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Guidelines For Organizing UPHC Services
Guidelines For Organizing UPHC Services
January 2018
Over the last two decades, India’s urban population has increased from 217 million to 377 million and
is expected to cross 600 million by 2031. As per 71st round of National Sample Survey (NSSO), there are
an estimated 52 million poor people living in the cities and towns of India. The challenge is not just
the sizeable numbers but also the unplanned manner the population is growing thereby increasing
the burden on the health system and related health and social indicators. The health indicators of the
urban poor are comparable to, and in many cases, worse off than, the poor living in rural areas of the
country.
In order to effectively address the health concerns of the urban population, Government of India launched
the National Urban Health Mission (NUHM) in May 2013. The initiatives under the NUHM aims to provide the
comprehensive primary healthcare services in urban areas, through Urban Primary Health Centres (U-PHCs),
Urban Community Health Centres (U-CHCs; which act as First Referral Units/FRUs), strong outreach services
and accessible frontline health workers. This is also in accordance to the strategic direction provided under
the National Health Policy-2017.
NUHM has identified some key activities to accelerate the pace of work such as: vulnerability mapping of
urban poor; service delivery and assured referral to urban poor through U-PHCs and U-CHCs; outreach services
through Urban Health and Nutrition Days (UHND). Furthermore, the mission also focuses on specific urban
health needs, in addition to Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A)
services like Non-Communicable diseases (NCDs), urban centric vector borne diseases, Tuberculosis etc.
U-PHCs are required to roll out the community based screening for five common NCDs like Hypertension,
Diabetes Mellitus, Cancer of Breast, Cervix and the Oral Cavity.
I appreciate the efforts undertaken by the Urban Health Division of the Ministry, National Health Systems
Resource Centre (NHSRC) and other experts/partners in bringing out this document, which will be an
informative and useful resource not only for the staff of the UPHCs but also for all the concerned stakeholders
associated with NUHM.
FOREWORD
Urban population, unlike the rural population, is highly heterogeneous. Most of the published
data do not capture the heterogeneity, as the Standard of Living Index often does not disaggregate it,
income-wise. Urban average figures thereof mask the health conditions of the urban poor. NUHM aims
to address the health concerns of the urban poor by facilitating equitable access to available health
facilities by rationalizing and strengthening the existing capacity of health delivery system.
U-PHC is the interface between health system and the urban poor. It is the epi-centre for the preventive,
promotive and curative healthcare, which operates and manages outreach sessions, special camps, home
visits by Auxiliary Nurse Midwives (ANMs), community mobilization through ASHAs and Mahila Arogya
Samitis (MAS), apart from providing medical care through the out-patient services. It is therefore of utmost
importance that a specific guidebook with uniform information and directives on effective management of
the U-PHC is published.
The paramount objective of the Guidebook is to strengthen the Preventive, Promotive and Curative
Health care system for urban population, with a special focus to vulnerable population. It also goes beyond
RMNCH and A services to provide comprehensive primary care including for NCDs in consonance with the
healthcare needs of the urban poor. In addition it is expected that the Medical Officer at UPHC, the prime
user of the document shall find this beneficial as it gives direct guidance for implementing health care
services of urban population, especially the urban poor.
FOREWORD
The Urban Primary Health Centre (U-PHCs) envisaged under the aegis of National Urban Health Mission
(NUHM) plays a pivotal role in delivering necessary primary healthcare services to the urban population
particularly the slum and vulnerable sections. In a country like India, where a substantial urban-rural
gap exists, the healthcare needs remain different for the diverse population. It is therefore imperative to
envisage healthcare facilities with structure and functionalities at best to fit to the needs of the urban
population.
Further, it is important to mention that the human resources engaged under NUHM requires a clear and
comprehensive understanding of the functioning of the U-PHCs. This will facilitate the staff to perform
efficiently and effectively in the delivery of health services for the target population. Hence, interaction and
coordination between different cadres of staff and convergence of their activities remain critical.
In the background of such thought, the idea to develop and publish a guidebook for operationalization of
the U-PHC was conceptualised and nurtured. This guidebook is aimed at providing a uniform and broad-
based understanding of the critical elements and functioning of the U-PHCs. It will be beneficial for the
medical officers, staff members of U-PHCs and the program managers at city/district and state levels.
I sincerely believe this book shall bring clarity about the critical elements, functionalities and
operationalization of U-PHCS at the state, city and district levels.
Table of Contents
1: Introduction............................................................................................................................................................................ 1
1.1 About National Urban Health Mission................................................................................................................ 1
1.2 Specific Interventions under Nuhm.................................................................................................................... 2
1.3 Comprehensive Primary Health Care through the Uphc............................................................................ 2
1.4 Objectives...................................................................................................................................................................... 4
1.5 Target Audience.......................................................................................................................................................... 5
1.6 Scope of the Guidelines............................................................................................................................................ 5
3: uphc services..........................................................................................................................................................................29
x | Guidelines for Organising Urban Primary Health Centre Services | June 2017
Annexures .............................................................................................................................................................................39
Annexure I: Minimum Requirements for UPHC.........................................................................................................39
Annexure II: Essential Drug List for Uphc....................................................................................................................43
Annexure III: Job Responsibilities of Uphc Staff........................................................................................................45
1. Medical Officer...............................................................................................................................................45
2. Public Health Manager................................................................................................................................47
3. Lady Health Visitor or Nurse......................................................................................................................48
4. Auxiliary Nurse Midwives (Anm).............................................................................................................49
5. Laboratory Technician.................................................................................................................................50
6. Pharmacist.......................................................................................................................................................50
7. Asha.................................................................................................................................................................50
8. Mahila Arogya Samiti...................................................................................................................................51
Annexure IV: Referral Form................................................................................................................................................53
Annexure V: Referral Register for Uphc........................................................................................................................55
Annexure VI: History Taking/Risk Assessment Form for Non-Communicable Diseases..............................57
List of Abbreviations
NPCDCS National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular
Diseases & Stroke
NHM National Health Mission
NRHM National Rural Health Mission
NUHM National Urban Health Mission
JnNURM Jawaharlal Nehru National Urban Renewal Mission
NVBDCP National Vector Borne Disease Control Programme
OCPs Oral Contraceptive Pills
OPD Outdoor Patient Department
PHCs Primary Health Centres
RBSK Rashtriya Bal Suraksha Karyakram
RCH Reproductive & Child Health
RKS Rogi Kalyan Samiti
RMNCH+A Reproductive, Maternal, Newborn, Child and Adolescent Health
RNTCP Revised National Tuberculosis Control Programme
RTI Reproductive Tract Infections
STI Sexually Transmitted Disease
TB Tuberculosis
ULB Urban Local Bodies
UPHC Urban Primary Health Centre
U5MR Under Five Mortality Rate
1
Introduction
1.1 About National Urban Health In order to effectively address the health concerns
of the urban poor population, the Ministry of Health
Mission
and Family Welfare, Government of India launched
Urban population in India has registered an increase the National Urban Health Mission (NUHM) in the
of 32% in the last decade from 2001 to 2011 and year 2013. The initiatives under the NUHM seek to
is standing at 37.7 Cr as per the GoI census 20111. strengthen the public health thrust in urban local
Growth in urban population has led to a rapid bodies, besides providing health care for the urban
increase in number of urban vulnerable poor, many poor. The focus of the NUHM is on alleviating the
of whom live in slums and other squatter settlements. distress and duress of the urban poor in seeking
The overall slum population is estimated to be 7.6 Cr, quality health services. Thus, it is envisaged that
which is 20% of the total urban population.2 during the mission period all 994 cities with a
population of above 50,000, and all the district and
The urban poor suffer from poor health status. As per state headquarters (irrespective of the population
the NFHS-4 (2015-16) data, Under-5 Mortality Rate size) would be covered. This will be in partnership with
(U5MR) among the urban poor is 34 per 1000 live the NRHM’s efforts so far to ensure that there is no
births, and Infant Mortality Rate (IMR) is 29 per 1000 duplication of services. Urban areas with population
live births. More than 49% of urban poor children are less than 50,000 will be covered through the health
underweight and 36.1 % of urban poor children miss facilities established under the National Rural Health
total immunisation before completing one year. Poor Mission (NRHM). The NUHM aims to focus on:
environmental condition in the slums along with high
population density makes them vulnerable to lung
• Urban poor population living in listed and
unlisted slums.
diseases like asthma/bronchitis, tuberculosis (TB)
etc. Slums also have a high-incidence of Water Borne • All other vulnerable population such as
(diarrhoea/dysentery) and Vector Borne Diseases homeless, rag-pickers, street children,
(Dengue, Chikungunya) and cases of malaria among rickshaw pullers, construction and brick and
the urban poor are twice as high as other urbanites. lime kiln workers, sex workers and other
temporary migrants.
