Concise guide to primary health care
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- Concise guide to primary health care
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Com H - ‘S'GRF_COM_H_5_C_SUDHA
Concise guide to primary health care
Table of Contents
1. Alma Ata Declaration
2. Concept of primary health care
3. Essential components of primary health care
4. Diagram of PHC personnel
5. Job responsibilities of Chief Medical Officer
6. Job responsibilities of Male Health Assistant
7. Job responsibilities of Female Health Assistant
8. Job responsibilities of Male Health Worker
9. Job responsibilities of Female Health Worker
10. NHRC recommendations & Karnataka Government’s Response
I. Alma Ata Declaration
The international conference on Primary Health Care meeting in Alma-Ata this twelfth
day of September in the year nineteen hundred and seventy eight, expressing the need for
urgent action by all governments all health and development workers and the worked
community to protect and promote the health of all people of the world, hereby makes the
following Declaration:
1. The conference strongly reaffirms the that health, which is a state of complete
physical mental and social well being and not merely the absence of diseases of
infirmity, is a fundamental human right and that the attainment of the highest
possible level of health is a most important world wide social goal whose
realization requires the action of many other social and economic sectors in
addition to the health sector.
2. The existing gross inequality in the health status of the people, particularly
between developed and developing countries as well as within coutries, is
politically, socially and economically unacceptable and is, therefore of common
concerns of all countries.
3. Economic and social development, based on New International Economic Order,
is of basic importance to the fullest attainment of health for all and to the
reduction of the gap between the health status of the developing and developed
countries. The promotion and protection of the health of the people is essential to
sustained economic and social development and contributes to a better quality of
life and to world peace.
4. The people have the right and duty to participate individually and collectively in
the planning and implementation of their health care.
5. Governments have a responsibility for the health of their people which can be
fulfilled only by the provision of adequate health and social measures. A main
social target of governments, international organization and the whole world
community in the coming decades should be the attainment by all peoples of the
world by the year 2000 of the level of health that will permit them to lead a
socially and economically productive life. Primary health care is the key to
attaining this target as part of development in the spirit of social justice.
6. Primary health care is essential health care based on practical scientifically sound
and socially acceptable methods and technology made universally accessible to
individuals and families in the community through their full participation and at a
cost that the community and country can afford to maintain at every stage of their
development in the spirit of self reliance and self-determination. IT forms as
integral part, both of the country’s health system, of which it is the central
function and main focus, and of the overall social and economic development of
the community with the national health system bringing health care as close a
possible to where people live and work, and constitutes the first element of the
continuing health care process.
7. Primary health care should:
a. reflect and evolve from the economic conditions and socio-cultural and
political characteristics of the country and its communities, and is based
on the application of the relevant results of social, biomedical and health
services research and public health experience.
b. Address the main health problems of the community, providing
promotive, preventive, curative and public health experience.
c. Includes at least: education concerning prevailing health problems and the
methods of preventing and controlling them, promotion of food supply
and proper nutrition, an adequate supply of safe water and basic sanitation,
maternal and child health care, including family planning, immunization
against the major infectious diseases prevention and control of locally
endemic diseases appropriate treatment of common diseases and injuries
and provision of essential drugs.
d.
8. All governments should formulate national policies, strategies and plans of action
to launch and sustain primary health care as part of a comprehensive national
health system and in coordination with other sectors. To this end, it will be
necessary to exercise political will, to mobilize the country’s resources and to use
available external resources rationally.
9. All countries should cooperate in a spirit of partnership and service to ensure
primary health care for all people since the attainment of health by people in any
one country directly concerns and benefits every other country, In this context the
joint WHO/UNICEF report on primary health care constitutes a solid basis for the
further development and operation of primary health care throughout the world.
10. An acceptable level of health for all the people of the world by the year 2000 can
be attained through a fuller and better use of the world’s resources, a considerable
part of which is now spent on armaments and military conflicts. A genuine policy
of independence, peace and disarmament could and should release additional
resources that could well be devoted to peaceful aims and should release
additional resources that could well be devoted to peaceful aims and I particular
to the acceleration of social and economic development of which primary health
care, as an essential part should be allotted its proper share.
II. Concept of Primary health care
1. The concept and dimension of primary health care and also those of health were
clearly defined at the international conference held at Alma Ata in 1978. Health
development should be considered as an integral part of social and economic
development.
