ICFAI UNIVERSITY

3 TIERS OF
HOSPITALS WITH
SPECIAL REFRENCE
TO TRIPURA

SUBMITTED BY : SONALI 2018-20

MISHRA
ID: 18IUT0180006
SUBMITTED TO : Prof.
SOUMEN MUKHERJEE
India has a vast health care system, but there
remain many differences in quality between rural
and urban areas as well as between public and
private health care. Despite this, India is a
popular destination for medical tourists, given
the relatively low costs and high quality of its
private hospitals. International students in India
should expect to rely on private hospitals for
advanced medical care.

Studying in India offers a number of health

challenges that students from developed
countries may be unused to, so it is important to
know how the health care system in India
operates in the event you need it. Health care in
India is a vast system and can be much like the
rest of the country: full of complexity and
paradoxes.

History and Today

India's Ministry of Health was established with independence from
Britain in 1947. The government has made health a priority in its
series of five-year plans, each of which determines state spending
priorities for the coming five years. The National Health Policy was
endorsed by Parliament in 1983. The policy aimed at universal
health care coverage by 2000, and the program was updated in
2002.

The health care system in India is primarily administered by the

states. India's Constitution tasks each state with providing health
care for its people. In order to address lack of medical coverage in
rural areas, the national government launched the National Rural
Health Mission in 2005. This mission focuses resources on rural
areas and poor states which have weak health services in the
hope of improving health care in India's poorest regions.

Private and Public

The health care system in India is universal. That being said, there is great
discrepancy in the quality and coverage of medical treatment in India. Healthcare
between states and rural and urban areas can be vastly different. Rural areas often
suffer from physician shortages, and disparities between states mean that residents
of the poorest states, like Bihar, often have less access to adequate healthcare than
residents of relatively more affluent states. State governments provide healthcare
services and health education, while the central government offers administrative
and technical services.

Lack of adequate coverage by the health care system in India means that many
Indians turn to private healthcare providers, although this is an option generally
inaccessible to the poor. To help pay for healthcare costs, insurance is available,
often provided by employers, but most Indians lack health insurance, and out-of-
pocket costs make up a large portion of the spending on medical treatment in India.

On the other hand private hospitals in India offer world class quality health care at a
fraction of the price of hospitals in developed countries. This aspect of health care
in India makes it a popular destination for medical tourists. India also is a top
destination for medical tourists seeking alternative treatments, such as ayurvedic
medicine. India is also a popular destination for students of alternative medicine.

International students should expect to rely on private hospitals for advanced

medical treatment in India. Local pharmacists can be a valuable resource for most
minor health ailments.

Knowing the Indian health care system and taking reasonable health and safety
precautions should help ensure that your time in India is a healthy and enjoyable
one!
 BAMUTIA –PHC
Bamutia is a large village located in Mohanpur Block of West Tripura district, Tripura with total
2376 families residing. The Bamutia village has population of 9804 of which 4939 are males
while 4865 are females as per Population Census 2011.

In Bamutia village population of children with age 0-6 is 1110 which makes up 11.32 % of total
population of village. Average Sex Ratio of Bamutia village is 985 which is higher than Tripura
state average of 960. Child Sex Ratio for the Bamutia as per census is 1037, higher than
Tripura average of 957.

Bamutia village has higher literacy rate compared to Tripura. In 2011, literacy rate of Bamutia
village was 91.79 % compared to 87.22 % of Tripura. In Bamutia Male literacy stands at 94.67
% while female literacy rate was 88.84 %.

As per constitution of India and Panchyati Raaj Act, Bamutia village is administrated by
Sarpanch (Head of Village) who is elected representative of village.

Particulars Total Male Female

Total No. of Houses 2,376 - -

Population 9,804 4,939 4,865

Child (0-6) 1,110 545 565

Schedule Caste 4,456 2,245 2,211

Schedule Tribe 501 254 247

Literacy 91.79 % 94.67 % 88.84 %

Total Workers 3,751 2,776 975

Main Worker 2,771 - -

Marginal Worker 980 422 558

EMPLOYEE DESCRIPTION
Proforma for PHCs on IPHS

Identificatio
n

Name of the State : TRIPURA

District : WEST TRIPURA

Tehsil/Taluk/Block : MANDWI

Location Name of PHC : BORAKHA BAZAR /

BORAKHA PHC

Is the PHC providing 24 hours and 7 days

delivery facilities Yes

I. Services
S.No.
1.1. Population covered (in numbers) 21722
1.2. Assured Services available (Yes/No)
a. OPD Services Y
b. Emergency services (24 Hours) Y
c. Referral Services Y
d. In-patient Services Y
1.3.
a. Number of beds available 10
Bed Occupancy Rate in the last 12 months (1-
b. less than 40%; 2 - 40-60%; 3 - More than 6
60%)
1.4. Average daily OPD Attendence
a. Males 18
b. Females 22
1.5. Treatment of specific cases (Yes / No)
a. Is surgery for cataract done in the PHC? N
b. Is the primary management of wounds done at
the PHC? Y
c. Is the primary management of fracture done at
the PHC? Y

