# Health Care Delivery in India for NEET PG PSM: IPHS 2022 Population Norms, HWCs, FRU, CHC and District Hospital Beds Source: https://tracknation.in/story/health-care-delivery-in-india-for-neet-pg-psm-iphs-2022-population-norms-hwcs-fru-chc-and-district-hospital-beds (TrackNation — free UPSC notes with PYQs) > NEET PG Community Medicine: the tiers of public health care in India under IPHS 2022 — ASHA, Sub Health Centre and PHC as Ayushman Bharat Health and Wellness Centres, CHC and First Referral Units, Block Public Health Units, urban HWC/UPHC/polyclinic/UCHC, and district hospital bed norms — with a referral-pyramid diagram, verified MCQs and revision cards. ## Start Here 🎯 **Exam priority: High-yield (Tier 1).** *Population norms for the SHC, PHC and CHC are asked almost every year, along with the definition of a First Referral Unit and the HWC packages. Every number here is from the **Indian Public Health Standards (IPHS) 2022**, which replaced the 2012 standards — older books still carry some outdated figures, so learn these.* CBME mapping: **CM 17** (health care of the community). ## The Tiers at a Glance *Tiers of public health care with IPHS 2022 population norms. Patients are referred upwards; the CHC at the block is the hub for its SHCs and PHCs.* | **Facility** | **Plains** | **Hilly / tribal / desert** | **Key point** | | ASHA | 1 per 1,000 | 1 per habitation | Attached to the HWC team | | Sub Health Centre (HWC-SHC) | 5,000 | 3,000 | CHO + one male and one female multipurpose worker | | Primary Health Centre (HWC-PHC) | 30,000 | 20,000 | Co-terminus with Panchayats; 1 MBBS MO (2 in a 24×7 PHC) | | Community Health Centre | 1,20,000 | 80,000 | At block level; 30 beds (non-FRU) | | District Hospital | Whole district | — | Beds graded by district population (see below) | - The **plains/hilly-tribal ratio** is the same at each level: SHC 5,000/3,000, PHC 30,000/20,000, CHC 1,20,000/80,000. - A CHC is set up at the **Community Development Block** (taluka/tehsil) level, matching the three-tier Panchayati Raj system (gram, block and zila panchayat). ## Health and Wellness Centres and CPHC - In **February 2018** the Government announced **1,50,000 Ayushman Bharat Health and Wellness Centres** by December 2022, made by upgrading existing SHCs, PHCs and UPHCs to deliver **Comprehensive Primary Health Care (CPHC)**. - IPHS 2022 has two kinds of HWC: **HWC-SHC** (rural SHC or urban HWC) and **HWC-PHC** (rural PHC or UPHC). - An HWC-SHC is run by a **Community Health Officer (CHO)** with one male and one female multipurpose worker (or two ANMs), plus ASHAs. - HWCs are also a platform for **teleconsultation** and extra diagnostics (hub-and-spoke with the nearest CHC). - Community governance: a **Jan Arogya Samiti** at each HWC; VHSNC/Mahila Arogya Samiti meetings are used for awareness. **The 12 CPHC service packages:** | **#** | **Package** | **#** | **Package** | | 1 | Care in pregnancy and childbirth | 7 | NCD screening, prevention and management | | 2 | Neonatal and infant health | 8 | Common eye and ENT problems | | 3 | Childhood and adolescent health | 9 | Basic oral health care | | 4 | Family planning, contraception and reproductive health | 10 | Elderly and palliative care | | 5 | Communicable diseases under national programmes | 11 | Emergency services incl. burns and trauma | | 6 | General outpatient care for acute simple illness | 12 | Screening and basic care of mental health | *Memory hook: HWCs expand care beyond the old selective package (pregnancy, children, reproductive health, communicable diseases) — the new ground is NCDs, eye/ENT, oral health, elderly and palliative care, emergencies and mental health.* ## CHC, FRU and the Block Public Health Unit - **Non-FRU CHCs** have **30 beds**. **FRU CHCs** also provide specialist care — **physician, surgeon, obstetrician, paediatrician and anaesthetist** — with a functional **operation theatre** and **blood storage unit**; 30-bed FRUs must offer maternity and surgery, and 50-bed FRUs may add eye, orthopaedics and ENT. - **What makes an FRU?