Guidelines for Organising

Urban Primary Health Centre Services

January 2018

National Urban Health Mission

Ministry of Health and Family Welfare
Government of India
 PREFACE

Over the last two decades, India’s urban population has increased from 217 million to 377 million and
is expected to cross 600 million by 2031. As per 71st round of National Sample Survey (NSSO), there are
an estimated 52 million poor people living in the cities and towns of India. The challenge is not just
the sizeable numbers but also the unplanned manner the population is growing thereby increasing
the burden on the health system and related health and social indicators. The health indicators of the
urban poor are comparable to, and in many cases, worse off than, the poor living in rural areas of the
country.

In order to effectively address the health concerns of the urban population, Government of India launched
the National Urban Health Mission (NUHM) in May 2013. The initiatives under the NUHM aims to provide the
comprehensive primary healthcare services in urban areas, through Urban Primary Health Centres (U-PHCs),
Urban Community Health Centres (U-CHCs; which act as First Referral Units/FRUs), strong outreach services
and accessible frontline health workers. This is also in accordance to the strategic direction provided under
the National Health Policy-2017.

NUHM has identified some key activities to accelerate the pace of work such as: vulnerability mapping of
urban poor; service delivery and assured referral to urban poor through U-PHCs and U-CHCs; outreach services
through Urban Health and Nutrition Days (UHND). Furthermore, the mission also focuses on specific urban
health needs, in addition to Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A)
services like Non-Communicable diseases (NCDs), urban centric vector borne diseases, Tuberculosis etc.
U-PHCs are required to roll out the community based screening for five common NCDs like Hypertension,
Diabetes Mellitus, Cancer of Breast, Cervix and the Oral Cavity.

I appreciate the efforts undertaken by the Urban Health Division of the Ministry, National Health Systems
Resource Centre (NHSRC) and other experts/partners in bringing out this document, which will be an
informative and useful resource not only for the staff of the UPHCs but also for all the concerned stakeholders
associated with NUHM.
 FOREWORD

Urban population, unlike the rural population, is highly heterogeneous. Most of the published
data do not capture the heterogeneity, as the Standard of Living Index often does not disaggregate it,
income-wise. Urban average figures thereof mask the health conditions of the urban poor. NUHM aims
to address the health concerns of the urban poor by facilitating equitable access to available health
facilities by rationalizing and strengthening the existing capacity of health delivery system.

U-PHC is the interface between health system and the urban poor. It is the epi-centre for the preventive,
promotive and curative healthcare, which operates and manages outreach sessions, special camps, home
visits by Auxiliary Nurse Midwives (ANMs), community mobilization through ASHAs and Mahila Arogya
Samitis (MAS), apart from providing medical care through the out-patient services. It is therefore of utmost
importance that a specific guidebook with uniform information and directives on effective management of
the U-PHC is published.

The paramount objective of the Guidebook is to strengthen the Preventive, Promotive and Curative
Health care system for urban population, with a special focus to vulnerable population. It also goes beyond
RMNCH and A services to provide comprehensive primary care including for NCDs in consonance with the
healthcare needs of the urban poor. In addition it is expected that the Medical Officer at UPHC, the prime
user of the document shall find this beneficial as it gives direct guidance for implementing health care
services of urban population, especially the urban poor.
 FOREWORD

The Urban Primary Health Centre (U-PHCs) envisaged under the aegis of National Urban Health Mission
(NUHM) plays a pivotal role in delivering necessary primary healthcare services to the urban population
particularly the slum and vulnerable sections. In a country like India, where a substantial urban-rural
gap exists, the healthcare needs remain different for the diverse population. It is therefore imperative to
envisage healthcare facilities with structure and functionalities at best to fit to the needs of the urban
population.

Further, it is important to mention that the human resources engaged under NUHM requires a clear and
comprehensive understanding of the functioning of the U-PHCs. This will facilitate the staff to perform
efficiently and effectively in the delivery of health services for the target population. Hence, interaction and
coordination between different cadres of staff and convergence of their activities remain critical.

In the background of such thought, the idea to develop and publish a guidebook for operationalization of
the U-PHC was conceptualised and nurtured. This guidebook is aimed at providing a uniform and broad-
based understanding of the critical elements and functioning of the U-PHCs. It will be beneficial for the
medical officers, staff members of U-PHCs and the program managers at city/district and state levels.

I sincerely believe this book shall bring clarity about the critical elements, functionalities and
operationalization of U-PHCS at the state, city and district levels.
 Table of Contents

1: Introduction............................................................................................................................................................................ 1
1.1 About National Urban Health Mission................................................................................................................ 1
1.2 Specific Interventions under Nuhm.................................................................................................................... 2
1.3 Comprehensive Primary Health Care through the Uphc............................................................................ 2
1.4 Objectives...................................................................................................................................................................... 4
1.5 Target Audience.......................................................................................................................................................... 5
1.6 Scope of the Guidelines............................................................................................................................................ 5

2: administrative organization of the uphc........................................................................................................... 7

2.1 Human Resources at the Uphc............................................................................................................................. 7
2.2 Timings........................................................................................................................................................................... 8
2.3 Management and Governance of the Uphc.................................................................................................... 9
2.4 Identifying and Registering Families/Individuals in Uphc Catchment Area......................................11
2.5 Organisation of Outreach Activities...................................................................................................................12
2.6 Social Mobilisation for Health through Asha and Mas.............................................................................14
2.7 Organisation of General Out-Patient Care.......................................................................................................15
2.8 Referral Mechanism.................................................................................................................................................17
2.9 Management of Clinical Support Services: Diagnostics Lab and Pharmacy.......................................19
2.10 Ancillary Services: Housekeeping and Waste Management.....................................................................20
2.11 Infection Control.......................................................................................................................................................22
2.12 Convergence with Icds, Water and Sanitation Departments..................................................................24
2.13 Public Private Partnership......................................................................................................................................25
2.14 Grievance Redressal.................................................................................................................................................26
2.15 Patient Feedback and Exit Interviews................................................................................................................27

3: uphc services..........................................................................................................................................................................29
x | Guidelines for Organising Urban Primary Health Centre Services | June 2017

Annexures .............................................................................................................................................................................39
Annexure I: Minimum Requirements for UPHC.........................................................................................................39
Annexure II: Essential Drug List for Uphc....................................................................................................................43
Annexure III: Job Responsibilities of Uphc Staff........................................................................................................45
1. Medical Officer...............................................................................................................................................45
2. Public Health Manager................................................................................................................................47
3. Lady Health Visitor or Nurse......................................................................................................................48
4. Auxiliary Nurse Midwives (Anm).............................................................................................................49
5. Laboratory Technician.................................................................................................................................50
6. Pharmacist.......................................................................................................................................................50
7. Asha.................................................................................................................................................................50
8. Mahila Arogya Samiti...................................................................................................................................51
Annexure IV: Referral Form................................................................................................................................................53
Annexure V: Referral Register for Uphc........................................................................................................................55
Annexure VI: History Taking/Risk Assessment Form for Non-Communicable Diseases..............................57
 List of Abbreviations

ANC Antenatal Check-ups

ANM Auxiliary Nurse Midwife
ASHA Accredited Social Health Activist
AWW Anganwadi Worker
AYUSH Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy
BMI Body Mass Index
BMWM Bio Medical Waste Management
CMHO Chief Medical and Health Officer
DOTS Directly Observed Treatment, Short Course
GoI Government of India
HBNC Home Based Neonatal Care
HIV Human Immunodeficiency Virus
ICDS Integrated Child Development Services
IDSP Integrated Disease Surveillance Programme
IFA Iron Folic Acid
IMNCI Integrated Management of Neonatal and Childhood Illnesses
IDSP Integrated Disease Surveillance Programme
IPHS Indian Public Health Standards
IUCD Intrauterine Contraceptive Device
LHV Lady Health Visitor
MAS Mahila Aarogya Samiti
MIS Management Information System
MO Medical Officer
MOIC Medical Officer In Charge
MoHFW Ministry of Health and Welfare
NCD Non Communicable Disease
NHSRC National Health Systems Resource Centre
NLEP National Leprosy Eradication Programme
xii | Guidelines for Organising Urban Primary Health Centre Services | June 2017

NPCDCS National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular
Diseases & Stroke
NHM National Health Mission
NRHM National Rural Health Mission
NUHM National Urban Health Mission
JnNURM Jawaharlal Nehru National Urban Renewal Mission
NVBDCP National Vector Borne Disease Control Programme
OCPs Oral Contraceptive Pills
OPD Outdoor Patient Department
PHCs Primary Health Centres
RBSK Rashtriya Bal Suraksha Karyakram
RCH Reproductive & Child Health
RKS Rogi Kalyan Samiti
RMNCH+A Reproductive, Maternal, Newborn, Child and Adolescent Health
RNTCP Revised National Tuberculosis Control Programme
RTI Reproductive Tract Infections
STI Sexually Transmitted Disease
TB Tuberculosis
ULB Urban Local Bodies
UPHC Urban Primary Health Centre
U5MR Under Five Mortality Rate
 1
Introduction

1.1 About National Urban Health In order to effectively address the health concerns
of the urban poor population, the Ministry of Health
Mission
and Family Welfare, Government of India launched
Urban population in India has registered an increase the National Urban Health Mission (NUHM) in the
of 32% in the last decade from 2001 to 2011 and year 2013. The initiatives under the NUHM seek to
is standing at 37.7 Cr as per the GoI census 20111. strengthen the public health thrust in urban local
Growth in urban population has led to a rapid bodies, besides providing health care for the urban
increase in number of urban vulnerable poor, many poor. The focus of the NUHM is on alleviating the
of whom live in slums and other squatter settlements. distress and duress of the urban poor in seeking
The overall slum population is estimated to be 7.6 Cr, quality health services. Thus, it is envisaged that
which is 20% of the total urban population.2 during the mission period all 994 cities with a
population of above 50,000, and all the district and
The urban poor suffer from poor health status. As per state headquarters (irrespective of the population
the NFHS-4 (2015-16) data, Under-5 Mortality Rate size) would be covered. This will be in partnership with
(U5MR) among the urban poor is 34 per 1000 live the NRHM’s efforts so far to ensure that there is no
births, and Infant Mortality Rate (IMR) is 29 per 1000 duplication of services. Urban areas with population
live births. More than 49% of urban poor children are less than 50,000 will be covered through the health
underweight and 36.1 % of urban poor children miss facilities established under the National Rural Health
total immunisation before completing one year. Poor Mission (NRHM). The NUHM aims to focus on:
environmental condition in the slums along with high
population density makes them vulnerable to lung
• Urban poor population living in listed and
unlisted slums.
diseases like asthma/bronchitis, tuberculosis (TB)
etc. Slums also have a high-incidence of Water Borne • All other vulnerable population such as
(diarrhoea/dysentery) and Vector Borne Diseases homeless, rag-pickers, street children,
(Dengue, Chikungunya) and cases of malaria among rickshaw pullers, construction and brick and
the urban poor are twice as high as other urbanites. lime kiln workers, sex workers and other
temporary migrants.
• Public health thrust on sanitation, clean
1 Government of India (2011), Census 2011 (GoI), Ministry
of Home Affairs, Office of Registrar General & Census
drinking water, vector control, etc.
Commissioner.
2 Government of India (2013), National Urban Health Mission-
• Strengthening capacity of all public
Implementation Framework, Ministry of Health & Family healthcare providers including health
Welfare. personnel of urban local bodies.
2 | Guidelines for Organising Urban Primary Health Centre Services | June 2017

1.2 Specific Interventions under III. Vulnerability Assessment

NUHM In order to understand the target population
and their health needs, the UPHC shall conduct a
I. Facility Level vulnerability assessment. This may be conducted for
a. Establishment of UPHCs: UPHCs are to be all households/individuals in the UPHC’s catchment
established for every 50,000 population, area or only of the vulnerable population, as decided
in close proximity to urban slums. All by the state. The frequency of assessment can vary
facilities should have a registered RKS for from state to state as per the nature of vulnerable
management and monitoring of service population, however, the guidelines recommend
delivery and release and utilization of untied assessment to be made in every 6 months.
funds received by the facility.
IV. Involvement of ULBs
b. Establishment of UCHCs: UCHCs are to be
established for every 2.5 lakh population. NUHM aims to increase the participation of ULBs in
Cases from UPHCs shall be referred to UCHCs planning and implementation of health services.
where secondary care facilities will be available. For larger cities, including metro cities, NUHM is
to be implemented through the Municipal Bodies.
The UPHCs and UCHCs shall integrate
For smaller cities, NUHM will be implemented by
services under all national disease control
the Health Department, with active involvement
programs and provide the same to their
of the ULBs. In either case, there are some critical
catchment area in a seamless manner.
functions which require close collaboration between
II. Community Level NUHM and ULBs to positively influence the wider
determinants of health (this list is not exhaustive)
a. Urban ASHA: One urban ASHA for every 200-
such as Epidemic control (including control of vector
500 urban vulnerable households shall ensure
borne diseases), Disease surveillance, Treatment
delivery of services to vulnerable households
and disposal of sewage, Solid waste management
through home visits and provide an essential
including carcass disposal, Drinking water supply,
link between the community and the UPHCs.
Sanitation and prevention of public health nuisances,
b. Mahila Aarogya Samitis: These groups of Dangerous and offensive trade, licensing (in particular
community women, formed for every 50-100 slaughter house management, health safety in
households in slums and slum like settle- cinemas, restaurants etc), Food safety, Road safety,
ments, shall provide a platform for convergent including street lighting, Birth and death registration,
action and a mechanism for the community Management of cremations and burials, Control
to voice their health needs. MAS may monitor of stray dogs – and rabies control, Air pollution,
Urban Health & Nutrition Days, Special Convergence of slum redevelopment and affordable
Outreach Camps, deliveries and availability housing, Implementation of welfare schemes for
of referral transport. The MAS will be given vulnerable populations, especially the homeless.
an untied fund of Rs. 5000 every year which Irrespective of whether NUHM is implemented by the
shall be deposited in MAS account opened Health Department of the ULBs, the organization of
in nearest bank. The management of Untied primary healthcare services shall be the same.
fund is completely in the hands of MAS.
c. Outreach Services: Regular outreach 1.3 Comprehensive Primary Health
services shall be provided through Urban
Care through the UPHC
Health and Nutrition Days. Specialist services
shall be provided at the community through Historically, Primary Health Care in India has been
Special Outreach Camps depending upon limited to package of selective services, leading
special needs of the vulnerable population. to fragmentation of care and high out of pocket
 List of Abbreviations | 3

expenditures particularly on services not related vi. Management of Communicable diseases:

to maternal and child health or communicable National Health Programmes.
diseases. This feature is exacerbated in urban areas vii. Screening and Management of Non-
where primary health care is accessed at tertiary and Communicable diseases.
secondary care institutions, since the primary health
viii. Screening and Basic management of Mental
infrastructure is not as structured as in rural areas.
health ailments.
Urban areas furthermore have a large, and sometimes
unregulated private sector with significant variation in ix. Care for Common Ophthalmic and ENT
cost and quality of services. All these factors challenge problems.
the provision of primary health care in urban areas. x. Basic Dental health care.
In order to provide comprehensive primary xi. Geriatric and palliative health care services.
healthcare services in urban areas, the National xii. Trauma Care (that can be managed at this
Urban Health Mission aims to establish urban level) and Emergency Medical services.
primary healthcare centres (UPHCs), not as a stand-
alone health facility, but as hubs of preventive, With the Medical Officers, Public Health Managers
promotive and basic curative care for its 50,000 (PHM), Staff nurse, supplemented by the ANMs
population. In this well-defined catchment area, the and ASHAs, the team of the UPHC can provide the
UPHC is responsible for the primary health care and set of services defined above, with the requisite
public health needs of the population. With its focus training. Population enumeration, ensuring life
on continuity of care, the UPHC shall develop strong cycle appropriate services including screening for
upward (with higher facilities) and downward (with non-communicable diseases, treatment, referral and
community) linkages to develop a robust chain of follow up would be key components.
referral, while effectively gate-keeping the health
seeking behaviour of its population. In addition to basic health services, the UPHC
should also address social and environmental
Thus, the UPHC shall be the epicentre from which determinants in its catchment area through the
the core Primary healthcare team operates and ASHA & MAS, supported by the ANM and PHM. The
manages outreach sessions, special camps, home UPHC should also establish linkages with the ICDS
visits, oversee community mobilization through system, homeless shelters, housing programmes,
MAS, coordinate referrals and of course, provide and other relevant stakeholders so as to enable
healthcare at the facility. The package of 12 services non-medical services, particularly for its vulnerable
that the UPHC is expected to provide spans population.
preventive, promotive, curative, rehabilitative and
palliative care for the following areas: The UPHC also plays a critical role in referral and
follow up. In urban areas given the proximity to
i. Care in pregnancy and child-birth (the
secondary and tertiary care services, this is relatively
latter would be provided based on the state
easy but requires careful planning and management.
context).
The navigational role of the ASHA and ANM is also
ii. Neonatal and infant health care services. critical. The UPHC should also undertake planned
iii. Childhood and adolescent health care specialist consultation. This assumes particular
services including immunization. importance when the screening, early detection
iv. Family planning, Contraceptive services and and management of non-communicable diseases is
Other Reproductive Health Care services. included into the package of services.

