Planning, Budgeting and Material Management of CHC, PHC, SC/HWC
Comprehensive Notes for Nursing Students
Table of Contents
Introduction to Healthcare Centers in India
India’s public healthcare system operates on a three-tier structure, designed to provide comprehensive healthcare services to both rural and urban populations. This hierarchical system includes Sub-Centers/Health and Wellness Centers (SC/HWC), Primary Health Centers (PHC), and Community Health Centers (CHC). Effective healthcare center management requires detailed planning, systematic budgeting, and efficient material management.
Key Concept: Three-Tier Healthcare System
India’s public healthcare delivery system consists of three levels:
- Primary Level: Sub-Centers (SC) and Primary Health Centers (PHC), now being upgraded to Health and Wellness Centers (HWC)
- Secondary Level: Community Health Centers (CHC) and Sub-District/District Hospitals
- Tertiary Level: Medical Colleges and Advanced Specialty Hospitals
Under the Ayushman Bharat initiative launched in 2018, traditional Sub-Centers are being transformed into Health and Wellness Centers (HWCs) to provide expanded healthcare services and strengthen primary healthcare infrastructure across India.
Structure and Functions of Healthcare Centers
Sub-Centers (SC)/Health and Wellness Centers (HWC)
Sub-Centers are the most peripheral and first contact point between the primary healthcare system and the community. They are being upgraded to Health and Wellness Centers (HWCs) under the Ayushman Bharat program.
- Population Covered: 3,000-5,000 in plain areas and 1,000-3,000 in hilly/tribal/difficult areas
- Staffing: 1 Female Health Worker/ANM, 1 Male Health Worker, 1 ASHA (Accredited Social Health Activist) per 1,000 population
- Services: Maternal and child health, family planning, immunization, treatment of minor illnesses, first aid, health education
- Additional Services as HWC: Health promotion, preventive care, NCDs screening, essential drugs, basic laboratory services
Primary Health Centers (PHC)
PHCs are the cornerstone of rural healthcare that provide integrated curative and preventive healthcare to the rural population.
- Population Covered: 20,000-30,000 in plain areas and 10,000-20,000 in hilly/tribal/difficult areas
- Staffing: 1 Medical Officer, 1-2 Staff Nurses, 1 Pharmacist, 1 Laboratory Technician, 1 Health Assistant Male/Female, and support staff
- Services: OPD services, emergency care, obstetric and neonatal care, laboratory services, referrals, disease surveillance
- Beds: 4-6 beds for observation and basic inpatient care
Community Health Centers (CHC)
CHCs provide specialized health services and serve as referral centers for PHCs within their jurisdiction.
- Population Covered: 80,000-120,000
- Staffing: 4 Medical Specialists (Physician, Surgeon, Gynecologist, Pediatrician), 21 paramedical and other staff
- Services: Specialized OPD services, inpatient care, emergency obstetric care, specialized procedures, laboratory services, radiological services
- Beds: 30 beds for inpatient care
Memory Aid: “PSC-123” for Healthcare Hierarchy
Primary Health Center (2nd level) – 20,000-30,000 population
Sub-Center (1st level) – 3,000-5,000 population
Community Health Center (3rd level) – 80,000-120,000 population
Think: The numbers 1-2-3 reflect their position in the healthcare hierarchy!
Planning Process for Healthcare Centers
Effective healthcare center management begins with proper planning. The planning process involves several key steps for establishing and managing healthcare facilities.
Steps in Healthcare Center Planning
- Need Assessment: Identify health needs of the target population through demographic analysis, epidemiological data, and community surveys
- Resource Mapping: Evaluate available resources (human, financial, infrastructure) and identify gaps
- Goal Setting: Establish clear objectives and targets aligned with national health programs
- Operational Planning: Develop detailed action plans, including timelines, responsibilities, and resource allocation
- Implementation Framework: Create systems for service delivery, referral pathways, and coordination
- Monitoring Mechanism: Design methods to track progress, ensure quality, and measure outcomes
- Evaluation Strategy: Plan for periodic evaluations and integrating feedback for continuous improvement
Key Concept: Decentralized Planning
Under the National Rural Health Mission (NRHM), planning for healthcare centers follows a bottom-up approach where:
- Village Health Sanitation and Nutrition Committees (VHSNC) prepare Village Health Plans
- These are consolidated at block level into Block Health Plans
- Block plans are integrated into District Health Action Plans (DHAP)
- DHAPs are further consolidated into State Program Implementation Plans (PIPs)
Key Planning Considerations
Planning Aspect | SC/HWC | PHC | CHC |
---|---|---|---|
Infrastructure | Basic facility (150-200 sq m) | Medium facility (300-500 sq m) | Large facility (1500+ sq m) |
Essential Equipment | Basic diagnostic and treatment tools | Laboratory equipment, emergency tools | Specialized equipment, surgical tools |
Human Resources | ANM, ASHA, MPW | Medical Officer, Staff Nurse, Pharmacist | Specialists, Multiple Medical Officers |
Service Package | Basic preventive care | Primary curative and preventive care | Specialist services and referral care |
Memory Aid: “PRIME” Planning Framework
Population needs assessment
Resource identification and allocation
Infrastructure development
Manpower planning and training
Equipment and essential supplies management
Budgeting and Financial Management
Budgeting is a crucial aspect of healthcare center management that ensures optimal allocation and utilization of financial resources. Healthcare centers in India receive funding from multiple sources and must manage these resources efficiently.
