Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
TABLE OF CONTENTS
SECTION - A
STRUCTURAL STANDARDS
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--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.
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.
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.
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:
x Disaster Management.
A-5 DRUGS
Objective Elements
Objective Elements
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.
Objective Elements
SECTION - B
PROCESS STANDARDS
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 patients 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.
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.
Objective Elements
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.
Objective Elements
Objective Elements
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.
Objective Elements
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,
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:
x Management of disease outbreaks- Identification, classification (water-borne,
vector-borne, vaccine preventable), incidence reporting, investigation, data
collation, analysis and reporting.
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.
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.
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.
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
Objective Elements
Objective Elements
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.
Objective Elements
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.
Objective Elements
Objective Elements
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.
Objective Elements
Objective Elements
Objective Elements
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
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.
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.
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.
Objective Elements
Objective Elements
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.
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
Dental
DIAGNOSTIC SERVICES
LABORATORY IMAGING
ECG
OTHER SERVICES
SUPPORT SERVICES
ZONES
For planning purposes the Public Urban Health Centre has been divided into zones as
under:
Zone Functions
Reception and Registration
- Reception counter
- Record storage
Pharmacy
Entrance Zone (A)
- Issue counter
- Formulations
- Drugs storage
Public utilities
Pathology (optional)
- Laboratory
Diagnostic Zone (C) - 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
Patient Area
- Preparation & Examination
- Pre-anesthesia
- Post Operative
Staff Area
- Toilet & Changing
Supplies Area
- Trolley Bay
- Equipment Storage
Sterilization
- Receipt
Critical Zone (Labour Room &
- Wash
Sterilization) (D)
- Assembly
- Sterilization
- Sterile Storage
- Issue
Minor OT /L.D.R. Area
- Labour Room
- Minor OT
- Scrub and Gown
- Instrument Sterilization
- Disposal
Public Utilities
Civil Engineering
Facility Management Zone (E)
- 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
General Administration
Administrative Zone (F) General Stores
Public Utilities
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.
2. EMERGENCY
Total 52 Sq mtrs.
5. ADMINISTRATIVE DEPARTMENT
7. GENERATOR ROOM
8. RESIDENTIAL ACCOMMODATION
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.
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 patients 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 Citizens 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.
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
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.
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
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
Pharmacist (Storekeeper) 1
2.
Pharmacist 1
3. Physiotherapist 1
4. Public Health Nurse (PHN) 1
1 for PUHC (plus 1 for each 10,000 urban
5. Auxiliary Nurse Midwife (ANM) 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
Electrician 1 (On Contract)
15.
Plumber 1
Total Manpower 23
ANAESTHETICS
General Anesthetics
Sodium thiopentone Inj. 0.5, 1 g powder/vial
Local Anesthetics
Bupivacaine hydrochloride Inj. 0.25, 0.5%
Lignocaine hydrochloride Inj. 1,2,4,5% jelly 2%, Oint 2%
5 mcg/ml adrenaline Dental cartridge 2%
Lignocaine with adrenaline
adrenaline (1:80,000)
Ethyl chloride spray
Preoperative Medication and Sedation for Short Term Procedures
Atropine sulphate Inj. 0.6 mg/ml.
Inj. 25 mg/ml
Promethazine
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
Tab. 500 mg/Syp. 125 mg/5 ml
Paracetamol
Inj. 1.50 mg/ml
Tab. 200, 400 mg
Ibuprofen
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
Tab. 50, 100 mg
Phenytion sodium
Inj. 50 mg/ml
Inj. 200 mg/ml, Elixir 15 mg/5 ml
Phenobarbitone
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
Cap. 250, 500 mg, powder for susp. 125 mg/5ml
Amoxicillin
Inj. 125 mg/ml
Cap. 250, 500 mg, powder for susp. 125 mg/5ml
Ampicillin
Inj. 500 mg/vial
Cloxacillin Cap. 500 mg, powder for susp. 125 mg/5ml
Erythromycin (as estolate) Tab. 250 mg, powder for susp. 125 mg/5ml
Tab. 400 mg + 80 mg
Sulfamethoxazole trimethoprim Tab. 800 mg + 160 mg.
Susp. 200 mg + 40 mg in 5 ml
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
Powder, Susp. 95% w/v
Barium sulphate Powder (HD) 95% w/w,
250% w/v
Sodium diatrizoate and Inj. Meglumine
Inj. 60, 76%
diatrizoate
DISINFECTANTS AND ANTISEPTICS
Cetrimide + chlorhexidine Cream, lotion (15% + 7.5%, 5%)
Ethyl 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
Tab. (250 mg + 50 mg)
hydroxide+activated methylpoly siloxane
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
Syp. 1 mg/ml, Tab. 10 mg
Domperidone
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
Tab. 30 mcg + 150 mcg
Ethinyl oestradiol + levonorgestral
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
Tab. 15 mg
Neostigmine
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
Tab. 0.125 mg
Methylergometrine maleate
Inj. 0.2 mg/ml
Ergometrine Tab. Inj. 0.2 ml
Salbutamol Tab. Inj.
Tab. 10 mg + 3 mg + 15 mcg.
Vit. B1, B6, B12
Inj. 100 mg + 50 mg + 1000 mcg.
Tab. 5000 IU
Vit. A
Inj. 1 lac/ml
Tab. 100 mg
Vit. B1
Inj. 100 mg/ml
Tab. 50 mcg.
Vit. B12
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%
Eye oint 1%
Chloramphenicol
Eye drops 0.5%, 1%
Miconazole Eye applicaps 1% w/v
Eye oint. 0.5, 1%
Framycetin
Eye drops 0.5, 1%
Eye drops 0.3%
Ciprofloxacin
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 & patients cabin.