v. Management of Common Communicable The NUHM aims to provide comprehensive primary

Diseases and General Out-patient care for health care through the Urban Primary Health
acute simple illnesses and minor ailments. Centers with robust upward and downward linkages.
4 | Guidelines for Organising Urban Primary Health Centre Services | June 2017

The key principles of comprehensive primary health 9. Special efforts to identify, reach out to
care for urban areas followed in developing these and address healthcare needs of urban
guidelines are: marginalized populations.
1. Universal provision of basic preventive and
promotive care. 1.4 Objectives
2. An assured minimum package of services is The primary goal of the guideline is to improve
to be delivered to the population, as close the quality of service delivery and health
to home as convenient and necessary, to outcomes by recommending a basic set of
ensure universal access with quality. interventions to deliver primary health care
3. Increased focus on preventive and promotive services at the UPHCs. Specifically, the guidelines
care at the community level. aim to:
4. Improved management at UPHCs to reduce 1. Define the services to be delivered at the
patient load at secondary and tertiary centers. level of community, outreach, UPHC and
5. Reduction of out of pocket expenditure on referral linkages with UCHC.
drugs and diagnostics. 2. Provide guidance for planning, organizing
6. Provision of culturally appropriate health and managing service provision at the
care & counselling through trained frontline above levels.
health staff.
3. Indicate the broad infrastructural and
7. Integration and collaboration with Urban human resource requirements.
Local Bodies and other department for
4. Define the job descriptions of all UPHC
improved convergent actions for social and
staff.
environmental determinants of health.
5. Guide on establishing ancillary and support
8. Enhanced focus on screening of non-
services.
communicable diseases, early identification
of communicable diseases and early 6. Define monitoring, supervision and
outbreak identification and management. reporting mechanisms.

Figure 1: UPHC as the Epicenter for Comprehensive Primary Health Care

In-facility services
under all National
Health Programs Community Processes
Effective and Regular
Outreach Services (Community Based
interventions & Home visits
by ASHAs, ANMs and MAS)
The Urban
Convergence with Primary Health
Urban Development, Center
Swachh Bharat, Urban Population Based
Local Body (ULB) at Screening
ward level of NCDs

Multi-directional and
Assured Referral
 List of Abbreviations | 5

1.5 Target Audience 12. Ensuring infection control.

13. Establish Grievance Redressal.
The primary users of this document are all health
functionaries at the UPHC who are responsible 14. Conducting patient feedback and exit
for providing service package through the UPHC, interview.
outreach and community based interventions. 15. Convergence with national programs –
The detailed job descriptions of each functionary NPCDCS, RNTCP, NLEP, NVBDCP, RKSK,
are given in Annexure 3. This document will also be RBSK.
useful for program managers at state, district & city
levels who have a key role in supporting UPHCs in The second part of the Guideline: Adminsistrative
organising their services. organisation of the UPHC describes the range of
health services to be provided, namely:
1.6 Scope of the Guidelines 1. Care in pregnancy and child-birth.
2. Neonatal and infant health care services.
This document provides guidance for planning
and organising health services by the UPHC. 3. Childhood and adolescent health care
This entails two components: the planning and services including immunization.
management of health services and defining the 4. Family planning, Contraceptive services
range of services to be provided. Accordingly, and Other Reproductive Health Care
this document is divided into two components as services.
follows:
5. Management of Common Communicable
The introduction deals with the management Diseases and General Out-patient care.
and planning aspects of the UPHC, namely: 6. Management of Communicable diseases:
1. Human resources at the UPHC. National Health Programmes.

2. Timings 7. Integration with RNTCP.

3. Managing and governing UPHC. 8. Screening and Management of Non-

Communicable diseases - Integration with
4. Identifying and registering families in UPHC National Health Programme (NPCDCS).
catchment area.
9. Screening and Basic management of Mental
5. Organising outreach activities. health ailments.
6. Ensuring social mobilisation, health 10. Care for Common Ophthalmic and ENT
communication activities. problems.
7. Organising of general out-patient care. 11. Basic Dental health care.
8. Referral Mechanism. 12. Geriatric and palliative health care services.
9. Managing clinical support services- 13. Trauma Care (that can be managed at this
diagnostics and pharmacy. level) and Emergency Medical services.
10. Providing ancillary services- housekeeping The guidelines for planning and management of
and bio medical waste management. each service will essentially focus on the scope,
11. Converging with nutrition, water and purpose, responsibility and the process/activities to
sanitation. be undertaken for each service.
 2
Administrative Organization
of the UPHC

2.1 Human Resources at the UPHC details of selection, eligibility of each category of staff,
the organisation of training, or the requirements of
Scope: Defining number of staff required; Clarity on supervision and support from higher levels.
job descriptions, roles and responsibilities, and per-
formance measures for each staff; Skill sets required Purpose: A motivated, skilled work force is essential
and arrangements for training; Maintaining a positive for health service delivery and the achievement of
work-force environment. This scope does not include health outcomes.

Figure 2: Staff Structure at the UPHC

UCHC
For every 2.5 lakh population
Inpatient facility, 30-50 bedded
(5 lakh for metros)
(100 bedded in metros)

UPHC
MO I/C -1 ANMs -1
2nd MO (part time) -1 Public health Manager/
For every 50,000 population Nurse -1 office Mobilization -1
LHV -1 Support Staff -3
Pharmacist -1 M&E Unit -1
Lab Technician -1

1 ANM
For every 10, 000 population Out reach sessions in area of every ANM on weekly
basis

200-500 HHs
Community Health Volunteer (Asha/LW)
(1000-2500 population)

50-100 HHs
Mahila Arogya Samiti
(250-500 population)
8 | Guidelines for Organising Urban Primary Health Centre Services | June 2017

Activities: 7. The MOIC, Nurse Supervisor and Public

1. Each UPHC should put in place the following Health Manager are together responsible
minimum number of staff: 1 full time to ensure a positive practice environment
and 1 part time Medical Officer, nurse-1, for all those working at or under the UPHC.
pharmacist-1, laboratory technician-1, lady This would require public recognition and
health visitor (Nurse Supervisor)-1, ANM- appreciation and if possible incentives
3-5 (depending on population catered), for those doing their work well, polite
secretarial staff-1 and one Public Health supportive behaviour with junior staff as
Manager. In addition, there would be one colleagues, ready assistance in problem
ANM for every 10,000 population and one solving on a day-to-day basis and a
ASHA for every 2,000 population reporting learning, creative atmosphere. Above all, it
to the UPHC. requires a partnership with the community
that they serve- so that the work they do,
2. The UPHC staff needs to adhere to the dress
leads to community satisfaction, which
code as prescribed in each state.
has a direct relationship with provider
3. Duty roster mentioning the duty timing satisfaction as well. While material needs of
and responsibility of each staff, should be staff – like adequacy of salaries – cannot be
prepared regularly. taken care of within the limits of a UPHC,
4. More Medical Officers or nurses could be much can be done to improve performance
added in places where caseloads are high and provider satisfaction by creation of a
and all existing staff are fully utilised. Some positive practice environment.
of the outpatient care, especially follow-
8. The secretarial staff at UPHC level are
up care and repeat medications must be
expected to take care of all accounting
managed by the nurses so as to allow
and reporting activities. He/she should
more time for doctors to see new patients
also assist the RKS and MAS in all their
or manage complications where clinical
accounting and reporting related activities.
judgement is required.
He/she shall seek guidance from the
5. Job responsibilities for Medical Officer and block/ district/ municipal corporation level
Public Health Manager, LHV/ANM supervisor, accountant for all accounting and reporting
ANM and ASHA are given in Annexure 3. related assistance.
Job Responsibilities of ANMs have been
defined in “Operational Guidelines for
2.2 Timings
Enhancing Performance of ANMs in the
Urban Context”. • The UPHC should be operational for 8 hours
every day. Suggested timings include 12 pm
6. The MOIC with assistance from the Nurse
– 8 pm or dual shifts from 8 am – 12 pm and
Supervisor is required to ensure that the
4 pm – 8 pm.
skills with respect to standard treatment
guidelines and care protocols are present in • Each UPHC should have morning and
all the staff under them, and recommend for evening OPD. OPD timings may vary as per
training anyone who has significant gaps. state norms.
This includes the skills of the laboratory • The laboratory timings need to match the
assistant and the pharmacists. The MOIC OPD timings. The timings should cause
and Nurse Supervisors themselves must as little inconvenience to the patients as
be trained at the city or district level by possible. Patients should not have to make
appropriate resource teams and certified as repeat visits for tests, collection of reports,
having the necessary skills. post-test consultation etc.
 2 Administrative Organization of the UPHC | 9

2.3 Management and Governance preceded by the release of an annual report

of the UPHC of the UPHC performance.

Scope Public Consultations and Public information

1. Management of the UPHC. 5. Where new UPHCs are being created or any
2. The role and functions of the Patient Welfare other social barriers that exclude access to
Committee. vulnerable groups, discussions must be held
in consultation with the community as to
3. Patients charter, public information
which location would be most useful.
including signage, grievance redressal.
6. The patients’ charter is prominently
4. Information management and reporting
displayed in UPHC waiting area. Signage as
Ensuring quality of care.
required must be displayed at the centre.
5. Monitoring and reporting.
All of these should be in the language spoken
6. Financial management. by most of the service users of that area.
Purpose: The UPHC needs to provide quality services
Information Management and Reporting
that are responsive to people’s needs and demands
and hold itself accountable for its performance. 7. Monthly compilation and analysis of health
It must be able to measure the effectiveness of care information should be collected by UPHC staff
it provides, improve the efficiency with which it is for the IDSP programme, the RCH programme,
provided, and ensure quality of care. the various disease control programmes.
The same must be uploaded on the various
Responsibility: MOIC, Nurse and Public Health web-based databases of Govt. of India,
Manager including MCTS, HMIS, IDSP, and Nikshay, and
Activities: as per State Govt. requirements.

1. Management of the UPHC is through a 8. Monthly health service information on out-

management committee made up of the patients categorised by diagnosis should be
Medical Officer (s), the Nurse Supervisor or the reported to districts.
senior nurse and the Public Health Manager. 9. Governance data on stockout of essential
This committee should meet weekly. 2 medicines, staff absenteeism and
infrastructure upkeep is to be recorded.
Rogi Kalyan Samitis (Patient Welfare Committee)
10. Basic analysis of data should be performed
2. Each UPHC shall also constitute a Patient either through HMIS or manually or through
Welfare Committee or Rogi Kalyan Samiti (RKS) simple computer programmes.
as per guidelines. The guideline provides for
11. The UPHC needs to integrate monitoring
public participation, both of elected members
and reporting mechanisms for the routine
and of other public representatives.
and special outreach. For the monitoring and
3. Meeting of the RKS should be held at reporting of outreach sessions, the UPHC
least once in two months. In between the may refer to the Operational Guidelines
meetings, the management committee acts for Conducting Outreach Sessions in
as its secretariat in ensuring that the decisions Urban Areas (2015) and Guidelines for
of the RKS are implemented in the UPHC. ASHA and MAS in Urban Context (2015).
4. Reports to the RKS are made public
documents to inform the achievements, Ensuring Quality of Care
shortcomings, challenges and finances of 12. The quality of care provided should be
the UPHC. An annual review meeting is held ranked and scored according to the
10 | Guidelines for Organising Urban Primary Health Centre Services | June 2017

Quality of Care Framework (2013)

prepared by NHSRC and released by the Characteristics of a Model UPHC
Ministry of Health and Family Welfare. • The facility should have good visibility,
The quality score and sub-scores should with standardized colour coding of
be included as part of the Annual Report. signage and exterior façade.
13. Kayakalp Guidelines should also be followed • Map at the entry of the UPHC and
for the good up keep of U-PHC premise by signage at the appropriate places may
RKS and staff of U-PHC. be placed for guiding the patients
during their movement in the facility.
Financial Management • Facility should be clean with pleasant
14. Financial management is an important surroundings.
contributor to the functioning of the UPHC • Should have patient friendly
and its community outreach programmes. environment and waiting areas.
Good accounting practices lead to timely
• Should be friendly for the differently-
utilisation certificates and transparency and
abled. Stairs should be complemented
integrity in financial expenditures.
with ramp/lift for smooth access of
15. Better allocation of available resources services in the facility.
and innovative ways of raising resources is • Preference to senior citizens must be
essential to close the gaps. In particular, the given at every level of interaction.
UPHC management can make good use of
the untied funds received as grants and also
• Services rendered should be gender
sensitive with zero tolerance for
try to raise money from urban local bodies
compromise in dignity and privacy.
and donations for improving the quality of
services it provides. • Separate washrooms, breast feeding
corners, respectful behavior are some of
16. MOIC/nominated person in his/her absence
the key indicators for gender sensitivity.
shall be accountable for discharging financial
management responsibility. • Registration counter and emergency
facilities with triaging should be in the
17. The staff shall follow the Financial most accessible area.
Management Guidelines issued by the
Govt. of India for NHM and all related
• Waiting area should be immediately
adjacent to the consultation room.
letters/circulars. Some of the important
points to note are as follows: • Sufficient wheel chairs and stretchers
should be made available at the patient
a. Books and records as mentioned in
receiving area.
the financial management guidelines
should be maintained. All vouchers • All IEC displays should be relevant & easily
and supporting documents should be visible. It should be properly framed and
maintained chronologically. displayed, never pasted on wall.

b. Reporting to the block/district/ • All displays and signage should be in a

municipal corporation and submission language easily understood by the local
of Utilisation Certificates (UCs) should community.
be done on a timely basis. • The option of co-locating the AYUSH
centre with U-PHC may also be explored,
c. The UPHC shall be available for audit as
thus enabling the placement of AYUSH
and when required. Any issues pointed
doctor and other AYUSH paramedic staff
out by audit, shall be promptly attended
in the U-PHC.
to and resolved.
 2 Administrative Organization of the UPHC | 11

2.4 Identifying and Registering the ASHA along with the PHC staff to discuss
Families/Individuals in the services available at the UPHC.

