RURAL HEALTH SERVICES

Sub Centre.
PHC
CHC
Other rural services.(VILLAGE)
VHG
TBA
Anganwadi workers
ASHA

HEALTH ADMINISTRATION AT RURAL

LEVEL 3-TIER STRUCTURE
Primary care
Secondary Care
Tertiary
care

VILLAGE HEALTH GUIDE

SCHEME
1) Launched on 2nd October 1977.

2)Centrally sponsored under family

and welfare.

Village health guide

Preferably at least VIII Std passed
local women able to read and write
Undergoes 200 hours training over 3
months

Works for 2-3 hours per day

Paid Rs. 50/- and drugs kit Rs. 600/per year.

FUNCTIONS

Link between village, community, and

Government health care system.
Health education.
Communicable Diseases.
MCH, FW.
First aid.

Trained Birth attendant (Local

trained Dais)
Training for 30 working days
with certificate.
ii) Provided with delivery kit.
iii) Rs.10/- per delivery & Rs.3/per registered child.
i)

Anganwadi worker
i) Local woman with VIth Std.

education
ii) Provides non formal education to
children

Anganwadi worker
ICDS One anganwadi worker
appointed per 1000 population.
Part time employee.
4 months training.
Honorarium 1500 per month.
Mobile anganwadi programme.

ASHA
Under NRHM
1 for 1000 population.
Married, widow, divorced, 25-45 years.

RURAL HEALTH SERVICES

Primary health centre system.
3 tier system.

NAME OF
HEALTH
CENTRE

PLAINS

HILLY/TRI
BAL

Sub centre

5000

3000

PHC

30000

20000

CHC

1,20,000

80,000

RURAL HEALTH SYSTEM

148124 Sub Centres,
23887 Primary Health Centres (PHCs)
4809 Community Health Centres (CHCs)
As On March, 2011

SUB CENTRE

Most peripheral and

first contact point between
the primary health care
system and the community.
Rural health scheme-1977
Placing peoples health in
peoples hand.

One auxiliary nurse midwife (ANM) /

Female Health Worker.
One male health worker.
Under NRHM, there is a provision for
one additional second ANM on contract
basis.
One lady health visitor (LHV) is
entrusted with the task of supervision of
six sub-centres.

SUB CENTRES
Maternal and child health
Family welfare
Nutrition
Immunization
Diarrhoea control
Control of communicable diseases
programmes.

OBJECTIVES OF THE INDIAN PUBLIC

HEALTH STANDARDS FOR SUBCENTRE.

To specify the minimum assured (essential)

services that Sub-centre is expected to provide

and the desirable services which the states/UTs
should aspire to provide through this facility.
To maintain an acceptable quality of care for
these services.

CONT
To facilitate monitoring and
supervision of these facilities
To make the services provided more
accountable and responsive to peoples
needs.

SERVICES TO BE PROVIDED IN A
SUB-CENTRE

Type A: Shall provide all

services as envisaged for the
Sub-centre except the facilities
for conducting delivery will not
be available here.

CONT
Type B:
recommended services including facilities
for conducting deliveries at the Sub-centre
itself.
This Sub-centre will act as Maternal and
Child Health (MCH) centre with basic
facilities for conducting deliveries and
Newborn Care at the Sub-centre.

MCH
MATERMAL HEALTH
Antenatal care:
Early registration of all pregnancies,
within first trimester (before 12th week of
Pregnancy).
However even if a woman comes late in
her pregnancy for registration, she should
be registered and care given to her
according to gestational age.

CONT..
Minimum 4 ANC including Registration
1st visit: Within 12 weekspreferably
as soon as pregnancy is suspected for
registration, history and first antenatal
check-up
2nd visit: between 14 and 26 weeks
3rd visit: between 28 and 34 weeks
4th visit: between 36 weeks and term.

 Associated services like general

examination such as height, weight,
B.P, anaemia, abdominal examination,
breast examination, Folic Acid
Supplementation (in first trimester),
Iron & Folic Acid Supplementation
from 12 weeks, injection tetanus
toxoid, treatment of anaemia etc.

