How to acheive NABH Standards in PHC & CHC part 1-4

How to achieve NABH Standards in PHCs

1

Dr J L MeenaState Quality Assurance Medical Officer

Department of Health & Family Welfare

Government of GujaratMember of NABH Accreditation Committee, QCIMember of Quality Expert Group, Govt of India.

Email:- [email protected]:- https://gujhealth.gujarat.gov.in/quality-assurance-program.htm

mailto:[email protected]

https://gujhealth.gujarat.gov.in/quality-assurance-program.htm

NABH STANDARDS FOR PHC & CHC

SECTION – A: Infrastructure Standards

SECTION – B: Process Standards

SECTION – C: Governance Standards

SECTION – D: Outcome Standards

SECTION – A:Infrastructure Standards

Physical Facilities

Objective Elements

The facility shall confirm to the FAR Normsof that particular region as per the StateGovernment Rules.

For all expansion the space should beacquired as per the standards.

Land scraping should be compulsory.

The facility should be fenced to guardagainst entry of animals.

The facility shall confirm to the FAR (Floor Area Ratio)

Norms of that particular region as per the State

Government Rules.

PHC Gadboriad, Vadodara



Government Rules.



Government Rules.

PHC Sokhada, Vadodara



Government Rules.

PHC Champawadi, Tapi

For all expansion the space should be acquired as per

the standards.


For all expansion the space should be acquired as per

the standards.

Land scraping should be compulsory

PHC Khirasara, Rajkot


PHC Salun, Kheda


PHC Mahuwas, Navsari





The facility should be fenced to guard against entry of

animals.

Physical Facilities cont…

Objective Elements

Main entrance should be easily identifiable,welcoming, well lit and with mattress.

Emergency Exits should be provided.

It should confirm to the covered area rationvis-à-vis the size of plot.

Adequate circulatory space for movementof traffic including trolley and wheel chairsto be present.

Main entrance should be easily identifiable, welcoming, well lit and with mattress.

PHC Jetalpur, AhmedabadPHC Mahuwas, Navsari


PHC Salun, Kheda




PHC Salun, KhedaPHC Jetalpur, Ahmedabad



Adequate circulatory space for movement of traffic including trolley and wheel chairs to be present.

PHC Jetalpur, Ahmedabad




PHC Salun, Kheda

Physical Facilities cont……

Objective Elements cont….

Adequate ramps to be present to cater tothe requirements of immobile patients.

Accommodation (Semi-Full furnished)facilities (as per grades) for the core staff i.e.MO, Nurse, and Pharmacist to be available.

Laundry, Housekeeping, Security and Dietaryservices may be out sourced as per a MOUwith the provider on certain quality criteria.

Adequate ramps to be present to cater to the requirements of immobile patients.






Accommodation (Semi-Full furnished) facilities (as per grades) for the core staff i.e. MO, Nurse, and

Pharmacist to be available.

PHC Salun, Kheda










Laundry, Housekeeping, Security and Dietary services may be out sourced as per a MOU with the provider on certain quality criteria.


Physical Facilities cont……


There should be 24X7 availability of electricity and potable water supply with identified alternate sources.

Arrangement for fire safety shall be present.

Attendants lounge (temporary stay facility) should be provided within the campus.

Adequate drainage system should be built-in.

There should be 24X7 availability of electricity and potable water supply with identified alternate

sources.

PHC Salun, Kheda













PHC Salun, KhedaPHC Jetalpur, Ahmedabad

Mock drill and training



PHC Tankal, Kandolpada & Mahuwas, Navsari


PHC Tankal & Kandolpada Navsari


PHC Tankal, Navsari


DH Gandhinagar, Gandhinagar





PHC Salun, Kheda





Adequate drainage system should be built-in.

PHC Salun, Kheda

2. Functional PlanObjective Elements cont….

• The building should have a functional plan having ear marked space for waiting area, OPD, Labour Room, Minor OT, Major OT in CHC, Sterilization Room, Pharmacy, Dressing Room, Injection Room, X-ray Room, Dark Room, Patients Wards, Store Room (for drugs, linen and equipments), Counseling Centers, Administrative Office, Toilet (male & female) with running water facilities, Nurses Room, Cold Chain Room, Immunization, post-mortem facility with capacity of 2 bodies platform. Laboratory services should be as per IPHS guidelines. There shall be rooms for other state run programs like TB, Leprosy, Opthalmic, ICTC, Sickle Cell Anemia, ANC, FP, CNDC.

