GOVERNMENT OF ANDHRA PRADESH

ABSTRACT

Commissionerate of Health and Family Welfare – Conversion of Dispensaries, Civil

Hospitals, Subsidiary Health Centres and MMUs as Primary Health Centres (PHCs) /
Community Health Centres (CHCs) and Establishment of Community Health and
Nutrition Clusters (CHNCs) – Orders - Issued.
HEALTH, MEDICAL AND FAMILY WELFARE (F.I) DEPARTMENT

G.O.Ms.No. 92 Dated: 23-04-2010.

1. From the DH, Lr. No. Rc/ Spl./AD (Plg.)/2008, dt.21.07.2008.

2. From the DH, Lr. No. Rc/ Spl./AD (Plg.)/2008, dt.21.11.2008.
3. G.O.Ms.No.355 HM&FW (C1) Dept., dt. 12.9.2001
4. G.O.Ms No. 637 HM&FW (G1) Dept., dt. 3.11.2003
5. G.O.Ms No. 448 of HM&FW (F1) Dept., dt. 30.12.2008
***
ORDER:

The Director of the Department of Health, Government of Andhra Pradesh, in

the reference first cited, has submitted comprehensive proposals for conversion of
Government Dispensaries (GDs), Government Civil Hospitals (GCHs), Subsidiary
Health Centres (SHCs) and Mobile Medical Units (MMU) existing in the rural areas
as Primary Health Centres (PHCs) / Community Health Centres (CHCs), as the case
may be, based on the infrastructure and the human resources available at these
health facilities.

2. The Director has submitted that Primary Health Centre’ (PHC) is the
cornerstone of rural health services that provides comprehensive preventive,
promotive and curative health care to twenty to fifty thousand rural population.
Therefore, the rural areas of Andhra Pradesh should have about 1,892 PHCs across
the state in order to deliver effective primary health services. However, currently only
1,571 PHCs are functioning throughout the state, which indicates a substantial
shortfall in access to rural citizens, especially those living in remote and interior
areas of the state.

3. Further, the Director of Health has informed that one hundred seventeen (117)
GDs, thirty-four (34) GCHs, twenty-six (26) SHCs and twenty-five (25) MMUs are
currently functioning in different parts of the state. These institutions, which might
have had some historical significance, are anachronistic in the contemporary primary
health architecture. By virtue of their limited mandate and constricted resource base,
these institutions have not been able to contribute effectively to the goal of securing
universal access to primary health services for all rural citizens of the state.
Moreover, the existence of these institutions has prevented effective rationalisation
of the primary health care institutions and their service area and stymied efforts to
strengthen the PHC / CHC system by competing for resources.

(P.T.O.)
 :: 2 ::

4. In this context, the Government has decided to strengthen the primary health
system through a series of measures, which include amongst several others:
rationalising the nomenclature, functions, responsibilities and service area of all
health institutions in the state. Accordingly, the Government after careful examination
of the proposal of the Director of Health - with inputs from the Strategic Planning and
Innovation Unit (SPIU) of the Department and the Commissioner of Family Welfare -
has decided that the entire rural area of the state should be organised into a series of
Community Health and Nutrition Clusters (CHNCs), with each cluster providing
comprehensive primary health care services to about one to two lakh rural
population. Each CHNC will comprise of a Community Health Centre (CHC) and a
cluster of five to ten PHCs along with their Sub-Centres, depending on the
population, distance, remoteness, disease burden, etc.

5. The Community Health Centre (CHC) will be the nucleus of the CHN Cluster
that would provide the dynamic interface between the primary and secondary health
system. Each CHC, as the First Referral Unit (FRU), shall be fortified with
Comprehensive Emergency Obstetric and Neonatal Care (CEMONC Centre) facility.
Each CHC shall monitor, guide and support a cluster of five to ten PHCs. Each PHC
in turn will support, guide, monitor and facilitate the functions of about five to fifteen
Sub-Centres (SCs), based on population, distance, access, remoteness, disease
burden etc.

6. To augment the primary health system, the Government hereby orders for
conversion of the existing two hundred and three (203) Health institutions (viz. Govt.
dispensaries, Civil Hospitals, Mobile Medical Units etc.) in the rural and remote areas
of the state into PHCs / CHCs, as the case may be, based on the existing human
resources, location, infrastructure, etc. The details of these Health institutions are
shown in the Annexure-I appended to this order.

7. Further, the Government orders that the directions issued in the reference 3rd
cited, wherein certain PHCs / CHCs were ordered to be transferred from the
Directorate of Health to AP Vaidya Vidhana Parishad (APVVP) and vice versa, shall
be considered while demarcating the Community Health and Nutrition Clusters and
the service area of each CHC, PHC and the Sub-centre.

8. It is hereby ordered that all subsidiary PHCs, Mandal PHCs, Block PHCs,
Upgraded PHCs, 24/7 PHCs, Modified PHCs, Stationery PHCs, and such other
assorted health institutions shall be converted either as a PHC or as a CHC based
on the infrastructure, human resources, need, location, etc. It is ordered that effective
the date of issuance of this order, there shall be only CHCs, PHCs, and Sub-Centres
in the primary health system (Directorate of Public Health and Family Welfare) and
Area and District Hospitals in the secondary health care system (AP Vaidya Vidhana
Parishad). Accordingly, the nomenclature as well as the functions of all health
institutions in the rural areas of the state shall be rationalised forthwith.

(Contd..3)
 :: 3 ::

9. Considering the addition of two hundred and three health institutions to the
primary health system, the service area of all Sub-centres, PHCs and CHCs are
ordered to be rationalised duly considering the ease of access to the citizens as the
central principle for such rationalisation. It is ordered that the service of health
institutions shall be rationalised to ensure that each Sub-centre serves about two to
five thousand population and a PHC provides preventive, promotive and curative
health services to about twenty to fifty thousand population and a CHNC provides
primary health care to about one to two lakh rural population. While undertaking the
rationalisation exercise, the guidelines of the Government issued in Memo No.
12231/F1/2008 dated 23 April 2010 shall be followed scrupulously.

