IPHS Guidelines for

PHC

By SHYAM MURTI

BOHARE

Roll no. 87

MBBS

2014

Topics to be covered

• IPHS Genesis

• Objectives of IPHS for PHCs

• Infrastructure

• Types of PHCs

• Manpower

• Drugs

• Services provided

• Basic laboratory & Diagnostic Services

IPHS Genesis• PHC is a basic health unit to provide as close to the people as possible, an integrated

curative and preventive health care to the rural population with emphasis on preventive and promotive aspects of health care. (Bhore Committee, 1946)

• As of 31st March 2015, there are 1,55,708 PHCs in India. Out of these, 9,192 PHCs are in Madhya Pradesh. (Rural Health Statistics Bulletin - 2016)

• PHCs are not spared from issues such as the inability to perform up to the expectation due to:

non-availability of doctors at PHCs

even if posted, doctors do not stay at the PHC HQ

inadequate physical infrastructure and facilities

3

insufficient quantities of drugs

lack of accountability to the public and lack of community participation

lack of set standards for monitoring quality care etc.

• In order to provide optimal level of quality health care, NRHM has provided the opportunity to set Indian Public Health Standards (IPHS) for Health Centres functioning in rural areas in early 2007.

• IPHS have been used as the reference point for public health care infrastructure planning & up-gradation.

Objectives of IPHS for PHCs

a) To provide comprehensive primary health care to the community through the PHCs.

b) To achieve and maintain an acceptable standard of quality of care.

c) To make the services more responsive and sensitive to the needs of the community.

Infrastructure

The PHC should have its own building. It should also have:

• Sign-age

• Entrance with Barrier free access

• Disaster prevention measures (desirable for new upcoming facilities)

• Environmental friendly features

• Out Patient Department

• Wards (4-6 beds in a Primary Health Centre)

• Waiting Area

• Labour room

• Laboratory6

• Minor OT/Dressing Room/Injection Room/Emergency

• Dirty utility room for dirty linen and used items

• Computer facility with internet for MIS (Management Information System)

• Provision of new born care corner in the facility

• One room for counselling

• Residential Accommodation

• Waste disposal pit,

• Cold chain, logistic and generator room

• Boundary wall/Fencing

Types of PHCs

From service delivery angle, PHCs may be of two types, depending upon delivery case load:

• Type A PHC: PHC with delivery load of less than 20 deliveries per

month,

• Type B PHC: PHC with delivery load of 20 or more deliveries per

month

Manpower• The manpower that should be available in the PHCs is given in the table:

• For Type B PHCs, additional staff in the from of one MBBS medical officer (desirable, If the case load of delivery cases is more than 30 per month) one Staff Nurse and one sanitary worker cum watchman have been provided have been provided to take care of additional delivery case load.

• Medical Officer should be available on call duty to manage emergencies.

• Accommodation for at least one MO & 3 staff nurses will be provided.

Drugs

• All the drugs available in the Sub-Centre should also be available in the PHC. All the drugs as per state/UT essential drug list shall be available.

• In addition, all the drugs required for the National Health Programmes and emergency management should be available in adequate quantities so as to ensure completion of treatment by all patients.

• Drugs of that discipline of AYUSH to be made available for which the doctor is present.

SERVICES PROVIDED

• Medical care:

OPD services

a) 4 hrs in morning & 2 hrs in afternoon,b) At least two hours per day twice in a week for field duties and monitoring.{desirable}

24 hrs emergency services

Referral Services

In-patient services[6 beds].

• Maternal & child health care:

1. Antenatal care: Early registration, Antenatal checkups; Routine lab investigations; Identification and management of high risk and alarming signs during pregnancy and labour ; Nutrition & health counseling.

2. Intranatal care: Management of normal deliveries; Assisted vaginal deliveries;

Proficient in identification of PPH, eclampsia & prompt referral.

3. Postnatal care: Counseling on nutrition, hygiene, immunization, essential new born care.

4. New born care: Initiation of breast feeding, Facilities for Essential new born care [ENBC] & Resuscitation [Newborn care corner in labourroom/OT], Management of neonatal hypothermia(KMC*)

5. Care of the child: Routine & emergency care of sick children including IMNCI

strategy; Assessment of growth & development; Full

immunization of children. Vitamin A prophylaxis; Prevention &

management of routine childhood diseases& infections.

