BSC – SEM 7 – UNIT 5 – COMMUNITY HEALTH NURSING – II
Delivery of community health services.
Planning, Budgeting, and Material Management of CHC, PHC, and SC/HWC
1. Introduction
The Indian healthcare system operates at three levels—Community Health Centres (CHCs), Primary Health Centres (PHCs), and Sub-Centres (SCs) or Health and Wellness Centres (HWCs). Effective planning, budgeting, and material management are crucial for their smooth functioning and delivery of quality healthcare services.
2. Planning of CHC, PHC, and SC/HWC
(A) Community Health Centre (CHC)
CHCs serve as referral units for PHCs and provide secondary-level healthcare.
Infrastructure Planning:
30-bed facility with outpatient (OPD) and inpatient (IPD) services.
Departments: General Medicine, Surgery, Pediatrics, Obstetrics & Gynecology, and other specialties.
Laboratory, X-ray, and pharmacy facilities.
Manpower Planning:
Medical Officers (Specialists: Surgeon, Physician, Pediatrician, Gynecologist).
Nurses, Pharmacists, Lab Technicians, and Support Staff.
Service Planning:
Emergency care, maternal and child health, communicable and non-communicable diseases (NCD) management.
Implementation of National Health Programs.
Referral System:
CHCs act as referral centers for PHCs and refer complicated cases to District Hospitals.
(B) Primary Health Centre (PHC)
PHCs are the first contact point between the community and the healthcare system.
Infrastructure Planning:
Typically caters to 30,000 people in plains and 20,000 in hilly/tribal areas.
Consists of OPD, minor surgical units, delivery rooms, and immunization areas.
Manpower Planning:
Medical Officer (MBBS or AYUSH), Staff Nurses, Pharmacists, Lab Technicians, ANMs, and Support Staff.
Service Planning:
Maternal and child health services.
Disease prevention and treatment.
Immunization, family planning, and health promotion.
Referral System:
PHC refers patients to CHCs for advanced care.
(C) Sub-Centre (SC) / Health & Wellness Centre (HWC)
SCs are the most peripheral units providing preventive and basic curative services.
Infrastructure Planning:
Covers 5,000 people in plains and 3,000 in hilly/tribal areas.
HWC model includes a Wellness Room, Yoga/AYUSH services, and a Community Health Worker (CHW) Corner.
Manpower Planning:
Auxiliary Nurse Midwife (ANM), Male Health Worker (MPW), ASHA Workers.
Under HWCs, a Mid-Level Health Provider (MLHP) is added.
Service Planning:
Immunization, ANC/PNC services, health education, basic treatment for minor ailments.
Screening for hypertension, diabetes, and tuberculosis (TB).
Referral to PHCs for advanced care.
3. Budgeting of CHC, PHC, and SC/HWC
(A) CHC Budgeting
Sources of Funds:
National Health Mission (NHM), State Government, Local Health Societies.
Expenditure Heads:
Salaries and Wages.
Equipment procurement.
Medicines and consumables.
Infrastructure maintenance.
Training and capacity building.
(B) PHC Budgeting
Sources of Funds:
NHM, Rural Health Funds, State Health Budgets, CSR initiatives.
Transport and communication for referral services.
4. Material Management of CHC, PHC, and SC/HWC
Efficient material management ensures uninterrupted availability of drugs, medical supplies, and equipment.
(A) Essential Components of Material Management
Procurement Planning:
Demand estimation based on disease trends and past usage.
Centralized or decentralized procurement based on facility needs.
Inventory Control:
Maintenance of stock registers and periodic audits.
FIFO (First In, First Out) and FEFO (First Expiry, First Out) for perishable items.
Storage and Distribution:
Proper storage conditions (temperature control for vaccines, cold chain management).
Regular supply chain assessment.
Waste Management:
Biomedical Waste Management following BMW Rules, 2016.
Segregation of infectious and non-infectious waste.