Recording tobacco use by all

antenatal mothers.
Minimum laboratory investigations

CONT

Name based tracking of all pregnant women

for assured service delivery.
Identification of high risk pregnancy cases.
Identification and management of danger
signs during pregnancy.
Malaria prophylaxis in malaria endemic
zones for pregnant women as per the
guidelines of NVBDCP.

Provide information about provisions

under current schemes and programmes
like Janani Suraksha Yojana.
Identify suspected RTI/STI case, provide
counselling, basic management and
referral services.
Counselling & referral for HIV/AIDS.
Name based tracking of missed and left
out ANC cases

Counselling on diet, rest, tobacco

cessation.
Pre-birth preparedness

INTRA-NATAL CARE:
Essential
Promotion of institutional deliveries.

Skilled attendance at home deliveries

when called for.
Appropriate and timely referral of
high risk cases which are beyond her
capacity of management.

ESSENTIAL FOR TYPE B SUBCENTRE

Managing labour using Partograph.

Identification and management of

danger signs during labor.
Proficient in identification and basic
fist aid treatment for PPH, Eclampsia,
Sepsis and prompt referral of such cases
as perAntenatal Care and Skilled birth
Attendance at birthor SBA Guidelines.

CONT
Minimum 24 hours of stay of
mother and baby after delivery
at Sub-centre. the environment
at the Sub-centre should be
clean and safe for both mother
and baby.

POSTNATAL CARE:
Initiation of early breast-feeding within
one hour of birth.
Ensure post-natal home visits on 0,3,7
and 42nd day for deliveries at home and
Sub-centre (both for mother & baby).
Ensure 3, 7 and 42nd day visit for
institutional delivery (both for mother
& baby) cases.

POSTNATAL CARE
In case of Low birth weight baby (less
than 2500 gm), additional visits are to
be made on 14, 21 and 28th days.

CONT
During post-natal visit, advice regarding
care of the mother and care and feeding
of the newborn and examination of the
newborn for signs of sickness and
congenital abnormalities as per IMNCI
Guidelines and appropriate referral, if
needed.

CONT
Counselling on diet & rest,
hygiene,contraception, essential newborn
care, immunization, infant and young
child feeding, STI/RTI and HIV/AIDS.
Name based tracking of missed and left
out PNC cases.

CHILD HEALTH
Newborn Care Corner In The Labour
Room to provide Essential Newborn
Care.
Counselling on exclusive breast-feeding
for 6 months.
Appropriate and adequate
complementary feeding from 6 months
of age while continuing breastfeeding.

CHILD HEALTH
Assess the growth and development of
the infants and under 5 children and
make timely referral.
Immunization Services:
Full Immunization of all infants and
children against vaccine preventable
diseases as per guidelines of Government
of India

Cont.
Vitamin A prophylaxis to the children
as per National guidelines.
Prevention and control of childhood
diseases like malnutrition, infections,
ARI, Diarrhea, Fever, Anemia etc.
including IMNCI strategy.

Cont
Name based tracking of all infants and
children to ensure full immunization
coverage.
Identification and follow up, referral
and reporting of Adverse Events
Following Immunization (AEFI).

FAMILY PLANNING AND

CONTRACEPTION
Education, Motivation and counselling
to adopt appropriate Family planning
methods.

Cont
Provision of contraceptives such a condoms,
oral pills, emergency contraceptives, Intra
uterine Contraceptive Devices (IuCD)
insertions (wherever the ANM is trained in
IuCD insertion).
Follow up services to the eligible couples
adopting any family planning methods
(terminal/spacing).

SAFE ABORTION SERVICES

(MTP)
Counselling and appropriate referral for
safe abortion services (MTP) for those in
need.
Follow up for any complication after
abortion/MTP and appropriate referral
if needed.

CURATIVE SERVICES
Essential
Provide treatment for minor ailments
including fever, diarrhea, ARI, worm
infestation and First Aid including first aid
to animal bite cases (wound care,
tourniquet (in snake bite) assessment and
referral).
Appropriate and prompt referral.

CURATIVE SERVICES
Provide treatment as per AYUSH as per
the local need. ANMs and MPW (M) be
trained in basic AYUSH drugs.
Once a month clinic by the PHC medical
officer.
LHV, HWM and ANM should be
available for providing assistance.

