IPHS Guidelines for Primary Health Centres, 2012.

Indian Public Health Standards (IPHS)Guidelines forPrimary Health CentresRevised 2012Directorate General of Health ServicesMinistry of Health & Family WelfareGovernment of India

ContentsMessageForewordPrefaceAcknowledgementsvviviiviiiExecutive Summary 1Indian Public Health Standards for Primary Health Centres 3Introduction........................................................................................................................................................ 3Objectives of Indian Public Health Standards (IPHS) for Primary Health Centres (PHC).................................... 4Services at the Primary Health Centre for Meeting the IPHS............................................................................. 4Infrastructure ................................................................................................................................................... 12Manpower........................................................................................................................................................ 16Drugs ............................................................................................................................................................... 17The Transport Facilities with Assured Referral Linkages .................................................................................. 17Laundry Services............................................................................................................................................... 17Dietary Facilities for Indoor Patients ................................................................................................................ 17Waste Management at PHC Level .................................................................................................................... 17Quality Assurance............................................................................................................................................. 17Monitoring of PHC Functioning ....................................................................................................................... 18Accountability .................................................................................................................................................. 18Statuary and Regulatory Compliance .............................................................................................................. 18AnnexuresAnnexure 1:National Immunization Schedule for Infants, Children and Pregnant Women..................19Annexure 2: Layout of PHC.................................................................................................................... 21Annexure 2A: Layout of Operation Theatre ............................................................................................ 22

Annexure 3:List of Suggested Equipment and Furniture Including Reagents and Diagnostic Kits........23Annexure 3A: Newborn Corner in Labour Room/OT................................................................................ 27Annexure 4: Essential Drugs for PHC..................................................................................................... 29Annexure 5: Universal Precautions ....................................................................................................... 45Annexure 6: Check List for Monitoring by External Mechanism ........................................................... 46Annexure 7: Job Responsibilities of Medical Officer and Other Staff at PHC ........................................ 49Annexure 8: Charter of Patients’ Rights for Primary Health Centre....................................................... 63Annexure 9: Proforma for Facility Survey for PHC on IPHS ................................................................... 64Annexure 10: Facility Based Maternal Death Review Form..................................................................... 73Annexure 11: Integrated Disease Surveillance Project Formats ............................................................. 77Annexure 11A: Form P Weekly Reporting Format - IDSP........................................................................... 78Annexure 11B: Form L Weekly Reporting Format - IDSP............................................................................ 79Annexure 11C: Format for instantaneous reporting of Early Warning Signals/Outbreaksas soon as it is detected ..................................................................................................... 80Annexure 12: List of Statutory and Regulatory Compliances................................................................... 81Annexure 13: List of Abbreviations.......................................................................................................... 82References 84Members of Task Force for Revision of IPHS 85

MESSAGENational Rural Health Mission (NRHM) was launched to strengthen the Rural Public HealthSystem and has since met many hopes and expectations. The Mission seeks to provide effectivehealth care to the rural populace throughout the country with special focus on the States andUnion Territories (UTs), which have weak public health indicators and/or weak infrastructure.Towards this end, the Indian Public Health Standards (IPHS) for Sub-Centres, Primary HealthCentres (PHCs), Community Health Centres (CHCs), Sub-District and District Hospitals werepublished in January/February, 2007 and have been used as the reference point for public healthcare infrastructure planning and up-gradation in the States and UTs. IPHS are a set of uniform standards envisagedto improve the quality of health care delivery in the country.The IPHS documents have been revised keeping in view the changing protocols of the existing programmes andintroduction of new programmes especially for Non-Communicable Diseases. Flexibility is allowed to suit thediverse needs of the states and regions.Our country has a large number of public health institutions in rural areas from sub-centres at the most peripherallevel to the district hospitals at the district level. It is highly desirable that they should be fully functional and deliverquality care. I strongly believe that these IPHS guidelines will act as the main driver for continuous improvement inquality and serve as the bench mark for assessing the functional status of health facilities.I call upon all States and UTs to adopt these IPHS guidelines for strengthening the Public Health Care Institutionsand put in their best efforts to achieve high quality of health care for our people across the country.New Delhi23.11.2011(Ghulam Nabi Azad)

ForewordAs envisaged under National Rural Health Mission (NRHM), the public health institutions in ruralareas are to be upgraded from its present level to a level of a set of standards called “IndianPublic Health Standards (IPHS)”. The Indian Public Health Standards are the benchmarks forquality expected from various components of Public health care organizations and may be usedfor assessing performance of health care delivery system.As early as 1951, the Primary Health Centres (PHCs) were established as an integral part ofcommunity development programme. Since then lot of changes have taken place. Currently thePHC covers a population of 20,000-30,000 (depending upon the geographical location) and isoccupying a place between a Sub-Centre at the most peripheral level and Community Health Centre at blocklevel.As setting standards is a dynamic process, need was felt to update the IPHS keeping in view the changing protocolsof existing National Health Programmes, introduction of new programmes especially for Non-CommunicableDiseases and prevailing epidemiological situation in the country. The IPHS for PHC has been revised by a taskforce comprising of various stakeholders under the Chairmanship of Director General of Health Services. Subjectexperts, NGOs, State representatives and health workers working in the health facilities have also been consultedat different stages of revision.The newly revised IPHS for PHC has considered the services, infrastructure, manpower, equipment and drugs intotwo categories of Essential (minimum assured services) and Desirable (the ideal level services which the states andUnion Territories (UTs) shall try to achieve). PHCs have been categorized into two categories depending upon thecase load of deliveries. This has been done to ensure optimal utilization of resources. Sates/UTs are expected tocategorize the PHCs and provide infrastructure according to the laid down guidelines in this document.I am sure this document will help the States Governments and Panchayati Raj Institutions to monitor effectively asto how many of the PHCs are conforming to IPHS and take measures to upgrade the remaining to desired level.I would like to acknowledge the efforts put by the Directorate General of Health Services in preparing the guidelines.Comments and suggestions for further improvement are most welcome.(P.K.Pradhan)

PrefaceStandards are a means of describing a level of quality that the health care organizations areexpected to meet or aspire to achieve. For the first time under National Rural Health Mission(NRHM), an effort had been made to develop Indian Public Health Standards (IPHS) for a vastnetwork of peripheral public health institutions in the country and the first set of standards wasreleased in early 2007.A Primary Health Centre (PHC) serves as a first port of call to a qualified doctor in the publichealth sector in rural areas providing a range of curative, promotive and preventive health care.A PHC providing 24-hour services and with appropriate linkages, plays an important role in increasing institutionaldeliveries thereby helping to reduce maternal mortality and infant mortality.The IPHS for Primary Health Centres has been revised keeping in view the resources available with respect tofunctional requirements of Primary Health Centre with minimum standards for such as building, manpower,instruments and equipment, drugs and other facilities etc. The revised IPHS has also incorporated the changedprotocols of the existing health programmes and new programmes and initiatives especially in respect of Non-Communicable Diseases. The task of revision was completed as a result of consultations held over many monthswith task force members, programme officers, Regional Directors of Health and Family Welfare, experts, healthfunctionaries, representatives of Non-Government organizations, development partners and State/Union TerritoryGovernment representatives after reaching a consensus. The contribution of all of them is well appreciated. Severalinnovative approaches have been incorporated in the management process to ensure community and PanchayatiRaj Institutions’ involvement and accountability.From Service delivery angle, PHCs may be of two types depending upon the delivery case load – Type A and TypeB. The PHCs with delivery case load of less than 20 deliveries in a month will be of Type A and those with deliverycase load of 20 or more in a month will be of Type B. This has been done to ensure optimal utilization of manpowerand resources.Setting standards is a dynamic process and this document is not an end in itself. Further revision of the standardsshall be undertaken as and when the Primary Health Centres will achieve a minimum functional grade. It is hopedthat this document will be of immense help to the States/Union Territories and other stakeholders in bringing upPrimary Health Centres to the level of Indian Public Health Standards.(Dr. Jagdish Prasad)

AcknowledgementsThe revision of the existing guidelines for Indian Public Health Standards (IPHS) for different levels of Health Facilitiesfrom Sub-Centre to District Hospitals was started with the formation of a Task Force under the Chairmanship ofDirector General of Health Services (DGHS). This revised document is a concerted effort made possible by the advice,assistance and cooperation of many individuals, Institutions, government and non-government organizations.I gratefully acknowledge the valuable contribution of all the members of the Task Force constituted to revise IndianPublic Health Standards (IPHS). The list of Task Force Members is given at the end of this document. I am thankfulto them individually and collectively.I am truly grateful to Mr. P.K. Pradhan, Secretary (H & FW) for the active encouragement received from him.I also gratefully acknowledge the initiative, inspiration and valuable guidance provided byDr. Jagdish Prasad, Director General of Health Services, Ministry of Health and Family Welfare, Government ofIndia. He has also extensively reviewed the document while it was being developed.I sincerely acknowledge the contribution of Dr. R.K Srivastava, Ex- DGHS and Chairman of Task Force constituted forrevision of IPHS who has extensively reviewed the document at every step, while it was being developed.I sincerely thank Miss K. Sujatha Rao, Ex-Secretary (H&FW) for her valuable contribution and guidancein rationalizing the manpower requirements for Health Facilities. I would specially like to thankMs. Anuradha Gupta, Additional Secretary and Mission Director NRHM, Mr. Manoj Jhalani Joint Secretary(RCH), Mr. Amit Mohan Prasad, Joint Secretary (NRHM), Dr. R.S. Shukla Joint Secratary (PH), Dr. ShivLal, former Special DG and Advisor (Public Health), Dr. Ashok Kumar, DDG Dr. N.S. Dharm Shaktu, DDG,Dr. C.M. Agrawal DDG, Dr. P.L. Joshi former DDG, experts from NHSRC namely Dr. T. Sunderraman,Dr. J.N. Sahai, Dr. P. Padmanabhan, Dr. J.N. Srivastava, experts from NCDC Dr. R.L. Ichhpujani, Dr. A.C. Dhariwal,Dr. Shashi Khare, Dr. S.D. Khaparde, Dr. Sunil Gupta, Dr. R.S. Gupta, experts from NIHFW Prof. B. Deoki Nandan,Prof. K. Kalaivani, Prof. M. Bhattacharya, Prof. J.K. Dass, Dr. Vivekadish, programme officers from Ministry ofHealth Family welfare and Directorate General of Health Services especially Dr. Himanshu Bhushan, Dr. ManishaMalhotra, Dr. B. Kishore, Dr. Jagdish Kaur, Dr. D.M. Thorat and Dr. Sajjan Singh Yadav for their valuable contributionand guidance in formulating the IPHS documents.I am grateful to the following State level administrators, health functionaries working in the health facilities andNGO representatives who shared their field experience and greatly contributed in the revision work; namely:Dr. Manohar Agnani, MD NRHM from Government of MP Dr. Junaid Rehman from Government of Kerala.viiiIndian Public Health Standards (IPHS) Guidelines for Primary Health Centres

Dr. Kamlesh Kumar Jain from Government of Chhattisgarh.Dr. Y.K. Gupta, Dr. Kiran Malik, Dr. Avdesh Kumar, Dr. Naresh Kumar, Smt. Prabha Devi Panwar, ANM andMs. Pushpa Devi, ANM from Government of Uttar Pradesh.Dr. P.N.S. Chauhan, Dr. Jayashree Chandra, Dr. S.A.S. Kazmi, Dr. L.B. Asthana, Dr. R.P. Maheshwari, Dr. (Mrs.) PushpaGupta, Dr. Ramesh Makwana and Dr. (Mrs.) Bhusan Shrivastava from Government of Madhya Pradesh.Dr. R.S. Gupta, Dr. S.K. Gupta, Ms. Mamta Devi, ANM and Ms. Sangeeta Sharma, ANM from Government ofRajasthan.Dr. Rajesh Bali from Government of Haryana.NGO representatives: Dr. P.K. Jain from RK Mission and Dr. Sunita Abraham from Christian Medical Association ofIndia.Tmt. C. Chandra, Village Health Nurse, and Tmt. K. Geetha, Village Health Nurse from Government of Tamil Nadu.I express my sincere thanks to Architects of Central Design Bureau namely Sh. S. Majumdar, Dr. Chandrashekhar,Sh. Sridhar and Sh. M. Bajpai for providing inputs in respect of physical infrastructure and building norms.I am also extremely grateful to Regional Directors of Health and Family Welfare, State Health Secretaries, StateMission directors and State Directors of Health Services for their feedback.I shall be failing in my duty if I do not thank Dr. P.K. Prabhakar, Deputy Commissioner, Ministry of Health and FamilyWelfare for providing suggestions and support at every stage of revision of this document.Last but not the least the assistance provided by my secretarial staff and the team at Macro Graphics Pvt. Ltd. isduly acknowledged.(Dr. Anil Kumar)Member Secretary-Task forceCMO (NFSG)Directorate General of Health ServicesJune 2012Ministry of Health & Family WelfareNew Delhi Government of IndiaIndian Public Health Standards (IPHS) Guidelines for Primary Health Centresix

Executive SummaryPrimary Health Centre is the cornerstone of ruralhealth services- a first port of call to a qualifieddoctor of the public sector in rural areas for thesick and those who directly report or referred fromSub-Centres for curative, preventive and promotivehealth care.A typical Primary Health Centre covers a populationof 20,000 in hilly, tribal, or difficult areas and 30,000populations in plain areas with 6 indoor/observationbeds. It acts as a referral unit for 6 Sub-Centres andrefer out cases to CHC (30 bedded hospital) and higherorder public hospitals located at sub-district anddistrict level. However, as the population density inthe country is not uniform, the number of PHCs woulddepend upon the case load. PHCs should become a24 hour facility with nursing facilities. Select PHCs,especially in large blocks where the CHC/FRU is overone hour of journey time away, may be upgraded toprovide 24 hour emergency hospital care for a numberof conditions by increasing number of Medical Officers,preferably such PHCs should have the same IPHS normsas for a CHC.Standards are the main driver for continuousimprovements in quality. The performance of PrimaryHealth Centres can be assessed against the setstandards. Setting standards is a dynamic process.Currently the IPHS for Primary Health Centres hasbeen revised keeping in view the resources availablewith respect to functional requirements of PrimaryHealth Centre with minimum standards such asbuilding, manpower, instruments and equipment,drugs and other facilities etc. The revised IPHS hasincorporated the changed protocols of the existinghealth programmes and new programmes andinitiatives especially in respect of Non-communicablediseases.The overall objective of IPHS for PHC is to providehealth care that is quality oriented and sensitive tothe needs of the community. These standards wouldalso help monitor and improve the functioning of thePHCs.Service DeliveryFrom Service delivery angle, PHCs may be of twotypes, depending upon the delivery case load –Type A and Type B.Type A PHC: PHC with delivery load of less than20 deliveries in a month,Type B PHC: PHC with delivery load of 20 or moredeliveries in a monthAll “Minimum Assured Services” or EssentialServices as envisaged in the PHC should beavailable. The services which are indicated asDesirable are for the purpose that we shouldaspire to achieve for this level of facility.Appropriate guidelines for each NationalProgramme for management of routineand emergency cases are being provided to thePHC.Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres 1

Minimum Requirement forDelivery of the Above-mentionedServicesThe following requirements are being projected basedon case load of 40 patients per doctor per day, theexpected number of beneficiaries for maternal andchild health care and family planning and about 60%utilization of the available indoor/observation beds (6beds). Besides one MBBS medical officer, one AYUSHmedical officer (desirable) has been provided to providedchoices to the people, wherever an AYUSH publicfacility is not available in the near vicinity. Manpowerhas been rationalized. For Type B PHCs, additional staffin the from of one MBBS medical officer (desirable) oneStaff Nurse and one sanitary worker cum watchmanhave been provided have been provided to take careof additional delivery case load. It would be a dynamicprocess in the sense that if the utilization goes up, thestandards would be further upgraded.FacilitiesThe document includes a suggested layout of PHCindicating the space for the building and otherinfrastructure facilities. A list of manpower, equipment,furniture and drugs needed for providing the assuredand desirable services at the PHC has been incorporatedin the document. A Charter of Patients’ Rights forappropriate information to the beneficiaries, grievanceredressal and constitution of Rogi Kalyan Samiti/Primary Health Centre Management Committee forbetter management and improvement of PHC serviceswith involvement of Panchayati Raj Institutions (PRI)has also been made as a part of the Indian PublicHealth Standards. The monitoring process and qualityassurance mechanism is also included.2Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

Indian Public Health Standards for PrimaryHealth CentresIntroductionThe concept of Primary Health Centre (PHC) is not newto India. The Bhore Committee in 1946 gave the conceptof a PHC as a basic health unit to provide as close to thepeople as possible, an integrated curative and preventivehealth care to the rural population with emphasis onpreventive and promotive aspects of health care.The health planners in India have visualized the PHCand its Sub-Centres (SCs) as the proper infrastructureto provide health services to the rural population. TheCentral Council of Health at its first meeting held inJanuary 1953 had recommended the establishmentof PHCs in community development blocks to providecomprehensive health care to the rural population. Thesecentres were functioning as peripheral health serviceinstitutions with little or no community involvement.Increasingly, these centres came under criticism, as theywere not able to provide adequate health coverage,partly, because they were poorly staffed and equippedand lacked basic amenities.The 6 th Five year Plan (1983-88) proposed reorganizationof PHCs on the basis of one PHC for every 30,000 ruralpopulations in the plains and one PHC for every 20,000population in hilly, tribal and desert areas for moreeffective coverage. However, as the population densityin the country is not uniform, the number of PHCswould depend upon the case load. PHCs should becomefunctional for round the clock with provision of 24 × 7nursing facilities. Select PHCs, especially in large blockswhere the CHC is over one hour of journey time away,may be upgraded to provide 24 hour emergencyhospital care for a number of conditions by increasingthe number of Medical Officers; preferably such PHCsshould have the same IPHS norms as for a CHC. Thereare 23673 PHCs functioning in the country as on March2010 as per Rural Health Statistics Bulletin, 2010. Thenumber of PHCs functioning on 24x7 basis are 9107andnumber of PHCs where three staff Nurses have beenposted are 7629 (as on 31-3-2011).PHCs are the cornerstone of rural health services- a firstport of call to a qualified doctor of the public sector inrural areas for the sick and those who directly reportor referred from Sub-Centres for curative, preventiveand promotive health care. It acts as a referral unit for6 Sub-Centres and refer out cases to Community HealthCentres (CHCs-30 bedded hospital) and higher orderpublic hospitals at sub-district and district hospitals. Ithas 4-6 indoor beds for patients.PHCs are not spared from issues such as the inability toperform up to the expectation due to (i) non-availabilityof doctors at PHCs; (ii) even if posted, doctors do not stayat the PHC HQ; (iii) inadequate physical infrastructureand facilities; (iv) insufficient quantities of drugs; (v) lackof accountability to the public and lack of communityparticipation; (vi) lack of set standards for monitoringquality care etc.Standards are a means of describing the level of qualitythat health care organizations are expected to meetor aspire to. Key aim of these standards is to underpinthe delivery of quality services which are fair andresponsive to client’s needs, provided equitably anddeliver improvements in the health and wellbeing of thepopulation. Standards are the main driver for continuousIndian Public Health Standards (IPHS) Guidelines for Primary Health Centres 3

improvements in quality. The performance of health caredelivery organizations can be assessed against standards.The National Rural Health Mission (NRHM) has providedthe opportunity to set Indian Public Health Standards(IPHS) for Health Centres functioning in rural areas.In order to provide optimal level of quality health care,a set of standards called Indian Public Health Standards(IPHS) were recommended for Primary Health Centre(PHC) in early 2007.The nomenclature of a PHC varies from State to Statethat include a Block level PHCs (located at block HQ andcovering about 100,000 population and with varyingnumber of indoor beds) and additional PHCs/New PHCscovering a population of 20,000-30,000 etc. Regardingthe block level PHCs it is expected that they areultimately going to be upgraded as Community HealthCentres with 30 beds for providing specialized services.Setting standards is a dynamic process. Currently theIPHS for Primary Health Centres has been revisedkeeping in view the resources available with respectto functional requirement for PHCs having 6 bedswith minimum standards such as building manpower,instruments, and equipment, drugs and other facilitiesetc. The revised IPHS has incorporated the changedprotocols of the existing health programmes and newprogrammes and initiatives especially in respect of Noncommunicablediseases.It is desirable that on the basis of essential services,State/UT should issue the Government notification forminimum mandate standard for services at PHC.Objectives of Indian Public HealthStandards (IPHS) for PrimaryHealth Centres (PHC)The overall objective of IPHS is to provide health carethat is quality oriented and sensitive to the needs of thecommunity.The objectives of IPHS for PHCs are:i. To provide comprehensive primary health careto the community through the Primary HealthCentres.ii. To achieve and maintain an acceptable standardof quality of care.iii. To make the services more responsive andsensitive to the needs of the community.Services at the Primary HealthCentre for meeting the IPHSFrom Service delivery angle, PHCs may be of two types,depending upon the delivery case load – Type A andType B.Type A PHC: PHC with delivery load of less than 20deliveries in a month,Type B PHC: PHC with delivery load of 20 or moredeliveries in a monthAll the following services have been classified asEssential (Minimum Assured Services) or Desirable(which all States/UTs should aspire to achieve at thislevel of facility).Medical careEssential OPD services: A total of 6 hours of OPD servicesout of which 4 hours in the morning and 2 hoursin the afternoon for six days in a week. Timeschedule will vary from state to state. MinimumOPD attendance is expected to be 40 patients perdoctor per day. In addition to six hours of duty atthe PHC, it is desirable that MO PHC shall spend atleast two hours per day twice in a week for fieldduties and monitoring. 24 hours emergency services: appropriatemanagement of injuries and accident, First Aid,stitching of wounds, incision and drainage ofabscess, stabilisation of the condition of the patientbefore referral, Dog bite/snake bite/scorpion bitecases, and other emergency conditions. Theseservices will be provided primarily by the nursingstaff. However, in case of need, Medical Officer maybe available to attend to emergencies on call basis. Referral services. In-patient services (6 beds).Maternal and Child Health Care IncludingFamily PlanningEssentiala) Antenatal carei. Early registration of all pregnancies ideallyin the first trimester (before 12 th week ofpregnancy). However, even if a woman comes4Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

