Indian Public Health Standards, 2022: Volume III (Health and Wellness Centre-Primary Health Centre)

The IPHS 2022 state that existing Sub Health Centres and Primary Health Centres are being transformed into Health and Wellness Centres under the Ayushman Bharat scheme. This is to deliver “preventive, promotive, curative, palliative, and rehabilitative services.” There are to be 150,000 such Ayushman Bharat-Health and Wellness Centres (AB-HWCs) in the country by December 2022.

Health and Wellness Centres (HWCs) aim to deliver ‘comprehensive primary healthcare’ and will be concerned primarily with services related to pregnancy and childbirth, neonatal and infant healthcare, childhood and adolescent healthcare, and reproductive healthcare.

Other services within the ambit of HWCs include screening and management of communicable diseases, non-communicable diseases and mental health ailments; care for ophthalmic, oral and ENT problems; elderly and palliative health care services; and emergency medical services.

The standards classify Health and Wellness Centres-Primary Health Centres (HWC-PHC) into three types. HWC-PHCs will function in rural areas, ideally providing round-the-clock healthcare services – especially for pregnancies and deliveries. Urban HWC-PHCs will focus on routine outpatient care and conducting deliveries. Specialist urban PHCs/Polyclinics will aim to provide specialist services only on day-care and outpatient basis.

A rural HWC-PHC in the plains will provide services to a population of 30,000 people and an HWC-PHC in tribal and hilly areas will cater to a population of 20,000. One urban PHC will provide health services to 50,000 people and a multispecialty polyclinic will cater to a population of around 2.5-3 lakh persons.

A PHC connected to a cluster of Sub Health Centres will be developed as a Health and Wellness Centres-Primary Health Centre to provide additional primary healthcare services. It will act as the first point of referral for all the Sub Health Centres it is connected to.

An urban HWC-PHC should ideally be located within a radius of one kilometre from the periphery of urban slums and temporary settlements it aims to serve. Multispecialty polyclinics, on the other hand, should be situated in locations easily accessible from all PHCs and HWCs in the area.

To ensure easy access to the facility, all HWC-PHCs should comply with norms such as the Guideline and Space Standards for Barrier Free Environment for Disabled and Elderly Persons published by the Government of India in 1998.

To fulfil essential requirements, HWC-PHCs in rural areas are expected to have two beds, those in urban areas require two day-care beds (as urban HWC-PHCs are not expected to provide in-patient care) and 24x7 HWC-PHCs – urban and rural – require six beds.

Rural HWC-PHCs with six beds and urban HWC-PHCs with six day-care beds are required to have four oxygen cylinders with a capacity of 1,500 litres each. Round-the-clock HWC-PHCs (24x7 PHCs) with 10 beds need to have five such oxygen cylinders, the standards note.

The IPHS provide a list of essential medicines for HWC-PHCs to be made available to patients free of cost under Government of India’s Free Drugs Service Initiative. These include medicines like anaesthetic agents, analgesics, medicines used to counter anaphylactic reactions, antidotes for poisons. PHCs are also expected to carry anti-bacterial medicines, adrenaline, vaccines, and contraceptives.

Focus and Factoids by Akshita Hazarika.

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