• Public health thrust on sanitation, clean
1 Government of India (2011), Census 2011 (GoI), Ministry
of Home Affairs, Office of Registrar General & Census
drinking water, vector control, etc.
Commissioner.
2 Government of India (2013), National Urban Health Mission-
• Strengthening capacity of all public
Implementation Framework, Ministry of Health & Family healthcare providers including health
Welfare. personnel of urban local bodies.
2 | Guidelines for Organising Urban Primary Health Centre Services | June 2017
The key principles of comprehensive primary health 9. Special efforts to identify, reach out to
care for urban areas followed in developing these and address healthcare needs of urban
guidelines are: marginalized populations.
1. Universal provision of basic preventive and
promotive care. 1.4 Objectives
2. An assured minimum package of services is The primary goal of the guideline is to improve
to be delivered to the population, as close the quality of service delivery and health
to home as convenient and necessary, to outcomes by recommending a basic set of
ensure universal access with quality. interventions to deliver primary health care
3. Increased focus on preventive and promotive services at the UPHCs. Specifically, the guidelines
care at the community level. aim to:
4. Improved management at UPHCs to reduce 1. Define the services to be delivered at the
patient load at secondary and tertiary centers. level of community, outreach, UPHC and
5. Reduction of out of pocket expenditure on referral linkages with UCHC.
drugs and diagnostics. 2. Provide guidance for planning, organizing
6. Provision of culturally appropriate health and managing service provision at the
care & counselling through trained frontline above levels.
health staff.
3. Indicate the broad infrastructural and
7. Integration and collaboration with Urban human resource requirements.
Local Bodies and other department for
4. Define the job descriptions of all UPHC
improved convergent actions for social and
staff.
environmental determinants of health.
5. Guide on establishing ancillary and support
8. Enhanced focus on screening of non-
services.
communicable diseases, early identification
of communicable diseases and early 6. Define monitoring, supervision and
outbreak identification and management. reporting mechanisms.
In-facility services
under all National
Health Programs Community Processes
Effective and Regular
Outreach Services (Community Based
interventions & Home visits
by ASHAs, ANMs and MAS)
The Urban
Convergence with Primary Health
Urban Development, Center
Swachh Bharat, Urban Population Based
Local Body (ULB) at Screening
ward level of NCDs
Multi-directional and
Assured Referral
List of Abbreviations | 5
2.1 Human Resources at the UPHC details of selection, eligibility of each category of staff,
the organisation of training, or the requirements of
Scope: Defining number of staff required; Clarity on supervision and support from higher levels.
job descriptions, roles and responsibilities, and per-
formance measures for each staff; Skill sets required Purpose: A motivated, skilled work force is essential
and arrangements for training; Maintaining a positive for health service delivery and the achievement of
work-force environment. This scope does not include health outcomes.
UCHC
For every 2.5 lakh population
Inpatient facility, 30-50 bedded
(5 lakh for metros)
(100 bedded in metros)
UPHC
MO I/C -1 ANMs -1
2nd MO (part time) -1 Public health Manager/
For every 50,000 population Nurse -1 office Mobilization -1
LHV -1 Support Staff -3
Pharmacist -1 M&E Unit -1
Lab Technician -1
1 ANM
For every 10, 000 population Out reach sessions in area of every ANM on weekly
basis
200-500 HHs
Community Health Volunteer (Asha/LW)
(1000-2500 population)
50-100 HHs
Mahila Arogya Samiti
(250-500 population)
8 | Guidelines for Organising Urban Primary Health Centre Services | June 2017
2.4 Identifying and Registering the ASHA along with the PHC staff to discuss
Families/Individuals in the services available at the UPHC.
child tracking system and/or HMIS- and mis- 2.5 Organisation of outreach
matches should be identified and corrected.
The focus should be on the vulnerable
activities
population. These are the facility specific Scope: Planning and implementation of Urban
denominators that would be used for mea- Health and Nutrition Days (UHND) and Special
suring performance. Outreach Camps.
11. In the special outreach sessions, specialists 3. In practice, at the appointed time, the ASHA
from higher centers should be called for would call all members and convene the
addressing health needs for locally endemic meeting with clear agenda for the meeting,
diseases and population sub group-specific such as tobacco control, hypertension,
problems, chronic and non-communicable diarrhoea in the neighbourhood or any
diseases. Basic laboratory investigations organisational issues such as improving
(using portable/disposable kits) and drug UPHC or outreach services, water and
dispensing services must be ensured by sanitation problems. Posters or leaflets
MOIC along with ANM. ASHA and MAS designed may be used during each meeting.
should ensure that camps are attended Twenty women in a group of 500 people
by those needing such care. Lab Tech, being sensitised on some key messages
Pharmacist, Physiotherapists may also be is a very effective way of community
participating in these sessions. mobilisation for a theme.
12. Records of outreach camp including patient 4. Site of meetings could be innovative. It could
details, services provided referral details be one fixed place, or it could be in different
should be maintained systematically to houses by turn.
enable follow up.
5. Agenda of all meetings should include some
solidarity building activities, collecting
2.6 Social Mobilisation for Health information on key health events like births,
through ASHA and MAS deaths, specific illness episodes etc. and
imparting information on the time of the
Scope: The establishment, support and functions
next outreach session and special health
of MAS, support and functioning of ASHAs in the
camps, if these are scheduled.
urban context, involvement and participation of
other relevant community based organisations and 6. At least once in three months there should
partnerships. be a meeting at the UPHC level of all the
conveners of the MAS, the ASHAs under the
Purpose: Most preventive and promotive actions
UPHC area, and the ANMs. Potentially there
and a considerable level of self-care and primary
are 100 MAS and 50 ASHAs and five ANMs
care occurs at the level of the community and
in such a meeting. Alternately, the most
family. To ensure a pro-active community and family
active MAS from each ANM’s area could be
participation through social mobilisation of health
called. The content of the meeting would be
for NUHM.
to review MAS and ASHA functioning and
Responsibility: Public Health Manager, ANM, ASHA planning activities for the next three to six
and MAS months. The public health manager and the
elected ward member(s) of that area should
Activities: also attend.
1. Mahila Arogya Samitis should be constituted 7. On special occasions and themes, and
for every 500 population- or approximately when funds are available, these meetings
100 households. These could have 10 to 20 could take the form of one or two day
members, who could be chosen by asking training programme. Observing special
every 10 houses to choose two members. days like World Health Day, HIV day or
2. MAS should meet at least once a month. It World Malaria Day etc., could be one
is the role of the ASHA to ensure this and way of bringing focus on issues which
she may need the help of other partners to are important health issues for that
manage it. community.
