Primary Health Centre (PHC)

Indian Public Health Standard Primary Health Centre (PHC), Sub Centre and Community Health Centre, Functions of Health Personels

1. By. Kailash Nagar Assist. Prof. Dept. of Community Health Nsg . Dinsha Patel College of Nursing, Nadiad Primary Health Centre (IPHS-SS, PHC & CHC)

2. Tier of health care in India The health care services in India are organized at three levels , each level supported by the higher level, to which the patient is referred.

3. Concept of Health and Wellness Centre The Government of India has launched ambitious health insurance scheme — Ayushman Bharat-National Health Promotion Mission which will leverage on comprehensive primary health care through health and wellness centres for preventive, promotive and curative care and will ensure seamless continuum of care.

4. The National Health Policy, 2017 has envisioned Health and Wellness Centres as the foundation of India’s health 22 system. Existing sub- centres will be transformed into Health and Wellness Centres . Under this 1.5 lakh centres will bring health care system closer to the homes of people. These centres will provide comprehensive health care, including for non-communicable diseases and maternal and child health services. These centres will also provide free essential drugs and diagnostic services.

5. Indian Public Health Standards for Sub-centre The overall objective of IPHS is to provide health care that is quality oriented and sensitive to the needs of the community. The objectives of IPHS for SubCentres are: To provide basic Primary health care to the community. 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 .

6. Minimum Requirement (Assured Services) to be provided in a Sub-centre: SC are expected to provide promotive , preventive and few curative primary health care services as below: Antenatal care: · Intra-natal care: · Promotion of institutional deliveries · Postnatal care: Immunization Services Vitamin A prophylaxis to the children as per guidelines. · Prevention and control of childhood diseases like malnutrition, infections, ARI, Diarrhea, Fever, etc. Family Planning and Contraception Adolescent health care

7. Assistance to school health services. Control of local endemic diseases such as malaria, kala azar , japanese encephalitis, filariasis , dengue etc and control of epidemics Disease surveillance Water Quality Monitoring: (Disinfection of water sources /Testing of water quality using Rapid Test (Bacteriological) Promotion of sanitation including use of toilets and appropriate garbage disposal. Field visits Community level households will be visited by appropriate health/voluntary workers (such as ASHA, ANM, MPW – male) for disease surveillance, community need assessment, family welfare services, including RTI/STI awareness.

8. Community needs assessment Curative Services: Provide treatment for minor ailments including fever, diarrhea, ARI, worm infestation and First Aid. Appropriate and prompt referral Organizing Health Day at Anganwadi centres at least once in a month with the help of Medical Officer of PHC, ASHA, AWW, PRI, self-help groups etc. Implementation of National Health Programmes : Record of Vital Events, Maintenance of all the relevant records concerning mother, child and eligible couples in the area.

9. Minimum Requirements at PHC for meeting IPHS : These standards would help monitor and improve the functioning of PHCs. Objectives of IPHS: • To provide comprehensive health care (i.e. preventive, promotive , curative services) • 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.

10. 1. Medical care: OPD services: 4 hours in the morning and 2 hours in the afternoon / evening. Minimum OPD attendance should be 40 patients per doctor per day. (b) 24 hours emergency services: Appropriate management of injuries and accident, First Aid, Dog bite/snake bite/scorpion bite cases, and other emergency conditions (c) Referral services (d) In-patient services (6 beds)

11. 2. Maternal and Child Health Care including family planning: a) Antenatal care: Early registration of all pregnancies and minimum 3 antenatal checkups with minimum laboratory investigations . b) Intra-natal care: (24-hour delivery services both normal and assisted) Promotion of institutional deliveries, appropriate and prompt referral for cases needing specialist care. (c) Postnatal Care: Two postpartum home visits, first within 48 hours of delivery, 2nd within 7 days through Sub-centre staff, essential new born care, provision of facilities under Janani Suraksha Yojana (JSY). d) New Born care & Care of the child : Emergency care of sick children including Integrated Management of Neonatal and Childhood Illness (IMNCI), full Immunization of all infants and children against vaccine preventable diseases, Vitamin A prophylaxis to the children e) Family Planning: Education, Motivation and counseling towards family planning, Provision of contraceptives.

12. 3. Medical Termination of Pregnancies 4. Management of Reproductive Tract Infections / Sexually Transmitted Infections 5. Nutrition Services (coordinated with ICDS) 6. School Health : 7. Adolescent Health Care : 8. Promotion of Safe Drinking Water and Basic Sanitation 9. Prevention and control of locally endemic diseases like malaria, Kala azar , JE 10. Disease Surveillance and Control of Epidemics :

13. 11. Collection and reporting of vital events 12. Education about health / Behaviour Change Communication (BCC) 13. National Health Programmes 14. Referral Services: 15. Training: (ASHA, AWW, TBA SBA, VHG, LHV) 16. Basic Laboratory Services: 17. Monitoring and Supervision: 18. AYUSH services 19. Rehabilitation: 20. Selected Surgical Procedures: The vasectomy, tubectomy (including laparoscopic tubectomy ), MTP, hydrocelectomy and cataract surgeries as a camp/fixed day approach have to be carried out in a PHC having facilities of O.T. 21. Record of Vital Events and Reporting

14. Duties of various health professionals engaged in rendering services in public health system Duties of Medical Officer, Primary Health Centre I. Curative work II. Preventive and promotive work III. Training: IV. Administrative Work: 2. Job Responsibilities of Health Educator 3. Job Responsibilities of Health Assistant Female /LHV – Lady Health Visitor/Female Supervisor Supervise and guide \ Team Work Supplies, equipment and maintenance of Sub- centres : Records and reports : Training Maternal and Child Health: Family Planning and Medical Termination of Pregnancy Nutrition Health Education:

15. d) Job Responsibilities of Health Assistant Male (Supervisor) Supervise and guide Team work Supplies, equipment and maintenance of sub- centres Records and reports Malaria Communicable Disease Leprosy Tuberculosis Environmental Sanitation Universal Immunization Programme Family Planning

16. d) Job Responsibilities of Health Workers Female. Maternal and Child Health: Family Planning: Medical Termination of Pregnancy: Nutrition: Universal Programme on Immunization (UIP) Dai Training : Communicable Diseases: Vital Events: Record Keeping: Role of ANM as a facilitator of ASHA

17. Job Responsibilities of Health Worker (Male) Malaria and other diseases under NVBDCP: National Leprosy Eradication Programme : National Blindness Control Programm Revised National Tuberculosis Control Programme : Universal Immunization Programme : Reproductive and Child Health Programme Environment Sanitation :

18. Job responsibility of Mid-level health care provider at sub-center The trained MLP would broadly be expected to carry out public health functions, ambulatory care, management and leadership at the Health & Wellness Centers (H&WCs). They would be expected to: Implement National Programs Administration and management at Health and Wellness Centers (or Sub-centers) Health education and encourage awareness about Family Planning, Maternal and Child Health, and Non-Communicable Diseases.

19. Preventive, promotive and curative care Identification of Danger Signs and Referral after pre-referral stabilization Implement Biomedical waste disposal guidelines and Infection Control policies Supervision of health workers for Maternal and Child Health, Family Planning and Nutrition related services.