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253Introduction to Health Systems
unit for 6 subcentres and refers out cases to community health
centres (CHCs-30 bedded hospital) and higher order public sub-
district and district hospitals.
As per the National Health Plan (1983), one PHC is present
for every 30,000 rural populations in the plains and for every
20,000 population in hilly, tribal, and desert areas for more
effective coverage. However, as the population density in the
country is not uniform, the number of PHCs depends upon
the case load. PHCs are functional round the clock with the
provision of 24 × 7 nursing facilities.
Functions of the PHC
The PHCs hold a key position in the nation’s healthcare system.
They provide integrated curative and preventive healthcare to
the rural population with an emphasis on preventive and
promotive aspects of healthcare. The functions of the PHC are
given below:
1. To provide basic laboratory workers.
2. To collect and report vital statistics.
3. To educate the community about health.
4. To provide maternal-child health including family
planning.
5. To help in the effective implementation of national health
programs.
6. Prevention and control of locally endemic diseases.
7. To provide medical care.
8. Referral services.
9. To ensure safe water supply and basic sanitation.
10. To provide training for health guides, health workers, local
dais, and health assistants.
The PHCs are equipped with facilities for selected minor
surgical procedures (e.g. vasectomy, tubectomy, MTP) and for
pediatric care.
Indian Public Health Standards (IPHS) for PHCs
To provide a need-based optimal level of quality healthcare, a
set of standards called Indian Public Health Standards (IPHS)
have been recommended for PHCs.
254 Social Pharmacy
The objectives of IPHS for PHCs are:
1. To provide comprehensive primary health care to the
community through the primary health centres.
2. To achieve and maintain an acceptable standard of
quality of care.
3. To make the healthcare services more responsive and
sensitive to the needs of the community.
Types of Services by PHC
Depending upon the load of delivery cases, PHCs are classified
as:
1. Type A: PHC with a delivery load of less than 20 deliveries
per month.
2. Type B: PHC with a delivery load of 20 or more per month.
Services provided by PHC as given below have been
classified as essential (minimum assured services) or desirable.
1. Medical care: PHCs provide:
i. 6 hours per day OPD services for 6 days per week. The
Medical Officer at PHC should spend at least two
hours per day twice a week for monitoring field work
and monitoring.
ii. 24-hour emergency services to manage injuries and
accidents, first aid, stitching of wounds, incision and
drainage of abscess, stabilization of the condition of the
patient before referral, dog bite/snake bite/scorpion
bite cases, and other emergency conditions;
iii. Referral services.
iv. In-patient services (6 beds).
2. Maternal and child healthcare including family
planning:
a. Antenatal care:
i. Chemoprophylaxis for malaria in high malaria
endemic areas for pregnant women.
ii. Counseling on diet, tobacco cessation, pre-birth
preparedness, danger signs, and rest.
iii. Early registration of pregnancy (ideally within the
first trimester).
255Introduction to Health Systems
iv. Folic acid and iron supplementation.
v. Identification, management, and timely referral for
HIV/AIDS, and high-risk pregnancy cases.
vi. Laboratory investigations like urine examination for
albumin and sugar test, blood test for hemoglobin,
blood grouping and Rh typing, and rapid plasma
reagin (RPR) test for syphilis.
vii. Minimum 4 antenatal check-ups.
viii. Recording of general check-ups, height, weight,
blood pressure, and abdominal examination.
ix. Tetanus toxoid immunization.
b. Intranatal care:
i. 24-hour services for both normal and assisted
delivery.
ii. Appropriate and prompt referral for cases needing
specialist care.
iii. Conducting assisted vaginal deliveries including
forceps/vacuum delivery whenever required.
iv. Management of normal deliveries.
v. Management of pregnancy-induced hypertension.
vi. Management of labor using Partograph.
vii. Manual removal of placenta.
viii. Minimum 48 hours of stay after delivery.
ix. Pre-referral management in obstetric emergencies
that need expert assistance.
x. Promotion of institutional deliveries.
c. Postnatal care:
i. Counseling on contraception, nutrition, immuni-
zation, hygiene, and essential newborn care.
ii. Initiation of early breastfeeding within one hour of
birth.
iii. Minimum 2 postpartum home visits, first within
48 hours of delivery and 2nd within 7 days through
subcenter staff; 3 additional visits for a low birth
weight baby (less than 2.5 kg) on the 14th day, 21st
day.
