NEW CONCEPTS OF HEALTH COMMUNITY AND QUESTIONING HEALTH SERVICES IN INDIA
Item
- Title
- NEW CONCEPTS OF HEALTH COMMUNITY AND QUESTIONING HEALTH SERVICES IN INDIA
- extracted text
-
A.
1
THE ECUMENICAL CHRISTIAN CENTRE, WHITEFIELD,B'LORE-16
Seminar on Community Health - 29 January — 1 Feb 1981
REPORT AND RECOMMENDATIONS
The seminar on Community Health, sponsored by the Ecumenical
Christian Centre in January - February was attended by 40 men
and women — doctors, nurses, para-medical workers, representatives
from medical colleges, hospitals and community health workers
involved in tribal, slum and rural areas from all over India. The
seminar affirmed that community health work should be'self dest
ructive' and that it should not be institutionalised. The
community health workers should be prepared to move to fresh
areas at a stage when their services are not required for the
people.
PERSPECTIVES ;
The ultimate aim of the community health work should be
structural changes where in each person's dignity is honoured
and his/her physical, mental, social and spiritual well being
is taken care of.
It should function as a catalyst creating
awareness for structural change at the grass root level as well
as conscientising or even pressurising the power structures. The
poor people should be made aware of the extent of the exploi
tation and oppression and should be motivated to right for
their rights.
APPROACH;
Health work should not be done in isolation from other
development activities. Otherwise it will turn out to be a
hap hazard patch work which postpones the radical change required.
Genuine participation of the people in the health programmes
should ensure decision making by the people at all levels, in
planning and implementation.
Community health programme should
be preventive rather than curative.
the work will ensufe effectiveness.
Periodical evaluation of
COST:
It is high time that community health workers should resort
to cheaper medicines which the community can afford. Indegenous
medicines should be encouraged as far as possible. Awareness
should be created among the medical personnel not to be biased
by the oropoganda of pharmaceutical companies. Young doctors
should be more cost benefit oriented in their therapy. Raising
resistance by correcting the nutritional deficiency by making
use of the locally available food stuffs will go a long way in
preventing disease.
Foreign tree drugs should be discouraged.
2
2
PERSONNEL AN? TRAINING .
The content of the training of the community health worker
should be the simple medical knowledge. Apart from the medical
education they should be' trained how to educate the community
about their rights ancpabout the exploitative nature of the
society at the micro‘/level, The trainee should be a person who
accept the basic perspectives of the programmes. He/she should
have leadership qual/ities. The community health worker who
undergoes training shpui<j be acceptable to the community. They
should be paid a fair v>jage.
'
There is dire need to' change theg present system of
education of the doctors and other medical personnel to make
it relevant to the realities of the/ country.
GOVERNMENT AND OTHER AGENCIES';'
The community health workers should help people to obtain
the maximum benefit from the government.
In the actual health
services their work should complement rather than compete with
the government or other agencies. It is highly essential that
duplication should be avoided at all levels. Co-operation and
common programmes should be encouraged with groups having the
same perspectives.
RECOMMENDATIONS;
l) Bring down the cost of health care and drugs.
II) Indegenous medicine especially the use of herbal medicine
should be encouraged.
Ill) The Christian Medical Association, the Catholic Hospital
Association and the Voluntary Hospital Association should
work together in dealing with the problem of community
health especially in—
1. manufacturing low cost medicines in bulk for the use of
non-profit making service organisations.
2. Central purchasing and distribution of drugs.
3, Research and publications.
IV) A forum should be formed to educate people about the
false propoganda, promotion and use of unnessary drugs
and tonics.
: 5 :
" Loss o~" Initiative : Although it is alleged the human donkey
probably needs, in this state of modern barbarism, seme sort of vegetable
dangled in '■''rant of his nose, these need not he golden carrots; a nosy of
prestige will do as well.
Second: Bureaucracy : This car be checked by democratic control
of organization from bottom to top.
Third : The "r.oortance of the Patient’s Own Selection of a Doctor;
This is a myth; its only proponents are the doctors themselves- not the
patients; Give a limited choice-say two or three doctors, then if the patient
is not satisfied, send him to a psychiatrist! Sauce for the goose is sauce for
the gander - the doctor must also bo given seme measure of selection of
patients! Ninety-nine percent of patients want results, realizing the
inseparability of health from ecancmic security.
Let us abandon our isolation and grasp the realities of the present
economic crisis. The world is changing beneath cur vary eyes and already
the barque of Aesculapius is beginning to 'eel beneath its keel the
great surge and movement of the rising world tide which is sweeping on,
obliterating old landscapes arid, old scones.
ba wrecked.
1'e must go with the tide or
The people are ready for socialised medicine. The obstructionists to
the people’s health security lie within the profession itself as well as
cutside it. 'Recognize this fact. It is the ell-iwooriant fact or the
situation. These men i>dth the nocking face of the reactionary or the listlessneee
of the futflitarian proclaim thoir principles under the guise of "maintenance
of ths sacred relationship between doctor and patient," "inefficiency of other
non-profit nationalized enterprises," "the danger of socialism," "the freedom
of irdividualisn." These are the enemies of the people, and make no mistake they are the enemies of medicine too.
The situation which is confronting medicine today Is a enntost of two
forces in medicine itself.
One holds that the important thing is the
maintenance of our vested historical interest, our private property, cur
monopoly of health distribution. The other contends that the function of medicine
is greater than the maintenance of the doctor’s position, that the security
of the peoples’ health is our primary duty, that we are above professional
privileges.
So the old challenge of Shakespeawe’s character in Henry TV still
rings out across the centuries: "Under which Fing , Bezcnian, stand or die"
CASTS 0Y THE °ECPLE V'SPSHS THE!
DOCTORS
BY
PR. NCFMAN Bl-rMUNE
"Toni ght there has been brough before you the most
interesting’case’ ever presented to this Society. It is- the Cass
of the People versus the Doctors. Tn the problem now under discussion
it is necessary to emphasize that medical men themselves are being
weighed in the balance. Yet ve are acting both as defendant and judge.
That behooves us to apply our minds with the utmost objectivity to
this question.”
That sakes it necessary to bring tho problem back to its
proper setting. Fo~ the health of the nation involves more than the
personal fate of the private doctor. What we have here is an ethical
and. moral problem in the field of social and political economics,
and not. medical economics alone. Medicine must be seen as part of
the social structure.
It is the product of any given social environment.
Every social structure has an economic base, and in Canada that economic
base is called capitalism7,’ avowedly founded on individualism,
competition and private profit.
But this system of capitalism is undergoing
an economic crisis - a deadly disease requiring systemic treatment.
And here a problem presents itself with special urgency. There are
those who are trying to treat tho systemic disease as if it is only a
temporary illness.
They are doomed to failure.
The palliative measures suggested by most of our political quacks
are like aspirin tablets given for a syphilitic headache.
relieve; they never will. cure.
They may
Medicine is a typical, loosely organized, basically individualistic
industry in this "catch as catch can" capitalistic system operating as a
monopoly on a private profit basis. How, it is inevitable that medicine
should undergo rauch the same crisis as the rest of tha capitalistic world
and should present much the same interesting and uncomfortable phenomena.
This may be epitomized as "poverty of health in the midst of scientific .
abundance in a country of disease."
Just as thousands of people are
hungry in a country which produces more food than the neople can consume
(we even burn coffee, kill hogs and nay farmers not to plant wheat and
cotton), just as thousands are wretchedly clothed though the manufacturers can
makn more clothing than they can soil, so millions are sick, hundreds of
thousands suffer pain, and tens of thousands die prematurely through lack
of adequate medical care, whiph is available but for which they cannot
pay.
’ ‘
.Tnab^Hy to purchase iP cenbinad with poor distribution. The
economics ^3 a part of the problem of world economics
vjfrom it.
an we aro practising it
is a luxury trade.
We are sealing bread at the price of Jewels.
The r>oor,
who emprise fifty ner cent of our population, cannot pay, and starve; we,
the doctors, cannot sell and suffer. The people have no health protection
and we have no eccnnaic security.
aspects of this problem.
This brings us to the point of the two
There are in this country three great economic groups; first,
the ecmfortable; second, the uncomfortable; third, the miserable. Tn
the upper bracket are those who are moderately uncomfortable and insecure;
and in the lower, those vast masses, not in brackets but in chains, who
are living cn the edge of the subsistence level. These people in the
in the lower income class are receiving only one-third of the home, office
and clinic services from physicians that a fundamental standard of health
requires.only fifty-five per cent of as many cases are being hospitalized as
an adequate standard would prosciil^e, and only fifty-four ner cent of as
many days are being spent in hospitals as are desirable.
Tn short, one has to suffer a major surgical catastrophe to have
even approximate adeffiate care. The report of the fommittee on the Cost of
Medical Care (American Medical Association) showed that Z6«6^ of people
whose income is loss than $1200 a year received no medical, dental or
eye care whatsoever in a year.
Tf this combined with those whose income
is $10,000 or more (ll.tf# of such persons received no similar care) we
are faced with the appalling fact that 38.2/S of all people, irrespective of
income, received no medical, dental or eye care whatsoever.
of tills alarming state of affairs ?
What is the cause
First, financial inability to pay is
the major cause; second, ignorance; third, apathy; fourth, lack of medical
service.
I’lhormous accumulation of scientific knowledge has made it practically
impossible for any one man to have an entire grasp of even the facts- much
less their application.- of the aim total of medical knowledge. This
has brought specilization in concentrated centers of copulation. The
general practitioner, unsupported by specialists, knows that he cannot give
the people their money’s worth, yet the financial cost of specialization bars
many from proceeding to such fields. The necessity to make money after a
a difficult financial struggle to pay for medical education drives the
young doctor too often into any form of remunerative work, however uncongenial
it say be. There he is, caught ip in the coils of economics, from which not
one in a thousand can ever escape.
The Tee for service is very disturhint
: 3 :
morally to practitioners.
The natient. is frequently unable to appraise
correctly the value of the doctor's’ service or disservice. Perrot
snd Collins in 1933, in an investi.gation of 9130 familiea in America,
found the depression poor had a larger incidence of illness than *ny
other group, A£so that 611' of all physicians* calls to such a class were
free, that 33* of calls to the moderately comPortable were free, and
that 26* of calls to oven those ccrifortably well off were not naid for.
Permit mo a ftew categorical statements, for dogmatism has a certain
role in ths realm of vacillation :
The best form of providing health protection would be to change the ecoi
-nd.c system which produces ill health, and to liquidate ignorance,
poverty and unemployment.
The practice of each individual purchasing
his own medical care does not work. It ie unjust, inefficient, wasteful
and e.onpletoly outmoded. Doctors, private charity and philanthropic
institutions have kept it alive as long as possible.
Tt should have
died a natural death a hundred years ago, with the coming of the industrial
revolution in the opening years of the 19th century.
Tn our highly geared,
modem industrial society there is no such thing as private health - all
health is public. The illness and naiad justnents of one unit of the mass
effoctsall other mentors. The protection of the people’s health should be
recogrdzed by the. Government as its primary obligation and duty to its
citizens.
Socialized medicine and thn abolition or restriction of private
practice would appear to be the realistic solution of the problem.
let us
take the profit, the private economic profit, ot of medicine, and purify owr
profession of rapacious individualism.
Jet us make it disgraceful to
enrich ourselves at the expense of the miseries of our fellow men. Let us
organize ourselves so that we can no longer be exploited as we are being
exploited by cur politicians.
Let us redefine medical ethics - not as a code of professional
etiquette between doctors, but as a code of fundamental morality and justice
between medicine and the people.
♦
In our medical- societies, let us discuss more o'ten the great
nrofcras of our age and not merely interesting cases; the relationship of
medicine to thn State; the duties of the profession to the people; the
matrix of economics and sociology in which we exist. Let us recognize
that our most important contemporaneous problems are economic and social
: A :
and not merely technical and scientific in the narrow sense that we
eranlcy the words.
Medicine, Tike any other organization today, whether it ba the
Church or the Bar, is judging its leaders by their attitude to the
fundamental social and oeorvsnic issues of the day. We need fewer
leading physicians and famous surgeons in. modern medicine and more
farsighted, Bceially-iTORgirative statesmen.
The. medical uro'c ssi.cn must - as the traditional, historical and
altruistic guardians of the people’s health - presort to the Government
a complete, comprehensive program of planned medical service for all ths
people. Then, in whatever position t;h-> profession finds itself after
such a plan has been evolved, that position it must accent. This apparent
irrniolatian as a burnt offering on the altar of ideal public health will
result in the pretension rising like a glorious Phoenix from the dead
ashes of its former self.
Medicine Mist bo entirely reorganized and unified, welded into a great
army or doctors, dentists, nurses, technician/* and social service workers,
to make a collectivized attack on disease and utilizing all the present
scientific knowledge of its members to that end. Let us say to the people
- not "now much have yei got?" - but, "Hew test can we serve you?" - not
Socialized medicine means:
First, that health protectiorilfecomns public property, like the post office,
the. array, the navy, the judiciary and the school.
Second, that it is supported by public funds.
Third, that service is available to all, not according to income but
according to need.
Charity must be abolished and' justice substituted.
Charity debases the donor and debauches the recipient.
Fourth, its workers am to be -paid by the State, with assured salaries
and pensions.
Fifth, there- should bo democratic self-government by the health workers
themselves.
Twenty-five years ago it was though contewtible to be called a socialist.
Today it is ridiculous not to be one.
Medical foforms, such as limited health insurance schemes, are not
socialized raodicino. They are bastard foias of socialism produced by
belated humanitarianism out of necessity.
The three major objections which the opponents of socialized medicine
eittphasizc am :
S 5
L?rst : Lobs of Tm'tiative : Although it is alleged the human donkey
nrobably needs, ir this state of modem barbarlma, acme sort of vegetable
dangled in •"'rent of his nose, these need not he golden carrots; a posy of
prestige uiU do as well.
Second; Rumauemcv ? rahin car be checked by democratic control
of organization from bottom to top.
Third : The Importance of the Patient* s Own Selection of a Doctor;
This is a myth; its only proponents are the doctors themselves- not the
patients. Give a limited choice-say two or three doctors, then if the patient
is not satisfied, send him to a nsychiatristi Sauce for the goose is sauce for
the gar/’er - the doctor must also be given some measure of selection of
patientsI Ninety-nine nercent of patients want results, realizing the
inseparability of health from economic security.
Let us abandon our isolation end grasp the realities of the present
economic crisis. The world is changing beneath our very eyes and already
the barque of Aesculapius is beginning to feel beneath its keel the
great surge and movement of the rising world tide which is seeming on,
obliterating old landscapes odd old acenes.
bo wrecked.
L'e must go with the tide or
The poOnle am ready for socialized modidne.
The obstructionists to
the eeqnle’s health security 1 io within the profession itself as wall as
outside it. 'Recojjnize this fact. It is the nll-iwnortant fact Of the
situation. These men with the necking face of the reactionary or the listlessmss
of the utilitarian proclaim their nrlncinles under the guise of "maintenance
of the sacred relationship between doctor and patient," "inefficiency of other
non-profit nationalized enterprises," "the danger of socialism," "the freedom
of individualism." These are the enemies of the naonle, and make no mistake -
they are the enemies of medicine too.
The situation which is confronting medicine today is a contest of two
forces in medicine itself.
One holds that the important thing is the
maintenance of our vested historical interest, our private property, our
monopoly of health distribution.
The other contends that the function of medicine
is greater than the maintenance of the doctor* s position, that the security
of the peoples’ health is our primary duty, that we are above professional
privileges.
So the old challenge of Shakespeare's character in Henry TV still
rings out across the centuries: "Under which King , Bezonlan, stand or die"
pl
F^2»tl
£-5H
■I <*ru, iad <<t,\ cz^r b cj-i.<^f,' wo/^j
Cv5 '4 11 'y
■7t:
Q£
,
<? ? ^c< o y
u^p^n
If L^>t' <-<C? crTz'. L-g? g) ^■7 \^_f os’/O,M
/”7 ‘t'W
Z. 7
? 7
o<-
S7
A?
( bl d/)
y-7) %»°«¥Z
/ / h! t"'mrrv
Lt
(bLbO
t-'-icn £iszx~- !''$.
It
£9
/9
°9
4Z.Jb' 'I
9Z
b-!"
hr
(ll'ol)
ft
It
^9
tat/c/n
^QPd
LS
h/
;M '<>7<<U'^
'•fll'y^rl
c<zuer>^>
79
bl
['■.>:> yyozryj
'yl'd
Id
<H
-1-^
h$
CAZO4*'-C?ip< >Cr;
L<
£&
r£
fl
ojd^f-/
j^rripsUgf -■$ Jo? ‘ U-'d l/J OJ-L’^.j
£‘
bh
r.
S|»jp<-oH |S( -’u.w?j2
jT^/^9
!^ ' b/.yi
■tL-y^bi
<ynoy7tzT3^-f J c^aez<Yic>-j
?
Id 11 — l_.h
I 570 9 3 S C^)^>L^-y
" !*?/?*
c
. (, ~ •^i-* ^/ _ fx,.
b ,|'^?-ypu^r <-^p?qpL>'“'/"
>> I, p
C/P)
°9 - 596/
L.
^■ 9- ^hh'
^/l
-f^ir'Q' ■ z >/
9
^-i~i
'h
7O-3jj 1^1-07 ,ll'7ru-,c‘
O7^^7
„
Ih
Qb
t
^r-
7 (//■!
(^.^Lb) 2L
)y £
(bld 7Z. h!) 1 " '
fy""'i^> -7
ij. !
Q'b k> I 4^5
L 2_
~r <■'!->
(-!Wj'ir)
7d^-
-1'
~7 I
PcrLo S'*.
ko.C*C<
cj
Sr
7.2
Oce-yj
73k
CPl-f .
7X^3 ?ooe — P>;
y
/-f-Cc.\ //A >fcicxcaXen P-fericjs
16
/tc.e:b?z7/-S
7C
77
77era. <4
16
C>H
^HVV^yV'
(_rZ‘~^ 1-an^imc.i
Puji'LpjljZ.o
Tj
l&xtuPic^r
6'0
To x icaic^j r Ho TArcU,
P-i-
p^‘
H
Toxicol^' /'<edLcoi PPoPa
62.
/-/d
V V/-- .
"7—
PHZ
TX/ii
7
' '<-*
I OX /
crLuO e’oo e
o<r C^yQ c> /<c->o c<i
i6
C6> i-t
66
C>Z7 L>T <C /"l-CzTTi'c C J X<t<s£xi,o'6l2jo - / A-«i-o t>T
C6 ri~
£7
y
^7
"S e»A w (as_ i-o
/-henjo ■■
i f~>
I'r'L-~'——^---ic-j ~ Sy ,'r>pc? > i^-'f~>
7o
b
6;Z.
,z
,
h CIO 1
C'i4
• r cXzJ't Co k • /3^zr? C>T)
l HOi-r
I
Qcm^nn^-j
-/97<i j ‘6’
,z
/'<iA4*C. IS.
7.
6o
61
P<3C^>T
<72
P» O --
Sezr^ootzv r A.-oycci' 6cc<cl^loz^
Per^j^i "Seemly — '/c^.w
_______ ____________
6^1.
L-o.
^6
/\f i ai+ - /7A
^1
66
ctljlji
3
y.
