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Transcript of Indian Public Health Standards
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Indian Public Health Standards
State Institute of Health & Family Welfare, Jaipur
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Existing Standards
Hospital Standards by Bureau of Indian Standards (BIS)
BIS Standards considered very resource intensive in current scenario
No such standards for primary health care institutions
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Describe a level of quality that health care facilities are expected to meet
Setting standards is a dynamic process Revision of standards will occur as and when
the facilities achieve a minimum functional grade
Standards are also flexible, to be applied keeping in view the needs of the States
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Infrastructure:Number v/s Functionality
March 2008, Impressive Numbers 146036 SCs23458 PHCs4276 CHCs
Functionality ? For quality, equity& accountabilityInfrastructureManpowerLogisticsDrugsEquipment
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NRHM aims to Reduce child and maternal deaths Stabilize population Ensure gender and demographic balance
Required- restructuring the delivery mechanism for health servicesNRHM proposed-Up gradation of public health institutions
from their present level to achieve a level of set standards called “Indian Public Health Standards (IPHS)”
IPHS Genesis
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Need for IPHS
Quality management Quality Assurance Effective, economical and accountable
health care delivery system Optimal level of services
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Minimum resources available at the facilitiesMinimum functional level of institutions
SpaceBuildingManpowerInstrumentsEquipments Drugs
Standards for periodic monitoring at State and
Central Governments, and PRIs -how many of their health facilities are conforming to IPHS standards
Considerations in Setting IPHS
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Process of Formulating IPHS
Constitution of Expert Committee under DGHS Discussion with members (ministry officials, State
Governments representatives, academicians, management experts, economists, donor agencies, public health professionals, and other organizations such as NGOs etc
Circulation of draft IPHS for public health institutions in rural areas
Putting drafts standard on website Finalization of draft IPHS for public health
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Most peripheral and first contact point
Services of acceptable standards to the people, through certain available guidelines
First step is to lay down norms and standards for Sub Centres
Why IPHS for Sub-Centres….
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IPHS for Sub-Centres…
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Location
Not too close to an existing sub centre/PHC
As far as possible, no person travels more than 3 km to reach the sub-centre
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Manpower
HW(F)
HW(M)
Additional HW(F)
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Drugs
Elementary drugs for minor ailments such as
ARIDiarrheaFeverWorm infestation
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Services
All “Assured Services” (preventive, promotive, few curative and referral services andNHPs)
Full immunization and Vitamin A prophylaxisEssential newborn careAntenatal, natal and postnatal carePrevention of malnutrition and common
childhood diseasesFamily planning services Counseling
Community needs assessment
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Minimum laboratory servicesHemoglobin estimationUrine for albumin and sugar and Referral to PHC for blood grouping
Malaria prophylaxis Provision of Janani Suraksha Yojana (JSY) Adolescent health care and school health
services Organizing VHND
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Appropriate and prompt referral services Providing treatment as per AYUSH according to
local need Training of TBAs, ASHA/Community Health
Volunteers Recording and reporting of vital events Syndromic surveillance to be done and reported
to PHC every week Water Quality Monitoring & Disinfection of water
sources
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Residential Accommodation especially for the
ANMs
Maintenance of equipment -through preventive maintenance or prompt repair of non-functional equipment to ensure uninterrupted delivery of services, by making use of the untied funds
Potable water for patients and staff and water
Wherever possible, uninterrupted power supply
Other Norms for SC…
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Availability of model citizen’s charter
A grievance redressal mechanism
Constitution of village health and sanitation committee
Involvement of PRI
SC also to Ensure
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Funding, Monitoring & Evaluation
Assistance from Ministry of Health & FW, GOI Untied funds are provided (currently Rs.10,000
per Sub centre under NRHM) One Health Assistant (Female) / Lady Health
Visitor (LHV) and one Health Assistant (Male) located at the PHC are entrusted with the task of supervision of all the Sub-centres (generally six sub centres) under a PHC
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Primary Health Centres
Population of 20,000-30,000 4-6 indoor beds Link between SC and CHC 23458( March 2008)PHCs are functioning
in the country
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Why IPHS for Primary Health Centres..
PHC -first port of call to a qualified doctor in rural areas
Referral unit for 6 Sub-centres Referring unit for CHCs and DH Provides a range of curative, promotive and
preventive health care services
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IPHS for PHC
IPHS set in view of Minimum resources available and
mentions Minimum functional standards
InnovationsConstitution of RMRS involvement of PRICitizens’ Charter
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24x7 PHC should …..
Provide 24-hour delivery services, both normal and assisted
Provide Obstetric First Aid and Referrals to First Referral Units (FRUs)/other hospitals, for high risk pregnancy cases beyond the capability of Medical Officer, PHC
Provide 24 hours emergency services for management of injuries and accidents
Provide emergency care of sick children
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Minimum Requirements for PHC Basis
Average case load of 40 patients per doctor per day
60% utilization of the available indoor/observation beds (6 beds)
Standards upgraded with utilization Manpower
One more Medical Officer (AYUSH or lady doctor) and two more staff nurses existing total staff strength of 15 in the PHC
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Proposed Manpower at PHC Existing Recommended Medical Officer 1 2(one AYUSH or LMO)Pharmacist 1 1Nurse-midwife (Staff 1 3 (for 24-hour PHCs)(Nurse) (2 may be contractual)Health workers (F) 1 1Health Educator 1 1Health Asstt. (Male & Female) 2 2Clerks 2 2Laboratory Technician 1 1
Driver 1 Optional/vehicles may be out-sourced.