UPHC Catchment Area d. Data Collection: During this visit, the

household level information must be
Scope: All persons living in the catchment area of updated using a simple questionnaire. The
UPHC as per their health needs and demands. questionnaire must gather information
related to vulnerable individual’s risk factors
Purpose: To understand the profile of the catchment
and chronic illnesses
population and their healthcare needs.
a. The information should capture basic
Responsibility: Medical Officer In Charge (MOIC) demographic data: name of each
and Public Health Manager member, age, sex, relationship with head
of household, occupation and current
Process:
need and access to primary healthcare
a. Defining Area: MOIC should obtain a broad services, number of under-five children,
written mandate from the Nodal Officer in immunisation status, pregnant women
the Municipal Corporation / Chief Medical with ANC history, eligible couples,
and Health Officer (CMHO) of the district, and it would also include vulnerability
regarding the area to be covered. category. The data base would include
b. Source of Data: The database of all listing the migratory or homeless
households and individuals should be population based on the Vulnerability
obtained from one of the following sources- Assessment Guidelines (2017). This could
Census, Election Commission’s house lists, be done in a paper format or in an
Pulse Polio lists or any other survey done in electronic format. The visit should also
the state/city. Even one of these would be include examinations like Blood Pressure
adequate but the preference is the order indi- measurements; glucometer readings for
cated above. If none are available, the MOIC blood sugar are optional.
along with Public Health Manager must b. After the assessment, each family
ensure a formal house listing. Households member should be given a health card
should be given a unique number derived for future reference and follow ups.
from any of the available lists (refer b). If not,
e. Data Management & Line-listing: Demo-
then house number may be allotted based
graphic database must be uploaded on the
on the house-listing. Aadhar number may
website. This would require a computer at
also be recorded wherever available.
the UPHC with internet connectivity. A tab-
c. House Visits: A house listing team comprising let with every UPHC is also desirable. The
of the ASHA/link worker/community Public Health Manager should undertake
organisations/NGOs is recommended to this task with the help of other staff. From
visit each house, as per the State’s discretion the data base that is created, separate lists
and fill up the basic details of demographic of eligible couples, pregnant women, in-
data in a format. ANMs and PHMs need to fants, children aged one to four, and those
supervise this activity. PHM also needs to with different specific chronic illness as in-
analyse the report and bring out the areas cluded in the package are also generated,
of concern and actions required to address recorded and reported. Computerisation
these gaps. Over a period of three months, facilitates this process greatly. The lists of
each household to be catered by the UPHC pregnant women and children under one
should be visited on an appointed time by should match with those on the mother and
12 | Guidelines for Organising Urban Primary Health Centre Services | June 2017

child tracking system and/or HMIS- and mis- 2.5 Organisation of outreach
matches should be identified and corrected.
The focus should be on the vulnerable
activities
population. These are the facility specific Scope: Planning and implementation of Urban
denominators that would be used for mea- Health and Nutrition Days (UHND) and Special
suring performance. Outreach Camps.

Reporting: Purpose: To reach out to vulnerable population with

a. The demographic database and the basic preventive health services, and refer them to
registered population database should be the UPHC or higher center for further care [Detailed
reviewed annually and checked with the guidelines on organizing outreach activities have
field situation. The chronic illnesses database been released in “Operational Guidelines for
is also reviewed and updated along with any Outreach Activities in Urban Areas” ].
additional details available. The separate Responsibility: ANM and ASHA at the outreach
lists of eligible couples, pregnant women, venue; MOIC and PHM for planning and MAS for
infants, and children aged one to five, would awareness generation.
get regularly updated each month and any
changes needed on the demographic data Planning of Outreach Activities
base could be carried out on a quarterly 1. Each UPHC shall determine the minimum
basis (later with inter-operable systems it requirement of outreach sessions it needs for
could happen on a real-time basis). immunisation sessions, health and nutrition
b. Relevant data as required and asked for days and for health camps with an NCD
should be uploaded on to the web-portal of focus. Since a UPHC caters to approximately
the state government. States may decide to 50,000 population, and is expected to
provide names and individual details to be have five ANMs under it, it may decide on
uploaded or may only provide the aggregate anywhere from 10 to 20 outreach sites such
number of registered population. If there is that there is one site close to every 2,500 to
any change in this registered population 5,000 population sub-group.
database or in the demographic database, 2. The timing of the outreach session is critical,
or in the data uploaded onto the state web- and should be held at a time convenient to
portal, the changes should be made as and the community. The site and the timing –
when notified along with an audit trail which the day in the month and the time of the
would record who made the change, when day, should be fixed in consultation with
and what was the changed data. the MAS.

Improving Access to Vulnerable Section of Urban Poor

To target special interventions for the vulnerable groups in the cities, mapping of the vulnerable
groups should be undertaken as a periodic exercise, ideally every six months. The vulnerable sections
would include the rag pickers, street children, construction workers, sex workers, street vendors and
other such migrant workers. It is also envisaged that dedicated drug distribution centres be opened
for the identified vulnerable groups, through Non-Government Organisation (NGO)/Civil Society
Organisations (CSOs), which will have provisions for emergency Over-The-Counter (OTC) drugs and
contraceptives. Special attention should be paid to organising outreach sessions for these vulnerable
communities.
 2 Administrative Organization of the UPHC | 13

3. Outreach locations could preferably be an 9. List of essential services at the UHND

ICDS centre, but it may also be a school, a Service Essential Service Delivery
community hall or rented room paid for by
Maternal Care Registration, three ANCs, identification
the ULB, or any private premises. Ideally it and treatment for anaemia, referral to
should have two to three rooms that can UPHC for one ANC, identification of
be temporarily taken over for three to four risk factors, referral for institutional
delivery, postnatal care follow-up,
hours for one day in a month.
counselling.
4. Vulnerability assessment/ health service Immunisation Immunisation as per schedule.
needs assessment of the population, in the Child Care Identification of danger signs, referral,
catchment area of the UPHC shall guide in follow-up, distribution of ORS,
deciding the location and nature of services paediatric cotrimoxazole, postnatal
visits/ counselling for newborn
to be provided through outreach.
care, identification and treatment of
5. Outreach activities should be organised malnourished children.
in partnership with MAS in that area, Family Family planning, Counselling,
the ASHAs working in that area and any Planning distribution of OCP/CC, referral for
sterilisation, follow-up of contraceptive
community based organisation or NGO
related complications.
which is acceptable to the MAS and to the
Adolescent Counselling related to sexual
UPHC committee. Health concerns, pregnancy, contraception,
abortion, menstrual problems,
Urban Health and Nutrition Days: Tetanus immunisation as per
UIP schedule, weight and height
6. The outreach sessions are so planned that
measurement, BMI calculation and
an ANM organises one outreach session per appropriate nutritional counselling
month or additional sessions if required can for underweight or overweight
be proposed as per the need. If there are condition as may be. Examines blood
for haemoglobin and treats anaemia
five ANMs under a UPHC, there would be
till it normalises.
20 outreach sessions held per month. On
Vector-borne Slide collection, testing using RDKs,
occasions the ANM may have to hold two Disease Counselling for practices for vector
such sessions per week, especially if some control and protection.
posts are vacant. If the vacancy is higher, Tuberculosis, Detecting suspected cases of leprosy
the outreach sessions are planned for most Leprosy, HIV and TB.
vulnerable groups, and the rest are required Non- Screening for non-commun-
to come to the UPHC. communicable icable diseases, follow-up of under
Disease treatment patients and referrals as
7. Though ASHAs, UPHC staff and MAS assist required.
ANM in organising, but the accountability
for the camp is with the ANM of the Special Outreach
allocated area. 10. Special outreach for the vulnerable groups
8. The ANM should maintain a record of needs to be organised on a monthly basis.
services provided in each outreach session. The special outreach should focus on the
A simple line list of service user, the identity vulnerable groups who are hard to reach
of the service user and the nature of and for whom accessing health service
service provided is adequate. Where it is a is a major concern. The location of these
category of patient requiring follow-up like sessions should be in the area where such
a pregnant woman, or an infant coming population resides (Community Centre,
for immunisation, or an adult taking NCD School, Railway Station, railway tracks, city
medication, the required follow-up data is outskirts, Bus Stands, underpasses, outside
also recorded. place of worship etc.)
14 | Guidelines for Organising Urban Primary Health Centre Services | June 2017

11. In the special outreach sessions, specialists 3. In practice, at the appointed time, the ASHA
from higher centers should be called for would call all members and convene the
addressing health needs for locally endemic meeting with clear agenda for the meeting,
diseases and population sub group-specific such as tobacco control, hypertension,
problems, chronic and non-communicable diarrhoea in the neighbourhood or any
diseases. Basic laboratory investigations organisational issues such as improving
(using portable/disposable kits) and drug UPHC or outreach services, water and
dispensing services must be ensured by sanitation problems. Posters or leaflets
MOIC along with ANM. ASHA and MAS designed may be used during each meeting.
should ensure that camps are attended Twenty women in a group of 500 people
by those needing such care. Lab Tech, being sensitised on some key messages
Pharmacist, Physiotherapists may also be is a very effective way of community
participating in these sessions. mobilisation for a theme.
12. Records of outreach camp including patient 4. Site of meetings could be innovative. It could
details, services provided referral details be one fixed place, or it could be in different
should be maintained systematically to houses by turn.
enable follow up.
5. Agenda of all meetings should include some
solidarity building activities, collecting
2.6 Social Mobilisation for Health information on key health events like births,
through ASHA and MAS deaths, specific illness episodes etc. and
imparting information on the time of the
Scope: The establishment, support and functions
next outreach session and special health
of MAS, support and functioning of ASHAs in the
camps, if these are scheduled.
urban context, involvement and participation of
other relevant community based organisations and 6. At least once in three months there should
partnerships. be a meeting at the UPHC level of all the
conveners of the MAS, the ASHAs under the
Purpose: Most preventive and promotive actions
UPHC area, and the ANMs. Potentially there
and a considerable level of self-care and primary
are 100 MAS and 50 ASHAs and five ANMs
care occurs at the level of the community and
in such a meeting. Alternately, the most
family. To ensure a pro-active community and family
active MAS from each ANM’s area could be
participation through social mobilisation of health
called. The content of the meeting would be
for NUHM.
to review MAS and ASHA functioning and
Responsibility: Public Health Manager, ANM, ASHA planning activities for the next three to six
and MAS months. The public health manager and the
elected ward member(s) of that area should
Activities: also attend.
1. Mahila Arogya Samitis should be constituted 7. On special occasions and themes, and
for every 500 population- or approximately when funds are available, these meetings
100 households. These could have 10 to 20 could take the form of one or two day
members, who could be chosen by asking training programme. Observing special
every 10 houses to choose two members. days like World Health Day, HIV day or
2. MAS should meet at least once a month. It World Malaria Day etc., could be one
is the role of the ASHA to ensure this and way of bringing focus on issues which
she may need the help of other partners to are important health issues for that
manage it. community.
 2 Administrative Organization of the UPHC | 15

8. In addition to the above, when dealing with 2.7 O

 rganisation of General Out-
MAS or community based organisations
representing specific vulnerable groups,
patient Care
assistance should be taken from selected Scope: Patient registration, queue management,
NGOs or academic departments of social standards of time management, privacy and
work or departments of public health. laboratory and pharmacy support. Purpose items
Professional associations could also assist in 3, 6 and 7 listed below are specific to registered
providing training and support to the MAS patients in the facility’s catchment area whereas
members and ASHAs of that area and hold the rest relates to anyone seeking care at the UPHC
special health camps as needed, responsive irrespective of identity.
to the needs of that vulnerable group.
Purpose: The general out-patient care includes
9. All the above are also effective forms of
provision of health advice related to preventive,
health communication and measures to
promotive and curative needs of patients. This
improve positive health practices and
would include:
change behaviours which have adverse
health consequences. This is supplemented 1. Accurate and timely diagnosis and treatment
by ASHAs making a home visit to every or referral for illnesses.
house in her service area and spending time 2. Patient care as required at the facility
on health communication and gathering level for maternal and newborn health,
health information. immunisation, child health, adolescent
10. Routine house visits take place at a frequency health or national disease control
of one per month and are used for imparting programmes as per protocol.
key health messages and encouraging 3. Screening for chronic diseases as per
utilisation of services as relevant to the protocol, regular and assured follow up care
individuals in that household. The list of the for patients so that they can have requisite
ASHA's activities at the level of the family is monitoring, access to routine prescribed
part of the services described in 2.3 to 2.6 medication, counselling and early detection
of this chapter. and referral for complications.

