Indian Public Health Standards

Indian Public Health Standards (IPHS) Guidelines for Community Health Centres Revised 2012

 Directorate General of Health Services Ministry of Health & Family Welfare Government of India

Indian Public Health Standards (IPHS) Guidelines for Community Health Centres Revised 2012

Directorate General of Health Services Ministry of Health & Family Welfare Government of India

All essential services as envisaged in the CHC should be made available, which includes ---

routine and emergency care in Surgery, Medicine, Obstetrics and Gynaecology, Paediatrics, Dental and AYUSH in addition to all the National Health Programmes. Standards of services under existing programmes were updated and standards added for newly developed non communicable disease programmes based on the inputs from various programme divisions. Standards for Newborn stabilization unit, MTP facilities for second trimester pregnancy (desirable), The Integrated Counselling and Testing Centre (ICTC), Blood storage and link Anti Retroviral Therapy centre have been added.

Minimum Requirement for Delivery of the Above-Mentioned Services The following requirements are being projected based on the assumption that there will be average bed occupancy of 60%. The strength may be further increased if the occupancy increases with subsequent up gradation. With regards to Manpower, 2 specialists, namely, Anesthetist and Public Health Specialist will be provided in addition to the available specialists, namely, Surgery, Medicine, Obstetrics and Gynecology and Pediatrics. A Block Public Health Unit is envisaged at the CHC having a Block Medical Officer/Medical superintendent, one  Public Health specialist and at least one Public Health Nurse. The support manpower will include a Dental Assistant, Multi Rehabilitation Worker, Cold Chain and Vaccine Logistic Assistant in addition to the existing staff. The manpower at CHC has been rationalized in order to ensure optimal utilization of scarce manpower.

Accountability It is mandatory for every CHC to have functional “Rogi Kalyan Samiti” (RKS) to ensure accountability and also shall have the Charter of Patients’ Rights displayed prominently at the entrance. A grievance redressal mechanism under the overall supervision of RKS would also be set up.

 Quality of Services Standard Operating Procedures and Standard Treatment Protocols for common ailments and the National Health Programmes should be available and followed. To maintain quality of services, external monitoring through Panchayati Raj Institutions and internal monitoring at appropriate intervals is advocated. Guidelines are being provided for management of routine and emergency cases under the National Health Programmes so as to maintain uniformity in Management in tune with the National Health Policy

Service Delivery in CHCs OPD Services and IPD Services: General, Medicine, Surgery, Obstetrics & Gynaecology, Paediatrics, Dental and AYUSH services

Eye Specialist services (at one for every 5 CHCs). Emergency Services Laboratory Services National Health Programmes Every CHC has to provide the following services which have been indicated as Essential and Desirable. All States/UTs must ensure the availability of all Essential services and aspire to achieve Desiable services which are the ideal that should be available. I. Care of Routine and Emergency Cases in Surgery Essential This includes dressings, incision and drainage, and surgery for Hernia, Hydrocele, Appendicitis, Haemorrhoids, Fistula, and stitching of injuries. Handling of emergencies like Intestinal Obstruction, Haemorrhage, etc. Other management including nasal packing, tracheostomy, foreign body removal etc. Fracture reduction and putting splints/plaster cast. Conducting daily OPD. II. Care of Routine and Emergency Cases in Medicine Essential Specific mention is being made of handling of all emergencies like Dengue Haemorrhagic Fever, Cerebral Malaria and others like Dog & snake bite cases, Poisonings, Congestive Heart Failure, Left Ventricular Failure, Pneumonias, meningoencephalitis, acute respiratory conditions, status epilepticus, Burns, Shock, acute dehydration etc. In case of National Health Programmes, appropriate guidelines are already available, which should be followed. Conducting daily OPD. III. Maternal Health Essential Minimum 4 ANC check ups including Registration & associated services : As some antenatal cases may directly register with CHC, 

