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Indian Public Health Standards (IPHS) For 101 to 200 bedded District Hospitals
Directorate General of Health Services Ministry of Health & Family Welfare Government of India
1. Introduction 2. Objectives of IPHS for District Hospitals 3. Definition of District Hospital 4. Grading of District Hospital 5. Functions 6. Essential Services 7. Physical Infrastructure 8. Manpower 9. Equipment 10. Laboratory Services 11. Recommended allocation of bed strength at various levels 12. List of Drugs 13. Capacity Building 14. Quality Assurance in Services 15. Rogi Kalyan Samities / Hospital Management Committee 16. Citizen’s Charter Annexure – I: Guidelines for Bio-Medical Waste Management Annexure – II: Reference Laboratory Networks List of Abbreviations References 3 5 6 6 6 7 35 44 49 64 68 70 81 81 82 82 91 95 100 101
India’s Public Health System has been developed over the years as a 3-tier system, namely primary, secondary and tertiary level of health care. District Health System is the fundamental basis for implementing various health policies and delivery of healthcare, management of health services for defined geographic area. District hospital is an essential component of the district health system and functions as a secondary level of health care which provides curative, preventive and promotive healthcare services to the people in the district. Every district is expected to have a district hospital linked with the public hospitals/health centres down below the district such as Sub-district/Sub-divisional hospitals, Community Health Centres, Primary Health Centers and Sub-centres. As per the information available, 609 districts in the country at present are having about 615 district hospitals. However, some of the medical college hospitals or a sub-divisional hospital is found to serve as a district hospital where a district hospital as such (particularly the newly created district) has not been established. Few districts have also more than one district hospital. The Government of India is strongly committed to strengthen the health sector for improving the health status of the population. A number of steps have been taken to that effect in the post independence era. One such step is strengthening of referral services and provision of speciality services at district and sub-district hospitals. Various specialists like surgeon, physicians, obstetricians and gynecologists, pediatrics, orthopedic surgeon, ophthalmologists, anesthetists, ENT specialists and dentists have been placed in the district headquarter hospitals. The district hospitals caters to the people living in urban (district headquarters town and adjoining areas) and the rural people in the district. District hospital system is required to work not only as a curative centre but at the same time should be able to build interface with the institutions external to it including those controlled by non-government and private voluntary health organization. In the first changing scenario, the objectives of a district hospital need to unify scientific thought with practical operations which aim to integrate management techniques, interpersonal behaviour and decision making models to serve the system and improve its efficiency and effectiveness. The current functioning of the most of the district hospitals in the public sector are not up to the expectation especially in relation to availability, accessibility and quality. The staff strength, beds strength, equipment supply and service availability and population coverage are not uniform among all the district hospitals. As per Census 2001, the population of a district varies from as low as 32,000 (Yanam in Pondicherry, Lahaul & Spiti in Himachal Pradesh) to as high as 30 lakhs (Ludhiana, Amritsar districts). The bed strength also varies from 75 to 500 beds depending on the size, terrain and population of the district. As per the second phase of the facility survey undertaken by the Ministry of Health & Family Welfare, Government of India, covering
Almost all the DHs in India have one operation theatre and 48% of them have an OT specifically for gynecological purpose. The performance of district hospitals can be assessed against a set of standards. essential pharmaceuticals and supplies. District Hospitals have come under constantly increasing pressure due to increased utilization as a result of rapid growth in population. female health workers and laboratory technicians are available in almost all district hospitals. and constantly rising expectation level of the use of the services. intensive care units. Standards are the main driver for continuous improvements in quality. It has been observed that development of hospitals is not keeping pace with the scientific development. resulting in the use of sophisticated and advanced technology in diagnosis and therapies. Only 68% of the district hospitals have linkage with the district blood banks. ♦ The facilities at district hospitals require continuation upgradtion to keep pace with the advances in medical knowledge. The electricity facility is available in 97% of the districts with a stand by generator facility in 92% of the cases. About 73% of the surveyed district hospitals have laboratories. Most of the district hospitals suffer from large number of constraints such as ♦ Buildings are either very old and in dilapidated conditions or are not maintained properly. central sterilization department. management and accountability of district hospitals through hospital management committees. storage and retrieval of information. biomedical advancement. dietary and management of nursing services. ♦ A typical district hospital lacks modern diagnostics and therapeutic equipments. A separate aseptic labor room is found in only 45% of the surveyed district hospitals. The key aim of the standard is to underpin the delivery of quality services which are fair and responsive to clients’ needs. The need for evaluating the care being rendered through district hospitals has gained strength of late. increase awareness among common consumers. 80% of the DHs have at least one pathologist and 83% of the total DHs have at least one anesthetist. staff nurses. ♦ There is a lack of trained and qualified staff for hospitals management and for the management of other ancillary and supportive services viz. Standards are a means of describing the level of quality that health care organization are expected to meet or aspire to. which should be provided equitably and which deliver improvements in health and well being of the population.370 district hospitals from 26 states have revealed that 59% of the surveyed district hospitals have tap water facility. As regards manpower 10% of the district hospitals do not have O&G specialists and pediatricians. There is an urgent need to provide guidance to those concerned with quality assurance in district hospitals services to ensure efficiency and effectiveness of the services rendered. The position of general duty officers. diagnostic procedures. referral support and resources. laundry. Only half of the total number of district hospitals have OPD facility for RTI/STI. ♦ There is lack of community participation and ownership. 4 . proper emergency services. house keeping. medical records.
nic.mohfw. 2. Rationalisation of Service Norms for Secondary Care Hospitals prepared by Govt. The current effort is only to workout standards for a minimum functional grade level district hospital. IPHS for CHC. However. The specific objectives of IPHS for DHs are: 5 . The present draft guidelines are an effort to prepare Indian Public Health Standards for the District Hospitals.in. The expansions already done have resulted in construction touching the boundaries walls with no scope of further expansions. This is not to say that standards for various hospitals do not exist in the country. Setting standards is a dynamic process. Guidelines for Development and Operations. This document contains the standards to bring the District Hospitals to a minimum acceptable functional grade with scope for further improvement in it. 500 bedded teaching and non teaching and 750 bedded teaching and non teaching will be published by BIS later. Community Health Centres and so on up to the district level hospitals. Objectives of Indian Public Health Standards (IPHS) for District Hospitals: The overall objective of IPHS is to provide health care that is quality oriented and sensitive to the needs of the people of the district. the original client group will not be able to have same access to the desired health facilities). As far as possible. In this context a set of standards are being recommended for district hospitals to be called as Indian Public Health Standards (IPHS) for District Hospitals. 1998 and Indian Public Health Standards (IPHS) for Community Health Centres. These standards are flexible as per the requirements and resources available to the concerned State/UT Government. Setting standards is a dynamic process. and citizens’ charter etc peculiar to the public hospitals. WHO. of Tamil Nadu. accountability. PHC and Sub-centres have been finalized available on the ministry’s website www. the hospital management. The timeframe for implementation and achievement of these Standards could be extended for five years and to be done in phases. This document contains the standards to bring the District Hospitals to a minimum acceptable functional grade with scope for further improvement in it. Most of the existing hospitals below district level (31-50 Bed category) are located in older buildings in urbanized areas / towns as compared to most Primary Health Centres / Sub-centres. District Health Facilities. Primary Health Centres. The Bureau of Indian standards(BIS) have developed standards for hospitals services for 30 bedded and 100 bedded hospitals and standards for 250 bedded.The National Rural Health Mission (NRHM) has provided the opportunity to set Indian Public Health Standards (IPHS) for various health institutions at various levels starting from Sub-centres. Reference has been made to the BIS Standard for 100 bedded hospitals. States should not dislocate the said hospitals to a new location (in case of dislocating to a new location. these standards are considered very resource intensive and lack the processes to ensure community involvement.
preventive and promotive) for a defined population. To provide comprehensive secondary health care (specialist and referral services) to the community through the District Hospital. drugs and other supportive services etc. Some may require the intervention of highly specialist services and use of sophisticated expensive medical equipments. which in turn is a function of the size of the population it serves. Patients with such diseases can be transferred to tertiary and other specialized hospitals. affordable healthcare services (curative including specialist services. Functions A district hospital has the following functions: 1. To make the services more responsive and sensitive to the needs of the people of the district and the hospitals/centers from which the cases are referred to the district hospitals Definition 3. 5. has been given. the number of beds required for a district having a population of 10 lakhs will be around 300 beds. diagnostic and investigation facilities.000 (Census 2001). with their full participation and in co-operation with agencies in the district that have similar 6 . However. ii. To achieve and maintain an acceptable standard of quality of care. The disease prevalence in a district varies widely in type and complexities. It is not possible to treat all of them at district hospitals.i. equipment norms. A district hospital should however be able to serve 85-95% of the medical needs in the districts. iii. The term District Hospital is used here to mean a hospital at the secondary referral level responsible for a district of a defined geographical area containing a defined population. Based on the assumptions of the annual rate of admission as 1 per 50 populations and average length of stay in a hospital as 5 days.00. manpower. Grading of district hospitals: The size of a district hospital is a function of the hospital bed requirement. The minimum functional grade of the different grades of district hospitals requiring the physical infrastructure.000 to 30. It provides effective. Grade I: District hospitals norms for 500 beds Grade II: District hospitals norms for 300 beds Grade III: District hospitals norms for 200 beds Grade IV: District hospital norms for 100 beds. It is expected that the hospital bed occupancy rate should be at least 80%. it would be prudent to prescribe norms by grading the size of the hospitals as per the number of beds. as the population of the district varies a lot. 4. In India the population size of a district varies from 35.
Community Health Centres.2 Paraclinical services Laboratory Services X-Ray Facility Sonography (Ultrasound) ECG Blood transfusion and storage facilities Physiotherapy Dental Technology (Dental Hygiene) Drugs and Pharmacy 7 . 6. It covers both urban population (district headquarter town) and the rural population in the district. 2. Essential Services Services include OPD. Secondary level health care services regarding following specialties will be assured at hospital: 6. To provide wide ranging technical and administrative support and education and training for primary health care. emergency services.1 Consultation services with following specialists: General Medicine General Surgery Obs & Gyne Paediatrics including Neonatology Emergency (Accident & other emergency) (Casualty) Critical care (ICU) Anaesthesia Ophthalmology ENT Dermatology and Venerology including STI/RTI Orthopaedics Radiology Dental care Public Health Management 6. Function as a secondary level referral centre for the public health institutions below the district level such as Sub-divisional Hospitals. Primary Health Centres and Sub-centres. indoor.concern. 3.
etc.6.17.00 lakhs for repair/upgradating of impaired equipments/instruments with the approval of executive committee of RKS. ventilation and air-conditioning Transport Communication Medical Social Work Nursing Services Sterilization and Disinfection Horticulture (Landscaping) Lift and vertical transport Refrigeration 6. 8 . Administrative services (i) (ii) (iii) (iv) (v) (vi) (vii) Finance* Medical records (Provision should be made for computerized medical records with anti-virus facilities whereas alternate records should also be maintained) Procurement Personnel Housekeeping and Sanitation Education and Training Inventory Management * Financial accounting and auditing be carried out as per the rules along with timely submission of SOEs/UCs. Finalcial powers of Head of the Institution Medical Superintendent to be authorized to incure and expenditure up to Rs.3 Support Services Medico-legal/postmortem Ambulance services Dietary services Laundry services Security services Counseling services for domestic violence. Gender and socially sensitive service delivery be assured. gender violence. adolescents.4. Waste management Ware housing/central store Maintenance and repair Electric Supply (power generation and stabilization) Water supply (plumbing) Heating.
Manpower and outsourcing work could be done through local tender mechanism. 6. It will amount to suspension of status of IPHS of the concerned institutions for absence period. waste disposal etc. Outsourcing of services like laundry. Services under various National Health and Family Welfare Programmes Epidemic Control and Disaster Preparedness 9 .No equipment/instruments should remain non-functional for more than 30 days. housekeeping and sanitation. to be arranged by hospital itself. dietary.5. 6.6. ambulance.
Following services mix of procedures in medical and surgical specialties would be available: SERVICE MIX OF PROCEDURES IN MEDICAL AND SURGICAL SPECIALITIES S. Name of Procedure MEDICAL 1 Pleural Aspiration 2 Pleural Biopsy 3 Bronchoscopy 4 Lumbar Puncture 5 Pericardial tapping 6 Skin scraping for fungus / AFB 7 Skin Biopsies 8 Abdominal tapping 9 Liver Biopsy 10 Liver Aspiration 11 Fibroptic Endoscopy 12 Peritoneal dialysis 13 Hemodialysis 14 Bone Marrow Biopsy OPD Procedures (Including IPD) 1 Dressing (Small. No. Medium and Large) 2 Injection (I/M & I/V) 3 Catheterisation 4 Steam Inhalation 5 Cut down (Adult) 6 Enema 7 Stomach Wash 8 Douche 9 Sitz bath 10 CVP Line 11 Blood Transfusion 12 Hydrotherapy 13 Bowel Wash Skin Procedures 1 Chemical Cautery 2 Electro Cautery 3 Intra Lesional Injection 10 .
only cradle 2. deudenum) (Diagnostic and 1 Therapeutic) 2 Sigmoidoscopy and Colonoscopy 3 Bronchoscopy and Foreign Body Removal 4 Arthros copy (Diagnostic and Therapeutic) 5 Laproscopy (Diagnostic and Therapeutic) 6 Colposcopy 7 Hysteroscopy Psychiatry Services 1 Modified ECT 2 Narcoanalysis Physiotherapy Services 1 With Electrical Equipments 1.6 .5 .Ventilator 2. DPT.4 Biopsy Paediatric Procedures 1 Immunization (BCG.Cut down 2.Gases (oxygen) 2.7 .9 .Computerised Tractions (Lumbar & Cervical) 1.10 .Incubator 2.Plural/Acite Tap 2. stomach.2 . OPV.13 .Exchange Transfusion 2.Lum bar Puncture 2.Radiant Heat Warmer 2.8 . Measles.Pulse Oxementer 2.Bone Marrow 2.1 .12 . DT) 2 Services related to new borne care 2.11 .Phototherapy 2.Live Biopsy u/s guided Cardiology Procedures and Diagnostic Tests 1 ECG 2 TMT 3 Holter 4 Thrombolytic Therapy 5 C V P Line 6 Defibrilator Shock 7 NTG/Xylocard Infusion 8 ECHO Cardiography Endoscopic Specialised Procedures and Diagnostic Gastroscopy (Oesophagus.Short wave diathermy 11 .2 .1 .3 .4 .
Foreign Body Removal (conjuctival) 1.6 .3 .18 .Corneal Scarping 12 .Vibrator Belt Massage 2 With Mechanical Gadgets/Exercises 2.Post Polio Exercise 2.2 .Breathing Exercises & Postural Drainage Eye Specialist Services (Opthalmology) 1 OPD Procedures 1.Electrical Stimulator with TENS 1.5 .Walking Bars 2.19 .1.Mechanical Tractions (Lumber & Cervical) 2.Shoulder Pulley 2.13 .7 .Automated Perimetry 1.Gripper 2.Foreign Body Removal (Corneal) 1.I & C of chalazion 1.14 .12 .4 .16 .) 1.Refraction (by using snellen’s chart) 1.9 .9 .3 .Stye 1.20 .5 .Epilation 1.3 .Syringing and Probing 1.Supinator Pronator Bar 2.Paraffin Wax Bath 1.Cauterization (Thermal) 1.Electric Vibrator 1.Suture Removal 1.11 .Conjuctival Resuturing 1.Cerebral Palsy – Massage 2.Shoulder Wheel 2.Visco Weight Cuffs 2.Obesity Exercises 2.7 .Exercycle 2.8 .9 .U V (Therapeutic) 1.Wart Excision 1.10 .Subconj Injection 1.6 .5 .17 .11 .4 .7 .Tonometry 1.1 .Electrical Stimulator 1.12 .Refraction (by auto refrectro meter) 1.Infra Red Lamp (Therapy) 1.15 .6 .8 .Syringing & Probing 1.Ultra Sonic Therapy 1.4 .1 .Retrobular Injection (Alcohol etc.8 .2 .10 .Pterygium Excision 1.10 .Biometry / Keratometry 1.
