Community Health Care Centre

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Community

Health Care

CentreSubmitted by: Jhanvi Mishra,KanikaRajput,Jatin Grover


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What is community health care

centre? Group practise This is the combination of two or more practisin

doctors with shared sta! and premises"


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WHAT IS CHCs:-add it inform of chart kanika

The #ommunity $ea%th #entre $#', the third tierof the network of rura% hea%th care institutions, wasre(uired to act primari%y as a referra% centre &for theneihbourin )$#s, usua%%y * in number' for the

patients re(uirin specia%ised hea%th care services"#ommunity $ea%th #entres $#s+- beddedhospita%' and hiher order pub%ic

hospita%s at sub+district and district hospita%s" .t has

*+/ indoor beds for patients" The standards prescribed in this document are for a)$# coverin 0-,--- to

-,--- popu%ations with / beds"


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Mut%i purpose


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Objectives of Indian Public HealthStandards (IPHS) for CHCs

To provide optima% e1pertcare to the

community" To achieve and maintain an acceptab%e

standard of (ua%ity of care"

To ensure that services at #$# are

commensurate with universa% best practicesand are responsive and sensitive to the c%ientneeds2e1pectations"


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Objectives:- The objective of havin a referra% centre for the primary hea%th care

institutions was two+fo%d3

to make modern hea%th care services accessib%e to the rura% peop%e

and

to ease the overcrowdin in the district hospita%s"

The #$#s were accordin%y desined to be e(uipped with: fourspecia%ists

medicine,

surery,

paediatrics and

ynaeco%oy3 - beds for indoor patients3 operation theatre, %abourroom, 4+ray

machine, patho%oica% %aboratory, standby enerator , etc", a%on withthe comp%ementary medica% and

para medica% sta!"


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The findings of the Study areas follows:

&a' Given the other re%evant factors, the servicesof a #$# are %ike%y to be used %ess intensive%y, if:

&i' its eoraphica% coverae is very %are3

&ii' it has inade(uate medica% sta!, particu%ar%ythe specia%ists3 and

&iii' the mean distance of the )$#s from the #$#is %oner"


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Service 5e%ivery in #$#s

OPD Services and IPD Services:

Genera%,

Medicine, Surery, 6bstetrics 7 Gynaeco%oy,

)aediatrics, 5enta% and 89S$ services ;ye Specia%ist services &at one for every < #$#s'"

;merency Services

=aboratory Services

>ationa% $ea%th )rorammes"Desiable serviceswhich

are the ideal that should be available.


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Delivery space:


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? 8%% @8ssured ServicesA as envisaed in the )$# shou%d be avai%ab%e, which

inc%udes routine, preventive, promotive, curative and emerency care inadditionMinimum Re(uirement for 5e%ivery of the 8bove+mentioned Services:

The fo%%owin re(uirements are bein projected based on the basis of40 patients per doctor per day, the expected

number of beneciaries for maternal and childhealth care and family planning and about 60%utiliation of the available indoor!observationbeds "6 beds#.

.t wou%d be a dynamic process in the sense that if the uti%iBation oes up, the

standards wou%d be further upraded" 8s reards, manpower, one moreMedica% 6Ccer &may be from 89S$ or a %ady doctor' and

two more sta! nurses are added to the e1istin tota% sta! strenth of D< in the

)$# to make it 0*1E services de%ivery centre" to a%% the nationa% hea%thprorammes"


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Personnel Essential Desirable Qualifcations

Remarks


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8S );R T$; F8#.=.T;S:

THERE SHOULD BE

INDIVIDUAL ROOMS

AVAILABLE FOR INDIVIDUAL

PURPOSES . SUCH AS THEFOLLOWS IN FITHER SLIDES


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Basic requirements:


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WHAT ARE

SRTANDARDS ??Standards are a means of describin the %eve% of(ua%ity that hea%th care oraniBations are e1pectedto meet or aspire to"

.n order to provide optima% %eve% of

(ua%ity hea%th care, a set of standards are beinrecommended for )rimary $ea%th

#entre to be ca%%ed .ndian )ub%ic $ea%th Standards

&.)$S' for )$#s"