6
GHi
TEACHING FILES - T SERI ES
Teaching Programme Planning
T -
1
T -
2
•
Teaching Programme Until 1976
T -
3
■
Teaching Programme since July 1978
T -
4
T -
5
•
Internship Programme
T -
6
•
Student Conferences/Seminars
T -
7
-
Field Visits
T -
8
-
Practicals/Records
T -
9
•
Examinations/Evaluations
■
Extension Programmes
T -10
internship Handouts
Health Centre Project Reports
T - 11
T - 12
-
Overseas Student Programme
T - 13
•
Chains - Simulation Game
Harijan stories (SEARCH)
T - 14
T - 15
-
monsoon Came (SEARCH)
T - 16
T -'l7
Chikkanahalli -• Simulation Game
■
Occupational Health Survey Forms
T - 18
Research Protocols
T - 19
Karnataka State Council for Science
& Technology Report
T - 20
-
Audio-visual aids - Catalogues
T - 21
-
Rook catalogues
T - 22
-
Louis Baretto’s Papers
T - 23
Bibliographies
T - 24
•
Bio—: datas
T - 2S
■
Chikkanahalli Uork Sheets (filled)
T - 26
■
R.O.P. Organisation
T - 27
•
R.O.P. Student Evaluations
T - 28
R.O.P. Projects 1980
T - 29
R.O.P. Projects 1981
T - 30
■
R.O.P. Projects 1981
-2-
T - 31
—
R. O.P. notice Soard
T - 32
-
rallur Papers (Gen/sW)
T - 33
*
Medical Education (R’J)
T - 34
-
Papers by Dr.David llackay
T - 35
-
Goa Workshop Papers (OH)
T - 36
-
FICCI Workshop Papers (Rural Development)
T - 37
—
UH workshop Papers (Alternatives in
Development)
T - 38
-
1AI3H Conference Papers
T - 39
-
Student Vacation Projects
T - 40
-
Pathology Handouts
T - 43A
-
grain Drain Papers
T - 41
-
Study Tour (Occupational Health)
T - 42
-
Hisce Han sous Papers (study Tour)
T - 43
-
Soilepsy Seminar Papers
T - 44
-
Conference (Economic Planning)
T — 45
-
DTnH Programme
T - 46
—
DIH Programme
ROSS INSTITUTE FILE! - R SERI ES
1
•
Ross Institute Link up
2
P^b^it<t^n^HsAlt-h~^&risi)__^--
3
Community Health on Plantation
4
Community Health Seminar
5
Plantation Medical Records
6
-
Health management workshop
7
Pesticide Toxicity Papers
8
Epidemiology seminar (riunnar)
9
P.M.O. 1st Refresher Course Report
10
-
Primary Health Care in Plantations
(Conference 1978)
11
Handouts of Medical Advisor
12
Handouts of Medical Advisor
13
•
Handouts of Medical Advisor
Link workers Scheme Handouts
14
15
-
Medical Advisor (Papers)
16
-
UPASI Programmes Evaluation
17
Child Care in Plantations
(Conference 1979)
18
CLWS Reports
19
P.M.O. Course Pathology Handouts
20
-
Health Fane gement Seminar 198D
21
-
Occupational Health Institutions (INDIA)
Reports
22
•
Occupational Mental Health (HH Seminar)
23
-
Management Seminars (P.m.il. Course)
24
-
Plantation Labour - Reports
25
-
Plantation Health - District Reports
26
-
Economics of Tea - Report
27
-
UPASI Proformas
29
Pesticides in Plantations
29
P.M.O.’s Course - Information Sheet
30
Ross Institute Handouts
1
-2-
R - 31
R - 32
Ross Institute Hyderabad (Archives)
•
R - 33
Neurological Emergencies (P.H.O. Course Papers)
Shunt Feed Chlorinators
R - 34
-
Water Seminar Report
R - 35
■
Water Seminar Report
R - 36
•
Water Seminar ftandouts
R - 37
•
Water Seminar standouts
R - 38
•
Food Hygiene Course
Programmes
R - 39
Food Hygiene Course Question Papers
R - 40
Plantation Chronicle Health Issues
R - 41
.
Plantation Labour Act
R - 42
■
'Handouts on Bangalore Industries
(Public Sector)
R - 43
•
bibliography on Occupational Lung Disease.
Interns T.A.T. Based on Hopkins Project
R - 44
R - 45
•
Intorns attitude Survey (Case studies)
R - 46
•
Conference on Social Aspects of medical
Education in India (Nov. 1977)
FILING INDEX
ROSS UNIT
(R- Series)
(S. J. M. C.)
Shelf
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31,
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
I
Rosse Unit - link up (Background)
Ross Unit Archives - I (1974-83)
Ross Unit Archives - II (1974-83)
LLoyd Jones Report - 194
(Plantation Health)
R.I. Bulletin - Rabies/l-lalariCv (1940 ) Sanitation
Ross Unit Reports - 1948-54
Ross Unit Reports - 1955-60
Ross Unit Reports - 1961-70
London School Reports - 1966-71
London School Reports - 1974-81
London - Prospectus of Courses
TUC - Occupational Health Institute Reports
UPASI CLWS Reports 1971-74
UPASI CLWS (Munnar) Reports
Planters Chronical - Health Issues
Ross Unit - SJMC Handouts
R.I. Hyderabad Archives
Plantation Medical Records
PHO course Information sheet
Community Health Seminar (Nilgiris) 1974.
PMO’s Refresher Course (I) Handouts (1977)
PMO's Management Workshop (1977)
PMO's Pathology Handouts (1977 )
PMO's Management Seminar IIM (1977)
PMO's Course Report
1977
Water & Epidemiology Seminar (Munnar)
1977
PMO’s Conference (1978) Primary Health Care
PMO's Refresher Conference (1979) Child Care
PMO's Refresher course II - 1979
PMO's Seminar on Health Management (1980)
Occupational Health and Mental Health in Industry Course (1977)- IIM
Water Seminar 1981 (Proceedings.)
Water Seminar 1981 (Technical Notes)
Water Seminar 1981 (Technology Information)
shunt Feed Chlorinators
BEL Handouts Reports
I T I Handouts / Reports
H.M.T Handouts / Reports
HAL Handouts / Reports
Internation Instrument Reports
Leslico Safety Equipment Diary
Hygifie Equipment Catalogues
Hygine Equipment Catalogues
Tatas Industrial Health Service Report
Safety Equipment Catalogues
Indian Industry Review - 1978
IIM Courses / Handouts
2
2
SHELF
II
48. Industrial House Journals / Handouts
(Foregn)
49. Industrial House Journals / Handouts
(Indian)
50. Agro chemicols - product information
51. Agro Technology — product information (Tea factory)
52. Rubber Reports
53. Cardamom Reports
54. Tea Reports
55, Plantation Labour (Note)
56. Link Worker Schemd - Handouts
57. UPASI Handouts for PMO’s
58. Dr. Mackays Papers
59. UPASI Medical Advisers papers
60. UPASI- CLWS Handouts
61. Occupational Health Medical Records
62. Occupational Health Legislation (India)
63. Occupational Health Legislation (U.K.)
64. Occup Lung Disease
65. Occupational Cancers
66. Occupational Dermatits
67. Skin Protection - Product informecion
68. Environmental Pollution
69. Monitoring Environment - ROHE Seminar 1983
70. Neise Hazard
71. Lead Poisoning
72. Occup. Lung Disease - Bibliography
73. Occupational Health Education Materials
74. Occupational Health Teaching Aids/Books Catalogue
75. Occupational Health Rehabilitation / Training - U.K.
76. Industrial /accidents
77. Road Safety Handouts / studies
78. Occupational Health General Principles (RN Personal)
79. Toxicology and Hazards K-E (RN Pexsonal)
80. Toxicology and Hazards M-Z (RN personal)
81. Toxicology - Medical Data A-Z
82. Toxicology Hazard data A-Z
83. Occupational Eye disease
84. Occupational Health Service in Hospitals
85. Occupational Health in chemical Industries - Thesis
86. Occupational Health Training - Sumposium 1970
87. Sickness Absenteeism
88. Occupational Hdalth Practicals: Demonstration Materials
89. IAOH Conferences - 1976 / 1977
90. KSCST
Seminar and Project Guidelines
91. KSCST Reports
92. Bio-Medical Engineering - Reports
93. Royal Society - Year Books
Rcxv-?'
S94.
SHELF
94.
95.
96.
97.
98.
99.
100.
101.
102.
103.
III
Central Labour Institute Reports
Central minhg Research Station Reports
NIOH - Ahmedabad Reports
Work Physiology Studies
Pesticide Studies
Pneunoconicsis Studies
Trade Unions
Food hygiene Course Papers
Food Hygiene Course Programmes
Food Hygiene Papers SJMC hostel (Dr. Dara Amar)
• •3
V
1Q4.
Food Handlers project reports
DRHSTP
(ft P Series)
SHELF
P1
P2
P3
IV
What we Believe in
CHW Information Sheet
CHW Btochures
List of Superios / Bishops
SJMCH Brochure
College Prospectus
CHW Handouts
Biodates
Mallur Paper Chains - SEARCH
game
SEARCH - Hard.j an Story
SEARCH - Chikkanahalli exercises
SEARCH - Monsoon game - Car
SEARCH
- Monsoon scenauio worksheets
Rop material
participation assessment farms
Communication exercise
5
6
24
25
26.
27.
28
29.
30
31
32
33
34
35- 47
Cl^r>ice- 48
Search Quest
GOVERMMEisT OF KARMAIhKA
DJEARffiiEM 1 OF HEALTH & FAMILY NliiFAke ^aRVICES
SHORT COi-lIhuL a LHORI I'Aluo IN THE IMFLEIlNIATION
OF £x£LHa 11Y HuAlTH CaRE ■SLAVICKS,
1,
H^-iLlH &. F» uOalE :
The Health &FW goals as spelled out under National
Health policy is of much helpful to the States to
devise their own goals and judge the progress made.
However these goals have concentrated almost entirely
on
’Health status’ indicators.
As-, against these
indicators many of the States may not be in a position
to indicate their level of achievement to all the
indicators.
Further there are certain indicators
against which the letel of achievement cannot be
indicated in the usual situations but require special
studies or surfcey.
Such indicators needs thorough
^vamination to include them or not.
''here may be some other areas where a particular state
might have progressed very well.
Hence,
there is a
need to include some of the socio-economic indicators
like provision and quality of health care including
institution & Heal th. Manpower status, consolidation
of the infra-structure,. safe water supply, adult
literacy rate etc.,
2
- 2 HEALTH IN jRASThUC'iURE:
2.
During the previous three, 5 year plan period, population
norms has been the criteria for establishing the rural
health infra-structure.
This is most convenient and
reasonable.
■ >•'
There may be certain regions in plain areas where the
prescribed population might have spread over wide areas
where in people have to travel long distances for
availing the health care facilities from the institutions.
In such instances there is a need to consider 'distance
factor’ also while establishing the health institutions
especially Primary Health Centres.
3,
0 ON STRUG 11 ON OF HEALTH INSTITUTIONS:
Compared to the cost of the construction of building
recommended by Planning Commission and the actual cost
being incurred by the State, it can be said that, there
is a difference which can be observed from the following:
(Rs. in lakhs)
i
I
1
1
ISub Centres
j£HCs
Plg.Commn.
recommendati on
(unit cost)
1r25
1.00
3.00
■J
|CHCS
i
10.00
Actual cost being
'incurred by State
(uni t'cost)
6.90
(including qrts)
25-30
3
■
1
_I
!
;
'
-
~
unless an alternative to bring down the cost is devised,
it is likely that the completion of the building will be
a long drawn process.
Because of the poor progress in
respect of building works in the State the Planning
Commission has recommended nearly 87% of the budget
under
for construction, of buildings in the 1990-91
Annual Plan Budget.
The State will.have to decide the future course of action
whether to bring down the cost of construction of buildings,
or continue as usual.
This is' to be considered as a
future policy matter.
4•
*GJE 0M1MG og
HEALTH CBNTKBS:
2HCS play a vital role in the delivery of primary health
care services.
There arc various factors involved in the
effective functioning of Primary Health Centres.
(i) Residential quarters:
The Medical Officers of
Primary Health Centres staying always in th<.
headquarters and av&ilablc for long hours
to.the people for providing services
determine- the'quality of.services ' given
by these institutions.
■The- State'so far could only provide
residential’'quarters at mere a quarter no.
of PHC locations & the remaining are without
provision of quarters requiring huge funds,
the position is likely to continue in
future, al so.
4
- 4 > (ii) Mobil! ty: Due to expansion of health
infrastructure all these years,
sufficient funds are not allocated
to provide vehicles to all the health
institutions either for early arrival
of the Medical Officers & the staff
or for better field work & supervision.
The position is likely to. continue
unless some efforts are made by the -State.
(iii) Professional equipments & reading materials:
It is observed that when once the
doctor report to work in rural areas
there will be meagre chances to
utilise the professional equipments
either due to lack of opportunities
oi’ equipments themselves.
Further,
there will be no opportunities to
update their knowledge because ' of
non-availability of reading materials
like- periodicals, magazines, reports
etc., There is a heed to look into
these aspects and improve in future.
(iv)
Management Training:
The holding of
continuing education training progra
mmes has definitely provided opportu
nities to update the knowledge of
inservice doctors to some extent. But
those who are fresh from College
after graduation will not be in a
position to manage health institutions
in rural areas unless they are given
....5.
(
atleast 2-3 months training in
'Health Management' immediately
after recruitment before actually
posting them at rural hospitals.
5•
The
mobile
TRAINING WITS:
1 Health Sector 1 consists of huge manpower berth
technical & non-technical.
Although there arc few
training centres to impart continuing education pro
grammes, it has not become possible to bring a fast
turn over of all the candidates, atleast opcc in
3-5 years for updating the knowledge in health field.
It is an important short coming in the Statu.
The
Statu has also recognised the need of such Mobile
Training Units at District Level to train the Medical
and para-medical on '4s is where is basis'.
This is
to be considered for future policy.
6.
FP.HCI ALIS1 AT COMMUNITY HEALTH CENTRES :
The concept of a' Community Health Centre is to provide
better referral services in the rural areas.
To meet
this objective the staff pattern includes four specia
lists of physician, surgeon, obstetrics & (Gynaecologist
and a Poadiatrician, one among them trained or qualified
in Public Health.
This typo of staff pattern calls
for posting of candidates with proscribed' qualification
...6.
- 6 -
to provide the. desired services.
As many of these CHCS
arc located at Taluk hc-adquarts(urban) which will bo
having basic facilities, the doctors of Assistant Surgeon
or Deputy Surgeon rank will manage to get postings at
these institutions irrespective of qualification and thus
it is observed that there is a gross " mal-distribution"
of special! sts because bf non creation of posts with
Unless such designated posts
/
arc guaranteed and the qualified candidates work against
specialist designation.
such posts, the qualitative roferal services cannot exist
in the Communi ty Health Centres': - Realising this important
problem,
the- department has formulated the proposals and
it is under active consideration of the, Government.
It is feared; that there will be problems also in future
regarding the promotions of the specialist cadres.
Hence,
this needs to be examined carefully.
7.
WORKER (MALE) AT SUB C EMIRES:
As per the National Guidelines of the State should
achieve 100% requirement of sub centres at the end of
7th five year plan.
Each Sub Centre should have one
Health Workdr(Female) and one Health Worker(Male) to
provide basic heal th care services.
Karnataka State
required 7025 Sub Centres based on projected rural
population. by 1990.
As against this the- State has, on
7
- 7 -today 7793 Health Worker (Female) almost working in
the designated Sub Centres with itinerary work and the
remaining i’.,w working in taluk level and other institutions
withou’; i . .nerary work.
With reg.id to Health Worker (Male) we have as on today
5556 srncti n< ■1 posts requiring nearly additional 1500
posts t-„ b^ created.
At the present rate of pay scales
it is estimated that nearly Rs.300/- lakhs is required
p<-r annum towards salaries, if these posts arc newly
created.
When the funds are meagre to meet the basic
requirement to the already established institutions,
Should w; still go on creating the posts or should we
enhance the allocation of population for the Health
Worker(Male) from present 5000 to 7500-8000.
This is well justified as far as Karnataka State is
cone -T'd, in vi^w of 'Leprosy Eradication' having made
as a vi r ti cal programme and 'Malaria Eradication' has
b c on sa ti sfac to ry.
There will be no set back if Karnataka State adapts
this as a policy to enhance- the- allocation of population
to the Health Worker(Malo).
The present five- Heal ih^Family Welfare Training Centres
will be able to turnover 300 candidates every year to
fill up vocancies falling due to retirement etc.
8
- 9 Hv-alth Engineering, but still the education, guidance,
utility monitoring, feed back, availability of services
etc., should be looked after by the
' health sector '
through the locally placed district health system. This
is possible only by way of establishing a sanitary wing
with most essential staff under District Health System
to take stock of the availability of water, quan tity,
quality and quality control, utility, improvement of
sanitary facilities including availability of sanitayy
latrines, construction, maintainc-nce and education in
basic sanitation etc., in rural areas.
10.
POOR EMPHASIS ON SUPPORTIVE ACTIVITIES?
The -World Health Organisation has recommended various
supportive activities which on one side for strengthening
the eight elements of Primary Health Care & on the other
side to strengthen the Health Care System.
Although there has been good progress in the implementation
of the schemes and establishment of Health System, some
areas like health service research, appropriate technology,
referral support, leadership for Health for all, have
not received due individual attention so far.
This is
due to lack of nodal cell exclusively for
Primary Health Care System development at the State1cvcl.
Further, unless these areas arc accepted and politically
committed as a policy, there will not be success stories
in Primary Health Bare System Development.
* * *
Drugs in Small f;ural_H. .
; A repliminary study
ital '
Note; Tic]; where in>.;icatcd
A.
General Description of hospital
1.
State in which hospital located;
2.
Bed strength;
3.
Staff position (specify number and grades);
4.
5.
a.
Medical Officer
b.
Nurses
c.
Others
■•■•■50
Facilities available
a.
Laboratory
b. X-ray
c.
Pharmacy
d. O.T.
Patient load - numbers seen in last year.
a.
6.
?'25
-<25
Out-patients;
b. In-patients:
Commonest disorders seen (top 5 only)
Medical
Obst St Gynae
Paediatric
Surgical
OPD
______ - - IPD
B.
Drug Availability (range and type)
7.
How many drugs are available in your pharmacy?
a.
tablets/capsules:
b.
Injections:
c.
Syrups/liquids;
d.
Skin/eye/ear;
e.
Total
p.t.o..
2
2
8.
9.
What are the brands you stock in the following categories
(Mention brand names (company names in brackets) eg,,
Baralgan (Hoechst))
a.
Antibiotics
b.
Analgesic/antipyretic
c.
Anti-inflammatory
d.
Antidi a rrhoeals
e.
Steroids
f.
Ho rmona1 preparations
g•
Psychotropic drugs
h.
Anti-histaminics
i.
Cough syrups
j.
Tonics/Vitamins
k.
Skin prcparations
1.
Non-allopathic druas
73r~ combinations')
m.
Food substitutes
n•
Eye/ear preparations
»
What fixed-drug combination drugs do you stock in the
following categories?
a.
Antibiotics
b.
Vitamins with other drugs
c.
Steroids with other drugs
d.
Antihistaminics with others
. . .3
3
C.
D.
Drug selection/Purchase/Priclnq
10.
Who selects drugs in your hospital?
11.
What are all the criteria for selection?
12.
Do you purchase -
a.
whole sale;
b.
by generic names
retail;
or
through medical representative
brand names?
13.
Do you purchase any drugs in bulk? Specify.
14.
Do you prepare any medicines/mixtures/ointments in
the hospital? Specify.
15.
Do you get drugs donated from abroad?
(Mention names and sources).
16.
How do you price your medicines?
(What percentage formula over wholesale-retail price)
a.
Injections;
b.
Tablets/capsules;
c.
Vaccines?
d.
Samples:
e.
Foreign drugs:
Dispensinq/Prescribing
17.