2. Health is defined as a state of complete physical, mental and social wellbeing, and
not merely the absence of disease or infirmity. Health is also a fundamental
human right, and therefore the attainment of the highest level of health is a most
important social goal.
3. Its availability should be at a cost which the community and the country can
afford to maintain at every stage of their development in a spirit of self-reliance
and self-development.
4. The primary health care, an integral part of the country’s health system should be
a central function and the main agent for delivering health care. It is the first level
of contact of the individuals, the family and the community with the national
health system, bringing health care nearer to people. This should get full support
in the following areas from the rest of the health system:
a. consultation on health problems
b. referral of patients to local or other specialized institutions
c. supportive supervision and guidance; and
d. logistic support and supplies
III. Essential components of primary health care
For effective primary health care the following eights essential components are to be
implemented in an integrated manner.
a. Education of the people about prevailing health problems and methods of
preventing and controlling them.
b. Promotion of food supply and proper nutrition.
c. Adequate supply of safe water and basic sanitation.
d. Maternal and child health care and family planning.
e. Immunization against major infectious diseases.
f. Prevention and control of locally endemic diseases.
g- Appropriate treatment of common diseases and injuries.
h. Provision of essential drugs.
IV. Flow chart
V. Job responsibilities of Chief Medical Officer
The medical officer of primary health care centre is responsible for providing direction
and guidance in all the health activities radiating from his health centre. His main
responsibilities are divided into five main categories: curative work, preventive work,
promotive work, training and Administrative responsibilities.
Curative Work
1. Organize dispensary, out-patient department and in-patient wards and allot
duties.
2. Make arrangements for the distribution of work in the treatment of emergency
cases which come outside the normal OPD hours.
3. Organize laboratory services for proper diagnosis of doubtful cases.
4. Make arrangements for rendering services for the treatment of minor ailments
at community level and at the PHC through the agency of health assistants,
health workers and health guides, and trained dais.
5. Attend cases referred by health assistants, health workers, health guides and
trained dais.
6. Screen cases needing specialized medical attention and nursing care and refer
them to referral institutions.
7. Provide guidance to the health assistants, health workers, and health guides in
the treatment of minor ailments.
8. Cooperate and/or coordinate with other institutions providing health services
in the Block
Preventive Work
1. Ensure that health assistants, health workers, health guides and trained dais
are fully conversant with the health programs to be implemented in the
villages where they work.
2. Supervise their work regularly, both in the clinics and in the community
setting, and will give them necessary guidance and direction.
3. Visit each sub-centre at least once a week on a fixed day not only to check the
work of the staff but also to provide services and guidance to health assistants,
health workers, health guides and trained dais.
4. During field visits, provide technical guidance to health guides and encourage
them to participate in promotive and preventive health activities.
5. Visit schools in the catchment area at least once a year for medical check-up,
immunizations, health education and follow up treatments.
6. Carry out MCH services by involving health assistants, health workers, health
guides and trained dais in the effective implementation of MCH, family
planning and nutrition programmes.
7. Ensure that all steps are being taken for the control of communicable diseases
and proper improvement of sanitation in the villages.
8. Take necessary action in case of any outbreak in the catchment area.
Promotive Work
1. Organize/participate in village health committee/village panchayat meetings
to discuss health programmes with the public and enlist their cooperation.
2. Keep close liaison with the block development officer and his staff,
community leaders and various social welfare agencies in his are and involve
them tot eh best advantage in the promotion of health programmes.
3. Organize camps, meeting, health education talks and demonstrations, display
of posters, exhibitions and films with the assistance of the block extension
educator, health assistants and health workers.
4. Whenever possible, he will conduct field surveys to identify local health
problems, and then, based on these health problems he will devise a strategy
for effective delivery of health services in his area.
Training
1. He will organize training programmes, including continuing education, with
the assistance of the block extension educator and under the guidance of the
district health authorities and Health and Family Welfare Training Centres
under the multipurpose worker scheme.
I. He will educate the community as to the selection of health guides and will
take necessary steps to train health guides from his area.
3. He will also provide assistance to the health assistants and health workers in
organizing training programmes for indigenous dais practicing in the area.
Administrative
1. Supervise the work of staff working under him.
2. Ensure general cleanliness inside and outside the primary health centre and
also proper maintenance of all the equipment under his charge.
3. Keep the inventory and stock register of all the stores and equipments
supplied to him up-to-date and will be responsible for its correct accounting.
4. Prepare indents for drug, instruments, linen, etc., sufficiently in advance and
will submit them to the appropriate health authorities.
