SMCH/HCDS/21: Indian Public Health Standard II

Quadrant 1

Personal Details

Role Name Affiliation

Principal Investigator Prof. CP Mishra Department of Community Medicine,
Institute of Medical Sciences, Banaras
Hindu University, Varanasi

Paper Coordinator Prof. Najam Khalique Department of Community Medicine,

J N Medical College, AMU, Aligarh

Assistant Professor
Content Writer Dr. Uzma Eram Department of Community Medicine,
J N Medical College, AMU, Aligarh
Department of Community Medicine,
Content Reviewer Prof. M Athar Ansari J N Medical College, AMU, Aligarh

Description of Module

Items Description of Module

Subject name Social Medicine & Community Health
Paper name Health Care Delivery System
Module name/Title Indian Public Health Standard II
Module Id SMCH/HCDS/21
Pre-requisites Understanding of organization and functioning of health system.
To know the IPHS guidelines for CHC, Sub-Divisional Hospital and
Objectives District Hospital.
AYUSH, Janani Shishu Suraksha Karyakram, Management Information
Keywords System, Rogi Kalyan Samitee.

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 Indian Public Health Standards (IPHS) II: Guidelines for Community Health Centre

Introduction:

Health care delivery in India has been envisaged at three levels namely primary, secondary
and tertiary. The secondary level of health care essentially includes Community Health Centres
(CHCs), constituting the First Referral Units (FRUs) and the Sub-district and District Hospitals. The
CHCs were designed to provide referral health care for cases from the Primary Health Centres level
and for cases in need of specialist care approaching the centre directly. 4 PHCs are included under
each CHC thus catering to approximately 80,000 to 1,20,000 population.(1)CHC is a 30-bedded
hospital providing specialist care in Medicine, Obstetrics and Gynecology, Surgery, Paediatrics,
Dental and AYUSH.(2)

Learning Outcomes

Upon completion this module, the reader should be able to:

 Understand need for a proper set of guidelines for Community Health Centre (CHC)
 Enumerate objectives of IPHS for community Health Centre
 Describe essential services provided by CHC
 Identify human recourse and facilities at CHC.
 Understand the importance of standard Treatment protocol in quality assurance.
 Understand the importance of monitoring of CHC functioning

Main Text

1. Need for guidelines for Community Health Centre (CHC)

In order to ensure quality of services, the Indian Public Health Standards (IPHS) were set up for
CHCs so as to provide a optimum expert care to the community and maintain an acceptable standard
of quality of care.

2.Objectives of Indian Public Health Standards (IPHS) for CHCs

 To provide optimal expert care to the community.

 To achieve and maintain an acceptable standard of quality of care.
 To ensure that services at CHC are commensurate with universal best practices and are
responsive and sensitive to the client needs/expectations.

3.Service Delivery in CHCs(3)

 OPD Services and IPD Services: General, Medicine, Surgery, Obstetrics & Gynaecology,
Paediatrics, Dental and AYUSH services.
 Eye Specialist services (at one for every 5 CHCs).
 Emergency Services
 Laboratory Services
 National Health Programmes

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Every CHC has to provide the following services which have been indicated as Essential:

3.1. Care of Routine and Emergency Cases in Surgery

This includes dressings, incision and drainage, and surgery for Hernia, Hydrocele, Appendicitis,
Haemorrhoids, Fistula, and stitching of injuries. Handling of emergencies like Intestinal Obstruction,
Haemorrhage, etc. Other management including nasal packing, tracheostomy, foreign body removal
etc. Fracture reduction and putting splints/plaster cast. Conducting daily OPD.

3.2. Care of Routine and Emergency Cases in Medicine

Specific mention is being made of handling of all emergencies like Dengue Haemorrhagic Fever,
Cerebral Malaria and others like Dog & snake bite cases, Poisonings, Congestive Heart Failure, Left
Ventricular Failure, Pneumonias, meningoencephalitis, acute respiratory conditions, status epilepticus,
Burns, Shock, acute dehydration etc. In case of National Health Programmes, appropriate guidelines
are already available, which should be followed. Conducting daily OPD.