Figure 3: Schematic Representation of Social Mobilization Process

Local NGO/professional ASHA organises MAS

HHs select 10-20
associations train MAS to undertake monthly
members to constitute
members to undertake meetings on community
MAS
outreach activities health issues

MAS and ASHA MAS organises routine HH MAS, ASHA and ANM
maintain record book visits per month to impart meet once in three
for every household key health messages and months at the UPHC.
monitoring their health encourage utilisation of Public Health Team leader
records UPHC services leads the meeting
16 | Guidelines for Organising Urban Primary Health Centre Services | June 2017

4. Assured NCD screening services and its 6. Preference needs to be given to elderly,
linkages with organized screening. Follow pregnant women, and other vulnerable
up of those detected with any morbidity groups. This could be done by separate
or illness. queues or in some instances separate clinics
5. Facilitation of access to emergency with special waiting arrangements, till their
transport and stabilisation care for medical number comes up.
or surgical emergencies. Ideally patients 7. All patients waiting for consultation treatment
should bypass this stage and go directly should be seated and should have access to
to site of care, but the facility needs to be safe drinking water and toilet facilities.
prepared for the same.
8. Records of patients treated under national
6. Identification of patients with symptoms programmes as per protocol, and for regular
of chronic complex illnesses - like cancer, chronic illnesses should be maintained
psychosis, etc. and referral to a higher centre. for all visits. Records could be in the form
7. Response and feedback to referrals from of registers, case-sheets or digital records
frontline workers- ASHAs, ANMs etc. as depending on the existing systems.
needed. 9. To manage the consultation time
8. Building a relationship of trust, confidence, adequately, preliminary tests such as Blood
understanding and satisfaction with the Pressure examination, height and weight
population served. examination may be done by the nursing
staff prior to consultation.
Responsibility:
10. Consultation should cover previous health
Overall: MOIC
history, living conditions and family history.
Registration & waiting The staff at the registration
room counter Following consultations, MO should provide
a diagnosis, treatment and follow-up plan
Consultation MO, ANM/Nurse for queue
management, records and ask patients if they have any questions
Lab Lab technician regarding the consultation provided.
Pharmacy Pharmacist 11. There should be adequate privacy for
patients to discuss their health problems
Activities: without being overheard, and to be
1. All patients should be registered according examined without being seen by the waiting
to category of care and if they are already public or others.
registered from the catchment population, 12. The patient should be referred for laboratory
their number should be recorded in the tests based on the symptoms, if any
registration book. diagnostic services are required.
2. All registered patients need to be provided 13. The patient needs to be directed for follow
with a registration slip. up consultation after the diagnostic reports
3. All patient details need to be recorded in the are made available, to facilitate further line
patient’s card. of treatment as needed.
4. No person should be turned away without 14. The patient needs to be directed to the
providing basic consultation, even if it is for pharmacy if any medicine has been prescribed
referral to a higher centre. under the initial consultation by the MO.
5. Patients should be provided a queue 15. Special clinics may be organised in the
number that would be used to call the afternoon or evening, on some specified
patients for consultation. days, to enable a more focused follow up
 2 Administrative Organization of the UPHC | 17

on some categories of chronic illness or for 4. Existing hospitals including ULB maternity
adolescent clinics etc. Schedule of such clinics homes, state government hospitals and
should be displayed at the UPHC and actively medical colleges other than private
disseminated during outreach activities by hospitals, will be deemed to act as referral
the ASHAs/ANMs and during UHNDs. points for different types of healthcare
services such as maternal health, child
2.8 Referral Mechanism health, diabetes, trauma care, orthopaedic
complications, dental surgeries, critical
Scope: Establishing a two-way referral mechanism illness, surgical cases etc.
to ensure continuity of care.
5. It is also expected that the collaboration
Purpose: with District Hospitals/Area Hospitals/
Sub-District hospitals and local
1. To enhance the system’s ability to transfer
Medical Colleges may be promoted
patients between different providers and levels
for strengthening the training support
of the health care system, along with detailed
and supplement human resource at the
records and documentation of the case.
U-PHC level.
2. To provide follow up care after referral
consultant or supervise adherence to long 6. In addition to specialized clinical facilities
term treatment plan as advised at the at the above mentioned hospitals, UPHC
higher centre. need to identify centers providing services
such as de-addiction for substance abuse,
Responsibility: Medical Officers, Staff Nurse, ANM mental health services, rehabilitation,
domestic violence help center, nutritional
Process: rehabilitation center (NRC) and others
1. Urban Community Health Centre (U-CHC) as per population needs. Such multi-
should be set up as a satellite hospital for directional referral pathway is very
every 4-5 UPHCs. UCHC would cater to a important to ensure that all health needs
population of 2,50,000. It would provide of the community are met.
in-patient services and would be a 30-50
7. Wherever public sector coverage is
bedded facility. For metros, U-CHCs would
inadequate, reputed private sector
be set up with a population of above five
institutions may be considered.
lakhs, wherever required.
The empanelled/accredited facilities could
2. UCHCs are designated to provide specialist be reimbursed for the services provided
services. So, every UCHC should have as per the pre-decided rates, negotiated
defined linkages with the ground level with them at the time of empanelling/
facilities ie. UPHCs. This will help in effective accrediting them and indicated in the
management and follow-up of the patients city level urban health Programme
requiring specialized care. Implementation Plans (PIPs) subject
3. UCHCs can also plan to send specialist to to approval at the appropriate level.
the feeding UPHCs on monthly/ fortnightly This will not only ensure flexibility to
basis. This will help in providing specialist adapt to different conditions in different
services closer to people and would also cities but also increase the range of
assist in their timely review and follow ups. options for the beneficiaries. For all such
(Referring a patient from U-PHC to higher PPP models, robust monitoring indicator
facility can be referred from Section 7.16 of and mechanism needs to be defined in
‘Referral Unit’, NUHM Framework). the MOU.
18 | Guidelines for Organising Urban Primary Health Centre Services | June 2017

Activities: A handout/card could be prepared at the

UPHC mentioning the details of the higher
1. UPHC needs to identify a contact person/
facility where the patient is referred.
desk in each referral center to inform and
take information regarding the patients 6. All relevant diagnostic results (laboratory,
referred, to ensure that they receive the radiological studies, previous referral
necessary consultation that can enable information, etc.) should accompany the
follow up by UPHC. Patient Referral Form.
2. All referrals should be in writing on a referral 7. The UPHC staff would communicate and if
slip (Given in Annexure 4). possible schedule an appointment with the
3. At the site of registration, the referring receiving clinic/hospital to ensure advance
facility and provider should record the notice of the referral given and that the
information in digital form or if not patient is expected. This is mandatory if the
digitized, then in a referral register. referral is an emergency. For emergency
A feedback referral form could be attached referral, transport needs to be made available
to the OPD slip at the time of referral. The as per established practice or availability
following information must mandatorily in the State. Toll free nos. 102/108 or any
be sent along with the patient: other can be used for calling ambulances
if available. All referred cases needs to be
Identity Details: Medical/Clinical Details given a referral card or slip. It shall be the
Full name of patient w 
w  Date and time of responsibility of UPHC staff and ambulance
(and name of person referral staff to ensure safety in transit, monitoring,
responsible in case of and documentation.
minors w Diagnosis, if known

Name of the person w Treatment given

w  Following activities should be carried out at the
responsible in case of w Reason for referral secondary (UCHC/District Hospital)/tertiary level for
minors – (name, address
w N
ame of physician the referred patients -
and phone number)
or facility where the 1. At the referred facility, the patient should be
Age and sex of the
w 
patient
patient is referred guided by the registration desk/helpdesk
Address and telephone w 
w  Name of the doctor/ staff to meet the appropriate provider.
number (if available) of nurse and the UPHC In large hospitals, to encourage referral
patient making the referral
and to slowly shift to UPHC as gate-keeper,
w ID of the patient Contact details of MO/
w  the registration-cum-helpdesk for referred
MOIC and the UPHC patients should be separate from that for
making the referrals
other patients. To qualify for this preferential
treatment, the patient should be coming in
4. To establish an effective linkage, digital
with the UPHC referral slip duly signed by
platforms can also be used for sending
the MOIC/MO.
patients information to the referred
clinician/ facility, or conveyed by fax/email. 2. Providers at the referred facilities shall
receive the referred patient, along with the
5. Irrespective of providing the information
referral note from the UPHC which could be
in writing, the health provider should also
in digitised form or on paper. They would
inform the patient on reasons for referral and
assess them and provide the necessary
risks of non-referral. They should also provide
interventions.
details on how to reach the receiving facility,
location and transport, whom to see, what The details of referral process are explained in
is likely to happen, and follow-up on return. Section 7 of NUHM training Module
 2 Administrative Organization of the UPHC | 19

2.9 Management of Clinical • Blood smear examination malaria.

Support Services: Diagnostics • Blood for grouping and Rh typing.

Lab and Pharmacy • RDK for Pf malaria in endemic districts.

• Rapid tests for pregnancy.
Scope: Management of laboratory and pharmacy • RPR test for syphilis/YAWS surveillance
services as required for a UPHC. (endemic districts).
Purpose: Organisation of appropriate laboratory • Rapid test kit for faecal contamination of
and pharmacy services is essential to support water.
quality of care and effectiveness in service delivery • Estimation of chlorine level of water
by the UPHC. using orthotoludine reagent.
Responsibility: Laboratory technician, Pharmacist, • Blood sugar.
MOIC • Blood lipids, blood biochemistry for
urea, creatinine and liver function tests
Laboratory could be done locally if auto-analyser
1. The UPHC needs to be staffed by a qualified available or outsourced.
laboratory technician. In the absence of a
5. The laboratory should adhere to minimum
qualified technician, certain essential but
quality standards as defined in Quality
simple tests can be sustained by multi-
Assurance Standards for UPHCs. Quality
skilling other staff.
checks may require cross checking of
2. If U-PHC does not have a Lab Technician, a sample of tests done in a reference
it can also serve as a collection centre laboratory, which may be done once in
for diagnostic tests in partnership with six months. For malaria and tuberculosis
empanelled private diagnostic centres. every positive slide and small percentage of
However, monitoring and audit mechanisms negative slides (about 5 to 10%) should be
must be established clearly and robustly sent monthly for a quality test (as per the
while entering PPPs. guidelines of the national programme).
3. Simple tests of larger volume should be 6. The working area should have defined
done in the UPHC, but technically more protocol for patient entry, sample collection,
demanding tests which are of lesser volume testing areas, report collection etc.
could be outsourced to a suitable laboratory
7. All staff should be in hospital attire and
under a contract or to the government
practice infection prevention protocols. It
hospitals linked with the UPHC.
should never be a thorough fare and entry
4. The minimum laboratory services that a must be restricted.
UPHC should provide are:
8. INQUAS and EQUAS must be in place for all
• Routine blood tests (Hb%, platelets critical equipment and tests.
count, total RBC, WBC, bleeding and
9. A standard should be established for the
clotting time).
time within which the laboratory—whether
• Routine urine tests (sugar, albumin, in house or outsourced—will provide the
microscopy). results and the format and routes (SMS,
• Diagnosis of RTIs/STIs with wet paper, email etc.) by which it would be
mounting, grams stains, etc. provided to all.
• Sputum testing for mycobacterium (as 10. Laboratory timings should match with the
per guidelines of RNTCP). OPD timings. It should be kept in mind that
20 | Guidelines for Organising Urban Primary Health Centre Services | June 2017

patients do not have to make repeated visits 2.10 Ancillary Services:

to the facility for tests, collecting reports,
Housekeeping and Waste
post test consultation etc.
Management
11. Disposal of used syringes, cotton and other
waste items must be disposed as per the Scope: Measures to ensure cleanliness in all internal
biomedical waste management guidelines. and external areas of the UPHC including- biomedical
waste management, infection control practices,
Pharmacy sanitation, environmental hygiene, odour control;
1. The UPHC pharmacy should, at all times, pests, rodents and animal control.
maintain stock supply of essential drugs
Purpose: To provide processes, instructions and
as listed for UPHC. The list of drugs for
minimum service delivery can be referred to methodology for management of housekeeping
in Annexure 2, Essential Drugs for UPHC, and biomedical waste management, with the
(IPHS Guidelines for PHC, Revised 2012). aim of patient and public safety through reduced
infections, and better patient experience in terms of
2. The essential drug list has to be displayed
comfort and satisfaction.
prominently at the visible place of the facility.
3. The threshold level for placing the order/ I. For House-keeping
indent for refill should be a stock level,
Responsibility: Responsibility of sanitary staff
equivalent to three months utilisation in the
under overall supervision of MOIC and PHM.
previous year. At no time should the stock
levels fall below a one month of supply for 1. The minimum cleaning frequency and
any drug/ consumable. This buffer is required methods need to be defined and maintained
in anticipation of a sudden spurt in demand as a reference document.
as would happen in an epidemic. 2. The procedures would, for example,
4. The pharmacy should maintain records of all specify that UPHC external environment
medicines and drugs at its facility along with should be cleaned once a day, consulting
proper inventory mechanisms (First Expiry rooms should be cleaned thrice a day, the
First Out - FEFO). Expired drugs should be toilets should be cleaned thrice a day, linen
removed from the shelves and returned washed twice a week, and soiled linen
for disposal as soon as they expire. Soon to should be replaced at once.
expire (within 3 months) drugs should be 3. For each activity, it would specify additional
sent back to the district / ULB store so that quality standards: For example,
they can be used in a high volume facility.
a. Sweeping and mopping with dis-
5. The UPHC pharmacy should also ensure that
infectant materials.
the ANMs and ASHAs under the UPHC have
adequate drug stocks. For this purpose, each i. At least twice a day, additionally
of them should have a simple stock card which when needed.
shows the number of drugs they have for the ii. Mopping should be done in one
beginning of the month, the number that direction.
was added and the number spent, as also the b. Wash the walls with a brush, using
numbers disposed due to expiry or damage. detergent and water.
6. Stock and issue register with details of
c. Do high dusting with a wet mop.
medicine needs to be maintained in the
facility. As per the norm, random quality d. Clean fans and lights with soap and water.
check of the medicine from the stock should e. Disinfect all work surfaces by wiping
also be conducted at regular interval. with disinfectant.
 2 Administrative Organization of the UPHC | 21

f. Clean the cupboards, shelves, beds, lock- the necessary sanitation staff is hired and
ers, intravenous fluid stands, stools and appropriately instructed and trained.
other fixtures, with detergent and water. 5. Provide the necessary sanitary equipment
g. Change curtains periodically or whenever and consumables to keep the premises
soiled, and send them regularly for clean including safety equipment like gloves
laundry. and boots.

h. Clean the patients’ beds (if any) every 6. The person appointed for supervision should
week with detergent and water. Use 1% have a checklist with dates; the staff should
hypochlorite when soiled with blood or sign against each item, stating when it was
body fluids. done and the supervisor counter-signs it.

i. Collect the waste category-wise, from all II. Waste management at the UPHC
the departments (OPD, Injection room,
laboratory, pharmacy and other places), Responsibility:
and store them at the designated Overall MOIC
location. Daily Monitoring Staff Nurse or any other
staff delegated by MOIC
j. Clean the kidney basins, basins, bed
Segregation All staff handling waste
pans, urinals, etc. with detergent and
Collection, Housekeeping Staff
water, and disinfect them with Phenyl,
Transportation & Storage
especially when these have been used
Disposal Outsourced Agency/
for infected patients. Housekeeping Staff
k. Clean the floor of bathrooms with a
broom and detergent thrice a day and Activities:
then with disinfectant solutions. During 1. Segregation of Waste: This shall be done
out-patient hours, clean them hourly. at point of generation as per Biomedical
l. Clean the toilets with a brush, using Waste (Management & Handling) Rules
detergent disinfection with Phenyl. 2016 in different colour coded bins with
liners. Infectious waste must not mix with
m. Stains may be removed using
non-infectious waste. Adequate number
Hydrochloric acid.
of bins and liners for proper segregation
n. Clean the wash-basins with detergent and collection of biomedical waste should
powder every morning. During out- be provided at point of use. Needles and
patient hours, clean them every hour other sharp items should be handled and
o. Segregate, store and dispose bio- disposed as per standard protocols to avoid
medical waste as per guidelines. accidental sharp injuries. There are also
protocols for liquid waste, blood spillage,
p. Check for cobwebs, wild growth of
laboratory waste and contaminated plastic
vegetation, and nests/beehives in the
that must be adhered to. For liquid waste
building once a week and remove as
management, clean the liquid waste spill by
and when required.
adding equal or more quantity of bleaching
q. Store and dispose non-functional powder solution. Leave the area for 30
furniture, equipment, instruments, minutes and then wipe the area with a swab/
stationeries and other junk material, as cloth. Discard the swab/cloth after cleaning,
per instructions. into the red bin meant for plastics and other
4. Based on these work specifications, either waste. If possible, dispose the liquid waste
the work is outsourced through bidding, or into the drains.
22 | Guidelines for Organising Urban Primary Health Centre Services | June 2017

