This is IPHS presentation .hope it is helpful to you. contents are - introduction,origin of iphs, iphs for subcenter,phc, in maharashtra ,summary and references

1. Sub Centers and Primary Health
Centers
-------------- By- Dr.Pallavi Gawande

2.  Introduction
 Why Standards
 Origin of IPHS
 IPHS for Sub Center
 IPHS for Primary Health Center(PHC)
 IPHS in Maharashtra
 Summary
 References

3. The Indian Public Health Standards (IPHS) for
Sub-centers
Primary Health Centers (PHCs)
Community Health Centers (CHCs)
Sub-District Hospitals
District Hospitals
were published in January/ February, 2007 and have been used
as the reference point for public health care infrastructure
planning and up-gradation in the States and UTs.

4. Conti.....
 IPHS describes benchmark for quality expected from various
components of Health Care organizations.
 Standards for quality of services, facilities, infrastructure, manpower,
machine and equipment, drugs etc. This is main driving force for
continuous improvement in quality.
 Setting standards is a dynamic process, Revision of standards will
occur as and when the facilities achieve
a minimum functional grade.

5.  Functioning of Rural health care institutes is not
satisfactory.
 The health care system in India has expanded
considerably over the last few decades, however, the
quality of services is not uniform.
 Lack of comprehensive and realistic mandatory
standards for public health institutions in Indian
context.

6. Need of IPHS:
 Quality management, Quality assurance
 Effective, economical and accountable Health care
delivery system.
 Optimal level of services

7. Aims to:
 Provide accessible , affordable, accountable
quality health care.
 Reduce child and maternal deaths.
 Stabilize population.
 Ensure gender and demographic balance.

9.  The Minimum Needs Program (MNP) was introduced in the
country in the first year of the Fifth Five Year Plan (1974–
78) with the objective to provide certain basic minimum
needs.
 Most peripheral and first contact point
 Services of acceptable standers to the people, through
certain available guidelines.
 First step is to lay norms and standards for sub Centers
 There are 147069 Sub-centers functioning in the country as
on March 2010 as per Rural Health Statistics Bulletin, 2010.

10. o To specify the minimum assured (essential) services that
Sub-centre is expected to provide and the desirable
services which the states/UT s should aspire to provide
through this facility.
o To maintain an acceptable quality of care for these
services.
o To facilitate monitoring and supervision of these facilities.
o To make the services provided more accountable and
responsive to people’s needs.

11. Type A
 Type A Sub Centre will provide all recommended services
except that the facilities for conducting delivery will not be
available.
 However, the ANMs have been trained in midwifery, they
may conduct normal delivery in case of need.
 Sub-centres located in remote, difficult, hilly, desert or tribal
area such situations, ANMs would be required to conduct
deliveries at homes and ANMs of these Sub-centres should
mandatorily be Skilled Birth Attendance (SBA) trained.

12. Type B (MCH Sub-Centre)
 Centrally or better located Sub-centers with good
connectivity to catchment areas.
 They have good physical infrastructure preferably with
own buildings, adequate space, residential
accommodation and labor room facilities.
 They already have good case load of deliveries from
the catchment areas.
 There are no nearby higher level delivery facilities.

13. Type of sub-
centre
Sub-centre A Sub-centre B
(MCH Sub-centre)
Staff Essential Desirable Essential Desirable
ANM/Health
Worker (Female)
1 +1 2
Health Worker
(Male)
1 1
Staff Nurse (or
ANM, if Staff Nurse
is not available)
1**
Safai-Karamchari 1
(Parttime)
1
(Fulltime)
** if number of deliveries at the Sub-centre is 20 or more in a month

14.  Not too close to an existing sub center/PHC
 As far as possible, no person travels more than 3 km to
reach the sub-centre
 In the field of rural health, the objective was to
establish: one Sub-centre for a population 5000 people
in the plains and for 3000 in tribal and hilly areas,

15.  Elementary drugs for minor ailments such as
 ARI
 Diarrhea
 Fever
 Worm infestation
List of drugs given in Annexure 6

16.  Sub-centers are expected to provide promotive, preventive and
few curative primary health care services.
 Both types of Sub-centers should provided Non-Communicable
Diseases related services.
site of service delivery may be at following places:
 In the village: Village Health and Nutrition Day/Immunization
session.
 During house visits.
 During house to house surveys.
 During meetings and events with the community.
 At the facility premises.