10. The Commissioner of Health and Family Welfare, Director of Public Health
and Family Welfare, the Commissioner of AP Vaidya Vidhana Parishad and the
District Collectors shall take necessary action accordingly.

11. This order is issued with the concurrence of Finance (Exp. M&H.II/2010) U.O
No.2260/33/A2 Dated 22.2.2010.

(BY ORDER AND IN THE NAME OF THE GOVERNOR OF ANDHRA PRADESH)

DR. P. VENKAT RAMESH

SECRETARY TO THE GOVERNMENT

To
The Commissioner of Health and Family Welfare.
The Director of Public Health and Family Welfare.
The Commissioner of AP Vaidya Vidhana Parishad.
All District Collectors and District Magistrates.
All District Medical and Health Officers.
All District Coordinators of Health Services of APVVP.
All Superintendents of Area and District Hospitals.
Copy to:
1. The Secretary to Government of India, Ministry of Health and Family Welfare,
Nirman Bhavan, New Delhi.
2. The Secretary to Government of India, Department of Medical Research, Ministry
of Health and Family Welfare, Nirman Bhavan, New Delhi.
3. The Director-General of Health Services, Ministry of Health and Family Welfare,
Government of India, Nirman Bhavan, New Delhi.
4. The Mission Director, NRHM, Nirman Bhavan, New Delhi.
5. The Director, NIHFW, New Delhi.
6. The Principal Secretaries / Special Secretaries to the Chief Minister.
7. Director of Medical Education / Director of IPM / Commissioner of AYUSH /
Director General of Drug Control Administration / Managing Director of
APHMHIDC / Project Director of APSACS / Director of Indian Institute of Health &
Family Welfare / Vice-Chancellor of NTR University of Health Sciences.

(P.T.O.)
 :: 4 ::

8. The OSD to Hon’ble Minster ( ME), AP Secretariat, Hyderabad.

9. The OSD to Hon’ble Minster ( H&FW), AP Secretariat, Hyderabad.
10. The OSD to Hon’ble Minster (Aarogyasri, 108,104 & APHMHIDC),
AP Secretariat, Hyderabad.
11. All Regional Directors of Health.
12. All Nodal Officers (Health Reform) of the Department of Health and Family
Welfare.
13. All the DM&HOs / District Coordinator of Health Services (DCHS).
14. All Superintendents of Teaching / District / Area Hospitals.
15. Principals of Medical College of the state.
16. The Director of Treasury and Accounts, AP Hyderabad.
17. The PS to the Principal Secretary to Government, Medical and Health
Department.
18. Finance (Expr .M &HII) and (SMPC) Depts.
19. All Officers / Sections in HM&FW Dept.
20. SPIU of HM &FW Department.
21. Representative, Family Health International Hyderabad.
22. Director, Indian Institute of Public Health, Hyderabad.

//FORWARDED:: BY ORDER//

SECTION OFFICER
 GOVERNMENT OF ANDHRA PRADESH
HEALTH, MEDICAL AND FAMILY WELFARE (F1) DEPARTMENT

Memo No. 12231/F1/2008 Dated: 23-04-2010

Subject:- Revitalisation of Primary Health System in Andhra Pradesh –

Rationalisation of Health Facilities, Constitution of
Community Health and Nutrition Clusters (CHNCs) and
Delineation of Service Area of Community Health Centres
(CHCs), Primary Health Centres (PHCs) and Sub-Centres
(SCs) – Guidelines - Issued.

Reference:- G.O.Ms No 92 of Medical, Health & Family Welfare

Department, dated 23.04.2010

1. In the reference cited, the Government have ordered for conversion of two-
hundred and three (203) Government Dispensaries (GDs), Government Civil
Hospitals (GCHs), Subsidiary Health Centres (SHCs) and Mobile Medical Units
(MMU) in the rural areas of the state as Primary Health Centres (PHCs) /
Community Health Centres (CHCs). Further, the Government have directed that the
primary health services in the rural areas of the state be strengthened through
Community Health and Nutrition Clusters (CHNCs), each comprising of a referral
centre (a Community Health Centre (CHC) or a Area Hospital) and a cluster of
Primary Health Centres (PHCs) and the attached Sub-Centres. Further, government
have ordered that the service area of all primary health institutions (CHCs, PHCs
and SCs) and the functionaries be rationally organised to ensure equitable access to
quality health care for all citizens of the state. In this direction, the government is
issuing the following guidelines for rationalising the service area of the health
institutions and the functionaries.

2. The Objective. The Government of Andhra Pradesh has been making

sustained efforts to provide quality health care to its citizens, with special attention to
those living in remote and interior locations and those belonging to the
disadvantaged strata of the society. In this direction, the Government has been
implementing the National Rural Health Mission (NRHM), along with several other
schemes, programmes and activities with the aim of achieving the Millennium
Development Goals (MDGs) by making the health delivery system effective and
responsive to the needs of the people.

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3. The Government ‘s endeavour is to strengthen the capacity of the health
delivery system for effective prevention and efficient management of diseases;
provision of universal and comprehensive reproductive and child health services;
strengthening the referral system and improving the quality of hospital care in
conformity with the Indian Public Health Standards (IPHS). The first amongst a
series of interventions in this direction is to create the institutional architecture that
would enable effective and efficient functioning of the health delivery system.