5. Scrutinize the programmes of her staff and suggest changes, if necessary to
suit the priority of work.
6. Ensure the proper maintenance of vehicles under his charge.
7. Prepare and display charts in his office to explain clearly and geographical
area, location of peripheral health units, morbidity and mortality, health
statistics and other important information about his area.
8. Hold monthly staff meetings with his staff for evaluating the progress of work
and suggesting steps to be taken for the further improvements.
9. Ensure the regular supply of medicines to health guides and disbursement of
honorarium to trained dais.
10. Maintain the prescribed records at the PHC level.
11. Receive reports from the periphery, get them complied and submit the returns
regularly to the district health authorities.
12. Keep notes of the field visits he makes in his area and submit every month his
tour reports to the CMO.
13. Discharge all the financial duties entrusted to him.
14. Discharge the day-to-day administrative functions pertaining to the primary
health center.
VI. Job Responsibilities of the Male Health Assistant
The responsibilities of the male health assistant are divided into 13 main categories:
A. Supervision and Guidance
1. Supervise and guide the health worker <male> in the delivery of health center
services to the community.
2. Strengthen the knowledge and skills of the health worker <male>.
3. Help the health worker <male> in improving his skills in working in the
community.
4. Help and guide the health worker <male> in planning and organizing his
programme of activities.
5. Visit each health worker <male> at least once a week on a fixed day to observe
and guide him in his day-to-day activities.
6. Assess periodically the progress of work of the health worker <male> and
submit an assessment report to the medical officer of the primary health centre.
7. Carry out supervisory home visits in the area of the health worker <male>
B. Team Work
1. Help the health workers to work as part of the health team.
2. Coordinate his activities with those of the health assistant <female> and other
health personnel.
3. Coordinate the health activities in his area with the activities of workers of
other department and agencies, and attend meetings at block level.
4. Conduct regular staff meeting with the health workers in coordination with the
health assistant <female>.
5. Attend staff meetings at the primary health centre.
6. Assist the medical officers of the primary health centre in the organization of
the different health services in the area.
7. Participate as a member of the health team in camps and campaign in health
programmes.
C. Supplies and Equipment
1. In collaboration with the health assistant <female>, check at regular intervals
the stores available at the sub-center and indent for and procure the supplies and
equipment in good time.
2. Check that the drugs at the sub-centre are properly stored and that the
equipment is well maintained.
3. Ensure that the health worker <male> maintains his kit in the proper way.
D. Records and Reports
1. Scrutinize the maintenance of records by the health worker <male> and guide
him in their proper maintenance.
2. Maintain the prescribed records and prepare the necessary reports.
3. Review reports received from the health worker <male>, consolidate them, and
submit periodical reports to the medical officer of the primary health center
E. Malaria
1. Give radical treatment to all cases when
when blood
blood smears
malaria.
smears are
are positive
positive for
for malaria.
2. Supervise the spraying of insecticides during local spraying.
F. Communicable Diseases
1. Be alert to the sudden outbreak of epidemics of diseases such as diarrhoeal
diseases, poliomyelitis, infective hepatitis, encephalitis, plague and take all
necessary remedial measures.
2. Take necessary control measures when any notifiable disease is reported.
3. In cases with continued fever, or prolonged cough, or spitting of blood, take
sputum smears and send them for examination.
4. In cases uspected of having leprosy, take skin smears and send them for
examination.
5. Carry out destruction of stray dogs.
G. Environmental Sanitation
1. Help the community in the construction of a) soakage pits; b) kitchen gardens;
c)manure pits; d) compost pits; e)sanitary latrines; f) smokeless chulhas.
2. Supervise the chlorination of water sources including wells.
H. Immunization
1. Conduct immunization of all school going children with the help of the health
worker <male>.
2. Supervise the immunization of all children from one to five years
I. Family Welfare
1. Personally motivate resistant cases for family planning.
2. Guide the health worker <male> in establishing male depot holders for the
distribution of conventional contraceptives and train the depot holders with the
assistance of the health worker <male>.
J. Nutrition
1. Identify case of malnutrition among infants and young children <zero to five
years>, give the necessary treatment and advice and refer various cases to the
primary health center.
K. Vital events
1. Report births and deaths occurring in his area to the medical officer of the
primary health center.
L. Primary Medical Care
1. Provide treatment for minor ailments, provide first-aid for accidents and
emergencies, and refer cases beyond his competence to the primary health center
or nearest hospital.