d. Are minor surgeries like draining of abscess

etc done at the PHC? Y

e. Is the primary management of cases of

poisoning / snake, insect or scorpion bite done Y
at the PHC?
f. Is the primary management of burns done at
PHC? Y

1.6. MCH Care including Family Planning

1.6.1. Service availability (Yes / No)
a. Ante-natal care Y
b. Intranatal care (24 - hour delivery services
both normal and assisted) Y
c. Post-natal care Y
d. New born Care Y
e. Child care including immunization Y
f. Family Planning Y
g. MTP N
h. Management of RTI / STI Y
i. Facilities under Janani Suraksha Yojana Y
1.6.2. Availability of specific services (Yes / No)
a. Are antenatal clinics organized by the PHC
regularly? Y
b. Is the facility for normal delivery available in
the PHC for 24 hours? Y
c. Is the facility for tubectomy and vasectomy
available at the PHC? N
d. Is the facility for internal examination for
gynaecological conditions available at the
PHC? N
e. Is the treatment for gynecological disorders
like leucorrhoea, menstrual disorders available
at the PHC?
N
f. If women do not usually go to the PHC, then
what is the reason behind it? Y
g. Is the facility for MTP (abortion) available at
the PHC? N
h. Is there any precondition for doing MTP such
as enforced use of contraceptives after MTP or
asking for husband's consent for MTP? N
i. Do women have to pay for MTP?
N
j. Is treatment for anemia given to both pregnant
as well as non-pregnant women? Y
k. Are the low birth weight babies managed at
the PHC? N
l. Is there a fixed immunization day?
Y
m. Is BCG and Measles vaccine given regularly
in the PHC? Y
n. How is the vaccine received at PHC and
distributed to Sub Centres? Y
o. Is the treatment of children with pneumonia
available at the PHC? Y
p. Is the management of children suffering from
diarrhea with severe dehydration done at the
PHC?
Y

1.7. Other functions and services performed

(Yes / No)
a. Nutrition services Y
b. School Health programmes Y
c. Promotion of safe water supply and basic
sanitation Y
d. Prevention and control of locally endemic
diseases Y
e. Disease surveillance and control of epidemics Y
f. Collection and reporting of vital statistics Y
g. Education about health / behaviour change
communication Y
h. National Health Programmes including
HIV/AIDS control programmes N
i. AYUSH services as per local preference Y
j. Rehabilitation services Y
1.8. Monitoring and Supervision activities (Yes /
No)
a. Monitoring and supervision of activities of
sub-centres through regular meetings /
periodic visits, etc. Y
b. Monitoring of National Health Programmes Y
c. Monitoring activities of ASHAs Y
d. Visits of Medical Officer to all sub-centres at
least once in a month Y
e. Visits of Health Assistants (Male) and LHV to
sub-centres once a week N
2

Current Remarks /
Existin Availabilit Suggestio
Recommende
S.No. Personnel g y at PHC ns /
d
pattern (Indicate Identified
Numbers) Gaps
2 (one from
AYUSH and
one other
2.1. Medical Officer 1 Medical 2
Officer
preferrably a
Lady Doctor)
2.2. Pharmacist 1 1 2
3 (for 24 hour
PHCs; 2 may
2.3. Nurse - Midwife (Staff Nurse) 1 5
be
contractual))
2.4. Health Worker (Female) 1 1 2
2.5. Health Educator 1 1 0
2.6. Health Assistant (One male and One female 2 2 0
2.7. Clerks 2 2 0
2.8. Laboratory Technician 1 1 1
Optional;
vehicles may
2.9. Driver 1 1
be out-
sourced
2.10. Class IV employees 4 4 6
Total 15 17/18
III. Training of personnel during previous (full) year
3.1. Available training for Number trained
a. Tradition birth attendants 0
b. Health Worker (Female) 7
c. Health Worker (Male) 13
d. Medical Officer 1
e. Initial and periodic training of paramedics in
treatment of minor ailments 0

f. Training of ASHAs 28
g. Periodic training of Doctors through
Continuing Medical Education, conferences,
0
skill development training etc. on emergency
obstetric care
h. Training of Health Workers in antenatal care
and skilled birth attendance 5

