The document provides key health indicators, top causes of death and disability, and an overview of health programs in the districts of Sundargarh and Rayagada in Odisha. It summarizes the status of primary healthcare through HWCs, secondary care facilities, cross-cutting areas like human resources and quality, and specific programs on RMNCAH+N, non-communicable diseases, tuberculosis, and COVID-19 vaccination. Overall service coverage is good but gaps exist in infrastructure, human resources, training, and utilization of referral transport. Community processes and comprehensive primary care services need strengthening, particularly follow-up care and tracking of cases.
The document summarizes a study that reviewed existing regulatory mechanisms in five Indian states - Assam, Chhattisgarh, Madhya Pradesh, Maharashtra and Karnataka - to address the shortage of doctors in rural areas. The study found that while states have policies on compulsory rural service for doctors, implementation and monitoring is weak. Doctors interviewed expressed concerns about long service durations and the compulsory nature of bonds. They also highlighted issues with rural postings like lack of infrastructure and non-clinical deployment. The report provides recommendations to improve regulatory measures based on these findings.
This document summarizes a presentation given on the South Sudan Integrated Service Delivery Program (ISDP) in Nzara County from July to December 2014. It provides an overview of county demographics and health facilities. Key highlights include training activities, community mobilization efforts, and challenges around staffing and infrastructure. Priorities for the next quarter include scaling up integrated community case management, postpartum care, and minor facility renovations. The presentation concludes with a success story of increased facility deliveries in Ringasi following community sensitization and hiring a female midwife.
Dissemination of community scoore card to districtsCissy Namuzimbi
The community score card approach was used to assess the quality of HIV/AIDS services in 3 districts of Uganda. Key findings included poor ratings for male circumcision and adolescent HIV care due to cultural beliefs and lack of privacy. ART access received fair-good ratings but with stockouts and stigma as issues. Family planning services faced challenges of negative beliefs and domestic violence. Staffing gaps exceeded 50% at some health centers. Recommendations focused on increasing staffing, addressing stockouts, improving community sensitization and awareness of patient rights.
Concepts of SDN Elements and Programmatic ReviewRogelio Ilagan
This document discusses service delivery networks (SDNs) in the context of the Philippine health system. It provides background on SDNs and their goals of improving equitable access to health services through efficient provision and continuity of care. Key points include:
- SDNs were redefined in 2016 to better achieve universal health care goals. This involved expanding the roles of DOH, PhilHealth, LGUs and other agencies.
- SDNs are composed of primary, specialty and apex hospital networks to provide integrated care. Gaps remain in guidance for public-private integration and inter-facility referrals.
- Successful implementation requires addressing issues like governance, resources, incentives and sustainability at local levels. Perceived gaps include a
Understanding the Satisfaction, Perceptions, and Expectations of Clients of P...HFG Project
Taking quality health care to the farthest corners of the country is at the heart of the Government of India’s public health policy and programming. The National Health Mission’s reproductive, maternal, newborn, child and adolescent health (RMNCH+A) strategic approach underscores the need to ensure quality health care. A key thrust of the government’s reform focus has, thus, been on plugging service delivery gaps through improved, evidence-based decision making. The USAID-funded Health Finance and Governance (HFG) project supported the country’s Ministry of Health and Family Welfare (MoHFW) to yield preliminary insights into the level of patient satisfaction and utilization of public health services.
Voluntary medical male circumcision (VMMC) is reported as the number of males circumcised with support from PEPFAR funds. This number is broken down by age, HIV status, and circumcision technique. An additional breakdown of surgical circumcisions by follow-up status within 14 days is included to monitor program quality. The number of circumcisions performed indicates the reach of services and whether targets are met, while disaggregations allow evaluation of which populations are accessing services and adjustment of modeling inputs.
The document summarizes the Kayakalp initiative launched by the Indian government to promote cleanliness and hygiene in public health facilities. The initiative recognizes and rewards facilities that achieve high scores on criteria assessing cleanliness, sanitation, waste management, and infection control. Facilities are evaluated through internal and peer assessments as well as external assessments by trained teams. Cash awards are given to the top performing facilities at the state and national level to invest in improving amenities and services. The document outlines the goals of Kayakalp and provides details on the assessment process, criteria, and cash prizes awarded to winning facilities in 2015-2016, 2016-2017.
The document summarizes a study that reviewed existing regulatory mechanisms in five Indian states - Assam, Chhattisgarh, Madhya Pradesh, Maharashtra and Karnataka - to address the shortage of doctors in rural areas. The study found that while states have policies on compulsory rural service for doctors, implementation and monitoring is weak. Doctors interviewed expressed concerns about long service durations and the compulsory nature of bonds. They also highlighted issues with rural postings like lack of infrastructure and non-clinical deployment. The report provides recommendations to improve regulatory measures based on these findings.
This document summarizes a presentation given on the South Sudan Integrated Service Delivery Program (ISDP) in Nzara County from July to December 2014. It provides an overview of county demographics and health facilities. Key highlights include training activities, community mobilization efforts, and challenges around staffing and infrastructure. Priorities for the next quarter include scaling up integrated community case management, postpartum care, and minor facility renovations. The presentation concludes with a success story of increased facility deliveries in Ringasi following community sensitization and hiring a female midwife.
Dissemination of community scoore card to districtsCissy Namuzimbi
The community score card approach was used to assess the quality of HIV/AIDS services in 3 districts of Uganda. Key findings included poor ratings for male circumcision and adolescent HIV care due to cultural beliefs and lack of privacy. ART access received fair-good ratings but with stockouts and stigma as issues. Family planning services faced challenges of negative beliefs and domestic violence. Staffing gaps exceeded 50% at some health centers. Recommendations focused on increasing staffing, addressing stockouts, improving community sensitization and awareness of patient rights.
Concepts of SDN Elements and Programmatic ReviewRogelio Ilagan
This document discusses service delivery networks (SDNs) in the context of the Philippine health system. It provides background on SDNs and their goals of improving equitable access to health services through efficient provision and continuity of care. Key points include:
- SDNs were redefined in 2016 to better achieve universal health care goals. This involved expanding the roles of DOH, PhilHealth, LGUs and other agencies.
- SDNs are composed of primary, specialty and apex hospital networks to provide integrated care. Gaps remain in guidance for public-private integration and inter-facility referrals.
