ACCREDITATION STANDARDS FOR PRIMARY URBAN HEALTH …

ACCREDITATION STANDARDS FORPRIMARY URBAN HEALTH CENTRE

FIRST EDITION : NOVEMBER, 2009

National Accreditation Board For Hospitals& Healthcare Providers

Accreditation Standards for Primary Urban Health Centre

@ National Accreditation Board for Hospitals and Healthcare Providers2

TABLE OF CONTENTS

PART 1 – ACCREDITATION STANDARDS

S.No. Particulars Page No.

SECTION - A STRUCTURAL STANDARDS 5 - 8

01 Physical Facilities 5

02 Functional Plan 5 – 6

03 Equipments & Instruments 6

04 Man Power & Staffing 6 – 7

05 Drugs 7

06 Transport & Ambulance Services 7 – 8

07 Communication Facility 8

SECTION - B PROCESS STANDARDS 9 - 15

08 Access to the facility 9

09 Availability of Staff 9

10 Evaluation of Patients 9 – 10

11 Care of Patients 10

12 Control of Infection 11

13 Bio-Medical Waste Management 11 – 12

14 Sanitation, Hygiene and Potable Water 12

15 Counseling and IEC 12 – 13

16 Preventive Health 13

17 Participation in National Health Programs 14

18 Referral Services 14

19Community Mobilization with RWAs, NGOs and Local Self Help groups

14

20 Social Responsibility 15

SECTION - C GOVERNANCE STANDARDS 16 - 19

21 Ownership of Building 16

22 Quality Assurance 16

23 Rights and Responsibility of Patients 16 – 17

24 Rights and Responsibility of Staff 17

25 Training Development and Motivation of Staff 17 - 18

26 Surveillance of ANMs, LHVs and other field workers 18


27 Public Private Partnership 18

28 Pricing and Services 18

29 Community Based Health Insurance 19

30 License and Statutes 19

31 Local Social Customs 19

32 End of Life Care 19

SECTION - D OUTCOME STANDARDS 20 - 21

33 Utilization indices of the Centre 20

34 Primary Urban Health Centre Statistics 20

35 Reporting of Birth, Death and Other details 20

36 Medical Records 21

37 Patient & Employee Satisfaction 21

38 Health Information System 21

PART 2 - GUIDE BOOK

SECTION - A STRUCTURAL STANDARDS 23 - 58

01 Functions / Service Outlay 24

02 Zones 25 - 27

03 Area & Space Requirements 28 - 33

04 Instruments & Equipments 34

05 Common Surgical Consumables 35

06 Laboratory & Radiology Items 36 - 37

07 Furniture Items 38

08 General & Miscellaneous Items 39 - 40

09 Stationary & Linen Items 41 - 42

10 Manpower & Staffing 43

11 Essential Drug List 44 - 56

12 Ambulance Requirements 57

13 Primary Urban Health Centre Schematic Layout 58

SECTION - B PROCESS STANDARDS 59 - 92

01 Clinical & Diagnostic Service in PUHC 60 - 65

02 Clinical Services in Outreach 66 - 67

03 Convergence with related sectors 68

04 Strengthening of Referral System 69 - 77

05 Capacity Building & Training of Staff 78 - 79

@ National Accreditation Board for Hospitals and Healthcare Providers 3



06 Behaviour Change Communication (BCC) 80 - 82

07 Information, Education & Communication (IEC) 80 - 81

08 Bio Medical Waste Management 83

09 Hand Washing Techniques 84

10 Management of Information 85 - 86

11 Facility Management 87

12 Community Participation and Empowerment 88 - 92

SECTION - C GOVERNANCE STANDARDS 93 - 147

01 Citizen Charter for primary Urban Health Centre 94 - 100

02 Job Responsibilities of Primary Urban Health Centre Staff 101 - 133

03 Self Appraisal of Primary Urban Health Centre Staff 134 - 146

04List of Licenses and Acts: Applicable to Public Healthcare facilities

147

SECTION - D OUTCOME STANDARDS 148 - 162

01 Optimal Facility Management & Efficient Processes 149 - 150

02 Service Guarantee 151 - 155

03Increased Utilization of Services leading to Positive Health Outcomes

156

04 Client Satisfaction 157

05 Community Involvement and Empowerment 157

06 Patient Exit Interview 158 - 160

07 Quality Assurance (Monitoring & Evaluation) 161 - 162

PART -1

ACCREDITATION STANDARDS



SECTION - A

STRUCTURAL STANDARDS

A - 1 PHYSICAL FACILITIES

Objective Elements

a. The facility shall confirm to the FAR Norms of that particular region as per the State

Government Rules.

b. For all expansions the space shall be acquired as per the standards

c. Land scaping shall be compulsory.

d. The facility shall be fenced to guard against entry of animals.

e. Main entrance shall be easily identifiable, welcoming, well lit and with mattress.

f. Emergency Exits shall be provided.

g. It shall confirm to the covered area ratio vis-à-vis the size of plot.

h. Adequate circulatory space for movement of traffic including trolley and wheel chairs

to be present.

i. Adequate ramps to be present to cater to the requirements of immobile patients.

j. Accommodation (Semi-Full furnished) facilities (as per grades) for the core staff i.e.

MO, Nurse, and Pharmacist to be available.

k. Laundry, Housekeeping, Security and Dietary services shall be out sourced as per a

MOU with the provider on certain quality criteria.

l. There shall be 24X7 availability of electricity and potable water supply with identified

alternate sources.

m. Arrangement for fire safety shall be present.

n. Adequate drainage system shall be built-in.

A - 2 FUNCTIONAL PLAN

Objective Elements

a. The building shall have a good functional plan having ear marked space for waiting

area, OPD, Labour Room, Minor OT, Sterilization Room, Pharmacy, Dressing Room,

Injection Room, X-ray Room, Dark Room, Store Room (for drugs, linen and

equipments), Counseling Centers, Administrative Office, Toilet (male & female) with


running water facilities, Nurses Room, Cold Chain Room, Immunization, space for

Laboratory services shall be as per the area and space requirements annexed.

There shall be rooms for other state run programs like TB, Leprosy, Ophthalmic,

ICTC, Sickle Cell Anemia, ANC, FP, CNDC.

b. OT, Labour room and dressing rooms shall have tiled (glazed) walls to height of four

feet to ensure easy cleaning.

A - 3 EQUIPMENTS AND INSTRUMENTS

Objective Elements

a. The facility shall have adequate number of equipments along with instruments as

stated in instruments and equipments and common surgical consumables list for

Primary Urban Health Centre in the Reference Manual.

b. The equipments shall be in functional order and have an up time of 98%.

c. All equipments shall have insurance cover.

d. There shall be appropriate mechanism for repair, maintenance and two year

renewable AMC of all the equipments.

e. The instruments used shall be adequately disinfected, sterilized and kept in good

working condition.

f. Organization shall have resources for ensuring skill based training on use/ handling

of equipments.

g. There shall be simple yet effective Condemnation Policy for equipments and instruments.

A - 4 MANPOWER & STAFFING

Objective Elements

a. The staffing norms as stated in Reference Manual for Primary Urban Health Centre

to be maintained.

b. At least 2 Medical Officer (MBBS) to be present all the time. Out of the 2 at least 1

shall be trained in emergency obstetric care.

c. One AYUSH expert shall be present.

d. 1 nurse to be present in the centre.

e. Roster for doctor and nurses to be displayed.

f. Emergency call, Roster to be available for the core staff i.e. Doctors, nurses and

pharmacists.




g. Organization shall have resources and be able to demonstrate carrying out following

trainings:

Managerial/ Administrative training to MO/ Head.

Programme implementation training to MO/ Head.

Induction training to staff at all levels.

Job based skills training.

Special clinical skill training on minor surgical procedure, obstetrics care,

new born care, basic life support and local anesthesia block.

Disaster Management.

A - 5 DRUGS

Objective Elements

a. A unified formulary based on workload, essential drug list of WHO or as specified by

State Government or essential drug list in Reference Manual for Primary Urban

Health Centre to be maintained.

b. Availability of drugs and surgical consumable to be ensured.

c. Availability of drugs to be displayed along with expiry dates.

d. Medical Officers to prescribe drugs based on the available formulary or essential

drug list.

e. Medicines dispensed shall have clear instruction on dose and schedule for

consumption purposes.

f. Consumption report of the drugs to be submitted to the district authorities of the

particular district.

g. Minimum balance and re-order level to be maintained.

h. Lead time of sourcing the drugs and consumable to be maximum of 1 week.

i. Drugs shall be stored in well lit and well ventilated rooms.

j. Certain drugs to be kept in the refrigerator.

k. The Temperature of the refrigerator to be maintained at 4 to 6 degree centigrade.

A - 6 TRANSPORT AND AMBULANCE SERVICES

Objective Elements

a. Local network of ambulances shall be outsourced and linked to Primary Urban


Health centre.

b. There shall be at least one ambulance.

c. Driver for the same to be available all the times.

d. Ambulance shall be in working condition all the time.

e. Emergency drugs to be available in the ambulance.

f. Basic resuscitation kit to be available in the ambulance.

g. At least 2 number of stretcher trolleys to be available.

h. At least 2 wheel chairs to be available.

i. The Stretcher trolleys and wheel chairs to be in working condition all the times.

j. There shall be local public transport facility available.

A - 7 COMMUNICATION FACILITIES

Objective Elements

a. The center shall have adequate stationeries for written communication.

b. At least 2 telephone (24X7) connections to be available in the facility.

c. A dial-up internet connection to be available.

d. Arrangements for a public address system to be available.

e. Organization shall use Signboards, Posters or/ and wall painting displaying the

activities and services (along with timings) at the facility and the important contact

numbers at prominent sites in the campus as well as in all villages. These shall be in

local language.

f. Campaigns for National Health Programs shall be displayed in the form of wall

painting or boards.

g. Lay out map of the Primary Urban Health Centre and signage shall be in vernacular

and symbols to address the needs of vulnerable patients.




SECTION - B

PROCESS STANDARDS

B - 1 ACCESS TO THE FACILITY

Objective Elements

a. The facility shall be easily assessable by at least two approachable all weather

roads.

b. There shall be transport facility from main road to the facility campus in case it is at

significant distance.

c. The roads shall be metallic to facilitate the patient’s movement by ambulance, three

wheelers and any other public or private mode of transport.

d. Adequate sign postings to be available at various strategic locations so as to guide

patients to the facility.

B - 2 AVAILABILITY OF STAFF

Objective Elements

a. At least 1 medical officer and 1 nurse shall be available at all times in the facility.

b. Staff shall attend to any emergency at all times beyond the normal OPD or working

hours.

c. At least 1 staff member shall be available at all times to provide guidance or basic

information to the patients and their families.

d. Facility shall have Assistant Professor from Medical College designated as its

Radiological Surveillance Officer.

e. Facility shall be guarded by Security personnel 24X7.

f. Available staff shall be immunized and insured for health / hospitalization.

B - 3 EVALUATION OF THE PATIENT

Objective Elements

a. All patients to under go a unified assessment with privacy and dignity.


b. The nurse / ANM shall carry out assessment in terms of noting the vitals, height and

weight of the patient in a pre designated area of the OPD card.

c. Medical officer to document the findings of the patient in a definite area in the OPD

card.

d. Advise for medication and investigation to be documented in predefined areas of the

card.

e. The documentation to be legible, timed, dated, named and signed by the medical

officers.

f. The instructions to be communicated to the patient in an understandable (verbal and

written) manner.

g. The assessment of the patient is uniform in all settings i.e. Emergency, OPD etc.

h. Records of all such assessments to be maintained (for time limits as per regulations)

in the center.

B - 4 CARE OF PATIENTS

Objective Elements

a. Patients shall have a welcoming effect from the facility.

b. The staff shall be courteous, humane and empathetic.

c. Care shall commensurate with the amenities available.

d. Care shall be provided in manner in which dignity and privacy of patient is

maintained.

e. Centre shall have written SOPs on Care.

f. Care shall be comprehensive in nature i.e. preventive, promotive, curative and

rehabilitative in nature.

g. A Referral card to be given to the patients on their referral to the higher facility for

treatment.

h. In case of death a death summary to be given to the patient’s family.

i. A general consent to be obtained for all patients accepted in the center.

j. An informed consent to be obtained for patients undergoing any procedures.

k. A list of procedures for which informed consent to be obtained shall be available in

the center.

l. The consent for shall be in vernacular / local language.

m. Consent shall be obtained either by the medical officer or the nurse.

n. Behavior of the staff towards all the patients and family members to be very cordial,

caring and basic health services to be provided all the time.




B - 5 CONTROL OF INFECTION

Objective Elements

a. Organization shall have written Infection Control Policy.

b. Organization shall have identified/ ear marked resources (0.5% Sodium

Hypochlorite, Laboline etc) for infection control.

c. Organization shall have written protocols on cleaning of the infection prone areas

(OT and Labour room) and equipments used in patient care.

d. The center shall take all precautions to control infection.

e. Adherence to standard precautions to be maintained by all staff.

f. Mopping (by latest available disinfectants) of all areas of the center to be carried out

at least twice a day.

g. Carbolisation of the OT, Labour Room, Laboratory to be carried out at least twice a

day.

h. Availability of running tap water for hand washing of staff to be maintained 24 hours

a day.

i. The hospital environment to be kept clean from litters, pest and stray animals.

j. Adequate lighting arrangement and cross ventilation to be present in all areas.

k. Sanitation of the toilets and hygiene of the staff to be maintained.

l. Adequate amount of bleaching lotion to be available for disinfection purposes.

m. The labour room, OT and OPD areas to be washed with soap and water at least

once in 2 weeks and a documentation there of to be maintained.

n. Autoclaving of all the instruments and linen used in the labour room, OT, dressing

room to be done.

o. Quality checks of the autoclave to be maintained by using quick strips (Signaloc).

B - 6 BIO-MEDICAL WASTE MANAGEMENT

Objective Elements

a. Centre waste generated shall be managed in accordance with the Bio-medical waste

management and handling rules 1998.

b. General waste to be collected in black bags.

c. The yellow bags to be subjected to deep burial and a pit for the same to be created with

in the premises according to the dimensions specified by the biomedical rules 1998.


d. Facilities for syringe and needle destruction to be available and practiced.

e. Chemical treatment of plastics to be carried out by using freshly prepared bleaching

lotion.

f. A site for composting of biodegradable waste to be available with in the hospital

premises.

g. Annual report to be submitted to the competent authority by 31 st January every

year.

h. Accidental spillage of waste shall be reported and handled as per the BMW

Guidelines.

i. Segregation of wastes to be done in maximum of 3 bags (Black, Yellow & Blue).

j. Organization shall have resources to train all health personnel on handling BMW as

per regulations.

B - 7 SANITATION, HYGIENE AND POTABLE WATER

Objective Elements

a. The facility shall have Reverse Osmosis (RO) Plant.

b. The center shall promote sanitation hygiene and availability of potable water in the

community by involving the RWAs, Self Help Groups and NGOs.

c. The center shall distribute chlorine tablets to the community and educate them about

their usage.

d. The perils of open defecation to be informed to the community living in JJ clusters

and slums.

e. Creation of soak pit and trench lavatories to be carried out by involving the local self

help groups and NGOs in JJ clusters and slums.

f. Health education and maintenance of hygiene to be done by adopting

the principles of school health and involving public opinion makers.

g. A plan to combat disasters, epidemics in the community shall be ready in the facility,

communicated to all concerned and rehearsed at least twice a year.

B - 8 COUNSELING AND IEC

Objective Elements

a. The health workers and related staff to be involved in counseling the community

regarding population stabilization, safe sex, hygiene, breast feeding, anemia,




nutrition, spacing of children, Vitamin-A deficiency etc.

b. Appropriate IEC tools to be available so as to create awareness amongst the

community for availing the services of the center.

c. Thrust to be given for reproductive and child health services.

d. Staff of the center to disseminate the plans and programs (specific to the area) of the

Government by using all IEC tools available e.g. posters, pamphlets, wall hangings,

paintings, audiovisual tools etc.

e. Counseling shall also include knowledge about HIV/AIDs and other communicable

and lifestyle diseases.

f. Organization shall have policy of printing "name & contact number of doctor" on the

cards (OPD & Discharge), IEC tools used.

B - 9 PREVENTIVE HEALTH

Objective Elements

a. The organization shall give impetus to the preventive aspect of health care.

b. The staff (Doctors, Nurses, ANMs, Pharmacist, Laboratory technician, Radiographer

etc.) shall maintain open channels of communication with the patients and their

families.

c. Immunization shall commensurate with the universal immunization program.

d. Expecting mothers to be given two doses of tetanus immunization in their antenatal

checkups.

e. New borns to be immunized according to the schedule and a card stating their

immunization status and growth pattern along with the mile stones to be available

with all parents.

f. Field health workers shall educate about adolescent health and life style

management.

g. Organization shall be involved in:

Management of disease outbreaks- Identification, classification (water-borne,

vector-borne, vaccine preventable), incidence reporting, investigation, data

collation, analysis and reporting.

Water quality surveillance.

Disaster mapping- identification, preparedness (equipments, antidotes,

emergency care, referral services) and networking.

h. Organization shall have identified resources (equipments & drugs) for

handling such preventive programmes/ actions.


B - 10 PARTICIPATION IN NATIONAL HEALTH PROGRAMS

Objective Elements

a. The center shall participate in all the National Health programs as stated in

Reference Manual for Primary Urban Health Centre.

b. Community mobilization and their participation to make the program successful is

responsibility of the centre.

c. Report of such program shall be submitted to the authorities periodically by the

MOIC.

B -11 REFERRAL SERVICES

Objective Elements

a. The center shall practice a bi-directional or standardized referral system as per the

policy.

b. The referral cards (with contact numbers) according to the colour coding to be

available and a document there of to be maintained.

c. Patient shall be referred to the secondary or tertiary healthcare facility in the close

proximity to the center, based on the condition of the patient.

d. All such patient to be followed up for their progress by the MOIC.

e. Entries of the transferring in or out to be maintained in register or the computer.

f. Patient referred from the center shall be transported in an Ambulance.

B - 12 COMMUNITY MOBILIZATION WITH RWAs/ NGOs / LOCAL

SELF HELP GROUPS

Objective Elements

a. The organization shall have a continuous interaction with the RWAs / NGOs / Local

Self Help Groups.

b. All meetings shall be planned and that the agenda of meeting shall be area specific

and / or as per the requirements of the community.

c. All meetings to be documented.




d. Disease profile along with seasonal variation to be discussed and appropriate

proactive intervention to be planed.

e. Gatekeeper approach in mobilizing the community shall be followed.

B - 13 SOCIAL RESPONSIBILITY

Objective Elements

a. The center shall understand that it is and integral part of the society.

b. The center shall carry out camps, melas, and healthy competitions etc. periodically.

c. Respect to the senior citizens and active participation in school health shall be

documented.

d. Training to the community on household remedies and first Aid shall to be carried out

and documented.

e. A sense of ownership of the facility by the community to be created.

f. Center shall participate in all cultural activities in the community.



SECTION - C

GOVERNANCE STANDARDS

C - 1 OWNERSHIP OF BUILDING

Objective Elements

a. A building of the facility to be owned by the government.

b. It shall have the approved building plan along with sanction from the local authorities.

c. The X-ray facility shall be approved by AERB.

C - 2 QUALITY ASSURANCE

Objective Elements

a. The hospital shall have a quality assurance manual.

b. Standards operating procedures to be available at various patient care area e.g.

OPD, Emergency, Pharmacy, Lab and Imaging.

c. The manual shall include infection control and waste management issues.

d. Safety of patients and staff shall have due consideration in the manual.

e. Scope of Corporate Social Responsibility (CSR) shall be encouraged for upgrading

the services.

C - 3 RIGHTS AND RESPONSIBILITY OF PATIENTS

Objective Elements

a. Rights and responsibility of the patients shall be in accordance with the Citizen

Charter for Primary Urban Health Centre.

b. A citizen charter to be displayed mentioning the user charges, quality of the services,

name of the medical officer with the telephone numbers etc.

c. The rights of the patients as a consumer have to be respected and displayed e.g.

rights to choose, right to deny, right to gather information etc.

d. A mechanism for grievance redressal to be in place and practiced.


e. All redressal mechanisms to be documented.

f. Users and providers will be jointly responsible to maintain the building of the Primary

Urban Health Centre in an orderly manner.

g. Patients to follow the instruction of the health care providers sincerely.

h. The patients have the right to their privacy, information and disease condition that

shall not be disclosed to others.

i. Citizen charter and rights of the patients shall be displayed in local language and

shall be universal for the state.

C - 4 RIGHTS AND RESPONSIBILITY OF STAFF

Objective Elements

a. The staff shall respect patients' right.

b. They shall carry out their respective job responsibilities as described in the annexure.

c. They shall demonstrate reasonable skill to provide care to the patients.

d. They are entitled to all the benefits (immunization, healthcare cover through

insurance, semi to fully furnished staff quarters as per entitlement and availability, its

maintenance and security) due to them by virtue of their employment.

e. Staff shall be cordial, humane, empathetic and respectful to their colleagues and the

patients.

f. Employees to be immunized for Hepatitis, Tetanus etc.

C - 5 TRAINING DEVELOPMENT AND MOTIVATION OF STAFF

Objective Elements

a. The organization shall arrange for continuous updation of knowledge and skills of the

staff.

b. Periodic training programs on the subjects of waste management, infection control,

communication etc. to be carried out and documented.

c. Training for behavioral change communication shall be carried out and documented.

d. Training on all aspects of various national health programs to be carried out.

e. Evaluation of all such training to be documented.

f. Several cash and non-cash incentives to be given so as to constantly motivate the

staff.




g. All trainings provided must be on both theoretical as well as practical aspects

h. There shall be policy on encouragement and appreciation of performers through

incentives and awards.

C - 6 SURVEILLANCE OF ANMS, ASHAS AND OTHER FIELD

WORKERS

Objective Elements

a. The activities of ANMs and ASHAs to be reviewed regularly by the MOIC.

b. Feedback mechanisms to exist so as to asses the visits of the above workers in the

community.

c. Local NGOs and Community Based Organizations to be involved in the surveillance

program.

d. Monitoring of distribution of iron tablets, motivating patient for institutional deliveries

to be carried out as an on going program.

e. The field workers shall have sufficient materials for their use.

f. A training and motivational program to exist for the above workers.

g. Validation of the process shall be carried out by higher authorities.

C - 7 PUBLIC PRIVATE PARTNERSHIPS

Objective Elements

a. Involving a private provider for scavenger services.

b. Involving a private transporter for transporting patients.

C - 8 PRICING AND SERVICES

Objective Elements

a. Unified pricing mechanism as per the policy of the state concerning the user fee to

be applied.

b. Patients to be informed about the charges.

c. Always a receipt to be given to the patients.

d. Proper accounting of the collections to be maintained.


C - 9 COMMUNITY BASED HEALTH INSURANCE

Objective Elements

a. A mechanism for micro health insurance through a co-operative approach to exist so

as to cater to the requirements of the patients.

b. Local NGOs and co-operative society to be involved to arrange for certain basic

expenses for the patients.

C - 10 LICENSE AND STATUTES

Objective Elements

a. All licenses to be available in the hospital e.g. Narcotics, Waste management,

BARC, AERB, fire safety etc as applicable.

b. Statutory requirements concerning patient and staff safety and welfare shall be met

with.

C - 11 LOCAL SOCIAL CUSTOMS

Objective Elements

a. Respect for local social customs to be given by the organization.

b. Myths concerning health availing practices to be evaded e.g. taking of local pudia for

viral hepatitis (jaundice) isolating post partum mothers etc.

C - 12 END OF LIFE CARE

Objective Elements

a. Centre shall provide appropriate respect and dignity to the dying and the dead.

b. All death cases to be recorded and reported.

c. Death certificate (MCCD- Medical Certificate for Cause of Death) to be issued to the

next of kin.

d. Organization shall carry out Death Audits periodically.




SECTION - D

OUTCOME STANDARDS

D - 1 UTILIZATION INDICES OF THE CENTRE

Objective Elements

a. Hospital to record all parameters as stated in the Quality Assurance Manual for

Primary Urban Health Center.

b. Utilization of OPD, IPD, X-ray, Labor Room, Man Power, Laboratory services,

Referral services (to & from the facility), ambulance services, MLC services to be

analyzed and maintained for continuous quality improvement.

c. Utilization of equipments shall be monitored on regular basis.

D - 2 PRIMARY URBAN HEALTH CENTRE STATISTICS

Objective Elements

a. Hospital statistics in terms of OPD attendance, Immunization rate, birth rate, death

rate, minor and major operations etc. to be documented and reported.

b. A bulletin is published every quarterly stating the above details.

D - 3 REPORTING OF BIRTH, DEATH AND OTHER DETAILS

Objective Elements

a. All the birth and the death in the Centre and the population to be reported to the

concerned Nagar palikas, municipal authorities and other local authorities.

b. Incidence and prevalence of diseases to be reported to the district authorities.

c. Epidemics and communicable diseases to be reported to the authorities.

d. Accidents and mishaps shall also be reported to authorities as per decided timelines.


D - 4 MEDICAL RECORDS

Objective Elements

a. The contents of the medical records are pre-defined.

b. An audit of the medical records is carried out every quarter.

c. The records are kept at for pre defined duration as per the policy.

d. There shall be provisions for storing and retrieval of the records.

e. All entries by the doctors and nurses are legible and complete.

f. All records must be computerized for accurate record maintenance.

D - 5 PATIENT & EMPLOYEE SATISFACTION SURVEY

Objective Elements

a. On going mechanism of conducting patient satisfaction through involvement of local

NGOs, RKS and RWA members shall be present.

b. On going mechanism of conducting employee satisfaction shall be present.

c. Organization shall have Grievance Redress Policy and mechanism.

d. Organization shall have in use feedback mechanism like use of feedback forms,

suggestion forms to be dropped in suggestion/ complaint boxes at identified places.

D - 6 HEALTH INFORMATION SYSTEM

Objective Elements

a. Community statistics like IMR, MMR, birth rate, death rate etc. to be documented

and reported.

b. Reporting of all the details to be done through a web based health information

system to the authorities on a daily, weekly, monthly and annual basis.

c. Health Information System tools shall be as per the state directives.


PART – 2 GUIDE BOOK

STRUCTURAL STANDARDS



FUNCTIONS/ SERVICE OUTLAY

Primary Urban Health Centre is a first level contact facility serving a range of customers,

containing as much as possible all specialties such as:

OPD CLINICS

Obstetrics & Gynaecology Paediatrics

General Medicine AYUSH

Dental

DIAGNOSTIC SERVICES

LABORATORY IMAGING

Haematology/ Cytology X-Ray

Biochemistry/ Microbiology Ultrasound/ Doppler

ECG

OTHER SERVICES

Physiotherapy Minor OT / Procedure Room

Dressing / Injection / Plaster

SUPPORT SERVICES

Facility Maintenance Ambulance

Primary Urban Health Centre is basically working as an outpatient department only. It is

usually not integral to a hospital but linked to the identified secondary & tertiary level

healthcare providers through a functional two way referral linkage.

.


ZONES

For planning purposes the Public Urban Health Centre has been divided into zones as

under:

Zone Functions

Entrance Zone (A)

Reception and Registration

- Reception counter

- Record storage

Pharmacy

- Issue counter

- Formulations

- Drugs storage

Public utilities

Ambulatory Zone (OPD) (B)

Examination and Workup

- Examination room

- Sub-waiting

Consultation

- Consultation rooms

- Toilets

- Sub-waiting

Nursing Station

- Nurses Desk

- Clean Utility

- Dirty Utility

- Treatment rooms (Injection, Dressing, Plaster,

ECG)

- Sub-waiting

Casualty / Emergency

Public Utilities

Diagnostic Zone (C)

Pathology (optional)

- Laboratory

- Sample Collection

- Bleeding Room

- Washing / disinfection




- Storage

- Sub-waiting

Imaging (Radiography, Ultrasound)

- Preparation

- Change & Toilet

- Control

- Dark Room (film developing and processing)

- Ultrasound Room

- Sub-waiting

Public Utilities

Critical Zone (Labour Room &

Sterilization) (D)

Patient Area

- Preparation & Examination

- Pre-anesthesia

- Post Operative

Staff Area

- Toilet & Changing

Supplies Area

- Trolley Bay

- Equipment Storage

Sterilization

- Receipt

- Wash

- Assembly

- Sterilization

- Sterile Storage

- Issue

Minor OT /L.D.R. Area

- Labour Room

- Minor OT

- Scrub and Gown

- Instrument Sterilization

- Disposal

Public Utilities

Facility Management Zone (E) Civil Engineering

- Building maintenance


- Horticulture

- Water Supply

- Drainage and Sanitation

Electrical Engineering

- Sub-station and generation

- Illumination

- Ventilation

Mechanical Engineering

- Air-conditioning

- Refrigeration

Other Services

- Telephone and Intercom

- Fire Protection

- Waste disposal

- Mortuary

Administrative Zone (F)

General Administration

General Stores

Public Utilities




AREA & SPACE REQUIREMENTS

Functional Areas represent the areas where the primary functions of the respective sub-unit

are performed e.g. the Consulting Rooms in an OPD, Treatment Room in an Emergency,

etc. As far as possible, the size of these areas shall not be changed. Relations of all other

areas shall be established in relation to the properties of these areas.

