Community

Health Care
Centre
Submitted by: Jhanvi Mishra,Kanika
Rajput,Jatin Grover

What is community health care

centre?

Group practise
This is the combination of two or more practising
doctors with shared staff and premises.

WHAT IS CHCs:-add it in
form of chart kanika
The Community Health Centre (CHC), the third tier
of the network of rural health care institutions, was
required to act primarily as a referral centre (for the
neighbouring PHCs, usually 4 in number) for the
patients requiring specialised health care services.
Community Health Centres (CHCs-30 bedded
hospital) and higher order public
hospitals at sub-district and district hospitals. It has
4-6 indoor beds for patients.
The standards prescribed in this document are for a
PHC covering 20,000 to
30,000 populations with 6 beds.

 Mutli purpose

Objectives of Indian Public Health

Standards (IPHS) for CHCs
To provide optimal expert care to the
community.
To achieve and maintain an acceptable
standard of quality of care.
To ensure that services at CHC are
commensurate with universal best practices
and are responsive and sensitive to the client
needs/expectations.

Objectives: The objective of having a referral centre for the primary health care
institutions was two-fold;
to make modern health care services accessible to the rural people
and
to ease the overcrowding in the district hospitals.
The CHCs were accordingly designed to be equipped with: four
specialists
medicine,
surgery,
paediatrics and
gynaecology; 30 beds for indoor patients; operation theatre, labour
room, X-ray
machine, pathological laboratory, standby generator , etc., along with
the complementary medical and
para medical staff.

The findings of the Study are

as follows:
(a) Given the other relevant factors, the services
of a CHC are likely to be used less intensively, if:
(i) its geographical coverage is very large;
(ii) it has inadequate medical staff, particularly
the specialists; and
(iii) the mean distance of the PHCs from the CHC
is longer.

Service Delivery in CHCs

OPD Services and IPD Services:

General,
Medicine, Surgery, Obstetrics & Gynaecology,
Paediatrics, Dental and AYUSH services
Eye Specialist services (at one for every 5 CHCs).
Emergency Services
Laboratory Services
National Health Programmes. Desiable services
which
are the ideal that should be available.

Delivery space:

 All Assured Services as envisaged in the PHC should be available, which

includes routine, preventive, promotive, curative and emergency care in
additionMinimum Requirement for Delivery of the Above-mentioned Services:

the basis of
40 patients per doctor per day, the expected
number of beneficiaries for maternal and child
health care and family planning and about 60%
utilization of the available indoor/observation
beds (6 beds).

The following requirements are being projected based on

It would be a dynamic process in the sense that if the utilization goes up, the
standards would be further upgraded. As regards, manpower, one more
Medical Officer (may be from AYUSH or a lady doctor) and
two more staff nurses are added to the existing total staff strength of 15 in the
PHC to make it 24x7 services delivery centre. to all the national health
programmes.

 Personnel Essential Desirable Qualifications

Remarks

AS PER THE FACILITES

THERE SHOULD BE
INDIVIDUAL ROOMS
AVAILABLE FOR INDIVIDUAL
PURPOSES . SUCH AS THE
FOLLOWS IN FITHER SLIDES

Basic requirements:

WHAT ARE
SRTANDARDS ??
Standards are a means of describing the level of
quality that health care organizations are expected
to meet or aspire to.
In order to provide optimal level of
quality health care, a set of standards are being
recommended for Primary Health
Centre to be called Indian Public Health Standards
(IPHS) for PHCs.

Physical Infrastructure
The CHC should have 30 indoor beds
with one Operation
theatre, labour room,
X-ray,
ECG and
LABORATORY facilites

Location of the centre

To the extent possible, the centre should be located at
the centre of the block headquarter in order to
improve access to the patients. evaluated followed by
necessary changes in the Plan and training of the
staff.
The CHC should be, as far as possible, environment
friendly
and energy efficient.
Rain-Water harvesting, solar energy
use and use of energy-efficient CFL bulbs/equipment
should be encouraged. Provision should be
made for horticulture services including herbal garden

The building should have

areas/space marked for the
following:SIGNAGE

On-the-way signages of the CHC & location

should be displayed on all the approach
roads.
Safety, hazards and caution signs shall be
displayed prominently at relevant places,
e.g. radiation hazards for pregnant woman in
X-Ray.
Fluroscent Fire-Exit signages at strategic
locations.

Barrier free access

environment
*For easyA ccess to non-ambulant (wheel-chair
stretcher), semi-ambulant, visually disabled and
elderly persons as per Guidelines and Space
Standards for barrier-free built environment for
Disabled and Elderly Persons of Government of India.
Ramp as per specification, Hand-railing,proper
lightning etc must be provided in all health facilities
and retrofitted in older one which lack the same.
Registration cum Inquiry counters.
Pharmacy for drug dispensing and storage.
Clean Public utilities separate for males and
females.

Outpatient
Department
Planned keeping in mind the maximum peak hour
load and shall have scope for future expansion.

Layout of the Out Patient

Department shall follow the
functional flow of the patients: e.g.

