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Indian Public Health Standards (IPHS)Guidelines for
Primary Health CentresRevised 2012
Directorate General of Health ServicesMinistry of Health & Family Welfare
Government of India
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Indian Public Health Standards IPHSGuidelines for
Primary Health Centres
Revised 2012
Directorate General of Health ServicesMinistry of Health & Family Welfare
Government of India
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CONTENTS
Message v
Foreword vi
Preface vii
Acknowledgements viii
Execuve Summary 1
Indian Public Health Standards for Primary Health Centres 3
Introducon ....................................................................................................................................................... 3
Objecves of Indian Public Health Standards (IPHS) for Primar Health Centres (PHC)....................................4
Services at the Primar Health Centre for Meeng the IPHS ............................................................................. 4
Infrastructure ..................................................................................................................................................12
Manpower ....................................................................................................................................................... 16
Drugs ............................................................................................................................................................... 17
The Transport Facilies with Assured Referral Linkages .................................................................................17
Laundr Services .............................................................................................................................................. 17
Dietar Facilies for Indoor Paents ...............................................................................................................17
Waste Management at PHC Level ...................................................................................................................17
Qualit Assurance ............................................................................................................................................ 17
Monitoring of PHC Funconing ....................................................................................................................... 18
Accountabilit ................................................................................................................................................. 18
Statuar and Regulator Compliance .............................................................................................................. 18
Annexures
Anneure 1: Naonal Immunizaon Schedule for Infants, Children and Pregnant Women .................19
Anneure 2: Laout of PHC .................................................................................................................... 21
Anneure 2A: Laout of Operaon Theatre ............................................................................................22
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Anneure 3: List of Suggested Equipment and Furniture Including Reagents and Diagnosc Kits .......23
Anneure 3A: Newborn Corner in Labour Room/OT ...............................................................................27
Anneure 4: Essenal Drugs for PHC .....................................................................................................29
Anneure 5: Universal Precauons ...................................................................................................... 45
Anneure 6: Check List for Monitoring b Eternal Mechanism ..........................................................46
Anneure 7: Job Responsibilies of Medical Ocer and Other Sta at PHC .......................................49
Anneure 8: Charter of Paents’ Rights for Primar Health Centre ...................................................... 63
Anneure 9: Proforma for Facilit Surve for PHC on IPHS ...................................................................64
Anneure 10: Facilit Based Maternal Death Review Form ....................................................................73
Anneure 11: Integrated Disease Surveillance Project Formats .............................................................77
Anneure 11A: Form P Weekl Reporng Format - IDSP ........................................................................... 78
Anneure 11B: Form L Weekl Reporng Format - IDSP ........................................................................... 79
Anneure 11C: Format for instantaneous reporng of Earl Warning Signals/Outbreaks
as soon as it is detected ..................................................................................................... 80
Anneure 12: List of Statutor and Regulator Compliances .................................................................. 81
Anneure 13: List of Abbreviaons .........................................................................................................82
References 84
Members of Task Force for Revision of IPHS 85
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Naonal Rural Health Mission (NRHM) was launched to strengthen the Rural Public Health
Sstem and has since met man hopes and epectaons. The Mission seeks to provide eecvehealth care to the rural populace throughout the countr with special focus on the States and
Union Territories (UTs), which have weak public health indicators and/or weak infrastructure.
Towards this end, the Indian Public Health Standards (IPHS) for Sub-Centres, Primar Health
Centres (PHCs), Communit Health Centres (CHCs), Sub-District and District Hospitals were
published in Januar/Februar, 2007 and have been used as the reference point for public health
care infrastructure planning and up-gradaon in the States and UTs. IPHS are a set of uniform standards envisaged
to improve the qualit of health care deliver in the countr.
The IPHS documents have been revised keeping in view the changing protocols of the eisng programmes and
introducon of new programmes especiall for Non-Communicable Diseases. Fleibilit is allowed to suit the
diverse needs of the states and regions.
Our countr has a large number of public health instuons in rural areas from sub-centres at the most peripheral
level to the district hospitals at the district level. It is highl desirable that the should be full funconal and deliver
qualit care. I strongl believe that these IPHS guidelines will act as the main driver for connuous improvement in
qualit and serve as the bench mark for assessing the funconal status of health facilies.
I call upon all States and UTs to adopt these IPHS guidelines for strengthening the Public Health Care Instuons
and put in their best eorts to achieve high qualit of health care for our people across the countr.
New Delhi
23.11.2011
(Ghulam Nabi Azad)
MESSAGE
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As envisaged under Naonal Rural Health Mission (NRHM), the public health instuons in rural
areas are to be upgraded from its present level to a level of a set of standards called “Indian
Public Health Standards (IPHS)”. The Indian Public Health Standards are the benchmarks for
qualit epected from various components of Public health care organizaons and ma be used
for assessing performance of health care deliver sstem.
As earl as 1951, the Primar Health Centres (PHCs) were established as an integral part of
communit development programme. Since then lot of changes have taken place. Currentl the
PHC covers a populaon of 20,000-30,000 (depending upon the geographical locaon) and is
occuping a place between a Sub-Centre at the most peripheral level and Communit Health Centre at block
level.
As seng standards is a dnamic process, need was felt to update the IPHS keeping in view the changing protocols
of eisng Naonal Health Programmes, introducon of new programmes especiall for Non-Communicable
Diseases and prevailing epidemiological situaon in the countr. The IPHS for PHC has been revised b a task
force comprising of various stakeholders under the Chairmanship of Director General of Health Services. Subject
eperts, NGOs, State representaves and health workers working in the health facilies have also been consulted
at dierent stages of revision.
The newl revised IPHS for PHC has considered the services, infrastructure, manpower, equipment and drugs into
two categories of Essenal (minimum assured services) and Desirable (the ideal level services which the states and
Union Territories (UTs) shall tr to achieve). PHCs have been categorized into two categories depending upon the
case load of deliveries. This has been done to ensure opmal ulizaon of resources. Sates/UTs are epected to
categorize the PHCs and provide infrastructure according to the laid down guidelines in this document.
I am sure this document will help the States Governments and Panchaa Raj Instuons to monitor eecvel as
to how man of the PHCs are conforming to IPHS and take measures to upgrade the remaining to desired level.
I would like to acknowledge the eorts put b the Directorate General of Health Services in preparing the guidelines.
Comments and suggesons for further improvement are most welcome.
(P.K.Pradhan)
FOREWORD
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PREFACE
Standards are a means of describing a level of qualit that the health care organizaons are
epected to meet or aspire to achieve. For the rst me under Naonal Rural Health Mission
(NRHM), an eort had been made to develop Indian Public Health Standards (IPHS) for a vast
network of peripheral public health instuons in the countr and the rst set of standards was
released in earl 2007.
A Primar Health Centre (PHC) serves as a rst port of call to a qualied doctor in the public
health sector in rural areas providing a range of curave, promove and prevenve health care.
A PHC providing 24-hour services and with appropriate linkages, plas an important role in increasing instuonal
deliveries thereb helping to reduce maternal mortalit and infant mortalit.
The IPHS for Primar Health Centres has been revised keeping in view the resources available with respect to
funconal requirements of Primar Health Centre with minimum standards for such as building, manpower,
instruments and equipment, drugs and other facilies etc. The revised IPHS has also incorporated the changed
protocols of the eisng health programmes and new programmes and iniaves especiall in respect of Non-
Communicable Diseases. The task of revision was completed as a result of consultaons held over man months
with task force members, programme ocers, Regional Directors of Health and Famil Welfare, eperts, healthfunconaries, representaves of Non-Government organizaons, development partners and State/Union Territor
Government representaves aer reaching a consensus. The contribuon of all of them is well appreciated. Several
innovave approaches have been incorporated in the management process to ensure communit and Panchaa
Raj Instuons’ involvement and accountabilit.
From Service deliver angle, PHCs ma be of two tpes depending upon the deliver case load – Tpe A and Tpe
B. The PHCs with deliver case load of less than 20 deliveries in a month will be of Tpe A and those with deliver
case load of 20 or more in a month will be of Tpe B. This has been done to ensure opmal ulizaon of manpower
and resources.
Seng standards is a dnamic process and this document is not an end in itself. Further revision of the standards
shall be undertaken as and when the Primar Health Centres will achieve a minimum funconal grade. It is hopedthat this document will be of immense help to the States/Union Territories and other stakeholders in bringing up
Primar Health Centres to the level of Indian Public Health Standards.
(Dr. Jagdish Prasad)
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Indian Public Health Standards (IPHS) Guidelines for PRIMARy HEALTH CENTRES viii
ACKNOWLEDGEMENTS
The revision of the eisng guidelines for Indian Public Health Standards (IPHS) for dierent levels of Health Facilies
from Sub-Centre to District Hospitals was started with the formaon of a Task Force under the Chairmanship of
Director General of Health Services (DGHS). This revised document is a concerted eort made possible b the advice,
assistance and cooperaon of man individuals, Instuons, government and non-government organizaons.
