COMMUNITY HEALTH CENTRE

Introduction: - The community Health Centre are established & maintained by state govt, by upgrading the
primary health centre, each community health centre covering a population of 80,000 to 1.20 lakh with 30 beds
and specialist in surgery, medicine, obstetric, and gynaecology & paediatrics with x-ray & laboratory facilities. As
on 31st March 2017, 5624 community health centres were established.

Learning Objectives: -

 To know about the Health Care delivery system & health information system of the country & state &
district & its functioning.
 To elaborate all National programme relevant to the community family & individual.
 Enumerate the functions of components of community Health Centre.
 Outline the demographic pattern of community & appreciate the role of individual family, community &
socio-cultural in health & diseases.
 To understand the principles of health economics, health administration, health education &
communication in relation to the community.

Functions of CHC: -

In order to provide quality care in CHCs Indian Public Health Standards (IPHS) are providing following services
which have been indicated as essential & desirable:

1) Care of routine & emergency care in surgery:-

 Include dressing, incision and surgery for hernia, hydrocele, appendicitis & sticking injuries.
 Handling of emergency like Intestinal obstruction haemorrhage, etc.
 Factors reduction & putting splints/plaster, etc conduct daily OPD.
2) Maternal Health: -
 Minimum 4 checkups including registration & associated services.
 24 hr delivery services including normal & assisted deliveries
 Managing labour using partograph
 All referred cares of complication in pregnancy labour & post-natal period must be adequately
tested.
 Ensure post-natal care for 2-3 day at the facility both for mother & new born & sending
directions to the ANM of concerned area for ensuring 7 th & 42th day post-natal home visit.
 Minimum 48 hr of stay after delivery 3-7 day stay post delivery for managing complication.
 Provision for JSY (Janani Suraksha Yojna) & JSSY (Janani Shishu Suraksha Yojna)
3) Care of Routine & Emergency cases in medicine: -
 Specific mention is being made of handling of all emergencies like dengue, haemorrhage, fever,
malaria & other like snake bite cases, poisoning, CHF, LVF, pneumonia, acute respiratory
infection, burns, acute dehydration etc.
 Conducting daily OPD.
4) New born care & Child health: -
 Essential new born care providing new born corner in the labour room & operation theatre.
 Early initiation of breast feeding within 1 hr of birth & promotion of exclusive breast feeding for
6 months.
 New born stabilisation unit
 Routine & emergency care of sick children including facility based strategy.
 Full immunization of infant & children.
5) Family Planning: -
 Full range of family planning services in IEC counselling, provision of contraceptive, non-scalpel
vasectomy, laparoscopic sterilization services
 Safe abortion services as per MTP act & abortion care guidelines
6) All the National Health Programs: -
 RNTCP
 National vector borne disease control programme
 HIV / AIDS control programme
 National leprosy eradication programme
 National blindness control programme
 NPPCD
 NMHP
 NPCDCS
 National Iodine deficiency programme
 National tobacco control programme
 National program for elderly health care
 Physical Medicine & Rehabilitation: -
 Primary preventive & disability
 Screening & early identification
 Counselling
 Community based rehabilitation services
7) Oral Health: -
 Dental Health & dental health education services as well as root canal treatment &
filling/extraction of routine & emergency cases
 Oral health education in collaboration with other activities.
8) School Health Services: -
 Screening Health Care & referral
 Immunization
 Micronutrient management
 Capacity building
 Monitoring & Evaluation
 Mid-day meal
9) Adolescent Health Care: -
 Adolescent & reproductive health information, counselling & services related to sexual concern,
pregnancy, contraception, abortion, menstrual problem etc.
 Services for tetanus immunization of adolescent nutritional counselling, prevention &
management of nutritional anaemia.
 Sexually transmitted infections management

10) Diagnostic Services: -

 In addition to the lab facilities & x-ray, ECG should be made available in CHC with appropriate
training to a nursing staff as lab technician or ECG technician.
 All necessary facilities for collecting & transport of samples should be made available.