ii.iii.iv.v.vi.vii.late in her pregnancy for registration she shouldbe registered and care given to her accordingto gestational age. Record tobacco use by allantenatal mothers.Minimum 4 antenatal checkups and provision ofcomplete package of services.Suggested schedule for antenatal visits:1 st visit: Within 12 weeks—preferably as soonas pregnancy is suspected—for registration ofpregnancy and first antenatal check-up.2 nd visit: Between 14 and 26 weeks.3 rd visit: Between 28 and 34 weeks.4 th visit: Between 36 weeks and term.Associated services like providing iron and folicacid tablets, injection Tetanus Toxoid etc (as perthe “guidelines for Ante-Natal Care and SkilledAttendance at birth by ANMs and LHVs) Ensure,at-least 1 ANC preferably the 3 rd visit, must beseen by a doctor.Minimum laboratory investigations likeHaemoglobin, Urine albumin and sugar, RPRtest for syphilis and Blood Grouping and Rhtyping.Nutrition and health counseling. Brief advice ontobacco cessation if the antenatal mother is asmoker or tobacco user and also inform aboutdangers of second hand smoke.Identification and management of high risk andalarming signs during pregnancy and labour.Timely referral of such identified cases to FRUs/other hospitals which are beyond the capacity ofMedical Officer PHC to manage.Tracking of missed and left out ANC.Chemoprophylaxis for Malaria in high malariaendemic areas for pregnant women as perNVBDCP guidelines.b) Intra-natal care: (24-hour delivery services bothnormal and assisted)i. Promotion of institutional deliveries.ii. Management of normal deliveries.iii. Assisted vaginal deliveries including forceps/vacuum delivery whenever required.iv. Manual removal of placenta.v. Appropriate and prompt referral for cases needingspecialist care.vi. Management of pregnancy Induced hypertensionincluding referral.vii. Pre-referral management (Obstetric first-aid) inObstetric emergencies that need expert assistance(Training of staff for emergency management tobe ensured).viii. Minimum 48 hours of stay after delivery.ix. Managing labour using Partograph.c) Proficient in identification and basic first aidtreatment for PPH, Eclampsia, Sepsis andprompt referralAs per ‘Antenatal Care and Skilled Birth Attendanceat Birth’ Guidelinesd) Postnatal Carerdi. Ensure post- natal care for 0 & 3 day at the healthfacility both for the mother and new-born andsending direction to the ANM of the concernedarea for ensuring 7 th & 42 nd day post-natal homevisits. 3 additional visits for a low birth weightbaby (less than 2500 gm) on 14 th day, 21 st day andon 28 th day.ii. Initiation of early breast-feeding within one hourof birth.iii. Counseling on nutrition, hygiene, contraception,essential new born care (As per Guidelines of GOIon Essential new-born care) and immunization.iv. Others: Provision of facilities under JananiSuraksha Yojana (JSY).v. Tracking of missed and left out PNC.e) New Born carei. Facilities for Essential New Born Care (ENBC) andResuscitation (Newborn Care Corner in LabourRoom/OT, Details given in Annexure 3A).ii. Early initiation of breast feeding with in one hourof birth.iii. Management of neonatal hypothermia (provisionof warmth/Kangaroo Mother Care (KMC),infection protection, cord care and identificationof sick newborn and prompt referral.Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres 5

f) Care of the childi.ii.Routine and Emergency care of sick childrenincluding Integrated Management of Neonataland Childhood Illnesses (IMNCI) strategy andinpatient care. Prompt referral of sick childrenrequiring specialist care.Counseling on exclusive breast-feeding for6 months and appropriate and adequatecomplementary feeding from 6 months of agewhile continuing breastfeeding. (As per NationalGuidelines on Infant and Young Child Feeding,2006, by Ministry of WCD, Government ofIndia).Janani Suraksha YojanaJanani Suraksha Yojana (JSY) is a safe motherhoodintervention under the National Rural Health Mission(NRHM) being implemented with the objective ofreducing maternal and neo-natal mortality by promotinginstitutional delivery among the poor pregnant women.This scheme integrates cash assistance with deliveryand post-delivery care.While the scheme would create demand for institutionaldelivery, it would be necessary to have adequate numberof 24X7 delivery services centre, doctors, mid-wives,drugs etc. at appropriate places. Mainly, this will entail Linking each habitation (village or a ward in anurban area) to a functional health centre- publicor accredited private institution where 24X7delivery service would be available, Associate an ASHA or a health link worker to eachof these functional health centre. It should be ensured that ASHA keeps track of allexpectant mothers and newborn. All expectantmother and newborn should avail ANC andimmunization services, if not in health centres,atleast on the monthly health and nutrition day,to be organised in the Anganwadi or sub-centre. Each pregnant women is registered and a microbirthplan is prepared. Each pregnant woman is tracked for ANC, For each of the expectant mother, a place of deliveryis pre-determined at the time of registration andthe expectant mother is informed,iii. Assess the growth and development of the infantsand under 5 children and make timely referral.iv. Full Immunization of all infants and children againstvaccine preventable diseases as per guidelinesof GOI. (Current Immunization Schedule atAnnexure 1). Tracking of vaccination dropouts.v. Vitamin A prophylaxis to the children as pernational guidelines.vi. Prevention and control of routine childhooddiseases, infections like diarrhoea, pneumoniaetc. and anemia etc.vii. Management of severe acute malnutrition casesand referral of serious cases after initiation oftreatment as per facility based guidelines.A referral centre is identified and expectantmother is informed,ASHA and ANM to ensure that adequate fundis available for disbursement to expectantmother,ASHA takes adequate steps to organize transportfor taking the women to the pre-determinedhealth institution for delivery.ASHA assures availability of cash fordisbursement at the health centre and sheescorts pregnant women to the pre-determinedhealth centre.ASHA package in the form of cash assistance forreferral transport, cash incentive and transactionalcost to be provided as per guidelines.Janani Shishu Suraksha Karyakram (JSSK)JJSSK launched on 1st of June of 2011 is an initiativeto assure free services to all pregnant women andsick neonates accessing public health institutions.The scheme envisages free and cashless services topregnant women including normal deliveries andcaesarian section operations and also treatment of sicknewborn (up to 30 days after birth) in all Governmenthealth institutions across State/UT.This initiative supplements the cash assistancegiven to pregnant women under the JSY and isaimed at mitigating the burden of out of pocketexpenditure incurred by pregnant women and sicknewborns,6Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

Entitlements for Pregnant Women1. Free and Zero expense delivery and CaesarianSection2. Free Drugs and Consumables3. Free Diagnostics (Blood, Urine tests andUltrasonography etc. as required.)4. Free diet during stay in the health institutions (upto 3 days fro normal deliveries and upto 7 daysfor caesarian deliveries)5. Free provision of the Blood6. Free transport from home to health institutions,between facilities in case of referrals and dropback from institutions to home.g) Family Welfarei. Education, Motivation and Counseling to adoptappropriate Family planning methods.ii. Provision of contraceptives such as condoms, oralpills, emergency contraceptives, IUCD insertions.iii. Referral and Follow up services to the eligiblecouples adopting permanent methods(Tubectomy/Vasectomy).iv. Counseling and appropriate referral for coupleshaving infertility.v. Permanent methods like Tubal ligation andvasectomy/NSV, where trained personnel andfacility exist.Medical Termination of PregnanciesEssentialCounseling and appropriate referral for safe abortionservices (MTP) for those in need.Desirable MTP using Manual Vacuum Aspiration (MVA)technique will be provided in PHCs, where trainedpersonnel and facility exist. Medical Method of Abortion with linkage fortimely referral to the facility approved for 2 ndtrimester of MTP.Management of Reproductive TractInfections/Sexually Transmitted InfectionsEssentiala. Health education for prevention of RTI/STIs.b. Treatment of RTI/STIs.7.Exemption from all kinds of user chargesEntitlements for Sick newborn till 30 daysafter Birth1. Free and zero expense treatment2. Free Drugs and Consumables3. Free Diagnostics4. Free provision of the Blood5. Free transport from home to healthinstitutions, between facilities in case of referralsand drop back from institutions to home.6. Exemption from all kinds of user chargesNutrition Services (coordinated with ICDS)Essentiala. Diagnosis of and nutrition advice to malnourishedchildren, pregnant women and others.b. Diagnosis and management of anaemia andvitamin A deficiency.c. Coordination with ICDS.School HealthTeachers screen students on a continuous basis andANMs/HWMs (a team of 2 workers) visit the schools(one school every week) for screening, treatment ofminor ailments and referral. Doctor from CHC/PHC willalso visit one school per week based on the screeningreports submitted by the teams. Overall services to beprovided under school health shall includeEssentialHealth service provisionScreening, health care and referral: Screening of general health, assessment ofAnaemia/Nutritional status, visual acuity,hearng problems, dental check up, common skinconditions, Heart defects, physical disabilities,learning disorders, behavior problems, etc. Basic medicines to take care of common ailments,prevalent among young school going children. Referral Cards for priority services at District/Sub-District hospitals.Immunization: As per national schedule Fixed day activity Coupled with education about the issueIndian Public Health Standards (IPHS) Guidelines for Primary Health Centres 7

Micronutrient (Vitamin A & IFA) management: Weekly supervised distribution of Iron-Folatetablets coupled with education about the issue Administration of Vitamin-A in needy cases.De-worming Biannually supervised schedule Prior IEC Siblings of students also to be coveredCapacity buildingMonitoring & EvaluationMid Day Meal: in coordination with departmentof school education, Ministry of Human ResourceDevelopmentDesirableHealth Promoting Schools Counseling services Regular practice of Yoga, Physical education,health education Peer leaders as health educators. Adolescent health education-existing in few places Linkages with the out of school children Health clubs, Health cabinets First Aid room/corners or clinics.Adolescent Health CareTo be provided preferably through adolescent friendlyclinic for 2 hours once a week on a fixed day. Servicesshould be comprehensive i.e. a judicious mix of promotive,preventive, curative and referral servicesCore package (Essential) Adolescent and Reproductive Health: Information,counseling and services related to sexualconcerns, pregnancy, contraception, abortion,menstrual problems etc. Services for tetanus immunization of adolescents Nutritional Counseling, Prevention andmanagement of nutritional anemia STI/RTI management Referral Services for VCTC and PPTCT services andservices for Safe termination of pregnancy, if notavailable at PHCOptional/additional services (desirable): as per local needOutreach services in schools (essential) and communityCamps (desirable) Periodic Health check ups and health educationactivities, awareness generation and Co-curricularactivitiesPromotion of Safe Drinking Water andBasic SanitationEssential Disinfection of water sources and Coordinationwith Public Health Engineering department forsafe water supply. Promotion of sanitation including use of toiletsand appropriate garbage disposal.Desirable Testing of water quality using H S - Strip Test2(Bacteriological).Prevention and control of locally endemicdiseases like malaria, Kala Azar, JapaneseEncephalitis etc. (Essential)Collection and reporting of vital events.(Essential)Health Education and Behaviour ChangeCommunication (BCC). (Essential)Other National Health ProgrammesRevised National Tuberculosis Control Programme(RNTCP)EssentialAll PHCs to function as DOTS Centres to deliver treatmentas per RNTCP treatment guidelines through DOTSproviders and treatment of common complicationsof TB and side effects of drugs, record and report onRNTCP activities as per guidelines. Facility for Collectionand transport of sputum samples should be available asper the RNTCP guidelines.National Leprosy Eradication ProgrammeEssentiala. Health education to community regardingLeprosy.b. Diagnosis and management of Leprosy and itscomplications including reactions.c. Training of leprosy patients having ulcers forself-care.d. Counselling for leprosy patients for regularity/completion of treatment and prevention ofdisability.8Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

Integrated Disease Surveillance Project (IDSP)Essentiala. Weekly reporting of epidemic prone diseases in S,P & L forms and SOS reporting of any cluster ofcases (formats for the data collection are added inAnnexures 11, 11A, 11B, 11C).b. PHC will collect and analyse data fromSub-Centre and will report information to districtsurveillance unit.c. Appropriate preparedness and first level action inout-break situations.d. Laboratory services for diagnosis of Malaria,Tuberculosis, and tests for detection of faecalcontamination of water (Rapid test kit) andchlorination level.National Programme for Control of Blindness (NPCB)Essentiala. The early detection of visual impairment andtheir referral.b. Detection of cataract cases and referral forcataract surgery.c. Provision of Basic treatment of common eyediseases.d. Awareness generation through appropriate IECstrategies for prevention and early detection ofimpaired vision and other eye conditions.e. Greater participation/role of community inprimary prevention of eye problems.National Vector Borne Disease Control Programme(NVBDCP)Essential in endemic areasDiagnosis and Management of Vector borne Diseases is tobe undertaken as per NVBDCP guidelines for PHC/CHC:a. Diagnosis of Malaria cases, microscopicconfirmation and treatment.b. Cases of suspected JE and Dengue to be providedsymptomatic treatment, hospitalization and casemanagement as per the protocols.c. Complete treatment to Kala-azar cases in Kala-azar endemic areas as per national Policy.d. Complete treatment of microfilaria positive caseswith DEC and participation in and arrangementfor Mass Drug Administration (MDA) along withmanagement of side reactions, if any. Morbiditymanagement of Lymphoedema cases.National AIDS Control ProgrammeEssentiala. IEC activities to enhance awareness and preventivemeasures about STIs and HIV/AIDS, Prevention ofParents to Child Transmission (PPTCT) services.b. Organizing School Health Education Programme.c. Condom Promotion & distribution of condoms tothe high risk groups.d. Help and guide patients with HIV/AIDS receivingART with focus on adherence.Desirablea. Integrated Counseling and Testing Centre, STIservices.b. Screening of persons practicing high-risk behaviourwith one rapid test to be conducted at the PHClevel and development of referral linkages withthe nearest ICTC at the District Hospital level forconfirmation of HIV status of those found positiveat one test stage in the high prevalence states.c. Risk screening of antenatal mothers with onerapid test for HIV and to establish referral linkageswith CHC or District Hospital for PPTCT servicesin the six high HIV prevalence states (TamilNadu, Andhra Pradesh, Maharashtra, Karnataka,Manipur and Nagaland) of India.d. Linkage with Microscopy Centre for HIV-TBcoordination.e. Pre and post-test counseling of AIDS patients byPHC staff in high prevalence states.National Programme for Prevention and Control ofDeafness (NPPCD)Essentiala. Early detection of cases of hearing impairmentand deafness and referral.b. Basic Diagnosis and treatment services forcommon ear diseases like wax in ear, otomycosis,otitis externa, Ear discharge etc.c. IEC services for prevention, early detectionof hearing impairment/deafness and greaterparticipation/role of community in primaryprevention of ear problems.National Mental Health Programme (NMHP)Essentiala. Early identification (diagnosis) and treatment ofmental illness in the community.Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres 9

.c.Basic Services: Diagnosis and treatment ofcommon mental disorders such as psychosis,depression, anxiety disorders and epilepsy andreferral).IEC activities for prevention, stigma removal,early detection of mental disorders and greaterparticipation/role of Community for primaryprevention of mental disorders.National Programme for Prevention and Control ofCancer, Diabetes, CVD and Stroke (NPCDCS)CancerEssentiala. IEC services for prevention of cancer and earlysymptoms.b. Early detection of cancer with warning signalslike change in Bladder/Bowel habits, bleedingper rectum, blood in urine, lymph nodeenlargement, Lump or thickening in Breast,itching and/or redness or soreness of the nipplesof Breast, non healing chronic sore or ulcer in oralcavity, difficulty in swallowing, obvious changein wart/mole, nagging cough or hoarseness ofvoice etc.c. Referral of suspected cancer cases with earlywarning signals for confirmation of the diagnosis.DesirablePAP smearOther NCD DiseasesEssentiala. Health Promotion Services to modify individual,group and community behaviour especiallythrough;i. Promotion of Healthy Dietary Habits.ii. Increase physical activity.iii. Avoidance of tobacco and alcohol.iv. Stress Management.b. Early detection, management and referral ofDiabetes Mellitus, Hypertension and otherCardiovascular diseases and Stroke through simplemeasures like history, measuring blood pressure,checking for blood, urine sugar and ECG.DesirableSurvey of population to identify vulnerable, high riskand those suffering from disease.National Iodine Deficiency Disorders ControlProgramme (NIDDCP)Essentiala. IEC activities to promote the consumption ofiodated salt by the people.b. Monitoring of Iodated salt through salt testing kits.National Programme for Prevention and Control ofFluorosis (NPPCF) (In affected (Endemic Districts)Essentiala. Referral Services.b. IEC activities to prevent Fluorosis.Desirablea. Clinical examination and preliminary diagnosticparametres assessment for cases of Fluorosis iffacilities are available.b. Monitoring of village/community level activity.National Tobacco Control Programme (NTCP)Essentiala. Health education and IEC activities regardingharmful effects of tobacco use and second handsmoke.b. Promoting quitting of tobacco in the community.c. Providing brief advice on tobacco cessation to allsmokers/tobacco users.d. Making PHC tobacco free.DesirableWatch for implementation of ban on smoking in publicplaces, sale of tobacco products to minors, sale oftobacco products within 100 yards of educationalinstitutions.National Programme for Health Care of ElderlyEssentialIEC activities on healthy aging.Desirable‘Weekly geriatric clinic at PHC’ for providing completehealth assessment of elderly persons, Medicines,Management of chronic diseases and referral services.Oral HealthEssentialOral health promotion and check ups & appropriatereferral on identification.10Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

Physical Medicine and Rehabilitation (PMR) ServicesDesirablea. Primary prevention of Disabilities.b. Screening, early identification and detection.c. Counseling.d. Issue of Disability Certificate for obvious Disabilitiesby PHC doctor.Referral ServicesAppropriate and prompt referral of cases needingspecialist care including:a. Stabilization of patient.b. Appropriate support to patient during transport.c. Providing transport facilities either by PHC vehicleor other available referral transport.d. Drop back home for patients as mandatedunder JSSKTrainingEssentiala. Imparting training to undergraduate medicalstudents and intern doctors in basic health care.b. Orientation training of male and female healthworkers in various National Health Programmesincluding RCH, Adolescent health services andimmunizationc. Skill based training to ASHAs.d. Initial and periodic Training of paramedics intreatment of minor ailments.e. Periodic training of Doctors and para medicsthrough Continuing Medical Education,conferences, skill development trainings.f. All health staff of PHC must be trained in IMEP.Desirableg. Othersi. There should be provision of induction trainingfor doctors, nursing and paramedical staff.ii. Whenever new/higher responsibility is assignedor new equipment/technology is introduced,there must be provision of training.iii. There must be mechanism for ensuring qualityassurance in trainings by Training feedbackand Training effectiveness evaluation.iv. Appropriate placement for trained personshould be ensured.v. Trainings in minor repairs and maintenanceof available equipment should be provided tothe user.vi. Training of para medics in indenting,forecasting, inventory and store managementvii. Development of protocols for equipment(operation, preventive and breakdownmaintenance).Note: 1. Trainings should commensurate with job responsibilitiesfor each category of health personnel.Note: 2. Since ECG machine is envisaged in PHCs hence labtechnician or some other paramedic should be trained intaking ECG.Basic Laboratory and Diagnostic ServicesEssential Laboratory services includingi. Routine urine, stool and blood tests (Hb%,platelets count, total RBC, WBC, bleeding andclotting time).ii. Diagnosis of RTI/STDs with wet mounting, Gramsstain, etc.iii. Sputum testing for mycobacterium (as perguidelines of RNTCP).iv. Blood smear examination malarial.v. Blood for grouping and Rh typing.vi. RDK for Pf malaria in endemic districts.vii. Rapid tests for pregnancy.viii. RPR test for Syphilis/YAWS surveillance (endemicdistricts).ix. Rapid test kit for fecal contamination of water.x. Estimation of chlorine level of water using ortho-toludine reagent.xi. Blood Sugar.Desirablexii. Blood Cholesterol.xiii. ECG.Validation of reports: periodic validation of laboratoryreports should be done with external agencies like DistrictPHC/Medical college for Quality Assurance. Periodiccalibration of Laboratory and PHC equipment.Monitoring and SupervisionEssentiali. Monitoring and supervision of activities of Sub-Centre through regular meetings/periodic visits, byLHV, Health Assistant Male and Medical Officer etc..ii. Monitoring of all National Health Programmesby Medical Officer with support of LHV, HealthAssistant Male and Health educator.iii. Monitoring activities of ASHAs by LHV and ANM(in her Subcentre area).Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres 11

iv. Health educator will monitor all IEC and BCCactivitiesv. Health Assistants Male and LHV should visit Sub-Centres once a week.vi. Checking for tracking of missed out and left outANC/PNC, Vaccinations etc. during monitoringvisits and quality parameters (including usingPartograph, AMTSL, ENBC etc.) during deliveryand post delivery.vii. Timely payment of JSY beneficiaries.viii. Timely payment of TA/DA to ASHAs.Desirablei. MO should visit all Sub-Centres at least once in amonth. This will be possible only if more than oneMedical Officer is posted in the PHC.Functional Linkages with Sub-CentresEssential There shall be a monthly review meeting at PHCchaired by MO (or in-charge), and attended by allthe Health Workers (Male and Female) and HealthAssistants (Male and female). On the spot Supervisory visits to Sub-Centres. Organizing Village Health and Nutrition day atAnganwadi Centres.Desirable ASHAs and Anganwadi Workers should attendmonthly review meetings. Medical Officer shouldorient ASHAs on selected topics of health care.Mainstreaming of AYUSHDesirable Provision of one AYUSH Doctor and one AYUSHPharmacist has been made at PHC to providechoices to the people wherever an AYUSHpublic facility is not available in the near vicinity.The AYUSH doctor at PHC shall attend patientsfor system specific AYUSH based preventive,promotive and curative health care and takeup public health education activities includingawareness generation about the uses of medicinalplants and local health practices. The signboard of the PHC should mention AYUSHfacilities. Ayush Doctor should support in implementationof national health programmes after requisitetraining if required.Locally available medicinal herbs/plants should begrown around the PHC.Selected Surgical Procedures(Desirable)The vasectomy, tubectomy (including laparoscopictubectomy), MTP, hydrocelectomy as a fixed dayapproach have to be carried out in a PHC having facilitiesof O.T. During all these surgical procedures, universalprecautions will be adopted to ensure infectionprevention. These universal precautions are mentionedat Annexure 5.Record of Vital Events and ReportingEssentiala. Recording and reporting of Vital statistics includingbirths and deaths.b. Maintenance of all the relevant records concerningservices provided in PHC.Maternal Death Review (MDR).(Desirable)Facility Based MDR shall be conducted at the PHC, theform is given at Annexure 10.InfrastructureThe PHC should have a building of its own. Thesurroundings should be clean. The details are asfollows:PHC BuildingLocationIt should be centrally located in an easily accessible area.The area chosen should have facilities for electricity, allweather road communication, adequate water supplyand telephone. At a place, where a PHC is already located,another health centre/SC should not be established toavoid the wastage of human resources.PHC should be away from garbage collection, cattleshed, water logging area, etc. PHC shall have properboundary wall and gate.AreaIt should be well planned with the entire necessaryinfrastructure. It should be well lit and ventilated withas much use of natural light and ventilation as possible.12Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

