Compulsory Ethiopian Standard

Comprehensive Health Post Requirements

CES xx
Table of contents
1. Scope..............................................................................................................................4
2. Normative Reference.....................................................................................................4
3. Terms and Definitions....................................................................................................4
4. General Requirement.....................................................................................................4
5. Specific requirement......................................................................................................7
5.1. Facility Based Services..............................................................................................7
5.2. Community based services.......................................................................................11
Forward

This Ethiopian Standard has been prepared under the direction of the Technical Committee
for Medical Science & Health care practices (TC 90) and published by the Ethiopian
Standards Agency (ESA).

Application of this standard is COMPULSORY with respect to health and safety. A

Compulsory Ethiopian Standard shall have the same meaning, interpretation and application
as a "Technical Regulation “as implied in the WTO-TBT Agreement.

Implementation of this standard shall be effective as of xxxxxxx 2022.

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1. Scope
This Ethiopian standard specifies minimum requirements for the establishment and
maintenance of comprehensive health post (CHP)with respect to practices, premises,
professionals and products or materials that are required to provide comprehensive health
services at primary level of care.

2. Normative References
The following documents, in whole or in part, are normatively referenced in this document and
are indispensable for its application. For dated references, only the edition cited applies. For
undated references, the latest edition of the referenced document (including any amendments)
applies.
1.1 Ethiopian Food, medicine and Healthcare Administration and Control
Proclamation No. 661/2009
1.2 Ethiopian Food, Medicine and Healthcare Administration and Control
Regulation No. 189/2010
1.3 Health Policy of Ethiopia
1.4 Drug Policy of Ethiopia
1.5 Commercial Code of Ethiopia
1.6 Criminal Code of Ethiopia
1.7 Medicines Waste Management and Disposal Directive No 2/2011
1.8 Ethiopian National Guideline for Health Waste Management, 2008
1.9 Ethiopian Building Proclamation, No.624/2009
1.10 National Fire Protection standard
1.11 CES 246 - Health institutions–General requirement

3. Terms and Definitions

For the purpose of this standard the definition of terms shall apply:
3.1 Comprehensive health services: a package of services comprising promotive,
preventive, curative and community based rehabilitative health extension services.
3.2 Comprehensive health post: A service delivery outlet where comprehensive health
extension services are provided.
3.3 Mobile health services: It refers to an approach to deliver health extension services for mobile
communities.

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 3.4 Facility based services: a range of comprehensive health extension services that are
provided at fixed place (health post) by qualified health professionals on daily basis.
3.5 Community based services: a variety of preventive, promotive, curative and
rehabilitative health extension services which are provided at out-reach level (household,
schools, youth centres and others) by a team of health professionals on scheduled basis.
4. General Requirements
4.1 The Comprehensive Health Post (CHP) shall provide comprehensive health extension
service.
4.2 The CHP shall provide health services through household services, community level
services, school health services, facility level health services, mobile health services and
work place health services.
4.2 The CHP shall be open for 24 hours a day and seven days a week.
4.3 The CHP shall collect, organize, analyse, use and report routine local health data.
4.4 The CHP shall have functional referral and linkage system.
4.5 The CHP shall effectively utilize all HEP strategies, guidelines, manuals, SOPs,
directives in all its day-to-day activities.
4.6 The CHP should promote privacy of patients and clients.

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5. Specific requirements
5.1 Practice
5.1.1 Preventive and promotive health services
5.1.1.1 The CHP shallpromote early ANC, PMTCT, LLIN use, maternal nutrition, birth
preparedness and complication readiness, danger signs, maternal waiting services,
skilled delivery, postpartum care, postpartum FP, FP, EPI, initiation of early
breastfeeding and healthy life style.
5.1.1.2 The CHP shall promote self-breast examination.
5.1.1.3 The CHP shall actively engage the community on identification and referral of TB
suspected cases.
5.1.1.4 The CHP shall identify index TB cases and their contacts.
5.1.1.5 The CHP shall coordinate malaria prevention, control and elimination.
5.1.1.6 The CHP shall screen and identify TB and leprosy suspected cases and link with
the nexthigher level health facility for diagnosis and treatments.
5.1.1.7 The CHP shall create awareness; carry out screening and link of common
communicable and non-communicable diseases, and mental neurological and
substance use Disorder (MNSD).
5.1.1.8 The CHP shall provide integrated community management of new-born and
childhood illness (ICMNCI)
5.1.1.9 The CHP shall practice out-reach community-based promotion of hygiene and
environmental health.
5.1.1.10 The CHP shall promote improved latrine construction and utilization.
5.1.1.11 The CHP shall promote sanitation marketing for improved latrine and healthy
housing conditions.
5.1.1.12 The CHP shall promote appropriate personal hygiene practice.
5.1.1.13 The CHP shall promote safe water management at household and community
level.
5.1.1.14 The CHP shall promoteproper solid and liquid waste management.
5.1.1.15 The CHP shall promote institutional health for hygienic, safety and healthy
environment.
5.1.1.16 The CHP shall create demand for all health packages.
5.1.1.17 The CHP shall promote community engagement and participation.
5.1.1.18 The CHP shall provide health education and promotion.

