 |
HEALTH & FAMILY WELFARE DEPARTMENT HIMACHAL PRADESH
|
|
SERVICE NORMS
FOR DIFFERENT LEVELS OF HEALTH INSTITUTIONS |
|
Service /
|
Primary Health Care |
Secondary Health Care |
Tertiary Health Care |
|
|
PHC I |
PHC II
CHC I |
CHC II |
CH
(50 beds) |
CH (100 beds) DH /ZH |
Medical Colleges |
GENERAL SURGICAL SERVICES
|
|
EMERGENCY SERVICES:
TRAUMA AND LIFE
SUPPORT |
First Aid
Dressing |
Resuscitate
Stabilise
Refer |
As in CHC I |
As in CHC II
|
As in CHC +
Specialized Ortho care
|
Severe Head and spinal
injuries |
|
SHOCK
|
Refer |
Supportive treatment
Refer |
Initiate treatment
Refer |
Initiate treatment
Refer |
Investigate
Treat |
|
|
HEAD INJURIES |
First aid, refer
|
First aid, refer
|
First aid, observe,
refer |
Stabilise, manage,
refer |
Treatment |
Complicated and
referred cases |
|
FRACTURES |
First Aid, Refer |
First Aid, Refer |
Stabilise |
Stabilise
Reduce |
Stabilise
Reduce
Surgical management of
compound fractures |
Complicated and
referred cases |
|
SURGICAL PROCEDURES
MINOR: |
Removal of FB
Stitching of wounds |
Basic techniques:
Drainage of abscess;
Removal of cyst, lymph
nodes, lipoma;
Others as in PHCI
|
As in CHC I
+
Lymph node biopsy and
other biopsies
|
As in CHC II +
Debridement |
As in CH +
Split thin graft
Biopsy of the skin |
|
|
MAJOR : |
Refer |
Vasectomy, tubectomy,
circumcision |
Appendicectomy,
Herniotomy, hydrocele, large abscesses, |
Rectal prolapse,
prostectomy, haemmoroidectomy, cystotomy, Hystectomy and other
gynaecological operations. |
Cholecystectomy
Surgical management of
intestinal obstruction, pyelolithotomy, intussusceptions, volvulus |
|
|
SNAKE AND DOG BITE
CASES |
First Aid |
Manage |
Manage |
Manage |
Manage complications |
Referred cases |
|
ACUTE POISONINIG |
Refer |
Symptomatic &
Refer |
Symptomatic &
Refer |
Investigate
Manage |
Investigate
Manage and refer the
complicated cases for example patients needing ventilatory support. |
|
|
|
ANAESTHESIA
|
|
|
BASIC TECHNIQUE |
Local anasthesia |
Local Anesthesia |
Care of airway
Intubation
Equipment handling |
Care of airway
Intubation
Equipment handling |
Management of Spinal
and general anasthesia |
Management of Spinal
and general anesthesia |
|
|
BLOCK ANAESTHESIA |
|
|
Yes |
Yes |
Yes |
Yes |
|
|
SPINAL ANAESTHESIA |
|
|
Yes |
Yes |
Yes |
Yes |
|
|
GENERAL ANAESTHESIA
|
|
|
|
Yes |
Yes |
Yes |
|
|
OBSTETRICS AND GYAENOCOLOGY, INCLUDING REPRODUCTIVE HEALTH
|
|
|
HIGH RISK PREGNANCY,
INCL APH, PPH, ECLAMPSIA ETC. |
Early diagnosis and
refer |
Early diagnosis and
refer |
Early diagnosis and
refer |
Investigate and
management |
Investigate and
management |
Referred cases
|
|
|
NORMAL AND
COMPLICATED DELIVERY ** |
Antenatal care
Domiciliary normal
delivery |
Ante natal care Normal
institutional delivery, |
Ante natal care
Institutional delivery, episiotomy
Forceps |
Forceps
Vacuum extraction,
breach delivery, manual removal of placenta, |