The plinth area would vary from 375 to 450 sq. metresdepending on whether an OT facility is opted for.Sign-ageThe building should have a prominent board displayingthe name of the Centre in the local language at the gateand on the building. PHC should have pictorial, bilingualdirectional and layout sign-age of all the departmentsand public utilities (toilets, drinking water).Prominent display boards in local language providinginformation regarding the services available/usercharges/fee and the timings of the centre. Relevant IECmaterial shall be displayed at strategic locations.Citizen charter including patient rights and responsibilitiesshall be displayed at OPD and Entrance in local language.Entrance with Barrier free accessBarrier free access environment for easy access to nonambulant(wheel-chair, stretcher), semi-ambulant,visually disabled and elderly persons as per guidelinesof GOI.Ramp as per specification, Hand- railing, properlightning etc must be provided in all health facilitiesand retrofitted in older one which lack the same. Thedoorway leading to the entrance should also have aramp facilitating easy access for old and physicallychallenged patients. Adequate number of wheel chairs,stretchers etc. should also be provided.Disaster Prevention MeasuresFor all new upcoming facilities in seismic 5 zone or otherdisaster prone areas.Building and the internal structure should be madedisaster proof especially earthquake proof, flood proofand equipped with fire protection measures.Earthquake proof measures - structural and nonstructuralshould be built in to withstand quake as pergeographical/state govt. guidelines. Non-structuralfeatures like fastening the shelves, almirahs, equipmentetc. are even more essential than structural changesin the buildings. Since it is likely to increase the costsubstantially, these measures may especially be takenon priority in known earthquake prone areas.PHC should not be located in low lying area to preventflooding as far as possible.Fire fighting equipment – fire extinguishers, sandbuckets etc. should be available and maintained to bereadily available when needed. Staff should be trainedin using fire fighting equipment.All PHCs should have Disaster Management Plan in linewith the District Disaster management Plan. All healthstaff should be trained and well conversant with disasterprevention and management aspects. Surprise mockdrills should be conducted at regular intervals.Waiting Areaa. This should have adequate space and seatingarrangements for waiting clients/patients as perpatient load.b. The walls should carry posters imparting healtheducation.c. Booklets/leaflets in local language may be providedin the waiting area for the same purpose.d. Toilets with adequate water supply separate formales and females should be available. Waitingarea should have adequate number of fans,coolers, benches or chairs.e. Safe Drinking water should be available in thepatient’s waiting area.There should be proper notice displaying departmentsof the centre, available services, names of the doctors,users’ fee details and list of members of the Rogi KalyanSamiti/Hospital Management Committee.A locked complaint/suggestion box should be providedand it should be ensured that the complaints/suggestionsare looked into at regular intervals and addressed.The surroundings should be kept clean with no waterloggingand vector breeding places in and around thecentre.Outpatient Departmenta. The outpatient room should have separate areasfor consultation and examination.b. The area for examination should have sufficientprivacy.c. In PHCs with AYUSH doctor, necessaryinfrastructure such as consultation room forAYUSH Doctor and AYUSH Drug dispensing areashould be made available.d. OPD Rooms shall have provision for ample naturallight, and air. Windows shall open directly to theexternal air or into an open verandah.Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres 13

e.f.Adequate measures should be taken for crowdmanagement; e.g. one volunteer to call patientsone by one, token system.One room for Immunization/Family Planning/Counseling.Wards 5.5 m x 3.5 m eacha. There should be 4-6 beds in a Primary Health Centre.Separate wards/areas should be earmarked formales and females with the necessary furniture.b. There should be facilities for drinking water andseparate clean toilets for men and women.c. The ward should be easily accessible from the OPDso as to obviate the need for a separate nursingstaff in the ward and OPD during OPD hours.d. Nursing station should be located in such a waythat health staff can be easily accessible to OT andlabour room after regular clinic timings.e. Proper written handover shall be given to incomingstaff by the outgoing staff.f. Dirty utility room for dirty linen and used items.g. Cooking should not be allowed inside the wardsfor admitted patients.h. Cleaning of the wards, etc. should be carried outat regular intervals and at such times so as not tointerfere with the work during peak hours andalso during times of eating. Cleaning of the wards,Labour Room, OT, and toilets should be regularlymonitored.Operation Theatre (Optional)To facilitate conducting selected surgical procedures(e.g. vasectomy, tubectomy, hydrocelectomy etc.).a. It should have a changing room, sterilization areaoperating area and washing area.b. Separate facilities for storing of sterile andunsterile equipment/instruments should beavailable in the OT.c. The Plan of an ideal OT has been annexed showingthe layout.d. It would be ideal to have a patient preparationarea and Post-Operative area. However, in viewof the existing situation, the OT should be wellconnected to the wards.e. The OT should be well-equipped with all thenecessary accessories and equipment.f. Surgeries like laparoscopy/cataract/Tubectomy/Vasectomy should be able to be carried out inthese OTs.g. OT shall be fumigated at regular intervals.h.i.One of the hospital staff shall be trained inAutoclaving and PHC shall have standard Operativeprocedure for autoclaving.OT shall have power back up (generator/Invertor/UPS). OT should have restricted entry. Separatefoot wear should be used.Labour Room (3.8 m x 4.2 m)Essentiala. Configuration of New Born care corner•y Clear floor area shall be provided in the roomfor newborn corner. It is a space within thelabour room, 20-30 sq ft in size, where aradiant warmer (Functional) will be kept.•y Oxygen, suction machine and simultaneouslyaccessibleelectrical outlets shall be providedfor the newborn infant in addition to thefacilities required for the mother. BothOxygen Cylinder and Suction Machine shouldbe functional with their tips cleaned andcovered with sterile gauze etc for ready to usecondition. They must be cleaned after use andkept in the same way for next use.•y The Labour room shall be provided with agood source of light, preferably shadow-less.•y Resuscitation kit including Ambu Bag (Paediatricsize) should be placed in the radiant warmer.•y Provision of hand washing and containmentof infection control if it is not a part of thedelivery room.•y The area should be away from draught ofair, and should have power connection forplugging in the radiant warmer.b. There should be separate areas for septic andaseptic deliveries.c. The Labour room should be well-lit and ventilatedwith an attached toilet and drinking water facilities.Facilities for hot water shall be available.d. Separate areas for Dirty linen, baby wash, toilet,Sterilization.e. Standard Treatment Protocols for commonproblems during labour and for newborns to beprovided in the labour room.f. Labour room should have restricted entry.Separate foot wear should be used.g. All the essential drugs and equipment (functional)should be available.h. Cleanliness shall always be maintained in Labourroom by regular washing and mopping withdisinfectants.14Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

i.j.k.Labour Room shall be fumigated at regular interval(Desirable).Delivery kits and other instruments shall beautoclaved where facility is available.If Labour Room has more than one labour tablethen the privacy of the women must be ensuredby having screens between 2 labour tables.Minor OT/Dressing Room/Injection Room/Emergencya. This should be located close to the OPD to caterto patients for minor surgeries and emergenciesafter OPD hours.b. It should be well equipped with all the emergencydrugs and instruments.c. Privacy of the patients should be ensured.Laboratory (3.8 m x 2.7 m)a. Sufficient space with workbenches and separatearea for collection and screening should beavailable.b. Should have marble/stone table top for platformand wash basins.General storea. Separate area for storage of sterile and commonlinen and other materials/drugs/consumableetc. should be provided with adequate storagespace.b. The area should be well-lit and ventilated androdent/pest free.•y Sufficient number of racks shall beprovided.•y Drugs shall be stored properly andsystematically in cool (away from directsunlight), safe and dry environment.•y inflammable and hazardous material shall besecured and stored separatelyc. Near expiry drugs shall be segregated and storedseparatelyd. Sufficient space with the storage cabins separatelyfor AYUSH drugs be provided.Dispensing cum store area: 3 m x 3 mInfrastructure for AYUSH doctorBased on the system of medicine being practiced,appropriate arrangements should be made for theprovision of a doctor’s room and a dispensing room cumdrug storage.Waste disposal pit - As per GOI/Central PollutionControl Board (CPCB) guidelines.Cold Chain room – Size: 3 m x 4 mLogistics Room – Size: 3 m x 4 mGenerator room – Size: 3 m x 4 mOffice room 3.5 m x 3.0 mDirty utility room for dirty linen and used itemsResidential AccommodationEssentialDecent accommodation with all the amenities likes24-hrs. water supply, electricity etc. should be availablefor Medical Officer, nursing staff, pharmacist, laboratorytechnician and other staff.If the accommodation can not be provided due to anyreason, then the staff may be paid house rent allowance,but in that case they should be staying in near vicinity ofPHC so that they are available 24 × 7, in case of need.Boundary wall/FencingEssentialBoundary wall/fencing with Gate should be providedfor safety and security.Environment friendly featuresDesirableThe PHC should be, as far as possible, environmentfriendly and energy efficient. Rain-Water harvesting,solar energy use and use of energy-efficient bulbs/equipment should be encouraged.Other amenitiesEssentialAdequate water supply and water storage facility (overhead tank) with pipe water should be made available.ComputerEssentialComputer with Internet connection should be providedfor Management Information System (MIS) purpose.Lecture Hall/AuditoriumDesirableFor training purposes, a Lecture Hall or a small Auditoriumfor 30 Person should be available. Public address systemand a black board should also be provided.Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres 15

The suggested layout of a PHC and Operation Theatre isgiven at Annexure 2 and Annexure 2A respectively. TheLayout may vary according to the location and shape ofthe site, levels of the site and climatic conditions. Theprescribed layout may be implemented in PHCs yet tobe built, whereas those already built may be upgradedafter getting the requisite alteration/additions. Thefunds may be made available as per budget provisionunder relevant strategies mentioned in NRHM/RCH-IIprogram and other funding projects/programs.Equipment and Furniturea.b.c.The necessary equipment to deliver the assuredservices of the PHC should be available in adequatequantity and also be functional.Equipment maintenance should be given specialattention.Periodic stock taking of equipment and preventive/round the year maintenance will ensure properfunctioning equipment. Back up should be madeavailable wherever possible. A list of suggestedequipment and furniture including regents anddiagnostic kits is given in Annexure 3.ManpowerTo ensure round the clock access to public health facilities,Primary Health Centres are expected to provide 24-hourservice with basic Obstetric and Nursing facilities. UnderNRHM, PHCs are being operationalized for providing24 X 7 services in various phases by placing at least 3Staff Nurses in these facilities. If the case load is there,operationalization of 24 X 7 PHC may be undertaken in aphase-wise manner according to availability of manpower.This is expected to increase the institutional deliverieswhich would help in reducing maternal mortality.From Service delivery angle, PHCs may be of two types,depending upon the delivery case load – Type A andType B.Type A PHC: PHC with delivery load of less than 20deliveries in a month,Type B PHC: PHC with delivery load of 20 or moredeliveries in a monthSelect PHCs, especially in large blocks where the CHC isover one hour of journey time away, may be upgraded toprovide 24 hour emergency hospital care for a numberof conditions by increasing number of Medical Officers,preferably such PHCs should have the same IPHS normsas for a CHC.The manpower that should be available in the PHC isgiven in the table below: For Type B PHCs, additional staff in the from ofone MBBS medical officer (desirable, If the caseload of delivery cases is more than 30 permonth) one Staff Nurse and one sanitary workerManpower: PHCStaff Type A Type BEssential Desirable Essential DesirableMedical Officer- MBBS 1 1 1 #Medical Officer –AYUSH 1^ 1^Accountant cum Data Entry Operator 1 1Pharmacist 1 1Pharmacist AYUSH 1 1Nurse-midwife (Staff-Nurse) 3 +1 4 +1Health worker (Female) 1* 1*Health Assistant. (Male) 1 1Health Assistant. (Female)/Lady Health Visitor 1 1Health Educator 1 1Laboratory Technician 1 1Cold Chain & Vaccine Logistic Assistant 1 1Multi-skilled Group D worker 2 2Sanitary worker cum watchman 1 1 +1Total 13 18 14 21*For Sub-Centre area of PHC.#If the delivery case load is 30 or more per month. One of the two medical officers (MBBS) should be female.^To provide choices to the people wherever an AYUSH public facility is not available in the near vicinity.16Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

cum watchman have been provided have beenprovided to take care of additional delivery caseload. Medical Officer should be available on call duty tomanage emergencies. Accommodation for at least one MO and 3 StaffNurses will be provided. One of the Class IV employee may be identified ashelper to Cold Chain & Vaccine Logistic Assistant& trained.The job responsibilities of the different personnel are givenin Annexure 7. Funds may be made available for hiringadditional manpower as per provision under NRHM.DrugsEssential:a.b.c.d.All the drugs available in the Sub-Centre shouldalso be available in the PHC. All the drugs asper state/UT essential drug list shall be available.In addition, all the drugs required for the NationalHealth Programmes and emergency managementshould be available in adequate quantities soas to ensure completion of treatment by allpatients.Adequate quantities of all drugs should bemaintained through periodic stock-checking,appropriate record maintenance and inventorymethods. Facilities for local purchase of drugsin times of epidemics/outbreaks/emergenciesshould be made available.Drugs of that discipline of AYUSH to be madeavailable for which the doctor is present.The list of suggested drugs is given inAnnexure 4.The Transport Facilities withAssured Referral LinkagesReferral Transport FacilityIt is desirable that the PHC has ambulance facilitiesfor transport of patients for timely and assuredreferral to functional FRUs in case of complicationsduring pregnancy and child birth. This may beoutsourced either through Govt/PPP model or linkageswith Emergency Transport system should be in place.Transport for Supervisory and OtherOutreach ActivitiesIt is desirable that the vehicle is made available throughoutsourcing.Laundry ServicesProvision for clean linen shall be made for admittedpatients. At least 5 sets of linen shall be made available.Laundry Services may be available in house oroutsourced.Dietary Facilities for indoorPatientsDesirableNutritious and well- balanced diet shall be providedto all IPD patients keeping in mind their culturalprefernces. A suitable arrangement with a localagency like a local women’s group/NGO/Self-HelpGroup for provision of nutritious and hygienic food atreasonable rates may be made wherever feasible andpossible.Waste Management at PHCLevel“Guidelines for Health Care Workers for WasteManagement and Infection Control in Primary HealthCentres” are to be followed.Quality AssurancePeriodic skill development training of the staffof the PHC in the various jobs/responsibilitiesassigned to them.Standard Treatment Protocol for all NationalHealth Programmes and locally common diseaseshould be made available at all PHCs.Regular monitoring is another important means.A few aspects that need definite attention are:i. Interaction and Information Exchange withthe client/patient:• Courtesy should be extended to patients/clients by all the health providers includingthe support staff.Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres 17

ii.• All relevant information should beprovided as regards the condition/illnessof the client/patient.• Attitude of the health care providersneeds to undergo a radical change soas incorporate the feeling that client isimportant and needs to be treated withrespect.Cleanliness should be maintained in allareas.Monitoring of PHC functioningThis is important to ensure that quality is maintainedand also to make changes if necessary.Internal Mechanisms: Record maintenance, checkingand supervision.Medical AuditDeath AuditPatient Satisfaction Surveys: For both OPD and IPDpatients.Evaluation of Complaints and suggestions received;External Mechanisms: Monitoring through the PRI/Village Health Sanitation and Nutrition Committee/RogiKalyan Samiti/community monitoring framework. (asper guidelines of GOI/State Government). A checklistfor the same is given in Annexure 6. A format forconducting facility survey for the PHCs to have baselineinformation on the gaps in comparison to Indian PublicHealth Standards and subsequently to monitor theavailability of facilities as per IPHS guidelines is given atAnnexure 9.Social auditAccountabilityTo ensure accountability, the Charter of Patients’Rights should be made available in each PHC (asper the guidelines given in Annexure 8). Every PHCshould have a Rogi Kalyan Samiti/Primary HealthCentre’s Management Committee for improvementof the management and service provision of thePHC (as per the Guidelines of Government of India).This committee will have the authority to generate itsown funds (through users’ charges, donation etc.) andutilize the same for service improvement of the PHC. ThePRI/Village Health Sanitation and Nutrition Committee/Rogi Kalyan Samiti should also monitor the functioningof the PHCs.Statuary and RegulatoryCompliancePHC shall fulfil all the statuary and regulatoryrequirements and comply to all the regulationsissued by local bodies, state and union of India. PHCshall have copy of these regulations/Acts. List ofstatuary and regulatory compliances is given inAnnexure 12.18Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

AnnexuresAnnexure 1National Immunization Schedule for Infants,Children and Pregnant WomenVaccine When to give Dose Route SiteFor Pregnant WomenTT-1 & 2 Early in pregnancy and 4 weeks 0.5 ml Intra-muscular Upper Armafter TT-1*[one dose (booster)* if previouslyvaccinated within last 3 years]TT-Booster If pregnancy occur within three 0.5 ml Intra-muscular Upper Armyears of last TT vaccinations*For InfantsBCGAt birth (for institutionaldeliveries) or along with DPT-1(upto one year if not given earlier)0.1 ml (0.05 ml forinfant up to 1 month)Intra-dermal Left Upper ArmHepatitis B- 0OPV - 0Immunization programme provides vaccination against seven vaccine preventable diseasesAt birth for institutional delivery,preferably within 24 hrs of deliveryAt birth for institutional deliverieswithin 15 days0.5 ml Intra-muscular Outer Mid-thigh (Anterolateralside of mid thigh)2 drops Oral OralOPV 1, 2 & 3 At 6 weeks, 10 weeks & 14 weeks 2 drops Oral OralDPT 1, 2 & 3 At 6 weeks, 10 weeks & 14 weeks 0.5 ml Intra-muscular Outer Mid-thigh (Anterolateralside of mid thigh)Hepatitis B- 1,2 & 3At 6 weeks, 10 weeks & 14 weeks 0.5 ml Intra-muscular Outer Mid-thigh (Anterolateralside of mid-thigh)Measles 1 & 2 At 9-12 months and 16-24 months 0.5 ml Sub-cutaneous Right upper ArmVitamin-A At 9 months with measles 1 ml (1 lakh IU) Oral Oral(1 st dose)For ChildrenDPT booster 16-24 months 0.5 ml Intra-muscular Outer Mid-thigh (Anterolateralside of mid-thigh)2 nd booster at 5 years of age 0.5 ml Intra-muscular Upper ArmIndian Public Health Standards (IPHS) Guidelines for Primary Health Centres 19

Vaccine When to give Dose Route SiteOPV Booster 16-24 months 2 drops Oral OralJE^ 16-24 months 0.5 ml Sub-cutaneous Upper ArmVitamin A 2 nd dose at 16 months with DPT/ 2 ml (2 lakh IU) Oral Oral(2 nd to 9 th dose) OPV booster. 3 rd to 9 th doses aregiven at an interval of 6 monthsinterval till 5 years ageDT Booster 5 years 0.5 ml Intra-muscular Upper ArmTT 10 years & 16 years 0.5 ml Intra-muscular Upper Arm* TT-2 or Booster dose to be given before 36 weeks of pregnancy.^ JE in Selected Districts with high JE disease burden (currently 112 districts)A fully immunized infant is one who has received BCG, three doses of DPT, three doses of OPV, three doses of Hepatitis B and Measles beforeone year of age.Note: The Universal Immunization Programme is dynamic and hence the immunization schedule needs to be updated from time to time.20Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

Annexure 2Layout of PHCTOILET1500X1500BABYWASHDIRTYUTILITY1800X1500LABOURROOM3800X4200TOILET1500X2100LADIES WARD5500X3500STRELISATION3885X2100TOILET1500X1800DIRTYLINEN1800X2000GENT’S WARD5500X3500NURSESROOM3100X3500MINOR O.T./DRESSING/INJECTION.4000X4500LAB.3000X3500REGISTRATION& RECORD3000X3000ENTRANCE3000X4500NOTE: THIS DRAWING IS ONLY FOR REFERENCETHE DESIGN SHALL BE PREPARED AS PERTHE LOCATION AND SHAPE OF THE SITELEVELS OF THE SITE AND CLIMATICCONDITIONS.M.O.3500X4500DISPENSINGCUM STORE.3000X3500OFFICE3000X3500M.O.3500X4500WATTING3000X3500IMMUNISATION/FP/COUNSELLING3000X3500GENERALSTORE2100X3500COLDCHAIN2100X3500WC WCGENT’STOILET2200X3500LADIESTOILET2200X3500WC WCCORRIDOR 1800 WIDEPRIMARY HEALTH CENTERTYPICAL PLANPLINTH AREA 385.00S.MWCSTAFFGENT’S1800X2700STAFFLADIES1800X2100WCCORRIDOR 1800 WIDEIndian Public Health Standards (IPHS) Guidelines for Primary Health Centres 21

Annexure 2A: Layout of Operation TheatreW3D2CHANGE(MALE)(2240X1500)SCRUB(1500X1500)D2DIRTY UTILITY(1750X1500)D1D4CHANGE(FEMALE)(2245X1500)OPERATION THEATRE(5750X4600)D1D1 D6LINEN STORE(3000X1500)POST-OPERATIVE CARE(5565X3000)D2STERILIS ATION(1500X3000)W1D1D6PLUG-ON TOMAIN HOSPITAL CORRIDOROPERATION THEATRE UNITCOVERED AREA-84.00 SO.MTS.TYPICAL LAYOUT FOR OPERATION THEATRENOTE:The layout shown integrates the O.T. withthe exisng facility following the principlesof funconal consistency. Care has beentaken to ensure that the dirty ulityremains accesible from outsidethe building.R.C.H. PROGRAMGUIDE TO FACILITIES DESIGNE.C.: PLUG-ON FACILITIES Drg, No.222Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

Annexure 3List of suggested equipment and Furnitureincluding Reagents and diagnostic KitsEssential1.2.3.Normal Delivery Kit.Equipment for assisted vacuum delivery.Equipment for assisted forceps delivery.4. Standard Surgical Set (for minor procedures likeepisiotomies stitching).5. Equipment for Manual Vacuum Aspiration.6. Equipment for New Born Care and NeonatalResuscitation.7. IUCD insertion kit.8. Equipment/reagents for essential laboratoryinvestigations.9. Refrigerator.10. ILR (Small) and DF (Small) with Voltage Stabilizer.11. Cold Boxes (Small & Large): Small- one, Large –two.12. Vaccine Carriers with 4 Icepacks: Two per SC(maximum 2 per polio booth) + 1 for PHC.13. Spare ice pack box: 8, 25 & 60 ice pack boxes pervaccine carrier, Small cold box & Large cold boxrespectively.14. Waste disposal twin bucket, hypochlorite solution/bleach: As per need.15. Freeze Tag: 2 per ILR bimonthly.16. Thermometres Alcohol (stem): Need Based17. Ice box.18. Computer with accessories including internetfacility.19. Binocular microscope.20. Equipment under various National Programmes.21. Radiant warmer for new born baby.22. Adult weighing scale.23. Baby weighing scale.24. Height measuring Scale.25. Table lamp with 200 watt bulb for New bornbaby.26. Phototherapy unit (Desirable).27. Self inflating bag and mask-neonatal size.28. Laryngoscope and Endotracheal intubation tubes(neonatal).29. Mucus extractor with suction tube and a footoperated suction machine.30. Feeding tubes for baby.31. Sponge holding forceps – 2.32. Vulsellum uterine forceps – 2.33. Tenaculum uterine forceps – 2.34. MVA syringe and cannulae of sizes 4-8 (2 sets; onefor back up in case of technical problems).35. Kidney tray for emptying contents of MVA syringe.36. Torch without batteries – 2.37. Battery dry cells 1.5 volt (large size) – 4.38. Bowl for antiseptic solution for soaking cotton swabs.39. Tray containing chlorine solution for keepingsoiled instruments.40. Kits for testing residual chlorine in drinking water.41. H S Strip test bottles.2Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres 23

