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DH
DISTRICT Hospitals
Indian Public Health Standards (IPHS): Guidelines for District Hospitals

An
OVERVIEW

definition
As the name suggests_

India’s Public Health System has been developed over the years as
a 3-tier system, namely primary, secondary and tertiary level of
health care.

D I STRICT HOSPITAL I S A HOSPITAL AT THE

SECONDARY REFERRAL LEVEL RESPONSIBLE FOR A
D I STRICT OF A DEFINED GEOGRAPHICAL AREA
CONTAINING A DEFINED POPULATION. Every district
i s e xpected to have a district hospital . Provides curative,
preventive and promotive healthcare services to the people in the
district. At present there are 605 district hospitals in 640 districts of
the country as per NRHM data as on 30-6-2010.

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District hospitals (Objectives as per IPHS)

The spe cific objectives of IPHS for District Hospitals are:

To provide co mprehensive secondary h ealthcare (specialist

and referral services) to the community through the
District Hospital.

To achieve and maintain an acce ptable standard of quality

o f care.

To make the se rv ices mo re responsive and sensitive to the

needs of the people of the district and the
hospitals/centres from where the cases are referred to the
district hospitals.

District hospitals (Grading of district hospital)

The bed strength of district hospitals_
7 5 to 500 beds
Bed strength depends on_
S i ze, Terrain, Population of the district.
The si ze of a district hospital is a fu n ction of the h ospital bed
re q uirement, which in turn is a fu n ction o f the size of the population i t
se rves.
Based on the assumptions of the annual rate of admission_
1 / 50 populations & average length o f stay in a hospital as 5 days:
di strict population be ds
say10 lakhs 300
Grading the size of the hospitals as per the number of beds.
Grade I: District hospitals norms for 5 0 0 beds
Grade II: District Hospital Norms for 4 0 0 beds
Grade III: District hospitals norms for 3 0 0 beds
Grade IV: District hospitals norms for 2 0 0 beds
Grade V : District hospitals norms for 1 0 0 beds

A district hospital should however be able to serve 85-95% o f the medical

n e eds in the districts. It is expected that the hospital bed occupancy rate
should be at least 80%.

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District hospitals (Functions)

A district hospital should_

•Provide all basic services.

•Aim to develop super-speciality services.
•Be ready for epidemic diseases and disaster management.
•Provide facility for skill based trainings.
•Provide OPD , INDOOR, E MERGENCY S ERVICES.
•Services for newborn care (Special Newborn Care Units
(S NCU)), psychiatric, physical medicine, rehabilitation,
accident and trauma, dialysis, anti-retroviral therapy.
•Super-speciality and related diagnostic facilities in more
than 300 bedded hospitals.

District hospitals (Services)

essential d esirable

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District hospitals (Services)

essential d esirable

District hospitals (Services)

essential d esirable

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District hospitals (Services)

essential d esirable

District hospitals (patient safety and control)

E ssential
H an d washing facilities in all OPD clinics, wards, emergency, ICU
and OT areas.
S afe clinical practices as per standard protocols.
There shall be pro per written h anding over system between health
care staff.
Formation of I n fe ction control team and provision of trained
Infection Control nurses.
Hospital shall develop stan dard o perating procedure for aseptic
procedures, culture surveillance and determination of hospital
acquired infections.
S afe Injection administration practices as per prescribed protocols.
S afe Blood transfusion practices need to be implemented.
Ensuring S afe disposal of Bio-medical waste as per rules.
For Di spo sal of Mercury, guidelines may be seen at An n e xure II B.
R e gular T raining o f Health care wo rkers in patient safety, infection
control and Bio-medical waste management.
Compliance to co rre ct method o f h and hygiene by health care
workers should be ensured.

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District hospitals (patient safety and control)

Desirable
Provision of locally made Hand rub solution in critical care areas
like ICU, Nursery, Burns ward etc. to ensure Hand Hygiene by Health
care workers at the point of care.
Use of safe Surgery check lists in the ward and operation Theatre
to minimize the errors during surgical procedures. (for the detailed
checklist refer to An n e xure IV).
A culture of encouraging reporting of Adverse Events happening in
the hospital to a hospital committee should be developed to find out
the cause of the adverse event and taking the corrective steps to
prevent them in future. Committee should also have patient and
community representatives as members.
Guidelines for Airborne Infection Control as given in An n e xure III
sh o uld be followed.
An tibiotic Policy – Hospital shall develop i ts own antibiotic policy to
check indiscriminate use of antibiotics and reduce the emergence of
resistant strains.