3.3. Maternal Health Essential Minimum

4 ANC check ups including Registration & associated services : As some antenatal cases may directly
register with CHC. Managing labour using Partograph. All referred cases of Complications in
pregnancy, labour and post-natal period must be adequately treated. Ensure post-natal care for 0 & 3rd
day at the health facility both for the mother and newborn and sending direction to the ANM of the
concerned area for ensuring 7th & 42nd day post-natal home visits. Minimum 48 hours of stay after
delivery, 3-7 days stay post delivery for managing Complications. Proficiency in identification and
Management of all complications including PPH, Eclampsia, Sepsis etc. during PNC. Essential and
Emergency Obstetric Care including surgical interventions like Caesarean Sections and other medical
interventions. Provisions of Janani Suraksha Yojana (JSY) and Janani Shishu Suraksha Karyakram
(JSSK) as per guidelines. (4)

3.4. Newborn Care and Child Health

Essential Essential Newborn Care and Resuscitation by providing Newborn Corner in the Labour
Room and Operation Theatre (where caesarean takes place). Early initiation of breast feeding with in
one hour of birth and promotion of exclusive breast-feeding for 6 months. Counselling on Infant and
young child feeding as per IYCF guidelines. Routine and emergency care of sick children including
Facility based IMNCI strategy. Full Immunization of infants and children against Vaccine Preventable
Diseases and Vitamin-A prophylaxis as per guidelines of Govt. of India. Tracking of vaccination drop
outs and left outs. Prevention and management of routine childhood diseases, infections and anaemia
etc. Management of Malnutrition cases. Provisions of Janani Shishu Suraksha Karyakram (JSSK) as
per guidelines.

3.5. Family Planning

Essential Full range of family planning services including IEC, counselling, provision of
Contraceptives, Non Scalpel Vasectomy (NSV), Laparoscopic Sterilization Services and their follow
up. Safe Abortion Services as per MTP Act and Abortion care guidelines of MOHFW, desirable MTP
Facility approved for 2nd trimester of pregnancy.

3.6. Other National Health Programmes (NHP):(5)

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All NHPs should be delivered through the CHCs. Integration with the existing programmes is vital to
provide comprehensive services. The requirements for the important NHPs are being annexed as
separate guidelines and following are the assured services under each NHP.

3.6.1.RNTCP: CHC should provide diagnostic services through the microscopy centres which are
already established in the CHCs and treatment services as per the Technical and Operational
Guidelines for Tuberculosis Control

3.6.2.HIV/AIDS Control Programme: The services to be provided at the CHC level are

a) Integrated Counselling and Testing Centre.

b) Blood Storage Centre
c) Sexually Transmitted Infection Clinic.
d) Link Anti Retroviral Therapy Centre.

3.6.3.National Vector Borne Disease Control Programme: The CHCs are to provide
diagnostic/linkages to diagnosis and treatment facilities for routine and complicated cases of Malaria,
Filaria, Dengue, Japanese Encephalitis and Kala-azar in the respective endemic zones

3.6.4.National Leprosy Eradication Programme (NLEP): The minimum services that are to be
available at the CHCs are for diagnosis and treatment of cases and complications including reactions
of leprosy along with conselling of patients on prevention of deformity and cases of uncomplicated
ulcers.

3.6.5.National Programme for Control of Blindness: The eye care services that should be made
available at the CHC are as given below.

a) Vision Testing and Refraction.

b) The early detection of visual impairment and their referral.
c) Provision of Basic services for Diagnosis and treatment of common eye diseases.
d) Surgical services including cataract by IOL implantation is desirable.
e) Syringing and probing.

One ophthalmologist is being envisaged for every 5 lakh population i.e. one ophthalmologist will
cater to 5 CHCs.

3.6.6.National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular

Diseases and Stroke (NPCDCS)

 Cancer: Screening for Cervical, Breast & Oral Cancers. Education about Breast Self
Examination and Oral Self Examination. PAP smear for Cancer Cervix.
 Diabetes, CVD and Strokes: Promotion of Healthy Dietary Habits, promotion of
physical activity, avoidance of tobacco and alcohol. Stress Management, Treatment &
Timely Referral of Diabetes Mellitus, Hypertension, IHD, CHF and assured basic
investigations.

3.6.7.National Programme for Prevention and Control of Deafness (NPPCD): The early detection
of cases of hearing impairment and deafness and referral. Provision of Basic Diagnosis and treatment
services for common ear diseases. Awareness generation through appropriate IEC strategies and
greater participation/ role of community in primary prevention and early detection of hearing
impairment/ deafness.

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3.6.8.National Mental Health Programme (NMHP) : Early identification, Diagnosis and treatment
of common mental disorders.