What categories of staff in your hospital a. prescrilc?
1-. dispense?
18.Do you have a trained pharmacist?
19. Does your hospital dispense drugs in any of the following
situation? If so, in each one (a) who prescribes? (b) who
dispenses?
(c) is there a standardised list for each level
a.
Mobile clinics
(a)
(b)
(c)
b.
Village Health Centre/Sub-Centre
(a)
(b)
(c)
c.
School/Hostel/infirmary
(a)
(b)
(c)
d.
Rehabilitation Centre
(a)
(b)
(c)
What is the regime you follow in your hospital for the
treatment of (specify brand names of drugs) -
20.
a.
Malaria
b.
Tuberculosis
c.
Diarrhoea in children
aDo
21.
b.
you have any policy about use of expired drugs?
If you use
some beyond the expiry date, which are these?
ct.For how long beyond expiry date do you use them?
5
22.
Do you use any drugs as Placebos?
Yes/No
If yes, which are the commonest and
for what situation?
23.
Are you aware o. th- drugs banned }a<
July 19837
Government in
Do you have a b*r '.-.d brand list?
Have you weeded th:se drugs out of your hospital?
information
E•
24.
25.
F.
a.
Product literature
- Yes/No
b.
Drug company handouts
- Yes/No
c.
Any other sources
Do you have in your hospital -
a.
formulary;
b.
list of minimum/essential drugs; and
c.
standardised drug regimes?
Adverse Reactions
26.
G.
How do you/your staff get information on drug indications/
doses/side effects.
Have you had any adverse reactions with drugs in your
practice in the last one year?
YES/NO
If yes, specify:
Drug Budget
26.1
What is the annual expenditure on drugs in the last
financial year?
26.2
Did the pharmacy run at a loss or a profit?
If so, how much during that year?
LOSS/PROFIT
6
H.
Additional Infomation
27.
Have you taken any initiatives in recent times to
rationalise the prescribing/dispensing practices
in your institution?
What are they?
How successful have you been?
28.
If there are any other problems/issues that you
have come across with your hospital, please
mention them here.
29.
Have you identified any forms of irrational prescribing,
over-prescribing, under-prescribing or wrong prescribing
of the medical practitioners in your area through
prescriptions your patients may have brought with them?
Give details.
7
7
30.
Are there any pressing drugs issues on which you would
like reliable information?
31.
Do you have any suggestions for issues/problems that
should be discussed/considered at the workshop? Mention
3
C’
D.
Drug selection/Purchase/Pricino
10.
Who selects drugs in your hospital?
11.
What are all the criteria for selection?
12.
Do you purchase -
a.
whole sale;
b.
by generic names
’ x
retail;
or
through medical representative
brand names?
13.
Do you purchase any drugs in bulk? Specify.
14.
Do you prepare any medicines/mixtures/ointments in
the hospital? Specify.
15.
Do you get drugs donated from abroad?
(Mention names and sources).
16.
How do you price your medicines?
(What percentage formula over wholesale-retail price)
a.
Injections;
b.
Tablets/capsules;
C.
Vaccines:
d.
Samples;
e.
Foreign drugs;
Dispensinq/Prescribing
17.
What categories of staff in your hospital -
a. prescribe?
b. dispense?
4
18.Do you have a trained pharmacist?
Does your hospital dispense drugs in any of the following
situation? If sc, in each one (a) who prescribes? (b) who
dispenses? (c) is there a standardised list for each level?
19.
a.
Mobile clinics
(a)
(b)
(c)
b.
Village Health Ccntre/Sub-Centre
(a)
(b)
(c)
c.
School/Hostel/infirmary
(a)
(b)
(c)
d.
Rehabilitation Centre
(a)
(b)
(c)
What is the regime you follow in your hospital for the
treatment of (specify brand names of drugs) -
20.
a.
Malaria
b.
Tuberculosis
c.
Diarrhoea in children
aDo
21.
b.
you have any policy about use of expired drugs?
If you use.
some beyond the expiry date, which are these?
cc..For how long beyond expiry date do you use them?
5
22.
Do you use any drugs as Placebos?
Yes/No
If yes, which are the commonest and
for what situation?
23.
Are you aware of the drugs banned by the Government in
July 1983?
Do you have a banned brand list?
Have you weeded these drugs out of your hospital?
E.Drug information
24.
25.
F.
a.
Product literature
- Yes/No
b.
Drug company handouts
- Yes/No
c.
Any other sources
Do you have in your hospital -
a.
formulary;
b.
list of minimum/essential drugs; and
c.
standardised drug regimes?
Adverse Reactions
26.
G.
How do you/your staff get information on drug indications/
doses/side effects.
Have you had any adverse reactions with drugs in your
practice in the last one year?
YES/NO
If yes, specify;
Drug Budget
26.1
What is the annual expenditure on drugs in the last
financial year?
26.2
Did the pharmacy run at a loss or a profit?
If so, how much during that year?
LOSS/PROFIT
6
H.
Additional Information
27.
Have you term any initiatives in recent times to
rationalise t'.e prescribing/dispensing practices
in your intit ution?
What are they?
How successful have you been?
28.
If there are any other problems/issues that you
have come across with your hospital, please
mention them here.
29.
Have you identified any forms of irrational prescribing,
over-prescribing, under-prescribing or wrong prescribing
of the medical practitioners in your area through
prescriptions your patients may have brought with them?
Give details.
.7
7
30.
Are there any pressing drugs issues on which you would
like reliable information?
31.
Do you have any suggestions for issues/problems that
should be •discussod/considercd at the workshop? Mention.
Drugs in Small Hural Hos-ital
: A repliminary study ' “
Note; Tick where indicated
A. General Description of hosoitai
1.
State in which hop_-itai located;
2.
Beo strength;
3.
Staff position (specify number and grades);
4.
5.
a.
Medical Off io .r
b.
Nurses
c.
Others
•■-50
"'25
Facilities avail-bio
a.
Laboratory
b. X-ray
c.
Pharmacy
d. C.T.
x •
Patient load - numbers seen in last year.
a.
6.
-~_25
Out-patients;b. In-patients.
Commonest disorders seen (top 5 only)
Medical
Obst & Gynae
Paediatric
Surgical
OPD
IPD
B. Drug Availability (rance and type)
7.
How many drugs are available in your pharmacy?
a.
tablets/capsules:
b.
Injections;
c.
Syrups/liquids;
d.
Skin/eye/ear;
e.
Total
p.t.o....2
2
8.
9.
What are the brands you stock in the following categories
(Mention brand names (company names in brackets) eg.,
Baralgan (Hoechst))
a.
Antibiotias
b.
Ana Igos i c./ a n t. ipy retie
c.
Ant i -:j
d.
Antidia rr p_-_al_s
e.
Steroids
f.
Hormonal preparations
g•
Psychotropic drugs
h•
Anti-histaminics
i.
Cough syrups
j.
Tonics/Vitaniins
k.
Skin preparations
1.
Non-allopathic drugs
(or combinations)
m.
Food substitutes
n.
Eye/ear preparations
What fixed-drug combination drugs do you stock in the
following categories? ,
a.
'Antibiotics
b.
Vitamins with other drugs
c.
Steroids with other drugs
d.
Antihistaminics with others
3
3
C”
Drug selection/:;’cl,a sq/p/jcine
10.
Who selects : rugs in your hospital?
11.
What are all the criteria for selection?
12.
Do you purchase -
a.
whole sale;
b.
by generic names
retail;
or
through medical representative
brand names?
13.
Do you purchase any drugs in bulk? Specify.
14.
Do you prepare any medicines/mixtures/ointments in
the hospital? Specify.
15.
Do you get drugs donated from abroad?
(Mention names and sources).
16.
How do you price your medicines?
(What percentage formula over wholesale-retail price)
a.
Injections;
b.
Tablets/capsules;
c.
Vaccines;
d.
Samples:
e.
Foreign drugs*.
D. Dispensing/Prescribing
17.
'What categories of staff in your hospital a. prescribe?
b. dispense?
4
18.Do you have a trained pharmacist?
Does your hospital dispense drugs in any of the following
situation? If so, in each one (a) who prescribes? (b) who
dispenses?
(c) is there a standardised list for each level?
19.
a.
Mobile clinics
(a)
(b)
(c)
b.
Village Health Contre/Sub-Centre
(a)
(b)
(c)
c.
School/Hostel/infirmary
(a)
(b)
(c)
d.
Rehabilitation Centre
(a)
(b)
(c)
What is the regime you follow in your hospital for the
treatment of (specify brand names of drugs) -
20.
a.
Malaria
b.
Tuberculosis
c.
Diarrhoea in children
aUo
21.
b.
you have any policy about use of expired drugs?
If you use
some beyond the expiry date, which are these?
c.For how long beyond expiry date do you use them?
I
5
22. Do you use any
::rvgs as Placebos?
If yes, which a
for• what situat.1
23.
Are "ou a- ar
July*1983"
•_ /
Yes/No
he commonest and
.i -
’ -jos t i, ec bv ’ !r; Government in
Do you have a banned brand list?
Have you weeded these drugs out of your hospital?
E•Drug information
24.
25.
How do you/your staff get information on drug indications/
doses/side effects.
a.
Product literature
- Yes/No
b.
Drug company handouts
- Yes/No
c.
Any other sources
Do you have in your hospital -
a.
formulary;
b.
list of minimum/essential drugs; and
c.
standardised drug regimes?
F. Adverse Reactions
26.
Have you had any adverse reactions with drugs in your
practice in the last one year?
YES/NO
If yes, specify;
G. Drug Budget
26.1
What is the annual expenditure on drugs in the last
financial year?
26.2
Did the pharmacy run at a loss or a profit?
If so, how much during that year?
LOSS/PROFIT
7
30. Are there any p
ng drugs Issues on which you would
like reliable in 'or:?tion'?
31. Do you have any suggestions for issues/problems that
should be discussed/considered at the workshop? Mention.
2£?jag„in Small Rural Hcs _ital
: A repliminary study
Note; Tick where indicated
A• General Description of hospita1
1.
State in which, hospital located;
r *
'
2.
Bed strength;
3.
Staff position (specify number and grades);
-^25
a.
Medical Officer
b.
Nurses
c.
Others
:v50
7-25
e
4• Facilities available
a. Laboratory
b. X-ray
c.
d. O.T.
Pharmacy
5. Patient load - numbers seen in last year.
a. Out-patients;
b. In-patients;
6o Commonest disorders seen (top 5 only)
Medical
Obst Ll Gynae
!
Paediatric
OPD
1
1
i
i
__________________ i________________
IPD
I
1
1
1
J
p
Surgical
.
-
_ _ - -
B. Drug Availability (range and type)
7.
How many drugs are available in your pharmacy?
a.
tablets/capsules;
b.
Injections;
c.
Syrups/liquids;
d.
Skin/eye/ear;
e.
Total
p.t.o....2
2
8.
9.
What are the brands you stock in the following categories
(Mention brand names (company names in brackets) eg.,
Baralgan (Hoechst))
a.
Ant i b i o t i cs
b.
Analgesic/antipyretic
c.
Anti-inflammatory >
d.
Antidiarrhoeals
e.
Steroids
f.
Ho rmonal preparations
g•
Psychotropic drugs
h.
Anti-histaminics
i.
Cough syrups
j.
Tonics/Vitamins
k.
Skin preparations
1•
Hon-allopathic drugs
(or combination's)
m.
Food substitutes
n.
Eye/ear preparations
What fixed-drug combination drugs do you stock in the
following categories?
a.
Antibiotics
b.
Vitamins with other drugs
c.
Steroids with other drugs
d.
Antihistaminics with others
3
3
c-
Drug selection/Purchase/Pricing
10.
Who selects drugs in your hospital?
11.
What are all the criteria for- selection?
12.
Do you purchase -
a.
whole sale;
b.
by generic names
retail;
or
through medical representative
brand names?
13.
Do you purchase any drugs in bulk? Specify.
14.
Do you prepare any medicines/mixtures/ointments in
the hospital? Specify.
15.
Do you get drugs donated from abroad?
(Mention names and sources).
16.
How do you price your medicines?
(What percentage formula over wholesale-retail price)
a.
Injections;
b. Tablets/capsules;
c.
Vaccines;
d.
Samples:
e.
Foreign drugs;
D. Dispensinq/Presc.ribin2
17.
What categories of staff in your hospital -
a. prescribe'
b. dispense?
4
18.Do you have a trained pharmacist?
19.
Does your hospital dispense drugs in any of the following
situation? If so, in each one (a) who prescribes? (b) who
dispenses?
(c) is there a standardised list for each level?
a.
Mobile clinics
(a)
(b)
(c)
b.
Village Health Centre/Sub-Centre
(a)
(b)
(c)
c.
School/Hostel/infirmary
(a)
(b)
(c)
d.
Rehabilitation Centre
(a)
(b)
(c)
20.
What is the regime you follow in your hospital for the
treatment of (specify brand names of drugs) -
a.
Malaria
b.
Tuberculosis
c.
Diarrhoea in children
aDo
21.
b.
you have any policy about use of expired drugs?
If you use-
some beyond the expiry date, which are these?
cc.For how long beyond expiry date do you use them?
5
22. Do you use any drugs as Placebos?
Yes/No
If yes, which are the commonest and
for what situation?
23. Are you a jure
July 19837
art r-
: c
Government in
Do you have a banned brand list?
Have you weeded these drugs out of your hospital?
E.Drug information
24. How do you/your staff get information on drug indications/
doses/side effects.
a.
Product literature
- Yes/No
b.
Drug company handouts
- Yes/No
c.
Any other sources
25. Do you have in your hospital -
a. formulary;
b. list of minimum/essential drugs; and
c. standardised drug regimes?
F. Adverse Reactions
26. Have you had any adverse reactions with drugs in your
practice in the last one year?
YES/NO
If yes, specify;
G. Drug Budget
26.1
What is the annual expenditure on drugs in the last
financial year?
26.2
Did the pharmacy run at a loss or a profit?
If so, how much during that year?
LOSS/PROFIT
6
H. Additional Infer a :ion
27.
Have you taken any initiatives in recent times to
rationalise the prescribing/dispensing practices
in your institution?
What are they?
How successful have you been?
28.
If there are any other problems/issues that\you
have come across with your hospital, please
mention them here.
29.
Have you identified any forms of irrational prescribing,
over-prescribing, under-prescribing or wrong prescribing
of the medical practitioners in your area through
prescriptions your patients may have brought with them?
Give details.
.7
»
7
30. Are there any pres -ing drugs issues on which you would
like reliable infoxibation?
31. Do you have any suggestions for issues/problems that
should be discussed/considered at the workshop? Mention.
Small dural Hospital
” A repliminary study
Note: Tick where jn<Sic at cd
A• General-Pesoription of ho sp it a1
1- State in whicl
hos-ital located:
Be(S strength:
3.
Staff position (r.y
4.
5.
”25
<.25
2.
a.
Medical Officer
b.
Nurses
c.
Others
••’50
;ify number and grades);
Facilities available
a.
Laboratory
c.
Pharmacy
b. X-ray
v
d. -0.T.
Patient load - numbers seen in last year.
a.
Out-patients:b. In-patients;
6. Commonest disorders seen (top 5 only)
Medical
Obst & Gynae
Paediatric
Surgical
OPD
__________
_________________________
IPD
-
B.
„
Drug Availability (rance and type)
7.
How many drugs are available in your pharmacy?
a.
tablets/capsules:
b.
Injections:
c.
Syrups/liquids:
d.
Skin/eye/ear:
e.
Total
p.t.o....2
2
8.
9.
What are the brands you stock in the following categories
(Mention brand names (company names in brackets) eg.,
Baralgan (Hoechst))
a.
Antibiotics
b.
Analgesic/’ n; ipyrctic
c.
Anti-in: ' ~.m: ’ ton
d.
Antidiarrh.o .-als
e.
Steroids
f.
Ho rm on al preparations
g.
Psychotropic drugs
h•
Anti-histaminics
i.
Cough syrups
j.
Tonics/Vitamins
k.
Skin preparations
1.
Non-allopathic drugs
Tor combinations)
m.
Food substitutes
n.
Eye/ear preparations
Vfhat fixed-drug combination drugs do you stock in the
following categories?
a.
Antibiotics
b.
Vitamins with other drugs
c.
Steroids with other drugs
d.
Antihistaminics with others
. .. . .3
3
C.
Drug selection/Purchase/Pricinq
10.
Who selects drugs in your hospital?
11.
What are all the criteria for selection?
12.
Do you purchase -
a.
whole -sale;
b.
by generic names
retail;
or
- through medical representative
brand names?
13.
Do you purchase any drugs in bulk? Specify.
14.
Do you prepare any medicines/mixtures/ointments in’
the hospital? Specify.
15.
Do you get drugs donated from abroad?
(Mention names and sources).
16.
How do you price your medicines?
(What percentage formula over wholesale-retail price)
a. Injections;
D.
b.
Tablets/capsules;
c.
Vaccines;
d.
Samples:
e.
Foreign drugs:
Dispensinq/Prescri bing
17.
What categories of staff in your hospital -
a. pres or : '
b. di opens e?
I
4
18.Do you have a trained pharmacist?
19.
Does your hospital dispense drugs in any of the following
situation? If sc-, in each one (a) who prescribes? (b) who
dispenses? (c) is there a standardised list for each level?
a. Mobile clinics
(a)
(b)
(c)
b.
Village Health Centre/Sub-Centre
(b)
c.
School/Hostel/infirmary
(b)
d.
Rehabilitation Centre
(a>
(b)
What is the regime you follow in your hospital for the
treatment of (specify brand names of drugs) -
20.
a. Malaria
b. Tuberculosis
c.
aJ9o
21.
Diarrhoea in children
<
you have any policy about use of expired drugs?
b. If you use
some beyond the expiry date, which are these?
■•
I
Ci .For- how
long beyond expiry date do you use them?
' 4•>
;
5
22. Do you use any drugs as Placebos?
Yes/No
If yes, which are the commonest and
for what situation?
2-3. Are you aware of the drugs banned by the Government in
July 1983?
Do you have a banned brand list?
Have you weeded these drugs out of your hospital?
9
E•Drug information
24.
25.
How do you/your staff get information on drug indications/
doses/side effects.
a.
Product literature
- Yes/No
b.
Drug company handouts
- Yes/No
c.
Any other sources
Do you have in your hospital -
a. formulary?
b. list of minimum/essential drugs; and
c.
F.
Adverse Reactions
26.
G.
standardised drug regimes?
Have you had any adverse reactions with drugs in your
practice in the last one year?
YES/NO
If yes, specify:
Drug Budget
26.1
What is the annual expenditure on drugs in the last
financial year?
26.2
Did the pharmacy run at a loss or a profit?
If so, how much during that year?
LOSS/PROFIT
6
H.
Additional Information
27.
Have you taker any initiatives in recent times to
rationalise t'.c prescribing/dispensing practices
in your institution?
What are they?
How successful have you been?
28.
If there are any other problems/issues that you
have come across with your hospital, please
mention them here.
29.
Have you identified any forms of irrational prescribing,
over-prescribing, under-prescribing or wrong prescribing
of the medical practitioners in your area through
prescriptions your patients may have brought with them?
Give details.
7
30.
Are there any pressing drugs issues on which you would
like reliable information?
31.
Do you have any suggestions for issues/problems that
should be discuss-d/ccnsidered at the workshop? Mention.
l3_pAISE_F0R_YQUR health.
How much money does the government spend on your health? Given
below in repees are the per capita expenditure incurred by each
state on health.
