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Health care delivery system

The health care delivery system in India is comprised of five major sectors - public, private, indigenous systems of medicine, voluntary agencies, and national health programmes. At the central level, the Union Ministry of Health and Family Welfare oversees the country's health administration along with the Directorate General of Health Services and Central Council of Health. The health system is organized at three levels - central, state, and district - with the goal of improving population health, care experiences, and reducing economic burden.

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HEALTH CARE DELIVERY SYSTEM IN INDIA Introduction Health is the birth right of every individual. Today health is considered more than a basic human right; it has become a matter of public concern, national priority and political action. Our health system has traditionally been a disease-oriented system but the current trend is to emphasize health and its promotion. Definition Health: WHO: defined health as “a state of complete physical, mental, social and spiritual well being not merely the absence of disease or infirmity.” WEBSTER: defined health as “ a quality of life resulting from total functioning of the individual that empower him to achieve personally satisfying and socially useful life.” H.S HAYMAN: defined health as “ a state of feeling sound in body, mind, and spirit with sense of reserve power.” Health care services: It is defined as multitude of services rendered to individuals, families or communities by the agents of the health services or professions for the purpose of promoting, maintaining, monitoring or restoring health. Definitions of health care delivery:  Health care delivery system refers to the totality of resources that a population or society distributes in the organization and delivery of health population services. It also includes all personal and public services performed by individuals or institutions for the purpose of maintaining or restoring health. -Stanhope(2001)  It implies the organization, delivery of staffing regulation and quality control. Philosophy of Health Care Delivery System:  Everyone from birth to death is part of the market potential for health care services.  The consumer of health care services is a client and not a customer.  Consumers are less informed about health services than anything else they purchase.  Health care system is unique because it is not a competitive market  Restricted entry in to the health care system.
Goals/Objectives of Health Care Delivery System: 1) To improve the health status of population and the clinical outcomes of care. 2) To improve the experience of care of patients families and communities. 3) To reduce the total economic burden of care and illness. 4) To improve social justice equity in the health status of the population. Principles of Health Care Delivery System: 1. Supports a coordinated, cohesive health-care delivery system. 2. Opposes the concept that fee-for-practice. 3. Supports the concept of prepaid group practice 4. Supports the establishment of community based, community controlled health-care system. 5. Urges an emphasis be placed on development of primary care 6. Emphasizes on quality assurance of the care 7. Supports health care as basic human right for all people. 8. Opposes the accrual of profits by health-care-related industries. Functions of Health Care Delivery System: 1) To provide health services. 2) To raise and pool the resources accessible to pay for health care. 3) To generate human and physical sources that makes the delivery service possible. 4) To set and enforce rules of the game and provide strategic direction for all the different players involved. Characters of Health Care Delivery System 1) Orientation towards health. 2) Population perspectives. 3) Intensive use of information. 4) Focus on consumer. 5) Knowledge of treatment outcome. 6) Constrained resources
HEALTH CARE DELIVERY SYSTEM IN INDIA In India it is represented by five major sectors or agencies which differ from each other by health technology applied and by the source of fund available. These are: I. PUBLIC HEALTH SECTOR A. Primary Health Care Primary Health Centres, Sub- Centres. B. Hospital/Health Centres Community Health Centres, Rural Health Centres, District Hospitals/ District Health Centre, Specialist Hospitals, Teaching Hospitals. C. Health Insurance Schemes Employees State Insurance Central Government Health Scheme D. Other Agencies Defence services, Railways. II. PRIVATE SECTOR A. Private Hospitals, Polyclinics, Nursing Homes and Dispensaries. B. General Practitioners and Clinics. III. INDIGENOUS SYSTEMS OF MEDICINE Ayurveda Sidda Unani Homeopathy Naturopathy Yoga Unregistered practioners IV. VOLUNTARY HEALTH AGENCIES V. NATIONAL HEALTH PROGRAMMES
India is a union of 31 states and 7 Union territories. Under the constitution states are largely independent in matters relating to the delivery of health care to the people. Each State, therefore, as developed its own system of health care delivery, independent of the Central Government. Health system in India has 3 links 1. Central level. 2. State level 3. District level Synoptic view of the health system in India Community Health Centres PHCs Village Health Guide, ASHAs, Trained Dais, Anganwadi Workers People/ Community/ Society/ Villages National level State and Union Territories District Health Organization and Basic Specialities Hospitals Sub- District / Taluk Hospital Sub – Centres
Health administration at the central level The official organs of the health system at the national level consist of 3 units: 1. Union Ministry of Health and Family Welfare. 2. The Directorate General of Health Services. 3. The Central Council of Health and Family Welfare. I. Union Ministry of Health and Family Welfare Organisation The Union Ministry of Health and Family Welfare is headed by a Cabinet Minister, a Minister of State, and a Deputy Health Minister. These are political appointment and have dual role to serve political as well as administrative responsibilities for health. Currently the union health ministry has the following departments: 1. Department of Health 2. Department of Family Welfare 3. Department of Indian System of Medicine and Homoeopathy a. Department of Health It is headed by a secretary to the Government of India as its executive head, assisted by joint secretaries, deputy secretaries, and a large administrative staff. Functions This includes the Union list and the Concurrent list. (Article 246 of the Constitution of India) Union list 1. International health relations and administration of port-quarantine 2. Administration of central health institutes such as All India Institute of Hygiene and Public Health, Kolkata; National Institute for Control of Communicable Diseases, Delhi, etc. 3. Promotion of research through research centres and other bodies. 4. Regulation and development of medical, nursing and other allied health professions. 5. Establishment and maintenance of drug standards. 6. Census, and collection and publication of other statistical data.