Sources of Funding
- Central Government Funds: Through National Health Mission (NHM) and other centrally sponsored schemes
- State Government Funds: State health budget allocations
- Panchayat Funds: Local self-government allocations
- Untied Funds: Flexible funds for local health action
- User Fees: Nominal charges for certain services
- Donations and Contributions: From community and philanthropic organizations
Untied Funds Distribution
Healthcare Facility | Annual Untied Fund Amount | Key Decision Makers |
---|---|---|
Sub-Center/HWC | ₹10,000-20,000 | ANM, Gram Panchayat representative |
Primary Health Center | ₹25,000-50,000 | Medical Officer, Hospital Development Committee |
Community Health Center | ₹50,000-1,00,000 | Medical Superintendent, Rogi Kalyan Samiti |
Ward Health & Sanitation Committee | ₹10,000 | Ward Member (Chair), JHI/JPHN (Convener) |
Budgeting Process
- Budget Preparation: Estimating resource requirements based on previous year’s expenditure, projected activities, and anticipated needs
- Budget Approval: Review and approval by relevant committees (Hospital Development Committee, Rogi Kalyan Samiti)
- Fund Allocation: Distribution of approved funds for different activities and components
- Budget Implementation: Utilization of funds as per approved plans and following financial rules
- Budget Monitoring: Tracking expenditure against allocations and ensuring compliance with financial norms
- Financial Reporting: Regular submission of expenditure reports and utilization certificates
- Audit: Internal and external audits to ensure financial accountability
Key Concept: Hospital Development Committee (HDC)
HDCs play a crucial role in the financial management of healthcare facilities:
- Chaired by the Block Panchayat President with Medical Officer as member secretary
- Manages joint bank accounts for facility funds
- Authorized to withdraw up to ₹1,000 per day for immediate needs
- Can approve tender works worth ₹20,000 to ₹1,00,000
- Meets every three months to review financial status and approve expenditures
Permissible Expenditure from Untied Funds
- Minor facility modifications (privacy curtains, repairs, etc.)
- Essential equipment (examination tables, BP apparatus, weighing scales)
- Maintenance of water supply and electricity
- Referral transport for emergency cases
- Incentives for ASHAs and community health workers
- Purchase of disinfectants and cleaning supplies
- Environmental sanitation activities
- Community health awareness programs
Memory Aid: “SAFE-BUD” for Healthcare Budgeting
Sources identification (multiple funding streams)
Allocation planning (based on priorities)
Financial controls implementation
Expenditure tracking and reporting
Balance maintenance between different needs
Utilization certificates submission
Documentation of all financial transactions
Material Management in Healthcare Centers
Material management is a methodical technique that includes planning strategies, organizing, and regulating the flow of materials from procurement to utilization. Efficient material management is essential for healthcare center management to ensure continuous availability of necessary supplies and equipment.