2. Collection of waste: Waste should be For more details on Infection Control and
collected by housekeeping staff at the BMW Management, Infection Control and
respective department in two shifts, morning Environmental Plan- Guidelines for Healthcare
and evening (or as required) preferably workers for Waste Management and Infection
when there are minimum OPD patients/ Control may be referred to.
visitors, except, if applicable, in labour
room where the waste should be collected 2.11 Infection control
after every delivery case. Waste should be
collected in two shifts or when waste bin is Scope: To enable health functionaries to implement
¾ full, whichever is earlier. the infection control programme effectively in
order to protect themselves and others from the
3. Transportation of waste: Daily waste
transmission of infections. This includes:
should be transported to disposal site in
closed container through a pre-defined • Hand washing and antisepsis (hand hygiene).
route avoiding crowded area. A large plastic • Use of personal protective equipment when
bag should be used to line the wheelable bin handling blood, excretions, secretions etc.
to prevent any liquid leaks from the waste
• Appropriate handling of patient care
bags from soiling the bin. This plastic bag
equipment and soiled linen.
should be replaced in each shift.
• Prevention of needle stick/sharp injuries.
4. Safe disposal of waste: The disposal of
waste is done by the outsourced agency • Environmental cleaning and spills-
hired for waste management. Anatomical management.
waste (yellow bag) is disposed in deep burial • Appropriate handling of waste.
pits constructed as per specifications of BMW
Purpose: To provide process, instructions and
Management and Handling Rules. Sharps in
methodology for infection control for provider,
puncture proof box should be disinfected
patient and public safety in terms of reduced
and disposed in sharp pits. Contaminated
infections and better patient experience.
solid waste (red bag) should be disinfected,
mutilated and then disposed with general Responsibility: MOIC, Staff Nurse, Sanitary Staff
waste. General waste is collected from
1. All aspects of bio-waste management and
the facility and disposed by Municipal
good housekeeping contribute to infection
Corporation in landfills.
control (Refer 3.13 on Housekeeping
5. Common bio-waste disposal: Given and bio-medical waste management). In
space constraints, a common arrangement addition, the following need to be observed:
for waste disposal for all public health
2. Suitable seating arrangements of patients
facilities in the defined urban area may be
and issue of disposal masks to patients who
explored.
are coughing or sneezing while in the queue.
6. Monitoring and quality control: MOIC
3. Hand washing and antisepsis:
should take rounds of UPHC to assess the
process flow and compliance of bio-medical a. After handling any blood, body fluids,
waste regulations once a week. Observations secretions, excretions and contaminated
should be recorded and corrective and items.
preventive action should be taken. If required b. Before and after examining a newborn
under MIS or another authority, reporting or pregnant woman or immune-
should be done in the prescribed format and compromised patient, or doing any
within time. interventional procedure.
 2 Administrative Organization of the UPHC | 23

c. Between contact with different patients- appropriately before being used on

which would mean hand washing after another patient.
seeing one patient and before seeing d. Decontaminate, wash and clean
the next one. instruments before sending them for
d. Between tasks and procedures on sterilisation.
the same patient to prevent cross e. After the instruments are sterilised,
contamination. handle them with sterile gloves and
e. Immediately after removing gloves. store the sterile instruments in special
areas meant for storing them.
4. Use of personal protective equipment like
gloves, protective eye wear, mask, apron, 6. Use of Disinfectant:
gown, boots/shoe covers and hair cover: a. Store bleaching powder in dry, dark and
cool places and the bleaching powder
a. The health care worker is at a risk
container should always be kept closed.
of exposure to blood, body fluids,
excretions or secretions and hence, b. While preparing 1% bleaching powder
should choose their equipment and solution, add 1 tablespoon of bleaching
items of personal protection accordingly powder in 1 litre water and stir the
to protect himself or herself. solution well.

b. Should avoid any contact with c. After the solution is ready, pour the
contaminated (used) personal protective solution in the waste bin meant for
equipment and surfaces, clothing or disinfection of used plastics and sharps.
people outside the patient care area. d. Bleaching powder solution needs to be
prepared every day.
c. Discard the used personal protective
equipment in appropriate disposal 7. Prevention of needle stick/sharps injuries:
bags, and dispose off, as per the policy a. Place the used disposable syringes and
(BMWM protocol). the needles, scalpel blades and other
d. Do not share personal protective sharp items in a puncture-resistant
equipment with others. container, with a closable lid located
close to near usage area.
e. A health worker needs to change
personal protective equipment b. Take extra care when cleaning sharp
reusable instruments or equipment.
completely, and thoroughly wash hands
each time before attending to another c. Never recap or bend needles.
patient or another duty. d. Sharps must be appropriately disinfec-
5. Patient Care Equipment: ted and/or destroyed as per protocol.
a. Handle patient care equipment soiled e. Healthcare providers, especially those
with blood, secretions or excretions with dealing with injectables or blood
care in order to prevent exposure to skin samples regularly should be immunised
and mucous membranes, clothing and against Hepatitis B infection.
the environment. 8. Cleaning floors:
b. Handle, transport and process used linen a. Wear personal protective gears like gloves
that is soiled with blood, body fluids, and apron while cleaning the floors.
secretions or excretions with care, to b. The UPHC floor must be cleaned regularly
ensure that there is no leaking of fluid. with hot water and soap/floor cleaner.
c. Ensuring sterilisation of all reusable c. Mop/cloth needs to be disinfected after
equipment; they should be reprocessed every use.
24 | Guidelines for Organising Urban Primary Health Centre Services | June 2017

2.12 Convergence with ICDS, Water 5. The ANM/ASHA will be responsible for
coordination with the AWW and will also
and Sanitation Departments monitor the service received by these
Scope: It provides a framework for convergence of beneficiaries and their performance.
all health and allied services at the UPHC level.

Purpose: To ensure coordinated planning and

delivery of urban services for all departments.

Responsibility: Medical Officer, Public Health

ASHA
Manager, ANM, ASHA and MAS

Convergence with ICDS uhnd

1. All Anganwadi Centres (AWCs) in the
catchment area must be identified and
anm aww
mapped.
2. UPHC needs to establish a functional liaison spl
between the ANM, ASHA and the Anganwadi outreach aww
worker (AWW) in the area.
aww asha anm
3. At the community and outreach level, the
frontline (ANM, ASHA and AWW) workers
will jointly provide nutrition services. These
would include:
Convergence with Swachh Bharat Mission
• Diagnosis and nutrition advice to and Urban Local Body
malnourished children, pregnant women
and adolescent girls and boys. Efforts should be made to work closely with the
• Diagnosis and management of anaemia Urban Local Body by participating regularly in
and Vitamin A deficiency. the Ward Co-ordination Committee meeting and
getting ward Counsellor engaged in the RKS. U-PHC
• The outreach camps or the Urban
will also participate actively in the activities related
Health and Nutrition Day (UHND) can
to Swachh Bharat Mission in its catchment area.
be organised at the AWC, where the
AWW takes the lead responsibility in
Convergence with Water and Sanitation
organising and mobilising women and
Department
children through ASHA and MAS.
1. The Medical officer and PHM needs to
• The UPHC staff must ensure the full
identify the officials responsible for water,
immunisation coverage and provision
sanitation, garbage disposal in their ward
of RMNCH+A services at the community
or locality and develop functional linkages
level.
with them.
• Effective referrals to NRC should 2. At the level of ward, locality, zone (as
be ensured for severe and acute appropriate as per the states context) a
malnourished children. coordination committee may be estab-
4. Children, women or adolescents, if lished to address issues of public health,
diagnosed as malnourished/anaemic in the vector control, solid waste management,
UHND or in the UPHC, should be attached to sanitation in the UPHC catchment area.
their nearest AWC for ensuring services. The committee may include representatives
 2 Administrative Organization of the UPHC | 25

of the Public Health Engineering Department In process of entering a PPP, following three things
(PHED)/Jal Nigam/Municipal Corporation, needs to be kept in mind:
Resident Welfare Association, MAS, and • Rationale for entering a PPP mode.
other bodies as applicable.
• Factors to be considered while planning a
3. ASHAs and ANMs needs to identify issues PPP model.
of water supply, water quality, garbage
collection, drainage and sanitation faced by
• Outcome indicators for proper monitoring.
the community and report to the PHM. The Major challenges in providing primary healthcare in
PHM and MO should take up these issues urban context are HR constraints, limited outreach,
with the ward level officials or personnel limited range of services and infrastructural
responsible for these services in the area. limitations. Hence PPPs can be used as a tool to
They should also act as advocates of the deliver various services under NUHM; Clinical
community to improve the basic services in services at UPHCs, specialist outreach services,
their catchment area. community outreach services, diagnostic services,
4. The Committee should find local solutions mobile health units etc. Withdrawing Specialists or
for environmental sanitation with collabo- Doctors from public health facilities for outreach
rative efforts. tends to make such facilities non-functional. Under
such conditions, ongoing private doctors to conduct
5. In addition, UPHCs must have sufficient
outreach could be considered.
stock of chlorine tablets/drops and all ASHAs
should be given adequate supply. To establish a successful PPP, state needs to conduct
a situational analysis, identify appropriate private
partner to bridge the gaps in service delivery, identify
2.13 Public Private Partnership
the type and scope of PPP model, prepare RFPs
Scope: Partnership between government and and SLAs taking into consideration the healthcare
private agencies to provide services close to people needs and local conditions with key performance
at affordable costs indicators (KPIs) and finally develop a robust and
reliable mechanism to monitor the performance
Purpose:
and service delivery standards. The RFP and SLA
a. To enhance the system’s ability to provide guidelines have been issued by the MoHFW.
effective services in collaboration with
PPP model for UPHC management: A cluster of UPHCs
private providers.
or a single PHC in an urban area can be provided to
b. To guide stakeholders in understanding the private partner for operation and maintenance.
contracting mechanisms under Public A set of key performance indicators (KPI) are to be
Private Partnership. shared among the two partners including, both
Responsibility: Government officials, private entity quantitative as well as qualitative indicators. An
incentive can be added to the fixed payment, based
Process: on the performance against the KPIs.
PPP is a form of contract between a government and Two types of outreach under NUHM namely, UHND
a private entity, wherein these two bodies jointly and special outreach can be conducted by private
provide public services in line with the pre-defined specialists through competitive bidding under PPP.
terms of contract. While primary healthcare is the The District Health Society or Urban Local Body
mandate of the State, in the urban areas to compensate would invite tender for the engagement of private
for the lack of structured primary healthcare facility service providers. Charitable institutions, private
and to leverage the large number of private providers specialist clinics or multispecialty hospitals would
available, PPPs may be considered. be eligible.
26 | Guidelines for Organising Urban Primary Health Centre Services | June 2017

Critical Success Factors for Private Sector Participation it provides, improve the efficiency with which it is
in Primary Care are effective governance structure, provided and ensure quality of care.
sharing of responsibilities based on capabilities,
Responsibility: Official designated at each level
incentivizing performance, effective monitoring,
(state, district and facility)
no delays in payment and standardizing practices
for PPPs in similar activities. Defining the roles, Activities:
responsibilities and scope of work along with 1. Grievance Redressal System in UPHCs
monitoring mechanisms are important prerequisites shall be established as per the Grievance
before MOU is signed. Redressal Guidelines for NHM (2017).
2. As per the GRS guidelines, each state shall
2.14 Grievance Redressal have a centralized set-up, operated through
a call center (104), to address grievances and
Scope: Addressing the complaints and grievances
provide medical advice. The system enables
of patients regarding the service provided at the
tracking, investigating and resolution of
UPHC level.
complaints in a timely manner.
Purpose: The UPHC needs to provide quality services 3. UPHCs under NUHM should also be linked
that are responsive to people’s needs and demands to the centralized system. Each UPHC shall
and hold itself accountable for its performance. It have a nodal officer designated for grievance
must be able to measure the effectiveness of care redressal.

Figure 4: Grievance Redressal Flowchart as per Grievance Redressal Guidelines (2017)

Helpdesk/Complaint Box
Grievance
Registration Web Portal-Online
Patient &
Nodal Officer
Call Center (104)
receive Registered Grievances segregated
SMS with according to District/Block/Facility
registration
number
Received by State Nodal Officer

IF Action Taken

No Action File Closed

Chief Medical Officer (7 days)

Complaint
escalates to Complaint
higher level in State Nodal Officer (7 days) followed-up &
7 days Resolved

Hon. HFM
 2 Administrative Organization of the UPHC | 27

4. The State Program Officer for NUHM should or the help-desk and a questionnaire that
maintain a directory with details of each literate persons can fill up without guidance
UPHC in-charge. The Directory should and drop into a box kept for the purpose.
be handed over to the 104 call center for 2. Questionnaire should be decided by the
facilitating complaint resolution. Public Health Manager in consultation with
5. In each UPHC there should be a clear display the MOIC. Questions will include timeliness
of GR helpline number and methods by of care, subjective satisfaction with care,
which a grievance can be registered. The health outcomes as perceived, out-of-
process of redressal and timeline should pocket expenditure and provider to patient
also be displayed. relationship.
6. The UPHCs from which frequent complaints 3. All UPHCs needs to conduct exit-
are received may be invited for the review, interviews of out-patients for collection
inquired into further, and appropriate and analysis of their feedback. This will
corrective action taken. help in understanding their out-of-pocket
7. RKS of the UPHC should review the number expenditures, problems in accessing health
of grievances registered and number service and overall satisfaction with care
resolved every month for their UPHC. provided in the facility.
4. On each day, at least 5 persons who are
2.15 Patient Feedback and Exit leaving the facility are contacted and
requested to fill the questionnaire and drop it
Interviews into the box kept for the purpose. A separate
Scope: To enable patients to provide feedback on box/ file must be placed for submitting the
the service received at the UPHC. filled-in feedback forms.
5. If the person is not literate, the help-desk
Purpose: Patient feedback/exit interview will help
in charge could conduct it as an interview.
the UPHC to strengthen the quality of service
The selection should be random but at
provisioning, be more responsive to patient needs
least half of it should be women and one
and meet the expectations of the patients and
third could be women or men with young
reduce out-of-pocket expenditure.
children.
Responsibility: 6. Anonymity needs to be maintained. The
• MOIC: For use of information and oversight. patients must not be forced to disclose their
• Public Health Manager: Organisation and identity.
oversight over the feedback system. 7. The Public Health Manager supervised by
• Help-desk in charge (if this is established) the MOIC is responsible for analysing the
or else registration clerk: Collection of feedback and preparing a comprehensive
feedback. report. The report should be shared
with the RKS and the city/ district health
Activities: society.
1. Two forms of feedback collection are A comprehensive report on the specific actions
envisaged: A semi-structured interview that taken and support needed for improving the service
is administered by the registration clerk should also be prepared.
 3
UPHC Services

Services under NUHM are envisaged at four levels:

