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ACCREDITATION STANDARDS FOR

PRIMARY URBAN HEALTH CENTRE

FIRST EDITION : NOVEMBER, 2009

National Accreditation Board For Hospitals


& Healthcare Providers
Accreditation Standards for Primary Urban Health Centre

TABLE OF CONTENTS

PART 1 ACCREDITATION STANDARDS


S.No. Particulars Page No.
SECTION - A STRUCTURAL STANDARDS 5-8
01 Physical Facilities 5
02 Functional Plan 56
03 Equipments & Instruments 6
04 Man Power & Staffing 67
05 Drugs 7
06 Transport & Ambulance Services 78
07 Communication Facility 8
SECTION - B PROCESS STANDARDS 9 - 15
08 Access to the facility 9
09 Availability of Staff 9
10 Evaluation of Patients 9 10
11 Care of Patients 10
12 Control of Infection 11
13 Bio-Medical Waste Management 11 12
14 Sanitation, Hygiene and Potable Water 12
15 Counseling and IEC 12 13
16 Preventive Health 13
17 Participation in National Health Programs 14
18 Referral Services 14
Community Mobilization with RWAs, NGOs and Local Self
19 14
Help groups
20 Social Responsibility 15
SECTION - C GOVERNANCE STANDARDS 16 - 19
21 Ownership of Building 16
22 Quality Assurance 16
23 Rights and Responsibility of Patients 16 17
24 Rights and Responsibility of Staff 17
25 Training Development and Motivation of Staff 17 - 18
26 Surveillance of ANMs, LHVs and other field workers 18

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27 Public Private Partnership 18


28 Pricing and Services 18
29 Community Based Health Insurance 19
30 License and Statutes 19
31 Local Social Customs 19
32 End of Life Care 19
SECTION - D OUTCOME STANDARDS 20 - 21
33 Utilization indices of the Centre 20
34 Primary Urban Health Centre Statistics 20
35 Reporting of Birth, Death and Other details 20
36 Medical Records 21
37 Patient & Employee Satisfaction 21
38 Health Information System 21
PART 2 - GUIDE BOOK
SECTION - A STRUCTURAL STANDARDS 23 - 58
01 Functions / Service Outlay 24
02 Zones 25 - 27
03 Area & Space Requirements 28 - 33
04 Instruments & Equipments 34
05 Common Surgical Consumables 35
06 Laboratory & Radiology Items 36 - 37
07 Furniture Items 38
08 General & Miscellaneous Items 39 - 40
09 Stationary & Linen Items 41 - 42
10 Manpower & Staffing 43
11 Essential Drug List 44 - 56
12 Ambulance Requirements 57
13 Primary Urban Health Centre Schematic Layout 58
SECTION - B PROCESS STANDARDS 59 - 92
01 Clinical & Diagnostic Service in PUHC 60 - 65
02 Clinical Services in Outreach 66 - 67
03 Convergence with related sectors 68
04 Strengthening of Referral System 69 - 77
05 Capacity Building & Training of Staff 78 - 79

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Accreditation Standards for Primary Urban Health Centre

06 Behaviour Change Communication (BCC) 80 - 82


07 Information, Education & Communication (IEC) 80 - 81
08 Bio Medical Waste Management 83
09 Hand Washing Techniques 84
10 Management of Information 85 - 86
11 Facility Management 87
12 Community Participation and Empowerment 88 - 92
SECTION - C GOVERNANCE STANDARDS 93 - 147
01 Citizen Charter for primary Urban Health Centre 94 - 100
02 Job Responsibilities of Primary Urban Health Centre Staff 101 - 133
03 Self Appraisal of Primary Urban Health Centre Staff 134 - 146
List of Licenses and Acts: Applicable to Public Healthcare
04 147
facilities
SECTION - D OUTCOME STANDARDS 148 - 162
01 Optimal Facility Management & Efficient Processes 149 - 150
02 Service Guarantee 151 - 155
Increased Utilization of Services leading to Positive Health
03 156
Outcomes
04 Client Satisfaction 157
05 Community Involvement and Empowerment 157
06 Patient Exit Interview 158 - 160
07 Quality Assurance (Monitoring & Evaluation) 161 - 162

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PART -1
ACCREDITATION STANDARDS
Accreditation Standards for Primary Urban Health Centre

SECTION - A
STRUCTURAL STANDARDS

A-1 PHYSICAL FACILITIES

Objective Elements

a. The facility shall confirm to the FAR Norms of that particular region as per the State
Government Rules.
b. For all expansions the space shall be acquired as per the standards
c. Land scaping shall be compulsory.
d. The facility shall be fenced to guard against entry of animals.
e. Main entrance shall be easily identifiable, welcoming, well lit and with mattress.
f. Emergency Exits shall be provided.
g. It shall confirm to the covered area ratio vis--vis the size of plot.
h. Adequate circulatory space for movement of traffic including trolley and wheel chairs
to be present.
i. Adequate ramps to be present to cater to the requirements of immobile patients.
j. Accommodation (Semi-Full furnished) facilities (as per grades) for the core staff i.e.
MO, Nurse, and Pharmacist to be available.
k. Laundry, Housekeeping, Security and Dietary services shall be out sourced as per a
MOU with the provider on certain quality criteria.
l. There shall be 24X7 availability of electricity and potable water supply with identified
alternate sources.
m. Arrangement for fire safety shall be present.
n. Adequate drainage system shall be built-in.

A-2 FUNCTIONAL PLAN

Objective Elements

a. The building shall have a good functional plan having ear marked space for waiting
area, OPD, Labour Room, Minor OT, Sterilization Room, Pharmacy, Dressing Room,
Injection Room, X-ray Room, Dark Room, Store Room (for drugs, linen and
equipments), Counseling Centers, Administrative Office, Toilet (male & female) with

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running water facilities, Nurses Room, Cold Chain Room, Immunization, space for
Laboratory services shall be as per the area and space requirements annexed.
There shall be rooms for other state run programs like TB, Leprosy, Ophthalmic,
ICTC, Sickle Cell Anemia, ANC, FP, CNDC.
b. OT, Labour room and dressing rooms shall have tiled (glazed) walls to height of four
feet to ensure easy cleaning.

A-3 EQUIPMENTS AND INSTRUMENTS

Objective Elements

a. The facility shall have adequate number of equipments along with instruments as
stated in instruments and equipments and common surgical consumables list for
Primary Urban Health Centre in the Reference Manual.
b. The equipments shall be in functional order and have an up time of 98%.
c. All equipments shall have insurance cover.
d. There shall be appropriate mechanism for repair, maintenance and two year
renewable AMC of all the equipments.
e. The instruments used shall be adequately disinfected, sterilized and kept in good
working condition.
f. Organization shall have resources for ensuring skill based training on use/ handling
of equipments.
g. There shall be simple yet effective Condemnation Policy for equipments and instruments.

A-4 MANPOWER & STAFFING

Objective Elements

a. The staffing norms as stated in Reference Manual for Primary Urban Health Centre
to be maintained.
b. At least 2 Medical Officer (MBBS) to be present all the time. Out of the 2 at least 1
shall be trained in emergency obstetric care.
c. One AYUSH expert shall be present.
d. 1 nurse to be present in the centre.
e. Roster for doctor and nurses to be displayed.
f. Emergency call, Roster to be available for the core staff i.e. Doctors, nurses and
pharmacists.

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Accreditation Standards for Primary Urban Health Centre

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

x Managerial/ Administrative training to MO/ Head.


x Programme implementation training to MO/ Head.
x Induction training to staff at all levels.
x Job based skills training.
x Special clinical skill training on minor surgical procedure, obstetrics care,
new born care, basic life support and local anesthesia block.

x Disaster Management.

A-5 DRUGS

Objective Elements

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


State Government or essential drug list in Reference Manual for Primary Urban
Health Centre to be maintained.
b. Availability of drugs and surgical consumable to be ensured.
c. Availability of drugs to be displayed along with expiry dates.
d. Medical Officers to prescribe drugs based on the available formulary or essential
drug list.
e. Medicines dispensed shall have clear instruction on dose and schedule for
consumption purposes.
f. Consumption report of the drugs to be submitted to the district authorities of the
particular district.
g. Minimum balance and re-order level to be maintained.
h. Lead time of sourcing the drugs and consumable to be maximum of 1 week.
i. Drugs shall be stored in well lit and well ventilated rooms.
j. Certain drugs to be kept in the refrigerator.
k. The Temperature of the refrigerator to be maintained at 4 to 6 degree centigrade.

A-6 TRANSPORT AND AMBULANCE SERVICES

Objective Elements

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

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Accreditation Standards for Primary Urban Health Centre

Health centre.
b. There shall be at least one ambulance.
c. Driver for the same to be available all the times.
d. Ambulance shall be in working condition all the time.
e. Emergency drugs to be available in the ambulance.
f. Basic resuscitation kit to be available in the ambulance.
g. At least 2 number of stretcher trolleys to be available.
h. At least 2 wheel chairs to be available.
i. The Stretcher trolleys and wheel chairs to be in working condition all the times.
j. There shall be local public transport facility available.

A-7 COMMUNICATION FACILITIES

Objective Elements

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


b. At least 2 telephone (24X7) connections to be available in the facility.
c. A dial-up internet connection to be available.
d. Arrangements for a public address system to be available.
e. Organization shall use Signboards, Posters or/ and wall painting displaying the
activities and services (along with timings) at the facility and the important contact
numbers at prominent sites in the campus as well as in all villages. These shall be in
local language.
f. Campaigns for National Health Programs shall be displayed in the form of wall
painting or boards.
g. Lay out map of the Primary Urban Health Centre and signage shall be in vernacular
and symbols to address the needs of vulnerable patients.

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Accreditation Standards for Primary Urban Health Centre

SECTION - B
PROCESS STANDARDS

B -1 ACCESS TO THE FACILITY

Objective Elements

a. The facility shall be easily assessable by at least two approachable all weather
roads.
b. There shall be transport facility from main road to the facility campus in case it is at
significant distance.
c. The roads shall be metallic to facilitate the 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.

B-2 AVAILABILITY OF STAFF

Objective Elements

a. At least 1 medical officer and 1 nurse shall be available at all times in the facility.
b. Staff shall attend to any emergency at all times beyond the normal OPD or working
hours.
c. At least 1 staff member shall be available at all times to provide guidance or basic
information to the patients and their families.
d. Facility shall have Assistant Professor from Medical College designated as its
Radiological Surveillance Officer.
e. Facility shall be guarded by Security personnel 24X7.
f. Available staff shall be immunized and insured for health / hospitalization.

B-3 EVALUATION OF THE PATIENT

Objective Elements

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

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b. The nurse / ANM shall carry out assessment in terms of noting the vitals, height and
weight of the patient in a pre designated area of the OPD card.
c. Medical officer to document the findings of the patient in a definite area in the OPD
card.
d. Advise for medication and investigation to be documented in predefined areas of the
card.
e. The documentation to be legible, timed, dated, named and signed by the medical
officers.
f. The instructions to be communicated to the patient in an understandable (verbal and
written) manner.
g. The assessment of the patient is uniform in all settings i.e. Emergency, OPD etc.
h. Records of all such assessments to be maintained (for time limits as per regulations)
in the center.

B-4 CARE OF PATIENTS

Objective Elements

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


b. The staff shall be courteous, humane and empathetic.
c. Care shall commensurate with the amenities available.
d. Care shall be provided in manner in which dignity and privacy of patient is
maintained.
e. Centre shall have written SOPs on Care.
f. Care shall be comprehensive in nature i.e. preventive, promotive, curative and
rehabilitative in nature.
g. A Referral card to be given to the patients on their referral to the higher facility for
treatment.
h. In case of death a death summary to be given to the patients family.
i. A general consent to be obtained for all patients accepted in the center.
j. An informed consent to be obtained for patients undergoing any procedures.
k. A list of procedures for which informed consent to be obtained shall be available in
the center.
l. The consent for shall be in vernacular / local language.
m. Consent shall be obtained either by the medical officer or the nurse.
n. Behavior of the staff towards all the patients and family members to be very cordial,
caring and basic health services to be provided all the time.

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Accreditation Standards for Primary Urban Health Centre

B-5 CONTROL OF INFECTION

Objective Elements

a. Organization shall have written Infection Control Policy.


b. Organization shall have identified/ ear marked resources (0.5% Sodium
Hypochlorite, Laboline etc) for infection control.
c. Organization shall have written protocols on cleaning of the infection prone areas
(OT and Labour room) and equipments used in patient care.
d. The center shall take all precautions to control infection.
e. Adherence to standard precautions to be maintained by all staff.
f. Mopping (by latest available disinfectants) of all areas of the center to be carried out
at least twice a day.
g. Carbolisation of the OT, Labour Room, Laboratory to be carried out at least twice a
day.
h. Availability of running tap water for hand washing of staff to be maintained 24 hours
a day.
i. The hospital environment to be kept clean from litters, pest and stray animals.
j. Adequate lighting arrangement and cross ventilation to be present in all areas.
k. Sanitation of the toilets and hygiene of the staff to be maintained.
l. Adequate amount of bleaching lotion to be available for disinfection purposes.
m. The labour room, OT and OPD areas to be washed with soap and water at least
once in 2 weeks and a documentation there of to be maintained.
n. Autoclaving of all the instruments and linen used in the labour room, OT, dressing
room to be done.
o. Quality checks of the autoclave to be maintained by using quick strips (Signaloc).

B-6 BIO-MEDICAL WASTE MANAGEMENT

Objective Elements

a. Centre waste generated shall be managed in accordance with the Bio-medical waste
management and handling rules 1998.
b. General waste to be collected in black bags.
c. The yellow bags to be subjected to deep burial and a pit for the same to be created with
in the premises according to the dimensions specified by the biomedical rules 1998.

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


e. Chemical treatment of plastics to be carried out by using freshly prepared bleaching
lotion.
f. A site for composting of biodegradable waste to be available with in the hospital
premises.
g. Annual report to be submitted to the competent authority by 31 st January every
year.
h. Accidental spillage of waste shall be reported and handled as per the BMW
Guidelines.
i. Segregation of wastes to be done in maximum of 3 bags (Black, Yellow & Blue).
j. Organization shall have resources to train all health personnel on handling BMW as
per regulations.

B-7 SANITATION, HYGIENE AND POTABLE WATER

Objective Elements

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


b. The center shall promote sanitation hygiene and availability of potable water in the
community by involving the RWAs, Self Help Groups and NGOs.
c. The center shall distribute chlorine tablets to the community and educate them about
their usage.
d. The perils of open defecation to be informed to the community living in JJ clusters
and slums.
e. Creation of soak pit and trench lavatories to be carried out by involving the local self
help groups and NGOs in JJ clusters and slums.
f. Health education and maintenance of hygiene to be done by adopting
the principles of school health and involving public opinion makers.
g. A plan to combat disasters, epidemics in the community shall be ready in the facility,
communicated to all concerned and rehearsed at least twice a year.

B-8 COUNSELING AND IEC

Objective Elements

a. The health workers and related staff to be involved in counseling the community
regarding population stabilization, safe sex, hygiene, breast feeding, anemia,

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Accreditation Standards for Primary Urban Health Centre

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


b. Appropriate IEC tools to be available so as to create awareness amongst the
community for availing the services of the center.
c. Thrust to be given for reproductive and child health services.
d. Staff of the center to disseminate the plans and programs (specific to the area) of the
Government by using all IEC tools available e.g. posters, pamphlets, wall hangings,
paintings, audiovisual tools etc.
e. Counseling shall also include knowledge about HIV/AIDs and other communicable
and lifestyle diseases.
f. Organization shall have policy of printing "name & contact number of doctor" on the
cards (OPD & Discharge), IEC tools used.

B-9 PREVENTIVE HEALTH

Objective Elements

a. The organization shall give impetus to the preventive aspect of health care.
b. The staff (Doctors, Nurses, ANMs, Pharmacist, Laboratory technician, Radiographer
etc.) shall maintain open channels of communication with the patients and their
families.
c. Immunization shall commensurate with the universal immunization program.
d. Expecting mothers to be given two doses of tetanus immunization in their antenatal
checkups.
e. New borns to be immunized according to the schedule and a card stating their
immunization status and growth pattern along with the mile stones to be available
with all parents.
f. Field health workers shall educate about adolescent health and life style
management.
g. Organization shall be involved in:
x Management of disease outbreaks- Identification, classification (water-borne,
vector-borne, vaccine preventable), incidence reporting, investigation, data
collation, analysis and reporting.

x Water quality surveillance.


x Disaster mapping- identification, preparedness (equipments, antidotes,
emergency care, referral services) and networking.
h. Organization shall have identified resources (equipments & drugs) for
handling such preventive programmes/ actions.

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B - 10 PARTICIPATION IN NATIONAL HEALTH PROGRAMS

Objective Elements

a. The center shall participate in all the National Health programs as stated in
Reference Manual for Primary Urban Health Centre.
b. Community mobilization and their participation to make the program successful is
responsibility of the centre.
c. Report of such program shall be submitted to the authorities periodically by the
MOIC.

B -11 REFERRAL SERVICES

Objective Elements

a. The center shall practice a bi-directional or standardized referral system as per the
policy.
b. The referral cards (with contact numbers) according to the colour coding to be
available and a document there of to be maintained.
c. Patient shall be referred to the secondary or tertiary healthcare facility in the close
proximity to the center, based on the condition of the patient.
d. All such patient to be followed up for their progress by the MOIC.
e. Entries of the transferring in or out to be maintained in register or the computer.
f. Patient referred from the center shall be transported in an Ambulance.

B - 12 COMMUNITY MOBILIZATION WITH RWAs/ NGOs / LOCAL


SELF HELP GROUPS

Objective Elements

a. The organization shall have a continuous interaction with the RWAs / NGOs / Local
Self Help Groups.
b. All meetings shall be planned and that the agenda of meeting shall be area specific
and / or as per the requirements of the community.
c. All meetings to be documented.

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Accreditation Standards for Primary Urban Health Centre

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


proactive intervention to be planed.
e. Gatekeeper approach in mobilizing the community shall be followed.

B - 13 SOCIAL RESPONSIBILITY

Objective Elements

a. The center shall understand that it is and integral part of the society.
b. The center shall carry out camps, melas, and healthy competitions etc. periodically.
c. Respect to the senior citizens and active participation in school health shall be
documented.
d. Training to the community on household remedies and first Aid shall to be carried out
and documented.
e. A sense of ownership of the facility by the community to be created.
f. Center shall participate in all cultural activities in the community.

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SECTION - C
GOVERNANCE STANDARDS

C-1 OWNERSHIP OF BUILDING

Objective Elements

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


b. It shall have the approved building plan along with sanction from the local authorities.
c. The X-ray facility shall be approved by AERB.

C-2 QUALITY ASSURANCE

Objective Elements

a. The hospital shall have a quality assurance manual.


b. Standards operating procedures to be available at various patient care area e.g.
OPD, Emergency, Pharmacy, Lab and Imaging.
c. The manual shall include infection control and waste management issues.
d. Safety of patients and staff shall have due consideration in the manual.
e. Scope of Corporate Social Responsibility (CSR) shall be encouraged for upgrading
the services.

