CES 300-2 Compulsory

Ethiopian Standard
Second Edition
03-04-2021

Comprehensive Health Post Requirements

ICS: 11.020
Published by Ethiopian Standards Agency
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FOREWORD

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 clause 4 and 5. A Compulsory Ethiopian
standard shall have the same meaning, interpretation and application of a “Technical Regulation “as implied in
the WTO-TBT Agreement.
Implementation of this standard shall be effective as of 03-04-2021.

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ETHIOPIAN STANDARD CES 300-2

Comprehensive Health Post Requirements

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.
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.

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.
4.3 The CHP shall be open for 24 hours a day and seven days a week.
4.4 The CHP shall collect, organize, analyse, use and report routine local health data.
4.5 The CHP shall have functional referral and linkage system.
4.6 The CHP shall effectively utilize all HEP strategies, guidelines, manuals, SOPs, directives in all its
day-to-day activities.
4.7 The CHP should promote privacy of patients and clients.

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5. Specific requirements
5.1 Preventive and promotive health services
5.1.1Practice
5.1.1.1 The CHP shall promote 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 next
higher 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 promote proper 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.
5.2 Outpatient services
5.2.1.1 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,

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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,
5.3 Delivery service
5.3.1.1 The CHP shall provide focused ante natal care (FANC) supported by rapid tests for
laboratory needs.
5.3.1.2 The CHP shall conduct normal delivery and active management of the third stage of labour.
5.3.1.3 The CHP shall provide post natal care.
5.3.2Premises
5.3.2.1 The premises shall be well marked and easily accessible for disabled clients, elderly,
children and pregnant mother.
5.3.2.2 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.
5.3.2.3 Patient waiting area and corridor of the CHP shall be safe and child friendly.
5.3.2.4 The room arrangements of outpatient services shall consider proximity between related
services with easy access to dispensary and other admin services.
5.3.2.5 The CHP should have uninterrupted water and power sources
5.3.2.6 All outpatient rooms shall have adequate light, ventilation and sanitation facilities.
5.3.2.7 The CHP should have information, communication equipment and data processing devices
with internet connection.
5.3.2.8 The CHP shall have means of emergency communication and transportation.
5.3.2.9 The CHP shall have residential rooms for its staffs.

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5.3.2.10 The CHP shall have waste disposal system such as incinerator, placenta pit and solid waste
disposal pit).
5.3.2.11 The CHP shall have fence.
5.3.2.12 The CHP Premises shall contain a minimum of the following rooms/areas.
Number of Space (Sq. meter)
Premises required
rooms
2 15 for
Waiting area
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 room 2 12 for
including emergency each
Clean utility room 1 7
Latrine for male, female and 5 35
disables(separated with partition)
Staff office 1 9
Staff office and
HIS Card room 1 9
Guard’s room 1 7
Janitor`s room 1 4
Residential 8 15 for
Professionals` living rooms
rooms each
Common kitchen 1 20
Common shower and 4 30
toilet(separated with partition)
5.3.3Professionals
5.3.3.1 The CHP shall be directed by a licensed family health professional or health officer.
5.3.3.2 The CHP staffs shall provide both facility-based and community-based services.
5.3.3.3 The CHP 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

5.3.4Product
5.3.4.1 The CHP shall have medicines and medical supplies based on the national list.
5.3.4.2 The CHP shall have the following equipment’s and supplies.

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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. Cold chain boxes 4
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

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56. Safety boxes

57. Snellen’s chart
58. Specula of different sizes
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

5.4 Pharmaceutical Services

5.4.1Practices
5.4.1.1 CHP shall have a standard operating procedure (SOP) for dispensing and medication use
counseling to ensure patients’ safety and correct use of medications.
5.4.1.2 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.
5.4.1.3 All medicines to be dispensed shall be labeled and the labels shall be unambiguous, clear,
legible and indelible.
5.4.1.4 The CHP shall refill medications for chronic illnesses.
5.4.1.5 Filled prescriptions shall be signed and accountability must be accepted by the dispensing
pharmacy technician.
5.4.1.6 The CHP shall use the formulary list as well as policies and guidelines in managing
medicines based on the drug list of CHP.
5.4.1.7 The storage condition shall provide adequate protection to the medicines from
all environmental factors until the medicine is delivered to the patient.
5.4.1.8 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).
5.4.1.9 Medicines shall be stored and handled in accordance with the medicine manufacturer’s
requirements.
5.4.1.10 Expired or obsolete medicines shall be stocked in a separate place until disposition.
5.4.1.11 Medicines requiring special environmental conditions shall be stored accordingly.
5.4.1.12 Temperature and humidity shall be maintained according to manufacturer’s requirement.

