Unit 7 health team

UNIT-VIII HEALTH TEAM
GNM (COMMUNITY HEALTH NURSING)
DR.ANJALATCHI
M.SC(N)MD(AM)MBA(HA)
ERA COLLEGE OF NURSING ,LUCKNOW

HEALTH TEAM
• Learning content :
• Health team
Introduction
Definition
Concept
Composition
Functions

Role of nursing personnel at various
levels
• District public health nursing officer
• Block health nurse
• Public health nurse
• Lady health visitors/health visitors
• Health worker female /ANM

PUBLIC HEALTH NURSES/STAFF NURSE

HEALTH TEAM CONCEPT
Health Team Concept:
• Physician of today is overworked professionally.
Many of the functions of the physician can be
performed by auxiliaries, given suitable training.
• Auxiliary Worker: Is that one who has less than
full professional qualifications in a particular field
and is supervised by a professional worker.
• The practice of modern medicine has become a
joint effort of many groups of workers,both
medical and non- medical.

• The team must have a leader.
• 1.Evaluate the team adequately.
• 2.Know the motivations of each member in
order to stimulate and enhance their
potentialities.
• Team leader should be able to:-
• Health team approach aims to produce the
right “mix” of health personal for providing
full health coverage of the entire population.

Job Responsibilities of Health
Assistant Female (LHV – Lady Health
Visitor) (Female Supervisor)
• Note: Under the Multipurpose Workers
Scheme a Health Assistant Female is expected
to cover a population of 30,000 (20,000 in
tribal and hilly areas) in which there are six
Sub-Centres, each with the Health Worker
Female. The Health Assistant Female will carry
out the following duties:

SUPERVISION AND GUIDANCE
• Supervise and guide the Health Worker Female, Dais
and guide ASHA in the delivery of health care service to
the community.
• Strengthen the knowledge and skills of the Health
Worker Female.
• Helps the Health Worker Female in improving her skills
in working in the community.
• Helpandguidethe HealthWorkerFemaleinplanning and
organizing her programmes of activities.
• Visit each Sub-Centre at least once a week on a fixed
day to observe and guide the Health Worker Female in
her day to day activities.

• Assess fort nightly the progress of assessment
report work of the Health Worker Female and
submit with respect to their duties under various
National Health Programmes.
• Carry out supervisory home visits in the area of
the Health Worker Female with respect to their
duties under various National Health
Programmes.
• Supervise referral; of all pregnant women for RPR
testing at PHC.

TEAM WORK
• Help the health workers to work as part of the health
team.
• Coordinate her activities with those of the Health
Assistant Male and other health personnel including
the dais.
• Coordinate the health activities in her area with the
activities of workers of other departments and
agencies and attend meeting at PHC level.
• Conduct regular staff meetings with the health workers
in coordination with the Health Assistant (Male).
• Attend staff meetings at the Primary Health Centre.

• Assist the Medical Officer of the Primary
Health Centre in the organization of the
different health services in the area.
• Participate as a member of the health team in
mass camps and campaigns in health
programmes.
• Facilitate and Participate in activities of village
Health & Nutrition Day.

SUPPLIES, EQUIPMENT AND
MAINTENANCE OF SUB-CENTRES
• In collaboration with the Health Assistant Male, check
at regular intervals the stores available at the Sub-
Centre and help in the procurement of supplies and
equipment.
• Check that the drugs at the Sub-Centre are properly
stored and that the equipment is well maintained.
• Ensure that the Health Worker Female maintains her
general kit, midwifery kit and Dai kit in the proper way.
• Ensure that the Sub-Centre is kept clean and is properly
maintained.

RECORDS AND REPORTS
• Scrutinize the maintenance of records by the
Health Worker Female and guide her in their
proper maintenance.
• Review reports received from the Health
Workers Female, consolidate them and submit
monthly reports to the Medical Officer of the
Primary Health Centre.

WHERE KALA-AZAR IS ENDEMIC,
ADDITIONAL DUTIES ARE
• She will supervise the work of Health Worker Female
during concurrent visit and will check whether the
worker is performing her duties.
• She should check minimum of 10% of the house in a
village to verify that the Health Worker Female really
visited those houses ad carried her job properly. Her
job of identifying suspected Kala- Azar cases and
ensuring complete treatment has been done properly.
• She will carry with her the proper record forms, diary
and guidelines for identifying suspected Kala-Azar
cases.

• She will be responsible along with Health Assistant
Male for ensuring complete treatment of Kala- Azar
patients in his area.
Male for ensuring complete coverage during the spray
activities and search operation.
• She will also undertake health education activities
particularly through interpersonal communication,
arrange group meetings with leaders and organizing
and conducting training of community leaders with
the assistance of health team.

WHERE JAPANESE ENCEPHALITIS IS
ENDEMIC HER SPECIFIC DUTIES ARE
AS BELOW
• She will supervise the work of Health Worker
Female during concurrent visit and will check
whether the worker is performing her duties.
• She should check along with minimum of 10% of
the house in a village to verify that the Health
Worker Female really visited those houses and
carried her job properly. Her job of identifying
suspected JE cases and ensuring complete
treatment has been done properly.