Adolescent Health Care

Education, counselling and referral.
Prevention and treatment of
Anemia.
Counselling on harmful effects of
tobacco and its cessation.

School Health Services

Screening, treatment of minor ailments,
immunization, de-worming, prevention
and management of Vitamin A and
nutritional deficiency anemia and referral
services through fixed day visit of school
by existing ANM/MPW.

CONT
Staff of Sub-centre shall provide
assistance to school health services as a
member of team.

Control of Local Endemic

Diseases
Assisting in detection, Control and
reporting of local endemic diseases such
as malaria, kala Azar, Japanese
encephalitis, Filariasis, Dengue etc.
Assistance in control of epidemic
outbreaks as per programme guidelines.

Water and Sanitation

Disinfection of drinking water sources.
Promotion of sanitation including use
of toilets and appropriate garbage
disposal.

National Health Programmes

Communicable Disease Prgramme
National AIDS Control Programme
(NACP):
Essential
Condom promotion & distribution of
condoms to the high risk groups.

CONT
Help and guide patients with HIV/AIDS
receiving ART with focus on adherence.
IEC activities to enhance awareness and
preventive measures about STIs and
HIV/AIDS, PPtCt services and HIV-TB
coordination.

CONT.
Linkage with Microscopy Centre for
HIV-TBcoordination.
HIV/STI Counseling, Screening and
referral in type b Sub-centres
(Screening in Districts where the
prevalence of HIV/AIDS is high).

National Vector Borne Disease

Control
Programme (NVBDCP):
Collection of blood slides of fever
patients
Rapid Diagnostic tests (RDt) for
diagnosis of Pf malaria in high Pf
endemic areas.
Appropriate anti-malarial treatment.

CONT

Assistance for integrated vector control

activities in relation to Malaria, Filaria,
JE, Dengue, kala-Azar etc. as prevalent
in specific areas. Prevention of breeding
places of vectors Indian Public Health
Standards (IPHS) Guidelines for Subcentres through IEC and community
mobilization.

Cont.
Annual mass drug administration with
single dose of Diethyl carbamazine (DEC)
to all elligible population at risk of
lymphatic filariasis.
Promotion of use of insecticidal treated
nets, wherever supplied.
Record keeping and reporting.

National Leprosy Eradication

Programme (NLEP):
Health education to community
regarding signs and symptoms of leprosy,
its complications, curability and
availability of free of cost treatment.

Cont
Referral of suspected cases of leprosy
(person with skin patch, nodule,
thickened skin, impaired sensation in
hands and feet with muscle weakness)
and its complications to PHC

CONT
Provision of subsequent doses of MDT
and follow up of persons under treatment
for leprosy, maintain records and monitor
for regularity and completion of
treatment.

Revised National Tuberculosis

Control Programme
(RNTCP):
Referral of suspected symptomatic
cases to the PHC/Microscopy centre.
Provision of DOTS at Sub-centre,
proper documentation and follow-up.

CONT
Sputum collection centers established
in sub-centre for collection and
transport of sputum samples in rural,
tribal, hilly &difficult areas of the
country where Designated Microscopy
Centres are not available as per the
RNTCP guidelines.

Non-communicable Disease
(NCD) Programmes
National Programme for Control of
Blindness (NPCB):
Detection of cases of impaired vision in
house to house surveys and their
appropriate referral. the cases with
decreased vision will be noted in the
blindness register.

CONT
Spreading awareness regarding eye
problems, early detection of decreased
vision, available treatment and health
care facilities for referral of such cases.
IEC is the major activity to help
identify cases of blindness and refer
suspected cataract cases.

CONT
The cataract cases brought to the
District
Hospital by MPW/ANM/and ASHAS.
Assisting for screening of school
children for diminished vision and
referral.

National Programme for Prevention

and Control
of Deafness (NPPCD):
Detection of cases of hearing
impairment and deafness during House
to house survey and their appropriate
referral.
Awareness regarding ear problems,
early detection of deafness, available
treatment and health care facilities for
referral of such cases.

