1. VISIT TO A P.H.C / C.H.C
Dr. Indrajeet Kumar
Tutor, Department of P.S.M

2. NATIONAL
LEVEL HOSPITALS
REGIONAL HOSPITALS
AIIMS, IGIMS
STATE LEVEL HEALTH ORGANIZATIONS
Medical Colleges
DISTRICT HEALTH ORGANIZATIONS
SUB. DISTRICT / TALKAS HOSPITALS
COMMNITY HEALTH CENTRES
(1 : 1,00,000 in Plains, 1 : 80,000 in tribal / Hilly areas)
PRIMARY HEALTH CENTRES
1 : 30,000 (Plains), 1 : 20,000 (Tribal / Hilly areas)
SUB – CENTRES
1 : 5000 (Plains), 1 : 3000 (Tribal / Hilly areas)
VILLAGE LEVEL 1 : 1000 Population
Anganwadi worker, Birth attendant, Health guide, link
worker (ASHA)
HEALTH CARE DELIVERY SYSTEM
OR
LEVELS OF HEALTH CARE
PRIMARYHEALTHCARESECONDARYHEALTHCARETERTIARYHEALTHCARE

3. What to see……….
• 1. Name of the place & it’s location
• 2. Population covered by it.
• 3. Number of sub-centre & PHC(addl.PHC) under it.
• 4. Infra-structure.(OPD room, indoor 6/30 beds, O.T, labor room, lab., store etc.)
• 5. Manpower.
• 6. Services provided (Functions)

4. Staffing Pattern of C.H.C
PERSONNEL Existing Strength Strength as per IPHS Qualification
Block Health officer - - Sr. most specialist
General Surgeon 1 1 MS / DNB General Surgery
Physician 1 1 MD / DNB General Medicine
Obstetrician & Gynaecologist 1 1 MD / DNB / DGO Obs. & Gyn.
Paedetrician 1 1 MD (Paed) / DNB (Paed./ DCH
Anaesthetist 1 MD (Anaes.)/DNB/ D.A/ 1yr.
Cert. course in anaesth.
Public Health manager 1 MD(PSM) / MD(CHA) / P.G
degree with MBA
Eye Surgeon 1 / 1 for every 5 CHC MD/ MS/DNB
(Ophthalmology)
Dental Surgeon 1 BDS
General Duty M.O 6 ( at least 2 female doctors) MBBS
Specialist of Ayush 1 P.G in AYUSH
General duty M.O AYUSH 1 Graduate in AYUSH
TOTAL 4 15 / 16

5. Support Manpower
Personnel Existing As per IPHS
Staff Nurse 7 + 2(1ANM & 1PHN for FW appointed
under the ASHA scheme)
19
Public Health Nurse (PHN) 1 ( appointed under ASHA scheme)
ANM 1 (Appointed under ASHA Scheme)
Pharmacist / Compounder 3
Pharmacist – AYUSH 1
Lab – technician 1 3
Radiographer 1 2
Ophthalmic Assistant 0 -1 1
Dresser(certified by Red Cross / St. Johns ambulance) 1 2
Ward Boys / Nursing Orderly 2 5
Sweeper 5
Chowkidar 3 5
Dhobi 1
Mali 1
Aya 5
Peon 2
OPD Attendant 1
Registration Clerk 2
Statistical Assistant / Data Entry Operator 0-1 (Flexible as per requirement) 2
Accountant Admin. Assistant 1
OT Technician 1
TOTAL 21 – 22 +2 64

6. Functions of Community Health Centre
• To provide specialist services (routine and emergency cases in surgery, medicine,
obs & gyn. and Paediatrics) .
• Indoor patient care (30 beds are available).
• RCH services.
• Services for National Health Programmes.
• Cold chain maintenance through ILR and deep-freezers, cold boxes, and day
carriers.
• Laboratory and x-ray services.
• Blood storage facility.
• Referral Services
• Training and continuing education of health teams.
• Information, education and communication (IEC)activities for specific problems.
• To elicit community participation.
• To enhance public private partnership(PPP).

7. Services for National Health Programmes
• RCH (Reproductive and Child Health).
• National Immunization Programme (UIP)
• Janani Suraksha Yojna (JSY).
• Polio Eradication Programme.
• RNTCP (Revised National Tuberculosis Programme) .
• National Malaria Control Programme. National Vector Borne Disease
• National Filaria Control Programme. Control prog.
• National leprosy Eradication Programme (NLEP)
• National Programme for control of Blindness

8. RCH I & II (Reproductive & Child Health)
• Services for Mother: a. Essential Obstetric Care - early registration : at least 3 ANC
- provision of safe delivery : 3 post-natal checkups.
b. Emergency Obstetric Care ( strengthen FRUs with emergency
obstetric kit, equipment kit & skilled manpower)
c. 24 X 7 Delivery Services.
d. Medical Termination of Pregnancy.
e. Control of reproductive Tract Infection (RTI) & Sexually
Transmitted diseases (STD/STI)
Services for Child:- a. immunization.
b. Essential New born Care ( to reduce PMR & NMR) facility
:- Resuscitation of new born with asphyxia.
:- Prevention of hypothermia.
:- Prevention of infection.
:- Exclusive breast feeding.
:- Referral of sick.
:- Train M.O in such care.
c. Oral rehydration therapy.
d. Acute Respiratory Disease Control.
e. Prevention & control of vitamin A deficiency in children. 5 doses of vit A to
children between 9m to 3yrs (9m – 16m – then 3 doses every 6m)

9. DISPOSABLE DELIVERY KIT (DDK)
CONTENTS OF DISPOSABLE DELIVERY KIT :- Cleanliness during intra natal care:-
Plain Polythene sheet 75 x 75 cm 1pc clean surface for delivery
Soap (carbolic) 1pc clean hands & fingernails
Cotton 2.5gm X 2gm 2pc
Cotton Thread (10No) 30cm 3pc clean thread
Gauge 10cm x 10cm 4pc
Stainless steel Blade (ISI) 1pc clean blade
clean cord,
keeping birth canal clean by avoiding harmful
practices.

