Important topic for nursing students, and those preparing for competitive exam, interview and placement. This topic highlights the health administration of India and recent developments, drastically changing the health care system from the grass root level to attain the Universal Health Coverage goal. Its an attempt to give a brief insight of the rapid changing health delivery system of World largest democratic country.

1. MANJUSHA SAMUDRE
(Associate Professor)
Bel-Air College of Nursing, Panchgani.

2. INTRODUCTION
The quality of services in Indian health care system
is not uniform, due to various reasons like non
availability of man power, problems of access,
acceptability, lack of community involvement, etc.
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3. What is INDIAN PUBLIC HEALTH
STANDARDS?
Indian Public Health Standards are a set of
standards envisaged to improve the quality of
health care delivery in the country under the
National Rural Health Mission.
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4. DO WE NEED INDIAN PUBLIC HEALTH
STANDARDS?
• Quality Management.
• Quality Assurance.
• Optimal level of services.
• Effective, economic and
accountable and health care
delivery system.
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5. INDIAN PUBLIC HEALTH STANDARDS
AIMS:
• Provide accessible, affordable,
equitable and accountable and
quality health care.
• Reduce child and maternal
deaths.
• Stabilize population.
• Ensure gender and
demographic balance.
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6. “YOU LIVE, YOU LEARN, YOU
UPGRADE”
-Anonymous.
NHM
NRHM
RMNCH+A and CD/NCD
NUHM
sub-mission
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7. WHO RECOMMENDS THESE STANDARDS?
A Task Group under the Director General
of Health Services was constituted to
recommend the Standards.
The IPHS is based on its recommendation.
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8. RURAL HEALTH SYSTEM IN INDIA
SUB CENTRE LEVEL PRIMARY HEALTH CENTRE
LEVEL
COMMUNITY HEALTH CENTRE
LEVEL
5-6 Villages 30-40 Villages 1000 Villages
Population:
3000-5000
Population: 20000-30000 Population: 80000-120000.
First point of contact
between primary
health care and
community
A referral unit for 6 Sub
Centre.
First Referral Unit.
4-6 bedded,
under Medical Officer and
14 Subordinate.
30 bedded hospital,
4 PHC with special services.
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9. 3/20/2023 9
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10. SUB CENTRE
• PURPOSE: preventive and promotive and basic level of
curative care.
• POPULATION: 3000-5000.
• 2011 Census: 1,48,124 sub centres in India.
• OBJECTIVE:
1. To provide basic primary care to the community.
2. To achieve and maintain an acceptable standard of quality
of care.
3. To make services more responsive and sensitive to the
needs of the community.
4. To facilitate supervision and monitoring of health services.
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11. CATEGORIES OF SUB CENTRE
SUB
CENTRE
TYPE A
EXCEPT DELIVERY
TYPE B
Recommended services
INCLUDES DELIVERY
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12. PHYSICAL INFRASTRUCTURE
OF SUB-CENTRE
• Building: Own building/Rental (with premises and
adequate space.
• Budget: NRHM provides ₹10,000/Sub Centre. As
per district list.
• Location: easy access to the people and safety of
the ANM. No person has to travel more than 3Km.
Panchayat should be consulted prior finalizing the
location.
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13. PHYSICAL INFRASTRUCTURE
OF SUB-CENTRE
• Building and layout: Type B Sub Centre, should
have about 4-5 rooms:
WAITING
ROOM
CLINIC/
OFFICE
WARD
2-4 BEDS
LABOUR
ROOM
STORE
WC WC WC
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14. FACILITIES THROUGH SUB CENTER
• Infrastructure for Type A and Type B Sub-center.
• List of equipments.
• List of furniture.
• List of drugs.
• Appropriate information to the beneficiaries,
• Grievance redressal
• Constitution of Village Health Sanitation
• Nutrition Committee
• FOCUS : better management and improvement of Subcentre
services with involvement of Panchayati Raj Institutions (PRI) have
also been made as a part of the Indian Public Health Standard.
• The monitoring process and quality assurance mechanism is also
included.
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15. SERVICES PROVIDED AT
SUB CENTRE
• Maternal health.