2. Attend to case referred by the health workers and refer cases beyond his
competence to the primary health center or nearest hospital.
M. Health education
1. Carry out educational activities for control of communicable disesases,
environmental sanitation, MCH, family planning, nutrition, immunization, and the
need for registration of vital events.
2. Arrange group meetings with leaders and involve them in spreading the
message for various health programmes.
3. Organize and conduct training of community leaders with the assistance of
health worker <male>.
VII. Job responsibilities of female Health Assistant
The responsibilities of the female Heath Assistant are divided into 11 main categories.
A. Supervision and Guidance
1. Supervise and guide the health worker <female> in the delivery of health center
services to the community.
2. Strengthen the knowledge and skills of the health worker <female>.
3. Help the health worker <female> in improving her skills in working in the
community.
4. Help and guide the health worker <female> in planning and organizing her
programme of activities.
5^ Visit each health worker <female> at least once a week on a fixed day to
observe and guide her in her day-to-day activities.
6. Assess periodically the progress of work of the health worker <female> and
submit an assessment report to the medical officer of the primary health centre
n
7\farry out suPervisory home visits in the area of the health worker <female>
B. learn Work
1. Help the health workers to work as part of the health team.
2. Coordinate her activities with those of the health assistant <male> and other
health personnel including dais.
3. Coordinate the health activities in her area with the activities of workers of
other department and agencies, and attend meetings at block level.
4. Conduct regular staff meeting with the health workers in coordination with the
health assistant <male>.
5. Attend staff meetings at the primary health centre.
6. Assist the medical officers of the primary health centre in the organization of
the different health services in the area.
7. Participate as a member of the health team in mass camps and campaigns in
health programs.
C. Supplies, Equipment and maintenance of sub-center
1. In collaboration with the health assistant <male>, check at regular intervals the
stores available at the sub-center and help in the procurement of supplies and
equipment.
2. Check that the drugs at the sub-center are properly stored and that the
equipment is well maintained.
3. Ensure that the health worker <female> maintains her general kit and
midwifery kit in the proper way.
4. Ensure that the sub-center is kept clean and is properly maintained
D. Records and Reports
1. Scrutinize the maintenance of records by the health worker <female> and guide
her in their proper maintenance.
2. Maintain the prescribed records and prepare the necessary reports.
3. Review reports received from the health workers <female> consolidate them
and submit periodical reports to the medical officer of the primary health center
E. Training
1. Organize and conduct training for dais with the assistance of the health worker
<female>.
F. Maternal and child health
1. Conduct weekly MCH clinics at each sub-center with the assistance of the
health worker <female>
RuSPiOud to,calls from the health worker <female> and trained dais, and from
the health worker <male> in the twilight area and render necessary help
G. family welfare and medical termination of pregnancy
1. Conduct weekly family welfare clinics <along with the MCH clinics> at each
sub-center with the assistance of the health worker <female>
2. Personally motivate resistant cases for family planning.
3. Provide information on the availability of services for medical termination of
pregnancy and refer suitable cases to the approved institutions
4. 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 worker <female>.
H. Nutrition
1. Identify case of malnutrition among infants and young children <zero to five
years>, give the necessary treatment and advice and refer various cases to the
primary health center.
I. Immunization
1. Supervise the immunization of all pregnant women, and infants <zero to one
year>.
J. Primary Medical Care
1. Provide treatment for minor ailments, provide first-aid for accidents and
03568 beyOnd his comPetence t0 the primary health center
onrearest'hosp1^
2. Attend to case referred by the health workers and refer cases beyond his
comPetence to the primary health center or nearest hospital
K. Health education
1. Carry out educational activities for MCH, family planning, nutrition,
immunization with the assistance of the health worker <female>.
2. Arrange group meetings with leaders and involve them in spreading the
message for various health programmes.
3. Organize and conduct training of community leaders with the assistance of
health worker <female>
4. Organize and utilize mahila mandals, teachers and other women in the
community in the family welfare programmes.
VIII. Job responsibilities of Male Health Worker
The responsibilities of the male health worker are divided into 12 categories
A. Malaria
1. Identify fever cases.
2. Make thick and thin blood films of all fever cases.
3. Send the slides for laboratory examination.
4. Administer presumptive treatment to all fever cases.
5. Record the results of examination of blood films.
tteatmem11 03868 °f P°sitive blood flIms t0 the health assistant <male> for radical
Dear Abhay & Renuka,
Greetings from Community Health Cell!