National Mental Health

Programme:
Identification and referral of common
mental illnesses for treatment and
follow them up in community.
IEC activities for prevention and early
detection of mental disorders and
greater participation/role of
Community for primary prevention of
mental disorders.

NATIONAL PROGRAMME FOR

PREVENTION AND CONTROL OF
CANCER, DIABETES,
CARDIOVASCULAR DISEASES AND
STROKE
IEC Activities to promote healthy lifestyle
sensitize the community about prevention
of Cancers, Diabetes, CVD and Strokes,
early detection through awareness
regarding warning signs and appropriate
and prompt referral of suspect cases.

CONT
National Iodine Deficiency
Disorders Control Programme:
IEC Activities to promote
consumption of salt.
Iodized salt by the community.
testing of salt for presence of Iodine
through Salt testing kits by ASHAs.

National Tobacco Control

Programme:
Spread awareness and health education
regarding ill effects of tobacco use
especially in pregnant females and NonCommunicable diseases where tobacco is a
risk factor.

National Programme for Health

Care of Elderly
Counseling of Elderly persons and
their family members on healthy
ageing.
Referral of sick old persons to PHC.

Promotion of Medicinal Herbs

Locally available medicinal
herbs/plants should be grown around
the Sub-centre as per the guidelines of
Department of AYUSH.

RECORD OF VITAL EVENTS

Essential
Recording and reporting of vital events
including births and deaths,
particularly of mothers and infants to
the health authorities.

Type of Subsubcent centre

re

Subcentre

B (MCH
Subcentre)

Staff

Essential

Desirable

Essential

Desirable

ANM/Healt
h Worker
(Female)

+1

Health
Worker
(Male)
Staff Nurse
(or ANM, if
Staff
Nurse is
not
available)

1**

Safai1 (Part1 (Fullkaramchari time)

*to be outsourced. time)
*
** if number of deliveries at the Sub-centre is 20 or more in a month

PHC
Origin of Primary Health Centre The
concept of primary health centre is not
new to India.
The Bhore Committee in 1946 gave the
concept of primary health centre as a
basic health unit, to provide as close to
the people as possible, an integrated
curative and preventive health care to
the rural population.

PHC
The PHCs are established and
maintained by the State Governments
under the Minimum Needs Programme
(MNP)/ Basic Minimum Services
(BMS) Programme

PHC
As per minimum requirement, a PHC is
to be manned by a Medical Officer
supported by 14 paramedical and other
staff. Under NRHM, there is a provision
for two additional Staff Nurses at PHCs
on contract basis. It acts as a referral
unit for 6 Sub Centres.

PHC
It has 4 - 6 beds for patients. The
activities of PHC involve curative,
preventive, promotive and Family
Welfare.
Some diagnostic services also.

SET UP
PHC
30,000
20,000
4-6 Beds
Some diagnostic facilities.

FUNCTIONS OF THE PHC

Its functions cover all the 8 essential
elements of PHC as outlined in Alma
Ata declaration:

Medical care
MCH including family planning
Safe water supply and basic sanitation
Prevention and control of local
endemic diseases
Collection and reporting of vital
statistics

FUNCTIONS
Education about health BCC, IEC.
National health programs
School health.
Referral services
Training of health guides, health
workers, local dais and health assistants
Basic laboratory service
Monitoring and supervision.

IPHS PHC
Services at the Primary Health Centre
for meeting the IPHS
Type A PHC: PHC with delivery load
of less than 20 deliveries in a month.
Type B PHC: PHC with delivery load
of 20 or more deliveries in a month.

Objectives of Indian Public Health

Standards (IPHS) for Primary
Health Centres (PHC)
To provide comprehensive primary health
care to the community through the Primary
Health Centres.
To achieve and maintain an acceptable
standard of quality of care.
To make the services more responsive and
sensitive to the needs of the community.

Manpower at PHC
Existing

Recommended (IPHS)

Medical Officer
Pharmacist

1
1

2(one AYUSH or LMO)

1

Nurse-midwife (Staff
(Nurse)

3 (for 24-hour PHCs)

(2 may be contractual)

Health workers (F)

Health Educator

Health Asstt. (M&F)

Clerks

2
2

2
2

Laboratory Technician

Driver
Class IV

1
4

Optional/vehicles out-sourced.
4

Total

15

17/18

Community Health Centres

(CHCs)
CHCs are being established and
maintained by the State Government
under MNP/BMS programme.

