Indian Public Health Standards, 2022: Volume-I (Sub District Hospital and District Hospital)

Every district must have at least one functioning district hospital which can provide secondary healthcare services and critical services like high dependency unit (HDU), intensive care unit (ICU), operation theatre, labour, delivery, and recovery (LDR) complex, special new-born care unit and laboratories.

Building on the recommendation of the National Health Policy, 2017, IPHS propose one bed per 1,000 people in a district as an essential requirement. Moreover, two beds per 1,000 people in a district is set as the desirable target.

The health facilities should adhere to the National Building Code of India. They must also implement relevant provisions from The Rights of Persons with Disabilities Act, 2016, to ensure accessibility for people with disabilities. Additionally, district hospitals are required to have a daily provision of roughly 450-500 litres of water per bed.

SDHs and DHs with 100 beds are required to have 12 beds in the special new-born care unit (SNCU) and another 12 in the mother and new-born care unit (MNCU). SDHs with 100 beds are required to allot three labour, delivery, and recovery (LDR) beds. DHs with 100 beds must have four LDR beds.

DHs and SDHs with 100 beds are required to have 67 oxygen-supported beds. As per the IPHS, the total oxygen requirement for such facilities is about 1,353,600 litres per day. These norms are estimated according to requirements at the peak of the Covid-19 pandemic, the report states. Requirements at other times may be 40-60 per cent lesser than these estimates.

The IPHS list essential specialist and healthcare staff for DHs and SDHs. These include: medical officer, specialist in general medicine, obstetrician and gynaecologist, paediatrician, orthopaedic specialist, anaesthesiologist, ophthalmologist, dentist, radiologist and specialists in ENT and psychiatry.

The additional specialist staff listed to meet ‘desirable’ level includes dermatologist, cardiologist, nephrologist, urologist and gastroenterologist.

The standards outline the requirement of one nurse per six beds in the general wards. ICUs should have one nurse for every unit and HDUs must have one nurse for every two units. Special new-born care units (SNCUs), on the other hand, require one nurse for every three units. The ratio of one nurse per two units is to be followed for new-born intensive care units, paediatric intensive care units and paediatric high dependency units.

The IPHS highlights two Government of India initiatives. Following on the Free Drugs Service Initiative, the standards provide a list of essential medicines for DHs and SDHs which should be made available free of cost. The standards also list various essential diagnostic procedures that can be provided free of cost or for a nominal fee in DHs and SDHs under the Free Diagnostics Service Initiative.

Essential biomedical equipment should be available at all public health facilities to ensure delivery of adequate health services. The IPHS provide a list of such equipment necessary in various departments in DHs and SDHs.

All statutory acts, rules and regulations must be strictly adhered to, the IPHS states. Senior officials must ensure that provisions under the Consumer Protection Act, 2019; the Indian Medical Council Act, 1956; the Medical Termination of Pregnancy Act, 1971; and the Right to Information Act, 2005, are complied with.

Focus and Factoids by Akshita Hazarika.

PARI Library's health archive project is part of an initiative supported by the Azim Premji University to develop a free-access repository of health-related reports relevant to rural India.