Indian Public Health Standards

State Institute of Health & Family Welfare, Jaipur

 Existing Standards

Ø Hospital Standards by Bureau of Indian

Standards (BIS)
Ø BIS Standards considered very resource
intensive in current scenario
Ø No such standards for primary health care
institutions
•

SIHFW: an ISO 9001: 2008 Certified Institution 2

Ø Describe a level of quality that health care
facilities are expected to meet
Ø Setting standards is a dynamic process
Ø Revision of standards will occur as and when
the facilities achieve a minimum functional
grade
Ø Standards are also flexible, to be applied
keeping in view the needs of the States


SIHFW: an ISO 9001: 2008 Certified Institution 3

 Infrastructure:
Number v/s Functionality
Ø March 2008, Impressive Numbers
Ø146036 SCs
Ø23458 PHCs
Ø4276 CHCs
Ø Functionality ? For quality, equity& accountability
ØInfrastructure
ØManpower
ØLogistics
ØDrugs
ØEquipment
SIHFW: an ISO 9001: 2008 Certified Institution 4
 IPHS Genesis
ØNRHM aims to
ØReduce child and maternal deaths
ØStabilize population
ØEnsure gender and demographic
balance
ØRequired- restructuring the delivery
mechanism for health services
ØNRHM proposed-
ØUp gradation of public health institutions
from their present level to achieve a level
of set standards called “Indian Public
Health Standards (IPHS)”
SIHFW: an ISO 9001: 2008 Certified Institution 5
 Need for IPHS

Ø Quality management
Ø Quality Assurance
Ø Effective, economical and accountable
health care delivery system
Ø Optimal level of services
•

SIHFW: an ISO 9001: 2008 Certified Institution 6

Considerations in Setting IPHS
ØMinimum resources available at the facilities
Ø

ØMinimum functional level of institutions

ØSpace
ØBuilding
ØManpower
ØInstruments
ØEquipments
Ø
ØDrugs
ØStandards for periodic monitoring at State and

Central Governments, and PRIs -how many of

their health facilities are conforming to IPHS
standards SIHFW: an ISO 9001: 2008 Certified Institution 7
 Process of Formulating IPHS
Ø Constitution of Expert Committee under DGHS
Ø Discussion with members (ministry officials, State
Governments representatives, academicians,
management experts, economists, donor
agencies, public health professionals, and other
organizations such as NGOs etc
Ø Circulation of draft IPHS for public health
institutions in rural areas
Ø Putting drafts standard on website
Ø Finalization of draft IPHS for public health
institutions
• SIHFW: an ISO 9001: 2008 Certified Institution 8
Why IPHS for Sub-Centres….

ØMost peripheral and first contact point

ØServices of acceptable standards to the
people, through certain available guidelines
Ø

ØFirst step is to lay down norms and standards

for Sub Centres

SIHFW: an ISO 9001: 2008 Certified Institution 9

IPHS for Sub-Centres…

SIHFW: an ISO 9001: 2008 Certified Institution 10

 Location

Ø Not too close to an existing sub

centre/PHC
Ø As far as possible, no person travels more
than 3 km to reach the sub-centre
•

SIHFW: an ISO 9001: 2008 Certified Institution 11

 Manpower

HW(F)
HW(M)

Additional HW(F)

SIHFW: an ISO 9001: 2008 Certified Institution 12

 Drugs

Ø Elementary drugs for minor ailments

such as
ØARI
ØDiarrhea
ØFever
ØWorm infestation

SIHFW: an ISO 9001: 2008 Certified Institution 13

 Services
Ø All “Assured Services” (preventive, promotive,
few curative and referral services andNHPs)
ØFull immunization and Vitamin A
prophylaxis
ØEssential newborn care
ØAntenatal, natal and postnatal care
ØPrevention of malnutrition and
common childhood diseases
ØFamily planning services
ØCounseling
Ø Community needs assessment
 SIHFW: an ISO 9001: 2008 Certified Institution 14
Ø Minimum laboratory services
ØHemoglobin estimation
ØUrine for albumin and sugar and
ØReferral to PHC for blood
grouping
Ø Malaria prophylaxis
Ø Provision of Janani Suraksha Yojana (JSY)
Ø Adolescent health care and school health
services
Ø Organizing VHND