CHC
As per minimum norms, a CHC is
required to be manned by four medical
specialists i.e. Surgeon, Physician,
Gynecologist and Pediatrician supported
by 21 paramedical and other staff. It has
30 in-door beds with one OT, X-ray,
Labour Room and Laboratory facilities.

CONT
It serves as a referral centre for 4 PHCs
and also provides facilities for obstetric
care and specialist Consultation.

FUNCTIONS OF CHC
Providing speciality services
Giving all preventive and curative health
services.
Caring and supervision of concerned PHCs
Providing consultancy and referral services
to PHCs
Referring patients to district hospitals and
teaching hospitals.

Cont.
Implementation of all national health
programmers with active participation
in them.
Providing reproductive and child health
services including family planning
services.

RURAL FAMILLY WELFARE

CENTRE
PHCes of block level
1 April 1980
1 assistant surgeon and 11 para medical
staffs
April 2002 state govt.

URBAN HEALTH SERVICES

In India 377 million people live in urban
places, out of which an estimated 97
million people live in urban poverty.
Rapid urbanization and the significant
growth of urban poor population in
absolute numbers already have new
demands on the available infrastructure
and service delivery mechanisms.

URBAN HEALTH SERVICES

The urban poor are a mix of people living in
slums and the homeless.
Urban poverty is characterized by food
insecurity, varied morbidity pattern, poor
access to drinking water and sanitation,
high costs of living and job insecurity.
All these aspects affect the health seeking
behavior of the urban poor and in
general the health.

SIGNIFICANCE OF URBAN
HEALTH

The World Health Day theme for 2010

Urbanization and Health

92

SLUMS
Nearly one-third of Indias urban citizens
live in crowded informal settlements or
slum communities.
UN-HABITAT has estimated that by the
year 2020, Indias total slum population
will cross 200 million people.

What are slums?

Habitations located on disputed as well
as unused government, municipal and
private land and characterized by a
serious lack of basic amenities and
sanitation with dense and overcrowded
housing conditions.

Health Delivery System

in Urban Slums
The government of India appointed the
Krishnan Committee in 1982 to address the
problems of urban health.
The health post scheme was devised for
urban areas based on the recommendations
of the Krishnan Committee. Its
report specifically outlines which services
have to be provided by the health post .

Cont
These services have been divided into
outreach, preventive, family planning,
curative, support (referral) services
and reporting and record keeping.

Cont
Outreach services include population
education, motivation for family
planning, and health education. In the
present context, very few outreach
services are being provided to urban
slums.

Cont
A municipal corporation covers a population
of above three lakh; there are three types of
municipal councils (A) 1 lakh population,
(B) 40,000 to 1 lakh and (C) less than 40,000.
Primary health services are provided in
urban areas through health posts.
There are four types of health posts (A, B, C
and D) according to population size (as per
GoI guidelines).

Cont.
According to the Krishnan Committee
recommendations, the health post was to
be located in slum areas.
The committee had recommended one
voluntary health worker (VHW) per
2,000 population with an honorarium of
Rs 100.

Cont
The health post (HP) scheme was
launched in 1983-84. A deputy director
and joint director were assigned to urban
health, but functioned chiefly to promote
family planning goals.
The scheme is centrally funded, and the
financial provisions at present continue to
be the same as those 15 years before.

Urban Revamping Scheme

Urban revamping scheme was introduced
following recommendations by Krishnan
committee 1983 .
To provide primary health care, family
welfare, service delivery outreach and
MCH services in urban areas.
HEALTH POSTS:
There are 871 health posts functioning in
10 States and 2 UTs.

Type of health post

Type of health post

Population

Type A

<5000

Type B

5000-10000

Type C

10000-25000

Type D

25000-50000

Ifpopulationoftheareaismorethan50000thenitistobedividedintosectors
of50000populationandapostisestablishedateachsector.

URBAN PHC
Organization
Municipality
Commissioner
Health Officer
Dispensary/Hospital
Medical officer

Functions
Medical care
MCH and family planning.
Prevention and control of communicable
diseases.
Safe drinking water.
Environmental sanitation.
Dietary services.