EMERGENCY DRUGS
Atropine, Adrenaline
Sodabicarbonate, Digoxin
Efcorline, Decadron
Dopamine, 25% Dextrose
IV fluids, Plasma Expanders
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.
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.
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.
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.
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.
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.
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.
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.
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
6 10
Birth 14 wks 9 mths 15 mths 2 to 5 yrs
Weeks Weeks
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
First Dose as early as possible during pregnancy after 1st trimester
Tetanus Toxoid
Second dose 1 month after first dose
(PW)
Booster if previously vaccinated within 3 years
Immunization schedule may get modified with introduction of newer vaccines in the National
/ State immunization programme.
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.
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.
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.
For instance, cooperation could be sought from the NGOs 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
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.
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.
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.
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.
Symptomatic search,
RTI/STI referral, community level
Diagnosis and Management of
follow-up for ensuring
(including treatment, referral of complicated cases,
adherence to treatment
HIV/AIDS) complicated cases hospitalization (if needed)
regime of cases
undergoing treatment
Height/weight
measurement,
Hb testing, distribution of
Diagnosis and
therapeutic doses of IFA, treatment of seriously
deficient patients,
promotion of iodized salt, Management of acute
referral of acute deficiency cases,
Nutrition nutrition supplements to
deficiency cases. Early hospitalization
deficiency identified children and identification of mild
Treatment and
disorders and severe under-
pregnant/ lactating rehabilitation of
nutrition, counseling for
women Promotion of
optimal feeding severe under-nutrition
breast feeding,
practices or
complementary feeding
referral
for
prevention of under-
nutrition
Slide collection, testing
using
RDKs, DDT ,chemical,
Vector-borne Diagnosis and
biological larvicides etc Management of terminally
treatment, referral of
diseases ill cases, hospitalization
Counseling for practices terminally ill cases
for
vector control and
protection
REFERRAL SLIPS
REFERRAL SLIP
Referred from:
H.O.P. I. : --------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------
Investigations: --------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------
Diagnosis: -------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------
Hospital: ----------------------------------------------------------------------------------------------------------
REFERRAL SLIP
Referred from:
H.O.P. I. : --------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------
Investigations: --------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------
Diagnosis: -------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------
Hospital: ---------------------------------------------------------------------------------------------------------
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
were in operation a few months ago are no more considered effective due to new
discoveries and technology. These discoveries in new technology deal with conceptual
aspects, technical aspects, managerial aspect as well as human aspect. A good training &
capacity building system also ensures that employees develop in directions congruent with
their career plans. Capacity Building and Training is a part of management development and
also a form of organizational development.
It is important for the management to devise a cohesive Infrastructure and Action Plan for
Staff Education, training and development to meet the established needs of both the
employee and the client. The management shall coordinate and provide comprehensive
internal training programmes that would encompass the requirement of the organization in
terms of policy, procedure and skill as well as the aspirations, abilities and needs of all
employees
Many researches have estimated that the average employee in an organization is working at
much less than his capacity potential. If these employees can be properly motivated, they
could work at 80-90% of their capacity. Behavioural Science concepts like motivation and
good human relations shall be used. Training could be one of the main instruments to attain
such improvement.
Also, employees who are well trained produce superior performance, which in turn requires
a minimum of supervision and correction. Training must be continuously repeated to
reinforce the learning and maintain the desired behaviour.
It is essential that each staff job group in the Hospital shall have a training road map that is
appropriate to his needs.
General Capacity Building and Training methods can be used with different categories of
staff. Some of this are:
Lectures
Workshops
Conferences, projects, panels, etc
Case studies
Role playing, demonstrations and skills etc.
The model depicted below portrays a structure for moving staff to a level of competence and
confidence in their work. The model includes six steps beginning with the manager clarifying
expectations of the employee (learner). Second, an employees 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 learners
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
basic skills. The training shall be held regularly and on the job assessment shall be an
essential part of routine monitoring.
Induction and refresher trainings of ASHAs have to be undertaken. Ongoing support in the
field has to be provided through formation of Mentor groups.
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
activities 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.
IEC programmes accent so far has been on awareness generation about the programme
and service facilities, with the presumption that this would ensure adequate utilization. IEC
materials were produced and activities developed on mass scale to reach out to people with
messages on health and population issues.
These efforts have surely raised information and awareness levels but have fallen short in
changing behaviours and attitudes. It is increasingly becoming evident that if a change in
attitude and behaviour is desired, at user level, at provider level and at manufacturer level
we need a need-based, demand-driven, area-specific, client-centered IEC strategy that
addresses the individual, group and creates a supporting and enabling environment.
IEC has a major role to play in creating demand by repositioning the accessibility and
availability of services and the service providers image in such a way that it would match
peoples perspectives and needs. Information alone is not sufficient to change behaviour, we
need to work beyond information and awareness parameters and graduate towards
behaviour and social change.
IEC for Primary Urban Health Centre requires a clear, holistic and (creative, cultural, gender)
sensitive perspective. It would include evidence based meticulously packaged information
component, and a simple mode of communication so that the target group can understand
and use the information easily resulting in desired healthy behaviour practices. This
necessarily has focus on four essential elements:
The population to be targeted, their problems of public health and family health
The health information, awareness and behaviour message content, structure and
form
The creation and dissemination of culturally appropriate products and activities,
The facilitation of behaviour change through creation of a supportive environment
Each of these components needs to be fully and accurately understood. To achieve this
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 specifically address the following aspects of
the behaviour:
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
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 of BCC activities in the PUHC area.