2 Administrative Organization of the UPHC | 15
MAS and ASHA MAS organises routine HH MAS, ASHA and ANM
maintain record book visits per month to impart meet once in three
for every household key health messages and months at the UPHC.
monitoring their health encourage utilisation of Public Health Team leader
records UPHC services leads the meeting
16 | Guidelines for Organising Urban Primary Health Centre Services | June 2017
4. Assured NCD screening services and its 6. Preference needs to be given to elderly,
linkages with organized screening. Follow pregnant women, and other vulnerable
up of those detected with any morbidity groups. This could be done by separate
or illness. queues or in some instances separate clinics
5. Facilitation of access to emergency with special waiting arrangements, till their
transport and stabilisation care for medical number comes up.
or surgical emergencies. Ideally patients 7. All patients waiting for consultation treatment
should bypass this stage and go directly should be seated and should have access to
to site of care, but the facility needs to be safe drinking water and toilet facilities.
prepared for the same.
8. Records of patients treated under national
6. Identification of patients with symptoms programmes as per protocol, and for regular
of chronic complex illnesses - like cancer, chronic illnesses should be maintained
psychosis, etc. and referral to a higher centre. for all visits. Records could be in the form
7. Response and feedback to referrals from of registers, case-sheets or digital records
frontline workers- ASHAs, ANMs etc. as depending on the existing systems.
needed. 9. To manage the consultation time
8. Building a relationship of trust, confidence, adequately, preliminary tests such as Blood
understanding and satisfaction with the Pressure examination, height and weight
population served. examination may be done by the nursing
staff prior to consultation.
Responsibility:
10. Consultation should cover previous health
Overall: MOIC
history, living conditions and family history.
Registration & waiting The staff at the registration
room counter Following consultations, MO should provide
a diagnosis, treatment and follow-up plan
Consultation MO, ANM/Nurse for queue
management, records and ask patients if they have any questions
Lab Lab technician regarding the consultation provided.
Pharmacy Pharmacist 11. There should be adequate privacy for
patients to discuss their health problems
Activities: without being overheard, and to be
1. All patients should be registered according examined without being seen by the waiting
to category of care and if they are already public or others.
registered from the catchment population, 12. The patient should be referred for laboratory
their number should be recorded in the tests based on the symptoms, if any
registration book. diagnostic services are required.
2. All registered patients need to be provided 13. The patient needs to be directed for follow
with a registration slip. up consultation after the diagnostic reports
3. All patient details need to be recorded in the are made available, to facilitate further line
patient’s card. of treatment as needed.
4. No person should be turned away without 14. The patient needs to be directed to the
providing basic consultation, even if it is for pharmacy if any medicine has been prescribed
referral to a higher centre. under the initial consultation by the MO.
5. Patients should be provided a queue 15. Special clinics may be organised in the
number that would be used to call the afternoon or evening, on some specified
patients for consultation. days, to enable a more focused follow up
2 Administrative Organization of the UPHC | 17
on some categories of chronic illness or for 4. Existing hospitals including ULB maternity
adolescent clinics etc. Schedule of such clinics homes, state government hospitals and
should be displayed at the UPHC and actively medical colleges other than private
disseminated during outreach activities by hospitals, will be deemed to act as referral
the ASHAs/ANMs and during UHNDs. points for different types of healthcare
services such as maternal health, child
2.8 Referral Mechanism health, diabetes, trauma care, orthopaedic
complications, dental surgeries, critical
Scope: Establishing a two-way referral mechanism illness, surgical cases etc.
to ensure continuity of care.
5. It is also expected that the collaboration
Purpose: with District Hospitals/Area Hospitals/
Sub-District hospitals and local
1. To enhance the system’s ability to transfer
Medical Colleges may be promoted
patients between different providers and levels
for strengthening the training support
of the health care system, along with detailed
and supplement human resource at the
records and documentation of the case.
U-PHC level.
2. To provide follow up care after referral
consultant or supervise adherence to long 6. In addition to specialized clinical facilities
term treatment plan as advised at the at the above mentioned hospitals, UPHC
higher centre. need to identify centers providing services
such as de-addiction for substance abuse,
Responsibility: Medical Officers, Staff Nurse, ANM mental health services, rehabilitation,
domestic violence help center, nutritional
Process: rehabilitation center (NRC) and others
1. Urban Community Health Centre (U-CHC) as per population needs. Such multi-
should be set up as a satellite hospital for directional referral pathway is very
every 4-5 UPHCs. UCHC would cater to a important to ensure that all health needs
population of 2,50,000. It would provide of the community are met.
in-patient services and would be a 30-50
7. Wherever public sector coverage is
bedded facility. For metros, U-CHCs would
inadequate, reputed private sector
be set up with a population of above five
institutions may be considered.
lakhs, wherever required.
The empanelled/accredited facilities could
2. UCHCs are designated to provide specialist be reimbursed for the services provided
services. So, every UCHC should have as per the pre-decided rates, negotiated
defined linkages with the ground level with them at the time of empanelling/
facilities ie. UPHCs. This will help in effective accrediting them and indicated in the
management and follow-up of the patients city level urban health Programme
requiring specialized care. Implementation Plans (PIPs) subject
3. UCHCs can also plan to send specialist to to approval at the appropriate level.
the feeding UPHCs on monthly/ fortnightly This will not only ensure flexibility to
basis. This will help in providing specialist adapt to different conditions in different
services closer to people and would also cities but also increase the range of
assist in their timely review and follow ups. options for the beneficiaries. For all such
(Referring a patient from U-PHC to higher PPP models, robust monitoring indicator
facility can be referred from Section 7.16 of and mechanism needs to be defined in
‘Referral Unit’, NUHM Framework). the MOU.
18 | Guidelines for Organising Urban Primary Health Centre Services | June 2017
f. Clean the cupboards, shelves, beds, lock- the necessary sanitation staff is hired and
ers, intravenous fluid stands, stools and appropriately instructed and trained.
other fixtures, with detergent and water. 5. Provide the necessary sanitary equipment
g. Change curtains periodically or whenever and consumables to keep the premises
soiled, and send them regularly for clean including safety equipment like gloves
laundry. and boots.
h. Clean the patients’ beds (if any) every 6. The person appointed for supervision should
week with detergent and water. Use 1% have a checklist with dates; the staff should
hypochlorite when soiled with blood or sign against each item, stating when it was
body fluids. done and the supervisor counter-signs it.
i. Collect the waste category-wise, from all II. Waste management at the UPHC
the departments (OPD, Injection room,
laboratory, pharmacy and other places), Responsibility:
and store them at the designated Overall MOIC
location. Daily Monitoring Staff Nurse or any other
staff delegated by MOIC
j. Clean the kidney basins, basins, bed
Segregation All staff handling waste
pans, urinals, etc. with detergent and
Collection, Housekeeping Staff
water, and disinfect them with Phenyl,
Transportation & Storage
especially when these have been used
Disposal Outsourced Agency/
for infected patients. Housekeeping Staff
k. Clean the floor of bathrooms with a
broom and detergent thrice a day and Activities:
then with disinfectant solutions. During 1. Segregation of Waste: This shall be done
out-patient hours, clean them hourly. at point of generation as per Biomedical
l. Clean the toilets with a brush, using Waste (Management & Handling) Rules
detergent disinfection with Phenyl. 2016 in different colour coded bins with
liners. Infectious waste must not mix with
m. Stains may be removed using
non-infectious waste. Adequate number
Hydrochloric acid.
of bins and liners for proper segregation
n. Clean the wash-basins with detergent and collection of biomedical waste should
powder every morning. During out- be provided at point of use. Needles and
patient hours, clean them every hour other sharp items should be handled and
o. Segregate, store and dispose bio- disposed as per standard protocols to avoid
medical waste as per guidelines. accidental sharp injuries. There are also
protocols for liquid waste, blood spillage,
p. Check for cobwebs, wild growth of
laboratory waste and contaminated plastic
vegetation, and nests/beehives in the
that must be adhered to. For liquid waste
building once a week and remove as
management, clean the liquid waste spill by
and when required.
adding equal or more quantity of bleaching
q. Store and dispose non-functional powder solution. Leave the area for 30
furniture, equipment, instruments, minutes and then wipe the area with a swab/
stationeries and other junk material, as cloth. Discard the swab/cloth after cleaning,
per instructions. into the red bin meant for plastics and other
4. Based on these work specifications, either waste. If possible, dispose the liquid waste
the work is outsourced through bidding, or into the drains.