I gratefull acknowledge the valuable contribuon of all the members of the Task Force constuted to revise Indian
Public Health Standards (IPHS). The list of Task Force Members is given at the end of this document. I am thankful
to them individuall and collecvel.
I am trul grateful to Mr. P.K. Pradhan, Secretar (H & FW) for the acve encouragement received from him.
I also gratefull acknowledge the iniave, inspiraon and valuable guidance provided b
Dr. Jagdish Prasad, Director General of Health Services, Ministr of Health and Famil Welfare, Government of
India. He has also etensivel reviewed the document while it was being developed.
I sincerel acknowledge the contribuon of Dr. R.K Srivastava, E- DGHS and Chairman of Task Force constuted for
revision of IPHS who has etensivel reviewed the document at ever step, while it was being developed.
I sincerel thank Miss K. Sujatha Rao, E-Secretar (H&FW) for her valuable contribuon and guidance
in raonalizing the manpower requirements for Health Facilies. I would speciall like to thank
Ms. Anuradha Gupta, Addional Secretar and Mission Director NRHM, Mr. Manoj Jhalani Joint Secretar
(RCH), Mr. Amit Mohan Prasad, Joint Secretar (NRHM), Dr. R.S. Shukla Joint Secratar (PH), Dr. Shiv
Lal, former Special DG and Advisor (Public Health), Dr. Ashok Kumar, DDG Dr. N.S. Dharm Shaktu, DDG,
Dr. C.M. Agrawal DDG, Dr. P.L. Joshi former DDG, eperts from NHSRC namel Dr. T. Sunderraman,
Dr. J.N. Sahai, Dr. P. Padmanabhan, Dr. J.N. Srivastava, eperts from NCDC Dr. R.L. Ichhpujani, Dr. A.C. Dhariwal,
Dr. Shashi Khare, Dr. S.D. Khaparde, Dr. Sunil Gupta, Dr. R.S. Gupta, eperts from NIHFW Prof. B. Deoki Nandan,
Prof. K. Kalaivani, Prof. M. Bhaachara, Prof. J.K. Dass, Dr. Vivekadish, programme ocers from Ministr of
Health Famil welfare and Directorate General of Health Services especiall Dr. Himanshu Bhushan, Dr. ManishaMalhotra, Dr. B. Kishore, Dr. Jagdish Kaur, Dr. D.M. Thorat and Dr. Sajjan Singh yadav for their valuable contribuon
and guidance in formulang the IPHS documents.
I am grateful to the following State level administrators, health funconaries working in the health facilies and
NGO representaves who shared their eld eperience and greatl contributed in the revision work; namel:
Dr. Manohar Agnani, MD NRHM from Government of MP Dr. Junaid Rehman from Government of Kerala.
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Indian Public Health Standards (IPHS) Guidelines for PRIMARy HEALTH CENTRES ix
Dr. Kamlesh Kumar Jain from Government of Chhasgarh.
Dr. y.K. Gupta, Dr. Kiran Malik, Dr. Avdesh Kumar, Dr. Naresh Kumar, Smt. Prabha Devi Panwar, ANM and
Ms. Pushpa Devi, ANM from Government of Uar Pradesh.
Dr. P.N.S. Chauhan, Dr. Jaashree Chandra, Dr. S.A.S. Kazmi, Dr. L.B. Asthana, Dr. R.P. Maheshwari, Dr. (Mrs.) Pushpa
Gupta, Dr. Ramesh Makwana and Dr. (Mrs.) Bhusan Shrivastava from Government of Madha Pradesh.
Dr. R.S. Gupta, Dr. S.K. Gupta, Ms. Mamta Devi, ANM and Ms. Sangeeta Sharma, ANM from Government of
Rajasthan.
Dr. Rajesh Bali from Government of Harana.
NGO representaves: Dr. P.K. Jain from RK Mission and Dr. Sunita Abraham from Chrisan Medical Associaon of
India.
Tmt. C. Chandra, Village Health Nurse, and Tmt. K. Geetha, Village Health Nurse from Government of Tamil Nadu.
I epress m sincere thanks to Architects of Central Design Bureau namel Sh. S. Majumdar, Dr. Chandrashekhar,
Sh. Sridhar and Sh. M. Bajpai for providing inputs in respect of phsical infrastructure and building norms.
I am also etremel grateful to Regional Directors of Health and Famil Welfare, State Health Secretaries, State
Mission directors and State Directors of Health Services for their feedback.
I shall be failing in m dut if I do not thank Dr. P.K. Prabhakar, Deput Commissioner, Ministr of Health and Famil
Welfare for providing suggesons and support at ever stage of revision of this document.
Last but not the least the assistance provided b m secretarial sta and the team at Macro Graphics Pvt. Ltd. is
dul acknowledged.
(Dr. Anil Kumar)
Member Secretar-Task force
CMO (NFSG)
Directorate General of Health ServicesJune 2012 Ministr of Health & Famil Welfare
New Delhi Government of India
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Indian Public Health Standards (IPHS) Guidelines for PRIMARy HEALTH CENTRES 1
ExECUTIVE SUMMARy
Primar Health Centre is the cornerstone of rural
health services- a first port of call to a qualified
doctor of the public sector in rural areas for thesick and those who directl report or referred from
Sub-Centres for curative, preventive and promotive
health care.
A tpical Primar Health Centre covers a populaon
of 20,000 in hill, tribal, or dicult areas and 30,000
populaons in plain areas with 6 indoor/observaon
beds. It acts as a referral unit for 6 Sub-Centres and
refer out cases to CHC (30 bedded hospital) and higher
order public hospitals located at sub-district and
district level. However, as the populaon densit in
the countr is not uniform, the number of PHCs would
depend upon the case load. PHCs should become a
24 hour facilit with nursing facilies. Select PHCs,
especiall in large blocks where the CHC/FRU is over
one hour of journe me awa, ma be upgraded to
provide 24 hour emergenc hospital care for a number
of condions b increasing number of Medical Ocers,
preferabl such PHCs should have the same IPHS norms
as for a CHC.
Standards are the main driver for connuous
improvements in qualit. The performance of PrimarHealth Centres can be assessed against the set
standards. Seng standards is a dnamic process.
Currentl the IPHS for Primar Health Centres has
been revised keeping in view the resources available
with respect to funconal requirements of Primar
Health Centre with minimum standards such as
building, manpower, instruments and equipment,
drugs and other facilies etc. The revised IPHS has
incorporated the changed protocols of the eisnghealth programmes and new programmes and
iniaves especiall in respect of Non-communicable
diseases.
The overall objecve of IPHS for PHC is to provide
health care that is qualit oriented and sensive to
the needs of the communit. These standards would
also help monitor and improve the funconing of the
PHCs.
Service DeliverFrom Service deliver angle, PHCs ma be of twotpes, depending upon the deliver case load –
Tpe A and Type B.
Type A PHC: PHC with deliver load of less than
20 deliveries in a month,
Type B PHC: PHC with deliver load of 20 or more
deliveries in a month
All “Minimum Assured Services” or Essenal
Services as envisaged in the PHC should be
available. The services which are indicated asDesirable are for the purpose that we should
aspire to achieve for this level of facilit.
Appropriate guidelines for each Naonal
Programme for management of roune
and emergenc cases are being provided to the
PHC.
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Indian Public Health Standards (IPHS) Guidelines for PRIMARy HEALTH CENTRES2
Minimum Requirement forDeliver of the Above-menonedServices
The following requirements are being projected based
on case load of 40 paents per doctor per da, the
epected number of beneciaries for maternal andchild health care and famil planning and about 60%
ulizaon of the available indoor/observaon beds (6
beds). Besides one MBBS medical ocer, one AyUSH
medical ocer (desirable) has been provided to provided
choices to the people, wherever an AyUSH public
facilit is not available in the near vicinit. Manpower
has been raonalized. For Tpe B PHCs, addional sta
in the from of one MBBS medical ocer (desirable) one
Sta Nurse and one sanitar worker cum watchman
have been provided have been provided to take careof addional deliver case load. It would be a dnamic
process in the sense that if the ulizaon goes up, the
standards would be further upgraded.
Facilies
The document includes a suggested laout of PHC
indicang the space for the building and otherinfrastructure facilies. A list of manpower, equipment,
furniture and drugs needed for providing the assured
and desirable services at the PHC has been incorporated
in the document. A Charter of Paents’ Rights for
appropriate informaon to the beneciaries, grievance
redressal and constuon of Rogi Kalan Sami/
Primar Health Centre Management Commiee for
beer management and improvement of PHC services
with involvement of Panchaa Raj Instuons (PRI)
has also been made as a part of the Indian Public
Health Standards. The monitoring process and qualitassurance mechanism is also included.
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Indian Public Health Standards (IPHS) Guidelines for PRIMARy HEALTH CENTRES 3
INDIAN PUBLIC HEALTH STANDARDS FOR PRIMARyHEALTH CENTRES
IntroduconThe concept of Primar Health Centre (PHC) is not new
to India. The Bhore Commiee in 1946 gave the concept
of a PHC as a basic health unit to provide as close to the
people as possible, an integrated curave and prevenve
health care to the rural populaon with emphasis on
prevenve and promove aspects of health care.