10. VITAMIN- A PROPHYLAXIS
• Every child between 9m – 3yrs of age
given 5 doses of vitamin A.
• 1st dose at 9month 1,00,000 IU or 1ml
along with measles vaccine.
• 2nd dose at 16month 2,00,000 IU or 2ml
along with booster of DPT.
• 3rd dose after 6month 2L IU
• 4th dose after 6month 2L IU
• 5th dose after 6month 2L IU

11. NATIONAL IMMUNIZATION PROGRAMME (UIP)
To prevent the 6/7 vaccine preventable diseases . Points to be noted are:-
a. Cold Chain equipments:- Walk in Cooler (WIC)
Deep Freezer 300/140L
Ice lined Refrigerator (ILR) 300/240L
Cold Boxes
Vaccine Carrier (x)
Day carrier
b. Vaccines , Diluent & VVM (vaccine Vial monitor)
c. AD syringe (auto Disabled syringe)
d. Hub cutter.
e. Disposal of used syringes.

12. Heat sensitive colour monitors which change colour on exposure to heat

14. Janani Suraksha Yojana (JSY)
Aim is to:-
:-Reduce MMR(212 / 1,00,000 live birth) & IMR (44/100 live birth )
:- Increase Institutional delivery in BPL families.
• Target Group:-
:- all pregnant lady of BPL family of age 19yrs or more & married.
:- up to two live birth*.
In JSY to promote institutional delivery cash benefit / assistance has been
linked to institutional delivery. Incentive is given to ASHA ( Rs.600) and
Pregnant lady (Rs.1400).

15. Revised National Tuberculosis Control Programme (RNTCP)
• Provide Diagnostic Services through the Microscopy Centre which
are established in the CHC (1per 1,00,000Population).
• Provide treatment services by providing DOTS as per technical
guidelines.
• Treatment of common complications of TB and side effect of drugs.
• Record and report on RNTCP activities as per guidelines.

16. National Malaria Control Programme (NMCP)
under NVBDC prog
• Provide diagnostic and treatment facility for routine and complicated cases of
Malaria, Filaria, Degue, Japanese Encephalitis and Kala-azar in the respective
endemic zone.
• Malaria control Programmes
National malaria Control Program. (NMCP) in 1953
National Malaria eradication Program. (NMEP) in 1958
Modified Plan of Operation (MPO) in 1977
Enhanced Malaria Control Project. In 1997
• Selection of PHC for EMCP
a. API (Annual Parasite Incidence) of >2 for at least 3yrs.
b. P.falciparum cases being >30% of total malaria cases.
c. 25% population of PHC being tribal.
d. Reported death due to malaria from the PHC.

17. Main components strengthened under this project
1. Early case detection – by providing card test.
2. Early treatment – by Malaria kit & artesunate , artemesin.
3. Personal Protection – by providing ITN (Insecticide treated Net)
4. vector Control – by se of larvivorous fish e.g Gambusia affinis, Lebister reticulatus.
In uncomplicated P.falciparum malaria (adult)
1st day Chloroquine 600mg base
+
Primaquine 45mg(0.75mg/kg)
2nd day Chloroquine 600mg base.
3rd day Chloroquine 300mg base.
Uncomplicated P.vivax
Chloroquine 25mg/kg over 3days as above.
Primaquine 0.25mg/kg daily for 14days
(adult 15mg daily)

18. National Filaria Control Programme
under NVBDC Prog.
• Complete treatment of microfilaria positive cases with DEC.
• Participation and arrangement of Mass Drug Administration (MDA)
with DEC and albendazole on National Filaria Day every year along
with management of side effects if any.
• Morbidity management of Lymphoedema cases.

19. National Leprosy Eradication Programme (NLEP)
• WHO Classification for treatment
purpose:
• Pauci-bacillary leprosy(PB):- 1-5 skin
lesion &/or one nerve involvement.
• Multi-bacillary:- Having 6 or > Skin
lesions &/or more than one nerve
involvement.
MB adult MB child
Rifampicin: 600mg once a month supervised 450mg
Dapsone 100mg daily 50mg
Clofazimine 300mg once a month supervised 150mg
50mg daily 50mg alt. day
Duration of Tt: 12 month 12 month
P.B Adult P.B Child
Rifampicin: 600mg once a month supervised 450mg
Dapsone: 100mg daily 50mg
Duration: 6month 6 month
Multi Drug Therapy (MDT)

20. National Programme for Control Of Blindness
• Facilities available at CHC are:
> Diagnosis and treatment of common eye diseases.
> Refraction services
> surgical services including cataract by IOL implantation at selected CHCs
optionally.
( 1 eye surgeon has been envisaged for every 5 lakh population.)