** IPHS 2022 says FRUs "go beyond obstetric services": a unit qualifies when it provides **both elective and emergency secondary-level surgery** with the infrastructure, staff, drugs and diagnostics to support it. - Urban CHCs always function as FRUs. - Every block-headquarters CHC is to become a **Block Public Health Unit (BPHU)**, with four functional areas (clinical services, public health functions, a block public health laboratory and an HMIS unit) — supported by the XV Finance Commission health grants and PM-ABHIM. ## Urban Health Care | **Urban facility** | **Population norm** | **Notes** | | Urban HWC | 15,000–20,000 | Serves slum and other vulnerable pockets | | Urban PHC | 50,000 | Close to slums; OPD-based (24×7 if already doing deliveries) | | Multispecialty polyclinic | 2.5–3 lakh | Catchment of 5–6 UPHCs; ambulatory specialist care | | Urban CHC | 2.5 lakh (non-metro) — 50 beds; 5 lakh (metro/million-plus) — 100 beds | Always functions as an FRU | The **National Urban Health Mission** created UPHCs, UCHCs and outreach for slum dwellers, the homeless, rag-pickers and migrants. ## Hospital Beds: District and Sub-District Hospitals - The **Bhore Committee (1946)** recommended **1 bed per 1,000 population**; the **National Health Policy 2017** recommends **2 beds per 1,000**. IPHS 2022 makes 1/1,000 the *essential* norm for every district and 2/1,000 the *desirable* target. - Census 2011 puts the average district population at about 19 lakh. - Only beds used for more than 24 hours count as in-patient beds; emergency, labour-delivery-recovery, dialysis, day-care and pre/post-operative beds are extra. - A district with fewer than 5 lakh people and a functional DH does not need a sub-district hospital. | **District population** | **Essential beds (+ emergency/day-care)** | **Desirable beds** | | < 2 lakh | 50 + 15 | 100 | | 2–5 lakh | 100 + 25 | 200 | | 5–10 lakh | 200 + 38 | 300 | | 10–20 lakh | 300 + 49 | 400 | | 20–30 lakh | 400 + 60 | 500 | | > 30 lakh | 500 + 65 | 700 | ## Traps the Examiner Sets - SHC 5,000 / 3,000 — not 10,000. PHC 30,000 / 20,000. CHC 1,20,000 / 80,000. - Urban PHC is **50,000**; urban HWC 15,000–20,000; polyclinic 2.5–3 lakh. - An HWC-SHC is led by a CHO, not a medical officer. - FRU = emergency *and* elective surgery with an OT and blood storage — not obstetric care alone. - Bhore 1946: 1 bed/1,000; NHP 2017: 2 beds/1,000. - There are 12 CPHC packages; mental health, oral health, eye/ENT and palliative care are among them. ## Rapid-Revision Cards - 5,000 plains / 3,000 hilly-tribal-desert. - 30,000 plains / 20,000 hilly-tribal. - 1,20,000 plains / 80,000 hilly-tribal; at block level. - UHWC 15–20k; UPHC 50k; polyclinic 2.5–3 lakh; UCHC 2.5 lakh (50 beds) or 5 lakh metro (100 beds). - 1 per 1,000; 1 per habitation in tribal/hilly/desert areas. - CHO + 1 male and 1 female MPW (or 2 ANMs) + ASHAs. - 12 — packages 7–12 add NCD, eye/ENT, oral, elderly/palliative, emergency, mental health. - 1,50,000 HWCs announced Feb 2018, by Dec 2022. - Elective + emergency secondary surgery with OT, blood storage, staff — beyond obstetrics. - Physician, surgeon, obstetrician, paediatrician, anaesthetist. - 30. - Every block-HQ CHC; clinical, public health, block public health lab, HMIS unit. - Bhore 1946: 1/1,000; NHP 2017: 2/1,000; IPHS: 1 essential, 2 desirable. - 300 + 49 essential; 400 desirable. - 1 MBBS MO (essential); 24×7 PHC: 2 MOs. ## Sources ## Sources *Facts in this article were checked against these documents.* - Indian Public Health Standards 2022 — Health and Wellness Centre: Sub Health Centre and Urban HWC — MoHFW / NHSRC, 2022 (link) - Indian Public Health Standards 2022 — Health and Wellness Centre: Primary Health Centre — MoHFW / NHSRC, 2022 (link) - Indian Public Health Standards 2022 — Community Health Centre — MoHFW / NHSRC, 2022 (link) - Indian Public Health Standards 2022 — Sub District Hospital and District Hospital — MoHFW / NHSRC, 2022 (link) ## Test Yourself: Practice Questions Eighteen questions in NEET PG style. ## Practice Questions (NEET PG pattern) *Original questions written in the style of the exam: +4 for a correct answer, −1 for a wrong one. Every answer was checked against the sources listed above. NEET PG papers are not published by NBEMS, so these are not past-paper questions.* **Q1.** Under IPHS 2022, a Sub Health Centre in a tribal area serves a population of - (a) 1,000 - (b) 10,000 - (c) 5,000 - (d) 3,000 **Answer: (d)** — SHC: 5,000 in plains, 3,000 in hilly, tribal and desert areas. **Q2.** The population norm for a rural PHC in the plains is - (a) 30,000 - (b) 80,000 - (c) 20,000 - (d) 50,000 **Answer: (a)** — PHC: 30,000 in plains and 20,000 in hilly and tribal areas. **Q3.