Delivery of CH Services

DELIVERY OF COMMUNITY
HEALTH SERVICES
HEALTH CARE SYSTEMS
• The health care system is intended to deliver the

health care services. It constitutes the
management sector and involves organizational
matters, it operates in the context of the
socioeconomic and political framework of the
country.
• In India, it is represented by five major sectors or
agencies which differ from each other by the
health technology applied and by the source of
funds for operation.
: 1. PUBLIC HEALTH SECTOR
Primary Hospitals/Health Health Insurance Other

Health Care Centers Schemes agencies
Primary health Community health Employees State Defence
centers centers Insurance services
Sub - centers Rural hospitals Central Govt. Railways
Health Scheme
District hospital
/health centre
Specialist hospitals
Teaching hospitals
2. PRIVATE SECTOR
(a) Private hospitals, polyclinics.

Nursing homes, and dispensaries
(b). General practitioners and clinics
3. INDIGENOUS SYSTEMS OF MEDICINE
 Ayurveda and Siddha

 Unani and Tibbi
 Homoeopathy
 Unregistered practitioners
4. VOLUNTARY HEALTH AGENCIES
5. NATIONAL HEALTH
PROGRAMMES
Organization, Planning,
Budgeting and Material
management of SC, PHC,
CHC
• Under NRHM, the public health institutions in
rural areas are to be upgraded from its present
level to the level of a set standards called “Indian
Public health Standards (IPHS)”
• The quality of services is not uniform, due to
various reasons like-
Non availability of manpower, problem of
access, acceptability, lack of community
involvement etc.
• Standards are being introduced in order to
improve the quality of public health level.
• These standards must be followed by the
sub centre, Primary health centre,
community health nursing, sub divisional
hospital, sub district hospital and district
hospital
• In primary health care, rural health
services are developed into a three tier
system according to the size of population.
SUB-CENTRE (SC)
• A sub-centre is the most peripheral and
first point of contact between the primary
health care system and community.
• SC provides all the primary health care
services at the grass-root level.
• The purpose of the SC is largely
preventive and promotive, basic level of
curative care.
• As per population norms ,
 One sub-centre – 3000 population
(Hilly/Tribal/Difficult areas)
--5000 population
(Plain areas)
 In 2011 --- Total Sub-centre =1,48,124
OBJECTIVES
• To provide basic health care to the
community
• To achieve and maintain an acceptable
standard of quantity of care
• To make the services more responsive and
sensitive to the needs of the community
• To facilitate supervision and monitoring of
health services
Categories of Sub-centre
• Type A: Shall provide all services as envisaged
for the Sub-centre except the facilities for
conducting delivery will not be available here.
• Type B: They will provide all recommended
services including facilities for conducting
deliveries at the Sub-centre itself.
This Sub-centre will act as Maternal and Child
Health (MCH) centre with basic facilities for
conducting deliveries and Newborn Care at the
Sub-centre.
Services provided at SC
• 1. Maternal health care :
Antenatal care :
(a) Early registration of pregnancy -(ideally before 12 weeks of
pregnancy). Minimum three antenatal check-ups. Recording
of general check-up, weight, blood pressure, abdominal
examination, hemoglobin, routine urine examination and
blood group (at first visit if not done previously);
(b) Folic acid supplementation from first trimester and folic
acid and iron supplementation from 12 weeks onwards;
(c) Tetanus toxoid immunization
(d) Identification of high-risk pregnancy and referral
(e) Counselling on diet, pre-birth preparedness and rest
• Intranatal care :
(a) Promotion of institutional deliveries;
(b) Skilled attendance at home deliveries;
and
(c) Appropriate and prompt referral in case
of complications.
• Post-natal care:
(a) Minimum of 2 post-partum home visits,
first within 48 hours and 2nd within 7 days of
delivery
(b) Initiation of breast feeding within 1/2. hour
of delivery;
(c) Counselling on diet, hygiene and
contraception; and
(d) Provision of facilities of Janani Suraksha
Yojana.
2. Child health care :
(a) Essential new born care as per guidelines
(b) Promotion of exclusive breast feeding for 6
months
(c) Full immunization of all infants and children
against vaccine preventable diseases
(d) Vitamin A prophylaxis
(e) Prevention and control of childhood diseases
like malnutrition, ARI, diarrhoea etc.
3. Family Planning and Contraception
(a) Education, motivation and counselling to