17.  It is desirable, minimum of six of hours of routine OPD services in
a day for six days in a week
 Type A: Shall provide all services as envisaged for the Sub-centre
except the facilities for conducting delivery will not be available
here.
 Type B: They will provide all recommended services including
facilities for conducting deliveries at the Sub-centre itself. This
Sub-centre will act as Maternal and Child Health (MCH) centre
with basic facilities for conducting deliveries and Newborn Care
at the Sub-centre.
 the facilities for attending to home deliveries shall remain
available at both types of Sub-centres.

18. Every sub-center has to provide the following services
which have been indicated as Essential and Desirable.
Maternal Health
 Antenatal care:
Minimum 4 ANC check ups including Registration
associated services.
 Recording tobacco use by all antenatal mothers.
 Minimum laboratory investigations like Urine Test for pregnancy
confirmation, hemoglobin estimation, urine for albumin and sugar
and linkages with PHC for other required tests

19. Intra-natal care:
 Promotion of institutional deliveries
 Skilled attendance at home deliveries when called.
 Appropriate and Timely referral of high risk cases which are
beyond her capacity of management.

20. Essential for Type B Sub-centre
 Managing labour using Partograph.
 Identification and management of danger signs during labor.
 Proficient in identification and basic fist aid treatment for PPH,
Eclampsia, Sepsis and prompt referral of such cases as per
Antenatal Care and Skilled Birth Attendance at Birth or SBA
Guidelines.
 Minimum 24 hours of stay of mother and baby after delivery at
Sub-centre.
 The environment at the Sub-centre should be clean and safe for
both mother and baby.

21. Postnatal care:
 Ensure post-natal home visits on 0,3,7 and 42nd day for deliveries
at home and Sub-centre (both for mother & baby).
 Ensure 3, 7 and 42nd day visit for institutional delivery (both for
mother & baby) cases.
 In case of Low Birth weight Baby (less than 2500 gm), additional
visits are to be made on 14, 21 and 28th days.
 Counseling on diet & rest, hygiene, contraception, essential
newborn care, immunization, infant and young child feeding,
STI/RTI and HIV/AIDS.
 Name based tracking of missed and left out PNC cases.

22. Child Health
 Newborn Care Corner In The Labour Room to provide Essential
Newborn Care (Essential If the Deliveries take Place at the Type B
Sub-centre)
 Counseling on IYCF ( Infant and young child Feeding)
 Full Immunization and Vitamin A prophylaxis to the children as
per National guidelines.

23. Family Planning and Contraception
 ••Education, Motivation and counselling to adopt appropriate
Family planning methods.
 ••Provision of contraceptives.
School Health Services
 ••Screening, treatment of minor ailments, immunization, de-
worming, prevention and management of Vitamin A and
nutritional deficiency anemia and referral services through fixed
day visit of school by existing ANM/MPW
 ••Staff of Sub-centre shall provide assistance to school health
services as a member of team

24. Control of Local Endemic Diseases
 ••Assisting in detection, Control and reporting of local endemic
diseases such as malaria, Kala Azar, Japanese encephalitis,
Filariasis, Dengue etc.
 ••Assistance in control of epidemic outbreaks as per programme
guidelines.
Disease Surveillance, Integrated Disease Surveillance Project
(IDSP)
 Immediate reporting of any cluster/outbreak based on syndromic
surveillance.
 Weekly submission of report to PHC in ’S’ Form as per IDSP
guidelines.