- Successful implementation requires addressing issues like governance, resources, incentives and sustainability at local levels. Perceived gaps include a
Understanding the Satisfaction, Perceptions, and Expectations of Clients of P...HFG Project
Taking quality health care to the farthest corners of the country is at the heart of the Government of India’s public health policy and programming. The National Health Mission’s reproductive, maternal, newborn, child and adolescent health (RMNCH+A) strategic approach underscores the need to ensure quality health care. A key thrust of the government’s reform focus has, thus, been on plugging service delivery gaps through improved, evidence-based decision making. The USAID-funded Health Finance and Governance (HFG) project supported the country’s Ministry of Health and Family Welfare (MoHFW) to yield preliminary insights into the level of patient satisfaction and utilization of public health services.
Voluntary medical male circumcision (VMMC) is reported as the number of males circumcised with support from PEPFAR funds. This number is broken down by age, HIV status, and circumcision technique. An additional breakdown of surgical circumcisions by follow-up status within 14 days is included to monitor program quality. The number of circumcisions performed indicates the reach of services and whether targets are met, while disaggregations allow evaluation of which populations are accessing services and adjustment of modeling inputs.
The document summarizes the Kayakalp initiative launched by the Indian government to promote cleanliness and hygiene in public health facilities. The initiative recognizes and rewards facilities that achieve high scores on criteria assessing cleanliness, sanitation, waste management, and infection control. Facilities are evaluated through internal and peer assessments as well as external assessments by trained teams. Cash awards are given to the top performing facilities at the state and national level to invest in improving amenities and services. The document outlines the goals of Kayakalp and provides details on the assessment process, criteria, and cash prizes awarded to winning facilities in 2015-2016, 2016-2017.
How to construct a highway to health knowledge and remote praxis support ? Th...Paulo Lopes
An overview about Telmedicine Brazilian Project, focus on the Brazilian Telemedicine University Network - RUTE and IDB Telehealth Project to LATAM, based in Luiz Ary Messina (RUTE - National Coordinator) and Alaneir de Fatima dos Santos (coordinator of IDB Telehealth Project)
Information about Admission in Gulab Devi Medical Complex_2016Atiqa khan
The document provides information about admission to Gulab Devi Medical Complex. It outlines the programs offered including degrees in Pharm-D, DPT, B.Sc Allied Sciences, and diplomas. It lists the affiliated universities and recent merit percentages. The document discusses the entry test, admission form fees, minimum criteria, account information, contacts, website, and email for admissions. It provides courtesy to related websites for more details.
This document provides guidance on starting a Rural Health Clinic (RHC). It begins with an introduction that describes the RHC program's goals of improving access to primary care in rural underserved areas through a team-based care delivery model. It then provides overviews of the major RHC requirements, including being located in a rural and underserved area, staffing requirements, services provided, and recordkeeping. The document guides readers through determining if a site is eligible and conducting a financial feasibility analysis to determine if the RHC program and payment methodology would be suitable. It aims to help health care practitioners and organizations understand the process for becoming a Federally-certified RHC.
This document outlines the Philippine Health Sector Roadmap for 2014-2016. It details strategies, actions, targets, resource needs, and supporting agencies across four outcomes: 1) Achieve MDGs, 2) Financial risk protection, 3) Access to quality health care, and 4) Improved health governance. Key strategies include expanding PhilHealth enrollment, improving benefit coverage, upgrading health facilities, deploying health workers, and hospital governance reform. Tables provide specific priorities, targets, and resource allocation for provinces with high numbers or percentages of poor households. The roadmap aims to improve health, especially for the poor and vulnerable in the Philippines.
The document discusses Link ART Centres, which were established to improve access to antiretroviral therapy (ART) for HIV patients by reducing travel burdens. It outlines the concept, objectives, structure, roles and responsibilities of Link ART Centres. The objectives are to integrate ART services into primary/secondary healthcare, build ART treatment capacity at primary levels, and improve adherence by reducing travel costs and time. Link ART Centres are located at primary facilities and provide drugs to stable patients, while more complex cases are referred to nodal ART Centres. The document reviews infrastructure needs, staffing roles, and the expanded "LAC Plus" model.
The document provides information about the CCHP-MH (Certified Correctional Healthcare Professional - Mental Health) certification from the National Commission on Correctional Health Care (NCCHC). The certification recognizes qualified mental health professionals working in correctional settings. It requires a graduate degree, professional licensure, three years of correctional experience, and passing an exam on correctional mental health topics. Maintaining the certification involves annual fees and continuing education requirements. The goal is to promote high standards in correctional mental healthcare and recognize expertise for working in the challenging correctional environment.
This report assesses the introduction of two laparoscopic procedures - laparoscopic inguinal hernia repair (LIHR) and laparoscopic assisted hysterectomy (LAH) - in Australia. Literature reviews found insufficient evidence to determine if the procedures provided clear benefits over open surgery. Surveys of 15 Australian hospitals performing LIHR found a lack of consistency in surgeon training and little prospective audit of clinical outcomes. Similarly for LAH, literature reviews revealed inadequacies in study size and quality of evidence. The case studies highlighted variations in record keeping between hospitals, limiting the conclusions that could be drawn. Overall, the report found a need for higher quality studies to properly evaluate these new laparoscopic procedures.
This document discusses sexually transmitted infections (STIs) in Sudan. It provides data showing high rates of STIs like urethral discharge, vaginal discharge, and genital ulcers in Sudan. It outlines the causes of STIs in Sudan and discusses specific infections like HIV/AIDS, human papillomavirus, and genital ulcers. It also describes Sudan's STI management protocol, services provided at STI centers, and the need to update guidelines and raise awareness about STIs in Sudan and their hidden prevalence.
Starting Your TeleMental Health Program outlines key steps for developing a tele-mental health program, including conducting a needs assessment, establishing policies and procedures, ensuring HIPAA compliance, obtaining proper equipment, providing training to staff, and documenting medical records. Tele-mental health programs allow for the delivery of mental healthcare through videoconferencing technology regardless of patient location. Reimbursement for tele-mental health services varies by state and insurance provider.
This document summarizes Medicare payments for outpatient dialysis services in 2015. It finds that payment adequacy indicators are generally positive, as access to care and quality of care have been maintained or improved in recent years while costs increased modestly. The aggregate Medicare margin for outpatient dialysis facilities in 2013 was 4.3%, and is projected to be 2.4% in 2015. Therefore, the Commission recommends eliminating the update to the outpatient dialysis payment rate for 2016, as payments appear adequate.