IV. Essential Laboratory Services

Current
Remarks / Suggestions /
S.No. Availability
Identified Gaps
at PHC
4.1. Routine urine, stool and blood tests Y
4.2. Blood grouping Y
4.3. Bleeding time, clotting time N
Diagnosis of RTI/STDs with wet mounting, grams stain,
3.4. N
etc.
4.5. Sputum testing for TB N
4.6. Blood smear examination for malaria parasite Y
4.7. Rapid tests for pregnancy Y
4.8. RPR test for Syphills / YAWS surveillance N
4.9. Rapid tests for HIV N

V. Physical Infrastructure (As per specifications)

Remarks /
If
Current Suggestio
available,
S.No. Availability ns /
area in Sq.
at PHC Identified
mts.)
Gaps
5.1. Where is this PHC located?
a. Within Village Locality Y
b. Far from village locality N
c. If far from locality specify in km N
5.2. Building
Is a designated government building available for the Y
a.
PHC? (Yes / No)
b. If there is no designated government building, then where does the PHC located
Rented premises N
Other government building N
Any other specify N
c. Area of the building (Total area in Sq. mts.)
d. What is the present stage of construction of the building
Construction complete
Construction incomplete Y
Compound Wall / Fencing (1-All around; 2-
e. 1
Partial; 3-None)
Condition of plaster on walls (1- Well plastered with
plaster intact every where; 2- Plaster coming off in some
f. 2
places; 3- Plaster coming off in many places or no
plaster)
Condition of floor (1- Floor in good condition; 2- Floor
g. coming off in some places; 3- Floor coming off in many 1
places or no proper flooring)
Whether the cleanliness is Good / Fair /
h. GOOD
Poor?(Observe)
OPD Y
Rooms Y
Wards Y
Toilets Y
Premises (compound) Y
Are any of the following close to the PHC? (Observe)
I.
(Yes/No)
i. Garbage dump Y
ii. Cattle shed N
iii. Stagnant pool N
iv. Pollution from industry N
Is boundary wall with gate existing? (Yes /
j. N
No)
5.3. Location
a. Whether located at an easily accessible area? (Yes/No) Y
Distance of PHC (in Kms.) from the farthest village in
b. 12 KM.
coverage area
Travel time (in minutes) to reach the PHC from farthest
c. 30 MIN.
village in coverage area
d. Distance of PHC (in Kms.) from the CHC 15 KM
e. Distance of PHC (in Kms.) from District Hospital 25KM.
Prominent display boards regarding service availability
5.4. Y
in local language (Yes/No)
5.5. Registration counters (Yes/No) Y
5.6. Y
Pharmacy for drug dispensing and drug storage
a. Y
(Yes/No)
Counter near entrance of PHC to obtain contraceptives,
b. Y
ORS packets, Vitamin A and Vaccination (Yes / No)
5.7. Separate public utilities for males and females (Yes/No) Y
5.8. Suggestion / complaint box (Yes/No) Y
5.9. OPD rooms / cubicles (Yes/No) (Give numbers) Y
Adequate no. of windows in the room for light and air in
5.10 Y
each room (Yes/No)
5.11. Family Welfare Clinic (Yes/No) N
5.12. Waiting room for patients (Yes/No) Y
5.13. Emergency Room / Casualty (Yes/No) N
5.14. Separate wards for males and females (Yes/No) Y
5.15 No. of beds : Male 4
5.16 No. of beds : Female + Pregnancy 6
5.17. Operation Theatre (if exists)
a. Operation Theatre available (Yes/No)(minor) Y
b. If operation theatre is present, are surgeries carried out in N
the operation theatre?
Yes
No N
Minor one
Sometimes only
c. If operation theatre is present, but surgeries are not being
conducted there, then what are the reasons for the same?
Non-availability of doctors /staff
Lack of equipment / poor physical state of the operation
theatre
No power supply in the operation theatre
Any other reason (specify)
Operation Theatre used for obstetric / gynaecological
d.
purpose (Yes / No)
e. Has OT enough space (Yes / No)
5.18. Labour room
a. Labour room available? (Yes/ No) Y
b. If labour room is present, arc deliveries carried out in the
labour room?
Yes Y
No
Sometimes
 If labour room is present. but deliveries are not being
c.
conducted there, then what are the reasons for the same?