C-3 RIGHTS AND RESPONSIBILITY OF PATIENTS

Objective Elements

a. Rights and responsibility of the patients shall be in accordance with the Citizen
Charter for Primary Urban Health Centre.
b. A citizen charter to be displayed mentioning the user charges, quality of the services,
name of the medical officer with the telephone numbers etc.
c. The rights of the patients as a consumer have to be respected and displayed e.g.
rights to choose, right to deny, right to gather information etc.
d. A mechanism for grievance redressal to be in place and practiced.

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e. All redressal mechanisms to be documented.


f. Users and providers will be jointly responsible to maintain the building of the Primary
Urban Health Centre in an orderly manner.
g. Patients to follow the instruction of the health care providers sincerely.
h. The patients have the right to their privacy, information and disease condition that
shall not be disclosed to others.
i. Citizen charter and rights of the patients shall be displayed in local language and
shall be universal for the state.

C-4 RIGHTS AND RESPONSIBILITY OF STAFF

Objective Elements

a. The staff shall respect patients' right.


b. They shall carry out their respective job responsibilities as described in the annexure.
c. They shall demonstrate reasonable skill to provide care to the patients.
d. They are entitled to all the benefits (immunization, healthcare cover through
insurance, semi to fully furnished staff quarters as per entitlement and availability, its
maintenance and security) due to them by virtue of their employment.
e. Staff shall be cordial, humane, empathetic and respectful to their colleagues and the
patients.
f. Employees to be immunized for Hepatitis, Tetanus etc.

C-5 TRAINING DEVELOPMENT AND MOTIVATION OF STAFF

Objective Elements

a. The organization shall arrange for continuous updation of knowledge and skills of the
staff.
b. Periodic training programs on the subjects of waste management, infection control,
communication etc. to be carried out and documented.
c. Training for behavioral change communication shall be carried out and documented.
d. Training on all aspects of various national health programs to be carried out.
e. Evaluation of all such training to be documented.
f. Several cash and non-cash incentives to be given so as to constantly motivate the
staff.

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Accreditation Standards for Primary Urban Health Centre

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


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

C-6 SURVEILLANCE OF ANMS, ASHAS AND OTHER FIELD


WORKERS

Objective Elements

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


b. Feedback mechanisms to exist so as to asses the visits of the above workers in the
community.
c. Local NGOs and Community Based Organizations to be involved in the surveillance
program.
d. Monitoring of distribution of iron tablets, motivating patient for institutional deliveries
to be carried out as an on going program.
e. The field workers shall have sufficient materials for their use.
f. A training and motivational program to exist for the above workers.
g. Validation of the process shall be carried out by higher authorities.

C-7 PUBLIC PRIVATE PARTNERSHIPS

Objective Elements

a. Involving a private provider for scavenger services.


b. Involving a private transporter for transporting patients.

C-8 PRICING AND SERVICES

Objective Elements

a. Unified pricing mechanism as per the policy of the state concerning the user fee to
be applied.
b. Patients to be informed about the charges.
c. Always a receipt to be given to the patients.
d. Proper accounting of the collections to be maintained.

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C-9 COMMUNITY BASED HEALTH INSURANCE

Objective Elements

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


as to cater to the requirements of the patients.
b. Local NGOs and co-operative society to be involved to arrange for certain basic
expenses for the patients.

C - 10 LICENSE AND STATUTES

Objective Elements

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


BARC, AERB, fire safety etc as applicable.
b. Statutory requirements concerning patient and staff safety and welfare shall be met
with.

C - 11 LOCAL SOCIAL CUSTOMS

Objective Elements

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


b. Myths concerning health availing practices to be evaded e.g. taking of local pudia for
viral hepatitis (jaundice) isolating post partum mothers etc.

C - 12 END OF LIFE CARE

Objective Elements

a. Centre shall provide appropriate respect and dignity to the dying and the dead.
b. All death cases to be recorded and reported.
c. Death certificate (MCCD- Medical Certificate for Cause of Death) to be issued to the
next of kin.
d. Organization shall carry out Death Audits periodically.

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Accreditation Standards for Primary Urban Health Centre

SECTION - D
OUTCOME STANDARDS

D-1 UTILIZATION INDICES OF THE CENTRE

Objective Elements

a. Hospital to record all parameters as stated in the Quality Assurance Manual for
Primary Urban Health Center.
b. Utilization of OPD, IPD, X-ray, Labor Room, Man Power, Laboratory services,
Referral services (to & from the facility), ambulance services, MLC services to be
analyzed and maintained for continuous quality improvement.
c. Utilization of equipments shall be monitored on regular basis.

D-2 PRIMARY URBAN HEALTH CENTRE STATISTICS

Objective Elements

a. Hospital statistics in terms of OPD attendance, Immunization rate, birth rate, death
rate, minor and major operations etc. to be documented and reported.
b. A bulletin is published every quarterly stating the above details.

D-3 REPORTING OF BIRTH, DEATH AND OTHER DETAILS

Objective Elements

a. All the birth and the death in the Centre and the population to be reported to the
concerned Nagar palikas, municipal authorities and other local authorities.
b. Incidence and prevalence of diseases to be reported to the district authorities.
c. Epidemics and communicable diseases to be reported to the authorities.
d. Accidents and mishaps shall also be reported to authorities as per decided timelines.

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D-4 MEDICAL RECORDS

Objective Elements

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


b. An audit of the medical records is carried out every quarter.
c. The records are kept at for pre defined duration as per the policy.
d. There shall be provisions for storing and retrieval of the records.
e. All entries by the doctors and nurses are legible and complete.
f. All records must be computerized for accurate record maintenance.

D-5 PATIENT & EMPLOYEE SATISFACTION SURVEY

Objective Elements

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


NGOs, RKS and RWA members shall be present.
b. On going mechanism of conducting employee satisfaction shall be present.
c. Organization shall have Grievance Redress Policy and mechanism.
d. Organization shall have in use feedback mechanism like use of feedback forms,
suggestion forms to be dropped in suggestion/ complaint boxes at identified places.

D-6 HEALTH INFORMATION SYSTEM

Objective Elements

a. Community statistics like IMR, MMR, birth rate, death rate etc. to be documented
and reported.
b. Reporting of all the details to be done through a web based health information
system to the authorities on a daily, weekly, monthly and annual basis.
c. Health Information System tools shall be as per the state directives.

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PART 2
GUIDE BOOK
STRUCTURAL STANDARDS
Accreditation Standards for Primary Urban Health Centre

FUNCTIONS/ SERVICE OUTLAY

Primary Urban Health Centre is a first level contact facility serving a range of customers,
containing as much as possible all specialties such as:

OPD CLINICS

Obstetrics & Gynaecology Paediatrics

General Medicine AYUSH

Dental

DIAGNOSTIC SERVICES

LABORATORY IMAGING

Haematology/ Cytology X-Ray

Biochemistry/ Microbiology Ultrasound/ Doppler

ECG

OTHER SERVICES

Physiotherapy Minor OT / Procedure Room

Dressing / Injection / Plaster

SUPPORT SERVICES

Facility Maintenance Ambulance

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


usually not integral to a hospital but linked to the identified secondary & tertiary level
healthcare providers through a functional two way referral linkage.
.

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Accreditation Standards for Primary Urban Health Centre

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

Examination and Workup


- Examination room
- Sub-waiting
Consultation
- Consultation rooms
- Toilets
- Sub-waiting
Nursing Station
Ambulatory Zone (OPD) (B)
- Nurses Desk
- Clean Utility
- Dirty Utility
- Treatment rooms (Injection, Dressing, Plaster,
ECG)
- Sub-waiting
Casualty / Emergency
Public Utilities

Pathology (optional)
- Laboratory
Diagnostic Zone (C) - Sample Collection
- Bleeding Room
- Washing / disinfection

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Accreditation Standards for Primary Urban Health Centre

- 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

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Accreditation Standards for Primary Urban Health Centre

- 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

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Accreditation Standards for Primary Urban Health Centre

AREA & SPACE REQUIREMENTS

Functional Areas represent the areas where the primary functions of the respective sub-unit
are performed e.g. the Consulting Rooms in an OPD, Treatment Room in an Emergency,
etc. As far as possible, the size of these areas shall not be changed. Relations of all other
areas shall be established in relation to the properties of these areas.

Support Areas are the ones where functions which directly support or enable the primary
functions of the respective sub-unit are performed e.g. the clean utility room in a Nursing
Unit, Recovery room in a LDR Suite, etc. The size of these areas can be changed to
accommodate design constraints but the integrity of their relation to functional areas shall be
maintained. Support areas of two or more similar functional units, located in proximity of
each other, or on the same floor, can be grouped and shared by each functional unit.

Service Areas represents the areas where such functions are performed which do not
directly support the performance of primary functions of the respective sub-unit e.g. the
Sluice Room in a Nursing Unit, etc. The size of these areas and their relation to functional
areas can be changed to accommodate design constraints.

1. OUT PATIENT DEPARTMENT

Functional Area Minimum Functional Area Total Functional Area


Consulting Rooms (4) 10 Sq mtrs. 40 Sq mtrs.
Support Areas
Reception & Registration 8 Sq mtrs. 8 Sq mtrs.
Waiting Areas 15 Sq mtrs. 15 Sq mtrs.
Social Workers Office 8 Sq mtrs. 8 Sq mtrs.
Dressing & Plaster Room 10 Sq mtrs. 10 Sq mtrs.
Sample Collection Room 6 Sq mtrs. 6 Sq mtrs.
Immunization Room 6 Sq mtrs. 6 Sq mtrs.
Pharmacy cum Dispensary 12 Sq mtrs. 12 Sq mtrs.
Physiotherapy 10 Sq mtrs. 10 Sq mtrs.
Service Areas

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Water Facility 3 Sq mtrs. 3 Sq mtrs.


Toilet (Male & Female) 5 Sq mtrs. 10 Sq mtrs.
Janitors Closet 3 Sq mtrs. 3 Sq mtrs.
Trolley Bay 4 Sq mtrs. 4 Sq mtrs.
Total 135 Sq mtrs.

2. EMERGENCY

Functional Area Minimum Functional Area Total Functional Area


Consulting Room 10 Sq mtrs. 10 Sq mtrs.
Treatment/ Procedure Room 10 Sq mtrs. 10 Sq mtrs.
Injection Room 8 Sq mtrs. 8 Sq mtrs.
Service Area
Ambulance Receiving Area 20 Sq mtrs. 20 Sq mtrs.

Trolley Bay 4 Sq mtrs. 4 Sq mtrs.

Total 52 Sq mtrs.

3. LABORATORY & IMAGING

Functional Area Minimum Functional Area Total Functional Area


Clinical Pathology 10 Sq mtrs. 10 Sq mtrs.
Bio-chemistry 6 Sq mtrs. 6 Sq mtrs.
Microscopic 3 Sq mtrs. 3 Sq mtrs.
Staining Area 4 Sq mtrs. 4 Sq mtrs.
X-ray Room 16 Sq mtrs. 16 Sq mtrs.
Dark Room 6 Sq mtrs. 6 Sq mtrs.
Ultrasound Room 10 Sq mtrs. 10 Sq mtrs.
Support Areas
Reception and Waiting 15 Sq mtrs. 15 Sq mtrs.
Laboratory Store 6 Sq mtrs. 6 Sq mtrs.
Imaging Store 4 Sq Mtrs. 4 Sq Mtrs.
Service Area
Toilet (Male & Female) 4 Sq mtrs 8 Sq mtrs.
Janitors Closet 2 Sq mtrs. 2 Sq mtrs.
Total 90 Sq mtrs.

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Accreditation Standards for Primary Urban Health Centre

4. MINOR OT / LABOUR & DELIVERY SUITE

Functional Area Minimum Functional Area Total Functional Area


Minor OT 20 Sq mtrs. 20 Sq mtrs.
Labour Room (2 Table) 25 Sq mtrs. 25 Sq mtrs.
Scrub Room 3 Sq mtrs. 3 Sq mtrs.
Sterilization Room 6 Sq mtrs. 6 Sq mtrs.
Support Area
Examination Room 8 Sq mtrs. 8 Sq mtrs.
Counseling Room 10 Sq mtrs. 10 Sq mtrs.
Store 4 Sq mtrs. 4 Sq mtrs.
Recovery Room 6 Sq mtrs. 6 Sq mtrs.
Sterile Store 4 Sq mtrs. 4 Sq mtrs.
Service Area
Trolley Bay 4 Sq mtrs. 4 Sq mtrs.
Toilet 6 Sq mtrs. 6 Sq mtrs.
Janitors Closet 3 Sq mtrs. 3 Sq mtrs.
Sluice Room 3 Sq mtrs. 3 Sq mtrs.
Waiting Area 6 Sq mtrs. 6 Sq mtrs.
Total 108 Sq mtrs.

5. ADMINISTRATIVE DEPARTMENT

Functional Area Minimum Functional Area Total Functional Area


MOICs Room 10 Sq mtrs. 10 Sq mtrs.
Account Office 7 Sq mtrs. 7 Sq mtrs.
Medical Records Room 10 Sq mtrs. 10 Sq mtrs.
Central Reception 5 Sq mtrs. 5 Sq mtrs.
Toilet (Male & Female) 5 Sq mtrs. 10 Sq mtrs
Total 42 Sq mtrs.

6. STORE & PHARMACY SERVICES

Functional Area Minimum Functional Area Total functional Area


Medical Store 15 Sq mtrs. 15 Sq mtrs.
General Store 15 Sq mtrs. 15 Sq mtrs.
Mortuary 8 Sq mtrs. 8 Sq mtrs.
Total 38 Sq mtrs.

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7. GENERATOR ROOM

Functional Area Minimum Functional Area Total Functional Area


Generator Room 8 Sq mtrs. 8 Sq mtrs.
Water Pump Room 4 Sq mtrs. 4 Sq mtrs.
Total 12 Sq mtrs.

8. RESIDENTIAL ACCOMMODATION

Functional Area Minimum Functional Area Total Functional Area


Doctors 80 Sq mtrs. 80 Sq mtrs.
Nurses 60 Sq mtrs. 60 Sq mtrs.
Pharmacist 60 Sq mtrs. 60 Sq mtrs.
Sweeper/Driver 45 Sq mtrs. 45 Sq mtrs.
Total 245 Sq mtrs

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


need to add 30% of this area for circulation space and corridors, stairs, ramps, emergency
exit etc. Hence the total covered area would be around 620 Sq mtrs.

Since the health center is a horizontal structure the space calculated above is adequate, to
this accommodation area for the staff is to be added which comes to 865 Sq mtrs. Adequate
space for landscaping, gardening and parking area needs to be added. Therefore, a total
area of 1600 Sq. mtrs. would be adequate for creating a Public Urban Health Centre.

PRIMARY URBAN HEALTH CENTRE (PUHC) BUILDING

a. Location:
i. It shall be located in an easily accessible area. The building shall have a
prominent board displaying the name of the centre in the local language. The
area chosen shall have the facility for electricity, all weather road
communication, adequate water supply, telephone.
ii. It shall be well planned with the entire necessary infrastructure. It shall be well lit
and ventilated with as much use of natural light and ventilation as possible.
iii. Shall have non-slippery floors.

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Accreditation Standards for Primary Urban Health Centre

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.

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Clean linen shall be provided and cleanliness shall be ensured at all times.
d. There shall be separate room for Injection & Emergencies, one for Dressings and
minor procedure.
It shall be located close to the OPD Consulting rooms to provide easy and quick
access to patients for injections / minor surgeries and emergencies during OPD
hours.
It shall be well equipped with all the emergency drugs and required instruments.

e. Labour & Delivery Suite:

Labour & Delivery suite shall have in its close proximity sufficient space for
examination / history taking / weighing / recording BP / immunization / group and
individual counseling. The rooms shall be well lit and ventilated and preferably with
dual entrance.

f. Laboratory

Sufficient waiting space


Separate area for sample collection and conducting the tests shall be available.
Shall have marble/stone table top for platform and wash basins.
Running water supply shall be available in Lab.
Exhaust fan shall be available.

g. X-Ray & Ultrasound Room

AERB and BARC certificates to be obtained for the equipments & building plan.
Radiation safety devices shall be provided to radiographers and patients.
Lead shielded doors of X-ray room
Wall thickness of X-ray room shall be 0.1 mm
Radiation hazards warning symbols display as per AERB guidelines.
Display of instructions in Hindi and English warning women of child bearing age
on dangers of radiation in pregnancy.
Patient instructions like full bladders; empty stomach etc shall be displayed
outside the USG room.

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Accreditation Standards for Primary Urban Health Centre

INSTRUMENTS & EQUIPMENTS

S.No. Name of Item Quantity


1 Nebulizer with heavy duty motor (portable) single port 1
2 Ambu's Bag (Adult & Child) 1
3 Anterior Wall retractor vaginal size S/M/L 2
4 Artery Forceps Curved 6"ss 6
5 Artery Forceps Straight 6"ss 6
6 Autoclave ISI marked with 4 Dressing Drum 2
7 B.P. Apparatus 4
8 Bowl SS 20 cm 4
9 Cuscus speculum Small / Medium / Large 4
10 Digital Thermometer 6
11 Forceps Chital 9"ss 4
12 Forceps Dissecting Plain 6"ss 2
13 Forceps Dissecting Toothed 6"ss 4
14 Forceps Sinus 6"ss 2
15 Forceps Sponge Holding 9" 4
16 Gynae Examination Light with ordinary bulb floor model 2
17 Height Measuring Scale 2
18 SS Instrument Tray with Cover 8" x 10" 4
19 Key spanner for oxygen cylinder 2
20 Kidney Tray SS 25 cms 4
21 Needle Holder Straight / Curved 6"ss 2
22 Oxygen Cylinder B Type 10 Ltr. ISI Marks with all requisite certificates. 2
23 Oxygen Cylinder Trolley 2
24 Oxygen Flow meter with humidifier bottle 2
25 Posterior Wall retractor (Sims) Small / Medium / Large 4
26 Scissors 6' SS 4
27 Scissors Sharp Tailor Model 2
28 Stethoscope having good conduction tube for adult & child 4
29 Syringe Cum Needle Destroyer Manual Model 2
30 Uterine Sound ss 4
31 Volsellum ss 4
32 Alis Tissue Forceps 2
33 Adult Weighing Scale (Manual) 1
34 Foot Operated Suction Machine 1

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35 Electrical Suction Machine 1


36 B.P. Handle 4 2
37 Nasal Speculum 2
38 Percussion Hammer 4
39 Electric Sterilizer 2
40 Spot Light 1
41 Weighing Scale digital (Neonatal) 1
42 Single Panel X-ray view box 1

COMMON SURGICAL CONSUMABLES

S.No. Name of Item Quantity


1 Bandage all sizes do
2 Cotton do
3 Adhesive wound Dressing different Sizes do
4 Alcohol Swab do
5 Adhesive Plaster do
6 Disposable Blade do
7 Oxygen Mask Adult & Pediatrics do
8 Disposable Draw Sheet do
9 Sterile Surgical pad 10 x 10 cm do
10 Crepe Bandage 8 cm / 10 cm / 15 cm do
11 Disposable Syringe AD 2 cc, 5 cc, 1 cc 10 cc do
12 IV Set do
13 Scalp Vein Set 23, 24 G do
14 Lint Cloth do
15 Hypodermic Needle 22G, 23G, 26G, 24G do
16 Disposable Gloves different sizes Sterile & Non Sterile do
17 Hypo Allergic Paper Tape 1" do
18 Face Mask do
19 Poly Mask (Adult / Paeds) do
20 Ryle's Tube do
21 Gastric Levage Tube do
22 Suction Catheters do
23 Mucus Extractor with Suction Tube do
24 Rubber Sheething do
25 Wooden Tongue Depresser do