42. Head Light.43. Ear specula.44. B.P. Apparatus table model – 2.45. Stethoscope – 2.46. 3 sets of NSV instruments.47. Minilap kits –5.Desirable1. Room Heater/Cooler for immunization clinic withelectrical fittings as per need.2. Ear Syringe.3. Otoscope.4. Jobson Horne Probe.5. Tuning fork.6. Noise Maker.7. ECG machine ordinary – 1.8. Nebuliser – 1Requirements for a fully equipped andoperational labour roomEssentialA fully equipped and operational labour room musthave the following:1. A labour table2. Suction machine3. Facility for Oxygen administration4. Sterilisation equipment5. 24-hour running water6. Electricity supply with back-up facility (generatorwith POL)7. Attached toilet facilities8. Newborn Corner: Details mentioned inAnnexure 3A9. Emergency drug tray: This must have the followingdrugs:•y Inj. Oxytocin•y Inj. Diazepam•y Tab. Nifedepine•y Inj. Magnesium sulphate•y Inj. Lignocaine hydrochloride•y Inj. Methyl ergometrine maleate•y IV Haemaccel•y Sterilised cotton and gauze10. Delivery kits, including those for normal deliveryand assisted deliveries. PRIVACY of a woman inlabour should be ensured as a quality assuranceissue.List of equipment for Pap smear1. Cusco’s vaginal speculum (each of small, mediumand large size)2. Sim’s vaginal speculum – single & double ended -(each of small, medium and large size)3. Anterior Vaginal wall retractor4. Sterile Gloves5. Sterilised cotton swabs and swab sticks in a jarwith lid6. Kidney tray for keeping used instruments7. Bowl for antiseptic solution8. Antiseptic solution: Chlorhexidine 1% or Cetrimide2% (if povidone iodine solution is available, it ispreferable to use that)9. Cheatle’s forceps10. Proper light source/torch11. For vaginal and Pap Smears:•y Clean slides with cover slips•y Cotton swab sticks•y KOH solution in bottle with dropper•y Saline in bottle with dropper•y Ayre’s spatula•y Fixing solution/hair sprayRequirements of the laboratoryEssentialReagents1. Reagents of Cyan meth - haemoglobin method forHb estimation2. Uristix for urine albumin and sugar analysis3. ABO & Rh antibodies4. KOH solution for Whiff test5. Gram’s iodine6. Crystal Violet stain7. Acetone-Ethanol decolourising solution.8. Safranine stain9. PH test strips10. RPR test kits for syphilis24Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

11. H S Strip test kits for fecal contamination of2drinking water12. Test kits for estimation of residual chlorine indrinking water using orthotoludine reagent13. 1000 Nos Whole Blood Finger Prick HIV Rapid Testand STI Screening Test each.EssentialGlassware and other equipment:1. Colorimetre2. Test tubes3. Pipettes4. Glass rods5. Glass slides6. Cover slips7. Light Microscope8. Differential blood cell counter (Desirable)9. Glucometer (Desirable)List of Furniture at PHCThe list is indicative and not exhaustive. The Furniture/fittings and Medical and Surgical itmes are to beprovided as per need and availability of space andservices provided by the PHC.Essential Items1. Examination table 42. Writing tables with table sheets 63. Plastic chairs (for in-patients’ attendants) 64. Armless chairs 165. Full size steel almirah 76. Table for Immunization/FP/Counseling 17. Bench for waiting area 28. Wheel chair 29. Stretcher on trolley 210. Wooden screen 111. Foot step 512. Coat rack 213. Bed side table 614. Bed stead iron (for in-patients) 615. Baby cot 216. Stool 1017. Medicine chest 118. Lamp 319. Side Wooden racks 420. Fans 621. Tube light 822. Basin 223. Basin stand 224. Buckets 425. Mugs 426. LPG stove 127. LPG cylinder 228. Sauce pan with lid 229. Water receptacle 330. Rubber/plastic shutting2 metres31. Drum with tap for storing water 232. Mattress for beds 1233. Foam Mattress for OT table 234. Foam Mattress for labour table 235. Bed sheets 3036. Pillows with covers 3037. Blankets 1838. Baby blankets 439. Towels 1840. Curtains with rods20 metres41. Dustbin 542. Coloured Puncture proof bags as per need43. Generator (5 KVA with POL for immunizationpurpose) 1Essential Medical/Surgical items1. Blood Pressure Apparatus 32.(Non-mercury is desirable)Stethoscope 33. Tongue Depressor 104. Torch 25. Thermometre Clinical 46. Hub cutter 27. Needle Destroyer 28. Labour table1 (02 for Type B PHC)9. OT table 110. Arm board for adult and child 411. Instrument trolley 212. I V stand 1013. Shadowless lamp light (for OT and Labour room) 214. Macintosh for labour and OT table As per needIndian Public Health Standards (IPHS) Guidelines for Primary Health Centres 25

15. Kelly’s pad for labour and OT table 2 sets16. Red BagsAs per need17. Black bagsAs per needDesirable1. Black Board/Overhead Projector 12. Public Address System 126Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

Annexure 3A: Newborn Corner in Labour Room/OTDelivery rooms in Operation Theatres (OT) and in Labourrooms are required to have separate resuscitationspace and outlets for newborns. Some term infants andmost preterm infants are at greater thermal risk andoften require additional personnel (Human Resource),equipment and time to optimize resuscitation.An appropriate resuscitation/stabilization environmentshould be provided as provision of appropriatetemperature for delivery room & resuscitation of highriskpreterm infants is vital to their stabilization.Services at the CornerThis space provides an acceptable environmentfor most uncomplicated term infants, but may notsupport the optimal management of newborns whomay require referral to SNCU. Services provided in theNewborn Care Corner are: Care at birth Resuscitation Provision of warmth Early initiation of breastfeeding Weighing the neonateConfiguration of the cornerClear floor area shall be provided in the room fornewborn corner. It is a space within the labourroom, 20-30 sq ft in size, where a radiant warmerwill be kept.Oxygen, suction machine and simultaneouslyaccessibleelectrical outlets shall be provided forthe newborn infant in addition to the facilitiesrequired for the mother. Clinical procedures: Standard operatingprocedures including administration of oxygen,airway suctioning would be put in place.Resuscitation kit should be placed as part ofradiant warmer.Provision of hand washing and containment ofinfection control if it is not a part of the deliveryroom.The area should be away from draught of air, andshould have power connection for plugging in theradiant warmer.Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres 27

Equipment and Consumables required for the CornerItemNo.Item DescriptionEssentialDesirableQuantityInstallationTrainingCivilMechanicalElectrical1Open care system: radiant warmer, fixed height, with trolley,drawers, O2-bottlesE 1 X X X X X2Resuscitator (silicone resuscitation bag and mask with reservoir)hand-operated, neonate, 500 mlE 1 X3 Weighing Scale, spring E 1 X4 Pump suction, foot operated E 1 X5 Thermometre, clinical, digital, 32-34 0 C E 26 Light examination, mobile, 220-12 V E 1 X X7 Hub Cutter, syringe E 1 XConsumables8 I/V Cannula 24 G, 26 G E9 Extractor, mucus, 20ml, ster, disp Dee Lee E10 Tube, feeding, CH07, L40cm, ster, disp E11 Oxygen catheter 8 F, Oxygen Cylinder E12 Sterile Gloves E28Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

Annexure 4Essential Drugs for PHCAll the drugs available at the Sub-Centre level should also be available at the PHC, perhaps in greater quantities,(if required). List of the drugs given under is not exhaustive and exclusive but has been provided for delivery ofminimum assured services.OxygenInhalationDiazepamInjection 5 mg/mlAcetyl Salicylic AcidTablets 300 mg, 75 mg & 50 mgIbuprofenTablets 400 mgParacetamolInjection 150 mg/mlSyrup 125 mg/5mlChlorpheniramine MaleateTablets 4 mgDexchlorpheniramine MaleateSyrup 0.5 mg/5 mlDexamethasoneTablets 0.5 mgPheniramine MaleateInjection 22.75 mg/mlPromethazineTablets 10 mg, 25 mgSyrup 5 mg/5 mlCapsules 250 mg, 500 mgAmpicillinCapsules 250 mg, 500 mgPowder for suspension 125 mg/5 mlBenzylpenicillinInjection 5 lacs, 10 lacs unitsCloxacillinCapsules 250 mg, 500 mgLiquid 125 mg/5 mlProcaine BenzylpenicillinInjection Crystalline penicillin (1 lac units)+ Procaine penicillin (3 lacs units)CephalexinSyrup 125 mg/5 mlGentamicinInjection 10 mg/ml, 40 mg/mlIndian Public Health Standards (IPHS) Guidelines for Primary Health Centres 29

Activated Charcoal PowderAntisnake Venom(Lyophilyzed Polyvalent Serum)CarbamazepinePhenytoin SodiumMebendazoleAlbendazoleDiethylcarbamazine CitrateAmoxycillinGlyceryl TrinitrateIsosorbide 5 MononitratePropranololAmlodipineAtenololEnalapril MaleateAmpouleTablets 100 mg, 200 mgSyrup 20 mg/mlCapsules or Tablets 50 mg,100 mgSyrup 25 mg/mlTablets 100 mgSuspension 100 mg/5 mlTablets 400 mgTablets 150 mgPowder for suspension125 mg/5 mlSublingual Tablets 0.5 mgInjection 5 mg/mlTablets 10 mgTablets 10 mg, 40 mgInjection 1 mg/mlTablets 2.5 mg, 5 mg, 10 mgTablets 50 mg, 100 mgTablets 2.5 mg, 5 mg, 10 mgInjection 1.25 mg/mlTablets 250 mgTablets 25 mg, 50 mg, 100 mgTablets 12.5, 25 mgTablets 25 mgTablets 5 mg, 10 mgMethyldopaTab. MetoprololHydrochlorthiazideTab. CaptoprilTab. Isosorbide Dinitrate (Sorbitrate)Benzoic Acid + Salicylic Acid Ointment or Cream 6%+3%Miconazole Ointment or Cream 2%Framycetin Sulphate Cream 0.5%Neomycin +BacitracinOintment 5 mg + 500 IUPovidone Iodine Solution and Ointment 5%Silver Nitrate Lotion 10%Nalidixic AcidTablets 250 mg, 500 mgNitrofurantoinTablets 100 mgNorfloxacinTablets 400 mgTetracyclineTablets or Capsules 250 mgGriseofulvinCapsules or Tablets 125 mg, 250 mgNystatinTablets 500,000 IU30Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

MetronidazoleDextran Injection 6%Silver Sulphadiazine Cream 1%Pessaries 100,000 IUTablets 200 mg, 400 mg SyrupBetamethasone Cream/Ointment 0.05%Dipropionate CalamineZinc OxideGlycerinLotionDusting PowderSolutionBenzyl Benzoate Lotion 25 %Benzoin CompoundChlorhexidineEthyl AlcoholTinctureSolution 5% (conc. for dilution)70% SolutionGentian Violet Paint 0.5%, 1%Hydrogen Peroxide Solution 6%Bleaching PowderFormaldehyde IPPotassium PermanganateFurosemideAluminium Hydroxide + MagnesiumHydroxideOmeprazoleRanitidine HydrocholorideDomperidoneMetoclopramideDicyclomine HydrochlorideHyoscine Butyl BromideBisacodylIsphaghulaOral Rehydration SaltsOral Contraceptive pillsCondoms (Nirodh)Copper T (380 A)PrednisolonePowderSolutionCrystals for solutionInjection, 10 mg/mlTablets 40 mgSuspensionTabletCapsules 10, 20, 40 mgTablets 150 mg, 300 mgInjection 25 mg/mlTablets 10 mgSyrup 1 mg/mlTablets 10 mgSyrup 5 mg/mlInjection 5 mg/mlTablets 10 mgInjection 10 mg/mlTablets or 10 mgInjection 20 mg/mlTablets/suppository 5 mgGranulesPowder for solution As per IPTablets 5 mg, 10 mgIndian Public Health Standards (IPHS) Guidelines for Primary Health Centres 31

GlibenclamideInsulin Injection (Soluble)MetforminRabies VaccineTetanus ToxoidTablets 2.5 mg, 5 mgInjection 40 IU/mlTablets 500 mgInjectionInjectionChloramphenicol Eye Drops Drops/Ointment 0.4%, 1%Ciprofloxacin Hydrochloride Eye Drops Drops/Ointment 0.3%Gentamicin Eye/Ear Drops 0.3%Miconazole Cream 2%Sulphacetamide Sodium Eye Drops Drops 10%, 20%, 30%Tetracycline Hydrochloride Eye oint Ointment 1%Prednisolone Sodium Phosphate Eye Drops 1%Xylometazoline Nasal Drops Drops 0.05%, 0.1%DiazepamAminophyllineBeclomethasone DipropionateSalbutamol SulphateDextromethorphanDextroseNormal SalinePotassium ChlorideRinger LactateSodium BicarbonateAscorbic AcidCalcium saltsTablets 2 mg, 5 mg, 10 mgInjection 25 mg/mlInhalation 50 mg, 250 mg/doseTablets 2 mg, 4 mgSyrup 2 mg/5 mlInhalation 100 mg/doseTablets 30 mgIV infusion 5% isotonic 500 ml bottleIV Infusion 0.9% 500 ml bottleSyrup 1.5 gm/5 ml, 200 mlIV infusion 500 mlInjectionTablets 100 mg, 500 mgTablets 250 mg, 500 mgMultivitamins Tablets (As per Schedule V)Broad spectrum antibiotic/antifungalWax dissolvingNVPSTI syndromic treatment kitClofazimineDrugs and Logistics for ImmunizationEssentialEar dropsEar dropsTablets and bottle (5 ml)As per NeedTablets 100 mg (loose)VaccinesAntirabies vaccineAD syringesBCG, DPT, OPV, Measles, TT, Hep B, JE andother vaccines if any as per GOI guidelinesAs per need(0.5 ml & 0.1 ml) - need based32Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

Reconstitution syringesVaccine CarriersZipper bagVial Opener5 ml – need basedas per needper vaccine carrierNeed basedVitamin A1 months supply for all the SCs directlyunder the PHC+ 10% buffer stockNote: Minimum and maximum Stock: 0.5 and 1.25 month respectively. Indent order and receipt of vaccines and logistics should be monthlyat minimum stock level. CC & VL Assistant should coordinate timely receipt of required vaccines and Logistics from the District Stores.Emergency drug kit to manage Anaphylaxis and other AEFIEssentialInj. Adrenaline,Inj. Hydrocortisone,Inj. Dexamethasone,Ambu bag (Paediatric),Sterile hypodermic syringe for single use with reuse prevention feature 2ml and 5ml syringes, Needles (Size 24, 22, 20).Drugs and Consumables for MVA:Syringe for local anaesthesia (10 ml) and Sterile Needle (22-24 gauge).Chlorine solution.Antiseptic solution (savlon).Local Anaesthetic agent (injection 1% Lignocaine, for giving para cervical block).Sterile saline/sterile water for flushing cannula in case of blockage.Infection prevention equipment and supplies.Drugs under RCH for Primary Health CentreMany of these drugs are already included in the above mentioned Essential Drug List. For grouping purposerepetition is being done.Essential Obstetric Care Drug Kit for PHCSl. No. Name of the Drug/Form Dosage Quantity/Kit1 Diazepam Injection IP Diazepam IP 5 mg/ml; 2 ml in each ampoule 50 ampoules2 Lignocaine Injection IP Lignocaine Hydrochloride IP 2% w/v; 30 ml in each 10 vialsvial3 Pentazocine Injection IP Pentazocine Lactate IP eq. to Pentazocine 30 mg/ml; 50 ampoules01 ml in each ampoule4 Dexamethasone Injection IP Dexamethasone Sodium Phosphate IP eq. toDexamethasone Phosphate, 4 mg/ml.; 02 ml in eachampoule100 ampoulesIndian Public Health Standards (IPHS) Guidelines for Primary Health Centres 33

Sl. No. Name of the Drug/Form Dosage Quantity/Kit5 Promethazine Injection IP Promethazine hydrochloride IP, 25 mg/ml; 02 ml in 50 ampouleseach ampoule6 Methylergometrine Injection IP Methylergometrine maleate, 0.2 mg/ml; 01 ml in 150 ampouleseach ampoule7 Etofylline BP plus Anhydrous Etofylline BP 84.7 mg/ml & Theophylline IP eq. to 100 ampoulesTheophylline IP CombinationInjection (As per standards provided)Theophylline anhydrous, 25.3 mg/ml; 02 ml in eachampoule8 Adrenaline Injection IP 0.18% w/v Adrenaline tartrate or Adrenaline Tartrate 50 ampoules.IP eq. to Adrenaline 1 mg/ml; 01 ml in each ampoule9 Methylergometrine Tablets IP Methylergometrine maleate IP, 0.125 mg 500 tablets10 Diazepam Tablets IP Diazepam IP 5 mg 250 tablets11 Paracetamol Tablets IP Paracetamol IP 500 mg 1000 tablets12 Co-trimoxazole combination ofTrimethoprim & SulphamethoxazoleTablets IP (Adults)Trimethoprim IP 80 mg/Sulphamethoxazole IP400 mg2000 tablets13 Amoxycillin Capsules IP Amoxycylline Trihydrate IP eq. to amoxycylline 2500 capsules250 mg14 Doxycycline Capsules IP Doxycycline Hydrochloride eq. to Doxycycline 500 capsules100 mg15 Metronidazole Tablets IP Metronidazole IP 200 mg 1000 tablets16 Salbutamol Tablets IP Salbutamol sulphate eq. to Salbutamol 2 mg 1000 tablets17 Phenoxymethylpenicillin PotassiumTablets IP18 Menadione Injection USP (VitaminK3)Phenoxymethylpenicillin Potassium IP eq. toPhenoxymethylpenicillin 250 mgMenadione USP 10mg/ml; 01 ml in each ampoule2000 tablets200 ampoules19 Atropine Injection IP Atropine Sulphate IP 600µg/ml; 02 ml in each 50 ampoulesampoule20 Fluconazole Tablets (As perFluconazole USP 150 mg500 tabletsstandards provided)21 Methyldopa Tablets IP Methyldopa IP eq. to Methyldopa anhydrous 500 tablets250 mg22 Oxytocin Injection IP Oxytocin IP 5.0 I.U./ml; 02 ml in each ampoule 100 ampoules23 Phenytoin Injection BPPhenytoin Sodium IP 50 mg/ml; 02 ml in each 25 ampoules(in solution form)ampoule24 Cephalexin Capsules IP Cephalexin IP eq. to Cephalexin anhydrous 250 mg 1000 capsules25 Compound Sodium Lactate InjectionIP0.24 % V/V of Lactic Acid (eq. to 0.32% w/v ofSodium Lactate), 0.6 % w/v Sodium Chloride, 0.04%w/v Potassium Chloride and 0.027% w/v CalciumChloride; 500 ml in each bottle/pouch200 FFS pouches/BFS Bottles26 Dextrose Injection IP Dextrose IP, 5% w/v; 500 ml in each bottle/pouch 100 FFS pouches/BFS bottles27 Sodium Chloride Injection IP Sodium Chloride IP 0.9% w/v; 500 ml in each bottle/pouch100 FFS pouches/BFS bottles28 Lindane Lotion USP Lindane IP 1% w/v; each tube containing 50 ml 100 tubes29 Dextran 40 Injection IP Dextrans 10% w/v; 500 ml in each bottle 5 bottles30 Infusion Equipment IV Set with hypodermic needle 21G of 1.5” length 20034Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

List of RTI/STI Drugs under RCH ProgrammeEssentialSl. No. Drug Strength Annual Quantity I. FRU1 Ciprofloxacin Hydrochloride Tablets 500 mg I tablet 1000 Tablets2 Doxycycline Hydrochloride Capsules 100 mg I cap 6000 Capsules3 Erythromycin Estolate Tablets 250 mg I tablet 1000 Tablets4 Benzathine Penicillin Injection 24 lakhs units/vial 1000 vials5 Tinidazole Tablets 500 mg tablet 5000 Tablets6 Clotrimazole Cream 100 mg pessary 6000 Pessaries7 Clotrimazole Cream 2% w/w cream 500 Tubes8 Compound Podophyllin 25% w/v 5 Bottles9 Gramma Benzene Hexachloride 1 % w/v 10 BottlesApplication (Lindane Application)10 Distilled Water 10001 AmpoulesList of AYUSH Drugs to be used by AYUSH doctor posted at PHCs (as per the list providedby the Department of AYUSH, Ministry of Health & Family Welfare, Government ofIndia)List of Ayurvedic Medicines for PHCs1. Sanjivani Vati2. Godanti Mishran3. AYUSH-644. Lakshmi Vilas Rasa (Naradeeya)5. Khadiradi Vati6. Shilajatwadi Louh7. Swag Kuthara rasa8. Nagarjunabhra rasa9. Sarpagandha Mishran10. Punarnnavadi Mandura11. Karpura rasa12. Kutajaghan vati13. Kamadudha rasa14. Laghu Sutasekhar rasa15. Arogyavardhini Vati16. Shankha Vati17. Lashunadi Vati18. Agnitundi Vati19. Vidangadi louh20.21.22.23.24.25.26.27.28.29.30.31.32.33.34.35.36.37.38.39.Brahmi VatiSirashooladi Vajra rasaChandrakant rasaSmritisagara rasaKaishora gugguluSimhanad gugguluSimhanad gugguluYograj gugguluGokshuradi gugguluGandhak RasayanRajapravartini vatiTriphala gugguluSaptamrit LouhKanchanara gugguluAyush GhuttiTalisadi ChurnaPanchanimba ChurnaAvipattikara ChurnaHingvashtaka ChurnaEladi churnaIndian Public Health Standards (IPHS) Guidelines for Primary Health Centres 35

40.41.42.43.44.45.46.47.48.49.50.51.52.53.54.55.56.57.58.59.60.61.62.63.64.65.66.67.68.69.70.71.72.73.74.75.76.77.78.Swadishta virechan churnaPushyanuga ChurnaDasanasamskara ChurnaTriphala ChurnaBalachaturbhadra ChurnaTrikatu ChurnaSringyadi ChurnaGojihwadi kwath ChurnaPhalatrikadi kwath ChurnaMaharasnadi kwath ChurnaPashnabhedadi kwath ChurnaDasamoola kwath ChunaEranda PakaHaridrakhandaSupari pakSoubhagya ShunthiBrahma RasayanaBalarasayanaChitraka hareetakiAmritarishtaVasarishtaArjunarishtaLohasavaChandansavaKhadirarishtaKutajarishtaRohitakarishtaArk ajwainAbhayarishtaSaraswatarishtaBalarishtaPunarnnavasavLodhrasavaAshokarishtaAshwagandharishtaKumaryasavaOasamoolarishtaArk Shatapushpa (Sounf)Drakshasava79. Aravindasava80. Vishagarbha Taila81. Pinda Taila82. Eranda Taila83. Kushtarakshasa Taila84. Jatyadi Taila/Ghrita85. Anu Taila86. Shuddha Sphatika87. Shuddha Tankan88. Shankha89. Abhraka Bhasma90. Shuddha Gairika91. Jahar mohra Pishti92. Ashwagandha Churna93. Amrita (Giloy) Churna94. Shatavari Churna95. Mulethi Churna96. Amla Churna97. Nagkesar Churna98. Punanrnava99. Dadimashtak Churna100. Chandraprabha VatiList of Unani Medicines for PHCs1. Arq-e-Ajeeb2. Arq-e-Gulab3. Arq-e-kasni4. Arq-e-Mako5. Barashasha6. Dawaul Kurkum Kabir7. Dwaul Misk Motadil Sada8. Habb-e-Aftimoon9. Habb-e-Bawasir Damiya10. Habb-e-Bukhar11. Habb-e-Dabba-e-Atfal12. Habb-e-Harmal13. Habb-e-Hamal14. Habb-e-Hilteet15. Habb-e-Hindi Oabiz16. Habb-e-Hindi Zeeqi36Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