• She will carry with her the proper record forms, diary
and guidelines for identifying suspected JE cases.
• She will be responsible for ensuring complete
treatment of JE patients in her area.
Male for ensuring complete coverage during the spray
activities and search operation.
• She will also undertake health education activities
particularly through interpersonalcommunication,
• arranging group meetings with leaders and organizing
and conduction training of community leaders with the
assistance of health team.
•

TRAINING
• Organize and conduct training for Dais/ASHA
with the assistance of the Health Worker
Female.
• Assist the Medical Officer of the Primary
Health Centre in conducting training
programme for various categories of health
personnel.

MATERNAL AND CHILD HEALTH
• Conduct weekly MCH clinics at each Sub-Centre
with the assistance of the Health Worker Female
and dais.
• Respond to calls from the Health Worker Female,
the Health Worker Male, the health guides and
the trained Dais and render the necessary help.
• Conduct deliveries when required at PHC level
and provide domiciliary and midwifery services.

FAMILY WELFARE AND MEDICAL
TERMINATION OF PREGNANCY
• She will ensure through spot checking that Health
Worker Female maintains up-to date eligible couple
registers all the times.
• Conduct weekly family planning clinics along with the
MCH clinics at each Sub-Centre with the assistance of
the Health Worker Female.
• Personally motivate resistant case for family planning.
• Provide information on the availability of services for
medical termination of pregnancy and for sterilization.
Refer suitable cases for MTP to the approved
institutions.

• Guide the Health Worker Female in
establishing female depot holders for the
distribution of conventional contraceptives
and train the depot holders with the
assistance of the health workers female.
• Provide IUCD services and their follow up.
• Assist M.O. PHC in organization of family
planning camps and drives.

NUTRITION
• Ensure that all cases of malnutrition among
infants and young children (0-5 years) are
given the necessary treatment and advice and
refer serious cases to the Primary Health
Centre.
• Ensure that iron and folic acid vitamin A are
distributed to the beneficiaries as prescribed.
• Educate the expectant mother regarding
breast feeding.

UNIVERSAL IMMUNIZATION
PROGRAMME
• Supervise the immunization of all pregnant women and
children (0-5 years).
• She will also guide the MPW (M) and MPW(F) to
procure supplies organize immunization camps provide
guidance for maintaining cold chain, storage of vaccine,
health education and also in immunizations.
• Supervise the immunization of all pregnant women and
infants.
• Follow the directions given in Manual of Health Worker
(female) under National Immunization Programme.

ACUTE RESPIRATORY INFECTION
• Ensure early diagnosis of pneumonia cases.
• Provide suitable treatment to mild/moderate
cases of ARI.
• Ensure early referral in doubtful/severe cases.

SCHOOL HEALTH
• Assist Medical Officer in school health
services.

PRIMARY MEDICAL CARE
• Ensure treatment for minor ailments, provide
ORS & First Aid for accidents and emergencies
and refer cases beyond her competence to the
Primary Health Centre or nearest hospital.

HEALTH EDUCATION
• Carry out educational activities for MCH, Family Welfare,
Nutrition and Immunization, Control of blindness, Dental
care and other National Health Programmes like leprosy,
Tuberculosis and NCD programmes with the assistance of
the Health Worker Female.
• Arrange group meetings with the leaders and involve them
in spreading the message for various health programmes.
• Organize and conduct training of women leaders with the
assistance of the Health Worker Female.
• Organize and utilize Mahila Mandal, Teachers and other
women in the Community in the family welfare
programmes, including ICDS personnel.

JOB FUNCTIONS OF HEALTH WORKER
FEMALE (ANM)
• She will carry out the following functions:
• She will carry out all the activities related to
various
• programs in a integrated manner when
visiting the
• village/households

MATERNAL AND CHILD HEALTH
• 1.Register and provide care to pregnant women
• throughout the period of pregnancy. Ensure that every
pregnant woman makes at least 4 (Four) visits for Ante
Natal Check-up including
• Registration.
• Suggested schedule for antenatal visits
• 1st visit: Within 12 weeks—preferably as soon as
pregnancy is suspected—for registration of pregnancy
and first antenatal check-up However, even if a woman
comes late in herpregnancy for registration, she should
be registered, and care given to her according
togestational age.

• 2nd visit: Between 14 and 26 weeks
• 3rd visit: Between 28 and 34 weeks
• 4th visit: Between 36 weeks and term
• Provide ante natal check ups and associated
• services such as IFA tablets, TT immunization
etc.

• 2. Test urine of pregnant women for albumin
and sugar. Estimate haemoglobin level.
• 3. Refer all pregnant women to PHC/CHC for
RPR test for syphilis and Blood grouping.
• 4. Refer cases of abnormal pregnancy and
cases with medical and gynaecological
problems to Health Assistant Female (LHV) or
the Primary Health Centre.

• 5. Conduct deliveries in Sub-centre, if facilities of a
• Labour room are available and in her area when
• called for.
• 6. Supervise deliveries conducted by Dais and assist
• them whenever called for.
• 7. Refer cases of difficult labour and newborns with
• abnormalities, help them to get institutional care
• and provide follow up to the patients referred to
• or discharged from hospital.

• 8. ANM will identify the ultimate beneficiaries,
complete necessary formalities and obtain necessary
approvals of the competent authority before
disbursement to the beneficiaries under Janani
Suraksha Yojana (JSY) and by 7th of each month will
submit accounts of the previous month in the
prescribed format to be designed by the State.
• ANM will prepare a monthly work schedule in the
meeting of all accredited workers to be held on every
3rd Friday of every month, which is mandatory. The
guideline under JSY is to be followed.
• In addition ANM will take weekly/fortnightly meetings
with all ASHAs of her area to guide and monitor them.