Support Areas are the ones where functions which directly support or enable the primary

functions of the respective sub-unit are performed e.g. the clean utility room in a Nursing

Unit, Recovery room in a LDR Suite, etc. The size of these areas can be changed to

accommodate design constraints but the integrity of their relation to functional areas shall be

maintained. Support areas of two or more similar functional units, located in proximity of

each other, or on the same floor, can be grouped and shared by each functional unit.

Service Areas represents the areas where such functions are performed which do not

directly support the performance of primary functions of the respective sub-unit e.g. the

Sluice Room in a Nursing Unit, etc. The size of these areas and their relation to functional

areas can be changed to accommodate design constraints.

1. OUT PATIENT DEPARTMENT

Functional Area Minimum Functional Area Total Functional Area

Consulting Rooms (4) 10 Sq mtrs. 40 Sq mtrs.

Support Areas

Reception & Registration 8 Sq mtrs. 8 Sq mtrs.

Waiting Areas 15 Sq mtrs. 15 Sq mtrs.

Social Workers Office 8 Sq mtrs. 8 Sq mtrs.

Dressing & Plaster Room 10 Sq mtrs. 10 Sq mtrs.

Sample Collection Room 6 Sq mtrs. 6 Sq mtrs.

Immunization Room 6 Sq mtrs. 6 Sq mtrs.

Pharmacy cum Dispensary 12 Sq mtrs. 12 Sq mtrs.

Physiotherapy 10 Sq mtrs. 10 Sq mtrs.

Service Areas


Water Facility 3 Sq mtrs. 3 Sq mtrs.

Toilet (Male & Female) 5 Sq mtrs. 10 Sq mtrs.

Janitor’s Closet 3 Sq mtrs. 3 Sq mtrs.

Trolley Bay 4 Sq mtrs. 4 Sq mtrs.

Total 135 Sq mtrs.

2. EMERGENCY


Consulting Room 10 Sq mtrs. 10 Sq mtrs.

Treatment/ Procedure Room 10 Sq mtrs. 10 Sq mtrs.

Injection Room 8 Sq mtrs. 8 Sq mtrs.

Service Area

Ambulance Receiving Area 20 Sq mtrs. 20 Sq mtrs.


Total 52 Sq mtrs.

3. LABORATORY & IMAGING


Clinical Pathology 10 Sq mtrs. 10 Sq mtrs.

Bio-chemistry 6 Sq mtrs. 6 Sq mtrs.

Microscopic 3 Sq mtrs. 3 Sq mtrs.

Staining Area 4 Sq mtrs. 4 Sq mtrs.

X-ray Room 16 Sq mtrs. 16 Sq mtrs.

Dark Room 6 Sq mtrs. 6 Sq mtrs.

Ultrasound Room 10 Sq mtrs. 10 Sq mtrs.

Support Areas

Reception and Waiting 15 Sq mtrs. 15 Sq mtrs.

Laboratory Store 6 Sq mtrs. 6 Sq mtrs.

Imaging Store 4 Sq Mtrs. 4 Sq Mtrs.

Service Area

Toilet (Male & Female) 4 Sq mtrs 8 Sq mtrs.


Total 90 Sq mtrs.




4. MINOR OT / LABOUR & DELIVERY SUITE


Minor OT 20 Sq mtrs. 20 Sq mtrs.

Labour Room (2 Table) 25 Sq mtrs. 25 Sq mtrs.

Scrub Room 3 Sq mtrs. 3 Sq mtrs.

Sterilization Room 6 Sq mtrs. 6 Sq mtrs.

Support Area

Examination Room 8 Sq mtrs. 8 Sq mtrs.

Counseling Room 10 Sq mtrs. 10 Sq mtrs.

Store 4 Sq mtrs. 4 Sq mtrs.

Recovery Room 6 Sq mtrs. 6 Sq mtrs.

Sterile Store 4 Sq mtrs. 4 Sq mtrs.

Service Area


Toilet 6 Sq mtrs. 6 Sq mtrs.


Sluice Room 3 Sq mtrs. 3 Sq mtrs.

Waiting Area 6 Sq mtrs. 6 Sq mtrs.

Total 108 Sq mtrs.

5. ADMINISTRATIVE DEPARTMENT


MOICs Room 10 Sq mtrs. 10 Sq mtrs.

Account Office 7 Sq mtrs. 7 Sq mtrs.

Medical Records Room 10 Sq mtrs. 10 Sq mtrs.

Central Reception 5 Sq mtrs. 5 Sq mtrs.

Toilet (Male & Female) 5 Sq mtrs. 10 Sq mtrs

Total 42 Sq mtrs.

6. STORE & PHARMACY SERVICES

Functional Area Minimum Functional Area Total functional Area

Medical Store 15 Sq mtrs. 15 Sq mtrs.

General Store 15 Sq mtrs. 15 Sq mtrs.

Mortuary 8 Sq mtrs. 8 Sq mtrs.

Total 38 Sq mtrs.


7. GENERATOR ROOM


Generator Room 8 Sq mtrs. 8 Sq mtrs.

Water Pump Room 4 Sq mtrs. 4 Sq mtrs.

Total 12 Sq mtrs.

8. RESIDENTIAL ACCOMMODATION


Doctors

Nurses

Pharmacist

Sweeper/Driver

80 Sq mtrs.

60 Sq mtrs.

60 Sq mtrs.

45 Sq mtrs.

80 Sq mtrs.

60 Sq mtrs.

60 Sq mtrs.

45 Sq mtrs.

Total 245 Sq mtrs

Total area required barring residential accommodation is 477 Sq mtrs. approximately. We

need to add 30% of this area for circulation space and corridors, stairs, ramps, emergency

exit etc. Hence the total covered area would be around 620 Sq mtrs.

Since the health center is a horizontal structure the space calculated above is adequate, to

this accommodation area for the staff is to be added which comes to 865 Sq mtrs. Adequate

space for landscaping, gardening and parking area needs to be added. Therefore, a total

area of 1600 Sq. mtrs. would be adequate for creating a Public Urban Health Centre.

PRIMARY URBAN HEALTH CENTRE (PUHC) BUILDING

a. Location:

i. It shall be located in an easily accessible area. The building shall have a

prominent board displaying the name of the centre in the local language. The

area chosen shall have the facility for electricity, all weather road

communication, adequate water supply, telephone.

ii. It shall be well planned with the entire necessary infrastructure. It shall be well lit

and ventilated with as much use of natural light and ventilation as possible.

iii. Shall have non-slippery floors.




b. Entrance:

i. It shall be well-lit and ventilated with space for Registration and record room,

drug dispensing room, and waiting area for patients.

ii. The doorway leading to the entrance shall also have a ramp facilitating easy

access for handicapped patients, wheel chairs, stretchers etc.

iii. Waiting area:

• This shall have adequate space and seating arrangements for waiting

patients / attendants.

• The walls shall carry posters imparting health education.

• Booklets / leaflets may be provided in the waiting area for the same

purpose.

• Toilets with adequate water supply separate for males and females shall be

available, preferably with Western and Indian WC sheets.

• Drinking water shall be available in the patient’s waiting area.

• There shall be proper signage displaying parts of the centre, a board

displaying available services, names of the doctors, list of members of the

Rogi Kalyan Samiti, and the referral facilities.

• A locked complaint / suggestion box shall be provided and it shall be

ensured that the complaints/suggestions are looked into at regular intervals

and the complaints are addressed.

• The surroundings shall be kept clean with no water-logging / vector

breeding places in and around the centre.

• The Citizen’s Charter shall be displayed in a prominent position on the

centre premises.

• There shall be green area – wherever space is available, horticulture /

plantation of trees and plants. In areas with space constraint potted plants

can be used.

c. Outpatient Department:

• The OPD shall have separate rooms, atleast (air-conditioned) for consultation

and examination with a wash basin and attached toilet. (Atleast two rooms one

for MO I/C and the other for two Medical Officers.)

• The Consultation rooms shall have separate areas for consultation and

examination.

• The area for examination shall have sufficient privacy.

• In PUHCs with AYUSH doctors, necessary infrastructure such as consultation

room for AYUSH Doctor and AYUSH Drug dispensing shall be made available.


• Clean linen shall be provided and cleanliness shall be ensured at all times.

d. There shall be separate room for Injection & Emergencies, one for Dressings and

minor procedure.

• It shall be located close to the OPD Consulting rooms to provide easy and quick

access to patients for injections / minor surgeries and emergencies during OPD

hours.

• It shall be well equipped with all the emergency drugs and required instruments.

e. Labour & Delivery Suite:

Labour & Delivery suite shall have in its close proximity sufficient space for

examination / history taking / weighing / recording BP / immunization / group and

individual counseling. The rooms shall be well lit and ventilated and preferably with

dual entrance.

f. Laboratory

• Sufficient waiting space

• Separate area for sample collection and conducting the tests shall be available.

• Shall have marble/stone table top for platform and wash basins.

• Running water supply shall be available in Lab.

• Exhaust fan shall be available.

g. X-Ray & Ultrasound Room

• AERB and BARC certificates to be obtained for the equipments & building plan.

• Radiation safety devices shall be provided to radiographers and patients.

• Lead shielded doors of X-ray room

• Wall thickness of X-ray room shall be 0.1 mm

• Radiation hazards warning symbols display as per AERB guidelines.

• Display of instructions in Hindi and English warning women of child bearing age

on dangers of radiation in pregnancy.

• Patient instructions like full bladders; empty stomach etc shall be displayed

outside the USG room.




INSTRUMENTS & EQUIPMENTS

S.No. Name of Item Quantity

1 Nebulizer with heavy duty motor (portable) single port 1

2 Ambu's Bag (Adult & Child) 1

3 Anterior Wall retractor vaginal size S/M/L 2

4 Artery Forceps Curved 6"ss 6

5 Artery Forceps Straight 6"ss 6

6 Autoclave ISI marked with 4 Dressing Drum 2

7 B.P. Apparatus 4

8 Bowl SS 20 cm 4

9 Cuscus speculum Small / Medium / Large 4

10 Digital Thermometer 6

11 Forceps Chital 9"ss 4

12 Forceps Dissecting Plain 6"ss 2

13 Forceps Dissecting Toothed 6"ss 4

14 Forceps Sinus 6"ss 2

15 Forceps Sponge Holding 9" 4

16 Gynae Examination Light with ordinary bulb floor model 2

17 Height Measuring Scale 2

18 SS Instrument Tray with Cover 8" x 10" 4

19 Key spanner for oxygen cylinder 2

20 Kidney Tray SS 25 cms 4

21 Needle Holder Straight / Curved 6"ss 2

22 Oxygen Cylinder B Type 10 Ltr. ISI Marks with all requisite certificates. 2

23 Oxygen Cylinder Trolley 2

24 Oxygen Flow meter with humidifier bottle 2

25 Posterior Wall retractor (Sims) Small / Medium / Large 4

26 Scissors 6' SS 4

27 Scissors Sharp Tailor Model 2

28 Stethoscope having good conduction tube for adult & child 4

29 Syringe Cum Needle Destroyer Manual Model 2

30 Uterine Sound ss 4

31 Volsellum ss 4

32 Alis Tissue Forceps 2

33 Adult Weighing Scale (Manual) 1

34 Foot Operated Suction Machine 1


35 Electrical Suction Machine 1

36 B.P. Handle 4 2

37 Nasal Speculum 2

38 Percussion Hammer 4

39 Electric Sterilizer 2

40 Spot Light 1

41 Weighing Scale digital (Neonatal) 1

42 Single Panel X-ray view box 1

COMMON SURGICAL CONSUMABLES


1 Bandage all sizes do

2 Cotton do

3 Adhesive wound Dressing different Sizes do

4 Alcohol Swab do

5 Adhesive Plaster do

6 Disposable Blade do

7 Oxygen Mask Adult & Pediatrics do

8 Disposable Draw Sheet do

9 Sterile Surgical pad 10 x 10 cm do

10 Crepe Bandage 8 cm / 10 cm / 15 cm do

11 Disposable Syringe AD 2 cc, 5 cc, 1 cc 10 cc do

12 IV Set do

13 Scalp Vein Set 23, 24 G do

14 Lint Cloth do

15 Hypodermic Needle 22G, 23G, 26G, 24G do

16 Disposable Gloves different sizes Sterile & Non Sterile do

17 Hypo Allergic Paper Tape 1" do

18 Face Mask do

19 Poly Mask (Adult / Paeds) do

20 Ryle's Tube do

21 Gastric Levage Tube do

22 Suction Catheters do

23 Mucus Extractor with Suction Tube do

24 Rubber Sheething do

25 Wooden Tongue Depresser do




26 Suture Silk 1-0 do

27 Tuberculin Syringe do

28 Suture Catgut 1-0 do

29 I.V. Canula 22, 24 do

30 Paraffin Gauze / Chlorhexidine Gauge do

31 Baladona Plaster do

32 First-Aid Dressing water proof do


LABORATORY & RADIOLOGY ITEMS


1 Acetic Acid Glacial do

2 Acetone do

3 Beakers all sizes do

4 Blood Cell Counter 6 units do

5 Blood Grouping kit Anti A, B, AB & D (Rh) do

6 Boric Powder do

7 Blood Grouping Plate do

8 Bleaching Powder / Solution do

9 Carbol Fuschin do

10 Cedar Wood Oil do

11 Centrifuge Tube do

12 Cover Slip all size do

13 Diamond Pencil for Slide Marking do

14 Distille Water 5 Ltr. Pack do

15 Dropper do

16 ESR Pipette Disposable do

17 ESR Stand (6 Tubes) 2

18 EDTA Tubes (Glass) do

19 Filter Paper Sheet Round do

20 Glucometer 1

21 Glucometer Strip Compatible do

22 Hb Pipette with rubber tube do

23 Hb tube do

24 Haemoglobinometer Complete do

25 Hydrogen peroxide for lab use do

26 Improved Neubaur's chamber do

27 Lancet Disposable Sterile do

28 Lieshman Stain do

29 Microscope slide (glass) deluxe do

30 Multi stick for urine do

31 N/10 HCL do

32 Pasture pipette do

33 Pipette RBC do

34 Pipette WBC (as per requirement)




35 Pipette Stand do

36 Platelets count fluid do

37 Pot Permanganate do

38 Pregnancy test card / strip do

39 R B C diluting fluid do

40 Slide Staining Tray do

41 Sod. Citrate Soln. do

42 Sprit Lamp / Bunsen Burner do

43 Stop Watch do

44 Sulphur Powder do

45 Sulphur Acid do

46 Tepol Liquid do

47 Test Tube Holder do

48 Test Tube Size 12 x 100 mm do

49 Test Tube Size SS body do

50 Tissue Paper Roll do

51 TLC / DLC Counting Chamber do

52 Tourniquets (Velcro) do

53 Uristicks for Glucose and Albumin do

54 WBC Diluting Fluid do

55 Widal Testing kit do

56 Xylene do

57 Urine Sticks for Microalbumin do

58 Binocular Microscope 1

59 Centrifuge Machine for 8 tubes 1

60 EDTA Powder do

61 Vacutainers Plain do

62 Filter Paper do

RADIOLOGY ITEMS

1 100 MA X-ray Machine 1

2 High End Ultrasound Machine 1

3 ECG Machine 1

4. TLD Badge for Radiographer 1

5. Lead Apron 2


FURNITURE ITEMS


1 Steel Almirah Big 9

2 Steel Almirah Small 4

3 Table Officer 2

4 Office Table Assistant 6

5 Office Table Clerk 2

6 Office Chair 24

7 Office Chair 3

8 Bench Stell 4

9 Airport Bench (3 Seats) 4

10 Examination Table 4

11 Gynae Examination Table 2

12 Mattress for Examination Table 4

13 Foot Step 6

14 Steel Racks with cover 6 shelve 6

15 Steel Racks with cover 2 shelve 5

16 Revolving Stool ss top 8

17 Wooden Stool 6

18 Revolving Stool adjustable height for dispensary / lab with cushion top 2

19 Hydraulic Stool 2

20 Screen Three Fold / Hanging Screens 6

21 Notice Board 1

22 Computer Table 1

23 Computer Chair 1

24 Notice Board Pannel for IEC 2

25 Wheel Chair 1

26 Stretcher with Trolley 1

27 Instrument Trolley 3

28 Dressing Trolley 1

29 Side Wooden Rack 1

30 I. V. Stand 1




GENERAL & MISCELLANEOUS ITEMS


1 Broom phool (as per requirement)

2 Broom Naryal do

3 Liquid Soap do

4 Room Freshener do

5 Floor Mops do

6 Duster do

7 Wiper do

8 Dustbin Plastic- Small/ medium / big do

9 Electric Tubes do

10 CFL Bulb do

11 Phenyl 5 Ltr. do

12 Finit/ Baygon do

13 Finit Pump do

14 Degradable polybags Black for BMW do

15 Degradable polybags Yellow for BMW do

16 Degradable polybags Red for BMW do

17 Bleaching Powder do

18 Glass Tumber do

19 Toilet Cleaner do

20 Naphthalene Ball do

21 Odonil do

22 Safety Razor do

23 Measuring Tape do

24 Plastic Bucket - 30 Ltr do

25 Detergent Powder do

26 Soap Cake do

27 Locks with Keys Big & Small do

28 Biomedical Waste Bins do

29 Mugs do

30 Water Jugs 20 Ltr. do

31 Hot Case Electric do

32 R.O.System do

33 Water Cooler do

34 Desert Cooler do


35 Air Condition (window type) (as per requirement)

36 Invertors with Adequate Back up do

37 Domestic Refrigerators 165 Ltr. do

38 Computer with Broad Band and Accessories do

39 Fire Extinguishers do

40 Signages do

41 Torch Medium / Large do

42 Torch Cells do

43 Telephone with Intercom facility do

44 Vaccine Carrier do

45 Brush for Toilet do

46 Calculator 10 Digits do

47 Canvas Bag do

48 Door Mat Rubber / Small / Medium / Large do

49 Rat Trape do

50 Jerican White Empty 5 Ltr/ 10 Ltr / 20 Ltr do

51 Table Glass do

52 Dial Thermometer do

53 Rain Coat do

54 Sealing Wax do

55 Suggestion Box do

56 Stand for Refrigerator do

57 Cup & Plate Set do

58 Hot Plate do

59 Umbrella do

60 Lathi for Chowkidar do

61 Voltage Stabilizer 1/2, 1 & 2 KV do

62 Fire Extinguishers

63 Waste Paper Basket Plastic do

64 Emergency Light do

65 Gloves for Cleaning (Heavy duty Rubber) do

66 Gum Boots do

67 Tissue Paper Roll do

68 Paper Napkins do

69 Liquid Spray cleaner (Colin/Brisk) do

70 Heat Convertor do

71 Room Heater do




72 Chemical Treatment Bucket 20 Ltr. (as per requirement)

73Foot operated dustbin ss Frame with Removable Pot made of HDPE material Black / Yellow / Red do

74 UPS for Computers do

75 Pen Drive 4 GB / 8 GB do

76 Goggles for Universal Precautions do

77 CVT 2 KVA do

78 Hot Water Bottle do

79 Fly Catcher do

80 Extension Board do

81 PUC Pipe do

82 Bamboo for Floor Mops do


STATIONARY & LINEN ITEMS


1 OPD Slips As per requirement

2 OPD Register As per requirement

3 Stock Register As per requirement

4 Rulled Register 2Q, 4Q As per requirement

5 Immunization Register As per requirement

6 Immunization Card As per requirement

7 Eligible Couple Register As per requirement

8 Special Drug Forms As per requirement

9 Morbidity Reporting Proforma ICD-10 As per requirement

10Reporting Proformas Under Various National Health Programmes As per requirement

11 Pilot Pen (Blue/Red) V5 As per requirement

12 Zotter Pen (Blue/Red/Green) As per requirement

13 Ball Pen As per requirement

14 Gel Pen As per requirement

15 Marker Pen As per requirement

16 Permanent Marker As per requirement

17 Ink for Pilot Pen As per requirement

18 Refills for Zotter Pen As per requirement

19 Refills for Ball Pen As per requirement

20 Pencil HB As per requirement

21 High Lighter Pen As per requirement

22 Eraser/Rubber As per requirement

23 Scale (12") As per requirement

24 Stapler Pin As per requirement

25 All Pin As per requirement

26 Board Pin 13mm As per requirement

27 U Clip As per requirement

28 Tags Cotton As per requirement

29 All Pin Cushion As per requirement

30 Gum Botle 700 ml Big As per requirement

31 Stamp Pad As per requirement

32 Ink for Stamp Pad As per requirement

33 White Fluid As per requirement




34 Cello Tape Size 1/2 Inches, 1 Inches As per requirement

35 Slip Pad As per requirement

36 White Envelop (4"X6") As per requirement

37 White Envelop (4"X9") As per requirement

38 White Envelop A-4 Size As per requirement

39 Envelop (File size) brown Plastic Coated As per requirement

40 Dak Pad As per requirement

41 Paper Weight As per requirement

42 File Cover As per requirement

43 File board As per requirement

44 File Wrapper As per requirement

45 Photocopy Paper (all size) 75 GSM & ISI As per requirement

46 Typing Paper As per requirement

47 Duplicating Paper As per requirement

48 Note sheet Superior As per requirement

49 Carbon paper (Blue) all size As per requirement

50 Short hand book As per requirement

51 Attendance Register As per requirement

52 Diary Register As per requirement

53 Dispatch Register As per requirement

54 Cartridges for Printers As per requirement

LINEN ITEMS

1 Bed Sheet As per requirement

2 Draw Sheet As per requirement

3 Towel Large/Medium/Small As per requirement

4 Screen Cloth As per requirement

5 Pillow As per requirement

6 Pillow Cover As per requirement

7 Curtain Cloth As per requirement

8 Doctor Coat As per requirement

9 Coat for Paramedical Staff As per requirement

10 Apron As per requirement

11 Patient Blanket As per requirement

12 Blanket for Chowkidar As per requirement



MANPOWER & STAFFING

S.No. Category of Staff Recommended*

1.

Medical Officer In-charge (MO I/C)

Second Medical Officer

1 (1 MBBS Doctor and 1 Lady Medical Officer or from AYUSH)

1

2.Pharmacist (Storekeeper) Pharmacist

1

1

3. Physiotherapist 1

4. Public Health Nurse (PHN) 1

5. Auxiliary Nurse Midwife (ANM) 1 for PUHC (plus 1 for each 10,000 urban poor population attached to the centre) in slums / JJ Clusters etc.

6. Laboratory Technician 1

7. Radiographer 1

8. Dresser 1

9. Nursing Orderly / Peon 1

10. Sweeper cum Chowkidaar (SCC) 3

11. CDEO cum Assistant 1

12. Medical Records Clerk 1

13. Social Mobilization Officer 1

14. Driver 1

15.Electrician

Plumber

1 (On Contract)

1

Total Manpower 23

Note: * This recommendation is for 50,000 population. In case of higher catchment

population the staff will be increased proportionately till such time as there is one PUHC for

every 50,000 population. In addition care must be taken to ensure sufficient leave reserve

and staff for special programs like Pulse Polio etc.


ESSENTIAL DRUG LIST

ANAESTHETICS

General Anesthetics

Sodium thiopentone Inj. 0.5, 1 g powder/vial

Halothane Inhalation

Ether inhalation

Nitrous oxide inhalation

Oxygen inhalation

Carbon dioxide inhalation

Ketamine hydrochloride

Inj. 50 mg/ml

Local Anesthetics

Bupivacaine hydrochloride Inj. 0.25, 0.5%

Lignocaine hydrochloride Inj. 1,2,4,5% jelly 2%, Oint 2%

Lignocaine with adrenaline 5 mcg/ml adrenaline Dental cartridge 2% adrenaline (1:80,000)

Ethyl chloride spray

Preoperative Medication and Sedation for Short Term Procedures

Atropine sulphate Inj. 0.6 mg/ml.

Promethazine Inj. 25 mg/ml

Syrp. 5 mg/5ml

Diazepam Inj. 5 mg/ml, Tab. 5 mg

Midazolam Inj. 1 mg/ml.

Glycopyrrolate Inj. 0.02 mg/ml.

ANALGESICS, ANTI-PYRETICS AND DRUGS FOR GOUT

Non Opioids

Acetyle salicylic acid Tab. 100, 325 mg

Allopurinol Tab. 100 mg

ParacetamolTab. 500 mg/Syp. 125 mg/5 ml

Inj. 1.50 mg/ml

IbuprofenTab. 200, 400 mg

Syr. 100 mg/5 ml

Indomethacin Cap 25 mg.

Diclofenac sodium Tab. 50 mg, Inj. 25 mg/ml

Opioids

Pentazocin lactate Inj.30 mg/ml

Morphine sulphate Inj. 10 mg/ml

Pethidine hydrochloride Inj. 50 mg/ml




Anti-Migraine Drugs

Dihydroergotamine mesylate Tab. 1 mg

For Prophylaxis propranolol 10, 40 mg

ANTIALLERGIC AND DRUGS USED IN ANAPHYLAXIS

Chlorpheniramine meleate Tab. 4 mg

Prednisolone Tab. 5 mg

Epinephrine hydrochloride Inj. 1 mg/ml

Pheniramine meleate Inj. 22.75 mg/ml

Promethazine Tab. 10, 25 mg, Syr. 5 mg/ml

Dexamethasone sodium phosphate Tab. 0.5 mg, Inj. 4 mg/ml

Hydrocortisone sodium succinate Inj. 100 mg/ml

Cetirizine Tab. 10 mg

ANTIDOTES AND OTHER SUBSTANCES USED IN POISONING

Atropine Inj. 1 mg/ml

Activated charcoal power PAM Inj. 25 mg/ml

Anti snake venom Inj Polyvalent

Desferrioxamine Power for Inj. 500 mg in vial

ANTI-EPILEPTIC DRUGS

Phenytion sodiumTab. 50, 100 mg

Inj. 50 mg/ml

PhenobarbitoneInj. 200 mg/ml, Elixir 15 mg/5 ml

Tab. 30, 60 mg

Carbamazepine Tab. 100, 200 mg, Syr. 100 mg/5ml

Sodium valproate Tab. 200 mg, Syr. 200 mg/5 ml

Diazepam Inj. 5 mg/ml

ANTI-INFECTIVE DRUGS

Anti Helminthics

Intestinal Anthelmintics

Albendazole Tab. 400 mg, Susp. 200 mg/5ml

Pyrantel pamoate Tab. 200 mg, powder for susp. 50 mg/ml

ANTI-BACTERIALS

Penicillins

AmoxicillinCap. 250, 500 mg, powder for susp. 125 mg/5ml

Inj. 125 mg/ml

AmpicillinCap. 250, 500 mg, powder for susp. 125 mg/5ml

Inj. 500 mg/vial

Cloxacillin Cap. 500 mg, powder for susp. 125 mg/5ml


Inj. 500 mg/vial

Benzathine penicillin Powder for Inj. 0.6 1.2, 2.4 MU/vial

Benzyl penicillin Powder for Inj. 0.5 MU/vial

Procaine penicillin Powder for Inj. 0.4 MU/vial

OTHER ANTI BACTERIALS

Gentamicin Inj. 10, 40 mg/ml

Amikacin Inj. 100, 250, 500 mg/2ml

Ciprofloxacin

Tab. 200, 400 mg

Infusion 100 mg/50mg,

Susp. 200 mg/5ml

Nalidixic acid Tab. 500 mg, Syr. 300 mg/5ml

Metronidazole

Tab. 200, 400 mg

Inj. 500 mg/100ml. Vial

Susp. 200 mg/5ml

Caftazidime Inj. 250 mg, 500 mg, 1 g

Cephalexin Cap. 250, 500 mg

Syr. 125 mg/5ml

Ceftriaxone Inj. 500 mg. 1 g

Chloramphenicol Cap. 250 mg. Syr. 125 mg/ml

Inj. 1 g/vial

Erythromycin (as estolate) Tab. 250 mg, powder for susp. 125 mg/5ml

Sulfamethoxazole trimethoprim

Tab. 400 mg + 80 mg

Tab. 800 mg + 160 mg.

Susp. 200 mg + 40 mg in 5 ml

Doxycycline Cap. 100 mg

Tetracyclin Ap. 250, 500 mg

Norfloxacn Tab. 400 mg, 200 mg

ANTI-LEPROSY DRUGS

Clofazimine Cap. 50, 100 mg

Dapsone Tab. 50, 100 mg

Rifampicn Cap., Tab. 150, 300, 450, 600 mg

ANTI-TUBERCULOSIS DRUGS

Ethambutol Tab. 400, 800 mg

Isoniazid Tab. 100, 300 mg, Syp. 100 mg/5ml

Rifampicin Cap. 150, 300, 450, 600 mg. , Syp. 0.75 g/vial




Streptomycin Inj. 0.75 g/vial

PyrazinamideTab. 300, 500, 750 mg

Syp. 250 mg/5ml

ANTI-FUNGAL DRUGS

Griseofulvin Tab. 125, 250 mg

Ketoconazole Tab. 200 mg

ANTI-PROTOZOAL DRUGS

Trinidazole Tab. 300, 600 mg, powder for susp. 150 mg/5ml

Diloxanide furoate Tab. 500 mg

Choloroquine phosp. Tab. 250 mg, Inj. 40 mg/ml

Syp. 160 mg/10ml

Primaquine Tab. 7.5, 15 mg.