4. The Framework. To ensure effective monitoring, co-ordination, and

support to the PHCs and the Sub-centres, and to strengthen the referral system,
especially between the primary and secondary health system, the Government has
decided to organise primary health care delivery to the rural areas through
‘Community Health and Nutrition Clusters (CHNCs). Each Cluster would provide
health services to one to two lakh rural citizens living in the villages serviced by 4 to
8 adjacent PHCs, with a Referral Hospital as the Mentoring Institution (MI). The
CHC (either under DH or APVVP control) as the first referral unit (FRU), would
provide Comprehensive Emergency Obstetric and Neonatal Care (CEMONC) for
the cluster and would also be the head quarters of the Community Health Co-
ordination Unit (CHCU) that would supervise, monitor and coordinate the
functioning of PHCs and perform the mentoring role. In the absence of a CHC
within the cluster, an Area Hospital will be the Mentoring Institution and will house
the CHCU. The Mentoring Institution will therefore play a dual role; one of being
the first referral unit and second of being the co-ordination unit.

5. The primary health system shall comprise of three-tier system of sub-centre,

PHC and CHC. All other institutions like: subsidiary PHCs, upgraded PHCs,
Mandal PHCs, 24/7 PHCs, stationery PHCs, Block PHCs, government dispensaries,
mobile medical units, government civil hospitals, etc., should be converted as either a
PHC or a CHC depending on population, access, infrastructure, staff, demand for
services etc. It should be noted that no new health institutions are being sanctioned
during the current year. The principal endeavour is to strengthen the existing system
rather than expand the institutions at this juncture.

6. The Coverage. The current exercise is limited to the rural areas, tribal
areas and grade-3 and 2 municipalities, but does not include Municipal Corporations
and Grade-1 Municipalities. Similar exercise for the urban areas (Grade I
Municipalities and Corporations) will be undertaken separately. This exercise
envisions that all health institutions in the rural areas - like dispensaries, civil
hospitals, mobile medical units, subsidiary health centres, upgraded PHCs, Mandal
PHCs/24-hour PHCs, etc. – will be converted either as a PHC or a CHC. However,

2
in this process, no health institution will be closed, shifted, or reduced in status
from its current position, unless there are compelling reasons for doing so, like for
example, two health facilities being located either in the same or in the adjacent
villages. If such an action is mandated for any strong reason, the same shall be
justified with evidence and due approval be obtained from the District Health
Committee.

7. Revitalisation of Primary health Care System. The process for

revitalisation of primary health system include the following:
a) Rational organization of the service area of ASHA worker, sub-centre, and
PHC and filling the gaps for universal coverage;
b) Constitution of Community Health and Nutrition Clusters (CHCN) and
Measures for Streamlining the Referral System;
c) Review and defining the package of services provided by the Sub-centres and
PHCs and clear delineation of service area and functional responsibilities of
each and every staff member in the CHCN;
d) Rationalisation of Human Resources, Equipment and Infrastructure; and
e) Action Plan for Strengthening the Health Institutions and the Quality of Care.

Service Area Rationalisation

8. The primary health system comprises of hierarchically organised but inter-

connected, mutually supportive system of three-tier institutions; sub-centre, PHC
and the CHC. The spatial distribution of these institutions should ensure equitable
access to all citizens to comprehensive primary health services. The service area of
each institution, i.e., sub-centre, PHC and CHC, should be clearly defined so that
every person living in that area is aware not only of the health institution responsible
for package of services for his / her village but also the referral network. The
objective is to provide access for every citizen to quality health care system.

9. This exercise should start from the habitation level and proceed to the
higher levels and not vice versa. This would entail that the service area of the
ASHA worker is delineated first, followed by the Sub-centre and the PHC. Once the
service area of all PHCs are clearly defined, the constitution of community health
and nutrition clusters (CHNC) would be the logical evolution. The service area
delineation should adhere to the Indian Public Health Standards (IPHS).

10. ASHA Worker Service Area: The first step is to rationalise the service
area of ASHA worker. Every ASHA worker should have a well defined service area
duly taking the habitation of the village as the unit for service area. Every habitation

3
of the village must receive the services of ASHA worker. Special attention must be
paid to ensure that all SC, ST and Minority habitations have access to the services of
ASHA worker. If any habitation is not currently reached by the ASHA worker,
proposal must be made for either another ASHA worker or action be taken to utilise
the services of the existing Community Resource Person (CRP) of the local Village
Organisation (VO) or the Anganwadi Worker as the link health worker. In the tribal
areas, the Community Health Worker (CHW) shall be the ASHA worker, wherever
they exist. The service area of an ASHA worker should be within a radius of one kilo
meter.

11. Sub-Centre Service Area: Each sub-centre should provide services to about
3,000 to 5,000 population in the plain areas, and this norm should be substantially
less in the tribal areas. In the plain areas, it is expected that each SC will serve 4 to 5
villages located at a distance of 1 to 5 km. The Sub-centre must be equidistant from
the villages it serves and be located at the centre of its service area to the extent
possible. This might necessitate moving one or more existing village from one sub-
centre to another, even if it means that village is in another Mandal. Proximity and
access alone should be considered while delineating the service area. A revenue
village should be the unit for organising the service area of the sub-centre, while a
habitation should be the unit for organising the ASHA service area.

12. The service area of the Sub-centre should be divided and clearly demarcated
for each of the two ANMs, duly ensuring that the service area of each ANM is
contiguous. This exercise should be done with greatest diligence in the tribal areas of
the state. It shall be noted that no new sub-centres are being sanctioned at this
moment. However, if there are compelling reasons for either creating or shifting any
sub-centre, the same shall be submitted as part of the proposal for strengthening the
CHN Cluster.