Glaucoma (Trabeculectomy) 2.S M R 2.4 . Aural.Enucleaion without Implant 2.Paracentesis 2.Perforating Coneo Scleral Injury Repair 2.Vestibular Function Test/Caloric Test 2 Minor Procedures .13 Angiofibroma Excision) 13 .5 .6 .Packing (Anterior & Posterior Nasal) 2.Cutting of Iris Prolapse 2.12 .Punch Biopsy (Oral Cavity & Oropharynx) 2.5 .1 .7 .13 .10 .10 .3 .2 .Air Injection & Resuturing 2.2 . Oropharynx.Cautrization (Oral.3 .Cataract Extraction 2.Small Lid Turnour Excision 2.15 .11 .3 .Uncomplicated Lid Tear 1.Canthotomy 2.Inter Nasal Antrostomy (nilateral & Bilateral) 2.Fracture Reduction Nose with Septal Correction .Enucleation with Implant 2.Conjuctival Cyst 2.5 .1 Oropharynx) 2.Capsulotomy 2.Transantral Procedures (Biopsy.11 .4 Nose Surgery 2.8 .Retinoscopy 2 IPD Procedures 2.1 . Aural & nasal) 2.6 .7 .2 . Chamber Wash 2.23 .Ant.9 .Eustachian Tube Function Test 1.Septoplasty 2.21 .Antral Punchure (Unilateral & Bilateral) 2.22 .24 .8 .1.Foreign Body Removal (Ear and Nose) 1.Evisceration ENT Services 1 OPD Procedures 1.I & D Lid Abscess 1.Chemical Cauterization (Nose & Ear) 1.14 .Fracture Reduction Nose 2.9 .Syringing of Ear 1.Therapeutic Removal of Granulations (Nasal.Examination under GA 2. 2. Excision of cyst and 2.I & D Septal Abscess (Unilateral & Bilateral) 2.4 .12 .Indirect Opthalmoscopy 1.
Tracheostomy Audiometry .1 5.1 .1 4.Stapedotomy .3 4.14 2.Stiching of LCW (Nose & Ear) .Preauricular Sinus Excision .2.8 3.Hearing Aid Analysis and Selection Throat Surgery .Myringoplasty .Tonsillectomy .Tympanoplasty .5 6 6.Rhinoplasty .Septoplasty with reduction of terbinate (SMD) Ear Surgery .2 3.1 3.1 6.15 2.4 3.16 3 3.4 5 5.3 7 7.Adenoidectomy .2 5.Mastoidectomy .7 3.Direct Laryngoscopy & Biopsy .Hypopharyngoscopy .6 3.Transantral Biopsy .2 4.Broncoscopic & F B Removal General ENT Surgery .3 3.Tongue Tie excision Endoscopic ENT Procedures .4 5.2 6.3 5.Direct Laryngoscopy .Broncoscopic Diagnostic .Examination under Microscope .Mastoid Abscess I & D .Ear Piercing .Adenoidectomy + Tonsillectomy .9 4 4.5 3.Audiogram (Pure tone and Impedence) Obstetric & Gynecology Specialist Services 1 Episiotomy 2 Forceps delivery 3 Craniotomy-Dead Fetus/Hydrocephalus 4 Caeserean section 5 6 7 8 9 Female Sterilisation ( Mini Laparotomy & Laparoscopic) D&C MTP Hysterectomy Bartholin Cyst Excision 14 .Myringotomy .
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Suturing Perimeal Tears Ovarian Cystectomy / Oophrectomy Vaginal Hysterectomy Haematocolpes Drainage Colpotomy Casserian Hystrectomy Assisted Breech Delivery Cervical Biopsy Cervical Cautery Nomal Delivery Casserian EUA Midtrimestor Abortion Ectopic Pregnancy Ruptured Retain Placenta Suturing Cervical Tear Assisted Twin Delivery
Dental Services 1 Dental Caries/Dental Abcess/Gingivitis Cleaning Periodontitis 2 Surgery 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Minor Surgeries, Impaction, Flap Malocclusion Prosthodontia (Prosthetic Treatment) Trauma including Vehicular Accidents Maxillo Facial Surgeries Neoplasms Sub Mucus Fibrosis (SMF) Scaling and Polishing Root Canal Treatment Extractions Light Cure Amalgum Filling (Silver) Sub Luxation and Arthritis of Temporomandibular Joints Pre Cancerous Lesions and Leukoplakias Intra oral X-ray Fracture wiring Apiscectomy Gingivectomy Removal of Cyst Complicated Extractions (including suturing of gums) 15
SURGICAL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 Abcess drainage including breast & perianal Wound Debridement Appendicectomy Fissurotomy or fistulectomy Hemorrohoidectomy Circumcision Hydrocele surgery Herniorraphy Suprapubic Cystostomy Urethral Dilatation Cystoscopy Endoscopy Esophagoscopy Diagnostic Laparoscopy Colonoscopy Sigmoidoscopy Colposcopy Hysteroscopy Arthroscopy Tonsillectomy Mastoidectomy Stapedotomy Craniotomy (Neurosurgical) Episiotomy Forceps delivery Craniotomy-Dead Fetus/Hydrocephalus Caeserean section Female Sterilisation ( Mini Laparotomy & Laparoscopic) Vasectomy D&C MTP Hysterectomy FNAC Total Parotidectomy Intra-oral removal of submandibular duct Calculous Excision Branchial Cyst or Fistula/sinus Lingual Throid 16
38 39 40 41 Breast 1 2 3 4 5 6
Thyroid Adenoma Resection / Enucleation Hemithyroidectomy (Sub total Thyroidectomy/Lobectomy) Cysts and Benign Tumour of the Palate Excision Submucous Cysts Excision fibroadenoma – Lump Simple Mastectomy Halstead’s Radical, Mastectomy/Patey’s Operation Sectoral Mastectomy/Microdochectomy/Lumpectomy Wadge Biopsy Excision Mammary Fistula
Hernia 1 Ingunial Hernia repair reinforcement 2 Ingunial Hernia repair with mesh 3 Femoral Hernia repair 4 Epigastric/Ventral Hernia repair 5 Recurrent Ingunial Hernia repair 6 Ventral Hernia repair with mesh 7 Strangulated Ventral or Incisional Hernia/Ingunial 8 Recurrent Incisional Hernia 9 Diaphargmatic Hernia Abdomen 1 Exploratory Laparotomy 2 Gastrostomy or Jejuncstomy 3 Simple Closure of Perforated Ulcer 4 Reamstedt’s Operation 5 Gastro-Jejunostomy 6 Vagotomy & Drainage Procedure 7 Adhesonolysis or division of bands 8 Mesenteric Cyst 9 Retroperitoneal Tumour Excision 10 Intussuception (Simple Reduction) 11 Burst Abdomen Repair Spleen and Portal Hypertension 1 Splenectomy Pancreas
Abscess/Perigastric Abscess Biliary System 1 Cholecystostomy 2 Cholecystectomy 3 Cholecystectomy and Choledocholithotomy Colon. Rectum and Anus 1 Fistula in ane low level 2 Fistula in ane high level 3 Perianal Abscess 4 Catheters 5 IV Sets 6 Colostomy Bags 7 Ischiorectal Abscess 8 Ileostomy or colostomy alone 9 Sigmoid Myotomy 10 Right Hemicolectomy 11 Sigmoid & Descending Colectomy 12 Haemorroidectomy 13 Sphincterotomy of Fissurectomy 14 Tube Caecostomy 15 Closure of loop colostomy 16 Rectal Prolapse Repair 18 .1 Drainage of Pseudopancreatic Cyst 2 Retroperitoneal Drainage of Abscess Appendix 1 Emergency Appendisectomy 2 Interval Appendisectomy 3 Appendicular Abscess Drainage Small Intestine 1 Resection and Anastomosis 2 Intussusception 3 Intestinal Fistula 4 Multiple Resection and Anaestomosis 5 Intestinal Performation Liver 1 Open Drainage of liver abscess 2 Drainage of Subdia.
Testes.17 Anal Sphincter Repair after injury 18 Thiersch’s operation 19 Volvulus of colon 20 Resection anastomosis 21 Imperforate anus with low opening 22 Pilonidal Sinus Penis. Scrotum 1 Circumcision 2 Partial amputation of Penis 3 Total amputation of Penis 4 Orchidopexy (Unilateral & Bilateral) 5 Orchidectomy (Unilateral & Bilateral) 6 Hydrocele (Unilateral & Bilateral) 7 Excision of Multiple sebaceous cyst of scrotal skin 8 Reduction of Paraphimosis Other Procedures 1 Suture of large laceration 2 Suturing of small wounds 3 Excision of sebaceous cyst 4 Small superficial tumour 5 Large superficial tumour 6 Repair torn ear lobule each 7 Incision and drainage of abscess 8 Lymph node biopsy 9 Excision Biopsy of superficial lumps 10 Excision Biopsy of large lumps 11 Injection Haemorrhoids/Ganglion/Keloids 12 Removal of foreign body (superficial) 13 Removal of foreign body (deep) 14 Excision Biopsy of Ulcer 15 Excision Multiple Cysts 16 Muscle Biopsy 17 Tongue Tie 18 Debridment of wounds 19 Excision carbuncle 20 Ingroving Toe Nail 19 .
Syndactly.21 Excision Soft Tissue Tumour Muscle Group 22 Diabetic Foot Asnd carbuncle Urology 1 Pyelolithotomy 2 Nephrolithotomy 3 Simple Nephrostomy 4 Implantation of ureters Bilateral 5 Vesico-vaginal fistula 6 Nephrectomy 7 Uretrolithotomy 8 Open Prostectomy 9 Closure of Uretheral Fistula 10 Cystolithotomy Superopubic 11 Dialatition of stricture urethra under GA 12 Dialation of stricture urethra without anaesthesia 13 Meatotomy 14 Testicular Biopsy 15 Trocar Cystostomy Plastic Surgery Burn Dressing Small. medium (10% to 30%). large 30% to 60%. Constriction 13 brings) 14 Reconstruction of Hand (Tendon) 15 Polio Surgery 16 Surgery concerning disability with Laprosy 20 . 1 extensive > 60% 2 Ear lobules repair one side (bilateral) 3 Simple wound 4 Complicated wound 5 Face Scar – Simple 6 Cleft Lip – One side 7 Small wound skin graft 8 Simple injury fingers 9 Finger injury with skin graft 10 Multiple finger injury 11 Crush injury hand 12 Full thickness graft Congenitial Deformity (Extra digit.
Phalanges carpals. fixation or femur. Metacarples.2 malleolus patella fracture and fracture of calcaneum talus single forearm. B.1 Osteotomy/Open Reduction of Hip disclocation. tibia humerus 2. Prepuceal Dilatation.3 Girdle stone Arthoplasty 2 Fractures Open reductuin int. Innominate 1. Reduction Paraphimosis.17 Surgery concerning with TB Paediatric Surgery 1 Minor Surgery. Bone. Fixation bimaleolar fracture and fracture dialocation of ankle montaggia fracture dialocation Medical concyle of humerus fracture lateral condyle of humerus Olecranen fracture. I & D. tibia.3 forearm 2. fixation of hand & foot bones Tarsals. Meatotomy Gland Bipsy. small soft Tissue tumour 2 (Benign) 3 Rectal Polyp removal. head of radius lower end of radius. DHS/Richard Screw Plate 1. Metatarsals.4 Ext.2 Synovial or bone biopsy from HIP 1.1 reduction and int. medial 2.5 head fibula. Forarm Humerus inter-condylar fracture of humerus and femur and open 2. bone fracture External Fixation Appleication Pelvis femur. lower and of Inia 21 . deep abscess 4 Big soft tissue tumour 5 Branchial cyst/fistula/sinus 6 Ingunial Herniotomy (Unilateral & Bilateral) 7 Orchidopexy 9Unilateral & Bilateral) 8 Pyoric Stenosis Ramsteadt operation 9 Exploratory Laprotomy 10 Neonatal Intestinal Obstruction / Resection / Atresia 11 Gastrostomy. colostomy 12 Umbilical Hernia / Epigastric Hernia 13 Sacrocaccygeal Teratoma 14 Torsion of Testis 15 Hypospadius single stage (first stage) Orthopaedic Surgery 1 Hip Surgery Femoral Neck nailing with or without plating replacement prosthesis / Upper Femoral Osteotomy. excision 2.
8 4. Humerus. Thigh.21 4. femur forearm without fixation Debridement of hand/foot Debridement primary closure of compound fractures of tibia. Clavicle Ankle Bimalleolar Open reduction. Hand foot Amputation (Thigh or arm.3 4. shoulder.16 4.6 4.2 4.18 4.4 4 4. digits) Disarticulation of hip or shoulder (Disarticulation of knee 22 . Foot bone and cervicle Forearm or Arm. Knee Closed Fixation of hand / foot bone Open Reduction Shoulder dislocation. Triple/elbow.2.12 4.10 4.19 4.17 4.22 4.8 2. Tibia) Fibula Radius Ulna (Clavicle) and Wrist.6 2. Aknle Dislocation elbow. Wrist/Hip) Arthodesis – MP & IP Joints Excision Exostosis long bones. single / two Currentage Bone Grafting of Bone Tumour of fumur/tibia Humerus & forearm Surgery tumours of small bone hand and foot Debridement primary closure of compounds fracture of tibia.Sequentrectomy of femur. Ankle. feet or hand.5 4. Two .9 4.14 4.3 3. More than two) Tendon Surgery (Repair and Lengthening) Surgery of chronic Osteomlitis (Saucerization.11 4.2 3.15 4. Wrist.23 Drainage of fracture Interlocking nailing of long bones Debridement & Secondary closure Percutaneous Fixation (small and long bones) Closed Reduction Hand.1 4. femur forearm with fixation Tendon surgery soft tissue release in club foot Internal fixation of small bone (Single. knee dislocation Acromiocalvicular or stemoclavicular Jt. leg or forearm.7 2.7 4.9 3 3.4 4. Ankle Trimalleolar open reduction Wrist dislocation on intercarpal joints MP & IP Joints Knee Synovectomy / Menisectomy Fasciotomy leg/forearm High Tibial Osteotomy Arthodesis (Shoulder/Knee Ankle.13 4.20 4. Hip.1 3. Leg.