• Child health.
• Family Planning and
Contraception.
• Adolescent health.
• School health services.
• Control of local endemic
diseases.
• Safe abortion services.
• Water quality monitoring.
• Curative services.
• Coordinating and
monitoring.
• Promotion of medical
herbs.
• Outreach/field services.
• Record of vital events.
• National health
programme.
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16. SUB CENTRE
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17. EQUIPMENT AT SUB CENTRE
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18. DRUGS FOR SUB CENTRE
1. DRUG KIT ‘A’
• Oral Rehydration Salt.
• Iron Folic Acid Tablets.
• Vitamin A solution.
• Tab. Clotrimoxazole
(pediatric)
2. DRUG KIT ‘B’
• Inj. Methylergometrine
Maleate.
• Tab. Methylergometrine
Maleate.
• Tab. Paracetamol.
• Tab. Mebendazole.
• Tab. Dicyclomine HCL.
• Ointment. Povidone Iodine
5%.
• Cotton Bandage.
• Absorbent cotton.
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19. DRUGS FOR SUB CENTRE
3. Additional drugs required at birth by ANMs
and LHVs:
[Inj. Gentamycin, Inj. Magnesium Sulphate, Inj.
Oxytocin, Cap. Ampicillin, Tab. Metronidazole
and Tab. Misoprostol.]
4. Other Drugs and Vaccines:
[BCG, DPT, OPV, Measles, DT, TT, Hepatitis-B,
Syrup Cotrimoxazole, Syrup Paracetamol, Tab.
Albendazole, adhesive tape and Savlon solution]
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20. RECORDS AT SUB CENTRE
1. Eligible couple register
including contraception.
2. Maternal and child health
register.
a. Antenatal, intranatal
,postnatal.
b. Above five child
immunization.
c. Referral .
d. Under-five register:
immunization and growth
monitoring.
3. Birth and deaths register.
4. Drug register.
5. Equipments, furniture
register.
6. Passive surveillance register
for malaria.
7. Janani Suraksha Yojana
Register.
8. Accounts register.
9. Water quality and
sanitation register.
10. Minor Ailment register.
11. National Health
Programme records/register.
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21. 3/20/2023 21
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22. PRIMARY HEALTH CENTRE
• Basic health unit to provide as close to the people
as possible, an integrated curative and preventive
health care to rural population with emphasis on
preventive and promotive aspects of health care.
• POPULATION: 20,000 hilly/tribal area-30,000 rural
area.
• Referral Unit for 6 Sub Centre and Refers out cases
to CHC and higher orders public hospitals.
• Census 2011-23,887 PHCs functioning in India.
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23. PRIMARY HEALTH CENTRE
OBJECTIVES:
• 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 needs of the community.
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24. SERVICES PROVIDED AT PHC
• Medical Care.
• Maternal Care.
• Child Care.
• Family Planning.
• Management of
Reproductive Tract
Infections /Sexually
Transmitted Infections.
• Nutrition services.
• Disease surveillance and
control of epidemics.
• Training.
• Basic laboratory services.
• Monitoring (NHP) and
supervision (ASHA).
• Record of vital events and
reporting.
• Mainstreaming of AYUSH.
• National Health
Programme.
• Referral Services.
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25. 3/20/2023 25
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26. BUDGETING FOR PHC
• ₹ 25,000 is being released for each facility for
suggested areas:
- such as minor modification to the center, provision of
running water supply, electricity and Adhoc payments
for cleaning up center, especially after childbirth,
incentives to individuals .
• Purchase of consumables.
• Labour and supplies: for environmental sanitation
and payment/reward to ASHA for certain activities.
• Engagement of full time/part time staff and payment,
Organizing “Swasthya Mela” for purpose of
awareness generation of health schemes.
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27. INFRASTRUCTURE FOR PHC
WC WC
OPD
DRESSING ROOM OFFICE
LABORATORY
MALE FEMALE
LABOUR
ROOM
WAITING
ROOM WARD
CORRIDOR
PHARMACY
COLD CHAIN
ROOM
GENERAL STORE
GENERATOR
ROOM OPERATION THEATER
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28. EQUIPMENTS AT PHC
• Normal delivery kit.
