Note on IPHS 2022
Introduction/ Background:
Milestones ·
1952- Establishment of PHCs in India ·
1978- Alma Ata Declaration – “Health for All” through the Primary
Health Care Approach ·
India signed it and committed to achieve health for all by 2000 ·
2005- National Rural Health Mission (NRHM) ·
2007- Indian Public Health Standards (IPHS) ·
2012- First Revision of IPHS ·
2013- National Urban Health Mission (NUHM) ·
2017- National Health Policy ·
2018- Ayushman Bharat Health and Wellness Centres (AB-HWCs) ·
2022- Second Revision of IPHS ·
India has committed to achieve Universal Health Coverage (UHC) by
2030- The concept covers
three key elements — access, quality, and financial protection.
There is a three tier system of
healthcare in rural areas which starts with the Sub Centre, then the Primary
Health Centre (PHCs) and the last one is the Community Health Centre. The establishment of PHCs in India started as
early as in 1952, and there have been several changes to meet the
increasing demand for health care services. Quality services like preventive,
promotive, curative, supervisory, and outreach services are to be provided by
the PHCs, and the National Rural Health Mission 2005 (NRHM 2005) aimed at
strengthening the PHCs for this.
The Indian Public Health
Standards (IPHS) was first published in 2007 under the NRHM 2005. IPHS have
been used as reference points for public health care infrastructure planning
and upgradation. The IPHS was first revised in 2012 and then in 2022.
Since the last
revision of the
IPHS in 2012,
a number of
new initiatives, interventions, programmes
and projects have
been introduced in the public
health system. The
introduction of comprehensive
primary health care
through strengthened sub-centres
and PHCs (now
known as Health
and Wellness Centres
or HWC), and similarly, in urban
areas, Urban Health and Wellness Centres, speciality UPHCs (Polyclinics), are
some of the new additions. Since then, key
policy shifts have been proposed under the National Health Policy 2017 (NHP 2017)
for public health care delivery system in the following areas:
·
Clinical care: From standalone curative
to a preventive, promotive and rehabilitative approach for achieving
comprehensive wellness in health.
·
Primary care: From selective care to
assured comprehensive care with linkages to referral hospitals.
·
Drugs,
diagnostics, and emergency
services: From user
fees and cost recovery
to assured free
drugs, diagnostic and emergency services to all in public hospitals.
·
Infrastructure and
human resource for
health development: From
a normative approach
to a targeted approach to reach underserved areas
with “time to care approach”.
·
Urban health: From token interventions to
on-scale assured interventions to organise PHC delivery and referral support
for urban poor. Also, to advocate for collaboration with other sectors to
address wider determinants of urban health.
·
National Health Programmes: Integration
with health systems for programme effectiveness and in turn contributing to
strengthening health systems for efficiency.
The above mentioned are the
important developments in the domain of “Health for All”. The NHP 2017 and
Ayushman Bharat 2018 necessitated the revision of IPHS 2012. It is essential to
incorporate them in existing IPHS.
The Indian Public Health Standard 2022 (IPHS 2022):
India has commitment to achieve Universal Health Coverage (UHC) by 2030. The
concept covers three key elements — access, quality, and financial protection.
According to NITI Aayog “UHC entails
ensuring all people have access to quality health services – including
prevention, promotion, treatment, rehabilitation, and palliation – without
incurring financial hardship. The concept covers three key elements — access,
quality, and financial protection. India is committed to achieving Universal
Health care for all by 2030, which is fundamental to achieving the other
Sustainable Development Goals.”. These are the guiding principles while
developing the IPHS 2022 document.
The IPHS 2022 guidelines have been framed for:
·
District Hospitals (DH) & Sub-District
Hospitals (SDH).
·
Community Health Centres (CHC) – rural and
urban.
·
Primary Health Centres (PHC) and Health and
Wellness Centre for rural and urban, including Multispecialty UPHC
(Polyclinics) in urban areas.