256 Social Pharmacy
iv. Provision of facilities under Janani Suraksha Yojana
(JSY).
d. Newborn care:
i. Early initiation of breastfeeding within one hour of
birth.
ii. Essential New Born Care (ENBC) and Resuscitation.
iii. Identification of sick newborns and prompt referral.
iv. Management of neonatal jaundice, hypothermia,
infection protection, and cord care.
e. Care of the child:
i. Assess the growth and development of infants and
under 5 children.
ii. Counseling on exclusive breastfeeding for 6 months
and complementary feeding from 6 months of age
along with breastfeeding.
iii. Full immunization of all infants and children against
vaccine-preventable diseases as per specified guide-
lines.
iv. Management of acute and severe malnutrition
cases.
v. Prevention and control of infections like diarrhea,
pneumonia, and anemia, etc.
vi. Routine and emergency care of sick children
including Integrated Management of Neonatal and
Childhood Illnesses (IMNCI) strategy and inpatient
care. Prompt referral of sick children requiring
specialist care.
vii. Vitamin A prophylaxis to children as per national
guidelines.
f. Family welfare:
i. Counseling and appropriate referral for couples
having infertility.
ii. Education, motivation, and counseling of couples to
adopt appropriate family planning methods.
iii. Provision of contraceptives such as condoms, oral
pills, emergency contraceptives, and IUCD inser-
tions.
257Introduction to Health Systems
iv. Referral and follow-up services to the eligible
couples adopting permanent methods (tubectomy/
vasectomy).
3. Medical termination of pregnancies (MTP).
4. Management of reproductive tract infections/sexually
transmitted infections.
5. Nutrition services.
6. School health services.
7. Adolescent healthcare.
8. Disease surveillance and control of locally endemic
diseases like malaria, kala-azar, Japanese encephalitis,
etc.
9. Collection and reporting of vital events.
10. Promotion of safe drinking water, sanitation including use
of toilet and appropriate garbage disposal.
11. Testing of water quality and disinfection of water sources.
12. National health programs:
a. Revised National Tuberculosis Control Programme
(RNTCP): All PHCs function as DOTS (Directly
Observed Therapy) Centres to treat TB patients
through DOTS as per RNTCP treatment guidelines
and maintain records of RNTCP activities. Facilities for
the collection and transport of sputum samples should
be available as per the RNTCP guidelines.
b. National Programme for Control of Blindness
(NPCB):
i. Basic services: Diagnosis and treatment of common
eye diseases.
ii. Refraction services.
iii. Etection of cataract cases and referral for cataract
surgery.
iv. Awareness generation through appropriate IEC
strategies for prevention and early detection of
impaired vision and other eye conditions.
c. National Vector Borne Disease Control Programme
(NVBDCP):
i. Diagnosis and reporting of malaria cases after
microscopic confirmation and treatment.
258 Social Pharmacy
ii. Symptomatic treatment, hospitalization, and case
management of Japanese Encephalitis (JE),
lymphoedema/elephantiasis, and dengue cases as
per the protocols.
iii. Complete treatment to kala-azar cases in endemic
areas as per guidelines issued by NVBDC.
iv. Complete treatment of microfilaria positive cases.
d. National AIDS Control Programme:
i. IEC activities to enhance awareness and preventive
measures about STIs and HIV/AIDS, Prevention of
Parents to Child Transmission (PPTCT) preventive
services.
ii. screening with one rapid test, counseling and
referral of HIV suspects and high-risk groups.
iii. condom promotion and distribution of condoms to
the high-risk groups.
iv. Help and guide patients with HIV/AIDS.
v. Pre- and post-test counseling of AIDS patients by
PHC staff in high prevalence states.
e. National Leprosy Eradication Programme (NLEP):
i. Health education to the community regarding signs
and symptoms, complications, and treatment of
leprosy.
ii. Training of leprosy patients having ulcers for self-
care.
iii. Counseling of leprosy patients about the treatment
of leprosy.
f. National Programme for Prevention and Control of
Deafness (NPPCD):
a. Early detection of cases of hearing impairment and
deafness.
b. Creating awareness in the community regarding
basic diagnosis and treatment services for common
ear diseases like wax in the ear, otomycosis, otitis
externa, ear discharge, etc.
c. Education of the community regarding prevention,
early detection of hearing impairment/deafness,
259Introduction to Health Systems
g. National Mental Health Programme:
a. Early diagnosis and treatment of common mental
illnesses.
b. IEC activities for prevention and early detection of
mental disorders and role of community for primary
prevention of mental disorders.
h. National Cancer Control Programme and National
Programme for Prevention and Control of Diabetes,
Cardiovascular Diseases (CVD), and Stroke:
a. Essential IEC activities to promote a healthy lifestyle
to sensitize the community about the prevention of
cancers, cardiovascular diseases, diabetes, and
strokes.
b. Early detection and prompt referral of suspect cases.
c. Health promotion services to modify individual,
group and community behavior through the
promotion of healthy dietary habits, increased
physical activity, avoidance of tobacco and alcohol,
and stress management.
i. National Iodine Deficiency Disorders Control
Programme:
a. Essential IEC activities to promote the consumption
of iodized salt by the community.
b. Testing of salt for the presence of iodine through salt
testing kits.
j. National Tobacco Control Programme:
a. Health education and IEC activities regarding ill
effects of tobacco use and secondhand smoke
especially in pregnant females, and in patients with
non-communicable diseases where tobacco is a risk
factor.
b. Promoting quitting of tobacco in the community.
c. Implementation of ban on smoking in public places,
sale of tobacco products to minors, sale of tobacco
products within 100 yards of educational
institutions.