7. Immigration and emigration. 8. Regulation of labour in the working of mines and oil fields. Concurrent list The functions listed under the concurrent list are the responsibility of both the union and state governments. The centre and states have simultaneous powers of legislation. They are as follows: 1. Prevention of extension of communicable diseases from one unit to another. 2. Prevention of adulteration of food stuffs. 3. Control of drugs and poisons. 4. Vital statistics. 5. Labour welfare. 6. Ports other than major. 7. Economic and social health planning 8. Population control and family planning. Department of Family Welfare It was created in 1966 within the Ministry of Health and Family Welfare. The secretary to the Government of India in the Ministry of Health and Family Welfare is in overall charge of the Department of Family Welfare. He is assisted by an additional secretary and commissioner, and one joint secretary. The following divisions are functioning in the department of family welfare. 1. Programme appraisal and special scheme 2. Technical operations: looks after all components of the technical programme viz. Sterilization/IUD/Nirodh, post partum, maternal and child health, UPI, etc. 3. Maternal and child health 4. Evaluation and intelligence: helps in planning, monitoring and evaluating the programme performance and coordinates demographic research. 5. Nirodh marketing supply/ distribution.
Functions a. To organize family welfare programme through family welfare centres. b. To create an atmosphere of social acceptance of the programme and to support all voluntary organizations interested in the programme. c. To educate every individual to develop a conviction that a small family size is valuable and to popularize appropriate and acceptable method of family planning d. To disseminate the knowledge on the practice of family planning as widely as possible and to provide service agencies nearest to the community
ORGANISATIONAL STRUCTURE OF THE HEALTH AND SERVICES AT CENTRAL LEVEL ADNL. DIR. A.V ADNL. DIR. (P) ADNL. DIR. (PH) ADNL. DIR. (M) DDA(C&B) DD (CBHI) DDG(P) DDG(M) DDA(G) DDG(RH) ADG(M) ADMIN SECTION DDG(PH) DG(NCD) ADMN.STAFF DDA(CGHS) ADG(ME) DDA(C&B) NSG ADV DY.DIR(LIB) ADG(OPTH) DIR(CGHS) ADG(CGHS) DDA(CGHS) CHIEFARCHT DDG(STORES) MINISTRY OF HEALTH AND FAMILY WELFARE CENTRAL COUNCIL OF HEALTH CABINET MINISTERS POLICY MAKING AND LEGISLATION DEPARTMENT OF HEALTH DEPARTMENT OF FAMILY WELFARE SECRETARYTO GOVERNMENT DIRECTOR GENERAL OF HEALTH SERVICE
DIRECTOR A.V - Director Audio-Visual Aids. DDG (P) - Deputy director general planning. ADNL.DIR. (PH) - Additional Director Public Health. ADNL.DIR. (M) - Additional Director Medicine. DDA (C&B) - Deputy director in administration communication and Broad casting. DDA (G) - Deputy Director in Administration General. ADMIN - Administration. DIR (CBHI) - Director of Central Bureau of Health Institute. DDG (RH) - Deputy Director General Rural Health. DDG (PH) - Deputy Director General Public Health. DDG (M) - Deputy Director General Medicine. ADG (M) - Additional Deputy General Medicine. DG (NCD) - Director General National Communicable Diseases. DDA (CGHS) - Deputy Director of Administrative Central Government Health Service. ADG (ME) - Additional Director General Medical Education. NSG ADV - Nursing Advisor. DY.DIR (LIB) - Deputy Director in Library Science. ADG (OPTH) - Additional Director General Opthalmology. CHIEF ARCHT - Chief Architect.