• IUCD insertion kit.
• Investigation kit.
• Drinking water testing kit.
• Neonatal resuscitation
kit.
• Radiant
warmer/Incubator.
• Baby weighing scale.
• Phototherapy unit.
• Antiseptic solution.
• Binocular microscope.
• Equipments for eye care
and vision testing.
• Computer with internet
connection.
• Refrigerator and ice box.
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29. DURGS AT PHC
• Inj. Diazepam.
• Inj. Lignocaine
Hydrochloride.
• inj. Pethidine
Hydrochloride.
• Inj. Pentazocine Lactate.
• Inj. Dexamethasone
Sodium Phosphate.
• Inj. Promethazine.
• Inj. Hydrochloride
adrenaline bitartrate.
• Inj. Ethophylline plus
anhydrous theophylline
combination
aminophylline.
• Inj. Methylergometrine
Maleate.
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30. COMMUNITY HEALTH CENTRE
• Secondary level: Community health center
constituting the First Referral Unit.
• 1CHC caters 4PHCs.
• Population: 80,000(Hilly/Tribal)-1,20,000(plain).
• Bed capacity: 30.
• Census 2011: 4809 CHCs in India.
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31. OBJECTIVES OF CHC
• 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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32. PHYSICAL INFRASTRUCTURE OF CHC
ENQUIRY REGISTRATION
WAITING
ROOM
OPD/CLINIC DRESSING ROOM
ENTRY CORRIDOR
WARD : MEDICINE
WARD : PED
WARD :
DENTAL/AYUSH
WARD : SURGERY
WARD : OBS/GYNE
BILLING DIAGNOSTICS PHARMACY LABOUR ROOM OT
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33. SERVICES PROVIDED AT CHC
• OPD Clinic:
1.Medical
2.Surgical
3.Gynaegology and Obstetrics
4.Pediatrics
5.Public health
6.Anesthesia
7.Eye
8.Dental
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34. SERVICES PROVIDED AT CHC
• Care of routine and emergency cases in surgery.
• Care of routine and emergency cases in
medicine.
• Maternal Heath.
• Newborn Care and Child Health.
• Family planning.
• National Health Programmes.
• Other services: School health, referral, blood
storage facility, adolescent health.
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35. MANPOWER AT CHC
PERSONNEL ESSENTIAL DESIRABLE QUALIFICATION
BLOCK PUBLIC HEALTH
UNIT
Block medical
officer/medical
superintendent
1 Senior most
specialist/Trained in
Professional
Development Course.
Public health specialist 1
Public health nurse 1 +1
SPECIAL SERVICES
General Surgeon 1 MS/DNB.
Physician 1 MD/DNB
Obstetrician and
Gynecologist
1 DGO/MD/DNB
Pediatrician 1 DCH/MD/DNB
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36. MANPOWER AT CHC
PERSONNEL ESSENTIAL DESIRABLE
PARAMEDICAL
Lab. Technician 2
Radiographer 1
Ophthalmic Assistant 1
Dental Assistant 1
Cold chain and Vaccine Logistic Assistant 1
OT Technician 1
Multi Rehabilitation/Community Based
Rehabilitation worker.
1 +1
Counsellor 1
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37. MANPOWER AT CHC
PERSONNEL ESSENTIAL DESIRABLE QUALIFICATION
SPECIAL SERVICES
Anesthetist 1 MD/DNB/DA/LSAS
TRAINED MO.
GENERAL DUTY PARAMEDICAL
Dental Surgeon 1 BDS
General Duty Medical Officer 2 MBBS
Medical Officer-AYUSH 1 Graduate in AYUSH
NURSES AND PARAMEDICAL
STAFF NURSE 10
Pharmacist 1 +1
Pharmacist-AYUSH 1
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38. MANPOWER AT CHC
PERSONNEL ESSENTIAL DESIRABLE
ADMINISTRATIVE STAFF
Registration Clerk 2
Statistical Assistant/Data Entry
Operator.