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5.4.1.13 Special storage conditions shall be maintained for medicines requiring cold chain system
and Inflammable substances.
5.4.1.14 Firefighting equipment or system shall be installed to medicines storage places.
5.4.1.15 Written procedures shall be available for the return of expired, damaged, leftover and empty
packs from outlets to medical store to prevent potential misuse.
5.4.1.16 Daily medicine consumption at different outlets of the CHP shall be recorded, compiled and
analyzed for the appropriate supply and use of medicines.
5.4.1.17 The disposal of medicine wastes shall be in compliance with the appropriate medicines
waste management and disposal national regulation.
5.4.1.18 The CHP shall maintain records to assure that patients receive the medications prescribed
by a health professional.
5.4.1.19 There shall be a standardized prescription registration book for recording prescriptions and
dispensed medicine.
5.4.1.20 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
5.4.1.21 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.
5.4.1.22 Every transaction related with medicines should be recorded on stock control cards.
5.4.2Premises
5.4.2.1 Dispensing counter shall be designed to secure patient privacy and confidentiality.
5.4.2.2 Entrances, dispensing counters and doorways shall be accessible to persons with disability.
5.4.2.3 The ceiling, wall and floor shall be constructed to protect the safety of medicines from
burglary, rodents, direct sunlight, moisture and damages.
5.4.2.4 The shelf must be fixed at a minimum of 20cm above the floor, 1m wide between shelves;
50cm away from the wall and ceiling.
5.4.2.5 The pharmacy premises shall have the following minimum rooms/areas.

S.No Rooms required Number of rooms Area required (Sq.

meter)
1. Waiting area Open space (part of OPD
corridor)
2. Dispensing room 1 12

3. Medical store intended for medicines, 1 15

vaccines, lab reagents and medical equipment
storage

5.4.3Professionals
5.4.3.1 The CHP pharmacy shall have one licensed pharmacy technician.
5.4.4Products
5.4.4.1 The CHP shall have the following products and equipments.

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o
SR.N Quantity
Equipment
1. Refrigerator with thermometer 1
2. Wall thermometer 1
4. Computer (optional) 1
5. Fire extinguisher 2
6. Ventilator or AC as required 1
7. Hygrometer 1
8. Tablet counter 1
10. Dispensing table 1
11. Scissors
12. Adult and pediatric weighing balance

5.5 Medical laboratory services

5.5.1Practice
5.5.1.1 The CHP laboratory shall provide both microscopic and non-microscopic test services.
5.5.1.2 The laboratory shall have written procedure manuals, SOPs or guidelines for all tests and
equipment and quality assurance and control processes.
5.5.1.3 There shall be inspection, maintenance, calibration, and testing of all equipment
5.5.1.4 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
5.5.1.5 There shall be laboratory safety program, including infection control
5.5.1.6 There shall be documentation of quality control data (internal and external quality
control), calibration report, refrigerator readings and so on.
5.5.1.7 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.
5.5.1.8 The CHP shall have protocols and procedures for the availability of laboratory information
management system.
5.5.1.9 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
5.5.1.10 The CHP shall have monitoring and evaluation tools to assess activities including:
a) Adherence to SOPs;

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b) Adherence to safety guidelines;

c) QA activities; and
d) Laboratory performance and workload
5.5.1.11 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.
5.5.1.12 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.
5.5.1.13 Laboratory results shall be legible, without transcription mistakes and reported only to
persons authorized.
5.5.1.14 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
5.5.1.15 The laboratory shall meet regularly with clinical staff regarding services and clinical
interpretations.
5.5.1.16 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.
5.5.2Premises
5.5.2.1 There shall be a suitable environment to prevent damage, deterioration, loss or
unauthorized access.
5.5.2.2 The laboratory shall be located and designed to:
a) provide suitable, direct access for patients,
b) Allow reception of deliveries of chemicals

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c) Allow safe disposal of laboratory materials and specimens.

