CHC -Executive Summary

Executive Summary
The Scheme
Our health policy envisages a three tier structure comprising the primary, secondary and tertiary
health care facilities to bring health care services within the reach of the people. The primary tier is
designed to have three types of health care institutions, namely, a Sub-Centre (SC) for a  population
of 3000-5000, a Primary Health Centre (PHC) for 20000 to 30000 people and a Community Health
Centre (CHC) as referral centre for every four PHCs covering a population of 80,000 to 1.2 lakh. The
district hospitals were to  function as the secondary tier for the rural health care,  and as the primary
tier for the urban population. The tertiary health care was to be provided by health care institutions in
urban areas which are well equipped with sophisticated diagnostic and investigative facilities.
In pursuance of this policy, a vast network of health care institutions has been created, both in rural
and urban areas, and substantial resources, though inadequate vis-a-vis requirement, have gone
into planning and implementing the health and family welfare programmes. Increased availability and
utilisation of health care services have resulted in a general improvement of the health status of our
population, as is reflected in the increased life expectancy and marked decline in birth and mortality
rates over the last fifty years. However, these achievements are uneven, with marked disparities
across states and districts, and between urban and rural people.
These disparities in the health outcome could be attributed to a large  extent, to the
differential access to health services by different segments of the population. While the demand side
factors do play a role in exercising the choice of the modes of delivery of health care services, for the
vast majority of our people, the access to health care services is determined primarily by the
availability (and the quality of delivery) of public health institutions. This is especially true of the
majority of the rural people, for whom alternatives to the public health services hardly exist.
In fact, the Fifth Five Year Plan document noted with concern the disparities in  access to
health services between urban and rural areas and the tardy implementation of the schemes in the
health sector. The primary rural health care services were brought under the Minimum Needs
Programme (MNP) during the Fifth Plan (1974-79). It was decided to integrate and strengthen the
rural health care institutions through suitable organic  and functional linkages between the different
tiers of the primary health care system.
In this framework, the Community Health Centre (CHC), the third tier of the network of rural health
care units, was required to act primarily as a referral centre (for the neighbouring PHCs, usually 4 in
number) for the patients requiring specialised treatment in the areas of medicine, surgery, paediatrics
and gynaecology. The objective was two-fold; to make modern health care services accessible to the
rural people and to ease the overcrowding of the district hospitals. To enable the CHCs  to contribute
towards meeting the intended  objectives, these were designed to be equipped with: four specialists
in the areas of medicine, surgery, paediatrics and gynaecology;  30 beds for indoor patients;
operation theatre, labour room, X-ray machine, pathological laboratory, standby generator etc. along
with the complementary medical and para medical staff.
Evaluation Study
At the instance of Planning Commission, the Programme Evaluation Organisation undertook the
study to evaluate the functioning of the Community Health Centres (CHCs) and  their effectiveness in
bringing specialised health care within the reach of rural people.