Objectives of CHC (Acc. to IPHS)

 To provide optimal expert care to the community.

 To achieve and maintain an acceptable standard of quality and care.
 To ensure that services @CHC are with universal based practices and are responsive and sensitive to the
client needs/expectation.

Key Components of Community Health Centre: -

 Community Health Centre is a model of primary health care that can take a variety of names depending
on the region of world in which it is located.
 Community Health Centre deliver comprehensive primary health care through an inter-professional that
indicates primary care services, psychological care services, health promotion programmes &
population / community health programmes.
 Community Health Centre integrates into their daily activity, attention to the broader course of illness,
life poverty, inadequate housing, food insecurity and other intersectoral services of cooperation.
 Community Health Centre place a strong emphasis community engagement of civic participation in
health & health care which often includes the participation of local community members in the
governance of local health centres.
 Community Health Centre takes responsibility for a defined population that can be geographically
determined or defined through empanelment of citizens in a CHC.
 Community Health Centre contribute to universal Health Services coverage & are strongly committed to
being accessible for individual & family, social status & other factor including the ability to pay for care.

HEALTH ORGANISATION STRUCTURE AT BLOCK LEVEL

Directorate of
Health Services
(DHS)
(7 Additional DHS & Deputy DHS, 3 Assistant Directors, Program Officers & other officers in the headquarters)

District Medical
Officers (DMO)
(3 Deputy DMO, RCH Officer, Junior Administrative MO & Administrative Assistant & other officers in District
Headquarters)

TB Women General District Dist. TB Mental Leprosy

Hospital & Children Hospital Hospital Centre Health Hospital
(TB) Hospital (GH) (DH) (DTBC) Centre (LEP)
(W & CH) (MHC)

Taluk Hospital Taluk Headquarters

(TH) Hospital (THQH)

Community
Health Centre
(CHC)

24 x 7 Primary Primary Family Health

Health Centre Health Centre Centre
(24 x 7 PHC) (PHC) (FHC)

SubCentre

IPHS STAFF PATTERN OF CHC: -

In order to provide round the clock clinical service in community health centre, IPHS staffing pattern are follows:

POPULATION UNDER CHC

CHC It is established to cover about 80,000 population in hilly / tribal difficult area & 1,20,000 population in
plain area.

Population of Dhamdha: - 204,491 (Acc. To 2011 census of India)

Female population: - 102,130

Male population: - 102,361

Urban – 84.13 km 2

Area: 888km2

Rural – 804.21 km2

Total No. of Village in Tehsil Dhamdha – 162

Total No. of PHC under CHC Dhamdha – 5

REPORT OF COMMUNITY HEALTH CENTRE, DHAMDHA

On 7/1/2023, we the MSc (N) previous year students along with 4 th year BSc (N) student posted in CHC Dhamdha
@ 11 AM.

As we enter the main gate of CHC, on our right side government approved Dhamtari medical shop is present with
the facilities of latest medicines with mentioned expiry date, along with a good spacious parking area in left side.

While entering the hospital, various OPD with different allotted numbers are available in CHC Dhamdha as
mentioned below:

Room no. 1 OPD registration window in front. Inside the door.

Room no. 2 Pharmacy with all govt supply with mentioned expiry date on it in the right side of pharmacy, a good
spacious with proper facility of light & ventilation & toilet for both male & female & the desk centre is available
in the waiting hall “May I Help You” with a good service provided by mitanin.

Room no. 3 Labour Room

Room no. 4 Gynaec OPD conducted by Dr. Rachna Agarwal with USG day on Thursday.

Room no. 5 OPD conducted by Dr. Praful Dhirwar

Room no. 6 Dental OPD

Room no. 7 Medicine OPD

Room no. 8 Neonatal unit: - The unit has 1 radiant warmer, 2 phototherapy unit, electronic weight machine, 1
electric O2 cylinder, BMW waste management, 1 neutralizer, 1 IV stand, proper lightning & ventilation present.

Room no. 9 Labour room ward with 1 toilet, 2 observation table. Nurse firstly assess the pregnant lady then
decide to take her in labour room or observation room.