Metronidazole Tab. 200, 400 mg, Inj. 500 mg/100ml, Susp. 200 mg/5ml

ANTI VIRAL

Acyclovir Inj. 250 mg, Tab. 200 mg

ANTI-PARKINSONISM DRUGS

Trihexyphenidyl Tab. 2 mg

Bromocriptine Ab. 2.5 mg

Levodopa + Carbidopa Tab. 100 mg + 10 mg

Tab. 250 mg + 25 mg

Selegilline Tab. 5 mg

DRUGS AFFECTING BLOOD

Anti Anaemic Drugs

Ferrous Sulphate Tab. 200 mg (equivalent to 60 mg elemental iron)

Ferrous fumerate Drops 5 mg/drop

Folic acid Tab. 1.5 mg

Iron sorbital citric acid complex Inj. 75 mg iron / 1.5 ml

Ferrous fumerate + folic acid 60 mg + 0.2 mg

Hydroxy cobalamine Inj. 1 mg/ml

Drugs Affecting Coagulation

Vitmin K Inj. 10 mg/ml

Heparin Inj. 5000 IU/ml, 20,000 IU

Inj. 5000 IU/ml low molecular weight

Streptokinase Inj. 15,00,000 IU

Protamine sulphate Inj. 10 mg/ml in 5 ml ampoule

Acenocoumarin Tab. 1, 2, 4 mg

BLOOD PRODUCTS AND SUBSTITUTES


Polymer from degraded Inj. Gelatin as 0.63g of nitrogen + electrolytes (3.5g) made isotonic solution

Dxtran 40 injectable solution

CARDIOVASCULAR DRUGS

Anti-Anginal Drugs

Propranolol Tab. 10, 40, 80 mg

MetoproololInj. 1 mg/ml

Tab. 50, 100 mg

Atenolol Tab. 50, 10 mg

Glyceryl Trinitrate Tab. 0.5 mg

Inj. 5, 25 mg

Isosorbide dinitrate Tab. 10, 20 mg

Isosorbide mononitrate Tab. 10, 20, 40 mg

Diltiazem Tab. 30. 60 mg

Anti Dysrhythmic Drugs

MexiletineCap. 50, 150 mg

Inj. 250 mg/10ml

Lignocaine Inj. 2% (21.3 mg/ml)

Amiodarone Tab. 200 mg

VerapamilTab. 40, 80 mg

Tab. Syr. 240 mg, Inj. 5 mg/2ml

Anti-Hypertensive Drugs

Nifedipine Cap. 5, 10 mg

Hydralazine Tab. 25, 50 mg, Inj

Methyldopa Tab. 250 mg

Enalpril Tab. 2.5, 5 mg

Sodium Nitroprusside Inj. 50 mg/5ml

Amlodipine Tab. 5 ml

Hydrochlorothiazide Tab. 25 mg

Chlorthalidone Tab. 25, 50 mg

Drugs used in Vascular shock and Peripheral Vascular Diseases

Dobutamine Nj. 125 mg/10 ml

Mephentermine Inj. 30 mg/ml

Dopamine Inj. 40 mg/ml

Cardiac Glycosides

Digoxin Tab. 0.25 mg

DERMATOLOGICAL DRUGS




Anti-Fungal Drugs

Clotrimazole Oint. 1% powder 1% Vaginal pessary 100 mg

Miconazole Oint 2%

Benzoic acid + Salicylic acid Oint. (6% + 3%)

Anti-Infective Drugs

Silver sulfadiazine Cream 1%

Framycetin Cream 1%

Povidone iodine Powder 5%, lotion 5%, Hand scrup 10%, Ointment

Gentian violet 0.5% 1%

Acyciovir Cream 5%

Anti Inflammatory and Anti Pruritic Drugs

Betamethasone Oint/Cream 0.025%

Calamine Lotion

Keratoplastic and Keratolytic Agents

Coal tar Sol. 5%

Salicylic acid Oint. 2%

Podophyllin Resin 10, 25%

Dithranol Oint. 0.1, 2%

Glycerine Sol. 5%

Scabicides and Pediculocides

Benzyl benzoate Lotion 12.5, 25%

Gamma benzene hexachloride Lotion 1%

Ultra-violet blocking Agents

Para amino benzoic acid Cream/gel 10%

Zinc oxide Cream/Oint.

DIAGNOSTIC AGENTS

Ophthalmic Diagnostic Agents

Flurescein 2% eye drops

Tropicamide 1% eye drops

Contrast Agents

Barium sulphate

Powder, Susp. 95% w/v

Powder (HD) 95% w/w,

250% w/v

Sodium diatrizoate and Inj. Meglumine diatrizoate

Inj. 60, 76%

DISINFECTANTS AND ANTISEPTICS

Cetrimide + chlorhexidine Cream, lotion (15% + 7.5%, 5%)

Ethyl alcohol Solution


Glutaraldehyde activated Lotion 2% w/v

Tincture benzoin Co. Carbolic acid Solution

Hydrogen peroxide Sol. W/v

Acriflavin + Glycerine Sol. (0.1% acriffavin)

Potassium permanganate Crystals for sol.

Povidone iodine Sol. 10%

Acetic acid 3%

Calcium hypochlorite Powder

Methyl alcohol Solution

Eusol Solution

Spirit Solution

DIURETICS

Frusemide Tab. 40 mg, Inj. 10 mg/ml

Spironolactone Tab. 25 mg

Mannitol Inj. 10%, 20

Glycerol Syp.

Amiloride Tab. 5 mg

Hydrothiazide Tab. 25 mg.

GASTROINTESTINAL DRUGS

Antacids and other Anti-ulcer drugs

Mangesium hydroxide+aluminium hydroxide+activated methylpoly siloxane

Tab. (250 mg + 50 mg)

Ranitidine Tab. 150 mg, Inj. 50 mg/2ml

Omeprazole Cap. 20 mg

Cisapride Tab. 10 mg

Famotidine Tab. 20, 40 mg

Anti-Emetic Drugs

Metoclopromide Inj. 5 mg/ml, Tab. 10 mg

Domperidone Syp. 1 mg/ml, Tab. 10 mg

Inj. 2.5 ml

Prochlorperazine Tab. 2.5, 5 mg. Inj. 5 ml

Anti-Haemorrhoidal Drugs

5 Amino Salicylic acid Tab. 400 mg, Suppository

Sulfasalazine Tab. 500 mg

Hydrocortisone 25 mg suppository




Anti-Spasmodic Drugs

Dicylomine Tab. 10 mg, Inj. 10 mg/ml

Hyoscine butylbromide Tab. 10 mg, Inj. 20 mg/ml

Cathartic Drugs

Bisacodyl Tab. 5 mg

Lactulose Syp. 667 mg/ml

Ispaghula Husk

Drugs used in Diarrhoea

ORS (WHO) Powder 27.9 g/ft

Furazolidone Tab. 100 mg, powder for susp. 25 mg/5ml

HORMONES, OTHER ENDOCRINE DRUGS AND CONTRACEPTIVES

Adrenal hormones and Synthetic Substitutes

Prednisolone Tab. 5 mg

Methylprednisotone Inj. 500 mg/ml

Dexamethesone Tab. 0.5, 4 mg

Hydrocortisone Inj. 100 mg/ml

Androgens

Testosterone propinate Inj. 25, 50 mg/ml

Nandrolone decanoate Inj. 25 mg/ml

Contraceptives

Ethinyl oestradiol + levonorgestral Tab. 30 mcg + 150 mcg

30 mcg + 250 mcg

Ethinyl oestradiol + norethisterone Tab. 35 mcg + 1 mg

Oestrogens

Ethinyl oestradiol Tab. 0.01, 0.05 mg

Conjugated estrogen Tab. 1.25, 0.625 mg

Insulin and other Anti-Diabetics Drugs

Glibenclamide Tab. 5 mg

Metformin Tab. 500, 850 mg

Insulin soluble Inj. 40 IU/ml

Insulin semilente Inj. 40 IU/ml

Insulin Lente Inj. 40 IU/ml

Ovulation Inducer

Clomiphene Tab. 50 mg

HMG Inj. 1000, 5000, 10,000 IU

HCG Inj. 1000, 5000, 10,000 IU


Progesterones

Norethisterone Tab. 5 mg

Medroxy progesterone acetate Tab. 10 mg

17 Hydroxy progesterone caproate Inj. 500 mg

Thyroid Hormones and Anti-Thyroid Drugs

Thyroxine sodium Tab. 100 mcg

Carbimazole Tab. 5 mg

IMMUNOLOGICAL AGENTS

Tetanus toxoid Inj.

B.C.G. IP (Freeze dried) Inj.

D.P.T. IP (adsorbed) Inj.

D.T. IP (Adsorbed) Inj.

M.M.R. USP (live vaccine Inj.

Rubella BP (live vaccine) Inj.

T.I.G. Inj., 250 IU

Hepatitis B Inj. 20 mcg.

Hepatitis B Sera

Antiscorpion Sera

Tuberculin PPD Inj.

Anti D-Immuno globulin (human) Inj

Diphtheria Anti toxin Rabies Immunoglobulin Inj.

Measles IP Inj. 100 TICD 50

Poliomyelitis IP Oral

Anti rabies (Vero cells) Inj.

MUSCLE RELAXANT AND ANTICHOLINESTERASE

NeostigmineTab. 15 mg

Inj. 0.5, 2.5 mg/ml

Vecuronium Inj. 2 mg/ml

Atracurium Inj. 10 mg/ml

Pancuronium Inj. 2 mg/ml

Suxamethonium Nj. 50 mg/ml

OXYTOCICS AND ANTIOXYTOCICS

Isoxsuprine Tab. 10 mg, nj. 5 mg/ml

Methylergometrine maleate Tab. 0.125 mg

Inj. 0.2 mg/ml

Ergometrine Tab. Inj. 0.2 ml

Salbutamol Tab. Inj.




Oxytocin Inj. 10 IU/ml

Magnesium sulphate Inj. 25% w/v

Dinoprostone Inj. 0.5 mg/syringe

Ethacridine lactate Inj. 1 mg/ml

Terbutaline Tab. Inj.

DRUGS ACTING ON RESPIRATORY SYSTEM/ANTIASTHMATIC DRUGS

Etiophylline + theophylline

Tab. 100 mg (77 + 23 mg,

Tab. SR 300 mg, Inj. 220 mg/2ml (169.4 + 50.6 mg)

Salbutamol Tab. 2, 4 mg, Syp 2 mg/5ml

Terbutaline Tab. 2.5, 5 mg, Inj. 0.5 mg/5ml

Syp. 1.5 mg/5ml

Aminophylline Inj. 25 mg/ml

Epinephrine Inj.

Sodium Cromoglycate Inhalation

Salbutamol Solution for nebulizer 5 mg/ml

Beclomethasone Inhalation 100 mcg/dose

Anti-Tussives

Bromhexine hydrochloride Syp. 4 mg/5ml

Noscapine linctus 7 mg/ml, Drps 1.83 mg/ml

SOLUTION CORRECTING WATER AND ELECTROLYTE

Dextrose Inj. 5%, 10% 25%, 50%

Sodium chloride Inj. 0.9%, 1.8%, 3.5%

Ringer lactate Inj.

Distilled water Inj.

Dextrose with saline Inj. 2.5% + 0.9%, 5% + 0.45%, 5% + 0.9%

Water for Injection Inj.

Dextran 10% in dextrose 5%

Potassium chloride Inj. 150 mg/ml

Calcium Gluconate Inj. 37.5 mg/ml

Calcium chloride Inj. 10% solution

27% calcium For IV use

Sodium bicarbonate Inj. 1.4% isotonic

Isolyte G

Isolyte M

Chlorine tablets Tablets


VITAMINS AND MINERALS

Vit. B1, B6, B12 Tab. 10 mg + 3 mg + 15 mcg.

Inj. 100 mg + 50 mg + 1000 mcg.

Vit. A Tab. 5000 IU

Inj. 1 lac/ml

Vit. B1 Tab. 100 mg

Inj. 100 mg/ml

Vit. B12 Tab. 50 mcg.

Inj. 500 mcg/ml

Vit. D3 Granules 1 g sachet (60,000 IU)

Vit. C Tab. 100, 500 mg

Iron Folic acid Tab.

Nicotinamide Tab.

Riboflavin Tab.

Vit. B complex with multi. Vit as per schedule 5

Pyridoxine Tab. 10, 25 mg

Calcium Gluconate Tab. 500 mg

Multivitamin NFI Drops

DENTAL PREPARATIONS

Tannic acid Gum paint 20%

Povidine iodine Mouth wash 1%

Cetrimide + Choline salicylate Gel for oral ulcer (0.01% + 9% all w/v)

Idofoam Powder

OPHTHALMOLOGICAL PREPARATIONS

Anti-Infective Agents

Sulfacetamide Eye drops 20%

Oxytetracycline Eye oint. 1%

Chloramphenicol Eye oint 1%

Eye drops 0.5%, 1%

Miconazole Eye applicaps 1% w/v

Framycetin Eye oint. 0.5, 1%

Eye drops 0.5, 1%

Ciprofloxacin Eye drops 0.3%

Eye oint. 0.3%

Gentamycin Eye drops 0.3%

Acylovir Eye applicap 3%

Ketoconazole Eye drops 1%




Anti-Inflammatory Agents

Dexamethasone + Neomycin Eye oint. (0.1% + 0.5%)

Dexamethasone Eye drops 0.1%

Flubiprofen Eye drops 0.3%

Dexamethesone + Gentamycin Eye drops (0.1% + 0.35)

Xylometazoline Eye drops 0.05%, 1%

Indomethacin Eye drops

Miotics and Anti-Glaucoma Drugs

Pilocarpine Eye drops 2%, 4%

Timolol Eye drops 0.5%

Acetazolamide Tab. 250 mg

Mydriatics

Homatropine Eye Drops 2%

Cyclopentolate Eye drops 1%

Tropicamide Eye drops 1%

Phenylepherine Eye drops 5, 10%

Atropine Eye oint. 1%

Others

Methyl Cellulose In. 2%

Balanced Salt Sol for irrigation

Fluoroscein Drops 2%

SOLUTIONS FOR PARENTERAL NUTRITION

Fat emulsion for infusion parenteral nutrition 10%

Human normal serum albumin infusion 5, 20% (salt free)

ENT DRUGS

Gentamicin Ear drops (0.3% w/v)

Gentamicin + betamethasone Ear drops (0.3% w/v +0.1%)

Sodabicarb glycerine Drops 8%

Clotrimazole Ear drops 1%

Xylometazoline Nasal drops 0.1, 0.05%

Glucose in glycerine Drops 25%

Chloromphenicol Ear drops 1%

Paraffin Liquid

Boric acid with spirit Drops

Icthyol glycerine Ear packing 10%

Bismuth iodoform paraffin Paste


AMBULANCE REQUIREMENTS

The basic life support vehicle shall have two compartments: Drivers cabin & patient’s cabin.

Communication System (Wireless or Mobile phone)

Siren & Light switch DRIVERS CABIN

PA system

Room height of at least 6 ½ feet

Two stretchers with one trolley

Railing for IV suspension

Oxygen cylinder

Suction machine (foot operated)

ET tube

Ambu bag

Laryngoscope

Suction catheters

Foley’s catheter

PATIENTS CABIN

EMERGENCY DRUGS

Atropine, Adrenaline

Sodabicarbonate, Digoxin

Efcorline, Decadron

Dopamine, 25% Dextrose

IV fluids, Plasma Expanders




PRIMARY URBAN HEALTH CENTRE SCHEMATIC LAYOUT



CLINICAL & DIAGNOSTIC SERVICES IN PUHC

Each PUHC must provide a mandated set of healthcare services. These healthcare services

will be delivered in two modes - Centre based activities and Outreach activities.

1. Centre Based Clinical Processes: Encompassing all the essential elements of

preventive, promotive, curative and rehabilitative primary healthcare. This includes:

• OPD Services for curative medical care

• Emergency care during the OPD hours

• Preventive and promotive services.

• Implementation of all National Health programmes

• Referral to higher centers as per need and follow-up

• Basic laboratory services

• IEC / BCC component of healthcare

I. Center based Curative Medical care

a. No indoor patient facility is envisaged for PUHC. Wherever required the patient

can be observed during the OPD hours before shifting the patient to the FRU for

which one to two observation beds will be provided.

b. Service delivery will be mainly OPD based: Six hours a day.

c. Provision of 24 hours emergency services in Primary Urban Health Centre is not

visualized as operationalizing effective functional round the clock emergency

services will require lot of manpower and infrastructural inputs which will not be

cost effective.

(In selected PUHCs the 24 x 7 emergency may have to be provided. Selection

of these health facilities will be guided by the presence / accessibility of the first

referral unit especially in the peripheral rural belt).

d. Minimum OPD attendance visualized is 40 patients per doctor per day.

Standard Treatment Protocols for the common diseases are available and shall

be followed at the PUHCs. All centre personnel (medical and otherwise) shall be

well trained and equipped to provide this level appropriate care at the PUHC

level. The training component has to be ensured and periodically assessed and

updated. All PUHCs must possess the "Standard Treatment Protocols" as

developed by the State.

i. Emergency Medical care during OPD hours: First aid for injuries and

accidents, animal bite, burns, dehydration and other emergency conditions.

Stabilization of the condition of the patient before referral.


ii. Selected Surgical Procedures: Simple incision and drainage, suturing of

simple Clean Lacerated wounds. During surgical procedures, universal

precautions will be adopted to ensure infection prevention.

iii. Referral for the Cases requiring Secondary / Tertiary Care: All patients

requiring higher level care to be referred in time to a linked and identified centre

with a complete referral slip. The centre must have a two way referral linkage to

facilitate back referrals / follow-up.

iv. Rehabilitation: Disability prevention, early detection and referral for appropriate

intervention to an identified linked referral unit.

v. Provision of AYUSH Services (atleast one system of ISM / Homeopathy)

wherever AYUSH unit is co-located.

vi. Provision of OPD based specialist services in the disciplines like Internal

medicine, Gynecology, Pediatrics, Ophthalmology, ENT, Dental services. These

services provided near home will increase the credibility o the PUHC, increase

its utilization and decongest the overburdens secondary / tertiary care facilities.

Rogi Kalyan Samitis can play an important role in facilitating / monitoring these

clinics.

• One out of every four to five PUHCs may run a specialist clinic with the nearest

centres being linked to it.

• The following specialties can be taken up, guided by a felt need.

1. Medicine

2. Gynecology

3. Pediatrics

4. Ophthalmology (Refractionist)

5. ENT

6. Dental Services

• The selection of the centre will be guided by the proximity / distance from the

hospital or an existing Polyclinic, availability of the space, perceived need of the

community.

• The specialist clinic can be operationalized through the State or be a RKS

initiative.

• The Logistics will be guided by the specialty chosen.

• In case sufficient space is not available the separate PUHCs may host different

specialist clinic and the information regarding the same may be disseminated to

the linked PUHCs.

vi. Evening OPDs might be conducted in PUHCs where a significant portion of

catchment population cannot access the health facility during morning hours.




Selection of PUHCs for evening OPDs shall be guided by its proximity to

Slums, JJ Clusters, Industrial areas, absence of any other service provider in

the vicinity like ESI dispensary etc.

Services: The evening OPD shall provide all services except the Lab services.

The weekly ANC clinics, Well baby Clinics, etc shall continue to be a part of

morning shift but all pregnant women and children coming to evening OPDs

must be registered / examined and provided appropriate care. One out of the

two immunization days of the week can be conducted in evening OPD.

Timings of OPD: 2 pm to 8 pm.

The Staff for the evening OPD shall be over and above that for a PUHC. This

shall include - one Medical Officer, one Pharmacist, one ANM, one Nursing

Orderly and one CDEO cum assistant. SCC is already present in the evening

shift. The entire staff be pooled and will do evening shifts by rotation.

Logistics: No separate Logistics are required.

This activity may be facilitated and monitored through the Rogi Kalyan Samitis.

vii. Geriatric care: Special emphasis shall be there for taking care of the senior

citizens visiting the health centre. From having user friendly access, freedom

from long waiting queus, assistance in obtaining and understanding medications

to special assistance like that in obtaining dentures / spectacles etc. In providing

this special assistance, Rogi Kalyan Samiti can play an important role.

• Safe and affordable transport to the PUH centre shall be available for all,

especially for the older persons, whenever possible, by using a variety of

community-based resources, including volunteers.

• Simple and easily readable signage shall be posted throughout the PUHC

centre to facilitate orientation and personalize providers and services.

• Key PUHC staff shall be easily identifiable using name badges and name

boards.

• The PHC facility shall be equipped with good lighting, non-slip floor surfaces,

stable furniture and clear walkways, comfortable seating facility.

II. Centre based Preventive and Promotive services

a. Maternal and Child Health Care:

i. Antenatal care:

• Early registration of all pregnancies with a duly filled ANC Card ideally in the first

trimester (before 12th week of pregnancy) and provision of antenatal care

appropriate to gestation.

• Minimum 3 antenatal checkups, appropriately timed as per RCH guidelines and

provision of complete package of services. Registration as soon as pregnancy is


detected, preferably within first trimester, Provision of associated services like

providing iron and folic acid tablets, injection Tetanus Toxoid etc.

• Laboratory investigations -- hemoglobin, urine albumin and sugar.

• Nutrition and health counseling

• Identification of high-risk pregnancies / appropriate management. Referral to

First Referral Units (FRUs) / other linked hospital for high risk pregnancy.

ii. Preparation / planning for delivery in an institution.

iii. Postnatal care

• A minimum of 2 postpartum home visits, first within 48 hours of delivery, 2nd

within 7 days

• Initiation of early breast-feeding within half-hour of birth

• Education on nutrition, hygiene, contraception, essential new born care (As per

Guidelines of GOI on Essential new-born care)

• In case of availability of special schemes for pregnant women -- JSY,

MAMTA Scheme, Ladli Scheme the same shout be publicized through the

centre and the ANM / ASHA shall facilitate utilization of these benefits by the

eligible beneficiaries.

iv. Care of the child:

• Emergency care of sick children including Integrated Management of Neonatal

and Childhood Illness (IMNCI) during the working hours.

• Care of routine childhood illness.

• Essential Newborn Care (the staff / centre shall be equipped to give basic

essential newborn in case a new born is brought to the centre or a home

delivery takes place in the catchment area).

• Promotion of exclusive breast-feeding for six months.

• Full immunization of all infants and children against vaccine preventable

diseases as per guidelines of GOI / State.

• Vitamin A prophylaxis for the children as per guidelines.

• Prevention and control of childhood diseases, infections.

B. Adolescent Health Care: Special emphasis on detection and management of

nutritional disorders and high risk behaviour. Life skill education, counseling and

appropriate treatment.

C. Management and Prevention of Reproductive Tract Infections / Sexually

Transmitted Diseases: Treatment of Reproductive Tract Infections and

Sexually Transmitted diseases and health education for prevention of RTIs /

STDs




D. Family Planning:

i. Education, Motivation and counseling to adopt appropriate Family planning

methods.

ii. Provision of contraceptives such as condoms, oral pills, emergency

contraceptives.

iii. Carry out IUCD insertions.

iv. Follow up services to the eligible couples adopting permanent methods

(Tubectomy / Vasectomy).

v. Counseling and appropriate referral for safe abortion services (MTP) for those in

need.

vi. Counseling, workup and appropriate referral for couples having infertility.

E. Implementation of National Health Programmes:

a. Integrated Disease Surveillance Project (IDSP)

Disease Surveillance and Control of Epidemic

i. Alertness to detect unusual health events and take appropriate remedial

measures

ii. Disinfection of water sources

iii. Testing of water quality using H2S Strip Test (bacteriological)

iv. Promotion of sanitation including use of toilets and appropriate garbage

disposal.

b. Revised National Tuberculosis Control Programme (RNTCP)

i. All PUHCS to function as DOTS Centers to deliver treatment as per RNTCP

treatment guidelines through DOTS providers.

ii. Treatment of common complications of TB and side effects of drugs.

iii. Record and report on RNTCP activities as per guidelines.

c. National Programme for Control of Blindness (NPCB)

i. Basic services: Diagnosis and treatment of common eye diseases.

ii. Screening for refraction disorders and referral for Refraction study.

iii. Detection of cataract cases and referral for cataract surgery.

d. National Vector Borne Disease Control Programme (NVBDCP):

i. Diagnosis of Malaria cases, Microscopic confirmation and treatment.

ii. Cases of suspected Dengue, Chikungunia to be provided symptomatic

treatment, referral for hospitalization and case management as per the

protocols.


iii. IEC Activities regarding spread and prevention, symptoms of VBDs to enable

early detection of disease and its complications.

iv. Elimination of Vector breeding sites.

e. National Leprosy Elimination Programme (NLEP):

i. Identification of leprosy patients on basis of clinical examination.

ii. Referral of the patients to secondary care level when required - doubtful clinical

diagnosis requiring investigations, complicated cases, severe drug reaction etc.

iii. Complete treatment with Multi Drug Therapy.

iv. Information, Education and Communication (IEC) activities.

v. Rehabilitation / Disability prevention.

f. National Iodine Deficiency Disorder Control Programme (NIDDCP):

i. Goitre detection and appropriate management / referral.

ii. Urine iodine estimation in children aged 6-12 yrs.

iii. Salt iodine estimation of salt samples collected from household.

iv. IEC activities to create awareness of lodine deficiency disorders.

g. National AIDS Control Programme (NACP):

i. IEC activities to enhance awareness and preventive measures about STIs and

HIV / AIDS, Prevention of Parents to Child Transmission (PTCT) services.

ii. Screening of persons practicing high-risk behaviour at the nearest ICTC.

iii. Risk screening of antenatal mothers with one rapid test for HIV from linked

ICTC.

iv. Linkage with Microscopy Centre for HIV-TB co-ordination.

v. Condom Promotion & distribution of condoms to the high risk groups.

vi. Help and guide patients with HIV/AIDS receiving ART.

f. Provision of Essential Laboratory Services:

1. H b%, TLC

2. Blood Sugar

3. VDRL

4. Urine Albumin, Sugar and Microscopy

5. Urine Pregnancy Test

6. Stool Microscopy

7. Diagnosis of RTI / STDs with wet mounting, Grams stain, etc.

8. Blood smear examination for malarial parasite




9. Tests specified as a part of IDSP

g. Radiological Services

a. X RAY

• Plain and Computed Radiography

• Contrast studies like Barium swallow, Barium meal, follow through and Barium

enema; IVU; RGU / MCU; HSG ; water soluble contrast studies for GIT;

Fistulograms: Sinograms

b. ULTRASONOGRAPHY

• General Abdominal and Pelvic studies.

• Obstetrical and Gynecological including endovaginal exams, TIFFA

• Soft tissue and superficial structures including Breast, Thyroid, Scrotal and

Transrectal Prostate examinations.

• Pediatric and Neonatal studies.

• Musculoskeletal examinations such as Hips, Shoulders and Knees.

c. DOPPLER STUDIES (if available)

• Peripheral, Cerebro-vascular and abdominal Doppler.

• Assessment of post Kidney and Liver Transplant patients.

• Penile Doppler examination


CLINICAL SERVICES IN OUTREACH

One ANM is assigned to each 10,000 population. She will carry out the household survey of

her assigned area and also prepare and maintain the eligible couple registers. At any given

time she will know about the individuals / families requiring help i.e. pregnant women / the

children requiring immunization, patients with TB. Leprosy on MDT, the cataract cases

requiring surgery, households requiring Chlorine drops to make drinking water safe, families

eligible for special health schemes - JSY, MAMTA, LADLI.

Need for Outreach Clinical services: Although in an urban setting the distances are

relatively smaller, the terrain easy and transport more easily available, there might be areas /

situations / certain specific vulnerable groups which might require provision of outreach

services. Constraints like pre-occupation of the habitants with earning a livelihood, women

and children of a particular segment finding it difficult to access a Health Centre in absence

of a male attendant create a need for outreach activities to reach these beneficiaries. Such

outreach activities are especially required in the slums, JJ clusters, resettlement colonies,

unauthorized colonies and villages.

These can be carried out in two forms:

i. Periodic Health & Nutrition Days: Without setting up any fixed units like sub centres,

health posts etc, outreach activities can be in the form of regular Health and Nutrition

days, Immunization sessions. This activity shall be structured with prescribed

manpower and equipment and will be amenable to objective assessment in terms of

the services being provided, both quantitatively and qualitatively. PUHC will be

responsible for conducting this activity in its catchment area. The staff and logistics will

flow from the PUHC.

ii. By setting up a fixed Outreach Centre: Setting up of fixed outreach centers ie. sub

centre / health post like structure for every 5000 to 6000 population is not mandated

and is only recommended on a felt need basis. Experience has shown that setting up

of these structures and making them optimally functional is not an easy task and many

times not cost effective or even workable in overcrowded slums / constantly shifting JJ

clusters. Also, smaller distances and easier terrain obviate the need for setting up of

these structures on every five to six thousand population.