Safe disposal methods like incineration, deep burial, or autoclaving.
5. Summary Table: Comparison of CHC, PHC, and SC/HWC
Aspect
CHC
PHC
SC/HWC
Population Coverage
80,000–1.2 lakh
30,000 (Plains) / 20,000 (Hilly)
5,000 (Plains) / 3,000 (Hilly)
Beds
30
6
No inpatient facility
Medical Officers
Specialists (Surgeon, Pediatrician, Gynecologist)
MBBS/AYUSH
No doctors, only ANM/MLHP
Services
Secondary Care, Emergency, Surgery
Basic OPD, Minor Procedures, ANC, Immunization
Preventive & Primary Care, Health Promotion
Budget Source
NHM, State Health Societies
NHM, State Budget, Local Health Funds
NHM, Panchayat, State Govt.
Key Expenditure
Salaries, Equipment, Medicines, Infrastructure
Salaries, Drugs, Outreach Programs
ANM Salary, Community Outreach, Medicines
Manpower Planning of CHC, PHC, and SC/HWC as per IPHS Standards
(Indian Public Health Standards – IPHS, Ministry of Health & Family Welfare, Govt. of India)
1. Introduction
Manpower planning for healthcare facilities such as Community Health Centres (CHC), Primary Health Centres (PHC), and Sub-Centres (SC) / Health & Wellness Centres (HWC) is essential for ensuring the effective delivery of healthcare services. The Indian Public Health Standards (IPHS) define the recommended staffing pattern for these facilities to maintain quality care and improve health outcomes.
2. Manpower Planning for CHC (Community Health Centre)
🔹 Staffing Pattern as per IPHS:
CHC functions as a 30-bedded hospital and serves as a referral unit for PHCs. It provides secondary-level healthcare services.
Category
Staff Requirement (Per CHC)
Medical Officers
6-7
– General Surgeon
1
– Physician
1
– Obstetrician & Gynecologist
1
– Pediatrician
1
– Anesthetist
1
– Public Health Programme Manager
1
– Dental Surgeon (Optional)
1
Nursing Staff
10-12
– Staff Nurses
6
– ANMs
3
– Nurse Midwife / Mid-Level Health Provider
2
Pharmacy & Lab Staff
3-4
– Pharmacist
1
– Laboratory Technician
1
– Radiographer
1
Support & Administrative Staff
8-10
– Ophthalmic Assistant
1
– Health Assistant (Male & Female)
2
– Block Health Manager
1
– Account Assistant
1
– Data Entry Operator
1
– Ward Boy / Nursing Orderly
2
– Cleaning & Maintenance Staff
2
🔹 Services Provided at CHC:
Outpatient & inpatient services.
24×7 Emergency care & surgeries.
Maternal and child healthcare (MCH).
Management of communicable & non-communicable diseases.
Laboratory, Radiology, and Blood storage unit.
Referral and ambulance services.
3. Manpower Planning for PHC (Primary Health Centre)
PHC is the first contact between the community and healthcare providers. It provides preventive, curative, and promotive healthcare services.
🔹 Staffing Pattern as per IPHS:
Category
Staff Requirement (Per PHC)
Medical Officers
2
– MBBS Medical Officer
1
– AYUSH Medical Officer (Optional)
1
Nursing & Paramedical Staff
6-8
– Staff Nurses
3
– ANMs
1
– Pharmacist
1
– Lab Technician
1
Support & Administrative Staff
5-6
– Health Assistant (Male & Female)
2
– Accountant-cum-Data Entry Operator
1
– Ward Boy / Nursing Orderly
1
– Cleaning & Maintenance Staff
1
🔹 Services Provided at PHC:
OPD services for general ailments.
24×7 normal delivery services.
Immunization, maternal & child health (MCH) services.
Disease control programs (TB, Malaria, HIV/AIDS, etc.).
Family planning & counseling services.