• It should adhere to the requirements as stated in relevant IPHS standards.

• CHC should have Blood storage facility.

The building should have a functional plan having ear marked space for waiting area, OPD, Labour Room, Minor OT, Major OT in CHC, Sterilization Room, Pharmacy, Dressing Room, Injection Room, X-ray Room,

Dark Room, Patients Wards, Store Room (for drugs, linen and equipments), Counseling Centers, Administrative Office, Toilet (male & female) with running water facilities, Nurses Room, Cold Chain

Room, Immunization, post-mortem facility with capacity of 2 bodies platform. Laboratory services should be as per IPHS guidelines. There shall be rooms for other state run programs like TB, Leprosy, Opthalmic,

ICTC, Sickle Cell Anemia, ANC, FP, CNDC.


The building should have a functional plan having ear marked space for waiting area, OPD, Labour Room, Minor OT, Major OT in CHC, Sterilization Room, Pharmacy, Dressing Room, Injection Room, X-ray Room,

Dark Room, Patients Wards, Store Room (for drugs, linen and equipments), Counseling Centers, Administrative Office, Toilet (male & female) with running water facilities, Nurses Room, Cold Chain

Room, Immunization, post-mortem facility with capacity of 2 bodies platform. Laboratory services should be as per IPHS guidelines. There shall be rooms for other state run programs like TB, Leprosy, Opthalmic,

ICTC, Sickle Cell Anemia, ANC, FP, CNDC.

It should adhere to the requirements as stated in relevant IPHS standards.

PHC Orna, Surat

CHC should have Blood storage facility.

Objective Elements Cont..

• Facility should have VIP room, furnished

and equipped with hydraulic cardiac bed,

pulse Oximeter, ECG and Central oxygen

line.

• There should be a dedicated room for

visiting doctors in OPD.

• OT, Labour room and dressing rooms

should have tiled (glazed) walls to height

of four feet to ensure easy cleaning.

2. Functional Plan Cont…

Facility should have VIP room, furnished and equipped with hydraulic cardiac bed, pulse Oximeter,

ECG and Central oxygen line.

PHC Salun, Kheda

There should be a dedicated room for visiting doctors in OPD.

PHC Salun, Kheda

There should be a dedicated room for visiting doctors in OPD.


OT, Labour room and dressing rooms should have tiled (glazed) walls to height of four feet to ensure

easy cleaning.

PHC Salun, Kheda

3. Equipment and Instruments


• The facility should have adequate number of equipments along with instruments as stated in IPHS.

• The equipments should be in functional order and have an up time of 98 %.

• All equipments should have insurance cover.

• There should be appropriate mechanism for repair, maintenance and AMC of all the equipments.

The facility should have adequate number of equipments along with instruments as stated in

IPHS.

PHC Salun, Kheda PHC Jetalpur, Ahmedabad

The equipments should be in functional order and have an up time of 98 %.



The facility should have adequate number of equipments along with instruments as stated in IPHS.


All equipments should have insurance cover.

All equipments should have insurance cover.

There should be appropriate mechanism for repair, maintenance and AMC of all the equipments.


PHC Salun, Kheda




• The instruments used should be adequately disinfected, sterilixed and kept in good working condition.

• Utilization of equipments should be monitored on regular basis.

• Organization should have resources for ensuring skill based training on use/handling of equipments.

• There should be simple yet effective Condemnation Policy for equipments and instruments.

3. Equipment and Instruments Cont..

The instruments used should be adequately disinfected, sterilized and kept in good working

condition.

PHC Salun, Kheda

The instruments used should be adequately disinfected, sterilized and kept in good working

condition.

PHC Salun, Kheda & Hadiyol, SK

Utilization of equipments should be monitored on regular basis.



ECG UTILIZATION IN PERCENTAGE

MonthECG Utilization in

%(in round figures)Total

January 11 10% 221

February 11 11% 231

March 11 10% 223

April 11 05% 113

May 11 07% 149

June 11 06% 121

August 11 06% 125

September 11 06% 138

October 11 08% 167

ECG Utilization

ECG Average Time = 10 mins / ECGECG machine in the hospital = 03 Per day =24 ECG/machine (if one machine is used for4 hrs) Per day = 72 ECG (Total no. of ECG thatcan be done in one day if all the 3 machineswork for 4 hrs)

Working note:-No. of ECG Machine = 03Working hrs in a day = 4 hrs which is 240 min /dayAverage time taken for 1 ECG = 10 mins.Hence total no. of ECG that can be done in:•one machine per day = 240/ 10= 24•3 machines per day = 24*3 = 72•one month = 72 * 30 = 2160Hence utilization rate for the month of January 11= 221 / 2160 * 100 = 10.23%

Organization should have resources for ensuring skill based training on use/handling of equipments.

