STRUCTURE AT VILLAGE, SUB-CENTRE, PHC, CHC & RURAL HOSPITAL LEVELS

STRUCTURE AT VILLAGE, SUB-CENTRE, PHC, CHC, AND RURAL HOSPITAL LEVELS

• Health care delivery system in India is organized in a tiered structure: Village → Sub-Centre → Primary Health Centre (PHC) → Community Health Centre (CHC) → Rural Hospital.

• The goal is universal access to essential health services in accordance with the principle of Antyodaya (upliftment of the last person).

• Ayurveda emphasizes preventive and promotive health under Swasthavritta, aligning with modern public health systems.

“स्वस्थस्य स्वास्थ्य रक्षणं आतुरस्य विकार प्रशमनं च।”
— चरक संहिता सूत्र स्थान ३०/२६
(Swasthasya Swasthya Rakshanam Aturasya Vikara Prashamanam Cha — the aim is preservation of health in the healthy and treatment of disease in the sick.)

VILLAGE LEVEL HEALTH CARE STRUCTURE

• The village is the primary unit of the Indian health system.

• Key Personnel:

  • ASHA (Accredited Social Health Activist): Community-based worker under NRHM.

  • Anganwadi Worker: Provides maternal-child health and nutrition services.

  • Traditional Birth Attendant (Dai): Trained for home-based maternal care in remote areas.

• Responsibilities:

  • Health education, basic medication, first aid.

  • Immunization assistance.

  • Identification of high-risk cases for referral.

  • Promotion of hygiene and sanitation.

AYURVEDIC PARALLEL

• In ancient texts, health promotion was done through Achara Rasayana, Dinacharya, and Ritucharya teachings.

• Community wellness was a responsibility of Rajavaidya (State physician).

“नित्यं हिताहितं देशकालात्मनःानुसारं युक्त्याऽऽशितं उपशितं च”
— चरक संहिता सूत्रस्थान ५/१३
(One should consume food and live according to what is suitable or unsuitable, considering place, time, and one's constitution.)

SUB-CENTRE (SC)

• First contact point between community and health system.

• Population coverage:

  • 5,000 people in general areas.

  • 3,000 in tribal/hilly areas.

• Staff:

  • 1 ANM (Auxiliary Nurse Midwife)

  • 1 Male Health Worker

  • Additional contractual staff under NHM

• Functions:

  • Maternal and child health services

  • Family planning, immunization

  • Nutrition advice

  • Disease surveillance

  • Health promotion activities

MODERN COMMUNITY MEDICINE REFERENCE

• Indian Public Health Standards (IPHS) describe essential services to be delivered at this level.

• Sub-centres are upgraded under Health and Wellness Centres (Ayushman Bharat Yojana).

AYURVEDIC INSIGHT

• Reflects the concept of "स्वस्थवृत्त पालन" through public education on diet, lifestyle, seasonal regimens.

• Early detection and prevention as in Roga Anutpatti Karya.

PRIMARY HEALTH CENTRE (PHC)

• Serves as a referral unit for 6 sub-centres.

• Population coverage:

  • 30,000 in plain areas

  • 20,000 in hilly/tribal areas

• Staff:

  • Medical Officer (MBBS / Ayurveda)

  • Pharmacist, Nurse, Health Educator

  • Lab technician, Block extension educator

• Facilities:

  • 24x7 delivery services

  • Outpatient and inpatient services

  • Immunization, minor surgeries

  • Disease control programs (TB, Malaria, Leprosy)

MODERN ASPECT

• Acts under National Health Mission (NHM) for integrated service delivery.

• Digital health records, telemedicine services under Ayushman Bharat - HWC.

AYURVEDIC RELEVANCE

• Comparable to ancient Arogya Vardhini Kendras.

• Ayurvedic PHCs offer classical therapies like Panchakarma, Rasayana, and Yoga for chronic disease management.

“तत्र रोगाणां शमकः औषधि:। आरोग्यस्य वर्धकं रसायनम्।”
— अष्टाङ्ग हृदयम् उत्तरस्थान ३९/१
(Medicines pacify diseases, but Rasayana enhances health.)

COMMUNITY HEALTH CENTRE (CHC)

• First level referral unit for 4 PHCs.

• Population coverage:

  • 1.2 lakh in plain areas

  • 80,000 in tribal/hilly areas

• Staff:

  • 4 Medical Specialists (Physician, Surgeon, Pediatrician, OBGY)

  • AYUSH Doctor

  • Nurses, Lab Technicians, Pharmacists

• Facilities:

  • 30-bedded inpatient hospital

  • Emergency care

  • Minor surgeries

  • Obstetric services including caesarean delivery

MODERN POINTS

• CHCs are designed based on IPHS norms.

• Function as First Referral Units (FRUs).

• Special focus on maternal & neonatal emergencies.

AYURVEDIC PARALLEL

• Comprehensive care centers for chronic diseases, preventive Rasayana, and surgical interventions as described by Sushruta.

“आयुषः कर्म चिकीर्षन् सञ्ज्ञाय सर्वं परिक्ष्य च।”
— सुश्रुत संहिता सूत्रस्थान १/३८
(One desirous of treating must first know all aspects of life and disease.)

RURAL HOSPITAL

• Upgraded CHC/PHC for advanced rural health care.

• Bed strength: 30-100 beds depending on population needs.

• Provides multi-speciality services, diagnostic care, surgeries.

• Modern Features:

  • ICU, blood storage units

  • Referral to District Hospitals

  • Integrated AYUSH services

  • Full-fledged Operation Theatres

MODERN MEDICINE INPUT

• Strengthening under IPHS and Rural Health Mission

• Use of e-health, telemedicine, mobile medical units in remote locations

AYURVEDIC PERSPECTIVE

• Place for implementation of Shalya and Kayachikitsa therapies

• Offers both curative and rejuvenative care including Rasayana, Ksharasutra, and Vasti karma.

“यत्र रोगाणां सम्यक् प्रशमनं भवति, तद्वैद्यगृहं आरोग्यम्”
— आयुर्वेददीपिका टीका
(Where proper alleviation of diseases occurs, that place is truly a health home.)