• 9. Tracking of all pregnancies by name for
scheduled ANC/PNC services.
• 10. Make postnatal home visits on 0, 3, 7 and
42nd day for deliveries at home and Sub-centre
and on 3, 7, and 42nd day for institutional
delivery.
• Post-natal visits are to be made for each delivery
happened in her area and she should render
• advice regarding care of the mother and care and
feeding of the newborn.

• 11. In case of Low Birth weight Baby, a total of
six post natal visits are to be made on 0, 3, 7,
14, 21 and 28th day to screen for congenital
abnormalities, assess the neonate for danger
signs of sickness etc. as per IMNCI guidelines
and appropriate referral.
• 12. Initiation of early breast-feeding within
one hour of birth, exclusive breastfeeding for
6 months and timely weaning at 6months as
per Infant and Young Child Feeding Guidelines.

• 13.Assess the growth and development of the
infants and under 5 children and make timely
referral.
• 14. Provide treatment for all cases of
Diarrhoea,acute respiratory infections
(pneumonia) and other minor ailments and
refer cases of severe dehydration, respiratory
distress, infections,severe acute malnutrition
and other serious conditions as per IMNCI
guidelines/National Guidelines.

• 15. Educate mothers individually and in
groups in better family health including
maternal and child health, family planning,
nutrition, immunization, control of
communicable diseases, personal and
environmental hygiene.
• 16. Assist Medical Officer and Health Assistant
(Female) in conducting antenatal and
postnatal clinics at the Sub-centre.

FAMILY PLANNING
• 1. Utilize the information from the eligible couple and child
register for the family Planning programme.
• She will be squarely responsible for maintaining eligible
couple registers and updating at all times.
• 2. Spread the message of family planning to the couples
and motivate them for family planning individually and in
groups.
• 3. Distribute conventional contraceptives and oral
contraceptives to the couples, provide facilities and to help
prospective acceptors in getting family planning services, if
necessary, by accompanying them or arranging for the
Dai/ASHA to accompany them to hospital.

• 4. Provide follow-up services to female family planning
acceptors, identify side effects, give treatment on the spot
for side effects and minor complaints and refer those cases
that need attention by the physician to the PHC/ Hospital.
• 5. IUCD insertion can be done by a trained ANM.
• 6. Establish female depot holders, help the Health Assistant
(Female) in training them, and provide a continuous supply
of conventional contraceptives to the depot holders.
• 7. Build rapport with acceptors, village leaders, ASHA, Dais
and others and utilize them for promoting Family Welfare
Programme.
• 8. Identify women leaders and train them with help of the
Health Assistant (Female).
• 9. Participate in Mahila Mandal meetings and utilize such
gatherings for educating women in Family Welfare
Programme.

Medical Termination of Pregnancy
• 1. Identify the women requiring help for
medical termination of pregnancy and refer
them to nearest approved institution.
• 2. Educate the community of the
consequences of unsafe abortion methods
and septic abortion; inform them about the
availability of services for medical termination
of pregnancy.

Nutrition
• 1. Identify cases of Low Birth weight, malnutrition among
infants and young children (zero to five years), give the
necessary treatment and advice and refer serious cases to
the Primary Health Centre.
• 2. Distribute Iron and Folic Acid tablets as prescribed to
pregnant women, nursing mothers, adolescent girls and
syrups to young children (up to five years), as per the
national guidelines.
• 3. Administer Vitamin A solution to children as per the
guidelines.
• 4. Educate the community about nutritious diet for
mothers and children.
• 5. Coordinate with Anganwadi Workers.

Universal Programme on
Immunization (UIP)
• 1. Immunize pregnant women with tetanus toxoid.
• 2. Administer DPT vaccine, oral poliomyelitis vaccine, measles vaccine and BCG
vaccine to all infants
• and children, (Hepatitis B in pilot areas) as per immunization schedule.
• 3. Ensure injection safety, safe disposal and record, report and manage minor &
serious Adverse Event Following Immunization (AEFI). Submit monthly UIP reports,
weekly surveillance reports (AFP, Measles under IDSP). Serious AEFI and
outbreakshould be reported immediately.
• 4. ANM is responsible for cold chain maintenance for vaccines during fixed and
outreach sessions.
• 5. Manage waste generated during immunization as per GOI/CPCB guidelines.
• 6. Preparing work plan, estimating beneficiaries and logistics, preparing due list of
expected beneficiaries in coordination with Angan wadi worker and
ASHA/mobilizer on the session day and ensure their vaccination through adequate
• mobilization.

• 7. Maintain Tracking Bag/Tickler box at each Sub centre, file updated counterfoils
and utilize them for follow up.
• 8. Tracking of dropouts and left outs, records/ reports (including MCH register and
immunization card counterfoils), surveillance/reporting Vaccine Associated
Paralytic Poliomyelitis (VAPP) and AEFI incidents in catchment area.
• 9. Indent order of vaccines and logistics should be weekly based on the due
beneficiary list. HW/Alternate Vaccinator should receive the required quantity of
vaccine and logistics on the day of Immunization and supply to the session site.
• 10. Work plan indicating village, place, date & time of organizing proposed
session, including the names of ASHA and AWW must be displayed at each Sub-
centre.
• 11. Posters/Paintings on key messages, Immunization schedule, Positioning during
vaccine administration, Safe Injection Practices, VVM,AEFI awareness, use of Hub
cutters.
• 12. Village-wise dropout list for display at Sub-centre
• 13. Norm for due beneficiaries: 3 per session.