- The document discusses trauma centers and their role in providing care to seriously injured patients. It defines trauma centers and describes their classification levels from I to V, with Level I centers providing the highest level of surgical specialties and care.
- The roles and requirements of Levels I-V trauma centers are outlined, including necessary coverage of specialists, transfer agreements, and quality assessment programs. Level I centers provide leadership and research.
- Two levels of pediatric trauma centers (P-I and P-II) are also defined, with Level P-I centers requiring at least two pediatric surgeons and other pediatric specialists.
- The document then discusses components and resources needed for trauma centers in Indonesia, including minimum hospital
The document outlines plans for operationalizing Health and Wellness Centers under Ayushman Bharat to deliver comprehensive primary health care in India. It discusses strengthening existing primary health centers and subcenters to become Health and Wellness Centers that provide preventive, promotive, curative, rehabilitative and palliative care. Key elements include expanding the primary health care workforce through a certificate program for Mid-Level Health Providers, multi-skilling frontline workers, improving infrastructure, ensuring drug and diagnostic availability, developing a robust IT system, and implementing quality standards.
The document discusses universalizing access to primary healthcare in India. It outlines the current healthcare structure and reasons for poor access, including insufficient funding, lack of availability and affordability. It proposes a roadmap to improve the system through measures like increasing infrastructure and availability of resources, improving human resource management, strengthening regulations, and public-private partnerships. The goal is to ensure equitable, affordable and quality healthcare access for all Indians.
ayushmann bharat by Government of India under Modi governmentTusharBansal425676
The document discusses Ayushman Bharat - Health and Wellness Centres (AB-HWCs) and provides information on:
1. AB-HWCs aim to provide comprehensive primary healthcare through an integrated approach and move towards universal health coverage.
2. Key issues discussed include assigning populations to AB-HWCs, strengthening infrastructure, addressing human resource gaps, expanding services, and financial planning.
3. States are encouraged to develop a vision document by December 2019 to comprehensively plan AB-HWC implementation.
Universal Health Coverage (UHC) aims to ensure universal access to healthcare in Tamil Nadu by 2023. The state is transforming all rural and urban primary health centres into Health and Wellness Centres (HWCs) which provide comprehensive primary healthcare services. As of August 2019, over 2000 HWCs have been established across 39 districts utilizing standardized treatment guidelines, healthcare teams, IT systems, diagnostic services and community outreach programs. The hub and spoke laboratory model supports last-mile delivery of diagnostic services at HWCs. Mentoring teams provide clinical audits and tele-consultations to strengthen referrals and continuity of care under UHC.
Telemedicine in Skilled Nursing Facilities by Reza SadeghianReza Sadeghian
This document discusses using telemedicine in skilled nursing facilities to help avoid unnecessary hospitalizations. It finds that two-thirds of nursing home residents are on Medicaid and most are also enrolled in Medicare. These residents frequently experience avoidable hospitalizations, which are expensive and disruptive. The document outlines a study using telemedicine carts equipped with examination tools to help nurse practitioners manage acute changes in residents' conditions and palliative care assessments remotely rather than transferring residents to hospitals unnecessarily. The study found the telemedicine approach helped avoid hospital transfers 60% of the time with estimated cost savings of $396,000.
Sindh provincial acceleration operational plan for MDGs4 &5 june 18, 2014Abdul Rehman Pirzado
This document outlines a provincial acceleration operational plan for achieving Millennium Development Goals 4 and 5 in Sindh, Pakistan from 2013-2015. It summarizes the socio-demographic characteristics of Sindh's population, health indicators, coverage across the continuum of care, proposed sites and process of implementation, interventions, indicators to measure impact and progress, budget requirements, current status and constraints. The plan aims to reduce maternal and child mortality rates through integrated MNCH services, strengthening health information systems, and community interventions delivered by lady health workers and community midwives across Sindh. Barriers to implementation including lack of resources, awareness, and coordination between programs are also discussed.
The Integrated Disease Surveillance Project (IDSP) was launched in 2004 with World Bank assistance to improve disease outbreak detection and response in India. It established a decentralized surveillance system from the national to district levels. Key components include syndromic surveillance, reporting of priority diseases, strengthening laboratories, and using information technology. However, integration with other health programs remains a challenge. Issues exist at the national, state, and district levels including staff shortages, lack of coordination, and underreporting that weaken disease surveillance. While IDSP established an important framework, ongoing efforts are needed for it to reach its full potential.
This document summarizes a project conducted by Cancer Care Ontario to engage regional cancer centre healthcare professionals in identifying important cancer surveillance information. Over 400 participants provided input through workshops and an online survey. They generated over 1,500 indicator concepts, which were distilled down to 118 final concepts. These concepts spanned the cancer continuum from prevention to end-of-life care. The indicators could be used both locally for populations as well as provincially through Cancer Care Ontario reporting. The engagement of healthcare professionals from across the province helped identify key cancer surveillance data needs.
How to construct a highway to health knowledge and remote praxis support ? Th...Paulo Lopes
An overview about Telmedicine Brazilian Project, focus on the Brazilian Telemedicine University Network - RUTE and IDB Telehealth Project to LATAM, based in Luiz Ary Messina (RUTE - National Coordinator) and Alaneir de Fatima dos Santos (coordinator of IDB Telehealth Project)
Information about Admission in Gulab Devi Medical Complex_2016Atiqa khan
The document provides information about admission to Gulab Devi Medical Complex. It outlines the programs offered including degrees in Pharm-D, DPT, B.Sc Allied Sciences, and diplomas. It lists the affiliated universities and recent merit percentages. The document discusses the entry test, admission form fees, minimum criteria, account information, contacts, website, and email for admissions. It provides courtesy to related websites for more details.
This document provides guidance on starting a Rural Health Clinic (RHC). It begins with an introduction that describes the RHC program's goals of improving access to primary care in rural underserved areas through a team-based care delivery model. It then provides overviews of the major RHC requirements, including being located in a rural and underserved area, staffing requirements, services provided, and recordkeeping. The document guides readers through determining if a site is eligible and conducting a financial feasibility analysis to determine if the RHC program and payment methodology would be suitable. It aims to help health care practitioners and organizations understand the process for becoming a Federally-certified RHC.
