Primary and Community Health Centres do not conform to Indian Public Health Standards – results of a study from a hilly district of India, 2011

INTRODUCTION: The health planners in India have visualized PHCs and CHCs as the key health care delivery institutions in rural areas. These centres are supposed to have health manpower, infrastructure and service delivery as per the Indian Public Health Standards guidelines (2010). We evaluated PHCs and CHCs in district Shimla of Himachal Pradesh, India to see if they conform to IPHS guidelines.

METHODS: We selected all seven CHCs and random sample of PHCs. We evaluated them in terms of health manpower, infrastructure and services from September 2010 through August 2011. We collected data from the selected units using structured data collection instruments designed by IPHS for each type of these health care institutions.

RESULTS: We surveyed all seven CHCs and 12 PHCs of the district. No specialist doctor was posted at any of CHCs against a sanctioned strength of at least four (Surgeon, Physician, Obstetrician and Paediatrician) per CHC. In three (42.8%) CHCs and eight (75%) PHCs no pharmacist was posted. Eight (75%) PHCs didn’t have any staff nurse posted. Three (42.8%) CHCs and 10 (83.3%) PHCs didn’t have a laboratory technician.

In CHCs, separate labour room was available in six (85.7%) whereas a separate laboratory was available in all seven. Separate labour room and laboratory were available in four (25%) PHCs.

Immunization services were provided by all (100%) CHCs & PHCs.  Laboratory services were available only at four (57.2%) CHCs and two (16.7%) PHCs. Six (85.7%) CHCs and one (8.3%) PHC were conducting institutional deliveries.

CONCLUSIONS: IPHS guidelines are not being followed at PHC and CHC levels of the district. Health manpower shortage is the key bottleneck in service delivery. Political advocacy is needed to ensure sufficient health manpower availability to deliver quality health care.