PHC Salun, Kheda

Organization should have resources for ensuring skill based training on use/handling of equipments.

There should be simple yet effective Condemnation Policy for equipments and instruments.

There should be simple yet effective Condemnation Policy for equipments and instruments.

PHC Salun, Kheda

4. Man Power & Staffing


• The staffing norms as stated in IPHS to be maintained.

• Roster for doctor and nurses to be displayed.

• Emergency call, Roster to be available for the core staff i.e. Doctors, nurses and pharmacists.

Medical Officer

Male Supervisor Female supervisor

•MPHW•FHW•ASHA•AWW•MLW•Other field workers

AYUSH

•Pharmacist•Laboratory technician•Staff nurses•Class iv•Driver•AccountantSecurity

The staffing norms as stated in IPHS to be maintained.

Sr.

NoPersonnel Recommended Current Availability

Identified

Gaps Remarks

1 Medical Officer

2 (1 AYUSH and 1

MO2 0

2 Pharmacist 1 1 0

3 Staff Nurse 3 2 1

4 Health Worker (Female) 7 6 1

Health Worker (Male) 7 5 0

5 Health Educator 1 1 0

6Health Assistant (One male and

One female2 1 1

7 Clerks 2 1 1Contractual

8 Laboratory Technician 1 1 0

9 Driver1

1 0

10 Security 2 2

10 Class IV 4 4 0






Roster for doctor and nurses to be displayed.

PHC Salun, Kheda

Emergency call, Roster to be available for the core staff i.e. Doctors, nurses and pharmacists.

PHC Salun, Kheda

• Organization should have resources and be able to demonstrate following trainings :

1. Managerial / Administrative training to MO / Head.

2. Programme implementation training to MO / Head.

3. Induction training to staff at all levels.

4. Job based skills training.

5. Special clinical skill training on minor surgical procedure, obstetrics care, new born care, basic life support and local anesthesia block.

6. Disaster Management.

4. Man Power & Staffing Cont…

1. Managerial / Administrative training to

MO / Head.

2. Programme implementation training

to MO / Head.

State level training

3. Induction training to staff at all levels.

4. Job based skills training.

PHC Salun, Kheda

5. Special clinical skill training on minor surgical procedure, obstetrics care, new born care, basic life support and local anesthesia block.

6. Disaster Management

PHC Dabhoda-Gandhinagar & Salun-Kheda

5. Drugs


• A unified formulary based pn workload, essential drug list as specified by State Government to be maintained.

• Availability of drugs and surgical consumable to be ensured.

• Availability of drugs to be displayed along with expiry dates.

• Medical Officers to prescribe drugs based on the available formulary or essential drug list.

A unified formulary based pn workload, essential drug list as specified by State Government to be maintained.

A unified formulary based pn workload, essential drug list as specified by State Government to be maintained.

Availability of drugs and surgical consumable to be ensured.

PHC Salun, Kheda

Availability of drugs to be displayed along with expiry dates.

PHC Salun, Kheda

Medical Officers to prescribe drugs based on the available formulary or essential drug list.

Medical Officers to prescribe drugs based on the available formulary or essential drug list.

PHC Salun, Kheda

• Medicines dispensed should have clear instruction on dose and schedule for consumption purposes.

• Consumption report of the drugs to be submitted to the district authorities of the particular district.

• Minimum balance and re-order level to be maintained.

5. Drugs Cont…

Medicines dispensed should have clear instruction on dose and schedule for consumption purposes.

PHC Salun, Kheda

Consumption report of the drugs to be submitted to the district authorities of the particular district.