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)hysica% .nfrastructure The CHC should have 30 indoor beds

with one Operation

theatre, labour room, X-ray,

ECG and

!"O#!TO#$ %a&ilites


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=ocation of the centre To the e1tent possib%e, the centre shou%d be %ocated at

the centre of the b%ock head(uarter in order toimprove access to the patients" eva%uated fo%%owed bynecessary chanes in the )%an and trainin of the

sta!" The #$# shou%d be, as far as possib%e, environment

friend%y

and enery eCcient"

Rain+ater harvestin, so%ar enery

use and use of enery+eCcient #F= bu%bs2e(uipment

shou%d be encouraed" )rovision shou%d be

made for horticu%ture services inc%udin herba% arden


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The bui%din shou%d haveareas2space marked for the

fo%%owin:AS.G>8G;A 6n+the+way sinaes of the #$# 7 %ocation shou%d be disp%ayed on a%% the approach

roads"

Safety, haBards and caution sins sha%% be

disp%ayed prominent%y at re%evant p%aces,

e"" radiation haBards for prenant woman in 4+Ray"

F%uroscent Fire+;1it sinaes at strateic

%ocations"


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Harrier free access

environmentIFor easy8 ccess to non+ambu%ant &whee%+chair

stretcher', semi+ambu%ant, visua%%y disab%ed ande%der%y persons as per @Guide%ines and SpaceStandards for barrier+free bui%t environment for

5isab%ed and ;%der%y )ersonsA of Government of .ndia" Ramp as per specication, $and+rai%in,proper

%ihtnin etc must be provided in a%% hea%th faci%itiesand retrotted in o%der one which %ack the same"

Reistration cum .n(uiry counters"

)harmacy for dru dispensin and storae"

#%ean )ub%ic uti%ities separate for ma%es and

fema%es"

6 t ti t


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6utpatient5epartment

)%anned keepin in mind the ma1imum peak hour

%oad and sha%% have scope for future e1pansion.Layout o te Out Patient

De!artment sall ollo" te functiona% ow of the patients: e""

En#uiry$Re%istration$&aitin%$Sub&atin%$

'linic$Dressin% room(In)ectionRoom$*illin%$

Di%nostics +lab(,-ray$!armacy$E/it


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#%inics for Larious Medica%

5iscip%ines:.n Genera% medicine, enera% surery, denta%,obstetric and ynaeco%oy,paediatrics and fami%y we%fare"Separate cubic%es for enera% medicine andsurery with separate area for interna% e1amination &privacy' can beprovided if there are no separate rooms for each"

0e cubiscle for consu%tation and e1amination in a%% c%inics shou%dprovide for doctors

table1 cair1 !atient2s stool1 ollo"er2s seat1 "as

basin "it and "asin% acilities1 e/aminationcoucand e#ui!ment or e/amination" Room sha%% have, for teadmission o li%t

and air1 one or more a!ertures1 suc as

"indo"s and an li%ts1 o!enin% directly to

te e/ternal air or into an o!en veranda.

0e "indo"s sould be in t"o o!!osite

"alls.


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Fami%y e%fare #%inic: The c%inic shou%d provide educative, preventive,

dianostic and curative faci%ities for materna%, chi%dhea%th, schoo% hea%th and hea%th education"

)eop%e visitin hospita% shou%d be informed of persona%

and environmenta% hyiene, c%ean habits, need fortakin preventive measures aainst epidemics, fami%yp%annin, non+communicab%e diseases"

Treatment room in this c%inic shou%d act as operatinroom for .#5 insertion and investiation, etc" .t shou%d

be in c%ose pro1imity .ndian )ub%ic $ea%th Standards&.)$S' Guide%ines for #ommunit y hea%th centres D to6bstetric 7 Gynaeco%oy


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Fami%y e%fare

counse%%in room shou%d be provided: aitin room for patients" The )harmacy shou%d be %ocated in an area

convenient%y accessib%e from a%% c%inics"

The dispensary and compoundin room shou%d

have two dispensin windows, compoundincounters and she%ves"

Thepattern of arranin the counters and she%vessha%% depend on the siBe of the room"

The medicines which re(uire co%d storae andb%ood re(uired for operations and emerenciesmay be kept in refrierators"

;


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;merency

Room2#asua%ty: .t is recommended to have a separateearmarked emerency area to be %ocated nearthe entrance of hospita% prefera%b%y havin *

rooms one for doctor,

one for minor 6T,

one for p%aster2dressin'

and one for patient observation &8t %east * beds'"


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Treatment Room:

o3inor O0

In)ection Room andDressin% Room

Observation Room.