1974-75
1975-76
Nagaland
Pondicherry
Goa, Taman & Biu
Arunachal Pradesh
Meghalaya
Sikikm
Himachal Pradesh
Punjab
Jammu & Kashmir
Manipur
Kerala
Maharashtra
Rajasthan
Tripura
West Eengal
Haryana
Karnataka
Tamil Nadu
Gujarat
80.84
38.84
35.20
«•
18.52
—
17.10
12.34
15.77
16.20
12.87
13.52
12.11
11.09
9.78
9.99
8.81
9.81
8.57
75.84
50.04
47.59
43.12
24.81
23.06
19.36
17.88
17.02
16.98
14.12
13.41
13.27
13.22
12.31
11.19
11.26
10.94
10.68
ALL INCIA
9.44
10.63
Assam (including Mizoram)
Orissa
Andhra Pradesh
Madhya Pradesh
Uttar Pradesh
Bihar
9.56
6.93
7.85
8.38
5.08
4.09
10.27
9.13
8.86
6.98
5.36
4.46
State/U.T.s
But if you are in the villages your share dwindles further.
As Dr.M.P.f.'iangudkar, Chairman of the committee appointed by the
Government of Maharashtra to study the state of health services
in Maharashtra reported, out of the total health expenditure of
Rs.156 million by the Government in the state, 80% was spent on
3 cities - Bombay, FUne and Nagpur; 6.2% was spent on the district
towns; 4.5% on the villages and 0.9% on the tribal areas. Per
capita per year health expenditure in the village was 13 paise.’
— <2
6K^<aJC
o tj
4
<T"a
fT^-e; ~e ^
—^C.(^
lUU* Id
I?
^keliuux.
Ay
aQ.
bjiol’-ig.
9^21
ERI1WY HEALTH CARE
Primary Health Care is essential health.care made
universally accessible, to individuals and families
in the cormunity by moans accejtable_to them, through1
their full particiration and at a cost that the
Community and country can afford. It forris an
integral part both of the country's health system
of which it is the nucleus and of the overall
social and economic development of the community.
Primary Health Care addresses the main health problems in
tile connunity, providing pro-motive, preventive, curative and rehabili
tative services accordingly. Since these services reflect and evolve
from the economic conditions and social values of the country and its
connunities, they will vary by country and conriunity, hut will include
at least: promotion of proper nutrition and an adequate supply of
safe water; basic sanitation; natcrnal and child care, including family
planning; immunization against the major infectious diseases; prevention
and control of locally endemic diseases; education concerning prevailing
health problems and the methods of preventing and controlling then;
and appropriate treatment for common diseases.and. injuries.
In order to make Primary Health Care universally accessible
in the conr.iunity as quickly as possible, maximum community and individual
self-reliance for hath development are essential. To attain such selfreliance requires full coiTrrunit.v_participation in the planning, prgapization and management of Primary Health Care> Such participation is
best mobilized through appropriate education which cna' les corrwnitics
to deal~withthoirrosl heal th problems in the most suitable ways.
They will thus be in a better posticn to take rational decisions
concerning Primary Health Core and to -make sure that the right kind
of support is provided by the other levels of the national health
system. These other levels have to be organized and strop' thened h
so as to support Primary Health Care with technical knowledge,
II
training, guidance and supervision, logistic support, supplies,
II
information, financing, and referral facilities.bi.nclfninjfinsti- “
tutions to which unsolved problems and individual patients can be
referred•
Primary Health Care is likely to be most effective if it
employs means that arc understood and accepted by tho corn"unity and
applied by community health workers at a cost tho community and the
country can afford. These community health workers, including tradi
tional practitioners where applicable, will function best if they
reside in the community they .serve and Sire properly .traj ned socially
and technically to respond to its expressed health needs.
Since Primary Health Care is an integral part both of
the country's health, system and of overall oconoric and social
development, without which it is bound to fail, it has to be
coordinated, on a national basis with the other levels of the health
system as well as with, the other sectors that contribute, to a
country's total development strategy.
@ @ e @ ©
10 - point declaration on health
NEW DELHI, Sept. 20. - The declaration of Alm Ata approve:’ 1; the
world conference on primary health care early this month says that an
acceptable level of health can be attained for all the people by
2000_A.D. through a. fuller use of the world’s resources part_cf"w:.j.d'
are now spent on armaments.
According to a press release by the World Health Ci’ganisatron,
the declaration approved unanimously by delegates from 140 nations and
numerous non-governmental organisations ’’calls for urgent ar.. effective
international and national action to develop and iw.pli.-.cnt yimrary
health care throughout the world and particv.la.rly in ciovcloping
countries."
The 10 points of the Alma Ata declaration ago
(l) Health, which is a state of complete physical, mental
and social, well-being and not merely the absence of disease or infir
mity, i s a fundamental human right.
(2) The existing_grosc_; ncpuality in the health, status of the
people, particularly between developed and developing countries is
economically unacceptable and is. therefore^ of common concern to all
countries.
~Econo.. ‘ic and social..development, based on a new international
(3)
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.
(4) The people ligyo the right ..and„du^ito_^rticimtc individually
and collectively in the planning and implementation of their health care.
(5) Governments hove a r.c^syonsibili;tp for the her 1th of their
people which can be fulfilled only by the prqyisior cf adequate health
and social measures. A main social target of Governments, inter
national organisations and the whole world community in the.- coming
decades should be the attainment by all peoples of the world by 2000 A -D •
of a love], of health that trill permit them to lead a socially and
economically productive life.
11 i jICE.AL
PAR 7
(6) Primary health care is essential health care ’ asci on
practical, * scientific.-- lly soundyand socially acccptal lc_ i v /thcds_ and
technology made universally accessible to individuals and families in
the community through their full participation and at a cost -tliat 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 an integral part both_of the country’s health system, of which
it is the central function and main focus, and of"thc over-all social
and economic development of the co. munity.
(7) Prir.iary health care reflects and evolves from the economic
conditions and socio-cultural and politial charotcristies of the
country and includes at least education concerning prevailing health
problems and -the methods of preventing_and_ controlling then.'
~
2
(8) All Governments should formulate national policies, stra
tegies and plans of action to launch and sustain primary health care as part
of a comprehensive national health, system and in co-ordination .with
other sectors.
(9) All countries should co-operate 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.
(10) An acceptable level of health can be a ttained for all the
people of the world by 20C0 A.D. through a fuller- and bettor use of the
world's resources, a.considerable..partj_o£ which.arc. nowspcnt_on
armaments and military conflicts .-EH.
(a)
@/ @/ @
M3*/28978/
CHAPTER
9
INSTRUCTIONS
FOR
COMMUNITY HEALTH WORKERS
CHW-C I
Vital Event?
Vital events refer r.o events which affect life such as birth and death.
The reporting of births and deat ns in vill ges is done by the village chowkida
dais, and ether loaders of the oommufiity including yourself.
9.1
Report all births and deaths in his/her area to the Health Worker(Male)
In the course of your visits to the homes, enquire whether any births or
deaths have occurred since your last visit. Make a note of these births and
deaths in your diary and inform the Health Worker(Male) about them on his
next visit to your village. Giv? the Health Worker(Male) the exact address
so that he can visit the house and collect the necessary data about births
and deaths.
912
Educate the community about the importance ef registering all births
and deaths
You should impress upon the community that it is essential to register
every birth and every death in the village for the following reasons s
Information about the births occurring in a village helps the Health
Workers to plan for the provision of services to the newborn babies
and their mothers both at home as well as at the Subcentre
2. Death registration is necessary because it can help to find out
whether any deaths have been due to communicable diseases so that
the necessary measures can be taken to prevent further deaths
1.
3.
The registration of deaths will help to irlcntify <nd investigate
those deaths occurring during pregnancy and within 40 days of
delivery as well as deaths occurring in the newborn, i.e. within 28
days after birth. This information can bo usod to plan improvements
in maternal and child health services.
4.
Registration of births and deaths is also necessary in order to assess
the birth rate, the death rate, the growth of population and the age
distribution ofthe population. This information helps in planning
for the needs of the population in terms of education, health care,
food,housing, employment and social welfare.
////////
LAL BAR'ADW HEALTH TYfinWCE SOW1?
ATI'S AND QPJHCTTVFS
1.
To make health care possible by the people.
2.
To provide low cost medical care.
3.
To foster unity and self help.
4.
To make each one responsible for their own health, and thus build
up a'^oaTthy community.
POLICY
1.
A policy should be drawn up by the Committee and it should be made
clear to every member before starting the Scheme.
2.
This policy can be revised as and when needed with the consent
cf the general body.
Membership Fee (M.F)
3.
The present membership fee is Rs.2/- per family per month. This
can be revised as and when needed with the consent of the General
body.
4.
The M.F. should be paid between the 5th and 10th of every month*
It can also be paid once a year as Rs.24/- or Rs.6/- every three
months. Rut the date should be same.
The fees can be paid by cash or kind (market rate) or by both.
5.
Pass-Book should be maintained for each family.
6.
The pass book should contain the following details.
(a) The name of the family members (Husband, Wife and Children
who are not married) should be entered.
If it is a joint family with unmarried brothers, sisters
and parents of the head of the family, it should be registered
as a separate family.
(b) The fees should be entered clearly and correctly in the
pass book.
(e) In the same way the date of the visit, name of the medicine
given by the health workers «r in the dispensary and the
total cost should be entered.
7.
Maximum benefit for a family per year will be upto a) value of
Rs.100/- of medicines. .Once they exceed this amount they should
pay the full cost.
8.
Selection of membersi
Before registering the family, all the members of the family should
have a physical examination and the children below ,5 years should
have small pox, BCG, DPT, Polio Cholera and Typhoid Vaccination.
All the members should have small pox, Cholera, Typhoid Vaccination
every year. If they fail to have the vaccination and get any of
these disease all the expenses should be met by the family.
2.
• 2 :
9.
Any one who gets sick should cone for treatment; immediately t«
avoid unnecessary expense.
10t During the physical examination if any one is found to have a serious
disease, such as, heart disease, paralysis, deformity, fracture,
diabetes, serious TH cases, the family can become a member, but
that particular patient should be treated by a specialist and the
expenses should be met by the family. (As a health Insura.nce
member a reccmmenda.tion letter can be obtained from the President
of the Lal Bahadur Co-operative Society or Sister-in-charge,
St. Philomena’s Hospital).
11.
The following diseases can be treated under the Scheme:
1) Common Piarrhoia
2) Cold, Cough, Fever
3) Ordinary aches and pains.
4) Anaemia and malnutrition
5) Common Stomach problem
6) Early stages of TB and chronic cases if it is not too severe
(provided thny continue the treatment for two years regularly).
If they don't takent^e treatment -regularly then they will be out
from the Inruronce benefit (i.e) should'pay for the treatment.
Ordinary cuts, wounds and sores.
Sore eye & ear infections.
Scabies.
Asthma or Peneumonia if not too advanced. If any of these above
diseases by chance becomes serious and needs to go to hospital
a letter of recommendation will be given but the expenses will not
be mot under the Scheme.
11) Normal deliveries will be conducted.
12) Complicated, cases should be taken to the hospital.
13) Treatment during pregnancy will be given under the Scheme.
7)
8)
9)
10)
DEFAULTERS
The membership will expire 30 days after the due date. (All the
benefits also will be closed). After the date of exniry they will
cease to be a member. Whatever amount has been deposited will not be
refunded. If they ,Tant to be members again they have to join as a new
member. But if they have received their total benefit of Rs.100 for
that year no benefit will be give till the next year. If they had partial
partial benefit, the resis will be given to them for the total year.
11 .
To those families who had never benefited from any medical care
during the year a health shield will be presented by the
Officials at the annual meeting.
12.
The treatment will be given by the health workers as far as
possible.
13.
Most of the deliveries will be conducted by the trained midwife.
14.
Financial report rill be prepared and presented every 3 months
to members.
Application to CXFAM for the -braining of Basic Health
Workers and for Health Insurance Scheme of Dhamara Phimanapally
Background information
I.OCATTDM: It is a Village in Devarakonda Taluk of Nalgonda District
in Andhra Pradesh. It also belongs to Nalgonda Diocese.
PO~liJLATTQ]J: Dhamara r'hirjanapally has 3 villages with a population of
3,500. The names of the villages are Dhamara Bhirnanapally, Karmaguda,
and Lambadi Tanda.
SOCIO HCOHO’IC CrTTTTTOP; Tn Karmaguda is agriculture, and in the other
two villages agriculture and othev types of Labourers. For about
6 to 7 months a year the people are occupied, the rest of the vear the
work depends upon the cultivation and rains. The Average income of a
labourer family is Rs. °0 - 100 if both husband and wire get a job, and
the average size of a family is about 6 members.
The main crops are Jawar and Cash Crops like Tobacco, Chillies
and Caster seeds. The crons depend unon the rains. There is no
possibility of digging wells due to the rocky land, also (PH) and
fluride content of the water is very high. Hence it is not good for
cultivation. The peonlo are very poor. The average land holding is
about 5-10 acres but due to draught cultivation is not possible, hence
most of the people are in debt even if they have land.
HEAT TH COMDIT1!ON; The I igh content of fluoride in the water is a big
public health problem'. Most of the children suffer from Calcium
deficiency and deformity of bones. Women after 2-3 pregnancies
suffer from Osteomalacia, which is a biv public health problem, Men
also suffer from the same. Other diseases are nutritional deficiency
diseases such as
Anaemia,
Protein Malnutrition,
Vitamin 'A' Deficiency
Vitamin 1P' Deficiency
Diarrhoea,
Fever,
Typhoid,
Gastric Ulcors,
T.B. (almost one in every family),
Scabies, eye infection and other common and seasonal diseases.
There are no medical facilities in these villages except a
small dispensary run by the Sisters. The nearest health centre, is
16 k.M. away in Marriguda. The nearest Hospital is in Nalgonda which
is 50 K.M. also Devarakonda which is 50 K.M. away. These villages
are A - 5 K.M. away from the main road. There is no bus service from
the villages to the main road. The patient has to be carried or taken
in a bullock cart to reach the main road. There are no regular bus
services, except three or four times a day.
....2/-
: 2 :
PROJECT PROPOSAL:
X
Though the sisters run a dispensarv, so far only curative
services have been civen-to the people.
The Parish has started a youth club and this association has
been registered as "Lal Bahadur Labour Cooperative Society". The main
aim .of this association is to up lift their economic condition by
improving their agricultural and health condition.
T.S.I. mobile training team has offered to haln in different
aspects of training. In the month of January, we are planning to
have a training programme for basic health workers and agriculture
extention work by the I.S.I. team. The reason for training, the Basic
Health Workers is to provide better health care since there is only one •
sister in the dispensary. In order to reduce the cost of medical care
and to have better health, We are planning to have a health insurance
programme. The youth of the association are very much interested and
have taken the lead to start this scheme. The insurance fens is Rs.2/~
ner month per family (the aims and policy are enclosed). At present
about 300 families have been enrobed and more will be encouraged to
j oin.
In order to start the health insurance scheme an initial
expense is needed for one year as a subsidy.
Hence we request a grant of Ps.15,000/- Rs.10,000/- for the
medicines and Rs.5,000/- for training and salary of basic health
workers. The peonies’ contribution will be almost Rs.6,000/- to
Rs.7,000/-.
This first year will be on an experimental basis. In the
second year we are planning to reduce the cost and if any help is
needed we will, request later. We are also planning to get some help
from the Government by the second year.
JOB RESPONSIBILITIES OF HEALTH WORKER ,( MALE )
NOTE;
Udder the multi furpose workers scheme, a Health Worker (Mile) is
expected to cover a population of 5,000 wherein he will carry out the
responsibi 1 i+.ies assigned to.him.
He will have different'sets of res
ponsibilities for M3H, Family ELanning, Immunization, and Nutriti on in
the intensive and twilight areas of the Health Worker (Female). (The
functions to be carried out only in the twilight area.are printed in
italics) <
:
He will make a visit to each family once a month.
He will carry out the following functions:
1.1
MALARIA
1.1.1
Identify fever cases
Make thick and thin blood films of all fever cases
1.1.2
1.1.3
•
Send the slides for laboratory examination
1.1.4
Administer presumptive treatment to all fever cases
1.1.5
Record the results of examination of blood films.
1.1.6
Refer all cases of positive blood films to the Health Assistant
(Wale)for radical treatment.
‘ ■
1.1.7
Educate the community on the importance of blood film examina
tion for fever cases, treatment of fever cases, insecticidal r~r
spraying of houses, larviciding measures, and other measures
to control the spread of malaria.
‘ SMALLPOX
1.? .
1.2.1
Identify cases of fever with rash and report them to the
Health Assistant (Male).
1.2.2
Take containment measures until the arrival of the Health
Assistant (Male), i.e. isolation of the suspected case.
1.2.3
Conduct a scar survey to identify the unprotected children
and adults.
1.2.4
In the intensive area conduct primary vaccination of all the
unprotected above the age of one year and periodic revaccina
tion of all children and adults.
1.2
In the twilight area, conduct primary vaccination of all the
unprotected from birth onwards and periodic revaccination of
all children and adults.
«5
1.2.6
1.3
Educate the community on the importance of smallpox vaccina
tion, care to be taken in case of an outbreak of smallpox
the reporting of all cases of fever with rash, and the reward
available, for reporting a case of smallpox.
COMMUNICABLE DISEASES
1.3*1
Identify cases of notifiable diseases, i.e. cholera, smallpox,
plague, poliomyelitis, and persons with continued fever, or
prolonged cough, or spitting of blocfl, which he cones across diring
’ liis home visits and notify the Health Assistant (Male) and
Primary Health Centre about then •
1.3*2
Carry out control measures until the arrival of the Health
Assistant (Male).
1.3.3
Educate the community abort the importance of control and pre
ventive measures against such communicable diseases including tub
erculosis.
: 2 :
1".3.4
Report tlic presence of stray dogs to the Health Assistant
(Male).
1-4-5
ENVIRONMENTAL SANITATION
1.4.1
Chlorinate public water sources at regular intervals.
1.4.2
Educate the connunity on (a) the method of disposal of liquid
wastes; (b) the method of disposal of solid wastes; (c) hone
sanitation; (d) advantages and-us.e.of.sanitary ■type of latrines
(e) construction "an-1 use of smokeless chulas.
1.4.3
Help the community in the ccnstruction of (a) soutage pits;
(b) kitchen gardens (c) manure pits; (d) compost pits; (e)
sanitary latrines.
1.5..
Immunization:
1.5.1
In the intensive area, adranister DFT vaccination, BCG vaccination
and, wherever available, oral poliomyelitis vaccine to all children
aged one to five years (Also refer to 1.2.4 for smallpox vaccina
tion) .
1.5.2
In the twilight area, administer DPT vaccination, BCG vaccination
and, wherever avail a bln, oral poliomyelitis vaccine to all children
aged zero to five years (Also refer to 1.2.5 for smallpox vaccina
tion and to 1.8.3 for tetanus toxoid).
1.5.3
Assist the Health Assistant (Male) in the school immunization
programmes.
■ ■
1.5.4
Educate the people in the community about the importance of
immunization against the various communicable diseases.. ,>
1.6
FAMILY PLANNING
1.6.1
Utilize the information from the Eligible Couple Register for
the fa.mily planning programme.
. .
1.6.2
Spread the message of.family planning to the couples in his area.
arid motivate them for family planning individually and in groups*.
1.6.3
Distribute conventional contraceptives to the couples.
1.6.4
Provide facilities and help to prospective acceptors of
vasectomy in obtaining the services.
1.6.5
Provide follow-up service's to . ale family planning-=acceptors in
the intensive area and all family planning accepter s in the
twilight area, identify sidjc-nffects, 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.
1.6.6.
Build rapport with satisfied acceptors, village teachers.and
others and utilize them for promoting family welfare programmes.
1.6.7
Establish male depot holders in the intensive area and male
and female depot holders in the twilight area. Help tiro.