the suggested schedule of antenatal visits is reproduced below. 1st visit: Within 12 weeks—preferably as soon as pregnancy is suspected—for registration of pregnancy and first antenatal check-up. 2nd visit: Between 14 and 26 weeks 3rd visit: Between 28 and 34 weeks 4th visit: Between 36 weeks and term 24-hour delivery services including normal and assisted deliveries. Managing labour using Partograph. All referred cases of Complications in pregnancy, labour and post-natal period must be adequately treated. Ensure post-natal care for 0 & 3rd day at the health facility both for the mother and newborn and sending direction to the ANM of the concerned area for ensuring 7th & 42nd day post-natal home visits. Minimum 48 hours of stay after delivery, 3-7 days stay post delivery for managing Complications. Proficiency in identification and Management of all complications including PPH, Eclampsia, Sepsis etc. during PNC. Essential and Emergency Obstetric Care including surgical interventions like Caesarean Sections and other medical interventions. Provisions of Janani Suraksha Yojana (JSY) and Janani Shishu Suraksha Karyakram (JSSK) as per guidelines. IV. Newborn Care and Child Health Essential Essential Newborn Care and Resuscitation by providing Newborn Corner in the Labour Room and Operation Theatre (where caessarian takes place). Details of Newborn Corner given at Annexure 1A. Early initiation of breast feeding with in one hour of birth and promotion of exclusive breast-feeding for 6 months. Newborn Stabilization Unit (Details given at Annexure 1B). Counseling on Infant and young child feeding as per IYCF guidelines. Routine and emergency care of sick children including Facility based IMNCI strategy. Full Immunization of infants and children against Vaccine Preventable Diseases and   Vitamin-A prophylaxis as per guidelines of Govt. of India. Tracking of vaccination drop outs and left outs. Prevention and management of routine childhood diseases, infections and anemia etc. Management of Malnutrition cases. Provisions of Janani Shishu Suraksha Karyakram (JSSK) as per guidelines. V. Family Planning Essential Full range of family planning services including IEC, counseling, provision of Contraceptives, Non Scalpel Vasectomy (NSV), Laparoscopic Sterilization Services and their follow up. Safe Abortion Services as per MTP act and Abortion care guidelines of MOHFW. Desirable MTP Facility approved for 2nd trimester of pregnancy. VI. Other National Health Programmes (NHP): (Essential Except as Indicated) All NHPs should be delivered through the CHCs. Integration with the existing programmes is vital to provide comprehensive services. The requirements for the important NHPs are being annexed as separate guidelines and following are the assured services under each NHP. Communicable Diseases Programmes RNTCP: CHC should provide diagnostic services through the microscopy centres which are already established in the CHCs and treatment services as per the Technical and Operational Guidelines for Tuberculosis Control (Annexure 2). HIV/AIDS Control Programme: The services to be provided at the CHC level are (Annexure 3). Integrated Counselling and Testing Centre. Blood Storage Centre1 . Sexually Transmitted Infection clinic. Desirable Link Anti Retroviral Therapy Centre.

National Vector Borne Disease Control Programme: The CHCs are to provide diagnostic/linkages to diagnosis and treatment facilities for routine and complicated cases of Malaria, Filaria, Dengue, Japanese Encephalitis and Kala-azar in the respective endemic zones (Annexure 4). National Leprosy Eradication Programme (NLEP): The minimum services that are to be available at the CHCs are for diagnosis and treatment of cases and complications including reactions of leprosy along with conselling of patients on prevention of deformity and cases of uncomplicated ulcers (Annexure 5). National Programme for Control of Blindness: The eye care services that should be made available at the CHC are as given below. Essential Vision Testing with Vision drum/Vision Charts. Refraction The early detection of visual impairment and their referral. Awareness generation through appropriate IEC strategies and involving community for primary prevention and early detection of impaired vision and other eye conditions. Desirable Intraocular pressure measurement by Tonometers. Syringing and probing. The provision for removal of Foreign Body. Provision of Basic services for Diagnosis and treatment of common eye diseases. Surgical services including cataract by IOL implantation. One ophthalmologist is being envisaged for every 5 lakh population i.e. one ophthalmologist will cater to 5 CHCs. (Annexure 6). Under Integrated Disease Surveillance Project, CHC will function as peripheral surveillance unit and collate, analyse and report information to District Surveillance.