25. National Health Programmes
Communicable Disease Programme
 National Vector Borne Disease Control Programme
(NVBDCP)
 National AIDS Control Programme (NACP)
 National Leprosy Eradication Programme (NLEP)
 Revised National Tuberculosis Control Programme
(RNTCP)

26. Non-communicable Disease (NCD) Programmes
 National Programme for Control of Blindness (NPCB)
 National Programme for Prevention and Control of Deafness
(NPPCD)
 National Mental Health Programme.
 National Programme for Prevention and Control of Cancer,
Diabetes, Cardiovascular Diseases and Stroke.
 National Iodine Deficiency Disorders Control Programme.
 National Tobacco Control Programme.
 National Programme for Health Care of Elderly.

27.  Laboratory
 Electricity
 Water
 Telephone
 Assured Referral linkages
 Toilet
 Waste Disposal: Guidelines for Health Care Workers for
Waste Management and Infection Control in Sub Centers to be
followed.

28. Monitoring Mechanism
1. Internal mechanism
2. External mechanism
A check list for monitoring of internal mechanism of Sub-centers is
given at Annexure 9.
A simpler check list for monitoring of external mechanism that can
be used by PRI/NGO is given in Annexure 9A.
Quality Assurance and Accountability
 In order to ensure quality of services and patient satisfaction, it is
essential to encourage community participation.
 To ensure accountability, the Citizens’ Charter should be available
in all Sub-centers (Annexure 11).

29.  Annexure 1: National Immunization Schedule for Infants, Children and
Pregnant Women.
 Annexure 2: Job Functions of Health Worker Female/ANM, Staff Nurse,
Health Worker Male .
 Annexure 3: Layout of Sub-Centre
 Annexure 4: List of Furniture, Other Fittings and Sundry Articles
 Annexure 5: Equipment and Consumables
 Annexure 5A: Newborn Corner in Labour Room
 Annexure 6: Suggested List of Drugs
 Annexure 7: Standards for Deep Burial Pit; Bio-Medical Waste
(Management and Handling) Rules, 1998
 Annexure 8: Records and Reports.
 Annexure 8A: Register
 Annexure 8B: IDSP Format
 Annexure 9: Checklist
 Annexure 9A: A simpler checklist that can be used by non-governmental
organization/Panchayati Raj Institutions/Self Help Groups
 Annexure 10: Proforma for Facility Survey of Sub-Centers on IPHS
 Annexure 11: Model Citizen’s Charter for Sub-Centers
 Annexure 12: List of Abbreviations

31.  In order to provide optimal level of quality health care, a set
of standards called Indian Public Health Standards (IPHS)
were recommended for PHC in early 2007.
 PHC is the cornerstone of rural health services- a first port
of call to a qualified doctor of the public sector in rural
areas for curative, preventive and promotive health care.
 It acts as a referral unit for 6 Sub-Centers and refer out
cases to CHC (30 bedded hospital) and higher order public
hospitals.
 There are 23673 PHCs functioning in the country as on
March 2010 as per Rural Health Statistics Bulletin, 2010.

32.  To provide comprehensive primary health care to the
community through the Primary Health Centers.
 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.

33.  From Service delivery angle, PHCs may be of two
types, depending upon the delivery case load – Type A
and Type B.
Type A PHC Type B PHC
PHC with delivery load of less than
20 deliveries in a month.
PHC with delivery load of 20 or more
deliveries in a month

34. Medical care
 OPD services: A total of 6 hours of OPD services it is
desirable that MO PHC shall spend at least two hours
per day twice in a week for field duties and monitoring.
 24 hours emergency services.
 Referral services.
 ••In-patient services (6 beds)

35. Maternal and Child Health Care Including Family
Planning
Antenatal care
 Early registration and Minimum 4 antenatal checkups
and provision of complete package of services.
 Identification and management of high risk.
 Timely referral of such identified cases.

36. Intra-natal care (24-hour delivery services both normal
and assisted)
 Promotion of institutional deliveries.
 Assisted vaginal deliveries including forceps/ vacuum
delivery whenever required.
 Manual removal of placenta.
 Pre-referral management (Obstetric first-aid) in Obstetric
emergencies that need expert assistance (Training of staff
for emergency management to be ensured).