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5.1.2 Outpatient services
5.1.2.1 The CHP shall provide shall provide the following services:
a. Integrated management of new-born and childhood illness (IMNCI),
b. Pre-referral management of labour complications,
c. Manage maternal sepsis, mastitis, PPH and pre-referral PPH,
d. Screen children and maternal malnutrition,
e. SAM and MAM management for malnourished children,
f. Immunizations service,
g. All family planning methods except permanent methods,
h. Comprehensive abortion care,
i. Manage neglected tropical diseases (NTDs) based on national protocols,
j. Treat menstrual problems and irregularities,
k. Adolescent friendly sexual and reproductive health services,
l. Major communicable and non-communicable diseases interventions,
m. Syndromic case management for STIs,
n. Post-exposure prophylaxis (PEP) for occupational exposure and sexual assault
victims,
o. Diagnose (RDT) and treat uncomplicated malaria cases and provide pre-referral
treatment for severe and complicated malaria cases,
p. Basic palliative and rehabilitative care,
q. Follow up for chronic illnesses,
r. Basic emergency service,
s. Disaster management service,
t. Conduct surveillance based on the national guideline,
u. Basic wound management,
v. Minor surgeries including male circumcision,
w. Assess, diagnose and manage common illnesses for all age groups according to
the national guideline
x. First-line treatment for common childhood illnesses such as pharyngitis,
tonsillitis, sinusitis, otitis media, eye infections, UTIs and scabies,

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5.1.3 Delivery service
5.1.3.1 The CHP shall provide focused ante natal care (FANC) supported by rapid tests for
laboratory needs.
5.1.3.2 The CHP shall conduct normal delivery and active management of the third stage of
labour.
5.1.3.3 The CHP shall provide post natal care.

5.2 Premises
5.2.1 The premises shall be well marked and easily accessible for disabled clients, elderly,
children and pregnant mother.
5.2.2 The outpatient service shall be located where access for ambulatory patients is the
easiest and where in coming client would not have to pass through other service
outlets.
5.2.3 Patient waiting area and corridor of the CHP shall be safe and child friendly.
5.2.4 The room arrangements of outpatient services shall consider proximity between
related services with easy access to dispensary and other admin services.
5.2.5 The CHP should have uninterrupted water and power sources
5.2.6 All outpatient rooms shall have adequate light, ventilation and sanitation facilities.
5.2.7 The CHP should have information,communication equipment and data processing
devices with internet connection.
5.2.8 The CHP shall have means of emergency communication and transportation.
5.2.9 The CHP shall have residential rooms for its staffs.
5.2.10 The CHP shall have waste disposal system such as incinerator, placenta pit and solid
waste disposal pit).
5.2.11 The CHP shall have fence.
5.2.12 The CHP Premises shall contain a minimum of the following rooms/areas.
Number of Space (Sq.
Premises required
rooms meter)
Waiting area 2 15 for each
MCH service (ANC,FP, EPI) 1 12
Labour room with bathroom 1 25
Outpatient Delivery room (with two coaches) 1 28
service units PNC room with baby corner 1 35
Procedure room 1 12
Adult and child examination 2 12 for each
roomincluding emergency
Clean utility room 1 7

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 Latrine for male, female and 5 35
disables(separated with partition)
Staff office Staff office 1 9
and HIS Card room 1 9
Guard’s room 1 7
Janitor`s room 1 4
Residential 8 15 for each
Professionals` living rooms
rooms
Common kitchen 1 20
Common shower and 4 30
toilet(separated with partition)