Lower Segment Caesarean
Section |
Complicated and
referred case
|
|
|
ECTOPIC PREGNANCY /
ABNORMAL PRESENTATION |
Refer |
Refer |
Stabilize and refer |
Exploratory laparotomy |
Exploratory laparotomy
for ruptured ectopic pregnancy |
Complicated and
referred cases |
|
|
ABORTION (THREATENED
/ INCOMPLETE ) |
Refer |
MTP in first trimester |
Conservative D&C
MTP in second trimester
|
MTP in second trimester |
MTP in second trimester
|
Complicated and
referred case |
|
|
PID |
Refer |
Refer |
Diagnose and manage |
Diagnose and manage |
Diagnose and manage |
Referred cases |
|
MENSTRUAL
IRREGULARITIES |
Refer |
Refer |
Refer |
Diagnose and manage |
Diagnose and manage |
Referred cases |
|
INFERTILITY |
Refer |
Refer |
Refer |
Diagnose and manage |
Diagnose and manage |
Referred cases |
|
CERVICAL EROSION |
Refer |
Refer |
Refer |
Manage |
PAP Smear
Biopsy
Manage |
Complicated and
referred cases |
|
FAMILY PLANNING ** |
Counseling
Contraceptives
(Spacing methods)
|
Counseling
Vasectomy
Tubectomy
|
Laparoscopic tubectomy,
NSV |
Laparoscopic tubectomy,
NSV |
Laparoscopic tubectomy,
NSV |
Recanalisation
|
|
DISEASES OF CENTRAL NERVOUS SYSTEM |
|
INFECTIONS:
ENCEPHALITIS,
MENINGITIS |
Symptomatic and Refer |
Symptomatic and Refer |
Symptomatic and Refer |
Investigate and manage
|
Investigate and manage
|
CT Scan, EEG
Treatment |
|
SEIZURE DISORDERS:
(CONVULSIONS
EPILEPSY)
|
Symptomatic and Refer |
Symptomatic and Refer |
Symptomatic and Refer |
Investigate
Manage |
Investigation, LP,
Manage |
CT Scan, EEG
Treatment |
|
COMA/ LOSS OF
CONSCIOUSNESS, CVA |
Symptomatic Refer |
Symptomatic Refer |
Maintain airway
Investigate manage |
Investigate
Medical decompression
Manage |
Investigate
Surgical decompression
Manage |
CT Scan, EEG
Treatment |
|
MUSCLE AND NERVE
DISORDERS |
Symptomatic Refer |
Symptomatic Refer |
Symptomatic and Refer |
Investigate and manage
|
Investigate and manage
|
CT Scan, EEG ,EMG,NCV,
Muscle biopsy;
Treatment |
| |
|
|
|
|
|
|
|
|
DISEASES OF RESPIRATORY SYSTEM
|
|
RESPIRATORY TRACT
INFECTIONS (UPPER AND LOWER) |
Initiate management
Refer |
Initiate management
Refer |
Initiate management
Refer |
PH change
Manage severe cases
|
PH change
Severe distress |
|
|
BRONCHIAL ASTHMA |
Refer |
Symptomatic and refer |
Symptomatic and refer |
Investigate Manage
|
Investigate severe
cases
Manage |
Referred cases |
|
COPD (CHRONIC
BRONCHITIS AND EMPHYSEMA) |
Refer |
Symptomatic and refer |
Symptomatic and refer |
Investigate
Manage |
Severe cases |
|
|
TUBERCULOSIS **
|
Suspect, refer |
Microscopy
Treatment |
Microscopy
Treatment |
Microscopy
Treatment |
District TB Centre |
Resistant cases |
|
PLEF
|
Refer |
Refer |
Investigate
Treatment |
Investigate
Treatment |
Confirm diagnosis |
Treat malignant cases
|
|
LUNG CANCER |
Refer |
Refer |
Symptomatic and
supportive treatment
Refer |
Symptomatic and
supportive treatment
Refer |
Symptomatic and
