the concept of Primary Health Centre (PHC) is not new to
India. The Bhore Committee in 1946 gave the concept of a PHC as a basic health
unit to provide as close to the people as possible, an integrated curative and
preventive health care to the rural population with emphasis on preventive and
promotive aspects of health care. The health planners in India have visualized
the PHC and its Sub-Centres (SCs) as the proper infrastructure to provide
health services to the rural population. The Central Council of Health at its
first meeting held in January 1953 had recommended the establishment of PHCs in
community development blocks to provide comprehensive health care to the rural
population. These centres were functioning as peripheral health service
institutions with little or no community involvement. Increasingly, these
centres came under criticism, as they were not able to provide adequate health
coverage, partly, because they were poorly staffed and equipped and lacked
basic amenities. The 6th Five year Plan (1983-88) proposed reorganization of
PHCs on the basis of one PHC for every 30,000 rural populations in the plains
and one PHC for every 20,000 population in hilly, tribal and desert areas for
more effective coverage. However, as the population density in the country is
not uniform, the number of PHCs would depend upon the case load. PHCs should
become functional for round the clock with provision of 24 × 7 nursing
facilities. Select PHCs, especially in large blocks where the CHC is over one
hour of journey time away, may be upgraded to provide 24 hour emergency
hospital care for a number of conditions by increasing the number of Medical
Officers; preferably such PHCs should have the same IPHS norms as for a CHC.
There are 23673 PHCs functioning in the country as on March 2010 as per Rural
Health Statistics Bulletin, 2010. The number of PHCs functioning on 24×7 basis
are 9107and number of PHCs where three staff Nurses have been posted are 7629
(as on 31-3-2011). PHCs 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. It acts as a referral unit for 6
Sub-Centres and refer out cases to Community Health Centres (CHCs-30 bedded
hospital) and higher order public hospitals at sub-district and district
hospitals. It has 4-6 indoor beds for patients. PHCs are not spared from issues
such as the inability to perform up to the expectation due to (i)
non-availability of doctors at PHCs; (ii) even if posted, doctors do not stay
at the PHC HQ; (iii) inadequate physical infrastructure and facilities; (iv)
insufficient quantities of drugs; (v) lack of accountability to the public and
lack of community participation; (vi) lack of set standards for monitoring
quality care etc.

Standards are a means of describing the level of
quality that health care organizations are expected to meet or aspire to. Key
aim of these standards is to underpin the delivery of quality services which
are fair and responsive to client’s needs, provided equitably and deliver
improvements in the health and wellbeing of the population. Standards are the
main driver for continuous improvements in quality. The performance of health care
delivery organizations can be assessed against standards. The National Rural
Health Mission (NRHM) has provided the opportunity to set Indian Public Health
Standards (IPHS) for Health Centres functioning in rural areas. In order to
provide optimal level of quality health care, a set of standards called Indian
Public Health Standards (IPHS) were recommended for Primary Health Centre (PHC)
in early 2007. The nomenclature of a PHC varies from State to State that
include a Block level PHCs (located at block HQ and covering about 100,000
population and with varying number of indoor beds) and additional PHCs/New PHCs
covering a population of 20,000-30,000 etc. Regarding the block level PHCs it
is expected that they are ultimately going to be upgraded as Community Health
Centres with 30 beds for providing specialized services.The overall objective
of IPHS is to provide health care that is quality oriented and sensitive to the
needs of the community.