The health planners in India have visualized the PHC
and its Sub-Centres (SCs) as the proper infrastructure
to provide health services to the rural populaon. The
Central Council of Health at its rst meeng held in
Januar 1953 had recommended the establishment
of PHCs in communit development blocks to provide
comprehensive health care to the rural populaon. These
centres were funconing as peripheral health service
instuons with lile or no communit involvement.
Increasingl, these centres came under cricism, as the
were not able to provide adequate health coverage,
partl, because the were poorl staed and equipped
and lacked basic amenies.
The 6th Five ear Plan (1983-88) proposed reorganizaon
of PHCs on the basis of one PHC for ever 30,000 rural
populaons in the plains and one PHC for ever 20,000
populaon in hill, tribal and desert areas for more
eecve coverage. However, as the populaon densit
in the countr is not uniform, the number of PHCs
would depend upon the case load. PHCs should become
funconal for round the clock with provision of 24 × 7
nursing facilies. Select PHCs, especiall in large blocks
where the CHC is over one hour of journe me awa,
ma be upgraded to provide 24 hour emergenc
hospital care for a number of condions b increasing
the number of Medical Ocers; preferabl such PHCs
should have the same IPHS norms as for a CHC. There
are 23673 PHCs funconing in the countr as on March
2010 as per Rural Health Stascs Bullen, 2010. The
number of PHCs funconing on 247 basis are 9107and
number of PHCs where three sta Nurses have been
posted are 7629 (as on 31-3-2011).
PHCs are the cornerstone of rural health services- a rst
port of call to a qualied doctor of the public sector in
rural areas for the sick and those who directl report
or referred from Sub-Centres for curave, prevenve
and promove health care. It acts as a referral unit for
6 Sub-Centres and refer out cases to Communit Health
Centres (CHCs-30 bedded hospital) and higher order
public hospitals at sub-district and district hospitals. It
has 4-6 indoor beds for paents.
PHCs are not spared from issues such as the inabilit to
perform up to the epectaon due to (i) non-availabilit
of doctors at PHCs; (ii) even if posted, doctors do not sta
at the PHC HQ; (iii) inadequate phsical infrastructure
and facilies; (iv) insucient quanes of drugs; (v) lack
of accountabilit to the public and lack of communit
parcipaon; (vi) lack of set standards for monitoring
qualit care etc.
Standards are a means of describing the level of qualit
that health care organizaons are epected to meet
or aspire to. Ke aim of these standards is to underpin
the deliver of qualit services which are fair and
responsive to client’s needs, provided equitabl and
deliver improvements in the health and wellbeing of the
populaon. Standards are the main driver for connuous
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Indian Public Health Standards (IPHS) Guidelines for PRIMARy HEALTH CENTRES4
improvements in qualit. The performance of health care
deliver organizaons can be assessed against standards.
The Naonal Rural Health Mission (NRHM) has provided
the opportunit to set Indian Public Health Standards
(IPHS) for Health Centres funconing in rural areas.
In order to provide opmal level of qualit health care,
a set of standards called Indian Public Health Standards
(IPHS) were recommended for Primar Health Centre(PHC) in earl 2007.
The nomenclature of a PHC varies from State to State
that include a Block level PHCs (located at block HQ and
covering about 100,000 populaon and with varing
number of indoor beds) and addional PHCs/New PHCs
covering a populaon of 20,000-30,000 etc. Regarding
the block level PHCs it is epected that the are
ulmatel going to be upgraded as Communit Health
Centres with 30 beds for providing specialized services.
Seng standards is a dnamic process. Currentl the
IPHS for Primar Health Centres has been revised
keeping in view the resources available with respect
to funconal requirement for PHCs having 6 beds
with minimum standards such as building manpower,
instruments, and equipment, drugs and other facilies
etc. The revised IPHS has incorporated the changed
protocols of the eisng health programmes and new
programmes and iniaves especiall in respect of Non-
communicable diseases.
It is desirable that on the basis of essenal services,
State/UT should issue the Government nocaon for
minimum mandate standard for services at PHC.
Objecves of Indian Public HealthStandards (IPHS) for PrimarHealth Centres (PHC)
The overall objecve of IPHS is to provide health care
that is qualit oriented and sensive to the needs of the
communit.
The objecves of IPHS for PHCs are:
To provide comprehensive primar health carei.
to the communit through the Primar Health
Centres.
To achieve and maintain an acceptable standardii.
of qualit of care.
To make the services more responsive andiii.
sensitive to the needs of the communit.
Services at the Primar HealthCentre for meeng the IPHSFrom Service deliver angle, PHCs ma be of two tpes,
depending upon the deliver case load – Tpe A and
Type B.
Type A PHC: PHC with deliver load of less than 20deliveries in a month,
Type B PHC: PHC with deliver load of 20 or moredeliveries in a month
All the following services have been classied as
Essenal (Minimum Assured Services) or Desirable
(which all States/UTs should aspire to achieve at this
level of facility).
Medical care
Essenal
OPD services: A total of 6 hours of OPD services
out of which 4 hours in the morning and 2 hours
in the aernoon for si das in a week. Time
schedule will var from state to state. Minimum
OPD aendance is epected to be 40 paents per
doctor per da. In addion to si hours of dut at
the PHC, it is desirable that MO PHC shall spend at
least two hours per da twice in a week for eld
dues and monitoring.
24 hours emergency services: appropriate
management of injuries and accident, First Aid,
stching of wounds, incision and drainage of
abscess, stabilisaon of the condion of the paent
before referral, Dog bite/snake bite/scorpion bite
cases, and other emergenc condions. These
services will be provided primaril b the nursing
sta. However, in case of need, Medical Ocer ma
be available to aend to emergencies on call basis.
Referral services.
In-paent services (6 beds).
Maternal and Child Health Care Including
Famil Planning
Essenal
a) Antenatal care
Earl registraon of all pregnancies idealli.
in the rst trimester (before 12th week of
pregnanc). However, even if a woman comes
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Indian Public Health Standards (IPHS) Guidelines for PRIMARy HEALTH CENTRES 5
late in her pregnanc for registraon she should
be registered and care given to her according
to gestaonal age. Record tobacco use b all
antenatal mothers.
Minimum 4 antenatal checkups and provision ofii.
complete package of services.
Suggested schedule for antenatal visits:
1st visit: Within 12 weeks—preferabl as soon
as pregnanc is suspected—for registraon of
pregnanc and rst antenatal check-up.
2nd visit: Between 14 and 26 weeks.
3rd visit: Between 28 and 34 weeks.
4th visit: Between 36 weeks and term.
Associated services like providing iron and folic
acid tablets, injecon Tetanus Tooid etc (as per
the “guidelines for Ante-Natal Care and Skilled
Aendance at birth b ANMs and LHVs) Ensure,
at-least 1 ANC preferabl the 3rd visit, must be
seen b a doctor.
Minimum laborator invesgaons likeiii.
Haemoglobin, Urine albumin and sugar, RPR
test for sphilis and Blood Grouping and Rh
tping.
Nutrion and health counseling. Brief advice oniv.
tobacco cessaon if the antenatal mother is a
smoker or tobacco user and also inform about
dangers of second hand smoke.
Idencaon and management of high risk andv.alarming signs during pregnanc and labour.
Timel referral of such idened cases to FRUs/
other hospitals which are beond the capacit of
Medical Ocer PHC to manage.
Tracking of missed and le out ANC.vi.
Chemoprophlais for Malaria in high malariavii.
endemic areas for pregnant women as per
NVBDCP guidelines.
b) Intra-natal care: (24-hour deliver services both
normal and assisted)
Promoon of instuonal deliveries.i.
Management of normal deliveries.ii.
Assisted vaginal deliveries including forceps/iii.
vacuum deliver whenever required.
Manual removal of placenta.iv.
Av. ppropriate and prompt referral for cases needing
specialist care.
Management of pregnanc Induced hpertensionvi.
including referral.
Pre-referral management (Obstetric rst-aid) invii.
Obstetric emergencies that need epert assistance
(Training of sta for emergenc management to
be ensured).
Minimum 48 hours of sta aer deliver.viii.
Managing labour using Partograph.i.
c) Procient in idencaon and basic rst aid
treatment for PPH, Eclampsia, Sepsis and
prompt referral
As per ‘Antenatal Care and Skilled Birth Aendance
at Birth’ Guidelines
d) Postnatal CareEnsure post- natal care for 0 & 3i. rd da at the health
facilit both for the mother and new-born and
sending direcon to the ANM of the concerned
area for ensuring 7th & 42nd da post-natal home
visits. 3 addional visits for a low birth weight
bab (less than 2500 gm) on 14th da, 21st da and
on 28th da.
Iniaon of earl breast-feeding within one hourii.
of birth.