adopt appropriate family planning method
(b) Provision of contraceptives such as
condoms, oral pills, emergency
contraceptives and IUD insertion (wherever
ANM is trained for IUD insertion)
(c) Follow up services to the eligible couples
adopting permanent methods of tubectomy
and vasectomy.
4. Counselling and appropriate referral for safe
abortion service (MTP)
5. Adolescent health care - Education,
counselling and referral
6. Assistance to school health services.
7. Water quality monitoring.
8. Promotion of sanitation including use of toilet
and appropriate garbage disposal
9. Field visits by appropriate health workers for
disease surveillance, family welfare services
including STI, RTI awareness.
10. Community need assessment.
11. Curative services for minor ailments including
fever, diarrhoea, worm infestation and first-aid,
appropriate and prompt referral if needed. To
organize Health Day at anganwadi centres at least
once in a month. To provide AYUSH treatment.
12. Training of Traditional Birth Attendants
and ASHA/ community health volunteers.
13. Co-ordinate services of anganwadi
workers, ASHA, village health and
sanitation committee etc.
14. National health programmes.
Manpower at Sub-centre
DRUGS FOR SC
Equipment
• The equipment provided to the Sub-centres should be
adequate to provide all the assured services in the
Sub-centres.
• This will include all the equipment necessary for
conducting safe deliveries at Sub-centre (for type B
Sub-centres), home deliveries (for both Type A and
Type B), immunization, contraceptive services like IUD
insertion, etc.
• In addition, equipment for first aid and emergency
care, water quality testing, blood smear collection
should also be available
PRIMARY HEALTH CENTRE
INTRODUCTION
 Primary health centers are the corner stone of rural
health services .
 It act as a referral unit for 6 sub centers and refer out
cases to CHCs .
 It covers a population of 30,000 in plain area and 20,000
in hilly and tribal area.
 There are 4-6 beds for patients and some diagnostic
facilities are also available.
 In 2011, Total PHC = 23,887
DEFINITION
• The primary health center (PHC) is the
basic structural and functional unit of the
public health services in developing
countries, to provide accessible,
affordable, and available primary health
care to people.
OBJECTIVES
• To provide comprehensive primary health
care to the community at PHCs.
• To achieve and maintain an acceptable
standards of quality of care .
• To make the services more responsive and
sensitive to the need of the community
Functions of the PHC
The functions of the primary health center in India cover all the
elements of primary health care as outlined in the Alma-Ata
Declaration. They are :
1. Medical care
2. MCH including family planning
3. Safe water supply and basic sanitation
4. Prevention and control of locally endemic diseases
5. Collection and reporting of vital statistics
6. Education about health
7. National Health Programmes - as relevant
8. Referral services
9. Training of health guides, health workers, local dais
and health assistants
10. Basic laboratory services
SERVICES PROVIDED AT PHC
1. MEDICAL CARE :
a) OPD services : 4 hours in the morning and 2
hours in the afternoon/evening.
b) 24 hours emergency services: appropriate
management of injuries and accident, First-aid,
stabilization of the condition of patient before
referral, dog bite/snake bite/ scorpion bite
cases, and other emergency conditions
(c) Referral services
(d) In-patient services (6 beds).
2. MATERNAL AND CHILD HEALTH
CARE
 Antenatal care
 Intranatal care
 Postnatal care
 New born care
 Care of the child
3. Full range of family planning services including
counselling and appropriate referral for couples
having infertility.
4. Medical termination of pregnancy using manual
vacuum aspiration technique
5. Health education for prevention and
management of RTl/STI.
6. Nutrition Services : Diagnosis ·and management
of malnutrition, anaemia and vitamin A
deficiency and coordination with ICDS.
.
7. School health services.
8. Adolescent health care.
9. Disease surveillance and control of
epidemics
10. Collection and reporting of vital events.
11. Promotion of sanitation including use of
toilet and appropriate garbage disposal.
12. Testing of water quality and disinfection of
water sources.
13. National health programmes.
14. Appropriate and prompt referral of cases
needing special care and providing transport
facilities
15. Record of vital events, reporting of births
and deaths, and maintenance of all relevant
records concerning services provided in PHC.
16. Training
17. Basic laboratory services
18. Monitoring and supervision :
19. Selected surgical procedures
The vasectomy, tubectomy (including
laparoscopic tubectomy), MTP,
hydrocelectomy and cataract surgeries as a
camp/fixed day approach have to be
carried out in a PHC having facilities of
O.T.
20. Mainstreaming of AYUSH
MANPOWER at PHC

Delivery of CH Services

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DELIVERY OF COMMUNITY

• The health care system is intended to deliver the

Primary Hospitals/Health Health Insurance Other

(a) Private hospitals, polyclinics.

 Ayurveda and Siddha

(a) Education, motivation and counselling to

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