Referral to CHC for specialized care.
4. Manpower Planning for SC/HWC (Sub-Centre/Health & Wellness Centre)
A Sub-Centre (SC) is the peripheral healthcare unit catering to a rural population of ~5000 in plains & ~3000 in hilly/tribal areas. It has been upgraded under the Ayushman Bharat Health & Wellness Centre (HWC) initiative.
🔹 Staffing Pattern as per IPHS:
Category
Staff Requirement (Per SC/HWC)
Healthcare Workers
3-4
– Auxiliary Nurse Midwife (ANM)
1
– Male Health Worker (MPW)
1
– Mid-Level Health Provider (MLHP) / Community Health Officer (CHO)
1
Community-Based Staff
1-2
– Accredited Social Health Activist (ASHA)
1-2
🔹 Services Provided at SC/HWC:
Maternal & child healthcare.
Antenatal and postnatal care (ANC/PNC).
Immunization and nutrition programs.
Basic treatment of minor ailments.
Screening for hypertension, diabetes, and tuberculosis (TB).
Community-based health promotion & education.
Referral to PHC for advanced care.
5. Summary Table: Manpower Planning Comparison
Facility
Population Coverage
Medical Officers
Nursing & Paramedical Staff
Support Staff
CHC (Community Health Centre)
80,000 – 1.2 Lakh
6-7
10-12
8-10
PHC (Primary Health Centre)
30,000 (Plains) / 20,000 (Hilly)
2
6-8
5-6
SC/HWC (Sub-Centre / Health & Wellness Centre)
5,000 (Plains) / 3,000 (Hilly)
None
3-4 (ANM, MPW, MLHP/CHO)
1-2 (ASHA Workers)
Rural Health Services in India: Organization, Staffing, and Material Management
1. Introduction
Rural health services in India follow a three-tier structure to provide comprehensive healthcare. These include village-level services, Sub-Centres (SC) / Health & Wellness Centres (HWC), Primary Health Centres (PHC), Community Health Centres (CHC), and hospitals at the district, state, and central levels.
The Indian Public Health Standards (IPHS) define the staffing and infrastructure requirements for these healthcare institutions. The National Health Mission (NHM) and Ayushman Bharat Health & Wellness Centres (AB-HWC) play a vital role in strengthening rural healthcare.
Support Staff (Ward Boy, Accountant, Cleaning Staff)
5
C. Material Management
Drugs & Supplies:
Antibiotics, analgesics, surgical dressings.
Diagnostic Facilities:
X-ray, ultrasound, laboratory tests.
Blood Storage Facility:
Blood bank unit.
Ambulance Services:
For emergency patient transport.
7. District, State, and Central Hospitals
A. District Hospital
100-500 beds with specialist services.
ICU, blood bank, C-section services.
B. State-Level Hospitals / Medical Colleges
Tertiary healthcare & super-specialty services.
Training and research hub.
C. Central-Level Health Institutions
AIIMS, PGIMER, NIMHANS provide advanced medical care.
D. Staffing (As per IPHS)
Hospital Level
Doctors & Specialists
Nurses & Paramedics
Support Staff
District Hospital
15-50
50-100
50+
State-Level Hospital
100-200
200-400
100+
Central-Level Hospital
500+
1000+
500+
E. Material Management
Advanced Medical Equipment:
CT scan, MRI, ventilators.
Pharmaceutical Supplies:
High-end antibiotics, cancer drugs.
Blood & Organ Bank Facilities.
Hospital Information System (HIS) for Patient Records.
Urban Health Services in India: Organization, Staffing, and Functions
1. Introduction
Urban health services in India are structured to provide preventive, promotive, curative, and rehabilitative healthcare to populations living in urban areas, including slum dwellers, daily wage laborers, and middle-to-high-income groups. The National Urban Health Mission (NUHM) under the National Health Mission (NHM) focuses on improving healthcare for the urban poor, particularly in slums.