Room no. 10 Labour room contain 3 labour table 1 warmer 1 wt machine for neonatal, 1 wt machine for mother,
4 cylinder of O2, BMW management, 1 wash trolley.

Room no. 11 Labour ward with full facility of lightning & ventilation.

Room no. 12 USG Room

Room no. 13 Nursing Station (Matron Room)

Room no. 14 Ophthalmology room which is full facilitated by chart & ophthalmic machine for eye check

Room no. 15 Ortho OPD (Dr. Vipin Jain)

Pedia OPD (Dr. Deepak Panigrahi)

Room no. 16 ICTC Room (Integrated Counselling & Testing Centre) where counselling to HIV patients are given &
for record a register is maintained.

Room no. 17 X-ray room with latest facility of mobile x-ray machine.

Room no. 18 Specimen collection room

Room no. 19 Lab for investigation / sample withdraw

Room no. 20 Vaccination room with all vaccines are available with maintaining cold chain. But mainly the storage
of CHC dhamdha vaccines is done in old CHC.

Room no. 21 Dressing room with proper BMW management

Room no. 22 Casualty, IV stand, bed & BMW management is there.

Room no. 24 LSCS post operative room with bed capacity: 17 bed, 6 IV Stand, 10 bed side locker & 2 cooler

Room no. 25 Post operative room & along with postnatal room both patient are kept here.

Room no. 26 BMO office (Dr. Mr. Dhanwantri Prasad thakur is branch medical officer of dhamdha)

Room no. 27 Nursing station for OT nurses when they do documentation

Room no. 28 Operation theatre, Caesarean operation, Complete tubectomy all conducting there.

Room no. 29 Pre operation room (well arranged room with proper beds IV stand)

ACTIVITY DONE IN CHC DHAMDHA: -

In CHC Dhamdha we visit old CHC where all the office works as well as immunization room is there in old CHC
where the cold chain of the vaccine are maintain. In old CHC Mrs. Rukmani Netam old LHV staff gave us detail
information regarding cold vaccine & immunization schedule. Different types of refrigerator used for maintaining
cold chain of vaccine it includes maintaining cold chain in vaccine carrier.

1. COLD CHAIN:-

Introduction: A system of storing and transporting the vaccine at low temperature from the place of
manufacturer to the actual vaccination site is called cold chain.

Importance of cold chain:-

• Obtaining the vaccine from the manufacturer storing & transporting vaccines.

• Maintaining the supply of vaccine.

• Having information about essential equipment supply of electricity etc.

• Keeping the vaccine at low temp.

• Protecting the vaccine from sunlight exposure.

• Maintaining the potency of vaccines.

Components of cold chain:-

• Apparatus / Equipment

• Supplies

• Manual Efforts
• Transportation

• Communication

COLD BOXES:

• This can transport large quantities of vaccines by vehicle to outreach sites.

• Size of box – 5ltr to 20ltr.

• It can preserve vaccine for up to 1 week without any power supply.

ICE PACKS:

• Flat bottles of plastic which are filled with water. No salt should be added in water.

• These are used in the vaccine carrier after freezing with water.

• Before using it we have to conditioner the ice pack.

Types of Equipment’s:-

• Vaccine carriers

• Cold packs

• Day carriers

• Refrigerators

• Walk in cooler

• Others

VACCINE CARRIERS:-

• They are suitable to carry small quantities of vaccine to health sub-centre, village & small towns ie. 10-20
vials at a time.

• A square box made up of heat resistance material & light in weight.

• Four packs of ice are kept in these on all four sides.

• Vaccine can be kept up to 2 – 3 days.

REFIGRATORS:

Refrigerator used for storage of vaccine in centre are of 3 types:-

1) WICR (Walk In Cold Room) / WIFR (Walk In Freezer Room)

2) Deep freezer

3) ILR (Ice Lined Refrigerator)

1. WICR / WIFR:
• Used at regional level for storage of vaccine up to 3 months, maintained temp +2oC - +8oC

• WICR / WIFR are refrigerated enclosure accessible via at least one door & large enough for a person to
walk into housed within existing buildings.