District hospitals ( S ervice Mix of Procedures in Medical and

S u r gical Specialities )
Medical
OPD Procedures (Including IPD)
Skin Procedures
Pediatric Procedures
Cardiology Procedures and Diagnostic Tests
Endoscopic Specialized Procedures and Diagnostic
Psychiatry Services
PMR Services
Eye Specialist Services (Ophthalmology)
Orthopedic Surgery
Liver
Biliary System
Urology
Plastic Surgery
ENT Services
Obstetric & Gynecology Specialist Services
Surgical
Abdomen
Spleen and Portal Hypertension
Pancreas
Small Intestine
Fractures
Pediatric Surgery

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District hospitals ( P hysical Structure )

Are a and space n orms o f the h ospital

number of beds required for a population of10 lakhs:
total number of admissions/year_
10,00,000 × 1/50 = 20,000 Bed days/year = 20,000 × 5 = 100,000
Total number of beds required when occupancy is 100% _
100000/365 = 275 beds
Total number of beds required when occupancy is 80%_
100000/365 × 80/100 = 220 beds

R e quirement of beds in a District Hospital would also be determined by

fo llowing factors:
Urban and Rural demographics and likely burden of diseases
Geographic terrain
Communication network
Location of FRUs and Sub-district Hospitals in the area Nearest
Tertiary care hospital and its distance & travel time
Facilities in Private and Not-for profit sectors
Health care facilities for specialized population–Defence, Railways, etc.

District hospitals ( P hysical Structure )

Are a and space n orms o f the h ospital

L an d Area
( De sirable)
Minimum Land area requirement are as follows:
Upto 100 beds = 0.25 to 0.5 hectare
Upto 101 to 200 beds = 0.5 hectare to 1 hectare
500 beds and above = 6.5 hectare (4.5 hectare for hospital and 2
hectare for residential).
S i ze o f h ospital as per n umber o f Beds
a. Ge n eral Hospital _
8 0 to 85 sqm per bed to calculate total plinth area. ( De sirable).
b. T eaching H ospital _
1 00 to 110 sq m per bed to calculate total plinth area.

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District hospitals ( P hysical Structure )

Fo llowing facilities/area may also be c onsidered (Desirable)

(i) Operation Theatre a. One OT for every 50 general in-patient beds

b. One OT for every 25 surgical beds.
(ii) ICU beds 5 to 10 % of total beds
(iii) Floor space for
each ICU Bed 25 to 30 sq m (this includes support services)
(iv) Floor space for
Pediatric ICU beds 10 to 12 sq m per bed
(v) Floor space for High
Dependency Unit (HDU) 20 to 24 sq m per bed
(vi) Floor space Hospital
beds (General) 15 to 18 sq m per bed
(vii) Beds space 7 sq m per bed.
(viii) Min. distance between
centers of 2 beds 2.5 m (minimum)
(ix) Clearance at foot
end of each bed 1.2 m (minimum)
(x) Minimum area for 20% of the floor area (if on same wall)
apertures (windows/ 15% of the floor area (if on opposite walls)
Ventilators opening in
fresh air)

District hospitals ( P hysical Structure )

H o spital B uilding – Planning and L ayout
Hospital Management Policy should emphasize on hospital buildings with
e arthquake proof, flood proof and fire protection features.
Infrastructure should be e co -friendly and disabled (physically and
visually handicapped) fri e ndly.
i ) Appearance and u pkeep
The hospital should have a h i g h boundary wall with min. 2 exit gates.
Building shall be plaste red and painted with uniform color scheme.
There shall be n o u n wanted/outdated posters pasted on the walls of
building and boundary of the hospital.
There shall be n o o u tdated/unwanted h oardings in hospital premises.
There shall be pro v ision of adequate light in the n ight.
Proper lan dscaping should be ensured.
There shall be n o e n croachment in and around the hospital.
i i ) S ignage
The building should have a pro mi nent board displaying the name of
the Centre in the local language at the gate and on the building.
Signage indicating acce ss to various facilities at strategic points in
the Hospital for guidance of the public should be provided. For
showing the directions, color coding may be used.
C i tizen charter shall be displayed at OPD and Entrance in local
language including patient rights and responsibilities.

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District hospitals ( P hysical Structure )

H o spital B uilding – Planning and L ayout
i i i) General Maintenance
Building should be well maintained with n o se e page, cracks in the
walls, no broken windows and glass panes. There should be n o
g ro wth of algae and mosses o n walls etc. Hospital should have anti-
skid and non-slippery floors.
i v ) C ondition of roads, pathways and drains
Approach road to emergency shall be all we ather mo torable road.
Roads shall be i llu minated i n the nights.
There shall be de di cated parking space separately for ambulances,
Hospital staff and visitors.
There shall be n o stagnation/over flow o f drains.
There shall be n o wate r logging/marsh in or around the hospital
premises.
There shall be n o o pen sewage/ditches in the hospital.
v ) Environmental friendly fe atures
v i ) B arrier free access
v i i) Administrative Block
v i ii) Roof Height
The roof height should n o t be less than approximately 3.6m measured
at any point from floor to roof.