37. Proficient in identification and basic first aid treatment for PPH,
Eclampsia, Sepsis and prompt referral: As per ‘Antenatal Care and
Skilled Birth Attendance at Birth’ Guidelines
Postnatal Care
 Ensure post- natal care for 0 & 3rd day and ensuring 7th & 42nd
day post-natal home visits by ANM.
 Initiation of early breast-feeding within one hour of birth.
 Counseling on nutrition, hygiene, contraception, essential new
born care (As per Guidelines of GOI on Essential new-born care)
and immunization.
 Others: Provision of facilities under Janani Suraksha Yojana
(JSY).
 Tracking of missed and left out PNC

38. New Born care
 Facilities for Essential New Born Care (ENBC) and
Resuscitation (Newborn Care Corner in Labour
Room/OT, Details given in Annexure 3A).
Care of the child
 Routine and Emergency care of sick children including
Integrated Management of Neonatal and Childhood
Illnesses (IMNCI) strategy and inpatient care.
 Full Immunization and vitamin A prophylaxis of all
child
 Tracking of vaccination dropouts

39. Family Welfare
 Education, Motivation and Counseling to adopt
appropriate Family planning methods.
 Permanent methods like Tubal ligation and
vasectomy/NSV, where trained personnel and facility
exist.
Medical Termination of Pregnancies
 Counseling and appropriate referral for safe abortion
services (MTP) for those in need.

40. Nutrition Services (coordinated with ICDS)
• Diagnosis of and nutrition advice to malnourished children,
pregnant women and others.
• Diagnosis and management of anaemia and vitamin A
deficiency.
• Coordination with ICDS.
School Health
Health service provision:
• Screening, health care and referral.
• Immunization.
• Micronutrient (Vitamin A & IFA) management.
• De-worming.
• Monitoring & Evaluation.
• Mid Day Meal.

41.  Prevention and control of locally endemic diseases like malaria,
Kala Azar, Japanese Encephalitis etc.
 Collection and reporting of vital events.
 Health Education and Behavior Change Communication (BCC).
Other National Health Programmes.
 Revised National Tuberculosis Control Programme (RNTCP)
 National Leprosy Eradication Programme
 Integrated Disease Surveillance Project (IDSP)
 National Programme for Control of Blindness (NPCB)

42.  National Programme for Prevention and Control of
Deafness (NPPCD)
 National Vector Borne Disease Control Programme
(NVBDCP)
 National AIDS Control Programme
 National Mental Health Programme (NMHP)
 National Tobacco Control Programme (NTCP)
 National Programme for Prevention and Control of Cancer,
Diabetes, CVD and Stroke (NPCDCS)
 National Programme for Prevention and Control of
Fluorosis (NPPCF) (In affected (Endemic Districts)
 National Iodine Deficiency Disorders Control Programme
(NIDDCP)

43. Revised National Tuberculosis Control Programme
(RNTCP)
Essential
 All PHCs to function as DOTS Centres to deliver
treatment as per RNTCP treatment guidelines
through DOTS providers and treatment of
common complications of TB and side effects of
drugs, record and report on RNTCP activities as
per guidelines.
 Facility for Collection and transport of sputum
samples should be available as per the RNTCP
guidelines.

44. National Leprosy Eradication Programme
Essential
 Health education to community regarding
Leprosy.
 Diagnosis and management of Leprosy and its
complications including reactions.
 Training of leprosy patients having ulcers for
self-care.
 Counseling for leprosy patients for regularity/
completion of treatment and prevention of
disability.

45. Other NCD Diseases
 Health Promotion Services to modify individual, group and
community behaviour especially through
 Promotion of Healthy Dietary Habits.
 Increase physical activity.
 Avoidance of tobacco and alcohol.
 Stress Management.
 Early detection, management and referral of Diabetes Mellitus,
Hypertension and other Cardiovascular diseases and Stroke
through simple measures like history, measuring blood pressure,
checking for blood, urine sugar and ECG.

46. Training
 Orientation training of male and female health workers in
various National Health Programmes including RCH,
Adolescent health services and immunization
 Skill based training to ASHAs.
 Initial and periodic Training of paramedics in treatment of
minor ailments.
 Periodic training of Doctors and para medics through
Continuing Medical Education, conferences, skill
development trainings.
 All health staff of PHC must be trained in IMEP.????

