Indian Public Health Standards, 2022: Volume-II (Community Health Centre)

The 2022 IPHS guidelines categorise rural and urban Community Health Centres (CHCs) as either First Referral Unit (FRU) CHCs which provide essential as well as specialised care, and non-FRU CHCs which provide only essential care. Rural areas can have either FRU and non-FRU CHCs but urban areas will only have FRU CHCs, the guidelines state.

Non-FRU CHCs are to provide healthcare services for maternal and child health, infectious diseases, nutritional disorders, mental health conditions, non-communicable diseases, ophthalmic, oral and ENT related conditions. FRU CHCs – in addition to essential healthcare services – will also provide specialist care, operative services and facilities for blood transfusion.

All CHCs at the level of block headquarters will be developed to function as Block Public Health Unit (BPHUs). BPHUs will have functional areas for clinical service delivery, public health functions, a block public health laboratory and a Health Management Information System unit. This will aid in reducing pressure on health facilities at higher levels, the guidelines state.

One rural CHC in hilly and tribal areas will provide services to 80,000 people, and a rural CHC in the plains will cater to a population of 120,000 people. An urban CHC with 50 beds will be established in non-metro cities with a population of 2.5 lakhs, and one with 100 beds will be set up in metro cities with a population of 5 lakhs and above.

The health facilities should adhere to the National Building Code of India. CHCs are required to have a daily provision of roughly 340 to 450 litres of water per bed. They are also expected to have one toilet for every six beds in the facility. One toilet per 100 men and two per 100 women are also required to meet outpatient needs.

FRU CHCs are required to have one operation theatre functioning at all hours and one elective operation theatre. Urban FRU CHCs with 100 beds will need to have an additional operation theatre working round the clock.

FRU CHCs with 30 beds are required to have 20 oxygen-supported beds and non-FRU CHCs with 30 beds will need 18 oxygen-supported beds. On the other hand, FRU CHCs with 50 beds are expected to have 26 beds with oxygen support and urban FRU CHCs with 100 beds are required to have 43 oxygen-supported beds.

The IPHS list the essential specialist and healthcare staff for CHCs. These include: physician, surgeon, obstetrician and gynaecologist, paediatrician, anaesthesiologist, ophthalmologist, orthopaedic specialist, microbiologist or pathologist, physical medicine and rehabilitation specialist, a general duty medical officer, a dental medical officer and an AYUSH medical officer.

The standards outline the requirement of one nurse for every six beds in inpatient departments (IPDs) and one nurse per three beds in new-born sick units (NBSUs). Each operation theatre should have two nurses per shift and two nurses in pre and post operation areas. Labour delivery and recovery (LDR) rooms have a requirement of one nurse or midwife per two LDRs and one neonatal nurse for every four LDRs.

IPHS 2022 elaborate on the Rogi Kalyan Samitis (RKS) that have been established to facilitate the provision of good healthcare especially to patients from marginalized communities. RKSs aim to ensure that patients are not charged fees for health services that fall under government programmes like Surakshit Matritva Aashwasan, national programmes for tuberculosis, HIV, malaria and the prevention and control of non-communicable diseases.

The IPHS emphasize on the strict compliance with statutory acts, rules and regulations like the Indian Medical Council Act, 1956; the Medical Termination of Pregnancy Act, 1971; and the Narcotic Drugs and Psychotropic Substances Act, 1985.

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.