DESIGN OF PRIMARY HEALTH CENTRE BUILDING ⋆ Archi-Monarch

A Primary Health Centre (PHC) is the first point of contact between the community and the healthcare system. It is a basic healthcare facility that provides essential medical services, particularly in rural and semi-urban areas. PHCs are part of a country’s primary healthcare network, offering preventive, promotive, curative, and rehabilitative healthcare services at an affordable cost.

Importance of PHCs in Healthcare Systems

PHCs play a crucial role in the overall healthcare system by:

Providing Accessible Healthcare – They ensure that people in remote and underserved areas receive basic medical care.
Reducing Burden on Hospitals – By handling common illnesses and minor medical conditions, PHCs help decongest secondary and tertiary hospitals.
Preventing Diseases – They promote vaccination, maternal care, and health awareness to prevent major outbreaks.
Enhancing Health Equity – PHCs make healthcare affordable and inclusive, reducing disparities between urban and rural populations.
Early Diagnosis and Treatment – By offering basic diagnostic services, they enable early detection and management of diseases, reducing complications.

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1) Healthcare System in India

India has a three-tier healthcare system designed to provide medical services to its vast and diverse population. This system consists of:

Primary Healthcare – Includes Sub-Centres (SCs) and Primary Health Centres (PHCs), mainly catering to rural areas by providing preventive, curative, and promotive healthcare.
Secondary Healthcare – Comprises Community Health Centres (CHCs) and District Hospitals, offering specialized medical care and referrals.
Tertiary Healthcare – Involves advanced treatment provided by medical colleges, super-specialty hospitals, and research institutions.

Despite significant progress, India faces challenges such as unequal access to healthcare, shortage of medical professionals, and infrastructure gaps, particularly in rural areas.

2) Importance of Primary Health Centres

Primary Health Centres (PHCs) serve as the foundation of India’s rural healthcare system, addressing the needs of nearly 70% of India’s population residing in villages. They act as the first point of contact between the community and the formal healthcare system.

The key roles of PHCs include:

Providing Essential Healthcare – PHCs offer services such as maternal and child healthcare, immunization, disease prevention, and basic treatments.
Reducing Burden on Higher Facilities – By handling common illnesses and preventive care, PHCs reduce unnecessary referrals to secondary and tertiary hospitals.
Controlling Epidemics and Disease Outbreaks – PHCs play a crucial role in detecting and managing communicable diseases like tuberculosis, malaria, and COVID-19.
Promoting Health Awareness – They conduct awareness programs on nutrition, family planning, hygiene, and sanitation.

The efficiency of PHCs is vital to achieving Universal Health Coverage (UHC) and ensuring equitable access to healthcare.

3) Primary Health Centre Building Design

Designing a Primary Health Centre (PHC) building requires careful planning to ensure it meets healthcare needs, follows regulations, and provides a comfortable environment for patients and staff.

The PHC should have a building of its own. The surroundings should be clean.

Below are key aspects of a well-designed PHC:

i) Location

It should be centrally located in an easily accessible area. The area chosen should have facilities for electricity, all weather road communication, adequate water supply and telephone.

At a place, where a PHC is already located, another health centre / SC should not be established to avoid the wastage of human resources.

PHC should be away from garbage collection, cattle shed, water logging area, etc. PHC shall have proper boundary wall and gate.

ii) Area

It should be well planned with the entire necessary infrastructure. It should be well lit and ventilated with as much use of natural light and ventilation as possible.

The plinth area would vary from 375 to 450 sq. metres depending on whether an OT facility is opted for.

iii) Sign-age

The building should have a prominent board displaying the name of the Centre in the local language at the gate and on the building. PHC should have pictorial, bilingual directional and layout sign-age of all the departments and public utilities (toilets, drinking water).

Prominent display boards in local language providing information regarding the services available / user charges / fee and the timings of the centre. Relevant IEC (International Electrotechnical Commission) material shall be displayed at strategic locations.

Citizen charter including patient rights and responsibilities shall be displayed at OPD (Outpatient Department) and Entrance in local language.

iv) Entrance with Barrier free access

Barrier free access environment for easy access to non- ambulant (wheel-chair, stretcher), semi ambulant, visually disabled and elderly persons as per guidelines of GOI (Government of India).

Ramp as per specification, Hand- railing, proper lightning etc must be provided in all health facilities and retrofitted in older one which lack the same.