SIHFW: an ISO 9001: 2008 Certified Institution 15
Ø
Ø Appropriate and prompt referral services
Ø Providing treatment as per AYUSH according to
local need
Ø Training of TBAs, ASHA/Community Health
Volunteers
Ø Recording and reporting of vital events
Ø Syndromic surveillance to be done and reported
to PHC every week
Ø Water Quality Monitoring & Disinfection of water
sources

SIHFW: an ISO 9001: 2008 Certified Institution 16

 Other Norms for SC…

ØResidential Accommodation especially for the

Ø
ANMs
ØMaintenance of equipment -through preventive
maintenance or prompt repair of non-functional

equipment to ensure uninterrupted delivery of

services, by making use of the untied funds
Ø

ØPotable water for patients and staff and water

Ø

ØWherever possible, uninterrupted power supply

Ø SIHFW: an ISO 9001: 2008 Certified Institution 17
 SC also to Ensure

ØAvailability of model citizen’s charter

Ø

ØA grievance redressal mechanism

Ø

ØConstitution of village health and

sanitation committee
Ø

ØInvolvement of PRI
Ø

SIHFW: an ISO 9001: 2008 Certified Institution 18

Funding, Monitoring & Evaluation

Ø Assistance from Ministry of Health & FW, GOI

Ø Untied funds are provided (currently Rs.10,000
per Sub centre under NRHM)
Ø One Health Assistant (Female) / Lady Health
Visitor (LHV) and one Health Assistant
(Male) located at the PHC are entrusted with
the task of supervision of all the Sub-centres
(generally six sub centres) under a PHC
•

SIHFW: an ISO 9001: 2008 Certified Institution 19

Primary Health Centres

Ø Population of 20,000-30,000
Ø 4-6 indoor beds
Ø Link between SC and CHC
Ø 23458( March 2008)PHCs are functioning
in the country
Ø
Ø
Ø
SIHFW: an ISO 9001: 2008 Certified Institution 20
Why IPHS for Primary Health Centres..

Ø PHC -first port of call to a qualified doctor in

rural areas
Ø Referral unit for 6 Sub-centres
Ø Referring unit for CHCs and DH
Ø Provides a range of curative, promotive and
preventive health care services
Ø


Ø
Ø
SIHFW: an ISO 9001: 2008 Certified Institution 21
 IPHS for PHC
Ø IPHS set in view of
ØMinimum resources available
and mentions
ØMinimum functional standards
Ø Innovations
ØConstitution of RMRS
Øinvolvement of PRI
ØCitizens’ Charter
Ø
SIHFW: an ISO 9001: 2008 Certified Institution 22
 24x7 PHC should …..

Ø Provide 24-hour delivery services, both normal

and assisted
Ø Provide Obstetric First Aid and Referrals to
First Referral Units (FRUs)/other hospitals,
for high risk pregnancy cases beyond the
capability of Medical Officer, PHC
Ø Provide 24 hours emergency services for
management of injuries and accidents
Ø Provide emergency care of sick children
•

SIHFW: an ISO 9001: 2008 Certified Institution 23
•
Minimum Requirements for PHC
Ø Basis
ØAverage case load of 40 patients per
doctor per day
Ø60% utilization of the available
indoor/observation beds (6 beds)
ØStandards upgraded with utilization
Ø Manpower
ØOne more Medical Officer (AYUSH or
lady doctor) and two more staff nurses
existing total staff strength of 15 in the
PHC
SIHFW: an ISO 9001: 2008 Certified Institution 24
 Proposed Manpower at PHC
Existing Recommended
Medical Officer 1 2(one AYUSH or LMO)
Pharmacist 1 1
Nurse-midwife (Staff 1 3 (for 24-hour PHCs)
(Nurse) (2 may be contractual)
Health workers (F) 1 1
Health Educator 1 1
Health Asstt. (Male & Female) 2 2
Clerks 2 2
Laboratory Technician 1 1
Driver 1 Optional/vehicles may be
out-sourced.
Class IV 4 4
Total 15 200817/18
SIHFW: an ISO 9001: Certified Institution 25
 Services at PHC
Ø MCH
Ø 24 X 7 Delivery & New born care
Ø ARSH
Ø Immunization
Ø NH Programs
Ø Permanent FP methods-TT/ vasectomy/
NSV
Ø MTP using MV technique (if trained
personnel and facility exists)