However in the initial phase till the required number of PUHCs is made available with

equitable distribution, a fixed outreach centre may be required in certain areas guided by the

distance of the habitation / cluster from the nearest PUHC. An already existing structure i.e.

a willing mother anganwadi / extant subcentre / health outpost of MCD / IPPVIII / Basti Vikas

Kendra may be used for this purpose. In such a case while making the PUHC health action

plan this activity may be reflected and requirements in terms of necessary logistics may be

projected in the plan.




IMMUNIZATION SCHEDULE

VACCINES

Birth6

Weeks 10

Weeks 14 wks 9 mths 15 mths 2 to 5 yrs

PRIMARY VACCINATION

BCG X

Oral Polio X X X X

DPT X X X

Hepatitis B X X X X

Measles X

MMR X

Typhoid X

BOOSTER DOSES

Oral Polio + DPT 16 months to 24 months

DT 5 years

Tetanus Toxoid At 10 years and again at 16 years

Typhoid 2 years the first dose

Vitamin A 9, 18, 24, 30, and 36 months.

PREGNANT WOMEN

Tetanus Toxoid (PW)

First Dose as early as possible during pregnancy after 1st trimester

Second dose 1 month after first dose

Booster if previously vaccinated within 3 years

Immunization schedule may get modified with introduction of newer vaccines in the National

/ State immunization programme.


CONVERGENCE WITH RELATED SECTORS

a. Nutritional Services (in convergence with ICDS)

i. All the anganwadis in the catchment area must be identified and mapped. There

shall be functional Iiason between the ANM and the the Anganwadi worker in

the area.

ii. Diagnosis of and nutrition advice to malnourished children, pregnant women and

others.

iii. Diagnosis and management of Anemia and Vitamin A deficiency.

iv. Coordination with ICDS. A child / woman / adolescent diagnosed as

malnourished / anemic in the health and nutrition day / or in the PUHC to be

attached to the anganwadi and systematically monitored. MO / ANM / ASHA /

AWW to take responsibility.

b. Health of School going Children:

All Schools in the catchment area to be mapped. Children referred from the school

for investigations, management to be taken care of. Participation in school health

fairs, monitoring activities if required.

c. Health of School dropouts / Children not going to School

Identification of children not going to schools through ASHAs and facilitating their

health checkup.

d. Promotion of Safe Drinking Water and Basic Sanitation

ANMs / ASHAs / Health & Sanitation Committees to find local solutions with the help

of provisions under State Health Mission and Departments of Health / Water &

Sanitation. All PUHCs to have sufficient stock of Chlorine Tablets / drops. All ASHAs

to be given adequate stock of Chlorine Tablets / drops.




STRENGTHENING OF REFERRAL SYSTEM

Referral services from operational point of view could be primary health care, medical care,

secondary, tertiary and apical care. Referrals are defined as a system by which patients

while undergoing treatment by a doctor are given facilities from the hospital to avail the

specialized consultation, medical care, ancillary services etc. wherever required. The

cardinal feature of referral system is that the individual continues to be the patient of the

doctor whom he consulted first.

Existing hospitals, including Urban Local Body maternity homes, state government hospitals

and medical colleges, apart from private hospitals will be empanelled / accredited to act as

referral points for different types of healthcare services like maternal health, child health,

diabetes, trauma care, orthopedic complications, dental surgeries, mental health, critical

illness, deafness control, cancer management, tobacco counseling / cessation, critical

illness, surgical cases etc.

There might be different and multiple facilities for the different healthcare services,

depending upon type of hospitals available in the city. This will not only ensure flexibility to

adapt to different conditions in different cities but also increase the range of options for the

beneficiaries.

The empanelled / accredited facilities would be reimbursed for the services provided as per

the pre-decided rates, negotiated with them at the time of empanelling / accrediting them.

The rates will be determined by the consultations undertaken during preparation of the PIPs

and based on the National Commission on Macroeconomics and Health report.

For empanelled government facilities, apart from District / Sub-District Hospitals (being

supported under NRHM), Rogi Kalyan / Hospital Management Societies will be funded (per

case basis including support for referral transportation), which will be utilized for

providing cash-less services to urban poor covered under NUHM.

Such empanelled hospitals, which do not have hospital management societies, will be

required to form such societies to be eligible for receiving the funding support. During the

field visits it was observed that many of ULBs have maternity homes functioning with heavy

case load but inadequate infrastructure, therefore it is proposed to support the existing

maternity hospitals on a city specific case to case basis as referrals for maternal and child

care.

The referral services will be cash-free for the beneficiary and will be financed by community

health insurance or voucher scheme as per the PIP developed for the city.

All engagements would be contractual with no permanent liability to Government of India.

Collaboration with local Medical Colleges may be promoted for strengthening the training

support and supplement human resource at the PUHC level.


The Commandments for referral system are-

• Unified system of records appropriate to each level of medical care in the area shall

be developed. These records would entail referral registers, referral cards/referral

slips and patient history cards. These basic records shall be of the same type in all

institutions in a given area. Records shall ultimately reflect flow of patients from the

periphery to the institutes of middle order or higher order.

• The records shall also be able to give information on the investigations and

treatment given to a patient in an institution where he has been referred. After due

treatment has been given to the patient, the patient records shall move back to the

referring agency/ doctors etc. and the patient records shall reflect the diagnosis

and treatment suggested to enable the referring physicians to carry out the follow

up. The importance of such records cannot be over emphasized as these records

form the basis for the functioning of the referral service system.

• Whenever a patient is referred to an institution there shall be arrangements for

identification of the patient so that the patient does not get lost in general crowd

attending a large hospital. This can be achieved through distinct and identifiable

referral cards and having local arrangements for the reception of these patients.

The details of the modality of such reception system can be worked out by each

institution depending upon the local circumstances.

• In some bigger hospitals there may be need for having a separate reception

counter for referred cases if the workload justifies. In others there may not be a

separate reception counter, but some system of segregating referred patient from

the general patients shall be instituted. It would not suffice to identify these patients

when they are referred to an institution. Arrangements must be made to give little

priority to these patients in so far as diagnosis and treatment is concerned. The

dictum is to treat referral cases as VIP.

• Ideally all the patients who are referred shall be provided some transport facility to

reach the institution where they have been referred.

• Perhaps it would not be practical and neither feasible to undertake the

transportation of these patients by the medical organizations. However, all

emergencies which are referred to various institutions as far as possible must be

direct responsibility of medical institutions. For other deserving cases voluntary

organizations may be involved in the transportation process.

• For instance, cooperation could be sought from the NGO’s to provide transportation

to the patients residing in the interiors at least once a week. It has been observed

that absence of transportation facility hampers the flow of poor and emergency

patients from the periphery to the institutions of high order and visa versa. Unless

some provisions are made in this regard the system is not likely to work.

• The patients shall have the choice to choose their own entry points in the referral

services system, but once the patients enter a particular entry point further referral




to the institutions of higher order or peripheral institutions shall be regulated by the

system.

• The referral service system will not work unless all the professionals located in all

the segments of the medical care organization understand and appreciate the

importance of the referral services system. To include the importance of this

system all the professionals in various organizations need to be developed into one

team of workers whose members are located in different organizations. Team

building does not come on its own or through office orders. It can only be achieved

through a process of in service education, continuous meetings and reinforcing the

importance and the use of the referral services system. It is therefore

recommended that efforts in this direction be made at all levels of the referral

service system.

• In an ideal referral system not only the patients move from one segment of the

organization to another, the movement of specialists from the institutions of higher

order to the more peripheral institutions is also an integral part of the system. This

will not only enable the patients to get specialist advice near their homes but also

would act as an educational tool for the professionals who are working in the more

peripheral institutions. The added advantage of the flow of specialist to the

periphery is the understanding of the working conditions in the periphery as well as

understanding of the problems of the population which is located in the rural areas.

The community orientation of the professionals is one of the essential features of

the referral service system.

• For provision of transport in emergency cases, the golden rule of “1 hour” needs to

be kept in mind. The ambulance shall be used for transporting patients only and

not staff, materials etc.

• Transportation of referred cases particularly emergency or serious cases generally

poses problems. While steps to smoothen such situations shall be initiated, it is

worthwhile to consider active involvement of the community in this regard.

• The immediate practical steps like convincing the community about the importance

of referral and need for its support through transport facilities, making them aware

of their role and responsibility towards their own healthcare, helping them in

organizing locally suited transport system village based or sub-centre based and

enabling them in its effective management etc., need to be initiated by health staff.

• Active involvement of community must be considered. Interalia to transport system,

development of communications (telephone, intercom, cellular, pager etc.) be

considered.

• It shall be emphasized that referral system is a two-way process and that retention

of patients in a referral institution shall be as brief as possible.


Acute Conditions / Trauma:

Appropriate and prompt referral of case needing hospital care including:

• Stabilization of patient.

• Appropriate support for patient during transport.

• Providing transport facilities either by ambulance or other available referral transport.

Chronic Conditions requiring referral for Specialist Consultation / Care:

• Complete referral slip (including history / examination / differential diagnosis / tests &

treatment done till date) shall be made.

• Subsequent Follow-up of these case and care as per the plan of action outlined by

the consultant. Liasoning with the referral institutions identified for PUHC area.

Having a two way linkage with the concerned officials of the referral centre.

Indicative Service Norms by levels of Service Delivery*

Levels of Service delivery

Services**Community (Outreach)

First point of service

delivery (PUHC)

Referral Centre - RC

(Specialist services)

A. Essential Health Services

Maternalhealth

Registration, ANC,

identification of danger signs, referral for institutional delivery, follow-up.

Counseling and behaviour

promotion

ANC, PNC, initial management of complicated delivery cases and referral, management of regular maternal health conditions,

referral of complicated cases

Delivery (normal and complicated), management of

Complicated gynae /maternal

health condition, hospitalization and surgical interventions, including blood transfusion.

Familywelfare

Counseling, distribution of

OCP/CC, referral for

sterilization, follow-up of

contraceptive related

complications

Distribution of OCP/CC, IUD insertion, referral for sterilization, management of contraceptive related

complications

Sterilization operations, fertility

treatment

Child health and nutrition

Immunization,identification of danger signs, referral, follow-up, distribution of ORS, pediatric cotrimoxazole post-natal visits / counseling for newborn care

Diagnosis and treatment of

childhood illnesses, referral of acute cases / chronic illness Identification and

referral of neonatal sickness

Management of complicated

Pediatric / neo-natal cases, hospitalization, surgical interventions, blood transfusion




RTI/STI

(including HIV/AIDS)

Symptomatic search, referral, community level follow-up for ensuring adherence to treatment regime of cases undergoing treatment

Diagnosis and treatment, referral of complicated cases

Management of complicated cases, hospitalization (if needed)

Nutrition

deficiencydisorders

Height/weight measurement,

Hb testing, distribution of

therapeutic doses of IFA,

promotion of iodized salt,

nutrition supplements to

identified children and

pregnant/ lactating women Promotion of breast feeding,

complementary feeding for

prevention of under-nutrition

Diagnosis and treatment of seriously deficient patients,

referral of acute deficiency cases. Early identification of mild and severe under-nutrition, counseling for optimal feeding practices or

referral

Management of acute deficiency cases, hospitalization

Treatment and rehabilitation of

severe under-nutrition

Vector-borne

diseases

Slide collection, testing using

RDKs, DDT ,chemical,

biological larvicides etc

Counseling for practices for

vector control and protection

Diagnosis and treatment, referral of terminally ill cases

Management of terminally ill cases, hospitalization

Mental Health

Case detection and referral,

counseling, rehabilitation

Diagnosis and treatment

Psychiatric and neurological services, including hospitalization, if needed

Oral Health

Basic dental education,

screening for precancerous

lesions, referrals


Management of complicated cases, hospitalization (if

needed)

A7.2Hearing

Impairment/

Deafness

Early detection and awareness

for preventive steps/actions,

referral



needed)

Chestinfections

(TB/ Asthma)

Symptomatic search and

referral, ensuring adherence to

DOTs, other treatment

Diagnosis and treatment, referral of complicated cases (MDR, reactions,

terminal illness)

Management of complicated cases

Cardio- BP measurement, Diagnosis and Management of emergency


vascular

diseases

symptomatic search and

referral, follow-up of under treatment patients

treatment, emergency resuscitation, referral of cardiac

emergencies cases

cases, hospitalization and

surgical interventions (if needed)

Diabetes

Blood/urine sugar test (using

disposable kit), symptomatic

search and referral, follow-up

of under-treatment patients

Diagnosis and treatment, referral of complicated cases


needed)

Cancer

Symptomatic search and

referral, follow-up of under treatment patients

Identification and referral, follow-up of under-treatment patients

Diagnosis, treatment,

hospitalization (if and

when needed)

Trauma care

(burns & injuries)

First aid and referral

First aid , emergency

resuscitation, documentation for MLC (if applicable) and referral

Case management and hospitalization,physiotherapy and rehabilitation

Other surgical

interventions--- not applicable ---

Identification and referral

Hospitalization and surgical interventions

B. Other support services

IEC/BCC

IPC, Health Camps / fairs,

performing arts, wall/poster

writing, events (in schools,

women’s groups)

Distribution of health

education material

Distribution of health

education material

Counseling

Individual and group/family

counseling – HIV / AIDS / Mental disorders / stress management / Tobacco /Alcohol. Substance abuse

Patient / attendant counseling

Patient / attendant counseling

Personal & Social

Hygiene

IEC on hygiene, community

mobilization for cleanliness

drives, disinfection of water

sources, etc.

--- not applicable --- --- not applicable ---

*Norms adapted from NCMH Report ** Services based on situational analysis




HUB & SPOKE MODEL OF REFERRAL SYSTEM

PRIMARY URBAN HEALTH

CENTRES / DISPENSARIES

SECONDARY CARE HOSPITALS

TERTIARY CARE HOSPITAL



REFERRAL SLIPS

(NAME & LOCATION OF PRIMARY URBAN HEALTH CENTRE)

REFERRAL SLIP

Referred from:

Casualty /OPD /C.R. No. ---------------------------------------------------------------------

Name: -------------------------------------------------------------------- Age ------------ Sex ---------------

W/o, D/o, S/o: ---------------------------------------------------------------------------------------------------

Address (complete) : ------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------

H.O.P. I. : --------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------

Investigations: --------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------

Treatment given: -----------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------

Diagnosis: -------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------

Referred to Senior Resident: -------------------------------------------------------------------------------

Hospital: ----------------------------------------------------------------------------------------------------------

Name:------------------------------------------------ Signature: ------------------------------------

Date: ------------------------------------------------- Designation: ---------------------------------



(NAME & LOCATION OF PRIMARY URBAN HEALTH CENTRE)

REFERRAL SLIP

asualty /OPD /C.R. No. ------------------------------------------------------------------------------------

ame: ------------------------------------------------------------------- Age ------------ Sex ---------------

/o, D/o, S/o: --------------------------------------------------------------------------------------------------

ddress (complete) : -----------------------------------------------------------------------------------------

----------------------------------------- Designation: ---------------------------------

Referred from:

C

N

W

A

----------------------------------------------------------------------------------------------------------------------

H.O.P. I. : --------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------

Investigations: --------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------

Treatment given: -----------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------

Diagnosis: -------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------

Referred to Senior Resident: -------------------------------------------------------------------------------

Hospital: ---------------------------------------------------------------------------------------------------------

Name:------------------------------------------------ Signature: ------------------------------------

Date: --------



CAPACITY BUILDING & TRAINING OF STAFF

The increasing pace of technological change is perhaps the single biggest impetus for

training & capacity building in healthcare. Training & Capacity Building is essential because

technology is developing continuously at a very fast pace. The systems and practices that

w

discoveries

aspects,

ca h

their career plans. Capacity Building and Training is a part of

a

It r

S

employee and the client. The management shall coordinate and provide comprehensive

in n

te ll

employees

Many researches have e

m

could work at 80-90% of their capacity. Behavioural Science concepts like motivation and

g n

su

A s

a

reinforce the learning and maintain the desired behaviour.

It is essential that each

a

G g methods can be used with different categories of

staff. Some of this are:

ectures

Conferences, projects, panels, etc

Case studies

Role playing, demonstrations and skills etc.

ere in operation a few months ago are no more considered effective due to new

and technology. These discoveries in new technology deal with conceptual

technical aspects, managerial aspect as well as human aspect. A good training &

pacity building system also ensures that employees develop in directions congruent wit

management development and

lso a form of organizational development.

is important for the management to devise a cohesive Infrastructure and Action Plan fo

taff Education, training and development to meet the established needs of both the

ternal training programmes that would encompass the requirement of the organization i

rms of policy, procedure and skill as well as the aspirations, abilities and needs of a

stimated that the average employee in an organization is working at

uch less than his capacity potential. If these employees can be properly motivated, they

ood human relations shall be used. Training could be one of the main instruments to attai

ch improvement.

lso, employees who are well trained produce superior performance, which in turn require

minimum of supervision and correction. Training must be continuously repeated to

staff job group in the Hospital shall have a training road map that is

ppropriate to his needs.

eneral Capacity Building and Trainin

L

Workshops



M

he model depicted below portrays a structure for moving staff to a level of competence and

odel for Staff Development Process

T

confidence in their work. The model includes six steps beginning with the manager clarifying

expectations of the employee (learner). Second, an employee’s manager and the staff

development educator assist the employee in identifying his or her learning needs. Third, the

staff development educator identifies learning resources appropriate to meet the learner’s

needs. Fourth, the learner participates in the appropriate learning experience. Fifth, the

learner receives coaching and validation in the new knowledge or skill in the work setting.

Sixth, the learner obtains feedback from his or her immediate supervisor. The model

continues with step 1 as new learning needs are identified.

All Clinical & Paramedical staff of Primary Urban Health Centre has to be updated in their

asic skills. The training shall be held regularly and on the job assessment shall be an

Induction and refresher trainings of ASHAs have to be undertaken. Ongoing support in the

ded through formation of Mentor groups.

b

essential part of routine monitoring.

field has to be provi



BEHAVIOUR CHANGE COMMUNICATION

Behavior change has become a central objective of public health interventions over the last

half decade, as the influence of prevention within the health services has increased. The

increased influence of prevention has coincided with increased multi-lateral and bi-lateral aid

in the area of human development, and the increased need for the international development

community to show cost-effectiveness for allocated money spent.

Behavior change programs, which have evolved over time, encompass a broad range of

ctivities and approaches, which focus on the individual, community, and environmental

influences on behavior.

Behavior change programs usually focus on activities that help a person or a community to

reflect upon their risk behaviors and change them to reduce their risk and vulnerability are

known as interventions.

Sensitization of

1. Service Providers: For patient friendly behaviour, client – centered services and

treatment of patients with dignity and respect

2. Community: On influencing the health seeking behaviour of potential beneficiaries

and orient them towards seeking safe and rational health care. There will be a focus

towards making the community aware about the available health services.

3. Specific Issues: The BCC activities will be focused to create awareness in the

community on specific diseases like malaria, TB, Diarrhea, Non Communicable

diseases like Coronary Heart Disease, Diabetes Mellitus and Cancer etc. Women

and Children will be specifically targeted.

a

INFORMATION, EDUCATION & COMMUNICATION (IEC)

formation, Education and ComIn munication (IEC) are essential component of any

C programme’s accent so far has been on awareness generation about the programme

nd service facilities, with the presumption that this would ensure adequate utilization. IEC

aterials were produced and activities developed on mass scale to reach out to people with

essages on health and population issues.

s have surely raised information and awareness levels but have fallen short in

hanging behaviours and attitudes. It is increasingly becoming evident that if a change in

development programme. IEC is a strategic approach to health communication that uses

information and education materials and activities to generate awareness and influence

ealth practices.h

IE

a

m

m

These effort

c



a provider level and at manufacturer level

w ecific, client-centered IEC strategy that

ddresses the individual, group and creates a supporting and enabling environment.

s and graduate towards

ehaviour and social change.

would include evidence based meticulously packaged information

omponent, and a simple mode of communication so that the target group can understand

• The population to be targeted, their problems of public health and family health

information, awareness and behaviour message content, structure and

propriate products and activities,

hieve this

ifically address the following aspects of

the behaviour:

awareness about the health services

• s and with the help of

ttitude and behaviour is desired, at user level, at

e need a need-based, demand-driven, area-sp

a

IEC has a major role to play in creating demand by repositioning the accessibility and

availability of services and the service provider’s image in such a way that it would match

people’s perspectives and needs. Information alone is not sufficient to change behaviour, we

need to work beyond information and awareness parameter

b

IEC for Primary Urban Health Centre requires a clear, holistic and (creative, cultural, gender)

sensitive perspective. It

c

and use the information easily resulting in desired healthy behaviour practices. This

necessarily has focus on four essential elements:

• The health

form

• The creation and dissemination of culturally ap

• The facilitation of behaviour change through creation of a supportive environment

Each of these components needs to be fully and accurately understood. To ac

goal, it would require clearly defined project objectives, a strong organizational structure, a

sound training programme and a positive attitude of those involved in policy formulation and

implementation of the programmes.

The BCC & IEC strategy at PUHC would spec

• Sensitizing providers for friendly behaviour with patients

• Promoting provider behaviour for rational drug use and adequate prescriptions

• Facilitating community to demand services by service providers

• Improving

• Promoting correct perception about the gravity of different types of sickness

• Reducing the perceived quality gap though better communication

• Promoting cleanliness, proper waste disposal, and prevention of diseases

Organizing of the camps / campaigns / outreach activitie

ASHAs ensure active participation by the community.

• Celebration of health days and weeks and publicity programmes al local fairs on

market days etc.

Accreditatio

@ Natio

n Standards for Primary Urban Health Centre

nal Accreditation Board for Hospitals and Healthcare Providers 91

• Mass communication programmes like film shows, exhibition, lectures and dramas,

with the help of the District BCC officer.

• Maintaining a list of prominent acceptors of family planning methods and opinion

leaders and will try to involve them in the promotion of Health and Family Welfare

programmes.

• Orientation training for Health and Family Welfare workers, opinion leaders, local

medical practitioners, school teachers, dais and others involved in Health & Family

Welfare work. Arrange group meetings with the leaders and involve them in

of BCC activities in the PUHC area.

• Make sure that IEC and BCC activities cover the entire population through map

spreading the message for various health programmes. He / she will organize health

education sessions in schools and for out of school youth.

• Organize and utilize Mahila Mandal, teachers and other women including ICDS

personnel in the community in various National Health Programmes.

• Preparing a monthly report on the progress

based micro planning.

BEHAVIOUR CHANGE COMMUNICATION MATRIX

BEHAVIOUR CHANGE COMMUNICATION MATRIX

S.NO. PRACTICES SEGMENT BEHAVIOUR CHANGE MESSAGE THEME MEDIA CHANNEL INDICATOR

1.

Utilization of public

health services

Urban Demanding Reasonable

we believe in

h

UHC

Scroll

Radio

Poste

Inform

Broch

TV sp

Healt

board

Jingles

rs

ation booklet

ures

ots

Insurance

PBelieve in our services as

you! Statistics

2. Drinking water Urban Aware Reinforce measuresWater for survivapurified watebeing!

ater

cide

TV sp

Hoard

Bus p

Kiosk

ots

ings

anels

s

W

In

l,r for well

borne d

nce rate

isease

3.Sanitarypractices

UrbanHygiene conscious

ReiterateCleanliness is healthiness!

sea encte

TV sp

Wall

Bus p

Kiosk

ots

Writings

anels

s

Dira

se Incid e

4. Injury UrbanPrompt health seeking behaviour

Seek public health services

Holistic services from womb to tomb… a we care

sUHC ion

News

Kiosk

papers P Utilizat rate.bec use

5. Poisoning UrbanSkeptical about MLC

Awareness of the importance of seeking immediate, trained and reliable medical help

Trust us……we’l nlet you down!

pap UHC ion l wo ’t

ers P rateNews Utilizat

6. Snake bite UrbanSeek help from nearest hospital

Mobilization towards public services

Anti snake bite v monly available hethink…just act!

N pap UHC ion enore D

is on’t ers Pews Utilizat rate

n Standards for Primary Urban Health Centre

nal Accreditation Board for Hospitals and Healthcare Providers 83

COLOUR CODE YELLOW BAG

BLUE/WHITE

PUNCTURE

PROOFCONTAINER

BLACK BAG RED BAG

TREATMENTOPTION

INCINERATION AUTOCLAVING/SHREDDING

SHREDDING DISPOSAL

AUTOCLAVING/SHREDDING

WASTECONSTITUENTS

LABEL FOR BIO-MEDICAL WASTE

CONTAINERS/BAGS

BIOHAZARD SYMBOL

HUMAN ANATOMICAL WASTE – TISSUES,

ORGANS, BODY PARTS, PLACENTA OR ANY OTHER

MATERIALS WHICH WAS ONCE A PART OF THE

BODY.

MICROBIOLOGY AND BIOTECHNOLOGY WASTE,

HISTOPATHOLOGY SPECIMEN,

SOLID WASTE ITEMS CONTAMINATED WITH

BLOOD & BODY FLUIDS LIKE COTTON, SWABS,

DRESSINGS,

SANITARY PADS, LINEN ETC.

DISCARDED MEDICINES/ CYTOTOXIC DRUGS

SHARP WASTES HYPODERMIC

NEEDLES

SYRINGES

SCALPELS

LANCETS

BLADES.

BROKEN GLASS

ALL SOAKED IN 1% HYPOCHLORITE SOLUTION AND

TAKEN FOR SHREDDING AND FINAL DISPOSAL.

WRAPPING MATERIAL, PAPER,

CARD BOARD PLASTIC BAGS, DISPOSABLE GLASS & PLATES,

METAL CANS,FLOWERS

KITCHEN WASTE

LEFT OVER FOOD

(TAKEN AWAY BY LOCAL AUTHORITIES

FOR DISPOSAL)

IV TUBINGS/ CATHETERS/

IV SETS/ URINE BAGS/ DIALYSIS KIT/GLOVES/ BLOOD EMPTY BAGS/

SYRINGES SEPARATED FROM BARREL & ALSO

VACUTAINERS WITHOUT NEEDLES CUT INTO PIECES

AT SOURCE OF GENERATION,

PUT IN TO 1% SODIUM HYPOCHLORITE SOLUTION

FOR AT LEAST HALF AN HOUR & TRANSFERRED TO

BAG FOR AUTOCLAVING AND SHREDDING

Accreditatio

@ Natio

BIO MEDICAL WASTE MANAGEMENT

HANDWASHING TECHNIQUES



MANAGEMENT OF INFORMATION

All health servic nizati the rovide.

Usually, they are on p ca e form

of monthly o rt

This information is supplem s c s and

administrative re Alth iquitous, spread

dissatisfaction with them.

Monitoring systems are multi-functio to monitor whether or not services

are going according to plan by tracking how funds are expended and what activities are

undertaken.

They also n ude m ce is more

often used to describe the process of monitoring disease incidence lth status.

Monitori st also or ds, setting

priorities, a urces and in nci

1. PUHC has a set of periodical reports to be generated as per the formats provided by

the State / the Health Mission.

2. Th at

he

3. As ble

for

4. Each PUHC functionary will have a component to contribut

must be trained and facilitated in collection, compilation, report generation from work

done by

5 MO I/C w fo mp a

reports.

6 Maintena le C,

logistics non he

centre ha d m

7 Recordin : A t on

deaths ta lace in her assign . The a ess of the nearest linked birth /

deaths registration office must be displayed in the centre.

The various parameters for monitoring are-

O ce

AN of preg

e orga

based

rterly

cords.

ons ha

eriodic

s.

ented

ough

ve s

retu

by

such

ystems for monitoring

rns received from health

other sources such a

systems are ub

services they p

re providers in th

ensuses, survey

there is wide

r qua repo

nal. They must help

g of o

ed f

flue

eed to incl

ng systems mu

llocating reso

onitorin

be us

utcomes – tho

other functions

ng change.

ugh

– a

the

sse

term surveillan

and hea

ssing health nee

e rec

alth c

far a

scrut

ords

enter

s pos

iny a

shall be

and thro

sible the

nd use.

mainta

ugh the

record

ined as per guidelines for se

outreach

s and rep

rvices rendered both

terized and easily availa

e in the report. He / She

se

orts

ssio

sha

ns.

ll be compu

them.

ill be r

nce o

(Consu

s to be

g of V

king p

.

.

.

esponsible

f all the re

mables /

maintaine

ital Events

r accuracy / co

vant records con

consumable item

eticulously.