17.Habb-e-Jadwar56.Majoon Mochras18.Habb-e-Jawahir57.Majoon Muqawwi-e-Reham19.Habb-e-Jund58.Majoon Nankhwah20.Habb-e-Kabid Naushadri59.Majoon Panbadana21.Habb-e-karanjwa60.Majoon Piyaz22.Habb-e-khubsul Hadeed61.Majoon Suhag Sonth23.Habb-e-Mubarak62.Majoon Suranjan24.Habb-e-Mudirr63.Majoon Ushba25.Habb-e-Mumsik64.Marham Hina26.Habb-e-Musaffi65.Marham Kafoor27.Habb-e-Nazfuddam66.Marham Kharish28.Habb-e-Nazla67.Marham Ouba29.Habb-e-Nishat68.Marham Ral Safaid30.Habb-e-Raal69.Qurs Aqaqia31.Habb-e-Rasaut70.Qurs Dawaul shifa32.Habb-e-Shaheeqa71.Qurs Deendan33.Habb-e-Shifa72.Qurs Ghafis34.Habb-e-Surfa73.Qurs Habis35.Habb-e-Tabashir74.Ours Mulaiyin36.Habb-e-Tankar75.Ours Sartan Kafoor37.Habb-e-Tursh Mushtahi76.Qurs Mulaiyin38.Ltrifal Shahatra77.Qurs Sartan Kafoori39.Ltrifal Ustukhuddus78.Qurs Zaranbad40.Ltrifal Zamani79.Qurs Ziabetus Khaas41.Jawahir Mohra80.Qurs Ziabetus sada42.Jawarish Jalinoos81.Qurs-e-Afsanteen43.Jawarish Kamooni82.Qurs-e-Afsanteen44.Jawarish Mastagi83.Qurs-e-Sartan45.Jawarish Tamar Hindi84.Qutoor-e-Ramad46.Khamira Marwareed85.Raughan Baiza-e-Murgh47.Kushta Marjan Sada86.Raughan Bars48.Laooq Katan87.Raughn Kamila49.Laooq khiyarshanbari88.Raughan Qaranful50.Laooq Sapistan89.Raughan Surkh51.Majoon Arad Khurma90.Raughan Turb52.Majoon Dabeedulward91.Roghan Malkangni53.Majoon Falasifa92.Roghan Qust54.Majoon Jograj Gugal93.Safppf Amla55.Majoon Kundur94.Safoof AmlaIndian Public Health Standards (IPHS) Guidelines for Primary Health Centres 37

95. Safoof Chutki96. Safoof Dama Haldiwala97. Safof Habis98. Safoof Muqliyasa99. Safoof Mustehkam Dandan100. Safoof naushadar101. Safoof Salilan102. Safoof Teen103. Sharbat Anjabar104. Sharbat Buzoori Motadil105. Sharbat faulad106. Sharbat Khaksi107. Sharbat sadar108. Sharbat Toot Siyah109. Sharbat Zufa110. Sunoon Mukhrij-e-Rutoobat111. Tiryaq Nazla112. Tiryaq Pechish113. Zuroor-e-OulaList of Sidha Medicines for PHCs1. Amai out parpam - For diarrhea2. Amukkarac curanam - For general debility, insomnia, Hyper acidity3. Anna petic centuram - For anemia4. Antat Tailam - For febrile convulsions5. Atotataik kuti nir - cough and cold6. Aya kantac centuram - aneamia7. Canku parpam - anti allergic8. Canta cantirotayam - fevers and jaundice9. Cilacattu parpam - Urinary infection, white discharge10. Civanar Amirtam - anti allergic, bronchial asthma11. Comput Tinir - indigestion, loss of appetite12. Cuvacakkutori mathirai - asthma and cough13. Elatic curanam - allergy, fever in primary complex14. Incic Curanam - indigestion, flatulence15. Iraca Kanti Mrluku - skin 9 infections, venereal infections16. Kantaka racayanam - skin diseases and urinary infections17. Kapa Curak Kutinir - fevers18. Karappan tailam - eczema19. Kasturik Karuppu - fever, cough, allergic bronchitis20. Korocanai Mattirai - sinus, fits21. Kunkiliya Vennay - external application for piles and scalds22. Manturati Ataik Kutinir - anaemia23. Mattan Tailam - ulcers and diabetic carbuncle24. Mayanat Tailam - swelling, inflammation25. Muraukkan Vitai Mattirai - intestinal worms26. Nantukkal parpam - diuretic27. Nelikkai llakam - tonic38Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

28.29.30.31.32.33.34.35.36.37.Neruncik Kutinir - diureticNilavakaic Curanam - constipationNila Vempuk Kutinir - feverOmat Tinir - indigestionParankip pattaic curanam - skin diseasesPattuk karuppu - DUB, painful menstruationTayirc Cuntic Curanam - diarrhea, used as ORSTerran kottai llakam - tonic, used in bleeding pilesTiripalaic Curanam - styptic and tonicVisnu Cakkaram - pleurisyPatent & Proprietary Drug1.777 oil - for psoriasisList of Homeopathy Medicines for PHCsSl. No. Name of Medicine Potency1 Abrotanum 302 Abrotanum 2003 Absinthium Q4 Acconite Nap. 65 Acnite Nap. 306 Aconite Nap. 2007 Aconite Nap. 1M8 Aconite Nap. 309 Actea Racemosa 20010 Actea Racemosa 3011 Aesculus Hip 20012 Aesculus Hip 1M13 Agaricus musca 3014 Agaricus musca 20015 Allium cepa 616 Allium cepa 3017 Allium cepa 20018 Aloe soc. 619 Aloe soc. 3020 Aloe soc. 20021 Alumina 3022 Alumina 20023 Ammon carb 3024 Ammon Carb 20025 Ammon Mur 3026 Ammon Mur 200Sl. No. Name of Medicine Potency27 Ammon Phos 3028 Ammon Phos 20029 Anacardium Ori. 3030 Anacardium Ori. 20031 Anacardium Ori. 1M32 Angustura Q33 Anthracinum 20034 Anthracinum 1M35 Antim Crud 3036 Antim Crud 20037 Antim Crud 1M38 Antimonium Tart 3X39 Antimonium Tart 640 Antimonium Tart 3041 Antimonium Tart 20042 Apis mel 3043 Apis mel 20044 Apocynum Can Q45 Apocynum Can 3046 Arg. Met 3047 Arg. Met 20048 Arg. Nit. 3049 Arg. Nit. 20050 Arnica Mont. Q51 Arnica Mont. 3052 Arnica Mont. 200Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres 39

Sl. No. Name of Medicine Potency53 Arnica Mont 1M54 Arsenicum Alb. 655 Arsenicum Alb. 3056 Arsenicum Alb. 20057 Arsenicum Alb. 1M58 Aurum Met. 3059 Aurum Met. 20060 Bacillinum 20061 Bacillinum 1M62 Badiaga 3063 Badiaga 20064 Baptisia Tinct Q65 Baptisia Tinct 3066 Baryta Carb. 3067 Baryta Carb. 20068 Baryta Carb. 1M69 Baryta Mur. 3X70 Belladonna 3071 Belladonna 20072 Belladonna 1M73 Bellis Perennis Q74 Bellis Perennis 3075 Benzoic Acid 3076 Benzoic Acid 20077 Berberis vulgaris Q78 Berberis vulgaris 3079 Berberis vulgaris 20080 Blatta Orientalis Q81 Blatta Orientalis 3082 Blumea Odorata Q83 Borax 3084 Brovista 3085 Bromium 3086 Bryonia Alba 3X87 Bryonia Alba 688 Bryonia Alba 3089 Bryonia Alba 20090 Bryonia Alba 1M91 Bufo rana 3092 Carbo veg 3093 Carbo veg 20094 Cactus G. Q95 Cactus G. 3096 Calcarea Carb 30Sl. No. Name of Medicine Potency97 Calcarea Carb 20098 Calcarea Carb 1M99 Calcarea Fluor 30100 Calcarea Fluor 200101 Calcarea Fluor 1M102 Calcarea Phos 30103 Calcarea Phos 200104 Calcarea Phos 1M105 Calendula Off. Q106 Calendula Off. 30107 Calendula Off. 200108 Camphora 6109 Camphora 200110 Cannabis Indica 6111 Cannabis Indica 30112 Cantharis Q113 Cantharis 30114 Cantharis 200115 Capsicum 30116 Capsicum 200117 Carbo Animalis 30118 Carbo Animalis 200119 Carbolic Acid 30120 Carbolic Acid 200121 Carduus Mar Q122 Carduus Mar 6123 Carduus Mar 30124 Carcinosinum 200125 Carcinosinum 1M126 Cassia sophera Q127 Caulophyllum 30128 Caulophyllum 200129 Causticum 30130 Causticum 200131 Causticum 1M132 Cedron 30133 Cedron 200134 Cephalendra Indica Q135 Chamomilla 6136 Chamomilla 30137 Chamomilla 200138 Chamomilla 1M139 Chelidonium Q140 Chelidonium 3040Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

Sl. No. Name of Medicine Potency141 Chin Off. Q142 Chin Off. 6143 Chin Off. 30144 Chin Off. 200145 Chininum Ars 3X146 Chininum Sulph 6147 Cicuta Virosa 30148 Cicuta Virosa 200149 Cina Q150 Cina 3X151 Cina 6152 Cina 30153 Cina 200154 Coca 200155 Coculus Indicus 6156 Coculus Indicus 30157 Coffea Cruda 30158 Coffea Cruda 200159 Colchicum 30160 Colchicum 200161 Colocynthis 6162 Colocynthis 30163 Colocynthis 200164 Crataegus Oxy Q165 Crataegus Oxy 3X166 Crataegus Oxy 30167 Crataegus Oxy 200168 Crotalus Horridus 200169 Croton Tig. 6170 Croton Tig. 30171 Condurango 30172 Condurango 200173 Cuprum met. 30174 Cuprum met. 200175 Cynodon Dactylon Q176 Cynodon Dactylon 3X177 Cynodon Dactylon 30178 Digitalis Q179 Digitalis 30180 Digitalis 200181 Dioscorea 30182 Dioscorea 200183 Diphtherinum 200184 Drosera 30Sl. No. Name of Medicine Potency185 Drosera 200186 Dulcamara 30187 Dulcamara 200188 Echinacea Q189 Echinacea 30190 Eqyusetum 30191 Eqyusetum 200192 Eupatorium Perf. 3X193 Eupatorium Perf. 30194 Eupatorium Perf. 200195 Euphrasia Q196 Euphrasia 30197 Euphrasia 200198 Ferrum Met. 200199 Flouric Acid 200200 Formica Rufa 6201 Formica Rufa 30202 Gelsimium 3X203 Gelsimium 6204 Gelsimium 30205 Gelsimium 200206 Gelsimium 1M207 Gentiana Chirata 6208 Glonoine 30209 Glonoine 200210 Graphites 30211 Graphites 200212 Graphites 1M213 Guaiacum 6214 Guaiacum 200215 Hamamelis Vir Q216 Hamamelis Vir 6217 Hamamelis Vir 200218 Helleborus 6219 Helleborus 30220 Hepar Sulph 6221 Hepar Sulph 30222 Hepar Sulph 200223 Hepar Sulph 1M224 Hippozaeniim 6225 Hydrastis Q226 Hydrocotyle As. Q227 Hydrocotyle As. 3X228 Hyocyamus 200Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres 41

Sl. No. Name of Medicine Potency229 Hypericum Q230 Hypericum 30231 Hypericum 200232 Hypericum 1m233 Ignatia 30234 Ignatia 200235 Ignatia 1m236 Lodium 30237 Lodium 200238 Lodium 1m239 Lpecacuanha Q240 Lpecacuanha 3X241 Lpecacuanha 6242 Lpecacuanha 30243 Lpecacuanha 200244 Lris Tenax 6245 Lris Veriscolor 30246 Lris Veriscolor 200247 Jonosia Ashoka Q248 Justicia Adhatoda Q249 Kali Broamtum 3X250 Kali Carb 30251 Kali Carb 200252 Kali Carb 1M253 Kali Cyanatum 30254 Kali Cyanatum 200255 Kali Lod 30256 Kali lopd 200257 Kali Mur 30258 Kali Mur 200259 Kali Sulph 30260 Kalmia Latifolium 200261 Kalmia Latifolium 30262 Kalmia Latifolium 30263 Kreosotum 200264 Kreosotum 1M265 Kreosotum Q266 Lac Defloratum 30267 Lac Defloratum 200268 Lac Defloratum 1M269 Lac Can 30270 Lac Can 200271 Lachesis 30272 Lachesis 200Sl. No. Name of Medicine Potency273 Lachesis 1M274 Lapis Albus 3X275 Lapis Albus 30276 Ledum Pal 30277 Ledum Pal 200278 Ledum Pal 1M279 Lillium Tig. 30280 Lillium Tig. 200281 Lillium Tig. 1M282 Labella inflata Q283 Labella inflata 30284 Lucopodum 30285 Lucopodum 200286 Lucopodum 1M287 Lyssin 200288 Lyssin 1M289 Mag. Carb 30290 Mag. Carb 200291 Mag phos 30292 Mag phos 200293 Mag phos 1M294 Medorrhinum 200295 Medorrhinum 1M296 Merc Cor 6297 Merc Cor 30298 Merc Cor 200299 Merc Sol 6300 Merc Sol 30301 Merc Sol 200302 Merc Sol 1m303 Mezeruim 30304 Mezeruim 200305 Millefolium Q306 Millefolium 30307 Muriatic Acid 30308 Muriatic Acid 200309 Murex 30310 Murex 200311 Mygale 30312 Naja Tri 30313 Naja Tri 200314 Natrum Ars 30315 Natrum Ars 200316 Natrum Carb 3042Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

Sl. No. Name of Medicine Potency317 Natrum Carb 200318 Natrum Carb 1M319 Natrum Mur 6320 Natrum Mur 30321 Natrum Mur 200322 Natrum Mur 1M323 Natrum Phos 30324 Natrum Sulph 30325 Natrum Sulph 200326 Natrum Sulph 1M327 Nitric Acid 30328 Nitric Acid 200329 Nitric Acid 1M330 Nux Vomica 6331 Nux Vomica 30332 Nux Vomica 200333 Nux Vomica 1M334 Nyctenthus Arbor Q335 Ocimum Sanctum Q336 Oleander 6337 Petroleum 30338 Petroleum 200339 Petroleum 1M340 Phosphoric Acid Q341 Phosphoric Acid 30342 Phosphoric Acid 200343 Phosphoric Acid 1M344 Phosphorus 30345 Phosphorus 200346 Phosphorus 1M347 Physostigma 30348 Physostigma 200349 Plantago Major Q350 Plantago Major 6351 Plantago Major 30352 Platina 200353 Platina 1M354 Plumbum Met 200355 Plumbum Met 1M356 Podophyllum 6357 Podophyllum 30358 Podophyllum 200359 Prunus Spinosa 6360 Psorinum 200Sl. No. Name of Medicine Potency361 Psorinum 1M362 Pulsatilla 30363 Pulsatilla 200364 Pulsatilla 1M365 Pyrogenium 200366 Pyrogenium 1M367 Ranunculus bulbosus 30368 Ranunculus bulbosus 200369 Ranunculus repens 6370 Ranunculus repens 30371 Ratanhia 6372 Ratanhia 30373 Rauwolfia serpentina Q374 Rauwolfia serpentina 6375 Rauwolfia serpentine 30376 Rhododendron 30377 Rhododendron 200378 Rhus tox 3X379 Rhus tox 6380 Rhus tox 30381 Rhus tox 200382 Rhus tox 1M383 Robinia 6384 Robinia 30385 Rumex criispus 6386 Rumex criispus 30387 Ruta gr 30388 Ruta gr 200389 Sabal serreulata Q390 Sabal serreulata 6391 Sabina 3X392 Sabina 6393 Sabina 30394 Sang can 30395 Sang can 200396 Sarsaprilla 6397 Sarsaprilla 30398 Secalecor 30399 Secalecor 200400 Selenium 30401 Selenium 200402 Senecio aureus 6403 Sepia 30404 Sepia 200Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres 43

Sl. No. Name of Medicine Potency405 Sepia 1M406 Silicea 30407 Silicea 200408 Silicea 1M409 Spigellia 30410 Spongia tosta 6411 Spongia tosta 30412 Spongia tosta 200413 Stannum 30414 Stannum 200415 Staphisagria 30416 Staphisagria 200417 Staphisagria 1M418 Sticta pulmonaria 6419 Sticta pulmonaria 30420 Stramonium 30421 Stramonium 200422 Sulphur 30423 Sulphur 200424 Sulphur 1M425 Sulphuric acid 6426 Sulphuric acid 30427 Syphilimum 200428 Syphilimum 1M429 Tabacum 30430 Tabacum 200431 Tarentula cubensis 6432 Tarentula cubensis 30433 Tellurium 6434 Tellurium 30435 Terebinthina 6436 Terebinthina 30437 Terminalia arjuna Q438 Terminalia arjuna 3X439 Terminalia arjuna 6440 Thuja occidentalis Q441 Thuja occidentalis 30442 Thuja occidentalis 200Sl. No. Name of Medicine Potency443 Thuja occidentalis 1M444 Thyroidinum 200445 Thyroidinum 1M446 Tuberculinum bov 200447 Uran. Nit 3X448 Urtica urens Q449 Urtica Urens 6450 Ustilago 6451 Verst Blb 6452 Vibrurnan opulus 6453 Vibrurnan opulus 30454 Vibrurnan opulus 200455 Vipera tor 200456 Vipera tor 1M457 Verat viride 30458 Verat viride 200459 Viscum album 6460 Wyethia 6461 Wyethia 30462 Wyethia 200463 Zinc met 200464 Zinc met 1M465 Zinck phos 200466 Zinck phos 1M467 Globules 20 No.468 Suger of milk469 Glass piles 5 ml470 Glass piles 10 ml471 Butter Paper472 Blank Sticker Ointment ½*3/2 inch473 Aesculus Hip474 Arnica475 Calendula477 Cantharis478 Hamamelis Vir479 Twelve Biochemic Medicines 6x & 12x480 Chinerairia Eye Drop481 Mullein Oil (Ear Drop)44Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

Annexure 5Universal PrecautionsThe universal precautions should be understood andapplied by all medical and paramedical staff involvedin providing health services. The basic elementsinclude: Hand washing thoroughly with soap and runningwater:•y Before carrying out the procedure.•y Immediately if gloves are torn and hand iscontaminated with blood or other body fluids.•y Soon after the procedure, with gloves on andagain after removing the gloves. Barrier Precautions: using protective gloves, mask,waterproof aprons and gowns. Strict asepsis during the operative procedureand cleaning the operative site. Practise the “notouch technique” e.g., any instrument or part ofinstrument which is to be inserted in the cervicalcanal must not touch any non-sterile object/surface prior to insertion. Decontamination and cleaning of all instrumentsimmediately after each use. Sterilisation/high level disinfection of instrumentswith meticulous attention. Appropriate waste disposal.Sterilisation of instruments1.2.Instruments and gloves must be autoclavedIn case autoclaving is not possible, the instrumentsmust be fully immersed in water in a coveredcontainer and boiled for at least 20 minutes.Sterilisation of Copper T insertioninstruments Copper T is available in a pre-sterilised pack.Ensure that the instruments and gloves usedfor insertion are autoclaved or fully immersedin a covered container and boiled for at least20 minutes.Sterilisation and maintenance of MVAequipmentThe four basic steps are: Decontamination of instruments, gloves, cannulaeand syringes in 0.5% chlorine solution. Cleaning in lukewarm water using a detergent. Sterilisation/High Level Disinfection. Storage and re-assembly of instruments.The person responsible for cleaning must wear utilitygloves.Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres 45

Annexure 6Check List for Monitoring By External MechanismA simple check list that can be used by NGOs/PRI.Information should be collected by group discussionwith people availing of PHC service.Number of patients used the out-patient services inthe past quarter: How many of them are from SC, ST, and otherbackward classes? How many of them are women? How many of them are children? How many are below poverty line? Are generic drugs prescribed?Availability of Medicines in the PHCIs the Anti-snake venom regularly available in the PHC?Yes/No/No informationIs the anti-rabies vaccine regularly available in the PHC?Yes/No/No informationAre the drugs for Malaria regularly available in the PHC?Yes/No/No informationAre the drugs for Tuberculosis regularly available in thePHC?Are drugs for treatment of Leprosy (MDT Blister Packs)and its complications regularly available in the PHC ?Are all medicine given free of charge in the PHC?: Yes, all the medicines are given free of charge. Some medicines are given free of charge whileothers have to be brought from medical store. Most of the medicines have to be bought frommedical store. No information.Which medicines have to be bought from themedical store? (If possible give the doctor’sprescription along with the checklist.)Availability of curative servicesIs the primary management of wounds done atthe PHC? (stiches, dressing, etc.)Is the primary management of fracture done atthe PHC?Are minor surgeries like draining of abscess etc.done at the PHC?Is the primary management of cases of poisoningdone at the PHC?Is the primary management of burns done atPHC?Availability of Reproductive and ChildHealth ServicesAre Ante-natal clinics organized by the PHCregularly?Is the facility for normal delivery available in thePHC for 24 hours?•y Are deliveries being monitored throughPartograph?•y How many deliveries conducted in the pastquarter?•y How many of them belong to SC, ST and otherbackward classes?Is the facility for tubectomy and vasectomyavailable at the PHC?46Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

