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Wednesday, December 21, 2022

Note on IPHS 2022

 

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.

 

India is a signatory to the Alma Ata Declaration of 1978 and had committed to attaining “Health for All” by 2000 through the Primary Health Care approach. It was the first international declaration underlining the importance of primary health care.  Primary Health Care seeks to extend the first level of the health system from sick care to the development of health. It seeks to protect and promote the health of defined population health problems at an early stage. The National Rural Health Mission (NRHM) was launched by the Prime Minister of India in 2005 with a goal to improve the availability and accessibility of quality health care to the people, especially for those residing in rural areas, the poor, and women.

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.

 

 

 

 

 

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

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.

 

There are 4535 CHCs functioning in the country as on March 2010 as per Rural Health Statistics Bulletin 2010.

 

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

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.

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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