supportive treatment
Refer |
Treatment |
|
OCCUPATIONAL LUNG
DISEASES |
Suspect, refer |
Suspect, refer |
Investigate and
supportive treatment |
Investigate, confirm
diagnosis, treat |
Investigate and manage |
|
CARDIO VASCULAR DISEASES
|
|
HYPERTENSION
|
Manage mild cases |
Manage moderate cases |
Investigate and Manage
moderate cases |
Investigate and Manage
moderate cases |
Investigate and manage
serious cases, ICU |
Investigate and manage
serious cases, ICU |
|
CORONARY ARTERY
DISEASE
(ANGINA, MI) |
Refer |
Initiate treatment and
refer |
Initiate treatment and
refer |
Investigate manage and
refer |
Investigate
TMT, Doppler
Treat |
Angiography
Angioplasty
By-pass surgery |
|
RHEUMATIC FEVER AND
VALVULAR DISEASES. |
Screen
Refer |
Screen
Symptomatic Refer |
Screen
Symptomatic Refer |
Screen
Symptomatic Refer |
Investigate
Confrim diagnosis,
manage |
Complicated cases |
|
PERICARDIAL DISEASES |
Refer |
Refer |
Refer |
Screen, symptomatic and
refer. |
|
|
|
DISORDERS OF CARDIAC
RHYTHM |
Refer |
Refer |
Investigate and manage |
Investigate and manage |
Investigate and manage |
Treat |
|
CONGESTIVE HEART
FAILURE
|
Refer |
Refer |
Initiate treatment
Refer |
Initiate treatment
Refer |
Investigate
Treat |
|
|
|
GASTRO
INTESTINAL DISEASES |
|
|
ACUTE DIARRHOEAL
DISEASES:
Gastro enteritis,
Cholera,
Amebiasis Diarrhoea
** |
ORT
HAF
IEC |
Management of mild,
moderate cases |
ORT
Management of severe
cases |
Management of severe
cases |
Investigate
Management of severe
cases |
|
|
|
GIT DISORDERS e.g.
Dyspepsia, Upper GI bleed, PU. |
Symptomatic management |
Symptomatic management |
Symptomatic
Supportive management |
Symptomatic
Supportive management,
Sigmoidoscopy
|
Investigate
Endoscopy
Colnoscopy
Treatment |
Complicated cases |
|
|
LIVER DISORDERS:
Hepatitis,
Cirrhosis, malignancy. |
Symptomatic Refer
|
Symptomatic refer
|
Symptomatic treatment |
Confirm diagnosis
|
Confirm diagnosis |
Complicated cases |
|
|
CANCER OF GUT |
Refer |
Refer |
Diagnosis |
Diagnosis |
Diagnosis |
Surgery
Radiotherapy |
| |
|
|
|
|
|
|
|
|
RENAL DISOREDRS |
|
RENAL AND URINARY
TRACT INFECTIONS |
Symptomatic Refer
|
Symptomatic Refer
|
Investigate
Manage
Refer |
Investigate
Manage
Refer |
Diagnose
Treat |
Dialysis
Transplant
Advanced management |
|
HAEMATURIA DUE TO
ANY CAUSE LIKE CALCULUS, MALIGNANCY, TUMOURS ETC |
Refer |
Refer |
Symptomatic treatment
Refer |
Symptomatic treatment
Refer |
Investigate
Treat |
|
|
ACUTE AND CHRONIC
RENAL FAILURE |
Refer |
Refer |
Supportive treatment
Refer |
Supportive treatment
Refer |
Investigate
Peritoneal dialysis |
Haemodialysis
|
|
BLOOD
DISORDERS (HAEMOTOLOGY) |
|
ANAEMIA **
|
Prevention of anaemia,
Manage mild cases,
nutritional csg. |
Prevention of anaemia,
Manage mild cases,
nutritional csg. |
Treat moderate
Nutr. Anaemia,
Dewormimg |
Treat moderate
Nutr. Anaemia,
Dewormimg |
Investigate
Treatment of severe
cases.