260 Social Pharmacy
k. Oral Health: Oral health promotion and checkups and
appropriate referral on identification.
l. National Programme for Health Care of Elderly:
a. IEC activities on healthy aging people.
b. Complete health assessment of elderly persons,
medicines, management of chronic diseases, and
referral services.
m. Physical Medicine and Rehabilitation (PMR)
Services:
a. Primary prevention of disabilities.
b. Early identification, detection, and counseling of
persons with disabilities
c. Community-based rehabilitation services.
d. Issue of disability certificate for obvious disabilities
by PHC doctor.
n. National Programme for Prevention and Control of
Fluorosis (NPPCF) (in affected (endemic) districts):
a. IEC activities to prevent fluorosis.
b. Clinical examination and preliminary diagnostic
parameters for cases of fluorosis.
13. Appropriate and prompt referral of cases needing special
care and providing transport facilities either by PHC
vehicle or other available referral transport.
14. Basic Laboratory and Diagnostic Services:
i. Routine urine, stool, and blood tests (Hb%, platelets
count, total RBC, WBC, blood sugar, blood grouping
and Rh typing, cholesterol, bleeding, and clotting
time).
ii. Diagnosis of RTI/STDs with wet mounting, Gram
stain, etc.
iii. Sputum testing for Mycobacterium (as per guidelines
of RNTCP).
iv. Blood smear examination for malaria parasite.
v. Rapid pregnancy tests.
vi. RPR test for syphilis.
vii. Rapid test kit for fecal contamination of water.
261Introduction to Health Systems
viii. Estimation of chlorine level of water using ortho-
toluidine reagent.
ix. ECG.
15. Record of vital events, reporting of births and deaths, and
maintenance of all relevant records concerning services
provided in PHC.
16. Orientation training of male and female health workers in
various National Health Programmes including RCH,
adolescent health services, and immunization.
17. Skill-based training for ASHAs.
18. Initial and periodic training of doctors/paramedics
through continuing medical education, conferences, and
skill development training.
19. Mainstreaming of AYUSH-based preventive, promotive,
and curative healthcare and public health education
activities including awareness about the uses of medicinal
plants and local health practices.
Urban Healthcare Services
1. Urban Primary Health Centre (U-PHC)
As per the norm, one U-PHC is required for approximately
50,000–60,000 urban populations. The U-PHCs are preferably
located within or near a slum to provide services including
OPD (consultation), basic lab diagnosis, drug/contraceptive
dispensing, and counseling for all communicable and non-
communicable diseases. The working hours of U-PHC may be
12 noon to 8 pm. U-PHCs do not provide in-patient care.
2. Urban Community Health Centre and Referral Hospitals
Urban Community Health Centres (U-CHCs) are set up in cities
with a population of above 2.5 lakhs (100 beds for every 5 lakhs
population in metro cities). A 30–50 bedded U-CHC should be
established for providing in-patient care. The Central
Government provides only a one-time capital cost for setting
up the U-CHCs and the recurrent costs including the salary of
the staff are borne by the respective state governments. The U-
CHCs provide medical care and facilities for minor surgeries,
and institutional delivery.
262 Social Pharmacy
3. Outreach Services
National Urban Health Mission (NUHM) supports the
engagement of ANMs in conducting outreach services for
targeted groups, particularly slum dwellers and the vulnerable
population to provide preventive and promotive healthcare
services at the household and community level.
4. Referral Linkages
State government hospitals, medical colleges, and private
hospitals including maternity homes are enlisted/approved to
act as referral points for different types of healthcare services
like maternal and child health, diabetes, critical illness, trauma
care, orthopedic complications, mental health, deafness control,
cancer management, tobacco counseling/cessation, critical
illness, diabetes, surgical cases dental surgeries, etc.
5. Community Process
The NUHM encourages the effective participation of
community-based institutions like Mahila Arogya Samiti
(MAS) and Rogi Kalyan Samitis in the planning and
management of healthcare services. It promotes the
engagement of community health volunteers—Accredited
Social Health Activist (ASHA) or Link Workers (LW) in urban
poor settlements.
a. Mahila Arogya Samiti (MAS): One Mahila Arogya Samiti
covers 250-1,000 beneficiaries and between 50 and 100
households. MAS acts as a community-based peer
education group in slums to facilitate community
mobilization, access to identified facilities, monitor
preventive and promotive care, and management of grants
received
b. ASHA/Link Worker: ASHA (frontline community worker)
serves as an effective link between the health facility and
the urban slum population. Each link worker/ASHA has
a well-defined service area (one ASHA for 1000–2500
urban poor population covering about 200 to 500
households). However, the states have the flexibility to
either engage ASHA or entrust her responsibilities to