Class IV 4 4Total 15 17/18SIHFW: an ISO 9001: 2008 Certified Institution 25
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Services at PHC
MCH 24 X 7 Delivery & New born care ARSH Immunization NH Programs Permanent FP methods-TT/ vasectomy/
NSV MTP using MV technique (if trained
personnel and facility exists)
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Common eye diseases and Refraction Services
School Health Nutrition ( coordinated through ICDS) Selected surgeries
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Other services Referral transport ISM based treatment through AYUSH doctor Laboratory
MalariaTBSTI/RTIEntericRoutine –Urine, stool, blood
IDSP Training Waste Mgt. Laundry (outsourced)
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Facilities at PHC under IPHS Waiting OPD Wards Nursing station OT, MOT, Labor room Laboratory Accommodation Store Dispensing Electricity, Telephone, Water
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Monitoring and Supervision
MO to Sub-centres once a month Health Assistants Male and LHV to Sub-
centres once a week Internal Mechanism: Record maintenance,
checking and supportive supervision External Mechanism: Monitoring through the
PRI / Village Health Committee / RMRS (as per guidelines of State Government)
Charter of Patients’ Rights available at PHC RMRS
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IPHS for CHCs: Objectives
To provide optimal expert 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
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CHC/FRU
30-bedded hospital located at the block headquarter
Secondary level of health care Specialist care
MedicineSurgeryOb & Gy.Pediatrics
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AnesthesiaPublic health
80,000 -1,20,000 pop.
Catchment- 4 PHCs
Referral point for PHCs(FRU for obstetric emergencies
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Infrastructure for IPHS CHC
Assured services at CHC Specialist care
MedicineSurgeryOb & Gy.Pediatrics
Blood storage unit Operation theatre, labor room, X-ray
laboratory, ECG Referral transport NH Programs
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Entrance Zone and OPDsAdmin. zoneEmergency Room/CasualtyTreatment room (MOT, Injection / dressing
room)Wards- male and female with space between
bedsOther Services
CSSD
Infrastructure Requirements for IPHS CHC
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Electricity with Back-up, Water, TelephonesLaundry & Waste mgt.Separate toilets for male & female Maintenance and sanitation facilityComputerization for record and
surveillance
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Manpower at IPHS CHC
RegularSurgeryMedicineObstetrics and Gynecology Pediatrics
ContractualAnesthetist Public Health Program Manager
Support manpower
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Public health Nurse ANM in addition to the existing staffOphthalmic Assistant
Recommended One Ophthalmologist for every 5
CHCsOne Dental Surgeon6 GDMOs One AYUSH specialist One AYUSH general doctor
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Proposed Manpower(specialists) at CHC under IPHS
Personnel Minimum requirement Proposed
General Surgeon 1 1 Physician 1 1 Ob. & Gy. 1 1
Pediatrics 1 1
Anesthetist - 1
Public Hlth. Health Manager.
- 1
Eye surgeon - 1
Total 4 6/7
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Total Manpower for IPHS CHC
Block Health Officer Physician Surgeon Ob. & Gy. Paediatrician Anesthetist Public Health
Manager Dental Surgeon
Ophthalmologist (one for 5 CHCs) 6 GDMO (2 LMOs) 1 AYUSH specialist 1 AYUSH GDMO Support Manpower (total 64) includes: 19 S/N, 1 PHN,
1ANM and 1 Ophthalmic Assistant
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Ensuring Accountability and Quality
Mandatory “Rogi Kalyan Samiti”/ RMRS A grievance redressal mechanism under
supervision of Rogi Kalyan Samitis Social audit by involvement of the community
through Rogi Kalyan Samitis (RKSs) is recommended
Charter of Patients’ Rights displayed prominently at the entrance
Standard Operating Procedures and Standard Treatment Protocols
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IPHS for Sub-divisional /Sub-district Hospitals
5-6 lakhs people about 1200 such hospitals in the country with
number of beds ranging from 50 to 100 beds or more
Two IPHS Standards for SDH have been prepared according to bed strength for 31-50 beds and 51-100 beds
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First Referral Units for specialist services from neighboring Community Health Centres
A Sub-district/Sub-divisional Hospital provides emergency obstetric and neo-natal care
It also saves travel time to the DH, reduces the workload of the district hospital
Need for IPHS for SDH
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Minimum Assured Services at SDH
OPD, indoor and emergency services Consultation
General MedicineGeneral SurgeryObstetric & GynecologyPediatricsAnesthesiaOrthopedics
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ENTRadiologist and sonologistOphthalmologyCommunity HealthSkin & VD, RTI/STIDental careAYUSH
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Other services at SDH
Lab, X-ray, Ultrasound, ECG
Blood transfusion and storage
Physiotherapy Medico
legal/postmortem
Ambulance services Dietary services Laundry services Security services Housekeeping Inventory Mgt. Waste management
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IPHS for District Hospitals
Administrative unit Pop. 2-5 million 617 Districts in the country
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IPHS for DHs: Objectives
To provide comprehensive secondary health care (specialist and referral services)
To achieve and maintain an acceptable standard of quality of care
To make services more responsive and sensitive to the needs of the people
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DH and IPHS
Services depend on size of bed compliment
Norms vary based on bed compliment Norms developed for
101-200 beds201-300 beds and 301-500 beds
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Minimum Functional standards for DH: Areas
Physical infrastructure Manpower Diagnostic and investigation
facilities Equipment Drugs Other supportive services
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Thank You