Introduction

The public healthcare system in India evolved due to a number of influences from the past 70
years, including British influence from the colonial period.[1] The need for an efficient and
effective public health system in India is large. Public health system across nations is a
conglomeration of all organized activities that prevent disease, prolong life and promote
health and efficiency of its people. Indian healthcare system has been historically dominated
by provisioning of medical care and neglected public health.[2] 20% of all maternal deaths and
25% of all child deaths in the world occur in India. 34 out of 1000 children are dead by the
time they reach the age of 5.[3] 58% of Indians are immunized in urban areas compared to
only 39% in rural areas. Communicable disease is the cause of death for 53% of all deaths in
India.[

Rural Health care is one of biggest challenges facing the Health Ministry of India. With more
than 70 percent population living in rural areas and low level of health facilities, mortality
rates due to diseases are on a high.

RHs are being established and maintained by the State government under MNP/BMS
programme.
As per minimum norms, a RH is required to be manned by four medical specialists i.e.
surgeon, physician, gynecologist and pediatrician supported by 21 paramedical and other
staff. It has 30 in-door beds with one OT, X-ray, labour room and laboratory facilities.
It serves as a referral centre for 4 PHCs and also provides facilities for obstetric care and
specialist consultation
An existing facility (District Hospital, Sub-divisional Hospital, Community Health Centre
etc.) can be declared a fully operational First Referral Unit (FRU) only if it is equipped to
provide round-the-clock services for emergency obstetric and New Born Care, in addition to
all emergencies that any hospital is required to provide. It should be noted that there are three
critical determinants of a facility being declared as a FRU:
 Emergency Obstetric Care including surgical interventions like caesarean sections;
 new-born care; and
 blood storage facility on a 24-hour basis.
Route map
 The public private partnership