District hospitals ( DEPARTMENT LAYOUT)

Clinical Services
I ) Outdoor Patient Department (OPD)
The facility shall be planned keeping in mind the maximum peak hour
patient load and shall have the scope for future expansion. OPD shall
have approach from main road with signage visible from a distance.
a. R eception and Enquiry
Enquiry/May I Help desk shall be available with competent staff
fluent in local language. The service may be outsourced.
Services available at the hospital displayed at the enquiry.
Name and contacts of responsible persons like Medical
superintendent, Hospital Manager, Causality Medical officer, Public
Information Officer etc. shall be displayed.
b. W aiting area
Waiting area at the scale o f 1 sq ft/per average daily patient with
mi n imum 400 sq ft of area is to be provided.
c. L ayout o f o pd
En q uiry→Registration→Waiting→Sub-waiting→Clinic→Dressing
ro o m/Injection R oom→Billing→Diagnostics ( lab/X-ray)→Pharmacy→Exit

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District hospitals ( DEPARTMENT LAYOUT)

Clinical Services
d. Patient amenities (norms g iven i n following pages)
Potable drinking water.
Functional and clean toilets with running water and flush.
Fans/Coolers.
Seating arrangement as per load of patient.
e . C linics
The clinics should include general, medical, surgical, ophthalmic,
ENT, dental, obsetetric and gynaecology, Post Partum Unit,
paediatrics, dermatology and venereology, psychiatry, neonatology,
orthopaedic and social service department.
Doctor chamber should have ample space to sit for 4 -5 people.
Chamber size of 12.0 sq meters is adequate.
f. Nu rsing services
g . Desirable services
Air-cooling, Patient calling system with electronic display, Specimen
collection centre, Television in waiting area

District hospitals ( DEPARTMENT LAYOUT)

Clinical Services
I I ) Imaging
The department shall be lo cated at a place which is accessible to
bo th OPD and wards and also to o peration theatre department.
The size of the room shall depend on the type and size of equipment
installed.
The ro o m shall h ave a sub-waiting area with toilet facility and a
change room facility.
Film developing and processing (dark room) shall be provided in the
department.
I I I) C linical L aboratory
The department shall be situated such that it has e asy access to IPD
as we ll as OPD patients.
The Laboratory shall have adequate space from the point of view of
workload as well as maintenance of high level of hygiene to prevent
the infection.
S to rage space shall be adequate ( 1 0 % o f total floor space) with
separate storage space for inflammable items.
I V ) B lood B ank
Blood bank shall be in clo se proximity to pathology department and
at an acce ssible distance to o peration theatre department, intensive
care units and emergency and accident department.

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District hospitals ( DEPARTMENT LAYOUT)

Clinical Services
V ) I ntermediate Care Area (Indoor Patient Department)
General IPD beds shall be categorized as following_
Male Medical ward
Male surgical ward
Female Medical ward
Female surgical ward
Maternity ward
Paediatric ward
Nursery
Isolation ward
As per need and infrastructure hospital have following_
wards
Emergency ward/trauma ward
Burn Ward
Orthopedic ward
Post operative ward
Ophthalmology Ward
Malaria Ward
Infectious Disease Ward
Private ward

District hospitals ( DEPARTMENT LAYOUT)

Clinical Services
V I ) Pharmacy (Dispensary)
located in an area conveniently acce ssible from all clinics . The size
should be adequate to co n tain 5 percent o f the total clinical visits
to th e O PD i n one session. For e v ery 200 O PD patients daily there
sh o uld be o ne dispensing counter.

V I I) Patient
C onveniences

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District hospitals ( DEPARTMENT LAYOUT)

Clinical Services
V I II) Dharamshala
It is a premises providing te mpo rary accommodation for short
du ration. The area shall be minimum 0.25 hectares of land adjoining
or within the Hospital premises.
I X) I ntensive Care Unit and High Dependency Wards
The number of patients requiring intensive care may be about 5 to
10 percent of total medical and surgical patients in a hospital.
The unit shall not have less than 4 beds nor more than 12 beds.
Number of beds may be restricted to 5% of the total bed strength
initially but should be expanded to 10% gradually.
in a 500-bedded hospital, total of 25 beds will be for Critical
Care. Out of these, 13 may be ICU beds and 12 will be allocated for
High Dependency Wards.
X) o peration theatre
The location of O pe ration theatre should be in a quite environment,
free from noise and other disturbances, free from contamination
and possible cross infection, maximum protection from solar
radiation and convenient relationship with surgical ward, intensive
care unit, radiology, pathology, blood bank and CSSD.