Objectives of Material Management
Primary Objectives
- Achieve high efficiency with low procurement costs
- Ensure continuous supply of essential materials
- Maintain good supplier relations
- Train personnel in material handling
- Implement efficient information systems
Secondary Objectives
- Forecast material requirements accurately
- Maintain inter-departmental harmony
- Oversee product improvement
- Ensure standardization of supplies
- Make informed make-or-buy decisions
Elements of Material Management
- Material Planning: Forecasting requirements based on patient load, services, and consumption patterns
- Procurement: Acquiring required materials through systematic purchasing processes
- Inventory Control: Maintaining optimal stock levels to balance between stockouts and excess inventory
- Storage: Proper warehousing and storage practices to maintain quality and prevent deterioration
- Distribution: Efficient systems for issuing materials to various departments as needed
- Disposal: Proper disposal of expired materials, unusable items, and hazardous waste
Types of Materials in Healthcare Centers
Category | Examples | Management Considerations |
---|---|---|
Pharmaceuticals | Essential medications, vaccines, IV fluids | Temperature control, expiry tracking, FEFO principle |
Medical Supplies | Bandages, syringes, catheters, dressings | Sterility maintenance, usage tracking |
Equipment | BP apparatus, stethoscopes, examination tables | Maintenance schedules, calibration, asset tracking |
Linen & Clothing | Bedsheets, pillowcases, staff uniforms | Laundry cycles, replacement schedules |
Office Supplies | Registers, forms, stationery | Usage monitoring, bulk ordering |
Key Concept: Inventory Control Methods
Several methods can be used to optimize inventory management in healthcare centers:
- ABC Analysis: Classifying items based on annual consumption value (A: high value, B: moderate value, C: low value)
- VED Analysis: Categorizing items as Vital, Essential, or Desirable
- EOQ (Economic Order Quantity): Determining optimal order quantity to minimize total costs
- Two-Bin System: Using two containers for each item; when one is empty, it triggers reordering while the second is used
- FEFO (First Expired, First Out): Items with earlier expiry dates are used first
Procurement Process
- Need Identification: Determining requirements based on consumption and forecasts
- Specification Development: Creating clear specifications for required items
- Supplier Selection: Identifying reliable vendors through proper channels
- Purchase Order Placement: Formal ordering with clear terms and conditions
- Receiving and Inspection: Checking received items against specifications
- Payment Processing: Releasing payment after verification
- Record Maintenance: Documenting all procurement activities
Storage Guidelines
- Store emergency medications in easily accessible locations
- Implement FEFO (First Expired, First Out) principle for all consumables
- Use proper labeling and organization systems
- Maintain appropriate temperature and humidity conditions
- Secure storage areas to prevent unauthorized access
- Separate incompatible materials to prevent cross-contamination
- Keep proper documentation of all stored items
- Conduct regular stock verification and audits
Memory Aid: “PRECISE” for Material Management
Planning requirements accurately
Right procurement procedures
Efficient inventory control systems
Careful storage practices
Inspection of received materials
Systematic distribution methods
Effective disposal mechanisms
Role of Nurse in Material Management
- Maintaining adequate supplies in respective departments
- Ensuring proper storage conditions for sensitive materials
- Monitoring usage patterns and reporting abnormalities
- Training subordinates in proper material handling
- Minimizing wastage through efficient utilization
- Participating in inventory checks and audits
- Providing feedback on quality and effectiveness of supplies
- Contributing to procurement planning based on clinical needs
Best Practices and Recent Updates
Implementing best practices in healthcare center management is essential for optimizing resource utilization and improving service delivery. Here are three key best practices and recent updates in the management of healthcare centers in India.
Best Practice 1: Digital Inventory Management Systems
Healthcare centers are increasingly adopting digital inventory management systems to improve efficiency and reduce manual errors.
Key Features:
- Real-time tracking of inventory levels and consumption patterns
- Automated alerts for reordering and expiry dates
- Integration with procurement and financial management systems
- Data analytics for optimizing stock levels and reducing wastage
- Barcode/QR code scanning for efficient stock management
Recent implementations in several states have shown 15-20% reduction in stockouts and 25-30% decrease in expired medications.
Best Practice 2: Green and Climate Resilient Healthcare Facilities
The Ministry of Health and Family Welfare released guidelines in 2023 for developing environmentally sustainable and climate-resilient healthcare facilities.
Key Components:
- Energy-efficient building designs and renewable energy integration
- Water conservation and rainwater harvesting systems
- Sustainable waste management practices
- Procurement of eco-friendly materials and supplies
- Disaster preparedness and structural resilience
Facilities implementing these guidelines have reported up to 40% reduction in energy costs and improved operational resilience during extreme weather events.
Best Practice 3: Integrated Financial Management Information System (IFMIS)
The National Health Mission has introduced an Integrated Financial Management Information System to enhance transparency and efficiency in budget utilization.
Key Benefits:
- Streamlined fund flow from central to facility level
- Real-time expenditure tracking and reporting
- Enhanced financial accountability and reduced delays
- Automated generation of financial statements and utilization certificates
- Data-driven decision-making for resource allocation
Early adopter states have reported improvements in fund utilization rates from 60-70% to over 90% within one fiscal year.
Recent Policy Updates
- Ayushman Arogya Mandir Rebranding (2024): Health and Wellness Centers have been rebranded as “Ayushman Arogya Mandir” with standardized design, signage, and service packages.
- Expansion of HWC Services (2023-24): Addition of screening and management for three new Non-Communicable Diseases in the HWC service package.
- Updated Indian Public Health Standards (IPHS) Guidelines (2022): Revised norms for infrastructure, human resources, equipment, and service delivery at different levels of healthcare facilities.