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Accreditation Standards for Primary Urban Health Centre

26 Suture Silk 1-0 do


27 Tuberculin Syringe do
28 Suture Catgut 1-0 do
29 I.V. Canula 22, 24 do
30 Paraffin Gauze / Chlorhexidine Gauge do
31 Baladona Plaster do
32 First-Aid Dressing water proof do

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LABORATORY & RADIOLOGY ITEMS

S.No. Name of Item Quantity


1 Acetic Acid Glacial do
2 Acetone do
3 Beakers all sizes do
4 Blood Cell Counter 6 units do
5 Blood Grouping kit Anti A, B, AB & D (Rh) do
6 Boric Powder do
7 Blood Grouping Plate do
8 Bleaching Powder / Solution do
9 Carbol Fuschin do
10 Cedar Wood Oil do
11 Centrifuge Tube do
12 Cover Slip all size do
13 Diamond Pencil for Slide Marking do
14 Distille Water 5 Ltr. Pack do
15 Dropper do
16 ESR Pipette Disposable do
17 ESR Stand (6 Tubes) 2
18 EDTA Tubes (Glass) do
19 Filter Paper Sheet Round do
20 Glucometer 1
21 Glucometer Strip Compatible do
22 Hb Pipette with rubber tube do
23 Hb tube do
24 Haemoglobinometer Complete do
25 Hydrogen peroxide for lab use do
26 Improved Neubaur's chamber do
27 Lancet Disposable Sterile do
28 Lieshman Stain do
29 Microscope slide (glass) deluxe do
30 Multi stick for urine do
31 N/10 HCL do
32 Pasture pipette do
33 Pipette RBC do
34 Pipette WBC (as per requirement)

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Accreditation Standards for Primary Urban Health Centre

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

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Accreditation Standards for Primary Urban Health Centre

FURNITURE ITEMS

S.No. Name of Item Quantity


1 Steel Almirah Big 9
2 Steel Almirah Small 4
3 Table Officer 2
4 Office Table Assistant 6
5 Office Table Clerk 2
6 Office Chair 24
7 Office Chair 3
8 Bench Stell 4
9 Airport Bench (3 Seats) 4
10 Examination Table 4
11 Gynae Examination Table 2
12 Mattress for Examination Table 4
13 Foot Step 6
14 Steel Racks with cover 6 shelve 6
15 Steel Racks with cover 2 shelve 5
16 Revolving Stool ss top 8
17 Wooden Stool 6
18 Revolving Stool adjustable height for dispensary / lab with cushion top 2
19 Hydraulic Stool 2
20 Screen Three Fold / Hanging Screens 6
21 Notice Board 1
22 Computer Table 1
23 Computer Chair 1
24 Notice Board Pannel for IEC 2
25 Wheel Chair 1
26 Stretcher with Trolley 1
27 Instrument Trolley 3
28 Dressing Trolley 1
29 Side Wooden Rack 1
30 I. V. Stand 1

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Accreditation Standards for Primary Urban Health Centre

GENERAL & MISCELLANEOUS ITEMS

S.No. Name of Item Quantity


1 Broom phool (as per requirement)
2 Broom Naryal do
3 Liquid Soap do
4 Room Freshener do
5 Floor Mops do
6 Duster do
7 Wiper do
8 Dustbin Plastic- Small/ medium / big do
9 Electric Tubes do
10 CFL Bulb do
11 Phenyl 5 Ltr. do
12 Finit/ Baygon do
13 Finit Pump do
14 Degradable polybags Black for BMW do
15 Degradable polybags Yellow for BMW do
16 Degradable polybags Red for BMW do
17 Bleaching Powder do
18 Glass Tumber do
19 Toilet Cleaner do
20 Naphthalene Ball do
21 Odonil do
22 Safety Razor do
23 Measuring Tape do
24 Plastic Bucket - 30 Ltr do
25 Detergent Powder do
26 Soap Cake do
27 Locks with Keys Big & Small do
28 Biomedical Waste Bins do
29 Mugs do
30 Water Jugs 20 Ltr. do
31 Hot Case Electric do
32 R.O.System do
33 Water Cooler do
34 Desert Cooler do

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Accreditation Standards for Primary Urban Health Centre

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


36 Invertors with Adequate Back up do
37 Domestic Refrigerators 165 Ltr. do
38 Computer with Broad Band and Accessories do
39 Fire Extinguishers do
40 Signages do
41 Torch Medium / Large do
42 Torch Cells do
43 Telephone with Intercom facility do
44 Vaccine Carrier do
45 Brush for Toilet do
46 Calculator 10 Digits do
47 Canvas Bag do
48 Door Mat Rubber / Small / Medium / Large do
49 Rat Trape do
50 Jerican White Empty 5 Ltr/ 10 Ltr / 20 Ltr do
51 Table Glass do
52 Dial Thermometer do
53 Rain Coat do
54 Sealing Wax do
55 Suggestion Box do
56 Stand for Refrigerator do
57 Cup & Plate Set do
58 Hot Plate do
59 Umbrella do
60 Lathi for Chowkidar do
61 Voltage Stabilizer 1/2, 1 & 2 KV do
62 Fire Extinguishers
63 Waste Paper Basket Plastic do
64 Emergency Light do
65 Gloves for Cleaning (Heavy duty Rubber) do
66 Gum Boots do
67 Tissue Paper Roll do
68 Paper Napkins do
69 Liquid Spray cleaner (Colin/Brisk) do
70 Heat Convertor do
71 Room Heater do

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Accreditation Standards for Primary Urban Health Centre

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


Foot operated dustbin ss Frame with Removable Pot made of
73 HDPE material Black / Yellow / Red do
74 UPS for Computers do
75 Pen Drive 4 GB / 8 GB do
76 Goggles for Universal Precautions do
77 CVT 2 KVA do
78 Hot Water Bottle do
79 Fly Catcher do
80 Extension Board do
81 PUC Pipe do
82 Bamboo for Floor Mops do

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Accreditation Standards for Primary Urban Health Centre

STATIONARY & LINEN ITEMS

S.No. Name of Item Quantity


1 OPD Slips As per requirement
2 OPD Register As per requirement
3 Stock Register As per requirement
4 Rulled Register 2Q, 4Q As per requirement
5 Immunization Register As per requirement
6 Immunization Card As per requirement
7 Eligible Couple Register As per requirement
8 Special Drug Forms As per requirement
9 Morbidity Reporting Proforma ICD-10 As per requirement
Reporting Proformas Under Various National Health
10 Programmes As per requirement
11 Pilot Pen (Blue/Red) V5 As per requirement
12 Zotter Pen (Blue/Red/Green) As per requirement
13 Ball Pen As per requirement
14 Gel Pen As per requirement
15 Marker Pen As per requirement
16 Permanent Marker As per requirement
17 Ink for Pilot Pen As per requirement
18 Refills for Zotter Pen As per requirement
19 Refills for Ball Pen As per requirement
20 Pencil HB As per requirement
21 High Lighter Pen As per requirement
22 Eraser/Rubber As per requirement
23 Scale (12") As per requirement
24 Stapler Pin As per requirement
25 All Pin As per requirement
26 Board Pin 13mm As per requirement
27 U Clip As per requirement
28 Tags Cotton As per requirement
29 All Pin Cushion As per requirement
30 Gum Botle 700 ml Big As per requirement
31 Stamp Pad As per requirement
32 Ink for Stamp Pad As per requirement
33 White Fluid As per requirement

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Accreditation Standards for Primary Urban Health Centre

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


35 Slip Pad As per requirement
36 White Envelop (4"X6") As per requirement
37 White Envelop (4"X9") As per requirement
38 White Envelop A-4 Size As per requirement
39 Envelop (File size) brown Plastic Coated As per requirement
40 Dak Pad As per requirement
41 Paper Weight As per requirement
42 File Cover As per requirement
43 File board As per requirement
44 File Wrapper As per requirement
45 Photocopy Paper (all size) 75 GSM & ISI As per requirement
46 Typing Paper As per requirement
47 Duplicating Paper As per requirement
48 Note sheet Superior As per requirement
49 Carbon paper (Blue) all size As per requirement
50 Short hand book As per requirement
51 Attendance Register As per requirement
52 Diary Register As per requirement
53 Dispatch Register As per requirement
54 Cartridges for Printers As per requirement

LINEN ITEMS
1 Bed Sheet As per requirement
2 Draw Sheet As per requirement
3 Towel Large/Medium/Small As per requirement
4 Screen Cloth As per requirement
5 Pillow As per requirement
6 Pillow Cover As per requirement
7 Curtain Cloth As per requirement
8 Doctor Coat As per requirement
9 Coat for Paramedical Staff As per requirement
10 Apron As per requirement
11 Patient Blanket As per requirement
12 Blanket for Chowkidar As per requirement

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Accreditation Standards for Primary Urban Health Centre

MANPOWER & STAFFING

S.No. Category of Staff Recommended*


Medical Officer In-charge (MO I/C) 1 (1 MBBS Doctor and 1 Lady Medical
1. Officer or from AYUSH)

Second Medical Officer 1

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

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


population the staff will be increased proportionately till such time as there is one PUHC for
every 50,000 population. In addition care must be taken to ensure sufficient leave reserve
and staff for special programs like Pulse Polio etc.

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Accreditation Standards for Primary Urban Health Centre

ESSENTIAL DRUG LIST

ANAESTHETICS
General Anesthetics
Sodium thiopentone Inj. 0.5, 1 g powder/vial

Halothane Inhalation Inj. 50 mg/ml


Ether inhalation
Nitrous oxide inhalation
Oxygen inhalation
Carbon dioxide inhalation
Ketamine hydrochloride

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

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Accreditation Standards for Primary Urban Health Centre

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

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Inj. 500 mg/vial


Benzathine penicillin Powder for Inj. 0.6 1.2, 2.4 MU/vial
Benzyl penicillin Powder for Inj. 0.5 MU/vial
Procaine penicillin Powder for Inj. 0.4 MU/vial
OTHER ANTI BACTERIALS
Gentamicin Inj. 10, 40 mg/ml

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

Tab. 200, 400 mg


Ciprofloxacin Infusion 100 mg/50mg,
Susp. 200 mg/5ml

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

Tab. 200, 400 mg


Metronidazole Inj. 500 mg/100ml. Vial
Susp. 200 mg/5ml

Caftazidime Inj. 250 mg, 500 mg, 1 g

Cap. 250, 500 mg


Cephalexin
Syr. 125 mg/5ml

Ceftriaxone Inj. 500 mg. 1 g

Cap. 250 mg. Syr. 125 mg/ml


Chloramphenicol
Inj. 1 g/vial

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

Doxycycline Cap. 100 mg

Tetracyclin Ap. 250, 500 mg


Norfloxacn Tab. 400 mg, 200 mg
ANTI-LEPROSY DRUGS
Clofazimine Cap. 50, 100 mg
Dapsone Tab. 50, 100 mg
Rifampicn Cap., Tab. 150, 300, 450, 600 mg
ANTI-TUBERCULOSIS DRUGS
Ethambutol Tab. 400, 800 mg
Isoniazid Tab. 100, 300 mg, Syp. 100 mg/5ml
Rifampicin Cap. 150, 300, 450, 600 mg. , Syp. 0.75 g/vial

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Streptomycin Inj. 0.75 g/vial


Tab. 300, 500, 750 mg
Pyrazinamide
Syp. 250 mg/5ml
ANTI-FUNGAL DRUGS
Griseofulvin Tab. 125, 250 mg
Ketoconazole Tab. 200 mg
ANTI-PROTOZOAL DRUGS
Trinidazole Tab. 300, 600 mg, powder for susp. 150 mg/5ml
Diloxanide furoate Tab. 500 mg
Tab. 250 mg, Inj. 40 mg/ml
Choloroquine phosp.
Syp. 160 mg/10ml
Primaquine Tab. 7.5, 15 mg.
Tab. 200, 400 mg, Inj. 500 mg/100ml, Susp. 200
Metronidazole
mg/5ml
ANTI VIRAL
Acyclovir Inj. 250 mg, Tab. 200 mg
ANTI-PARKINSONISM DRUGS
Trihexyphenidyl Tab. 2 mg
Bromocriptine Ab. 2.5 mg
Tab. 100 mg + 10 mg
Levodopa + Carbidopa
Tab. 250 mg + 25 mg
Selegilline Tab. 5 mg
DRUGS AFFECTING BLOOD
Anti Anaemic Drugs
Ferrous Sulphate Tab. 200 mg (equivalent to 60 mg elemental iron)
Ferrous fumerate Drops 5 mg/drop
Folic acid Tab. 1.5 mg
Iron sorbital citric acid complex Inj. 75 mg iron / 1.5 ml
Ferrous fumerate + folic acid 60 mg + 0.2 mg
Hydroxy cobalamine Inj. 1 mg/ml
Drugs Affecting Coagulation
Vitmin K Inj. 10 mg/ml
Inj. 5000 IU/ml, 20,000 IU
Heparin
Inj. 5000 IU/ml low molecular weight
Streptokinase Inj. 15,00,000 IU
Protamine sulphate Inj. 10 mg/ml in 5 ml ampoule
Acenocoumarin Tab. 1, 2, 4 mg
BLOOD PRODUCTS AND SUBSTITUTES

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Polymer from degraded Inj. Gelatin as 0.63g


of nitrogen + electrolytes (3.5g) made
isotonic solution
Dxtran 40 injectable solution
CARDIOVASCULAR DRUGS
Anti-Anginal Drugs
Propranolol Tab. 10, 40, 80 mg
Inj. 1 mg/ml
Metoproolol
Tab. 50, 100 mg
Atenolol Tab. 50, 10 mg
Tab. 0.5 mg
Glyceryl Trinitrate
Inj. 5, 25 mg
Isosorbide dinitrate Tab. 10, 20 mg
Isosorbide mononitrate Tab. 10, 20, 40 mg
Diltiazem Tab. 30. 60 mg
Anti Dysrhythmic Drugs
Cap. 50, 150 mg
Mexiletine
Inj. 250 mg/10ml
Lignocaine Inj. 2% (21.3 mg/ml)
Amiodarone Tab. 200 mg
Tab. 40, 80 mg
Verapamil
Tab. Syr. 240 mg, Inj. 5 mg/2ml
Anti-Hypertensive Drugs
Nifedipine Cap. 5, 10 mg
Hydralazine Tab. 25, 50 mg, Inj
Methyldopa Tab. 250 mg
Enalpril Tab. 2.5, 5 mg
Sodium Nitroprusside Inj. 50 mg/5ml
Amlodipine Tab. 5 ml
Hydrochlorothiazide Tab. 25 mg
Chlorthalidone Tab. 25, 50 mg
Drugs used in Vascular shock and Peripheral Vascular Diseases
Dobutamine Nj. 125 mg/10 ml
Mephentermine Inj. 30 mg/ml
Dopamine Inj. 40 mg/ml
Cardiac Glycosides
Digoxin Tab. 0.25 mg
DERMATOLOGICAL DRUGS

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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

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Glutaraldehyde activated Lotion 2% w/v


Tincture benzoin Co. Carbolic acid Solution
Hydrogen peroxide Sol. W/v
Acriflavin + Glycerine Sol. (0.1% acriffavin)
Potassium permanganate Crystals for sol.
Povidone iodine Sol. 10%
Acetic acid 3%
Calcium hypochlorite Powder
Methyl alcohol Solution

Eusol Solution
Spirit Solution
DIURETICS
Frusemide Tab. 40 mg, Inj. 10 mg/ml
Spironolactone Tab. 25 mg
Mannitol Inj. 10%, 20
Glycerol Syp.
Amiloride Tab. 5 mg
Hydrothiazide Tab. 25 mg.

GASTROINTESTINAL DRUGS
Antacids and other Anti-ulcer drugs
Mangesium hydroxide+aluminium
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

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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

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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.

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Oxytocin Inj. 10 IU/ml


Magnesium sulphate Inj. 25% w/v
Dinoprostone Inj. 0.5 mg/syringe
Ethacridine lactate Inj. 1 mg/ml
Terbutaline Tab. Inj.
DRUGS ACTING ON RESPIRATORY SYSTEM/ANTIASTHMATIC DRUGS
Tab. 100 mg (77 + 23 mg,
Etiophylline + theophylline Tab. SR 300 mg, Inj. 220 mg/2ml (169.4 + 50.6
mg)
Salbutamol Tab. 2, 4 mg, Syp 2 mg/5ml
Tab. 2.5, 5 mg, Inj. 0.5 mg/5ml
Terbutaline
Syp. 1.5 mg/5ml
Aminophylline Inj. 25 mg/ml
Epinephrine Inj.
Sodium Cromoglycate Inhalation
Salbutamol Solution for nebulizer 5 mg/ml
Beclomethasone Inhalation 100 mcg/dose
Anti-Tussives
Bromhexine hydrochloride Syp. 4 mg/5ml
Noscapine linctus 7 mg/ml, Drps 1.83 mg/ml
SOLUTION CORRECTING WATER AND ELECTROLYTE
Dextrose Inj. 5%, 10% 25%, 50%
Sodium chloride Inj. 0.9%, 1.8%, 3.5%
Ringer lactate Inj.
Distilled water Inj.
Dextrose with saline Inj. 2.5% + 0.9%, 5% + 0.45%, 5% + 0.9%
Water for Injection Inj.
Dextran 10% in dextrose 5%
Potassium chloride Inj. 150 mg/ml
Calcium Gluconate Inj. 37.5 mg/ml
Calcium chloride Inj. 10% solution
27% calcium For IV use
Sodium bicarbonate Inj. 1.4% isotonic
Isolyte G
Isolyte M
Chlorine tablets Tablets

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VITAMINS AND MINERALS

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%

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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

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AMBULANCE REQUIREMENTS

The basic life support vehicle shall have two compartments: Drivers cabin & patients cabin.

Communication System (Wireless or Mobile phone)


DRIVERS CABIN Siren & Light switch
PA system
Room height of at least 6 feet
Two stretchers with one trolley
Railing for IV suspension
Oxygen cylinder
Suction machine (foot operated)
ET tube
Ambu bag
Laryngoscope
PATIENTS CABIN
Suction catheters
Foleys catheter

EMERGENCY DRUGS
Atropine, Adrenaline
Sodabicarbonate, Digoxin
Efcorline, Decadron
Dopamine, 25% Dextrose
IV fluids, Plasma Expanders

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PRIMARY URBAN HEALTH CENTRE SCHEMATIC LAYOUT

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CLINICAL & DIAGNOSTIC SERVICES IN PUHC

Each PUHC must provide a mandated set of healthcare services. These healthcare services
will be delivered in two modes - Centre based activities and Outreach activities.