SIHFW: an ISO 9001: 2008 Certified Institution 26

Ø Common eye diseases and Refraction
Services
Ø School Health
Ø Nutrition ( coordinated through ICDS)
Ø Selected surgeries
•
•
•
•
• SIHFW: an ISO 9001: 2008 Certified Institution 27
 Other services
Ø Referral transport
Ø ISM based treatment through AYUSH doctor
Ø Laboratory
Ø Malaria
Ø TB
Ø STI/RTI
Ø Enteric
Ø Routine –Urine, stool, blood
Ø IDSP
Ø Training
Ø Waste Mgt.
Ø Laundry (outsourced)
Ø
SIHFW: an ISO 9001: 2008 Certified Institution 28
•
Facilities at PHC under IPHS
Ø Waiting
Ø OPD
Ø Wards
Ø Nursing station
Ø OT, MOT, Labor room
Ø Laboratory
Ø Accommodation
Ø Store
Ø Dispensing
Ø Electricity, Telephone, Water
SIHFW: an ISO 9001: 2008 Certified Institution 29
 Monitoring and Supervision
Ø MO to Sub-centres once a month
Ø Health Assistants Male and LHV to Sub-
centres once a week
Ø Internal Mechanism: Record maintenance,
checking and supportive supervision
Ø External Mechanism: Monitoring through the
PRI / Village Health Committee / RMRS (as
per guidelines of State Government)
Ø Charter of Patients’ Rights available at PHC
Ø RMRS

SIHFW: an ISO 9001: 2008 Certified Institution 30

IPHS for CHCs: Objectives

Ø To provide optimal expert care to the

community
Ø To achieve and maintain an acceptable
standard of quality of care
Ø To make the services more responsive
and sensitive to the needs of the
community

SIHFW: an ISO 9001: 2008 Certified Institution 31

 CHC/FRU

Ø 30-bedded hospital located at the block

Ø
headquarter
Ø Secondary level of health care
Ø

Ø Specialist careØ

ØMedicine
Ø

ØSurgery
Ø

ØOb & Gy.

Ø

ØPediatrics

SIHFW: an ISO 9001: 2008 Certified Institution 32

 ØAnesthesia
Ø

Ø
ØPublic health
Ø 80,000 -1,20,000 pop.
Ø

Ø Catchment- 4 PHCs
Ø

Ø Referral point for PHCs(FRU for

obstetric emergencies
•


•
SIHFW: an ISO 9001: 2008 Certified Institution 33
Infrastructure for IPHS CHC
Assured services at CHC


Ø Specialist care
ØMedicine
ØSurgery
ØOb & Gy.
ØPediatrics
Ø Blood storage unit
Ø Operation theatre, labor room, X-ray
laboratory, ECG
Ø Referral transport
Ø NH Programs
Ø
SIHFW: an ISO 9001: 2008 Certified Institution 34
Ø
Infrastructure Requirements
for IPHS CHC
ØEntrance Zone and OPDs
ØAdmin. zone
ØEmergency Room/Casualty
ØTreatment room (MOT, Injection / dressing
room)
ØWards- male and female with space between
beds
ØOther Services
ØCSSD
SIHFW: an ISO 9001: 2008 Certified Institution 35
 ØElectricity with Back-up, Water,
Ø
Telephones
Ø
ØLaundry & Waste mgt.
Ø
ØSeparate toilets for male & female
Ø
ØMaintenance and sanitation facility
ØComputerization for record and
surveillance

SIHFW: an ISO 9001: 2008 Certified Institution 36

Manpower at IPHS CHC

Ø Regular
ØSurgery
ØMedicine
ØObstetrics and Gynecology
ØPediatrics
Ø Contractual
ØAnesthetist
ØPublic Health Program
Manager
Ø Support manpower

SIHFW: an ISO 9001: 2008 Certified Institution 37

 ØPublic health Nurse
ØANM in addition to the existing
staff
ØOphthalmic Assistant
Ø

Ø Recommended
ØOne Ophthalmologist for
every 5 CHCs
ØOne Dental Surgeon
Ø6 GDMOs
ØOne AYUSH specialist
ØOne AYUSH general doctor

SIHFW: an ISO 9001: 2008 Certified Institution 38

 Proposed Manpower(specialists) at CHC
under IPHS
Personnel Minimum requirement Proposed