3.6.9.National Iodine Deficiency Disorders Control Programme.

3.6.10.National Programme for Prevention and Control of Fluorosis: In Fluorosis affected

Villages Monitoring of village/community level Fluorosis, surveillance and IEC activities.

3.6.11.National Tobacco Control Programme (NTCP)

2.6.12.National Programme for Health Care of Elderly: Geriatric Clinic twice a week.

3.6.13.Physical Medicine and Rehabilitation: Community based Rehabilitation Services

3.6.14.Oral Health: Dental care as well as root canal treatment and filling/extraction of routine and
emergency cases.

3.7. Other Services

 School Health
 Adolescent Health Care
 Blood Storage Facility
 Diagnostic Services: In addition to the lab facilities and x-ray, ECG should be made available
in the CHC.
 Referral (transport) Services.

4. Human resource and facilities at CHC

4.1.The existing staff at CHC is as follows:

PERSONNEL – Doctors NO QUALIFICATION

Medical Superintendent 1 Senior most specialist
Public Health Specialist 1 MD (PSM/Comm. Med)
General Surgeon 1 MS/DNB, (General Surgery)
Physician 1 MD/DNB, (General Medicine)
Obstetrician & Gynaecologist 1 DGO /MD/DNB
Paediatrician 1 DCH/MD (Paediatrics)/ DNB
Anaesthetist 1 MD (Anesthesia)/DNB/ DA
Dental Surgeon 1 BDS
General Duty Medical Officer 2 MBBS
Medical Officer – AYUSH 1 Graduate in AYUSH
Total 11

PERSONNEL –Staff NO PERSONNEL -Staff NO

Lab. Technician 2 Registration Clerk 2
Radiographer 1 Statistical Assistant/ Data Entry 2
Operator
Dietician 1 Account Assistant 1
Ophthalmic Assistant 1 Administrative Assistant 1
Dental Assistant 1 Dresser 1
Vaccine Assistant 1 Ward Boys/Nursing Orderly 5
OT Technician 1 Driver 1

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Multi Rehabilitation 1

TOTAL 46

4.2.Physical Infrastructure

The CHC should have 30 indoor beds with one Operation theatre, labour room, x-ray, ECG and
laboratory facility. the centre should be located at the centre of the block headquarter. should have the
facility for electricity, all weather road communication, adequate water supply, telephone.

Clinics for Various Medical Disciplines should be in separate cubicles. Waiting room for patients
should be present. The Pharmacy should be located in an area conveniently accessible from all clinics.
Separate wards for Males and Females. Labour room should be equipped with Newborn care Corner.
Residential facilities should be available for Medical Officer, nursing staff, pharmacist, laboratory
technician and other staff. Computer with Internet connection should be provided for Management
Information System (MIS) purpose.(6)

4.3.The Transport Facilities with Assured Referral Linkages

5.Quality Assurance

Standard Treatment protocol is the “Heart” of quality and cost of care. Standard treatment protocol for
all national programmes and locally common diseases should be made available at all CHCs.Routine
Monitoring by District Health Authority at least once in a month.

6. Monitoring of CHC functioning

This is important to ensure that quality is maintained and also to make changes if necessary.

Summary:

The Community Health Centres (CHCs) constitute the secondary level of health care, were designed
to provide referral as well as specialist health care to the rural population. It is manned by four
medical specialists i.e. Surgeon, Physician, Gynecologist and Pediatrician supported by 21 -Nursing
& paramedical and other staff. It has 30 in-door beds with one OT, Xray, Labour Room and
Laboratory facilities. It serves as a referral centre for 4 PHCs and also provides facilities for obstetric
care and specialist consultations.Indian Public Health Standards (IPHS) for CHCs have been
prescribed under National Rural Health Mission (NRHM) to provide optimal specialized care to the
community and achieve and maintain an acceptable standard of quality of care. The revised IPHS has
incorporated the changed protocols of the existing health programmes and new programmes and
initiatives. These standards would act as benchmarks and help monitor and improve the functioning of
the CHCs.

References:

1. Indian Public Health Standards (IPHS) for Community Health Centre (April 2005),
Directorate General of Health Services, Ministry of Health & Family Welfare, Government of
India.
2. National Rural Health Mission 2005-2012 – Reference Material (2005), Ministry of Health &
Family Welfare, Government of India.