UNION MINISTRY OF HEALTH AND FAMILY WELFARE CABINET MINISTER HEADED BY MINISTER OF STATE DEPUTY HEALTH MINISTER UNIONMINISTRYOF HEALTH AND FAMILYWELFARE DEPARTEMENT OF HEALTH DEPARTEMENT OF FAMILY WELFARE SECRETARY TO GOVT. OF INDIA ( EXECUTIVE HEAD) SECRETARY TO GOVT. OF INDIA (MINISTRY OF HEALTH AND FAMILY WELFARE) JOINT SECRETARIES ADDITIONAL SECRETARY AND COMMISSIONER (FAMILY WELFARE) DEPUTY SECRETARIES JOINT SECRETARY - 1 LARGE ADMINISTRATIVE STAFF DEPUTY SECRETARIES LARGE ADMINISTRATIVE STAFF DEPARTMENT OF ISM& H SECRETARY TO GOVT. OF INDIA JOINT SECRETARIES DEPUTY SECRETARIES LARGE ADMINISTRATIVE STAFF
3. The department of Indian system of medicine and homeopathy It was established in March 1995 and had continued to make steady progress. Emphasis was on implementation of the various schemes introduced such as education, standardization of drugs, enhancement of availability of raw materials, research and development, information, education and communication and involvement of ISM and Homeopathy in national health care. Most of the functions of this ministry are implemented through an autonomous organization called DGHS. II. Directorate General of Health Services Organisation The DGHS is the principal adviser to the Union Government in both medical and public health matters. He is assisted by a team of deputies and a large administrative staff. The Directorate comprises of three main units: i. Medical care and hospitals ii. Public health iii. General administration Functions General functions: 1. The general functions are surveys, planning, coordination, programming and appraisal of all health matters in the country. Specific functions 1. International health relations and quarantine All the major ports in the country and international airports are directly controlled by Directorate General of Health Services. All matters relating to obtaining assistance from International agencies and the coordination of their activities in the country are undertaken by Directorate General of Health Services. 2. Control of drug standards The Drugs Control Organization is a part of DGHS. Its primary function is to lay down and enforce standards and control of the manufacture and distribution of drugs through both Central and State Government Officers. It also has the powers to test the quality of the imported drugs. 3. Medical store depot
The union government runs medical store depots at Mumbai, Chennai, and Kolkata etc. These depots supply the civil medical requirements of the Central and State Governments. The Medical Stores Organization endeavour to ensure the highest quality, cheaper bargain and prompt supplies. 4. Post graduate training The DGHS is responsible for the administration of the national institutes. Such as All India Institute of Hygiene and Public Health at Kolkata, National Institute of Mental Health Science at Bangalore etc. 5. Medical education The DGHS is directly in charge of the following medical colleges in India; the Lady Hardinge, the Maulana Azad and the medical colleges at Pondicherry and Goa and many medical colleges in country are guided and supported by the centre. 6. Medical research The council plays a significant role in aiding, promoting and coordinating scientific research on human diseases, their causation, prevention and cure. The research work is done through the councils several permanent research institutes, research units, field surveys etc. It maintains Cancer Research Centre, Tuberculosis Chemotherapy Centre at Chennai. 7. Central government health scheme 8. National health programmes The various health programmes for the eradication of the malaria and for the control of tuberculosis, filaria, leprosy, AIDS and other communicable diseases are going on. The DGHS plays a very important role in planning, guiding and coordinating all the national health programmes in the country. 9. Central health education bureau An outstanding activity of bureau is the preparation of education material for creating health awareness among the people. 10. Health statistics The DGHS is responsible for maintenance of statistics regarding health. 11. National medical library The central medical library of DGHS was started in 1966, to help in advancement of medical health and related sciences by collection, dissemination, and exchange of information.
DIRECTORATE GENERAL OF HEALTH SERVICES (DGHS) Organization: PRINCIPALADVISER TO UNION GOVERNMENT DIRECTORATE GENERAL OF HEALTH SERVICES DIRECTOR GENERAL OF HEALTH SERVICES ADDITIONAL DIRECTOR GENERAL OF HEALTH SERVICE TEAM OF DEPUTIES LARGE ADMINISTRATIVE STAFFS MEDICAL AND PUBLIC HEALTH MATTERS
III. Central Council of Health The Central Council of Health was set up by a Presidential Order on August 9, 1952, under Article 263 of the Constitution of India for promoting coordinated and concerted action between the centre and the states in the implementation of all the programmes and measures pertaining to the health of the nation. The Union Health Minister is the chairman and the state health ministers are the members. Functions 1. To consider and recommend broad outlines of policy in regard to matters concerning health in all its aspects such as the provision of remedial and preventive care, environmental hygiene, nutrition, health education and the promotion of facilities for training and research. 2. To make proposals for legislation in fields of activity related to medical and public health matters and to lay down the pattern of development for the country as a whole. 3. To make recommendations to the Central Government regarding distribution of available grants-in-aid for health purposes to the states and to review periodically the work accomplished in different areas through the utilisation of these grants-in-aid. 4. To establish any organisation or organisations invested with appropriate functions for promoting and maintaining cooperation between the Central and State Health administrations.