Is the facility for internal examination forgynaecological conditions available at the PHC?Is the treatment for gynaecological disorderslike leucorrhea, menstrual disorders available atthe PHC?•y Yes, treatment is available.•y No, women are referred to other healthfacilities.•y Women do not disclose their illness.•y No idea.Is there any fixed day health services for adolescentHealth?Is there any fixed day heath services for familyplanning?If women do not usually go to the PHC, then whatis the reason behind it?Is the Counseling for Family Planning given duringMCH Services.Is the facility for Medical Termination of Pregnancy(MTP) (abortion) available at the PHC?Is there any pre-condition for doing MTP suchas enforced use of contraceptives after MTP orasking for husband’s consent for MTP?•y No precondition.•y Precondition only for some women.•y Precondition for all women.•y No idea.Do women have to pay for Medical Terminationof Pregnancy?Is treatment for anaemia given to both pregnantas well as non-pregnant women?•y All women given treatment for anaemia.•y Only pregnant women given treatment foranaemia.• y No women given treatment for anaemia.Are the low birth weight babies managed at thePHC?Is there a fixed immunization day?Are BCG and Measles vaccine given regularly atthe PHC?Is the treatment of children with pneumoniaavailable at the PHC?Is the management of children suffering fromdiarrhoea with severe dehydration done at thePHC?Availability of laboratory services at thePHC Is blood examination for anaemia done at the PHC?Is detection of malaria parasite by blood smearexamination done at the PHC?Is sputum examination done to diagnosetuberculosis at the PHC?Is urine examination for pregnant women done atthe PHC?General questions about the functioning of the PHC. Was there an outbreak of any of the followingdiseases in the PHC area in the last three years?•y Malaria•y Measles•y Gastroenteritis (diarrhoea and vomiting).•y Jaundice.•y Fever with loss of consciousness/convulsions.If yes, did the PHC staff respond immediately to stopthe further spread of the Epidemic.What steps did the PHC staff take?How is the behaviour of PHC staff with the patient?•y Courteous•y Casual/indifferent•y Insulting/derogatoryIs there corruption in terms of charging extra money forany of the service provided?Does the doctor do private practice during or after theduty hours?Are there instances where patients from a particularsocial background (SC, ST, minorities, villagers) havefaced derogatory or discriminatory behaviour or serviceof poorer quality?Have patients with specific health problems (HIV/AIDS,leprosy suffered discrimination in any form? Such issuesmay be recorded in the form of specific instances.Are women patients interviewed in an environmentthat ensures privacy and dignity?Are examinations on women patients conducted inthe presence of a women attendant and proceduresconducted under conditions that ensure privacy?Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres 47

Is the PHC providing in patient care?Do patients with chronic illness receive adequate careand drugs for the entire requirement?If the PHC is not well equipped to provide the servicesneeded, are patient transported immediately withoutdelay, with all the relevant papers, to a site where thedesired service is available?Is facility for transportation of patients includingpregnancy and labour cases available?Is there a publicly display mechanism, whereby acomplaint/grievance can be registered?48Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

Annexure 7Job Responsibilities of Medical Officer and otherStaff at PhcDuties of Medical Officer, PrimaryHealth CentreThe Medical Officer of Primary Health Centre (PHC)is responsible for implementing all activities groupedunder Health and Family Welfare delivery system in PHCarea. He/she is responsible in his individual capacity,and as over all in charge. It is not possible to enumerateall his tasks. However, by virtue of his designation, it isimplied that he will be solely responsible for the properfunctioning of the PHC, and activities in relation to RCH,NRHM and other National Programs. The detailed jobfunctions of Medical Officer working in the PHC are asfollows:Curative WorkThe Medical Officer will organize the dispensary,outpatient department and will allot duties to theancillary staff to ensure smooth running of theOPD.He/she will make suitable arrangements for thedistribution of work in the treatment of emergencycases which come outside the normal OPD hours.He/she will organize laboratory services for caseswhere necessary and within the scope of hislaboratory for proper diagnosis of doubtful cases.He/she will make arrangements for renderingservices for the treatment of minor ailmentsat community level and at the PHC through theHealth Assistants, Health Workers and others.He/she will attend to cases referred to him/herby Health Assistants, Health Workers, ASHA/Voluntary Health Workers where applicable, Daisor by the School Teachers.He/she will screen cases needing specializedmedical attention including dental careand nursing care and refer them to referralinstitutions.He/she will provide guidance to the HealthAssistants, Health Workers, Health Guides andSchool Teachers in the treatment of minorailments.He/she will cooperate and coordinate with otherinstitutions providing medical care services in his/her area.He/she will visit each Sub-Centre in his/her areaat least once in a month on a fixed day not onlyto check the work of the staff but also to providecurative services. This will be possible only if morethan one Medical Officer is posted in PHC.Organize and participate in the “Village Healthand Nutrition Day” at Anganwadi Centre once ina month.Preventive and Promotive WorkThe Medical Officer will ensure that all the membersof his/her Health Team are fully conversant with thevarious National Health & Family Welfare Programsincluding NRHM to be implemented in the areaallotted to each Health functionary. He/she will furthersupervise their work periodically both in the clinics andIndian Public Health Standards (IPHS) Guidelines for Primary Health Centres 49

in the community setting to give them the necessaryguidance and direction.He/she will prepare operational plans and ensureeffective implementation of the same to achieve the laiddown targets under different National Health and FamilyWelfare Programmes. The MO will provide assistancein the formulation of village health and sanitation planthrough the ANMs and coordinate with the PRIs in his/her PHC area.He/she will keep close liaison with Block DevelopmentOfficer and his/her staff, community leaders and varioussocial welfare agencies in his/her area and involvethem to the best advantage in the promotion of healthprogrammes in the area.Wherever possible, the MO will conduct fieldinvestigations to delineate local health problems forplanning changes in the strategy for the effectivedelivery of Health and Family welfare services. He/shewill coordinate and facilitate the functioning of AYUSHdoctor in the PHC.Reproductive and Child Health ProgrammeMCH and Family Welfare ServicesAll MCH and Family Welfare services as assured at PHCshould be made available: The MO will promote institutional delivery andensure that the PHC functions as 24 x 7 servicedelivery PHC, wherever it is supposed to be so. He/she will provide leadership and guidancefor special programmes such as in nutrition,prophylaxis against nutritional anemia amongstmothers and children, adolescent girls, Prophylaxisagainst blindness and Vitamin A deficiency amongstchildren (1-5 years) and also will coordinate withICDS. He/she will provide MCH services such as antenatal,intra-natal and postnatal care of mothersand infants and child care through clinics at thePHC and Sub-Centres. He/she will ensure through his/her health teamearly detection of diarrhoea and dehydration. He/she will arrange for correction of moderateand severe dehydration through appropriatetreatment.He/she will ensure through his/her health teamearly detection of pneumonia cases and provideappropriate treatment.He/she will supervise the work of Healthsupervisors and Health workers in treatment ofmild and moderate ARI.He/she will visit schools in the PHC area at regularintervals and arrange for medical check up,immunization and treatment with proper followup of those students found to have defects.He/she will be responsible for proper andsuccessful implementation of Family WelfareProgramme in PHC area, including education,motivation, delivery of services and after care.He/she will be squarely responsible for givingimmediate and sustained attention to anycomplications the acceptor develops due toacceptance of Family Planning methods.He/she will extend motivational advice to alleligible patients he/she sees in the OPD.He/she will get himself trained in tubectomy,wherever possible and organize tubectomy camps.He/she will get training in NSV and IUCD, organizeand conduct vasectomy camps.He/she will seek help of other agencies such asDistrict Bureau, Mobile Van and other association/voluntary organizations for tubectomy/IUCDcamps and MTP services.The following duties are common to all the activitiescoming under package of services for MCH:a. He/she will provide leadership to his/herteam in the implementation of Family WelfareProgramme in the PHC catchments area.b. He/she will ensure adequate supplies ofequipment, drugs, educational material andcontraceptives required for the servicesprogrammes.Adequate stocks of ORS to ensure availability ofORS packets throughout the year.Monitor all cases of diarrhea especially for childrenbetween 0-5 years.Recording and reporting of all details due todiarrhea especially for children between 0-5 years.Organize chlorination of wells and coordinate withaccountable authorities for sanitation.50Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

Training of all health personnel like ASHAs,Anganwadi Workers, Dais and others who areinvolved in health care regarding relevant NationalHealth Programmes including ORT.Universal Immunization Programme (UIP) He/she will plan and implement UIP in line withthe latest policy and ensure cent percent coverageof the target population in the PHC (i.e. pregnantmothers and new born infants). He/she will ensure adequate supplies of vaccinesmiscellaneous items required from time to timefor the effective implementation of UIP. He/she will ensure proper storage of vaccines andmaintenance of cold chain equipment, planning andmonitoring of performance and training of staff.National Vector Borne Disease Control Programme(NVBDCP)MalariaHe/she will be responsible for all NVBDCPoperations in his/her PHC area and will beresponsible for all administrative and technicalmatters. He/she should be completely acquainted with allproblems and difficulties regarding surveillanceand spray operations in his/her PHC area and beresponsible for immediate action whenever thenecessity arises. The Medical Officer will guide the Health Workersand Health Assistants on all treatment schedules,especially radical treatment with primaquine.As far as possible he/she should investigate allmalaria cases in the area with less than API 2regarding their nature and origin, and institutenecessary measures in this connection. He/she should ensure that prompt remedialmeasures are carried out by the Health Assistant,about positive cases detected in areas with APIless than two. He/she should give specific instructions to themin this respect, while sending the result of bloodslides found positive. Activities related to Quality assurance of malariamicroscopy and RDT.Ensuring logistic supply to all the Sub-Centres andASHAs.Referral services for severe and complicatedmalaria cases and provisioning for theirtransportation.Organizing training of ASHAs and supervisingtheir skill and knowledge of use of RDT and antimalarialdrugs.He/she will check the microscopic work of theLaboratory Technician and dispatch prescribedper-centage of such slides to the ZonalOrganization/Regional Office for Health andFamily Welfare (Government of India) and Stateheadquarters for cross checking as laid downfrom time to time.Stratify Sub-Centres areas based on API to identifyhigh risk Sub-Centres i.e. API 2 and above, API 5and above and develop micro action plan forcarrying out Indoor Residual Spray.Supervising the skill of spray squads in sprayactivities and spray operations in the field.Identification of high risk Sub-Centres fordistribution of LLIN.Organisation of village level treatment camps ofcommunity owned bednets.He/she should, during his/her monthly meetings,ensure proper accounts of slides and anti malariadrugs issued to the Health Workers and HealthAssistant Male.The publicity material and mass media equipmentreceived from time to time will be properlydistributed or affixed as per the instructions fromthe district organization.He/she should consult the guidelines onManagement and treatment of cerebral malariaand treat cerebral malaria cases as and whenrequired.He/she should ensure that all categories of staffin the periphery administering radical treatmentto the malaria positive cases should follow theguidelines of NVBDCP and in case any side effectis observed in a case, who is receiving primaquine,the drug is stopped by the worker and such caseshould immediately be referred to PHC.Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres 51

FilariaHe/she will be responsible for all Elimination ofLymphatic Filariasis (ELF) activities in his/her areaand will be responsible for all administrative andtechnical matters.He/she should be completely acquainted with allproblems and difficulties in line-listing of filariacases, providing morbidity management servicesand conducting Mass Drug Administration (MDA).He/she will be responsible for all health educationactivities in his/her area.He will be responsible for Mf survey in nightin sentinel and random sites in his area, if it isidentified.He will ensure that all records/reports are sent intime & kept safe.Where Kala Azar and Japanese Encephalitis are endemicthe following additional duties are expected from him.Kala Azar: He/she will be responsible for all anti Kala Azaroperations in his/her area and will be responsiblefor all administrative and technical matters. He/she should be completely acquainted with allproblems and difficulties regarding surveillance,diagnosis, treatment and spray operations in his/her PHC areas and be responsible for immediateaction whenever the necessity arises. He/she will guide the health workers and healthassistants on all treatment schedules, criteriafor suspecting a case to be of Kala Azar, controlactivities, complete treatment and to approachfor immediate medical care. He/she will check the rapid (rK-39) test conductedby the Laboratory Technicians. He/she will organize and supervise the Kala Azarsearch operations in his/her area. He should, during his monthly meetings ensureproper accounts of drugs, Chemicals, Glass-wareetc. He/she will be responsible for all Health Educationactivities in his/her area. He/she will be overall responsible for all KalaAzar control activities in his/her areas Includingadvance planning for spray operations and microaction plan. One Medical Officer who can bemade solely responsible for Kala Azar control maybe identified.He/she will be responsible for regular reportingto the District Malaria Officer/Civil Surgeon,Monitoring, Record Maintenance of adequateprovisions of Drugs, Chemicals, etc.Acute Encephalitis Syndrome (AES)/JapaneseEncephalitis (JE): He/she will be responsible for all AES/JE preventionand control activities in his/her area and will beresponsible for all administrative and technicalmatters. He/she will be overall responsible for all AES/JEcontrol activities in his/her areas including sprayoperations. For the purpose, he/she may identifyone Medical Officer who can be made solelyresponsible for AES/JE control. He/she should be completely acquainted with allproblems and difficulties regarding surveillance,diagnosis, treatment and spray operations in his/her PHC area and be responsible for immediateaction whenever the necessity arises. He/she will guide the Health Workers and HealthAssistants on all treatment schedules, criteria forsuspecting a case to be of JE and the approachesfor motivation of the people for accepting JEcontrol activities and to approach for immediatemedical care to prevent death. He/she will arrange admission & appropriatemanagement of AES/JE cases at PHC level or makearrangements for referral to CHC/District Hospital. He/she will arrange to collect and transport serasample to the identified virology lab and fullyparticipate in JE Vaccination Programme. He/she will be responsible for all health educationactivities in his/her area. He/she will be responsible for regular reportingto the District Malaria Officer, Civil Surgeon,Monitoring, Record Maintenance of adequateprovisions for drugs etc.Dengue/Chikungunya He/she will be responsible for all Dengue/Chikungunya prevention and control activities52Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

in his/her area and will be responsible for alladministrative and technical matters.He/she should be completely acquainted with allproblems and difficulties regarding surveillance,diagnosis, treatment and vector control activitiesin his/her PHC area and be responsible forimmediate action whenever the necessityarises.He/she will arrange admission & appropriatemanagement of Dengue/Chikungunya cases atPHC level or make arrangements for referralto CHC.He/she will arrange to collect and transport serasample to the identified Sentinel SurveillanceHospitals for confirmation.He/she will be responsible for all health educationactivities in his/her area.He/she will be responsible for regular reportingto the District Malaria Officer, Civil Surgeon,Monitoring, Record Maintenance of adequateprovisions for drugs etc.Control of Communicable Diseases He/she will ensure that all the steps are beingtaken for the control of communicable diseasesand for the proper maintenance of sanitation inthe villages. He/she will take the necessary action in case ofany outbreak of epidemic in his/her area. Perform duties under the Integrated DiseaseSurveillance Project.Leprosy Diagnose cases, ensure registration andmanagement of leprosy & its complications withdue counselling. Ensure regularity and completion of treatmentand retrieval of defaulters. Ensure regular updation of records, availabilityof adequate stock of MDT, Prednisolone, othersupportive drugs and materials and timelysubmission of reports. Refer and follow up all the cases with grade-2disability to district hospitals for assessment andmanagement.Tuberculosis He/she will provide facilities for early detectionof cases of Tuberculosis, confirmation of theirdiagnosis and treatment. He/she will ensure that all cases of Tuberculosistake regular and complete treatment. Ensure functioning of Microscopic Centre (if thePHC is designated so) and provision of DOTS.Sexually Transmitted Diseases (STD) He/she will ensure that all cases of STD arediagnosed and properly treated and their contactsare traced for early detection. He/she will provide facilities for RPR test, for allpregnant women at the PHC. He will receive STI syndromic treatment trainingand provide syndromic treatment for STIs.School Health He/she will visit schools in the PHC area at regularintervals and arrange for Medical Checkups,immunization and treatment with proper followup of those students found to have defects.National Programme for Control of Blindness He/she will make arrangements for rendering:•y Treatment for minor ailments.•y Testing of vision. He/she will refer cases to the appropriate institutesfor specialized treatment. He/she will extend support to mobile eye careunits.TrainingHe/she will organize training programmesincluding continuing education for the staff ofPHC and ASHA under the guidance of the districthealth authorities and Health & Family WelfareTraining centres.He/she will ensure that staff is sent for appropriatetrainings.He/she will maintain and update a data base ofstaff and the trainings undergone by the them.He/she will provide opportunity to the staff forusing the knowledge, skills and competencieslearnt during the training.Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres 53

He/she will assess functioning of analysis andarrange for retraining if required.He/she will ensure appropriate infrastructure fortrainings like venue, training aids, training materialand other logistics.He/she will organize training programs for ASHAwith focus on developing appropriate skills as perlocal need.He/she will also make arrangements/provideguidance to the Health Assistant Female andHealth Worker Female in organizing trainingprogrammes for ASHAs.Administrative WorkHe/she will supervise the work of staff workingunder him/her.He/she will ensure general cleanliness inside andoutside the premises of the PHC and also propermaintenance of equipment under his/her charge.He/she will ensure to keep up to date inventoryand stock register of all the stores and equipmentsupplied to him/her and will be responsible for itscorrect accounting.He/she will get indents prepared timely for drugs,instruments, vaccines, ORS and contraceptive etc.sufficiently in advance and will submit them tothe appropriate health authorities.He/she will check the proper maintenance of thetransport given in his/her charge.He/she will scrutinize the programmes of his/herstaff and suggest changes if necessary to suit thepriority of work.He/she will get prepared and display charts in his/her own room to explain clearly the geographicalareas, location of peripheral health units,morbidity and mortality, health statistics andother important information about his/her area.He/she will hold monthly staff meetings withhis/her own staff with a view to evaluating theprogress of work and suggesting steps to be takenfor further improvements.He/she will ensure the regular supply of medicinesand disbursements in Sub-Centres and to ASHAs.He/she will ensure the maintenance of theprescribed records at PHC level.He/she will receive reports from the periphery,get them compiled and submit them regularly tothe district health authorities.He/she will keep notes of his/her visits to the areaand submit every month his/her tour report tothe CMO.He/she will discharge all the financial dutiesentrusted to him/her.He/she will discharge the day to day administrativeduties and administrative duties pertaining to newschemes.Other NCD Programmes Diagnosis and treatment of common ear diseases. Early detection of Hearing Impairment cases andreferral to District Hospital (Appropriate level). Refers suspected cancer cases with early warningsignals. Diagnosis and treatment of common mentaldisorders and to provide referral service. Treatmentof psychosis, depression, anxiety disorders andepilepsy could be done at this level after training. IEC activities for prevention and early detection ofmental disorders. Early detection, treatment as far as possible andreferral of Diabetes Mellitus, Hypertension, CVDand Stroke. ‘Weekly geriatric clinic at PHC’ for providingcomplete health assessment of elderly persons,Medicines, Management of chronic diseases andreferral services. Basic Physical Medicine and Rehabilitationservices including preventive, therapy and referralservices.Health promotion related IEC and BCC Activities.Job Responsibilities of HealthEducatorAlthough it is desirable to have one Health Educator inevery PHC. However, at least one Health Educator shouldbe available in each block i.e. at block headquarterlevel PHC. He/she will be under the immediateadministrative control of the PHC Medical Officer.He/she will be responsible for providing support to allhealth and family welfare programmes in the block.54Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

Duties and Functions He/she will have with him/her all informationrelevant to development activities in the block,particularly concerning health and familywelfare, and will utilize the same for programmeplanning. He/she will develop his/her work plan inconsultation with the Medical Officer of his/herPHC and the concerned Block Extension Educator. He/she will collect, analyse and interpret the datain respect of extension education work in his/herPHC area. He/she will be responsible for regular maintenanceof records of educational activities, tourprogrammes, daily dairies and other registers, andwill ensure preparation and display of relevantmaps and charts in the PHC. He/she will assist the Medical Officer, PHC inconducting training of health workers and ASHAs. He/she will organize the celebration of healthdays and weeks and publicity programmes at localfairs, on market days, etc. He/she will organize orientation training for healthand family welfare workers, opinion leaders, localmedical practitioners, school teachers, dais andother involved in health and family welfare work. He/she will assist the organizing masscommunication programmes like film shows,exhibition, lecturers and dramas. He/she will supervise the work of field workers inthe area of education and motivation. He/she will supply educational material on healthand family welfare to health workers in the block. While on tour he/she will verify entries in theeligible couple register for every village and dorandom checking of family welfare acceptors. While on tour he/she will check the available stockof conventional contraceptive with the depotholders and the kits with HWs and ASHAs. He/she will help field workers in winning overresistant cases and drop-outs in the health andfamily welfare programmes. He/she will maintain a complete set of educationalaids on health and family welfare for his/her ownuse and for training purpose.He/she will organize population education andhealth education sessions in schools and for outofschool children and youth.He/she will maintain a list of prominent acceptorsof family planning methods and opinion leadersvillage wise and will try to involve them inthe promotion of health and family welfareprogrammes.He/she will prepare a monthly report on theprogress of educational activities in the block andsend it to the higher authority.Health promotion related IEC and BCC ActivitiesJob Responsibilities of HealthAssistant Female (LHV – LadyHealth Visitor) (FemaleSupervisor)Note: Under the Multipurpose Workers Scheme a Health AssistantFemale is expected to cover a population of 30,000 (20,000 in tribaland hilly areas) in which there are six Sub-Centres, each with theHealth Worker Female. The Health Assistant Female will carry outthe following duties:Supervision and guidanceSupervise and guide the Health Worker Female,Dais and guide ASHA in the delivery of health careservice to the community.Strengthen the knowledge and skills of the HealthWorker Female.Helps the Health Worker Female in improving herskills in working in the community.Help and guide the Health Worker Female in planningand organizing her programmes of activities.Visit each Sub-Centre at least once a week on afixed day to observe and guide the Health WorkerFemale in her day to day activities.Assess fort nightly the progress of assessmentreport work of the Health Worker Female andsubmit with respect to their duties under variousNational Health Programmes.Carry out supervisory home visits in the area of theHealth Worker Female with respect to their dutiesunder various National Health Programmes.Supervise referral; of all pregnant women for RPRtesting at PHC.Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres 55

Team WorkHelp the health workers to work as part of thehealth team.Coordinate her activities with those of the HealthAssistant Male and other health personnelincluding the dais.Coordinate the health activities in her area withthe activities of workers of other departmentsand agencies and attend meeting at PHC level.Conduct regular staff meetings with the healthworkers in coordination with the Health Assistant(Male).Attend staff meetings at the Primary HealthCentre.Assist the Medical Officer of the Primary HealthCentre in the organization of the different healthservices in the area.Participate as a member of the health team in masscamps and campaigns in health programmes.Facilitate and Participate in activities of villageHealth & Nutrition Day.Supplies, equipment and maintenance ofSub-CentresIn collaboration with the Health Assistant Male,check at regular intervals the stores available atthe Sub-Centre and help in the procurement ofsupplies and equipment.Check that the drugs at the Sub-Centre areproperly stored and that the equipment is wellmaintained.Ensure that the Health Worker Female maintainsher general kit, midwifery kit and Dai kit in theproper way.Ensure that the Sub-Centre is kept clean and isproperly maintained.Records and ReportsScrutinize the maintenance of records by theHealth Worker Female and guide her in theirproper maintenance.Review reports received from the Health WorkersFemale, consolidate them and submit monthlyreports to the Medical Officer of the PrimaryHealth Centre.Where Kala-Azar is endemic, additional duties are She will supervise the work of Health WorkerFemale during concurrent visit and will checkwhether the worker is performing her duties. She should check minimum of 10% of the house ina village to verify that the Health Worker Femalereally visited those houses ad carried her jobproperly. Her job of identifying suspected Kala-Azar cases and ensuring complete treatment hasbeen done properly. She will carry with her the proper record forms,diary and guidelines for identifying suspectedKala-Azar cases. She will be responsible along with Health AssistantMale for ensuring complete treatment of Kala-Azar patients in his area. She will be responsible along with Health AssistantMale for ensuring complete coverage during thespray activities and search operation. She will also undertake health educationactivities particularly through interpersonalcommunication, arrange group meetings withleaders and organizing and conducting trainingof community leaders with the assistance ofhealth team.Where Japanese Encephalitis is endemic herspecific duties are as below She will supervise the work of Health WorkerFemale during concurrent visit and will checkwhether the worker is performing her duties. She should check along with minimum of 10% of thehouse in a village to verify that the Health WorkerFemale really visited those houses and carried herjob properly. Her job of identifying suspected JEcases and ensuring complete treatment has beendone properly. She will carry with her the proper record forms, diaryand guidelines for identifying suspected JE cases. She will be responsible for ensuring completetreatment of JE patients in her area. She will be responsible along with Health AssistantMale for ensuring complete coverage during thespray activities and search operation. She will also undertake health education activitiesparticularly through interpersonal communication,56Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