NM must collec

ed area

leteness

cerning se

s) and th

informati

ddr

nd timely

rvices provid

e personnel

on all ma

submission of all

ed in

workin

ternal

PUH

g in t

and infant

PD attendan

C check-up nant women



Tetanus toxoid (2nd dose) coverage among pregnant women

Institutional deliveries

Total number of still births

Complete immunization among children < 12mnths

Number of live births,

Total number of investigations done

Total number of referred cases (BPL referrals)

Patient satisfaction

Case detection for malaria through blood examination

Case detection of TB through identification of chest symptomatic

Referral for sputum microscopy examination for TB

Number of cases screened and treated for dental ailments

Number of cases screened for diabetes at PUHCs

Number of cases referred and operated for heart related ailments

First aid and referral of burns and injury cases

Death rate,

Awareness of community about tobacco products / alcohol and substance abuse.

Equipment utilization rate,

Ambulance utilization rate,

Discipline state-absenteeism, misconduct, negligence

Frequency of training of various categories of staff

Hospital Management Information System

Cities / population with all slums and facilities mapped

Number of Slum/ Cluster level Health and Sanitation Day

Number of ASHA receiving full honorarium

Number of Mahila Arogya Samiti formed



FACILITY MANAGEMENT

1. Physical upkeep of the premises including white wash and minor repairs. No

seepage, leaking cisterns, taps, water pipes.

2. Availability of continuous water supply including that in the toilets.

. Upkeep of the equipment and timely renewal of the Annual Maintenance contracts.

. Availability of security and sanitation services.

Cleanl

a. uired. The floors shall be mopped

and dried before the patient inflow begins. Periodical washing as directed by the

Cleaning of walls, tiles and window panes periodically.

c.

d. stbins daily.

v. Toilet must be inspected by the Medical Officer incharge daily.

3. Availability of Drinking water.

4. Electricity with functional / sufficient power backup (Generator / Inverter as per of the

required strength)

5. Uninterrupted supply of logistics by following the inventory management principles ,

Factoring in the seasonal variations, other events like camps / outreach sessions

while preparing the indents / placing timely indents.

6

7. Ensuring Punctuality and taking care of absenteeism. Delegation of duties to

alternate in case of short absence. Arrangement of alternative staff in case of long

leave.

8

iness and Sanitation:

Mopping of the Floors daily and as and when req

Medical Officer Incharge.

b.

Cleaning of furniture, equipment, counters, shelves daily.

Emptying the du

e. Getting the linen washed regularly.

f. Sanitation :

i. Separate toilets for men and women

ii. Clean tiles and wall

iii. Seat to be cleaned daily with the toilet cleaner and brush.

iv. Continuous water supply must be ensured.



COMMUNITY PARTICIPATION AND EMPOWERMENT

Community participation in planning, implementing and monitoring Primary healthcare

ntres is essential for it to succeed

d yield results. Therefore presence of Rogi Kalyan Samiti,

t to community and various committees has been ingrained in

. The basic structure, objectives, functions of a

been recommended.

delivery in urban settings through Primary Urban Health Ce

in achieving its objectives an

involving ASHA in reaching ou

the recommended Public Health Standards

PUHC Rogi Kalyan Samiti, ASHA and committees has

ROGI KALYAN SAMITI

Rogi Kalyan Samiti (Patient Welfare Committee) is a simple managemen

registered society setup for sustained and result oriented improvement in functioning of the

t structure form of a

d monitoring of the

HC more sensitive and responsive to

cal autonomy and flexibility in implementation of activities

ctivities / initiatives carried with the objective of delivering

as per the Public Health Standards laid

the recommended Public

er logistics.

Ensure accountability of the health providers to the community.

Ensure a rationalized, prioritized utilization of funds.

Introduce transparency with regard to the management of funds.

Generate resources through donations and fund raising events, community

contributions.

health institution (PUHC) and quality of care provided.

Need for Rogi Kalyan Samiti

1. To ensure community participation in planning, implementation an

Primary Urban Health Centre and make the PU

the patients.

2. Provide the required lo

required for optimal functionalization of the centre.

3. To provide funds for local a

quality assured healthcare.

Objectives:

Ensure delivery of the mandated services

down for the PUHC.

Ensure upgradation of the PUHC (Centre / Outreach) to

Health Standards.

Ensure a grievance redressal mechanism.

Ensure availability of the essential drugs and oth



Functions and activities:

To achieve the above mentioned objectives, the Samiti shall direct its efforts and resources

liness / quality of

ions / average waiting time for the patients.

vels regarding the services being provided.

condition.

HC.

Monitor attendance of all categories of staff of the PUHC.

rms, Badges, I-Card by all the PUHC staff.

er, Display of referral map and chain, whether

same to patient /

, Tet. Toxoid, Oxygen Cylinder etc.

he complaints of patients / patient party.

and materials of the Primary Urban Health

ealth Centre building

ble with the PUHC.

ntenance and upkeep of the PUHC.

for day-to-day

management of the Primary Urban Health Centre e.g. Scientific Disposal of wastes,

Solar Lighting Systems etc.

Instal signages, repair of furniture.

To undertake customized solutions to address problems like lack of running water.

for undertaking following activities:

Periodical monitoring, visits, patient feedbacks to assess the time

services / adherence to the Public Health Standards / attitude in interactions with

patient / availability of medicat

Monitoring of the outreach activities.

Assessment of patient satisfaction le

Assessment of the problems / limitations being faced by the staff and finding

solutions.

Minor repairs / renovation / upkeep of the PUHC premises.

Minor electrical works / repairs of the electrical gadgets.

Ensure that all equipments at the PUHC are properly maintained and kept in good

running

Improve the laboratory testing facilities at the PU

Ensure wearing of Unifo

Monitor quality and use of Ambulance services, if available, at the PUHC.

Ensure timely submission of report and returns.

Referral system & referral regist

ground(s) for referring are properly elaborated.

Maintenance of Grievance Book at PUHC and availability of the

patient party.

Ensure adequate stock of ARV, AVS

Enquiry into t

Assessment and rationalization of men

Centre.

Making arrangement for maintenance of Primary Urban H

(including residential buildings), vehicles and equipment availa

Encouraging community participation in the mai

Adopting sustainable and environmental friendly measures



ty and its compliance.

Regularly examine, address the complaints received in the complaint box positioned

an drinking water.

Ensure clean male & female toilets with running water availability.

nerated in the centre / outreach.

awareness generation especially on issues like female

foeticide, gender bias.

he unit level mentoring activity.

funds / maintenance funds are made available to the

KS. In addition the RKS has the mandate to generate its funds through donations /

ents. The State funds separately approved for activities which are to be carried

ut by the RKS can be released to the RKS account.

entoring group will provide the orientation training to the RKS

ucture, Memorandum of Association, Rules & Regulations will be

is (RKS) for improved

etter services to the

Centres shall be as

Ward Counselor – Chairman

Medical Officer In-charge of the PUHC – Secretary & Convener

Ensure display of the Citizen's Charter in the health facili

in a prominent position in the waiting area.

Operationalization of periodical Specialist clinics.

Facilitating / monitoring OPDs

Beautification / landscaping / horticulture of the PUHC premises.

Making the waiting area patient friendly.

Ensure availability of cle

Establish clothes and toy banks through which those who have plenty can share with

those less privileged.

Ensure safe disposal of the biomedical waste ge

Play a catalyst role in

Ensure continuous capacity building of the PUHC staff / ASHAs / workers of

converging agencies like ICDS.

Ensure timely payments to ASHAs, contribute in t

Constitution as per the State Guidelines

Revenue: Certain funds like untied

R

fundraising ev

o

District / State level RKS M

members as to how to discharge the functions of RKS functionaries.

Detailed Guidelines on Str

provided by the State.

Each Primary Urban Health Centre shall have a Rogi Kalyan Samit

functioning of the Primary Urban Health Centres and for rendering b

patients.

The composition of the Rogi Kalyan Samiti for the Primary Urban Health

under:



One ANM of the PUHC – Member

orking in the area of health or social sector – Member

number of

be Chairman of more than one RKS.

The

ed.

Pharmacist – Member

One NGO representative w

In case where there are two Ward Counselors within the area of a PUHC, the Ward

Counselor having the largest part of the PUHC area falling within his ward constituency, will

be the Chairman of the Rogi Kalyan Samiti. If there are more PUHCs than the

Ward Counselors, one Ward Counselors can

The details of the Rogi Kalyan Samiti will be displayed in Primary Urban Health Centre.

Samiti will have the mandate to improve the service delivery and ensure adherence to the

standards prescrib

ASHA

Accredited Social Health Activist (ASHA) for every 2000 (1500 to 2500) population

pocket, one local woman volunteer is to be selected and will serve as the link worker called

t (Paracetamol, ORS, Chlorine

rea will facilitate the outreach

ill validate / verify the work

e field.

ch as nutrition, basic sanitation

e information on existing health services and the need for their timely

lth

es,

and complementary feeding, immunization, care of the young child,

ch

5. She will work with the Health & Sanitation Committee of her area to get optimum

y pregnant women & children requiring treatment

th

ASHA. She will be trained and provided a basic drug ki

tablets, bandages, cotton, betadine etc. Her work in her a

activities of the ANM, initiate local health planning. ANM in turn w

done by her and also provide support and guidance to these volunteers in th

Role envisaged for ASHAs:

1. To carry out the survey of the households in her area.

2. To create awareness about determinants of health su

& hygienic practices, healthy living and working conditions.

3. She will provid

utilization. She will mobilize the community and facilitate them in accessing hea

services available at the Primary Urban Health Centres, referral centr

anganwadis.

4. To counsel women on birth preparedness, importance of safe delivery, breast

feeding

contraception and prevention of common infections including Reproductive Tract

Infections / Sexually Transmitted Infections (RTIs / STIs). She will ensure that ea

child in her area is fully immunized.

benefit from various initiatives related to safe water supply and sanitation being

undertaken by the Government. She will promote construction of household /

community toilets.

6. She will arrange escort / accompan

/ admission to the nearest pre-identified health facility i.e. Primary Urban Heal



Centre / Maternity home / Sub district / District hospital as per the need. She will

r ailments such as diarrhoea, fever

ctly Observed Treatment

vised National Tuberculosis Control Programme. She

al Programmes by

made available to every

ts) packets for Oral Rehydration Therapy

Condoms etc. A

nusual health problems / disease outbreaks in the community

cluster of households. ASHA will be trained for the role envisaged for her as per the modules

ixed

or some of the activities carried out by her. ANM will provide the supervision and

e work done by her. There will be continuous

nd in the field ASHA will be supported by the

Ensure safe drinking water

open defecation.

omposition of a Health and Sanitation Committee (one for 2000 population)

nt: Representative Self Help Group, Senior Citizen Group, Resident Welfare

ssociation, Gender Resource Centre in that order.

make the women in her area aware of the Janani Suraksha Yojana and help them in

availing benefits of the scheme.

7. ASHA will provide Primary Medical care for mino

and first aid for minor injuries. She can be a provider of Dire

Short course (DOTS) under Re

will help in effective field level implementation of other Nation

creating awareness about them.

8. She will act as adepot holder for essential provisions being

habitation like ORS (Oral Rehydration Sal

(ORT), Iron Folic Acid Tablet (IFA), Chlorine Tablets, Oral Pills &

Drug kit will be provided to each ASHA.

9. To inform about any u

to the Primary Urban Health Centre.

ASHA will initiate local health planning by assessing the quantum of healthcare needs in her

prepared for such a community worker.

She will enter her activities in the diary provided to her. She will be paid certain f

incentives f

mentoring support in the field and also verify th

capacity building and training of ASHAs a

mentor groups / ANMs / PHN / MO / Social Mobilization Officer.

HEALTH & SANITATION COMMITTEES

Activities:

Cleanliness & Sanitation activities

Setting up community toilets / facilitating household toilets / promoting use of toilet

and preventing

To be vigilant and eliminate / render safe all vector breeding sites.

Local Health & Nutrition activities, Health and Nutrition days

C

Preside

A

Convener: Area ASHA



Members:

i. Government Employees (retired) / honorarium paid staff e.g. School teacher,

Anganwadi Worker, preferably not more than one third.

ii. Representative of local women’s self help group

iii. Representative of the local NGO



CITIZEN CHARTER FOR PRIMARY URBAN HEALTH CENTRE

Primary Urban Health Centre is the peripheral most health facility manned by the Medical

fficer and support staff along with the required logistics to provide holistic primary

ealthcare to the citizens residing in the catchment area of the centre. One PUHC is

isualized for every 50,000 population. It is a manifestation of the commitment of all

ealthcare providers to make quality assured, affordable, accountable, responsive primary

ealthcare universally available.

bjective of this document:

o inform the beneficiaries about the health facility, its structure, its mandate, the service

omponents available in the health facility, the entitlements of the beneficiary, the

sponsibilities of the beneficiaries and the available mechanism of grievance redressal.

ommitment of the Charter:

Access of all beneficiaries to the PUHC and utilization of existing facility without

discrimination.

• Quality oriented service delivery in a responsive and responsible manner.

• To provide holistic primary healthcare in an OPD mode with the level appropriat

emergency care and referral after stabilization.

Dissemination of information about the existence / location of referral centres and

facilities involved in dealing with other determinants of health.

• To provide the information in writing about the diagnosis / treatment advised and

being administered.

• Provision of timely, detailed and complete referral as and when required with

facilitation of access to the referral facility.

• Community involvement in planning / implementation and monitoring of the PUHC

activities.

• Provision for the complaints / grievances to be addressed in a time-bound fashion.

Service Components of a Primary Urban Health Centre

• Registration timings and timings for delivery of services to be mentioned clearly.

• Mention the services which are free of cost and services having nominal user fee.

• Layout of available services along with locations within the facility.

Curative Component:

OPD Services: Management of the common ailments as per the Standard

Treatment Protocols developed by the State.

O

h

v

h

h

O

T

c

re

C

•

e

•



Emergency Medical care: During the OPD hours, first aid and stabilization followed

by referral if required for injuries / accidents / animal bite cases and other emergency

conditions.

Minor Surgical Procedures: Simple Incision and drainage, suturing of simple clean

lacerated wounds. During all these surgical procedures, universal precautions will be

adopted to ensure infection prevention.

Referral for the Cases requiring Secondary / Tertiary care: All patients requiring

higher level care to be referred in time to a linked and identified centre with a

complete referral slip. Follow up of these cases in Primary Urban Health Centre.

Rehabilitation: Disability prevention, early detection, intervention and referral.

Provision of AYUSH services wherever AYUSH unit is co-located.

Geriatric care: Special emphasis on taking care of the senior citizens visiting the

health centre. From having user friendly access, freedom from long queues,

assistance in obtaining and understanding medications to special assistance like that

in obtaining dentures / spectacles through the Rogi Kalyan Samitis.

II. Preventive & Promotive services

1. Reproductive and Child Health Programme:

Maternal Health Services:

a. Antenatal Care:

i. Early registration (ideally before 12th week) of all pregnancies with a duly filled

ANC card.

ii. Antenatal checkups and provision of complete package of services.

iii. Provision of associated services like providing iron and folic acid tablets, injection

tetanus toxoid etc. (as per the guidelines for antenatal care)

iv. Laboratory investigations like haemoglobin, urine albumin and sugar.

v. Nutrition counselling.

vi. Identification of high risk pregnancies / referral to First Referral Units (FRUs) /

other linked hospital for high risk pregnancy.

b. Preparation / planning for delivery in an institution

c. Postnatal Care

Two postpartum home visits through the ANM to ensure wellbeing of mother and

newborn within 48 hrs and seven days of delivery – to initiate early breast

feeding and reinforce advice on nutrition, hygiene, contraception.



Child Health Services:

for the children as per the guidelines.

:

ling to adopt appropriate family planning

es etc.

name of the person

Treatment of RTIs and STDs and health education for prevention of RTIs / STDs.

ated Disease Surveillance Project (IDSP):

c. Promotion of sanitation including use of toilets and appropriate garbage disposal.

entres to deliver

ders and

common complications of TB and side effects of drugs.

a. Care of routine childhood illness.

b. Promotion of exclusive breast feeding for 6 months.

c. Full immunization of all infants and children against vaccine preventable

diseases as per guidelines of Government of India. Immunization days to be

specified.

d. Vitamin A prophylaxis

Adolescent Health

Detection and management of nutritional disorders and high risk behaviour.

Family Planning Services:

a. Education, Motivation and counse

methods.

b. Provision of contraceptives such as condoms, oral pills, emergency

contraceptiv

c. Carry out IUD insertions.

d. Follow up services to the eligible couples adopting permanent spacing / method

(Tubectomy / Vasectomy).

e. Counseling and appropriate referral for couples having infertility.

f. All incentives shall be clearly mentioned along with

responsible.

Management and Prevention of Reproductive Tract Infections / Sexually

Transmitted Diseases:

2. Integr

a. To detect unusual health events and take appropriate remedial measures.

b. Facilitate disinfection of water sources.

3. Revised National Tuberculosis Control Programme (RNTCP):

All Primary Urban health Centres to function as DOTS C

treatment as per RNTCP Treatment Guidelines through DOTS provi

treatment of

4. National Programme for Control of Blindness (NPCB):

a. Basic Services: Diagnosis and treatment of common eye diseases.



b. Screening for refraction disorders and referral for Refraction study.

c. Detection of cataract cases and referral for / facilitation of cataract surgery.

5. National Vector Borne Disease Control Programme (NVBDCP):

a. Diagnosis of Malaria cases, microscopic confirmation and treatment.

b. Cases of suspected Dengue, Chikungunia to be provided symptomatic

treatment, referral for hospitalization and cases management as per the

protocols.

c. IEC activities regarding spread and prevention, symptoms of VBDs and early

detection of complications.

6. National Leprosy Elimination Programme (NLEP):

a. Identification of leprosy patients on basis of clinical examination.

b. Referral of the patients to secondary care level when required.

c. Complete treatment with MDT.

e. Rehabilitation / disability prevention.

Programme (NIDDCP):

up.

c. s to create awareness of Iodine deficiency disorders.

a. res about STIs and

high risk behaviour at the nearest ICTC.

d. s to the high risk groups.

Convergence:

i.

ii. Diagnosis and management of Anemia and Vitamin A deficiency.

d. IEC activities

7. National Iodine Deficiency Disorder Control

a. Goitre detection and work

b. Salt iodine estimation of salt samples collected from household.

IEC activitie

8. National AIDS Control Programme (NACP):

IEC activities to enhance awareness and preventive measu

HIV / AIDS.

b. Screening of persons practicing

c. Risk screening of antenatal mothers with one rapid test for HIV.

Condom promotion and distribution of condom

e. Help and guide patients with HIV / AIDS in receiving ART.

III. Addressing other Determinants of Health – Inter-sectoral

A. Nutritional Services (in convergence with ICDS)

Diagnosis of and nutrition advice to malnourished children, pregnant women and

others.



iii. Health and Nutrition days to be conducted at the identified Anganwadis in the

.

i.

d by the ASHAs and

ssary screening / age appropriate immunization / health

ntre / outreach activities.

C. Promotion of Safe Drinking Water and Basic Sanitation

i. how to make drinking

ii. Provision of Chlorine tablets / drops through the centre / ASHAs.

IV. Ref

rral of cases needing specialist care / indoor care

a.

way link with the concerned officials there.

.

The following tests will be provided at the PUHC laboratory

.

viii.

catchment areas.

iv. Anganwadis in the catchment area shall be listed out

B. Health of School going Children (Convergence with School Health)

All children referred from the school for investigations, management to be taken

care of.

ii. School dropouts / children not going to school to be identifie

provided with the nece

education through the ce

IEC regarding consumption of safe drinking water and

water safe.

erral Services:

Appropriate and prompt refe

including:

Stabilization of patient

b. Appropriate support for patient during transport

c. Follow up of these cases. Liasoning with the referral institutions for PUHC area.

Having a two

V Provision of Essential Diagnostic services:

i. Hb %, TLC

ii. Blood Sugar

iii. Urine Albumin, Sugar and Microscopy

iv. Urine Pregnancy Test

v. Stool Microscopy

vi. Sputum testing for tuberculosis (if designated as a microscopy centre under

RNTCP)

vii Blood smear examination for malarial parasite

Tests specified as a part of IDSP



The following investigation will be provided at the PUHC Radiology

a. X RAY

nd Barium

b. ULTRAS OGRAPHY

• Obstetrical and Gynecological including endovaginal exams, TIFFA

ast, Thyroid, Scrotal and

uch as Hips, Shallers and Knees.

iii. ukkad Nataks, well baby shows, camps etc.

LADLI.

and private hospitals

mandated to provide free services to under privileged shall be displayed.

II.

ou

colonies, unauthorized colonies and villages through regular Health & Nutrition days,


• Contrast studies like Barium swallow, Barium meal, follow through a



ON


• Soft tissue and superficial structures including Bre

Transrectal Prostate examinations.


• Musculoskeletal examinations s





VI. Education about Health and its Determinants / National Health Programmes /

Special schemes of the department

i. Display of IEC material in the waiting areas.

ii. Distribution of handbills / leaflets / pamphlets.

Conduct of N

iv. Use of available IEC material in outreach activities.

v. Effective Behaviour Change Communication through ASHAs.

vi. Dissemination of information about special schemes like MAMTA / JSY /

vii. List of Gender Resource Centre, local grant in-aid NGOs,

V Provision of Services through Outreach activities

Provision of basic curative / preventive care in areas / certain specific vulnerable

gr ps through outreach activities especially in the slums, JJ clusters, resettlement

Immunization sessions.



PUHC will be responsible for conducting this activity in its catchment area. The staff

logistics will flow frand om the PUHC.

III. Continuous Capacity Building

s jobs /

.

Any layed on notice boards.

im

2. To keep the surrounding area clean.

age the building / other infrastructure.

Medical Officer Incharge regarding treatment

follow ups.

ut sex selective procedures,

voluntary workers attached to

aint can be directly addresses to the Medical Officer Incharge or

sitioned in a prominent place in the waiting area. These

ner. If required, Medical Officer Incharge

UHC level, the Chief District Medical Officer will

lyan Samiti.

Directorate Services and Family Welfare or State Health Society depending upon

d the Chief District Medical Officer along with

official address and phone numbers will be displayed in the Primary Urban Health Centre.

V

Periodic skill development / training of the staff of the PUHC in the variou

responsibilities assigned to ensure quality. ASHAs will be provided with the induction

/ refresher trainings and ongoing support in the field.

IX Ensure rational use of drugs

short term withdrawal of services shall be disp

Responsibilities of the Citizens

In addition to the rights, the citizens also have certain responsibilities towards the

Pr ary Urban Health Centre.

1. To keep the premises clean, not to spit / smoke / litter the area.

3. Not to disfigure / dam

4. To observe etiquette like standing in the que, talkin low tones, assist old / infirm.

5. Follow the instructions given by the

advised and referrals /

6. Inform the Medical Officer Incharge abo

environmental hazards, excessive vector breeding or reporting of cases in the

community.

7. Cooperation with the health functionaries and

Primary Urban Health Centres like ASHAs.

Grievance Redressal Mechanism

Any grievance / compl

placed in the complaint box po

complaints will be dealt within a time bound man

may bring it up before the Rogi Kalyan Samiti.

In case the grievance is not resolved at the P

take it up through the District Rogi Ka

The next level if required will be the level of the Integrated District Health Society,

of Health

the nature of grievance.

The name of the Medical Officer Incharge an



Display at the Primary Urban Health Centre

• A board displayed in Hindi, at the

summariz

conspicuous place clearly visible carrying

ed citizens charter showing available services.

r printed pamphlets.

• ckground with white letters

• Preferably no abbreviations to be used

• Language both Hindi and English fo

• Size preferably 4 ft X 6 ft for board.

Colour unique dark blue ba

• Facility specific

Periodical Review of the Charter

Charter will be reviewed periodically and suitably modified.



JOB RESPONSIBILITIES OF PRIMARY URBAN HEALTH CENTRE STAFF

MED AL OFFICER INCHARGE, PRIMAIC RY URBAN HEALTH CENTRE

impleme

PUHC a However, by virtue of his / her

esignation as the incharge and administrative head, it is implied that he /she will be solely

nsive health care including the implementation of

alyan of

I. Healthcare Delivery

d curative to the

enefic

department and will

diagnosis and treatment on the

OPD slip. As far as possible the medications shall be the ones available in the

• ensure that he / she himself / herself along with all others involved

in delivery of curative medical services are fully conversant with the standard

case to the specialist as and when required. While

late organization of the specialist / evening

he working hours appropriate care for

dequate stocks of ORS to maintain availability of ORS packets

Medical Officer Incharge of a Primary Urban Health Centre (PUHC) is responsible for

nting all activities grouped under Health and Family Welfare delivery system in

rea. It is not possible to enumerate all his / her tasks.

d

responsible for provision of comprehe

National Health Programmes. He / She will also be the Member Secretary of the Rogi

Samiti of the Primary Urban Health Centre and will be responsible for executionK

his / her responsibilities in that capacity.

The detailed job responsibilities of Medical Officer working in the PUHC are as follows:

The Medical Officer will provide comprehensive Medical Care, preventive an

b iaries including Family Planning services.

• The Medical Officer will organize the dispensary, outpatient

allot duties to the ancillary staff to ensure smooth running of the OPD.

• After examination of the patient the Medical Officer will record symptoms and

findings in brief, investigations done / advised,

PUHC.

He / She will

treatment protocols appropriate to the category of staff and are using them while

providing healthcare.

• He / She may refer the

making the referral to the specialist or hospital, the Medical Officer will give the

history, short resume of the case, findings, provisional diagnosis and the

treatment given on the OPD slip.

• He / She will supervise and regu

OPDs.

• He / She will ensure that during t

emergencies is promptly available in the PUHC including that for injuries and

burns.

• Will ensure a

throughout the year. He / She will arrange for correction of moderate and severe

dehydration through appropriate treatment (using IV rehydration if required)



• Monitor all cases of diarrhoea / ARI especially for children between 0 – 5 years.

ring drinking water safe.

(ASHAs),

s who are involved in health care regarding

ealth team early detection of pneumonia

atment. He / She will attend to all cases

entre by ANM / ASHA / School teacher / AWW and provide

t.

higher level care including dental

care and nursing care, he / she will ensure that a complete referral slip is

prepared and the patient to the appropriate higher centre.

• He / She will cooperate and coordinate with the institutions providing medical

care services in his / her area.

• He / She will ensure availability of all laboratory services mandated to be carried

out at the PUHC and refer the patient to an attached centre for more

sophisticated tests.

• He / She will make arrangements for providing services in areas / population

pockets which are not able to access the PUHC services by organizing health

and nutrition days at the anganwadi centres once in a month or through fixed

outreach centres.

• He / She will supervise outreach activities including the fixed outreach centres in

his / her area at least once in a fortnight.

II. Preventive and Promotive Work

The Medical Officer will ensure that all the members of his / her Health Team are fully

conversant with the various National Health & Family Welfare Programmes under National

Urban Health Mission to be implemented in the area allotted to each Health functionary. He /

she will further supervise their work periodically both in the clinics and in the community

setting to give them the necessary guidance and direction.

Based on the information collected by ASHA and the ANM from their surveys, he / she will

prepare operational plans and ensure effective implementation of the same to achieve the

laid down targets under different National Health and Family Welfare Programmes. The

second MO / PHN will provide assistance in the formulation of local health and sanitation

plan through the ANMs and coordinate with the local self help groups / health and sanitation

committees in his / her PUHC area.

He / she will keep close liaison with Block Development Officer and his / her staff,

community leaders and various social welfare agencies in his / her area and involve them to

the best advantage in the promotion of health programmes in the area.

Recording and reporting of all deaths due to diarrhoea / ARI especially for

children between 0 – 5 years.

• Spread awareness and provide chlorine tablets for rende

Training of all health personnel like Accredited Social Health Activist

Anganwadi workers, dais and other

ORT programme.

• He / She will ensure through his / her h

cases and provide appropriate tre

referred to the c

appropriate managemen

• After careful screening in all cases requiring the



W ealth

p amily

elfare services. He / she will coordinate and facilitate the functioning of AYUSH doctor in

• Ensure availability of supplement of Iron / Folic acid and Vitamin A.

Health Programme

entation.

Outreach A

•

isk cases.

Universal

•

.e. pregnant mothers and children in 0 – 5 year

ation sessions if required.

• e will also ensure proper storage of vaccine and maintenance of cold

2. Fam

• He / She will be responsible for proper and successful implementation of Family

Planning Programme in the PUHC area, including education, motivation, delivery

of services and after care.

herever possible, the MO will conduct field investigations to delineate local h

roblems for planning changes in the strategy of the effective delivery of Health and F

w

the PUHC.

1. Nutritional Services

• Liason closely with the Anganwadis and AWWs located in the PUHC area.

• Will provide leadership & guidance for special programmes such as in tackling

anemia, malnutrition, identification, treatment and follow-up of nutritional

disorders especially anemia and malnutrition by ensuring nutritional

supplementation at the nearby Anganwadi and nutritional rehabilitation at home

through ASHA.

2. Reproductive & Child

• Antenatal care / preparation and necessary linkage for Intranatal care / Post natal

care.