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3. Govt. Of India(2012) Indian Public Health Standards Guidelines for Community Health
Centre, Ministry of health and family welfare, New Delhi
4. Guidelines for Ante-Natal Care and Skilled Attendance at Birth by ANMs and LHVs (2005),
Maternal Health Division, Department of Family Welfare, Ministry of Health & Family
Welfare, Government of India.
5. RCH Phase II, National Programme Implementation Plan (PIP) (2005), Ministry of Health &
Family Welfare, Government of India.
6. Bulletin on Rural Health Statistics in India (2005), Infrastructure Division, Department of
Family Welfare; Ministry of Health & Family Welfare, Government of India.

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Indian Public Health Standards (IPHS) II: Guidelines for Sub-District/Sub-Divisional Hospitals
(31 to 100 Bedded)

Introduction

Sub-district (Sub-divisional) hospitals are below the district and above the block level (CHC)
hospitals and act as First Referral Units for the Tehsil/Taluk/block population in which they are
geographically located. Specialist services are provided through these Sub district hospitals and they
receive referred cases from neighbouring CHCs, PHCs and SCs. They have an important role to play
as First Referral Units in providing emergency obstetrics care and neonatal care and help in bringing
down the Maternal Mortality and Infant Mortality. They form an important link between SC, PHC and
CHC on one end and District Hospitals on other end. It also saves the travel time for the cases needing
emergency care and reduces the workload of the district hospital. In some of the states, each district is
subdivided in to two or three sub divisions. A subdivision hospital caters to about 5-6 lakhs people. In
bigger districts the Sub-district hospitals fills the gap between the block level hospitals and the district
hospitals. There are about 1200 such hospitals in the country with a varying strength of number of
beds ranging from 31 to 100 beds or more.

Learning Outcomes

Upon completion this module, the reader will be able to:

 Understand need for a proper set of guidelines for Sub-District/Sub-Divisional Hospitals

 Enumerate objectives of IPHS for Sub-District/Sub-Divisional Hospitals
 Describe essential services provided by Sub-District/Sub-Divisional Hospitals
 List Physical Infrastructure of Sub-District/Sub-Divisional Hospitals
 Mention human resources requirement for Sub-District/Sub-Divisional Hospitals
 Understand the importance of quality assurance in service delivery
 Understand the importance of record maintenance.
 Enumerate the functions of Rogi Kalyan Samities (RKS)/ Hospital Management Committee
(HMC)

Main Text

1. Need for guidelines for Sub-District/Sub-Divisional Hospitals

The Government of India is strongly committed to strengthen the health sector for improving the
availability, accessibility of affordable quality health services to the people. In order to improve the
quality and accountability of health services a set of standards need to be there for all health service
institutions including Sub-district hospitals.

The Bureau of Indian standards (BIS) has developed standards for hospitals services for 30 bedded
and 100 bedded hospitals. However, these standards are considered very resource intensive and lack
the processes to ensure community involvement, accountability, the hospital management, and
citizens’ charter etc. peculiar to the public hospitals.(1)

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2.Objectives of Indian Public Health Standards (IPHS) for Sub-district Hospitals

 To provide comprehensive secondary health care to the community through the Sub-district
Hospital.
 To achieve and maintain an acceptable standard of quality of care.
 To make the services more responsive and sensitive to the needs of the people of the Sub-
district/Sub-division and act as the First Referral Unit (FRU.

3. Services Available(2)

 General Medicine
 General Surgery
 Accidents and emergency services including poisoning and trauma Care
 General Orthopaedic
 Obstetrics & Gynaecology
 FP services like Counseling, Tubectomy, NSV, IUCD, OCPs, Condoms, eCPs, Follow up
services
 Paediatrics including Neonatalogy and Immunization
 Anaesthesia
 Ophthalmology
 Ent
 Radiology including Imaging services
 Dental care
 Dot centre Designated Microscopy centre
 AYUSH
 Public Health Management
 Integrated Counseling and Testing Centre
 Disability Certification
 Services provided under other National Health Programmes including lifestyle disorders
 Laboratory services, X-ray, Ultrasound, ECG, Blood transfusion and storage
 Services under Various National Health and Family Welfare Programmes
 Epidemic Control and Disaster Preparedness
 Patient Safety and infection control