• Community level: Home visits, MAS While in some cases, the services provided at
meetings, other community based fora or different levels overlap, in most cases there is
group meetings. a clear distinction in the limits of each level.
The following summary table provides NUHM
• Outreach: Activities held as part of UHND,
services at the four levels of care. Which services
Special Outreach and NCD Screening Days.
to be provided at UCHCs are mentioned in the last
• UPHC: Services provided within UPHC column, however this guideline details services
premises. for the first three levels only.
• UCHC: Services provided within UCHC Detailed description of services at all levels, are
premises. given on following pages.
S.No. Area Community Level Outreach Level UPHC Level UCHC Level
1 Care in Pregnancy: Early diagnosis of pregnancy, Early registration of pregnancy, ANC by MO to include minimum Normal vaginal delivery, assisted
Maternal Health support throughout pregnancy, Issue of Maternal & Child lab investigations: haemoglobin, vaginal delivery, C-section,
motivation for institutional Health Card (MCH Card) after urine albumin and sugar, RPR ante partum and post-partum
delivery, nutrition information, registration, regular Ante natal test for syphilis, blood grouping haemorrhage, eclampsia,
hygiene, enabling Take Home check-ups with 7 components and Rh typing, and HIV testing, puerperal sepsis, obstructed
Rations (THR) for pregnant ie (As per ANC & Skilled birth clinical examination to rule out labour, hospitalisation and
woman through AWW, offering attendant Guideline), screening other co-morbidities notably surgical interventions, including
pregnancy test kit to those for hypertension, diabetes, diabetes, hypertension, heart blood transfusion. Safe
who need, identify high risk anemia, immunization for disease, TB, other risk factors abortions.
births, anemia cases, facilitating mother – TT, iron-folic acid and growth retardation,high
referrals, helping birth planning, calcium supplementation, risk ANC, PNC, high risk PNC,
identification of postpartum MCH card, Identification and early assessment of complicated
complication, postpartum referral of high risk pregnancy & delivery cases and referral.
support. postnatal high risk cases. At Delivery Points:
ƒƒ Normal vaginal delivery
(if resources are available
to conduct delivery as
per protocol); Pre-referral
management (obstetric first-
aid) in obstetric emergencies
that need expert assistance
(training of staff for
emergency management to
30 | Guidelines for Organising Urban Primary Health Centre Services | June 2017

be ensured).
ƒƒ ASHA visits every pregnant woman at least once a month. In high risk pregnancies, she makes a referral to UPHC, or organises a home
visit by the ANM.
ƒƒ Post partum visit should be ensured on 0th, 3rd, 7th and 14th days of delivery.
ƒƒ At least one ANC, preferably during the 3rd visit, must be done by a doctor (medical ANC), preferable at the UPHC where the woman is
registered.
ƒƒ At delivery points, Minimum 48 hours of stay after delivery. This requires a clean bed, clean toilets, and arrangements for food and
privacy for breastfeeding.
ƒƒ Initiation of breastfeeding within one hour of birth.
ƒƒ Recognition of gender based violence during pregnancy (and also at all other times).
S.No. Area Community Level Outreach Level UPHC Level UCHC Level
2 Neonatal and 6 household visits in neonatal Complete immunization, Vitamin If birth occurs at UPHC: Congenital anomalies,
infant health (0-1 period for improved newborn A supplementation, height and Initiation of breast-feeding
Management of complicated
yrs of age) care practices, Home based weight measurement. within an hour of birth;
paediatric/ neo-natal cases,
new born care, identification Care of common illnesses of new Screening for birth defects
hospitalisation, surgical
and care of low birth weight/ born, Identification of congenital (as per the RBSK protocol) 7
interventions, blood transfusion.
preterm newborn (with referral anomalies, and appropriate appropriate referral; Essential Management of severe acute
as required), counselling referral . new born care : wiping the baby, malnutrition (SAM).
and support for exclusive weighing the baby, prevention
breastfeeding, complementary Hospitalisation, treatment
of hypothermia by wrapping the and rehabilitation of severe
feeding, improved weaning baby, examination to rule out
practices; nutrition counselling; undernutrition.
health problems, cord care.
Education of prevention of
infections; identification of ARI/ Immunisation
diarrhoea and treatment (ORS). Management of Birth
asphyxia, severe ARI,
diarrhoea management, acute
gastroenteritis with dehydration,
pneumonia case management,
Treatment and stabilization and
referral of severe cases, Weekly
immunization sessions.
ƒƒ Monthly visit by ASHA to all families with children below one year of age; information on immunization sessions, All ASHAs must be
given the HBNC kit for providing care to neonates at home.
ƒƒ Convergence with ICDS essential, ANM to maintain & update MCTS register, linelisting of children who missed immunization, display of
immunization schedule, maintenance and monitoring of vaccine cold chain.
3 UPHC Services | 31
S.No. Area Community Level Outreach Level UPHC Level UCHC Level
3 Child Health & Growth monitoring, prevention Child Health: Prompt Immunization, management of Treatment of childhood illnesses
Adolescent Health through IYCF counselling, management of ARI and fever; SAM, severe anaemia, persistent and infections, Treatment of
access to food supplementation acute diarrhoea; detection malnutrition and nutritional disability and developmental
through ICDS; Detection of and treatment of anaemia and deficiencies; severe diarrhoea delays.
SAM, referral and follow up de-worming; Early detection and ARI management;
care; Prevention of anaemia, of growth abnormalities, Diagnosis of disability and
use of iodized salt, de-worming; developmental delays and developmental delays and
Prevention of diarrhoea, prompt disability. referral, Skin infection.
treatment and referral if needed. Adolescent health: Detection Convergence with RBSK &
Pre-school and school children: and treatment of anaemia and ICDS, Confirmation of any
biannual screening, eye care, de- other nutritional deficiencies; type of deficiencies/disease/
worming, school health records bi-annual de-worming and developmental delays upto 6
Adolescent health: anemia adolescent counselling & referral years.
detection, peer counselling, as per need. Diagnosis and treatment of
sexual health education, childhood illnesses, Referral
personal hygiene, encourage of acute deficiency cases and
adolescent health days. chronic illnesses.
Outbreak investigation if there
are more than five cases seen
from one cluster of any of
infections within a week.
1. The ASHA/ANM/MAS must mobilise both girls and boys for counselling and treatment. In urban areas adolescent males have
significant health problems as they are engaged in labour work and other kinds of physical occupations. So they must be provided
32 | Guidelines for Organising Urban Primary Health Centre Services | June 2017

health check-ups related to their living conditions and appropriate counselling related to sexual concerns, drug abuse, mental health,
etc.
2. Similarly, adolescent girls attending the clinic must be provided information, counselling and services related to sexual concerns,
pregnancy, contraception, abortion, menstrual problems and menstrual hygiene, drug abuse, mental health, nutrition etc. responsive
to their requests.
S.No. Area Community Level Outreach Level UPHC Level UCHC Level
4 Family Planning Health communication and preventive education for early marriage, Counselling for family planning, IUCD, Vasectomy, tubectomy,
Services identify eligible couples, motivation for family planning – delaying Medical examination required manual vacuum aspiration,
first child and birth spacing, information and access to spacing before start of OCPs, access to all safe abortions, Sterilisation
methods - OCP, ECP, condoms; Referral for sterilisation, follow-up of spacing methods including IUCD operations, infertility treatment.
contraceptive related complications. insertion, referral for sterilisation, Complications in contraceptive
management of contraceptive
Counselling for family planning, access to all spacing methods RTI/ usage, hormonal and menstrual
related complications.
STI: Knowledge of and referral for RTI/STI, follow-up for ensuring disorders, infections etc.
adherence to treatment regime of cases undergoing treatment. Medical Abortion in the first RTI/STI: Management
trimester if indicated, after of complicated cases,
necessary medical examination hospitalisation (if needed).
(where resources available as per
protocol).
RTI/STI: opportunistic screening
of RTI/STI, wet mount test,
diagnosis and treatmentUTI
treatment, menstrual disorder.
First aid for gender based
violence – link to referral center
and legal support services.
Laboratory tests for VDRL and
for HIV if UPHC is designated
for same, otherwise to refer to
designated referral facility.
ƒƒ Empowering girls and women to understand that they have the right to decide the number of children and social reasons for delaying
the first child, spacing the second and limiting to a smaller family size.
ƒƒ ANM and ASHA should take the lead in counselling the woman immediately after marriage, and during and after pregnancy on reasons
and choice of contraception.
5 Management Identification and referral for Diagnosis and management Diagnosis and management of Management of complicated
of common testing at UPHC, symptomatic of fevers, ARI, diarrhoea, skin all fevers, infections etc. cases, hospitalization.
communicable care for fevers, diarrhoea, aches infections.
diseases and pains.
Management of aches, pains,
Skin infections, abscesses – rash, gastritis, acute febrile
identify, refer. illness; Referral for severe and
complicated cases, Acute febrile
illness, indigestion, gastritis.
3 UPHC Services | 33
S.No. Area Community Level Outreach Level UPHC Level UCHC Level
6 Management of TB, HIV, Leprosy, Malaria, Kala Identification, examination and Diagnosis and treatment/ Diagnosis and treatment of
communicable Azar, Filariasis, other vector referral to UPHC for suspected management plan, referral of complicated or severe cases,
diseases (National borne diseases: Prevention, cases. acute and chronic cases, Report hospitalization.
Health Programs) identification, use of RDT, to IDSP.
prompt treatment initiatives, Lab testing for all vector borne
vector control measures; diseases; Drug dispensation for
education for prevention; TB.
identification, use of RDT, Follow
up on medication compliance. Maintenance or records for all
cases of TB, leprosy.
Mass drug administration
in Filariasis prevention, Establish diagnosis if fever
immunization of Jap B, RDK persists for more than 5 days.
testing for malaria, Counseling UPHC to serve as DOTS center,
for leprosy on treatment regular follow up to ensure
compliance. compliance to drug regimen.
Vector Borne Diseases:
Identification of suspected
cases, Slide collection, testing
using RDKs. Counselling for
practices for vector control and
personal protection. Community
education.
ƒƒ Visit the family and neighbouring families to ensure that no contacts have similar symptoms. This is particularly important for TB and
34 | Guidelines for Organising Urban Primary Health Centre Services | June 2017

leprosy. For vector borne and water borne diseases, an active case detection survey in neighbouring houses is required. In HIV, it
requires testing for spouse but care is needed on issues of confidentiality and prevention of stigma.
ƒƒ Facilitate the visit of the public health response team from the UPHC to take community level action in case of vector borne or water
borne diseases.
ƒƒ Examine every case of fever. If fever persists beyond five days, then always try and establish a diagnosis.
ƒƒ If there is a cluster of infection cases then always ask support for higher diagnostics like ruling out Swine flu.
ƒƒ Every UPHC is necessarily a part of IDSP, and is hence required to file three reports on a weekly basis- L form which is the report of cases
tested and cases found positive for infectious diseases, from the laboratory; P forms,which are presumptive (not necessarily confirmed)
cases of any of the notifiable infectious disease; and S forms which are cases suspected and reported by ANMs. Ensure maintaining a
copy of these reports sent and analyse them periodically to understand the communicable disease situation in the UPHC catchment
population/ area.
S.No. Area Community Level Outreach Level UPHC Level UCHC Level
7 Screening & Management of Non-Communicable diseases
NCD Hypertension: Screening, NCD Screening Day Comprehensive NCD screening Diagnosis and treatment/
(Hypertension, primary & Secondary Prevention. Hypertension: BP for 30+ patients who missed management of all NCDs,
measurements, medication, screening day. hospitalization if needed.
Diabetes, Cancers Diabetes: Screening, primary &
enable specialist consultation,
– oral, breast, Secondary Prevention. Hypertension: Medical Integration with RNTCP for TB
follow up.
cervical) management. elimination with urban areas.
Cancers: awareness generation
Diabetes: Blood sugar
regarding signs and symptoms . Diabetes: Medical management, Integration with NPCDCS at
test, medication, follow up provision of regular drug supply community and facility levels.
Counselling on mitigation of risk diagnostics, enable specialist
for diabetes and hypertension.
factors. consultation, diet counselling,
Refer persons with >140/90 BP Cancer: Cervical cancer
Silicosis, Flourosis: Preventive
and >140 random sugar to UPHC. screening using acetic acid.
action and early case
Diagnosis and treatment plan for
identification. Cancer: Screening of oral cancer, HT and DM cases.
COPD: Prevention and early clinical breast examination, (with
detection, referral. adequate privacy), early referral, Referral for complicated and
follow up. severe cases.
Epilepsy: Early case
Counselling regarding risk Systematic recording of NCD
identification and referral.
factors, diet management as cases.
appropriate for all NCDs. COPD: diagnosis, treatment plan
Silicosis, Flourosis: Early case Epilepsy: diagnosis, treatment
identification. plan.
COPD: identification
ƒƒ Population enumeration and listing of target population (all 30+ individuals).
ƒƒ Risk assessment of 30+ persons through prescribed format.
ƒƒ Inform all 30+ about advantages of screening, screening day and ensure they attend, esp high risk persons.
ƒƒ Ensure treatment compliance for those on medication through visits. Referral of at-risk cases to UPHC.
ƒƒ NCD Screening to be organized weekly for every 10,000 population.
ƒƒ Implementation of NCD Screening to be supported by District NCD Cell for planning, monitoring and reporting.
ƒƒ Once diagnosis for HT & DM is established, patients to be given at least a months supply of medication.
ƒƒ First follow up at the end of the first three months after diagnosis, and sooner if required.
ƒƒ An annual specialist consultation at the nearest nodal CHC with an NCD clinic, is also recommended.
3 UPHC Services | 35
S.No. Area Community Level Outreach Level UPHC Level UCHC Level
8 Mental Health Screening of mental illness using Detection & referral of mental Initial screening and referral. Psychiatric services, including
screening questions and tools, illness, community education Referral to de-addiction centers, hospitalisation, if needed.
Identification of cases, referral and preventive measures against if needed. Management of
and follow up; community substance abuse. violence related concerns.
education and sensitization on
mental health issues, substance
abuse.

9 Dental Care Education on oral hygiene Dental hygiene, screening for Diagnosis, treatment of Treatment for tooth abscess,
Identification of cases, referral cavities, gingivitis, dental caries, infections and referral; oral dental caries, scaling, extraction,
special outreach camps for ulcers. Treatment or referral. health clinics on specific days. etc. Referral for further care.
diagnosisand treatment,
counselling and oral health
education.
10 Eye/ENT Identification of glaucoma, Eye care in newborn, screening Treatment for conjunctivitis, Diagnosis and management
trachoma, and referral to UPHC. for visual acuity, cataract, Management of colds, of infections, disorders, further
refractive errors. identification of cases and referral of complicated cases,
Early identification of squint,
referral. hospitalisation (if needed).
lazy eye in children, other eye Nose, throat infections.
disorders; Identificationof
cases of hearing impairment (if
reported by family/ community),
referral for testing.
11 Geriatric & Support to family in palliative Management of common Diagnosis, treatment plan, Diagnosis and management of
36 | Guidelines for Organising Urban Primary Health Centre Services | June 2017

Palliative Care care, counselling to the elderly geriatric ailments, counselling, referral for specialist care geriatric conditions, referral for
on keeping healthy, active, supportive treatment. advanced treatments required.
appropriate diet, recreational Pain management and provision
activities. of palliative care with support of
ASHA.
In view of increasing geriatric population in urban areas, UPHCs should organize special outreach sessions or weekly geriatric clinics at the
UPHC..
 S.No. Area Community Level Outreach Level UPHC Level UCHC Level
12 Trauma Care First aid and referral. First aid and referral emergency resuscitation, Treatment, Case - management
(burns & injuries) documentation for MLC (if and hospitalisation,
First aid and first responder
training for school teachers, applicable) and referral. physiotherapy and
rehabilitation.
community volunteers, ASHAs Management of animal bites,
and AWW. insect bites, rodent bites,
stabilization care and treatment
in poisoning and trauma of any
nature; Management of injury,
simple fractures and burns and
abscess management.
ƒƒ All UPHC staff should be trained in first aid, first responder care. UPHC should be equipped with necessary equipment and drugs for
stabilization of patients of trauma, fracture, respiratory distress, burns, poisoning, fall and other accidents common in urban areas.
ƒƒ They should also have an emergency response system in place, in case of a hazard in the community eg: building collapse, fire,
demolition etc.
ƒƒ UPHC must be able to arrange for emergency transport quickly when needed. All wheelchairs and stretchers at the UPHC should be
functional and placed appropriately for quick and easy access.