Make sure that IEC and BCC activities cover the entire population through map
based micro planning.
S.NO. PRACTICES SEGMENT BEHAVIOUR CHANGE MESSAGE THEME MEDIA CHANNEL INDICATOR
Scroll board
Radio Jingles
Utilization of
public Posters
Urban Believe in our services as
1. Demanding Reasonable Information booklet PUHC Statistics
health services we believe in you! Brochures
TV spots
Health Insurance
TV spots
Water for survival, Hoardings Water borne disease
2. Drinking water Urban Aware Reinforce measures purified water for well Bus panels
being! Incidence rate
Kiosks
TV spots
Sanitary Hygiene Cleanliness is Wall Writings Disease Incidence
3. Urban Reiterate
practices conscious healthiness! Bus panels rate
Kiosks
Prompt health Holistic services from Newspapers
Seek public health
4. Injury Urban seeking womb to tomb.because PUHC Utilization rate
services Kiosks
behaviour we care
Awareness of the
Skeptical about importance of seeking Trust uswell wont
5. Poisoning Urban Newspapers PUHC Utilization rate
MLC immediate, trained and let you down!
reliable medical help
Anti snake bite venom is
Seek help from Mobilization towards
6. Snake bite Urban only available here Dont Newspapers PUHC Utilization rate
nearest hospital public services
thinkjust act!
Accreditation Standards for Primary Urban Health Centre
BLUE/WHITE
PUNCTURE
COLOUR CODE YELLOW BAG BLACK BAG RED BAG
PROOF
CONTAINER
TREATMENT INCINERATION AUTOCLAVING/ SHREDDING AUTOCLAVING/
OPTION SHREDDING DISPOSAL SHREDDING
WASTE HUMAN ANATOMICAL SHARP WASTES WRAPPING MATERIAL, IV TUBINGS/ CATHETERS/
CONSTITUENTS WASTE TISSUES, HYPODERMIC PAPER,
ORGANS, BODY PARTS, IV SETS/ URINE BAGS/
NEEDLES
PLACENTA OR ANY OTHER CARD BOARD PLASTIC DIALYSIS KIT/GLOVES/
MATERIALS WHICH WAS SYRINGES BAGS, DISPOSABLE BLOOD EMPTY BAGS/
ONCE A PART OF THE GLASS & PLATES, SYRINGES SEPARATED
LABEL FOR BIO- BODY.
SCALPELS
METAL CANS, FROM BARREL & ALSO
MEDICAL WASTE LANCETS FLOWERS VACUTAINERS WITHOUT
MICROBIOLOGY AND
CONTAINERS/BAG NEEDLES CUT INTO PIECES
BIOTECHNOLOGY WASTE, BLADES. KITCHEN WASTE
S
HISTOPATHOLOGY AT SOURCE OF
SPECIMEN, BROKEN GLASS LEFT OVER FOOD GENERATION,
SOLID WASTE ITEMS
CONTAMINATED WITH
BLOOD & BODY FLUIDS PUT IN TO 1% SODIUM
LIKE COTTON, SWABS, ALL SOAKED IN 1% (TAKEN AWAY BY HYPOCHLORITE SOLUTION
DRESSINGS, HYPOCHLORITE LOCAL AUTHORITIES FOR AT LEAST HALF AN
SOLUTION AND FOR DISPOSAL) HOUR & TRANSFERRED TO
SANITARY PADS, LINEN
ETC. TAKEN FOR BAG FOR AUTOCLAVING
SHREDDING AND AND SHREDDING
DISCARDED MEDICINES/
BIOHAZARD SYMBOL CYTOTOXIC DRUGS FINAL DISPOSAL.
MANAGEMENT OF INFORMATION
All health service organizations have systems for monitoring the services they provide.
Usually, they are based on periodic returns received from health care providers in the form
of monthly or quarterly reports.
Monitoring systems are multi-functional. They must help to monitor whether or not services
are going according to plan by tracking how funds are expended and what activities are
undertaken.
They also need to include monitoring of outcomes though the term surveillance is more
often used to describe the process of monitoring disease incidence and health status.
Monitoring systems must also be used for other functions assessing health needs, setting
priorities, allocating resources and influencing change.
1. PUHC has a set of periodical reports to be generated as per the formats provided by
the State / the Health Mission.
2. The records shall be maintained as per guidelines for services rendered both at
health center and through the outreach sessions.
3. As far as possible the records and reports shall be computerized and easily available
for scrutiny and use.
4. Each PUHC functionary will have a component to contribute in the report. He / She
must be trained and facilitated in collection, compilation, report generation from work
done by them.
5. MO I/C will be responsible for accuracy / completeness and timely submission of all
reports.
6. Maintenance of all the relevant records concerning services provided in PUHC,
logistics (Consumables / non consumable items) and the personnel working in the
centre has to be maintained meticulously.
7. Recording of Vital Events: ANM must collect information on all maternal and infant
deaths taking place in her assigned area. The address of the nearest linked birth /
deaths registration office must be displayed in the centre.
OPD attendance
ANC check-up of pregnant women
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.
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. Upkeep of the equipment and timely renewal of the Annual Maintenance contracts.
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. Availability of security and sanitation services.
a. Mopping of the Floors daily and as and when required. The floors shall be mopped
and dried before the patient inflow begins. Periodical washing as directed by the
Medical Officer Incharge.
b. Cleaning of walls, tiles and window panes periodically.
c. Cleaning of furniture, equipment, counters, shelves daily.
d. Emptying the dustbins daily.
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.
