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IPHS FOR PHC

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IPHS GenesisNRHM aims:-

To reduce child and maternal deaths, To stabilize population and To ensure gender and demographic balance.

• Required -Restructuring the delivery mechanism for health services.

• NRHM proposed- Up gradation of public health institution to achieve a level of set standards

called “Indian Public Health Standards (IPHS)”.

Need for IPHS

Quality management

Quality Assurance

Effective, economical and accountable health care delivery system

Optimal level of services

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objective of IPHS

The overall objective of IPHS is to provide health care that is quality oriented and sensitive to the needs of the community.

The objectives of IPHS for PHCs :

To provide comprehensive primary health care to the community through the Primary Health Centres.

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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Why IPHS for Primary Health Centres?

PHC -first port of call to a qualified doctor in rural areas

Referring unit for 6 Sub-centres

Referral unit to CHCs and DH

Provides a range of curative, promotive and preventive health care services.

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Primary Health Centres

• Population of 20,000-30,000

Total 23673 PHCs are functioning in the country as on March 2010 as per Rural Health Statistics Bulletin, 2010.

The number of PHCs functioning on 24x7 basis are 9107

Number of PHCs where three staff Nurses have been posted are 7629 (as on 31-3-2011).

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IPHS for PHC

IPHS

- Minimum resources available

- Minimum functional standards Innovations

- Constitution of RKS

- Involvement of PRI and

- Citizens’ Charter

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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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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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Functions of PHC Medical care (OPD services, 24 hours emergency services, Referral

services, In-patient services (6 beds)) Maternal and Child Health Care Including Family Planning: ANC, Intra-

natal care: (24-hour delivery services both normal and assisted), Proficient in identification and basic first aid treatment for PPH, Eclampsia, Sepsis and prompt referral, Postnatal Care, New Born care, Care of the child, Family Welfare,

Medical Termination of Pregnancies Management of Reproductive Tract Infections/Sexually Transmitted

infections Nutrition Services (coordinated with ICDS) Adolescent Health Care Promotion of Safe Drinking Water and Basic Sanitation Prevention and control of locally endemic diseases like malaria, Kala

Azar, Japanese Encephalitis etc Collection and reporting of vital events. Health Education and Behaviour Change Communication (BCC).

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National Health Programmes

Revised National Tuberculosis Control Programme(RNTCP) National Leprosy Eradication Programme Integrated Disease Surveillance Project (IDSP) National Programme for Control of Blindness (NPCB) National Vector Borne Disease Control Programme (NVBDCP) National AIDS Control Programme National Programme for Prevention and Control of Deafness (NPPCD) National Mental Health Programme (NMHP) National Programme for Prevention and Control of Cancer, Diabetes,

CVD and Stroke (NPCDCS) National Iodine Deficiency Disorders Control Programme (NIDDCP) National Programme for Prevention and Control of Fluorosis (NPPCF)

(In affected (Endemic Districts) National Tobacco Control Programme (NTCP) National Programme for Health Care of Elderly Oral Health Physical Medicine and Rehabilitation (PMR) Services

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Modifications in the updated Indian Public Health Standard (IPHS)for Primary Health Centre (PHC)

A. Service delivery angle:

PHCs may be of two types, depending upon the delivery case load – Type A and Type B.

Type A PHC: PHC with delivery load of less than 20 deliveries in a month,

Type B PHC: PHC with delivery load of 20 or more deliveries in a month

PHCs have been categorized into three types- depending upon the case load and the distance

1.Essential standards for a normal PHC without 24 by 7 services,

2. with 24 by 7nursing facilities and

3. with 24 by 7 emergency hospital care facilities

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B. All “Minimum Assured Services” or Essential Services as envisaged in

the PHC should be available, which includes routine, preventive,

promotive, curative and emergency care in addition to all the national

health programmes.

The services which are indicated as Desirable are for the purpose that we

should aspire to achieve for this level of facility.

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c. Infrastructure: Added

i. Sign-age

ii. Barrier free access,

iii. Disaster prevention measures (desirable for new upcoming facilities),

iv. Environmental friendly features,

v. Computer facility with internet for MIS,

vi. Provision new born care corner in the facility,

vii. One room for counselling,

viii. Waste disposal pit,

ix. Cold chain logistic and generator room,

x. Boundary wall,

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D. Manpower: the new IPHS recommends the changes in manpower at PHC

i. One ophthalmic assistant for every PHC

ii. One Multi-Rehabilitation Worker or Community Based Rehabilitation worker (desirable)

iii. One data handler

iv. One cold chain and vaccine logistic assistant (desirable)

E. Drugs: The newly revised list of essential drug and the drug list for obstetric care are incorporated in these guidelines.

F. Equipment: The necessary equipment to deliver the assured services of the PHC should be available in adequate quantity and also be functional.

G. Immunizations

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Non communicable disease Programme

H. Standards of existing programmes were updated based on the inputs from various programme division along with new standards added for following newly launched (non communicable) disease programmes.

i. National Programme for prevention and control of deafness.

ii. National Mental Health Programme.

iii. National Cancer control programme.

iv. National program for prevention and control of Diabetes, CVD, and Strokes.

v. National Iodine deficiency Disorders control program

vi. National program for prevention and control of Fluorosis : in-affected Districts

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vii. National Tobacco Control program

viii. National program for health care of Elderly

ix. Oral Health

x. Disability, physical medicine and rehabilitation services.

xi. The Integrated Counseling and Testing Centre (ICTC) has been added

(Desirable)

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I. Job Responsibility of health personals is updated.

J. Reporting format under Integrated Disease Surveillance Project included

K. Checklists for monitoring and facility survey updated.

L. Facility based MDR (Maternal Death Review) is added as annexure and is supposed to be one of the desirable services at PHC.