AT THE STATE LEVEL Historically, the first milestone in the state health administration was the year 1919, when the states (provinces) obtained autonomy, under the Montague-Chelmsford reforms, from the central Government in matters of public health. By 1921-22, all the states had created some form of public health organisation. The Government of India Act, 1935 gave further autonomy to the states. The state is the ultimate authority responsible for health services operating within its jurisdiction. State health administration At present there are 31 states in India, with each state having its own health administration. In all the states, the management sector comprises the state ministry of Health and a Directorate of Health. 1. State Ministry of Health The State Ministry of Health is headed by a Minister of Health and FW and a Deputy Minister of Health and FW. In some states, the Health Minister is also in charge of other portfolios. The Health secretariat is the official organ of the State Ministry of Health and is headed by a Secretary who is assisted by Deputy Secretaries, and a large administrative staff. The major functions which are performed by the secretariat which includes the following  Formulation, review, and modification of policy outlines.  Execution of policies programmes etc.  Coordination with government of India and other state governments.  Control of smooth and efficient functioning of administrative machinery.
ORGANIZATION PATTERN AT STATE LEVEL M.of H&FW M. of M.E H. SECRETARY M.E SECRETARY STATE HEALTH COUNCIL H.COMMISSIONER STATE POLICY MAKING LEGISLATION&RECORDING DSIH&FW DH&FWS D ofH.S (CMD) AUTO INS. DME RGUHS AD RCH AD CMD AD AIDS AD PHC LOGISTIC OFFICER JD FW RCH R R JD CMD JD HET JD TB JD H&P JD LEP JD M DD TB DD H&P DD LEP HFW TC(5) DTC(24) DD FW LHV TC(4) TC ANM TC(24) ADNS(2) MC(5) TH(14) DC(1) Nsg.C(4) Nsg.S(11) PMB(1) JD LAB DD M DD PHA
M .of H&FW - Ministry of Health and Family Welfare. M.E - Medical Education. DSIH - Director of State Institute of Health. DH&FWS - Director of Health and Family Welfare Service. DHS (CMD) - Director Health System Communicable Diseases. HFW TC - Health and Family Welfare Training Centres. DTC - District Training Centres. AD - Additional Director. JD - Joint Director. RCH - Reproductive and Child Health. CMD - Communicable Diseases. AIDS - Acquired Immuno Deficiency Syndrome. PHC - Primary Health Centre. HET - Health Education Training. AUTO INS - Autonomous Institutions. RGUHS - Rajiv Gandhi University of Health Sciences. MC - Medical Colleges. TH - Teaching Hospitals. DC - Dental Colleges. PMB - Para Medical Board. ADNS - Additional Director of Nursing Services. LHV - Lady Health Visitor.
2. State Health Directorate The Director of Health Services is the chief technical adviser to the state Government on all matters relating to medicine and public health. He is also responsible for the organization and direction of all health activities. The Director of Health and Family Welfare is assisted by a suitable number of deputies and assistants. The Deputy and Assistant Directors of Health may be of two types –  Regional  Functional. The regional directors inspect all the branches of public health within their jurisdiction, irrespective of their specialty. The functional directors are usually specialists in a particular branch of public health such as mother and child health, family planning, nutrition, tuberculosis, leprosy, health education, etc. Responsibilities 1. It studies in depth the health problems and needs in the state and plans schemes to solve them. 2. Provide curative and preventive services. 3. Provision for control of milk and food sanitation. 4. Assumes total responsibility for taking steps in prevention of outbreak of communicable diseases. 5. Establishment and maintenance of central laboratories for preparation of vaccines. 6. Promotion of health education. 7. Promotion of health programmes such as family planning and school health. 8. Recruitment of personnel for rural health services. 9. Planning and carrying out surveys in relation to nutrition, health education etc. 10. Collection, tabulation and publication of vital statistics. 11. Establishing training courses for health personnel and formulating job descriptions. Eg; for health worker, sanitary inspector. 12. Coordination of all health services with other ministeries of state such as minister of education, agriculture with the central health ministry and voluntary agencies.
AT THE DISTRICT LEVEL The district is the most crucial level in the administration and implementation of medical /health services. At the district level there is a district medical and health officer or CMO who is overall Subdivisions i. Tehsils (talukas) ii. Community development blocks iii. Municipalities and corporations iv. Villages v. Panchayaths Most of the districts in India are divided into two or more subdivisions, each in charge of an assistant collector or sub-collector. Each division is again divided into tehsils in charge of a Tehsildar. A tehsil usually comprises between 200 and 600 villages. Finally, there are the village panchayaths, which are institutions of rural local self-government. The urban areas of the district are organised into the following local self-government: o Town area committee – 5,000 – 10,000 o Municipal boards – 10,000 – 2,00,000 o Corporations – population above 2,00,000. The town area committees are like panchayaths. They provide sanitary services. The municipal boards are headed by a chairman/president, elected usually by the members. Corporations are headed by mayors. The councilors are elected from different wards of the city. The executive agency includes the commissioner, the secretary, the engineer, and the health officer. The activities are similar to those of the municipalities but on a much wider scale.