Rogi Kalyan Samiti (Patient Welfare Committee) is a simple management structure form of a
registered society setup for sustained and result oriented improvement in functioning of the
health institution (PUHC) and quality of care provided.
Objectives:
Ensure delivery of the mandated services as per the Public Health Standards laid
down for the PUHC.
Ensure upgradation of the PUHC (Centre / Outreach) to the recommended Public
Health Standards.
Ensure a grievance redressal mechanism.
Ensure availability of the essential drugs and other 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.
To achieve the above mentioned objectives, the Samiti shall direct its efforts and resources
for undertaking following activities:
Ensure display of the Citizen's Charter in the health facility and its compliance.
Regularly examine, address the complaints received in the complaint box positioned
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 clean drinking water.
Ensure clean male & female toilets with running water availability.
Establish clothes and toy banks through which those who have plenty can share with
those less privileged.
Ensure safe disposal of the biomedical waste generated in the centre / outreach.
Play a catalyst role in awareness generation especially on issues like female
foeticide, gender bias.
Ensure continuous capacity building of the PUHC staff / ASHAs / workers of
converging agencies like ICDS.
Ensure timely payments to ASHAs, contribute in the unit level mentoring activity.
Revenue: Certain funds like untied funds / maintenance funds are made available to the
RKS. In addition the RKS has the mandate to generate its funds through donations /
fundraising events. The State funds separately approved for activities which are to be carried
out by the RKS can be released to the RKS account.
District / State level RKS Mentoring group will provide the orientation training to the RKS
members as to how to discharge the functions of RKS functionaries.
Each Primary Urban Health Centre shall have a Rogi Kalyan Samitis (RKS) for improved
functioning of the Primary Urban Health Centres and for rendering better services to the
patients.
The composition of the Rogi Kalyan Samiti for the Primary Urban Health Centres shall be as
under:
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 number of
Ward Counselors, one Ward Counselors can be Chairman of more than one RKS.
The details of the Rogi Kalyan Samiti will be displayed in Primary Urban Health Centre. The
Samiti will have the mandate to improve the service delivery and ensure adherence to the
standards prescribed.
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
ASHA. She will be trained and provided a basic drug kit (Paracetamol, ORS, Chlorine
tablets, bandages, cotton, betadine etc. Her work in her area will facilitate the outreach
activities of the ANM, initiate local health planning. ANM in turn will validate / verify the work
done by her and also provide support and guidance to these volunteers in the field.
Centre / Maternity home / Sub district / District hospital as per the need. She will
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 minor ailments such as diarrhoea, fever
and first aid for minor injuries. She can be a provider of Directly Observed Treatment
Short course (DOTS) under Revised National Tuberculosis Control Programme. She
will help in effective field level implementation of other National Programmes by
creating awareness about them.
8. She will act as adepot holder for essential provisions being made available to every
habitation like ORS (Oral Rehydration Salts) packets for Oral Rehydration Therapy
(ORT), Iron Folic Acid Tablet (IFA), Chlorine Tablets, Oral Pills & Condoms etc. A
Drug kit will be provided to each ASHA.
9. To inform about any unusual health problems / disease outbreaks in the community
to the Primary Urban Health Centre.
ASHA will initiate local health planning by assessing the quantum of healthcare needs in her
cluster of households. ASHA will be trained for the role envisaged for her as per the modules
prepared for such a community worker.
She will enter her activities in the diary provided to her. She will be paid certain fixed
incentives for some of the activities carried out by her. ANM will provide the supervision and
mentoring support in the field and also verify the work done by her. There will be continuous
capacity building and training of ASHAs and in the field ASHA will be supported by the
mentor groups / ANMs / PHN / MO / Social Mobilization Officer.
Activities:
President: Representative Self Help Group, Senior Citizen Group, Resident Welfare
Association, Gender Resource Centre in that order.
Members:
Primary Urban Health Centre is the peripheral most health facility manned by the Medical
Officer and support staff along with the required logistics to provide holistic primary
healthcare to the citizens residing in the catchment area of the centre. One PUHC is
visualized for every 50,000 population. It is a manifestation of the commitment of all
healthcare providers to make quality assured, affordable, accountable, responsive primary
healthcare universally available.
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 appropriate
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.
Curative Component:
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.
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.
Adolescent Health:
Detection and management of nutritional disorders and high risk behaviour.
iii. Health and Nutrition days to be conducted at the identified Anganwadis in the
catchment areas.
iv. Anganwadis in the catchment area shall be listed out.
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, Shallers and Knees.
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.
iii. Conduct of Nukkad Nataks, well baby shows, camps etc.
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 / LADLI.
vii. List of Gender Resource Centre, local grant in-aid NGOs, and private hospitals
mandated to provide free services to under privileged shall be displayed.
PUHC will be responsible for conducting this activity in its catchment area. The staff
and logistics will flow from the PUHC.
The detailed job responsibilities of Medical Officer working in the PUHC are as follows:
I. Healthcare Delivery
The Medical Officer will provide comprehensive Medical Care, preventive and curative to the
beneficiaries including Family Planning services.
The Medical Officer will organize the dispensary, outpatient department and will
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, diagnosis and treatment on the
OPD slip. As far as possible the medications shall be the ones available in the
PUHC.
He / She will ensure that he / she himself / herself along with all others involved
in delivery of curative medical services are fully conversant with the standard
treatment protocols appropriate to the category of staff and are using them while
providing healthcare.
He / She may refer the case to the specialist as and when required. While
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 regulate organization of the specialist / evening
OPDs.
He / She will ensure that during the working hours appropriate care for
emergencies is promptly available in the PUHC including that for injuries and
burns.