Health Assistant (Male) and Health Assistant (Female) in train
ing then, and provide a continuous supply of conventional
contraceptives to the depot holders.
-1.6.8
Identify the male leaders in each village in the intensive
areas and the male and female leaders in the twi 1 -i ght. area*
1.6.9
Assist the Health Assistant (Male) in training the loaders in
the community, and in educating and involving the community.
in family welfare programme.
.. ,
s
1.7
1.7.1
Identify the women in the twilight-area requiring hcljj for
rr’icrl
-ticn of pre ■-.nancy and refer them, to the nearest
: 3 F
Educate the cornunity on the availability of services for nodical
termination of pregnancy.
MATERNAL AND CHILD HEALTH (in the twilight area)
1.7.2
1>C*"
1.8.1
Identify and refer women .-with abnormal pregnancy to the Health
Worker (Fenalc).
1.8.2
Identifyand refer women with nodical and gynaecological problens
to the Health Worker (Fenalc).
1.8.3
Immunize pre"rant wonen with tetanus toxoid.
1.8.4
Fefer cases of. difficult labour and newborns with abnormalities to
the Health Worker (Female).
1.8.5
Educate the connunity about the availability of maternal and child
health services and encourage then to utilize the facilities.
1.9,
NUTRITION
1.9.1
Identify eases of malnutrition anong pre-school children one to
five years in the intensive area.and refer then to Balwadis/Rrimry
Health Centre for nutrition supplements.
1.9.2
Identify cases of malnutrition among pre-school children (zero to
five years), in the twilight area_and refer then to Balwadis/Primary
Health Centre for nutrition supplements. '
’ ’'
1.9.3
*
Distribute iron and folic acid as prescribed to children fron
one to five years in the intesive area arid to pregnant and nursing
notlicrs, children fron zero to five years, and family planning
acceptors in the twilight area.
1.9.4
Mminister vitamin 'A' solution as prescribed to childrexi fron
one to five years in both the intensive and "the twill ght areas.
1.9.5
Educate the community about nutritious diet for nothdrs and children.
1.10
VITAL EVENTS
1110.1
Enquire about births and deaths occurring in the intensive and
twilight areas, record then in the births .su^LCerths register
and report then to the Health Assistant (Male).
1.10.2
Educate.the community on the importance of registration of births
and deaths and the method of registration.
1.11
RECORD KEEPING
1.11.1
Survey all the families in bis area and collect general information
abort each villagp/lpcolity in lais area.
1.11.2
1.11.3
Prepare, maintain and utilize family record and village registers.
With the assistance of the Health Worker (Female) prepo.ro the
Eligible Couple Register fron the family records and maintain it
up to date.
1.11-4
Prepare and subnit periodical reports in time to the Health
Assistant (Mile).
1.11.5
Prepare and maintain naps and charts for his area and utilize
then for planning his work.
1.12
PRIMARY MEDICAL CARE
1.12.1
Provide treatment for minor ailment^, provide first aid for
accilents and emergencies, and refer eases beyond his competence
to the Primary Health Centre or nearest-hospital.
13
1.
TEAM ACTIVCTTSS
1.13.1
Attend and participate in the staff meetings at Primary Health
Cor.trc/Community Development Block er both.
: 4 :
1 «13 .2
Coordinate his activities with chc Health Worker (Female) and
etho3' health workers, including the dais in the twilight area.
1«13«3
Moot with the Health Assistant (Milo) each week and seek his
advice and guidance whenever necessary.
TEAM W3RK
2.1
DEFINITION
A TEAM IS A GROUP OF IERSONS WITH DIFFERENT LEVELS OF KNOWLEDGE,
ABILITIES, AND EERSONALITES SHO MUST COMPLEMENT EACH OTHER AND
WHO SHARE A COMMON, UNIFYING GOAL.
(J. Bryant) - Health & The Develepaxy world)
As a health worker at the jxxiptery you arc a nchbor of the health team at
the block. Moreover, you are the member of the team closest to the community
and, therefore, the first line of health a citivitos is to be delivered by you
and your team mate, the Health Worker (Female).
REMEMBER THAT SHARED PARTICI RATION IS THE HIGHEST ELEMENT OF TEAM
WCRK. IF YOU FORGET THIS IRDICIFLE AND TRY TO ORGANIZE YOUR AGTIVI TIES IN ISOLATION YOU ARE BOUND TO FAIL.
.. -I
J
’
Team work lias to be planned so tint each member of the team develops his or
her activities to achieve the common goal.
2.2
HOW TO ORGANIZE YOUR ACTIVITIES IN THE TEAM
. ' .- ■
, Your activities have to bo coordinated with:
1. the Health Worker (Female) and
2. the Health Assistant (Mole)
However, you must also remember that the con,.unity is the consumer of your
services so that you rust coordinate your work with the corrrpnity leaders
to make sure that the needs of the community arc satisfied, Also, although your team leader is the Molical Officer (PHC), you arc not likely to be
in very close contact with him, except when he visits your area, because of the
location of the subcontro. The responsibilities of team coordination vri 1 ~l
bo delegated to the Health Assistant (Nb.lc) with whom, close collabofation
is necessary for success.
2.3
COORDINATING ACTIVITIES WITH THE HEALTH WORKER (FEMALE)
The job responsibilities of the Health Worker (Female) complement
your job responsibilities and the two of you will provide comprehensive
health services to the whole coni unity. This can only be achieved if -nth
of you coordinate your activities in the following ways:
i.
Organizing your daily activities through consultation
This win avoid duplicating activities and will, in the
long run, save tine and unnecessary travel and expenses.
.....Cent’
: 5 :
YOU SHDUID ENSURE THAT AT LEAST FIFTEEN MINUTES EVERY DAY ARE SENT .
IN 'MUTUAL CONSUT.Tf.TTOM WITH THE HEALTH WORKER (FEMALE) TO ASSESS THE
DAY'S WORK AID ELAN THE WORK FOR THE NEXT DAY._______ .______ _________
.,
■in . Exchanging information on activities of mutual interest, e.g.,
family planning, nutrition, and health education activities.
Although the El ig-i bl e Couple Register is maintained by you,
.yet the Health Worker (Female) must feel information into it
"sp that the recprds are kept up to date. This information
is.used by both of you in implementing the programme.
ini. Organising combined activities. Health education activities
should be organised together with the Health Worker (Female)
involving other concerned workers and interested persons if
necessary.
iv.
Planning your activities so that one of you is always available
at tlie subcentre to deliver medical care, both routine or in
an emergency.
v.
Combining your activities in tine of crisis, e.g., an epidemic
outbreak when vaccination is one of the activities which is
organised to stop the spread.of disease.
vi.
Following up cases during home visits. This can be organised
to avoid duplication and is a sequel to exchange of information.
vii.
Cooperating in the compilation of reports, records, charts and
the preparation of maps.
In the Twilight Area: In the initial stages of implementation of
the program' e, the Health Worker (Female) will be concentrating her act
ivities in the intensive area around the subcentre. It will not be
possible for her to look after the needs of the community living away from
the subcentre (usually beyond 5 kilometres). In this twilight area you
will liavc to extend your services to cover some of the responsibilities
of the Health Worker (Female), and work closely.with the dais.
IN THE'TVffiLIGHT AREA YOU WILL :1V _ TO PROVIDE THE ffiSLTlTWO.. KER '
(FEMALE) WITH INFORMATIONWIUGH SHE CANNOT COLLECT HERSELF BECAUSE 0?
HER WORKTOAD IN THE INTENSIVE AREA . HER SERVICES IN THE TWILIGHT
AREA WILL BE AVAILABLE ON ®SAKD ONLY AID YOU SHOULD CALL ON HER ■
SERVICES WHEN REQUIRED W.ILE UNDERTAKING SOME OF HER ROUTINE ACTIVITIES .
2.4
GuORDIIETING ACTIVITIES VJITH THE HEALTH ASSISTANT (MALE)
Your supervisor will visit you at least on one day a wook.and he
will spend the whole day with you. He vH 11 guide you in your work and will
help you to improve your knowledge and skills^ He is also, in many ways,
deputizing for the Medical Officer of the PHC and you should avail yourself
of his leadership during these visits. Besides, the Health Assistant(Male)
has other specific activities assigned to him such as giving radical treat
ment to malaria cases and immunization of school children, and you arc ex
pected to help him in these tasks.
Success can bo achieved only if your activities arc coordinated
in the following ways:
i. FLannjng your activitcs in eonsultation iith your supervisor.
This is necessary as ho may need your help in delivering sone
of the programmes whore your participation is required and the
workload has to bo distributed. Also, in planning your pro
gramme together ho will know where to contact an:1, locate you
in case o* emergency an-1. ’-ice versa.
: 6 :
identified, This is an essential feature of. the
supervisory visit and both of your should utilize
the opportunity to the best advantage.
■i-i-i . Utilizing your supervisor to establish where your
efforts have not achieved the desired degree of
success.
iv. Visiting with your supervisor problem areas which
you were unable to tackle on your own.
'Utilising
v.
your supervisor's visit to improve your knowledge
knowledge and skills.
DO NOT BE ASHAMED TO ASK FOR GUIDANCE FROM HOUR SU PEP-VISOR . HE IS
THERE TO GUIDE AND fflJ YOU IN YOU! WORK.
_____
vi.
Taking the necessary action on your supervisor's
suggestions to improve the delivery of the services.
vii.
Coordinating your activities with those- of your
supervisor. This is an essential feature of team work.
viii.
Preparing the connunity or the schools for i.ass programme
which your supervisor wiI1 be implementing. Your
contribution in motivating and brining the community
together to accept the programme vri.11 help in achieving
success.
ix.
Physically assisting your supervisor in performing
immunizations in schools and the promotion of sanitation
programmes.
x.
Keeping your supervisor informed of positive malaria
eases who will require radical treatment.
xi.
Herting your supervisor and seeking his advice and
assistance in the face of outbreaks of epidemics, such
as cholera, smallpox or malaria*
,
ALWAYS USE THE SUERVISCD' 5 VISIT TO SOLVE DIFFICULTIES At© DISCUSS
POINTS OF MUTUAL INTEREST . IE1 EMBER TUT YOUR WORK IS COMPLEMENTARY
TO THAT OF THE SUPERVISOR A D YOUR; JOB DESCRIPTION DEMANDS THAT BOTH
OF YOU WORK TOGETHER. ’;’'
2.5
COORDINATING ACTIVITIES WITH CTHET- MEM ’SRS OF THE TEAM AT BLOG!
LEVEL:
You are expected to attend staff meetingssat the Primary
Health Centre/community development block or both. These meetings will
help you in getting to know what health activities are going on or are
being planned in the block. Other activitos which lead to team coordina
tion at the periphery include the following:
i.
A monthly meeting of the Health Assistants (Malo and
Female) with the Health Workers (Male and Female) to
review the overall activities developed in the sub
centre during the month and plan forthcoming activi
ties to be delivered by the team.
TO. E.OBLEM SOLVING.
: 7 :
ii.
Periodic ncctings between the connunity leaders,
health assistants and health workers help to foster
nutual undcrstgnding and acceptance of the health
programme. Involvement of the ccununity leaders
in planning activities will also help in getting
full cor.inunity participation.
INVOLVING THE OOM .UNITY IN PLANNING ITS -HEALTH SERVICES -HELPS TO
ATTAIN FULL AC .EFTANCE AND COOPERATION IN THE DELIVELY OF THESE SERVICES.
2.6
VISITS BY THE MEDICAL OFFICER FROM THE IL IMAEY HEALTH GENTLE
Under the Multipurpose Workers Schcnc, each Metical
Officer in the EHC trill bo the supervisor of half the area in the block,
whilb ‘*lhe 1-fedical Officer-in-Chargo of the PHC is the overall tean
leader. You must, therefore, expect at least a monthly visit by the
doctor from the PHC, and you should try to get the i axinun benefit from
this visit.
IDEALLY THE VISIT SY THE DOCTOR SHOULD COINCIDE WITH THE VISIT BY THE
HEALTH ASSISTANT (MALE) SO THESE TWO OFFICERS MUCH ILAN THEIR WORK IN
ADVANCE; IF BOTH VISIT TOGETHER MORE ITO PITIABLE-DISCUSSIONS ARE
LIKELY -TO -RESULT -Al© UNTFOR fl’Y IN HE HEALTH SERVE CES OF THE AREA
IS ESTABLISHED .
You should ;
i. plan this visit in advance with your supervisor so
that he is fully aware of what your difficulties
arc;
■
•— .
'
ii. prepare a listof any points which need clarification
by the doctor;
. '
-■
' •
iii. .arrange for the doctor and your supervisor to visit
the cownunity leaders;
iv.
arrange for the doctor and your supervisor to visit
areas with health related problems;
v.
inform patients who need to be seen by the doctor
about his visit and request then to be present at
the subcentre at the r ight tine.
The doctor's visit is a supervisory visit to assess the type of services
delivered and to advise on how things can be improved. It is your duty,
therefore, to ask for adxtvc and to be,frank and honest in your discussions
with your team, leader-. Ycu will alscfbo abloato learn cany tilings by
assisting the doctor during the doctor during the clinical sessions.
THE DOCTOR'S VISIT, AS WELL AS THE VISIT
’ Y0OT1’SUJE?VISCR, MUST ALWAYS
BE PUNNED IN /©VANCE Ad© YOU SHOULD KNOW THE EXACT DATE AND THE GF THE
VISITS. THIS WILL -HELff -YOU TO ARRANGE YOUR PROGRAMME A® ARI-ANGE FOR THE
COMMUNITY LEADERS TC: MEET THE DOCTOR AND THE HEALTH ASSISTANT (MALE).
............... Contd/5-
: 8 :
RECORD KEEPING?
Information on the village where you are working and its people,
as well as information on the work you carry out is made available through
the recoi s which are kept at the subcentre and which you will be required
to compile. The number and types of records which need to be kept are
decided by the health authorities of the state in which you are working
and it is your duty to know how, when and'where to fill them as well as
what to include in the prescribed forms supplied to you. A set of stnadard
forms which.you.will be required to complete is included for your guidance
in the supplement to the I'bnual (see Annexurds 4-.1, 4>2 and 4*3) •
REi'EMBER THAT ONLY THOSE RECORDS WHICH ARE ACCURATED- 1AINTAINEDARE USEFUL.
RECORDS WHICH ARE HAPHAZARDLY COMPLETED ARE NOT ONLY USELESS HJT IISLEAD^LHG Al® WILL INEVITABLY TEAT) TO FALSE DECISIONS AND...CONCLUSIONS.
4.1
THE IECESSITY FCR RECORD KEEPING
Records are necessary for three main purposes:
1. To collect base-line information winch could be used to:
i. plan progratines for development;
ii. plan training programmes;
iii. plan field activities including supervision;
iv. evaluate progress.
2. To keep a record of activities.
These records could be used to:
i. get information on the amount of work donq each day, each.
voek, etc.;
ii* find out what types of ailr.icnts arc scon by the health worker;
iii. assess the wcitload of the health worker;
iv. Compile administrative information, c.g., the amount of drugs
used in relation to the number and types of patients treated,
tlie amount of fuel used in relation to distances covered, etc.
3* For research purposes.
4.2
Although you will not be required to collect data and records for
research purposes, your base-line records and your records of daily
actitivitos may, if necessary, be used for research, purposes.
RECORDS TO BE i'AINTAINED BY THE HEALTH WORKER. (HALE) AT THE SUBCEOTRE
Your duties in relation to record keeping start from the time you
assume duties at the subcentre and continue throughout with periodic reports
and other records wliich are required to be kept according to your job
description.
The types of records you must maintain 1 include:
1. General information collected through an initial baae-linc survey
of tlie villages to compile an inventors'- of the health} environ
mental and family activities, as well as related information
which will h&lp you in your -work ( Village Record).
Zia Tkp icfiictbBeao® af tfteily folders which include tlie .Household
and Family Rec-rd .-.nd the Individual Health Cards.
3« The maintenance oftcccrds relating to malaria and other-eunnunicablc diseases.
4» The maintenance of records relating to eligible couples, depot holders
and other activities in the fpied of family planning.
5. The recording of vital events, i.e. birhts and dec’lb.
: 9 :
7.
The maintenance of records relating to the adrinistration
of iron and folicacid tablets and vitamin A solution.
8.
-Records of r.edical care provided and drugs utilized.
9« Records cf activities carried out in the fields of education
and environmental health.
1&. The compilation of monthly reports and ether periodic reports
as and w?ren requested.
11.-Records of liaison activities between yourself and your super
visor and th.e Health. Worker (Female).
BESIDES KEEPING THE RECORDS YOU MUST ENSURE THAT THEY ARE DESPATCHED TO
■THE FIGHT PERSON AT THE TIGHT TIi-I USING THE RECOGNIZED CIIAITELS .
REMEMBER THAT MANY OF YOUR RECORDS OOIiTAIII IIIFORMATIOIJ WHICH IS COLLECTED
IN CO HFEffll-JCE. THESE RECORDS MUST, THGREFCRE, BE CAREFULLY PRESERVED AID
NOT i-ADE AVAILABLE TO EDISONS UNAUTHORISED TO HAVE THEM.
4.3
YOUR--ACTIVITIES WITH REGARD TO RECORD KEEPING
Record keeping can be a tine~censuring. j el? it you do not develop
a system which is feasible and. easy to maintain! Therefore, do not let
records collect at the subcentre to be sorted cut periodically but record
your day’s activities when you finish your day’s work. Hot only will this
rake ycur record keeping easier, but it will also ensure that all informa
tion is included and there is less chance of forgetting things.
"ALWAYS RESERVE THE LAST HALF HOUR CF THE DAY FIT. CCI-iFLETlUG TIE RECORDS ■
4.3 .1
COLLECT Il'G GENUAL IITCRMATICH
As a nrveomor to your area, your first job is to got to lme'~ the
area, the people and the environment,. You can only achieve this by carry
ing out a survey to include all the relevant inferratirn which will help
you in developing your activities.
The base-line -survey in a public health, pro} rar.ro is an operation
which by roans cf census, rapping and sampling procedures will determine
the quantity, nature, distribution, accessibility and other characteristics
cf the-houses, population, environmental conditions, health units, schorls etc.
The objectives for conducting the base-line survey are as follows:
1. General
i. Tc pcrr.it the adequate planning of your-activities
ii. To ensure that the desired population coverage is achieved.
2. Specific
ii Tib find out the exact location of tiro houses, schools,
wells and other water points.
ii* To collect demographic data, i.c.
a. To find out the total population in the area (population
census)
b. to find out the agc-group distribution
c. to find cut the sex distribution
d'.' to' find out the family size distribution.
iii. To collect social data, i.c.
a. tc find out the educational levels of tiro population
b. to find out the religious groups
c. to find out population r.overicnts
d. tc- find cut the soci.l siructu'x- <• f
o >.'■
: 10 :
iv.
v.
To collect economic data, i.e.
a.
to find out the sources of incone (agriculture, animal
busLandry, cottage industries, etc)
b.
to find out the living conditions (type of house,
accomodation for livestock and poultry, etc).
To list the cornunications available, i.e.
a.
vi.
the type and nuir.ber of roads and pathways
b.
water communications such as rivers, or lakes
c.
public transport availability such as buses, trains, etc.
To list the channels of comunication, i.e.
a. indigenous, such an drunbeating, kirtans, carrier pigeons,
etc.
b. modern, such as radio, telephone, newspapers,, etc.
vii.
Toccollect health data, etc.
.
a. inrunization status of the population
b. nutritional status of mothers and children
c.
number of couples eligible for family planning advice
d.