HEALTH ORGANIZATION AT DISRICT LEVEL HEALTH MINSTER HEALTH SECRETARY DIRECTOR OF H&FW DISTRICT COMMISSIONER DFWO DISTRICT H.O DISTRICT M.SDISTRICT H.O DNO NO PHN SENIOR HA M&F JUNIOR HA M&F TD/CHV/AWW DLO DMO NSG SUPNT WARD SISTER STAFF NURSES ANM DTO
DHO - District Health Officer. DMS - District Medical Superintendent. DFWO - District Family Welfare Officer. DLO - District Leprosy Officer. DMO - District Medical Officer. DTO - District Tuberculosis Officer. DNO - District Nursing Officer. PHN - District Public Health Nurse. HA M&F - Health Assistant Male and Female. TD - Trained Dias. CHV - Community Health Visitor. AWW - Anganwadi Workers. ASHA - Accredited Social Health Activitist. ANM - Auxillary Nurse Midwives. NSG SUPNT - Nursing Superintendent.
PANCHAYATHI RAJ The panchayath Raj is a 3-tier structure of rural local self-government in India linking the villages to the district. The three institutions are: a. Panchayath – at the village level. b. Panchayath samithi – at the block level. c. Zilla parishad – at the district level. The panchayathi Raj institutions are accepted as agencies of public welfare. All development programmes are channelled through these bodies. The panchayathi Raj institutions strengthen democracy at its root and ensure more effective and better participation of the people in the government. At the village level The panchayathi Raj at the village level consists of: 1. The gram sabha 2. The gram panchayath 3. The nyaya panchayath Gram sabha: It is the assembly of all the adults of the village,which meets atleast twice a year. It considers proposals for taxation, discusses the annual programme and elects members of the gram panchayat. Gram panchayat: it is an executive organ of the gram sabha, and an agency for planning and development at the village level. Its strength varies from 15 to 30 and covers 5000 and 15,000 population and more. Members of panchayat hold office for a period of 3 to 4 years.every panchayat has an elected president(sarpanch), a vice president, and a panchayat secretary. The power of panchayat secretary cover the entire field of civic administration, including sanitation and public health and social and economic development of village. Nyaya panchayat: it consists of 5 members from the panchayat. Its functions includesolving of disputes between two groups, two parties etc.
At the block level The panchayathi raj agency at the block level is the panchayath samithi. The panchayathi samithi consists of all sarpanchs of the village panchayaths in the block. The block development officer is the ex-officio secretary of the panchayath samithi. The prime function of the panchayat samiti is the execution of the community development programme in the block. The block development officer and his staff give technical assistance and guidance to the village panchayaths engaged in the development work. At the district level The zilla parishad is the agency of rural local self-government at the district level. The members of the zilla parishad include all leaders of the panchayath samithis in the district, MPs, MLAs of the district, representatives of SC, SD and women, and 2 persons of experience in administration. The collector of the district is a non-voting member. Thus, the membership of the zilla parishad is fairly large varying from 40 to 70. The zilla parishad is primarily supervisory and coordinating body. Its functions and powers vary from state to state. In some states, the zilla parishads are vested with the administrative functions.
