Field Visit Report: Community Health Centre (CHC),
Name of Block/District; Bangalore urban
Submitted Date of Visit: 23/9/25
Name of the Centre: sumanhalli Community Health Centre (CHC)
This report presents a detailed analysis of the field visit conducted by [Link]. Nursing students to
the Community Health Centre (CHC), sumanahalii community health center, on 23/9/25. The
primary objective was to critically evaluate the implementation of the Indian Public Health
Standards (IPHS) at the CHC level, analyze the interprofessional team dynamics, and assess the
delivery of referral and specialized services. The visit provided insights into the infrastructure,
service delivery, human resources, and challenges of a secondary-level rural healthcare
institution. Key findings highlight robust maternal and child health services and functional
referral systems, while also identifying significant challenges such as staff shortages, high patient
load, and infrastructural gaps. The report concludes with critical reflections and
recommendations relevant to the role of an Advanced Practice Nurse in strengthening secondary-
level care.
Introduction
A Community Health Centre (CHC) is a 30-bedded hospital/FRU (First Referral Unit)
established to provide specialized secondary-level healthcare to a rural population of
approximately 120,000. As aspiring nurse leaders, clinicians, and educators, understanding the
operational dynamics of a CHC is paramount. This visit aimed to move beyond theoretical
knowledge of the health system and critically appraise its functioning, focusing on the role of
nursing within an interprofessional team at this critical level of the healthcare pyramid.
Objectives of the Visit:
To appraise the infrastructure and facilities of the CHC against the IPHS guidelines.
To analyze the range and quality of specialized services offered (e.g., Specialist care,
Emergency Obstetric Care, Lab & Radiological services).
To examine the roles, responsibilities, and challenges faced by nursing personnel in a
CHC setting.
To evaluate the referral system (both from PHC/UPHC to CHC and from CHC to District
Hospital).
To assess the record-keeping, HMIS, and inventory management systems.
Methodology
The visit employed a multi-method approach for a holistic understanding:
Semi-Structured Interviews: Conducted with the Chief Medical Officer, Nursing
Superintendent, and available Specialist Doctors (e.g., Surgeon, Gynecologist).
Focused Observation: Systematically observed the OPD, IPD (wards, labour room, OT),
laboratory, pharmacy, and record room using an observation checklist.
Document Review: Analyzed HMIS data, monthly reports, referral registers, and
inventory logs.
Brief Interaction: Held informal discussions with staff nurses, ANMs, and Class IV
employees to understand ground-level challenges.
Observations and Findings
Infrastructure and Physical Facilities
The CHC is located at a strategic point in the block, serving as the nodal referral center for four
Primary Health Centres. The infrastructure was largely as per IPHS, but with notable areas for
improvement.
Building & Layout: A two-story building with separate OPD and IPD blocks. Signage
was clear. The premises were generally clean.
Wards: Separate male, female, and pediatric wards were available. Each ward had 10-12
beds, often found to be fully occupied. Basic amenities (toilets, water) were functional
but required more frequent maintenance.
Critical Care Areas:
o Operation Theatre (OT): Functional for minor and major surgeries, including C-
sections. Basic equipment was available, but a need for an upgraded anesthesia
workstation was noted.
o Labour Room: A 4-bedded delivery room equipped with a radiant warmer,
resuscitation kit, and suction apparatus. Adherence to protocols like "Maternal
and Child Health (MCH) Wing" and "Delivery Point" was observed.
o Emergency/Triage: A dedicated room was present but was undersized for the
patient's load. Triage was performed informally by staff nurses based on
experience.
Diagnostic Facilities: The laboratory performed basic hematology, biochemistry, and
urine tests. A digital X-ray machine and ultrasound facility were present and heavily
utilized.
Human Resources
A critical gap was observed between the sanctioned strength and the staff in position, a key
finding for nursing management analysis.
Posit
Sanctioned
ion
Post Strength (as Remarks
Fille
per IPHS)
d
Medical
4 4
Officers
Specialists Critical Shortage. Gynecologist & Physician
(Surgeon, 7 4 were present; Surgeon and Anesthetist posts were
Physician, etc.) vacant.
Significant Shortage. Led to high nurse-patient
Nursing Staff ~20-25 ~15
ratios, especially in wards.
Pharmacist, 2
2 each
Lab Technician each
ANM/LHV ~10 ~7 Affected outreach and follow-up programs.