Trainingarranging group meetings with leaders andorganizing and conduction training of communityleaders with the assistance of health team.Organize and conduct training for Dais/ASHA withthe assistance of the Health Worker Female.Assist the Medical Officer of the Primary HealthCentre in conducting training programme forvarious categories of health personnel.Maternal and Child HealthConduct weekly MCH clinics at each Sub-Centrewith the assistance of the Health Worker Femaleand dais.Respond to calls from the Health Worker Female,the Health Worker Male, the health guides andthe trained Dais and render the necessary help.Conduct deliveries when required at PHClevel and provide domiciliary and midwiferyservices.Family Welfare and Medical Termination ofPregnancyShe will ensure through spot checking that HealthWorker Female maintains up-to date eligiblecouple registers all the times.Conduct weekly family planning clinics alongwith the MCH clinics at each Sub-Centre with theassistance of the Health Worker Female.Personally motivate resistant case for familyplanning.Provide information on the availability of servicesfor medical termination of pregnancy and forsterilization. Refer suitable cases for MTP to theapproved institutions.Guide the Health Worker Female in establishingfemale depot holders for the distribution ofconventional contraceptives and train the depotholders with the assistance of the health workersfemale.Provide IUCD services and their follow up.Assist M.O. PHC in organization of family planningcamps and drives.NutritionEnsure that all cases of malnutrition amonginfants and young children (0-5 years) are giventhe necessary treatment and advice and referserious cases to the Primary Health Centre.Ensure that iron and folic acid vitamin A aredistributed to the beneficiaries as prescribed.Educate the expectant mother regarding breastfeeding.Universal Immunization ProgrammeSupervise the immunization of all pregnantwomen and children (0-5 years).She will also guide the MPW (M) and MPW(F) toprocure supplies organize immunization campsprovide guidance for maintaining cold chain,storage of vaccine, health education and also inimmunizations.Supervise the immunization of all pregnantwomen and infants.Follow the directions given in Manual of HealthWorker (female) under National ImmunizationProgramme.Acute Respiratory Infection Ensure early diagnosis of pneumonia cases.Provide suitable treatment to mild/moderatecases of ARI.Ensure early referral in doubtful/severe cases.School HealthAssist Medical Officer in school health services.Primary Medical CareEnsure treatment for minor ailments, provideORS & First Aid for accidents and emergenciesand refer cases beyond her competence to thePrimary Health Centre or nearest hospital.Health EducationCarry out educational activities for MCH, FamilyWelfare, Nutrition and Immunization, Control ofblindness, Dental care and other National HealthProgrammes like leprosy, Tuberculosis and NCDprogrammes with the assistance of the HealthWorker Female.Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres 57

Arrange group meetings with the leaders andinvolve them in spreading the message for varioushealth programmes.Organize and conduct training of women leaderswith the assistance of the Health Worker Female.Organize and utilize Mahila Mandal, Teachersand other women in the Community in thefamily welfare programmes, including ICDSpersonnel.Job Responsibilities of HealthAssistant MaleUnder the Multipurpose workers scheme a HealthAssistant Male is expected to cover a populationof 30,000 (20,000 in tribal and hilly areas) in whichthere are six Sub-Centres, each with the healthworker male.The Health Assistant Male will carry outthe following dutiesSupervise and guidance Supervise and guide the Health Worker Male,in the delivery of health care service to thecommunity. Strengthen the knowledge and skills of the HealthWorker Male. Help the Health Worker Male in improving hisskills in working in the community. Help and guide the Health Worker Male inplanning and organizing is programmes ofactivities. Visit each Health Worker Male at least once aweek on a fixed day to observe and guide him inhis day to day activities. Assess monthly the progress of work of the HealthWorker Male and submit with assessment report tothe Medical Officer of the Primary Health Centre. Carry out supervisory home visits in the area ofthe Health Worker Male.Team Work Help the health workers to work as part of thehealth team.Coordinate his activities with those of the HealthAssistant Female and other health personnelincluding the Dais and Health Guide.Coordinate the health activities in his area withthe activities of workers of other departmentsand agencies and attend meetings.Conduct staff meetings fort nightly with the healthworkers in coordination with the Health AssistantFemale at one of the Sub-Centres by rotation.Attend staff meetings at the Primary Health Centre.Assist the Medical Officer of the Primary HealthCentre in the organization of the different healthservices.Participate as a member of the health team in masscamps and campaigns in health programmes.Assist the Medical Officer of the Primary HealthCentre in conducting training programmes forvarious categories of health personnel.Facilitate and Participate in the activities of villageHealth & Nutrition Day.Supplies, equipment and maintenance ofSub-Centres In collaboration with the Health Assistant Female,check at regular intervals the stores available atthe Sub-Centres and ensure timely placement ofindent for and procure the supplies and equipmentin good time. Check that the drugs at the Sub-Centre are properlystored and that the equipment is well maintained. Ensure that the Health Worker Male maintains hisgeneral kit proper way.Records and Reports Scrutinize the maintenance of records by theHealth Worker Male and guide him in their propermaintenance. Review records received from the Health WorkerMale, consolidate them and submit reports to theMedical Officer of the Primary Health Centre.Malaria He will supervise the work of Health Worker Maleduring concurrent visits and will check whetherthe worker is performing his duty as laid down inthe schedule.58Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

He should check minimum of 100 of the houses ina village to verify the work of the Health WorkerMale.He will carry with him a kit for collection of bloodsmears during his visit to the field and collect thickand thin smears from any fever case he comesacross.He will be responsible for prompt radicaltreatment to positive cases in his area. He willplan, execute and supervise the administrationof radical treatment in consultation with PHCMedical Officer.Supervise the spraying of insecticides during localspraying along with the Health Worker Male.Where Kala-Azar is endemic additional duties are: He will supervise the work of Health WorkerFemale during concurrent visit and will checkwhether the worker is performing her duties. He should check minimum of 10% of the housein a village to verify that the Health Worker Malereally visited those houses and carried his jobproperly. His job of identifying suspected Kala-Azar cases and ensuring complete treatment hasbeen done properly. He will carry with him the proper record forms,diary and guidelines for identifying suspectedKala-Azar cases. He will be responsible for ensuring completecoverage treatment of Kala-Azar patients in hisarea. He will be responsible for ensuring completecoverage during the spray activities and searchoperation. He will also undertake health education activitiesparticularly through interpersonal communication,arranging group meetings with leaders andorganizing and conducting training of communityleaders with the assistance of health team.Where Japanese Encephalitis is endemic his specificduties are as below: He will supervise the work of Health Worker femaleduring concurrent visit and will check whether theworker is performing his duties. He should check minimum of 10% of the house in avillage to verify that the Health Worker Male reallyvisited those houses and carried his job properly.His job of identifying suspected encephalitis casesand ensuring motivation of community has beendone properly.He will carry with him the proper record forms,diary and guidelines for identifying suspectedencephalitis cases.He will also undertake health education activitiesparticularly through interpersonal communication,arranging group meetings with leaders andorganizing and conduction training of communityleaders with the assistance of health team.Where Lymphatic Filariasis is Endemic, His specificDuties are as Follows: He will supervise the work of Health Worker (Male)and volunteers during concurrent visit and will checkwhether the worker is performing his duties. He should check minimum 10% of the houses ina village to verify that the health worker (male)really visited those houses and carried his jobproperly. He will carry with him the proper record forms,diary and guidelines for Mass Drug Administration(MDA) and drug distribution. He will be responsible for ensuring coverage andcompliance of drug above 80% during MDA. He will also undertake health educationactivities particularly through interpersonalcommunication, arranging group meetings withleaders and organizing and conducting trainingof community leaders with the assistance ofhealth team.Communicable Disease Be alert to the sudden outbreak of epidemicsof diseases, such as diarrhea/dysentery, feverwith rash, jaundice, encephalitis, diphtheria,whooping cough or tetanus poliomyelitis, tetanusneonatarum, acute eye infections and take allpossible remedial measures. Take the necessary control measures when anynoticeable disease is reported to him. Take measures for control of stray dogs withthe help of the Health Worker Male and localauthorities.Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres 59

Leprosy Ensure that all the cases of leprosy take regularand complete treatment and ensure retrieval ofdefaulter Assess and monitor grade 1 & 2 disability forleprosy disabled patients.Provide information on the availability of servicesfor medical termination of pregnancy and refersuitable cases to the approved institutions.Ensure follow up of all cases of vasectomy,tubectomy, IUCD and other family planningacceptors.Tuberculosis Check whether all cases under treatment forTuberculosis are taking regular treatment,motivate defaulters to take regular treatment andbring them to the notice of the Medical Officer,PHC. Ensure that all cases of Tuberculosis take regularand complete treatment and inform the MedicalOfficer, PHC about any defaulters to treatment.Non Communicable DiseasesHealth Promotion and IEC ActivitiesEnvironmental Sanitation Community sanitation Safe water sources Soakage pits Kitchen gardens Manure pits Compost pits Sanitary latrines Smokeless chullas and supervise theirconstruction. Supervise the chlorination of water sourcesincluding wells.Universal Immunization Programme Conduct immunization of all school going childrenwith the help of the Health Workers.Family Welfare Personally motivate resistant case for familyplanning. Guide the Health Worker Male in establishingfamily planning depot holders and supervise thefunctioning. Assist M.O. PHC in organization of family planningcamps and drives.Job Responsibilities of LaboratoryTechnicianNOTE: All Primary Health Centre and subsidiary health Centre havebeen provided with a post of laboratory technician/assistant. Thelaboratory technician will be under the direct supervision of theMedical Officer, PHC. The laboratory technician will carry out thefollowing duties:General Laboratory Procedures1.2.3.4.5.6.7.8.Manage the cleanliness and safety of thelaboratory.Ensure that the glassware and equipment are keptclean.Handle properly and ensure maintenance of themicroscope.Sterilize the equipment as required.Dispose of specimens and infected material in asafe manner.Maintain the necessary records of investigationsdone and submit the reports to the MedicalOfficer, PHC.Prepare monthly reports regarding his work.Indent for supplies for the laboratory though theMedical Officer, PHC and ensure the safe storageof materials received.Laboratory Investigations (Minimum)1.2.Carry out examination of urinei. Specific gravity and PH.ii. Test for glucose.iii. Test for protein (albumen).iv. Test for bile pigments and bile salts.v. Test for ketone bodies.vi. Microscopic examination.Carry out examination of stoolsi. Gross examination.ii. Microscopic examination.60Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

3.4.5.6.7.8.Carry out examination of bloodi. Collection of blood specimen by finger pricktechnique.ii. Hemoglobin estimation.iii. RBC count.iv. WBC count (total and differential).v. Preparation, staining and examination of thickand thin blood smears for malaria parasitesand for microfilaria.vi. Erythrocyte Sedimentation Rate.vii. VDRL.viii. Blood grouping and Rh typing.ix. Rapid HIV and STI Screening testCarry out examination of sputumPreparation, staining and examination of sputumsmears for Mycobacterium tuberculosis (whereverthe PHC is recognized as microscopy centre underRNTCP).Carry out examination of semeni. Microscopic examination.ii. Sperm count motility, morphology etc.Prepare throat swabsi. Collection of throat swab and examination fordiphtheria.Test samples of drinking wateri. Testing of samples for gross impurities.ii. Rapid tests for detecting fecal contaminationby H 2S strip test.iii. Residual chlorine in drinking water by testingkits.Under NVBDCP, in endemic areas, he will alsoi. Conduct rapid diagnostic test for Kala-azar forsuspected case of Kala-Azar (rk 39) in OPD orreferred by ASHAs or Health Workers.ii. Conduct Aldehyde test, maintain all recordsof sera samples drawn, aldehyde tests andalso assist in Kala-Azar search operations.iii. Collect sera samples from suspectedencephalitis cases and send to sentinelsurveillance laboratory for testing, maintainall records of sera samples drawn and theirresults.Job Responsibility ofImmunization Staff at Phc/Chc/Sub-Divisional/Sub-District/District HospitalCold Chain and Vaccine Logistic(CC&VL) AssistantQualification & ExperienceGraduate or Diploma in Pharmacy/Nursing with 1-2years experience in medical store management.Job Responsibilities1. Support the MO I/C in UIP implementation,focusing on improved management of the coldchain inclusive of basic preventive maintenanceof cold chain equipment, vaccine & logisticsmanagement (goods clearance, eliminationof overstocking and stock outs of vaccine) andinjection safety including proper waste disposal.2. Ensure monthly reporting of Immunization dataincluding vaccine usage, VAPP and AEFI cases asper GOI guidelines and annual progress report.3. Assist MO I/C to conduct periodic programmereviews and undertake action on operationalprocedures specifically logistics affecting theimplementation and management of the UIP.4. Maintaining of accurate stock records and periodicreview of supply requisitions.5. Assist MO I/C in preparing annual vaccine forecastsof the PHC/CHC.6. Provide technical guidance to the PHC/CHC levelstaff on cold chain management and conductperiodical evaluation for the purpose of repairand replacement.7. Undertake field visits to session sites and providesupportive supervision to health care workers tomaintain proper cold chain for vaccines, logisticsand waste disposal.8. Assist MO during monthly meetings and providefeedback/refresher trainings to workers on issuesrelated to cold chain & vaccine logistics.Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres 61

9. Assist MO in micro planning for adequate & timelysupply of vaccines & logistics through alternatevaccine delivery mechanism.10. Recording of temperature in the Temp. recordBook twice daily as per guidelines.11. Any other immunization related work as specifiedby Medical Officer.Cold Chain Handler (Helper)Qualification and ExperienceMatriculation Pass with 1-2years of working experiencein stores.Job Description1. Cleaning cold chain and immunization room.2. Ice packs - filling, arranging in DF for conditioning,packing cold box, returning vaccines and ice packsfrom carriers when they return from field.3. Equipment – cleaning and defrosting ILR & DF,cleaning and preventive maintenance of coldboxes and vaccine carriers.4. Unloading and dispatch of vaccines and logistics.5.Other immunization related work as specified byDIO/CCO/VLM.Data HandlerQualification & ExperienceDesirableThe Candidate must be a Graduate in Commerce/Science/Arts with Diploma in Computer Application from arecognized institution with 2 yrs experience in the relatedarea. Permanent resident of the district concerned.Job Description1. The Computer Assistant shall undertake dataentry of immunization report, vaccine and logisticsreceipt, release and logbook data.2. He/She shall compile the information on a monthlybasis & forward the data to the DIO/ADIO/state.3. He/She shall be responsible for operation & upkeep of HMIS Software.4. He/She shall under take visit to the field fortraining of field functionaries, collection of data &validation.62Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

Annexure 8Charter of Patients’ Rights for Primary HealthcentreCitizen’s CharterMission StatementAccess to services: The PHC provides medical care to allpatients without any discrimination of gender, cast, orreligion. The Medical Officer is responsible for ensuringthe delivery of services.Standards of Services: This PHC provides quality ofservice on the minimum assured services set by IndianPublic Health Standards (IPHS).Your Rights in the PHC1. Right to access to all the services provided by thePHC.2. Right to Information-including information relatingto your treatment.3. Right of making decision regarding treatment.4. Right for privacy and confidentiality.5. Right to religious and cultural freedom.6. Right for Safe and Secure Treatment.7. Right for grievance redressal.Services Availabllea. OPD services: Location, Name of doctors, timings,and user fees/charges.b. Indoor services: Location and number of beds.c. 24 x 7 Emergency, referral and normal deliveryd.services.Laboratorycharges.services: Location, timings ande.f.g.Family Welfare services: Location, and timings offamily Planning clinics. Forth coming schedule ofsterilization camps.Immunization services: Location and days ofvaccination.AYUSH services: location, name of doctor, timingsand user fees/charges.Medical Facilities Not Available:..................................Complaints & Grievances: Every complaint will be duly acknowledged. We aim to settle your genuine complaintswithin.......... days of its receipt. Suggestions/Complaint boxes are also provided atenquiry counter and........... in the PHC. If we cannot, we will explain the reasons and thetime we will take to resolve.Your Responsibilities: Please do not inconvenience other patients. Please help us in keeping the PHC and itssurroundings neat and clean. Beware of Touts. If you find any such person inpremises tell the PHC authorities. The PHC is a “No Smoking Zone” and smoking is aPunishable Offence. Please refrain from demanding undue favours fromthe staff and officials as it encourages corruption. Please provide useful feedback & constructedsuggestions. These may be addressed to theMedical Officer Incharge of the PHC.Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres 63

Annexure 9Proforma for Facility Survey for PHC on IPHSIdentificationName of the State: __________________________________________________________________________________District: ___________________________________________________________________________________________Tehsil/Taluk/Block: __________________________________________________________________________________Location & Name of PHC: ____________________________________________________________________________Is the PHC providing 24 hours and 7 days delivery facilitiesDate of Data CollectionDay Month yearName and Signature of the Person Collecting DataServicesPopulation covered (in numbers)Type of PHC:a. Type Ab. Type BAssured Services available (Yes/No)a. OPD Servicesb. Emergency services (24 Hours)c. Referral Servicesd. In-patient ServicesNumber of beds availablea.Bed Occupancy Rate in the last 12 months(1- less than 40%; 2 - 40-60%; 3 - More than60%)Average daily OPD Attendencea.b.MalesFemalesTreatment of specific cases (Yes/No)a.b.Is the primary management of wounds done atthe PHC?Is the primary management of fracture done atthe PHC?64Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

c.d.e.Are minor surgeries like draining of abscess etc.done at the PHC?Is the primary management of cases of poisoning/snake, insect or scorpion bite done at the PHC?Is the primary management of burns done atPHC?MCH Care including Family WelfareService availability (Yes/No)a. Ante-natal careb. Intranatal care (24 - hour delivery services bothnormal and assisted)c. Post-natal cared. New born Caree. Child care including immunizationf. Family Planningg. MTPh. Management of RTI/STIi. Facilities under Janani Suraksha YojanaAvailability of specific services (Yes/No)a. Are antenatal clinics organized by the PHCregularly?b. Is the facility for normal delivery available in thePHC for 24 hours?c. Is the facility for tubectomy and vasectomyavailable at the PHC?d. Is the facility for internal examination forgynaecological conditions available at the PHC?e. Is the treatment for gynecological disorders likeleucorrhoea, menstrual disorders available at thePHC?f. If women do not usually go to the PHC, then whatis the reason behind it?g. Is the facility for MTP (abortion) available at thePHC?h. Is there any precondition for doing MTP suchas enforced use of contraceptives after MTP orasking for husband’s consent for MTP?i. Do women have to pay for MTP?j. Is treatment for anemia given to both pregnant aswell as non-pregnant women?k. Are the low birth weight babies managed at thePHC?l. Is there a fixed immunization day?m. Is BCG and Measles vaccine given regularly in thePHC?n. How is the vaccine received at PHC and distributedto Sub-Centres?o. Is the treatment of children with pneumoniaavailable at the PHC?p. Is the management of children suffering fromdiarrhea with severe dehydration done at thePHC?Other functions and services performed(Yes/No)a. Nutrition services.b. School Health programmes.c. Promotion of safe water supply and basicsanitation.d. Prevention and control of locally endemicdiseases.e. Disease surveillance and control of epidemics.f. Collection and reporting of vital statistics.g. Education about health/behaviour changecommunication.h. National Health Programmes including HIV/AIDScontrol programes.i. AYUSH services as per local preference.j. Rehabilitation services (please specify).Monitoring and Supervision activities(Yes/No)Monitoring and supervision of activities of Sub-Centres through regular meetings/periodic visits,etc.Monitoring of National Health ProgrammesMonitoring activities of ASHAsVisits of Medical Officer to all Sub-Centres at leastonce in a month.Visits of Health Assistants (Male) and LHV to Sub-Centres once a week.Timely payment of JSY beneficiaries.Timely payment of TA/DA to ASHAs.a.b.c.d.e.f.g.Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres 65

ManpowerSl. No. Staff Recommended Current Availability atPHC(Indicate Numbers)1 Medical Officer- MBBS2 MO –AYUSH3 Accountant/Clerk4 Pharmacist5 Pharmacist AYUSH6 Nurse-midwife (Staff-Nurse)7 Health workers (F)8 Health Asstt. (Male)9 Health Asstt. (Female)/LHV10 Health Educator11 Data entry cum computer operator12 Laboratory Technician13 Cold Chain & Vaccine Logistic Assistant14 Multi-skilled Group D worker15 Sanitary worker cum watchmanTotalRemarks/Suggestions/Identified GapsTraining of personnel during previous (full) yearSl. No. Available training for Number trained1 Tradition birth attendants2 Health Worker (Female)3 Health Worker (Male)4 Medical Officer5 Initial and periodic training of paramadics in treatmentof minor ailments6 Training of ASHAs7 Periodic training of Doctors throughContinuing Medical Education, conferences, skilldevelopment training etc. on emergency obstetric care,Training in FP services.-IUCD, Minilap and NSV, LSAS8 Training of Health Workers in antenatal care and skilledbirth attendance66Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

Essential Laboratory ServicesSl. No. Current Availability at PHC Remarks/Suggestions/Identified Gaps1 Routine urine, stool and blood tests2 Blood grouping3 Bleeding time, clotting time4 Diagnosis of RTI/STDs with wet mounting, grams stain etc.5 Sputum testing for TB6 Blood smear examination for malaria parasite7 Rapid tests for pregnancy8 RPR test for Syphills/YAWS surveillance (in high endemic area only)9 Rapid tests for HIV10 Others (specify)Any other Services if available e.g., ECGPhysical Infrastructure (As per specifications)Sl. No. Current Availability at PHC If available, area inSq. mts.1 Where is this PHC located?a. Within Village Localityb. Far from village localityc. If far from locality specify in km2 Buildinga. Is a designated government building available for the PHC?(Yes/No)b. If there is no designated government building, then wheredoes the PHC located? Rented premises/Other governmentbuilding/Any other specifyc. Area of the building (Total area in Sq. mts.)d. What is the present stage of construction of the buildingConstruction? Complete/Construction incompletee. Compound Wall/Fencing (1-All around; 2-Partial; 3-None)f. Condition of plaster on walls (1- Well plastered with plasterintact everywhere; 2- Plaster coming off in some places;3- Plaster coming off in many places or no plaster)g. Condition of floor (1- Floor in good condition; 2- Floor comingoff in some places; 3- Floor coming off in many places or noproper flooring)h. Whether the cleanliness is Good/Fair/Poor? (Observe)OPDWardsToiletsPremises (compound)i. Are any of the following close to the PHC? (Observe)(Yes/No)i. Garbage dumpii. Cattle shediii. Stagnant pooliv. Pollution from industryRemarks/Suggestions/Identified GapsIndian Public Health Standards (IPHS) Guidelines for Primary Health Centres 67

