10Know The Government Health SystemIn 1978, India was one of the countries that promised to putin place a system that would provide primary health care toall its population. Because of this promise, a system wasdesigned to respond to the health needs of people even inthe most remote areas.However, as health is a State subject, each statehas its own ways of doing things. It is importantfor every health worker to know the local systemwell. We should know what the differentemployees of the health department aresupposed to do and the various facilities thatshould be available at each health centre.Though there are small differences, at a broad level, thestructure of the health department is the same. In this chapter,let us get to know of the government health structure.
10-1 The Government Health Structure Population Health Health Personnel Present Facilities at Centre level establishment Every ---- Village health guide VHG to get some small medicines (also Anganwadi worker (AW) at for fever, diarrhoea etc. Village Also with AW if no VHG Anganwadi) Of 1000 Trained Dai Trained dais to get Delivery Kits pop. Every 5000 Sub-centre 1 Auxilliary Nurse Midwife Immunisation (ANM) Delivery(3000 in Some medicines and contraceptives 1 Male health workertribal/hilly) Every Primary 1 or 2 Medical Officers Laboratory with microscope for Health Centre ANM and MHW malaria and TB 30,000 Deep freeze for 24 hour cold chain Health Assistants ( 1 for every six (20,000 in male or female health workers) for immunisation tribal/hilly Pharmacist Ambulance for evacuation Health Supervision in field, areas) Block Extn Educator epidemic control Lab technician Leprosy worker Driver Clerks Every Community Block Medical Officer 30 bedded hospital Ambulance 1,00,000 Health Centre Medical, Surgical, Women’s and Maternity centre Child specialists Or Block General Nurses X-Ray, Laboratory Malaria Supervisor Operation theatre Post mortem facility X-Ray technician BCG vaccinator etc. District Referral Chief Medical and Health Officer Specialists and super specialists of (Joint director health) heart, bones, chest, gastrointestinalheadquarter hospital system, etc or Dy Directors of Malaria, TB, Leprosy, Immunisation, Family Nationalised programme info and Medical resources College welfare and Public Health State Referral Specialists and State incharges of Facilities for rare diseases; hospitals for all national health programmes Training for paramedical workers speciality e.g., bones, chest, etc ANM training college* VHGs are not working in most states. All VHGs are supposed to be women . The Anganwadiworker is however functional in many states and doing well. She gets medicines every now and thenfor simple illnesses. Dais are suppose to be trained and provided presterilised Delivery kits to be usedat the time of delivery.
10-4Duties of Male health worker:§ Male health worker is supposed to go to every household every fifteen daysand take blood slides for malaria if any person has had fever since the last visit.He is also supposed to advise people about sanitation, purification of water sourceslike wells, hand pumps, etc. and give materials for the same. He is also supposedto give immunisation, keep records, and prevent and take care of epidemics. Hisduties are : 1. survey all families and maintain general info about all his locality; prepare and maintain family records for recording particulars of FP, immunisation, local health programmes, etc. 2. malaria i. identify fever cases ii. make blood slides, send them to the lab and give first dose for malaria iii. record results of the blood slides and educate community about early diagnosis and treatment of malaria and of spraying of houses. 3. communicable diseases i. identify diarrhoea cases, fever with rash, jaundice, tetanus, whooping cough and diphtheria, eye infections and report to MO and health asst.. ii. give ORS to all cases of diarrhoea/dysentery and vomiting iii. identify and refer STDs iv. educate community about importance of communicable diseases v. identify and refer all cases of blindness. vi. identify and refer all cases of suspected leprosy and to check if leprosy patients are taking regular treatment. vii. identify all suspected cases of TB and motivate them to give sputum for examination; to check if patients are taking TB treatment regularly. viii. chlorinate public water sources including wells regularly. ix. educate community on waste disposal, sanitary latrines and smokeless chullahs x. administer immunisation to all infants in the area 4. family planning i. utilise info from eligible couple register and motivate couple to use contraceptives. ii. distribute contraceptives directly or through male depot holders. iii. provide follow up services who have used family planning services.National Health ProgrammesMany health programmes of national importance are run directly by the central government. There are nationalprogrammes that provide services till village level through the state administered health system for diseaseslike: malaria, leprosy, TB, filarial, AIDS, blindness and goitre. Such services are also for reproductive andchild health, immunisation, Japanese Encephalitis, Guinea work eradication, Cancer Control, Mental Health,Diabetes Control, and for Family Welfare. There is also a National Water Supply and Sanitation Programmeand the Minimum Needs Programme.Many are funded fully by the Centre – as in the case of malaria for the northeast states. Others are on a 50-50basis that allots funds to the states only if they put in a matching component. Many states with no money areunable to pursue many of the programmes, because they are unable to put their own budgets into health.