First referral unit
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The document outlines the criteria and guidelines for establishing First Referral Units (FRUs) in India. FRUs are intended to be fully functional health facilities providing emergency obstetric and newborn care. Key points include that by the 10th Five Year Plan each district should have 3-4 FRUs. Critical services of a FRU include 24/7 delivery services, emergency obstetric care like C-sections, newborn care, and referral services. Facilities should have a minimum of 20 beds, operation theater, and labor room. Human resources need 4 medical officers and adequate nursing staff. By 2009, Tamil Nadu increased its FRUs from 105 in 1992-1997 to 291.
First referral unit
- 2. IntroductionHistorical background CSSM Programme- setting up FRUs at the community health centers/sub-district level hospitals.RCH Programme -Supply of Emergency Obstetric Drug Kit -Provision for Private Anesthetic ServicesDrug and Cosmetics RuleTenth Plan: Recommended ApproachIdentified establishment of fully functional and operational FRUs as the priority area for the provision of Emergency Obstetric and New-born Care.By the end of the Tenth Five Year Plan, each district should have at least 3-4 fully functional facilities which are equipped to provideEmergency Care on a round-the-clock basis.
- 3. Cont…..Mapping the existing health facilities, available manpower and other resources for each district
- 4. Critical Determinants of a FRU’s24-hour delivery services including normal and assisted deliveriesEmergency Obstetric Care including surgical interventions like Caesarean Sectionsand other medical interventionsNew-born CareEmergency Care of sick childrenFull range of family planning services including LaproscopicServices
- 5. Cont….Safe Abortion Services Treatment of STI / RTIBlood Storage Facility Essential Laboratory Services Referral (transport) Services
- 6. Points to be consider while selecting the facilityInfrastructure needsA minimum bed strength of 20-30 and North- East and EAG States of 10-12beds initially.A fully functional operation theatre equipped for undertaking anesthetic andemergency surgical procedures.A fully operational LabourRoom.
- 7. Cont………An area earmarked and equipped for New-born Care in the Labour Room and also in the ward.A functional laboratory with facilities for all essential investigations.Blood storage facility as per the guidelines issued by Govt. of India (GoI).24-hour water supply.Arrangements for waste disposal.
- 8. Cont……Regular electricity supply with back-up arrangements to ensure uninterrupted supplyTelephone connection.Ambulance (owned or arranged through local hiring).
- 9. Cont….Selection of sitesUnder the RCH Programme funds were provided toCHCs and district hospitals.
- 10. Equipment Kits Supplied Under CSSM Programme
- 11. Human resources: Re-deployment and multi-skillingPolicy options for human resource managementFacilities to manage Obstetrical and medical emergencies.strength of 4 medical officers (surgeon, obstetrician, physician and pediatrician) was recommended. Adequate number of Medical Personnels including nursing staffs.In-patient wards.
- 12. Cont….Re-deployment & multi-skillingStrengthening of BPHCs and PHCs will be done in a need based manner.All the block PHCs shall have minimum 30 indoor beds with complete facilities for institutional delivery and usual indoor treatment care.Well-functioning PHCs running with indoor facilities will be identified and their infrastructure strengthened.
- 13. Cont….The existing manpower will be strengthened by withdrawing and posting of manpower from PHCs that are providing only OPD services.All the staff of PHCs, doing outdoor services shall be with drawn and re-deployed in BPHCs and PHCs running
- 14. Cont….Provision of support services like blood storage, Laboratory services, pharmacy services.Assessment of available manpower and other resources in FRUs.Training programme (FOGSI)Multi-skilling training of paramedical workers
- 15. Functional/financial autonomyHire locally available specialists and/or paramedical workers from the private/ NGO sector in case of needMake local arrangements for referral transportGenerate resources locally andOut-source non-clinical services.
- 16. Referral Transport(i) Appropriate referral transport from the periphery to the functioning First Referral Units providing emergency services and (ii) Also from FRUs to district/tertiary level institutions.
- 17. Selection of FRU Unit
- 18. Current Information1992-1997 - 105 FRUs in Tamil Nadu2009 - 291 FRUs in Tamil Nadu
- 19. Summary
- 20. Evaluation………, …………,$ ………….. are the clinical facilities should be needed in PHCs or CHCs to declare as a FRU.Under CSSM Programme, ……… number of kits were designed for surgical procedure.Up to 2009, the total number of FRUs operationalised in Tamil Nadu is ………
- 21. AssignmentWrite an assignment on standing orders followed in FRU in case of obstetrical emergencies.
- 22. Conclusion
- 23. THANK YOU