Use of family planning methods
e.
environmental sanitation, viz. water supply, excreta
disposal, sullage disposal and refuse disposal.
f; incidence of connunicable diseases.
4.3.2
COiDUCTIlTG A BASE-LAIE SURVEY;
A door-to-door survey may take a coup e of weeks to complete but
it will be very useful and toll help you to plan your activities on a
realistic basic with factual information to build on. Forms for collecting
the information required for the base-line survey are included in the
supplement (sec Household and Family Record annexure 4*1, and Village
Record annexure 4*2)•
If information is already available with the Health Assistant
(Male) use it for your base-line survey. If it is not available, with the
help of your supervisor and the collaboration of the Health Worker (Female)
proceed as folldws:
1• Acquire the forms in sufficient numbers.
2. Conduct the survey and fill up the forms id th the ramarks relevant
to the surVey.
3.
On completing the survey, chart the information on a map of the
area, This will give you the information you require at a glance.
4« Keep your chart up-dated whenever any changes occur.
FACTUAL IHFORMATIOH MUST BE AVAILABLE IF WORK IS TO BE PROPERLY PLEIIED,
AIT TIME SPEHT III COLLECTIOH OF BASE-LIHE 'IHFORMATIOH IS TIME VEIL SPEHT.
......... ........Contd/11-
Hie iicrs included in the charts or naps of the area under your
Care will be as follows:
1. The numbered houses.
2. The roads and pathjays as well as any waterways.
3- The location of the subcentre, school, market, police station,
panchayat gliar, post offi. co, etc.
4« The location of the water points and the type of supply.
5« The typo of latrine used by each household.
6. The method of refuse disposal in use.
7 • The r.cthod of sul Iago disposal.
8. The house with eligible couples•
9. The houses with children aged 0 to 1 year and 1 to 5 years.
10. The location of depot holders (ihrodhj
11. The location of practising dais.
12. Any other information which will be of help to you in your work.
IT WOULD BE A BIG ADVAl'ITAGE TO HUMBER TIE HOUSES TIT YOUR /«, IF THEY
ARE HOT ITOMBERED ALREADY. THIS WILL EHLP YOU TO IIIDEX YOUR. FAMILY RECORDS
AD TIE HOUSE WILL BE EASY TO LOCATE FOF EERGEFCY AID OTHER SEEVICES .
4.3.3
MAIHTAII'IIITG FAMILY FOLDERS
Family records arc important as "the unit to which tlic services
are directed is the family rather than the individual. The family records
shop Id be kept up to date by entering the information on the day when the
it is obtained. For this purpose a good filing system lias to bd worked
out and tlic records -..us-t bo kept in the proper order for easy retrieval.
WHE1EVER A FAMILY FOLDER IS USED IT MUST- BE REPLACED JIT ITS PROPER -RACE
AFTER USB. THIS WILL MAKE RETRIEVAL AT AI Y LATER DATE EASY .
The . arily folder should contain the following:
1 . The Household and Family Record which includes information
about the socio-economic status of the fairly, die number of
family members, the immunization status of the family members
the nutritional status of the mother and children, the use of
family planning methods by the couple, the environmental sani
tation of the household and the presence of communicable diseases
in any family member.
2. The individual Health Cards winch are prepared for each family
member and winch record the health of meh individual, his or her
ailments and the treatment received.
4*3 -4
REPORTING COMMUNICABLE DISEASES :
Under the riulti-porposc workers scheme, a number of records have
been combined in order to reduce tho volume of work. The information to bo
collected is included in annexures 4«’b 4.2 and 4*3 • However, you must still
send special reports on those diseases wliich require reporting by current
standing orders. For instance, refer to section 15.2.7 for reporting of
blood smears.
MAKE SURE THAT YOU KEEP YOURSELF- INFORMED AS TO THE DISEASES -WHICH MUST
BE REPORTED III ACCORDANCE WITH CURRENT STAIDI1TG'ORDERS.... .
4.3.5
MAINTAINING RECORDS OH VITAL EVENTS _(BIKCHS. AID DEATHS)
The reporting of births and deaths in villages is done by the
village. chowkidar, dais and other leaders of the community. As a health
: 12 :
worker who visits people in their hor.es you arc in an advantageous position
to know what events have token plo.ee since your Inst visit. When you visit
a home you must ask about births and deaths and keep a record if any have
occurred since your last visit.
'■
—■—
1
BIRTHS /ID DEATHS MUST BE REPORTED TO THE HEALTH A SSISTAIT (MAZE) WHO ■
WILL III TURN REPORT THEM TO THE LEDICAL OFITPEF/ (PRIMARY HEALTH CEiTRE) .
With regard to the registration of these vital events, it is
your duty and re sponsibi 11 ty to educate the cou.Tunity on the importance
of registration. You rust tell the’.1. that:
i.
Birth registration is necessary so that the health workers
can provide services to the newborn -and at the sar.c tine look
after the ■ .other and advise her about her own health and how to lo
look after her new baby.
ii.
Death registration is necessary as part of the cornunicablo
diseases surveillance operationssand to find out other causes
of death, particularly in infants and during pregnancy and
childbirth. If the patient lias not boon sson by a doctor, the
signs and symptoms preceding death r.ust be recorded to give
sone idea of the possible cause of death.
AS ERT- GF YOUR EDUCATIONAL KC-RAMi E YOU MUST -IIT'ORM THE COMMUNITY WHERE
BIRTHS AID DEATHS CAP BE REGISTERED._____________________________________
4.3
.6
llAIllTAIHinG THE ELIGIBLE COUPLE REGISTER
The rraintcnanco of the Eligible Couple Register is the cost
important inforr'ation in which, family planning services can bo delivered
TIto initial records arc collected during the base-line survey and all
consequent information is entered both in the Eligible Couple Register
which is kept under the family planning prograir.ro, and the family folder,
in which all information on the farily is recorded.
YOU MUST COLLABORATE CLOSELY WITH THE HEALTH WORKER (PTMAIE) III COMPILING.
THE-LLIGIBLE- COUPLE -REGISTER-AID.TVJITADIIHG IT UP. TO DATE..
4.3.7
MAIITAIIJIHG IMMUNIZATION RECORDS:
Immunization of children is a very useful and efficici’fatwoapon
for the control of coinunicolic diseases. It is, therefore, important
that all children should be’ prbtcctccT with’' the' necessary vaccinations.
Wherever a special immunization card is available, this should 1 c kept
up to date, so that primary vaccination and booster doses arc given in
accordance with the schedules in Use. The ii.ir.unization status of each
farily ncrior should also be reborded in the Household and Family Record
(Annexuro 4«1)’ and the Individual Health Cards in the family folder. ■
YOU MUST REFER TO THE IMMUNIZATION RECORDS PERIODICALLY TO KEEP YOURSELF
INFORMED ABOUT THE DATES VJHEIT BOOSTER IMMUNIZATION IS DUE AID TO ENSURE
THAT THE MOTHERS BRING THEIR CHILDREN TO BE IMMUNIZED IN TIME. IT IS
YOUR DUTY TO INFORM THE MOTHERS-OF THESE DATES ON YOUR HOME VISITS OR ON
THE VISITS CARRIED OUT BY YOUR COLLEAGUE, THE HEALTH WORKER (FEMALE) .
.
You will include information on immunizations given in your monthly
report (see annexuro 4*3)•
4.3.S
MAII-TA-INIIIG RECORDS-OF THE DISTRIBUTION OF IRON AID
FOLIC ACID AID VITAMIN A SOLUTION
Under the i®H programme you arc required to maintain a record
:13:
issued and in balance.
which includes:
i.
You arc alsoroqircd to sublit a monthly report
A statement of the beneficiaries of iron and folic acid;
ii.
A statement of tile beneficiaries of vitamin A solution;
iii.
The.position regarding the receipt, issue, and stock held
of iron and folic acid;
iv.
The position regarding the receipt, issue, and stock hold
of vitarino A solution.
,
Refer to sections 11.8.4 and 11 .8.5 for details on those records
and reports.
You will also indudo this information in ycur monthly report
(see annexure 4-3)•
4.3-9
UAIIJTAIHIUG RECORDS OF OTHER ACTIVITIES :
Tlio health authorities will want to know how much work you have
dene during the month, the nun’er of blood slides you have taken, the type
of ailments you have treated, the number of wells you have chlorinated, the
educational activities you have organized, the nun?er of ho- c visits you
have carried out, etc. Daily records of all your activities rust, therefore
be kept in your diary and all this information will be compiled in your
monthly report ( see Monthly Report Form for Male and Female Health Workers,
annexure 4*3).
YOU SHOULD PREPARE CHARTS AID GRAPHS SHOWING THE WORK BEING DONE III THE
VARIOUS FIELDS OF HEALTH SERVICES DELIVERY IM YOUR ARE/.. THESE CHARTS
SHOULD BE DISPLAYED III THE SUBCE1TRE. THEY WILL SHOW AT A GLAIJCE HCW
YCUR WORK -HAS BEEN -IPRC GUESSING A D WILL HELP IN SEIF-EVALUATION OF YOUR
ACTIVITIES.
You ray display your maps and charts on the walls of the sub centre or you
may prepare an album al out 22 cm x 17 cm in which'the maps and charts can
?.'o .maintained. The important raps and charts which you should maintain
arc listed below:
A. Tfeps of each village in the area showing:
i. Numbered houses .
ii. Roads.
iii. Location of sub centre, panchayat ghar, police station, etc.
iv. Water points
v. Types cf latrines.
vi. Houses with eligible couples
vii. Houses with children zero to five years.
viii. Location of depot holders of ilirodh.
ix. Location of dais (trained/untrained) .
B. Bar diagram charts (ycarwiso and m.cnthwisc) indicating the
foilowing:
1. Irmunization: Humber of persons given
i. Smallpox vaccination (liirary/rovaccination)
ii. BCG vaccination (2 doses)
iii. DPT Vaccination (2 doses)
iv. Poliomyelitis vaccination (2 doses)
v. Tetanus toxoid (2 doses)
2.
Ifelaria
i. lumber of 1 lood films taken
ii. 1’u. '
f -'osit?..i’- o"£^s ,f
HEALTH CO-OPERATIVE - A NEW STRATEGY IN THE DELIVERY
OF COMPREHENSIVE HEALTH CARS - AN EXPERIMENT AT MALLUR
INTRODUCTION
Health facilities in rural areas in the country were provided
through Primary Health Centres started as part of a national rural
development scheme called 'Community Programmes' in 1952, with a very
modest staff in each centre to form the nucleus of integrated health
services and cater to the need of about 60,000 population in a Block.
There are now over 5,200 Primary Health Centres, each Centre serving
a population of 80,000 to 120,000.
For establishing an effective and viable Primary Health Care
system, the co-operation of the local community must be ensured. In
fact, the people should be adequately motivated, involved in decision
making and actively participate in health programmes, so that ultimately
it becomes their own "peoples programme". Local resources such as
co-operatives, agriculture, manpower, buildings and most important of
all local leadership, should be used to solvo and finance the local
health programmes. It is desirable' that the Primary Heal til Care system
should be a self-sufficient fiscal entity. Community priorities are
more likely to be met if the people themselves raise and spend the
resources required. A "Totil health" approach is essential. Promotional,
Preventive and Curative care need to bo completely integrated.
THE MALLUR MILK CO-OPERATIVE (ffl-ic)'
Mallur is a village in Kolar District of Karnataka, situated
55 miles from, the city of Bangalore. The Mallur Milk Cooperative (MMC)
was an established concern with a sound and progressive leadership
and had been functioning for many years. In addition to production
and sale of milk, it provided other benefits like provision of
fodder and cattle foods, tractor facilities and looms at low rates
of interest.
Besides the people of Mallur, two other villages, Muthur
and Kachahalli were members of the Co-operative and the total
population covered was about 5,000. These villages had a silk farm
co-operative besides cooperative dairying. The economic position was
satisfactory, and, therefore, all conditions were favourable for
the introduction of other self-supporting schemes.
The inspiration for establishment ef a Comprehensive Health
Care Progranmc for the Cooperative Members and their families of these
villages, cane from Sr Anne Cummins of Coordiniting Agency for
Health Planning (CAHP) and Fr Jonas of the Catholic Bishops Conference
of India (CBCl). With these pioneers, the De in and the Department of
Preventive and Social Medicine of St John’s Medical College,
representatives of the Karnataka Government and Bangalore Government
Dairy with loaders of the Mallur Milk Cooperative, worked out a scheme
for tagging on a health service to the existing MMC.
The main objectives of the Mallur Hs?Ath Project were:
(a)
to study and devise methods by which the financial
base needed for effective health services could emerge
from the people themselves in a self-sustaining manner;
X.
7
2
:2:
(b)
to help in the establishment of rur.il health
centres with the staff and rendering of effective
health services to a wide circle of needy pcopld
without distinction of race, caste or creed;
(c)
to study the required strategy and methodology for
the effective rendering of primary health care
in rural areas by trying to determine the priority
areas in health care and devising the structure found
suitable to village conditions;
(d)
to help in those developmental activities which are
very necessary to ensure effective rendering of
health services in rural areas; and
(e)
to train intern doctors, nurses and other medical
and para-medical staff for the purpose of rendering
assistance in rural areas.
The St John's Medical College and its Department of
Preventive and Social Medicine were to be mainly
concerned in acting as a catalytic agency, in the
formation of a self-sustaining rural community
health scheme, fulfilling the above objectives.
It was estimated that a monthly budget of Rs.2,500-3,000/would be required for running the Health Cooperative and financial
support was forthcoming by a joint contribution of 3 paise per litre from the
BMC and Bangalore Dairy, in a phased formula as shown in Table I bolow. ’•
Ultimately the MMC was to completely finance the scheme.
Table I (Contributions to the Health Co-operative)
Contributions/litre
Yocir
Milk Co-operative
Bangalore
1st
1 p.
2 p.
2nd
2 p.
3rd
3 p.
1 Pnil
Dairy
This budget was adequate to support a health programme,
organised by a Medical Officer, Nurse, Compounder and an Ayah. The
staff were appointed by the Health Co-operative Committee.
The Health Co-operative Committee included the
followirg members:
Chairman, MMC
Secretary, MMC
Dean, St John's Medical College, Bangalore
Head of the Dept of Preventive and Social Medicine,
St John's Medical College, Bangalore
Director/General Manager, Bangalore Dairy
Representative of State Health Service
Medical Officer, Mallur Health Cooperative (Secretary)
The composition ensured integrated planning between the MMC and Health
Co-operative.
3
:3:
The Heilth Cooperative got off to a good start by being
inaugurated on 19 March 1973 by the Minister of Animal Husbandry.
Dr VK Rajkunar, a Senior House Officer in St Martha's Hospital,
joined as Resident Medical Officer in charge of the Co-operative.
The Health Cooperative, in November 1973, was joined by
another dedicated worker, Maria, an Italian Public Health Nurse.
She with her companion Cathy, a Volunteer from Canada, looked
after the Maternal and Child Health Work.
Within five months of starting the project (.iugust 1973),
the cost of fodder went up and milk production of the Milk Cooperative
fell as some members began to sell out on higher rates. The MMC
took a decision, much to the discomfiture of the Government Dairy
Authorities, to sell directly to private parties in Bangalore, who
offered better prices. The Government Dairy, therefore, stopped its
contribution of 2 paise per litre as health subsidy, and the Health
Co-operativo was in a critical situation. It is at this stage, a
momentous decision was taken by the responsible village leaders who
were more than convinced of the positive role of the Health Centre
and its staff in improving the health status of the people in Mallur
and other villages. The Milk Cooperative was doing well and decided
to contribute 5 paise per litr_ for health and took over financial
responsibility for running the Health Centre. This financial!
strategy on the part of village loaders resulted in the Project
becoming a viable unit. The Milk Cooperative has borne the entire
recurring costs of the health project over since. Receipts/Payments
position for the period 1975-76 is appended (Table II).
Although the Mallur Health Project is mainly financed
by the Mallur Milk Cooperative, it also receives help and technical
direction from St John's Medical College and the Government Health
Service. These inputs are shown in Table III.
Table III
Source
Capital
Recurring
1. Mallur
Milk
Cooperative
Buildings, Furniture,
Refrigerator, Health
Education Materials
Salaries, Rents/Electricity,
Drugs, General Stores, Petrol
2. St. John's
Medical
College
Physicians and
Midwifery Kit, Minor
Surgical Equipment,
Lab Equipment
Motor Cycle (on loan
through UNICEF)
Interns services
Specialist Services
Rent and electrical charges
for interns quarters
3. Government
Health
Service
Nil
Vaccines, Vit. A., Iron,
Folic acid supplementary
FP Devices, Surveillance of
Communicable Diseases (through
PHC Sidlaghatta) Health Educa
tion Films (through Health
Education Departmentof DHS)
4
:4s
SERVICES RENDERED THROUGH COMMUNITY PARTICIPATION
The St John's Medical College adopted this Health Cooperative
as a rural training centre for interns. Visits by specialists of other
departments including specialist camps were organized. At present,
4 interns aro attached at any one time for whom residential accommodation
has been provided by the MMC on a rental basis. The interns conduct
base line demographic surveys, immunization and school health programmes,
special health projects and mass health education programmes.
The Health Cooperative Committee meets at Mallur periodically
to discuss progress and plan for the future.
Dr Rajkumar after a dedicated service of nearly 4 years
resigned from his post and Dr Kiriti Keshavan has taken over from
15 June 1977.
The Health Team comprising of Dr Kiriti, his staff and
interns under the technical supervision of Department of Preventive
and Social Medicine, St John's Medical College, has made good contact
with the villagers and a comprehensive health care programme has been
introduced. The community of Mallur and other member villages actively
participate in all programme. They have no unreasonable expectations
or demands, as the health project is their own programme brought
about through their own contributions. This is a basic difference
between Health Centrj organised through Cooperatives and Governmental
Agencies. The loaders are actively involved in the planning and
organization as the Chaiman, MMC is the Chairman of the Health
Cooperative Committee and the Secretary, MMC its member. Paramedical
workers arc drawn from the village community and trained for Community
Health work. The Ynung Farmers Association actively assists in any
of the health programmes. They help interns in their survey- programmes
of immunizations and environmental sanitation including chlorination
of wells and construction of sanitary latrines. They also organise the
physical arrangements for the Mass Health Education Programmes. The
Mahila Mandal runs a nursery school and acts as a forum, where health
education, applied nutrition programmes are undertaken.
The Health Team and interns organise the following services
with community participation.
PERSONAL SERVICES
1. Curative Clinic (daily out-patients)
2. Maternity and Child Health Services: .
i. antc-ntal care; ii. midwifery (domiciliary)
iii. postnatal care;iv. under five clinics (domiciliary)
3.
School health services for village schools
4,
Immunization programmes for smallpox, triple antigen,
tetanus toxoid, BCG, typhoid and oral polio
5.
TB and Leprosy case detection, treatment and follow up.
6.
Motivation for family planning
7.
Specialist Camps at Mallur (monthly visits by Specialists
from St Martha's Hospital, Bangalore)
8.
Hospital Referrals
9.
Family record maintenance
5
:5:
COMMUNITY SBiviCis
1. protection of well water by chlorination
2. Popularisation and construction of sanitary latrines
and soakago pits and other advise on environmental
sanitation
3- Collection of health data through periodical surveys
4. Coordination and cooperation with government health
personnel in National Health Programme activities
5. Health education at personal, group and village levels
6. Nutrition education and nutrition supplementation
programmes
Members of the Milk Cooperative and their families are
entitled to all the above mentioned services free of cost. Non-members
coning from other surrounding villages pay for drugs/dressings and
minor surgery, all preventive and promotive work are given free to
all categories. Table IV below shows the percentage of member and non
member families in each village.