4. Physical Infrastructure(3)

Size of the hospital The size of a Sub-district hospital is a function of the hospital bed requirement
which in turn is a function of the size of the population serve. Average size of the Subdistrict is taken
as 2,50,000 populations which should have 50-100 beds. The location may be near the residential
area. It must be serviced by public utilities: Water, sewage and storm-water disposal, electricity, gas
and telephone. It should have

1. Ambulatory Care Area (OPD) including waiting spaces, Clinics, nursing services
2. Diagnostic Services: Imaging, Clinical Laboratory, Blood Storage Unit

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 3. Intermediate Care Area (IPD): separate for male and females
4. Pharmacy (Dispensary)
5. ICU with 4 beds equipped with High end monitor, Ventilator and O2 therapy devices
6. Accidents and emergency services: 24x7
7. Operation Theatre
8. Delivery Suite Unit with Post Partum unit
9. Hospital services including Management Information System (MIS), Central Sterile Supply
Department (CSSD), Hospital Laundry, Medical and General store, Mortuary, engineering
services, Residential Quarters, Parking,

5.Human resources

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6. Quality Assurance in Service Delivery

Quality of service should be maintained at all levels. Standard treatment protocols for locally common
diseases and diseases covered under all national programmes should be made available at all Sub-
district hospitals. All the efforts that are being made to improve hardware i.e. infrastructure and

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software i.e. human resources are necessary but not sufficient. These need to be guided by standard
treatment protocols and Quality Assurance in Service Delivery.

7. Record Maintenance

Computers have to be used for accurate record maintenance and with connectivity to the District
Health Systems, State and National Level.

8. Rogi Kalyan Samities (RKS)/ Hospital Management Committee (HMC)

Each Sub-district hospital should have a Rogi Kalyan Samiti/Hospital Management Committee with
involvement of PRIs and other stakeholders. These RKS should be registered bodies with an account
for itself in the local bank. The RKS/HMC will have authority to raise their own resources by
charging user fees and by any other means and utilize the same for the improvement of service
rendered by the Sub-district Hospital.

References:

1. Indian Standard Basic Requirement for Hospital Planning; Part 2 Upto 100 Bedded Hospital,
Bureau of Indian Standards, New Delhi, January, 2001.
2. Govt. Of India(2012) Indian Public Health Standards Guidelines for Sub-District/Sub-
Divisional Hospitals (31 to 100 Bedded), Ministry of health and family welfare, New Delhi
3. Bulletin on Rural Health Statistics in India (2005), Infrastructure Division, Department of
Family Welfare; Ministry of Health & Family Welfare, Government of India.

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 Indian Public Health Standards (IPHS): Guidelines for District Hospitals (101 to 500 Bedded)

Introduction

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, delivery of healthcare and 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 Centres and Sub-centres. (1)

Learning Outcomes

Upon completion this module, the reader will be able to:

 Understand need for a proper set of guidelines for District Hospitals.

 Enumerate objectives of IPHS for District Hospitals.
 State grading of District Hospitals.
 Describe essential services provided by District Hospitals.
 Lists physical Infrastructure
 Mention Manpower Requirements
 Understand the importance of Quality Assurance and Quality Control of Processes in service
Delivery
 Enumerate functions of Rogi Kalyan Samities (RKS)/ Hospital Management Committee
(HMC)

Main Text

1. Need for guidelines for District Hospitals.

The district hospitals cater 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 organizations.

The Bureau of Indian standards (BIS) has developed standards for hospitals services for 500 bedded
hospitals. (2) However, these standards are considered very resource intensive and lack the processes to
ensure community involvement, accountability, the hospital management, and citizens’ charter etc.
peculiar to the public hospitals.

In this context a set of standards are being recommended for district hospitals called as Indian Public
Health Standards (IPHS) for District Hospitals, which will be discussed here.

2. Objectives of Indian Public Health Standards (IPHS) for District Hospitals

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  To provide comprehensive secondary health care to the community.
 To achieve and maintain an acceptable standard of quality of care.
 To make the services more responsive and sensitive to the needs of the people.