Dispensary
A dispensary is an office in a school,
hospital or other organization that
dispenses medications and medical
supplies.
In a traditional dispensary set-up a
pharmacist dispenses medication as per
prescription or order form.

Staff Pattern

MO
Nurse midwife
Male health assistant
Female health
assistant
Male health worker
Female health
worker

Pharmacist
Lab technician
Store keeper
Watchman
Driver
Cook

URBAN FAMILY WELFARE

CENTRES
Urban Family Welfare Centers are on
ground since First Five Year Plan to provide
family welfare services in urban areas
Most of UFWCs are equipped to provide
contraceptive supplies. At present 1083
centers are functioning.
There are three types of Urban Family
Welfare centers based on the population
covered by each centre.

Staffing pattern for Urban Family

Welfare Centers
TYPE

POPULATION
COVERED

NO. UNITS

Type I

10000 - 25000

326

Type II

25000 - 50000

125

Type III

Above 50000

632

Staffing
Pattern
ANM -1, FP Field
Worker -1
FPExtensionEdu
cator/LHV -1FP
Field
Worker(Male) -1
ANM -1
Medical Officer
-1(Pref. Female)
ANM - 2, LHV 1, FP Field
Worker (Male) 1 , Storekeeper-

Cont.
TYPE OF HEALTH POST

NO. OF HEALTH POSTS

65

76

165

565

URBAN HOSPITALS
Satellite hospitals.
Big dispensaries,
hospitals.
District hospitals
District health
centres
NUHM

Sub
divisional
health
centres

5 lakh

NUHM
One Urban Primary Health Centre
(U-PHC) for every fifty to sixty thousand
population.
One Urban Community Health Centre (U-CHC)
for five to six U-PHCs in big cities.
One Auxiliary Nursing Midwives (ANM) for
10,000 population.
One Accredited Social Health Activist ASHA
(community link worker) for 200 to 500
households.

NUHM
The scheme will focus on primary health
care needs of the urban poor.
This Mission will be implemented in 779
cities and towns with more than 50,000
population and cover about
7.75 crore people.

NUHM
The interventions

Reduction in Infant Mortality Rate (IMR)

Reduction in Maternal Mortality Ratio

(MMR)

Universal access to reproductive health

care

Convergence of all health related

interventions.

URBAN FAMILY WELFARE

CENTRES
1950
India, the second most populous country in
the world, has no more than 2.5 per cent of
global land but is the home of 1/6th of the
world's population.
2007, April1083.

URBAN HEALTH POSTS

ABCD
871-(2007)

RCH
FIRST AID
Contraceptives
Other services.

 SPECIALITY HOSPITALS.
TEACHING HOSPITALS.
300 ( 2009).

SUPER SPECIALITY HOSPITALS

PMSSY.
First Phase
6 AIMS.
Jodhpoor
Bhopal
Raipur
Patna
Bhuwaneshwar
Rishikesh

Cont..
Up gradation of 13 existing.
960 bedded.
500-Medical college.
300-Speciality/super speciality.
100-ICU/ trauma.
30- PM&Rehab.
30- AYUSH.
42 speciality discipline.

Cont..
Second phase
Besides, the government has also
approved setting up of two such
institutions,
one
each
in West
Bengal and Uttar Pradesh.

Cont..
The steering committee on health for 12th
Five Year Plan has recommended the Union
government to create four new AIIMS like
institutions (ALIs) over and above the eight
already approved under the Pradhan Mantri
Swasthya Suraksha Yojana (PMSSY).

THIRD PHASE

Government Medical College, Jhansi, Uttar

Pradesh; Government Medical College, Rewa,
Madhya
Pradesh; Government
Medical
College,
Gorakhpur,
UttarPradesh; Government Medical College,
Dharbanga, Bihar; Government Medical
College,
Kozhikode,
Kerala; Vijaynagar
Institute of Medical Sciences, Bellary,
Karnataka and Government Medical College,
Muzaffarpur, Bihar.

Referral

Primary level
health care facility

Community level

Urban Health service delivery model