Counseling on nutrion, hgiene, contracepon,iii.essenal new born care (As per Guidelines of GOI
on Essenal new-born care) and immunizaon.
Others: Provision of facilies under Jananiiv.
Suraksha yojana (JSy).
Tracking of missed and le out PNC.v.
e) New Born care
Facilies for Essenal New Born Care (ENBC) andi.
Resuscitaon (Newborn Care Corner in Labour
Room/OT, Details given in Anneure 3A).Earl iniaon of breast feeding with in one hourii.
of birth.
Management of neonatal hpothermia (provisioniii.
of warmth/Kangaroo Mother Care (KMC),
infecon protecon, cord care and idencaon
of sick newborn and prompt referral.
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f) Care of the child
Roune and Emergenc care of sick childreni.
including Integrated Management of Neonatal
and Childhood Illnesses (IMNCI) strateg and
inpaent care. Prompt referral of sick children
requiring specialist care.
Counseling on eclusive breast-feeding forii.
6 months and appropriate and adequate
complementar feeding from 6 months of age
while connuing breaseeding. (As per Naonal
Guidelines on Infant and young Child Feeding,
2006, b Ministr of WCD, Government of
India).
Assess the growth and development of the infantsiii.
and under 5 children and make mel referral.
Full Immunizaon of all infants and children againstiv.
vaccine preventable diseases as per guidelines
of GOI. (Current Immunizaon Schedule at
Annexure 1). Tracking of vaccinaon dropouts.
Vitamin A prophlais to the children as perv.
naonal guidelines.
Prevenon and control of roune childhoodvi.
diseases, infecons like diarrhoea, pneumonia
etc. and anemia etc.
Management of severe acute malnutrion casesvii.
and referral of serious cases aer iniaon of
treatment as per facilit based guidelines.
Janani Suraksha yojana
Janani Suraksha yojana (JSy) is a safe motherhoodintervenon under the Naonal Rural Health Mission
(NRHM) being implemented with the objecve of
reducing maternal and neo-natal mortalit b promong
instuonal deliver among the poor pregnant women.
This scheme integrates cash assistance with deliver
and post-deliver care.
While the scheme would create demand for instuonal
deliver, it would be necessar to have adequate number
of 24x7 deliver services centre, doctors, mid-wives,
drugs etc. at appropriate places. Mainl, this will entail
Linking each habitaon (village or a ward in anurban area) to a funconal health centre- public
or accredited private instuon where 24x7
deliver service would be available,
Associate an ASHA or a health link worker to each
of these funconal health centre.
It should be ensured that ASHA keeps track of all
epectant mothers and newborn. All epectant
mother and newborn should avail ANC and
immunizaon services, if not in health centres,
atleast on the monthl health and nutrion da,
to be organised in the Anganwadi or sub-centre.Each pregnant women is registered and a micro-
birth plan is prepared.
Each pregnant woman is tracked for ANC,
For each of the epectant mother, a place of deliver
is pre-determined at the me of registraon and
the epectant mother is informed,
A referral centre is idened and epectant
mother is informed,
ASHA and ANM to ensure that adequate fundis available for disbursement to epectant
mother,
ASHA takes adequate steps to organize transport
for taking the women to the pre-determined
health instuon for deliver.
ASHA assures availabilit of cash for
disbursement at the health centre and she
escorts pregnant women to the pre-determined
health centre.
ASHA package in the form of cash assistance for
referral transport, cash incenve and transaconal
cost to be provided as per guidelines.
Janani Shishu Suraksha Karakram (JSSK)
JJSSK launched on 1st of June of 2011 is an iniave
to assure free services to all pregnant women and
sick neonates accessing public health instuons.
The scheme envisages free and cashless services to
pregnant women including normal deliveries and
caesarian secon operaons and also treatment of sick
newborn (up to 30 das aer birth) in all Government
health instuons across State/UT.
This initiative supplements the cash assistance
given to pregnant women under the JSy and is
aimed at mitigating the burden of out of pocket
ependiture incurred b pregnant women and sick
newborns,
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g) Famil Welfare
Educaon, Movaon and Counseling to adopti.
appropriate Famil planning methods.
Provision of contracepves such as condoms, oralii.
pills, emergenc contracepves, IUCD inserons.
Referral and Follow up services to the eligibleiii.
couples adopng permanent methods
(Tubectom/Vasectom).
Counseling and appropriate referral for couplesiv.
having inferlit.
Permanent methods like Tubal ligaon andv.
vasectom/NSV, where trained personnel and
facilit eist.
Medical Terminaon of Pregnancies
Essenal
Counseling and appropriate referral for safe aboron
services (MTP) for those in need.
Desirable
MTP using Manual Vacuum Aspiraon (MVA)
technique will be provided in PHCs, where trained
personnel and facilit eist.
Medical Method of Aboron with linkage for
mel referral to the facilit approved for 2nd
trimester of MTP.
Management of Reproducve Tract
Infecons/Seuall Transmied Infecons
Essenal
Health educaon for prevenon of RTI/STIs.a.
Treatment of RTI/STIs.b.
Nutrion Services (coordinated with ICDS)
Essenal
Diagnosis of and nutrion advice to malnourisheda.
children, pregnant women and others.
Diagnosis and management of anaemia andb.
vitamin A decienc.
Coordinaon with ICc. DS.
School Health
Teachers screen students on a connuous basis and
ANMs/HWMs (a team of 2 workers) visit the schools
(one school ever week) for screening, treatment of
minor ailments and referral. Doctor from CHC/PHC will
also visit one school per week based on the screening
reports submied b the teams. Overall services to beprovided under school health shall include
Essenal
Health service provision
Screening, health care and referral:
Screening of general health, assessment of
Anaemia/Nutrional status, visual acuit,
hearng problems, dental check up, common skin
condions, Heart defects, phsical disabilies,
learning disorders, behavior problems, etc.
Basic medicines to take care of common ailments,
prevalent among oung school going children.
Referral Cards for priorit services at District/
Sub-District hospitals.
Immunizaon:
As per naonal schedule
Fied da acvit
Coupled with educaon about the issue
Entlements for Pregnant Women
Free and Zero epense deliver and Caesarian1.
Secon
Free Drugs and Consumables2.
Free Diagnoscs (Blood, Urine tests and3.
Ultrasonograph etc. as required.)
Free diet during sta in the health instuons (up4.to 3 das fro normal deliveries and upto 7 das
for caesarian deliveries)
Free provision of the Blood5.
Free transport from home to health instuons,6.
between facilies in case of referrals and drop
back from instuons to home.
Eempon from all kinds of user charges7.
Entlements for Sick newborn ll 30 days
aer Birth
Free and zero epense treatment1.
Free Drugs and Consumables2.
Free Diagnoscs3.
Free provision of the Blood4.
Free transport from home to health5.
instuons, between facilies in case of referrals
and drop back from instuons to home.
Eempon from all kinds of user charges6.
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Micronutrient (Vitamin A & IFA) management:
Weekl supervised distribuon of Iron-Folate
tablets coupled with educaon about the issue
Administraon of Vitamin-A in need cases.
De-worming
Biannuall supervised schedule
Prior IEC
Siblings of students also to be covered
Capacity building
Monitoring & Evaluaon
Mid Day Meal: in coordinaon with department
of school educaon, Ministr of Human Resource
Development
Desirable
Health Promong Schools
Counseling services
Regular pracce of yoga, Phsical educaon,health educaon
Peer leaders as health educators.
Adolescent health educaon-eisng in few places
Linkages with the out of school children
Health clubs, Health cabinets
First Aid room/corners or clinics.
Adolescent Health CareTo be provided preferabl through adolescent friendl
clinic for 2 hours once a week on a ed da. Services
should be comprehensive i.e. a judicious mi of promove,
prevenve, curave and referral services
Core package (Essenal)
Adolescent and Reproducve Health: Informaon,
counseling and services related to seual
concerns, pregnanc, contracepon, aboron,
menstrual problems etc.
Services for tetanus immunizaon of adolescents
Nutrional Counseling, Prevenon and
management of nutrional anemia
STI/RTI management
Referral Services for VCTC and PPTCT services and
services for Safe terminaon of pregnanc, if notavailable at PHC
Oponal/addional services (desirable): as per local need
Outreach services in schools (essenal) and community
Camps (desirable)
Periodic Health check ups and health educaon
acvies, awareness generaon and Co-curricular
acvies
Promoon of Safe Drinking Water and
Basic Sanitaon
Essenal
Disinfecon of water sources and Coordinaon
with Public Health Engineering department for
safe water suppl.
Promoon of sanitaon including use of toilets
and appropriate garbage disposal.
Desirable
Tesng of water qualit using H2S - Strip Test
(Bacteriological).