1 2 NAME OF ILLNESS Bleeding during first trimester Bleeding during second trimester RECOMMENDED SERVICE MIX (SUGGESTED ACTIONS) Treat and provide blood transfusion Treat and provide blood transfusion 23 .37 4. Excision Arthoplasty of small joints Operation of hallus valgus Bone Surgery (Needle biopsy. Shoulde spica POP Jacket. Screw.44 4. Calcanlum.25 4.46 elbow/wrist/ankle.32 4.36 4.42 4.39 4.24 4.26 4.45 4.38 4.41 4.35 4. medium and large) Patellectomy Olacranon fixation Open Ligament repair of elbow. Axial Skelton.43 4.30 4.40 4.33 4.28 4. Elbow Bone Grafting (small grafting and long bone) Ingrowing toe-nail Soft tissue Biopsy Skin Graft (small.31 4. Tibia. Fore-quarter or hind-quarter) POP Aplication (Hip Spica.34 4. Non-Axial) Removal K Nail AO Plates Removal Forearm Nail. B-K/B-E POP) Corrective Osteotomy of long bones Excision Arthoplasty of elbow & other major joints. Ankle & Wrist Arthrotomy of hip/shoulder/elbow Carpal Tunnel Release Dupuytrens contracture Synovectomy of major joint shoulder/hip/ Elbow Repair of ligaments of knee Closed Nailing of long bones External fixator readjustment dynamisation removal of external fixation/removal of implant Excision of soft tissue tumour muscle group RECOMMENDED SERVICE MIX (SUGGESTED ACTIONS) FOR DIFFERENT ILLNESSES CONCERNING DIFFERENT SPECIALITIES: OBSTETRIC & GYNECOLOGY S. No.27 4.4. A-K/A-E POP.29 4. Wires Skeltal Traction Femur.
S. prolonged labour .Obstructed Treat labour ) PPH Puerperal Spesis Ectopic Pregnancy Hypertentive disorders Septic abortion Medical disorders complicating pregnancy ( heart disease . No.diabetes.PROM. 3 4 5 6 7 8 9 10 11 12 NAME OF ILLNESS Bleeding during third trimester Normal Delivery Abnormal lablour ( Mal presentation. ovarian masses ) Initial investigation at PHC / Gr III level Breast Tumors Treat Treat Treat Instigate and refer Cancer Cervix screening Collection of PAP SMEAR and Initial investigation at PHC / Grade III biopsy level Cancer cervix /ovarian Initial investigation at PHC / Gr III level Infertility Prevention of MTCT Diagnose and refer Investigate and refer Pretest and post test and counseling and treatment 6 7 8 24 . hepatitis ) Bronchial asthma Gynecology Treat RECOMMENDED SERVICE MIX (SUGGESTED ACTIONS) Treat and provide blood transfusion Yes Treat and refer if necessary Treat Treat and refer if necessary Treat Refer and follow up services Treat 1 2 3 4 5 RTI / STI DUB Benign disorders ( fibroid. prolapse.
S. No. 9 10 NAME OF ILLNESS MTP / MVA services Tubectomy RECOMMENDED SERVICE MIX (SUGGESTED ACTIONS) Treat Yes GENERAL MEDICINE 25 .
treat & decide further Ref. f) Viral Hepatitis g) Leptospirosis / Menningitis and Haemorrhagic fever h) Malignancy (<1 RECOMMENDED SERVICE MIX (SUGGESTED ACTIONS) Basic investigation and Treatment (>1 Investigation and treatment Refer if necessary Treat Treat Treat Treat If HBs.Ref. 1 NAME OF THE ILLNESS Fever -a) Short duration week) Fever -b) Long duration week) c) Typhoid d) Malaria / Filaria e) Pulmonary Tuberculosis.S.I / G-II district 26 . ILLNESSES : Bronchial Asthma / Pleuraleffusion / Pneumonia / Allergic Bronchitis/COPD Diagnose and Treat 3 COMMON CARDIAC PROBLEMS a) Chest pain (IHD) Treat and decide further management Emergencies . To Gr . Ag +ve refer to tertiary care Refer to Gr-I / G-II District level Refer to Gr-I / G-II District 2 COMMON RESP.District Hospital Treat 4 a) b) 5 a) b) G I TRACT G I Bleed / Portial hypertension / Gallblader disorder AGE / Dysentry / Diarrhoreas NEUROLOGY Chronic Hpeadache Chronic Vertigo/ CVA/TIA/Hemiplegia/ Paraplegia Investigate. To Gr-II / Gr-I . No.
S. To tertiary Ref.I / G-II district Treat 8 Screening. NAME OF THE ILLNESS RECOMMENDED SERVICE MIX (SUGGESTED ACTIONS) Investigate Diagnose with facility for nebulisation Treat Refer if no improvement Diagnose Treat Investigate Diagnose Treat Refer Investigate Diagnose Treat Refer if no improvement Investigate Diagnose Treat Refer if no improvement Investigate 27 1 ARI/ Bronchitis Asthmatic 2 3 Diarrohoeal Diseases Protein Energy Malnutrition and Vitamin Deficiencies 4 Pyrexia of unknown origin 5 6 Bleeding Disorders Diseases of Bones and Joints . No. No. emergency care and referral PAEDIATRICS S. To Gr . 6 a) b) c) 7 NAME OF THE ILLNESS HAEMATOLOGY Anaemia Bleeding disorder Malignancy COMMUNICABLE DISEASES Cholera Measles Mumps Chickenpox PSYCHOLOGICAL DISORDERS Acute psychosis / Obsession / Anxiety neurosis RECOMMENDED SERVICE MIX (SUGGESTED ACTIONS) Basic investigation and Treatment Refer if necessary Stabilise Ref.
Treat Examine and refer Manage and Refer Identify and manage & refer if needed. major -refer Manage Refer Exclusive breast feeding & refer to ART Centre Manage Identify & Refer Diagnose & refer Manage Manage 28 . Treat and Refer if no improvement.D. Identify and manage Diagnosis and manage Minor -manage. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 NAME OF THE ILLNESS Attention at birth (to prevent illness) Hypothermia Birth asphyxia Hypoglycemia Meconium aspiration syndrome Convulsions (seizures) Neonatal Sepsis LBW Neonatal Jaundice Preterm Congenital malformations R.ARI Dangerously ill baby Feeding Problems Neonatal diarrhoea Birth injury Neonatal Meningitis Renal problems/Congenital heart ndisease/Surgical emergencies HIV/AIDS Hypocalcemia Metabolic Disorders Hyaline Membrane diseases Neonatal Malaria Blood disorders RECOMMENDED SERVICE MIX (SUGGESTED ACTIONS) 5 cleans warm chain Warm chain Resuscitation And Treatment Treat Treat & refer if no improvement. Investigate & Treat Treat Treat including exchange transfusion Warm chain. kangaroo care. feeding.7 8 9 10 Childhood Malignancies Liver Disorders Paediatric Surgical Emergencies Poisoning. No. Bites Diagnose Treat Refer if no improvement Early Diagnosis and Refer Investigate Diagnose Treat Refer if no improvement Investigate and Diagnose Refer Treat NEONATOLOGY S.S. Sting.
Resistant/ 3 4 5 6 7 8 . Soft Fibroma.25 26 27 Developmental Delays UTIs Failure to Thrive CBR Manage& refer Manage & Refer DERMATOLOGY RECOMMENDED SERVICE MIX (SUGGESTED ACTIONS) Treat Treat Treat Treat Identify / Treat and refer Treat Diagnosis and Treat Treat Treat Treat Treat / Refer Treat Treat Treat / 29 S.Toxin induced b) Leprosy .Tumors / Cysts. Morphea Skin Tumors. Seb.Verrucca Molluscum Contagiosa Pityriasis Rosea LGV HIV b) Bacteria Pyoderma Chancroid Gonorrhea Leprosy Tuberculosis c) Fungal Sup. Nail disorder. Alopecia. Benign Surface. 1 NAME OF THE ILLNESS Infections a) Viral . No. ) Acne Vulgaris. Appendageal Tumors Miscellaneous a. Miliaria.Mycosis Subcut .Mycetoma d) Parasitic Infestation Scabies / Pediculosis/Larva Migrans e)Spirochaetes Syphilis Papulosquamous Psoriasis (classical)uncomplicated/Lichen Planus Pigmentary Disorder Vitiligo Keratinisation Disorder Ichthyosis/Traumatic Fissures Autoimmune Collagen Vascular DLE.Keratosis.HIV .
Refer Complications / reaction Allergy . Hemoptysis Bronchoscopy Chest Pain Investigation Treatment Wheezing Treatment. No. 1 2 3 4 5 6 RECOMMENDED SERVICE MIX (SUGGESTED ACTIONS) Fever Investigation and Treatment Cough with Expectoration / Blood Stained Treatment Investigation and Treatment.EMF / SJS / TEN Psoriasis/Collagen Vascular/Auto immune Disorders Treat / c) Deep Mycosis. PFT NAME OF THE ILLNESS Breathlessness Investigation and Treatment Chest Physiotherapy PSYCHIATRY S. STD Complications Refer d) Genetically Determined Refer Disorders CHEST DISEASES S. 1 2 3 4 5 6 7 8 NAME OF THE ILLNESS Schizophrenia Depression Mania Anxiety Disorders Mental Retardation Other Childhood Disorders Alcohol and Drug Abuse Dementia RECOMMENDED SERVICE MIX (SUGGESTED ACTIONS) Follow up Follow up Follow up Follow up Follow up Follow up Follow up Follow up 30 . No.
A. DM Asymptomatic Urinary Abnormalities Nephrolithiasis Acute renal Failure/ Chronic Renal Failure Tumors RECOMMENDED SERVICE MIX (SUGGESTED ACTIONS) Treat Treat Refer to Tertiary Treat Refer to the District Refer to District Hospital Suspect / Refer to District level Refer to Tertiary NEURO MEDICINE AND NEURO SURGERY S.Adults HT. Refer if necessary Investigate and Treatment Referral 31 . No. No.V.DIABETOLOGY S. 1 2 3 4 5 6 NAME OF THE ILLNESS Epilepsy C.Children/ Acute Nephritis Nephrotic Syndrome . 1 2 3 4 5 6 7 8 NAME OF THE ILLNESS Uncomplicated UTI Nephrotic Syndrome . 1 2 3 4 5 6 NAME OF THE ILLNESS Screening for Diabetes Gestational Diabetes/DM with Pregnancy DM with HT Nephropathy/Retinopathy Neuropathy with Foot Care Emergency :i) Hypoglycemia ii)Ketosis iii)Coma RECOMMENDED SERVICE MIX (SUGGESTED ACTIONS) Diagnose and Treat Diagnose and Treat Diagnose and Treat Diagnose and Refer Diagnose and Treat Diagnose and Treat NEPHROLOGY S. No. Infections Trauma Chronic headache Chronic Progressive Neurological disorder RECOMMENDED SERVICE MIX (SUGGESTED ACTIONS) Investigate and Treat Investigate and Treat Investigate and Treat Investigate and Treat.
Circumcision.Biopsy / Excision of Lipoma / Ganglion / Lymph Node. Gastrointestinal disorder Appendicitis/Anorectal abcesses/Rectalprolapse/Liver abscess/Haemorrhoids/Fistula Assault injuries/Bowel injuries/Head injuries/Stab injuries/Multiple injuries/Perforation/Intestinal obstruction Breast/Oral/GItract/Genitourinary (Penis.GENERAL SURGERY S.Testis) Thyroid. Swelling a.Varicose veins Burns < 15% >15% a) Assualt / RTA b) Poisonings c) Rape d) Postmortem 1 Basic Techniques Treat Investigate / Diagnosis Treatment Treat 2 Elective Surgeries Treat 3 Emergency surgeries Benign/ Malignant Diseases Others Burns Medico legal Treat 4 5 6 7 Treat Treat Treat Treat AR Entry / Treat AR Entry / Treat AR Entry / Treat done 32 . Supra pubic cysostomy. Seb-Cyst / Dermoid / Ear Lobe Repair / Circumcision b. b.Hernia. Genitourinary tract Hydrocele. Major Classification RECOMMENDED SERVICE MIX (SUGGESTED ACTIONS) NAME OF THE ILLNESS a. Lymphnodes. Prostate. No. Breast Lumps. FNAC Thyroid. Minor Cases under LA Abcess I&D/Suturing.
1 2 3 4 5 6 7 NAME OF THE ILLNESS Superficial Infection Deep Infections Refractive Error Glaucoma Eye problems following systemic disorders Cataract Foreign Body and Injuries Squint and Amblyopia/Corneal Blindness (INF.OPTHALMOLOGY S. Leucoma)/ Oculoplasty Malignancy/Retina Disease Paediatric Opthalmology RECOMMENDED SERVICE MIX (SUGGESTED ACTIONS) Treatment with drugs Treat Treat Treat Treat Treat Treat 8 9 10 Refer Refer Refer EAR. Surgery if needed Diagnose and Refer RECOMMENDED SERVICE MIX (SUGGESTED ACTIONS) 33 . NOSE. No. No. THROAT S. NAME OF THE ILLNESS EAR 1 2 3 4 5 ASOM/SOM/CSOM Otitis External / Wax Ears Polyps Mastoiditis Unsafe Ear Treat/Surgical if needed Treat Surgical Treatment Treatment (Medical). INJ.
No.THROAT 1 Tonsillitis/Pharyngitis/Laryngitis 2 Quinsy 3 Malignancy Larynx 4 Foreign Body Esophagus NOSE 1 Epistaxis 2 Foreign Body 3 Polyps 4 Sinusitis 5 Septal Deviation ORTHOPADICS S. 1 2 3 4 NAME OF THE ILLNESS Osteomyelitis Rickets /Nutritional Deficiencies Poliomyelitis with residual Deformities/JRA/RA RTA/Polytrauma RECOMMENDED SERVICE MIX (SUGGESTED ACTIONS) All Stabilisations Surgery Manage with Physiotherapy Corrective Surgery/ Physiotherapy Manage Treat Treat Treat (Removal) Treat (surgery if needed) Treat (surgery if needed) Treat Surgery Diagnose and Refer Diagnose and Refer 34 .
CHILDREN 1 2 3 4 5 6 7 8 9 10 Hydronephrosis Urinary Tract Injuries PUV/ Posterior Urethral Valve Cystic Kidney Urinary Obstruction Undesended Testis Hypospadias and Epispadias Mega Ureter Extrophy Tumours .Urinary Tact Diagnose and refer Diagnose and refer Diagnose and refer Diagnose and refer Urethral Catheter Insertion Referral Diagnose and refer Diagnose and refer Diagnose and refer Diagnose and refer Diagnose and refer NAME OF THE ILLNESS RECOMMENDED SERVICE MIX (SUGGESTED ACTIONS) ADULT All above and 1 2 3 4 5 Stricture Urethra Stone Diseases Cancer . No.UROLOGY S.Urinary and Genital Tract Trauma Urinary Tact GUTB Diagnose and refer Diagnose and refer Diagnose and refer Diagnose and refer Diagnose and refer OLD AGE 1 Prostate Enlargement and Urinary Retention Urethral Catheter Insertion Referral 35 .
Prostate.2 3 4 5 Stricture Urethra Stone Diagnose and refer Diagnose and refer Cancer (Kidney. Flap Malocclusion Prosthodontia (Prosthetic Treatment) Trauma Maxillo Facial Surgeries Neoplasms 36 . Impaction.Testis. 1 2 NAME OF THE ILLNESS Dental Caries/Dental Abcess/Gingivitis Periodontitis Cleaning Surgery Treat Cleaning Treat Surgery if necessary and refer Refer Treat with appliances Treat (wiring and planting) Refer Refer RECOMMENDED SERVICE MIX (SUGGESTED ACTIONS) Treat 3 4 5 6 7 8 Minor Surgeries. Bladder. No.Penis Diagnose and refer and Urethra) Trauma Urinary Tract Diagnose and refer DENTAL SURGERY S.