Healthcare systems The healthcare system is intended to deliver the healthcare services. It constitutes the management sector and involves the organisational matters. It operates in the context of the socioeconomic and political framework of the country. In India, it is represented by five major sectors and agencies which differ from each other by the health technology applied and by the source of funds for the operation. i. Public health sector ii. Private sectors iii. Indigenous system of medicine iv. Voluntary health agencies v. National health programmes Primary healthcare in India It is a three-tier system of healthcare delivery in rural areas based on the recommendations of the Shrivastav Committee in 1975. 1. Village level: The following schemes are operational at the village level: a. Village health guides scheme b. Training of local dais c. ICDS scheme 2. Sub-centre level: This is the peripheral outpost of the existing health delivery system in rural areas. They are being established on the basis of one sub-centre for every 5000 population in general and one for every 3000 population in hilly tribal and backward areas. Each sub- centre is manned by one male and one female multipurpose health worker. Functions a. Mother and child healthcare b. Family planning c. Immunization d. IUD insertion e. Simple laboratory investigations
3. Primary health centre level: The Bhore committee in 1946 gave the concept of a primary health centre as a basic health unit to provide as close to the people as possible. The Bhore committee aimed at having a health centre to serve a population of 10,000 to 20,000. The national health plan, 1983 proposed reorganization of primary health centres on the basis of one PHC for every 30,000 rural population in the plains, and one PHC for every 20,000 population in hilly, tribal and backward areas for more effective coverage. Functions of the PHC a. Medical care. b. MCH including family planning. c. Safe water supply and basic sanitation. d. Prevention and control of locally endemic diseases. e. Collection and reporting of vital statistics. f. Education about health. g. National health programmes as relevant. h. Referral services. i. Training of health guides, health workers, local dais, and health assistants. j. Basic laboratory services. STAFFING PATTERN: Population in hilly tribal areas : 20,000 Population in rural areas(plain): 30,000 MAIN PHC Medical officers - 2 Pharmacist – 1 Block extension educator – 1 Lab technichian – 1 Community health nurse – 1 Opthalmic assistant – 1 Staff nurse -3 Siddha pharmacist -1 Jr. Health assistant - 6 Group D workers – 4
ADDITIONAL PHC Medical officer - 1 Staff nurse -3 Community health nurse/LHV - 1 Male health assistant -1 Auxillary nurse mid-wife – 6 Jr. Health assistant -3 Pharmacist - 1 SDA/ Computer operator - 1 Driver - 1 Group D worker - 4
ORGANIZATION CHART OF PRIMARY HEALTH CENTER MINISTER OF HEALTH AND FAMILY WELFARE DIRECTOR OF HEALTH AND FAMILY WELFARE SERVICES ZILLA PARISHAD DISTRICT HEALTH OFFICER TALUK HEALTH OFFICER MEDICAL OFFICER FOR HEALTH LADY MEDICAL OFFICER Sr. HAM Sr. HAF BHEO Jr. HAM Jr. HAf LAB TECHNICIAN (1) REFRACTION IST(1) PHARMACIST (1) FDA (1) SDA (1) DRIVER(1) GROUP D OFFICIALS(4)
Sr. HAM : Senior Health Assistant Male Sr. HAF : Senior Health Assistant Female BHEO : Block Extension Officer FDA : First Division Assistant SDA : Second Division Assistant RESPONSIBILITIES OF MALE HEALTH ASSISTANT 1. Conduct survey of the sub centre area and maintain records of all families. 2. Maintain information of all vital events. 3. Participate in malaria control programme. 4. Participate in leprosy control programme. 5. Participate in family planning services by keeping list of eligible couples, provide information on the family planning method and follow up of family planning acceptors. 6. Identifying and reporting of all communicable diseases. 7. Co ordinate the activities with health workers and the block staff. 8. Maintaining records. RESPONSIBILITIES OF FEMALE HEALTH ASSISTANT 1. Registration and care of prenatal, intranatal, and postnatal mothers and children at home. 2. Registration and follow up of all eligible couples. 3. Conduct and supervise deliveries conducted by dais. 4. Immunize pregnant mother and children. 5. Refer mother and children at the time of need to hospitals and follow up them after discharge. 6. Carry out family planning services including the distribution of contraceptives. 7. Treatment for minor ailments. 8. Prevent communicable diseases. 9. Maintenance of records and registrs of all the services provided and also of vital events such as births and deaths.
SUB CENTRE The Sub Centre is the peripheral outpost of the existing health care delivery system in rural areas. They are being established on the basis of one Sub Centre for every 5000 population in plains and one for every 3000 population in hilly, tribal and backward areas. STAFFING PATTERN: Population in hilly tribal areas - 3000. Population in rural area (plains) - 5000. M.P.H.W/ V.H.N - 1 M.P.H.W/ H.W(M) – 1 Village health guide – 1 Traditional health attendant – 1 VILLAGE LEVEL 1. Village health guides scheme. 2. Local dias. 3. Anganwadi worker. 4. ASHA workers. The above schemes are in operation for universal coverage and equitable distribution of health resources so that health care must penetrate into the farthest reaches of rural areas 1. VILLAGE HEALTH GUIDES. They are from the same community and serve as a link between community and governmental infrastructure. They undergo training in primary health centre, subcentre for knowledge regarding primary health care. The national target is to achieve one health guide for each village or 1000 rural population. Guidelines for selection include three months training with stipend rupees 200 per month.  The guidelines include:  They should be permanent residents of the local community.  They should be able to read and write, minimum sixth standard education.