13. PHC Service Area: Each PHC should support about six to ten sub-centres
located within a distance of 5 to 25 kms. The PHC service area rationalisation should
include review and delineation of sub-centres attached to each PHC duly ensuring
that the sub-centres are nearly equidistant from the PHC. In this configuration, a
CHC will not directly support sub-centres and instead would be a mentoring, guiding
and support facility for the PHCS. Therefore, sub-centres attached to any CHC
should be transferred to the direct management of the adjacent PHC to the extent
possible. The service area of the PHC can include villages in more than one Mandal,
since the principle is ease of access to the citizens rather than administrative
convenience should guide the rationalisation process. Each PHC should provide
comprehensive preventive, promotive, curative and referral services to about 30,000
to 50,000 rural citizens.
4
14. If the existing PHC is located at the extreme corner of its service area, an
earnest effort must be made to see that its service area becomes more manageable by
redistributing the sub centres and become more equidistant from PHC. If two health
institutions, especially a PHC and a CHC, are located in the same village, one of
them would have to be relocated to another village. If two PHCs are located very
close to each other, the PHC in a rented building may be shifted another suitable
place for better coverage and function. Henceforth, all PHCs and CHCs should
provide services round the clock. Therefore there should not be any distinction
such as Mandal PHCs, 24/7 PHCs etc.

Constitution of Community Health and Nutrition Clusters (CHNC)

15. The rationalisation of service area of the ASHA worker, Sub-centre and the
PHC should be followed by delineation of Community Health and Nutrition Cluster
(CHNC), with the Community Health Centre (CHC) as the First Referral Unit
(FRU) and the Mentoring Institution (MI). An Area Hospital could be the MI if
there is no CHC in the cluster. Four to ten PHCs surrounding the CHC should be
tagged on to the Referral Hospital. The service area of all the PHCs so tagged would
constitute the CHN Cluster. Each CHNC is expected to provide services to about
one to two lakh rural citizens.

16. The Cluster Institution or the Mentoring Institution, as mentioned above, will
perform dual functions. On one hand, it will function as the first referral unit
providing Basic or Comprehensive Emergency Obstetric and Neonatal services
(BEMONC or CEMONC) based on the infrastructure and specialist doctors, while
on the other, it will be the headquarters of Community Health Coordination Unit
(CHCU), which will be responsible for supervision, monitoring, co-ordination and
mentoring of all PHCs and Sub-centres within the CHN cluster.

17. Streamlined Referral System: The effectiveness of the health system can
be strengthened through streamlined referral system. This will reduce congestion in
the outpatient clinics, ensure faster and effective specialist treatment and avoidable
costs for the patient. This is particularly important for reducing MMR and IMR,
particularly neonatal morbidity and mortality. The CHC shall be the FRU for all the
PHCs under its supervision. While the patient has a choice of a health facility, it shall
be the duty of the PHC to guide and direct the patient to its FRU. All CHCs will be
strengthened to provide comprehensive emergency obstetric and neonatal care
during the current 5-year plan. Each CHC must have an Obstetrician, Paediatrician
and an Anaesthetist and preferably a General Physician. The plan of action for
revitalisation should include specific proposals in this regard. The free standing

5
health institutions of the Medical, Health and Family Welfare Department like the
PP units, MCH Centres, FP Centres, CEMONC centres etc., should be integrated
with the CHC and appropriate proposal must be made in the plan for revitalisation.

18. The FRU can be a CHC under the control of Director of Public Health or
belonging to the APVVP or an area Hospital. An upgraded PHC or a Civil Hospital
may be proposed for conversion as a CHC only if it has the required staff and the
infrastructure. The Community Health Co-ordination Unit, however, will be under
the direct control of the Directorate of Public Health.

19. Community Health Coordination Unit (CHCU): The Mentoring

Institution will also be the headquarters of the CHCU. A DCS or the senior-most
medical officer in the CHN Cluster will be designated as the Cluster Co-ordinator,
who will be responsible for the overall supervision and monitoring of the functioning
of all PHCs in the cluster. The CHCU will integrate the functionaries of all
institutions responsible for primary health care, and will include the PHN,
Ophthalmic Officer, Sub-Unit Officer (Malaria) and the functionaries responsible for
Leprosy and HIV/AIDS in the cluster.

20. The Community Health Cluster Coordinator (CHCC) would be responsible

for the overall coordination and supervision of all primary health functions in the
CHN Cluster, but would not be responsible for the management of the FRU. Until
an officer is designated as the CHCC, the Superintendent of the Cluster Hospital
(CHC or Area Hospital, as the case may be) or the senior most medical officer in the
cluster or the deputy civil surgeon in the cluster – whoever is the most senior – would
function as the CH Cluster Coordinator. The Coordinator will undertake extensive
tour in the cluster and monitor and guide effective implementation of the primary
health care activities in the cluster and secure synergy and integration with nutrition
and socio-economic development activities of the Rural Development and Women
Welfare and Child Development Department activities.

21. The CHCC will be the most important functionary in the CHN cluster
responsible for all activities of the medical and health department in the cluster. The
PHC MOs will report to the Deputy DMHO / DMHO only through the CH Cluster
Coordinators. The government in due course will empower the CHCC to perform all
functions of the department in the cluster. One district level programme officer will
be designated as the Nodal Officer for each revenue division, who along with the
Deputy DMHO will co-ordinate and monitor the functions of all CHCCs.

6
Action Plan for Strengthening the Health Institutions and Quality of Care

22. After rationalisation of the service area of Sub-centres and PHCs and
constitution of CHN Clusters, a comprehensive plan should be prepared to: a) define
the area of operations and the functions of each and every functionary of the
Medical, Health and Family Welfare Department in the CHN Cluster; and b) based
on this review a proposal must be prepared for rational deployment of the staff to
ensure equitable distribution of staff amongst all PHCs; c) those functionaries with
area of operation beyond one PHC should be located at the CHCU under the direct
control and supervision of Cluster Co-ordinator and they shall be responsible for
services to all PHCs in the Cluster. It should be noted that no new staff will be
sanctioned and every effort must be made to ensure optimum deployment and
productivity of each and every staff member of the department. While finalising the
action plan, especially in backward and remote areas, alternative options like
involving non-governmental organisations and other creative and innovative
proposition.