Area of the hospital: An area of 65-85 m2 per bed has been considered to be reasonable. Local agency Guidelines and By-laws should strictly be followed. such as a deep well for water. existing utilities. flexibility in altering the area be kept. ♦ It should be in an area free of pollution of any kind. surface area. nearest city. limitation of the site that would affect planning. The area will include the service areas such as waiting space.000 Bed days per year = 20. be sited at the lowest point of the district. For the purpose of convenience the average size of the district is taken in this document as one million populations. sewage and storm-water disposal.2. Hospital Management Policy should emphasize on quake proof. Site information: Physical description of the area which should include bearings. major bus stand. it must not. generators for electricity and radio communication for telephone. boundaries. gas and telephone. Infrastructure should be eco-friendly and disabled (physically and visually handicapped) friendly. etc. airport. port. registration counter.000. railway station.3. 7. and horticulture services including herbal garden. In areas where such utilities are not available. Provision should be made for water harvesting. Size of the hospital: the size of a district hospital is a function of the hospital bed requirement which in turn is a function of the size of the population serve. water and land pollution.4. Based on the assumptions of the annual rate of admission as 1 per 50 populations. ♦ Too old building may be demolished and new construction done in its place. land used in adjoining areas. And average length of stay in a hospital as 5 days. ♦ It should be free from dangers of flooding.1.00.7. Factors to be considered in locating a district hospital ♦ The location may be near the residential area. In case of specific requirement of a hospital. topography. In India the population size of a district varies from 50. rain fall and data on weather and climate. generating back-up.000 to 15.000 x 5 = 100. fire proof and flood proof buildings. noise. seeds etc will be made available. 37 . The number of beds required for a district having a population of 10 lakhs will be as follows: The total number of admissions per year = 10. therefore. ♦ Disability Act will be followed.00. ♦ Necessary environmental clearance will be taken. solar energy / power back-up. ♦ It must be serviced by public utilities: water. substitutes must be found.000 x 1/50 = 20. A room for horticulture to store garden implements. entrance hall. 7. maps of vicinity and landmarks or centers. electricity. Physical infrastructure 7. including air.000 Total number of beds required when occupancy is 100% = 100000/365 = 275 Total number of beds required when occupancy is 80% = 100000/365 x 80/100 7.
the following items must be. lifts. considered: size. utilities available. step-by-step process of site selection occurs only in ideal circumstances. And new construction should be put in place. store or workshop or for any other use of the district hospital. the availability of a site outweighs other rational reasons for its selection. ♦ If they are too old and dilapidated then they must be demolished. topography. Circulation Areas Circulation areas like corridors. Building and Space Requirements Administrative Block: Administrative block attached to main hospital along with provision of MS Office and other staff will be provided. Floor Height The room height should not be less than approximately 3. Entrance Area Physical Facilities Ambulatory Care Area (OPD) Waiting Spaces 38 . ramps.5. staircase and other common spaces etc. drainage. In some cases. In the case of either site selection or evaluation of adaptability.7.6 In the already existing structures of a district hospital ♦ It should be examined whether they fit into the design of the recommended structure and if the existing parts can be converted into functional spaces to fit in to the recommended standards.7. Site selection criteria A rational. and planners arid architects are confronted with the job of assessing whether apiece of land is suitable for building a hospital. 7. in the hospital should not be more than 55% of the total floor area of the building. natural features and limitations. laundry.6 m measured at any point from floor to floor height. soil conditions. ♦ If the existing structures are too old to become part of the new hospital. 7. could they be converted to a motor pool. toilets.
psychiatry. Clinical Laboratory 39 . Clinics The clinics should include general. general waiting and subsidiary waiting spaces are required adjacent to each consultation and treatment room in all the clinics. preferably. Film developing and processing (dark room) shall be provided in the department for loading. one nursing station per ward will be provided. social service and treatment rooms. Nursing Station: On an average. However. unloading. dental. For National Health Programme. Nursing Services Various clinics under Ambulatory Care Area require nursing facilities in common which include dressing room. Main entrance. if required. The clinics for infectious and communicable diseases should be located in isolation. ophthalmic. provided with independent access. surgical. Separate Reporting Room for doctors should be there. The size of the room should depend on the type of instrument installed. injection room. in remote corner. neonatology. obsetetric and gynaecology. orthopaedic and social service department. it should be ensured that nursing station caters to about 40-45 beds. side laboratory. developing and processing of X-ray films. The room should have a sub-waiting area with toilet facility and a change room facility. paediatrics. assistance and enquiry counter facility be made available in all the clinics.Registration. dermatology and venereology. medical. Out of these half will be for acute patients and chronic patients. adequate space be made available. etc. The department should be located at a place which is accessible to both OPD and wards and also to operation theatre department. ENT. Diagnostic Services Imaging Role of imaging department should be radio-diagnosis and ultrasound along with hire facilities depending on the bed strength.
intensive care units and emergency and accident department. pantry. Intermediate Care Area (Inpatient Nursing Units) General Nursing care should fall under following categories: General Wards: Male / Female Private Wards: Wards for Specialities Depending upon the requirement of the hospital and catchment area. 10% of the total bed strength is recommended as private wards beds. etc. The distances to be traveled by a nurse from bed areas to treatment room. Separate Reporting Room for doctors should be there.. Separate Reporting Room for doctors should be there. Blood Bank Blood bank shall be in close proximity to pathology department and at an accessible distance to operation theatre department. treatment room. It should be ensure that nursing 40 . nursing store along with wards and toilets as per the norms. appropriate beds may be allowed for private facility. Ward Unit The basic aim in planning a ward unit should be to minimize the work of the nursing staff and provide basic amenities to the patients within the unit. should be kept to the minimum. Location Location of the ward should be such to ensure quietness and to control number of visitors.For quick diagnosis of blood. Blood Bank should follow all existing guidelines and fulfill all requirements as per the various Acts pertaining to setting up of the Blood Bank. doctors’ duty room. Ward unit will include nursing station. pantry etc. urine. a small sample collection room facility shall be provided. On an average one nursing station per ward will be provided. isolation room.
Out of these. acute coronary occlusion. However. critically ill patients requiring highly skilled life saving medical aid and nursing care are concentrated. Private ward: Depending upon the requirement of the hospital and catchment area appropriate beds may be allocated for private facilities. The size should be adequate to contain 5 percent of the total clinical visits to the OPD in one session. uninterrupted electric supply.station caters to above 40-45 beds. Number of beds will be restricted to 5% of the total bed strength. Location This unit should be located close to operation theatre department and other essential departments. Changing room should be provided for. Intensive Care Unit and High Dependency Wards General In this unit. 41 . Pharmacy (Dispensary) The pharmacy should be located in an area conveniently accessible from all clinics. The unit shall not have less than 4 beds nor more than 12 beds. It should be the ultimate medicare the hospital can provide with highly specialized staff and equipment. These should include major surgical and medical cases. such as. 13 may be ICU beds and 12 will be allocated for High Dependency Wards. 10% of the total bed strength is recommended as private wards beds. This unit will also need all the specialized services. severe haemorrhage. such as. Easy and convenient access from emergency and accident department is also essential. out of which half will be for acute patients and chronic patients. Out of these. For example. kidney and respiratory catastrophe. total of 25 beds will be for Critical Care. poisoning etc. The number of patients requiring intensive care may be about 2 to 5 percent total medical and surgical patients in a hospital. in a 500-bedded hospital. they can be equally divided among ICU and High Dependency Wards. head injuries. heating. piped suction and medical gases. Pharmacy should have component of medical store facility for indoor patients and separate pharmacy with accessibility for OPD patients. X-ray and pathology so that the staff and ancillaries could be shared.
ventilation. Out of these. heating. piped suction and medical gases. they can be equally divided among ICU and High Dependency Wards. Pre-operative Room and Post Operative Resting Room. total of 25 beds will be for critical care. blood bank and CSSD. central air conditioning and efficient life services. radiology. ventilation and efficient life service. staff and supplies. namely. All these should be properly channelized. nurses and sometime pathologist and radiologist operate upon or care for the patients. airconditioning. maximum protection from solar radiation and convenient relationship with surgical ward. free from noise and other disturbances. The location of Operation theatre should be in a quite environment. An Operation Theatre should also have Preparation Room. Protective Zone. Out of these 13 may be ICU beds and 12 will be allocated for high dependency wards. pathology. such as. Operating room should be made dust-proof and moisture proof. in a 500 bedded hospital. There may be four well defined zones of varying degree of cleanliness namely. Number of beds for both the units will be restricted to 5% of the total bed strength. Zoning should be done to keep the theatres free from micro organisms. if the theatres are located on upper floors. There should be an easy ambulance approach with adequate space for free passage of vehicles and covered area for alighting patients. Facilities Nurses Station Clean Utility Area Equipment Room Critical Care Area (Emergency Services) It should preferably have a distinct entry independent of OPD main entry so that a very minimum time is lost in giving immediate treatment to casualities arriving in the hospital. A good natural light and pleasant environment would also be of great help to the patients and staff as well. There should also be 42 . Therapeutic Services Operation Theatre Operation theatre usually have a team of surgeons anesthetists. This unit also need constant specialized services. intensive care unit. free from contamination and possible cross infection. Aspectic or Sterile Zone and Disposal or Dirty Zone. Clean Zone. Normally there are three types of traffic flow. For example. patients. electric supply.
slop sink. work bench and draining boards. It should have a single leaf door with self closing device and viewing window to communicate with the operation theatre. used instruments and other disposable / non disposable items should be removed to a room after each operation. Delivery Suite Unit The delivery suit unit be located near to operation theatre. The delivery Suit Unit should include the facilities of accommodation for various facilities as given below: Reception and admission Examination and Preparation Room Labour Room (clean and a septic room) Delivery Room Neo-natal Room Sterilizing Rooms Sterile Store Room Scrubbing Room Dirty Utility Physiotherapy The physiotherapy department provides treatment facilities to patients suffering from crippling diseases and disabililties. Theatre refuse. store and toilets separate for male and female. Hospital Services 43 . A pair of surgeon’s sinks and elbow or knee operated taps are essential. Non-disposable instruments after initial wash are given back to instrument sterilization and rest of the disposable items are disposed off and destroyed. such as. gymnasium. The department is more frequently visited by out-patients but should be located at a place which may be at convenient access to both outdoor and indoor patients with privacy. The theatre should have sink / photo sensors for water facility. Normative standards will be followed. put on their sterile gown. office. It should have a central air conditioning facility. The room should be provided with sink. It should also have a physical and electro-therapy rooms.a Scrub-up room where operating team washes and scrub-up their hands and arms. Laminar flow of air be maintained in operation theatre. Operation Theatre should also have a SubSterilizing unit attached to the operation theatre limiting its role to operating instruments on an emergency basis only. dirty linen. Dirty linen is sent to laundry through a separate exit. gloves and other covers before entering the operation theatre.
security and fire fighting arrangements. Engineering Services Electric Engineering Sub Station and Generation Electric sub station and standby generator room should be provided. It should easily be accessible from outside along with vehicular accessibility and separate room for dietician and special diet. Illumination 44 . At the same time location should involve the shortest possible time in delivering food to the wards. It should have a provision of hot water supply. It should be located such that the noise and cooking odours emanating from the department do not cause any inconvenience to the other departments. Mortuary It provides facilities for keeping of dead bodies and conducting autopsy. it is recommended to locate the department at a position of easy access to operation theatre department. pressing and storage of soiled and cleaned linens.Hospital Kitchen (Dietary Service) The dietary service of a hospital is an important therapeutic tool. Central Sterile and Supply Department (CSSD) As the operation theatre department is the major consumer of this service. It should be so located that the dead bodies can be transported unnoticed by the general public and patients. Medical and General Stores There are of medical and general store should have vehicular accessibility and ventilation. Hospital Laundry It should be provided with necessary facilities for drying.
The illumination and lightning in the hospital should be done as per the prescribed standards. Air coolers or hot air convectors may be provided for the comfort of patients and staff depending on the local needs. Emergency portable light units should be provided in the wards and departments. Ventilation The ventilation in the hospital may be achieved by either natural supply or by mechanical exhaust of air. Hospital should be provided with water coolers and refrigerator in wards and departments depending upon the local needs. Mechanical Engineering Air-conditioning and Room Heating in operation theatre and neonatal units should be provided. Call Bells Call bells with switches for all beds should be provided in all types of wards with indicator lights and location indicator situated in the nurses duty room of the wards. Emergency Lighting Shadow less light in operation theatre and delivery rooms should be provided. Public Health Engineering Water Supply Arrangement should be made for round the clock piped water supply along with an overhead water storage tank with pumping and boosting arrangements. sub-soil water and sewerage 45 . surface water. Approximately 10000 litres of potable water per day is required for a 100 beded hospital. Drainage and Sanitation The construction and maintenance of drainage and sanitation system for waste water. Separate provision for fire fighting and water softening plants be made available.
Residential Quarters All the essential medical and para-medical staff will be provided with residential accommodation. Building Maintenance: Provision for building maintenance staff and an office-cum store will be provided to handle day to day maintenance work Parking: Sufficient parking place as per the norms will be provided Administrative Services: Two sections (i) General section to deal with overall upkeep of the hospital and welfare of its staff and patients (ii) Medical Records section. Waste Disposal System National guidelines on Bio-Medical Waste Management and a Notification of Environment and Forests are at Annexure . Committee Room: A meeting or a committee room for conferences. trainings with associated furniture.shall be in accordance with the prescribed standards. 46 . Prescribed standards and local guidelines shall be followed.I Trauma Centre Guidelines to be followed Fire Protection Telephone and Intercom Medical Gas Cooking Gas: Liquefied petroleum gas (LPG) Laboratory Gas: Liquefied petroleum gas (LPG) and other specified gases.
MANPOWER REQUIREMENTS 8.1.8. S. No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 1\9 Note: 1 2 MAN POWER – DOCTORS Staff Hospital Superintendent Medical Specialist Surgery Specialists O&G specialist Psychiatrist Dermatologist / Venereologist Paediatrician Anesthetist (Regular / trained) ENT Surgeon Opthalmologist Orthopedician Radiologist Microbiologist Casualty Doctors / General Duty Doctors Dental Surgeon Forensic Expert Public Health Manager1 AYUSH Physician2 Pathologists Total District Headquarters Hospital (101-200 bedded) 1 3 2 4 1 1 2 2 1 1 1 1 1 6 1 1 1 2 2 34 May be a Public Health Specialist or management specialist trained in public health Provided there is no AYUSH hospital / dispensary in the district headquarter 47 .
2. S. One may from AYUSH 48 .8. No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 MAN POWER – PARA MEDICAL Staff Staff Nurse* Hospital worker (OP/ward +OT+ blood bank) Sanitary Worker Ophthalmic Assistant / Refractionist Social Worker / Counsellor Cytotechnician ECG Technician ECHO Technician Audiometrician Laboratory Technician ( Lab + Blood Bank) Laboratory Attendant (Hospital Worker) Dietician PFT Technician Maternity assistant (ANM) Radiographer Dark Room Assistant Pharmacist1 Matron Assistant Matron Physiotherapist Statistical Assistant Medical Records Officer / Technician Electrician Plumber District Headquarters Hospital (101-200 bedded) 75 to 100 20 15 1 1 1 1 1 12 4 1 6 2 1 5 1 2 1 1 1 1 1 1 * 1 Staff Nurse for every eight beds with 25% reserve.