• Ensuring antenatal day every week with delivery of complete and quality assured

antenatal care including clinical examination, investigation, and supplem

• Identification and referral of high risk cases. Follow-up of these high risk cases

through pregnancy, intranatal period and postnatal period.

ctivity

• Ensure that areas where center based facilities are not accessible, outreach

activities are carried out and their quality / content are maintained.

Ensure that the essential contacts with PUHC are made for investigations and

management of high r

Immunization Programme

Ensure cent percent coverage as per the State Immunization schedule of the

target population in PUHC area (i

age group) through immunization sessions twice a week and conduct of outreach

immuniz

• He / She will ensure adequate supplies of vaccines miscellaneous items required

from time to time for the effective implementation of UIP.

He / Sh

chain equipment, planning and monitoring of performance and training of staff.

ily Planning Services



• He / She will be squarely responsible for giving immediate and follow-up attention

to any complications resulting from acceptance of family planning methods.

He / She will ensure that all l • ogistics (equipments, drugs, educational material

•

•

• PUHC to enable the adolescents

• for fever cases.

• of mosquitoes breeding site in the PUHC and in the area

•

• aware of Chikungunia / Dengue and

trained to detect early case of Dengue Shock Syndrome, Dengue Hemorrhagic

priate SOP at the PUHC and community level

• media equipment received from

and contraceptives) required for implementation of family planning activities are

available in the centre.

He / She will assist the districts in organizing the vasectomy camps.

3. Adolescent Health

Conduct of health talks / check up of school dropouts and children not going to

school / adolescents identified and collected by ASHAs.

Creating adolescent friendly environment in the

to approach the Medical Officer, Public Health Nurse, ANM with their problems /

queries.

4. National Vector Borne Disease Control Programme (NVBDCP)

Ensure facility for blood testing

• Will liaison with the authorities carrying out spraying activities and providing

logistics like larvicides in PUHC area.

Ensure elimination

through education / awareness generation by ASHAs, ANMs and liaisoning with

local self help groups.

Ensure that all positive cases are treated adequately.

• Ensure that cases of complicated Malaria are referred.

Ensure that all his team members are

Syndrome and institute appro

before prompt referral.

• Ensure sufficient stock of Chloroquine and IV fluids.

• Report all cases of suspected Dengue, Chikungunia and smear positive malaria

cases promptly.

Judicious use of all publicity material and mass

time to time.

• He / She shall ensure that all categories of staff in the centre are sufficiently

trained and observe the instructions laid down under NVBDCP on the treatment

of smear positive cases.

6. Tuberculosis

• Ensure high index of suspicion in the patients visiting OPD, provide facilities for

early detection of case, confirmation and prompt institution of treatment.



• He / She will also ensure that all cases of confirmed Tuberculosis take regular

and complete treatment.

• Ensure smooth functioning of DOTs centre and Microscopy centre if operating in

the PUHC.

7. Sexually Transmitted Disease

• He / she will ensure that all cases of STD are diagnosed and properly treated

and their contacts are traced for early detection.

He / She will provide facilities for RPR test, for all pregnant women at the PUHC.

rosy

•

8. Lep

Leprosy and

confirmation of their diagnosis and treatment.

sy take regular and complete treatment.

9. Control of Communicable Diseases

duties under the IDSP.

.

Blin

III. Tra

• versed with SOPs and follow these in Health

• adequately trained for

• of

skills of his / her staff with the help of State and District level trainings.

Organize training for ASHAs attached to the PUHC.

•

• He / she will provide facilities for early detection of cases of

• He / she will ensure that all cases of Lepro

• He / she will ensure that all the steps are being taken for the control of

communicable diseases and for the proper maintenance of sanitation in the area.

• He / she will take the necessary action in case of any outbreak of epidemic in his

/ her area.

• Perform

10 National Programme for Prevention of Visual Impairment and Control of

dness

• He / she will make arrangements for rendering:

a. Treatment for minor ailments

b. Testing of vision

• He/she will refer cases to the appropriate institutes for specialized treatment.

ining

Ensure that his health team is well

Care delivery at the PUHC.

The team members have defined work allocation and are

it.

Worker specific / relevant training are ensured with continued upgradation

•

Provide hands on training to the ANMs, ASHAs.



• Provide feedback on value addition done by the different trainings provided to his

/ her staff members at the district and state level under various programmes

• Will maintain a database of the trainees / trainings already conducted for his / her

PUHC staff.

• He / she will supervise the work of staff working under him / her.

eneral cleanliness inside and outside the premises of the

• d stock

• s prepared timely for drugs, instruments, vaccines, ORS

mit them to the

appropriate health authorities.

• He / she will scrutinize the programmes of his / her staff and suggest changes if

• red and display charts in his / her own room to explain

units, morbidity and

ion about his / her area.

own staff with a view to

•

d records at PUHC level.

rmats and their timely submission to the headquarter.

rt to the CDMO.

• day administrative duties and administrative

duties pertaining new schemes.

vi. Administrative Work

• He / she will ensure g

PUHC and also proper maintenance of equipment under his / her charge.

He / she will ensure maintenance of a regularly updated inventory an

register of all the stores and equipment supplied to him / her and will be

responsible for its correct accounting.

He / she will get indent

and contraceptive etc. sufficiently in advance and will sub

• He / she will check the proper maintenance of the transport given in his / her

charge.

necessary to suit the priority of work.

He / she will get prepa

clearly the geographical areas, location of peripheral health

mortality, health statistics and other important informat

• He / she will hold monthly staff meetings with his / her

evaluating the progress of work and suggesting steps to be taken for further

improvements.

He / she will ensure the regular supply of medicines and disbursements of

incentives to ASHAs.

• He / she will ensure the maintenance of the prescribe

• He / she will be responsible for compilation of accurate and complete reports in

the prescribed fo

• He / she will keep notes of his / her visits to the area and submit every month his

/ her tour repo

• He / she will discharge all the financial duties entrusted to him / her.

He / she will discharge the day to



SECOND MEDICAL OFFICER

ative Work I. Cur

he Medical Officer will provide comprehensive Medical Care, preventive and curative to the

ervices.

diagnosis and treatment on the

PUHC.

ill ensure that he / she himself / herself along with all others involved

y of staff and are using them while

providing healthcare.

• He / She may refer the case to the specialist as and when required. While

or hospital, the Medical Officer will give the

history, short resume of the case, findings, provisional diagnosis and the

• He / She will provide appropriate care for emergencies including that for injuries

• He / She will correct moderate and severe dehydration through appropriate

if required). He / she will ensure early detection

of pneumonia cases and provide appropriate treatment.

Recording and reporting of all deaths due to diarrhoea / ARI especially for

hlorine tablets for rendering drinking water safe.

personnel like Accredited Social Health Activist (ASHAs),

ing

will attend to all cases referred to the centre by ANM / ASHA / School

• all cases requiring the higher level care including

ices mandated to be carried

attached centre for more

T

beneficiaries including Family Planning s

• After examination of the patient the Medical Officer will record symptoms and

findings in brief, investigations done / advised,

OPD slip. As far as possible the medications shall be the ones available in the

• He / She w

in delivery of curative medical services are fully conversant with the standard

treatment protocols appropriate to the categor

making the referral to the specialist

treatment given on the OPD slip.

and burns.

treatment (using IV rehydration

• Monitor all cases of diarrhoea / ARI especially for children between 0 – 5 years.

children between 0 – 5 years.

• Spread awareness and provide c

Training of all health

Anganwadi workers, dais and others who are involved in health care regard

ORT programme.

• He / She

teacher / AWW and provide appropriate management.

After careful screening in

dental care and nursing care, he / she will ensure that a complete referral slip is

prepared and the patient to the appropriate higher centre.

• He / She will cooperate and coordinate with the institutions providing medical

care services in his / her area.

• He / She will ensure availability of all laboratory serv

out at the PUHC and refer the patient to an

sophisticated tests.



• He / She will provide services in areas / population pockets which are not able to

access the PUHC services by participating health and nutrition days at the

anganwadi centres once in a month or through visits in the fixed outreach

centres as per the schedule prepared by the Medical Officer In-charge.



I ork

he Medical Officer will ensure that all the members of his / her Health Team are fully

ational Health & Family Welfare Programmes under National

irection.

prepare ope

laid down ta

will provide in the formulation of local health and sanitation plan through the

/ her PUHC

He / she wil

leaders and agencies in his / her area and involve them to the best

the Social M

Wherever

problems fo of the effective delivery of Health and Family

•

• in Nutritional deficiency

bilitation at home through ASHA.

2. Rep

•

re.

on, and supplementation.

• plete services in areas where center based

•

risk cases.

I. Preventive and Promotive W

T

conversant with the various N

Urban Health Mission to be implemented in the area allotted to each Health functionary. He /

she will further supervise their work periodically both in the clinics and in the community

setting to give them the necessary guidance and d

Based on the information collected by ASHA and the ANM from their surveys, he / she will

rational plans and ensure effective implementation of the same to achieve the

rgets under different National Health and Family Welfare Programmes. The MO

assistance

ANMs and coordinate with the local self help groups / health and sanitation committees in his

area.

l keep close liaison with Block Development Officer and his / her staff, community

various social welfare

advantage in the promotion of health programmes in the area. He / she will be assisted by

obilization Officer in this.

possible, the MO will conduct field investigations to delineate local health

r planning changes in the strategy

welfare services.

1. Nutritional Services

Liaison closely with the Anganwadis and AWWs located in the PUHC area.

Will actively participate in special programmes such as

identification, treatment and follow-up of nutritional disorders especially anemia

and malnutrition by ensuring nutritional supplementation at the nearby

Anganwadi and nutritional reha

roductive & Child Health Programme

Will provide Antenatal care / preparation and necessary linkage for Intranatal

care / Post natal ca

• Conduct antenatal day every week with delivery of complete and quality assured

antenatal care including clinical examination, investigati

• Identification and referral of high risk cases. Follow-up of these high risk cases

through pregnancy, intranatal period and postnatal period.

Outreach Activity

Provide quality assured / com

facilities are not accessible, outreach activities.

Ensure that the essential contacts with PUHC are made for investigations and

management of high



Universal Immunization Programme

Provide cent percent coverage of the target population in PUHC area (i.e.

pregnant mothers and children in 0 – 5 year age group) through immunization

sessions twice a week and conduct of outreach immunization se

•

ssions if

required.

• Ensure proper storage of vaccine and maintenance of cold chain equipment,

planning and monitoring of performance and training of staff.

3. Family Planning Services

• Provide Family Planning services in the PUHC area, including education,

motivation, delivery of services and after care.

• He / She will be squarely responsible for giving immediate and follow-up

attention to any complications resulting from acceptance of family planning

methods.

• He / She will assist in organizing the vasectomy camps.

4. Adolescent Health

• Conduct of health talks / check up of school dropouts and children not going to

school / adolescents identified and collected by ASHAs.

• Creating adolescent friendly environment in the PUHC to enable the adolescents

to approach the Medical Officer, Public Health Nurse, ANM with their problems /

queries.

5. National Vector Borne Disease Control Programme (NVBDCP)

• Ensure blood testing for fever cases.

• Ensure elimination of mosquitoes breeding site in the PUHC and in the area

through education / awareness generation by ASHAs, ANMs and liaisoning with

local self help groups.

• Treat all positive cases adequately.

• Refer all cases of complicated Malaria in time.

• Ensure that all his team members are aware of Chikungunia / Dengue and

trained to detect early case of Dengue Shock Syndrome, Dengue Hemorrhagic

Syndrome and institute appropriate SOP at the PUHC and community level

before prompt referral.

• Report all cases of suspected Dengue, Chikungunia and smear positive malaria

cases promptly.

• Judicious use of all publicity material and mass media equipment received from

time to time.



• He / She shall ensure that all categories of staff in the centre are sufficiently

trained and observe the instructions laid down under NVBDCP on the treatment

mpt institution of treatment.

of smear positive cases.

6. Tuberculosis

• Maintain a high index of suspicion in the patients visiting OPD, provide facilities

for early detection of case, confirmation and pro

• He / She will also ensure that all cases of confirmed Tuberculosis take regular

and complete treatment.

• Ensure smooth functioning of DOTs centre and Microscopy centre if operating in

the PUHC.



7. Sexually Transmitted Disease

•

8. Lep

Leprosy take regular and complete treatment.

•

• ties under the IDSP.

0. National Programme for Prevention of Visual Impairment and Control of

• ding charts.

III. Trai

gs.

to the PUHC.

•

•

e. Evaluate the work being done and guide her in

• ntre at least once a week on a fixed day and while

conducting the clinic, also monitor / evaluate the work being done at the centre.

Provide necessary guidance for online correction.

• Diagnose and treat all cases of STD and contacts.

Ensure RPR test, for all pregnant women at the PUHC.

rosy

• Early detection of cases of Leprosy and confirmation of their diagnosis and

treatment.

• Ensure that all cases of

9. Control of Communicable Diseases

• Take all necessary steps for the control of communicable diseases.

Take the necessary action in case of any outbreak of epidemic in his / her area.

Perform du

1

Blindness

• Treatment for minor ailments

Testing of vision to screen using Snellen chart / near rea

• Refer cases to the appropriate institutes for specialized treatment.

ning

• Assist Medical Officer Incharge in organizing / conducting trainin

• Organize training for ASHAs attached

• Provide hands on training to the ANMs, ASHAs.

Provide feedback on value addition done by the different trainings provided to his

/ her staff members

IV. Monitoring & Evaluation

• Will be responsible for monitoring the work being done by the ANMs in the centre

and the field including Outreach activity. Monitoring will be structured and as per

defined formats.

Will periodically check and initial the ANM registers – Survey registers, eligible

couple registers etc.

• Assess fortnightly the progress of work of the ANM. Submit a report to the

Medical Officer Incharg

improving her performance.

Visit each outreach ce



• Similarly will evaluate the performance of ASHAs in consultation with the

concerned PHN and ANM. Provide all support and guidance wherever required

and be an active member of the ASHA mentor group.

o the Medical Officer Incharge on the monitoring and

• He / she will assist the Medical Officer Incharge preparing charts to explain

clearly the geographical areas, location of peripheral health units, morbidity and

mortality, health statistics and other important information about PUHC area.

• He / she will attend weekly / monthly staff meetings with a view to evaluating the

progress of work and suggesting steps to be taken for further improvements.

• He / she will discharge all the financial duties entrusted to him / her.

• He / she will discharge any other duty assigned to him by the Medical Officer

Incharge or upon introduction of a new scheme.

• Provide the feedback t

evaluation.

V. Administrative Work

• He / she will ensure general cleanliness inside and outside the premises of the

PUHC and also proper maintenance of equipment under his / her charge.

• He / she will ensure to keep up to date inventory and stock register of all the

stores and equipment supplied to him / her and will be responsible for its correct

accounting.



PHARMACIST

and for the safe custody of the

with the guidelines / instructions by Medical Officer

me.

with a

•

anliness of the dispensing room, replenishment of stocks, arranging

•

tles

• the

ion of the doses and also will

explain the doses verbally, where required.

• The Pharmacist (s) will remain on duty to clear the patient at the end of the

dispensary hours and shall leave the dispensing room only after taking

permission of the Medical Officer Incharge.

• He / she shall see that the stock registers maintained in the dispensing room are

signed by the Medical Officer Incharge daily.

• The Pharmacist will immediately comply with the instruction and arrange for the

stocks with him to be checked at any time by the Medical Officer Incharge or

Second Medical Officer and any other official deputed to check it.

• In the temporary absence of storekeeper, the Pharmacist shall perform the

duties of the storekeeper whenever required by the Medical Officer Incharge.

• The Pharmacist will wear white coat, the prescribed uniform while on duty.

• He / she will not allow any outsider in the dispensing room unnecessarily.

• He / she will assist in making arrangements for the outreach activities / camps.

• The Pharmacist will perform such other duties as may be assigned to him by the

Medical Officer Incharge from time to time.

• The Pharmacist will be personally responsible for the correct dispensing as per

prescriptions issued by the Medical Officers

stores in accordance

Incharge from time to ti

• The Pharmacist will at all times be courteous and helpful in dealing with the

patients and under no circumstances enter into arguments, whatsoever

beneficiary instead he / she will report the matter to the Medical Officer Incharge.

He / she will be in position at the dispensary 15 minutes before the opening time

to ensure cle

the medicines.

He / she will be personally responsible for ensuring that the dispensing room is

kept absolutely clean all the time, medicines are arranged properly and bot

are properly closed with labels intact.

He / she will dispense medicines with great care, accuracy as per

instructions on the prescription.

• The Pharmacist will write the names of the medicines whenever necessary on

the envelope / container, bottle to avoid confus



PHARMACIST (STOREKEEPER)

• The Storekeeper is answerable to the Medical Officer Incharge. He / she is

entrusted with the supervision of dispensary stores and the safety, protection

from loss, theft, pilferage and damage or deterioration of the stocks entrusted to

his / her charge.

• He / she will arrange to keep stores in a neat and orderly manner and ensure

that all containers, bottles, packages etc. are properly labeled.

• He / she will prepare and submit regular indents to the Medical Officer Incharge

and after getting approved and countersigned submit it to the Central Medical

Store in accordance with the delivery programme issued by the store from time

to time.

• He / she will ensure sufficient buffer stock and will bring to the notice of the

Medical Officer Incharge when the stock requires replacement / procurement in

time to allow replacement to be made before actual depletion occurs i.e. before

the stock become 'NIL'. If required he / she shall prepare supplementary indents

for submission to the Central Medical Store.

• He / she will procure indents from Central Stores / any other source whenever

required.

• He / she will examine, count, measure or weigh, as the case may be, the stores

received and supervise its safe delivery to the dispensary stores. At the time of

the receipt, he / she will check that the quantities are correct and that the stores

are in good condition. He / she will immediately bring to the notice of Medical

Officer Incharge anything found contrary before the stocks are taken on the

stock register.

• He / she will meticulously maintain the expiry date register. All received stock will

be entered with the batch no. / date of expiry / quantity received at the time of

receiving the stock. He / she will plan release of stores in such a way that the

items are used well before expiry dates.

• He / she will bring to the notice of the Medical Officer Incharge stocks of such

preparations which are accumulating in the dispensary store beyond the need of

the dispensary.

• He / she will be responsible for correct accounting of all the stocks and for

maintaining stock and issue registers and inventories in respect of the

consumable, non consumable items, the dead stock and liveries. He / she shall

make entries in the register and file the vouchers in serial order and produce the

same for checking / inspection at the time of verification of stores and get the

entries in the register counters signed by the Medical officer Incharge.

• He / she shall issue to Pharmacist, Lab technician, ANM etc. stores under his

custody only on the authorization of the Medical Officer Incharge. He / she will

ensure that seal is broken / label defaced before issue of items.



rekeeper will be responsible for obtaining written acknowledgement from

sons to whom the stores are issued from the stores. These shall be filed

in serial order.

• ctions regarding store keeping and accounting

•

•

PUHC.

deputed by the controlling authority.

s / DPMU / and other agencies. He / she will

•

•

l

ty and

e the required entries in the stock

registers.

• He / she will ensure the smooth working of the PUHC equipment like

microscope, refrigerators, inverter, coolers, water cooler with aquaguard etc. by

maintaining AMCs and ensuring their payments in time.

• The Sto

the per

• He / she will initial all entries in the stock ledger pertaining to the receipts and

issue of the store. Receipt entries will be made in red ink and issue entries in

blue ink.

He / she will comply with all instru

procedure issued by the controlling authority from time to time.

On transfer or while proceeding on leave. he / she will hand over the charge of

the store to his successor and furnish a handling over and taking over charge to

the Medical Officer Incharge in the prescribed form / register.

He / she will assist in dispensing work whenever so required by the Medical

Officer Incharge of the

• The Pharmacist will immediately comply with the instruction and arrange for the

stocks with him to be checked at any time by the Medical Officer Incharge or

other Medical officers and any other official

• He / she will assist the Medical Officer Incharge in dealing with the

correspondence with the Directorate

also assist Medical Officer Incharge in preparing reports / statistics.

In case of epidemics and under special circumstances, storekeeper will have to

arrange for the required medicines / logistics.

• The bag and the raincoat / umbrella for outdoor official duty shall be kept in such

a manner that these are made readily available in the dispensary for performing

outdoor duty.

• Storage and prevention of losses in the stores. The articles are to be properly

stored in the Store room. The Storekeeper is also responsible for preventing

damages in the store. The store must be free from rats, termites, cockroaches.

He / she will not allow any outsider to sit in the store unnecessarily.

• He / she will check at regular intervals the stores available at the outreach centre

and help in the procurement of supplies and equipment. Check that the drugs at

the outreach centre are properly stored and that the equipment is wel

maintained.

• Ensure that sufficient stock is there for the outreach activities / ASHA activi

to provide for referrals from the nearby schools.

• Periodically check stock registers of the outreach centre. Issue the indents

required at the outreach centre and mak



rticles beyond repair are condemned and disposed

cedure and functional replacements are available

without any delay.

•

charge from time to time.

• He / she will see that the a

through the laid down pro

• He / she will actively participate in the camp activities by providing various

logistics / and the Medical Officer in organizing the activity.

He / she will carry out such other duties as may be assigned to him by the

Medical Officer In

PUBLIC HEALTH NURSE (PHN)

Public Healt

the healthcare delivery in the centre and the catchment area of the PUHC, especially the

slum population, JJ clusters, resettlement colonies etc. She will act as a guide supervisor to

PHN is resp

Role:

• Provision of healthcare delivery including implementation of the National Health

• supervisor to ANM and ensure ASHA – ANM synergy.

•

Provision o

Maternal &

ed postnatal care. All high risk cases to

prophylactic / therapeutic doses of iron and compliance is ensured through

•

ANMs.

Whenever necessary, actively participate in immunization related activities

h Nurse will assist the Medical Officers in planning, implementing and evaluating

various health functionaries while also improving their skill through hands on training. The

onsible to Medical Officers and community in general.

Programmes.

To act as a

To assist the Medical Officer Incharge in managing various activities of the

health team in PUHC and outreach in the community

f Healthcare:

Child Health

• Conduct of the weekly antenatal clinic, ensure early registration of all the

pregnant women by ANMs in their area, ensure complete checkup,

preparedness for the birth, completion of ANC, JSY, Referral cards wherever

appropriate. Ensure delivery of home bas

be examined by the Medical Officer and necessary management and referral

protocols decided. PHN to ensure follow up through ANM and ASHA. Ensure

that all pregnant women are screened for anaemia and provided with

ANMs and ASHAs.

Supervise the weekly Well Baby Clinics with Immunization sessions, weigh and

record weight of the infant / child on the immunization card with date. Screen the

infant / children for developmental milestones and detect any deviations from the

same. Demonstrate the technique of correct immunization to the

including the adverse events which are to be immediately brought to the notice

of the Medical Officer.



• Ensure preparation and display of material like growth / development charts in

the immunization / well baby room.

Motivate / scree • n cases for use of appropriate family planning methods – IUCD

• the adolescent health talks and screening clinics at the centre in the

• ancer screening

•

Nutrition

ds for those visiting the centres /

Primary Me

•

•

ic.

preparation of the area maps.

in developing interpersonal skills by practical demonstrations in the

•

insertion and use of oral pills, permanent methods. Advise and educate

regarding use of emergency contraception.

Organize

outreach with the help of ANMs and ASHAs

Participate in special campaigns / screening activities i.e. C

week.

Provide information on the availability of services for MTP and ensure referral of

suitable cases to the approved institutions.

• Preparation of a plan of action for each identified anemic / malnourished baby

with the concerned ANM / ASHA. Appropriate counseling of the mothers of the

identified anemic and malnourished babies and attachment of the babies to the

nearest Anganwadi for SNP and the plan of action shared with the AWW,

Medical Officer to provide required technical advice in management anemia /

malnutrition.

• Hold practical demonstrations on how to prepare nutritious / wholesome meals

with simple, easily available and affordable foo

during outreach sessions.

dical Care

• Supervise the ANMs / ASHAs and give hands on training for treatment of minor

ailments, first aid for accidents and emergencies.

Attend to the cases referred by ANMs / ASHAs

Supervision of ANMs

Preparation of the ANM roster to ensure that ANMs are in the field for atleast

four days in a week. By rotation they would assist in the centre based antenatal /

well baby clin

• Ensure meticulous maintenance of Survey registers and Eligible couple registers

by the ANMs. By making field visits guide them in

• Monitor the outreach activities and guide ANM in conducting them well. Observe

the ANM while on job and strengthen the knowledge and skills of the ANMs.

Help them

centre and the field.

Help and guide the ANM’s in planning and organizing her plan of activities.



• Conduct regular meeting with ANM’s (weekly) in coordination with Medical

Officer Incharge. Assess periodically the progress of work of ANM and submit a

monthly assessment report to the Medical Officer Incharge of the PUHC. Carry

Mentoring

• Will supervise ANM / ASHA synergy, the support provided by the ANMs to the

ASHAs, the capacity building of ASHAs, filling up of the diaries and verification

ial record maintenance by the ANMs and timely

disbursement of incentives to the ASHAs.

• Planning the schedule of the outreach sessions.

• Supervise the conduct of outreach activities.

of the PUHC.

and regular

• n health camps, well baby

shows, IEC activities and special state / national campaigns and programmes.

IEC Activiti

•

Status of Women

out supervisory home visits in the area of ANM.

of Urban Social Health Activist (ASHAs)

• Will be the key member in the unit level ASHA mentor group.

by the ANMs, financ

• Deliver the health talks in the Mahila Mandal meetings / adolescent health

activities organized by ASHAs.

Outreach Activities

• Participate in the innovative activities being carried out by NGO’s in the

catchment area

• Encourage community involvement and participation by identifying

meetings with community leaders.

Participate as an active member of the health team i

Training

• Organize and conduct trainings of ANMs, ASHAs and AWW with the help of

Medical Officers.

es

Preparation of locally relevant IEC material / charts / monthly report analysis

graphical charts with the help of ANMs and ASHAs.

Topics like:

MCH care

Family Planning

Nutrition

Immunization

Personal Hygiene

Environmental Sanitation

Adult Education



Right Age of Marriage

PNDT

Drug Addition etc.

Collection and judicious utilization of IEC material provided by the district.

Prepare the IEC / BCC plan for the PUHC

•

• group meetings with community leaders, teachers etc. and involve them

Ensure that the ANM maintains her equipment / records in a proper way.

• Ensure that the ANM / Immunization / IUCD insertion room is kept clean and

•

Records &

• Review reports received from ANMs, consolidates them and submits periodical

ical Officer Incharge of the PUHC.

• eing maintained properly.

HA is optimally utilized.

ssigned by Medical Officer Incharge from time to time.

• Supervise distribution of IEC material by ANMs / ASHAs.

• Observation of National / International day & weeks.

Arrange

in spreading the message for family welfare programme.

Supplies, Equipment and Maintenance at Health Centre / Outreach

•

equipment available and functional.

Preparation of a consolidated report of work done by the ANMs at the centre and

in the outreach.

Reports

• Scrutinizes and validates the records / reports prepared by the ANM and guides

her in their proper maintenance. She will be responsible for the completeness

and accuracy of the reports generated by the ANMs.

report to Med

• Supervise the ANM – ASHA chain.

Ensures that the records pertaining to ASHAs are b

• Also ensures that the information gathered by AS

Any other duties / jobs a

AUXILLARY NURSE MIDWIFE (ANM)

• Register and provide care to pregnant women throughout the period of

ll be registered, and care given to her according to

Maternal & Child Health

pregnancy. Registration of a pregnant woman for ANC shall take place as soon

as the pregnancy is suspected, ideally in the first tri-mester (before or at 12th

week of pregnancy). However, even if a woman come late in her pregnancy for

registration, she sha

gestational age.



• Ensure that every pregnant woman makes at least 3 visits for Antenatal

checkup. First visit to the antenatal clinic as soon as pregnancy is suspected /

between the 4th and 6th month (before 26 weeks), 2nd visit at 8th month (around

32 weeks) and 3rd visit at 9th month (around 36 weeks). Ensure complete

antenatal checkups and associated services such as IFA tablets, TT

umin and sugar.

•

r facilitate the access to this referral

m hospital.

g with ASHAs will identify the ultimate beneficiaries, complete

e beneficiaries under Janani

ed in her areas and

• n

• including

anning

will be squarely responsible for maintaining eligible couple

registers and updating at all times.

message of family planning to the couples and motivate them for

• ptives to the couples,

spective acceptors in getting family planning services, if necessary,

hem or arranging for the ASHA to accompany them to

services to female family planning acceptors, identify side

n the spot for side effects and minor complaints and call

tion by the Medical Officer to the PUHC.

ASHAs, help in training them, and provide a

ot holders.

immunization etc.

• Ensure investigations – urine of pregnant women for alb

Estimation of haemoglobin level, blood sugar, blood group, VDRL.

Ensure that all cases of abnormal pregnancy and cases with medical and

gynaecological problems have been examined and provided a complete referral

to an identified referral unit. She will furthe

unit by providing the address, timings etc. If need be the ASHA of the area can

accompany the woman. ANM along with ASHA will provide follow up to the

patients referred to or discharged fro

• ANM alon

necessary formalities before disbursement to th

Suraksha Yojana (JSY)

• Make at least two post natal visits for each delivery happen

render advice regarding care of the mother and care and feed of the newborn.

