Community Health Centres (CHCs) are an essential part of India’s public healthcare system, serving as secondary-level referral units for Primary Health Centres (PHCs).
Established to provide comprehensive healthcare services, CHCs play a crucial role in bridging the gap between primary and tertiary healthcare facilities, particularly in rural and semi-urban areas.
Importance in the Public Healthcare System
CHCs are vital in ensuring accessible and affordable healthcare, especially in rural areas where private healthcare is often expensive or unavailable.
They contribute significantly to reducing maternal and infant mortality rates, managing non-communicable diseases (NCDs), and improving overall public health outcomes.
By strengthening CHCs with adequate infrastructure, medical personnel, and technology, India moves closer to achieving universal health coverage (UHC) and healthcare equity.
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1) Introduction
The CHC should have 30 indoor beds with one Operation theatre, labour room, x-ray, ECG and laboratory facility. In order to provide these facilities, following are the guidelines.
i) Location of the centre
All the guidelines as below under this sub-head may be applicable only to centres that are to be newly established and priority is to be given to operationalise the existing CHCs.
- To the extent possible, the centre should be located at the centre of the block headquarter in order to improve access to the patients.
- The area chosen should have the facility for electricity, all weather road communication, adequate water supply, telephone etc. 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.
- CHC should be away from garbage collection, cattle shed, water logging area, etc.
ii) Disaster Prevention Measures
Building structure and the internal structure should be made disaster proof especially earthquake proof, flood proof and equipped with fire protection measures.
iii) Earthquake proof measures
Structural and non-structural elements should be built in to withstand quake as per geographical/state govt. 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.
CHC should not be located in low lying area to prevent flooding.
CHC should have dedicated, intact boundary wall with a gate. Name of the CHC in local language should be prominently displayed at the entrance which is readable in night too.
iv) 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.
Each CHC should develop a fire fighting and fire exit plan with the help of Fire Department. Regular mock drills should be conducted.
All CHCs should have a 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.
After each drill the efficacy of the Disaster Plan, preparedness of the CHC, and the competence of the staff should be evaluated followed by necessary changes in the Plan and training of the staff.
The CHC should be, as far as possible, environment friendly and energy efficient. Rain-Water harvesting, solar energy use and use of energy-efficient CFL bulbs/equipment should be encouraged. Provision should be made for horticulture services including herbal garden.
The building should have areas/space marked for the following:
2) Entrance Zone
i) Signage
- Prominent display boards in local language providing information regarding the services available and the timings of the institute.
- Directional and layout signages for all the departments and utilities (toilets, drinking water etc.) shall be appropriately displayed for easy access. All the signages shall be bilingual and pictorial.
- Citizen charter shall be displayed at OPD and Entrance in local language including patient’s rights and responsibilities.
- On-the-way signages of the CHC & location should be displayed on all the approach roads.
- Safety, hazards and caution signs shall be displayed prominently at relevant places, e.g. radiation hazards for pregnant woman in x-Ray.
- Fluroscent Fire-Exit signages at strategic locations.
- Barrier free access environment for easy access to non-ambulant (wheel-chair stretcher), semi-ambulant, visually disabled and elderly persons as per – Guidelines and Space Standards for barrier-free built environment for Disabled and Elderly Persons‖ of 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.
- Registration cum Inquiry counters.
- Pharmacy for drug dispensing and storage.
- Clean Public utilities separate for males and females.
- Suggestion / complaint boxes for the patients / visitors and also information regarding the person responsible for redressal of complaints.
3) Outpatient Department
The facility shall be planned keeping in mind the maximum peak hour load and shall have scope for future expansion.
Name of Department and doctor, timings and user fees / charges shall be displayed. Layout of the Out Patient Department shall follow the functional flow of the patients: Example below.
Enquiry → Registration → Waiting → Sub Wating → Clinic → Dressing room / Injection Room → Billing → Dignostics (lab/x-ray) → pharmacy → Exit
i) Clinics for Various Medical Disciplines
These clinics include general medicine, general surgery, dental, obstetric and gynaecology, paediatrics and family welfare. Separate cubicles for general medicine and surgery with separate area for internal examination (privacy) can be provided if there are no separate rooms for each.
The cubicles for consultation and examination in all clinics should provide for doctor’s table, chair, patient’s stool, follower’s seat, wash basin with hand washing facilities, examination couch and equipment for examination.
- Room shall have, for the admission of light and air, one or more apertures, such as windows and fan lights, opening directly to the external air or into an open verandah. The windows should be in two opposite walls.
- Family Welfare Clinic – The clinic should provide educative, preventive, diagnostic and curative facilities for maternal, child health, school health and health education. Importance of health education is being increasingly recognized as an effective tool of preventive treatment. People visiting hospital should be informed of personal and environmental hygiene, clean habits, need for taking preventive measures against epidemics, family planning, non-communicable diseases etc. Treatment room in this clinic should act as operating room for IUCD insertion and investigation, etc. It should be in close proximity to Obstetric & Gynaecology. Family Welfare counselling room should be provided.