No 101-200 Bedded Hospital Emergenc y / FW OT * General OT 1 2 1 4 Staff 1 2 3 Staff Nurse OT Assistant Sweeper Total 8 4 3 15 49 .4. S.8. 8.ADMINISTRATIVE STAFF Staff Manager (Administration) Junior Administrative Officer Office Superintendent Assistant Junior Assistant / Typist Accountant Record Clerk Office Assistant Computer Operator Driver Peon Security Staff* District Headquarters Hospital plus JD-HS office (101-200 bedded) 1 1 2 2 2 1 1 1 2 2 2 Total 17 Note : Drivers post will be in the ratio of 1 Driver per 1 vehicle. MAN POWER – OPERATION THEATRE District Headquarters Hospital Sl.3. No 1 2 3 4 5 6 7 8 9 10 11 12 MANPOWER. Driver will not be required if outsourced * The number would vary as per requirement and to be outsourced.
No 1 2 3 4 Staff Staff Nurse MNA / FNA Lab Technician Safar Karamchari Total Blood Bank 3 1 1 1 6 Blood Storage 1 1 1 3 50 .5.8. MAN POWER – BLOOD BANK / STORAGE S.
Funriture & Hosptial Accessories 15. Surgical Equipment Sets 11. Administration 19. PhysioTherapy Equipments 12. 51 . Operation Theatre Equipment 9. X Ray Room Accessories 3. Hospital Plants 21. Ear Nose Throat Equipments 6. The equipments required are worked out under the following headings 1. Transport The detailed information on service norms for equipments is given in the Annexures I to XXII in Table VI. Linen 17.9. Eye Equipments 7. Cardiac Equipments 4. EQUIPMENT NORMS Equipment norms are worked out keeping in mind the assured service recommended for various grades of the district hospitals. Refrigeration & AC 20. Endoscopy Equipments 13. PM equipments 16. Imaging equipments 2. Anaesthesia Equipments 14. Hospital Fittings & Necessities 22. Labour ward & Neo Natal Equipments 5. Teaching Equipments 18. Laboratory Equipments 10. Dental Equipments 8.
department should be having a separate ultra-sound machine of its own) C.A. X-ray machine (Mobile) C arm with accessories * Dental X ray machine Ultra Sonogram (Obs & Gyne.ray lobby Multiple Lead Apron Intensifying screen X-ray District Headquarters Hospital (101-200 bedded) 1 3 12 6 1 2 1 III CARDIAC EQUIPMENTS S. 1 2 3 4 5 Name of the Equipment ECG machine computerized ECG machine ordinary 12 Channel stress ECG test equipments Tread Mill * Cardiac Monitor Cardiac Monitor with defibrillator District Headquarters Hospital (101-200 bedded) 1 1 4 2 52 .A.ray dark room Cassettes X. X-ray machine 60 M. 1 2 3 4 5 6 District Headquarters Hospital (101200 bedded) 1 1 7 8 9 10 Name of the Equipment 500 M.ray developing tank Safe light X.A. X-ray machine* 300 M. No.A. No. 1 1+1 II X-RAY ROOM ACCESSORIES S. No. X-ray machine 100 M. IMAGING EQUIPMENT S. Scan Mammography Unit * Echocardiogram* * To be provided as per need. 1 2 3 4 5 6 7 Name of the Equipment X.ray lobby single X.I.T.ray X.
P.6 7 8 9 10 11 12 13 Ventilators (Adult) Ventilators (Paediatrics) Pulse Oximeter Pulse Oximeter with NIB. S.apparatus stand model Stethoscope 1 1 3 1 2 10 10 5 * To be provided as per need.P.P* Infusion pump B. 1 2 3 4 5 Name of the Equipment Audiometer Operating Microscope (ENT) Head light (ordinary) (Boyle Davis) ENT Operation set including headlight. Tonsils Mastoid Set District Headquarters Hospital (101-200 bedded) 1 2 1 1 53 . EAR NOSE THROAT EQUIPMENT S. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 IV LABOUR WARD & NEO NATAL EQUIPMENTS District Headquarters Name of the Equipment Hospital (101-200 bedded) Baby Incubators 1 Phototherapy Unit 2 Emergency Resuscitation Kit-Baby 2 Radiant Warmer 2 Room Warmer 2 Foetal Doppler 2 CTG Monitor 2 Delivery Kit 10 Episiotomy kit 2 Forceps Delivery Kit 2 Crainotomy 1 Vacuum extractor metal 2 Silastic vacuum extractor 2 Pulse Oximeter baby and adult 1 each Cardiac monitor baby 1 Nebulizer baby 2 Weighing machine adult 3 Weighing machine infant 3 V. No.apparatus table model B. No.
EYE EQUIPMENTS District Headquarters Name of the Equipment Hospital (101-200 bedded) Cryo Surgery Unit 1 Opthalmoscope .6 7 8 9 10 11 12 13 14 15 16 17 Micro Ear Set myringoplasty Stapedotomy Set Stapeidoplasty ENT Nasal Set (SMR. 1 2 3 4 54 .to be supplied by Blindness Control Society VII. No. Rhinoplasty) Laryngoscope fibreoptic ENT Laryngoscope indirect Otoscope Oesophagoscope Adult Oesophagoscope Child Head Light (cold light) Tracheostomy Set Tuning fork 1 1 1 1 2 2 1 1 1 2 1 S. OPERATION THEATRE EQUIPMENT District Headquarters Name of the Equipment Hospital (101-200 bedded) Auto Clave HP Horizontal Auto Clave HP Vertical (2 bin) 2 Operation Table Ordinary Paediatric* Operation Table Hydraulic Major 2 S. 1 2 3 4 5 S.Direct 2 Slit Lamp 1 Retino scope 1 Perimeter 1 IOL Operation set 2 Laser Photocoagulometer* * . No. No. 1 2 3 4 5 6 7 VI. DNS. Septoplasty. Polypetcomy. DENTAL EQUIPMENTS District Headquarters Name of the Equipment Hospital (101-200 bedded) Air Rotor 1 Dental Unit with motor for dental OP 1 Dental Chair 1 Dental Lab Dental Kit 2 VIII.
No. table top Cell Counter Electronic Hot plates District Headquarters Hospital (101-200 bedded) 6 2 2 2 1 10 2 3 3 2 3 1 3 55 .Medium* Diathermy Machine (Electric Cautery) Suction Apparatus .S. IX.Foot operated Dehumidifier* Ultra violet lamp philips model 4 feet Ethylene Oxide sterilizer* Microwave sterilizer* District Headquarters Hospital (101-200 bedded) 2 1 1 1 1 1 2 2 3 3 2 1 1 4 3 1 4 1 1 * To be provided as per need. 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Name of the Equipment Operation table Hydraulic Minor Operating table non-hydraulic field type Operating table Orthopedic * Autoclave with Burners 2 bin* Autoclave vertical single bin Shadowless lamp ceiling type major* Shadowless lamp ceiling type minor* Shadowless Lamp stand model Focus lamp Ordinary Sterilizer big (Instrument) Sterilizer Medium (Instrument) Steriliser Small (Instruments) Bowl Steriliser .Electrical Suction Apparatus . LABORATORY EQUIPMENTS S.big* Bowl steriliser . No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Name of the Equipment Binocular Microscope Chemical Balances Simple balances Electric Calorimeter Auto analyser Semi auto analyser Micro pipettes of different volumes Water bath Hot Air oven Lab Incubator Distilled water Plant Electricentrifuge.
15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 Name of the Equipment Rotor / Shaker Counting chamber PH meter Paediatric Glucometer / Bilirubinometer Glucometer Haemoglobinometer TCDC count apparatus ESR stand with tubes Test tube stands Test tube rack Test tube holders Spirit lamp Rotatry Microtome Wax Embel Bath Auto Embedic Station Timer stop watch Alarm clock Elisa Reader cum washer Blood gas analyser Electrolyte Analyser Glycosylated Haemoglobinometer Blood Bank Refrigerator Haematology Analyser with 22 parameters Blood Collection Monitor Laboratory Autoclaves Blood Bank Refrigerator Ordinary Refrigerator Floatation Bath Emergency Drug Trolley with auto cylinder Dialected Tube Scaler Class – I Bio Safety Cabinet Knife Sharpner Air Conditioner with Stabilizer Cyto Spin RO Plant Computer with UPS and Printer District Headquarters Hospital (101-200 bedded) 3 3 2 1 2 1 4 6 6 6 8 1 1 2 1 1 1 1 1 3 1 1 3 4 3 1 1 1 1 1 1 1 1 56 .S. No.
S. No.D. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 District Headquarters Hospital (101-200 bedded) 2 2 1 2 2 2 2 2 2 2 2 2 3 8 2 5 2 1 1 8 5 1 1 1 1 1 7 1 2 1 2 2 57 P.set MTP Set Biopsy Cervical Set D & C Set I. Fissure Knee hammer Hernia. Fistula. SURGICAL EQUIPMENT SETS S.V.C.U. Tray Abdominal Hysterectomy set Laparotomy Set Formaline dispenser Kick Bucket General Surgical Instrument Set Piles. Hydrocele Varicosevein etc Gynaec Electric Cautery Vaginal Examination set Suturing Set MTP suction apparatus Thoracotomy set Neuro Surgery Craniotomy Set I M Nailing Kit SP Nailing Compression Plating Kit AM Prosthesis Dislocation Hip Screw Fixation Fixation Fracture Hip Spinal Column Back Operation Set Thomas Splint Paediatric Surgery Set Mini Surgery Set Urology Kit Surgical Package for Cholecystectomy Surgical package for Thyroid GI Operation Set Appendicectomy set Name of the Equipment .X. Kit LSCS set MVA Kit Vaginal Hysterectomy Proctoscopy Set P.
laryngoscope magills with four blades Endo tracheal tubes sets Magills forceps (two sizes) . 1 2 3 4 5 6 7 Name of the Equipment Endoscope fibre Optic (OGD) * Arthroscope Laparoscope operating major with accessories * Laparoscope diagnostic and for sterilisation * Colonoscope and sigmoidoscope* Hysteroscope * Colposcope * * . 1 2 3 District Headquarters Hospital (101-200 bedded) 3 2 6 58 District Headquarters Hospital (101-200 bedded) 1 1 1 Name of the Equipment Anaesthetic . 1 2 3 Name of the Equipment Skeleton traction set Interferential therapy unit Short Wave Diathermy District Headquarters Hospital (101-200 bedded) 1 1 1 XII.to be provided as per need XIII. 40 41 42 43 44 45 46 47 L. PHYSIOTHERAPY EQUIPMENTS S. No. ENDOSCOPY EQUIPMENTS S. No.S.P.Tray Uretheral Dilator Set TURP resectoscope Haemodialysis Machine Amputation set Universal Bone Drill Crammer wire splints Heamo dialysis machine Name of the Equipment District Headquarters Hospital (101-200 bedded) 5 4 1 1 8 XI. No. No. ANAESTHESIA EQUIPMENTS S.
R. Blood Bank.T Tubes connecting for ETT Air way female* Air way male* Mouth prop* Tongue depressors* O2 cylyinder for Boyles N2O Cylinder for Boyles CO2 cylinder for laparoscope* PFT machine Boyles Apparatus with Fluotec and circle absorber Exchange Transfusion Sets* * .4 5 6 7 8 9 11 12 13 14 15 16 Connector set of six for E. FURNITURE & HOSPITAL ACCESSORIES S. Doctor' s Table Duty Table for Nurses Table for Sterilisation use (medium) Long Benches(6 1/2' x 1 1/2' ) Stool Wooden Stools Revolving Steel Cup-board Wooden Cup Board Racks -Steel – Wooden Patients Waiting Chairs (Moulded) * Attendants Cots * Office Chairs Office Table Foot Stools * Filing Cabinets (for records) * M.Requirements (record room use) * Paediatric cots with railings Cradle* Fowler' s cot Ortho Facture Table* Hospital Cots (ISI Model ) Hospital Cots Paediatric (ISI Model ) Wooden Blocks (Set)* District Headquarters Hospital (101-200 bedded) 30 8 10 8 30 30 10 20 10 10 20 10 6 6 20 8 1 5 3 1 1 200 10 3 59 .to be provided as per need 6 6 10 20 8 10 10 10 1 1 XIV.T. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Name of the Equipment Doctor' s chair for OP Ward. Lab etc. No.D.
Assorted Basin Assorted (SS) Basin Stand Assorted (SS) (2 basin type ) ( 1 basin type) Delivery Table (SS Full) Blood Donar Table* O2 Cylinder Trolley(SS) Saline Stand (SS) Waste Bucket (SS)* Dispensing Table Wooden Bed Pan (SS)* Urinal Male and Female Name Board for cubicals* Kitchen Utensils* Containers for kitchen* Plate.S.S. Tumblers* Waste Disposal .)* Bed Side Lockers (SS)* Examination Couch (SS) Instrument Trolley (SS) Instrument Trolley Mayos (SS) Surgical Bin Assorted Wheel Chair (SS) Stretcher / Patience Trolley (SS) Instrument Tray (SS) Assorted Kidney Tray (SS) .Trolley (SS) Linen Almirah Stores Almirah Arm Board Adult* Arm Board Child* SS Bucket with Lid Bucket Plastic* Ambu bags O2 Cylinder with spanner ward type District Headquarters Hospital (101-200 bedded) 6 6 3 8 6 6 6 80 0 3 8 4 30 6 5 50 50 50 8 10 8 1 10 30 50 1 30 30 1 10 2 3 3 10 15 8 10 6 30 60 .Bin / drums Waste Disposal . 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 Name of the Equipment Back rest* Dressing Trolley (SS) Medicine Almairah Bin racks (wooden or steel)* ICCU Cots Bed Side Screen (SS-Godrej Model) Medicine Trolley(SS) Case Sheet Holders with clip(S. No.
One fan per four beds in the ward.M.to be provided as per need XVI. POST MORTEM EQUIPMENTS S.to be provided as per need $ . No. 1 2 3 4 5 6 7 8 9 Name of the Equipment Mortuary table (Stainless steel) * P.stainless steel Needle cutter and melter Thermometer clinical * Thermometer Rectal* Torch light* Cheatles forceps assortted* Stomach wash equipment* Infra Red lamp* Wax bath* Emergency Resuscitation Kit-Adult* Enema Set* Ceiling Fan$ * . No. No.S. District Headquarters Hospital (101-200 bedded) 2 20 25 4 10 10 4 5 1 2 6 As per requirement XV. LINEN S.equipments (list) Weighing machines (Organs) Measuring glasses(liquids) Aprons* PM gloves ( Pairs )* Rubber sheets* Lens Spot lights * . 1 2 3 4 5 6 7 8 Name of the Equipment Bedsheets Bedspreads Blankets Red and blue Patna towels Table cloth Draw sheet Doctor' s overcoat Hospital worker OT coat District Headquarters Hospital (101-200 bedded) 800 1200 50 300 60 100 60 250 District Headquarters Hospital (101-200 bedded) 2 4 2 3 10 10 2 2 61 . 66 67 68 69 70 71 72 73 74 75 76 Name of the Equipment Diet trolley .