Department of Health and Family Welfare (DoHFW), Government of West Bengal (GoWB)
has taken initiatives to strengthen the health and medical care services in the state,
particularly in the Primary Health Care.
The purpose of these initiatives is to improve the health status of the poor and vulnerable
population in the state.
b. One such initiative that the department already identified for implementation was
establishment of Diagnostic Facilities in the Rural Hospitals (RH) under Public Private
Partnership (PPP).
The objective of this initiative was to ensure greater access of the people to quality diagnostic
services at affordable cost.
Accordingly, Government Order was issued in April 1, 2004 and GoWB initiated the process
for establishing Diagnostic Facilities under PPP in 17 RHs in the first phase. Encouraged by
the initial success of the scheme, DoHFW has now decided to replicate this scheme across all
the Rural Hospitals in the state
An agreement would have to be signed by the selected Private Partner with Chief Medical
Officer of Health (CMOH) and Member Secretary of the District Health and Family Welfare
Samiti (DHFWS) of the concerned district to operate the diagnostic centers.
Broad Terms & Conditions: i. Duration of Agreement – 5 years initially, renewal subject to
review.
ii. Termination of Agreement – Grounds for termination are specified in Section 3 of this
brochure.
iii. District Health & Family Welfare Samiti (DHFWS) would provide rent-free ready-to-use
space within the Rural Hospital for establishment of diagnostic facility as per provisions of
Clinical Establishments Act, 1950 as amended in 1998 and Clinical Establishment Rules as
modified from time to time.
iv. In case ready-to-use space is not available, DHFWS will undertake necessary work to
make the space in ‘ready to use’ condition. However, the Private Partner will be allowed to
undertake minor repair works at their own cost with the concurrence of the concerned PWD
officials who will be approached through Superintendent / Medical Officer in Charge of the
Rural Hospital.
v. Furniture, refrigerator and equipment as per norms of Clinical Establishments Act and
Rules would be installed by the Private Partner at their own cost.
vi. Ownership status for all movable assets created from investments made by the Private
Partner will remain with the Private Partner. vii. Block Health & Family Welfare Samiti
(BHFWS) will provide free supply of water (including water tax, if any) for use by the
Private Partner.
viii. Private Partner will pay the consumption charges for the use of electricity. Separate
connection for electricity metre shall have to be applied for in the name of the Private Partner
and the charges (security deposit etc) incurred for procurement of the metre etc. will also be
borne by the Private Partner. 4
ix. Private Partner will mandatorily conduct the tests as mentioned in Annexure-IV of this
brochure.
x. In Rural Hospitals where X-Ray and / or ECG facilities are functioning, the Private
Partner shall not be allowed to set up the same. The applicants are therefore advised to verify
this before submitting their application for a particular Rural Hospital.
xi. However, if a Rural Hospital has functioning X-Ray and / or ECG facility, and the
Applicant is capable and interested in providing these facilities with their own manpower but
using the ECG and / or X-Ray equipment of the government, they may take over the custody
of this / these equipment and conduct the test / tests with these equipment.
In that eventuality, the entire responsibility of maintenance of rented equipment will be that
of the Private Partner during the contract period. All such equipment shall have to be returned
to the government at the end of the contract period. The Private Party will be charging the
same rates for the test / tests, in these case also at Gvernment approved rates and out of the
total cases, maximum no. of 20% cases belonging to BPL category will have to be tested free
of cost.
However, for the cases referred from the private doctors / hospitals / nursing homes, the
Private Partner will be at liberty to fix up its own rate, which will have to be intimated to
DHFWS & BHFWS and the same will have to be displayed at the facility.
xii. The private partner will be authorized to collect charges for the diagnostic tests from all
patients referred by government health facilities as per rates fixed by DoHFW, GoWB for the
District and Sub Divisional Hospitals.
xiii. The Private Partner will be entitled to conduct tests referred by private doctors /
hospitals / nursing homes also. For these test the Private Partner shall be entitled to levy and
collect charges for all the mandatory tests at prevailing market rates from patients referred by
private practitioners. However, these rates will have to be intimated in writing to BHFWS
and DHFWS and prominently displayed in the health facility.
xiv. User charges for additional tests other than mandatory tests conducted by the private
party shall be fixed by the private party. However, these rates will have to be intimated in
writing to BHFWS and DHFWS and prominently displayed in the health facility.
xv. Private Partner will be responsible for hiring qualified technical personnel as per
statutory requirements.
xvi. Private Partner will obtain necessary permissions and licenses such as Laboratory
License (Clinical Establishment Rules), Trade License and comply with all statutory
requirements for running the operations.
xvii. Private Partner will be responsible to set up systems for their own operations in respect
of inventory management, customer servicing, financial accounting, record-keeping and MIS.
 xviii. Private Partner shall have to set up collection centers in the Primary Health Centres
(PHC) within the jurisdiction of that particular Rural Hospital for which the Private Partner is
selected.
xix. All the proposals for each Rural Hospital will be initially evaluated by a Committee to
assess the technical soundness of the proposal. If only one proposal is found to be 5
technically sound for a Rural Hospital the same shall be recommended for award of contract
to the competent authority.
xx. In case more than one proposal is found to be technically sound for a Rural Hospital,
commercial proposals from all technically successful applicants shall be invited for which the
intimation with all relevant details will be given after the technical evaluation is over.
xxi. The Private Partner will be authorized to display the signboard indicating the name of his
organization on the Diagnostic facility to be set up under PPP.
 Staffing pattern

Designation Total no qualification

Block health officer 1 Senior most specialist

General surgeon 1 MS/DNB(surg)

Physician 1 MS/DNB(med)

OBG specialist 1 MS/DNB(OBG)

Paediatric 1 MS/DNB(paed)

Anesthesia 1 MD(anesthesia)

Public health manager 1 MD(PSM)

Eye surgeon 1 MS/DNB(opthal)