This document outlines the Philippine Health Sector Roadmap for 2014-2016. It details strategies, actions, targets, resource needs, and supporting agencies across four outcomes: 1) Achieve MDGs, 2) Financial risk protection, 3) Access to quality health care, and 4) Improved health governance. Key strategies include expanding PhilHealth enrollment, improving benefit coverage, upgrading health facilities, deploying health workers, and hospital governance reform. Tables provide specific priorities, targets, and resource allocation for provinces with high numbers or percentages of poor households. The roadmap aims to improve health, especially for the poor and vulnerable in the Philippines.
The document discusses Link ART Centres, which were established to improve access to antiretroviral therapy (ART) for HIV patients by reducing travel burdens. It outlines the concept, objectives, structure, roles and responsibilities of Link ART Centres. The objectives are to integrate ART services into primary/secondary healthcare, build ART treatment capacity at primary levels, and improve adherence by reducing travel costs and time. Link ART Centres are located at primary facilities and provide drugs to stable patients, while more complex cases are referred to nodal ART Centres. The document reviews infrastructure needs, staffing roles, and the expanded "LAC Plus" model.
The document provides information about the CCHP-MH (Certified Correctional Healthcare Professional - Mental Health) certification from the National Commission on Correctional Health Care (NCCHC). The certification recognizes qualified mental health professionals working in correctional settings. It requires a graduate degree, professional licensure, three years of correctional experience, and passing an exam on correctional mental health topics. Maintaining the certification involves annual fees and continuing education requirements. The goal is to promote high standards in correctional mental healthcare and recognize expertise for working in the challenging correctional environment.
This report assesses the introduction of two laparoscopic procedures - laparoscopic inguinal hernia repair (LIHR) and laparoscopic assisted hysterectomy (LAH) - in Australia. Literature reviews found insufficient evidence to determine if the procedures provided clear benefits over open surgery. Surveys of 15 Australian hospitals performing LIHR found a lack of consistency in surgeon training and little prospective audit of clinical outcomes. Similarly for LAH, literature reviews revealed inadequacies in study size and quality of evidence. The case studies highlighted variations in record keeping between hospitals, limiting the conclusions that could be drawn. Overall, the report found a need for higher quality studies to properly evaluate these new laparoscopic procedures.
This document discusses sexually transmitted infections (STIs) in Sudan. It provides data showing high rates of STIs like urethral discharge, vaginal discharge, and genital ulcers in Sudan. It outlines the causes of STIs in Sudan and discusses specific infections like HIV/AIDS, human papillomavirus, and genital ulcers. It also describes Sudan's STI management protocol, services provided at STI centers, and the need to update guidelines and raise awareness about STIs in Sudan and their hidden prevalence.
Starting Your TeleMental Health Program outlines key steps for developing a tele-mental health program, including conducting a needs assessment, establishing policies and procedures, ensuring HIPAA compliance, obtaining proper equipment, providing training to staff, and documenting medical records. Tele-mental health programs allow for the delivery of mental healthcare through videoconferencing technology regardless of patient location. Reimbursement for tele-mental health services varies by state and insurance provider.
This document summarizes Medicare payments for outpatient dialysis services in 2015. It finds that payment adequacy indicators are generally positive, as access to care and quality of care have been maintained or improved in recent years while costs increased modestly. The aggregate Medicare margin for outpatient dialysis facilities in 2013 was 4.3%, and is projected to be 2.4% in 2015. Therefore, the Commission recommends eliminating the update to the outpatient dialysis payment rate for 2016, as payments appear adequate.
- The document discusses trauma centers and their role in providing care to seriously injured patients. It defines trauma centers and describes their classification levels from I to V, with Level I centers providing the highest level of surgical specialties and care.
- The roles and requirements of Levels I-V trauma centers are outlined, including necessary coverage of specialists, transfer agreements, and quality assessment programs. Level I centers provide leadership and research.
- Two levels of pediatric trauma centers (P-I and P-II) are also defined, with Level P-I centers requiring at least two pediatric surgeons and other pediatric specialists.
- The document then discusses components and resources needed for trauma centers in Indonesia, including minimum hospital
The document outlines plans for operationalizing Health and Wellness Centers under Ayushman Bharat to deliver comprehensive primary health care in India. It discusses strengthening existing primary health centers and subcenters to become Health and Wellness Centers that provide preventive, promotive, curative, rehabilitative and palliative care. Key elements include expanding the primary health care workforce through a certificate program for Mid-Level Health Providers, multi-skilling frontline workers, improving infrastructure, ensuring drug and diagnostic availability, developing a robust IT system, and implementing quality standards.
The document discusses universalizing access to primary healthcare in India. It outlines the current healthcare structure and reasons for poor access, including insufficient funding, lack of availability and affordability. It proposes a roadmap to improve the system through measures like increasing infrastructure and availability of resources, improving human resource management, strengthening regulations, and public-private partnerships. The goal is to ensure equitable, affordable and quality healthcare access for all Indians.
ayushmann bharat by Government of India under Modi governmentTusharBansal425676
The document discusses Ayushman Bharat - Health and Wellness Centres (AB-HWCs) and provides information on:
1. AB-HWCs aim to provide comprehensive primary healthcare through an integrated approach and move towards universal health coverage.
2. Key issues discussed include assigning populations to AB-HWCs, strengthening infrastructure, addressing human resource gaps, expanding services, and financial planning.
3. States are encouraged to develop a vision document by December 2019 to comprehensively plan AB-HWC implementation.
Universal Health Coverage (UHC) aims to ensure universal access to healthcare in Tamil Nadu by 2023. The state is transforming all rural and urban primary health centres into Health and Wellness Centres (HWCs) which provide comprehensive primary healthcare services. As of August 2019, over 2000 HWCs have been established across 39 districts utilizing standardized treatment guidelines, healthcare teams, IT systems, diagnostic services and community outreach programs. The hub and spoke laboratory model supports last-mile delivery of diagnostic services at HWCs. Mentoring teams provide clinical audits and tele-consultations to strengthen referrals and continuity of care under UHC.
Telemedicine in Skilled Nursing Facilities by Reza SadeghianReza Sadeghian
This document discusses using telemedicine in skilled nursing facilities to help avoid unnecessary hospitalizations. It finds that two-thirds of nursing home residents are on Medicaid and most are also enrolled in Medicare. These residents frequently experience avoidable hospitalizations, which are expensive and disruptive. The document outlines a study using telemedicine carts equipped with examination tools to help nurse practitioners manage acute changes in residents' conditions and palliative care assessments remotely rather than transferring residents to hospitals unnecessarily. The study found the telemedicine approach helped avoid hospital transfers 60% of the time with estimated cost savings of $396,000.