Urban health services operate through Urban Primary Health Centres (UPHCs), Urban Community Health Centres (UCHCs), Dispensaries, Special Clinics, and Municipal & Corporate Hospitals.
2. Organization of Urban Health Services
The urban healthcare system is structured at multiple levels, ensuring healthcare delivery to diverse populations.
Level
Target Population
Healthcare Focus
Slum Health Services (UHCs, Mobile Health Units, Outreach Clinics)
Urban Poor & Slum Dwellers
Preventive & Basic Curative Care
Urban Primary Health Centre (UPHC)
50,000 People
OPD, Maternal & Child Health, Family Planning
Urban Community Health Centre (UCHC)
2.5-5 lakh People
30-50 Bedded Secondary Care
Urban Dispensaries
General Urban Population
OPD & Minor Treatments
Special Clinics (TB, HIV, MCH Clinics)
Varies
Disease-Specific Services
Municipal & Corporate Hospitals
Large Urban Areas
Tertiary & Multi-Specialty Care
3. Urban Health Services at Slum Level
A. Organization
Urban slums have poor sanitation, overcrowding, and limited access to healthcare.
Health services are provided through Urban Health Posts (UHPs), Outreach Clinics, Mobile Medical Units (MMUs), and ASHA workers.
B. Staffing
Staff
Roles & Responsibilities
ASHA Worker
Home-based care, maternal health, child immunization
ANM
Immunization, antenatal & postnatal care
Medical Officer (Visiting)
Weekly OPD services
Health Volunteers
Community outreach and health promotion
C. Functions
Maternal & child health (MCH) services.
Immunization & family planning.
Health awareness on hygiene & nutrition.
Referral to UPHC for specialized care.
4. Urban Primary Health Centre (UPHC)
A. Organization
Each UPHC covers ~50,000 people and acts as the first point of contact for urban populations.
It provides outpatient care, minor procedures, and maternal & child health (MCH) services.
B. Staffing
Category
Staff Requirement (Per UPHC)
Medical Officer (MBBS/AYUSH)
1
Staff Nurses
2
Pharmacist
1
Lab Technician
1
ANM/Health Worker
2
Public Health Manager
1
Data Entry Operator
1
Support Staff (Cleaning, Security)
2
C. Functions
General OPD services.
Management of Communicable & Non-Communicable Diseases (NCDs).
Maternal & Child Health Services (Antenatal, Postnatal, Safe Delivery, Family Planning).
Referral Services to Urban CHCs & Hospitals.
Health Promotion & Disease Prevention.
5. Urban Community Health Centre (UCHC)
A. Organization
30 to 50-bed hospitals catering to 2.5 – 5 lakh people.
Provides secondary-level care and referral services.
Specialized Services: ICU, Surgery, Dialysis, Cardiology, Cancer Treatment, etc.
B. Staffing
Category
Staff Requirement (Per 100-bed Hospital)
Doctors (Specialists & General Physicians)
20-30
Nursing Staff
50-100
Lab & Radiology Staff
10-20
Pharmacists
5-10
Support Staff (Ward Boys, Cleaners, Security, Admin)
50+
C. Functions
Inpatient & Outpatient Services.
Emergency & Trauma Care.
Advanced Surgical Procedures.
Intensive Care Units (ICU, NICU, PICU).
Multi-Specialty Treatment.
Medical Research & Training.
Defense Services & Institutional Services.
1. Introduction
Defense and institutional healthcare services play a crucial role in providing preventive, promotive, curative, and rehabilitative healthcare to personnel serving in armed forces (Army, Navy, Air Force), paramilitary forces, and their families. Community health nursing plays a significant role in these settings, ensuring comprehensive healthcare for defense personnel and institutionalized individuals (e.g., inmates, residents of mental health institutions, orphanages, elderly homes, and special care centers).