Communicable Diseases
• 1. Notify the MO, PHC immediately about any abnormal increase in cases of
diarrhoea/dysentery, fever with rigors, fever with rash, flaccid paralysis of acute
onset in a child <15 years (AFP), , Tetanus, fever with jaundice or fever with
unconsciousness, minor and serious AEFIs which she comes across during her
home visits, take the necessary measures to prevent their spread, and inform the
Health Assistant (Male)/LHV to enable him/her to take further action.
• 2. HIV/STI Counseling, HIV/STI screening after receiving training.
• 3. Leprosy
 Impart Health Education on Leprosy and its treatment to the community.
 Refer suspected new cases of leprosy and those with complications to PHC.
 Provide subsequent doses of MDT to patients Ensure regularity and completion of
treatment and assist health supervisor in retrieval of absentee/defaulter.
 Update the case cards at Sub-centres & treatment register at sector PHC.
 Assist leprosy disabled people in self care practices, monitor them and refer them
to PHC when ever required.

4.Assist the Health Worker (Male) in maintaining a
record of cases in her area, who are under
treatment for malaria, tuberculosis and leprosy,
and check whether they are taking regular
treatment, motivate defaulters to take regular
treatment and bring these cases to the notice of
the Health Worker (Male) or Health Assistant
(Male).
5. Give Oral Rehydration solution to all cases of
diarrhea/dysentery/vomiting. Identify and refer
all cases of blindness including suspected cases of
cataract to M O, PHC.

6. Education, Counselling, referral, follow-up of cases of STI/RTI, HIV/AIDS.
7. Malaria
• She will identify suspected malaria fever cases during ANC or Immunisation
Clinic and home visits, and will make blood smears or use RDt for diagnosis
of Pf malaria.
• to advise seriously ill cases to visit PHC for immediate treatment. All the
fever cases with altered sensorium must be referred to PHC/District
Hospital. the cases will be referred after collection of blood smear and
performing RDt. to arrange transportation for such patients from home to
the PHC/District Hospital.
• to contact all ASHAs/FtDs of the area during visit to the village and collect
blood smears for transportation to laboratory. to cross verify their records by
visiting patients diagnosed positive between the previous and current visit.
• to provide treatment to positive cases as per the drug policy.
• to replenish the stock of micro slides, RDks and/or drugs to ASHAs/FtDs
wherever necessary.
• to keep the records of blood smears collected and patients given anti-
malarial treatment.
• to ensure early diagnosis & radical treatment of the diagnosed
positive cases (PV & PF) compliance of Radical

8.Where Filaria is endemic:
• Identification of cases of lymphoedema/
elephantiasis and hydrocele and their referrals to
PHC/CHC for appropriate management.
• training of patients with lymphoedema/
elephantiasis about care of feet and home based
management remedies.
• Identification and training of drug distributors
including ASHAs and Community Health Guides
for mass drug distribution of DEC + Albendazole
on National Filaria Day.

9.Where kala-Azar is endemic:
• From each family
• She shall enquire about the presence of any fever cases having a history of prolong
fever more than 15 days duration in a village during her visit.
• She will refer such cases to the nearest PHC for clinical examination by the Medical
Officer and confirmation by RDk.
• She shall take the migratory status of the family/guest during last three months.
• She will also follow up and persuade the patients to ensure complete treatment.
• She will keep a record of all such cases and shall verify from PHC about their
diagnosis during the monthly meeting or through health supervisor during her
visit.
• She will carry a list of all kala-azar cases in her area for follow up and will
ensure, administration of complete treatment at PHC.
• She will assist the male health worker in supervision of the spray activities.
• She will conduct all health education activities particularly through inter-personal
communication by carrying proper charts etc. for community awareness and their
• involvement.

10.Where Dengue/Chikungunya is endemic
– From each family
• She shall enquire about the presence of any fever case having rash
and joint pain a village during her visit.
• She will refer such cases to the nearest PHC for clinical examination by
the Med Officer and for laboratory confirmation by sending blood
sample to the nearest Sentinel Surveillance hospital.
– She will supervise the source reduction activities in her area
including at the time of observance of anti-Dengue month
– She will coordinate the activities carried out by Village Health
Sanitation and Nutrition Committee.
– She will conduct health education activities particularly
throughinter-personal communication by carrying proper
charts etc. for social mobilization and community awareness to
eliminate source of Aedes breeding and also guide the
community for proper water storage practices.

• Where JE is endemic:
– From each family
• She shall enquire about the presence of any fever case
having encephalitis presentation.
• ƒShe will refer such cases to the nearest PHC
for early diagnosis and management of such
cases.
– She will conduct health education activities
particularly through inter-personal
communication by carrying proper charts etc. for
social mobilization and community awareness for
early referral of cases.