23. While undertaking this exercise, the following package of services to be

provided at the PHC and Sub-Centre shall be taken in to consideration.

Package of Services at the PHC / Sub-Centre

24. One of the key inputs to effective health care delivery envisages well-defined
roles and responsibilities for the Sub centre, PHC and CHC and all its functionaries.
The PHC should reach out to the community and provide integrated – RCH, disease
prevention and management, health promotion, etc. - and comprehensive
preventive, promotive and curative – services. The PHC should effectively utilise the
services of all its staff and all field staff, especially the Medical Officers, should visit
each and every village in its service area at least once a month. Ideally each PHC
should have two medical officers; and they should be mobile for atleast six days a
week. Where there is only one MO, she/ he shall be mobile for atleast four days a
week.

25. Some of the key functions of the PHC include the following:

a) Role of the Medical Officer at the PHC: Curative activity following the
standard treatment protocols; referral of patients who need specialist care;
laboratory monitoring; indenting medicines as per the disease burden;
overall management of the staff and the resources, including review and

7
 reporting of all primary health activities. Above all, the MO shall be
responsible for prevention and management of infectious diseases,
environmental sanitation, safe motherhood and child survival and
monitoring of all pregnant and lactating women and children below 5 years.
b) MOs role in the field: MO must visit every sub-centre and every village in
the service area of the PHC on a fixed day of the week/Fortnight. The
PHCs with 4-5 sub-centres will receive the MO once every week and those
with more sub-centres, once in a fortnight. All villages should receive MOs
visit atleast once a month. PHC The list of services to be provided in the
field are:-

i. Ante-Natal Care (ANC): first trimester registration of all pregnancies;

screening for pre-existing diseases and their treatment; four ANC visits
(3 by the MO); three TT injections; regular intake of Iron and Folic Acid
(IFA) tablets throughout pregnancy for not less than 120 days;
supplementary nutrition; identification of high risk pregnancies; birth
planning for all in the third trimester; and ensuring institutional delivery
/ skilled birth attendance; post-natal care. Monitoring of prenatal,
intranatal and postnatal complications and prompt referral to the
Referral Hospital.
ii. Child health screening using IMNCI protocols where applicable: age
groups of
1. 0-1 year: Immunization, growth monitoring, exclusive breast
feeding and weaning advice, treatment of pre-existing conditions,
care of Grade 3 and 4 malnutrition children in health facility/FRU
and screening for childhood illness and referral as appropriate.
2. 1-5years: immunisation, growth monitoring, vitamin A
supplementation, nutrition support.
3. 5-15 years: registration and coverage by the school health
programme
iii. Disease control: to identify / follow up of diagnosed patients suffering
from specific diseases like TB, Leprosy etc
iv. Eligible Couple follow up and action plan through FP/Spacing/
counselling to avoid pregnancy below the age of 18 years.
v. Water quality monitoring including sanitation and chlorination
vi. Vector control measures monitoring
vii. IEC activities to SHGs, VHSCs & ASHAs. Weekly theme for IEC talks
may be developed and followed.
viii. School health programme: To be started in June/ July in all the Govt.
schools and social welfare hostels and all the children in the schools of

8
 the area to undergo basic health screening initially and those identified
as high risk to be ear marked for follow up visits.
1. each child to have a card
2. DPT/ TT as per the schedule are given
3. De-worming to be under taken in the initial visit and the next after a
six months period.
4. Children requiring specialist care are to be referred to the concerned
specialist at a referral unit.
5. Further follow up visits to the schools may be once in 3 months.
ix. Health Education; IEC Campaign

Action Plan – Road Map for Revitalisation

26. The DMHO of the district shall be responsible for preparation of action plan
for the ‘Revitalisation of Primary Health Care’ for the district duly following these
guidelines. The DMHO shall undertake this exercise under the overall supervision of
the District Collector and District Magistrate with the technical guidance of the
Regional Director and the Nodal Officer of the Health Department and in
partnership with the District Coordinator of Hospital Services. The DMHO and
DCHS together will hold workshops with all Medical Officers to explain the
programme of action and the Medical Officers in turn will undertake mapping and
service area rationalisation exercise for the ASHAs, Sub-centres and prepare
proposals for the PHC. Based on this exercise, the DMHO and DCHS with the
inputs from Dy. DMHO, Programme Officers, Medical Officers and other
functionaries will prepare the action plan duly paying attention to the following
paras. The Action Plan will be reviewed and approved by the District Health
Committee chaired by the District Collector. In case of ITDA areas, the entire
proposal must be reviewed and approved by the Project Officer of ITDA.

27. The Plan should include: a) delineation of the service area of ASHA, Sub-
Centre and PHC; b) constitution of CHN Clusters and identification of Referral
Institution and establishment of CHCU; b) proposal for rational deployment of
staff, equipment and other resources; d) measures for strengthening of the civil
works and supply of essential equipment; e) delineation of route maps and
schedule for fixed-day visit to sub-centres and villages; f) schedule for preparation
of village / sub-centre and PHC Health Plans; and g) proposals for strengthening
the health system, including establishment / upgradation of health facilities in
2011-12, 2012-13 and 2013-14.

28. The Action Plan should also include the following inter alia:

9
 a) Upgradation or shifting of Health Institutions with detailed reasons for the
proposal.
b) Merger of other vertical programme institutions – both physically and
functionally – with the PHC / CHC / Area / District Hospitals.
c) Proposal for transfer of institutions from DH to APVVP and vice versa.
d) Proposals for rationalising the deployment of Human Resources with
detailed reasons thereof.
e) Proposal for rationalising the equipment deployment – identify equipment
that is not being used that could be transferred to another health institution
along with equipment required by each institution with reasons for such a
proposal duly indicating the time frame within which it is required.
f) Civil works Required – duly phasing them into those requiring immediate
approval, and those that can be / should be taken up during the next three
years (duly indicating the year in which it could be taken up) along with
reasons for the proposals. The proposal should explain the description of the
civil works required, estimated cost and the rationale for the proposal.
g) Detailed Plan of Action for brining the PHC / CHC in conformity with the
IPHS standards by 2015.