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


preventive, promotive, curative and rehabilitative primary healthcare. This includes:
OPD Services for curative medical care
Emergency care during the OPD hours
Preventive and promotive services.
Implementation of all National Health programmes
Referral to higher centers as per need and follow-up
Basic laboratory services
IEC / BCC component of healthcare

I. Center based Curative Medical care

a. No indoor patient facility is envisaged for PUHC. Wherever required the patient
can be observed during the OPD hours before shifting the patient to the FRU for
which one to two observation beds will be provided.
b. Service delivery will be mainly OPD based: Six hours a day.
c. Provision of 24 hours emergency services in Primary Urban Health Centre is not
visualized as operationalizing effective functional round the clock emergency
services will require lot of manpower and infrastructural inputs which will not be
cost effective.
(In selected PUHCs the 24 x 7 emergency may have to be provided. Selection
of these health facilities will be guided by the presence / accessibility of the first
referral unit especially in the peripheral rural belt).
d. Minimum OPD attendance visualized is 40 patients per doctor per day.
Standard Treatment Protocols for the common diseases are available and shall
be followed at the PUHCs. All centre personnel (medical and otherwise) shall be
well trained and equipped to provide this level appropriate care at the PUHC
level. The training component has to be ensured and periodically assessed and
updated. All PUHCs must possess the "Standard Treatment Protocols" as
developed by the State.
i. Emergency Medical care during OPD hours: First aid for injuries and
accidents, animal bite, burns, dehydration and other emergency conditions.
Stabilization of the condition of the patient before referral.

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


simple Clean Lacerated wounds. During surgical procedures, universal
precautions will be adopted to ensure infection prevention.
iii. Referral for the Cases requiring Secondary / Tertiary Care: All patients
requiring higher level care to be referred in time to a linked and identified centre
with a complete referral slip. The centre must have a two way referral linkage to
facilitate back referrals / follow-up.
iv. Rehabilitation: Disability prevention, early detection and referral for appropriate
intervention to an identified linked referral unit.

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


wherever AYUSH unit is co-located.

vi. Provision of OPD based specialist services in the disciplines like Internal
medicine, Gynecology, Pediatrics, Ophthalmology, ENT, Dental services. These
services provided near home will increase the credibility o the PUHC, increase
its utilization and decongest the overburdens secondary / tertiary care facilities.
Rogi Kalyan Samitis can play an important role in facilitating / monitoring these
clinics.
One out of every four to five PUHCs may run a specialist clinic with the nearest
centres being linked to it.
The following specialties can be taken up, guided by a felt need.
1. Medicine
2. Gynecology
3. Pediatrics
4. Ophthalmology (Refractionist)
5. ENT
6. Dental Services
The selection of the centre will be guided by the proximity / distance from the
hospital or an existing Polyclinic, availability of the space, perceived need of the
community.
The specialist clinic can be operationalized through the State or be a RKS
initiative.
The Logistics will be guided by the specialty chosen.
In case sufficient space is not available the separate PUHCs may host different
specialist clinic and the information regarding the same may be disseminated to
the linked PUHCs.

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


catchment population cannot access the health facility during morning hours.

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


Slums, JJ Clusters, Industrial areas, absence of any other service provider in
the vicinity like ESI dispensary etc.
Services: The evening OPD shall provide all services except the Lab services.
The weekly ANC clinics, Well baby Clinics, etc shall continue to be a part of
morning shift but all pregnant women and children coming to evening OPDs
must be registered / examined and provided appropriate care. One out of the
two immunization days of the week can be conducted in evening OPD.
Timings of OPD: 2 pm to 8 pm.
The Staff for the evening OPD shall be over and above that for a PUHC. This
shall include - one Medical Officer, one Pharmacist, one ANM, one Nursing
Orderly and one CDEO cum assistant. SCC is already present in the evening
shift. The entire staff be pooled and will do evening shifts by rotation.
Logistics: No separate Logistics are required.
This activity may be facilitated and monitored through the Rogi Kalyan Samitis.

vii. Geriatric care: Special emphasis shall be there for taking care of the senior
citizens visiting the health centre. From having user friendly access, freedom
from long waiting queus, assistance in obtaining and understanding medications
to special assistance like that in obtaining dentures / spectacles etc. In providing
this special assistance, Rogi Kalyan Samiti can play an important role.
Safe and affordable transport to the PUH centre shall be available for all,
especially for the older persons, whenever possible, by using a variety of
community-based resources, including volunteers.
Simple and easily readable signage shall be posted throughout the PUHC
centre to facilitate orientation and personalize providers and services.
Key PUHC staff shall be easily identifiable using name badges and name
boards.
The PHC facility shall be equipped with good lighting, non-slip floor surfaces,
stable furniture and clear walkways, comfortable seating facility.

II. Centre based Preventive and Promotive services

a. Maternal and Child Health Care:


i. Antenatal care:
Early registration of all pregnancies with a duly filled ANC Card ideally in the first
trimester (before 12th week of pregnancy) and provision of antenatal care
appropriate to gestation.
Minimum 3 antenatal checkups, appropriately timed as per RCH guidelines and
provision of complete package of services. Registration as soon as pregnancy is

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


providing iron and folic acid tablets, injection Tetanus Toxoid etc.
Laboratory investigations -- hemoglobin, urine albumin and sugar.
Nutrition and health counseling
Identification of high-risk pregnancies / appropriate management. Referral to
First Referral Units (FRUs) / other linked hospital for high risk pregnancy.

ii. Preparation / planning for delivery in an institution.

iii. Postnatal care


A minimum of 2 postpartum home visits, first within 48 hours of delivery, 2nd
within 7 days
Initiation of early breast-feeding within half-hour of birth
Education on nutrition, hygiene, contraception, essential new born care (As per
Guidelines of GOI on Essential new-born care)
In case of availability of special schemes for pregnant women -- JSY,
MAMTA Scheme, Ladli Scheme the same shout be publicized through the
centre and the ANM / ASHA shall facilitate utilization of these benefits by the
eligible beneficiaries.

iv. Care of the child:


Emergency care of sick children including Integrated Management of Neonatal
and Childhood Illness (IMNCI) during the working hours.
Care of routine childhood illness.
Essential Newborn Care (the staff / centre shall be equipped to give basic
essential newborn in case a new born is brought to the centre or a home
delivery takes place in the catchment area).
Promotion of exclusive breast-feeding for six months.
Full immunization of all infants and children against vaccine preventable
diseases as per guidelines of GOI / State.
Vitamin A prophylaxis for the children as per guidelines.
Prevention and control of childhood diseases, infections.

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


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

C. Management and Prevention of Reproductive Tract Infections / Sexually


Transmitted Diseases: Treatment of Reproductive Tract Infections and
Sexually Transmitted diseases and health education for prevention of RTIs /
STDs

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D. Family Planning:
i. Education, Motivation and counseling to adopt appropriate Family planning
methods.
ii. Provision of contraceptives such as condoms, oral pills, emergency
contraceptives.
iii. Carry out IUCD insertions.
iv. Follow up services to the eligible couples adopting permanent methods
(Tubectomy / Vasectomy).
v. Counseling and appropriate referral for safe abortion services (MTP) for those in
need.
vi. Counseling, workup and appropriate referral for couples having infertility.

E. Implementation of National Health Programmes:

a. Integrated Disease Surveillance Project (IDSP)


Disease Surveillance and Control of Epidemic
i. Alertness to detect unusual health events and take appropriate remedial
measures
ii. Disinfection of water sources
iii. Testing of water quality using H2S Strip Test (bacteriological)
iv. Promotion of sanitation including use of toilets and appropriate garbage
disposal.

b. Revised National Tuberculosis Control Programme (RNTCP)


i. All PUHCS to function as DOTS Centers to deliver treatment as per RNTCP
treatment guidelines through DOTS providers.
ii. Treatment of common complications of TB and side effects of drugs.
iii. Record and report on RNTCP activities as per guidelines.

c. National Programme for Control of Blindness (NPCB)


i. Basic services: Diagnosis and treatment of common eye diseases.
ii. Screening for refraction disorders and referral for Refraction study.
iii. Detection of cataract cases and referral for cataract surgery.

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


i. Diagnosis of Malaria cases, Microscopic confirmation and treatment.
ii. Cases of suspected Dengue, Chikungunia to be provided symptomatic
treatment, referral for hospitalization and case management as per the
protocols.

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iii. IEC Activities regarding spread and prevention, symptoms of VBDs to enable
early detection of disease and its complications.
iv. Elimination of Vector breeding sites.

e. National Leprosy Elimination Programme (NLEP):


i. Identification of leprosy patients on basis of clinical examination.
ii. Referral of the patients to secondary care level when required - doubtful clinical
diagnosis requiring investigations, complicated cases, severe drug reaction etc.
iii. Complete treatment with Multi Drug Therapy.
iv. Information, Education and Communication (IEC) activities.
v. Rehabilitation / Disability prevention.

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


i. Goitre detection and appropriate management / referral.
ii. Urine iodine estimation in children aged 6-12 yrs.
iii. Salt iodine estimation of salt samples collected from household.
iv. IEC activities to create awareness of lodine deficiency disorders.

g. National AIDS Control Programme (NACP):


i. IEC activities to enhance awareness and preventive measures about STIs and
HIV / AIDS, Prevention of Parents to Child Transmission (PTCT) services.
ii. Screening of persons practicing high-risk behaviour at the nearest ICTC.
iii. Risk screening of antenatal mothers with one rapid test for HIV from linked
ICTC.
iv. Linkage with Microscopy Centre for HIV-TB co-ordination.
v. Condom Promotion & distribution of condoms to the high risk groups.
vi. Help and guide patients with HIV/AIDS receiving ART.

f. Provision of Essential Laboratory Services:


1. H b%, TLC
2. Blood Sugar
3. VDRL
4. Urine Albumin, Sugar and Microscopy
5. Urine Pregnancy Test
6. Stool Microscopy
7. Diagnosis of RTI / STDs with wet mounting, Grams stain, etc.
8. Blood smear examination for malarial parasite

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9. Tests specified as a part of IDSP

g. Radiological Services

a. X RAY
Plain and Computed Radiography
Contrast studies like Barium swallow, Barium meal, follow through and Barium
enema; IVU; RGU / MCU; HSG ; water soluble contrast studies for GIT;
Fistulograms: Sinograms

b. ULTRASONOGRAPHY
General Abdominal and Pelvic studies.
Obstetrical and Gynecological including endovaginal exams, TIFFA
Soft tissue and superficial structures including Breast, Thyroid, Scrotal and
Transrectal Prostate examinations.
Pediatric and Neonatal studies.
Musculoskeletal examinations such as Hips, Shoulders and Knees.

c. DOPPLER STUDIES (if available)


Peripheral, Cerebro-vascular and abdominal Doppler.
Assessment of post Kidney and Liver Transplant patients.
Penile Doppler examination

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CLINICAL SERVICES IN OUTREACH

One ANM is assigned to each 10,000 population. She will carry out the household survey of
her assigned area and also prepare and maintain the eligible couple registers. At any given
time she will know about the individuals / families requiring help i.e. pregnant women / the
children requiring immunization, patients with TB. Leprosy on MDT, the cataract cases
requiring surgery, households requiring Chlorine drops to make drinking water safe, families
eligible for special health schemes - JSY, MAMTA, LADLI.

Need for Outreach Clinical services: Although in an urban setting the distances are
relatively smaller, the terrain easy and transport more easily available, there might be areas /
situations / certain specific vulnerable groups which might require provision of outreach
services. Constraints like pre-occupation of the habitants with earning a livelihood, women
and children of a particular segment finding it difficult to access a Health Centre in absence
of a male attendant create a need for outreach activities to reach these beneficiaries. Such
outreach activities are especially required in the slums, JJ clusters, resettlement colonies,
unauthorized colonies and villages.

These can be carried out in two forms:


i. Periodic Health & Nutrition Days: Without setting up any fixed units like sub centres,
health posts etc, outreach activities can be in the form of regular Health and Nutrition
days, Immunization sessions. This activity shall be structured with prescribed
manpower and equipment and will be amenable to objective assessment in terms of
the services being provided, both quantitatively and qualitatively. PUHC will be
responsible for conducting this activity in its catchment area. The staff and logistics will
flow from the PUHC.

ii. By setting up a fixed Outreach Centre: Setting up of fixed outreach centers ie. sub
centre / health post like structure for every 5000 to 6000 population is not mandated
and is only recommended on a felt need basis. Experience has shown that setting up
of these structures and making them optimally functional is not an easy task and many
times not cost effective or even workable in overcrowded slums / constantly shifting JJ
clusters. Also, smaller distances and easier terrain obviate the need for setting up of
these structures on every five to six thousand population.

However in the initial phase till the required number of PUHCs is made available with
equitable distribution, a fixed outreach centre may be required in certain areas guided by the
distance of the habitation / cluster from the nearest PUHC. An already existing structure i.e.
a willing mother anganwadi / extant subcentre / health outpost of MCD / IPPVIII / Basti Vikas
Kendra may be used for this purpose. In such a case while making the PUHC health action
plan this activity may be reflected and requirements in terms of necessary logistics may be
projected in the plan.

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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.

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CONVERGENCE WITH RELATED SECTORS

a. Nutritional Services (in convergence with ICDS)


i. All the anganwadis in the catchment area must be identified and mapped. There
shall be functional Iiason between the ANM and the the Anganwadi worker in
the area.
ii. Diagnosis of and nutrition advice to malnourished children, pregnant women and
others.
iii. Diagnosis and management of Anemia and Vitamin A deficiency.
iv. Coordination with ICDS. A child/ woman / adolescent diagnosed as
malnourished / anemic in the health and nutrition day / or in the PUHC to be
attached to the anganwadi and systematically monitored. MO / ANM / ASHA /
AWW to take responsibility.

b. Health of School going Children:


All Schools in the catchment area to be mapped. Children referred from the school
for investigations, management to be taken care of. Participation in school health
fairs, monitoring activities if required.

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


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

d. Promotion of Safe Drinking Water and Basic Sanitation


ANMs / ASHAs / Health & Sanitation Committees to find local solutions with the help
of provisions under State Health Mission and Departments of Health / Water &
Sanitation. All PUHCs to have sufficient stock of Chlorine Tablets / drops. All ASHAs
to be given adequate stock of Chlorine Tablets / drops.

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Accreditation Standards for Primary Urban Health Centre

STRENGTHENING OF REFERRAL SYSTEM

Referral services from operational point of view could be primary health care, medical care,
secondary, tertiary and apical care. Referrals are defined as a system by which patients
while undergoing treatment by a doctor are given facilities from the hospital to avail the
specialized consultation, medical care, ancillary services etc. wherever required. The
cardinal feature of referral system is that the individual continues to be the patient of the
doctor whom he consulted first.

Existing hospitals, including Urban Local Body maternity homes, state government hospitals
and medical colleges, apart from private hospitals will be empanelled / accredited to act as
referral points for different types of healthcare services like maternal health, child health,
diabetes, trauma care, orthopedic complications, dental surgeries, mental health, critical
illness, deafness control, cancer management, tobacco counseling / cessation, critical
illness, surgical cases etc.

There might be different and multiple facilities for the different healthcare services,
depending upon type of hospitals available in the city. This will not only ensure flexibility to
adapt to different conditions in different cities but also increase the range of options for the
beneficiaries.

The empanelled / accredited facilities would be reimbursed for the services provided as per
the pre-decided rates, negotiated with them at the time of empanelling / accrediting them.
The rates will be determined by the consultations undertaken during preparation of the PIPs
and based on the National Commission on Macroeconomics and Health report.

For empanelled government facilities, apart from District / Sub-District Hospitals (being
supported under NRHM), Rogi Kalyan / Hospital Management Societies will be funded (per
case basis including support for referral transportation), which will be utilized for
providing cash-less services to urban poor covered under NUHM.

Such empanelled hospitals, which do not have hospital management societies, will be
required to form such societies to be eligible for receiving the funding support. During the
field visits it was observed that many of ULBs have maternity homes functioning with heavy
case load but inadequate infrastructure, therefore it is proposed to support the existing
maternity hospitals on a city specific case to case basis as referrals for maternal and child
care.

The referral services will be cash-free for the beneficiary and will be financed by community
health insurance or voucher scheme as per the PIP developed for the city.
All engagements would be contractual with no permanent liability to Government of India.
Collaboration with local Medical Colleges may be promoted for strengthening the training
support and supplement human resource at the PUHC level.

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The Commandments for referral system are-

Unified system of records appropriate to each level of medical care in the area shall
be developed. These records would entail referral registers, referral cards/referral
slips and patient history cards. These basic records shall be of the same type in all
institutions in a given area. Records shall ultimately reflect flow of patients from the
periphery to the institutes of middle order or higher order.

The records shall also be able to give information on the investigations and
treatment given to a patient in an institution where he has been referred. After due
treatment has been given to the patient, the patient records shall move back to the
referring agency/ doctors etc. and the patient records shall reflect the diagnosis
and treatment suggested to enable the referring physicians to carry out the follow
up. The importance of such records cannot be over emphasized as these records
form the basis for the functioning of the referral service system.

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


identification of the patient so that the patient does not get lost in general crowd
attending a large hospital. This can be achieved through distinct and identifiable
referral cards and having local arrangements for the reception of these patients.
The details of the modality of such reception system can be worked out by each
institution depending upon the local circumstances.

In some bigger hospitals there may be need for having a separate reception
counter for referred cases if the workload justifies. In others there may not be a
separate reception counter, but some system of segregating referred patient from
the general patients shall be instituted. It would not suffice to identify these patients
when they are referred to an institution. Arrangements must be made to give little
priority to these patients in so far as diagnosis and treatment is concerned. The
dictum is to treat referral cases as VIP.

Ideally all the patients who are referred shall be provided some transport facility to
reach the institution where they have been referred.

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


transportation of these patients by the medical organizations. However, all
emergencies which are referred to various institutions as far as possible must be
direct responsibility of medical institutions. For other deserving cases voluntary
organizations may be involved in the transportation process.

For instance, cooperation could be sought from the 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

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


system.

The referral service system will not work unless all the professionals located in all
the segments of the medical care organization understand and appreciate the
importance of the referral services system. To include the importance of this
system all the professionals in various organizations need to be developed into one
team of workers whose members are located in different organizations. Team
building does not come on its own or through office orders. It can only be achieved
through a process of in service education, continuous meetings and reinforcing the
importance and the use of the referral services system. It is therefore
recommended that efforts in this direction be made at all levels of the referral
service system.

In an ideal referral system not only the patients move from one segment of the
organization to another, the movement of specialists from the institutions of higher
order to the more peripheral institutions is also an integral part of the system. This
will not only enable the patients to get specialist advice near their homes but also
would act as an educational tool for the professionals who are working in the more
peripheral institutions. The added advantage of the flow of specialist to the
periphery is the understanding of the working conditions in the periphery as well as
understanding of the problems of the population which is located in the rural areas.
The community orientation of the professionals is one of the essential features of
the referral service system.

For provision of transport in emergency cases, the golden rule of 1 hour needs to
be kept in mind. The ambulance shall be used for transporting patients only and
not staff, materials etc.

Transportation of referred cases particularly emergency or serious cases generally


poses problems. While steps to smoothen such situations shall be initiated, it is
worthwhile to consider active involvement of the community in this regard.

The immediate practical steps like convincing the community about the importance
of referral and need for its support through transport facilities, making them aware
of their role and responsibility towards their own healthcare, helping them in
organizing locally suited transport system village based or sub-centre based and
enabling them in its effective management etc., need to be initiated by health staff.

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


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

It shall be emphasized that referral system is a two-way process and that retention
of patients in a referral institution shall be as brief as possible.

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Acute Conditions / Trauma:

Appropriate and prompt referral of case needing hospital care including:


Stabilization of patient.
Appropriate support for patient during transport.
Providing transport facilities either by ambulance or other available referral transport.