2
Account Assistant 1
Administrative Assistant 1
GROUP D STAFF
Dresser(certified by Red
Cross/Johns Ambulance)
1
Ward Boys/Nursing Orderly 5
Driver 1
Total 46 52
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39. BUDGET FOR CHC
• ₹50,000 is being released:
-minor modification to the center.
-purchase of consumables.
-Adhoc payments.
-transportation of emergencies.
-larvicidal measures for stagnant water.
-repair/operationalizing soak pits.
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40. CHC Equipment
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41. DRUGS AT CHC
• Inj. Lignocaine
Hydrochloride.
• Inj. Diazepam.
• Inj. Acetyl Salicylic Acid.
• Inj. Ibuprofen.
• Paracetamol.
• Pentazocine Lactate.
• Chloroquine Phosphate.
• Adrenaline bitartrate.
• Prednisolone
• Promethazine HCl.
• Chlorpheniramine
maleate.
• Prednisolone.
• Norfloxacin.
• Doxycycline
• Metronidazole.
• Oxygen.
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42. RECORDS AT CHC
1. Eligible couple register
including contraception.
2. Maternal and child health
register.
a. Antenatal, intranatal
,postnatal.
b. Above five child
immunization.
c. Number of HIV/STI
screening and referral.
d. Under-five register:
immunization and growth
monitoring.
3. Birth and deaths register.
4. Drug register.
5. Equipments, furniture
register.
6. Passive surveillance register
for malaria.
7. Janani Suraksha Yojana
Register.
8. Accounts register.
9. Water quality and
sanitation register.
10. Minor Ailment register.
11. National Health
Programme records/register.
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43. 3/20/2023 43
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44. CATEGORY
SUB-
DISTRICT
CAT I
31-50 Beds
CAT II
51-100 Beds
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45. SUB-DISTRICT
• The term Sub-district/Sub-divisional hospital is used as a
hospital at the secondary referral level responsible for the
Sub-district/Sub-division of a defined geographical area
containing a defined population.
• Sub-district hospitals are below the district and above the
block level hospitals(CHC) and act as FRU for
Tehsil/Taluka/Block population in which they are
geographically located and form link between Sub-centre,
PHC and CHC on one end and District Hospital on the
other end.
• Bed strength-31-100 bedded.
• Population catered-5-6 Lakhs.
• India has currently-1200 Sub-district hospital.
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46. OBJECTIVES FOR SUB DISTRICT
• To provide comprehensive secondary health care
to the community through Sub-district hospital.
• To achieve and maintain an acceptable standard
of quality of care.
• To make the services more responsive and
sensitive to the needs of the people of the Sub-
district and act as FRU for the hospital/centres
from which the cases are referred to the Sub-
district hospitals.
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47. FUNCTIONS OF SUB DISTRICT
• It provides effective, affordable health care
services for the defined population.
• It covers both urban population and the rural
population of the sub division.
• Functions as a FRU for the public health
institutions below the Tehsil/Taluka level such as
CHC, PHC and SC.
• It provides education and training for primary
health care staff.