H. Printer with Internet Connection** Xerox Machine Typewriter (Electronic )* Intercom (15 lines)* Intercom (40 lines)* Fax Machine Telephone District Headquarters Hospital (101-200 bedded) 4 1 1 1 1 1 62 . 1 2 3 4 5 6 7 8 9 Name of the Equipment Slide Projector O.P Screen White / colour boards Television colour Tape Recorder* ( 2 in 1 ) VCD Player Radio LCD Projectors * .to be provided as per need District Headquarters Hospital (101-200 bedded) 1 1 1 1 1 1 1 1 XVIII. TEACHING EQUIPMENT 600 300 80 300 600 200 20 150 150 100 50 100 200 S. No. ADMINISTRATION S. 1 2 3 4 5 6 7 Name of the Equipment Computer with Modem with UPS. No.9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Patients house coat (for female) Patients Pyjama (for male) Shirt Over shoes pairs Pillows Pillows covers Mattress (foam) Adult Paediatric Mattress Abdominal sheets for OT Pereneal sheets for OT Leggings Curtain cloth windows and doors Uniform / Apron Mortuary sheet Mats (Nylon) Mackin tosh sheet (in meters) Apron for cook XVII.
5 KV Solar Water heater * Incinerator* Central supply of 02. XX. Vacuum * Cold storage for mortuary * * . 1 2 3 4 5 6 7 8 Name of the Equipment Generator 40 / 50 KV Generator 75 KV Generator 125 KV Portable 2. HOSPITAL PLANTS S. No. HOSPITAL FITTINGS & NECESSITIES S.to be provided as per need District Headquarters Hospital (101-200 bedded) 1 1 XXI. REFRIGERATION & AC 1 Sl.8 9 10 Paging System* Public Address System* Library facility* * .to be provided as per need ** At least one for Medical Records and one for IDSP XIX. No. 1 2 3 4 5 Name of the Equipment Ceiling Fans* Exhaust Fan* Pedestal Fan* Wall Fan* Hotwater geiser* District Headquarters Hospital (101-200 bedded) 50 10 2 3 2 63 . 1 2 3 4 5 6 7 Name of the Equipment Refrigerator 165 litres Blood Bank Refrigerator ILR Deep Freezer Coolers* Air conditioners Central A/C for OT District Headquarters Hospital (101-200 bedded) 4 1 1 1 As per requirement 8 1 * One cooler per 8 beds in the wards. N20. No.
64 . No. 1 2 3 4 5 6 7 8 9 10 Name of the Equipment Ambulance Van (Family Welfare)* Pickup vehicles Maruti (Omni)* Mortuary Van Administrative vehicle (Car)* Minidor 3 wheeler* Bicycle* Camp Bus* Progamme vehicle* Motorcycle* District Headquarters Hospital (101-200 bedded) 3 1 * To be provided as per need.to be provided as per need XXII. TRANSPORT 2 2 2 2 70 3 S.6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Fire extinguishers* Sewing Machine* Lawn Mover* Vaccum cleaner* Aqua guard* Solar water heater * Neon sign for hospital* Garden equipment* Borewell motor OHT * Water dispenser / Water cooler* Laundry (steam) * Emergency lamp Emergency trauma set* Tube lights* Drinking Water Fountain* * .
and HCV Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes District Hospitals (101-200 bedded) Sl. No. Sugar. a list of National Reference Laboratories has been provided as annexure: District Hospitals (101200 bedded) S.10. Speciality Diagnostic Services / Tests Urine for Albumin.specific gravity. Haematology Diagnostic Services / Tests Haemoglobin estimation Total Leucocyte count Differential Leucocyte count Absolute Eosinophil count Reticulocyte count Total RBC count E.R.S. I. Stool Analysis Yes Yes Yes Yes 65 . Bleeding time Clotting time Prothrombin time Peripheral Blood Smear Malaria/Filaria Parasite Platelet count Packed Cell volume Blood grouping Rh typing Blood Cross matching ELISA for HIV. HBS AG. bile pigments.acetone.Reaction (pH) Stool for Ovacyst (Eh) Culture and Sensitivity Hanging drop for V. Deposits. No. Urine Analysis c.Cholera Occultblood b. Speciality CLINICAL PATHOLOGY a. for advanced diagnostic tests.bile salts. LABORATORY SERVICES AT DISTRICT HOSPITAL: Following services will be ensured.
sputum. No. Sputum d. count Cell count. MICROBIOLOGY Smear for AFB (Acid Fast Bacilli). culture sensitivity etc. PATHOLOGY a. Speciality Diagnostic Services / Tests District Hospitals (101-200 bedded) III. PAP smear b. SEROLOGY Yes Yes Yes 66 . Bacteriological analysis of water by Rapid H2S test to be done in districts where there is no separate public health laboratory Pregnancy test (Urine gravindex) Coomb' s tests. Gram Staining Cell count cytology Cytology Sputum cytology Bone Marrow Aspiration Coagulation disorders Sickle cell anaemia Thalassemia All types of specimens. Aspirated fluids II.d. Haematology Morphology. KLB (Diphtheria Bacilli) Culture and sensitivity for blood. Histopathology Sl. CSF Analysis f. urine etc. Semen Analysis e. Lepto spirosis (Rapid test / ELISA) WIDAL test Yes Yes IV. sputum etc. Stool culture for enteco pathogene Supply of different Specimen collection and transportation media for peripheral Laboratories KOH Study for Fungus Grams Stain for Throat swab. Biopsies Yes Yes Yes Yes e.pus.
sugar Blood gas analysis Estimation of residual chrorine in water by OT test Thyroid T3 T4 TSH CPK Chloride District Hospitals (101-200 bedded) Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes V. HBs Ag. potassium Serum Phosphorous Serum Magnesium CSF for protein. No. blood cholesterol Serum bilirubin Liver function tests Kidney function tests Lipid Profile Blood uric acid Serum calcium. HCV RA factor test Yes Yes Sl. Speciality Diagnostic Services / Tests Blood Sugar Glucose Tolerance Test Glycosylated Hemoglobin Blood urea.RPR test Elisa test for HIV. sodium. BIOCHEMISTRY 67 .
No. Spine. Skull. ENT IX. RADIOLOGY Yes Yes Yes Sl. OPHTHALMOLOGY Yes Yes Yes Yes VIII. PHYSIOLOGY Pulmonary function tests Yes 68 . Speciality CARDIAC INVESTIGATIONS Diagnostic Services / Tests a) ECG b) Stress tests c) ECHO a) Refraction by using Snellen' s chart Retinoscopy Ophthalmoscopy Audiometry Endoscopy for ENT a) Xray for Chest. No.Sl. Abdomen. VI. bones IITB X-Ray – CR Digital OPG d) HSG f) Ultrasonography Colour Doppler g) Spiral CT scan MRI 0.5 TESSLA District Hospitals(101-200 bedded) Yes Yes VII. Speciality District Hospitals Diagnostic Services / Tests (101-200 bedded) Oesophagus Stomach Colonoscopy Bronchuscopy Arthros copy Laparoscopy (Diagnostic) Colposcopy Hysteroscopy Yes Yes X ENDOSCOPY XI.
10 Beds (M+F) 15+15 Urology. $ including post – caesarean patients # including paediatric beds @ 10% Paying Wards 69 . ENT) 11 Post – Operative Ward Beds (M+F) 10+16$ 12 Accident and Trauma ward Beds 10 13 Labour room Boards 3 14 Labour room (Eclampsia) Beds 15 Septic Labour room Boards 16 Ante-natal ward Beds 15 17 Post-natal ward Beds 15 18 Postpartum ward Beds 20 19 Post operative ward Beds 20 Ophthalmology ward Beds 21 Burns Ward Beds * including ophthalmic ward. RECOMMENDED ALLOCATION OF BED STRENGTH AT VARIOUS LEVELS RECOMMENDED ALLOCATION OF BED STRENGTH District Headquarters Hospital (101-200 bedded) Sl.11. No 1 2 Item Type General Medicine Beds (M+F) 15+15 New born ward Beds 5 Mothers room with dining and 3 Beds 5 toilets 4 Paediatrics ward Beds 10 5 Critical care ward – IMCU Beds 5 6 Isolation Ward Beds 4 Dialysis unit (as per 7 Beds specifications) Thoracic medicine ward with 8 Beds (M+F) room for pulmonary function test 9 Blood bank Yes General surgery ward (incl.
REQUIREMENTS FOR OPERATION THEATRE: District Headquarters Hospital (101200 bedded) S. No Item 1 2 3 Elective OT-Major Emergency OT/FW OT Ophthalmology /ENT OT 1 1 1 70 .
Amikacin sulphate 100mg Cap.Gentamycin 40mg/2ml vial Inj. No A) 1 2 3 4 5 6 B) 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 C) 32 33 Tab.Ciprofloxacin 250mg Tab.Ibuprofen Chemotherapeutics Inj.Ciprofloxacin 500mg Inj.Cefoperazone 1Gm Inj.cefotaxime 500mg Tab.Trimethoprim+Sulphamethazol ss Tab.Norfloxacin 400mg Tab.Ampicillin 250mg Cap.Amikacin sulphate 500mg Inj.Diclofenac sodium Tab.12.Diclofenac sod Tab.Tetracycline 250mg Tab.Ciprofloxacin 100ml Tab.Amoxycillin 500mg Anti Diarrhoeal Tab.Erythromycin 500mg Syrup Cotrimoxazole 50ml Syrup Ampicillin 125mg/5ml 60ml Inj.Erythromycin 250mg Tab.Ampicillin 500mg Inj.Aspirin 300mg Tab. LIST OF MEDICINES / INSTRUMENTS / EQUIPMENTS /LAB REAGENTS / OTHER CONSUMABLES AND DISPOSABLES FOR DISTRICT HOSPITALS S.Norfloxacin 200mg Tab.Dolonex DT 20mg Tab.crystalline penicillin 10 lac unit Cap.Cefodroxyl 250mg Inj.Vionocef(Ceffixime)250mg Inj.Metronidazole 200mg Tab.Paracetamol 500mg Inj.Fortified procaine pen 4 lac Inj.Metronidazole 400mg NAME OF THE ITEM Analgesics/Antipyretics/Anti Inflamatory 71 .Crystalline penicillin 5 lac unit Inj.Ofloxacin 200mg Inj.
Dextrose 25%100ml bot I.Dextrose 10% 500ml bottle Inj.P 500gm Net P.Dextrose in Normal saline 500ml bt Inj.Normal saline (Sod chloride) 500ml Inj.Water for 10ml amp Inj.V.P Bandage a) 10cm b)15cm Framycetin skin oint 100 G tube Silver Sulphadiazene Oint 500gm jar Antiseptic lotion containing : a)Dichlorometxylenol 100ml bot b)Haffkinol 5litre jar Sterilium lotion Bacillocid lotion Infusion Fluids Inj.O.Water for 5ml amp Inj.5cm x 5mtr Absorbent cotton I.Plasma Substitute 500ml bot Inj.Mannitol 20% 300ml Inj.Furazolidone 100mg Tab.34 35 36 37 D) 38 39 40 41 Syrup.Ringer lactate 500ml Inj.Diolaxanide Fuzate Tab.dextrose 5% 500ml Inj.Lomodex Other Drugs & Material All Glass Syringes 2ml 5ml 10ml 42 43 44 45 46 47 48 49 50 51 E) 52 53 54 55 56 57 58 59 60 61 62 63 F) 64 72 .Metronidazole Tab.Metronidazole 100ml Inj.Tinidazole 300mg Dressing Material/Antiseptic lotion Povidone Iodine solution 500ml Phenyl 5litr jar(Black Phenyl) Benzalkonium chloride 500ml bottle Rolled Bandage a)6cm b)10cm c)15cm Bandage cloth(100cmx20mm) in Than Surgical Guaze(50cmx18m) in Than Adhesive plaster 7.
1/0. b)2 No.25 h)No.24 g)No.26 Scalp vein sets no a)19 b)20 c)21 d)22 e)23 f)24 g)25 h)26 Gelco all numbers Tab.Polyvitamin NFI Therapeutic Inj.23 f)No.Complex NFI Therapeutic Tab.20 c)No.65 66 67 68 69 70 71 72 73 74 75 76 77 78 20ml Hypodermic Needle (Pkt of 10 needle) a)No.22 e)No.1 Sutupak 1.5" Catgut Chromic a)1 No. c)1-0 No d)2-0 N0 e)8-0 Vicryl No.B.Dexamethasone 2mg/ml vial Inj.19 b)No.2.Vitamin B Complex 10ml Inj.21 d)No.2/0 Prolene X Ray film 50 film packet(in Pkt) size a)6.B12 Folic acid Surgical Gloves a)6 " b)6.1/2x8.1/2" c)7" d)7.1/2" b)8"x10" c)10"x12' d)12"x15" 73 .
Omeprazole Cough syrup 5litre Jar Cough syrup with Noscapine 100ml Coir Mattress Inj.Antacid Inj.Marcaine Inj.Diazepam Inj.Salbactum+Cefoperazone2Gm 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 74 .5lac vial Inj.5g Ether Anaesthetic 500ml Halothane Eye Drops Sulphacetamide eye drops 10% 5ml Framycetin with steroid eye drops 5ml Framycetin eye drops 5ml Ciprofloxacin eye drops Gentamycin eye drops Other Material Rubber Mackintosch Sheet in mtr Sterile Infusion sets(Plastic) Antisera I) A 5ml II)B 5ml III)D 5ml IV)AB 5ml Inj.79 80 81 82 83 84 85 86 G) 87 88 89 90 91 H) 92 93 94 Fixer Developer CT Scan film Ultrasound scan film Dental film Oral Rehydration powder 27.Ranitidine 2ML Tab.PAM Tab.Lignocaine 5% Inj.Ranitidine Tab.Lignocaine 1% Inj.lignocaine 2% Inj.Streptokinase 7.2mg/amp Inj.MethylErgometrine 0.Antacid ARS Syp.Streptokinase 15lac vial Inj.Rabipur Inj.
Pheniramine maleate Tab.Benadryl) Tab.Gattifloxacin 400mg Tab.115 116 117 118 119 120 121 122 123 I) 1 2 3 4 5 6 7 8 9 10 11 12 J) 13 14 15 16 17 K) 18 19 20 21 22 23 24 25 26 27 28 Inj.Mebendazole 100mg Syp.Isoniazid 100mg Tab.Rifampicin Tab.Prochlorperazine(Stemetil) Tab.Neomycin Inj.Bisacodyl Tab.Perinorm syrup.Piperazine Citrate 75 .Valdecoxib 20mg Tab.Isoniazid+Thiacetazone Cap.Amoxycillin250+cloxacillin 250 Inj.Diethylcarbamazin Drugs acting on Digestive system Tab.Furazolidone Inj.Chlorpheniramine maleate 4mg Tab.Benzathine penicillin 12lac Antihistaminics/anti-allergic Inj.Protein(Provita) Antibiotics and Chemotherapeutics Tab.Piperazine citrate Tab.Perinorm Inj.Pefloxacin 400mg Tab.Mebendazole Sy.Cyclopam Tab.Erythromycine Tab.Atrovastatin 10mg Sy.Cyclopam Inj.Chloroquine phosphate Inj.Ethambutol 400mg Tab.Cefuroxime 250/750 Tab.Himalt-X Sy.Erythromycine Esteararte 250mg Syp.Quinine Tab.Cetrizine Tab.Amoxycillin with clavutanite acid 600mg Cap.Phenoxymethyl Penicillin125mg Cap.Chloroquine phosphate 250mg Inj.Diphenhydramine (eqv.