5.3 Professionals
5.3.1 The CHP shall be directed by a licensed family health professionalor health officer.
5.3.2 The CHP staffs shall provide both facility-based and community-based services.
5.3.3 TheCHP shall have the following professionals.
Professionals required Level of education Number required
Family health professional BSc 1
Health officer BSc 1
Midwife Level 4 1
Nurse Level 4 1
Environmental health Level 4 1
Health extension worker Level 4 2
Cleaners 2
Guard 3

5.4 Product
5.4.1 The CHP shall have medicines and medical supplies based on the national list.
5.4.2 The CHP shall have the following equipment’s and supplies.
S.No Equipment Quantity
1. Adjustable stools 2
2. Ambubag, adult and pediatrics 2
3. Apron
4. Baby crib 1
5. Bedpans
6. Boots
7. Bowls and stands
8. Cabinets and shelves 1
9. Cap, surgical, woven
10. Coldchain boxes 4

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11. Delivery coaches 2
12. Delivery forceps 1
13. Delivery sets 2
14. Different types of splints
15. Drape
16. Dressing set 1
17. Dressing trolley 2
18. Dust mask
19. Episiotomy set 1
20. Examination coaches 2
21. Face mask
22. Face shield/eye shield
23. Fetoscope 2
24. Four wheel mobile stretcher 1
25. Garbage bins
26. Glucometer 1
27. Goggle 2
28. Gown, surgical, woven (plain)
29. Hand carrying stretcher 2
30. Heavy duty glove
31. Infant meter and height scale 2
32. Instrument drum 1
33. Instrument tables (Mayo type) 1
34. Instrument tray 2
35. IV stands 2
36. Kick buckets
37. Kidney basin, different size 2
38. Measuring tape 2
39. Minor procedure Coach 2
40. Minor surgical procedure linen
41. Minor surgical set 2
42. Mobile examination lamp 1
43. Mobile operating lights 1
44. NG tube
45. Ophthalmoscope
46. Otoscope
47. Packing nasal forceps 1
48. Patient screen, partition curtains 2
49. Pickup forceps with jar 1
50. Plastic garbage bags
51. Pulse oximeter (finger tip) 2
52. Reflex hammer 2
53. Refrigerator 1
54. Respiratory mask
55. Resuscitation set on trolley 2
56. Safety boxes
57. Snellen’s chart
58. Specula of different sizes

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59. Sphygmomanometer 1
60. Stand lamp/ torch
61. Sterilization drum
62. Sterilizer (steam and dry) 1
63. Stethoscope 2
64. Suction apparatus
65. Suction machines (pedal, electrical) 1
66. Surgical glove
67. Surgical splints 1
68. Surgical woven different size 2
69. Suture set 2
70. Thermometer
71. Top (shirts), Surgical, woven, small,
medium & large
72. Tourniquets
73. Trousers, surgical, woven, small, medium
&large
74. Tuning forks , 500Hz
75. Weighing scale adult and pediatric 2
76. Wheelchairs

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5.5 PharmaceuticalServices
5.5.1 Practices
5.5.1.1 CHP shall have a standard operatingprocedure (SOP)
fordispensingandmedicationusecounselingtoensure patients’safetyand correctuse
of medications.
5.5.1.2 The dispensers shall make sure that prescriptions are legible, written by authorized
prescriber and complete. Prescription papers shall be standardized as per the
appropriate organ.
5.5.1.3 All medicines to be dispensed shall be labeled and the labels shall be
unambiguous, clear, legible and indelible.
5.5.1.4 The CHP shall refill medications for chronic illnesses.
5.5.1.5 Filled prescriptions shall be signed and accountability must be accepted by the
dispensing pharmacy technician.
5.5.1.6 The CHP shall use the formulary list as well as policies and guidelines in
managing medicines based on the drug list of CHP.
5.5.1.7 The storage condition shall provide adequate protection to the
medicines from all environmental factors until the medicine is delivered to the
patient.
5.5.1.8 The CHP shall ensure that all areas where medicines are stored are
according to acceptable standards (palletized or shelved, ease for free
movement, ventilated, rodent free, temperature and moisture controlled and
others).
5.5.1.9 Medicines shall be stored and handled in accordance with the
medicinemanufacturer’s requirements.
5.5.1.10 Expired or obsolete medicines shallbe stocked in a separate place until disposition.
5.5.1.11 Medicines requiring special environmental conditions shall be stored accordingly.
5.5.1.12 Temperature and humidity shallbe maintained according to manufacturer’s
requirement.
5.5.1.13 Special storage conditions shall be maintained for medicines requiring cold chain
system and Inflammable substances.
5.5.1.14 Firefighting equipment or system shall be installed to medicines storage places.
5.5.1.15 Written procedures shall be available for the return of expired, damaged, leftover
and empty packs from outlets to medical store to prevent potential misuse.