Sindh provincial acceleration operational plan for MDGs4 &5 june 18, 2014Abdul Rehman Pirzado
This document outlines a provincial acceleration operational plan for achieving Millennium Development Goals 4 and 5 in Sindh, Pakistan from 2013-2015. It summarizes the socio-demographic characteristics of Sindh's population, health indicators, coverage across the continuum of care, proposed sites and process of implementation, interventions, indicators to measure impact and progress, budget requirements, current status and constraints. The plan aims to reduce maternal and child mortality rates through integrated MNCH services, strengthening health information systems, and community interventions delivered by lady health workers and community midwives across Sindh. Barriers to implementation including lack of resources, awareness, and coordination between programs are also discussed.
The Integrated Disease Surveillance Project (IDSP) was launched in 2004 with World Bank assistance to improve disease outbreak detection and response in India. It established a decentralized surveillance system from the national to district levels. Key components include syndromic surveillance, reporting of priority diseases, strengthening laboratories, and using information technology. However, integration with other health programs remains a challenge. Issues exist at the national, state, and district levels including staff shortages, lack of coordination, and underreporting that weaken disease surveillance. While IDSP established an important framework, ongoing efforts are needed for it to reach its full potential.
This document summarizes a project conducted by Cancer Care Ontario to engage regional cancer centre healthcare professionals in identifying important cancer surveillance information. Over 400 participants provided input through workshops and an online survey. They generated over 1,500 indicator concepts, which were distilled down to 118 final concepts. These concepts spanned the cancer continuum from prevention to end-of-life care. The indicators could be used both locally for populations as well as provincially through Cancer Care Ontario reporting. The engagement of healthcare professionals from across the province helped identify key cancer surveillance data needs.
Sri Lanka is well known for its better health indices when compared with other countries in South Asia. However, the burdens of Non Communicable Diseases (NCD) have increased rapidly during last two decades. NCDs such as neoplasms, cardiovascular diseases, diabetes and chronic respiratory pathologies recorded were 10.2, 41.7, 13.3 (related deaths per 100,000 population) respectively during the year 1990. However by 2009, the same NCDs recorded 18.5, 60.6, and 21.9 (related deaths per 100,000 populations) respectively according to the Annual Health Bullatin released by the Medical Statistics Unit - Ministry of Healthcare & Nutrition [1]. Most communicable diseases have been controlled successfully (e.g. Malaria, Polio) several infective diseases, such as, Tuberculosis and Leprosy has been re-emerged due to various reasons. Dengue is also still remains a major crisis in Sri Lankan health sector.
Health Information Systems have been shown an integral role in health systems in facing double burden of disease, specially quantifying the cost of care. Also, Health Information Systems are one of WHO's 6 building blocks for health system strengthening. This work investigates the Sri Lankan scenario empirically based on selected electronic health information systems to evaluate the effect of reducing uncertainty and promoting coordination in the clinical care pathway.
Paper presentation on Rural Health Practitioners at GPH, Sri-Lanka 2014Dr. Suchitra Lisam
The presentation is about the study carried out in Assam in 2013 to assess the role of Rural Health Practitioners (RHPs) towards augmenting health care service delivery at health centers.
Essential Newborn Care, Examination of Newborn, Early Recognition of Danger Signs,
Stabilization and Referral, Counseling of Mother for breastfeeding, Warmth, Care of Baby,
Immunization, Post partum Care and Family planning methods
This document discusses India's health expenditure and initiatives by the Ministry of Health and Family Welfare. It provides data showing that India ranks low globally in terms of government and out-of-pocket health expenditures as percentages of total health expenditure. The National Health Policy 2017 aims to increase public health expenditure to 2.5% of GDP by 2025. Key programs discussed include Ayushman Bharat, which aims to deliver comprehensive primary healthcare through Health and Wellness Centers and provide financial protection through Pradhan Mantri Jan Arogya Yojana. The National Health Mission supports primary healthcare services and programs related to reproductive, maternal, child, adolescent health as well as control of communicable diseases.
Clinical Data Quality in Mozambique: A Comparative ExerciseJSI
Presentation for the American Public Health Association & Expo in Atlanta, GA. November 2017:
Ensuring that quality data are collected and reported to the Ministry of Health (MOH) is a priority in Mozambique as it is the foundation for the provision of quality health services. Since 2014, the Strategic Information Project in Mozambique (M-SIP) has provided technical assistance to MOH to conduct annual rounds of data quality assessments (DQA) in each province. Seven indicators were selected as part of the national DQA strategy. Each DQA had a quantitative and a system assessment component. The quantitative component includes tracing and verification of reported data, where recounted data is compared to data reported at three levels: health facility (HF), district, and province. M-SIP conducted all DQAs using the same methodology making the results comparable. After three consecutive national rounds, there is a clear trend of improvement, despite deviations remaining high. The regular, reinforcing nature of this activity and consistency of HF recommendations has had a positive impact on the data quality and results of the assessments. For example, the overall national deviation of the “patients active in ART” indicator decreased from 37% to 22% over the three-year period. The successful implementation of the DQA activity, as well as its unique, inclusive approach to promoting MOH ownership, has resulted in MOH recognition—at all levels—that DQA activities are crucial to future success. The M-SIP and MOH teams are now developing a more methodological approach to MOH staff empowerment, enabling fully independent MOH implementation of this activity while continuing to improve the quality of data.
The document provides information about the National Urban Health Mission (NUHM) in India. Some key points:
- NUHM was approved in 2013 to address health issues of urban poor populations as urban populations are growing rapidly in India.
- It covers cities/towns with populations over 50,000 and district/state headquarters over 30,000. Over 5,000 urban primary health centers (UPHCs) and 180 urban community health centers (U-CHCs) have been added since NUHM.
- The service delivery mechanism includes UPHCs for every 50,000 urban population, U-CHCs for populations over 100,000, and outreach sessions. Accredited Social Health Activists (
The document discusses data management in Uganda's health sector. It notes that data, both electronic and paper-based, is governed by technical working groups for health information systems and eHealth. Data is collected from communities, health facilities, and aggregated and transmitted to the national level. Access to the data is managed at the national and district levels. The Ministry of Health also uses a health service delivery hotline to collect community complaints and feedback to improve services. On a quarterly basis, data is cleaned, analyzed, and shared through reports to review health sector performance and inform efforts to harmonize health information systems.
