Indian Public Health Standards (IPHS)

Guidelines for Sub-CentresRevised 2012

Dr Deepak UpadhyayMBBS, MD, MBA(HCSM)

Department of Community MedicineRohilkhand Medical College & Hospital

Background • One of the important components of National

Rural Health Mission(NRHM) is to strengthenthe Sub-centres to the level of Indian PublicHealth Standards (IPHS), which were firstprescribed in early 2007

• September 2005, a total of 1,46,027 sub-centres are functional in the country

• There are 1,47,069 Sub-centers functioning inthe country as on March 2010 as per RuralHealth Statistics Bulletin, 2010.

Objectives of IPHS

• To specify the minimum assured (essential)services that Sub-centre is expected to provideand the desirable services which the states/UT sshould aspire to provide through this facility

• To maintain an acceptable quality of care forthese services

• To facilitate monitoring and supervision of thesefacilities

• To make the services provided more accountableand responsive to people’s needs

Categorization of Sub-Centres• Type A: Provide all recommended services

except that the facilities for conductingdelivery will not be available.

• Type B: Provide all recommended servicesincluding facilities for conducting deliveriesat the Sub-centre itself.

– They will be expected to conduct around 20deliveries in a month.

– They should be provided with all labourroom facilities and equipment includingNewborn care corner

Manpower requirement (2012 guideline)

Manpower requirement (2007 guideline)

Services to be Provided1.Maternal Health:

Antenatal care:

• Early registration of all pregnancies, withinfirst trimester (before 12 week of Pregnancy)

• Minimum 4 ANC including Registration

• Recording tobacco use by all antenatalmothers.

• Urine Test for pregnancy confirmation andlinkages with PHC for other required tests.

• Name based tracking of all pregnant womenfor assured service delivery.

• Provide information about provisions undercurrent schemes and programmes like JananiSuraksha Yojana.

• Identification & basic management ofSTI/RTI.

• Counselling & referral for HIV/AIDS

Intra natal care:

• Essential for Type B Sub-centre

• Managing labour using Partograph.

• Identification and management of danger signsduring labour.

• Proficient in identification and basic fist aidtreatment for PPH, Eclampsia, Sepsis andprompt referral

Post natal care:

• Ensure post- natal home visits on 0,3,7 and42nd day for deliveries at home and sub-centre ( both for mother & baby).

• Ensure 3, 7 and 42 day visit for institutionaldelivery (both for mother & baby) cases

• In case of Low Birth weight Baby (less than2500 gm), additional visits are to be made on14, 21 and 28 days

• Tracking of missed and left out PNC

2.Child Health• Newborn Care Corner In The Labour Room

to provide Essential Newborn Care( essentialin type B)

• Promotion of exclusive breast-feeding for 6months. Appropriate and adequatecomplementary feeding from 6 months of agewhile continuing breastfeeding.

• Assess the growth and development of theinfants and under 5 children and make timelyreferral.

• Immunization Services

• Identification and follow up, referral andreporting of Adverse Events FollowingImmunization (AEFI).

3. Family Planning and Contraception

4. Safe abortion services (MTP)

5. Curative Services

– Essential

• Provide treatment for minor ailmentsincluding fever, diarrhea, ARI, worminfestation and first aid to animal bitecases, care of the wound assessment andreferral).

– Desirable

• Once a month clinic by the PHC medicalofficer

6. Adolescent Health Care

7. School Health Services:

– Screening

– Treatment of minor ailments

– Immunization

– De-worming

– Prevention and management of Vitamin Aand nutritional deficiency anemia

– Referral services through fixed day visitof school by existing ANM/MPW

8. Control of Local Endemic Diseases

9. Disease Surveillance, Integrated DiseaseSurveillance Project (IDSP)

10.Water and Sanitation

Desirable :

oDisinfection of drinking water sources

o Testing of water quality using Rapid Test(Bacteriological)

o Promotion of sanitation including use oftoilets and appropriate garbage disposal

11.Out reach/Field Services• VHND should be organised at least once in a

month in each village

• Home Visits:– Essential :To check out on disease incidences

reported to HW. Notify the M.O PHC immediatelyabout any abnormal increase in cases ofdiarrhoea/dysentery, fever with rigors, fever withrash, flaccid paralysis of acute onset in a child <15years (AFP), Tetanus, fever with jaundice or feverwith unconsciousness, minor and serious AEFIs whichshe comes across during her home visits

– Desirable :Visits to houses of eligible couples whoneed contraceptive services, but are not currentlyusing them

• House-house survey: done once annually,preferably in April. The Male multipurposeworker would take the lead and beaccountable for the organization of thesesurveys and the subsequent preparation oflists and referrals

12.Coordination and Monitoring:

• Coordinated services with AWWs, ASHAs,Village Health Sanitation and NutritionCommittee PRI etc

National programmes• Communicable disease programmes

– National AIDS Control Programme(NACP)

– National Vector Borne Disease ControlProgramme (NVBDCP)

– National Leprosy Eradication Programme(NLEP)

– Revised National Tuberculosis ControlProgramme (RNTCP)

National programmes

Non-communicable Disease (NCD) Programmes

• National Programme for Control of Blindness (NPCB)

• National Programme for Prevention and Control ofDeafness (NPPCD)

• National Mental Health Programme

• National Programme for Prevention and Control ofCancer, Diabetes, Cardiovascular Diseases andStroke

• National Iodine Deficiency Disorders ControlProgramme

• National Tobacco Control Programme

• National Programme for Health Care of Elderly

logistics• Two drug kits – A & B

SNo Kit A Kit B

1 ORS powder Methylergometrine tablets

2 IFA tablets (Large) Methylergometrine Injections

3 IFA tablets (Small) Paracetamol tablets

4 IFA Syrup Albendazole tablets

5 Folic acid tablets Dicyclomine tablets

6Cotrimoxazole (Pediatric)

tabletChloramphenicol Eye Ointment

7 Zinc Tablets Povidone Iodine Ointment

8 Vitamin A Syrup Cotton bandage

9GV Crystals

(MethylrosaniliniumChloride)

Absorbent Cotton

Other Drugs & vaccines• BCG, DPT, OPV, Measles, TT, Hepatitis B, JE and any

other vaccines as per Immunization Schedule

• Syrup Cotrimoxazole

• Tab. Cotrimoxazole 80+400 mg (for adults)

• Syrup Paracetamol

• Tab. Albendazole 400 mg

• Adhesive tape (leucoplast & Micropore)

• Savlon solution (Anti-septic Solution)

• Betadine solution (Povidone Iodine solution 5%)

• Clove oil

• Gum paints

Registers at Sub centre

1. Eligible Couple Register including Contraception

2. Maternal and Child Health Register

I. Antenatal, intra-natal, postnatal

II. under-five register

I. Immunization

II. Growth monitoring

III.Above Five Child immunization

IV. Number of HIV/STI screening and referral

3. Births and Deaths Register

4. Drug Register

5. Equipment Furniture and other accessoriesRegister

6. Communicable diseases / Epidemic Register /Register for Syndromic Surveillance

7. Passive surveillance register for malaria cases8. Register for records pertaining to Janani

Suraksha Yojana9. Register for maintenance of accounts including

untied funds.10. Register for water quality and sanitation11. Minor ailments Register12. Records/registers as per various National Health

Programme guidelines (NLEP, RNTCP, NVBDCP,etc.)