Indian Public Health Standards

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Indian Public Health Standards:

Indian Public Health Standards State Institute of Health & Family Welfare, Jaipur

Existing Standards :

Existing Standards Hospital Standards by Bureau of Indian Standards (BIS) BIS Standards considered very resource intensive in current scenario No such standards for primary health care institutions 2 SIHFW: an ISO 9001:2008 certified Institution

Standards in IPHS………..:

Standards in IPHS……….. Describe a level of quality that health care facilities are expected to meet . Setting standards is a dynamic process Revision of standards will occur as and when the facilities achieve a minimum functional grade. Standards are also flexible , to be applied keeping in view the needs of the States. 3 SIHFW: an ISO 9001:2008 certified Institution

Infrastructure: Number v/s Functionality:

Infrastructure: Number v/s Functionality March 2008, Impressive Numbers 146036 SCs, 23458 PHCs, and 4276 CHCs . Functionality ? For quality, equity& accountability Infrastructure Manpower Logistics Drugs Equipment 4 SIHFW: an ISO 9001:2008 certified Institution

IPHS Genesis:

NRHM aims to reduce child and maternal deaths, stabilize population and ensure gender and demographic balance . Required - restructuring the delivery mechanism for health services . NRHM proposed- up gradation of public health institutions to achieve a level of set standards called “ Indian Public Health Standards (IPHS)”. IPHS Genesis 5 SIHFW: an ISO 9001:2008 certified Institution

Need for IPHS:

Need for IPHS Quality management Quality Assurance Effective, economical and accountable health care delivery system Optimal level of services 6 SIHFW: an ISO 9001:2008 certified Institution

Slide 7:

Minimum resources available at the facilities. Minimum functional level of institutions Space, Building, Manpower, Instruments, Equipments, Drugs Standards for periodic monitoring at State and Central Governments, and PRIs -how many are conforming to IPHS standards. Considerations in setting IPHS 7 SIHFW: an ISO 9001:2008 certified Institution

Process of Formulating IPHS :

Process of Formulating IPHS Constitution of Expert Committee under DGHS Discussion with members (ministry officials, State Governments representatives, academicians, management experts, economists, donor agencies, public health professionals, and other organizations such as NGOs etc. Circulation of draft IPHS Putting drafts standard on website Finalization of IPHS for public health institutions 8 SIHFW: an ISO 9001:2008 certified Institution

Why IPHS for Sub-Centres….:

Most peripheral and first contact point Services of acceptable standards to the people, through certain available guidelines. First step is to lay down norms and standards for Sub Centres. Why IPHS for Sub-Centres…. 9 SIHFW: an ISO 9001:2008 certified Institution

IPHS for Sub-Centres…:

IPHS for Sub-Centres… 10 SIHFW: an ISO 9001:2008 certified Institution

Location:

Location Not too close to an existing sub centre/PHC As far as possible, no person travels more than 3 km to reach the sub-centre. 11 SIHFW: an ISO 9001:2008 certified Institution

Manpower:

Manpower HW(F) HW(M) Additional HW(F) 12 SIHFW: an ISO 9001:2008 certified Institution

Drugs:

Drugs Elementary drugs for minor ailments such as ARI Diarrhea Fever Worm infestation 13 SIHFW: an ISO 9001:2008 certified Institution

Services:

Services All “Assured Services” (preventive, promotive , few curative and referral services and NHPs). Full immunization and Vitamin A prophylaxis Essential newborn care Antenatal, natal and postnatal care Prevention of malnutrition and common childhood diseases Family planning services Counseling. Community needs assessment Minimum laboratory services Hemoglobin Urine for albumin, sugar Referral to PHC for blood grouping 14 SIHFW: an ISO 9001:2008 certified Institution

Other services:

Other services Malaria prophylaxis JSY ARSH and school health services VHND Referral services AYUSH Training of TBAs, ASHA/Community Health Volunteers Recording and reporting of vital events Syndromic surveillance done and reported weekly to PHC Water Quality Monitoring & Disinfection of water sources 15 SIHFW: an ISO 9001:2008 certified Institution

Other Norms for SC…:

Residential Accommodation especially for the ANMs Maintenance of equipment -through preventive maintenance or prompt repair of non-functional equipment to ensure uninterrupted delivery of services , by making use of the untied funds Potable water for patients and staff and water Wherever possible , uninterrupted power supply Other Norms for SC… 16 SIHFW: an ISO 9001:2008 certified Institution

SC also to ensure:

Availability of model citizen’s charter A grievance redressal mechanism, Constitution of VHSC Involvement of PRI SC also to ensure 17 SIHFW: an ISO 9001:2008 certified Institution

Funding, Monitoring & Evaluation:

Funding, Monitoring & Evaluation Assistance from Ministry of Health & FW, GOI Untied funds - currently Rs.10,000 per SC under NRHM ) One HA (Female ) and one HA (Male ) located at the PHC are entrusted with the task of supervision of all the Sub-centres under a PHC. 18 SIHFW: an ISO 9001:2008 certified Institution

Primary Health Centres:

Primary Health Centres Population of 20,000-30,000 4-6 indoor beds Link between SC and CHC 23458 (March 2008), Rajasthan: 10742 (March, ‘09) 19 SIHFW: an ISO 9001:2008 certified Institution

Why IPHS for Primary Health Centres.. :

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. 20 SIHFW: an ISO 9001:2008 certified Institution

IPHS for PHC:

IPHS for PHC IPHS Minimum resources available Minimum functional standards Innovations Constitution of RMRS Involvement of PRI and Citizens ’ Charter 21 SIHFW: an ISO 9001:2008 certified Institution

24x7 PHC should …..:

24x7 PHC should ….. Provide 24-hour delivery services, both normal and assisted Provide Obstetric First Aid and Referrals to First Referral Units (FRUs )/other hospitals, for high risk pregnancy cases beyond the capability of Medical Officer, PHC. Provide 24 hours emergency services for management of injuries and accidents. Provide emergency care of sick children 22 SIHFW: an ISO 9001:2008 certified Institution

Minimum requirements for PHC:

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 23 SIHFW: an ISO 9001:2008 certified Institution

Proposed Manpower at PHC:

Proposed Manpower at PHC Existing Recommended Medical Officer 1 2(one AYUSH or LMO) Pharmacist 1 1 Nurse-midwife (Staff 1 3 (for 24-hour PHCs) (Nurse) (2 may be contractual) Health workers (F) 1 1 Health Educator 1 1 Health Asstt . (M&F) 2 2 Clerks 2 2 Laboratory Technician 1 1 Driver 1 Optional/vehicles out-sourced . Class IV 4 4 Total 15 17/18 24 SIHFW: an ISO 9001:2008 certified Institution

Services at PHC:

Services at PHC MCH 24 X 7 Delivery & New born care ARSH Immunization NH Programs Permanent FP methods-TT/ vasectomy / NSV MTP using MV technique (if trained personnel and facility exists) common eye diseases and Refraction Services School Health Nutrition (coordinated through ICDS) Selected surgeries 25 SIHFW: an ISO 9001:2008 certified Institution

Other services:

Other services Referral transport ISM based treatment through AYUSH doctor Laboratory Malaria TB STI/RTI Enteric Routine –Urine, stool, blood IDSP Training Waste Mgt. Laundry (outsourced) 26 SIHFW: an ISO 9001:2008 certified Institution

Facilities at PHC under IPHS:

Facilities at PHC under IPHS Waiting OPD Wards Nursing station OT, MOT, Labor room Laboratory Accommodation Store Dispensing Electricity, Telephone, Water 27 SIHFW: an ISO 9001:2008 certified Institution

Monitoring and Supervision:

MO to SC once a month Health Assistants Male and LHV to SC once a week Internal Mechanism : Record maintenance, checking and supportive supervision External Mechanism : Monitoring through the PRI / Village Health Committee / RMRS (as per guidelines of State Government). Charter of Patients’ Rights available at PHC RMRS 28 SIHFW: an ISO 9001:2008 certified Institution Monitoring and Supervision

IPHS for CHCs: Objectives:

IPHS for CHCs: Objectives Provide optimal expert care to the community Achieve and maintain an acceptable standard of quality of care Make the services more responsive and sensitive to the needs of the community 29 SIHFW: an ISO 9001:2008 certified Institution

CHC/FRU:

CHC/FRU 30-bedded hospital located at the block headquarter, Secondary level of health care Specialist care Medicine Surgery Ob & Gy . Pediatrics Anesthesia Public health 80,000 -1,20,000 pop. Catchment-4 PHCs Referral point for PHCs (FRU for obstetric emergencies 30 SIHFW: an ISO 9001:2008 certified Institution

Infrastructure for IPHS CHC:

Infrastructure for IPHS CHC Assured services at CHC Specialist care Medicine Surgery Ob & Gy . Pediatrics Blood storage unit Operation theatre, labor room, X-ray laboratory, ECG . Referral transport NH Programs 31 SIHFW: an ISO 9001:2008 certified Institution

Infrastructure for IPHS CHC:

Entrance Zone and OPDs Admin. zone Emergency Room/Casualty Treatment room (MOT , Injection / dressing room) Wards- male and female with space between beds Other Services CSSD Electricity with Back-up, Water, Telephones Laundry & Waste mgt. Separate toilets for male & female Maintenance and sanitation facility Computerization for record and surveillance. Infrastructure for IPHS CHC 32 SIHFW: an ISO 9001:2008 certified Institution