Table IV (Percentage of member and non-member families in each village)
Families
Village
Mcmbc-r
Non-member
Total
Mallur
188
202
390
Muthur
63
124
187
Kachahalli
30
21
51
Bhatrenahalli
17
14
31
Hhrlurnaganahalli
6
18
24
304
379
683
45%
55.5%
CONCLUSION
Our experience over the last two and half years have shown
that
i)
A health function can be grafted on to an economic
cooperative
ii) A sound cooperative such as MMC can support
substantially the recurring costs of a health programme
iii) Tagging on of a health function to a cooperative,
benefits not only the members and their families but also the non
members who get indirect benefits of professional services, preventive
and promotive programmes.
The Department of Preventive and Social Medicine and its
staff, was mainly concerned in acting as a "catalytic agent, in the
formation of a self sustaining rural community health scheme. An
experiment was embarked upon and the Mallur Project is this experiment.
A Total He ilth Care Programme can bo effectively delivered through
6
:6:
a Cooperative in rural areas.
The Mallur Milk Cooperative is even contemplating
construction of a 15 bedded hospital at Mallur, with the help of
Government and its own funds. We are convinced of the responsible
rolo of Village Loaders in such a programme.
Further, the Health Centre with its working philosophy
has indirectly helped the Department of Preventiveand Social Medicine
to conceptualise a primary health care system for training of future
physicians, so that they play their rightful role in a contemporary
society.
Tho Health Team and interns have played an important
role in the development of the village in general and health aspects
in particular. We are fully aware that in the planning of such
self-supporting programmes, tho Health Team has to be actively
supported by other members who will attend to the social and economic
development problems of the community. Success or failure would depend
on tackling the financial side efficiently.
A drive to improve the education of the people including
health education, is to bo attempted through use of Village Level
Workers. Their training programme is being organised. Whether
there has been an improvement in the morbidity and mortality statistics
at Mallur, subsequent to the introduction of these cooperatives in
comparison with other areas in the vicirity, needs study and this
has been taken up as a health project.
The question of introducing such self-sustaining
Cooperative SPhemcs to other areas should receive active consideration.
Challenges have to be met in rural India and we hope that with the
cooperation and participation that is readily forthcoming from the
simple rural folk, our economic and health projects will meet with
success.
/////////////
Uuzj-iCx.
c'v/cz>>-'>o .
/7
■n , —:
l.-aJ /y
32...
<<f H.eck.^.i
. ^e'e^hi'cc^
^> ?/f«y>/
S"^>35fv<yoZ cr>-7 Ol—n-.-'U-l &.) - 7■' &>/' J
33. C. Ir-i5 — £^-y-r-e‘^->^
'-i
7^c-fe->.-4
3<-z.
r-Cjr^L^'^l
r~C?etfcal
}
..
&&-■">>'£■<>,
‘5pec*alJ'Ll,
A- /
, 1° <-'re^
T^) /?mXe3^,
'S6 «fot3 .
/^ZfA^TcX^xy? ey T)vL.«ri
) “>■= l’crpc^T ,
?j<-ppp>l^-/
f-'&■>'>' Dt^^j
jL--?._>e:z>-^> x?/ z^c^-e-^^e-o
p-^, /Xr</Z/
/&<?
/9/Zccz-j<;i<a>L<? /<’arZ'A<ri
O
/3oijZc>>i,
I3o
us ft
<SvAgry-><^/
^g
7?///e<xic-g
jftr.
_
af
d Le
Q •■ e>)
/cx_->
>"
y
'|V'^< < '
^^l)/
■ c>
l^v5V3n_.^'>O>-) ^’.
‘Sc.^crc/
H^O^Cc-i
l^i ft)
wtot-gz-i/'
Z^g
c,^;)
3q-?>(,
3 7
<^.CXr-XT-t_Z?/^'dr-K-> L>->
L\J s'Cc’ '■'"’Cg
Oc^
--
Z-/:^D/2 >/c. /
-CU:i, <~u. ’
l^y
^=rz) yO'^^o
c-v t>---- Ry 'T^cyc. ken ,^\.
<,.,.) ft>^A
^r~
'[J y.
ftF^y
1^7^
tlc’Z)') t'ryc^o hy '7t\’--------------------- ------- —
/qycf
;
S^elkOY
Collar, J?Knr,ha^
^Pha-rmcc
,
^Xg.
J C3T_^-i f~) ^4
(Zs~>ol L^OLA-CtC.
/-Zc"Ck//^\
£-^Cla <<=<.1'1 CV,^
Ch >ifc>ke^
• Ntr^bvAl
fcJ&Y /Cl ^CUlC'
&/ cjxucr c^f-
/□<3y ■yottlrzfL
PP]y
Lt-fie. aC
e----------- 1----------->----------- ■ J'-’-P p Lx>-,
^7
/
Cc^T&C t -. 73
L^k
/3_-l/^,J>y z
PU-k-^^ )4e^
b!
'------—
'
] ■
e/o
pr-HL.
P^P
A-^y'^Y/
(jp/^
LLrj*~) f'rc.-J
^-C
Ac^CyZeu/Tto
L/'cZ x Q.PO3^7
B^gJsq . 3?oao/
^>O .
Pl> PfiyjuK
C’C' P PP<-'^ICF,.P
" "-’ 1---- T Lci-P
f
TP Lt.
/^K-'-Cjri
Nd'e)
Lo./o^cxlc'C^'<ji
M^-.cP 7 7
PLcn ■ &/ I' y f^-cP,
&ol.
1^17^-
cr(
gCpcC
F&a K h-Z,^^)
P,<p!/
(P^J)
-2.
77-jP
iy^A
6X>->c’i
<^<oOzxir-/7oo
Kncr^L^cA. ^Vo PDec
^'PL^->C'1)'y^I &( L<~>^ x
(=■ 71-
7^-'^hc£
^77fc)
A>o^y ^-l<y,-A.-5
<CL^
<sf /6> 7o^> l^l^y
rLc. 7
M<P^J s-l’Lc^^ TL^K^ C^F.
^•7-
<4-P c-/t'>
<P^-t>)' T7'>‘-^i
'
1
(=- j ■
l_c-x^
Ccr-p'
77)>^a
J
Tki-y^y
/73a
yffc^,.&oz
—L)lhcc^ '7<^sv>
riplef'i.’i-GD- Fayj
(-W-ft.
77-S~.viy.f> -/
/Mfr
L> C> T
O^-><_4 7 O7^yCX2--l-y
iJ^c^
p ^.
/-?<:■/' ,!
----
LJlhc>-o 7c^<ru.
FS.ulleK'l-S > ' 5e.p^ /7&.2J
1/ —’-'ll
bl
F
•'"“(I8
F^yi
k
Ckcpfe^ & j
^/d-K-.
^■f L-’-^'-C-’'^ fl-c-i-i
TJl’z/ov'
z^c-AJ-utr^/
^Q2?k<^7 CcV’'7°;'
f
/?«?
/S^Hcc vZjz.,
Le-p^^i
-r
Pc.Kc^Cy L.^
Qc^c.^^ fxTMCj
rr> <=: <r-<cx I & ?
C
J
5c—<-Uz
^7
77x£_
/A —<--'
P<? “Tple
«?_Tt£ ll'-G.
AC
~-AC (~xr^r.e,
?/-
7a^>
C
5<?o
a-l
r'r^^i.c^C^A , <S^5//2.
c^cLc—<=-^r(
AxZ CCr-ti'CCx'c
^-^plr
/Zx_e.
p^c<foLc.^^
^^~^(Z>Cl g-^~>
Zbb c</
/ Z .
-
y^l<^c^>ce.
-^~f
C-j • 5>c—y < vx ■
7X^
/^b/,C
e/n)
G^pl^
y
iJ-e^oAck - ^6* Ms*
'>
”
t La-7C,->/2'>e-'<rQ.<r>x
>.lf<~->
.
X
rf'-‘-
'
/O-y-vx C.^>
<^-s-ue_
frfo&JlKI'en
TAcp^ erf
r-CcJ.
°'f
‘~>c.^->c^-> .
/2/V’7
'^-’-r'
/3>--c-—ct
Xxxb/ityOaA/./
z)£?/xc<?^ —
ce^frcol Sc>-e^Cv,
R.\'-ypl<2 Ct->-u'. z C Al
,-, cAa. y C_-
■^"'u,4''
l<X^C
<->>
^->-1 I'L>~>
^yctc-A o.l-> cv o
fOl.
/L
Fens. ■, .. K-tfAjG
i- <r-^>l
L-^-e-yi‘-o
c.
L.^'cA
7^_,cLvc.
)
/
C-l'^e-^^'Cc^ i
/=-<rt
c~nc&.
/3 -Al f^C-^nc. y
/~> J^>-r-> /Di, y — / 7 4>’''
f^Lcc^-i'C&l
~>" /"Sc^.iez Lr^x>
<y
z-?.</o/‘
-2^itixc<.
PKo <
CC.I-- P C cP L.rO <pL<_ •s/>
LeJlUr^cinn .To/fi/c
^-7'7
6'A.
H rxj
December 25
26 December
_____
IQ
^p'cyfQc f^cjeJE^
_ /S-fer^ A>cC<<o A
_
'
Kj
/~:>e-
ZA yZv/,< r. A A: <^
___
_______________________________
December 27
DTlez
GRERTEG7
I^E.
Health >n /a/o/>? is
NIEOICEHNSiPG
/5
ovep
the
OP OOP HEALTH
5'/5T£r1. ZTERHHL
-f-GPPE
PEG} o/PEO
TROG
THP)T THE
PRO EDGE R Z3x/6
EXPLOIT
To
The 'peuhpppge‘
rtor
PECotHE P
IN
ILL NEPLTH"
op
VESTEL)
TJoctoR-
E>C>ES
PEOPLE
THE
VICILPPGP
XOT
PPP THf)7
P>oee
/PTE<PES7
Multiple
OFTEr!
c&m&i rrtiops
drugs
CoriTRlhlPG
/77;^O<& Sz
Pp R-p G-D ERR L'-/
Vl~ftMii^&,
firlovUTS
lR RECESS
bJl-)F)T
PRR
/S
INOlR.
mrrreted
i £>
TRFR£
NPTICiNiEL-
R
LPF)^rR&E
C>F
—
PRE
REQUIRED
Presently
‘EirCR
/-Ask/Ai
OF
in
ColoSSF)!_
OF
PRU&S
c.gniR>i rA RERof^S
Comm! H02
Ke-pcn ,1^75
Date :
i'rO I
i‘12.
/^cd^xI'c^ )
//
"
fty'
^<^J-fCa.l pv^ckfr'iTrie^
Dale :
/.
J
Ke.
f'o
— 'f
i^l &
j'Octtzrr-
C^lo
j'~>C\~r'&.
eJi by /Lq
'yercX'-r
F)-72>
Date :
Dale :
Si' his?
P Pg>
PPe.
Pcc\ cP>
^"7
R&CC&r>Z£^daPri$
5p<Ay G^cr^p
^-!-& o IP
P~>-
c<f
P II
<S^
/d- -5 s
—
/)Cl~1^
P //Prcr-) a. Kt-?
Date :
—P~>
To
x/
icrp> s&iP >e//c^-7o?
ft? c
b) 7-=-
i o'Cjy^
>tsp
ex / , A,
®
7~Dy
&
Date :
1 CM ftJ)C -5 <5, S
~7
<^>->
I ft
"r^r, ■> n,
(■ n
O / G^ y
7^*5ft Fftr<_-e
/O Aci/
plc-~^iA>z>cr.
/ ^> s /
P-Kcnft-U.
h/o
f2>PL
I Cj pa
^cxZ/oA^cx^^U^
c^-v/os/s
cf-r^G
&
C m-s I'cH
Dale .
'Veck^'
Dale :
cc^o /
/C F~1 /z/>C ■S&fZ.
f~te_ Ce.cyv-nje^> c
lQ>
»
/-?/1
Date:
1
Dale :
z?
Date :
P)Lq
rc>
tbf
Dale :
15
d
eJ'~> -h~i c^Li fcv .
Fdl^i i''
emiy hb
Z>,
fj
he
~7ch?-
(S'/
s-ri£>h
Go ^>^-5
C^c. C-e^TL^l^~> he c^
C cn^/y^
lA
c-szjv<
d
X^^U'O ,
'rC^Zi
A (^gynssu tl&
CX
hj?cd%
K) g’-hCe >C
.
I
>3Ax/
/773-74
’5><=y>
. o-s-i^ ‘^hcX'YCcL h>y
-L^—)
^z^-, e>L t,
/A-e_ C. C5~>"L- 7i,c--ryo ha~y->
c-l
Z?i
A
//Z>
rue-eoL
/lx
Date :
ft f
fecks-l o/azjy
<£>
Dale :
f- Qc
CZGg
G>~^?
*5.
< cce~p [/c.
Date :
.p
Co
~7.
'vcJPzox fPo^o
/4-Cc^l CP
PC-ry^
ex / Zu?_n
/c-^SoA
^Gcu? X>^4>'
h>^^c^ci.
Gt A S-T^n ixK/fs-n^
CC-L^Cc-l
CASE RECORD
Analysed by
Technical Guidance Cell of the German Leorosy
Relief Association
1• Patient's Name
(in Glock L tters)
2.
: PAR
"TH ft A7 r^i ft
father's Name
3. Permanent Native Addrsss
5. Physical Assessment
Classi fication
-Bacteriology
Deformity
6. Educational History
7. Vocational History
Ulcors
/
2
8. Family & Contacts
:
Hale
/
Particulars of Children
Total No. of Dependants
9.
10.
The Problem
Whether new type of work
preferred? If so,
detai Is of u irk
He
1
Fc
F emale
1
1
T ota 1
Z.
COMPREHENSIVE RURAL HEALTH PROJECT, JAMKHED
STANDING ORDERS
Jan. 1972
UNDER-FIVES
I.
A.
DIARRHJEA
Signs and Symptoms:
Treatment:
1.
2.
3.
4.
B.
Loose bowel movements, more than three times,
with or without fever. May be present with
cold, ear infection, etc.
Advise plenty of fluids, sugar water with a pinch of
salt.
Pectokab, 1 tsp. with every stool.
Sulphamezathine
Baby aspirin for fever p.r.n.
DEHYDRATION
Causes:
Diarrhoea , vomiting or ferer
Signs and Symptoms:
ASSESSMENT OF DEHYDRATION BY FIVE CLINICAL SIGNS
Appearance
Skin
Anterior
Eyes
Mouth
MILD
Fretful
Elasticity
Normal or
slightly
reduced
Fontanelle
Normal or
slightly
depressed
Normal or
slightly
sunken
Dry, red
MODER-ATE
Restless
Moderately
Impaired
Moderately
sunken
Sunken
Very dry,
slight
cyanosis
SEVERE
Semi-coma
Severely.
Impaired
Deeply
sunken
Deeply
sunken
1 staring'
Very dry
cyanosed
Note;
Do not rely on akin elasticity in the presence of malnutrition
Treatment:
1.
Fluid replacement
Fluid requirement first 24 hours
Mild dehydration - 90 cc/lb body weight
Moderate dehydration - 110 cczlb body weight
2
Severe dehydration:
2.
refer immediately to Jamkhed clinic after
giving initial 100 cc. subcutaneous saline.
Treat cause of dehydration
II. FEVER
Causes
A.
UPPER RESPIRATORY INFECTION
Signs and Symptoms: Fever, running nose, cough and semetimes
Treatment:
• “aby aspirin
vomiting.
2. Sulphamezathine
3. Cough sedative
4. Plenty of fluids and normal diet.
B.
EAR INFECTION
Signs and Symptoms:
May be as above with ear ache, ear
discharge, eardrums red and tender.
Treatment:
1. As above
2. Local treatment: a)
b)
IIL
Antibiotic eardrops
Hydrogen Peroxide (HgOg)
PNEUMONIA
Signs and Symptoms:
Patient looks sick, rapid respiration with
alaenasi working, chest pain, high fever,
cough. May be restless. Rales heard and
poor air entry.
Treatment:
1.
2.
3.
4.
5.
IV.
Plenty of fluids
Normal diet
Aspirin
Antibiotics-Procaine Pencillin, 4 lakhs
Refer to hospital
MEASLES
Signs and Symptoms:
Cough, fever, redness of eyes, running nose
rash appears (4th day),on face, trunk, extre-mities, irregular, maculo-popular.
Treatment:
1.
2.
3.
V.
Plenty of fluids and food, normal diet.
Aspirin
Antibiotics to prevent complications, such as
otitis, pneumonia, diarrhoea- Sulphamezthine.
PERTUSSIS
Signs and Symptoms:
Persistent cough, often with whoop, fever,
running nose, and red eyes.
Treatment:
1.
2.
3.
4.
5.
Chloromycetin
Phenob aib
Cough sedative ,
Aspirin
Adequate fluids and frequent small feeds.
3/
3
VI. FEBRILE CONVULSIONS
Signs and Symptoms:
Fever due to any cause and convulsions
involving one or more extremities.
Treatment:
1.
2.
3.
4.
5.
Give paraldehyde, 1 cc per year of age, I.M.
Cold sponging and aspirin
Phenobarbitone
Treat cause of fever
Refer to hospital
VII. ROUND WORMS
Treatment:
1. For children up to 5 years, piperazine
liquid , 1 tsp. t.i.d. x 2 days
For children 5 years to 12 years, Piperazine
ii t.i.d. x 2 days.
VIII.
IMPETIGO
Signs and Symptoms:
Repeated boils
Treatment:
IX.
1.
2.
3.
4.
Inject pecaine penicillin , 4 lakhs, I.M.
Sulpb -jozathine
G.V. Ointment
Advise to wash and scrub with soap and water.
1.
2.
Benzyl benzoate for external use
Wash and boil clothes and dry in sun.
1.
Apply penicillin eye ointment
SCABIES
Treatment:
X.
SORE EYES
Treatment:
XI.
TRACHOMA
Signs and Symptoms:
Small granules in eye lids (patient
complains of sand in eyes.)
Treatment:
Sulphacetamide drops to eyes
ADULTS
I.
FLU, UPPER RESPIRATORY INFECTION
Signs and Symptoms:
Headache, feeling weak, cough and fever,
1-4 days
Treatment:
1.
2.
3.
4.
Plenty of fluids
Normal diet
Aspirin
Inject Novalgin, 2 cc I.M., if necessary.
4/
4
II.
PNEUMONIA
Signs and Symptoms:
Fever, cough, chest pain, shortness of breath
rapid breathing, alaenasi working. Rales heard
over one or both sides of chest.
Treatment:
1.
2.
3.
4.
5.
6.
III.
Inject Terramycin, 250 mgm. I.M.
LAS i.q.o.d. x 1 day
Aspirin ii t.i.d. x 1 day
Cough sedative i.t.i.d. x 1 day
Advise hospitalisation or consultation with doctors.
Plenty of fluids and nonnal diet.
TYPHOID
Signs and Symptoms:
Fever, body ache, coated tongue, patient looks
sick, Cough, diarrhoea or constipation, abdominal
distension.
Treatment:
1.
2.
3.
4.
IV.
Chloromycetin ii tablets q.i.d.
B.Complex
High protein diet with plenty of fluids
Advise hospitalisation
PEPTIC ULCER DISEASE
Signs and Symptoms:
Apigastric pain, acid eructations, pain
increased after hot food or on empty stomach
Treatment:
1.
2.
3.
4.
V.
Magnesium trisilicate t.i.d.
Belladonna tab i t.i.d,
Advise small, frequent food
B1 and diet.
DIARRHOEA AND VOMITING
Signs and Symptoms:
Loose bowel movements and abdominal pain.
Abdomen soft, generalised tenderness but no
gourding.
Treatment:
1.