 They should be acceptable to all sections of the community.  They should be able to spare at least two to three hours per day for community health work. 2. LOCAL DAIS (TRADITIONAL BIRTH ATTENDANTS) Under rural health scheme training is given for all local dais in the country to improve their knowledge in the elementary concepts of maternal and child health and sterilization, besides obstetric skills. Training is given for 30 days with stipend of rupees 300. Training is given at PHC, sub centre, or MCH centre. During training each dai is required to conduct at least two deliveries under guidance and supervision of health worker female, ANM or health assistant female. They should practice asepsis. On successful completion of training each dais is provided a delivery kit and a certificate. They should propagate small family norm needs. The national target is to train one local dais in each village. 3. ANGANWADI WORKERS Angan literally means a courtyard. Under integrated child developmental service, there is an anganwadi worker for a population of 1000. The anganwadi worker is selected from the community she is expected to serve. She under goes training in various aspects of health, nutrition, and child development for four months. She must have passed SSLC. OBJECTIVES:  To improve health status of under five children.  To reduce incidence of mortality, malnutrition, school drop outs.  To promote maternal education and training for child care and child rearing. FUNCTIONS: 1. Non formal preschool education for 3 to 6 years age children. 2. Immunization. 3. Maintenance of growth chart. 4. Health and nutrition education of women and children. 5. Supplementary and therapeutic nutrition to under five, pregnant mothers, and lactating mothers. 6. Growth monitoring and referral services.
BENEFICIARIES:  Nursing mothers  Pregnant women  Other women(15 to 45 years)  Children below the age of 6 years  Adolescent girls 4. ASHA WORKERS UNDER NRHM National rural health mission aims to provide accessible, affordable, accountable, effective, and reliable primary health care and bridging gap in rural health care through Accredited social health activist (ASHA). ASHA must be the resident of the village – a woman preferably in the age group of 25 to 45 years with formal education up to eighth class, having communication skills and leadership qualities. The general norm of selection will be one ASHA for 1000 population. In tribal, hilly and desert areas the norm could be relaxed to one ASHA per habitation. Target is to select and train at least 40 percentage of ASHA in one year. Community health centres As on 31st March 2003, 3076 community health centres were established by upgrading the primary health centres, each CHC covering a population of 80,000 to 1.20 lakh with 30 beds and specialist in surgery, medicine, obstetrics and gynecology, and pediatrics‘ with x-ray and laboratory facilities. Functions 1. Care of routine and emergency cases in surgery. 2. Care of routine and emergency cases in medicine. 3. 24-hour delivery services including normal and assisted deliveries. 4. Essential and emergency obstetric cases including surgical interventions. 5. Full range of family planning services including laparoscopic services. 6. Safe abortion services. 7. Newborn care.
8. Routine and emergency care of sick children. 9. Other management including nasal packing, tracheostomy, foreign body removal, etc. 10. All national health programmes should be delivered. 11. Blood shortage facility. 12. Essential laboratory services 13. Referral services. JOB DESCRIPTION OF NURSING PERSONNEL PUBLIC HEALTH NURSE Essential qualification B.Sc degree in nursing from any university or institute or certificate in Public Health Nursing from any recognised institution. Professional qualification Experience of working with rural communities. Pay scales The pay scale should be the same as prescribed by State Government for similar categories of personnel under them. Membership The Public Health Nurse should be a member of the District Health and Family Welfare Team in the District Health Organization and will enjoy the status equivalent to that of the District Mass E ducation and the Information Officer. Duties and functions  To help in the organization of Maternal and Child Health Programme as a whole.  To promote health and nutrition education activities through the Lady Health Visitors and Auxillary Nurse Midwives by providing them with printed material produced by various agencies.  To ensure that the LHVs/ANMs/Female Multipurpose Workers, etc. Integrated MCH/FP and Health and Nutrition/Education in their day to day activities.