EnquiryRegistrationWaitingSubW
ating
ClinicDressing room/Injection
RoomBilling
Dignostics (lab/X-ray)pharmacyExit

Clinics for Various Medical

Disciplines

In General medicine, general surgery, dental,obstetric and gynaecology,

paediatrics and family welfare.Separate cubicles for general medicine and
surgery with separate area for internal examination (privacy) can be
provided if there are no separate rooms for each.

The cubiscle

for consultation and examination in all clinics should

provide for doctors

table, chair, patients stool, followers seat, wash

basin with hand washing facilities, examinationcouch
and equipment for examination. Room shall have, for the
admission of light
and air, one or more apertures, such as
windows and fan lights, opening directly to
the external air or into an open verandah.
The windows should be in two opposite
walls.

Family Welfare Clinic:

The clinic should provide educative, preventive,
diagnostic and curative facilities for maternal, child
health, school health and health education.
People visiting hospital should be informed of personal
and environmental hygiene, clean habits, need for
taking preventive measures against epidemics, family
planning, non-communicable diseases.
Treatment room in this clinic should act as operating
room for IUCD insertion and investigation, etc. It should
be in close proximity Indian Public Health Standards
(IPHS) Guidelines for Communit y health centres 13 to
Obstetric & Gynaecology

Family Welfare
counselling room should be provided

Waiting room for patients.

The Pharmacy should be located in an area
conveniently accessible from all clinics.
The dispensary and compounding room should
have two dispensing windows, compounding
counters and shelves.
Thepattern of arranging the counters and shelves
shall depend on the size of the room.
The medicines which require cold storage and
blood required for operations and emergencies
may be kept in refrigerators.

Emergency
Room/Casualty:
It is recommended to have a separate
earmarked emergency area to be located near
the entrance of hospital preferalbly having 4
rooms
one for doctor,
one for minor OT,
one for plaster/dressing)
and one for patient observation (At least 4 beds).

Treatment Room:

oMinor OT
Injection Room and
Dressing Room
Observation Room.

WARDS:Separate for Males and

FemalesWards :5.5x3.5 m each:
Be centered such that it serves all the clinics from
that place.
The nursing station should be
spacious enough to accommodate a medicine chest/a
work counter (for preparing dressings,medicines),
hand washing facilities, sinks,dressing tables with
screen in between and colour coded bins (as per
IMEP guidelines for community health centres).
It should have provision for Hub cutters and needle
destroyers.
Examination and dressing table.

measurements:

 Patient Area:

Enough space between beds.

Toilets; separate for males and females.
Separate space/room for patients needing
Isolation

. Ancillary rooms:
Nurses rest room.
There should be an area separating OPD
and Indoor facility.

 Operation theatre/Labour room:

Patient waiting Area.

Pre-operative and Post-operative
(recovery) room.
Staff area.
Changing room separate for males and
females.
Storage area for sterile supplies.
Operating room/Labour room.
Scrub area.
Instrument sterilization area.
Disposal area.
Newborn care Corner

Urban:With number of more

beds.

 Public utilities: Separate for males and female; for patient as well as for
paramedical & Medical staff.Disabled friendly, WC with wash basins as specified
under Guidelines for disabled friendly environment should be provided. Physical

Infrastructure for Support Services

Central Steritization Supply Department (CSSD):

Sterilization and Sterile storage.
Laundry: Storage should be separate for dirty
linen and clean linen.
Outsourcing is recommended after
appropriate training of washer man regarding
segregation and separate treatment for
infected and non-infected linen.
Engineering Services: Electricity/telephones
/water/civil Engineering may be outsourced.
Maintenance of proper sanitation in toilets
and other public utilities should be given
utmost attention. Sufficient funding for this
purpose must be kept and the services may
be outsourced.
Water Supply : Arrangements shall be made
to supply 10,000 litres of potable water per
day to meet all the requirements (including
laundry) except fire fighting. Storage capacity

Emergency Lighting : Emergency portable/

fixed light units should also be provided
in the wards and departments to serve as
alternative source of light in case of power
failure. Generator back-up should be available
in all facilities. Generator should be of good
capacity. Solar energy wherever feasible may
be used.
Generator : 5 KVA with POL for Immunization
Cold Chain maintenance.

Telephone: minimum two direct lines with

intercom facility should be available.

Administrative zone:

Separate rooms should be available for:

Office
Stores
Residential Zone
Minimum 8 quarters for Doctors.
Minimum 8 quarters for staff nurses/
paramedical staff.
Minimum 2 quarters for ward boys.
Minimum 1 quarter for driver.
If the accommodation can not be provided due to
any reason, then the staff may be paid house rent
allowance, but in that case they should be staying in
near vicinity of CHC so that they are available for 24 x
7 in case of need.

Function & Space Requirement for

Community Health Centre:
It is suggested considering the land cost &
availability of land, CHC building may be
constructed in two floors.

HIERACRHY :
Health care delivery in India has been envisaged at three
levels namely
primary,
secondary and
tertiary.
The secondary level of health care essentially includes
Community Health Centres (CHCs), constituting the First
Referral Units (FRUs) and the Sub-district and District
Hospitals.
The CHCs were designed to provide referral health care for
cases from the Primary Health Centres level and for cases in
need of specialist care approaching the centre directly.
4 PHCs are included under each CHC thus catering to
approximately 80,000 populations in tribal/hilly/desert areas
and 1,20,000 population for plain areas.