** A Community Health Centre in hilly and tribal areas covers a population of - (a) 1,20,000 - (b) 30,000 - (c) 80,000 - (d) 2,50,000 **Answer: (c)** — CHC: 1,20,000 in plains and 80,000 in hilly and tribal areas. **Q4.** Urban Primary Health Centres are established for a population of - (a) 50,000 - (b) 30,000 - (c) 2.5 lakh - (d) 15,000–20,000 **Answer: (a)** — UPHCs: one per 50,000, close to slums; urban HWCs 15,000–20,000. **Q5.** An Urban Health and Wellness Centre caters to a population of - (a) 15,000–20,000 - (b) 1 lakh - (c) 50,000 - (d) 5,000 **Answer: (a)** — One urban HWC per 15,000–20,000, mainly slum and vulnerable pockets. **Q6.** A Health and Wellness Centre at the sub-centre level is led by a - (a) Community Health Officer - (b) Medical Officer (MBBS) - (c) Lady Health Visitor - (d) Block Extension Educator **Answer: (a)** — HWC-SHC staff: CHO plus one male and one female multipurpose worker, with ASHAs. **Q7.** The ASHA norm in plain areas is - (a) one per 1,000 population - (b) one per 5,000 - (c) one per village of any size - (d) one per 500 **Answer: (a)** — One ASHA per 1,000 population, or one per habitation in tribal, hilly and desert areas. **Q8.** How many service packages are envisaged under Comprehensive Primary Health Care at HWCs? - (a) 15 - (b) 6 - (c) 8 - (d) 12 **Answer: (d)** — Twelve packages, from care in pregnancy to screening and basic management of mental health. **Q9.** Which of the following is one of the CPHC service packages at Health and Wellness Centres? - (a) Cataract surgery - (b) Dialysis - (c) Screening and basic management of mental health ailments - (d) Caesarean section **Answer: (c)** — Mental health screening is package 12; the others are secondary or tertiary services. **Q10.** Under IPHS 2022, a facility qualifies as a First Referral Unit when it provides - (a) a blood bank alone - (b) 24-hour delivery services - (c) only emergency obstetric care - (d) both elective and emergency secondary-level surgery with supporting infrastructure **Answer: (d)** — FRUs go beyond obstetric services: elective and emergency secondary-level surgery with HR, OT, blood storage, drugs and diagnostics. **Q11.** The specialists at an FRU CHC include all EXCEPT - (a) orthopaedic surgeon (essential) - (b) paediatrician - (c) obstetrician - (d) anaesthetist **Answer: (a)** — FRU CHC specialists: physician, surgeon, obstetrician, paediatrician and anaesthetist; orthopaedics is desirable only in 50-bed FRUs. **Q12.** A non-FRU Community Health Centre has - (a) 50 beds - (b) 30 beds - (c) 100 beds - (d) 6 beds **Answer: (b)** — Non-FRU CHCs have 30 essential beds. **Q13.** In metro and million-plus cities, an Urban CHC serves a population of - (a) 2.5 lakh with 50 beds - (b) 50,000 with 6 beds - (c) 5 lakh with 100 beds - (d) 1,20,000 with 30 beds **Answer: (c)** — UCHC: 2.5 lakh and 50 beds in non-metro cities; 5 lakh and 100 beds in metros. **Q14.** The Bhore Committee (1946) recommended hospital beds of - (a) 1 per 10,000 - (b) 5 per 1,000 - (c) 2 per 1,000 - (d) 1 per 1,000 population **Answer: (d)** — Bhore: 1/1,000; NHP 2017: 2/1,000. IPHS 2022 treats 1 as essential and 2 as desirable. **Q15.** The National Health Policy 2017 recommends hospital beds of - (a) 1 per 1,000 - (b) 2 per 1,000 population - (c) 3 per 1,000 - (d) 0.5 per 1,000 **Answer: (b)** — NHP 2017: two beds per 1,000 population. **Q16.** Multispecialty polyclinics in urban areas serve - (a) 15,000–20,000 people - (b) 10 lakh people - (c) 2.5–3 lakh people, the catchment of 5–6 UPHCs - (d) 50,000 people **Answer: (c)** — Polyclinics provide ambulatory specialist care to 2.5–3 lakh, covering 5–6 UPHCs. **Q17.** CHCs at block headquarters are to be developed as - (a) District Hospitals - (b) Polyclinics - (c) Medical colleges - (d) Block Public Health Units **Answer: (d)** — All block-HQ CHCs become Block Public Health Units with four functional areas. **Q18.** A district of 15 lakh population needs how many essential in-patient beds under IPHS 2022? - (a) 150 - (b) 500 - (c) 100 (+ 25) - (d) 300 (+ 49 emergency/day-care) **Answer: (d)** — 10–20 lakh: 300 essential beds plus 49 emergency/day-care beds; 400 desirable. ### Active Recall From memory: give the IPHS 2022 population norms for the SHC, PHC and CHC (plains and hilly-tribal) and for urban HWCs, UPHCs, polyclinics and UCHCs; say who runs an HWC-SHC, how many CPHC packages there are, what defines an FRU and which specialists it has, and the hospital-bed norms of the Bhore Committee and NHP 2017.