5.5.2.3 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.
5.5.2.4 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

5.5.3Professional
5.5.3.1 All laboratory services shall be directed by a licensed medical laboratory
technician/laboratory technologist.
5.5.3.2 The Laboratory service shall have and maintain job descriptions, including qualifications to
perform specific functions.
5.5.3.3 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

5.5.4Products
5.5.4.1 The CHP shall have the following minimum equipment and consumables:

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Tests Major equipment required

Parasitology:  Binocular Microscope(Shared)#1
 Stool microscopy  Slide
 Blood film for malaria and other  Staining reagents
hemoparasite/ Malaria Rapid Test  Rapid test kits

Urine analysis:  Binocular microscope (shared)

 Urinalysis
 HCG test
Hematology:  Haemoglobinometer/ Haemocytometer
 Hemoglobin/ Hematocrit Binocular microscope (shared)
 Total WBC count  Microhematocrit centrifuge
 Differential white cell count  Microhematocrit reader
 ESR
 Blood film

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
o

Bacteriology(Optional)
-test

Chemistry

5.5.4.2 The CHP shall have consumables, reagents and supplies.

5.5.4.3 The CHP shall haves helves and cupboards
5.5.4.4 The CHP laboratory bench tops shall be impervious to water and resistant to moderate heat.

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Bibliography
 Ethiopian Food, medicine and Healthcare Administration and Control Proclamation No. 661/2009
 Ethiopian Food, Medicine and Healthcare Administration and Control Regulation No. 189/2010
 Health Policy of Ethiopia
 Drug Policy of Ethiopia
 Commercial Code of Ethiopia
 Criminal Code of Ethiopia
 Medicines Waste Management and Disposal Directive No 2/2011
 Ethiopian National Guideline for Health Waste Management, 2008
 Ethiopian Building Proclamation, No.624/2009
 National Fire Protection standard

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 Organization and Objectives
The Ethiopian Standards Agency (ESA) is the national standards body of Ethiopia
established in 2010 based on regulation No. 193/2010.ESA is established due to the
restructuring o f Quality a nd Standards Authority o f Ethiopia ( QSAE) w hich w as
established in 1998.

ESA’s objectives are:-

 Develop Ethiopian standards an d establish a system that enable to

Ethiopian Standards Agency
የኢትዮጵያ የደረጃዎች ኤጀንሲ

check whether goods and services are in compliance with the

required standards,
 Facilitate the country’s technology transfer through the use of
standards,
 Develop national standards for local products and se rvices so as to
make them competitive in the international market.
Ethiopian Standards
The Ethiopian Standards are developed by national technical committees which are
composed of different stakeholders consisting of educational Institutions, research
institutes, government or ganizations, certification, inspection, and testing
organizations, regulatory bodies, consumer association etc. The requirements and/
or recommendations contained in Ethiopian Standards are consensus based that
reflects the interest of the TC representatives and also of comments received from
the public and other sources. Ethiopian Standards are approved by the National
Standardization Council and are kept under continuous review after publication and
updated regularly to take account of latest scientific and technological changes.
Orders f or a ll Ethiopian Standards, International Standard and ASTM standards,
including electronic versions, should be addressed to the Documentation and
Publication Team at the Head office and Branch (Liaisons) offices. A catalogue of
Ethiopian Standards is also available freely and can be accessed in f rom our
website.
ESA has the copyright of all its publications. No part of these publications may be
reproduced in any form without the prior permission in writing of ESA.
International Involvement
ESA, representing Ethiopia, is a member of the International Organization for
Standardization ( ISO), and Codex Alimentarius Commission ( CODEX). It also
maintains close working relations with the International Electro-technical
Commission (IEC) and American Society for Testing and Materials (ASTM).It is a
founding member of the African Regional Organization for standardization
(ARSO).

More Information?
Contact us at the following address.
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 011-646 08 80
 2310 Addis Ababa, Ethiopia
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