- Waiting room for patients.
- The Pharmacy should be located in an area conveniently accessible from all clinics. The dispensary and compounding room should have two dispensing windows, compounding counters and shelves. The pattern of arranging the counters and shelves shall depend on the size of the room. The medicines which require cold storage and blood required for operations and emergencies may be kept in refrigerators.
- Emergency Room/Casualty – At the moment, the emergency cases are being attended in OPD during OPD hours and in inpatient units afterwards. It is recommended to have a separate earmarked emergency area to be located near the entrance of hospital preferalbly having 4 rooms (one for doctor, one for minor OT, one for plaster/dressing) and one for patient observation (At least 4 beds).
4) Treatment Room
Minor OT
Injection Room and Dressing Room
Observation Room
5) Wards : Separate for Males and Females
i) Nursing Station
The nursing station shall be centered such that it serves all the clinics from that place.
The nursing station should be spacious enough to accommodate a medicine chest / a work counter (for preparing dressings, medicines), hand washing facilities, sinks, dressing tables with screen in between and colour coded bins (as per IMEP guidelines for community health centres).
It should have provision for Hub cutters and needle destroyers.
ii) Examination and dressing table
In a Community Health Centre, examination tables facilitate patient assessment, treatment, and medical procedures, ensuring accessibility and hygiene.
Dressing tables provide a private space for wound care, changing, and post-examination comfort. Both are essential for enhancing patient experience, supporting medical staff, and maintaining smooth workflow in clinical environments.
iii) Patient Area
- Enough space between beds.
- Toilets; separate for males and females.
- Separate space / room for patients needing isolation.
iv) Ancillary rooms
- Nurses rest room.
- There should be an area separating OPD and Indoor facility.
v) Operation theatre / Labour room
- Patient waiting Area.
- Pre-operative and Post-operative (recovery) room.
- Staff area.
- Changing room separate for males and females.
- Storage area for sterile supplies.
- Operating room/Labour room.
- Scrub area.
- Instrument sterilization area.
- Disposal area.
- Newborn care Corner.
6) Newborn Care Stabilization Unit
Public utilities: Separate for males and female; for patient as well as for paramedical & Medical staff. Disabled friendly, WC with wash basins as specified under Guidelines for disabled friendly environment should be provided.
7) Physical Infrastructure for Support Services
i) Central Steritization Supply Department (CSSD)
Sterilization and Sterile storage.
ii) Laundry
Storage should be separate for dirty linen and clean linen. Outsourcing is recommended after appropriate training of washer man regarding segregation and separate treatment for infected and non-infected linen.
iii) Engineering Services
Electricity / telephones / water / civil Engineering may be outsourced. Maintenance of proper sanitation in toilets and other public utilities should be given utmost attention. Sufficient funding for this purpose must be kept and the services may be outsourced.
iv) Water Supply
Arrangements shall be made to supply 10,000 litres of potable water per day to meet all the requirements (including laundry) except fire fighting.
Storage capacity for 2 days requirements should be on the basis of the above consumption. Round the clock water supply shall be made available to all wards and departments of the hospital. Separate reserve emergency overhead tank shall be provided for operation theatre.
Necessary water storage overhead tanks with pumping/boosting arrangement shall be made. The laying and distribution of the water supply system shall be according to the provisions of NBC.
Cold and hot water supply piping should be run in concealed form embedded into wall with full precautions to avoid any seepage. Geyser in O.T./L.R. and one in ward also should be provided. Wherever feasible solar installations should be promoted.
v) Emergency Lighting
Emergency portable / fixed light units should also be provided in the wards and departments to serve as alternative source of light in case of power failure. Generator back-up should be available in all facilities. Generator should be of good capacity. Solar energy wherever feasible may be used.
vi) Generator
5 kVA with POL for Immunization Cold Chain maintenance.
vii) Telephone
Minimum two direct lines with intercom facility should be available.
8) Administrative zone
Separate rooms should be available for:
- Office
- Stores
9) Residential Zone
- Minimum 8 quarters for Doctors.
- Minimum 8 quarters for staff nurses / paramedical staff.
- Minimum 2 quarters for ward boys.
- Minimum 1 quarter for driver.
If the accommodation cannot 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 CHC so that they are available for 24 x 7 in case of need.
10) Function & Space Requirement for CHC
It is suggested considering the land cost & availability of land, CHC building may be constructed in two floors.
11) Function & Space Requirement for Different Zones
12) Capacity Building
Training of all cadres of worker at periodic intervals is an essential component. Multi skill training for Doctors, Staff Nurses and paramedical workers is recommended.