Blood Transfusion
|
Complicated cases |
|
LEUKAEMIA |
Refer |
Refer |
Symptomatic management |
Symptomatic management |
Investigate
Treatment |
Investigate
Treament |
|
BLEEDING DISORDERS |
Refer |
Refer |
Treat anaemia
Refer |
Treat anaemia
Refer |
Investigate
Treat |
Investigate]
Refer |
|
INFECTIONS |
|
TUBERCULOSIS **
|
Suspect, refer |
Microscopy
Treatment |
Microscopy
Treatment |
Microscopy
Treatment |
District TB Centre |
Resistant cases |
|
HIV / AIDS ** |
Counseling |
Counseling |
Counseling |
Manage |
Investigate
Manage |
Investigate
Manage |
|
MALARIA **
|
Passive Surveillance
Presumptive treatment |
Active and Passive
Surveillance,
RT |
Active and Passive
Surveillance,
RT |
Treatment of
complications |
Treatment of
complications |
|
|
LEPROSY **
|
Manage
Refer |
Manage
Refer |
Investigate
Manage |
Diagnose
Treatment |
Diagnose
Treatment |
Complicated and
undiagnosed cases |
|
SEXUALLY TRANSMITTED
DISEASES ** |
Syndromic Case
management |
Syndromic Case
management |
Diagnosis and
management |
Diagnosis and
management |
Diagnosis and
management |
Referred cases
|
|
PAEDIATRICS
|
|
NEO NATAL CARE
LBW BABIES
PREMATURE BABIES
|
Refer |
Refer |
Resuscitation
Maintain vitals
Refer
|
Resuscitation
Maintain vitals
Refer
|
Manage in Special Care
Nursery |
|
|
NEONATAL JAUNDICE |
Refer |
Refer |
Observe
Refer |
Investigate
Phototherapy |
Investigate
Phototherapy |
Investigate
Treat |
|
ACUTE RESPIRATORY
INFECTION ** |
Diagnose
Treat Pneumonia
Refer others |
Diagnose
Treat Severe Pneumonia
|
Treat referred cases |
Treat referred cases |
Treat referred cases |
|
|
ACUTE DIARRHOEAL
DISEASES
|
ORT
HAF
IEC |
Management of mild,
moderate cases |
ORT
Management of severe
cases |
Management of severe
cases |
Investigate
Management of severe
cases |
|
|
CONGENITAL DEFECTS
|
Refer |
Refer |
Manage and advise |
Manage and advise |
Manage in SCN and
refer |
Life threatening
defects |
EYE,EAR, NOSE AND THORAT
|
|
EYE |
Infections
Community Eye care |
Infections
Community eye care
|
As in CHC I |
As in CHC I +I
Removal of Foreign
Body |
Management of
corneal adhesions, ulcer, cataract, glaucoma |
Corneal grafting,
retinal disease, Eye bank, specialized care |
|
EAR NOSE
THROAT
(FBS, PERITONSILLAR
ABSCESS, MASTIOD ABSCESS, SOM, EPISTAXIS ) |
Removal FB
|
Removal FB
|
Removal FB
Manage Epistaxis
|
As in CHC II |
As in CH +
Laryngoscopic
removal FB, Manage Mastoid absecc, |
Micro Surgery
Complications,
Hearing Aids |
|
|
PSYCHIATRIC
AILMENTS AND MENTAL HEALTH |
|
|
PSYCHIATRIC
PROBLEMS,
DEPRESSION,
MENTAL RETARDATION
BEHAVIOURAL PROBLEMS |
Screen
Refer |
Screen
Refer |
Manage mild cases |
Manage mild – moderate
cases |
Manage severe cases
Regular psychiatric
treatment |
Complicated and
referred cases |
|
|
DRUG ADDICTION AND
ALCOHOLISM |
Screen
Refer |
Screen
Refer |
Manage mild cases |
Manage mild – moderate
cases |
Manage severe cases
Regular psychiatric
treatment |
Complicated and
referred cases |
|
ENDOCRINAL DISORDERS
|
|
|
DIABETES AND ITS
COMPLICATIONS,
THYROID DISORDERS
(HYPERTHYROIDISM,
HYPOTHYROIDISM)
ADRENAL DISORDERS. |
Screen |
Screen |
Manage uncomplicated
cases of DM |
Observe and Manage
|
Investigate
Manage
Refer |
Investigate
Advanced treatment
|
|
| |
|
|
|
|
|
|
|
|
|
|
|
|
MUSCULO SKELETAL DISORDERS
|
|
ARTHRITIS:
Osteo arthritis
Rheumatoid arthritis
Arthritis, spondylitis. |
Conservative treatment |
Conservative treatment |
Palliative therapy
|
Palliative therapy |
Investigate
Treat
Physiotherapy
|
Advanced cases |
|
|
DENTAL CARE |
Dental Hygiene |
Conservative dentistry |
Conservative dentistry |
As in CHC + Filling |
As in CH + management
of jaw fracture |
Specialized dentistry
in dental colleges |
|
Note: Health institution of
higher level shall perform all the functions of lower level.