22 | Guidelines for Organising Urban Primary Health Centre Services | June 2017
2. Collection of waste: Waste should be For more details on Infection Control and
collected by housekeeping staff at the BMW Management, Infection Control and
respective department in two shifts, morning Environmental Plan- Guidelines for Healthcare
and evening (or as required) preferably workers for Waste Management and Infection
when there are minimum OPD patients/ Control may be referred to.
visitors, except, if applicable, in labour
room where the waste should be collected 2.11 Infection control
after every delivery case. Waste should be
collected in two shifts or when waste bin is Scope: To enable health functionaries to implement
¾ full, whichever is earlier. the infection control programme effectively in
order to protect themselves and others from the
3. Transportation of waste: Daily waste
transmission of infections. This includes:
should be transported to disposal site in
closed container through a pre-defined • Hand washing and antisepsis (hand hygiene).
route avoiding crowded area. A large plastic • Use of personal protective equipment when
bag should be used to line the wheelable bin handling blood, excretions, secretions etc.
to prevent any liquid leaks from the waste
• Appropriate handling of patient care
bags from soiling the bin. This plastic bag
equipment and soiled linen.
should be replaced in each shift.
• Prevention of needle stick/sharp injuries.
4. Safe disposal of waste: The disposal of
waste is done by the outsourced agency • Environmental cleaning and spills-
hired for waste management. Anatomical management.
waste (yellow bag) is disposed in deep burial • Appropriate handling of waste.
pits constructed as per specifications of BMW
Purpose: To provide process, instructions and
Management and Handling Rules. Sharps in
methodology for infection control for provider,
puncture proof box should be disinfected
patient and public safety in terms of reduced
and disposed in sharp pits. Contaminated
infections and better patient experience.
solid waste (red bag) should be disinfected,
mutilated and then disposed with general Responsibility: MOIC, Staff Nurse, Sanitary Staff
waste. General waste is collected from
1. All aspects of bio-waste management and
the facility and disposed by Municipal
good housekeeping contribute to infection
Corporation in landfills.
control (Refer 3.13 on Housekeeping
5. Common bio-waste disposal: Given and bio-medical waste management). In
space constraints, a common arrangement addition, the following need to be observed:
for waste disposal for all public health
2. Suitable seating arrangements of patients
facilities in the defined urban area may be
and issue of disposal masks to patients who
explored.
are coughing or sneezing while in the queue.
6. Monitoring and quality control: MOIC
3. Hand washing and antisepsis:
should take rounds of UPHC to assess the
process flow and compliance of bio-medical a. After handling any blood, body fluids,
waste regulations once a week. Observations secretions, excretions and contaminated
should be recorded and corrective and items.
preventive action should be taken. If required b. Before and after examining a newborn
under MIS or another authority, reporting or pregnant woman or immune-
should be done in the prescribed format and compromised patient, or doing any
within time. interventional procedure.
2 Administrative Organization of the UPHC | 23
b. Should avoid any contact with c. After the solution is ready, pour the
contaminated (used) personal protective solution in the waste bin meant for
equipment and surfaces, clothing or disinfection of used plastics and sharps.
people outside the patient care area. d. Bleaching powder solution needs to be
prepared every day.
c. Discard the used personal protective
equipment in appropriate disposal 7. Prevention of needle stick/sharps injuries:
bags, and dispose off, as per the policy a. Place the used disposable syringes and
(BMWM protocol). the needles, scalpel blades and other
d. Do not share personal protective sharp items in a puncture-resistant
equipment with others. container, with a closable lid located
close to near usage area.
e. A health worker needs to change
personal protective equipment b. Take extra care when cleaning sharp
reusable instruments or equipment.
completely, and thoroughly wash hands
each time before attending to another c. Never recap or bend needles.
patient or another duty. d. Sharps must be appropriately disinfec-
5. Patient Care Equipment: ted and/or destroyed as per protocol.
a. Handle patient care equipment soiled e. Healthcare providers, especially those
with blood, secretions or excretions with dealing with injectables or blood
care in order to prevent exposure to skin samples regularly should be immunised
and mucous membranes, clothing and against Hepatitis B infection.
the environment. 8. Cleaning floors:
b. Handle, transport and process used linen a. Wear personal protective gears like gloves
that is soiled with blood, body fluids, and apron while cleaning the floors.
secretions or excretions with care, to b. The UPHC floor must be cleaned regularly
ensure that there is no leaking of fluid. with hot water and soap/floor cleaner.
c. Ensuring sterilisation of all reusable c. Mop/cloth needs to be disinfected after
equipment; they should be reprocessed every use.
24 | Guidelines for Organising Urban Primary Health Centre Services | June 2017
2.12 Convergence with ICDS, Water 5. The ANM/ASHA will be responsible for
coordination with the AWW and will also
and Sanitation Departments monitor the service received by these
Scope: It provides a framework for convergence of beneficiaries and their performance.
all health and allied services at the UPHC level.
of the Public Health Engineering Department In process of entering a PPP, following three things
(PHED)/Jal Nigam/Municipal Corporation, needs to be kept in mind:
Resident Welfare Association, MAS, and • Rationale for entering a PPP mode.
other bodies as applicable.
• Factors to be considered while planning a
3. ASHAs and ANMs needs to identify issues PPP model.
of water supply, water quality, garbage
collection, drainage and sanitation faced by
• Outcome indicators for proper monitoring.
the community and report to the PHM. The Major challenges in providing primary healthcare in
PHM and MO should take up these issues urban context are HR constraints, limited outreach,
with the ward level officials or personnel limited range of services and infrastructural
responsible for these services in the area. limitations. Hence PPPs can be used as a tool to
They should also act as advocates of the deliver various services under NUHM; Clinical
community to improve the basic services in services at UPHCs, specialist outreach services,
their catchment area. community outreach services, diagnostic services,
4. The Committee should find local solutions mobile health units etc. Withdrawing Specialists or
for environmental sanitation with collabo- Doctors from public health facilities for outreach
rative efforts. tends to make such facilities non-functional. Under
such conditions, ongoing private doctors to conduct
5. In addition, UPHCs must have sufficient
outreach could be considered.
stock of chlorine tablets/drops and all ASHAs
should be given adequate supply. To establish a successful PPP, state needs to conduct
a situational analysis, identify appropriate private
partner to bridge the gaps in service delivery, identify
2.13 Public Private Partnership
the type and scope of PPP model, prepare RFPs
Scope: Partnership between government and and SLAs taking into consideration the healthcare
private agencies to provide services close to people needs and local conditions with key performance
at affordable costs indicators (KPIs) and finally develop a robust and
reliable mechanism to monitor the performance
Purpose:
and service delivery standards. The RFP and SLA
a. To enhance the system’s ability to provide guidelines have been issued by the MoHFW.
effective services in collaboration with
PPP model for UPHC management: A cluster of UPHCs
private providers.
or a single PHC in an urban area can be provided to
b. To guide stakeholders in understanding the private partner for operation and maintenance.
contracting mechanisms under Public A set of key performance indicators (KPI) are to be
Private Partnership. shared among the two partners including, both
Responsibility: Government officials, private entity quantitative as well as qualitative indicators. An
incentive can be added to the fixed payment, based
Process: on the performance against the KPIs.