1. I personally feel that it is better to have a larger number of state representatives
for the July JSA meeting. I would therefore fi$j preference to’ FomTway'
reimbursement, where it is possible for 3 or 4 participants from a state to come.
JSA has been built over all these years through a great degree of contributions of
time, human resource^. However there could be a flexibility and where necessary a
v \^‘y
.
two way fare as suggested could be made available. The National Secretariat could
yVxCV^^:
vC1 . v j-vc 'v make the decisions in consultation with the state groups.
%
cl.r
4
K©vV.'
2. As we have been talking of developing a younger generation to tackle the tasks
before us, in addition to those mentioned?! would like to introduce Shekar Saha
currently working with CINI in Murshidabad district, West Bengal. He did/One
Year community health fellowship with us, during which he showed a great
enthusiasm for JSA/PHM. He worked in Assam for a few months.
3. We have just come back from a meeting of Civil Society Facilitators,
Knowledge Network members and the country stream partners of the WHO
Commission on Social Determinants of Health. This process has started generating
a fair degree of thinking and some action towards reduction of inequalities in
health. Civil Society [elj^fgiftg, PHM yin puts were ffairly sharp and challenging,
keeping the views on the deepe^1 distal determinants of health such as
trade issues,
...............
...... .
IPR, food securities and also on the need for strong public sector health systems.
Some countries sudh as Chile, Brazil, Iran, Norway, Sweden, New Zealand etc are
doing services work in this regard. The Government of India really needs to be
pushed much more. Ms Ganga Murthy , Economic Advisor, Ministry of Health,
attended on behalf of the Government of India. However she had not been/
benefited showing the lack of seriousness by Ministry of Health^ugh she was
defensive. Narendra and Amrit
sure could persuade her and others to initiate
something at least at state level. A
A t
t
During the Pre-NHA II phase, we need to do more sery+ce engagement with
government and the public sector.
/x
Best wishes,
Thelma Narayan.
A
p
7. Educate the community on the importance of blood film examination for fever
cases, treatment of fever cases, insecticidal spraying of houses, larviciding
measures, and other measures to control the spread of malaria
B. Communicable Diseases
1. Identify cases of notifiable diseases, i.e., cholera, plague, poliomyelitis, and
persons with continued fever, or prolonged cough, or spitting of blood, which he
comes across during his home visits and notify the health assistant <male> and
primary health center about them.
2. Carry out control measures until the arrival of the health assistant <male>.
3. Educate the community about the importance of control and preventive
measures against such communicable diseases including tuberculosis
4. Report the presence of stray dogs to the health assistant <male>
C. Environmental Sanitation
1. Chlorinate public water sources including wells at regular intervals.
2. Educate the community on a) the method of disposal of liquid wastes; b) the
method of disposal of solid wastes; c) home sanitation; d) advantages and use of
sanitary type of latrines; e) construction and use of smokeless chulhas.
3 Help the community in the construction of a) soakage pits; b) kitchen gardensc) manure pits; d) compost pits; e) sanitary latrines
D. Immunization
1 . In the intensive area, administer DPT vaccination, BCG vaccination and,
wherever available, oral poliomyelitis vaccine to all children aged one to five
years.
2. In the twilight area, administer DPT vaccination, BCG vaccination and,
wherever available, oral poliomyelitis vaccine to all children aged zero to’five
years.
3. Assist the health assistant <male> in the school immunization programmes.
4. Educate the people in the community about the importance of immunization
against the various communicable diseases.
E. Family Planning
1 ■ Utilize the information from the Eligible Couple Register for the family
planning programme.
2 Spread the message of family planning to the couples in his area and motivate
them for family planning individually and in groups.
3. Distribute conventional contraceptives to the couples.
4 Provide facilities and help to prospective acceptors of vasectomy in obtaining
the services.
&
5. Provide follow-up services to make family planning acceptors in the intensive
area all family planning acceptors in the twilight area, identify side-effects give
treatment on the spot for side-effect and minor complaints, and refer those cases
that need attention by the physician to the PHC/hospital.
b. Budd rapport with the satisfied acceptors, village teachers and others and
utilize them for promoting family welfare programmes.
7. Establish male depot holders in the intensive area and male and female depot
holders in the twilight area. Help the health assistant <male> and health assistant
Dear Abhay & Renuka,
Greetings from Community Health Cell!
1. I personally feel that it is better to have a larger number of state representatives
for the July JSA meeting. I would therefore give preference to a one way
reimbursement, where it is possible for 3 or 4 participants from a state to come.