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8R5S:Separate for Males and

Females'ards ()*)+3*) m ea&h( He centered such that it serves a%% the c%inics from

that p%ace"

The nursin station shou%d be

spacious enouh to accommodate a medicine chest2a

work counter &for preparin dressins,medicines',hand washin faci%ities, sinks,dressin tab%es withscreen in between and co%our coded bins &as per.M;) uide%ines for community hea%th centres'"

.t shou%d have provision for $ub cutters and need%edestroyers"

;1amination and dressin tab%e"


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measurements:


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Patient 4rea: ;nouh space between beds"

Toi%ets3 separate for ma%es and fema%es"

Separate space2room for patients needin

.so%ation

"4ncillary rooms:

>urses rest room"

There shou%d be an area separatin 6)5

and .ndoor faci%ity"


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Urban:With number of more

beds.


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Public utilities: Separate for ma%es and fema%e3 for patient as we%% as forparamedica% 7 Medica% sta!"5isab%ed friend%y, # with wash basins as specied

under Guide%ines for disab%ed friend%y environment shou%d be provided")hysica%.nfrastructure for Support Services

'entral Steriti5ation Su!!ly De!artment +'SSD: Steri%iBation and Steri%e storae"

Laundry: Storae shou%d be separate for dirty

%inen and c%ean %inen"

6utsourcin is recommended after

appropriate trainin of washer man reardin

sereation and separate treatment for infected and non+infected %inen"

En%ineerin% Services: ;%ectricity2te%ephones

2water2civi% ;nineerin may be outsourced"

Maintenance of proper sanitation in toi%ets

and other pub%ic uti%ities shou%d be iven

utmost attention" SuCcient fundin for this

purpose must be kept and the services may

be outsourced"

&ater Su!!ly : 8rranements sha%% be made

to supp%y D-,--- %itres of potab%e water per

day to meet a%% the re(uirements &inc%udin

%aundry' e1cept re htin" Storae capacity


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Emergency Lighting :Emergency portable/fixed light units should also be providedin the wards and departments to serve asalternative source of light in case of powerfailure. Generator back-up should be availablein all facilities. Generator should be of goodcapacity. Solar energy wherever feasible may

be used.

Generator :5 KVA with POL for ImmunizationCold Chain maintenance.

Telephone:minimum two direct lines withintercom facility should be available.


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8dministrative Bone: Separate rooms shou%d be avai%ab%e for: 6Cce

Stores

Residentia% None

Minimum O (uarters for 5octors"

Minimum O (uarters for sta! nurses2

paramedica% sta!"

Minimum 0 (uarters for ward boys"

Minimum D (uarter for driver"

.f the accommodation can not be provided due to any reason, then the sta! may be paid house rent

a%%owance, but in that case they shou%d be stayin in

near vicinity of #$# so that they are avai%ab%e for 0* 1

E in case of need"


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Function 7 Space Re(uirement for

#ommunity $ea%th #entre: .t is suested considerin the %and cost 7

avai%abi%ity of %and, #$# bui%din may beconstructed in two oors"


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HIERACRHY : $ea%th care de%ivery in .ndia has been envisaed at three

%eve%s name%y

primary,

secondary and

tertiary"

The secondary %eve% of hea%th care essentia%%y inc%udes#ommunity $ea%th #entres $#s', constitutin the FirstReferra% nits &FRs' and the Sub+district and 5istrict$ospita%s"

The #$#s were desined to provide referra% hea%th care for

cases from the )rimary $ea%th #entres %eve% and for cases inneed of specia%ist care approachin the centre direct%y"

* )$#s are inc%uded under each #$# thus caterin toappro1imate%y O-,--- popu%ations in triba%2hi%%y2desert areasand D,0-,--- popu%ation for p%ain areas"

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