Chronic Conditions requiring referral for Specialist Consultation / Care:

Complete referral slip (including history / examination / differential diagnosis / tests &
treatment done till date) shall be made.
Subsequent Follow-up of these case and care as per the plan of action outlined by
the consultant. Liasoning with the referral institutions identified for PUHC area.
Having a two way linkage with the concerned officials of the referral centre.

Indicative Service Norms by levels of Service Delivery*

Levels of Service delivery


Services** First point of service Referral Centre - RC
Community (Outreach)
delivery (PUHC) (Specialist services)
A. Essential Health Services

Registration, ANC, ANC, PNC, initial Delivery (normal and


management of complicated), management
identification of danger of
complicated delivery
signs, referral for
cases and referral, Complicated gynae
Maternal institutional delivery,
management of regular /maternal
health follow-up.
maternal health
Counseling and conditions, health condition,
behaviour hospitalization and surgical
referral of complicated interventions, including
promotion cases blood transfusion.
Counseling, distribution
of Distribution of OCP/CC,
IUD insertion, referral
OCP/CC, referral for Sterilization operations,
Family for sterilization,
fertility
welfare sterilization, follow-up of management of
contraceptive related treatment
contraceptive related
complications
complications
Diagnosis and
Immunization,
treatment of Management of
identification of danger
signs, referral, follow-up, childhood illnesses, complicated
Child health distribution of ORS, referral of acute cases / Pediatric / neo-natal cases,
and nutrition pediatric cotrimoxazole chronic illness hospitalization, surgical
post-natal visits / Identification and interventions, blood
counseling for newborn transfusion
referral of neonatal
care
sickness

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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

Case detection and Psychiatric and


referral, Diagnosis and neurological services,
Mental Health
treatment including hospitalization, if
counseling, rehabilitation needed
Basic dental education, Management of
screening for Diagnosis and complicated cases,
Oral Health hospitalization (if
precancerous treatment
lesions, referrals needed)

Early detection and


A7.2Hearing awareness Management of
Diagnosis and complicated cases,
Impairment/ for preventive hospitalization (if
treatment
steps/actions,
Deafness needed)
referral

Symptomatic search and Diagnosis and


Chest treatment, referral of
infections referral, ensuring complicated cases Management of
adherence to (MDR, reactions, complicated cases
(TB/ Asthma)
DOTs, other treatment terminal illness)
Cardio- BP measurement, Diagnosis and Management of emergency

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vascular symptomatic search and treatment, emergency cases, hospitalization and


resuscitation, referral of
diseases referral, follow-up of surgical interventions (if
cardiac
under treatment patients needed)
emergencies cases
Blood/urine sugar test
(using
disposable kit), Management of
symptomatic Diagnosis and complicated cases,
Diabetes treatment, referral of hospitalization (if
search and referral, complicated cases
follow-up needed)
of under-treatment
patients

Symptomatic search and Identification and Diagnosis, treatment,


referral, follow-up of
Cancer referral, follow-up of hospitalization (if and
under-treatment
under treatment patients patients when needed)
First aid , emergency
Trauma care Case management and
resuscitation, hospitalization,
(burns & First aid and referral documentation for MLC physiotherapy and
injuries) (if applicable) and rehabilitation
referral
Other surgical Identification and Hospitalization and surgical
--- not applicable ---
interventions referral interventions

B. Other support services


IPC, Health Camps /
fairs,
performing arts,
Distribution of health Distribution of health
IEC/BCC wall/poster
education material education material
writing, events (in
schools,
womens groups)
Individual and
group/family
counseling HIV / AIDS / Patient / attendant Patient / attendant
Counseling Mental disorders / stress counseling counseling
management / Tobacco
/Alcohol. Substance
abuse
IEC on hygiene,
community
Personal & mobilization for
Social cleanliness --- not applicable --- --- not applicable ---
Hygiene drives, disinfection of
water
sources, etc.

*Norms adapted from NCMH Report


** Services based on situational analysis

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HUB & SPOKE MODEL OF REFERRAL SYSTEM

PRIMARY URBAN HEALTH


CENTRES / DISPENSARIES

SECONDARY CARE HOSPITALS

TERTIARY CARE HOSPITAL

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REFERRAL SLIPS

(NAME & LOCATION OF PRIMARY URBAN HEALTH CENTRE)

REFERRAL SLIP

Referred from:

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

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

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

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


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

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

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

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


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

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

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

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

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

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

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(NAME & LOCATION OF PRIMARY URBAN HEALTH CENTRE)

REFERRAL SLIP

Referred from:

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

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

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

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


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

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

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

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


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

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

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

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

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

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

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CAPACITY BUILDING & TRAINING OF STAFF

The increasing pace of technological change is perhaps the single biggest impetus for
training & capacity building in healthcare. Training & Capacity Building is essential because
technology is developing continuously at a very fast pace. The systems and practices that
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.

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Model for Staff Development Process

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.

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BEHAVIOUR CHANGE COMMUNICATION

Behavior change has become a central objective of public health interventions over the last
half decade, as the influence of prevention within the health services has increased. The
increased influence of prevention has coincided with increased multi-lateral and bi-lateral aid
in the area of human development, and the increased need for the international development
community to show cost-effectiveness for allocated money spent.

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

INFORMATION, EDUCATION & COMMUNICATION (IEC)

Information, Education and Communication (IEC) are essential component of any


development programme. IEC is a strategic approach to health communication that uses
information and education materials and activities to generate awareness and influence
health practices.

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

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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:

Sensitizing providers for friendly behaviour with patients


Promoting provider behaviour for rational drug use and adequate prescriptions
Facilitating community to demand services by service providers
Improving awareness about the health services
Promoting correct perception about the gravity of different types of sickness
Reducing the perceived quality gap though better communication
Promoting cleanliness, proper waste disposal, and prevention of diseases
Organizing of the camps / campaigns / outreach activities and with the help of
ASHAs ensure active participation by the community.
Celebration of health days and weeks and publicity programmes al local fairs on
market days etc.

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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.

@ National Accreditation Board for Hospitals and Healthcare Providers 91


BEHAVIOUR CHANGE COMMUNICATION MATRIX

BEHAVIOUR CHANGE COMMUNICATION MATRIX

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

BIO MEDICAL WASTE MANAGEMENT

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.

@ National Accreditation Board for Hospitals and Healthcare Providers 83


HANDWASHING TECHNIQUES
Accreditation Standards for Primary Urban Health Centre

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.

This information is supplemented by other sources such as censuses, surveys and


administrative records. Although such systems are ubiquitous, there is widespread
dissatisfaction with them.

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.

The various parameters for monitoring are-

OPD attendance
ANC check-up of pregnant women

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Accreditation Standards for Primary Urban Health Centre

Tetanus toxoid (2nd dose) coverage among pregnant women


Institutional deliveries
Total number of still births
Complete immunization among children < 12mnths
Number of live births,
Total number of investigations done
Total number of referred cases (BPL referrals)
Patient satisfaction
Case detection for malaria through blood examination
Case detection of TB through identification of chest symptomatic
Referral for sputum microscopy examination for TB
Number of cases screened and treated for dental ailments
Number of cases screened for diabetes at PUHCs
Number of cases referred and operated for heart related ailments
First aid and referral of burns and injury cases
Death rate,
Awareness of community about tobacco products / alcohol and substance abuse.
Equipment utilization rate,
Ambulance utilization rate,
Discipline state-absenteeism, misconduct, negligence
Frequency of training of various categories of staff
Hospital Management Information System
Cities / population with all slums and facilities mapped
Number of Slum/ Cluster level Health and Sanitation Day
Number of ASHA receiving full honorarium
Number of Mahila Arogya Samiti formed

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Accreditation Standards for Primary Urban Health Centre

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.

Cleanliness and Sanitation:

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.

iv. Continuous water supply must be ensured.

v. Toilet must be inspected by the Medical Officer incharge daily.

@ National Accreditation Board for Hospitals and Healthcare Providers 87


Accreditation Standards for Primary Urban Health Centre

COMMUNITY PARTICIPATION AND EMPOWERMENT

Community participation in planning, implementing and monitoring Primary healthcare


delivery in urban settings through Primary Urban Health Centres is essential for it to succeed
in achieving its objectives and yield results. Therefore presence of Rogi Kalyan Samiti,
involving ASHA in reaching out to community and various committees has been ingrained in
the recommended Public Health Standards. The basic structure, objectives, functions of a
PUHC Rogi Kalyan Samiti, ASHA and committees has been recommended.

ROGI KALYAN SAMITI

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.

Need for Rogi Kalyan Samiti

1. To ensure community participation in planning, implementation and monitoring of the


Primary Urban Health Centre and make the PUHC more sensitive and responsive to
the patients.
2. Provide the required local autonomy and flexibility in implementation of activities
required for optimal functionalization of the centre.
3. To provide funds for local activities / initiatives carried with the objective of delivering
quality assured healthcare.

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.

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Functions and activities:

To achieve the above mentioned objectives, the Samiti shall direct its efforts and resources
for undertaking following activities:

Periodical monitoring, visits, patient feedbacks to assess the timeliness / quality of


services / adherence to the Public Health Standards / attitude in interactions with
patient / availability of medications / average waiting time for the patients.
Monitoring of the outreach activities.
Assessment of patient satisfaction levels regarding the services being provided.
Assessment of the problems / limitations being faced by the staff and finding
solutions.
Minor repairs / renovation / upkeep of the PUHC premises.
Minor electrical works / repairs of the electrical gadgets.
Ensure that all equipments at the PUHC are properly maintained and kept in good
running condition.
Improve the laboratory testing facilities at the PUHC.
Monitor attendance of all categories of staff of the PUHC.
Ensure wearing of Uniforms, Badges, I-Card by all the PUHC staff.
Monitor quality and use of Ambulance services, if available, at the PUHC.
Ensure timely submission of report and returns.
Referral system & referral register, Display of referral map and chain, whether
ground(s) for referring are properly elaborated.
Maintenance of Grievance Book at PUHC and availability of the same to patient /
patient party.
Ensure adequate stock of ARV, AVS, Tet. Toxoid, Oxygen Cylinder etc.
Enquiry into the complaints of patients / patient party.
Assessment and rationalization of men and materials of the Primary Urban Health
Centre.
Making arrangement for maintenance of Primary Urban Health Centre building
(including residential buildings), vehicles and equipment available with the PUHC.
Encouraging community participation in the maintenance and upkeep of the PUHC.
Adopting sustainable and environmental friendly measures for day-to-day
management of the Primary Urban Health Centre e.g. Scientific Disposal of wastes,
Solar Lighting Systems etc.
Instal signages, repair of furniture.
To undertake customized solutions to address problems like lack of running water.

@ National Accreditation Board for Hospitals and Healthcare Providers 89


Accreditation Standards for Primary Urban Health Centre

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.

Constitution as per the State Guidelines

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.

Detailed Guidelines on Structure, Memorandum of Association, Rules & Regulations will be


provided by the State.

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:

Ward Counselor Chairman


Medical Officer In-charge of the PUHC Secretary & Convener

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Accreditation Standards for Primary Urban Health Centre

One ANM of the PUHC Member


Pharmacist Member
One NGO representative working in the area of health or social sector Member

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.

Role envisaged for ASHAs:

1. To carry out the survey of the households in her area.


2. To create awareness about determinants of health such as nutrition, basic sanitation
& hygienic practices, healthy living and working conditions.
3. She will provide information on existing health services and the need for their timely
utilization. She will mobilize the community and facilitate them in accessing health
services available at the Primary Urban Health Centres, referral centres,
anganwadis.
4. To counsel women on birth preparedness, importance of safe delivery, breast
feeding and complementary feeding, immunization, care of the young child,
contraception and prevention of common infections including Reproductive Tract
Infections / Sexually Transmitted Infections (RTIs / STIs). She will ensure that each
child in her area is fully immunized.
5. She will work with the Health & Sanitation Committee of her area to get optimum
benefit from various initiatives related to safe water supply and sanitation being
undertaken by the Government. She will promote construction of household /
community toilets.
6. She will arrange escort / accompany pregnant women & children requiring treatment
/ admission to the nearest pre-identified health facility i.e. Primary Urban Health

@ National Accreditation Board for Hospitals and Healthcare Providers 91


Accreditation Standards for Primary Urban Health Centre

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.

HEALTH & SANITATION COMMITTEES

Activities:

x Cleanliness & Sanitation activities


x Ensure safe drinking water
x Setting up community toilets / facilitating household toilets / promoting use of toilet
and preventing open defecation.

x To be vigilant and eliminate / render safe all vector breeding sites.


x Local Health & Nutrition activities, Health and Nutrition days

Composition of a Health and Sanitation Committee (one for 2000 population)

President: Representative Self Help Group, Senior Citizen Group, Resident Welfare
Association, Gender Resource Centre in that order.

Convener: Area ASHA

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Accreditation Standards for Primary Urban Health Centre

Members:

i. Government Employees (retired) / honorarium paid staff e.g. School teacher,


Anganwadi Worker, preferably not more than one third.
ii. Representative of local womens self help group
iii. Representative of the local NGO

@ National Accreditation Board for Hospitals and Healthcare Providers 93


Accreditation Standards for Primary Urban Health Centre

CITIZEN CHARTER FOR PRIMARY URBAN HEALTH CENTRE

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.

Objective of this document:


To inform the beneficiaries about the health facility, its structure, its mandate, the service
components available in the health facility, the entitlements of the beneficiary, the
responsibilities of the beneficiaries and the available mechanism of grievance redressal.

Commitment of the Charter:

Access of all beneficiaries to the PUHC and utilization of existing facility without
discrimination.
Quality oriented service delivery in a responsive and responsible manner.
To provide holistic primary healthcare in an OPD mode with the level 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.

Service Components of a Primary Urban Health Centre

Registration timings and timings for delivery of services to be mentioned clearly.


Mention the services which are free of cost and services having nominal user fee.
Layout of available services along with locations within the facility.

Curative Component:

OPD Services: Management of the common ailments as per the Standard


Treatment Protocols developed by the State.

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Emergency Medical care: During the OPD hours, first aid and stabilization followed
by referral if required for injuries / accidents / animal bite cases and other emergency
conditions.
Minor Surgical Procedures: Simple Incision and drainage, suturing of simple clean
lacerated wounds. During all these surgical procedures, universal precautions will be
adopted to ensure infection prevention.
Referral for the Cases requiring Secondary / Tertiary care: All patients requiring
higher level care to be referred in time to a linked and identified centre with a
complete referral slip. Follow up of these cases in Primary Urban Health Centre.
Rehabilitation: Disability prevention, early detection, intervention and referral.
Provision of AYUSH services wherever AYUSH unit is co-located.
Geriatric care: Special emphasis on taking care of the senior citizens visiting the
health centre. From having user friendly access, freedom from long queues,
assistance in obtaining and understanding medications to special assistance like that
in obtaining dentures / spectacles through the Rogi Kalyan Samitis.

II. Preventive & Promotive services

1. Reproductive and Child Health Programme:


Maternal Health Services:
a. Antenatal Care:
i. Early registration (ideally before 12th week) of all pregnancies with a duly filled
ANC card.
ii. Antenatal checkups and provision of complete package of services.
iii. Provision of associated services like providing iron and folic acid tablets, injection
tetanus toxoid etc. (as per the guidelines for antenatal care)
iv. Laboratory investigations like haemoglobin, urine albumin and sugar.
v. Nutrition counselling.
vi. Identification of high risk pregnancies / referral to First Referral Units (FRUs) /
other linked hospital for high risk pregnancy.

b. Preparation / planning for delivery in an institution

c. Postnatal Care
Two postpartum home visits through the ANM to ensure wellbeing of mother and
newborn within 48 hrs and seven days of delivery to initiate early breast
feeding and reinforce advice on nutrition, hygiene, contraception.

@ National Accreditation Board for Hospitals and Healthcare Providers 97


Accreditation Standards for Primary Urban Health Centre

Child Health Services:


a. Care of routine childhood illness.
b. Promotion of exclusive breast feeding for 6 months.
c. Full immunization of all infants and children against vaccine preventable
diseases as per guidelines of Government of India. Immunization days to be
specified.
d. Vitamin A prophylaxis for the children as per the guidelines.

Adolescent Health:
Detection and management of nutritional disorders and high risk behaviour.

Family Planning Services:


a. Education, Motivation and counseling to adopt appropriate family planning
methods.
b. Provision of contraceptives such as condoms, oral pills, emergency
contraceptives etc.
c. Carry out IUD insertions.
d. Follow up services to the eligible couples adopting permanent spacing / method
(Tubectomy / Vasectomy).
e. Counseling and appropriate referral for couples having infertility.
f. All incentives shall be clearly mentioned along with name of the person
responsible.

Management and Prevention of Reproductive Tract Infections / Sexually


Transmitted Diseases:
Treatment of RTIs and STDs and health education for prevention of RTIs / STDs.

2. Integrated Disease Surveillance Project (IDSP):


a. To detect unusual health events and take appropriate remedial measures.
b. Facilitate disinfection of water sources.
c. Promotion of sanitation including use of toilets and appropriate garbage disposal.

3. Revised National Tuberculosis Control Programme (RNTCP):


All Primary Urban health Centres to function as DOTS Centres to deliver
treatment as per RNTCP Treatment Guidelines through DOTS providers and
treatment of common complications of TB and side effects of drugs.

4. National Programme for Control of Blindness (NPCB):


a. Basic Services: Diagnosis and treatment of common eye diseases.

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Accreditation Standards for Primary Urban Health Centre

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


c. Detection of cataract cases and referral for / facilitation of cataract surgery.

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


a. Diagnosis of Malaria cases, microscopic confirmation and treatment.
b. Cases of suspected Dengue, Chikungunia to be provided symptomatic
treatment, referral for hospitalization and cases management as per the
protocols.
c. IEC activities regarding spread and prevention, symptoms of VBDs and early
detection of complications.

6. National Leprosy Elimination Programme (NLEP):


a. Identification of leprosy patients on basis of clinical examination.
b. Referral of the patients to secondary care level when required.
c. Complete treatment with MDT.
d. IEC activities
e. Rehabilitation / disability prevention.

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


a. Goitre detection and workup.
b. Salt iodine estimation of salt samples collected from household.
c. IEC activities to create awareness of Iodine deficiency disorders.

8. National AIDS Control Programme (NACP):


a. IEC activities to enhance awareness and preventive measures about STIs and
HIV / AIDS.
b. Screening of persons practicing high risk behaviour at the nearest ICTC.
c. Risk screening of antenatal mothers with one rapid test for HIV.
d. Condom promotion and distribution of condoms to the high risk groups.
e. Help and guide patients with HIV / AIDS in receiving ART.

III. Addressing other Determinants of Health Inter-sectoral Convergence:


A. Nutritional Services (in convergence with ICDS)
i. Diagnosis of and nutrition advice to malnourished children, pregnant women and
others.
ii. Diagnosis and management of Anemia and Vitamin A deficiency.

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Accreditation Standards for Primary Urban Health Centre

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.

B. Health of School going Children (Convergence with School Health)


i. All children referred from the school for investigations, management to be taken
care of.
ii. School dropouts / children not going to school to be identified by the ASHAs and
provided with the necessary screening / age appropriate immunization / health
education through the centre / outreach activities.

C. Promotion of Safe Drinking Water and Basic Sanitation


i. IEC regarding consumption of safe drinking water and how to make drinking
water safe.
ii. Provision of Chlorine tablets / drops through the centre / ASHAs.

