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IPHS for PHC According to Park's Textbook of Preventive and Social Medicine

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Definition and Basis

All block-level PHCs are ultimately to be upgraded to CHC (30 beds) providing specialized services.

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Objectives of IPHS for PHC

1. To provide comprehensive primary health care to the community through PHCs
2. To achieve and maintain an acceptable standard of quality of care
3. To make services more responsive and sensitive to the needs of the community

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Types of PHC (by delivery load)

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Services Provided at PHC

1. Medical Care

• (a) OPD services: 4 hours in the morning + 2 hours in the afternoon/evening. Minimum OPD attendance = 40 patients per doctor per day
• (b) 24-hour emergency services: Accident/injury management, first aid, stabilization before referral, dog bite/snake bite/scorpion bite
• (c) Referral services
• (d) In-patient services: 6 beds

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2. Maternal and Child Health Care

• Early registration + minimum 4 ANC check-ups
• At least one ANC (preferably 3rd visit) by a doctor
• Minimum lab investigations: Hb, blood grouping & Rh typing, urine albumin & sugar, RPR for syphilis
• Nutrition and health counselling; folic acid, iron tablets, TT immunization
• Tracking of missed/left-out ANC; identification of high-risk pregnancies

• 24-hour services for normal delivery
• Assisted deliveries (forceps, vacuum)
• Manual removal of placenta; management of PIH
• Managing labour using Partograph
• Pre-referred management in obstetric emergencies; prompt referral for PPH, eclampsia, sepsis
• Minimum 48 hours stay after delivery
• Janani Suraksha Yojana (JSY) facilities

• PNC on 0th and 3rd day at facility; ANM ensures 7th and 42nd day home visits
• 3 additional visits for LBW (<2500 g) on 14th, 21st, 28th day
• Early breastfeeding initiation within 1 hour of birth

• Essential Newborn Care (ENBC) and resuscitation - Newborn Care Corner in labour room/OT
• Kangaroo Mother Care (KMC) for hypothermia

• Emergency care including IMNCI
• Full immunization as per national schedule
• Promotion of breastfeeding for 6 months
• Vitamin A prophylaxis; management of severe acute malnutrition; growth and development assessment

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3. Family Planning Services

• Full range of FP services including counselling
• Referral for infertility

4. Medical Termination of Pregnancy (MTP)

• Using Manual Vacuum Aspiration (MVA) technique, where trained personnel available

5. RTI/STI Services

• Health education for prevention and management

6. Nutrition Services

• Diagnosis and management of malnutrition, anaemia, Vitamin A deficiency
• Coordination with ICDS

7. School Health Services

• Essential: Screening for anaemia, nutritional status, visual acuity, hearing, dental, physical disabilities, learning disorders; basic medicines; immunization; Vit A, iron, folic acid; deworming; mid-day meal
• Desirable: Health-promoting schools

8. Adolescent Health Care

• Adolescent-friendly clinic: 2 hours once a week on a fixed day
• Comprehensive promotive, preventive, curative and referral services
• Adolescent reproductive health, STI/HIV management, tetanus immunization, nutritional counselling

9. Disease Control

• Prevention and control of locally endemic diseases: malaria, kala-azar, Japanese encephalitis

10. Collection and Reporting of Vital Events

11. Health Education and BCC

12. Sanitation Promotion

• Use of toilet, appropriate garbage disposal

13. Water Quality Testing and Disinfection

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14. National Health Programmes

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15. Referral Transport

• Drop-back home facility for patients under JSSK is mandatory

16. Record Maintenance

• Vital events, births, deaths, all relevant records

17. Training

• Health workers, TBAs, paramedics, ASHAs, ANMs/LHVs, doctors (CME, emergency obstetric care skills)
• IMNCI training; AYUSH training

18. Basic Laboratory Services

• Routine urine, stool, blood tests (CBC, blood grouping, blood sugar, cholesterol)
• BT, CT; RTI/STD diagnosis (wet mount, Gram stain)
• Sputum testing for TB (if designated microscopy centre under RNTCP)
• Blood smear for malarial parasite
• Rapid pregnancy test; RPR for syphilis; Typhi Dot for typhoid
• Rapid diagnostic tests for malaria; faecal contamination of water; chlorine estimation

19. Monitoring and Supervision

• Monthly review meetings at PHC (chaired by MO)
• MO visits all sub-centres at least once a month
• Health Assistants (male) and LHV visit sub-centres once a week

20. Selected Surgical Procedures

• Vasectomy, tubectomy (including laparoscopic), MTP, hydrocelectomy, cataract surgeries - as camp/fixed-day approach in PHC with OT facilities

21. Mainstreaming of AYUSH

22. Physical Medicine and Rehabilitation (PMR)

• Desirable: Primary prevention, screening, counselling, disability certificate issue

23. Maternal Death Review (MDR)

• Desirable: Facility-based MDR at PHC

24. Functional Linkages with Sub-centres

• Monthly review meetings; on-the-spot supervisory visits; organizing Village Health and Nutrition Days at anganwadi centres

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Staffing Pattern (IPHS)

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Key Points to Remember (Exam High-Yield)

• IPHS for PHC revised in 2012
• Covers 20,000-30,000 population
• 6 beds at PHC
• Two types: Type A (<20 deliveries/month) and Type B (≥20 deliveries/month)
• OPD: 4 hours morning + 2 hours afternoon; minimum 40 patients/doctor/day
• 24-hour emergency + 24-hour delivery services
• MO must visit sub-centres at least once a month
• Drop-back facility under JSSK is mandatory
• Lab services include 10 types of rapid/routine tests
• Partograph use is mandatory for labour monitoring
• Minimum 48-hour postnatal stay