2. Defense Healthcare Services in India
The defense healthcare system in India operates under the Armed Forces Medical Services (AFMS) and follows a three-tier system:
Healthcare Level
Facility Type
Service Focus
Primary Level
Military Hospitals, Regimental Aid Posts (RAPs), Field Hospitals
OPD, minor treatments, preventive care
Secondary Level
Command & Zonal Military Hospitals
Specialist consultations, surgeries, diagnostics
Tertiary Level
Armed Forces Medical College (AFMC), Research Hospitals
Multi-specialty & super-specialty care
A. Community Health Nursing in Defense Healthcare
Immunization programs for armed forces & their families.
Occupational health services to prevent injuries.
Health education on hygiene, sanitation, and nutrition.
Mental health & stress management counseling for soldiers.
Epidemic control & communicable disease prevention in camps.
Environmental health monitoring in military camps & barracks.
3. Institutional Healthcare Services
Institutional healthcare services cater to vulnerable populations in institutions such as:
Correctional Facilities (Prisons)
Mental Health Institutions
Orphanages & Child Care Homes
Old Age Homes & Geriatric Care Centers
Rehabilitation Centers for Addicts
Facilities for Disabled Individuals
A. Organization of Institutional Healthcare Services
Institution Type
Healthcare Services Provided
Prisons / Correctional Facilities
Infectious disease control, mental health care, addiction rehabilitation
Mental Health Institutions
Psychiatric treatment, therapy, community reintegration
Orphanages & Child Care Homes
Pediatric care, vaccinations, nutrition support
Old Age Homes
Geriatric care, chronic disease management, palliative care
Rehabilitation Centers (Substance Abuse)
Detoxification, counseling, psychiatric nursing
Facilities for Disabled Persons
Physiotherapy, special education, occupational therapy
4. Staffing in Defense & Institutional Healthcare Services
A. Staffing in Defense Healthcare Services
Category
Defense Facility Staff (Per Hospital)
Medical Officers (MBBS / AFMS Officers)
5-10
Nursing Officers (Community Health Nurses)
10-20
Physiotherapists
3-5
Mental Health Counselors
2-3
Public Health Officers
1-2
Lab Technicians & Radiographers
5-8
Pharmacists
2-4
Medical Assistants & Support Staff
20-30
B. Staffing in Institutional Healthcare Services
Institution Type
Staffing Pattern
Prison Health Units
Medical Officer, Nurse, Counselor, Lab Technician
Mental Health Institutions
Psychiatrists, Psychiatric Nurses, Social Workers
Orphanages
Pediatrician, Community Nurse, Nutritionist
Old Age Homes
Geriatric Nurse, Physician, Physiotherapist
Rehabilitation Centers
Counselors, Detox Specialists, Nursing Staff
5. Role of Community Health Nurses in Defense & Institutional Services
8. Challenges in Defense & Institutional Healthcare
Challenges
Defense Services
Institutional Services
Access to Remote Areas
Field hospitals in war zones face supply challenges
Inmates in prisons lack specialist healthcare
Shortage of Manpower
Limited specialists in high-risk areas
Inadequate trained mental health professionals
Mental Health Issues
PTSD & combat stress among soldiers
High prevalence of psychiatric disorders
Emergency Preparedness
Rapid response needed for battlefield injuries
Disaster response in institutional settings
Other Systems of Medicine and Health in India
(Indian System of Medicine, AYUSH Clinics, Alternative Health Care Systems, Referral Systems, and Indigenous Health Services)
1. Introduction
India has a diverse healthcare system that includes modern allopathic medicine and traditional/alternative systems of medicine. The Indian government promotes the integration of traditional healthcare with modern medicine through the AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha, Homeopathy) system.
Apart from AYUSH, other indigenous health services, alternative healthcare systems, and community-based healing practices exist in India, especially in tribal and rural areas.
