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First refferal unit spm according to park

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Here is a complete, textbook-accurate answer on the First Referral Unit (FRU) as per Park's Textbook of Preventive and Social Medicine:

First Referral Unit (FRU) - Park's SPM

Definition / Identity

The First Referral Unit is the Community Health Centre (CHC) functioning at the sub-district level. It serves as the first point of specialist referral care above the PHC level.
  • Park's Textbook of Preventive and Social Medicine, p. 514

Community Health Centre (CHC) - Basic Structure

FeatureDetails
LevelSub-district / Block level
Population served80,000 - 1,20,000
PHCs covered4 PHCs
Indoor beds30 beds
Specialists (existing)4 - Surgeon, Physician, Gynaecologist, Paediatrician
Specialists (IPHS norm)6 - includes Anaesthetist + Eye Surgeon
Paramedical staff (existing)21
Paramedical staff (IPHS norm)24 (including 2 nurse midwives)
Facilities1 OT, X-ray, Labour room, Laboratory
Total CHCs functional (March 2018)5,624

Minimum Services Provided by a Fully Functional FRU

  1. 24-hour delivery services (normal and assisted deliveries)
  2. Emergency obstetric care including caesarean sections
  3. Newborn care
  4. Emergency care of sick children
  5. Full range of family planning services including laparoscopic services
  6. Safe abortion services
  7. Treatment of STI/RTI
  8. Blood storage facility
  9. Essential laboratory services
  10. Referral (transport) services

Three Critical Determinants for "FRU" Declaration

A health facility must have all three on a 24-hour basis:
  1. Surgical interventions
  2. Newborn care
  3. Blood storage facility

Physical Requirements to Perform Full FRU Function

  • Minimum 20-30 beds (relaxable to 10-12 in difficult areas like NE states/EAG underserved areas)
  • Fully functional Operation Theatre
  • Fully functional Labour Room
  • Area earmarked for newborn care (in labour room and ward)
  • Functional laboratory
  • Blood storage facility
  • 24-hour water supply and electricity
  • Waste disposal arrangements
  • Ambulance facility

Role in National Programs

  • FRU at CHC/sub-district level is the key site for Emergency Obstetric Care (EmOC) under RCH-II
  • MBBS doctors are trained in life-saving anaesthetic skills specifically for FRU functioning
  • Under NPHCE: diseases needing further investigation are referred to the FRU (CHC) or District Hospital
  • Under LaQshya Programme: implemented at DH, SDH, high-caseload CHCs, and FRUs to improve quality of care in labour rooms and operation theatres
  • Norm: 1 FRU per 5,00,000 population
Source: Park's Textbook of Preventive and Social Medicine, pp. 514, 600
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