Additional Issues

29. It should be noted that the above guidelines are for the purpose of general
guidance, and the entire exercise must be done with the participation of all medical
officers, nurses and paramedical staff duly dictated by the goals, purpose and the
objective for which it is being done, which is to secure quality health care for all,
especially the most disadvantaged and the most excluded.

30. The entire exercise must be completed and comprehensive proposals shall be
submitted to the Government through the Commissioner of Health and Family
Welfare by 15 May 2010.

DR P VENKAT RAMESH
SECRETARY TO THE GOVERNMENT

To
The Commissioner of Health and Family Welfare
The Director of Public Health and Family Welfare

10
The Commissioner of AP Vaidya Vidhana Parishad
All District Collectors and District Magistrates
The Project Officers of ITDA
All District Medical and Health Officers
All District Coordinators of Health Services of APVVP
All Superintendents of Area and District Hospitals

Copy to:
1. The Secretary to Government of India, Ministry of Health and Family Welfare,
Nirman Bhavan, New Delhi
2. The Mission Director, NRHM, Nirman Bhavan, New Delhi.
3. The Director, NIHFW, New Delhi.
4. The Principal Secretary to the Chief Minister (KR)
5. The Special Chief Secretary to Government of AP, Tribal Welfare Department.
6. Director of Medical Education / Director of IPM / Commissioner of AYUSH /
Director General of Drug Control Administration / Managing Director of
APHMHIDC / Project Director of APSACS / Director of Indian Institute of
Health & Family Welfare / Vice-Chancellor of NTR University of Health
Sciences /
7. The Commissioner of Tribal Welfare
8. The OSD to Hon’ble Minster ( ME), AP Secretariat, Hyderabad.
9. The OSD to Hon’ble Minster ( H&FW), AP Secretariat, Hyderabad.
10. The OSD to Hon’ble Minster (Aarogyasri) AP Secretariat, Hyderabad.
11. All Regional Directors of Health
12. All Superintendents of Teaching Hospitals
13. Principals of Medical College of the state
14. The PS to the Principal Secretary to Government, Medical and Health
Department
15. All officials of SPIU of HM &FW Department
16. Representative, Family Health International Hyderabad
17. Director, Indian Institute of Public Health, Hyderabad
18. All Nodal Officers of the Medical and Health Department