JSA has been built over all these years through a great degree of contributions of
time, human resources and financial support from member institutions. These
contributions should be encouraged. However there could be a flexibility and
where necessary a two way fare as suggested could be made available. The
National Secretariat could make the decisions in consultation with the state groups.
2. As we have been talking of developing a younger generation to tackle the tasks
before us, in addition to those mentioned earlier, I would like to introduce Shekar
Saha, currently working with CINI in Murshidabad district, West Bengal. He did a
One Year community health fellowship with us, during which he showed a great
enthusiasm for JSA/PHM. He worked in Assam for a few months.
3. We have just come back from a meeting of Civil Society Facilitators,
Knowledge Network members and the country stream partners of the WHO
Commission on Social Determinants of Health. This process has started generating
a fair degree of thinking and some action towards reduction of inequalities in
health. Civil Society (largely PHM) inputs were fairly sharp and challenging,
keeping the -v^s on the deeper distal determinants of health such as trade issues,
IPR, food security and also on the need for strong public sector health systems.
Some countries such as Chile, Brazil, Iran, Norway, Sweden, New Zealand etc are
doing s ^v-ke work in this regard. The Government of India really needs to be
pushed ■fiuch more. Ms Ganga Murthy , Economic Advisor, Ministry of Health
attended on behalf of the Government of India. However she had not been briefed
showing the lack of seriousness by Ministry of Health. Though she was defensive.
Narendra and Am^it, I am sure could persuade her and others to initiate something
at least at state level.
During the Pre-NHA II phase, we need to do more serious engagement with
government and the public sector.
Best wishes,
Thelma Narayan.
<female> in training them, and provide a continuous supply of conventional
contraceptives to the depot holders.
8. Identify male leaders in each village in the intensive area and the male and
female leaders in the twilight area.
9. Assist the health assistant <male> in training the leaders in the community, and
in educating and involving the community in female welfare programmes.
F. Medical termination of pregnancy
1. Identify the women in the twilight area requiring help for medical termination
of pregnancy and refer them to the nearest approved institution.
2. Educate the community on the availability of services for medical termination
of pregnancy.
G. Maternal and child health
1. Identify and refer women with abnormal pregnancy to the health worker
<Female>.
2. Identify and refer women with medical and gynecological problem to the health
worker <female>.
3. Immunize pregnant women with tetanus toxoid.
4. Refer case of difficult labour and newborns with abnormalities to the health
worker <female>.
5. Educate the community about the availability of maternal and child health
services and encourage them to utilize the facilities.
H. Nutrition
1. Identify cases of malnutrition among pre-school children <one to five years> in
the intensive area and refer them to Balwadis/Primary Health Centre for nutrition
supplements.
2. Identify case of malnutrition among pre-school children <zero to five years>, in
the twilight area and refer them to Balwadis/Primary Health Center for nutrition
supplements.
3. Distribute iron and folic acid as prescribed to children from one to five years in
the intensive area and to pregnant and nursing mothers, children from zero to five
years, and family planning acceptors in the twilight area.
4. Administer Vitamin A solution as prescribed to children from one to five years
in both the intensive and the twilight areas.
5. Educate the community about nutritious diet for mothers and children.
I. Vital Events
1. Enquire about births and deaths occurring in the intensive and twilight areas,
record them in the births and deaths register and report them to the health assistant
<male>.
2. Educate the community on the importance of registration of births and deaths
and the method of registration.
J. Record Keeping
1. Survey all the families in his area and collect general information about each
village/locality in his area.
2. Prepare, maintain and utilize family records and village registers.
3. With the assistance of the health worker <female> prepare the Eligible Couple
Register from the family records and maintain it up-to-date.
4. Prepare and submit periodical reports in time to the health assistant <male>.
5. Prepare and maintain maps and charts for his are and utilize them for planning
E
b
his work.
I. Primary Medical Care
1. Provide treatment for minor ailments, provide first-aid for accidents and
emergencies, and refer cases beyond his competence to the primary health centre
or nearest hospital.
J. Team Activities
1. Attend and participate in the staff meeting at primary health center, community
development block or both.
2. Coordinate his activities with the health worker <female> and other health
worker, including the dais in the twilight area.
3. Meet with the health assistant<male> each week and seek his advice and
guidance whenever necessary.
IX. Job responsibilities of Female Health Worker
The responsibilities of the female health worker are divided into 11 categories.