Assess the growth and development of the infant and take necessary actio

required to rectify the defect.

Educate mothers individually and in groups in better family health

maternal and child health, family planning, nutrition, immunization, control of

communicable diseases, personal and environmental hygiene.

Family Pl

• Utilize the information from the eligible couple register for the family planning

programme. She

• Spread the

family planning individually and in groups.

Distribute conventional contraceptives and oral contrace

facilitate pro

by accompanying t

hospital.

• Provide follow-up

effects, give treatment o

those cases that need atten

• Establish female depot holders in

continuous supply of conventional contraceptives to the dep



• local leaders, ASHA, dais and others and take their

Family Welfare Programme.

• ndal meetings and utilize such gatherings for educating

Medical Termination of Pregnanc

pregnancy and refer

of pregnancy. Help in

adoption of a spacing method after MTP conducted for an unwanted pregnancy.

• ition among infants and young children, with

lement it with the help of ASHAs and AWWs. Refer the severe /

complicated malnutrition cases to the linked hospital.

Iron and Folic Acid tablets as prescribed to pregnant women, nursing

•

•

Universal I

nus toxoid

G

ization

schedule.

Report all adverse events to the Medical Officer.

oordination with Local Dais

and involve them in promoting Family welfare

Communic

•

the necessary measures to prevent their spread.

Build rapport with acceptors,

help in promoting

Participate in Mahila Ma

women in Family Welfare Programme.

y

• Identify the women requiring help for medical termination of

them to nearest approved institution.

• Educate the community of the consequences of septic abortion and inform them

about the availability of services for medical termination

Nutrition

• Have a strong liaison with the Anganwadi worker (AWW) of her area.

Identify cases of anemia and malnutr

the Medical Officer / Public Health Nurse make a plan of action for the identified

children and imp

• Distribute

mothers, and young children (upto five years) as per the guidelines.

Administer Vitamin A solution to children as per the guidelines.

Educate the community about nutritious diet for mothers and children.

mmunization Programme

• Immunize pregnant women with teta

• Administer DPT vaccine, oral poliomyelitis vaccine, measles vaccine and BC

vaccine to all infants and children, Hepatitis B, Typhoid as per the immun

• Ensure injection safety.

•

C

List Dais in her area

able Diseases

Inform the Medical Officer, PUHC immediately about any abnormal increase in

cases of diarrhoea / dysentery, fever with rigors, fever with rash, fever with

jaundice or fever with unconsciousness which she comes across during her

home visits, take



• If she comes across a case of fever during her home visits she will advise the

patient to come to PUHC for the blood examination.

Identify cases of skin patches, especially if accompanied by loss of sensation,

which she comes across during her home visits and bring them to PUHC for

examination by the Medical Officer.

•

•

Vital Event

d

• t records concerning mothers, children and eligible

Record Ke

egisters

register (ANM specific) in which she records detailed household survey

•

d couples. Accordingly she prepares her

• PUHC) – details of ANC, intranatal

•

ach, Cases referred for Tubectomy / Vasectomy and cases operated.

•

• Keep a follow up of patients on t/t for leprosy, tuberculosis and ensure

compliance and completion of treatment with the help of ASHAs wherever

available. Motivate defaulters to take regular treatment.

• Give Oral Rehydration solution to all cases of diarrhoea / dysentery / vomiting.

Train ASHA in ORT as she is a depot holder for ORS.

Identify and call all cases of visual impairment including suspected cases of

cataract to the PUHC. ASHA can accompany the patient for the required

surgery.

• Education, Counseling, referral, follow-up of cases STI / RTI, HIV / AIDS.

s

• Facilitate (by providing the address of the nearest registering office) according of

vital events including births and deaths, particularly of mothers and infants an

inform the Medical officer of the PUHC.

Maintenance of all the relevan

couples in the area.

eping

R

• Survey

of her area and allotted families.

Eligible couple Register (ANM specific) in which she records the eligible couples

– both protected and unprotecte

workplan and follows them up.

Pregnant women register (common for the

care, outcome of pregnancy and postnatal period.

Detailed record of Family planning activities carried out at the centre – IUCD

inserted, Oral Contraceptives distributed at the centre, in the field through ASHA,

other outre

• Immunization registers with detailed record of child / vaccines given and next

due.

Prepare and submit the prescribed weekly / monthly reports in time.

• Fill up any format provided under the IDSP.



Treatment of Minor Ailments

Provide treatment for minor ailments i.e. Parace • tamol for fever, first aid for minor

eam Activ

Primary Urban Health Centre

• ith the local self help groups, health and

•

•

•

session and will

le couple register of the village

dopting family planning.

intake of full course of IFA tablets and TT

A on the dose schedule and side effects of oral pills.

abour so that she

ASHA on date, time and place for initial and periodic training

•

• She will also maintain financial records of the ASHAs working in her area.

accidents while on a home visit.

itiesT

• Organize staff meetings at

• Coordinate her activities with the Health volunteers / NGOs / ASHA and Dais.

Help in creation of and coordinate w

sanitation committees.

Dispose medical waste as per the guidelines.

Participate as an active member of the team in camps and campaigns.

Role of ANM as a facilitator of ASHA

Auxillary Nurse Midwife (ANM will guide Urban Social health Activist (ASHA) in performing

the following activities:

She will hold weekly / fortnightly meeting with ASHA and discuss the activities

undertaken during the week / fortnight. She will guide her in case ASHA had

encountered any problem during the performance of her activity.

• ANM will act as a resource person for the training of ASHA.

• ANM will inform ASHA regarding date and time of the outreach

also guide her for bringing the beneficiary to the outreach session.

• ANM will participate and guide in organizing the Health days at Anganwadi

centres.

• She will take help of ASHA in updating eligib

concerned.

• She will utilize ASHA in motivating the pregnant women for coming to PUHC for

initial checkups. She will also help ANMs in bringing married couples to the

PUHC for a

• ANM will ensure compliance in

injections etc. with the help of ASHAs.

• ANMs will orient ASH

• ANMs will educate ASHA on danger signs of pregnancy and l

can timely identify and help beneficiary in getting further treatment.

• ANMs will inform

schedule. She will also ensure that during the training ASHA gets the

compensation for performance and also TA / DA for attending the training.

She will be responsible for ensuring correct filling up of diaries by the ASHAs,

verification of the work done and timely disbursal of incentives.



LABORATORY TECHNICIAN

All Primary Urban Health Centre will have Laboratory technician / assistant. The Laboratory

ill be under the direct supervision of the Medical Officer Incharge, PUHC. The technician w

laboratory technician will carry out the following duties:

I. Gen

1.

4.

5. f specimens and infected material in a safe manner as per the

6. Maintain the necessary records of investigations done and submit the reports to

e Medical Officer, PUHC

8.

II. Lab ns

ut examination of urine

i. Specific gravity and PH

III. Car Examination of Blood

iii. RBC count

eral Laboratory Procedures

Maintain the cleanliness and safety of the laboratory

2. Ensure that the glassware and equipment are kept clean

3. Handle and maintain the microscope

Sterilize the equipment as required

Dispose o

Biomedical Waste Disposal guidelines

th

7. Prepare monthly reports regarding his work

Indent for supplies for the laboratory though the Medical Officer, PUHC well in

time and ensure the safe storage of materials received

oratory Investigatio

1. Carry o

ii. Test for glucose

iii. Test for protein (albumen)

iv. Test for bile pigments and bile salts

v. Test for ketone bodies

vi. Rapid Test for Pregnancy (RPT)

viii. Microscopic examination

2. Carry out examination of stools

i. PH

ii. Microscopic examination

ry out

i. Collection of blood specimen by finger prick technique

ii. Hemoglobin estimation



iv WBC count (total and differential)

ocyte sedimentation rate

x. Typhoid (Typhi Dot)

i. Preparation, staining and examination of sputum smear for Mycobacterium

PUHC is recognized as microscopy centre under

V. Carry out Examination of Semen

ii.

iii. hlorine in drinking water by testing kits

v. Preparation, staining and examination of thick and thin blood smears for malaria

parasites and for microfilaria

vi. Erythr

vii. Blood Sugar

viii. Blood Grouping

ix. VDRL

Rapid Diagnostic test for

IV. Carry out Examination sputum

tuberculosis (wherever the

RNTCP).

i. Microscopic examination

Sperm count and motility

VI. Test samples of drinking water

i. Testing of samples for gross impurities

ii. Rapid tests for detecting faecal contamination by H2S strip test

Residual c

Perform any other tests as per the IDSP (Integrated Disease Surveillance Project)

Perform any other duty as assigned by Medical Officer Incharge from time to time.



All Primary Urban Health Centre will have Radiographer. The Radiographer will be under the

direct supervision of the Medical Officer Incharge, PUHC. The Radiographer will carry out

e following duties: th

• Maintain the cleanliness and safety of the X-Ray, Dark room and USG room

in the medical diagnosis

ological diagnosis.

ls, such as kilo voltage and mili amperage to

timing of exposure; regulates the length and

• nd restrains patients; and takes x-rays of

he work area.

•

as patient records, daily logbooks, and monthly

ssure x-ray unit meets standards required by

olicies

uired.

and day-to-day utilization.

accounts and statistics of each room to

s for patients in surgery.

ins and makes minor adjustments to radiographic equipment,

including determining repairs needed to equipment and report equipment failure

t rectified well in time.

onnel from radiation hazards.

ough the Medical Officer,

PUHC well in time and ensure the safe storage of materials received

• Administers contrast media to patients for gastrointestinal and other special

• Sets up and operates radiographic equipment used

and/or treatment of patients.

• Selects proper ionizing factors for radi

• Adjusts and sets radiographic contro

prescribed specifications for proper

intensity of film exposure.

Receive patient's requisition, positions a

patient’s chest, limbs or other parts of the body as required by the Medical

Officer.

• Implements infection control procedures for t

• Checks X-rays for clarity of image, and retakes x-rays when needed.

Develops, fixes, washes, and dries exposed films using film processing and

drying equipment.

• Maintains required records such

reports.

• Distribute films to appropriate medical staffs.

• Maintains quality control checks to a

laws, rules and departmental p

• Assist Medical Officers as and when req

• Responsible for films used

• Provide details on daily poor quality films

be handed over to the management.

• Performs radiographic procedure

• Cleans, mainta

to Medical Officer Incharge and get i

• Protects patient and other pers

• Indent for radiographic supplies, film and equipment th

studies.

RADIOGRAPHER



• Observes the safety requirements and follow safety procedures and instructions

erformed and percentage of wastage.

y other duties as may be assigned to him by the Medical

ns


meal, follow through and Barium

b. ULTRASONOGRAPHY

ding endovaginal exams, TIFFA

ctures including Breast, Thyroid, Scrotal and

ions.

.


and shall refrain from any willful act that could be detrimental to self, co-workers,

and the radiation installation and public.

• To provide statistical details of cases p

• He will carry out an

Officer Incharge

Radiological Investigatio

a. X RAY

• Contrast studies like Barium swallow, Barium




• Obstetrical and Gynecological inclu

• Soft tissue and superficial stru

Transrectal Prostate examinat


• Musculoskeletal examinations such as Hips, Shallers and Knees






DRESSER

• The Dresser will be responsible for the overall management of the Dressing

room and do the require dressings.

• He will render first aid in emergency cases and help the Medical Officer in

e Medical Officer.

f lotions, powders and

• dressing material will be kept in a separate tray.

•

at a time and keep it in a sterilized tray.

zed

medical Waste disposal.

patient or the female attendant of the PUHC or will call

• tles / jars etc. properly covered, corked,

dages, gauze etc. stored

• a white apron and liveries provided.

e removal of foreign

• tore and maintain a

ntain separate register for special drugs like eye, ear, and ointment

•

handling the injured.

• He will issue the lotions and ointments to the patients under the guidance of the

Pharmacist as prescribed by th

• He will keep the Dressing room clean and tidy. All types o

ointments shall be properly labeled and arranged.

• He will keep medicaments for Eye and Ear in a separate tray.

The lotions, paints etc. and

• He will prepare the drum with instruments and dressing material for sterilization.

He will take out for use from the dressing drum a small quantity of sterilized

dressing

• He will wash his hands with soap and water before dressing and use sterili

dressings provided for the purpose.

• He will take proper care of the soiled dressings and put the same in covered

waste receptacle. These soiled dressings must be disposed as per the

guidelines issued for Bio

• In case of a female patient, he will not do the dressing except in the presence of

a female relative of the

ANM to do the dressing if need be.

• He will maintain proper accounts of the medicaments, drawn from the stores.

He will keep the bulk containers, bot

stoppered and labeled.

• He will keep dressing material i.e cotton, linen, ban

properly and not exposed to dust.

The dresser while on duty will have on

• He will assist the Medical Officer in minor operations lik

body, repair of wounds etc. and keep sutures (needle thread) instruments etc.

sterilized and ready for use.

He will indent the creams / lotions / ointments from the s

stock register for these.

• He will mai

issued from the dressing room.

He will carry out any other duties as may be assigned to him by the Medical fficer

Incharge.



NURSING ORDERLY / PEON

to

him by the Medical Officer Incharge.

• h a Medical Officer he will control the influx of patients to the

doctor’s room.

ble for the proper upkeep and cleaning of doctor’s consulting

er rooms including all furniture, equipment therein.

d examination table for the patients.

dical Officer Incharge.

• Similarly he will collect dak any other logistics from the District / State HQ / or

the Medical Officer Incharge.

et the indents from the main store.

ndant at the

• e for procurement of water for mixtures /

r official duty

shall return / deposit the raincoat / umbrella / bag to the concerned official.

responsibility in the conduct of

him by the Medical

Officer Incharge from time to time.

The Nursing Orderly / Peon will carry out duties in the PUHC or outside that as assigned

When posted wit

• He will be responsi

rooms and oth

• He will arrange the doctor’s tables an

• He will be responsible for the delivery of dak or any other material to the district

headquarters / to the Central store and such other place as may be required

under instructions from Me

any other place as instructed by

• He will accompany the storekeeper and g

• The Nursing Orderly / Peon will perform duties of watchmen / atte

PUHC as specified by the Medical Officer Incharge at the time of need.

Wherever necessary, he will arrang

drinking purposes.

• The Peon / Nursing Orderly / Messenger after performing outdoo

• He will participate enthusiastically and with

various camps / all outdoor activities.

• He will perform such other duties as may be assigned to



SWEEPER CUM CHOWKIDAAR - SCC(Dual work of security and sanitation in shift duties)

The SCC on morning shift will report • for duty sufficiently early to sweep and mop

• take the charge of the Primary Urban Health

• d locked so as to exclude the

• re taking over duty and show

per on relief from

s placed outside, the rooms are

• lights, heaters, fans etc. are

•

•

ons etc. He will empty waste

•

iomedical waste. These activities will be

performed before opening or after closing of the centre.

ing and unloading store from the vans.

g to

•

se of the specimen after the completion of their

• e shelves when he is attached with the store.

the Primary Urban Health Centre floors etc. so that work can start at the

scheduled hour.

The Sweeper cum Chowkidaar will

Centre premises after the PUHC hours.

He will ensure that all the rooms are properly bolte

possibility of entry by an unauthorized person.

He will inspect the lock and seal of the medical sto

the same to the next SCC, Medical Officer Incharge / Storekee

duty.

• He will check that the almirahs containing store

properly locked and sealed. Any deficiency noticed will be brought to the notice

of the Medical Officer Incharge by him immediately.

Before closing the rooms he will ensure that all

switched off and the water taps are closed.

The SCC will not sleep while on duty.

• He shall arrange for procuring water needed for mixtures and drinking purposes.

He will daily sweep and mop the floors of the PUHC building and surroundings,

clean all wash basins, latrines and urinals, spitto

paper baskets, dustbins etc. at the provided places.

He will see that the biomedical waste is segregated and disposed as per the

guidelines issued for disposal of b

• He will clean the walls / cisterns with a brush broom at least once a week.

• He will in turn do dak work, urgent indents, telephone duties on both working and

closed days besides load

• He will indent and obtain phenyl, vim in time, sweeping material like brooms,

mops etc. for performing his duties.

• When posted to the laboratory he will perform the cleaning duties pertainin

the laboratory and its surroundings as detailed above.

He will wash and clean laboratory slides, bottles etc. used for investigation

purposes and correctly dispo

examination and when they are no longer required.

He will wash and clean th

• Under mo condition, he will leave the PUHC premises without handing over the

charge.

• The SCC will perform such other duties as may be assigned to him by the

Medical Officer Incharge.



SOCIAL MOBILIZATION OFFICER (SMO)

He /she will be under the immediate administrative council of the Primary Urban Health

Centre Medical officer. He / she will be responsible for providing support to all health and

Communitization Activities

of various h establish and

nit i.e.

together sm

dedicated e ce by an individual trained in

them awar s, accessing and

•

• r Incharge in organizing regular meetings of RKS

•

• Coordinating District / State level trainings for RKS members

Related to s / Local Self Help Groups (like Mahila

Arogya Samiti) / other Community Based Groups (CBOs)

• Help ASHA in the formulation of Health and Sanitation Committees in community

and plan for their capacity building.

• Hand holding and Capacity Building training for SHG / MAS members in

consultation with Medical Officer.

• Make sure the reimbursement of HSCs seed fund.

• Supporting institutionalization of HSCs / MAS / CBO through training on themes -

group meeting, recording of meetings, book keepings.

• Promoting community risk pooling through collection of small thrift for health

exigency in HSCs / MAS / CBO.

• Facilitating linkage with bank by opening up bank account for MAS / CBO.

• Will assist in the health insurance scheme implementation once it is taken up.

family welfare programmes in the area. His focus work areas will be:

With the emphasis on Community Involvement in planning, implementation and monitoring

ealth interventions there has to be a strong and concerted effort to

maintain a continuous interaction between the community and the local health u

PUHC. Many of the important interventions like setting up and registering the Rogi Kalyan

Samitis / forming health and sanitation committees for every 2000 population / putting

aller self help groups required for mounting risk pooling activity will require

ffort at the grassroot level and active field presen

these activities. He / she will stimulate and guide this local initiative, assist them by making

e of the existing guidelines, available funds for various activitie

using the same and record keeping.

Related to Rogi Kalyan Samitis:

Help in identification of the members

• Registration of the society

Assist Medical Office

• Taking minutes of the proceedings and ensuring follow up activities

Maintaining records including financial records

• Preparing reports of RKS

Health & Sanitation Committee



Related to Accredited Social Health Activist (ASHA)

• Assist the Medical Officer to develop the plan for ASHAs induction training and

•

HAs. Building credibility, helping her access the resistant

will help field workers in winning over

• ach ASHA considering 400 - 450

• NM in monitoring work of ASHAs in the community, through verification of

Support to

Officer. The specific tasks to be

•

• ces and required logistics

Reporting

ces.

• ctivities of PUHC and help Medical Officers

• es for the timeliness and

and their catchments, depiction of households and beneficiaries on the

• le for preparation and display of relevant maps of the

area which will be prepared with the help of the ANM and ASHA

• Facilitate selection of ASHAs

concurrent training and implement the same.

He / she along with the ANM, PHN will be a part of the Unit level core mentor

team for the AS

families, enhancing her communication skills, establishing her contacts with local

water, sanitation functionaries. He / she

resistant cases and drop outs in the health and family welfare programmes.

Map the defined and delineated catchment for e

households each.

Help A

reported beneficiaries.

Outreach Activities

He / she will be responsible for planning of outreach activities in the PUHC catchments in

consultation with PHNs, ANMs, ASHAs and Medical

accomplished are:

• Facilitate preparation of monthly outreach plan for slums in consultation with

concerned ASHAs and ANMs.

Esure the implementation of monthly outreach plan.

Help ASHAs in mobilization of community resour

support for outreach activities – place, tables, chairs, water etc.

and Data Management & Monitoring Activities

Help ANMs / ASHAs in compilation of data for activities outreach and coverage of servi

• Support ASHAs to maintain registers, review registers and reporting formats and

compile data accurately for assigned clusters submit to Medical Officer.

Generating reports on the monthly a

in presenting it to appropriate authority / forums.

Will assist in monitoring the outreach activities / centr

completeness of services being provided. Will ensure that the outreach centre is

kept clean and is properly maintained.

Mapping and IEC / BCC Activities

• Help ANMs / ASHA and MAS in participatory geographical and social mapping

the slums

map.

He / she will be responsib



C

• Coordinate with other Govt. Offices, municipality, District Tuberculosis Office /

t with the school health functionaries in the area.

n organization of the camps /

ivities and with the help of ASHAs ensure active

nd publicity

ization of mass communication programmes like film

strict BCC officer.

• He / she will maintain a list of prominent acceptors of family planning methods

titioners, school teachers, dais and others

preading the message for various health

en leaders with the help of

ious National Health Programmes.

he

oordination and Management

DOTs centres, MDT centres, Malaria circle / beat office.

• Establishing the vital network with the area Anganwadis and their functionaries,

supervisors.

• Establishing contac

• Liasoning closely with the local NGOs and ensuring their participation in various

activities as and when required.

• Risk pooling is a proposed activity under the urban health mission. Once

operationalised it will need a strong community based working mechanism. He

will with the help of ASHAs, local NGOs, existing self help groups if any help in

building this mechanism

• He / she will ensure that the benefit of various entitlement schemes being run by

the Government for vulnerable segments reach them. This activity will include

generation of awareness and facilitation of access to these benefits by the

identified beneficiaries.

IEC & BCC Activities

• Along with the other staff he will participate i

campaigns / outreach act

participation by the community.

• He / she will organize the celebration of health days and weeks a

programmes al local fairs on market days etc.

• He / she will assist organ

shows, exhibition, lectures and dramas, with the help of the Di

and opinion leaders and will try to involve them in the promotion of Health and

Family Welfare programmes.

• He / she will organize orientation training for Health and Family Welfare workers,

opinion leaders, local medical prac

involved in Health & Family Welfare work. Arrange group meetings with the

leaders and involve them in s

programmes. Organize and conduct training of wom

the Medical Officer / ANM.

• He / she will organize health education sessions in schools and for out of school

youth.

• Organize and utilize Mahila Mandal, teachers and other women including ICDS

personnel in the community in var

• He / she will prepare a monthly report on the progress of BCC activities in t

PUHC area.



• Coordinating the campaign of IEC / BCC in the PUHC catchment.

activities cover the entire population through map

Trainings:

•

Any other y the Medical Officer Incharge

• Make sure that IEC and BCC

based micro planning.

• He / she will assist the Medical Officer, PUHC in conducting training of various

staff and ASHA.

He / she will maintain a complete set of educational aids on Health and Family

Welfare for his / her own use and for training purpose.

• Trainings of RKS / SHG functionaries.

activity assigned b



COMPUTER DATA ENTRY OPERATOR (CDEO) CUM ASSISTANT

The data generated at the PUHC suffers from serious flaws like authenticity, incompleteness

and inconsistencies. Major reason for that being lack of accurate and complete recording by

l Officers on ththe Medica e OPD slips and leaving the work of entering / recording the same

it being the

In order to / reliable data all these problems have to be

a CDEO wi

• ttendance registers. Computer generation of OPD slip

•

• eports – hard and soft copies in the prescribed formats

programmes.

• e diseases to the concerned departments.

• om the ANMs and its compilation

•

•

s for staff / community workers.

in master register to a worker who is not qualified to do so (in most of the cases

Nursing Orderly / Peon) and existence of long elaborate formats.

generate authentic / complete

addresses. CDEO cum Assistant has been proposed to take care of all data collection,

compilation, generation of various kinds of reports and their onward transmission. Duties of

ll be:

Maintenance of the OP a

and patient registration.

Entry of complete diagnosis and treatment prescribed in the computerized

registry.

Generation of monthly r

provided under different

• Transmission of the reports in time to various concerned units – DPMU / SPMU /

Directorates.

Immediate notification of notifiabl

• Accurate compilation and onward transmission of the data pertaining to IDSP.

Collection of data pertaining to ASHA activity fr

in prescribed formats.

Maintaining all relevant records financial and otherwise, related to ASHAs / other

community structures.

Assisting the Medical Officer Incharge in preparing communications, orders,

disseminating various guideline

• Any other work assigned by the Medical Officer Incharge.



MEDICAL RECORDS CLERK

•

for submittin

To develop and maintain an information base and providing statistical data and

g mothly reports

• Attend the correspondence of birth and death reports requested by the patients

or nearest relatives.

• To initiate, process, and check the patient records from IP, OP, Emergency to

ensure all the necessary forms and information are available.

• To assemble medica record in accordance with the prescribed standard order.

• To maintain & preserve patient records including X rays and diagnostic reports in

a scientific way for the period recommended in the retention schedule.

• To retrieve medical records to meet the needs of patient care, medical

education, training, research, medico legal problems & evaluation of patient care

• To prepare complete procedures related to medical reports, certificates, death

and birth reports, and to submit the data to the appropriate authorities.

• To expedite any responsibilities related to the medical records assigned by the

Medical Officer Incharge from time to time.

• He / she is also responsible for delivery and collection of out patient file from the

respective consultant room/ casualty and then maintaining the same in the

medical records room.

• Compiles and furnishes the required information to the Medical Officer Incharge.

• Issues medico legal files and other certificates to the police in case required by

them.

• Custodian of the MLC registers.

• Send the monthly report of various notifiable diseases (malaria, tuberculosis etc)

to CDEO.



SELF APPRAISAL OF PRIMARY URBAN HEALTH CENTRE STAFF

FORM 6.1 SELF APPRAISAL - MEDICAL OFFICERS: Clinical Care Competencies

Facilitation Help Required at LevelS.No. Skill / Competency Gap

PUHC District State

1.

Clinical Protocol / Standard

Treatment Guidelines adopted by

the State for various management

of comm

level

Am I familiar with the Standard

on illness at the PUHC

2. under LA, carrying out

suscitation pro

Am I confident in setting up IV

es, suturing simple woulin nds

re cedure, using

Nebulizers, Ryles tube, Catheters

3.all the different medications /

gistics available i

Am

effects / dosages / interactions of

lo n my PUHC

I aware of the uses / side

4. equipment / apparatus needed in

the PUHC

Am I confident in use of all the

5.Insertion / abdominal examination

a pregnant woman

Do I have the specific skills like

lvic examination and pe IUCD

in

6.

Am I familiar with guidelines of

National Programs being

nted in my PUHC

impleme

7. cardiovascular emergencies,

snake / dog bites

Am I confident of dealing with

8.

Am I aware of various

empowerments / health and social

sector schemes for the vulnerable

population

9.

Am I aware of the State

Guidelines for Biomedical Waste

Management

10.Am I aware of the PEP Protocols

and policy of procuring the same



11.Am I aware of referral center

availability of transport facilities

s and

12.slip to the referred patient

Am I giving a duly filled referral

13.recording to be undertaken in

Am I aware of stepwise action /

case of adverse events related to

Immunization / medicines

14.condition and the management

an

Am I spending enough time with

each patient, explaining the

pl



FORM 6.2 SELF APPRAISAL - MEDICAL OFFICERS: Managerial Competencies

Facilitation Help Required at Level S.N

o.Skill / Competency Gap

PUHC District State

1.

Do I have a copy of the Public

Health UHC

available in the centre

Standards for a P

2.

A

re

c

re

m I aware of the roles and

sponsibilities of the staff in my

are and have I delegated

sponsibilities to each one

3.

A

s e / functions / proceedings

o

m

m I clear on the objectives

tructur

f the Jan Swasthya Samitis and

y Role as the member secretary

4.A

s

m I aware of the GFR for the

tate

5.Am I familiar with the I

M

nventory

anagement Principles

6.

A

fo s

for their u

m I aware of the funds available

r the PUHC and the guideline

sage

7.

A

le n arise in a

PUHC

m I aware of possible medico

gal issues that ca



FORM 6.3 SELF APPRAISAL - STOR KEEPERSE

Facilitation Help Required at Level S.No. Skill / Competency Gap

PUHC District State

1.A

R

m I aware of my Roles /

esponsibilities

2.

A

t the

r

o

q

re the indents I am preparing

imely, rational (as per

equirements of various sections

f the PUHC) and in sufficient

uantities

3.

A y stock registers, issue

registers, vouchers, maintained

as per guidelines

re m

4.Is my store well organized,

clean and pest free

5.

Is my expiry register are in order

and I am always well aware of

the drugs nearing expiry to take

the necessary steps while

issuing

6.

Am I always able to maintain

buffer stocks, plan for the

outreach, ASHA requirements

or there are frequent stock outs

7.

Is all my stock – consumable

and non consumable fully

accounted for and recorded in

separate registers

8.

All bills are paid in time and

necessary records maintained –

Electricity, water, telephone,

internet etc.

9.

Are all equipment / apparatus in

my PUHC like microscope,

refrigerator, inverter, coolers,

water cooler with aqua-guard /

RO etc. functioning properly and

covered under AMC

10.