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1 3 4 5 6 7 8 9 10

DAY 1 0 0 0 0 0 0 0 0

DAY 2 0 0 0 0 0 0 0 0

DAY 3 56 0 0 0 16 36 6 0

DAY 4 102 0 0 0 24 32 2 0

DAY 5 68 0 0 0 4 58 0 10

DAY 6 134 0 0 0 6 68 4 0

DAY 7 0 0 0 0 0 0 0 0

WEEK -1 360 0 0 0 50 194 12 10

Minimum balance and re-order level to be maintained. “Medicine with balance sheet”


• Lead time of sourcing the drugs and consumable to be maximum of 1 week.

• Drugs shall be stored in well lit and well ventilated rooms.

• Certain drugs to be kept in the refrigerator.

• The Temperature of the refrigerator to be maintained at 2 to 6 degree centigrade.

5. Drugs Cont…

Lead time of sourcing the drugs and consumable to be maximum of 1 week.


Drugs shall be stored in well lit and well ventilated rooms.




PHC Salun, Kheda

Certain drugs to be kept in the refrigerator.

PHC Salun, Kheda

The Temperature of the refrigerator to be maintained at 2 to 6 degree centigrade.

PHC Dabhoda, Gandhinagar

The Temperature of the refrigerator to be maintained at 2 to 6 degree centigrade.

Objective Elements• There should be at least one ambulance.• Local network of ambulances should be

outsourced and linked to PHC / CHC block.• Driver for the same to be available all the

times.• Ambulance should be in working condition all

the time.

6. Transport and Ambulances

There should be at least one ambulance.


There should be at least one ambulance.


Local network of ambulances should be outsourced and linked to PHC / CHC block.

PHC Salun, Kheda PHC Jetalpur, Ahmedabad

Driver for the same to be available all the times.

PHC Salun, Kheda

Ambulance should be in working condition all the time.

PHC Jetalpur, AhmedabadPHC Champawadi, Tapi

• Emergency drugs to be available in theambulance.

• Basic resuscitation kit to be available in theambulance.

• The Stretcher trolleys and wheel chairs in theambulance to be in working condition all thetimes.

6. Transport and Ambulances Cont…

Emergency drugs to be available in the ambulance.

PHC Salun, Kheda

Basic resuscitation kit to be available in the ambulance.

PHC Salun, Kheda

The Stretcher trolleys and wheel chairs in the ambulance to be in working condition all the times.

The Stretcher trolleys and wheel chairs in the ambulance to be in working condition all the

times.

PHC Salun, Kheda

The Stretcher trolleys and wheel chairs in the ambulance to be in working condition all the

times.


7. Communication Facilities

Objective Elements• The center should have adequate

stationeries for written communication.• At least 2 telephone (24X7) connections to

be available in the facility.• An internet connection to be available.• Arrangements for a public address system to

be available.

The center should have adequate stationeries for written communication.


At least 2 telephone (24X7) connections to be available in the facility.

PHC Salun, Kheda

An internet connection to be available.

PHC Salun, Kheda

An internet connection to be available.


Arrangements for a public address system to be available.

PHC Salun, Kheda

• Organization should use Signboards, Posters or / and wall painting displayed the activities and services (along with timings) at the facility and the important contact numbers at prominent sites in the campus as well as in all villages. These should be in local language.

• Campaigns for National Health Programs should be displayed in the form of wall painting or boards.

• Lay out map of the facility and signage shall be in vernacular and symbols to address the needs of vulnerable patients.

7. Communication Facilities Cont…

Organization should use Signboards, Posters or / and wall painting displayed the activities and services (along with

timings) at the facility and the important contact numbers at prominent sites in the campus as well as in

all villages. These should be in local language.


Organization should use Signboards, Posters or / and wall painting displayed the activities and services (along with timings) at the facility and the important

contact numbers at prominent sites in the campus as well as in all villages. These should be in local language.

PHC Salun, Kheda

Organization should use Signboards, Posters or / and wall painting displayed the activities and services (along with timings) at the facility and the important contact numbers at prominent sites in the campus

as well as in all villages. These should be in local language.





PHC Salun, Kheda

Campaigns for National Health Programs should be displayed in the form of wall painting or boards.

Campaigns for National Health Programs should be displayed in the form of wall painting or boards.

PHC Salun, Kheda

Lay out map of the facility and signage shall be in vernacular and symbols to address the needs of

vulnerable patients.






PHC Salun, Kheda



PHC Orna, Surat

Lay out map of the facility and signage shall be in vernacular and symbols to address the needs of vulnerable patients.

PHC Salun, Kheda



Health for All

How to acheive NABH Standards in PHC & CHC part 1-4

Healthcare