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 5.5.1.16 Daily medicine consumption at different outlets of the CHP shall be recorded,
compiled and analyzed for the appropriate supply and use of medicines.
5.5.1.17 The disposal of medicine wastes shall be in compliance with the appropriate
medicines waste management and disposal national regulation.
5.5.1.18 The CHP shall maintain records to assure that patients receive the medications
prescribed by a health professional.
5.5.1.19 There shall be a standardized prescription registration book for recording
prescriptions and dispensed medicine.
5.5.1.20 Each patient with a chronic disease shall have a separate Patients Medication
Profile Card (PMP) that should be filled appropriately with all the relevant
information for each patient
5.5.1.21 Patient and medication related records and information shall be documented and
kept in a secure place that is easily accessible only to the authorized personnel.
5.5.1.22 Every transaction related with medicines should be recorded on stock control
cards.

5.5.2 Premises
5.5.2.1 Dispensing countershall be designed tosecure patientprivacyand confidentiality.
5.5.2.2 Entrances, dispensing counters and doorways shall be accessible to persons with
disability.
5.5.2.3 The ceiling, wall and floor shall be constructed to protect the safety of medicines
from burglary, rodents, direct sunlight, moisture and damages.
5.5.2.4 The shelf must be fixed at a minimum of 20cm above the floor, 1m wide between
shelves; 50cm away from the wall and ceiling.
5.5.2.5 The pharmacypremisesshallhavethefollowing minimumrooms/areas.

S.No Rooms required Numberofrooms Area required

(Sq. meter)
1. Waitingarea Open space (part of
OPD corridor)
2. Dispensing room 1 12
3. Medical storeintendedformedicines, 1 15
vaccines, lab reagents and
medical equipmentstorage

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5.5.3 Professionals
5.5.3.1 The CHP pharmacyshall have one licensed pharmacy technician.

5.5.4 Products
5.5.4.1 The CHP shall have the following products and equipments.
R.No Quantity
Equipment
1. Refrigerator with thermometer 1
2. Wall thermometer 1
4. Computer (optional) 1
5. Fireextinguisher 2
6. VentilatororAC asrequired 1
7. Hygrometer 1
8. Tablet counter 1
10. Dispensing table 1
11. Scissors
12. Adultand pediatricweighing balance

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5.6 Medical laboratory services
5.6.1 Practice
5.6.1.1 The CHP laboratory shall provide both microscopic and non-microscopic test
services.
5.6.1.2 The laboratory shall have written procedure manuals, SOPs or guidelines for all
tests and equipment and quality assurance and control processes.
5.6.1.3 There shall be inspection, maintenance, calibration, and testing of all equipment
5.6.1.4 The laboratory shall establish a system for management of reagents, including
availability, storage, and testing for accuracy; Procedures for collecting, identifying,
processing, and disposing of specimens
5.6.1.5 There shall be laboratory safety program, including infection control
5.6.1.6 There shall be documentation of quality control data (internal and external
quality control), calibration report, refrigerator readings and so on.
5.6.1.7 The CHP shall have protocols and procedures for the availability of laboratory
services including the emergency services for 24 hours a day and seven days a
week.
5.6.1.8 The CHP shall have protocols and procedures for the availability of laboratory
information management system.
5.6.1.9 The CHP shall have standardized data collection instruments and including at least
the followings:
a) Laboratory request forms
b) Laboratory report forms
c) Laboratory specimen and results registers
d) Quarterly/monthly reporting forms including summary of tests conducted,
summary of tests referred, summary of quality assurance report
e) Equipment and supplies inventory registers
f) Quality assurance record forms
g) Sample referral forms
5.6.1.10 The CHP shall have monitoring and evaluation tools to assess activities including:
a) Adherence to SOPs;
b) Adherence to safety guidelines;
c) QA activities; and
d) Laboratory performance and workload