Prevenon and control of locall endemic
diseases like malaria, Kala Azar, Japanese
Encephalis etc. (Essenal)
Collecon and reporng of vital events.(Essenal)
Health Educaon and Behaviour Change
Communicaon (BCC). (Essenal)
Other Naonal Health Programmes
Revised Naonal Tuberculosis Control Programme
(RNTCP)
Essenal
All PHCs to funcon as DOTS Centres to deliver treatmentas per RNTCP treatment guidelines through DOTS
providers and treatment of common complicaons
of TB and side eects of drugs, record and report on
RNTCP acvies as per guidelines. Facilit for Collecon
and transport of sputum samples should be available as
per the RNTCP guidelines.
Naonal Lepros Eradicaon Programme
Essenal
Health educaon to communit regardinga.
Lepros.Diagnosis and management of Lepros and itsb.
complicaons including reacons.
Training of lepros paents having ulcers forc.
self-care.
Counselling for lepros paents for regularit/d.
compleon of treatment and prevenon of
disabilit.
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Integrated Disease Surveillance Project (IDSP)
Essenal
Weekl reporng of epidemic prone diseases in S,a.
P & L forms and SOS reporng of an cluster of
cases (formats for the data collecon are added in
Annexures 11, 11A, 11B, 11C).
PHC will collect and analse data fromb. Sub-Centre and will report informaon to district
surveillance unit.
Appropriate preparedness and rst level acon inc.
out-break situaons.
Laborator services for diagnosis of Malaria,d.
Tuberculosis, and tests for detecon of faecal
contaminaon of water (Rapid test kit) and
chlorinaon level.
Naonal Programme for Control of Blindness (NPCB)
Essenal The earl detecon of visual impairment anda.
their referral.
Detecon of cataract cases and referral forb.
cataract surger.
Provision of Basic treatment of common eec.
diseases.
Awareness generaon through appropriate IECd.
strategies for prevenon and earl detecon of
impaired vision and other ee condions.
Greater parcipaon/role of communit ine.
primar prevenon of ee problems.
Naonal Vector Borne Disease Control Programme
(NVBDCP)
Essenal in endemic areas
Diagnosis and Management of Vector borne Diseases is to
be undertaken as per NVBDCP guidelines for PHC/CHC:
Diagnosis of Malaria cases, microscopica.
conrmaon and treatment.
Cases of suspected JE and Dengue to be providedb.
smptomac treatment, hospitalizaon and case
management as per the protocols.Complete treatment to Kala-azar cases in Kala-c.
azar endemic areas as per naonal Polic.
Complete treatment of microlaria posive casesd.
with DEC and parcipaon in and arrangement
for Mass Drug Administraon (MDA) along with
management of side reacons, if an. Morbidit
management of Lmphoedema cases.
Naonal AIDS Control Programme
Essenal
IEC acvies to enhance awareness and prevenvea.
measures about STIs and HIV/AIDS, Prevenon of
Parents to Child Transmission (PPTCT) services.
Organizing School Health Educaon Programme.b.
Condom Promoon & distribuon of condoms toc.the high risk groups.
Help and guide paents with HIV/AIDS receivingd.
ART with focus on adherence.
Desirable
Integrated Counseling and Tesng Centre, STIa.
services.
Screening of persons praccing high-risk behaviourb.
with one rapid test to be conducted at the PHC
level and development of referral linkages with
the nearest ICTC at the District Hospital level for
conrmaon of HIV status of those found posiveat one test stage in the high prevalence states.
Risk screening of antenatal mothers with onec.
rapid test for HIV and to establish referral linkages
with CHC or District Hospital for PPTCT services
in the si high HIV prevalence states (Tamil
Nadu, Andhra Pradesh, Maharashtra, Karnataka,
Manipur and Nagaland) of India.
Linkage with Microscop Centre for HIV-TBd.
coordinaon.
Pre and post-test counseling of AIDS paents be.
PHC sta in high prevalence states.
Naonal Programme for Prevenon and Control of
Deafness (NPPCD)
Essenal
Earl detecon of cases of hearing impairmenta.and deafness and referral.
Basic Diagnosis and treatment services forb.
common ear diseases like wa in ear, otomcosis,
os eterna, Ear discharge etc.
IEC services for prevenon, earl deteconc.
of hearing impairment/deafness and greaterparcipaon/role of communit in primar
prevenon of ear problems.
Naonal Mental Health Programme (NMHP)
Essenal
Ea. arl idencaon (diagnosis) and treatment of
mental illness in the communit.
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Basic Services: Diagnosis and treatment ofb.
common mental disorders such as pschosis,
depression, aniet disorders and epileps and
referral).
IEC acvies for prevenon, sgma removal,c.
earl detecon of mental disorders and greater
parcipaon/role of Communit for primar
prevenon of mental disorders.
Naonal Programme for Prevenon and Control of
Cancer, Diabetes, CVD and Stroke (NPCDCS)
Cancer
Essenal
IEC services for prevenon of cancer and earla.
smptoms.
Earl detecon of cancer with warning signalsb.
like change in Bladder/Bowel habits, bleeding
per rectum, blood in urine, lmph node
enlargement, Lump or thickening in Breast,
itching and/or redness or soreness of the nipples
of Breast, non healing chronic sore or ulcer in oral
cavit, dicult in swallowing, obvious change
in wart/mole, nagging cough or hoarseness of
voice etc.
Referral of suspected cancer cases with earlc.
warning signals for conrmaon of the diagnosis.
Desirable
PAP smear
Other NCD Diseases
Essenal
Health Promoon Services to modif individual,a.
group and communit behaviour especiall
through;
Promoon of Health Dietar Habits.i.
Increase phsical acvit.ii.
Avoidance of tobacco and alcohol.iii.
Stress Management.iv.
Earl detecon, management and referral ofb.
Diabetes Mellitus, Hpertension and otherCardiovascular diseases and Stroke through simple
measures like histor, measuring blood pressure,
checking for blood, urine sugar and ECG.
Desirable
Surve of populaon to idenf vulnerable, high risk
and those suering from disease.
Naonal Iodine Decienc Disorders Control
Programme (NIDDCP)
Essenal
IEC acvies to promote the consumpon ofa.
iodated salt b the people.
Monitoring of Iodated salt thrb. ough salt tesng kits.
Naonal Programme for Prevenon and Control ofFluorosis (NPPCF) (In aected (Endemic Districts)
Essenal
Referral Services.a.
IEC acvies to prevent Fluorosis.b.
Desirable
Clinical eaminaon and preliminar diagnosca.
parametres assessment for cases of Fluorosis if
facilies are available.
Monitoring of village/communit level acb. vit.
Naonal Tobacco Control Programme (NTCP)
Essenal
Ha. ealth educaon and IEC acvies regarding
harmful eects of tobacco use and second hand
smoke.
Promong quing of tobacco in the communit.b.
Providing brief advice on tobacco cessaon to allc.
smokers/tobacco users.
Makd. ing PHC tobacco free.
DesirableWatch for implementaon of ban on smoking in public
places, sale of tobacco products to minors, sale of
tobacco products within 100 ards of educaonal
instuons.
Naonal Programme for Health Care of Elderl
Essenal
IEC acvies on health aging.
Desirable
‘Weekl geriatric clinic at PHC’ for providing complete
health assessment of elderl persons, Medicines,Management of chronic diseases and referral services.
Oral Health
Essenal
Oral health promoon and check ups & appropriate
referral on idencaon.
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Phsical Medicine and Rehabilitaon (PMR) Services
Desirable
Primar prevenon of Disabilies.a.
Screening, earl idencaon and detecon.b.
Counseling.c.
Issue of Disabilit Cercate for obvious Disabiliesd.
b PHC doctor.
Referral ServicesAppropriate and prompt referral of cases needing
specialist care including:
Stabilizaon of paent.a.
Appropriate support to paent during transport.b.
Providing transport facilies either b PHC vehiclec.
or other available referral transport.
Drop back home for paents as mandatedd.
under JSSK
TrainingEssenal
Imparng training to undergraduate medicala.
students and intern doctors in basic health care.
Orientaon training of male and female healthb.
workers in various Naonal Health Programmes
including RCH, Adolescent health services and
immunizaon
Skill based training to ASHAs.c.
Inial and periodic Training of paramedics ind.
treatment of minor ailments.
Periodic training of Doctors and para medicse. through Connuing Medical Educaon,
conferences, skill development trainings.
All health sta of PHC must be trained in IMEP.f.
Desirable
Othersg.
There should be provision of inducon trainingi.
for doctors, nursing and paramedical sta.
Whenever new/higher responsibilit is assignedii.
or new equipment/technolog is introduced,
there must be provision of training.
There must be mechanism for ensuring qualitiii.
assurance in trainings b Training feedback
and Training eecveness evaluaon.
Appropriate placement for trained personiv.
should be ensured.
Trainings in minor repairs and maintenancev.
of available equipment should be provided to
the user.
Training of para medics in indenng,vi.
forecasng, inventor and store management
Development of protocols for equipmentvii.
(operaon, prevenve and breakdown
maintenance).
Note: 1. Trainings should commensurate with job responsibilies
for each categor of health personnel.
Note: 2. Since ECG machine is envisaged in PHCs hence labtechnician or some other paramedic should be trained in
taking ECG.