Duvadilan Tab.Digoxine Tab.Promethazine Hcl Phenergan inj.Haloperidol Inj.adrenaline Inj.Verapamil(Isoptin) tab.Chlorpromazine 25mg(like Largactil) Inj.Ferrous sulphate200mg Inj.Propranolol Tab.Diazepam 5mg Tab.Belladona Drugs related to Hoemopoetic system Tab.Enalepril2.Iron Dextran/Iron sorbitol Eye oint Chloramphenicol eye oint & applicaps Chloramphenicol + Dexamethsone oint Gentamycin eye/ear drops Dexamethasone eye drops Drosyn eye drops Atropine eye oint Drugs acting on Cardiac vascular system Inj.Mephentine Tab.Diazepam 5mg Tab.Isoxuprine Inj.Pethidine Inj.Pavlon 2ml amp Inj.Digoxine Inj.Haloperidol Tab.Methyldopa Tab.Phenobarbitone 30mg Tab.5/5mg Drugs acting on Central/peripheral Nervous system Inj.Isosorbide Dinitrate(Sorbitrate) Tab.Largactil 25mg Tab.Pyrantel Pamoate Tab.Phenobarbitone 60mg Tab.Pentazocine (Fortwin) Inj.atropine sulphate Inj.Atenolol Tab.29 30 L) 31 32 M) 33 34 35 36 37 38 N) 39 40 41 42 43 44 45 46 47 48 49 50 51 O) 52 53 54 55 56 57 58 59 60 61 62 63 64 Sy.Pacitane 76 .
Magsulph Hormonal Preparation Inj.Primolut-N Sysran N Haymycin vaginal tab Inj.Deriphylline Tab.Cry Insulin Inj.65 66 67 68 69 70 71 P) 72 73 74 75 76 77 78 Q) 79 80 R) 81 82 83 84 85 S) 86 87 88 89 90 91 92 93 94 95 T) 96 97 98 99 Tab. Mesoprosl Tab.Aminophylline Inj.Aminophylline Tab.Frusemide 40mg Inj.Pyridicil Inj.Methyl Ergometrine Tab.Frusemide Drugs acting on Uterus and Female Genital Tracts Inj.Salbutamol Antiseptic Ointment Furacin skin oint Framycetin skin oint Drugs acting on UroGenital system Tab.Prostodin Tab.Insulin Rapid Insulin lente Besal Inj.Salbutamol 2mg Syrup Tedral Syrup.Phenergan Syrup Paracetamol Ethyl chloride spray Lignocaine oint Gentamycin eye/ear drops Betnesol-N/Efcorlin Nasal drops Drugs acting on Respiratory system Inj.Deriphylline Tab.Surmontil Syrup.Pitocin Inj.Duvadilan Inj Duvadilan Tab.Mixtard 77 .KCL Liquid KCL Tab.
Calcium Gluconate Tab.Benzoin Glcial acetic caid Benedict solution Caster oil Liquid paraffin Glycerine Glycerine Suppositories Turpentine oil Potassium Permangnate Formaldehyde Dextrose Powder Methylated spirit Cotrimazole lotion Cotrimazole cream Tab.Cholcalciferol16lac Inj.Vit "A" Inj.Biguanide Tab.AntiDiphtheria Serum Inj.Glibenclamide Tab.Calcium lactate Tr.Cyclophosphamide Inj.Testesterone plain 25mg Testesterone Depot 50mg Tab.Sodabicarb Inj.Iodine Tr.Ascorbic acid Inj.Vit "A" & "D" Tab.Prednisolone 5mg Tab.Antisnake venom Inj.Tolbutamide 500mg Tab.100 101 102 103 104 105 106 107 U) 108 109 110 111 112 113 114 V) 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 Inj.Ascorbic acid 100mg Other drugs Inj.Pyridoxin 50mg Inj.Antirabies vaccine Inj.Chlorpropamide 100mg Tab.Theophylline ECG Roll 78 .Vit K Tab.Betamethasone Vitamins Inj.
Others Tab.Dipyridamol(Like Persentine) Inj.Metaclopramide Tab.139 140 141 142 143 144 145 146 147 148 149 (W) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Burnion Oint Flemigel APC Ointment Syp.Paracetamol 79 .Lignocaine Hcl 2% Inj.Taxim Inj.Nor adrenaline Betadine lotion Tab.Isolyte-P Inj. Pilex Rumalaya Gel Pinku Pedratic Cough Syp.Tetglobe Inj. Septilin Tab.magnesium sulphate Benzyl Benzoate GammaBenzene Hexachloride Inj.Doxycycline 100mg Inj.Liv52 Syrup Liv52 Cap.Cephalexin 250mg Tab.stilboesteral Inj.1000IU Tab. Mentat Oint.Nitrofurantine Inj.Amitryptilline Tab. Gasex Syp.Pyridoxine Hydrogen peroxide Inj.Isolyte-M Inj.Valethemide Bromide(Epidosyn) Inj.Himobin APDYL Cough &Noscopin Tab.trifluoperazine(1mg) Tab.Dopamine Tab.Heparin sod.Glyceryl Trinitrate Tab.Folic acid Inj.Isolyte-G Cap. Cystone Tab.
Vitamin A Tab.5% 1 Bacitrium powder 10mg botts Bleaching Powder 5 Kg Pkts(ISI Mark) Ether Solvent Sodium Hypochloride Sod. Methyl Prednisolon 500mg vial Inj.Theophylline Etophylline Inj.Ferrous sulphate200mg+Folic acid Tab. B12 (Cynacobalamine) Neosporin.Alprazolam 0.Thyroxine sod 0.Multivitamin I.Potassium chloride Inj.5%.U Inj.Tetanus Toxoid 5ml vial Inj.Amlodipine 5mg Tab. Diphthoria antition ADS)10000I.Phenobarbitone 30mg Tab.Amlodipine 10mg 80 .1mg Warfarin sod 5mg Tab. 5 ltrs/1 ltrs Inj.U Inj.Calcium pantothernate Inj. 1.30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 Pilocarpine eye drops 1% Sy.Xylocaine 4% 30 ml Halothane Mixture Alkaline Inj.Ferrous sulphate 300mg Tab.Phenobarbitone 60mg Tab.Quinine Dihydrochloride Tetanus Antitoxin 10000 I. Hydroxy Progesterone500mg/2ml Inj.V Inj.Pyridoxin 10mg Tab. Gas gangrene Antitoxin(AGGS)10000 Inj.25mg Tab.Griseofulvin125mg Tab.Cutting) Inj. Nebasuef . Phenabarbitone 200mg Inj. Soframycin Pow Magnasium Sulphate Powder Furacin Cream Xylocaine jelly Formaldehyde Lotion Cetrimide 100ml bott 3.Orciprenaline Suturing needles (RB.
Betamethasone Cream Clotrimazole skin 1% 15gm Oint Dexamethasone 1%+ Framycetin Oint contain clotrimazole+Genta+Flucon Oint Flucanazole 10 mg Cream Framyctin 1% 20gm tube/100gm Lot.Complex Vit D-3 Granules Opthalmic & ear drops Glycerine Mag sulphate ear drops Pilocarpine eye drops 4% Oint Acyclovir 3% 5gm tube Benzyl Benzoate emulsion 50ml bot Oint.isoniazid 100mg/5ml 100ml bot Liquid paraffin Linctus codein 500ml bot Cream Miconozole 2% 15gm tube Syp.Riboflavin 10mg Syp.Nefidipine 30mg Tab.Furazolidone Oint.2% jar of 500g Oint Silversulpadiazene 1% 25g AIDS Protective kit 81 .Ferrous Gluconate 100ml bottle Cream Fluconozole 15gm tube Sus.Nalidixic acid syp.Norfloxacin Phenylepinephrine eye drops Pilocarpine eye drops 2% Syp.Primaquine Suspension Pyrantel pamoate Sus Rifampicin Syp.Salbutamol 100ml bot Syp.Pottassium chloride 400ml bot Syp.Gamabenzene hexachloride1% bt Glycerine Suppository USP 3gm bott/10 Cream Nitrofurazone 0.Theophylline 100ml Syp.Vitamin B.70 71 72 73 74 75 76 77 78 78A 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 Tab.Hydrocortisone acetate Syp.Nefidipine 20mg Tab.
14.e.13. information exchange. human resources are necessary but not sufficient. Capacity Building Training of all cadres of workers at periodic intervals is an essential component of the IPHS for district hospitals.e. Financial Audit. Both medical and paramedical staff should undergo continuing medical education (CME) at intervals. District hospitals also should provide the opportunity for the training of medical and paramedical staff working in the institutions below district level such as skill birth attendant training and other skill development / management training. infrastructure and software i. Monitoring of laboratory Internal Quality Assessment Scheme External Quality Assessment Scheme Record Maintenance 82 . These need to be guided by standard treatment protocols and Quality Assurance in Service Delivery Quality Control Internal Monitoring Social audit through Rogi Kalyan Samities / Panchayati Raj Institutions Medical Audit. Standard treatment protocols for locally common diseases and diseases covered under all national programmes should be made available at all district hospitals. Annual Jansamvad may also be held as a mechanism of monitoring. Technical Audit. External Monitoring Monitoring by PRI / Rogi Kalyan Samities Service / performance evaluation by independent agencies District Monitoring Committees formed under NRHM shall monitor the upgradation of Hospitals to IPHS. Monitoring of Accessibility and equity issues. Disaster Preparedness Audit. All the efforts that are being made to improve hardware i. Quality Assurance in Service Delivery Quality of service should be maintained at all levels.
and a grievance redressal system. Yet we insist that all our users receive courteous and prompt attention. State and National Level. Standards of Service: • • • • This is a District.Computers have to be used for accurate record maintenance and with connectivity to the District Health Systems. road in front of ………… This hospital hasDoctors: ………………… (including residents ………). The RKS / HMC will have authority to raise their own resources by charging user fees and by any other means and utilized the same for the improvement of service rendered by the District Hospital. 83 . Locations: It is located on ………. Standards are influenced by patients load and availability of resources. OUR MOTTO . The means through which complaints regarding denial or poor quality of services will be redressed. Rogi Kalyan Samities (RKS) / Hospital Management Committee (HMC) Each district hospital should have a Rogi Kalyan Samiti / Hospital Management Committee with involvement of PRIs and other stakeholders as per the guidelines issued by the Government of India. The quality of services they are entitled to. 15. Citizen’s Charter Each District hospital should display a citizen’s charter for the district hospital indicating the services available. Sub-district/divisional hospital. It provides medical care to all patients who come to the hospital. 16. A modal citizen’s charter is given as under.SERVICE WITH SMILE CITIZENS CHARTER This charter seeks to provide a framework which enables our users to know: • • • What services are available in this hospital. if any. These RKS should be registered bodies with an account for itself in the local bank. user fees charged.
Emergency Operations are done in- OT located on …………. Beds: ……………………. Reception and Registration Services: This counter is functioning round the clock. floor of ………… building. The decision rests with the treating doctor.Nurses: ………………….. Location guide maps have been put up at various places in this hospital. Colour coded guidelines and directional signboards are fixed at strategic points for guidance. Telephone enquiries can be made over telephone numbers: …………………….. (including supervisory staff).. Maternity OT Orthopaedic Emergency OT Burns and plastic OT Main OT for Neurosurgery cases Emergency Operation Theatre is functioned round the clock. & ……………………. Casualty & Emergency Services: All Casualty Services are available round the clock. All Staff member wear identity cards. Doctors wear white aprons and nurses are in uniform. Emergency services are available for all specialities as listed in the OPD Services. In serious cases. OPD Services: Various outpatient services available in the hospital are detailed below (as available): OPD Place Time of Registration Time of OPD 84 . • • • • Duty Doctor is available round the clock. Specialist doctors are available on call from resident doctors. Fax: ………………………. treatment/management gets priority over paper work like registration and medico-legal requirements. General Information Enquiry.
General Medicine Paediatrics General Surgery Paediatric Surgery Neuro Surgery Cardiac Surgery Obstetric & Gynec. Eye ENT Skin Urology Cardiology Psychiatry Radiotherapy Neurology Orthopaedics Burns & plastics Dental OPD ISM Services: Homeopathic Ayurvedic Any other In OPDs specialists are available for consultation.
OPD services are available on all working days excluding Sundays and Gazetted Holidays. On Saturdays, the hospital functions from ……………. AM to …………….. PM. Medical Facilities Not Available: Organ Transplantation ……………………….. ……………………….. ……………………… Some specialities do not have indoor patients services: Psychiatry D-addiction Dental Nuclear Medicine Genetic Counselling Endochronology Geriatrics Laboratory Services: Routine: Laboratory Services are provided in the field of (as available): • • • • • • Bio-chemistry Microbiology Haematology Cytology Histopathology including FNAC Clinical Pathology
There is a Central Collection Centre for receiving and collecting various specimens for testing. The timings for receiving specimens are 9:00 AM to 11:30 AM.
Emergency: Emergency Laboratory Services are available 24 hours for limited tests relating to clinical pathology and bio-chemistry. Radio Diagnostic Services: Routine: These services include: X-Rays Ultrasound and CAT Scan Routine X-Rays are done from 9:00 AM to 1:00 PM. Registration is done from 9:00 AM to 11:30 AM. Ultrasound examination is done from 9:00 AM to 4:00 PM. Emergency: Emergency X-Ray services are also available round the clock. CAT Scan services are also available round the clock. Indoor Patient Services: There are total of ………. Wards providing free indoor patient care. Emergency ward A admits emergency cases for medical problems. Emergency ward B admits emergency cases for surgical problems. There is a ------------- bedded Intensive Care Unit for care of seriously ill patients. A --------------- bedded Intensive Coronary Care Unit takes care of heart patients requiring intensive treatment. In the Burns Department, there are ----------- bedded Intensive Care Unit to treat seriously injured burns patients. There are --------------- labour rooms for conducting deliveries round the clock. ------------------ nurseries provide necessary care to the newborns – normal as well those born with disease. All indoor patients receive treatment under the guidance and supervision during office hours i.e. 9:00 AM to 4:00 PM.
treatment is given by doctor on duty and specialists are available on call.Outside office hours.Ambulances are available to pick up patients from their places (on payment of nominal charges) and also for discharged patients. are charged for as per Government approved rates. Every patient is given one attendant pass. Barium-meal. Canteen for patients and their attendants is available. Public Telephone Booths are provided at various locations. Stand-by Electricity Generators have been provided. Ultra Sound. Admitted patients should contact the Staff Nurse for any medical assistance they need. A Staff Nurse is on duty round the clock in the ward.D. Complaints & Grievances: There will be occasions when our services will not be upto your expectations.O. by the Additional Medical Superintendent. ----------. In case of emergency CMO (on duty) may waive off these charges. Chemist Shops are available outside the hospital. Mortuary Van is available on payment between 9:00 AM to 4:00 PM. For poor patients. Investigations like CAT Scan. 88 . Free diet is provided to all patients in the General Wards. ECHO. TMT etc. Visitors are allowed only between 5:00 PM to 7:00 PM. these charges can be waived partially or fully on the recommendation of the H. Other Facilities: Other facilities available include: Cold Drinking Water Wheel chairs and trolleys are available in the OPD and casualty. Adequate toilet Facilities for use of patients and their attendants are available. Lifts are available for access to higher floors.
designation and telephone number of the nodal officer concerned is duly displayed at the Reception. (M)…………………. Suggestions/Complaint boxes are also provided at various locations in the hospital.lacs patients attend the OPD annually and more than -----------. Please try to appreciate the various constraints under which the hospital is functioning. Please help us in keeping the hospital and its surroundings neat and clean.. We aim to settle your genuine complaints within 10 working days of its receipt. Beware of Touts. Designation……………. On an average more than --------. ……………………. The Hospital is a “No Smoking Zone” and smoking is a Punishable Offence. ♦ “No Smoking Please” ♦ Don’t split here & there 89 .. Please do not inconvenience other patients. Dr. Tele (O)……………… (R)…………………. Please use the facilities of this hospital with care. If we cannot. Name. These may be addressed to the Medical Superintendent of the Hospital. Please provide useful feedback & constructed suggestions. we will explain the reasons and the time we will take to resolve. It will only help us serve you better.lacs patients are attended annually in the casualty and emergency wards. Please refrain from demanding undue favours from the staff and officials as it encourages corruption. Every grievance will be duly acknowledged. Meeting Hours…………… to …………………… Responsibilities of the Users: The success of this charter depends on the support we receive from our uses.Please do not hesitate to register your complaints.