- Telemedicine Integration (2024): Mandatory integration of telemedicine services at PHC and CHC levels to improve specialist access in rural areas.
Healthcare Committees and Governance
Various committees play crucial roles in the planning, budgeting, and material management of healthcare centers. These committees ensure community participation and decentralized decision-making in healthcare center management.
Hospital Development Committee (HDC)
- Composition: Chaired by Block Panchayat President, Medical Officer as Member Secretary
- Financial Powers: Joint account operation, approval of expenditures
- Functions:
- Overall management of healthcare facility
- Purchase of laboratory equipment and reagents
- Management of day-to-day expenses
- Procurement of office equipment and stationery
- Planning for infrastructure development
- Meeting Frequency: Quarterly (every three months)
Ward Health and Sanitation Committee (WHSC)
- Composition: Chaired by Ward Member, JHI/JPHN as Convener
- Other Members: ASHAs, Anganwadi workers, Kudumbashree health workers, school heads, NGOs
- Functions:
- Preparation and implementation of Ward Health Plan
- Conducting household health surveys
- Organizing awareness and IEC activities
- Maintaining health registers at ward level
- Monitoring ASHA workers’ activities
- Overseeing JSY payments
- Financial Resources: ₹10,000 from NRHM, ₹5,000 from Panchayat, ₹10,000 from Suchitwa Mission
- Meeting Frequency: Monthly
Village Health Sanitation and Nutrition Committee (VHSNC)
- Composition: Gram Panchayat members, ANM/ASHA, Anganwadi worker, SHG representatives, community members
- Functions:
- Village health planning and monitoring
- Facilitating community health needs assessment
- Supporting healthcare providers in service delivery
- Managing untied funds for local health action
- Promoting health awareness and behavior change
- Financial Resources: Annual untied fund of ₹10,000
- Meeting Frequency: Monthly
Rogi Kalyan Samiti (RKS)
- Composition: Healthcare facility in-charge, local elected representatives, community members, NGO representatives
- Functions:
- Facility management and development
- Quality improvement initiatives
- Resource mobilization and allocation
- Patient welfare activities
- Monitoring of service delivery and user satisfaction
- Financial Powers: Management of user fees and grants, approval of facility-level expenditures
- Meeting Frequency: Quarterly
Memory Aid: “CHAIR” for Committee Effectiveness
Community representation ensures local needs are addressed
Health professionals provide technical expertise
Authority to make decisions and allocate resources
Inclusive approach with diverse stakeholders
Regular meetings and documentation of actions
Conclusion
Effective healthcare center management involving planning, budgeting, and material management is essential for the optimal functioning of CHCs, PHCs, and SC/HWCs in India. These processes ensure that healthcare facilities can deliver quality services to the community within available resources.
Key takeaways include:
- Planning should be participatory and needs-based, involving both healthcare professionals and community representatives
- Budgeting must balance routine operational needs with development priorities while ensuring transparency and accountability
- Material management should focus on ensuring continuous availability of essential supplies while minimizing wastage
- Committees at various levels play crucial roles in governance, decision-making, and community engagement
- Recent innovations and best practices can significantly enhance efficiency and effectiveness of healthcare facilities
As healthcare delivery continues to evolve in India, nursing professionals must stay updated on management practices and contribute actively to improving the functioning of healthcare facilities at all levels. Through efficient planning, budgeting, and material management, healthcare centers can maximize their impact and provide better services to the communities they serve.
Important Note for Nursing Students
Understanding the managerial aspects of healthcare facilities is increasingly important for nursing professionals, as they often take on leadership roles in healthcare settings. Familiarize yourself with the latest guidelines and practices to contribute effectively to healthcare center management.
References
- Ministry of Health and Family Welfare. (2022). Indian Public Health Standards (IPHS) Guidelines for Primary Health Centres. Government of India.
- National Health Mission. (2023). Operational Guidelines for Health and Wellness Centers. Ministry of Health and Family Welfare, Government of India.
- National Health Systems Resource Centre. (2024). Budget Tracking Toolkit for Healthcare Facilities. New Delhi, India.
- Ministry of Health and Family Welfare. (2023). Guidelines for Green and Climate Resilient Healthcare Facilities. Government of India.
- Ayushman Bharat. (2024). Standard Operating Procedures for Ayushman Arogya Mandir. National Health Authority, India.
- National Health Mission. (2023). Financial Management Guidelines for Health Facilities. Government of India.
- Basavanthappa BT. (2023). Planning, Budgeting and Material Management. In: Community Health Nursing (3rd ed.). Jaypee Brothers Medical Publishers.
- National Rural Health Mission. (2024). Guidelines for Untied Funds Utilization at Village Level. Ministry of Health and Family Welfare, Government of India.