IV. Referral Services:


Appropriate and prompt referral of cases needing specialist care / indoor care
including:
a. Stabilization of patient
b. Appropriate support for patient during transport
c. Follow up of these cases. Liasoning with the referral institutions for PUHC area.
Having a two way link with the concerned officials there.

V. Provision of Essential Diagnostic services:


The following tests will be provided at the PUHC laboratory
i. Hb %, TLC
ii. Blood Sugar
iii. Urine Albumin, Sugar and Microscopy
iv. Urine Pregnancy Test
v. Stool Microscopy
vi. Sputum testing for tuberculosis (if designated as a microscopy centre under
RNTCP)
vii. Blood smear examination for malarial parasite
viii. Tests specified as a part of IDSP

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The following investigation will be provided at the PUHC Radiology

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.

c. DOPPLER STUDIES (if available)


Peripheral, Cerebro-vascular and abdominal Doppler.
Assessment of post Kidney and Liver Transplant patients.
Penile Doppler examination

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.

VII. Provision of Services through Outreach activities


Provision of basic curative / preventive care in areas / certain specific vulnerable
groups through outreach activities especially in the slums, JJ clusters, resettlement
colonies, unauthorized colonies and villages through regular Health & Nutrition days,
Immunization sessions.

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Accreditation Standards for Primary Urban Health Centre

PUHC will be responsible for conducting this activity in its catchment area. The staff
and logistics will flow from the PUHC.

VIII. Continuous Capacity Building


Periodic skill development / training of the staff of the PUHC in the various jobs /
responsibilities assigned to ensure quality. ASHAs will be provided with the induction
/ refresher trainings and ongoing support in the field.

IX. Ensure rational use of drugs


Any short term withdrawal of services shall be displayed on notice boards.

Responsibilities of the Citizens


In addition to the rights, the citizens also have certain responsibilities towards the
Primary Urban Health Centre.
1. To keep the premises clean, not to spit / smoke / litter the area.
2. To keep the surrounding area clean.
3. Not to disfigure / damage the building / other infrastructure.
4. To observe etiquette like standing in the que, talkin low tones, assist old / infirm.
5. Follow the instructions given by the Medical Officer Incharge regarding treatment
advised and referrals / follow ups.
6. Inform the Medical Officer Incharge about sex selective procedures,
environmental hazards, excessive vector breeding or reporting of cases in the
community.
7. Cooperation with the health functionaries and voluntary workers attached to
Primary Urban Health Centres like ASHAs.
Grievance Redressal Mechanism
Any grievance / complaint can be directly addresses to the Medical Officer Incharge or
placed in the complaint box positioned in a prominent place in the waiting area. These
complaints will be dealt within a time bound manner. If required, Medical Officer Incharge
may bring it up before the Rogi Kalyan Samiti.
In case the grievance is not resolved at the PUHC level, the Chief District Medical Officer will
take it up through the District Rogi Kalyan Samiti.
The next level if required will be the level of the Integrated District Health Society,
Directorate of Health Services and Family Welfare or State Health Society depending upon
the nature of grievance.
The name of the Medical Officer Incharge and the Chief District Medical Officer along with
official address and phone numbers will be displayed in the Primary Urban Health Centre.

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Display at the Primary Urban Health Centre


A board displayed in Hindi, at the conspicuous place clearly visible carrying
summarized citizens charter showing available services.
Language both Hindi and English for printed pamphlets.
Size preferably 4 ft X 6 ft for board.
Colour unique dark blue background with white letters
Preferably no abbreviations to be used
Facility specific
Periodical Review of the Charter
Charter will be reviewed periodically and suitably modified.

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JOB RESPONSIBILITIES OF PRIMARY URBAN HEALTH CENTRE STAFF

MEDICAL OFFICER INCHARGE, PRIMARY URBAN HEALTH CENTRE


Medical Officer Incharge of a Primary Urban Health Centre (PUHC) is responsible for
implementing all activities grouped under Health and Family Welfare delivery system in
PUHC area. It is not possible to enumerate all his / her tasks. However, by virtue of his / her
designation as the incharge and administrative head, it is implied that he /she will be solely
responsible for provision of comprehensive health care including the implementation of
National Health Programmes. He / She will also be the Member Secretary of the Rogi
Kalyan Samiti of the Primary Urban Health Centre and will be responsible for execution of
his / her responsibilities in that capacity.

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)

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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.

II. Preventive and Promotive Work


The Medical Officer will ensure that all the members of his / her Health Team are fully
conversant with the various National Health & Family Welfare Programmes under National
Urban Health Mission to be implemented in the area allotted to each Health functionary. He /
she will further supervise their work periodically both in the clinics and in the community
setting to give them the necessary guidance and direction.

Based on the information collected by ASHA and the ANM from their surveys, he / she will
prepare operational plans and ensure effective implementation of the same to achieve the
laid down targets under different National Health and Family Welfare Programmes. The
second MO / PHN will provide assistance in the formulation of local health and sanitation
plan through the ANMs and coordinate with the local self help groups / health and sanitation
committees in his / her PUHC area.
He / she will keep close liaison with Block Development Officer and his / her staff,
community leaders and various social welfare agencies in his / her area and involve them to
the best advantage in the promotion of health programmes in the area.

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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.

2. Reproductive & Child Health Programme


Antenatal care / preparation and necessary linkage for Intranatal care / Post natal
care.
Ensuring antenatal day every week with delivery of complete and quality assured
antenatal care including clinical examination, investigation, and supplementation.
Identification and referral of high risk cases. Follow-up of these high risk cases
through pregnancy, intranatal period and postnatal period.

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.

Universal Immunization Programme


Ensure cent percent coverage as per the State Immunization schedule of the
target population in PUHC area (i.e. pregnant mothers and children in 0 5 year
age group) through immunization sessions twice a week and conduct of outreach
immunization sessions if required.
He / She will ensure adequate supplies of vaccines miscellaneous items required
from time to time for the effective implementation of UIP.
He / She will also ensure proper storage of vaccine and maintenance of cold
chain equipment, planning and monitoring of performance and training of staff.

2. Family Planning Services


He / She will be responsible for proper and successful implementation of Family
Planning Programme in the PUHC area, including education, motivation, delivery
of services and after care.

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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.

4. National Vector Borne Disease Control Programme (NVBDCP)


Ensure facility for blood testing for fever cases.
Will liaison with the authorities carrying out spraying activities and providing
logistics like larvicides in PUHC area.
Ensure elimination of mosquitoes breeding site in the PUHC and in the area
through education / awareness generation by ASHAs, ANMs and liaisoning with
local self help groups.
Ensure that all positive cases are treated adequately.
Ensure that cases of complicated Malaria are referred.
Ensure that all his team members are aware of Chikungunia / Dengue and
trained to detect early case of Dengue Shock Syndrome, Dengue Hemorrhagic
Syndrome and institute appropriate SOP at the PUHC and community level
before prompt referral.
Ensure sufficient stock of Chloroquine and IV fluids.
Report all cases of suspected Dengue, Chikungunia and smear positive malaria
cases promptly.
Judicious use of all publicity material and mass media equipment received from
time to time.
He / She shall ensure that all categories of staff in the centre are sufficiently
trained and observe the instructions laid down under NVBDCP on the treatment
of smear positive cases.

6. Tuberculosis

Ensure high index of suspicion in the patients visiting OPD, provide facilities for
early detection of case, confirmation and prompt institution of treatment.

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He / She will also ensure that all cases of confirmed Tuberculosis take regular
and complete treatment.
Ensure smooth functioning of DOTs centre and Microscopy centre if operating in
the PUHC.

7. Sexually Transmitted Disease


He / she will ensure that all cases of STD are diagnosed and properly treated
and their contacts are traced for early detection.
He / She will provide facilities for RPR test, for all pregnant women at the PUHC.

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.

9. Control of Communicable Diseases


He / she will ensure that all the steps are being taken for the control of
communicable diseases and for the proper maintenance of sanitation in the area.
He / she will take the necessary action in case of any outbreak of epidemic in his
/ her area.
Perform duties under the IDSP.

10. National Programme for Prevention of Visual Impairment and Control of


Blindness
He / she will make arrangements for rendering:
a. Treatment for minor ailments
b. Testing of vision
He/she will refer cases to the appropriate institutes for specialized treatment.

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.

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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.

vi. Administrative Work


He / she will supervise the work of staff working under him / her.
He / she will ensure general cleanliness inside and outside the premises of the
PUHC and also proper maintenance of equipment under his / her charge.
He / she will ensure maintenance of a regularly updated inventory and stock
register of all the stores and equipment supplied to him / her and will be
responsible for its correct accounting.
He / she will get indents prepared timely for drugs, instruments, vaccines, ORS
and contraceptive etc. sufficiently in advance and will submit them to the
appropriate health authorities.
He / she will check the proper maintenance of the transport given in his / her
charge.
He / she will scrutinize the programmes of his / her staff and suggest changes if
necessary to suit the priority of work.
He / she will get prepared and display charts in his / her own room to explain
clearly the geographical areas, location of peripheral health units, morbidity and
mortality, health statistics and other important information about his / her area.
He / she will hold monthly staff meetings with his / her own staff with a view to
evaluating the progress of work and suggesting steps to be taken for further
improvements.
He / she will ensure the regular supply of medicines and disbursements of
incentives to ASHAs.
He / she will ensure the maintenance of the prescribed records at PUHC level.
He / she will be responsible for compilation of accurate and complete reports in
the prescribed formats and their timely submission to the headquarter.
He / she will keep notes of his / her visits to the area and submit every month his
/ her tour report to the CDMO.
He / she will discharge all the financial duties entrusted to him / her.
He / she will discharge the day to day administrative duties and administrative
duties pertaining new schemes.

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SECOND MEDICAL OFFICER

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.

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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.

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II. Preventive and Promotive Work

The Medical Officer will ensure that all the members of his / her Health Team are fully
conversant with the various National Health & Family Welfare Programmes under National
Urban Health Mission to be implemented in the area allotted to each Health functionary. He /
she will further supervise their work periodically both in the clinics and in the community
setting to give them the necessary guidance and direction.
Based on the information collected by ASHA and the ANM from their surveys, he / she will
prepare operational plans and ensure effective implementation of the same to achieve the
laid down targets under different National Health and Family Welfare Programmes. The 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.

2. Reproductive & Child Health Programme


Will provide Antenatal care / preparation and necessary linkage for Intranatal
care / Post natal care.
Conduct antenatal day every week with delivery of complete and quality assured
antenatal care including clinical examination, investigation, and supplementation.
Identification and referral of high risk cases. Follow-up of these high risk cases
through pregnancy, intranatal period and postnatal period.

Outreach Activity
Provide quality assured / 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.

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Universal Immunization Programme


Provide cent percent coverage of the target population in PUHC area (i.e.
pregnant mothers and children in 0 5 year age group) through immunization
sessions twice a week and conduct of outreach immunization sessions if
required.
Ensure proper storage of vaccine and maintenance of cold chain equipment,
planning and monitoring of performance and training of staff.

3. Family Planning Services


Provide Family Planning services in the PUHC area, including education,
motivation, delivery of services and after care.
He / She will be squarely responsible for giving immediate and follow-up
attention to any complications resulting from acceptance of family planning
methods.
He / She will assist in organizing the vasectomy camps.

4. Adolescent Health
Conduct of health talks / check up of school dropouts and children not going to
school / adolescents identified and collected by ASHAs.
Creating adolescent friendly environment in the PUHC to enable the adolescents
to approach the Medical Officer, Public Health Nurse, ANM with their problems /
queries.

5. National Vector Borne Disease Control Programme (NVBDCP)


Ensure blood testing for fever cases.
Ensure elimination of mosquitoes breeding site in the PUHC and in the area
through education / awareness generation by ASHAs, ANMs and liaisoning with
local self help groups.
Treat all positive cases adequately.
Refer all cases of complicated Malaria in time.
Ensure that all his team members are aware of Chikungunia / Dengue and
trained to detect early case of Dengue Shock Syndrome, Dengue Hemorrhagic
Syndrome and institute appropriate SOP at the PUHC and community level
before prompt referral.
Report all cases of suspected Dengue, Chikungunia and smear positive malaria
cases promptly.
Judicious use of all publicity material and mass media equipment received from
time to time.

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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.

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7. Sexually Transmitted Disease


Diagnose and treat all cases of STD and contacts.
Ensure RPR test, for all pregnant women at 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.

9. Control of Communicable Diseases


Take all necessary steps for the control of communicable diseases.
Take the necessary action in case of any outbreak of epidemic in his / her area.
Perform duties under the IDSP.

10. National Programme for Prevention of Visual Impairment and Control of


Blindness
Treatment for minor ailments
Testing of vision to screen using Snellen chart / near reading charts.
Refer cases to the appropriate institutes for specialized 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

IV. Monitoring & Evaluation


Will be responsible for monitoring the work being done by the ANMs in the centre
and the field including Outreach activity. Monitoring will be structured and as per
defined formats.
Will periodically check and initial the ANM registers Survey registers, eligible
couple registers etc.
Assess fortnightly the progress of work of the ANM. Submit a report to the
Medical Officer Incharge. Evaluate the work being done and guide her in
improving her performance.
Visit each outreach centre at least once a week on a fixed day and while
conducting the clinic, also monitor / evaluate the work being done at the centre.
Provide necessary guidance for online correction.

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Similarly will evaluate the performance of ASHAs in consultation with the


concerned PHN and ANM. Provide all support and guidance wherever required
and be an active member of the ASHA mentor group.
Provide the feedback to the Medical Officer Incharge on the monitoring and
evaluation.
V. Administrative Work
He / she will ensure general cleanliness inside and outside the premises of the
PUHC and also proper maintenance of equipment under his / her charge.
He / she will ensure to keep up to date inventory and stock register of all the
stores and equipment supplied to him / her and will be responsible for its correct
accounting.
He / she will assist the Medical Officer Incharge preparing charts to explain
clearly the geographical areas, location of peripheral health units, morbidity and
mortality, health statistics and other important information about PUHC area.
He / she will attend weekly / monthly staff meetings with a view to evaluating the
progress of work and suggesting steps to be taken for further improvements.
He / she will discharge all the financial duties entrusted to him / her.
He / she will discharge any other duty assigned to him by the Medical Officer
Incharge or upon introduction of a new scheme.

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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.

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PHARMACIST (STOREKEEPER)

The Storekeeper is answerable to the Medical Officer Incharge. He / she is


entrusted with the supervision of dispensary stores and the safety, protection
from loss, theft, pilferage and damage or deterioration of the stocks entrusted to
his / her charge.
He / she will arrange to keep stores in a neat and orderly manner and ensure
that all containers, bottles, packages etc. are properly labeled.
He / she will prepare and submit regular indents to the Medical Officer Incharge
and after getting approved and countersigned submit it to the Central Medical
Store in accordance with the delivery programme issued by the store from time
to time.
He / she will ensure sufficient buffer stock and will bring to the notice of the
Medical Officer Incharge when the stock requires replacement / procurement in
time to allow replacement to be made before actual depletion occurs i.e. before
the stock become 'NIL'. If required he / she shall prepare supplementary indents
for submission to the Central Medical Store.
He / she will procure indents from Central Stores / any other source whenever
required.
He / she will examine, count, measure or weigh, as the case may be, the stores
received and supervise its safe delivery to the dispensary stores. At the time of
the receipt, he / she will check that the quantities are correct and that the stores
are in good condition. He / she will immediately bring to the notice of Medical
Officer Incharge anything found contrary before the stocks are taken on the
stock register.
He / she will meticulously maintain the expiry date register. All received stock will
be entered with the batch no. / date of expiry / quantity received at the time of
receiving the stock. He / she will plan release of stores in such a way that the
items are used well before expiry dates.
He / she will bring to the notice of the Medical Officer Incharge stocks of such
preparations which are accumulating in the dispensary store beyond the need of
the dispensary.
He / she will be responsible for correct accounting of all the stocks and for
maintaining stock and issue registers and inventories in respect of the
consumable, non consumable items, the dead stock and liveries. He / she shall
make entries in the register and file the vouchers in serial order and produce the
same for checking / inspection at the time of verification of stores and get the
entries in the register counters signed by the Medical officer Incharge.
He / she shall issue to Pharmacist, Lab technician, ANM etc. stores under his
custody only on the authorization of the Medical Officer Incharge. He / she will
ensure that seal is broken / label defaced before issue of items.

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The Storekeeper will be responsible for obtaining written acknowledgement from


the persons to whom the stores are issued from the stores. These shall be filed
in serial order.
He / she will initial all entries in the stock ledger pertaining to the receipts and
issue of the store. Receipt entries will be made in red ink and issue entries in
blue ink.
He / she will comply with all instructions regarding store keeping and accounting
procedure issued by the controlling authority from time to time.
On transfer or while proceeding on leave. he / she will hand over the charge of
the store to his successor and furnish a handling over and taking over charge to
the Medical Officer Incharge in the prescribed form / register.
He / she will assist in dispensing work whenever so required by the Medical
Officer Incharge of the PUHC.
The Pharmacist will immediately comply with the instruction and arrange for the
stocks with him to be checked at any time by the Medical Officer Incharge or
other Medical officers and any other official deputed by the controlling authority.
He / she will assist the Medical Officer Incharge in dealing with the
correspondence with the Directorates / DPMU / and other agencies. He / she will
also assist Medical Officer Incharge in preparing reports / statistics.
In case of epidemics and under special circumstances, storekeeper will have to
arrange for the required medicines / logistics.
The bag and the raincoat / umbrella for outdoor official duty shall be kept in such
a manner that these are made readily available in the dispensary for performing
outdoor duty.
Storage and prevention of losses in the stores. The articles are to be properly
stored in the Store room. The Storekeeper is also responsible for preventing
damages in the store. The store must be free from rats, termites, cockroaches.
He / she will not allow any outsider to sit in the store unnecessarily.
He / she will check at regular intervals the stores available at the outreach centre
and help in the procurement of supplies and equipment. Check that the drugs at
the outreach centre are properly stored and that the equipment is well
maintained.
Ensure that sufficient stock is there for the outreach activities / ASHA activity and
to provide for referrals from the nearby schools.
Periodically check stock registers of the outreach centre. Issue the indents
required at the outreach centre and make the required entries in the stock
registers.
He / she will ensure the smooth working of the PUHC equipment like
microscope, refrigerators, inverter, coolers, water cooler with aquaguard etc. by
maintaining AMCs and ensuring their payments in time.

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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 (PHN)

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.

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Ensure preparation and display of material like growth / development charts in


the immunization / well baby room.
Motivate / screen cases for use of appropriate family planning methods IUCD
insertion and use of oral pills, permanent methods. Advise and educate
regarding use of emergency contraception.
Organize the adolescent health talks and screening clinics at the centre in the
outreach with the help of ANMs and ASHAs
Participate in special campaigns / screening activities i.e. Cancer screening
week.
Provide information on the availability of services for MTP and ensure referral of
suitable cases to the approved institutions.

Nutrition

Preparation of a plan of action for each identified anemic / malnourished baby


with the concerned ANM / ASHA. Appropriate counseling of the mothers of the
identified anemic and malnourished babies and attachment of the babies to the
nearest Anganwadi for SNP and the plan of action shared with the AWW,
Medical Officer to provide required technical advice in management anemia /
malnutrition.
Hold practical demonstrations on how to prepare nutritious / wholesome meals
with simple, easily available and affordable foods for those visiting the centres /
during outreach sessions.