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48. PHYSICAL INFRASTRUCTURE
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49. SERVICES AT SUB-DISTRICT
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50. SERVICES AT SUB-DISTRICT
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51. MANPOWER AT SUB DISTRICT/SUB
DIVISIONAL HOSPITAL
DOCTOR SUB-DISTRICT HOSPITAL
31-50 BEDDED
SUB DRICTRICT HOSPITAL
51-100 BEDDED
Hospital Superintendent 1 1
Medical Specialist 1 2
Surgery Specialist 1 1
OBG Specialist 1 2
Dermatologist/ Venerologist 1 1
Pediatrician 1 1
Anesthetist 1 2
Ophthalmologist 1 1
Orthopedician 1 1
Ophthalmologist 1 1
Radiologist 1 2
Casualty Doctors 7 9 (4feamle allopathy)
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52. MANPOWER AT SUB DISTRICT/SUB
DIVISIONAL HOSPITAL
DOCTOR SUB-DISTRICT HOSPITAL
31-50 BEDDED
SUB DRICTRICT HOSPITAL
51-100 BEDDED
Dental Surgeon 1 1
Public Health Manager - 1
Forensic Specialist 1 1
ENT Surgeon 1 1
AYUSH Physician 2 2
Pathologist/MD
Pathology/Biochemistry
- 1
TOTAL 22 32
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53. MANPOWER AT SUB DISTRICT/SUB
DIVISIONAL HOSPITAL
MEDICAL STAFF SUB-DISTRICT HOSPITAL
31-50 BEDDED
SUB DRICTRICT HOSPITAL
51-100 BEDDED
Staff Nurse 18 50 (including 5 Incharge)
Hospital worker
(OT/Ward + OT+ Blood bank)
5 -
Sanitary Worker 5 -
Attendant - 1
Ophthalmic Assistant/ Refractionist 1 1
ECG Technician 1 1
Audiometry Technician - 1
Laboratory Technician 5 5
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54. MANPOWER AT SUB DISTRICT/SUB
DIVISIONAL HOSPITAL
MEDICAL STAFF SUB-DISTRICT HOSPITAL
31-50 BEDDED
SUB DRICTRICT HOSPITAL
51-100 BEDDED
Laboratory Attendant 2 3
Radiographer 2 3
Pharmacist 4 5
Matron 1 2
Physiotherapist 1 1
Statistical Assistant 1 1
Medical Records Officer 1 1
Electrician 1 1
Plumber 1 1
TOTAL 49 77
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55. MANPOWER AT SUB DISTRICT/SUB
DIVISIONAL HOSPITAL
ADMINISTRATIVE STAFF SUB-DISTRICT HOSPITAL
31-50 BEDDED
SUB DRICTRICT HOSPITAL
51-100 BEDDED
Office Superintendent 1 -
Junior Administrative Officer - 1
Accountant 2 2
Computer Operator 6 6
Driver 1 2
Peon 2 2
Security 2 2
TOTAL 14 15
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56. MANPOWER AT SUB DISTRICT/SUB
DIVISIONAL HOSPITAL
OPERATION
THEATRE STAFF
SUB-DISTRICT HOSPITAL
31-50 BEDDED
SUB DRICTRICT HOSPITAL
51-100 BEDDED
Emergency/FW OT Emergency/FW OT General OT
Staff Nurse 2 4 1
OT Assistant 2 4 2
Sweeper 1 2 1
TOTAL 5 10 4
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57. MANPOWER AT SUB DISTRICT/SUB
DIVISIONAL HOSPITAL
BLOOD STORAGE STAFF SUB-DISTRICT HOSPITAL
31-50 BEDDED
SUB DRICTRICT HOSPITAL
51-100 BEDDED
Staff Nurse 1 1
MNA/FNA 1 1
Blood Bank Technician 1 5
Sweeper 1 3
Attendant - 2
TOTAL 4 12
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58. BUDGET
• Financial powers: Institutional Medical
Superintendent.
• ₹15 Lakhs for repair/upgrading of impaired
equipments/instruments after approval of
executive committee of Rogi Kalian Samiti(RKS).
• No equipment should remain non-functional for
than 30 days in a year.
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59. EQUIPMENT
• Imaging equipments.
• X-ray room accessories.
• Cardiac Equipments.
• Labour ward and
neonatal equipments.
• Eye Equipments.
• Dental Equipments.
• OT Equipments.
• Laboratory equipment.
• Physiotherapy.
• Endoscopic equipment.
• Anesthesia equipment.
• Furniture and Hospital
accessories.
• Teaching Equipments.
• Refrigeration and AC.
• Transport.
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60. DRUGS AT SUB DISTRICT
• Analgesic.
• Antipyretics.
• Anti inflammatory.
• Anti Diarrheal.
• Antibiotics.
• Anti allergic.
• CVS related drugs.
• RS related drugs.
• CNS related drugs.
• Vitamins.
• Eye drops.
• Hematopoietic related
drugs.
• Drugs related to Genito-
urinary system.
• Lotions.
• Hormonal preparations.
• Dressing material.