Basic Laborator and Diagnosc Services
Essenal Laboratory services including
Roune urine, stool and blood tests (Hb%,i.
platelets count, total RBC, WBC, bleeding and
clong me).
Diagnosis of RTI/STDs with wet mounng, Gramsii.
stain, etc.
Sputum tesng for mcobacterium (as periii.
guidelines of RNTCP).Blood smear eaminaon malarial.iv.
Blood for grouping and Rh tping.v.
RDK for Pf malaria in endemic districts.vi.
Rapid tests for pregnanc.vii.
RPR test for Sphilis/yAWS surveillance (endemicviii.
districts).
Rapid test kit for fecal contaminaon of water.i.
Esmaon of chlorine level of water using ortho-.
toludine reagent.
Blood Sui. gar.
Desirable
Bii. lood Cholesterol.
ECiii. G.
Validaon of reports: periodic validaon of laborator
reports should be done with eternal agencies like District
PHC/Medical college for Qualit Assurance. Periodic
calibraon of Laborator and PHC equipment.
Monitoring and Supervision
Essenal
Monitoring and supervision of acvies of Sub-i.
Centre through regular meengs/periodic visits, b
LHV, Health Assistant Male and Medical Ocer etc..
Monitoring of all Naonal Health Programmesii.
b Medical Ocer with support of LHV, Health
Assistant Male and Health educator.
Monitoring acvies of ASHAs b LHV and ANMiii.
(in her Subcentre area).
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Health educator will monitor all IEC and BCCiv.
acvies
Health Assistants Male and LHV should visit Sub-v.
Centres once a week.
Checking for tracking of missed out and le outvi.
ANC/PNC, Vaccinaons etc. during monitoring
visits and qualit parameters (including using
Partograph, AMTSL, ENBC etc.) during deliverand post deliver.
Timel pament of JSy beneciaries.vii.
Timel pament of TA/DA to ASHAs.viii.
Desirable
MO should visit all Sub-Centres at least once in ai.
month. This will be possible onl if more than one
Medical Ocer is posted in the PHC.
Funconal Linkages with Sub-Centres
Essenal
There shall be a monthl review meeng at PHC
chaired b MO (or in-charge), and aended b all
the Health Workers (Male and Female) and Health
Assistants (Male and female).
On the spot Supervisor visits to Sub-Centres.
Organizing Village Health and Nutrion da at
Anganwadi Centres.
Desirable
ASHAs and Anganwadi Workers should aend
monthl review meengs. Medical Ocer should
orient ASHAs on selected topics of health care.
Mainstreaming of AyUSH
Desirable
Provision of one AyUSH Doctor and one AyUSH
Pharmacist has been made at PHC to provide
choices to the people wherever an AyUSH
public facilit is not available in the near vicinit.
The AyUSH doctor at PHC shall aend paents
for sstem specic AyUSH based prevenve,
promove and curave health care and take
up public health educaon acvies including
awareness generaon about the uses of medicinalplants and local health pracces.
The signboard of the PHC should menon AyUSH
facilies.
AyUSH Doctor should support in implementaon
of naonal health programmes aer requisite
training if required.
Locall available medicinal herbs/plants should be
grown around the PHC.
Selected Surgical Procedures
(Desirable)
The vasectom, tubectom (including laparoscopic
tubectom), MTP, hdrocelectom as a ed da
approach have to be carried out in a PHC having facilies
of O.T. During all these surgical procedures, universal
precauons will be adopted to ensure infecon
prevenon. These universal precauons are menoned
at Annexure 5.
Record of Vital Events and ReporngEssenal
Recording and reporng of Vital stascs includinga.
births and deaths.
Maintenance of all the relevant records concerningb.
services provided in PHC.
Maternal Death Review (MDR).
(Desirable)
Facilit Based MDR shall be conducted at the PHC, the
form is given at Annexure 10.
InfrastructureThe PHC should have a building of its own. The
surroundings should be clean. The details are as
follows:
PHC Building
Locaon
It should be centrall located in an easil accessible area.
The area chosen should have facilies for electricit, all
weather road communicaon, adequate water suppl
and telephone. At a place, where a PHC is alread located,
another health centre/SC should not be established to
avoid the wastage of human resources.
PHC should be awa from garbage collecon, cale
shed, water logging area, etc. PHC shall have properboundar wall and gate.
Area
It should be well planned with the enre necessar
infrastructure. It should be well lit and venlated with
as much use of natural light and venlaon as possible.
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The plinth area would var from 375 to 450 sq. metres
depending on whether an OT facilit is opted for.
Sign-age
The building should have a prominent board displaing
the name of the Centre in the local language at the gate
and on the building. PHC should have pictorial, bilingual
direconal and laout sign-age of all the departments
and public ulies (toilets, drinking water).
Prominent displa boards in local language providing
informaon regarding the services available/user
charges/fee and the mings of the centre. Relevant IEC
material shall be displaed at strategic locaons.
Cizen charter including paent rights and responsibilies
shall be displaed at OPD and Entrance in local language.
Entrance with Barrier free access
Barrier free access environment for eas access to non-ambulant (wheel-chair, stretcher), semi-ambulant,
visuall disabled and elderl persons as per guidelines
of GOI.
Ramp as per specicaon, Hand- railing, proper
lightning etc must be provided in all health facilies
and retroed in older one which lack the same. The
doorwa leading to the entrance should also have a
ramp facilitang eas access for old and phsicall
challenged paents. Adequate number of wheel chairs,
stretchers etc. should also be provided.
Disaster Prevenon Measures
For all new upcoming facilies in seismic 5 zone or other
disaster prone areas.
Building and the internal structure should be made
disaster proof especiall earthquake proof, ood proof
and equipped with re protecon measures.
Earthquake proof measures - structural and non-
structural should be built in to withstand quake as per
geographical/state govt. guidelines. Non-structural
features like fastening the shelves, almirahs, equipmentetc. are even more essenal than structural changes
in the buildings. Since it is likel to increase the cost
substanall, these measures ma especiall be taken
on priorit in known earthquake prone areas.
PHC should not be located in low ling area to prevent
ooding as far as possible.
Fire ghng equipment – re enguishers, sand
buckets etc. should be available and maintained to be
readil available when needed. Sta should be trained
in using re ghng equipment.
All PHCs should have Disaster Management Plan in line
with the District Disaster management Plan. All health
sta should be trained and well conversant with disaster
prevenon and management aspects. Surprise mock
drills should be conducted at regular intervals.
Waing Area
This should have adequate space and seanga.
arrangements for waing clients/paents as per
paent load.
The walls should carr posters imparng healthb.
educaon.
Booklets/leaets in local language ma be providedc.
in the waing area for the same purpose.
Toilets with adequate water suppl separate ford. males and females should be available. Waing
area should have adequate number of fans,
coolers, benches or chairs.
Safe Drinking water should be available in thee.
paent’s waing area.
There should be proper noce displaing departments
of the centre, available services, names of the doctors,
users’ fee details and list of members of the Rogi Kalan
Sami/Hospital Management Commiee.
A locked complaint/suggeson bo should be provided
and it should be ensured that the complaints/suggesonsare looked into at regular intervals and addressed.
The surroundings should be kept clean with no water-
logging and vector breeding places in and around the
centre.
Outpaent Department
The outpaent room should have separate areasa.
for consultaon and eaminaon.
The area for eaminaon should have sucientb.
privac.
In PHCs with AyUSH doctor, necessarc.infrastructure such as consultaon room for
AyUSH Doctor and AyUSH Drug dispensing area
should be made available.
OPD Rooms shall have provision for ample naturald.
light, and air. Windows shall open directl to the
eternal air or into an open verandah.
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Adequate measures should be taken for crowde.
management; e.g. one volunteer to call paents
one b one, token sstem.
One room for Immunizaon/Famil Planning/f.
Counseling.
Wards 5.5 m 3.5 m each
There should be 4-6 beds in a Primar Health Centre.a. Separate wards/areas should be earmarked for
males and females with the necessar furniture.
There should be facilies for drinking water andb.
separate clean toilets for men and women.
The ward should be easil accessible from the OPDc.
so as to obviate the need for a separate nursing
sta in the ward and OPD during OPD hours.
Nursing staon should be located in such a wad.
that health sta can be easil accessible to OT and
labour room aer regular clinic mings.
Proper wrien handover shall be given to incominge.
sta b the outgoing sta.Dirt ulit room for dirt linen and used items.f.
Cooking should not be allowed inside the wardsg.
for admied paents.
Cleaning of the wards, etc. should be carried outh.
at regular intervals and at such mes so as not to
interfere with the work during peak hours and
also during mes of eang. Cleaning of the wards,
Labour Room, OT, and toilets should be regularl
monitored.
Operaon Theatre (Oponal)
To facilitate conducng selected surgical procedures
(e.g. vasectom, tubectom, hdrocelectom etc.).
It should have a changing room, sterilizaon areaa.
operang area and washing area.