** Treatment protocol as per guidelines of National
Programmes
NORMS OF DIAGNOSTIC SERVICES IN HIMACHAL PRADESH
|
Institutions
|
PHC I |
PHC II
CHC I |
CHC II |
CH
(50 beds) |
CH (100 beds) DH /ZH |
Medical Colleges |
|
|
LABORATORY
SERVICES
|
Nil |
ROUTINE HAEMATOLOGY
:
(Hb, TLC,DLC, ESR,
Blood Group and cross match,
BT, CT)
ROUTINE URINE AND
STOOL TESTS ( albumin, sugar,
microscopic examination,)
Semen test
Urine for pregnancy
Sputum for AFB
Malaria Parasite
VDRL
|
As in CHC I +
Blood sugar, LFT (serum
bilirubin, SGOT, SGPT, alkaline phosphatase)
RFT (blood urea, serum
creatnine)
|
As in CHC II +
Basic Biochemistry
(Sugar, Urea,
Cholestrol, Bilirubin, )
Serology
Haemogram
Cytology
(PAP Smear)
Electrolytes.
|
As in CH +
Other serology
(Coombs Test)
Other Biochemistry
(Calcium, Phosphorus,
uric acid )
Lipid profile
Culture and sensitivity
Coagulation studies
Histopathology
Cytology
Fluid studies ( ascitic
fluid, pleural fluids)
|
|
|
RADIOLOGICA L
SERVICES |
Nil |
X-ray ( Chest,
Bones, Abdomen, KUB) |
Plain X-ray Chest,
Spines
Bones, Abdomen, KUB |
Plain X-ray
Skull, sinuses
Spines,
Contrast X-rays
Barium studies
Cholecystogramme
IVP, IVC
Myelography
Ultrasonography
Linear scanning
Sector scanning |
Plain X-ray
Skull, sinuses, Spines,
Contrast X-rays
Barium studies
Cholecystogram
IVP, IVC
Myelography
Ultrasonography
Linera scanning
Sector scanning
|
CT SCAN, MRI,
Intervention radiology
|
|
BLOOD TRANSFUSION
|
Nil |
Nil |
To be provided |
To be provided |
To be provided |
To be provided |
| |
|
|
|
|
|
|
|
|
|
JUSTIFICATION OF
NORMS FOR SERVICES
In a public health system, due
attention must be accorded to the needs of clients so as to achieve
maximum client satisfaction, attain highest levels of
professional efficiency and optimum utilization of scarce
resources. Unfortunately current health scenario does not
speak well on these three accounts. By and large
clients remain unsatisfied, peripheral health facilities
remain underutilsed and there is perennial resource
constraint
Though there has been considerable
progress in the health care delivery over the years, with near
absence of referral system, there is unnecessary
duplication of services at different levels. Resulting in similar
level of care being provided in primary, secondary as well
as tertiary care situations. Thus it is common practice
notice the out patient services in the secondary and
tertiary hospitals overburdened with patients suffering from
ailments which could have been easily handles at primary
care level.
As a part of reform process in the Health Department,
various initiatives like rationalization, decentralization
functional integration etc. are being implemented. Imroving
quality of care is high priority on our reform agenda.
Fixing of norms for manpower, services, equipments,
facilities, buildings etc. is being undertaken.
Norm setting for services will result in defining service
mix at three levels of delivery , in establishing referral
system, which will enable strengthening of Secondary care
System, adequate utilization of primary health care
system and provide enhanced support and technical guidance
to primary health care system. Secondary health
care system has the responsibility to provide more rational
and greater access to specialized and tertiary level care
facilities for the disadvantaged and needy sections of the
community. This will greatly reduce the load on the
already overburdened tertiary care facilities. The type of
services under different specialities to be provided
at different levels of facility have been identified.
For smooth functioning of health institutions, and to
bring about need based qualitative imrovement,
an attempt had been made to define standards set of
services for different level of institutions
with the objective to improving access to basic health
services in the neediest sections of society.
It will result in improvement of referral mechanism from
primary to secondary and tertiary level
It will result in proper utilization of primary health care
facilities (PHCs, CHCs)