Primary Medical Care


Supervise the ANMs / ASHAs and give hands on training for treatment of minor
ailments, first aid for accidents and emergencies.
Attend to the cases referred by ANMs / ASHAs

Supervision of ANMs
Preparation of the ANM roster to ensure that ANMs are in the field for atleast
four days in a week. By rotation they would assist in the centre based antenatal /
well baby 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.

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Conduct regular meeting with ANMs (weekly) in coordination with Medical


Officer Incharge. Assess periodically the progress of work of ANM and submit a
monthly assessment report to the Medical Officer Incharge of the PUHC. Carry
out supervisory home visits in the area of ANM.

Mentoring of Urban Social Health Activist (ASHAs)


Will be the key member in the unit level ASHA mentor group.
Will supervise ANM / ASHA synergy, the support provided by the ANMs to the
ASHAs, the capacity building of ASHAs, filling up of the diaries and verification
by the ANMs, financial record maintenance by the ANMs and timely
disbursement of incentives to the ASHAs.
Deliver the health talks in the Mahila Mandal meetings / adolescent health
activities organized by ASHAs.

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

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Right Age of Marriage


PNDT
Drug Addition etc.
Collection and judicious utilization of IEC material provided by the district.
Prepare the IEC / BCC plan for the PUHC
Supervise distribution of IEC material by ANMs / ASHAs.
Observation of National / International day & weeks.
Arrange group meetings with community leaders, teachers etc. and involve them
in spreading the message for family welfare programme.

Supplies, Equipment and Maintenance at Health Centre / Outreach


Ensure that the ANM maintains her equipment / records in a proper way.
Ensure that the ANM / Immunization / IUCD insertion room is kept clean and
equipment available and functional.
Preparation of a consolidated report of work done by the ANMs at the centre and
in the outreach.

Records & Reports


Scrutinizes and validates the records / reports prepared by the ANM and guides
her in their proper maintenance. She will be responsible for the completeness
and accuracy of the reports generated by the ANMs.
Review reports received from ANMs, consolidates them and submits periodical
report to Medical Officer Incharge of the PUHC.
Supervise the ANM ASHA chain.
Ensures that the records pertaining to ASHAs are being maintained properly.
Also ensures that the information gathered by ASHA is optimally utilized.

Any other duties / jobs assigned by Medical Officer Incharge from time to time.

AUXILLARY NURSE MIDWIFE (ANM)

Maternal & Child Health


Register and provide care to pregnant women throughout the period of
pregnancy. Registration of a pregnant woman for ANC shall take place as soon
as the pregnancy is suspected, ideally in the first tri-mester (before or at 12th
week of pregnancy). However, even if a woman come late in her pregnancy for
registration, she shall be registered, and care given to her according to
gestational age.

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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.

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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.

Medical Termination of Pregnancy


Identify the women requiring help for medical termination of pregnancy and refer
them to nearest approved institution.
Educate the community of the consequences of septic abortion and inform them
about the availability of services for medical termination of pregnancy. Help in
adoption of a spacing method after MTP conducted for an unwanted pregnancy.

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.

Universal Immunization Programme


Immunize pregnant women with tetanus toxoid
Administer DPT vaccine, oral poliomyelitis vaccine, measles vaccine and BCG
vaccine to all infants and children, Hepatitis B, Typhoid as per the immunization
schedule.
Ensure injection safety.
Report all adverse events to the Medical Officer.

Coordination with Local Dais


List Dais in her area and involve them in promoting Family welfare

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.

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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.

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Treatment of Minor Ailments


Provide treatment for minor ailments i.e. Paracetamol for fever, first aid for minor
accidents while on a home visit.
Team Activities
Organize staff meetings at Primary Urban Health Centre
Coordinate her activities with the Health volunteers / NGOs / ASHA and Dais.
Help in creation of and coordinate with the local self help groups, health and
sanitation committees.
Dispose medical waste as per the guidelines.
Participate as an active member of the team in camps and campaigns.

Role of ANM as a facilitator of ASHA


Auxillary Nurse Midwife (ANM will guide Urban Social health Activist (ASHA) in performing
the following activities:
She will hold weekly / fortnightly meeting with ASHA and discuss the activities
undertaken during the week / fortnight. She will guide her in case ASHA had
encountered any problem during the performance of her activity.
ANM will act as a resource person for the training of ASHA.
ANM will inform ASHA regarding date and time of the outreach session and will
also guide her for bringing the beneficiary to the outreach session.
ANM will participate and guide in organizing the Health days at Anganwadi
centres.
She will take help of ASHA in updating eligible couple register of the village
concerned.
She will utilize ASHA in motivating the pregnant women for coming to PUHC for
initial checkups. She will also help ANMs in bringing married couples to the
PUHC for adopting family planning.
ANM will ensure compliance in intake of full course of IFA tablets and TT
injections etc. with the help of ASHAs.
ANMs will orient ASHA on the dose schedule and side effects of oral pills.
ANMs will educate ASHA on danger signs of pregnancy and labour so that she
can timely identify and help beneficiary in getting further treatment.
ANMs will inform ASHA on date, time and place for initial and periodic training
schedule. She will also ensure that during the training ASHA gets the
compensation for performance and also TA / DA for attending the training.
She will be responsible for ensuring correct filling up of diaries by the ASHAs,
verification of the work done and timely disbursal of incentives.
She will also maintain financial records of the ASHAs working in her area.

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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:

I. General Laboratory Procedures


1. Maintain the cleanliness and safety of the laboratory
2. Ensure that the glassware and equipment are kept clean
3. Handle and maintain the microscope
4. Sterilize the equipment as required
5. Dispose of specimens and infected material in a safe manner as per the
Biomedical Waste Disposal guidelines
6. Maintain the necessary records of investigations done and submit the reports to
the Medical Officer, PUHC
7. Prepare monthly reports regarding his work
8. Indent for supplies for the laboratory though the Medical Officer, PUHC well in
time and ensure the safe storage of materials received

II. Laboratory Investigations


1. Carry out examination of urine
i. Specific gravity and PH
ii. Test for glucose
iii. Test for protein (albumen)
iv. Test for bile pigments and bile salts
v. Test for ketone bodies
vi. Rapid Test for Pregnancy (RPT)
viii. Microscopic examination
2. Carry out examination of stools
i. PH
ii. Microscopic examination

III. Carry out Examination of Blood


i. Collection of blood specimen by finger prick technique
ii. Hemoglobin estimation
iii. RBC count

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iv WBC count (total and differential)


v. Preparation, staining and examination of thick and thin blood smears for malaria
parasites and for microfilaria
vi. Erythrocyte sedimentation rate
vii. Blood Sugar
viii. Blood Grouping
ix. VDRL
x. Rapid Diagnostic test for Typhoid (Typhi Dot)

IV. Carry out Examination sputum


i. Preparation, staining and examination of sputum smear for Mycobacterium
tuberculosis (wherever the PUHC is recognized as microscopy centre under
RNTCP).

V. Carry out Examination of Semen


i. Microscopic examination
ii. Sperm count and motility

VI. Test samples of drinking water


i. Testing of samples for gross impurities
ii. Rapid tests for detecting faecal contamination by H2S strip test
iii. Residual chlorine in drinking water by testing kits

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.

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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.

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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.

c. DOPPLER STUDIES (if available)


Peripheral, Cerebro-vascular and abdominal Doppler.
Assessment of post Kidney and Liver Transplant patients.
Penile Doppler examination

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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.

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NURSING ORDERLY / PEON

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.

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SWEEPER CUM CHOWKIDAAR - SCC


(Dual work of security and sanitation in shift duties)

The SCC on morning shift will report for duty sufficiently early to sweep and mop
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.

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SOCIAL MOBILIZATION OFFICER (SMO)

He /she will be under the immediate administrative council of the Primary Urban Health
Centre Medical officer. He / she will be responsible for providing support to all health and
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 Rogi Kalyan Samitis:


Help in identification of the members
Registration of the society
Assist Medical Officer Incharge in organizing regular meetings of RKS
Taking minutes of the proceedings and ensuring follow up activities
Maintaining records including financial records
Preparing reports of RKS
Coordinating District / State level trainings for RKS members

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.

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Related to Accredited Social Health Activist (ASHA)


Facilitate selection of ASHAs
Assist the Medical Officer to develop the plan for ASHAs induction training and
concurrent training and implement the same.
He / she along with the ANM, PHN will be a part of the Unit level core mentor
team for the ASHAs. Building credibility, helping her access the resistant
families, enhancing her communication skills, establishing her contacts with local
water, sanitation functionaries. He / she will help field workers in winning over
resistant cases and drop outs in the health and family welfare programmes.
Map the defined and delineated catchment for each ASHA considering 400 - 450
households each.
Help ANM in monitoring work of ASHAs in the community, through verification of
reported beneficiaries.

Support to Outreach Activities


He / she will be responsible for planning of outreach activities in the PUHC catchments in
consultation with PHNs, ANMs, ASHAs and Medical Officer. The specific tasks to be
accomplished are:
Facilitate preparation of monthly outreach plan for slums in consultation with
concerned ASHAs and ANMs.
Esure the implementation of monthly outreach plan.
Help ASHAs in mobilization of community resources and required logistics
support for outreach activities place, tables, chairs, water etc.

Reporting and Data Management & Monitoring Activities


Help ANMs / ASHAs in compilation of data for activities outreach and coverage of services.
Support ASHAs to maintain registers, review registers and reporting formats and
compile data accurately for assigned clusters submit to Medical Officer.
Generating reports on the monthly activities of PUHC and help Medical Officers
in presenting it to appropriate authority / forums.
Will assist in monitoring the outreach activities / centres for the timeliness and
completeness of services being provided. Will ensure that the outreach centre is
kept clean and is properly maintained.

Mapping and IEC / BCC Activities


Help ANMs / ASHA and MAS in participatory geographical and social mapping
the slums and their catchments, depiction of households and beneficiaries on the
map.
He / she will be responsible for preparation and display of relevant maps of the
area which will be prepared with the help of the ANM and ASHA

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Coordination and Management


Coordinate with other Govt. Offices, municipality, District Tuberculosis Office /
DOTs centres, MDT centres, Malaria circle / beat office.
Establishing the vital network with the area Anganwadis and their functionaries,
supervisors.
Establishing contact with the school health functionaries in the area.
Liasoning closely with the local NGOs and ensuring their participation in various
activities as and when required.
Risk pooling is a proposed activity under the urban health mission. Once
operationalised it will need a strong community based working mechanism. He
will with the help of ASHAs, local NGOs, existing self help groups if any help in
building this mechanism
He / she will ensure that the benefit of various entitlement schemes being run by
the Government for vulnerable segments reach them. This activity will include
generation of awareness and facilitation of access to these benefits by the
identified beneficiaries.

IEC & BCC Activities


Along with the other staff he will participate in organization of the camps /
campaigns / outreach activities and with the help of ASHAs ensure active
participation by the community.
He / she will organize the celebration of health days and weeks and publicity
programmes al local fairs on market days etc.
He / she will assist organization of mass communication programmes like film
shows, exhibition, lectures and dramas, with the help of the District BCC officer.
He / she will maintain 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.
He / she will organize 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. Organize and conduct training of women leaders with the help of
the Medical Officer / ANM.
He / she will organize health education sessions in schools and for out of school
youth.
Organize and utilize Mahila Mandal, teachers and other women including ICDS
personnel in the community in various National Health Programmes.
He / she will prepare a monthly report on the progress of BCC activities in the
PUHC area.

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Coordinating the campaign of IEC / BCC in the PUHC catchment.


Make sure that IEC and BCC activities cover the entire population through map
based micro planning.
Trainings:
He / she will assist the Medical Officer, PUHC in conducting training of various
staff and ASHA.
He / she will maintain a complete set of educational aids on Health and Family
Welfare for his / her own use and for training purpose.
Trainings of RKS / SHG functionaries.
Any other activity assigned by the Medical Officer Incharge

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Accreditation Standards for Primary Urban Health Centre

COMPUTER DATA ENTRY OPERATOR (CDEO) CUM ASSISTANT

The data generated at the PUHC suffers from serious flaws like authenticity, incompleteness
and inconsistencies. Major reason for that being lack of accurate and complete recording by
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.

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MEDICAL RECORDS CLERK

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.

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SELF APPRAISAL OF PRIMARY URBAN HEALTH CENTRE STAFF

FORM 6.1 SELF APPRAISAL - MEDICAL OFFICERS: Clinical Care Competencies

Facilitation Help Required at Level


S.No. Skill / Competency Gap
PUHC District State

Am I familiar with the Standard


Clinical Protocol / Standard
Treatment Guidelines adopted by
1.
the State for various management
of common illness at the PUHC
level

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 the uses / side


effects / dosages / interactions of
3.
all the different medications /
logistics available in my PUHC

Am I confident in use of all the


4. equipment / apparatus needed in
the PUHC

Do I have the specific skills like


pelvic examination and IUCD
5.
Insertion / abdominal examination
in a pregnant woman

Am I familiar with guidelines of


6. National Programs being
implemented in my PUHC

Am I confident of dealing with


7. cardiovascular emergencies,
snake / dog bites

Am I aware of various
empowerments / health and social
8.
sector schemes for the vulnerable
population

Am I aware of the State


9. Guidelines for Biomedical Waste
Management

Am I aware of the PEP Protocols


10.
and policy of procuring the same

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Am I aware of referral centers and


11.
availability of transport facilities

Am I giving a duly filled referral


12.
slip to the referred patient

Am I aware of stepwise action /


recording to be undertaken in
13.
case of adverse events related to
Immunization / medicines

Am I spending enough time with


each patient, explaining the
14.
condition and the management
plan

@ National Accreditation Board for Hospitals and Healthcare Providers 143


Accreditation Standards for Primary Urban Health Centre

FORM 6.2 SELF APPRAISAL - MEDICAL OFFICERS: Managerial Competencies

S.N Facilitation Help Required at Level


Skill / Competency Gap
o. PUHC District State

Do I have a copy of the Public


1. Health Standards for a PUHC
available in the centre

Am I aware of the roles and


responsibilities of the staff in my
2.
care and have I delegated
responsibilities to each one

Am I clear on the objectives


structure / functions / proceedings
3.
of the Jan Swasthya Samitis and
my Role as the member secretary

Am I aware of the GFR for the


4.
state

Am I familiar with the Inventory


5.
Management Principles

Am I aware of the funds available


6. for the PUHC and the guidelines
for their usage

Am I aware of possible medico


7. legal issues that can arise in a
PUHC

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FORM 6.3 SELF APPRAISAL - STOREKEEPERS

Facilitation Help Required at Level


S.No. Skill / Competency Gap
PUHC District State

Am I aware of my Roles /
1.
Responsibilities

Are the indents I am preparing


timely, rational (as per the
2. requirements of various sections
of the PUHC) and in sufficient
quantities

Are my stock registers, issue


3. registers, vouchers, maintained
as per guidelines

Is my store well organized,


4.
clean and pest free

Is my expiry register are in order


and I am always well aware of
5. the drugs nearing expiry to take
the necessary steps while
issuing

Am I always able to maintain


buffer stocks, plan for the
6.
outreach, ASHA requirements
or there are frequent stock outs

Is all my stock consumable


and non consumable fully
7.
accounted for and recorded in
separate registers

All bills are paid in time and


necessary records maintained
8.
Electricity, water, telephone,
internet etc.

Are all equipment / apparatus in


my PUHC like microscope,
refrigerator, inverter, coolers,
9.
water cooler with aqua-guard /
RO etc. functioning properly and
covered under AMC

Are all items beyond repair


condemned and disposed
through the laid down
10.
procedures and functional
replacements are available
without any delay

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FORM 6.4 SELF APPRAISAL - PHARMACISTS

Facilitation Help Required at Level


S.No. Skill / Competency Gap
PUHC District State

Am I aware of the uses, doses,


side effects, interactions,
1. storage specifications and
correct dispensing procedure
of the drugs in my charge

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

146 @ National Accreditation Board for Hospitals and Healthcare Providers


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FORM 6.5 SELF APPRAISAL PUBLIC HEALTH NURSE (PHN)

Facilitation Help Required at Level


S.N Skill / Competency Gap
PUHC District State

Am I aware of my Roles /
1.
Responsibilities

Am I aware of the role of


2.
ANMs and ASHAS

Do I have the necessary


knowledge / skills /
competencies in
immunization, Antenatal,
Natal, Post natal, Essential
3. Newborn care, Family
Planning, Nutritional
surveillance and
management of malnutrition
etc. to play my role
meaningfully

Am I aware about the cold


chain defrosting procedures /
protocols in case of breach of
cold chain, contingency plan
4. for storage of vaccines in time
of electricity / equipment
failure, stepwise protocol in
case of adverse event for
immunization

Am I fully conversant with the


5. safe disposal of biomedical
waste

Do I have the necessary skills


/ competencies for
6. supervising and mentoring
the ANMs and ASHAS under
me

Have I made a roster time /


topic wise to impart skills /
7.
competencies mentioned
above to my ANMs

Have I made a systematic


need analysis for monthly
outreach activities (HNDays)
8.
and if so have I identified a
venue, made a schedule,
projected the requirements in

@ National Accreditation Board for Hospitals and Healthcare Providers 147


Accreditation Standards for Primary Urban Health Centre

the facility level planning for


logistics and other resources

Am I supervising the HNDs


9.
as per the checklist

Have I ensured that all my


ANMs are doing their field
work, keeping their records
10. and registers in the manner
that shall lead to a hundred
percentage coverage of their
catchment population

Am I clear on the definitions /


terms in the reporting formats
and have developed
11.
mechanisms for accurate and
complete data capture by the
ANMs

Do I have the necessary skills


to compile and analyse the
data, draw inferences and
12.
make / suggest
improvements. Do I have IT
skills

Are the ASHAS in my areas


trained in their key activities.
13.
Are their referrals being given
due

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FORM 6.6 SELF APPRAISAL AUXILLARY NURSE MIDWIFE (ANM)

Facilitation Help Required at Level


S.N Skill / Competency Gap
PUHC District State

Do I know my roles and


1.
responsibilities

Do I have the required


knowledge, skills and
competencies
Immunization the
schedule, technique, cold
chain, management of
adverse events, tracking of
defaulters / use of ASHAS to
ensure 100% coverage
Malnutrition Weighing of
all children, screening them
for anaemia and Vitamin A
deficiency on their visit for
immunization. Detecting
malnutrition and managing
it.
Complete and appropriate
antenatal, postnatal,
essential newborn care
2.
Detection, counseling,
health education about
menstrual hygiene / safe
sexual practices
Counseling and facilitation in
adoption of family planning
measures.
Suspect and refer TB,
leprosy patient. Help in
initiation and completion of
treatment.
Bring down the incidence /
morbidities associated with
vector borne diseases.
Safe disposal of biomedical
waste.
Prevention and control of
infection.