• Important storage point in the temperature-controlled supply chain & usually used at the central or
national level.

Types of WICR / WIFR – Plug in Model, Split Unit Model

2. DEEP FREEZER’S:

The cabinet temperature is maintained between -15oC to -25oC which is used for storing of OPV & also for
freezing ice packs.

• It can maintain the cabinet temperature in the range of -15oC to -25oC & 18-26 hrs at ambient temp of
42oC & 32oC respectively, if not opened.

• The deep freezer have vaccine storage capacity & ice pack freezing capacity.

• These are available in different size (large & small) capacity 300ltr.

• The deep freezer is provided with special installation which helps in maintaining inside temperature in
the range of -21oC to -15oC

3. ICE-LINED REFRIGERATORS:

These types of refrigerators are top opening because they can hold air inside better than a refrigerator with a
front opening.

It can keep vaccines safe as little as 8hrs continuous electricity supply in a 24hr period.

Inside the ILR there is a lining of water containers (ice packs or tubes) when the refrigerators is functioning the
water in the container freezes & if the electricity supply fails then the ice lining maintains the inside temperature
of the refrigerator at a safe level for vaccines.

Therefore the temperature is maintained in ILR for much longer duration than in deep freezer & ILRs can keep
vaccines safe. Capacity 300/240 ltrs.

The ILR got 2 sections: The top, The bottom

The bottom of the refrigerator is the coldest place & OPV can be kept at bottom of the basket.

• The DPT, DT, TT & BCG vaccine should never be kept directly on the floor of the refrigerator as they can
freeze & get damaged.

• The top section of the ILR is known as Section B & it maintains the temperature of +2oC to +8oC. All the
vaccines should be kept in the basket provided with the refrigerator.

• BCG, DPT, DT & TT vaccines all kept in the upper part of the baskets.

• In case basket is not available keep two layers of empty ice pack laid flat on the floor, do not keep the
vaccines on the floor of the ILR.
VACCINE STABILITY:

Vaccine stability according to the sensitivity to heat: (from most to least sensitive)

• BCG

• Varicella Laster

• MR

• Hepatitis B

• DT (Diphtheria , Tuberculosis)

Temperature must be recorded twice in a day with dial thermometer (alcohol0stem-thermometer)

VACCINE STORAGE:

DON’T’S

• No food or medical specimen

• Do not place fridge in direct sunlight or near heat source.

• Do not store vaccine for more than 1 month @PHC & 3 month @CHC

• Keep away vaccine from fridge wall & cold air vents.

DO’S

• Use a dedicated vaccine fridge

• Safeguard electricity supply

• Not more than 50% full

• Place vaccine in clearly labelled plastic mesh baskets.

• Defrost/calibrate fridge regularly

• Ensure back up facilities are available in the event of fridge failing.

VVM (VACCINE VIAL MONITOR):

VVM is a label containing heat sensitive material that is placed on a vaccine vial to register heat exposure
overtime.

To check the heat damage before opening a vial.

A vaccine vial is inspect by volunteer which containing a heat sensitive material as label to register cumulative
heat exposure over time.

The combined effect of time & temperature cause the inner square of the VVM to darken.

STAGES OF VVM:

Stage 1: Inner square lighter than outer circle.

Stage 2: Inner square filled slit lighter than outer circle.

Stage 3: Colour of inner square matches the outer circle.

Stage 4: Colour of inner square darkened than outer circle.

CONCLUSION: -

India has over the year, built a large number of community health centre which cover a desirable population with
all facilities and the latest govt of India schemes. In our report we cover the complete or envisaged the
community health centre in Dhamdha in which CHC, its functions, its objectives, key compnents, mapping
pattern, structural organisation of CHC according to IPHS, orientation report with all the activities profound in
CHC Dhamdha with complete detail of Immunization and cold chain details & comparison between the staffing
pattern of IPHS & CHC Dhamdha.