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IPHS Genesis NRHM aims:-  To reduce child and maternal deaths,  To stabilize population and  To ensure gender and demographic balance. Required -Restructuring the delivery mechanism for health services. NRHM proposed-  Up gradation of public health institution to achieve a level of set standards called “Indian Public Health Standards (IPHS)”. 2

Need for IPHS  Quality management  Quality Assurance  Effective, economical and accountable health care delivery system  Optimal level of services 3

objective of IPHS The overall objective of IPHS is to provide health care that is quality oriented and sensitive to the needs of the community.  The objectives of IPHS for PHCs :  To provide comprehensive primary health care to the community through the Primary Health Centres.  To achieve and maintain an acceptable standard of quality of care.  To make the services more responsive and sensitive to the needs of the community. 4

Why IPHS for Primary Health Centres?  PHC -first port of call to a qualified doctor in rural areas  Referring unit for 6 Sub-centres  Referral unit to CHCs and DH  Provides a range of curative, promotive and preventive health care services. 5

Primary Health Centres Population of 20,000-30,000  Total PHCs are functioning in the country as on March 2010 as per Rural Health Statistics Bulletin,  The number of PHCs functioning on 24x7 basis are 9107  Number of PHCs where three staff Nurses have been posted are 7629 (as on ). 6

IPHS for PHC  IPHS - Minimum resources available - Minimum functional standards  Innovations - Constitution of RKS - Involvement of PRI and - Citizens’ Charter 7

Minimum Requirements for PHC  Basis Average case load of 40 patients per doctor per day, 60% utilization of the available indoor/ observation beds (6 beds). Standards upgraded with utilization  Manpower One more medical officer (AYUSH or lady doctor) and two more staff nurses existing total staff strength of 15 in the PHC 8

Facilities at PHC Under IPHS Waiting OPD Wards Nursing station OT, MOT, Labor room Laboratory Accommodation Store Dispensing Electricity, Telephone, Water 9

Functions of PHC  Medical care (OPD services, 24 hours emergency services, Referral services, In-patient services (6 beds))  Maternal and Child Health Care Including Family Planning: ANC, Intra- natal care: (24-hour delivery services both normal and assisted), Proficient in identification and basic first aid treatment for PPH, Eclampsia, Sepsis and prompt referral, Postnatal Care, New Born care, Care of the child, Family Welfare,  Medical Termination of Pregnancies  Management of Reproductive Tract Infections/Sexually Transmitted infections  Nutrition Services (coordinated with ICDS)  Adolescent Health Care  Promotion of Safe Drinking Water and Basic Sanitation  Prevention and control of locally endemic diseases like malaria, Kala Azar, Japanese Encephalitis etc  Collection and reporting of vital events.  Health Education and Behaviour Change Communication (BCC). 10

National Health Programmes  Revised National Tuberculosis Control Programme(RNTCP)  National Leprosy Eradication Programme  Integrated Disease Surveillance Project (IDSP)  National Programme for Control of Blindness (NPCB)  National Vector Borne Disease Control Programme (NVBDCP)  National AIDS Control Programme  National Programme for Prevention and Control of Deafness (NPPCD)  National Mental Health Programme (NMHP)  National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS)  National Iodine Deficiency Disorders Control Programme (NIDDCP)  National Programme for Prevention and Control of Fluorosis (NPPCF) (In affected (Endemic Districts)  National Tobacco Control Programme (NTCP)  National Programme for Health Care of Elderly  Oral Health  Physical Medicine and Rehabilitation (PMR) Services 11

Modifications in the updated Indian Public Health Standard (IPHS) for Primary Health Centre (PHC) A. Service delivery angle: PHCs may be of two types, depending upon the delivery case load – Type A and Type B.  Type A PHC: PHC with delivery load of less than 20 deliveries in a month,  Type B PHC: PHC with delivery load of 20 or more deliveries in a month PHCs have been categorized into three types- depending upon the case load and the distance 1.Essential standards for a normal PHC without 24 by 7 services, 2. with 24 by 7nursing facilities and 3. with 24 by 7 emergency hospital care facilities 12