Separate facilies for storing of sterile andb.
unsterile equipment/instruments should be
available in the OT.
The Plan of an ideal OT has been anneed showingc.
the laout.
It would be ideal to have a paent preparaond.
area and Post-Operave area. However, in view
of the eisng situaon, the OT should be wellconnected to the wards.
The OT should be well-equipped with all thee.
necessar accessories and equipment.
Surgeries like laparoscop/cataract/Tubectom/f.
Vasectom should be able to be carried out in
these OTs.
OT shall be fumigated at regular intervals.g.
One of the hospital sta shall be trained inh.
Autoclaving and PHC shall have standard Operave
procedure for autoclaving.
OT shall have power back up (generator/Invertor/i.
UPS). OT should have restricted entr. Separate
foot wear should be used.
Labour Room (3.8 m 4.2 m)
Essenal
Conguraon of New Born care cornera.
Clear oor area shall be provided in the roomy
for newborn corner. It is a space within the
labour room, 20-30 sq in size, where a
radiant warmer (Funconal) will be kept.
Ogen, sucon machine and simultaneousl-y
accessible electrical outlets shall be provided
for the newborn infant in addion to the
facilies required for the mother. Both
Ogen Clinder and Sucon Machine should
be funconal with their ps cleaned andcovered with sterile gauze etc for read to use
condion. They must be cleaned aer use and
kept in the same wa for net use.
The Labour room shall be provided with ay
good source of light, preferabl shadow-less.
Resuscitaon kit including Ambu Bag (Paediatricy
size) should be placed in the radiant warmer.
Provision of hand washing and containmenty
of infecon control if it is not a part of the
deliver room.
The area should be awa from draught ofy
air, and should have power connecon for
plugging in the radiant warmer.
There should be separate areas for sepc andb.
asepc deliveries.
The Labour room should be well-lit and venlatedc.
with an aached toilet and drinking water facilies.
Facilies for hot water shall be available.
Separate areas for Dirt linen, bab wash, toilet,d.
Sterilizaon.
Standard Treatment Protocols for commone.
problems during labour and for newborns to be
provided in the labour room.Labour room should have restricted entr.f.
Separate foot wear should be used.
All the essenal drugs and equipment (funconal)g.
should be available.
Cleanliness shall alwas be maintained in Labourh.
room b regular washing and mopping with
disinfectants.
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Labour Room shall be fumigated at regular intervali.
(Desirable).
Deliver kits and other instruments shall be j.
autoclaved where facilit is available.
If Labour Room has more than one labour tablek.
then the privac of the women must be ensured
b having screens between 2 labour tables.
Minor OT/Dressing Room/Injecon Room/
EmergencThis should be located close to the OPD to catera.
to paents for minor surgeries and emergencies
aer OPD hours.
It should be well equipped with all the emergencb.
drugs and instruments.
Privac of the paents should be ensured.c.
Laborator (3.8 m 2.7 m)
Sucient space with workbenches and separatea.
area for collecon and screening should beavailable.
Should have marble/stone table top for plaormb.
and wash basins.
General store
Separate area for storage of sterile and commona.
linen and other materials/drugs/consumable
etc. should be provided with adequate storage
space.
The area should be well-lit and venlated andb.
rodent/pest free.
Sucient number of racks shall beyprovided.
Drugs shall be stored properl andy
sstemacall in cool (awa from direct
sunlight), safe and dr environment.
inammable and hazardous material shall bey
secured and stored separatel
Near epir drugs shall be segregated and storedc.
separatel
Sucient space with the storage cabins separateld.
for AyUSH drugs be provided.
Dispensing cum store area: 3 m 3 m
Infrastructure for AyUSH doctor
Based on the sstem of medicine being pracced,
appropriate arrangements should be made for the
provision of a doctor’s room and a dispensing room cum
drug storage.
Waste disposal pit - As per GOI/Central Polluon
Control Board (CPCB) guidelines.
Cold Chain room – Size: 3 m 4 m
Logiscs Room – Size: 3 m 4 m
Generator room – Size: 3 m 4 m
Oce room 3.5 m 3.0 m
Dirt ulit room for dirt linen and used items
Residenal Accommodaon
Essenal
Decent accommodaon with all the amenies likes
24-hrs. water suppl, electricit etc. should be available
for Medical Ocer, nursing sta, pharmacist, laborator
technician and other sta.
If the accommodaon can not be provided due to an
reason, then the sta ma be paid house rent allowance,
but in that case the should be staing in near vicinit of
PHC so that the are available 24 × 7, in case of need.
Boundar wall/Fencing
Essenal
Boundar wall/fencing with Gate should be provided
for safet and securit.
Environment friendl features
Desirable
The PHC should be, as far as possible, environment
friendl and energ ecient. Rain-Water harvesng,
solar energ use and use of energ-ecient bulbs/equipment should be encouraged.
Other amenies
Essenal
Adequate water suppl and water storage facilit (over
head tank) with pipe water should be made available.
Computer
Essenal
Computer with Internet connecon should be provided
for Management Informaon Sstem (MIS) purpose.
Lecture Hall/Auditorium
Desirable
For training purposes, a Lecture Hall or a small Auditorium
for 30 Person should be available. Public address sstem
and a black board should also be provided.
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The suggested laout of a PHC and Operaon Theatre is
given at Annexure 2 and Annexure 2A respecvel. The
Laout ma var according to the locaon and shape of
the site, levels of the site and climac condions. The
prescribed laout ma be implemented in PHCs et to
be built, whereas those alread built ma be upgraded
aer geng the requisite alteraon/addions. The
funds ma be made available as per budget provisionunder relevant strategies menoned in NRHM/RCH-II
program and other funding projects/programs.
Equipment and FurnitureThe necessar equipment to deliver the assureda.
services of the PHC should be available in adequate
quant and also be funconal.
Equipment maintenance should be given specialb.
aenon.
Periodic stock taking of equipment and prevenve/c.
round the ear maintenance will ensure properfunconing equipment. Back up should be made
available wherever possible. A list of suggested
equipment and furniture including regents and
diagnosc kits is given in Annexure 3.
Manpower
To ensure round the clock access to public health facilies,
Primar Health Centres are epected to provide 24-hour
service with basic Obstetric and Nursing facilies. Under
NRHM, PHCs are being operaonalized for providing
24 x 7 services in various phases b placing at least 3
Sta Nurses in these facilies. If the case load is there,
operaonalizaon of 24 x 7 PHC ma be undertaken in a
phase-wise manner according to availabilit of manpower.
This is epected to increase the instuonal deliveries
which would help in reducing maternal mortalit.From Service deliver angle, PHCs ma be of two tpes,
depending upon the deliver case load – Type A and
Type B.
Type A PHC: PHC with deliver load of less than 20
deliveries in a month,
Type B PHC: PHC with deliver load of 20 or more
deliveries in a month
Select PHCs, especiall in large blocks where the CHC is
over one hour of journe me awa, ma be upgraded to
provide 24 hour emergenc hospital care for a number
of condions b increasing number of Medical Ocers,
preferabl such PHCs should have the same IPHS norms
as for a CHC.
The manpower that should be available in the PHC is
given in the table below:
For Tpe B PHCs, addional sta in the from of
one MBBS medical ocer (desirable, If the case
load of deliver cases is more than 30 per
month) one Sta Nurse and one sanitar worker
Sta Type A Type B
Essenal Desirable Essenal Desirable
Medical Ocer- MBBS 1 1 1#
Medical Ocer –AyUSH 1^ 1^
Accountant cum Data Entr Operator 1 1
Pharmacist 1 1
Pharmacist AyUSH 1 1
Nurse-midwife (Sta-Nurse) 3 +1 4 +1
Health worker (Female) 1* 1*
Health Assistant. (Male) 1 1
Health Assistant. (Female)/Lad Health Visitor 1 1
Health Educator 1 1
Laborator Technician 1 1Cold Chain & Vaccine Logisc Assistant 1 1
Mul-skilled Group D worker 2 2
Sanitar worker cum watchman 1 1 +1
Total 13 18 14 21
Manpower: PHC
* For Sub-Centre area of PHC.# If the deliver case load is 30 or more per month. One of the two medical ocers (MBBS) should be female.^ To provide choices to the people wherever an AyUSH public facilit is not available in the near vicinit.
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Indian Public Health Standards (IPHS) Guidelines for PRIMARy HEALTH CENTRES 17
cum watchman have been provided have been
provided to take care of addional deliver case
load.
Medical Ocer should be available on call dut to
manage emergencies.
Accommodaon for at least one MO and 3 Sta
Nurses will be provided.
One of the Class IV emploee ma be idened ashelper to Cold Chain & Vaccine Logisc Assistant
& trained.
The job responsibilies of the dierent personnel are given
in Annexure 7. Funds ma be made available for hiring
addional manpower as per provision under NRHM.
Drugs
Essenal:
All the drugs available in the Sub-Centre shoulda.
also be available in the PHC. All the drugs asper state/UT essenal drug list shall be available.