Non-availability of doctors / staff
Poor condition of the labour room
No power supply in the labour room
Any other reason (specify)
d. Is separate areas for septic and aseptic deliveries N
available? (Yes / No)
5.19. Laboratory:
a. Laboratory (Yes/No) Y
Are adequate equipment and chemicals available?
b. Y
(Yes/No)
c. Is laboratory maintained in orderly manner? (Yes / No) N
5.20. Ancillary Rooms - Nurses rest room (Yes/No) Y
5.21. Water supply
Source of water (1- Piped; 2- Bore well/ hand pump /
a. 1
tube well; 3- Well; 4- Other (specify))
b. Whether overhead tank and pump exist (Yes / No) Y
If overhead tank exist, whether its capacity sufficient?
c. Y
(Yes/No)
If pump exist, whether it is in working condition? (Yes /
d. Y
No)
5.22 Sewerage
Type of sewerage system ( 1- Soak pit; 2- Connected to
1
Municipal Sewerage)
5.23. Waste disposal Y
How the waste material is being disposed (please
specify)?
5.24. Electricity Y
Is there electric line in all parts of the PHC? (1- In all
a. 1
parts; 2- In some parts; 3- None)
Regular Power Supply (1- Continuous Power Supply; 2-
b. Occasional power failure; 3- Power cuts in summer only; 1
4- Regular power cuts; 5- No power supply
Stand by facility (generator) available in working
c. N
condition (Yes / No)
5.25. Laundry facilities:
a. Laundry facility available(Yes/No) Y
b. If no, is it outsourced?
5.26. Communication facilities
a. Telephone (Yes/No) N
b. Personal Computer (Yes/No) Y
c. NIC Terminal (Yes/No) N
d. E.Mail (Yes / No) Y
e. Is PHC accesible by
i. Rail (Yes / No) N
ii. All whether road (Yes / No) Y
iii. Others (Specify)
5.27. Vehicles
Vehicle (jeep/other vehicle) available? (Yes / No) N
Remarks /
If
Current Suggestio
available,
Availability ns /
area in Sq.
at PHC Identified
mts.)
Gaps
5.28. Office room (Yes/No) Y
5.29. Store room (Yes/No) Y
5.30. Kitchen (Yes / No) Y
5.31. Diet:
a. Diet provided by hospital (Yes/No) Y
b. If no, how diet is provided to the indoor patients?
5.32. Residential facility for the staff with all amenities
Medical Officer Y
Pharmacist N
Nurses Y
Other staff N
5.33. Behavioral Aspects (Yes / No) Y
a. How is the behaviour of the PHC staff with the patient
Courteous Y
Casual/indifferent
Insulting / derogatory
Any fee for service is charged from the users? (Yes /
b.
No). If yes, specify. N
Is there corruption in terms of charging extra money for
c.
any of the service provided? (Yes / No) N
Is a receipt always given for the money charged at the
d.
PHC? (Yes / No) N
Is there any incidence of any sexual advances. oral or
e. physical abuse, sexual harassment by the doctors or any
other paramedical? (Yes / No) N
Are woman patients interviewed in an environment that
f.
ensures privacy and dignity? (Yes / No) Y
Are examinations on woman patients conducted in
presence of a woman attendant, and procedures
g.
conducted under conditions that ensure privacy? (Yes /
No) Y
Do patients with chronic illnesses receive adequate care
h.
and drugs for the entire duration? (Yes / No) Y
If the health centre is unequipped to provide the services
i. how and where the patient is referred and how patients
transported? Y
Is there a publicly displayed mechanism, whereby a
j.
complaint/grievance can be registered? (Yes / No) Y

Is there an outbreak of any of the following diseases in

k.
the PHC area in the last three years?
Malaria Y
Measles N
Gastroenteritis N
Jaundice N
If yes, did the PHC staff responded immediately to stop
l.
the further spread of the epidment
Does the doctor do private practice during or after the
m.
duty hours? (Yes/ No)
Are there instances where patients from particular social
background dalits, minorities, villagers) have faced
n.
derogatory or discriminatory behavior or service of
poorer quality? (Yes / No)
Have patients with specific health problems (HIV/AIDS,
o.
leprosy suffered discrimination in any form? (Yes / No)