Will ensure adequate stocks of ORS to maintain availability of ORS packets
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.
Recording and reporting of all deaths due to diarrhoea / ARI especially for
children between 0 5 years.
Spread awareness and provide chlorine tablets for rendering drinking water safe.
Training of all health personnel like Accredited Social Health Activist (ASHAs),
Anganwadi workers, dais and others who are involved in health care regarding
ORT programme.
He / She will ensure through his / her health team early detection of pneumonia
cases and provide appropriate treatment. He / She will attend to all cases
referred to the centre by ANM / ASHA / School teacher / AWW and provide
appropriate management.
After careful screening in all cases requiring the 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.
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.
Wherever possible, the MO will conduct field investigations to delineate local health
problems for planning changes in the strategy of the effective delivery of Health and Family
welfare services. He / she will coordinate and facilitate the functioning of AYUSH doctor in
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.
Ensure availability of supplement of Iron / Folic acid and Vitamin A.
Outreach Activity
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 risk cases.
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 logistics (equipments, drugs, educational material
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 PUHC to enable the adolescents
to approach the Medical Officer, Public Health Nurse, ANM with their problems /
queries.
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.
8. Leprosy
He / she will provide facilities for early detection of cases of Leprosy and
confirmation of their diagnosis and treatment.
He / she will ensure that all cases of Leprosy take regular and complete treatment.
III. Training
Ensure that his health team is well versed with SOPs and follow these in Health
Care delivery at the PUHC.
The team members have defined work allocation and are adequately trained for
it.
Worker specific / relevant training are ensured with continued upgradation of
skills of his / her staff with the help of State and District level trainings.
Organize training for ASHAs attached to the PUHC.
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.
I. Curative Work
The Medical Officer will provide comprehensive Medical Care, preventive and curative to the
beneficiaries including Family Planning services.
After examination of the patient the Medical Officer will record symptoms and
findings in brief, investigations done / advised, diagnosis and treatment on the
OPD slip. As far as possible the medications shall be the ones available in the
PUHC.
He / She will ensure that he / she himself / herself along with all others involved
in delivery of curative medical services are fully conversant with the standard
treatment protocols appropriate to the category of staff and are using them while
providing healthcare.
He / She may refer the case to the specialist as and when required. While
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 provide appropriate care for emergencies including that for injuries
and burns.
He / She will correct moderate and severe dehydration through appropriate
treatment (using IV rehydration if required). He / she will ensure early detection
of pneumonia cases and provide appropriate treatment.
Monitor all cases of diarrhoea / ARI especially for children between 0 5 years.
Recording and reporting of all deaths due to diarrhoea / ARI especially for
children between 0 5 years.
Spread awareness and provide chlorine tablets for rendering drinking water safe.
Training of all health personnel like Accredited Social Health Activist (ASHAs),
Anganwadi workers, dais and others who are involved in health care regarding
ORT programme.
He / She will attend to all cases referred to the centre by ANM / ASHA / School
teacher / AWW and provide appropriate management.
After careful screening in all cases requiring the 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 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.
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 MO
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. He / she will be assisted by
the Social Mobilization Officer in this.
Wherever possible, the MO will conduct field investigations to delineate local health
problems for planning changes in the strategy of the effective delivery of Health and Family
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 in Nutritional deficiency
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.
Outreach Activity
Provide quality assured / complete services in areas where center based
facilities are not accessible, outreach activities.
Ensure that the essential contacts with PUHC are made for investigations and
management of high risk cases.
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.
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
Maintain a 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.
8. Leprosy
Early detection of cases of Leprosy and confirmation of their diagnosis and
treatment.
Ensure that all cases of Leprosy take regular and complete treatment.
III. Training
Assist Medical Officer Incharge in organizing / conducting trainings.
Organize training for ASHAs attached to the PUHC.
Provide hands on training to the ANMs, ASHAs.
Provide feedback on value addition done by the different trainings provided to his
/ her staff members
PHARMACIST
The Pharmacist will be personally responsible for the correct dispensing as per
prescriptions issued by the Medical Officers and for the safe custody of the
stores in accordance with the guidelines / instructions by Medical Officer
Incharge from time to time.
The Pharmacist will at all times be courteous and helpful in dealing with the
patients and under no circumstances enter into arguments, whatsoever with a
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 cleanliness of the dispensing room, replenishment of stocks, arranging
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 bottles
are properly closed with labels intact.
He / she will dispense medicines with great care, accuracy as per the
instructions on the prescription.
The Pharmacist will write the names of the medicines whenever necessary on
the envelope / container, bottle to avoid confusion 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.
PHARMACIST (STOREKEEPER)
He / she will see that the articles beyond repair are condemned and disposed
through the laid down procedure and functional replacements are available
without any delay.
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 Incharge from time to time.
Public Health Nurse will assist the Medical Officers in planning, implementing and evaluating
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
various health functionaries while also improving their skill through hands on training. The
PHN is responsible to Medical Officers and community in general.
Role:
Provision of healthcare delivery including implementation of the National Health
Programmes.
To act as a supervisor to ANM and ensure ASHA ANM synergy.
To assist the Medical Officer Incharge in managing various activities of the
health team in PUHC and outreach in the community
Provision of Healthcare:
Maternal & 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 based postnatal care. All high risk cases to
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
prophylactic / therapeutic doses of iron and compliance is ensured through
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 ANMs.
Whenever necessary, actively participate in immunization related activities
including the adverse events which are to be immediately brought to the notice
of the Medical Officer.
Nutrition
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 clinic.
Ensure meticulous maintenance of Survey registers and Eligible couple registers
by the ANMs. By making field visits guide them in preparation of the area maps.