Non-Communicable Diseases
• IEC Activities for prevention and early detection of hearing
impairment/deafness in health facility, community and schools,
harmful effectsof tobacco, mentalillnesses, Iodine Deficiency Disorders
(IDD), Diabetes, CVD and Strokes.
• House to House surveys to detect list & refer cases of hearing & visual
impairment and (along with annual survey register/enumeration survey.
Minimum is annual survey, desirable to be done twice yearly subject to
availability of second ANM).
• ••Sensitization of ASHA/AWW/PRI about prevention and treatment of
deafness.
• ••Mobilizing community members for screening
• camps and assisting in conduction of screening
• camps to identify hearing or visual impairment cases if needed.
• ••Motivation for quitting and referrals to Tobacco Cassation Centre at
District Hospital.
• ••Sensitization of ASHA/AWW/PRI about the Noncommunicable diseases.
• ••Identification and referral of carer of common mental illnesses and
Epilepsy for treatment and follow them up in community.

• Greater participation/role of Community for primary
prevention of NCD and promotion of healthy lifestyle.
• ••Ensuring regular Testing of salt at household level for
presence of Iodine through Salt Testing Kits by ASHAs.
• In Fluorosis affected districts
• IEC to prevent Fluorosis.
• Identify the persons at risk of Fluorosis, suffering from
Fluorosis and those having deformities due to Fluorosis.
• Line listing, source reduction activities,reconstructive
surgery cases, rehabilitative intervention activities, focused
local action and referral of what is not possible locally.
• ••Promoting formation and registration of Self Health Care
Group of Elderly Persons’.

• Oral Health education especially to antenatal
and lactating mothers, school and adolescent
children, first aid and referral for cases of oral
problems.
• ••Health communications on Disability,
Identification of Disabled persons and their
appropriate referral.

Vital Events
• Record and report to the health authorities
the vital events including births and deaths,
particularly of mothers and infants in her area.

Record Keeping
• 1. Maintenance of all the relevant records concerning mothers, children and eligible
couples in her
area.
• 2. Register
• (a) pregnant women at earliest contact
• (b) infants zero to one year of age
• (c) women aged 15-44 years
• (d) Under and above five children
• (e) Adolescents.
• 3. Maintain the pre-natal and maternity records and child care records.
• 4. Prepare the eligible couple and child register and maintaining it up-to-date.
• 5. Maintain the records as regards contraceptive distribution, IUD insertion. Couples
sterilized, clinics held at the Sub-centre and supplies received and issued.
• 6. Prepare and submit the prescribed weekly/ monthly reports in time to the Health
Assistant (Female).
• 7. While maintaining passive surveillance register for malaria cases, she will record:
• No. of fever cases
• No. of blood slides prepared
• No. of malaria positive cases reported
• No. of cases given radical treatment

Treatment of Minor Ailments
• 1. Provide treatment for minor ailments, first-
aid for accidents and emergencies and refer
cases beyond her competence to the Primary
HealthCentre/Community Health Centre or
nearest hospital.
• 2. Provide treatment as per AYUSH* as needed
at the local level.

Team Activities
• 1. Attend and participate in staff meetings at Primary Health
Centre/Community Development
• Block or both.
• 2. Coordinate her activities with the Health Worker (Male) and other
health workers including the
• Health volunteers/ASHA and Dais.
• 3. Coordinate with PRI and Village Health Sanitation and Nutrition
Committee.
• 4. Draft annual Village Health Plan with the help of Health Worker (Male),
PRI and VHSC for submitting the same to block.
• 5. Meet the Health Assistant (Female) each week and seek her advice and
guidance whenever necessary.
• 6. Maintain the cleanliness of the Sub-centre.
• 7. Dispose medical waste as per the IMEP guidelines, of GOI.
• 8. Organize, participate and guide in organizing the VHN Days at
Anganwadi Centers.
• 9. Participate as a member of the team in camps and campaigns.

House-to House Surveys
• These surveys would be done once in April
annually. Some of the diseases would require
special surveys- but at all times not more than
one survey per month would be expected.
Surveys would be done with support and
participation of HW (male), ASHAs, Anganwadi
Workers, community volunteers, panchayat
members and Village Health Sanitation and
Nutrition Committee. Other details are given on
page no. 11.

• These surveys would be done once annually,
preferably in April. Some of the diseases would
require special surveys- but at all times not more
than one survey per month would be expected.
Surveys would be done with support and
participation of ASHAs, Anganwadi Workers,
community volunteers, panchayat members and
Village Health Sanitation and Nutrition
Committee members.
• The Male Health worker would take the lead and
be accountable for the organization of these
surveys and the subsequent preparation of lists
and referrals. The surveys would include.

Essential
• Age and sex of all family members.
• ••Assess and list eligible couples and their unmet
needs for contraception.
• ••Identify persons with skin lesions or other
symptoms suspicious of leprosy and refer:
essential in high leprosy prevalence blocks.
• ••Identify persons with blindness, list and refer:
Identify persons with hearing impairment/
deafness, list and refer.
• ••Annual mass drug administration in filaria
endemic areas.

Desirable
• Identify persons with disabilities, list and refer and
• call for counselling where needed.
• ••Identify and list senior citizens who need special
• care and support.
• ••Identify persons with mental health problems and
• Epilepsy; list and refer.
• ••In high endemicity areas-survey for fever suspicious of
kala- azar, for epidemic management of malaria, for
detection of fluorosis affected cases etc.
• ••Any other obvious disease/disorder; list and refer.