Dental surgeon 1 BDS

General duty 06 MBBS

Medical officer 2 females MBBS

AYUSH specialist 1 PG in AYUSH

MO of AYUSH 1 Graduate in AYUSH

Supporting staff
 Designation Number

Staff nurse 19

PHN 1

ANM 1

Pharmacist/compounder 3

Pharmacist Ayush 1

Lab technician 3

Radiographer 2

OPTHALMIC ASSISTANT 1

Driver 2

Ward boy 5

Sweeper 5

Chowkidar 5

Dhobi 1

Mali 1

Aaya 5

Peon 2

Opd assistant 1

Registration worker 2

Statistical assistant 2

Accountant 1

Registers maintained
 admission register

 discharge register

 report book

 log register

 referral register

 trauma register

 immunization register

 diet register

 pathology register

 female round order register

 male round order register

 brought in dead register

 emergency register

 emergency stock register

 MTP register
 Facilities provided

 A team of well-disciplined, well-trained medical staff, non-medical staff and experienced

1 Care of Routine and Emergency Cases in Surgery Essential This includes dressings,
incision and drainage, and surgery for Hernia, Hydrocele, Appendicitis, Haemorrhoids,
Fistula, and stitching of injuries. Handling of emergencies like Intestinal Obstruction,
Haemorrhage, etc. Other management including nasal packing, tracheostomy, foreign body
removal etc. Fracture reduction and putting splints/plaster cast. Conducting daily OPD
2 Care of Routine and Emergency Cases in Medicine Essential Specific mention is being
made of handling of all emergencies like Dengue Haemorrhagic Fever, Cerebral Malaria and
others like Dog & snake bite cases, Poisonings, Congestive Heart Failure, Left Ventricular
Failure, Pneumonias, meningoencephalitis, acute respiratory conditions, status epilepticus,
Burns, Shock, acute dehydration etc. In case of National Health Programmes, appropriate
guidelines are already available, which should be followed. Conducting daily OPD
.3 Maternal Health Essential Minimum 4 ANC check ups including Registration &
associated services : As some antenatal cases may directly register with rural hospital the
suggested schedule of antenatal visits is reproduced below. 1st visit: Within 12 weeks—
preferably as soon as pregnancy is suspected—for registration of pregnancy and first
antenatal check-up. 2nd visit: Between 14 and 26 weeks 3rd visit: Between 28 and 34 weeks
4th visit: Between 36 weeks and term 24-hour delivery services including normal and
assisted deliveries. Managing labour using Partograph. All referred cases of Complications in
pregnancy, labour and post-natal period must be adequately treated. Ensure post-natal care
for 0 & 3rd day at the health facility both for the mother and newborn and sending direction
to the ANM of the concerned area for ensuring 7th & 42nd day post-natal home visits.
Minimum 48 hours of stay after delivery, 3-7 days stay post delivery for managing
Complications. Proficiency in identification and Management of all complications including
PPH, Eclampsia, Sepsis etc. during PNC. Essential and Emergency Obstetric Care including
surgical interventions like Caesarean Sections and other medical interventions. Provisions of
Janani Suraksha Yojana (JSY) and Janani Shishu Suraksha Karyakram (JSSK) as per
guidelines
.4 Newborn Care and Child Health Essential Essential Newborn Care and Resuscitation by
providing Newborn Corner in the Labour Room and Operation Theatre (where caessarian
takes place). Details of Newborn . Early initiation of breast feeding with in one hour of birth
and promotion of exclusive breast-feeding for 6 months. Newborn Stabilization Unit
Counseling on Infant and young child feeding as per IYCF guidelines. Routine and
emergency care of sick children including Facility based IMNCI strategy. Full Immunization
of infants and children against Vaccine Preventable Diseases and Indian Public Health
Standards (IPHS) Guidelines for Community health centres
Vitamin-A prophylaxis as per guidelines of Govt. of India. Tracking of vaccination drop outs
and left outs.
Prevention and management of routine childhood diseases, infections and anemia etc.
Management of Malnutrition cases. Provisions of Janani Shishu Suraksha Karyakram (JSSK)
as per guidelines
5. Family Planning Essential Full range of family planning services including IEC,
counseling, provision of Contraceptives, Non Scalpel Vasectomy (NSV), Laparoscopic
Sterilization Services and their follow up. Safe Abortion Services as per MTP act and
Abortion care guidelines of MOHFW. Desirable MTP Facility approved for 2nd trimester of