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 in developing interpersonal skills by practical demonstrations in the
centre and the field.
Help and guide the ANMs in planning and organizing her plan of activities.
Outreach Activities
Planning the schedule of the outreach sessions.
Supervise the conduct of outreach activities.
Participate in the innovative activities being carried out by NGOs in the
catchment area of the PUHC.
Encourage community involvement and participation by identifying and regular
meetings with community leaders.
Participate as an active member of the health team in health camps, well baby
shows, IEC activities and special state / national campaigns and programmes.
Training
Organize and conduct trainings of ANMs, ASHAs and AWW with the help of
Medical Officers.
IEC Activities
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
Status of Women
Any other duties / jobs assigned by Medical Officer Incharge from time to time.
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
immunization etc.
Ensure investigations urine of pregnant women for albumin and sugar.
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 further facilitate the access to this referral
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 from hospital.
ANM along with ASHAs will identify the ultimate beneficiaries, complete
necessary formalities before disbursement to the beneficiaries under Janani
Suraksha Yojana (JSY)
Make at least two post natal visits for each delivery happened in her areas and
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 action
required to rectify the defect.
Educate mothers individually and in groups in better family health including
maternal and child health, family planning, nutrition, immunization, control of
communicable diseases, personal and environmental hygiene.
Family Planning
Utilize the information from the eligible couple register for the family planning
programme. She will be squarely responsible for maintaining eligible couple
registers and updating at all times.
Spread the message of family planning to the couples and motivate them for
family planning individually and in groups.
Distribute conventional contraceptives and oral contraceptives to the couples,
facilitate prospective acceptors in getting family planning services, if necessary,
by accompanying them or arranging for the ASHA to accompany them to
hospital.
Provide follow-up services to female family planning acceptors, identify side
effects, give treatment on the spot for side effects and minor complaints and call
those cases that need attention by the Medical Officer to the PUHC.
Establish female depot holders in ASHAs, help in training them, and provide a
continuous supply of conventional contraceptives to the depot holders.
Build rapport with acceptors, local leaders, ASHA, dais and others and take their
help in promoting Family Welfare Programme.
Participate in Mahila Mandal meetings and utilize such gatherings for educating
women in Family Welfare Programme.
Nutrition
Have a strong liaison with the Anganwadi worker (AWW) of her area.
Identify cases of anemia and malnutrition among infants and young children, with
the Medical Officer / Public Health Nurse make a plan of action for the identified
children and implement it with the help of ASHAs and AWWs. Refer the severe /
complicated malnutrition cases to the linked hospital.
Distribute Iron and Folic Acid tablets as prescribed to pregnant women, nursing
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.
Communicable 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 the necessary measures to prevent their spread.
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.
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.
Vital Events
Facilitate (by providing the address of the nearest registering office) according of
vital events including births and deaths, particularly of mothers and infants and
inform the Medical officer of the PUHC.
Maintenance of all the relevant records concerning mothers, children and eligible
couples in the area.
Record Keeping
Registers
Survey register (ANM specific) in which she records detailed household survey
of her area and allotted families.
Eligible couple Register (ANM specific) in which she records the eligible couples
both protected and unprotected couples. Accordingly she prepares her
workplan and follows them up.
Pregnant women register (common for the PUHC) details of ANC, intranatal
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 outreach, Cases referred for Tubectomy / Vasectomy and cases operated.
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.
LABORATORY TECHNICIAN
All Primary Urban Health Centre will have Laboratory technician / assistant. The Laboratory
technician will be under the direct supervision of the Medical Officer Incharge, PUHC. The
laboratory technician will carry out the following duties:
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.
RADIOGRAPHER
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
the following duties:
Maintain the cleanliness and safety of the X-Ray, Dark room and USG room
Sets up and operates radiographic equipment used in the medical diagnosis
and/or treatment of patients.
Selects proper ionizing factors for radiological diagnosis.
Adjusts and sets radiographic controls, such as kilo voltage and mili amperage to
prescribed specifications for proper timing of exposure; regulates the length and
intensity of film exposure.
Receive patient's requisition, positions and restrains patients; and takes x-rays of
patients chest, limbs or other parts of the body as required by the Medical
Officer.
Implements infection control procedures for the work area.
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 as patient records, daily logbooks, and monthly
reports.
Distribute films to appropriate medical staffs.
Maintains quality control checks to assure x-ray unit meets standards required by
laws, rules and departmental policies
Assist Medical Officers as and when required.
Responsible for films used and day-to-day utilization.
Provide details on daily poor quality films accounts and statistics of each room to
be handed over to the management.
Performs radiographic procedures for patients in surgery.
Cleans, maintains and makes minor adjustments to radiographic equipment,
including determining repairs needed to equipment and report equipment failure
to Medical Officer Incharge and get it rectified well in time.
Protects patient and other personnel from radiation hazards.
Indent for radiographic supplies, film and equipment though 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
studies.
Observes the safety requirements and follow safety procedures and instructions
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 performed and percentage of wastage.
He will carry out any other duties as may be assigned to him by the Medical
Officer Incharge
Radiological Investigations
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, 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
handling the injured.
He will issue the lotions and ointments to the patients under the guidance of the
Pharmacist as prescribed by the Medical Officer.
He will keep the Dressing room clean and tidy. All types of lotions, powders and
ointments shall be properly labeled and arranged.
He will keep medicaments for Eye and Ear in a separate tray.
The lotions, paints etc. and dressing material will be kept in a separate tray.
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 at a time and keep it in a sterilized tray.
He will wash his hands with soap and water before dressing and use sterilized
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 Biomedical Waste disposal.