Role of ANM as a Facilitator of ASHA
• Auxiliary Nurse Midwife (ANM) will guide ASHA in performing the
following activities:
• She will hold weekly/fortnightly meeting with
• ASHA and discuss the activities undertaken during the week/fortnight. She
will guide her in case
• ASHA had encountered any problem during the performance of her
activities.
• ••ANM will act as a resource person for the training of ASHA.
• ••ANM will inform ASHA regarding date and time of the outreach session
and will also guide her for bringing the beneficiary to the outreach session
• ••ANM will participate and guide in organizing the Health Days at
Anganwadi Centres.
• ••She will take help of ASHA in updating eligible couple register of the
village concerned.

• She will utilize ASHA in motivating the pregnant
women for coming to subcentre for initial checkups.
ASHA will also help ANMs in bringing married couples
to Sub-centres for adopting family planning methods.
• ••ANM will guide ASHA in motivating pregnant women
for taking full course of IFA Tablets and TT injections
etc.
• ••ANMs will orient ASHA on the dose schedule and
• side affects of oral pills.
• ••ANMs will educate ASHA on danger signs of pregnancy
and labour so that she can timely identify and help
beneficiary in getting further treatment.

• ANMs will inform ASHA on date, time and place
for initial and periodic training schedule. She will
also ensure that during the training ASHA gets
the compensation for performance and also
TA/DA for attending the training.
• ••Train in Salt Testing using salt Testing Kits.
• The second ANM will follow similar job
responsibilities as the above. It is to be ensured
that one ANM out of the two is available at the
Sub-centre. Other ANM will perform the field
duties. The time schedule for their turn visits be
prepared with the approval of the Panchayats
involved.

PUBLIC HEALTH NURSE JOB DUTIES:
• Serves patients by visiting homes; determining patient and family
needs; developing health care plans; providing nursing services and
treatments; referring patients with social and emotional problems
to other community agencies.
• Helps the community health care team by coordinating assessment,
planning, and providing of needed health and related services;
participating in case conferences with physicians, hospital and
rehabilitative personnel, and representative of other agencies.
• Provides health information by instructing family in care and
rehabilitation of patient; maintaining health and prevention of
disease for family members; teaching home nursing, maternal and
child care; providing instructions in other subjects related to
individual and community welfare.

• Safeguards health of children by participating in child
health conferences, school health; providing group
instruction for parents; conducting immunization programs.
• Arranges convalescent and rehabilitative care of sick or
injured persons by cooperating with families, community
agencies, and medical personnel.
• Improves quality results by studying, evaluating, and
recommending changes in processes; implementing
changes.
• Keeps vehicle and equipment operating by following
operating instructions; troubleshooting breakdowns;
maintaining supplies; performing preventive maintenance;
calling for repairs.

• Keeps vehicle and equipment operating by
following operating instructions; troubleshooting
breakdowns; maintaining supplies; performing
preventive maintenance; calling for repairs.
• Keeps supplies ready by inventorying stock;
placing orders; verifying receipt.
• Documents actions by completing forms, reports,
logs, and patient records.
• Avoids legal challenges by complying with legal
requirements; keeping patient information
confidential.

• Updates public health job knowledge by
participating in educational opportunities;
reading professional publications; maintaining
personal networks; participating in
professional organizations.
• Enhances public health department and city
reputation by accepting ownership for
accomplishing new and different requests;
exploring opportunities to add value to job
accomplishments.

Public Health Nurse
Skills and Qualifications:
• Verbal Communication, Health Promotion and
Maintenance, Listening, Quality Management,
Energy Level, Integrity, Infection Control,
Informing Others, Nursing Skills, Medical
Teamwork, Multi-tasking
• Minimum qualification GNM/B.sc(N)
• State registration council
•

PUBLIC HEALTH NURSE SUPERVISOR

DUTIES AND RESPONSIBILITIES OF
BLOCK EXTENTION EDUCATOR

• The Block Extension Educator is the kind pin for
organizing Information, Education Communication
activities relating to Health and Family Welfare
Programme in the Primary Health Centre/ Block
Area. He would be under the immediate
administrative Control of the Medical Officer of the
Primary Health Centre and he will function under the
technical supervision and guidance of the District Mass
Education and Information Officer. His main
functioning would relate to the promotion of Health
and Family Welfare Programme. He will consult
District health Officer in formulating the special
programme for his Primary Health Centre

Duties and Functions:
• Identify the educational needs related to various
Maternity and child Health and Family Welfare
Programmes in the Primary Health Centre, area.
• 2. Collect all information relating to Maternity
and Child Health and Family Welfare and prepare plan
for I.E.C. activities in consultation with the Medical
Officer, Primary Health Centre, and
• 3. Form Health Committee at Village level to
enlist co-operation of the opinion leader especially
women for Maternity and child Health and Youths
Family Welfare, Family Welfare Media Programme
once a Month (i.e) 12 meetings per year.

• Procure maintain and maximum use of mass Media
equipments.
• 5. Maintain records of IEC activities, tour
programmes daily diaries and other registers and
ensure preparation and display of relevant maps and
charts in the Primary Health Centre.
• 6. Maintain liaison with District Bureau to
procure regular and adequate supply of IEC materials
and contraceptives and ensure proper distribution and
ensure availability with each and every health staff,
namely M.P.H.W (F) and Male Workers and Male
Supervisors ensure display of materials at each sub-
centre.