The doorway leading to the entrance should also have a ramp facilitating easy access for old and physically challenged patients. Adequate number of wheel chairs, stretchers etc. should also be provided.

v) Disaster Prevention Measures

For all new upcoming facilities in seismic 5 zone or other disaster prone areas.

Building and the internal structure should be made disaster proof especially earthquake proof, flood proof and equipped with fire protection measures.

Earthquake proof measures – structural and non- structural should be built in to withstand quake as per geographical / state government guidelines. Non-structural features like fastening the shelves, almirahs, equipment etc. are even more essential than structural changes in the buildings. Since it is likely to increase the cost substantially, these measures may especially be taken on priority in known earthquake prone areas. PHC should not be located in low lying area to prevent flooding as far as possible.

Fire fighting equipment – fire extinguishers, sand buckets etc. should be available and maintained to be readily available when needed. Staff should be trained in using fire fighting equipment.

All PHCs should have Disaster Management Plan in line with the District Disaster management Plan.

All health staff should be trained and well conversant with disaster prevention and management aspects. Surprise mock drills should be conducted at regular intervals.

vi) Waiting Area

This should have adequate space and seating arrangements for waiting clients / patients as per patient load.
The walls should carry posters imparting health education.
Booklets / leaflets in local language may be provided in the waiting area for the same purpose.
Toilets with adequate water supply separate for males and females should be available.
Waiting area should have adequate number of fans, coolers, benches or chairs.
Safe Drinking water should be available in the patient’s waiting area.

There should be proper notice displaying departments of the centre, available services, names of the doctors, users’ fee details and list of members of the Rogi Kalyan Samiti / Hospital Management Committee.

A locked complaint / suggestion box should be provided and it should be ensured that the complaints / suggestions are looked into at regular intervals and addressed.

The surroundings should be kept clean with no water- logging and vector breeding places in and around the centre.

vii) OPD (Outpatient Department)

The outpatient room should have separate areas for consultation and examination.

The area for examination should have sufficient privacy.

In PHCs with AyUSH doctor, necessary infrastructure such as consultation room for AyUSH Doctor and AyUSH Drug dispensing area should be made available.

OPD Rooms shall have provision for ample natural light, and air. Windows shall open directly to the external air or into an open verandah.

Adequate measures should be taken for crowd management; e.g. one volunteer to call patients one by one, token system.

One room for Immunization / Family Planning / Counseling.

viii) Wards 5.5 m x 3.5 m each

There should be 4-6 beds in a Primary Health Centre. Separate wards / areas should be earmarked for males and females with the necessary furniture.

There should be facilities for drinking water and separate clean toilets for men and women.

The ward should be easily accessible from the OPD so as to obviate the need for a separate nursing staff in the ward and OPD during OPD hours.

Nursing station should be located in such a way that health staff can be easily accessible to OT and labour room after regular clinic timings.

Proper written handover shall be given to incoming staff by the outgoing staff.

Dirty utility room for dirty linen and used items.

Cooking should not be allowed inside the wards for admitted patients.

Cleaning of the wards, etc. should be carried out at regular intervals and at such times so as not to interfere with the work during peak hours and also during times of eating. Cleaning of the wards, Labour Room, OT, and toilets should be regularly monitored.

ix) Operation Theatre (Optional)

To facilitate conducting selected surgical procedures (e.g. vasectomy, tubectomy, hydrocelectomy etc.).

It should have a changing room, sterilization area operating area and washing area.

Separate facilities for storing of sterile and unsterile equipment/instruments should be available in the OT.

The Plan of an ideal OT has been showing the layout below.

It would be ideal to have a patient preparation area and Post-Operative area. However, in view of the existing situation, the OT should be well connected to the wards.

The OT should be well-equipped with all the necessary accessories and equipment.

Surgeries like laparoscopy / cataract / Tubectomy / Vasectomy should be able to be carried out in these OTs.

OT shall be fumigated at regular intervals

One of the hospital staff shall be trained in Autoclaving and PHC shall have standard Operative procedure for autoclaving.

OT shall have power back up (generator / Invertor / UPS). OT should have restricted entry. Separate foot wear should be used.

x) Labour Room (3.8 m x 4.2 m)

Essential

Configuration of New Born care corner.