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61. 3/20/2023 61
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62. OBJECTIVES FOR DISTRICT HOSPITAL
• To provide comprehensive secondary health
care to the community through the District
Hospital.
• To achieve and maintain an acceptable standard
of quality of care.
• To make the services more responsive and
sensitive to the needs of the people of the
district and the hospitals from which the cases
are referred to the District Hospitals.
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63. FUNCTIONS OF DISTRICT HOSPITAL
• To provide effective, affordable health care
services for a defined population, with their full
participation and in cooperation with agencies in
the district that have similar concern.
• Secondary level referral centre for public health
institutions below the District Hospital.
• Provide wide range of technical and
administrative support and education and
training for primary health care.
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64. GRADING OF DISTRICT HOSPITAL
GRADING BED STRENGTH
GRADE I District Hospital norms for 500 beds
GRADE II District Hospital norms for 400 beds
GRADE III District Hospital norms for 300 beds
GRADE IV District Hospital norms for 200 beds
GRADE V District Hospital norms for 100 beds
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65. ESSENTIAL SERVICES AT
DISTRICT HOSPITAL
• Services include: OPD/IPD/ER.
• Paraclinical services: Laboratory, X-ray, Sonography
services, ECG, Blood bank.
• Support services: Medio-legal, Ambulance services,
dietary services, laundry, security services, electric
supply, lift, refrigeration.
• Administrative services: finance, medical records,
house keeping, accounting, sanitation, education
and training, inventory and accounting.
• Services under National Health Programmes.
• Epidemics Control and disaster Preparedness.
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66. MAN POWER AT DISTRICT HOSPITAL
SPECIALITY 100 BEDS 200 BEDS 300 BEDS 400 BEDS 500 BEDS
DOCTORS 29 34 50 58 68
STAFF NURSE 45 90 135 180 225
PARAMEDICAL 31 42 66 81 100
TOTAL
STRENGTH
105 166 251 319 393
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67. BUDGET
• Medical Superintendent is authorized person
for expenditure and incurring upto ₹2 Lakh for
upgrade and maintenance.
• No equipment should be non functioning for
more than 30 days , amounts to suspension.
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68. EQUIPMENT
• Imaging equipments.
• X-ray room accessories.
• Cardiac Equipments.
• Labour ward and
neonatal equipments.
• Eye Equipments.
• Dental Equipments.
• OT Equipments.
• Laboratory equipment.
• Physiotherapy.
• Endoscopic equipment.
• Anesthesia equipment.
• Furniture and Hospital
accessories.
• Teaching Equipments.
• Refrigeration and AC.
• Transport.
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69. DRUGS AT DISTRICT HOSPITAL
• Analgesic.
• Antipyretics.
• Anti inflammatory.
• Anti Diarrheal.
• Antibiotics.
• Anti allergic.
• CVS related drugs.
• RS related drugs.
• CNS related drugs.
• Vitamins.
• Eye drops.
• Hematopoietic related
drugs.
• Drugs related to Genito-
urinary system.
• Lotions.
• Hormonal preparations.
• Dressing material.
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70. Bibliography
• DGHS, MOHFW, IPHS Guidelines, Revised 2012, 2022
• G. M. Veerabhadrappa, ‘The short textbook of community health
nursing, Volume 1, 1st Edition, Jaypee Brothers Medical Publishers
Pvt, Ltd, Page no: 20-38
• K. K. Gulani, ‘ Community Health Nursing Principles and Practices’
3rd Edition, Kumar Publishing House, Delhi, Page No 535-566
• K. Park, ‘Textbook on Preventive and Social Medicine’ 26th Edition
2021, Banarasidas Bhanot Publication, Jabalpur. Page 972-976
• Keshaw Swarnakar, ‘Community Health Nursing’ 4th Edition 2020
Page no 735
• S.D. Mannivannan, ‘Textbook of Community Health Nursing-II’ CBS
Publishers and Distributors Pvt. Ltd 1st Edition 2018 New Delhi.
Page no: 51-71.
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71. OUR FUTURE…
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72. “ TO IMPROVE IS TO CHANGE; TO BE PERFECT IS TO CHANGE OFTEN”
- Winston Churchill
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