Guidelines for Operationalising A Primary Health ... - NRHM Manipur

Critical determinants of a facility being a24-hour functioning PHCRecommended Service PackageA facility which is designated as a 24-hour PHC should be equipped for providing round the clockdelivery services and new born care, in addition to all the other emergencies that any primary health carecentre is required to cater to. The package of services to be provided by a PHC for it to be designated asa 24-hour PHC is detailed in Box-1. Services marked with an asterix (*) are critical for labelling a PHCas one providing round-the-clock delivery and newborn care services. It must be kept in mind that thefollowing services are in addition to all the services that a PHC is normally required to provide.Box-1: Essential service package to be provided by a 24-hour functional PHC1. 24-hour delivery services, both normal and assisted (*)2. Essential newborn care (*)3. Referral for emergencies (*)4. Ante-natal care and routine immunisation services for children and pregnant women (besidesfixed day services).5. Post-natal care6. Early and safe abortion services (including MVA)7. Family planning services8. Prevention and management of RTIs/STIs9. Essential laboratory services(*): Critical determinants of functionality1. 24-hour Delivery Services, both Normal and Assisted:Provision of round the clock delivery services, post-natal care, newborn care and referral linkages are thecritical determinants for designating a PHC as a 24-hour PHC. These PHCs should therefore be able toprovide services for• Conducting normal deliveries• Conducting assisted vaginal deliveries (Forceps delivery, vacuum delivery) whenever required.• Management and referral for manual removal of placenta• Administration of parenteral oxytocics, parenteral antibiotics and anticonvulsants for pregnancyinduced hypertension• Management of common obstetric complications such as post-partum haemorrhage, pre-eclampsiaand shock.• Pre-referral management (obstetric first-aid) and stabilization of patients with those obstetricemergencies which cannot be managed at the PHC level, prior to referral.The absence of staff skilled in the techniques of conducting assisted deliveries and other specialisedinterventions like manual removal of placenta, is foreseen as a problem that will be faced by a number ofPHCs. The states are therefore advised that, for provision of the full range of delivery services (bothnormal and assisted) and management of obstetric complications, they must ensure that the staff at thePHCs is fully trained/re-oriented in the above skills to enable them to provide these services.3