A. Maternal and child health
1. Register and provide care to pregnant women throughout the period of
pregnancy.
2. Test urine of pregnant women for albumen and sugar and estimate hemoglobin
level during her home visits and at the clinic.
3. Refer cases of abnormal pregnancy and cases with medical and gynecological
problems to the health assistant <female> or the primary health center.
4. Conduct about 50 per cent of total deliveries in her intensive area and whenever
called in the twilight area.
5. Supervise deliveries conducted by dais and assist them whenever called in.
6. Refer cases of difficult labour and newborns with abnormalities and help them
to get institutional care and provide follow-up care to patients referred to or
discharged from hospital.
7. Make at least three postnatal visits for each delivery conducted in the intensive
area and render advice regarding care of the mother and care and feeding of the
newborn.
8. Assess the growth and development of the infant and take any necessary action.
9. Help the medical officer and health assistant <female> in conducting MCH and
family planning clinics at the sub-center.
10. Educate mothers individually and in groups for better family health including
MCH, family planning, nutrition, immunization, control of communicable
diseases, personal and environmental hygiene and care of minor ailments.
B. Family Planning
1. Utilize the information from the Eligible Couple Register for the family
planning programme.
2. Spread the message of family planning to the couples in his area and motivate
them for family planning individually and in groups.
3. Distribute conventional contraceptives to the couples, provide facilities and
help the prospective acceptors in getting family planning services, if necessary by
accompanying them or arranging for the dais to accompany them to hospital.
4. Provide follow-up services to female family planning adopters, identify side
effects, give treatment on the spot for side-effect and minor complaints, and refer
those cases that need attention by the physician to the PHC/hospital.
6. Build rapport with the satisfied acceptors, village teachers and others and
utilize them for promoting family welfare programmes.
7. Establish female depot holders, help the health assistant <female> in training
them, and providing a continuous supply of conventional contraceptives to the
depot holders.
8. Identify female leaders and help the health assistant <female> to train them.
9. Participate in mahila mandal meetings, and utilize such gatherings for educaing
women in family welfare programmes.
C. Medical Termination of pregnancy
1. Identify the women requiring help for medical termination of pregnancy and
refer them to the nearest approved institution.
2. Educate the community of the availability of services for medical termination
of pregnancy.
D. Nutrition
1. Identify cases of malnutrition among infants and young children (0 to 5 years),
give the necessary treatment and advice and refer serious cases to the PHC.
2. Distribute iron and folic acid tablets as prescribed to pregnant and nursing
mothers, infants and young children (0 to 5 years) and family planning acceptors.
3. Administer Vitamin A solution as prescribed to children from 1 to 5 years.
4. Educate the community about nutritious diet for mothers and children.
E. Communicable Diseases
1. Identify cases of notifiable diseases, i.e., cholera, plague, poliomyelitis, and
persons with continued fever of prolonged cough, or spitting of blood, which she
comes across during her home visits and notify the health worker <male> about
them.
F. Immunization
1. Immunize pregnant women with tetanus toxoid.
2. Administer BCG vaccination to all newborn infants, and DPT vaccination, oral
poliomyelitis vaccine <where available> and BCG vaccine <if not given at birth>
to all infants (0 to 1 years).
G. Dai training
1. List dais in the intensive and twilight areas and involve them in promoting
family welfare.
2. Help the health assistant <Female> in the training program of dais.
H. Vital Events
1. Record births and deaths occurring in the intensive area in the births and deaths
register and report them to the health worker <male>.
I. Record Keeping
1. Register a) pregnant women from three months of pregnancy onwards; b)
infants zero to one year of age; and c) women aged 15 to 44 years through
systematic home visits in the intensive area and at the clinic.
2. Maintain the prenatal and maternity records and child care records.
3. Assist the health worker (male) in preparing the Eligible Couple Register and
maintaining it up-to-date.
4. Prepare and submit the prescribed periordical reports in time to the health
assistant(female).
5. Prepare and maintain maps and charts for her area and utilize them for planning
her work.
J. Primary Medical Care
1. Provide treatment for minor ailments, provide first-aid for accidents and
emergencies, and refer cases beyond her competence to the primary health centre
or nearest hospital.
K. 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 guides and dais.
3. Meet with the health assistant (female) each week and seek her advice and
guidance whenever necessary.