PPP is a form of contract between a government and Two types of outreach under NUHM namely, UHND
a private entity, wherein these two bodies jointly and special outreach can be conducted by private
provide public services in line with the pre-defined specialists through competitive bidding under PPP.
terms of contract. While primary healthcare is the The District Health Society or Urban Local Body
mandate of the State, in the urban areas to compensate would invite tender for the engagement of private
for the lack of structured primary healthcare facility service providers. Charitable institutions, private
and to leverage the large number of private providers specialist clinics or multispecialty hospitals would
available, PPPs may be considered. be eligible.
26 | Guidelines for Organising Urban Primary Health Centre Services | June 2017
Critical Success Factors for Private Sector Participation it provides, improve the efficiency with which it is
in Primary Care are effective governance structure, provided and ensure quality of care.
sharing of responsibilities based on capabilities,
Responsibility: Official designated at each level
incentivizing performance, effective monitoring,
(state, district and facility)
no delays in payment and standardizing practices
for PPPs in similar activities. Defining the roles, Activities:
responsibilities and scope of work along with 1. Grievance Redressal System in UPHCs
monitoring mechanisms are important prerequisites shall be established as per the Grievance
before MOU is signed. Redressal Guidelines for NHM (2017).
2. As per the GRS guidelines, each state shall
2.14 Grievance Redressal have a centralized set-up, operated through
a call center (104), to address grievances and
Scope: Addressing the complaints and grievances
provide medical advice. The system enables
of patients regarding the service provided at the
tracking, investigating and resolution of
UPHC level.
complaints in a timely manner.
Purpose: The UPHC needs to provide quality services 3. UPHCs under NUHM should also be linked
that are responsive to people’s needs and demands to the centralized system. Each UPHC shall
and hold itself accountable for its performance. It have a nodal officer designated for grievance
must be able to measure the effectiveness of care redressal.
Helpdesk/Complaint Box
Grievance
Registration Web Portal-Online
Patient &
Nodal Officer
Call Center (104)
receive Registered Grievances segregated
SMS with according to District/Block/Facility
registration
number
Received by State Nodal Officer
IF Action Taken
Hon. HFM
2 Administrative Organization of the UPHC | 27
4. The State Program Officer for NUHM should or the help-desk and a questionnaire that
maintain a directory with details of each literate persons can fill up without guidance
UPHC in-charge. The Directory should and drop into a box kept for the purpose.
be handed over to the 104 call center for 2. Questionnaire should be decided by the
facilitating complaint resolution. Public Health Manager in consultation with
5. In each UPHC there should be a clear display the MOIC. Questions will include timeliness
of GR helpline number and methods by of care, subjective satisfaction with care,
which a grievance can be registered. The health outcomes as perceived, out-of-
process of redressal and timeline should pocket expenditure and provider to patient
also be displayed. relationship.
6. The UPHCs from which frequent complaints 3. All UPHCs needs to conduct exit-
are received may be invited for the review, interviews of out-patients for collection
inquired into further, and appropriate and analysis of their feedback. This will
corrective action taken. help in understanding their out-of-pocket
7. RKS of the UPHC should review the number expenditures, problems in accessing health
of grievances registered and number service and overall satisfaction with care
resolved every month for their UPHC. provided in the facility.
4. On each day, at least 5 persons who are
2.15 Patient Feedback and Exit leaving the facility are contacted and
requested to fill the questionnaire and drop it
Interviews into the box kept for the purpose. A separate
Scope: To enable patients to provide feedback on box/ file must be placed for submitting the
the service received at the UPHC. filled-in feedback forms.
5. If the person is not literate, the help-desk
Purpose: Patient feedback/exit interview will help
in charge could conduct it as an interview.
the UPHC to strengthen the quality of service
The selection should be random but at
provisioning, be more responsive to patient needs
least half of it should be women and one
and meet the expectations of the patients and
third could be women or men with young
reduce out-of-pocket expenditure.
children.
Responsibility: 6. Anonymity needs to be maintained. The
• MOIC: For use of information and oversight. patients must not be forced to disclose their
• Public Health Manager: Organisation and identity.
oversight over the feedback system. 7. The Public Health Manager supervised by
• Help-desk in charge (if this is established) the MOIC is responsible for analysing the
or else registration clerk: Collection of feedback and preparing a comprehensive
feedback. report. The report should be shared
with the RKS and the city/ district health
Activities: society.
1. Two forms of feedback collection are A comprehensive report on the specific actions
envisaged: A semi-structured interview that taken and support needed for improving the service
is administered by the registration clerk should also be prepared.
3
UPHC Services
be ensured).
ASHA visits every pregnant woman at least once a month. In high risk pregnancies, she makes a referral to UPHC, or organises a home
visit by the ANM.
Post partum visit should be ensured on 0th, 3rd, 7th and 14th days of delivery.
At least one ANC, preferably during the 3rd visit, must be done by a doctor (medical ANC), preferable at the UPHC where the woman is
registered.
At delivery points, Minimum 48 hours of stay after delivery. This requires a clean bed, clean toilets, and arrangements for food and
privacy for breastfeeding.
Initiation of breastfeeding within one hour of birth.
Recognition of gender based violence during pregnancy (and also at all other times).
S.No. Area Community Level Outreach Level UPHC Level UCHC Level
2 Neonatal and 6 household visits in neonatal Complete immunization, Vitamin If birth occurs at UPHC: Congenital anomalies,
infant health (0-1 period for improved newborn A supplementation, height and Initiation of breast-feeding
Management of complicated
yrs of age) care practices, Home based weight measurement. within an hour of birth;
paediatric/ neo-natal cases,
new born care, identification Care of common illnesses of new Screening for birth defects
hospitalisation, surgical
and care of low birth weight/ born, Identification of congenital (as per the RBSK protocol) 7
interventions, blood transfusion.
preterm newborn (with referral anomalies, and appropriate appropriate referral; Essential Management of severe acute
as required), counselling referral . new born care : wiping the baby, malnutrition (SAM).
and support for exclusive weighing the baby, prevention
breastfeeding, complementary Hospitalisation, treatment
of hypothermia by wrapping the and rehabilitation of severe
feeding, improved weaning baby, examination to rule out
practices; nutrition counselling; undernutrition.
health problems, cord care.
Education of prevention of
infections; identification of ARI/ Immunisation
diarrhoea and treatment (ORS). Management of Birth
asphyxia, severe ARI,
diarrhoea management, acute
gastroenteritis with dehydration,
pneumonia case management,
Treatment and stabilization and
referral of severe cases, Weekly
immunization sessions.
Monthly visit by ASHA to all families with children below one year of age; information on immunization sessions, All ASHAs must be
given the HBNC kit for providing care to neonates at home.
Convergence with ICDS essential, ANM to maintain & update MCTS register, linelisting of children who missed immunization, display of
immunization schedule, maintenance and monitoring of vaccine cold chain.
3 UPHC Services | 31
S.No. Area Community Level Outreach Level UPHC Level UCHC Level
3 Child Health & Growth monitoring, prevention Child Health: Prompt Immunization, management of Treatment of childhood illnesses
Adolescent Health through IYCF counselling, management of ARI and fever; SAM, severe anaemia, persistent and infections, Treatment of
access to food supplementation acute diarrhoea; detection malnutrition and nutritional disability and developmental
through ICDS; Detection of and treatment of anaemia and deficiencies; severe diarrhoea delays.