·
Sub-health Centre- Health and Wellness Centre
(SHC-HWC) for rural and urban areas.
The National Health Policy 2017
envisages the attainment of the highest possible level of health and well-being
for all. It aspires to achieve increased and more equitable access to
healthcare by improving quality and investment in public health. An important
steps towards improving quality of healthcare delivery is through the IPHS; a
set of uniform standards to provide norms and benchmarks for quality of
infrastructure, human resources services to be delivered from public health
facilities at all level.
With the launch of NUHM 2013, NHP
2017, and AB in 2018, the focus has
shifted from selective health services to comprehensive and quality Primary and
Secondary health care services to all population irrespective of their
geographical location or financial status from Health & Wellness Centre
(HWC) level to District Hospital level.
HWCs have been designated to
provide 12 packages of comprehensive Primary Health Care while Community Health
Centres (CHCs) have been designated to provide basic secondary care services
near to the community with special focus to the underserved and remote areas of
the community. District Hospitals supported by Sub-District Hospitals are the
epicentre in a district for providing assured secondary care referral care services
for those referred from HWCs and CHCs.
Revision of IPHS guidelines for
DHs, SDHs, CHCs and PHCs was required to include the widened scope of
comprehensive Primary Health Care services and strengthen the secondary
healthcare service delivery.
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2012 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. |
2022 |
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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 |
Community Health Centre in rural areas (CHC) is
to be established for a population norm of 80,000 (in hilly and tribal areas)
and 1,20,000 (in plains) and/or time to care approach. |
|
CHC is a 30-bedded hospital providing specialist care in Medicine,
Obstetrics and Gynecology, Surgery, Paediatrics, Dental and AYUSH. |
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There are 4535 CHCs functioning in the country as on March 2010 as
per Rural Health Statistics Bulletin 2010. |
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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. |
The broad objectives of the IPHS for public health facilities
includes the following: To define uniform benchmark ensuring high quality
services that are accountable, responsive, and sensitive to the needs of the
community. 1. To specify the minimum assured (Essential) and achievable
(Desirable) services that are expected to be provided at different levels of
public health facilities. 2. To provide guidance on health systems strengthening components
which includes architectural design of facilities, human resources for
health, drugs, diagnostics, equipment, administrative and logistical support
services to improve the overall health related outcomes. 3. To achieve and maintain an acceptable standard of the quality of
care at public facilities. 4. To facilitate monitoring and supervision of the
facilities. 5. To provide guidance and tools for governance, leadership and
evaluation |
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Physical Infrastructure Disaster Prevention Measures: (For all new
upcoming facilities in seismic zone 5 or other disaster prone areas).
Building structure and the internal structure should be made disaster proof
especially earthquake proof, flood proof and equipped with fire protection
measures. |
Disaster
And Emergency Preparedness: All health care facilities should be resilient to
climatic and environmental changes. They should also be capable of handling
sudden health care needs during disasters and unforeseen
emergencies/epidemics/ pandemics. |
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Emergency Room/Casualty: At the moment, the emergency cases are being
attended in OPD during OPD hours and in inpatient units afterwards. It is
recommended to have a separate earmarked emergency area to be located near the
entrance of hospital preferably having 4 rooms (one for doctor, one for minor OT, one for plaster/dressing) and one for patient observation (At least 4 beds). |
Emergency Care: Every district should have at least one district
hospital which should be comprehensively functional for providing secondary
care services as defined in the guidelines. While all secondary care services
are important, certain critical services like emergency, High Dependency Unit
(HDU)/Intensive Care Unit (ICU), Operation Theatre (OT), Labour Delivery
& Recovery complex, Special Newborn Care Unit (SNCU), lab and imaging
services, etc. need to be prioritised. While operationalising any FRU, the population norms of five lakhs
and/or time to care approach should be taken into consideration. The
principle for the ‘time to care’ approach should ensure the availability of
emergency care services and stabilisation of the patient within the ‘Golden Hour’ from the onset of the emergency within the population being
catered to. |
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