In addion, all the drugs required for the Naonalb.
Health Programmes and emergenc management
should be available in adequate quanes so
as to ensure compleon of treatment b all
paents.
Adequate quanes of all drugs should bec.
maintained through periodic stock-checking,
appropriate record maintenance and inventor
methods. Facilies for local purchase of drugs
in mes of epidemics/outbreaks/emergencies
should be made available.
Drugs of that discipline of AyUSH to be maded.
available for which the doctor is present.
The list of suggested drugs is given in
Annexure 4.
The Transport Facilies withAssured Referral Linkages
Referral Transport FacilitIt is desirable that the PHC has ambulance facilies
for transport of paents for mel and assured
referral to funconal FRUs in case of complicaons
during pregnanc and child birth. This ma be
outsourced either through Govt/PPP model or linkages
with Emergenc Transport sstem should be in place.
Transport for Supervisor and Other
Outreach Acvies
It is desirable that the vehicle is made available through
outsourcing.
Laundr ServicesProvision for clean linen shall be made for admiedpaents. At least 5 sets of linen shall be made available.
Laundr Services ma be available in house or
outsourced.
Dietar Facilies for indoorPaents
Desirable
Nutrious and well- balanced diet shall be provided
to all IPD paents keeping in mind their culturalprefernces. A suitable arrangement with a local
agenc like a local women’s group/NGO/Self-Help
Group for provision of nutrious and hgienic food at
reasonable rates ma be made wherever feasible and
possible.
Waste Management at PHCLevel
“Guidelines for Health Care Workers for Waste
Management and Infecon Control in Primar HealthCentres” are to be followed.
Qualit AssurancePeriodic skill development training of the sta
of the PHC in the various jobs/responsibilies
assigned to them.
Standard Treatment Protocol for all Naonal
Health Programmes and locall common disease
should be made available at all PHCs.
Regular monitoring is another important means.A few aspects that need denite aenon are:
Interacon and Informaon Echange withi.
the client/paent:
Courtes should be etended to paents/
clients b all the health providers including
the support sta.
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Indian Public Health Standards (IPHS) Guidelines for PRIMARy HEALTH CENTRES18
All relevant informaon should be
provided as regards the condion/illness
of the client/paent.
Atude of the health care providers
needs to undergo a radical change so
as incorporate the feeling that client is
important and needs to be treated with
respect.
Cleanliness should be maintained in allii.
areas.
Monitoring of PHC funconing
This is important to ensure that qualit is maintained
and also to make changes if necessar.
Internal Mechanisms: Record maintenance, checking
and supervision.
Medical Audit
Death Audit
Paent Sasfacon Surveys: For both OPD and IPD
paents.
Evaluaon of Complaints and suggesons received;
External Mechanisms: Monitoring through the PRI/
Village Health Sanitaon and Nutrion Commiee/Rogi
Kalan Sami/communit monitoring framework. (as
per guidelines of GOI/State Government). A checklist
for the same is given in Annexure 6. A format for
conducng facilit surve for the PHCs to have baseline
informaon on the gaps in comparison to Indian Public
Health Standards and subsequentl to monitor the
availabilit of facilies as per IPHS guidelines is given at
Annexure 9.
Social audit
Accountabilit
To ensure accountabilit, the Charter of Paents’
Rights should be made available in each PHC (as
per the guidelines given in Annexure 8). Ever PHC
should have a Rogi Kalyan Sami/Primary Health
Centre’s Management Commiee for improvement
of the management and service provision of the
PHC (as per the Guidelines of Government of India).
This commiee will have the authorit to generate its
own funds (through users’ charges, donaon etc.) and
ulize the same for service improvement of the PHC. The
PRI/Village Health Sanitaon and Nutrion Commiee/Rogi Kalan Sami should also monitor the funconing
of the PHCs.
Statuar and RegulatorCompliance
PHC shall fulfil all the statuar and regulator
requirements and compl to all the regulations
issued b local bodies, state and union of India. PHC
shall have cop of these regulations/Acts. List of
statuar and regulator compliances is given in
Annexure 12.
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Indian Public Health Standards (IPHS) Guidelines for PRIMARy HEALTH CENTRES 19
Vaccine When to give Dose Route Site
For Pregnant Women
TT-1 & 2 Earl in pregnanc and 4 weeks
aer TT-1*
[one dose (booster)* if previousl
vaccinated within last 3 ears]
0.5 ml Intra-muscular Upper Arm
TT-Booster If pregnanc occur within three
ears of last TT vaccinaons*
0.5 ml Intra-muscular Upper Arm
For Infants
BCG At birth (for instuonal
deliveries) or along with DPT-1
(upto one ear if not given earlier)
0.1 ml (0.05 ml for
infant up to 1 month)
Intra-dermal Le Upper Arm
Hepas B- 0 At birth for instuonal deliver,preferabl within 24 hrs of deliver 0.5 ml Intra-muscular Outer Mid-thigh (Antero-lateral side of mid thigh)
OPV - 0 At birth for instuonal deliveries
within 15 das
2 drops Oral Oral
OPV 1, 2 & 3 At 6 weeks, 10 weeks & 14 weeks 2 drops Oral Oral
DPT 1, 2 & 3 At 6 weeks, 10 weeks & 14 weeks 0.5 ml Intra-muscular Outer Mid-thigh (Antero-
lateral side of mid thigh)
Hepas B- 1,
2 & 3
At 6 weeks, 10 weeks & 14 weeks 0.5 ml Intra-muscular Outer Mid-thigh (Antero-
lateral side of mid-thigh)
Measles 1 & 2 At 9-12 months and 16-24 months 0.5 ml Sub-cutaneous Right upper Arm
Vitamin-A
(1st dose)
At 9 months with measles 1 ml (1 lakh IU) Oral Oral
For Children
DPT booster 16-24 months 0.5 ml Intra-muscular Outer Mid-thigh (Antero-
lateral side of mid-thigh)
2nd booster at 5 ears of age 0.5 ml Intra-muscular Upper Arm
Anneure 1
NATIONAL IMMUNIZATION SCHEDULE FOR INFANTS,
CHILDREN AND PREGNANT WOMEN
Immunizaon programme provides vaccinaon against seven vaccine preventable diseases
ANNExURES
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Indian Public Health Standards (IPHS) Guidelines for PRIMARy HEALTH CENTRES20
Vaccine When to give Dose Route Site
OPV Booster 16-24 months 2 drops Oral Oral
JE^ 16-24 months 0.5 ml Sub-cutaneous Upper Arm
Vitamin A
(2nd to 9th dose)
2nd dose at 16 months with DPT/
OPV booster. 3rd to 9th doses are
given at an interval of 6 months
interval ll 5 ears age
2 ml (2 lakh IU) Oral Oral
DT Booster 5 ears 0.5 ml Intra-muscular Upper Arm
TT 10 ears & 16 ears 0.5 ml Intra-muscular Upper Arm
* TT-2 or Booster dose to be given before 36 weeks of pregnanc.
^ JE in Selected Districts with high JE disease burden (currentl 112 districts)
A full immunized infant is one who has received BCG, three doses of DPT, three doses of OPV, three doses of Hepas B and Measles before
one ear of age.
Note: The Universal Immunizaon Programme is dnamic and hence the immunizaon schedule needs to be updated from me to me.
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Indian Public Health Standards (IPHS) Guidelines for PRIMARy HEALTH CENTRES 21
A n n e x u r e 2
L A y O U T O F
P H C
T O I L E T
1 5 0 0 X
1 5 0 0
T O I L E T
1 5 0 0 X
2 1 0 0
T O I L E T
1 5 0 0 X
1 8 0 0
D I R T Y
L I N E N
1 8 0 0 X 2 0 0 0
L A D I E S W A R D
5 5 0 0 X 3 5 0 0 S
T R E L I S A T I O N
3 8 8 5 X 2 1 0 0
G E N T ’ S W A R D
5 5 0 0 X 3 5 0 0
N U R S E S
R O O M
3 1 0 0 X 3 5 0 0
L A B .
3 0 0 0 X 3 5 0 0
M . O .
3 5 0 0 X 4 5 0 0
M . O .
3 5 0 0 X 4 5 0 0
E N T R A N C E
3 0 0 0 X 4 5 0 0
R
E G I S T R A T I O N
& R E C O R D
3 0 0 0 X 3 0 0 0
M I N O R O . T . /
D R E S S I N G /
I N J E C T I O N .
4 0 0 0 X 4 5 0 0
D I S P E
N S I N G
C U M S T O R E .
3 0 0 0
X 3 5 0 0
O F F I C E
3 0 0 0 X 3 5 0 0
G E N E R A L
S T O R E
2 1 0 0 X 3 5 0 0
G E N T ’ S
T O I L
E T
2 2 0 0 X 3 5 0 0
L A D I E
S
T O I L E
T
2 2 0 0 X 3
5 0 0
C O L D
C H A I N
2 1 0 0 X 3 5 0 0
I M M U N I�
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