pregnancy.
6 Other National Health Programmes (NHP): Essential Except as Indicated) All NHPs
should be delivered through the RH Integration with the existing programmes is vital to
provide comprehensive services. The requirements for the important NHPs are being annexed
as separate guidelines and following are the assured services under each NHP.
Communicable Diseases Programmes RNTCP: RH should provide diagnostic services
through the microscopy centres which are already established in the RHs and treatment
services as per the Technical and Operational Guidelines for Tuberculosis Control .
HIV/AIDS Control Programme: The services to be provided at the RH level are. Integrated
Counselling and Testing Centre. Blood Storage Centre1 . Sexually Transmitted Infection
clinic. Desirable Link Anti Retroviral Therapy Centre. Blood storage units should have at
least number of units of Blood equal to double of the average daily requirement/consumption.
National Vector Borne Disease Control Programme: The s are to provide diagnostic/linkages
to diagnosis and treatment facilities for routine and complicated cases of Malaria, Filaria,
Dengue, Japanese Encephalitis and Kala-azar in the respective endemic zones National
Leprosy Eradication Programme (NLEP): The minimum services that are to be available at
the RHs are for diagnosis and treatment of cases and complications including reactions of
leprosy along with conselling of patients on prevention of deformity and cases of
uncomplicated ulcers National Programme for Control of Blindness: The eye care services
that should be made available at the RH are as given below. Essential Vision Testing with
Vision drum/Vision Charts. Refraction The early detection of visual impairment and their
referral. Awareness generation through appropriate IEC strategies and involving community
for primary prevention and early detection of impaired vision and other eye conditions.
Desirable Intraocular pressure measurement by Tonometers. Syringing and probing. The
provision for removal of Foreign Body. Provision of Basic services for Diagnosis and
treatment of common eye diseases. Surgical services including cataract by IOL implantation.
One ophthalmologist is being envisaged for every 5 lakh population i.e. one ophthalmologist
will cater to 5 RHs.. Under Integrated Disease Surveillance Project, RH will function as
peripheral surveillance unit and collate, analyse and report information to District
Surveillance
7 Health Promoting Schools Counseling services :Regular practice of Yoga, Physical
education, health education Peer leaders as health educators. Adolescent health education-
existing in few places Linkages with the out of school children Health clubs, Health cabinets
First Aid room/corners or clinics. Adolescent Health Care To be provided preferably through
adolescent friendly clinic for 2 hours once a week on a fixed day. Services should be
comprehensive i.e. a judicious mix of promotive, preventive, curative and referral services
Core package (Essential) Adolescent and Reproductive Health: Information, counseling and
services related to sexual concerns, pregnancy, contraception, abortion, menstrual problems
etc. Services for tetanus immunization of adolescents Nutritional Counseling, Prevention and
management of nutritional anemia STI/RTI management Referral Services for VCTC and
PPTCT services and services for Safe termination of pregnancy, if not available at PHC
Optional/additional services (desirable): as per local need Outreach services in schools
(essential) and community Camps (desirable) Periodic Health check ups and health education
activities, awareness generation and Co-curricular activities
8 Essential Blood Storage Facility
9 Diagnostic Services In addition to the lab facilities and X-ray, ECG should be made
available in the RH with appropriate training to a nursing staff/Lab. Technician. All
necessary reagents, glass ware and facilities for collecting and transport of samples should be
made available.
10 Referral (transport) Services
 Conclusion
As a part of our rural community posting we the 1st year MSc Nursing students visited Rural
hospital Singur to see the structural and functional aspect of a rural hospital, also to know the
staffing pattern and various services provided. I would like to thank our faculty Lt Col
Rituparana and Lt Col Surekha ranjan who arranged this visit for us also the administration of
RH who allowed us to visit them and to know about them