The Nursing Superintendent played a pivotal role in scheduling, supervision, and maintaining
nursing standards, demonstrating a clear leadership function.
Service Delivery: A Critical Analysis
Clinical Services (OPD & IPD):
o Specialist OPDs: Medicine and Gynecology OPDs were functional and saw high
patient turnout. The absence of a regular surgical OPD due to the vacant surgeon
post was a major service gap.
o Inpatient Care: The IPD managed cases of pneumonia, diarrhea, febrile
illnesses, uncomplicated diabetes, hypertension, and post-operative cases.
Reproductive & Child Health (RCH) Services:
o Emergency Obstetric Care (EmOC): The CHC performed C-sections and
managed eclampsia, PPH, etc., qualifying it as a Basic Emergency Obstetric Care
(BEmOC) center. However, the lack of a full-time anesthetist was a constraint.
o Family Planning: Provided a full range of services including tubectomies,
vasectomies, and IUCD insertions.
o Child Health: A well-functioning immunization clinic was observed. The
management of childhood illnesses was integrated into the OPD.
National Health Programs: The CHC was actively involved in the Revised National
Tuberculosis Control Programme (RNTCP), National Vector Borne Disease Control
Programme (NVBDCP), and Non-Communicable Disease (NCD) screening. NCD clinics
were held weekly.
Role of Nursing Personnel: An [Link]. Nursing Perspective
The role of nurses at the CHC was complex and extended beyond basic bedside care:
Clinical Experts: Managing post-operative patients, administering IV medications,
monitoring labor progression, and assisting in surgeries.
Managers & Leaders: The Nursing Superintendent was responsible for duty rosters,
inventory of medical-surgical supplies, and mentoring junior nurses.
Educators & Counselers: Providing pre-operative counseling, family planning advice,
and health education to patients and attendants.
Liaison Officers: Acting as a critical link between patients, doctors, and paramedical
staff. They also coordinated with ANMs from sub-centers for referrals and follow-ups.
Record Keeping and HMIS
The HMIS reporting was robust and timely. The register for referrals (Form S-10) was
meticulously maintained, allowing for tracking of patients referred to and from the CHC. Stock
registers for drugs and supplies were maintained, though occasional discrepancies between
physical stock and register entries were reported due to manual entry.
Critical Analysis of Strengths and Challenges
Strengths
Functional as a 24x7 First Referral Unit (FRU).
Strong leadership from the CMO and Nursing Superintendent.
Effective implementation of key national health programs, especially immunization.
Functional diagnostic support (Lab, X-ray, USG).
Challenges & Recommendations
Recommendation from a Nursing Leadership
Challenge Implication
Perspective
Shortage
Increased workload, Advocate for policy-level changes for better
of
compromised quality of recruitment and retention. Implement nurse-led
Specialist
care, inability to provide clinics for NCD follow-up, antenatal counseling,
Doctors &
all mandated services. and postnatal care to decongest OPDs.
Nurses
High Nurse burnout, potential Conduct a workload assessment and present the
Nurse- for medication errors, data to the district health administration. Implement
Patient reduced patient a primary nursing model for better patient
Ratio satisfaction. allocation and accountability.
Infrastruct Overcrowded OPD and
Propose minor infrastructural modifications (e.g.,
ural emergency, lack of
better queue management, partitions). Strengthen
Constraint privacy, infection control
infection control protocols with frequent audits.
s challenges.
Vacancies
Increased non-nursing Lobby for filling these positions. Until then, create
in
duties for staff nurses a clear delegation of tasks to optimize nursing time
Paramedic
(e.g., clerical work). for clinical care.
al Staff
Learning Outcomes
The visit to the CHC was an invaluable experience that provided a realistic picture of the
strengths and vulnerabilities of India's rural secondary healthcare system. Key learning outcomes
for an [Link]. Nursing student include:
1. A profound understanding of the interprofessional collaboration required at a CHC.
2. Insight into the expanded and leadership roles of nurses beyond direct patient care.
3. The ability to critically analyze systemic challenges like human resource shortages and
their impact on service delivery.
4. The importance of robust HMIS and record-keeping for monitoring and evaluation.
conclusion
The CHC, [Name], serves as a vital lifeline for its population. While it performs commendably
under constraints, strategic investments in human resources, particularly in nursing and specialist
positions, and empowering nurses through advanced practice roles are crucial for it to fully
realize its potential as an effective First Referral Unit.
