What services and equipment should sub centres (Subhealth Centers) have to provide essential healthcare?

Sub Centres (Subhealth Centers) Essential Services and Equipment

Sub centres should function as basic-level maternal and child health facilities equipped to provide routine antenatal care, normal delivery services, immediate postpartum care, basic newborn care, immunization, and health education, with clear protocols for stabilization and timely referral of complications to higher-level facilities.

Core Service Capabilities

Sub centres must provide comprehensive primary maternal and child health services including:

• Antenatal care with minimum 8 visits throughout pregnancy, including blood pressure monitoring, hemoglobin testing, weight monitoring, fetal growth assessment, and distribution of nutritional supplements 1
• Normal spontaneous vaginal delivery services for low-risk pregnancies at term (≥37 weeks gestation) with physiologically stable mothers and fetuses 1
• Partograph-based labor monitoring starting at active phase (cervical dilation ≥4 cm) with documentation of fetal heart rate, cervical dilation, fetal descent, uterine contractions, maternal vital signs, and amniotic fluid status 1
• Active management of third stage of labor with intramuscular oxytocin 10 IU immediately after delivery, controlled cord traction, and uterine massage 1, 2
• Immediate postpartum monitoring for minimum 2 hours with vital signs every 15 minutes in first hour and every 30 minutes in second hour, assessing uterine contraction and bleeding 1
• Immediate newborn care including drying, stimulation, skin-to-skin contact, delayed cord clamping after 1 minute, and facilitation of early breastfeeding within first hour 2, 3
• Routine childhood immunization services integrated with growth monitoring and health education 4

Essential Equipment and Supplies

Patient Care Area Equipment

Each delivery bed area requires 1:

• Delivery bed with adjustable positioning capability
• Examination light with adequate illumination for perineal inspection
• Suction apparatus (manual or electric) for airway clearance
• Oxygen supply with flow meters and masks (adult and neonatal sizes)
• Resuscitation equipment including bag-valve-mask devices for mother and newborn
• Fetal heart rate monitoring equipment (Doppler or Pinard stethoscope)
• Blood pressure monitoring equipment with appropriate cuff sizes
• Thermometer for maternal and neonatal temperature assessment
• Weighing scale for newborn weight measurement
• Sterile delivery kit including instruments for episiotomy and repair
• IV access supplies and fluid administration sets

Medications and Consumables

Essential pharmaceutical supplies 1, 2:

• Oxytocin 10 IU ampoules for active management of third stage and postpartum hemorrhage prevention
• Misoprostol tablets as backup uterotonic agent
• Magnesium sulfate for seizure prophylaxis in preeclampsia during stabilization before transfer
• Injectable antibiotics for infection management and prophylaxis
• Local anesthetic (lidocaine) for perineal repair
• Iron and folic acid supplements for antenatal distribution
• Vitamin K for newborn prophylaxis
• Tetracycline eye ointment for neonatal ophthalmia prophylaxis
• Sterile gloves, gauze, sutures and wound care supplies

Laboratory and Diagnostic Capability

Minimum diagnostic services 1:

• Hemoglobin testing for anemia screening
• Urine dipstick testing for proteinuria and glucose
• Blood glucose monitoring capability
• Basic obstetric ultrasound access (may be through referral arrangement)

Referral Protocols and Transport

Sub centres must establish clear referral pathways 1:

• Written protocols for identifying complications requiring transfer to Level II or III facilities
• Emergency transport arrangements with ambulance access and communication systems
• Stabilization capability before transfer including IV access, oxygen administration, and initial medication administration
• Referral documentation with partograph, vital signs, interventions performed, and estimated time of complication onset

Specific Referral Triggers

Immediate transfer required for 1:

• Severe preeclampsia (blood pressure ≥160/110 mmHg with proteinuria)
• Antepartum hemorrhage (placenta previa, abruption)
• Prolonged labor (crossing action line on partograph)
• Fetal distress (persistent abnormal heart rate patterns)
• Postpartum hemorrhage exceeding 500 mL or ongoing bleeding
• Retained placenta beyond 30 minutes
• Preterm labor <37 weeks gestation
• Multiple gestation
• Malpresentation (breech, transverse lie)
• Newborn requiring resuscitation beyond initial stimulation
• Newborn with respiratory distress, cyanosis, or poor feeding

Staffing Requirements

Personnel with appropriate training 1:

• Midwives or trained birth attendants with competency in normal delivery, active management of third stage, neonatal resuscitation, and recognition of complications
• Support staff for cleaning, sterilization, and record-keeping
• 24-hour availability of trained personnel for delivery services
• Continuous observation capability during labor and immediate postpartum period

Physical Infrastructure

Facility design considerations 5, 1:

• Separate clean and dirty utility areas for instrument processing and waste management
• Hand-washing facilities with running water and soap at point of care
• Adequate lighting including emergency backup power for nighttime deliveries
• Privacy for examination and delivery
• Climate control to maintain appropriate temperature for newborn care
• Storage areas for clean supplies separate from contaminated materials
• Waiting area for family members

Quality Monitoring

Sub centres must track 1:

• Maternal and neonatal outcomes including complications and deaths
• Referral rates and reasons for transfer to higher facilities
• Partograph completion rates for all deliveries
• Postpartum hemorrhage incidence and management
• Early breastfeeding initiation rates within first hour

Common Pitfalls to Avoid

• Do not attempt to manage preterm deliveries <37 weeks at sub centre level—immediate transfer to Level II or III facility is required 1, 3
• Do not use ergometrine (methylergonovine) as first-line uterotonic due to vasoconstriction and hypertension risk; oxytocin is the only recommended agent 2
• Do not delay transfer when complications are identified—stabilize and transfer immediately rather than attempting definitive management 1
• Do not leave mother-infant dyad unobserved during first 2 hours postpartum when sudden collapse events are most likely 2
• Do not perform routine episiotomy—use selective approach only when indicated 1
• Do not administer oxytocin as rapid IV bolus—causes hypotension; use slow infusion if IV route necessary 2