♦ Use Dustbin ♦ Keep Hospital Clean ♦ Give regards to Ladies and Senior Citizens 90 .
IEC activities. Civil and electrical works to house and operate the waste treatment facilities. The rules also envisage that common facility or any other facilities can be used for waste treatment. it has been decided to take up pilot projects in selected Government hospitals – Central and State. where required. The Ministry of Environment & Forests notified the “Bio-Medical Waste (Management & Handling) Rules. it is the duty of every “Occupier”. microwave system for the treatment of waste. It is. to take all steps to ensure that the waste generated is handled without any adverse effect to human health and environment. protective gears. Purchase of equipments such as: a) Incinerator b) Microwave c) Autoclave d) Shredder 2. clinic. or ensure requisite treatment of waste at a common treatment facility or any other treatment facility. etc. dispensary. it is incumbent on the occupier to ensure that the waste is treated within a period of 48 hours. 1998” in July. pathological lab. In accordance with the rules (Rule 4). nursing homes.Annexure – I Guidelines for the Project providing financial support to the selected Government Hospitals for Hospital Waste Management. autoclave. i. shall set up requisite biomedical waste treatment facilities like incinerator. Schedule VI of the rules also provides the time limits by which the waste treatment facilities are required to be in place. Hospital Waste Management System must be established in accordance with the BioMedical Waste (Management & Handling) Rules. Other equipments including colour coded bags and puncture proof containers. The Rules further state that every Occupier. AIM: The aim of the scheme is to implement pilot projects to have a demonstration effect by providing financial assistance to identified hospitals/institutions under Central/State Governments for: 1. however. not incumbent that every institution has to have its own waste treatment facilities. 4. In connection with the implementation of the Rules. The hospitals.e. 3. a person who has the control over the institution and/or its premises. 1998. etc. No untreated bio-medical waste shall be kept stored beyond a period of 48 hours (Rules 5 & 6). are. 91 . However. 1998 (Annexure). animal house. therefore. required to set in place the biological waste treatment facilities. Training 5.
1998.Segregation must be done at the source of generation of waste. These will destroy the used needles reducing it to ashes and cut the syringe effectively preventing the re-use. The correct colour bag should be used for the particular treatment option. 2. The categories for segregation of waste and colour coding and type of container should be as in Schedule 1 and 2 of the Bio-Medical Waste (Management & Handling) Rules. does not have sharp edges and is easy to clean and disinfect. & 6 as stated in the Schedule – I of the bio-Medical Waste (Management & Handling) Rules. Autoclaving/Microwaving: Standards for autoclaving and microwaving are provided in the Bio-Medical Waste (Management & Handling) Rules.11. 4. 1. 3. IEC activities including preparation and 92 . Shredder: Shredding will cause a reduction in the volume of waste and will also effectively prevent its re-use. it should be ensured that waste is disinfected by chemicals/microwaving/autoclaving before shredding. Needle and Syringe Destroyer: These units can be used for needles and syringes at the point of use. 3. The various options for treatment of waste can be selected according to feasibility and type of waste as given in the Schedule – I. 6. remain secure during transportation. installation of incinerators by individual hospitals may not be encouraged and such waste should be transported to the common facility for proper treatment. The equipment for autoclaving or microwaving waste should conform to these standards. As 80-85% of waste generated in hospitals is non-hazardous or general waste. 1998. Incineration: The incinerator installed must meet the specification and emission standards as given in the Bio-Medical Waste (Management & Handling) Rules. Transportation of Waste: Within the hospital in dedicated wheeled containers. 5. Wherever common facilities for treatment and disposal of bio-medical waste are available. dated 18. 1998. 2. training. The assistance will be given direct to the hospital/institute for purchase of equipments for waste treatment facilities/installation of equipment and civil/electrical works to house the waste treatment facilities. 4. Z.28015/50/2003-H. The various options are: 1. The wheeled container should be designed so that waste can be easily loaded. 1998.2003) – a certificate may be taken from the State Pollution Control Board. segregation will reduce the quantum of waste that needs special treatment to only 15-20% of the total waste. It is required for waste category 4 and 7 of the Schedule – I of the Bio-Medical Waste (Management & Handling) Rules. 5. 1998 and must meet the guidelines developed by Central Pollution Control Board for design and construction of bio-medical waste incinerator (circulated to all States/UTs vide letter no. Waste category. 7 of Schedule – I of the Bio-Medical Waste (Management & Handling) Rules. trolleys or carts should be used to transport the bins or plastic bags to the site of storage/treatment. These options can be selected for waste categories 3. 1998.
100 kg to 360 kg.00 lakhs 4. etc.85 lakhs per hospital or Rs.50 crore per State/UT. for Disposal of hospital wastes = Rs. The application for financial assistance should be forwarded to this Ministry through the State Government/UT Administration concerned. The equipments will be purchased as per prescribed procedure.50.00 Rs. These will be entered into an Assets Register to be maintained by the hospital.10. The grant will be subject to the condition that the State Government/UT Administration/Hospital will give an undertaking that they will provide the required trained manpower for running of the equipments and their maintenance for proper treatment and disposal for the bio-medical waste. Procurement of equipments like needle shredder puncture proof containers for sharps. as far as possible.5.50 lakhs Rs. 93 . Autoclave (Approx.00 lakhs Rs. by way of complementary equipments supported by estimates of concerned authorities. Literature/IEC/Training of Staff = = 7. Waste transportation: Onsite-wheel barrow/wheeled= container or similar carriage 5. Civil and Electrical works 6.00 lakhs The following eligibility conditions have to be fulfilled for availing of financial assistance: i. ii. pamphlets.2. The funds sanctioned will be utilized for the purpose for which it is sanctioned. The cost of equipments to be purchased should be indicated. The proposal for additionalities. iv. vi. Vol.publication of literature.00 lakhs Rs. in the form of equipment should be.000. protective gears for staff etc. posters.2.30. if any. of Rs.35. Shredder (Approx. colour coded bags. The State Government/UT Administration should ensure that the existing facilities are inspected by a responsible officer and deficiencies pointed out. v. The estimated costs are as under:1. 1015 litrs) = = = Rs.1. iii. trolleys. The grant will be subject to the condition that the State Government / UT Administration will give an undertaking that adequate arrangements for running the equipments and their maintenance for disposal of hospital waste shall be made. The financial assistance will be limited to Rs. Incinerator or Microwave 2./hour) 3.00 lakhs Upto max. Cap.
The proposals then will be processed for sanction of financial assistance to the Government Hospitals/institutes.GHS concerned with hospitals matters will be the Nodal Officer for implementation of the scheme. The Member Secretary of the Committee will be Director/Deputy Secretary dealing with hospital matters. DDG level officer in the Dte. the Head of the Institutions may send their proposal through Dte. 94 . the Joint Secretary dealing with hospital matters.5 crore per State/UT.1. Joint Secretary (FA) or his representative.vii.GHS.5 crore. The proposals will be examined through a Committee consisting of Additional Secretary. The funds for setting up facilities for disposal of hospital waste will be sanctioned to the State Government/UT Administration/Occupier and it will be implemented by the concerned Government and to the concerned Head of the Hospital in case of Central Government Hospitals/Institutions.1. The accounts of the hospital about purchase of equipment/maintenance of the equipments/transportation of thw waste/expenditure incurred on civil/electrical works will be audited by the Accountant General of the State Government / UT Administration and its utilization certificate will be forwarded to the Ministry of Health & Family Welfare within a period of six months after the expiry of the financial year during which the grants is sanctioned. In the case of Central Government Hospitals/Institutions. Scrutiny of Applications: The applications received from the State Government/UT Administrations for setting up of facilities for disposal of hospital waste in the hospitals under their administrative control will be considered in the Ministry in a Committee headed by Additional Secretary and proposals cleared for giving financial assistance. The State/UTs will have the option to choose any equipment (s) from the list above to cover as many hospitals as possible. the financial assistance per State will be provided upto a maximum amount of Rs. DDG level officer dealing with hospitals in Dte.85 lakhs per hospital or Rs. The Joint Secretary (Hospital).GHS and one representative of Central Pollution Control Board/Ministry of Environment & Forests as members. Chairman. However. The financial assistance will be limited to Rs.
4 Labs Central Zone Advance Diagnostic Facilities Bacterial diagnosis Enteric bacteria: Vibrio cholerae. Delhi STM. Delhi 95 .II REFERRAL LABORATORY NETWORKS Referral Laboratory Network for Advanced diagnostic facilities IDSP Level . Delhi Neisseria meningitidIs and N.Annexure . John Medical Medical College College. Pune NICD. Salmonella CMC Vellore South Zone North East Zone Zone South Zone IDSP Level – 5 Labs NICED & PGIMER RMRC KEM Chandigarh Dibrugarh. Chest University of Delhi NICD. Mumbai. Vellore Streptococcus pyogenes and S pneumoniae C. Shigella. Kolkata Surat CMC Medical Vellore & College PGIMER Chandigarh AFMC. Trivandrum Agra BHU MGR Maulana Medical Azad University Medical College. NICD Cuttack Medical College AFMC Pune Trivandrum AIIMS Medical Delhi College CRI Kasauli Indore St. Delhi STM. Kolkata BJ MC CMC Vellore AFMC. gonorrheae Staphylococcus SN State PH PGIMER Medical Lab Chandigarh College. Pune VP Chest Institute. Bangalore BHU CMC.diphtheriae VP.
Delhi NICED Kolkata EVRC. Vellore CMC. Vellore - NIV Neurotropic viruses HIV DRDE DRDE AIIMS & NICD Delhi AIIMS - - NIV NIMHANS NARI.Tuberculosis Leptospirosis State TB Demonstration & Training Centre (for all zones) ICGEB. Vellore AIIMS & NICED Villupuram Kolkata Chest Institute AIIMS & NICED NICD Delhi Kolkata Chest Institute AIIMS & NICED NICD Delhi Kolkata Chest Institute AIIMS ICGEB. Pondicherry AIIMS IVRI RMRC. Vellore - NIV. Chennai VCRC. Mumbai. TRC RMRC Port Blair Viral Diagnosis Enteric viruses DRDE CMC. Delhi Parasitic Diagnosis 96 . Vellore - Myxoviruses DRDE CMC. NICD & NACO ICGEB. Vellore CMC. Delhi DRDE Virology Institute. Allepey Tamil Nadu University. BJMC Bubaneswar & Dibrugarh NTI. NIV & NICD NIV Arboviruses DRDE CMC. HSADL Bhopal Hepatitis viruses DRDE CMC.
HAFFKIN' s. Chandigarh Dibrugarh. Delhi Haffikins NICD. Mumbai AFMC Pune NICED & NICD Microbial water quality monitoring NEERI. Delhi ICGEB. Pondicherry Plague DRDE NICD Bangalore CMC. Institute Delhi AFMC NICD IVRI NICED NIV NICED NIV NIV ICGEB. Calcutta BJMC NICD IVRI KEM Mumbai. CMC Nagpur Vellore. Delhi VCRC Pondicherry Zoonoses Dengue DRDE VCRC. Delhi NIV /NICD Rickettsial diseases DRDE Others of Public Health Importance Anthrax DRDE CMC. AIIMS Madurai & NIMHANS VCRC. Cuttack Trivandrum AIIMS Medical Medical Delhi College College CRI Kasauli 97 . PGIMER RMRC. Vellore IGIB NICED. AIIMS Pondicherry Institute of Virology. Vellore NICD.Malaria All State Public Health Laboratories MRC. Delhi Filaria All State Public Health Laboratories NVBDCP. Aleppey JE DRDE CRME.
AFMC. NICED. NICD Capacity building All the L4 & L5 laboratories (in their area of expertise) NIV. BJMC. RMRC. NICD Quality assurance All the L4 & L5 laboratories (in their area of expertise) CMC.Port Blair NIV. HSADL Outbreak investigation support Medical Colleges and state public health laboratories as L3/ L4 NICD. NICED 98 . NARI. NTI. VCRC Laboratory data management Medical Colleges. state public health laboratories and all the L4 & L5 laboratories (in their area of expertise) NIV. NICD.Port Blair NIV. RMRC. NIV. TRC. NICD.Unknown pathogens Other laboratories to perform support functions NIV. TRC. NARI. NICD Quality control of reagents & kits evaluation All the L4 & L5 laboratories (in their area of expertise) CMC.
NICD.MRC.Delhi AFMC. IVRI. NIV.Production & supply of reagents/ kits/ biological/ standard reference materials DRDE. Port Blair Biosafety & biocontainment Other laboratories to perform support function HSADL. NIV/MCC. NICED. Pune NARI TRC. NICD 99 . DRDE. Chennai RMRC.
LIST OF ABBREVIATIONS BJMC CHC CME CSSD CRI CRME DRDE ICGEB EVRC FRU HSADL IGIB IPHS IVRI KEM MRC NARI NEERI NICED NIV NRHM PRI RKS/HMC RMRC STM VCRC BJ Medical College Community Health Centre Continuing Medical Education Central Sterile and Supply Department Central Research Institute Centre for Research in Medical Entomology Defense Research and Development Establishment International Centre for Genetic Engineering and Bio-technology Enterovirus Research Centre First Referral Unit High Security Animal Diseases Laboratory Institute of Genomics and Integrative Biology Indian Public Health Standards Indian Veterinary Research Institute King Edmund Memorial Hospital Malaria Research Centre National AIDS Research Institute National Environmental Engineering Institute National Institute of Cholera and Endemic Diseases National Institute of Virology National Rural Health Mission Panchayati Raj Institution Rogi Kalyan Samiti / Hospital Management Committee Regional Medical Research Centre School of Tropical Medicines Vector Control Research Centre 100 .
References 1. of India. 2001. Indian Standard Basic Requirement for Hospital Planning. 101 . WHO. 2001 2. of Tamil Nadu. Directorate General of Health Services. Bureau of Indian Standards. (Unpublished) 3. New Delhi. Guidelines for Development and Operations. Population Census of India. Indian Public Health Standards (IPHS) for Community Health Centres. 1998. Govt. Rationalisation of Service Norms for Secondary Care Hospitals. India. Part 2 Upto 100 Beded Hospital. Ministry of Health & Family Welfare. District Health Facilities. Office of the Registrar General. 4. Govt. Health & Family Welfare Department. January. 5.
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