 To help in developing school health programme in the district.  To ensure regular supply of equipments, records, registers, drugs, vaccines and other sundries necessary for MCH work.  To ensure the maintenance of prescribed records and submission of periodical progress of MCH/FP/Nutrition work activities.  To help the Statistical Officer in the District Family Welfare Bereau in compiling the periodic progress report of MCH activities.  to provide continuing education for the female MCH/FO/functionaries in the district through short in-service training sources.  To work together with the functionaries of other government departments like Social Welfare, Rural Department and Education engaged in programmes for women and children.  To co-operate MCH/FP activities undertaken through the voluntary organization in the district and provide health inputs to the possible extent for mothers and children organized in balwadis, anganwadis etc.  To tour for a minimum of 15 days in a month and visit PHCs, Sub-centres, village dais, balwadi etc. According to an advance programme duly approved by the District Medical Officer/ District Family Welfare Officer. NURRSING SUPERINTENDENT GRADE I Educational qualification General: Pre- university course/ 10+2 or equivalent exam Professional : 3 years General Nursing/9months/6months Midwifery/Psychiatric Nursing Diploma/certificate, recognised by INC. OR Revised GNM/Psychiatric Nursing Diploma/certificate, recognised by INC. OR Basic B.Sc Nursing from recognosed university according to INC norms. Registration : Registered with the Karnataka State Nursing Council/INC
Experience: Should have experience as NS grade II. Standard norms There should be one NS grade I for 200 bedded hospital, one NS grade I for 2-4 NS grade II. Job summary NS is responsible to the Medical Superintendent, in a hospital having 200 or above bed strength. She is accountable for the safe and efficient running of the various nursing department in the hospital. She is assisted in carrying out her duties by DNS/ANS, ward supervisor and clerical, linen room and domestic staff. General and office duties  Maintain necessary records concerning the nursing staff, student, confidential report and health records etc.  Submit annual report of nursing service department of Medical Superintendent, INC and Nurses Registration Council.  Participate in professional and community activities.  Maintain cordial relation with public and voluntary workers. Nursing Services  Participate in the formulation of philosophy of the hospital in general and those specific to nursing service.  Determines goals, aims, objectives and policies of the nursing services.  Implement hospital policies and rules through various nursing unit.  Decide and recommend personnel and material requirement in nursing service department.  Interview and recruit nursing staff.  Assist in student selection and recruitment  Ensure safe and efficient nursing care.  Make regular visit in hospital and wards.  Take hospital rounds with Medical Superintendent.  Select and secure proper equipment needed for hospital.  Look after the welfare of patients, their relatives and nursing staff.  Prepare budget for nursing service department.
 Function as a member of the condemnation for linen and other nursing home equipment.  Prepares duty roster and plan staff leave.  Give guidance and counselling to the subordinate staff.  Maintain discipline among nurses and other auxiliary staff.  Enforces implementation of hospital rules, regulations and policies.  Participate in hospital and inter-hospital meeting.  Investigate complaints and take necessary action.  Evaluate confidential staff report and recommends for promotion  Plan staff development programme and arrange for in-service education.  Inspect hospital kitchen and dietary services of the hospital.  Arranges students clinical experiences.  Initiate and participate in nursing research. NURRSING SUPERINTENDENT GRADE II Educational qualification General: Pre- university course/ 10+2 or equivalent exam Professional : 3 years General Nursing/9months/6months Midwifery/Psychiatric Nursing Diploma/certificate, recognised by INC. OR Revised GNM/Psychiatric Nursing Diploma/certificate, recognised by INC. OR Basic B.Sc Nursing from recognised university according to INC norms. Registration : Registered with the Karnataka State Nursing Council/INC Experience: Should have experience as senior staff nurse.
Standard Norms Since it is the second level nursing supervisory role, it needs at least the Nursing Superintendent group II for three senior staff nurse (1:3). Job Summary She/he is responsible for developing and supervising nursing service of a department or a floor consisting of two or more wards or units managed by the senior staff nurses. These units may be in-patient wards, out-patient department clinics, operatio theatres, obstetric unit, CSSD etc. She/he is responsible to the NS Gr I. Patient care and ward/ unit management Organises and plan the nursing care activities of the department. Plan staffing pattern and necessary requirement for his/her department. Complies and submit nursing statistics to the concerned authorities. Conduct and attend to the departmental and inter-departmental meeting. Make regular rounds of her/his department. Look in to general comfort of patients and their relatives. Receive report from the Night Supervisors of his/her department. Evaluate nature and quantum of care required in each unit. Make rotation plan for nursing staff and domestic staff under his/her jurisdiction. Plan ward management with each ward. Reinforces the principles of good management in the ward. Supervises the proper use and care of equipment. Act as the public relation officer of the unit and deal with the problem faced by the ward supervisor. Officiate in the absence of NS Gr I. Educational function  Arrange classes and clinical teaching of nursing students in the department related to the speciality experiences  Implement the ward teaching programme and clinical experience of the students with the help of doctors and nurses.  Does counselling and guidance of staff and the students.
 Arrange and conduct staff development programmes.  Assist in planning for and participation in the training of auxiliary personnel. General  Escorts NS Gr I, Medical Superintendent and special visitors for hospital rounds.  Acts as a Liaison officer between the nursing department and higher hospital authoriyies.  Carried out any other duties delegated by the NS Gr I. BIBLIOGRAPHY 1. Park K. Preventive and social medicine. Banasridas bhanot publications; 20TH ed. 2009, p 776-815 2. Basvanthappa. B.T, Nursing Administration (2007), Jaypee Brothers Medical Publication. New Delhi. P 535-547. 3. Gulani. Community health nursing. Kumar medical publishers; 1ST ed. 2005. P591- 610. 4. Kasturi Sundar Rao. An introduction to community health nursing. Bi publications; 4TH ed.2004. P363-376. 5. Louis White. Foundation of skills and concepts. 1ST ed. P 72-76. 6. Jaiwanti P. TNAI. Nursing administration and management. Dhalta publications;