2. Indian System of Medicine (ISM)
A. AYUSH – The Indian Traditional Medicine System
AYUSH is officially recognized by the Ministry of AYUSH, Government of India, and includes the following five systems:
System
Description
Focus Areas
Ayurveda
Oldest system, based on three doshas (Vata, Pitta, Kapha)
Ayushman Bharat – Integrating AYUSH in Primary Health Care
Establishment of AYUSH Hospitals in Districts
Research & Development under Central Council for Research in AYUSH
3. Alternative Health Care Systems
Apart from AYUSH, various alternative healthcare approaches are practiced in India and globally.
Alternative System
Principles
Commonly Used For
Chiropractic Care
Spinal manipulation for nerve function
Back pain, posture correction
Acupuncture (TCM – Traditional Chinese Medicine)
Needle therapy to balance energy (Qi)
Pain relief, stress management
Reiki & Energy Healing
Hands-on energy transfer for healing
Mental well-being, relaxation
Traditional Herbal Medicine
Use of herbs and plant extracts
Immune boosting, chronic illness
Aromatherapy
Essential oils for mental and physical wellness
Stress, anxiety, pain relief
Cupping Therapy
Suction therapy for blood circulation
Detox, pain relief, muscle relaxation
Integration of Alternative Medicine in Healthcare
AYUSH & Integrative Health Clinics offer combined allopathy & alternative medicine.
Government supports research in alternative medicine through National Institutes & Research Councils.
4. Indigenous Health Services in India
A. Tribal & Rural Healing Practices
India’s tribal and rural communities have indigenous health practices that are deeply rooted in nature and culture.
Community
Healing Practices
Adivasis (Tribals)
Herbal medicine, bone setting, spiritual healing
Vaidyas & Hakims
Traditional Ayurvedic & Unani practitioners
Dais (Traditional Birth Attendants – TBAs)
Midwifery, herbal postnatal care
Faith Healers
Religious/spiritual healing for mental health
B. Role of Indigenous Practitioners
Provide first-contact healthcare in remote areas.
Herbal remedies and natural treatments for common ailments.
Collaboration with modern medicine under community health programs.
C. Government Support for Indigenous Medicine
Documentation & Preservation of Tribal Medicine.
AYUSH Research on Indigenous Herbs & Practices.
Training & Certification for Traditional Healers under NHM.
5. Referral System in AYUSH & Alternative Healthcare
A. Need for an Efficient Referral System
Since AYUSH and alternative medicine cannot handle all medical conditions, a structured referral system ensures that patients receive the right care at the right level.
B. Levels of AYUSH Referral System
Referral Level
Facility
Conditions Referred
Primary Level
AYUSH Clinics at PHCs
Minor ailments, lifestyle diseases
Secondary Level
AYUSH Hospitals & Specialty Clinics
Chronic diseases, detox therapies
Tertiary Level
AYUSH Research Institutes, Integrated Health Centers
Complicated cases needing integrative treatment
Referral to Allopathy
District/State Hospitals
Emergencies, advanced diagnostics
C. Challenges in the Referral System
Lack of coordination between AYUSH & allopathy.
Patient resistance due to preference for one system.
Shortage of AYUSH doctors in hospitals.
Need for Electronic Health Records (EHRs) for seamless referrals.
6. Role of Community Health Nurses in AYUSH & Indigenous Healthcare
Community Health Nurses (CHNs) play an important role in bridging modern medicine with traditional & alternative health services.
Community Health Nurse’s Role
Functions
Health Promotion
Educating about Ayurveda, Yoga, Homeopathy benefits
Immunization Support
Integrating AYUSH-based immunity boosters in PHCs
Referrals & Linkages
Referring chronic cases to AYUSH specialists
Maternal & Child Health (MCH)
Training TBAs in safe delivery practices
Research & Documentation
Studying effectiveness of indigenous health practices
7. Government Schemes & Policies Supporting AYUSH & Alternative Medicine