SAM, referral and follow up de-worming; Early detection and ARI management;
care; Prevention of anaemia, of growth abnormalities, Diagnosis of disability and
use of iodized salt, de-worming; developmental delays and developmental delays and
Prevention of diarrhoea, prompt disability. referral, Skin infection.
treatment and referral if needed. Adolescent health: Detection Convergence with RBSK &
Pre-school and school children: and treatment of anaemia and ICDS, Confirmation of any
biannual screening, eye care, de- other nutritional deficiencies; type of deficiencies/disease/
worming, school health records bi-annual de-worming and developmental delays upto 6
Adolescent health: anemia adolescent counselling & referral years.
detection, peer counselling, as per need. Diagnosis and treatment of
sexual health education, childhood illnesses, Referral
personal hygiene, encourage of acute deficiency cases and
adolescent health days. chronic illnesses.
Outbreak investigation if there
are more than five cases seen
from one cluster of any of
infections within a week.
1. The ASHA/ANM/MAS must mobilise both girls and boys for counselling and treatment. In urban areas adolescent males have
significant health problems as they are engaged in labour work and other kinds of physical occupations. So they must be provided
32 | Guidelines for Organising Urban Primary Health Centre Services | June 2017
health check-ups related to their living conditions and appropriate counselling related to sexual concerns, drug abuse, mental health,
etc.
2. Similarly, adolescent girls attending the clinic must be provided information, counselling and services related to sexual concerns,
pregnancy, contraception, abortion, menstrual problems and menstrual hygiene, drug abuse, mental health, nutrition etc. responsive
to their requests.
S.No. Area Community Level Outreach Level UPHC Level UCHC Level
4 Family Planning Health communication and preventive education for early marriage, Counselling for family planning, IUCD, Vasectomy, tubectomy,
Services identify eligible couples, motivation for family planning – delaying Medical examination required manual vacuum aspiration,
first child and birth spacing, information and access to spacing before start of OCPs, access to all safe abortions, Sterilisation
methods - OCP, ECP, condoms; Referral for sterilisation, follow-up of spacing methods including IUCD operations, infertility treatment.
contraceptive related complications. insertion, referral for sterilisation, Complications in contraceptive
management of contraceptive
Counselling for family planning, access to all spacing methods RTI/ usage, hormonal and menstrual
related complications.
STI: Knowledge of and referral for RTI/STI, follow-up for ensuring disorders, infections etc.
adherence to treatment regime of cases undergoing treatment. Medical Abortion in the first RTI/STI: Management
trimester if indicated, after of complicated cases,
necessary medical examination hospitalisation (if needed).
(where resources available as per
protocol).
RTI/STI: opportunistic screening
of RTI/STI, wet mount test,
diagnosis and treatmentUTI
treatment, menstrual disorder.
First aid for gender based
violence – link to referral center
and legal support services.
Laboratory tests for VDRL and
for HIV if UPHC is designated
for same, otherwise to refer to
designated referral facility.
Empowering girls and women to understand that they have the right to decide the number of children and social reasons for delaying
the first child, spacing the second and limiting to a smaller family size.
ANM and ASHA should take the lead in counselling the woman immediately after marriage, and during and after pregnancy on reasons
and choice of contraception.
5 Management Identification and referral for Diagnosis and management Diagnosis and management of Management of complicated
of common testing at UPHC, symptomatic of fevers, ARI, diarrhoea, skin all fevers, infections etc. cases, hospitalization.
communicable care for fevers, diarrhoea, aches infections.
diseases and pains.
Management of aches, pains,
Skin infections, abscesses – rash, gastritis, acute febrile
identify, refer. illness; Referral for severe and
complicated cases, Acute febrile
illness, indigestion, gastritis.
3 UPHC Services | 33
S.No. Area Community Level Outreach Level UPHC Level UCHC Level
6 Management of TB, HIV, Leprosy, Malaria, Kala Identification, examination and Diagnosis and treatment/ Diagnosis and treatment of
communicable Azar, Filariasis, other vector referral to UPHC for suspected management plan, referral of complicated or severe cases,
diseases (National borne diseases: Prevention, cases. acute and chronic cases, Report hospitalization.
Health Programs) identification, use of RDT, to IDSP.
prompt treatment initiatives, Lab testing for all vector borne
vector control measures; diseases; Drug dispensation for
education for prevention; TB.
identification, use of RDT, Follow
up on medication compliance. Maintenance or records for all
cases of TB, leprosy.
Mass drug administration
in Filariasis prevention, Establish diagnosis if fever
immunization of Jap B, RDK persists for more than 5 days.
testing for malaria, Counseling UPHC to serve as DOTS center,
for leprosy on treatment regular follow up to ensure
compliance. compliance to drug regimen.
Vector Borne Diseases:
Identification of suspected
cases, Slide collection, testing
using RDKs. Counselling for
practices for vector control and
personal protection. Community
education.
Visit the family and neighbouring families to ensure that no contacts have similar symptoms. This is particularly important for TB and
34 | Guidelines for Organising Urban Primary Health Centre Services | June 2017
leprosy. For vector borne and water borne diseases, an active case detection survey in neighbouring houses is required. In HIV, it
requires testing for spouse but care is needed on issues of confidentiality and prevention of stigma.
Facilitate the visit of the public health response team from the UPHC to take community level action in case of vector borne or water
borne diseases.
Examine every case of fever. If fever persists beyond five days, then always try and establish a diagnosis.
If there is a cluster of infection cases then always ask support for higher diagnostics like ruling out Swine flu.
Every UPHC is necessarily a part of IDSP, and is hence required to file three reports on a weekly basis- L form which is the report of cases
tested and cases found positive for infectious diseases, from the laboratory; P forms,which are presumptive (not necessarily confirmed)
cases of any of the notifiable infectious disease; and S forms which are cases suspected and reported by ANMs. Ensure maintaining a
copy of these reports sent and analyse them periodically to understand the communicable disease situation in the UPHC catchment
population/ area.
S.No. Area Community Level Outreach Level UPHC Level UCHC Level
7 Screening & Management of Non-Communicable diseases
NCD Hypertension: Screening, NCD Screening Day Comprehensive NCD screening Diagnosis and treatment/
(Hypertension, primary & Secondary Prevention. Hypertension: BP for 30+ patients who missed management of all NCDs,
measurements, medication, screening day. hospitalization if needed.
Diabetes, Cancers Diabetes: Screening, primary &
enable specialist consultation,
– oral, breast, Secondary Prevention. Hypertension: Medical Integration with RNTCP for TB
follow up.
cervical) management. elimination with urban areas.
Cancers: awareness generation
Diabetes: Blood sugar
regarding signs and symptoms . Diabetes: Medical management, Integration with NPCDCS at
test, medication, follow up provision of regular drug supply community and facility levels.
Counselling on mitigation of risk diagnostics, enable specialist
for diabetes and hypertension.
factors. consultation, diet counselling,
Refer persons with >140/90 BP Cancer: Cervical cancer
Silicosis, Flourosis: Preventive
and >140 random sugar to UPHC. screening using acetic acid.
action and early case
Diagnosis and treatment plan for
identification. Cancer: Screening of oral cancer, HT and DM cases.
COPD: Prevention and early clinical breast examination, (with
detection, referral. adequate privacy), early referral, Referral for complicated and
follow up. severe cases.
Epilepsy: Early case
Counselling regarding risk Systematic recording of NCD
identification and referral.
factors, diet management as cases.
appropriate for all NCDs. COPD: diagnosis, treatment plan
Silicosis, Flourosis: Early case Epilepsy: diagnosis, treatment
identification. plan.
COPD: identification
Population enumeration and listing of target population (all 30+ individuals).
Risk assessment of 30+ persons through prescribed format.
Inform all 30+ about advantages of screening, screening day and ensure they attend, esp high risk persons.
Ensure treatment compliance for those on medication through visits. Referral of at-risk cases to UPHC.
NCD Screening to be organized weekly for every 10,000 population.