3 UPHC Services | 37
 Annexure – I

Minimum Requirements for U-PHC

Layout
Room
Ward* Consultation room
Out-patient department Dressing room
Waiting area Labour room
Store Laboratory
Nursing station Pharmacy
* for maternity homes and bedded U-PHCs

Basic Amenities
Utility
Beds Hand washing including availability of water and soap in dressing
rooms
Private area for expansion Wheelchair, stretcher etc.
24*7 electricity supply Fire safety equipment- fire extinguisher, sand buckets
Drinking water facilities Computer with internet connection for MIS purpose
Fans, coolers/warmers Maintenance of registers for monitoring and record keeping
Separate Toilets for men and women

List of Furniture
Furniture Item
Writing tables (officer) with table sheets Inverter for fridge
Armless chairs Lamps
Basin with stands Mattress for beds
Bed sheets Medicine box
Bed stead iron for treatment room Notice board
Bedside table Office chairs
Benches for waiting area Pillows with covers
Bio-medical bins with liners Revolving stool (examination)
Buckets and mugs Rubber sheeting
40 | Guidelines for Organising Urban Primary Health Centre Services | June 2017

Furniture Item
Cloth screen - three-fold Side wooden racks
Computer table with chair Steel almirah - big
Curtains Steel almirah - small
Dustbins Stretcher on trolley
Examination beds Towels
Foot steps Wheelchairs
Generator(7.5 KV) Wooden screen
Inverter for computer

List of Essential Equipment and Instruments

Item
Adult weighing scale Kidney tray for emptying contents of MVA syringe
Anterior wall retractor Kidney trays
Artery forceps (large and small) Measuring tape
B.P. (digital) apparatus MVA syringe and cannula of sizes
Baby weighing scale Nebulizer
Bowl for antiseptic solution for soaking cotton swabs Needle destroyer
Bowls - stainless steel Oxygen concentrator
Clinical digital thermometers Oxygen cylinder on trolley with spanner and flow meter
Cold boxes ( large and small) Percussion (knee) hammer
Computer with internet facility Probe for ear wax removal
Deep freezer (small with voltage stabiliser) Refrigerator
Dressing trolley Resuscitation self-inflating bags (Ambu’s) and masks of
different sizes
Ear specula Scissors
Ear syringe Sims speculum
ECG machine Single panel X-ray view box
Emergency tray and equipment Sponge holding forceps
Forceps chelate 9 “ Spot light
Forceps plain 6 “ Stainless steel tray with cover
Forceps toothed 6 “ Sterilizer
Head light Stethoscope
Height measuring scale Suction Apparatus
Ice box Syringes of different sizes
Ice lined refrigerator (small) Torch with batteries
Ice packs Tray containing chlorine solution for keeping soiled
instruments
Instrument trolley Tuning fork
IUCD kit Vaccine carriers with four icepacks
IV giving sets with intracaths Volsellum uterine forceps
IV stand
 Minimum Requirements for U-PHC | 41

Laboratory Requirement for U-PHC

Name of the Item
Haematology analyser Vacutainers
Semi-auto analyser Tourniquets
Colorimeter Microscope (preferably binocular)
Test tubes Centrifuge machine
Glass slides and cover slips Hot air oven or incubator or water bath
Glass beaker Burette (used to measure amount of alkali/acid for
titration)
Glass flask General laboratory stands, racks, filter papers
Pipettes Reagents, chemicals etc.
Syringes and needles Refrigerator
Gloves and masks Bio-medical waste management buckets
Lancets Urine containers
 A n n e x u r e – II

Essential Drug List for UPHC

(Note: Essential Drug List for U-PHC can be referred from State)

The following list is suggestive and not exhaustive. Requirement may be decided as per facility load.
Drug list
1. Acetyl Salicylic Acid Tablets 150mg 2. Fluconazole Tablets 50mg
3. Acyclovir 200mg 4. Folic Acid & Ferrous Sulphate Tablets (Large)
5. Albendazole 400mg 6. Folic Acid & Ferrous Sulphate Tablets (Small)
7. Amoxycillin Capsules 250mg 8. Folic Acid Tablets 5mg
9. Amoxycillin Trihydrate Dispersible Tablets 125mg 10. Glibenclamide Tablets 5mg
11. Ascorbic Acid Tablets (Chewable) 12. Glimepiride Tablets 1mg
13. Atenolol Tablets 50mg 14. Glipizide Tablets 5mg
15. Atorvastatin Tab 10mg 16. Ibuprofen Tablets 400mg
17. Azithromycin Tablets 500mg 18. Inj. Ranitidine
19. Bisacodyl Tablets 5mg 20. Levocetirizine Tablets 5mg
21. Calcium Gluconate Tablets 500mg 22. Metformin HCL Tablets 500mg
23. Cefadroxil Kid Tablets 125mg 24. Methyldopa Tablets 250mg
25. Cefadroxil Tablet 500mg 26. Methylergometrine Maleate Tablet 0.125mg
27. Cefiximine Tablets 200mg 28. Metronidazole Tablets 200mg
29. Chlorine Tablets 0.5gm 30. Norfloxacin Tablets 400mg
31. Chloroquine Phosphate Tablet 250mg (150mg base) 32. Norfloxacin Kid Tablets 100mg
33. Chlorpheniramine Maleate Tablets 4mg 34. Ofloxacin Tablets 200mg
35. Ciprofloxacin Tablets 250 mg 36. Omeprazole Capsules 20mg
37. Clotrimazole Vaginal Tablets 100mg 38. Pantoprazole Tablets 40mg
39. Dexamethasone Tablets 0.5mg 40. Paracetamol Tablets 500mg
41. Diazepam Tablets 5mg 42. Primaquine Phosphate Tablets 2.5mg
43. Diclofenac Sodium Tablets 50mg 44. Primaquine Phosphate Tablets 7.5mg
45. Dicyclomine Tablets 20mg 46. Tab Fenoxidenadine 120mg
47. Diethyl Carbamazine Citrate 50mg 48. Tab Ranitidine 150mg
49. Domperidone Tablets 10mg 50. Tab Tinidazole 500mg
51. Doxycycline Capsules 100mg 52. Vitamin A & D Capsules
53. Eteophylline with Theophylline Tablets 54. Zinc Sulphate Dispersible Tablets 20mg
55. Fluconazole Tablets 150mg
44 | Guidelines for Organising Urban Primary Health Centre Services | June 2017

Miscellaneous
Miscellaneous
1. Albendazole Suspension 200mg/5ml 2. Inhaler Beclomethasome
3. Anti-Rabies Vaccine 4. Inhaler Salbutamol
5. Azithromycin Oral Suspension 200mg/5ml 6. Injections for Emergency Treatment
7. Betamethasone Valerate Cream 8. Insulin Preparations
9. Chloroquine Phosphate syrup (60ml) 10. Levocetirizine Dihydrochloride Syrup
11. Clotrimazole Cream 1%w/w 12. Metronidazole Suspension 100mg/5ml
13. Dicyclomine HCL Oral Solution 10mg/5ml 14. Neomycin, Bacitracin &Polymyxin - B Oint
15. Domperidone Suspension 1mg/ml 16. Paracetamol Syrup 125mg/5ml
17. Folic Acid & Ferrous Sulphate Syrup 100ml 18. Povidone Iodine Ointment 5%
19. Framycetin Sulphate Cream 20. Povidone Iodine Solution 5%
21. Gamma Benzene Hexachloride Application 22. Reagent Strips for estimation of Albumin &
Glucose In Urine
23. Gentamicin Eye Drops 0.3% w/v 24. Salbutamol Syrup 2mg/5ml
25. Gentian Violet Topical Solution 26. Silver Sulphadiazine Cream 1 %
27. I.V. Fluids 28. Vitamin A solution 1Lac IU/1ml
29. Ibuprofen Suspension 100mg/5ml

Emergency Drugs
1. Drugs & Injectable as per requirement
2. Fluids & Plasma Expanders
3. Oxygen Cylinders/Oxygen Concentrator
4. Essential Equipment – Suction Machine,
Ambu Bag, ECG Machine, etc.
5. Suture Kit

Surgical
1. Absorbent Gauze (20mt x 90cm)
2. Absorbent Cotton Wool
3. Adhesive Tape 5cmx10mtr
4. Adhesive Tape 7.5cmx10mtr
5. Bandage Cloth (20mt x 90cm)
6. Disposable Hypodermic Needle Size:22x1”
7. Disposable Hypodermic Needle Size:23x1”
8. Disposable Hypodermic Needle Size:24x1”

Disposable Syringe 2 ml and 5ml (Without Needle)

 A n n e x u r e – III

Job Responsibilities of UPHC staff

1. Medical Officer • He/she shall attend to cases referred to

him/her by Female Health Workers, ASHA,
The Medical Officer (MO) of Urban Primary Health Voluntary Health Workers where applicable,
Centre (UPHC) is responsible for implementing all Dais or by the School Teachers.
activities grouped under Health and Family Welfare
• He/she shall screen cases needing
delivery system in UPHC area. The MO will be solely
specialised medical attention including
responsible for the proper functioning of the UPHC,
dental care and nursing care and refer them
and activities in relation to National Health Prog-
to referral institutions.
rammes. The detailed job functions of MO working
in the UPHC are given below. Refer IPHS for PHC and • He/she shall provide guidance to the Health
programme documents for role and responsibilities Workers, Health Guides and School Teachers
related to National Health Programmes. in the treatment of minor ailments.
• He/she shall cooperate and coordinate with
Curative Work: other institutions providing medical care
• The Medical Officer shall organise the services in his/her area.
dispensary, outpatient department and shall • He/she shall visit each Sub-Centre in his/her
allot duties to the ancillary staff to ensure area at least once in a month on a fixed day
smooth running of the OPD. not only to check the work of the staff but
• He/she shall make suitable arrangements also to provide curative services. This will
for the distribution of work in the treatment be possible only if more than one Medical
of emergency cases which come outside the Officer is posted in PHC.
normal OPD hours. • He/she shall organise and participate in
• He/she shall organise laboratory services the “Urban Health and Nutrition Day” at
for cases where necessary and within the Anganwadi Centre once in a month.
scope of his laboratory for proper diagnosis
of suspected cases. Preventive and Promotive Work:
• He/she shall make arrangements for The Medical Officer shall ensure that all the members
rendering services for the treatment of of his/her Health Team are fully conversant with
minor ailments at community level and the various National Health and Family Welfare
at the UPHC through the Frontline Health Programmes including NUHM to be implemented
Workers and others. in the area allotted to each health functionary.
46 | Guidelines for Organising Urban Primary Health Centre Services | June 2017

He/she shall further supervise their work periodi- • He/she shall also make arrangements/provide
cally both in the clinics and in the community setting guidance to the Health Worker (Female) in
to give them the necessary guidance and direction. organising training programmes for ASHAs.

He/she shall prepare operational plans and ensure Administrative Work:

effective implementation of the same to achieve the • He/she shall supervise the work of staff
laid down targets under different National Health working under him/her.
and Family Welfare Programmes. The MO shall
provide assistance in the formulation of health and
• He/she shall ensure general cleanliness
inside and outside the premises of the UPHC
sanitation plan through the ANMs and coordinate
and also proper maintenance of equipment
with the elected public representatives in his/her
under his/her charge.
PHC area.
• He/she shall ensure to keep up to date
He/she shall keep close liaison with civil inventory and stock register of all the stores
administrative officers and his/her staff, community and equipment supplied to him/her and shall
leaders and various social welfare agencies in his/ be responsible for its correct accounting.
her area and involve them to the best advantage in
the promotion of health programmes in the area.
• He/she shall get indents prepared timely
for drugs, instruments, vaccines, ORS and
Wherever possible, the MO shall conduct field contraceptive etc. sufficiently in advance
investigations to delineate local health problems for and shall submit them to the appropriate
planning changes in the strategy for the effective health authorities.
delivery of health and family welfare services. He/ • He/she shall check the proper maintenance
she shall coordinate and facilitate the functioning of of the transport given in his/her charge.
AYUSH doctor in the PHC.
• He/she shall scrutinise the programmes
Training: of his/her staff and suggest changes if
necessary to suit the priority of work.
• He/she shall organise training programmes
including continuing education for the staff • He/she shall get prepared and display charts
of PHC and ASHA under the guidance of the in his/her own room to explain clearly the
district/city health authorities and Health geographical areas, location of peripheral
and Family Welfare Training centres. health units, morbidity and mortality, health
statistics and other important information
• He/she shall ensure that staff is sent for
about his/her area.
appropriate trainings.
• He/she shall maintain and update a data
• He/she shall hold monthly staff meetings
with his/her own staff with a view to evalu-
base of staff and the trainings undergone by
ating the progress of work and suggesting
the them.
steps to be taken for further improvements.
• He/she shall provide opportunity to the
• He/she shall ensure the regular supply
staff for using the knowledge, skills and
of medicines and disbursements in Sub-
competencies learnt during the training.
Centres and to ASHAs.
• He/she shall ensure appropriate infrastructure
• He/she shall ensure the maintenance of the
for trainings like venue, training aids, training
prescribed records at PHC level.
material and other logistics.
• He/she shall organise training programmes
• He/she shall receive reports from the
periphery, get them compiled and submit
for ASHAs with focus on developing
them regularly to the district/city health
appropriate skills as per local need.
authorities.
 Job Responsibilities of UPHC staff | 47

• He/she shall keep notes of his/her visits to the • Participate in community mobilisation
area and submit every month his/her tour processes like selection of ASHAs and
report to the district/city health authorities. formation of MAS and ensure their training.
• He/she shall discharge all the financial duties • Assist Medical Officer in monitoring and
entrusted to him/her. supervision of staff on daily basis, like
• He/she shall discharge the day to day punctuality, maintenance of record, analysis
administrative duties and administrative of data etc.
duties pertaining to new schemes.
Management of infrastructure, equipment and all
support services
2. Public Health Manager • He/she shall coordinate to ensure timely
The role of Public Health Manager (PHM) at a UPHC completion of civil work in the UPHC if any.
is envisaged as the nodal person responsible for all • He/she shall assist Medical Officer in
non-clinical activities at the UPHC. He/she will assist examination of tender document for civil
the Medical Officer in provisioning of services at the work in UPHC.
UPHC level and outreach locations. Key roles and
responsibilities of PHM are as below:
• He/she shall ensure that all equipment
and instruments are in good condition and
Planning and budgeting – Overall management and calibrated.
functioning of healthcare facility • He/she shall monitor and manage Annual
• He/she shall have a significant managerial Maintenance Contract.
role relating to planning and budgeting, • He/she shall ensure timely delivery of
organising staffing, directing, coordinating, supplies to the UPHC.
and monitoring/reporting to ensure optimal
utilisation of the facility. Quality assurance and Infection Control and Environment
• He/she shall be nodal person for all activities Management
and programmes. • The PHM shall assist in gap analysis of
• He/she shall provide financial oversight in existing services, preparation of action plan
planning and budgeting. to fill identified gaps and implementation of
the guidelines.
• He/she shall compile the overall profile of
facility regarding geographical coverage, • He/she shall ensure bio-medical waste
target population, demographic and management practices as per the guidelines.
socio-economic indicators and update • He/she shall facilitate periodic meeting of
periodically. Quality Assurance Committee/team and
• He/she shall ensure efficient functioning prepare agenda notes and action taken
of OPD and shall strive to reduce patient report for the same. He/she shall also
waiting time. maintain minutes of the meeting.
• He/she shall refer to IPHS for assessing the • He/she shall ensure that protocols for service
functional status of health facilities and to delivery of National Health Programmes are
bring up the UPHC to the comparable level. being followed.