The document discusses quality improvement in rural healthcare settings in Virginia. It recommends establishing a Rural Health Performance and Quality Advisory Council to support quality improvement efforts. Several databases and quality measures are mentioned that could help measure progress, identify health inequities, and increase transparency of quality data. The document also discusses survey results showing areas for improvement in rural hospitals, such as staffing, handoffs, and nonpunitive responses to errors. It proposes expanding membership of the Advisory Council to include more stakeholders and continue quality planning efforts.
The document discusses quality improvement in rural healthcare settings in Virginia. It recommends establishing a Rural Health Performance and Quality Advisory Council to support quality improvement efforts. Several databases and quality measures are mentioned that could help measure progress, identify health inequities, and increase transparency of quality data. The document also discusses survey results showing areas for improvement in rural hospitals, such as staffing, handoffs, and nonpunitive responses to errors. It proposes expanding membership of the Advisory Council to include more stakeholders and continue planning quality improvement initiatives.
NATIONAL HEALTH MISSION: ACHIEVEMENTS & CHALLENGESPragyan Parija
The document summarizes the achievements and challenges of India's National Health Mission. It discusses improvements in key health indicators like MMR, IMR and TFR. However, it notes ongoing challenges like inadequate infrastructure and human resources, as well as issues achieving targets for communicable and non-communicable disease control programs. The document provides an overview of the goals and components of the National Health Mission while highlighting gaps that still need to be addressed.
Transitioning from reaching every district to reaching every communityJSI
This presentation focuses on learning acquired from the last 2-3 year effort in 8 districts across both Uganda and Ethiopia and REC-QI potential to add to the arsenal of RI strengthening tools. REC is now the number one approach to reaching hard-to-reach health facilities. Adding Quality improvement to RED/REC will combine the “what” (RED/REC) and “how” (QI) factors to strengthening for sustainable improvement in coverage and brings together all EPI stakeholders. In addition, by working at both national and lower level, REC-QI encourages peer learning and incorporation of innovations into national policies, guidelines, and protocols.
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2. District CRM Teams
Sundargarh Rayagada
Raghuram Rao Padmini Kashyap
Ram Chahar A. C. Mallick
Mandar Randive Vimlesh Purohit
Suchi Khanna Santosh Ojha
Haifa Thaha Debajit Bora
Rishita Mukherjee T Ankitha
Anil M H Vipin Garg
Shweta Singh Shailey Gokhale
Debasis Swain Subrat Panda
3. Key Indicators
MMR (SRS) IMR Trend (Census & SRS Data)
75
61
46
38
78
63
48
39
55
43
35
30
18
28
38
48
58
68
78
88
2005 2010 2015 2019
Odisha Total Odisha Rural Odisha Urban
S. No. Indicators Odisha India
1 Neo Natal Mortality Rate (NNMR)1 31 23
2 Under Five Mortality Rate (U5MR)1 44 36
3 Still Birth Rate2 10 4
4 Total Fertility Rate (TFR)2 1.9 2.2
5 Sex Ratio at Birth2 933 899
6 TB Annualized total case notification rate (%) 114 163
7 Leprosy Prevalence Rate / 10,000 population 1.45 0.61
4. Top 5 causes & risks of DALYs, 1990-2019
S. No. 1990 2019
Causes of DALYs4
1 Diarrhoeal Diseases 1. Diarrhoeal Diseases
2 Lower respiratory care infection 2. Malaria
3 Drug Susceptible TB 3. Drug Susceptible TB
4 Neonatal preterm Birth 4. Lower respiratory care infection
5 Malaria 5. Ischemic Heart Disease
Causes of Risks4
1 Low Birth weight 1. Low Birth weight
2 Child wasting 2. High Systolic Blood pressure
3 Short gestation 3. Short gestation
4 Unsafe water source 4. High fasting plasma glucose
5 Household air pollution from solid fuels 5. Unsafe water source
Source: 1. Sample Registration Survey (SRS) Bulletin 2018; 2. Registrar General of India (RGI) Statistical Report (SRS) 2018 & 2019; 3.QPR NHM MIS Report [Status as on
01.03.2020 & recent 31.12.2020; 4. Institute for Health Metrics and Evaluation (IHME). Findings from the Global Burden of Disease Study 2017. Seattle, WA: IHME, 2018
8. Good Practices
Matrujyoti scheme – ensured quality antenatal care including Ultrasonography for
mothers
Advanced Rehabilitation centre and Integrated Physiotherapy Unit
Focus on service support (HR, referral and infrastructure upgradation) through DMF
Daman initiative for combating Malaria
Monthly SNCU performance-based incentive
9. ToR – I (Primary Care)
Checkpoints Status
Conversion of HWCs and
Operationalizing for 12 packages
of Comprehensive Primary Health
Care Services (CPHC), both urban
& rural areas
• Odisha has operationalized 1660 / 5021 AB-HWCs for FY 21-
22 (SHC-3636; PHC-1288 and UPHC-97)
• 7 / 12 packages of CPHC services are being provided
currently and training for expanded package is in the
pipeline
• NCD screening is limited to Hypertension and DM in most
of the facilities
Health promotion and wellness
initiatives
• Wellness calendar is followed in most of the facilities.
However, scope of improvement in wellness activities
10. ToR – I (Primary Care)
Checkpoints Status
Covid 19 – preparedness, response and
challenges with reference to ECRP I and II
• Procurement of 6 bedded prefab units for PHCs is under tendering
• Sites for Pediatric ICUs are identified and procurements ongoing
IT applications in CP/CPHC - status,
utilization and challenges
• NCD-HWC app, AB-HWC portal & ANMOL functional at SHC-HWC. MO-
NCD portal used in PHC&UPHC-HWC.