District hospitals ( DEPARTMENT LAYOUT)

Clinical Services
XI )Accident and Emergency Services
24 x 7 operational emergency with dedicated emergency room shall be
available with adequate man power.
It should preferably have a di sti nct e ntry independent of OPD main
entry so that a very minimum time is lost. There should be an easy
ambulance approach
Lay out shall follow the fu n ctional flow.
Signage of emergency shall be displayed at the entry of the hospital
with directional signage at key points.
Emergency shall have dedicated triage, resuscitation and observation
area. Screens shall be available for privacy.
S e parate provision for e xamination o f rape/ sexual assault victim
should be made available in the emergency as per guidelines of the
Supreme Court.
Emergency should have mo bi le X-ray/ laboratory, side labs/plaster
ro o m/and minor OT facilities. Separate emergency beds may be provided.
Emergency block to have EC G, Pulse Oxymeter, Cardiac Monitor with
De fibrillator, Multiparameter Monitor, Ventilator also.
S tretcher, wheelchair and trolley shall be available at the e ntrance
of the emergency at designated area.

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District hospitals ( DEPARTMENT LAYOUT)

District hospitals ( DEPARTMENT LAYOUT)

Clinical Services
XI I) Delivery S uite Unit
The delivery suit unit be located near to operation theatre &
located preferably on the ground floor.
The delivery Suit Unit should include the facilities of
accommodation for various facilities as given below:
Reception and admission
Examination and Preparation Room
Labour Room (clean and a septic room)
Delivery Room
Neo-natal Room
Sterilizing Rooms
Sterile Store Room
Scrubbing Room
Dirty Utility
Doctors Duty Room
Nursing Station
Nurses changing Room
Group C & D Room
Eclampsia Room

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District hospitals ( DEPARTMENT LAYOUT)

Clinical Services
XI II) Post Partum Unit
It is desirable that every District Hospital should have a Post
Partum Unit with dedicated staff and infrastructure to provide
Post natal services, all Family Planning Services, Safe Abortion
services and immunization in an integrated manner. The focus will
be to promote Post Partum Sterilization and will be provided if the
case load of the deliveries is more than 75 per month.
Ho spital Administrative and S upport S ervices
Man agement Information System ( MIS)
C o mputer with I nternet connection is to be provided for MIS purpose.
Provision of flow of Information from PHC/CHC to district hospital
and from there to district and state health organization should be
established.

District hospitals ( DEPARTMENT LAYOUT)

Me dical and General S tores
Medical and general stores should have v e h icular accessibility and
v e n tilation, security and fire fighting arrangements. Hospital shall
have standard operating procedure for local purchase, indent
management, storage preparation of monthly requirement plan and
Inventory analysis.
Fo r S torage of Vaccines and o ther logistics
Cold Chain Room: 3 . 5 m × 3 m in size
Vaccine & Logistics Room: 3 . 5 m × 3 m in size
Minimum and maximum Stock shall be 0.5 and 1.25 month respectively.
Indent order and receipt of vaccines and logistics should be monthly.
V e ntilation
The ventilation in the hospital may be achieved by e i ther n atural
su pply or by mechanical exhaust of air.
Me chanical Engineering
Air-conditioning and Room Heating in operation theatre and neo-natal
units should be provided.
W ater S upply
Arrangement should be made for ro u n d the clock piped water supply
alo ng with an overhead water storage tank with pumping and boosting
arrangements. Water requirement pe r bed per day = 450 to 500 lts.
(Excluding requirements for AC, Fire-fighting, Horticulture and steam).

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District hospitals ( DEPARTMENT LAYOUT)

i llumination

District hospitals ( DEPARTMENT LAYOUT)

Man power requirement

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District hospitals ( DEPARTMENT LAYOUT)

Man power requirement

District hospitals ( DEPARTMENT LAYOUT)

Man power requirement

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District hospitals ( DEPARTMENT LAYOUT)

Man power requirement

District hospitals ( equipments )

Imaging equipment
X-Ray Room Accessories
Cardiopulmonary Equipment
Labour ward, Neo Natal and Special Newborn
Care Unit (SNCU) Equipment
Immunization Equipment
Ear Nose Throat Equipment
Eye Equipment
Dental Equipment
Operation Theatre Equipment
Laboratory Equipment
Surgical Equipment Sets
Physical Medicine and Rehabilitation (PMR)
Equipment
Endoscopy Equipment
Anesthesia Equipment
Furniture & Hospital Accessories
Post Mortem equipment
Linen
Teaching Equipment
Administration
Refrigeration & AC
Hospital Plants
Hospital Fittings & Necessities
Transport
Radiotherapy
Intensive Care Unit (ICU)

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