Management of health human resource, training and Grievance redressal

capacity building • The PHM shall ensure display of the Charter of
• Plan and organise training and capacity Patient’s Rights focusing NUHM component
building of staff posted at the UPHC. in UPHC.
48 | Guidelines for Organising Urban Primary Health Centre Services | June 2017

• He/she shall facilitate periodic meetings of of progress on programme indicators to

Rogi Kalyan Samiti for improvement of the appropriate authority.
management and service provisions of the
Disease surveillance and epidemic control
UPHC as per the RKS guidelines issued from
time to time. • The PHM shall coordinate with existing
mechanism of disease reporting under IDSP
Community mobilisation, special outreach and referral to ensure timely reporting to appropriate
support authority. This will require networking,
• The PHM will be the nodal officer in charge liaison and coordination with multiple
of selection of ASHAs and all activities with stakeholders like UPHC staff, private and
respect to their payment of incentives and other public health providers, community,
grievances. officials of other departments.
• He/she shall be responsible of training of IEC activities and public health education
ASHAs and replenishment of their kits.
• The PHM shall work towards spreading
• He/she shall ensure periodical meeting of awareness regarding seasonal occurrence of
MAS, utilisation of MAS fund and submission diseases, and preventive measures. He/she
of quarterly report. shall make use of special health days, special
• He/she shall provide supportive supervision campaigns, available IEC/BCC materials to
to ANMs for community mobilisation events increase awareness especially among poor
and special outreach camps. and vulnerable communities.
• He/she shall facilitate referrals if advised Data collection, HMIS reporting and analysis
during special outreach camps.
• The PHM shall ensure timely reporting and
Supply chain management uploading of HMIS data and other reports.
• The PHM shall ensure to keep up-to-date • He/she shall ensure quality of data being
inventory and stock register of the stores submitted. To ensure the quality and
and equipment, drug supplied and shall be timeliness, he/she shall train/handhold staff
responsible for its accounting. of the UPHC.
• He/she shall ensure timely preparation • PHM shall do a monthly analysis on outputs/
of indents for drugs, linen, vaccines, ORS, inputs for cost effectiveness and share
consumables, instruments, contraceptives the same with UPHC Staff and district
sufficiently in advance and shall ensure authorities.
submission of the same to the appropriate
authority. 3. Lady Health Visitor or Nurse
Management of support services Supervision and guidance
• He/she shall assist Medical Officer in • She shall supervise and guide the Multi-
management of support services like purpose Health Worker (Female), and guide
security, laundry, transportation, diet etc. ASHA in the delivery of health care service
• He/she shall ensure convergence and to the community.
coordination of national and state health • She shall strengthen the knowledge and
programmes. skills of the Health Worker (Female).
• The PHM shall ensure bringing convergence • She shall help the Health Worker (Female)
amongst all National Health Programmes in improving her skills in working in the
in the catchment area as well as reporting community.
 Job Responsibilities of UPHC staff | 49

• She shall help and guide the Health Worker and submit monthly reports to the Medical
(Female) in planning and organising her Officer of the Primary Health Centre.
programmes of activities.
• She shall assess fortnightly the progress 4. Auxiliary Nurse Midwives (ANM)
of assessment report work of the Health
Worker (Female) and submit with respect to Responsibilities of ANM for outreach sessions:
their duties under various National Health • Unlike rural areas, Sub-Centres will not be
Programmes. set up in the urban areas as distances and
• She shall carry out supervisory home visits in mode of transportation are much better
the area of the Health Worker (Female) with here. Outreach services will be provided
respect to her duties under various National through the Female Health Workers
Health Programmes. (FHWs), essentially ANMs with an induction
training of three to six months, who will be
• She shall supervise referral of all pregnant
headquartered at the Urban PHCs.
women for ANC check-ups at the UPHC.
• The ANMs will report at the UPHC and
Team Work then move to their respective areas for
• She shall help the health workers to work as outreach services (including school health)
part of the Health Team. on designated days. They will be provided
• She shall coordinate her activities with other mobility support for providing outreach
health personnel. services.

• She shall coordinate the health activities • On other days, they will conduct
in her area with the activities of workers of immunisation and ANC clinics etc. at the
other departments and agencies and attend UPHC itself.
meetings at PHC level. • Responsible for providing preventive
• She shall conduct regular staff meetings and promotive healthcare services at the
with the health workers in coordination with household level through regular visits and
the other health personnel. outreach sessions.

• She shall attend staff meetings at the Urban • Each ANM will organise a minimum of one
Primary Health Centre. routine outreach session in her area every
month. Outreach sessions shall be planned
• She shall assist the Medical Officer of the
to reach out to the vulnerable sections like
Primary Health Centre in the organisation of
slum population, rag pickers, sex workers,
the different health services in the area.
brick kiln workers, street children and
• She shall participate as a member of the rickshaw pullers.
health team in mass camps and campaigns
• Special outreach sessions (for slum and
in health programmes.
vulnerable population) – Once in a week
• She shall facilitate and participate in activities the ANMs covering slum/ vulnerable
of the UHND. populations shall organise one special
outreach session in partnership with other
Records and Reports
health professionals (doctors/ pharmacists/
• She shall scrutinise the maintenance of technicians/ nurses - government or
records by the Health Worker (Female) and private). It will include screening and follow-
guide her in their proper maintenance. up, basic lab investigations (using portable/
• She shall review reports received from the disposable kits), drug dispensing, and
Health Workers (Female), consolidate them counselling.
50 | Guidelines for Organising Urban Primary Health Centre Services | June 2017

5. Laboratory Technician 7. ASHA

• Lab maintenance: General lab maintenance, • Each slum/community shall have one
including equipment, glassware, sterilization frontline community worker called ASHA.
of equipment, disposal of specimen and ASHA, similar to ASHA under NRHM,
infected material as per protocol, hygiene covering about 1,000 - 2,500 beneficiaries,
maintenance in lab. between 200 - 500 households based on
• Ensure proper flow of patients, sample, spatial consideration, shall preferably be co-
maintenance of testing area. Ensuring located at the Anganwadi Centre functional
adherence to infection prevention protocols, at the slum level, for delivery of services at
maintaining entry restriction to the lab. the doorstep.
• Investigations: Conduct tests as mentioned • She shall remain in charge of each area and
in 2.9 (page 19) and any other tests as serve as an effective demand generating
specified by the medical officer, collection of link between the health facility (Urban Pri-
sample, preparation of reagents, stains, media mary Health Centre) and the urban slum
and other processes necessary for lab tests. populations. She shall maintain interper-
sonal communication with the beneficiary
• Reporting & Record Keeping: maintain
families and individuals to promote the
necessary records of investigations done
desired health seeking behaviour. She shall
in defined registers such as lab tests, tests
be responsible for the MAS (community
referred, lab stock & store register, lab indent
groups) for which they are designated.
register. Prepare monthly reports of the lab
tests done. • The ASHA shall help the ANM in delivering
outreach services in the vicinity of the
• Inform MO of any unusual observations,
doorsteps of the beneficiaries. Preferably
positives test, and any patterns observed in
some suitable identified place for ASHA
samples received.
may be arranged in the slums which may be
AWW centres, clubs, community premises
6. Pharmacist set up under the JnNURM, Sub Health Posts
• Drug storage and dispensation: drug set up in IPP cities, municipal premises etc.,
dispensation and distribution, maintain or even her own residence.
continuous supply of drugs and
• Essential services to be rendered by the
consumables, proper storage of drugs to
ASHA may be as follows:
ensure potency and quality, ensure hygiene
in the pharmacy, display of EDL in UPHC. • Actively promote good health practices
and community support.
• Procurement and management of drugs,
and ensuring no stock-outs in the facility. • Facilitate awareness on essential RCH
services, sexuality, gender equality, age
• Inventory management, ensuring timely
at marriage/pregnancy; motivation
indents, stock maintenance and making and
on contraception adoption, medical
raising indents.
termination of pregnancy, sterilisation,
• Reporting and record keeping: maintenance spacing methods. Early registration of
of stock and store registers, utilization pregnancies, pregnancy care, clean and
drug records software such as E-Aushadhi, safe delivery, nutritional care during
prepare monthly reports. pregnancy, identification of danger
• Random sampling and testing of medicine signs during pregnancy; counselling on
stocks. immunization, ANC, PNC etc.
 Job Responsibilities of UPHC staff | 51

• Act as a depot holder for essential preparing of resource map in the

provisions like Oral Rehydration Therapy communities for identifying vulnerable and
(ORS), Iron Folic Acid Tablet (IFA), socio-economically disadvantaged group.
chloroquine, oral pills and condoms, etc.
• Monitoring and facilitating access to
• Identify target beneficiaries and support essential public services and ensuring
the ANM in conducting regular monthly that all the people in the community or
outreach sessions and tracking service geographical area of MAS, particularly
coverage. marginalised, vulnerable groups and
• Facilitate access to health-related disabled are receiving the services related
services available at the Anganwadi/ to health, water, sanitation, nutrition and
Primary Urban Health Centres/ULBs, education.
and other services being provided by
• Organising local collective action for
the ULB/State/ Central Government.
preventive and promotive health activities
• Encourage formation and promotion of in the locality and amongst the families that
MAS in her community. are part of the group.
• Arrange to escort/accompany pregnant • Supporting ANM, AWW and ASHA in
women and children requiring organising the Urban Health Nutrition Day
treatment to the nearest Urban Primary and immunisation sessions. Mobilising
Health Centre, secondary/tertiary level
pregnant women and children, particularly
healthcare facility.
from marginalised families, and coordinate
• Ensure reinforcement of community with ASHA and ANM in organising outreach
action for immunisation, prevention of sessions (both routine and special) activities
water borne and other communicable in the community.
diseases like TB (DOTS), malaria,
chikungunya and Japanese encephalitis.
• The Mahila Arogya Samiti (MAS) is also
responsible for community health planning
• Carry out preventive and promotive which should be done on a monthly basis.
health activities with AWW/ MAS.
• Informing the UPHC or its functionaries in
• Maintain necessary information and
the event of any disease outbreak, which
records about births and deaths,
could be a single unusual disease, or a cluster
immunisation, antenatal services in
of three to five cases of a common disease
her assigned locality as also about any
happening within two weeks to a month.
unusual health problem or disease
outbreak in the slum and share it with • Providing feedback to UPHC on the services
the ANM in charge of the area. being provided.
• Maintaining records of births and deaths
8. Mahila Arogya Samiti in the slum cluster.
• Supporting and contributing
to mapping • Managing untied funds for Rs. 5,000
and listing of slum households; also given annually to MAS.
 A n n e x u r e – IV

Referral Form

Referral Form Original / Copy

Name of facility:
Referred by: Name: Position:
Name & Address of UPHC: Date of referral:
Referred to Facility Name
and Address:
Patient’s Name
Identity Number Age: Sex: M F
Patient’s address
Clinical history
Findings
Treatment given
Reason for referral
Documents accompanying
referral
Print name, sign & date Name: Signature: Date:
Note to receiving facility: On completion of patient management please fill in and detach the referral back slip
below and send with patient or send by fax or mail.
-----------------------receiving facility - tear off when making back referral--------------------------

Back referral from Tel No. Fax No.

Facility Name
Reply from Name: Date:
(person completing form) Position: Specialty:
To Initiating Facility:
(enter name and address)
Patient Name
Identity Number Age: Sex: M F
Patients address
54 | Guidelines for Organising Urban Primary Health Centre Services | June 2017

This patient was seen by: Date:

(give name and specialty)
Patient history
Special investigations and
findings
Diagnosis
Treatment / operation
Medication prescribed
Please continue with:
(meds, follow-up, care)
Refer back to: Date:
Print name, sign & date Name: Signature: Date:
S.No.

Date of referral
made

Name of the
Patient

Sex
(M/F)

Identity No.
(if NA, then
address)

Referred to
(name of facility
/ specialty)

Reason for
Referral

Date Back
Annexure – V

referral received

Follow-up
required
YES / NO

Follow-up
Referral Register for UPHC

completed
YES / NO

Appropriate
referral
YES / NO
 A n n e x u r e – VI

History Taking/Risk Assessment Form for

Non- Communicable Diseases

General Information
Name of ASHA Village
Name of ANM Sub Centre
PHC Date
Personal Details
Name Any Identifier (Aadhar Card, UID, Voter ID)
Age RSBY beneficiary: (Y/ N ) ________________________
Sex Telephone No.
Address

Part A: Risk Assessment

Question Range Circle any Write score
1. What is your age? (in complete 30-39 years 0
years) 40-49 years 1
≥ 50 years 2
2. Do you smoke or consume Never 0
smokeless products such as Gutka; Used to consume in the past / Sometimes 1
or Khaini ? now
Daily 2
3. Do you consume Alcohol daily? No 0
Yes 1
4. Measurement of waist (in cm) Female Male
<80 cm <90 cm 0
80-90 cm 90-100 cm 1
>90 cm >100 cm 2
5. Do you undertake any physical Less than 150 minutes in a week 0
activities for minimum of 150
At least 150 minutes in a week 1
minutes in a week?
58 | Guidelines for Organising Urban Primary Health Centre Services | June 2017

6. Do you have a family history (any No 0

one of your parents or siblings) of Yes 2
high blood pressure, diabetes and
heart disease?
Total Score
A score above 4 indicates that the person may be at risk for these NCDs and needs to be prioritized for attending
the weekly NCD day

Part B: Early Detection: Ask if patient has any of these symptoms

B1: Women and Men Yes/No B2: Women only Yes/No
Shortness of breath Lump in the breast
Coughing more than 2 weeks Blood stained discharge from the nipple
Blood in sputum Change in shape and size of breast
History of fits Bleeding between periods
Difficulty in opening mouth Bleeding after menopause
Ulcers /patch /growth in the mouth Bleeding after intercourse
that has not healed in two weeks
Any change in the tone of your voice Foul smelling vaginal discharge
In case the individual answers Yes to any one of the above mentioned symptoms, refer the patient immediately to the
nearest facility where a Medical Officer is available.
 Design & Layout: JS MEDIA (www.jsmedia.in)

Ministry of Health and Family Welfare

Government of India