3. Grading of District Hospitals

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 it serves. Depending upon this district hospitals are of fllowing types:

 Grade I: District hospitals norms for 500 beds

 Grade II: District Hospital Norms for 400 beds
 Grade III: District hospitals norms for 300 beds
 Grade IV: District hospitals norms for 200 beds
 Grade V: District hospitals norms for 100 beds

4. Services that a District Hospital is expected to provide should cover:(3)

 General Medicine
 General Surgery
 Obstetric & Gynaecology Services
 Family Planing services like Counseling, Tubectomy (Both Laparoscopic and Minilap), NSV,
IUCD, OCPs, Condoms, ECPs, Follow up services
 Paediatrics including Neonatology and Immunization
 Emergency (Accident & other emergency)
 Critical care/Intensive Care (ICU)
 Anaesthesia
 Ophthalmology
 Otorhinolaryngology (ENT)
 Orthopaedics
 Radiology including Imaging
 Psychiatry
 Geriatric Services (10 bedded ward)
 Health promotion and Counseling Services
 Dental care
 District Public Health Unit
 Dot centre
 AYUSH
 Integrated Counseling and Testing Centre; STI Clinic; ART Centre
 Blood Bank
 Disability Certification Services
 Services under Other National Health Programmes

Diagnostic and other Paraclinical services regarding

 Laboratory services including Pathology and Microbiology

 Designated Microscopy centre
 x-Ray, Sonography
 eCG
 Endoscopy

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  Blood Bank and Transfusion Services
 Physiotherapy
 Drugs and Pharmacy

Ancillary and support services

 Medico-legal/post mortem
 Ambulance services
 Waste management including Biomedical Waste
 Ware housing/central store
 Electric Supply (power generation and stabilization)
 Water supply (plumbing) Heating, ventilation and air-conditioning transport
 Communication
 CSSD - Sterilization and Disinfection
 Horticulture (Landscaping)
 Refrigeration
 Referral services

5. Physical Infrastructure(4)

Size and Location: 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 it serves. It should be centrally located in an easily
accessible area. The area chosen should have facilities for electricity, all weather road
communication, adequate water supply and telephone.

Departmental Lay Out: The district hospital should have

1. Outdoor Patient Department (OPD)

2. Imaging
3. Clinical Laboratory
4. Blood Bank
5. Indoor Patient Department
6. Pharmacy (Dispensary)
7. Intensive Care Unit and High Dependency Ward
8. Accident and Emergency Services
9. Operation Theatre
10. Delivery Suite Unit
11. Physical Medicine and Rehabilitation

Hospital Administrative and Support Services

1. Management Information System (MIS)

2. Hospital Kitchen
3. Central Sterile Supply Department
4. Medical and General Stores
5. Mortuary
6. Engineering Services
7. Waste Disposal System
8. Hospital Transport Services

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Residential: Residential facilities should be available for Medical Officer, nursing staff, pharmacist,
laboratory technician and other staff. Computer with Internet connection should be provided for
Management Information System (MIS) purpose.

6.Manpower Requirements

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7.Quality Assurance and Quality Control of Processes and service Delivery

Quality of service should be ensured at all levels. Standard treatment protocols for locally common
diseases and diseases covered under all national programmes should be made available at all district

18
hospitals. Hospital should develop and implement standard operating procedures for the critical
administrative and clinical processes. Relevant work instructions and clinical protocols should be
displayed at point of use. For proper monitoring and delivery of services District hospitals would
develop and implement checklists for various processes.

8.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.

Summary

District Hospital is a hospital at the secondary referral level responsible for a district of a defined
geographical area containing a defined population. Its objective is to provide comprehensive
secondary health care services to the people in the district at an acceptable level of quality and being
responsive and sensitive to the needs of people and referring centres. Every district is expected to
have a district hospital. As the population of a district is variable, the bed strength also varies from 75
to 500 beds depending on the size, terrain and population of the district. Standards are the main driver
for continuous improvements in quality. Currently the IPHS for DHs has been revised keeping in
view the resources available with respect to functional requirements such as building, manpower,
instruments and equipment, drugs and other facilities etc. The revised IPHS has incorporated the
changed protocols of the existing health programmes and new programmes and initiatives. These
standards would also help monitor and improve the functioning of the District Hospitals

References:

1. District Health Facilities, Guidelines for Development and Operations; WHO; 1998.
2. Indian Standard Basic Requirement for Hospital Planning; Part 2 100-500 Beded Hospital,
Bureau of Indian Standards, New Delhi, January, 2001.
3. Govt. Of India(2012) Indian Public Health Standards Guidelines for District Hospitals,
Ministry of Health and Family Welfare, New Delhi.
4. Bulletin on Rural Health Statistics in India (2005), Infrastructure Division, Department of
Family Welfare; Ministry of Health & Family Welfare, Government of India.

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