//FORWARDED BY ORDER//

SECTION OFFICER

11
 Annexure 1 to G.O.Ms 92 of MH&FW Department dated 23 April 2010

CONVERSION OF GOVERNMENT DISPENSARIES / MM UNITS / L F DISPENSARIES INTO PHCs

Sl. Name of the District Mandal Name of the existing Name of the new institution with Remarks
1 2 3 4 5 6
1 SRIKAKULAM Gara GD Kalingapatnam PHC Kalingapatnam
2 Amdalavalasa GD Akkulapeta PHC Akkulapeta
3 Ponduru GD Tadivalasa PHC Tadivalasa, Ponduru(M)
4 V.Kothur GD Venkatapuram PHC Venkata-puram, V.Kota (M)
5 Kavirty GD Rajapuram PHC Rajapuram, Kaviti (M)
6 Kavirty GD Manikyapuram PHC Manikyapuram, Kaviti (M)
7 Kavirty GD Borivanka PHC Borivanka, Kaviti (M)
8 Narsannapeta GD Urlam PHC Urlam, Narsannapeta (M)
9 Ichapuram M.M.U. Ichapuram PHC Ichapuram
10 L.N.Peta SHC, LN Peta PHC, LN Peta Merged with
existing PHC
11 Hiramandalam SHC,Hiramandalam PHC,Hiramandalam
12 Kavity SHC,Belgaon PHC,Belgaon
13 Ponduru Govt.Hl.Ponduru CHC Ponduru
14 Amadalavalasa Govt.Hl.Amadalavalasa CHC Amadalavalasa
1 VIZIANAGARAM Kothavalasa GD Kothavalasa PHC Baligattam, Kothavalasa (M)
2 Gurla GD Kotagandedu PHC Kotagandedu, Gurla (M)
3 Garividi GD Konuru PHC Konuru, Garividi (M)
4 Balijapeta GD Chilakalapalli Merged with PHC Balijapeta
5 G.L.Puram GD Gorada PHC Gorada
6 Kurupam M.M.Unit Neelakatapuram PHC Neelakatapuram
7 Jiyyammavalasa M.M.Unit Jiyyammavalasa Merged with proposed CHC
8 Salur M.M.Unit Mamidipalli PHC Baguvalasa by changing H.Q.
9 G.L.Puram GTH Bhadragiri CHC Bhadragiri, G.L.Puram (M0
1 VISAKHAPATNAM Ravikamatham GD Kothakota PHC Kothakota, Ravikamatham (M)
2 V.Madugula GD Kinthali PHC Kinthali (M) V.Madugula
3 Pedagantyada GD Pedagantyada PHC Pedagantyada
4 Anakapalli GD Thagarampudi PHC Thagarampudi
5 G.K.veedhi M.M.Unit R.V.Nagar PHC R.V.Nagar
6 G.K.veedhi M.M.Unit Pedavalasa Merged with existing PHC
7 Arukuvally M.M.Unit Sukarmetta PHC Sukarmetta
8 Munchingput M.M.Unit Kilagada Merged with PHC Dumbrigade
9 Dumbrigade M.M.Unit Araku PHC Seeleru
10 Pedabailu M.M.Unit Pedabailu Merged with PHC Pedabailu
1 EAST GODAVARI Gollaprolu GD Gollaprolu PHC Gollaprolu
2 Pithapuram GD Mallam PHC Mallam
3 Prathipadu GD Shanti Asramam PHC Shanti Asramam
4 Prathipadu GD Peddipalem PHC Peddipalem
5 Kirlampudi GD Geddanaopalli PHC Geddanaopalli
6 Kirlampudi GD Veeravaram PHC Veeravaram
7 Korukonda GD Dosakayapalli PHC Dosakayapalli
8 Jaggampeta GD Katravulapalli PHC Katravulapalli
9 Peddapuram GD Pulimeru PHC Pulimeru
10 U.Kothapalli GD Nagulapalli PHC Nagulapalli
11 U.Kothapalli GD Komaragiri PHC Komaragiri
12 Pedapudi GD Peddada PHC Peddada
13 Pedapudi GD Samapara PHC Samapara
14 Kakinada (U) Unit - Hospital, APSP, Condinued as Unit Hospital
15 Rajanagaram GD Palacherla PHC Palacherla
16 Mandapeta GD Kesavaram PHC Kesavaram
17 Kapileswarapuram GD Atchutapuram PHC Atchutapuram
18 Kapileswarapuram GD Vakatippa PHC Vakatippa
19 Alamuru GD Chopella PHC Chopella
20 K.Gangavaram GD Dangeru PHC Dangeru
21 Ambajipet GD Mukkamala PHC Mukkamala
22 Inavilli GD Veeravallipalem PHC Veera-vallipalem
23 1.Polavaram GD Kesanakurru PHC Kesanakurru
24 Inavilli GD G.Vemavaram PHC G.Vemavaram
25 Allavaram GD Bendamur Lanka PHC Bendamur Lanka
26 Mamidikuduru GD Lutukurru PHC Lutukurru
27 Sakninetipalli GD Rameswaram PHC Rameswaram
28 Biccavolu GD Konkuduru PHC Konkuduru
29 Karapa GD Velangi PHC Velangi
30 Katrenikona M.M.Unit Pallamkurru PHC Pallamkurru
31 Ramchodavaram M.M.Unit Rampachodavaram PHC Seethapalli
32 Kapileswarapuram GH Kapileswarapuram CHC Kapileswarapuram
Kapileswarapuram SHC Kapileswarapuram PHC Peddapalla
33 Samalkota GH Samalkota CHC Samalkota
34 K.Gangavaram GH Pekeru PHC Pekeru
1 WEST GODAVARI Tallapudi GD Anadevarapeta PHC Anadevarapeta, Tallapudi (M)
2 Chagallu GD Marikondapadu PHC Marikondapadu, Chagallu.
3 Ganapavaram GD Pippara PHC Pippara, Ganapavaram (M)
4 Buttaigudem UM.M.Unit K.R.Puram-I PHC K.R.Puram-I, Buttaigudem (M)
5 Buttaigudem GD Doramamidi PHC Doramamidi
6 Nidadavole GD Nidadavole CHC Nidadavole
7 Buttaigudem M.M.Unit K.R.Puram - II PHC Gaddapalli
8 T.Narsapuram M.M.Unit Borrampalem PHC Borrampalem
9 Bhimavaram M.M.Unit Bhimavaram PHC Konithiwada
1 KRISHNA Ghantasala LFD Ghantasala PHC Ghantasala
2 Ghantasala SHC Srikakulam PHC Srikakulam
3 Pamarru GD Zamigolvepalli PHC Zamigolvepalli
4 Pamidimukalla LFD .Kapileswarapuram PHC Kapileswarapuram
5 Unguturu GD Indupalli PHC Indupalli
6 LFD Kanumuru Pamarru PHC Kanumuru
7 MMU Kolletikota Kaikalur Merged with existing PHC
8 GH pamarru Pamarru PHC pamarru
9 GH Yalamarru Peddaupparapadu PHC Yalamarru
10 GH manda-pakala Koduru PHC mandapakala
11 Gh Kowtharam Gudlavalleru PHC Kowtharam
1
2 GUNTUR Nakrekallu NSP
SHC Dispensary
Nakrekallu Nakrekallu PHC Nakrekallu Both
Dispensary &
