District Hospital

• hospital at the secondary referral level responsible for a district of a defined geographical area containing a defined population.

• at present there are 605 district hospitals in 640 districts of the country as per NRHM data as on 30-6-2010.

Specific objectives of IPHS for District Hospitals

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

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

• To make the services more responsive and sensitive to the needs of the people of the district and the hospitals/centres from where the cases are referred to the district hospitals.

Grading of the Hospital

• Grade I: District hospitals norms for 500 beds

• Grade II: District Hospital Norms for 400 beds

• Grade III: District hospitals norms for 300 beds

• Grade IV: District hospitals norms for 200 beds

• Grade V: District hospitals norms for 100 beds.

Services related to newborn care

• Care of LBW newborns <1800gm

• Neonatal resuscitation

• Care of sick newborn

• Vit K for premature babies

• Antenatal corticosteroids to mother in case of preterm babies

• Zero day immunization

• Management of complications through SNCU.

• Disability Certification Services

Obstetrics and Gynaecology• PPTCT• Colposcopy • Hysteroscopy • Laproscopy (diagnostic/operative)• Vaccum delivery• Endometrial biopsy• Cervical biopsy• Endometrial aspiration• Hysterotomy • Sling operation• Management of severe anaemia• Tuboplasty

Surgery • Hydatid cyst excision

Ortho surgery• Arthroscopy • Total hip replacement• Total knee replacement

S. no. name of the illness Recommended service mix

1 Gestational trophpblastic disease Investigate. Treat and refer

2 Intrauterine death Investigate. Treat and refer

3 Surgical disorders with pregnancy Investigate. Treat and refer

4 Bleeding disorders in pregnancy Refer at earliest

5 Medicolegal cases (rape, sexual assault)

Registration, examination, sample collection, treat, provision of emergency contrception

6 Poisoning Management

Health Promotion and Counselling

Community Health Services

District Public Health Unit

• One Epidemiologist• One Entomologist• One Microbiologist• One IEC Officer• One District Public Health Nursing Officer• One District Data analyst/Demographer

Capacity building

• Both medical and paramedical staff should undergo continuing medical education (CME) at intervals.

• Training need assessment/Skill Gap analysis should be done on regular basis and trainings should be planned accordingly.

Special Newborn Care Unit(SNCU)

• The SNCU at the district hospital is expected to provide the following services:

• Care at birth• Resuscitation of asphyxiated newborns.• Managing sick newborns (except those• requiring mechanical ventilation and major• surgical interventions).• Kangaroo mother care.• Post natal care.• Follow-up of high risk newborns.• Referral services.• Immunization services.

• Guidelines to reduce Environmental Pollution due to Mercury Waste

• Guidelines for air borne infection control• Steps for Safety in Surgical Patients Steps for safety in surgical patients( in preoperative ward) Surgical Safety Checklist in the Operation Theatre• Management Information System (MIS) Format