47. Basic Laboratory and Diagnostic Services
Essential Laboratory services including
 Routine urine, stool and blood tests.
 Diagnosis of RTI/STDs with wet mounting, Grams stain, etc.
 Sputum testing for mycobacterium (as per guidelines of RNTCP).
 Blood smear examination malarial.
 Blood for grouping and Rh typing.
 RDK for Pf malaria in endemic districts.
 Rapid tests for pregnancy.
 RPR test for Syphilis/YAWS surveillance (endemic districts).
 Rapid test kit for fecal contamination of water.
 Estimation of chlorine level of water using orthotoludine reagent.
 Blood Sugar.
Desirable
 Blood Cholesterol.
 ECG.

48. Monitoring and Supervision
 Monitoring and supervision of activities of Sub- Centre through
regular meetings/periodic visits, by LHV, Health Assistant Male
and Medical Officer etc..
 Monitoring of all National Health Programmes by Medical
Officer with support of LHV, Health Assistant Male and Health
educator.
 Monitoring activities of ASHAs by LHV and ANM (in her Sub
centre area).
 Health educator will monitor all IEC and BCC activities
 Health Assistants Male and LHV should visit Sub- Centers once a
week.
 Timely payment of JSY beneficiaries.
 Timely payment of TA/DA to ASHAs.

49. PHC Building
 It should be centrally located in an easily accessible area.
 PHC should be away from garbage collection cattle shed,
water logging area, etc. PHC shall have proper boundary
wall and gate.
 Prominent display boards in local language providing
information regarding the services available/user
charges/fee and the timings of the centre.
 Barrier free access environment for easy access to
nonambulant (wheel-chair, stretcher), semi-ambulant,
visually disabled and elderly persons as per guidelines of
GOI.

50.  The outpatient room should have separate areas for
consultation and examination.
 All PHCs should have Disaster Management Plan in
line with the District Disaster management Plan.
 The area for examination should have sufficient
privacy.
 One room for Immunization/Family Planning/
Counseling.

52.  All the drugs available in the Sub-Centre should also
be available in the PHC. All the drugs as per state/UT
essential drug list shall be available.
 In addition, all the drugs required for the National
Health Programmes and emergency management
should be available.
 Drugs of that discipline of AYUSH to be made
available for which the doctor is present.
 The list of suggested drugs is given in Annexure 4.

53.  The Transport Facilities with Assured Referral
Linkages
 Waste Management at PHC Level Guidelines for
Health Care Workers for Waste Management and
Infection Control in Primary Health Centres are to be
followed.

54. Source -http://www.nrhm.maharashtra.gov.in/health.htm

55. Sr. No Type of
Institution
Total no.
in state
No of Institutes
selected for IPHS
(2013-14)
Upgraded
24*7/ FRU
upto May
2013
%
Upgradation
1 PHC 1816 704 409 58.10
2 RH/SDH 455 200 107 53.05
3 DH/RRH 23 23 23 100.00
4 GH/WH 14 14 14 100.00
Total 12887 941 409/144 58.10/60.75
Status of up gradation of Health Institutions as per IPHS standard
Source-http://www.nrhm.maharashtra.gov.in/iphsmonitor.htm

56. Ministry of Health and Family Welfare,
Government of India. Indian Public Health
Standards (IPHS) For Sub Centers:
Guidelines. New Delhi; Revised 2012
Ministry of Health and Family Welfare,
Government of India. Indian Public Health
Standards (IPHS) For Primary Health
Center: Guidelines. New Delhi; Revised
2012

57.  Park K., Park's Text Book of Preventive and
Social Medicine,19th Edition,
Jabalpur(India):M/s.Banarasidas Bhanot
Publishers,2009
 National Rural Health Mission 2005-2012 –
Reference Material (2005),Ministry of Health
& Family Welfare, Government of India.
 State Health Society Maharashtra, IPHS in
Maharashtra; 2009 Dec.
 Sunderlal .Text book of community medicine
3rd edition.New delhi. Cbs publication 2011