SHC merged
3 Pidugurala GD Karalapadu PHC Karalapadu
4 Repalle M.M.Unit Repalle PHC Gangedipalem, Repalle (M)
5 Ipuru SHC Inomalla PHC Muppalla
6 SHC Mulpuru Mulpuru PHC Venigalla, pedakakani (M)
7 GD Edlapalli Tsundur PHC Kavuru, Chilakaluripeta (M)
8 GD Intur Amarthalur PHC Ponnekallu, Thadikonda (M)
9 GD Vatticherukur Vattocherukur PHC Vatticherukur
1 PRAKASAM Pamur GD Pamur + SHC PHC Pamur
2 Ballikureva GD Guntupalli PHC Guntupalli
3 Giddalur GD Sanjeevaraopet PHC Sanjeevaraopet
4 N.G.Padu G.D.Pothavaram PHC Pothavaram
5 N.G.Padu GD Timmasamudram PHC Timmasamudram
6 Vetapalem GD Pandillapalli PHC Pandillapalli
7 Martur GD Dronadula PHC Dronadula
8 Incollu GD Duddakur PHC Duddakur
9 Pamur SHC Pamur Merged with existing PHC Pamur
10 Cumbum SHC Cumbum PHC Lingapuram
11 Komorolu GH Komorolu (12 Bedded) PHC Komorolu
12 Mundlamur GH Marella PHC Marella
13 Chirala M.M.Unit Chirala PHC Uppugunduru,
14 P.Dornala M.M.Unit P.Dornala New PHC Karavadi,
1 NELLORE Kavali M.M.Unit Kavali PHC Sarvayapalem
2 M.M.Unit Nellore PHC South mopur
3 SHC Allur CHC Allur , GH Allur merged with
GH Allur CHC Allur
4 Vidavalur GH Vidavalur PHC Vidavalur
5 Venkatagiri GH Venkatagiri PHC Bangarupeta
7 Sangam GD Sangam PHC Sangam
8 T.P.Gudur GD, Kodur PHC Kodur
SHC Kodur
9 Indukurpeta GD Jagadevpeta PHC Jagadevpeta
10 Kaluvoya GD Kullur PHC Kullur
11 Chejerla GD Chittalur PHC Chittalur
12 Chillakur GD Vallipedu PHC Vallipedu
13 GD Varagalli PHC Varagalli
14 G.D.Nidigurthy PHC Nidigurthy
15 G.D.Chinnathota PHC Chinnathota
16 G.D.Gunapatipalem PHC Gunapatipalem
17 SHC Pedapariya PHC Pedapariya
GD, Pedapariya
1 CHITTOOR Yadamaris GD Madhireddy-palle PHC Madhireddy-palle
2 Pulicherla GD Kallur PHC Kallur
3 R.C.Puram GD Kuppambadur PHC Kuppambadur
4 S.R.Puram GD Arimakulapalle PHC Arimakulapalle
5 Thamballapalle GD Kosuvaripalle PHC Kosuvaripalle
1 KADAPA Obulavaripalli GD Mukkavaripalli PHC Mukkavaripalli
2 Vempalli SHC Vempalli PHC Tallapalli
3 L.R.Palli SHC L.R.Palli PHC Konampeta
4 Mydukur GD Onipenta PHC Onipenta
5 Kadapa M.M.Unit Kadapa PHC Akkayapalli, Kadapa ( R )
6 Rural Kadapa
1 ANANTHAPUR Vajrakanuru GD, Vajrakanuru PHC Vajrakanuru
2 Madakasine GD, Neela-kantapuram PHC Neelakantapuram
3 Thanakallur GD, Kokkanti PHC Kokkanti
4 Bommanahal GD, Sreedharegatta PHC Sreedharegatta
5 Kanekal GD, Garudachedu PHC Garudachedu
6 Uravakonda GD, Raketla PHC Raketla
7 MMU Kalyandurg Kalyandurg PHC Avuladatla Rayadurgam (M)
1 KURNOOL Atmakur SHC Bairluty PHC Bairluty
2 Sanjamale SHC Sanjamale PHC Sanjamale
3
4 Nandavaram GD, Halaharvi PHC, Halaharvi
5 Sirivelle GD, Yerraguntla PHC, Yerraguntla
6 Rudravaram GD, Narsapuram PHC, Narsapuram
7 Kurnool GD, Gargeyapuram PHC Gargeyapuram
8 Orvakal GD, Narnoor PHC Narnoor
9 Midthur GD, Kadumur PHC Kadumur
10 Pagidyala GD, Prathakota PHC Prathakota
11 Uyyalawada GD, Mayelur PHC Mayelur
12 Sanjamala GD, Nossam PHC Nossam
13 Owk GD, Uppalapadu PHC Uppalapadu
14 Halagunda GD, Gajjanahalli PHC , Gajjanahalli
1 MAHABUBNAGAR Amarabad M.M.Unit Mannanur Merged with existing PHC Mannahur
2 Koilkonda GD Koilkonda CHC Koilkonda
3 Kosigi CHl.Kosigi CHC Kosigi
1 RANGA REDDY Manchal GOVT.CIVIL DISPENSARY PHC ARUTLA
2 Dharur GCH Dharur PHC Dharur
3 Malkajgiri GOVT.CIVIL Alwal PHC Alwal
1 MEDAK Jagdevpur Jagdevpur GCD PHC Jagdevpur
2 Hathnoora Chintalcheru GCD PHC Chintalcheru
3 Jharasangam Jharasangam GD PHC Jharasangam
Jharasangam SHC
4 Koheer Koheer SHC PHC Bilalpur
1 NIZAMABAD Balkonda GH Balkonda (30 Bedded) PHC Kisannagar
2 Balkonda Kisannagar
3 Bichkonda GH Bichkonda CHC Bichkonda
4 Kotgir GH Kotgir CHC Kotgir
5 Chowtapalli SHC Cowtapalli SHC Chowtapally
1 ADILABAD Sarangapur GD Sarangapur PHC Sarangapur
2 Lohesra GD Lahesra PHC Lahesra
3 Jainad SHC Jainad PHC Jainad
GD Jainad
4 Koutala GD Babapur Gangapur PHC Babapur Gangapur
1 KARIMNAGAR Eligedu GD Eligaidu converted as PHC Eligaidu
2 Eligedu SHC Eligaidu PHC Bornapalli
3 Huzurabad GD KC Camp, Huzurabad PHC KC Camp, Huzurabad
4 Jagityal GD Dharoor Camp, PHC Dharoor Camp,
5 Mahadevpur M.M.Unit Mahadevpur PHC Kaleswaram
6 Veenavanka GH Veenavanka, PHC Veenavanka,
7 Ramagundam GH Ramagundam PHC Ramagundam
8 Thimmapur GD LMD Colony CHC LMD Colony
9 GH Basanthnagar CHC Basanthnagar
1 WARANGAL Hanamkonda GH Kazipet CHC Kazipet
2 Cherial SHC Cherial PHC Mustiyala
1 KHAMMAM Dummugudem GH Dummugudem Both Merged with PHC
SHC Dummugudem Dummugudem
2 Venkatapuram GH Venkatapuram PHC Venkatapuram
3 Chintoor GH Chintoor PHC Chintoor
4 Thirumalayapalem GH Sublaid PHC Sublaid
5 Garla GH Garla CHC Garla
1 NALGONDA Athmakur SHC Athmakur PHC Athmakur (S )
2 Nereducherla SHC Penchikaladinne PHC Penchikaladinne
3 Nandigudem GH Nandigudem CHC Nandigudem
4 Munagala GH Munagala PHC Munagala