• Nikshay and IHIP portal not operationalized
• Challenge of internet connectivity in hard-to-reach areas and
application limitations
Referral mechanism – linkages to other levels
of care
• Continuum of care – challenges of direct referrals to DH and downward
referrals
• Telemedicine services utilized primarily for routine illnesses, potential
challenges of overloading the hub and need for sub hubs
• Tele-radiology services restricted to CT scan
11. ToR – II (Secondary Care)
Checkpoints Status
Availability of critical care services and
operational status of critical care areas :
Emergency, SNCU, ICU, OT, LDR, etc at FRUs-
CHC/SDH/DH (both in urban & rural areas)
• Emergency services and critical care services were largely available
at DH level due to lack of specialists at CHC/SDC level facilities
• High LAMA and referral rate for all cases
• Large physical distances between secondary care and tertiary care
services
Diagnostics : Availability, DVDMS / other IT
appn for management, Quality control,
BMMP
• E-Niramaya operational till CHC and in few PHCs
• Diagnostics not completely available as per Free Drugs guidelines
• BMMP outsourced and operational
• State initiative (Nirmal Yojana) for cleanliness and security
operational
Medicines • EDL notified and displayed in all the facilities. Prescription audits
conducted
• Stock outs and expired drugs were observed in few facilities
• Untied funds given to facilities for local purchase as required
12. ToR – II (Secondary Care)
Checkpoints Status
Referral Transport System (Ambulances) Ambulance services including additional Patient Transport Vehicles &
Ambulances from DMF – service optimal and supplemented by DMF
funds
DH Strengthening (including skill based in-
service training - LSAS & CEmONC)
LSAS and CEmONC trained HR – shortages observed
Covid 19 – preparedness, response and
challenges with reference to ECRP I and II
Sites finalized for 50 bedded Prefab Units, Pediatric ICU under
operationalization, RTPCR labs established and LMO under tender
process.
PSA and Medical Gas Pipeline functional
PM-JAY – uptake in public institutions and
challenges
State has its own Insurance scheme named Biju Swasthya Kalyan
Yojana covering OPD and IPD
Central PSU hospitals not fully empaneled
13. ToR – III (Cross Cutting themes)
Checkpoints Status
Quality Improvement • Majority Urban PHCs have been ISO certified
• Existing coverage of NQAS and LaQshya certification of facilities is limited
• Biomedical Waste Management systems in place in all facilities;
• Infection control practices can be further strengthened in health facility,
ambulances and community
• Blood banks were functional as per norms and collection adequate, however
component separation is limited
• There is persistent trend of MP and HBsAg of donated blood last 3 years and higher
detection of Syphilis in 2021
14. ToR – III (Cross Cutting themes)
Checkpoints Status
Human Resource for
Health
• Enabling HR policy with incentive for specialists, however paucity of specialists at
CHC/SDH level facilities
• NHM HR continue to be repurposed for COVID-19 duties
Indian Public Health
Standards
• Gaps in compliance to IPHS standards at all levels
Legal framework, and
accountability
• PCPNDT, MTP, CEA, BMW Rules, Drugs & Cosmetic Act notified, however
implementation needs to be strengthened
Financing • 2nd tranche is yet to be released as utilization is less than 50%
• Good systems for PPP contracting and payments
15. Community Processes &
Comprehensive Primary Health Care
• PHC HWC functional and SHC HWC are work in progress
• Standardized branding for HWCs
• Basic services for RMNCAH, NCD (HT & DM), TB, Leprosy and Malaria provided, UPHCs are providing
comprehensive services
• Referrals for Continuum of Care directly to DH/SDH level. Limited post treatment follow-up for downward
referrals of CBAC
• Wellness activities can be strengthened
• Good coordination with Panchayat, SHGs and ICDS dept including ASHAs, ANMs – Gaon Kalyan Samiti
(GKS), MAS, JAS
• No backlog of ASHA Payments (On an average INR 4500 - 6000 month earned by ASHAs)
• Gaps in infrastructure (electricity, water supply, boundary wall) observed at the HWCs
16. RMNCAH+N - Infrastructure and service
delivery
• Positive response for maternity services, well equipped LR/OTs, MDR and CDR functional and no stock outs
observed for essential drugs in LR. Anti-D and HB IG are available at district
• Under-utilization and operationalization of subdistrict delivery points
• Well functional and operational referral services in both districts - High referrals from peripheral facilities in
Sundergarh to DHH & RGH
• Communication challenges in hard-to-reach areas
• Overcrowding at RGH resulting in early discharge of women - lack of PNC beds
• Need for Obst HDUs and FRUs strategically covering the districts
• Gaps in quality maintenance despite national certification (LaQshya) at DHH-Rayagada, Sundargarh State
certifications pending (DHH/RGH)
• Vehicle not being provided to beneficiaries for drop back under JSSK instead Rs 500/- given (<50% uptake due
to early discharge)
17. RMNCAH+N - Clinical skills, training and
competency
OBSERVATIONS
• Trained staff available at DH level facilities, adhering clinical protocols and documentation practices.
• Limitations in Line listing for high-risk pregnancies & follow-up actions – sub-optimal PMSMA utilization.
• Sub-optimal clinical knowledge and practices with training gaps observed in sub district staff in
Sundargarh.
• Use of Inj. Tramadol during intrapartum and post partum period at Rayagada.
• High percentage of admissions from perinatal asphyxia indicative of poor intrapartum care practices.
18. RMNCAH+N
Newborn and Child health
• SNCUs functional in both districts, provision
of Family participatory care available
• Vacancy in SNCU-Rayagada for MOs, DMF
support is supplementing specialist services
in Sundargarh
• SNCU inborn admissions high (60%), esp.
from birth asphyxia – quality of intrapartum
services low
• High OOPE reported by users for newborn
care services including referral to tertiary
centers (Sundargarh)
Immunization
• Good knowledge of ANMs on vaccination schedule and
placement of vaccines
• ILRs maintained in good condition at most of the sites
• e-VIN not fully functional - indent of vaccine, logistics and
temperature monitoring gaps observed
RKSK services
• Activities of Health & Wellness Ambassador and Health
Messenger under School Health Program were observed at
Rayagada
• Shraddha clinics functional at both districts, however low
footfalls and utilization
19. RMNCAH+N
RBSK and DEIC
• Established services, working well in both districts
• HR gaps observed in Rayagada (Paediatrician & Psychiatrist)
• Pre-discharge screening of SNCU admissions being done at DEICs
NRC
• Antibiotics universally prescribed to all admissions
• Follow up and tracking done telephonically
• Service delivery satisfactory
• Low footfall in NRC due to COVID-19
Family
Planning
• Limited availability and gaps in roll out of DMPA, Chaya
• PPIUCD services – good uptake in both districts
• Limited post LSCS sterilization services (RGH), fixed Day services not fully operational yet
• Poor follow up of users for contraceptive adherence
• Good NSV and PPIUCD services in Rayagada district. Service available even at few SC-HWC.
20. Non-Communicable Diseases
• District NCD clinic functional
• Geriatric ward established and functional at DHHs
• Dialysis Unit in PPP mode functional at district level
• Operational ecosystem for physiotherapy established at different levels of
facilities.