3. Have I marked my catchment

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Accreditation Standards for Primary Urban Health Centre

population and mapped it

Have I linked myself to my


4.
catchment anganwadis

Do I know ASHAs of my areas


5. and have I developed the
desired rapport with them

Am I providing the necessary


6. help to my ASHAS facing
problems in the field

Are my surveys registers /


eligible couple registers
updated. Have I managed to
7. devise a network of ASHAS
and Anganwadis in my area to
achieve the objective of 100%
coverage

Am I facilitating their timely


8.
incentive disbursal

Am I conducting the HNDay as


9.
per the defined structure

Am I collecting and entering


complete accurate data as
required. Am I along with the
10.
PHN analyzing the data and
identifying the areas needing
thrust

Have I made an IEC / BCC


11.
plan for my area

150 @ National Accreditation Board for Hospitals and Healthcare Providers


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FORM 6.7 SELF APPRAISAL LAB TECHNICIAN

Facilitation Help Required at Level


S.No. Skill / Competency Gap
PUHC District State

Do I know my roles and


1.
responsibilities

Do I have the necessary


knowledge, skill and competencies
2.
to carry out the tests mandated at
the PUHC

Am I ensuring safe disposal of the


3. biomedical waste generated in my
lab

Am I fully conversant with the use


and care of my microscope, digital
4. diagnostic equipments like
hemoglobinometer, glucometers,
semi auto analysers etc.

Am I carrying out the periodical


5. standardization of my equipment
to ensure accuracy

Is my lab refusing any tests


6. because of lack of logistics /
equipments / skills

Am I taking the necessary


7. precautions for prevention and
control of infection

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FORM 6.8 SELF APPRAISAL RADIOGRAPHER

Facilitation Help Required at Level


S.N Skill / Competency Gap
PUHC District State

Do I know my roles and


1.
responsibilities

Do I have the necessary knowledge,


2. skill and competencies to carry out
the tests mandated at the PUHC

Am I ensuring safe disposal of the


3. biomedical waste generated in my
department

Am I fully conversant with the use


and care of digital diagnostic
4.
equipments like X-ray and
Ultrasound

Am I carrying out the periodical


5. standardization of my equipment to
ensure accuracy

Is my department refusing any tests


6. because of lack of logistics /
equipments / skills

Am I taking the necessary


precautions for Radiation exposure
7. hazards by using radiation safety
devices like Lead shielded gowns,
badges and gonad shield

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FORM 6.9 SELF APPRAISAL DRESSER

Facilitation Help Required at Level


S.No. Skill / Competency Gap
PUHC District State

Do I know my role and


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 fully conversant with


4. the use of Autoclave for
sterilizing the instruments

Am I disposing the
Biomedical waste
5. generated in the dressing
room safely as per
guidelines

Am I fully conversant with


the dispensing guidelines
6.
for the ointments / lotions
/ eye / ear drops

Am I doing all I can to


allay the anxiety and pain
7.
of the patient / attendant
accompanying the injured

@ National Accreditation Board for Hospitals and Healthcare Providers 153


Accreditation Standards for Primary Urban Health Centre

FORM 6.10 SELF APPRAISAL SOCIAL MOBILIZATION OFFICER

Skill / Competency Gap Facilitation Help Required at Level


S.No.
PUHC District State

Do I know my roles and


1.
responsibilities

Am I aware of the different health


initiatives / components of national
2. health programs which need to be
implemented outside the PUHC in
the community

Am I fully familiar with the healthcare


community partnerships, linkages
and their scope of activities
3.
Community health workers like
ASHAS, Rogi Kalyan Samitis, health
and sanitation committees

Do I have the required skills and


competencies to initiate local health
initiatives, build up self help groups,
4.
help in identification of members for
RKS, HSCs, potential ASHAS. And
help in their capacity building

Have I mapped the population,


landmarks, anganwadi workers,
5.
NGOs, in my area with the help of
ANMs / ASHA

Am I assisting in RKS meetings and


6. maintaining the RKS records as per
the guidelines.

Am I providing the necessary


7. liasoning with the water / sanitation /
Schools / local NGOs

Am I facilitating the PUHC in effective


8. implementation of BCC strategies in
the field

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FORM 6.11 SELF APPRAISAL COMPUTER DATA ENTRY OPERATOR CUM ASSISTANT

Facilitation Help Required at Level


S.No. Skill / Competency Gap
PUHC District State

Am I fully conversant with the


1.
OPD Registration system

Have I familiarized myself with


2. the medical terms and
functioning of a PUHC

Am I generating meaningful
3. and accurate reports for
analysis and evaluation

Is my ASHA database updated


ASHA package of services and
4. incentives will maintained. Am I
able to predict trends in service
provision

Is my work helping streamlining


5. Management of information in
the PUHC.

@ National Accreditation Board for Hospitals and Healthcare Providers 155


Accreditation Standards for Primary Urban Health Centre

FORM 6.12 SELF APPRAISAL NURSING ORDERLY


Facilitation Help Required at Level
S.No. Skill / Competency Gap
PUHC District State
Do I know my role and
1.
responsibilities
Can I say with confidence that
my PUHC is a clean, place
2.
with clean walls, furniture and
equipment
Am I able to regulate and
3. manage the patient inflow in
an optimum fashion
Am I able to provide them with
sufficient, clean seating area
4.
with enough light hand
ventilation while waiting
Am I facilitating the elderly in
5. obtaining necessary
healthcare
Am I familiar with the Dispatch
6.
and receipt procedures
Am I fully conversant with the
guidelines on safe disposal of
7. biomedical waste and
prevention and control of
infections

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FORM 6.13 SELF APPRAISAL ROGI KALYAN SAMITI

Facilitation Help Required at Level


S.No. Skill / Competency Gap
PUHC District State

Am I aware of the objectives


1.
of the Rogi Kalyan Samiti

2. Am I aware of my role in it

Am I aware of the
proceedings / delegations /
3.
responsibilities / record
keeping involved

Am I using this empowerment


judiciously for improving the
4.
healthcare delivery at my
PUHC

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FORM 6.14 SELF APPRAISAL ASHAs

Facilitation Help Required at Level


S.No. Skill / Competency Gap
PUHC District State

Do I know about the health


1. and social entitlements for
the poor

Do I know the basic health


components for which I
2.
am to mobilize and assist
the community

Have I been able to strike


3. a rapport with the
community

Do I have the required


4. Interpersonal
communication skills

Do I know how to fill my


5.
diary

Is my household survey
6.
complete and accurate

Has it helped me and my


7. ANM in local health
planning

Have I formed a HSC in


8.
my area

Do I think I have made a


9. difference in my peoples /
areas life

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LIST OF LICENSES AND ACTS: APPLICABLE TO PUBLIC HEALTHCARE


FACILITIES

1. Building Permit (From the Municipality).


2. No objection certificate from the Chief Fire Officer.
3. License under Bio-medical Management and handling Rules, 1998.
4. No objection certificate under Pollution Control Act.
5. Radiation Protection Certificate in respect of all X-ray and CT Scanners from BARC.
6. Excise permit to store Spirit.
7. Narcotics and Psychotropic substances license and Act.
8. Vehicle registration certificates.
9. Air (prevention and control of pollution) Act, 1981.
10. Atomic energy regulatory body approvals.
11. Biomedical waste management handling rules 1998.
12. Consumer protection Act, 1986.
13. Dentist regulations, 1976.
14. Drugs and cosmetics Act, 1940.
15. Employees provident fund Act, 1952.
16. Equal remuneration Act, 1976.
17. Fatal accidents Act, 1955.
18. Indian lunacy Act, 1912.
19. Indian medical council Act and code of medical ethics, 1956.
20. Indian nursing council Act, 1947.
21. Indian penal code, 1860.
22. Indian trade unions Act, 1926.
23. Maternity benefit Act, 1961.
24. MTP Act, 1971.
25. Minimum wages Act, 1948.
26. National building code.
27. Negotiable instruments Act, 1881.
28. Payment of wages Act, 1936.
29. Persons with disability Act, 1995.
30. Pharmacy Act, 1948.
31. PNDT Act, 1996.
32. Protection of human rights Act, 1993.
33. BARC, Act.
34. Registration of births and deaths Act, 1969.
35. Tax deducted at source Act.
36. License for the blood bank.
37. Constitution of India.
38. Transplantation of human organs Act, 1994.

@ National Accreditation Board for Hospitals and Healthcare Providers 159


Accreditation Standards for Primary Urban Health Centre

OPTIMAL FACILITY MANAGEMENT & EFFICIENT PROCESSES

I. Facility Management & Processes

Access clean, old age, disabled friendly.


Well maintained building. Clean green compound, with
a. Building and Compound
no seepage, no water logging.
No broken windows, doors

Comfortable sufficient with seating arrangement and


fan.
Potable Drinking water facility available.
b. Waiting area
Clean separate toilets for male & female available.
Signages appropriately displayed.
IEC Material displayed.

Space well lit, ventilated.


All rooms clean, well mopped, dust free with clean linen
Privacy of patient maintained
c. Working areas
Continuous availability of water
Continuous availability of electricity
Safe and secure work environment

Uninterrupted supply
d. Medicines & Logistics
Rational use

Availability of functional equipment


e. Equipment AMC mechanisms in place
Reagents, consumables available

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

h. Availability of Staff Trained staff as per the norms is available

Accurate information collection, compilation, report


Management of Health generation by the centre and timely onward
i. transmission.
information
Analysis, evaluation and use of data

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Recording and reporting of Vital statistics including


births and deaths, particularly of mothers and infants.
Maintenance of all the relevant records concerning
services provided in PUHC

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

Judicious use of IEC material prepared by the State /


district
Information Education Posters / flex boards placed in the waiting areas /
Communication (IEC) and different rooms
k
Behaviour Change
Communication (BCC) Pamphlets, leaflets distributed / placed in accessible
locations (on registration counter)
IPC at all levels of staff patient interaction

l Patient Satisfaction Functional Grievance redressal mechanism in place

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Accreditation Standards for Primary Urban Health Centre

SERVICE GUARANTEE

1. Clinical Care Component ( Direct Healthcare)

Six hours OPD services. Time schedule as per the


a. Medical services
department

First Aid, Stabilization of condition of patient before referral,


Appropriate PUHC level management and referral of injuries,
b. Emergency services
accidents, animal bites and other emergencies during OPD
hours.

Treatment of common acute and chronic infective and non


c. Curative OPD services
infective illnesses as per the Standard Treatment Protocols.

Screening / PUHC level Management / Referral / Follow up /


Non Communicable counseling for Life Style disorders (NCDs) especially
d.
Diseases hypertension, diabetes, Coronary vascular disease, Asthma,
COPD etc.

e. Eye Treatment of common eye disorders

f. Nutritional disorders Detection, Management, Counseling

Treatment of Menstrual problems


Gynecological
g. Diagnosis / treatment of patient and partner / follow up and
disorders
counseling for RTI / STI

Screening for malignancies / appropriate referral of


h. Cancer
suspected cases

i. Geriatric problems Sensitive Management / Counseling for Geriatric problems

2. Preventive and Promotive

a. Maternal Health

Early registration of pregnancies, ideally in first trimester


(Before 12 weeks of pregnancy)
Antenatal checkups and provision of complete package of
services. First visit as soon as pregnancy is suspected,
second between 4th and 6th month (around 26 weeks), 3rd
visit at eighth month (around 32 weeks) and 4th visit at 9th
month (around 36 weeks). Associated services like provision
of Iron and Folic Acid tablets, Injection TT (as per the
i. ANC Care
Guidelines for Antenatal Care and Skilled Birth Attendance
at Birth by ANMs and LHVs)
Minimal Laboratory investigations like Hb%, Urine, Albumin /
Sugar and M/E
Nutrition and health, danger sign counseling
Identification of high risk, appropriate management and
referral to the attached referral centres

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Management of Pregnancy Induced Hypertension (PIH)


including referral

Promotion of Institutional delivery by formulating of Birth plan


ii. Intranatal Care
and facilitation in implementing the same.

A minimum of two postpartum checkups, first within 48 hrs


and second within 7 days of delivery and detection and
management (referral for) of any complications
iii. Postnatal Care Initiation of early breast feeding within half an hour of birth
Education on nutrition, hygiene, contraception and essential
newborn care. (As per Guidelines of GOI on Essential New
Born Care)

b. New Born & Child Care:

In case of a new born being brought to the centre, availability


i. New Born Care of facilities / skills for neonatal resuscitation & management
of neonatal hypothermia / hypoglycemia

Emergency care of sick children


Care of routine childhood illnesses
Promotion of exclusive Breast Feeding for six months

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

Lifestyle education, Nutritional counseling, appropriate


treatment

d. Family Planning

Education, Motivation and counseling to adopt to appropriate


Family Planning methods
Provisions of contraceptives such as condoms, oral pills,
emergency contraceptives, IUCD insertions
Referral for Tubal ligation, Vasectomy / NSV
Follow up services to the Eligible couples adopting
permanent methods
Counseling and appropriate referral for safe abortion
services (MTP) for those in need

e. Management of RTI and STI diseases

Health education for prevention of RTI & STI


Treatment of RTI / STIs

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f. Infertility

Counseling and appropriate referral for infertility

g. Services under other National Health Programmes

Sputum examination for Tuberculosis


i. RNTCP DOTS regime for Tuberculosis
Follow up / Counseling

Diagnosis / Management / Counseling and prevention of


ii. NLEP
disabilities for Leprosy

Screening for Refraction disorders and referral for Refraction


iii. NBCP study
Detection of Cataract cases and referral for Cataract surgery

Diagnosis of Malaria cases, Microscopic confirmation and


treatment
iv. NVDCP Symptomatic treatment and referral for Dengue, Chikungunia
if so required
Elimination of vector breeding sites

Goitre detection and appropriate management / referral.


Urine iodine estimation in children aged 6-12 yrs.

v. NIDDCP Salt iodine estimation of salt samples collected from


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

Alertness to detect unusual health events / increase in usual


vi. IDSP
health events and take appropriate remedial measures

IEC activities to enhance awareness and preventive


measures about STIs and HIV / AIDS.
Screening of persons practicing high risk behaviour at the
nearest ICTC.
vii. NACP Risk screening of antenatal mothers with one rapid test for
HIV.
Condom promotion and distribution of condoms to the high
risk groups.
Help and guide patients with HIV / AIDS in receiving ART.

3. Provision of AYUSH services as per local preference

4. Inter-sectoral Convergence

a. Convergence with Water and Sanitation

Promotion of Safe Water supply and basic sanitation


Promotion of sanitation including use of toilets and

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appropriate garbage disposal

b. Convergence with Integrated Child Development Scheme

Identification of malnourished children and appropriate


supplementation / referral if required / nutritional
rehabilitation

c. Convergence with School Health

Investigations and management of children referred from


schools

5. Referral Services

Appropriate and prompt referral of cases needing specialist


care with duly filled referral slips / stabilization if required /
transport if required

6. Basic Laboratory Services

Hb%, TLC
Blood sugar
Urine Albumin, Sugar and Microscopy
Urine Pregnancy test
Stool Microscopy
Sputum testing for Tuberculosis (if designated as Microscopy
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.

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DOPPLER STUDIES (if available)


Peripheral, Cerebro-vascular and abdominal Doppler.
Assessment of post Kidney and Liver Transplant patients.
Penile Doppler examination

8. Health & Nutrition Day

The organization of the Health and Nutrition Day on a regular


basis as per the guidelines will result in the achievement of the
following Outcomes:
100% coverage with preventive, promotive interventions,
especially for pregnant women, children and adolescents
Preventive and promotive coverage for the National Disease
Control Programmes
Increased awareness about the determinants of health such
as nutrition, sanitation, timely care etc.
Improved knowledge about the services offered under the
various National Health Programmes
Greater emphasis on the communitys role in making the
health system responsive to the health needs of the
community and in demanding and ensuring accountability

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INCREASED UTILIZATION OF SERVICES LEADING TO POSITIVE HEALTH


OUTCOMES

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.

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5. Decrease in case of Scabies / Pyodermas.


6. Decrease in number of vector borne fevers.

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.

COMMUNITY INVOLVEMENT AND EMPOWERMENT

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.

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PATIENT EXIT INTERVIEW ( Prior Consent to be taken)

PATIENT EXIT INTERVIEW ( Prior Consent to be taken)


Name of the District:

Name of the Primary Urban Health Centre:

Parent Agency - GNCTD / MCD / NDMC /


Others:

Name of the Medical Officer In-charge:

Date of Exit Interview:


Time Taken for Interview:
Starting Time:
Finishing Time:
Conducted by:
Name & Designation:
Signature:
1. Name of the Patient
2. Age of the Patient
3. Sex of the Patient
4. Do you have a BPL / equivalent card
5. Do you belong to SC /ST
How long did it take you to travel to this
6.
PUHC
7. What mode of transport did you take
8. Did you spend any money in reaching here
From Neighbours
From ANM
From ASHA
At a Health Camp
9. How did you come to know of this facility
From posters / leaflets
From a Religious leaders
From a Private Practitioner
Any other way

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

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How long did you wait to get your Card


11.
made (in minutes

Polite
12. Was the staff at registration counter polite Indifferent
Rude

How long did you have to wait before you


13.
reached the doctor

Was there clean and comfortable place to


14.
sit while waiting?

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

How long did you wait in the Pharmacy que


22.
before you got your medicines

Warm and Helpful


23. How was the behaviour of the Pharmacists Indifferent
Rude
All
24. Did you get the medicines Some
None
Yes
25. Did the pharmacist explain about the doses
No

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Yes
If the service provider was ANM, was she
26. Indifferent
warm and helpful
Rude

How long did you wait for the service


27. Immunization / IUCD Insertion / ANC
checkup

Were you satisfied with the cleanliness of


Floor Yes
28. Furniture
Sheets on examination table No

Toilets

29. Was drinking water available Yes / No

Total time spent in the Primary Urban


30.
Health Center

31. Time spent with the Medical Officer

Were you satisfied with the overall


2 1 0
32. Behaviour of the staff Yes Partially No
Cleanliness of the facility Yes Partially No
Availability of medicines / tests Yes Partially No

You would continue to use the Primary


33. Urban Health Center for treatment
because:

Long waiting time


Dirty environment
If not then what are the reasons for your Rude / Indifferent behaviour
34.
not wanting to return Incompetent staff / ineffective treatment
Non availability of medicines / tests
Too far

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QUALITY ASSURANCE (MONITORING & EVALUATION)

Effective monitoring followed by evaluation and necessary online corrections is mandatory


for ensuring optimal functioning of the PUHC and delivery of quality healthcare. To facilitate
a systematic upgradation of the PUHCs to the standards defined above and ensure
subsequent adherence to the same, a Quality Assurance Manual has been devised which
shall form an inseparable addendum to this volume. It outlines the need, management
framework for Quality Assurance, and provides the necessary formats* for objectively
assessing the facility and undertaking measures to ensure quality in processes, inputs and
desirable outputs / outcomes.

*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.

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PUHC QUALITY ASSURANCE SUMMARY REPORT

PRIMARY URBAN HEALTH CENTRE QUALITY ASSURANCE SUMMARY REPORT


Action Required
S.No. Action Category Gaps Timeline Review On
PUHC District State

1. Facility Management

a. Land & Building

b. Manpower

c. Equipments

d. Drugs & Logistics

Water, Electricity,
e.
Telephone

f. Cleanliness / Sanitation

2. Managing Information

a. Managing Information

Service Provision and


3.
Utilization Trends

Service Provision
b. Clinical Protocols /
Procedures

c. Utilization trends

4. Training Requirements

d.

5. Governance

6. Behaviour Change Communication

7. Grievance Redressal Mechanism

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