2.
3i
4.
5.
VI.
Diarrhoea tab ii t.i.d. x 1 day
Sulphamezathine ii t.i.d. x 2 days
Plenty of fluids
Diligan i p.r.n. for vomiting
If severe, start I.V. fluids.
ARTHRITIS
Signs and Symptoms:
Joint pains in one or more joints
Treatment:
1.
2.
3.
4.
Aspirin ii t.i.d. 3 days
Methyl salicytate for external use
If having extreme pain, inject Butazolidine
3 cc, deep I.M.
Advise consultation with doctor.
5/
5
VII.
RHEUMATIC FEVER
Signs and Symptoms:
'• t•
Fever, fleeting joint pains, pains mainly
of large joints. Very tender and swollen.
Rapid pulse. History of previous attack
often present. Ask for history of suggest-ive of heart disease, such as chest pain,
shortness of breath, cough.
Treatment:
1.
2.
3.
4*
5.
VIII*
Aspirin ii t.i.d.
Bedrest
Las i.q.o.d.
Inject Butazolidine, 1 amp I.M., if necessary
Advise Sonsultation with doctor.
BRONCHIAL ASTHMA
Signs and Symptcms: Repeated attacks of difficulty in breathing
wheezing, cough and mucoid sputum, prolonged
expiration with generalised rhonchi.
Acute attack treatment:
1.
2.
3.
Inject Adrenaline i cc
subcutaneously
Aminophylline 1 t.i.d.
PET i h.s. q.o.d.
Chitinid treatment:
1,
2,
Aminopgylline i t.i.d.
PET i h.s. q,o,d.
ANTENATAL care
Complete ob stoical history
Danger signs needing hospital referral.
1.
2,
3.
4.
5.
6.
Anaemia, hemoglobin below 9 grams.
Bleeding after previous delivery of during this delivery
Any baby born dead or after difficult delivery
forcepts or caesarian
Swelling Of hands or face
Diastolid blood pressure over 90 nun Hg
Breathlessness with heart murum or cough or sputum for
1 month,
/
I.
REGULAR ANTENATAL CARE
1,
2,
3,
4«
5.
Two doses of Tetanus Toxoid during pregnancy
Fersolate i daily
Calcium gluconate i daily
B Complex i daily
Family Planning advice should be given at each ANG visit
-.6/
6
:
II.
:
toxaemia of pregnancy
Signs and Symptoms:
1.
2.
3.
Any two of the following present:
Albuminuria
High blood pressure, diastolic above
90 mm Hg.
Swelling of face or extremities
Treatment:
1.
2.
3.
4.
III.
Advise low salt diet
Diuril iron alternate days
Rest
Advise consultation with doctor. Warn
patient about dangers of eclampsia.
VOMITING OF PREGNANCY
Treatment:
1.
2.
3.
T
•
Diligan i p.r.n.
Vitamin B2 i daily
ANC pack
If persistent and uncontrollable, consult with doctor.
IV.
ANEMIA OF PREGNANCY
Treatment:
1.
Folic acid
i b.i.d.
If hemoglobin below 9 grams^ refer to hospital
TUBERCULOSIS
Signs and Symptoms:
Feser, especially in the evening, loss of appetite,
loss of weight, cough of more than two weeks duration
hemoptysis. Two confirm diagnosis:
1.
2,
collect sputum for AFB x 3
advise chest X-Ray and screening.
1.
2.
3.
4.
5.
6.
Streptomicin
Isozone Forte
Mult ivit amin
Cough sedative
Good nutrition,no diet restriction
Advise patient to cover mouth while coughing.
Treatment:
T
Contacts:
(a)
,
(b)
Treat all contacts with INH
(l) Adults - 300 mgm. daily
(2) 5-12 years - 200 mgm. daily
(3) 2-5 years - 100 mgm. daily
(4) below 2 years - 50 mgm. daily.
Advise chest screening of all contacts.
7/
7
LEPROSY
Signs and Symptoms:
Anaesthetic patches, thickened, greater auricular,
ulna and lateral popliteal nerves, Loss of sensation
in hands and feet and motor weakness of fingers.
Loss of eye brows, thickening of skin, especially
ear lobes. Trophic ulcers. Take skin clip for AFB,
Treatment:
1.
D.D.S. dosage schedule:
(1) 5 mgm. twice a week x 4 weeks
(2) 10 mgm. twice a week x 4 weeks
(3) 20 mgm. a week x 4 weeks
(4) 25 mgm. a week x 4 weeks
(5) 25 mgm. a 4 times a week x 4 weeks
(6) 25 mgm. 6 times x 4 weeks
(7) 50 mgm. times a week x 8 weeks
100
(8)
mgm. 6 times a week
2.
Examine eyes for corneal ulceration and give sulphacetamide
drops
3.
Trophic ulcers should be taken care of with acriflavine
dressing, penicillin ointment, magnesium sulphate soaks.
4.
Glycerin for dry nadal mucous membranes.
Treatment for D.D.S. reactions (in order):
1.
2.
3.
4.
Contacts:
Rest, Aspirin
Chloroquine i t.i.d. x 3 days
Lamprene i on alternate days, increasing to
if necessary.
Precin.
i daily,
Treat all contacts of lepromatous and indeterminate cases
with D.D.S.
ERUG REACTION
Drug reaction may be mild, moderate, or severe.
I.
Mild reaction:
Such as urticaria and drug rash may occur immediately
to one week after drug has been started.
Treatment:
1.
2.
II.
Stop the drug causing reaction.
Benadryl, 50 mgm. t.i.d. or q.i.d.
Moderate reaction:
Occuring within few hours of intake of drug,
urticaria, vomiting, diarrhoea, dizziness,
fall, in blood pressure.
Treatment:
1.
2.
3.
4.
Inject Synopen 1 amp I.M.
Inject Adrenaline 1cc, if necessary
Benadryl 50 mgm. t.i.d. or q.i.d.
If hypotensive, intravenous fluids be started.
8/
8
I
III.
Severe reaction : (anaphylactic shock), inmediate shock like and
't
frequently fatal reactions which occur within
minutes of administration of drugs. Three syndromes
of anaphlyaxis may be recognised:
1.
2.
3.
Laryngeal edema
Bronchospasm and
Vascular collapse
Signs and Symptoms: Apprehension, paraesthesia, generalised urticaria/
choking, sensation, cyanosis, wheezing cough,
:
incontinence, shcck, fever, dilatation of pupils,
loss of consciousness and convulsions, death may
occur within 5-10 minutes. Therefore, treatment
must be available wherever injections are given.
Treatment:
1.
2.
3.
1.
5.
6.
7.
8.
Adrenaline 1 cc I.M. immediately
Il ace patient in shock position.
Maintain adequate airway
Injedt Synopen 1 amp I.M.
If patient has not responded to adrenaline, give
Betnesol I.V. 2 anp.
For hyj&ension, start intraennous fluids with
noradrenaline 4 mgm. in 1 litre of saline
02 (Oxygen)
For bronchospasm (wheezing), give aminophylline
I.V. slowly.
REFERENCE TABLE
DRUG DOSAGE IN CHILDREN
0-6
mos
over 6 mos
- 1 year
1-4 years
4-10 years
Baby Aspirin
| tab
t.i.d.
1 tab
t.i.d.
2 tabs
t.i.d.
Adult ASA
t.i.d.
Sulphamezathine
i tab
t.i.d.
1 tab
t.i.d.
1 tab
t.i.d.
1 tab
q.i.d.
Phenob arbit one
5 Mgm.
t.i.d.
7i mgm.
tli.d.
10 mgm.
t.i.d.
15 mgm.
t.i.d.
Chlorcmycetin
100 mgm,
t.i.d.
200 mgm,
t.i.d.
250 mgm.
t.i.d.
25O mgn.
q.i.d.
Paraldehyde
1 cc per year of age
Streptomycin
200 mgm.
per day
400 mgn.
per day
| gram
per day
4 gram
per day
INH
50 mgn
per day
50 mgm.
per day
100 mgm.
per day
200 mgm.
per day.
RURAL
CC'ulJlIITf
HEALTH'
PROJECT,
^4HHSD.
PARTICIPATION IN A COHTJNITY
HEALTH PROGRAMME.
R. S. AROLE, M.B.B.S.,
M.P.H.
A medical programme aimed at the community must have
corn-unity support Tor its success. We therefore need to realise
we are not only working for the community, but also must work
with the community. We must convince ourselves of this reality
and find, ways and means of getting the community involved in the
health programmes. Since about 30 per cent of our population
lives in the rural areas and since only about 20 per cent of the
nation’s resources and efforts reach these villages, I am mainly
concerned with the practice of community medicine in rural areas.
For a whole-hearted participation of the community in the
health programme, it is essential that the community is involved
not only in the implementation of the programme, but-also in
decision making,
The community must be convinced that a certain
programme we want to introduce is really necessary. The community
must first decide and we should make ourselves available to help in
-its implementation.
Our role as health workers then is to be
activators and to be their guide in decision malting.
It is possible that the community is unaware of its health
needs. It may be necessary for us to draw their attention to these
needs? but, we must resist the temptation to force anything on
them. We often discharge a child cured from diphtheria or tetanus
from the health centre. The health team accompanies the child
and the parents to their village. The parents or relatives gather
the villagers and tell the story of the child’s recovery; Here is
an opportunity to explain to the villagers that the family need not
have suffered financially and the child need not have, undergone
the ordeal of illness and hospitalization had ho been immunized
against the disease. We then offer our services to the villagers
to get all children immunized to avert a similar problem. The
result might be that tho community makes a de: ision to invite us
to give immunizations. This'way and by other methods, we generate
a need. However, we do not take action until the community takes
the decision and participates in collecting children (30 per cent
of the total under five population must be immunized) and helping
our team in their work. It has been possible for us to immunize
12,000 chiIdren in 30 surrounding villages in the past 2 years
by this type of co-operation.
• Apart from generating need, _we can also begin .with a felt
need of the community. In this context we must, understand that
their priorities may be different from ours.
Continued exposure
to sick people in the hospital distorts our outlook to the community
Wo get so disease-oriented that we forget that large numbers of
people are healthy and only a few are not well. The priorities
of the community may not even be related to their health. Their
felt need may not be related to health.
Considerable time should
be spent with the community to find out their.felt needs and we
should use our ingenuity in translating their needs into health
programmes. When we began our work in Jarurhed2 years ago, the
area was facing famine. The felt needs were food and water supply.
Through these felt needs, we wei-e able to focus the attention of
the community, on the problem of nutrition of ©hildfen under five
years. We were able to organize uhder-five clinics in 15 different
villages. Cne of the components of the uhder-five clinics is
supplementary feeding. We find raw materials from various agencies
and the community takes responsibility for supplying fuel,
sweeteners, and the personnel to cook and distribute the food,
2
:
2
:
and to 2<eep records. Three thousand children are caredfor in
these villages with the help of volunteers.
Similarly, the
felt need for water supply was translated into getting an
agency to dig community wells for 5 villages. As a result the
community set apart 2-3 acres of land in each village to grow
appropriate crops for mothers and children of the village.
A reasonable felt need of a community is to have someone to
take. care of emergencies and of day to day minor' illnesses.
Since
health, personnel are not always available to nieot their needs, the
community participates in solving this problem.
One or two
interested people are chosen by the community. We give them
training in treating minor illnesses and in following up children
with fever and diarrhoea and pregnant mothers.
They also get
training in health education.
In ore village, our nurse after
regular visits to it for one month could register 5 women for
antenatal care and could got 5 women for tubectomy, An illiterate
villager worker after training convinced over 30 women for regular
antenatal care and brought 25 women for tubeotomy in a period of
only two weeks'. Out of 55 villages in our area only four villages
have a qualified physician leaving 51 villages without a doctor.
In the absence of a qualified physician, someone in the village
usually practises medicine.
From the villagers point of view,
he fulfils the important function of giving cheap symptomatic
relief from minor illness and gives moral support during illness.
Since these indigenous practitioners enjoy respect and confidence
of the community, we need to get this segment of the community
involved in our programmes.
If net, they can effectively obstruct
a good programme.
If we understand the services they can give
to the community and refrain from belittling them or from being
snobbish, they can be useful.
3y giving them advice, by
enhancing their s2n_lls, by supplying them with simple, cheap
drugs, wo can improve the quality of care in addition to gaining
partial control over their practice. Most important, we can
get involved in the community health programmes.
Young people from the villages who study in schools and
colleges in t?_e towns, understand us. They are eager to improve
village health conditions.
Formation of youth clubs in the
villages has often helped in health education, improved
sanitation, and in family planning work.
The. community must have a stake in the health programme.
The receivers of the health services must have some way of
reciproeating the gift. We therefox’o need to give opportunities
for the community to solvo some of the problems related to
community health.
The community in Jamkhed with its poverty, ■
lack of good housing facilities, lack of electricity and running
water, made available simple accomodation for our work and staff
of 20 workers. The people emptied a veterinary dispensary to
house our out-patient clinics. A village store room was
converted into wards and a private house was given to house the
operation theatre and laboratory. The community in the
surrounding area donated lands and building for our work in
their own villages. This kept us obliged to the community.
There is mutual co-operation in health work.
It is necessary to know the structure of a village well
enough to bo able to Work effectively.
The caste system is
still dominant in rural areas and Jamkhod is no exception, The
higher oasto people are used to making decisions for the whole
village.
They often perpetuate injustice to weaker communities,
predominantly the harijan community, which is the most deprived
as fur as health is concerned. In our anxiety to reach these poor
masses, we should remember not to by-pass the existing community
structure. If we do wo might antagonise the establishment and
.
...
...3.
accomplish nothing. in spite of the unjust system, we have to
work through them; often beginning our programmes with them as
they are undoubtedly looked upon as loaders.
Similarly, political
loaders both elected and self-appointed should bo recognized.
5
o
GO
n<,-Q
Community involvement in decision racking, actual
rticipation in programmes, and genuine mutual dependence
tween us and the community are necessary fcr the success of a
raraunity health programme.
VOLUNTARY HEALTH ASSOCIATION OF INDIA
C-45, SOUTH EXTENSION
Phone : 616308, 78433
PART-II, NEW DELHI-1 1 0049
Telegrams : -VOLHEALTH New Delhi-49'
VHAI - 251
VILLAGE HEALTH WORKERS (VHWs) SCHEME
Ingredients for Success.
DEFINITION
* A village health worker is any health worker who works for the
people of his or her own neighbourhood to improve their health.
* A village health worker is one of the people chosen by the people,
to work for the people, of that neighbourhood.
* A village health worker is regularly guided and supervised to work
with the people of the neighbourhood, and regularly trained by health
professionals.
THE INGREDIENTS OF SUCCESS IN VHW SCHEMES
1.
Involvement of the community. Many people now believe that
community participation is a "must”, if the goal is not just health but
total development . Total development cannot happen without
involvement of the people in planning and determining their own destiny.
When the people are fully consulted and involved, only then are their
full energies released.
The projects now using village health workers have all involved some
degree of community participation. But the degree of this community
participation should now be carefully evaluated for each project and
compared with the project outcomes such as extent of change in birth
and death rates.
My own impression is that success is greater where community
involvement has been greater.
2.
Respect for the VHW’s as persons. Widows, Harijans and women
without issue have found fulfilment and work. This has awakened hidden
talents.
Comments from VHW’s (at Jamkhed)
"They (the project leaders) believed in us. That was what got
us started. Before I did not have any ideas. Now I have
so many ideas about improving my village that I cannot go
to sleep at night".
These VHW’s like new flowers must not be crushed but allowed to
flower fully.
: 2 :
Psychologically crushing the village volunteers, destroys the scheme.
The Tumkur project near Bangalore used hundreds of volunteer workers
to control T.B. a few years ago. According to a leading person in
National T.B. Programme, this volunteer involvement failed mainly
because the doctors and other professionals were unable to accord
proper respect and unable to listen to any ideas from the volunteers.
There was an authoritarian relationship resented by the volunteers.
3.
Financial plan of support.
" There is no need to form them into a cadre and pay them a
remuneration from public funds. It would be desirable to leave
them to wo: k on a self employment and part time basis"
--Report of the Group on Medical Education & Support
Manpower, Ministry of Health & Family Planning,
New Delhi April 1975.
Unfortunately, very few villages have been found willing to support
such workers and Panchayats in some States cannot legally use their
funds for such purposes. Thus the project or PHC must pay!the VHW,
with all the dangers that the chance for local participation in the
scheme and necessary for consulting the village-will disappear.
In another ■?. r&?. last year a small scheme using VHWs failed
to control TB and other diseases as hoped by the doctor in charge.
He had excellent rapport with the village people but supervision was
not effective due to lack of community support (Panch was weak) and
project did not pay the health worker . So there was no control
from either village or project over the VHW.
GOOD LEADERSHIP AND ADMINISTRATION - HEALTH PROJECT
MANAGEMENT
There is an old saying that if one wants a new and difficult job done,
one should find an experienced and trained hand for the job.
Frequently a young doctor at age 25 with no previous experience of
administration is placed in charge of 40 staff in a Primary Health
Centre or health project.
If an inexperienced young manager is also expected to start village
health worker schemes, which could add on up to 100 workers per PHC
to supervise, the results will not be good.
Already serious project failures have occurred, traceable to
inexperienced doctors without suitable training.
One project had a doctor who had not learnt to share his medical
knowledge with lay people, and so when a village health worker brought
a patient with TB, he did not tell the patient or the village health worker
about the diagnosis. Consequently they could not cooperate with him in
keeping the patient on treatment.
: 3 :
Another project had a doctor, who was not familiar with high risk,
under-fives, third degree malnutrition, tetanus toxoid in pregnancy,
and other community health concepts. He also had difficulties relating
to the nurse, in accepting that a nurse had useful ideas. Such
difficulties are bad enough in a clinic, but in village health worker
schemes,they make for certain failure.
Those projects which have succeeded so far, have succeeded because
top management has been sound, and has personally taken part in training
of the nurses and village health workers.
TRAINING IN HEALTH PROJECT MANAGEMENT.
For expansion cf programmes it will be necessary to give wider-and
broader training t’o PHC or health project doctor, or special
administrators from management or social science backgrounds may
be. recruited .
All project managers will need training in several areas, beside public
health, so that the necessary knowledge attitudes and skills are acquired.
Some suggested topics -
Management.
Decision making, problem solving, use of time,
management by objectives, project formulation,, costing, .
cost and benefit^ personnel management, budgeting,
management of physical plant,vehicles and materials,
control, evaluation, organisation structure, leadership
styles, participatory management.
Sociology
Economic causes-of ill health, socio economic analysis
"of a village, village-expectations of outside agencies,
village profiles of land, water, literacy, power, health,
caste, crops and markets, ..food taboos. Local leaders
of various caste or community groups could be asked
to tell about their own villages.
Communication
~~
Art of listening, known village perceptions of health
programmes, exact local meanings of certain words
used for disease, making visual aids locally, transactional
analysis as an aid to better inter personal communication
in the health team, how to conduct a meeting and elicit
all points of view .
Training.
Writing learning objectives, writing lesson plans,
designing curriculum to suit local conditions and
priorities, teaching methods for training village
health workers.
Public Health
Community diagnosis, survey, selection of priorities,
community participation, census and population projections
for the local area , writing objectives, writing detailed
plans for control of local diseases and pests, organisation
of mass campaigns, health records, information system
and built in evaluation.
This was a paper presented to the Nov 76 Seminar on "Community Leader
ship - Education of Agents for Health Care" by Dr. Murray Laugesen,
Community Health Consultant at VHAL The Seminar was sponsored by^the
Indian Association for Advancement cf Medical Education, IC"'SR, AHM3 & a :
Position: 6090 (1 views)