfaction Surveys: For both OPD and IPD patients.

28. External Mechanisms: Monitoring through the PRI/ Village Health Sanitation and Nutrition Committee Social audit

29. REFERENCE Park’s Textbook Of Preventive And Social Medicine- 23 rd Edition Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres Revised 2012

30. THANK YOU