6. Family welfare: Education, motivation & counseling to adopt appropriate family

planning methods; Provision of contraceptives.

• School Health:

- Teachers screen students on a continuous basis

- ANMs/HWMs (a team of 2 workers) visit the schools (one school every week)

- Doctor from CHC/PHC will also visit one school per week for screening,

immunization, micronutrient management, de-worming

• Adolescent health care:

Through adolescent friendly clinic for 2 hours once a week on a fixed day.

Adolescent and Reproductive Health Information, counseling and services related to

sexual concerns, pregnancy, contraception, abortion etc.

Services for tetanus immunization

Nutritional Counseling, Prevention and management of nutritional anemia

Services for safe termination of pregnancy

• Management of Reproductive tract infections/ STDs:

Health education for prevention of RTI/STIs; Treatment of RTI/STIs.

• Medical Termination of Pregnancies:

Counselling and appropriate referral for safe abortion services (MTP) for those in need.

• Nutrition Services:

Diagnosis of and nutrition advice to malnourished children, pregnant women and others

Diagnosis and management of anaemia and vitamin A deficiency.

Coordination with ICDS

• National Health Programmes:

1. RNTCP: Function as DOTS centres to deliver treatment as per guidelines. Collection & transport of sputum samples.

2. NLEP: Diagnosis & management of leprosy & it’s complications; Training of patients having ulcers for self-care.

3. Integrated disease surveillance project [IDSP]: Weekly reporting of epidemic prone diseases; Appropriate preparedness & first level action on out-break situations.

4. NPCB: Early detection of visual impairment & referral. Awareness generation through

appropriate IEC strategies.

5. NVBDCP: Diagnosis & management of vector borne diseases.

6. National AIDS control programme: IEC activities to enhance awareness & preventive

measures about STIs & HIV/AIDS. Help & guide patients receiving ART.

7. NPCDCS: IEC services for prevention of cancer & early detection; Health promotion

services to modify lifestyle; Early detection, management & referral of cases of non communicable diseases.

8. National Programme for Prevention and Control of Deafness (NPPCD)

9. National Mental Health Programme (NMHP)

10. National Iodine Deficiency Disorders Control Programme (NIDDCP)

11. National Programme for Prevention and Control of Fluorosis (NPPCF) (In affected(Endemic Districts)

12. National Tobacco Control Programme (NTCP)

13. National Programme for Health Care of Elderly

14. Oral Health

15. Physical Medicine and Rehabilitation (PMR) Services (Desirable)

• Training: -

Undergraduate medical students & intern doctors in basic health care.

Orientation training of male & female health worker.

Skill based training to ASHA worker.

Initial and periodic Training of paramedics in treatment of minor ailments

• Promotion of safe drinking water & basic sanitation: Disinfection of water

sources and Coordination with Public Health Engineering department for safe water

supply; Promotion of sanitation

• Monitoring & supervision of activities & Functional linkages with sub-centres

• Record of vital events including births & deaths

• Prevention &control of locally endemic diseases like malaria, Kala azar,JE etc.

• Referral services

• Maternal Death Review (MDR) (Desirable)

• Mainstreaming of AYUSH (Desirable)

• Selected Surgical Procedures (Desirable)

Basic Laboratory and Diagnostic Services

Essential Laboratory services include:

Routine urine, stool and blood tests (Hb%, platelets count, total RBC, WBC,

bleeding and clotting time).

Diagnosis of RTI/STDs with wet mounting, Grams stain, etc.

Sputum testing for mycobacterium (as per guidelines of RNTCP).

Blood smear examination malarial.

Blood for grouping and Rh typing.

RDK for Pf malaria in endemic districts.

Rapid tests for pregnancy.

RPR test for Syphilis/YAWS surveillance (endemic districts).

Rapid test kit for fecal contamination of water.

Estimation of chlorine level of water using orthotoludine reagent.

Blood Sugar.

Other Facilities include:

Transport Facilities with Assured Referral Linkages

Laundry Services

Dietary Facilities for indoor patients

References

• IPHS Guidelines for Primary Health Centres Revised 2012

• Park’s Textbook of Preventive & Social Medicine 24th Edition