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Physical InfrastructureThe healthcare in rural areas has been developed as a threetierstructure based on predetermined population norms(Table A11.1). The sub-centre is the most peripheralinstitution and the first contact point between the primaryhealthcare system and the community. Each sub-centre ismanned by one Auxiliary Nurse Midwife (ANM) and onemale Multi-purpose Worker [MPW(M)]. A Lady HealthWorker (LHV) is in charge of six sub-centres each of whichare provided with basic drugs for minor ailments and areexpected to provide services in relation to maternal and childhealth, family welfare, nutrition, immunization, diarrhoeacontrol, and control of communicable diseases. Sub-centresare also expected to use various mediums of interpersonalcommunication in order to bring about behavioural changein reproductive and hygiene practices. The sub-centres areneeded for taking care of basic health, needs of men, womenand children. As per the figures provided by the UMHFWthere were 146,026 sub centres functioning in September20051—about 12 per cent lower than the prescribed numberas per government norms.Primary Health Centres (PHCs) comprise the second tierin rural healthcare structure envisaged to provide integratedcurative and preventive healthcare to the rural population withemphasis on preventive and promotive aspects. (Promotiveactivities include promotion of better health and hygienepractices, tetanus inoculation of pregnant women, intake ofIFA tablets and institutional deliveries.) PHCs are establishedand maintained by State Governments under the MinimumNeeds Programme (MNP)/Basic Minimum ServicesProgramme (BMS). A medical officer is in charge of the PHCsupported by fourteen paramedical and other staff. It acts as areferral unit for six sub-centres. It has four to six beds for inpatients.The activities of PHC involve curative, preventive,and Family Welfare Services. There were 23,236 PHCsfunctioning in September 2005 compared to 23,109 a yearearlier, according to the Ministry of Health. Though thenumbers appear to be increasing there is still a shortfall of about16 per cent when compared to the required norms for PHCs.Community Health Centres (CHC) forming the uppermosttier are established and maintained by the State Governmentunder the MNP/BMS programme. Four medical specialists
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