4. Maintain the cleanliness of the sub centre.
5. Participate as a member of the team in camps and campaigns.
10. NHRC Recommendations for PHC
1. The sitting and distribution and physical accessibility of PHCs and sub centers
must be ensured. They should provide good quality services during the prescribed
timings. They should provide good quality services during the prescribed timings.
Indications and mechanisms for monitoring quality of care need to be developed
and used. No money should be taken for services that are to be provided free. The
Citizens charger for services at PHCs should be prominently displayed and
implemented. Staff vacancies need to be filled up and staff needs such as quarters,
toilets, water supply and electricity need to be insured. Adequate provision of
medicines, laboratory equipment and consumables, registers etc is a basic
requirement. Maintaining staff motivation through good management practices
will help improve the quality of services and to foster a relationship of mutual
respect and trust between providers and people.
2. State and Central health budgets would need to be increased as per the National
Health Policy 2002 and the Common Minimum Programme commitments.
Distribution of the health budget between the primary, secondary and tertiary
level of care would also need to follow norms such as 65%, 20% and 15%
respectively.
3. The urban poor should have access not just to family welfare services but to
comprehensive primary healthcare through health centers, which cater to 50,000
people.
4. The camp approach should not be used for tubectomies/sterilizations. Good
quality, safe contraceptives need to be available in health centers at different
levels, with adequate facilities for screening follow-up and discussion about
possible side-effects. Patient feedback on quality of care should be regularly taken
and acted upon.
5. Medical and health care should be made available to women and children as close
to their residence as possible.
The
6.
department of health at state and central level needs to have structural
mechanisms through which it can function along with other agencies like the
pollution control board, Ministry of Environment and forests etc., to
implement regulatory and preventive measures, and to provide for occupational
health and safety, as well as access to medical care where environmental injury
has occurred. In short there is need for a public health response to environmental
health problems.
7. Rational drug policies, essential drug lists standard treatment guidelines and
formularies need to be adopted in the public and private sector, and more
importantly they should be used and regularly updated.
8. With the rising number of traffic and other accidents early trauma care using
standard protocols need to be ensured through provision of infrastructure and
training. Preventive measures such as use of helmets and seat belts should be
mandatory.
9. Medical and Psychosocial care and support for persons with mental illness should
be available in decentralized manner. This will require adequate training and
continuing education. Public awareness and sensitivity also needs to be increased.
10. National guidelines regarding public health issue need to be followed increasing
community involvement and feeling of community ownership of health institutions
and programme would help in better outreach and quality. Training and involvement
of community health work/social health activities would provide a valuable link.
JANAAROGYA AN DOLANA - (JAAK)
People's campaign towards "Health for all Now"!
( HAIR PERSON
''' L'n ikash Rao
Hunt Convenors
‘' f. Basavaraju-BGVS
i'll. S.Chander- CHC
^f' fovcee Charles - FEVORD K
i 'i .s . f<. fikterajakshi - VHAK
Mi. Ohalesha-NESA
Roopa Batti-FRLHT
PARTNERS
AH India Janvadi Mahila Sanghatane
(AIDWA)
< i immunity Health Cell (CHC)
Hha/at Cyan Vigyan Samithi (BGVS)
('.itholic Health Association of
K.iinalaka (CHA-Ka)
< •'ii'Hian MedicalAssociation of
(CMAI)
/’///</ Action Forum -Karnataka
(OAF K)
‘imily Planning Association of India
UJ
. i.itiun of Voluntary Organizations
11 < ukrng for Rural Development
* unataka- (FEVORD-K)
Foundation for Revitalization of Local
" Fadftions (FRLHT)
lanodaya
A uni Women’s Programme (JWP)
* - notaka State Medical & Sales
R< 7 v esen tativesAssociation
(KSMSRAJ
Karnataka Kolegeri Nivasigala
Samyuktha
^nahatane (KKNSS)
Mahila Samakhya -Karnataka (MSK)
Nt u v Entity for SocialAction (NESA)
I >\'ekananda Foundation (VF)
I'('funtary Health Association of
* > utaka
(VHAK)
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_________________ ,
Address for Correspondence
Community Health Cell, 367, Srinivasa Nilaya, Jakkasandra, I main, I Block, Koramangala, Bangalore - 560 034
Phone : 080 - 2553 1518 Telefax: 2552 5372- E-mail : chc@sochara.org
Bharat Cyan Vigyan Samithi. IISC Campus. Bangalore - 560 012. Phone : 080 293 2395 E-mail: bgvs_kar@hotmail.com
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RF_COM_H_5_C_SUDHA.pdf
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