VI. Equipment (As per list)

 Remarks / Suggestions /
Equipment Available Functional
Identified Gaps

VII. Drugs (As per essential drug list)

Remarks / Suggestions /
Drug Available
Identified Gaps

VIII. Furniture
Remarks /
Current If Suggestio
S.No. Item Availability available, ns /
at PHC numbers Identified
Gaps
8.1. Examination Table Y 2
8.2. Delivery Table Y 1
8.3. Footstep Y 2
8.4. Bed Side Screen Y 2
8.5. Stool for patients Y 3
8.6. Arm board for adult & child N
8.7. Saline stand Y 6
8.8. Wheel chair Y 1
8.9. Stretcher on trolley Y 2
8.10. Oxygen trolley Y 1
8.11. Height measuring stand N
8.12. Iron bed Y 6
8.13. Bed side locker Y 6
8.14. Dressing trolley Y 1
8.15. Mayo trolley N
8.16. Instrument cabinet N
8.17. Instrument trolley Y 1
8.18. Bucket Y 6
8.19. Attendant stool Y 2
8.20. Instrument tray Y 3
8.21. Chair Y 12
8.22. Wooden table Y 6
8.23. Almirah Y 7
8.24. Swab rack N
8.25. Mattress Y 6
8.26. Pilow Y 10
8.27. Waiting bench for patients / attendants Y 2
8.28. Medicine cabinet Y 1
8.29. Side rail N
8.30. Rack Y 4
8.31. Bed side attendant chair Y 6
8.32. Others
IX. Quality Control
Whether functional / available as per
S.No. Particular norms
Remarks
9.1. Citizen's charter (Yes/No) Y
Constitution of Rogi Kalyan Samiti (Yes/No) (give
9.2. a list of office order notifying the members)
Y
 Internal monitoring (Social audit through
Panchayati Raj Institution / Rogi Kalyan Samitis,
9.3. medical audit, technical audit, economic audit,
Y
disaster preparedness audit etc. (Specify)
External monitoring /Gradation by PRI (Zila
9.4. Parishad)/ Rogi Kalyan Samitis
Y
9.5. Availability of Standard Operating Procedures
(SOP) / Standard Treatment Protocols (STP)
N

OBSERVATION:
Primary Health Centres are the cornerstone of rural health services- a first port of call to a
qualified doctor of the public sector in rural areas for the sick and those who directly report or
referred from Sub-centres for curative, preventive and promotive health care. A typical
Primary HealthCentre covers a population of 20,000 in hilly, tribal, or difficult areas
and 30,000 populations in plain areas with 4-6 indoor/observation beds. It acts as a referral unit for
6 sub-centres and refer out cases to CHC (30 bedded hospital) and higher order public hospitals
located at sub-district and district level. Standards are the main driver for continuous improvements
in quality. The performance of Primary Health Centres can be assessed against the set standards.
In order to provide optimal level of quality health care, a set of standards are being recommended
for Primary Health Centre to be called Indian Public Health Standards (IPHS) for PHCs. The
launching of National Rural Health Mission (NRHM) has provided this opportunity. The standards
prescribed in this document are for a PHC covering 20,000 to 30,000 populations with 6 beds.
Setting standards is a dynamic process. Currently the IPHS for Primary Health Centres has been
prepared keeping in view the resources available with respect to functional requirement for Primary
Health Centre with minimum standards such as building manpower, instruments, and equipments,
drugs and other facilities etc. The overall objective of IPHS for PHC is to provide health care that
is quality oriented and sensitive to the needs of the community. These standards would help
monitor and improve the functioning of the PHCs.
The objective of the IPHS for PHCs
 To provide comprehensive primary healthcare to the community through the PHCs
 To achieve and maintain an acceptable standard of quality and care.
 To make the services more responsive and sensitive to the needs of the community.

FACILITIES AT BAMUTIA
 Bamutia serves people from Fatikchera ,Taltala, bamutia, Tea garden ,Harindarnagar ,IB colony etc which fulfils the
guideline of covering population
 This follows seasonal visit as during winters there is less visit of the patients
 OPD service is provided for 4 hours in the morning from 8 am then 2 hours in the evening
 Minimum attendance of patients per day is 40 .
 24 hours of emergency service is provided like Trauma, road traffic accident etc
 They also admit the people if required.
 Appropriate management of injuries asnd accident ,first aid ,stabilisation of the condition of the patient before referral,