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5.6.1.11 Laboratory report shall include the following:
a) All laboratory test result/reports shall have reference (normal) ranges specific for
age and gender.
b) Copies or files of reported results shall be retained by the laboratory so that
prompt retrieval of the information is possible.
c) The length of time that reported data are retained shall be 5 years for legal reason
minimal errors or loss of patient test results.
d) Reports shall be filed with the patient's medical record and duplicate copies shall
be filed in the laboratory in a manner which permits ready identification and
accessibility and with appropriate backup.
e) In the case of laboratory tests performed by an outside laboratory, the original
report from such laboratory shall be contained in the medical record.
5.6.1.12 Quality assured test results shall be reported on standard forms to the clinician
with the following minimum information:
a. Patient identification
b. Date and time of specimen collection;
c. The test performed and date of report;
d. The reference or normal range;
e. The laboratory interpretation where appropriate;
f. The name and initial of the person who performed the test,
g. The authorized signature of the person reviewing the report and releasing the
results.
5.6.1.13 Laboratory results shall be legible, without transcription mistakes and reported
only to persons authorized.
5.6.1.14 The laboratory shall have protocols and procedures in place to protect the privacy
of patients and integrity of patient records whether printed or electronic. Policies
shall be established which define who may access patient data
5.6.1.15 The laboratory shall meet regularly with clinical staff regarding services
and clinical interpretations.
5.6.1.16 The laboratory shall keep a record of the complaint. The record shall include the
nature of the complaint, the date of occurrence, individuals involved, any
investigations undertaken by the laboratory and resolution.

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5.6.2 Premises
5.6.2.1 There shall be a suitable environment to prevent damage, deterioration, loss or
unauthorized access.
5.6.2.2 The laboratory shall be located and designed to:
a) provide suitable, direct access for patients,
b) Allow reception of deliveries of chemicals
c) Allow safe disposal of laboratory materials and specimens.
5.6.2.3 The laboratory facilities shall meet at least the following:
a) Laboratory shall have adequate lighting, ventilation
b) The laboratory shall have a reliable supply of running water. At least two sinks
shall be provided where appropriate: one for general laboratory use and the
other reserved for hand washing.
c) Continuous power supply
d) Working surface covered with washable materials
e) Internal surfaces, i.e. of floors, walls, and ceilings shall be: Smooth,
impervious, free from cracks, cavities, recesses, projecting ledges and other
features that could harbor dust or spillage; easy to clean and decontaminate
effectively
f) Lockable doors and cupboards
g) Closed drainage from laboratory sinks (to a septic tank or deep pit)
h) Separate toilets/latrines for staff and patients (shared with other services)
i) Emergency of safety services shall be included in the laboratory services design
specifications.

5.6.2.4 The CHP laboratory shall have one room with the following arrangements:
Room required Number of Area require
room required
Recording and reporting area 1 with different partition 20sqm.
Specimen collection area
Microscopic analysis and rapid- test analysis
area
Storage corner

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5.6.3 Professional
5.6.3.1 All laboratory services shall be directed by a licensed medical laboratory
technician/laboratory technologist.
5.6.3.2 The Laboratory service shall have and maintain job descriptions, including
qualifications to perform specific functions.
5.6.3.3 The laboratory shall have the following staffs.
S.No. Staff required Number required
1. Medical laboratory technician/technologist 01
2. Cleaner (shared with other services) 01

5.6.4 Products
5.6.4.1 The CHP shall have the following minimum equipment and consumables:
Tests Major equipment required
Parasitology:  Binocular Microscope(Shared)#1
 Stool microscopy  Slide
 Blood film for malaria andother  Staining reagents
hemoparasite/ Malaria Rapid Test
Urine analysis:  Binocular microscope (shared)
 Urinalysis

Hematology:  Haemoglobinometer/ Haemocytometer

 Hemoglobin/ Hematocrit Binocular microscope (shared)
 Total WBC count  Microhematocrit centrifuge
 Differential white cell count  Microhematocrit reader
 ESR

Serology:  All serological test kits

 HBsAg  Shaker
 HCV test(optional)  RDT kit
 HIV test  HIV test kit
 ASO/RF/ /(Optional)
 VDRL/ RPR
 RDT for malaria
 RH and blood group

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Bacteriology(Optional) Binocular microscope (shared)
 Gram stain
 ZiehlNeelson stain(AFB)
 Indian Ink
Chemistry Glucometer
 Blood glucose

5.6.4.2 The CHP shall have consumables, reagents and supplies.

5.6.4.3 The CHP shall haveshelves and cupboards
5.6.4.4 The CHP laboratory bench tops shall be impervious to water and resistant to moderate
heat.

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