• Establish working relationship with the Block Development Officer
and enlist his staff’s co-operation in the implementation of
Maternity and Child Health and Family Welfare Programme.
• 8. Co-ordinate with Education Department. Nehru Yuva
Kendra, Social Welfare Department. Agriculture Industrial
Department etc., for promoting family welfare and MCH Scheme.
• 9. He should participate all the function and festivals
conducted in the Block areas and conduct propaganda and publicity
on Family Welfare Scheme.
• 10. He will be member of the Local Block Level Family Welfare
Committee and act as a resource person.
• 11. Organise Mass Media Programme, Mini-exhibitions. Film
shows, Cultural programmes weekly/Monthly celebrations and IEC
programmes at local fairs on market day etc., utilising Audio
Cassettes.

• Work with industrial/factories and other Government and
Non-Government agencies to strength IEC activities relates
to Maternity and Child Health and Family Welfare.
• 13. Use various approaches (individual. group and
Mass) to popularize Maternity and Child Health and Family
Welfare Programme among rural people.
• 14. Organise Educational Programmes for formal and
non-formal (out of school) groups on population education
and health measures.
• 15. Co-ordination with animators of Adult Education
Department in organising learners classes.
• 16. Co-ordinate activities with Service Organisations
like Rotary/Lions/Jacess/LPG distributors etc
• 17. Organise short Orientation Training
Camps/Educational Programme for various voluntary
agencies and other target groups.

• Conduct Family Welfare Leaders Camps.
• 19. Use opinion leaders, satisfied customers and secure
credible Persons to bring out recording news letters etc.,
• 20. Organising service Training for Lady Health Visitors
and Multi Purpose Health Workers on IEC.
• 21. Organise short orientation training on IEC for
supportive staff such as private Medical Practitioners,
teachers, Social /communicators, Sanitary Workers,
Adult Education Supervisors, Animators and ICDS workers.
• 22. Prepare talking points in relation to educational
activities carried out in the Primary Health Centre Area.
• 23. Provide guidance to field staff in IEC activities
related to Maternity and Child Health and Family Welfare.

• Work with all the Co-operative Society members; provide
Male staff to visit Co-operative societies regularly. Supply
them Nirodh, Organised Training and discussions for
members various Co-operative societies.
• 25. He will review youth club and organize their
activities. He will review the woman’s club and organize its
activities.
• 26. He will organize special Health campaigns in the
event of any epidemic or out break of any diseases.
• 27. He will propagate preventive aspects of health
through the Health Staff and promote hygiene and
sanitation in the Village.

• Conduct periodical evaluations to study the
impact of IEC.
• 29. Tour for 15 days in a month for the
purposes for inspections and conducting field
programmes.
• 30. He should submit monthly reports on
Mass Education and Extension education
activities of Primary Health Centre, before 10th of
every month to district Family Welfare, Maternity
and Child Health Officer and copy to the district
Mass Education and Information Officer.

DUTIES AND RESPONSIBILITIES OF THE
POST OF COMMUNITY HEALTH NURSE
• INTRODUCTION
• 1.The Community Health Nurse shall work under the immediate
control, guidance and supervision of the Medical Officer in-charge
of the Block Primary Health Centre and over all-administrative, and
technical control and supervision and guidance of the Deputy
director of Health Services concerned.
• (2) She will supervise, control and guide the Female component of
the Field Health Staff i.e., Sector Health Nurses (Multipurpose
Health Supervisors (Female) and Village Health Nurse (i.e.
Multipurpose Health Workers (Female).
• (3) The Female component of the Field Health Staff of the Primary
Health Centres and Health Sub-centres of the Block shall work
under the immediate technical control and supervision of the
Community Health Nurse and over all administrative control of the
medical Officer of the Primary Health Centre concerned.

• (4) The community Health Nurse shall keep herself
conversant with the villages, Topography and the
demographic characteristics, health needs and demands
and public health problems in the block area.
• (5) The Community Health Nurse is responsible to assist
the Medical Officers of the Primary Health Centres
concerned and thus ensure the performance and
achievement by the Female component of the Field Health
Staff of the Primary Health ‘centres and Health Sub-centres
in respect of various Health Programmes are including
Family Welfare Programme in the block area. She shall
ensure that all the activities under various Health and
Family Welfare Programmes are implemented by the Sector
Health Nurses (i.e. Multipurpose Health Supervisors
(Female) and Village Health Nurses (i.e. Multipurpose
Health Workers (Female) in the area of their jurisdiction.

FUNCTIONS UNDER MATERNITY AND
CHILD HEALTH SERVICES
• (1) She shall ensure rendering of Mother and Child Health
care services such as pre-natal, inter natal, and postnatal
care of mothers and infants and Pre-School child health
care by and through the Female component of the Field
Health Staff of the Primary Health Centres, Health Sub-
Centres and Supervision of Services rendered by Dais.
• (2) She shall assist the Medical Officers of the Primary
Health Centres and ensure by effective supervision in
screening of high-risk cases of pregnancy and
infants. Children by the Female component of the Field
Health Staff for arranging for provision of special care and
higher medical attention by referral to the appropriate
higher treatment facility centres.