Are all items beyond repair

condemned and disposed

through the laid down

procedures and functional

replacements are available

without any delay



FORM 6.4 SELF APPRAISAL - PHARMACISTS


PUHC District State

1. s and

Am I aware of the uses, doses,

side effects, interactions,

storage specification

correct dispensing procedure

of the drugs in my charge

2.ith

Is my pharmacy clean,

organized, well stocked w

drugs arranged and within

easy reach

3.

Am I dispensing accurately

and making sure that the

patient understands, especially

use of inhalers etc.

4.

Is my daily consumption

register, stock register being

maintained as prescribed

5.

Am I playing my role in

outreach services / ASHA

mechanism



FORM (PHN) 6.5 SELF APPRAISAL – PUBLIC HEALTH NURSE

Facilitation Help Required at Level S.N Skill / Competency Gap

PUHC District State

1.A

R

m I aware of my Roles /

esponsibilities

2.A

A

m I aware of the role of

NMs and ASHAS

3.

D

k

c s in

im

N

N Family

P

s

manag nutrition

e

m

o I have the necessary

nowledge / skills /

ompetencie

munization, Antenatal,

atal, Post natal, Essential

ewborn care,

lanning, Nutritional

urveillance and

ement of mal

tc. to play my role

eaningfully

4.

A

c

proto n case of breach of

c

f

o

f

c

im

m I aware about the cold

hain defrosting procedures /

cols i

old chain, contingency plan

or storage of vaccines in time

f electricity / equipment

ailure, stepwise protocol in

ase of adverse event for

munization

5.

A

s iomedical

w

m I fully conversant with the

afe disposal of b

aste

6.

D

/

s nd mentoring

t

m

o I have the necessary skills

competencies for

upervising a

he ANMs and ASHAS under

e

7.

H

t

c

a

ave I made a roster time /

opic wise to impart skills /

ompetencies mentioned

bove to my ANMs

8.

H

n

o

a

v

p nts in

ave I made a systematic

eed analysis for monthly

utreach activities (HNDays)

nd if so have I identified a

enue, made a schedule,

rojected the requireme



the facility level p

logistics and other resources

lanning for

9.Am I s

as per the checklist

supervising the HND

10.

H

A

w

a

t d

p

c

ave I ensured that all my

NMs are doing their field

ork, keeping their records

nd registers in the manner

hat shall lead to a hundre

ercentage coverage of their

atchment population

11.

A

t eporting formats

a

m

c

A

m I clear on the definitions /

erms in the r

nd have developed

echanisms for accurate and

omplete data capture by the

NMs

12.

D

t

d

make / suggest

im

s

o I have the necessary skills

o compile and analyse the

ata, draw inferences and

provements. Do I have IT

kills

13.

Are the ASHAS in my areas

trained in their key activities.

Are their referrals being given

due



FO )RM 6.6 SELF APPRAISAL – AUXILLARY NURSE MIDWIFE (ANM


PUHC District State

1.Do I know my roles and

responsibilities

2.

ls and

on their visit for

ucation about

menstrual hygiene / safe

nseling and facilitation in

adoption of family planning

Do I have the required

knowledge, skil

competencies

Immunization – the

schedule, technique, cold

chain, management of

adverse events, tracking of

defaulters / use of ASHAS to

ensure 100% coverage

Malnutrition – Weighing of

all children, screening them

for anaemia and Vitamin A

deficiency

immunization. Detecting

malnutrition and managing

it.

Complete and appropriate

antenatal, postnatal,

essential newborn care

Detection, counseling,

health ed

sexual practices

Cou

measures.

Suspect and refer TB,

leprosy patient. Help in

initiation and completion of

treatment.

Bring down the incidence /

morbidities associated with

vector borne diseases.

Safe disposal of biomedical

waste.

Prevention and control of

infection.

3. Have I marked my catchment



population and mapped it

4.y

Have I linked myself to m

catchment anganwadis

5.

f my areas

Do I know ASHAs o

and have I developed the

desired rapport with them

6.

Am I providing the necessary

help to my ASHAS facing

problems in the field

7.

isters / Are my surveys reg

eligible couple registers

updated. Have I managed to

devise a network of ASHAS

and Anganwadis in my area to

achieve the objective of 100%

coverage

8. Am I facilitating their timely

incentive disbursal

9.Am I conducting the HNDay as

per the defined structure

10.

ete accurate data as

t

Am I collecting and entering

compl

required. Am I along with the

PHN analyzing the data and

identifying the areas needing

thrus

11.Have I made an IEC / BCC

plan for my area



FORM 6.7 SELF APPRAISAL – LAB TECHNICIAN


PUHC District State

1. my roles and

responsibilities

Do I know

2.ill and competencies

to carry out the tests mandated at

Do I have the necessary

knowledge, sk

the PUHC

3.

Am I ensuring safe disposal of the

biomedical waste generated in

lab

my

4.

and care of my microscope, digi

diagnostic equipments l

hemoglobinometer, glucomete

semi auto analysers etc.

Am I fully conversant with the use

tal

ike

rs,

5.

Am I carrying out the periodical

standardization of my equipme

to ensu

nt

re accuracy

6.

Is my lab refusing any tests

because of lack of logistics /

equipments / skills

7.

Am I taking the necessary

precautions for prevention and

control of infection



FORM 6.8 SELF APPRAISAL – RADIOGRAPHER


PUHC District State

1.Do I know my roles a

responsibilities

nd

2.

Do I have the necessary knowled

skill and competencies to carry

the tests mandated a

ge,

ut

t the PUHC

o

3.

the

Am I ensuring safe disposal of

biomedical waste generated in my

department

4.

e

c

and

Am I fully conversant with the

and care of digital diagnosti

equipments like X-ray

Ultrasound

us

5.

al

my equipment to

Am I carrying out the period

standardization of

ic

ensure accuracy

6.

g any tests

Is my department refusin

because of lack of logistics /

equipments / skills

7.

s ry

ure

fety

like Lead shielded gowns,

Am I taking the neces

precautions for Radiation expos

hazards by using radiation sa

devices

a

badges and gonad shield



FORM 6.9 SELF APPRAISAL – DRESSER


PUHC District State

1.Do I know my role and

responsibilities

2.

Am I confident in giving

.

basic first aid / dressing of

minor wounds, assisting

my MO in minor

procedures

3.ention and control of

Am I following the

protocols laid down for

prev

infections

4.

Am I fully conversant with

the use of Autoclave for

sterilizing the instruments

5.

Am I disposing the

per

Biomedical waste

generated in the dressing

room safely as

guidelines

6.delines

Am I fully conversant with

the dispensing gui

for the ointments / lotions

/ eye / ear drops

7.

can to

allay the anxiety and pain

of the patient / attendant

accompanying the injured

Am I doing all I



FORM 6. FFICER 10 SELF APPRAISAL – SOCIAL MOBILIZATION O

Skill / Competency Gap Facilitation Help Required at Level S.No.

PUHC District State

1.Do I know my roles and

responsibilities

2.

ional

Am I aware of the different health

initiatives / components of nat

health programs which need to be

implemented outside the PUHC in

the community

3. health workers like

Am I fully familiar with the healthcare

– community partnerships, linkages

and their scope of activities –

Community

ASHAS, Rogi Kalyan Samitis, health

and sanitation committees

4.

Do I have the required skills and

n of members for

competencies to initiate local health

initiatives, build up self help groups,

help in identificatio

RKS, HSCs, potential ASHAS. And

help in their capacity building

5.the help of

ANMs / ASHA

Have I mapped the population,

landmarks, anganwadi workers,

NGOs, in my area with

6.

Am I assisting in RKS meetings and

maintaining the RKS records as per

the guidelines.

7.

Am I providing the necessary

liasoning with the water / sanitation /

Schools / local NGOs

8.

Am I facilitating the PUHC in effective

implementation of BCC strategies in

the field



FORM 6.11 SELF APPR TOR CUM ASSISTANT AISAL – COMPUTER DATA ENTRY OPERA


PUHC District State

1.Am I fully conversant with

OPD Registratio

the

n system

2.

with

and

Have I familiarized myself

the medical terms

functioning of a PUHC

3.

l

te reports for

Am I generating meaningfu

and accura

analysis and evaluation

4.

ed

will maintained. Am I

rvice

Is my ASHA database upda

ASHA package of services and

incentives

t

able to predict trends in se

provision

5.

lining

in

Is my work helping stream

Management of information

the PUHC.



FORM 6.12 SELF APPRAISAL – NURSING ORDERLY


PUHC District State

1.Do I know my role and responsibilities

2.

Can I say with confidence that my PUHC is a clean, place

with clean walls, furniture and equipment

3.hion

Am I able to regulate and manage the patient inflow in an optimum fas

4.

Am I able to provide them with

sufficient, clean seating area with enough light hand ventilation while waiting

5. Am I facilitating the elderly in obtaining necessary healthcare

6.Am I familiar with the Dispatch and receipt procedures

7.

Am I fully conversant with the guidelines on safe disposal of biomedical waste and prevention and control of infections



FORM 6.13 SELF APPRAISAL – ROGI KALYAN SAMITI


PUHC District State

1.Am I aware of the objectives

of the Rogi Kalyan Samiti

2. Am I aware of my role in it

3.ns /

Am I aware of the

proceedings / delegatio

responsibilities / record

keeping involved

4.

ent

Am I using this empowerm

judiciously for improving the

healthcare delivery at my

PUHC



FORM 6.14 SELF APPRAISAL – ASHAs


PUHC District State

1. ements for

Do I know about the health

and social entitl

the poor

2. for which I

Do I know the basic health

components

am to mobilize and assist

the community

3.

Have I been able to strike

a rapport with the

community

4.

ed

Do I have the requir

Interpersonal

communication skills

5.Do I know how to fill my

diary

6. Is my household survey

complete and accurate

7. local health

planning

Has it helped me and my

ANM in

8.Have I formed a HSC in

my area

9.

Do I think I have made a

difference in my people’s /

areas life



LIST OF LICENS LTHCAREES AND ACTS: APPLICABLE TO PUBLIC HEAFACILITIES

1. Building Permit (From the Municipality).

2. N e hief Fire Officer.

3. Li Management and handling Rules, 1998.

4. N er P llution Control Act.

5. R respect of all X-ray and CT Scanners from BARC.

6. Ex

7. N ances license and Act.

8. Vehicle registration certificates.

9. Ai ollution) Act, 1981.

10 Atomic energy regulatory body approvals.

11. Biomedical waste management handling rules 1998.

12. Consumer protection Act, 1986.

13. Dentist regulations, 1976.

14. Drugs and cosmetics Act, 1940.

15. Employees provident fund Act, 1952.

16. Equal remuneration Act, 1976.

17. Fatal accidents Act, 1955.

18. Indian lunacy Act, 1912.

19. Indian medical council Act and code of medical ethics, 1956.

20. Indian nursing council Act, 1947.

21. Indian penal code, 1860.

22. Indian trade unions Act, 1926.

23. Maternity benefit Act, 1961.

24. MTP Act, 1971.

25. Minimum wages Act, 1948.

26. National building code.

27. Negotiable instruments Act, 1881.

28. Payment of wages Act, 1936.

29. Persons with disability Act, 1995.

30. Pharmacy Act, 1948.

31. PNDT Act, 1996.

32. Protection of human rights Act, 1993.

33. BARC, Act.

34. Registration of births and deaths Act, 1969.

35. Tax deducted at source Act.

36. License for the blood bank.

37. Constitution of India.

38. Transplantation of human organs Act, 1994.

o objection certificate from th

cense under Bio-medical

C

o objection certificate und o

adiation Protection Certificate in

cise permit to store Spirit.

arcotics and Psychotropic subst

r (prevention and control of p

.



OPTIMAL FACILITY MANAGEMENT & EFFICIENT PROCESSES

I. Facility Management & Processes

a. Building and Compound

Access clean, old age, disabled friendly.

Well maintained building. Clean green compound, with

no seepage, no water logging.

No broken windows, doors

b. Waiting area

Comfortable sufficient with seating arrangement and

fan.

Potable Drinking water facility available.

Clean separate toilets for male & female available.

Signages appropriately displayed.

IEC Material displayed.

c. Working areas

Space

All rooms clean, well mopped, dust free with clean linen

Privacy of patient maintained

Continuous availability of water

Continuous availability of electricity

Safe and secure work environment

well lit, ventilated.

d. Medicines & Logistics Uninterrupted supply

Rational use

e. Equipment

Availability of functional equipment

AMC mechanisms in place

Reagents, consumables available

f.

Infection prevention and

control (including

Biomedical waste disposal)

All concerned have the necessary knowledge & training

Availability of logistics ensured

g. Records, Registers, Reports

Availability of registers

Records / Registers to be complete and accurate

Reports generated and forwarded in time

Analysed and evaluated locally

h. Availability of Staff Trained staff as per the norms is available

i.Management of Health

information

Accurate information collection, compilation, report

generation by the centre and timely onward

transmission.

Analysis, evaluation and use of data



Recording and reporting of Vital statistics including

births and deaths, particularly of mothers and infants.

Maintenance of all the relevant records concerning

services provided in PUHC

j Capacity Building

For Staff:

Clinical care skills

Managerial skills

Attitude / Behaviour skills

For Community Representatives:

ASHAs

Rogi Kalyan Samitis

Health & Sanitation Committees

Mahila Arogya Samitis

For Community:

Community based initiatives

Home based care

Preventive and promotive aspects of health

k

Information Education

Communication (IEC) and

Behaviour Change

Communication (BCC)

Judicious use of IEC material prepared by the State /

district

Posters / flex boards placed in the waiting areas /

different rooms

Pamphlets, leaflets distributed / placed in accessible

locations (on registration counter)

IPC at all levels of staff – patient interaction

l Patient Satisfaction Functional Grievance redressal mechanism in place



SERVICE GUARANTEE

1. Clinical Care Component ( Direct Healthcare)

a. Medical services r the Six hours OPD services. Time schedule as pe

department

b. Emergency services

patient before referral,

nd referral of injuries,

accidents, animal bites and other emergencies during OPD

First Aid, Stabilization of condition of

Appropriate PUHC level management a

hours.

c. Curative OPD serviceon acute and chronic infective and non

ent Protocols. s

infective illnesses as per the Standard Treatm

Treatment of comm

d.Non Communicable

Diseases

up /

s) especially

ry vascular disease, Asthma,

Screening / PUHC level Management / Referral / Follow

counseling for Life Style disorders (NCD

hypertension, diabetes, Corona

COPD etc.

e. Eye orders Treatment of common eye dis

f. Nutritional disorders Detection, Management, Counseling

g.disorders artner / follow up and Gynecological

Treatment of Menstrual problems

Diagnosis / treatment of patient and p

counseling for RTI / STI

h. Cancer referral of Screening for malignancies / appropriate

suspected cases

i. Geriatric problems Sensitive Management / Counseling for Geriatric problems

2. Preventive and Promotive

a. Maternal Health

i. ANC Care of Iron and F

Early registration of pregnancies, ideally in first trimester

(Before 12 weeks of pregnancy)

ancy is suspected,

second between 4th and 6

th month (around 26 weeks), 3

rd

2 weeks) and 4th visit at 9

th

ision

e

Attendance

e, Albumin /

h risk, appropriate management and

Antenatal checkups and provision of complete package of

services. First visit as soon as pregn

visit at eighth month (around 3

month (around 36 weeks). Associated services like prov

olic Acid tablets, Injection TT (as per th

Guidelines for Antenatal Care and Skilled Birth

at Birth by ANMs and LHVs)

Minimal Laboratory investigations like Hb%, Urin

Sugar and M/E

Nutrition and health, danger sign counseling

Identification of hig

referral to the attached referral centres



Management of Pregnancy Induced Hypertension (PIH)

including referral

ii. Intranatal Care e same.

Promotion of Institutional delivery by formulating of Birth plan

and facilitation in implementing th

iii. Postnatal Care

A minimum of two postpartum checkups, first within 48 hrs

livery and detection and

within half an hour of birth

ntraception and essential

n GOI on Essential New

and second within 7 days of de

management (referral for) of any complications

Initiation of early breast feeding

Education on nutrition, hygiene, co

ewborn care. (As per Guidelines of

Born Care)

b. New Born & Child Care:

i. New Born Care

centre, availability

tion & management

lycemia

In case of a new born being brought to the

of facilities / skills for neonatal resuscita

of neonatal hypothermia / hypog

Care of the Child

E sick children

Feeding for six months

accine

phylaxis to the children as per the guidelines

tions.

mergency care of

Care of routine childhood illnesses

Promotion of exclusive Breast

Full immunization of all infants and children against V

preventable diseases as per guidelines of GOI

Vitamin A pro

P

maln

revention and control of childhood diseases like

utrition and infec

c. Adolescent Health

riate Lifestyle education, Nutritional counseling, approp

treatment

d. Family Planning

Education, Motivation and counseling to adopt to appropriate

Family Planning methods

Provisions of contraceptives such as condoms, oral pills,

emergency contraceptives, IUCD insertions

Referral for Tubal ligation, Vasectomy / NSV

Follow up services to the Eligible couples adopting

permanent methods

Counseling and appropriate referral for safe abortion

services (MTP) for those in need

e. Management of RTI and STI diseases

Health education for prevention of RTI & STI

Treatment of RTI / STIs



f. Infertility

Counseling and appropriate referral for infertility

g. Services under other National Health Programmes

i. RNTCP

Sputum examination for Tuberculosis

DOTS regime for Tuberculosis

Follow up / Counseling

ii. NLEP Diagnosis / Management / Counseling and prevention of

disabilities for Leprosy

iii. NBCP

Screening for Refraction disorders and referral for Refraction

study

Detection of Cataract cases and referral for Cataract surgery

iv. NVDCP c treatment and referral for Dengue, Chikungunia

Diagnosis of Malaria cases, Microscopic confirmation and

treatment

Symptomati

if so required

Elimination of vector breeding sites

v. NIDDCP

anagement / referral.

of salt samples collected from

create awareness of lodine deficiency

Goitre detection and appropriate m

Urine iodine estimation in children aged 6-12 yrs.

Salt iodine estimation

household.

IEC activities to

disorders.

vi. IDSP Alertness to detect unusual health events / increase in usual

health events and take appropriate remedial measures

vii. NACP

IEC activities to enhance awareness and preventive

gh risk behaviour at the

for

measures about STIs and HIV / AIDS.

Screening of persons practicing hi

nearest ICTC.

Risk screening of antenatal mothers with one rapid test

HIV.

Condom promotion and distribution of condoms to the high

risk groups.

Help and guide patients with HIV / AIDS in receiving ART.

3. Provision of AYUSH services as per local preference

4. Inter-sectoral Convergence

a. Convergence with Water and Sanitation

oilets and

Promotion of Safe Water supply and basic sanitation

Promotion of sanitation including use of t



appropriate garbage disposal

b. Convergence with Integ ment Scheme rated Child Develop

tional

Identification of malnourished children and appropriate

supplementation / referral if required / nutri

rehabilitation

c. Convergence with School Health

Investigations and management of children referred from

schools

5. Referral Services

Appropriate and prompt referral of cases needing specialist

care with duly filled referral slips / stabilization if required /

transport if required

6. Basic Laboratory Services

Hb%, TLC

Blood sugar

Urine Albumin, Sugar and Microscopy

Urine Pregnancy test

Stool Microscopy

Sputum testing for Tuberculosis (if designated as Microscopy

SP

centre under RNTCP)

Blood smear examination for malarial parasite

Test specified as a part of ID

7. R oladi ogy Services

X RAY

Plain and Computed Radiography

Contrast studies like Barium swallow, Barium meal, follow

r GIT; Fistulograms: Sinograms

al exams,

perficial structures including Breast,

letal examinations such as Hips, Shallers and

through and Barium enema; IVU; RGU / MCU; HSG ; water

soluble contrast studies fo

ULTRASONOGRAPHY

General Abdominal and Pelvic studies.

Obstetrical and Gynecological including endovagin

TIFFA

Soft tissue and su

Thyroid, Scrotal and Transrectal Prostate examinations.

Pediatric and Neonatal studies.

Musculoske

Knees.



DOPPLER STUDIES (if available)

r.

y and Liver Transplant patients.

Peripheral, Cerebro-vascular and abdominal Dopple

Assessment of post Kidne

Penile Doppler examination

8. H lth yea & Nutrition Da

tion Day on a regular

sanitation, timely care etc.

l Health Programmes

role in making the

bility

The organization of the Health and Nutri

basis as per the guidelines will result in the achievement of the

following Outcomes:

100% coverage with preventive, promotive interventions,

especially for pregnant women, children and adolescents

Preventive and promotive coverage for the National Disease

Control Programmes

Increased awareness about the determinants of health such

as nutrition,

Improved knowledge about the services offered under the

various Nationa

Greater emphasis on the community’s

health system responsive to the health needs of the

community and in demanding and ensuring accounta



INCREASED UTILIZATION OF SERVICE ALTH S LEADING TO POSITIVE HEOU OTC MES

I is ifficu and not very pr tum but the

utilization trends have to be monito ncrease in the utilization trend of

2 to 0% e period a year ago is expected. This increase

shall vary from service to service depending u the

local need for the service, the nat ice

earlier and the empowerment provid arameters which can be taken up

for evaluating increase in utilization trends:

1. Increase in m

2. Increase in num ing the services.

unization coverage / increased completion of Primary

immunization within first Increase in Hepatitis B birth dose.

4. Increased ANC beneficiaries / Increased first trimester registrations / Increased

referrals for high risk pre

5. Increased number of pregnancies concluding in Institutional deliveries.

6. Increased number of wo tnatal visits – 1 and 2 by ANM.

7. Increase in nu

8. Increase in num

9. Increase in pr ment.

10. Number of Hypertensives / Diabetics being successfully followed up in the centre

11. Increase in number of patients converted from anemic to non anemic state.

12. Increase in nu or without anemia and

liasoned with

13. Number of children (out

free state.

14. Number of patients provided nebulization in the centre.

15. Number of Cataract ca n.

As far as the morbidities a decreasing trend indicates success of the

interventions, especially the pr

1. Decrease in anem

2. Decrease in Lo birth weight babies.

3. Decrease in cases of m

4. Decrease in the cases of acute diarrhea.

t d lt actical to set rigid target in terms of numbers / quan

red and evaluated. An i

0 5 over and above that in the sam

pon the level of previous performance,

ure of bottlenecks hampering the provision of serv

ed now. Some of the p

onthly / average daily OPD attendance.

ber of senior citizens access

3. Increase in Imm

year of life /

gnancy.

men receiving pos

mber of IUCD acceptors.

ber of OC users.

oportion of TB patients on DOTs completing their treat

(as per the protocols).

mber of children identified malnutrition with

local anganwadi and being followed up.

of those identified) brought to normal weight and anemia

se referred and operated with restoration of visio

are concerned

eventive and BCC efforts. Some of the parameters can be:

ia in pregnancy

easles.



5. Decrease in case of S

6. Decrease in nu

The chronic disease trends and difficult to monitor and not in the scope but

the optimum managemen nsured.

cabies / Pyodermas.

mber of vector borne fevers.

of PUHC alone

t / follow up as per protocols can be e

CLIENT SATISFACTION

Client satisfaction shall n re. It

shall cover the access, the our /

attotide pf the care prov r,

clean toilets, the quality

availability of tests and medications hall also

To facilitate objective asse udits shall be made

a port of the PUHC asses re a

part of the Quality Assuran

ow form an integral part of any performance evaluation of cent

time spent by the patient in getting the service, the behavi

iders, the basic requirements like seating space, drinking wate

of care provided, the counseling and follow up advise. The

be assessed.

ssment – Client exit interviews / prescription a

sment protocol. The required formats have been framed and a

ce Manual.

COMMUNITY INVOLVEMENT AND EMPOWERMENT

S. No.

1Forming the link between the centre and each

household

One trained ASHA for every 2000

population.

2Empowering the community by participation in

planning for and monitoring of the PUHC. Formation of Rogi Kalyan Samiti.

3Empowering the community for local health

and related activities.

Formation of Health and

Sanitation Committees for every

2000 population.

4 Individual Empowerment. Display of Citizen's Charter and

Grievance redressal mechanism.

Once upgraded as per the Standards, the PUHC is expected to deliver the above mentioned service

with universal coverage, and equity, in an age / gender / culture sensitive manner responsive to the

community needs. The focus in addition to the complete coverage shall be on the quality of the

services provided.



PATIENT EXIT INTERVIEW ( Prior Consent to be taken)

PATIENT EXIT INTERVIEW ( Prior Consent to be taken)

Name of the District:

Name of the Primary Urban Health Centre:

Parent Agency - GNCTD / MCD / NDMC /

Others:

Name of the Medical Officer In-charge:

Date of Exit Interview:

Time Taken for Interview:

Starting Time:

ng Time: Finishi

Conducted by:

ame & Designation: N

Signature:

1. Name of the Patient

2. Age of the Patient

3. Sex of the Patient

4. Do you have a BPL / equivalent card

5. Do you belong to SC /ST

6.How long did it take you to travel to this

PUHC

7. What mode of transport did you take

8. Did you spend any money in reaching here

9. How did you come to know of this facility From posters / leaflets

From Neighbours

From ANM

From ASHA

At a Health Camp

From a Private Practitioner

From a Religious leaders

Any other way

10.What is the ailment for which you have

come

Do not know

Already Diagnosed and on treatment

No ailment. Come for advice on Family Planning. Antenatal care, Immunization, Nutritional disorder

ther: Specify Any O



11.How long did you wait to get your Card

made (in minutes

12. Was the staff at registration counter polite Indifferent

Rude

Polite

13.reached the doctor

How long did you have to wait before you

14.Was there clean and comfortable place to

sit while waiting?

15. Did the Doctor greet you warmly

Warmly

Indifferent

Rude

16.Did the Doctor listen patiently to your

complaint Was in a hurry

Did not listen

Yes

17.ask questions

A little

No

Did the Doctor give you an opportunity to Yes

18.e Doctor discuss your illness and

t tme

Yes

No

Did th

rea nt with you A little

19.Was

examinld hav

No

there sufficient privacy for

ation

Yes

Cou e been better

20. D he No

id tell about the next visit Yes

21.How long did you wait to get your

r istraeg tion number

22.How long did you wait in the Pharmacy que

before you got your medicines

23. How was the behaviour of the Pharmacists

Warm and Helpful

Indifferent

Rude

24. Did you get the medicines

All

Some

None

25. Did the pharmacist explain about the dosesYes

No



26.warm and helpful

Indifferent

Rude

If the service provider was ANM, was she Yes

27. Immunization /

How lon

IUCD Insertion / ANC

checkup

g did you wait for the service –

28. Furniture

Were you satisfied with the cleanliness of

Floor

ation table

es

oSheets on examin

Toilets

Y

N

29. Was drinking water available es / No Y

30.Health Ce

Total time spent in the Primary Urban

nter

31. Time spent with the Medical Officer

32.

sfied with the overall

ff

acility

2 1 0

es Partially No

es Partially No

es Partially No

Were you sati

Behaviour of the sta

Cleanliness of the f

Availability of medicines / tests

Y

Y

Y

33.

se the Primary

:

You would continue to u

Urban Health Center for treatment

because

34.If not then what are the reasons for your

not wanting to return

ong waiting time

irty environment

ehaviour

t staff / ineffective treatment

ity of medicines / tests

L

D

Rude / Indifferent b

Incompeten

Non availabil

Too far



QUA EVALUATION)LITY ASSURANCE (MONITORING &

Effective monitoring followed by evaluation an ssary online corrections is mandatory

for ensuring optimal functioning of the PUHC and delivery of quality healthcare. To facilitate

a systematic upgradation of the PUHCs to the standards defined above and ensure

s ssurance Manual has been devised which

shall form an inseparable addendum to this volume. It outlines the need, management

f the necessary formats* for objectively

assessing the facility and undertaking measures to ensure quality in processes, inputs and

d

*These formats are suggestive and can be altered and improved upon by the users.

Once upgraded as per the Standards, the PUHC is expected to deliver the above mentioned

service iversal coverage, and equity, in nder / culture sensitive manner

responsive to the community needs. The focus in addition to the complete coverage shall be

o e

d nece

ubsequent adherence to the same, a Quality A

ramework for Quality Assurance, and provides

esirable outputs / outcomes.

with un an age / ge

n th quality of the services provided.



PUHC QUALITY ASSURANCE SUMMARY REPORT

PRIMARY URBAN HEALTH CENTRE QUA ASSURANCE SUMMARY REPORT LITY

Action RequiredS.No. Action Category Gaps

PUHC District StateTimeline Review On

1. Facility Management

a. Land & Building

b. M anpower

c. E ts quipmen

d. Drugs & Logistics

e.Teleph

Water, Electricity,

one

f. Cleanlines s / Sanitation

2. Managing Information

a. Managing Information

3.Serv

U

ice Provision and

tilization Trends

b. C cols /

Procedures

Service Provision –

linical Proto

c. Utilization trends

4. Training Requirements

d.

5. Governance

6. Behaviour Change Communication

7. Grievance Redressal Mechanism

Date post:	11-Jan-2022
Category:	Documents
Upload:	others
View:	2 times
Download:	0 times

ACCREDITATION STANDARDS FOR PRIMARY URBAN HEALTH …

Documents