• Planned initiative of ASTHA Gruha for People With Mental Illness (PWMI) in
Sundargarh
21. Non-Communicable Diseases
NPCDCS
• Screening services are limited to
diabetes and hypertension at most of
the observed sites.
• Screening for common cancers was
lacking at most of the facilities
• Lack of follow up and tracking
mechanism for diagnosed cases
• Approx. 20% of dialysis patients were
infected with HCV but not yet linked
to Hepatitis treatment center
(Rayagada).
NOHP
• Challenges in service delivery due to inadequate infrastructure
(dental chairs, etc.) though Human Resource in place.
NMHP
• Need for intensive training of ASHAs in detection and
management- follow-up of care lacking
• Community awareness activities are limited
• Services are restricted primarily at district level and focused on
treatment.
• Non-availability of drugs for sub-district level for follow-up cases
and not linked to telemedicine
• Lack of recovery/ healing plan of existing patients
22. NTEP
Public sector Private Sector
PTER is increased to 1725/L due to implementation of
active case findings through different campaign modes
during 2020 & 2021, however concerns on quality of
sample collected (>50% saliva samples)
Enforcement issues related to mandatory notification
and schedule H1 ( more focus on chemists as
compared to doctors)
Molecular Diagnostics available at District HQ level only
except in 3 districts (Sundargarh, Mayurbhanj and
Ganjam) where available upto block level.
Incomplete mapping of the private health facilities
The referral from general OPDs for TB testing is
significantly below bench mark of 5% & Low cross
referral from other national programs ( like HWCs, NCD
clinics, NRC, ICTC,ART etc (< 1%)
Teething issues with PPSA and the operation model (
field strategy and HR)
Strengthening of Sputum Transportation mechanism
23. Other Communicable Diseases
Malaria
• Test Positive Rate, API and death rate has
significantly decreased since last 5 years.
NVHCP
• Diagnostic and treatment services has been
initiated.
• Screening & linkage of PW for hepatitis B need
to be strengthened
Filaria
• High MF Rate (>1%)
• Districts are under MDA ( old and new)
Dengue
• Major outbreak observed. RRT have been
constituted and responded to control
outbreaks.
NACP
• At several HFs HWs are not aware of PEP
protocol and availability
• Late diagnosis and delayed initiation of ART
due to limited access to ART center ( distance)
observed in one of the district.
24. COVID 19 Vaccination
83
42
71
33
77
33
0
50
100
1st Dose (%) 2nd Dose (%)
COVERAGE
State Sundergarh Rayagada
Observation Recommendation
• Vaccination sites well maintained with appropriate
display of IEC materials, however challenges in
getting a slot in CoWin for 2nd dose reported
Need to improve second dose coverage through
• Focused monitoring for coverage of the campaign
• Training/Retraining of frontline workers on vaccine
hesitancy and ensuring active involvement
• Vaccine coverage of both the districts are below the
state average & Vaccine hesitancy observed in
some pockets
• ‘Har Ghar Dastak’ campaign operational in urban
areas but not much in rural areas
25. Health Finance
• RoPs –Timely disseminated till block level and being used as a guiding document.
• Consolidated ASHA Payment through E-ASHA portal
• Good accounting practices observed (Cash book, Bank reconciliation, fixed assets and staff
register)
• DBT payments coverage is above 80%-JSY, FP, TB schemes, even state sponsored
Sampoorna schemes
• No pendency under State Share and Treasury transfer of GoI funds under NHM & ECRP-II
26. Health Finance
Observations Recommendations
Single Nodal Account: Process started, yet to be
completed
State needs to ensure mapping of PFMS codes and implement SNA
across the districts.
DBT payment is a norm for NHM & State schemes.
However, payments are made monthly leading to delays.
DSC based payments exists only for TB schemes.
1. DBT payments to be made real-time and not monthly.
2. Follow-up actions of failed payments required strengthening.
3. Use of DSC to be ensured for all programmes at all levels
Auditing and internal control mechanisms: In place.
Statutory Audit and Concurrent Auditors appointed.
Timely completion of audit for FY 2020-21 to be ensured.
RKS meetings need to be regularized and their records to
be duly maintained, particularly at the block level.
Minutes of meeting, Signature of competent authorities and ATR of
decisions arrived must be maintained properly.
15th Finance Commission-SLC,DLC constituted, facilities
identified, plan approved by GoI
State to ensure no duplication of activity from various grants viz.
NHM, 15th Finance Commission & PMABHIM grants, DMFF and
ECRP-1 & 2 grants
27. Areas of concern
Delay in funds transfer from State
Treasury to SHS
• Audit Report and Audited UCs from State is yet to
be received for F.Y. 2020-21.
• II Tranche of funds from GoI is pending due to
low expenditure
S. No. Financial
Years
No. of days Average
Delay
(in days)
1 2020-21 0-228 days 58
2 2019-20 5-147 days 64
3 2018-19 6-114 days 51
4 2017-18 8-41 days 21
5 2016-17 13-21 days 17
28. Utilization of Funds
(Rs. In Cr.)
Sr. No. Programmes Outlay (2021-22) Utilization till Sept.2021 % Utilization
1 RCH Flexible Pool 426.63 117.05 27%
2 Health System Strengthening under
NRHM
1,775.32 581.07 33%
3 NUHM Flexible Pool 64.70 21.76 34%
4 Flexible Pool for Communicable
diseases
170.75 39.47 23%
5 Flexible pool for NCDs 87.98 15.26 17%
6 Details of Expenditure under ECRP-
II
789.66 44.28 6%
7 Details of Expenditure under ECRP-I 148.18 146.44 99%
29. Take home message for GoI
Quarterly follow up for ATR of CRM observations
Revision of NRC technical and operational guidelines including budgetary norms
Consider Epidemiology unit at state and district
eVIN operational challenges to be resolved
Option of Aadhar based authentication in addition to DSC for payments
Ambulance norms for difficult and hard to reach areas
https://fb.watch/9cgONwgSFV/ -Advanced Rehab Crentre DHH, Sng(ARC)
https://fb.watch/9cjvduqguS/ -Integrated Physiotherapy Unit Sundargarh
https://fb.watch/9cfZ3Q2HtN/ -MWH Video
https://fb.watch/9bT6AAg1iv/ -Mental Health Out-bound Call Centre Video