Clear floor area shall be provided in the room for the newborn corner. It is a space within the labour room, 20-30 sq ft in size, where a radiant warmer (Functional) will be kept.
Oxygen, suction machine and simultaneously- accessible electrical outlets shall be provided for the newborn infant in addition to the facilities required for the mother. Both Oxygen Cylinder and Suction Machine should be functional with their tips cleaned and covered with sterile gauze etc for ready to use condition. They must be cleaned after use and kept in the same way for next use.
The Labour room shall be provided with a good source of light, preferably shadow-less.
Resuscitation kit including Ambu Bag (Paediatric size) should be placed in the radiant warmer.
Provision of hand washing and containment of infection control if it is not a part of the delivery room.
The area should be away from draught of air, and should have power connection for plugging in the radiant warmer.

There should be separate areas for septic and aseptic deliveries.

The Labour room should be well-lit and ventilated with an attached toilet and drinking water facilities. Facilities for hot water shall be available.

Separate areas for Dirty linen, baby wash, toilet, Sterilization.

Standard Treatment Protocols for common problems during labour and for newborns to be provided in the labour room.

Labour room should have restricted entry. Separate foot wear should be used.

All the essential drugs and equipment (functional) should be available.

Cleanliness shall always be maintained in Labour room by regular washing and mopping with disinfectants.

Labour Room shall be fumigated at regular interval.

Desirable

Delivery kits and other instruments shall be autoclaved where facility is available.

If Labour Room has more than one labour table then the privacy of the women must be ensured by having screens between 2 labour tables.

xi) Minor OT / Dressing Room / Injection Room / Emergency

This should be located close to the OPD to cater to patients for minor surgeries and emergencies after OPD hours.

It should be well equipped with all the emergency drugs and instruments.

Privacy of the patients should be ensured.

xii) Laboratory (3.8 m x 2.7 m)

Sufficient space with workbenches and separate area for collection and screening should be available.

Should have marble / stone table top for platform and wash basins.

xiii) General store

Separate area for storage of sterile and common linen and other materials / drugs / consumable etc. should be provided with adequate storage space.

The area should be well-lit and ventilated and rodent / pest free.

Sufficient number of racks shall be provided.
Drugs shall be stored properly and systematically in cool (away from direct sunlight), safe and dry environment.
inflammable and hazardous material shall be secured and stored separately.

Near expiry drugs shall be segregated and stored separately.

Sufficient space with the storage cabins separately for AyUSH drugs be provided.

Dispensing cum store area: 3 m x 3 m

Infrastructure for AyUSH doctor

Based on the system of medicine being practiced, appropriate arrangements should be made for the provision of a doctor’s room and a dispensing room cum drug storage.

Waste disposal pit – As per GOI / Central Pollution Control Board (CPCB) guidelines.
Cold Chain room – Size: 3 m x 4 m
Logistics Room – Size: 3 m x 4 m
Generator room – Size: 3 m x 4 m
Office room – Size: 3.5 m x 3.0 m

Dirty utility room for dirty linen and used items

xiv) Residential Accommodation

Essential – Decent accommodation with all the amenities likes 24-hrs. water supply, electricity etc. should be available for Medical Officer, nursing staff, pharmacist, laboratory technician and other staff.

If the accommodation can not be provided due to any reason, then the staff may be paid house rent allowance, but in that case they should be staying in near vicinity of PHC so that they are available 24 × 7, in case of need.

xv) Boundary wall / Fencing

Essential – Boundary wall/fencing with Gate should be provided for safety and security.

xvi) Environment friendly features

Desirable – The PHC should be, as far as possible, environment friendly and energy efficient. Rain-Water harvesting, solar energy use and use of energy-efficient bulbs/ equipment should be encouraged.

xvii) Other amenities

Essential – Adequate water supply and water storage facility (over head tank) with pipe water should be made available.

xviii) Computer

Essential – Computer with Internet connection should be provided for Management Information System (MIS) purpose.

xix) Lecture Hall / Auditorium

Desirable For training purposes, a Lecture Hall or a small Auditorium for 30 Person should be available. Public address system and a black board should also be provided

The suggested layout of a PHC and Operation Theatre is given at Annexure 2 and Annexure 2A respectively. The Layout may vary according to the location and shape of the site, levels of the site and climatic conditions. The prescribed layout may be implemented in PHCs yet to be built, whereas those already built may be upgraded after getting the requisite alteration/additions. The funds may be made available as per budget provision under relevant strategies mentioned in NRHM/RCH-II program and other funding projects/programs.

xx) Equipment and Furniture

The necessary equipment to deliver the assured services of the PHC should be available in adequate quantity and also be functional.

Equipment maintenance should be given special attention.

Periodic stock taking of equipment and preventive/ round the year maintenance will ensure proper functioning equipment. Back up should be made available wherever possible.