B. All “Minimum Assured Services” or Essential Services as envisaged in the PHC should be available, which includes routine, preventive, promotive, curative and emergency care in addition to all the national health programmes.  The services which are indicated as Desirable are for the purpose that we should aspire to achieve for this level of facility. 13

c. Infrastructure: Added i. Sign-age ii. Barrier free access, iii. Disaster prevention measures (desirable for new upcoming facilities), iv. Environmental friendly features, v. Computer facility with internet for MIS, vi. Provision new born care corner in the facility, vii. One room for counselling, viii. Waste disposal pit, ix. Cold chain logistic and generator room, x. Boundary wall, 14

D. Manpower: the new IPHS recommends the changes in manpower at PHC i. One ophthalmic assistant for every PHC ii. One Multi-Rehabilitation Worker or Community Based Rehabilitation worker (desirable) iii. One data handler iv. One cold chain and vaccine logistic assistant (desirable) E. Drugs: The newly revised list of essential drug and the drug list for obstetric care are incorporated in these guidelines. F. Equipment: The necessary equipment to deliver the assured services of the PHC should be available in adequate quantity and also be functional. G. Immunizations 15

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Non communicable disease Programme H. Standards of existing programmes were updated based on the inputs from various programme division along with new standards added for following newly launched (non communicable) disease programmes. i. National Programme for prevention and control of deafness. ii. National Mental Health Programme. iii. National Cancer control programme. iv. National program for prevention and control of Diabetes, CVD, and Strokes. v. National Iodine deficiency Disorders control program vi. National program for prevention and control of Fluorosis : in-affected Districts 17

vii. National Tobacco Control program viii. National program for health care of Elderly ix. Oral Health x. Disability, physical medicine and rehabilitation services. xi. The Integrated Counseling and Testing Centre (ICTC) has been added (Desirable) 18

I. Job Responsibility of health personals is updated. J. Reporting format under Integrated Disease Surveillance Project included K. Checklists for monitoring and facility survey updated. L. Facility based MDR (Maternal Death Review) is added as annexure and is supposed to be one of the desirable services at PHC. 19

Minimum 4 antenatal checkups and provision of complete package of services. Suggested schedule for antenatal visits -  1st visit: Within 12 weeks—preferably as soon as pregnancy is suspected— for registration of pregnancy and first antenatal check-up  2nd visit: Between 14 and 26 weeks  3rd visit: Between 28 and 34 weeks  4th visit: Between 36 weeks  Brief advice on tobacco cessation if the antenatal mother is a smoker or tobacco user and also inform about dangers of second hand smoke.  Identification and management of danger signs during pregnancy and labour.  Timely referral of such identified cases which are beyond the capacity of management.  Tracking of missed and left out ANC. 20

Postnatal Care:  Ensure post- natal care for 0 & 3rd day at the health facility both for the mother and new-born and sending direction to the ANM of the concerned area for ensuring 7th & 42 nd day post- natal home visits. 3 additional visits for a low birth weight baby (less than 2500gm.) on 14th day, 21st day and on 28 th day.  Janani Suraksha Yojana (JSY), Janani Shishu Suraksha Karyakram (JSSK) 21

Care of the child  Routine and Emergency care of sick children including Integrated management of Neonatal and Childhood Illnesses (IMNCI) strategy and inpatient care of all sick newborn and sick children.  Promotion of exclusive breast-feeding for 6 months.  Counselling on Infant and young child feeding as per Infant and Young Child Feeding (IYCF) guidelines.  Full Immunization of all infants and children against vaccine preventable diseases as per guidelines of GOI.  Vitamin A prophylaxis to the children as per national guidelines.  Prevention and control of routine childhood diseases, infections like diarrhoea, pneumonia and anaemia etc.  Management of severe acute malnutrition cases and referral of serious cases after initiation of treatment as per facility based guidelines.  Growth Monitoring 22

Job Responsibilities of Medical Officer  Curative Work  Preventive and Promotive Work  Reproductive and Child Health Programme  Universal Immunization Programme (UIP)  National Vector Borne Disease Control Programme (NVBDCP) 23

 Control of Communicable Diseases  Sexually Transmitted Diseases (STD)  School Health 24