Sl. No. Current Availability at PHC If available, area inSq. mts.j.Is boundary wall with gate existing? (Yes/No)3 Locationa. Whether located at an easily accessible area? (Yes/No)b. Distance of PHC (in Kms.) from the farthest village incoverage areac. Travel time (in minutes) to reach the PHC from farthestvillage in coverage aread. Distance of PHC (in Kms.) from the CHCe. Distance of PHC (in Kms.) from District Hospital4 Prominent display boards regarding service availability in locallanguage (Yes/No)5 Registration counters (Yes/No)a. Pharmacy for drug dispensing and drug storage (Yes/No)b. Counter near entrance of PHC to obtain contraceptives, ORSpackets, Vitamin A and Vaccination (Yes/No)6 Separate public utilities for males and females (Yes/No)7 Suggestion/complaint box (Yes/No)8 OPD rooms/cubicles (Yes/No) (Give numbers)9 OPD rooms/cubicles (Yes/No) (Give numbers) each room(Yes/No)10 Family Welfare Clinic (Yes/No)11 Waiting room for patients (Yes/No)12 Emergency Room/Casualty (Yes/No)13 Separate wards for males and females (Yes/No)14 No. of beds: Male15 No. of beds: Female16 Operation Theatre (if exists)a. Operation Theatre available (Yes/No)b. If operation theatre is present, are surgeries carried out inthe operation theatre?Yes/No/Sometimesc. If operation theatre is present, but surgeries are not beingconducted there, then what are the reasons for the same?Non-availability of doctors/staff Lack of equipment/poorphysical state of the operation theatreNo power supply in the operation theatre/Any other reason(specify)d. Operation Theatre used for obstetric/gynaecological purpose(Yes/No)e. Has OT enough space (Yes/No)17 Labour rooma. Labour room available? (Yes/No)b. If labour room is present, are deliveries carried out in thelabour room?Yes/No/SometimesRemarks/Suggestions/Identified Gaps68Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

Sl. No. Current Availability at PHC If available, area inSq. mts.c. If labour room is present but deliveries are not beingconducted there, then what are the reasons for the same?Non-availability of doctors/staff Poor condition of thelabour room/No power supply in the labour room/Anyother reason (specify)d. Is separate areas for septic and aseptic deliveries available?(Yes/No)e. Is Newborn care corner available (Yes/No)18 Laboratorya. Laboratory (Yes/No)b. Are adequate equipment and chemicals available? (Yes/No)c. Is laboratory maintained in orderly manner? (Yes/No)19 Ancillary Rooms - Nurses rest room (Yes/No20 Water supplya. Source of water (1- Piped; 2- Bore well/hand pump/tubewell; 3- Well; 4- Other (specify)b. Whether overhead tank and pump exist (Yes/No)c. If overhead tank exists whether its capacity sufficient?(Yes/No)d. If pump exists whether it is in working condition? (Yes/No)21 SewerageType of sewerage system (1- Soak pit; 2- Connected toMunicipal Sewerage)22 Waste disposalHow the waste material is being disposed (please specify)?23 Electricitya. Is there electric line in all parts of the PHC? (1- In all parts;2- In some parts; 3- None)b. Regular Power Supply (1- Continuous Power Supply;2-Occasional power failure; 3- Power cuts in summer only;4-Regular power cuts; 5- No power supplyc. Stand by facility (generator) available in working condition(Yes/No)24 Laundry facilitiesa. Laundry facility available(Yes/No)b. If no, is it outsourced?25 Communication facilitiesa. Telephone (Yes/No)b. Personal Computer (Yes/No)c. NIC Terminal (Yes/No)d. E.Mail (Yes/No)e. Is PHC accessible byi. Rail (Yes/No)ii. All whether road (Yes/No)iii. Others (Specify)26 VehiclesVehicle (jeep/other vehicle) available? (Yes/No)27 Office room (Yes/No)Remarks/Suggestions/Identified GapsIndian Public Health Standards (IPHS) Guidelines for Primary Health Centres 69

Sl. No. Current Availability at PHC If available, area inSq. mts.28 Store room (Yes/No)29 Kitchen (Yes/No)30 Diet:a. Diet provided by hospital (Yes/No)b. If no, how diet is provided to the indoor patients?31 Residential facility for the staff with all amenitiesMedical OfficerPharmacistNursesOther staff32 Behavioral Aspects (Yes/No)a. How is the behaviour of the PHC staff with the patient?Courteous/Casual/indifferent/Insulting/derogatoryb. Any fee for service is being charged from the users? (Yes/No). If yes, specify.c. Is there corruption in terms of charging extra money for anyof the service provided? (Yes/No)d. Is a receipt always given for the money charged at the PHC?(Yes/No)e. Is there any incidence of any sexual advances, verbal orphysical abuse, sexual harassment by the doctors or anyother paramedical? (Yes/No)f. Are woman patients interviewed in an environment thatensures privacy and dignity? (Yes/No)g. Are examinations on woman patients conducted in presenceof a woman attendant, and procedures conducted underconditions that ensure privacy? (Yes/No)h. Do patients with chronic illnesses receive adequate care anddrugs for the entire duration? (Yes/No)i. If the health centre is unequipped to provide the services;how and where the patient is referred and how patientstransported?j. Is there a publicly displayed mechanism; whereby acomplaint/grievance can be registered? (Yes/No)k. Is there an outbreak of any of the following diseases in thePHC area in the last three years?MalariaMeaslesGastroenteritisJaundicel. If yes, did the PHC staff responded immediately to stop thefurther spread of the epidemicm. Does the doctor do private practice during or after the dutyhours? (Yes/No)n. Are there instances where patients from particular socialbackground? SC, ST, dalits, minorities, villagers have facedderogatory or discriminatory behavior or service of poorerquality? (Yes/No)o. Have patients with specific health problems (HIV/AIDS,leprosy) suffered discrimination in any form? (Yes/No)Remarks/Suggestions/Identified Gaps70Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

Equipment (As per list)Equipment Available Functional Remarks/Suggestions/Identified GapsDrugs (As per essential drug list)Drug Available Remarks/Suggestions/Identified GapsFurnitureSl. No. Item Current Availabilityat PHC1 Examination Table2 Delivery Table3 Footstep4 Bed Side Screen5 Stool for patients6 Arm board for adult & child7 I V stand8 Wheel chair9 Stretcher or trolley10 Oxygen trolley11 Height measuring stand12 Iron bed13 Bed side locker14 Dressing trolley15 Mayo trolley16 Instrument cabinet17 Instrument trolley18 Bucket19 Attendant stool20 Instrument tray21 ChairIf available,area in Sq. mts.Remarks/Suggestions/Identified GapsIndian Public Health Standards (IPHS) Guidelines for Primary Health Centres 71

Sl. No. Item Current Availabilityat PHC22 Wooden table23 Almirah24 Swab rack25 Mattress26 Pilow27 Waiting bench for patients/attendants28 Medicine cabinet29 Side rail30 Rack31 Bed side attendant chair32 OthersIf available,area in Sq. mts.Remarks/Suggestions/Identified GapsQuality ControlSl. No. Particular Whether functional/available as per norms1 Citizen’s charter (Yes/No)2 Constitution of Rogi Kalyan Samiti (Yes/No) (give acopy of office order notifying the members)3 Internal monitoring (Social audit through PanchayatiRaj Institution/Rogi Kalyan Samitis, medical audit,technical audit, economic audit, disaster preparednessaudit etc. (Specify)4 External monitoring/Gradation by PRI (Zila Parishad/Rogi Kalyan Samitis)5 Availability of Standard Operating Procedures (SOP)/Standard Treatment Protocols (STP)/Guidelines etc.(Please provide a list)Remarks72Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

Annexure 10Facility Based Maternal Death Review FormNoteThis form must be completed for all deaths, including abortions and ectopic gestation related deaths, in pregnantwomen or within 42 days after termination of pregnancy irrespective of duration or site of pregnancy.Attach a copy of the case records to this formComplete the form in duplicate within 24 hours of a maternal death. The original remains at the institution wherethe death occurred and the copy is sent to the person responsible for maternal health in the StateFor Office Use Only:FB-MDR No:year:General InformationAddress of Contact Person at District and State:Residential Address of Deceased Woman:Address where Died:Name and Address of facility:Block:District:State:Details of Deceased Womani. Name: /Age (years): /Sex: /Inpatient Number:ii.iii.iv.v.vi.Gravida: /Live Births (Para): /Abortions: /No. of Living children:Timing of death: During pregnancy/during delivery/within 42 days of deliveryDays since delivery/abortion:Date and time of admission:Date/Time of death:Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres 73

Admission at Institution Where Death Occurred or from Where ItWas Reported;i. Type of facility where died:Phc 24 x 7 PHC Sdh/RuralHospitalDistrictHospitalMedicalCollege/TertiaryHospitalPrivateHospitalPvt ClinicOtherii.Stage of pregnancy/delivery at admission:Abortion Ectopic pregnancy Not in labour In labour Postpartumiii.Stage of pregnancy/delivery when died:Abortion Ectopic pregnancy Not in labour In labour Postpartumiv.v.vi.Duration of time from onset of complication to admission:Condition on Admission: Stable/Unconscious/Serious/Brought deadReferral history: Referred from another centre?How many centres?Type of centre?Antenatal CareReceived Antenatal care or not/Reasons for not receiving care/Type of Ante Natal care provided/High risk pregnancy: aware of risk factors?/what risk factors?Delivery, Puerperium and Neonatal Informationi. Details of labor: /had labor pains or not/stage of labor when died/duration of laborii.iii.Details of delivery: /undelivered/normal/assisted (forceps or vacuum)/surgical intervention (C-section)Puerperium: /Uneventful/Eventful (PPH/Sepsis etc.)Comments on labour, delivery and puerperium: (in box below)74Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

iv.Neonatal Outcome: /stillborn/neonatal death immediately after birth/alive at birth/alive at 7 days/Comments on baby outcomes(in box below)InterventionsSpecific medical/surgical procedures/rescuscitation procedures undertakenCause of Deatha. Probable direct obstetric (underlying) cause of death: Specify:b.c.d.Indirect Obstetric cause of death: Specify:Other Contributory (or antecedent) cause/s: Specify:Final Cause of Death:(after analysis)Factors(other than medical causes listed above)a.b.c.d.Personal/FamilyLogisticsFacilities availableHealth personnel relatedComments on potential avoidable factors, missed opportunities and substandard careAutopsyPerformed/Not PerformedIf performed please report the gross findings and send the detailed report laterCase Summary(please supply a short summary of the events surrounding the death):Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres 75

Form filled by:NameDesignationInstitution and locationSignature and StampDateNote: To facilitate the investigation, for detailed Questions refer to annexures on FBMDR.76Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

Annexure 11 : INTEGRATED DISEASE SURVEILLANCE PROJECTFORMATSForm SReporting Format for Syndromic Surveillance(To be filled by Health Worker, Village Volunteer, Non-formal Practitioners)State................................... District............................... Block............................. Year.............................Name of the health worker/Volunteer/Practitioner Name of the Surpervisor Name of the Reporting UnitID No./Unique idenlifier (To be filled by DSU) Reporting FromweekTodd mm yya b c d e f g h i j k l m nCasesDeathsMale Female Total Male Female Total

Annexure 11 AForm PWeekly Reporting Format - IDSPName of Reporting Institution:I.D. No.:State: District: Block/Town/City:Officer-in-Charge Name: Signature:IDSP Reporting Week:- Start Date:- End Date:- Date of Reporting:-__/__/____ __/__/____ __/__/____Sl. No. Diseases/Syndromes No. of cases1 Acute Diarrhoeal Disease (including acute gastroenteritis)2 Bacillary Dysentery3 Viral Hepatitis4 Enteric Fever5 Malaria6 Dengue/DHF/DSS7 Chikungunya8 Acute Encephalitis Syndrome9 Meningitis10 Measles11 Diphtheria12 Pertussis13 Chicken Pox14 Fever of Unknow Origin (PUO)15 Acute Respiratory Infection (ARI) Influenza Like lllness (ILI)16 Pneumonia17 Leptospirosis18 Acute Flaccid Paralysis < 15 year of Age19 Dog bite20 Snake bite21 Any other State Specific Disease (Specify)22 Unusual Syndromes NOT Captured Above (Specify clinical diagnosis)Total New OPD attendance (Not to be filled up when data collected for indoor cases)Action taken in brief if unusual increase noticed in cases/deaths for any of the abovediseases78Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

Annexure 11 BForm LWeekly Reporting Format - IDSPName of the Laboratory:Institution:State: District: Block/Town/City:Officer-in-Charge: Name: Signature:IDSP Reporting Week:- Start Date:- End Date:- Date of Reporting:-__/__/____ __/__/____ __/__/____Diseases No. Samples Tested No. Found PositiveDengue/DHF/DSSChikungunyaJEMeningococcal MeningitisTyphoid FeverDiphtheriaCholeraShigella DysenteryViral Hepatitis AViral Hepatitis ELeptospirosisMalaria PV: PF:Other (Specify)Other (Specify)Line List of Positive Case (Except Malaria cases):NameAge(Yrs)Sex(M/F)Address:Village/TownName of Test DoneDiagnosis (Lab confirmed)Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres 79

Annexure 11 CFormat for instantaneous reporting of Early Warning Signals/Outbreaksas soon as it is detectedState: District: Date of reporting:Is there any unusual increase in Case/Deaths or unusual event in any area? Yes/NoIf yes, provide the following information:Disease/Syndrome (Provisional/Confirmed)Area affected (Block, PHC, Sub-Centre, Village)No. of casesNo. of deathsDate of start of the outbreakTotal population of affected area (Village)Salient epidemiological observationsLab results (type of sample, number of samples collected andtested, What tests, where, results)Control measures undertaken (Investigated by RRT or not)Present statusAny other information* State SSU need to report instantaneously as well as weekly compilation on every Monday to the CSU including NIL reports80Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

Annexure 12List of Statutory and Regulatory Compliances1.2.3.4.5.6.7.8.9.10.11.No objection certificate from the Competent FireAuthorityAuthorisation under Bio-medical Waste(Management and Handling) Rules, 1998Authorisation from Atomic Energy RegulationBoard.Hazardous Waste (Management, Handling andTrans-boundary Movement) Rules 2008Authorisation from Atomic Energy RegulationBoard (if X-Ray facility available)Excise permit to store SpiritVehicle registration certificates for AmbulancesConsumer Protection ActDrug & Cosmetic Act 1950Fatal Accidents Act 185512.13.14.15.16.17.18.19.20.21.22.23.24.Indian Lunacy Act 1912Indian Medical Council Act and code of Medical EthicsIndian Nursing Council ActInsecticides Act 1968Maternity Benefit Act 1961Boilers Act as amended in 2007MTP Act 1971Persons with Disability Act 1995Pharmacy Act 1948PNDT Act 1996Registration of Births and Deaths Act 1969Right to Information ActClinical Establishments (Registration andRegulation) Act 2010Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres 81

Annexure 13List of AbbreviationsAEFI : Adverse Event Following ImmunizationAIIMS : All India Institute of Medical SciencesANC : Ante Natal Check-upANM : Auxiliary Nurse MidwifeARI : Acute Respiratory InfectionsASHA : Accredited Social Health ActivistAYUSH : Ayurveda, Yoga & Naturopathy, Unani, Siddha and HomeopathyAWW : Anganwadi WorkerBCC : Behaviour Change CommunicationBCG : Bacille Calmette Guerians VaccineBIS : Bureau of Indian StandardsCBHI : Community Based Health Insurance Schemes/Central Bureau of Health IntelligenceCHC : Community Health CentreCMO : Chief Medical OfficerDDK : Disposable Delivery KitDEC : Di Ethyle CarbamazineDEMO : District Extension and Media OfficerDGHS : Director General of Health ServicesDOTS : Directly Observed Treatment Short CourseDPT : Diphtheria, Pertussis and Tetanus VaccineDT : Diphtheria and Tetanus VaccineDy. DEMO : Deputy District Extension and Media OfficerEAG : Empowered Action GroupELF : Elimination Of Lymphatic FilariasisFRU : First Referral UnitHSCC : Hospital services Consultancy Corporation82Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

ICDS : Integrated Child Development Services SchemeIDSP : Integrated Disease Surveillance ProjectID/AP : Infrastructure Division/Area ProjectsIEC : Information, Education and CommunicationIFA : Iron and Folic AcidIPHS : Indian Public Health StandardIUCD : Intra Uterine Contraceptive DeviceJSY : Janani Suraksha Yojana (JSY)LHV : Lady Health VisitorMCH : Maternal and Child HealthMO : Medical OfficerMTP : Medical Termination of PregnancyNVBDCP : National Vector Borne Disease Control ProgrammeNACP : National AIDS Control ProgrammeNCDC : National Centre for Disease ControlNIDDCP : National Iodine Deficiency Disorders Control ProgrammeNIHFW : National Institute of Health & Family WelfareNLEP : National Leprosy Eradication ProgrammeNPCB : National Programme for Control of BlindnessNPCDCS : National Programme for Prevention and Control of Cancer Diabetes, CVD and StrokeNRHM : National Rural Health MissionNVBDCP : National Vector Borne Disease Control ProgrammeOPV : Oral Polio VaccineORS : Oral Rehydration SolutionPHC : Primary Health CentrePPTCT : Prevention of Parents to Child TransmissionPRI : Panchayati Raj InstitutionRBC : Red Blood CorpuscleRCH : Reproductive and Child HealthRKS : Rogi Kalyan SamitiRNTCP : Revised National Tuberculosis Control ProgrammeRTI : Reproductive Tract InfectionsSC : Sub-CentreSTI : Sexually Transmitted InfectionsTOR : Terms of ReferenceVHSC : Village Health and Sanitation CommitteeVHSNC : Village Health Sanitation and Nutrition CommitteeVAPP : Vaccine-associated Paralytic PoliomyelitisWBC : White Blood CorpuscleIndian Public Health Standards (IPHS) Guidelines for Primary Health Centres 83

REFERENCES1.2.3.4.National Rural Health Mission 2005–2012 –Reference Material (2005), Ministry of Health &Family Welfare, Government of India.Bulletin on Rural Health Statistics in India (2005),Infrastructure Division, Department of FamilyWelfare; Ministry of Health & Family Welfare,Government of India.Guidelines for Operationalising 24 x 7 PHC(2005) (unpublished), Maternal Health Division,Department of Family Welfare, Ministry of Health& Family Welfare, Government of India.Guidelines for Ante-Natal Care and SkilledAttendance at Birth by ANMs and LHVs (2005),Maternal Health Division, Department of FamilyWelfare, Ministry of Health & Family Welfare,Government of India.5.6.7.8.RCH Phase II, National Program ImplementationPlan (PIP) (2005), Ministry of Health & FamilyWelfare, Government of India.Guidelines for Setting up of Rogi Kalyan Samiti/Hospital Management Committee (2005),Ministry of Health & Family Welfare, Governmentof India.Indian Standard: Basic Requirements for HospitalPlanning, Part-1 up to 30 Bedded Hospital, IS:12433 (Part 1)-1988, Bureau of Indian Standards,New Delhi.Indian Public Health Standards (IPHS) forCommunity Health Centre (April 2005),Directorate General of Health Services, Ministryof Health & Family Welfare, Government ofIndia.84Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres

members of Task Force for revision of IPHS(As per order No. T 21015/55/09 – NCD, Dte.GHS, dated 29-1-2010 and minutes ofmeeting of Task Force held on 12-2-2010)1.2.3.4.5.6.7.8.9.Dr. R.K. Srivastava, Director General of HealthServices – ChairmanDr. Shiv Lal, Special DG (PH), Dte.GHS, NirmanBhawan, New Delhi – Co-Chairman.Sh. Amarjit Sinha, Joint Secretary, NRHM, Ministryof Health & F.W., Nirman Bhawan, New Delhi.Dr. Amarjit Singh, Executive Director,Jansankhya Sthirata Kosh, Bhikaji Cama Place,New Delhi – 110066.Dr. B. Deoki Nandan, Director National Institute ofHealth & Family Welfare, Baba Gang Nath Marg,Munirka, New Delhi – 110067Dr. T. Sunderraman, Executive Director, NationalHealth Systems Resource Centre, NIHFWCampus, Baba Gang Nath Marg, Munirka,New Delhi – 110067.Dr. N.S. Dharmshaktu, DDG (NSD), Dte.G.H.S.,Nirman Bhawan, New Delhi.Dr. S.D. Khaparde, DC (ID), Ministry of Health &F.W., Nirman Bhawan, New Delhi.Dr. A.C. Dhariwal, Additional Director (PH) andNPO, National Centre for Disease Control (NCDC),22, Sham Nath Marg, New Delhi – 110054.10. Dr. C.S. Pandav, Prof. and Head, CommunityMedicine, AIIMS, New Delhi.11. Dr. J.N. Sahay, Advisor on Quality improvement,National Health Systems Resource Centre,NIHFW Campus, Baba Gang Nath Marg, Munirka,New Delhi – 110067.12. Dr. Bir Singh, Prof. Department of CommunityMedicine, AIIMS and Secretary General. IndianAssociation of Preventive and Social Medicine.13. Dr. Jugal Kishore, Professor of CommunityMedicine, Maulana Azad Medical College, BahadurShah Zafar Marg, New Delhi – 11000214. Mr. J.P. Mishra, Ex. Programme Advisor, EuropeanCommission, New Delhi15. Dr. S. Kulshreshtha, ADG, Dte. GHS., NirmanBhawan, New Delhi.16. Dr. A.C. Baishya, Director, North Eastern RegionalResource Centre, Guwahati, Assam.17. Dr. S. K. Satpathy, Public Health Foundation ofIndia, Aadi School Building, Ground Floor, 2 BalbirSaxena Marg, New Delhi – 110016.18. Dr. V.K. Manchanda, World Bank, 70, Lodhi Estate,New Delhi – 110003.19. Sh. Dilip Kumar, Nursing Advisor, Dte. G.H.S.,Nirman Bhawan, New Delhi.20. Dr. Anil Kumar, CMO (NFSG), Dte.G.H.S, NirmanBhawan, New Delhi- Member SecretaryIndian Public Health Standards (IPHS) Guidelines for Primary Health Centres 85

Directorate General of Health ServicesMinistry of Health & Family WelfareGovernment of India