In case of a female patient, he will not do the dressing except in the presence of
a female relative of the patient or the female attendant of the PUHC or will call
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, bottles / jars etc. properly covered, corked,
stoppered and labeled.
He will keep dressing material i.e cotton, linen, bandages, gauze etc. stored
properly and not exposed to dust.
The dresser while on duty will have on a white apron and liveries provided.
He will assist the Medical Officer in minor operations like removal of foreign
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 store and maintain a
stock register for these.
He will maintain separate register for special drugs like eye, ear, and ointment
issued from the dressing room.
He will carry out any other duties as may be assigned to him by the Medical fficer
Incharge.
The Nursing Orderly / Peon will carry out duties in the PUHC or outside that as assigned to
him by the Medical Officer Incharge.
When posted with a Medical Officer he will control the influx of patients to the
doctors room.
He will be responsible for the proper upkeep and cleaning of doctors consulting
rooms and other rooms including all furniture, equipment therein.
He will arrange the doctors tables and examination table for the patients.
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 Medical Officer Incharge.
Similarly he will collect dak any other logistics from the District / State HQ / or
any other place as instructed by the Medical Officer Incharge.
He will accompany the storekeeper and get the indents from the main store.
The Nursing Orderly / Peon will perform duties of watchmen / attendant at the
PUHC as specified by the Medical Officer Incharge at the time of need.
Wherever necessary, he will arrange for procurement of water for mixtures /
drinking purposes.
The Peon / Nursing Orderly / Messenger after performing outdoor official duty
shall return / deposit the raincoat / umbrella / bag to the concerned official.
He will participate enthusiastically and with responsibility in the conduct of
various camps / all outdoor activities.
He will perform such other duties as may be assigned to him by the Medical
Officer Incharge from time to time.
The SCC on morning shift will report for duty sufficiently early to sweep and mop
the Primary Urban Health Centre floors etc. so that work can start at the
scheduled hour.
The Sweeper cum Chowkidaar will take the charge of the Primary Urban Health
Centre premises after the PUHC hours.
He will ensure that all the rooms are properly bolted locked so as to exclude the
possibility of entry by an unauthorized person.
He will inspect the lock and seal of the medical store taking over duty and show
the same to the next SCC, Medical Officer Incharge / Storekeeper on relief from
duty.
He will check that the almirahs containing stores placed outside, the rooms are
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 lights, heaters, fans etc. are
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, spittoons etc. He will empty waste
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 biomedical waste. These activities will be
performed before opening or after closing of the centre.
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 loading and unloading store from the vans.
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 pertaining to
the laboratory and its surroundings as detailed above.
He will wash and clean laboratory slides, bottles etc. used for investigation
purposes and correctly dispose of the specimen after the completion of their
examination and when they are no longer required.
He will wash and clean the shelves when he is attached with the store.
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.
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
family welfare programmes in the area. His focus work areas will be:
Communitization Activities
With the emphasis on Community Involvement in planning, implementation and monitoring
of various health interventions there has to be a strong and concerted effort to establish and
maintain a continuous interaction between the community and the local health unit i.e.
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
together smaller self help groups required for mounting risk pooling activity will require
dedicated effort at the grassroot level and active field presence by an individual trained in
these activities. He / she will stimulate and guide this local initiative, assist them by making
them aware of the existing guidelines, available funds for various activities, accessing and
using the same and record keeping.
Related to Health & Sanitation Committees / 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.
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
the Medical Officers on the OPD slips and leaving the work of entering / recording the same
in master register to a worker who is not qualified to do so (in most of the cases it being the
Nursing Orderly / Peon) and existence of long elaborate formats.
In order to generate authentic / complete / reliable data all these problems have to be
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
a CDEO will be:
Maintenance of the OP attendance registers. Computer generation of OPD slip
and patient registration.
Entry of complete diagnosis and treatment prescribed in the computerized
registry.
Generation of monthly reports hard and soft copies in the prescribed formats
provided under different programmes.
Transmission of the reports in time to various concerned units DPMU / SPMU /
Directorates.
Immediate notification of notifiable diseases to the concerned departments.
Accurate compilation and onward transmission of the data pertaining to IDSP.
Collection of data pertaining to ASHA activity from the ANMs and its compilation
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 guidelines for staff / community workers.
Any other work assigned by the Medical Officer Incharge.
To develop and maintain an information base and providing statistical data and
for submitting mothly reports
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.
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.
Am I confident in setting up IV
lines, suturing simple wounds
2. under LA, carrying out
resuscitation procedure, using
Nebulizers, Ryles tube, Catheters
Am I aware of various
empowerments / health and social
8.
sector schemes for the vulnerable
population
Am I aware of my Roles /
1.
Responsibilities
Is my pharmacy clean,
organized, well stocked with
2.
drugs arranged and within
easy reach
Am I dispensing accurately
and making sure that the
3.
patient understands, especially
use of inhalers etc.
Is my daily consumption
4. register, stock register being
maintained as prescribed
Am I playing my role in
5. outreach services / ASHA
mechanism
Am I aware of my Roles /
1.
Responsibilities
Am I confident in giving
basic first aid / dressing of
2. minor wounds, assisting
my MO in minor
procedures.
