Indian Public Health Standards, 2022: Volume-II (Community Health Centre)

FOCUS

The Indian Public Health Standards (IPHS) are a set of specifications for the planning and maintenance of public healthcare infrastructure in the country. The standards aim to enable the public healthcare sector in providing affordable and accessible health services. Initially published in 2007 under the National Rural Health Mission, the standards were first revised in 2012.

Introduction of initiatives and programmes since 2012 such as the National Urban Health Mission in 2013, the National Health Policy in 2017 and Ayushman Bharat in 2018 necessitated further revision of the IPHS, the report notes. In addition to outlining minimum standards for public healthcare facilities and a framework for their implementation, the IPHS 2022 set forth norms to meet a ‘desirable’ level of functioning.

This revised edition of the IPHS – published by the Ministry of Health and Family Welfare, Government of India – was released on April 16, 2022. It was brought out in four volumes covering standards for Sub District Hospital and District Hospital (Volume I); Community Health Centre (Volume II); Health and Wellness Centre-Primary Health Centre (Volume III); and Health and Wellness Centre-Sub Health Centre (Volume IV).

This 176-page document includes norms for Community Health Centres (CHCs) providing secondary healthcare services. Volume II contains 8 sections: Background (Section 1); Introduction (Section 2); Objectives of IPHS for CHC/UCHC (Section 3); Types/Categories of CHC/UCHC (Section 4); Population Norms for CHCs (Section 5); General Principles of IPHS (Section 6); Criteria for IPHS Compliance (Section 7); and Service Provision (Section 8). The section on service provision covers standards and norms for infrastructure, human resources, medicines, diagnostics, equipment, quality assurance and implementation of IPHS.

    FACTOIDS

  1. The 2022 IPHS guidelines categorise rural and urban Community Health Centres (CHCs) as either First Referral Unit (FRU) CHCs which provide essential as well as specialised care, and non-FRU CHCs which provide only essential care. Rural areas can have either FRU and non-FRU CHCs but urban areas will only have FRU CHCs, the guidelines state.

  2. Non-FRU CHCs are to provide healthcare services for maternal and child health, infectious diseases, nutritional disorders, mental health conditions, non-communicable diseases, ophthalmic, oral and ENT related conditions. FRU CHCs – in addition to essential healthcare services – will also provide specialist care, operative services and facilities for blood transfusion.

  3. All CHCs at the level of block headquarters will be developed to function as Block Public Health Unit (BPHUs). BPHUs will have functional areas for clinical service delivery, public health functions, a block public health laboratory and a Health Management Information System unit. This will aid in reducing pressure on health facilities at higher levels, the guidelines state.

  4. One rural CHC in hilly and tribal areas will provide services to 80,000 people, and a rural CHC in the plains will cater to a population of 120,000 people. An urban CHC with 50 beds will be established in non-metro cities with a population of 2.5 lakhs, and one with 100 beds will be set up in metro cities with a population of 5 lakhs and above.

  5. The health facilities should adhere to the National Building Code of India. CHCs are required to have a daily provision of roughly 340 to 450 litres of water per bed. They are also expected to have one toilet for every six beds in the facility. One toilet per 100 men and two per 100 women are also required to meet outpatient needs.

  6. FRU CHCs are required to have one operation theatre functioning at all hours and one elective operation theatre. Urban FRU CHCs with 100 beds will need to have an additional operation theatre working round the clock.

  7. FRU CHCs with 30 beds are required to have 20 oxygen-supported beds and non-FRU CHCs with 30 beds will need 18 oxygen-supported beds. On the other hand, FRU CHCs with 50 beds are expected to have 26 beds with oxygen support and urban FRU CHCs with 100 beds are required to have 43 oxygen-supported beds.

  8. The IPHS list the essential specialist and healthcare staff for CHCs. These include: physician, surgeon, obstetrician and gynaecologist, paediatrician, anaesthesiologist, ophthalmologist, orthopaedic specialist, microbiologist or pathologist, physical medicine and rehabilitation specialist, a general duty medical officer, a dental medical officer and an AYUSH medical officer.

  9. The standards outline the requirement of one nurse for every six beds in inpatient departments (IPDs) and one nurse per three beds in new-born sick units (NBSUs). Each operation theatre should have two nurses per shift and two nurses in pre and post operation areas. Labour delivery and recovery (LDR) rooms have a requirement of one nurse or midwife per two LDRs and one neonatal nurse for every four LDRs.

  10. IPHS 2022 elaborate on the Rogi Kalyan Samitis (RKS) that have been established to facilitate the provision of good healthcare especially to patients from marginalized communities. RKSs aim to ensure that patients are not charged fees for health services that fall under government programmes like Surakshit Matritva Aashwasan, national programmes for tuberculosis, HIV, malaria and the prevention and control of non-communicable diseases.

  11. The IPHS emphasize on the strict compliance with statutory acts, rules and regulations like the Indian Medical Council Act, 1956; the Medical Termination of Pregnancy Act, 1971; and the Narcotic Drugs and Psychotropic Substances Act, 1985.


    Focus and Factoids by Akshita Hazarika.


    PARI Library's health archive project is part of an initiative supported by the Azim Premji University to develop a free-access repository of health-related reports relevant to rural India.

AUTHOR

Ministry of Health and Family Welfare, Government of India, New Delhi

COPYRIGHT

Ministry of Health and Family Welfare, Government of India, New Delhi

PUBLICATION DATE

16 Apr, 2022

TAGS

#healthcare #health-infrastructure #community-health-centre #health-workers #indian-public-health-standards #health-services #primary-health-centres #public-health-system

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