Manpower at IPHS CHC:

Manpower at IPHS CHC Regular Surger y , Medicine , Obstetrics and Gynecology and Pediatrics. Contractual Anesthetist and Public Health Program Manager Support manpower Public health Nurse ANM in addition to the existing staff. Ophthalmic Assistant Recommended One Ophthalmologist for every 5 CHCs One Dental Surgeon, 6 GDMOs, One AYUSH specialist and One AYUSH general doctor 33 SIHFW: an ISO 9001:2008 certified Institution

Specialists at CHC under IPHS:

Specialists at CHC under IPHS Personnel Minimum requirement Proposed General Surgeon 1 1 Physician 1 1 Ob. & Gy . 1 1 Pediatrics 1 1 Anesthetist - 1 Public Hlth . Health Manager . - 1 Eye surgeon - 1 Total 4 6/7 34 SIHFW: an ISO 9001:2008 certified Institution

Total Manpower for IPHS CHC:

Total Manpower for IPHS CHC Block Health Officer Physician Surgeon Ob. & Gy . Paediatrician Anesthetist Public Health Manager Dental Surgeon Ophthalmologist (one for 5 CHCs) 6 GDMO (2 LMOs) 1 AYUSH specialist 1 AYUSH GDMO Support Manpower (total 64) includes: 19 S/N, 1 PHN, 1ANM and 1 Ophthalmic Assistant 35 SIHFW: an ISO 9001:2008 certified Institution

Ensuring Accountability and Quality :

Ensuring Accountability and Quality Mandatory RMRS (RKS) A grievance redressal mechanism under supervision of RMRS (RKS) Social audit by involvement of the community through RMRS (RKS) is recommended. Charter of Patients’ Rights displayed prominently at the entrance. Standard Operating Procedures and Standard Treatment Protocols External monitoring through PRIs, & internal monitoring 36 SIHFW: an ISO 9001:2008 certified Institution

IPHS for Sub-divisional /Sub-district Hospitals:

IPHS for Sub-divisional /Sub-district Hospitals 5-6 lakhs people . About 1200 such hospitals in the country with number of beds ranging from 50 to 100 beds or more. Two IPHS Standards for SDH have been prepared according to bed strength - for 31-50 beds and 51-100 beds . 37 SIHFW: an ISO 9001:2008 certified Institution

Need for IPHS for SDH:

First Referral Units for specialist services from neighboring Community Health Centres. A Sub-district/Sub-divisional Hospital provides emergency obstetric and neo-natal care It also saves travel time to the DH ,reduces the workload of the district hospital. Need for IPHS for SDH 38 SIHFW: an ISO 9001:2008 certified Institution

Minimum Assured Services at SDH :

Minimum Assured Services at SDH OPD, indoor and emergency services Consultation General Medicine General Surgery Obstetric & Gynecology Pediatrics Anesthesia Orthopedics ENT Radiologist and sonologist Ophthalmology Community Health Skin & VD, RTI/STI Dental care AYUSH 39 SIHFW: an ISO 9001:2008 certified Institution

Other services at SDH:

Other services at SDH Lab, X-ray, Ultrasound, ECG Blood transfusion and storage, Physiotherapy Medico legal/postmortem* Ambulance services Dietary services Laundry services Security services Housekeeping Inventory Mgt. Waste management 40 SIHFW: an ISO 9001:2008 certified Institution

IPHS for District Hospitals:

IPHS for District Hospitals Administrative unit Pop. 2-5 million 617 districts (Rajasthan: 33) 41 SIHFW: an ISO 9001:2008 certified Institution

IPHS for DHs: objectives :

IPHS for DHs: objectives Provide comprehensive secondary health care (specialist and referral services). Achieve and maintain an acceptable standard of quality of care. Make services more responsive and sensitive to the needs of the people 42 SIHFW: an ISO 9001:2008 certified Institution

DH and IPHS:

DH and IPHS Services depend on size of bed compliment Norms vary based on bed compliment Norms developed for 101-200 beds , 201-300 beds and 301-500 beds . 43 SIHFW: an ISO 9001:2008 certified Institution

Minimum Functional standards for DH: Areas :

Minimum Functional standards for DH: Areas Physical infrastructure, Manpower, Diagnostic and investigation facilities, Equipment , Drugs and Other supportive services 44 SIHFW: an ISO 9001:2008 certified Institution

Thank You For more details log on to www. sihfwrajasthan.com or contact : Director-SIHFW on [email protected] :

Thank You For more details log on to www. sihfwrajasthan.com or contact : Director-SIHFW on [email protected]

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