Implementation of NCD Screening to be supported by District NCD Cell for planning, monitoring and reporting.
Once diagnosis for HT & DM is established, patients to be given at least a months supply of medication.
First follow up at the end of the first three months after diagnosis, and sooner if required.
An annual specialist consultation at the nearest nodal CHC with an NCD clinic, is also recommended.
3 UPHC Services | 35
S.No. Area Community Level Outreach Level UPHC Level UCHC Level
8 Mental Health Screening of mental illness using Detection & referral of mental Initial screening and referral. Psychiatric services, including
screening questions and tools, illness, community education Referral to de-addiction centers, hospitalisation, if needed.
Identification of cases, referral and preventive measures against if needed. Management of
and follow up; community substance abuse. violence related concerns.
education and sensitization on
mental health issues, substance
abuse.
9 Dental Care Education on oral hygiene Dental hygiene, screening for Diagnosis, treatment of Treatment for tooth abscess,
Identification of cases, referral cavities, gingivitis, dental caries, infections and referral; oral dental caries, scaling, extraction,
special outreach camps for ulcers. Treatment or referral. health clinics on specific days. etc. Referral for further care.
diagnosisand treatment,
counselling and oral health
education.
10 Eye/ENT Identification of glaucoma, Eye care in newborn, screening Treatment for conjunctivitis, Diagnosis and management
trachoma, and referral to UPHC. for visual acuity, cataract, Management of colds, of infections, disorders, further
refractive errors. identification of cases and referral of complicated cases,
Early identification of squint,
referral. hospitalisation (if needed).
lazy eye in children, other eye Nose, throat infections.
disorders; Identificationof
cases of hearing impairment (if
reported by family/ community),
referral for testing.
11 Geriatric & Support to family in palliative Management of common Diagnosis, treatment plan, Diagnosis and management of
36 | Guidelines for Organising Urban Primary Health Centre Services | June 2017
Palliative Care care, counselling to the elderly geriatric ailments, counselling, referral for specialist care geriatric conditions, referral for
on keeping healthy, active, supportive treatment. advanced treatments required.
appropriate diet, recreational Pain management and provision
activities. of palliative care with support of
ASHA.
In view of increasing geriatric population in urban areas, UPHCs should organize special outreach sessions or weekly geriatric clinics at the
UPHC..
S.No. Area Community Level Outreach Level UPHC Level UCHC Level
12 Trauma Care First aid and referral. First aid and referral emergency resuscitation, Treatment, Case - management
(burns & injuries) documentation for MLC (if and hospitalisation,
First aid and first responder
training for school teachers, applicable) and referral. physiotherapy and
rehabilitation.
community volunteers, ASHAs Management of animal bites,
and AWW. insect bites, rodent bites,
stabilization care and treatment
in poisoning and trauma of any
nature; Management of injury,
simple fractures and burns and
abscess management.
All UPHC staff should be trained in first aid, first responder care. UPHC should be equipped with necessary equipment and drugs for
stabilization of patients of trauma, fracture, respiratory distress, burns, poisoning, fall and other accidents common in urban areas.
They should also have an emergency response system in place, in case of a hazard in the community eg: building collapse, fire,
demolition etc.
UPHC must be able to arrange for emergency transport quickly when needed. All wheelchairs and stretchers at the UPHC should be
functional and placed appropriately for quick and easy access.
3 UPHC Services | 37
Annexure – I
Layout
Room
Ward* Consultation room
Out-patient department Dressing room
Waiting area Labour room
Store Laboratory
Nursing station Pharmacy
* for maternity homes and bedded U-PHCs
Basic Amenities
Utility
Beds Hand washing including availability of water and soap in dressing
rooms
Private area for expansion Wheelchair, stretcher etc.
24*7 electricity supply Fire safety equipment- fire extinguisher, sand buckets
Drinking water facilities Computer with internet connection for MIS purpose
Fans, coolers/warmers Maintenance of registers for monitoring and record keeping
Separate Toilets for men and women
List of Furniture
Furniture Item
Writing tables (officer) with table sheets Inverter for fridge
Armless chairs Lamps
Basin with stands Mattress for beds
Bed sheets Medicine box
Bed stead iron for treatment room Notice board
Bedside table Office chairs
Benches for waiting area Pillows with covers
Bio-medical bins with liners Revolving stool (examination)
Buckets and mugs Rubber sheeting
40 | Guidelines for Organising Urban Primary Health Centre Services | June 2017
Furniture Item
Cloth screen - three-fold Side wooden racks
Computer table with chair Steel almirah - big
Curtains Steel almirah - small
Dustbins Stretcher on trolley
Examination beds Towels
Foot steps Wheelchairs
Generator(7.5 KV) Wooden screen
Inverter for computer
(Note: Essential Drug List for U-PHC can be referred from State)
The following list is suggestive and not exhaustive. Requirement may be decided as per facility load.
Drug list
1. Acetyl Salicylic Acid Tablets 150mg 2. Fluconazole Tablets 50mg
3. Acyclovir 200mg 4. Folic Acid & Ferrous Sulphate Tablets (Large)
5. Albendazole 400mg 6. Folic Acid & Ferrous Sulphate Tablets (Small)
7. Amoxycillin Capsules 250mg 8. Folic Acid Tablets 5mg
9. Amoxycillin Trihydrate Dispersible Tablets 125mg 10. Glibenclamide Tablets 5mg
11. Ascorbic Acid Tablets (Chewable) 12. Glimepiride Tablets 1mg
13. Atenolol Tablets 50mg 14. Glipizide Tablets 5mg
15. Atorvastatin Tab 10mg 16. Ibuprofen Tablets 400mg
17. Azithromycin Tablets 500mg 18. Inj. Ranitidine
19. Bisacodyl Tablets 5mg 20. Levocetirizine Tablets 5mg
21. Calcium Gluconate Tablets 500mg 22. Metformin HCL Tablets 500mg
23. Cefadroxil Kid Tablets 125mg 24. Methyldopa Tablets 250mg
25. Cefadroxil Tablet 500mg 26. Methylergometrine Maleate Tablet 0.125mg
27. Cefiximine Tablets 200mg 28. Metronidazole Tablets 200mg
29. Chlorine Tablets 0.5gm 30. Norfloxacin Tablets 400mg
31. Chloroquine Phosphate Tablet 250mg (150mg base) 32. Norfloxacin Kid Tablets 100mg
33. Chlorpheniramine Maleate Tablets 4mg 34. Ofloxacin Tablets 200mg
35. Ciprofloxacin Tablets 250 mg 36. Omeprazole Capsules 20mg
37. Clotrimazole Vaginal Tablets 100mg 38. Pantoprazole Tablets 40mg
39. Dexamethasone Tablets 0.5mg 40. Paracetamol Tablets 500mg
41. Diazepam Tablets 5mg 42. Primaquine Phosphate Tablets 2.5mg
43. Diclofenac Sodium Tablets 50mg 44. Primaquine Phosphate Tablets 7.5mg
45. Dicyclomine Tablets 20mg 46. Tab Fenoxidenadine 120mg
47. Diethyl Carbamazine Citrate 50mg 48. Tab Ranitidine 150mg
49. Domperidone Tablets 10mg 50. Tab Tinidazole 500mg
51. Doxycycline Capsules 100mg 52. Vitamin A & D Capsules
53. Eteophylline with Theophylline Tablets 54. Zinc Sulphate Dispersible Tablets 20mg
55. Fluconazole Tablets 150mg
44 | Guidelines for Organising Urban Primary Health Centre Services | June 2017
Miscellaneous
Miscellaneous
1. Albendazole Suspension 200mg/5ml 2. Inhaler Beclomethasome
3. Anti-Rabies Vaccine 4. Inhaler Salbutamol
5. Azithromycin Oral Suspension 200mg/5ml 6. Injections for Emergency Treatment
7. Betamethasone Valerate Cream 8. Insulin Preparations
9. Chloroquine Phosphate syrup (60ml) 10. Levocetirizine Dihydrochloride Syrup
11. Clotrimazole Cream 1%w/w 12. Metronidazole Suspension 100mg/5ml
13. Dicyclomine HCL Oral Solution 10mg/5ml 14. Neomycin, Bacitracin &Polymyxin - B Oint
15. Domperidone Suspension 1mg/ml 16. Paracetamol Syrup 125mg/5ml
17. Folic Acid & Ferrous Sulphate Syrup 100ml 18. Povidone Iodine Ointment 5%
19. Framycetin Sulphate Cream 20. Povidone Iodine Solution 5%
21. Gamma Benzene Hexachloride Application 22. Reagent Strips for estimation of Albumin &
Glucose In Urine
23. Gentamicin Eye Drops 0.3% w/v 24. Salbutamol Syrup 2mg/5ml
25. Gentian Violet Topical Solution 26. Silver Sulphadiazine Cream 1 %
27. I.V. Fluids 28. Vitamin A solution 1Lac IU/1ml
29. Ibuprofen Suspension 100mg/5ml
Emergency Drugs
1. Drugs & Injectable as per requirement
2. Fluids & Plasma Expanders
3. Oxygen Cylinders/Oxygen Concentrator
4. Essential Equipment – Suction Machine,
Ambu Bag, ECG Machine, etc.
