THE SUB DISTRICT

HOSPITALS/ SUB
DIVISIONAL HOSPITALS
What is IPHS?
Indian Public Health Standards(IPHS) are a set of
standards envisaged to improve the quality of health care
delivery in the country under the National Rural Health
Mission.
The Indian Public Health Standards (IPHS) for Sub-
centres, Primary Health Centres (PHCs), Community
Health Centres (CHCs), Sub-District and District Hospitals
were published in January/ February, 2007 and have
been used as the reference point for public health care
infrastructure planning and up-gradation in the States and
UTs.

What is the need for IPHS?
The health care system in India has expanded
considerably over the last few decades, however,
the quality of services is not uniform, due to
various reasons like non-availability of manpower,
problems of access, acceptability, lack of
community involvement, etc. Hence, standards
are being introduced in order to improve the
quality of public health level.

Introduction
Sub-district (Sub-divisional) hospitals are below the district and above the
block level (CHC) hospitals and act as First Referral Units. Specialist
services are provided through these sub-district/ district hospitals.

Link between district and the block level(CHC) hospitals to provides
specialist services, emergency obstetrics care and neonatal care.

A subdivision hospital caters to about 5-6 lakh people, in bigger districts
the SDHs fills the gap between the block level hospitals and the district
hospitals. There are about 1200 such hospitals in the country with a
varying strength of number of beds ranging from 31 to 100 beds or more.

The key aim of standard is to underpin the delivery of quality services
which are fair and responsive to clients needs, provided equitably and
deliver improvements in health and well being of the population.
Performance can be assessed against a set of standards.


Objectives
The overall objective of IPHS is to provide health care that is quality
oriented and sensitive to the needs of the people of the district.

i. To provide comprehensive secondary health care (specialist and
referral services) to the community through the Sub District Hospital.

ii. To achieve and maintain an acceptable standard of quality of care.

iii. To make the services more responsive and sensitive to the needs
of the people of the district and act as the First Referral Unit (FRU)
for the hospitals/centers from which the cases are referred to the Sub
District hospitals



Norms
Definition of Sub District hospitals-
A hospital at the secondary referral level responsible for the Sub District
/ Sub Division of a defined geographical area containing a defined
population.

Grading of Sub District hospitals
The size of a sub district hospital is a function of the hospital bed
requirement, which in turn is a function of the size of the population it
serves. In India the population size of a sub district varies from 1,00,000
to 5,00,000. Based on the assumptions of the annual rate of admission
as 1 per 50 populations and average length of stay in a hospital as 5
days, the number of beds required for a sub district having a population
of 5 lakh will be around 100-150 beds.

Grade I: Sub District hospitals norms for 100 beds or more
Grade II: Sub District hospitals norms for 50 beds not exceeding 100
beds


Functions

I. It provides effective, affordable healthcare services (curative
including specialist services, preventive and promotive) for a
defined population, with their full participation and in co-operation
with agencies in the district that have similar concern.

II. It covers both urban population (sub divisional headquarter town)
and the rural population of the sub division.

III. Provide education and training for primary health care staff.

Accidents & Emergencies
Family planning services
DOT center & DMC
ICTC Center
Disability Certificate

Essential Services
Desirable Services.

Critical Care / ICU
Psychiatry
Geriatric Services
Tobacco Cessation Services
Physical Medicine & Rehabilitation


Accidents and emergency services
These services are to be made available on 24x7
basis.
Mobile Xray.
Basic laboratory facilities.
Plaster room and minor OT facilities.
Sufficient waiting area for relatives and located in
such a way which does not disturb functioning of
emergency services.

Planning (Physical Infrastructure)
Size of the hospital
The size of a Sub-district hospital is a function of the hospital bed
requirement which in turn is a function of the size of the population
serve.

The number of beds required for a Sub-district
having a population of 2,50000 will be as follows:

The total number of admissions per year = 2,50,000 x 1/50 = 5,000
Bed days per year = 5,000 x 5 = 25,000
Total number of beds required when occupancy is
100% = 25000/365 = 69 beds
Total number of beds required when occupancy is
80% = 25000/365 x 80/100 = 55 beds
Area of the hospital:
An area of 65-85 m2 per bed has been considered to be
reasonable.

Site information:
Physical description of the area which should include bearings,
boundaries, topography, surface area, land used in adjoining
areas, limitation of the site that would affect planning, maps of
vicinity and landmarks or centers, existing utilities, nearest city,
port, airport, railway station, major bus stand, rain fall and data
on weather and climate.
Floor Height:
The room height should not be less than approximately 3.6 m
measured at any point from floor to floor height.

Circulation Areas:
Corridors, toilets, lifts, ramps, staircase and other common spaces etc.
should not be more than 55% of the total floor area of the building.
Infra structure


Signage
Barrier free access
Disaster prevention measures
New born stabilization unit
Blood storage facility
Human Resource

Medical Superintendent
Doctors (+3)
HR for Obstetric cases
Dietician
Dental Technician/ Assistant / Hygienist
Multi Rehabilitation Workers
Cold chain & Vaccine logistic Assistant
Physical Infrastructure

Generator
HVAC plant
Manifold room
Broiler
Kitchen
Essential residence

Thank You
Source:
Directorate General of Health Services
Ministry of Health & Family Welfare
Government of India