III. IMMUNISATION
• (1) She shall assist the Medical Officer, Primary Health Centre to Plan,
organize and implement immunisation service under UIP as per the latest
policy and National immunization Schedule and Sate Government
instructions and ensure universal coverage of eligible beneficiary
population in each village and Habitation in the block area thro’ the
Female component of the Field Health staff of the Health Sub-Centres and
Primary Health Centres by proper calendar of activities and visits.
• (2) She shall assist the Medical Officers, Primary Health Centres to ensure
adequate supplies of vaccines i.e antigens and all equipments and items
required for immunization services from time to time for the effective
implementation of the immunization services in the Community.
• (3) She shall with the guidance and support of the Medical Officer,
Primary Health Centre ensure proper storage of vaccines under optimum
and prescribed temperature in Primary Health Centres in the field and she
will inspect the cold chain equipments in all places and ensure continuous
cold chain during transport of vaccines.

• (4) She shall assist the Medical Officer, Primary Health Centre to
investigate and report all adverse event, reactions and complications
arising out of administration of immunization and arrange to undertake
necessary remedial corrective measures as required under guidance and
supervision of the Medical Officers of the Primary Health Centres.
• (5) She shall assist the Medical Officers of the Primary Health Centres and
District Health authorized to plan, organize and implement services for
effective administration of various nutrition programmes and
administration of Vitamin-A solution and Iron and folic Acid
supplementation to the eligible beneficiaries that the Female Field Health
Staff.
• (6) She shall ensure that the Sector Health Nurses and Village Health
Nurses of Primary Health Centres and Health Sub Centres visit all the
TamilNadu Nutritious Noon Meal Programme Centres/Community
Nutrition Centres and ICDS (Anganwadi) Centres in her area regularly and
ensure provision of health care services including referral as per
programme instructions to the children.

• (7) She shall ensure that the periodic monitoring of the growth and
development of children from the time of birth as carried out by Village
Health Nurses and Sector Health Nurse at appropriate intervals and so
that the Health cards and related records are maintained by concerned
Field Health and Nutrition functionaries as per programme directives.
• (8) She shall assist the Medical Officer, Primary Health Centres in ensuring
that all cases of maternal and infant and child deaths are investigated
socio-epidemiologically and notified to higher authorities and arrange to
undertake rendering of suitable preventive and remedial measures to
prevent such mortality under the guidance and supervision of Medical
Officers of Primary Health Centres and district Health Authorities.
• (9) She shall assist the Medical Officers to ensure conduct of regular
surveillance by all the field Health Staff of the Primary Health Centers and
Health Sub-Centres in respect of occurrence of the Vaccine preventable
diseases in her block area and maintain Health Sub-Centre wise and
Primary Health Centre wise account of all cases of vaccine preventable
diseases in collaboration and coordination with Block Health supervisor
(Male).

• (10) She shall verify the stock position of all the
items of equipments, syringes, needles and
vaccines and ensure proper flow of materials and
vaccines with little room for shortage or surplus.
• (11) She will maintain and ensure sterilization of
syringes and needles and adoption of practice of
one syringe. One needle for one child for each
Immunisation administered by Field Health staff
implementing immunization services both in the
clinic and in the community.

FAMILY WELFARE
• (1) She shall be responsible to assist the Medical Officers of the
Primary Health Centres for the successful and affective
implementation of National Family Welfare Programme through the
Female Health Staff of Primary Health Centres and Health sub-
Centres in her block.
• (2) The Community Health Nurse is responsible for
implementation of activities under information and Education on
Family Welfare in collaboration with Block Extension Educator and
motivation of staff and strengthen and supervision of Family
Welfare Services and after care and follow-up.
• (3) She shall with the Female Health Supervisors i.e Sector
Health Nurse arrange follow-up of Family Welfare cases and accepts
of Family Welfare methods such as intrauterine device and oral pills
etc. for immediate management and referral if any

SUMMARY
• Till now we discussed about health team like
introduction, definition, composition,
function of health team .
• Role of nursing personnel at various officers
like district public health nursing officers,
block health nurse, public health nurses , lady
health visitors/health supervisor, health
worker female/ANM.

Conclusion
• I hope you all understand the health team and
their composition followed by function
• discussed various health workers like
PHN,DPHNS,BHN, LHV/LHVS, HW(ANM) their
role and responsibilities in health care
services.
• If you got chance to work as a health team in
various department will you able to all apply
this knowledge with confidently.

Question related to topic?
• Define the health team?
• Enumerate the composition of health team?
• Discuss the function of health team?
• Explain in detail about district public health nursing officer?
• Describe the role and responsibilities of block health
nurses
• Discuss the role and responsibilities of public health nurse?
• Describe the role and responsibilities of lady health
visitors/health supervisor?
• Understand the role and responsibilities health worker
female (ANM)?

BIBILIOGRAPHY
 STUDENT REFERENCE ?
1. K.Park the text book of” preventive and
social medicine” 24th edition, jaypee
brothers, new delhi. Page no. 846-856
2. IPHS standard for community health centre
guidelines.
3. IPHS standards for primary health centre
4. IPHS standards for subcentre

TEARCHER REFERNCES?
1. K.Park the text book of” preventive and
social medicine” 24th edition, jaypee
brothers, new delhi. Page no. 846-856
2. IPHS standard for community health centre
guidelines.
3. IPHS standards for primary health centre
4. IPHS standards for subcentre

Unit 7 health team

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