5. Suture Kit
Surgical
1. Absorbent Gauze (20mt x 90cm)
2. Absorbent Cotton Wool
3. Adhesive Tape 5cmx10mtr
4. Adhesive Tape 7.5cmx10mtr
5. Bandage Cloth (20mt x 90cm)
6. Disposable Hypodermic Needle Size:22x1”
7. Disposable Hypodermic Needle Size:23x1”
8. Disposable Hypodermic Needle Size:24x1”
He/she shall further supervise their work periodi- • He/she shall also make arrangements/provide
cally both in the clinics and in the community setting guidance to the Health Worker (Female) in
to give them the necessary guidance and direction. organising training programmes for ASHAs.
• He/she shall keep notes of his/her visits to the • Participate in community mobilisation
area and submit every month his/her tour processes like selection of ASHAs and
report to the district/city health authorities. formation of MAS and ensure their training.
• He/she shall discharge all the financial duties • Assist Medical Officer in monitoring and
entrusted to him/her. supervision of staff on daily basis, like
• He/she shall discharge the day to day punctuality, maintenance of record, analysis
administrative duties and administrative of data etc.
duties pertaining to new schemes.
Management of infrastructure, equipment and all
support services
2. Public Health Manager • He/she shall coordinate to ensure timely
The role of Public Health Manager (PHM) at a UPHC completion of civil work in the UPHC if any.
is envisaged as the nodal person responsible for all • He/she shall assist Medical Officer in
non-clinical activities at the UPHC. He/she will assist examination of tender document for civil
the Medical Officer in provisioning of services at the work in UPHC.
UPHC level and outreach locations. Key roles and
responsibilities of PHM are as below:
• He/she shall ensure that all equipment
and instruments are in good condition and
Planning and budgeting – Overall management and calibrated.
functioning of healthcare facility • He/she shall monitor and manage Annual
• He/she shall have a significant managerial Maintenance Contract.
role relating to planning and budgeting, • He/she shall ensure timely delivery of
organising staffing, directing, coordinating, supplies to the UPHC.
and monitoring/reporting to ensure optimal
utilisation of the facility. Quality assurance and Infection Control and Environment
• He/she shall be nodal person for all activities Management
and programmes. • The PHM shall assist in gap analysis of
• He/she shall provide financial oversight in existing services, preparation of action plan
planning and budgeting. to fill identified gaps and implementation of
the guidelines.
• He/she shall compile the overall profile of
facility regarding geographical coverage, • He/she shall ensure bio-medical waste
target population, demographic and management practices as per the guidelines.
socio-economic indicators and update • He/she shall facilitate periodic meeting of
periodically. Quality Assurance Committee/team and
• He/she shall ensure efficient functioning prepare agenda notes and action taken
of OPD and shall strive to reduce patient report for the same. He/she shall also
waiting time. maintain minutes of the meeting.
• He/she shall refer to IPHS for assessing the • He/she shall ensure that protocols for service
functional status of health facilities and to delivery of National Health Programmes are
bring up the UPHC to the comparable level. being followed.
• She shall help and guide the Health Worker and submit monthly reports to the Medical
(Female) in planning and organising her Officer of the Primary Health Centre.
programmes of activities.
• She shall assess fortnightly the progress 4. Auxiliary Nurse Midwives (ANM)
of assessment report work of the Health
Worker (Female) and submit with respect to Responsibilities of ANM for outreach sessions:
their duties under various National Health • Unlike rural areas, Sub-Centres will not be
Programmes. set up in the urban areas as distances and
• She shall carry out supervisory home visits in mode of transportation are much better
the area of the Health Worker (Female) with here. Outreach services will be provided
respect to her duties under various National through the Female Health Workers
Health Programmes. (FHWs), essentially ANMs with an induction
training of three to six months, who will be
• She shall supervise referral of all pregnant
headquartered at the Urban PHCs.
women for ANC check-ups at the UPHC.
• The ANMs will report at the UPHC and
Team Work then move to their respective areas for
• She shall help the health workers to work as outreach services (including school health)
part of the Health Team. on designated days. They will be provided
• She shall coordinate her activities with other mobility support for providing outreach
health personnel. services.
• She shall coordinate the health activities • On other days, they will conduct
in her area with the activities of workers of immunisation and ANC clinics etc. at the
other departments and agencies and attend UPHC itself.
meetings at PHC level. • Responsible for providing preventive
• She shall conduct regular staff meetings and promotive healthcare services at the
with the health workers in coordination with household level through regular visits and
the other health personnel. outreach sessions.
• She shall attend staff meetings at the Urban • Each ANM will organise a minimum of one
Primary Health Centre. routine outreach session in her area every
month. Outreach sessions shall be planned
• She shall assist the Medical Officer of the
to reach out to the vulnerable sections like
Primary Health Centre in the organisation of
slum population, rag pickers, sex workers,
the different health services in the area.
brick kiln workers, street children and
• She shall participate as a member of the rickshaw pullers.
health team in mass camps and campaigns
• Special outreach sessions (for slum and
in health programmes.
vulnerable population) – Once in a week
• She shall facilitate and participate in activities the ANMs covering slum/ vulnerable
of the UHND. populations shall organise one special
outreach session in partnership with other
Records and Reports
health professionals (doctors/ pharmacists/
• She shall scrutinise the maintenance of technicians/ nurses - government or
records by the Health Worker (Female) and private). It will include screening and follow-
guide her in their proper maintenance. up, basic lab investigations (using portable/
• She shall review reports received from the disposable kits), drug dispensing, and
Health Workers (Female), consolidate them counselling.
50 | Guidelines for Organising Urban Primary Health Centre Services | June 2017
Referral Form
Date of referral
made
Name of the
Patient
Sex
(M/F)
Identity No.
(if NA, then
address)
Referred to
(name of facility
/ specialty)
Reason for
Referral
Date Back
Annexure – V
referral received
Follow-up
required
YES / NO
Follow-up
Referral Register for UPHC
completed
YES / NO
Appropriate
referral
YES / NO
A n n e x u r e – VI
General Information
Name of ASHA Village
Name of ANM Sub Centre
PHC Date
Personal Details
Name Any Identifier (Aadhar Card, UID, Voter ID)
Age RSBY beneficiary: (Y/ N ) ________________________
Sex Telephone No.
Address