General Surgeon 1 1
Physician 1 1
Ob. & Gy. 1 1
Pediatrics 1 1
Anesthetist - 1
Public Hlth. Health - 1
Manager.
Eye surgeon - 1
Total 4 6/7

SIHFW: an ISO 9001: 2008 Certified Institution 39

 Total Manpower for IPHS CHC
Ø Block Health Officer Ø Ophthalmologist
Ø
•
Physician  (one for 5 CHCs)
Ø Surgeon Ø 6 GDMO (2 LMOs)
Ø Ob. & Gy. Ø 1 AYUSH specialist
Ø Paediatrician Ø 1 AYUSH GDMO
Ø Anesthetist Ø Support Manpower
Ø Public Health  (total 64) includes:
Manager Ø 19 S/N, 1 PHN, 1ANM
Ø Dental Surgeon and 1 Ophthalmic
 Assistant
Ø
SIHFW: an ISO 9001: 2008 Certified Institution 40
 Ensuring Accountability and
Quality
Ø Mandatory “Rogi Kalyan Samiti”/ RMRS
Ø A grievance redressal mechanism under
supervision of Rogi Kalyan Samitis
Ø Social audit by involvement of the community
through Rogi Kalyan Samitis (RKSs) is
recommended
Ø Charter of Patients’ Rights displayed prominently
at the entrance
Ø Standard Operating Procedures and Standard
Treatment Protocols
Ø External monitoring through PRIs, & internal
monitoring
SIHFW: an ISO 9001: 2008 Certified Institution 41
Ø
IPHS for Sub-divisional /Sub-
district Hospitals
Ø 5-6 lakhs people
Ø about 1200 such hospitals in the country with
number of beds ranging from 50 to 100
beds or more
Ø Two IPHS Standards for SDH have been
prepared according to bed strength for 31-
50 beds and 51-100 beds
Ø
Ø
SIHFW: an ISO 9001: 2008 Certified Institution 42
 Need for IPHS for SDH

ØFirst Referral Units for specialist services

from neighboring Community Health Centres
Ø

ØA Sub-district/Sub-divisional Hospital
provides emergency obstetric and neo-natal
care
Ø

ØIt also saves travel time to the DH, reduces

the workload of the district hospital
Ø
Ø
Ø
SIHFW: an ISO 9001: 2008 Certified Institution 43
Minimum Assured Services at SDH

Ø OPD, indoor and emergency services

Ø Consultation
ØGeneral Medicine
ØGeneral Surgery
ØObstetric & Gynecology
ØPediatrics
ØAnesthesia
ØOrthopedics

SIHFW: an ISO 9001: 2008 Certified Institution 44

 ØENT
ØRadiologist and sonologist
ØOphthalmology
ØCommunity Health
ØSkin & VD, RTI/STI
ØDental care
ØAYUSH
•

SIHFW: an ISO 9001: 2008 Certified Institution 45

 Other services at SDH

Ø Lab, X-ray, Ø Ambulance services

Ultrasound, ECG Ø Dietary services
Ø Blood transfusion Ø Laundry services
and storage Ø Security services
Ø Physiotherapy
Ø Housekeeping
Ø Medico
Ø Inventory Mgt.
legal/postmortem
Ø Waste management
Ø
Ø
SIHFW: an ISO 9001: 2008 Certified Institution 46
IPHS for District Hospitals

Ø Administrative unit
Ø Pop. 2-5 million
Ø 617 Districts in the country
•


SIHFW: an ISO 9001: 2008 Certified Institution 47

IPHS for DHs: Objectives

Ø To provide comprehensive secondary

health care (specialist and referral
services)
Ø To achieve and maintain an acceptable
standard of quality of care
Ø To make services more responsive and
sensitive to the needs of the people
Ø

SIHFW: an ISO 9001: 2008 Certified Institution 48

 DH and IPHS

Ø Services depend on size of bed

compliment
Ø Norms vary based on bed compliment
Ø Norms developed for
Ø101-200 beds
Ø201-300 beds and
Ø301-500 beds
•
• SIHFW: an ISO 9001: 2008 Certified Institution 49
Minimum Functional standards for
DH: Areas
Ø Physical infrastructure
Ø Manpower
Ø Diagnostic and investigation
facilities
Ø Equipment
Ø Drugs
Ø Other supportive services

SIHFW: an ISO 9001: 2008 Certified Institution 50

Thank You