Am I following the
protocols laid down for
3.
prevention and control of
infections
Am I disposing the
Biomedical waste
5. generated in the dressing
room safely as per
guidelines
FORM 6.11 SELF APPRAISAL COMPUTER DATA ENTRY OPERATOR CUM ASSISTANT
Am I generating meaningful
3. and accurate reports for
analysis and evaluation
2. Am I aware of my role in it
Am I aware of the
proceedings / delegations /
3.
responsibilities / record
keeping involved
Is my household survey
6.
complete and accurate
Uninterrupted supply
d. Medicines & Logistics
Rational use
Infection prevention and All concerned have the necessary knowledge & training
f. control (including
Biomedical waste disposal) Availability of logistics ensured
Availability of registers
Records / Registers to be complete and accurate
g. Records, Registers, Reports
Reports generated and forwarded in time
Analysed and evaluated locally
For Staff:
Clinical care skills
Managerial skills
Attitude / Behaviour skills
For Community Representatives:
ASHAs
j Capacity Building Rogi Kalyan Samitis
Health & Sanitation Committees
Mahila Arogya Samitis
For Community:
Community based initiatives
Home based care
Preventive and promotive aspects of health
SERVICE GUARANTEE
a. Maternal Health
Care of the Child Full immunization of all infants and children against Vaccine
preventable diseases as per guidelines of GOI
Vitamin A prophylaxis to the children as per the guidelines
Prevention and control of childhood diseases like
malnutrition and infections.
c. Adolescent Health
d. Family Planning
f. Infertility
4. Inter-sectoral Convergence
5. Referral Services
Hb%, TLC
Blood sugar
Urine Albumin, Sugar and Microscopy
Urine Pregnancy test
Stool Microscopy
Sputum testing for Tuberculosis (if designated as Microscopy
centre under RNTCP)
Blood smear examination for malarial parasite
Test specified as a part of IDSP
7. Radiology Services
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
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, Shallers and
Knees.
It is difficult and not very practical to set rigid target in terms of numbers / quantum but the
utilization trends have to be monitored and evaluated. An increase in the utilization trend of
20 to 50% over and above that in the same period a year ago is expected. This increase
shall vary from service to service depending upon the level of previous performance, the
local need for the service, the nature of bottlenecks hampering the provision of service
earlier and the empowerment provided now. Some of the parameters which can be taken up
for evaluating increase in utilization trends:
1. Increase in monthly / average daily OPD attendance.
2. Increase in number of senior citizens accessing the services.
3. Increase in Immunization coverage / increased completion of Primary
immunization within first year of life / Increase in Hepatitis B birth dose.
4. Increased ANC beneficiaries / Increased first trimester registrations / Increased
referrals for high risk pregnancy.
5. Increased number of pregnancies concluding in Institutional deliveries.
6. Increased number of women receiving postnatal visits 1 and 2 by ANM.
7. Increase in number of IUCD acceptors.
8. Increase in number of OC users.
9. Increase in proportion of TB patients on DOTs completing their treatment.
10. Number of Hypertensives / Diabetics being successfully followed up in the centre
(as per the protocols).
11. Increase in number of patients converted from anemic to non anemic state.
12. Increase in number of children identified malnutrition with or without anemia and
liasoned with local anganwadi and being followed up.
13. Number of children (out of those identified) brought to normal weight and anemia
free state.
14. Number of patients provided nebulization in the centre.
15. Number of Cataract case referred and operated with restoration of vision.
As far as the morbidities are concerned a decreasing trend indicates success of the
interventions, especially the preventive and BCC efforts. Some of the parameters can be:
1. Decrease in anemia in pregnancy
2. Decrease in Lo birth weight babies.
3. Decrease in cases of measles.
4. Decrease in the cases of acute diarrhea.
The chronic disease trends and difficult to monitor and not in the scope of PUHC alone but
the optimum management / follow up as per protocols can be ensured.
CLIENT SATISFACTION
Client satisfaction shall now form an integral part of any performance evaluation of centre. It
shall cover the access, the time spent by the patient in getting the service, the behaviour /
attotide pf the care providers, the basic requirements like seating space, drinking water,
clean toilets, the quality of care provided, the counseling and follow up advise. The
availability of tests and medications hall also be assessed.
To facilitate objective assessment Client exit interviews / prescription audits shall be made
a port of the PUHC assessment protocol. The required formats have been framed and are a
part of the Quality Assurance Manual.
S. No.
Forming the link between the centre and each One trained ASHA for every 2000
1
household population.
Empowering the community by participation in
2 Formation of Rogi Kalyan Samiti.
planning for and monitoring of the PUHC.
Formation of Health and
Empowering the community for local health
3 Sanitation Committees for every
and related activities.
2000 population.
Display of Citizen's Charter and
4 Individual Empowerment.
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.
Do not know
Already Diagnosed and on treatment
What is the ailment for which you have No ailment. Come for advice on Family
10.
come Planning. Antenatal care, Immunization,
Nutritional disorder
Any Other: Specify
Polite
12. Was the staff at registration counter polite Indifferent
Rude
Warmly
15. Did the Doctor greet you warmly Indifferent
Rude
Yes
Did the Doctor listen patiently to your
16. Was in a hurry
complaint
Did not listen
Yes
Did the Doctor give you an opportunity to
17. A little
ask questions
No
Yes
Did the Doctor discuss your illness and
18. A little
treatment with you
No
Yes
Was there sufficient privacy for
19. Could have been better
examination
No
Yes
20. Did he tell about the next visit
No
How long did you wait to get your
21.
registration number
Yes
If the service provider was ANM, was she
26. Indifferent
warm and helpful
Rude
Toilets
*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 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.
1. Facility Management
b. Manpower
c. Equipments
Water, Electricity,
e.
Telephone
f. Cleanliness / Sanitation
2. Managing Information
a. Managing Information
Service Provision
b. Clinical Protocols /
Procedures
c. Utilization trends
4. Training Requirements
d.
5. Governance